College of Behavioral & Social Sciences
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Item Parenting in place: Young children's living arrangement and migrants' sleep health in South Africa(Wiley, 2023-07-11) Madhavan, Sangeetha; Wan Kim, Seung; White, Michael; Gomez-Olive, XavierMigration research tends to treat childrearing as a secondary role for migrants. By prioritising the economic objectives of migration, most models present migrants as either delaying childbearing or, if they have young children, not living with them. However, migration has become increasingly feminised, the types of mobility more varied, while the returns to migration remain uncertain at best. At the same time, norms around childrearing are shifting, and the capacity of kin to take care of children may be weakening. In such contexts, migrants may not want to or be able to be separated from their children. Confronting such difficult decisions and their consequences may be reflected in poor sleep health for the migrant parent. We draw on data from the Migration and Health Follow-Up Study (MHFUS) in South Africa to examine the following questions: (i) To what extent is children's coresidence associated with sleep health for migrant parents? (ii) Do effects vary by sex of migrant? and (iii) Do effects vary by location of migrant? Results from propensity score matching confirm that migrants who coreside with all their young children are more likely to experience healthy sleep compared to those who have nonresident or no young children. However, stratified analysis shows that these effects are only significant for women and those not living in Gauteng province. The value of these findings is underscored by the need for research on the well-being of migrant parents who are negotiating multiple agendas in economically precarious and physically insecure destinations.Item Patient and provider perceptions of a peer-delivered intervention (‘Khanya’) to improve anti-retroviral adherence and substance use in South Africa: a mixed methods analysis(Cambridge University Press, 2022-08-26) Rose, Alexandra L.; Belus, Jennifer M.; Hines, Abigail C.; Barrie, Issmatu; Regenauer, Kristen S.; Andersen, Lena S.; Joska, John A.; Ciya, Nonceba; Ndamase, Sibabalwe; Myers, Bronwyn; Safren, Steven A.; Magidson, Jessica F.Background. Despite a high prevalence of problematic substance use among people living with HIV in South Africa, there remains limited access to substance use services within the HIV care system. To address this gap, our team previously developed and adapted a six-session, peer-delivered problem-solving and behavioral activation-based intervention (Khanya) to improve HIV medication adherence and reduce substance use in Cape Town. This study evaluated patient and provider perspectives on the intervention to inform implementation and future adaptation. Methods. Following intervention completion, we conducted semi-structured individual interviews with patients (n = 23) and providers (n = 9) to understand perspectives on the feasibility, acceptability, and appropriateness of Khanya and its implementation by a peer. Patients also quantitatively ranked the usefulness of individual intervention components (problem solving for medication adherence ‘Life-Steps’, behavioral activation, mindfulness training, and relapse prevention) at post-treatment and six months follow-up, which we triangulated with qualitative feedback to examine convergence and divergence across methods. Results. Patients and providers reported high overall acceptability, feasibility, and appropriateness of Khanya, although there were several feasibility challenges. Mindfulness and Life-Steps were identified as particularly acceptable, feasible, and appropriate components by patients across methods, whereas relapse prevention strategies were less salient. Behavioral activation results were less consistent across methods. Conclusions. Findings underscore the importance of examining patients’ perspectives on specific intervention components within intervention packages. While mindfulness training and peer delivery models were positively perceived by consumers, they are rarely used within taskshared behavioral interventions in low- and middle-income countries.Item EFFECTS OF INTERSECTING STIGMAS ON HIV AND ALCOHOL-RELATED HEALTH BEHAVIORS(2021) Regenauer, Kristen S; Magidson, Jessica F; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)South Africa (SA) has a high burden of HIV and problematic alcohol use. However, associations between HIV stigma and alcohol-outcomes, and alcohol stigma and HIV-outcomes are largely unknown. Further, limited research has examined the role of avoidance in these associations. Therefore, as part of a larger clinical trial, we explored these associations among people living with HIV (PLWH) and problem drinking in SA (N=64). Patients had blood drawn for