Clinical trials have indicated that autologous hematopoietic stem cell transplantation (HSCT) can persistently suppress inflammatory disease activity in a subset of patients with severe multiple sclerosis (MS), but the mechanism has remained unclear. To understand whether the beneficial effects on the course of disease are mediated by lympho-depletive effects alone or are sustained by a regeneration of the immune repertoire, we examined the long-term immune reconstitution in patients with MS who received HSCT. After numeric recovery of leukocytes, at 2-yr follow-up there was on average a doubling of the frequency of naive CD4+ T cells at the expense of memory T cells. Phenotypic and T cell receptor excision circle (TREC) analysis confirmed a recent thymic origin of the expanded naive T cell subset. Analysis of the T cell receptor repertoire showed the reconstitution of an overall broader clonal diversity and an extensive renewal of clonal specificities compared with pretherapy. These data are the first to demonstrate that long-term suppression of inflammatory activity in MS patients who received HSCT does not depend on persisting lymphopenia and is associated with profound qualitative immunological changes that demonstrate a de novo regeneration of the T cell compartment.

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The concept of ‘community participation’ plays a central role in policies and interventions seeking to reduce health inequalities. This paper seeks to contribute to debates about the role of participation in health by suggesting how social psychological concepts can add to the theorisation of participation. It criticises traditional concepts of development and introduces some of the challenged that are present for development and community theorists in conditions of rapid globalisation. The paper proceeds to demarcate the space which a social psychology of participation occupies within the terrain of existing research into the health‐society interface. The concepts of empowerment and social capital are identified as important starting points to address the relative lack of social psychological attention to community‐level determinants of health. It is suggested that social identities, social representations and power are crucial elements for constructing a social psychology of participation. The paper concludes by highlighting the vital link that should exist between the development of theory and practical interventions. Paulo Freire's notion of conscientisation is a guiding notion throughout the paper. Copyright © 2000 John Wiley & Sons, Ltd.

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BackgroundA growing number of studies highlight men's disinclination to make use of HIV services. This suggests there are factors that prevent men from engaging with health services and an urgent need to unpack the forms of sociality that determine men's acceptance or rejection of HIV services.MethodsDrawing on the perspectives of 53 antiretroviral drug users and 25 healthcare providers, we examine qualitatively how local constructions of masculinity in rural Zimbabwe impact on men's use of HIV services.ResultsInformants reported a clear and hegemonic notion of masculinity that required men to be and act in control, to have know-how, be strong, resilient, disease free, highly sexual and economically productive. However, such traits were in direct conflict with the 'good patient' persona who is expected to accept being HIV positive, take instructions from nurses and engage in health-enabling behaviours such as attending regular hospital visits and refraining from alcohol and unprotected extra-marital sex. This conflict between local understandings of manhood and biopolitical representations of 'a good patient' can provide a possible explanation to why so many men do not make use of HIV services in Zimbabwe. However, once men had been counselled and had the opportunity to reflect upon the impact of ART on their productivity and social value, it was possible for some to construct new and more ART-friendly versions of masculinity.ConclusionWe urge HIV service providers to consider the obstacles that prevent many men from accessing their services and argue for community-based and driven initiatives that facilitate safe and supportive social spaces for men to openly discuss social constructions of masculinity as well as renegotiate more health-enabling masculinities.

We examined the social roots of stigma by means of a case study of HIV/AIDS management among young people in a South African community (drawing from interviews, focus groups, and fieldworker diaries). We highlight the web of representations that sustain stigma, the economic and political contexts within which these representations are constructed, and the way in which they flourish in the institutional contexts of HIV/AIDS interventions. Stigma serves as an effective form of "social psychological policing" by punishing those who have breached unequal power relations of gender, generation, and ethnicity. We outline an agenda for participatory programs that promote critical thinking about stigma's social roots to stand alongside education and, where possible, legislation as an integral part of antistigma efforts.

Levels of heterosexually transmitted HIV infection are high amongst South African youth, with one recent survey reporting levels of 18.9% amongst 17-20 year olds and 43.1% amongst 21-25 year olds. In these groups levels of knowledge about HIV are high, but perceived vulnerability and reported condom use are low. Much existing research into youth HIV in developing countries relies on survey measures which use individual knowledge, attitudes and reported behaviour as variables in seeking to explain HIV transmission amongst this group. This paper reports on a focus group study that seeks to complement existing individual-level quantitative findings with qualitative findings highlighting community and social factors that hinder condom use amongst youth in the township of Khutsong, near Carletonville. Study informants comprised 44 young women and men in the 13-25 year age group. Data analysis highlighted six factors hindering condom use: lack of perceived risk; peer norms; condom availability; adult attitudes to condoms and sex; gendered power relations and the economic context of adolescent sexuality. Informants did not constitute a homogenous group in terms of their understandings of sexuality. While there was clear evidence for the existence of dominant social norms which place young peoples' sexual health at risk, there was also evidence that many young people are self-consciously critical of the norms that govern their sexual behaviour, despite going along with them, and that they are aware of the way in which peer and gender pressures place their health at risk. There was also evidence that a minority of youth actively challenge dominant norms and behave in counter-normative and health-enhancing ways. The actively contested nature of dominant sexual norms provides a fertile starting point for peer education programmes that seek to provide the context for the collective negotiation of alternative sexual norms that do not endanger young peoples' sexual health.

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