Rebecca Hodes | The Univeristy of Cape Town (original) (raw)

Papers by Rebecca Hodes

Culture, Health and Sexuality , 2022

This article explores the reception of the contraceptive implant, Implanon, by healthcare workers... more This article explores the reception of the contraceptive implant,
Implanon, by healthcare workers and patients in family planning
units in South Africa’s public health sector. Based on observations
conducted at public health facilities in the Eastern Cape Province,
and on interviews with nurses and patients in the same province,
the study explored real-world experiences of the implant. This article
examines the strategies used by nurses to promote use of
the device, and explores how patients themselves responded to a
widescale, national rollout of the implant within government family
planning services. The study examines the reception of
Implanon in the context of the post-Apartheid era in South Africa,
in which the vestiges of Apartheid-era healthcare provision, and
lack thereof, continue to animate personal experiences of
contraception.

Critical Public Health, 2018

The global rollout of antiretroviral treatment (ART) for HIV is one of the largest public health ... more The global rollout of antiretroviral treatment (ART) for HIV is one of the
largest public health interventions ever undertaken. As the rollout
expands, a growing body of research has focused on adherence to
ART: how is it measured, what are the flaws of these metrics, and how
may these be improved? We provide an overview of current, critical
developments in adherence research among adolescents, and of how
research on adherence to ART among adolescents within hyper-epidemic
contexts has challenged definitions and measurements of adherence. We
then explore the development of adherence metrics within an interdisciplinary
study about HIV-positive adolescents: the Mzantsi Wakho study.
Tracing the conceptualisation and adaptation of adherence metrics
within this study, we examine how qualitative and quantitative
approaches may be combined to establish more comprehensive adherence
metrics. Findings highlight the challenges and the imperatives of
synthesising numerous methods, data points, and temporalities. They
also point to the need for researchers to establish direct and continued
participation by adolescents themselves to better conceptualise and
measure adherence, as well as other health behaviours.

Sex Education, 2019

Sex education within the formal bounds of school curricula or clinic consultation is traditionall... more Sex education within the formal bounds of school curricula or
clinic consultation is traditionally conceived as age-appropriate
and accurate information, delivered by a sanctioned adult such
as a nurse or teacher. This article explores another kind of curriculum
– taught and learned among young men themselves in the
kasi (township) in which they live. Findings are based on primary
data gathered during interviews and research workshops with
boys and young men (aged 14–22), including focus group discussions
and participatory research exercises. In exploring young
men’s sexual ideas, practices, hopes and fears, it focuses on
three themes: (i) consent and coercion; (ii) pleasure and risk; and
(iii) advice and authority. We examine diverse perspectives on
these themes, and trace the tensions and ambiguities that surface
within young men’s accounts. We focus in particular on contradictions
between what is learned about sex through formal curricula,
and what is learned through peers and older men, including
within ulwaluko (a rite of passage of traditional initiation and
circumcision for Xhosa men).

Medical Humanities, 2018

This article provides a history of three pharmaceuticals in the making of modern South Africa. Bo... more This article provides a history of three pharmaceuticals in the making of modern South Africa. Borrowing and adapting Arthur Daemmrich’s term ’pharmacopolitics’, we examine how forms of pharmaceutical governance
became integral to the creation and institutional practices of this state. Through case studies of three medicaments: opium (late 19th to early 20th
century), thalidomide (late 1950s to early 1960s) and contraception (1970s to 2010s), we explore the intertwining of pharmaceutical regulation, provision and consumption. Our focus is on the modernist imperative towards the rationalisation of pharmaceutical oversight, as an extension of the state’s bureaucratic and ideological objectives, and, importantly, as its
obligation. We also explore adaptive and illicit uses of medicines, both by purveyors of pharmaceuticals, and among consumers. The historical sweep of our study allows for an analysis of continuities and changes in
pharmaceutical governance. The focus on South Africa highlights how the concept of pharmacopolitics can usefully be extended to transnational—as well as local—medical histories. Through the diversity of our sources, and the breadth of their chronology, we aim to historicise modern pharmaceutical practices in South Africa, from the late colonial era to the Post-Apartheid present.

