Culture Matters in Communicating the Global Response to COVID-19

Current communication messages in the COVID-19 pandemic tend to focus more on individual risks than community risks resulting from existing inequities. Culture is central to an effective community-engaged public health communication to reduce collective risks. In this commentary, we discuss the importance of culture in unpacking messages that may be the same globally (physical/social distancing) yet different across cultures and communities (individualist versus collectivist). Structural inequity continues to fuel the disproportionate impact of COVID-19 on black and brown communities nationally and globally. PEN-3 offers a cultural framework for a community-engaged global communication response to COVID-19.

Prevalence of psychological distress and its association with socio-demographic and HIV-risk factors in South Africa: Findings of the 2012 HIV prevalence, incidence and behaviour survey

BACKGROUND

In South Africa, there are limited nationally representative data on the prevalence and factors associated with psychological distress. This study used a 2012 nationally representative population-based household survey to investigate factors associated with psychological distress in South Africa.

METHODS

The survey is based on a multistage stratified cross-sectional design. Univariate and multivariate logistic regression models were fitted to identify factors associated with psychological distress.

RESULTS

Out of a total 25860 participants, 23.9% reported psychological distress. Higher likelihood of reporting psychological distress was significantly associated with being female [OR = 1.68 (95% CI: 1.34-2.10), p < 0.001], aged 25 to 49 years [OR = 1.35 (95% CI: 1.08-1.70), p = 0.010] and 50 years and older [OR = 1.44 (95% CI: 1.06-1.97), p = 0.023)], Black Africans [OR = 1.61 (95% CI: 1.24-2.10), p < 0.001)], a high risk drinker [OR = 1.37 (95% CI: 1.02-1.83), p = 0.037], a hazardous drinker [OR = 4.76 (95% CI: 2.69-8.42), p < 0.001] and HIV positive, [OR = 1.79 (95% CI:1.55-2.08) p < 0.001], while lower likelihood of reporting psychological distress was significantly associated with being married [OR = 0.78 (95% CI: 0.62-0.98), p = 0.031), employed [OR = 0.71 (95% CI: 0.57-0.88), p = 0.002], and living in a rural formal area [OR = 0.73 (95% CI: 0.55-0.97), p = 0.033].

CONCLUSION

There is a need to develop strategies to alleviate psychological distress in the general population, with a particular focus on those who may be more vulnerable to distress such as females, the aged, excessive alcohol users, the unemployed, people living with HIV and those residing in urban areas as identified in the current findings.

Black Scholarship: Doing Something Active and Positive about Academic Racism

This ‘article’ serves as introduction to the Special Issue: black scholarship. As such, it outlines the various articles contained in, as well as the rationale for the issue. In this article the authors argue that programmatic anti-racist interventions such as this Special Issue are crucial to the process of redressing the ‘racialised’ patterns of research and authorship characterising mainstream psychology journals.

Perceptions on Integration of Traditional and Western Healing in the New South Africa

A focus group study was conducted to investigate the perceptions of various stakeholders (viz., psychiatrists, medical doctors, psychologists, traditional healers and consumers) on integration of the traditional and western healing systems in the new South Africa and other pertinent issues in this debate such as registration, medical aid (health insurance) access and the issuing of sick-leave certificates by traditional healers. Thematic content analysis of the transcripts of the focus groups' discussions revealed that several strategies for integration were preferred by each of the focus groups. Similarly, a number of models of registration were put forward. There were also different views expressed about whether or not traditional healers should have access to medical aid schemes or issue sick-leave certificates. Collectively, most focus groups preferred (a) formal cooperation between the two systems; (b) registration of traditional healers with their own independent body; and (c) traditional healers not having any access to medical aid schemes. However, there was no consensus concerning whether or not traditional healers should issue sick-leave (medical) certificates. The significance of these results as well as their policy implications are discussed.

"It's important to take your medication everyday okay?" An evaluation of counselling by lay counsellors for ARV adherence support in the Western Cape, South Africa

There is growing interest in standard care programmes for antiretroviral (ARV) adherence support. In South Africa, individual counselling following ARV initiation is a main strategy for supporting adherence in the public sector. Egan's client-centred "Skilled Helper" counselling model is the predominant model used in HIV counselling in this context. This study evaluated counselling delivered by lay ARV adherence counsellors in Cape Town in terms of adherence to Egan's model. Thirty-eight transcripts of counselling sessions with non-adherent patients were analysed based on the methods of content analysis. These sessions were conducted by 30 counsellors. Generally counsellors' practice adhered neither to Egan's model nor a client-centred approach. Inconsistent with evidence-based approaches to counselling for ARV adherence support, counsellors mainly used information-giving and advice as strategies for addressing clients' non-adherence. Recommendations for improving practice are made. The question as to how appropriate strategies from developed countries are for this setting is also raised.

