Longitudinal analysis of HIV risk behaviour patterns and their predictors among public primary care patients with tuberculosis in South Africa

The goal of this study was to identify various HIV risk behaviours among tuberculosis (TB) patients in a longitudinal study design in South Africa. In 42 public primary healthcare facilities in three districts in three provinces, adult new TB and TB retreatment patients with hazardous or harmful alcohol use were interviewed within 1 month of initiation of anti-TB treatment and were followed up at 6 months. The total sample with a complete 6-month follow-up assessment was 853. At the follow-up assessment, several HIV risk behaviours significantly reduced from baseline to follow-up. In multivariate Generalized Estimating Equations logistic regression analyses, high poverty (odds ratio (OR): 2.68, 95% confidence interval (CI): 1.56­4.62),Posttraumatic Stress Disorder (PTSD) symptoms (OR = 1.55, 95% CI = 1.03­2.36), and sexual partner on antiretroviral therapy(ART) (OR = 1.84, 95% CI = 1.09­3.10) were associated with a higher odds, and excellent/very good perceived health status (OR:0.61, 95% CI: 0.37­0.98), severe psychological stress (OR = 0.51, 95% CI = 0.34­0.77), and HIV non-disclosure to most recent sexual partner (OR = 0.40, 95% CI = 0.25­0.65) were associated with a lower odds of inconsistent condom use. Being HIV positive (OR = 4.18, 95% CI = 2.68­6.53) and excellent/very subjective health status (OR = 2.98, 95% CI = 1.73­5.13) were associated with a higher odds, and having PTSD symptoms (OR = 0.60, 95% CI = 0.36­0.99), being on ART (OR = 0.48, 95% CI= 0.25­0.95), having a sexual partner on ART (OR = 0.41, 95% CI = 0.18­0.96), and HIV status non-disclosure (OR = 0.25, 95%CI = 0.15­0.41) were associated with a lower odds of having sex with an HIV-positive or HIV status unknown person. High poverty index (OR = 1.97, 95% CI = 1.19­3.25) and having a sexual partner on ART (OR = 4.37, 95% CI = 1.82­10.48) were associated with a higher odds, and having a partner with HIV-negative status (OR = 0.29, 95% CI = 0.16­0.51) and inconsistent condom use (OR = 0.39, 95% CI = 0.24­0.64) were associated with a lower odds of HIV status non-disclosure at last sex. The study found that among TB patients with problem drinking over a 6-month TB treatment period, the frequency of some HIV risk behaviours (inconsistent condom use) declined (OR = 0.64, 95% CI = 0.41­0.98), but also persisted at a high-level calling for a strengthening and integration of HIV prevention into TB management

Mental health and HIV sexual risk behaviour among University of Limpopo students

Background. Little attention has been paid to the role of poor mental health among young people with regard to HIV risk behaviour and HIV prevention in Africa. Objective. To determine the association between mental health; substance use and HIV sexual risk behaviour among a sample of university students in South Africa. Methods. A cross-sectional survey was conducted among undergraduate students who were recruited conveniently from public campus venues at the University of Limpopo Medical University of Southern Africa (Medunsa) campus. The sample included 722 university students (57.6 men and 42.4women) with a mean age of 21.7 years (standard deviation _}8.8). Results. Of the 722 students; 39.5 reported depression; 23.4 screened positive for post-traumatic stress disorder (PTSD); 22 reported hazardous or harmful alcohol use; 33 reported .2 sexual partners in the past 12 months; 50 reported inconsistent condom use; 46 reported unknown HIV status of a sexual partner and 20 reported alcohol use in the context of sex in the past 3 months. In multivariate analysis; HIV risk behaviour was associated with; among men; hazardous or harmful alcohol use and having screened positive for PTSD; and among women; being in the 4th or more year of study and current cannabis use. Conclusion. Poor mental health; including substance use; was found to be associated with HIV risk behaviour. Co-ordinated mental health and sexual and reproductive health services that meet the needs of university students would be desirable

Alcohol use and associated factors among adolescent students in Thailand / El uso de alcohol y factores asociados entre los estudiantes adolescentes de Tailandia

