Anna Strebel

Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa.

Background: The HIV epidemic continues to amplify in southern Africa and there is a growing need for HIV prevention interventions among people who have tested HIV positive. Methods: Anonymous surveys were completed by 413 HIV-positive men and 641 HIV-positive women sampled from HIV/AIDS services; 73% were <35 years old, 70% Black African, 70% unemployed, 75% unmarried, and 50% taking antiretroviral treatment. Results: Among the 903 (85%) participants who were currently sexually active, 378 (42%) had sex with a person to whom they had not disclosed their HIV status in the previous 3 months. Participants who had not disclosed their HIV status to their sex partners were considerably more likely to have multiple partners, HIV-negative partners, partners of unknown HIV status and unprotected intercourse with non-concordant sex partners. Not disclosing their HIV status to partners was also associated with having lost a job or a place to stay because of being HIV positive and feeling less able to disclose to partners. Conclusions: HIV-related stigma and discrimination are associated with not disclosing HIV status to sex partners, and non-disclosure is closely associated with HIV transmission risk behaviours. Interventions are needed in South Africa to reduce the AIDS stigma and discrimination and to assist people with HIV to make effective decisions on disclosure.

Social constructions of gender roles, gender-based violence and HIV/AIDS in two communities of the Western Cape, South Africa

The links between gender roles, gender-based violence and HIV/AIDS risk are complex and culturally specific. In this qualitative study we investigated how women and men in two black communities in the Western Cape, South Africa, constructed their gender identities and roles, how they understood gender-based violence, and what they believed about the links between gender relations and HIV risk. First we conducted 16 key informant interviews with members of relevant stakeholder organisations.Then we held eight focus group discussions with community members in single-sex groups. Key findings included the perception that although traditional gender roles were still very much in evidence, shifts in power between men and women were occurring. Also, genderbased violence was regarded as a major problem throughout communities, and was seen to be fuelled by unemployment, poverty and alcohol abuse. HIV/AIDS was regarded as particularly a problem of African communities, with strong themes of stigma, discrimination, and especially ‘othering’ evident. Developing effective HIV/AIDS interventions in these communities will require tackling the overlapping as well as divergent constructions of gender, gender violence and HIV which emerged in the study.

Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa.

Abstract Since the primary mode of HIV transmission in sub-Saharan Africa is heterosexual, research focusing on the sexual behaviour of men who have sex with men (MSM) is scant. Currently it is unknown how many people living with HIV in South Africa are MSM and there is even less known about the stigmatisation and discrimination of HIV-positive MSM. The current study examined the stigma and discrimination experiences of MSM living with HIV/AIDS in South Africa. Anonymous venue-based surveys were collected from 92 HIV-positive MSM and 330 HIV-positive men who only reported sex with women (MSW). Internalised stigma was high among all HIV-positive men who took part in the survey, with 56% of men reporting that they concealed their HIV status from others. HIV-positive MSM reported experiencing greater social isolation and discrimination resulting from being HIV-positive, including loss of housing or employment due to their HIV status, however these differences were not significant. Mental health interventions, as well as structural changes for protection against discrimination, are needed for HIV-positive South African MSM.

Whose Epidemic is it? Reviewing the Literature on Women and AIDS

AIDS is widely presented as a critical problem for women, which raises special issues of prevention and care. Although it is suggested that women are particularly vulnerable physiologically to HIV infection, biomedical research into treatment and prevention options specifically for women has been limited. Considerable social science research at both the theoretical and applied level has been documented. While analyses have tended to highlight broad structural factors, interventions have often been at individual/group level. The literature demonstrates the dilemma of AIDS being seen as womens responsibility, although they lack the power and means to implement safe sex. Gender imbalances in depictions of and responses to AIDS need to be attended to if the epidemic is to be effectively addressed.

The Social Construction of Sexually Transmitted Infections (STIs) in South African Communities

Since the medical link between sexually transmitted infections (STIs) and HIV/AIDS was established, there has been an increased focus on the spread of STIs in South Africa. The aim of this study was to provide an in-depth picture of the dynamics involved in sexuality and the spread of STIs and HIV/AIDS. The authors present the findings of a focus group study, which was a part of a larger, national project addressing the broad question of health-care seeking behavior for STIs. A discourse analysis carried out on 10 focus groups reveals complex and rich narratives on the way in which STIs are constructed in South African communities. The dominant discourses focused on the continuing stigmatization of STIs, causal explanations, and prevention strategies. The analysis raises important recommendations for both educational interventions and health services toward the challenge of halting the spread of STIs and HIV/AIDS.

