Violence, rape, and sexual coercion: everyday love in a South African township

"I Don't Want to Be Known as a Weak Man": Insights and Rationalizations by Male Students on Men's Sexual Violence Perpetration against Female Students on Campus

Understanding how men view rape is foundational for rape prevention, but it is not always possible to interview men who rape, especially in a college campus context. We explore male students' insights into and rationalizations for why men on campus perpetrate sexual violence (SV) against female students by analysing qualitative focus group discussion data with male students. Men contended that SV is a demonstration of men's power over women, yet they did not perceive sexual harassment of female students as serious enough to constitute SV and appeared to be tolerant of it. Men perceived "sex for grades" as exploitative and rooted in the power asymmetry between privileged male lecturers and vulnerable female students. They were disdainful of non-partner rape, describing it as acts exclusively perpetrated by men from outside campus. Most men felt entitled to have sex with their girlfriends, although an alternative discourse challenged both this entitlement and the dominant masculinity linked to it. Gender-transformative work with male students is needed to support them to think and do things differently while they are on campus.

Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review

Gender inequity, including low sexual relationship power (SRP), is an important determinant of intimate partner violence (IPV) and negative sexual, reproductive, and mental health. Different versions of the Sexual Relationship Power Scale (SRPS) are commonly used within youth studies to examine how gender inequities, including controlling behaviors, in heterosexual relationships impact the lives of young people in sub-Saharan Africa. This review aims to (1) describe definitions and measures of SRP within sub-Saharan African youth studies and (2) review and summarize associations between SRP equity, IPV, and sexual, reproductive, and mental health. After searching Pubmed, Ovid Med, Psych info, Web of Science, Google Scholar, and relevant research forums, 304 papers were identified, of which 29 papers based on 15 distinct studies (published 2004-2019) met our criteria for being youth-specific, conducted in sub-Saharan Africa, and including a quantitative measure of SRP. Details of each SRPS are described, including any adaptations and psychometric properties, as well as associations with IPV, sexual, reproductive, and mental health behaviors and outcomes. Results indicate that there are variations to the SRPS, and a paucity of evidence has detailed the psychometric properties of such measures within sub-Saharan African youth studies. Measures of SRP equity are associated with experiences (among women) and perpetration of (among men) IPV as numerous pathways to HIV risk; however, the evidence remains mixed. In order to address overlapping epidemics of violence against women and HIV, efforts are needed to ensure that measures, including the SRPS, are valid and reliable among highly affected populations.

Rape survivors in South Africa: analysis of the baseline socio-demographic and health characteristics of a rape cohort

Background

Little is known about women who have experienced a recent rape, and how they differ from women without this exposure. Identifying factors linked to rape is important for preventing rape and developing effective responses in countries like South Africa with high levels of sexual violence.

Objective

To describe the socio-demographic and health profile of women recently exposed to rape and to compare them with a non-rape-exposed group.

Methods

The Rape Impact Cohort Evaluation Study (RICE) enrolled 852 women age 16–40 years exposed to rape from post-rape care centres in Durban (South Africa) and a control group of 853 women of the same age range who have never been exposed to rape recruited from public health services. Descriptive analyses include logistic regression modelling of socio-demographic characteristics associated with recent rape exposure.

Results

Women with recent rape reported poorer health and more intimate partner violence than those who were not raped. They had a lower likelihood of having completed school (Odds Ratio [OR] 0.46 95% Confidence Interval (CI): 0.24–0.87) and dependence on a government grant as a main source of income (OR 0.61: 95%CI 0.49–0.77). They were more likely to live in informal housing (OR 1.88 95%CI: 1.43–2.46) or rural areas (OR 2.24: 95%CI 1.61–3.07) than formal housing areas – however they were also more likely to report full-time employment (OR 4.24: 95%CI 2.73–6.57).

Conclusion

The study shows that structural factors, such as lower levels of education, poverty, and living in areas of poor infrastructure are associated with women’s vulnerability to rape. It also shows possible protection from rape afforded by the national financial safety net. It highlights the importance of safe transportation in commuting to work. Preventing rape is critical for enabling women’s full social and economic development, and structural interventions are key for reducing women’s vulnerability.

Awareness and Rejection Accounts of Intimate Partner Violence by Young Women in Soweto, Johannesburg, South Africa

Intimate partner violence (IPV) is the most prevalent form of interpersonal violence experienced by women in South Africa. A study conducted with young women from South Africa, aged 13 to 23 years, estimated that 42% experienced physical violence from their intimate partners. The subtle and nuanced social dynamics of IPV are less understood owing to little qualitative research on this subject. This study qualitatively explored how young women perceive and experience IPV. Participants were recruited through snowballing from townships in Soweto, outside Johannesburg. In-depth, face-to-face, and semistructured interviews were conducted with seven young women aged 15 to 20 years. The discourse analysis was implemented to understand participants' construction of IPV. Participants reported direct experiences of IPV and indirect through exposure to interparental and interpersonal violence. Findings indicate a progressive shift of perceptions from absolute tolerance of relationship violence to rejection. However, victim blaming and relegating relationship violence to the private realm still existed. Essentialisation of masculine qualities such as anger was used to construct and understand men's use of violence. Young women highlighted infidelity, pregnancy, and sex demands from their partners as reasons for them being subjected to IPV.

Measuring sexual relationship power equity among young women and young men South Africa: Implications for gender-transformative programming

INTRODUCTION

Measures used to assess equitable relationship dynamics, including the sexual relationship power scale (SRPS) have previously been associated with lower HIV-risk among young women, and reduced perpetration of intimate partner violence among men. However, few studies describe how the SRPS has been adapted and validated for use within global youth sexual health studies. We examined gender-specific psychometric properties, reliability, and validity of a SRPS used within a South African youth-engaged cohort study.

METHODS

Young men and women (16-24 years) enrolled in community-based cohorts in Durban and Soweto (2014-2016) reporting a primary partner at 6-month follow-up completed a 13-item (strongly agree/agree/disagree/strongly disagree) South African adaptation of Pulerwitz's SRPS (range 13-52, higher scores indicating greater sexual relationship power [SRP] equity). SRPS modifications were made using gender-specific exploratory factor analyses (EFAs), removing items with factor loadings <0.3. Cronbach alphas were conducted for full and modified scales by gender. Using modified scales, unadjusted and adjusted regression models examined associations between 1. relevant socio-demographic and relationship determinants and SRP equity, and 2. SRP equity and sexual relationship related outcomes. All models adjusted for education, age, site, and current employment.

