When the clinic becomes a home. Successful VCT and ART services in a stressful environment.

With the upscaling of antiretroviral therapy (ART) in resource-poor countries, many HIV-positive persons in Ghana have been accessing treatment in hospitals. Prevalence is relatively low compared to other African countries, 1.30%. HIV/AIDS remains heavily stigmatised in Ghana, which influences the provision and use of ART. This article investigates how HIV-positive persons accessing care and treatment go about their everyday lives in the ART clinic and how they have eventually come to see the clinic as a safe place that they call 'home'. The study took place in two Ghanaian hospitals in the Ashanti Region which in 2013 had the country's highest HIV prevalence rate of 1.30% [Ghana Health Service [GHS]/National AIDS Control Programme [NACP] (2013). 2013 HIV Sentinel Survey Report, Accra, Ghana]. It was conducted through ethnographic research, with data gathered in the two facilities through participant observation, conversations and in-depth interviews. It took place over a period of 15 months, between 2007 and 2010. In all, 24 health workers and 22 clients were interviewed in depth, while informal conversations were held with many others. The findings show that clients have adopted the clinic as a second home and used it to carry out various activities in order to avoid identification and stigmatisation as People Living with AIDS (PLWA). The most dramatic outcome was that, contrary to Ghanaian norms and values, people turned to non-kin for assistance. Accordingly, fellow clients and health personnel, rather than relatives, have become their 'therapy management group' [Janzen, J. M. (1987). Therapy Management: Concept, Reality, Process. Medical Anthropology Quarterly, 1(1), 68-84]. The clients have thus created a fictive family within the clinic - made up of health workers (as 'parents'), the clients themselves (as 'children') and the peer educators (as 'aunts' and 'uncles'). In the face of persistent stigma associated with HIV infection in Ghana, the use of the clinic as a 'home' has on the one hand helped those receiving treatment to maintain their position, respect and reputation within their families and community, while on the other it prevents PLWA from disclosing. The study concludes that compassion is an important element in the professionalisation of healthcare workers in low-prevalence countries.

The idea of African men: dealing with the cultural contradictions of sex in academia and in Kenya.

In this paper, I reflect on the notion of 'African men' as it is employed in global health scholarship and disentangle the way the idea is used as a generative concept. I explore how this notion circulates and gets modified, adapted and reproduced by scholars, on the one hand, and by various groups of men in Africa, on the other. I argue that the use of the idea of African men as an a priori category in scholarly imagination and practice presents us with stereotypes that impede much research. I then briefly connect with what has been analysed as the hegemonic discourse on Africa as the paradigm of difference, and the history of local modes of self-presentation as Africans. In Kenya, among both men and women, the use of the phrase African men as a natural category of sexual agents has been used to explain or justify men's multiple sexual relations. Yet if we look more closely at men's experiences, it becomes clear how men are caught up in conflicting discourses of masculinity. I conclude that we need to analyse gender as a performative quality that is both constructed and meaningful.

Female sexuality in Nairobi: flawed or favoured?

Studies of female sexuality in Africa tend to adopt an instrumental approach, many times problematizing sexual conduct in relation to HIV infection and/or reproduction. This study aimed to explore sexuality as a relational concept. Using interviews and participant observation, the paper shows how sexuality becomes a point of self-identification for young professional women in Nairobi between 20 and 30 years-old. These women form a group who implicitly and explicitly criticize conventional gender roles through the overt pursuit of sexual pleasure as recognition of their womanhood. This aspect of the feminine sense of self is at odds with normative notions of femininity. To avoid criticism for being 'un-proper', women adopt a deferential attitude towards men. The focus on upwardly mobile professional women and their experiments with new types of heterosexual relations in dating provides insight into both sexuality and gender.