Gender differences in public perceptions on National Health Insurance

Background. Implementation of National Health Insurance (NHI) commenced recently. With the promise of addressing drastic inequalities in the health sector, NHI has the potential to positively transform the health system. In particular, NHI could have a significant positive impact on females, who are disadvantaged under the current system, with higher rates of poor health and lower rates of medical scheme membership compared with males. Despite NHI’s transformative potential, however, the public discourse on NHI as portrayed in the mediasuggests that it is an unpopular policy. The evidence presented in this paper is to the contrary.Objectives. To assess the general public’s opinion on NHI and to explore gender differences in perceptions.Methods. This paper reports on findings from a 2010 cross-sectional nationally representative survey of the South African population that assessed social attitudes, including perceptions on NHI. Sex-disaggregated data were analysed in SPSS version 20.Results and conclusions. There is broad public acceptance of NHI, indicating that an overwhelming majority of South Africans would prefer an NHI system to the current two-tiered system. Support for NHI has increased since similar studies in 2005 and 2008, with the simultaneous growth of public discourse on the policy. More females than males support NHI, reflecting the potential of the NHI system to have a positive impact on gender equality and the health of women and girls

Translating research into policy: The case of orphans and vulnerable children in South Africa

Policies are often developed without taking into account social science research findings and recommendations, despite the plethora of such research studies.This is largely because researchers and policy makers often work in isolation, yet if they worked synergistically they could have a significant impact on implementing interventions known to work to improve the lives of populations. Several approaches have been advanced to encourage policy makers to take heed of scientific findings and to urge scientists to take into account the needs of policy makers in designing their research agenda.This paper aims to illustrate how policy has been informed using the case study of the Orphans and Vulnerable Children project in South Africa. It further highlights the successes and challenges encountered thus far with this project. In some countries, particularly those of the north, there has been major progress in bridging this gap between research and policy; however, in developing countries much remains to be done. Keywords: policies, evidence-based research, orphans and vulnerable children (OVC), social science Journal of Social Aspects of HIV/AIDS Vol. 3 (2) August 2006: 450-45

Examining the impact of HIV&AIDS on South African educators

Our aim in this study was to examine the impact of HIV&AIDS on South African educators. A cross-sectional survey was conducted in public schools combining HIV testing and a face-to-face interview with participants from a nationally representative sample of public educators. The results show that HIV is highly prevalent among South African public educators (12.7%) and the educators who are absent from school for longer periods (20 days or more) compared with those who are absent for less than four days have higher HIV prevalence (16.8% vs 11.95%). Educators also spend time away from teaching while they attend funerals for colleagues who have died (6.7%), for family members (13.4%) and for members of their communities (47.6%). This makes them feel depressed (71%). These results suggest that HIV&AIDS has an impact on the quality of education. There is a need to prevent new HIV infections and reduce morbidity through the implementation of comprehensive integrated prevention and treatment programmes targeted at educators. There is also a need to support educators in coping with the problem of HIV&AIDS at work and in the community

HIV/AIDS prevalence among South African health workers

Introduction. Studies on HIV prevalence among health workers usually focus on occupational exposure to HIV. Little is known about HIV prevalence in this group. However, it is expected that HIV prevalence among health workers will reflect prevalence in their society. Objective. To determine HIV prevalence among South African health workers. Method. A stratified cluster sample was drawn of 5% of health facilities in South Africa (N = 222) representative of the public and private health sectors in South Africa. The sample was designed to obtain a nationwide representative sample of medical professionals and non-professional health workers. A subsample comprising health workers in four provinces was tested for HIV status. The Orasure HIV-1 device in combination with the Vironostika HIV UNI-Form II plus O enzyme-linked immunosorbent assay (ELISA) kits were used to collect oral fluid specimens for HIV testing. Results. Based on a sample of 721 health workers and a response rate of 82.5% (or 595 respondents), the study found that an estimated 15.7% (95% confidence interval (CI): 12.2 - 19.9%) of health workers employed in the public and private health facilities located in four South African provinces, were living with HIV/AIDS in 2002. Among younger health workers, the risk is much higher. This group (aged 18 - 35 years) had an estimated HIV prevalence of 20% (95% CI: 14.1 - 27.6%). Non-professionals had an HIV prevalence of 20.3%, while professionals had a prevalence of 13.7%. Conclusion. HIV prevalence among health workers in South Africa is high; this calls for the introduction of antiretroviral programmes targeting them. In addition, there is a need for the development of new policy regarding placement of infected health workers in tuberculosis (TB) wards, coupled with vigorous human resource planning to replace the health workers likely to die from AIDS. Infection control procedures also need to be reviewed. S Afr Med J 2004; 94: 846-850

