The reintegration of obstetric fistula survivors in Malawi: Perspectives of healthcare providers.

OBJECTIVE: In Malawi, women face a high risk of obstetric fistulas. There are many socio-cultural implications for women suffering from the condition, many of which continue to affect them even after they have undergone treatment and attempt to reintegrate into their lives. The focus of this study was to explore the socio-cultural factors that influence the reintegration of obstetric fistula survivors in Malawi from the perspectives of healthcare providers. DESIGN: This qualitative study was conducted at a hospital in Central Malawi, which houses a non-governmental organization (NGO) that is wholly dedicated to the treatment and reintegration of obstetric fistula patients and survivors. In total, in-depth interviews was conducted with 15 healthcare providers. FINDINGS: After surgery, survivors are given economic and social empowerment assistance to allow them to gain independence from their families. Counselling interventions help patients overcome their isolation and depression so they may begin to interact with others. In some circumstances, the initial surgeries may be unsuccessful, causing anxiety and doubt among the women. Some survivors no longer desired to bear children in the future, which negatively impacted their marriages and social status. KEY CONCLUSION: It is imperative to overcome the socio-cultural beliefs that impact the treatment of obstetric fistula. The perspectives of healthcare providers involved in obstetric fistula treatment can assist policy makers to conceptualize and implement effective policies and programmes that will improve the quality of care offered to obstetric fistula survivors after their treatment. IMPLICATIONS FOR PRACTICES: These first-hand experiences and knowledge of healthcare providers are significant in identifying challenges and barriers that fistula survivors encounter during the reintegration process.

Contraceptive use among young mothers with repeat births: Evidence from a qualitative study in KwaZulu-Natal, South Africa.

Teenage pregnancy and rapid repeat pregnancies are declining globally, but they continue to be a significant health issue. Many studies have explored contraceptive use by adolescents, but too date there is a lack of literature on the contraceptive use dynamics of young women in repeat births. This study was conducted in Umlazi, a township located in the province of KwaZulu-Natal. A total of 50 interviews with young mothers aged 18-24 years were conducted. The results revealed that contraceptive use among young mothers remains a challenge, resulting in a significant lack of contraceptive use. This study concludes that much more needs to be done to help young women protect themselves from unwanted and unplanned repeat pregnancies, which includes raising contraception awareness as well as educating young women about their own sexual reproductive health.

Heterogeneity in COVID-19 infection among older persons in South Africa: Evidence from national surveillance data.

Background: The 2021 World Health Organization study on the impact of COVID-19 on older people (≥60 years) in the African region highlighted the difficulties they faced as the virus spread across borders and dominated the way of life. These difficulties included disruptions to both essential health care services and social support, as well as disconnections from family and friends. Among those who contracted COVID-19, the risks of severe illness, complications, and mortality were highest among near-old and older persons. Objective: Recognizing that older persons are a diverse group including younger- and older-aged individuals, a study was conducted to track the epidemic among near-old (50-59 years) and older persons (≥60 years) in South Africa covering the 2 years since the epidemic emerged. Methods: Using a quantitative secondary research approach, data for near-old and older persons were extracted for comparative purposes. COVID-19 surveillance outcomes (confirmed cases, hospitalizations, and deaths) and vaccination data were compiled up to March 5th, 2022. COVID-19 surveillance outcomes were plotted by epidemiological week and epidemic waves to visualize the overall growth and trajectory of the epidemic. Means for each age-group and by COVID-19 waves, together with age-specific rates, were calculated. Results: Average numbers of new COVID-19 confirmed cases and hospitalizations were highest among people aged 50-59- and 60-69-years. However, average age-specific infection rates showed that people aged 50-59 years and ≥80 years were most vulnerable to contracting COVID-19. Age-specific hospitalization and death rates increased, with people aged ≥ 70 years most affected. The number of people vaccinated was slightly higher among people aged 50-59 years before Wave Three and during Wave Four, but higher among people aged ≥ 60 years during Wave Three. The findings suggest that uptake of vaccinations stagnated prior to and during Wave Four for both age groups. Discussion: Health promotion messages and COVID-19 epidemiological surveillance and monitoring are still needed, particularly for older persons living in congregate residential and care facilities. Prompt health-seeking should be encouraged, including testing and diagnosis as well as taking up vaccines and boosters, particularly for high-risk older persons.

Older men, younger women: blesser-blessee relationships among university students in Durban, South Africa.

