Attitudes to voluntary counselling and testing for HIV among pregnant women in rural south-west Uganda

This paper describes the results of a study exploring the attitudes of women attending maternity clinics to voluntary counselling and testing during pregnancy in rural areas in south-west Uganda. It was a qualitative study using focus group discussions (FGDs). Twenty-four FGDs were carried out with 208 women attending maternity clinics in three sites in rural south-west Uganda. The FGDs were all recorded and transcribed, and analysed using standard computer-based qualitative techniques. Almost all women were willing in principle to take an HIV test in the event of pregnancy, and to reveal their HIV status to maternity staff. They were anxious, however, about confidentiality, and there was a widespread fear that maternity staff might refuse to assist them when the time came to deliver if their status were known. This applied more to traditional birth attendants than to biomedical health staff. There were also rumours about medical staff intentionally killing HIV-positive patients in order to stem the spread of the epidemic. Women were concerned that if their husbands found out they were HIV-positive they would be blamed and separation or domestic violence might result. In conclusion: although VCT during pregnancy is acceptable in principle, much will need to be done to ensure confidentiality and allay women's fears of stigmatisation and discrimination during delivery. Community sensitisation will be necessary and male partners will have to be involved if interventions are to be acceptable.     

The Effects of Calcium and Vitamin D on Blood Pressure in Conscious Sheep

ABSTRACT

The metabolic and haemodynamic effects of elevating plasma calcium levels were examined in both normal and ACTH-hypertensive sheep. Six weeks of dietary Ca⁺⁺ supplementation did not alter plasma calcium levels, blood pressure or heart rate. Five days of CaCl₂ infusion (2 mmol/h) or intravenous vitamin D injections elevated plasma ionised and total Ca⁺⁺ levels and heart rate but mean arterial pressure was unchanged. As in other species, elevation of plasma Ca⁺⁺ levels over 4 hours by infusion of CaCl₂ at 2, 5, and 10 mmol/h increased mean arterial pressure and decreased heart rate. The course of ACTH-induced hypertension was not altered in animals supplemented with CaCl₂ in their drinking water for 6 weeks nor by intravenous injection of vitamin D for 5 days. This study does not support a major role for altered plasma ionised or total Ca⁺⁺ levels in the genesis of ACTH-dependent hypertension in the sheep.     

Economic hardship associated with managing chronic illness: a qualitative inquiry

Background  

Chronic illness and disability can have damaging, even catastrophic, socioeconomic effects on individuals and their households. We examined the experiences of people affected by chronic heart failure, complicated diabetes and chronic obstructive pulmonary disease to inform patient centred policy development. This paper provides a first level, qualitative understanding of the economic impact of chronic illness.