PhD student (in Sociology and the CSSR) Gabby Kelly was quoted in an article by Rebecca Davis, published in the online Daily Maverick, debunking reports that some South African women drink whilst pregnant in order to harm their children. Sky News published a sensationalist report claiming that women are so desparate to access the more generous care dependency grant rather than the more modest child support grant.that they drink whilst pregnant in order to ensure that their children are born with foetal alcohol syndrome, a disability which may render them eligible for the care dependency grant. But the consensus among academic researchers is that there is no evidence for this.
AIDS and Society Research Unit
Fidelis Hove, Nicoli Nattrass, Tafara Ngwaru & Eduard Grebe. Photo by Janneke van Rooyen.
On 14 December, three CSSR students, all supervised by Prof Nicoli Nattrass, were awarded PhDs in Economics. The three students were supported financially by the CSSR and worked on various aspects of the HIV/AIDS epidemic in Africa. Fidelis Hove's thesis examined the use of HIV prevalence estimates in regression models (including evidence from Zimbabwe and on the relationship between armed conflict and HIV). Tafara Ngwaru investigated the impact of socio-economic status and other structural drivers on HIV in Southern Africa, while Eduard Grebe's thesis focused on 'civil society leadership' on AIDS in South Africa and Uganda. Eduard will rejoin the CSSR as a postdoctoral fellow in January 2013.
The CSSR has just published seven Working Papers written by students in the CSSR. Amy Thom has co-authored two papers on her research into food boxes and food security. Beth Vale's three papers draw on her research into community health workers. Sam Telzak's paper examines social mobility, while Zoe Gauld's examines the possibility of replacing a purely race-targeted system with a points-based system for admissions into medical schools.
CSSR researchers continue to conduct and publish research on social, economic and political aspects of HIV-AIDS and related illnesses, and to edit and contribute to online media. Publications in 2012 included one book (Nicoli Nattrass' The AIDS Conspiracy: Science Fights Back), seven articles in peer-reviewed journals, six CSSR Working Papers, and six students' theses and dissertations, as well as many shorter publications. A full list is attached.
In the late 1970s, North Western Tanzania and Southern Uganda probably constituted the epicentre of the African HIV epidemic. By the time Museveni’s National Resistance Army took Kampala in 1986, AIDS constituted a real crisis. But the new government's willingness to confront the disease (which contrasted with the denial exhibited by most African governments), its frank prevention campaigns and its emphasis on "partnership" with civil society contributed to a stellar international reputation and significant investments by donors. But its reputation probably gained most from the declines in HIV prevalence observed in Uganda from the early 1990s. This paper interrogates whether the Museveni government's reputation for excellent leadership on AIDS is deserved. It does so by examining the role of underlying epidemiological trends in explaining the HIV prevalence declines (by implementing a standard epidemiological model) and the evolving role of non-state actors in the Ugandan AIDS response. Particular attention is paid to institutional arrangements and a political culture that discourages vocal civil society and to donor dependence and donor dominance of the policy agenda.
This paper investigates community health workers’ negotiation between the prescribed ‘manual’ for care and the lived realities of their field, exploring how standards of public health are re-appropriated through the micro-politics of everyday practice. What inventiveness, agency and tactical manoeuvres are woven between abstract ideals and situational demands and what are the implications for our understanding of carework? Using in-depth qualitative methods, the paper investigates the practice of care amongst a cohort of fifteen community health workers, serving as antiretroviral adherence supporters in two Cape Town primary healthcare clinics. It shows community health work, as a model for care, to be complex and demanding – a composite of practices prescribed by a range of institutions with diverging interests. This onerous care manual is expected to be delivered by a cadre of lay health workers positioned at the interface between communities and clinics - with minimal training, limited resources and little authority. Within this demanding occupational terrain, careworkers have crafted space for agency and tactics. Through a series of improvisations, respondents mediate between the often-incongruent demands of patients, employers, funders, and state policy, whilst also negotiating their own self-care and aspirations for upward mobility. In a policy context that has sought to standardise, systematise and regulate carework, this practice is contrastingly inventive and adaptive. The makeshift, unplanned, and chancy nature of carework is often far from its original design, calling into question how the success of this model should be understood.
Nicoli Nattrass recently gave a Potter Talk on the topic "The Unemployment Challenge in South Africa". The video is now online and can be watched below. The Potter Talks are a series of exciting and thought provoking short lectures given by prominent academics, thought leaders, innovators and students on issues affecting civil society in South Africa, organised by the David and Elaine Potter Foundation. The goal of the talks is to inspire, educate and engage.
CSSR researchers have conducted considerable cross-national research on spending on HIV and AIDS, including Matthew MacDevette's CSSR Working Papers numbers 294 and 297 (both 2011) and Nicoli Nattrass's letter (written with Greg Gonsalves) in Science (in 2010). Sarah Harper's new study of "The Fungibility of Aid Earmarked for HIV/AIDS Control Programs", published online in World Development, shows that donor funding on HIV and AIDS is generally not fungible, i.e. increased donor funding for HIV-AIDS programmes has generally not led to domestic governments in Africa and elsewhere switching their own funds to other programmes.
