• Understanding and measuring AIDS-related settings: A developing country perspective

      C Daly; L Gilborn; R Mudoi; J Pulerwitz; I Gupta; V S Mahendra; S Bharat; B George; L Samson (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2007-11-19)
      AIDS-related stigma and discrimination remain pervasive problems in health care institutions worldwide. This paper reports on stigma-related baseline findings from a study in New Delhi, India to evaluate the impact of a stigma-reduction intervention in three large hospitals. Data were collected via in-depth interviews with hospital staff and HIV-infected patients, surveys with hospital workers (884 doctors, nurses and ward staff) and observations of hospital practices. Interview findings highlighted drivers and manifestations of stigma that are important to address, and that are likely to have wider relevance for other developing country health care settings. These clustered around attitudes towards hospital practices, such as informing family members of a patient\'s HIV status without his/her consent, burning the linen of HIV-infected patients, charging HIV-infected patients for the cost of infection control supplies, and the use of gloves only with HIV-infected patients. These findings informed the development and evaluation of a culturally appropriate index to measure stigma in this setting. Baseline findings indicate that the stigma index is sufficiently reliable (alpha = 0.74). Higher scores on the stigma index – which focuses on attitudes towards HIV-infected persons – were associated with incorrect knowledge about HIV transmission and discriminatory practices. Stigma scores also varied by type of health care providers – physicians reported the least stigmatising attitudes as compared to nursing and ward staff in the hospitals. The study findings highlight issues particular to the health care sector in limited-resource settings.To be successful, stigma-reduction interventions, and the measures used to assess changes, need to take into account the socio-cultural and economic context within which stigma occurs. SAHARA J Vol. 4 (2) 2007: pp. 616-625
    • Understanding culture and HIV/AIDS in sub-Saharan Africa

      Sovran, S (Taylor & Francis, 2013-10-10)
      Early in the study of HIV/AIDS, culture was invoked to explain differences in the disease patterns between sub-Saharan Africa and Western countries. Unfortunately, in an attempt to explain the statistics, many of the presumed risk factors were impugned in the absence of evidence. Many cultural practices were stripped of their meanings, societal context and historical positioning and transformed into cofactors of disease. Other supposedly beneficial cultural traits were used to explain the absence of disease in certain populations, implicitly blaming victims in other groups. Despite years of study, assumptions about culture as a cofactor in the spread of HIV/AIDS have persisted, despite a lack of empirical evidence. In recent years, more and more ideas about cultural causality have been called into question, and often disproved by studies. Thus, in light of new evidence, a review of purported cultural causes of disease, enhanced by an understanding of the differences between individual and population risks, is both warranted and long overdue. The preponderance of evidence suggests that culture as a singular determinant in the African epidemic of HIV/AIDS falls flat when disabused of its biased and ethnocentric assumptions.Keywords: culture, HIV/AIDS, sub-Saharan Africa, population risk
    • Understanding of the risk of HIV infection among the elderly in Ga-Rankuwa, South Africa

