"I have an evil child at my house": stigma and HIV/AIDS management in a South African community

We examined the social roots of stigma by means of a case study of HIV/AIDS management among young people in a South African community (drawing from interviews, focus groups, and fieldworker diaries). We highlight the web of representations that sustain stigma, the economic and political contexts within which these representations are constructed, and the way in which they flourish in the institutional contexts of HIV/AIDS interventions.Stigma serves as an effective form of "social psychological policing" by punishing those who have breached unequal power relations of gender, generation, and ethnicity. We outline an agenda for participatory programs that promote critical thinking about stigma's social roots to stand alongside education and, where possible, legislation as an integral part of antistigma efforts.     

Drug quality screening in developing countries: establishment of an appropriate laboratory in Swaziland.

A simple, low-cost, accurate thin-layer chromatography (TLC) method has been used to establish the first drug quality screening laboratory in Swaziland. For this purpose, office space at the central medical stores was first converted into a simple laboratory. Basic equipment, supplies, and materials were purchased, existing manpower was trained to perform accurately the TLC procedure, and a system was established for the qualitative/quantitative screening of selected drugs purchased by the Ministry of Health prior to their distribution to user facilities. The TLC method described can be used to set up similar low-cost, drug quality screening laboratories in other developing countries where analytical chemistry expertise is lacking, resources are scarce, and sophisticated analytical laboratories to assess drug quality are not available.     

Supporting people with AIDS and their carers in rural South Africa: possibilities and challenges

Under-served rural areas--home to over half of people in sub-Saharan Africa--bear a heavy HIV/AIDS burden. We present a case study of the existence and quality of support networks available to people with AIDS and their carers in a South African rural area. Drawing on 45 interviews and 13 focus groups, we identify key local HIV/AIDS-relevant actors and agencies in civil society, the public and the private sectors. The most effective support comes from families and neighbours, volunteer health workers and two lone missionaries. This support is undermined by counter-productive responses by faith-based organisations, traditional healers and local leaders, and by poor levels of support from public and private sector agencies. We discuss ways in which existing and latent networks might best be strengthened and supported.     

Tolerance and safety of different concentrations of chlorhexidine for peripartum vaginal and infant washes: HIVNET 025

BACKGROUND: There is a continuing need to evaluate sustainable interventions for prevention of mother-to-child transmission (MTCT) of HIV type 1. We evaluated different concentrations (0.25%, 1%, and 2%) of chlorhexidine (CHX) for perinatal maternal and infant washes to identify the maximum tolerable concentration of CHX for such an intervention. METHODS: Women were enrolled during their third trimester at the maternity unit of the Chris Hani Baragwanath Hospital in Soweto, South Africa, and perinatal maternal and infant washes were completed. Subjective maternal symptoms as well as infant examinations were used to assess tolerability of the washes. RESULTS: The 0.25% concentration of CHX was well tolerated by the mothers (n = 29). Ten of 79 women (13%) with 1% CHX washes complained of mild vaginal area burning or itching, and washes were stopped in 5 (6%). Twenty-three of 75 women (31%) in the 2% CHX wash group had subjective complaints, and the washes were stopped in 12 (16%). There were no clinical indications of toxicity of the CHX washes among infants. CONCLUSION: A 1% solution of CHX appears to be a safe and tolerable concentration of CHX for consideration in an MTCT prevention trial.     

Diet‐induced prediabetes: Effects on the activity of the renin–angiotensin–aldosterone system in selected organs

Aims/IntroductionDerangements often observed with type 2 diabetes are associated with disturbances in renin–angiotensin–aldosterone system (RAAS) activity. A positive correlation between local RAAS activity and the complications observed in type 2 diabetes has been noted. However, the detrimental ramifications due to moderate hyperglycemia noted in prediabetes, and the affected organ system and mechanistic pathways are not elucidated. Hence, this study investigated the effects of diet‐induced prediabetes on RAAS in various organs.Materials and MethodsMale Sprague–Dawley rats were separated into two groups: (i) non‐prediabetes through exposure to standard rat chow group; and (ii) diet‐induced prediabetes group by exposure to a high‐fat high‐carbohydrate diet for 32 weeks. RAAS activity in the skeletal muscle, adipose tissue, liver, pancreas and heart was determined through the analysis of RAAS components, such as renin, angiotensinogen, angiotensin‐converting enzyme and angiotensin II type 1 receptor through polymerase chain reaction, as well as the quantification of angiotensin II and aldosterone concentration. Furthermore, nicotinamide adenine dinucleotide phosphate oxidase, superoxide dismutase and glutathione peroxidase 1 concentrations were determined in the skeletal muscle, pancreas and heart, in addition to the hepatic triglycerides.ResultsThe RAAS components were elevated in the diet‐induced prediabetes group when compared with the non‐prediabetes group. This was further accompanied by increased nicotinamide adenine dinucleotide phosphate oxidase and reduced superoxide dismutase and glutathione peroxidase 1 concentrations in the selected organs, in addition to the elevated hepatic triglycerides concentration in the diet‐induced prediabetes by comparison to non‐prediabetes group.ConclusionsDue to these observed changes, we suggest that local RAAS activity in the prediabetes state in selected organs elicits the derangements noted in type 2 diabetes.     

A model to enhance job satisfaction for radiographers in the public healthcare system in Gauteng province,South Africa

IntroductionThe World Health Organization seeks to address the maldistribution of healthcare professionals which results in inequitable services to underserved communities (World Health Organization (WHO), 2015). In South Africa, the underserved areas are the public sector hospitals and the rural areas. Radiographers, like other healthcare professionals, are also unequally distributed between the public and private sector hospitals, and between the rural and urban areas. Since one of the perceived factors for maldistribution is job satisfaction, it is essential to explore factors that contribute to job satisfaction/dissatisfaction amongst radiographers to develop a model to attract and retain radiographers in the public sector.MethodsThe study used exploratory sequential mixed methods approach to explore job satisfaction amongst radiographers, employed by public tertiary hospitals in the Gauteng province, South Africa. In phase one of the study (qualitative), individual and focus group interviews were used to collect data, and in phase two (quantitative), a self-developed questionnaire was used. The data collected was analyzed in sequential order, where thematic analysis was performed for phase one of the study, and SPSS version 23 was used in phase two.ResultsIn phase one, five themes emerged, namely the influence of government policies on job satisfaction, lack of career pathing, poor remuneration, working conditions, and the role of the human resources department. In phase two, the Pearson's correlation test was performed which showed that there was a significant correlation of intent to leave, p = .005 with the following factors: government policy on Occupational Specific Dispensation (OSD) and Performance Management Development System (PMDS), working conditions, supervision, equipment and infrastructure, and poor remuneration.ConclusionGovernment policies, working conditions, and poor remuneration play a significant role in job satisfaction amongst radiographers employed by public tertiary hospitals in the Gauteng province.Implications for practiceThe proposed model could enhance job satisfaction for radiographers employed by the public sector hospitals and ultimately increase attraction and retention rates of radiographers for this sector.