• TB/HIV risk factors identified from a General Household Survey of South Africa in 2006

      Appunni, SS; Blignaut, R; Lougue, S (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2014-10-08)
      The level of human immunodeficiency virus (HIV), tuberculosis (TB) as well as the co-infection TB/HIV in South Africa is among the highest in the world. TB is curable while HIV is not, yet the combination of both is a growing feature in the world. This study examined TB and HIV affecting people living in South Africa. Analyses have been undertaken based on data from the General Household Survey of South Africa in 2006. The study focused on  respondents aged 15–49 years, corresponding to a total of 55,384 people composed of 25,859 males and  29,525 females. Among this population, 5935 people suffered from illness/injury, including 2469 (41.6%) males and 3466 (58.4%) females. Weighted multivariate logistic regression is performed on TB and/or HIV in  association with the province, background characteristics of the target population, and selected socioeconomic and demographic variables included in the survey. In this study we focus on variables of health status and whether  subjects suffered from TB and/or HIV. Findings of this investigation show that TB is the second most common  cause of illness in the provinces of KwaZulu-Natal (KN) (9.1%), North West (5.4%) and Limpopo (4.2%). People who are married have a 50% lower risk compared to those currently not married to suffer from TB and/or HIV.  Those with living spouses have a 5% lower risk to suffer from TB and/or HIV than those whose partners are not alive. This study concluded that rapid action is needed to curb the spread of TB and/or HIV to produce a healthy population. Therefore, follow-up care and special preventative measures are urgently needed in provinces with higher reported rates of TB and/or HIV such as KN.Keywords: socioeconomic, demography, illness/injuries, living spouses, TB/HIVCette e´tude examine les maladies affectant la population de l’Afrique du Sud. L’objectif de l’e´tude est d’examiner les facteurs a` risque de TB/VIH a` partir d’une enqueˆte ge´ne´rale aupre`s des me´nages de l’Afrique du Sud en 2006. Plus pre´cise´ment, nous mettons l’accent sur les variables de l’e´tat de sante´ et si les sujets ont souffert de la tuberculose ou du VIH. L’e´tude a porte´ sur les re´pondants aˆge´s de 15–49 ans, correspondant a` un total de 55 384 personnes, compose´e de 25 859 hommes et 29 525 femmes . Parmi cette population, 5935 personnes ont souffert de maladie/blessure avec 2469 (41,6%) des hommes et 3466 (58,4%) femmes. Cet article fournit des estimations multivarie´es ponde´re´s de la tuberculose (TB) et/ou le virus de  l’immunode´ficience humaine (VIH) par province en association avec les caracte´ristiques de base de la  population cible et certaines variables socio-e´conomiques et de´mographiques. La tuberculose est la deuxie`me cause de maladie dans les provinces du KwaZulu Natal (9,1%), du Nord-Ouest (5,4%) et le Limpopo (4,2%) . Les personnes marie´es ont 50% moins de risque de souffrir de la tuberculose et/ou du VIH que les marie´es . En outre, ceux qui ont leur conjoint encore en vie ont 5% moins de risque de souffrir de la tuberculose et/ou du VIH que les veuves et veufs. En ge´ne´ral, cette e´tude a montre´ que les personnes ayant un conjoint ou un parent vivant ont un risque plus faible de maladie de la tuberculose/VIH par rapport a` ceux qui ne sont pas marie´s ou ne n’ont pas de parents en vie. Les conclusions de cette e´tude militent pour une action rapide est ne´cessaire pour enrayer la propagation de la tuberculose et du VIH afin de produire une population saine. Par conse´quent, les suivi des soins et des mesures spe´ciales de pre´vention sont ne´cessaires d’urgence dans les provinces de haute prevalence de tuberculose et/ou VIH signale´s comme le KwaZulu Natal.Mots cle´s: maladies, VIH/SIDA, tuberculose, socio-e´conomiques, de´mographiques
    • The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

