A reconfiguration of the sex trade: How social and structural changes in eastern Zimbabwe left women involved in sex work and transactional sex more vulnerable
Identifieur interne : 000342 ( Pmc/Checkpoint ); précédent : 000341; suivant : 000343A reconfiguration of the sex trade: How social and structural changes in eastern Zimbabwe left women involved in sex work and transactional sex more vulnerable
Auteurs : Jocelyn Elmes [Royaume-Uni] ; Morten Skovdal [Danemark] ; Kundai Nhongo [Zimbabwe] ; Helen Ward [Royaume-Uni] ; Catherine Campbell [Royaume-Uni] ; Timothy B. Hallett [Royaume-Uni] ; Constance Nyamukapa [Royaume-Uni, Zimbabwe] ; Peter J. White [Royaume-Uni] ; Simon Gregson [Royaume-Uni, Zimbabwe]Source :
- PLoS ONE [ 1932-6203 ] ; 2017.
Abstract
Understanding the dynamic nature of sex work is important for explaining the course of HIV epidemics. While health and development interventions targeting sex workers may alter the dynamics of the sex trade in particular localities, little has been done to explore how large-scale social and structural changes, such as economic recessions–outside of the bounds of organizational intervention–may reconfigure social norms and attitudes with regards to sex work. Zimbabwe’s economic collapse in 2009, following a period (2000–2009) of economic decline, within a declining HIV epidemic, provides a unique opportunity to study community perceptions of the impact of socio-economic upheaval on the sex trade. We conducted focus group discussions with 122 community members in rural eastern Zimbabwe in January-February 2009. Groups were homogeneous by gender and occupation and included female sex workers, married women, and men who frequented bars. The focus groups elicited discussion around changes (comparing contemporaneous circumstances in 2009 to their memories of circumstances in 2000) in the demand for, and supply of, paid sex, and how sex workers and clients adapted to these changes, and with what implications for their health and well-being. Transcripts were thematically analyzed. The analysis revealed how changing economic conditions, combined with an increased awareness and fear of HIV–changing norms and local attitudes toward sex work–had altered the demand for commercial sex. In response, sex work dispersed from the bars into the wider community, requiring female sex workers to employ different tactics to attract clients. Hyperinflation meant that sex workers had to accept new forms of payment, including sex-on-credit and commodities. Further impacting the demand for commercial sex work was a poverty-driven increase in transactional sex. The economic upheaval in Zimbabwe effectively reorganized the market for sex by reducing previously dominant forms of commercial sex, while simultaneously providing new opportunities for women to exchange sex in less formal and more risky transactions. Efforts to measure and respond to the contribution of sex work to HIV transmission need to guard against unduly static definitions and consider the changing socioeconomic context and how this can cause shifts in behavior.
Url:
DOI: 10.1371/journal.pone.0171916
PubMed: 28225822
PubMed Central: 5321466
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<front><div type="abstract" xml:lang="en"><p>Understanding the dynamic nature of sex work is important for explaining the course of HIV epidemics. While health and development interventions targeting sex workers may alter the dynamics of the sex trade in particular localities, little has been done to explore how large-scale social and structural changes, such as economic recessions–outside of the bounds of organizational intervention–may reconfigure social norms and attitudes with regards to sex work. Zimbabwe’s economic collapse in 2009, following a period (2000–2009) of economic decline, within a declining HIV epidemic, provides a unique opportunity to study community perceptions of the impact of socio-economic upheaval on the sex trade. We conducted focus group discussions with 122 community members in rural eastern Zimbabwe in January-February 2009. Groups were homogeneous by gender and occupation and included female sex workers, married women, and men who frequented bars. The focus groups elicited discussion around changes (comparing contemporaneous circumstances in 2009 to their memories of circumstances in 2000) in the demand for, and supply of, paid sex, and how sex workers and clients adapted to these changes, and with what implications for their health and well-being. Transcripts were thematically analyzed. The analysis revealed how changing economic conditions, combined with an increased awareness and fear of HIV–changing norms and local attitudes