Identification of patients with recent-onset psychosis in KwaZulu Natal, South Africa: a pilot study with traditional health practitioners and diagnostic instruments.

PURPOSE: There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data are available from low- and middle-income countries. In sub-Saharan Africa, most people with psychoses remain undetected and untreated, partly due to lack of formal health care services. This study in rural South Africa aimed to investigate if it is possible to identify individuals with recent-onset psychosis in collaboration with traditional health practitioners (THPs). METHODS: We developed a strategy to engage with THPs. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent-onset psychosis to the study. At referral, the THPs rated probability of psychosis ("maybe disturbed" or "disturbed"). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated. RESULTS: 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP "disturbed" rating was 53.8%. Test characteristics of the CAPE were poor. CONCLUSION: THPs were open to identifying and referring individuals with possible psychosis. They recognized "being disturbed" as a condition for which collaboration with formal psychiatric services might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of individuals with recent-onset psychosis in rural South Africa.

Culture, sexuality, and women's agency in the prevention of HIV/AIDS in southern Africa.

Using an ethnographic approach, the authors explored the awareness among women in southern Africa of the HIV epidemic and the methods they might use to protect themselves from the virus. The research, conducted from 1992 through 1999, focused specifically on heterosexual transmission in 5 sites that were selected to reflect urban and rural experiences, various populations, and economic and political opportunities for women at different historical moments over the course of the HIV epidemic. The authors found that the female condom and other woman-controlled methods are regarded as culturally appropriate among many men and women in southern Africa and are crucial to the future of HIV/AIDS prevention. The data reported in this article demonstrate that cultural acceptability for such methods among women varies along different axes, both over time and among different populations. For this reason, local circumstances need to be taken into account. Given that women have been clearly asking for protective methods they can use, however, political and economic concerns, combined with historically powerful patterns of gender discrimination and neglect of women's sexuality, must be viewed as the main obstacles to the development and distribution of methods women can control.

Social theory and social class.

Concepts of class developed with the emergence of industrial society in the nineteenth century. For an understanding of current divisions, theories must reflect the advances of capitalism and the global economy that characterize the late twentieth century. In industrialized societies, reductions in the industrial workforce and the growth of finance, investment and real-estate industries worldwide have produced a new, largely female, service workforce. Large sectors of industry have departed in search of cheaper labour in poorer countries, which also have a rising number of women workers. In those areas, as a result, a new industrial workforce has emerged. Concomitantly, accumulation of land in less developed agricultural regions for production for the world market has led to an increase in mobile agricultural labour and a shift of landless labourers to the cities of less developed countries. In addition, both upward and downward mobility have occurred for individuals and groups in specific populations, as well as for particular diseases in developed and less developed countries. All these processes have precipitated fundamental changes in class, gender and family relationships and transformed the living conditions of populations in both developed and less developed societies. These changes have major implications for the patterns of health and disease in the world today. Objective measures of social change may be difficult to construct and use in epidemiological cancer research. Since questions of class and shifting social relations are directly implicated in the patterns of disease, they must be assessed in future research as accurately as possible.

Sex, drugs and videotape: the prevention of AIDS in a New York City shelter for homeless men.

This paper documents a process of social change through participant observation. During the course of research a group response was facilitated by a team of residents, staff and researchers. The social context, a shelter for homeless men in New York City, will be presented first, emphasizing those aspects of resident living that are germane to HIV transmission. Next, we describe the group response, the creation of a video. This activity gave numerous insights to the investigators into how the men perceived the homeless state and something of their relationships to others within and outside the institutions. In particular, their views on women and sex were expressed in the video. The insights gained by the men and the investigators are analyzed in terms of a self-help strategy which was effective in conveying information about HIV transmission and prevention.

Knowledge and perceptions of HIV infection among homeless pregnant women.

This research examines the knowledge and perceptions of HIV infection among pregnant women in a hotel for the homeless in New York City in the Spring of 1987. The primary method of research was participatory observation. Issues examined include knowledge of the modes of transmission, use of preventive strategies, and familiarity with persons who have AIDS.

Work and reproduction: sociologic context.

For nearly all women in the U.S., combining reproduction with employment is a complex juggling act. Reproduction as a social process is defined, followed by a review of the status of women at work, ways in which work influences the experience of reproduction, and various maternity provisions in the workplace.

Union Carbide and the community surrounding it: the case of a community in Puerto Rico.

Based on fieldwork in Puerto Rico, this article examines the views on health hazards of residents in a semi-rural community in relation to the influx of industrial development since the early 1970s. It is suggested that "folk" terminology and particular aspects of Puerto Rican culture are less significant in this instance than many studies in medical anthropology suggest. The focus is on the emergence of a protest movement concerned with health problems which community residents and workers attribute to a nearby Union Carbide factory. Residents of El Ingenio, Yabucoa, Puerto Rico, have brought a law suit against Union Carbide and, the management of the plant has attempted to dispel the conflict. The article argues that health concerns of residents, industrial workers, and plant management cannot be interpreted without taking into account problems of unemployment, political affiliations, and company policies and their impact over time.

The logic of noncompliance: management of epilepsy from the patient's point of view.

Studies of patient compliance with medical regimens reveal that one-quarter to one-half of patients act at variance with their physician's suggestions. Using anthropological methods of long-term participant observation, seven epileptic patients were intensively studied for ten months in a variety of social contexts, including visits to health resources. Their conceptions of proper management of epilepsy were elicited, and their communication of these conceptions to providers of health care was observed. Although most of these patients were noncompliant, no single pattern of noncompliance encompassed their behavior as a group, and some of them had more than one drug consumption strategy. Furthermore, some patients were found to be noncompliant with biomedical regimens, yet actively and consistently pursuing alternative regimens. A range of such alternative therapies were identified both for low-income and middle-income patients. These case histories suggest that patients actively assess the quality of care given by their providers of health care. From the patient's point of view, biomedical strategies form one facet of many coping mechanisms in the management of epilepsy.