Browsing by Author "Makhakhe, Nosipho Faith."

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An exploration of factors that influence food choices among students of the University of KwaZulu-Natal, Howard College Campus, Durban, South Africa.
(2021) Malambe, Lindokuhle Sizolwethu.; Meyer -Weitz, Anna.; Makhakhe, Nosipho Faith.
Background: Food is an important aspect of our life and unhealthy food choices are a major cause of Non-Communicable Diseases (NCDs), that lead to rising mortality globally and in South Africa. The transition from high school to university makes food choices very challenging to university students, who were used to home-prepared meals. As students move away from home and become more independent as they enter university life, they tend to opt for easy and convenient foods served in cafeterias or fast-food outlets on and around campus. These fast foods are generally regarded to be unhealthy due to high fat and carbohydrate compositions. These dietary habits are detrimental to university students’ health and wellbeing, which increase their susceptibility to chronic illnesses in later years. The aim of the study is to explore qualitatively the factors that influence food choices among students at the University of KwaZulu-Natal, Howard College Campus in Durban, South Africa in applying the Food Choice Process Model (FCPM). Objective: The study explores the factors that influence food choices and whether these factors propel or hinder healthy food choices among university students. It aims to examine students’ beliefs, attitudes, and knowledge regarding food and healthy eating, and how best to inform students about making healthy food choices. Methods: An in-depth semi-structured interview guide was used for data collection which allowed for flexibility of responses since it is iterative in nature and consists of open-ended questions, that gives opportunities for further probing and exploration. Purposive sampling was used to invite 16 university students to participate in the study and thematic analysis was used to analyze the data. Results: The findings suggest that university students describe their food choices with respect to life events or experiences and personal food systems. As a life experience, university students perceived modifications to the food environment that includes an increase in fast foods establishments and convenient stores and restaurants, which also marks a shift from traditional to modern foods. University students indicated how factors such as taste, time, convenience, and the daily living determine their dietary patterns. Conclusion: University students seem to have adequate knowledge on what constitutes healthy dietary patterns, but do not practice these habits despite their awareness of the benefits of healthy eating and the risks associated with unhealthy eating. The study further revealed the importance of different stakeholders and health supportive environments in promoting healthy food choices among university students.
Inner-city female sex workers in Durban, South Africa : a qualitative inquiry.
(2017) Makhakhe, Nosipho Faith.; Meyer-Weitz, Anna.
Background: Female sex workers (FSWs) in sub-Saharan Africa and South Africa are classified as a most-at-risk-population with regards to HIV acquisition and transmission. This is due to the nature of their work, which involves multiple partnerships and risky sexual behaviour. In order to fight against HIV and AIDS and to reduce the rate of new infections among FSWs, their clients and the broader population, it is vital that FSWs are exposed to effective HIV-related health promotion interventions. Objectives: Due to the criminalised and stigmatised nature of sex work in South Africa, FSWs are a hidden population. This makes it difficult to design and implement appropriate HIV-related interventions for this group. Using the ecological systems theory as a framework, the objective of this study was to characterise Durban inner-city FSWs by providing a detailed and current understanding of this vulnerable group, pertaining to who they are, where they work, the challenges they face in the sex trade as well as the type of health-care services they need. This will aid in informing the design, adaptation and implementation of more effective targeted HIV-related health-promotion interventions. Methods: This qualitative-descriptive case study was conducted among 39 participants recruited through snowballing. The majority of study participants were black South African isiZulu-speaking street-based FSWs. This study made use of the constructivist paradigm, which enabled the researcher to understand the world of sex workers from their Individual-lived experiences. Data were collected through participant observations, focus-group discussions and key informant interviews. Data analysis was conducted using a framework analysis. Results: The majority of FSWs trading in Durban inner city are born in KwaZulu-Natal, with some coming from neighbouring provinces and other African countries as well as China