- by: Ros Dowse, Rhodes University
Part 3: Patient Information
Abstract
The objectives were to design a simple, illustrated patient information leaflet for the antiretroviral regimen of stavudine, lamivudine and efavirenz and to evaluate its readability and acceptability in the local Xhosa population. In order to achieve this, a further objective was to design and evaluate illustrations to include in the patient information leaflet which were culturally acceptable and well interpreted. Illustrations or pictograms were designed to illustrate selected instructions appearing in the patient information leaflet and were individually tested in 30 Xhosa participants who had a maximum of 8 years of formal schooling. Results were used to improve the pictograms for inclusion in the patient information leaflet. The patient information leaflet was designed and tested in sixty Xhosa participants with varied levels of education who had stated they could read. Demographic data were collected and they were then asked to read the patient information leaflet, available in both English and isiXhosa, and a series of questions was asked to assess its comprehension and acceptability. The overall average rate o f understanding was 95. Six of the 20 questions were located and understood by all participants, and only two questions resulted in less than an 85 correct response. Physical appearance and quantity of information were highly rated and all participants were enthusiastic about the inclusion of pictograms.
Introduction
The communication of health-related information in Africa has involved various media including theatre (Mbizvo, 2006), video (Mathews, 2002), television and radio (Health Communication Partnership, 2008) and folk media which includes poems, dance drama, story-telling, rhymes and sayings (Gokah, 2007). However, the most commonly employed method has been the use of print media (Peltzer, 2002). Low literacy rates coupled with inadequate infrastructure and poor technological development in African countries have favoured the use of posters, billboards and pamphlets for health promotion and patient education.
Medicine-taking behaviour is complex, multi-factorial, and depends on a dynamic interaction of several factors, including cognitive, behavioural, social, environmental and physiologic factors (WHO, 2003). A minimum requirement for using medicines safely and effectively is a basic understanding of the medicine instructions and the ability to recall this information. However, the communication of this information to the average patient in southern Africa presents a complex challenge to health professionals as poorly resourced health care systems result in minimal time spent with individual patients and the cultural, educational, socioeconomic and linguistic differences that often exist between health professionals and patients may further challenge successful communication. Limited reading skills, a poor knowledge of the body and its systems and inadequate insight into diseases and their treatment also disadvantage patients seeking to address their health problems. Read more
- by: Mia Malan, Stellenbosch University
Abstract
The ways in which journalists frame HIV stories can strongly contribute towards news consumers’ perceptions of the epidemic. This paper discusses the news values of HIV radio programmes in Ethiopia, Kenya and South Africa. It argues that the culturally appropriate ‘humanisation’ of HIV stories and the proper use of conflict as adding news value are paramount to the impact of stories. The skillful application of news values can make almost any HIV-related story newsworthy and therefore part of mainstream news. Moreover, it is maintained that HIV advocacy environments contribute to the newsworthiness of HIV stories in the media. The AIDS advocacy milieus of South Africa and Kenya are compared and related to the type of HIV stories that are published and broadcast in the respective countries. Journalism training methods are critically discussed in the context of the above. It is argued, that, in developing countries, where journalists often lack basic journalism skills, it is not sufficient to provide reporters with HIV-related information; HIV information sharing should be combined with general journalism training and mentoring.
Introduction
In December 2007, an excited Bashir Osman – a Somaligna-speaking journalist from Dire Dawa in the east of Ethiopia – broadcast a live call-in show on breastfeeding and HIV to his Somali audience on Dire 106.1 FM. According to the most recent Ethiopian government figures, Dire Dawa has the second highest HIV prevalence rate in the country, and almost doubles the national average. Each year there are almost 1, 000 HIV positive pregnancies with at least 230 children born with the virus. Yet this was the first HIV programme that Bashir had ever produced.
AIDS was so stigmatised in the region that Dire 106.1 FM hardly ever discussed it on air. And Osman had no problem following this route. A week before the
broadcast, the journalist – like most of his listeners – refused to be in the same room as people with HIV because he “didn’t want to risk breathing the same air” (Osman cited in De Masi, 2008) as them. He would never consider sharing a plate, or hosting an HIV positive person in his home, and thought it a deep insult to be tested for the virus.
But then Osman accessed what turned out to be a precious piece of culturally relevant information: he learned that babies of HIV positive women can get infected with the virus through their mothers’ breast milk (personal communication, December 6, 2007). All mothers with babies in his community breastfed their infants … including his very own wife. His own five-month old baby could be at risk, he perceived with shock, because neither he nor his wife knew their HIV status. The realisation changed Osman’s entire view on AIDS, and HIV was suddenly a virus that had the potential to directly impact his own life and those of everyone else he knew, in ways he had previously vehemently denied (personal communication, December 6, 2007). In short, this piece of information made AIDS newsworthy to Osman, his community and his editors. It became something that was crucial and worthwhile to talk about. Read more
- by: Emma Durden, University of Cape Town and University of KwaZulu-Natal
Abstract
This paper explores two essential questions related to health promotion and HIV/AIDS education.
