Programming for HIV prevention in South African schools: A report on program implementation

An evaluation study conducted in KwaZulu Natal, South Africa, provides important insights into whether learners who participated in a fact-based, interactive course had more knowledge about HIV risks, prevention, and care practices; more positive attitudes toward prevention practices and people living with HIV and AIDS; and a higher prevalence of reported safe behaviors than comparable learners who did not participate in the course. Results show that the Life Skills Grade 9 Curriculum had a positive impact of students’ knowledge of HIV/AIDS, attitudes about abstinence, and intention to use condoms. There was, however, no evidence of increased adoption of such protective behaviors as abstinence and condom use. Teachers’ skills, comfort level, and effectiveness are likely to improve with experience. A number of recommendations emerged from the study that aim to improve teacher preparation and support as well as the overall program

Sexual behaviour of Cape Townhigh-school students

Objectives. To document prevalence rates for selected aspects of sexual behaviour among Cape Town high-school students and to conduct a survival analysis of age at first intercourse. Design. Cross-sectional survey. Setting. State high schools in Cape Town. Subjects. A multistage cluster sample of 2 740 grade 8 and 11 students at 39 schools. Outcome measures. Ever having had sexual intercourse; for those who had, age at first intercourse, number of partners during the previous 12 months, time since last intercourse; and, at last intercourse, whether the partner had been known for more than 7 days, whether any method was used to prevent pregnancy or disease, and (if so) what was used. Results. Overall, 29.9% had participated in sexual intercourse, with a higher proportion among males and those in grade 11. By the age of 14 years, 23.4% of males and 5.5% of females had participated in sexual intercourse. By the age of 19 years, these proportions were 71.8% and 58.2% respectively. The median time since last intercourse was 4 weeks, the median number of partners in the past year was 1, and 78.4% had known their most recent partner for more than 7 days. At their last coital episode, 65.4% had used contraception, and the most common methods were condoms and injectable steroids, which were used by 67.7% and 43.2% respectively. Conclusions. The proportion of sexually active students has increased since 1990. Intervention programmes should commence in primary school. Large numbers of students are at risk for pregnancy and sexually transmitted infections

The role of community advisory boards in health research: Divergent views in the South African experience

In the light of the growing involvement of community advisory boards (CABs) in health research, this study presents empirical findings of the functions and operations of CABs in HIV/AIDS vaccine trials in South Africa. The individual and focus group interviews with CAB members, principal investigators, research staff, community educators, recruiters, ethics committee members, trial participants and South African AIDS Vaccine Initiative (SAAVI) staff members demonstrated differences in the respondents’ perceptions of the roles and responsibilities of CABs. These findings question the roles of the CABs. Are they primarily there to serve and be accountable to the community, or to serve the accomplishment of the research objectives? Four emergent themes are discussed here: purpose; membership and representation; power and authority; sources of support and independence. The CABs’ primary purpose carries significant implications for a wide range of issues regarding their functioning. The dual functions of advancing the research and protecting the community appear to be fraught with tension, and require careful reconsideration

Age at the onset of tobacco smoking in South Africa : a discrete-time survival analysis of the prognostic factors

Background: While knowledge of onset of smoking tobacco, and associated risk factors can aid the formulation of evidence-based policy and interventions, such information is scarce in South Africa. We assessed age at onset of tobacco smoking in South Africa and identified its risk factors. Methods: We analysed data of 15,316 respondents aged 15–98 years from the 2012 South African National Health and Nutrition Examination Survey. Descriptive statistics and survival analysis techniques were used alongside weighted percentages. Results: Overall lifetime prevalence of smoking was 20.5%. Among the 3360 ever-smoked respondents, the overall median age at smoking onset was 18 years (Inter-quartile range (IQR) =5) with 2% starting before age 10 while 60% had smoked before age 20. Likelihood of tobacco smoking was higher among adolescents ( = 60 years, thrice higher among males, 29% higher among urban dwellers and thrice higher in Western Cape and Free State than in North West Province. The onset of tobacco smoking was earlier among males, wealthier and “coloured” people from Northern and Eastern Capes. Conclusion: The onset of tobacco smoking peaked at 15–22 years and varied by province, sex, location, race and other characteristics. The age restrictions on smoking in South Africa has changed over time, coupled with the recent open and electronic advertisement of tobacco, and social media could have influenced the earlier onset of tobacco smoking in South Africa. Stricter regulations on tobacco-related advertisement and sales should be implemented.Publisher PDFPeer reviewe

