Browsing by Subject "HIV/AIDS "

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    A systematic review of the assessment of out-of-pocket payment removal policies in reducing the economic burden caused by direct and indirect costs of HIV service utilization in South Africa
    (2023) Majokweni, Hlombekazi; Sinanovic, Edina
    Background: The call for universal health coverage (UHC) has led to some policy introductions such as the removal of out-of-pocket payments (OOPs) in the form of user fees at point of care in primary health facilities in South Africa. The cost of healthcare for patients is not only a barrier to access and utilisation but can also lead to catastrophic spending and impoverishment. For people living with HIV (PLWH), health expenses can threaten their financial wellbeing due to HIV treatment requiring multiple health visits and other healthrelated costs. We examine how the UHC policy of user fee removal has contributed to reducing the economic burden of HIV/AIDS for PLWH and their households. Methods: Searches were conducted on Africa Wide, CINAHL, EconLit, Health Source, PsycInfo, PubMed and Web of Science. We included quantitative and qualitative articles that reported costs of HIV service utilization or reported impoverishment and catastrophic health expenditure (CHE) as part of their outcomes. We reviewed and extracted data that would assist in answering the review question and reported on the total cost of utilization and its impact on PLWH. Results: We found 12 eligible articles. The reviewed data showed that PLWH spent a substantial amount of money on transport, additional care such as private doctors, traditional healers, and special food showing that user fee removal alone is insufficient for financial protection. People borrowed money, took interest bearing loans and sold assets to cover healthcare expenses. PLWH experienced CHE across various thresholds, and people in the rural areas had more odds of CHE compared to those in urban areas. Additional care outside of the public health system and transport were drivers of CHE and impoverishment. Conclusion: The UHC policy of user fee removal at point of care has been beneficial in reducing the economic burden of HIV/AIDS service utilization for people living in close proximity to the primary healthcare facilities and those who receive care in well-resourced facilities. However, the same cannot be said about those who have to travel long distances to health facilities and are forced to seek additional care for their health needs to be sufficiently met.
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    Accelerating Sustainable Development Goals for South African adolescents from high HIV prevalence areas: a longitudinal path analysis
    (2021-11-11) Meinck, Franziska; Orkin, Mark; Cluver, Lucie
    Background Adolescents experience a multitude of vulnerabilities which need to be addressed in order to achieve the Sustainable Development Goals (SDGs). In sub-Saharan Africa, adolescents experience high burden of HIV, violence exposure, poverty, and poor mental and physical health. This study aimed to identify interventions and circumstances associated with three or more targets (“accelerators”) within multiple SDGs relating to HIV-affected adolescents and examine cumulative effects on outcomes. Methods Prospective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with > 30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-negative/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes controlling for outcome at baseline and socio-demographics. The study corrected for multiple-hypothesis testing and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated. Results Sample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food sufficiency and AIDS-free caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. AIDS-free caregiver was associated with the largest reductions. Combinations of accelerators resulted in a percentage reduction of risk of up to 40%. Conclusion Positive parenting, parental monitoring, food sufficiency and AIDS-free caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to the corresponding real-world interventions parenting programmes, cash transfers and universal access to antiretroviral treatment, which when provided together, may help governments in sub-Saharan Africa more economically to reach their SDG targets.
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    Acceptability and feasibility of peer-administered group interpersonal therapy for depression for people living with HIV/AIDS—a pilot study in Northwest Ethiopia
    (2021-07-28) Asrat, Biksegn; Lund, Crick; Ambaw, Fentie; Schneider, Marguerite
    Background Psychological treatments are widely tested and have been effective in treating depressive symptoms. However, implementation of psychological treatments in the real world and in diverse populations remains difficult due to several interacting barriers. In this study, we assessed the acceptability and feasibility of peer-administered group interpersonal therapy for depressive symptoms among people living with HIV/AIDS in Northwest Ethiopia. Method We conducted a single-arm, peer-administered, group interpersonal therapy intervention with eight weekly sessions from 15 August to 15 December 2019 among people living with HIV/AIDS in Northwest Ethiopia. Four interpersonal therapy groups were formed for the intervention with a total of 31 participants. Results Of the 31 recruited participants, 29 completed the intervention providing a retention rate of 93.5%. The process of the intervention and its outcomes were highly acceptable as most participants expressed success in resolving their psychosocial problems, adjusting to life changes and coping with stigma. The intervention was also reported to be feasible despite anticipated barriers such as access to transportation, perceived stigma and confidentiality concerns. The post-intervention assessment revealed significant reduction in depressive symptoms (mean difference (MD) = 9.92; t =  − 7.82; 95% CI, − 12.54, − 7.31; p < 0.001), improvement in perceived social support (MD = 0.79; t = 2.84; 95% CI, 0.22, 1.37; p = 0.009) and quality of life (MD = 0.39; t = 4.58; 95% CI, 0.21, 0.56; p < 0.001). Conclusion Group interpersonal therapy is feasible and acceptable, and people living with HIV/AIDS can benefit from group interpersonal therapy in managing depressive symptoms and in improving perceived social support and quality of life. Future studies should examine the effectiveness of group interpersonal therapy in this setting.