In sub-Saharan Africa, sexual relationships between younger women and older men have been shown to pose a risk of HIV transmission. In South Africa, there has been growing interest in blesser-blessee relationships. This study explores perceptions of these relationships among university students in Durban, South Africa. The study draws on 15 in-depth interviews with students. Participants suggest that older men engage in these relationships for sexual gratification and younger women do so for monetary or material gain. Interviews revealed that participants believed that these relationships are common with both men and women engaging in them and putting themselves at risk of HIV infection. It is imperative to explore the context and motivation for these relationships because of their broader social and health implications. In addition, greater effort should be geared towards addressing the underlying factors that facilitate blesser-blessee relationships.

Challenges with couples HIV counselling and testing among black MSM students: perspectives of university students in Durban, South Africa.

Research suggests that HIV infections among men who have sex with men (MSM) are acquired from primary partners, yet MSM continually fail to take part in couples HIV counselling and testing (CHCT). To identify factors that inhibit MSM in universities from regularly testing for HIV with their sexual partners, this study considered the perspectives and experiences of 15 MSM students in Durban, South Africa. The findings show that despite appreciating the value of couple testing it is relatively uncommon. MSM resist doing so with their casual partners as this would presumably signal an intention to advance the relationship beyond the short-term. Other barriers included; experienced and perceived homophobia at public testing centres, trust-based assumptions that primary partners need not test for HIV and fear of discord. They also employed alternative strategies to purportedly determine their casual and primary partners' status in the absence of CHCT. Alternative strategies include; initiating sexual relationships with casual partners whose sexual history is known and making use of home-based testing kits to avoid CHCT at public testing centres. These findings emphasise the need for LGBTIQ-friendly couple-based approaches as a necessary component of HIV prevention interventions among MSM in universities.

Religion and non-marital fertility: A qualitative study of the perspectives and experiences of South African Muslim women.

In light of the rising number of children born outside of formal marriage, there is increasing concern about the well-being of these mothers and children, especially since they mostly come from disadvantaged populations. This study aims to determine the role religion plays in the experience of non-marital fertility. This study draws on data from ten in-depth interviews with women in Durban, South Africa. The study found that women did not anticipate the negative impact of non-marital fertility prior to experiencing their first birth. The main reason contributing to the experience of non-marital fertility was the lack of sex education. Many women believed that Islam allowed only married women to use contraceptives because unmarried women are expected to practice celibacy and their religion advocates for a two-parent household. As a result, unmarried women with children found themselves often ostracised from their community. The study recommends a comprehensive sexual education regime to address the challenges associated with non-marital fertility.

Factors influencing HIV-risk perception among MSM students at a university in Durban, South Africa.

Risk perception is embedded in attitudes and beliefs that determine how one ultimately behaves. In relation to HIV-risk behaviours, risk perception is a key dimension in most health behaviour models used to construct health promotion campaigns. This study aimed to understand HIV-risk perception and associated factors among men who have sex with men (MSM). The qualitative data used in this study came from 15 in-depth interviews with MSM studying at the University of KwaZulu-Natal in Durban, South Africa. The findings show that MSM perceive themselves to be at risk for HIV due to their awareness of the main routes of infection. This perception exists because HIV has affected them through the loss of close family members. With each sexual encounter, risk perception changed based on factors such as the sexual role being assumed (insertive versus receptive), the socio-economic status of the partner, perceived level of discriminatory dating patterns, and the use of preventive measures. High levels of risk perception among the men did not translate into positive attitudes towards condoms as many of them preferred to have unprotected sex with trusted partners. Despite perceiving their risk of HIV infection to be high, MSM continue to engage in multiple sexual partnerships and high partner turnover. However, the men in this study were keen to protect their health; with time, they have developed more positive attitudes towards HIV and they understand that it is possible to protect oneself before and after infection.

Barriers to condom use in casual sexual relationships known as ukujola in KwaZulu-Natal, South Africa.

South Africa has the largest number of people living with HIV in the world. Of the nine provinces in South Africa, KwaZulu-Natal is the worst affected. HIV is largely transmitted through unprotected penetrative sexual intercourse. Male latex condoms are central to HIV prevention because of their effectiveness in preventing HIV transmission in almost all sexual encounters if used consistently and correctly. There are, however, various barriers to condom use. This study sought to unpack barriers to condom use in the context of ukujola (casual or informal sexual relationships) in a South African, isiZulu-speaking community. A generic qualitative approach was used, drawing on a range of methods - four focus groups and twenty in-depth interviews. The study was conducted exclusively with isiZulu-speaking African participants, aged 21-34 years, from the uMgungundlovu district in KwaZulu-Natal, South Africa. Ukujola relationships encompass all casual relationships, i.e. those in which there has never been involvement of the families. The involvement of families in negotiating ilobolo (bride wealth) is a prerequisite for legitimate relationships, particularly marriage. Multiple concurrent sexual partnerships typically exist in ukujola relationships, and unprotected sex is common. The interviews suggest the existence of various barriers to condom use, including lack of trust, sexual pleasure and alcohol. There is a need for increased HIV prevention campaigns with particular emphasis on consistent condom use.

