Quality of life and physical functioning in HIV‐infected individuals receiving antiretroviral therapy in KwaZulu‐Natal,South Africa

KwaZulu‐Natal province, South Africa, accounts for 28.7% of the HIV infection total and one‐third of infections among youth and children in South Africa. The purpose of this study was to examine the variables of HIV/AIDS symptoms, social support, influence of comorbid medical problems, length of time adhering to antiretroviral therapy medications, quality of life, adherence to antiretroviral medications, and physical functioning in HIV‐infected individuals. Based on our model, the combination of these variables was found to determine physical functioning outcomes and adherence to HIV medications. Significant relationships were observed between physical functioning and the dependent variables of length of time on medications, comorbid health problems, and social support. A linear regression model was built to determine the degree to which these variables predicted physical functioning. In total, these predictor variables explained 29% of the variance in physical functioning. These results indicate that those individuals who reported a greater length of time on medications, fewer comorbid health problems, and greater social support had better physical functioning.     

Social construction and cultural meanings of STI/HIV-related terminology among Nguni-speaking inmates and warders in four South African correctional facilities

Cultural sensitivity is increasingly recognized as a means to enhance the effectiveness of health promotion programmes all over the world. Sociocultural meanings and terminology of diseases are important in understanding how different groups perceive and interpret illness. This study was conducted as part of the process of developing and adapting a sexually transmitted infection (STI)/HIV peer led health education intervention for soon-to-be-released inmates who were predominantly Nguni speakers in South Africa. Two focus group discussions (FGDs) were conducted with prison inmates in each of four facilities. Additionally, one FGD was conducted in each prison with non-health trained (custodial) personnel who were Nguni speakers from the same community (n = 27). The data revealed unique terminology and meanings attached to several biomedically defined STIs. These sociocultural constructions were not limited to inmates as findings from warders' discussions showed a similar pattern. Moreover, we found the existence of a number of traditional 'folk' STIs and culture-specific prevention methods. These conceptualizations influence reported health-care-seeking behaviour, where dual consultation of traditional healers and biomedical remedies is widely practiced. The research has biopsychological as well as cultural implications for the development and adaptation of contextually relevant health promotion interventions.     

A case study of antenatal syphilis screening in South Africa: successes and challenges.

BACKGROUND: To evaluate the process of providing routine syphilis screening to antenatal care (ANC) clients at primary healthcare clinics in KwaZulu-Natal Province, South Africa. GOAL: To document the program performance and make recommendations for improving the current program and informing proposals for on-site testing. STUDY DESIGN: Nine health facilities were recruited for the study. The methodology used for this case study included: Key informant interviews, inventory, focus group discussions with clients, client flow analysis, exit interviews with clients and observations of consultations. RESULTS: All 51 women attending their first ANC visit had a blood sample taken for a syphilis rapid plasma reagin (RPR) test. Unreliable transport resulted in an average 4 weeks turnaround time to get RPR test results back to clinics. Due to late presentation in the pregnancy for their first ANC visit, 15% would have been unable to complete their treatment before delivery if they had been found positive. Health providers gave minimal information and/or counseling on syphilis, neither did they stress the importance of treatment of positive clients and their partners. There was no strategy to track positive clients who had not been treated or their partners. Providers were unclear on whether partners should be tested before treatment. CONCLUSION: Although testing was readily available, most of the constraints were centered round logistics of ensuring treatment of women and their partners. These issues must be addressed by sexually transmitted infection managers and policymakers.     

The effectiveness of a peer-led HIV/AIDS and STI health education intervention for prison inmates in South Africa.

This article reports on the effectiveness of the first systematically developed health education intervention for the reduction of risky sexual behavior among soon-to-be-released prisoners in South Africa. Data from three out of four prisons are eligible for data analysis including 263 inmates. Using a nested experimental design, short-term evaluation while inmates were still in prison demonstrate that experimental groups showed higher knowledge of sexually transmitted infections and had a more positive intention to reduce risky behavior than the control group in two out of three prisons. Long-term assessment 3 to 6 months after release from prison indicates that experimental groups were more positive about sexual communication, self-efficacy, and intention. Groups educated by an HIV-negative educator perform marginally better than those in groups with an HIV-positive peer educator. It is argued that peer-led health education programs may be effective in reducing risky behavior amongst soon-to-be-released inmates.     

Radiologic abnormalities in South African mica millers: a survey of a mica milling plant in the Limpopo Province

All 73 workers at a South African mica milling plant were surveyed for radiographic evidence of abnormalities related to dust exposures at work. Chest x-rays were taken and questionnaires administered to determine occupational and environmental exposure histories. Dust levels to which workers were exposed were measured. All but one of 12 airborne inhalable and respirable dust levels were below the occupational exposure limits (OEL-RLs) of 10 mg/m3 and 5 mg/m3 respectively. The mica concentrations were below the OEL-RL of 1 mg/m3 for respirable mica. Mean age and service duration of the workers were 45 and 14 years, respectively. 19 workers (27%) had changes referable to their exposures to asbestos, mica, silica, or combinations. Of these, four showed additional radiographic changes in keeping with tuberculous lung scarring. Six had evidence of lung changes consistent with past tuberculosis alone. Rates of radiologic abnormalities were higher in older workers and those with longer service. An association between mica and radiologic changes could not be convincingly shown because of the nature of the survey and the co-exposure to other mineral dusts. Nevertheless, six workers had radiologic changes consistent with pneumoconiosis attributable to mica or the combination of mica and silica.     

Exploring the trauma care nurse's lived experiences of dealing with the violent death of their clients

A phenomenological approach was used to explore the phenomenon, violent death, from the perspective of trauma care nurses working in Kwa-Zulu Natal. Three relatively unstructured interviews were undertaken on an individual basis with each lasting thirty to forty-five minutes long. The researchers applied the principle of theoretical saturation and a total of seven participants from three level-one trauma units were included in the study. All the interviews were tape recorded and transcribed, and manual analysis, as well as a qualitative software package--NUD*IST--was used to identify experiential themes within the data. The trauma care nurses conceptualized violent death as being sudden, unpredictable, senseless and not as dignified or peaceful as a non-violent death. A number of issues that made confronting violent death difficult were raised and the trauma care nurses described a number of emotional and physical reactions that they experienced due to exposure to these situations. A number of recommendations were suggested for the trauma care nurses, nursing management, nurse educators and for future research in an attempt to prevent the loss of these valuable nurses from the nursing profession.     

South African Zulu widows in a time of poverty and social change

Interviews were carried out with 16 South African Zulu widows. Much of what the widows had to say seemed like what one might hear from widows in economically developed countries, but there were also striking differences. All the widows lived in poverty, and for some their grief seemed much more about the poverty than about the husband's death. Most widows observed a year of traditional ukuzila mourning practices, which made them a threat to others and which is difficult to carry out in the social upheaval of modern South Africa. Widowhood was in some cases a struggle with witchcraft—as cause of the death or as an accusation directed at the widow.