Swazi Men Research Articles

\u201cWe have to learn to cooperate with each other\u201d: a qualitative study to explore integration of traditional healers into the provision of HIV self-testing and tuberculosis screening in Eswatini

BackgroundTraditional healing plays an important role in healthcare in Eswatini, and innovative collaborations with traditional healers may enable hard-to-reach men to access HIV and tuberculosis diagnostic services. This study explored attitudes towards integration of traditional healers into the provision of HIV self-testing kits and sputum collection containers.MethodsA qualitative study was conducted in 2019–2020 in Shiselweni region, Eswatini. Eight male traditional healers were trained on HIV and tuberculosis care including distribution of HIV self-testing kits and sputum collection containers. Attitudes towards the intervention were elicited through in-depth interviews with the eight traditional healers, ten clients, five healthcare workers and seven focus group discussions with community members. Interviews and group discussions were conducted in SiSwati, audio-recorded, translated and transcribed into English. Data were coded inductively and analysed thematically.Results81 HIV self-testing kits and 24 sputum collection containers were distributed by the healers to 99 clients, with 14% of participants reporting a reactive HIV self-test result. The distribution of sputum containers did not result in any tuberculosis diagnoses, as samples were refused at health centres.Traditional healers perceived themselves as important healthcare providers, and after training, were willing and able to distribute HIV self-test kits and sputum containers to clients. Many saw themselves as peers who could address barriers to health-seeking among Swazi men that reflected hegemonic masculinities and patriarchal attitudes. Traditional healers were considered to provide services that were private, flexible, efficient and non-judgemental, although some clients and community members expressed concerns over confidentiality breaches. Attitudes among health workers were mixed, with some calling for greater collaboration with traditional healers and others expressing doubts about their potential role in promoting HIV and tuberculosis services. Specifically, many health workers did not accept sputum samples collected outside health facilities.ConclusionsOffering HIV self-testing kits and sputum containers through traditional healers led to high HIV yields, but no TB diagnoses. The intervention was appreciated by healers’ clients, due to the cultural literacy of traditional healers and practical considerations. Scaling-up this approach could bridge testing gaps if traditional healers are supported, but procedures for receiving sputum samples at health facilities need further strengthening.

Towards a context-specific understanding of masculinities in Eswatini within voluntary medical male circumcision programming

Compelling evidence from three randomised controlled trials, which showed that voluntary medical male circumcision (VMMC) reduces HIV acquisition from women to men by up to 60%, led to WHO recommending that VMMC be implemented in 14 priority countries. As one of the priority countries, Eswatini aimed to reach 80% VMMC coverage among boys and men aged 10–49 years since programme inception in 2009. By the end of 2019, however, the country had reached a modest 40%. VMMC is intrinsically tied to perceptions of masculinity and male gender identity. Comprehending the role of context-specific masculinity as it relates to VMMC may contribute to our understanding of community attitudes towards VMMC and men’s decision-making. Drawing on focus group discussion data, this study aimed to explore the linkage between sexuality, masculinity and health interventions within Eswatini. Using critical discourse analysis, the study identified two discourses: sexuality, masculinity and circumcision, and income, masculinity, and circumcision. In the first discourse, participants constructed discursive linkages between circumcision as an adult and loss of penile sensitivity, decreased libido and sexual performance, and adverse events. The second discourse, income, masculinity, and circumcision located circumcision within the social and material realities faced by Swazi men, gender norms and provision within family structures.

“I will take ARVs once my body deteriorates”: an analysis of Swazi men’s perceptions and acceptability of Test and Start

Swaziland has the highest HIV prevalence in the world. To mitigate the spread and devastation caused by HIV and to improve the wellbeing of people living with HIV, the country has adopted the latest available HIV prevention campaigns, including “Test and Start”. Because evidence from randomised controlled trials has demonstrated a significant risk reduction in HIV transmission when HIV-positive people start antiretroviral therapy (ART) early, Swaziland aims to find these people and link them to treatment. This study presents findings regarding the perceptions of this promising HIV-prevention intervention among men aged 17–69 years. A combination of qualitative methods including focus group discussions (12), in-depth interviews (17), informal conversations and participant observation (21) were used to collect data in two peri-urban communities in 2013–2014. Findings illustrate that men still fear taking an HIV test because of a relatively high probability of a positive test which some still interpret as a death sentence. Other potential barriers to the effectiveness of Test and Start programmes include lack of hospitality in hospitals, fear of starting treatment early related to side effects of ART, poverty, and lack of trust in the financial stability of the Swazi government. We argue that several social factors need to be considered for the Test and Start programme to be more effective.