      Lekalakala-Mokgele, E (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2014-10-08)
      The literature pertaining to the elderly shows that HIV infection among this population is on the increase, suggesting that the elderly population engages in activities risky for HIV infection. Reports on such behaviour  include frequent sexual relations with much younger people and having multiple partners. A study was carried out in Ga-Rankuwa, a black township in Gauteng Province, South Africa to explore and describe the understanding of these elderly people regarding their risks of HIV infection and AIDS. Using a qualitative, exploratory design, three focus-group interviews were conducted with 32 women aged over 50 years. Findings revealed that older persons have knowledge about transmission of HIV infection and AIDS. However, a few had misconceptions as to how HIV infection is transmitted, as they believed that poor nutrition and sharing facilities play a role. Knowledge of mechanisms of protecting themselves against infection, such as use of a condom during coitus and wearing gloves when caring for infected family members, was also evident. The elderly indicated that they would prefer an older person, who they could identify with, to educate them more about HIV infection and AIDS. Although majority of participants had knowledge of how HIV is transmitted, and issues that put them at risk of transmission, a few the older persons had misconceptions about how HIV is transmitted due to lack of knowledge, as they believed that poor nutrition and sharing facilities can transmit infection. The lack of knowledge underscores the importance of addressing sexual risk with older people. It was very clear that more needs to be done in terms of education campaigns to dispel the myths of HIV infection and to empower the elderly.Keywords: HIV infection, AIDS, risk, elderly, fears, HIV testingLa litte´rature relative aux personne aˆge´es indique que l’infection a` VIH est a` la hausse parmi cette population, c’est qui sugge`re que la population aˆge´e s’engage dans des activite´s a risque vis-a`-vis de l’infection a` VIH. Les publications ont mentionne´es de genre de comportements incluant de fre´quente relation sexuelles avec de jeunes gens et aussi ayant de multiple sexuel partenaires. Une e´tude avais e´te´ conduite en Garankuwa, un bas-lieu noir dans la province de Gauteng, en Afrique du Sud pour explorer et de´crire la connaissance de ces personnes aˆge´es concernant les risques qu’ils courent a l’e´gards de l’infection a` VIH et du SIDA. En utilisant la perceptive qualitative de l’approche exploratoire, trois groupes d’entrevues ont e´te´ mene´es avec 32 femmes aˆge´es de plus de 50 ans. Les re´sultants ont re´ve´le´ que les personnes aˆge´es ont suffisamment la connaissance sur la mode de transmission de l’infection a` VIH et le SIDA. Cependant, quelques-uns parmi eux avaient de fausse compre´hension sur la fac¸on dont l’infection a` VIH est transmise, car ils croient que la pauvre qualite´ alimentaire et le partage des installations sanitaires jouent un roˆle. La connaissance de me´canismes pour se prote´ger contre l’infection, par exemple l’utilisation de condom pre´servatif lors du coı¨t et de porter des gants pendant qu’ ils dispensent des soins aux membres de leur familles infecte´s e´tait e´galement e´vidente. Les personnes aˆge´es ont indique´ qu’ils pre´fe´reraient une personne aˆge´e et mature, a` qui ils pourraient s’identifier, de leur e´duquer davantage sur l’infection a` VIH et le sida. Par conse´quent, it e´tait clair que le besoin en termes d’e´ducation de masse sur les mythes a` propos de l’infection a` VIH et le SIDA devrait eˆtre envisage´ pour ce groupe a` risque.Mots cle´s: infection par le VIH, le SIDA, le risque, les personnes aˆge´es, la peur, le de´pistage du VIH
    • Understanding the response of large South African companies to HIV/AIDS

      D Dickinson; Senior lecturer in industrial relations at the Graduate School of Business Administration, University of the Witwatersrand; M Stevens; Project manager and senior researcher at the Centre for Health Policy at the University of the Witwatersrand (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2005-10-13)
      This paper provides a framework analysing the response of South African companies to HIV/AIDS. Drawing on three case studies of companies, each with over 20 000 South African-based employees, we identify six ‘drivers\' that influence corporate behaviour regarding HIV/AIDS: legal requirements, voluntary regulation, business costs, social pressures, visibility of the disease, and individuals within companies.We suggest that costs calculations, while possibly underestimating indirect and macro-implications, are not key in driving company responses to HIV/AIDS.The law and voluntary regulation have influenced, but not determined, the response of companies to HIV/AIDS. Social pressures on companies are of importance, but the scale and complexity of need in South Africa has seen the deflecting of this driver. Of greater reference in determining responses has been the social pressure of other companies\' responses.The general visibility of the AIDS epidemic is also a significant factor in explaining companies\' responses to HIV/AIDS. Moreover, the visibility of HIV/AIDS within companies has influenced the responses of often relatively weak, internal agents who have been attempting to drive companies\' HIV/AIDS programmes. We conclude that external drivers – legal requirements, economic performance, and social pressures – have framed corporate responses to HIV/AIDS to a degree, but have generally been weak. Moreover, there has been relatively little synergy between these external drivers and the internal drivers – voluntary regulation, visibility, and company HIV/AIDS ‘champions\' – that could propel companies into pro-active, bold responses to HIV/AIDS. Keywords: companies, HIV response, South Africa. RÉSUMÉ Cette communication met &#224 disposition un cadre qui analyse la r&#233ponse des soci&#233t&#233s sud-africaines au VIH/SIDA. En tirant sur trois &#233tudes de cas de ces soci&#233t&#233s, chacune ayant 20 000 employ&#233s vivant en Afrique du Sud, nous identifions six conducteurs qui influencent le comportement de corporation par rapport au VIH/SIDA: des dispositions r&#233glementaires, un r&#232glement volontaire, des coûts d\'affaires, des pressions sociales, une visibilit&#233 de la maladie et des individus au sein des soci&#233t&#233s. Nous sugg&#233rons que les calculs de co&#251ts, entre temps les implications indirectes et macros sont peut-être sousestim&#233es, ne sont pas prioritaires pour diriger les r&#233ponses des soci&#233t&#233s au VIH/SIDA. La loi et le règlement volontaire ont influenc&#233, et non pas d&#233termin&#233, la r&#233ponse des soci&#233t&#233s. Les pressions sociales sur les soci&#233t&#233s ont plus d&#39importance, mais l&#39ampleur et la complexit&#233 du besoin en Afrique du Sud a d&#233tourn&#233 ce conducteur. La pression sociale des r&#233ponses des autres soci&#233t&#233s fut une r&#233f&#233rence importante qui a d&#233termin&#233 la r&#233ponse. La visibilit&#233 g&#233n&#233rale de l&#39&#233pid&#233mie du SIDA est &#233galement un facteur important dans l&#39explication des r&#233ponses de soci&#233t&#233s au VIH/SIDA. D&339autant plus que la visibilit&#233 du VIH/SIDA au sein des soci&#233t&#233s a influenc&#233 les r&#233ponses des agents, souvent relativement faibles, qui ont essay&#233 de diriger les programmes de VIH/SIDA dans les soci&#233t&#233s. Nous tirons la conclusion que les conducteurs externes – les dispositions r&#233glementaires, la performance &#233conomique et les pressions sociales – ont encadr&#233 les r&#233ponses des corporations au VIH/SIDA &#224 un certain degr&#233, mais ils ont &#233t&#233 g&#233n&#233ralement faibles. De plus, il y a eu une synergie relativement petite entre les conducteurs externes et les conducteurs internes – le r&#232glement volontaire, la visibilit&#233 et les ‘champions\' du VIH/SIDA dans la soci&#233t&#233 qui pourraient propulser les soci&#233t&#233s vers des r&#233ponses pro-actives et audacieuses au VIH/SIDA. Mots cl&#233s: soci&#233t&#233s, r&#233ponses au VIH, l&#39Afrique du Sud. Journal of Social Aspects of HIV/AIDS, Vol 2(2) 2005: 286-295
    • Understanding the role played by parents, culture and the school curriculum in socializing young women on sexual health issues in rural South African communities

