Sufficient informed consent to medical treatment of adults legal and ethical perspectives from Malawi

This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under civil law. Inconsistencies and uncertainties in the law are made apparent. It evaluates to which degree disclosure standards of other Commonwealth jurisdictions (e.g. the case of Montgomery) would be suitable for the health care setting of a country like Malawi that is characterized by shortages of resources, high illiteracy rates and a communitarian cultural context. Doctor-patient communication is not alien to African culture and part of sufficient informed consent. In order to balance the need for efficiency in health care delivery, accountability for quality care, fairness and effective patient-doctor communication the authors suggest to adopt the reasonable patient test only, if a defence of heavy workload on case-to-case basis is introduced at the same time. This does not dispense the need for organisational diligence on part of the institutional health care provider within its capacity

Barriers and impact of disclosure of HIV status to children at the National Hospital, Abuja Nigeria

Background: HIV infected children survive to adolescence because of anti retroviral therapy, however, only a small proportion know their diagnosis.Disclosure is critical to long-term disease management, yet little is known about if, how, and when disclosure takes place and the barriers associated with it, and its impact on children in resource limited settings. Objective: This study set out to determine the process of and barriers to HIV disclosure in children as well as the immediate impact of this on children and their caregivers. Methods: A cross-sectional study was done June-July 2016 using a structured questionnaire, convenience sampling and quantitative methods at the infectious disease clinics of National Hospital Abuja. A sample of 164 caregivers of HIV positive children aged 5 to 16 years receiving antiretroviral therapy for at least one year were enrolled. Results: Prevalence of full disclosure was 24.5%, partial 22.7% with overall prevalence of 47.2%. Main barrier to disclosure was child's age and fear of informing others. The impact of disclosure on caregivers was relief in 45.5% but emotional and difficult for others. Immediate reactions by children were sadness; tearfulness and worry in 28.6%, some showed no reaction while others even expressed relief. On a longer term, disclosure had several effects. Main predictors of disclosure on regression were the child's age and caregiver's opinion on disclosure. Conclusion: The prevalence of full disclosure is low and several barriers affect disclosure. Caregiver's and HCWs need empowerment and support with culturally appropriate skills and platforms to deal with the barriers, process and impact of disclosure

Determinants of HIV serostatus disclosure and assessment of the competence of health care personnel in HIV serostatus disclosure

Background: Disclosure of HIV serostatus is essential for the care and eradication of HIV infection. The World Health Organization recommends disclosure to school-age children and younger children but this practice is commonly hindered by stigmatization and other presumed psychosocial effects of the disease. Objective: To identify limitations to the disclosure of serostatus in HIV-infected children, outcomes of disclosure as well as compare the outcomes of disclosure by either parents/caregiver only with the involvement of health care personnel. Methods: A questionnaire-based study of primary caregivers of children aged 6 years to 18 years with HIV infection who were enrolled at two government-owned tertiary institutions in Lagos State, Nigeria. The healthcare personnel directly involved in the care of these children also participated in the study. Results: A total of 190 primary caregivers participated in the study. In all, 29 health care personnel completely filled the questionnaires. Disclosure (partial and full) was recorded among 31.0%. Older children and children with single parents were more likely to know their HIV status. Similar positive and negative impacts of disclosure were observed irrespective of the individuals involved in the processes. In all, 62.1% of healthcare personnel have had training on disclosure. Conclusion: Disclosure rate in HIV-infected children was low. There is a need for more training of health personnel and education of caregivers on the benefits of disclosure as well as the introduction of effective measures to tackle the barriers to disclosure

Knowledge, attitude, and practice and service barriers in a tuberculosis programme in Lakes State, South Sudan: a qualitative study