Economic remittances from employment in the Second World War and family conflicts, Swaziland, 1941-1950

Swaziland was connected to the Allied conduct of the Second World War through colonial ties and about four thousand Swazi men were recruited to serve in the war. Historians are beginning to analyse the different ways in which Swazi society was shaped and probably changed by the events of the war. However, no research has been conducted to show how Swazi civilians were affected by the events of the war and how they responded. This article contributes toward closing this research gap by interrogating the negative impact of economic remittances on family relation. The article focuses on family conflicts that surrounded authority over remittances at family level and how the remittances were utilized. Much as there are positive impacts of remittances from war service, they do not form part of the subject of the article. The article argues that remittances from employment in the Second World War negatively affected Swazi families as it resulted in conflicts that left families divided for a long time or permanently. This argument integrates a neglected angle of the impact of the war on Swazi society. While the argument of the article is built around remittances from employment in the Second World War, it is contextualized within the broader literature on the impact of remittances. The research methodologies employed for data collection are archival and qualitative.

The Impact of Cultural Norms on HIV Transmission in Swaziland

The Impact of Cultural Norms on HIV Transmission in Swaziland

From first love to marriage and maturity: a life-course perspective on HIV risk among young Swazi adults

This paper uses a life-course approach to explore the sexual partnerships and HIV-related risk of men and women in Swaziland throughout their adolescence, 20s and 30s. Twenty-eight Swazi men and women between the ages of 20 and 39 discussed their life histories in 117 in-depth interviews, with an average follow-up of nine months. Many participants described painful childhood experiences, including a lack of positive role models for couple relationships. Women’s first sexual partnerships often involved coercion or force and resulted in pregnancy and abandonment by partners, leaving women economically vulnerable. Most men and women reported a desire to marry and associated marriage with respectability and monogamy. Men typically did not feel ready to marry until their 30s, while women often married only after years in tumultuous relationships. A high degree of relationship instability and change was observed over the study period, with half of participants reporting concurrency within their primary relationship. Participants’ narratives revealed significant sources and circumstances of risk, particularly multiple and concurrent sexual partnerships, violence and lack of mutual trust within relationships, as well as social ideals that may provide opportunities for effective HIV prevention.

Men's use of sexual health and HIV services in Swaziland: a mixed methods study.

Over one-quarter of the adult population in Swaziland is estimated to be HIV positive. Men's use of sexual health (SH) services has significant implications for HIV prevention. This study aimed to understand Swazi men's health-seeking behaviours in relation to SH and HIV services. A household survey was conducted in Manzini (n=503), complemented by 23 semi-structured interviews and two focus group discussions (with a total of 10 participants). One-third of male survey participants used SH services in the past year, most commonly HIV testing (28%). Service users were more likely to be sexually active (aOR 3.21, 95% CI: 1.81-5.68 for those with one partner; and aOR 2.35, 95% CI: 1.25-4.41 for those with multiple partners) compared with service non-users. Service users were less likely to prefer HIV services to be separated from other healthcare services (aOR 0.50, 95% CI: 0.35-0.71), or to agree with travelling further for their HIV test (aOR 0.52, 95% CI: 0.33-0.82) compared with non-users, after controlling for age-group and education. Men avoided SH services because they feared being stigmatised by STI/HIV testing, are uncomfortable disclosing SH problems to female healthcare providers, and avoided HIV testing by relying on their wife's results as a proxy for their own status. Informal providers, such as traditional healers, were often preferred because practitioners were more often male, physical exams were not required and appointments and payment options were flexible. To improve men's uptake of SH services, providers and services need to be more sensitive to men's privacy concerns, time restrictions and the potential stigma associated with STI/HIV testing.

Swazi men’s perception of the protective effect of male circumcision and its implications for HIV prevention strategy

Background: For years, male circumcision (MC) has been known to reduce the risk of sexually transmitted infections (STIs). Of late, MC has been recognised and recommended as a complementary HIV preventive measure in high prevalent areas. The objective of this study was to to assess the perceptions of Swazi men about the protective effect of circumcision against STIs including HIV, and its implication to the mass MC strategy for HIV prevention. Methods: An explorative qualitative study was conducted targeting men aged ≥18 years seeking services at Family Life Association of Swaziland clinic in Mbabane, Swaziland. Unstructured individual face-to-face interviews were conducted for 17 men. Results: Results showed that Swazi men perceived the protective effect of MC differently, ranging from perceptions of ineffectiveness and unworthy, especially against HIV, to perceptions of total protection and a solution to all STIs. Perceptions were influenced by the ongoing circumcision campaigns, individual knowledge of biological sciences, misconceptions as well as life experiences. Promiscuous men were more likely to have a positive perception and acceptance of the procedure than their non-promiscuous counterparts. Conclusion: Swazi men hold mixed perceptions about MC, accounting for its relatively low uptake. The relatively low uptake of circumcision does not necessarily imply failure of the strategy but rather a natural selection of the most relevant and at-risk portion of the population. It is recommended that more effort be put towards correcting misconceptions and convincing those who still hold a negative perception about the procedure.

