Priscilla Reddy

Health care seeking behaviour of patients with sexually transmitted diseases: determinants of delay behaviour

The study aimed to determine the factors associated with a delay in seeking health care for symptoms of sexually transmitted diseases (STDs) among a sample of 1482 patients attending STD clinics. Of the sample 78% were male, 58% sought help from the clinic within the first 6 days of noticing symptoms, 24% waited between 7 and 10 days and 17% waited longer than 10 days before seeking health care. Patients who delayed were those who treated themselves prior to seeking health care, who were female, whose friends waited before seeking treatment, who held misconceptions regarding the cause of STDs, who perceived STDs not to be serious and who valued personal autonomy in sexual behaviours less and had less positive outcome expectations of refusing sex. The data suggest that targeted interventions should be directed specifically at women and the youth. Early health care seeking could be facilitated through improved basic knowledge regarding STDs, control over ones own sexual behaviour and social support for early health care seeking.

Sexual behaviour of Cape Town high-school students

OBJECTIVES To document prevalence rates for selected aspects of sexual behaviour among Cape Town high-school students and to conduct a survival analysis of age at first intercourse. DESIGN Cross-sectional survey. SETTING State high schools in Cape Town. SUBJECTS A multistage cluster sample of 2,740 grade 8 and 11 students at 39 schools. OUTCOME MEASURES Ever having had sexual intercourse; for those who had, age at first intercourse, number of partners during the previous 12 months, time since last intercourse; and, at last intercourse, whether the partner had been known for more than 7 days, whether any method was used to prevent pregnancy or disease, and (if so) what was used. RESULTS Overall, 29.9% had participated in sexual intercourse, with a higher proportion among males and those in grade 11. By the age of 14 years, 23.4% of males and 5.5% of females had participated in sexual intercourse. By the age of 19 years, these proportions were 71.8% and 58.2% respectively. The median time since last intercourse was 4 weeks, the median number of partners in the past year was 1, and 78.4% had known their most recent partner for more than 7 days. At their last coital episode, 65.4% had used contraception, and the most common methods were condoms and injectable steroids, which were used by 67.7% and 43.2% respectively. CONCLUSIONS The proportion of sexually active students has increased since 1990. Intervention programmes should commence in primary school. Large numbers of students are at risk for pregnancy and sexually transmitted infections.

Sex differences in under and over nutrition among school-going Black teenagers in South Africa: an uneven nutrition trajectory

Objectives  To investigate the nutritional status of Black South African teenagers by sex and compare it with nutritional profiles of teenagers from other countries.

STD-related knowledge, beliefs and attitudes of Xhosa-speaking patients attending STD primary health-care clinics in South Africa

The primary aim of this study was to describe patients at sexually transmitted disease (STD) clinics in Cape Town, South Africa, in terms of gender, education and age differences relative to their STD knowledge and beliefs, their condom use, as well as their attitudes towards condom use and their condom-use behaviour. The information was collected with a view to developing a health education intervention. Structured interviews were conducted with 2978 randomly sampled Xhosa-speaking STD clinic attenders about their knowledge, beliefs and practices regarding STDs and related behaviours. More males (75%) than females (25%) presented for STD treatment. The majority of patients (92%) were younger than 35 years. Female patients were found to be more aware than male patients of the sexual nature of STD transmission, valued personal autonomy in sexual behaviour and expressed a greater need to use condoms. Males perceived STD symptoms to be more serious, had more misconceptions about the cause of STDs and also more negative beliefs and attitudes towards condom use. Only 34.9% of the patients reported using condoms in the last 6 months while only 24.5% reported regular use. Those who reported condom use were more knowledgeable about the sexual transmission of STDs and the effects of STDs on the neonate. They also had fewer misconceptions about the causes of STDs and perceived STD symptoms to be more serious, attached greater value to personal autonomy in sexual behaviour and condom use and had more positive outcome expectancies of refusing sex than those who never used condoms. The data suggest that targeted interventions directed at males will have to address their inadequate knowledge regarding STDs in terms of transmission, causes, consequences, prevention and cure. Their negative beliefs and attitudes towards condoms will need special attention, especially in view of their multiple partner behaviour. Interventions directed at females will need to improve their knowledge regarding STD consequences, causes, recognition of symptoms as well as improve their knowledge of aspects of prevention and cure. All interventions must facilitate personal autonomy in decision making about sexual behaviour and condom use for both men and women, through skills development programmes that promote self-efficacy in the individual and instil a culture of mutual respect of such in the community.

