Browsing by Author "Govender, Eliza Melissa."

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Breaking free : exploring dialogue for collective action in the Footballers 4 Life Intervention at the Heidelberg Correctional Centre.
(2013) Sibisi, Wandile.; Govender, Eliza Melissa.; Roma-Reardon, Josianne.
Many community development initiatives place great emphasis on the need for the a participatory approach towards development. Here the beneficiaries are expected to engage in dialogue and collective action in order to be empowered and consequently developed. This study therefore seeks to explore the elements of dialogue and collective action in a crime prevention and health promotion intervention that was administered by a non-governmental organisation called Footballers for Life (F4L) at the Heidelberg Correctional Centre (Johannesburg, South Africa) from March to August 2011 amongst a group of 40 male offenders. Premised on the idea that true human development should be participatory and therefore dialogical, this study used Participatory Communication to explore dialogue for collective action within the mentioned intervention. Participatory Communication was applied through the use of the Communication for Participatory Development Model (CFPD), which was used as a guide through which dialogue for collective action was explored. Furthermore, F4L is an organisation that uses retired professional football stars who, acting as role models, offer a unique approach towards effecting behaviour change amongst the communities they work with. Hence in this regard this study used the Social Cognitive Theory to primarily explore the significance of role modelling towards behaviour change in the F4L programme at the Heidelberg Correctional Centre. Taking a qualitative research approach, this study used interviews, focus groups as well as a participant observation schedule to collect the relevant data. This data was analysed through a thematic analysis which was facilitated through the use of a data analysis software package called NVivo. The study reveals how the offenders were excluded from the initial dialogue that took place between F4L and the prison in the recognition of the problems facing the offenders and planning of the intervention. Upon invitation to join the F4L programme the offenders went into it without any sense of ownership or clear understanding of what the programme was about potentially threatening the envisaged purpose of the programme. However, the study also found that the democratic leadership style and genuine efforts of the F4L head Coach (Silver) were able to play a key role in fostering a sense of brotherhood and therefore ownership of the developmental process amongst the offenders leading to the attainment of certain individual as well as social outcomes, i.e. self-reliance, empathy, budgeting skills, collective efficacy as well as communal trust.
A case study on Brothers for Life campaign: demand creation for oral PrEP among AGYW through exploring the perceptions and acceptability of males on the implementation of Pre-exposure prophylaxis (PrEP) in Vulindlela, KwaZulu-Natal.
(2021) Ndlovu, Lungelo.; Govender, Eliza Melissa.
HIV prevalence in South Africa remains high among Adolescent girls and young women particularly in male counterparts in rural KwaZulu-Natal. Perpetuation of HIV in rural KZN is due to multiple factors including cultural beliefs, practices, and values. Nevertheless, the introduction of Pre– exposure prophylaxis (PrEP) for HIV prevention has presented an opportunity not only for a decline in general HIV mortality but also a prevention method that is female - centred already existing HIV prevention methods. Previous case studies have demonstrated the efficacy of Oral PrEP, but it remains ineffective for AGYW because much of it relied on the negotiation with partners. Therefore, this study set out to explore male involvement in Oral PrEP mobilization by understanding the perceptions and support of men in heterosexual relationship and fathers of AGYW in Vulindlela. Using the Social Cognitive Theory (SCT) within the Social Ecological Model, this study explored the relevance of a B4L poster approach with two specific groupings of males, firstly those who are in heterosexual relationships aged 24- 35 years and secondly male parents (also referred to as fathers in this study) who are aged 35 - 49 years in Vulindlela, South Africa. This study employed the qualitative approach, using focus groups and action media to gain an understanding of males’ perceptions and support of Oral PrEP uptake among young women. Findings reveal that even though Oral PrEP is a female centered prevention method and previous interventions were implemented to encourage women, male involvement is important. The support of male partners and fathers to daughters has the potential to promote acceptance of Oral PrEP. However, trust in heterosexual relationships remains an issue for acceptance of Oral PrEP among young women and fathers believe that promoting Oral PrEP to their daughters is encouraging promiscuous behaviour. Also, encouraging male partners to take Oral PrEP may assist in preventing female partners from contracting HIV because they are in multiple intimate relationships. Findings also presented that a poster can be an effective medium of communication if factors such as language, posters are displayed in relevant spaces to reach a wider audience, role modelling and poster is attractive. Key Words: Pre-Exposure Prophylaxis, Human Immunodeficiency Virus, Brothers’ for Life, Adolescent Girls and Young Women, Male involvement, Participatory Action Research.
The communicative role played by social workers in the introduction and uptake of oral pre-exposure prophylaxis(oral prep) in Vulindlela.
(2021) Dlamini, Buyisiwe Lorraine.; Govender, Eliza Melissa.