Prevalence of tobacco use among adults in South Africa: Results from the first South African National Health and Nutrition Examination Survey

Background. Data on tobacco use have informed the effectiveness of South Africa (SA)’s tobacco control strategies over the past 20 years.Objective. To estimate the prevalence of tobacco use in the adult SA population according to certain demographic variables, and identify the factors influencing cessation attempts among current smokers.Methods. A multistage disproportionate nationally representative stratified cluster sample of households was selected for the South African National Health and Nutrition Examination Survey, conducted in 2012. A sample of 10 000 households from 500 census enumerator areas was visited. A detailed questionnaire was administered to all consenting adults in each consenting household.Results. Of adult South Africans, 17.6% (95% confidence interval (CI) 6.3 - 18.9) currently smoke tobacco. Males (29.2%) had a prevalence four times that for females (7.3%) (odds ratio 5.20, 95% CI 4.39 - 6.16; p<0.001). The provinces with the highest current tobacco smoking prevalence were the Western Cape (32.9%), Northern Cape (31.2%) and Free State (27.4%). Among current tobacco smokers, 29.3% had been advised to quit smoking by a healthcare provider during the preceding year, 81.4% had noticed health warnings on tobacco packages, and 49.9% reported that the warning labels had led them to consider quitting.Conclusion. A large proportion of adult South Africans continue to use tobacco. While considerable gains have been made in reducing tobacco use over the past 20 years, tobacco use and its determinants need to be monitored to ensure that tobacco control strategies remain effective

Family Planning Among Hiv Positive And Negative Clients In A Resource Poor Setting In South Africa

Objective: To investigate family planning needs, knowledge of HIV transmission and HIV disclosure in a cohort sample that had undergone PMTCT in a resource poor setting. Design. Cross-sectional survey. Setting: Five clinics implementing PMTCT from Qaukeni Local Service Area, O.R. Tambo District in the Eastern Cape. Subjects: The sample at postnatal care consisted of one postnatal interview (n= 1310) when the infants were aged three months or less (n= 141, 10.8%), 4-6 months (n=200, 15.3%), 7-12 months (n=785, 59.9%), or 13-18 months (n=183, 14.0%). Results: One hundred and sixteen women were found HIV positive, 642 HIV negative and 552 with unknown HlV status. Considering those with HIV test results, 15.3% were HIV positive. Almost four out of five women got counselling on safe sex during pregnancy but only two out of three women practiced safe sex during pregnancy. Postnatally, almost all women received counselling on family planning, yet use of contraceptives and condoms were low. HIV positive women used condoms more often than HIV negative women. HIV positive women were significantly more likely than HIV negative women to say that they did not intend to have more children. For HIV positive women PMTCT knowledge was a positive predictor for the intention to have a child, while age, having a partner, HIV disclosure to partner and number of children were not significant. Pregnancy desire did not differ between HIV positive and HIV negative women regarding marital status, having two or more live births and HIV disclosure. Conclusion: High pregnancy desires, low contraceptive and condom use were found among HIV positive women. The incorporation of HIV prevention into promotion of contraceptives by family planning programmes and service providers needs to be improved. East African Medical Journal Vol. 85 (3) 2008: pp. 20-2

