The implementation of the national HIV/AIDS policy in the Vhembe District

[摘要] ENGLISH ABSTRACT: The implementation of national policies is a key function of governmentthrough its various departments. This is very crucial in the health sectorwhere lives of individuals are involved. The implementation of the nationalHIV/AIDS policy is very important in dealing with the epidemic.This study combined both quantitative and qualitative methods toanalyse the implementation of the South African government's nationalHIV/AIDS policy in the Vhembe District of the Limpopo Province. Thequantitative phase involved the stratified sampling process, resulting inidentifying 2 health workers from each of the 25 health units in the districtcomprising of 22 community clinics, the infection control unit, the counsellingunit at the hospital and 2 from among the doctors. A total of fifty respondentswere selected from a workforce of about 500.The staff profile indicates that 76 % of the health workers interviewedwere below 40 years of age and 28% of them were chief professional nurses.Of the health workers, 78 % had been in the current position for between 1and 5 years, 6 % for 6 to 10 years, 6 % for 16 or more years and 10 % forless than one year. All of them had a diploma as a minimum qualification, 8% had 2 diplomas, 2 % had 3 or more diplomas, 2% had degrees and 2 %had a degree plus diplomas.In terms of HIV/AIDS policy implementation, 100% of all the facilitiesprovided HIV prevention information to clients, 60% of these facilities workedwith other organisations in HIV prevention, but only 4% had voluntarycounselling and testing (VCT) services. In these health units only 28% hadhad staff trained regarding HIV/AIDS issues. In addition 96 % of the healthunits had the male condom stocked at any one time and only 12 % stockedthe female condom.In terms of sexually transmitted diseases (STD) control, all clinics wereusing the syndromic approach in management of STDs and also claimed tohave youth-friendly services. On the other hand only 80 % of the facilitieshad had staff trained in STD management using the syndromic approach.In the area of prevention of mother-to-child transmission of HIV, (PMTCT) none of the clinics had VCT services for pregnant women and only8% of them had PMTCT counsellors. Because of the lack of VCT services only4% of the clinics had known HIV positive mothers attending the antenatalcare services.On the issue of post-exposure prophylaxis (P.E.P.) all clinics hadprotocols for this and 88% of them had antiretroviral drugs (ARVs) stockedfor post-exposure treatment for health workers. However, only 8% of theseclinics had a betadine douche as the only post-exposure intervention forraped women.In the area of treatment care and support for patients none of theseclinics offered ARVs, 24 % had protocols for prevention and management ofopportunistic infections, 4% were involved in any form of home-based care,4% had HIV/AIDS dedicated services and 24% collaborated with communitynon-governmental organisations (NGOs) in HIV/AIDS care.The qualitative phase of the study highlighted what health workersperceived as prominent features of the national HIV/AIDS policy and theseincluded prevention of HIV by use of condoms, faithfulness and pre-testcounselling. The respondents also interpreted the social response bygovernment to include provision of home-based care, care of orphans, foodprovision and safe guarding rights of victims. Other issues that wereperceived to be part of the national HIV/AIDS policy were STD management,health education, provision of training to health workers in HIV/AIDS issues,provision of home-based care and occupational health and safety for healthworkers.The government was also perceived to have a negative attitudetowards AIDS NGOs, not providing adequate numbers of the female condomand denying patients antiretroviral drugs (ARVs).The recommendations made on the basis of the study thereforeinclude strengthening the training of health workers in HIV/AIDS care andmanagement, improved provision of VCT services, wider distribution of thefemale condom, provision of prevention of mother-to-child transmission ofHIV (PMTCT) services and the linking of research and care to provide evidence-based practice. Other recommendations are that there should besupport programmes for health workers with HIV, addressing gender issues inimplementation and provision of ARVs especially where it is already knownthat they help.

[发布机构] Stellenbosch University