Women In South Africa Research Articles

Microbiological and Behavioural Determinants of Genital HPV Infections among Adolescent Girls and Young Women in South Africa

Microbiological and Behavioural Determinants of Genital HPV Infections among Adolescent Girls and Young Women in South Africa

Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study.

Preconception care is biomedical, behavioural, and social health interventions provided to women and couples before conception. This service is sometimes prioritised for women at high risk for adverse pregnancy outcomes. Evidence revealed that only very few women in Africa with severe chronic conditions receive or seek preconception care advice and assessment for future pregnancy. Thus, this study aimed to explore the perceptions and practice of preconception care by healthcare workers and high-risk women in Kwa-Zulu-Natal, South Africa. This exploratory, descriptive qualitative study utilised individual in-depth interviews to collect data from 24 women at high risk of adverse pregnancy outcomes and five healthcare workers. Thematic analysis was conducted using Nvivo version 12. Five main themes that emerged from the study include participants’ views, patients’ access to information, practices, and perceived benefits of preconception care. The healthcare workers were well acquainted with the preconception care concept, but the women had inconsistent acquaintance. Both groups acknowledge the role preconception care can play in the reduction of maternal and child mortality. A recommendation is made for the healthcare workers to use the ‘One key’ reproductive life plan question as an entry point for the provision of preconception care.

The Effect of PrEP Use Disclosure on Adherence in a Cohort of Adolescent Girls and Young Women in South Africa.

Effective strategies to support PrEP adherence among adolescent girls and young women (AGYW) are needed. We examined PrEP use disclosure and its effect on adherence among 200 AGYW ages 16-25 initiating PrEP in South Africa to help inform these strategies. We estimated the relative prevalence of high adherence (intracellular tenofovir-diphosphate concentration ≥700 fmol/punch) 3- and 6-months after PrEP initiation among those who disclosed vs. did not disclose their PrEP use, both overall and by age. Most AGYW disclosed to a parent (58%), partner (58%), or friend (81%) by month 6. We did not observe a strong effect of disclosure on adherence overall; however, among younger AGYW (≤ 18years), those who disclosed to a parent were 6.8 times as likely to have high adherence at month 6 than those who did not (95% CI 1.02, 45.56). More work is needed to understand parents' roles as allies and identify ways peers and partners can motivate PrEP use for AGYW.

Evaluating the Validity and Reliability of the Gender Equitable Men\u2019s Scale Using a Longitudinal Cohort of Adolescent Girls and Young Women in South Africa

Inequitable gender norms and beliefs contribute to increased sexual risk behavior, and, among adolescent girls and young women (AGYW), risk of HIV acquisition. We investigated the longitudinal measurement properties of the Gender Equitable Men’s Scale (GEMS) when applied to a cohort of AGYW in rural South Africa (2011–2015). We used item response theory [Person-Item maps, Differential Item Functioning (DIF)] and measurement invariance confirmatory factor analysis models to assess the validity and reliability of the GEMS instrument. Item difficulty and endorsement of gender equitable beliefs both shifted over time. DIF analysis identified item bias for over half of the items; influenced by age, pregnancy, sexual debut, and intimate partner violence. Measurement invariance models revealed strong longitudinal invariance properties. GEMS is a reliable longitudinal measurement of gender equitable beliefs, with notable bias for specific items when administered to subgroups. Additional items specific to the adolescent experience are warranted for a more stable assessment of gender equitable beliefs in a population facing shifting norms as they mature.

How COVID-19 Pandemic Worsens the Economic Situation of Women in South Africa.

Little is known about the general equilibrium impact COVID-19 induces on different gender groups. This paper addresses the problem of relatively few general equilibrium studies focusing on gender impacts of COVID-19. The analysis uses a gendered Computable General Equilibrium model linked to a microsimulation model that analyses a mild and severe scenario of the pandemic on economic and distributional outcomes for females. Irrespective of scenario, findings show that because women employment tend to have unskilled labour which is more concentrated in sectors that are hurt the most by COVID-19 response measures, they suffer disproportionately more from higher unemployment than their male counterparts. The poverty outcomes show worsened vulnerability for female-headed households given that, even prior to the pandemic, poverty was already higher amongst women. These simulated results are consistent with recently observed impacts and address research gaps important for well-designed public policies to reverse these trends.