Since the discovery of HIV and Aids many efforts to reduce the spread of the virus have been taken, these include biomedical interventions such as male circumcision, male and female condoms and PrEP. Several HIV prevention methods have been effective to curb the spread of HIV infections, with Voluntary Male Medical Circumcision (VMMC) and PrEP, have shown impact in overall reduction of HIV transmission. (Moodley, et al., 2016). PrEP has been shown to reduce the risk of HIV infection from unprotected sex by over 90 percent, and from injecting drugs by more than 70 percent (CDC, 2019). Biomedical interventions have been shown to be more effective when implemented in conjunction with behavioral interventions, and where contextual factors such as cultural context are considered in the implementation of such interventions (Baxter & Karim, 2016) A key factor that surfaces from the various studies considered here is that, biomedical interventions have less efficacy when used independently but works best with behavioral interventions rooted in various social and cultural contexts of those targeted. Such behavioral interventions including peer education, mass media communication, school-based sex education programmes, socioeconomic interventions and behavioural counselling, have opened up a greater scope for clinical social work in South Africa, and have been demonstrated to be instrumental in targeted awareness among adolescents and young adults (Baxter & Karim, 2016; AVERT, 2019; Morojele, et al., 2006). Biomedical HIV prevention technologies, such as antiretroviral pre‐exposure prophylaxis (PrEP) hold huge potential to substantially reduce HIV acquisition in high‐risk populations globally (Giovenco, 2019). Although many people who could benefit from PrEP are still unaware of its existence hence the need for social workers to raise awareness through education and interventions directed at sociostructural change in the communities. This dissertation provides an understanding of the communicative role played and can play by social workers in the future uptake and introduction to HIV prevention methods in Vulindlela. This study investigates the level of knowledge amongst social workers working with HIV clients. By employing a culture-centred approach (CCA) and the Social Ecology Model of communication and Health Behaviour (SEMCHB), this dissertation seeks to reach a holistic understanding of how social workers communicate with their clients about HIV prevention methods and their level of knowledge about HIV prevention methods such as PrEP. A phenomenological approach was adopted for this research study. Three interviews were held separately with social workers working in Vulindlela using semi – structured questionnaires to collect data. Thematic analysis was used to develop themes that emerged from the data collected. Key findings of the study revealed that social workers were heavily integrated in the communities in which they work and therefore have increased community exposure to play an important communicative role in the introduction and uptake of oral PrEP. The study overall found that HIV interventions does not need to be largely concentrated with nurses and primary health care facilities but can be extended to social development interventions in communities as well.
A comparative study of students' attitudes, preferences and acceptance levels towards microbicide products : the tenofovir gel and the dapivirine ring at UKZN.
Nota, Phiwe Babalo.; Govender, Eliza Melissa.
Despite vast efforts to curb HIV and AIDS, the global epidemic has evolved over the past three decades, with Southern Africa1 proving to be the epicentre of the epidemic. Unlike women in other parts of the world, statistics show that African women are disproportionately vulnerable to HIV infection, with women between the ages of 15 to 24 twice more likely to be infected then men in Southern Africa. Female vulnerability to HIV infection is exacerbated by various factors including social, cultural, economic and biological factors. Microbicides are biomedical technologies that are designed to give women some degree of control in prevention of HIV and other sexually transmitted diseases. Microbicides refer to antiretroviral-based substances: they are biomedical tools which could empower women who cannot negotiate safe sex practices and as such, they have the potential to change the landscape of the HIV and AIDS pandemic. However, there are no microbicide products that have been licenced and made available for women to use as they are still undergoing clinical trials. There is a dearth of research of female perceptions, attitudes and possible acceptance levels of microbicides as HIV prevention methods. This dissertation provides a small-scale comparative study of two microbicide products; the tenofovir gel and dapivirine ring. This study investigates UKZN female students’ perceptions, attitudes and acceptance levels towards microbicides as HIV prevention methods. By employing a culture-centred approach, this dissertation seeks to reach a holistic understanding of female students’ preferences towards HIV prevention methods for the purpose of knowing what potential users of microbicides desire and need. A mixed method approach formed the methodological basis of this research study: two focus group discussions with UKZN female students were conducted, and 100 self-administered questionnaires were used to collect data. Thematic analysis was used to develop themes that emerged from the data collected. Key findings from the questionnaire revealed that a high percentage (62%) of female students asserted that they would use microbicides if they were available as HIV prevention methods; 66% of the female respondents stipulated that they would prefer using the tenofovir gel as opposed to the dapivirine ring. Female students indicated that microbicides must be available in other forms. It was concluded that the formulation in which microbicides are developed is important: product characteristic will influence acceptability of the products as well as adherence. Cultural issues will impact the acceptance and uptake of microbicides. It was also discovered that male involvement in microbicide development might foster better acceptance and uptake of these biomedical tools.
An exploration of community radio, culture and health communication among rural and semi-urban dwellers in the central region of Ghana: a case study of Covid-19 and Radio Peace.
(2022) Essel, Emmanuel.; Govender, Eliza Melissa.
The mainstream global COVID-19 communication for development and social change approaches, instituted by the neoliberal forces, hinge on information dissemination targeting individual behavioural change to halt the spread of the virus (Dutta et al., 2020). Ghana’s public health communication about COVID-19 has primarily employed persuasive approaches using mainstream channels to share the WHO-approved non-pharmaceutical interventions (NPIs): personal hygiene, mass masking, social distancing and pharmaceutical measures. However, the adequacy of mainstream approaches to meet the COVID-19 communication needs among marginalised communities is unclear. This study focuses on pandemic responses and explores community participation through counter-discursive platforms like community radio. This thesis explores how local cultures influence the ability, modality and extent of community members’ participation in the workings of community radio in promoting COVID-19 relevant health communication. This study uses qualitative data from three semi-urban and rural community radio host districts in Ghana collected between July and December 2021. Radio Peace, a community radio station in Winneba, Ghana’s Central Region, serves as a single case study. Purposive sampling was employed to select participants from the Effutu Municipal, Awutu Senya West, and Gomoa West Districts, Ghana’s Central Region. By using the culture-centred approach and participatory communication, eight (8) focus group discussions (FGDs) and eleven (11) in-depth interviews (IDIs) were conducted to understand how community radio attends to the communicative needs of marginalised people living within the selected communities. Data were analysed using reflexive thematic analysis. The findings suggest that community radio enhances the agency of marginalised people by providing an accessible public sphere for community-level dialogue concerning COVID-19 prevention using indigenous language. However, the involvement of marginalised people in Radio Peace’s COVID-19 communication intervention was limited by structural factors. These include indecorous language during on-air discourses, economic challenges of batteries to power radio sets, irregular community visits by the station’s staff, transmission challenges, and difficulty in calling into programmes due to jammed telephone lines. The study concludes that social, economic and cultural contexts significantly influence active listeners’ ability to participate in community radio interventions that pertain to COVID-19 communication. It also considers that community radio effectively communicates COVID-19 prevention messages that offer active listeners opportunities to be involved meaningfully in the interventions. Thus, the study proposes the socio-cultural model for the future conception, design and implementation of COVID-19 communication interventions for community radio in a manner that allows for marginalised people’s meaningful participation in such responses. Access, social capital and community participation are critical for effectively implementing the socio-cultural model for COVID-19 communication using community radio. The success of the socio-cultural model for COVID-19 communication hinges on a nuanced understanding of the beneficiary communities’ local needs, values, structural factors and economic capabilities.