National HIV incidence measures - new insights into the South African epidemic

Background and objectives. Currently South Africa does not have national HIV incidence data based on laboratory testing of blood specimens. The 2005 South African national HIV household survey was analysed to generate national incidence estimates stratified by age, sex, race, province and locality type, to compare the HIV incidence and HIV prevalence profiles by sex, and to examine the relationship between HIV prevalence, HIV incidence and associated risk factors. Method. The detection of recent infections was performed on confirmed HIV-positive samples, using the BED capture enzyme immunoassay optimised for dried blood spot (DBS) specimens. BED HIV incidence calculations applied adjustment procedures that were recently revised and approved by the Centers for Disease Control and Prevention for subtype C blood specimens. Results. HIV incidence in the study population aged 2 years and older was 1.4% per year, with 571 000 new HIV infections estimated for 2005. An HIV incidence rate of 2.4% was recorded for the age group 15 - 49 years. The incidence of HIV among females peaked in the 20 - 29-year age group at 5.6%, more than six times the incidence found in 20 - 29-year-old males (0.9%). Among youth aged 15 - 24 years, females account for 90% of the recent HIV infections. Non-condom use among youth, current pregnancy and widowhood were the socio-behavioural factors associated with the highest HIV incidence rates. Conclusions. The HIV incidence estimates reflect the underlying transmission dynamics that are currently at work in South Africa. The findings suggest that the current prevention campaigns are not having the desired impact, particularly among young women.South African Medical Journal Vol. 97 (2) 2007: pp.194-19

Prevalence and correlates of anal sex among secondary school students in Cape Town, South Africa

Research efforts have overlooked anal sex as a risk factor for adolescents’ acquisition of HIV despite the high rates of HIV among South African youth. Here, we report findings from a survey conducted in 2012 among secondary school youth, ages 16–24, in Cape Town. 937 adolescents completed a pencil-and-paper survey. Eleven and 31% of female and male youth, respectively, reported ever having anal sex. By comparison, 59% and 78% of female and male youth reported ever having vaginal sex. The percentage of youth reporting lifetime rates of anal sex increased with age: 32% of 20-to-24 year olds had anal sex compared to 16% of 16-to-17-year olds. When the sample was stratified by sex, this difference appeared to be driven by older male, but not female, sexual behavior. Despite noted differences in prevalence rates by sex, both boys and girls who had anal sex were more likely than their same-sex peers who had vaginal sex to report sexual coercion victimization and perpetration experiences and inconsistent condom use. Interestingly, some differences in HIV motivation, information, and behavioral skills were noted for youth who had vaginal sex versus youth who had never had sex; scores were largely similar for youth who had anal sex versus youth who had never had sex however. Together, these findings suggest that anal sex is not uncommon and may be an important marker for other HIV risk behaviors in at least one lower income South African community. Anal sex needs to be explicitly discussed in adolescent HIV prevention and healthy sexuality programing, incorporating age-relevant scenarios about negotiating condoms and other healthy relationship behaviors (e.g., refusing sex when it is not wanted)

Marital status and risk of HIV infection in South Africa

Objective. Available evidence on the relationship between marital status and HIV is contradictory. The objective of this study was to determine HIV prevalence among married people and to identify potential risk factors for HIV infection related to marital status in South Africa. Methods. A multistage probability sample involving 6 090 male and female respondents, aged 15 years or older was selected. The sample was representative of the South African population by age, race, province and type of living area, e.g. urban formal, urban informal, etc. Oral fluid specimens were collected to determine HIV status. A detailed questionnaire eliciting information on socio-demographic, sex behaviour and biomedical factors was administered through face-to-face interviews from May to September 2002. Results. HIV prevalence among married people was 10.5% compared with 15.7% among unmarried people (p-value < 0.001). The risk of HIV infection did not differ significantly between married and unmarried people (odds ratio (OR) = 0.85, 95% confidence interval (CI): 0.71 - 1.02) when age, sex, socio-economic status, race, type of locality, and diagnosis of a sexually transmitted infection (STI) were included in the logistical regression model. However, the risk of HIV infection remained significantly high among unmarried compared with married people when only sex behaviour factors were controlled for in the model (OR 0.55; 95% CI: 0.47 - 0.66). Conclusions. The relationship between marital status and HIV is complex. The risk depends on various demographic factors and sex behaviour practices. Increased prevention strategies that take socio-cultural context into account are needed for married people. S Afr Med J 2004; 94: 537-543