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    • Factors associated with consistent condom use by employees in the brewery industry in Nigeria

      Adegbenga Sunmola (Taylor & Francis Group, 2004-05-01)
      Many employees of large organisations in Nigeria face significant risks for HIV infection, especially due to occasional or regular job transfers, involvement in casual sexual encounters and lack of consistent condom use. The current study analysed the determinants of consistent condom use in 710 sexually active men (N = 617) and women (N = 93) recruited from the country's brewery industry. Results showed that only 12% of the employees consistently used a condom. Men who used condoms for all sexual encounters were more likely to be single, had 12 – 18 years of schooling, worked as intermediate level staff, thought a condom was useful to prevent HIV infection, and perceived that condoms hinder sexual satisfaction. Women who consistently used condoms were more likely to have 7 – 12 years of schooling. It is appropriate that brewery authorities develop work place programmes to enhance condom use among employees in order to prevent the spread of HIV infection.
    • Editorial Board

      Taylor & Francis Group, 2004-05-01
    • Culture and African contexts of HIV/AIDS prevention, care and support

      Collins O. Airhihenbuwa; J. DeWitt Webster (Taylor & Francis Group, 2004-05-01)
      Culture plays a vital role in determining the level of health of the individual, the family and the community. This is particularly relevant in the context of Africa, where the values of extended family and community significantly influence the behaviour of the individual. The behaviour of the individual in relation to family and community is one major cultural factor that has implications for sexual behaviour and HIV/AIDS prevention and control efforts. As the impact of HIV/AIDS in Africa remains unabated, a culture-centered approach to prevention, care and support is increasingly recognised as a critical strategy. In this article PEN-3, a model developed to centralise culture in health promotion interventions, is presented as a framework to be used in HIV/AIDS prevention, care and support in Africa. The three domains of the PEN-3 model incorporate specific constructs: relationships and expectations, cultural empowerment, and cultural identity.The cultural empowerment and relationships and expectations domains are ‘assessment/appraisal’ domains used for cultural assessment. Community identity is the ‘application/transformation’ domain that helps the public health practitioner assist the community to identify the point of entry of the intervention. In this paper the authors describe PEN-3 and then present examples of how the assessment/appraisal domains can be utilised to frame HIV/AIDS-related concerns in the context of Africa.
    • Treating AIDS: Dilemmas of unequal access in Uganda

      Susan Reynolds Whyte; Michael A. Whyte; Lotte Meinert; Betty Kyaddondo (Taylor & Francis Group, 2004-05-01)
      The price of antiretroviral (ARV) medicines in Uganda has fallen dramatically in recent years and more people are under treatment. By mid-2003 it was estimated that 10 000 people were taking ARVs. Drawing on participant observation, qualitative interviews, work with key informants and document reviews, we seek to map out the channels through which ARVs are being made available to people and to describe and assess the social implications of the present system of distribution. Four channels of access to ARV medicines were common in mid-2003: (i) Medicines were provided free in structured research and treatment programmes funded by donors, but only to those who lived in a defined catchment area and met inclusion criteria. (ii) Gazetted treatment centres provided drugs on a fee-for-service basis; these urban-based institutions account for the largest number of drugs dispensed. (iii) Private practitioners, mainly based in Kampala, provided discrete treatment for those who could afford it. (iv) Finally, medicines were ‘facilitated’ along informal networks, supplying friends and relatives on a less regular basis, sometimes for free, sometimes for cash. However, access to ARVs remains highly uneven. We argue that cheaper drugs make possible different kinds of access, different qualities of care, and a growing awareness of inequity. Because the price of drugs has fallen drastically, middle-class families now have the possibility of buying them. But this requires tough prioritising and many cannot follow the regimen regularly. Health workers must consider whether patients will be able to purchase the drugs or not. In a kind of popular social pharmacy, people assess who can and should and does get access to ARVs. Further research should examine the whole range of ARV access channels in different countries and the associated patterns of social differentiation and exclusions.
    • The evaluation of immediate behavioural outcomes of the syndromic case management approach for the treatment of patients with sexually transmitted infections at PHC centres in South Africa: Knowledge, attitudes, beliefs and sexual behaviour