      Mpondo, Feziwe; Ruiter, Robert A.C.; Schaafsma, Dilana; van den Borne, Bart; Reddy, Priscilla S. (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2018-04-11)
      Background: the decline in South Africa’s HIV infection rates especially among young women is encouraging. However, studies show that the 15–24-year-old cohort remains vulnerable. As they still report early sexual debut, being involved in sexual partnerships with older men as well as having unprotected sex. These risky sexual behaviors may be linked to factors such as the parent–child sexual health communication and the timing of the first talk. The quality of sexual health information received in school may also be important for enhancing healthier sexual behaviors. Aims andObjectives: to investigate the what, when and how sexual health communication occurs in rural South African families and to determine whether such communication patterns have changed over time. We also wanted to get an in-depth understanding of the roles played by culture, sexual health education and peers in the socialization of young women on sexual matters.Methods: a purposive sample of (n = 55) women who were 18–35 years old was selected and interviewed in focus group discussions (FGDs).Results: the FGD findings show that parent–child communication on sexual matters in rural communities is limited to messages that warn against pregnancy. It is also laden with cultural idioms that are not well explained. The school sexual health curriculum also fails to adequately equip adolescents to make informed decisions regarding sexual matters. All this seems to leave room for reception of misguided information from peers.Conclusions: findings highlight a need for designing interventions that can create awareness for parents on the current developmental needs and sexual behavior of adolescents. For adolescents programs would need to focus on providing skills on personal responsibility, and how to change behavior to enhance sexual health.Keywords: adolescents, rural communities, communication, culture, sexual health
    • Understanding the role played by parents, culture and the school curriculum in socializing young women on sexual health issues in rural South African communities

      Feziwe Mpondo; Robert A.C. Ruiter; Dilana Schaafsma; Bart van den Borne; Priscilla S. Reddy (Taylor & Francis Group, 2018-01-01)
      Background: the decline in South Africa’s HIV infection rates especially among young women is encouraging. However, studies show that the 15–24-year-old cohort remains vulnerable. As they still report early sexual debut, being involved in sexual partnerships with older men as well as having unprotected sex. These risky sexual behaviors may be linked to factors such as the parent–child sexual health communication and the timing of the first talk. The quality of sexual health information received in school may also be important for enhancing healthier sexual behaviors. Aims and Objectives: to investigate the what, when and how sexual health communication occurs in rural South African families and to determine whether such communication patterns have changed over time. We also wanted to get an in-depth understanding of the roles played by culture, sexual health education and peers in the socialization of young women on sexual matters. Methods: a purposive sample of (n = 55) women who were 18–35 years old was selected and interviewed in focus group discussions (FGDs). Results: the FGD findings show that parent–child communication on sexual matters in rural communities is limited to messages that warn against pregnancy. It is also laden with cultural idioms that are not well explained. The school sexual health curriculum also fails to adequately equip adolescents to make informed decisions regarding sexual matters. All this seems to leave room for reception of misguided information from peers. Conclusions: findings highlight a need for designing interventions that can create awareness for parents on the current developmental needs and sexual behavior of adolescents. For adolescents programs would need to focus on providing skills on personal responsibility, and how to change behavior to enhance sexual health.
    • Using HIV&AIDS statistics in pre-service Mathematics Education to integrate HIV&AIDS education