"I am aware of the risks, I am not changing my behaviour": risky sexual behaviour of university students in a high-HIV context.

Unprotected sexual activity increases the risk of pregnancy and HIV and AIDS. More than three decades into the AIDS pandemic, the condom remains the most effective strategy for protecting against the dual risks of pregnancy and HIV and AIDS, but data from national surveys suggest that condom use among young people aged 15-24 is on the decline in South Africa. This study uses qualitative data from 20 in-depth interviews and one focus group to examine the risk behaviours of university students aged 18-24 years old, with particular emphasis on understanding the decline in the use of condoms. It is well documented that South Africa has one of the highest prevalence rates of HIV and AIDS in the world, however the findings of this study suggest that even though students were well informed about the perceived risks associated with unsafe sexual behaviours, they continue to engage in risk behaviours including unprotected sexual intercourse, multiple sexual partners and the use of alcohol. Male students were more likely than female students to report risky sexual behaviours. Condom use is occurring but not consistently. The majority of students did not use condoms during their first sexual encounter because of a lack of preparedness. Negative attitudes towards condoms continue to discourage students from using them consistently, especially those provided by the government. In light of this, it is recommended that rigorous efforts are directed towards challenging inaccurate perceptions about, and attitudes towards, condom use to promote consistency.

Factors that impact the timely treatment of obstetric fistulas in Malawi: The perspective of health care providers.

BACKGROUND: In sub-Saharan African countries, women face a high risk of obstetric fistulas. In Malawi, the prevalence rate is 1 per 1000 women. Studies suggest that several obstacles exist that prevent obstetric fistula patients from getting timely treatment for their condition. AIM: The aim of this article was to find out the factors that delay the timely treatment of obstetric fistula patients at Malawian hospitals. SETTING: The study was conducted at the Queen Elizabeth Central Hospital, a referral hospital, situated in Blantyre, Malawi, and the findings have been generalised to all the hospitals in Malawi. METHODS: An exploratory case study, employing key interview questions, was used to provide insights into why there are delays in providing treatment and care for fistula patients. Purposive sampling technique was used to identify study respondents. Key informant interviews were conducted with 16 health care personnel at a hospital in Malawi. RESULTS: The presence of numerous cases of complicated obstetric fistula cases overwhelms the health care system in Malawi. In addition, the severe shortage of staff, lack of obstetric fistula surgery training, low staff morale, inadequate infrastructure or equipment and water scarcity in the city of Blantyre contribute towards delayed treatment of fistulas at the hospitals. CONCLUSION: The presence of numerous cases of obstetric fistulas is overwhelming health services, and hence there is a need for devising and implementing health policies that will motivate Malawian health personnel to undertake obstetric fistula surgery and care.

Men's motivation for contraceptive use in Inanda township, KwaZulu-Natal, South Africa.

Men's involvement in sexual and reproductive health is under-researched in South Africa despite evidence to suggest that men are key decision-makers in various household matters. Against this background, this study aimed to explore men's perspectives on contraceptive use in a South African township with a focus on motivations for contraception use and the challenges men face in using contraceptives. In-depth interviews were conducted with a sample of 20 men. Findings suggest that awareness of contraception among men is high and attitudes towards contraceptives are generally favourable. Contraceptive use is strongly influenced by the perceived risk of unplanned pregnancy and HIV infection. Condoms are the most commonly known and used method of contraception by men. Men complained that there are limited contraceptive options for them and consistent condom use remains difficult. To increase the uptake and use of contraceptives, sexual and reproductive programmes should fully include men in design and delivery. In the longer term, investment in the development of a wider range of contraceptive methods will increase options for men.

Men's and women's roles in decision making about abortion in the context of HIV.

OBJECTIVE: Mother-to-child transmission of HIV is a matter of global concern but is particularly serious in Zimbabwe. A number of strategies have been identified to limit the risk of mother-to-child transmission, including abortion. The aim of the current study was to assess men's and women's roles in decision making about abortion in a setting with a high prevalence of HIV. METHODS: Qualitative research based on eight focus group discussions was conducted among adult men and women in Gokwe North District, Zimbabwe. RESULTS: Both men and women expressed strong, negative attitudes towards abortion. Often, HIV-infected women considered carrying their pregnancy to term so as to fulfil societal and cultural expectations of childbirth after marriage. Termination of pregnancy by HIV-infected women was discouraged due to the availability of highly active antiretroviral drugs. Fear of giving birth to a sick and HIV-infected child, however, remained high. Also, the restricted legal environment appeared to complicate HIV-positive women's decisions to abort. Male involvement in decision making about abortion was relatively limited; if women opted for termination of pregnancy they were likely to do so secretly without obtaining their partner's consent. CONCLUSIONS: In the context of HIV, it is important for prevention programmes to target both men and women in order to reduce the risk of mother-to-child transmission.