      Leickness Simbayi; Anna Strebel; Michelle Andipatin; Cheryl Potgieter; Kopano Ratele; Nokuthula Shabalala; Tamara Shefer; Tanya Wilson (Taylor & Francis Group, 2004-05-01)
      This study aimed to determine the immediate behavioural outcomes of the WHO syndromic case management model for STIs in the public health sector in South Africa, on the levels of knowledge, attitudes and beliefs, and behavioural practices (KABPs) concerning STIs. An outcomes evaluation was conducted using KABP methodology. Exit interviews were conducted with 126 STI and non-STI patients at 24 primary health care (PHC) centres in four provinces. Both groups were found to have equally high levels of knowledge about STIs and their attitudes towards and beliefs about STIs were mostly practical and slightly negative, with only promiscuity both stereotyped and stigmatised. However, both groups were found to engage in risky sexual behavioural practices although they also indicated very strong intentions to use condoms in future. Overall, no significant differences were found between the two groups on any of the variables investigated. The implications of these findings for the control and prevention of both classic STIs and HIV/AIDS in South Africa are discussed.
    • Social grants as safety net for HIV/AIDS-affected households in South Africa

      Frikkie Booysen (Taylor & Francis Group, 2004-05-01)
      South Africa has a well-developed system of social security and the reach of the social grant safety net has expanded rapidly over the past five years. Social grants are likely to play an important role in mitigating the impact of HIV/AIDS, given that eligibility for these grants is driven largely by the increasing burden of chronic illness, the mounting orphan crisis and the impoverishment of households associated with the epidemic.This paper investigates the role of social grants in mitigating the socio-economic impact of HIV/AIDS in South Africa, using data from a panel designed to investigate the household impact of the epidemic. Data were collected from a total of 351 purposively sampled households interviewed four times over a period of two and a half years. Affected households were more dependent on income from social grants compared with households that had never experienced morbidity or mortality.A significantly larger proportion of affected households qualified for social assistance. Access to the old age pension remained relatively stable, highlighting the high take-up rate of this grant, while access to the child support and disability grant increased over time.Yet, take-up of these grants remains low and there is still much scope to improve take-up rates. Social grants also play an important role in poverty alleviation.The rate of poverty reduction continued to increase over time in affected households, but remained relatively stable in the case of households that had not experienced morbidity or mortality.This saw the gap in the incidence, depth and severity of poverty between affected households and households that had not experienced morbidity decline. Social grants also translated into a significant reduction in the severity of poverty in affected households.
    • Introducing SAHARA J

      Taylor & Francis Group, 2004-05-01
    • Introducing SAHARA J / Introduction au Journal de SAHARA

      SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2004-07-14
      Social and behavioural patterns contribute more to the spread (or to the prevention) of an epidemic than the availability of medical treatment. Currently no cure or vaccine for HIV/AIDS is available and access to affordable antiretrovirals is still not available to the wider public. Thus, social and behavioural interventions become a key option to prevent and control the further spread of HIV/AIDS. By understanding the role that various psychosocial, cultural and religious factors play in the transmission of HIV infection in communities, possible strategies and options for prevention programmes can be developed. Social Aspects of HIV/AIDS and Health, Human Sciences Research Council (HSRC), South Africa, has established a Social Aspects of HIV/AIDS Research Alliance in sub-Saharan Africa (SAHARA), a vehicle for facilitating the sharing of research expertise, sharing knowledge, conducting multi-site multicountry research projects that are intervention-based with the explicit aim of generating new social science evidence for prevention, care and impact mitigation of the HIV/AIDS epidemic. We have begun to produce a peer-reviewed medium of communication of social aspects of HIV/AIDS evidence-based information that will be accessible to African scientists. Its output will be generated from the alliance SAHARA and wishes to encourage policy makers, programme planners, researchers in universities and fellow science councils, NGOs, community groups, donors and multilateral agencies. Africa has the highest burden on HIV/AIDS in the world. This must be overcome.The Journal of Social Aspects of HIV/AIDS is being launched precisely to tackle HIV/AIDS care, support, behaviour change, behavioural surveillance, counselling, impact, mitigation, stigma, discrimination, prevention, treatment, adherence, culture, faith-based approaches, evidence-based intervention, health communication, structural and environmental intervention, financing, policy, media, etc. Priority is given to articles which are relevant to Africa and the developing world and which address social issues related to HIV and AIDS. In particular, papers presented at the biannual International Conferences of HIV/AIDS and STI in Africa and biannual Social Aspects of HIV/AIDS Research Alliance (SAHARA) conferences are published.The journal is available in hard copy and online: Website: www.sahara.org.za Happy reading! The Editors Les comportements sociaux contribuent plus amplement à la propagation d'une épidémie (ou à sa prévention) que la disponibilité des traitements médicaux. A l'heure actuelle, il n'existe pas de remède ni de vaccin et l'accès aux rétroviraux n'est toujours pas abordable pour le grand public. Par conséquent, les interventions de type social et comportemental deviennent une option-clé pour la prévention et le contrôle de la propagation du VIH/SIDA. Comprendre le rôle joué par les différents facteurs psychosociaux, culturels et religieux dans la transmission du VIH au sein des communautés permet de penser des solutions, de mettre au point des stratégies dans le but de développer des programmes de prévention. Le Conseil de Recherche en Sciences Humaines (Human Sciences Research Council (HSRC) en Afrique du Sud et sa branche des Aspect Sociaux du VIH/SIDA et de la Santé ont créé l'Alliance pour la Recherche sur les Aspects Sociaux du VIH/SIDA en Afrique sub-saharienne (SAHARA). Il s'agit d'un véhicule voué à faciliter le partage de l'expertise en recherche, des connaissances, voué également à réaliser des projets de recherche multi-sites et multi-pays générateurs d'intervention et capables d'apporter de nouveaux témoignages en sciences sociales. Ces témoignages sont à leur tour utilisables en matière de prévention, de soins et de limitation de l'impact de l'épidémie du VIH/SIDA. Nous avons commencé à produire un moyen de communication sur les aspects sociaux du VIH/SIDA qui est revu par les pairs, fondé sur des témoignages et qui sera accessible aux scientifiques africains. Les informations qu'il contient proviennent de l'alliance SAHARA et ont pour but d'encourager les décideurs de politiques, les planificateurs de programmes, les chercheurs d'universités et leurs collègues des conseils scientifiques, les ONG, les groupes communautaires, les donateurs et les agences multilatérales. L'Afrique détient le plus haut taux de VIH/SIDA au monde. Nous devons vaincre ce fait. Nous sommes justement en train de lancer le Journal des Aspects Sociaux du VIH/SIDA pour s'attaquer aux questions de soins, soutien, changement de comportements, surveillance des comportements, conseil, impact, atténuation, opprobre, discrimination, prévention, traitement, adhésion, culture, approches fondées sur la foi, intervention fondée sur les témoignages, communication en matière de santé, intervention structurelle et d'environnement, financement, politique, média, etc. La priorité est donnée aux articles applicables à l'Afrique et qui traitent de sujets sociaux en rapport avec le VIH et le SIDA. Sont publiés en particulier, les articles présentés aux conférences internationales biannuelles du VIH/SIDA et au STI en Afrique, ainsi qu'aux conférences bi-annuelles de l'Alliance pour la Recherche sur les Aspects Sociaux du VIH/SIDA (SAHARA). Site Internet : www.sahara.org.za Bonne lecture ! Les Éditeurs
    • Culture and African contexts of HIV/AIDS prevention, care and support