1: Do HIV positive health promoters and peer educators have positive effects on students’ health attitudes, behaviours and HIV stigma reduction?
2: Which programme characteristics have better effects on health education performance? The paper seeks to address these questions with relation to the DramAidE Health Promoters Project run at a number of Higher Education Institutions in South Africa. The project makes use of HIV positive young people to live openly as role models with HIV on campus, to break stigma around the disease, increase prevention efforts, and encourage testing for HIV and positive living with HIV. A project evaluation conducted in 2007 included interviewing students, staff and the HIV positive health promoters working at nine campuses across South Africa, and forms the basis for this study.
Introduction
This chapter introduces the DramAidE Health Promoters Project and gives some background on its history and the rationale for its inception, with an overview of the current situation and response to HIV/AIDS at Higher Education Institutions in South Africa. The Health Promoter Project is rooted in the fields of peer education and entertainment education, and this chapter explores some of the theories that inform those practices, as well as an overview of some of the literature on similar projects that employ HIV positive people.
The chapter then explores two areas of study, namely the effect that HIV positive peer educators have on other students, and the programme characteristics that have better effects on health education performance; in an attempt to highlight good practice in the field of health promotion and HIV prevention efforts in South Africa. Some of the data relevant to the DramAidE Health Promoters Project are presented and discussed, with conclusions regarding the successes, challenges and potential of this strategy.
The DramAidE Health Promoters Project
The social impact of the HIV/AIDS epidemic in South Africa highlights the need to ensure that communities band together to deal with all aspects of the disease. Social behaviour change theories suggest that it is most effective to educate, sensitise and mobilise individuals by addressing the community in which these individuals find themselves, and to make HIV/AIDS a community concern (UNAIDS, 1999b). A number of commentators on HIV/AIDS behaviour change interventions agree that behaviour change can only happen in a supportive context where individuals are empowered to act within the group (Tomaselli, 1997; Airhihenbuwa & Obregon, 2000; Papa et al, 2000; Kelly, Parker & Lewis, 2001; Tufte, 2002).
The Health Promoters Project is a project running in Higher Education Institutions across South Africa, where these institutions are seen as able to respond to HIV/AIDS in a strategic and focused manner, as communities that find themselves within other broader communities. It is understood that the Higher Education sub-sector in South Africa may be disproportionately more affected by HIV/AIDS than other sectors, as the majority of students found on campuses across the country are in the in the age group with the highest prevalence of HIV infection (SAUVCA, 2006). According to a 2000 study conducted by the research organisation Abt Associates, the rate of HIV infection at a university undergraduate level was estimated to be roughly 22. This was expected to rise to 33 by 2005 (Thom & Cullinan, 2003). Read more
- by: Tanja E. Bosch - University of Cape Town
Abstract
There is widespread global use of technology in medicine and health communication, leading to terms such as telemedicine, telehealth and e-health. A wide range of information and communication technologies (ICTs) is used both in the provision of services, as well as for messaging and communication campaigns. In South Africa, limited Internet penetration has led to increased experimentation with cell phones as a tool for social change. This paper provides a discussion of three of such projects: The Teen SMS Helpline of the South African Depression and Anxiety Group (SADAG); SIMPill which assists patients with compliance to their tuberculosis medication; and CellLife’s Cell phones for HIV programme. The projects are described, and the paper reflects on the general possibilities for using cell phones in healthcare, weighing advantages and disadvantages, particularly in the local South African context.
Introduction
The global trend of using new technologies in healthcare and health communication has made its way to Africa. A range of healthcare initiatives makes use of palm devices, the Internet, and other information and communication technologies, giving rise to the terms e-health, tele-health, and telemedicine (see Oh, Rizo, Enkin & Jada, 2005, for a literature review on the topic).
While the growing body of literature on this subject explores both the Internet and cell phones as ‘new’ media in the use of health promotion efforts, it is cell phones that are emerging as most popular, and possibly most effective, in health communication on the continent. Internet penetration in South Africa is increasing steadily, but the numbers of people with access to high-speed Internet connectivity here and elsewhere across Africa are probably still too low to allow the widespread success of Internet based applications, outside of telecentres set up specifically for this purpose. Recent statistics indicate that only one in 700 Africans has access to the Internet, versus one in four Europeans (Chakraborty, 2008).