Meeting Adversity with Resilience: Survival of Zimbabwean Migrant Women in South Africa

Meeting Adversity with Resilience: Survival of Zimbabwean Migrant Women in South Africa

Maternal PrEP Use in HIV-Uninfected Pregnant Women in South Africa: Role of Stigma in PrEP Initiation, Retention and Adherence.

Pregnant women in sub-Saharan Africa are at high risk of HIV acquisition and require effective methods to prevent HIV. In a cohort of pregnant women offered Pre-exposure prophylaxis (PrEP), we evaluate the relationship between internalized and anticipated stigma and PrEP initiation at first antenatal visit, 3-month continuation and adherence using multivariable logistic regression. High internalized and anticipated PrEP stigma are associated with lower PrEP care initiation at first antenatal visit (aOR internalized stigma = 0.06; 95% CI = 0.03–0.11 and aOR anticipated stigma = 0.55; 95% CI = 0.31–1.00) compared to women with low reported stigma, after controlling for covariates. Women whose partners have not been tested for HIV or whose serostatus remains unknown have 1.6-times odds of PrEP retention at 3-months compared to women whose partners have been tested (aOR = 1.60; 95% CI = 1.02–2.52) after adjusting for covariates. PrEP counseling and maternal PrEP interventions must consider individual- and relational-level interventions to overcome anticipated PrEP stigma and other barriers to PrEP initiation and adherence.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10461-021-03374-x.

Consumer Journeys of Adolescent Girls and Young Women in South Africa: Implications for Marketing HIV Prevention Products

Background: Female-initiated prevention products could reduce HIV infection rates in contexts with pronounced gender inequality like South Africa, but uptake and adherence remain low when available. Insights into the behavior of target consumers are needed to effectively promote these products; however, perceptions of stigma may discourage honest reporting. Focus of the Article: To address this need, we examined differences among the consumer journeys of six segments of South African adolescent girls and young women (AGYW), who vary on sexual health beliefs, sexual experience, and self-enhancement, when buying hygiene products. Research Question: We hypothesized that segments would differ in what motivated their purchases and in engagement with different touchpoints, reflecting a need for targeted outreach strategies. Methods: 1,500 low-income, Black South African AGYW (14–25 years of age) were surveyed face-to-face in their homes about their consumer journeys when purchasing deodorant and sanitary products, with the aim of extending the insights obtained to HIV prevention. Results: We found notable similarities across segments but also several important differences underscoring the potential for tailored marketing of HIV prevention products. Among some of the segments, differences were found in prepurchase mindsets and touchpoints, retail and brand drivers, and postpurchase feelings. Recommendations for Research or Practice: These findings highlight the need for tailored outreach among AGYW and may inform the design of effective, personalized marketing strategies that enhance the appeal of HIV prevention products. Limitations: To circumvent potential stigma associated with HIV, survey questions were anchored on personal hygiene products. While this may encourage greater honesty, findings may not fully generalize to HIV prevention products.

"An Unchanging God in a Changing World": Sexual Practice and Decision-Making among Christian Women in South Africa.

This study explored the relationship between sexual health and religion among young, Pentecostal Christian women navigating the transition to adulthood in Khayelitsha township,in theCity of Capetown, South Africa. Between February and August 2019, eleven semi-structured interviews and three focus group discussions were conducted. Thematic analysis and discourse analysis were used to analyse the data collected. The study found that the relationship between sexual health and religion was complex and multifaceted, shaped by the religious dichotomisation of "right" and "wrong", socio-economic constraints and culture. Despite the perceived decline of religious influence on the sexual and social lives of youth, religion continues to play an instrumental role in shaping the dreams, aspirations and lifestyles of young people, especially as they transition to adulthood. We argue therefore, that religion is a significant spiritual and cultural resource that young women use to develop their sexual and social identities, although it cannot always be equated with their sexual practice or decision-making related to sexual health. In the light of this, churches should still be seen as key partners in the fight against HIV as their involvement can act as a stabilising force for young people dealing with poverty and uncertainty. Church engagement with young people should offer programmes that include but are not limited to sexual health.