      van Laren, L (Taylor & Francis, 2012-12-13)
      In South Africa, the HIV&AIDS education policy documents indicate opportunities for integration across disciplines/subjects. There are different interpretations of integration/inclusion and mainstreaming HIV&AIDS education, and numerous levels of integration. Integration ensures that learners experience the disciplines/subjects as being linked and related, and integration is required to support and expand the learners’ opportunities to attain skills, acquire knowledge and develop attitudes and values across the curriculum. This study makes use of self-study methodology where I, a teacher educator, aim to improve my practice through including HIV&AIDS statistics in Mathematics Education. This article focuses on how I used HIV&AIDS statistics to facilitate pre-service teacher reflection and introduce them to integration of HIV&AIDS education across the curriculum. After pre-service teachers were provided with HIV statistics, they drew a pie chart which graphically illustrated the situation and reflected on issues relating to HIV&AIDS. Three themes emerged from the analysis of their reflections. The themes relate to the need for further HIV&AIDS education, the changing pastoral role of teachers and the changing context of teaching. This information indicates that the use of statistics is an appropriate means of initiating the integration of HIV&AIDS education into the academic curriculum.Keywords: integration, HIV&AIDS education, statistics, pre-service teachers, self-study methodology
    • Using HIV&AIDS statistics in pre-service Mathematics Education to integrate HIV&AIDS education

      van Laren, L (Taylor & Francis, 2012-12-13)
      In South Africa, the HIV&AIDS education policy documents indicate opportunities for integration across disciplines/subjects. There are different interpretations of integration/inclusion and mainstreaming HIV&AIDS education, and numerous levels of integration. Integration ensures that learners experience the disciplines/subjects as being linked and related, and integration is required to support and expand the learners’ opportunities to attain skills, acquire knowledge and develop attitudes and values across the curriculum. This study makes use of self-study methodology where I, a teacher educator, aim to improve my practice through including HIV&AIDS statistics in Mathematics Education. This article focuses on how I used HIV&AIDS statistics to facilitate pre-service teacher reflection and introduce them to integration of HIV&AIDS education across the curriculum. After pre-service teachers were provided with HIV statistics, they drew a pie chart which graphically illustrated the situation and reflected on issues relating to HIV&AIDS. Three themes emerged from the analysis of their reflections. The themes relate to the need for further HIV&AIDS education, the changing pastoral role of teachers and the changing context of teaching. This information indicates that the use of statistics is an appropriate means of initiating the integration of HIV&AIDS education into the academic curriculum.Keywords: integration, HIV&AIDS education, statistics, pre-service teachers, self-study methodology
    • Using HIV&AIDS statistics in pre-service Mathematics Education to integrate HIV&AIDS education

      van Laren, L (Taylor & Francis, 2012-12-13)
      In South Africa, the HIV&AIDS education policy documents indicate opportunities for integration across disciplines/subjects. There are different interpretations of integration/inclusion and mainstreaming HIV&AIDS education, and numerous levels of integration. Integration ensures that learners experience the disciplines/subjects as being linked and related, and integration is required to support and expand the learners’ opportunities to attain skills, acquire knowledge and develop attitudes and values across the curriculum. This study makes use of self-study methodology where I, a teacher educator, aim to improve my practice through including HIV&AIDS statistics in Mathematics Education. This article focuses on how I used HIV&AIDS statistics to facilitate pre-service teacher reflection and introduce them to integration of HIV&AIDS education across the curriculum. After pre-service teachers were provided with HIV statistics, they drew a pie chart which graphically illustrated the situation and reflected on issues relating to HIV&AIDS. Three themes emerged from the analysis of their reflections. The themes relate to the need for further HIV&AIDS education, the changing pastoral role of teachers and the changing context of teaching. This information indicates that the use of statistics is an appropriate means of initiating the integration of HIV&AIDS education into the academic curriculum.Keywords: integration, HIV&AIDS education, statistics, pre-service teachers, self-study methodology
    • Using HIV&AIDS statistics in pre-service Mathematics Education to integrate HIV&AIDS education

