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Record No. 13187 Record ID 013187 Publication type Journal Article Title HIV/AIDS Misconceptions may be Associated with Condom Use among Black South Africans: an Exploratory Analysis Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Bogart, L. M.; Skinner, D.; Weinhardt, L. S.; Glasman, L.; Sitzler, C.; Toefy, Y.; Kalichman, S. C. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 10(2) Pages 181-187, tab. Language English Descriptor HIV Acquired Immunodeficiency Syndrome-etiology; Acquired Immunodeficiency Syndrome-prevention & control; Condoms-utilization; Health Knowledge, Attitudes, Practice African Continental Ancestry Group Descriptor-Geographic South Africa Abstract In South Africa, approximately 20of 15-49-year-olds are infected with HIV. Among black South Africans, high levels of HIV/AIDS misconceptions (e.g. HIV is manufactured by whites to reduce the black African population; AIDS is caused by supernatural forces or witchcraft) may be barriers to HIV prevention. We conducted a cross-sectional study of 150 young black adults (aged 18-26; 56males) visiting a public clinic for sexually transmitted infections, to investigate whether HIV/AIDS misconceptions were related to low condom use in main partner relationships. We assessed agreement with HIV/AIDS misconceptions relating to the supernatural (e.g. witchcraft as a cause of HIV) and to genocide (e.g. the withholding of a cure). In multivariate models, agreement that `Witchcraft plays a role in HIV transmission' was significantly related to less positive attitudes about condoms, less belief in condom effectiveness for HIV prevention, and lower intentions to use condoms among men. The belief that `Vitamins and fresh fruits and vegetables can cure AIDS' was associated with lower intentions among men to use condoms. Women who endorsed the belief linking HIV to witchcraft had a higher likelihood of unprotected sex with a main partner, whereas women who endorsed the belief that a cure for AIDS was being withheld had a lower likelihood of having had unprotected sex. Knowledge about distinct types of HIV/AIDS misconceptions and their correlates can help in the design of culturally appropriate HIV-prevention messages that address such beliefs.

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Record No. 13186 Record ID 013186 Publication type Journal Article Title The Influence of Antiretroviral Treatment on Willingness to Test: a Qualitative Study in Rural KwaZulu-Natal, South Africa Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Phakathi, Z.; Rooyen, Van H.; Fritz, K.; Richter, L. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 10(2) Pages 173-180, tab. Language English Descriptor HIV Acquired Immunodeficiency Syndrome-therapy; Mass Screening Anti-Retroviral Agents Descriptor-Geographic South Africa-KwaZulu-Natal; Abstract Previous quantitative studies suggest a mutually reinforcing relationship between HIV counselling and testing (HCT) and antiretroviral treatment (ART). HCT is the entry into ART, and access to ART appears to increase HIV-testing uptake in settings with historically low uptake. Adopting a qualitative approach, this study examined the influence of ART on willingness to test for HIV, in a rural community in South Africa. Ninety-six in-depth interviews from a large community-based HIV-prevention trial were analysed. The data provide insight into the community members' views, perceptions and experiences regarding ART, and how they draw on these in making decisions about HIV testing. Several key factors that supported a positive relationship between ART and HIV testing were noted. These included the beliefs that ART brings hope and that it prolongs life; the powerful positive effect of witnessing the recovery of someone on treatment; and that ART encourages early HIV-testing behaviour. A few negative factors that could potentially weaken the effects of this positive relationship between ART and HCT uptake were the disclosure difficulties experienced by those enrolled in treatment, beliefs that ART does not cure HIV disease, and the travel distance to testing and treatment facilities from where people live and work. HIV/AIDS-service providers and programme planners should actively draw on these observations, to encourage increased HIV testing in communities and to ensure that the maximum number of people get the HIV treatment and care services that they require.

