A psychoeducational approach for prevention of burnout among teachers dealing with HIV/AIDS in South Africa

Teaching is one of the most stressful occupations, with high stress and burnout levels of teachers necessitating intervention. This is especially relevant for South African teachers tasked with additional responsibilities of dealing with HIV/AIDS issues, as well as attending to normal curricula duties. A burnout prevention intervention, based on Paulo Freire’s adult educational approach, using transpersonal psychology techniques, was introduced to HIV/AIDS coordinator teachers (n?=?27) at high-risk schools in the Western Cape, South Africa, who attended six three-hour weekly workshops. This paper presents the bottom-up thematic analyses of the group, as well as individual global analysis (n?=?10) of the qualitative data, derived from focus group interviews and workshop evaluations after the intervention, providing insights into the experiences of workshop participants and their teaching contexts. The mind map of one participant is illustrated. The findings of the study confirmed that transpersonal practices (TP) presented in psychoeducation workshops were helpful in mediating stress and burnout in the work and personal contexts of teachers dealing with HIV/AIDS. TP offer practical applications of right brain emotional and social intelligence practices that could be incorporated into care and wellness school programmes for teachers vulnerable to stressors related to HIV/AIDS.     

What motivates lay volunteers in high burden but resource-limited tuberculosis control programmes? Perceptions from the Northern Cape province, South Africa.

SETTING: The Northern Cape province, Republic of South Africa. OBJECTIVES: To explore factors that motivate lay volunteers to join tuberculosis (TB) control programmes in high burden but resource-limited settings. DESIGN: A qualitative study consisting of three focus group discussions and a documentary review of the records of 347 lay volunteers involved in the tuberculosis programme in the Northern Cape province of South Africa. Additional data were also collected in a cross-sectional study that involved questionnaire interviews with 135 lay volunteers. SUBJECTS: Lay volunteers in the TB programme. One focus group discussion was also carried out with youth not involved in the TB programme. RESULTS: Volunteers do not receive any monetary incentives in the TB programme in the Northern Cape province, but due to the high level of unemployment in this setting, hope for eventual remuneration was found to be the strongest factor motivating youth to join the programme. The study found attrition rates among volunteers to be high (22% had dropped out of the programme within one year of joining); 75% of the dropouts gave loss of interest and a desire for paid work as the reasons for leaving the TB programme. Other motivating factors identified included altruism, a need to find something to do with one's spare time, gaining work experience, and the novelty of the community-based TB programme. CONCLUSION: In the absence of monetary incentives, attrition rates of lay volunteers may be high and this can threaten the effectiveness of community-based TB programmes. In resource-limited settings, it is important to identify and implement appropriate alternative incentives that could motivate lay persons in order to sustain community participation in high TB burden areas.     

Children and youth at risk: adaptation and pilot study of the CHAMP (Amaqhawe) programme in South Africa

This paper reports on the adaptation and pilot study of the CHAMP programme (Collaborative HIV/AIDS and Adolescent Mental Health Programme) in South Africa with specific reference to outcome effects among adults. CHAMP was originally developed in the United States and is a developmentally-timed intervention, which aims to prevent HIV infection in youth through promoting resiliency in pre-adolescents and their families as well as strengthening the community protective shield. The adaptation was informed by a focused ethnographic study of the risk influences for HIV transmission in adolescents at the individual, family/interpersonal and community levels within the study site and achieved through a collaborative partnership of academics, community members, graphic artists and service providers. The CHAMP programme in South Africa (Amaqhawe) employs participatory adult education principles, including a participatory cartoon-based narrative method to deliver its content. Proximal outcome effects of the pilot study demonstrate positive effects amongst the parent participants at the individual and interpersonal/family levels of influence compared to the comparison group indicating the potential applicability of the CHAMP programme in South Africa.     

