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1.
PLoS One ; 15(2): e0229487, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101591

RESUMO

BACKGROUND: The emergence of a large population of orphaned youth in sub-Saharan Africa is due to the natural maturity of orphaned children. Research indicates that orphaned youth face more negative psychosocial challenges than their younger counterparts do. Furthermore, these challenges are intensified for early school leavers. This paper describes how experiencing maternal death affects the psychosocial wellbeing of orphaned youth who left school before completing high school. METHODS: An exploratory qualitative study was undertaken among purposively sampled orphaned youth using in-depth interviews with open-ended questions. Fifty participants were recruited through social workers, community based organisations, and tribal authorities in a rural local municipality of Mpumalanga Province, South Africa. All data analyses were performed using NVivo10, following an inductive thematic approach. RESULTS: The narratives with the participants revealed that they live in a socially depressed environment and are subjected to extreme poverty characterised by frequent hunger. Furthermore, they do not enjoy family support and when they live with their extended families, they experience ill treatment and unsympathetic gestures. The death of their mothers has made a negative psychological impact on their psychosocial wellbeing, resulting in the development of internalising depressive symptoms. They suffer from emotional distress and prolonged bereavement characterised by perpetual yearning for the mother and, they resort to silence as a coping strategy. The study established that they were forced to leave school early for a variety of reasons. However, leaving school early became a major stressor and contributed to their negative psychosocial wellbeing. CONCLUSION: Maternal death has a negative impact on the psychosocial wellbeing of the participants even after they have crossed the 18 years threshold of orphan hood. Yearning for their mothers negatively affected their ability to develop coping strategies, which led to isolation, sadness, hopelessness, lack of peace, and fear of an uncertain future. The lack of routine screening for mental health in schools and other settings in South Africa increases their vulnerability to undiagnosed depression. The school health services should develop interventions for mental health screening in schools. For early school leavers, relevant policies should consider the continuation of support through NGOs and community networks.

2.
Biomed Res Int ; 2019: 9623159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886271

RESUMO

Background: Maintaining optimal adherence to antiretroviral treatment (ART) is a challenge for adolescents with perinatally HIV (ALPHIV), and there is little consensus on what factors contribute to adherence in this population. This study assessed self-reported medication adherence among ALPHIV and explored structural factors that hinder or motivate them to adhere. Methods: This qualitative study used in-depth interviews with ALPHIV at the infectious disease control centre of a teaching hospital in Botswana. Thirty adolescents aged 12-19 years who were aware of their HIV status were recruited purposively. Transcribed interviews were analysed using the thematic approach and NVivo data analysis software. Findings: Nonadherence was a problem across age groups and gender. Perceived stigma was a major barrier to ART adherence. The fear of stigma and unintended disclosure were more pronounced in those attending boarding school. The adolescents were not willing to take medication in front of roommates and outside of the home. They opted for hiding and taking medication in privacy which led to missed doses. The heightened fear of being seen collecting ART medication affected keeping appointments for clinic visits. Fear of stigma also influenced the choice of action when there was a clash between school activities, dosing times, and scheduled clinic appointments for ART refill. The home environment was the main facilitator for adherence. Support was the strongest motivator for adolescents to adhere and keep up with clinic visits. On a personal level, the desire to be healthy and live long was a major motivator to adhere. Conclusions: The fear of stigma shaped the adolescents' adherence behaviour. Perceived stigma affected the time and place to take medication, the visit to the clinic for ART refill, and self-disclosure of HIV status. There is need to encourage adolescents to self-disclose their HIV status to friends since the fear of unintended disclosure fuelled perceived stigma. Planning of clinic appointments should also be consistent with realistic daily activities of adolescents.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31861151

