Escalation of non-communicable diseases (NCDs) among urban South African populations disproportionately afflicted by HIV/AIDS presents not only medical challenges but also new ways in which people understand and experience sickness. In Soweto, the psychological imprints of political violence of the Apartheid era and structural violence of HIV/AIDS have shaped social and health discourses. Yet, as NCDs increasingly become part of social and biomedical discussions in South African townships, new frames for elucidating sickness are emerging. This article employs the concept of syndemic suffering to critically examine how 27 women living with Type 2 diabetes in Soweto, a township adjacent to Johannesburg known for socio-economic mobility as well as inequality, experience and understand syndemic social and health problems. For example, women described how reconstructing families and raising grandchildren after losing children to AIDS was not only socially challenging but also affected how they ate, and how they accepted and managed their diabetes. Although previously diagnosed with diabetes, women illustrated how a myriad of social and health concerns shaped sickness. Many related diabetes treatment to shared AIDS nosologies, referring to diabetes as 'the same' or 'worse'. These narratives demonstrate how suffering weaves a social history where HIV becomes ordinary, and diabetes new.
SYNDEMIC SUFFERING IN SOWETO: VIOLENCE AND INEQUALITY AT THE NEXUS OF HEALTH TRANSITION IN SOUTH AFRICA
TThis article examines the roles of structural and interpersonal violence in individual experiences of health transition in South Africa, focusing on women's narratives of distress and diabetes as well as epidemiology. Over the past decade marked increases in noncommunicable diseases, including type 2 diabetes, have transitioned in South Africa to afflict those who concurrently face great mental health burdens and the world's largest HIV and AIDS and tuberculosis epidemics. First, this article considers how social and health problems cluster among impoverished populations through a discussion of syndemics theory. Drawing from the VIDDA Syndemic employed to describe the experience of Mexican immigrant women living with diabetes and depression in urban United States, this analysis demonstrates how violence plays a unique role as a perpetuator of suffering through structural, social, psychological, and even biological pathways. Second, data around stress and structural violence, gun violence, and gender-based violence that emerged from a small study of urban South African women with type 2 diabetes are presented to discuss how violence functions as a cofactor of the syndemic of diabetes and depression in this context. This analysis emphasizes the role of historical and social contexts in how conditions such as depression and diabetes are distributed epidemiologically and experienced individually. Finally, this article argues that the utility of understanding the role of violence in health transition may be a fundamental source of intervention to mitigate the effects of the double burden of diseases on socially and economically marginalized populations in middle-income countries such as South Africa.
There is substantial evidence for the links between poverty and both physical and mental health; but limited research on the relationship of physical and mental health problems exists in low- and middle-income countries. The objective of this paper is to evaluate the prevalence and co-morbidity of psychological distress among women with common physical diseases in a socio-economically disadvantaged urban area of South Africa.
Women enrolled in the Birth to twenty (Bt20) cohort study were evaluated for this paper. Bt20 was founded in 1990 and has followed more than 3,000 children and their caregivers since birth; this study evaluates the health of the caregivers (average age 44) of these children. Psychological distress was evaluated by administering the General Health Questionnaire (GHQ-28) and we evaluated the presence of physical disease by self-report.
Forty percent of the sample presented with psychological distress using the GHQ scoring method. More than half of the women who reported a history of a physical disease, including diabetes, heart attack, asthma, arthritis, osteoporosis, epilepsy, and tuberculosis, reported psychological disorder. Presence of one physical disease was not associated with increased rates of psychological distress. However, women who reported two diseases had increased rates of psychological symptoms, and this upward trend continued with each additional physical disease reported (measured to five).
These data indicate high prevalence rates of co-morbid psychological distress among women with physical disease. This argues for the need of greater mental health support for women living with physical diseases.