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Record No. 13185 Record ID 013185 Publication type Journal Article Title The Role of `Pimping' in the Mediation of Transactional Sex at a University Campus in Zimbabwe Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Masvawure, T. B. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 10(2) Pages 165-171 Language English Descriptor HIV; Unsafe Sex; Prostitution; Students; Women Descriptor-Geographic Zimbabwe Abstract The article focuses on a very specific form of transactional sex that exists at a university campus in Zimbabwe, which students refer to as `pimping.' Drawing extensively on the specific experiences of a male student pimp, the article demonstrates that, in practice, transactional sex takes different forms and is not always confined to two parties (namely, a woman and a man). In this case, `pimp-mediated' transactional sex introduces a third person - the pimp - into what is traditionally understood to be a relationship between the two parties and, in the process, dramatically transforms the social obligations that define this particular social relation. A major transformation that occurs in pimp-mediated transactional sex is that it makes the pimps, rather than the women, the central people in these relationships. This, I argue, makes transactional sex more efficient and potentially increases the female participants' vulnerability to HIV infection.

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Record No. 13184 Record ID 013184 Publication type Journal Article Title `Keeping Healthy in the Backseat': How Motherhood Interrupted HIV Treatment in Recently Delivered Women in Kenya Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Awiti-Ujiji, O.; Ekström, A. M.; Ilako, F.; Indalo, D.; Lukhwaro, A.; Wamalwa, D.; Rubenson, B. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2010 Volume and n° 10(2) Pages 157-163, tab. Language English Descriptor HIV Anti-Retroviral Agents-usage thérapeutique; Medication Adherence Postpartum Period Mothers Descriptor-Geographic Kenya-Busia; Kenya-Kibera; Abstract Although there is a large body of literature related to the experiences of motherhood and aspects of the change that it brings about, how the experience of motherhood affects the healthcare of women with chronic illness is less documented. This study explores how motherhood in newly delivered HIV-infected mothers in Kenya interrupted their antiretroviral treatment (ART). Qualitative interviews were performed with 26 mothers on ART in a rural or urban area. The data were organised and interpreted using content analysis. The study found that adherence to ART was influenced by contextual differences in socio-cultural expectations and family relationships. Urban life enabled women to make decisions on their own and to negotiate challenges that were often unpredictable. Women in rural areas knew what was expected of them and decisions were normally not for them to make alone. The women in Busia and Kibera had difficulties combining adherence with attaining the socio-cultural definition of good mothering. Lack of support from health providers and weak healthcare systems contributed to inadequate stocks of HIV drugs and inaccessibility of HIV-related care. From the data, we developed the main theme `keeping healthy in the backseat' and the two sub-themes `regaining self-worth through motherhood' and `mother first - patient later.' We suggest that motherhood is context-specific and follows socio-cultural practises, which made it difficult for the women in Kenya to follow ART instructions. There is a need to reassess HIV-related services for mothers on ART in order to give them a better chance to stay on treatment and satisfy their aspiration to be `good mothers.' Contextspecific HIV-treatment policies are necessary for ensuring adherence and successful treatment outcomes.

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Record No. 13183 Record ID 013183 Publication type Journal Article Title Socioeconomic Status and Barriers to the Use of Free Antiretroviral Treatment for HIV/AIDS in Enugu State, South-Eastern Nigeria Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Okoli, C. I.; Cleary, S. M. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2010 Volume and n° 10(2) Pages 149-155, tab. Language English Descriptor HIV Acquired Immunodeficiency Syndrome Anti-Retroviral Agents-therapeutic use; Health Services Accessibility Social Class Descriptor-Geographic Nigeria-Enugu; Abstract With about 3 million people living with HIV, Nigeria has approximately 8of the global burden of HIV cases. In 2009, only about 34of those in need of antiretroviral treatment (ART) were able to access care, which means that Nigeria was far from achieving the United Nations target of `universal access' by 2010. This study aimed to describe the barriers to accessibility and the coping strategies employed to overcome these barriers among users of free ART services overall and by socioeconomic status (SES). Data were collected from 240 people receiving ART at one urban and one peri-urban health facility in Enugu State, south-eastern Nigeria. Information on SES, demographic characteristics, and barriers and coping mechanisms for accessing ART were elicited from the respondents. The high cost of transportation, HIV stigma, and long waiting hours were found to be key barriers to the use of ART services. On average, ART clients spent just under four hours at the clinic during their monthly appointments. The use of personal savings and financial support from relatives were the main means to access treatment. When the data were analysed according to clients' SES, transportation costs were a chief concern among the poorest while those who were better off were more likely to be concerned about stigma and discrimination. These findings should be borne in mind when designing and locating services to maximise ongoing accessibility to ART.

