Health Promotion.

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Exploring young men's perceptions of care and support for people living with HIV/AIDS.
(2014) Ballard, Kyle.; Sliep, Yvonne.
Care and support for people living with HIV/AIDS (PLWHAs) in South Africa, is primarily provided by women in the local community, with young men largely absent. Understanding young men’s perceptions and understandings of care and support for PLWHAs, and what role they feel they play has been under-researched and inadequately conceptualised. This study explores the meanings that young men associate with care and support for PLWHAs in their communities. Data was collected from a semi-structured focus group of six young men, and later 3 semi-structured interviews with three of the young men from the focus group, from a peri-urban area in KwaZulu Natal. The data was analysed using Interpretive Practice, drawing on social capital theory, and the theory of planned behaviour. Findings indicate that the meanings these young men associate with care and support for PLWHAs are complex, contradictory and influenced by multiple discourses, expectations, and aspirations. Care and support for PLWHAs represents a set of roles and tasks which young men simultaneously feel expected to perform, as well as ridiculed for performing, by both men and women. It requires careful negotiation into roles which are acceptable by hegemonic masculinity, and do not intrude on women’s social space as caregivers. Alternate roles are fulfilling for young men, such as economic provider, joker, loyal friend, and protector, particularly because it provides a means to construct and sustain masculine respect and identity. Importantly, not all young men associate the same meanings to care and support for PLWHAs, nor construct and sustain their masculine identities the same way. Interventions seeking to encourage young men to engage in care and support for PLWHAs need to understand masculinity, femininity and the implications of the roles prescribed in their intervention. Individual interpretations and embodiment by each young man should also be facilitated if the messages are to be accepted and change behaviour effectively.
Experiences of home-based care organizations in the context of the global financial crisis.
(2014) Gwelo, Netsai Bianca.; Akintola, Olagoke.
Background: The global economic crisis has posed major threats to the fight against HIV and AIDS especially in developing countries. The crisis which originated in well-developed economies such as the US in 2007/2008 (Kin & Penn, 2008) has impacted key drivers of growth in trade, investment, mining and manufacturing at a global level. However, it is unclear how this crisis is affecting small, non-profit organizations providing care and associated services to people living with and affected by HIV/AIDS. Aim: The aim of this study was to explore the experiences of home-based care organizations in the context of the global financial crisis and its implications on the provision of services offered by home-based care organizations through the perspective of the managers. Methods: In-depth qualitative interviews were conducted with 10 managers who work in care organizations that provide care services to people living with HIV/AIDS using an interview schedule containing open-ended questions. Findings: The findings of the study show that the global financial crisis at the macro level has affected government and donors/funders’ grants to non-profit organizations. This has resulted in a reduction of funds allocated to care organizations. Funding cuts have severely affected care organizations at the exo-level. Care organizations were forced to employ different strategies such as organizational restructuring in order to survive in the new funding environment. This led to downscaling of services and the number of communities served, retrenchment of paid staff and reduced incentives for volunteer caregivers. Organizational restructuring had profoundly implications on recruited workers at the meso-level. Paid staff were confronted with retrenchment while volunteer caregivers were confronted with rationalization of incentives. At the micro level, there were severe implications for beneficiaries of care services. People who depended on these services are at a high risk of becoming more vulnerable to diseases and poverty. Recommendations: These findings highlight the need for the government to play a bigger role in the provision of funds and support to home-based care organizations. The government needs to incorporate home-based care into its social and economic policies to create a reliable source of funds for care organizations.
'Just a snip?' : Lemba circumcisers' perspectives on medical male circumcision for HIV prevention in Mberengwa district of rural Zimbabwe.
(2014) Shumba, Kemist.; Akintola, Olagoke.
Medical Male Circumcision (MMC) is an HIV ‘prevention technology’ hailed for holding the promise to containing the epidemic. MMC augments the vision of the Joint United Nations Programme on HIV/AIDS (UNAIDS) that pins hope on the possibility of zero new infections through the adoption of a comprehensive prevention approach. This study’s impetus stems from the view that the success of MMC is anchored not only on the premise that its wide-scale implementation subsequently lowers HIV incidence in heterosexual men practicing vaginal penetrative sex, but is also dependent on the readiness of the target population to undergo circumcision. From a culture-centred approach which holds that health promotion programmes should be planned, implemented and evaluated within the context of the relevant socio-cultural beliefs and value systems prevalent in a particular community, the study is a qualitative exploration of perceptions on MMC for HIV prevention among the Lemba people of Mberengwa. The Lemba are a traditionally circumcising cultural group. In light of the culture-centred approach, how they perceive MMC is worth investigation if success has to be achieved in its implementation among this cultural group. The objective of the study is to identify factors influencing collaboration of Lemba traditional circumcisers and medical institutions rolling out voluntary MMC. Purposively selected Lemba surgeons and elders participated in this study. Findings suggest that the Lemba practise male circumcision not as a mere surgical operation but as a symbolic cultural ritual that is value laden. However, they are ready to embrace MMC provided that it is done in a way that does not compromise the cultural values they attach to male circumcision. A deeper insight into Lemba perspectives generated in this study has been used to suggest ways in which the Ministry of Health and Child Care in Zimbabwe can scale-up roll out of voluntary MMC in Mberengwa through creating synergies between cultural and medical perspectives. For example, the majority of participants suggested that making use of Lemba initiates with medical training to conduct circumcisions in Murundu camps can help increase uptake of VMMC.
