The selection of our three strategic research areas – Gender in HIV/AIDS Risk and Response, Antiretroviral Therapy Adherence and Expansion, and HIV Prevention for Women, Youth and Families – was informed by a desire to invest in areas where HIV social science can help to define a strategic and sustainable public health response to a ‘new’ HIV/AIDS paradigm in South Africa and beyond. Gender continues to structure the risk and response to HIV/AIDS; the expansion of ART programs and the task of lifelong adherence remain constrained by stigma, poverty, and the dysfunction in the primary healthcare system; and prevention remains a complex problem that continues to resist easy remedies.
Theme 1: Gender in HIV/AIDS Risk and Response
Gender remains a core determinant of the HIV/AIDS epidemic, both globally and in South Africa. Young women are particularly vulnerable to HIV infection, and face twice the likelihood of being infected as men of the same age group. Social scientists have played a critical role in understanding the complexity of the gendered dimensions of HIV/AIDS epidemic, and increasingly, in formulating a response. We need to better understand the ways in which gender structures the risk of HIV/AIDS infection, the distribution of caregiving burdens, and the health-seeking practices of both men and women. Research studies by those involved in the SASH Programme around urgent gender and HIV/AIDS priorities include:
- Lesbian, bisexual and gender non-conforming women and HIV
- Sex workers rights and access to health care as critical interventions for this key population
- Substance abuse, social support needs and health service access among HIV-positive men in Gugulethu
- Qualitative systematic review on theories of change in gender transformation interventions with men and boys
- Men’s movement through the ‘HIV cascade’ and the development of a health information management intervention to bring community and clinic actors together to better support men’s engagement with ART.
Theme 2: ART Adherence and Expansion
Antiretroviral therapy (ART) including testing, take-up of therapy, and treatment adherence, continues to be a major challenge. In sub-Saharan Africa, where 70% of people living with HIV/AIDS reside, ART has only recently become more widely available and the need for simple, affordable, and sustainable strategies for delivering ART continues to be daunting. Although the basic, clinical, and management sciences will play an important role in addressing many of these ART adherence and expansion challenges, social scientists will also be vital in understanding the ways individuals, communities and health systems can interact to promote and sustain long-term treatment. Research studies by those involved in the SASH Programme which speak to the urgent priorities around ART adherence and expansion include:
- Experiences of and reasons for first-line and second-line treatment failure
- Evaluating a new model of caregiver-led paediatric disclosure to HIV-positive children and adolescents
- Interventions to address HIV and psychological wellbeing among HIV-positive adolescents and orphans
- Grassroots involvement in the development of HIV policy in South Africa
- The history of AIDS activism, and the evolution of health activism since the end of AIDS denialism
- Systematic review (mixed methods) on barriers to ART initiation, retention and adherence for pregnant and post-partum women
Theme 3: HIV Prevention for Women, Youth and Families
Finally, primary HIV prevention remains a challenge. The emergence of biomedical strategies for prevention – such as treatment as prevention, microbicides, pre-exposure prophylaxis, and male circumcision – strengthens the arsenal for HIV prevention, yet we do not fully understand how these strategies will be incorporated into the contexts of people’s daily lives and how these strategies might affect other risk behaviors. Social scientists will be needed to both map how prevention efforts can change attitudes and reshaping behaviors, as well as how these efforts can best be promoted and sustained in families, communities, and the health system itself. Research studies by those involved in the SASH Programme around urgent priorities about prevention include:
- “Coming of Age in Khayelitsha”: Adolescent lifecourse, structure, community, and agency in the context of HIV
- Evaluation of a male bystander intervention to prevent sexual and gender-based violence on campuses
- The role of sexual pleasure in HIV prevention and sexual health programming
- Heterosexual anal intercourse: Perceptions and practices among young people in five African countries
- Evaluating the use of incentives for accessing HIV testing, and sexual and reproductive health services
- Developing ‘perceptibility’ measures of user experiences of vaginal products (creams, gels, foams, rings)
- Concepts of ‘community’ in cluster RCTs in HIV prevention and treatment research
Visit our research section to view the research the SASH Programme is currently involved in.
Please visit the publications section to view our list of research publications.