HIV/AIDS

Sex Workers in Kenya, Numbers of Clients and Associated Risks: An Exploratory Survey

by Michael Elmore-Meegan

Sexual Risk Taking in Relation to Sexual Identification, Age, and Education in a Diverse Sample of African American Men Who Have Sex with Men (MSM) in New York …

by Jeff T. Steen

Behaviour change theory in practice: A review of four HIV organizations

by David Blackbeard

(2012) ‘I am also a human being!’ Antiretroviral treatment in local moral worlds

by Dominik Mattes

In: Anthropology & Medicine 19(1), Special Issue: Medical Anthropology in Europe: shaping the field: 75-84.

The experiences and practices of antiretroviral drug consumers in Tanzania are shaped by economic scarcity, limited... more The experiences and practices of antiretroviral drug consumers in Tanzania are shaped by economic scarcity, limited state-provided social welfare, and fragile kinship-based solidarity. Embedding antiretroviral therapy (ART) in patients’ ‘local moral worlds’ brings further existential dimensions to the fore that articulate closely with the priority the treatment acquires in their lives. An exemplary case study of a middle-aged HIV-positive man suggests that dignity, social recognition, and belonging may be of central interest and temporarily overshadow patients’ concern for mere survival. A stronger focus on patients’ moral concerns contributes to a better understanding of the complex dynamics that prevent HIV-positive people from becoming the ‘pharmaceutical selves’ that are promoted during treatment enrolment. Moreover, it is indispensable to account for the lived experiences of patients struggling with what too readily has been termed a ‘chronic disease’.

(2011) "We are just supposed to be quiet": the production of adherence to antiretroviral treatment in urban Tanzania

by Dominik Mattes

In: Medical Anthropology 30(2): 152-182.

This article investigates the implementation of antiretroviral therapy (ART) in urban Tanga, Tanzania. First, the... more This article investigates the implementation of antiretroviral therapy (ART) in urban Tanga, Tanzania. First, the enrollment procedures of the national treatment program and medical professionals' techniques to produce adherent patients are examined. Second, exemplary case studies of patients and their families are explored to depict varying responses to the increasing medicalization of everyday lives through the therapy's rigid treatment regime. I argue that the observed disciplinary power exerted on users of antiretroviral medicines throughout treatment preparation and surveillance contrasts with the emergence of ‘therapeutic citizens’ as described in the wake of ART introduction in other African settings. There are also frictions between propagated biomedical truths and ‘rational’ lifestyles, on the one hand, and patient reasoning on the other; the latter being strongly influenced by perceived gender roles, economic constraints, and the struggle to maintain mostly kinship-based support networks.

Pathologising healthy children? A review of the literature exploring the mental health of AIDS-affected children in sub-Saharan Africa

by Morten Skovdal

Transcultural Psychiatry (in press)

Needle exchange and the HIV epidemic in Vancouver: Lessons learned from 15 years of research

by Elaine Hyshka

Hyshka, E., Strathdee, S., Wood, E., Kerr, T.

During the mid-1990s, Vancouver experienced a well characterized HIV outbreak among injection drug users (IDU) and... more During the mid-1990s, Vancouver experienced a well characterized HIV outbreak among injection drug users (IDU) and many questioned how this could occur in the presence of a high volume needle exchange program (NEP). Specific concerns were fuelled by early research demonstrating that frequent needle exchange program attendees were more likely to be HIV positive than those who attended the NEP less frequently. Since then, some have misinterpreted this finding as evidence that NEPs are ineffective or potentially harmful. In light of continuing questions about the Vancouver HIV epidemic, we review 15 years of peer-reviewed research on Vancouver's NEP to describe what has been learned through this work. Our review demonstrates that: (1) NEP attendance is not causally associated with HIV infection, (2) frequent attendees of Vancouver's NEP have higher risk profiles which explain their increased risk of HIV seroconversion, and (3) a number of policy concerns, as well as the high prevalence of cocaine injecting contributed to the failure of the NEP to prevent the outbreak. Additionally, we highlight several improvements to Vancouver's NEP that contributed to declines in syringe sharing and HIV incidence. Vancouver's experience provides a number of important lessons regarding NEP. Keys to success include refocusing the NEP away from an emphasis on public order objectives by separating distribution and collection functions, removing syringe distribution limits and decentralizing and diversifying NEP services. Additionally, our review highlights the importance of context when implementing NEPs, as well as ongoing evaluation to identify factors that constrain or improve access to sterile syringes.

