George Petros

A Controlled Study of an HIV/AIDS/STI/TB Intervention with Traditional Healers in KwaZulu-Natal, South Africa

Traditional healers play an important role in southern Africa culture and health care including the HIV epidemic. Here we report among the first controlled studies of an HIV/AIDS, sexually transmitted infections (STI) and tuberculosis (TB) intervention for traditional healers in South Africa. At baseline 233 traditional healers were assessed in four selected communities in the KwaZulu-Natal province and received either an experimental intervention or a no intervention control condition. The intervention group received training in HIV/AIDS, STI, and TB prevention over 3.5 days as well as a supervisory follow-up visit. At 7–9 months follow-up intervention effects were significant for HIV knowledge and HIV and STI management strategies including conducting risk behavior assessments and counseling, condom distribution, community HIV/AIDS and STI education, and record keeping. The study found a high level of preparedness among traditional healers to work with and refer patients to biomedical health practitioners, yet no higher levels of referral to biomedical practitioners were found after the training.

HIV/AIDS/STI/TB knowledge, beliefs and practices of traditional healers in KwaZulu-Natal, South Africa.

Abstract The aim of this study was investigate the HIV/AIDS/STI and TB knowledge, beliefs and practices of traditional healers in South Africa. In a cross-sectional study 233 traditional healers were interviewed in three selected communities in KwaZulu-Natal. Results indicate that the most common conditions seen were STIs, a variety of chronic conditions, HIV/AIDS (20%) and tuberculosis (29%). Although most healers had a correct knowledge of the major HIV transmission routes, prevention methods and ARV treatment, their knowledge was poorer on other HIV transmission routes, and 21% believed that there is a cure for AIDS. A minority reported unsafe practices in terms of reuse of razor blades on more than one patients and the reuse of enema equipment without sterilization, and two-thirds used gloves when carrying out scarifications. Randomized control trials are called for to test the effectiveness of traditional healing for HIV/AIDS, STI and TB prevention and care.

Traditional circumcision during manhood initiation rituals in the Eastern Cape, South Africa: a pre-post intervention evaluation

BackgroundCircumcisions undertaken in non-clinical settings can have significant risks of serious adverse events, including death. The aim of this study was to test an intervention for safe traditional circumcision in the context of initiation into manhood among the Xhosa, Eastern Cape, South Africa.MethodsTraditional surgeons and nurses registered with the health department were trained over five days on ten modules including safe circumcision, infection control, anatomy, post-operative care, detection and early management of complications and sexual health education. Initiates from initiation schools of the trained surgeons and nurses were examined and interviewed on 2nd, 4th, 7th and 14th day after circumcision.ResultsFrom 192 initiates physically examined at the 14th day after circumcision by a trained clinical nurse high rates of complications were found: 40 (20.8%) had mild delayed wound healing, 31 (16.2%) had a mild wound infection, 22 (10.5%) mild pain and 20 (10.4%) had insufficient skin removed. Most traditional surgeons and nurses wore gloves during operation and care but did not use the recommended circumcision instrument. Only 12% of the initiates were circumcised before their sexual debut and they reported a great deal of sexual risk behaviour.ConclusionFindings show weak support for scaling up traditional male circumcision.

Disability grant for people living with HIV/AIDS in the Eastern Cape of South Africa.

A cross-sectional explorative descriptive qualitative/quantitative study was conducted in the Eastern Cape of South Africa. The qualitative component involved 38 HIV/AIDS stakeholders who were interviewed telephonically using a semi-structured interview schedule. The quantitative component comprised 607 People Living With HIV/AIDS (PLWHA) who were interviewed using a structured questionnaire. The majority of PLWHA were female, never married, unemployed, aged between 26 to 45 years, Black African, and had more than grade 7 education. All stakeholders supported the disability grant (DG) because it improved the lifestyle of PLWHA. The CD4 count was cited as the main criterion for putting PLWHA on the DG. The conditions and characteristics of the DG were not clearly explained to PLWHA. The DG application process was viewed to be too long. Access to service points was perceived as a challenge for some PLWHA. The DG was used to meet basic household and health care needs. Not being on a DG was associated with lower CD4 counts, often without enough food, and less often without needed medicines in the past 12 months. Having the DG stopped was associated with often not having enough medicines that were needed in the past 12 months. We conclude that the DG is a lifeline for most HIV/AIDS-affected families. We recommend that DG should not use CD4 cell counts as criterion for DG eligibility; the conditions and characteristics of the DG should be fully explained to recipients; the DG application process should be completed within one day; PLWHA who no longer qualify for the DG yet do not have adequate financial means to meet basic necessities should be put on a nutritional support program; and access to the location of the grants by the poor and vulnerable should be improved.

Primary health care service delivery in South Africa

PURPOSE The papers aim is to determine the role of non-profit organizations (NPOs) in filling possible gaps in primary health care (PHC) service provision. DESIGN/METHODOLOGY/APPROACH District (n = 10) and sub-district needs (n = 14) analyses were conducted in five South African provinces. In each case, the district/sub-district manager was interviewed using a semi-structured interview guide. FINDINGS The service gaps identified were understaffing/lack of capacity, difficulty in retaining and recruiting staff, service disparities, inaccessibility of services/low-service utilisation and limited funding. It was believed that NPOs could fill these gaps. About 83 per cent perceived the relationship between government and NPOs as good. Contract monitoring, quality of service, communication and quality control were said to be unsatisfactory. The majority of sub-districts (11) indicated that they provided supplies to NPOs; 50 per cent perceived the relationship between the sub-districts and NPOs as good or very good. NPOs have critical role to play in PHC service delivery. ORIGINALITY/VALUE The study provides critical information required to make informed effective strategic decisions that support district/sub-district performance and sustainability in a decentralized health system.

Hazardous Alcohol Use among Persons Living with Human Immunodeficiency Virus Infection in the Eastern Cape, South Africa

The study assessed the prevalence of hazardous alcohol use among people living with HIV (PLHIV) and its correlates with socio-economic characteristics, disease variables and ART adherence in South Africa. The sample included 607 PLHIV (males =475, females =132; age range =18–61), sampled by all districts in the Eastern Cape. Participants were recruited through a health facility in the community through key informants or a support group. Results indicate that male PLHIV were more often than female PLHIV “past month” (18.9% vs. 6.1%) and hazardous alcohol drinkers (6.1% vs. 2.7%); using a cut-off score of 8 and more on the Alcohol Use Disorders Identification Test (AUDIT). Not having a disability grant for HIV/AIDS and the disability grant terminated were both related to past month alcohol use, while having the “disability grant stopped” was also related with hazardous or harmful drinking. Not having an AIDS diagnosis and not being on ART were both associated with past month alcohol use and hazardous or harmful drinking. CD4 counts and non-adherence to ART were both not significantly related with alcohol use status. Brief health provider initiated alcohol interventions for PLHIV should be promoted, with emphasis on targeting men.