RESUMO

The uptake of vasectomy in many countries in sub-Saharan Africa is low. In Eswatini, a kingdom with strong patriarchal norms, the use of vasectomy is at 0.3%. This is despite great efforts to introduce vasectomy and involve men in reproductive health. This study explored the views of men about the acceptability of vasectomy and their willingness to adopt vasectomy as a family planning option. Focus group discussions were conducted with adult men recruited from health facilities located in rural, semi urban, and urban areas in two of the regions of Eswatini. A thematic approach was used to analyze the data. The acceptability of and intention to use vasectomy as a family planning option was very low. Cultural beliefs, societal norms, lack of knowledge about the procedure for vasectomy, and misconceptions influenced the acceptability of vasectomy greatly. The participants could not grasp the concept of a family planning method that is as permanent as vasectomy. However, the decisions to accept or reject vasectomy were influenced by their misconceptions and fears about vasectomy and were not based on facts. To address the need to involve men in reproductive health and improve the acceptability and adoption of vasectomy, planning should be conducted with them and informed by their understanding of their needs.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31480218

RESUMO

Since the start of the HIV and AIDS epidemic, very little research has been conducted on the older persons' provision of HIV-related care to adult children. This is despite the fact that a large proportion of adults who die of AIDS-related illnesses stay with their elderly parents during the terminal stage of their illnesses. This paper explores how older persons in rural settings experience caring for their adult children with AIDS-related illnesses. In-depth interviews took place with older persons aged 60 years and above. The qualitative data analysis was informed by thematic approach to identify and report themes using inductive approach. The paper found that the older persons undertake the caring role without resources and support. As a result, they are burdened with having to care for adult children with AIDS-related illness. Fatigue arising from the hard work of physically caring for their sick adult children day and night adds to the physical burden on the older persons. Older persons will continue to carry the burden of caring for people with AIDS-related illnesses due to the increase in the number of new infections in South Africa. There is a need to involve them in HIV/AIDS programmes; their experience and wisdom would surely contribute positively and assist in addressing HIV prevention.


Assuntos
Síndrome de Imunodeficiência Adquirida/terapia , Crianças Adultas , Cuidadores/estatística & dados numéricos , População Rural/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Humanos , Pessoa de Meia-Idade , África do Sul
5.
BMC Public Health ; 19(1): 1087, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399048

RESUMO

BACKGROUND: In South Africa, the occurrence of the double burden of malnutrition is on the rise at a household level predisposing children and their mothers to negative health outcomes. However, few studies have been conducted at a household level. Therefore, we studied a double burden of malnutrition using child-mother pairs in a rural setting. METHODS: A cross-sectional quantitative survey was conducted among 508 child-mother pairs selected from primary schools using a multistage sampling in a rural Dikgale Health and Demographic Site in Limpopo Province, South Africa. Anthropometric measurements of children and mothers, and socio-demographic data were collected. WHO AnthroPlus was used to generate body-mass-index z-scores of children and the BMI was used to indicate overweight and obesity among the mothers. Mann Whitney test was used to compare the means of variables between sexes and age groups, while the prevalence of thinness and overweight/obesity were compared using a chi-square. Multivariate logistic regression with a stepwise backward elimination procedure, controlling for confounding, was used to determine the association between the thinness and overweight/obesity and the covariates. RESULTS: Twenty five percent (25%) of the children were thin, 4% were overweight and 1% obese, while mothers were overweight (27.4%) and 42.3% obesity (42.3%) were observed among the mothers. The odds of being thin were higher in boys than in girls (AOR = 1.53, 95%CI: 1.01-2.35). Overweight/obese mothers were more likely to have thin children (AOR = 1.48, 95% CI: 1.01-2.18) and less likely to have overweight/obese children (AOR = 0.18, 95%CI: 0.07-0.46). CONCLUSION: A double burden of malnutrition was observed on a household level with thinness among children and overweight/obesity among mothers. A need to address the dual problems of undernutrition and rapidly rising trends of overweight/obesity cannot be over-emphasized.


