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      Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy


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          Following calls for targeted HIV prevention interventions in so-called “hotspots”, we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities’ sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesion and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people’s perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful.

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          Most cited references52

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          Self-efficacy mechanism in human agency.

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            From social integration to health: Durkheim in the new millennium

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              The sense of control as a moderator of social class differences in health and well-being.

              The authors examined social class differences in 2 aspects of the sense of control (mastery and perceived constraints) in 3 national probability samples of men and women ages 25-75 years (N1 = 1,014; N2 = 1,195; N3 = 3,485). Participants with lower income had lower perceived mastery and higher perceived constraints, as well as poorer health. Results of hierarchical multiple regression analyses showed that for all income groups, higher perceived mastery and lower perceived constraints were related to better health, greater life satisfaction, and lower depressive symptoms. However, control beliefs played a moderating role; participants in the lowest income group with a high sense of control showed levels of health and well-being comparable with the higher income groups. The results provided some evidence that psychosocial variables such as sense of control may be useful in understanding social class differences in health.

                Author and article information

                Afr J AIDS Res
                Afr J AIDS Res
                African journal of AIDS research : AJAR
                15 June 2020
                March 2018
                22 June 2020
                : 17
                : 1
                : 72-81
                [1 ]Africa Health Research Institute, KwaZulu-Natal, South Africa
                [2 ]Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
                [3 ]Institute of Global Health, University College London, London, UK
                [4 ]Faculty of Medicine and Faculty of Social, Human and Mathematical Sciences, Southampton University, Southampton, UK
                [5 ]London School of Hygiene & Tropical Medicine, London, UK
                [6 ]School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
                [7 ]Research Department of Epidemiology & Public Health, University College London, London, UK
                Author notes
                [* ]Corresponding author, nngwenya@ 123456ahri.org

                Open Access article distributed in terms of the Creative Commons Attribution License [CC BY 4.0] ( http://creativecommons.org/licenses/by/4.0)


                community cohesion,efficacy,inequity,perceived control,social mobility


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