From Survival to Glamour: Motivations for Engaging in Transactional Sex and Relationships Among Adolescent Girls and Young Women in South Africa

We explored transactional sex and relationships (TSR) among South African adolescent girls and young women (AGYW) using (1) survey data from 4,399 AGYW aged 15–24 years, and (2) qualitative data from 237 AGYW and 38 male peers. Ten percent of sexually active AGYW reported having ever had transactional sex; 14% reported having stayed in a relationship for money or material items. Factors associated with higher reporting of TSR included HIV positivity, higher food insecurity, and alcohol use. Those AGYW who were between the ages of 20–24 years (OR: 1.0; 95% CI: 0.81–1.24), had a sexual partner older than her by 5 years or more (OR: 1.89; 95% CI: 1.58–2.26), and had a transactional relationship in the past (OR: 61.1; 95% CI: 47.37–78.76) were more likely to report having transactional sex. AGYW qualitative narratives included both assertions of agency in choosing to engage in TSR, and power inequities resulting in condomless sex. Our findings can inform interventions to addressing transactional sex and relationships, critical to South Africa’s HIV response.

Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa

Women in South Africa living with HIV who use alcohol may not adhere to ART, affecting the country’s 90-90-90 targets. The Women’s Health CoOp (WHC), a woman-focused HIV intervention, has shown efficacy in numerous trials with key populations of women in South Africa who use alcohol and drugs. In a hybrid implementation effectiveness study, the WHC was implemented in usual care clinics by healthcare providers in a modified stepped-wedge design. We present the outcomes of alcohol use and ART adherence with 480 women, with a 95% 6-month follow-up rate across 4 implementation cycles. Compared with the first cycle, women in the fourth cycle were significantly less likely (OR = 0.10 [95% CI 0.04, 0.24]) to report alcohol use disorder risk and were 4 times more likely (OR = 4.16 [95% CI 1.05, 16.51]) to report ART adherence at 6-month follow-up. Overall, acceptability and satisfaction were extremely high. The WHC intervention was successful in reaching key populations of women to reduce alcohol use and increase ART adherence, which is essential for South Africa to reach the 90-90-90 goals.

Critiquing the ethics review process in the 2019 Nieuwoudt et al. study on the impact of age and education on cognitive functioning among coloured South African women

In April 2019, Nieuwoudt et al . published an article on the impact of age and education on cognitive functioning among coloured women in the Western Cape Province, South Africa (SA). The study reported that coloured women in SA have increased risk for low cognitive functioning, as a result of limited education and unhealthy lifestyles. The article was widely criticised, and the journal subsequently withdrew the piece. It was argued that the study was unethical as it perpetuated racial stereotypes through its failure to recognise the distinction between race and ethnicity when undertaking biological research on a race group. The study had received ethical approval, which raised pertinent questions about the ethics review process. This article looks at ( i ) the role of research ethics committees (RECs); and ( ii ) the normative framework within which ethics committees operate. It avers that an understanding of the ethical issues of scientific validity, fair subject selection and minimising harms must be viewed in the light of the complex social issues surrounding the construction of coloured identity in SA. The article finds that the REC should have considered this study unapprovable, because its methodology was based on racist assumptions, and its focus on one race or ethnic group posed social risks for that community. The REC ought to have interrogated why researchers were unclear in their distinction between race and ethnicity, and have been mindful of race being a social rather than a biological construct.

Physical Activity in Pregnancy: Beliefs, Benefits, and Information-Seeking Practices of Pregnant Women in South Africa.