      Rodriguez, Violeta J.; LaCabe, Richard P.; Privette, C. Kyle; Douglass, K.Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo “Willy”; et al. (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2017-09-19)
      The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ~72,200 to ~8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff–patient relationship,  and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.Keywords: implementation science, PMTCT, HIV, South Africa
    • The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

      Violeta J. Rodriguez; Richard P. LaCabe; C. Kyle Privette; K. Marie Douglass; Karl Peltzer; Gladys Matseke; Audrey Mathebula; Shandir Ramlagan; Sibusiso Sifunda; Guillermo “Willy” Prado (Taylor & Francis Group, 2017-01-01)
      The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff–patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.
    • The association between social networks and self-rated risk of HIV infection among secondary school students in Moshi Municipality, Tanzania

      Lyimo, EJ; Todd, J; Richey, LA; Njau, B (Taylor & Francis, 2014-11-21)
      This study describes the social networks of secondary school students in Moshi Municipality, and their association with self-rated risk of human immunodeficiency virus (HIV) infection. A cross-sectional analytical study was conducted among 300 students aged 15–24 years in 5 secondary schools in Moshi, Tanzania. Bonding networks were defined as social groupings of students participating in activities within the school, while bridging networks were groups that included students participating in social groupings from outside of the school environs. A structured questionnaire was used to ask about participation in bonding and bridging social networks and self-rated HIV risk behavior. More participants participated in bonding networks (72%) than in bridging networks (29%). Participation in bridging networks was greater among females (25%) than males (12%, p , .005). Of 300 participants, 88 (29%) were sexually experienced, and of these 62 (70%) considered themselves to be at low risk of HIV infection. Factors associated with self-rated risk of HIV included: type of school (p , .003), family structure (p , .008), being sexually experienced (p , .004), having had sex in the past three months (p , .009), having an extra sexual  partner (p , .054) and non-condom use in last sexual intercourse (p , .001), but not the presence or type of social capital. The study found no association between bonding and bridging social networks on self-rated risk of HIV among study participants. However, sexually experienced participants rated themselves at low risk of HIV infection despite practicing unsafe sex. Efforts to raise adolescents’ self-awareness of risk of HIV infection through life skills education and HIV/acquired immunodeficiency syndrome risk reduction strategies may be beneficial to students in this at-risk group.Keywords: bonding, bridging, social network, risk behaviors, HIV, school students
    • 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
    • The experiences of Batswana families regarding hospice care of AIDS patients in the Bophirima district, North West province, South Africa

      Makhele, MF; Mulaudzi, FM (Taylor & Francis, 2012-08-28)
      The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients, with some patients, too ill to be nursed at home, being sent to hospices for continued care. The Batswana had mixed feelings about hospice care, because their beliefs on patient care are based on the ubuntu philosophy, which emphasises the principle of caring for one another. The purpose of thisstudy was to explore and describe the experiences of Batswana families regarding hospice care for patients in the Thlabane township in the province of the North West as well as to make recommendations to policy-makers to ensure that hospices are accepted by community members and utilised effectively. A qualitative, explorative, descriptive research design was applied. Purposive sampling was applied to select study participants with whom in-depth unstructured interviews were conducted. A qualitative data analysis was done by categorising, ordering, and summarising the data, and describing the findings. The findings indicated that families of patients in hospice care experienced such care as foreign to their culture. These families also experienced stigmatisation, firstly owing to thestigma associated with AIDS and secondly because they opted for hospice care. However, they also observed the high quality of care provided by the hospice and understood its benefits for AIDS patients. The study concluded that hospice care relieved families of terminally ill AIDS patients of the burden of care and enabled them to keep on working and earning a living. Recommendations to policy-makers included enhancing hospice care and ensuring the provisioning of culturally safe hospice care.
    • The Farmer Life School: experience from an innovative approach to HIV education