      J DeWitt Webster; Department of Health Management and Policy, University of Michigan School of Public Health.; CO Airhihenbuwa,; Department of Biobehavioral Health, the Pennsylvania State University. (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2004-07-14)
      Culture plays a vital role in determining the level of health of the individual, the family and the community. This is particularly relevant in the context of Africa, where the values of extended family and community significantly influence the behaviour of the individual. The behaviour of the individual in relation to family and community is one major cultural factor that has implications for sexual behaviour and HIV/AIDS prevention and control efforts. As the impact of HIV/AIDS in Africa remains unabated, a culture-centered approach to prevention, care and support is increasingly recognised as a critical strategy. In this article PEN-3, a model developed to centralise culture in health promotion interventions, is presented as a framework to be used in HIV/AIDS prevention, care and support in Africa.The three domains of the PEN-3 model incorporate specific constructs: relationships and expectations, cultural empowerment, and cultural identity.The cultural empowerment and relationships and expectations domains are ‘assessment/appraisal' domains used for cultural assessment. Community identity is the ‘application/transformation' domain that helps the public health practitioner assist the community to identify the point of entry of the intervention. In this paper the authors describe PEN-3 and then present examples of how the assessment/appraisal domains can be utilised to frame HIV/AIDS-related concerns in the context of Africa. Keywords: culture, Africa, HIV/AIDS, model. RÉSUMÉ La culture joue un rôle très important lorsqu'on détermine le niveau de santé d'un individu, d'une famille et d'une communauté. Ce dernier a un rapport particulier dans le contexte Africain où la valeur attribuée à la famille étendue et à la communauté va influencer d'une manière significative le comportement de l'individu. Le comportement de l'individu vis-à-vis la famille et la communauté est un facteur culturel majeur qui a des conséquences sur le comportement sexuel et sur les efforts de prévention ainsi que le contrôle du VIH/SIDA.Vu que l'effet du VIH/SIDA, en Afrique, reste toujours élevé, une approche de prévention, de soin et de soutien basée sur la culture est de plus en plus reconnue comme strategie essentielle à mettre en oeuvre. Dans cet article, le PEN-3, un modèle développé afin de placer la culture au centre des interventions de l'avancement de santé, est présenté comme structure de base qui sera utiliser dans la prévention du VIH/SIDA, aux soins et au soutien en Afrique. Les trois domaines du modèle PEN-3 se constituent: des relations et des attentes, du développement par la culture et d'une identité culturelle. Les deux premiers domaines sont des domaines utilisés lors de l'évaluation culturelle. L'identité culturelle est un domaine de transformation grâce auquel le personnel du service de santé public peut aider la communauté à identifier le point de départ de l'intervention. Dans cette communication, les auteurs décrivent le PEN-3, ensuite, ils démontrent comment les domaines d'évaluation peuvent être utilisés afin de cadrer toutes les préoccupations du VIH/SIDA dans le contexte de l'Afrique. Mots clés: la culture, l'Afrique, le VIH/SIDA, le modèle. SAHARA J Vol.1(1) 2004: 4-13
    • Factors associated with consistent condom use by employees in the brewery industry in Nigeria

      AM Sunmola; Department of Psychology, University of Ibadan (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2004-07-14)
      Many employees of large organisations in Nigeria face significant risks for HIV infection, especially due to occasional or regular job transfers, involvement in casual sexual encounters and lack of consistent condom use. The current study analysed the determinants of consistent condom use in 710 sexually active men (N = 617) and women (N = 93) recruited from the country's brewery industry. Results showed that only 12% of the employees consistently used a condom. Men who used condoms for all sexual encounters were more likely to be single, had 12 - 18 years of schooling, worked as intermediate level staff, thought a condom was useful to prevent HIV infection, and perceived that condoms hinder sexual satisfaction.Women who consistently used condoms were more likely to have 7 - 12 years of schooling. It is appropriate that brewery authorities develop work place programmes to enhance condom use among employees in order to prevent the spread of HIV infection. Keywords: condom use, HIV/AIDS, Nigeria. RÉSUMÉ Beaucoup d'employés des grandes entreprises du Nigéria courent un grand risque de contamination par le VIH surtout à cause des déplacements réguliers ou qui se font de temps en temps dûs au travail, des relations sexuelles non suivies et de ne pas utiliser des préservatifs à chaquefois. Cette étude a fait une analyse des déterminants de l'utilisation des préservatifs de manière systèmatique chez 710 hommes (N = 617) et femmes (N = 93) qui sont sexuellement actifs et qui travaillent dans la brasserie du pays. Les résultats ont montré que 12% des employés utilisent des préservatifs systèmatiquement. Les hommes qui se servent des préservatifs à chaquefois qu'ils ont des rapports sexuels étaient plus souvent célibataires, ont subit 12 - 18 ans de scolarisation, étaient dans des postes moyennement placés sur l'échelon, ils considéraient des préservatifs comme un moyen de prévention contre la contamination par le VIH et ils pensaient que les préservatifs diminuent le plaisir sexuel. Les femmes qui utilisaient des préservatifs ont subit 7-12 ans de scolarisation. Il est nécessaire que les autorités de la brasserie puissent mettre en place des programmes/projets de sensibilisation à l'utilisation des préservatifs parmi les employés avec le but d'éviter la dissémination de l'infection par le VIH. Mots clés : l'utilisation des préservatifs,VIH/SIDA, le Nigéria. SAHARA J Vol.1(1) 2004: 27-34
    • Treating AIDS: Dilemmas of unequal access in Uganda

