Breaking barriers: How transwomen meet their healthcare needs.

BACKGROUND:  Transgender women - individuals assigned male at birth but who identify as female - are disproportionately affected by, among others, human immunodeficiency virus (HIV), other sexually transmitted diseases (STIs) and mental health issues. Studies show that transgender women often encounter discrimination and stigma when seeking healthcare from health facilities. AIM:  This study assessed the healthcare needs of transgender women, their experiences of the mainstream healthcare system and alternative strategies for navigating the healthcare system. SETTING:  The study was carried out in the City of Ekurhuleni Metropolitan Council in South Africa's Gauteng province. METHODS:  A case study design was followed. Participants were purposively selected and included 10 transgender women aged 26-50. Individual semi-structured interviews were conducted over 2 months. RESULTS:  Participants expressed a need for hormone replacement therapy, HIV treatment and prevention and treatment for STIs. Experiences of participants within the healthcare system were predominantly negative, with instances of discrimination, stigma and privacy violations being commonplace. Alternative strategies to meet their healthcare needs included the use of self-medication, consulting traditional healers and utilising non-governmental organisations. CONCLUSION:  There is an urgent need for equitable and inclusive health management of transgender women in South Africa.Contribution: This study provided a first look in a South African context into how and to what extent transwomen employ alternative healthcare strategies such as self-medication and utilising non-governmental organisations when faced with mainstream healthcare access barriers. The use of traditional doctors was identified as a novel, alternative strategy used by transwomen to access healthcare and treatment.

Improving the distribution of antiretroviral medicines through centralised dispensing: perspectives of HIV+ patients and nurses at a chronic dispensing unit in Ekurhuleni, Gauteng Province, South Africa.

Introduction: South Africa's public healthcare facilities are continuously inundated with arduous challenges. A Chronic Dispensing Unit (CDU) can help to alleviate these challenges by reducing the workload of nurses at Primary Health Care clinics, decrease patient waiting time, and enhance accessibility of antiretroviral treatment (ART) for HIV+ patients through the dispensing, packaging, and distribution of chronic medicines to stable patients. Determining the effectiveness of a CDU is therefore critical as it can benefit both the patients and the CDU as a service provider. This study ascertained the efficiency of the Germiston CDU in Ekurhuleni, Gauteng Province, in distributing ART to clinics in order to make possible recommendations for quality improvement. No such study has so far been conducted at this CDU. Methods: an exploratory quantitative research design was adopted. Data collection techniques consisted of researcher-assisted and self-administered questionnaires. The sample included 60 patients and 11 nurses who volunteered to participate in the study. Results: main findings showed that patient participants believed there was a noteworthy reduction in patients' waiting time at clinics. They were also highly satisfied with the CDU's level of service delivery. Responses from nurse participants indicated an increase in accessibility of ART since the induction of the CDU. However, emerged challenges linked to CDU service delivery warrant a closer inspection of the CDU processes as it revealed shortfalls within the system that may hamper quality of service delivery. Conclusion: in general, services rendered by CDU were deemed effective. However, as a recommendation, challenges linked to CDU service delivery must be addressed.

Deploying a Fotonovela to Combat Methamphetamine Abuse among South Africans with Varying Levels of Health Literacy.

Poor health literacy in the Western Cape Province of South Africa is one of the main factors hampering methamphetamine (MA) use prevention efforts in the area, where the abuse of this drug is a major health and social problem affecting especially previously disadvantaged communities. In the first part of a two-part study, we compared a health-related fotonovela about MA to an existing brochure group and a control group. Main findings show that the vast majority of readers preferred the fotonovela over the existing brochure. This included participants from all three age groups and for both levels of health literacy (low/high) distinguished (n = 372). Furthermore, specifically for older people with low levels of health literacy, the fotonovela outperformed the existing brochure condition for knowledge level. In the second part of the study, we found that healthcare providers (n = 75) strongly prefer a fotonovela over an existing brochure, while this cohort viewed the potential use of fotonovelas in a health care setting as very positive. Our findings add to the promising results of an earlier fotonovela study about MA use in South Africa, providing further support for considering using narratives in health communication as a serious option to effectively communicate convincing health information about this drug to target audiences in the Western Cape Province.

Using a fotonovela to battle crystal meth in South Africa.

This study evaluated the effects of a health-related fotonovela about crystal meth (S-methamphetamine hydrochloride) among "Colored" people (an ethnic label for people of mixed race) in the Western Cape province of South Africa. Crystal meth use is most common among Colored people in this province and it is considered a major social problem. The fotonovela was compared to a no-message control group and a traditional brochure in a randomized controlled trial (N = 303). The fotonovela outperformed the control condition for knowledge level and it outperformed the traditional brochure on intention toward starting conversations about crystal meth. Especially readers with relatively low levels of education clearly preferred the fotonovela over the traditional brochure.