The Psychology of AIDS Transmission — Issues for Intervention

In this study various aspects of AIDS amongst a sample of students at the University of the Western Cape in South Africa are examined. A modified version of the World Health Organisation Survey on knowledge, attitudes, beliefs and practices, together with a survey of psychological dimensions considered important in mediating between knowledge and behaviour change, were used. Included were psychological defences of denial, rationalization and repression, social variables of peer pressure and sexual self-concept, and locus of control. Results indicated a number of significant relationships among variables. These are discussed together with their implications for appropriate intervention strategies.

AIDS fatigue and university students’ talk about HIV risk

Drawing on a qualitative study that included 20 focus group discussions with male and female students at an urban-based university in South Africa, this article reports on perceptions, attitudes and reported behaviour with respect to HIV and AIDS and safer sex in the campus setting, with an aim to better understand how young people are responding to the challenges of HIV and AIDS in contemporary South Africa. The findings demonstrate the gap between reported HIV-prevention knowledge and safer-sex practices among a group of young and educated South Africans. Although the participants reported that students were knowledgeable about HIV and had easy access to condoms on campus, a range of factors mediated their capacity to apply this knowledge to safer-sex practices. Besides the usual set of complex social-cultural dynamics, including normative gender roles and power inequalities between men and women, socioeconomic challenges, and differences in age and status between sexual partners, the findings reveal substantial denial, stigma and HIV/AIDS ‘fatigue.’ The findings point to the importance of seeking creative ways to impart HIV-prevention and safer-sex messages that are not explicitly referent to HIV but link rather with broader issues concerning relationships, lifestyle and identity, and hence are responsive to the particular cultural context of university campuses.

‘We Do Not Cook, We Only Assist Them’: Constructions of Hegemonic Masculinity Through Gendered Activity

This article discusses how the gendering of activity by boys coincides with, contests or recreates constructions of hegemonic masculinity in the context of South Africa. The study used a qualitative methodology including a series of three focus groups with 14–16 year-old boys across six different schools in the Western Cape, South Africa. A discursive analysis in which particular attention was paid to how participants construct their masculinity in relation to what they may or may not do as boys/men was conducted. The findings foreground how articulations of masculinity by boys are characterised by efforts to gender activity in the process of, amongst other things, counter blushing—meaning not to be regarded as girl-like or a moffie, or other derogatory notions that do not fit with hegemonic masculinity in a particular context. However, resistances and alternative views on what boys/men can and cannot do also emerged, highlighting the contested nature of current constructions of masculinity among young people in South Africa.

Gender and psychiatric diagnosis: a profile of admissions to mental hospitals in the Western Cape Province, South Africa

SummaryObjectives: This retrospective, epidemiological study aimed to identify gender patterns of admission to public mental hospitals, with regard to psychiatric diagnosis and management. Methods: The hospital records of a random, stratified sample of all 7938 patients admitted to the three psychiatric hospitals in the Western Cape Province for a calendar year were studied for gender differences regarding demographic features, admission-related variables, DSM-IV diagnosis, as well as management during hospitalisation and on discharge. Results: Findings were that more women than men were admitted overall. For women the main DSM-IV diagnoses were mood (41%) followed by psychotic disorders (29%); while for men the main diagnoses were psychotic disorders (47%) and substance abuse (23%). Significantly more women than men were labelled with mood, anxiety and adjustment disorders, and with avoidant, dependent, histrionic and borderline personality disorders. Significantly more men were diagnosed as substance abusers, schizophrenic and with cognitive disorders, and also anti-social personality disorder. More women were medicated, both during hospitalisation and on discharge; and more women also received ECT, while more men absconded from hospital. Conclusions: While some results confirm international research, there are areas of variance, as in schizophrenic and bipolar disorders. The findings have psychiatric service implications and indicate the need for further research into the gendered development of psychopathology.

Deconstructing the ‘sugar daddy’: A critical review of the constructions of men in intergenerational sexual relationships in South Africa

abstract Since a recent Human Sciences Research Council (HSRC) prevalence study highlighted the relationship between intergenerational sex and risk of HIV infection, a range of studies in southern Africa have documented the commonality of sexual relations between older men and young women. For the most part, these studies have focused on the material and status benefits for the young women, and on their vulnerability to HIV, violence and unwanted pregnancies, within the context of gender power inequalities to negotiate safe and equitable sex. In this Focus we review this literature and argue that there is a relative absence of focus on attempting to understand the older mens positions. We suggest the need for research that offers a more nuanced account of the complexities of mens performances of sexuality, which will move beyond depicting older men as inevitable perpetrators of unequal sexual relationships with younger women. In order to better understand and address the complexities of intergenerational sexual relationships, mens constructions of their sexuality and their gains and investments in such relationships require more critical analysis.