RESULTS

235 sexually-active youth (66% women, median age = 20) were included. Mean scores across all 13 scale items were 2.71 (SD 0.30) for women and 2.70 (SD 0.4) for men. Scale Cronbach's alphas were 0.63 for women and 0.64 for men. EFAs resulted in two gender-specific single-factor SRPS. Modified SRPS Cronbach alphas increased to 0.67 for women (8-items) and 0.70 for men (9-items). After adjusting for age, site and current employment, higher education remained associated with SRP equity across genders. In adjusted models, correlates of SRP equity included primary partnerships that were age-similar (<5 years older) and <2 years in length for women and living in Soweto and younger age for men. Greater SRP equity among women was also independently associated with no recent partner violence.

CONCLUSIONS

Results highlight important gender differences in SRP equity measures and associations, highlighting the critically need for future research to examine gendered constructions of SRP equity in order to accurately develop, validate and use appropriate measures within quantitative surveys.

Feeling Under Pressure: Perspectives of the Meaning of Love and Sexual Relationships Amongst Young Men in KwaZulu-Natal Province, South Africa

This study aimed to explore perspectives on the meaning of love and sexual relations amongst young men in KwaZulu-Natal province of South Africa. Gaining insights into these perspectives will help to understand the sexual behaviors of these young men better and to eventually develop more effective HIV prevention interventions. Focus group discussions were conducted in two study areas using a predetermined semistructured discussion guide. The findings indicate that the phenomenon of romantic relationship try-outs together with the idea of "feeling under pressure" to propose love to more than one woman seem to be accepted practices that often lead to multiple concurrent sexual partners and therefore potentially risky sexual behaviors. The fear of impregnating a woman is seen to be of a more significant concern than acquiring a sexually transmitted infection due to the stigma and embarrassment associated with pregnancy outside marriage. Given these findings, it is recommended that future studies investigate perspectives on sexuality and reproductive health in male populations in great detail prior to the development of behavioral change interventions because failure to do so may hamper well-intended but poorly targeted health interventions.

An epidemiology of sexual assault among elderly women in the Mthatha area of South Africa

Background South Africa has one of the highest rates of rape in the world, but this barely seems to surprise anyone. It is extremely disturbing, especially when children and elderly women are raped. Women and children are usually the weakest group in society physically, as well as the most exposed to abuse and neglect. It should be the responsibility of a civil society to protect these vulnerable groups from harm. Objective This study investigated the trend of rapes among elderly women in the Mthatha area of South Africa. Method This was a retrospective descriptive study from the records of the Sinawe Centre. All cases of the rape of elderly women (i.e. those aged ≥65 years) between 2007 and 2011 were recorded. The Sinawe Centre is now a one-stop centre known as the Thuthuzela-Sinawe Centre, which is the only centre to deal with cases of rape in this area. Results A total 2579 adult victims of rape (i.e. those aged ≥16 years) were reported at the Sinawe Centre over a five-year period (2007-2011). Of these, 145 (5.6%) involved elderly women. The average rate of rape among elderly women was 20.7/10,000 adult women per year. There was an increase in elderly rape from 17.1/10,000 women in 2007 to 40/10,000 women in 2009. The highest percentage (45.5%) of women were aged between 65 and 70 years, and the lowest percentage (4.1%) were aged between 86 and 90 years. The highest number of cases (56; 38.6%) were reported in 2009 (p < .05; χ²= 45.2). In the majority of cases (122; 84.2%), there was a single perpetrator. There were two perpetrators in 14 (9.6%) cases, and three or more perpetrators were recorded in nine (6.2%) rapes. A little more than half (74; 51%) were known to the victims. In 117 (83%) cases, the rape took place in the home. Human immunodeficiency virus infection was found to be prevalent in five (3.6%) cases of elderly rape. Conclusion There are a high number of rapes among elderly women in the Mthatha area of South Africa. It is a matter of serious concern, and needs urgent attention.

'I can tell that he's serious because uyandicheckha': the reproduction of sexual vulnerability through scripted sexual practices

This paper explores how vulnerability is produced through the adoption of sexually scripted practices by young people in a rural area in the Eastern Cape of South Africa. It uses script theory to explore how scripted practices sustain and reproduce dominant gender norms, and in the process reproduce vulnerability for young women. Qualitative data drawn from 23 individual interviews and six focus groups with participants between 18 and 35 years of age were analysed to explore how sexual relationships are configured. An analysis of how relationships are arranged and constructed illustrates the material practices which allow vulnerability to occur. A critical set of practices such as ukucheckha (going to see a girlfriend), ukuoutha (going out to sleep over at a boyfriend's room) and ukushiywa (being replaced) are scripted into relationships and essential for their functioning. However, scripted practices at the cultural level make it difficult for young women to negotiate sexual safety at the interpersonal level, jeopardising personal and sexual safety. A focus on scripted sexual practices highlights the reproduction of sexual vulnerability particularly for young women. Interventions need to attend to the material realities which produce vulnerability for young women.

A Qualitative Exploration of Date Rape Survivors' Physical and Psycho-Social Experiences in a Nigerian University

Date rape (DR) is a serious but under-recognized public health problem that affects female university undergraduates. The burden of the problem in Nigerian universities is, however, yet to be fully investigated. The study was designed to explore the physical and psycho-social experiences of DR female survivors at the University of Ibadan. The study was qualitative in nature and involved eight consenting DR survivors. A pre-tested In-Depth Interview (IDI) guide that included questions relating to survivors' personal profile, context of DR experienced, factors that promoted survivors' vulnerability, reported adverse health consequences, help-seeking behaviors, and effects of the rape episode on dating relationship was used to facilitate the conduct of the narrative interview. The interviews were conducted in accordance to the protocol approved by the Joint University of Ibadan and University College Hospital Ethics Review Committee, and were taped-recorded and subjected to content analysis. Participants' mean age was 17.3 ± 2.3 years. All the participants were teenagers when they were first raped. Coercive and deceptive means were used to perpetrate the act of rape. Participants' use of verbal appeals, crying, and physical resistance to prevent being raped proved abortive. The experienced adverse physical health consequences included vaginal bleeding and injury. Major psycho-social effects of the experienced DR included self-blame, depression, hatred for men, and suicidal feelings. DR experiences occurred mainly in isolated settings, and most participants could not seek for medical help and other forms of care due to fear of being stigmatized. Some of the DR survivors continued their dating relationships when apologies were tendered by the perpetrators. DR is a traumatic experience, which is characterized by physical and psycho-social adverse effects. DR survivors, however, rarely seek for help as a result of the fear of being stigmatized. Multiple behavioral change interventions are needed to address the phenomenon.