Background: The World Health Organisation (WHO) estimates the incidence of tuberculosis (TB) in South Sudan to be 79 per 100,000 for new sputum smear positive TB and 140 per 100,000 for all forms of TB cases. The case detection rate of 53% for all forms of TB in South Sudan is below the WHO target of 70%.Objective: To explore knowledge, attitude, and practice barriers as well as service barriers to implementing TB programme in Lakes State, South Sudan.Method: This was a qualitative study conducted in May 2015.Results: Despite some understanding of the symptoms, causes, and consequences of TB, the stigma for TB and lack of disclosure of the disease, is very high among the local community. The limited network of TB facilities for case detection, lack of community distribution of TB drugs and lack of food at hospitals when patients were admitted for treatment, are key barriers to TB service delivery.Conclusion: To overcome barriers it is recommended that the local community worldview should be incorporated into TB awareness, testing, and treatment, and attention should be paid to areas where traditional practices, such as elimination of maize, clash with modern treatments

What should I tell my patient? Disclosure in anaesthesiology: difficulties, requirements, guidelines and suggestions

South African anaesthesiologists have embraced the requirement for authentic informed consent, but there is no consensus regarding the comprehensiveness and specificity requirements with regard to the information that needs to be supplied to the patient, and upon which decisions will be based. Anaesthesiology is an unusual specialty. The scope of knowledge and expertise that practitioners require is wide-ranging, from the basic and applied biomedical sciences and technology, clinical knowledge and experience, through to hands-on operating room experience and expertise, feeding into the requirement to inform. Contemporary practice environments limit contact time with patients. Societal ethos demands recognition of basic human rights, amongst others the right to personal autonomy. The South African Health Professions Council has published a series of booklets describing guidelines to ethical medical practice, one of which is on informed consent. This article discusses the information requirements for valid informed consent from both a moral and regulatory perspective. The practical implications for anaesthesiologists of the HPCSA guidelines on informed consent are discussed, a model interview is proposed, and a number of illustrative cases are discussed. The aim is to answer the question: What should I as anaesthesiologist tell my patient?

Reticence in disclosure of HIV infection and reasons for bereavement: impact on perinatally infected adolescents' mental health and understanding of HIV treatment and prevention in Johannesburg, South Africa

Survival rates of perinatally infected HIV-positive adolescents (PIA) are increasing in sub-Saharan Africa. There is a gap in understanding how disclosure and bereavement have an impact on PIA beliefs and understanding of their HIV infection and its management. In-depth interviews were conducted with 25 purposively selected adolescents aged 13­19 years from 5 public health clinics in Johannesburg, South Africa. Data were analysed using NVivo 10 using a thematic approach. PIA experience incomplete disclosure both of their HIV status and reasons for their bereavements, which limits their understanding of how they became infected, vertical transmission and prevention options like prevention of mother-to-child transmission (PMTCT). Most participants were orphaned and were experiencing complicated grieving (i.e., engaged in unresolved tasks of grieving) which had a negative impact on their mental health, and ability to accept their HIV status and adhere to treatment. PIA need improved communication regarding vertical transmission and how they became HIV-positive, as well as reasons for death of their loved ones to properly understand their HIV status and engage effectively in management. Honest communication about how relatives died and truthful engagement in the process of disclosure of HIV status is necessary to reduce stigma and complicated grieving, and improve mental health in this population

The multidimensional nature of HIV stigma: evidence from Mozambique

HIV stigma continues to be a major challenge to addressing HIV/AIDS in various countries in sub-Saharan Africa, including Mozambique. This paper explores the multidimensional nature of HIV stigma through the thematic analysis of five qualitative studies conducted in high HIV prevalence provinces in Mozambique between 2009 and 2012. These studies included 23 interviews with people living with HIV (PLHIV) (10 women and 13 men); 6 focus groups with 32 peer educators (24 women and 8 men) working for community-based organisations (CBOs) providing services to PLHIV; 17 focus groups with community members (72 men and 70 women); 6 interviews (4 women and 2 men) with people who had family members living with HIV/AIDS; 24 focus groups (12 with men and 12 with women) and 6 interviews with couples. Our findings indicate that HIV stigma is a barrier to HIV testing and counselling, status disclosure, partner notification, and antiretroviral therapy (ART) access and adherence, and that moral stigma seems to be more common than physical stigma. Additionally, the findings highlight that HIV stigma is a dynamic social process that is conceptualised as being tied to personal responsibility. To effectively diminish HIV stigma in Mozambique, future interventions should address moral stigma and re-conceptualise HIV as a chronic disease

