Alta C. van Dyk

Traditional African1 Beliefs and Customs: Implications for AIDS Education and Prevention in Africa

Many Western-based AIDS education and prevention programmes have failed dismally in Africa and they may only succeed if traditional African beliefs and customs are taken into account. This article discusses relevant aspects of the traditional African worldview by explaining what health, sickness and sexuality mean in traditional Africa. Traditional African perceptions of causes of illness (including AIDS), perceptions of sexuality, and cultural beliefs inhibiting the usage of condoms are described in terms of the influence of the macro-cosmos (the ancestors), the meso-cosmos (witches and sorcerers) and the micro-cosmos (everyday life). The implications for AIDS education and prevention in Africa are discussed and suggestions are offered for the development of such programs.Many Western-based AIDS education and prevention programmes have failed dismally in Africa and they may only succeed if traditional African beliefs and customs are taken into account. This article discusses relevant aspects of the traditional African worldview by explaining what health, sickness and sexuality mean in traditional Africa. Traditional African perceptions of causes of illness (including AIDS), perceptions of sexuality, and cultural beliefs inhibiting the usage of condoms are described in terms of the influence of the macro-cosmos (the ancestors), the meso-cosmos (witches and sorcerers) and the micro-cosmos (everyday life). The implications for AIDS education and prevention in Africa are discussed and suggestions are offered for the development of such programs.

“What is the Point of Knowing?”: Psychosocial Barriers to HIV/AIDS Voluntary Counselling and Testing Programmes in South Africa

Voluntary Counselling and Testing (VCT) programmes are regarded as an important strategy in the management of the HIV/AIDS pandemic worldwide. Such programmes, however, often have limited success due to various problems such as the existence of attitudes and beliefs that act as psychosocial barriers. This article, which presents a study of attitudes towards VCT in South Africa, attempts to ascertain the reasons for peoples continued resistance to VCT programmes. A semi-structured questionnaire was used to survey the views of 1422 people. The results indicate that while the research participants, in principle, were not opposed to VCT, they professed a deep mistrust of health-care professionals, and feared discrimination and rejection by the latter, their sexual partners, and their communities. Participants did not know how to disclose their HIV-positive status, and were concerned about testing that did not include treatment and/or follow-up support, as well as their ability to deal with the ensuing psychological turmoil in the event of testing HIV-positive. The authors proposed various suggestions concerning how to improve VCT services in South Africa.Voluntary Counselling and Testing (VCT) programmes are regarded as an important strategy in the management of the HIV/AIDS pandemic worldwide. Such programmes, however, often have limited success due to various problems such as the existence of attitudes and beliefs that act as psychosocial barriers. This article, which presents a study of attitudes towards VCT in South Africa, attempts to ascertain the reasons for peoples continued resistance to VCT programmes. A semi-structured questionnaire was used to survey the views of 1422 people. The results indicate that while the research participants, in principle, were not opposed to VCT, they professed a deep mistrust of health-care professionals, and feared discrimination and rejection by the latter, their sexual partners, and their communities. Participants did not know how to disclose their HIV-positive status, and were concerned about testing that did not include treatment and/or follow-up support, as well as their ability to deal with the ensuing psycho...

Treatment adherence following national antiretroviral rollout in South Africa

The national antiretroviral (ARV) programme in South Africa commenced in 2004. ARV drugs became readily available to all South Africans due to the concerted efforts of ‘access to all’ campaigns. This study investigates medication adherence among a sample of South Africans after the ARV rollout in order to gain insight into the adherence challenges they face. A semi-structured questionnaire was completed by 439 participants from across the country. The results show that only 40% of the respondents were able to reach the optimum adherence level of 90% or above. The patients who displayed below-optimum adherence often had not been part of an ARV-preparation programme, did not have HIV-treatment supporters, lacked general knowledge about drug adherence, and felt unsupported by healthcare providers in their day-to-day effort to adhere to their medications. They often had no money for food or transportation, ran out of ARVs for various reasons, suffered from HIV-treatment fatigue, battled with depression, abuse...The national antiretroviral (ARV) programme in South Africa commenced in 2004. ARV drugs became readily available to all South Africans due to the concerted efforts of ‘access to all’ campaigns. This study investigates medication adherence among a sample of South Africans after the ARV rollout in order to gain insight into the adherence challenges they face. A semi-structured questionnaire was completed by 439 participants from across the country. The results show that only 40% of the respondents were able to reach the optimum adherence level of 90% or above. The patients who displayed below-optimum adherence often had not been part of an ARV-preparation programme, did not have HIV-treatment supporters, lacked general knowledge about drug adherence, and felt unsupported by healthcare providers in their day-to-day effort to adhere to their medications. They often had no money for food or transportation, ran out of ARVs for various reasons, suffered from HIV-treatment fatigue, battled with depression, abused alcohol, could not disclose to sexual partners that they were on ARVs, and often had to hide or skip ARV dosages because they feared stigma and discrimination. Suggestions to assist patients to adhere to their ARV medications are made.

Perspectives of South African school children on HIV/AIDS, and the implications for education programmes.

