The consultation relationship as a complex partnership: experiences of psychological consultation in Atlantis

Community psychology has as its fundamental aim the wish to make mental health care more accessible, applicable and practicable to a greater number of people. In the South African context with its history of the inequitable distribution of mental health services and the shortage in resources to meet the needs of the majority, this is a particularly salient issue. Consultation has been suggested as a way of sharing psychological skills with front line mental health workers. The literature on consultation, however, is limited in its understanding of the complex interplay of power dynamics between the consultant and consultee, and the effects of this on the aims and goals of the consultation relationship. In this study a comparative, qualitative analysis of consultation with a school nurse and a mental health worker in Atlantis is discussed. Atlantis, a coloured town situated 48 kilometres from Cape Town along the west coast, is a remnant of Apartheid's separate development policy. A thematic analysis of the consultation relationships highlights the complex interplay of culture, race, class, language, gender and 'goodness of fit' between consultant and consultee in the consultation partnership. Recommendations are made regarding the use of needs assessment, the assessment of suitability of both consultant and consultee for consultation work, issues of power and empowerment and the goals and aims of the consultation partnership

The psychological impact of rape : a long longitudinal study of adult female survivors in the Western Cape, South Africa

Includes bibliographical references.There is a broad body of research which suggests that rape is highly pathogenic, most commonly described in terms of Post Traumatic Stress Disorder (PTSD). The bulk of this research has been conducted in developed countries. In contrast, despite very high rates of rape in South Africa, there is almost no research in this country on the psychological impact of rape, either in the immediate aftermath or in the longer term. This research sought to investigate whether female survivors of rape, living in a palpably different context to those within which the majority of research has been conducted, present with symptomatology similar to that described in the international literature. Sixty-four adult, female rape survivors presenting with a complaint of rape within the last 72 hours at a post-rape health care facility located within a low socio-economic, urban context, were enrolled into the study. Survivors were interviewed at 1, 4, 12 and 24 weeks post-rape. The quantitative questionnaires assessed pre-assault, assault and post-assault variables and included a psychiatric assessment instrument. There was evidence of a high degree of both psychiatric and psychological distress over a period of six months from the time of the rape in over half of the women taking part in this study. The majority of survivors met a diagnosis of PTSD at the Weeks 4,12 and 24 interviews

WOMEN’S EXPERIENCES OF REPORTING RAPE TO THE POLICE: A QUALITATIVE STUDY

South Africa has the highest incidence of rape in the world among the countries that reportreliable crime statistics (Snyman, 2005). Between April 2006 and March 2007, 52 617 rapeswere reported to the police in South Africa (“Information management, South African PoliceServices”, n.d.). A national crime survey conducted by Statistics South Africa (SSA) found thatone out of two rape survivors reported the matter to the police (SSA, 2000), while a threeprovincesurvey by the Medical Research Council on violence against women found that onlyone in nine victims reported their rape experience (Jewkes, Penn-Kekana, Levin, Ratsaka &Schrieber, 2001)

Preventing human immunodeficiency virus infection among sexual assault survivors in Cape Town, South Africa: an observational study.

We describe 131 South African sexual assault survivors offered HIV post-exposure prophylaxis (PEP). While the median days completed was 27 (IQR 27, 28), 34% stopped PEP or missed doses. Controlling for baseline symptoms, PEP was not associated with symptoms (OR = 1.30, 95% CI = 0.66, 2.64). Factors associated with unprotected sex included prior unprotected sex (OR = 6.46, 95% CI = 3.04, 13.74), time since the assault (OR = 1.33, 95% CI = 1.12, 1.57) and age (OR = 1.30, 95% CI = 1.08, 1.57). Trauma counseling was protective (OR = 0.18, 95% CI = 0.05, 0.58). Four instances of seroconversion were observed by 6 months (risk = 3.7%, 95% CI = 1.0, 9.1). Proactive follow-up is necessary to increase the likelihood of PEP completion and address the mental health and HIV risk needs of survivors. Adherence interventions and targeted risk reduction counseling should be provided to minimize HIV acquisition

Women's experiences of reporting rape to the police : a qualitative study

CITATION: Du Plessis, N., Kagee, A. & Maw, A. 2009. Women's experiences of reporting rape to the police : a qualitative study. Social Work, 45(3):275-289, doi:10.15270/45-3-204.The original publication is available at http://socialwork.journals.ac.zaMany survivors of rape experience secondary traumatisation when they report their experience to the police. By means of qualitative interviews the authors explored the experiences of 16 women of reporting rape to the police in the Western Cape. Most participants reported being dissatisfied with the manner in which they were treated or the way in which their cases were handled by the South African Police Service (SAPS). These findings are similar to those of a similar study conducted over 10 years ago, which suggests that despite government efforts to improve services provided to rape survivors, very little appears to have changed.http://socialwork.journals.ac.za/pub/article/view/204Publisher's versio

Evaluating the effectiveness of hierarchical management systems

This paper demonstrates a possibilities of using brute force methods for evaluating the effectiveness of hierarchical management systems. Proposed model of hierarchy provides finding the optimal distribution of load between the executive elements at a predetermined structure. A simple hierarchical structure has been used as an example to investigate the functionality of the model and its software implementation

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis. Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting. Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis. Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries