Factors influencing uptake of HIV care and treatment among children in South Africa - a qualitative study of caregivers and clinic staff.

Despite antiretroviral therapy rollout in South Africa, fewer children than expected are accessing HIV care services. Our objectives were to describe barriers and facilitators of uptake of HIV care among children. Our study involved six private-sector clinics which provide HIV care free-of-charge in and around Gauteng province, South Africa. In-depth interviews were conducted in July 2008 with 21 caregivers of HIV-infected children attending these clinics, 21 clinic staff members and three lead members of staff from affiliated care centres. Many children were only tested for HIV after being recurrently unwell. The main facility-related barriers reported were long queues, negative staff attitudes, missed testing opportunities at healthcare facilities and provider difficulties with paediatric counselling and venesection. Caregivers reported lack of money for transport, food and treatments for opportunistic infections, poor access to welfare grants and lack of coordination amongst multiple caregivers. Misperceptions about HIV, maternal guilt and fear of negative repercussions from disclosure were common. Reported facilitators included measures implemented by clinics to help with transport, support from family and day-care centres/orphanages, and seeing children's health improve on treatment. Participants felt that better public knowledge about HIV would facilitate uptake. Poverty and the implications of children's HIV infection for their families underlie many of these factors. Some staff-related and practical issues may be addressed by improved training and simple measures employed at clinics. However, changing caregiver attitudes may require interventions at both individual and societal levels. Healthcare providers should actively promote HIV testing and care-seeking for children

Gender, power and resistance to change among two communities in the Western Cape, South Africa

This study investigates how women and men in the Western Cape, South Africa, construct their gender identities and roles. As part of the development of an HIV prevention intervention for men, key informant interviews and focus group discussions were conducted. Several themes regarding the construction of gender were identified. First, participants reported that traditional gender relations of male dominance and female subservience were still in evidence, along with traditional gender roles that mandated a division of labour between the household and paid workforce. Second, participants reported a shift in gender roles and relations in the direction of increased power for women. Last, hostile resistance to changes in gender power relations was evident in the discussions. Redefining masculinity and femininity and shifting gender relations in the direction of 'power with' instead of 'power over' is perhaps a necessary prelude to lasting social change and curbing the HIV epidemic in South Africa.

Evaluation of antiretroviral therapy (ART)-related counselling in a workplace-based ART implementation programme, South Africa.

Counselling about antiretroviral therapy (ART) is thought important to prepare patients for treatment and enhance adherence. A workplace-based HIV care programme in South Africa instituted a three-step ART counselling protocol with guidelines prompting issues to be covered at each step. We carried out an early evaluation of ART counselling to determine whether patients understood key information about ART, and the perceptions that patients and health care professionals (HCP) had of the process. Among 40 patients (median time on ART 83 days), over 90% answered 6/7 HIV/ART knowledge-related questions correctly. 95% thought counselling sessions were good. 93% thought ongoing counselling was important. Recommendations included the need for continuing education about HIV/ART, being respectful, promoting HIV testing and addressing the issues of infected partners and stigma. 24 participating HCP identified additional training needs including counselling of family and friends, family planning, sexually transmitted infections and running support groups. 90% of HCP thought that counselling guidelines were helpful. The programme appears to be preparing patients well for ART. Counselling should be offered at every clinic visit. Counselling guidelines were a valuable tool and may be useful elsewhere. The evaluation helped to assess the quality of the programme and to suggest areas for improvement

The impact of and responses to HIV/AIDS in the private security and legal services industry in South Africa

The generalised nature of the HIV/AIDS epidemic in South Africa means that it impacts unevenly on businesses. Companies respond in varied ways, and with varied means, to the challenges posed by the epidemic. Assessment of the impacts of HIV/AIDS, and of the responses of companies to it, are critical to help mitigate the impact of the epidemic on productivity, labour costs, and the supply of skills. This report documents the first study of its kind to be conducted in the private security and legal services industries, and provides clarity on the current status of both industries in terms of the prevalence and incidence rates of HIV, the impact of the epidemic on businesses in the sectors, and their responses to HIV/AIDS thus far. The findings represent a first step in the continued monitoring and evaluation of the impacts of the epidemic in both sectors, and the recommendations offer a starting point for refining HIV/AIDS management strategies at a sector and company level.

Knowledge, atttiudes, beliefs and practices related to HIV/AIDS among employees in the private security sector in South Africa

Presentation published as a abstract in Abstracts for XVII International Conference on AIDS, Mexico City, Mexico, 3-8 Augus

A comparison of HIV prevalence and incidence estimates between the private security sector and the general public of South Africa

Presentation published as a abstract in Abstracts for XVII International Conference on AIDS, Mexico City, Mexico, 3-8 Augus

Knowledge, attitudes, beliefs and practices related to HIV/AIDS among employees in the private security industry in South Africa

Paper presented at the AIDS Conference, Mexico City, 3-8 AugustThe aim of the study was to critically assess HIV/AIDS related knowledge, attitudes, beliefs and practices among employees in the private security industry in three provinces in South Africa. A second-generation surveillance approach was used where 15 private security companies participated. Fieldworkers approached participants at selected companies and asked them permission to complete a questionnaire and to provide a dry blood spots (DBS) specimen for HIV testing. A total of 2787 employees participated and 2224 agreed to be interviewed and to give a blood specimen for an HIV test. The participants showed high levels of knowledge about HIV/AIDS and positive attitudes towards PLWHA. Most of the participants (86.7%0 had one regular partner while 14.6% of the participants had two or more sexual partners (17.6% males vs. 5.6% females). A tenth of the participants (10.7%) had had sex with someone 10 years younger than themselves. Participants under 24 years old reported high condom use (62.4% males & 53.6% females) compared to their above 50 year old counterparts (16.4% males & 9.1% females). Participants with two or more partners reported high condom use (63.9% males & 44.8% females) compared to those with one partner (37% males and 31% females). The majority of participants knew where to get VCT services (88.1%) but only 53.2% reported to have ever tested for HIV. HIV/AIDS education programmes should promote safer sex practices among older employees. The 'know your status' campaign needs to be strengthened so that employees can know their status