Guidelines for support to mothers of sexually abused children in North-West province

Background: South Africa is reported to have the highest rate of sexual assault in the world with over 40% of cases occurring among children. Children who are sexually abused have support programmes and policies to assist them in coping, but there are no support programmes for mothers or caretakers. Caretakers need support for themselves and assisting them will incrementally benefit children under their care. Often mothers of these children experience shock, anger, disbelief and suffer secondary trauma such as depression and post-traumatic stress disorder (PTSD) following their children's sexual abuse disclosure and yet there are no guidelines for support to these mothers within North-West province (NWP)Objectives: The study seeks to develop guidelines for support to mothers of sexually abused children in NWP.Methods: Concurrent convergence triangulation mixed method design was employed in this study. The population consisted of mothers of sexually abused children (SAC) (n = 17 participants for the qualitative component and n = 180 participants for the quantitative component). A sample of mothers of SAC was purposely selected.Results: The participants indicated significant levels of depression because of lack of support by stakeholders. Guidelines for support to assist mothers cope with their secondary trauma were developed based on the literature review, study findings as well as an ecological model of the impact of sexual assault on women's mental health. The results also showed extreme PTSD (47.8%), little support (38.8%), not coping (76.1%) and depression (36.1%).Conclusion: The stakeholders should consider a positive approach to support mothers whose children are sexually abused

Sexual behaviour and serostatus disclosure among persons living with HIV in Ibadan, Nigeria

The study aimed at assessing the practice of HIV status disclosure, sexual behaviour and knowledge of disclosure and safe sex practices among HIV seropositive individuals attending the President's Emergency Plan for AIDS Relief (PEPFAR) Clinic at the University College Hospital, Ibadan. Systematic random sampling technique was used to select 392 HIV positive adults at the PEPFAR clinic. Data were collected using a validated interviewer-administered questionnaire containing a 12-point knowledge scale. The mean age of respondents was 35.6 ± 9.6 years. Majority (69.9%) were females and 59.4% were married. The overall mean safe sex knowledge score of the respondents was 8.3 ± 2.4. Majority (70.9%) were aware that disclosure of HIV status to a partner before having sex could reduce HIV transmission, while 92.7% knew that consistent and correct use of condom could prevent its spread. However, only 39% of respondents had disclosed their status to all their sexual partners. More married respondents (48.5%) disclosed their status than the unmarried (27.0%) (p<0.05). The proportions of female and male respondents who disclosed their status were 40.3% and 37.1% respectively. Hindrances to disclosure included fear of stigmatization (46.4%) and fear of abandonment (26.4%). Majority of respondents (75.5%) who had disclosed their status to all sexual partners practiced safe sex than those who had not disclosed (59.2%) (p<0.05). Positive attitude towards the disclosure of one's serostatus to sexual partners and safe sex was exhibited by 62.8% and 58.4% of the respondents respectively. Non-usage of condom was more among the unmarried (38.6%) than the married (23.2%) (p<0.05); it was also more among females (33.8%) than males (28.7%), (p<0.05). High rates of non-disclosure of HIV status and unsafe sexual practices were noted. HIV/AIDS educational programmes and media campaigns should be intensified to promote the adoption of serostatus disclosure and safe sexual practices among HIV positive persons

Maximizing HIV Partner Notification Opportunities for Index Patients and their Sexual Partners in Malawi