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    Access to antiretroviral drugs in South Africa: the HIV/AIDS crisis in the light of the TRIPS Agreement, South African intellectual property and competition law
    (2011) Voogd, Janina; Thong, Lee-Ann
    The HIV/ AIDS crisis has reached a high degree of prominence and awareness in both developed and developing countries. However, at the same time rural areas with no, little or very inaccurate knowledge of the HIV/AIDS problem can still be found all over the world. Furthermore, it seems that the awareness for the problem has had its peak a few years ago and that, since then, it has decreased at least on the international level. It somehow appears that the immense crisis is not seen as such nowadays and that people all over the world - but particularly in many third-world countries - have accommodated to its cruel results. The dimensions of HIV/ AIDS seem to be taken as some kind of bizarre normality in many countries. Furthermore, the developed world appears to have acknowledged the fact that developing countries and HIV/ AIDS present an inseparable phenomenon.
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    Addressing the impact of HIV/AIDS on children in South Africa - Priorities for funders and development agencies
    (Children's Institute, 2004-03) Meintjes, Helen; Giese, Sonja
    This briefing paper is structured into two parts. Part A provides a brief overview of orphan numbers and what we know about the living circumstances of children growing up in the context of HIV/AIDS in South Africa. Part B of the paper provides a set of key recommendations to guide funders in responding to the impact of HIV/AIDS on children.
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    An agent-based model of binge drinking, inequitable gender norms and their contribution to HIV transmission, with application to South Africa
    (2023-07-29) Johnson, Leigh F.; Kubjane, Mmamapudi; de Voux, Alex; Ohrnberger, Julius; Tlali, Mpho
    Abstract Background Binge drinking, inequitable gender norms and sexual risk behaviour are closely interlinked. This study aims to model the potential effect of alcohol counselling interventions (in men and women) and gender-transformative interventions (in men) as strategies to reduce HIV transmission. Methods We developed an agent-based model of HIV and other sexually transmitted infections, allowing for effects of binge drinking on sexual risk behaviour, and effects of inequitable gender norms (in men) on sexual risk behaviour and binge drinking. The model was applied to South Africa and was calibrated using data from randomized controlled trials of alcohol counselling interventions (n = 9) and gender-transformative interventions (n = 4) in sub-Saharan Africa. The model was also calibrated to South African data on alcohol consumption and acceptance of inequitable gender norms. Binge drinking was defined as five or more drinks on a single day, in the last month. Results Binge drinking is estimated to be highly prevalent in South Africa (54% in men and 35% in women, in 2021), and over the 2000–2021 period 54% (95% CI: 34–74%) of new HIV infections occurred in binge drinkers. Binge drinking accounted for 6.8% of new HIV infections (0.0–32.1%) over the same period, which was mediated mainly by an effect of binge drinking in women on engaging in casual sex. Inequitable gender norms accounted for 17.5% of incident HIV infections (0.0–68.3%), which was mediated mainly by an effect of inequitable gender norms on male partner concurrency. A multi-session alcohol counselling intervention that reaches all binge drinkers would reduce HIV incidence by 1.2% (0.0–2.5%) over a 5-year period, while a community-based gender-transformative intervention would reduce incidence by 3.2% (0.8–7.2%) or by 7.3% (0.6–21.2%) if there was no waning of intervention impact. Conclusions Although binge drinking and inequitable gender norms contribute substantially to HIV transmission in South Africa, recently-trialled alcohol counselling and gender-transformative interventions are likely to have only modest effects on HIV incidence. Further innovation in developing locally-relevant interventions to address binge drinking and inequitable gender norms is needed.
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    AIDS Growth and Distribution in South Africa
    (2002) Nattrass, Nicoli
    This paper discusses recent research into the economic impact of AIDS in South Africa. It focuses on demographic and macroeconomic modelling and on firm-level impact studies. While the overall picture is murky, certain trends and findings are indicative of a likely increase in inequality. Relatively skilled workers could benefit from greater employment, higher wages, a larger supply of products produced for their niche markets, and may also live longer as it becomes economically viable for firms to provide anti-retroviral medication. The relatively unskilled and unemployed will probably experience declining income, falling consumer welfare, and suffer greater morbidity and mortality from AIDS. The size of the pie may shrink as a result of AIDS, but employed people - and especially the skilled amongst them - will enjoy a growing share.
