A qualitative study was conducted to comprehensively describe the experience of orphanhood and its impact on mental health from the culturally specific perspective of Ugandan youths. The researchers conducted interviews with a purposeful sample of 13 youths (ages 12 to 18) who had lost one or both parents to AIDS illness and who were supported by a non-governmental organisation. The orphaned youths experienced significant ongoing emotional difficulties following the death of their parent(s). The youths in this study were unfamiliar with the term ‘mental health’; however, they easily identified factors associated with good or poor mental health. The findings of this study suggest that Western terminologies and symptom constellations in the Diagnostic and Statistical Manual IV may not be applicable in an African cultural context.
Equity and HIV/AIDS
This study presents the experiences of a cohort of 17 patients enrolled in the first integrated TB and HIV treatment pilot programme, in Durban, South Africa, as a precursor to a pivotal trial to answer the question of when to start antiretroviral treatment (ART) in patients co-infected with HIV and TB. Individual interviews, focus group discussions, and observations were used to understand patients’ experiences with integrated TB and HIV treatment. The patients described incorporating highly active antiretroviral therapy (HAART) into their daily routine as ‘easy’; however, they experienced difficulties with disclosing their HIV status. Being on TB treatment created a safe space for all patients to conceal their HIV status from those to whom they did not wish to disclose. Directly observed therapy for TB may have the added benefit of creating a safe space for introducing ART to patients who are not ready to disclose their HIV+ status.
A coalition of health advocates from Sub-Saharan Africa has warned that the lives of millions of people in Sub-Saharan Africa are in jeopardy because of the lack of political will and investment to realise the right of access to life-saving treatment. ‘If the current cost constraints faced by HIV treatment programmes are not addressed, while the demand for expensive second-line treatment increases, we will find ourselves in a situation similar to the ’90s, where millions of lives were lost unnecessarily because people could not afford the treatment they needed to stay alive’, they said. The coalition rejects pitting HIV against other diseases because they believe there is ample evidence that ARV roll-out has strengthened health systems, and the work done by AIDS service organisations has revolutionised healthcare in the developing world.
The aim of the study was to evaluate data on behavioural indicators in relation to HIV prevention and occurrence in a rural youth population in South Africa. A representative community sample of youth using a three-stage cluster sampling method was chosen for a household survey, and qualitative data were obtained from the youths using ten focus group discussions. Results indicated a moderately adequate knowledge of HIV. HIV/AIDS knowledge was associated with more consistent condom use, and with a more supportive attitude towards persons with HIV or AIDS. Among female youth, 15.2% reported to have become victims of forceful sex during the last 12 months. For youth the major reasons for not using a condom with a non-commercial partner were 'not available', followed by 'did not like them', 'did not think of it', 'other' (mainly trust in partner), and 'partner objected'.
Conflict has long been assumed to contribute significantly to the spread of HIV infection. However, new research is casting doubt on this assumption. Studies from Africa suggest that conflict does not necessarily predispose to HIV transmission and indeed, there is evidence to suggest that recovery in the ‘post-conflict’ state is potentially dangerous from the standpoint of HIV transmission. There has also been concern that high rates of HIV infection among many of the militaries of sub-Saharan Africa poses a threat to regional security. However, data is lacking on this. These issues are of vital importance for HIV programming and health sector development in conflict and ‘post-conflict’ societies and will constitute formidable challenges to the international community. Further research is required to better inform the discussion of HIV, conflict and security in sub-Saharan Africa.
The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. A cross-sectional survey was conducted with surgeons who were members of the Association of Surgeons of South Africa to find out their attitudes to the preceding issues. The salient findings included the view that a patient-centred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. Patient-centred approaches and restrictive policies do not accord with clinicians’ sentiments. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.
Ugandan HIV activists have expressed concern over a recommendation by parliament's budget committee that the allocation for antiretroviral (ARV) drugs be cut. The national budget for 2008/09 allocated 76 billion shillings (US$38 million) to purchasing ARVs, the first such allocation in the country's history, but the house standing committee recommended that the amount be cut to 40 billion shillings in the 2009/2010 budget. ‘We recognise that HIV is a serious disease but it is not the only disease affecting Ugandans,’ said Rose Akol Okullo, chair of the committee. ‘Cancer and diseases afflicting women need equal attention if we are to meet the Millennium Development Goal on health. More than 300,000 HIV-positive people in Uganda need ARVs. AIDS activists argue that the committee's recommendation will allow the government to shirk its responsibility to provide drugs to them.
This article presents the first known systematic review of the research literature on carers of AIDS-orphaned children. Twenty-nine studies of caregivers of AIDS-orphaned children were identified and assessed, mostly in the developing world. Most studies included identifying the individuals who were providing care, assessing the capacity of the extended family to care for AIDS orphans and exploring the process of care placement. Few examined the caregiving experience in any depth, including the challenges of caring for orphans or the effects of caring for these children on the caregivers' health and wellbeing. The article concludes with suggestions for future research to guide policy and programming efforts.
This study has investigated human immunodeficiency virus (HIV) knowledge, attitudes and sexual at-risk behaviours of youths from disadvantaged communities of Dar es Salaam, Tanzania. Participants were 800 youths aged 12-15 years from poorer communities. Participants showed low levels of HIV knowledge, little experience with condom use and low intention to use condoms. Contrary to expectations, there were no significant differences between those in-school and those out-of-school. Gender differences were apparent, in that girls scored consistently lower than boys on all variables. HIV and AIDS education within the schools of Tanzania needs to be re-evaluated and better educational strategies developed.
Nearly 500 delegates from all over the world met at the Rio de Janeiro Global Forum to discuss how men can help improve gender equality, prevent domestic and sexual violence, and improve maternal and reproductive health for themselves and their partners. Gender roles play a major role because they can determine the extent of our vulnerability to the HIV infection. Research in nine Latin American countries found that young men, aged 10 to 24, were far more concerned with achieving and preserving their masculinity than with their health. Another study found that expectations about male behaviour may result in early sexual initiation and more sexual partners, less intimacy in relationships and reluctance to use condoms.