An exploration of the social-cultural factors that influence oral pre-exposure prophylaxis uptake and integration into sexual and reproductive healthcare services for young women in KwaZulu-Natal.
(2019) Nota, Phiwe Babalo.; Govender, Eliza Melissa.
In the past, HIV prevention efforts have disappointingly focused on reducing individual risk, with insufficient attention to socio-cultural, economic, structural, and other contextual factors that increase vulnerability to HIV. However, public health efforts towards HIV prevention now focus on combination strategies. This strategy recognizes that the integration of biomedical, social and structural interventions in mitigating the HIV and AIDS epidemic will translate to population-level impact. In Southern Africa, young women are disproportionately vulnerable to HIV infection, with women between the ages of 15 to 24 twice more likely to be infected than men. However, the licensure of oral pre-exposure prophylaxis (PrEP) and the South African National Department of Health policy on the integration of oral PrEP in sexual reproductive health (SRH) services creates renewed hope for young women who are often unable to negotiate safe sex practices. Nevertheless, the effectiveness of biomedical technologies is influenced by socio-cultural, structural and economic factors. This underscores the need to understand; (a) Populations that will consider using oral PrEP, (b) The likely socio-cultural challenges or opportunities that will influence acceptance, uptake and adherence of oral PrEP, and (c) How to integrate oral PrEP in already existing SRH services in a manner that ensures optimal adherence to oral PrEP to key population groups. This study sought to find effective ways in which oral PrEP can be integrated into SRH services in South Africa, KwaZulu-Natal (KZN). To attain an in-depth understanding of this topic, participatory visual methodologies in the form of journey mapping workshops and one-on-one interviews with 15 young women taking oral PrEP were facilitated. The participatory approach to this inquiry created an enabling space for young women to engage in dialogue about oral PrEP. Young women need to be placed at the centre of the response to HIV and AIDS in a meaningful way that will facilitate sustainable interventions in the fight against HIV and AIDS. Two nurses from both research sites were also interviewed to yield healthcare providers perspectives into the study inquiry. The study has the potential to inform policymakers on how existing SRH services can be improved to multi-dimensional systems that support oral PrEP uptake and adherence by young women at high risk of HIV. Findings of this study support the conclusion that oral PrEP needs to be integrated into already existing SRH services in ways that are context-specific and culturally relevant for communities. The young women in this study explicitly shared the various social and cultural factors that will influence them accessing oral PrEP in SRH services within their local clinics. Issues related to the structure, services offered and healthcare provider’s attitudes will affect acceptance, uptake and adherence of oral PrEP by young women in rural and urban KZN communities.
Exploring a possible communication strategy to promote voluntary medical male circumcision for HIV prevention among males at the University of KwaZulu-Natal, Howard College.
(2023) Kanyile, Sandile Justice.; Govender, Eliza Melissa.
HIV/AIDS remains a global health concern with about 38 million people living with HIV globally in 2019, this consisted of 36,2 million adults and 1,8 million children. It was further estimated that there would be about 690 000 AIDS-related deaths in 2019. Following the success of three randomised trials to test the medical effectiveness of Voluntary Medical Male Circumcision (VMMC), undertaken in South Africa, Kenya and Uganda, it was found that VMMC reduces the chances of males contracting HIV by 50% to 60%. This means that there is a link between poor VMMC uptake and HIV prevalence. As a result, WHO declared it as a strategy to be included as part of combination prevention strategies. Furthermore, WHO declared that “HIV remains the single largest cause of deaths among adolescent boys and men of reproductive age in eastern and southern Africa”. The targeted adolescent boys and men are the focus because they are challenged by sociocultural factors ranging from toxic masculinity to substance abuse that may lead them to potentially infecting their partners with HIV. It is for this reason that VMMC is the key focus in this study. This study was conducted at the University of KwaZulu-Natal, Howard College Campus. The UKZN students have been identified as in high risk of HIV infection with a notable high number of students living with HIV. The study was conducted within the university residences reserved for students. This study had three objectives: (1) to investigate the communication strategies adopted at UKZN to promote VMMC (2) to assess the perceptions of UKZN students on VMMC communication strategies that have been adopted at UKZN (3) to identify the cultural factors that influence communication strategies adopted to advance VMMC at UKZN. This study is framed by the culture-centered approach (CCA) in understanding students’ experiences when they engage with the VMMC communication strategies that are aimed at them. The CCA is founded on the principles of listening to the voices and creating spaces for dialogue and culture to inform health strategies. However, it can still be used as a tool to understand communication strategies, as done in this study. The data was collected through 8 individual semi-structured interviews and supported with an extensive literature review that also informed the analysis. The key findings from this study suggested that the participants have been exposed to mass media communicating about HIV prevention strategies at Howard College Campus, however, there has been limited VMMC uptake. The students have demonstrated poor preference for mass media as they did not resonate with the platform. Instead, the findings suggested that the students prefer to be directly approached by health promoters on campus and at their student accommodations. This was because the students prefer to engage with the health promoters by asking them questions and negotiating the meanings of the promoted messages. Furthermore, it was found that students would prefer that health promoters are popular individuals holding respectable statuses around campus as that would motivate the students to pay attention to them. This recommendation is consistent with previous studies done at UKZN where students preferred role-modelling as an effective strategy for health promotion. Lastly, the minority of the respondents suggested the use of social media platforms by UKZN to disseminate VMMC messages. The study found that participating in the communication process with VMMC promotion was important for UKZN students. Therefore, the communication strategy to advance VMMC communication in the future targets of HIV prevention should be culturally sensitive, context-specific and engage with the students through a two-way dialogue to avoid their marginalisation. Another finding was that some students would prefer to have VMMC messages available across social media platforms. In the context of entertainment education, the communication strategy does include the audience in the interventions as it seeks for social change. Furthermore, it has been applied in the promotion of VMMC to some extent, including on social media. Lastly, the study specifies that these results are limited to Black African students at Howard College Campus.