The impact of social environments on the effectiveness of youth HIV prevention: a South African case study

Few would disagree that 'social context' shapes the effectiveness of HIV-prevention programmes. However much work remains to be done in developing systematic conceptualisations of HIV/AIDS-relevant aspects of social environments in vulnerable communities. This paper contributes to this challenge through a case study (44 interviews, 11 focus groups with 55 people and fieldworker diaries) of the impact of social context on a participatory peer education programme involving young people in a peri-urban community in South Africa. Three interacting dimensions of context undermine the likelihood of effective HIV-prevention. Symbolic context includes stigma, the pathologisation of youth sexuality (especially that of girls) and negative images of young people. Organisational/network context includes patchy networking amongst NGOs, health, welfare and education representatives and local community leaders and groups. This is exacerbated by different understandings of the causes of HIV/AIDS and how to manage it. These challenges are exacerbated in a material-political context of poverty, unemployment and crime, coupled with the exclusion of young people from local and national decision-making and politics. HIV-prevention initiatives seeking to promote health-supporting social environments should work closely with social development programmes to promote young peoples' social and political participation, increase opportunities for their economic empowerment, challenge negative social representations of youth, and fight for greater recognition of their sexuality and their right to protect their sexual health.     

Appreciative inquiry into lifeskills-based HIV/AIDS education in South African schools

With a steady rise in the prevalence of HIV and AIDS throughout the world it has become vital for programme implementers at all levels to ensure that all HIV intervention programmes are effectively put into practice. The present research used qualitative and quantitative data to evaluate the lifeskills-based HIV/AIDS education programme being implemented in primary and secondary schools in South Africa, with special reference to KwaZulu-Natal. A qualitative questionnaire gathered information from nine respondents at three levels: Department of Education district officials, educators and learners. Six key themes were consequently identified to guide the evaluation: communication, empowerment, resources, networking, motivation, and evaluation and feedback. A quantitative questionnaire completed by 30 educators revealed an overall positive attitude towards the programme, regardless of the educator's gender, age or level of formal education. The results are discussed with special reference to continuation and improvement of the lifeskills-based HIV/AIDS education programme.     

Youth mortality due to HIV/AIDS in South Africa, 2001–2009: An analysis of the levels of mortality using life table techniques

South Africa has one of the highest HIV/AIDS prevalence rates in the world. It is estimated that 5.38 million South Africans are living with HIV/AIDS. In addition, new infections among adults aged 15+ were reportedly 316 900 in 2011. New infections among children (0–14 years old) was also high in 2011 at 63 600. This paper examines South Africa's mortality due to HIV/AIDS among the youth (15–34 years old). This age group is of fundamental importance to the economic and social development of the country. However, the challenges of youth development remain vast and incomparable. One of these challenges is the impact of HIV/AIDS on mortality. Life table techniques are used to estimate among others, sex differentials in death rates for the youth population, probability of dying from HIV/AIDS before the age of 35 and life expectancy should HIV/AIDS be eradicated from the population. The study used data from the National Registry of Deaths, as collated by Statistics South Africa from 2001 to 2009. Results show that youth mortality due to HIV/AIDS has remained consistently higher among older youths than in younger ones. By sex, mortality due to this cause has also remained consistent over the period, with mortality due to HIV/AIDS being higher among females than males. Cause-specific mortality rates and proportional mortality ratios reflect the increased mortality of older youth (especially 30–34 years old) and females within the South African population. Probability of dying from HIV/AIDS shows that over the period, fluctuations in likelihood of mortality have occurred, but for both males and females (of all age groups) the chances of dying from this cause decreased in 2007–2009.     

Life skills training as HIV/AIDS preventive strategy in secondary schools: evaluation of a large-scale implementation process

A life skills and HIV/AIDS education programme was implemented in secondary schools as a strategy to combat the spread of HIV/AIDS among school-going young people in South Africa. As part of a joint effort of the Departments of Health and Education, two teachers per school were trained to implement life skills training and HIV/AIDS education in schools as part of the school curriculum. The implementation of the intervention was evaluated in 24 schools in two educational districts in Gauteng province using an action research approach. Data about the implementation were gathered through interviews and focus group discussions with school principals, teachers and learners. A repeated measurement research design was used to assess the impact of the intervention in terms of knowledge, attitudes and reported risk behaviour in a sample of 667 learners representing learners from grades 8 to 12 from different population groups. Results showed that the programme was not implemented as planned in schools due to organisational problems in the schools, lack of commitment of the teachers and the principal, non-trusting relationships between teachers and learners, lack of resources and conflicting goals in the educational system. In an outcome evaluation over the period of a year it was found that learners' knowledge of HIV/AIDS increased and their attitudes were more positive although the changes may not be attributed to the programme alone. In the post-test more learners were sexually active, although preventive behaviour did not increase. The programme as implemented in the area did not succeed in changing high-risk behaviour patterns among school-going young people. From the evaluation of the intervention a few valuable lessons were learned about the content and implementation of HIV/AIDS preventive interventions, which could be useful in the implementation of various other HIV/AIDS preventive interventions in the community.     

