Informing Comprehensive HIV Prevention: A Situational Analysis of the HIV Prevention and Care Context, North West Province South Africa

摘要: Author(s): Lippman, Sheri A; Treves-Kagan, Sarah; Gilvydis, Jennifer M; Naidoo, Evasen; Khumalo-Sakutukwa, Gertrude; Darbes, Lynae; Raphela, Elsie; Ntswane, Lebogang; Barnhart, Scott | Abstract: ObjectiveBuilding a successful combination prevention program requires understanding the community's local epidemiological profile, social community norms that shape vulnerability to HIV and access care, available resources. We carried out situational analysis in order comprehensive address barriers care at multiple contextual levels North West Province of South Africa.MethodThe was conducted two sub-districts 2012 guided by an adaptation WHO's Strategic Approach, predominantly qualitative method, including observation service delivery points in-depth interviews focus groups with leaders, providers, members, recommend context-specific strategies. Analysis began during fieldwork nightly discussions findings continued coding original textual data from notebooks select number recorded interviews.ResultsWe over 200 individual group gleaned four principal including: fatalism, traditional gender norms, HIV-related stigma, challenges communication around HIV, all which fuel epidemic. At different response needed stem epidemic, we found evidence national policies programs are mitigating risk factors but little community-based responses HIV.ConclusionsUnderstanding structural helped our program, 'themes' identified into each component program. Activities underway engage communities, offer testing high transmission areas, stigma reduction, positive health, dignity for reduction improve skills. The process successfully shaped key programmatic decisions cultivated deeper collaboration stakeholders support implementation.