      M Salomon; M Mudhara; JF Bunders; K Swaans; M Mweli; JE Broerse (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2008-08-14)
      The Farmer Life School (FLS) is an innovative approach to integrating HIV education into life skills and technical training for farmers. This study aims to gain insight into the strengths and weaknesses of this relatively new approach, through the implementation of an adapted version in South Africa. The results are presented of a pilot with three groups of community gardeners, predominantly women, attending weekly sessions. Impact was assessed in terms of three key elements: participation, learning, and empowerment. Data were collected through extensive session reports, follow-up interviews, and reflection exercises with facilitators and participating groups and individuals. The results suggest that a group-based discovery learning approach such as the FLS has great potential to improve food security and wellbeing, while allowing participants to explore issues around HIV/AIDS. However, the analysis also shows that HIV/AIDS-related illness and death, and the factors that drive the epidemic and its impact, undermine farmers\' ability to participate, the safety and trust required for learning, and the empowerment process. Participatory approaches such as the FLS require a thorough understanding of and adaptation to the context. Keywords: Farmer Life School, HIV/AIDS, participation, learning, empowerment.SAHARA J Vol. 5 (2) 2008: pp. 56-64
    • The lived experiences of rural women diagnosed with the human immunodeficiency virus in the antenatal period

      Fords, Genevieve Marion; Crowley, Talitha; van der Merwe, Anita S. (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2017-09-29)
      Background: In South Africa, pregnant women are diagnosed with human immunodeficiency virus (HIV) at antenatal clinics and simultaneously initiated on antiretroviral treatment (ART). An HIV diagnosis together with the initiation of ART has an emotional impact that may influence how pregnant women cope with pregnancy and their adherence to a treatment plan. The aim of the study was to explore the lived experiences of women diagnosed with HIV in the antenatal period in a rural area in the Eastern Cape province of South Africa.Methods: A qualitative approach with a descriptive phenomenological design was utilised. The study applied purposive sampling to select participants from a local community clinic in the Eastern Cape. Ten semistructured interviews were conducted, transcribed and analysed using Colaizzi’s framework.Results: Four themes formed the essential structure of the phenomenon being investigated: a reality that hits raw, a loneliness that hurts, hope for a fractured tomorrow and support of a few. Although the participants had to accept the harsh reality of being diagnosed with HIV and experienced loneliness and the support of only a few people, they had hope to live and see the future of their children.Conclusion: Women diagnosed with HIV during pregnancy are ultimately concerned with the well-being of their unborn children, and this concern motivates their adherence to ART. Women’s lived experiences are situated in their unique sociocultural context, and although some known challenges remain, counselling and support strategies need to be informed by exploring context-specific issues and involving the local community.Keywords: HIV, pregnancy, lived experiences, rural
    • The lived experiences of rural women diagnosed with the human immunodeficiency virus in the antenatal period

      Genevieve Marion Fords; Talitha Crowley; Anita S van der Merwe (Taylor & Francis Group, 2017-01-01)
      Background: In South Africa, pregnant women are diagnosed with human immunodeficiency virus (HIV) at antenatal clinics and simultaneously initiated on antiretroviral treatment (ART). An HIV diagnosis together with the initiation of ART has an emotional impact that may influence how pregnant women cope with pregnancy and their adherence to a treatment plan. The aim of the study was to explore the lived experiences of women diagnosed with HIV in the antenatal period in a rural area in the Eastern Cape province of South Africa. Methods: A qualitative approach with a descriptive phenomenological design was utilised. The study applied purposive sampling to select participants from a local community clinic in the Eastern Cape. Ten semistructured interviews were conducted, transcribed and analysed using Colaizzi's framework. Results: Four themes formed the essential structure of the phenomenon being investigated: a reality that hits raw, a loneliness that hurts, hope for a fractured tomorrow and support of a few. Although the participants had to accept the harsh reality of being diagnosed with HIV and experienced loneliness and the support of only a few people, they had hope to live and see the future of their children. Conclusion: Women diagnosed with HIV during pregnancy are ultimately concerned with the well-being of their unborn children, and this concern motivates their adherence to ART. Women's lived experiences are situated in their unique sociocultural context, and although some known challenges remain, counselling and support strategies need to be informed by exploring context-specific issues and involving the local community.
    • The meaning and challenge of voluntary counselling and testing (VCT) for counsellors: report of the Kenya Association of Professional Counsellors (KAPC) conference for sub-Saharan Africa