      van Laren, L (Taylor & Francis, 2012-12-13)
      In South Africa, the HIV&AIDS education policy documents indicate opportunities for integration across disciplines/subjects. There are different interpretations of integration/inclusion and mainstreaming HIV&AIDS education, and numerous levels of integration. Integration ensures that learners experience the disciplines/subjects as being linked and related, and integration is required to support and expand the learners’ opportunities to attain skills, acquire knowledge and develop attitudes and values across the curriculum. This study makes use of self-study methodology where I, a teacher educator, aim to improve my practice through including HIV&AIDS statistics in Mathematics Education. This article focuses on how I used HIV&AIDS statistics to facilitate pre-service teacher reflection and introduce them to integration of HIV&AIDS education across the curriculum. After pre-service teachers were provided with HIV statistics, they drew a pie chart which graphically illustrated the situation and reflected on issues relating to HIV&AIDS. Three themes emerged from the analysis of their reflections. The themes relate to the need for further HIV&AIDS education, the changing pastoral role of teachers and the changing context of teaching. This information indicates that the use of statistics is an appropriate means of initiating the integration of HIV&AIDS education into the academic curriculum.Keywords: integration, HIV&AIDS education, statistics, pre-service teachers, self-study methodology
    • Using VCT statistics from Kenya in understanding the association between gender and HIV

      P N Ndindi; J Wanyungu; C Ajema; K N Otwombe (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2008-01-22)
      This paper demonstrates the importance of utilising official statistics from the voluntary counselling and testing centres (VCT) to determine the association between gender and HIV infection rates in Kenya.The study design adopted was a record based survey of data collected from VCT sites in Kenya between the second quarter of 2001 and the second quarter of 2004. Of those who were tested, significantly more females tested positive (P
    • Violence, abuse and discrimination: key factors militating against control of HIV/AIDS among the LGBTI sector

      Abaver, Dominic Targema; Cishe, Elphina Nomabandla (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2018-07-23)
      The Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) South  Africans continue to face considerable challenges, including societal stigma, homophobic violence (particularly corrective rape), and high rates of  sexually transmitted diseases and infections (particularly Human  Immunodeficiency Virus (HIV)/AIDS) even when  discrimination based on sexual orientation was outlawed by South African’s post-apartheid  constitution. This study was conducted to ascertain violence, abuse and discrimination against the LGBTI sector as key factors that hinder the smooth implementation of HIV/AIDS programme among sexually minority (LGBTI) group in Walter Sisulu University, South Africa. The self-structured questionnaire was used to collect data. The study involved 3048 purposively selected participants (1285 male and 1763 female) aged 17–38 years. About 70.5% of the participants witnessed physical attack as a form of violence against people in same-gender relationship; 47.7% disagreed that violent targeted at this sexually minority group is justified. The LGBTI face challenges which include verbal insults (937, 32.4%), bullying (532, 18.4%) and namecalling (1389, 48%). Discrimination against members of the LGBTI sector was witnessed in various forms: non-acceptance (981, 33.9%), disapproval of act of homosexuals (1308, 45.2) and denial of rights (327, 11.3). Violence, abuse and discrimination which constitute stigmatisation among the LGBTI sector are received with mix feeling. Some respondents justified the use of one or more of these key  elements of stigmatisation against the LGBTI (6.6%, supports violence), others condemned these acts of  stigmatisation (28.8%), against discrimination). Social stigma which resulted from violence, abuse and  discrimination exist in this institution and is responsible for the unwillingness of disclosure of sexual orientation  among the LGBTI members. An enabling environment should be created where the LGBTI members could come out freely to access programmes targeted at the prevention and control of HIV/AIDS. Keywords:  Social stigma, LGBTI, students, HIV/AIDS
    • Violence, abuse and discrimination: key factors militating against control of HIV/AIDS among the LGBTI sector