Water, sanitation and hygiene in community and home-based care for people living with HIV/AIDS/TB in Durban, South Africa.
(2015) Mulopo, Chanelle.; Akintola, Olagoke.
The majority of HIV/AIDS patients in South Africa receive health care services at home. However, few studies have examined water; sanitation and hygiene (WASH) in home and community-based care. The main objective of this study was to explore community health workers’ (CHWs) perceptions of WASH in home-based care and the implications for people living with HIV/AIDS/TB, their family members and the health workers themselves. The participants in this qualitative study were drawn from four community home-based care organizations that provide care to HIV/AIDS/TB clients. These organizations are located in four marginalized communities in Durban. Data was collected using participant observation of care-giving activities; semi-structured interviews with five home-based care project managers from the organizations and five focus group discussions with a total of 49 CHWs. Some AIDS patients are incontinent. It is typical for CHWs to find patients in closed areas with bedding soiled by urine and feces. It was found that CHWs had limited access to protective materials such as gloves and aprons and therefore tended to avoid carrying out activities that could help maintain proper hygiene in the home for fear of infection. Furthermore, limited access to water and an unreliable water supply meant that CHWs had to fetch water from immediate neighbors or surrounding areas and this limited the time spent with their patients. The unavailability of water had ramifications for the number of times patients could bath. Insufficient water also presented a challenge to CHWS and families in maintaining proper sanitation. There is a great need for adequate water, proper sanitation and hygiene in community-based care. Inadequate access to water influences sanitation and hygiene, and this affects the work of CHWs. The government needs to respond promptly to the water and sanitation needs of marginalized communities with limited resources. The study’s findings have implications for policy on WASH and community-based care in low-income communities.
A qualitative study into the psychosocial well-being of Durban's homeless youth.
(2015) Hills, Frances.; Meyer-Weitz, Anna.
This study explored the experiences of a sample of six male and four female homeless youth living on the streets of Durban, South Africa. It focused on their concepts of 'home' and their ideas around homelessness, as well as on the psychosocial and contextual factors that support their resilience and coping. In this qualitative study, participants were interviewed utilising a semi-structured interview schedule. Data were analysed using Interpretative Phenomenological Analysis (IPA). Two main themes emerged around the idea of 'home', namely family and belonging, and safety and protection. Homelessness was rejected as an undesirable way of life by all participants. Drug use and, particularly, violence were found to be endemic, with several allegations of violence and harassment made against the Durban Metro Police. Intrapersonal (physical and emotional strength, and religiosity/spirituality), Interpersonal (help from peers) and Community Resource factors (help from the public, sport and help from organisations for street children) emerged as factors contributing towards resilience in the sample.
Male partner support among young unmarried pregnant women in Durban.
(2015) Phiri, Thandiwe Msipu.; Akintola, Olagoke.
The improvement of maternal and child health (MCH) outcomes has been an important part of the millennium development goals (MDGs). Although the world is at end of the MDG era, MCH remains an important issue globally as the MDGs have not been achieved in most countries. Maternal physical and psychological wellbeing is crucial because poor health during pregnancy does not only affect mothers but their unborn infants as well hence the integration of maternal, newborn and child health (MNCH). Young women in universities are likely to experience pregnancy due to the risky sexual behavior in tertiary institutions which is characterized by lack of condom and/or contraceptive use and coercion. Therefore, most of these pregnancies are unintended. Unintended pregnancy can be a traumatic experience for students and has been associated with negative maternal and child health outcomes. In addition, pregnant young women in an academic environment are susceptible to stressors such as meeting academic demands, lack of financial resources, unstable relationships with their partners and social stigma. This is a problem because stress in pregnancy has been associated with anxiety, depressive symptoms and is a risk factor for postpartum depression. Therefore, it has potential negative effects on MNCH outcomes. One way to cope with stress in pregnancy is receiving social support because of its role in mediating psychological wellbeing in stressful situations. The role of male partners in giving social support was the main area of interest in this study. Therefore, this study explores the support needs of pregnant students at the University of KwaZulu Natal in Durban, South Africa. Participants were purposively selected among pregnant students at the university. The findings show that pregnant students experience challenges in their environment which is a source of stress in pregnancy. To cope with these challenges, they seek different types of support such as emotional, instrumental, informational and financial support. Male partners are considered to be an important source of support in mediating stress and fostering physical and psychological wellbeing. The types of support received from male partners are mainly emotional and instrumental support. There is need for greater social support at different levels ranging from interpersonal, community and policy and male partner support should be encouraged by the health system for better MNCH outcomes.
