"""Better a Dead Child than a Dry Womb!"" Reproduction and HIV/AIDS in Sub-Saharan Africa"

Childbearing is important to individuals and society in sub-Saharan Africa. Proven fertility and many children are powerful symbols of continuity and cohesion. Thus the reported high fertility rates; specifically in rural areas where modern family planning methods are unpopular and uncommon. Sub-Saharan Africa also bears the greatest burden of the HIV/AIDS epidemic. Heterosexual contact with an infected person is the commonest route of transmission in the region. Vertical transmission from mother to child is another apparent transmission mode. Antiretroviral therapy is exclusively unaffordable for many infected Africans. Counsellors discourage infected persons from future childbearing; even though they may still be in the prime of their reproductive years. Positive-living stresses 'a responsible sexual lifestyle for longer life'. The socio-cultural script for the need for children is in dis-equilibrium with the 'safe reproductive health' messages. This paper discusses the interplay between these two contemporary scripts; particularly examining spaces of negotiation. How does HIV/AIDS colour African reproduction?Current statistics about the HIV/AIDS epidemic in Nigeria do not reveal the broader social and economic impacts of the disease on the family.The study therefore primarily aimed to address the socio-economic effects of HIV infection on individuals and their families.The study was carried out in Lagos State. In-depth interviews were employed to collect information from 188 people living with HIV/AIDS through support groups in the state; while four focus group discussions were conducted to elicit information from people affected by AIDS about the socio-economic impacts of HIV/AIDS on families in Nigeria. From the survey; among people living with HIV/AIDS; 66of females and males were in the age group 21-40 years; while 10were older people above 60 years of age. Findings revealed that as HIV/AIDS strikes at parents; grand parents are assuming responsibility for bringing up the children of the infected persons and the orphans of those killed by the virus. It was striking that some of the older caregivers could not meet the requirement of these children.They are often forced to work more than they would have; or borrow in order to cope with the needs of these extra mouths. Some of the infected people have sold their properties to enable them to cope with the economic effects of the virus; while their children have had to drop out of school; since they could not afford the school fees and other related expenses. It was suggested that PLWHA should be economically empowered with adequate medical treatment; in order to reduce the impact of the disease on the family

The adventures of the Randy Professor and Angela the Sugar Mummy: sex in fictional serials in Ugandan popular magazines.

In 1996 newspaper vendors in Ugandan towns started selling a new kind of locally produced 'lifestyle' magazine. On the covers there were young, scantily dressed girls and inside news articles, fictional serials, lifestyle articles, agony aunt columns, etc. The new magazines gained an enormous popularity in a short space of time. Everywhere people were seen reading them and copies became brown and tattered from use. Using content analysis, we analyse the fictional serials which appeared in three of these magazines. We focus on these because they were the most sexually explicit type of content and, from a public health perspective, the most relevant with regard to HIV prevention. The stories were presented as simple entertainment, depicting the adventures of stereotypical characters. They provided people with explicit and unrestricted sexual fantasy which was, at the same time, devoid of any real risk. Although they could be interpreted as providing a discourse which challenged the main messages of HIV-prevention campaigns (sex is good for you, have as much of it as possible, and don't let condoms spoil the enjoyment), they also suggest that behaviour change may be more popular if sex and sexual health are not separated from sexual pleasure, and safe sex is promoted from a positive perspective (emphasis on sexual enjoyment) rather than a negative one (prevention of disease). The popularity of the magazines underscores the importance of entertainment value when discussing sex, and suggests alternative possibilities for disseminating health messages. Illustrated popular magazines such as those discussed here could be suitable as intervention, though they would need some adaptation to counter gender stereotypes and sexual violence.

"""Abortion? That's for women!"" Narratives and experiences of commercial motorbike riders in South-Western Uganda"

Although constitutionally illegal; induced abortion is a vital reproductive health option in Uganda. This paper analyses men's narratives about meanings of; and experiences with; abortion. Men play significant roles in abortion as instigators; facilitators; collaborators; transporters; advisors; informers; supporters or punishment givers. Many participants were knowledgeable about abortion. Attitudes were ambivalent; with initial reactions of denial and relegation of abortion to women's private domains. Further exploration; however; revealed active support and involvement of men. Interpretations of abortion ranged from 'dependable saviour' to 'deceptive sin'. Though a private action; abortion is socially scripted and often collectively determined by wider social networks of kinsmen; the community; peers; law and religion. A disjuncture exists between dominant public health discourse and the reality of local men who interact with women and girls as wives; lovers; sex sellers; mothers; daughters and sisters. Interventions targeting men about abortion should include safe sex education; provide safe abortion services and create stronger social support mechanisms. Policy and law should incorporate local knowledge and practice

Attitudes to voluntary counselling and testing for HIV among pregnant women in rural south-west Uganda.