toward sex work–had altered the demand for commercial sex. In response, sex work dispersed from the bars into the wider community, requiring female sex workers to employ different tactics to attract clients. Hyperinflation meant that sex workers had to accept new forms of payment, including sex-on-credit and commodities. Further impacting the demand for commercial sex work was a poverty-driven increase in transactional sex. The economic upheaval in Zimbabwe effectively reorganized the market for sex by reducing previously dominant forms of commercial sex, while simultaneously providing new opportunities for women to exchange sex in less formal and more risky transactions. Efforts to measure and respond to the contribution of sex work to HIV transmission need to guard against unduly static definitions and consider the changing socioeconomic context and how this can cause shifts in behavior.</p>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group><journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, CA USA</publisher-loc>
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<article-meta><article-id pub-id-type="pmid">28225822</article-id>
<article-id pub-id-type="pmc">5321466</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0171916</article-id>
<article-id pub-id-type="publisher-id">PONE-D-14-19196</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject>
<subj-group><subject>Sociology</subject>
<subj-group><subject>Sexual and Gender Issues</subject>
<subj-group><subject>Sex Work</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
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<subj-group><subject>Economics</subject>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Population Groupings</subject>
<subj-group><subject>Professions</subject>
<subj-group><subject>Sex Workers</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and health sciences</subject>
<subj-group><subject>Epidemiology</subject>
<subj-group><subject>HIV epidemiology</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject>
<subj-group><subject>Economics</subject>
<subj-group><subject>Commerce</subject>
<subj-group><subject>Payment</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Microbiology</subject>
<subj-group><subject>Medical Microbiology</subject>
<subj-group><subject>Microbial Pathogens</subject>
<subj-group><subject>Viral Pathogens</subject>
<subj-group><subject>Immunodeficiency Viruses</subject>
<subj-group><subject>HIV</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Pathology and Laboratory Medicine</subject>
<subj-group><subject>Pathogens</subject>
<subj-group><subject>Microbial Pathogens</subject>
<subj-group><subject>Viral Pathogens</subject>
<subj-group><subject>Immunodeficiency Viruses</subject>
<subj-group><subject>HIV</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Organisms</subject>
<subj-group><subject>Viruses</subject>
<subj-group><subject>Viral Pathogens</subject>
<subj-group><subject>Immunodeficiency Viruses</subject>
<subj-group><subject>HIV</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Organisms</subject>
<subj-group><subject>Viruses</subject>
<subj-group><subject>Immunodeficiency Viruses</subject>
<subj-group><subject>HIV</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and life sciences</subject>
<subj-group><subject>Organisms</subject>
<subj-group><subject>Viruses</subject>
<subj-group><subject>RNA viruses</subject>
<subj-group><subject>Retroviruses</subject>
<subj-group><subject>Lentivirus</subject>
<subj-group><subject>HIV</subject>
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</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Microbiology</subject>
<subj-group><subject>Medical Microbiology</subject>
<subj-group><subject>Microbial Pathogens</subject>
<subj-group><subject>Viral Pathogens</subject>
<subj-group><subject>Retroviruses</subject>
<subj-group><subject>Lentivirus</subject>
<subj-group><subject>HIV</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
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<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Pathology and Laboratory Medicine</subject>
<subj-group><subject>Pathogens</subject>
<subj-group><subject>Microbial Pathogens</subject>
<subj-group><subject>Viral Pathogens</subject>
<subj-group><subject>Retroviruses</subject>
<subj-group><subject>Lentivirus</subject>
<subj-group><subject>HIV</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Organisms</subject>
<subj-group><subject>Viruses</subject>
<subj-group><subject>Viral Pathogens</subject>
<subj-group><subject>Retroviruses</subject>
<subj-group><subject>Lentivirus</subject>
<subj-group><subject>HIV</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject>