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

Faced with an HIV prevalence of 31% among 18- to 49-year-olds, Swaziland developed a male circumcision policy in 2009, following compelling scientific evidence from three randomised controlled trials. Utilising United States Agency for International Development funds, the state set out to circumcise 80% of adult men in 2011. Only 8667 of the targeted 150,000 men were circumcised during the campaign. This paper presents findings from a 2012 to 2013 in-depth qualitative study among Swazi men. Methods included 13 focus group discussions, 20 in-depth interviews, 16 informal interviews and participant observation. 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.

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

Men and women in Swaziland who are engaged in multiple or concurrent sexual partnerships, or who have sexual partners with concurrent partners, face a very high risk of HIV infection. Ninety-four in-depth interviews were conducted with 28 Swazi men and women (14 of each sex) between the ages of 20 and 39 to explore participants' sexual partnership histories, including motivations for sexual relationships which carried high HIV risk. Concurrency was normative, with most men and women having had at least one concurrent sexual partnership, and all women reporting having had at least one partner who had a concurrent partner. 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.

Demographic and health surveys indicate limited impact of condoms and HIV testing in four African countries.

Condom promotion and HIV testing for the general population have been major components of HIV prevention efforts in sub-Saharan Africa's high prevalence HIV epidemics, although little evidence documents their public health impact. Recent enhancements to the large, population-based demographic and health surveys (DHS) and AIDS information surveys (AIS) allow use of these data to assess the population-wide impact of these strategies. We analysed the latest DHS and AIS data from four sub-Saharan African countries with high prevalence, heterosexually transmitted HIV epidemics (Côte d'Ivoire, Swaziland, Tanzania and Zambia; N = 48 298) to answer two questions: 1) Are men and women who use condoms less likely to be HIV-infected than those who do not?; and 2) Are men and women who report knowing their HIV status more likely to use condoms than those who do not? Consistent condom use was associated with lower HIV infection rates for Swazi men but with higher HIV infection rates for women in Tanzania and Zambia; it made no significant difference in the other five sex/country subgroups analysed. Inconsistent condom use was not significantly associated with HIV status in any subgroup. Knowing one's HIV status was consistently associated with higher rates of condom use only among married people who were HIV-positive, even though condom use in this group remained relatively low. Effects of knowing one's HIV status among other subgroups varied. These results suggest that condoms have had little population-wide impact for HIV/AIDS prevention in these four countries. HIV testing appears to be associated with increased condom use mainly among people in stable partnerships who test positive. HIV testing and condom promotion may be more effective when targeted to specific groups where there is evidence of benefit rather than to general populations.

‘Sharing my bed with the enemy’: Wives and violent husbands in post-colonial Swaziland

Colonialism produced numerous changes in Swazi socio-economic configurations as society was forced to respond to political and economic policies imposed by the colonial regime. These changes did not only inform colonial developments but had a profound bearing on post-colonial developments. One of these changes was the integration of Swazi women into wage employment in response to the growth of capitalist economic enterprises. Research on this development has been neglected such that up to now, we know little about the dynamics that drove indigenous Swazi women into wage employment. This paper argues that these dynamics are located in the exigencies of colonial policy that negatively impacted on the economic performance of areas occupied by the indigenous Swazi. It is shown that as the crises of product intensified in Swazi reserves, more women were released into wage employment. It is argued that this was not a smooth process, but women's integration into wage employment was a contested issue whereby Swazi men, families, indigenous chiefs, the monarchy, and colonial administrators attempted to frustrate female participation in wage employment. However, these attempts were not successful as women continued to take up wage employment with or without the permission of their husbands, fathers, families, chiefs, and colonial administrators.

Perspectives on intimate partner violence in Swaziland amongst 18–29-year-old men undergoing medical circumcision

Intimate partner violence (IPV) is perceived as a major contributor to HIV transmission in Swaziland. This exploratory study aimed to develop a culturally-specific understanding of men's perspectives of IPV. Focus group methods were used to gather information from 45 young urban Swazi men who had undergone medical male circumcision. A thematic analysis was conducted focussing on the manifestations of IPV and socio-cultural and economic factors which underpin, circumstances which trigger and social responses to IPV. The study identified numerous forms of economic, physical, emotional and sexual abuse that study participants perceived men used to control women in Swaziland. Many of these directly increased a woman's risk of HIV infection, including knowingly infecting a woman with HIV and intentionally impregnating a woman, a practice that has not previously been highlighted in the literature. Aspects of Swazi culture that may facilitate these particular forms of abuse are discussed. This study highlights the need for the gender issues which underpin IPV to be addressed in HIV prevention in Swaziland and for the development of an informed understanding of how and why IPV occurs in the Swazi context.

