The differences in HIV prevalence between South Africa's racial/ethnic groups (19.9%, 3.2%, and 0.5% among 15-49-year-old blacks, coloureds and whites, respectively) are as big as those between the countries with the highest and lowest levels of HIV prevalence worldwide. These large racial/ethnic differences are largely determined by different sexual network structures. In networks among black South Africans, sexual partnerships are more likely to be arranged concurrently - a configuration that leads to exponential increases in the spread of HIV. An examination of the historical origins of polygamy (where it is normative for partnerships to be arranged concurrently) and monogamy (serial or lifetime) reveals that it is the practice of universal monogamy in stratified societies which is the outlier. The ideology and practice of universal monogamy originated in Europe as the result of several factors, most prominently conflicts between the Christian Church and the nobility. After its imposition in Europe, the European colonial project would see this ideology disseminated around the world. Under the influence of liberalism it would mutate into a secular and unacknowledged value-programme of monogamy as a universal norm. This value-programme and practice of monogamy (mostly serial) is still the norm for white South Africans; thus, this sexual behaviour 'spandrel' (by-product of other historical processes) is a large contributor to the lower levels of HIV prevalence among whites. In pre-colonial African societies, polygyny was normative, and the Christian value-programme of monogamy never achieved the hegemonic status it did in Europe and other areas of conquest. Married black African men who converted to Christianity were no less likely to have additional sexual partners, but only more likely to conceal them. The ongoing secrecy about having concurrent partners has contributed to the connectedness of sexual networks among black Africans at large and in this manner has contributed to the rapid spread of HIV.

Despite advances in combination antiretroviral therapy (cARTs), children in Sub-Saharan Africa continue to experience neurocognitive deficits due to the virus crossing the blood-brain barrier (BBB). Based on the principles of neuroplasticity, our study sought to investigate the feasibility of introducing a pencil and paper cognitive rehabilitation tool called Brainwave-R, to ameliorate the effects of HIV neurocognition amongst children from a low socioeconomic background in rural South Africa. Five HIV positive and six HIV negative children were assigned to either an experimental or control group. The experimental group underwent two months of cognitive rehabilitation therapy to remediate sustained attention, using Brainwave-R, whereas the noncontact control group took part in placebo activities. Sustained attention measures were taken before and after the intervention training sessions, using a sustained attention subtest. The control group later received cognitive intervention three months following the conclusion of the research study. A Mann Whitney U Test revealed that the experimental group (Mdn=38.50) did not differ significantly from the control group (Mdn=37.00) after the cognitive rehabilitation intervention, U= 12.00, z= -.55, p= 0.66, r= -0.17. A Wilcoxon Signed Rank Test found that there was a significant improvement from pretest scores (Mdn=31.00) to post test scores (Mdn=38.00) following the rehabilitation for HIV positive participants in the sample, T=15.00, z = -2.02, p= 0.04, r= -0.90. The findings of our study raise the feasibility of a pencil and paper cognitive rehabilitation method to supplement antiretroviral (ARV) therapy in paediatric HIV.

The linked ideas that all members of society should only engage in monogamous relationships and that these should all be based on romantic love are decided outliers from a historical perspective. Despite this, there is a widespread contemporary belief that monogamy based on love is the most ethical and natural form of partnering for humans-mononormativism. It has long been accepted that our values influence how we frame and interpret scientific questions. In the article we ask, using the example of mononormativism, how does an individual's sexual ethics influence how they pursue HIV epidemiology? Using a Social Intuitionalist theoretical framework, we argue that a belief in monogamy-as-normative has contributed to certain researchers dismissing the evidence that the generalized HIV epidemics in parts of Africa are due to higher rates of non-monogamy.

Background: Sexual partner concurrency has been implicated in the genesis of generalized HIV epidemic in South Africa. Most South Africans, however, disapprove of concurrency in surveys. These surveys test individuals’ explicit attitudes which are susceptible to a number of important biases such as the social desirability bias. Assessment of implicit cognitions have been found to be better predictors of behaviour in socially sensitive domains. We hypothesized that South Africans may have implicit attitudes more tolerant of concurrency than lower concurrency prevalence populations. Methods: To test this hypothesis, we developed a concurrency-implicit association test (C-IAT) and compared the C-IATs of samples of South African and Belgian university students. Results: We found a large and statistically significant difference in the C-IAT between the South Africans (D600-score = -0.009, indicating absence of preference for concurrency or monogamy) and Belgians (D600-score = 0.783, indicating a strong preference for monogamy; t-test = 13.3; P < 0.0001). The effect size measure, Cohen’s d, was found to be 0.88, which is considered a large effect size in this field. Conclusions: Our results are compatible with the thesis that differences in implicit attitudes to concurrency play a role in the genesis of generalised HIV epidemics.

Background: Sexual partner concurrency has been implicated in the genesis of generalized HIV epidemic in South Africa. Most South Africans, however, disapprove of concurrency in surveys. These surveys test individuals’ explicit attitudes which are susceptible to a number of important biases such as the social desirability bias. Assessment of implicit cognitions have been found to be better predictors of behaviour in socially sensitive domains. We hypothesized that South Africans may have implicit attitudes more tolerant of concurrency than lower concurrency prevalence populations. Methods: To test this hypothesis, we developed a concurrency-implicit association test (C-IAT) and compared the C-IATs of samples of South African and Belgian university students. Results: We found a large and statistically significant difference in the C-IAT between the South Africans (D600-score = -0.009, indicating absence of preference for concurrency or monogamy) and Belgians (D600-score = 0.783, indicating a strong preference for monogamy; t-test = 13.3; P < 0.0001). The effect size measure, Cohen’s d, was found to be 0.88, which is considered a large effect size in this field. Conclusions: Our results are compatible with the thesis that differences in implicit attitudes to concurrency play a role in the genesis of generalised HIV epidemics.