Understanding HIV-related posttraumatic stress disorder in South Africa: a review and conceptual framework

A number of epidemiological studies have attempted to measure the prevalence of HIV-related posttraumatic stress disorder (PTSD) in sub-Saharan Africa. A systematic review of the literature identified eight relevant studies that put current estimates of the prevalence of HIV-related PTSD between 4.2and 40. Even the lower estimates suggest that PTSD in response to the trauma of being diagnosed and living with HIV is a significant mental health burden. However; a conceptual framework to advance our understanding of the prevalence and phenomenology of HIV-related PTSD is lacking. This article argues that the Ehlers et Clark (2000) cognitive model of PTSD provides a useful conceptual framework for understanding HIV-related PTSD in South Africa. The model emphasises the role of trauma appraisals in the development and maintenance of PTSD; which can also be usefully applied to some of the other psychological disorders associated with HIV infection. The model appears to fit some of the important research findings; and it offers insights into the relationships between HIV-related PTSD and other psychological disorders; HIV stigma; the high prevalence of non-HIV traumatic events; occasional problems with the delivery of antiretroviral drugs in the South African public health service; the unpredictable course of HIV illness; and the quality of HIV testing and counselling. Implications for individual treatment strategies and broader public health interventions are briefly discussed

Experiences of sexual relationships of young black women in an atmosphere of coercion

Negotiations surrounding sexual activity are characterised by multiple power disparities that include race; social status and age; with gender being the most dominant differential in heterosexual interactions. Research has shown that women are physiologically more at risk of contracting HIV than men; as indicated by the higher infection rates of the former. Many African societies operate via a hegemonic masculinity; with patriarchal governance and female subordination being the norm; placing women at even greater risk of HIV infection. In this qualitative phenomenological study; four black school-going adolescent women living in Grahamstown were interviewed using a semi-structured interview to gather data. An interpretative phenomenological analysis was conducted on the data to provide subjective insights of the experiences of the participants with regard to their interactions with men. From the findings; it became apparent that the participants felt pressured; coerced or manipulated by male counterparts. This pressure and coercion was not just felt in their interactions with older men; but also in their romantic partnerships. Three of the participants experienced pressure to engage in sexual intercourse with their boyfriends when they were unwilling or unready; and they reported being faced with additional pressure to engage in unprotected sex. Furthermore; it became apparent that each participant had an underlying fear of being raped and considered this as a genuine threat to her safety and sexual health. The atmosphere within which these participants negotiate their sexual agency is thus heavily informed by male control; coercion and the threat of violence or rape

The Alcohol Use Disorders Identification Scale (AUDIT) normative scores for a multiracial sample of Rhodes University residence students

Objective:The objective of this research is to obtain accurate drinking norms for students living in the university residences in preparation for future social norms interventions that would allow individual students to compare their drinking to an appropriate reference group. Method: Random cluster sampling was used to obtain data from 318 residence students who completed the Alcohol Use Disorders Identification Test (AUDIT); a brief; reliable and valid screening measure designed by the World Health Organisation (Babor et al. 2001). Results: The Cronbach alpha coefficient of 0.83 reported for this multicultural sample is high; suggesting that the AUDIT may be reliably used in this and similar contexts. Normative scores are reported in the form of percentiles. Comparisons between the portions of students drinking safely and hazardously according to race and gender indicate that while male students are drinking no more hazardously than female students; white students drink far more hazardously than black students. Conclusions: These differences suggest that both race- and gender-specific norms would be essential for an effective social norms intervention in this multicultural South African context. Finally; the racialised drinking patterns might reflect an informal segregation of social space at Rhodes University

'Here, we cannot practice what is preached': early qualitative learning from community perspectives on Zimbabwe's response to COVID-19

The ramifications of the COVID-19 pandemic extend beyond the direct health consequences to negative social, economic and wider health impacts. Integrating community engagement should be an integral pillar of national responses to strengthen countries' ability to mitigate these negative consequences. We present lessons from rapid qualitative research early in the COVID-19 pandemic in Zimbabwe, aimed at understanding community and health worker perspectives on COVID-19 and policy responses. We conducted phone interviews with community-based organisations (n=4) and healthcare workers (n=16), and collected information from social media and news outlets related to COVID-19. We conducted thematic analysis and present results around four themes. 1) Individuals are overloaded with information, but lack trusted sources, with consequences of widespread fear and unanswered questions. 2) Policies of social distancing are disconnected to communities' ability to follow such measures, without access at home to water, long-term food supplies, or a daily income. 3) Healthcare workers perceived themselves to be vulnerable, due to a shortage of personal protective equipment, contributing to ongoing strikes. 4) Health implications beyond COVID-19 are expected to be wide-reaching and severe, as resources are redirected. Our research emphasises the importance of listening to community perspectives and accounting for context-specific realities to design locally appropriate and effective responses to COVID-19. Communities require support with basic needs and reliable information to enable them to follow prevention measures. Healthcare workers urgently need personal 3 protective equipment. Lastly, continued provision of essential services and medication is essential in reducing excess mortality and morbidity from conditions other than COVID-19