Experiences of nurses working in Voluntary Counseling and Testing Services in Swaziland.

Swaziland is among the countries in the sub-Saharan Africa with high rates of HIV infection. The Swazi Government established Voluntary Counseling and Testing Services (VCT) as part of its response to the epidemic. This study describes the day-to-day experiences of nurses working in VCT services in Swaziland in order to answer the question, "What is it like to work at VCT services." Data were obtained through in-depth interviews. The sample consisted of 6 nurses who were purposively selected from the 4 geographical regions of Swaziland. Data were analyzed through the steps suggested by Tesch (1990). Findings from the analysis revealed that nurses working in VCT services experienced constant stress. The stress was attributed to the complexity of HIV, staff shortages, lack of social support, lack of supportive practice environments, and constant exhaustion. The experience of constant stress lead these nurses to feel disempowered. Data suggest that nurses working in VCT services in Swaziland need programs to support their efforts and to empower them in their testing activities.

Symptom burden of fatigue in men and women living with HIV/AIDS in Southern Africa.

HIV-related fatigue is a debilitating and disabling symptom that persists for months and years. In 743 HIV/AIDS patients from Southern Africa, the authors found ratings of HIV-related fatigue to be highly prevalent. The authors conducted a secondary data analysis within the theoretical context of the University of California, San Francisco Symptom Management Model. The analysis focused on 538 patients who reported fatigue to investigate correlates and predictors of fatigue severity in relationship to demographic and HIV/AIDS illness indicators, as well as HIV-specific physical and psychological symptoms. A hierarchical regression model explored the contributions of those five blocks on fatigue severity. Of the 47% of the total variance in fatigue severity, a combination of variables within the health and illness block (6%), the physical symptoms block (7%) and the psychological symptom block (2%) contributed significantly to the increase in fatigue severity scores. Fatigue severity in Southern Africa was moderate, and the factors contributing to the perceived fatigue were most likely related to symptoms of acute HIV disease (such as fever and gastrointestinal problems). In conclusion, fatigue severity is less impacted by demographic or environmental variables but much more by co-occurring symptoms and HIV disease severity. The results of this study imply the need for more research to understand if improvements in water quality and access to food would prevent infection and diarrhea and whether sufficient access to antiretroviral treatments to manage the HIV infection would improve fatigue and co-occurring symptom profiles.

Quality of life and the concept of "living well" with HIV/AIDS in sub-Saharan Africa.

PURPOSE: To increase understanding of the meaning of quality of life for people living with HIV/AIDS in four countries in sub-Saharan Africa: Botswana, Lesotho, South Africa, and Swaziland. METHODS: Using a cross-sectional design and convenience sample, we administered a survey and collected data on demographic characteristics, measures of severity of illness, and perceptions of quality of life. The purposefully selected sample (N=743) consisted of community-based people living with HIV/AIDS in 2002. Based on the Wilson and Cleary framework for organizing variables related to quality of life, a hierarchical multiple regression was conducted with quality of life as the dependent variable. RESULTS: The sample of 743 persons was 61.2% female with a mean age of 34 years. Approximately 62 % of the sample reported having received an AIDS diagnosis. Ten predictor variables explained 53.2 % of the variance in life satisfaction. Those participants with higher life satisfaction scores were less educated, had worries about disclosure and finances, did not have an AIDS diagnosis or other comorbid conditions, had lower symptom intensity, had greater functioning, and had fewer health worries. None of these participants was taking antiretroviral medications at the time of this study. CONCLUSIONS: Several dimensions of the Wilson and Cleary model of quality of life were significantly related to life satisfaction for people living with HIV/AIDS in sub-Saharan Africa. Quality of life for this sample was primarily defined as overall functional ability and control over symptom intensity. These findings are similar to studies in developed countries that have shown the significant relationships among functional abilities, symptom control, and perceived quality of life. As antiretroviral medications become more available in these areas, community members and care providers can help clients realize the possibility of living well with HIV/AIDS, and can work with clients to improve functional ability and control symptom intensity to make living well a reality.

HIV/AIDS symptom management in Southern Africa.

We describe self-reported strategies used by persons living with HIV/AIDS in Botswana, Lesotho, South Africa, and Swaziland to manage common HIV-related symptoms. A questionnaire asked participants to list three to six symptoms they had recently experienced, the care strategies they had used to make them better, where they had learned the strategy, and to rate the perceived effectiveness of the strategy. Data were collected in 2002 from 743 persons. The self-care management strategies were coded into eight categories: medications, complementary treatments, self-comforting, changing diet, seeking help, exercise, spiritual care, and daily thoughts/activities. Overall, participants reported medications as the most frequently occurring management strategy and the most effective. A very small inventory of behavioral strategies was available to participants to help them manage their HIV-related symptoms.

The symptom experience of people living with HIV/AIDS in Southern Africa.

This study describes the symptom experience of 743 men and women living with HIV/AIDS in Botswana, Lesotho, South Africa, and Swaziland. Data were obtained in 2002 by using a cross-sectional design. A survey of participants included 17 sociodemographic items and the 64-item Revised Sign and Symptom Checklist for Persons with HIV Disease. Results indicate a strong correlation between the frequency of reported symptoms and their intensity (r = .84, p < .00). Participants who reported having enough money for daily expenses also reported significantly fewer symptoms. There were no significant differences in symptom frequency between men and women or by location of residence. The study showed a complex picture of HIV-related symptoms in all four countries. Because of the high levels of symptoms reported, the results imply an urgent need for effective home- and community-based symptom management in countries where antiretroviral therapy is unavailable to help patients and their families manage and control AIDS symptoms and improve quality of life.

Primary and preferred sources for HIV/AIDS and sexual risk behavior information among adolescents in Swaziland, Southern Africa.

The HIV/AIDS epidemic in Sub-Saharan Africa poses a massive diffusion and persuasion challenge for health professionals. Individuals working with adolescents to prevent the spread of HIV/AIDS must gain an understanding of adolescent's preference in obtaining information about HIV/AIDS and sexual behaviors. This study describes the primary and preferred sources of information regarding HIV/AIDS and sexual risk behavior in relation to several socio-demographic variables (n=941) in Swaziland, Southern Africa. Although print/broadcast media was the primary source for HIV/AIDS and sexual risk behavior information for the students, most participants preferred information from the healthcare workers. This study suggests a greater role for healthcare providers in providing HIV/AIDS and sexual risk information.