      KF Hunt; University of Durham UK; E Gikundi; Associate Executive Director of KAPC; N Cohen; Centre for Studies in Counselling at the University of Durham, UK; M Robson; School of Psychology, University of Keele, UK; DH Balmer; Senior Research Fellow of the University of Durham, UK; CO Rachier; Executive Director of KAPC (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2005-05-06)
      A large number of voluntary counselling and testing (VCT) sites are being opened in sub-Saharan Africa. The services provided by these sites are playing an increasingly important role in the prevention of HIV/AIDS. The sites offer many possibilities and it is crucial that they provide the optimum services for clients. Counselling is an integral part of these services, yet it receives little attention. Counsellors need to be consulted if the optimum services are to be provided, but they are rarely consulted for their professional opinion. Accordingly, the Kenya Association of Professional Counsellors (KAPC) organised a 3-day conference in September 2002 to provide counsellors, drawn from the sub-Saharan region, with a forum to identify VCT-related issues and discuss their implications. The main aim of the conference was for counsellors to arrive at a consensual position regarding HIV/AIDS and what improvements they thought could be made for the VCT services to clients. The counsellors identified the issues that they considered important and this paper presents those issues together with recommendations regarding improvements. Key words:Voluntary counselling and testing (VCT), conference report, sub-Saharan Africa. Les sens et le défi de la consultation et du dépistage volontaires (VCT) auprès des conseillers: le rapport de la conférence sur l'Afrique subsaharienne de l'Association de Conseillers Professionnels du Kenya (KAPC) RÉSUMÉ Un grand nombre de sites de consultation et de dépistage volontaires (VCT) sont mis en place en Afrique subsaharienne. Les services pourvus dans ces sites jouent un rôle encore plus important dans la prévention du VIH/SIDA. Les sites offrent beaucoup de possibilités et il est crucial qu'ils pourvoient des services les meilleurs aux clients. La consultation psychologique fait partie intégrante de ces services, malgré qu'elle reçoit très peu d'attention. Les conseillers psychologiques doivent être consultés si on veut optimiser les services fournis. Malheureusement, ils sont rarement consultés pour leur opinion professionnelle. En conséquence, l'Association des Conseillers Professionnels du Kenya (KAPC) a organisé une conférence sur 3 jours, en septembre 2002, afin de donner aux conseillers, venus de la région subsaharienne, un forum à l'intérieur duquel ils peuvent identifier les problèmes et discuter leurs implications. Le but principal de cette conférence était de permettre les conseillers à se mettre d'accord sur le VIH/SIDA d'une manière unanime et de proposer une amélioration de services de VCT mis à disposition des clients. Les conseillers ont identifié des problèmes considérés primordiaux. Cette communication présente ces problèmes et les recommandations liées aux améliorations proposées. Mots clés : Consultation et dépistage volontaires (VCT), rapport de conférence, Afrique subsaharienne. Sahara J Vol.1(3) 2004: 175-181
    • ‘The mercurial piece of the puzzle’: Understanding stigma and HIV/AIDS in South Africa

      Gilbert, Leah (Taylor & Francis, 2016-01-20)
      Although stigma and its relationship to health and disease is not a new phenomenon, it has not been a major feature in the public discourse until the emergence of HIV. The range of negative responses associated with the epidemic placed stigma on the public agenda and drew attention to its complexity as a phenomenon and concept worthy of further investigation. Despite the consensus that stigma is one of the major contributors to the rapid spread of HIV and the frequent use of the term in the media and among people in the street, the exact meaning of ‘stigma’ remains ambiguous. The aim of this paper is to briefly re-visit some of the scholarly deliberations and further interrogate their relevance in explaining HIV-related stigma evidenced in South Africa. In conclusion a model is presented. Its usefulness – or explanatory potential – is that it attempts to provide a comprehensive framework that offers insights into the individual as well as the social/structural components of HIV-related stigma in a particular context. As such, it has the potential to provide more nuanced understandings as well as to alert us to knowledge-gaps in the process.Keywords: stigma, HIV/AIDS, South Africa
    • ‘The mercurial piece of the puzzle’: Understanding stigma and HIV/AIDS in South Africa

