ABSTRACT
Understanding pregnancy planning and contraceptive use is important in preventing unplanned/unwanted pregnancies among women on antiretroviral therapy (ART). Through a cross-sectional survey of 155 women living with HIV on ART in Botswana (mean age = 36); bivariate/multivariate analyses were used to identify and understand pregnancy planning and contraceptive use. Women who did not plan to have a child (n = 85) were older; less educated; had more children and worried about stigmatisation from family and healthcare workers (HCWs). Multivariate analyses found age (OR:3.41; CI:1.57-7.45; p = 0.002); perceived stigmatisation from family and healthcare workers (OR:3.62; CI:1.47-8.96; p = 0.005); and believing it is irresponsible for women living with HIV to want a child (OR:2.40; CI:1.10-5.24; p = 0.028) to be significantly associated with not planning to have a child. Although reported condom use among 85 women who did not plan to have a child was nearly 90; a total of 26 of these women (34) believed they did not have control over condom use. Lack of contraception was reported by 6 women who did not plan a child; this; coupled with the lack of control over condom use; puts unmet need for contraception at 38 Most women reported feeling comfortable talking with HCWs about contraceptives. However; almost a quarter of the women indicated they were infrequently advised about contraceptives at ART clinics. This study found discordance between pregnancy planning and contraceptive use among women on ART. Lack of control over condom use coupled with low hormonal contraceptive use creates unmet need for contraception and increases the risk of unwanted pregnancies. Regular clinic visits for women on ART present excellent opportunities to address contraceptive needs in a considerate and comprehensive manner
Subject(s)
Anti-Retroviral Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Botswana , Condoms/statistics & numerical data , Contraceptive Agents/administration & dosage , HIV Infections/drug therapy , Pregnancy , Reproductive BehaviorABSTRACT
Background: Doctors need to constantly update their knowledge and obtain information in order to practise high-quality medicine. Antiretroviral drugs have been available only since around 1996; therefore many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients. Where doctors source their general medical knowledge has been established; but little is known about where doctors source information on HIV/AIDS. This study investigated where private sector doctors from the eThekwini Metro obtain information on HIV and AIDS for patient management. Methods: A descriptive cross-sectional study among 133 private general practitioners (GPs) and 33 specialist doctors in the eThekwini Metro of KwaZulu-Natal; South Africa; was conducted with the use of questionnaires. The questionnaires were analysed using SPSS version 15. A p value of 0.05 was considered statistically significant. Results: The majority of the doctors (92.4) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME); textbooks; pharmaceutical representatives; workshops; colleagues and conferences were identified as other sources of information; while only 35.7of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9versus 72.7; p 0.05) and conferences (48.6versus 78.8; p 0.05) as sources of HIV information. More than 90of doctors reported that CME courses contributed to better management of HIV and AIDS patients.) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME); textbooks; pharmaceutical representatives; workshops; colleagues and conferences were identified as other sources of information; while only 35.7of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9versus 72.7; p 0.05) and conferences (48.6versus 78.8; p 0.05) as sources of HIV information. More than 90of doctors reported that CME courses contributed to better management of HIV and AIDS patients. Conclusion: Private sector doctors in the eThekwini Metro obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients
Subject(s)
HIV , Access to Information , Acquired Immunodeficiency Syndrome , Physicians , Private SectorABSTRACT
Background: Although private sector doctors are the backbone of treatment service in many countries; caring for patients with HIV entails a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients; in the private sector in developing countries; have highlighted some problems with management. In South Africa; two-thirds of doctors work in the private sector. Though many studies on HIV/AIDS have been undertaken; few have been done in the private sector in terms of the management of this disease. Therefore; a study was undertaken to evaluate the clinical management of HIV-infected patients by private sector doctors. Methods: A descriptive cross-sectional study was undertaken in the eThekwini Metro in KwaZulu-Natal; South Africa; with 190 private sector doctors who; in the first phase of the study; indicated that they manage HIV and AIDS patients and would be willing to participate in the second phase of the study. The HIV guidelines of the Department of Health and Human Services and the South African National Department of Health were used to compare the treatment of HIV patients by these doctors. Results: Eighty-five doctors (54.5) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8) to initiate therapy. Of the doctors; 134 (78.5) initiated therapy at CD4 count 200 cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI + 1 NNRTI combination. Doctors who utilised CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p 0.001). At initiation of treatment; 68.5of the doctors saw their patients monthly and 64.3saw them every three to six months; when stable. Conclusion: The majority of private sector doctors were compliant with current guidelines for HIV management; hence maintaining an acceptable quality of clinical healthcare