OBJECTIVE: Alcohol misuse is a relevant public health issue in Thailand. The assessment of the prevalence of alcohol use among adolescents may guide policies and programmes aimed at reducing alcohol use among this age group. METHOD: Using data from the Thailand Global School-based Student Health Survey (GSHS) 2008, we assessed the prevalence of alcohol use and the associated factors among adolescents (n = 2758). RESULTS: Overall, the prevalence of current alcohol use was 14.8% (21.2% males and 9.3% females). Variables positively associated with the outcome in multivariable analysis among boys were older age, other substance use (smoking and illicit drug use), sex in the past 12 months, physical fighting, injury in the past 12 months; and among girls, poverty, smoking, physical fighting and lack of parental or guardian connectedness. CONCLUSION: Efforts to prevent and control alcohol misuse may need to address a cluster of risk behaviours including cigarette smoking.

OBJETIVO: El abuso del alcohol es un problema de salud pública importante en Tailandia. La valoración de la prevalencia del uso de alcohol entre los adolescentes puede guiar las políticas y programas encaminados a reducir el uso del alcohol entre este grupo etario. MÉTODO: Usando datos de la Encuesta Mundial de Salud Escolar (GSHS) 2008, efectuada en Tailandia, se evaluó la prevalencia del uso del alcohol y los factores asociados, entre los adolescentes (n = 2758). RESULTADOS: En general, la prevalencia del uso del alcohol corrientemente fue 14.8% (21.2% varones y 9.3% hembras). Las variables positivamente asociadas con el resultado del análisis multivariable entre los muchachos fueron: tener más edad, uso de otra sustancia (hábito de fumar y uso ilícito de droga), sexo en los últimos 12 meses, pelea física, lesión en los últimos 12 meses. Entre las muchachas estas variables fueron: la pobreza, el hábito de fumar, la pelea física, y la falta de relación con los padres o los tutores. CONCLUSIÓN: Los esfuerzos por prevenir y controlar el abuso del alcohol entre los adolescentes pueden llevar a la necesidad de abordar una serie de comportamientos de riesgo, incluyendo el hábito de fumar.

Social Grants for People Living with HIV and on Antiretroviral Therapy in KwaZulu-Natal; South Africa: a Longitudinal Study

The aim of this studywas to assess the predictorsof thereceipt of a disability grant (DG) status and the impact of theDGon health outcomes of HIV patients and on antiretroviral therapy (ART) in a longitudinal study over 20 months in KwaZulu-Natal; South Africa. Consecutive patients; 735 (29.8 males and 70.2 females); who attended three HIV clinics completed the assessments (with a structured questionnaire and medical file review) prior to antiretroviral initiation; 519 after 6 months; 557 after 12months and 499 after 20 months on ART. The results indicate that a large number ofHIV or ART patients were found to be in receipt of a DG;which declined significantly over the time of being on ART (from 52.3 at 6months onART to 9.8 at 20months on ART). At various stages; being in receipt of aDGwas found to be associated with not being employed; higher quality of life (QoL); older age; higher alcohol use score; noformal salary as householdincome and higher subjective health status in multivariable analyses. A significant number of patients lost their DG status over the assessment period; which was not found to be associated with major health outcomes (CD4 cell counts; adherence to ART and HIV symptoms). In a multiple regression generalized estimating equation model; not being in receipt of a DG; health-related QoL; lower HIV symptoms and lower depression scores were associated with CD4 counts. HIV patients who no longer qualify for the DG and yet do not haveadequate financial means to meet basic necessities should be put on a nutritional support programme

Efficacy of a Lay Health Worker Led Group Antiretroviral Medication Adherence Training Among Non-Adherent HIV-Positive Patients in KwaZulu-Natal; South Africa: Results from a Randomized Trial