Condom use promotion among isiXhosa speaking women living with HIV in the Western Cape Province, South Africa: a pilot study

Abstract The prevalence of HIV infection continues to increase among women in South Africa while there are few interventions specifically targeting condom use promotion in this population. We report the results of an experimental pilot study of a health education intervention aimed at enhancing coping skills and consistent condom use among HIV-positive women attending primary health clinics in the Western Cape province of South Africa. One hundred and twenty women were randomised into the intervention condition or a control condition. Both groups completed an interviewer administered questionnaire that included measures of self-esteem, attitude towards condom use, and self-efficacy towards condom use and negotiating condom use, and provided vaginal swab specimen at baseline and three months after the intervention. Tests for intervention effects at three months while controlling for baseline revealed that only self-esteem was significantly higher in the intervention group relative to the control group. No significant differences were found on measures of coping skills and condom use behaviour. Importantly, incidence for Chlamydia Trachomatis, Neisseria Gonorrhea and Trichomona vaginalis during the study period were significantly lower in the intervention group than the control group. These results are strong indications that this intervention could serve as a basis for the development of potentially effective interventions to reduce STI-related sexual risk behaviours among HIV-positive black women in South Africa.

The Effectiveness of a Peer-Led HIV/AIDS and STI Health Education Intervention for Prison Inmates in South Africa

This article reports on the effectiveness of the first systematically developed health education intervention for the reduction of risky sexual behavior among soon-to-be-released prisoners in South Africa. Data from three out of four prisons are eligible for data analysis including 263 inmates. Using a nested experimental design, short-term evaluation while inmates were still in prison demonstrate that experimental groups showed higher knowledge of sexually transmitted infections and had a more positive intention to reduce risky behavior than the control group in two out of three prisons. Long-term assessment 3 to 6 months after release from prison indicates that experimental groups were more positive about sexual communication, self-efficacy, and intention. Groups educated by an HIV-negative educator perform marginally better than those in groups with an HIV-positive peer educator. It is argued that peer-led health education programs may be effective in reducing risky behavior amongst soon-to-be-released inmates.

The Impact of a Community-based Pilot Health Education Intervention for Older People as Caregivers of Orphaned and Sick Children as a Result of HIV and AIDS in South Africa

The increasing HIV and AIDS epidemic in South Africa poses a substantial burden to older people, in particular older women who mainly provide care for sick adult children and their grandchildren who have become orphaned and rendered vulnerable by the death or illness of their parents. In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge. The results provided valuable information upon which the development of future interventions may be based and psychosocial and structural needs of the older caregivers may be addressed by relevant stakeholders.

SISTA South Africa: The adaptation of an efficacious HIV prevention trial conducted with African-American women for isiXhosa-speaking South African women

Although new HIV treatments continue to offer hope for individuals living with HIV, behavioural interventions shown to reduce HIV risk behaviour remain one of the most powerful tools in curbing the HIV epidemic. Unfortunately, the development of evidencebased HIV interventions is a resource-intensive process that has not progressed as quickly as the epidemiology of the disease. As the epidemic continues to evolve, there is a need to expedite the development of evidence-based HIV interventions for populations that are often disproportionately impacted by HIV/AIDS. One mechanism of accelerating the development process is to adapt evidence-based HIV interventions for vulnerable populations. The aim of this paper was to describe the adaptation process of a HIV intervention for African-American women for black South African Xhosa women. For African-American women the intervention was effective in increasing consistent condom use, sexual self-control, sexual communication, sexual assertiveness and partner adoption of norms supporting consistent condom use.

Psychosocial determinants of suicide attempts among black south african adolescents: a qualitative analysis

In South Africa, one in five adolescents attempt suicide. Suicide attempts continue to rise. We aimed to identify psychosocial target points for future educational interventions. One-to-one semi-structured interviews were conducted to explore psychosocial factors associated with past suicide attempts among suicide survivors in Limpopo province, South Africa. A total of 14 adolescents (eight girls and six boys) who recently attempted suicide were interviewed. Lack of knowledge of available counsellors, conflicts in interpersonal relationships, perceived accusations of negative behaviour, inadequate social support, past family and peer suicide attempts and poor living circumstances were factors found to be related with suicide attempts. This study suggests that availability and access to counselling is essential in the prevention of suicide among young people, at both the individual level and family level.

Correlates of grief among older adults caring for children and grandchildren as a consequence of HIV and AIDS in South Africa

Objectives: Over the past few years, older people have become the main caregivers for their sick adult children and orphaned grandchildren due to HIV/AIDS in South Africa. This article aims to investigate the scope of care provided by older people, with a specific focus on the experience of grief due to multiple losses and its correlates. Methods: Quantitative interviews were conducted among 820 isiXhosa speaking caregivers of 60 years and older in the Eastern Cape of South Africa. Results: Older persons are involved in a wide range of care activities with several dependents to care for. Grief among older adults is most strongly predicted by perceived stigma around HIV and AIDS and worries about providing the care. Discussion: This study provides insight into correlates of grief among older caregivers and results in useful information to inform the development of interventions to assist older persons in coping with their responsibilities as caregivers.