Forced Sexual Experiences and Sexual Situation Self-Efficacy Among South African Youth

Nearly 20% of South African youth experience forced or coerced sexual intercourse. Understanding the factors associated with forced sex is important for informing prevention programs aimed at reducing sexual violence and HIV and AIDS. Multilevel regression models test the association between sexual situation self-efficacy and forced sex among 2,893 South African adolescents. Findings suggest that youth are more likely to experience forced sex after periods of time when their levels of self-efficacy are lower than their average levels of self-efficacy. Furthermore, youth who are lower on their self-efficacy compared to their peers are more likely to experience forced sex. Implications for prevention research are discussed.

Potential Behavioural and Psychological Contributions to Ethical HIV Vaccine Trials in South Africa

The development of an HIV vaccine is one of the best hopes for the future of the HIV pandemic. HIV vaccine trials involve multiple disciplines and professions, including psychologists and other behavioural scientists. One of the most important aspects of HIV vaccine trials, like all clinical trials, is their ethical conduct. This article argues that many of the ethical issues in HIV vaccine trials have strong behavioural (including psychological) components and implications. The article goes on to examine three complex ethical issues, namely informed consent, harm monitoring, and adolescent participation, to illustrate the contribution that psychologists have to make to these ethical issues. First, it is argued that informed consent (IC), which is an essential ethical prerequisite for trials, relies on certain behavioural components as, for example, in determining how understanding can best be assessed. Also, behavioural research can add to the controversial debate about whether IC could be viewed as a culture-bound phenomenon, or whether first-person consent should be done away with in certain cultural contexts. Second, the issue of harms from trial participation is examined. We argue that assessing and minimising social and behavioural harms for participants — an essential demonstration of ongoing respect for participants — can be usefully informed by behavioural science assessment techniques and counselling. Third, the article addresses the role behavioural science can play in the sensitive ethical issue of adolescent participation in HIV vaccine trials. We argue that psychology can inform the complex assessment of whether adolescents are able to make informed and voluntary decisions about their participation in trials. The article concludes that the contribution of psychology to the ethical conduct of HIV vaccine trials may be seen as a novel and unique contribution of psychology to health research.

In Their Own Voices

This study qualitatively examines the intersections of risk for intimate partner violence (IPV) and HIV infection in South Africa. Eighteen women seeking services for relationship violence were asked semistructured questions regarding their abusive experiences and HIV risk. Participants had experienced myriad forms of abuse, which reinforced each other to create a climate that sustained abuse and multiplied HIV risk. Male partners having multiple concurrent sexual relationships, and poor relationship communication compounded female vulnerability to HIV and abuse. A social environment of silence, male power, and economic constraints enabled abuse to continue. “Breaking the silence” and women's empowerment were suggested solutions.

‘Publish or perish’: Family life and academic research productivity

Research purpose: The influence of work-to-family and family-to-work spillovers is well documented in the human resources literature. However, little is known of the relationships between the pressures faced by academics to publish and the potential family life consequences of being a highly productive academic.Research design, approach and method: This research sought to investigate these relationships within the context of a large South African university by testing associations between family life variables such as marriage and dependent children against measures of the following specific types of research publication: (1) South African Department of Higher Education and Training–accredited journal publications; (2) Thompson Reuters Institute for Scientific Information (ISI) and ProQuest’s International Bibliography of the Social Sciences (IBSS)– indexed journal article publications; (3) conference proceedings publications; (4) conference paper presentations; (5) book chapter publications; (6) book publications; and (7) gross research productivity, reflecting a volume or quantity measure of research publication.Main findings: ISI and/or IBSS journal article publication is found to be negatively associated with dependent children, but only for male academics, and to be negatively associated with female gender over and above the effect of family life variables in testing.Practical/managerial implications: Human resources managers in universities need to be cognisant of the specific pressures faced by staff that are required to produce ever more research publications, in order to help them achieve work–life balance.Contribution: In a global context of increasing pressures for research publication, and for higher and higher numbers of publications, it is necessary to identify the potential costs involved for high-volume–producing academics, particularly in terms of family versus work.Keywords: research productivity; family-work life balance

Correlates of Mandrax use and condom beliefs in preventing sexually transmitted infections among a cohort of South African prison inmates

BACKGROUND

This study was designed to identify the extent to which self-reported Mandrax use impacts condom-use beliefs amongst South African prison inmates.

METHODS

Participants were inmates from four prisons in the provinces of KwaZulu-Natal and Mpumalanga. In total, 357 inmates participated in the parent study of which 121 are included in this analysis based on their self-reported use of Mandrax. The questionnaire was developed in English, translated into Zulu, and back translated into English. Age significantly predicted the use of Mandrax: younger prison inmates reported higher use. Linear regression analysis was conducted to determine whether the use of Mandrax was associated with length of incarceration and other demographic variables, as well as participants' self-reported condom use beliefs behavior.

RESULTS

Regression results indicated that two factors operationalizing condom-use beliefs were impacted by Mandrax use: 1) it is important to use condoms every time you have sex (p<0.01); 2) condoms work well to prevent the spread of HIV (p<0.02). Both factors were also inversely related to Mandrax use.

CONCLUSION

STI prevention programs among prison inmates that seek to promote safer sex behaviors among men must address attitudes to condom use, specifically consistent and correct use of latex condoms and reducing substance misuse.

Intimate Partner Violence, Relationship Power Inequity and the Role of Sexual and Social Risk Factors in the Production of Violence among Young Women Who Have Multiple Sexual Partners in a Peri-Urban Setting in South Africa

Introduction

This paper aims to assess the extent and correlates of intimate partner violence (IPV), explore relationship power inequity and the role of sexual and social risk factors in the production of violence among young women aged 16–24 reporting more than one partner in the past three months in a peri-urban setting in the Western Cape, South Africa. Recent estimates suggest that every six hours a woman is killed by an intimate partner in South Africa, making IPV a leading public health problem in the country. While there is mounting evidence that levels of IPV are high in peri-urban settings in South Africa, not much is known about how it manifests among women who engage in concomitantly high HIV risk behaviours such as multiple sexual partnering, transactional sex and age mixing. We know even less about how such women negotiate power and control if exposed to violence in such sexual networks.

