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In this paper, we examine a prominent interpretation of HIV risk in a rural South African setting experiencing a severe HIV epidemic well into older ages: the discourse of caregiving HIV transmission. By caregiving transmission, we refer to HIV infection resulting from caring for family members who are living with HIV and may be sick with AIDS-related illnesses. We draw on individual life history and community focus group interviews with men and women aged 40–80+, as well as interviews with health workers providing HIV counselling and testing services at local health facilities in their communities. We illustrate the social and strategic role caregiving HIV transmission discourses play in re-signifying HIV as a sexless infection for older women, thereby promoting HIV testing as well as blameless acceptance of an HIV diagnosis. We further highlight the role of rural health workers who serve as medical epistemic bricoleurs, vernacularising global HIV counselling and prevention messages by blending ideas of gender, generation, and local lived experiences and practices so that they resonate with community norms, values and understandings. Our study highlights the gendered and generational complexities and challenges experienced by rural South Africans aging in a community over-burdened by an HIV epidemic and AIDS-related mortality. [ABSTRACT FROM AUTHOR]

Men and women living with HIV with access to ARVs are living longer, healthier lives that can and often do include bearing children. Children occupy a key space in men and women's personal and social lives and often play a fundamental role in maintaining these relationships, irrespective of illness concerns. Couples living with HIV need to balance prevention needs and ill-health while trying to maintain healthy relationships. Health-care providers serving the reproductive needs of HIV-affected couples need to consider the social and relational factors shaping reproductive decisions associated with periconception risk behaviors. This paper based on qualitative research at three hospital sites in eThekwini District, South Africa, investigates the childbearing intentions and needs of people living with HIV (PLHIV), and the attitudes and experiences of health-care providers serving the reproductive needs of PLHIV, and client and provider views and knowledge of safer conception. This research revealed that personal, social, and relationship dynamics shape the reproductive decisions of PLHIV, and “unplanned” pregnancies are not always unintended. Additionally, conception desires are not driven by the number of living children; rather clients are motivated by whether or not they have had any children with their current partner/spouse. Providers should consider the relationship status of clients in discussions about childbearing desires and intentions. Although many providers recognize the complex social realities shaping their clients' reproductive decisions, they have outdated information on serving their reproductive needs. Appropriate training to enable providers to better understand the relationship and social realities surrounding their clients' childbearing intentions is required and should be used as a platform for couples to work together with providers toward safer conception. The adoption of a more participatory approach should be employed to equalize client–provider power dynamics and to ensure clients are more involved in decision-making about reproduction and conception. [ABSTRACT FROM AUTHOR]

The WHO estimates 58 million people experienced one or more TB disease episodes between 2000 and 2018. These 'former TB patients' are at greater risk of future TB infection and death than TB naïve people. Additionally, former TB patients experience social, psychological, and physiological difficulties after microbiological cure. Drawing on semi-structured interviews collected with 28 people from communities in Zambia (n = 8) and South Africa (n = 2) between October 2018 and March 2019, we describe their perceptions of having two or more TB episodes. Utilising a discursive analytic approach, we interrogated how participants conceptualise their risk of disease recurrence. Despite being surprised by subsequent TB episodes, participants utilised their bodily experiences of TB signs and symptoms alongside their experiential knowledge of health systems processes to procure timely diagnosis and care. Yet, many participants were unable to resume social and economic participation. Experiences of multiple TB episodes and correlating social, economic, and physiological vulnerabilities, challenged participants biomedical understanding of TBs curability. Through notions of dirt and 'staining', participants conceptualise TB as a sinister, malicious presence they are bound to encounter time and again. Health providers should discuss the risk of TB recurrence with patients and promote prevention, early detection, and diagnosis of TB disease. [ABSTRACT FROM AUTHOR]

