Developing a model for integration of core competencies related to HIV and AIDS into undergraduate nursing curriculum at the University of the Western Cape

Philosophiae Doctor - PhDThe HIV epidemic is in its third decade, and there is still neither a cure nor an effective vaccine in sight. Although the number of new HIV infections and AIDS-related deaths has decreased since the early 2000s, the number of people living with HIV remains high. Sub- Saharan Africa carries the burden of the epidemic, and South Africa has the highest number of people living with HIV globally. In South Africa HIV and AIDS is one of the health priorities, and nurses’ role in the fight against HIV infection is crucial, as nurses form the bulk of health care professionals in the country. The South African Government has increased its efforts in the fight against HIV infection, with the introduction of various policies and guidelines. For these policies to be implemented effectively and able to fight the HIV epidemic successfully, nurses’ training needs to provide adequate preparation for nurses to attend to people living with HIV and AIDS upon graduation. The literature highlights various shortfalls in nurses’ training related to HIV and AIDS care and management; in-service training has been the main training model so far, with limited emphasis on pre-service training. The purpose of this study was to develop a model for integration of HIV and AIDS nursing competencies into the undergraduate nursing programme at the University of the Western Cape. The study’s objectives include identification of HIV and AIDS-related core competencies for a nurse in South Africa, then integration of the identified competencies into the undergraduate nursing programme, supported by the Competency, Outcome, Performance, Assessment framework, within a constructivist paradigm. Applying the intervention research: design and development approach, the study was conducted in three phases. Data collection was carried out using nominal group technique, interviews, systematic research synthesis as well as workshops, and data were analysed qualitatively. The 112 participants included nurse educators, people living with HIV and AIDS, registered nurses in clinical practice, recent graduates, South African Nursing Council representatives, lecturers that teach in the nursing programme as well as nurse experts on HIV and AIDS in South Africa, with 12.8% of them participating in more than one phase of the study. Three competency categories covering seven core competencies were identified, namely: foundation (knowledge); supporting pillars (ethics, policies, interdisciplinary approach, personal and professional development); and performance (health education, holistic safe practice). Furthermore, four structural requirements were identified, namely teaching and learning strategies, learning opportunities, service readiness and staff development, forming the HIV and AIDS nursing core competency framework. Vertical and horizontal integration of the core competencies was completed, highlighting how they can be integrated into the undergraduate nursing programme, and this was validated by experts through a workshop. The integration model which was developed is flexible, allowing further adoption into any other undergraduate nursing programme, and provides the potential to assist in the systematic integration of HIV and AIDS into the nursing curriculum. This would enhance new nurse raduates’ competencies in the provision of HIV and AIDS-related care and management upon graduation

Social support and health behaviour in women living with HIV in KwaZulu-Natal

The article explores the relationship between social support and health behaviour of rural and urban women who are living with HIV in South Africa. Our study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV.The sample size was 262 women, 165 from urban area and 97 from rural area. Data were collected using 3 instruments, namely a demographic questionnaire, the health behaviour schedule and the Medical Outcomes Study (MOS) Social Support Survey. Significant findings indicate that in the urban area 71% of women had disclosed their HIV status to someone, while in the rural area 49% had done so.A total of 77% of the women indicated that they were sexually active – 21% had 2 partners and 20% indicated that they had at least one episode of a sexually transmitted disease since finding out their HIV status. A total of 16% said that they currently received counselling, which was significantly more frequent in the rural sample (27%) than the urban (11%).The membership of support groups is at 12% among the participating women, and social support as well as membership of a support group was higher in the rural group than the urban group. Good social support showed an association with condom use, support group attendance and taking vitamins. However, receiving counselling as well as membership of a support group showed stronger association with positive health behaviour than social support on its own.The higher social support was not associated with increased disclosure. Keywords: HIV, health behaviour, social support, rural/urban, women. Résumé Cet article va à la découverte de la relation entre le soutien social et le comportement sanitaire des femmes rurales et urbaines qui vivent avec le VIH en Afrique du Sud. Notre étude était une enquête descriptive d'un groupe de femmes enceintes et non enceintes vivant avec le VIH. L'échantillon était de 262 femmes, 165 originaires d'un milieu urbain et 97 d'un milieu rural. Les données ont été recueillies par le biais de trois utiles, notamment un questionnaire démographique, un barème du comportement sanitaire et l'Enquête du Soutien Social de l'Étude Médicale de Résultats. Les résultats significatifs de recherche démontrent que dans le milieu urbain 71% de femmes avaient révélé leur statut séropositif à quelqu'un alors que seulement 49% du milieu rural l'ont fait. 77% de femmes ont signalé qu'elles avaient des rapports sexuels – 21% avaient deux partenaires et 20% ont signalé qu'elles ont eu au moins une épisode de maladies sexuellement transmises depuis qu'elles ont découvert leur statut séropositif. 16% de ces femmes ont dit qu'elles sont actuellement en consultation psychologique. Les consultations se sont passées plus fréquemment auprès de l'échantillon rural (27%) par rapport à l'échantillon urbain (11%). 12% de femmes participantes fait partie des groupes de soutien. Le soutien social ainsi qu'appartenir à un groupe de soutien étaient plus importants dans le groupe rural que dans le groupe urbain. Un bon soutien social a démontré un lien avec l'utilisation de préservatifs, l'assister au groupe de soutien et la prise des vitamines. Cependant, être en consultation psychologique et appartenir à un groupe de soutien ont démontré une association forte à un comportement sanitaire positif beaucoup plus que le soutien social en tant que tel. Le soutien social plus élevé n'a pas été associé aux révélations augmentées. Mots clés:VIH, comportement sanitaire, soutien social, rural/urbain, femmes

An integrative review of measurement instruments used to assess the stigma that affects people who use drugs

This article aims to review how existing instruments to measure stigma affecting people who use drugs have been developed, which domains of stigma are measured, as well as metrics used to validate these instruments. Using the Whittemore and Knafl’s process for conducting an integrative review, six studies published between January 2002 and April 2019 were systematically analyzed. Overall, all the studies included had good methodological qualities. The results showed that the instruments measured one or more domain of stigma. However, most of these studies use already pre-validated instrument to measure stigma in mental health and adapt to fit the people who use drugs context. Based on the findings we therefore recommend that more studies exploring the experience of people who use drugs regarding stigma, and the perceptions of service provides rendering care to people who use drugs should be undertaken to develop relevant and context-specific stigma instrument