• ‘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.
    • Widowhood in the era of HIV/AIDS: A case study of Slaya District, Kenyanew!

      CR Ambasa-Shisanya (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2007-11-19)
      Luo women are believed to acquire contagious cultural impurity after the death of their husbands that is perceived as dangerous to other people. To neutralise this impure state, a sexual cleansing rite is observed. In the indigenous setting, the ritual was observed by a brother-in-law or cousin of the deceased husband through a guardianship institution. However, with the emergence of HIV/AIDS, many educated brothers-in-law refrain from the practice and instead hire professional cleansers as substitutes. If the deceased spouses were HIV positive, the ritual places professional cleansers at risk of infection. Thereafter, they could act as a bridge for HIV/AIDS transmission to other widows and to the general population. This paper provides insights into reasons for continuity of widowhood rites in Siaya District. Twelve focus group discussions and 20 in-depth interviews were conducted.The cultural violence against Luo widows could spread HIV/AIDS, but Christianity and condoms act as coping mechanisms. SAHARA J Vol. 4 (2) 2007: pp. 606-615
    • Willingness to pay for treatment with highly active antiretroviral (HAART) drugs: a rural case study in Cameroon

      K N Muko; The Catholic Health Service of the archdiocese of Bamenda, P.B. 16 Njinikom Boyo Division, Cameroon; E N Shu; The health policy unit of the department of pharmacology, College of Medicine, University of Nigeria, Nsukka; L Chigang; St Louis Clinic Bamenda, Cameroon; I G Ngwa; St Martin De Porres Hospital, Cameroon; V C Ngwa; St James University Hospital, Leeds, UK; A Meiburg; St Martin De Porres Hospital, Njinikom, Cameroon (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2004-10-01)
      This paper reports on the willingness of HIV/AIDS patients to pay for the most affordable triple therapy combination of antiretrovirals in a local setting in Cameroon. Questionnaires were used to evaluate willingness to pay, and patients who could still afford their medication 6 months after the survey were also investigated, to give an indication of actual ability to pay. In addition, oral interviews were carried out for clarification. In all, 84 patients out of a total of 186 were involved in the study. Results indicated that more men (39%) were willing to pay than women (22%), although more women (56%) were afflicted than men.Willingness to pay was directly dependent on cost with 69%, 22% and 9% of respondents indicating willingness to pay $1, $2 and $3 a day respectively. After 6 months of treatment, 22% of patients were still on therapy. A majority of patients stopped taking the drugs after 6 months due to financial constraints. Apart from cost, stigma, disbelief and side-effects of medication were found to be the main factors militating against willingness to pay. Improved counselling and provision of information, reduced cost of drugs including laboratory tests, and destigmatisation programmes are recommended to improve patients' ability to pay for antiretrovirals. SAHARA-J (2004) 1(2): 107-113 Keywords: HIV/AIDS, treatment, access to antiretrovirals, drug costs, affordability. RÉSUMÉ Cette communication porte sur une bonne volonté des patients souffrants du VIH/SIDA à payer un prix assez abordable de la thérapie triple des anti-rétroviraux dans un milieu rural au Cameroun. Des questionnaires ont été utilisés afin d'évaluer cette bonne volonté à payer les médicaments. De plus, les patients qui avaient les moyens d'acheter leurs médicaments 6 mois après ces épreuves furent interviewés également. En plus de cela, les patients ont été interviewés avec le but d'obtenir des éclaircissements. Parmi les 186 patients, 84 participaient à l'étude. Les résultats de cette étude ont démontré que davantage d'hommes (39%) avaient la bonne volonté de payer des médicaments que des femmes (22%), tandis que les femmes sont plus souffrantes (56%) que les hommes. Cette volonté de payer était directement liée au coût des médicaments avec 69%, 22% et 9% des interviewés qui veulent bien payer une somme de $1, $2 et $3 par jour respectivement. Au bout d'une période de 6 mois de traitement, 22% de patients étaient encore en thérapie. Une majorité de patients ont arrêté le traitement au bout de 6 mois faute de manque d'argent. En dehors du coût, le stigmate, l'incrédulité et les effets secondaires des médicaments étaient les facteurs principaux qui étaient contre la volonté de payer. Il est conseillé d'améliorer les services de consultation, de fournir de l'information, de réduire le coût de médicaments ainsi que les essais en laboratoire et l'élaboration des programmes de déstigmatisation afin d'améliorer la capacité de patients à payer pour les anti-rétroviraux. SAHARA-J (2004) 1(2): 107-113 Mots clés: le VIH/SIDA, le traitement, l'accès aux anti-rétroviraux, le coût de médicaments, avoir des moyens d'acheter.
    • Women in Chinsapo, Malawi: vulnerability and risk to HIV/AIDS