Methods

Two hundred and fifty nine women with multiple sexual partners, residing in a predominantly Black peri-urban community in the Western Cape, South Africa, were recruited into a bio-behavioural survey using Respondent Driven Sampling (RDS). After the survey, focus group discussions and individual interviews were conducted among young women and men to understand the underlying factors informing their risk behaviours and experiences of violence.

Findings

86% of the young women experienced IPV in the past 12 months. Sexual IPV was significantly correlated with sex with a man who was 5 years or older than the index female partner (OR 1.7, 95% CI 1.0–3.2) and transactional sex with most recent casual partner (OR 2.1, 95% CI 1.1–3.8). Predictably, women experienced high levels of relationship power inequity. However, they also identified areas in their controlling relationships where they shared decision making power.

Discussion

Levels of IPV among young women with multiple sexual partners were much higher than what is reported among women in the general population and shown to be associated with sexual risk taking. Interventions targeting IPV need to address sexual risk taking as it heightens vulnerability to violence.

Sexual and reproductive health perceptions and practices as revealed in the sexual history narratives of South African men living in a time of HIV/AIDS

The frequent positioning of men's sexual risk-taking as driving the HIV/AIDS epidemic in South Africa has triggered interest in men's sexual and reproductive health (SRH) perceptions, attitudes, and practices. Much research, however, presents men as a homogenous group, and focuses on the quantifiable aspects of male sexual behaviors, providing an inadequate basis for understanding men's SRH needs and addressing the gendered aspects of HIV prevention. This study used sexual history narratives to yield more nuanced and contextualized understandings of male sexuality as it relates to SRH. Fifty sexual life history individual interviews and 10 focus-group discussions (FGDs) with men, as well as 25 sexual life history interviews with women, were conducted with participants purposively sampled from three age categories: (18–24, 25–55, and 55+ years), a wide range of cultural and racial backgrounds, and in urban and rural sites across 5 provinces in South Africa. Interviews and FGDs elicited stories of participant's early knowledge of sex and sexual experimentation and then explored sexual relationships and experiences in adulthood—including engagement with HIV risks and SRH management. The data were analyzed using a thematic approach. Many male participants conformed to dominant norms of masculinity associated with a high risk of sexually transmitted infections including HIV, such as having regular unprotected sex, reluctance to test for HIV, and poor SRH-seeking behaviors. Yet, the narrative accounts reveal instances of men taking steps to protect their own SRH and that of their partners, and the complex ways in which hegemonic gender norms influence men and women's SRH. Ultimately, the study points to the value of sexual biographies for gaining a deeper understanding of male sexuality, and the social structures, meanings, and experiences that underlie it. Such insights are critical to more effectively engaging men in HIV prevention efforts.

The effects of gender and socioeconomic status on youth sexual-risknorms: evidence from a poor urban community in South Africa

HIV and AIDS remains one of the most serious problems facing youths in many sub-Saharan African countries. Among young people in South Africa, gender is linked with a number of HIV-risk behaviours and outcomes. The literature suggests that factors such as socioeconomic status, intimate partner violence, and several psychosocial factors contribute to gendered differences in sexual behaviour among youths in South Africa. However, the existing body of literature scarcely addresses the interaction between gender, confounding factors (particularly peer norms) and sexual behaviour outcomes. This study uses a survey design (n = 809) to examine how gender and socioeconomic status moderate the effects of norms and attitudes on higher-risk sexual behaviours among secondary school learners in a low-income community in South Africa. The findings suggest that gender interacts significantly with peer norms to predict sexual behaviour. Peer norms and the experience of intimate partner violence were significantly associated with sexual risk behaviour among girls participating in the study. The article discusses both the wider implications of these findings and the implications for school-based and peer-facilitated HIV interventions.

Exploring the relationships among food insecurity, alcohol use, and sexual risk taking among men and women living in South African townships

South African townships have among the highest rates of HIV infection in the world. Considerable research on understanding the high rates of HIV transmission in this country has identified alcohol use as a critical factor in driving the HIV epidemic. Although the relationship between alcohol use and sexual risk-taking is well documented, less is known about how other factors, such as food insecurity, might be important in understanding alcohol's role in sexual risk-taking. Furthermore, prior research has highlighted how patterns of alcohol use and sexual risk-taking tend to vary by gender. We examined how food insecurity is related to both alcohol use and sexual risk-taking. We administered anonymous community surveys to men (n = 1,137) and women (n = 458) residing within four contiguous Black African townships outside of Cape Town, South Africa. In multivariate linear regression, we found that food insecurity was related to having higher numbers of male sex partners and condom-protected sex acts among women only. These relationships, however, were fully mediated by women's alcohol use. Among men, we found that food insecurity was negatively related to unprotected sex; that is, men with greater food security reported more unprotected sex acts. Unlike the results found among women, this relationship was not mediated by alcohol use. Food insecurity appears to be an important factor in understanding patterns of sexual risk-taking in regards to gender and alcohol use, and may serve as an important point of intervention for reducing HIV transmission rates.

Material girls and Material love: Consuming femininity and the contradictions of post-girl power among Kenyan schoolgirls

In this paper, I use qualitative data to explore the practices engaged in by Kenyan schoolgirls to participate in modern consuming womanhood, as well as the contradictory implications of these practices for thinking about globalized mediated femininities and their enactment in resource-poor settings. The paper examines the centrality of consumption to valued modern femininity among young women around the world, as well as the structural reality of gendered access to income. I show how the cooptation of the materiality of romantic love and normative expectations of male provision in romantic relationships bridge the gap between consumption desires and economic realities among Kenyan schoolgirls in both powerful and problematic ways. The paper ends with a reflection of the implications of these findings for post-girl power, the post-feminist age and the re-inscription of patriarchy.

Let's talk about sex: gender norms and sexual health in English schools

The sexual health of young people in England is an urgent public health concern. While interventions to address young people's sexual health have focussed on knowledge, skills and contraception access, amazingly none in the UK has explicitly addressed the effects of the social hierarchies of gender and gendered behavioural ideals that shape young people's sexual expectations, attitudes and behaviour. The lack of attention to gender is a persistent gap in health research, practice and policy. A rigorous evaluation of such an intervention package would go some way to building an evidence base for challenging gender norms, which appear to be strongly associated with adverse sexual health outcomes.

Associations between psychosocial factors and incidence of sexually transmitted disease among South African adolescents

BACKGROUND

Adolescents living in South Africa are at high risk for HIV and other sexually transmitted diseases (STDs). The present study sought to identify correlates of curable STD incidence among a cohort of adolescents in Eastern Cape Province, South Africa.