Background. HIV testing and counselling (HTC) is important to effect positive sexual behaviour change and is an entry point to treatment; care; and psychosocial support. One of the most practical initiatives to increase HTC is to encourage sexual partners of HIV-infected persons to test for HIV. However; partner notification strategies must be feasible in the healthcare setting and acceptable to the population. Methods.We conducted a qualitative study during the pilot phase of an HIV partner notification trial to complement its assessment of feasibility and acceptability of methods of partner notification. We performed in-depth interviews with 16 consecutive HIV-positive index participants who consented and their 12 identifiable sexual partners. We also conducted two focus group discussions with healthcare workers to supplement the patient perspectives. In the main study; newly diagnosed HIV cases (index cases) were randomized to one of three methods of partner notification: passive; contract; and provider referral. Clients in the passive referral group were responsible for notifying their sexual partners themselves. Individuals in the contract referral group were given seven days to notify their partners; after which a healthcare provider contacted partners who had not reported for counselling and testing. In the provider group; a healthcare provider notified partners directly. Results.Although most index participants and partners expressed a preference for passive notification; they also highlighted benefits for provider-assisted notification and the universal right for all HIV-exposed persons to know their HIV exposure and benefit from HIV testing and access antiretroviral treatment. Several participants mentioned couples counselling as a way to diffuse tension and get accurate information. All mentioned benefits to HIV testing; including the opportunity to change behaviour. Conclusions. Provider-assisted partner notification is not preferred; but it is acceptable and may complement the passive method of notification. Couples counselling should also be encouraged

Stigma and HIV Disclosure in the Cape Metropolitan Area; South Africa

Disclosure rates of HIV-positive status remain low and are considered to be related to stigmatisation. Determining the factors that influence a person's decision to disclose a positive status is essential to understanding the process of and ways to improve disclosure rates. This study investigated the factors that influence the disclosure of a person's HIV-positive status and focused on socio-demographic factors; stigma and discrimination; religion; culture; fear of abandonment and rejection as well as knowledge of the disease that may all influence disclosure rates. A facility based descriptive cross-sectional research design with a quantitative approach was applied using convenience sampling. The sample comprised 150 individuals which was 12.5 of the study population. A self-administered questionnaire comprising mainly closed-ended questions; with a limited number of open ended questions was designed; tested and utilised. Statistical associations were determined between the demographic factors and responses to the questions. The open ended questions were analysed thematically by means of content analysis to extract meaning. The results revealed that fear of stigmatisation; especially among the male participants; was a major reason for delayed or non-disclosure. The results of the total study sample also showed that the level of education influenced the fear of stigmatisation; those with secondary school level education were most afraid of this (29). There was a statistically significant association between fear of blame or discrimination and disclosure to the sexual partner. This fear was most often cited by the participants who had never married (19). The participants who feared blame or discrimination the most reported having no income (23). The findings of this study indicate that numerous factors influence HIV disclosure. Stigma of individuals who are HIV-positive remains a barrier to disclosure as well as fear of blame and discrimination. Recommendations were made to facilitate and increase disclosure rates. This should include community based support groups and advocating partners to attend voluntary counselling and testing together to minimise the fear of blame

HIV-serostatus disclosure in the context of free antiretroviral therapy and socio-economic dependency: experiences among women living with HIV in Tanzania

The worldwide implementation of free antiretroviral therapy (ART) raised great hopes among policy makers and health organisations about the positive changes it would bring about in attitudes and behaviours towards HIV and AIDS; as well as for infected people's lives. A change in illness perception was anticipated; leading to the hypothesis of a possible change in disclosure rates; patterns and the choice of significant others to inform. In the era of free treatment availability in the United Republic of Tanzania; we examined reasons for disclosure and non-disclosure among HIV-seropositive women enrolled on ART and their choice of significant others to inform. In so doing; we contribute to the necessary yet neglected debate about the social impact of ART on the lives of infected women. The study; for which an ethnographic cross-sectional pilot approach was chosen; was conducted at the Care and Treatment Center (CTC) at Bombo Regional Hospital (BRH) in Tanga city; Tanzania. Data presented here derive from participant observation; questionnaires and semi-structured interviews conducted with 59 HIV-seropositive women on ART. Interestingly; and despite treatment availability; the choice of significant others to inform; as well as reasons for disclosure and non-disclosure; mirror findings from previous studies conducted before the introduction of free ART. The main reason for non-disclosure was fear of discrimination. The hope for social; economic or health support was the main motivation for disclosure; followed by the need for a 'clinic companion' in order to receive ART; as requested by hospital staff. Nevertheless; healthcare staff were not unanimous in thinking that disclosure is always beneficial; thus the recommended extent of disclosure varied. ART and concomitant factors were raised as an entirely new and significant reason for disclosure by interviewees. Finally; findings confirm that despite ART; disclosure remains a highly stressful event for women