Oxford Research Encyclopedia, African History

Approximately 36.7 million people worldwide are living with the Human Immunodeficiency Virus (HIV... more Approximately 36.7 million people worldwide are living with the Human
Immunodeficiency Virus (HIV). Almost 20 percent of South Africa’s adult population
(aged fifteen to forty-nine) is HIV-positive, and about one in every five people living with
HIV worldwide is in South Africa. The pandemic, and the political controversies it
elicited, have come to define both local and global understandings of the post-apartheid
nation. The history of HIV in South Africa begins in the 1980s during an era of
heightened repression by the apartheid state, in which discriminatory laws and fearful
public responses tapped into broader prejudices relating to race and sexuality. During the
1990s, as South Africa transitioned to democracy and as rates of HIV reached pandemic
levels, partnerships were built between civil society and state actors to confront the many
challenges that the HIV epidemic presented. However, from the late 1990s, corruption
and the abuse of political power within the Department of Health, together with the
government’s refusal to provide life-saving antiretroviral treatment (ART), ignited a new
era in health advocacy. While the HIV-treatment activist movement won the struggle for
public access to treatment, Jacob Zuma’s succession to President Thabo Mbeki heralded a new era of political controversies in the state’s HIV response. A copious historiography on the HIV epidemic in South Africa maps the contemporary chronology and evolution of the disease, including a focus on changing public understandings and responses

Keywords: HIV/AIDS epidemic, South Africa, apartheid, democracy, antiretroviral treatment, AIDS denialism, HIV activism

South African Medical Journal , 2017

Shortages of essential medicines are a daily occurrence in many of South Africa (SA)’s public hea... more Shortages of essential medicines are a daily occurrence in many of South Africa (SA)’s public health facilities. This study focuses on the responses of healthcare workers to stock-outs, investigating how actors at the ‘front line’ of public health delivery understand, experience and respond to shortages of essential medicines and equipment in their facilities. Findings are based on focus groups, observations and
interviews with healthcare workers and patients at healthcare facilities in the Eastern Cape Province of SA, conducted as part of the Mzantsi Wakho study. The research revealed a discrepancy between ‘informal’ definitions of stock-outs and their reporting through formal stockout management channels. Front-line healthcare workers had designed their own systems for classifying the severity of stock-outs, based on the product in question, and on their potential to access stocks from other facilities. Beyond formal systems of procurement and supply, healthcare workers had established vast networks of alternative communication and action, often using personal resources to procure medical supplies. Stock-outs were only reported when informal methods of stock-sharing did not secure top-up supplies. These findings have
implications for understanding the frequency and severity of stock-outs, and for taking action to prevent and manage stock-outs effectively.

Global Public Health, 2018

The global rollout of Antiretroviral Treatment (ART) has revealed an urgent need to understand th... more The global rollout of Antiretroviral Treatment (ART) has revealed an urgent need to understand the medicines-taking practices of HIV-positive adolescents. In the last decade, the literature on the social determinants of health has broadened the evidence-base on ART adherence. Interdisciplinary studies have expanded conceptions of medicines-taking beyond clinical or health systems frameworks, recognising the importance of socio-structural conditions and of patients’ beliefs and experiences. Participatory research techniques which foreground the perspectives of adolescents provide greater insights still into their adherence. This article explores the use of participatory methods within a broader study on the social determinants of ART adherence among HIV-positive adolescents in South Africa. We describe how participatory methods were incorporated into this study (n = 1,059 in the quantitative baseline). We focus on an exercise, ‘Yummy or crummy?’, that explored the multisensory dimensions of medicines-taking, including their colour, smell, shape, and delivery mechanism. We describe two principal findings: first, adolescents’ preference for greater understanding of the chemical workings of medicines, manifested in their preferences for colour, taste and shape of medicines; and second, the vital relationship between sensory preferences and the social imperatives of discretion and confidentiality regarding HIV-status.

African journal of AIDS research : AJAR, 2018

Research about HIV constitutes a global domain of academic knowledge. The patterns that structure... more Research about HIV constitutes a global domain of academic knowledge. The patterns that structure this domain reflect inequalities in the production and dissemination of knowledge, as well as broader inequalities in geopolitics. Conventional metrics for assessing the value and impact of academic research reveal that "Northern" research remains dominant, while "Southern" research remains peripheral. Southern theory provides a framework for greater critical engagement with knowledge produced by researchers within the global South. With a focus on HIV social science, we show that investigators working in and from Africa have produced and disseminated knowledge fundamental to the global domain of HIV research, and argue that their epistemological contribution may be understood within the framework of Southern theory. Through repurposing a bibliometrical measure of citation count, we constitute a new archive of highly cited social science research. With a focus on Sou...