      Dominic Targema Abaver; Elphina Nomabandla Cishe (Taylor & Francis Group, 2018-01-01)
      The Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) South Africans continue to face considerable challenges, including societal stigma, homophobic violence (particularly corrective rape), and high rates of sexually transmitted diseases and infections (particularly Human Immunodeficiency Virus (HIV)/AIDS) even when discrimination based on sexual orientation was outlawed by South African’s post-apartheid constitution. This study was conducted to ascertain violence, abuse and discrimination against the LGBTI sector as key factors that hinder the smooth implementation of HIV/AIDS programme among sexually minority (LGBTI) group in Walter Sisulu University, South Africa. The self-structured questionnaire was used to collect data. The study involved 3048 purposively selected participants (1285 male and 1763 female) aged 17–38 years. About 70.5% of the participants witnessed physical attack as a form of violence against people in same-gender relationship; 47.7% disagreed that violent targeted at this sexually minority group is justified. The LGBTI face challenges which include verbal insults (937, 32.4%), bullying (532, 18.4%) and name-calling (1389, 48%). Discrimination against members of the LGBTI sector was witnessed in various forms: non-acceptance (981, 33.9%), disapproval of act of homosexuals (1308, 45.2) and denial of rights (327, 11.3). Violence, abuse and discrimination which constitute stigmatisation among the LGBTI sector are received with mix feeling. Some respondents justified the use of one or more of these key elements of stigmatisation against the LGBTI (6.6%, supports violence), others condemned these acts of stigmatisation (28.8%), against discrimination). Social stigma which resulted from violence, abuse and discrimination exist in this institution and is responsible for the unwillingness of disclosure of sexual orientation among the LGBTI members. An enabling environment should be created where the LGBTI members could come out freely to access programmes targeted at the prevention and control of HIV/AIDS.
    • ‘We are left in the cold’: Nurses’ perceptions and responses to antiretroviral treatment roll-out in the Free State, South Africa

      de Wet, K; du Plooy, S (Taylor & Francis, 2012-08-27)
      The unprecedented roll-out of antiretroviral therapy (ART) in South Africa is a complex process where no previous endeavour exists that can measure, predict, or direct an intervention of this scale. In the Free State province, unique characteristics and problems distinguish its ART programme, although countrywide problems also occur within the province. The Free State province faces high vacancy rates among its health-care workers, the programme has lower patient enrolment rates because of an obsessionwith quality to the detriment of quantity, and various incidents of ART shortages have also shook the province. The ART rollout intervention thus far has been largely nurse-driven (however not nurse initiated), and they form what many refer to as the ‘backbone’ of the programme. In order to respond to the challenges faced by these front-line ART providers, continuous transformations inevitably take place to respond to new needs associated with the roll-out programme, but also to strengthen the primary health-care system in general. The objective of this article is to present a typology of contradictory contextual factors in the antiretroviral programme as identified through group interviews that were conducted with PNs at public healthcare clinics in the five districts of the Free State province during 2005 and 2006. We intend to show that transformations oftenhave contradictory and problematic outcomes as expressed and perceived by the nurses themselves. This unprecedented endeavour of ART roll-out inevitably has to treasure and support its most valued implementers, i.e. the front-line providers who are not only professionals in the health-care setting, but also social agents in a wider contextual framework.
    • ‘We keep her status to ourselves’: Experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine

      Rispel, LC; Cloete, A; Metcalf, CA (Taylor & Francis, 2015-05-05)
      In HIV-discordant relationships, the HIV-negative partner also carries the burden of a stigmatised disease. For this reason, couples often hide their HIV-discordant status from family, friends and community members. This perpetuates the silence around HIVdiscordant relationships and impacts on targeted HIV prevention, treatment and counselling efforts. This article reports on experiences of stigma and discrimination among HIV-discordant couples in South Africa, Tanzania and Ukraine. During 2008, HIV discordant couples who had been in a relationship for at least one year were recruited purposively through health-care providers and civil society organisations in the three countries. Participants completed a brief self-administered questionnaire, while semi-structured interviews were conducted with each partner separately and with both partners together. Interviews were analysed using thematic content analysis. Fifty-one couples were recruited: 26 from South Africa, 10 from Tanzania, and 15 from Ukraine. Although most participants had disclosed their HIV status to someone other than their partner, few were living openly with HIV discordance. Experiences of stigma were common and included being subjected to gossip, rumours and namecalling, and HIV-negative partners being labelled as HIV-positive. Perpetrators of discrimination included family members and health workers. Stigma and discrimination present unique and complex challenges to couples in HIV sero-discordant relationships in these three diverse countries. Addressing stigmatisation of HIV-discordant couples requires a holistic human rights approach and specific programme efforts to address discrimination in the health system. Keywords: HIV-discordance, stigma, discrimination, couples, South Africa, Tanzania, Ukraine
    • Weak signal detection: A discrete window of opportunity for achieving ‘Vision 90:90:90’?

