Liz Walker

Treading the path of least resistance: HIV/AIDS and social inequalities a South African case study.

This paper outlines aspects of the HIV/AIDS epidemic scenario and the complexities associated with it. It reveals the socio-epidemiological patterns of the epidemic and in doing so identifies the populations with the greatest and fastest growing rates of infection. From the data presented it is evident that the pattern of HIV/AIDS in developing countries in sub-Saharan Africa in particular is unique. The pattern emerging in South Africa follows closely. The features of this pattern are as follows: the epidemic is mainly a heterosexual epidemic, the rates of infection in the general population are very high and the percentage of HIV-positive women is greater than men. An additional unique feature is the young age of onset of infection for women. These data demonstrate the need to focus our attention on young African women and the factors underpinning their predicament. In order to understand their position we examine the long standing relationship between social inequalities and health in general and further invoke the concepts of vulnerability and social capital to shed light on the position of women in the epidemic. Within the constraints of limited and problematic statistical data, the paper argues that a mixture and complex interaction of material, social, cultural and behavioural factors shape the nature, process and outcome of the epidemic in South Africa. It concludes with recommendations for the way forward.

Men behaving differently: South African men since 1994

Liberal versions of sexuality, which mark South Africas new democracy, have had a number of highly contradictory consequences for women and men, as old notions of masculinity and male privilege have been destabilized. The transition to democracy has precipitated a crisis of masculinity. Orthodox notions of masculinity are being challenged and new versions of masculinity are emerging in their place. Some men are seeking to be part of a new social order while others are defensively clinging to more familiar routines. Drawing on in‐depth interviews with young African working class men, this paper explores new masculinities in contemporary South Africa. It examines how men negotiate their manhood in a period of social turbulence and transition. Masculinity, male sexuality, and the expectations which men have of themselves, each other and women are contested and in crisis.

'My biggest fear was that people would reject me once they knew my status...': stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg, South Africa.

Stigma is not a new concept; however, it remains highly significant in the context of HIV/AIDS in South Africa. There is wide consensus that HIV/AIDS-related stigma compromises the well-being of people living with the disease. This paper is part of a larger study that seeks to understand the social and cultural complexity related to the provision and outcomes of antiretroviral therapy (ART) in South Africa. It explores and analyses how patients on ART perceived and experienced stigma and how it has shaped their behaviour towards, as well as their understanding of the epidemic. The data have been collected by means of in-depth face-to-face interviews, conducted between June and November 2007, with a sample of 44 patients in an HIV/AIDS clinic in a resource-limited setting in Johannesburg, South Africa. The findings reveal that the level of felt and anticipated stigma is intense and affects all dimensions of living with HIV/AIDS, particularly disclosure and treatment. Stigma permeates the experience of HIV-positive people on ART who participated in this study. The intensity of HIV/AIDS-related stigma can threaten to compromise the value of ART, thus impacting on the daily lives of people living with HIV/AIDS (PLWHA). This study suggests that three decades into the epidemic, stigmatisation remains a core feature of the patient experience of HIV/AIDS. In the clinic in which this research was conducted, HIV/AIDS was regarded as a chronic condition increasingly manageable by ongoing access to ART. However, this approach was not shared by many family members, neighbours and employers who held highly stigmatised views.

Sex and secrecy: A focus on African sexualities

Sexual behaviour and attitudes towards sexuality often reveal wider social anxieties and tensions. In the Southern African region, an area experiencing rapid social transformation, such tensions ar...

HIV/AIDS: South African women at risk

A previous version of this paper was presented at the AIDS in Context Conference, University of the Witwatersrand, Johannesburg, 4–7 April 2001 This paper engages some aspects of the HIV/AIDS epidemic and the complexities associated with it. It outlines the socio-epidemiological patterns of the epidemic and in doing so identifies the groups with the greatest and fastest growing rates of infection. The pattern of the epidemic in South Africa is as follows: it is primarily a heterosexual one, the rates of infection in the general population are very high, and the percentage of HIV positive women is greater than men. An additional feature is the young age of onset of infection for women. These data demonstrate the need to focus our attention on young African women and the factors underpinning their predicament. In order to shed light on the position of women in the epidemic and the particular risks they face, we examine the long-standing relationship between gender and racial inequalities and health. Within the constraints of limited and flawed statistical data, the paper argues that a complex interaction of material, social, cultural and behavioural factors shape the nature, process and outcome of the epidemic in South Africa. It concludes with recommendations for the way forward.

