Conversations with mothers: exploring reasons for prevention of mother-to-child transmission (PMTCT) failures in the era of programmatic scale-up in Soweto, South Africa.

Reasons for incident cases of vertical HIV transmission in the era of free access to PMTCT in South Africa were investigated. This mixed-methods study was conducted in Soweto, South Africa from June-August, 2009. Birthmothers of HIV-infected infants born after 1 December 2008 were eligible. All participants completed an interviewer-administered questionnaire. Women also participated in a focus group (n = 10) or individual structured interview (n = 35). Mean age of participants (n = 45) was 28.7 years (SD = 5.4). Major findings are: (i) failure of per-guideline prescription of ARV strategies for infants (31%) and/or mothers (57%); (ii) maternal refusal of treatment (n = 5); (iii) preterm delivery (31%); (iv) delayed ANC attendance because of facility-related barriers and maternal apprehension around HIV testing; (v) fear of stigma; (vi) maternal difficulty with administering infant AZT (n = 9) and (vii) maternal confusion about infant feeding. A variety of individual, social, and structural factors must be addressed to optimize PMTCT service delivery in South Africa.

Awareness and Rejection Accounts of Intimate Partner Violence by Young Women in Soweto, Johannesburg, South Africa.

Intimate partner violence (IPV) is the most prevalent form of interpersonal violence experienced by women in South Africa. A study conducted with young women from South Africa, aged 13 to 23 years, estimated that 42% experienced physical violence from their intimate partners. The subtle and nuanced social dynamics of IPV are less understood owing to little qualitative research on this subject. This study qualitatively explored how young women perceive and experience IPV. Participants were recruited through snowballing from townships in Soweto, outside Johannesburg. In-depth, face-to-face, and semistructured interviews were conducted with seven young women aged 15 to 20 years. The discourse analysis was implemented to understand participants' construction of IPV. Participants reported direct experiences of IPV and indirect through exposure to interparental and interpersonal violence. Findings indicate a progressive shift of perceptions from absolute tolerance of relationship violence to rejection. However, victim blaming and relegating relationship violence to the private realm still existed. Essentialisation of masculine qualities such as anger was used to construct and understand men's use of violence. Young women highlighted infidelity, pregnancy, and sex demands from their partners as reasons for them being subjected to IPV.

Implications for HIV prevention: lesbian, gay and bisexual adolescents in urban South Africa are at increased risk of living with HIV.

Among adolescents (14-19 years) in Soweto, South Africa, 14% (4/29) who identified as lesbian, gay or bisexual (3 female and 1 male) reported living with HIV compared with only 2.3% (8/350) who identified as heterosexual (P = 0.002). These data indicate an urgent need to utilize evidence-based strategies to support access to HIV prevention education and services for lesbian, gay and bisexual youth.