biomarker-verified measures of outcome variables, and completed self-report measures for all variables. A significant interaction was found between internalized HIV stigma and avoidance in predicting self-report problematic alcohol use (b(SE)=.24(.09), p=.01) such that at low levels of avoidance, higher HIV stigma was associated with less problematic alcohol use (b(SE)=-1.92(.85), p=.03). A matching nonsignificant pattern was observed for biomarker-verified alcohol consumption, suggesting that the relationship between internalized HIV stigma and problematic alcohol use may be moderated by avoidance.Item Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 – 2011: a retrospective cohort study(Springer Nature, 2014-12-17) Mee, Paul; Wagner, Ryan G; Gómez-Olivé, Francesc Xavier; Kabudula, Chodziwadziwa; Kahn, Kathleen; Madhavan, Sangeetha; Collinson, Mark; Byass, Peter; Tollman, Stephen MIn 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008–2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003–2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.Item MORE THAN JUST ‘MOB VIOLENCE’: AN IN-DEPTH LOOK AT VIGILANTE VIOLENCE IN SOUTH AFRICAN TOWNSHIPS(2016) Gross, Mark; Madhavan, Sangeetha; Villarreal, Andres; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Vigilante violence is generally understood as an alternative means of controlling crime and providing security where the state does not. It has been found in nearly all modern societies at one point or another. Currently, in South Africa, vigilantism is common, accounting for roughly 5% of daily homicides. Despite its ubiquity, vigilante violence has largely been ignored by scholars, and in South Africa, vigilante violence tends to be dismissed as “mob violence.” This dissertation draws on extensive fieldwork, multiple qualitative and quantitative data sources, and different theoretical and methodological approaches, to provide a comprehensive analysis of vigilante violence in Gauteng, South Africa. The first paper address critical theoretical issues surrounding the role of weak and failed states in fostering vigilantism. In this analysis, I use large-scale quantitative data from the Gauteng City-Region Observatory 2013 Quality of Life Survey and an independently compiled database of newspaper articles detailing incidents of vigilantism in Gauteng. I employ measures of perceptions of government performance and the provision of state security to test the relationship between perceived state legitimacy and vigilante violence. I find that negative perceptions of government performance are actually associated with decreases in vigilante violence, while negative perceptions of state security are associated with increases. The second paper utilizes the same data sources and uses the well-establish social disorganization ad neighborhood effects literature to examine the relationship between neighborhood cohesion, collective efficacy, and vigilante violence. I find that, in contrast to existing research, higher levels of neighborhood cohesion and collective efficacy actually result in more incidents of vigilante violence. The third paper expands upon the micro-sociological perspective of violence developed by Collins (2008), “forward panic,” the process whereby the tension and fear marking most potentially violent situations is suddenly released, bringing about extraordinary acts of violence. Analysis of in-depth interviews shows that episodes of vigilante violence in townships are often clearly episodes of forward panic. Although the concept of forward panic focuses on individuals, I argue that if the pre-conditions that foster forward panics in individuals are structural, there is the potential for forward panic in entire groups or parts of communities.Item The Impact of Macro Level Grievance Resolution on Terrorism and Political Violence in South Africa(2012) Van Brakle, Mischelle; LaFree, Gary; Dugan, Laura; Criminology and Criminal Justice; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)In this dissertation, I examined the relationship between two socio-legal and two political macro level reforms in South Africa on levels of anti-apartheid, separatist and unknown terrorism and fatalities. These reforms were the repeal of the pass laws, the repeal of the race classification system, the legalization of formerly outlawed political parties and the first democratic election. The results suggest that socio-legal reforms were associated with temporary increases from separatist and unknown groups. As for the political reforms, the election was associated with decreases in unknown terrorist attacks and fatalities from all three group types. Recognizing the potential for violence from groups losing power is critical to developing effective counter-terrorism strategies, particularly when transitioning from authoritarian to more democratic governance structures.