Kaymarlin Govender

A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: A randomized controlled pilot study

BACKGROUND Co-morbid depression in HIV-positive patients on anti-retroviral (ART) treatment poses a public health threat. It compromises treatment adherence and accelerates disease progression. This study aimed to assess the feasibility of a group-based counselling intervention for depressed HIV-positive patients in primary health care (PHC) in South Africa using a task shifting approach. METHODS Using a randomized control design, 76 HIV-positive patients with co-morbid depression were initially recruited. This reduced to 34 in the final cohort. Participants were assessed using the Patient Health Questionnaire (PHQ9), Hopkins Symptom Checklist (HSCL-25) and Multidimensional Scale of Perceived Social Support (MSPSS) at baseline and 3-month follow-up. The intervention was adapted from a local group-based Interpersonal Therapy (IPT) intervention. Process evaluation interviews were held with the HIV counsellors who delivered the intervention and a sub-sample of participants. RESULTS Repeated measures ANOVA analysis showed significantly greater improvement on depression scores on the PHQ9 in the intervention group compared to the control group. A significant decline in the mean scores on the HSCL-25 was found for both groups although this was more pronounced for the intervention group. There was no significant improvement in the MSPSS scores. LIMITATIONS The small sample size of the final cohort affected the power of the study to detect significant differences between the intervention and control groups on the MSPSS. Longer term impact of the intervention is unknown. CONCLUSIONS These preliminary findings suggest that group-based counselling for depression in HIV-positive patients can potentially be effectively delivered by appropriately trained and supported lay HIV counsellors. The need for a larger trial is indicated.

Masculinity and HIV disclosure among heterosexual South African men: implications for HIV/AIDS intervention.

Relationships and constructions of masculinity are central to understanding the process of male HIV disclosure, which is an important step towards accessing HIV-related services. Data from in-depth interviews and focus-group discussions with 23 HIV-positive, self-identified heterosexual, Black South African men were used to explore the disclosure process and how this process was negotiated in the context of constructions of masculinity. Of these men, 20 had disclosed to one or more persons, with partners and siblings being the preferred confidants. Disclosure was dependent on the acceptance of HIV status, perceived support and healthy relationships with others, HIV counselling and participation in educational and training activities. Non-disclosure was explained as a result of stigma, fear of rejection, discrimination, a lack of healthy relationships with others and lack of access to suitable disclosure strategies. Negative perceptions of HIV and hegemonic conceptions of masculinity hindered men from disclosing and seeking health services. Many men, however, managed to renegotiate their masculine identities to become responsible, knowledgeable HIV-positive individuals, protecting their families and becoming community educators. Findings suggest the need to consider gendered, contextual, skills-building/income-generating and guided interventions to promote male HIV disclosure and service uptake.

The influence of anger, impulsivity, sensation seeking and driver attitudes on risky driving behaviour among post-graduate university students in Durban, South Africa

INTRODUCTION Road traffic accidents (RTAs) constitute a serious global health risk, and evidence suggests that young drivers are significantly overrepresented among those injured or killed in RTAs. This study explores the role of anger, impulsivity, sensation seeking and driver attitudes as correlates for risky driving practices among drivers, drawing comparisons between age and gender. METHOD The study used a cross-sectional survey design, with a sample of 306 post-graduate university students from two universities in Durban, South Africa, who completed the self-administered questionnaire. RESULTS The results indicate that drivers with higher driver anger, sensation seeking, urgency, and with a lack of premeditation and perseverance in daily activities were statistically more likely to report riskier driving acts. Males reported significantly more acts of risky driving behaviour (RDB) than females. Driver attitudes significantly predicted self-reported acts of RDB on most indicators. Older drivers (25 years and older) had safer driver attitudes and a lower sense of sensation seeking and urgency in life. CONCLUSION Interventions targeting young drivers, which focus on impeding the manifestation of anger, impulsivity and sensation seeking are recommended. Also, the empirical support for the attitude-behaviour hypothesis evidenced in this study vindicates the development or continuation of interventions that focus on this dynamic.