Translating global health research aims into action: the example of the ALPHA network*

There is increasing consensus on the importance of strengthening global health research to meet health and development goals. Three key global health research aims are to ensure that research (i) addresses priority health needs, (ii) contributes to policy development, and (iii) adds value to investments in developing countries through South–South collaboration and capacity‐strengthening in the South. The ALPHA network (Analysing Longitudinal Population‐based HIV/AIDS data on Africa) is an illustrative example of how these global health research aims can be translated into action. The network facilitates additional collaborative HIV epidemiological research among six independent research projects in Africa studying population‐based cohorts. Under the first of the earlier mentioned aims, the network addresses key epidemiology research issues in HIV/AIDS which are crucial to making progress and monitoring progress in the response against HIV/AIDS. Under the second aim, the network’s scientific programme of research has contributed to strengthening the evidence base on HIV epidemiology in Africa and has informed policy development in areas such as targeted HIV prevention, social support, monitoring epidemic response and epidemic forecasting. Under the third aim, investment in the network has added value to the research investment in the individual projects through capacity development among African researchers as well as through the collaborative research outputs of the individual projects. Lessons from the network are relevant to collaborations facing similar challenges in other areas of global health research. These include the importance of establishing transparent and efficient governance for research collaborations, developing advance consensus on data sharing, ensuring effective communication for networking and demonstrating the added value of research investment in South–South collaborations.     

HIV- and AIDS-related (mis)perceptions and (non)responses of school principals in the Eastern Cape,South Africa

Despite various HIV and AIDS training programmes offered for educators by the South African Department of Education, little has been achieved at the level of management in terms of creating a wider understanding of the social and cultural complexities of the condition and its impact on the quality of teaching and learning. Specifically, there is a lack of developmental programmes to help school principals provide leadership that can ensure that teachers and children who live in a context affected by the disease will still find themselves in a school environment of quality, care and compassion. With this in mind, we conducted a qualitative research enquiry among a sample of 12 school principals in the Eastern Cape Province in order to discover their perceptions about the impacts of HIV and AIDS on their schools and to learn how they have responded to the corresponding challenges. Our intention was to use the findings primarily to inform the development of an academic programme and short courses to empower school principals and leadership in this regard, but the findings may also be relevant as a guide for research on a larger scale.     

Constructions of sexuality and HIV risk among young people in Venda,South Africa: implications for HIV prevention

The study explored constructions of sexuality among young people of Venda in Limpopo, South Africa, and cultural practices that can be used to develop context-specific HIV prevention programmes. HIV prevention can be promoted by including some cultural practices in prevention programmes and changing some aspects of culture that may contribute negatively to health. Six focus group discussions were held with school-going young people (Grades 10 to 12) in urban and rural areas to explore their constructions of sexuality and HIV risk. Four focus group discussions were held with community leaders in the same areas to explore their constructions of young people’s sexuality and cultural practices relevant to HIV prevention. Through discourse analysis, the following dominant discourses that influence young people’s sexual risk behaviour were identified: rite of passage, the male sexual drive discourse (sex is natural and unavoidable); discourse of hegemonic masculinity (sex to prove masculinity); sex as a commodity; non-adherence to cultural practices; and HIV is normalised (AIDS is like flu). Some alternative constructions and shifts in gender norms were noticed, especially among female participants. The constructions of young people were not culture-specific but similar to those identified in other South African cultures. Community leaders identified a few cultural practices that could be considered in HIV prevention, for example, reinstating the rite of passage to provide age-appropriate sex and HIV education (behavioural intervention), and promoting traditional male circumcision (biological intervention). Cultural practices that contribute negatively to health should be challenged such as current constructions of gender roles (masculinity and femininity) and the practice that parents do not talk to young people about sex (both structural interventions).     

The Impact of a Community-based Pilot Health Education Intervention for Older People as Caregivers of Orphaned and Sick Children as a Result of HIV and AIDS in South Africa

The increasing HIV and AIDS epidemic in South Africa poses a substantial burden to older people, in particular older women who mainly provide care for sick adult children and their grandchildren who have become orphaned and rendered vulnerable by the death or illness of their parents. In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge. The results provided valuable information upon which the development of future interventions may be based and psychosocial and structural needs of the older caregivers may be addressed by relevant stakeholders.     

