Rachel T. Lebese

Professional nurses' views regarding stigma and discrimination in the care of HIV and AIDS patients in rural hospitals of the Limpopo province, South Africa.

The aim of the study was to determine the views of professional nurses on the manifestations of HIV and AIDS stigma and discrimination and their influence on the quality of care rendered to people living with HIV and AIDS in three rural hospitals of Limpopo province, South Africa. The study was qualitative, exploratory, descriptive and contextual in nature. The population included all professional nurses registered with the South African Nursing Council who were working with confirmed HIV-positive patients in the three hospitals and had received specialised training in voluntary counselling and testing (VCT), antiretrovirals (ARV), prevention of mother-to-child transmission (PMTCT) and couple counselling. A purposive sampling method was used to select both the wards and participants, based on set criteria. A total of 9 wards (6 adult medical and 3 maternity) and 37 participants were selected. Focus group discussions and semi-structured and key informant interviews were conducted. Data were analysed using a combination of data analysis guidelines from different sources. Results revealed that professional nurses were aware of the existence of HIV and AIDS stigma and discrimination in their wards and regarded these as bad and improper care of HIV-positive patients. Behaviour included leaving care of HIV patients to junior members of staff with limited skills and knowledge of HIV and AIDS; showing HIV-positive patients that their disease was dangerous and contagious; judgmental behaviour towards and stereotyping of HIV-positive patients; and regarding patients with HIV and AIDS as uncooperative and problematic in the wards.

The psychological experience of HIV and AIDS by newly diagnosed infected patients at Hospital A of Vhembe district, Limpopo province.

South Africa has one of the fastest growing rates of new HIV infection in the world. It is estimated that 5.7 million people in South Africa were infected with HIV. A combination of poverty, illiteracy, migrant labour, commercial sex workers and disruption of family and communal life has increased the individual’s risk of infection. The purpose of this study was to explore and describe the psychological experiences of HIV/AIDS by infected persons in Hospital A in the Vhembe district of Limpopo Province. The research design was qualitative, exploratory and descriptive, using the phenomenological approach. The target group for this study were males and females who visited the institution seeking health care, whose blood samples were found to be HIV positive, between the ages of 18 and 49 years at Hospital A in the Vhembe district of Limpopo Province. A convenience sampling method was used. Data was collected through in-depth unstructured one-to-one interview. Three phases suggested by Miles and Huberman were used which are: data display; in data reduction and lastly during data interpretation. Measures to ensure trustworthiness and ethical issues were ensured. The effects of HIV/AIDS on the infected persons were identified and the following theme and sub-theme: Psychological experiences, factors contributory to psychological imbalance and observations. Living with HIV/AIDS poses tremendous psychological and physical challenges to those who are infected. The experience of HIV-related symptoms is a significant part of that challenge. The physical and psychological symptoms are profoundly disruptive and impact on almost every aspect of daily life.

Experiences of family members caring for tuberculosis patients at home at Vhembe district of the Limpopo Province.

Tuberculosis (TB) is a potentially serious infectious disease which enters the body by inhalation and usually affects the lungs. TB is ranked amongst the leading infectious diseases worldwide, and in South Africa (SA) it has become an epidemic, because of its high prevalence. There are multiple factors that were found to attribute to the existence and spread of this disease. The purpose of this study was to explore and describe experiences of family members caring for TB patients at home, in the Vhembe District of the Limpopo Province. The study was qualitative, explorative, descriptive, phenomenological and contextual in nature. The population group selected for the study all comprised of family members caring for tuberculosis patients at home in Tshifulanani village. A purposive sampling method was applied in the study. Data were collected through semi-structured interviews guided by three questions. Techs eight steps of data analysis were followed. Measures to ensure trustworthiness and ethical issues were observed. The results of the study revealed that family members experienced difficulties when they care for TB patients at home. These difficulties included providing food, attending to hygiene needs, the lack of equipment, financial constraints as well as physical and psychological exhaustion. Recommendations were made concerning the provision food, attending to hygiene needs, assisting in the administration of medication, nursing practice and policy making.