Doubts, Dilemmas and Decisions: Towards Ethical Research on Gender and Schooling in South Africa

by Debbie Epstein

co-authored with Professor Robert Morrell (University of Cape Town) and Professor Relebohile Moletsane (University of KwaZulu-Natal)

This article discusses the tension between ‘do no harm’ on the one hand and the integrity of the research process and... more This article discusses the tension between ‘do no harm’ on the one hand and the integrity of the research process and its intended goals on the other. We discuss a set of choices confronted in the process of researching gender and sexuality in the context of HIV in South African schools. One dilemma was what to do with information that suggested that an adjunct member of the research team was undermining the gender equality goals of the project and possibly contravening school rules, national law and the professional teacher’s code. We explore how we confronted the dilemma of balancing ethical and consent requirements with the reality of interactions and culturally embedded responsibilities and moral consideration.

Nursing care of AIDS patients in Uganda

by Bonnie Fournier

2007. Transcultural Nursing, 18(3), 257-264.

This article reports the findings from a participatory action research study concerning the experience of Ugandan... more This article reports the findings from a participatory action research study concerning the experience of Ugandan nurses caring for individuals with HIV illness. Six key informants from government and non-governmental organizations were interviewed using a semistructured format. Six nurses from a large national referral hospital in Kampala, Uganda, participated in 10 focus group meetings during a period of 11 months. In-depth interviews, focus groups, and photovoice were used to collect the data. Findings indicate that nurses faced many challenges in their daily care, including poverty, insufficient resources, fear of contagion, and lack of ongoing education. Nurses experienced moral distress due to the many challenges they faced during the care of their patients. Moral distress may lead nurses to quit their jobs, which would exacerbate the acute shortage of nurses in Uganda. This study provides important knowledge for guiding clinical practice and nursing education in resource-constrained countries like Uganda.

Emerging healthcare issues and needs of young MSM & TG in India: needs assessment from multi-stakeholders perspective

by Maheswar Satpathy

The Virtues of Dockside Dalliance: Why Maritime Sugar Girls are Safer then Urban Streetwalkers in South Africa's Prostitution Industry

by Henry Trotter

in Susan Dewey & Patty Kelly (Eds.), Policing Pleasure: Sex Work, Policy and the State in Global Perspective (New York: NYU Press, 2011), pp. 86-99

South African sex workers are exposed to different amounts of violence depending on the prostitution sector that they... more South African sex workers are exposed to different amounts of violence depending on the prostitution sector that they work in, such as the street, truck stop, hotel, agency, brothel, and dockside trades. By comparing the structural features of these sectors, we can not only gauge the likelihood of violence within each, but also devise more precise policy instruments to reduce violence at an industry-wide level. I focus here on the neglected dockside prostitution sector, showing how its structural characteristics enhance the women’s power vis-à-vis their clients. Detailed policy recommendations conclude the article.

Navigating Risk: Lessons From the Dockside Sex Trade for Reducing Violence in South Africa's Prostitution Industry

by Henry Trotter

Sexuality Research & Social Policy: Journal of NSRC, 4/4 (Dec 2007): 106-119

The diversity of South Africa's prostitution industry exposes sex workers to varying levels of violence. The street,... more The diversity of South Africa's prostitution industry exposes sex workers to varying levels of violence. The street, truck stop, hotel, agency, brothel, and dockside trades are characterized by different structural features that determine the prevalence of client, police, and third-party abuse against prostitutes. Comparing the structural elements of each sector allows not only gauging the likelihood of violence within a given niche but also devising more precise policy instruments to reduce violence at an industry-wide level.

This article, "Navigating Risk," focuses on the dockside prostitution sector in Cape Town and Durban, showing how its structural features enhance the women's power vis-à-vis their clients and the police. It discusses 5 key variables that influence the likelihood of violence within each prostitution sector:

* the social and legal status of the client
* the location of the negotiation
* the location of the sexual act
* the level of discretion in the solicitation process
* and the role of third-party involvement

Detailed policy recommendations conclude the argument.

Soliciting Sailors: The Temporal Dynamics of Dockside Prostitution in South Africa

by Henry Trotter

Journal of Southern African Studies, Vol.35, No.3 (Sept 2009): 699-713

This paper examines the temporal dynamics of dockside prostitution in South Africa. It assesses how foreign sailors'... more This paper examines the temporal dynamics of dockside prostitution in South Africa. It assesses how foreign sailors' movements in and out of the country influence local prostitutes' solicitation strategies. It also considers the cultural legacies of their intimate engagements.

The paper focuses on two distinct temporal regimes that define sailors' experiences: the rapid turnaround cycle of Durban's container ship sector and the slower turnaround cycle of Cape Town's deep sea trawling sector.

It makes three sequentially related arguments: that sailors' temporal constraints dictate which solicitation techniques local prostitutes use; that solicitation techniques determine how culture is transmitted between the two ethnically alterior parties; and that the style of cultural transmission impacts how the sailors' cultures are ultimately received by the prostitutes and their communities.