Assuntos
Desnutrição/epidemiologia , Vigilância da População , Saúde da População Rural/estatística & dados numéricos , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Mães/estatística & dados numéricos , Instituições Acadêmicas , África do Sul/epidemiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-31438531

RESUMO

BACKGROUND: Overweight and obesity are increasing at an alarming rate in South Africa, while childhood undernutrition remains persistently high. This study determined the magnitude and predictors of stunting and underweight among schoolchildren in the Dikgale and Health Demographic Surveillance System Site, a rural site in South Africa. METHODS: A cross sectional study using multistage sampling was conducted among 508 schoolchildren and their mothers. Anthropometric measurements were taken from children and their mothers, while sociodemographic information was obtained from mothers using a questionnaire. The World Health Organization Anthro Plus was used to generate height-for-age and weight-for-age z-scores to indicate stunting and underweight, respectively, among the children. Maternal overweight and obesity were assessed using body mass index. Bivariate and multivariate logistic regression analyses were used to evaluate the predictors of stunting and underweight among schoolchildren. RESULTS: Twenty-two percent (22%) of children were stunted and 27% were underweight, while 27.4% of the mothers were overweight and 42.3% were obese. The odds of being stunted were lower in younger children, whereas having a mother who was overweight/obese and had a short stature increased the odds of stunting. Access to water, having a refrigerator, and having a young mother were protective against being underweight. Having a mother who was overweight/obese increased the odds of being underweight. CONCLUSIONS: The study showed a high prevalence of stunting and underweight among children, and overweight and obesity among mothers, indicating a household double burden of malnutrition. The age of the child and maternal overweight/obesity and short stature were predictors of stunting and underweight, while having a younger mother and access to water and a refrigerator were protective against being underweight. The need for an evidence-based and feasible nutrition program for schoolchildren, especially those in rural schools, cannot be over-emphasized.


Assuntos
Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Adolescente , Adulto , Índice de Massa Corporal , Peso Corporal , Criança , Estudos Transversais , Características da Família , Feminino , Humanos , Masculino , Mães , Estado Nutricional , Prevalência , Fatores de Risco , Saúde da População Rural , População Rural/estatística & dados numéricos , Instituições Acadêmicas , África do Sul/epidemiologia , Inquéritos e Questionários
7.
Artigo em Inglês | MEDLINE | ID: mdl-31330765

RESUMO

The study objectives were to determine the nutritional status of children between the ages of 12-60 months and to establish the association between attending preschool and the prevalence of undernutrition. This was a cross-sectional survey conducted in health facilities in Tshwane district in South Africa, consisting of both a questionnaire and anthropometric measures of 1256 mothers and their children. Weight-for-age (WAZ), height-for age (HAZ) and BMI-for-age (BAZ) were calculated and bivariate and multivariable analysis was performed to establish association. The results showed that child-related factors, namely birthweight, age, gender, and attending preschool increased the risk of undernutrition. Children over the age of 24 months were likely to be stunted and underweight. Maternal education reduced the odds of underweight. Children who stayed at home had reduced odds of underweight and stunting. High birthweight reduced the odds of wasting and underweight. The risks for undernutrition are multifaceted, but children who attend preschool have an increased risk of undernutrition. The risk of undernutrition increased with age and coincided with the time of cessation of breast-feeding and attendance at daycare or preschool. The complementary role of quality childcare in preschools and daycare centers is vital in alleviating the problem of undernutrition in underprivileged communities.


Assuntos
Creches , Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Estado Nutricional , Instituições Acadêmicas , Magreza/epidemiologia , Síndrome de Emaciação/epidemiologia , Creches/classificação , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Setor Informal , Masculino , Prevalência , Fatores de Risco , Instituições Acadêmicas/classificação , África do Sul/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-31330772

RESUMO

Eswatini is one of the countries in the African continent where post-partum sexual abstinence is practiced. Beside scarcity of research exploring sexual abstinence in Eswatini, there are only a few studies that explore post-partum abstinence across HIV-positive and negative women in sub-Saharan Africa. The study explored the practice of post-partum sexual abstinence in Swazi women and examined how cultural beliefs influence and promotes the perpetuation of the practice. The study population consisted of post-partum women who were selected, using purposive sampling. Thematic approach was used for data analysis. Despite feeling that the period for post-partum, sexual abstinence was long; the participants adhered to the practice as prescribed by their culture. Nevertheless, they felt that the practice is imposed on women only because while they are observing post-partum abstinence, their partners get to sleep with other sexual partners. They raised concerns that the practice increases the risk of acquiring HIV and sexually transmitted infections. There is an element of coercion to the practice of post-partum abstinence, the myths and misconceptions around the early resumption of sexual intercourse forces the practice on women. At the family and community level, the discussions to change the way sexual abstinence is viewed and practiced are crucial.