BackgroundNotwithstanding the benefits of physical activity (PA) during pregnancy, anecdotal evidence suggests ignorance, unscientific beliefs, and lack of awareness about PA among pregnant South African women.AimThis study examined the beliefs, perceived benefits, and sources of information on PA during pregnancy.MethodsA cross-sectional descriptive study was employed between June and September 2019 using an interviewer-administered questionnaire with 1,082 pregnant women. These women were attending antenatal primary health–care clinics in Buffalo City, Eastern Cape, South Africa. A self-designed questionnaire solicited information on beliefs, benefits, and sources of information regarding PA during pregnancy.ResultsA majority of the participants held positive beliefs concerning PA during pregnancy. They maintained that PA was safe for mother and fetus, improved labor and delivery (93.1%), promoted energy (89.0%), and should be discontinued when tired (76.6%). Most held negative convictions that PA during pregnancy increased body temperature (64.5%) and that pregnancy was a time to rest and refrain from PA (56.5%). Predominantl sources of information received about PA during pregnancy were television, the radio, and other media (70.2%). Most participants were aware of the benefits of PA during pregnancy —— reduction in infant weight (61.4%), lessening of moodiness (90.4), and decreased risk of gestational diabetes mellitus (92.9%), pregnancy-induced hypertension (92.5%), and complications at birth (97.8%), while common negative perceptions included musculoskeletal discomfort (82.7%), and back pain (85.7%). An overwhelming majority affirmed that PA improved self-image (95.7%), sleep patterns (94.2%), and respiratory function (95.8%).ConclusionOur findings suggested that women hold positive beliefs and perceive PA as beneficial to their health and the baby; however, they received most of their information from the Internet. Most women regarded pregnancy as a period to relax and rest. Interventions to promote PA during pregnancy are needed.

Exposure to Intimate Partner Violence and Hypertension Outcomes among Young Women in South Africa.

Hypertension and intimate partner violence is affecting longevity and quality of life among women worldwide. In this study, intimate partner violence is identified as a risk factor for hypertension outcomes among young women in South Africa. Using a nationally representative sample of 216 (N) young women (15–34 years old) from the South African Demographic and Health Survey, this study uses cross-tabulations and logistic regression methods to identify the odds of hypertension outcomes. Results show that between 20 and 41% of 15–34-year-old women have hypertension. Further, 68% of women with hypertension experienced physical intimate partner violence. Finally, the odds of hypertension are increased if young women experience physical (OR: 4.07; CI: 1.04726–15.82438) or sexual (OR: 2.56; CI: 1.18198–5.55834) intimate partner violence. Efforts to reduce hypertension outcomes in the country should include intimate partner violence awareness and assistance.

The Prevalence of Gender-Based Violence against Women in South Africa : A Call for Action

The prevalence of gender-based violence in South Africa is an intense and widespread problem that impacts almost every aspect of life. This call for states’ intervention in the prevention of gender-based violence (GBV) in the country. Reports show that intimate partner violence and sexual coercion are the most common forms of GBV globally, and these are the types of violence that are explored in this paper. GBV has serious consequences for women’s health, such as homicides, suicides, AIDS-related deaths as well as physical injuries, chronic pain syndrome, gastrointestinal disorders, complications during pregnancy, miscarriage and low birth-weight of children. GBV also poses significant costs for the economies of both developed and developing countries alike, including low productivity and earnings, and low accumulation of human and social capital. Findings from literature show that violence can negatively affect women’s physical, mental, sexual, and reproductive health, and may increase the risk of acquiring HIV in some settings. The study called on the government to take imperative actions to address gender-based violence (GBV). It recommended the implementation of a more strategic plan having recognized the detrimental impact of GBV on the victims and the general society.

Attitudes Toward a Proposed GPS-Based Location Tracking Smartphone App for Improving Engagement in HIV Care Among Pregnant and Postpartum Women in South Africa: Focus Group and Interview Study.

BackgroundPeripartum women living with HIV in South Africa are at high risk of dropping out of care and are also a particularly mobile population, which may impact their engagement in HIV care. With the rise in mobile phone use worldwide, there is an opportunity to use smartphones and GPS location software to characterize mobility in real time.ObjectiveThe aim of this study was to propose a smartphone app that could collect individual GPS locations to improve engagement in HIV care and to assess potential users’ attitudes toward the proposed app.MethodsWe conducted 50 in-depth interviews (IDIs) with pregnant women living with HIV in Cape Town and Johannesburg, South Africa, and 6 focus group discussions (FGDs) with 27 postpartum women living with HIV in Cape Town. Through an open-ended question in the IDIs, we categorized “positive,” “neutral,” or “negative” reactions to the proposed app and identified key quotations. For the FGD data, we grouped the text into themes, then analyzed it for patterns, concepts, and associations and selected illustrative quotations.ResultsIn the IDIs, the majority of participants (76%, 38/50) responded favorably to the proposed app. Favorable comments were related to the convenience of facilitated continued care, a sense of helpfulness on the part of the researchers and facilities, and the difficulties of trying to maintain care while traveling. Among the 4/50 participants (8%) who responded negatively, their comments were primarily related to the individual’s responsibility for their own health care. The FGDs revealed four themes: facilitating connection to care, informed choice, disclosure (intentional or unintentional), and trust in researchers.ConclusionsWomen living with HIV were overwhelmingly positive about the idea of a GPS-based smartphone app to improve engagement in HIV care. Participants reported that they would welcome a tool to facilitate connection to care when traveling and expressed trust in researchers and health care facilities. Within the context of the rapid increase of smartphone use in South Africa, these early results warrant further exploration and critical evaluation following real-world experience with the app.

