Psychosocial and Behavioural Correlates of Attitudes Towards Antiretroviral Therapy (ART) in a Sample of South African Mineworkers

Despite being one of the worst affected sectors in South Africa; the mining sector has proven to be one of the most active in intervention efforts in the fight against HIV and AIDS (Ellis; 2007). Owing to low uptake rates of antiretroviral therapy (ART) in mining companies in recent years (Connelly et Rosen; 2006) and the positive relationship between attitudes towards ART and ART uptake (Cooper et al.; 2002; Horne; Cooper; Gellaitry; Leake; et Fisher; 2007); this study sought to describe and investigate the psychosocial and behavioural correlates of attitudes towards ART in a sample of South African mineworkers. A total of 806 mineworkers from a large South African mine participated in this quantitative study. Despite a high rate of HIV testing behaviour (83.0) as well as favourable attitudes towards ART; analysis indicated that temporary employees and contractors were more vulnerable in terms of HIV risk; HIV testing behaviours and ART knowledge and attitudes. Employees who had more positive attitudes towards ART were more knowledgeable of ART and; importantly; had a more favourable attitude towards the mine's HIV/AIDS treatment programme. These findings are discussed in relation to the low ART uptake rates in this context and recommendations for the improvement of ART uptake amongst employees at this mining site

Bullying Boys:The Traumatic Effects of Bullying in Male Adolescent Learners

Objective:This study investigated the nature and extent of the relationship between bullying and trauma among male adolescent learners. Trauma was operationalised through the multiple constructs of post-traumatic stress; anxiety; depression; dissociation and anger. Method: In this quantitative study; two objective measures were administered (viz. the Olweus Bullying/Victimisation Scale and the Trauma Symptom Checklist for children) to a sample of male adolescent learners between the ages of 12 and 17; from a South African male-only high school (n = 486). Results and Discussion: Statistical analysis (correlational analysis and MANOVA) produced evidence to suggest that there was a statistically significant relationship between bullying and trauma; and this was strongest for the victim role. The relationship between bullying and trauma was dependent on the frequency of bullying; as the frequency of being bullied increased so too did the mean scores of all the five trauma subscales. In general; the findings indicated that learners presented with elevated levels of internalising trauma outcomes. Depression demonstrated the highest correlation with the victim role; followed by Posttraumatic stress. In addition; 22.4of learners could be clinically and sub-clinically diagnosed with post-traumatic stress and 21.0with dissociation. Overall; the findings corroborate the argument that repetitive stressful events (such as bullying) are related to symptomclusters of ongoing trauma

Bridging the Gap between VCT and HIV/AIDS Treatment Uptake: Perspectives from a Mining-Sector Workplace in South Africa

This qualitative study sought to understand users' perceptions of the voluntary counselling and testing (VCT) and HIV-treatment services offered by a mining company in South Africa; with the intention of making recommendations to improve the rates of uptake. A purposive sample of 75 employees was interviewed and three focus groups were conducted with VCT users as well as with HIV-positive employees currently enrolled in the company's treatment programme. The relatively high uptake of VCT at the workplace appeared to be a function of the convenience afforded by rapid testing and the on-site nature of the company's annual campaign; the group nature of the campaign; and increased HIV awareness facilitated by pre-test counselling. Notwithstanding this; the study revealed barriers to uptake of VCT in the workplace; including: perceived violations of confidentiality by healthcare staff and doubts about the voluntary basis of HIV testing; organisational factors; including the visible group nature of the VCT campaign; and fear of a HIV-positive result and discrimination in that event. In contrast to VCT uptake; there was a relatively low rate of enrolment in the treatment programme: a significant proportion of HIV-positive employees identified in the VCT campaign did not present to the company's clinic for treatment. Impediments to treatment uptake included fears of being identified in the workplace as HIV-positive; which arose from perceived confidentiality violations on the part of the healthcare staff as well as organisational factors they believed allowed easy identification of the programme's users; limited time to attend the clinic; poor quality of post-test counselling and follow-up; difficulties in coping with the diagnosis; and traditional explanatory models of illness; which precluded medical care. A combination of the current annual; opt-in VCT campaign and a provider-initiated opt-out approach to VCT should be carefully considered in order to bridge the gap between the current levels of VCT and HIV-treatment uptake by employees at the company

The development and evaluation of a manualised participatory HIV/AIDS risk reduction programme (Sex and Risk) for tertiary level learners: a pilot study.

This paper reports on a pilot study of the development and evaluation (using outcome and process measures) of a manualised participatory risk reduction programme, aimed at reducing high-risk sexual behaviour amongst tertiary level learners, called 'Sex and Risk' (S&R), at the University of Durban-Westville 1 in South Africa. The programme was grounded in a focused ethnographic study of the risk behaviours and life context of tertiary level learners at this institution, as well as informed by literature on successful behavioural risk reduction programmes on Western and African populations. Significantly, the S&R programme was shown to facilitate greater awareness in males of how social influences inform high-risk sexual behaviour. This greater awareness did not, however, translate into greater self-efficacy in relation to negotiating safer sexual relationships for either males or females and was attributed to the dominant social norms, which promote and sustain gender inequity that places the sexual health of young women and men at risk. Given that the S&R programme operates largely at the level of the individual, although it does address the subjective aspects of social influences on behaviour, these findings highlight the need for proximal situation-centred interventions, which promote more egalitarian social norms in sexual relationships, to accompany such curriculum interventions at tertiary institutions.

Pressure garment adherence in adult patients with burn injuries: an analysis of patient and clinician perceptions.

OBJECTIVE: This study provides a descriptive analysis of the factors affecting pressure garment adherence from the perspective of adult patients with burn injuries and occupational therapy clinicians. METHOD: Questionnaires were administered to 23 adult patients with burn injuries and 10 occupational therapy clinicians selected from six provincial hospitals in a large metropolitan area in South Africa. Adherence behavior was evaluated from the perspective of both sample groups in terms of four variables: garment type, garment comfort, garment cosmesis, and garment instructions. RESULTS: Adherence behavior was negatively influenced by differences in both patient and clinician perceptions across several variables, including the types and consequences of skin problems arising from pressure garment use, levels of satisfaction with garment construction and color, and the issuing and understanding of garment instructions. Other factors compromising adherence behavior included the negative effects of visible burn disfigurement, the issuing of pressure garments after hypertrophic scarring had developed, a lack of patient choice in the selection of scar management techniques, and a lack of social support in the wearing of pressure garments. CONCLUSION: Much of what is traditionally understood as "patient nonadherence" appeared to be largely because of rational choices made by patients in the face of several difficulties they experienced with the current form and nature of their pressure garment therapy. On the basis of these findings, a range of patient-centered interventions are indicated to enhance treatment efficacy and consumer satisfaction with this treatment regimen, including horizontal rather than vertical therapist-patient communication, closer interaction among members of the health care team, the facilitation of family and social support, and interactive health education interventions.

From policy to praxis--a framework for the delivery of district mental health care in KwaZulu-Natal.

This article provides a schema for the provision of mental health care at district level. A framework for service delivery was derived from research conducted by the Community Mental Health Programme (CMHP) into the development of aspects of a district mental health care system in a semi-rural community area in KwaZulu-Natal. Furthermore, information was drawn from interviews with key stakeholders, national and provincial policy documents as well as international experience in the implementation of community-based systems of mental health care.

Promoting group empowerment and self-reliance through participatory research: a case study of people with physical disability.

PURPOSE: Despite the growing popularity of the empowerment construct among social scientists, relatively few empowerment studies involving groupwork with people with physical disabilities exist. This article accordingly describes and analyses the organic development of the empowerment process within a spinal cord injury self-help group, set against the backdrop of policy imperatives for disability in post-apartheid South Africa. METHOD: The treatise on the group empowerment process is located within the context of a group evaluation conducted within a participatory research framework. Key variables informing the research approach included: quality of participation, control over resources and decision-making, shift in critical consciousness and understanding, malleability of roles within the group and role of the health professional. RESULTS: Group members assumed ownership of group management and decision-making and shifted from a professionally-led to a peer-led self-help group. Group objectives changed from providing mutual support to community education and outreach activities. The role of the health professional shifted from group facilitator to invited consultant. CONCLUSIONS: This case study demonstrates how group participation, promoted by a critically informed therapeutic and research praxis, can unlock the inherent potential for self-reliance and empowerment of socially marginalized collectives. It offers important insights with regard to group process, participatory research and the role of the health professional in creating opportunities for empowerment and self-reliance of people with disability.

Prevalence of minor psychiatric disorders in an adult African rural community in South Africa.

BACKGROUND: This paper reports on a two-stage community-based epidemiological study of selected minor psychiatric disorders conducted on an adult African population in South Africa. METHODS: Using a modified random cluster sampling method, 354 adults were identified as the first-stage sample, with the SRQ-20 being used as a first-stage screen. Clinical interviews based on DSM-IV checklists for generalized anxiety disorder, major depression and dysthymia were administered as the second-stage criterion to 81 subjects from the sample. RESULTS: The weighted prevalence for generalised anxiety and depressive disorders was 23.9% (95% CI 15.1%-32.7%), comprising: generalized anxiety 3.7%, major depression 4.8%, dysthymia 7.3%, and major depression and dysthymia 8.2%. Statistically significant associations were found between caseness and age, marital status, employment, income and educational level. CONCLUSIONS: The results are discussed in relation to comparative local and international data as well as in the context of the current restructuring of the mental-health care system in South Africa from tertiary curative care to integrated primary mental-health care.