Holy Cross Hospital is a 240 bed degree one infirmary located in the rural Pondoland of Eastern Cape in the old Transkei, South Africa. It serves a population of about 50,000 around Flagstaff, Lusikisiki, Mkambathi and Bizana. There are 153 members of the infirmary staffs. The bulk of the rural people are hapless and as such, diseases associated with poorness are prevailing among the people: TB, malnutrition and HIV/AIDS. The infirmary is divided into different units among them is the HIV Clinic where bulk of patient on the life salvaging ART roll up their medicines.
Fig 6: Number of employees at Holy Cross Hospital, Eastern Cape. Management 10, Professionals 56, Clerical 22, Unskilled 65
In the rural community where adult females are the objects of societal force like colza, domestic assault and worst affected by poorness, they can merely be subjugated by the harrying effects of HIV. There are other parts that could be attributed to the prevalence of the disease among the adult females rural inhabitants. Female venereal mutilation although non a bulwark in South African societies, this could non be wholly ruled out in the rural communities where a batch of activities on traveling are underreported due to hapless media coverage. In another scenario, the act of masochism is besides a fuelling factor- a male dominant society.
In the planetary, national and local reappraisals of HIV/AIDS incidence and prevalence, it has ever been that adult females are at higher proportion. Even in the events of related decease, adult females are at the greater loss. There must be factors responsible for such properties. In a related comparing, prenatal attendants in South Africa have greater Numberss of the virus than the mean population. Here, the ground is obvious ; to be pregnant meant unprotected sexual intercourse. Different reappraisals of one-year prenatal studies in South Africa as conducted by
UNAIDS, AIDS epidemic update, 2009 ( hypertext transfer protocol: //www.unicef.org/factoftheweek/index_53596.html )
the Human Sciences Research Council ( HSCR ) has ever shows a greater per centums than the national HIV/AIDS prevalence. This is besides the same in many other states of the universe. Although, the virus was foremost discovered in 1981 among homosexual work forces in the United States of America, the displacement in the paradigm is a cause for concern.
“ This epidemic unluckily remains an epidemic of adult females. ” – Michel Sidibe , Executive Director of UNAIDS.
“ At the terminal of 2009 it was estimated that out of the 33.3 million grownups world-wide populating with HIV and AIDS, more than half are adult females. It is suggested that 98 per centum of these adult females live in developing states. The AIDS epidemic has had a alone impact on adult females, which has been exacerbated by their function within society and their biological exposure to HIV infection.A Generally adult females are at a greater hazard of heterosexual transmittal of HIV. Biologically adult females are twice more likely to go septic with HIV through unprotected heterosexual intercourse than work forces. In many states adult females are less likely to be able to negociate rubber usage and are more likely to be subjected to non-consensual sex.
Additionally, 1000000s of adult females have been indirectly affected by the HIV and AIDS epidemic. Women ‘s childbearing function means that they have to postulate with issues such as mother-to-child transmittal of HIV. The duty of caring for AIDS patients and orphans is besides an issue that has a greater consequence on adult females ” ( Avert, 2010 ) 1.
2001 prevalence %
2002 prevalence %
2003 prevalence %
2004 prevalence %
2005 prevalence %
2006 prevalence %
2007 prevalence %
Estimated HIV prevalence among prenatal clinic attendants, by state ( hypertext transfer protocol: //www.avert.org/safricastats.htm
Male prevalence %
Female prevalence %
Estimated HIV prevalence among South Africans, by age and sex, 2008 ( hypertext transfer protocol: //www.avert.org/safricastats.htm )
There are different distinctive features to the epidemic of HIV/AIDS in different societies, but the common features globally are the larger adult females exposure. However in the context of Africa, the prevalent poorness, female gender misdemeanor and the alarming in incidences of colza instances in the rural South Africa, male dominated society, unemployment, and illiteracy are some of the prevailing fortunes increasing the exposure to the virus.