<subj-group><subject>Geographical Locations</subject>
<subj-group><subject>Africa</subject>
<subj-group><subject>Zimbabwe</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject>
<subj-group><subject>Economics</subject>
<subj-group><subject>Health Economics</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Health Care</subject>
<subj-group><subject>Health Economics</subject>
</subj-group>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>A reconfiguration of the sex trade: How social and structural changes in eastern Zimbabwe left women involved in sex work and transactional sex more vulnerable</article-title>
<alt-title alt-title-type="running-head">The impact of economic collapse on female sex work in Zimbabwe</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Elmes</surname>
<given-names>Jocelyn</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor001">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Skovdal</surname>
<given-names>Morten</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nhongo</surname>
<given-names>Kundai</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ward</surname>
<given-names>Helen</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Campbell</surname>
<given-names>Catherine</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hallett</surname>
<given-names>Timothy B.</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nyamukapa</surname>
<given-names>Constance</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>White</surname>
<given-names>Peter J.</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
<xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gregson</surname>
<given-names>Simon</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="econtrib001"><sup>‡</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>Department of Public Health, University of Copenhagen, Copenhagen, Denmark</addr-line>
</aff>
<aff id="aff003"><label>3</label>
<addr-line>Biomedical Research and Training Institute, Harare, Zimbabwe</addr-line>
</aff>
<aff id="aff004"><label>4</label>
<addr-line>Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom</addr-line>
</aff>
<aff id="aff005"><label>5</label>
<addr-line>MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom</addr-line>
</aff>
<aff id="aff006"><label>6</label>
<addr-line>Modelling and Economics Unit, National Infection Service, Public Health England, London, United Kingdom</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Kumar</surname>
<given-names>Anil</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>University of Missouri Kansas City, UNITED STATES</addr-line>
</aff>
<author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>
TBH declares working as a technical consultant to the Bill & Melinda Gates Foundation. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors have declared that no competing interests exist.</p>
</fn>
<fn fn-type="con"><p><list list-type="simple"><list-item><p><bold>Conceptualization:</bold>
JE MS SG PJW HW CC CN.</p>
</list-item>
<list-item><p><bold>Data curation:</bold>
KN JE.</p>
</list-item>
<list-item><p><bold>Formal analysis:</bold>
JE.</p>
</list-item>
<list-item><p><bold>Funding acquisition:</bold>
SG TBH CN PJW.</p>
</list-item>
<list-item><p><bold>Investigation:</bold>
KN JE.</p>
</list-item>
<list-item><p><bold>Methodology:</bold>
JE MS SG CN.</p>
</list-item>
<list-item><p><bold>Project administration:</bold>
JE KN.</p>
</list-item>
<list-item><p><bold>Resources:</bold>
SG.</p>
</list-item>
<list-item><p><bold>Supervision:</bold>
PJW SG CN TBH.</p>
</list-item>
<list-item><p><bold>Validation:</bold>
JE KN.</p>
</list-item>
<list-item><p><bold>Visualization:</bold>
JE.</p>
</list-item>
<list-item><p><bold>Writing – original draft:</bold>
JE.</p>
</list-item>
<list-item><p><bold>Writing – review & editing:</bold>
JE MS SG PJW.</p>
</list-item>
</list>
</p>
</fn>
<fn fn-type="other" id="econtrib001"><p>‡ PJW and SG are joint senior authors on this work</p>
</fn>
<corresp id="cor001">* E-mail: <email>jocelyn.elmes@imperial.ac.uk</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>22</day>
<month>2</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="collection"><year>2017</year>
</pub-date>
<volume>12</volume>
<issue>2</issue>
<elocation-id>e0171916</elocation-id>
<history><date date-type="received"><day>29</day>
<month>4</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>27</day>
<month>1</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>© 2017 Elmes et al</copyright-statement>
<copyright-year>2017</copyright-year>
<copyright-holder>Elmes et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:href="pone.0171916.pdf"></self-uri>