METHODS

Data were collected in conjunction with an HIV/STD prevention intervention randomized controlled trial. At 54 months postintervention, curable STD incidence (gonorrhea, chlamydial infection, and trichomoniasis) was assayed and self-report measures of potential correlates of STD incidence were collected.

RESULTS

Participants were adolescents reporting at least 1 sexual partner in the past 3 months (n = 659). As expected, univariate analyses revealed that girls were more likely than boys to have an STD. In addition, intimate partner violence, unprotected sex, and having older partners were associated with incident STD. In Poisson multiple regression analyses, sex (risk ratio [RR], 4.00; 95% confidence interval [CI], 2.51-6.39), intimate partner violence (RR, 1.23; 95% CI, 1.12-1.35), unprotected sex (RR, 1.42; 95% CI, 1.09-2.01), and multiple partners (RR, 1.70; 95% CI, 1.11-2.61), but not partner's age (RR, 1.00; 95% CI, 0.94-1.07) were associated with incident STD, adjusting for 42-month STD prevalence. Binge drinking, forced sex, and age were unrelated to STD incidence in both analyses. Interactions between sex and the hypothesized correlates were nonsignificant, suggesting that sex did not modify these relationships.

CONCLUSIONS

Interventions to reduce HIV/STD incidence among adolescents in South Africa should address the risk associated with sex, unprotected sex, intimate partner violence, and multiple partnerships.

Inkwari: an emerging high-risk place potentiating hiv spread among young adults in a hyper-endemic South African setting

Young adults in South Africa are at the epicenter of the HIV epidemic. The prevalence of HIV among young people in the province of KwaZulu-Natal (KZN) is particularly high. This study characterizes inkwari (Zulu word for raves or weekend-long parties) in eThekwini District, KZN and explored how these place-based dynamics shape the risk environment for the young adult attendees. In 2011, 13 qualitative interviews were conducted with men and women between 18 and 30 years-old who reported unprotected sex with at least one casual partner in the prior 3 months and attended an inkwari in the same time period. Interviews were analyzed using qualitative content analysis. Nine key informant interviews helped to triangulate these data. Five women and eight men were interviewed and the mean age was 25 years (SD 3.24). Ten reported meeting a sexual partner at an inkwari. Inkwari were characterized as sexualized settings with limited adult supervision. Participants attended inkwari to socialize with peers, use drugs and alcohol, and meet sexual partners. Sexual and physical violence also occurred at inkwari. Given the convergence of social, sexual, and substance-using networks at inkwari, further inquiry is needed to determine how this place may potentiate HIV transmission risk in an endemic setting.

The influence of relationship power dynamics on HIV testing in rural Malawi

Using the theory of gender and power (TGP) and data from the Tsogolo la Thanzi (TLT) study, we examined how relationship power shapes young people's decisions to test for HIV in rural Malawi (N=932), a high-HIV prevalence setting undergoing rapid expansions in testing services. We used generalized estimating equations (GEE) to examine associations among five constructs of relationship power (socioeconomic inequalities, relationship dominance, relationship violence, relationship unity, and mistrust), perceived risk, and receiving an HIV test over a 16-month period. The results indicate that young Malawians are testing for HIV at relatively high rates, repeatedly, and not just during pregnancy. Over the study period, 47.3% of respondents received at least one HIV test outside of TLT (range: 0-4). The GEE analysis revealed that men and women with higher levels of relationship unity were less likely to test for HIV. For men, being a victim of sexual coercion was an additional barrier to testing. Women's testing decisions were more strongly influenced by perceptions of a partner's risk for HIV than their own, whereas men relied more on self-assessments. The results highlight that testing decisions are deeply embedded within the relationship context, which should be considered in future HIV testing interventions.

Marital infidelity and intimate partner violence in rural Malawi: a dyadic investigation

Extramarital sexual partnerships are a common reason for intimate partner violence (IPV) in sub-Saharan Africa. Despite the fact that IPV requires an interaction between two partners, the majority of the research focuses on individuals rather than the broader relationship context where such violence takes place. Using a sample of 422 married couples from rural Malawi, this study examined the dyadic environment of marital infidelity and two types of IPV victimization: sexual coercion and physical abuse. We considered both self-reported marital infidelity and perceived partner infidelity to assess how well partners knew each other and to compare their respective associations with IPV. Logistic regression was used to test for associations between self-reported marital infidelity and IPV. Multilevel logistic regression was used to examine actor and partner effects of perceived partner infidelity on an individual's and their partner's experience of IPV. The results show that self-reported marital infidelity was not significantly associated with IPV for men or women. However, the perception of a partner's infidelity was significantly associated with both an individual's and their partner's risk for sexual coercion and physical abuse. Contrary to the "sexual double standard" hypothesis, women were not significantly more likely than men to report being physically abused when their partners suspected infidelity. Future studies should continue to explore the relationship context of IPV in sub-Saharan Africa in order to understand how spouses mutually shape each other's experience of IPV and subsequent health outcomes.

Revisiting the dynamics of early childbearing in South African townships

In South Africa over the last two decades, births to girls under the age of 20 years of age have steadily declined. The reason for the decline has been attributed to progressive social and educational policies and more accommodating reactions from families. This paper uses ethnographic data collected in 2001-2002 and again in 2013 in order to compare young women's perceptions and experiences of early childbearing at the turn of the twenty-first century with those of young women a decade later. It makes two main contributions to the literature on early childbearing in South Africa. First, it provides insight into the changes that have occurred regarding how young women experience pregnancy and motherhood over the last decade. Second, it considers changes not only in relation to time but also in relation to the significant social and ideological changes.

High and low contraceptive use amongst young male offenders: a qualitative interview study

Objectives

There are high rates of fatherhood and sexually transmitted infections (STIs) among young incarcerated men. Here we focus on a sample of men incarcerated in a Scottish Young Offender Institution, analysing their accounts of their contraceptive use. Those who report low or no use of contraception are compared with those who report high use.

Methods

Semi-structured interviews with 40 young male offenders, aged 16–21 years. Participants were purposively sampled using answers from a questionnaire administered to 67 inmates. Data from those men (n=31) reporting either high (n=14) or low/no use (n=17) of contraception are analysed here.

Results

Low users emphasise their desire for pleasure and appear fatalistic about both pregnancy and disease prevention. High users report a strong desire to protect themselves and their ‘manliness’ by using condoms to avoid the risk of STIs and, to a lesser extent, pregnancy. Both sets of men present themselves in a traditionally masculine way, with high users emphasising power, authority and self-control to justify their non-risk-taking contraceptive behaviour.