Children’s psychosocial wellbeing in the context of HIV/AIDS and poverty: a comparative investigation of orphaned and non-orphaned children living in South Africa

BackgroundRecent studies have questioned whether orphanhood is primarily associated with key dimensions of psycho-social wellbeing in children living in circumstances of material deprivation and high prevalence of HIV and AIDS.MethodsThis study uses cross-sectional data from a longitudinal study conducted between 2004-2007 to examine the psychosocial well-being of orphans and non-orphans in the Amajuba District of KwaZulu-Natal, South Africa. Psychosocial wellbeing included an assessment of orphans’ and non orphans’ level of anxiety and depression, affability and resilience. Stratified cluster sampling, based on both school and age, was used to construct a cohort of recent orphans and non-orphans and their households, randomly selected from schools.ResultsLevels of anxiety and depression, affability and resilience did not differ significantly between orphans and non-orphans, nor did salient household, poverty and caregiver characteristics vary substantially amongst orphans and non-orphans. Multivariate analyses indicated that children’s psychosocial outcomes, when controlling for orphan status and related demographic variables were more strongly influenced by household composition/size, living above or below the poverty threshold and factors associated with the caregiver-child relationship and caregiver health.ConclusionsThe results muster additional evidence for moving beyond narrow definitions of vulnerability associated exclusively with orphanhood to consider the multitude of material, social and relational factors affecting the psycho-social well-being of children in general who are living in circumstances of poverty and HIV and AIDS.

Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu-Natal, South Africa

Epidemiological modelling has concluded that if voluntary medical male circumcision (VMMC) is scaled up in high HIV prevalence settings it would lead to a significant reduction in HIV incidence rates. Following the adoption of this evidence by the WHO, South Africa has embarked on an ambitious VMMC programme. However, South Africa still falls short of meeting VMMC targets, particularly in KwaZulu-Natal, the epicentre of the HIV/AIDS epidemic. A qualitative study was conducted in a high HIV prevalence district in KwaZulu-Natal to identify barriers and facilitators to the uptake of VMMC amongst adolescent boys. Focus group discussions with both circumcised and uncircumcised boys were conducted in 2012 and 2013. Analysis of the data was done using the framework approach and was guided by the Social Cognitive Theory focussing on both individual and interpersonal factors influencing VMMC uptake. Individual cognitive factors facilitating uptake included the belief that VMMC reduced the risk of HIV infection, led to better hygiene and improvement in sexual desirability and performance. Cognitive barriers related to the fear of HIV testing (and the subsequent result and stigmas), which preceded VMMC. Further barriers related to the pain associated with the procedure and adverse events. The need to abstain from sex during the six-week healing period was a further prohibiting factor for boys. Timing was crucial, as boys were reluctant to get circumcised when involved in sporting activities and during exam periods. Targeting adolescents for VMMC is successful when coupled with the correct messaging. Service providers need to take heed that demand creation activities need to focus on the benefits of VMMC for HIV risk reduction, as well as other non-HIV benefits. Timing of VMMC interventions needs to be considered when targeting school-going boys.

Weighing up the burden of care on caregivers of orphan children: The Amajuba District Child Health and Wellbeing Project, South Africa

This paper assesses the burden on orphan caregivers relative to non-orphan caregivers in the context of high HIV/AIDS mortality in South Africa. It presents findings from the third round of a study conducted in the Amajuba District of KwaZulu-Natal between 2003 and 2007. Significant differences were found between orphan and non-orphan caregivers; the former being more likely to care for more children, have poorer health, higher levels of chronic illness, less adult help and they appeared to have more daily responsibilities. Orphan caregivers were also more likely to indicate that children in their care needed help for mental or behavioural problems but overall results showed that only 3.4% of all households had contact with child welfare agencies. The findings question assumptions about the capacity and capability of the extended family to absorb shocks to individuals and families.

An exploratory study of the individual determinants of students’ sexual risk behaviour at a South African university

The prevalence of sexual risk behaviour is high on campuses at South African universities, putting many students at risk of HIV infection. This study explores individual influences on students’ sexual risk-taking behaviour at the University of KwaZulu-Natal. The study collected cross-sectional data obtained between late 2008 and early 2010. A total of 80 in-depth interviews and four focus group discussions were conducted, allowing for an equal representation of males and females and a mix of different races (black, white, Indian and coloured) among students at two campuses (Howard College and Pietermaritzburg) and at different levels of study (undergraduate and postgraduate). The data were analysed using thematic analysis to identify factors associated with the students’ sexual risk behaviour. Sexual risk behaviour was found to be influenced by a range of individual factors, especially: personal beliefs about long-term relationships; attitudes towards sex for variety; a drive for material wealth; a lack of satisfaction in relationships; levels of trust and attention; pursuit of the long-term goal of marriage; and HIV denialism. As young adults, university students lack experience in assessing influences on their risk-taking behaviour, thus they require education on the individual risk factors that put them at risk of acquiring HIV infection. Likewise, the nature of these factors pose significant challenges to reducing sexual risk behaviour among university students.

