Jack Ume Tocco

Interpersonal Relationships and Social Support in Transitioning Narratives of Black Transgender Women in Detroit

Information about the health and well-being of transgender communities is sparse, and even less is known about ethnic minority transgender communities. The little research that exists suggests that transgender women suffer high rates of HIV seropositivity, poor mental health outcomes, and body-modification-related health problems, challenges that are intensified among some ethnic minority communities (Garofalo, Deleon, Osmer, Doll, & Harper, 2006; Golub, Walker, Longmire-Avital, Bimbi, & Parsons, 2010; Nemoto, Bodeker, & Iwamoto, 2011). Even so, transgender communities are tremendously resilient in the face of transphobia and great structural disadvantage (Bith-Melander et al., 2010; Fish, 2012). Social support has been shown to play a key role in overcoming adversities associated with marginalized identities, including racial and sexual minority statuses in the United States (Brown, 2008; Graham, 2012). Yet there is a dearth of information regarding psychosocial determinants of health, such as the role of social networks in the gender transition process and the well-being of transgender communities—including ethnic minority transgender communities. The role of social networks in influencing health outcomes may be particularly important among individuals of multiple marginalized identities, such as Black transgender women, whereby support derived from networks may mitigate the negative effects of transphobia and racial discrimination (Nemoto et al., 2011). Given the role of social resources in determining health outcomes, considering gender transition experiences and identity development in the context of social networks is likely a meaningful approach to understanding vulnerabilities and

‘Every disease has its cure’: faith and HIV therapies in Islamic northern Nigeria

Northern Nigeria has one of the highest levels of HIV prevalence among societies that are predominantly Muslim. In the last decade the region has experienced marked expansion of religiously-oriented healing practices following the formal adoption of Islamic sharia law. Since 2005, international funding has also made antiretroviral therapy (ART) more widely available throughout Nigeria. This study uses ethnographic data collected in Kano, northern Nigerias largest city, to examine Muslims’ perspectives on HIV treatment in the context of popular health beliefs and expanding therapeutic options. The research found that passages from classical Islamic texts are regularly cited by both HIV/AIDS practitioners and patients, especially when talking about the supposition that Allah sends a cure to humankind for every disease. Some religious scholar-practitioners (malamai) working in the Islamic traditions of prophetic medicine insist that HIV can be completely cured given sufficient faith in the supernatural power of the Quran; others claim that the natural ingredients prescribed in Islamic texts can cure HIV. Such assertions contradict the mainstream biomedical position that, with the proper therapeutic regimen, infection with HIV can be managed as a chronic illness, although not cured. Thus, these assertions constitute a challenge to the increasing therapeutic hegemony of antiretroviralbased care in Nigeria. Without falsifying the proposition that a divine cure for HIV exists, many Muslim patients on ART, and the predominantly Muslim biomedical staff who treat them, express scepticism about whether the cure has yet to be revealed to humans. These findings suggest that despite recent efforts in Nigeria to assert a unified Islamic perspective on HIV and AIDS, substantive disagreements persist over the causes, treatments and curability of the disease. The healing systems in which practitioners and patients operate influence how they interpret Islamic texts concerning the divinely ordained relationships between Allah, humans, diseases and cures.

Switching on After Nine: Black gay-identified men's perceptions of sexual identities and partnerships in South African towns.

ABSTRACT There is considerable diversity, fluidity and complexity in the expressions of sexuality and gender among men who have sex with men (MSM). Some non-gay identified MSM are known colloquially by gay-identified men in Mpumalanga, Province, South Africa, as ‘After-Nines’ because they do not identify as gay and present as straight during the day but also have sex with other men at night. Based on, key informant interviews and focus group discussions in two districts in Mpumalanga, we explored Black gay-identified mens perceptions of and relationships with After-Nine men, focusing on sexual and gender identities and their social consequences. Gay-identified men expressed ambivalence about their After-Nine partners, desiring them for their masculinity, yet often feeling dissatisfied and exploited in their relationships with them. The exchange of sex for commodities, especially alcohol, was common. Gay mens characterisation of After-Nines as men who ignore them during the day but have sex with them at night highlights the diversity of how same-sex practicing men perceive themselves and their sexual partners. Sexual health promotion programmes targeting ‘MSM’ must understand this diversity to effectively support the community in developing strategies for reaching and engaging different groups of gay and non-gay identified men.

Perspectives on HIV pre- and post-exposure prophylaxes (prep and pep) among female and male sex workers in Mombasa, Kenya: implications for integrating biomedical prevention into sexual health services.

Pre- and post-exposure prophylaxes (PrEP and PEP) can reduce the risk of HIV acquisition, yet often are inaccessible to and underutilized by most-vulnerable populations, including sex workers in sub-Saharan Africa. Based on in-depth interviews with 21 female and 23 male HIV-negative sex workers in Mombasa, Kenya, we found that awareness and knowledge of PrEP and PEP were low, although willingness to use both was high. Participants felt PrEP would be empowering and give added protection against infection, although some expressed concerns about side effects. Despite PEPs availability, few knew about it and even fewer had used it, but most who had would use it again. Sex workers valued confidentiality, privacy, trustworthiness, and convenient location in health services and wanted thorough HIV/STI assessments. These findings suggest the importance of situating PrEP and PEP within sex worker-friendly health services and conducting outreach to promote these biomedical prevention methods for Kenyan sex workers.

