Jonathan Stadler18 September 2014

Networks of infection in South Africa: Implications for HIV spread

Bushbuckridge, South Africa

•500 000 people in 133 villages.•a nodal area of extreme deprivation•male and female migrancy•antenatal HIV sero-prevalence 32.1%

•Bushbuckridge

I just woke up one morning thinking ‘who is going to help me?’ I wanted money to buy food and clothes. Then I thought I would go out and ask them [men] for money. I thought no. I cannot go and ask for money without having an affair with that person. If he has got something he can give it to me like a gift. If I hear my mother complaining about something like there is no meat or tea bags, I will go out and ask from my boyfriends to buy what I need

‘go and find a man to help you’

I didn’t love him – I just wanted his money. Because if you go out for ku phanda it is not that you love the person – you just want to crook the person. I just told myself I must just go out there and start crooking people.

• serial monogamy: sequential / serial

• concurrent partnerships:

• Focus on social structure • How people employ strategies to maximise their

social value / social capital• Socially marginalised – occupy the peripheries and

invest in sexual relationships to acquire ‘social capital’

• Sex – without condoms: sharing bodily fluids embodies ‘trust’ – solidifying bonds

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Male 27 (61%)

Female 17 (39%)

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A sexual network

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37

80

MaleFemale

3+2Partners

Multiple partnerships

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Female

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Nodes

Soweto

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Mozambique

Randfontein

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Phalaborwa

Randfontein

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Spatial spread

Male 6

Female 6

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Suspected AIDS deaths

What are the implications for prevention, treatment and care?

• Sexual networks and HIV spread - behaviour change approaches are unlikely to impact because vulnerability is shaped by position within networks … not by individual behaviour

• Do women regard themselves at risk of infection when they are not able to see the broader structures of which they are part?

• Does HIV risk outweigh the social risks faced by young women?

Implications … for planning?

• Structural dimensions – historical processes of segregation, creating rural and urban ghettos

Acknowledgements

• PhD project funders– University of Pretoria Post Graduate Awards– Mellon Fund– Centre for the Study of AIDS in Africa

• Support from DFID funded STRIVE RPC (REF PO 5244)• Friends and acquaintances in Bushbuckridge