Yandisa Sikweyiya

Background: Tuberculosis (TB) remains a major global public health challenge, with substantial variation across countries. South Africa has one of the highest TB incidence and mortality rates globally, while Bulgaria, a low-incidence country, faces a persistent TB burden among vulnerable populations. Objectives: To compare national trends in TB incidence and mortality in South Africa and Bulgaria from 2000 to 2023 and explore associations with selected socioeconomic indicators and health system coverage. Methods: An ecological, descriptive, analytical study used national-level data from the WHO, World Bank, and official statistics. TB trends were analyzed alongside income, poverty, unemployment, and Universal Health Coverage indicators. Time series measures and Pearson correlation were used descriptively to summarize co-variation over time. Results: Between 2000 and 2023, TB incidence declined by approximately 44% in the Republic of South Africa and 69% in Bulgaria. In both countries, TB incidence co-varied strongly with unemployment (RSA: r = 0.805; BG: r = 0.723). In Bulgaria, TB incidence was also strongly negatively associated with GDP per capita (r = −0.910), whereas no significant association with GDP was observed in South Africa. These findings indicate that TB trends co-varied more closely with labour market conditions in both contexts, while broader economic growth co-occurred with declining TB incidence only in Bulgaria. Conclusions: TB trends co-occurred with changes in socioeconomic conditions and health system coverage, with differing patterns across contexts. Findings highlight the relevance of equity-oriented, context-specific TB control strategies integrated with social and economic policies.

Tuberculosis (TB) remains a leading cause of infectious disease mortality globally, with men in sub-Saharan Africa (SSA) disproportionately affected. Men experience higher TB incidence, delayed care-seeking, poorer treatment adherence, and elevated mortality compared to women. Gender-transformative health promotion interventions that challenge harmful masculine norms, enhance health system responsiveness, and foster positive health behaviours show promise for improving linkage to and retention in TB care. However, evidence on their design, implementation, and effectiveness in SSA is limited. Following the Arksey and O’Malley framework, refined by Levac et al., this scoping review will map evidence on gender-transformative health promotion interventions targeting adult men (≥18 years) diagnosed with any form of TB in SSA. We will search PubMed via MEDLINE, the Cochrane Library, Embase.com, Global Health, Web of Science, PsycINFO, Google Scholar, Africa-Wide Information, and the WHO Library, and screen reference lists of included studies. Eligibility will follow the Population–Concept–Context (PCC) framework, focusing on interventions supporting linkage to care, treatment initiation, adherence, or retention in care. Data will be charted using a standardized extraction tool, quality appraised using the Mixed Methods Appraisal Tool, and narratively synthesized using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Stakeholder consultations will inform the interpretation of findings. As a protocol, no results are reported. The review will identify intervention characteristics, implementation strategies, barriers, facilitators, and outcomes across SSA contexts. Findings will guide the development of culturally sensitive, gender-responsive TB interventions aligned with the Sustainable Development Goal 3 to improve linkage and retention among men diagnosed with TB in SSA.

Background: Tuberculosis (TB) remains a major global health threat, with burdens distributed unevenly across regions. South Africa continues to record some of the world’s highest TB incidence and mortality rates, while Bulgaria—although a low-burden country has shown stagnant or rising mortality among vulnerable groups. Comparing these contrasting settings offers insight into how epidemiological, socio-economic, and health system factors shape TB outcomes. Objective: This study compares TB incidence and mortality trends in South Africa and Bulgaria from 2000 to 2023 and examines how HIV prevalence, migration, poverty, ageing, incarceration, health system performance, and underreporting influence TB dynamics. Methods: A narrative comparative analysis drawing on WHO Global TB Reports, peer-reviewed literature, and demographic and system indicators was conducted across four policy-aligned periods (2000–2009, 2010–2015, 2016–2020, 2021–2023). Results: South Africa experienced a sharp rise in TB incidence in the early 2000s, largely driven by the HIV epidemic and system bottlenecks. Incidence fell substantially after 2010 following ART expansion, GeneXpert implementation, and increased programmatic investment. In Bulgaria, TB incidence steadily declined, yet mortality remains disproportionately high due to underdiagnosis, population ageing, socioeconomic vulnerability, and surveillance gaps. Conclusion: Despite differing epidemiological profiles, both countries show how TB persists at the nexus of social inequity and system performance. Strengthened, equity-focused strategies are needed to improve early diagnosis, treatment outcomes, and progress toward TB elimination.

