Xanthe Hunt

Dating persons with physical disabilities: the perceptions of South Africans without disabilities

Abstract There is good reason to believe that the attitudes of persons without disability towards dating a person with a physical disability might be unfavourable. However, in general, and in the Global South in particular, there is a dearth of research in this area. This study sought to take the first step in addressing this lack of enquiry, by surveying the attitudes of a general population sample in South Africa towards dating people with physical disabilities, using a vignette. Data from 1723 survey respondents were analysed thematically. Findings reveal largely negative attitudes towards people with physical disabilities. Respondents without disability perceived numerous barriers to dating a person with a physical disability, including social stigma, anxiety and concerns about the burden of care they believed such a relationship would place upon them. However, there was some evidence to suggest that some positive attitudes do exist, and a few respondents were open to dating a person with physical disabilities. Findings contribute to a nuancing and expanding of the ‘myth of asexuality’ among physically disabled people by showing that people with physical disabilities are actively desexualised by persons without disability. Future research is needed to explore how the inclusive attitudes, of which we did find evidence here, can be further cultivated.

The sexual and reproductive rights and benefit derived from sexual and reproductive health services of people with physical disabilities in South Africa: beliefs of non-disabled people

Abstract There is a body of theoretical work, and some empirical research, which suggests that non-disabled people assume people with physical disabilities are not suitable romantic partners, do not have sexual drives or desires, or are not sexually active. It has also been proposed that people with physical disabilities face barriers to sexual healthcare access which are structural as well as social. The present paper explores non-disabled South Africans’ beliefs concerning the degree to which non-disabled respondents enjoy sexual and reproductive rights, and benefit from sexual and reproductive healthcare, compared to people without disability. Using a survey, we asked 1989 South Africans to estimate the degree to which people with physical disabilities and people without disability have sexual rights, and benefit from sexual and reproductive healthcare services, respectively. Respondents were more likely to support the idea that the population without disability were deserving of sexual rights compared to people with physical disabilities. Respondents were more likely to rate the degree to which people with physical disability benefit from sexual and reproductive healthcare as less than that for people without physical disabilities. These findings provide some of the first empirical support that non-disabled people perceive people with physical disabilities as having fewer sexual and reproductive rights, and deriving less benefit from sexual and reproductive health services, than the population without disability. To have diminished sexual rights, and benefit less from sexual and reproductive healthcare, we suggest, evinces a negation of the sexual and reproductive needs and capacity of people with physical disabilities.

Diffusing and scaling evidence‐based interventions: eight lessons for early child development from the implementation of perinatal home visiting in South Africa

Most low‐ and middle‐income countries lack resources with which to implement public health programs. As such, there is a necessity to facilitate programing that judiciously makes use of what resources there are. However, despite evidence for the efficacy of many interventions, translating these into real‐world effectiveness, and then into scalability, is complex and has often been neglected. We draw on a case study of Philani+ (a maternal and child health intervention implemented in South Africa) to distil eight features of health programing that aid intervention effectiveness. We argue that implementation science should turn its attention to the human resource “process” features of interventions. We describe the importance of staff selection (rigorous selection and hiring procedures); training (developing a set of common core pragmatic problem‐solving skills); monitoring (feedback about quality); community and institutional support (rapport with intervention communities); the importance of stable leadership (consistent leadership focusing on how to optimize the potential of staff); the importance of implementing with sustainable, long‐term change in mind; and, finally, we describe how cultivating consistency within an organization requires disciplined action and disciplined focus on the organizations vision.

The sexual lives of people with disabilities within low- and middle-income countries: a scoping study of studies published in English

ABSTRACT Background: Although approximately 80% of the global population of people with disabilities reside in low- and middle-income countries (LMICs), very little is known about their sexual lives due to a lack of empirical data. We aimed to provide a scoping review of English-language research conducted on disability and sexuality in LMICs. Objective: Our research questions concerned what topics in disability and sexuality have (and have not) been investigated, where this research has been carried out, and how this research has been conducted. Methods: A scoping review was conducted to examine the published English-language research literature on disability and sexuality within LMICs. We searched three electronic databases (PsycINFO, Web of Science, and PsycARTICLES) for research meeting these criteria published between 2000 and 2016 (inclusive). Through this search, we identified 103 articles. Results: It is concluded that: (a) disability and sexuality research in African countries has focused predominantly on sexual abuse and violence or HIV, (b) the sexuality of people with disabilities within many LMICs has received little or no empirical investigation, and (c) there have been very few experimental studies on disability and sexuality conducted in LMICs in general. Conclusions: Much remains unknown about the sexual health and sexual lives of the majority of people with disabilities, globally. Moreover, what has been done in certain contexts has tended to focus predominantly on vulnerabilities rather than emancipatory practices. Thus, urgent action is needed within LMICs on issues related to disability and sexuality to meet the goal of global optimal sexual health.

Psychotherapy with a language interpreter: considerations and cautions for practice

We examine the extent to which psychotherapy can be successfully conducted with the aid of an interpreter. We propose that, even if we assume idealistic levels of training on the part of the interpreter and the therapist, and openness on the part of the client, there are still many challenges inherent in interpreter-assisted therapy. We focus on some of the characteristics common to client experiences of effective psychotherapy, as well as the characteristics and habits of effective therapists, and show how the insertion of an interpreter into the therapeutic relationship could affect both. Where the literature provides, we also note steps which could be taken to minimise the harmful impacts and maximise the positive contributions which the therapist–interpreter–client dynamic could yield. In South Africa, where informal interpreters play the invaluable role of facilitating essential communication between psychotherapists and their clients, it is imperative that informal interpreters, and clinicians working with interpreters, are aware of some of the complex issues at play in interpreted interactions. The issue of interpreting in mental health care is commonly addressed only in regard to the question of the competence of interpreters; we suggest that attitudinal and skill issues are equally important for clinicians. We conclude that successful therapy with an interpreter necessitates a consideration of the dynamic interaction between all parties involved.