Unpacking the practice of ukujola in contemporary South Africa: understanding informal/casual sexual relations of young African adults in the context of HIV and AIDS.

HIV and AIDS continue to pose a global health and development challenge, particularly in sub-Saharan Africa. South Africa has the largest number of people living with HIV (PLHIV) in the world. In spite of the accelerated efforts to combat the HIV and AIDS epidemic, there still remains an unabated challenge, i.e. continuing new infections, particularly among young African adults. HIV is largely transmitted through unprotected vaginal and anal sexual intercourse. This study sought to unpack the meaning of ukujola (casual or informal sexual relationships) as socially constructed by Zulu people, and to identify underlying socio-economic factors for ukujola. This study uses a generic qualitative study approach in which 32 qualitative interviews (4 focus groups, 20 in-depth interviews and 8 key-informant interviews) were conducted with isiZulu-speaking participants (aged 21-34) from Umgungundlovu district, KwaZulu-Natal province. The study found that ukujola relationships are a relatively new phenomenon in Zulu society. Ukujola relationships encompass all "illegitimate" relationships, i.e. in which there has never been involvement of the families. The involvement of families in negotiating ilobolo (bride wealth) is a pre-requisite for legitimate relationships, particularly marriage. Multiple concurrent sexual partnerships typically exist in ukujola relationships, and unprotected sex is common. There is a need for a national dialogue on ilobolo in the context of HIV and AIDS.

Becoming a mother: perspectives and experiences of young women in a South African Township.

There has been growing interest in the high levels of pregnancy among young women in South Africa. This study aimed to explore a range of perspectives and experiences of early motherhood among young women in a township in KwaZulu-Natal, South Africa. This was done using in-depth interviews from a small sample of young mothers aged 18-24 years. All the young mothers reported that they had had their first child while still at school. None of them had intended or planned to have a child, and were therefore not ready for motherhood. Limited information on pregnancy prevention methods plays a key role in influencing early childbearing. Young mothers in the study wanted to assume financial responsibility for their children but they were finding it difficult to do so. Many faced numerous obstacles as they were no longer in a relationship with the father of their child and depended on their own parents for support. Participants described how the difficulties they faced in their daily lives and their new roles as mothers impacted negatively on their education and career aspirations. The study recommends greater involvement of schools and community in addressing the challenges of early childbearing.

Food challenges facing people living with HIV/AIDS in Zimbabwe.

This study explored the food challenges facing people living with HIV/AIDS in Tsholotsho, Zimbabwe. Tsholotsho is a socio-economically disadvantaged, rural district in Zimbabwe and has one of the highest HIV prevalence rates in the country. For this study, face to face in-depth interviews were held with men and women living with HIV/AIDS. The findings of the study indicate that the economic situation in the country coupled with the lack of adequate rainfall has posed challenges to the ability of HIV/AIDS patients to maintain a healthy diet. In addition, there were concerns about the departure of non-government organisations which used to provide them with food parcels. The interviews also reveal that indigenous foods are being replaced by processed foods that are less healthy. Lack of employment opportunities and safety networks were some of the other factors leading them to experience food challenges in their everyday lives particularly in terms of access. As food security and good nutrition are key for maintaining physical and emotional health, the cumulative effects of these factors create a difficult environment to access food.

Client and provider knowledge and views on safer conception for people living with HIV (PLHIV).

OBJECTIVE(S): The childbearing needs of people living with HIV (PLHIV) and the experiences of healthcare providers serving them are explored. We examine provider and client knowledge and views on safer conception methods. METHODS: The study uses exploratory qualitative research to understand provider and client perspectives on childbearing and safer conception. Interviews were conducted at 3 sites (1 rural, 2 urban) in eThekwini District, KwaZulu-Natal, South Africa between May 2011 and August 2012, including in-depth interviews with 43 PLHIV, 2 focus group discussions and 12 in-depth interviews with providers. RESULTS: Clients had little knowledge and providers had limited knowledge of safer conception methods. While clients were eager to receive counseling on safer conception, providers had some hesitations but were eager to receive training in delivering safer conception services. Clients and providers noted that biological parentage is a major concern of PLHIV. Clients were willing to use any of the described methods to have biological children but some expressed concerns about potential risks associated with timed unprotected intercourse. Male clients required access to reproductive health information. CONCLUSIONS: Providers need to routinely initiate discussions with clients about childbearing intentions. Providers need to be enabled with approved guidelines and training to support client access to safer conception methods.