There is a lack of theory-based randomized controlled trials to examine the effect of antiretroviral adherence in sub-Saharan Africa. We assessed the effectiveness of a lay health worker lead structured group intervention to improve adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in South Africa. A total of 152 adult patients on ART and with adherence problems were randomized 1:1 to one of two conditions; a standard adherence intervention package plus a structured three session group intervention or to a standard adherence intervention package alone. Self-reported adherence was measured using the Adult AIDS Clinical Trials Group adherence instrument prior to; post intervention and at follow-up. Baseline characteristics were similar for both conditions. At post-intervention; adherence information knowledge increased significantly in the intervention condition in comparison to the standard of care; while adherence motivation and skills did not significantly change among the conditions over time. There was a significant improvement in ART adherence and CD4 count and a significant reduction of depression scores over time in both conditions; however; no significant intervention effect between conditions was found. Lay health workers may be a useful adjunct to treatment to enhance the adherence information component of the medication adherence intervention; but knowledge may be necessary but not sufficient to increase adherence in this sample. Psychosocial informational interventions may require more advanced skill training in lay health workers to achieve superior adherence outcomes in comparison standard care in this resource-constrained setting

HIV Counselling and Testing Utilisation and Attitudes of Male Inmates in a South African Prison

The Department of Correctional Services Policy on the management of HIV and AIDS for offenders include voluntary counselling and testing (VCT) for HIV as one of the priorities in the rehabilitation of inmates. The aim of this study was to determine factors associated with the utilisation of VCT services in the correctional centres in terms of level of satisfaction; their experiences and expectations; and motivating factors and barriers for VCT utilisation at Losperfontein Correctional Centre; South Africa. This was a case control study (cases being those who underwent testing and controls those who did not) examining predictors of HIV VCT utilisation among 200male adult sentenced inmates serving medium and maximum sentences. Results indicate that a poor health system (OR=0.34; 95CI:0.23 - 0.50) was inversely associated with HIV testing acceptance in prison; while age; educational level; population group; marital status; length of incarceration and access to HIV testing in prison were not associated with HIV testing acceptance in prison. Half of the participants (50) agreed that VCT services are accessible and are promoted at their correctional centre. Most were satisfied with different components of VCT services; ranging from 79 (fair to very good) for 'the way he/she received you' to 62 'clarified all your concerns'. This study demonstrated some challenges and benefits to the field of health promotion and HIV prevention in the correctionalcentres especially with regard to VCT services

The Social and Clinical Characteristics of Patients on Antiretroviral Therapy who are 'Lost to Follow-up' in KwaZulu-Natal; South Africa: a Prospective Study

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms; quality of life; depression; herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naive patients recruited from three (one urban; one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months' follow-up. At 12-months follow-up 557 (75.9) individuals continued active ART; 177 (24.1) were all cause attrition; there were 82 deaths (13.8); 58 (7.9) transfers; 7 (1.0) refused participation; 8 (1.1) were not yet on ART and 22 (3.0) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio; RR=2.05; confidence intervals; CI=1.20 - 3.49) and higher depression levels (RR=1.05; CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme; such as delays in health care access (delayed health care seeking); health system delays; or inappropriate treatment criteria; need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome

Alcohol use and problem drinking in South Africa: findings from a national population-based survey

Objective: This study formed part of the South African National HIV; Incidence; Behaviour and Communication (SABSSM) 2008 survey; which included questions assessing the extent of alcohol use and problem drinking among South Africans. Method: A multistage random population sample of 15 828 persons aged 15 or older (56.3women) was included in the survey. Alcohol use was assessed using the Alcohol Use Identification Test (AUDIT). Tabulation of data for different age groups; geolocality; educational level; income; and population group produced the estimates and associated confidence intervals. The odds ratios for these variables in relation to hazardous or harmful drinking were also computed. Results: Current alcohol use was reported by 41.5of the men and 17.1of women. White men (69.8) were most likely and Indian/Asian women (15.2) least likely to be current drinkers. Urban residents (33.4) were more likely than rural dwellers (18.3) to report current drinking. Risky or hazardous or harmful drinking was reported by 9: 17among men and 2.9among women. In men; risky drinking was associated with: the 20-54 year age group; the Coloured population group; lower economic status; and lower education. Among women; risky drinking was associated with: urban residence; the Coloured population group; lower education; and higher income. Conclusion: An increase in current; binge drinking and hazardous or harmful drinking prevalence rates was observed from 2005 to 2008 in South Africa. Multilevel interventions are required to target high-risk drinkers and to create awareness in the general population of the problems associated with harmful drinking. Future prospective studies are needed to assess the impact of problem drinking