Resourcing resilience: social protection for HIV prevention amongst children and adolescents in Eastern and Southern Africa

Adolescents are the only age group with growing AIDS-related morbidity and mortality in Eastern and Southern Africa, making HIV prevention research among this population an urgent priority. Structural deprivations are key drivers of adolescent HIV infection in this region. Biomedical interventions must be combined with behavioural and social interventions to alleviate the socio-structural determinants of HIV infection. There is growing evidence that social protection has the potential to reduce the risk of HIV infection among children and adolescents. This research combined expert consultations with a rigorous review of academic and policy literature on the effectiveness of social protection for HIV prevention among children and adolescents, including prevention for those already HIV-positive. The study had three goals: (i) assess the evidence on the effectiveness of social protection for HIV prevention, (ii) consider key challenges to implementing social protection programmes that promote HIV prevention, and (iii) identify critical research gaps in social protection and HIV prevention, in Eastern and Southern Africa. Causal pathways of inequality, poverty, gender and HIV risk require flexible and responsive social protection mechanisms. Results confirmed that HIV-inclusive child-and adolescent-sensitive social protection has the potential to interrupt risk pathways to HIV infection and foster resilience. In particular, empirical evidence (literature and expert feedback) detailed the effectiveness of combination social protection particularly cash/in-kind components combined with “care” and “capability” among children and adolescents. Social protection programmes should be dynamic and flexible, and consider age, gender, HIV-related stigma, and context, including cultural norms, which offer opportunities to improve programmatic coverage, reach and uptake. Effective HIV prevention also requires integrated social protection policies, developed through strong national government ownership and leadership. Future research should explore which combinations of social protection work for sub-groups of children and adolescents, particularly those living with HIV.

Comparative economic positions of orphan, non-orphan and mixed households: Findings from round 3 of the Amajuba District Study in KwaZulu-Natal, South Africa

The HIV and AIDS pandemic in sub-Saharan Africa has orphaned many children, leaving the extended family responsible for their care. We use findings from a longitudinal study on child welfare in South Africa to compare the economic status of households that support only orphaned children (orphan households), those that support both orphan and non-orphan children (mixed households), and households that support only children whose parents are alive (non-orphan households). We ask the question “Which household type is the worst off?” We also discuss the extent to which the social grants system is assisting in poverty reduction, with particular reference to households’ abilities to provide material care for its children. Generally, the situation is one of dire poverty; 64% of all households fell below the poverty line. While mixed households appear to be the “worst off”, this is due mainly to them being larger and, therefore, carrying a greater burden. Government social grants provide an economic safety net but our data suggests that child support grants, in particular, are not being accessed by many in need of them.

“Shaping up”: The relationship between traditional masculinity, conflict resolution and body image among adolescent boys in South Africa

In South Africa, traditional versions of masculinity that once bestowed power and privilege onto white heterosexual men are being contested. White adolescent males must negotiate this changing environment at a time when they themselves are engaging in the process of identity development. Given the recent emergence of the masculine body ideal, the muscular mesomorph, and its association with traditional masculinity, this study sought to examine the relationship between traditional masculinity, conflict resolution and body image among a sample of predominantly white adolescent males in South Africa. The relationships between these variables were examined in accordance with Connells theory of body-reflexive practices (1995), which views the body as both an “object” and “agent” of practice. Our findings revealed that support for traditional masculine norms among adolescent males was associated with the desire for a larger, more muscular body and the use of maladaptive conflict resolution styles that exhibit a low concern for the welfare of others. In the context of recent sociocultural changes, these findings suggest that conflict resolution and the redefinition of the male body may be an emerging arena that provides new possibilities for young white males to enact a form of male power that is seen to be maladaptive in our context.