      Leah Gilbert (Taylor & Francis Group, 2016-01-01)
      Although stigma and its relationship to health and disease is not a new phenomenon, it has not been a major feature in the public discourse until the emergence of HIV. The range of negative responses associated with the epidemic placed stigma on the public agenda and drew attention to its complexity as a phenomenon and concept worthy of further investigation. Despite the consensus that stigma is one of the major contributors to the rapid spread of HIV and the frequent use of the term in the media and among people in the street, the exact meaning of ‘stigma’ remains ambiguous. The aim of this paper is to briefly re-visit some of the scholarly deliberations and further interrogate their relevance in explaining HIV-related stigma evidenced in South Africa. In conclusion a model is presented. Its usefulness – or explanatory potential – is that it attempts to provide a comprehensive framework that offers insights into the individual as well as the social/structural components of HIV-related stigma in a particular context. As such, it has the potential to provide more nuanced understandings as well as to alert us to knowledge-gaps in the process.
    • The physical activity levels among people living with human immunodeficiency virus/acquired immunodeficiency syndrome receiving high active antiretroviral therapy in Rwanda

      Frantz, JM; Murenzi, A (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2014-11-21)
      The accessibility of high active antiretroviral therapy (HAART) for local human immunodeficiency virus (HIV) patients is improving in Rwanda. It is well known that this therapy is associated with serious adverse effects, such as metabolic and morphologic changes. One of the recommended preventive modalities for these complications is participation in physical activity. The current study aims to determine the anthropometric profile and physical activity levels among people living with HIV and receiving HAART in Kigali, Rwanda. The study was a cross-sectional, descriptive quantitative survey. The participant’s levels of physical activity participation and their association with anthropometric profiles were measured, using a structured self-administered questionnaire for 407 clients passing through the clinics. Of the participants, approximately 70% were inactive and in addition, 40% were obese and 43% overweight. Obesity was found to be strongly associated with inactivity. Lack of motivation, and time as well as fear of worsening the disease were found to be barriers to participation in physical activity.Keywords: HIV, AIDS, physical inactivity, Rwanda, HAART
    • The political context of AIDS-related stigma and knowledge in a South African township

      B Forsyth; A Vandormael; J Grobbelaar; T Kershaw (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2008-08-14)
      The purpose of this study was to examine the presentation of AIDS-related stigma and knowledge within the political context of the South African government\'s response to the AIDS epidemic. It was during the 2000 - 2004 period that key government officials publicly challenged the orthodox views of HIV/AIDS, with the South African president, Thabo Mbeki, actively positing the primary role of poverty and other socio-economic stressors in the progression of the AIDS epidemic. This discursive position had real-time effects for AIDS policy-making and ultimately delayed the implementation of a national antiretroviral (ARV) rollout programme. Consequently this position was criticised by commentators in the media and elsewhere for contributing to an already widespread climate of AIDS stigmatisation and misinformation. To shed more light on these claims we conducted a survey in 2005 in Atteridgeville, a South African township, and compared results with those of a similar survey conducted shortly after ARV medications became available in 2004. Results indicated a reduction in AIDS stigma levels across the 1-year period, and that those participants who endorsed contentious political views (such as those expressed by key government officials) were more likely to have a higher level of AIDS-related stigma than those who disagreed. Nevertheless, this study cautions against drawing a causal relationship between the South African government\'s position and AIDS-stigmatising attitudes, and suggests that further political and social factors be accounted for in an attempt to gain a fuller understanding of this seemingly complex relationship. Keywords: HIV/AIDS, AIDS-related stigma, South African government, AIDS debate, antiretroviral rollout, Atteridgeville.SAHARA J Vol. 5 (2) 2008: pp. 74-82
    • The pull of soccer and the push of Xhosa boys in an HIV and drug abuse intervention in the Western Cape, South Africa

