African
Journals Online
African Journal of AIDS Research
Volume 2 Issue 1 (2003)
ABSTRACTS
Epidemiological and demographic
HIV/AIDS projections: South Africa
Thomas M Rehle1 and Olive Shisana2*
1
Independent Consultant in International Health and Disease Control, 1426 G
Street SE, Washington, DC 20003, USA
2 HSRC/SAHA,
Private Bag X9182, Cape Town 8000, South Africa
*
Corresponding author, e-mail: [email protected]
Abstract
The Epidemic Projection Package
(EPP) recently developed by the UNAIDS Reference Group on Estimates, Models and
Projections and the Spectrum model program developed by the Futures Group were
used to model the South African HIV epidemic, project future trends in HIV/AIDS
and estimate the demographic impact of AIDS. The national HIV prevalence
surveys among pregnant women from 1990-2001 and the first national,
population-based HIV survey in 2002 served as the data sets used to calibrate
the input HIV prevalence values for the model.
The scenario created by the model
showed that a dramatic rise in HIV prevalence during the 1990s has peaked in
2002 with 4.69 million infected people and it is projected that the epidemic in
South Africa has now begun to level off. Adult (15-49 years) incidence rates
have decreased substantially in the past five years since 1997 (4.2%) and are
expected to reach a level of 1.7% in 2003. The annual number of deaths due to
AIDS is projected to peak with 487 320 AIDS deaths in the year 2008. By 2020,
the total population of South Africa is expected to be 23% smaller than it
would be without AIDS, however, a negative population growth rate is not
expected during the projection period. Life expectancy at birth is expected to
hit a low of 45.6 years in the time period 2005–2010, which is 22
years less than it would have been in the absence of AIDS. Ten years from now
over 2.5 million AIDS orphans are projected for South Africa. Models play an
important role in estimating HIV variables that are difficult to measure.
Projections of the future HIV/AIDS burden in South Africa underscore the importance
of acting now to reduce the number of new infections and plan for medical and
social care needs.
Keywords: AIDS mortality,
demographic impact, HIV prevalence, modelling
African Journal of AIDS Research 2003, 2(1): 1-8
Behaviour and communication change in
reducing HIV: is Uganda unique?
Daniel Low-Beer1,2* and Rand L Stoneburner1
1 Health and Population
Evaluation Unit and Cambridge University Health, Cambridge University, United
Kingdom
2 Sidney Sussex College,
Sidney Street, Cambridge CB23HU, United Kingdom
* Corresponding author, e-mail:
[email protected]
Abstract
The clearest example of declines in
HIV prevalence and changes in sexual behaviour comes from Uganda. Are there
lessons to learn for other countries or is Uganda unique? In this paper, we
assess the epidemiological and behavioural data on Uganda comparatively to
other African countries and then analyse data from other populations where HIV
has declined. In Uganda, HIV prevalence declined from 21% to 9.8% from
1991-1998, there was a reduction in non-regular sexual partners by 65% and
greater levels of communication about AIDS and people with AIDS through social
networks, unlike the comparison countries. There is evidence of a basic
population level response initiated at community level, to avoid risk, reduce
risk behaviours and care for people with AIDS. The basic elements - a continuum
of communication, behaviour change and care - were integrated at community
level. They were also strongly supported by distinctive Ugandan policies from the
1980s. We identify a similar, early behaviour and communication response in
other situations where HIV has declined: Thailand, Zambia and the US Gay
community. In Thailand, visits to sex workers decreased by 55% and non-regular
partners declined from 28% to 15% (1990-1993): as important as the -100% condom
use policy - Similarly, in Zambia and Ethiopia risk behaviour has decreased and
analysis of Sexually Transmitted Disease (STD) rates among Gay populations in
the USA shows a decline from as early as 1985 in White Gay populations, with
later declines in Hispanic and Black Gay populations. These responses preceded
and exceeded HIV prevention. However, where they were built on by distinctive
HIV policies, HIV prevention has been scaled and led to national level declines
in HIV. It is not easy to transfer the lessons of these successes. They require
real social and political capital in addition to financial capital.
Nevertheless, similar characteristics are present in community responses in
Africa, Asia and USA, and even in fragmented signs of HIV declines in other
African cities. Only in a few situations has this behaviour and communication
process been recognised, mobilised and built on by HIV prevention policy. Where
this has occurred, HIV prevention success has been greater than biomedical
approaches or methods introduced from outside. It represents a social vaccine
for HIV from Africa, and is available now.