Awareness; and Use of and Barriers to Family Planning Services among Female University Students in Lesotho

Background. Unwanted pregnancy and sexually transmitted infections among young women can be prevented through effective use of contraception. Unmet need for contraception in developing world and rates of unintended pregnancy among young women is high. Aim. To assess the level of awareness of contraceptives and utilization of family planning services among young women and barriers that hinders effective use of such services. Methods: In a quantitative descriptive survey 360 female undergraduate students of the National University of Lesotho; Roma; Lesotho respondent to a hand delivered self-administered questionnaire. Results: Awareness of family planning is high (98.3). Condom is the most commonly known and used family planning method. Level of sexual experience and contraceptive prevalence is high. Access to services is good but there are misconceptions. Married status is associated with current use; positive perception on health benefit while formal teaching on family planning is associated with misconceptions. Conclusion: The level of awareness and utilization of family planning services is high among female students of University of Lesotho. There is the need to introduce family planning teaching that is based on accurate knowledge to school curriculum

Implementation of the National Programme for Prevention of Mother-To-Child Transmission of HIV: a Rapid Assessment in Cacadu District; South Africa

To conduct a rapid assessment of the prevention-of-mother-to-child-transmission-of-HIV (PMTCT) programme in two of the three local service areas in Cacadu district; Eastern Cape province; South Africa; we designed an exploratory study using a mixed-methods approach. Quantitative and qualitative data on PMTCT programme implementation were collected in 2008 through a structured assessment at the 44 health facilities implementing the programme in the province. This included in-depth interviews with 11 clinic supervisors; 31 clinic programme coordinators; and 8 hospital/maternity staff members in order to examine their perceived problems and suggestions regarding PMTCT programme implementation; an assessment of the clinic registers and recording systems; a meeting with stakeholders; and one feedback meeting with clinic managers; sub-district management and other stakeholders in regard to the results of the rapid assessment. Overall; most of the national criteria for PMTCT programme implementation were fulfilled across the health facilities. However; shortcomings were found relating to health policy; health services delivery and clients' health-seeking behaviour. The findings show the need for a well-functioning health system with adequate and trained staff; a reduced staff workload; proper case recording; an improved patient follow-up system; better support for staff; the empowerment of PMTCT clients; strong leadership; and coordination and collaboration between partners

Health-Related Quality of Life in a Sample of HIV-Infected South Africans

The study aims to assess the health-related quality of life and HIV symptoms of a sample of people living with HIV (PLHIV) in South Africa. The sample included 607 PLHIV from all districts of the Eastern Cape Province; recruited either through a health facility; from the community through key informants; or through support groups. At the time of the study; 66of the respondents reported having been given an AIDS diagnosis (advanced stage of HIV disease); 48were on antiretroviral therapy (ART); and 35were receiving a disability grant. The findings indicate a low degree of overall quality of life; with a mean score of 13.4 on the WHOQOL-HIV measure. Among the WHOQOL-HIV BREF subscales; logistic regression identified spirituality; environment; psychological health; and level of independence as predictors for overall quality of life. Among medical variables and HIV symptoms; CD4 cell count and having fewer HIV symptoms but not an AIDS diagnosis were identified as predictors for overall quality of life; among socio-economic variables; having sufficient food and a higher educational level were identified as predictors. The results highlight the need for better access to psychosocial support and medical services for PLHIV in South Africa; as well as the need to consider a patient's general health perceptions during the course of ART

Intimate Partner Violence and HIV Risk among Women in Primary Health Care Delivery Services in Vhembe District; South Africa