Subject(s)
Disease Management , Evaluation Study , HIV Infections , Patients , Physicians , Private SectorABSTRACT
This study investigates the experiences of doctors who perform elective surgical procedures in an area of South Africa with a high incidence of HIV and AIDS. A qualitative study approach was adopted. Interviews were individually conducted with 15 doctors. The transcribed interviews were read four times; each with a different data-collection purpose; and follow-up interviews were carried out when it was necessary to complete the data set. Surgical doctors from two semi-urban hospitals and one rural hospital in northern KwaZulu-Natal province took part in the study. The analysis of the interviews rendered four areas of concern in the experiences of doctors who perform surgery on HIV/AIDS patients. These were: personal factors; patient factors; factors relating to the structure of the health system; and factors concerning protocols for the treatment of patients with HIV or AIDS. Although the doctors were altruistic in their approaches to operating on HIV/AIDS patients; they commonly mentioned the increased levels of stress they experience as a result of a multiplicity of issues surrounding the treatment and care of an HIV/AIDS patient specifically. The public health system has not made special arrangements to deal with the increased patient loads in hospitals as a result of the HIV epidemic; and this will have to be addressed as the number of HIV/AIDS patients increases
Subject(s)
Acquired Immunodeficiency Syndrome , HIV Infections , Surgical Procedures, OperativeABSTRACT
Background: The danger of poor adherence to treatment by patients with HIV infection is that poor adherence correlates with clinical and virological failure. Understanding how private-sector doctors monitor adherence by their HIV-infected patients could assist in developing interventions to improve adherence by these patients. Information about such practices amongst private-sector doctors in the province of KwaZulu-Natal; however; is limited. This study was; therefore; undertaken to assess the private-sector doctor adherence-monitoring practices of HIV-infected patients in the eThekwini metro of KwaZulu-Natal. Methods: A descriptive cross-sectional study was undertaken amongst private general practitioners (GPs) and specialists managing HIV/AIDS patients in the eThekwini metro. Anonymous semi-structured questionnaires were used to investigate adherence-monitoring practices by these doctors and their strategies to improve adherence. Results: A total of 171 doctors responded; with over 75in practice for over 11 years and 78.9indicating that they monitored adherence. A comparison between the GPs and the specialists found that 82.6of the GPs monitored adherence compared with 63.6of the specialists (p = 0.016). The doctors used several approaches; with 60.6reporting the use of patient self-reports and 18.3reporting the use of pill counts. A total of 68.7of the doctors indicated that their adherence monitoring was reliable; whilst 19.7indicated that they did not test the reliability of their monitoring tools .The most common strategy used to improve adherence by their patients was through counselling. Other strategies included alarm clocks; SMSs; telephone calls to the patients; the encouragement of family support and the use of medical aid programmes. Conclusions: Private-sector doctors managing HIV/AIDS patients in the eThekwini metro of KwaZulu-Natal do monitor adherence and employ strategies to improve adherence
Subject(s)
Acquired Immunodeficiency Syndrome , Disease Management , HIV Infections , Physicians , Private Sector , Professional PracticeABSTRACT
There is increasing evidence of an association between female genital Schistosoma haematobium infection and HIV. In KwaZulu-Natal; we aimed to explore girls' water contact practice and to determine whether a study exclusively on girls would be manageable and welcomed. Three primary schools that had participated in a parasite control programme eight years prior were approached. Subject to consent; girls aged 9 to 12 years were interviewed on water-body contact; symptoms and household composition. Urine samples were analysed for S. haematobium infection eggs. Good dialogue was achieved in all schools and 95consented to participation; 43had an S. haematobium infection; geometric mean intensity 10.5 ova per 10 ml urine. Only 12had ever been treated for S. haematobium. Water-body contact was significantly associated with S. haematobium (OR 2.8; 95CI 1.3-5.9; p= 0.008); however; S. haematobium was also found in 20of girls who claimed to never have had water-body contact. Sixty-four percent thought they had no choice but to use unprotected water; 21had no mother in the household; and being an orphan increased the risk of having S. haematobium. The community welcomed the study. Prevalence levels in South Africa are so high that some communities are eligible for WHO-recommended regular mass treatment
Subject(s)
Nuclear Family , Schistosomiasis haematobia , Schools , WaterABSTRACT
