Lucy Mkandawire-Valhmu

The Critical Value of Focus Group Discussions in Research With Women Living With HIV in Malawi

This article is based on a critical ethnography about HIV and gender-based issues of power and violence conducted in Malawi in 2008. In all, 72 women living with HIV were recruited from four antiretroviral treatment clinics, three rural and one urban, to participate in 12 focus groups. Informed by a postcolonial feminist perspective, we analyze the process and products of these focus groups to interrogate their capacity to facilitate collective engagement with the social and structural realities confronting women in a resource-limited, highly AIDS-affected country. We present exemplars to show how women together created collective narratives to mobilize individuals to action. Findings indicate that focus groups can be used innovatively to benefit both the research and the participants, not only as a critical method of inquiry with marginalized groups but also as a forum in which validating dialogue, mutual support, and exchange of strategic information can generate transformative change to improve women’s lives.

Marriage as a risk factor for HIV: Learning from the experiences of HIV-infected women in Malawi

Abstract The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of womens lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriages effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what womens experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe womens lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review womens narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.

Study abroad as a tool for promoting cultural safety in nursing education.

Nurse educators are calling for the transformation of nursing education toward curricula that promote clinical reasoning through reflective practice and understanding of patient experiences in an effort to motivate students to become change agents. Study abroad programs can play an important role in this transformation through educating nurses in the delivery of culturally safe health care in a diverse world. Exposing nursing students to study abroad experiences that are guided by critical approaches such as a postcolonial feminist framework provides nursing students with opportunities to be immersed in the life and culture of people who have a completely different positioning and location while reflecting on the “us” versus “them” phenomenon that is pervasive in modern Western society and generates negative cultural comparisons. Attention to the design and implementation of such programs is important if nursing schools in the Western world are to uphold ethical standards, promote equality in relationships with host communities and avoid inadvertent exploitation and marginalization of vulnerable peoples. We present the development and implementation of a community health study abroad program for American nursing students in Malawi, Africa using a postcolonial feminist framework.

Applying a feminist approach to health and human rights research in Malawi: a study of violence in the lives of female domestic workers.

In this study, we responded to the human rights challenges posed in Malawi by burgeoning poverty, rapid urbanization, lack of employment opportunity for women, and AIDS-related morbidity and mortality as they affect young women in domestic service. Through focus groups and individual interviews with 48 female domestic workers, we examined violence from a postcolonial feminist perspective. In this article, we tell the story of how we operationalized our feminist science and forged relationships with Malawian women to identify the jeopardy they face and make steps toward an emancipatory change. We highlight substantive findings, but direct our focus to methodology, theoretical grounding, and implications for nursing research undertaken with vulnerable populations in the Third World.

Mentoring women faculty of color in nursing academia: Creating an environment that supports scholarly growth and retention

Our purposes in writing this article are to: (1) raise consciousness and prompt dialogue about issues contributing to the lack of racial/ethnic diversity among faculties of nursing, and (2) offer a vision for mentoring women faculty of color in nursing academia that is inclusive and supportive of scholarly growth and retention. Drawing from our own experiences as mentees and mentors, and bringing in literature to substantiate our argument, we examine racism and its ramifications for academic nursing and recommend strategies for opposing racism and encouraging collaborative mentorship.

Surviving life as a woman: a critical ethnography of violence in the lives of female domestic workers in Malawi.

A common form of employment for low-income third world women is domestic work. The power dynamics in this type of employer–employee relationship may place women at risk for abuse. Our aim in conducting this qualitative inquiry was to describe the experiences of violence in the lives of young female domestic workers in Malawi, a small country in South East Africa. Forty-eight women participated in focus group and individual interviews. “Surviving” was the main theme identified, with women employing creative ways of surviving the challenges they met at various points in their lives. This study provides information that health care professionals could use in assisting women through the process of surviving.

