Factors influencing acceptability of voluntary counselling and testing for HIV in Bushenyi district of Uganda.

OBJECTIVE: To understand the factors influencing choice of voluntary counselling and testing (VCT) for HIV with a view of suggesting measures for increased uptake. DESIGN: Focus group discussions were used to elicit reasons for carrying out VCT and a cross sectional survey to estimate the proportion of people who undertake VCT. SETTING: Bushenyi district, Uganda. PARTICIPANTS: A cluster random sample of 219 people and four purposively selected focus group discussions with 32 participants. MAIN OUTCOME MEASURES: Elicited attitudinal beliefs, self-efficacy expectations, and social influences that are probably associated with VCT for HIV based on the Attitude Social influence self-Efficacy (ASE) Model. The proportion of people who had ever undertaken VCT for HIV was also determined. RESULTS: Thirty-eight (17%) of the 219 people interviewed had ever undergone HIV. The factors influencing VCT for HIV were consequences of a test result, influences from a sexual partner, cost of VCT, physical accessibility of VCT, awareness, risk of HIV infection, need for linking VCT with care (especially availability of anti-retrovirals) and perceived quality of care of VCT services. CONCLUSIONS: Increased mobilisation and access for VCT, reducing costs of VCT, linking of VCT with care, and emphasising the positive consequences of VCT as well as providing high quality VCT services may increase the number of people seeking VCT.

Evaluating herbal medicine for the management of Herpes zoster in human immunodeficiency virus-infected patients in Kampala, Uganda.

OBJECTIVE: This study was carried out to evaluate the potential effectiveness of herbal treatments used for herpes zoster (HZ) by a great number of people living with acquired immunodeficiency syndrome (PLWAs) in Uganda. SETTING: Kampala, Uganda. Clinics of indigenous traditional healers, at the Department of Medicine of Mulago Hospital, Makerere University, and at The AIDS Support Organization (TASO) Clinic, providing primary care to people living with HIV and AIDS. DESIGN, PATIENTS, AND PARTICIPANTS: Nonrandomized, nonplacebo controlled, observational study in two phases. Inclusion criteria included HIV seropositivity and a recent HZ attack. In phase 1, 52 patients were enrolled, treated, and followed for up to 3 months at three healers' clinics, and compared to 52 TASO Clinic controls receiving ambulatory care. Phase 2 was similar in design to phase 1, but lasted longer (6-month follow-up) and involved 154 hospital outpatients treated with herbal medicine and 55 TASO controls. In both phases, healer patients were given herbal treatment according to healers' prescriptions, while controls received either symptomatic treatment or acyclovir. RESULTS: Healer patients and controls experienced similar rates of resolution of their HZ attacks. Fewer healer patients than controls experienced superinfection in phase 1 (18% versus 42%, p < 0.02) and fewer healer patients showed keloid formation in either phase. This difference was not statistically significant. In both phases, zoster-associated pain resolved substantially faster among healer patients with a higher degree of significance in phase 2 where the progression of pain over time could be seen because of the longer follow-up (phase 1: maximum p value (pmax) < pmax < 0.02 at 1 month, pmax < 0.005 at 2 months, pmax < 0.0001 at 3 months). CONCLUSION: Herbal treatment is an important local and affordable primary care alternative for the management of HZ in HIV-infected patients in Uganda and similar settings.

Young people and STDs: a prescription for change.

PIP: Sexually transmitted diseases (STD) are a major health problem in Uganda. However, since many STDs are not treated within the formal health sector, accurate data on the extent of the problem nationwide are lacking. A 1991 Ministry of Health survey nonetheless found that approximately 20% of hospital outpatient visits could be attributed to STDs. Ugandans, especially young people, who suspect they are infected with a STD often ask drug store proprietors, traditional healers, or family and friends for advice on diagnosis and care. They either delay or never seek care in the formal health sector. This behavior is due in part to the social stigmatization in Uganda of the discussion of sexuality and sexual health related problems. Young people may be too embarrassed to seek clinical care. The often high cost of treatment and the low quality of clinic counseling also discourage people from going to STD clinics. Many young people attending such clinics receive judgmental counseling and conflicting diagnoses which leave them more confused than before seeking care. The author stresses the need for community-based STD education and treatment networks which include the schools, mass media, the national health care system, and youth organizations. Young people need more than just random information and a pharmacist's prescription.^ieng