Finding the best fit : an exploration of contraceptive decision-making in a sample of female students at the University of KwaZulu-Natal.
(2016) Oyedeji, Enitan.; Patel, Cynthia Joan.
The discourse around contraceptive use has attracted researcher’s attention in recent times, due to the alarming rate of unwanted pregnancies and STIs including HIV/AIDS. In 2013, it was recorded that more than 99 000 schoolgirls fell pregnant at the rate of about 271 for every day of that year. These concerns emphasise the need for drastic improvement in sexual education and access to contraceptives such as condoms. Hence, this study attempts to examine how young women decide on contraception, focusing on the factors that influence the process. A grounded theory approach was used to explore the influences of contraceptive decision-making in a sample of seven (7) female students at the University KwaZulu Natal, Howard College campus. Data was collected through in-depth interviews and was analysed using Pidgeon and Henwood’s (1997) approach to grounded theory analysis. The aim was to gain insight on the factors influencing contraceptive decision-making by female university students. The research identified an interplay of various factors that influence respondents’choice of contraceptives. The factors include knowledge levels, partners’ role, social networking, health care workers (HCWs) and perceived side effects of contraceptives. This qualitative study showed that individual autonomous decision-making played a minor role in the decision-making process. The study highlights the need to empower young females to make informed decisions regarding the use of contraceptives.
Policy and practice of health care waste management in community-based care in South Africa.
(2016) Hangulu, Lydia.; Akintola, Olagoke.
Health care waste management (HCWM) is a growing concern more especially in the low- and middle-income countries (LMICs). Improper management of health care waste (HCW) has negative effects on the environment and on the health of the people. Unfortunately, no study has been found so far that addresses policy and practice of HCWM in community-based care (CBC) in South Africa. This thesis begins to address HCWM issues through five manuscripts that use various methods and approaches to develop an understanding of HCWM in CBC. The main scripts in this thesis present: 1) a scoping review that highlights the terminologies of HCW, definitions, categories and its classifications; 2) analysis of international and national policies that govern HCW in South Africa; 3) media analysis which explains how the South African media frames the issue of HCWM; 4) results from interviews with policy makers and stakeholders regarding their opinions on the practices of HCW in CBC; 5) results from focus group discussions, informal interviews and participant observations from the community health workers (CHWs) indicating their experiences about HCWM practices. This study is the first to be conducted in CBC. The methodologies used in this study provide useful insights into HCWM and the findings are an addition to the body of literature on HCWM in CBC, environmental health and public health.
Reflections on life stories by post-graduate students : intersectionality and agency.
(2016) Mbatha, Nombuso Nomfundo.; Sliep, Yvonne.
This study explored the reflections of post graduate students who completed a semester course called the Personal is the Professional, aimed at facilitating a reflexive and critical thinking. By working with their lived experiences students explored the intricacies of the society they live in and how this influences how they view the world and their professional lives. These include the intersection of gender, race, class and culture as dominant social discourses. In the telling and witnessing of life stories, the study traced how the students’ engagement with personal discourses created shifts in understanding how context shapes how they experience themselves and others. Through narratives, the study showed how students engage in and at times unintentionally contribute to dominant social discourses in their everyday lives. The results suggest that with increased reflexivity, there was a greater sense of personal and collective agency. This was evidenced by students’ ability to recognise and deconstruct their sense of self by looking deeply into the discourses as well as how they have impacted other students in the cohort. This study used qualitative methodology and was theoretically based on Bronfenbrenner’s (1977) Ecological perspective model and Bandura’s social cognitive theory (1989), which allowed the participants to locate themselves in different levels and structures that have impacted their lives. Data was collected through participant observation during class presentations and interactions; written tasks completed by the students throughout the module; and unstructured interviews to explore how students’ understanding of self and others had shifted over a five-month period. The sharing of personal stories in a safe space created the possibility to discover similarities and differences across different cultures, race groups and gender and resulted in a spirit of unity and collective agency. It also created a platform for deeper reflexivity. The written assignments provided a language and framework to create awareness and voice to articulate their experience resulting in a sense of freedom and confidence leading to a perception of greater agency in their personal and professional lives. The findings were discussed in relation to the existing literature, which was aligned to both local and international contexts. Implications of the study are discussed together with recommendations for further study in support of developing critical reflexivity and agency.
Investigating the mental health needs of Zimbabwean refugees in Durban, South Africa : a thematic analysis.
(2017) Dreyer, Chandré.; Cartwright, Duncan James.
