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Background: This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa. Method: Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people's organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. Results: Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. Conclusion: A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development. [ABSTRACT FROM AUTHOR]

Background: Despite 20 years of democracy, South Africa still suffers from profound health inequalities. Gender roles and norms are associated with individuals’ vulnerability that lead to ill-health. For instance, gender inequality influences women’s access to health care and women’s agency to make health-related decisions. This paper explores gender-awareness and inclusivity in organisations that advocate for the right to health in South Africa, and analyses how this knowledge impacts their work? Methods: In total, 10 in-depth interviews were conducted with members of The Learning Network for Health and Human Rights (LN), a network of universities and Civil Society Organisations (CSOs) which is explicitly committed to advancing the right to health, but not explicitly gendered in its orientation. Results: The results show that there is a discrepancy in knowledge around gender and gendered power relations between LN members. This discrepancy in understanding gendered power relations suggests that gender is ‘rendered invisible’ within the LN, which impacts the way the LN advocates for the right to health. Conclusions: Even organizations that work on health rights of women might be unaware of the possibility of gender invisibility within their organisational structures. [ABSTRACT FROM AUTHOR]

Background: During the era of apartheid in South Africa, a number of mental health professionals were vocal about the need for socio-economic and political reform. They described the deleterious psychological and social impact of the oppressive and discriminatory Nationalist state policies. However, they remained optimistic that democracy would usher in positive changes. In this article, we consider how mental health professionals working in post-apartheid South Africa experience their work. Methods: Our aim was to describe the experience of mental health professionals working in prisons who provide care to suicidal prisoners. Data were collected from in-depth semi-structured interviews and were analyzed using thematic content analysis. Results: Findings draw attention to the challenges mental health professionals in post-apartheid South Africa face when attempting to provide psychological care in settings where resources are scarce and where the environment is anti-therapeutic. Findings highlight the significant gap between current policies, which protect prisoners' human rights, and every-day practices within prisons. Conclusions: The findings imply that there is still an urgent need for activism in South Africa, particularly in the context of providing mental health care services in settings which are anti-therapeutic and inadequately resourced, such as prisons. [ABSTRACT FROM AUTHOR]

Background: Sexual orientation and gender identity are social determinants of health for people identifying as lesbian, gay, bisexual and transgender (LGBT), and health disparities among sexual and gender minority populations are increasingly well understood. Although the South African constitution guarantees sexual and gender minority people the right to non-discrimination and the right to access to healthcare, homo- and transphobia in society abound. Little is known about LGBT people's healthcare experiences in South Africa, but anecdotal evidence suggests significant barriers to accessing care. Using the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, this study analyses the experiences of LGBT health service users using South African public sector healthcare, including access to HIV counselling, testing and treatment. Methods: A qualitative study comprised of 16 semi-structured interviews and two focus group discussions with LGBT health service users, and 14 individual interviews with representatives of LGBT organisations. Data were thematically analysed within the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, focusing on availability, accessibility, acceptability and quality of care. Results: All interviewees reported experiences of discrimination by healthcare providers based on their sexual orientation and/or gender identity. Participants recounted violations of all four elements of the UN General Comment 14: 1) Availability: Lack of public health facilities and services, both for general and LGBT-specific concerns; 2) Accessibility: Healthcare providers' refusal to provide care to LGBT patients; 3) Acceptability: Articulation of moral judgment and disapproval of LGBT patients' identity, and forced subjection of patients to religious practices; 4) Quality: Lack of knowledge about LGBT identities and health needs, leading to poor-quality care. Participants had delayed or avoided seeking healthcare in the past, and none had sought out accountability or complaint mechanisms within the health system. Conclusion: Sexual orientation and gender identity are important categories of analysis for health equity, and lead to disparities in all four dimensions of healthcare access as defined by General Comment 14. Discriminatory and prejudicial attitudes by healthcare providers, combined with a lack of competency and knowledge are key reasons for these disparities in South Africa. [ABSTRACT FROM AUTHOR]

Background: This research aimed to identify and explore the experiences of Black registrars in their training in the Western Cape's academic hospitals in order to identify structures, practices, attitudes and ideologies that may promote or impede the advancement of Black doctors into specialist medicine. This is justified by the requirement for universities to work towards monitoring and evaluating efforts to create non-discriminatory and inclusive training environments. Methods: This study employed qualitative research methods. Ten Black African medical specialists were interviewed about their training experiences in two university training hospitals in the Western Cape Province, South Africa. Interview data was collected using open-ended questions and coded and analysed using thematic and critical discursive analysis techniques. Results: Four experiential themes emerged from the interview data, they included: 1) experiences of everyday racism during work hours, 2) the physical and psychological effects of tokenism and an increased need to perform, 3) institutional racism as a result of inconsistent and unclear methods of promotion and clinical competence building, and 4) an organisational culture that was experienced as having a race and gender bias. Conclusion: This is a pilot study and there are limits on the generalizability of the data due to the small sample. What is clear from our participants, though, is the strong experiential component of finding it challenging to be a Black trainee in a White-dominated profession. We are undertaking further research to explore the issues raised in more detail. [ABSTRACT FROM AUTHOR]