<abstract><p>Understanding the dynamic nature of sex work is important for explaining the course of HIV epidemics. While health and development interventions targeting sex workers may alter the dynamics of the sex trade in particular localities, little has been done to explore how large-scale social and structural changes, such as economic recessions–outside of the bounds of organizational intervention–may reconfigure social norms and attitudes with regards to sex work. Zimbabwe’s economic collapse in 2009, following a period (2000–2009) of economic decline, within a declining HIV epidemic, provides a unique opportunity to study community perceptions of the impact of socio-economic upheaval on the sex trade. We conducted focus group discussions with 122 community members in rural eastern Zimbabwe in January-February 2009. Groups were homogeneous by gender and occupation and included female sex workers, married women, and men who frequented bars. The focus groups elicited discussion around changes (comparing contemporaneous circumstances in 2009 to their memories of circumstances in 2000) in the demand for, and supply of, paid sex, and how sex workers and clients adapted to these changes, and with what implications for their health and well-being. Transcripts were thematically analyzed. The analysis revealed how changing economic conditions, combined with an increased awareness and fear of HIV–changing norms and local attitudes toward sex work–had altered the demand for commercial sex. In response, sex work dispersed from the bars into the wider community, requiring female sex workers to employ different tactics to attract clients. Hyperinflation meant that sex workers had to accept new forms of payment, including sex-on-credit and commodities. Further impacting the demand for commercial sex work was a poverty-driven increase in transactional sex. The economic upheaval in Zimbabwe effectively reorganized the market for sex by reducing previously dominant forms of commercial sex, while simultaneously providing new opportunities for women to exchange sex in less formal and more risky transactions. Efforts to measure and respond to the contribution of sex work to HIV transmission need to guard against unduly static definitions and consider the changing socioeconomic context and how this can cause shifts in behavior.</p>
</abstract>
<funding-group><award-group id="award001"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/501100000265</institution-id>
<institution>Medical Research Council</institution>
</institution-wrap>
</funding-source>
<award-id>(MR/K010174/1)</award-id>
<principal-award-recipient><name><surname>White</surname>
<given-names>Peter J.</given-names>
</name>
</principal-award-recipient>
</award-group>
<award-group id="award002"><funding-source><institution>UK National Institute for Health Research</institution>
</funding-source>
<award-id>HPRU-2012-10080</award-id>
<principal-award-recipient><name><surname>White</surname>
<given-names>Peter J.</given-names>
</name>
</principal-award-recipient>
</award-group>
<award-group id="award003"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100004440</institution-id>
<institution>Wellcome Trust</institution>
</institution-wrap>
</funding-source>
<award-id>090285/Z/09/Z</award-id>
<principal-award-recipient><name><surname>Ward</surname>
<given-names>Helen</given-names>
</name>
</principal-award-recipient>
</award-group>
<award-group id="award004"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100004440</institution-id>
<institution>Wellcome Trust</institution>
</institution-wrap>
</funding-source>
<award-id>090285/Z/09/Z</award-id>
<principal-award-recipient><name><surname>Gregson</surname>
<given-names>Simon</given-names>
</name>
</principal-award-recipient>
</award-group>
<award-group id="award005"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/100004440</institution-id>
<institution>Wellcome Trust</institution>
</institution-wrap>
</funding-source>
<award-id>084401/Z/07/Z</award-id>
<principal-award-recipient><name><surname>Gregson</surname>
<given-names>Simon</given-names>
</name>
</principal-award-recipient>
</award-group>
<funding-statement>JE thanks the Medical Research Council for PhD funding (grant number <ext-link ext-link-type="uri" xlink:href="http://www.mrc.ac.uk/index.htm">http://www.mrc.ac.uk/index.htm</ext-link>
) and the Wellcome Trust for postdoctoral funding (grant number: 090285/Z/09/Z; <ext-link ext-link-type="uri" xlink:href="http://www.wellcome.ac.uk/">http://www.wellcome.ac.uk/</ext-link>
). SG and HW thank the Wellcome Trust(grant numbers: 084401/Z/07/Z and 090285/Z/09/Z; <ext-link ext-link-type="uri" xlink:href="http://www.wellcome.ac.uk/">http://www.wellcome.ac.uk/</ext-link>