Exploring adolescent girls and young women’s oral PrEP readiness from a school based’ perspective in Vulindlela, KZN.
(2019) Bokolo, Simamkele.; Govender, Eliza Melissa.
Over the past decades, great strides have been made globally in reducing the incidence of new HIV infections. Despite significant breakthroughs in HIV prevention, certain segments of the population continue to experience a rise in new infections. In particular, adolescent girls and young women continue to bear a disproportionate burden of new HIV infections across the world, including South Africa. It is in this context that Oral Pre-Exposure Prophylaxis (Oral PrEP) was introduced as an alternative intervention for the prevention of new infections among individuals at high risk of HIV acquisition. A range of studies have attested to the effectiveness of oral PrEP when used properly alongside other HIV prevention strategies. While its effec-tiveness has been confirmed scientifically, there is limited academic knowledge of the percep-tions of the individuals and structures in the community that would support and facilitate the adoption of Oral PrEP amongst adolescent girls and young women (AGYW). This study sought to understand the role of schools as a community structure in preparing AGYW for Oral PrEP uptake in Vulindlela, a community bearing the greatest burden of HIV infections in rural KZN. Twelve semi-structured interviews were conducted with teachers and school heads in six schools in Vulindlela. A purposive sampling method was used to identify the Life Orientation teachers and senior staff members that were interviewed in the study. The Health Belief Model and the Culture-Centred Approach were used to obtain a detailed under-standing of the topic under study. The results showed that teachers were aware of the HIV risks facing young women in their schools, but had limited knowledge about Oral PrEP and how it works. Generally there were reservations about the distribution and use of Oral PrEP among learners, owing to concerns around increased sexual risk behaviour and promiscuity. The De-partment of Education's stance on HIV prevention in schools was also found to be a barrier to positioning schools as an environment that is conducive for the introduction of Oral PrEP. In order to realise the full potential of Oral PrEP, the cultural barriers in the community should be addressed as these have the potential to hinder or facilitate the uptake of this critical intervention. Community structures such as schools and health centres should be engaged with a view to creating an enabling environment for the uptake of Oral PrEP by school-going girls.
Exploring HIV risk compensation among men with medical male circumcision uptake and oral pre-exposure prophylaxis use: a comparative study in Umlazi and Vulindlela in KwaZulu-Natal.
(2021) Khanyile, Lungelo Englamerge.; Govender, Eliza Melissa.
There were approximately 38.0 million people globally, living with HIV at the end of 2019 and Sub-Saharan Africa accounts for a third of those living with HIV. New biomedical HIV prevention methods such as mother-to-child transmission (PMTCT), antiretroviral treatment (ART) and voluntary medical male circumcision (VMMC) have shown great promise. Oral PrEP has the potential to greatly aid in the reduction of HIV infection rates among men. The study uses the concepts of the Health Belief Model (HBM), Social Ecology Model for Communication and Health Behaviour (SEMCHB), and the Risk Compensation Theory (RCT) to understand factors that influence the decision-making process of men when choosing biomedical HIV prevention options. These theories also enable an understanding of how individuals perceive risk, the benefits of safe behaviour, and how this is realized in their actions. In this qualitative study, four focus group discussions were conducted with African males ages 18 – 39 in Umlazi and Vulindlela, KwaZulu-Natal. Data was analysed using thematic analysis, applying the constructs of the HBM, SEMCHB and RCT to develop themes and sub-themes. Key findings revealed that perception of risk and perceived susceptibility were low among the men. However, perceived severity was high. The researcher also observed a lack of knowledge of HIV acquisition, and lack of proper knowledge of biomedical HIV prevention methods, VMMC and PrEP.
Exploring students’ uptake of HIV testing services at the University of KwaZulu-Natal Howard College, as part of the universal test and treat initiative.
(2019) Okelola, Oluwabunmi Ajoke.; Govender, Eliza Melissa.
Adolescents and adults between the ages of 15 – 49 years remain disproportionately vulnerable to HIV infection in South Africa. An estimate of 7.2 million people are living with HIV in South Africa. In KwaZulu-Natal, which is the most severely affected province, studies reveal that 23% of those living with HIV, do not know their HIV positive status. In the light of this, there is an urgent need to bridge the gap in HIV testing as a means of preventing the transmission of the virus. This research is a case study which explores students’ uptake of HIV testing services as part of the Universal Test and Treat (UTT) initiative. By using the Social Ecology Model of Communication and Health Behaviour and the Health Belief Model, this study seeks to achieve a wholistic understanding of students’ testing practices, identify key facilitators and barriers to HIV testing and explore students’ knowledge of the (UTT) as a prevention and treatment approach to HIV. The global efforts to achieve a significant reduction in HIV infection by 2020 is a strong focus of the UTT approach which promotes combination prevention, highlighting the importance of getting everyone tested frequently, with those who test negative offered condoms and Pre-Exposure prophylaxis. Similarly, those who test positive are offered immediate treatment. There is a dearth of research on HIV Counselling and Testing (HCT) among students in the urban areas of KwaZulu-Natal. Using a qualitative approach to research, 4 focus group discussions with 19 male and 18 female students at the University of KwaZulu-Natal between the ages of 18- 35 years were conducted to collect data. Participants were purposively selected according to age, location, those that have tested for HIV at least once in the last 12 months and those that have never tested. Thematic analysis was used to create themes that emerged from data collected. Key findings in this study revealed that students are at risk of HIV infection because of risky sexual practices. Furthermore, misconceptions about HIV prevention methods were also identified in this study. Barriers to HCT include fear of a positive result, lack of confidentiality and privacy, HIV-related stigma and perceived low risk to HIV infection. Facilitators to HCT include perceived high risk to HIV infection and the use of incentives. Furthermore, there is a lack of knowledge about the UTT approach which contributes to negative perception of HCT. This study emphasized the need to increase knowledge and awareness of the UTT in order to impact the uptake of HIV testing services among university students.