To hasten Ebola containment, mobilize survivors

The current Ebola outbreak is unique in its magnitude and its dispersion in dense, mobile populations. Physician and nurse responders face high mortality, and foreign aid in the form of medical supplies and staff continues to be unequal to the scope of the problem. Fear and loss have overwhelmed affected communities, already among the poorest in the world and still recovering from brutal civil wars. While the number of Ebola cases in Liberia appears to be on the decline, Ebola infections in Sierra Leone and Guinea continue to increase.1 That the response to the epidemic be swift and massive is a matter of life and an unknown number of deaths. Survivors of Ebola infection are valuable resources still largely overlooked in the struggle to contain the epidemic. With a case recovery rate of around 30% at the present time for the current West African epidemic,2 survivors already number thousands. There are several reasons why Ebola survivors may be critical to controlling the epidemic. First, and most importantly, the recovered have developed immunity to the current strain of Ebola and therefore are able to care for the sick with little to no risk of re-infection. In a sense, survivors are the only people in the world who are ‘vaccinated’ against further Ebola infection with the strain in circulation. This uniquely positions them to mediate between the infected and uninfected and between local people and foreign responders. Second, survivors can donate their blood, as their antibodies might be protective and help those infected to survive the deadly virus. Although it has not yet been proven to be effective, passive immunotherapy with survivors’ blood (convalescent plasma) could be an effective treatment for the tens of thousands of people projected to battle Ebola. Indeed, research into the biological and clinical progress in survivors is critical to a further understanding of Ebola.3 Third, unlike most foreign response staff, survivors speak local languages, understand cultural dynamics and may be viewed more favourably than outsiders during this time of intense fear and community mistrust. Hence, they could care for the sick in both medical and home-based settings. Employing trained Ebola survivors as caregivers would also give them a source of income in a context of increased poverty and stigmatization. Finally, Ebola survivors may play a role in generating an effective, community-based response in exposed localities. Community-initiated actions in epidemics are recognized as important to public health, and have already been proven successful in an African context. For instance, over the past 15 years the Treatment Action Campaign (TAC) in South Africa has generated an effective, nationwide social movement among those HIV-positive, stigmatized, and deprived of treatment.4 A comparable movement among Ebola survivors could establish their effectiveness as advocates and educators, countering stigma and building community trust. Therefore, for all these reasons, we advocate creating and expanding initiatives to identify, recruit and train the recovered for roles they might desire. Adults known to having been infected and recovered should be identified through medical records and community leaders, as well as recruited through public messages. Their immunity can be established through blood tests. Interested survivors could be trained in essential caregiving roles, allowing non-immune staff to move to positions that minimize their exposure to Ebola. In this way, infections and mortality among healthcare workers would be greatly reduced. Survivors trained as community advocates and educators could teach others how Ebola is transmitted and could mitigate misinformation.5,6 They could also help families and communities to understand the necessity of isolating those who are symptomatic and of avoiding contact with their bodily fluids. To counter stigmatization of survivors as carriers of disease, public health campaigns will be needed to inform affected communities that the recovered pose no threat to the uninfected and, rather, have an important role in controlling the epidemic and caring for the sick. Training, remuneration and perhaps assignment of an honorific title should raise the status of survivors and counter stigma. Survivors can give hope and emotional support to both the uninfected and infected by demonstrating that life can go on after Ebola infection. Slowing and then stopping the spread of Ebola in West Africa is not only crucial to the region, but also to public health around the world, as demonstrated by the recent spread of the virus to Spain and the USA. But overcoming the crisis wrought by Ebola will require sustained action, cultural insight, and cooperation among affected communities and international responders. Training survivors has the potential to save untold thousands of lives and decrease the likelihood of infections spreading to unaffected populations. The United Nations International Childrens Emergency Fund (UNICEF), Medecins Sans Frontieres and Partners in Health have recently initiated interventions that incorporate Ebola survivors, thereby supporting the feasibility of our proposal.7,8 Survivors of the epidemic have a vital role to play in the recovery of their own communities and nations beyond the current outbreak. Even after Ebola transmission is controlled in West Africa, survivors who are trained as caregivers, community health educators and advocates can continue these supportive roles, helping to strengthen their countries’ poorly resourced and understaffed healthcare systems.

Intentional and Unintentional Condom Breakage and Slippage in the Sexual Interactions of Female and Male Sex Workers and Clients in Mombasa Kenya.