Journal of the International AIDS Society, 2018

Background The Sustainable Development Goals (SDGs) commit to strengthening collaborations betwee... more Background
The Sustainable Development Goals (SDGs) commit to strengthening collaborations between governments and civil society. Adolescents are among the key target populations for global development initiatives, but research studies and programmes rarely include their direct perspectives on how to promote health and wellbeing. This article explores how both the methods and the findings of participatory research provide insights into adolescents’ aspirations across the domains of health and social development. It investigates how adolescents conceive of health and social services as interconnected, and how this reflects the multisectoral objectives of the SDGs.

Methods
This research was conducted within a longitudinal, mixed‐methods study of HIV‐positive adolescents (n = 80 qualitative participants, n = 1060 quantitative interviews). Between November 2013 and February 2014, a participatory exercise – the “dream clinic” – was piloted with 25 adolescents in South Africa's Eastern Cape. Key themes were identified based on the insights shared by participants, and through visual and thematic analysis. These findings were explored through a second participatory exercise, “Yummy or crummy? You are the Mzantsi Wakho masterchef !,” conducted in January 2016. Findings are described in relation to emerging quantitative results.

Results
Mixed methods explored associations between access to food, medicines, clean water and sanitation in HIV‐positive adolescents’ aspirations for development. The exercises produced practicable recommendations for innovations in development, based on associations between healthcare, food security, clean water and sanitation, while illustrating the value of partnership and collaboration (the objective of SDG17). Findings capture strong interlinkages between SDGs 2, 3 and 6 – confirming the importance of specific SDGs for HIV‐positive adolescents. Study results informed the objectives of South Africa's National and Adolescent and Youth Health Policy (2017).

Conclusions
Participatory research may be used to leverage the perspectives and experiences of adolescents. The methods described here provide potential for co‐design and implementation of developmental initiatives to fulfil the ambitious mandate of the SDGs. They may also create new opportunities to strengthen the engagement of adolescents in policy and programming.

AIDS (London, England), Jan 15, 2018

HIV-positive adolescents have low-ART adherence, with consequent increased risks of mortality, mo... more HIV-positive adolescents have low-ART adherence, with consequent increased risks of mortality, morbidity, and viral resistance. Despite high rates of violence against children in the Africa region, no known studies have tested impacts on HIV-positive adolescents. We examine associations of ART adherence with adolescent violence victimization by caregivers, teachers, peers, community members, and healthcare providers. HIV-positive adolescents were interviewed (n = 1060), and clinic biomarker data collected. We sampled all 10-19-year olds ever ART-initiated within 53 clinics in 180 South African communities (90.1% reached). Analyses examined associations between nonadherence and nine violence types using sequential multivariate logistic regressions. Interactive and additive effects were tested with regression and marginal effects. Past-week self-reported ART nonadherence was 36%. Nonadherence correlated strongly with virologic failure (OR 2.3, CI 1.4-3.8) and symptomatic pulmonary tub...

Medical Anthropology Quarterly

Research delineates two epidemiological categories among HIV-positive adolescents: those who cont... more Research delineates two epidemiological categories among HIV-positive adolescents: those who contract the virus sexually and those who inherit it as infants. In this article, we are interested in how tacit inferences about adolescents&amp;#39; mode of infection contribute to their experiences of HIV-related blame, and their ability to achieve care, in their intimate, everyday settings. The analysis arises from ethnographic research with 23 HIV-positive adolescents living in South Africa&amp;#39;s Eastern Cape. From these, we draw particularly on the narratives of four HIV-positive teenage girls and their HIV-positive mothers. The article explores the social stakes entailed in ascriptions of adolescents&amp;#39; mode of infection, particularly in terms of how blame was allocated between mothers and daughters. It further considers how these families have sought to negotiate repudiation and thereby sustain intergenerational care. The article furthers limited research on the life projects and dilemmas of this HIV-positive adolescent cohort.

African Affairs, 2017

[Opening paragraph] In 2015, A CLUSTER OF NEW STUDENT ACTIVIST GROUPS emerged at South African u... more [Opening paragraph]

In 2015, A CLUSTER OF NEW STUDENT ACTIVIST GROUPS
emerged at South African universities. Their initial names differed across campuses, reflecting the institutional particularities of their concerns. While the language of tuition was the principal focus of advocacy groups at Stellenbosch and the University of Pretoria, catalysts for mobilization elsewhere included student housing shortages and the presence of colonial iconography. By late 2015, through campaigns to establish unity of purpose, student movements mobilized behind a common demand: free higher
education. The name attributed to the movement, “Fees Must Fall”, captured this commitment. For the first time in the post-apartheid era, students marched on campuses, to Parliament, and to the seat of government in Pretoria, to protest against the rising cost of university fees.