      SR Whyte; Institute of Anthropology, University of Copenhagen.; B Kyaddondo; AIDS Information Centre in Kampala.; L Meinert; Department of Social Anthropology, University of Aarhus.; MA Whyte; Institute of Anthropology, University of Copenhagen. (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2004-07-14)
      The price of antiretroviral (ARV) medicines in Uganda has fallen dramatically in recent years and more people are under treatment. By mid-2003 it was estimated that 10 000 people were taking ARVs. Drawing on participant observation, qualitative interviews, work with key informants and document reviews, we seek to map out the channels through which ARVs are being made available to people and to describe and assess the social implications of the present system of distribution. Four channels of access to ARV medicines were common in mid-2003: (i) Medicines were provided free in structured research and treatment programmes funded by donors, but only to those who lived in a defined catchment area and met inclusion criteria. (ii) Gazetted treatment centres provided drugs on a fee-for-service basis; these urban-based institutions account for the largest number of drugs dispensed. (iii) Private practitioners, mainly based in Kampala, provided discrete treatment for those who could afford it. (iv) Finally, medicines were ‘facilitated' along informal networks, supplying friends and relatives on a less regular basis, sometimes for free, sometimes for cash. However, access to ARVs remains highly uneven. We argue that cheaper drugs make possible different kinds of access, different qualities of care, and a growing awareness of inequity. Because the price of drugs has fallen drastically, middle-class families now have the possibility of buying them. But this requires tough prioritising and many cannot follow the regimen regularly. Health workers must consider whether patients will be able to purchase the drugs or not. In a kind of popular social pharmacy, people assess who can and should and does get access to ARVs. Further research should examine the whole range of ARV access channels in different countries and the associated patterns of social differentiation and exclusions. Keywords: Antiretrovirals, access, equity, Uganda, AIDS policy. RÉSUMÉ En Ouganda, le prix des médicaments antiretrovirals (ARVs) a baissé au cours des dernières années et davantage de gens sont sur médicaments.Vers le milieu de l'an 2003, on a compté qu'environ 10 000 personnes étaient sur des médicaments ARVs. A partir de constatations faites pas les participants, les interviews qualitatives, le travail fait auprès des informateurs clés et des révues, nous cherchons à tracer les canaux de distribution des ARVs mis à la disposition des gens ainsi que de décrire et d'évaluer les conséquences socialles de l'actuel système de distribution. Au milieu de l'an 2003, il y a eu quatre canaux d'accès aux médicaments ARVs: (i) Les médicaments ont été gratuitement fournis aux projets de recherche et de traitement qui etaient bien structurés et financés par des donateurs. Cependant, ce dernier était uniquement pour ceux qui habitaient le quartier désigné et qui répondaient aux critères d'inclusion. (ii) Les centres de traitement publiés dans le journal officiel du gouvernement fournissaient des médicaments à un prix. Ces établissements situés dans des milieux urbains comptaient le plus grand nombre des médicaments distribués. (iii) Les médecins du secteur privé, qui étaint en majorité à Kampala, dispensaient un traitement discret aux patients qui avaient des moyens financiers. (iv) Enfin, des médicaments etaient distribués par le biais des réseaux informels auprès des amis et des membres de familles de manière moins régulière à un prix ou bien gratuitement. Cependant, l'accès aux ARVs reste largement irrégulier. Dans cette communication, nous tenons l'argument que les drogues à prix bon marché favorisent des différents moyens d'accès, des différentes qualités de soin et une prise de conscience des injustices qui s'accroît. Puisque le prix des médicaments a trop baissé, des familles de la classe moyenne ont la possibilité d'en acheter. Néanmoins, ces familles sont amenées à mettre la priorité sur des médicaments et la plus part d'entre eux n'arrivent pas à suivre le régime régulièrement. Le personnel du service de santé doit s'assurer si les patients peuvent acheter des médicaments ou pas. Dans le cas d'une pharmacie sociallement populaire, les gens évaluent qui peut, qui doit et qui a accès aux ARVs. Une étude plus avancée doit être poursuivie afin d'examiner toute une gamme de canaux d'accès des ARVs dans des différents pays ainsi que des tendances liées à la distinction socialle et l'exclusion. Mots clés : des antiretrovirals, l'accès, l'équité, l'Ouganda, la politique du SIDA. SAHARA J Vol.1(1) 2004: 14-26
    • Social grants as safety net for HIV/AIDS-affected households in South Africa