This article explores how identities and contexts influence help-seeking avoidance behaviour among college men. This exploratory qualitative study purposively selected 88 male students (aged 18–30) from some universities and Technical and Vocational Training colleges (TVETs) in South Africa. Data were collected through focus group discussions (FGDs). Eight FGDs were conducted, one in each selected university (n = 2) and TVETs (n = 6) in 2018–2019. Data were analyzed using a thematic analysis approach. We found that college men’s early life experiences and socialisation strongly influenced their ability to express emotion and access services when in need of help. The data also revealed a masculinity that men aspired to and wanted to be seen as embracing or personifying while on campus. Most men ascribed to an ideal of masculinity that made it difficult for them to share their feelings (e.g., emotional pain, sadness; and bottle their emotions) and seek help from campus-based counselors or peers. The few men who reported using campus mental health support services appraised them as unsuitable and unhelpful for them, and indicated a preference for services that were more culturally relevant. Most men indicated a preference for male counselors, of which there were very few. These findings may be useful for the formulation of evidence-based context-specific and culturally sensitive approaches for increasing men’s access to mental health and psychological support services on South African college campuses.

Disabled masculinities pose a theoretical and, more importantly, a very visceral, real-life dilemma for many men. This dilemma arises from disability being linked with being reliant on others, feeble and defenceless, yet masculinity is primarily associated with being physically strong, healthy, dominant, and independent. Violence can play an ambiguous role in disabled men’s lives. Some men may have become disabled through their participation and/or exposure to violence, such as in war; men with disabilities may be more exposed to various forms of violence; living with disabilities may lead to violent, negative, ‘coping’ strategies against others and oneself; but disabilities can also lead some men re-assessing their masculinities and adopting more caring ways of being a man. This chapter seeks to explore these dilemmas, vulnerabilities, as well as shifts in masculinities and their links to violence, both amongst men born with disabilities and those who acquired disabilities later in life. It draws mainly on previous work by the authors in four different contexts: Turkey, Kachin State in Myanmar, South African township, and rural areas of Ghana. We thereby cover areas affected by armed conflict and high levels of criminal violence, as well as areas where these are largely absent.

Background: The extremely high prevalence of sexual violence victimisation reported among female students in South African public higher education demands urgent action to develop, rigorously evaluate and scale effective prevention interventions. This article details findings from a pilot feasibility study of Ntombi Vimbela! a campus sexual violence risk reduction intervention developed to tackle the high burden of sexual violence in higher education institutions in South Africa.Methods: Ntombi Vimbela! (NV!) is a sexual violence risk reduction intervention that comprises sexuality empowerment, gender and social norm change, early-risk identification, self-defence, resistance and mental wellbeing components. NV! is comprised of ten workshop sessions running for 3.5 h each. Workshops are co-delivered by two trained peer facilitators per group of at most 20 first-year female students. One-year post-intervention quantitative outcome assessments were remotely completed by 98 participants who participated in the NV! pilot workshops. Qualitative assessments were conducted with 35 participants through in-depth telephone interviews (IDTIs).Findings: One year after attending NV! workshops, most participants reported improved awareness of sexual rights, assertive communication, shifts in gender equitable beliefs, reductions in rape myth acceptance, improved expressed sexual relationship power sexual decision-making, and improved negotiation within their intimate relationships. Participants’ depressive symptoms also significantly decreased. Many participants improved awareness of sexual assault risk and vigilance, including using self-protection strategies such as removing themselves from environments where alcohol intoxication posed sexual assault risks. Some participants used assertive communication to withstand peer pressure to engage in risky sexual behaviours. Most participants scored highly on the self-defence efficacy scale. Some participants were exposed to and successful in using verbal and physical resistance strategies in potential sexual assault risky situations.Conclusion: These findings indicate the potential beneficial effects of NV! as a campus sexual violence risk reduction intervention at one-year post-intervention, which must be evaluated in a future rigorous randomised control trial.Pilot trial registered at: ClinicalTrials.gov NCT04607564 on 29/10/2020.

