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Background: This paper uses the concepts of organisational culture and organisational trust to explore the Implementation of equity-oriented policies -- the Uniform Patient Fee Schedule (UPFS) and Patients' Rights Charter (PRC) - in two South African district hospitals. It contributes to the small literatures on organisational culture and trust in low- and middle-income country health systems, and broader work on health systems' people-centeredness and "software". Methods: The research entailed semi-structured interviews (Hospital A n = 115, Hospital B n = 80) with provincial, regional, district and hospital managers, as well as clinical and non-clinical hospital staff, hospital board members, and patients; observations of policy implementation, organisational functioning, staff interactions and patient-provider interactions; and structured surveys operationalising the Competing Values Framework for measuring organisational culture (Hospital A n = 155, Hospital B n = 77) and Organisational Trust Inventory (Hospital A n = 185, Hospital B n = 92) for assessing staff-manager trust. Results: Regarding the UPFS, the hospitals' implementation approaches were similar in that both primarily understood it to be about revenue generation, granting fee exemptions was not a major focus, and considerable activity, facility management support, and provincial support was mobilised behind the UPFS. The hospitals' PRC paths diverged quite significantly, as Hospital A was more explicit in communicating and implementing the PRC, while the policy also enjoyed stronger managerial support in Hospital A than Hospital B. Beneath these experiences lie differences in how people's values, decisions and relationships influence health system functioning and in how the nature of policies, culture, trust and power dynamics can combine to create enabling or disabling micro-level implementation environments. Conclusions: Achieving equity in practice requires managers to take account of "unseen" but important factors such as organisational culture and trust, which are key aspects of the organisational context that can profoundly influence policies. In addition to implementation "hardware" such as putting in place necessary staff and resources, it emphasises "software" implementation tasks such as relationship management and the negotiation of values, where equity-oriented policies might be interpreted as challenging health workers' status and values, and paying careful attention to how policies are practically framed and translated into practice, to ensure key equity aspects are not neglected. [ABSTRACT FROM AUTHOR]

Background: South Africa has experienced a tremendous rise in methamphetamine use since the year 2000. Sex trading is a global phenomenon that has been observed in active drug users and has been associated with risks for HIV infection and violence. Objectives: This paper describes and examines the correlates of sex trading among active methamphetamine users in Cape Town, South Africa. Methods: Through peer referral, 360 (201 male; 159 female) active methamphetamine users were recruited in a peri-urban township. Demographics, sex trading, drug use, trauma, and mental health were assessed by a structured clinical interview and computer survey. Logistic regression models were used to examine predictors of sex trading for men and women. Results: In the past 3 months, 40% of men and 33% of women endorsed trading sex for methamphetamine or money. Among these, they reported trading with same sex partners (33%), high rates of inconsistent condom use (73%), and incidences of physical (23%) and sexual (27%) assault when sex trading. Increased drug use severity was correlated with sex trading. Women with experiences of violence and trauma were also more likely to trade sex. Conclusions/importance: The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. Targeted interventions geared towards safe sex practices may reduce risky sexual behaviors. Women need interventions that are attuned to their specific vulnerabilities. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior. [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]

Abstract: Ethnopharmacological relevance: This paper provides ethnobotanical information on medicinal plants used to treat diarrhoea in the Limpopo Province, South Africa. Documentation of this nature usually provides the basis for selecting medicinal plants for future phytochemical and pharmaceutical studies aimed at developing new, effective and affordable plant-derived diarrhoea remedies. Aim of the study: To record and document medicinal plants used by the Bapedi traditional healers to treat diarrhoea in the Limpopo Province, South Africa. Materials and methods: In order to record and document medicinal plants used by the Bapedi traditional healers to treat diarrhoea, 51 healers from 17 municipalities covering Capricorn, Sekhukhune and Waterberg districts in the Limpopo Province, South Africa were interviewed between January and July 2011. Data collected included the names of plants, plant part(s) used, methods of herbal preparation, administration, dosage and duration of treatments. Voucher specimens of the plants used by the Bapedi traditional healers to treat diarrhoea were collected, identified and deposited as future reference material at the Larry-Leach Herbarium (UNIN), University of Limpopo. Results: A total of 20 plant species representing 16 families and 20 genera were found to be commonly used by the Bapedi traditional healers to treat and manage diarrhoea in the Limpopo Province, South Africa. The largest proportion of the medicinal plants belonged to the families Anacardiaceae, Asteraceae, Fabaceae and Malvaceae (10% each). The most frequently used species were Punica granatum (39.2%), Grewia bicolor (33.3%), Dombeya rotundifolia (21.6%), Commiphora marlothii (19.6%) and Acacia senegal (13.7%). The roots were the most commonly used plant part (50%), followed by leaves (20%), bark (15%), fruits (10%), pericarp, seed, tuber and whole plants (5% each). Mono therapies based on preparations made from a single plant species were the most dominant (90%). All medicinal preparations were taken orally for 1 week or until diarrhoea subsided. The therapeutic claims of the medicinal plants documented in this study are well supported by literature, with 70% of the species having anti-diarrhoeal properties or are used as diarrhoea remedies both in South Africa and also in other countries. Conclusion: This study reveals that local communities in the Limpopo Province, South Africa still depend on traditional medicines for basic healthcare; and the use of traditional medicines is still an integral part of their socio-cultural life. [Copyright &y& Elsevier]

