‘Making known’ or ‘counting our children’?

The article explores how regimes of documentation, quantification, evidence, and accountability have come to shape encounters between program implementers, researchers, young people, and caregivers in one locality in northeastern KwaZulu-Natal, South Africa. Rather than simply critiquing the overemphasis on counting and accounting in global health, I examine the effects of these processes on the provision of services to young people and families. For those whose lives had been systematically excluded from view, processes of form filling could in fact be construed as services in themselves. Further, encounters structured around form filling could work to facilitate other modes of engagement, centered on the construction of forms of recognition, reciprocity, and obligation, and mediated by complex networks of patronage and dependence. Drawing on these findings, the article describes how local histories and contemporary life experiences can shape the ways in which technologies of global health are taken up, and their effects on everyday life.

Download Full-text

Primary healthcare and school health service utilisation by adolescents and young adults in KwaZulu-Natal, South Africa

BMC Health Services Research ◽

10.1186/s12913-019-4559-2 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Aoife M. Doyle ◽

Lerato Mchunu ◽

Olivier Koole ◽

Sandile Mthembu ◽

Siphephelo Dlamini ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Young People ◽

Health Service ◽

School Health ◽

Young Person ◽

Service Utilisation ◽

Kwazulu Natal ◽

Health Registers ◽

Youth Friendly

Abstract Background Young people aged 10–24 years are a vulnerable group with poor health service access relative to other populations. Recent South African initiatives, the She Conquers campaign, the Integrated School Health Policy and the Adolescent & Youth Health Policy, include a focus on improving the breadth and quality of youth-friendly health service delivery. However, in some settings the provision and impact of scaled-up youth friendly health services has been limited indicating a gap between policy and implementation. In this study we reviewed existing sources of data on health service utilisation to answer the following question: ‘What health conditions do young people present with and what services do they receive at public health clinics, mobile clinics and school health services?’ Methods We conducted a retrospective register review in three purposively selected primary healthcare clinics (PHCC), one mobile clinic, and one school health team in Hlabisa and Mtubatuba sub-districts of uMkhanyakude District, KwaZulu-Natal, South Africa. The focus was service utilisation for any reason by 10–24 year olds. We also conducted descriptive analysis of pre-existing data on service utilisation by young people available from the District Health Information System for all 17 PHCC in the study sub-districts. Results Three quarters of 4121 recorded young person visits in the register review were by females, and 40% of all young person visits were by females aged 20–24 years. The most common presenting conditions were HIV-related, antenatal care, family planning, general non-specific complaints and respiratory problems (excluding TB). There were relatively few recorded consultations for other common conditions affecting young people such as mental health and nutritional problems. Antibiotics, antiretrovirals, contraceptives, vitamins/supplements, and analgesics were most commonly provided. Routine health registers recorded limited information, were often incomplete and/or inconsistent, and age was not routinely recorded. Conclusions Measuring morbidity and service provision are fundamental to informing policy and promoting responsive health systems. Efforts should be intensified to improve the quality and completeness of health registers, with attention to the documentation of important, and currently poorly documented, young people’s health issues such as mental health and nutrition.

Download Full-text

Young women’s life experiences and perceptions of sexual and reproductive health in rural KwaZulu-Natal South Africa

Culture Health & Sexuality ◽

10.1080/13691058.2016.1182215 ◽

2016 ◽

Vol 18 (10) ◽

pp. 1122-1136 ◽

Cited By ~ 4

Author(s):

Aliza M. Waxman ◽

Hilton Humphries ◽

Janet Frohlich ◽

Sarah Dlamini ◽

Fanelesibonge Ntombela

Keyword(s):

South Africa ◽

Reproductive Health ◽

Sexual And Reproductive Health ◽

Life Experiences ◽

Kwazulu Natal

Download Full-text

South Africa: Providers should encourage sexually active youth to use condoms

10.31899/rh2001.1028 ◽

2001 ◽

Author(s):

Keyword(s):

South Africa ◽

Young People ◽

Reproductive Health ◽

Condom Use ◽

Service Providers ◽

Sexual Practices ◽

Sexually Active ◽

Kwazulu Natal ◽

Youth Centers ◽

Hiv Aids

To assess the effectiveness of youth centers in reaching adolescents with reproductive health information, life skills, and services, the Reproductive Health Research Unit in KwaZulu Natal and the Population Council conducted an assessment of 12 youth centers and their affiliated peer education programs. The centers were run by the KwaZulu Natal Department of Health, the loveLife program, and the Youth and Adolescent Reproductive Health Program. Researchers also examined young people’s use of condoms as protection against pregnancy and HIV/AIDS. Data sources for this study, conducted in 2000, were an inventory of youth center services, interviews with center staff and clients, service statistics, and community surveys of 1,399 young people aged 12–24 and their parents. As noted in this brief, the study found that many sexually active young people in South Africa are knowledgeable about the sexual transmission of HIV/AIDS but do not use condoms consistently. Service providers can do more to promote condom use among youth by placing condom dispensers in private places and counseling youth on correct condom use and safer sexual practices.