This study endeavoured to investigate the mental health needs of refugees to help establish the real cause of prevailing problems they experience in their host country, South Africa, so that deficits, gaps and needs in current intervention programs and services can be addressed to aid this population. The research questions aimed to investigate the psychological, emotional, social and environmental difficulties that refugees face on a daily basis which could contribute to their mental health needs. How refugees manage these difficulties was also investigated. A qualitative research design was used, with Braun and Clarke’s six-phased thematic analysis process used as the methodology of choice. Ten refugees from Zimbabwe living in Durban, South Africa, were purposively selected and semi-structured interviews were conducted to provide the required data. Thematic analysis was conducted and resulted in the identification of five themes: inaccessibility, basic needs, being a foreigner, emotional well-being, and internal and external coping strategies. The findings of this study show that refugees living in Durban present with mental health needs as they encounter various difficulties across the psychological, emotional, social and environmental domains. The primary difficulties identified by the refugees were difficulty with accessing employment and maintaining a secure income, as well as difficulty being a foreigner and not being accepted by the locals in Durban. The primary coping strategies identified by the refugees with these difficulties were their spiritual faith and social support. Limitations to the study included minimal time that the researchers could have with the refugees as only one interview could be conducted with each participant, and due to the sensitive experiences refugees might encounter, the possibility that some participants only share general and superficial concerns is possible.
Exploring the impact of risk and protective factors on the experiences of refugee youth living in Durban, KwaZulu-Natal.
(2017) Barakamfitiye, Kassa.; Sliep, Yvonne.
The following study aims to provide an in-depth understanding of risk and protective factors experienced by refugee youth from the Democratic Republic of Congo residing in South Africa and their impact on the mental health of the group. The lived experiences and the mental health status and problems of adult refugees living in South Africa are well documented; however much less is known about the lived experiences and mental health status and problems of refugee youth living in South Africa. Refugee youth living in South Africa face a number of challenges due to a high level of risk factors in their daily lives. Risks can be moderated by protective factors. Protective factors reduce the impact of risk factors and act as coping mechanisms which youth use to cope with their everyday challenges. The interaction between risk and protective factors are important as they influence youth’s mental health status. Responses to stress can be internalized or externalized problems resulting in a compromised mental health status. If responded to appropriately it can result in prosocial behaviour. The Social Development Model (SDM) was used as the theoretical framework for the project. The model was used to provide an in-depth understanding of the interactions between risk and protective factors and the impact these factors have on mental health of refugee youth. The study was qualitative where data was collected in the form of individual semi-structured interviews with eight refugee youth from the Democratic Republic of Congo (DRC) currently living in Durban. The sample was selected through convenience and purposive sampling techniques from a larger group from the same population. Study questions were based on the main risk and protective factors that are present to participants’ lives, including those related to structural violence. The findings of the study were analyzed and presented through thematic analysis. The study revealed several key findings related to the impact of xenophobia and financial difficulties. The results of the study showed that the young women tend to internalize problems resulting in more emotional and psychological distress such as social withdrawal, anxiety and fear and young men showed both internalized and externalized problems such as fear, avoidance, poor concentration, physical violence and so forth. Altruistic tendencies, empathy and sympathy were found in both male and female participants. These prosocial behaviours were as a result of the interaction between the risk and protective factors present in the youth’s lives.
The social and cultural determinants of the fertility rate among Congolese refugee women living in the inner city of Durban, South Africa.
(2018) Lwaboshi, Belinda.; Mkhize, Nhlanhla Jerome.
Population growth is one of the pressing demographic development problems affecting the world. Despite the growing number of people using up-to-date contraceptive methods, countries in the developing world, including the Democratic Republic of Congo (DRC), are still recording a high fertility rate. This study investigated the social and cultural determinants of fertility among Congolese refugee women living in the inner city of Durban, South Africa. The study adopted a qualitative method. Primary and secondary data were gathered and 12 semi-structured interviews were conducted. All interviews were audio-recorded and then transcribed with the participants’ consent. The analysis of data was done using thematic analysis techniques. The study found that the fertility rate among Congolese living in Durban, South Africa, is driven by various factors. Seven themes emerged that illustrated the reasons for the fertility rate among the study group. These were: the economic value attached to having children, gender preference (male child preference), the desire to save a marriage/union, the prestige of motherhood, filling the missing gap/replacing lost family members, fulfilling God’s recommendation to fill the earth, and other biblical reasons, children as social security during old age, and inadequate use of appropriate contraceptive methods. The study also found that gender played a pivotal role in determining fertility in the study group: men viewed themselves as decision-makers and heads of the family. The study findings concur with the previous literature on childbearing among refugee communities in developing countries in particular. The pivotal role of the gender of the couple in determining fertility casts doubt on the reliability of family planning methods that rely exclusively on the usage of contraceptive methods. This work provides essential recommendations on how health care services should be used in order to promote refugees’ well-being in Durban, South Africa.