Assuntos
Cultura Popular , Período Pós-Parto/psicologia , Abstinência Sexual/psicologia , Adulto , Coerção , Feminino , Humanos , Adulto Jovem
9.
Glob Health Action ; 10(sup2): 1341597, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28678650

RESUMO

BACKGROUND: Women in sub-Saharan Africa bear the brunt of the human immunodeficiency virus (HIV) epidemic, and older married women and those in cohabiting relationships are regarded as the largest HIV risk group. Although preventing HIV infection in married or stable relationships is an international HIV prevention priority, little is known about the influence of sociocultural contexts on safe-sex practice by women, particularly older women in rural communities in South Africa. OBJECTIVES: This study aimed to examine how older women in a rural patriarchal society negotiate safer sex within marital and long-term cohabitation relationships, and their perceptions and experiences of barriers that influence condom use. METHODS: Focus group discussions were conducted with married and cohabiting women aged 40-60 years recruited from primary health facilities in a rural district in Mpumalanga province, South Africa. A thematic analysis approach was used to analyse the data. RESULTS: We found that although women reported negotiating safe sex in their relationships, they dreaded the possible consequences of suggesting condom use with their partners. Many factors made negotiating safe sex complex for these women: living in a patriarchal society where women play no part in sexual decision making, the fear of possible consequences of insisting on condom use, women's inferior social position in marital relationships, cultural practices such as bride price, and gender inequality were the main barriers to practising safer sex. CONCLUSIONS: Older married and cohabiting women dreaded negotiating safer sex in this patriarchal society where women's subordination is legitimized. The findings suggest that the women were at high risk of HIV infection because of their inability to negotiate condom use, or to reject forced sex and non-consensual sex. There is a need for interventions targeting older married and cohabiting couples and key stakeholders within communities to create awareness about cultural practices and beliefs that undermine women and HIV prevention efforts.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Disparidades nos Níveis de Saúde , População Rural , Comportamento Sexual/etnologia , Adulto , Características Culturais , Características da Família , Feminino , Grupos Focais , Infecções por HIV/etnologia , Humanos , Casamento , Pessoa de Meia-Idade , Fatores de Risco , Sexo Seguro , África do Sul/epidemiologia
10.
PLoS One ; 12(1): e0169765, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28141858

RESUMO

BACKGROUND: Although HIV self-testing (HIVST) is globally accepted as an important complement to existing HIV testing approaches, South Africa has lagged behind in its adoption. As a result, data on the acceptability and uptake of HIVST testing is limited. The study investigated the acceptability of HIVST among students in Technical Vocational Education and Training (TVET) colleges in two provinces in South Africa. METHODS: A cross-sectional survey using a self-administered structured questionnaire was used to collect data among 3,662 students recruited from 13 TVET colleges. RESULTS: The mean age of the students was 21.9 years. The majority (80.9%) were sexually active; while 66.1% reported that they had one sexual partner, and 33.9% had two or more sexual partners in the past year, and66.5% used condoms during the last sexual act. Three-quarters tested for HIV in the past year but less than half knew about HIVST prior to the survey. The acceptability of HIVST was high; about three-quarters showed a willingness to purchase a self-test kit and a majority would self-test with partners. Acceptability of HIVST was associated with being sexually active (OR = 1.73, p = 0.02, confidence interval (CI): 1.08-2.75), having ever been tested for HIV (OR = 1.74, p = 0.001, CI: 1.26-2.38), and having multiple sexual partners (OR = 0.61, p = 0.01, CI: 0.42-0.88). Three-quarters would confirm test results at a local health facility. In terms of counselling, telephone hotlines were acceptable to only 39.9%, and less than half felt that test-kit leaflets would provide sufficient information to self-test. INTERPRETATIONS: The high acceptability of HIVST among the students calls for extensive planning and preparation for the scaling up of HIVST in South Africa. In addition, campaigns similar to those conducted to promote HIV counselling and testing (HCT) should be considered to educate communities about HIVST.