ASRU PhD student Eduard Grebe last week presented research results and reflections on the state of global AIDS advocacy at two events in Switzerland. On 17 April he presented a paper titled "The challenge of transnational prevention and treatment advocacy in an era of resource constraints and shifting global priorities: Reflections from South Africa" at the 2012 aidsfocus.ch conference in Berne under the theme "HIV, AIDS and Advocacy. Bringing about change in policies and practice". His comments focused on the challenges faced by the treatment access movement in the face of a backlash against AIDS-specific funding, a severely constrained financial environment (with industrialised countries reducing their contributions to global AIDS efforts), turmoil at the Global Fund and a shift in attention to other challenges like climate change.
On 19 April he presented a paper titled "The Treatment Action Campaign's struggle for AIDS treatment in South Africa" to the Etnologisches Seminar Basel at the University of Basel, in which he drew on his PhD research and joint work with Nicoli Nattrass to demonstrate the movement's effectiveness at the political and community levels, as well as its "political repertoire" and style of organisation.
This paper investigates the (potential) relationship between the quality of national HIV/AIDS responses (specifically: HAART and PMTCT coverage as indicators of treatment and prevention responses respectively) and the presence of Civil Society Organisations (CSOs) active on HIV/AIDS. Owing to limitations in data availability, cross-country regression analyses are restricted to Sub-Saharan Africa (N=42). A number of indicators of CSO presence are emnployed, principally the number of organisations listing HIV/AIDS as a focus area in a 2004 UN directory of African NGOs and the number of CSOs responding to, as well as the number of employees reported by CSOs responding to a 2009 UNAIDS civil society survey. Models are constructed that control for population size, national income, international AIDS assistance, burden of disease and other factors expected to influence the outcomes. Results are ambiguous, with some models indicating a positive relationship between the presence of CSOs and HAART and PMTCT coverage and others no, or even a negative relationship. These results therefore do not support the conclusion that the mere presence of CSOs result in better government responses. However, despite time-ordering, the models may suffer from an insurmountable endogeneity problem in that it is equally plausible that CSOs become active in response to poor government responses, and may therefore be associated with relatively poorer rather than better outcomes.
ASRU director Prof Nicoli Nattrass has written a new book, The AIDS Conspiracy: Science Fights Back, in which she explores conspiracy theories on the origins of AIDS (such as that it was manufactured by the US government), their surprising longevity, the campaign by scientists to combat spurious conspiracy theories and the consequences of these myths for behaviour. The book is published in the United States by Columbia University Press and will be released in South Africa in April by Wits University Press. An ebook is available in the Amazon Kindle store.
There is a substantial body of evidence showing that HIV causes AIDS—and that antiretroviral treatment (ART) has turned the viral infection from a death sentence into a chronic disease.1 Yet a small group of AIDS denialists keeps alive the conspiratorial argument that ART is harmful and that HIV science has been corrupted by commercial interests. Unfortunately, AIDS denialists have had a disproportionate effect on efforts to stem the AIDS epidemic. In 2000, South African President Thabo Mbeki took these claims seriously, opting to debate the issue, thus delaying the introduction of ART into the South African public health sector. At least 330,000 South Africans died unnecessarily as a result.
The “hero scientist” of AIDS denialism, University of California, Berkeley, virologist Peter Duesberg, argues that HIV is a harmless passenger virus and that ART is toxic, even a cause of AIDS. He has done no clinical research on HIV and ignores the many rebuttals of his claims in the scientific literature.4,5 As I describe in my new book, The AIDS Conspiracy: Science Fights Back, this has prompted further direct action against Duesberg by the pro-science community.
Town, South Africa, reveals a clear association between HIV prevalence
and the number of years of sexual activity, which is consistent with
arguments that emphasise sexual behaviour as the key driver of the
epidemic. Having engaged in a concurrent sexual partnership increases
HIV risk for young men, and full circumcision reduces it. HIV risk
for young women (but not young men) is also affected by socio-economic
status, measured in terms of participation in post-school education
(relative to making a transition from school to work, or school to
employment). Among young men, higher socio-economic status is
associated with safer sex, in terms of condom use, but the effects of
this are offset by the effect of having more than two sexual partners
and engaging in concurrent partnerships. The analysis suggests that
both sexual behaviour and socio-economic status matter, but that these
dynamics are highly gendered.
We explore the relationship between exposure to violence during childhood and educational outcomes in the context of higher than average rates of violence in Cape Town, South Africa and the disproportionate exposure to violence of young South Africans (black and coloured youth in particular). We match official police crime statistics at the neighbourhood level to the Cape Area Panel Study (CAPS) to provide a unique descriptive analysis of violence in Cape Town and determine the extent of selection bias using matching techniques. Using three measures of educational outcomes (numeracy and literacy test scores, dropout and high school exam results), we: (i) estimate kernel density functions of continuous educational outcomes measures by race and exposure to violence; and (ii) remove constant differences in unobserved family and neighbourhood background that may bias the results by using sibling and neighbourhood fixed effect models. In the baseline regressions, the measures of exposure to violence are significant and have a large negative effect on educational outcomes (with the exception of literacy scores). In the sibling and neighbourhood fixed effect regressions, the effect remains for two of the four measures of exposure to violence during childhood. These findings are robust to the inclusion of birth order effects.