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

“You Travel Faster Alone, but Further Together”: Learning From a Cross Country Research Collaboration From a British Council Newton Fund Grant

Abstract: Providing universal health coverage (UHC) through better maternal, neonatal, child and adolescent health (MNCAH) can benefit both parties through North–South research collaborations. This paper describes lessons learned from bringing together early career researchers, tutors, consultants and mentors from the United Kingdom, Kenya, and South Africa to work in multi-disciplinary teams in a capacity-building workshop in Johannesburg, co-ordinated by senior researchers from the three partner countries. We recruited early career researchers and research users from a range of sectors and institutions in the participating countries and offered networking sessions, plenary lectures, group activities and discussions. To encourage bonding and accommodate cross-cultural and cross-disciplinary partners, we asked participants to respond to questions relating to research priorities and interventions in order to allocate them into multidisciplinary and cross-country teams. A follow up meeting took place in London six months later. Over the five day initial workshop, discussions informed the development of four draft research proposals. Intellectual collaboration, friendship and respect were engendered to sustain future collaborations, and we were able to identify factors which might assist capacity-building funders and organizers in future. This was a modestly funded brief intervention, with a follow-up made possible through the careful stewardship of resources and volunteerism. Having low and middle-income countries in the driving seat was a major benefit but not without logistic and financial challenges. Lessons learned and follow-up are described along with recommendations for future funding of partnerships schemes

A decade of tobacco control: The South African case of politics, health policy, health promotion and behaviour change

BACKGROUND: The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown. OBJECTIVE: To describe the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners. METHODS: Four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) were conducted in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. We assessed the prevalence of current smoking (having smoked a cigarette on ≥1 day in the 30 days preceding the survey) and smoking-related attitudes and behaviours. RESULTS: Over the 12-year survey period current smoking among learners declined from 23.0% (1999) to 16.9% (2011) - a 26.5% reduction. Reductions in smoking prevalence were less pronounced amongst girls and amongst black learners. We observed an increase in smoking prevalence amongst learners between 2008 and 2011. Smoking-related attitudes and behaviours showed favourable changes over the survey period. CONCLUSION: These surveys demonstrate that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth

Intimate partner violence and its association with self-determination needs and gender-power constructs among rural South African women

This study aimed to identify psychosocial correlates of intimate partner violence (IPV) by using constructs derived from the self-determination theory (SDT) and gender-power scales. Cross-sectional data (N = 238) were collected from women in the Eastern Cape, South Africa, and were used to test a structural equation model (SEM). The majority (87%) of the participants reported having sexual partners in the past 3 months, and in terms of IPV victimization, 36% and 26% of women had ever experienced verbal and physical abuse, respectively. Bivariate correlations showed that autonomy and beliefs about gender equality (BGE) were strongly associated with IPV

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

Smoking is one of the major preventable causes of disease and premature death globally.[1] Tobacco is the second leading risk factor for the global burden of disease, accounting for 6.3% of disability-adjusted life-years lost[2] and causing six million deaths annually.[1] Since 1995 there has been a modest increase in tobacco consumption in low- and middle-income countries (LMICs), but a consistent decline in high-income countries (HICs).[3] By 2030 it is estimated that tobacco will kill more than eight million people annually, with 80% of these deaths occurring in LMICs.[3] Consumers in LMICs such as South Africa (SA) are likely to be less informed about the adverse health consequences of tobacco use than those in HICs, and are therefore likely to bear the major health impact of tobacco unless an aggressive educational programme is mounted