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Background: Limited research has been conducted on the forms, manifestations and effects of intersectional stigma among young HIV-positive men who have sex with men (MSM) and transgender women (TGW) in Zambia. In this study, we aimed to address this gap by elucidating the experiences of these in a small group of young, HIV + MSM and TGW in Zambia. Methods: We applied a mixed-methods design. Data were collected from January 2022 to May 2022. Qualitative data were collected using in-depth interviews while quantitative data were collected using a questionnaire. Qualitative transcripts were coded using thematic analysis while paper-based questionnaire data were entered into Kobo Connect. Descriptive statistics, using chi-squared tests were calculated using Excel. In this paper, we provide a descriptive profile of the sample and then focus on the qualitative findings on intersectional stigma, depression, and contemplation of suicide. Results: We recruited 56 participants from three sites: Lusaka, Chipata, and Solwezi districts. Participants' mean age was 23 years. The study found that 36% of all participants had moderate to significant symptoms of depression, 7% had major depression, 30% had moderate signs of anxiety, 11% had high signs of anxiety, 4% had very high signs of anxiety and 36% had contemplated suicide at least once. A greater proportion of TGW had moderate to significant symptoms of depression (40%) or major depression (10%) compared to MSM, at 33% and 6%, respectively (X2 = 0.65; p = 0.42). Similarly, more TGW (55%) had contemplated suicide than MSM peers (36%, X2=1.87; p = 0.17). In the qualitative data, four emergent themes about the forms, manifestations, and effects of intersectional stigma were (1) HIV, sexual orientation, and gender identity disclosure; (2) Dual identity; (3) Challenges of finding and maintaining sexual partners; (4) Coping and resilience. Overall, having to hide both one's sexuality and HIV status had a compounding effect and was described as living "a private lie." Conclusion: Effectively addressing stigmas and poor mental health outcomes among young HIV-positive MSM and TGW will require adopting a socio-ecological approach that focuses on structural interventions, more trauma-informed and identity-supportive care for young people with HIV, as well as strengthening of authentic community-informed public health efforts. [ABSTRACT FROM AUTHOR]

AbstractThere has been growing recognition of the need to address the sexual and reproductive health (SRH) needs of men and boys, including a need for more explicit guidance in domestic health policy and plans. This paper reports on a policy analysis, covering five East and Southern African countries, and discusses the extent and ways in which male clinical and non-clinical needs, and their roles in SRH are currently being reflected. It draws attention to the policy discourse, trends, and gaps in including men in the region as clients, partners and change agents to inform a way forward. [ABSTRACT FROM AUTHOR]

Background: Health technology assessment uses a multidisciplinary approach to support health benefits package design towards universal health coverage. The evidence-informed deliberative process framework has been used alongside Health technology assessment to enhance stakeholder participation and deliberations in health benefits package design. Applying the evidence-informed deliberative framework for Health assessment could support the morally diverse sexual reproductive health and rights (SRHR) benefits package design process. However, evidence on participation and deliberations for stakeholders in health technology assessment for SRHR benefits package design has not been curated in sub-Saharan Africa. This study synthesises literature to fill this gap. Methods: This scoping review applies the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews, and deductive analysis following the evidence-informed deliberative processes framework. The search strategy uses the Guttmacher–Lancet Commission-proposed comprehensive definition of SRHR and the World Health Organisation's universal health coverage compendium of SRHR interventions to generate search terms. Six databases and biographical hand searches were used to identify studies in Sub-Saharan Africa from 1994. Results: A total of 14 studies met the inclusion criteria. Evidence for yearly public budgets and explicit SRHR health technology assessment processes was not found. In 12 of the studies reviewed, new advisory committees were set up specifically for health technology assessment for SRHR priority-setting and benefits package design. In all decision-making processes reviewed, the committee member roles, participation and deliberations processes, and stakeholder veto powers were not clearly defined. Patients, the public, and producers of health technology were often excluded in the health technology assessment for the SRHR benefits package design. Most health technology assessment processes identified at least one decision-making criterion but failed to use this in their selection and appraisal stages for SRHR benefits design. The identification, selection, and scoping stages in health technology assessment for SRHR were non-existent in most studies. In 11 of the 14 processes of the included studies, stakeholders were dissatisfied with the health policy recommendation from the appraisal process in health technology assessment. Perceived benefits for evidence-informed deliberative processes included increased stakeholder engagement and fairness in decision-making. Conclusion: To support the integration of diverse social values in health technology assessment for fairer SRHR benefits package design, evidence from this review suggests the need to institutionalise health technology assessment, establish prioritisation decision criteria, involve all relevant stakeholders, and standardise the process and assessment methodological approaches. [ABSTRACT FROM AUTHOR]

This study explored the factor structure and psychometric properties of the Perceived Sense of School Membership (PSSM-18) Scale in two samples of South African adolescents. Principal components analysis (n = 1,052; males = 50.86%, M[subscript age] = 14.89, SD = 1.68) supported the retention of 15 items across a revised, three-factor structure of "acceptance," "belonging," and "inclusion" (PSSM-South African version [PSSM-SA]). Confirmatory factor analysis (n = 1,418; males = 49.86%, M[subscript age] = 14.93, SD = 1.70) provided an acceptable level of fit for the PSSM-SA. The structure was found to be invariant across sex, age, and poverty quintile groupings. Follow-up group comparisons showed selected scales were able to discriminate between groups and predicted alcohol and substance use, and the mean inter-item correlations indicated each scale possessed an appropriate level of internal consistency. The findings suggest the PSSM-SA is a valid and reliable measure of school belonging among South African high school-age children.