In the scientific position, adult females still take greater proportion of PLWHA. The open countries of female venereal piece of land are greater than male and vaginal mucosal are more crumbly which become easy bruised with harsh sex. For every brush of heterosexual intercourse, adult females are at greater hazard of reaching HIV ( WHO, 2010 ) . The same rule besides applies to the spread of sexually transmitted infections. Womans have been known to bear the greater load.
Access to information is besides another important factor that is missing among adult females. Many of which are uneducated and as such, the Numberss of adult females in the places of power and authorization are slender. To do informed pick and cognition of bar of HIV/AIDS is rather lacking. “ Lack of instruction and economic security affects 1000000s of adult females and misss, whose literacy degrees are by and large lower than work forces and male childs ‘ . Many adult females, particularly those populating with HIV, lose their places, heritage, ownerships, supports and even their kids when their spouses die. This forces many adult females to follow survival schemes that increase their opportunities of catching and distributing HIV. Educating misss makes them more equipt to do safer sexual determinations ” ( WHO, 2010 ) .
Crime rate is another spotlight to the spread of HIV/AIDS. This act of force makes adult females to be the objects of onslaughts. In the local communities across South Africa, gender force is prevailing attitude. It was late reported that British twosome tourers were abducted in the rural community of Khayelitstha in Cape Town. The adult female was said to hold been raped and finally killed by the rural goons. The act of this societal force is merely non against the local adult females once more, it has transcended beyond the local communities. The narrative became a planetary sensational narrative. “ A 26-year-old adult male has been charged with commandeering the auto of a British twosome who were honeymooning in Cape Town at the weekend and slaying the bride, constabulary said Wednesday.The adult male from Khayelitsha, the sprawling township on the outskirts of Cape Town where Anni Dewani ‘s organic structure was found, was charged within hours of being taken into constabulary detention on Tuesday ” ( Afro News 24, 2010 ) .
The common local believe in South Africa is that HIV/AIDS is curable by holding sexual intercourse with virgin or person old who has abstain from sex for long clip. This is a remarkable factor announcing the up-surge in the colza instances in the state. Of class the traditional physicians ( Sangoma ) frequently times indoctrinate immature work forces populating with the virus to hold sex with virgin in order to be remedy. Statistically, South Africa has the largest figure of PLWHA worldwide than any other state. And with the local believe, the present state of affairs would hold been expected.
Another misnomer is the tradition of adult females submissiveness. A good adult female is rather frequently viewed by the local communities as submissive to her hubby, non oppugning her hubby about his sexual life, ready to give sex anytime without dialogue and must bear many kids. This attitude frequently endangers adult females life and possibly the unborn kids in state of affairs where the adult male of the house engages in coincident multiple sexual partnerships. A recent study in a local community in a South Africa neighboring state, Botswana found that 62 % of work forces have engaged in multiple sexual partnerships in the old three months ( New York State, 2010 ) . This is merely what happens in a state non ill-famed for high incidence of force against adult females. Then, the state of affairs could be far making in the rural South African communities.
OPERATIONAL DEFINATIONS AND HYPOTHESIS
HIV/AIDS prevalence is greater among Womans?
HIV as normally known is Human Immunodeficiency virus while AIDS is the terminal phase of HIV infection. AIDS is Acquired Immune lack Syndrome. In most instances, HIV infection depending on the immune position of the septic persons can quickly come on to AIDS in a year`s clip without medical intercession. However, there were records of people that have lived more than 20 old ages on ART after despite the virus4. The commonest manner of transmittal of the virus in sub-Sahara Africa is through heterosexual intercourse.
Prevalence is an epidemiological parametric quantity evaluation the distribution of disease status in a population at a peculiar clip. While incidence focal points on the happening of new form of a disease status. Prevalence encompasses both the new and the bing diseased in a population. In the events of HIV/AIDS, new instances of HIV will be considered as incidence and both the new instances and those that have AIDS are expressed as the prevalence of the disease.