Colonial Policy, Male Opposition, and the Integration of Swazi Women into Wage Employment, 1935–1955

Colonialism entailed numerous changes in Swazi socio-economic configurations, including a growing recourse to waged employment. Yet little is known about the dynamics that drove indigenous Swazi women to work for wages. This article argues that colonial policy, by adversely impacting areas of production involving Swazi people, drove women to seek wage employment. Moreover, this was not a smooth process, but a contested issue. Swazi men, chiefs, the monarchy and colonial administrators all attempted to frustrate female participation in wage employment. In spite of such barriers, as oral interviews with mid-twentieth century working women show, women continued to take up wage employment, and eventually secured the implicit support of colonial administrators in the service of the colonial economy.

Swazi Men’s Contraceptive Knowledge, Attitudes, and Practices

This study investigated Swazi men's contraceptive knowledge, attitudes, and practices. Thirty adolescent men, aged from 16 to 18, and 86 adult men from urban and rural areas participated in focus group interviews. Adult Swazi men indicated that men were the sole decision makers about sexual and reproductive issues. The number and gender of children remains socially significant in Swaziland. Adolescent men expressed contradictory notions in expecting girls to refuse unprotected sex but maintaining that men were the sole decision makers about sexual matters. They agreed that women should commence childbearing activities at the age of 21 or later. This finding holds some promise for enabling more Swazi women to use contraceptives at least until they have completed their schooling. Contraceptive services were not readily accessible to men in Swaziland.

THE STATE, CHIEFS AND THE CONTROL OF FEMALE MIGRATION IN COLONIAL SWAZILAND, c. 1930s–1950s

Human migration has played an important role in the construction or dissolution of states in southern Africa. With the coming of the colonial period there was an intensification of the process of migration, mainly for work. Such movements were premised on the uneven development of colonial economies in which some areas became suppliers of labour while others became labour markets. In the case of Swaziland, the migration of labour was dominated by male migrants as the existing labour markets offered more opportunities for men. This view has become a conventional interpretation of the disparity in the mobility of men and women within states or across borders. This article uses the experience of Swaziland to extend the discourse on why men dominated the migration currents in Swaziland during the colonial period. It points out that it is no longer useful to rely on purely economic explanations of why more men were migrating than women in colonial Swaziland. The argument pushes the frontier of analysis beyond economics and argues that a more significant explanation is to be found in the power relations at the homestead level, whereby men had the power to determine if and when women could migrate. The discussion shows that Swazi men, in collaboration with colonial administrators, employed different strategies to control the mobility of women. The intention of the men was to keep women in the rural areas and they used their power in the homestead and their influence on the colonial administration to create barriers against female migration to local and cross-border industrial centres.

Labour Migration, Labour Shortage, and Employer Response in Swaziland, 1935–1945

Extracted from text ... South African Historical Journal 44 (May 2001), 163-183 Labour Migration, Labour Shortage, and Employer Response in Swaziland, 1935-1945 HAMILTON SIPHO SIMELANE University of Swaziland Introduction Labour history in colonial Swaziland has been the subject of several studies.1 The main focus of these studies, and many others not mentioned here, has been the migration of Swazi men to South African mines and other areas of employment. Some have even gone to the extent of explaining the impact of labour migration within the framework of the development of underdevelopment theory together with its accompanying dependency paradigm. The role of recruiting agents and ..

Eating Disorders and Dieting Behavior Among Australian and Swazi University Students

The eating behaviors of 192 Australian and 129 Swaziland university students were examined by using the Eating Attitudes Test (EAT-26; D. M. Garner, M. P. Olmsted, Y. Bohr, & P. E. Garfinkel, 1982). The results did not support the hypothesis that more Australian students than Swazi students would display eating disorder symptoms. Australian women scored significantly higher than Australian men. Surprisingly, scores on the EAT-26 for men and women from Swaziland did not differ significantly. Furthermore, there was little difference between the scores of Swazi men and either Australian women or Swazi women. Results are discussed in relation to various cultural factors and assessment issues.

Frequency of colour vision defects among Zulus in Natal.

SummaryThe HRR test was used to study the frequency of colour vision defects in 297 Zulu men and 43 Zulu women of Natal, two Basuto men in Natal, and two Swazi men and 21 Swazi women in the Transvaal.The frequencies agree with the work of other authors, that the numbers of red–green defectives in the black populations of Africa are less than half those among European whites. The observed frequency of women defectives is greater than that expected from the number of males, and the difference is probably due largely to the inclusion of a small number of women with considerable heterozygous manifestation.No yellow–blue deficient subjects were found.