      F Booysen; Department of Economics and the Centre for Health Systems Research & Development at the University of the Free State in Bloemfontein, South Africa (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2004-07-14)
      South Africa has a well-developed system of social security and the reach of the social grant safety net has expanded rapidly over the past five years. Social grants are likely to play an important role in mitigating the impact of HIV/AIDS, given that eligibility for these grants is driven largely by the increasing burden of chronic illness, the mounting orphan crisis and the impoverishment of households associated with the epidemic. This paper investigates the role of social grants in mitigating the socio-economic impact of HIV/AIDS in South Africa, using data from a panel designed to investigate the household impact of the epidemic. Data were collected from a total of 351 purposively sampled households interviewed four times over a period of two and a half years. Affected households were more dependent on income from social grants compared with households that had never experienced morbidity or mortality. A significantly larger proportion of affected households qualified for social assistance. Access to the old age pension remained relatively stable, highlighting the high takeup rate of this grant, while access to the child support and disability grant increased over time. Yet, take-up of these grants remains low and there is still much scope to improve take-up rates. Social grants also play an important role in poverty alleviation. The rate of poverty reduction continued to increase over time in affected households, but remained relatively stable in the case of households that had not experienced morbidity or mortality. This saw the gap in the incidence, depth and severity of poverty between affected households and households that had not experienced morbidity decline. Social grants also translated into a significant reduction in the severity of poverty in affected households. Keywords: HIV/AIDS, poverty, social assistance, public transfers, social grants, South Africa. RÉSUMÉ Le système de sécurité sociale de l'Afrique du Sud est très bien développé et le filet de sécurité de subventions sociales s'est répandu assez rapidement au cours de cinq dernières années. Les subventions sociales joueraient un rôle important en atténuant l'effet du VIH/SIDA, étant donné que le droit à ces subventions est largement influencé par l'augmentation du fardeau des maladies chroniques, la crise des orphelins qui s'accroît, ainsi que l'appauvrissement des foyers associé à l'épidémie. Cette article étudie le rôle de subventions sociales qui atténuent l'impact socio-économique du VIH/SIDA en utilisant des données provenant d'une commission d'enquete. Cette commission a pour mission d'examiner l'effet de l'épidémie sur un foyer. Des données ont été requis auprès de 351 foyers interviewés en tant qu'échantillon ciblé. Ces foyers ont été interviewés à quatre reprises au cours de deux ans et demi. Les foyers qui sont touchés par l'épidémie dépendaient beaucoup plus sur les subventions par rapport à ceux qui n'ont jamais été affectés par la morbidité et la mortalité. Une grande partie de foyers affectés a droit à l'aide sociale. L'accès à la retraite est resté relativement stable tandis que l'accès au soutien d'enfant et à la pension d'invalidité a augmenté au cours du temps. Pourtant, les demandes de subventions restent assez basses et il y a encore beaucoup de travail à faire afin d'améliorer le taux de demandes. Les allocations sociales jouent un rôle important en réduisant la pauvreté. Le rythme de réduction de la pauvreté a continué à augmenter au cours du temps dans des foyers touchés.Toutefois, dans le cas des foyers non-touchés, le rythme de réduction est resté relativement stable. De ce fait, l'écart créé par la fréquence, la profondeur et la gravité de la pauvreté entre les foyers affectés et ceux qui ne le sont pas diminue. Les allocations sociales ont réduit la gravité de pauvreté de manière significative dans les foyers affectés. Mots clés: le VIH/SIDA, la pauvreté, l'aide sociale, le transfert public, les allocations sociales, l'Afrique du Sud. SAHARA J Vol.1(1) 2004: 45-56
    • The evaluation of immediate behavioural outcomes of the syndromic case management approach for the treatement of patients with sexually transmitted infections at PHC centres of South Africa: Knowledge, attitudes, beliefs and sexual behaviour