Exploring the role of adolescent youth-friendly services (AYFS) in primary health care clinics that offer HIV and sexual reproductive health (SRH) services for adolescent girls and young women in Vulindlela, KwaZulu-Natal, South Africa.
(2020) Vukapi, Yonela.; Govender, Eliza Melissa.
In sub-Sahara Africa, adolescent girls and young women (AGYW) bear a disproportionate burden of sexual and reproductive health (SRH) risks, where HIV infection and adolescent fertility are a major concern. Specifically, in South Africa, it is estimated that nearly 2 000 AGYW between the ages of 15 to 24 years are infected with HIV every week. Furthermore, it is estimated that by 2019, 15,6% of females between the ages of 15 and 19 years in South Africa had begun childbearing. Consequently, systemizing and expanding the reach of quality AGYW health service provision is part of the South African National Adolescent and Youth Health Policy. To promote accessibility, efficiency, quality, and sustainability of adolescent youth-friendly health services (AYFS) in primary health care clinics, national response to the HIV and SRH needs of AGYW need to be prioritized. It is for this reason that AGYW is a key focus in this study. This study was conducted in Vulindlela, in the uMgungundlovu district in KwaZulu-Natal. This area reports high levels of HIV infection, with notable high fertility rates among AGYW. The study was conducted in 3 primary health care clinics that have initiated the AYFS programme, providing HIV and SRH care to AGYW. This study has three aims: (1) to investigate whether primary health care clinics offer youth-friendly HIV and SRH services to AGYW (2) to assess the current strategies employed in primary health care clinics to make HIV and SRH services adolescent youth-friendly and (3) to explore the potential of adolescent youth-friendly services in influencing HIV and SRH care among AGYW. This study is framed by the culture-centered approach (CCA) in understanding AGYW’s experiences when accessing HIV and SRH services in primary health care clinics. CCA is founded on the principles of listening to the voices of the margins that have hitherto been unheard in policy and programming circles. Purnell’s cultural competency model (CC) of health care nurses is also crucial for AYFS to effective among AGYW. This model encourages health care nurses to understand the heritage and culture in which their patients come from in order to provide acceptable and suitable HIV and SRH services. A participatory action research design was adopted, where data collection was threefold: a PhotoVoice workshop, focus group discussion and individual interviews. Key findings from this study highlighted that lack of congruent care, administration, time management, shortage of infrastructure and health care nurses negative attitudes were identified as the main deficits to AGYW SRH care clinic. However, AYFS in primary health care clinics could encourage HIV and SRH care among AGYW. Having younger health care nurses at the clinic was one strategy that AGYW alluded to in this study. AGYW also mentioned that having a separate building for AYFS would improve their adherence to HIV and SRH services like HIV testing, family planning and antenatal care. This study highlighted the need for greater understanding of the socio-cultural perceptions of health care workers’ perceptions of adolescent sexual and reproductive health, and the provision of HIV and SRH services. This study found that HIV and SRH services are currently not youth-friendly for AGYW across all three clinics in which the study was conducted. AGYW described that the clinic structure does not have enough space to, and therefore hinders their privacy at the clinic. Health care nurses attitudes and the lack of communication between AGYW and nurses at the clinic were some of the key findings in this study. On the contrary, health care nurses find it challenging to focus one patient at the clinic because of shortage of clinical staff and administrative staff.
Exploring the role of social media within Covid-19 prevention and mis/information on Facebook: a case study of the South African level 5 lockdown.
(2022) Ahmad, Aadila.; Govender, Eliza Melissa.
The outbreak of COVID-19 has created a global health crisis with a deep impact on the way in which we communicate and confront public health emergencies. The inundated utilization of social media has unified the world in a global pandemic experience. Social media has become an integral part of our lives particularly during the COVID-19 public health emergency. While lockdown regulations, due to COVID-19 has limited human and physical interaction, social media has been at the forefront of accessible information yet at the same time a platform for increased misinformation and myths surrounding the impact and risks of the pandemic. This study seeks to explore the role of social media discourses around COVID-19 prevention and misinformation during the first three weeks of the level 5 lockdown in South Africa. This study purposively selected 3 posts from the National Department of Health (NDoH) Facebook page between the 27th of March 2020 to the 18th of April 2020 that relate to COVID-19 prevention messaging and the way the NDoH has addressed the circulation of misinformation and fake news. The study uses a qualitative content analysis to analyse how the NDoH has utilized their Facebook page in disseminating COVID-19 prevention messaging, the common topics of discussion related to COVID-19 prevention and misinformation and fake news awareness and how the NDoH engaged in COVID-19 related messaging and prevention communication. The study adopts the three new categories of the uses and gratification theory (UGT); content, process, and social gratification (Stafford, Stafford and Schkade, 2004) to understand how the public engaged in COVID-19 related messaging on the National Department of Health’s Facebook page. Key findings of the study found that the NDoH, as a leading health institution in South Africa has utilized their Facebook page to introduce and encourage discussions around COVID-19 prevention messaging and misinformation and fake news awareness. The themes demonstrated the ways in which the NDoH Facebook was used to encourage discussions around the factors that influence COVID-19 prevention messaging, effects of the lockdown and COVID-19 mis/information, through the comments between the Facebook users. By reviewing the comments and the themes derived from them, it is evident that the NDoH, in initiating these discussions, has succeeded in utilizing their Facebook page to encourage discussions around COVID-19 prevention messaging and misinformation and fake news awareness. The common topics of discussion aligned with the rationale of the study that included; the influence of COVID-19 preventative apparel and physical prevention methods on prevention messaging; the influence of traditional medicine, herbal remedies and religious interventions on prevention messaging and the influence of scientific interventions and western medicine on prevention messaging which formed the theme of the factors that influence COVID-19 prevention messaging, experiences and consequences of lockdown which formed the theme effects of lockdown; as well as, fake news, general and mis/information regarding COVID-19 and conspiracy theories which formed the theme COVID-19 mis/information. Using the likes and shares of the posts and comments indicated that NDoH Facebook did encourage audience engagement of the posts regarding prevention strategies and misinformation during the level 5 lockdown in South Africa.
