Research

Cultural consensus modeling to measure transactional sex in Swaziland: Scale building and validation

Rebecca Fielding-Miller, Kristin Dunkle, Hannah Cooper, Michael Windle, Craig Hadley

Transactional sex is associated with increased risk of HIV and gender based violence in southern Africa and around the world. However the typical quantitative operationalization, “the exchange of gifts or money for sex,” can be at odds with a wide array of relationship types and motivations described in qualitative explorations. To build on the strengths of both qualitative and quantitative research streams, we used cultural consensus models to identify distinct models of transactional sex in Swaziland. The process allowed us to build and validate emic scales of transactional sex, while identifying key informants for qualitative interviews within each model to contextualize women’s experiences and risk perceptions. We used logistic and multinomial logistic regression models to measure associations with condom use and social status outcomes. Fieldwork was conducted between November 2013 and December 2014 in the Hhohho and Manzini regions. We identified three distinct models of transactional sex in Swaziland based on 124 Swazi women’s emic valuation of what they hoped to receive in exchange for sex with their partners. In a clinic-based survey (n = 406), consensus model scales were more sensitive to condom use than the etic definition. Model consonance had distinct effects on social status for the three different models. Transactional sex is better measured as an emic spectrum of expectations within a relationship, rather than an etic binary relationship type. Cultural consensus models allowed us to blend qualitative and quantitative approaches to create an emicly valid quantitative scale grounded in qualitative context.

Read more in the journal Social Science and Medicine

Closing the health gap in a generation: exploring the association between household characteristics and schooling status among orphans and vulnerable children in Swaziland

BN Dlamini, C Chiao

Swaziland has one of the highest HIV/AIDS prevalences in the world, which has contributed to many Swazi children being left as orphans and vulnerable children (OVC). In 2010, there were 78,000 AIDS orphans in the country and the number is expected to increase given the current HIV prevalence. The WHO aims to close the gap in a generation and eliminate health inequality; as a result the Swazi Government began in 2005 to provide financial support to the education of OVC. Prior research has indicated that household characteristics are some of the major determinants with respect to schooling status among children. We have examined the association between household characteristics and schooling status of OVC. Schooling status may vary by gender and by age, as well as by other sociodemographic factors, in sub-Saharan African societies, and therefore we have also included a comprehensive set of appropriate variables in all of our multivariate analyses. Using existing data from the Swaziland Multiple Indicator Cluster Survey 2010, a total of 5890 children aged 7-18 years old were analyzed. The results from the multivariate logistic regressions showed that non-OVC were more likely than OVC to be in school (OR = 2.18, p < 0.001), even after taking other variables into considerations. The OVC in socioeconomically disadvantaged households, such as those with lower levels of household wealt, and those who resided in an urban area, were less likely to be in school. These findings suggest that education programs for OVC need to be household-appropriate.

Read more in the journal AIDS Care

Urban cemeteries in Swaziland: Materializing dignity

Casey Golomski

This photo essay traces the materiality of urban cemeteries in Swaziland to underscore the production of dignity in contemporary funeral culture. Increasingly, death and burial in town are realities for many people who have lost social ties or land tenure in rural areas where burials customarily take place. Urban burials register anxieties about cultural and socio-economic change and the value of human life, but new mortuary consumer markets have incited novel commemorative practices that qualify these burials as dignified. The photos derive from long-term ethnographic research in Swaziland on transformations of dying, death and funerals in the wake Southern Africa’s HIV/Aids epidemic.

Read more in the journal Anthropology Southern Africa

Love, lust and the emotional context of multiple and concurrent sexual partnerships among young Swazi adults

Ruark, A., Dlamini, L., Mazibuko, N., Green, E. C., Kennedy, C., Nunn, A., … & Surkan, P. J. (2014). Love, lust and the emotional context of multiple and concurrent sexual partnerships among young Swazi adults. African Journal of AIDS Research, 13(2), 133-143.

Men distinguished sexual partnerships that were just for sex from those that were considered to be ‘real relationships’, while women represented most of their relationships, even those which included significant financial support, as being based on love. Besides being motivated by love, concurrent sexual partnerships were described as motivated by a lack of sexual satisfaction, a desire for emotional support and/or as a means to exact revenge against a cheating partner. Social and structural factors were also found to play a role in creating an enabling environment for high-risk sexual partnerships. These factors included social pressure and norms; a lack of social trust; poverty and a desire for material goods; and geographical separation of partners.