      Ezekiel Kalipeni; Department of Geography, 220 Davenport Hall, University of Illinois, Urbana-Champaign, 607 South Mathews Avenue, Urbana, Illinois; Jayati Ghosh (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2006-04-26)
      Malawi, a very poor country located in southern Africa, is no exception to the growing trend and severity in HIV prevalence. By the end of 2003 there were 900 000 adults and children in Malawi living with HIV/AIDS. Adult prevalence was estimated to be 15%, which is higher than the 7.1% average rate for sub-Saharan Africa. In order to understand the spread of HIV/AIDS it is imperative to address the economic, social, cultural, and political issues that impact on women's contraction and spread of the virus.We do so in this paper by critically examining the gendered context of HIV/AIDS with reference to Malawi.The theoretical framework for this research focuses on poverty, gender relations, regional migration patterns, and global economic changes which place women in highly vulnerable situations.The study was conducted in a low-income area in Lilongwe, the capital city of Malawi. In 2003 and 2004, 60 randomly selected women who lived in a low socioeconomic residential area completed a structured interview on issues concerning individual economic situations, marriage history, fertility, family planning and social networks, gender, sexual partnerships, and HIV/AIDS. Focus group interviews were also conducted with an additional 20 women.The results of our study indicate that the rising epidemic among women in Malawi is firstly driven by poverty which limits their options. Secondly, gender inequality and asymmetrical sexual relations are basic to spreading HIV/AIDS among women. Thirdly, in spite of their awareness through media and health care professionals, women are unable to protect themselves, which further increases their vulnerability. Keywords: Lilongwe, Malawi, HIV/AIDS, womenRésumé Le Malawi, un pays très pauvre situé en Afrique Australe, n'est pas exclut de la tendance croissante et la sévérité de la prédominance du VIH.A la fin de 2003, il y avait 900 000 adultes et enfants vivant avec le virus au Malawi. Le taux de prédominance chez les adultes fut prévu d'être à 15%, ce qui est supérieur à la moyenne de 7.1% du taux de l'Afrique sudsaharienne. Pour comprendre la propagation du VIH/SIDA, il faut absolument aborder les sujets économiques, sociaux, culturels et politiques qui ont l'impact sur la contamination des femmes et la propagation du virus. Dans cette présente, nous examinons, de façon critique, le contexte de sexes vis-à-vis le VIH/SIDA dans le cas du Malawi. Le cadre théorique de cette recherche met au point la pauvreté, les relations de sexes, la tendance de la migration régionale et les changements économiques mondiaux qui disposent les femmes à des situations de vulnérabilité élevée. Cet article présente les résultats d'une étude faite dans une partie moins aisée à Lilongwe, la capitale du Malawi. En 2003 et 2004, nous avons sélectionné, au hasard, 60 femmes qui vivaient dans un quartier socio-économiquement en bas d'échelle. Elles étaient sélectionnées selon les situations économiques personnelles, l'histoire du mariage, la fertilité, la limitation de naissances et les réseaux sociaux, les sexes, les relations sexuelles et le VIH/SIDA. En plus de ces entretiens bien structurés, des entretiens en groupe de foyer ont eu lieu avec 20 femmes de plus. Les résultats de cette étude montrent que l'accroissement de l'épidémie chez les femmes du Malawi est premièrement dû à la pauvreté qui restreint leurs options. Deuxièmement, l'inégalité de sexes et des relations sexuelles asymétriques sont à la base de la propagation du VIH/SIDA parmi les femmes. Troisièmement, en dépit de leur prise de conscience à travers les médias et le personnel de services de soin, les femmes sont incapables de se protéger. Ceci augment davantage leur vulnérabilité. Mots clés: Lilongwe, Malawi,VIH/SIDA, femmes SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) Vol. 2(3) 2005: 320-332
    • Youth living with HIV/AIDS in secondary schools: perspectives of peer educators and patron teachers in Western Uganda on stressors and supports

