Sexually transmitted diseases and condom interventions among prostitutes and their clients in Cross River State

The Cross River State commercial sex worker project started in 1989 as a pilot program to test HIV/AIDS and sexually transmitted disease interventions among full-time and part-time sex workers, their partners and their clients. Three main locations were targeted: Calabar and Ikom in the Cross River State in the first phase of the program and Port Harcourt where outreach started in 1992 to test the replicability of the project outside the Cross River State. The project activities were co-ordinated from Calabar which is 200 kilometres from Ikom and 180 kilometres from Port Harcourt. Approximately 800 prostitutes and 2,000 clients in Cross River State have been reached through 17 sites (12 in Calabar and 5 in Ikom) for full-time sex workers and ten sites (6 in Calabar and 4 in Ikom) for part-time sex workers. In Ikom, a large population of paramilitary men, such as customs officials deployed at border posts between Cross River State and the Republic of Cameroon have been targeted. In contrast, of the 25 sites estimated for full-time and 15 sites for part-time prostitutes in Port Harcourt, only twelve were reached because they were more widely dispersed and prostitute groups were more diverse when gauged by social and economic indicators. The Port Harcourt project aimed to reach approximately 1500 sex workers and 3000 clients within an eight-month period, January to August, 1992. Preliminary contact with prostitutes and their clients was made in 1987 in Calabar by members of the Cross River State AIDS committee. At the time, AIDS was hardly a topical issue for the generality of Nigerians. Primarily it was regarded as a subject of concern for prostitutes, foreigners, and Africans in East and Central African countries. It was not possible to initiate a formal project before 1989 because of financial constraints, resulting in a prolonged period of unstructured interaction with the target group. Nonetheless, this provided the opportunity to build understanding and trust and to sustain dialogue on issues of common interest with the target group. Also during this period, key members of the population such as 'chairladies' (leading prostitutes); their assistants; 'policing agents' responsible for maintenance of law and order and welfare of prostitutes; hotel proprietors and managers and others such as security agents with substantial influence or authority over the target population were identified, and their support secured. It became apparent through this interaction that the effectiveness of any HIV/AIDS and STD prevention and control program aimed at sex workers and their partners would depend on the active participation in project design and implementation of members of the target population. The main objectives were to develop and implement an intervention program to reduce the transmission of HIV/AIDS and STDs among prostitutes, as well as their partners and clients, through providing STD services, condom promotion and health education

A study on social support and ART adherence at Carletonville Hospital and Zola Clinic in Gauteng Province

The challenges facing the health system in South Africa are likely to impact on life-long adherence for patients in the context of the rollout of ART. Smaller ART programs have been able to demonstrate good adherence rates, but the question remains if this can be achieved by large public sector ART programs. Most adherence researchers share the basic understanding that patients are adherent when they take their medications as prescribed by the health provider. An approach to adherence that combines both clinical and social knowledge—a biosocial approach— is likely to move us to a better understanding of adherence and how to improve adherence to ART. This study on social support and ART adherence aims to gather and document information that could be used to improve services and program strategies for strengthening and maintaining adherence at ART rollout sites in Gauteng. The two study sites Carletonville Hospital and Zola Clinic were chosen randomly from all second-generation rollout sites in the Province. Data were collected from a total of 359 respondents, 164 in Carletonville and 195 in Zola. The response rate was 98.3%. The results showed that the majority of the respondents were female (72.1%) and about 44.9% were within the age group 30-39 years. In terms of educational attainment, most respondents (70.1%) had received secondary education and 2.5% had not attended school. Based on assets quintiles scores of 1-5, with 5 being the highest score, about one-third of the respondents scored 1, and only 7% scored 5. Compared with Carletonville, respondents from Zola were more educated and better resourced. At the facilities, treatment preparation and support and adherence assessment procedures are routine features of the ART program and entail pre and post test counseling, group education and adherence counseling and serve as mechanisms for adherence support. This is enhanced by routine follow-up appointments where ART patients are provided information on side effects of ARVs, effectiveness of treatment, CD4 cell and viral load counts and referral to services not provided at the facility. Additionally, support groups accessed by patients undertake a range of educational activities on staying healthy, viral load and CD4 cell counts and ARVs. Although respondents were largely positive about their interactions with health providers and the support they provided, some expressed concern about health workers being too busy to address their problems, not treating patients with enough respect and sometimes patients leaving without receiving treatment because staff were either absent or late or queues were too long. The HIV disclosure rate was high (95.5%). However, respondents were more likely to disclosure to a family member, but less likely to a friend, neighbor or religious leader. Selfreported adherence and viral load adherence rates were high (97.6% and 76.6% respectively) but CD4 adherence was lower at 51.0%. The study did not document a convincing association between social support and ART adherence. Only two variables (receiving food supplements and age groups) were significantly associated with CD4 and viral load adherence. Given the limitations of the study, a longitudinal study is needed in these sites to better understand the predictors of short and long-term adherence and to explore ways to better measure the relevance, content and quality of the social support services being utilized by ART patients at facility and community levels. Interventions and policies are needed to respond to the concerns identified from the study regarding inadequate attention and respect by health providers, absence or lateness of doctors and pharmacists and challenges pertaining to access to food, income and disability grants

Involving young people in the care and support of people living with HIV/AIDS in Zambia

