Report and policy brief from the 4th Africa Conference on Social Aspects of HIV/AIDS Research: innovations in access to prevention, treatment and care in HIV/AIDS, Kisumu, Kenya, 29 April - 3 May 2007

About 520 delegates from all over Africa and 21 countries attended the conference. This report and policy brief summarises the key findings and suggested policy options that emerged from rapporteur reports of conference proceedings including the following themes: (1) Orphans and vulnerable children, (2) Treatment, (3) Prevention, (4) Gender and male involvement, (5) Male circumcision, (6) People living with HIV/AIDS, (7) Food and nutrition, (8) Socioeconomics, and (9) Politics/policy. Two (11.8%) of the 17 OVC projects from the three countries were classified as best practice interventions. Of the 83 abstracts that were accepted at the conference, only 7 (8.4%) were dealing with antiretroviral therapy (ART). There has been tremendous effort by various organisations to provide information about prevention of HIV/AIDS. Information received by adolescents has been effective in increasing their knowledge, but without positive sexual behaviour change. The conference noted the contribution of gender discrimination and violence to the HIV epidemic and the different risks that men and women face in relation to the epidemic. Social scientists need to study the deep cultural meanings attached to male circumcision among different ethnic groups to be able to guide the debate on the latest biomedical findings on the protective effect of circumcision against HIV. Palliative care and support is crucial for coping among people living with HIV/AIDS (PLWHA) in order to deal with medical and psychological issues. Results from several countries have helped researchers to explore alternative ways of examining poverty in the context of HIV and AIDS. Policy frameworks which are likely to succeed in combating HIV/AIDS need to be updated to cover issues of access, testing, disclosure and stigma. In general, the conference was successful in identifying innovations in access to prevention, treatment and care in HIV/AIDS.

HIV/AIDS risk reduction counseling for alcohol using sexually transmitted infections clinic patients in Cape Town, South Africa

BACKGROUND

HIV is ravaging southern Africa, and HIV transmission risk behaviors are facilitated by alcohol use in sexual contexts. There are no known interventions that directly target HIV risk behavior among people who drink and are at risk for HIV in Africa.

PURPOSE

To test a behavioral risk reduction counseling intervention for use in sexually transmitted infection (STI) clinics in southern Africa.

METHODS

A randomized intervention trial was conducted with 143 STI clinic patients in Cape Town, South Africa. Participants received an experimental 60-minute HIV and alcohol risk reduction behavioral skills intervention or a control 20-minute HIV education condition. Participants were followed for 3 and 6 months after the intervention, with 73% retention.

RESULTS

Overall, the experimental intervention demonstrated more than a 25% increase in condom use and a 65% reduction in unprotected intercourse over the 6-month follow-up period, with risk reduction significantly greater for the experimental condition than for the control condition at both follow-ups. Alcohol use in sexual contexts [F(1,94) = 6.2; P < 0.05] and expectancies that alcohol enhances sexual experiences [F(1,94) = 8.3; P < 0.01] were also significantly lower for the experimental condition at the 3-month follow-up.

CONCLUSIONS

An HIV prevention counseling intervention reduced HIV transmission risks for up to 6 months in this STI clinic population. Effects may be sustained with structural interventions to reduce alcohol use in sexual contexts and support risk reduction behavior changes over the long-term.

Trauma history and severity of gambling involvement among horse-race gamblers in a South African gambling setting

The purpose of this study was to ascertain the frequency of gambling involvement and the prevalence of problem gambling among horse race gamblers and to discover whether problem gambling in this sample is associated with a history of trauma. Among a sample of 266 South African horse-race gamblers (94% men and 6% women, Mage 46.8 yr., SD = 13.9, range 18-85 years), 31.2% were classified as probable pathological gamblers and 19.9% with problem gambling. Major weekly gambling activities included racetrack betting (82%), purchase of lottery tickets or scratch tickets (35%), purchase of sports lottery tickets (23%), and using casino type games (18%). Trauma history was significantly associated with gambling severity.

HIV/AIDS/STI/TB knowledge, beliefs and practices of traditional healers in KwaZulu-Natal, South Africa

The aim of this study was investigate the HIV/AIDS/STI and TB knowledge, beliefs and practices of traditional healers in South Africa. In a cross-sectional study 233 traditional healers were interviewed in three selected communities in KwaZulu-Natal. Results indicate that the most common conditions seen were STIs, a variety of chronic conditions, HIV/AIDS (20%) and tuberculosis (29%). Although most healers had a correct knowledge of the major HIV transmission routes, prevention methods and ARV treatment, their knowledge was poorer on other HIV transmission routes, and 21% believed that there is a cure for AIDS. A minority reported unsafe practices in terms of reuse of razor blades on more than one patients and the reuse of enema equipment without sterilization, and two-thirds used gloves when carrying out scarifications. Randomized control trials are called for to test the effectiveness of traditional healing for HIV/AIDS, STI and TB prevention and care.