Factors Determining Disclosure by Parents among Children Living with HIV/AIDS Attending the Center of Excellence in Kigali University Teaching Hospital

"The increasing access to antiretroviral therapy (ART) and survival of HIV-infected children has raised challenges on disclosing HIV diagnosis to children. Many parents and guardians are reluctant to allow children living with HIV to know their status; arguing that they are too young and will not understand fully their circumstances causing emotional disturbances as a result. There are further concerns that children may blame their parents and ask questions on how they got the disease; even inadvertently ""blurting out the secret"" and thus exposing the family to stigma and discrimination. In this cross-sectional study; eligible children were recruited to participate. Data on these children was obtained from the electronic databases and completed with data extraction from the individual patient fie. A sample of both parents and guardians who disclosed and those who did not disclose have been interviewed to identify the factors and reasons behind their decision-making process in addition to what they believe would improve their disclosure. A total of 64of HIV positive (HIV+) children had their status disclosed to them by parents while 35.8 did not. The majority of parents or guardians (80) found that disclosing status improved adherence. A large number of parents or guardians (67) attended psychosocial support groups and accordingly disclosure status was highly associated with psychosocial support group attendance (p0.05). Disclosure and statistical tests showed that disclosure status was highly associated with CD4 outcomes (p0.05). In addition; disclosure status was highly associated with viral load outcome (p0.05). Moreover; 64.4 of children living with HIV underwent an increase of weight greater or equal 4 kg after disclosure and statistically disclosure status was highly associated with weight outcomes (p0.05)."

Disclosing HIV diagnosis to children in Odi district, South Africa: reasons for disclosure and non-disclosure

Background: The increasing access to antiretroviral therapy (ART) and survival of HIV- infected children has posed challenges to caregivers on disclosing the HIV diagnosis to children. Objectives: The objectives of this study was to determine the reasons of caregivers for the disclosure and non-disclosure of the HIV diagnosis to children on ART and to determine the caregivers' perceptions of children's reaction to disclosure. Method: A cross-sectional study was conducted amongst 149 caregivers of children between 4-17 years who receive ART from a district hospital in South Africa. Descriptive and inferential statistics were used in the analysis of data. Results: The prevalence of disclosure was 40and the mean age of disclosure was 9.3 years. Reasons for disclosure included that the child was not adhering to treatment (n = 59; 39); the child was consistently asking questions about the treatment and nature of the disease (n = 59; 39). Reasons for non-disclosure were that the child was too young (n = 90; 72); the child would tell others about diagnosis (n = 90; 21.1); the child would be socially rejected (n = 90; 18.6); fear of negative consequences for the child (n = 90; 13.3); and caregivers do not know how to tell or approach disclosure (n = 90; 8.9). Conclusion: Caregivers disclosed the diagnosis so that their child would adhere to ART medication; non-disclosing caregivers delayed disclosure because their children were too young to understand the HIV diagnosis. Disclosure of HIV to children should be integrated into regular discussions with caregivers of children in ART settings to improve their knowledge and skills to manage disclosure

Factors Associated with Disclosure of HIV Status among HIV Positive Children in Rwanda

As the number of treatment-managed cases of pediatric Human Immunodeficiency Virus (HIV) increases; the issue of disclosure has become increasingly important. In this article; we evaluate factors associated with disclosure in Rwanda among HIV-positive children of 7 to 15 years. A 2008 survey in Rwanda was conducted to determine these factors. Participants in the study included 1;034 children on HAART and in the pre-HAART phase; among them 65 knew their HIV status; and 35 were unaware. The child's age was positively associated with awareness of HIV status. Children with illiterate parents were two times (aOR: 2.2; 95 CI: 1.4-3.6) more likely to be disclosed than children with high school educated parents. Children who engaged in dialogue with their parents or other family members were 15 times and four times; respectively; (aOR: 15.2; 95 CI: 9.4- 24.7 and aOR: 4.1; 95 CI: 2.4-6.9) more likely to be disclosed than those who did not. Findings offer ways for Rwanda to improve its approach to disclosure issues; counseling and psychosocial support for HIV-positive children