Internet social support groups as moral agents: the ethical dynamics of HIV+ status disclosure: The ethical dynamics of HIV+ status disclosure

by David Rier

Sociology of Health and Illness 29(7):1043-58; 2007

This paper examines how, on Internet HIV/AIDS support groups, participants discuss the ethics of disclosing HIV... more This paper examines how, on Internet HIV/AIDS support groups, participants discuss the ethics of disclosing HIV seropositivity to partners. The data consist of all mentions of disclosure culled from over 16,000 pages overall of posts from 16 different groups, hosted on seven separate sites. The paper focuses on two main
questions. First, apart from providing support and information, did the groups also debate moral dilemmas (and, despite groups’ common perception as ‘safe spaces’ for non-judgmental exchanges, did these discussions include moral judgments and conflicts)? Secondly, did use of this new medium generate a new, alternative ethical discourse, or merely replicate existing discourses? The data demonstrate that online support groups did engage in debating, and trying verbally to enforce, certain views of the ethics of seropositivity disclosure. The most common view advocated full disclosure, though a range of positions existed.
Unlike with most online support groups described elsewhere, these discussions often included harshly-expressed moral judgments. The groups did not generate a truly new, alternative discourse, but served as clearinghouses for and transmitters of existing ‘off-line’ discourses, both mainstream and alternative.
Implications and limitations of the present study, and areas for further research, are discussed.

Keywords: Internet, support group, ethics, HIV

HIV/AIDS in Russia: determinants of regional prevalence

by Dominique Moran

International Journal of Health Geographics

co-authored with Jacob A Jordaan

Background: The motivation for this paper is to inform the selection of future policy directions for tackling HIV/AIDS... more Background: The motivation for this paper is to inform the selection of future policy directions for tackling HIV/AIDS in Russia. The Russian Federation has more people living with HIV/AIDS than any other country in Europe, and nearly 70% of the known infections in Eastern Europe and Central Asia. The epidemic is particularly young, with 80% of those infected aged less than thirty, and no Russian region has escaped the detection of infections. However, measures to address the
epidemic in Russia have been hampered by late recognition of the scale of the problem, poor data on HIV prevalence, potentially counterproductive narcotics legislation, and competing health priorities. An additional complication has been the relative lack of research into the spatial heterogeneity of the Russian HIV/AIDS epidemic, investigating the variety of prevalence rates in the constituent regions and questioning assumptions about the links between the epidemic and the
circumstances of post-Soviet transformation. In the light of these recent developments, this paper presents research into the determinants of regional HIV prevalence levels in Russia.

Results: Statistical empirical research on HIV and other infectious diseases has identified a variety of factors that influence the spread and development of these diseases. In our empirical analysis of determinants of HIV prevalence in Russia at the regional level, we identify factors that are statistically related to the level of HIV prevalence in Russian regions, and obtain some indication of the relative importance of these factors. We estimate an empirical model that includes factors
which describe economic and socio-cultural characteristics.

Conclusion: Our analysis statistically identifies four main factors that influence HIV prevalence in Russian regions. Given the different nature of the factors that we identify to be of importance, we conclude that successful HIV intervention policies will need to be multidisciplinary in nature. Finally,
we stress that further research is needed to obtain a better understanding of the statistical relations that we have identified; our empirical findings can serve as an important guide in these future research efforts, as they indicate which processes play an important role in regional HIV/AIDS
prevalence rates in contemporary Russia.

The Geography of HIV/AIDS in Russia: Risk and Vulnerability in Transition

by Dominique Moran

Eurasian Geography and Economics

A British geographer discusses the spatial distribution of HIV infections in the Russian Federation, and the... more A British geographer discusses the spatial distribution of HIV infections in the Russian Federation, and the comparative lack of geographical research probing this phenomenon. Drawing on literature that suggests a connection between HIV and the impact of transition, the paper reports results of exploratory analysis of associations between prevalence of HIV/AIDS (dependent variable) and a range of socioeconomic measures reflecting transition (independent variables). It offers some explanations for the distribution of prevalence rates, and considers the potential regional impacts of the epidemic, arguing that future geographical research will further explicate regional differentiation in the rates of infection

Op-ed: Digital Ways of Preventing HIV Are the Best Medicine

by Gurmit Singh

Co-authored with Christopher S Walsh

Op-ed: Digital Ways of Preventing HIV Are the Best Medicine

by Christopher Walsh

By Gurmit Singh & Christopher S Walsh

Why are we so fixated on finding a medical solution when, as social networks revolutionize sex in our community, gay... more Why are we so fixated on finding a medical solution when, as social networks revolutionize sex in our community, gay men are successfully using new technology to combat HIV?

Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011

by Cathy Puskas

HIV prevention for Black women: Structural barriers and opportunities

by Charmaine C. Williams