Prevalence = entire Numberss of people with disease status A- 100
entire figure of the population
The age of consent for expiration of gestation ( TOP ) in South Africa was one time said to be 12 old ages. However, this has late been reviewed by the Health Professions Council of South Africa ( HPCSA ) ( HPCSA, 2010 ) . Presently, there is no age limitation for TOP. Amongst many other things brewing the ceaseless addition in the figure of adolescent gestation and childhood HIV/AIDS is this reviewed ethical consideration of age of consent for TOP. Therefore, anybody that is 12 old ages old or more and pregnant are considered as female parent and the fable of muliebrity applies. In contrast, the same definition of been a adult female is considered after the age of adolescence ( after 18 old ages ) for non pregnant females. This regulation besides applies for work forces after adolescence.
Testing the hypothesis, it a widely believed that HIV/AIDS is a gender related disease status and that the status is at higher prevalence among adult females. There are different statements that could be put frontward to back up this misnomer in the society. For case, HIV/AIDS and STI prevalence is higher among female commercial sex workers. They serve as reservoir of infection in the community. This form could be acceptable as different people sleep with workers whose HIV and STI position are non verified. This may account for a greater incidence among adult females. However, it is merely a handful Numberss of adult females that engages in commercial sexual activities and this can non be generalised for all.
Cultural patterns are the ways of people which has been over clip been accepted as norm in the society. Africans have several norms and patterns that are assisting to fuel the spread of HIV/AIDS. But are at that place any cultural believe that make HIV/AIDS adult females heritage? Polygamy and multiple sexual partnerships are accepted among many African civilizations. Work force are frequently seen as the dominant factors in most African societies and the strength of his domination is frequently designated by how many adult females he could hold sex with. The work forces are even sometimes adored with particular fears: holding multiple sexual spouses as the nature of work forces, they need to hold frequent sex as to maintain tantrum and healthy and multiple sexual partnerships denote suppressing adult females. Are these defects in our modern society? Another ground ascribed to adult females higher HIV/AIDS prevalence?
In the aftermath of HIV/AIDS pandemic, the usage of barrier method of HIV bar was among the initial intercessions to control the spread of HIV. Male rubbers were so introduced and later the female rubbers. It is known facts that have been proved over times that condoms prevent HIV spread efficaciously. However, to utilize rubber in each sexual brush is non a exclusive duty, collaborative attempts is needed. In the society where adult females are already subdued by the social norms, regulations and ordinances, negociating sex with rubber is regarded as act of insubordination. Consistent and right usage of rubbers for adult females in heterosexual relationships is frequently compromised. Dry sex is another common demand of local African work forces from adult females. They claim that it gives work forces intense sexual satisfactions. Womans whose venereal mucosal are easy bruised are the object of mark for HIV and STI.
In the most of these concerns laid above, adult females are at the disadvantage. The survey below looks at the epidemic among adult females, prenatal attendants and work forces in the rural Pondoland.
aˆ? What is the prevalence of HIV/AIDS among adult females and work forces measuring Holy Cross Hospital, Eastern Cape for medical intervention?
aˆ? HIV/AIDS is more prevailing among adult females than work forces?
aˆ? For the Antenatal attendants, do they hold higher HIV prevalence than other two groups as depicted in the South African prenatal HIV prevalence?
aˆ? What are the cause ( s ) of higher HIV/AIDS among adult females in the rural Pondoland?
Analysis OF HIV/AIDS
Womans are the critical nutriment of our communities, yet most vulnerable to HIV/AIDS. This needs an pressing intercession. The disease status has all its tentacles in all facet of life of both rural and urban South African inhabitants. It has crippled many family of beginning of support and as such many rural fatherlands are being headed by kids. This is the coupled factor to increased Numberss of orphan kids in Pondoland.
Purpose OF THE STUDY
The causal relationships of the virus and higher prevalence among adult females are critically reviewed with the purpose of find precise and curious intercession schemes in the rural Pondoland. Although most rural African communities do hold common antiquity, the schemes conveying relieve from HIV/AIDS epidemic may be expressed to each community. This is an effort to concentrate on such schemes.