Conclusions

The masculine narrative regarding self-protection, utilised by the high users, may be an effective method of intervention with potential and actual low users. Conventional masculinity valorises risk-taking but if particular forms of risk avoidance – condom use – can be legitimised as confirming one's masculinity it may be possible to persuade low users to adopt them. The opportunity to work with young men whilst incarcerated should be grasped.

‘Rape is a huge issue in this country’: Discursive constructions of the rape crisis in South Africa

This article considers how the issue of rape in South Africa is discursively constructed by women who have not experienced it. Taking a feminist discursive analytic approach to data from 15 semi-structured interviews, the article identifies four interpretative repertoires which the women used in their talk of rape. These are the statistics repertoire, invoking putatively objective rape statistics; crime repertoire, locating rape within a crisis of crime; race repertoire, naming the racial Other as the rapist; and gender repertoire, explaining rape in terms of normal gendered dynamics and practices. The women chiefly deployed the statistics, crime and race repertoires. These repertoires intersected to construct rape as horrifically prevalent in South Africa yet concerning a classed, raced and spatially-distanced ‘Other’. They also elided a focus on the gendered scripts and power relations which South African feminists implicate centrally in what they deem a national rape crisis.

Trauma and posttraumatic stress disorder in South Africa: analysis from the South African Stress and Health Study

BACKGROUND

South Africa's unique history, characterised by apartheid, a form of constitutional racial segregation and exploitation, and a long period of political violence and state-sponsored oppression ending only in 1994, suggests a high level of trauma exposure in the general population. The aim of this study was to document the epidemiology of trauma and posttraumatic stress disorder (PTSD) in the South African general population.

METHODS

The South African Stress and Health Study is a nationally representative survey of South African adults using the WHO's Composite International Diagnostic Interview (CIDI) to assess exposure to trauma and presence of DSM-IV mental disorders.

RESULTS

The most common traumatic events were the unexpected death of a loved one and witnessing trauma occurring to others. Lifetime and 12-month prevalence rates of PTSD were 2.3% and 0.7% respectively, while the conditional prevalence of PTSD after trauma exposure was 3.5%. PTSD conditional risk after trauma exposure and probability of chronicity after PTSD onset were both highest for witnessing trauma. Socio-demographic factors such as sex, age and education were largely unrelated to PTSD risk.

CONCLUSIONS

The occurrence of trauma and PTSD in South Africa is not distributed according to the socio-demographic factors or trauma types observed in other countries. The dominant role of witnessing in contributing to PTSD may reflect the public settings of trauma exposure in South Africa and highlight the importance of political and social context in shaping the epidemiology of PTSD.

Gendered constructions of the impact of HIV and AIDS in the context of the HIV-positive seroconcordant heterosexual relationship

Introduction

This article explores the complex, dynamic and contextual frameworks within which men working in a mining community and their live-in long-term partners or spouses (termed “couples” in this study) respond to the introduction of HIV into their heterosexual relationships; the way in which partners adopt gendered positions in enabling them to make sense of their illness; how they negotiate their respective masculine and feminine roles in response to the need for HIV-related lifestyle changes; as well as the gendered nature of partner support in relation to antiretroviral therapy (ARV) adherence.

Methods

We conducted an in-depth qualitative study with a sample of 12 HIV-positive seroconcordant heterosexual couples in a South African mining organization. Transcripts based on semi-structured couple's interviews were analyzed using an inductive emergent thematic analytical method.

Results

The findings present compelling evidence that the impact of HIV and AIDS is mitigated, in the main, by the nature of the dyadic relationship. Where power and agency were skewed in accordance with traditional gender scripts, the impact of HIV and AIDS was deleterious in terms of negotiating disclosure, meeting expectations of care and support, and promoting treatment adherence. As a corollary, the study also revealed that where the relational dynamic evidenced a more equitable distribution of power, the challenge of negotiating illness was embraced in a way that strengthened the couples’ affiliation in profound ways, manifested not simply in a reduction in risk behaviours, but in both partner's courage to re-visit sensitive issues related to managing their relationship in the context of a debilitating illness.

Conclusions

Gendered positioning (by self and others) was found to play a crucial role in the way couples experienced HIV and ARV treatment, and underscored the positive role of a couples-counselling approach in the negotiation of the illness experience. However, as part of a broader social project, the findings highlight the need to address the shortcomings of a public health discourse on illness normalization that reifies and reinforces skewed gender relations. In essence, the findings make a compelling case for targeting couples as the primary unit of analysis and intervention in HIV and AIDS praxis, not only to enhance treatment and prevention outcomes, but to impact on and potentially transform the lived identity of such relationships, in AIDS-affected communities. We recommend early intervention with couples in terms of couples HIV testing, risk-reduction counselling and gender-based interventions giving couples opportunities to revisit and challenge their prevailing gendered identities. We note, however, that these efforts will be undermined in the long term, if the structural drivers of HIV risk and vulnerability, contained within macro-level social, economic and cultural practices, are not simultaneously addressed.

Women with pregnancies had lower adherence to 1% tenofovir vaginal gel as HIV preexposure prophylaxis in CAPRISA 004, a phase IIB randomized-controlled trial

Background

Antiretroviral prophylaxis may be a critical strategy to reduce periconception HIV transmission. Maximizing the benefit of periconception pharmacologic HIV risk-reduction requires an understanding of the links between pregnancy and adherence to this prevention strategy.

Methods

We assessed study gel adherence among women with pregnancies compared to women without pregnancies enrolled in the CAPRISA 004 phase IIB trial of 1% vaginal tenofovir gel. Pregnancy was assessed with monthly urine tests. Adherence was measured monthly and defined as proportion of sex acts covered by two returned, used applicators based on pre- and post-coital dosing. High adherence was defined as a median adherence score of >80%, that is, more than 80% of sex acts were covered by two applications of study gel. A multivariate generalized estimating equations (GEE) model with a binomial distribution was used to assess covariates associated with high adherence (>80%) over time. Median adherence before and after pregnancy was compared using Wilcoxon signed rank test.

