Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS.

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care.

Challenges in the management of support and care programmes for child-headed households in South Africa.

AIMS: The present study reports on data collected in a larger study on 'A situational analysis of child-headed households in South Africa'. The purpose of this study was to explore the management and control of available and required services, resources and safety nets for children in child-headed households. BACKGROUND: The significance of having a better understanding of the challenges, limitations but importance for government structures to manage and control programmes will enhance the implementation and maintenance of focused and sustainable support structures and programmes which will effectively address the needs of child-headed households. METHOD: An exploratory and descriptive, quantitative survey was conducted to provide information on government structures at a national level and the nine provinces in South Africa. The population consisted of the Departments of Social Development, Education, Health and Agriculture, at both national and provincial levels. RESULTS: The main findings included a lack of clarity regarding the concept and definition of a child-headed household, lack of empirical data, a diversity of needs and challenges in terms of location and geographical distribution of available infrastructure and support systems; programmes that are not inclusive and integrated; and contradictions in the stipulations and implementation of existing policies and capacity and human resources shortages. CONCLUSIONS: It was concluded that the magnitude, uniqueness and complexity of the phenomenon necessitate effective and sound scientific management principles. This is achieved by providing legal clarity of the concept; developing relevant policies and ensuring effective implementation thereof; rigorous monitoring and evaluation based on comprehensive empirical data; and protecting the rights and safety of these children and ensuring an enabling environment for all stakeholders to address needs and challenges. IMPLICATIONS FOR NURSING MANAGEMENT: The role of the nurse manager is to ensure a holistic approach to children living in child-headed households by acting as a facilitator, advocate, leader, coordinator and consultant.

Children's rights in the context of HIV/AIDS in Southern Africa.

Children in Southern Africa are living under extreme, difficult circumstances because of the spread of HIV/AIDS. Protecting and enhancing the rights of children can be regarded as an investment in the future. The principles identified in the World Fit for Children document from the United Nations International Children's Emergency Fund, within the context of HIV/AIDS, were used as a theoretical framework for a study conducted in one of the provinces of South Africa. A survey was conducted as a collaborative research project to map out critical trends regarding the fulfillment of children's rights, patterns, and structures of services available and the identification of capacity gaps. Right holders and duty bearers were interviewed, area surveys were conducted, and field observations were performed to determine data. Recommendations were made to raise the awareness of children's rights and to mobilize the community into action. To realize children's rights, emphasis must be placed on physical survival, development, and protection. Duty bearers should recognize and accept their responsibilities to establish, facilitate, manage, and/or control plans of action to address the devastating consequences of HIV/AIDS. Children should be empowered with knowledge, skills, and awareness to engage in and claim their rights.