Implementation of the Universal Test and Treat (UTT) strategy by health promoters at the University of KwaZulu-Natal, Howard College Campus.
(2019) Nkosi, Sandile Sydwell.; Govender, Eliza Melissa.
This study explored the effectiveness of the implementation of Universal Test and Treat (UTT) policy in reducing or eliminating the spread of HIV infection at the University of KwaZulu-Natal, Howard College Campus. HIV infection is a major health issue in the province of KwaZulu-Natal, with more than 1.6 million people living with HIV. The most infected population group is between (15-49) years and the epidemic spread is estimated to be increasing by 2.3% annually. The UTT policy aims to reduce HIV infection through expanding prevention and treatment preferences. This study is informed by one theoretical framework. The P-Process model, a tool for planning strategic evidence-based health communication programmes. The model was advanced by Johns Hopkins University in 1982. This model is currently used to design, implement, evaluate/assess, innovative and creative behaviour change communication strategies and programmes aimed at reducing the incident of HIV infection. The model enabled the researcher to explore the implementation of the UTT approach and the communication strategies used. Then, lastly, assess participation in HIV testing at Howard Campus. The study made use of two semi-structured interviews and one focus group discussion with the health promoters at the university. The study found that the communication strategies adopted when implementing the UTT policy were effective in motivating the university community to attend health programmes. However, few people signed up for HIV testing. In addition, the health promoters faced challenges which resulted into the UTT policy not getting people tested.
Influences of geo-spatial location on pre-exposure prophylaxis use in South Africa : positioning microbicides for better product uptake.
(Govender, E.M., Mansoor, L.E. and Abdool Karim, Q. 2017. Influences of geo-spatial location on pre-exposure prophylaxis use in South Africa: positioning microbicides for better product uptake. AIDS Care 29(6), 734-740., 2017) Abdool Karim, Quarraisha.; Govender, Eliza Melissa.; Mansoor, Leila Essop.
Abstract available in pdf.
Knowledge, attitudes and perceptions of medical male circumcision as an HIV prevention procedure by white and Indian male students at the University of KwaZulu-Natal's Howard College.
(2014) Sakarombe, Phebbie.; Govender, Eliza Melissa.
This study establishes the knowledge, perceptions and attitudes of white and Indian male students at the University of KwaZulu-Natal’s (UKZN) Howard College on Medical Male Circumcision (MMC) as an HIV prevention procedure. The study is informed by data that represents HIV as infecting and affecting larger proportions of black people compared to white and Indian people. This creates a perception that, in South Africa and elsewhere, HIV/AIDS is an exclusively “black” disease or problem. The researcher assessed the level of knowledge and attitudes of White and Indian male students in order to establish acceptability of HIV prevention by these two demographics. MMC was used as an example. This choice was informed by the UKZN’s formal adoption and roll out of MMC as its latest HIV prevention strategy for students. By establishing the level of knowledge, perceptions and attitudes of white and Indian male students on MMC and its reported medical benefits (for example, the fact that it reduces the risk of infection by at least 60%), the researcher sought to address two related questions: To what extent do non-black student demographics care about HIV prevention? To what extent do white and Indian students reflect about HIV prevalence amongst themselves? The study is rooted in the Health Belief Model, a model which explains health behaviour change in terms of barriers, benefits and cues to action. The study is also informed by the Social Ecology Model, which recognises the interwoven relationship that exists between individuals and their greater environment, and how one influences the other. The findings suggest that the perception that white and Indian students are not at risk of HIV is relatively widespread. By extension, the perception that strategies such as MMC are meant exclusively for black students is held by many. The attitude towards HIV prevention in general and MMC in particular is indifferent. Ironically, knowledge of HIV prevention in general is high, but has failed to translate into uptake for MMC by white and Indian male students at Howard College. These findings demonstrate that the association of HIV with a specific race is both a sad fact and a sign of enduring prejudices and stigma. The study recommends that such stigma should be dealt with through critical health communication strategies and approaches that i) question the social reproduction of stigma and ii) are race sensitive. Critical sentitivity to (the complexities of) race in public health communication has the potential to radically minimise the reproduction of distorted knowledge, attitudes and perceptions of certain races as natural bearers of deadly viruses.
“Let’s talk about sex baby” - A comparative study of parents’ perceptions of parent-child sexuality communication with their adolescent children in rural and urban settings in eThekwini Municipality, KwaZulu-Natal.
(2017) Gumede, Nompumelelo Promise.; Govender, Eliza Melissa.
In South Africa, the teenage pregnancy prevalence rate stands at 47 births per 1000 girls per annum for girls aged between 15 and 19 years, as opposed to 15 per 1000 girls in the United Kingdom (UK), and 24 per 1000 girls in the United States (US). Unintended adolescent pregnancies pose threats not only to the adolescent, but also to the adolescent’s family, community and country. There is worldwide agreement that ending adolescent pregnancies should be part of national strategies for poverty reduction and social justice, as they undermine the achievement of several Goals for Sustainable Development (SDGs). Parent-child communication on sexuality has been shown to improve sexual and reproductive outcomes in adolescents. However, little research is available to indicate the effectiveness of this approach within the African context, more specifically, the KwaZulu-Natal context in South Africa. This study explores Zulu speaking parents’ perceptions of parent-child communication on sexuality in a rural area, Umnini, and in an urban area, Queensburgh in KwaZulu-Natal, South Africa. Using a qualitative approach to research, involving focus group discussions (FGDs) with rural and urban Zulu-speaking parents, selected using nonrandom sampling, this study explores parents’ perceptions of parent-child communication on sexuality. Framed through the theoretical lens of Mohan Dutta’s Culture-Centred Approach (CCA) to health communication, and Kincaid et al’s Social Ecology Model for Communication and Health Behaviour (SEMCHB), findings reveal that the cultural context influences parental communication on sexuality, and that parent-child communication on sexuality needs to be embedded within a multi-level approach to health communication at the individual, social, community and policy levels.