The relationship between child rearing practices and adolescents’ attitudes toward sexual debut, Durban, South Africa.
(2018) Luthuli, Samkelisiwe.; Hlengwa, Wellington Mthokozisi.
About 30% of South African teenagers between the ages of 13-19 years have reported unplanned pregnancy in their lives. One of the determinants of the teenage pregnancy and HIV is early sexual debut. Adolescents who engage in sexual activities at an early stage become expose to more sexual partners and more unprotected sex which results in HIV, Sexual Transmitted Infections and unplanned pregnancy. Parents have a significant influence in shaping adolescents’ attitudes towards sexual behaviours through parenting practices such as communication, supervision and monitoring. The present study examined the relationship between child rearing practices and adolescents’ attitudes towards sexual debut. It further investigated whether (authoritative, authoritarian and permissive) parenting styles predicted initiation of sexual debut. The study used a cross-sectional survey design to gather the data. A sample of 150 learners was used. The measurements that were used to collect data were Parenting Styles Dimension Questionnaire (PSDQ) and Attitudes towards sexual debut questionnaire. Results indicated that there is a small positive relationship between Perceived benefits of having sex and permissive parenting style. A small positive relationship between perceived shame and guilt associated with having sex and authoritative parenting style was found. Moreover, a small negative relationship was found between Perceived shame and guilt associated with having sex and authoritarian parenting style. Standard multiple regression indicated that permissive parenting style followed by authoritative parenting style made the strongest contribution to explaining the dependent variable (Attitudes towards sexual debut). Adolescents who are raised by parents that adopt permissive and authoritative parenting style are having positive attitudes toward sex which can lead them to engage in early sexual debut. However adolescents that are raised by authoritarian parents have negative attitudes which can delay early sexual debut.
Use of sexual pleasure-enhancing substances among hair salon female workers in Durban: a qualitative inquiry.
(2020) Nxumalo, Sinethemba Virginia.; Shumba, Kemist.
The use of sexual pleasure-enhancing substances (SPES) is fast-gaining traction among sexually active, young Black females globally. The researcher’s interest is on the implications of this practice on safe sex. The use of pleasure-enhancing substances and vaginal practices, particularly intra-vaginal cleansing and the drying or tightening of the vagina is driven by beliefs that may ensure sexual pleasure as every woman’s prerogative. Thus, women risk acquiring sexually transmitted infections (STIs), including HIV. The belief that SPES are only efficacious without using the barrier method elevates women’s risk of acquiring HIV. This study aims to explore the use of SPES among female hair salon workers in Durban to foster an understanding of how this practice impacts on safe sex practices and sexual reproductive health. The study used qualitative interviews to elicit the views of 12 selected young Black African women (BAW) working in hair salons in Durban’s central business district (CBD) regarding the use of SPES and various vaginal practices. Purposive and the snowball sampling techniques were used to identify information-rich participants. Data were analysed using thematic analysis. The findings indicate that SPES affect safe sex practices and place women’s sexual reproductive health at risk. Most young BAW were not practising safe sex with their partners. The practice of unsafe sex among this cohort was driven by the need to sexually satisfy male partners, thus maintaining the much-needed grip in love relationships. The findings also indicate that BAW are conversant with sexual and reproductive health issues.
Physical and mental health challenges of migrant female head porters (Kayayei) in Ghana: guidelines for health promotion interventions.
(2021) Komesuor, Joyce.; Meyer -Weitz, Anna.
Background: While internal migrants (Kayayei) in Ghana have been perceived as a vulnerable group faced with mental and physical health challenges, there has not been enough research on the impact of the trade on their health. Grounded on the broad bioecological framework of Bronfenbrenner and Morris, this study investigated the lived experiences, prevalence of physical and mental health challenges, risk factors for mental health challenges, protective factors that mitigate the effects of the daily lived experiences on mental health. Methods: The study adopted a sequential exploratory mixed method design whereby qualitative data were collected and analysed first to get in-depth understanding of the physical and mental health of Kayayei, followed by the quantitative survey. For the qualitative study, the study employed a purposive sampling technique to select 31 Kayayei from the Agbogbloshie market. The study utilised Interpretive Phenomenology Analysis (IPA) to analyse the transcripts from the qualitative study interviews. The quantitative aspect of the study undertook a cross-sectional survey using an interviewer-administered questionnaire to collect data from 352 participants. On the other hand, the quantitative study used exploratory factor analysis, Chi-Square test, mean test, and binary logistic regression for the analysis. Results: Results for the qualitative study showed that the main reasons for migrating to Accra are economic and cultural restrictions and oppression. The findings also revealed that the Kayayei were often maltreated, lacked decent accommodation, and were involved in accidents. To cope with the situation, they used religion, social support, and distractions such as entertainment. The quantitative results indicated that participants had low level of education. Only 6.2 per cent (n=21) had Senior High education, and the majority suffered from poor physical (59.9%) and mental health, [anxiety a94.4 per cent, followed by depression 86.6 per cent, and stress at 42.4 per cent] challenges. The difficult nature of their work context coupled with maltreatment by their clients contributed to poor mental health outcomes. The results showed participants adopted various coping strategies to deal with