      Burman, Christopher J; Aphane, Marota; Delobelle, Peter (Taylor & Francis, 2016-02-01)
      Introduction: UNAIDS’ Vision 90:90:90 is a call to ‘end AIDS’. Developing predictive foresight of the unpredictable changes that this journey will entail could contribute to the ambition of ‘ending AIDS’. There are few opportunities for managing unpredictable changes. We introduce ‘weak signal detection’ as a potential opportunity to fill this void. Method: Combining futures and complexity theory, we reflect on two pilot case studies that involved the Archetype Extraction technique and the SenseMakerw CollectorTM tool. Results: Both the piloted techniques have the potentials to surface weak signals – but there is room for improvement. Discussion: A management response to a complex weak signal requires pattern management, rather than an exclusive focus on behaviour management. Conclusion: Weak signal detection is a window of opportunity to improve resilience to unpredictable changes in the HIV/AIDS landscape that can both reduce the risk that emerges from the changes and increase the visibility of opportunities to exploit the unpredictable changes that could contribute to ‘ending AIDS’.Keywords: complexity theory, futures science, autopoiesis, Cynefin framework, HIV/AIDSResumeIntroduction: L’ONUSIDA’ Vision 90:90:90 est un appel a ‘“mettre fin au SIDA”. De´veloppement de prospects pre´dictives de changements impre´visibles ce voyage entraıˆnera pourrait contribuer. Il y a peu de possibilite´s de gestion des changements imprevisibles. Nous introduisons la de´tection de signaux faibles comme une opportunite potentielle de combler cette lacune.Methode: combinant la science des futures et la theorie de la complexite nous reflechissons sur deux etudes de cas pilotes qui impliquent la Technique d’Extraction d’Arche type et l’outil SenseMakerw CollectorTM. Re´sultats: les deux techniques pilotes ont le potentiel de faire surface aux signaux faibles – mais il y a de la place pour de l’ame´lioration. Discussion: la gestion d’un signal faible complexe ne´cessite une gestion de formes, plutot que de se concentrer exclusivement sur les modes de comportement. Conclusion: detection des signaux faibles constitue une fenetre d’opportunite pour ame´liorer la resilience aux changements impre´visibles qui surviennent dans le paysage SIDA qui peuvent a la fois reduire le risque qui emerge de ces changements et accroıtre la visibilite des opportunites a exploiter les changements impre´visibles qui pourraient contribuer a mettre fin au SIDA”.Mots-cles: theorie de la complexite, sciences des futures, autopoiesis, Cynefin framework, VIH/SIDA
    • Weak signal detection: A discrete window of opportunity for achieving ‘Vision 90:90:90’?

      Christopher J. Burman; Marota Aphane; Peter Delobelle (Taylor & Francis Group, 2016-01-01)
      Introduction: UNAIDS’ Vision 90:90:90 is a call to ‘end AIDS’. Developing predictive foresight of the unpredictable changes that this journey will entail could contribute to the ambition of ‘ending AIDS’. There are few opportunities for managing unpredictable changes. We introduce ‘weak signal detection’ as a potential opportunity to fill this void. Method: Combining futures and complexity theory, we reflect on two pilot case studies that involved the Archetype Extraction technique and the SenseMaker® Collector™ tool. Results: Both the piloted techniques have the potentials to surface weak signals – but there is room for improvement. Discussion: A management response to a complex weak signal requires pattern management, rather than an exclusive focus on behaviour management. Conclusion: Weak signal detection is a window of opportunity to improve resilience to unpredictable changes in the HIV/AIDS landscape that can both reduce the risk that emerges from the changes and increase the visibility of opportunities to exploit the unpredictable changes that could contribute to ‘ending AIDS’.
    • What is the burden of illness in patients with reflux disease in South Africa?