Background: The rights of women and people living with HIV (PLHIV) are protected under South African law, yet there is a gap in the application of these laws. While there are numerous systemic and social barriers to women's and PLHIV's exercise of their legal rights and rights to access social services, there has been little effort to document these barriers as well as legal needs and knowledge in this context. Methods: 1480 HIV-positive and HIV-negative women recruited from an antenatal clinic in Umlazi Township completed a questionnaire on legal knowledge, experience of legal issues, assistance seeking for legal issues, and barriers to seeking assistance. We compared the legal knowledge and experience of legal issues of HIV-positive and HIV-negative women, and described assistance seeking and barriers to assistance seeking among all women. Results: Both HIV-positive and HIV-negative women had high levels of knowledge of their legal rights. There were few important differences in legal knowledge and experience of legal issues by HIV status. The most common legal issues women experienced were difficulty obtaining employment (11 %) and identification documents (7 %). A minority of women who had ever experienced a legal issue had sought assistance for this issue (38 %), and half (50 %) of assistance sought was from informal sources such as family and friends. Women cited lack of time and government bureaucracy as the major barriers to seeking assistance. Conclusions: These results indicate few differences in legal knowledge and needs between HIV-positive and HIV-negative women in this context, but rather legal needs common among women of reproductive age. Legal knowledge may be a less important barrier to seeking assistance for legal issues than time, convenience, and cost. Expanding the power of customary courts to address routine legal issues, encouragement of pro bono legal assistance, and introduction of legal navigators could help to address these barriers. [ABSTRACT FROM AUTHOR]

Background: In this article we describe a phenomenological lifeworld study based on the theory of communicative action of 13 women with noncommunicable disease (NCDs) in a rural area in South Africa. The purpose of the study was to generate key concepts of health care access and the management of NCDs in a rural South African context. Methods: The study employed a qualitative methodology with serial semistructured interviews. We used a content analytical approach to analyse key themes and patterns in participants' narratives of NCDs and health care access. Results: The findings are reported by theme and include analyses of narrative sequences related to 1) family environment, 2) experiences of NCDs, 3) understandings of the causes of NCDs, 4) accessibility of formal health care services, 5) experiences of formal health care services, 6) treating NCDs, and 7) experiences of informal health care services. The findings suggest that participation in the routines prescribed by formal health care services and reinforced by families and faith-based communities normalises the experience of NCDs to the extent that narratives of NCDs form the background, rather than the focus of broader illness narratives. Such narratives rather tend to focus on significant life events and relationships. The key features of the narratives include connections between social or autobiographical and biological understandings of NCDs, the appropriation of modern concepts of disease in illness narratives, and reflexive commentary on the modern features of NCDs. In the context of such narrative expertise formal health care services have a high level of acceptability in this rural area. Conclusion: Lifeworld analysis of health care access based on the theory of communicative action places consensual understandings of NCDs and their treatment as central to the health care experience. Our findings suggest that such analyses can facilitate potential feedback processes between health care users and professionals which generate consensus as well as institutional reform within formal health care services. [ABSTRACT FROM AUTHOR]

Background In a context of inadequate human resources for health, this study investigated whether traditional healers have the knowledge and skill base which could be utilised to assist in the scaling up of HIV prevention and treatment services in South Africa. Methods Using a cross-sectional research design a total of 186 traditional healers from the Northern Cape province were interviewed. Responses on the following topics were obtained: sociodemographic characteristics; HIV training, experience and practices; and knowledge of HIV transmission, prevention and symptoms. Descriptive statistics and chi square tests were used to analyse the responses. Results Traditional healers' knowledge of HIV and AIDS was not as high as expected. Less than 50% of both trained and untrained traditional healers would treat a person they suspected of being HIV positive. However, a total of 167 (89%) respondents agreed using a condom can prevent HIV and a majority of respondents also agreed that having one sexual partner (127, 68.8%) and abstaining from sex can prevent HIV (145, 78.8%). Knowledge of treatment practices was better with statistically significant results being obtained. Conclusion The results indicate that traditional healers could be used for prevention as well as referring HIV positive individuals for treatment. Traditional healers were enthusiastic about the possibility of collaborating with bio-medical practitioners in the prevention and care of HIV and AIDS patients. This is significant considering they already service the health needs of a large percentage of the South African population. However, further development of training programmes and materials for them on HIV and AIDS related issues would seem necessary. [ABSTRACT FROM AUTHOR]

Background: Research into the mistreatment of women during childbirth has increased over recent years. Overt violence is an important focus of research, but recently there has been increasing recognition that there are other ways in which women in labour may be uncared for or even hurt. As part of a larger study focussing on staff responses to stillbirths, we wanted to gain contextual information on how high risk pregnancies are handled in general in Khayelitsha Hospital, a district hospital in an impoverished urban setting in the Western Cape Province of South Africa. This health care system experiences an immense patient load, the poverty of the community it serves, and the numerous traumas affecting both patients and staff. Methods: In order to obtain rich exploratory data, a qualitative research methodology was used. The primary data source was observations in the labour ward, interviewing labour ward staff (doctors, nurse, and cleaners). The secondary data source was the analysis of hospital documents, specifically those related to labour ward policy. Results: From our numerous observations and discussions, it is clear that no one is being overtly mistreated in this hospital and patients are medically well attended to. Although we saw no physical abuse, we noted the silence in the ward. Beside medical related interactions, we also noted that there were limited interactions between the women and the health care providers. Conclusions: Silence can be a form of neglect as it leaves the women feeling uncared for and not seen. In an overburdened health care system where both staff and patients are often overwhelmed or traumatised, silence can be a way in which a system defends itself against what it knows it cannot provide. [ABSTRACT FROM AUTHOR]