      Melissa Medich; Deborah Mindry; Mark Tomlinson; Mary Jane Rotheram-Borus; Jason Bantjes; Dallas Swendeman (Taylor & Francis Group, 2018-01-01)
      There is growing interest in engaging men and boys in health and development programmes targeting the intersection of HIV risk, substance abuse, and violence. Understanding the conceptualisations of masculinities or masculine identities that shape both behaviours and opportunities for intervention is central to advancing the global agenda to engage men in health and development interventions. This paper examines an intervention using soccer and job training to engage and deliver activities for HIV prevention, substance abuse, and gender-based violence in a South African township. A literature review provides theoretical, historical and social context for the intersection of gender, masculinity, soccer, violence, and sexual relationships. Qualitative data from in-depth interviews and focus groups is analysed using theoretical and contextual frames to elucidate the negotiation of shifting, contradictory, and conflicting masculine roles. Results highlight how changing risky, normative behaviours among young men is a negotiated process entailing men's relationships with women and with other men.
    • The quality of material care provided by grandparents for their orphaned grandchildren in the context of HIV/AIDS and poverty: a study of Kopanong municipality, Free State

      Tamasane, T; Head, J (Taylor & Francis, 2011-07-08)
      A pervasive argument in the literature on AIDS orphans in South Africa is that grandparents, who often care for their orphaned grandchildren, lack the material means to provide adequate care. This study investigated that claim in an area of ubiquitous poverty and very high unemployment. It is based on the analysis of data obtained from two surveys carried out by the HSRC in the semi-rural municipality of Kopanong in the Free State. The first study was a census which targeted the whole population. The second, smaller survey sampled households which accommodated orphaned and vulnerable children. Based on four proxy indicators for material care: possession of birth certificates, uptake of welfare grants, levels of school attendance, and the number of meals consumed daily, the study revealed that there was very little difference in the quality of care provided by grandparents and other carers, including biological parents. Indeed, since the old age pension is much higher than the child support grant and the foster care grant it may be that grandparents who are pensioners generally have higher incomes than most other adults. In line with the findings of other research, the study found that poverty is a major problem confronting all carers in the area. It concludes that interventions thatprimarily target orphans overlook the material needs of all poor children. It therefore joins the calls of other researchers for greater state support for all poor children, irrespective of whether they are orphans and who their carers are.
    • The role of culture in effective HIV/AIDS communication by theatre in South Africa

      Uwah, C (Taylor & Francis, 2014-11-21)
      The need to effectively communicate HIV/AIDS messages in South Africa, given the high prevalence of the pandemic, cannot be overemphasised. Communication scholars have long emphasised the need to recognise adherence to cultural norms of target communities as catalyst for effective HIV/AIDS communication. Unfortunately this call has not been totally heeded by the designers of HIV/AIDS communication instruments. In the case of theatre, research has shown that in South Africa, theatre groups have gone into communities with pre-packaged plays without due cognisance of the cultural norms and beliefs of the target population. This research was conducted in KwaZulu-Natal (the province with the highest prevalence rate of HIV/AIDS infection in South Africa). Using a qualitative research methodology this paper investigated the inclusion/non-inclusion of the cultural norms of the target population in the design of the dramatic performance by the theatre group in its HIV/AIDS campaigns. The findings indicate that while the group did try to incorporate aspects of the cultural norms of the target population, it did so at a level that failed to effectively communicate the HIV/AIDS message to its audiences. This paper therefore seeks to show through empirical evidence that the non-inclusion of cultural norms and values of the target population has acted as a stumbling block in the effective communication of HIV/AIDS messages by theatre groups in the country.Keywords: theatre, culture, communities, effective communication, HIV/AIDS
    • The role of HIV/AIDS committees in effective workplace governance of HIV/AIDS in South African small and medium-sized enterprises (SMEs)