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Record No. 13182 Record ID 013182 Publication type Journal Article Title Understanding HIV-Related Posttraumatic Stress Disorder in South Africa: a Review and Conceptual Framework Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Young, C. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 10(2) Pages 139-148, tab., fig. Language English Descriptor HIV; Stress Disorders, Post-Traumatic; Prevalence; Epidemiologic Studies Descriptor-Geographic South Africa Abstract A number of epidemiological studies have attempted to measure the prevalence of HIV-related posttraumatic stress disorder (PTSD) in sub-Saharan Africa. A systematic review of the literature identified eight relevant studies that put current estimates of the prevalence of HIV-related PTSD between 4.2and 40. Even the lower estimates suggest that PTSD in response to the trauma of being diagnosed and living with HIV is a significant mental health burden. However, a conceptual framework to advance our understanding of the prevalence and phenomenology of HIV-related PTSD is lacking. This article argues that the Ehlers & Clark (2000) cognitive model of PTSD provides a useful conceptual framework for understanding HIV-related PTSD in South Africa. The model emphasises the role of trauma appraisals in the development and maintenance of PTSD, which can also be usefully applied to some of the other psychological disorders associated with HIV infection. The model appears to fit some of the important research findings, and it offers insights into the relationships between HIV-related PTSD and other psychological disorders, HIV stigma, the high prevalence of non-HIV traumatic events, occasional problems with the delivery of antiretroviral drugs in the South African public health service, the unpredictable course of HIV illness, and the quality of HIV testing and counselling. Implications for individual treatment strategies and broader public health interventions are briefly discussed.

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Record No. 13181 Record ID 013181 Publication type Journal Article Title Negotiating Therapeutic Citizenship and Notions of Masculinity in a South African Village Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Mfecane, S. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 10(2) Pages 129-138 Language English Descriptor Acquired Immunodeficiency Syndrome; Medication Adherence; Self-Help Groups; Rural Population Descriptor-Geographic South Africa-Bushbuckridge; Abstract The article explores the idea of therapeutic citizenship in relation to the experiences of men who attend support groups for people living with HIV or AIDS (PLHIV). At a rural South African health facility offering free antiretroviral (ARV) medicines, support groups aim to empower HIV-positive clients through knowledge and skills that enable them to adhere to their ARV regimen. Members are exhorted to abandon their `traditional' health and gender beliefs in favour of a biomedical understanding and approach to health; to embrace participation in a support group for PLHIV; and to actively challenge HIV stigma through the public disclosure of their HIV-test result. Fourteen months of ethnographic fieldwork conducted in Bushbuckridge, Mpumalanga Province, South Africa, investigated how men negotiated these efforts - normally characterised in the academic literature as `therapeutic citizenship' - in relation to men's socio-cultural definitions of masculinity. The findings reveal that most of the men gained the knowledge and skills necessary to adhere to treatment. Although they generally behaved in a disciplined way, they remained doubtful about their commitment to the particular kind of `HIV identity' that a support group conferred on them. Men who embrace this identity must abandon their previous masculine lifestyles and conform to the support group's messages concerning what it means to be a `responsible' HIV patient. The research documents some of the challenges men experience in negotiating these conflicting demands. The discussion draws on personal accounts by the participants to illustrate the ambivalence of men towards their `HIV identity' and to belonging to a support group.

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Record No. 13180 Record ID 013180 Publication type Journal Article Title Correlates of Sexual Faithfulness among Low-Literate Rural Males in the Amhara Region of Ethiopia Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Bogale, G. W.; Boer, H.; Seydel, E. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 10(2) Pages 123-127, tab. Language English Descriptor Acquired Immunodeficiency Syndrome-prevention & control; Safe Sex Men Rural Population Descriptor-Geographic Ethiopia-Amhara; Abstract HIV is a major threat to the people of the rural Amhara Region, northwest Ethiopia. To date, numerous studies have focused on condom use for HIV prevention. Using the theory of planned behaviour, this study investigates the psychosocial determinants of intended sexual faithfulness among rural males in the Amhara Region. In February 2008, we conducted a cross-sectional study with 100 males, with an age range of 20-50 years (mean age 38 years), in Dejen Woreda. The participants were illiterate or had a low level of literacy and all were rural farmers. Consequently, 10 literate male data collectors were recruited from the same community to assist in collecting data by means of a structured questionnaire. In the analysis of social cognitions as determinants of sexual faithfulness, attitude to faithfulness emerged as the best predictor of intended faithfulness, with significant contributions from self-efficacy and social norm for faithfulness. Thus, balanced and comprehensive HIV interventions focusing on attitudes, self-efficacy and social norms pertaining to faithfulness, sexual abstinence and condom use are needed to halt the spread of HIV among low-literate males in rural Amhara.