The Population Council, in collaboration with CARE International and Family Health Trust, conducted a study in Zambia to determine which care and support needs of people living with HIV and AIDS and their families could be met by trained youth, and to establish whether youth engaged in formalized care and support activities would increase their adoption of protective behaviors or reduce the stigma faced by members of AIDS-affected households. Discussions with caregivers and clients demonstrated that trained youth are able to meet a range of the needs of clients and orphans and vulnerable children, and that their efforts may be laying the foundation for decreased isolation and stigmatization of AIDS-affected families. This study also demonstrated that NGOs and youth clubs working in relatively isolated rural and semi-urban areas can meet with positive and enthusiastic responses and high levels of participation. A particular focus of the continuing study is to further strengthen local partnerships and expand network linkages in order to promote community ownership and sustainability

Pilot community-based intervention to address the needs of elderly caregivers in the Eastern Cape Province, South Africa

The HIV epidemic in South Africa has placed a substantial burden on elderly caregivers, mainly women, who are often tasked with caring for their grandchildren who are orphaned and rendered vulnerable by the death or illness of their parents. The Medical Research Council (MRC), Age-in-Action, and the Horizons Program conducted formative research, as described in this research summary, to assess the needs of elderly caregivers in the Eastern Cape Province of South Africa in 2005. The investigations revealed that elderly caregivers faced a number of challenges including difficulty communicating with youth, fears and a sense of hopelessness around matters regarding youth, barriers to accessing health care, insufficient funds to cover basic needs, and difficulty accessing social service grants. Based on these findings, Horizons, MRC, and Age-in-Action developed an intervention study to explore and test whether a health education program would effectively lead to: 1) Improved care and support provided by elderly caregivers; 2) Improved psychosocial outcomes for the caregivers themselves; and 3) Increased capacity on the part of health service providers to enhance the care they provide to the elderly

Involving young people in the care and support of people living with HIV in Zambia: An evaluation of program sustainability

In 2005, approximately 17 percent of the population of reproductive age in Zambia was infected with HIV and nearly 710,000 under the age of 18 were orphans. As the needs of people living with HIV (PLHIV) and orphans and vulnerable children (OVC) escalate, communities are seeking new ways of helping those affected by the disease. A Horizons intervention study conducted in northern Zambia from 2000–02 found that youth could be trained to help meet the care and support needs of PLHIV and their families, including OVC. Study participants belonged to anti-AIDS clubs that taught about HIV and how to prevent infection. Findings indicated that trained youth caregivers could meet a range of needs of PLHIV and OVC and that their efforts contributed to decreased isolation and stigmatization of AIDS-affected families. As noted in this brief, the focus of the follow-up phase (2003–05) was to strengthen local capacity to manage and sustain care and support activities by young people in the face of decreased input from Horizons. At the end of the follow-up phase, Horizons researchers examined the extent to which anti-AIDS clubs continued caregiving activities, sustained partnerships with local organizations, and mobilized resources to support the program

Understanding barriers to community participation in HIV and AIDS services: Final report

In 2003, South Africa announced its intention to roll out possibly the largest HIV and AIDS treatment program in the world. Much attention is currently focused on supply-side issues, particularly drug procurement and pricing. Far less attention has been paid to demand for and delivery of treatment, care, and support services. Further, although the role of the community and community organizations is articulated in government policy there has been little active engagement with NGOs on the development of these roles or how to encourage community organizations to support and participate in the antiretroviral (ARV) rollout. As noted in this final research report, this study collected data on barriers and challenges to the use of services and on involvement of community organizations in HIV and AIDS and ARV services for use in the design and implementation of appropriate interventions. The objectives were to improve understanding of the context of the utilization of public health HIV and ARV services, and assess the role communities and community-based organizations can play in implementing the government’s HIV and AIDS plan for the ARV rollout

Електричні властивості двошарових плівок окислів металів

Досліджені газочутливі властивості тонких двошарових плівок окислів металів, в яких нижній шар є крупнокристалічним, а верхній має високодисперсну структуру. Розглядаються фізичні основи і технологічні прийоми одержання таких плівок вакуумним методом. Двошарові плівки виявляють кращу чутливість до відновлюючих домішок у повітрі, ніж одношарові

Історична регіоналістика в системі "просторової історії": диференціації предметних полів

Стаття присвячена обґрунтуваннюзавдань іфункцій історичної регіоналістики як частини "просторової історії".Окреслено її дисциплінарні межі, об’єктно-предметну сферу, проаналізовано відповідний термінологічний інструментарій.Статья посвящена обоснованию задач и функций исторической регионалистики как части "пространственной истории". Проанализированы ее дисциплинарные границы, объектно-предметная сфера, соответствующий терминологический инструментарий.The article is devoted to the substantiation of tasks and functions of historical regional studies as the part of "spatial history". Disciplinary limits of the new trend and its subject – objectivity realm are outlined as well as corresponding set of terms is examined

Training youth caregivers to provide HIV education and support to orphans and vulnerable children in South Africa

In KwaZulu Natal, South Africa, in Durban’s peri-urban community of Valley of 1000 Hills, Horizons partnered with Valley Trust to implement and evaluate a program to provide education and support to orphans and vulnerable children. The study utilized a pre-post test design to assess the feasibility and impact of building the capacity of youth aged 18–24 years to provide HIV education and support to in-school orphans and vulnerable children in their communities. The Valley Trust Youth Caregiver Program trained older youth to provide HIV education, homework assistance, and psychosocial support to orphans and vulnerable children aged 11–15 years. The program aimed to increase HIV-related knowledge, improve HIV communication skills, and decrease stigmatizing attitudes. As noted in this brief, trained volunteer youth caregivers operating in a school-based setting can reach children who are orphaned and rendered vulnerable by their household and community circumstances. The education and support provided likely contribute to improvements in HIV-related knowledge, attitudes, and communication among program participants, given that the gains they made were often greater than those of nonparticipants