Power dynamics in the research interaction are inevitable, particularly in research in rural contexts. Hierarchical and heterogeneous research groups, and the disproportionate power of the researcher in relation to the research... more
Power dynamics in the research interaction are inevitable, particularly in research in rural contexts. Hierarchical and heterogeneous research groups, and the disproportionate power of the researcher in relation to the research participants, are some of the problems that create particular challenges for the social science researcher. Power relations within the research context also affect the way in which knowledge is generated. Participatory research (PR) acknowledges and actively addresses many of these power dynamics. Through the use of novel techniques, PR processes focus on maximising participation and facilitating the expression of multiple voices within the research context.
The use of visual representations de-emphasises verbal fluency and also creates the potential for change. PR also has a specific focus on accessing the more marginalized and most disempowered sections of a community. Despite the power dynamics, PR methods enable participants to articulate,
extend, and analyse their local knowledge. Using photographs of participatory activities, drawn from the Participatory Rural Appraisal (PRA) tradition, several ways in which participatory research techniques alter some of these research dynamics are illustrated, e.g. who talks and who acts in the process; whose knowledge dominates in the process; whose language is used as a medium in the process; and how is the knowledge produced. The potential of participatory research engagements to enable participation, access local knowledge, and facilitate critical reflection is discussed. The combination of these factors activates the agency of the research participants, potentially effecting change.
Sexual activity, sexuality and responses to HIV and AIDS in a rural context in South Africa were studied using a cultural-historical activity theory framework. Activity theory directs the focus onto activity and emphasises the importance... more
Sexual activity, sexuality and responses to HIV and AIDS in a rural context in South Africa were studied using a cultural-historical activity theory framework. Activity theory directs the focus onto activity and emphasises the importance of an historical perspective for understanding current preventative practices. Qualitative data were generated from interviews and focus groups with 45 male and female participants between 10 and 71 years of age. An activity system analysis illustrated critical historical
changes in a mediational artefact (the form of contraception) in sexual activity. The shift
from intercrural sex to the use of the injectable contraceptive set up particular
conditions for condom use in response to HIV and AIDS.
Adolescent boys living with chronic medical conditions face a challenging context for constructing a young masculine identity, conceptualised as an active positioning in relation to hegemonic masculinity. The research question was to... more
Adolescent boys living with chronic medical conditions face a challenging context for constructing a young masculine identity, conceptualised as an active positioning in relation to hegemonic masculinity. The research question was to identify constructions of masculinity among adolescent boys living with HIV. The purpose of the study was to explore the intersection of masculine identity construction with an HIV positive identity of relevance to policy and programmes for supporting adolescent boys. Dialogical Self Theory and Connell's concept of hegemonic masculinity were used as frameworks for understanding masculine identity construction as positioning. Participatory methods consisted of semi-structured interviews, focus groups, autophotography and biographical drawings. The purposive sample consisted of adolescent boys (N=7) from an HIV support group. The challenging context of chronic illness highlighted the construction of masculine identity through identifications and alignments in relation to hegemonic masculinity. The participants' narratives revealed the complexities of instantiating and sustaining a young masculine identity.
The researcher identified constructions of masculinity among adolescent boys (N=7) from clinic-based HIV support groups. The researchers combined hegemonic masculinity and dialogical self theory to identify the dynamics of individual and... more
The researcher identified constructions of masculinity among adolescent boys (N=7) from clinic-based HIV support groups. The researchers combined hegemonic masculinity and dialogical self theory to identify the dynamics of individual and group positioning around hegemonic masculinity. The researcher used multiple research methods including participant autophotography within a qualitative design, identifying individual and group constructions of masculinity, with a key focus on how the boys positioned a masculine identity in relation to hegemonic masculinity as an ideal standard or imperative. Multiple methods of data analysis were used to analyse and ‘dialogue’ multi-sourced verbal and visual data, consisting of content and thematic analysis and an adaptation of critical narrative analysis for selected texts. The findings were that active processes of positioning masculine identity occurred at individual and group levels. Two competing hegemonic versions of young masculinity were identified from partcipants' accounts. Various positioning strategies were noted, most especially a negotiated position described as 'walled masculinity' in which the boys identified ways of being acceptably masculine within the limitations of HIV positivity.