Results

Among 868 women, 53 had at least 1 pregnancy (4.06 per 100 woman years, 95% CI: 3.04, 5.31). Women with pregnancies had lower median adherence compared to women without pregnancies (50% [IQR: 45–83] vs. 60% [IQR: 50–100], p = 0.02). Women with pregnancies also had a 48% lower odds of high adherence compared to women without pregnancies when adjusting for confounders (aOR 0.52, 95%CI: 0.41–0.66, p<0.0001). Among women with pregnancies, adherence before and after pregnancy was not different (50% [IQR: 46–83] vs. 55% [IQR: 20–100], p = 0.68).

Conclusions

Women with pregnancies were less likely to have high adherence to study gel compared to women without pregnancies. Understanding these differences may inform findings from HIV prevention trials and future implementation of antiretroviral prophylaxis for at-risk women who choose to conceive. The protocol for the parent trial is registered on ClinicalTrials.gov, NCT00441298, http://www.clinicaltrials.gov/ct2/show/NCT00441298.

Reproductive decision-making and periconception practices among HIV-positive men and women attending HIV services in Durban, South Africa

Understanding reproductive decisions and periconception behavior among HIV-discordant couples is important for designing risk reduction interventions for couples who choose to conceive. In-depth interviews were conducted to explore reproductive decision-making and periconception practices among HIV-positive women with recent pregnancy (n = 30), and HIV-positive men (n = 20), all reporting partners of negative or unknown HIV-status, and attending HIV services in Durban, South Africa. Transcripts were coded for categories and emergent themes. Participants expressed strong reasons for having children, but rarely knew how to reduce periconception HIV transmission. Pregnancy planning occurred on a spectrum ranging from explicitly intended to explicitly unintended, with many falling in between the two extremes. Male fertility desire and misunderstanding serodiscordance contributed to HIV risk behavior. Participants expressed openness to healthcare worker advice for safer conception and modified risk behavior post-conception, suggesting the feasibility of safer conception interventions which may target both men and women and include serodiscordance counseling and promotion of contraception.

Condoms in sub-Saharan Africa

Sub-Saharan Africa (SSA) is the region with the world’s highest rates of HIV and other sexually transmissible infections (STIs), yet numerous studies show that condom use is generally rare. This suggests a need for a better understanding of how condoms fit within sexual practices and relationships in SSA. This paper seeks to address this need by reviewing research published between the late 1980s and 2011 on use and factors influencing use of male condoms in SSA. What is evident from this research is that condom use involves complex social and interpersonal dynamics, with structural and cultural conditions exerting an influence through framing social cognitions and setting boundaries on autonomy that make the apparently irrational choice of eschewing condoms a rational decision. The influences of poverty; relationships with parents, peers and partners; limited, insufficient or absent information especially in rural areas and among men who have sex with men; gender and sexual norms, and the dynamics of gendered power; and beliefs and attitudes about HIV, condoms and sexuality all have been shown to work against condom use for a large proportion of Africa’s people. However, promising results are shown in trends towards increased condom use among single women in numerous countries, increasing acceptance and use of condoms among some university students, successes in producing potentially sustainable condom use resulting from select interventions, and resistance to succumbing to the dominant gender–power dynamics and structural–cultural impediments that women in groups have mobilised.

Microbicides for HIV prevention

Although the HIV incidence rate has slowed in some countries, HIV remains a serious health challenge, particularly in the developing world. The epidemic is increasingly feminised, with young women at high risk of acquiring the virus. There is thus a clear requirement for acceptable woman-initiated methods of HIV prevention. Foremost among these are vaginally-applied substances known as microbicides; early research into potential microbicides focussed on non-HIV-specific compounds such as surfactants and polyanionic entry inhibitors. However, proof of the microbicide concept as a viable prevention strategy was not provided until the CAPRISA 004 trial of a microbicide containing the HIV-specific antiretroviral tenofovir was completed in mid-2010. Confirmation of the proof of concept provided by CAPRISA 004 by at least two major trials will hopefully lead to licensure of the product by 2018. Parallel studies are planned to ascertain the feasibility of implementation of these products in the public sector with subsequent research focussed on appropriate and acceptable methods of delivery of the active ingredient, and to increase adherence through other delivery systems such as vaginal rings.

'The study has taught me to be supportive of her': empowering women and involving men in microbicide research

Recognising that women often have little control over most HIV-prevention methods, including condoms, researchers have made efforts to develop new bio-technological interventions, such as microbicides, that could allow women greater autonomy in HIV-prevention decision making. In many situations, women are unable to negotiate condom use with their partners, meaning that they could be better protected through the use of an effective microbicide. This paper uses qualitative data from the Microbicide Development Programme 301 (MDP301) microbicide trial in Johannesburg, South Africa. Data is taken from in-depth interviews with male partners of female trial participants (n = 28), six focus-group discussions involving male partners of trial participants (n = 4) and female participants (n = 2). Data show that men's involvement in microbicide research ranges from a disinterest in trials to the desire to actively take part in and promote research that affects the health of themselves and their partners. Results showed that some participants were reluctant to disclose trial involvement and product use to their partners, making identifying men as potential research participants problematic. This paper considers how to involve men in microbicide research without undermining women's sense of empowerment and ownership of the trial and the product that is being tested.

Male circumcision, attitudes to HIV prevention and HIV status: a cross-sectional study in Botswana, Namibia and Swaziland

In efficacy trials male circumcision (MC) protected men against HIV infection. Planners need information relevant to MC programmes in practice. In 2008, we interviewed 2915 men and 4549 women aged 15–29 years in representative cluster samples in Botswana, Namibia and Swaziland, asking about socio-economic characteristics, knowledge and attitudes about HIV and MC and MC history. We tested finger prick blood samples for HIV. We calculated weighted frequencies of MC knowledge and attitudes, and MC history and HIV status. Multivariate analysis examined associations between MC and other variables and HIV status. In Botswana, 11% of young men reported MC, 28% in Namibia and 8% in Swaziland; mostly (75% in Botswana, 94% – mostly Herero – in Namibia and 68% in Swaziland) as infants or children. Overall, 6.5% were HIV positive (8.3% Botswana, 2.6% Namibia and 9.1% Swaziland). Taking other variables into account, circumcised men were as likely as uncircumcised men to be HIV positive. Nearly half of the uncircumcised young men planned to be circumcised; two-thirds of young men and women planned to have their sons circumcised. Some respondents had inaccurate beliefs and unhelpful views about MC and HIV, with variation between countries. Between 9 and 15% believed a circumcised man is fully protected against HIV; 20–26% believed men need not be tested for HIV before MC; 14–26% believed HIV-positive men who are circumcised cannot transmit the virus; and 8–34% thought it was “okay for a circumcised man to expect sex without a condom”. Inaccurate perceptions about protection from MC could lead to risk compensation and reduce women's ability to negotiate safer sex. More efforts are needed to raise awareness about the limitations of MC protection, especially for women, and to study the interactions between MC roll out programmes and primary HIV prevention programmes.