Gender perspectives in care provision and care receipt among older people infected and affected by HIV in Uganda

HIV/AIDS is a threat to the creation of human capital and development prospects in southern Africa and South Africa. The University of the Witwatersrand (Wits) is a well-regarded institution of higher education in Johannesburg. This paper outlines the university's qualified failure to implement its HIV/AIDS Policy through a comprehensive set of programmes. However, as we describe the decommissioning of this potential flagship programme to a 'tramp steamer,' we identify a number of challenges to the policy's implementation: the necessary scope of an effective programme, the limits to existing capacity, and the need to secure funding. We suggest that the key to failure of HIV/AIDS programmes at Wits lies with the configurations of power within the university and the funding logic that militates against institutions of higher education assuming the high cost of HIV/AIDS programmes. Such institutions receive funding and fees irrespective of whether or not students complete their education as HIV-positive or negative, are aware of their HIV status or not, and — if HIV-positive — are enrolled in a disease management programme or not. This financial logic, in which universities bear the cost of student HIV/AIDS programmes but receive little short-term benefit, poses a threat to the region's future human capital. While institutions of higher education may well recognise the moral imperative of responding to HIV/AIDS for the benefit of society, current funding models do not support this. Four suggestions are put forward to address this unfortunate political economy configuration; they involve changing funding formulas, securing direct funding from business as the primary recipient of the human capital created, soliciting international donor funding, and direct ring-fenced funding offered by government.     

Political will, traditional leaders and the fight against HIV/AIDS: a South African case study

"Political will" and leadership are increasingly considered key contextual influences on the outcomes of HIV/AIDS programmes in sub-Saharan Africa. Such debates tend to focus on the role of national leadership in shaping responses to the epidemic, with little attention to local leaders. Yet many of the settings in which HIV/AIDS flourishes are geographically distant from the reach of national leadership and policies. Furthermore, local leaders often play a key role in shaping how national policies and decisions are interpreted and implemented in local areas. Against this background, we present a case study of the impact of the leadership style of a traditional Chief on a community-based AIDS programme in a South African rural community, which sought to build community-level "AIDS competence", using the "empowerment via participation" approach. The case study involved 134 interviews and 57 focus groups conducted over three years. Thematic content analysis revealed a number of direct and indirect ways in which his leadership style impacted on project outcomes. Despite his strong support for the programme, the Chief's "traditional" attitudes towards women and youth, his celebration of polygamy, and his authoritarian governance style undermined the project's "empowerment via participation" agenda - especially the programme's attempts to reduce AIDS stigma, to build female and youth capacity to control their sexual health, and to encourage men to take responsibility for their role in tackling AIDS.     

HIV Risk and Prevention Among Men Who Have Sex with Men (MSM) in Peri-Urban Townships in Cape Town,South Africa

Current guidelines on HIV prevention for MSM emphasise the need for ‘combination prevention’ based on context-specific understandings of HIV risk. MSM in South Africa are a population with a high risk of HIV infection, however there is little research available on the drivers of this risk. In the context of a focus on combination prevention, this paper argues that effective HIV prevention for MSM in South Africa requires an understanding of the factors at multiple ‘distances’ from individuals that contribute to HIV risk. Based on qualitative research with MSM in Cape Town, South Africa, we situate HIV risk using a socio-ecological framework and identify factors at distal, proximal, and personal, levels that contribute to MSM’s high risk of HIV infection. By understanding the interactions and linkages between risk environments and the risk situations in which HIV is transmitted, HIV prevention programmes will be more effectively able to address the multiple drivers of HIV risk in this population.     

Evaluation of a drama-in-education programme to increase AIDS awareness in South African high schools: a randomized community intervention trial

A community intervention trial was undertaken in KwaZulu Natal, South Africa to evaluate the effectiveness of a high school drama-in-education programme. Seven pairs of secondary schools were randomized to receive either written information about HIV/AIDS or the drama programme. Questionnaire surveys of knowledge, attitude and behaviour were compared before and 6 months after the interventions. One thousand and eighty students participated in the first survey and 699 in the second. Improvements in knowledge (P=0.0002) and attitudes (P < 0.00001) about HIV/AIDS were demonstrated in pupils at schools receiving the drama programme when compared to pupils receiving written information alone. These changes were independent of age, gender, school or previous sexual experience. In schools receiving the drama programme, sexually active pupils reported an increase in condom use (P < 0.01). It is important to provide resources to sustain such programmes and to obtain stronger evidence of effect on behaviour by measuring changes in HIV incidence.     