Modeling Cash Plus Other Psychosocial and Structural Interventions to Prevent HIV Among Adolescent Girls and Young Women in South Africa (HPTN 068)

Poverty alleviation programs can reduce HIV incidence but may have greater impacts when combined with other psychosocial interventions. We modeled the change in HIV incidence among South African adolescent girls and young women (AGYW) associated with combining a cash transfer (the South African Child Support Grant (CSG)) with other structural and behavioral interventions. We modeled observational data from the HPTN 068 study where 2328 HIV negative AGYW (13–20 years) were followed for 4 years. In a Monte Carlo simulation based on this cohort (N = 10,000), CSG receipt was not independently associated with HIV incidence. Providing the CSG combined with increasing caregiver care and reducing adolescent depression had the largest reduction in HIV incidence with the fewest number of combined interventions (RD − 3.0%; (95% CI − 5.1%, − 0.9%). Combining a monthly grant with interventions to increase caregiver care and reduce adolescent depression could substantially reduce HIV incidence above the provision of cash alone.

“Give It to Him”: Sexual Violence in the Intimate Relationships of Black Married Women in South Africa

AbstractStudies have shown that violent, unwanted, and coerced sexual intercourse remains a common, normalized experience for many women in heterosexual relationships. While some studies have exami...

DREAMS Intervention Uptake and Its Association with HIV Related Outcomes Among Adolescent Girls and Young Women in South Africa: Findings from a Cross Sectional Household Study

DREAMS Intervention Uptake and Its Association with HIV Related Outcomes Among Adolescent Girls and Young Women in South Africa: Findings from a Cross Sectional Household Study

Clinical Features and Outcomes of COVID-19 Infection among Pregnant Women in South Africa.

Background and Objective:Studies among COVID positive pregnant women are limited. Previous studies reported high rate of symptoms, comorbidities, and poor fetal/neonatal outcome among women of different ethnicity. To date, no study was reported among pregnant African women. This study was conducted to determine the clinical features and outcomes of COVID-19 positive pregnant women in Ekurhuleni District in South Africa.Methods:Retrospective record review of 103 COVID-19 infected pregnant women during the period of April to September 2020 was performed. Clinical features, symptoms, comorbidities, laboratory results, maternal, and neonatal outcomes were analyzed. Descriptive statistics (mean + standard deviation, number, and percentages) and inferential statistics (Chi-square test) were calculated. Ethical clearance was obtained from the Human Research Ethics Committee of the University of Witwatersrand, South Africa.Results:Majority of patients (90%) were of African ethnicity and symptomatic (53%). The most common symptom, comorbidity, and laboratory abnormality was cough (62%), hypertension (23%), and high LDH (20%), respectively. Thrombocytopenia and lymphocytopenia occurred among 9% and 15% of the women, respectively. Although association was not significant, symptoms were more common among women who were HIV positive, had comorbidity, and had abnormal results. The most common complications were preterm labor (8%) and macerated stillbirths (6%). Six (6%) mothers died.Conclusion and Global Health Implications:COVID-positive pregnant South African women were commonly symptomatic, but incidence of adverse fetal outcomes was low. High rate of preterm labor, macerated stillbirths, and maternal deaths was a concern. This study has several strengths. It included all COVID-positive women over a 6-month period at all healthcare facility levels, such as clinics, community health centers/midwifery units, district, and regional/tertiary hospitals conducted in an African country. Previous studies primarily included hospitals, which increased a high probability of mainly including severely-ill women. The study might benefit the health care workers in other African countries.