Mokhantso Makoae

Confidentiality or continuity? Family caregivers' experiences with care for HIV/AIDS patients in home-based care in Lesotho

In the context of poor access to antiretroviral therapies in sub-Saharan Africa, the minimum treatment package intended to treat opportunistic infections common with HIV infection is inadequate but appealing, since it presumes universal coverage of medical care for patients living with HIV and AIDS. The overall objective of this study was to analyse the challenges which family caregivers encountered in home-based care when they tried to access medical treatment for home-based AIDS patients in the context of confidentiality and limited medical care. A qualitative study using in-depth interviews with a sample of 21 family caregivers — 16 females and 5 males aged between 23 and 85 years was conducted with the assistance of health personnel in two hospitals in Lesotho. Using the concept of continuity of care, this article discusses the experiences of family caregivers about home care, including their experiences of adherence to confidentiality by health care professionals and non-disclosure of AIDS as the context of illness, the circumstances under which the caregivers initiated caregiving and sought medical care, and how these factors could be stressors in caregiving. There was continuity of care where the caregivers obtained hospital support. However, when confidentiality was adhered to the caregivers were frustrated by lack of information, disrupted treatment, exclusion of their perspectives in medical care, failure to secure hospitalisation, ambiguous goals and non-responsiveness, so that continuity of care was jeopardised. Thus it can be concluded that professional-assisted disclosure benefited the patients because it facilitated continuity of care through the caregivers.

The assessment of the readiness of five countries to implement child maltreatment prevention programs on a large scale

This study aimed to systematically assess the readiness of five countries - Brazil, the Former Yugoslav Republic of Macedonia, Malaysia, Saudi Arabia, and South Africa - to implement evidence-based child maltreatment prevention programs on a large scale. To this end, it applied a recently developed method called Readiness Assessment for the Prevention of Child Maltreatment based on two parallel 100-item instruments. The first measures the knowledge, attitudes, and beliefs concerning child maltreatment prevention of key informants; the second, completed by child maltreatment prevention experts using all available data in the country, produces a more objective assessment readiness. The instruments cover all of the main aspects of readiness including, for instance, availability of scientific data on the problem, legislation and policies, will to address the problem, and material resources. Key informant scores ranged from 31.2 (Brazil) to 45.8/100 (the Former Yugoslav Republic of Macedonia) and expert scores, from 35.2 (Brazil) to 56/100 (Malaysia). Major gaps identified in almost all countries included a lack of professionals with the skills, knowledge, and expertise to implement evidence-based child maltreatment programs and of institutions to train them; inadequate funding, infrastructure, and equipment; extreme rarity of outcome evaluations of prevention programs; and lack of national prevalence surveys of child maltreatment. In sum, the five countries are in a low to moderate state of readiness to implement evidence-based child maltreatment prevention programs on a large scale. Such an assessment of readiness - the first of its kind - allows gaps to be identified and then addressed to increase the likelihood of program success.

Family in a changing South Africa: structures, functions and the welfare of members

ABSTRACT The historical review of South African families reveals that the family has undergone significant transformations, resulting in a mosaic of family formations that have had an impact on family functions. Notwithstanding the importance of the family being one of the fundamental social units, however, there is limited data on how these families function in South Africa. This article analyses the change in family structures and community members’ perspectives about how these structures and living arrangements of members contribute to family functioning and wellbeing of members, with a specific focus on Mpumalanga, South Africa. Literature searches, quantitative analyses of the 2002 and 2009 General Household Survey, and qualitative analysis obtained through focus group discussions and in-depth interviews were used. The results confirmed that there is a disaggregation of families with young adults being heads of smaller families, while ageing parents are in charge of large multi-generational families. The role of the extended family has been diminished, and new forms of support such as churches and neighbours’ networks have become more important. The critical role of inter-generational care was confirmed and also the disjuncture between generations attributed to erosion of family norms and values. The results of the study emphasised the importance of attending to a simultaneous and comprehensive family policy that addresses psychosocial and material support, when assessing family wellbeing.

Addressing adolescents' risk and protective factors related to risky behaviours: Findings from a school-based peer-education evaluation in the Western Cape.