      N Shabalala; Department of Psychology at the University of the Western Cape; K Ratelel; Psychology Department at the University of the Western Cape; M Andipatin; Department of Psychology at the University of the Western Cape; LC Simbayi; Human Sciences Research Council; C Potgieter; Department of Psychology at Pretoria University; T Wilson; Clinical psychologist in private practice; A Strebel; Sekao-Headways Research Training and Development agency; T Shefer; Women and Gender Studies Programme at the University of the Western Cape (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2004-07-14)
      This study aimed to determine the immediate behavioural outcomes of the WHO syndromic case management model for STIs in the public health sector in South Africa, on the levels of knowledge, attitudes and beliefs, and behavioural practices (KABPs) concerning STIs. An outcomes evaluation was conducted using KABP methodology. Exit interviews were conducted with 126 STI and non-STI patients at 24 primary health care (PHC) centres in four provinces. Both groups were found to have equally high levels of knowledge about STIs and their attitudes towards and beliefs about STIs were mostly practical and slightly negative, with only promiscuity both stereotyped and stigmatised. However, both groups were found to engage in risky sexual behavioural practices although they also indicated very strong intentions to use condoms in future. Overall, no significant differences were found between the two groups on any of the variables investigated. The implications of these findings for the control and prevention of both classic STIs and HIV/AIDS in South Africa are discussed. Keywords: sexually transmitted infections, syndromic case management, KABP, South Africa, primary health care centres. RÉSUMÉ Le but de cette étude était d'établir les résultats comportementaux immédiats du modèle de l'OMS de la gestion syndromique de cas de maladies sexuellement transmises (STIs) dans le secteur public de santé en Afrique du Sud au niveau de la connaissance, des attitudes, de la croyance et des pratiques (KABP) vis-à-vis les STIs. Une évaluation des résultats a été faite par le biais de la méthodologie KABP. Des entrevues de sortie ont eu lieu auprès de 126 patients de STIs et des patients qui n'en souffrent pas dans 24 centres de santé situés dans quatre provinces. Les résultats ont montré que les deux groupes avaient le même niveau de connaissance des STIs, leur attitude envers les STIs et ce qu'ils croyent des STIs étaient plutôt pratiques et un peu négatifs. La promiscuité était la seule à être stéréotypée et à être stigmatisée. Cependant, tous les deux groupes ont eu des rapports sexuels risqués, même s'ils ont montré une intention d'utiliser des préservatifs dans l'avenir. Dans l'ensemble, il n'y a pas eu de différences importantes entre les deux groupes sur les variables étudiées. Les conséquences de ces résultats pour le contrôle et la prévention des STIs et le VIH/SIDA en Afrique du Sud sont au centre de cette étude. Mots clés : les maladies/infections sexuellement transmises, la gestion syndromique de cas, les centres pour la santé primaire, l'Afrique du Sud. SAHARA J Vol.1(1) 2004: 35-44
    • Microbicide trials for preventing HIV/AIDS in South Africa: Phase II trial participants' experiences and psychological needs

      Annalie Pistorius; Janneke van de Wijgert; Mohlatlego Sebola; Barbara Friedland; Evelyn Nagel; Cathleen Bokaba; Anwar Hoosen (Taylor & Francis Group, 2004-08-01)
      The Microbicide Division of the Department of Medical Microbiology at MEDUNSA, South Africa, recently completed a phase II expanded safety trial of the candidate microbicide Carraguard. A microbicide is a vaginal product that women might use, if proven safe and effective, to protect themselves from HIV and possibly other sexually transmitted infections (STIs). The study participants were from Ga-Rankuwa and its neighbouring areas, an historically disadvantaged residential township near Pretoria. We conducted six focus group discussions with phase II trial participants to evaluate their experiences with trial participation and their psychological needs. Participants spontaneously talked about their experiences with the study gel and speculum examinations. They felt that they had received high quality medical care. They indicated that their personal hygiene and knowledge of the female reproductive system, HIV and other STIs had improved, which helped their families and empowered them as women. Participants valued being able to discuss their anxiety about HIV/AIDS with study staff. They felt that the study provided them with a supportive environment in which their personal problems (not necessarily restricted to HIV/AIDS) could be addressed. Some recommended that the study staff improve their professionalism and punctuality. They suggested the formation of participant support groups, and expressed a preference to remain involved in the trial. Some participants appeared to have become dependent on services provided during the trial.We have taken the results of these focus group discussions into account during planning for a phase III efficacy trial of Carraguard to be conducted in the same and other similar communities.
    • A study of local government HIV/AIDS projects in South Africa