Mapping sexuality : understanding the knowledge, attitudes and perceptions of adolescent females towards sexuality and sexual and reproductive health in KwaZulu-Natal, South Africa.
(2017) Coetzee, Gina Kirsten.; Govender, Eliza Melissa.
Within sub-Sahara Africa, adolescent girls bear a disproportionate burden of sexual and reproductive health (SRH) risks, where the dual risk of HIV infection and adolescent fertility is faced. Specifically in South Africa, it is estimated that nearly 2 000 adolescent girls and young women between the ages of 15 and 24 years are infected by HIV every week. Furthermore, it was estimated that, by 2016, 15,6% of females between the ages of 15 and 19 years old in South Africa had begun childbearing. It is for these reasons that adolescent girls have been identified as a key population. This study was located at Mayville Secondary School, in the eThekwini district of KwaZulu-Natal (KZN). This area reports high levels of HIV infection, with notably high adolescent fertility rates at this school. This study had three aims: to understand the influences on adolescent female sexuality, to outline the perceptions of SRH self-care among adolescent females, and to understand the perceptions of artbased methodologies in researching sensitive topics. By understanding adolescent sexuality, this study aimed to highlight the influence this had on the self-care capabilities of adolescent females in maintaining their SRH. A culture-centred understanding of Orem’s self-care model guided the study. A participatory action research design was adopted, where data collection was threefold: a bodymapping workshop, group discussion and individual interviews. Key findings highlighted parental relationships and SRH-specific health communication programmes as the most influential in the understanding of sexuality among adolescent females. However, lack of agency in preventing risk, such as rape, and the negative perceptions of health care workers were identified as the main self-care deficits among adolescent females. Furthermore, this study identifies the effectiveness of art-based methodologies in researching and communicating with adolescent females about sexuality. This study highlighted the need for greater understanding of the socio-cultural perceptions of health care workers’ understanding of adolescent sexuality, and the provision of SRH services. This study emphasises the need to reduce significant socio-cultural barriers to SRH, in order to ensure adolescent females have the ability to be effective self-care agents in maintaining good SRH.
Microbicide acceptability and utility study : investigating perceptions of men and women across urban and rural settings in Durban and Nelspruit.
(2017) Mbewe, Londeka S.; Govender, Eliza Melissa.
Women remain disproportionately infected by HIV, accounting for more than half of the global infected population. Biologically women are more susceptible to HIV infection than men, however, their vulnerability is aggravated by various socio-cultural, structural and economic factors. Women in Sub-Saharan Africa carry a significant burden of the epidemic, making up 56% of all adult infections in the region, and up to 70% of all global infections. Young women aged 15-24 (AGYW) are hardest-hit by HIV, reportedly making up 25% of all new infections in the region, despite constituting only 17% of the adult population. Despite the alarming infection rates, prevention options for women remain limited. Available methods such as the male and female condom have proven to be impractical for women, disregarding gender power dynamics that deny women the power to initiate or negotiate safe sex practices. Given the limitation of these prevention methods, the field of HIV has shifted focus to developing prevention methods that allow women autonomy over their protection against sexually acquired HIV. Microbicides are female-initiated biomedical prevention technologies designed to reduce women’s reliance on male partner’s cooperation or consent for use. Currently, there is no licensed microbicide product for public use, however, a couple of microbicide agents (the tenofovir gel and dapivirine ring) have demonstrated efficacy in clinical trials. Various microbicide agents are still undergoing clinical trials, coupled with a large volume of complimentary qualitative studies that examine possible barriers and facilitators for acceptance and utilisation in real life settings. This study investigates the perceptions of microbicides amongst men and women across urban and rural settings in Durban and Nelspruit, South Africa. The study aims to identify the factors that may impede or facilitate microbicide use amongst women. The study also builds on a paucity of literature on studies assessing the impact of male involvement, and its impact on acceptance and uptake of microbicides amongst women. This study aims to contribute to the body of knowledge on the various contextual factors to consider when introducing microbicides across diverse populations. The study employed a qualitative research approach, using focus group discussions as a data collection method. The data was collected from purposively selected men and women aged 18-55 from eight urban and rural settings in KwaZulu-Natal and Mpumalanga; provinces with the highest HIV prevalence in South Africa. The data was transcribed and analysed through thematic analysis, which was used to develop themes that emerged. Drawing from the Social Ecological Model of Communication and Health Behaviour (SEMCHB), identifying the community as an interrelated entity that has great influence in shaping an individual’s health behaviour. The study applied the Culture-Centred Approach (CCA), which proposes that health intervention programmes should be designed in a way that is consistent with a community’s cultural framework. The study found that even with initiatives to empower women, societal structures and masculinity still hold great influence on women’s decisions to adopt new prevention methods as they find it necessary to consult with men regarding decisions about their sexual health. Male involvement is questionable, demonstrating potential for acceptance and male partner support, while also posing a threat on women’s autonomy for protection against sexually acquired HIV. The study argues that while male involvement can promote acceptance and adherence to microbicides in some contexts, this may be detrimental in other contexts, affecting sustainable adherence and subjecting women to social harms such as intimate partner violence.
Processes and participation in HIV and AIDS communication : using bodymapping to explore the experiences of young people.
(2013) Govender, Eliza Melissa.; Tomaselli, Keyan Gray.; Durden, Emma.; Dalrymple, Lynn I.