Abstract Background: Peer-education programmes aim to bring about attitudinal and behavioural changes in their target audience. In the South African educational context, peer education is a favoured approach in dealing with issues such as HIV and AIDS, sexual decision-making and substance misuse. Given the reliance on peer-education programmes in the educational system, it is important to establish how well they are working. This study aims to assess the effect of an extensive, structured, time-limited, curriculum-based, peer-led educational programme on first-year high school learners in public schools in the Western Cape Province of South Africa. Method: The curriculum called ‘Listen Up’ addresses issues such as supporting peers, sexual decision-making, healthy relationships, HIV risk, alcohol misuse and unwanted pregnancy in seven structured sessions. The programme targeted adolescents in Grade 8 growing up in what are considered to be risky environments in public schools in the Western Cape during 2012 and 2013. The intervention was evaluated based on 10 scales sourced from published literature related to the outcome indicators of future orientation, sensation-seeking, self-efficacy in sexual relations, HIV transmission knowledge, HIV prevention knowledge, HIV attitudes, sexual attitudes, decision-making, healthy relationships and social support. Descriptive statistics were used to analyse demographic and community characteristics and analyses of variance were used to detect differences between groups. The surveys were administered to a total of 7709 learners across three waves of the study in 27 peer intervention schools and eight control schools. Results: Immediately post intervention, statistically significant differences were noted for the intervention schools when compared to their baseline levels on measures of future orientation, self-efficacy in sexual relations, knowledge regarding HIV transmission, knowledge regarding HIV prevention and knowledge in terms of healthy relationships. Comparing baseline values with results collected between five and seven months post intervention, statistically significant results were noted for self-efficacy in sexual relations and knowledge regarding HIV transmission. Conclusion: The findings of this study suggest that peer-education can improve adolescents’ self-efficacy in sexual relations as well as knowledge regarding the transmission of HIV and therefore can contribute to the prevention of HIV transmission among adolescents.

The Role of the Private Sector in HIV and AIDS Interventions in Developing Countries: The Case of Lesotho

The HIV and AIDS pandemic enters its fourth decade of expansion having undermined every aspect of society. This is particularly the case in sub-Saharan Africa, which remains the most heavily affected region, accounting for 72% of all new infections in 2008, and for 68% of the global number of people living with HIV in 2009 (United Nations, 2010; UNAIDS, 2010). UNAIDS further reports that during 2009 alone an estimated 1.3 million adults and children died as a result of AIDS in sub-Saharan Africa and that more than 15 million have died in the region since the beginning of the epidemic in the early 1980s (UNAIDS, 2008; 2010). The impact of the epidemic in sub-Saharan Africa is widely felt in, among others, the health, education, agriculture, mining, transport and other production sectors. Furthermore, to the extent that the vast majority of people living with HIV and AIDS are between the ages of 15 and 49 years—in the prime of their working lives (International Labour Organisation, 2006), the epidemic weakens economic activity through decreased productivity due to absenteeism resulting from sickness, caring for family and dependents; and organizing and attending funerals; low morale at work due to losing family, friends and colleagues; increased costs due to rising health insurance, sick leave, funeral costs, recruiting and training skilled workers; and reduced labour supply due to increased mortality (Phororo, 2003; Sidhu, 2008). Government income also declines as tax revenues fall and governments are pressured to increase their spending to deal with the expanding epidemic (Avert, 2011). It is largely against this background that the 2001 United Nations Declaration of Commitment on identified the private sector as an essential part of the national and global responses to [HIV and AIDS]. In line with this Declaration, and as the epidemic continues to affect the working population, the private sector in Africa has over the past years scaled up its response by complementing the work of the traditional public sector and civil society actors (Sidhu, 2008). Progressive companies throughout the region are putting in place a wide range of HIV and AIDS prevention, care, and treatment programmes. These include education and awareness campaigns; training of peer educators; distribution of condoms; promotion of HIV testing; and treatment of, and protection against, other sexually transmitted infections (Rosen et al, 2007). The prevention programmes are typically designed to reduce the incidence of the epidemic in the workplace. Care and treatment