On the other hand, the number of mobile subscribers in Africa has increased dramatically over the last few years. In 2007 Africa added over 60 million new
mobile subscribers and mobile phones represented 90 percent of all telephone subscribers (African Telecommunication/ICT Indicators, 2008). Indeed, cellphone penetration in Africa has increased rapidly since the privatisation of telephone monopolies in the mid-1990s (LaFraniere, 2005). Between 2000 and 2006, the total number of subscribers to cellphone services increased from 10 million to 110 million, in the 24 countries of sub-Saharan Africa, and South Africa had more subscribers to cell phones than fixed lines (Buys, Dasgupta, Thomas & Wheeler, 2008). Similarly, an earlier study revealed that the number of mobile subscribers in 30 Sub-Saharan countries rose from zero in 1994 to more than 82 million in late 2004 and the rate of growth for the entire continent has been more than 58 per year (Mbarika & Mbarika, 2006). Clearly, Sub-Saharan Africa is the world’s fastestgrowing wireless market and the rate of growth for the entire continent has been more than 58 per year (Mbarika & Mbarika, 2006). In South Africa, cellphone use is widespread, particular with the introduction of pre-paid services; and there are over 30 million users (Shackleton, 2007). Read more
- by: C.J. Polychroniou & Marcus Rolle
Malcolm Sawyer ~ Emeritus Professor of Economics. Leeds University Business School
More than a year ago, British voters sent waves of shock throughout Europe and the world economy with their decision to withdraw from the European Union (EU). However, the impact of Brexit on the UK’s economy and its implications for the future of the EU remain contested territory, especially since the conservative government of Theresa May has shown astonishing ineptness so far in terms of the conditions of the divorce. In this interview, well-known British economist Malcolm Sawyer of the University of Leeds provides an insightful analysis on the major issues and questions associated with Brexit, shedding light on what the future may hold for both the UK and the EU.
C.J. Polychroniou and Marcus Rolle: Britain’s decision last year to leave the European Union represents a shattering political development, the effects of which remain incalculable both for the future of the United Kingdom and for the EU itself. But before we explore the political economy of Brexit, let’s start by asking you to explain to us what you believe were the key factors that prompted British voters to seek a divorce from the European Union.
Malcolm Sawyer: The result of the referendum vote of June 2016 was close — 52 percent [voted] “leave EU” and 48 percent [voted] to remain. In any referendum (and indeed other elections), it is difficult [if not] impossible to discern what people thought they were voting for or against. In this referendum, whilst the consequences of a “remain” majority could be perceived as continuation with present arrangements, those of a “leave” majority were obscure — and indeed, the UK government is now grappling with working out what the consequences will be.
For those who voted for the UK to leave, my impressions are that the key factors include:
– The appeal of “take back control,” particularly with regard to immigration and the free movement of labor within the EU. Whilst there appear to be net economic benefits for the UK from immigration, there will be winners and losers, and people’s perceptions may often be of little or no benefits: added to which, hostility towards foreigners.
– The remoteness of the EU, often labelled in terms of “Brussels” with connotations that decisions of the EU were being imposed on the UK without input from the UK. This interacted with the “take back control” and could be stoked up by stories (often false) of decisions made by the EU.
– Disbelief that the UK’s membership of the EU brought economic benefits. The UK’s contribution to the EU budget (a net cost of around ½ percent of GDP) was apparent (though much overstated by the leave campaign), and the benefits for enhanced trade and cooperation much more nebulous. The remain campaign would cite 3 million jobs dependent on trade with EU (again overstated), but that would mean 27 million jobs were not dependent on such trade.
A breakdown of the vote revealed two fractures: a sharp division between young and old, and a huge gap between London and the North. What does the political economy have to do with these two fractures, and what sort of economic policies can be implemented in the future that can heal a divided nation?
The voting patterns with regard to remain/leave can be broken down along a number of lines — a tendency for large cities to vote remain (not just London), two countries voted to remain (Scotland, Northern Ireland) and two to leave (England, Wales). Having a university education tended to be associated with voting “remain,” and the old were much more likely than the young to vote leave (there being overlap between the two in that participation in higher education was much lower in the 1950s and 1960s than in the past two decades).
There appears to be association between socially conservative attitudes and voting leave. Areas of industrial decline appeared more likely to vote leave, [as did] areas where immigration had increased substantially in the past decade (noting that migration from other EU countries rose sharply after 2004 with the entry of the new member states in that year).