Prevalence of alcohol use by rural primary care outpatients in South Africa

In a primary care outpatient sample of 600 rural South Africans 37.4% of men and 10.7% of women were identified as hazardous drinkers, and 9.2% of men and 0.3% of women met criteria for probable alcohol dependence or harmful drinking as defined by AUDIT. Logistic multiple regression identified men and being single, divorced, or widowed as predictors for hazardous and harmful drinking.

A controlled study of an HIV/AIDS/STI/TB intervention with traditional healers in KwaZulu-Natal, South Africa

Traditional healers play an important role in southern Africa culture and health care including the HIV epidemic. Here we report among the first controlled studies of an HIV/AIDS, sexually transmitted infections (STI) and tuberculosis (TB) intervention for traditional healers in South Africa. At baseline 233 traditional healers were assessed in four selected communities in the KwaZulu-Natal province and received either an experimental intervention or a no intervention control condition. The intervention group received training in HIV/AIDS, STI, and TB prevention over 3.5 days as well as a supervisory follow-up visit. At 7-9 months follow-up intervention effects were significant for HIV knowledge and HIV and STI management strategies including conducting risk behavior assessments and counseling, condom distribution, community HIV/AIDS and STI education, and record keeping. The study found a high level of preparedness among traditional healers to work with and refer patients to biomedical health practitioners, yet no higher levels of referral to biomedical practitioners were found after the training.

Training primary care nurses to conduct alcohol screening and brief interventions in South Africa

Although progress has been made in developing a scientific basis for alcohol screening and brief intervention (SBI), training packages are necessary for its widespread dissemination in primary care settings in developing societies. Using a training package developed by the World Health Organisation 121 nurses from one rural site (29 clinics in Vhembe District) and one urban site (3 clinics and 6 mobile clinics in Polokwane/ Seshego) in South Africa were compared before and after SBI training regarding knowledge and attitudes, and the subsequent practice of SBI in routine clinical practice. Although the training effects were at times moderate, all changes were in a direction more conducive to implementing SBI. Health care providers significantly increased in knowledge, confidence in SBI and higher self-efficacy in implementing SBI at follow-up after 9 months after receiving the training. When delivered in the context of a comprehensive SBI implementation programme, this training is effective in changing providers' knowledge, attitudes, and practice of SBI for at-risk drinking.

New approaches, new activities and new outcomes in international conferences on HIV/AIDS in Africa--report of the 3rd African Conference on the Social Aspects of HIV/AIDS, Dakar, 10-14 October 2005

Africa's HIV/AIDS situation remains cause for concern. The impact of HIV is considerable and threatens the survival and development of African societies. Although much has been attempted, the results still leave much to be desired. AIDS is an epidemic that needs to be addressed with much creativity and spirit of initiative. It is against this background that the 3rd African conference on the social aspects of HIV/AIDS brought innovations in the way international conferences are designed, activities implemented and results obtained. The innovations concerned the approach to international conferences and take into account reconceptualising HIV/AIDS so as to encourage holistic approaches and better visibility of vulnerable groups. The activities of the conference were organised in such a way as to get people living with HIV/AIDS (PLWHA), grassroots communities and marginalised groups to play a focal role. The conference offered an opportunity for developing cultural activities that would translate the African cultural concepts that had been identified as important in the HIV situation and response analysis. Interaction at the conference created an opportunity to analyse the various dimensions of the political, cultural and economic determinants. The conference offered food for thought around response construction while singling out the themes of urgency and acceleration of response, synergy construction, and coordination and conception of political responses.