The Colour White: Racial and Gendered Closure in the South African Medical Profession

SASMW South African Scoiety of Medical Women MASA Medical Association of South Africa SAMDC South African Medical and Dental Council RWS Race Welfare Society DPSC Detainees Parents Support Committee MWIA Medical Womens International Association TRC Truth and Reconciliation Commission SAMJ South African Medical Journal NAMDA National Medical and Dental Association IRC Internal Reconciliation Commission This article explores meanings of whiteness through a case study of the South African Society of Medical Women [SASMW]. It unpacks the social meanings attached to being a white woman doctor in South Africa under apartheid, through an analysis of the professional struggles of the SASMW (overwhelmingly dominated by white women) from 1950–1990. I demonstrate that being white and female created opportunities for women doctors along with constraints. The SASMWs struggles to challenge gender obstacles in the medical profession were easily fought because they never sought to overturn the gendered hierarchies of the profession and the discourses attached to them. I argue that in the South African context the racial privilege enjoyed by white medical women facilitated their access to the profession. Their whiteness accorded them automatic entry into the medical profession, and a career through a political and economic system concerned with maintaining racial exclusion and privilege.

Secrecy, stigma and HIV/AIDS: An introduction

This paper situates the articles selected for this special issue of AJAR within the context of the Sex and Secrecy conference, from which they emerged and within the discourse of secrecy. Secrecy and silence which have characterised the HIV/AIDS epidemic in many societies, have been the focus of limited academic attention. Yet the power of the secret is evident in multiple spheres. This introduction uses the lens of secrecy to enhance our understanding of sexuality. One of the themes which ran throughout these papers was that of stigma and its links to secrecy and HIV/AIDS. The papers reviewed in this introduction highlight an alarming paradox. There is a high level of HIV awareness and unparalleled public attention around matters of sexuality and yet the authors in this special issue all point to the enormity of stigma and its consequences.

'My work is to help the woman who wants to have a child, not the woman who wants to have an abortion': discourses of patriarchy and power among African nurses in South Africa

Abstract This paper details the responses of a group of African Primary Health Care Nurses (PHCNs), practising in Soweto clinics, to the issue of abortion. The majority of nurses interviewed — 70 per cent of a sample of 27 — unequivocally and unambiguously rejected abortion. The central concern of this paper is to explore why the responses of this ‘rejecting group’ to women who face the predicament of an unwanted pregnancy were cast in such judgemental terms. I argue that this is best understood by unpacking and exploring their identities as African nurses, mothers and wives. In their discourse, abortion symbolises a denial of womens true calling. To them, when a woman has an abortion she is ending not only her pregnancy but also her opportunity to be a mother and even her womanhood. The issue of abortion also provided the opportunity to explore the complex and contradictory ways in which this group of women understands and responds to patriarchal relationships.

The practice of Primary Health Care: A case study

This paper focuses on the practice of Primary Health Care in Soweto. It does so through an investigation into the work of a group of Primary Health Care Nurses (PHCNs) who are based in Community Health Care Centres in Soweto. This paper highlights the conflictual and contradictory conditions under which the Primary Health Care Nurses are working and further documents gaps and weaknesses in the practice and training of PHCNs. The paper argues that a central weakness is the apparent lack of social awareness and gender sensitivity amongst the group of Primary Health Care Nurses studied.

'They heal in the spirit of the mother': gender, race and professionalisation of South African medical women

This paper details aspects of the gendered and racial character of medical professionalisation in South Africa during the apartheid years. It does so through a case study of the South African Society of Medical Women (SASMW) an organisation that was established in 1951 with the express purpose of promoting the interests of women doctors and combating gender inequality in the medical profession. (authors)