High prevalence of depression symptomology among adolescents in Soweto,South Africa associated with being female and cofactors relating to HIV transmission

Adolescents in HIV endemic settings are a priority demographic with respect to HIV prevention. Some studies have shown that behaviours associated with HIV transmission, may be mediated by mental health factors such as depression. We undertook this study to explore the prevalence and associations of depression symptomology among adolescents living in the HIV endemic community of Soweto, South Africa through the Botsha Bophelo Adolescent Health Study (BBAHS). We estimated the prevalence of depression using the Centre for Epidemiological Studies of Depression Scale, using a score of ≥24 to indicate ‘probable depression’. Among the 789 adolescents (14–19 years) with depression scores, 262 (33%) met the criteria for probable depression (99 [38%] men and 163 [62%] women; p = 0.061). In multivariable logistic regression, factors independently associated with depression included being female (AOR = 2.44, 95% CI: 1.45–4.00), marijuana use (AOR = 2.67, 95% CI: 1.21–5.93), physical violence (AOR = 1.63, 95% CI: 1.01–2.62), pregnancy (AOR = 2.00, 95% CI: 1.03–3.88) and incarceration (AOR = 2.09, 95% CI: 0.99–4.42). These data indicate that a concerning proportion of adolescents in Soweto may be suffering from depression and those screened as potentially depressed, were more likely to be female and have cofactors relating to increased risk for HIV. As part of a comprehensive HIV prevention strategy, we recommend that depression screening for adolescents be integrated into public and school health programs that triage those suffering into treatment programs.     

Motivators of adherence to integrated management among patients with chronic kidney disease: A qualitative study

The integrated management of chronic kidney disease (CKD) demands significant changes, as patients need to adhere to dialysis, medication, and dietary and fluid restrictions. Therefore, there is a need to identify the motivators of adherence to improve the quality of life of these patients. The aim of the present study was to explore the motivators of adherence to integrated management among patients with CKD in South Africa. A phenomenological design was used. A sample size of 12 participants was selected according to data saturation. The purposive sampling method was used to select the participants. Data were collected with the help of a semistructured interview schedule developed from the literature. A thematic framework analysis was conducted to identify the motivators of adherence to integrated management; these were found to be family support, anxiety about eligibility for kidney transplant, support of other patients, awareness of complications associated with non‐adherence to integrated management, and fear of being removed from the CKD program. Identified motivators could be used to develop specific interventions that address or foster adherence behavior as a requirement for integrated management.     

Men’s experience of perpetrating intimate partner violence following disclosure of HIV status by their seropositive female intimate partners: a qualitative study

BackgroundGender-Based (GB) intimate partner violence is a social and public health issue globally. Several risks of violence related to male sexual partners’ perpetration of intimate partner violence (IPV) following the disclosure of their female intimate partners’ HIV + status have been reported. No research has been conducted on male sexual partner’s perspectives of perpetrating IPV following their female intimate partners’ disclosure of human immunodeficiency virus (HIV) seropositive status as a risk factor for the perpetration of IPV in Ghana.ObjectiveThe objective of this study is to explore and describe male sexual partners’ views or perspectives of perpetrating IPV following their female intimate partners’ disclosure of being HIV positive in Ghana.MethodsInterpretive phenomenological approach was used to collect and analyse data from a purposive sample of 18 Male participants whose female intimate relations informed them of being HIV + in Ghana. The sample population was taken from Ghana because such research has been reported elsewhere but none has been done in Ghana. A semi-structured interview guide was used to collect the data. The interview guide covered topics such as background information, participants’ reaction to HIV positive disclosure, lived experiences of participants, and Participants’ understanding of different forms of IPV.ResultsThe findings of this study reveal five main themes that emerged from the interviews which include views on the perpetration of emotional, psychological, and verbal abuse; views on the perpetration of sexual deprivation; views on the perpetration of social isolation; views on the perpetration of financial abuse and views on escalated perpetration of physical abuse.ConclusionFrom the data, HIV positive status disclosure served as a risk factor for different forms of GB IPV against HIV positive women in Ghana, thus making this group more vulnerable and exposed to more GB IPV. Strategies to prevent the perpetration of IPV against women newly diagnosed as HIV positive are needed. We recommend screening all newly diagnosed HIV-positive women for abuse as an additional prevention strategy for IPV associated with disclosure of positive HIV status.

KEY MESSAGES

• HIV positive status disclosure serves as a risk for the perpetration of IPV.
• Men are predisposed to violence upon hearing that their female heterosexual intimate partners are HIV positive.
• HIV infection information is distressful to receive from an intimate partner.

     

Fulbright Scholar opportunities for global health and women's health care in HIV/AIDS in sub-Saharan Africa

This article addresses global health opportunities related to HIV/AIDS and women's health care in sub-Saharan Africa through Fulbright Scholar and Fulbright Student Awards. Although many universities offer a gateway to the J. William Fulbright awards, some disciplines and areas of specialization, including nursing and women's health, have had fewer scholars or students as recipients of these awards. Resource-limited countries, including the countries of sub-Saharan Africa, offer rich opportunities for cross-cultural exchange and advancement of global health. Amidst the context of the shortage of health care workers, the increasing prevalence of HIV/AIDS and other infectious and chronic diseases in sub-Saharan Africa, and the challenges of public health, this article addresses an example of partnerships in global nursing that can be developed through the Fulbright programs.     