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Record No. 13179 Record ID 013179 Publication type Journal Article Title HIV/AIDS and Mental Health Research in Sub-Saharan Africa: a Systematic Review Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Breuer, E.; Myer, L.; Struthers, H.; Joska, J. A. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 10(2) Pages 101-122, fig., tab. Language English Descriptor HIV Infections; Acquired Immunodeficiency Syndrome; Mental Health; Statistics as Topic; Review Descriptor-Geographic South Africa; Nigeria; Uganda Abstract The relationship between mental illness and HIV/AIDS is complex and bidirectional. A significant amount of research has been performed in high-income countries but less is known about HIV and mental health in sub-Saharan Africa. The objectives of the review were to search the literature for quantitative studies conducted in sub-Saharan Africa on mental health and HIV and to critically evaluate and collate the studies in order to identify research needs and priorities. The databases Ovid, MEDLINE, PsycINFO and the Social Sciences Citation Index (SSCI) were searched for variations of search terms related to HIV/AIDS and mental health and studies limited to the populations of African countries. In addition, we hand-searched indexes of key journals and the databases of academic theses. We included 104 papers or research publications. The majority of these were published after 2005. The major topics covered were: mental-health-related HIV-risk behaviour, HIV in psychiatric populations, and mental illness in HIV-positive populations. The reported prevalence levels of mental illness among people living with HIV or AIDS (PLHIV) was high, with all but one study noting a prevalence of 19or higher. Neurocognitive changes in adults with HIV were also prevalent, with reported deficits of up to 99in symptomatic PLHIV and 33in non-symptomatic PLHIV. Research on HIV in relation to mental health is increasing; however, there is a need for good-quality prospective studies to investigate the bidirectional effects of mental illness and HIV on each other.

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Record No. 11732 Record ID 011732 Publication type Journal Article Title An Assessment of Counselling and Support Services for People Living with HIV in Gauteng, South Africa: Findings of a Baseline Study Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Haffejee, Sadiyya; Groeneveld, Iris; Fine, Diane; Patel, Rabia; Bowman, Brett Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 9(4) Pages 367-372 Language English Descriptor HIV Infections; Mental Health; Psychology; Counseling; Self-Help Groups; Health Promotion Descriptor-Local People Living with HIV Descriptor-Geographic South Africa-Gauteng; Abstract An increasing body of literature shows that HIV/AIDS and mental health issues are closely related. In spite of this, the mental health correlates of HIV and AIDS remain largely unacknowledged and under-researched in sub-Saharan Africa. Furthermore, despite guidelines by the World Health Organization insisting that counselling with integrated psychological or mental healthcare helps people living with HIV or AIDS (PLHIV) to deal with their disease status and thus increases their quality of life, the services and interventions to address this significant health burden are still lacking, making the HIV/AIDS and mental-health nexus a sizeable social services and health problem. As part of an ongoing research programme at the University of the Witwatersrand to address this, the article reports on a baseline study that sought to identify the nature and extent of counselling and support services available to PLHIV in Gauteng Province. The study found that available counselling and support services are focused largely on voluntary counselling and testing for HIV (VCT), which appears to be primarily an educational intervention rather than a therapeutic modality. Service providers within this framework have inadequate knowledge and capacity to identify mental health problems. The findings of this study point to a strong need for integrated HIV/AIDS services that include assessment of mental health and substance abuse problems and their appropriate management. Appropriate training and supervision of healthcare workers and counsellors is an essential component in the identification and referral of HIV patients with mental health problems.