Utilization of delivery services in the context of prevention of HIV from mother-to-child (PMTCT) in a rural community, South Africa

The aim of this study was to investigate the utilization of delivery services in the context of PMTCT in a rural community in South Africa. Based on a cross-sectional survey, the sample included 870 pregnant women who had delivered before recruited from five PMTCT clinics and surrounding communities. Results indicated that 55.9% had delivered their last child in a health care facility and 44.1% at home (mostly without assistance from a traditional birth attendant). The odds of access to the health facility were (1) women who stayed close to the hospital (OR = 2.87), (2) those who had higher formal education (OR = 1.55), (3) higher traveling costs (affordability) to get to nearest clinic (OR = 1.77), and (4) those who were single (OR = 1.58). Childbirth experiences of the mother or mother-in-law greatly influenced the delivery choices in terms of home delivery. The majority of the pregnant women were aware of mother-to-child HIV transmission but only 9% of the pregnant women had ever been tested for HIV. HIV knowledge, HIV testing behaviour and attitudes were found to be not associated with the delivery option.

SEXUALITY OF 16- TO 17- YEAR-OLD SOUTH AFRICANS IN THE CONTEXT OF HIV/AIDS

The aim of this study was to better understand the sexuality of youth in the context of HIV/AIDS in South Africa. Participants (400 male and 400 female 16- and 17- year-olds) 400 were from rural and 400 from urban areas, and almost all were of African descent. Results indicate that two-thirds of the girls and more than half of the boys had had sexual intercourse and had petted. Almost half of the boys (44.3%) and 24% of the girls took less than a week to have sexual intercourse in their current steady relationship. Only 40% of the girls and 57% of the boys had used a condom during their first sexual intercourse; HIV-AIDS prevention efforts should be linked to research on sexuality to advance effectiveness.

Traditional healers' perceptions of smokeless tobacco use and health in the Limpopo Province of South Africa

Traditional healers (THs) exert a significant influence in indigenous South African communities, where smokeless tobacco (SLT) use and dependence is common among women. This study was conducted during 2002. It sought to explore THs' beliefs about SLT use and its health effects. In-depth interviews were conducted with 28--mostly female (68%)--registered THs, with a mean age of 55 years and with an average of 17 years of practice experience. These listed THs were randomly selected from two culturally diverse regions of the (largely rural) Limpopo Province in South Africa. The THs perceive the ritual (external) use of SLT as an absolute necessity in divination, but 32% have also prescribed its 'internal' use to their clients, usually following a "directive from the ancestors." Almost all the THs who themselves regularly consume SLT condemned the recreational use of SLT and believe that SLT is addictive. However, 39% of them claimed to be able to treat addiction resulting from tobacco use not sanctioned by the ancestors. This study has identified opportunities for enlisting THs' collaboration in future community-based tobacco dependence interventions.

LAY PROTOTYPES OF ILLNESS AMONG A NORTHERN SOTHO COMMUNITY IN SOUTH AFRICA

Illness representations have been shown to differ across cultures. The aim of the study was to study disease terminology and lay prototypes among a Northern Sotho community in South Africa. The sample for a free listing of disease terms included 41 (55%) women and 34 (45%) men, with a mean age of 36 years (SD=5.6, range 18 to 75 years). The sample for pile sorting of disease terms included 80 Northern Sotho-speaking third-year students from the University of Limpopo; 44 women, 36 men, mean age, 23.4 years (SD=3.4). From free listing of disease terms 50 were selected for pile sorting. Using hierarchical cluster analysis the following clusters could be identified: (1) respiratory problems, (2) internal body problems and sexually transmitted diseases, (3) chronic diseases and head diseases, (4) child diseases and mental problems, (5) child diseases and cancer, (6) feet problems, (7) gastrointestinal diseases. There was homogeneity of features within cluster and difference between clusters.

Utilisation of antenatal care in a Nigerian teaching hospital

Records of 300 antenatal clinic attendees of a Nigerian teaching hospital were analysed. Results show that many of them obtained care only late in pregnancy and inadequately. Reasons for the delay in seeking antenatal care should be further investigated.

Factors influencing the utilisation of prevention of mother-to-child transmission (PMTCT) services by pregnant women in the Eastern Cape, South Africa

The aim of the study was to identify factors influencing the utilisation of Prevention of Mother-to-Child Transmission (PMTCT) in a resource poor setting in South Africa. Opsomming Die doel van die studie was om faktore te identifiseer wat die benutting van die Voorkoming van Moeder-tot-Kind Oordrag (VMTKO) beïnvloed in ‘n omgewing in Suid-Afrika wat arm is aan hulpbronne. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

Community perception of quality of (primary) health care services in a rural area of Limpopo Province, South Africa: a qualitative study

