The social pathology of syphilis in Africans

Kark, Sidney L.

doi:10.1093/ije/dyg025

Cited by 25 publications

(19 citation statements)

References 27 publications

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“…The ‘oscillatory migration’ lifestyle where workers living temporarily in the cities and on the mines periodically visited their wives and families in rural ‘homelands’, was key to the spread of both TB (3) and sexually transmitted infections (4) in the last century. The social, economic and environmental conditions created by apartheid in the form of overcrowded squatter settlements, migrant labour and deliberately under-developed health services for Blacks created the milieu for HIV and TB to flourish (5).…”

Section: Introductionmentioning

confidence: 99%

HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response

2009

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One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0·7% of the world’s population, had 17% of the global burden of HIV infection, and one of the world’s worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government’s response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.

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Section: Introductionmentioning

confidence: 99%

HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response

2009

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“…By forcing men to spend lengthy periods of time far away from their wives and family, the migrant labour policy encouraged these men to acquire partners in and around their work places (Marks 2002). Kark (1949) demonstrated how important this process was in the genesis of the syphilis epidemic in South Africa. Hunter (2007) has persuasively developed this argument by revealing how three interlinked dynamics of post-apartheid South Africa have come together to promote MCPs and thereby, the spread of HIV: (1) rising unemployment that leave some groups such as poor women competing for the small pool of employed men; (2) reduced marital rates amongst Africans; (3) rising levels of women's migration.…”

Section: Introductionmentioning

confidence: 99%

“I don't use a condom (with my regular partner) because I know that I'm faithful, but with everyone else I do”: The cultural and socioeconomic determinants of sexual partner concurrency in young South Africans

Kenyon

Boulle

Badri

et al. 2010

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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35 AbstractFinding ways to reduce the high rates of sexual partner concurrency is increasingly believed to be vital to controlling HIV spread in southern Africa. We describe the frequency and correlates of sexual partner concurrency in a representative sample of 3 324 young South Africans aged 14-25. Of the 2 468 individuals who were sexually active 21% had engaged in concurrent sexual partnerships. Multivariate analysis revealed that concurrency was more common with males, Africans, those who knew their partner had another partner, early age of sexual debut, four or more lifetime sexual partners, alcohol consumption, and self-perception of being at high risk for acquisition of HIV. If the respondent's partner knew his or her friends (termed high structural embeddedness) this was associated with a 52% reduction in concurrency rates. There are significant differences in both the rates of concurrency and the risk factors underpinning these in the different racial/ethnic groups. Analysis of these underlying determinants suggests that cultural rather than socioeconomic factors predominate, which has important implications for the design and targeting of prevention efforts. RésuméTrouver des moyens de réduire les taux élevés de concomitance de partenaires sexuels (une même personne ayant deux ou plusieurs relations se chevauchant sur le moyen terme) est de plus en plus considéré comme vital pour contrôler la propagation du VIH en Afrique australe. Nous décrivons la fréquence et les corrélats de la concomitance des partenaires sexuels dans un échantillon représentatif de 3 324 jeunes Sud-Africains âgés de 14 à 25 ans. Sur les 2 468 individus qui étaient sexuellement actifs, 21% d' entre eux étaient impliqués dans des relations sexuelles concomitantes. L'analyse multivariée a révélé que la concomitance était plus fréquente chez les hommes, les noirs africains, ceux qui savaient que leur partenaire avait un autre partenaire, ceux qui ont eu leurs premiers rapports sexuels à un jeune âge, ceux qui ont eu plus de trois partenaires dans leur vie. La concomitance dépendait aussi de la consommation d'alcool et de la perception d' être ou non une personne à risque à l' égard de la contamination par le VIH. Le fait pour la personne interrogée de connaître les amis de son partenaire (appelé haut niveau d' encastrement structurel -'embeddedness') a été associé à une réduction de 52% des taux de concomitance. Il existe des différences significatives dans à la fois les taux de concomitance et les facteurs de risque pouvant expliquer ces taux dans les différents groupes raciaux/ethniques. L'analyse de ces déterminants sousjacents suggère que ce sont davantage les facteurs culturels que les déterminants socioéconomiques qui prédominent, ce qui a des implications importantes pour la conception et le ciblage d'une politique de prévention.

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“…Despite attempts to recognise the 'social', their focus was on the clinical prevention of disease in the community. Kark et al (1949) identified 'wider social forces' as being responsible for the so-called 'community syndrome', thus acknowledging the 'social' drivers of the epidemic. There is, however, little evidence to suggest that a real attempt was made to intervene on the macro-level, and thus to impact in 'upstream' ways on the 'community syndrome' -an option that might have yielded more long-term results.…”

Section: The South African Hiv/aids Epidemic In a Historical Contextmentioning

confidence: 99%

‘Upstream/downstream’ – locating the ‘social’ in health promotion and HIV/AIDS in south africa?

Gilbert

2012

South African Review of Sociology

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Strengthening HIV prevention remains an urgent global health priority. The problem is that 'advancement' in HIV prevention often stands for the development of biomedical technologies or interventions. Theories and practices of health promotion have been advocating a shift from a biological/medical preventive focus to a more social one; from the level of individuals to organisations, communities and broader social policy. It seems, however, that in practice a real shift in the desired direction remains an elusive goal. This article explores HIV/AIDS health promotion efforts in South Africa, focusing on the traditional dichotomies of bio-social; individual-society and downstream-upstream, in order to draw attention to associated complexities that should be taken on board. Relying on evidence from South Africa (past and present), the main thesis in the article demonstrates the limitation of these efforts, and argues for a more comprehensive approach along a flexible continuum of options, with a focus on the 'social'. The main argument advanced here, rests on the premise that there is a lack of fit between the forces that shaped the epidemic and efforts to prevent its rapid spread, despite the existence of an adequate sociological understanding of these forces. A model based on the critique developed in the article is presented as a 'way forward', suggesting solutions along a flexible 'continuum of options' that take the 'social' on board. While the focus of the article is on HIV/AIDS, the insights offered in the final thesis and the way forward should prove useful for health promotion efforts in dealing with other health problems as well.

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The social pathology of syphilis in Africans

Cited by 25 publications

References 27 publications

HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response

HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response

“I don't use a condom (with my regular partner) because I know that I'm faithful, but with everyone else I do”: The cultural and socioeconomic determinants of sexual partner concurrency in young South Africans

‘Upstream/downstream’ – locating the ‘social’ in health promotion and HIV/AIDS in south africa?

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