Importance OF THE RESEARCH STUDY
In the world, we do non cognize precisely how many people that are populating with HIV/AIDS in South Africa. The national and prenatal prevalence are extrapolations and tax write-offs. This study will be a study to cognize how many of Holy Cross Hospital grownup patients live with virus. The causes of such septic grownups and the necessary intercession to control the spread of the virus.
THE RESEACH METHODOLOGY ( HIV/AIDS prevalence is greater among adult females? A infirmary based survey )
The design of the survey will be randomised prospective survey of adult females, Antenatal attendants and work forces measuring Holy Cross Hospital, Eastern Cape, South Africa for medical interventions. The research is traveling to be questionnaires based with translator available to interpret and explicate inquiries to the participants in the survey. The translator will be chosen among the infirmary volunteered nurse for the interest of uniformity of linguistic communication interlingual rendition and consequence result. It is known fact that many of the grownup members of Pondoland rural community are non huge with usage of English linguistic communication.
The point distribution of the questionnaires will be at the outpatient section, exigency unit and at the antenatal clinic which takes topographic point every Thursdays. These are the first points of contact for any patient measuring the infirmary for the first clip. The survey will be conducted over the initial period of 1 ( one ) twelvemonth from January boulder clay December 2011. The mark figure of the participants will be capped as 500. There will be three groups of the participants: ( 1 ) adult females go toing outpatient and exigency sections for medical intervention, ( 2 ) work forces go toing outpatient and exigency sections for medical intervention and ( 3 ) adult females go toing prenatal clinic.
The age group that will be included are adult females and work forces between 18-65 old ages old and pregnant adult females more age 12. As the survey is divided into three groups and to be conducted in three infirmary section, the form of questionnaires distribution will be stratified. The first four months of 2011 ( January till April ) , both the principal research worker ( for my portion ) and the helper, we will merely concentrate on patient go toing exigency unit, May till August 2011 in the outpatient section and September through December in the prenatal unit.
The method of everyday attack will be that at every contact with the participants, the research aims and concentrate will be explained and the voluntaries are selected based on age standards will be tested for HIV. For every participant, voluntary guidance and proving for HIV will be conducted by the principal research worker and written consent will be documented for every participant. Note, all information will be treated with confidential and consequence of the research will non be linked to the participants. A rapid showing HIV proving kit for HIV 1 and 2 ( ELISA 1 and 2 ) will be used throughout the survey. Every consequence will be read after 30 proceedingss. For those proving positive for HIV, they will be offered medical aid for farther research lab trials ( CD4 counts, viral tonss, full blood counts and liver map trial ) and necessary medical intervention. Each participant will be allowed sufficient clip to make full in the questionnaires but should be return before go forthing the infirmary premises. The construction of the inquiries will be in different subdivisions with the initial portion turn toing the demographic informations, cognition about HIV/AIDS, behavioral hazard factors for HIV/AIDS, measuring hazard of societal force and preventative scheme for HIV/AIDS. The inside informations of the questionnaire are as follows:
Age: ( a ) 12 – 25 old ages ( B ) 26 – 35 old ages ( degree Celsius ) 36 – 45 old ages ( vitamin D ) 46 – 55 old ages ( vitamin E ) 56 – 65years ( degree Fahrenheit ) more than 65 old ages
Gender: ( a ) Male ( B ) Female
Occupation: ( a ) non-skilled worker ( B ) semi-skilled worker ( degree Celsius ) skilled worker ( vitamin D ) immigrant worker
Marital Status: ( a ) Single ( B ) life partnership ( degree Celsius ) Married ( vitamin D ) Divorced
Religion: ( a ) Christian ( B ) Muslim ( degree Celsius ) Traditional
Race: ( a ) Black ( B ) White ( degree Celsius ) Coloured ( vitamin D ) Indian
Monthly Income: ( a ) Roentgen 500.00 – Roentgen 3000.00 ( B ) Roentgen 3001.00 – Roentgen 10, 000.00 ( degree Celsius ) R 10,001.00 – Roentgen 20, 000.00 ( vitamin D ) greater than R 20, 000. 00 ( vitamin E ) unemployed