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Record No. 11731 Record ID 011731 Publication type Journal Article Title The Effects of Gender and Socioeconomic Status on Youth Sexual-Risk Norms: Evidence from a Poor Urban Community in South Africa Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Rogana, Michael; Hynieb, Michaela; Casalea, Marisa; Nixonc, Stephanie; Flickerd, Sarah; Jobsona, Geoff; Dawada, Suraya Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 9(4) Pages 355-366, tab. Language English Descriptor HIV; Acquired Immunodeficiency Syndrome; Sexual Behavior; Social Class; Urban Population; Adolescent Descriptor-Geographic South Africa Abstract HIV and AIDS remains one of the most serious problems facing youths in many sub-Saharan African countries. Among young people in South Africa, gender is linked with a number of HIV-risk behaviours and outcomes. The literature suggests that factors such as socioeconomic status, intimate partner violence, and several psychosocial factors contribute to gendered differences in sexual behaviour among youths in South Africa. However, the existing body of literature scarcely addresses the interaction between gender, confounding factors (particularly peer norms) and sexual behaviour outcomes. This study uses a survey design (n = 809) to examine how gender and socioeconomic status moderate the effects of norms and attitudes on higher-risk sexual behaviours among secondary school learners in a low-income community in South Africa. The findings suggest that gender interacts significantly with peer norms to predict sexual behaviour. Peer norms and the experience of intimate partner violence were significantly associated with sexual risk behaviour among girls participating in the study. The article discusses both the wider implications of these findings and the implications for school-based and peer-facilitated HIV interventions.

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Record No. 11730 Record ID 011730 Publication type Journal Article Title Rumours about Blood and Reimbursements in a Microbicide Gel Trial Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Stadlera, Jonathan; Saethreb, Eirik Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 9(4) Pages 345-353 Language English Descriptor Blood Specimen Collection; Anthropology; Clinical Trial; Anti-Infective Agents Descriptor-Geographic South Africa Abstract A rumour that emerged during a microbicide gel trial tells the tale of clinic staff purchasing trial participants' blood. This paper documents the rumour and explores its divergent interpretations and meanings in relation to the context of the trial and the social and economic setting at two of the trial sites (Soweto and Orange Farm) in South Africa. The article is based on qualitative research conducted during the Microbicides Development Programme (MDP) 301 trial to evaluate a microbicide vaginal gel for HIV prevention in women. The research incorporated in-depth interviews with female trial participants and their male partners, focus group discussions with male and female community members, and participant observation in the trial clinic and community setting at the two sites. The article analyses the different perspectives among the clinic staff, community and trial participants in terms of which the rumour about the exchange of blood for cash is seen as: 1) the result of ignorance of the clinical trial procedures; 2) the exploitation of poor and vulnerable women; 3) an example of young women's desire for material gain; and 4) a reciprocal exchange of 'clean blood' for cash between women trial participants and the health services. We suggest that the rumours about selling blood verbalise notions of gender and morality while also providing an appraisal of the behaviour of young women and a critique of social relationships between foreign researchers and local participants. Through stories about the clinical trial procedures and its potential reimbursements, the participants were creating and reconfiguring social relationships. Ultimately, rumours are one way in which foreign enterprises such as a clinical trial are rendered local

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Record No. 11729 Record ID 011729 Publication type Journal Article Title Disclosure among HIV-Positive Women: the Role of HIV/AIDS Support Groups in Rural Kenya Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Gilletta, Hannah J.; Parrb, Jennifer Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 9(4) Pages 325-336 Language English Descriptor HIV Seropositivity; Disclosure; Qualitative Research; Socioeconomic Factors; Self-Help Groups; Women Descriptor-Geographic Kenya Abstract Disclosure by people living with HIV or AIDS is critical for HIV prevention and care. However, many women choose not to disclose their HIV status for fear of negative outcomes, such as blame and rejection. The World Health Organization suggests that HIV/AIDS support groups help to encourage women to disclose their status, but little is known about the role of such groups in Kenya. This study used qualitative research methods to gain insight into rural women's experience of disclosing a positive HIV status and it explores opinions about the role of support groups in relation to disclosure. Focus group discussions and semi-structured interviews were conducted with HIV/AIDS support group members and leaders. Thematic analysis showed that the women felt a sense of duty to inform others of their HIV status, particularly in order to prevent HIV transmission and to encourage sexual partners to be tested. There were multiple problems associated with disclosure, and negative outcomes such as blame and rejection were common. Support groups gave the women confidence and provided emotional support, which may have assisted them with coping with the negative outcomes of disclosure. The findings demonstrate that such support may improve women's experience of HIV-status disclosure and possibly even promote disclosure. However, initiatives such as these must protect those who disclose and therefore should take into account the local cultural and economic context.

