Confidentiality and HIV/AIDS in South Africa

Keeping the diagnosis of a client confidential is one of the cornerstones of professional practice. In the case of a diagnosis such as HIV/AIDS, however, the ethics of this action may be challenged. Such a decision has a range of negative effects, for example, the blaming of others, supporting the denial of the client, and complicating the health education and care of the patient. It is suggested that the four ethical principles should be used to explore the ethics of such decisions, and that professional regulatory bodies and organizations should support professionals in situations where the client's sexual partner is informed against the wishes of the client.     

The sociological spread of HIV/AIDS in South Africa.

South Africa (SA) now accounts for more than 50% of newly reported HIV cases in sub-Saharan Africa annually. In 1993, approximately 90% of those reported as HIV positive in SA were of African descent. This paper examines sociological factors in the spread of HIV in SA through the application of Lalonde's (1974) Health Field Concept. SA's emerging District Health System (DHS) is discussed, as well as barriers to effective implementation and recommendations. Through Lalonde's sociopolitical view of health, a coordinated and multisectorial approach to HIV/AIDS in SA can be established. Without this approach, health care interventions will fail to target the population effectively, thereby reducing effectiveness and sustainability.     

Physiotherapy rehabilitation in the context of HIV and disability in KwaZulu-Natal,South Africa

Abstract

Purpose: The purpose of this study was to describe the experiences of people living with HIV (PLHIV) who had undergone a physiotherapy-led rehabilitation programme, with the aim of informing and improving future rehabilitation. Methods: The study population included patients living with HIV who were referred for physiotherapy rehabilitation at a public-funded KwaZulu-Natal hospital. Eight participants were considered for final analysis in the study. A qualitative research design was adopted using in-depth interviews to explore their experiences of their rehabilitation programme. Additionally all eligible participants were requested to complete the World Health Organisation Disability Assessment Schedule. Results: Participants presented varying activity-related challenges with mobility, self-care and life activities being the most severely affected areas. Participants showed little understanding of their health conditions, prescribed medication and in some cases therapy. HIV and disability impacted their daily lives, adversely affecting work and domestic activities. Although participants reflected positively on the rehabilitation experience they faced a number of barriers to accessing continued rehabilitation. Conclusion: PLHIV who experience disability are affected in major life areas but the current model of delivering rehabilitation provides a number of barriers to patients. A more accessible approach of delivering HIV-care and rehabilitation needs to be developed.

• Implications for Rehabilitation

• Physiotherapists and other rehabilitation professionals, particularly those working in the South African public sector, need to consider developing and implementing home-based rehabilitation interventions for patients living with HIV and disability. This will counter some of the barriers these patients face in accessing hospital-based therapy.

• With the increasing incidence of HIV-related disabilities as PLHIV live longer lives, rehabilitation professionals working with this patient population should keep up to date with recent literature and practical training courses related to the disease and its management.

     

HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa

Title. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. Aim. This paper is a report of a study exploring HIV/AIDS‐related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. Background. Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. Method. A cross‐sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in‐depth interviews. Findings. Hospital nurses reported a higher frequency of care for patients with HIV/AIDS (P < 0·05), but less HIV/AIDS training when compared to PHC nurses (P < 0·001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training (P < 0·001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge (P < 0·01) and training (P < 0·05). Three out of four nurses reported that they practised universal precautions (76·1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. Conclusion. There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa.     

Models of community/home-based care for people living with HIV/AIDS in Southern Africa.

The HIV/AIDS epidemic has placed a large burden on public health facilities in developing countries that are already functioning with limited resources. This has shifted the burden of care to families and communities, because public health services are often stretched beyond their capacities. A number of community/home-based care models and services have evolved in response to this need. This report reviews the most common community- and home-based care models in use as well as the experiences of selected African countries in their use of community/home-based care.     

The impact of 9/11 on HIV/AIDS care in Africa and the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The September 11, 2001 terrorist attacks in the United States sent shock waves throughout the world. The World Bank said the events of 9/11 were likely to have mid- to long-term negative effects in some countries, and donor assistance to Africa could be affected. The terrorist attacks also had the effect of bringing up the issue of security and the potential threat the HIV/AIDS epidemic poses to international security, especially in Africa. This article examines some of the effects of the 9/11 attacks on the fight against HIV/AIDS in Africa, and their implications.     