Keywords: AIDS, community,
comparative, epidemiology, prevention
African Journal of AIDS Research 2003, 2(1): 9-21
Investigating the interface
between health system reform and HIV/AIDS in sub-Saharan Africa: an approach
for improving the fight against the epidemic
Rasmus C Dawes*
Institute of Geography, University
of Copenhagen, Øster Voldgade 10, 1350 Copenhagen K, Denmark
e-mail: [email protected]
Abstract
During the period in which the
HIV/AIDS epidemic has taken hold in sub-Saharan Africa, health system reforms
have and continue to be introduced throughout the region. In spite of the
multidisciplinary research undertaken, it can be questioned whether the
relationships between processes of reform and some of the critical issues of
HIV/AIDS response have been fully appreciated. This is particularly worrying
since many countries in sub-Saharan Africa have already embarked on reform
whilst concurrently and independently attempting to develop and manage
effective responses to the overwhelming challenges posed by the HIV/AIDS
epidemic. This paper explores the relationship between health system reform and
HIV/AIDS, and argues that an interface approach is crucial for understanding
the complexity of combating the epidemic whilst reforming health systems. The
interface refers to the interacting processes between reform and the effects of
the disease and attempts to respond to it. It includes the ways in which
reforms, and such features as decentralisation and user fees, affect the
capacity to fight HIV/AIDS, and conversely how the implications of the disease
affect the performance of reformed health systems. Two sets of constraints in
the interface are defined: internal and delivery constraints. The former are
illustrated by deteriorating levels of human resources, poor integration of
HIV/AIDS activities and problems faced by tiered health systems. The latter are
illustrated by issues of access to relevant health services and
rural–urban disparities. Issues in the interface need to be addressed
by researchers and implementers in order to move forward in containing the
epidemic.
Keywords: health system reform,
HIV/AIDS, interface, internal and delivery constraints sub-Saharan Africa
African Journal of AIDS Research 2003, 2(1): 23-31
Perceived social context of
AIDS in a Black township in Cape Town
Seth C Kalichman1* and Leickness Simbayi2
1 Department of
Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT, 6269, USA
2 Human Sciences Research
Council, Cape Town, South Africa
* Corresponding author, e-mail:
[email protected]
Abstract
AIDS is only one of several life
threatening social problems facing people living in poverty. HIV/AIDS prevention messages and prevention
programmes should be framed within the context of relevant social problems. The
current study examined public perceptions of AIDS as a relative social problem
and AIDS-related socio-political beliefs among South African men and women
living in a Black township of Cape Town. Participants (224 men and 276 women)
completed surveys that assessed perceptions of HIV/AIDS relative to nine other
social problems: lack of housing, transportation, poor sanitation, sufficient
food, unemployment, discrimination, poor education, violence and crime.
Participants also responded to six items assessing socio-political views of
AIDS. Results showed that AIDS was perceived as a serious social problem in the
township, but was perceived as less serious than crime and not different from
violence and unemployment. Principal components factor analyses showed that
AIDS was associated with multiple social problems and that AIDS was most
closely associated with crime and violence, representing social problems that
directly cause death. Although AIDS perceptions were similar to those expressed
by the South African government, there was evidence for some mistrust about
both what the government was doing and what it was saying about AIDS. HIV
prevention messages in South Africa should be tailored to fit the perceived
social context of AIDS.
Keywords: HIV-AIDS prevention,
social context, social problems
African Journal of AIDS Research 2003, 2(1): 33-38
Predicting the social
consequences of orphan hood in South Africa
Rachel
Bray
Centre for Social Science Research,
Leslie Social Science Building, Upper Campus, University of Cape Town,
Rondebosch 7701, South Africa
e-mail: [email protected]
Abstract
This paper examines and questions
the predictions found in the academic and policy literature of social breakdown
in southern Africa in the wake of anticipated high rates of orphanhood caused
by the AIDS epidemic. Analysis of the logic underlying these predictions
reveals four causal relationships necessary to fulfil such dramatic and
apocalyptic predictions:
1 High AIDS mortality rates will
produce high numbers of orphans.
2 These orphans will become children
who do not live in appropriate social environments to equip them for adult
citizenship.
3 Poor socialisation will mean that
children orphaned by AIDS will not live within society’s moral codes (becoming,
for example, street children or juvenile delinquents).
4 Large numbers of such “asocial” or
“antisocial” children will precipitate a breakdown in the social fabric.
Evidence for each of these steps in
the argument is scrutinised using available data from southern Africa and other
regions that have moved further through the epidemic’s cycle. The paper finds
strong evidence for the first step, although variable definitions of “orphan”
make it difficult to draw accurate comparisons over time and space. Evidence
for the second step is found to be mixed in terms of outcomes of AIDS
orphanhood for child well-being. Moreover the argument takes little account of
the social and economic environments onto which AIDS is mapped, including the
economic fragility of households and pervading socio-cultural patterns of
child-rearing. Data to substantiate the third step are anecdotal at best and no
research is able to demonstrate a link between the long term effects of AIDS
orphanhood and rising rates of juvenile delinquency. Arguments made towards the
fourth step are shown to be based heavily on notions of the “correct” social
and physical environments for children and on unsubstantiated fears of
alternatives to these. There is no evidence from countries where numbers of
AIDS orphans are already high to suggest that their presence is precipitating
social breakdown.