There is, in my view, a division between remain voters and leave voters running along the lines of “what matters to them.” A potent slogan of the leave campaign was “taking back control” — applied to immigration (as the free movement of labor places few constraints on migration within the EU), and to the role of [the] European Court of Justice, and more generally, to adoption of laws (though the impact of EU legislation on UK legislation was often grossly overstated by leave campaign), and to some degree, over regulations associated with the single market, and over policies, such as the common fishery policy.
The remain campaign focused on the adverse economic consequences of the UK leaving the EU, and failed to address the issues raised by the leave campaign in connection with “take back control.” Although large numbers were bandied about for the economic losses associated with leave, in proportional terms, the losses were relatively small (less than 5 percent of GDP over a 15-year period, and then as compared with what would have otherwise occurred). If a person’s concern is over perception of a loss of control, and striving to take “back control,” then some economic loss may well appear inconsequential. But also, the leave campaign’s slogan to the effect that £350 million a week (equivalent to around 1 percent of UK GDP) was the cost to the UK of EU’s membership, money which could be spent on the NHS, served as an antidote to the remain campaign’s claims over economic damage from leaving the EU. The £350 million per week claim was much derided as inaccurate, representing the gross payments by UK to the EU and ignoring the money flowing back to the UK for the agricultural support policy, regional and structural funds, and research moneys to universities.
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- by: Leonid E. Grinin & Andrey V. Korotayev
This article* studies the issue of democratization of countries within globalization context, it points to the unreasonably high economic and social costs of a rapid transition to democracy as a result of revolutions or of similar large-scale events for the countries unprepared for it. The authors believe that in a number of cases the authoritarian regimes turn out to be more effective in economic and social terms in comparison with emerging democracies especially of the revolutionary type, which are often incapable to insure social order and may have a swing to authoritarianism. Effective authoritarian regimes can also be a suitable form of a transition to efficient and stable democracy. The article investigates various correlations between revolutionary events and possibilities of establishing democracy in a society on the basis of the historical and contemporary examples as well as the recent events in Egypt. The authors demonstrate that one should take into account a country’s degree of sociopolitical and cultural preparedness for democratic institutions. In case of favorable background, revolutions can proceed smoothly (‘velvet revolutions’) with efficient outcomes. On the contrary, democracy is established with much difficulty, throwbacks, return to totalitarianism, and with outbreaks of violence and military takeovers in the countries with high illiteracy rate and rural population share, with low female status, with widespread religious fundamental ideology, where a substantial part of the population hardly ever hears of democracy while the liberal intellectuals idealize this form, where the opposing parties are not willing to respect the rules of democratic game when defeated at elections.
Keywords: globalization, Near East, Egypt, democracy, revolution, reaction, extremists, counterrevolution, Islamists, authoritarianism, excessive expectations, military takeover, economic efficiency.
Sociopolitical destabilization may be produced by rather different causes. However, sociopolitical transformations may be considered as ones of the most powerful among them. This may look paradoxical, but attempts of transition to democratic forms of government may lead to a very substantial destabilization of a society in transition. The present article analyzes the relationships between revolution, democracy and the level of stability in respective sociopolitical systems.
There is a widespread opinion that globalization contributes to the spread of democracy. Besides, there is a conviction, which is more widespread among the politicians and ideologists than among the scholars that democracy contributes to a faster and/or more adequate economic growth. The following quotation passionately expresses this conviction: ‘For the past three decades, globalization, human rights, and democracy have been marching forward together, haltingly, not always and everywhere in step, but in a way that unmistakably shows they are interconnected. By encouraging globalization in less developed countries, we not only help to raise growth rates and incomes, promote higher standards, and feed, clothe, and house the poor; we also spread political and civil freedoms’ (Griswold 2006).
In this context, many supporters of democracy consider extremely disappointing that sometimes democracy does not work properly and the waves of democratization get weaker. Samuel Huntington (1993) called the period of a fast spread of democracy in the 1970s – early 1990s ‘the third wave of democratization’. On the threshold of the twenty-first century, many researchers noted that the number of democratic regimes ceased to grow and that it would be a dangerous intellectual temptation for the democrats to consider that the world is inevitably moving towards some final natural democratic state (see Diamond 1999, 2004, 2008). In this situation, the trend has strengthened which promotes democracy in all countries with non-democratic or partially democratic regimes. This trend, on the one hand, is based on the global geopolitical goals of the USA and the West (see, e.g., Brzezinski 1998), and on the other hand, relies upon an active support of a broad ideological and informal movement. And this justifies the efforts to support democracy and to encourage democratic opposition for the purpose of increasing chances of victory of democracy in case of the crisis of authoritarian regimes (Diamond 2000). The intensive efforts led to a number of interventions and color revolutions. Read more