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Record No. 11728 Record ID 011728 Publication type Journal Article Title Courting Success in HIV/AIDS Prevention: the Challenges of Addressing a Concentrated Epidemic in Senegal Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Foleya, Ellen E.; Nguerb, Rokhaya Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 9(4) Pages 325-336 Language English Descriptor HIV Infections-prevention&control; Acquired Immunodeficiency Syndrome Sexual Behavior National Health Programs Health Policy Social Conditions Descriptor-Geographic Senegal-Dakar; Abstract This article presents findings from a study of HIV/AIDS programmes for urban sex workers in Dakar, Senegal. The objective of the research was to assess HIV prevention and treatment efforts to date, and to identify challenges that must be overcome in the long term to reduce the spread of HIV in Senegal. The research team organised four day-long community dialogues, in June 2008, with registered and unregistered sex workers in the Senegalese capital. In addition to these sessions, we conducted interviews with physicians employed by the Senegalese Ministry of Health, leaders of sex-worker organisations, and directors and staff at non-governmental organisations whose programmes target sex workers and other vulnerable groups. Our findings indicate that Senegal's public health strategies have been largely effective at containing the country's HIV epidemic, but not at addressing the social drivers of HIV transmission or protecting the rights of sexual minorities, such as sex workers and men who have sex with men. For Senegal's HIV/AIDS response to continue on a successful path, it must expand to include structural interventions and incorporate a human-rights approach

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Record No. 11727 Record ID 011727 Publication type Journal Article Title Clinics and Home-Based Care Organisations: an Interface between the Formal and Informal Health Sectors Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Borosa, Adam Kenneth Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher Centre for AIDS Research, Development and Evaluation Date of publication 2011 Volume and n° 9(4) Pages 315-324, tab. Language English Descriptor Delivery of Health Care; Home Care Services, Hospital-Based; Qualitative Research; Primary Health Care; Health Care Sector Abstract The article outlines the findings of a study designed to explore the working relationship between home-based caregivers and clinic nurses at locations in two informal settlements in Johannesburg, South Africa. By considering the views and experiences of both sponsored and unsponsored caregivers, the research focused on how degrees of informality affect this relationship. The nurse/caregiver relationship represents a primary interface between the formal and informal health sectors and is an important part of the country's primary healthcare system. Despite the attention given to linking home-based care (HBC) with the formal health system, very little research has examined the functionality of this link at the ground level. Through a number of qualitative, semi-structured interviews with nurses, home-based caregivers, and staff from the Department of Health, information was collected to better understand what systems are in place to facilitate the relationship between clinics and HBC organisations, and whether these systems are helping to create the desired results. Do the formal and informal health sectors complement and strengthen or do they distract and damage each other? By examining the influence of degrees of informality, the research also lends insight into how this distinction plays a role in healthcare provision. For instance, how does state support impact the link between the formal and informal health sectors and the ultimate quality of care? And what steps can be taken to improve the health system in this regard, as a whole? The findings point to a number of problems and challenges with integrating HBC into the formal health sector. Degrees of informality are found to have a profound impact on the work of home-based caregivers in some respects, but a surprising lack of impact in others. These issues need to be confronted in order to improve the existing system and, ultimately, health outcomes in South Africa.