The aim of the study was to survey perceptions of quality of (primary) health care services provided in rural communities in the Limpopo province. Ten focus groups discussions were held with community members chosen by convenience from public places from four villages in the central region of the Limpopo Province. The sample included 42 women and 34 men (76 participants). Results indicated perceived quality discussed within the following categories: (1) conduct of staff (reception, communication, discrimination, care and compassion, respect for privacy), (2) technical care (examination, explanation of treatment, responsiveness, treatment outcomes), (3) health care facility, (4) health care organisation, (5) drugs (availability, explanation, effectiveness, payment), and (6) waiting time. The findings suggest some satisfaction with free basic and preventive health care and social services provided but there is a need to look closely into the interpersonal dimension of the services provided, provision of medication with adequate explanation to patients on the medication given, and on structural aspects, there is need for the government to give support to the clinics to provide adequate services. Improving drug availability, interpersonal skills (including attitudes towards patients) and technical care have been identified as the three main priorities for enhancing perceived quality of primary health care and health policy action.

Perceived HIV/AIDS impact among staff in tertiary institutions in the Eastern Cape, South Africa

A descriptive questionnaire-based study was undertaken among staff in tertiary institutions in the Eastern Cape Province. The objective of the study was to explore perceived HIV/AIDS impact on duties at work, staff morale, job satisfaction and workload among a proportionate sample of 872 employees in eight randomly selected tertiary institutions. The results of the study showed that HIV/AIDS impacts negatively on duties at work, lowers staff morale and increases staff workload.

Evaluation of HIV counselling and testing, self-disclosure, social support and sexual behaviour change among a rural sample of HIV reactive patients in South Africa

The aim of this study was to evaluate HIV counselling and testing, self-disclosure, social support and sexual behaviour change among HIV reactive patients among a rural sample of HIV reactive patients in South Africa. The sample consisted at the post-test counselling exit interview of 55 participants (41 women and 14 men) who tested HIV-positive conveniently selected from a rural hospital and at five months follow-up at their homes 47. Results indicated that most patients had an HIV test because of medical reasons. At follow-up only 36% had disclosed their HIV status and half of the participants had had sex without condoms in the past three weeks. Major reason for not disclosing of their HIV status were being afraid of negative reactions, fear of discrimination, fear of violence, concerns about confidentiality and not yet ready. Social support was found to be significantly related to disclosure of HIV status, while counselling context and content and counselling satisfaction were not related with HIV disclosure.

Health beliefs and prescription medication compliance among diagnosed hypertension clinic attenders in a rural South African Hospital

This study examines the relationship between health beliefs and the use of both prescribed medication and alternative healing agents among at least one year diagnosed hypertensives attending an hypertension out-patient clinic in a rural South African hospital. The sample included 33 men and 67 women, in the age range of 31 to 81 years, (M=60.7 years, SD=9.8 years). Main outcome measures included causative beliefs, health beliefs, and quality of the health care provider patient interaction. From the 100 patients studied 35% were not compliant with prescription medication. Most patients (almost 80%) had taken something else for their high blood pressure apart from prescription medication, especially those who had been non-compliant with prescription medication. Most popular were the use of home remedies and faith healing, followed by traditional healing and over-the-counter drugs. Non-compliant behaviour was associated with the use of alternative healing agents, the belief of curability of hypertension by traditional and faith healers, perceived benefits and barriers of antihypertensive medication and some items of the quality of the practitioner-patient relationship such as not explaining medical problems. Results are discussed in view of improving culturally sensitive compliance behaviour among hypertensive patients.

Perceptions of tuberculosis: attributions of cause, suggested means of risk reduction, and preferred treatment in the Limpopo province, South Africa

Despite the availability of effective treatment regimens, exceptionally high rates of tuberculosis persist in South Africa. A better understanding of public perceptions of tuberculosis is important for the improvement of the existing tuberculosis-control programmes. This study was aimed at investigating public perceptions about causes, suggested means of risk reduction, and preferred treatment of tuberculosis. The cross-sectional study included a sample of 80 community members from four different age groups chosen by quota sampling in a semi-urban community. Results indicated that 13.75% of the community members reported biomedical causes of tuberculosis, 35% suggested biomedical methods as a means for risk reduction, and 91.25% preferred medical treatment. Significant gender but not age difference was found. Women reported more often than men a biomedical cause of tuberculosis. A number of misconceptions about the cause and risk reduction of tuberculosis were also mentioned. The results suggest that people in a semi-urban area of the Limpopo province have limited knowledge and understanding of tuberculosis. It is suggested that healthcare workers provide services for increasing basic knowledge about causes and risk reduction of tuberculosis of the population in every age group.