HIV/AIDS and the workplace: perceptions of nurses in a public hospital in South Africa

AIM: The purpose of this article is to report a study of the perceptions and experiences of nurses caring for people living with HIV/AIDS in the public health sector in South Africa. BACKGROUND: The number of people living with HIV/AIDS in South Africa has escalated at an alarming rate. Many people being hospitalized are HIV positive, and hence nurses are in more regular and prolonged contact with people suffering from HIV/AIDS than is the case in other working environments. Although studies focusing on nurses' experiences of caring for patients with HIV/AIDS have been done in numerous countries, little is known about nurses' views in Africa, and South Africa in particular. To ensure quality care for patients with HIV/AIDS, it is important to understand nurses' experiences of nursing HIV-positive patients and how they may influence their attitudes towards these patients. METHOD: A qualitative approach was used, the primary method of data collection being in-depth interviews. These interviews were conducted with 35 nurses at a public hospital in the Gauteng province of South Africa in 2002-2003. FINDINGS: Seven themes were identified: helplessness, emotional stress and fatigue, fear, anger and frustration, occupational-related concerns, empathy, and self-fulfilment. CONCLUSIONS: Increased understanding of the stresses and rewards experienced by these nurses can contribute to policy development in this area. It is also important to provide appropriate preregistration and continuing education and support for nurses working in this field, and to ensure that the working environment is adequate in terms of resources.     

Acceptance and disclosure of HIV status through an integrated community/home-based care program in South Africa

AIM: To report the outcome of a comparative study among people living with HIV/AIDS (PLWHAs) served by an integrated community/home-based care (ICHC) programme and those who are not in any home-based care programme in terms of acceptance and disclosure of the HIV status. BACKGROUND: One of the major challenges in HIV/AIDS care in developing countries is acceptance and disclosure of a positive HIV status by PLWHAs. Denial and non-disclosure of HIV status hinders prevention efforts as well as access to treatment, care and support for PLWHAs. METHODS: Quantitative data were collected in 2004 from a group of PLWHAs served by the ICHC programme and a group that was not receiving any community/home-based care. Data were compared between the two groups in terms of acceptance and disclosure of HIV status. FINDINGS: The ICHC was effective in improving acceptance and disclosure of the HIV-positive status by PLWHAs in the programme. PLWHAs in the ICHC programme did not find disclosure of their status difficult, and had disclosed their positive HIV status to more people than those who are not in any programme. PLWHAs in the ICHC programme not only disclosed their positive HIV status within their family network and households, but also disclosed to the community in general, sports group, religious groups and other social networks. CONCLUSIONS: Community/home-based care programmes can serve as catalysts for acceptance and disclosure of a positive HIV status by PLWHAs.     

The collaborative project: an effective Canadian partnership in HIV/AIDS nursing care.

Since 1995, the Canadian Association of Nurses in AIDS Care (CANAC), the Canadian Nurses Association, the Victorian Order of Nurses of Canada, and the Ordre des Infirmières et Infirmiers du Québec have collaborated on several HIV/AIDS initiatives supported by the AIDS Care, Treatment, and Support Program, Health Canada (the national health organization). CANAC is the lead and sponsoring association in this collaboration. Phases I and II of the collaboration (December 1996 to March 1999) identified, promoted, and evaluated 17 nursing projects in HIV/AIDS care across Canada. This article describes the goals and outcomes of two of the collaboration's main projects: the identification of HIV/AIDS nursing research priorities and the mentorship program in HIV/AIDS care for Francophone nurses practicing in the province of Québec.     

Coming full circle: mentorship in HIV/AIDS care.

The role of the mentor has been found to be crucial for learning, yet mentorship in HIV/AIDS nursing care has not been well documented. The purpose of this study was to (a) examine the characteristics of a nurse mentor in HIV care as perceived by nursing and medical students and HIV staff, and (b) explore an HIV nurse mentor's perceptions of her role and responsibilities in the professional development of students and staff. Mentorship, as a process of "coming full circle," was highlighted by the mentor's accounts of early influences in her career as well as students' and staff members' intents to facilitate the professional development of the next generation. The legacy of excellent HIV nursing care can be continued if expert HIV nurse mentors are identified and encouraged to work with students, inexperienced nurses, and health care providers. Health care institutions have a responsibility to foster mentorship in HIV/AIDS care to assure quality health care for clients and the professional development of expert nurses in HIV/AIDS care.