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Record No. 11241 Record ID 011241 Publication type Journal Article Title The importance of Interdisciplinary Collaborative Research in Responding to HIV/AIDS Vulnerability in Rural Senegal Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Willems, R. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher NISC Pty Ltd Date of publication 2010 Volume and n° 8(4) Pages 433-442 Language English Descriptor Health Policy; Research; HIV Infections Descriptor-Geographic Senegal Abstract HIV prevalence in Senegal is less than 1, a success generally attributed to the country's quick response to the nascent epidemic of the 1980s and its continued efforts to curtail the spread of HIV. However, as the bulk of the healthcare infrastructure and support for HIV-positive individuals and AIDS patients are located in urban areas, there remains limited information on HIV and AIDS prevalence in rural areas. Several focus group discussions held with small-holder farmers in 2006, in the regions of Kolda and Tambacounda, Senegal, in the framework of a regional food-security development programme, revealed the growing vulnerability of rural populations to HIV and AIDS. Because current HIV/AIDS campaigns are strongly influenced by generalised, internationally formulated guidelines that fail to take into account the cultural particularities of the Senegalese context, the initial positive impact of these campaigns has dramatically decreased and at-risk behaviour in rural Senegal has been found to be on the increase. The article argues that in order for HIV/AIDS campaigns to have an impact there is an urgent need for evidence-based approaches built on a deeper understanding of the local socio-cultural situation through interdisciplinary research and collaboration.

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Record No. 11240 Record ID 011240 Publication type Journal Article Title Addressing the HIV/AIDS-Food Insecurity Syndemic in Sub-Saharan Africa Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Himmelgreen, D. A.; Turkon, D.; Watson, S.; Okello-Uma, I.; Sellen, D. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher NISC Pty Ltd Date of publication 2009 Volume and n° 8(4) Pages 401-412 Language English Descriptor HIV; Acquired Immunodeficiency Syndrome; Malnutrition; sub-Saharan Africa Abstract Recently a few vocal health experts have suggested that some of the billions of dollars currently used to prevent and treat HIV and AIDS be reallocated to address more basic problems such as malnutrition, tuberculosis, malaria, and enteric and diarrheal disease caused by lack of access to clean water. While not universally agreed upon, this reassessment of policy priorities acknowledges that there are multiple other health problems that deserve renewed attention from the international community. It also highlights the fact that the impacts of the HIV pandemic are exacerbated by widespread poverty, food insecurity and malnutrition, and gender inequality. Nowhere is this more evident than in sub-Saharan Africa, where multiple epidemics conflate and seriously compromise the survival of individuals and communities. Given the widespread occurrence of famine insub-Saharan Africa, issues of food and economic security become of paramount importance in efforts to address the region's HIV epidemics. This paper examines the historical, political-economic, and cultural dimensions of the HIV epidemic in the context of the growing problem of food and economic insecurity. Furthermore, using theoretical frameworks that emphasize the dynamic interrelation between HIV/AIDS and food insecurity, we present suggestions for combining traditional HIV-prevention strategies with food production and nutritioneducation programming. In light of the complex interactions between HIV/AIDS and food insecurity and the lack of accessible treatment modalities, such programming could potentially reduce the risk for transmission of HIV through behavioural changes and improved nutritional and immune status, and increase the life expectancy of people living with HIV or AIDS.

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Record No. 11239 Record ID 011239 Publication type Journal Article Title Mobilising Indigenous Resources for Anthropologically Designed HIV-Prevention and Behaviour-Change Interventions in Southern Africa Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Green, E. C.; Dlamini, C.; D'Errico, N. C.; Duby, Z. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher NISC Pty Ltd Date of publication 2010 Volume and n° 9(1) Pages 71-80 Language English Descriptor HIV Infection; Anthropology; Medicine, African Traditional; Behavior Descriptor-Geographic South Africa Abstract HIV prevention is often implemented as if African culture were either nonexistent or 4a series of obstacles to overcome in order to achieve an effective, gender-equitable, human rights-based set of interventions. Similarly, traditional or indigenous leaders, such as chiefs and members of royal families, have been largely excluded from HIV/AIDS responses in Africa. This qualitative study used focus group discussions and in-depth interviews with traditional leaders and 'ritual specialists' to better understand cultural patterns and ways of working with, rather than against, culture and traditional leaders in HIV-prevention efforts. The research was carried out in four southern African countries (Botswana, Lesotho, South Africa and Swaziland). The purpose was to discover what aspects of indigenous leadership and cultural resources might be accessed and developed to influence individual behaviour as well as the prevailing community norms, values, sanctions and social controls that are related to sexual behaviour. The indigenous leaders participating in the research largely felt bypassed and marginalised by organised efforts to prevent HIV infections and also believed that HIV-prevention programmes typically confronted, circumvented, criticised or condemned traditional culture. However, indigenous leaders may possess innovative ideas about ways to change individuals' sexual behaviour in general. The participants discussed ways to revive traditional social structures and cultural mechanisms as a means to incorporate HIV-prevention and gender-sensitivity training into existing cultural platforms, such as rites of passage, chiefs' councils and traditional courts.