Volumetric Analysis of the African Elephant Ventricular System

This study used magnetic resonance imaging (MRI) to determine the volume of the ventricular system in the brain of three adult male African elephants (Loxodonta africana). The ventricular system of the elephant has a volume of ～240 mL, an order of magnitude larger than that seen in the adult human. Despite this large size, allometric analysis indicates that the volume of the ventricles in the elephant is what one would expect for a mammal with an ～5 kg brain. Interestingly, our comparison with other mammals revealed that primates appear to have small relative ventricular volumes, and that megachiropterans and microchiropterans follow different scaling rules when comparing ventricular volume to brain mass indicating separate phylogenetic histories. The current study provides context for one aspect of the elephant brain in the broader picture of mammalian brain evolution. Anat Rec, 2011. © 2011 Wiley‐Liss, Inc.     

Distribution and morphology of catecholaminergic and serotonergic neurons in the brain of the highveld gerbil, Tatera brantsii

The distribution, morphology and nuclear subdivisions of the putative catecholaminergic and serotonergic systems within the brain of the highveld gerbil were identified following immunohistochemistry for tyrosine hydroxylase and serotonin. The aim of the present study was to investigate possible differences in the complement of nuclear subdivisions of these systems when comparing those of the highveld gerbil with those of the laboratory rat. The highveld gerbil was chosen as it is relatively closely related to the laboratory rat, but the Gerbillinae and Murinae lineages diverged over 20 million years ago. Moreover, even though brain sizes are similar, the life history and phenotypes between these two species are substantially different. The gerbils used in the present study were caught from the wild, which is again another contrast to the laboratory rat. While these differences may lead to the prediction of significant differences in the nuclear complement of these systems, we found that all nuclei identified in both systems in the laboratory rat in several earlier studies had direct homologs in the brain of the highveld gerbil. Moreover, there were no additional nuclei in the brain of the highveld gerbil that are not found in the laboratory rat. The only discernable difference between the two species was a greater density and number of catecholaminergic neurons in the olfactory bulb of the highveld gerbil. Thus, the evolution of nuclear parcellation in these systems appears to demonstrate a form of phylogenetic constraint related to the order Rodentia.     

Predictors of vaginal practices for sex and hygiene in KwaZulu-Natal, South Africa: findings of a household survey and qualitative inquiry

Vaginal practices in sub-Saharan Africa may increase HIV transmission and have important implications for development of microbicides and future HIV prevention technologies. It remains unclear which women undertake vaginal practices and what factors predict prevalence, practice type and choice of products. Using cross-sectional data from mixed research methods, we identify factors associated with vaginal practices among women in KwaZulu-Natal, South Africa. Data were gathered through focus group discussions, in-depth and key-informant interviews, followed by a province-wide, multi-stage cluster household survey, using structured questionnaires in face-to-face interviews with 867 women. This paper details six types of vaginal practices, which--despite their individual distinctiveness and diverse motivations--may be clustered into two broad groups: those undertaken for purposes of 'hygiene' (genital washing, douching and application) and those for 'sexual motivations' (application, insertion, ingestion and incisions). Multivariate analysis found significant associations between 'hygiene' practices and media access, religiosity and transactional sex. 'Sexual' practices were associated with partner concurrency, religiosity and use of injectable hormonal contraceptives. Future interventions relating to vaginal practices as well as microbicides need to reflect this characterisation of practices as sexual- and/or hygiene-related.     

An investigation into the level of empowerment of rural women in the Zululand district of KwaZulu-Natal province of South Africa

The aim of the study was to evaluate the outcome of the empowerment of rural women in relation to gender issues, power, and communication within the Zululand District of KwaZulu-Natal in SouthAfrica after implementation of a four-year Primary Health Care project in partnership with the Provincial Department of Health, and two Schools of Nursing at the University of KwaZulu-Natal and McMaster University in Canada. This project is based on substantial evidence which reveals that rural women are being neglected to the extent that these women have missed out on opportunities for development. The reasons for this disempowerment of women, particularly rural women, are thought to be due to the feminisation of poverty, as well as female submission, educational deprivation, privacy of domestic violence, exploitation, domination by men and cultural oppression (patriarchy). A qualitative research approach was used. Focus group discussion was utilised as the data collection technique, and this was also applied during the collection of baseline data. An interview guide covered issues of concern in the communities and households, including what the women would, or had done about these, how they engaged in decision-making in their families, how they handled situations when there was a difference of opinion, and their awareness of, and ability to claim their rights, including control of their lives. The data was collected from six clinics, from groups of six to ten women in the predominantly rural Zululand District of KwaZulu-Natal. The project has revealed improvement in the women's realisation of their rights, albeit limited, in communication, self-confidence, and reliance, including partnerships between Primary Health Care Nurses and women's groups. The formation of women's groups facilitated community development and participation in their own health, socio-economic and emotional development. The project suggests that such groups be encouraged and allowed to network for support as they understand their own problems better, they merely require facilitation.