Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy

Abstract

Following calls for targeted HIV prevention interventions in so-called "hotspots", we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities' sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesion and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people's perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful.

Persistently high incidence of HIV and poor service uptake in adolescent girls and young women in rural KwaZulu-Natal, South Africa prior to DREAMS

“…Our findings also confirm the socio-economic challenges that AGYW living in this deprived area of northern KZN face, with 9 in 10 having no employment (this includes part-time employment) and nearly 2 out of 3 of those aged 20–24 reporting at least one recent migration episode. Separate work that we have conducted [ 17 ] suggests that the community are aware that urban environments in this setting act as transition points for young adults seeking employment. These areas are perceived to be riskier environments, not least because of the loss of the community safety networks that adolescents and young adults can rely on in the more rural areas [ 17 ].…”

“…Separate work that we have conducted [ 17 ] suggests that the community are aware that urban environments in this setting act as transition points for young adults seeking employment. These areas are perceived to be riskier environments, not least because of the loss of the community safety networks that adolescents and young adults can rely on in the more rural areas [ 17 ]. Similar, to other studies from South Africa and elsewhere in sub-Saharan Africa, we found that having secondary education was associated with higher contraception use and greater awareness of HIV status [ 18 ] and being in school was found to be protective of AGYW [ 19 ].…”

Evaluating Complex Health Interventions With Randomized Controlled Trials: How Do We Improve the Use of Qualitative Methods?

“…While many social scientists would take an interest in describing the health perceptions of a particular population, when placed in relation to intervention evaluation this type of rich description is often perceived to be most valuable for designing the intervention itself. A diverse range of qualitative methods are available to do this early formative work, including participant observation (Dahlke, Hall, & Phinney, 2015;Peacock, Khumalo, & McNab, 2006), spiral walks (Ngwenya et al, 2018), audio diaries (Mupambireyi & Bernays, 2018) Research outlines a comprehensive means of providing rich description of the social context to inform trial design decisions early on using participatory qualitative methods. They suggest a streamlined and practical approach to analyzing the huge amount of data that can emerge from these participatory activities through generating 'community profiles' that can then be used to inform a trial.…”

Translating DREAMS into practice: Early lessons from implementation in six settings

“…Given the scale of problems facing AGYW, there is an urgent need to consider the context in which interventions are delivered to inform scale-up of evidence-based combination HIV prevention [24, 27–28]. By documenting early implementation in six diverse evaluation sites, we saw that various models of delivering the DREAMS core package emerged across sites—each with its own advantages and disadvantages based on the contexts.…”