For adolescent boys living with HIV, an emerging identity as a person living with HIV intersects with the construction of a masculine identity, conceptualised as situated positioning in relation to hegemonic masculinity. The research... more
For adolescent boys living with HIV, an emerging identity as a person living with HIV intersects with the construction of a masculine identity, conceptualised as situated positioning in relation to hegemonic masculinity. The research focus was to identify constructions of young masculinity at the intersection with identity as an HIV positive person, considering the reciprocal influence of masculine identity and emerging HIV positive identities. The concept of hegemonic masculinity was combined with Dialogical Self Theory in conceptualising masculine identity construction as active positioning. Visual methods (autophotography, biographical drawings and reflective interviews) were combined with semi-structured interviews and focus groups within an interpretive paradigm. Participants were all adolescent boys enlisted from an HIV support group, forming a purposive sample (N=7). Mixed data analysis methods highlighted the active dialoguing of situated masculine identity positions against hegemonic masculinities. Analysis revealed the complex processes of positioning a viable masculine identity in challenging contexts of health, spatial contexts, material conditions and hegemonic imperatives. The findings were potentially relevant for practice and policy promoting of gender equality and gender-equitable masculinities, such as participatory research and gender- based interventions.
There is little published literature on the ethical concerns of stakeholders in HIV vaccine trials. This study explored the ethical challenges identified by various stakeholders, through an open-ended, in-depth approach. While the few... more
There is little published literature on the ethical concerns of stakeholders in HIV vaccine trials. This study explored the ethical challenges identified by various stakeholders, through an open-ended, in-depth approach. While the few previous studies have been largely quantitative, respondents in this study had the opportunity to spontaneously identify the issues that they perceived to be of priority concern in the South African context. Stakeholders spontaneously identified the following as ethical priorities: informed consent, social harms, collaborative relationships between research stakeholders, the participation of children and adolescents, access to treatment for participants who become infected with HIV, physical harms, fair participant and community selection, confidentiality, benefits, and payment. While there is some speculation that research in developing countries poses special ethical challenges, overall no issues were identified that have not been anticipated in inte...
This article explores young South African women's constructions of the relationship between love and physical attractiveness. How these discourses are facilitated by an emerging South African consumer culture and the proliferation of mass... more
This article explores young South African women's constructions of the relationship between love and physical attractiveness. How these discourses are facilitated by an emerging South African consumer culture and the proliferation of mass media images which has accompanied this cultural change will also be discussed. This research took place among South African women between the ages of 18 and 25. Data was collected using focus groups and semi-structured interviews and was analysed using discourse analysis. One of the common ideas structuring the young women's speech in the interviews and focus groups was the importance of physical attractiveness in romantic relationships both as a prerequisite for feelings of sexual desire and for subjective experiences of self-worth.
Purpose: Healthiness is constructed, in Western culture, as a moral ideal or supervalue. This paper will interrogate the assumption that health and the pursuit of healthiness is always and unquestionably positive, by exploring how... more
Purpose: Healthiness is constructed, in Western culture, as a moral ideal or supervalue. This paper will interrogate the assumption that health and the pursuit of healthiness is always and unquestionably positive, by exploring how discourses of health and freedom interact to reinforce the current inequalities and detract from social transformation. Method: Twenty young South African adults were interviewed about their understandings and experiences of health. These discussions were analysed using Foucauldian discourse analysis. Results: Participants constructed healthiness as facilitating the experience of freedom, while at the same time being dependent on a personal orientation towards freedom (as opposed to merely submitting to dominant health authorities). Freedom discourses also played a role in connecting health to neoliberal discourses idealizing economic productivity and hard work. Participants were able to construct a self that is active, productive, valuable, hopeful, and self-assured when talking about health using discourses of freedom. However, these discourses also functioned to moralise and idealise healthiness, which contributed to blaming poor health on its sufferers. Conclusion: Health/freedom discourses can further reinforce the neoliberal value of individual responsibility by constructing self-improvement and self-work as the solution to ill-health, thereby contributing to victim-blaming and weakening support for public health interventions.