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    The Amy Biehl HIV/AIDS peer educators programme: An impact assessment of the valued benefits and disbenefits for the programme participants
    (2005) Porter, Stephen; Wale, Kim
    This paper is the final deliverable of an impact assessment programme commissioned by the Amy Biehl Foundation to investigate the deeper impacts, benefits and disbenefits, on the recipients of the HIV/AIDS peer educators programme. This paper posits an interesting methodology based on Sen’s capability approach which sought to explore the impact of the peer education programme upon dimensions of well-being and other agency objectives. The programme was found to be having a very positive impact upon the recipients. Overall the programme was found have important unintended, but predictable outcomes upon youth’s knowledge, confidence and inner voice. The suggestion in this paper is that changes in feelings of self-worth are valuable in enhancing choices and decisions made generally in the peer educators lives and especially in regards to the knowledge gained in the area of HIV/AIDS. This is a positive appraisal; it tells us that the programme empowers youths through knowledge and relationships, which in turn enhances their own feeling of self-worth1 . Coaching the peer educators with reliable knowledge about HIV/AIDS is instrumentally and substantively important, enabling informed choices that can lead them to enjoy a long and healthy life.
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    Antiretroviral roll-out in South Africa: where do children feature?
    (Children's Institute, 2004) Shung King, Maylene; Zampoli, Marco
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    The aura of silence: a psychosocial analysis of stigma amongst students working In the field of HIV And AIDS at the University of Cape Town
    (2007) Cooper, Sara; Foster, Don
    Eleven white, well-educated students from the University of Cape Town, all actively involved in the field of HIV/AIDS, were interviewed through a freeassociative-narrative method. This study sought to explore these students’ perceptions of and associations with HIV/AIDS and those infected, in an attempt to assess the extent to which stigma may occur amongst these students. To the authors’ knowledge, no other studies exploring HIV/AIDS-related stigma have been done on young adults who are actively engaging with, and highly educated on, issues around HIV and AIDS. The accounts revealed that underneath the overt denials of fear, the epidemic does seem to evoke various fears and anxieties for these students. Through their constructions of HIV/AIDS, the participants tend to ‘other’ the epidemic and those infected and thus distance themselves from a sense of threat. Such representations therefore appear to serve a protective function, enabling the participants to defend themselves from the anxieties they experience surrounding the epidemic. In line with psychosocial understandings of HIV/AIDS stigma, the results from this study indicate that this ‘atypical’ group of students may possess certain stigmatizing tendencies. This points to the fact that HIV/AIDS stigma may not be the product of a lack of education or ‘faulty’ thinking. There were however multiple, often contradictory and conflicting voices heard throughout the interviews. Many participants expressed an awareness of, and uneasiness with, their ‘othering’ and potentially stigmatizing tendencies. It is in this space, that the potential for change, and stigma reduction may exist. The findings from this study thus have both theoretical and practical implications for conceptualizing, and challenging HIV/AIDS stigma.
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    Beyond the Disease of Discrimination: A Critical Analysis of HIV-Related Stigma in KTC, Cape Town
    (2004) Mills, Elizabeth
    The aim of this paper is to explore the nature and dynamics of HIV-related stigma in the KTC with a view to understand the impact of stigma on the lives of HIV+ people and their social environment. This paper draws on qualitative research methods, including focus groups, interviews and participant observation. Research was conducted in KTC, a shack settlement in Cape Town, with a group of home-based carers, and their HIV-positive clients, in 2003 and 2004.? The complex matrix of factors, like socio-economic and gender inequality, which perpetuate HIV-related stigma in the context of KTC, is explored through this paper.? This paper argues that social networks in KTC can play both a constructive and destructive role in facilitating care, and HIV-related stigma respectively. Finally, the research and findings of this paper point to the need to shift away from the notion that stigma is experienced by the individual to a more multifaceted understanding of the impact of HIV-related stigma on the HIV+ individual's social environment.
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    'But where are our moral heroes?': An analysis of South African press reporting on children affected by HIV/AIDS
    (2005) Meintjes, Helen; Bray, Rachel
    Messages conveyed both explicitly and implicitly in the media play an important role in the shaping of public understanding of issues, as well as associated policy, programme and popular responses to these issues. This paper applies discourse analysis to a series of articles on children affected by HIV/AIDS published in 2002/2003 in the English-medium South African press. The analysis reveals layer upon layer of moral messaging present in the reporting, the cumulative effect of which is the communication of a series of moral judgements about who is and who is not performing appropriate roles in relation to children. Discourses of moral transgression specifically on the part of African parents and ‘families’ for failing in their moral responsibilities towards their children coalesce with discourses of anticipated moral decay amongst (previously innocent) children who lack their due care. The need for moral regeneration amongst South Africans generally (but implicitly black South Africans) is contrasted with an accolade of (usually white) middle class individuals who have gone beyond their moral duty to respond. The paper argues that in each instance, the particular moralism is questionable in the light of both empirical evidence and principles of human dignity underlying our constitution. Children – and particularly ‘AIDS orphans’ – are shown to be presented as either the quintessential innocent victims of the epidemic or as potential delinquents. While journalists intentions when representing children in these ways are likely to be positive, the paper argues that this approach is employed at a cost, both in the public’s knowledge and attitudes around the impact of AIDS, and more importantly, in the lives of children affected by the epidemic.
