Unsettling knowledge boundaries: the Indigenous pitiki space for Basotho women's sexual empowerment and reproductive well-being.

Indigenous knowledge systems embody a holistic, inclusive view of the world and foreground interconnectedness for the promotion of life. Through reflective engagement with the author's positioning as an Indigenous researcher, this article explores Indigenous knowledges of sexual, reproductive health and motherhood shared by Basotho women. It draws on the life stories of twenty never-married women and uses decolonial African feminist approaches to challenge the assumed universality of conceptions of sexual and reproductive health that are both deeply embedded and produced within specific relations of power. It illuminates the Indigenous pitiki space as an Indigenous knowledge hub purposed to empower Basotho women's sexual and reproductive health. Within this space, Indigenous knowledges and skills are shared amongst women, with the elderly imparting knowledges to the young women. In the context of unsurmountable health disparities, the article shows how Indigenous knowledge-sharing outside the exclusive 'westernised' health systems enables communal support for the well-being of women and children in African contexts. It emphasises the need for inclusive and expansive knowledge production systems not only to better inform equitable health solutions for Indigenous communities but also for epistemic redress in the discipline of Sociology.

The quality of rapid HIV testing in South Africa: an assessment of testers' compliance.

BACKGROUND: The aim of this study was to assess the quality of rapid HIV testing in South Africa. METHOD: A two-stage sampling procedure was used to select HCT sites in eight provinces of South Africa. The study employed both semi-structured interviews with HIV testers and observation of testing sessions as a means of data collection. In total, 63 HCT sites (one HIV tester per site) were included in the survey assessing qualification, training, testing practices and attitudes towards rapid tests. Quantitative data was analysed using descriptive statistics and qualitative data was content analysed. RESULTS: Of the 63 HIV testers, 20.6% had a nursing qualification, 14.3% were professional counsellors, 58.7% were lay HIV counsellors and testers and 6.4% were from other professions. Most HIV testers (87.3%) had had a formal training in testing, which ranged between 10-14 days, while 6 (9.5%) had none. Findings revealed sub-standard practices in relation to testing. These were mainly related to non-adherence to testing algorithms, poor external quality control practices, poor handling and communication of discordant results. CONCLUSION: Quality of HIV rapid testing may be highly compromised through poor adherence to guidelines as observed in our study.

Evaluation of the HIV lay counselling and testing profession in South Africa.

BACKGROUND: With the launch of the national HIV Counselling and Testing (HCT) campaign in South Africa (SA), lay HIV counsellors, who had been trained in blood withdrawal, have taken up the role of HIV testing. This study evaluated the experiences, training, motivation, support, supervision, and workload of HIV lay counsellors and testers in South Africa. The aim was to identify gaps in their resources, training, supervision, motivation, and workload related to HCT services. In addition it explored their experiences with providing HIV testing under the task shifting context. METHODS: The study was conducted in eight of South Africa's nine provinces. 32 lay counsellors were recruited from 67 HCT sites, and were interviewed using two questionnaires that included structured and semi-structured questions. One questionnaire focused on their role as HIV counsellors and the other on their role as HIV testers. RESULTS: Ninety-seven percent of counsellors reported that they have received training in counselling and testing. Many rated their training as more than adequate or adequate, with 15.6% rating it as not adequate. Respondents reported a lack of standardised counselling and testing training, and revealed gaps in counselling skills for specific groups such as discordant couples, homosexuals, older clients and children. They indicated health system barriers, including inadequate designated space for counselling, which compromises privacy and confidentiality. Lay counsellors carry the burden of counselling and testing nationally, and have other tasks such as administration and auxiliary duties due to staff shortages. CONCLUSIONS: This study demonstrates that HCT counselling and testing services in South Africa are mainly performed by lay counsellors and testers. They are challenged by inadequate work space, limited counselling skills for specific groups, a lack of standardised training policies and considerable administrative and auxiliary duties. To improve HCT services, there needs to be training needs with a standardised curriculum and refresher courses, for HIV counselling and testing, specifically for specific elderly clients, discordant couples, homosexuals and children. The Department of Health should formally integrate lay counsellors into the health care system with proper allocation of tasks under the task shifting policy.