Assuntos
Infecções por HIV/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde , Estudantes , Universidades , Educação Vocacional , Adulto , Aconselhamento , Demografia , Feminino , Humanos , Masculino , Comportamento Sexual , África do Sul , Adulto Jovem
11.
Nurs Res Pract ; 2016: 9637587, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28018673

RESUMO

To promote the appropriate implementation of procedures for health disclosure to children, it is important to understand the reasons why caregivers delay the disclosure of healthcare information to children. This paper explored the views of caregivers on what makes disclosure to children with perinatal acquired HIV (PAH) difficult and what could make disclosure in these cases easier. Data were collected using focus group interviews with caregivers who were purposely selected from a multicenter study conducted in Botswana and South Africa. Forty-seven nondisclosed caregivers of children between 5 and 18 years who were receiving ART were interviewed. Caregivers felt that children should be told of their HIV-positive status despite the fact that none had disclosed this information to the children. The caregivers reported lack of disclosure skills but believed they were primarily responsible for disclosure to children and required support from healthcare workers (HCWs) during the disclosure process. They believed that counseling on how to approach disclosure and training on when and how to disclose will make the disclosure process easier. HCWs have a crucial role to play in promoting disclosure to perinatally infected children. The development of appropriate disclosure guidelines and training for HCWs will facilitate disclosure to children.

12.
AIDS Res Treat ; 2016: 4842814, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27807481

RESUMO

Background. A formative assessment of the implementation of HIV testing and counseling (HTC) at school showed high acceptability and willingness to test among learners. However, the success of the proposed HTC depends on the support and acceptability of key stakeholders, including the parents. The aim of the study was to assess the opinions and acceptability of the implementation of HTC at school among parents of adolescents in high school. Methods. This was a cross-sectional household survey conducted with parents of adolescents attending high schools in educational districts in North West and Gauteng provinces, South Africa. Results. A total of 804 parents participated, and 548 (68.3%) were biological mothers, 85 (10.6%) were fathers, and the remaining were other relatives including grandmothers. Almost all (n = 742, 92.9%) parents were in support of implementation and provision of HTC at school, 701 (87.7%) would allow their children to be tested at school, 365 (46%) felt that parental consent was not needed to test at school, and 39.4% preferred to receive the HIV test results with their children. Conclusion. Parents accept the roll-out of an HTC program at school and have a role to play in supporting children who test positive for HIV.

13.
AIDS Res Treat ; 2016: 2607249, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27672451

RESUMO

Background. There is limited research on the disclosure experiences of adolescents with perinatal acquired HIV (PAH). The study explores how adolescents with PAH experience living with HIV and examined their perceptions and experiences regarding disclosure and onward self-disclosure to friends and sexual partners. Methods. Thematic analysis was used to analyze in-depth interviews conducted with 37 adolescents. Findings. Adolescents received disclosure about their status at mean age of 12 years. They perceived disclosure as necessary and appreciated the truthful communication they received. Adolescents have learned to accept and live with HIV, and they desired to be healthy and normal like other people. After receiving disclosure, they found their treatment meaningful, and they adhered to medication. However, they also expressed a strong message that their HIV status was truly their secret and that self-disclosure to others will take the feeling of being normal away from them because they will be treated differently. Conclusion. Adolescents maintained secrecy in order to be accepted by their peers but also to protect themselves from stigma and isolation. Given that adolescents want to be informed of their HIV status but desire controlling self-disclosure of their HIV status, these should form the basis for development of disclosure interventions.