Needs assessment for adapting TB directly observed treatment intervention programme in Limpopo Province, South Africa: A community-based participatory research approach

Background Limpopo Province is one of the hardest hit by tuberculosis and human immune virus infections in the country. The province has been implementing a directly observed treatment strategy since 1996. However, the cure rate was 64% in 2015 and remains far from the set target by the World Health Organization of 85%. Poor health-care seeking and adherence behaviours were identified as major risk behaviours. Aim To apply a Community-Based Participatory Research (CBPR) approach in identifying barriers and facilitators to health-care seeking and adherence to treatment, and to determine strategies and messages in order to inform the design of an adapted intervention programme. Setting This study was conducted in three districts in the Limpopo Province, Capricorn, Mopani and Sekhukhune districts. Methods The community participatory research approach was applied. Purposive sampling was used to sample participants. Focus group discussions were used to collect data. Participatory analysis was used comparing findings within and across all the participants. Results A total of 161 participated in the study. Participants included coordinators, professional nurses, supporters and patients. Major modifiable behavioural-related barriers were lack of knowledge about tuberculosis, misinformation and misperceptions cultural beliefs, stigma and refusal of treatment support. Environment-related barriers were attitudes of health workers, lack of support by family and community, lack of food and use of alcohol and drugs. Strategies and messages included persuasive and motivational messages to promote healthy behaviour. Conclusion Joint programmatic collaboration between the community and academic researchers is really needed for interventions to address the needs of the community.

The intimate partner violence experiences of sexual assault, a risk factor on the transmission of HIV infection among women in the Vhembe District of Limpopo Province, South Africa.

Violence against women is present in every country and it cut across boundaries of culture, class, education, income, ethnicity and age. Research has shown that there are links between HIV and AIDS, gender inequity and gender based violence that prevents women from influencing the circumstances of sex, resulting in unsafe sex practice and contracting of sexually transmitted infections including HIV and AIDS. The overall objective of the study was to increase understanding of Intimate Partner Violence experiences of sexual assault, its risk factor on the transmission of HIV infection among women admitted in Trauma Unit A of a particular hospital in the Vhembe District. This raises the questions “What is the women’s experience of sexual assault? Is sexual assault a risk factor to the transmission of HIV infection among women?” The research design was qualitative, exploratory descriptive and contextual in nature. In this study the target population consisted of all women who made use of a trauma unit A ata particular hospital in the LimpopoProvince. Six participants were selected by means of purposive sampling. In-depth individual interviews were conducted, using a voice recorder. The principles outlined by Lincoln and Guba were followed to ensure the trustworthiness of the study. Data analysis was guided by Tesch’s principles of qualitative data analysis. The findings of the study reflected that women experienced Intimate Partner Violence sexual assault in their lives and that sexual assault is a risk factor to the transmission of HIV infection among women. The study therefore, suggests a need for screening and prevention programmes that aims to reduce Intimate Partner Violence and HIV infection

The views of the elderly on the impact that HIV and AIDS has on their lives in the Thulamela Municipality, Vhembe District, Limpopo province

Background HIV and AIDS have a devastating impact on the lives of elderly people, particularly so because they are often expected to take care of their terminally ill children and assume the responsibility of looking after children orphaned by AIDS - in most cases with very little resources. Objectives The study sought to achieve to describe the views of elderly people regarding the impact of HIV and AIDS on their lives, to determine the challenges that elderly people living with HIV or AIDS (EPLWHA) face in their daily lives, and to gain a sense of the coping strategies they use to overcome the obstacles they face in relation to HIV and AIDS. Ethical issues, such as permission to conduct the study, informed consent, confidentiality and anonymity, withdrawal of participation and measure to ensure trustworthiness, were ensured. Design This was a qualitative, explorative, descriptive study. Participants were interviewed using an interview guide. Information provided by the participants was captured on a tape recorder and analysed using open coding, and thereafter collated into themes, categories and sub-themes. Results The study findings revealed that HIV and AIDS have serious negative impacts on the lives of elderly people, particularly those living in poverty. The following key areas in relation to EPLWHA were established: psychological or emotional health, as well as household and socio-economic burdens. Considering the role that elderly people play in the community in so far as HIV and AIDS are concerned, primary health promotion and social welfare programmes should be directed at educating all elderly people and their service providers on how to cope with the health and social problems related to HIV and AIDS.

Views of professional nurses regarding low tuberculosis cure rate in Greater Giyani Municipality, Limpopo Province

BACKGROUND Management of patients suffering from tuberculosis (TB) after discharge from hospital plays a critical role in the cure rate of TB. Despite interventions developed by the World Health Organization (WHO) to improve the cure rate, TB remains a worldwide health problem. OBJECTIVE The purpose of the study was to explore and describe the views of professional nurses regarding the low TB cure rate in primary healthcare facilities of Greater Giyani Municipality in Limpopo Province, South Africa, with the aim of determining strategies that can be used to improve this low rate. METHOD This study was qualitative, exploratory, descriptive and contextual in nature. The population consisted of professional nurses working in primary healthcare facilities within Greater Giyani Municipality, which has a TB cure rate below the national target of 85%. Data gathering was through individual face-to-face interviews using an interview guide. Open-coding was used to analyse the data in this study. RESULTS The theme that emerged from data was ‘factors contributing to low TB cure rate’. This theme was supported by the following sub-themes: poor referral system, lack of knowledge about TB and its treatment, stigma attached to TB, and cultural and religious beliefs. The professional nurses suggested counselling of TB patients upon diagnosis, advice about patients’ responsibilities and the involvement of family members. CONCLUSION The involvement of community stakeholders in TB prevention, health promotion and education activities devoted to disease spread and cure is vital so that the stigma attached to TB can be eliminated. TB education and awareness programmes should be included in the curriculum of primary schools.