Journal of Southern African Studies

Reproductive health matters, 2016

This paper is a sequel to a 2004 article that reviewed South Africa's introduction of new sex... more This paper is a sequel to a 2004 article that reviewed South Africa's introduction of new sexual and reproductive health (SRH) and rights laws, policies and programmes, a decade into democracy. Similarly to the previous article, this paper focuses on key areas of women's SRH: contraception and fertility, abortion, maternal health, HIV, cervical and breast cancer and sexual violence. In the last decade, South Africa has retained and expanded its sexual and reproductive health and rights (SRHR) policies in the areas of abortion, contraception, youth and HIV treatment (with the largest antiretroviral treatment programme in the world). These are positive examples within the SRHR policy arena. These improvements include fewer unsafe abortions, AIDS deaths and vertical HIV transmission, as well as the public provision of a human papillomavirus vaccine to prevent cervical cancer. However, persistent socio-economic inequities and gender inequality continue to profoundly affect South...

AIDS and behavior, Jan 8, 2016

Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence am... more Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence among HIV-positive adolescents is limited. This study quantitatively tests whether social protection is associated with reduced unprotected sex among 1060 ART-eligible adolescents from 53 government facilities in South Africa. Potential social protection included nine 'cash/cash-in-kind' and 'care' provisions. Analyses tested interactive/additive effects using logistic regressions and marginal effects models, controlling for covariates. 18 % of all HIV-positive adolescents and 28 % of girls reported unprotected sex. Lower rates of unprotected sex were associated with access to school (OR 0.52 95 % CI 0.33-0.82 p = 0.005), parental supervision (OR 0.54 95 % CI 0.33-0.90 p = 0.019), and adolescent-sensitive clinic care (OR 0.43 95 % CI 0.25-0.73 p = 0.002). Gender moderated the effect of adolescent-sensitive clinic care. Combination social protection had additive effects amon...

AMA journal of ethics, 2016

Donor financing for HIV prevention and treatment has shifted from supporting disease-specific (&q... more Donor financing for HIV prevention and treatment has shifted from supporting disease-specific ("vertical") programs to health systems strengthening ("horizontal") programs intended to integrate all aspects of care. We examine the consequences of shifting resources from three perspectives: first, through a broad analysis of the changing policy context of health care financing; second, through an account of changing priorities for HIV treatment in South Africa; and third, through a description of some clinical consequences that the authors observed in a research study examining adherence to antiretroviral therapy (ART) and sexual health among adolescents. We note that AIDS responses are neither completely vertical nor horizontal but rather increasingly diagonal, as disease-specific protocols operate alongside integrated supply chain management, human resource development, and preventive screening. We conclude that health care programs are better conceived of as net...

African journal of AIDS research : AJAR, Jul 1, 2016

Adolescents are the only age group with growing AIDS-related morbidity and mortality in Eastern a... more Adolescents are the only age group with growing AIDS-related morbidity and mortality in Eastern and Southern Africa, making HIV prevention research among this population an urgent priority. Structural deprivations are key drivers of adolescent HIV infection in this region. Biomedical interventions must be combined with behavioural and social interventions to alleviate the socio-structural determinants of HIV infection. There is growing evidence that social protection has the potential to reduce the risk of HIV infection among children and adolescents. This research combined expert consultations with a rigorous review of academic and policy literature on the effectiveness of social protection for HIV prevention among children and adolescents, including prevention for those already HIV-positive. The study had three goals: (i) assess the evidence on the effectiveness of social protection for HIV prevention, (ii) consider key challenges to implementing social protection programmes that ...

Introduction: Advances in biomedical technologies provide the potential for adolescent HIV-preven... more Introduction: Advances in biomedical technologies provide the potential for adolescent HIV-prevention and HIV-positive survival. The UNAIDS ’90-90-90’ treatment targets provide a new roadmap for ending the AIDS epidemic, principally through antiretroviral treatment, HIV testing and viral suppression among people with HIV. However, while imperative, HIV treatment and testing will not be sufficient to address the epidemic among adolescents in Southern and Eastern Africa. In particular, use of condoms and adherence to ART remain haphazard, with evidence that social and structural deprivation is negatively impacting adolescents’ capacity to protect themselves and others. This paper examines the evidence for and potential of interventions addressing these structural deprivations.

Discussion: New evidence is emerging around social protection interventions, including cash transfers, parenting support and educational support (‘cash, care and classroom’). These have the potential to reduce the social and economic drivers of HIV-risk, improve utilisation of prevention technologies and improve adherence to ART for adolescent populations in the hyper-endemic settings of Southern and Eastern Africa. Studies show that the integration of social and economic interventions has high acceptability and reach, and holds powerful potential for improved HIV, health and development outcomes.