We examined why male condoms broke or slipped off during commercial sex and the actions taken in response among 75 female and male sex workers and male clients recruited from 18 bars/nightclubs in Mombasa, Kenya. Most participants (61/75, 81%) had experienced at least one breakage or slippage during commercial sex. Many breakages were attributed to the direct actions of clients. Breakages and slippages fell into two main groups: those that were intentionally caused by clients and unintentional ones caused by inebriation, forceful thrusting during sex and incorrect or non-lubricant use. Participant responses included: stopping sex and replacing the damaged condoms, doing nothing, getting tested for HIV, using post-exposure prophylaxis and washing. Some sex workers also employed strategies to prevent the occurrence of condom breakages. Innovative client-oriented HIV prevention and risk-reduction interventions are therefore urgently needed. Additionally, sex workers should be equipped with skills to recognize and manage breakages.ResumenExaminamos por qué hubo rotura o deslizamiento de condones durante encuentros sexuales comerciales y las acciones de respuesta tomadas por 75 trabajadores sexuales—tanto hombres como mujeres—y sus clientes masculinos, reclutados de 18 bares/clubes nocturnos en Mombasa, Kenya. Las mayoría de los participantes (61/75, 81%) habían experimentado por lo menos una ocasión de rotura o deslizamiento durante sexo comercial. Muchas roturas fueron atribuídas a las acciones directas de clientes. Hubo dos temas en las ocasiones de roturas y deslizamientos: aquellos causados por clientes y aquellos no intencionales causados por intoxicación, empujes enérgicos durante sexo y uso incorrecto (o no uso) de lubricantes. Entre las respuestas se incluían: interrupir el sexo y reemplazar los condones dañados; no hacer nada; obtener una prueba para el VIH; usar la profilaxis de post-exposición; y “lavado”. Algunos trabajadores sexuales utilizaron una variedad de estrategias para evitar que los condones se rompieran. Se necesita urgentemente intervenciones innovadoras y centrados en el cliente para la prevención del VIH y la reducción del riesgo. Asismismo, los trabajadores de sexo deberían adquirir las habilidades para reconocer y manejar las roturas.

Reproductive Desires and Considerations of HIV-Positive Men in Heterosexual Relationships in New York City

The reproductive desires of HIV-positive men have been investigated far less than those of HIV-positive women, especially in the US. This qualitative study of a sample of 94 HIV-positive men in New York City who were in a relationship with a woman of reproductive age examined their reasons for wanting a child as well as the conditions under which they would feel ready to attempt conception. Participants felt a child would make them feel normal, give meaning to their lives, or make others in their life happy. Although they reported HIV-related concerns (i.e., horizontal or vertical transmission, reinfection, or shortened life expectancy), participants mostly discussed factors unrelated to HIV (e.g., finances, housing, incarceration, substance abuse, or relationships) as deterrents to acting on their desire to having a child. When providing information on safer conception, healthcare providers should be aware of the broad desires and factors informing HIV-positive men’s reproductive goals.

Love in Africa

Africans love discussing love. African singers sing about it, advice columnists and novelists write about it and television programmes and feature films depict it in all its permutations. Like people around the world, contemporary Africans are concerned about finding, losing and keeping love. Yet, given the paucity of scholarly attention to the subject, those who are not very familiar with the continent might be excused for holding the misconception that romantic love is of little importance in African life. What explains this inattention to the topic of love in Africa outside the continent, even as discourses about love have flourished on the continent? Addressing this and many other questions head-on, Love in Africa constitutes a largely well-rounded entrée into the long-ignored topic of romantic love in sub-Saharan Africa. In the volume’s superb introduction, editors Cole and Thomas argue that love as an analytic problem has been widely shunned by anthropologists – the social scientists with the most sustained engagement in twentieth-century Africa – because it has been considered too individual an experience and epiphenomenal to the ‘proper’ scientific study of kinship, courtship, marriage and exchange. This avoidance was often reinforced by the cultural ideologies of Africans, who tended to emphasise the importance of social exchange over personal affect in marriage during anthropology’s formative years. Moreover, as Cole and Thomas argue, anthropology’s failure to engage with love is in part a product of theWest’s history with Africa, since Europeans justified their slaveand colonial-era domination in part by depicting Africans as hypersexual and without the emotional or intellectual depth required for nobler sentiments like love. As the HIV epidemic continues to ravage the continent, scholarly attention has come – for better or worse – to focus much more on sexual behaviour than on love. In the eight chapters that follow, the contributors (predominantly North American historians and anthropologists) examine love in settings ranging historically and geographically from 1930s South Africa to contemporary Niger. Taken together, these chapters offer three overarching insights about love in Africa. The first is that ‘love is a crucial idiom through which people in Africa have debated generational and cultural distinctions and made political claims to inclusion, often by engaging new forms of media’ (13). Several of the contributors attend to this project by analysing the ways in which notions of love are constructed through expressions of social distinction. For example, in the first chapter, Thomas juxtaposes textual analyses of 1930s white South African anthropologists’ writing on black African intimacy with a 1930s black South African middle-class newspaper’s articles on intimacy and love. She argues persuasively that for the black elite, discourses and practices of ‘true love’ were a means of defining and defending their own respectability – against more functionalist discussions of black sex as a