Challenges faced by caregivers of children on antiretroviral therapy at Mutale Municipality selected healthcare facilities, Vhembe District, Limpopo Province

Background Children depend solely on caregivers who can be either parents or guardians for drug administration to enhance adherence to antiretroviral treatment (ART), which might pose any number of challenges. Purpose The purpose of this study was to explore and describe the challenges faced by caregivers of children on ART at Mutale Municipality, Vhembe District, Limpopo Province. Research design and method The research design was qualitative, explorative, descriptive and contextual in nature. The population consisted of 16 caregivers who were 18 years of age and above, and mentally capable, irrespective of educational qualifications, caring for children aged between 0 and 15 years who were on ART between April 2013 and October 2014. Non-probability, purposive sampling was used to select the 16 caregivers. Required permission, approval and ethical clearance were obtained from the University of Venda Higher Degree Committee, Limpopo Provincial Health Department and relevant institutions. An in-depth, individual, unstructured interview method was used to collect data. One central question was asked: ‘What are the challenges you experience when caring for a child on antiretroviral treatment?’ Subsequent questions were based on the participants’ responses to the central question. Qualitative data were analysed by means of Tesch’s open-coding method. Results The findings of this study revealed that participants, that is, caregivers of children on ART, experienced financial burdens because of transport costs needed to comply with follow-up dates and insufficient of money for food, clothing the child in need of care, pocket money for lunch boxes during school hours and time lost while waiting for consultations. Participants reported some level of stigmatisation against children on ART by family members, especially the husbands or in-laws of the secondary caregivers. Many primary and secondary caregivers seemed to have given up seeking support from government and community structures. Conclusion The conclusions drawn from this research are that caregivers hardly receive any support from family members or the community. Fear of disclosing the HIV-positive status of children resulted in the delay of financial support from the government, thus leading to serious financial burden on the caregivers.

Factors affecting integration of midwifery nursing science theory with clinical practice in Vhembe District, Limpopo Province as perceived by professional midwives

Background Professional midwives have an important role to play in midwifery training to produce a competent midwife. According to the social learning theory, professional midwives act as role models for students. When allocated for clinical learning experiences in the training hospitals, students will have the opportunity to observe the well-trained, skilled, and experienced professional midwives. The whole process will enable students to integrate theory with practice and they will become competent. Aim The aim of this study was to determine the factors affecting integration of midwifery nursing science theory with clinical practice as perceived by midwives. Setting The study was conducted at the training hospitals in Vhembe district of the Limpopo Province, South Africa. These hospitals were: Donald Fraser, Siloam, and Tshidzini. Methods A qualitative explorative, descriptive and contextual design was used. A Non-probability, convenient sampling method was used to select 11 midwives from the following hospitals: Donald Fraser, Siloam, and Tshidzini, in Vhembe district. In-depth individual interviews were conducted. Data were analysed through open coding method. Result One theme and five sub-themes emerged from the analysed data, namely: shortage of midwives, attitudes towards student midwives, reluctance to perform teaching functions, language barriers, and declining midwifery practice standards. Conclusion Shortage of midwives in the clinical areas led to fewer numbers of mentors whom the students could observe and imitate to acquire clinical skills. Some of the midwives were reluctant to teach students. Recommendations were made for both training institutions and hospitals to employ preceptors for students in the clinical practical.

The Importance of Indigenous Languages in Health-Care Services: Some Observations from Limpopo Province, South Africa

Abstract Tackling health issues with the languages which people understand is essential in improving the lives and prospects of millions of people. People in South Africa are vulnerable to Human Immune Virus (HIV) and Acquired Immune Disease Syndrome (AIDS), malnutrition, measles, diarrhea and other health challenges due in part to the lack of important information provided in their own languages and, in a culturally sensitive way. To link language and democracy, it is important that the leaders ensure accountability and transparency. To achieve this, people should be able to communicate with their leaders in the mother-tongue. English is still the language of power, money and status, and indigenous languages are still at a cognitive disadvantage, even though, all eleven languages are official and carry equal status in terms of the Constitution. It is, therefore, essential to develop these languages so that they can be used beyond their traditional domains.