Difficulties facing healthcare workers in the era of AIDS treatment in Lesotho.

Sub-Saharan Africa is most affected by the AIDS pandemic and Lesotho is no exception. In many countries, healthcare workers are at the forefront of the fight against AIDS. This study explores the difficulties facing healthcare workers in Lesotho using a combination of qualitative methods--focus group discussions and in-depth interviews. The findings suggest that healthcare workers are afraid of contracting HIV from their patients and this affects their delivery of services. In addition, the results revealed that poor infrastructure and shortage of supplies at the facilities hinder healthcare workers from performing their duties effectively. The other concern was the heavy workload and severe time constraints which puts enormous stress on healthcare workers. Stigma and discrimination emerged as major problems for healthcare workers. Addressing the challenges facing healthcare workers is essential in effectively managing the AIDS pandemic facing the continent.

Social representations of male circumcision as prophylaxis against HIV/AIDS in Zimbabwe.

BACKGROUND: The World Health Organisation recommended the scale-up of voluntary medical male circumcision (VMMC) as an additional HIV prevention method in 2007 and several countries with high HIV prevalence rates including Zimbabwe have since adopted the procedure. Since then researchers have been preoccupied with establishing the level of knowledge and acceptability of circumcision in communities that did not traditionally circumcise. Despite evidence to suggest that knowledge and acceptability of voluntary medical male circumcision is high, there is also emerging evidence that suggest that uptake of circumcision among men has been below expectations. The purpose of this study was thus to investigate people's representations of male circumcision that may influence its uptake. METHODS: Data for this study was collected through focus group discussions with men and women aged between 18 and 49 years. This age group was selected because they are still very sexually active and are within the target population of the upscale of voluntary medical male circumcision programme. Women were included in the study because they would be directly involved in a decision to have their son(s) get circumcised for HIV prevention. The study was carried out in Harare, Zimbabwe. Obtained qualitative data was analysed using thematic content analysis. RESULTS: Results suggest that circumcision is perceived as an alien culture or something for "younger" men or "boys" who are not yet married. The findings also suggest that there are beliefs that circumcision maybe associated with satanic rituals. The issue of condom use after circumcision was also discussed and it was found that some men do not see the need for using condoms after getting circumcised. CONCLUSIONS: There is an urgent need for the development of communications that directly address the misconceptions about voluntary medical male circumcision. There is need for communication that encourages circumcised men to continue using condoms.

Factors facilitating and inhibiting the use of female condoms among female university students in Durban, KwaZulu-Natal, South Africa.

OBJECTIVES: The study aimed to explore the factors facilitating and inhibiting female condom use among female university students in South Africa. METHODS: This qualitative study drew on 15 individual, in-depth interviews with female university students in Durban, South Africa. RESULTS: The results of the study highlight several factors that facilitate and inhibit female condom use. Protection from sexually transmitted infections (including HIV/AIDS) and prevention of pregnancy facilitated use of the device among female students. In addition, students expressed positive attitudes towards the female condom and preferred it to hormonal contraceptives because it offered them dual protection. Absence of side effects and greater power and autonomy to initiate safer sex were other factors that facilitated use. Inadequate availability, partner objection, stigma, insertion difficulties and lack of awareness served as significant barriers to consistent female condom use. CONCLUSIONS: Although the female condom can protect female students from infections and pregnancy, there are several barriers to its use. Interventions should aim to increase availability of the female condom, and male involvement should be increased to facilitate consistent use of the method.

Risk of Sexual Violence: Perspectives and Experiences of Women in a Hospital in the Democratic Republic of Congo.

Sexual violence in conflict situations is gaining worldwide recognition as a human rights issue. There is growing awareness and concern about the risks associated with sexual violence against women. This study was conducted in order to explore the perceptions and experiences of the risk of sexual violence in the Democratic Republic of Congo. The study draws on qualitative, in-depth interviews with women at a hospital in Bukavu. The findings show that women suffered humiliation, torture and beatings during their rape. Most women were raped by a number of men and others were forced to have sex with close family members. The rapist often used extreme brutality against the women which had major long-term consequences for women including unwanted pregnancies and/or HIV/AIDS. Many of the women experienced great uncertainty about their future and that of their children.