UNLABELLED: This paper describes the results of a study exploring the attitudes of women attending maternity clinics to voluntary counselling and testing during pregnancy in rural areas in south-west Uganda. It was a qualitative study using focus group discussions (FGDs). Twenty-four FGDs were carried out with 208 women attending maternity clinics in three sites in rural south-west Uganda. The FGDs were all recorded and transcribed, and analysed using standard computer-based qualitative techniques. Almost all women were willing in principle to take an HIV test in the event of pregnancy, and to reveal their HIV status to maternity staff. They were anxious, however, about confidentiality, and there was a widespread fear that maternity staff might refuse to assist them when the time came to deliver if their status were known. This applied more to traditional birth attendants than to biomedical health staff. There were also rumours about medical staff intentionally killing HIV-positive patients in order to stem the spread of the epidemic. Women were concerned that if their husbands found out they were HIV-positive they would be blamed and separation or domestic violence might result. IN CONCLUSION: although VCT during pregnancy is acceptable in principle, much will need to be done to ensure confidentiality and allay women's fears of stigmatisation and discrimination during delivery. Community sensitisation will be necessary and male partners will have to be involved if interventions are to be acceptable.

Breastfeeding practices and attitudes relevant to the vertical transmission of HIV in rural south-west Uganda.

Breastfeeding has been associated with a doubling of the risk of HIV transmission. In developed countries, it is recommended that HIV-positive women do not breastfeed, but this is not a feasible option in most of Africa. It is therefore important to know the extent to which breastfeeding practices are amenable to change. To study this, we carried out 24 focus group discussions with 208 women attending maternity clinics in three rural sites in rural south-west Uganda. Breastfeeding starts from a few minutes to a few days after delivery; most women reported starting after 2 days. The main reason for delay is lack of milk or that the breasts are 'blocked'. Most women thought that this delay was good for the baby, or at least not harmful. Almost all women reported giving the child a soup made of boiled mushrooms before starting to breastfeed. Once they have started breastfeeding, various supplementary foods are gradually introduced at 4-6 months. Women thought that ideally breastfeeding should last for 2-3 years, but in practice most stopped after 18 months. The father and his female relatives generally decide when the child should be weaned. The women thought that commercial milk formula foods were good but could not use them because they are too expensive and anyway unavailable in rural areas. Most women were unaware that HIV could be passed to the child through breastfeeding. Various practices identified as potentially risky are common in this population. Artificial feeding is not a viable option in this area, and although women were prepared to make sacrifices to prevent vertical transmission of HIV, practices are deeply ingrained in traditional culture and will need to be addressed in future interventions. Male partners will also need to be involved.

Female control of sexuality: illusion or reality? Use of vaginal products in south west Uganda.

This paper reports on a trial of vaginal products that were distributed and used by 131 women and 21 men in south west Uganda. It focuses specifically upon the issue of female control in heterosexual relationships and examines whether methods which are ostensibly under women's control, will in practice give women greater control of their sexual health. Participants were invited to select two from a range of vaginal products that included the female condom, contraceptive sponge, film, tablets, foam and gel, and use each for five weeks and their favourite product for a further three months. They were interviewed up to seven times over a five-month period. Although the women perceived that a major advantage of the products (with the exception of the female condom) was that they could be used secretly, less than 40% were using the products without their partner's knowledge after one week and this proportion declined over time with only 22% using the products secretly after ten weeks. In the main male partners were told as women felt it their duty to inform them. In general the women were very much more positive about the products than they were about the male condom, as were the men. A contributory factor to their popularity among women was the greater control they gave them. Even though, use of these products in practice often involved negotiation with male partners, the fact that use was contingent on women's action was empowering and increased somewhat their ability to control their sexual health.