Conclusions: Social protection is a largely untapped means of reducing HIV-risk behaviors and increasing uptake and adherence of biomedical prevention and treatment technologies. There is now sufficient evidence to include social protection programming as a key strategy not only to mitigate the negative impacts of the HIV epidemic among families, but also to contribute to HIV prevention among adolescents and potentially to remove social and economic barriers to accessing treatment. We urge a further research and programming agenda: to actively combine programmes that increase availability of biomedical solutions with social protection policies that can boost their utilisation.

Culture, Health and Sexuality , 2022

Critical Public Health, 2018

Sex Education, 2019

Medical Humanities, 2018

Oxford Research Encyclopedia, African History

Keywords: HIV/AIDS epidemic, South Africa, apartheid, democracy, antiretroviral treatment, AIDS denialism, HIV activism

South African Medical Journal , 2017

Global Public Health, 2018

African journal of AIDS research : AJAR, 2018

Journal of the International AIDS Society, 2018

AIDS (London, England), Jan 15, 2018

Medical Anthropology Quarterly

African Affairs, 2017

[Opening paragraph] In 2015, A CLUSTER OF NEW STUDENT ACTIVIST GROUPS emerged at South African u... more [Opening paragraph]

Journal of Southern African Studies

Reproductive health matters, 2016

AIDS and behavior, Jan 8, 2016

AMA journal of ethics, 2016

African journal of AIDS research : AJAR, Jul 1, 2016

Broadcasting the Pandemic is a monograph published by HSRC Press in 2014. It tells the story of a... more Broadcasting the Pandemic is a monograph published by HSRC Press in 2014. It tells the story of a South African television show, 'Siyayinqoba/Beat It!'. Created during the aspirational years of the political transition in which the broadcast media were poised to democratize the airwaves, 'Beat It!' was first screened on public television in 1999 and developed into one of the most powerful health education initiatives in contemporary history. Broadcasting the Pandemic traces the show’s evolution, exploring how 'Beat It!' used the medium of television to inform its viewers about HIV at a time of increasingly rapid infection rates, but in which government education and treatment campaigns were largely absent.

'Broadcasting the Pandemic' pioneers a new methodology in scholarship about South Africa – using a television programme to explore the history of AIDS activism and policy. It provides a contemporary history of television in South Africa, and of its role in the most influential social movement to have emerged from the democratic transition: the HIV activist movement. Its content will interest readers from a wide array of disciplines, including African Studies, journalism, public health, sociology, cultural studies and the history of medicine.

Contents:

Introduction
Chapter 1: HIV in South Africa: A brief history
Chapter 2: Politics and pandemic on South African television
Chapter 3: Stigma, disclosure and 'positive living' on Beat It!
Chapter 4: The revolution will be televised: HIV and the 'new struggle' on Beat It!
Chapter 5: Antiretrovirals on the airwaves: Using television to promote access to HIV treatment
Chapter 6: Confronting myths: Beat It!, biomedicine and traditional healing
Chapter 7: AIDS denialism, unregulated experiments and curative claims
Chapter 8: Broadcasting dissent: Beat It!'s programming on the SABC
Chapter 9: 'Beat It! has become my life partner': Participatory programming and HIV-positive patriotism

Appendices
Glossary
References
Index

Medical Humanities, 2018

This article provides a history of three pharmaceuticals in the making of modern South Africa. ... more This article provides a history of three pharmaceuticals in the making of modern South Africa. Borrowing and adapting Arthur Daemmrich’s term ’pharmacopolitics’, we examine how forms of pharmaceutical governance became integral to the creation and institutional practices of this state. Through case studies of three medicaments: opium (late 19th to early 20th century), thalidomide (late 1950s to early 1960s) and contraception (1970s to 2010s), we explore the intertwining of pharmaceutical regulation, provision and consumption. Our focus is on the modernist imperative towards the rationalisation of pharmaceutical oversight, as an extension of the state’s bureaucratic and ideological objectives, and, importantly, as its obligation. We also explore adaptive and illicit uses of medicines, both by purveyors of pharmaceuticals, and among consumers. The historical sweep of our study allows for an analysis of continuities and changes in pharmaceutical governance. The focus on South Africa highlights how the concept of pharmacopolitics can usefully be extended to transnational—as well as local—medical histories. Through the diversity of our sources, and the breadth of their chronology, we aim to historicise modern pharmaceutical practices in South Africa, from the late colonial era to the Post-Apartheid present.