Research posters

Beliefs and adherence to antiretroviral therapy and medication in KZN 

A large proportion of rural dwellers on antiretroviral therapy (ART)in KwaZulu-Natal believe that their lives would be impossible without taking their traditional, complementary and alternative medicines (TCAMs). This is a concern for medical doctors who notice unexplained medical conditions in their patients, reports Mr Shandir Ramlagan, a senior researcher in the Social Aspects of HIV/AIDS and Health Programme at the HSRC.

Ramlagan presented a study on the beliefs in TCAM medicines in rural KwaZulu-Natal - the province with the highest HIV prevalence (16.5%) in South Africa - and the effect it has on adherence to ART.

The study found that over 66% of respondents believed they would not be able to live without TCAM, and over 60% believed that TCAMs control their HIV and are their best hope for their future, compared to ART.

The study was conducted among 484 HIV-positive rural dwellers in three public sites who administered ART to HIV patients in the uThukela district in rural KwaZulu-Natal. Interviewers completed a semi-structured questionnaire, comparing the characteristics of those who used TCAM in the past six months with those who did not use TCAM during the same period. The respondents were interviewed on the day they were first placed on an ART programme.

Strange medical conditions in ART patients

Qualitative data showed that medical doctors were concerned with the effect of TCAMs as they see unexplained medical conditions in their patients, for example the use of traditional enemas on a daily basis which reduces ART absorption into the body. 

The study found that the contents of traditional medicines were unknown as are the effect they have on ARVs. Research should be undertaken into the effects of TCAM on patients on ART and patient education is essential in this regard. 

The same study also assessed attitudes towards the necessity of, and concerns with, taking prescription medications in general. Of all study respondents, 96% (96.5% male and 95.7% females) believed that doctors prescribe too many medicines. 

Just over 50% of these respondents believe that people who take medicines should take a break every now and then by stopping taking their medication. When respondents were asked if they believed that natural remedies are safer than Western medicines, 47% agreed, with 18% uncertain. Nearly 50% believed most medicines are addictive, and 90% believed that doctors place too much trust in medicines. 

The fact that such a large proportion of respondents hold a negative view of prescription medication in general is of some concern as this view could easily be transferred to ART, putting respondents at risk of not taking their therapy in the proper, consistent manner required and therefore running the risk of the ART not working, and leading to drug resistance. 

The study recommends an intensive education campaign to better inform patients on the importance of adherence to prescription medication at the patient-doctor level and at the level of home-based carers.
 

Men who have sex with men: To disclose or not

A study among HIV-positive men who have sex with men (MSM) in Cape Town showed a high percentage of participants engage in unprotected anal sex with partners who were unaware of their HIV-positive status. 

Secrecy and concealment of either sexual orientation or HIV positive status is typical of many sexual relationships between men because of the taboo nature of homosexuality in many African societies. Disclosure is important in the prevention of the further spread of HIV. 

The study, presented by Ms Allanise Cloete, a PhD intern in SAHA, aimed to inform the adaptation and development of an intervention that would reduce sexual risk for HIV-positive MSM in Cape Town, South Africa. 

The study included a survey among 92 HIV-positive MSM, purposefully sampled from venues where gay men congregate. Fifty-one percent were 25 years or younger, 33% described themselves as indigenous African, and the average number of years since testing HIV-positive was 2.7. 

It showed that 68 of the 92 participants in the study reported having anal sex with more than one partner without informing them that they were HIV-positive. And 36 of the 92 indicated that they had unprotected vaginal sex more than once in the previous three months with partners who were also unaware of their HIV-positive status. 

Almost 60% of the respondents indicated that it was difficult for them to tell other people about their status; 64% reported discrimination resulting from their positive status, including loss of housing or employment. Of interest is that 11% of the MSM reported that they were currently married. 

The study concluded that in developing interventions that would reduce risk behaviour for HIV-positive MSM, a strong component would need to be included focusing on disclosure decisions. But this will not be effective unless legal and other protective measures against discrimination were also implemented.

Strengthen families to strengthen children

Well-implemented home health visiting and early child development (ECD) programmes can help improve outcomes for children where HIV prevalence is high, provided support is available to caregivers and families to help alleviate the care burden for women and girls in households, said Dr Upjeet Chandan, a research specialist in the Child, Youth, Family and Social Development (CYFSD) programme. 

The study reviewed the evidence available from high-income countries on the best ways to strengthen families and how this evidence could be applied to strengthening children and families affected by HIV and AIDS in countries with a high HIV prevalence. 

The study, commissioned by the Joint Learning Initiative on Children and HIV/AIDS (JLICA) reflects a growing global consensus that one of the best ways to support children is by supporting their families. Programmes reviewed include home visiting programmes, ECD programmes, and behavioural parenting and family skills building programmes. 

Programmes that work 

Two key areas, namely home health visiting for pregnant mothers and young children, and a combination of centre and communitybased ECD programmes, emerged as areas of promising intervention that should be considered as key strategies, on a country-by-country basis, to improve the lives of children in high prevalence countries. 

Well-implemented, evidence-based home health visiting and ECD programmes can improve outcomes for children, and provide support to caregivers and families in the care of their youngest members. Such programmes can also alleviate the care burden for women and girls in households, enable caregivers to take up other activities such as income generation, schooling, and self-care, and provide a conduit for the delivery of other services, for example nutrition and health care. 

However, the study warns that without quality programmingit will be difficult to see quality results. For this reason careful attention must be paid to issues of programme implementation and ongoing monitoring and evaluation. 

Sufficient resources must be allocated to attract, train, and retain staff, and active efforts must be made to engage families in services. And while it is useful to learn from programmes in resourcerich countries, the study cautions that intervention strategies proven to work in resource-rich contexts cannot be implemented ‘as is' in resource-constrained settings and require testing through local effectiveness and implementation studies.