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Generational inversions:‘working’for social reproduction amid HIV in Swaziland

Golomski, C. (2014). Generational inversions:‘working’for social reproduction amid HIV in Swaziland. African Journal of AIDS Research, 13(4), 351-359.

Based on discourse analyses of ethnography at church worship services and life cycle rites between 2008 and 2011, the findings show how both elders and youth understood this crisis of ‘generational inversions’ as a non-alignment of age groups and articulated projects to restore succession and continuity in vernacular idioms of ‘work’ as moralised social and ritual action.

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Barriers and facilitators to combined ART initiation in pregnant women with HIV: lessons learnt from a PMTCT B+ pilot program in Swaziland

Parker, L. A., Jobanputra, K., Okello, V., Nhlangamandla, M., Mazibuko, S., Kourline, T., … & Teck, R. (2015). Barriers and facilitators to combined ART initiation in pregnant women with HIV: lessons learnt from a PMTCT B+ pilot program in Swaziland. Journal of acquired immune deficiency syndromes.

This study not only demonstrates challenges in initiating pregnant women on ART, but also identifies opportunities offered by PMTCT B+ for improving treatment initiation among women with lower CD4 counts.

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Sex is never the same: Men’s perspectives on refusing circumcision from an in-depth qualitative study in Kwaluseni, Swaziland

Adams, A., & Moyer, E. (2015). Sex is never the same: Men’s perspectives on refusing circumcision from an in-depth qualitative study in Kwaluseni, Swaziland. Global public health, 1-18.

We argue that the campaign’s failure can be partly explained by the fact that circumcision was perceived as a threat to Swazi masculinities, a factor hardly considered in the planning of the intervention. Results show that men believed circumcision resulted in reduced penis sensitivity, reduced sexual pleasure and adverse events such as possible mistakes during surgery and post-operative complications that could have negative effects on their sexual lives. Given the conflicting state of scientific data about the effects of circumcision on sexuality or sexual pleasure, this study addresses important lacunae, while also demonstrating the need for more research into the relationship between sexuality, masculinity and health interventions seeking to involve men.

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Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland

Jobanputra, K., Parker, L. A., Azih, C., Okello, V., Maphalala, G., Kershberger, B., … & Reid, T. (2015). Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland. PloS one, 10(2).

Children, adolescents and those with advanced disease were most likely to have high viral loads and least likely to achieve viral suppression at retesting; receiving adherence counselling was not associated with higher likelihood of viral suppression. Although the level of viral resistance was not quantified, this study suggests the need for ART treatment support that addresses the adherence problems of younger people; and to define the elements of optimal enhanced adherence support for patients of all ages with detectable viral loads.

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Feasibility and effectiveness of two community‐based HIV testing models in rural Swaziland

Parker, L. A., Jobanputra, K., Rusike, L., Mazibuko, S., Okello, V., Kerschberger, B., … & Teck, R. (2015). Feasibility and effectiveness of two community‐based HIV testing models in rural Swaziland. Tropical Medicine & International Health.   

In this high HIV prevalence setting, a community-based testing programme achieved high uptake of testing and appears to be an effective and affordable way to encourage large numbers of people to learn their HIV status (particularly underserved populations such as men and young people). However, for community HTC to impact mortality and incidence, strategies need to be implemented to ensure people testing HIV-positive in the community are linked to HIV care.

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Underutilization of isoniazid drug therapy to prevent TB disease progression in Swaziland

Cronin, B., Calnan, M., Haumba, S., & Adams, L. V. (2015). Underutilization of isoniazid drug therapy to prevent TB disease progression in Swaziland. Annals of Global Health, 81(1), 5.

An estimated 80% of the Swaziland population unknowingly contract tuberculosis (TB) as children and harbor inactive TB bacteria in their bodies – a condition called latent TB infection (LTBI). The TB infection can reactivate to cause TB disease in these individuals during their lifetime, especially if they are immunosuppresed by HIV (in Swaziland 75-80% of HIV patients also have latent TB infection). Swaziland has the highest TB incidence rate of any country in the world and TB causes an estimated 50% of the nation’s HIV patient deaths.

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