Understanding how men view rape is foundational for rape prevention, but it is not always possible to interview men who rape, especially in a college campus context. We explore male students’ insights into and rationalizations for why men on campus perpetrate sexual violence (SV) against female students by analysing qualitative focus group discussion data with male students. Men contended that SV is a demonstration of men’s power over women, yet they did not perceive sexual harassment of female students as serious enough to constitute SV and appeared to be tolerant of it. Men perceived “sex for grades” as exploitative and rooted in the power asymmetry between privileged male lecturers and vulnerable female students. They were disdainful of non-partner rape, describing it as acts exclusively perpetrated by men from outside campus. Most men felt entitled to have sex with their girlfriends, although an alternative discourse challenged both this entitlement and the dominant masculinity linked to it. Gender-transformative work with male students is needed to support them to think and do things differently while they are on campus.

In this paper, we explore the gender socialization of adolescent boys in soccer clubs, and ask whether there are opportunities for integrating gender transformative elements into that socialization. This qualitative study involved 11 in-depth interviews and informal conversations with male soccer coaches from Gugulethu township and Mthatha town in the Western Cape and Eastern Cape provinces of South Africa, respectively. Data were analyzed using a thematic analysis approach. We found that the coaches felt that the adolescent boys in their soccer clubs faced serious social and emotional challenges, with the boys’ poor socio-economic backgrounds and fragmented family structures being major contributors to these challenges. Most coaches also gave themselves the responsibility to try to address some of the challenges faced by their club members. To do this, they employed specific strategies, including creating an alliance with parents and professionals. In the process, the coaches engaged the boys on topics around respect, sexual and reproductive health, and avoiding alcohol, drugs, and involvement in criminal gangs. Some coaches also played a social fathering role to club members as a way of helping them to think differently about their lives, redirect risky practices, and reduce the chance for poor health outcomes. These findings highlight the role of soccer clubs and coaches as potential avenues for health- and equity-promoting gender socialization of adolescent boys.

We know from research that pandemics and disease outbreaks expose HCWs to an increased risk of short and long-term psychosocial and occupational impacts. We conducted qualitative research among 44 frontline health care workers (FHCWs) practicing in seven South African hospitals and clinics. FHCWs were interviewed on their experiences of working during the first-wave of the COVID-19 pandemic and its perceived impact on their wellness. In this study, FHCWs included the non-medical and medical professionals in direct contact with COVID-19 patients, providing health care and treatment services during the COVID-19 pandemic. Most of the FHCWs reported stressful and traumatic experiences relating to being exposed to a deadly virus and working in an emotionally taxing environment. They reported depression, anxiety, traumatic stress symptoms, demoralization, sleep difficulties, poor functioning, increased irritability and fear of being infected or dying from COVID-19. The mental health impacts of COVID-19 on HCWs were also associated with increased poor physical wellbeing, including fatigue, burnout, headache, and chest-pains. FHCWs reported professional commitment and their faith as critical intrinsic motivators that fostered adaptive coping while working on the frontline during the first-wave of the COVID-19 pandemic. Many alluded to gaps in workplace psychosocial support which they perceived as crucial for coping mentally. The findings point to a need to prioritize interventions to promote mental wellness among FHCWs to ensure the delivery of quality healthcare to patients during pandemics or deadly disease outbreaks.

Early sexual relationships are associated with an increased risk of acquiring sexually transmitted diseases including HIV/AIDs, teenage pregnancies, and unsafe abortions among other negative health outcomes. Understanding sexual relationships among very young adolescents (VYAs) is important to equip them to protect themselves from negative sexual health (SH) outcomes. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is an HIV prevention initiative that provided an evidence-based core package of interventions to VYAs to prevent HIV acquisition in 15 countries in sub-Saharan Africa. The Girl Only Club (GOC) was the primary context for the interventions. Our objective in this study was to explore if there was any difference in social support (SS) received concerning sexual relationships between the VYA girls who attended GOCs and those who did not. In-depth interviews were conducted with 43 VYA girls, aged 10–14 years, in two rural southern districts, Zomba and Machinga, in Malawi. Twenty-three VYA girls were participants in GOCs and 20 VYA girls did not participate. A thematic, descriptive approach that involved a constant comparative analysis guided the data analysis, and Nvivo 12 software was used. In both study sites available SS concerning sexual relationships is informational support including information from parents, older relatives, and friends. However, club participants differed from non-club participants in sexual and reproductive health (SRH) knowledge and use. Club participants reported consulting others on decision-making and information on sexual relationships; receiving detailed SH information from clubs; condom use due to education received from the clubs; quitting sexual relationships; and correcting misinformation with club information. GOC participants received more SS which made them more knowledgeable and better at handling sexual relationship issues than those not in clubs. Interventions that integrate SS including social asset building and safe spaces are critical for VYA SRH programming.