Do health care providers discuss HIV with older female patients?

Background: The World Health Organization expressed concern that older people in Africa who are ignored and excluded from HIV-prevention programmes are increasingly being infected with HIV. Studies show an inadequate awareness of the risks of HIV in the older female population. Older women are more susceptible to HIV because menopausal changes, such as vaginal dryness and thinning, increase the risk of HIV infection through tears and abrasions during unprotected sex.Furthermore, progression from HIV to AIDS occurs faster in the older population. Older women need to understand how HIV is transmitted and how it can be prevented in order to protect themselves. It may be postulated that health care providers are reluctant to discuss HIV-related issues with older female patients. The aim of this study was to determine whether older women could recall receiving HIV-related information from health care providers.Methods: This was a prospective cross-sectional study among 100 women,  aged 50 to 80, who attended the out-patient section at the Tshwane District Hospital during November and December 2006. Trained research assistants collected data in the patients’ mother tongue. A questionnaire was administered during face-to-face interviews.Results: Only 36% (95% confidence interval [CI]: 26.6% to 45.4%) of the respondents recalled receiving prior information regarding HIV from their health care providers. Of those, 19 (52.78%) said it was in the form of voluntary counselling and testing (VCT), and the remaining 17 (47.22%) received this information during general consultations. There was a statistically significant difference (p = 0.003; odds ratio [OR]: 0.26; 95% CI: 0.09–0.69) between their age stratification of 50 to 59 years and 60 to 80 years with respect to receiving information regarding HIV. In total, 23% of the respondents said they had been tested for HIV and most (n = 19; 82.61%) said they had received counselling. However, it is cause for concern that 17.39% (n = 4) of the respondents who had been tested could not recall receiving counselling.Conclusions: This study shows that older women are neglected regarding the provision of HIV-related information. HIV and its risks to older patients is not routinely part of patient care. VCT seems to be an effective solution. However, there are problems even within the VCT system, since some of the participants claim to have been tested for HIV, without receivingcounselling. It is suggested that part of the challenge may lie in the mindset of health care providers. Family physicians need to become proactive in terms of their own practice as well as in terms of their engagement with other health care professionals and students.Keywords: HIV; older females; older women; discussion; HIV talks; consultation

The impact of chronic pain on the quality of life of patients attending primary healthcare clinics

Objectives: The objective was to study the nature and magnitude of the impact of pain on the quality of life of patients with chronic pain.Design: This was a descriptive, cross-sectional quantitative study.Setting and subjects: One thousand and sixty-six adult patients were screened between October and December 2010 in four primary healthcare clinics in south-west Tshwane.Outcome measures: Patients reporting persistent pain for six months or longer were considered to be chronic pain patients (437, 41%), and were interviewed with regard to the impact of chronic pain on their quality of life using the Wisconsin Brief Pain Questionnaire.Results: Four hundred and nineteen patients (95.9%, 95% confidence interval (CI): 93.6-97.6) of chronic pain patients reported that chronic pain impacted on their quality of life and functioning. Sixty-eight per cent of patients (95% CI: 63.3-72.4) reported being severely adversely affected by chronic pain. Pain had a severe impact on sleep quality in 39.2% patients, walking ability (37.4%), routine housework (33.8%), mood (20.1%), interpersonal relationships (15.3%) and enjoyment of life (16.3%). The more intense the experience of severe pain was, the greater the impact of chronic pain on everyday life (p-value < 0.001). Equally, patients with better pain relief enjoyed a better quality of life (p-value < 0.001).Conclusion: A substantial proportion of patients attending primary  healthcare clinics experience chronic pain which impacts on their lives in multiple and significant ways