Uptake of HIV testing remains low among men in South Africa. As part of a trial, we assessed the acceptability of a theoretically derived and adapted tablet-based-application (EPIC-HIV1) in rural South Africa. We conducted 20 in-depth interviews with men aged ≥18 years and offered a tablet-based survey to all men aged ≥15 years who received EPIC-HIV1 (Sep-Dec 2018). We conducted a descriptive analysis of the survey and used Self-Determination Theory (SDT) to guide our thematic analysis. A total of 232/307 (75%) completed the survey, 55% of whom were aged 15–24 years. 96%[ CI: 92.8–98.2%; n = 223] found EPIC-HIV1 acceptable and 77% [95% CI: 71.8–82.6%; n = 179] found it user-friendly. 222 [96%] reported that EPIC-HIV1 motivated them to test; 83% (192/232) tested for HIV, of which 33% (64/192) were first time testers. Those who did not consent (n = 40) were more likely to have had an HIV-positive test result. Participants reported that the app boosted their confidence to test. However, they were unsure that the app would help them overcome barriers to test in local clinics. Given reach and usability, an adapted SDT male-tailored app was found to be acceptable and could encourage positive health-seeking behavioural change among men. [ABSTRACT FROM AUTHOR]

Background: Towards the end of the 2017 school year, a prominent beverage company in South Africa pledged to remove their sugar-sweetened beverages (SSBs) and advertisements from primary schools in order to contribute to the realization of a healthy school environment. Objectives: To assess the availability and advertising of the company's beverages in public primary schools in Gauteng province following their voluntary pledge to remove the products, and to explore perceptions of school staff regarding SSB availability in schools and processes related to the implementation of the pledge. Methods: In 2019, we conducted a representative survey of public sector primary (elementary) schools in Gauteng province, South Africa. A random sample of schools was drawn, with schools stratified by whether or not they charge fees. This was a proxy for the socioeconomic status of the locale and student body. At each school, the availability of beverages and presence of advertising or not was assessed by an observational audit tool and differences across fee status assessed by Pearson χ 2 test. Semi-structured interviews were conducted with a purposive sample of school officials. Data from the interviews were coded and thematic analysis conducted. Results: Two years following a voluntary pledge, the company's carbonated SSBs were available for sale in 54% (CI: 45–63%) of schools with tuck shops and advertised in 31% (CI: 25–39%). Qualitative interviews revealed a complex landscape of actors within schools, which, combined with indifference or resistance to the pledge, may have contributed to the continued availability of SSBs. Conclusions: Though we were unable to examine SSB availability before and after the pledge, our findings provide some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove SSBs and advertisements from schools. Mandatory regulations coupled with in-depth engagement with schools may be an avenue to pursue in the future. [ABSTRACT FROM AUTHOR]

Among men in South Africa, the prevalence of tobacco smoking is as high as 33%. Although smoking is responsible for most lung cancer in South Africa, occupational and environmental exposures contribute greatly to risk. We conducted a tobacco and lung cancer screening needs assessment and administered surveys to adults who smoked >100 cigarettes in their lifetime in Johannesburg (urban) and Kimberley (rural). We compared tobacco use, risk exposure, attitudes toward and knowledge of, and receptivity to cessation and screening, by site. Of 324 smokers, nearly 85% of current smokers had a <30 pack-year history of smoking; 58.7% had tried to stop smoking ≥1 time, and 78.9% wanted to quit. Kimberley smokers more often reported being advised by a healthcare provider to stop smoking (56.5% vs. 37.3%, p=0.001) than smokers in Johannesburg but smokers in Johannesburg were more willing to stop smoking if advised by their doctor (72.9% vs. 41.7%, p<0.001). Findings indicate that tobacco smokers in two geographic areas of South Africa are motivated to stop smoking but receive no healthcare support to do so. Developing high risk criteria for lung cancer screening and creating tobacco cessation infrastructure may reduce tobacco use and decrease lung cancer mortality in South Africa. [ABSTRACT FROM AUTHOR]