their situation. However, apart from humour, which helped mitigate stress (OR=0.358, 95% CI=0.169, 0.757, p= 0 007), all other coping strategies used by the Kayayei increased mental health distress. The use of denial coping strategy predicted depression (95% CI=2.428, 27.038, p=0.001), stress (95% CI=0.988, 3.323, p=0.005, p=0.005), and anxiety (95% CI= 2.37, 54.088, p= 0.002). The results also showed that participants received low to medium social support overall, while support from family and friends helped mitigate mental health distress. Conclusion: The results of the present study indicated that even though the work of Kayayei exposes them to physical and mental health challenges, the coping strategies they adopt create more rather than less mental health concerns. However, social support from family and friends helped to buffer the impact of the challenges. The findings of the present study were used to develop a multilevel prevention intervention aimed at training the Kayayei on the appropriate coping strategies to adopt to improve mental health outcomes. It is recommended that at the personal level, the Kayayei should have access to psychological counselling that will teach them how to adopt better coping strategies that could enhance their mental health outcomes. At the interpersonal level, the Kayayei should be assisted to form cooperatives that could facilitate social networks, proper integration, and social support for its members. At the structural level, relevant governmental and non-profit organisations should address the determinants of health including access to physical and mental health care services, employment opportunities, skills training, and affordable housing for the Kayayei. Finally, there should be structural change and interventions that target the mental health of the vulnerable in society, particularly women.
Exploring the use and adoption of urine diverting dehydration toilets in Umgababa community in eThekwini Municipality: the experiences of community members and leaders.
(2021) Shange, Thulisile Margaret.; Hangulu, Lydia.; Akintola, Olagoke Olufikayo.
Sanitation is the safe treatment and disposal of human faeces. Ensuring availability and sustainable management of sanitation for all is part of sustainable development goalsagenda 2030. Even though the adoption and use of UDDTs is low in eThekwini Municipality, most of these studies are quantitative in nature and have not been conducted in UMgababa community. Therefore, this study aimed at employing qualitative methods with the aim of exploring the problems associated with the adoption and use of UDDTs in UMgababa community from the perspective of community members and leaders. There were 15 participants in the study. All participants were chosen purposively. They were accessed using snowball sampling a technique that uses referrals. Semistructured interviews and observations were utilized to get data from all participants. All interviews were guided by interview guide with open ended questions. The findings show that there was blame game regarding the installation of UDDTs by Ward councilor and area coordinators. Community members did not have an idea who was responsible for installing of the UDDTs Instead they linked such developments to the ANC which is a leading political party in South Africa. They also mention that they were not consulted about the UDDTs instead the development came as an announcement from the municipality. Training received regarding the use of UDDTs lasted for five minutes. Community members resent the UDDTs adoption and use of UDDTs by community members. These results show that the government uses the top-down approach in designing interventions for the communities. These findings are important for policy makers to conduct an impact assessment and calls for prompt action to be taken to help address the lack of adequate adoption and use of UDDTs by the community members and ultimately improve the wellbeing of the people.
Teachers and healthcare workers' perceived reproductive health challenges faced by secondary school adolescents in low resource community of KwaZulu-Natal, South Africa.
(2021) Mbatha, Londiwe.; Akintola, Olagoke Olufikayo.; Gwelo, Netsai Bianca.
Adolescents’ early sexual debut contributes to the number of sexual and reproductive health challenges that they are faced with. In trying to deal with these reproductive health challenges that adolescents are facing South Africa recently adopted the Integrated School Health Policy, which enables adolescents to access sexual reproductive health care services and information in the school context. This study explored reproductive health challenges from the perspective of the life orientation teachers and school health nurses. Methods: Qualitative in-depth interviews were conducted with 15 participants in some low resource communities in Durban, KwaZulu-Natal, South Africa. Four of the participants were school health nurses and 11 of the participants were life orientation teachers. Results: The results of this study show that when it comes to reproductive health education teachers and school health nurses face numerous challenges. At the macro and exo level the Department of Education provides life orientation teachers with limited teaching resources and the life orientation curriculum covers the minimum number of reproductive health topics. On the other hand, the Department of Health does not have enough school health nurses, therefore leaving the available school health nurses with a load of work that is beyond their capacity. At the meso level parents find it difficult to communicate with their children about sex-related topics, this however is influenced by culture, religion, and tradition. Due to poor parent-child communication, children find themselves subjected to peers as their source of information and that leaves room for peer pressure or peer influence. At this level of influence families are confronted with poverty which impacts the behaviour of adolescents getting married at a young age and also being sexually active at a young age for transactional sex. This exposes the adolescents to teenage pregnancy, STI’s & STD’s as well as other reproductive health challenges. At the Micro level adolescents are less informed about reproductive health and by the onset of their sexual debut they engage themselves in an act that they are less informed about.