Safety Planning in Focus Groups of Malawian Women Living With HIV Helping Each Other Deal With Violence and Abuse

In this critical ethnography, 72 HIV-infected women in Southern Malawi participated in 12 focus groups discussing the impact of HIV and violence. Our analysis, informed by a postcolonial feminist perspective, revealed women’s capacity to collectively engage in safety planning. We present our findings about women’s experiences based on narratives detailing how women collectively strategized safety planning efforts to mitigate the impact of violence. This study helps to fill a gap in the literature on the intersection between HIV and violence in women’s lives. Strategies discussed by the women could form a basis for safety planning interventions for women in similar circumstances.

Transition to the tenure track for nurse faculty with young children: a case study.

ABSTRACT Recent efforts to ease the nursing shortage focus on recruiting and retaining younger faculty.The first years in a tenure‐track position are especially challenging for new faculty who struggle to negotiate demands of academia along with parenting young children.These struggles may influence retention and require further exploration. A case study using qualitative content analysis was conducted on the transitioning experiences of three assistant professors of nursing, who had young children, during their first two years on tenure track at a research‐intensive public university.Three main content areas emerged: adapting to the academic role, negotiating work/life demands, and benefiting from mentoring.To help ease the nurse faculty shortage, colleges and universities should strive to implement family‐friendly policies and mentoring programs to retain faculty with young children.

Methods and protocol of a mixed method quasi-experiment to evaluate the effects of a structural economic and food security intervention on HIV vulnerability in rural Malawi: The SAGE4Health Study

BackgroundPoverty and lack of a predictable, stable source of food are two fundamental determinants of ill health, including HIV/AIDS. Conversely, episodes of poor health and death from HIV can disrupt the ability to maintain economic stability in affected households, especially those that rely on subsistence farming. However, little empirical research has examined if, and how, improvements in people’s economic status and food security translate into changes in HIV vulnerability.MethodsIn this paper, we describe in detail the methods and protocol of an academic-NGO collaboration on a quasi-experimental, longitudinal study of the mechanisms and magnitude of the impact of a multilevel economic and food security program (Support to Able-Bodied Vulnerable Groups to Achieve Food Security; SAFE), as implemented by CARE. Primary outcomes include HIV vulnerability (i.e., HIV risk behaviors, HIV infection), economic status (i.e., income, household assets) and food security (including anthropometric measures). We recruited participants from two types of areas of rural central Malawi: traditional authorities (TA) selected by CARE to receive the SAFE program (intervention group) and TAs receiving other unrelated CARE programming (controls). In the intervention TAs, we recruited 598 program participants (398 women, 200 men) and interviewed them at baseline and 18- and 36-month follow-ups; we interviewed 301 control households. In addition, we conducted random surveys (n = 1002) in the intervention and control areas with a 36-month assessment interval, prior to and after implementation of SAFE. Thus, we are examining intervention outcomes both in direct SAFE program participants and their larger communities. We are using multilevel modeling to examine mediators and moderators of the effects of SAFE on HIV outcomes at the individual and community levels and determine the ways in which changes in HIV outcomes feed back into economic outcomes and food security at later interviews. Finally, we are conducting a qualitative end-of-program evaluation consisting of in-depth interviews with 90 SAFE participants.DiscussionIn addition to examining pathways linking structural factors to HIV vulnerability, this research will yield important information for understanding the impact of a multilevel environmental/structural intervention on HIV, with the potential for other sustainable long-term public health benefits.

The innovative and collective capacity of low-income East African women in the era of HIV/AIDS: contesting western notions of African Women.

Historically, African women have been viewed through a colonizing and Eurocentric lens emphasizing poverty, oppression, and suffering. A postcolonial, feminist approach to our two qualitative studies with human immunodeficiency virus (HIV)-infected women in Malawi and Kenya led us to depart from this discourse, highlighting womens capacity. Through this article, not only is a forum created for African womens voices to be heard as subaltern knowledge leading to transformational change, but also health care providers are made aware, through womens words, of how they might capitalize on grassroots womens movements, particularly in resource-poor communities, to implement effective HIV prevention and treatment strategies.