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The ineffectiveness of community-based interventions can often be traced to problems that occur during implementation. In this study, we outline the implementation of a human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevention program in an educational setting in South Africa. An action research approach was used in the implementation of the intervention and a process and outcome evaluation, integrating qualitative and quantitative research methods, was made. The research illustrated the various levels of interaction in the community and the complexity of the processes involved in the implementation of interventions to facilitate community change. Social ecological theory, systems theory, and the social constructional approach are used to clarify the complexities of the implementation of community interventions. (Contains 1 table and 2 figures.)

To provide understanding of social and psychological factors that affect disclosure of HIV status among women diagnosed HIV-positive in pregnancy, 438 HIV positive women attending antenatal al clinics in Pretoria, South Africa were invited to participate in a longitudinal study. A total of 293 (62%) women were enrolled from June 2003 to December 2004. Questionnaires assessing sociodemographics and psychological measures were administered during pregnancy and at 3 months postdelivery. At enrollment, 59% had disclosed to their partners and 42% to others. This rose to 67% and 59%, respectively, by follow-up. Logistic regression analysis identified being married (adjusted odds Ratio [AOR] 2.32; 95% confidence interval [CI] 1.20-4.47), prior discussion about testing (AOR 4.19; CI 2.34-7.49), having a partner with tertiary education (AOR 2.76; CI 1.29-5.88) and less experience of violence (AOR 0.48; CI 0.24-0.97) as factors associated with having disclosed to partners prior to enrollment. Better housing (AOR 1.26; CI 1.06-1.49), less financial dependence on partners (AOR 0.46; CI 0.25-0.85), and knowing someone with HIV (AOR 2.13; CI 1.20-3.76) were associated with prior disclosure to others. Increased levels of stigma at baseline decreased the likelihood of disclosure to partners postenrollment (AOR 0.91; CI 0.84-0.98) and increased levels of avoidant coping decreased subsequent disclosure to others (AOR 0.84; CI 0.72-0.97). These results provide understanding of disclosure for women diagnosed as HIV positive in pregnancy, and identify variables that could be used to screen for women who require help.

The high level of crime in South Africa affects many adolescents. Experience of community interpersonal violence affects the social, emotional, and cognitive functioning of adolescents and could have an impact on their personality development. The aim of the study was to explore possible differences in the expression of personality between adolescents exposed to community interpersonal violence and those not exposed to such violence. The sample comprised 183 Grade 12 learners from a secondary school in a middle-class community in Gauteng. Participants were divided into two groups: adolescents who reported exposure to community interpersonal violence (n = 93) and those who did not report exposure to such violence (n = 90). Both groups completed the 16 Personality Factor and Posttraumatic Diagnostic Scales. Differences between the groups were explored using a one-way between-groups multivariate analysis of variance and t-tests for independent groups. Results indicated statistically significant differences between the two groups on Factor G (rule consciousness), Factor I (emotional sensitivity), and Factor Q4 (anxiety). Adolescents exposed to interpersonal violence reported higher levels of posttraumatic stress disorder symptoms than the control group. The group that experienced posttraumatic stress disorder symptoms differed more in terms of personality functioning (Factors I and Q4). Violence-exposed adolescents experienced more emotional volatility, difficulty to regulate emotions, anxiety, and sensitivity to environmental stressors than those not exposed to such violence. Although causality cannot be assumed, it is possible that exposure to community interpersonal violence, which could result in posttraumatic stress disorder symptoms, has implications for the personality development of adolescents. Interventions for adolescents exposed to interpersonal violence are recommended to prevent the development of posttraumatic stress disorder symptoms. [ABSTRACT FROM AUTHOR]