Caring for adolescents by older carers in the context of HIV combination prevention interventions in rural KwaZulu-Natal: an ethnographic approach.
(2021) Gumede, Dumile Olivia.; Meyer-Weitz, Anna.
In South Africa and in many other developing countries, grandparents/older carers have taken the role of caring for children, even where the older carers themselves have no steady source of income and are suffering from chronic illnesses. While previous studies have documented the experiences of older carers who are raising young children, few researchers have examined the caring of adolescents and the care relationships from the perspectives of both the older carers and adolescents in South Africa. The study examined the caring of adolescents by older carers in a rural KwaZulu-Natal district in which HIV prevention interventions called DREAMS were implemented. Following an ethnographic approach, this study used repeat in-depth interviews, key informant interviews, and observations to elicit information from six adolescents aged 13 to 19, six older carers aged 50 and above, and two HIV programme facilitators (n=14) over 12 months, from October 2017 to September 2018, in the uMkhanyakude district, KwaZulu-Natal. Written informed consent was obtained from all individuals before participation. All data were collected in isiZulu and audio-recorded, transcribed, and translated into English. The researcher combined both thematic and dyadic analysis approaches to understand care relationships and the lives of adolescents and their older carers in order to add a deeper understanding of the data. A multitheoretical approach including the life course perspective, the social-ecological model, and the self-management framework was applied to examine and interpret data. The findings of the study indicated a dynamic process which influenced how older carers ended up taking the primary care responsibility of their grandchildren. The factors that positively or negatively affected the quality of relationships between adolescents and their older carers were adolescents’ difficult behaviours and carers’ behaviours (positive and negative). Gender was also used to frame the labels ascribed to the adolescents. The consequences of stigmatised labelling of adolescents negatively affected the adolescents in older carer families. Additionally, generational perspectives between adolescents and their older carers of romantic sexual viii relationships were highlighted. Further, the motivators and barriers to participation in DREAMS interventions of adolescents in older carer families were influenced by the four levels of the socio-ecological model namely individual, interpersonal, organisational, and community levels. The motivating factors included obtaining HIV and sexual and reproductive health information, perceived changes in risky behaviours, and improved care relationships and communication between adolescents and the older carers. The barriers to participation in DREAMS interventions included internalized stigma, negative peer pressure, and caregivers’ lack of information about the HIV prevention interventions as well as challenges related to the organisation responsible for implementing DREAMS interventions. Lastly, the older carers employed a range of self-management practices for chronic conditions to promote health and well-being; while, sometimes, putting their lives at risk. In conclusion, the adolescents and their older carers were emotionally distressed, thereby impacting their well-being and the quality of the care relationships. Furthermore, adolescents faced challenges as they explored their sexuality and transit to adulthood. The strenuous relationships with the adolescents, rather than chronic conditions, were the main stressors that undermined the older carers’ ability to selfmanage chronic illnesses. Further studies are required to understand the impact of COVID-19 on older carer families and its influence on self-management of chronic illnesses and caring for adolescents.
Understanding university students’ experiences of voluntary medical male circumcision: a qualitative inquiry.
(2021) Mbambo, Siyabonga Arron.; Shumba, Kemist.
Voluntary medical male circumcision remains the most crucial feature in the fight against new heterosexual HIV infections. Generally, men engage in sexual intercourse soon after undergoing VMMC. Therefore, research which focus on the factors influencing the men’s decision to undergo VMMC, their prevalent sexual experiences post VMMC, and meanings attached to VMMC after undergoing VMMC is important. The study used a qualitative research design and it is located within an interpretivist paradigm. In-depth individual interviews were conducted with UKZN Howard College students. A total of 10 students were purposively selected and participated in the in-depth interviews. Although ten interviews were pre-planned, data saturation was achieved from the eighth interview. Four participants were master’s students, three were honours students, and the rest were final year undergraduate students. All participants were Christians. The Health Belief Model was used as the conceptual framework and thematic analysis, as described by Braun and Clarke (2006), was used to analyse data. The in-depth individual interviews showed main motivations which resulted from the perceptions that influenced the men’s decision to undergo VMMC. VMMC main motivational factors included reducing chances of HIV infection, preventing STI infection, hygiene, peer pressure, enhancing sex, and abstaining from sex. Participants reported post-VMMC sexual experiences of big and clean penis, improved self-esteem, enhanced sexual functioning due to pleasurable sex, and removed sex pain. The new VMMC meanings post-VMMC procedure also elicited the need for dual protection and understanding of VMMC as painless procedure that means a personal responsibility. The findings from this study elicited that the participants experienced enhanced sexual functioning post-VMMC procedure. More research is needed to focus on the sexual experiences before and post-VMMC procedure in order to appropriately inform VMMC recruitment strategies.