Knowledge about HIV/AIDS
1. HIV is the abbreviation of Human Immunodeficiecy Virus Y N D
2. Sexual activity intercourse with multiple sexual spouses increases the hazard of geting HIV
Y N D
3. Transfusion of unscreened HIV infected blood can take to HIV infection Y N D
4. sharing nutrient with AIDS patient can take to HIV infection Y N D
5. venereal diseases are risk factors for HIV infection Y N D
6. Terbium is an illustration of timeserving infection Y N D
7. HIV infected individual should non unwrap his/her position because of stigma Y N D
8. HIV/AIDS is a godly penalty for unfaithfulness Y N D
9. PLWHA should non be employed because they are underproductive and weak
Y N D
10. HIV is passed on by sneezing, manus shingle, caressing, and kiping together
Y N D
11. HIV/AIDS is entirely big disease and the young person should non be concerned.
Y N D
12. HIV bar instruction should merely be a precedence in schools and colleges
Y N D
Adapted from: ( hypertext transfer protocol: //unesdoc.unesco.org/images/0012/001270/127076eo.pdf ) Y = Yes, N = No, D = Do n’t cognize, FBO = Faith Based Organisations, PLWHA = People Living with HIV/AIDS
Behavioural Risk Factors for HIV/AIDS
Make you smoke coffin nail, if yes, how many per twenty-four hours?
Make you imbibe alcohol? If yes, how many bottles per twenty-four hours?
Do you hold more than one sexual spouse? If yes how many?
Has any of your sexual spouse ( s ) been treated for STI in the past three months?
Make you cognize sexual spouse ( s ) HIV position? If yes, what is it?
Are you in polygamous relationship?
Have you been sexually been abused by your spouse or mistreat your sexual spouse in the past three months?
What is your sentiment about dry sex?
Have you portion needle and endovenous drug with your friend before? If yes when was it?
Make you prosecute or patronize commercial sex workers?
If employed, does your occupation maintain you off from your place more than two hebdomads or more?
Are you or your male spouse circumcised?
Measuring hazard of societal force
Have you of all time been sexually abused by opposite gender?
Have you been sexually abused by your spouse ( s ) or abused your sexual spouse in the past three months?
If yes, when was the first maltreatment? And how terrible was it?
Does your spouse have fire arm? And if yes, does he/she endanger to kill you before?
Have you of all time sustain any signifier of physical or emotional harm from spouse force?
Does your spouse respects your sentiment if you are non in the temper of holding sex?
How can you depict the last three sexual brushs with your spouse ( s ) ?
Make you cognize if your spouse has been reported as violent to any other individual?
Is your spouse of all time been arrested by constabulary for societal force or drink-driving?
Does your spouse have job with choler direction?
Measuring Preventive Strategies of HIV/AIDS
Which HIV/AIDS bar schemes do you cognize?
Make you see utilizing HIV bar if you are non certain of the HIV position of your spouse?
If your spouse is HIV positive, will you see utilizing rubber during intercourse? If yes, why?
Make you utilize any signifier of HIV preventative step during your last three sexual intercourse? If yes, which one or province them.
If condom explosion during sex, what is the immediate measure you should take?
If employed, what are the schemes in topographic point of your work guaranting bar of HIV?
What is your sentiment about male Circumcision and HIV bar?
If HIV and pregnant, will you take ART to forestall HIV transmittal to the unborn babe?
What option ( s ) are available for HIV positive spouses to forestall transmittal of HIV to unborn babe?
Have you been treated for genital disease in the past three months?
What is the nexus between genital disease and HIV?
