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. Keywords: Intervention, women, cultural adaptation, HIV transmission risk behaviours.SAHARA-J Vol. 5 (4) 2008: pp. 186-19

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

HIV Prevention in High-Risk Women in South Africa: Condom Use and the Need for Change

INTRODUCTION: Young women are at disproportionate risk of HIV infection in South Africa. Understanding risk behaviors and factors associated with ability to negotiate safe sex and condom use is likely to be key in curbing the spread of HIV. Traditionally prevention efforts have focused on creating behavioral changes by increasing knowledge about HIV/AIDS. METHODS: This was a cross-sectional analysis from a prospective observational cohort study of 245 women at a high-risk of HIV infection in KwaZulu-Natal, South Africa. RESULTS: Participants demonstrated a high level of HIV/AIDS knowledge. Overall, 60.3% of participants reported condom use. Reported condom use at last sexual encounter varied slightly by partner type (57.0% with steady versus 64.4% with casual partners), and self-perceived ability to choose to use a condom was significantly lower with steady partners compared to casual partners (p<0.01). In multivariate analysis, women who had high school education were more likely to use condoms at their last sex encounter compared to those with only primary school education (RR of 1.36 (95% Confidence Interval (CI) 1.06-1.75) and 1.46 (95% CI 1.13-1.88) for grades 8-10 and 11-12, respectively). Those who used condoms as a contraceptive method were twice as likely to use condoms compared to women who did not report using them as a contraceptive method. Greater perceived ability to choose to use condoms was associated with higher self-reported condom use at last encounter, irrespective of partner type (RR = 2.65 (95% CI 2.15-32.5). DISCUSSION: Self-perceived ability to use condoms, level of formal education and condom use as a contraceptive were all significantly associated with self-reported condom use at last sexual encounter. These findings suggest that that gender inequality and access to formal education, as opposed to lack of HIV/AIDS knowledge, prevent safer sexual practices in South Africa

Improving health literacy, self efficacy and personal skills: towards culturally tailored behavioural inreventions for African women

Black women in South Africa bear the highest burden of HIV and the condom use among this population of women is low. The aims of the research were to examine determinants of condom use among HIV positive and HIV negative isiXhosa speaking women separately. We found that dry sex (e.g. sex after vaginal treatment with substances that often dry and tighten the vaginal wall) among HIV-negative Xhosa women is primarily determined by the preference for dry sex of a dominant male partner. Women’s motivation for negotiating condom use is primarily influenced by their desire to please their partners For South African HIV-positive and HIV-negative black women the fear of stigma because of HIV/AIDS is the biggest barrier to participate in HIV/AIDS efficacy trials. Interventions to enhance condom use by HIV-positive black South African women need to focus on the reinforcement of self-confidence. HIV behavioural interventions have to be associated with poverty alleviation initiatives and have to be accompanied by behavioural interventions specific to men

Efficacy of SISTA South Africa on sexual behavior and relationship control among isiXhosa women in South Africa: results of a randomized-controlled trial

Background: The HIV epidemic has a devastating impact among South African women. The current study evaluated the efficacy of SISTA South Africa, a culturally congruent HIV intervention for isiXhosa women in South Africa, which was adapted from SISTA, an HIV intervention for African American women. Methods: A randomized-controlled trial recruited 342 isiXhosa women aged 18-35 years. Participants were randomized to the general health comparison or the SISTA South Africa intervention. Xhosa-speaking peer health educators tailored the SISTA South Africa curriculum, while maintaining the core elements of the original SISTA intervention. Participants completed assessments at baseline and 6 months follow-up. Results: Relative to participants in the comparison, participants in the HIV intervention reduced the frequency of unprotected vaginal intercourse acts (adjusted mean difference = 1.06; P = 0.02), were more likely to report not desiring dry sex (adjusted odds ratio = 0.229; 95% confidence interval = 0.10 to 0.47; P = 0.0001), and were more likely to perceive that their main sexual partner did not desire dry sex (adjusted odds ratio = 0.24; 95% confidence interval = 0.11 to 0.52; P = 0.0001). In addition, women randomized to the intervention also reported an increase in HIV knowledge, greater relationship control, and had more opposing attitudes toward HIV stigma. The HIV intervention did not reduce sexually transmitted infection incidence. Conclusions: This trial demonstrates that an HIV intervention, which is adapted to enhance its gender and cultural relevance for rural isiXhosa women, can reduce self-reported sexual risk behaviors and enhance mediators of HIV among this vulnerable population.

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 evidence-based 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

HIV Prevention in Resource Limited Settings: A Case Study of Challenges and Opportunities for Implementation

BACKGROUND: Sub-Saharan Africa has the highest global prevalence of HIV, and the prevention of transmission between HIV-seropositive and -serodiscordant sexual partners is a critical component of HIV prevention efforts. Behavioral interventions that have demonstrated efficacy in reducing risk behaviors associated with HIV transmission and infection and have been translated, or adapted, to a variety of settings. PURPOSE: This manuscript examined implementation of behavioral interventions within resource limited health care delivery settings, and their adoption and integration within service programs to achieve sustainability. METHODS: The CDC/Partner Program, an evidence-based risk reduction intervention, was implemented in Community Health Centers (CHCs) in Zambia using a staged technology transfer process, the Training the Trainers Model. Provincial workshops and training workshops on the provision of the intervention were used to establish a cadre of trainers to provide on-site intervention facilitators capable of ultimately providing coverage to over 300 CHCs. RESULTS: CHC staff provided the intervention to clinic attendees in four provinces over 4 years while also training new facilitators. The implementation process addressed multi-level issues within the context of training, consultants, decision making, administration, and evaluation as well as practical considerations surrounding travel, training, staff compensation and ongoing quality assurance. CONCLUSIONS: The majority of challenges to implementation and maintenance were addressed and resolved, with the exception of structural limitations related to restricted resources for personnel and funding. Strengths of the program included its collaborative structure, active program leadership, commitment and support at the provincial level, the use of task shifting by existing clinic staff, the train the trainer model and ongoing quality control. Enhanced infrastructure is needed in for future implementation, such as training centers within each province, certified expert coaches and annual workshops and system changes to ensure available staff

Translation and sustainability of an HIV prevention intervention in Lusaka, Zambia

The scale-up of HIV treatment programs in sub-Saharan Africa necessitates creative solutions that do not further burden the health system to meet global initiatives in prevention and care. This study assessed the work environment and impact of providing a behavioral risk reduction intervention in six community health centers (CHCs) in Lusaka, Zambia; opportunities and challenges to long-term program sustainability were identified. CHC staff participants (n = 82) were assessed on perceived clinic burden, job satisfaction, and burnout before and after implementation of the intervention. High levels of clinic burden were identified; however, no increase in perceived clinic burden or staff burnout was associated with providing the intervention. The intervention was sustained at the majority of CHCs and also adopted at additional clinics. Behavioral interventions can be successfully implemented and maintained in resource-poor settings. Creative strategies to overcome structural and economic challenges should be applied to enhance translation research