). SG additionally thanks the Bill and Melinda Gates Foundation (Grant numbers: OPP1161471, OPP1331208) and The Joint United Nations Programme on HIV/AIDS (Grant number: EIP/DFA/PG/ca12/18; <ext-link ext-link-type="uri" xlink:href="http://www.unaids.org/en/">http://www.unaids.org/en/</ext-link>
). PJW thanks the MRC for Centre funding (MR/K010174/1), and the UK NIHR Health Protection Research Unit in Modelling Methodology at Imperial College London in partnership with Public Health England for funding (HPRU-2012-10080). TBH thanks the Bill and Melinda Gates Foundation (Grant number: OPP 106713; <ext-link ext-link-type="uri" xlink:href="http://www.gatesfoundation.org/">http://www.gatesfoundation.org/</ext-link>
), The Joint United Nations Programme on HIV/AIDS (Grant number: EIP/DFA/PG/ca12/18; <ext-link ext-link-type="uri" xlink:href="http://www.unaids.org/en/">http://www.unaids.org/en/</ext-link>
), The World Bank (Grant number: 1078406; <ext-link ext-link-type="uri" xlink:href="http://www.worldbank.org/">http://www.worldbank.org/</ext-link>
) and The Rush Foundation (<ext-link ext-link-type="uri" xlink:href="http://www.rushfoundation.org/">http://www.rushfoundation.org/</ext-link>
). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed are those of the authors and not necessarily those of the Department of Health, MRC, NHS, NIHR, or Public Health England.</funding-statement>
</funding-group>
<counts><fig-count count="2"></fig-count>
<table-count count="2"></table-count>
<page-count count="22"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>Data are available within the paper and supporting information files. Participants did not consent to having the full transcripts made available. However, additional excerpts related to the study findings that are not within the paper of supporting information may be requested by contacting the corresponding author, JE and senior author SG.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>Data are available within the paper and supporting information files. Participants did not consent to having the full transcripts made available. However, additional excerpts related to the study findings that are not within the paper of supporting information may be requested by contacting the corresponding author, JE and senior author SG.</p>
</notes>
</front>
</pmc>
<affiliations><list><country><li>Danemark</li>
<li>Royaume-Uni</li>
<li>Zimbabwe</li>
</country>
<region><li>Angleterre</li>
<li>Grand Londres</li>
<li>Hovedstaden</li>
</region>
<settlement><li>Copenhague</li>
<li>Londres</li>
</settlement>
</list>
<tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Elmes, Jocelyn" sort="Elmes, Jocelyn" uniqKey="Elmes J" first="Jocelyn" last="Elmes">Jocelyn Elmes</name>
</region>
<name sortKey="Campbell, Catherine" sort="Campbell, Catherine" uniqKey="Campbell C" first="Catherine" last="Campbell">Catherine Campbell</name>
<name sortKey="Gregson, Simon" sort="Gregson, Simon" uniqKey="Gregson S" first="Simon" last="Gregson">Simon Gregson</name>
<name sortKey="Hallett, Timothy B" sort="Hallett, Timothy B" uniqKey="Hallett T" first="Timothy B." last="Hallett">Timothy B. Hallett</name>
<name sortKey="Hallett, Timothy B" sort="Hallett, Timothy B" uniqKey="Hallett T" first="Timothy B." last="Hallett">Timothy B. Hallett</name>
<name sortKey="Nyamukapa, Constance" sort="Nyamukapa, Constance" uniqKey="Nyamukapa C" first="Constance" last="Nyamukapa">Constance Nyamukapa</name>
<name sortKey="Ward, Helen" sort="Ward, Helen" uniqKey="Ward H" first="Helen" last="Ward">Helen Ward</name>
<name sortKey="White, Peter J" sort="White, Peter J" uniqKey="White P" first="Peter J." last="White">Peter J. White</name>
<name sortKey="White, Peter J" sort="White, Peter J" uniqKey="White P" first="Peter J." last="White">Peter J. White</name>
<name sortKey="White, Peter J" sort="White, Peter J" uniqKey="White P" first="Peter J." last="White">Peter J. White</name>
</country>
<country name="Danemark"><region name="Hovedstaden"><name sortKey="Skovdal, Morten" sort="Skovdal, Morten" uniqKey="Skovdal M" first="Morten" last="Skovdal">Morten Skovdal</name>
</region>
</country>
<country name="Zimbabwe"><noRegion><name sortKey="Nhongo, Kundai" sort="Nhongo, Kundai" uniqKey="Nhongo K" first="Kundai" last="Nhongo">Kundai Nhongo</name>
</noRegion>
<name sortKey="Gregson, Simon" sort="Gregson, Simon" uniqKey="Gregson S" first="Simon" last="Gregson">Simon Gregson</name>
<name sortKey="Nyamukapa, Constance" sort="Nyamukapa, Constance" uniqKey="Nyamukapa C" first="Constance" last="Nyamukapa">Constance Nyamukapa</name>
</country>
</tree>
</affiliations>
</record>
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