Browsing by Author "Wolff, Brent"

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    ABC for people with HIV: responses to sexual behaviour recommendations among people receiving antiretroviral therapy in Jinja, Uganda
    (Taylor & Francis, 2011) Allen, Caroline; Mbonye, Martin; Seeley, Janet; Birungi, Josephine; Wolff, Brent; Coutinh, Alex; Jaffar, Shabbar
    People living with HIV who are taking antiretroviral therapy (ART) are increasingly involved in ‘positive prevention’ initiatives. These are generally oriented to promoting abstinence, ‘being faithful’ (partner reduction) and condom use (ABC). We conducted a longitudinal qualitative study with people living with HIV using ART, who were provided with adherence education and counselling support by a Ugandan non- governmental organisation, The AIDS Support Organisation (TASO). Forty people were selected sequentially as they started ART, stratified by sex, ART delivery mode (clinic- or home-based) and HIV progression stage (early or advanced) and interviewed at enrolment and at 3, 6, 18 and 30 months. At initiation of ART, participants agreed to follow TASO’s positive-living recommendations. Initially poor health prevented sexual activity. As health improved, participants prioritised resuming economic production and support for their children. With further improvements, sexual desire resurfaced and people in relationships cemented these via sex. The findings highlight the limitations of HIV prevention based on medical care/personal counselling. As ART leads to health improvements, social norms, economic needs and sexual desires increasingly influence sexual behaviour. Positive prevention interventions need to seek to modify normative and economi
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    The Impact of the AIDS Epidemic on the Lives of Older People in Rural Uganda
    (School of Development Studies, 2008) Seeley, Janet; Kabunga, Elizabeth; Tumwekwase, Grace; Wolff, Brent; Grosskurth, Heiner
    The impact of HIV and AIDS on older people (over 60) is often portrayed as bound up in the care of children who are left when their parents die. There is, however, a growing awareness that the epidemic touches older people’s lives in other ways; affecting their socio-economic situation, their own sexuality and choices about partnerships as well as affecting relationships with their remaining children and relatives. Growing old presents challenges beyond HIV and AIDS as health wanes and the ability to plan ahead and care for ones-self and any dependents decreases. It is these dimensions of older people’s lives that we explore in this paper. Using a lifecourse approach we analyse longitudinal data from studies in 1991/1992 and 2006/2007 from rural Uganda to provide a picture of daily life of four older people, describing the challenges that they face in coming to terms with a world changed by the AIDS epidemic. By focusing on the lives of four people (three widows and a widower in their late 70s/80s) we show the great importance of their socio-economic status, as well as reciprocal relationships with family and friends, in sustaining them in the remaining years of their lives.
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    Money, men and markets: Economic and sexual empowerment of market women in southwestern Uganda
    (An International Journal for Research, Intervention and Care, 2005) Nyanzi, Barbara; Nyanzi, Stella; Wolff, Brent; Whitworth, James
    Market trading requires access to cash, independent decision-making, mobility and social interaction. This study sought to explore whether market work empowers women with respect to spending decisions and negotiation over sex and condom-use. A semi-structured questionnaire was administered to 212 market women; and 12 focus group discussions and 52 in-depths interviews were conducted among market women in southwestern Uganda. Market women reported high levels of independence, mobility, assertiveness and social interaction. Access to cash was not synonymous with control over it, however. Spending decisions were limited by men’s ability to selectively withdraw finances for expenditures central to women’s concerns including household and children’s needs. Trading in markets earns women masculine labels such as kiwagi, characterized variously as independent, rebellious and insubordinate. Earning money does not change expectations of correct behaviour for wives, making it difficult for women to initiate, deny sex or ask for condoms. Independence and income from market work may make it easier for women to enter and exit new sexual relationships. However, unable to protect themselves within partnerships, HIV risk may increase as a result.
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    ‘This is where we buried our sons’ : people of advanced old age coping with the impact of the AIDS epidemic in a resource-poor setting in rural Uganda
    (Ageing & Society, 2009) Seeley, Janet; Wolff, Brent; Kabunga, Elizabeth; Tumwekwase, Grace; Grosskurth, Heiner
    Much research on the impact of HIV and AIDS on older people fails to differentiate between age groups, and treats those aged from 50 years to the highest ages as homogeneous. The ‘oldest old’ or those aged over 75 years may be particularly vulnerable through declining health and independence as a result of the AIDS epidemic, which has forced some to take on roles that younger relatives would have performed had they lived. In this paper we describe the past and current experience of eight people in advanced old age living in rural Uganda who were informants for an ethnographic study of the impact of HIV and AIDS on households during 1991–92 and again in 2006–07. The aim of the study was to understand how they had coped with the impacts of the epidemic. From the eight case studies, it is concluded that family size, socio-economic status and some measure of good fortune in sustained good health enabled these people to live to an advanced age. While we recommend that targeted social protection is important in helping the poorest among the oldest, we suggest that sustaining respect for age and experience, and ensuring that older people do not feel discarded by family and society are as important as meeting their practical needs.
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    Women who fall by the roadside: gender, sexual risk and alcohol in rural Uganda
    (Addiction, 2006) Wolff, Brent; Busza, Joanna; Bufumbo, Leonard; Whitworth, Jimmy
    To investigate community perceptions about the different relationship between alcohol consumption and sexual risk-taking for men and women in a high HIV prevalence African setting Design and setting Participatory learning and action (PLA) activities were conducted in five rural villages in south-western Uganda in 2002. For each village, discussions and visualization activities over the course of 5 days explored local concepts of fun, drinking alcohol and HIV-related behavioural risks. Twelve focus group discussions (FGDs) investigated emerging themes. Analysis is based on visual outputs, observation notes and focus group transcripts. Participants Attendance at sex-segregated PLA sessions was open to all village residents. FGDs were purposively sampled from drinkers and general population groups. Findings For men, drinking is conducted invariably outside the home, usually at night in bars, emphasizing independence, masculinity and freedom from domestic responsibilities. For women, drinking outside male supervision challenges feminine ideals of domesticity and signifies potential sexual vulnerability. Accepting drinks from men was viewed as signifying assent to sex and refusal could justify men resorting to sexual coercion. Even though drinking is seen to promote sexual risk, HIV prevention campaigns were considered unwelcome in bars. Communities preferred seminars involving drinkers and non-drinkers alike. Conclusions Public drinking in this community serves as a marker for men willing to exercise privileges of independence (sexual and otherwise) and women willing to defy gender norms (and risk the sexual consequences). The social and symbolic context of drinking suggests why effective HIV prevention around alcohol should not be limited to drinking environments alone.