      Emmanuel Kimera; Sofie Vindevogel; John Rubaihayo; Didier Reynaert; Jessica De Maeyer; Anne-Mie Engelen; Johan Bilsen (Taylor & Francis Group, 2019-01-01)
      As Youth Living With HIV/AIDS (YLWHA) continue to survive and live with HIV chronically due to effective Antiretroviral Therapy (ART), it is paramount to work toward maximising their psychosocial wellbeing. The school where these YLWHA are expected to spend most of their time is an excellent environment to investigate this. In this study, we explore perspectives of Peer Educators (PEs) in secondary schools of one district in Western Uganda on how YLWHA are perceived in school, on their daily stressors and their way of coping with their HIV-positive serostatus given the support of the schools. We conducted eight focus groups with a total of 59 students who were members of Peer Educators Clubs (PECs) as well as 8 in-depth interviews with patron teachers of PECs in eight secondary schools of Kabarole district, selected through a stratified random sampling method. Focus groups and interviews were tape-recorded, transcribed and analysed thematically both inductively and deductively. Stressors and support in schools, as identified by the PEs were categorised into three interrelated thematic domains; psychological wellbeing of YLWHA, disclosure of HIV status by YLWHA, and health and treatment adherence. Stigma was found to be a key stressor and an intermediary in all the three thematic domains Stressors affecting psychological wellbeing were fear of death and uncertainty of the future compounded by financial and academic challenges. Stressors affecting disclosure centred around lack of privacy, confidentiality and fear of loss of friends. Stressors affecting treatment adherence included lack of privacy while taking drugs, unintended disclosure while obtaining drugs or seeking permission to attend clinic appointments and fear of drug adverse effects due to poor nutrition. A supportive school environment involved the availability of a school nurse, counselling services and PECs. We conclude that the school environment brings more stressors than supports for YLWHA. The daily stressors related to HIV stigma, uncertainty, disclosure, privacy and confidentiality render schooling a hassle for YLWHA. Interventions that promote resilient school communities are necessary to foster disclosure in a non-discriminatory and stigma-free environment. This calls for concerted efforts from all school stakeholders.
    • Zimbabwe's national AIDS levy: A case study

      Nisha Bhat; Peter H. Kilmarx; Freeman Dube; Albert Manenji; Medelina Dube; Tapuwa Magure (Taylor & Francis Group, 2016-01-01)
      Background: We conducted a case study of the Zimbabwe National AIDS Trust Fund (‘AIDS Levy’) as an approach to domestic government financing of the response to HIV and AIDS. Methods: Data came from three sources: a literature review, including a search for grey literature, review of government documents from the Zimbabwe National AIDS Council (NAC), and key informant interviews with representatives of the Zimbabwean government, civil society and international organizations. Findings: The literature search yielded 139 sources, and 20 key informants were interviewed. Established by legislation in 1999, the AIDS Levy entails a 3% income tax for individuals and 3% tax on profits of employers and trusts (which excluded the mining industry until 2015). It is managed by the parastatal NAC through a decentralized structure of AIDS Action Committees. Revenues increased from inception to 2006 through 2008, a period of economic instability and hyperinflation. Following dollarization in 2009, annual revenues continued to increase, reaching US$38.6 million in 2014. By policy, at least 50% of funds are used for purchase of antiretroviral medications. Other spending includes administration and capital costs, HIV prevention, and monitoring and evaluation. Several financial controls and auditing systems are in place. Key informants perceived the AIDS Levy as a ‘homegrown’ solution that provided country ownership and reduced dependence on donor funding, but called for further increased transparency, accountability, and reduced administrative costs, as well as recommended changes to increase revenue. Conclusions: The Zimbabwe AIDS Levy has generated substantial resources, recently over US$35 million per year, and signals an important commitment by Zimbabweans, which may have helped attract other donor resources. Many key informants considered the Zimbabwe AIDS Levy to be a best practice for other countries to follow.
    • Zimbabwean secondary school Guidance and Counseling teachers teaching sexuality education in the HIV and AIDS education curriculum