Behaviour change counselling for ARV adherence support within primary health care facilities in the Western Cape, South Africa

Health care systems have been described as ideal settings for behaviour change counselling interventions. There is little research evaluating the feasibility of implementing such interventions in routine practice in primary care facilities. We implemented an intervention called Options for Health within routine adherence counselling practice in 20 antiretroviral facilities in Cape Town, South Africa. Lay counsellors were trained to use Options to help clients to optimise ARV adherence and reduce sexual risk behaviour. Counsellors delivered the intervention to 9% of eligible patients over 12 months. Interviews with counsellors revealed barriers to implementation including a lack of counselling space, time pressure and patient resistance to counselling. Counsellors felt that Options was not appropriate for use with all patients and adherence problems, and used parts of the intervention as it suited their needs. Findings revealed weaknesses in the current adherence counselling system that have implications for the feasibility of behaviour change counselling within this context.

Social constructions of gender roles, gender-based violence and HIV/AIDS in two communities of the Western Cape, South Africa

The links between gender roles, gender-based violence and HIV/AIDS risk are complex and culturally specific. In this qualitative study we investigated how women and men in two black communities in the Western Cape, South Africa, constructed their gender identities and roles, how they understood gender-based violence, and what they believed about the links between gender relations and HIV risk. First we conducted 16 key informant interviews with members of relevant stakeholder organisations. Then we held eight focus group discussions with community members in single-sex groups. Key findings included the perception that although traditional gender roles were still very much in evidence, shifts in power between men and women were occurring. Also, gender-based violence was regarded as a major problem throughout communities, and was seen to be fuelled by unemployment, poverty and alcohol abuse. HIV/AIDS was regarded as particularly a problem of African communities, with strong themes of stigma, discrimination, and especially 'othering' evident. Developing effective HIV/AIDS interventions in these communities will require tackling the overlapping as well as divergent constructions of gender, gender violence and HIV which emerged in the study.

New approaches, new activities and new outcomes in international conferences on HIV/AIDS in Africa — Report of the 3rd African Conference on the Social Aspects of HIV/AIDS, Dakar, 10 – 14 October 2005

Africa's HIV/AIDS situation remains cause for concern. The impact of HIV is considerable and threatens the survival and development of African societies. Although much has been attempted, the results still leave much to be desired. AIDS is an epidemic that needs to be addressed with much creativity and spirit of initiative. It is against this background that the 3rd African conference on the social aspects of HIV/AIDS brought innovations in the way international conferences are designed, activities implemented and results obtained. The innovations concerned the approach to international conferences and take into account reconceptualising HIV/AIDS so as to encourage holistic approaches and better visibility of vulnerable groups. The activities of the conference were organised in such a way as to get people living with HIV/AIDS (PLWHA), grassroots communities and marginalised groups to play a focal role. The conference offered an opportunity for developing cultural activities that would translate the African cultural concepts that had been identified as important in the HIV situation and response analysis. Interaction at the conference created an opportunity to analyse the various dimensions of the political, cultural and economic determinants. The conference offered food for thought around response construction while singling out the themes of urgency and acceleration of response, synergy construction, and coordination and conception of political responses.

Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa

AIDS-related stigmas are pervasive in some segments of South African society and stigmas can impede efforts to promote voluntary counselling and testing and other HIV-AIDS prevention efforts. The current study examined associations among the belief that AIDS is caused by spirits and supernatural forces, AIDS-related knowledge and AIDS-related stigmas. A street intercept survey with 487 men and women living in a Black township in Cape Town, South Africa showed that 11% (n=54) believed that AIDS is caused by spirits and supernatural forces, 21% (n=105) were unsure if AIDS is caused by spirits and the supernatural, and 68% (n=355) did not believe that AIDS is caused by spirits and supernatural forces. Multiple logistic regression analyses controlling for participant age, gender, years of education and survey venue showed that people who believed HIV-AIDS is caused by spirits and the supernatural demonstrated significantly more misinformation about AIDS and were significantly more likely to endorse repulsion and social sanction stigmatizing beliefs against people living with HIV-AIDS. However, nearly all associations between beliefs that AIDS is caused by spirits and AIDS stigmas were non-significant when logistic regressions were repeated with AIDS-related knowledge included as a control variable. This finding suggests that relationships between traditional beliefs about the cause of HIV-AIDS and AIDS stigmas are mediated by AIDS-related knowledge. AIDS education efforts are urgently needed to reach people who hold traditional beliefs about AIDS to remedy AIDS stigmas.

The social construction of sexually transmitted infections (STIs) in South African communities

Since the medical link between sexually transmitted infections (STIs) and HIV/AIDS was established, there has been an increased focus on the spread of STIs in South Africa. The aim of this study was to provide an in-depth picture of the dynamics involved in sexuality and the spread of STIs and HIV/AIDS. The authors present the findings of a focus group study, which was a part of a larger, national project addressing the broad question of health-care seeking behavior for STIs. A discourse analysis carried out on 10 focus groups reveals complex and rich narratives on the way in which STIs are constructed in South African communities. The dominant discourses focused on the continuing stigmatization of STIs, causal explanations, and prevention strategies. The analysis raises important recommendations for both educational interventions and health services toward the challenge of halting the spread of STIs and HIV/AIDS.