The negotiation of sexual relationships among school pupils in south-western Uganda.

The objective of the study was to explore how school-going adolescents in south-western Uganda negotiate sexual relationships. Qualitative data were obtained from 15 boys and 15 girls (14-18 years old), during a series of role plays, focus group discussions and one-to-one interviews. A questionnaire was administered to 80 pupils (12-20 years old) from the same school. Most of the pupils were sexually active. Sexual relationships between boys and girls were mediated by peers. Boys initiated relationships. Exchange played an important role in the negotiation of sexual relationships. Money or gifts were given and received in exchange for sexual favours and to strengthen the relationship. To maximize gains, some adolescents had sexual relationships with adults. Sexual relationships were characterized by ambiguity. Love is intertwined with sexual desire, money and prestige. Girls have to be explicit enough to get a good deal; if they are too explicit they will be stigmatized as 'loose' but if they are not interested in money they may be suspected of wanting to spread HIV. Boys try to persuade girls that they have money, but do not want to emphasize this too much. In sexual negotiations a boy must persuade a girl that although he is modern and sophisticated (i.e. experienced) he does not chase after every girl; the girl does not want to come over as an unsophisticated virgin, but does not want to give the impression that she is loose either. There is a tension between the traditional ideal of female chastity and submissiveness and the modern image of sexual freedom. Multiple partnerships were highly valued as a sign of sophistication. Condoms were not considered important. Interventions aimed at reducing the spread of HIV do not seem to be having an effect on the behaviour of this group of adolescents. On the contrary, risky attitudes and behaviour are part of an adolescent ideal of modernity and sophistication. New approaches are needed to persuade this group of the need for change. Shifting the source of interventions from adults to the adolescents themselves, encouraging girls to try other means of earning money and debunking the idea that having many partners is sophisticated may be productive alternatives.

Socializing influences and the value of sex: the experience of adolescent school girls in rural Masaka, Uganda.

PIP: To explore the socializing influences which have shaped rural adolescent schoolgirls' views and values about sex in a high HIV prevalence area of Uganda, detailed qualitative data were obtained over a 1-year period from 15 schoolgirls aged 14-17 years. The girls were chosen for their willingness to participate actively in a series of role plays, focus group discussions, and one-to-one interviews. Results indicated that the girls have been subjected to a wide range of influences, including parents, social functions, other young children, nature, their paternal aunt, peers, school, and various media, such as pornography. Moreover, there was disagreement about the relative values of sex and virginity. Some were determined to retain their virginity but the majority felt that sex benefits them socially and personally. Notably, peer pressure was a major factor influencing the opinions of many girls, while traditional influences are in decline. Given the small sample size of the study, care should be taken in generalizing from the results. However, the data suggest that sex has a high value for at least a substantial minority of adolescent girls in rural Misaka, Uganda. Policy makers and health educators should therefore consider how best to devise safe messages about sex that are relevant and applicable to this vulnerable segment of the population.^ieng

Men's attitudes to condoms and female controlled means of protection against HIV and STDs in south-western Uganda.

PIP: There is widespread demand for the development of female controlled methods of protection against sexually transmitted diseases and HIV. The success of such methods will depend on their acceptability to women and their male partners. Currently, the only form of HIV prevention under women's control is the female condom. This paper reports on men's attitudes to female controlled methods in southwest Uganda. Data were collected in individual interviews with 50 men and 7 focus group discussions with 42 men. The men's attitudes to male condoms, female condoms and female controlled methods of protection generally were characterized by ambiguity and anxiety. Though men liked the male condom because it protects against infection and unwanted pregnancy, they were worried by rumors that it was unreliable. The central theme in the discussions was the anxiety of men about retaining control over their female partners. While men wanted women to be protected, they also wanted to remain in control, at least to some extent, of the means of protection. Once suitable female controlled methods have been identified, it will be necessary to use education and social marketing in a manner that men can be reassured of the positive benefits of these products to them as well as to women.^ieng

Women's attitudes to condoms and female-controlled means of protection against HIV and STDs in south-western Uganda.