and Thailand. Most participants were street-based and sex occurred in unsafe environments such as the veld or abandoned buildings. These venues expose FSWs to violence especially from clients who demand unprotected sex which increases their risk of HIV. Due to the criminalised nature of sex work in South Africa, FSWs are often victims of crime and suffer extortion from the police in the form of bribes to avoid arrest. Support organisations such as Lifeline and TB/HIV Care provide HIV counselling and testing (HCT), and peer education to FSWs and refer FSWs for further care. However, FSWs prefer receiving health care directly v from these support organisations because of long waiting times at public health facilities, as well as the perceived stigma and discrimination from health care providers. Conclusion: The challenges faced by Durban inner-city FSWs are similar to challenges faced by FSWs trading in other parts of South Africa and sub-Saharan Africa. Structural challenges such as the criminalisation of sex work make it difficult for FSWs to report the violent sexual crimes they experience at the hands of their clients. The police use condom possession as proof of engagement in sex work and go as far as confiscating condoms from FSWs. All these factors exacerbate FSWs exposure to HIV. Furthermore, HIV awareness among FSWs has not necessarily translated into behavioural change, especially when faced with the challenge of providing unprotected sex for more money. Health-promotion interventions need to strive to bridge the gap between knowledge and behavioural change. Even though this group has access to HCT, condoms and peer education, accessing follow-up care after being referred is a challenge due to time constraints and issues of perceived and internalised stigma. Effective health-care response for FSWs needs to be immediate and comprehensive to minimise the need for referral. Support organisations can work closely with sex worker sensitised clinics on site to provide health care. A sex worker clinic similar to the one in Hillbrow, Johannesburg or drop in centres would be beneficial for this group of sex workers. The government should also fast-track the provision of Pre-exposure prophylaxis (PrEP), test and treat as well as access to self-test kits to FSWs through health-support organisations.
Let’s talk about pre-exposure prophylaxis: a participatory HIV prevention intervention with and for female sex workers in Durban, South Africa.
(2021) Makhakhe, Nosipho Faith.; Sliep, Yvonne.; Meyer-Weitz, Anna.
Introduction: Since the discovery of HIV/AIDS in the early 1980s, scientists have been in search of a cure. Significant scientific efforts have so far led to the discovery of antiretroviral treatment that suppresses the replication of HIV that leads to AIDS. Recently, Tenofovir or Tenofovir-emtricitabine as antiretroviral treatment for HIV-positive persons can now be used as prevention in the form of oral pre-exposure prophylaxis (PrEP). This HIV prevention therapy is currently being administered to people considered at high risk of HIV, such as men who have sex with men, intravenous drug users and serodiscordant couples. In 2015, the WHO expanded its oral PrEP guidelines to include female sex workers (FSWs) who are a high-risk group for HIV worldwide. In response to these WHO guidelines, the South African government approved oral PrEP distribution among FSWs in 2016, as part of combination prevention with the expectation that FSWs would take up PrEP and this will reduce the rate of new HIV infections. However, the response to PrEP was underwhelming. Identifying the reasons for the low uptake of PrEP among FSWs is the primary objective of this study. This was followed with engaging FSW peer educators in a participatory intervention mapping process to design an intervention plan to address these challenges to uptake and potentially inform PrEP programming in Durban in the KwaZulu-Natal province which is a high HIV prevalence area in South Africa. Methods: This study was a participatory action intervention research that was conducted in two phases. The first phase was a qualitative needs analysis conducted from May to November 2018 to identify the challenges associated with PrEP uptake and retention, as well as to ascertain the motivating factors for PrEP use among FSWs. Interviews were conducted with 39 participants, 30 individual participants, and nine focus group participants. Eleven participants were FSW peer educators including one health worker and one researcher from sex work and PrEP distributing organisations (13 in total); the rest of the participants were FSWs (n=26). Consent was obtained from all participants. Data were analysed thematically. The second phase of this study was an intervention mapping phase during which a PrEP intervention plan was developed with eight FSW peer educators who were at the forefront of PrEP promotion among FSWs. This intervention plan was informed by data obtained from the needs analysis. A total of six meetings took place in which the