IntroductionAlcohol-related harm is a rising global concern particularly in low-income and middle-income countries where alcohol use fuels the high rates of violence, road traffic accidents and is a risk factor for communicable diseases... more
IntroductionAlcohol-related harm is a rising global concern particularly in low-income and middle-income countries where alcohol use fuels the high rates of violence, road traffic accidents and is a risk factor for communicable diseases such as HIV/AIDS and tuberculosis. Existing evidence to address alcohol-related harm recommends the use of intersectoral approaches, however, previous efforts have largely focused on addressing individual behaviour with limited attention to whole-of-community approaches. Whole-of-community approaches are defined as intersectoral interventions that are systematically coordinated and implemented across the whole community. The objective of this scoping review is to synthesise the existing literature on multisectoral, whole-of-community interventions which have been used to modify or prevent alcohol-related harms.Methods and analysisThis scoping review will follow the six-step approach that involves; (1) identifying the research question, (2) identifyin...
Background A growing number of studies highlight men's disinclination to make use of HIV services. This suggests there are factors that prevent men from engaging with health services and an urgent need to unpack the forms of sociality... more
Background A growing number of studies highlight men's disinclination to make use of HIV services. This suggests there are factors that prevent men from engaging with health services and an urgent need to unpack the forms of sociality that determine men's acceptance or rejection of HIV services. Methods Drawing on the perspectives of 53 antiretroviral drug users and 25 healthcare providers, we examine qualitatively how local constructions of masculinity in rural Zimbabwe impact on men's use of HIV services. Results Informants reported a clear and hegemonic notion of masculinity that required men to be and act in control, to have know-how, be strong, resilient, disease free, highly sexual and economically productive. However, such traits were in direct conflict with the 'good patient' persona who is expected to accept being HIV positive, take instructions from nurses and engage in health-enabling behaviours such as attending regular hospital visits and refraining from alcohol and unprotected extra-marital sex. This conflict between local understandings of manhood and biopolitical representations of 'a good patient' can provide a possible explanation to why so many men do not make use of HIV services in Zimbabwe. However, once men had been counselled and had the opportunity to reflect upon the impact of ART on their productivity and social value, it was possible for some to construct new and more ART-friendly versions of masculinity. Conclusion We urge HIV service providers to consider the obstacles that prevent many men from accessing their services and argue for community-based and driven initiatives that facilitate safe and supportive social spaces for men to openly discuss social constructions of masculinity as well as renegotiate more health-enabling masculinities.
Antiretroviral treatment for HIV is gradually being made available across sub-Saharan Africa. With antiretroviral treatment, HIV can be approached as a chronic, manageable condition rather than a shorter-term issue of palliative care.... more
Antiretroviral treatment for HIV is gradually being made available across sub-Saharan Africa. With antiretroviral treatment, HIV can be approached as a chronic, manageable condition rather than a shorter-term issue of palliative care. This treatment involves repeated interaction between health staff and patients for ongoing check-ups and prescription refills.This study aimed to understand patient and healthcare staff perceptions of good clinical antiretroviral treatment care.Over 100 h of ethnographic observation at healthcare sites; interviews and focus groups with 25 healthcentre workers (mostly nurses), 53 HIV-positive adults taking ARVs and 40 carers of children on ART. The data were analyzed using thematic content analysis.Three healthcare sites providing free antiretroviral drugs in rural Zimbabwe, where the adult HIV infection rate is approximately 20%.Contrary to reports of poor antiretroviral treatment adherence and task-oriented rather than patient-oriented nursing, our study found great patient commitment to adherence, outstanding nurse dedication and a pervasive sense of hope about coping with HIV. Within this context however there were some situations where patients and nurses had different expectations of the medical encounter, leading to stress and dissatisfaction. Patients and staff both emphasized the importance of nurse kindness, understanding, confidentiality and acceptance (i.e. treating HIV patients ‘like normal’) and patient adherence to medical directions. However, nurses at times overlooked the negative effects of long wait times and frequent hospital visits. Further, nurses sometimes conflated medical adherence with general patient obedience in all aspects of the nurse–patient relationships. Patients and staff were frustrated by the ambiguity and unpredictability surrounding key elements of hospital visits such as how much patients had to pay for service, how long it would take to be served, and whether drugs or the doctor's services would be available.