      Ephias Gudyanga; Naydene de Lange; Mathabo Khau (Taylor & Francis Group, 2019-01-01)
      In spite of the importance of sexuality education and HIV and AIDS education in preventing HIV infections, Zimbabwean secondary school Guidance and Counseling teachers are not engaging optimally with the current Guidance and Counseling, HIV and AIDS & Life Skills education curriculum, and hence, they are not serving the needs of the learners in the context of the HIV and AIDS pandemic. The aim of the study, therefore, was to explore how Guidance and Counseling teachers could be enabled to teach the necessary critical content in sexuality education in the HIV and AIDS education curriculum. A qualitative research design, informed by a critical paradigm, using participatory visual methodology and methods such as drawing and focus group discussion, was used with eight purposively selected Guidance and Counseling teachers from Gweru district, Zimbabwe. The study was theoretically framed by Cultural Historical Activity Theory. Guidance and Counseling teachers found themselves in a community with diverse cultural practices and beliefs of which some seemed to contradict what was supposed to be taught in the curriculum. The participatory visual methodology, however, enabled a process in which the Guidance and Counseling teachers could reflect on themselves, the context in which they taught, their sexuality education work and learn how to navigate the contradictions and tensions, and to use such contradictions as sources of learning and sources for change. The results have several implications for policy in terms of the Guidance and Counseling curriculum and engaging with cultural issues; and for practice in terms of teacher professional development, teacher training, and for stakeholder contribution.
    • Zimbabwe’s national AIDS levy: A case study

      Bhat, Nisha; Kilmarx, Peter H.; Dube, Freeman; Manenji, Albert; Dube, Medelina; Magure, Tapuwa (Taylor & Francis, 2016-01-20)
      Background: We conducted a case study of the Zimbabwe National AIDS Trust Fund (‘AIDS Levy’) as an approach to domestic government financing of the response to HIV and AIDS.Methods: Data came from three sources: a literature review, including a search for grey literature, review of government documents from the Zimbabwe National AIDS Council (NAC), and key informant interviews with representatives of the Zimbabwean government, civil society and international organizations.Findings: The literature search yielded 139 sources, and 20 key informants were interviewed. Established by legislation in 1999, the AIDS Levy entails a 3% income tax for individuals and 3% tax on profits of employers and trusts (which excluded the mining industry until 2015). It is managed by the parastatal NAC through a decentralized structure of AIDS Action Committees. Revenues increased from inception to 2006 through 2008, a period of economic instability and hyperinflation. Following dollarization in 2009, annual revenues continued to increase, reaching US$38.6 million in 2014. By policy, at least 50% of funds are used for purchase of antiretroviral medications. Other spending includes administration and capital costs, HIV prevention, and monitoring and evaluation. Several financial controls and auditing systems are in place. Key informants perceived the AIDS Levy as a ‘homegrown’ solution that provided country ownership and reduced dependence on donor funding, but called for further increased transparency, accountability, and reduced administrative costs, as well as recommended changes to increase revenue.Conclusions: The Zimbabwe AIDS Levy has generated substantial resources, recently over US$35 million per year, and signals an important commitment by Zimbabweans, which may have helped attract other donor resources. Many key informants considered the Zimbabwe AIDS Levy to be a best practice for other countries to follow.Keywords: health care financing, HIV, AIDS, Zimbabwe