HIV and AIDS is one of the biggest challenges facing South African young people today (Govender, 2010). Young people are at risk, partly through their own behaviour and partly through the attitudes, expectations and limitations of the societies in which they grow up (Panos AIDS Briefing, 1996).The are many HIV prevention programmes developed globally and nationally, specifically for young people but the pandemic still escalates rapidly. The fourth decade now calls for multidimensional approaches when communicating HIV prevention for young people. This thesis explores how young people can contribute to this multidimensional approach through their active participation in the various phases of developing HIV projects. The study does this through a sample of eight youth-focused HIV organisations in KwaZulu-Natal and a sample of students from the University of KwaZulu-Natal, to gain more insight into participation of young people in the development of HIV programmes. Bodymapping, a visual and art-based method, was used to explore young people’s understanding of HIV, their perceptions of HIV programmes and the possibilities of their participation in the developing of further HIV projects. The study used a grounded approach and applied principles of participatory action research to collect data in four phases. The first phase used interviews and focus group discussions with eight sample organisations to give insight into the programmes offered to young people and how they engage and make sense of their participation within these programmes. The second phase draws on previous bodymapping workshops that have been conducted with students from UKZN and young people in various communities to explore the application and relevance of bodymapping. In the third phase, data is presented on two bodymapping workshops conducted, to engage with young people about their contribution to the development of HIV programmes. The final phase draws on two focus group discussions, conducted with bodymapping participants, to examine their experiences and interpretation of the bodymapping process. Some of the key findings indicate that a blanket approach to HIV programmes will not always work, as young people’s sexual behaviour needs to be explored within a wider socio-ecological framework that recognises the inter-relational and interconnected system in which they make their sexual choices. The data indicates that youth and organisations strongly support the importance of participation and the inclusion of participants when developing HIV projects. However, discussions about participation indicated that while young people could identify the importance of participation, they still lacked an understanding of how to participate and how they could learn more about their lived experiences through participation. This was evident in the data where there was a distinction in how participation was defined from those in the UKZN group and those from rural KZN. In understanding what constitutes participation, young people are better positioned to aid the process of developing effective HIV related projects that are participant specific. I argue that bodymapping can be used as a process to initiate and aid the participation of young people in the various phases of developing HIV projects. A three level model for applying bodymapping and planning processes has been developed to encourage participation with young people where the first step ensures that young people define what participation means to them. This becomes the foundation for how communication practitioners and academics make sense and theorise participation from a participant informed perspective. Bodymapping was pivotal in this process of engaging young people in self-reflection and introspection which encouraged a process of dialogue towards better understanding and defining participation from a participant perspective. Bodymapping in this way can be identified as a catalyst that encourages dialogue as part of communication for participatory development.
(Re)positioning communication for enhanced multidrug-resistant tuberculosis treatment adherence in South Africa: towards an integrated communication model for young women.
(2019) Mugoni, Petronella Chipo.; Lubombo, Musara.; Govender, Eliza Melissa.
Tuberculosis (TB) is a significant public health threat in South Africa, which has been the leading cause of natural mortality over many years (Statistics South Africa 2018; Statistics South Africa 2017; ENCA 2015a). Although TB has been largely eradicated in the Global North and available literature explains how this was achieved, in developing countries like South Africa incidence of not only TB, but drug-resistant forms of the disease continue to grow (Shah et al. 2017). There are many explanations for these trends, including unavailability of less noxious anti-TB medications, serious side effects and lengthy treatment timelines, drug stock-outs, context-determined structural, socioeconomic, cultural and gender-based barriers to treatment adherence and inadequate or ineffective patient and community education about the disease (Shringarpure et al. 2016). Concerns occur on the backdrop of health systems that overly privilege biomedical responses to TB, to the detriment of all other interventions. Scholars protest that ‘The TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perceptions to determine why people who seek treatment may stop taking treatment’ (Cramm et al. 2010:2). Extant literature acknowledges the unsuitability, on its own, of the biomedical approach to reducing burdens of TB in epidemic countries like South Africa (Daftary et al. 2015). This recognition is accompanied by impetus to develop and apply theory-based strategies to encourage long-term adherence to TB treatment. Scholars insist that there are several health behaviour theories with potential to improve understanding in this area (Daftary et al. 2015; Munro et al. 2007). This research responds to the question of how health communication and promotion strategies can practically contribute to improving multidrug-resistant TB (MDR-TB) treatment adherence and clinical outcomes among a defined vulnerable population in KwaZulu-Natal province, South Africa. It aims to contribute knowledge to the under-researched area of non-biomedical responses to sub-optimal adherence to long-term DR-TB treatment in high TB/HIV burden areas (O’Donnell et al. 2017). Primary qualitative data was collected through focus group discussions and key respondent interviews with 20 purposefully selected participants in eThekwini Metro, KwaZulu-Natal, from March to September 2018. Ten of the participants comprised the case study of this research; culture-sharing young women, many of them isiZulu-speaking, aged 18 to 34 years from low socioeconomic communities being treated for MDR-TB at one public hospital in the Metro. The study proposes a ‘how to’ for MDR-TB health promotion in high burden areas. vii It finds that vulnerable young women's sub-optimal adherence to MDR-TB treatment is exacerbated by patriarchy, stigma and cultural beliefs and practices. Culturally prescribed family collaborative approaches to health-seeking among Zulu people urge for the incorporation of female elders, intimate male partners and older children into young women’s treatment. In contexts like eThekwini Metro where many MDR-TB patients demonstrate strong cultural beliefs and practices, emphasising biomedical treatment for individual patients as the denominator of treatment requires reconsideration. Findings also suggest that MDR-TB programmes would benefit from borrowing from HIV communication interventions by implementing standardised individual, couples’ and family counselling at intervals during the nine to 36 months of treatment to enhance patients’ adherence. Consideration should also be given to engaging traditional health practitioners as important partners in health promotion. Further, educating patients and communities about MDR-TB treatment should be bolstered through health promotion and communication via school curricula, culturally proximate television and radio (soap operas, dramas and hard news) programmes and Facebook and WhatsApp. Social media is important because it allows for low-cost group, one-on-one and anonymous exchanges and discussions of health information.