14.
Infect Dis Poverty ; 4: 18, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25954505

RESUMO

BACKGROUND: Provider-initiated HIV testing and counseling (PITC) is offered as part of the normal standard of care to increase access to treatment for HIV-infected children. In practice, HIV diagnosis occurs in late childhood following recurrent and chronic infections. We investigated primary caregivers' reported reasons for seeking HIV testing for children aged 5-18 years, determined the orphan status of the children, and compared the clinical profile and disease burden of orphans and non-orphans. METHODS: This was a cross-sectional survey of primary caregivers of HIV-infected children accessing antiretroviral treatment (ART) from two community hospitals and 34 primary healthcare facilities in a rural district in Mpumalanga province, South Africa. RESULTS: The sample consisted of 406 primary caregivers: 319 (78.6%) brought the child to the health facility for HIV testing because of chronic and recurrent infections. Almost half (n = 183, 45.1%) of the children were maternal orphans, 128 (31.5%) were paternal orphans, and 73 (39.9%) were double orphans. A univariate analysis showed that maternal orphans were significantly more likely to be older (OR = 2.57, p = 0.000, CI: 1.71-3.84), diagnosed late (OR = 2.48, p = 0.009, CI: 1.26-4.88), and to start ART later (OR = 2.5, p = 0.007, CI: 1.28-4.89) than non-orphans. There was a high burden of infection among the children prior to HIV diagnosis; 274 (69.4%) presented with multiple infections. Multiple logistic regression showed that ART start age (aOR = 1.19, p = 0.000, CI: 1.10-1.29) and time on ART (aOR = 2.30, p = 0.000, CI: 1.45-3.64) were significantly associated with orphanhood status. Half (n = 203, (50.2%) of the children were admitted to hospital prior to start of ART, and hospitalization was associated with multiple infections (OR = 1.27, p = 0.004, CI: 1.07-1.51). CONCLUSIONS: The study found late presentation with undiagnosed perinatal HIV infection and high prevalence of orphanhood among the children. The health of maternal orphans was more compromised than non-orphans. Routine PICT should be strengthened to increase community awareness about undiagnosed HIV among older children and to encourage primary caregivers to accept HIV testing for children.

15.
BMC Public Health ; 15: 388, 2015 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-25887602

RESUMO

BACKGROUND: The proposal by the South African Health Ministry to implement HIV testing and counselling (HTC) at schools in 2011 generated debates about the appropriateness of such testing. However, the debate has been between the Ministries of Education and Health, with little considerations of the students. The main aim of the study was to assess the students' opinions and uptake of HIV testing and counselling in general, and the acceptability of the provision of HIV testing and counselling in schools. The study also determined the association between socio-demographic characteristics, sexual behaviour, and HIV testing behaviour of the students. METHODS: A survey was conducted among grade 10-12 high school students in North West and Gauteng provinces, South Africa. Seventeen high schools (nine rural and eight urban) were randomly selected for the administration of a researcher-assisted, self-administered, semi-structured questionnaire. RESULTS: A total of 2970 students aged 14-27 years participated in the study; 1632 (55%) were girls, 1810 (61%) ever had sex, and 1271 (49.8%) had more than one sex partner. The mean age of first sexual activity was 15.6. Half (n = 1494, 50.1%) had been tested for HIV. Having multiple sexual partners, age, and gender were significantly associated with increased odds of having had a HIV test. Fear, being un-informed about HTC, and low HIV risk perceptions were the reasons for not getting tested. The acceptability of HTC at school was high (n = 2282, 76.9%) and 2129 (71.8%) were willing to be tested at school. Appropriateness, privacy, and secrecy were the main arguments for and against HTC at school. One-third (n = 860, 29%) had intentions to disclose their HIV status to students versus 1258 (42.5%) for teachers. Stigma, discrimination and secrecy were the primary reasons students did not intend to disclose. CONCLUSIONS: A high acceptability of HTC and willingness to be tested at school suggest that HIV prevention programs tailored to youth have a high potential of success given the readiness of students to uptake HTC. Bringing HIV testing to the school setting will increase the uptake of HTC among youth and contribute towards efforts to scale up HTC in South Africa.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Programas de Rastreamento/organização & administração , Programas de Rastreamento/psicologia , Serviços de Saúde Escolar/organização & administração , Estudantes/psicologia , Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/psicologia , Adolescente , Adulto , Atitude , Aconselhamento , Feminino , Humanos , Intenção , Masculino , População Rural , Comportamento Sexual , Estigma Social , África do Sul , Adulto Jovem
16.
PeerJ ; 3: e893, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25893147

