Caring for HIV-positive orphans in the context of HIV and AIDS: perspectives of Botswana grandmothers

"Knowledge I seek because culture doesn't work anymore … It doesn't work, death comes": the experiences of third-generation female caregivers (gogos) in South Africa discussing sex, sexuality and HIV and AIDS with children in their care

Background

Sexual reproductive health communication between parents and children has been shown to promote safer sexual choices. In many South African households, third-generation female caregivers, often grandmothers or other older females, locally known as gogos, are primary caregivers of children due to parents being deceased or absent. Subsequently, the responsibility of talking about sex and related issues has shifted to these gogos. This study explored the experiences of gogos living in Alexandra, Johannesburg on talking about sex, sexuality and HIV and AIDS with children aged 10–18 years that are in their care.

Methods

Ten primary caregivers were purposively selected. Data were collected through in-depth individual interviews. Thematic analysis was performed and inductive codes and themes identified.

Results

All gogos selected found it difficult to discuss sex, sexuality and HIV and AIDS due to culture and traditional values impacting on personal experiences as well as generation and gender barriers. Perceived low self-efficacy due to low levels of knowledge and limited skills in speaking about sex, sexuality and HIV and AIDS also contributed to low levels of sexual reproductive health communication.

Conclusions

This study highlights the need for interventions that focus on improving gogos’ knowledge about sexual reproductive health in addition to providing them with the skills to talk about sex, sexuality and HIV and AIDS with children in their care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10494-5.

Social and Structural Determinants of Household Support for ART Adherence in Low- and Middle-Income Countries: A Systematic Review

Adherence to HIV antiretroviral therapy (ART) is a crucial factor in health outcomes for people living with HIV (PLWH). Interventions to support ART adherence are increasingly focused on the household as a source of social support. This review aims to examine the social and structural determinants of support for ART adherence within households and families in low- and middle-income countries (LMICs). The review methodology followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seven databases were searched for peer-reviewed literature. The terms searched thematically covered (1) ART adherence, (2) household and family and (3) support and care. Thirty-three studies conducted in 15 LMICs were selected and a mixed methods synthesis was undertaken. Social and structural determinants affected the type, quality and amount of support for PLWH of all ages, which affected PLWH's ART adherence. Gender norms affected the type of support that household members give to PLWH. Education moderated household support for ART adherence through literacy and language skills. Cultural context, religious beliefs, and social norms reinforced or undermined household support for ART adherence. Stigma affected disclosure, generated secrecy around giving medication and impeded access to support from the community. Supporting PLWH exacerbated economic hardship for household members. Health system dysfunction negatively impacted trust and communication between household members and health professionals. Intersecting social and structural determinants particularly affected the care given by household members who were older, female, with little education and low socioeconomic status. Household members were able to overcome some of these barriers when they received support themselves. Household interventions to support PLWH's ART adherence should take structural factors into account to have maximum impact.

Sociodemographic Factors and Health-Related Characteristics That Influence the Quality of Life of Grandparent Caregivers in Zimbabwe

Very few studies have examined quality of life (QOL) in elderly carers of orphaned children in African settings. This study explored sociodemographic factors and health-related characteristics that influence QOL of grandparent carers in Zimbabwe. A cross-sectional study stratified by district was done to collect information on socioeconomic factors, health-related characteristics, and QOL of grandparent carers (N = 327; age: M = 62.4, SD = 11.2). Data were collected on socioeconomic factors, self-perceived health, health care access, chronic disease condition, health insurance status, types of health care services, and medications taken using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). Bivariate and multivariate analyses were used to investigate the associations between QOL and the predictor variables. Caregivers' level of education (odds ratio [OR] = 3.0; confidence interval [95% CI] = [1.0, 27]), fostering orphans only (OR = 0.4; 95% CI = [0.2, 0.7]), self-perceived health (OR = 10.2; 95% CI = [4.5, 25]), medical insurance (OR = 9.8; 95% CI = [1.9, 54]), and satisfaction with health care services (OR = 2.2; 95% CI = [1.2, 4.4]) were associated with QOL, after adjusting for all influencing factors. The results confirm that QOL is compromised by specific demographic and self-rated health characteristics. Thus, eradicating poverty and providing services and changing caregiver's perceptions about self-rated health may enhance QOL among grandparent caregivers.