Thinking about the environment and theorising change: how could Life History Strategy Theory inform mHealth interventions in low- and middle-income countries?

ABSTRACT Background: There is a growing body of literature outlining the promise of mobile information and communication technologies to improve healthcare in resource-constrained contexts. Methods: We reviewed the literature related to mobile information and communication technologies which aim to improve healthcare in resource-constrained contexts, in order to glean general observations regarding the state of mHealth in high-income countries (HIC) and low- and middle-income countries (LMIC). Results: mHealth interventions in LMIC often differ substantively from those in HIC, with the former being simpler, delivered through a single digital component (an SMS as opposed to a mobile phone application, or ‘app’), and, as a result, targeting only one of the many factors which impact on the activation (or deactivation) of the target behaviour. Almost as a rule, LMIC mHealth interventions lack an explicit theory of change. Conclusion: We highlight the necessity, when designing mHealth interventions, of having a theory of change that encompasses multiple salient perspectives pertaining to human behaviour. To address this need, we explore whether the concept of Life History Strategy could provide the mHealth field with a useful theory of change. Life History Strategy Theory may be particularly useful in understanding some of the problems, paradoxes, and limitations of mHealth interventions found in LMIC. Specifically, this theory illuminates questions regarding ‘light-weight’ programmes which solely provide information, reminders, and other virtual ‘nudges’ that may have limited impact on behaviours governed by extrinsic structural factors.

Intimacy, intercourse and adjustments: Experiences of sexual life of a group of people with physical disabilities in South Africa:

There is a growing recognition of the sexual and reproductive rights of people with disabilities, and since the World Health Organisation’s World Report on Disability, increased international attention has been given to these issues. Past research, however, suggests that this group encounter barriers to sexual and reproductive rights, which are both physical and attitudinal. Against this backdrop, this article employs a sequential mixed qualitative methodology to explore the practical and subjective experiences of 13 people with physical disabilities in South Africa, with regard to their sexual lives and experiences of sexuality. These experiences were marked by concerns about their ‘fitness’ as sexual beings and indicated that social forces were key in shaping their expectations for their own sexual life.

Paid staff or volunteers – does it make a difference? The impact of staffing on child outcomes for children attending community based programmes in South Africa and Malawi

ABSTRACT Background: Globally, and in low and middle income countries (LMIC) specifically, there is a critical shortage of workers. The use of volunteers to support such care delivery systems has been examined, there is scant literature on the impact of volunteers on child outcome in high human immunodeficiency virus (HIV)-affected communities. Objectives: To examine the differential impact of paid versus volunteer workforce in Community Based Organisations (CBOs) providing care to children and families affected by the HIV epidemic in South Africa and Malawi on child outcomes over time. Methods: This study compared child outcomes for 989 consecutive children attending CBOs (0.7% refusal) at baseline and 854 at follow-up (86.3% response rate). Results: Children attending CBOs with paid staff had higher self-esteem, fewer emotional/behavioural problems and less perceived stigma. Likewise, children attending CBOs with paid staff had fewer educational risks, and 20 heightened cognitive performance, and the digit-span memory test. After controlling for outcome at baseline, gender, age, HIV status, and disability, attending a CBO with paid staff remained a significant independent predictor of higher self-esteem scores, less perceived stigma, as well as fewer educational risks and better performance on the drawing test. We found no associations between CBO attendance – paid or volunteer – and children’s depressive and trauma symptoms. Conclusions: Our findings show that in order to most optimally impact on child outcome 30 community-based workers (CBWs) should ideally be paid with trained staff. Specialised input for more severe child difficulties is needed.

Disability, Theatre, and Postcoloniality: Reflections on the Politics of Performance

This chapter examines the nature and role of “disability theatre” in Global South contexts, through bringing together the voices of two scholars in disability studies, with that of the chief executive of a major Cape Town theatre complex, who is herself a disabled person. After exploring definitions of disability theatre, the question of its relevance to disability liberation in the postcolonial context is examined. Connections are made between colonisation based on geography, race, culture, and disability and the potential of performance art for expunging these “occupations”. Modes of exclusion of disability from the performing arts are discussed. Decolonisation is understood as taking ownership of representations of human experiences which are “always already” combinations of cultural and linguistic traditions. Disability theatre is viewed as capable of demythologising disability, “de-ablising” performance art, and promoting disability representation.

Shooting Back and (re)framing: Challenging Dominant Representations of People with Physical Disabilities in South Africa

The visual representation of people with physical disabilities has a history which is fraught. Disabled bodies have been variously portrayed as abnormal or abject, or else simply concealed. This mirrors social representations concerning the sexuality of disabled bodies which dictate that bodies which defy societal standards for normality cannot be sexual. People with physical disabilities are desexualised, a process sustained and maintained by their symbolic representation in the public imagining. Our chapter explores the ways in which photovoice can be used by people with physical disabilities in the global South to challenge dominant representations of their sexuality. Their images offer a valuable challenge to the moral and social agendas underlying societal thinking about and representing of bodies, sexuality and difference particularly relevant to the global South.