To provide understanding of social and psychological factors that affect disclosure of HIV status among women diagnosed HIV-positive in pregnancy, 438 HIV positive women attending antenatal al clinics in Pretoria, South Africa were invited to participate in a longitudinal study. A total of 293 (62%) women were enrolled from June 2003 to December 2004. Questionnaires assessing sociodemographics and psychological measures were administered during pregnancy and at 3 months postdelivery. At enrollment, 59% had disclosed to their partners and 42% to others. This rose to 67% and 59%, respectively, by follow-up. Logistic regression analysis identified being married (adjusted odds Ratio [AOR] 2.32; 95% confidence interval [CI] 1.20–4.47), prior discussion about testing (AOR 4.19; CI 2.34–7.49), having a partner with tertiary education (AOR 2.76; CI 1.29–5.88) and less experience of violence (AOR 0.48; CI 0.24–0.97) as factors associated with having disclosed to partners prior to enrollment. Better housing (AOR 1.26; CI 1.06–1.49), less financial dependence on partners (AOR 0.46; CI 0.25–0.85), and knowing someone with HIV (AOR 2.13; CI 1.20–3.76) were associated with prior disclosure to others. Increased levels of stigma at baseline decreased the likelihood of disclosure to partners postenrollment (AOR 0.91; CI 0.84–0.98) and increased levels of avoidant coping decreased subsequent disclosure to others (AOR 0.84; CI 0.72–0.97). These results provide understanding of disclosure for women diagnosed as HIV positive in pregnancy, and identify variables that could be used to screen for women who require help. [ABSTRACT FROM AUTHOR]

The study explores the experiences of volunteer community care workers working with HIV-affected families, participating in laughter therapy. Laughter therapy is being used as an intervention to positively influence individuals experiencing various forms of emotional distress. Community care workers play a vital role in the support of the HIV/AIDS-infected and -affected members in communities. The nature of this type of work and their limited training contributes to high levels of secondary trauma and emotional exhaustion. The purpose of the study was firstly, to explore the effects of working with orphans and vulnerable children (OVC) on the community care workers and secondly, to establish the impact that laughter therapy has to positively combat stresses of working within the care workers' environment. All the community care workers from a community-based organisation that provides care for HIV/AIDS-infected and -affected OVC and their families in the greater region of Soweto, South Africa, took part in daily laughter therapy sessions for one month. To assess the experiences of participants of laughter therapy, seven community care workers agreed to participate in a mixed method assessment. Interviews were conducted before and after the intervention using the Interpretative Phenomenological Analysis as framework. As supportive data, a stress and anxiety and depression scale were added in the interview. Participants reported more positive emotions, positive coping, improved interpersonal relationships and improvement in their care work after exposure to laughter therapy. Quantitative results on stress, anxiety and depression for each participant confirmed observed changes. Laughter therapy as a self-care technique has potential as a low-cost intervention strategy to reduce stress and counteract negative emotions among people working in highly emotional environments.

HIV-infected women need support to deal with their diagnosis as well as with the stigma attached to HIV. As part of their practical training, Master's-level psychology students negotiated with the staff of four clinics in townships in Tshwane, South Africa, to establish support groups for HIV+ women and offered to assist them in facilitating the groups. This study aimed to understand why the implementation of groups was successful in one clinic and not other clinics. The student reports on their experiences and interaction with clinic staff and clients were used as sources of data. Using qualitative data analysis, different dynamics and factors that could affect project implementation were identified in each clinic. The socio-ecological and systems theories were used to understand implementation processes and obstacles in implementation. The metaphor of building a bridge over a gorge was used to describe the different phases in and obstacles to the implementation of the intervention. Valuable lessons were learnt, resulting in the development of guiding principles for the implementation of support groups in community settings.

The implementation and evaluation of a peer education and support programme in secondary schools to prevent and reduce high-risk sexual behaviour amongst adolescents is discussed.The aims of the programme were to provide accurate information about HIV/AIDS, discuss and reconsider peer group norms, and establish support for learners. In the programme that was implemented in 13 secondary schools in Tshwane, South Africa, peer educators were identified, trained and supported to implement the programme in their schools with the assistance of a teacher and postgraduate students as facilitators. Peer educators organised HIV awareness activities, facilitated class discussions on risk behaviour and gender relationships, and supported learners in solving personal problems. Process evaluation included weekly reports and focus group discussions with peer educators and teachers. A quasiexperimental design involving an experimental and control group, as well as pre- and post-assessments, was used to evaluate the impact of the programme on psychological well-being, personal control, school climate and reported high-risk behaviour of learners aged between 13 and 20 years.The results showed that the percentage of learners in the experimental group who were sexually experienced remained unchanged over the time period of 18 months. In contrast, a significantly increased percentage of learners in the control group were sexually experienced after the same time period.The control group also perceived more of their friends to be sexually experienced. No differences were reported in condom use in either of the groups.The findings of this study suggest that peer education can contribute to a delayed onset of sexual activity, and can therefore contribute to the prevention of HIV/AIDS amongst adolescents.