RESUMO

The perspectives and practices of health care workers (HCWs) regarding disclosure to HIV-infected children have not been adequately investigated ten years after the roll-out of pediatrics antiretroviral therapy (ART). The aim of the study was to examine the opinions of HCWs about disclosure to HIV-infected children and determine their role in disclosure to children accessing ART in health centers in South Africa. This was a cross-sectional survey using a semi-structured questionnaire among HCWs in ART centers at three hospitals and 48 primary health facilities in two provinces in South Africa. Of the 206 HCWs, 140 (68.2%) were nurses, 44 (21.5%) were lay counsellors, and 4 (2%) were doctors. The majority (n = 183, 89.3%) felt that disclosure benefits children and they should be told about their HIV status. Over half (n = 93, 51.4%) recommended 11-18 years as the appropriate age to disclose. Half (n = 99, 48.5%) said that caregivers should take the lead to disclose, 87 (42.7%) said that disclosure is a shared responsibility of caregivers and HCWs, and 18 (8.8%) said HCWs should lead disclosure. HCWs perceived their role as that of preparing the caregiver for disclosure and the child to understand the disease. However, the lack of guidelines and training on disclosure counselling for children affects their ability to fully participate in disclosure to children. There is a need to adopt the World Health Organizations' disclosure guidelines for children and adapt them to the local cultural and community contexts and train HCWs to guide, support, and assist caregivers in their disclosure to HIV-infected children.

17.
Glob J Health Sci ; 5(4): 1-13, 2013 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-23777716

RESUMO

The introduction of routine HIV counselling and testing (HCT) has increased the number of pregnant women being tested and receiving prevention of mother to child transmission of HIV (PMTCT) interventions in South Africa. While many women may enroll in PMTCT, there are barriers that hinder the success of PMTCT programmes. The success of the PMTCT is dependent on the optimal utilization of PMTCT interventions which require the support of the woman's partner, and other members of her family. We conducted focus groups interviews with 25 HIV-positive post-natal women enrolled in PMTCT, in the City of Tshwane, South Africa. The study explored HIV-positive status disclosure to partners and significant family members and assessed the effect of nondisclosure on exclusive infant feeding. Most women disclosed to partners while few disclosed to significant family members. Most women initiated mixed feeding practices as early as one month and reported that they were pressurized by the family to mix feed. Mixed feeding was common among women who had not disclosed their HIV-positive status to families, and women who had limited understanding of mother to child transmission of HIV. Women who disclosed to partners and family were supported to adhere to the feeding option of choice. Health providers have a critical role to play in developing interventions to support HIV pregnant women to disclose in order to avoid mixed feeding. Improving the quality of information provided to HIV-positive pregnant women during counselling will also reduce mixed feeding.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Mães/psicologia , Autorrevelação , Aleitamento Materno/métodos , Aconselhamento , Família , Feminino , Grupos Focais , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Fórmulas Infantis/métodos , Cooperação do Paciente , Áreas de Pobreza , Parceiros Sexuais , Apoio Social , África do Sul/epidemiologia
18.
Southeast Asian J Trop Med Public Health ; 44(6): 1010-20, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24450238

