The gap in HIV testing remains significant and new modalities such as HIV self-testing (HIVST) have been recommended to reach key and under-tested populations. In December 2016, the World Health Organization (WHO) released the Guidelines on HIV Self-Testing and Partner Notification: A Supplement to the Consolidated Guidelines on HIV Testing Services (HTS) and urged member countries to develop HIVST policy and regulatory frameworks. In South Africa, HIVST was included as a supplementary strategy in the National HIV Testing Services Policy in 2016, and recently, guidelines for HIVST were included in the South African National Strategic Plan for HIV, sexually transmitted infections and tuberculosis 2017–2022. This document serves as an additional guidance for the National HIV Testing Services Policy 2016, with specific focus on HIVST. It is intended for policy advocates, clinical and non-clinical HTS providers, health facility managers and healthcare providers in private and public health facilities, non-governmental, community-based and faith-based organisations involved in HTS and outreach, device manufacturers, workplace programmes and institutes of higher education.
To cite this article: Renée van der Wiel (2013) "I am happy with one": Re-evaluating the relationship between gender, breast-cancer surgery, and survival, Agenda: Empowering women for gender equity, 27:4, 55-64To link to this article: http://dx.abstract This Article challenges the perception that women with breast cancer experience mastectomy as devastating, because of the value they attach to having two breasts. This argument is based on ethnographic fieldwork conducted at the Helen Joseph Breast Care Centre, a public health facility in Johannesburg, South Africa. Findings from this research contradict existing local and global research that has generally represented breast cancer and mastectomy as a cosmetic crisis for which the remedy is reconstructive breast surgery. At the Helen Joseph Breast Care Centre women were not especially fearful of mastectomy. Many patients, however, resisted the reconstructive surgery available to them, saying that they were content to have only one breast. Women also defied the notion that having two breasts is essential for women to remain attractive and to maintain heterosexual relationships. Breast cancer patients in this context were significantly less preoccupied with reconstructing a prior gendered body than they were with ensuring a healthy body. This Article aligns itself with feminist critique that suggests that portraying breast cancer predominantly as an assault on gendered appearance, misrepresents women as preoccupied with conforming to a normative, 'two-breasted' femininity. Rather, in experiencing breast cancer, women have a profound confrontation with their own survival, an issue largely obscured in existing evaluations of the relationship between gender and breast cancer surgery. This Article offers qualitative insights into breast cancer in South Africa -a developing health crisis that has thus far been relatively under-researched.
Warned by social scientists about ‘the disciplinary divide’ and the hostility of medical professionals to qualitative research, I was pleasantly surprised by the collegiality I experienced while conducting fieldwork among clinician-researchers in South Africa. This commentary is a challenge to common discourse, historically dominant in a global (north) anthropology, that biomedical practitioners are necessarily antagonistic to the humanities. Drawing on my field experiences, I propose an optimistic outlook for collaboration and inclusivity in developing medical and health humanities in Africa. While conducting anthropological fieldwork among doctors producing medical research, I gained access to elite professional spaces, even presenting anthropological work in medical research forums. I established relationships with leading figures in various clinical departments and research institutes. There were, unsurprisingly, times when I had to rigorously defend my methodology. I had to revise my methodological knowledge including on quantitative methods to explain varying epistemologies to both sympathetic and doubtful medical colleagues. But, I was often treated as a fellow researcher, a colleague. Some clinician-researchers accepted me as having different, valuable expertise to analyse human complexity and proposed opportunities for possible collaboration. I argue that these clinicians appreciated this expertise because of their pervasive perceptions of crisis in healthcare and an awareness of the complexities of biomedicine in an African context of social heterogeneity, medical pluralism and legacies of social injustice. These concerns around crisis and complexity may be points of leverage for expanding interdisciplinary collaboration and facilitating access to research sites and research forums.
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