The COVID-19 pandemic, particularly from 2020 to mid-2022, debilitated the management of the HIV epidemic in Africa. The multiple effects included well-documented HIV service interruptions, curtailment of HIV prevention programmes, the associated marked increase in both the risk for HIV infection among key populations and vulnerability of sub-populations (e.g. adolescent girls and young women) who are the focus of these programmes and — as importantly but less well-documented — the diverse negative socio-economic effects that accentuate HIV risk and vulnerability generally (e.g. loss of earnings, gender-based violence, stigma, police harassment of people during "lockdowns"). The global biomedical response to COVID-19 was necessary and remarkable for mitigating the bio-physical impacts of the pandemic (e.g. wide-spread surveillance coupled with rapid updates on the epidemiology of infections, rapid development of vaccines and revisions of treatment). However, drawing upon the widespread criticisms of state responses to the socio-economic effects of the COVID-19 pandemic and of "lockdowns" themselves, this article elaborates a core argument within those criticisms, namely that key lessons learnt during the HIV and AIDS and other pandemics were ignored, at least during the early stages of COVID-19. Our critique is that better integration of the social sciences and humanities in responses to pandemics can counter the reflex tendency to uncritically adopt a biomedical paradigm and, more importantly, to enable consideration of the social determinants of health in pandemic responses. At root, we re-assert a key value of 'integrated' interventions, namely the accommodation of context-sensitive considerations in the formulation of strategies, policies, plans and programme designs. [ABSTRACT FROM AUTHOR]

Drawing upon a post-structural ethnography of boys' constructions of gendered and sexual identities in one South African high school, this paper empirically seeks to theorise how 20 Grade 8 boys, identified as The Jokers, The Achievers, The Outcasts and The Average Ou's, simultaneously seek out spaces in male peer culture to cultivate, police and challenge hegemonic notions of masculinity. The paper illustrates the construction and positioning of masculinities across spaces of conflict, more particularly, the personal and social resources reproduced by boys in the pursuit of "desirable" masculinities across experiences of interpersonal conflict, punishment, friendship and play. Given the nature of these identity struggles in school boy peer culture, this paper highlights the need for fostering and maintaining peer conversational spaces where boys and girls are challenged to actively deconstruct prevailing gendered identities and work towards more expansive definitions of self.

The "new sociology of childhood" has activated a growing interest in children as social actors and their level of involvement in activities that affect their lives. In the field of research, debate is underway regarding the consent processes and methodological activities that support child participation. This paper highlights methodological and ethical considerations that emerged while engaging in research with young boys (aged 9-11 years old) with a formal diagnosis of attention-deficit/hyperactivity disorder (ADHD). Key issues include recruitment, informed consent, and participatory activities for data production. Sociocultural theories of childhood and disability are applied to reflect on the power and privilege operating through the research process. Engaging in research that involves children with disabilities, in which discourses of risk, stigma, and protection are elevated, problematizes the researcher-researched relationship and expands considerations of what constitutes ethical practice and "valuable data".

Background: This study investigated the relationship between school connectedness and health risk behaviors, specifically, substance abuse, violence-related behaviors, sexual risk behaviors, and suicidal ideation among school-going adolescents. School connectedness was understood to encompass a range of aspects pertaining to a learner's sense of belonging to the school. We hypothesized that strong perceptions of school connectedness will more likely be associated with lower levels of risk behaviors among school-going adolescents. Methods: The study was conducted in 2 neighboring public co-educational schools in Durban, South Africa. Independent measures assessed school connectedness, substance abuse, violence-related behaviors, sexual risk behaviors, and suicidal ideation. Results: Strong negative correlations were found between adolescents' perceptions of school connectedness and the 4 health risk behaviors, particularly suicidal ideation. The relative importance of risk factors was also evidenced in the sample. Conclusions: Adolescents with lower perceptions of school connectedness were more likely to engage in various risk behaviors, supporting the literature that a lack of school connectedness can act as a risk factor for adolescent involvement in clustering of risk behaviors. Further the relative weighting of individual risk factors, it is argued, was an effect of the sociocultural context of the study. (Contains 5 tables.)

University environments are fertile grounds for risky sexual behaviors. This study investigated students' risky sexual practices at the University of KwaZulu-Natal in Durban, South Africa. Data were collected using quantitative and qualitative methods. A total of 1,405 questionnaires were administered, and 80 in-depth interviews and four focus group discussions were conducted. Quantitative data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows 16.0. Qualitative data were analyzed using thematic analysis. The sample included 1,405 students, the majority (93%) of whom were never married and 97% were sexually experienced. Among males reporting male partnerships those who used alcohol were significantly more likely to report risky sexual practices. Among females reporting male partnerships, those 30 years and older were significantly less likely to report engaging in risky sexual behavior with male partners. Alcohol use was connected with inconsistent condom use and not using condom last sex among females. While low rates of condom use were a problem among older students aged 30 years and older, and risky sexual practices were more common among younger students. Risky sexual behaviors pose a big challenge for the successful HIV prevention interventions on university campuses.