This study examines clinical waste disposal and handling in the context of a community home-based care (CHBC) programme in Kanye, southern Botswana. This qualitative study involved 10 focus group discussions with a total of 82 AIDS primary caregivers in Kanye, one-to-one interviews with the five nurses supervising the programme, and participant observation. Numerous aspects of clinical or healthcare waste management were found to be hazardous and challenging to the home-based caregivers in the Kanye CHBC programme, namely: lack of any clear policies for clinical waste management; unhygienic waste handling and disposal by home-based caregivers, including burning and burying healthcare waste, and the absence of pre-treatment methods; inadequate transportation facilities to ferry the waste to clinics and then to appropriate disposal sites; stigma and discrimination associated with the physical removal of clinical waste from homes or clinics; poor storage of the healthcare waste at clinics; lack of incinerators for burning clinical waste; and a high risk of contagion to individuals and the environment at all stages of managing the clinical waste.
Equity and HIV/AIDS
Correct and consistent condom usage remains a pivotal strategy in reaching the target set by the South African government to reduce new HIV infections by 50% in the next 5 years. Studies have found that there has been an increase in condom usage by some categories of the population, but usage has not yet reached the desired levels in order to meet the target. This article reports on the findings of a study on condom usage in eight communities in the North West Province, which was part of a wider HIV and AIDS programme evaluation commissioned by the North West Provincial Department of Health. The main aim was to assess accessibility to condoms, and knowledge, attitudes and practices around condom use by four sampled communities in the North West Province. Eight focus group discussions were held and 50 households were interviewed. The study found positive results regarding accessibility and awareness of condoms. However, this often did not lead to the desired behavioural change of using condoms in risky sexual interactions. The majority of respondents still resisted condom usage, used condoms inconsistently, or were not in a position to negotiate protected sexual intercourse. The main reasons reported for this were: reduced pleasure, perceived and real physical side-effects, myths, lack of information, status, financial reasons, distrust in the efficacy of condoms, family planning, cultural reasons, gender-related reasons and trust. Many of the barriers to consistent condom use cannot be overcome by strategies that target the individual. Interventions need to address underlying developmental factors such as the non-biological factors that increase the susceptibility of women to HIV infection. As this falls outside of the scope of the mandate of the Department of Health, various partnerships with other key role players need to be established and/or strengthened, such as with local government, non-governmental organisations and faith-based organisations.
A comprehensive care and treatment program requires a well functioning laboratory services. This study assessed satisfaction of medical personnel to the laboratory services to guide process of quality improvement of the services. A cross-sectional survey in 24 randomly selected health facilities in Mainland Tanzania was conducted to assess the satisfaction of the medical personnel with the laboratory services. About one quarter of medical personnel in sending or receiving laboratories were dissatisfied with the services. Comparing the personnel in public and private, the personnel in public laboratories were 4 times more dissatisfied with the timely test and correct results; and 5 times more dissatisfied with clear and complete test results.
HIV-infected women need support to deal with their diagnosis as well as with the stigma attached to HIV. As part of their practical training, Master's-level psychology students negotiated with the staff of four clinics in townships in Tshwane, South Africa, to establish support groups for HIV+ women and offered to assist them in facilitating the groups. This study aimed to understand why the implementation of groups was successful in one clinic and not other clinics. The student reports on their experiences, and interactions with clinic staff and clients were used as a source of data. Using qualitative data analysis, different dynamics and factors that could affect project implementation were identified in each clinic. Socio-ecological and systems theories were used to understand implementation processes and obstacles in implementation. Valuable lessons were learnt, resulting in the development of guiding principles for the implementation of support groups in community settings.
The rate of new HIV infections, which has fuelled the global HIV/AIDS epidemic since the 1980s, has peaked throughout the world and is now declining. But population growth and the life-prolonging effects of antiretroviral (ARV) treatment mean that the total global number of HIV-infected people is likely to remain about the same for another two decades and will continue to increase in sub-Saharan Africa. Based on these findings the authors say it is time for the international community and governments to rethink their prioritisation of AIDS over other infectious diseases.
This study assessed the health-related quality of life and HIV symptoms of a sample of people living with HIV (PLHIV) in South Africa. The sample included 607 PLHIVs from all districts of the Eastern Cape Province, recruited either through a health facility, from the community through key informants, or through support groups. The findings indicate a low degree of overall quality of life, with spirituality, environment, psychological health and level of independence as predictors for overall quality of life. Among medical variables and HIV symptoms, CD4 cell count and having fewer HIV symptoms (but not an AIDS diagnosis) were identified as predictors for overall quality of life. Among socio-economic variables, having sufficient food and a higher educational level were identified as predictors. The results highlight the need for better access to psychosocial support and medical services for PLHIV in South Africa, as well as the need to consider a patient's general health perceptions during the course of ART.
This publication defines the essential interventions the health sector should deliver and provides key references as well as links to web-based resources. The document provides WHO’s best attempt to assemble and package normative advice for the health sector concerning the essential response to HIV/AIDS. We hope it will prove useful for all those who work in the health sector, whatever their capacity, as they confront the realities of HIV/AIDS throughout the world.
This paper examines the history of HIV/AIDS in Kenya since it was first diagnosed in the country. The introduction of highly active antiretroviral therapy (HAART) has dramatically improved the prognosis for individual patients with AIDS, but education and changing attitudes towards condoms have led to a progressive fall in incidence, so that the worst of the epidemic may now be over. Limited personal experience suggests that steroids may also have a role in salvaging critically ill AIDS patients, who need to be treated as emergencies. With an educated public and attention to alternative routes of infection such as blood transfusion, the epidemic should be increasingly contained during the next 25 years, and may even fizzle out.
The aim of this study was to determine the knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at a community health centre. Thirty-six educated women aged 18 - 39 years and attending the clinic took part, from informal settlements and mostly unemployed, receiving government grants. Most scored 80% or more with regard to general HIV knowledge. Attitudes were found to be positive with regard to both breastfeeding and formula feeding, but HIV status influenced it significantly. In conclusion, the women were knowledgeable about HIV transmission and mother-to-child transmission (MTCT), but an informed decision-making process was not followed, the sustainability of formula feeding after six months is a problem and health workers need to be trained about feeding options.
While clinical care providers, programme managers and other stakeholders increasingly recognise the critical importance of nutrition for the treatment of HIV and AIDS, interventions that link nutritional support to treatment are relatively new. The Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH) initiated one such intervention in 2002 in western Kenya with a large-scale expansion currently underway with the support of World Food Programme commodity donations and fresh food grown on AMPATH production farms. The intervention is designed to bolster nutrition security of the most vulnerable patients on antiretroviral regimens over a short period of time by providing supplemental household food rations. Weaning or transitioning clients off food supplementation is the major programmatic challenge facing this and similar nutrition interventions - especially given its critical importance in sustaining nutritional, health and productivity gains. The growing global interest in linking nutrition care to ARV treatment must not overlook the parallel need for long-term strategies to ensure nutrition security. In resource-poor settings, a high proportion of people living with HIV will be chronically food-insecure.