Child well-being is particularly relevant to South African social workers given the country's high rates of violence, poverty, inequality, unemployment, HIV/AIDS, and poor schooling outcomes. Guided by a social constructivist theoretical lens, and located within an interpretive qualitative research design, the aim of the study was to determine whether children's drawings and teacher interviews can differentiate qualitatively between children with positive well-being and those with compromised well-being. Children aged 6–8 years whose parents/caregivers were recipients of Child Support Grants (CSGs) were asked to draw a picture of themselves and their families and teachers were asked about the children's functioning. Findings from triangulation of drawings and interviews suggested that while a firm diagnosis of emotional, behavioral, or cognitive disorder could not be reached, it was possible to differentiate between children with positive well-being and those whose well-being appeared to be compromised by developmental delay, learning difficulties, emotional problems, behavioral problems, and/or social issues. It is therefore recommended that social workers make greater use of children's drawings and educator interviews as assessment tools. However, one should not rely solely on children's drawings, but should rather combine drawings with child and educator interviews. Findings also highlight the need for South African social workers to develop indicators that are culturally and ecologically applicable to African children. [ABSTRACT FROM AUTHOR]

Obesity among South African women represents an important dimension of noncommunicable disease (NCD) risk. Experiences of weight are an under-explored frame of reference for intervention. Using three-part in-depth interviews with 20 women and 9 focus groups with a total of 57 women (N = 77) in one low-income neighborhood, I relate women's positive perceptions of fatness to belonging and experiences of hunger. Aware of public health obesity messaging, participants tried to lose weight, yet stress and food scarcity impacted weight gain. Whereas public health interventions focus on behavior, responses to NCDs must recognize the role of food systems and poverty in shaping risk profiles. [ABSTRACT FROM AUTHOR]

HIV-positive adolescents who engage in unsafe sex are at heightened risk for transmitting or re-acquiring HIV. Disclosure of HIV-status to sexual partners may impact on condom use, but no study has explored the effects of (i) adolescent knowledge of one's HIV-status, (ii) knowledge of partner status and (iii) disclosure to partners, on safer sex behaviour. This study aimed to identify whether knowledge of HIV-status by HIV-positive adolescents and partners was associated with safer sex. Eight fifty eight HIV-positive adolescents (10–19 years old, 52% female, 68.1% vertically infected) who had ever initiated antiretroviral treatment in 41 health facilities in the Eastern Cape, South Africa, were interviewed using standardised questionnaires. Quantitative analyses used multivariate logistic regressions, controlling for confounders. Qualitative research included interviews, focus group discussions and observations with 43 HIV-positive teenagers and their healthcare workers.N = 128 (14.9%) of the total sample had ever had sex, whileN = 109 (85.1%) of sexually active adolescents had boy/girlfriend. In total, 68.1% of the sample knew their status, 41.5% of those who were sexually active and in relationships knew their partner's status, and 35.5% had disclosed to their partners. For adolescents, knowing one's status was associated with safer sex (OR = 4.355, CI 1.085–17.474,p = .038). Neither knowing their partner's status, nor disclosing one's HIV-status to a partner, were associated with safer sex. HIV-positive adolescents feared rejection, stigma and public exposure if disclosing to sexual and romantic partners. Counselling by healthcare workers for HIV-positive adolescents focused on benefits of disclosure, but did not address the fears and risks associated with disclosure. These findings challenge assumptions that disclosure is automatically protective in sexual and romantic relationships for HIV-positive adolescents, who may be ill-equipped to negotiate safer sex. There is a pressing need for effective interventions that mitigate the risks of disclosure and provide HIV-positive adolescents with skills to engage in safe sex. [ABSTRACT FROM AUTHOR]

