RESUMO
Background: Persons with disabilities are more likely to have poorer livelihood outcomes, including food insecurity. Inequalities are heightened for young women with disabilities, especially in times of crisis. Objectives: To understand the livelihood experience of young South African women with and without disabilities during the coronavirus pandemic (COVID-19). Method: We conducted a longitudinal study with 72 young women with and without disabilities enrolled in tertiary institutions in eThekwini, South Africa. We undertook a series of in-depth interviews collecting quantitative and qualitative data, prompting participants' experiences during the COVID-19 pandemic, including living arrangements, impact on education, access to resources and food security. Results: Participants reported livelihood changes related to living arrangements, education, income, and social connectedness during the pandemic. Social grants (old-age pension, child support, disability grant) and student stipends were critical financial resources to ensure food security. Participants with disabilities were more likely to experience food insecurities and moderate hunger, with their households having less access to mitigating resources such as land or livestock. Deaf participants also reported social isolation. Conclusion: The study shows that social protection mechanisms mitigated the financial impact of the lockdown for all recipients but that participants with disabilities still struggled more than others to ensure food security. These additional challenges may be related to pre-existing inequalities, with participants with disabilities and their households having less access to natural resources and financial stability. Contribution: This paper focuses on young women with and without disabilities and provides insight into the similarities and differences in their experiences.
RESUMO
BACKGROUND: HIV is one of the greatest public health challenges in South Africa. Potential HIV vaccines and antibodies are thought to be cost-effective biomedical HIV prevention methods and are currently under investigation in phase I, II, and III trials. Consequently, current and future clinical trials need to ensure sufficient recruitment and retention. To achieve this goal, clinical trial staff need to understand the socio-demographic and behavioural characteristics of people volunteering to screen for these trials and their reasons for volunteering. METHODS: We conducted a secondary analysis of participant screening data across five vaccine and monoclonal antibody trials at four sites in KwaZulu-Natal, South Africa. Our study reviewed the demographic, behavioural, motivational, and health-related data from the case report forms and screening questionnaires. Descriptive statistics, chi-squared, and one-way ANOVA tests were used to analyse participants' characteristics and motivation to participate in HIV vaccine and monoclonal antibody trials. Analyses were conducted using R version 3.5.2. RESULTS: Screening data from 1934 participants, including 79.2% of women, were obtained across all five trials (1034 enrolled, 900 screened out/declined). Screened participants predominately self-identified as black, heterosexual, cisgender women or men, many with lower educational backgrounds (43.9% did not complete secondary/high school), and several self-reported HIV-risk behaviours among themselves and their partners. 10.8% of the screened participants were living with HIV. Avoiding HIV risk was the main motivation to participate in clinical trials, followed by altruistic reasons such as a desire to help the community or helping to find a vaccine. DISCUSSION: The current recruitment approach of these trials attracts heterosexual participants who seek to reduce HIV risk and support their community. Hence, the data suggest the need for and potential acceptance of continued ongoing HIV prevention efforts. Current trials attract participants with lower educational levels, which may be driven by the site locations, current community mobilisation strategies and research site opening hours. The sites could consider more flexible working hours to accommodate working participants and find ways to connect participants to educational support and opportunities to upgrade education levels for the current clientele. TRIAL REGISTRATION: HVTN 100: A Safety and Immune Response Study of 2 Experimental HIV Vaccines, NCT02404311 . Registered on March 17, 2015. HVTN 111: Safety and Immune Response to a Clade C DNA HIV Vaccine, NCT02997969. Registered on December 16, 2016. HVTN 108: Evaluating the Safety and Immunogenicity of HIV Clade C DNA Vaccine and MF59- or AS01B-Adjuvanted Clade C Env Protein Vaccines in Various Combinations in Healthy, HIV-Uninfected Adults, NCT02915016. Registered on September 22, 2016. HVTN 702: Pivotal Phase 2b/3 ALVAC/Bivalent gp120/MF59 HIV Vaccine Prevention Safety and Efficacy Study in South Africa, NCT02968849. Registered on November 1, 2016. HVTN 703/HPTN 081: Evaluating the Safety and Efficacy of the VRC01 Antibody in Reducing Acquisition of HIV-1 Infection in Women, NCT02568215 . Registered on October 1, 2015.