Understanding the response of large South African companies to HIV/AIDS

This paper provides a framework analysing the response of South African companies to HIV/AIDS. Drawing on three case studies of companies, each with over 20 000 South African-based employees, we identify six ‘drivers’ that influence corporate behaviour regarding HIV/AIDS: legal requirements, voluntary regulation, business costs, social pressures, visibility of the disease, and individuals within companies. We suggest that costs calculations, while possibly underestimating indirect and macro-implications, are not key in driving company responses to HIV/AIDS. The law and voluntary regulation have influenced, but not determined, the response of companies to HIV/AIDS. Social pressures on companies are of importance, but the scale and complexity of need in South Africa has seen the deflecting of this driver. Of greater reference in determining responses has been the social pressure of other companies' responses. The general visibility of the AIDS epidemic is also a significant factor in explaining companies' responses to HIV/AIDS. Moreover, the visibility of HIV/AIDS within companies has influenced the responses of often relatively weak, internal agents who have been attempting to drive companies' HIV/AIDS programmes.

We conclude that external drivers — legal requirements, economic performance, and social pressures — have framed corporate responses to HIV/AIDS to a degree, but have generally been weak. Moreover, there has been relatively little synergy between these external drivers and the internal drivers — voluntary regulation, visibility, and company HIV/AIDS ‘champions’ — that could propel companies into pro-active, bold responses to HIV/AIDS.     

Piloting antiretroviral treatment in South Africa: the role of partnerships in the Western Cape's provincial roll-out

In 1999, the government of the Western Cape Province, South Africa, entered into a partnership with Médecins Sans Frontières (MSF) to provide HIV treatment through public health clinics in the peri-urban settlement of Khayelitsha. From 2000 onwards, this partnership ran South Africa's first antiretroviral treatment (ART) programme. Due to the province's limited experience (as of 1999) in implementing and monitoring an ART programme, and the National Department of Health's opposition to the public provision of ART, this partnership was instrumental in piloting and later scaling-up the Western Cape's ART programme. Numerous studies have documented this pilot ART programme from a health system or clinical perspective. This study instead used qualitative methods to examine the factors that facilitated the public provision of ART in the Western Cape. With reference to the role of partnerships in piloting new health interventions, the article explores the partnership that was established between the provincial government, civil society organisations, research institutes, and service providers to support the public provision of ART in Khayelitsha. This partnership has demonstrated that ART programmes can be implemented successfully within resource-constrained settings, achieving high levels of treatment adherence, low rates of loss to follow-up and excellent health outcomes. Lessons from the partnership's components and strategies are therefore of vital significance to realising the roll-out of ART programmes in various contexts across the developing world, demonstrating the crucial role of collaboration and integration in the establishment and maintenance of these programmes.     

‘Something for something’: The importance of talking about transactional sex with youth in South Africa using a resilience-based approach

Transactional sex is a common feature of sexual relationships in South Africa but has severe health implications for those who engage in it. This paper presents perspectives on transactional sex based on interviews and focus group discussions with young people in Gauteng and Limpopo, South Africa. The discussions were part of an evaluation of a peer education programme promoting HIV prevention called Vhutshilo, aimed at 14–16 year olds. The session on transactional sex entitled ‘Something for Something’ evoked strong responses from youth. Youth recognised transactional sex as a common phenomenon in their communities and associated it with many risks. However, when comparing young people's qualitative responses to the impact of the session as measured by the quantitative impact survey, no significant differences were discernible between youth in the programme and those in a control group who were not exposed to the session. Further analysis showed that the content of the session was limited to the negative consequences and health risks of transactional sex and focused mostly on the adverse contexts in South Africa that force youth into such relationships. The session did little to situate transactional relationships within the everyday realities of sexual decision making and youth values of peer status and consumerism. We argue that the session's findings reveal a narrow understanding of the dynamic contexts under which transactional sex occurs and fails to take into account the resilience of youth to make choices of whether or not to engage in such relationships, and how they can engage in these types of relationships safely. We conclude that HIV prevention curriculums need to leverage youth resilience and protective skills within the confines of difficult economic and social circumstances to allow them to successfully navigate safer sexual relationships.