Introduction: The burden of HIV is increasing among adults aged over 50, who generally experience increased risk of cormorbid illnesses and poorer financial protection. We compared patterns of health utilisation and expenditure among HIV-positive and HIV-negative adults over 50.Methods: Data were drawn from the Study on global AGEing and adult health in South Africa with analysis focusing on individual and household-level data of 147 HIV-positive and 2725 HIV-negative respondents.Results: HIV-positive respondents reported lower utilisation of private health-care facilities (11.8%) than HIV-negative respondents (25.0%) (p = .03) and generally had more negative attitudes towards health system responsiveness than HIV-negative counterparts. Less than 10% of HIV-positive and HIV-negative respondents experienced catastrophic health expenditure (CHE). Women (OR 1.8;p < .001) and respondents from rural settings (OR 2.9;p < .01) had higher odds of CHE than men or respondents in urban settings. Over half the respondents in both groups indicated that they had received free health care.Conclusions: These findings suggest that although HIV-positive and HIV-negative older adults in South Africa are protected to some extent from CHE, inequalities still exist in access to and quality of care available at health-care services – which can inform South Africa’s development of a national health insurance scheme. [ABSTRACT FROM AUTHOR]

Urban South Africa is a major destination for refugees across sub-Saharan Africa. Based on interviews with urban refugees, this study identified significant barriers to achieving livelihood security for this population, including community violence, crowding, fear of xenophobia, exploitation from officials and oversaturated markets for small businesses. Nevertheless, refugees identified several aspects of service provision from a non-governmental organization which proved helpful, especially through material assistance in helping establish viable, profit-generating small businesses. Recommendations for service delivery to this population include assessing refugees’ level of environmental vulnerability and providing a package of supports that address a clients’ particular living situation. [ABSTRACT FROM AUTHOR]

Aims To conduct a quantitative investigation of stress and the relationship with burnout among AIDS care volunteers. Background Volunteer caregivers experience stress that could lead to burnout. Yet, very few studies quantify stress and its relationship with burnout among AIDS care volunteers. Design This study uses a cross-sectional, exploratory survey design. Methods Face-to-face interviews were conducted with 126 volunteer caregivers working in 13 semi-rural communities (townships) in Durban, South Africa in April 2009. All participants were women, Christian and with low levels of education. A 22-item instrument was drawn from Pearlin et al.'s role overload and role captivity scales, Van Dyk's stress factor scale and the Maslach Burnout Inventory. Results Most of the volunteers had moderate-to-high levels of stress. 'Role/work overload' 'lack of support' and 'overwhelming nature of the disease' explained most of the variance in stress. Volunteers' age and number of patients in their care were predictors of stress. Caring for only AIDS patients, lack of support, stress emanating from perceived stigma and lack of training; and the overwhelming nature of AIDS were predictors of burnout. Conclusion High levels of stress could negatively impact volunteers' health and well-being and on-the-job performance. Policy makers must develop and fund home-based care models that take into account the stressors associated with AIDS care, by reducing the work load, providing ongoing psychosocial support and recruiting nurses to assist volunteers. The small non-probability sample used in this study highlights the need to treat the findings with caution. [ABSTRACT FROM AUTHOR]

Background: Most rural people in the Limpopo Province depend on plant resources to meet their livelihood needs. However, there is insufficient recorded information regarding their use and management. The current study therefore was carried out in selected villages of the Limpopo Province, to close this knowledge gap. Methods: Information was collected from 60 people residing in two villages, using a semi-structured questionnaire, supplemented with field observations. Results: A total of 47 wild plant species (95% indigenous and 5% exotics) from 27 families, mostly from the Fabaceae (17%), Anacardiaceae (9%), and Combretaceae (9%) were documented. These species were used primarily for firewood (40%), food (36%) and medicine (29%). Significantly used species included Sclerocarya birrea (85%), Combretum kraussii (35%) and Harpephyllum caffrum (35%). Local traditional rules and regulations including taboos, social beliefs and fines are in place to aid in the management of communal resources. However, a significant number (67%) of participants mentioned that they were not pleased with these rules and regulations. Conclusion: The current study concluded that plant resources still play an important role in the surveyed rural areas of the Limpopo Province. Furthermore, for sustainable utilization and long-term conservation of plants in these areas the government should assist communities in the management of their plant resources. [ABSTRACT FROM AUTHOR]

Objective. To explore levels of perceived racial and non-racial discrimination and their associations with self-esteem and mastery in the USA and South Africa. Design. We used ordinary least square regressions to test the cross-sectional associations between discrimination and psychological resources using two national probability samples of adults: the National Survey of American Life and the South African Stress and Health Study. Results. Levels of perceived racial discrimination were higher in the USA than in South Africa. In the USA, both African-Americans and Caribbean Blacks have comparable or higher levels of self-esteem and mastery than Whites. In contrast, South African Whites have higher levels of both self-esteem and mastery than Africans, Coloureds, and Indians. Perceived discrimination, especially chronic everyday discrimination, is inversely related to self-esteem and mastery in both societies. In South Africa, stress and socioeconomic status (SES) but not discrimination are important determinants of racial differences in self-esteem and mastery. Conclusions. In two racialized societies, perceived discrimination acts independent of demographic factors, general stressors, social desirability bias, racial identity, and SES, to negatively affect the psychological resources of self-esteem and mastery. [ABSTRACT FROM PUBLISHER]