The paper argues - somewhat
provocatively - that such apocalyptic predictions are unfounded and
ill-considered. By mis-representing the problems faced by children and their
families, attention is distracted from the multiple layers of social, economic
and psychological disadvantage that affect individual children, families and
communities. Consequently, insufficient consideration is given to the
multi-faceted supports necessary to assist children to cope with extremely
difficult circumstances brought about over the long term by the HIV/AIDS
epidemic.
Keywords: child well-being,
evidence, HIV/AIDS, social breakdown, vulnerability
African Journal of AIDS Research 2003, 2(1): 39-55
Investigating attitudes
towards caring for people with HIV/AIDS among hospital care workers in Ibadan,
Nigeria: the role of self-efficacy
BO Olley
MRC Research Unit on Anxiety
Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch,
South Africa
e-mail: [email protected]
Abstract
Fear of HIV infection and its
consequences may affect the willingness and capacity of health care workers to
provide good quality care for people with HIV/AIDS (PWHAs). The study was
founded on the proposition that self-efficacy may mediate the attitudinal
disposition of health care workers related to provision of care to PWHAs. Two
hundred and ten physicians (n = 103) and nurses (n = 107) sampled from the
University College Hospital, Ibadan, Nigeria, responded (48% response rate) to
a questionnaire which addressed self-efficacy relating to HIV/AIDS, knowledge
about HIV/AIDS and treatment of and attitudes towards HIV/AIDS patients.
Attitude questions included items on fear of HIV infection, futility in
providing care for HIV patients, distress in caring for the patient who is
likely to die and willingness to care for PWHAs. The major finding was a
significant association between reported high self-efficacy and less fear of
acquiring HIV, less futility in providing care for PWHAs and increased
willingness to provide such care. More years of education was associated with
higher willingness to care, less fear associated with care as well as lower
perceived futility related to the care of PWHAs. Female gender was
significantly related to the perception of futility related to the care of PWHAs.
There was no significant relationship between self-efficacy and knowledge about
HIV/AIDS. The findings have significant implications for hospital care for
PWHAs and suggest that self-efficacy, rather than knowledge about HIV/AIDS may
be important in mediating attitudes towards PWHAs and also in developing
intervention programmes aimed at helping health care providers to reframe their
attitudes.
Keywords: attitudes, health care
workers, HIV/AIDS care, Nigeria
African Journal of AIDS Research 2003, 2(1): 57-61
Waging war: discourses of
HIV/AIDS in South African media
Mark Connelly and Catriona Macleod*
Department of Psychology, University
of Fort Hare/Rhodes University, PO Box 7426, East London 5200, South Africa
* Corresponding author, e-mail:
[email protected]
Abstract
This paper explores a discourse of
war against HIV/AIDS evident in the Daily Dispatch, a South African daily
newspaper, from 1985 to 2000, and discusses the implications of this in terms
of the way in which HIV/AIDS is constructed. The discursive framework of the
war depends, fundamentally, on the personification of HIV/AIDS, in which agency
is accorded to the virus, and which allows for its construction as the enemy.
The war discourse positions different groups of subjects (the diseased body, the commanders, the experts, the
ordinary citizens) in relations of power. The diseased body, which is the point
of transmission, the polluter or infector, is cast as the
‘Other', as a dark and threatening force. This
takes on racialised overtones. The
government takes on the role of commander, directing the war through policy and
intervention strategies. Opposition to government is couched in a struggle
discourse that dove-tails with the overall framework of war. Medical and
scientific understandings pre-dominate in the investigative practices and
expert commentary on the war, with alternative voices (such as those of people
living with HIV/AIDS) being silenced. The ordinary citizen is incited to take
on prevention and caring roles with a strong gendered overlay.
Keywords: HIV/AIDS, media, war
discourse, discourse analysis
African Journal of AIDS Research 2003, 2(1): 63-73
What’s news: perspectives on
HIV/AIDS advocacy in the South African print media
Joanne Stein
AIDS and Society Research Unit,
Centre for Social Science Research, University of Cape Town, Private Bag,
Rondebosch 7701, South Africa
e-mail: [email protected]
Abstract
This paper explores stakeholders’
views regarding the question of whether HIV/AIDS coverage in the South African
media should be the product of media advocacy and a proactive agenda for
contributing to social change. Twenty-seven newspaper editors, journalists and
other key stakeholders with a vested interest in HIV/AIDS coverage in the print
media were interviewed during the course of 2002. Two overriding issues were
raised by informants for consideration. These were, firstly, the need to
balance the journalistic objectives of (a) advocacy and (b) neutrality and,
secondly, the need to balance the objectives of (a) advocacy and (b) news value
and profitability. Findings suggest that reticence regarding the adoption of an
explicit advocacy role regarding HIV/AIDS has much to do with the
media's evolving relationship with the post-apartheid government and
its controversial approach to HIV/AIDS.
Keywords: editorial policy, news
values
African Journal of AIDS Research 2003, 2(1): 75-83
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