Let’s talk about pre-exposure prophylaxis: a participatory HIV prevention intervention with and for female sex workers in Durban, South Africa.
(2021) Makhakhe, Nosipho Faith.; Sliep, Yvonne.; Meyer-Weitz, Anna.
Introduction: Since the discovery of HIV/AIDS in the early 1980s, scientists have been in search of a cure. Significant scientific efforts have so far led to the discovery of antiretroviral treatment that suppresses the replication of HIV that leads to AIDS. Recently, Tenofovir or Tenofovir-emtricitabine as antiretroviral treatment for HIV-positive persons can now be used as prevention in the form of oral pre-exposure prophylaxis (PrEP). This HIV prevention therapy is currently being administered to people considered at high risk of HIV, such as men who have sex with men, intravenous drug users and serodiscordant couples. In 2015, the WHO expanded its oral PrEP guidelines to include female sex workers (FSWs) who are a high-risk group for HIV worldwide. In response to these WHO guidelines, the South African government approved oral PrEP distribution among FSWs in 2016, as part of combination prevention with the expectation that FSWs would take up PrEP and this will reduce the rate of new HIV infections. However, the response to PrEP was underwhelming. Identifying the reasons for the low uptake of PrEP among FSWs is the primary objective of this study. This was followed with engaging FSW peer educators in a participatory intervention mapping process to design an intervention plan to address these challenges to uptake and potentially inform PrEP programming in Durban in the KwaZulu-Natal province which is a high HIV prevalence area in South Africa. Methods: This study was a participatory action intervention research that was conducted in two phases. The first phase was a qualitative needs analysis conducted from May to November 2018 to identify the challenges associated with PrEP uptake and retention, as well as to ascertain the motivating factors for PrEP use among FSWs. Interviews were conducted with 39 participants, 30 individual participants, and nine focus group participants. Eleven participants were FSW peer educators including one health worker and one researcher from sex work and PrEP distributing organisations (13 in total); the rest of the participants were FSWs (n=26). Consent was obtained from all participants. Data were analysed thematically. The second phase of this study was an intervention mapping phase during which a PrEP intervention plan was developed with eight FSW peer educators who were at the forefront of PrEP promotion among FSWs. This intervention plan was informed by data obtained from the needs analysis. A total of six meetings took place in which the individual, interpersonal and environmental determinants that have an impact on PrEP uptake, adherence, and retention were discussed. This resulted in the performance and change objectives, including a theory of change logic framework that systematically depicted the process of change. Furthermore, theory-based methods and activities were established which culminated into a PrEP intervention workshop programme. Additionally, the implementation and evaluation plans were also formulated. Results: The needs analysis showed that the majority of the participants could not distinguish between PrEP and antiretrovirals. This inability contributed to the stigma against PrEP. Another challenge was that distribution was fragmented with the research organisations distributing PrEP to FSWs through peer education and yet, PrEP was not well understood or promoted by health care providers from public health facilities. This resulted in the mistrust of PrEP efficacy among FSWs and delayed uptake and lessened retention. The FSWs taking PrEP were met with hostility from their friends who failed to understand that PrEP as an antiretroviral can be taken to prevent HIV. This resulted in HIV positive FSWs on antiretrovirals accusing PrEP users of deception, and HIV denialism. They also experienced similar reactions from intimate partners. These accusations were believed to arise because of lack of knowledge and competition for clients, given the preferred market for HIV-negative FSWs. PrEP users reported feeling stigmatised and thrust into interpersonal conflicts with their peers, which caused broken relationships, this led some FSWs to discontinue PrEP, while others took it secretly. The FSWs who remained on PrEP mentioned various motivating factors for adherence, such as PrEP being an empowering tool that gives them agency to prevent HIV and bodily autonomy as well as a sense of hope for the future, because HIV was no longer a consequence of sex work. The PrEP intervention mapping process which resulted in a workshop programme showed how FSWs can engage in reflexive dialogues that help promote agency, power, self-efficacy, hope and responsibility to the self and others, to encourage effective engagement in HIV prevention. Conclusion: This study recommends for a wider promotion and dissemination of PrEP through public health care facilities. This will encourage the normalisation of PrEP and curb the stigma associated with PrEP being for high-risk groups. Biomedical interventions should be coupled with behavioural strategies that engage users on the personal, interpersonal, and environmental challenges that have an impact on behavioural change. FSWs should be involved in the design and implementation of their own interventions to ensure effective approaches and to create a sense of responsibility, power and ownership. It is important for future interventions to realise that simply promoting a prevention method because it is medically effective will not warrant uptake and adherence on the part of end users; therefore, interventions need to engage with the complexity of human behaviour. This makes it imperative for practitioners to invest in understanding the patient’s deeper motivations that encourage or discourage behavioural change.

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