Clinical nursing and midwifery education in the pandemic age.

The COVID-19 pandemic has disrupted clinical nursing and midwifery education. This disruption has long-term implications for the nursing and midwifery workforce and for future healthcare responses to pandemics. Solutions may include enhanced partnerships between schools of nursing and midwifery and health service providers and including schools of nursing and midwifery in preparedness planning. These suggestions notwithstanding, we call upon national and international nursing and midwifery bodies to study how to further the clinical education of nurses and midwives during pandemics and other times of crisis.

Towards a definition of orphaned and vulnerable children.

The HIV epidemic presents challenges including orphans and a large mass of children rendered vulnerable by the epidemic and other societal forces. Focus on orphaned and vulnerable children (OVC) is important, but needs accurate definition. Twelve focus group interviews of service providers, leaders in these communities, OVC and their caretakers were conducted at six project sites across Botswana, South Africa and Zimbabwe to extend this definition. The loss of a parent through death or desertion is an important aspect of vulnerability. Additional factors leading to vulnerability included severe chronic illness of a parent or caregiver, poverty, hunger, lack of access to services, inadequate clothing or shelter, overcrowding, deficient caretakers, and factors specific to the child, including disability, direct experience of physical or sexual violence, or severe chronic illness. Important questions raised in this research include the long-term implications for the child and community, and the contribution of culture systems.

International partnerships in nursing education.

As economies are shrinking, international partnerships in nursing education are growing, with the more established educational institutions launching not only on-site internationally focused programmes but also educational partnerships that cross borders, regions, societies, cultures, languages and educational and nursing traditions. Below, some issues related to initiating and maintaining partnerships, as well as the benefits and problems based on personal experience with these partnerships in developing countries.

Care for the elderly, care by the elderly: The role of elderly women in a changing Tswana society.

With increasing urbanization and migration in Botswana and an increasing number of children born to unwed mothers, the grandmother (especially maternal) has become a key figure in many households. She is often the main care provider for children of absent daughters: a phenomenon observed elsewhere in Africa. But what happens when the grandmother herself is in need of care? There are indications that the elderly, especially old women, may have less access to modern health care facilities than the rest of the population. This article focuses on the family and resources available for care of the elderly, and presents preliminary results from an ongoing multidisciplinary project.

Aids and the elderly Tswana: the concept of pollution and consequences for AIDS prevention.

A study of elderly people in a village in southern Botswana is presented in this article. An argument is made for more in depth understanding of the role of elderly people in relation to the HIV/AIDS epidemic. It is demonstrated how Tswana indigenous medical ideology is behaviourally expressed in ways that identify elderly people as a group that may be at risk of catching and spreading HIV/AIDS. Through their position as respected members of the community, elderly people may also be a resource group in the struggle for AIDS prevention.

AIDS awareness and knowledge among Botswana women: implications for prevention programs.

In-depth interviews with 56 urban women in Botswana revealed high levels of AIDS awareness and high reliance on mass media information. Many of the women expressed confusion about AIDS as an illness, that is, its symptoms and the latent period. Nearly all of the women were aware that the virus that leads to AIDS is sexually transmitted and believed that condoms are effective for prevention. However, one third had incorrect knowledge about transmission, lacking a full understanding of sexual transmission and believing that transmission can occur through casual contact. Two thirds believed they were at risk for getting AIDS, usually because they did not trust their partners and lacked control over their partners' behaviors. More than half of the women said they had changed their behaviours to prevent AIDS. Thirty-six said they had only one partner, but only 11 said they used condoms or would do so with a future partner. The women's responses provide important information on gaps in AIDS knowledge that need to be addressed in AIDS prevention.

AIDS prevention for women: a community-based approach.

PIP: There were approximately 3 million HIV-positive women in the world, most of them in reproductive age according to the WHO's 1991 estimates. One third of the world's HIV-positive individuals are women; by the year 2000, women will account for half of the HIV-positive population. There are at least 200,000 HIV-positive women in Asia, mainly in Thailand, India, and China. The community-based Botswana project approach to AIDS prevention for women was based on a community-based model project at the University of Illinois to promote health in 2 low-income communities in Chicago by teams of trained residents and a nurse. Program elements included: women as health promoters; acceptance of primary health care; and emphasis on self-care in basic health. In Botswana the fertility rate is 5%, and approximately 40% of the women use contraceptives. The overall mortality rate is 37 per 1000. The 1st case of AIDS in Botswana was identified in 1985. As of January 1991, there were 180 cases and 59 AIDS-related deaths. There are 20,000 to 47,000 HIV-positive individuals in Botswana. There have been more women than men among reported AIDS cases in Botswana. Most women in their childbearing years are at moderate risk of HIV infection because of weak partner ties and occasional multiple partners. A 2-stage study of the effectiveness of nurse-managed peer education and support groups for AIDS prevention for women has been in operation for the 2nd year. In the 1st phase, interviews with more than 50 urban women explored their current risk of HIV infection and the risk-reduction strategies. The strategy for change used peer education and support groups led by trained community women to achieve lasting behavioral changes that promote health. The target group approach will include all women in the community. Heterosexual transmission of HIV is the predominant route of infection for women, hence promotion of safer sex is central in the Botswana intervention. The same AIDS preventive practices also protect against other sexually transmitted diseases including gonorrhea, syphilis, and chlamydiosis, which have high prevalence rates in Botswana.^ieng