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    CareConekta: study protocol for a randomized controlled trial of a mobile health intervention to improve engagement in postpartum HIV care in South Africa
    (2020-03-12) Clouse, Kate; Phillips, Tamsin K; Camlin, Carol; Noholoza, Sandisiwe; Mogoba, Phepo; Naidoo, Julian; Langford, Richard; Weiss, Martin; Seebregts, Christopher J; Myer, Landon
    Abstract Background South Africa is home to the world’s largest antiretroviral therapy program but sustaining engagement along the HIV care continuum has proven challenging in the country and throughout the wider region. Population mobility is common in South Africa, but there are important research gaps in describing this mobility and its impact on engagement in HIV care. Postpartum women and their infants in South Africa are known to be at high risk of dropping out of HIV care after delivery and are frequently mobile. Methods In 2017, we developed a beta version of a smartphone application (app) - CareConekta - that detects a user’s smartphone location to allow for prospective characterization of mobility. Now we will adapt and test CareConekta to conduct essential formative work on mobility and evaluate an intervention - the CareConekta app plus text notifications and phone calls and/or WhatsApp messages - to facilitate engagement in HIV care during times of mobility. During the 3-year project period, our first objective is to evaluate the feasibility, acceptability, and initial efficacy of using CareConekta as an intervention to improve engagement in HIV care. Our second objective is to characterize mobility among South African women during the peripartum period and its impact on engagement in HIV care. We will enroll 200 eligible pregnant women living with HIV and receiving care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa. Discussion This work will provide critical information about mobility during the peripartum period and the impact on engagement in HIV care. Simultaneously, we will pilot test an intervention to improve engagement with rigorously assessed outcomes. If successful, CareConekta offers tremendous potential as a research and service tool that can be adapted and evaluated in multiple geographic regions, study contexts, and patient populations. Trial registration ClinicalTrials.gov: NCT03836625. Registered on 8 February 2019.
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    Case study: Cell-Life
    (2009-02-28) Willmers, Michelle; Hodgkinson-Williams, Cheryl
    This case study analyses the ways in which the Cell-Life initiative, a collaboration between the University of Cape Town's departments of Civil and Electrical Engineering and the Cape Peninsula University of Technology, utilised technology-based solutions (in particular, cellphone technology) for the life management of patients living with HIV/AIDS.
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    Changes in self-reported HIV testing during South Africa's 2010/2011 national testing campaign: gains and shortfalls
    (2016) Maughan-Brown, Brendan; Lloyd, Neil; Bor, Jacob; Venkataramani, Atheendar S
    HIV counselling and testing is critical to HIV prevention and treatment efforts. Mass campaigns may be an effective strategy to increase HIV testing in countries with generalized HIV epidemics. We assessed the self-reported uptake of HIV testing among individuals who had never previously tested for HIV, particularly those in high-risk populations, during the period of a national, multisector testing campaign in South Africa (April 2010 and June 2011).
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    Child Protection Week 2003. Fact sheet No. 3: children and HIV/AIDS
    (Children's Institute, 2003-05) Giese, Sonja; Meintjes, Helen
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    Child-headed households in South Africa: A statistical brief 2009
    (Children's Institute, 2009) Meintjes, Helen; Hall, Katharine; Marera, Double-Hugh; Boulle, Andrew
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    Children 'in need of care' or in need of cash? Questioning social security provisions for orphans in the context of the South African AIDS pandemic
    (Children's Institute, 2003-12) Meintjes, Helen; Budlender, Debbie; Giese, Sonja; Johnson, Leigh
    Joint working paper of the Children's Institute and Centre for Actuarial Research, University of Cape Town.
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    Children experiencing orphanhood - the role of the health sector
    (Children's Institute, 2003-08) Giese, Sonja; Meintjes, Helen; Croke, Rhian; Chamberlain, Ross
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    Children's Institute submission on the draft regulations to the Children's Act 38 of 2005
    (Children's Institute, 2008-08) Proudlock, Paula; Meintjes, Helen; Moses, Sue
    Written submission to the national Department of Social Development, 11 August 2008.