Psychosocial and behavioural interventions towards HIV risk reduction for serodiscordant couples in Africa: A systematic review

Background: Sexual transmission of HIV frequently occurs in the context of a primary relationship between two partners; however, HIV prevention interventions generally focus on individuals at risk, rather than specifying couples as a unit of change and analysis, neglecting the crucial role that partners may play in sexual behaviour. This article reviews published scientific literature addressing couple-oriented HIV counselling and testing and other behavioural interventions using an online search for peer-reviewed papers. Methods: A systematic review was conducted to evaluate what has been published on psychosocial interventions in HIV serodiscordant couples in Africa. Electronic databases were searched from January 1990 to December 2015. Quality assessment of included studies was conducted using the Systematic Appraisal of Quality in Observational Research tool. Results: The electronic database searches initially retrieved 493 records; after cross-referencing, removing duplicates and applying strict inclusion and exclusion criteria, only eight papers were included in this review. All the studies under review showed that couples-focused counselling and educational programmes were associated with positive outcomes including reduced HIV transmission, reduced unprotected sex, increased rates of status disclosure and high levels of treatment adherence. Conclusions: The literature on interventions for HIV serodiscordant couples is sparse. However, most interventions indicate that couples-focused interventions are effective in HIV risk reduction. In spite of the limited available data and repeated recommendations by different health authorities, couple-centred approaches to HIV prevention have not been implemented on a large scale

The national health insurance and traditional healing in South Africa

In the proposed National Health Insurance system, the dominant view is that South Africa has a two-tier healthcare system – one private and the other public. The author challenges this view and presents data to show that significant numbers of South Africans use traditional healing methods for treatment for a range of conditions. She argues that the exclusion of the third tier traditional healing in NHI should be reconsidered

Suicide attempts during pregnancy in South Africa

Background: Research on suicide attempts during pregnancy is limited as these are considered to be rare in the perinatal period. Aim: A retrospective pilot study was undertaken to establish what percentage of suicide attempters admitted to a hospital were pregnant and to identify their clinical and sociodemographic characteristics. Setting: The study was conducted at a tertiary hospital in Durban, South Africa. Methods: A retrospective chart review was undertaken of all female patients admitted following suicide attempts over a period of 1 year. Clinical and sociodemographic data of pregnant suicide attempters were extracted. Results: Of 27 charts reviewed, 33% (n = 9) patients were pregnant at the time of the attempt. V Code diagnoses predominated, followed by major depressive disorder. Past psychiatric diagnoses and suicide attempts were also present Conclusion: Suicide attempts during pregnancy are not rare. Pregnant women should be routinely screened for prior suicide attempts, depression and stressors as part of perinatal assessments

The Development of a Screening Tool for the Early Identification of Risk for Suicidal Behavior Among Students in a Developing Country

ObjectiveAdolescent suicidal behavior is a public health concern in South Africa. The purpose of this article is to report on the development of a screening tool for teachers to identify South African students who are most at risk for suicidal behavior. This need is addressed within the context of the limited number of mental health professionals available to provide screening and care services in South Africa.MethodGrade 8 students participated by completing sociodemographic questionnaires and self-report psychometric instruments. A screening tool for suicidal behavior was developed using a 4-phase approach.ResultsTwelve factors for high-risk suicidal behavior were identified and included in the screening tool. While further research is needed to validate the screening tool, the findings provide a useful preliminary starting point for teachers to refer students at high risk for suicidal behavior to mental health services for treatment.ConclusionThis screening tool is based on factors that were identified as being associated with suicidal behavior from local research on South African adolescents. The tool contributes to research on adolescent mental health, particularly suicidal behavior, in developing low and middle income countries like South Africa, with the aim of creating African prevention and intervention programs. (PsycINFO Database Recor

Cumulative Risk, Emotion Dysregulation, and Adjustment in South African Youth

Research on cumulative risk is growing, however, little work has occurred in low- or middle-income countries, and few studies have focused on processes linking risk to outcomes. This study explored relations between components of cumulative risk and adjustment in a sample of 324 South African youth (M age = 13.11 years; SD = 1.54 years; 65% female; 56% Black/African; 14% Colored; 23% Indian; 7% White), and tested competing models of emotion dysregulation as a mediator or moderator of risk-adjustment links. Data was collected from youth and their female caregivers during home interviews. Structural equation models and regression analyses accounting for age and sex contributions revealed that emotion dysregulation mediated associations between sociodemographic risk and internalizing symptoms, externalizing problem behavior, and drug use severity, and moderated links between psychosocial risk and internalizing symptoms and externalizing problem behavior. For the mediator models, sociodemographic risk was associated with impaired emotion regulation, which in turn was linked with heightened adjustment difficulties. For the moderator models, psychosocial risk was linked with adjustment problems only when emotion dysregulation was high. These data indicate the importance of disentangling components of cumulative risk. Future research within the South African cultural context might build on these findings by adapting and testing school- or family-based prevention or intervention programs that include modules on emotion regulation