The aim of the study is to investigate intimate partner violence and HIV risk among women attending primary care health care facilities in Vhembe district; South Africa. The sample included 389 women with a mean age of 28 years (SD=7.1) randomly selected from four primary care facilities. Results indicate high rates of intimate partner violence and HIV risk: 34of the women reported a history of having an STI in the past 12 months; 17had consistently (every time) used a condom with their primary partner in the past three months; and 59reported knowing that their primary partners placed them at risk for HIV transmission. Combining physical or sexual abuse 28.5of the women reported that this IPV was perpetrated within the preceding 12 months. Logistic regression identified lower educational level; having had more sexual partners in the past 12 months; primary partner with known HIV risk; frequency of binge drinking among the primary partner and having had an STI as predictors for physical or sexual abuse. Among women who reported a history of physical or sexual abuse in the past 12 months only 26.9had disclosed their abuse status to their health care provider; and yet; 47.1of the abused women agreed that a health care provider should routinely ask the patient about abuse. Accordingly; programmes for the prevention of intimate partner violence and HIV risk need to target the above identified underlying factors. Health care workers are in a unique position to routinely assess all female patients for abuse and offer effective interventions that can improve their health

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

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. A sample of 186 pregnant women (29.6HIV positive and 70.4HIV negative) in four clinics in a rural district in the Eastern Cape were interviewed as part of the PMTCT programme after they had received their HIV test results. Regarding infrastructure; most women lacked transport to and communication with a health facility. More than 90felt that they had received adequate information on most of the components of the PMTCT programme. About 90of the women were satisfied with the HIV counselling they had received. Most women (54) felt they would receive support during their pregnancy mainly from their mothers; and/or husband/partner (50). Most pregnant women (92) preferred to give birth in hospital; while 8prefer to deliver at home; mostly with the assistance of a traditional birth attendant (TBA). Two-thirds of the HIV positive women stated they would feed their babies with formula milk only. Community attitudes towards people living with HIV/AIDS were mostly perceived as negative. Factors influencing the utilisation of PMTCT (that is the acceptance of antiretroviral therapy to HIV positive women; facility-based delivery; and adherence to ""take-home"" ART identified for mother and newborn); included: (1) HIV counselling by health care staff; (2) physical access to a health facility; (3) family and community support; (4) stigma; (5) delivery preference; and (6) infant feeding preferences."

Counselling and rehabilitation of victims of humans rights violations in Africa

On the basis of two service provider models (1) IRCT (International Rehabilitation Council for Torture Victims) and (2) IPSER (International Psychosocial and Socio-Ecological Research Institute) counselling and rehabilitation of victims of human rights violation in Malawi and Uganda are described. Follow-up studies show that both approaches of IRCT in Malawi and IPSER in Uganda can be effective. A number of case studies demonstrate the psychopathology involved and the psychosocial processes of therapeutic change of the victims of organised violence

Counselling and rehabilitation of victims of human rights violations in Africa

On the basis of two service provider models (1) IRCT (International Rehabilitation Council for Torture Victims) and (2) IPSER (International Psycho-social and Socio-Ecological Research Institute) counselling and rehabilitation of victims of human rights violations in Malawi and Uganda are described. Follow-up studies show that both approaches of IRCT in Malawi and IPSER in Uganda can be effective. A number of case studies demonstrate the psychopathology involved and the psychosocial processes of therapeutic change of the victims of organised violence

Causative and intervening factors of harmful alcohol consumption and cannabis use in Malawi

"The aim of this study was to identify culturally relevant factors in the causation of and intervention in harmful alcohol and cannabis use in Malawi. Therefore a community research was conducted through key informants; and subjects were followed up for 6 months. The data were analyzed and interpreted according to an African model of socialization and personhood. It was concluded that traditional intervention strategies on a social and community level are no longer effective in the transitional Malawian; and that strategies aiming at basic life-style changes like those in some ""Healing Churches"" are called for."

Nosology and etiology of a spirit disorder vimbuza in Malawi

In this study the traditional and transitional nosology and etiology of the spirit disorder vimbuza was investigated by interviewing patients (n = 116) who were suffering from that condition. The illness concept was compared with western psychiatric classifications. As a result; 23 symptom descriptions were identified; 13 can be referred to as conversion or dissociation disorder and 7 to depressive neurosis. The remaining 3 symptom descriptions refer to an acute delusional or confusional state. Comparing the traditional and transitional symptom descriptions on the head and heart; a shift from the heart to the head becomes evident in the transitional or urban Malawian. The transitional etiology is the same as the traditional etiology; only that the transitional person more often refers to 'Too much thinking' and 'natural' than to 'bad ancestral spirits' and 'witchcraft'