RESUMO

A cross sectional survey was conducted with 121 caregivers of HIV-infected children aged 6-13 years enrolled in an antiretroviral treatment (ART) program at a tertiary hospital to determine the profile and HIV disclosure status of children on ART, as well as the socio-demographic profile of their caregivers. The majority of caregivers (n=104, 87.4%) were females, with a mean age of 39.6 years (range 21-76 years). Eighty-four (70.6%) caregivers had secondary education, 61 (51.3%) were single, 83 (69.8%) were unemployed, 73 (61.9%) depended on childcare grants, and 51 (42.9%) were biological mothers. The mean age of children was 9.4 years (range 1-13 years), 109 (90.8%) were schooling, and the mean diagnosis age was 5.2 years. Prevalence of disclosure was 40 (33.3%), mean disclosure age was 9.4 years (range 3-13 years), and mean diagnosis age was 5.2 years. Fifteen (37.5%) of the children were told their HIV diagnosis by biological mothers, 10 (25%) by healthcare providers, 7 (17.5%) by grandmothers, and 8 (20%) were told by other relatives and foster parents. The prevalence of diagnosis disclosure to HIV infected children was higher than previously reported rates in South Africa and could be attributed to the older mean age of diagnosis. Although biological mothers were the main caregivers, they disclosed the HIV diagnosis to only one-third of the children. There is a need for more research to profile HIV infected children accessing ART in public health facilities to inform interventions to manage this growing population of children.


Assuntos
Antirretrovirais/uso terapêutico , Cuidadores/estatística & dados numéricos , Revelação , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Idoso , Antirretrovirais/administração & dosagem , Cuidadores/psicologia , Criança , Estudos Transversais , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Mães/psicologia , Mães/estatística & dados numéricos , Fatores Socioeconômicos , África do Sul/epidemiologia
19.
Glob J Health Sci ; 4(6): 119-28, 2012 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-23121748

RESUMO

Support groups are the most common and popular way of providing social support for people living with HIV and AIDS (PLWHA). Nevertheless, HIV positive men are reluctant to attend support groups, and in most mixed gender support groups, women outnumber men. The study used a sample men accessing antiretroviral treatment (ART) from a HIV clinic in South Africa, to examine their perceptions of support groups and explore their reasons for nonparticipation in such groups. Five focus groups interviews were conducted with 50 HIV positive men. Their age ranged from 28-70 years, all had disclosed their HIV status to partners and family members and were receiving ART for more than a year. The main barriers for nonparticipation related to issues on support groups were; Unavailability of support groups in local communities which translated to, no access, the timing of meetings and lack of transport money. Fear of unintended disclosure of HIV status due to breach of confidentiality with resulting stigma and social rejection. On a personal level, participants felt that they had adequate support at home. Participants would consider participating if men only support groups are initiated, support groups are held on weekends, and they are provided with more information on support groups. Health care providers have a critical role to play in creating awareness of and education on the role of support groups for PLWHA. Support group planners should consider men only support groups which has been shown to have positive outcomes and facilitates member participation.


Assuntos
Infecções por HIV/terapia , Acesso aos Serviços de Saúde/organização & administração , Grupos de Autoajuda/organização & administração , Adulto , Idoso , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Humanos , Masculino , Saúde do Homem , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estigma Social , África do Sul/epidemiologia
20.
AIDS Res Treat ; 2012: 402403, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23304469

RESUMO

We used a grounded theory approach to explore how a sample of caregivers of children on antiretroviral treatment (ART) experience HIV disclosure to their infected children. This paper explores caregivers' barriers to disclosing HIV to infected children. Caregivers of children aged 6-13 years who were receiving ART participated in four focus-group interviews. Three main themes, caregiver readiness to tell, right time to tell, and the context of disclosure, emerged. Disclosure was delayed because caregivers had to first deal with personal fears which influenced their readiness to disclose; disclosure was also delayed because caregivers did not know how to tell. Caregivers lacked disclosure skills because they had not been trained on how to tell their children about their diagnosis, on how to talk to their children about HIV, and on how to deal with a child who reacts negatively to the disclosure. Caregivers feared that the child might tell others about the diagnosis and would be discriminated and socially rejected and that children would live in fear of death and dying. Health care providers have a critical role to play in HIV disclosure to infected children, considering the caregivers' expressed desire to be trained and prepared for the disclosure.

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