      IK Wiklund; CJ Van Rensburg; J Carlsson; KR Kulich Kulich (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2007-02-28)
      Objectives: To describe the impact of heartburn on patients’ Health-Related Quality of Life (HRQL) in South Africa.Design: Survey of patient-reported outcomes and physician-assessed symptoms. Setting: South African, major referral gastroenterology clinic. Subjects: Consecutive patients with predominant symptoms of heartburn.Outcome measures:Patients completed the Afrikaans versions of the Gastrointestinal Symptom Rating Scale (GSRS), the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD) and the Short Form Health-36 (SF-36). Physician-assessed frequency and severity of heartburn during the previous 7 days were also recorded.Results: 125 patients with symptoms of heartburn (age: M=46.0 [±12 years]; females= 74%, 87% mixed race) completed the Afrikaans translation of GSRS, the QOLRAD and the Short-Form-36 (SF-36). Patients were bothered most by symptoms of reflux (mean GSRS score of 4.9, on a scale of 1 [not bothered] to 7 [very bothered]), indigestion (4.0) and abdominal pain (4.0). As a result of their symptoms, importantreflux related aspects of life, such as problems with food and drink (3.5), emotional distress (3.6), impaired vitality (3.7), sleep disturbance (3.8) and impaired physical/social functioning (4.3) were experienced (QOLRAD scores where 1 represents the most severe impact on daily functioning and 7 no impact). Overall HRQL measured by the SF-36 was poor across all domains and was significantly lower compared to the UK general population. Conclusions: There is consistentevidence that GERD symptoms substantially impair all aspects of HRQL in this mixed race South African population referred to this central clinic.
    • When the clinic becomes a home. Successful VCT and ART services in a stressful environment

      Dapaah, Jonathan Mensah; Spronk, Rachel (Taylor & Francis, 2016-09-14)
      With the upscaling of antiretroviral therapy (ART) in resource-poor countries, many HIV-positive persons in Ghana have been accessing treatment in hospitals. Prevalence is relatively low compared to other African countries, 1.30%. HIV/AIDS remains heavily stigmatised in Ghana, which influences the provision and use of ART. This article investigates how HIV-positive persons accessing care and treatment go about their everyday lives in the ART clinic and how they have eventually come to see the clinic as a safe place that they call ‘home’. The study took place in two Ghanaian hospitals in the Ashanti Region which in 2013 had the country’s highest HIV prevalence rate of 1.30% [Ghana Health Service [GHS]/National AIDS Control Programme [NACP] (2013). 2013 HIV Sentinel Survey Report, Accra, Ghana]. It was conducted through ethnographic research, with data gathered in the two facilities through participant observation, conversations and in-depth interviews. It took place over a period of 15 months, between 2007 and 2010. In all, 24 health workers and 22 clients were interviewed in depth, while informal conversations were held with many others. The findings show that clients have adopted the clinic as a second home and used it to carry out various activities in order to avoid identification and stigmatisation as People Living with AIDS (PLWA). The most dramatic outcome was that, contrary to Ghanaian norms and values, people turned to non-kin for assistance. Accordingly, fellow clients and health personnel, rather than relatives, have become their ‘therapy management group’ [Janzen, J. M. (1987). Therapy Management: Concept, Reality, Process. Medical Anthropology Quarterly, 1(1), 68–84]. The clients have thus created a fictive family within the clinic – made up of health workers (as ‘parents’), the clients themselves (as ‘children’) and the peer educators (as ‘aunts’ and ‘uncles’). In the face of persistent stigma associated with HIV infection in Ghana, the use of the clinic as a ‘home’ has on the one hand helped those receiving treatment to maintain their position, respect and reputation within their families and community, while on the other it prevents PLWA from disclosing. The study concludes that compassion is an important element in the professionalisation of healthcare workers in low-prevalence countries.Keywords: ART clinics, HIV/AIDS stigma, clients, health workers, therapy management group
    • ‘Why would you promote something that is less percent safer than a condom?’: Perspectives on partially effective HIV prevention technologies among key populations in South Africa

      Clara Rubincam; Peter A. Newman; Millicent Atujuna; Linda-Gail Bekker (Taylor & Francis Group, 2018-01-01)
      New biomedical prevention technologies (NPTs) for HIV, including oral Pre-Exposure Prophylaxis, and vaginal and rectal microbicides and HIV vaccines in development, may contribute substantially to controlling the HIV epidemic. However, their effectiveness is contingent on product acceptability and adherence. We explored perceptions and understanding of partially effective NPTs with key populations in South African townships. From October 2013 to February 2014, we conducted six focus groups and 18 individual interviews with Xhosa-speaking adolescents (n = 14), adult men who have sex with men (MSM) (n = 15), and adult heterosexual men (n = 9) and women (n = 10), and eight key informant (KI) interviews with healthcare workers. Interviews/focus groups were transcribed and reviewed using a thematic approach and framework analysis. Overall, participants and KIs indicated scepticism about NPTs that were not 100% efficacious. Some participants equated not being 100% effective with not being completely safe, and thus not appropriate for dissemination. KIs expressed concerns that promoting partially effective NPTs would encourage substitution of a more effective with a less effective method or encourage risk compensation. Educational and social marketing interventions that address the benefits and appropriate use of partially effective NPTs, including education and support tailored for frontline service providers, are needed to prepare for successful NPT implementation in South Africa.