The study explores and describes South African school childrens perspectives of HIV and AIDS, and links this to their respective cognitive developmental stage. The paper highlights developmental differences in the childrens perceptions of HIV or AIDS and makes specific recommendations for improving HIV/AIDS education in school. A questionnaire of mainly open-ended questions was used to survey the HIV/AIDS-related perceptions of 1 904 school-going children aged 6 to 19 years. In-depth content analyses as well as basic statistical analyses were performed on the data. Although the school children had a good basic knowledge of HIV/AIDS and generally positive attitudes towards HIV and AIDS, they believed many misconceptions and myths. The children were mostly very afraid of HIV or AIDS and felt extremely vulnerable to HIV infection. The particular developmental phase was the strongest predictor of a childs understanding of HIV/AIDS. The findings have been used to formulate guidelines for the development or enhancement of age-appropriate HIV/AIDS education programmes or curricula in schools. It is hoped that teachers, educators and youth workers will use these findings to re-evaluate and adjust their HIV/AIDS education programmes and messages to fit the needs of the young people in their care.The study explores and describes South African school childrens perspectives of HIV and AIDS, and links this to their respective cognitive developmental stage. The paper highlights developmental differences in the childrens perceptions of HIV or AIDS and makes specific recommendations for improving HIV/AIDS education in school. A questionnaire of mainly open-ended questions was used to survey the HIV/AIDS-related perceptions of 1 904 school-going children aged 6 to 19 years. In-depth content analyses as well as basic statistical analyses were performed on the data. Although the school children had a good basic knowledge of HIV/AIDS and generally positive attitudes towards HIV and AIDS, they believed many misconceptions and myths. The children were mostly very afraid of HIV or AIDS and felt extremely vulnerable to HIV infection. The particular developmental phase was the strongest predictor of a childs understanding of HIV/AIDS. The findings have been used to formulate guidelines for the development or ...

The embryologist as counsellor during assisted reproduction procedures

This study aimed to establish whether patients who receive support counselling by the embryologist as counsellor during assisted reproduction procedures would be better equipped with efficient coping mechanisms than patients who were not counselled. Sixty patients were randomly assigned to either the support counselling or the control groups. Questionnaires, measuring pre- and post-treatment levels of anxiety, depression and ways of coping, were presented to both groups. The support counselling group received emotional support and counselling from the embryologist. The control group were treated routinely, received no counselling or emotional support and were asked to phone the gynaecologist daily concerning embryo development. Despite reliable internal consistency, the hypothesis was not accepted due to non-significant differences between the groups. However, t-tests indicated a changed pattern of behaviour within the support counselling group, who experienced a statistically significant (P < 0.017) reduction in anxiety levels after the counselling intervention, as well as increased use of problem-focused coping strategies, such as instrumental action, in dealing with the demands of the treatment programme.

The Relationship Between Relative Deprivation and the Attitudes of Rural Afrikaans-Speaking Women Toward Blacks

ABSTRACT We investigated the relationship between different patterns of relative deprivation and attitudes toward Blacks in a random sample of 92 rural Afrikaans-speaking White women in the present and over time. The subjects experienced different patterns of relative deprivation when they compared their economic, social, and political positions to those of Blacks in the past and in the future. Significant negative relationships were found between the experience of different patterns of relative deprivation with respect to Blacks and attitudes toward Blacks.

Self-testing as strategy to increase the uptake of HIV testing in South Africa

With better health care and greater access to antiretrovirals (ARVs) it has become important to increase the uptake of HIV testing. Major testing campaigns have been launched in South Africa, but no official provision exists for clients who prefer self-testing for HIV. The purpose of this study was to investigate which HIV-testing model (client-initiated, provider-initiated or self-testing) a sample of South Africans preferred and why. A semi-structured questionnaire was completed by 466 participants and 9 provinces were represented by the sample. The results indicated that 22.3% of the participants preferred self-testing for HIV (while 66.1% preferred client-initiated and 11.6% provider-initiated counselling and testing). Participants who preferred self-testing for HIV were predominantly (p < 0.05) male, white, lived in cities or towns, did not know their HIV status, and had no intention of being tested at a medical facility in future. The underlying themes of why participants preferred self-testing for ...With better health care and greater access to antiretrovirals (ARVs) it has become important to increase the uptake of HIV testing. Major testing campaigns have been launched in South Africa, but no official provision exists for clients who prefer self-testing for HIV. The purpose of this study was to investigate which HIV-testing model (client-initiated, provider-initiated or self-testing) a sample of South Africans preferred and why. A semi-structured questionnaire was completed by 466 participants and 9 provinces were represented by the sample. The results indicated that 22.3% of the participants preferred self-testing for HIV (while 66.1% preferred client-initiated and 11.6% provider-initiated counselling and testing). Participants who preferred self-testing for HIV were predominantly (p < 0.05) male, white, lived in cities or towns, did not know their HIV status, and had no intention of being tested at a medical facility in future. The underlying themes of why participants preferred self-testing for HIV above testing in a medical facility were the need for privacy and confidentiality; the need to keep testing as well as the results secret; fear of discrimination and stigma; distrust in the health care system to keep results confidential; and an aversion to face-to-face counselling. Participants indicated that they would consider testing if self-testing for HIV with telephone counselling becomes readily available in their communities. HIV testing models in South Africa should be revisited and revised to offer people who would otherwise not be tested, with an alternative method of testing.

Impact of caring for people living with HIV on the psychosocial well-being of palliative caregivers

Acquired immunodeficiency syndrome (AIDS) continues to be a serious public health issue, and it is often the caregivers who carry the brunt of the epidemic. Caregivers of people with AIDS face distinctive demands that could make them more prone to occupational stress, with serious consequences for their psychosocial well-being. The impact of caring for people living with HIV infection on the psychosocial well-being of palliative caregivers was investigated using in-depth interviews and questionnaires in 28 participants. The results indicated no burnout, but occupational stress was prevalent. Factors impacting negatively on well-being were stressors inherent in AIDS care, such as suffering and dying of the persons being cared for, work-related stressors such as heavy workload, lack of support and ineffective coping mechanisms. Positive aspects of caring such as job satisfaction, holistic palliative care, effective coping mechanisms and psychosocial support were identified. Recommendations to curb the negative effects of caregiving are provided.