Bruce Rhodes

Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu-Natal, South Africa

Epidemiological modelling has concluded that if voluntary medical male circumcision (VMMC) is scaled up in high HIV prevalence settings it would lead to a significant reduction in HIV incidence rates. Following the adoption of this evidence by the WHO, South Africa has embarked on an ambitious VMMC programme. However, South Africa still falls short of meeting VMMC targets, particularly in KwaZulu-Natal, the epicentre of the HIV/AIDS epidemic. A qualitative study was conducted in a high HIV prevalence district in KwaZulu-Natal to identify barriers and facilitators to the uptake of VMMC amongst adolescent boys. Focus group discussions with both circumcised and uncircumcised boys were conducted in 2012 and 2013. Analysis of the data was done using the framework approach and was guided by the Social Cognitive Theory focussing on both individual and interpersonal factors influencing VMMC uptake. Individual cognitive factors facilitating uptake included the belief that VMMC reduced the risk of HIV infection, led to better hygiene and improvement in sexual desirability and performance. Cognitive barriers related to the fear of HIV testing (and the subsequent result and stigmas), which preceded VMMC. Further barriers related to the pain associated with the procedure and adverse events. The need to abstain from sex during the six-week healing period was a further prohibiting factor for boys. Timing was crucial, as boys were reluctant to get circumcised when involved in sporting activities and during exam periods. Targeting adolescents for VMMC is successful when coupled with the correct messaging. Service providers need to take heed that demand creation activities need to focus on the benefits of VMMC for HIV risk reduction, as well as other non-HIV benefits. Timing of VMMC interventions needs to be considered when targeting school-going boys.

Is there really a pot of gold at the end of the rainbow? Has the Occupational Specific Dispensation, as a mechanism to attract and retain health workers in South Africa, leveled the playing field?

BackgroundSouth Africa is experiencing a critical shortage of human resources for health (HRH) at a time when the population and the burden of ill-health, primarily due to HIV, AIDS and TB, are on the increase. This shortage is particularly severe within the nursing profession, which has witnessed significant emigration due to poor domestic working conditions and remuneration. Salaries and other benefits are an obvious pull factor towards foreign countries, given the often extreme international wage differentials. The introduction of the Occupation Specific Dispensation (OSD) in 2007 sought to improve the public services’ ability to attract and retain employees thereby reducing incentives to emigrate.MethodsUsing a representative basket of commonly bought goods (including food, entertainment, fuel and utilities), a purchasing power parity (PPP) ratio is an exchange rate between two currencies that equalises the international price of buying that basket. Our study makes comparisons, using such a PPP index, and allows the identification of real differences in salaries for our selected countries (South Africa, United States, United Kingdom, Canada, Australia and Saudi Arabia) for the same HRH professions. If PPP adjusted earnings are indeed different then this indicates an economic incentive to emigrate.ResultsSalaries of most South African HRH, particularly registered nurses, are dwarfed by their international counterparts (notably United States, Canada and Saudi Arabia), although the OSD has gone some way to reduce that disparity. All selected foreign countries generally offer higher salaries on a PPP adjusted basis. The United Kingdom (

Developing Energy-based Poverty Indicators for South Africa

43202) and Australia (

Anchoring and Yea-saying with Private Goods: An Experiment

38622), in the category of Medical Officer, are the only two examples where the PPP adjustment brings the salary below what is being offered in South Africa (

Using contingent valuation in hypothetical settings: estimating the WTP for an HIV/AIDS vaccine

50013 post OSD). The PPP adjusted salary differences between registered nurses is very slight for South Africa (

Is there a financial incentive to immigrate? Examining of the health worker salary gap between India and popular destination countries

18884 post OSD), Australia (

Closure of a Landfill Site in Ethekwini (Durban) Municipality: A Test for Strategic Bias in Contingent Valuation

21784) and the United Kingdom (

P4.63 Designing human immunodeficiency virus counselling and testing services to maximise uptake among high school learners in south africa: what matters?

20487). All other foreign countries show large salary advantages across the HRH categories examined.ConclusionWhilst South African salaries remain lower than their foreign counterparts by and large, the introduction and implementation of the OSD has made significant progress in reducing the gap between salaries of HRH in South Africa (SA) and the rest of the world. Given that the OSD has narrowed the gap between SA and overseas salaries whilst in the context of continued out migration of SA HRH, further research into push factors effecting migration needs to be undertaken.

A qualitative analysis of the barriers and facilitators of HIV counselling and testing perceived by adolescents in South Africa.

Energy provision and the role it plays in poverty alleviation is well documented. South Africa has an ambitious poverty alleviation program of halving 2004 poverty levels by 2014, which demands an increase in the provision of energy to both urban and rural impoverished areas. Yet the country has no energy based poverty indicators to guide such policy. This paper attempts to fill that gap by developing reliable, theoretically rigorous energy based indicators from extant data gathered in the 2005 South African household survey. An end-use and access-adjusted energy based poverty indicator compares favourably with other poverty variables using correlation analysis. We find that such indicators can assist government policy in meeting poverty targets such as that outlined by the Accelerated and Shared Growth Initiative for South Africa (AsgiSA).

Determining Preferences Related to HIV Counselling and Testing Services Among High School Learners in KwaZulu-Natal: A Discrete Choice Experiment.

This book explores frontier work at the intersection of experimental and environmental economics, with cutting edge research provided by premier scholars in the field. The book begins by focusing on improving benefit–cost analysis, which remains the hallmark of public policy decision-making around the globe. The contributors provide innovative avenues to credibly lead to more efficient policies. T