Social Impact of HIV/AIDS on Clients Attending a Teaching Hospital in Southern Nigeria

People living with human immunodeficiency virus and acquired immune deficiency syndrome (PLWHA) face numerous social challenges. The objectives of this study were to assess the level of self-disclosure of status by PLWHA; to describe the level and patterns of stigma and discrimination; if any; experienced by the PLWHA and to assess the effect of sero-positivity on the attitude of friends; family members; health workers; colleagues and community. This was a cross-sectional descriptive study carried out among PLWHA attending the University of Uyo Teaching Hospital; Uyo; Southern Nigeria. Information was obtained using an interviewer-administered semi-structured questionnaire; which was analysed using the Epi 6 software. A total of 331 respondents were interviewed. A majority; 256 (77.3); of the respondents were within the age range of 25-44 years. A total of 121 (36.6) PLWHA were single and 151 (46.6) were married; while the rest were widowed; divorced or separated. A majority; 129 (85.4); of the married respondents disclosed their status to their spouses and 65 (50.4) were supportive. Apart from spouses; disclosure to mothers (39.9) was highest. Most clients (57.7) did not disclose their status to people outside their immediate families for fear of stigmatization. Up to 111 (80.4) of the respondents working for others did not disclose their status to their employers. Among those whose status was known; discrimination was reported to be highest among friends (23.2) and at the workplace (20.2). Attitudes such as hostility (14.5); withdrawal (11.7) and neglect (6.8) were reported from the private hospitals. Apart from disclosure to spouses; the level of disclosure to others was very low. Those whose status was known mainly received acceptance from their families but faced discriminatory attitudes such as hostility; neglect and withdrawal from friends; colleagues and hospital workers. There is a need for more enlightenment campaigns on HIV/AIDS by stakeholders to reduce stigma and discrimination and ensure adequate integration of PLWHA into the society

Predictors of HIV Status Disclosure to Sexual Partners among People Living with HIV/AIDS in Ethiopia

Introduction: Disclosure of HIV positive sero-status to sexual partners; friends or relatives is useful for prevention and care. Identifying factors associated with disclosure is a research priority as a high proportion of people living with HIV/AIDS never disclose in Ethiopia. This study was carried out to assess the magnitude and factors associated of HIV seropositive status disclosure to sexual partners among peoples living with HIV/AIDS. Methods: A hospital based cross-sectional study was conducted April -June; 2010; among systematically selected 334 HIV patients attending at Woldia hospital; Ethiopia. Data were collected through pre-tested questionnaire; using exit interview. Bivariate and multivariable logistic regression models were fitted to identify associated factors for disclosing their HIV seropostive status to sexual partner. Results: One hundred nineteen nine (59.6) was females; 218(65) was from urban area; 297(85.8) are on antiretroviral therapy. The study found a significant association between higher educational status of the respondents (AOR:0.4; 95CI (0.17-0.92)) and sexual partners (AOR: 9.0; 95 CI(2.8-29.3)); knowing HIV status of sexual partner (AOR:8.1; 95CI(3.4 -19.2)); being on antiretroviral therapy (AOR:7.9; 95 CI(3.42-18.5)); having follow up counseling (AOR:5.26; 95CI(2.2-12.5)); and being tested for HIV in ante natal care clinic (AOR:0.21; 95CI(1.14- 6.46)) with disclosure of HIV status to sexual partner. Conclusion: The study concluded the need for giving more emphasis for the patients who are not on antiretroviral therapy and the need for giving emphasis on techniques how to disclose status to sexual partner

Disclosure among HIV-Positive Women: the Role of HIV/AIDS Support Groups in Rural Kenya