Objective: This paper focuses on the use of participatory approaches to research and intervention and explores the uses of photo-voice as a methodology and a means of promoting childhood and youth activism in the context of HIV and AIDS.Method: Photo-voice; a visual participatory methodology; was used with 21 Grade 8 and 9 learners in one of three schools participating in a larger project; to identify; understand and interpret incidents related to stigma and discrimination against people living with and affected by HIV and AIDS; as well as the strategies proposed by the learners to possibly reduce stigma. Results: Three themes emerged: awareness of HIV and AIDS; awareness of HIV-related stigma and its impacts; and acceptance of personal agency and taking action. Conclusions: Understandings of and perceptions about HIV and AIDS are improving; yet significant pockets of ignorance about the dynamics of HIV infection still remain among the youth. Negative attitudes towards people infected with and affected by the virus remain; and stigmatisation continues. The use of photo-voice and other participatory methodologies offers alternative strategies for involving youth in their own knowledge production; as well as in the development of an individual sense of agency for taking action
Subject(s)
Discrimination, Psychological , HIV Infections , Schools , Social StigmaABSTRACT
Objective:This paper focuses on the use of participatory approaches to research and intervention and explores the uses of photo-voice as a methodology and a means of promoting childhood and youth activism in the context of HIV and AIDS.Method: Photo-voice; a visual participatory methodology; was used with 21 Grade 8 and 9 learners in one of three schools participating in a larger project; to identify; understand and interpret incidents related to stigma and discrimination against people living with and affected by HIV and AIDS; as well as the strategies proposed by the learners to possibly reduce stigma. Results: Three themes emerged: awareness of HIV and AIDS; awareness of HIV-related stigma and its impacts; and acceptance of personal agency and taking action. Conclusions: Understandings of and perceptions about HIV and AIDS are improving; yet significant pockets of ignorance about the dynamics of HIV infection still remain among the youth. Negative attitudes towards people infected with and affected by the virus remain; and stigmatisation continues. The use of photo-voice and other participatory methodologies offers alternative strategies for involving youth in their own knowledge production; as well as in the development of an individual sense of agency for taking action
Subject(s)
Discrimination, Psychological , HIV Infections , Schools , Social StigmaABSTRACT
Objective: This paper focuses on the use of participatory approaches to research and intervention and explores the uses of photo-voice as a methodology and a means of promoting childhood and youth activism in the context of HIV and AIDS. Method: Photo-voice; a visual participatory methodology; was used with 21 Grade 8 and 9 learners in one of three schools participating in a larger project; to identify; understand and interpret incidents related to stigma and discrimination against people living with and affected by HIV and AIDS; as well as the strategies proposed by the learners to possibly reduce stigma. Results: Three themes emerged: awareness of HIV and AIDS; awareness of HIV-related stigma and its impacts; and acceptance of personal agency and taking action. Conclusions: Understandings of and perceptions about HIV and AIDS are improving; yet significant pockets of ignorance about the dynamics of HIV infection still remain among the youth. Negative attitudes towards people infected with and affected by the virus remain; and stigmatisation continues. The use of photo-voice and other participatory methodologies offers alternative strategies for involving youth in their own knowledge production; as well as in the development of an individual sense of agency for taking action
Subject(s)
HIV , Acquired Immunodeficiency Syndrome , Community Participation , Rural Population , Schools , StereotypingABSTRACT
This study describes the prevalence of virginity testing (VT) amongst rural secondary school students in KwaZulu- Natal (KZN); compares the attitudes of students of both sexes to VT; the differences in attitudes between girls who would/would not undergo such testing; and explores the relationship between risky sexual behaviour and girls who underwent virginity testing. A cross sectional descriptive study was undertaken with stratified random sampling of 10 secondary schools in Ugu District; KZN. Of 846 isiZulu-speaking students whose mean age was 16.1 years (SD 2.4); 492 (58.2) were girls; of whom 286 (58.1) had undergone VT and; in total 347 (70.5 ) girls supported VT.Girls whose mothers had less formal education were more likely to have participated in VT (P-0.03) with fewer older girls participating (P=0.0003). More girls than boys considered VT to protect against sexually transmitted infections (STIs) (P=0.02); and to be empowering (P0.005); but VT received support from both sexes as a traditional cultural practice. Participation in VT failed to prevent sexual intercourse and sexually transmitted diseases or to improve rates of condom use amongst those who were sexually active. South Africa's Bill of Rights supports gender equity. At community level VT has support despite its conflicting relationship with human rights; and questionable impact on preventing HIV/AIDS