The consistent and correct use of the male condom makes it highly effective in both disease prevention and as a contraceptive method. However, it is also well recognized that its use is under men's control. Because of this vital limitation, there have been frequent calls for female-controlled methods of HIV prevention, particularly from women from sub-Saharan Africa. Here we report on data collected in focus-group discussions (FGDs) with women aged 17-54 in South-Western Uganda. A total of 138 women, from rural villages, urban family planning clinics and a truck-stop town, were recruited to participate in 18 FGDs on the male condom, the female condom and existing formulations of vaginal microbicidal products. Three themes emerged: (i) problems with men's control over the male condom, (ii) the importance of control over and secrecy about protective measures and (iii) sexual pleasure associated with different methods. We found that the female condom, while being perceived as an improvement over the male condom, was recognized as having limited value because of the need to agree its use prior to sex taking place. Other products were considered to be significantly better than the female condom; the sponge, in particular, was perceived as having advantages over every other product. Women like the fact that it could be inserted some time before, and left in place some time after, sexual intercourse, that it was effective for multiple instances of intercourse, and that men would be unaware that it was being employed. Female-controlled methods to prevent sexually transmitted infections, including HIV, and to increase reproductive choice, hold the promise of ceding some control over sexual and reproductive health to women.

PIP: A focus group discussion with 138 women aged 17-54 in southwestern Uganda was undertaken to investigate the acceptability of female-controlled methods of HIV and sexually transmitted disease prevention. There were three themes that emerged from the discussion: 1) problems with men's control over the male condom; 2) the importance of control over and secrecy about protective measures; and 3) sexual pleasure associated with the different methods. Findings revealed that the female condom, while it was perceived as an improvement over the male condom, was recognized to have a limited value because of the need to agree about its use prior to sexual intercourse. Other products were considered to be significantly better than the female condom--the sponge, in particular. Women liked the fact that it could be inserted some time before, and left in place some time after sexual activity. Moreover, it was effective for multiple instances of intercourse, and those men would be unaware that it was being employed. Female-controlled methods to prevent sexually transmitted infections, including HIV, and to increase reproductive choice, hold the promise of providing some control over sexual and reproductive health to women.

Analysis of dithiocarbamate fungicides. Second-derivative UV-spectroscopic determination of CS2, COS, and thiram (TMTD).

The application of second-derivative UV-spectroscopy offers a highly sensitive and selective method for the determination of CS2 and COS, as acid hydrolysis products of dithiocarbamate und thiuram disulphide fungicides, using a methanolic amine absorption reagent (ethylenediamine, piperidine). With standard concentrations of 0.08-1.1 microgram CS2/ml and 0.3 to 2.0 micrograms COS/ml, respectively, calibration curves with good correlation coefficients (r > 0.999) were obtained. In comparison to the official method of the Deutsche Forschungsgemeinschaft (DFG method S15) the proposed alternative is at least 100 times more sensitive to CS2. Using the second derivative method it is possible not only to clearly differentiate between CS2 and COS but also to quantify both gases without resorting to tedious background corrections as compared to the direct photometric methods. Additionally, second derivative spectroscopy allows the direct determination of thiram in the concentration range 1-10 micrograms/ml after its extraction with chloroform. For example, thiram in water (10 micrograms/l) and in thiram/talc standards (10 mg/g) were determined with good precision (+/- 2.0%).

Analysis of dithiocarbamate fungicides. Reaction products of the thiuram disulphide fungicide thiram (TMTD) during acid hydrolysis.

The acid hydrolysis products (CS2, COS, and H2S) of thiram (tetramethylthiram disulphide, TMTD) absorbed in a methanolic amine reagent (ethylenediamine, piperidine) were investigated by second derivative UV spectroscopy. When the hydrolysis temperatures are below the boiling point the formation of the side products COS and H2S at the expense of CS2 is unavoidable. Failure to carefully scrub the liberated gases with a lead acetate solution leads to the absorption of H2S also in the amine reagent and, like COS, causes an absorption at 230 nm that is erroneously attributed to COS. With the second-derivative technique it has been undoubtedly proved that, under the conditions of the Deutsche Forschungsgemeinschaft method S 15, thiram liberates CS2 and COS in a molar ratio of 1.92 to 0.06 (average of eight determinations) but not in a molar ratio of 1.5 to 0.5, as previously reported by some workers. Under these conditions it is impossible, contrary to earlier claims, to differentiate thiram from other dithiocarbamates based on the ratio of the hydrolysis products in residue analysis.