Download Full-text

Impact evaluation of scripted lesson plans for HIV-related content in a life orientation curriculum: results from two provinces in South Africa

BMC Public Health ◽

10.1186/s12889-020-09640-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ilene S. Speizer ◽

Mahua Mandal ◽

Khou Xiong ◽

Ndinda Makina ◽

Aiko Hattori ◽

...

Keyword(s):

South Africa ◽

Young People ◽

Hiv Prevention ◽

Longitudinal Data ◽

Condom Use ◽

Genital Herpes ◽

Life Orientation ◽

School Based ◽

Kwazulu Natal ◽

And Control

Abstract Background Young people under age 25 years are a key population at risk of unintended pregnancies, HIV and other sexually transmitted infections. School-based programming, focusing on youth under 17 years is strategic given that many in this age group are in school or are required to be in school and spend a considerable amount of their time at school. Prior evaluations of school-based HIV prevention programs for young people often employed weak study designs or lacked biomarkers (e.g., HIV or STI testing) to inform outcomes. Methods This study used longitudinal data collected in 2016 from a cohort of grade-8 girls from Mpumalanga and KwaZulu-Natal Provinces in South Africa. We followed them for 2 years to examine the impact of the South African Department of Basic Education’s revised scripted lesson plans for the HIV and sexual content of a “life orientation” curriculum on knowledge, attitudes, condom use behaviors, pregnancy incidence, and genital herpes incidence. Schools were randomized to intervention and control arms. Multivariable analyses were undertaken using hazard modeling for incidence-based outcomes (genital herpes and pregnancy) and generalized linear latent and mixed modeling for outcomes measured at each time period (knowledge, attitudes, and condom use). Results At end line, 105 schools were included from the two provinces (44 from Mpumalanga and 61 from KwaZulu-Natal). Fifty-five were intervention and fifty were control schools. A total of 2802 girls were surveyed at both time periods (1477 intervention and 1325 control). At baseline, participating girls were about 13.6 years; by end line, they were about 2 years older. Longitudinal data demonstrated few differences between intervention and control groups on knowledge, attitudes, condom use, genital herpes, and pregnancy experience. Monitoring data demonstrated that the program was not implemented as intended. Our results demonstrated 7% incidence of genital herpes in the two-year follow-up period indicating sexual risk-taking among our cohort. Conclusions We did not find significant effects of the revised life orientation curriculum on key outcomes; however, this may reflect poor implementation. Future HIV prevention programs for young people need to be implemented with fidelity to ensure they meet the crucial needs of the next generation. Trial Registration: This study has been registered at ClinicalTrials.gov. The trial registration number is: NCT04205721. The trial was retrospectively registered on December 18, 2019.

Download Full-text

A qualitative enquiry into the meaning and experiences of wellbeing among young people living with and without HIV in KwaZulu-Natal, South Africa

Social Science & Medicine ◽

10.1016/j.socscimed.2020.113103 ◽

2020 ◽

Vol 258 ◽

pp. 113103

Author(s):

Darshini Govindasamy ◽

Giulia Ferrari ◽

Kealeboga Maruping ◽

Paidamoyo Bodzo ◽

Catherine Mathews ◽

...

Keyword(s):

South Africa ◽

Young People ◽

Kwazulu Natal

Download Full-text

Antiretroviral Therapy Based Hiv Prevention Targeting Young Female-Sex Workers: A Mixed Method Approach to Understand the Implementation of Prep in a Rural Area of Kwazulu-Natal, South Africa

10.21203/rs.3.rs-33332/v1 ◽

2020 ◽

Author(s):

Natsayi Chimbindi ◽

Nondumiso Mthiyane ◽

Thembelihle Zuma ◽

Kathy Baisley ◽

Deenan Pillay ◽

...

Keyword(s):