POPULATION SAMPLING AND RESULT ANALYSES
What inform the entire sampling population is the immense figure the infirmary serves, 50,000. 1 % of that is tantamount of 500. Although this is a little figure in associating to the entire population measuring the infirmary, but associating to the chief research worker and the helper, it is tremendous. That is why the survey would hold been conducted throughout a twelvemonth period. The purpose of the age distribution chosen was to affect grownups entirely in the survey ; nevertheless, adolescent gestation is a rampart happening in South African communities. That is why pregnant adult females from age 12 are portion of the proposed survey.
There are five constituents of the questionnaire and three groups of participants involved in the survey, the consequences will obtained individually for each group and interpreted utilizing Microsoft excel. The usage of Chi square trial will be employed the hypothesis – Hiv is higher among adult females than work forces.
Expected RESULTS FROM THE STUDY
The survey is expected to conform to the present form of the virus epidemic in South Africa. “ HIV/AIDS is more prevailing among female grownups under the age of 40 in about all age groups. Approximately 4 in every 5 people with HIV/AIDS aged 20-24 are adult females, and merely one tierce of people with HIV/AIDS aged 25-29 are work forces. Although prevalence is higher among adult females in general, merely 1 in every 6 HIV/AIDS infected people with multiple sex spouses are adult females ” ( Wikipedia, 2010 ) . Although some divergences are expected, could these be peculiar to the rural Pondoland community? South Africa adult females who have been disempowered revealed the high degree of colza and domestic maltreatment, a societal misnomer brewing the HIV/AIDS epidemic in the state ( Avert, 2010 ) .
The National HIV and Syphilis Antenatal Sero-prevalence Survey, 2005 and 2007, the per centum of pregnant adult females with HIV per twelvemonth was as follows ( Wikipedia, 2010 ) :
These one-year studies of HIV among the pregnant adult females are higher than the national prevalence of 10.8 % , though the incidence is higher among adult females 13.3 % than in work forces 8.2 % ( HSCR, 2005 ) . The same result is besides envisaged as above. Possibly there are disparities, they will be noted and a farther study may be needed.
EXPECTED CONTRIBUTIONS OF THE STUDY TO THE HOSPITAL
South Africa higher HIV/AIDS national statistic is higher than any other state, that is what has geared the exceeding authorities attempts in other to undertake the disease tendency. The robust attempts of the authorities are the largest HIV/AIDS strategy in the universe ( All Africa.com, 2010 ) . The tendency of the disease needed to be known exactly in Pondoland. The result of the survey could be presented to the regional wellness authorization for amendment of HIV/AIDS authorities intercession at the infirmary.
Critical reappraisals of different diaries have shown that HIV/AIDS has unprecedented rise among adult females ( UNICEF, 2009 ) , the result of the survey is expected to be in conformance. However, if the consequences show greater proportions of adult females than expected, it could spell a readjustment in the infirmary planning scheme to turn to direction of HIV/AIDS among adult females.
The local untypical causes of rise in HIV/AIDS will be known if there is any. The illation will be surmised from the response of adult females proving positive for HIV in the survey. Therefore local epidemiological form of HIV in Pondoland will be verified.
The result of this survey could name for more survey in HIV/AIDS and other local endemic disease in the infirmary. A rural infirmary where academic research is seldom conducted, this will be an oculus opener. It will be a beginning of inspiration particularly for the freshly graduated medical physicians and druggists in the infirmary set abouting their rural community service.
For effectual intercession to come into drama in the direction of the increased HIV/AIDS disparities among adult females and work forces, the specific factors responsible have to be outlined and schemes to battle these could be sourced. In the aftermath of HIV/AIDS in the 80s, the epidemic was rather rampart among homosexual in the USA and equal intercessions were ensued as reflected in the state HIV/AIDS statistics. Africa needed to larn from this.
The basic nutriment of any community is the valued lives of the household members. Womans who are the beginning of generational continuity are in hazard in our society. Didactic and pressing attack should be instituted in the rural and all African communities to halt the harness effects of HIV/AIDS. Prevention of Mother-to-Child HIV transmittal, handiness of free rubbers in public establishments, adult females empowerment and wellness instruction should parts of focus authorities and NGO agendas to readdress HIV/AIDS epidemic in Africa.