To explore the barriers and facilitators of linkage to and retention in care amongst persons who tested positive for HIV, qualitative research was conducted in a home-based HIV counselling and testing (HBCT) project with interventions to facilitate linkages to HIV care in rural KwaZulu-Natal, South Africa. The intervention tested 1272 adults for HIV in Vulindlela of whom 32% were HIV positive, received point-of-care (POC) CD4 testing and referral to local HIV clinics. Those testing positive also received follow-up visits from a counsellor to evaluate linkages to care. The study employed a qualitative methodology collecting data through in-depth semi-structured interviews. Respondents included 25 HIV-positive persons who had tested as part of HBCT project, 4 intervention research counsellors who delivered the HBCT intervention and 9 government clinic staff who received referrals for care. The results show that HBCT helped to facilitate linkage to care through providing education and support to help overcome fears of stigma and discrimination. The results show the perceived value of receiving a POC CD4 result during post-test counselling, both for those newly diagnosed and those previously diagnosed as HIV positive. The results also demonstrate that in-depth counselling creates an “educated consumer” facilitating engagement with clinical services. The study provides qualitative insights into the acceptability of confidential HBCT with same day POC CD4 testing and counselling as factors that influenced HIV-positive persons’ decisions to link to care. This model warrants further evaluation in non-research settings to determine impact and cost-effectiveness relative to other HIV testing and referral strategies. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) are important resources in health systems affected by the HIV/AIDS pandemic. International guidelines on task-shifting recommend that CHWs can provide diverse HIV services, ranging from HIV prevention to counselling patients for lifelong antiretroviral therapy. There is, however, little evidence on the experiences with CHW delivery of these services in Africa. This qualitative study included 102 interviews that explored experiences with information, education and communication (IEC) activities provided by CHWs within rural South Africa. Semi-structured interviews were conducted with CHWs (n= 17), their clients (n= 33) and the primary caregivers of these clients (n= 30), allowing for data source triangulation. Twenty-two follow-up interviews explored emergent themes from preliminary interviews. Despite limited formal education and training, CHWs in this study were significant providers of IEC, including provision of generic health talks and HIV-specific information and facilitation to support clients’ entry and maintenance in the formal health system. They often incorporated local knowledge and understanding of illness in their communication. CHWs in this study were able to bridge the lifeworlds of the community and the formal services to expedite access and adherence to local clinics and other services. As mediators between the two worlds, CHWs reinterpreted health information to make it comprehensible in their communities. With growing formalisation of CHW programmes in South Africa and elsewhere, CHWs’ important role in health service access, health promotion and health maintenance must be recognised and supported in order to maximise impact. [ABSTRACT FROM AUTHOR]

A number of studies indicate that social support is associated with better health outcomes among HIV-positive caregivers of children, suggesting its potential importance for interventions aimed at safeguarding the well-being of this population. However, there is very little published literature assessing the support–health relationship or evaluating applied social support interventions with HIV-positive populations in HIV-endemic contexts of the developing world. The global literature on social support and health suggests that, in order to refine theory and improve interventions, greater attention should be paid to specific dimensions of support, such as types and sources, as well as the processes through which support may be affecting health outcomes. This article presents and discusses data from in-depth interviews with 12 HIV-positive primary caregivers of children living in an HIV-endemic, low-resourced, urban South African community. The primary aim of this qualitative work was to provide further insight into survey findings of a positive relationship between social support and self-reported general health and functioning, by exploring caregivers' personal experiences of being supported within their community, and their perceptions on how this “informal” support may be influencing their health. Our qualitative data highlight the importance of instrumental and emotional support for this population, the relevance of support provider characteristics and some of the processes or pathways that are likely explaining the support–health link. These processes include psychological factors such as mastery and hope, coping strategies and positive health behaviours. We provide recommendations for future research to further this work, and discuss implications for health interventions. [ABSTRACT FROM PUBLISHER]

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In resource-limited settings, successful HIV treatment scale-up has been tempered by reports of funding shortfalls. We aimed to determine the priorities, including ethical considerations, of decision makers for HIV antiretroviral programs. We conducted qualitative interviews with 12 decision makers, identified using purposive sampling. Respondents engaged in one-on-one, semi-structured interviews. We developed an interview guide to direct questions about key priorities and motivations for decision making about HIV antiretroviral programs. We evaluated textual data from the interviews to identify themes. Among 12 respondents, 10 (83%) lived and worked in South Africa. Respondents came from Western Cape, Gauteng, and KwaZulu-Natal provinces and worked primarily in urban settings. The respondents supported prioritizing individual patients based on treatment adherence, pregnancy status to prevent maternal-to-child HIV transmission and/or orphans, and severity of illness. However, priorities based on severity of illness varied, with first-come/first-serve, prioritization of the most severely ill, and prioritization of the least severely ill discussed. Respondents opposed prioritizing based on patient socioeconomic characteristics. Other priorities included the number of persons receiving treatment; how treated patients are distributed in the population (e.g., urban/rural); and treatment policy (e.g., number of antiretroviral regimens). Motivations included humanitarian concerns; personal responsibility for individual patients; and clinical outcomes (e.g., patient-level morbidity/mortality, saving lives) and/or social outcomes (e.g., restoring patients as functional family members). Decision makers have a wide range of priorities for antiretroviral provision in South Africa, and the motivations underlying these priorities suggest at times conflicting ethical considerations for providing HIV treatment when resources are limited. [ABSTRACT FROM AUTHOR]