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Record No. 11238 Record ID 011238 Publication type Journal Article Title Implementation of the National Programme for Prevention of Mother-To-Child Transmission of HIV: a Rapid Assessment in Cacadu District, South Africa Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Peltzer, K.; Phaswana-Mafuya, N.; Ladzani, R. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher NISC Pty Ltd Date of publication 2010 Volume and n° 9(1) Pages 95-106 Language English Descriptor Infectious Disease Transmission, Vertical-prevention & control; HIV Health Plan Implementation Descriptor-Geographic South Africa Abstract To conduct a rapid assessment of the prevention-of-mother-to-child-transmission-of-HIV (PMTCT) programme in two of the three local service areas in Cacadu district, Eastern Cape province, South Africa, we designed an exploratory study using a mixed-methods approach. Quantitative and qualitative data on PMTCT programme implementation were collected in 2008 through a structured assessment at the 44 health facilities implementing the programme in the province. This included in-depth interviews with 11 clinic supervisors, 31 clinic programme coordinators, and 8 hospital/maternity staff members in order to examine their perceived problems and suggestions regarding PMTCT programme implementation; an assessment of the clinic registers and recording systems; a meeting with stakeholders; and one feedback meeting with clinic managers, sub-district management and other stakeholders in regard to the results of the rapid assessment. Overall, most of the national criteria for PMTCT programme implementation were fulfilled across the health facilities. However, shortcomings were found relating to health policy, health services delivery and clients' health-seeking behaviour. The findings show the need for a well-functioning health system with adequate and trained staff, a reduced staff workload, proper case recording, an improved patient follow-up system, better support for staff, the empowerment of PMTCT clients, strong leadership, and coordination and collaboration between partners.

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Record No. 11237 Record ID 011237 Publication type Journal Article Title Perceptions of HIV/AIDS Leaders about Faith-Based Organisations' Influence on HIV/AIDS Stigma in South Africa Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Keikelame, M. J.; Murphy, C. K.; Ringheim, K. E.; Woldehanna, S. Journal Title African Journal of AIDS Research ISSN 1727-9445 Place of Publication Grahamstown Publisher NISC Pty Ltd Date of publication 2010 Volume and n° 9(1) Pages 63-70 Language English Descriptor HIV Infections; Acquired Immunodeficiency Syndrome; Social Environment; Organizations Descriptor-Local People Living with HIV/AIDS Descriptor-Geographic South Africa Abstract The extent of the HIV pandemic - particularly in the hardest-hit countries, including South Africa - has prompted a call for greater engagement of all groups, including faith-based organisations (FBOs). Although FBOs are known to play a substantial role in providing care and support to those affected by HIV and AIDS, empirical evidence in regard to their actions in the broader context of stigma is limited. A qualitative, key-informant survey was conducted in South Africa as part of a six-country international study to examine perceptions of how FBOs have contributed to reduction in HIV risk, vulnerability and related impacts. The special emphasis of this paper is the influence of FBOs on stigma and discrimination. In-depth interviews were held with 34 senior-level key informants who act as key decision-makers in the response to HIV and AIDS in South Africa. Secular and faith-based respondents shared their perceptions of the faith-based response, including FBOs' actions in relation to HIV/AIDS stigma and discrimination. Our study revealed that while FBOs were perceived as taking some action to address stigma in South Africa, FBOs were also thought to contribute to HIV/AIDS- discrimination through conflating issues of sexuality and morality, and through associating HIV and AIDS with sin. The interviewees indicated a number of internal and external challenges faced by FBOs to deal effectively with stigma, including lack of information and skills, the difficulty of maintaining confidentiality in health services, and self-stigmatisation which prevents HIV-infected persons from revealing their status. Findings from this study may help both faith-based and secular groups capitalise on the perceived strengths of FBOs as well as to elucidate their perceived weaknesses so that these areas of concern can be further explored and addressed

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