      Leon Swartz; Niel Roux (Taylor & Francis Group, 2004-08-01)
      The primary goal of this study was to survey local government HIV/AIDS projects in South Africa. A total of 240 questionnaires were sent to local municipalities nationally between May and July 2002. A total of 44 municipalities returned their questionnaires, covering 53 projects. Most projects focused on prevention and awareness and the majority had awareness/prevention/information as part of their objectives as well as their activities. Home/community-based care was also prominent. It seems that in the future the focus of programme development will shift in this direction. Major constraints were a lack of funds, transport and trained personnel. Future emphasis must thus be put on these components. In addition government needs to put more resources into local government HIV/AIDS programmes since this tier will be the nodal point for national combatting of the HIV/AIDS epidemic.
    • Impact of long-term civil disorders and wars on the trajectory of HIV epidemics in sub-Saharan Africa

      David Gisselquist (Taylor & Francis Group, 2004-08-01)
      From the mid-1970s, seven countries in sub-Saharan Africa have experienced civil disorders and wars lasting for at least 10 years. In two — Sierra Leone during 1991–2002, and Somalia from 1988 and continuing — adult HIV prevalence remained below 1%. In the Democratic Republic of the Congo, HIV prevalence appears to have stabilised during post-1991 civil disorder and war. Limited information from Angola (civil war 1975–2002) and Liberia (civil disorder and war from 1989 and continuing) suggests low HIV prevalence. Mozambique's HIV prevalence was near 1% after its 1975 – 1992 civil war, but increased dramatically in the first post-war decade. Across African countries with long-term wars, HIV seems to have spread more slowly than in most neighbouring countries at peace. This evidence contributes to the ongoing debate about the factors that explain differential epidemic trajectories, a debate which is crucial to the design of HIV prevention programmes. One possible explanation for slow epidemic growth in wartime is that unsterile health care accounts for an important proportion of HIV transmission during peacetime, but much less when wars disrupt health services. However, other explanations are also possible. The roles of sex and blood exposures in HIV epidemics in war and peace await empirical determination.
    • Editorial Board

      Taylor & Francis Group, 2004-08-01
    • Gender and HIV/AIDS impact mitigation in sub-Saharan Africa — recognising the constraints

      Janet Seeley; Rachel Grellier; Tony Barnett (Taylor & Francis Group, 2004-08-01)
      In discussions of gender and HIV/AIDS, attention has focused on prevention. This is a vital area. However, we argue that there is also a need to focus more attention on the resulting impact of the epidemic, because inequalities that promote the spread of infection are also hampering containment and impact mitigation. We propose a framework highlighting the gendered constraints exacerbated by the epidemic. These constraints are reviewed under the following headings: Gender-specific constraints: stemming from the specific nature of gender relations themselves, such as the availability of labour in agriculture, business and for household tasks, as well as access to services and markets, and the incidence of gendered violence. Gender-intensified disadvantages: stemming from the uneven and often inequitable distribution of resources between men and women, including cultural/religious conventions, and the social rules and norms that regulate property rights, inheritance practices and resource endowments. Gender-imposed constraints: resulting from biases and partialities of those individuals who have the authority and power to allocate resources. These include provision of credit, information, agricultural extension and health care. The differential involvement of men and women in development programmes affects access to resources, as does political participation, including involvement in the formulation of policies aimed at poverty reduction.These constraints take us beyond gender relations and sexual behaviour. But women's lives will not change in the short term. The challenges they face in mitigating the impact of HIV/AIDS will not be addressed by focusing only on their specific vulnerability to HIV/AIDS infection. Unequal gender relations and the nature of ‘development’ need to be changed too.
    • Report and policy brief: 2nd Annual Conference on Social Aspects of HIV/AIDS Research, Cape Town, 9 – 12 May 2004

      S. Kleintjes; K. Peltzer; O. Shisana; C. Niang; J. Seager; L. Simbayi; D. Kaseje (Taylor & Francis Group, 2004-08-01)