individual, interpersonal and environmental determinants that have an impact on PrEP uptake, adherence, and retention were discussed. This resulted in the performance and change objectives, including a theory of change logic framework that systematically depicted the process of change. Furthermore, theory-based methods and activities were established which culminated into a PrEP intervention workshop programme. Additionally, the implementation and evaluation plans were also formulated. Results: The needs analysis showed that the majority of the participants could not distinguish between PrEP and antiretrovirals. This inability contributed to the stigma against PrEP. Another challenge was that distribution was fragmented with the research organisations distributing PrEP to FSWs through peer education and yet, PrEP was not well understood or promoted by health care providers from public health facilities. This resulted in the mistrust of PrEP efficacy among FSWs and delayed uptake and lessened retention. The FSWs taking PrEP were met with hostility from their friends who failed to understand that PrEP as an antiretroviral can be taken to prevent HIV. This resulted in HIV positive FSWs on antiretrovirals accusing PrEP users of deception, and HIV denialism. They also experienced similar reactions from intimate partners. These accusations were believed to arise because of lack of knowledge and competition for clients, given the preferred market for HIV-negative FSWs. PrEP users reported feeling stigmatised and thrust into interpersonal conflicts with their peers, which caused broken relationships, this led some FSWs to discontinue PrEP, while others took it secretly. The FSWs who remained on PrEP mentioned various motivating factors for adherence, such as PrEP being an empowering tool that gives them agency to prevent HIV and bodily autonomy as well as a sense of hope for the future, because HIV was no longer a consequence of sex work. The PrEP intervention mapping process which resulted in a workshop programme showed how FSWs can engage in reflexive dialogues that help promote agency, power, self-efficacy, hope and responsibility to the self and others, to encourage effective engagement in HIV prevention. Conclusion: This study recommends for a wider promotion and dissemination of PrEP through public health care facilities. This will encourage the normalisation of PrEP and curb the stigma associated with PrEP being for high-risk groups. Biomedical interventions should be coupled with behavioural strategies that engage users on the personal, interpersonal, and environmental challenges that have an impact on behavioural change. FSWs should be involved in the design and implementation of their own interventions to ensure effective approaches and to create a sense of responsibility, power and ownership. It is important for future interventions to realise that simply promoting a prevention method because it is medically effective will not warrant uptake and adherence on the part of end users; therefore, interventions need to engage with the complexity of human behaviour. This makes it imperative for practitioners to invest in understanding the patient’s deeper motivations that encourage or discourage behavioural change.
Mapping the integration of the fields of mental health and psychosocial support with peacebuilding through co-creation.
(2022) Dlamini, Noxolo Zanele.; Sliep, Yvonne.; Makhakhe, Nosipho Faith.
Protracted conflict, combined with the resultant psychological scarring have been a part of present life for many societies. Historically Peace Building and MHPSS (Mental Health and Psychosocial Support) have been used to address the effects of conflict separately, yet they offer different yet complementary solutions to the problem. The purpose of this research was to explore the integration of MHPSS and PB from the viewpoint of the participants of cocreation workshops conducted in 2019 and 2021 on the same topic. A qualitative descriptive design was utilised in this study as it allowed the researcher to explore how the participants responded to the co-creation methodology used in the workshops while gaining insight into their opinions on integration. The study was conducted using documented reports and transcripts of the co-creation workshops, followed by in-depth online interviews. A thematic analysis was used, and findings show that changing funding mandates were necessary as these impact on what humanitarian work is done. Through advocacy, information sharing, and policy change, the way in which donors approach this work could be changed. Much needs to be done to capacitate those working in the field and to raise awareness of the value of linking these disciplines. Greater understanding between the two fields and knowledge of the language, theories and tools used will need to be shared. The co-creation method that was used for the present study seems to have benefitted the process of integration in the participating organisations, through reflection, information sharing, research and writing.