South Africa ◽

Young People ◽

Hiv Prevention ◽

Sex Workers ◽

Female Sex Workers ◽

Community Members ◽

Long Distance ◽

Female Sex ◽

Kwazulu Natal ◽

Prep Awareness

Abstract Introduction: Pre-exposure prophylaxis (PrEP) has the potential to alter the HIV epidemic in South Africa. Between 2016 and 2018 PrEP was rolled-out for 18-24 year-old female-sex workers (FSW) in a rural KwaZulu-Natal subdistrict with very high HIV incidence among adolescent girls and young women (AGYW). Using a ‘framework of access’ model, we describe PrEP access, awareness and uptake for AGYW, including community members’ attitudes towards PrEP for young people.Methods: We enrolled a cohort of 2184 AGYW aged 13-22 living within the subdistrict and quantitatively measured their eligibility, awareness and uptake of PrEP and other HIV prevention interventions in 2017 and 2018. We supplemented this insight with in depth exploration by conducting 19 group discussions with young people and community members, nine stakeholder key informant interviews, 58 in-depth interviews with 15-24 year-olds and 33 with implementing partners, and participatory observations. All interviews were recorded, transcribed and analysed using thematic analysis.Results: PrEP awareness increased from 2% to 9% from 2017 to 2018. Among 965 AGYW sexually-active by 2018, 13.4% (95%CI: 11.4-15.7%) reported transactional sex and 10.6% (95%CI: 8.8-12.7%) sex for money. Of these latter 194 PrEP-eligible AGYW, 21 were aware of PrEP, but none had ever used it. Wider community members were generally unaware of PrEP but imagined it would benefit young people, HIV-serodiscordant couples and those in long-distance relationships. Youth saw PrEP as a positive alternative to condoms since it “will be in their system” and not get in the way of sex. Teachers and healthcare providers were more apprehensive: worrying that PrEP would lower personal responsibility for sexual health.Conclusions: Although PrEP awareness increased and it was generally acceptable, uptake was low even among eligible AGYW, i.e., who reported FSW activity. Condom use remained undesirable suggesting a need to include PrEP in offers of alternative HIV prevention technologies to comdoms. The targeted nature of public-sector PrEP for FSW may have limited the reach, and the future broader roll-out, of PrEP in this setting. Inclusive approaches to PrEP provision integrated with wider sexual healthmay help improve demand and access to PrEP.

Download Full-text

Deciphering the “duty of support”: caring for young people in KwaZulu-Natal, South Africa

Social Dynamics ◽

10.1080/02533952.2016.1218141 ◽

2016 ◽

Vol 42 (2) ◽

pp. 253-272 ◽

Cited By ~ 7

Author(s):

Lindsey Reynolds

Keyword(s):

South Africa ◽

Young People ◽

Kwazulu Natal

Download Full-text

Complex trauma and its relation to hope and hopelessness among young people in KwaZulu-Natal, South Africa

Vulnerable Children and Youth Studies ◽

10.1080/17450128.2020.1865593 ◽

2021 ◽

pp. 1-12

Author(s):

Nothando Ngwenya ◽

Tony Barnett ◽

Candice Groenewald ◽

Janet Seeley

Keyword(s):

South Africa ◽

Young People ◽

Complex Trauma ◽

Kwazulu Natal

Download Full-text

HIV-Related Knowledge, Attitudes, and Behaviors among Grade 10 Girls and Boys in Mpumalanga and KwaZulu-Natal: Cross-Sectional Results

The Open AIDS Journal ◽

10.2174/1874613602014010075 ◽

2020 ◽

Vol 14 (1) ◽

pp. 75-83 ◽

Cited By ~ 1

Author(s):

Ilene S. Speizer ◽

Khou Xiong ◽

Mahua Mandal ◽

Ndinda Makina-Zimalirana ◽

Aiko Hattori ◽

...

Keyword(s):

South Africa ◽

High Risk ◽

Young People ◽

Hiv Prevalence ◽

Trial Registration ◽

Cross Sectional ◽

Attitudes And Behaviors ◽

Kwazulu Natal ◽

And Behaviors ◽

And Control

Background: Young people in KwaZulu-Natal and Mpumalanga South Africa are at high risk of HIV and other sexually transmitted infections. Therefore, awareness programs are needed to reach these young people and change their knowledge, attitudes, and behaviors. Objective: The objective of this study is to use cross-sectional data from grade 10 female and male learners in randomly assigned intervention and control schools to examine their knowledge, attitudes, and sexual behaviors. Methods: Participants, who were in grade 10 in the 2018 school year and attending schools, were randomly assigned to the intervention and control arms for implementation of the Department of Basic Education’s adapted life orientation curriculum that included scripted lesson plans. The study took place in two high HIV prevalence provinces in South Africa. Participants completed self-administered tablet-based surveys and female participants provided a dried blood spot for HIV testing. Results: Results demonstrate that two-fifths to one-half of male learners reported being sexually experienced and a quarter (KwaZulu-Natal) to a third (Mpumalanga) of the female learners reported the same. A greater percentage of learners in Mpumalanga reported consistent condom use than learners in KwaZulu-Natal. HIV prevalence among female grade 10 learners in both provinces was about 6-7%. No notable differences were observed between intervention and control school learners on the knowledge, attitudes, and behavior outcomes. Conclusion: The findings demonstrate the importance of developing HIV prevention programs for young people in high HIV prevalence provinces since these young people remain at high risk for HIV and other negative outcomes. Trial Registration: This study has been registered at ClinicalTrials.gov. The trial registration number is: NCT04205721. The trial was retrospectively registered on December 18, 2019.

Download Full-text