"There is not a safe space where they can find themselves to be free": (Un)safe spaces and the promotion of queer visibilities among township males who have sex with males (MSM) in Cape Town, South Africa.

Males who have sex with males (MSM) are prioritised in the global fight against HIV/AIDS, as a key affected population to receive HIV prevention, treatment, and HIV-related care and support (WHO, 2016). There is, however, limited empirical research conducted on how to engage communities of South African MSM in clinical HIV prevention research programs. The development of LGBTIQ safe spaces may potentially be a viable option to promote community-based engagement by bridging the divides between HIV-prevention researchers, marginalised queer populations, and other HIV-prevention stakeholders located in heteronormative spaces (Molyneux et al., 2016). We conducted ten in-depth, qualitative interviews with MSM safe space members who have been involved in HIV prevention research programs. Data were analysed using a thematic analytic strategy (Braun and Clarke, 2006). Our results indicate that the "safe spaces" currently operational in Cape Town are not stable spaces nor are they always safe, but they form part of a broader and much more long-term political and geographical strategy of inclusion and emancipation.

Screening and pathways to maternal mental health care in a South African antenatal setting.

In low-resource settings, a stepped care approach is necessary to screen and provide care for pregnant women with mental health problems. This study sought to identify screening items that were most robust at differentiating women experiencing psychological distress and requiring counselling [assessed by screening with the Edinburgh Postnatal Depression Scale (EPDS) and a Risk Factor Assessment (RFA)] from those with a psychiatric disorder as diagnosed by a psychiatrist. Case records of women in an antenatal mental health service in Cape Town were reviewed. Composite scores and individual items on screening scales (EPDS, RFA) of participants who qualified for counselling (n = 308) were compared to those of participants who were diagnosed with a psychiatric disorder (n = 58). All participants with a psychiatric disorder were diagnosed with either depression or anxiety disorders. These participants had higher mean scores on the EPDS and RFA than those who qualified for counselling (p < 0.01). Logistic regression and ROC analyses suggested that the best items to distinguish women with depression or anxiety from those qualifying for counselling were 'I have felt sad and miserable', 'I am not pleased about being pregnant' and 'I have had serious depression, panic attacks or problems with anxiety before' (sensitivity 0.655, specificity 0.750 for this combination of three items). A small number of items may be useful in screening for mental illness in pregnancy which requires higher levels of care. Such screening may contribute to a more efficient stepped care approach.

Factors associated with prevalence of mental disorder in people living with HIV/AIDS in South Africa.

The study examines the association between the presence of mental disorder and a range of independent variables. A sample of 900 HIV-positive individuals was administered the Composite International Diagnostic Interview to determine the presence of selected mental disorders. A structured interview assessed support received and factors that may contribute to mental disorder. Overall prevalence of mental disorder was 43.7%--though higher in Stage 3 (49.7%) and in Stage 4 (68%) of the disease. Eighteen percent of respondents were receiving antiretroviral treatment. Having had pre- and post-test counselling was not related to mental disorder; nor were the number of sessions, the professional status of the counsellor and perceived helpfulness of counselling. Being in an HIV support group was related to presence of a mental disorder, although the frequency of attendance was not. Although most of those who disclosed their HIV status found the experience helpful there was a significant positive association between presence of a mental disorder and having disclosed HIV-positive status. Although being a member of an association for people with HIV/AIDS and being religious was perceived as helpful, neither was statistically associated with the presence of mental disorder. Discrimination by community and family and isolation were related to mental disorder. Death of a significant other due to AIDS was related to mental disorder. The findings suggest a strong need for provision of psychiatric care as part of AIDS care as well as strengthening of support services.

Is participation in HIV vaccine trials a health promoting behaviour?

Health behaviours are individual acts by which people aim to preserve or enhance their health. Theories commonly used to understand health behaviour include the Health Belief Model, the Theories of Reasoned Action and Planned Behaviour, the Transtheoretical Model of Change, Social Cognitive Theory and Problem-Behaviour Theory. Targets for health-promotion interventions include exercise, smoking cessation and condom use. Some behaviours that may contribute to changes in population health, however, are not health behaviours as traditionally understood. For example, participating in an HIV vaccine trial may have the potential to contribute long-term to lowering HIV incidence. To what extent, though, can or should we apply models of health behaviour to HIV vaccine trial participation? This article grapples with the theoretical challenges facing social scientists who conduct research related to HIV vaccine trial participation. We initially consider decision making regarding trial participation from both the participant and investigator perspectives, before considering how these alternate decision-making narratives might impact on the conduct of HIV vaccine trials. We conclude by arguing that social scientists need to move beyond a narrow focus on health promotion theory and to engage in the interrelated scientific activities of theory testing and theory building.

What should South African HIV vaccine trials do about social harms?

Phase I and II HIV vaccine trials are currently underway in South Africa. Sites are being prepared for Phase III vaccine trials. Participants in these trials risk exposure to 'social harms' that may impact on participant enrolment and retention and threaten their welfare. Potential social harms should be prevented, minimised and/or addressed. This paper examines the literature on potential social harms in HIV vaccine trials. It outlines the type and severity and frequency of potential social harms and ways these have been monitored in settings in the developed world and Thailand. We argue that many of these social harms are likely to manifest in South African trials, however, it is also likely social harms may manifest differently in our setting, such as domestic violence. Therefore careful formative research is required to identify what constitutes a social harm in our setting. Measures should be carefully tailored to record such events and methods established to prevent or address these.

Paediatric HIV/AIDS disclosure: towards a developmental and process-oriented approach.

As antiretroviral therapy becomes more widely available in low-resource settings and children with HIV/AIDS live for longer periods, disclosure of HIV diagnosis to infected children is becoming increasingly important. This article reviews the current literature on HIV-related disclosure in light of theories of cognitive development, and argues for the adoption of a process-oriented approach to discussing HIV with infected children. Disclosure presents unique challenges to healthcare workers and caregivers of children with HIV/AIDS that include controlling the flow of information about the child's HIV status to him/her and deciding on what is in his/her best interest. Health care workers' and caregivers' views regarding disclosure to children may often be contradictory, with healthcare workers likely to support disclosing the diagnosis of HIV/AIDS to children and caregivers more reluctant to discuss the disease with them. There is a clear need for practical interventions to support paediatric HIV disclosure which provide children with age-appropriate information about the disease.