Disclosure by people living with HIV or AIDS is critical for HIV prevention and care. However; many women choose not to disclose their HIV status for fear of negative outcomes; such as blame and rejection. The World Health Organization suggests that HIV/AIDS support groups help to encourage women to disclose their status; but little is known about the role of such groups in Kenya. This study used qualitative research methods to gain insight into rural women's experience of disclosing a positive HIV status and it explores opinions about the role of support groups in relation to disclosure. Focus group discussions and semi-structured interviews were conducted with HIV/AIDS support group members and leaders. Thematic analysis showed that the women felt a sense of duty to inform others of their HIV status; particularly in order to prevent HIV transmission and to encourage sexual partners to be tested. There were multiple problems associated with disclosure; and negative outcomes such as blame and rejection were common. Support groups gave the women confidence and provided emotional support; which may have assisted them with coping with the negative outcomes of disclosure. The findings demonstrate that such support may improve women's experience of HIV-status disclosure and possibly even promote disclosure. However; initiatives such as these must protect those who disclose and therefore should take into account the local cultural and economic context

HIV Positive Status Disclosure to Sexual Partner among Women Attending ART Clinic at Hawassa University Referral Hospital; SNNPR; Ethiopia

Background: Disclosure of HIV positive status has key role in the prevention and control of HIV/AIDS. Reports of non-disclosure and negative outcome of disclosure are common. Thus; disclosure of HIV positive status is a theme that demands investigation. Objective: The objective of this study was to determine the magnitude and outcome of HIV positive status disclosure to sexual partner among women living with HIV/AIDS and attending Hawassa University Referral Hospital; South Nations and Nationalities Peoples Region (SNNPR) during a period of March to April 2008. Methods: A cross sectional survey was conducted at Hawassa University Referral Hospital. Single population proportion formula was used to determine sample size. Using a structured and pre-tested questionnaire; data on disclosure were collected through interview. After explaining purpose of the survey; data collection was continued until the required sample was obtained. Then; data were entered using EPI info version 2002 statistical package and cross checked for reliability. Using SPSS 12.1 for windows statistical package; analysis was done. Results: Overall 85.7of the women had disclosed their HIV positive status to sexual partner. Main barriers of disclosure reported by non-disclosed subjects were; fear of abandonment; fear of break-up in relationship and fear of stigma. More than 59of the women with regular sexual partner faced negative partner reaction after disclosure. Compared with married women; those women who were in a cohabiting relationship were less likely to disclose their HIV status to sexual partners (AOR 0.16; 95CI 0.04; 0.60); women who did not know HIV status of their sexual partners were less likely to disclose their HIV positive status than their counter parts (AOR 0.02; 95CI 0.00; 0.08) and women who had been on ART for more than one year were more likely to disclose their HIV positive status than the reference groups (AOR 8.62; 95CI 1.35; 55.22). Conclusion: HIV positive status disclosure to sexual partner in this study was higher than what was reported in other studies in Ethiopia; for Mettu and Gore (69) but slightly lower than the report from Jimma (94.5) and Addis Ababa (92). Negative partner reaction following disclosure was higher. Effectively addressing issues of disclosure was recommended to encourage disclosure and cope with negative reactions after disclosure in People Living with HIV/AIDS (PLWHA). Besides; currently existing Information Education Communication (IEC) interventions on HIV/AIDS should be strengthened; to reduce negative partner reaction following disclosure

Exposure to Primary Healthcare for Medical Students: Experiences of Final-Year Medical Students

Introduction: Recognising the importance of primary healthcare in the achievement of the 1997 White Paper for the Transformation of the Health System and the Millennium Development Goals; the Faculty of Health Sciences of the University of the Witwatersrand introduced an integrated primary care (IPC) block. In a six-week final year preceptorship; medical students are placed in primary healthcare centres in rural and underserved areas. This article describes the experiences of medical students during their six weeks in the IPC block. Methods: The study was qualitative; based on data collected from the logbooks completed by the students during the IPC rotation. A total of 192 students were placed in 10 health centres in the North West and Gauteng provinces in the 2006 academic year. These centres included district hospitals; clinics and NGO community health centres. Results: The students reported that the practical experience enhanced their skills in handling patients in primary care settings. They developed an appreciation of primary healthcare as a holistic approach to healthcare. The students attained increased levels of confidence in handling undifferentiated patients; and became more aware of community health needs and problems in health service delivery. Conclusions: Exposure to the IPC block provided a valuable experience for final-year students; as it is critical for orienting students to the importance of primary healthcare; which is essential for the realisation of targets identified in the national health policy