Perceptions of gender-based violence among South African youth: implications for health promotion interventions

Gender-based violence is a widespread problem in South Africa. Past structural inequities have created a climate conducive to violence against women. As an initial step toward developing a health promotion program, we conducted exploratory formative research to examine the barriers that affect the health and well-being of youth. Fourteen focus groups (nine with girls and five with boys) were conducted with 112 adolescents in a racially mixed community on the outskirts of Cape Town, South Africa. We utilized grounded theory and thematic analysis to examine the data. The impact of poverty, ubiquitous gendered violence, transactional sex and unsafe recreational spaces emerged as the major themes. The experiences of youth were consumed by issues of safety rather than the pursuit of other developmentally appropriate markers. Our findings suggest that health promotion programs should create safe spaces for youth and opportunities to critically question the assumptions and manifestations of a patriarchal society. Furthermore, the findings indicate that there is a strong need for multi-sectorial interventions directed at many levels to prevent gender-based violence.

Promoting critical consciousness and social mobilization in HIV/AIDS programmes: lessons and curricular tools from a South African intervention

The development of critical consciousness is seen as a key stage in communities increasing levels of dialogue about priority problems and effecting structural change for health. However, relatively little research identifies concrete methods for programmes to build critical consciousness. We examined how a South African structural intervention used critical consciousness as a tool for prevention of intimate partner violence and HIV infection. We collected qualitative data in the form of in-depth interviews with managers, trainers, and participants of the Intervention with Microfinance for AIDS and Gender Equity intervention (IMAGE) in rural South Africa. The data were analysed through a coding structure developed in QSR NVivo. We draw practical lessons from IMAGE to guide other HIV programmes aiming to promoting critical consciousness and social mobilization. This research suggests that specific curricular tools can work towards critical consciousness and that mobilization efforts in future programmes can be strengthened by including individual and collective efforts by participants.

Addressing men and gender diversity in education: a promising solution to the HIV/AIDS epidemic

To date, researchers investigating gender in relation to social issues underscore women and appear to sideline men. Focusing on women in studies concerning sociogender issues may exclude not only men from mainstream research, but also those who do not fit into the binary gender system, including gay, lesbian, bisexual, and transgender (GLBT) people. One area closely related to gender issues is the HIV epidemic. Mainstream discussions of men and other versions of masculinity and femininity including GLBT people in the gender-related studies of the HIV epidemic can decrease the vulnerability of individuals against HIV infections regardless of their biological sex.

The last decade of microbicide clinical trials in Africa: from hypothesis to facts

Microbicide clinical trials have dominated biomedical HIV prevention research in the past decade. Two generations of microbicides have gone through large-scale human clinical trials. Candidate microbicides assessed in clinical trials in Africa have fallen into the categories of surfactants, polyanionic entry inhibitors, or vaginal milieu protectors. These include compounds such as nonoxynol-9, SAVVY, cellulose sulphate, Carraguard, PRO 2000, and BufferGel. Disappointingly, none of the products have shown efficacy against HIV. Each successive trial has benefited from the lessons learned in preceding trials. The trials have provided important lessons in basic, clinical, social, and behavioural science. More importantly, we have learned that the concept of a vaginally inserted product for HIV prevention is acceptable by women. We have now reached an end of an era of clinical testing with non-HIV-specific microbicides and move forward to testing novel strategies of antiretroviral therapeutic products such as preexposure prophylaxis (PrEP) for HIV prevention. PrEP for vaginal administration in various formulations is being tested to continue our commitment to providing more HIV prevention options to millions of women worldwide.

'I told him not to use condoms': masculinities, femininities and sexual health of Aboriginal Canadian young people

Gendered power imbalances in heterosexual relationships are a key target of gender-sensitive STI risk reduction interventions. Gendered aspects of sexual behaviour have not been explored among Canadian indigenous young people, who are at elevated risk for STI relative to other young Canadians. We used data from in-depth qualitative interviews with 15 male and 15 female indigenous young people to explore gendered sexual behaviour and its implications for STI reduction. There was a pervasive 'double standard' where young men were expected to be sexually aggressive and young women were expected to resist sexual advances; but we also observed 'alternative' or non-hegemonic behaviours. Specifically, young women were often very active participants in sexual negotiations, could refuse condom use and sometimes pressured their male partners to not use condoms. Young men also described being the object of coerced sex, and did not always perceive female sexual desire in negative terms, and were not always receptive to sex. The gendered sexual attitudes and behaviours in our sample were much more complex than usually described in the literature. Intervention work needs to take more realistic account of the sexual interactions that occur between young people.

Integrating HIV prevention into services for abused women in South Africa

The relationship between intimate partner violence (IPV) and HIV risk is well documented, but few interventions jointly address these problems. We developed and examined the feasibility of an intervention to reduce HIV risk behaviors among 97 women seeking services for IPV from a community-based NGO in Johannesburg, South Africa. Two versions of the intervention (a 6-session group and a 1-day workshop) were implemented, both focusing on HIV prevention strategies integrated with issues of gender and power imbalance. Attendance was excellent in both intervention groups. Assessments were conducted at baseline, post-intervention and two-month follow-up to demonstrate the feasibility of an intervention trial. Women in both groups reported reductions in HIV misperceptions and trauma symptoms, and increases in HIV knowledge, risk reduction intentions, and condom use self-efficacy. The 6-session group showed greater improvements in HIV knowledge and decreases in HIV misperceptions in comparison to the 1-day workshop. The study demonstrated the feasibility and potential benefit of providing HIV prevention intervention to women seeking assistance for IPV.

The fields of HIV and disability: past, present and future

This article provides an historic overview of the fields of disability and HIV. We describe this area of concern in terms of "fields" versus "a single field" because of the two related but distinct trends that have evolved over time. The first field involves people living with HIV and their experiences of disability, disablement and rehabilitation brought on by the disease and its treatments. The second involves people with disabilities and their experiences of vulnerability to and life with HIV. These two fields have evolved relatively independently over time. However, in the final section of this article, we argue that the divide between these fields is collapsing, and that this collapse is beginning to produce a new understanding about shared concerns, cross-field learning and the mutual benefits that might be realized from integrating policy and programmatic responses. We close by identifying directions that we expect these merging fields to take in the coming years.