      JR Vass (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2008-07-14)
      The primary purpose of this study was to assess the role, status and scope of workplace HIV/AIDS committees as a means of effective workplace governance of the HIV/AIDS impact, and their role in extending social protective HIV/AIDS-related rights to employees. In-depth qualitative case studies were conducted in five South African small and medium-sized enterprises (SMEs) that were actively implementing HIV/AIDS policies and programmes. Companies commonly implemented HIV/AIDS policies and programmes through a workplace committee dedicated to HIV/AIDS or a generic committee dealing with issues other than HIV/ AIDS. Management, through the human resources department and the occupational health practitioner often drove initial policy formulation, and had virtually sole control of the HIV/AIDS budget. Employee members of committees were mostly volunteers, and were often production or blue collar employees, while there was a notable lack of participation by white-collar employees, line management and trade unions. While the powers of workplace committees were largely consultative, employee committee members often managed in an indirect manner to secure and extend social protective rights on HIV/AIDS to employees, and monitor their effective implementation in practice. In the interim, workplace committees represented one of the best means to facilitate more effective workplace HIV/AIDS governance. However, the increased demands on collective bargaining as a result of an anticipated rises in AIDS-related morbidity and mortality might prove to be beyond the scope of such voluntary committees in the longer term. Le but de cette étude fut d'évaluer le rôle, le statue et le champ de comités de VIH/SIDA dans un milieu de travail comme moyen efficace de gérer l'impact du VIH/SIDA dans des lieux de travail, ainsi que leur rôle à étendre, aux employés, les droits sociaux et protectifs liés au VIH/SIDA. Des études de cas qualitatives et détaillées ont été menées auprès de 5 petites et moyennes entreprises sud-africaines qui exécutaient, de manière active, les politiques et les programmes du VIH/SIDA. Les sociétés communément exécutaient les politiques et les programmes du VIH/SIDA, en milieu de travail, à travers un comité dévoué au VIH/SIDA ou bien un comité générique qui s'occupe d'autres sujets en dehors du VIH/SIDA. La gestion, à travers le département de Ressources Humaines et la personne chargée de santé en milieu de travail, a souvent conduit la formulation initiale d'une politique. De plus, la gestion dominait le budget du VIH/SIDA. La plupart des employés, membres de comités, étaient des volontaires, et souvent ces volontaires étaient des ouvriers et des employés de services. Alors qu'il manquait la participation des cadres et des représentants de syndicats. Etant donné que le pouvoir des comités était largement consultatif, les membres de comités géraient, de manière indirecte, afin d'assurer et d'étendre les droits sociaux et protectifs de VIH/SIDA aux employés, ainsi que de contrôler une mise en œuvre efficace de ce derniers. Entre temps, les comités en milieu de travail représentent un des meilleurs moyens de faciliter davantage la gestion efficace du VIH/SIDA dans un milieu de travail. Cependant, les exigences croissantes des négociations liées à l'augmentation prévue de la morbidité et la mortalité liées au SIDA pourraient, à long terme, être au-delà du champ des comités volontaires. Keywords: HIV/AIDS, committees, workplace, governance, small and medium-sized enterprises (SMEs). SAHARA J Vol. 5 (1) 2008: pp. 2-10
    • The role of the expert witness

      S Grobler (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2008-07-14)
      No Abstract.
    • The social and clinical characteristics of patients on antiretroviral therapy who are ‘lost to follow-up’ in KwaZulu-Natal, South Africa: a prospective study

      Peltzer, K; Ramlagan, S; Khan, MS; Gaede, B (Taylor & Francis, 2012-08-27)
      A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms, quality of life, depression, herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naïve patients recruited from three (one urban, one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months’ follow-up. At 12-months follow-up 557 (75.9%) individuals continued active ART, 177 (24.1%)were all cause attrition, there were 82 deaths (13.8%), 58 (7.9%) transfers, 7 (1.0%) refused participation, 8 (1.1%) were not yet on ARTand 22 (3.0%) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio, RR=2.05, confidence intervals, CI=1.20 - 3.49) and higher depression levels (RR=1.05, CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme, such as delays in health care access (delayed health care seeking), health system delays, or inappropriate treatment criteria, need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome.