From “Secret” to “Sensitive Issue”: Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment

2021 ◽  
pp. 089826432110202
Author(s):  
Enid Schatz ◽  
Ifeolu David ◽  
Nicole Angotti ◽  
F. Xavier Gómez-Olivé ◽  
Sanyu A. Mojola
Keyword(s):  
Older Persons ◽  
Antiretroviral Treatment ◽  
Hiv Disclosure ◽  
Death Sentence ◽  
Treatment As Prevention ◽  
Negative Consequences ◽  
Middle Aged ◽  
Group Discussions ◽  
Rural South ◽  
South Africans

Objective As HIV shifts from “death sentence” to “chronic condition,” disclosure of HIV status to intimate partners and family is a significant component of both prevention and treatment adherence. While disclosure is closely considered in many studies, few examine middle-aged and older persons’ (age 40+) perspectives or practices. We trace older rural South Africans’ views on HIV disclosure to their partners and family members in a high prevalence community over a period of extensive antiretroviral treatment (ART) rollout. Methods Community focus group discussions (FGD) conducted in 2013 and 2018 show shifts in older persons’ thinking about HIV disclosure. Findings Our FGD participants saw fewer negative consequences of disclosure in 2018 than in 2013, and highlighted positive outcomes including building trust (partners) as well as greater support for medication collection and adherence (family). Discussion Particularly as the epidemic ages in South Africa and globally, tracing changes in older persons’ views on disclosure is an important step in developing messaging that could enhance treatment as prevention and ART adherence.

scholarly journals Older people living at home: experiences of healthy ageing

2021 ◽  
Vol 22 ◽  
Author(s):  
Astrid Fjell ◽  
Kristin Ådnøy Eriksen ◽  
Monica Hermann ◽  
Anne-Marie Boström ◽  
Seiger Berit Cronfalk
Keyword(s):  
Health Care ◽  
Older People ◽  
Older Persons ◽  
Health Care Services ◽  
Healthy Ageing ◽  
Group Discussions ◽  
Care Services ◽  
Manifest Content ◽  
Professional Perspective ◽  
At Home

Abstract Aim: The purpose of this study was to investigate how old persons perceived their life to be, how they viewed the ageing process and their need of health care and societal support. Background: The purpose of WHO’s Healthy Ageing strategy and development of age-friendly environments is to support physiological and psychosocial changes in old persons by facilitating basic needs. Interventions to operationalize these needs in older people living at home are often developed from a professional perspective and to a small extent involves the perceptions, experience and expectations of the older persons. Method: This qualitative study has an explorative design using focus group discussions to collect data. In all, 34 persons between 69 and 93 years of age participated in seven group discussions. The interviews were analyzed using inductive manifest content analysis. Findings: The main results suggest that most old persons enjoyed life and wished it to continue for as long as possible. Important was to sustain networks and to feel useful. Unexpected changes were described as threats and the need to use health care services was associated with illness and being dependent. The result is presented in three categories with sub-categories: ‘Embracing life’, ‘Dealing with challenges’ and ‘Considering the future’.

scholarly journals Magnesium and Hypertension in Old Age

Nutrients ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 139 ◽  
Author(s):  
Ligia J. Dominguez ◽  
Nicola Veronese ◽  
Mario Barbagallo
Keyword(s):  
Older Persons ◽  
Magnesium Deficiency ◽  
Favorable Effect ◽  
Processed Food ◽  
Negative Consequences ◽  
Magnesium Supplementation ◽  
Cerebrovascular Complications ◽  
Close Relationship ◽  
Causes Of Mortality

Hypertension is a complex condition in which various actors and mechanisms combine, resulting in cardiovascular and cerebrovascular complications that today represent the most frequent causes of mortality, morbidity, disability, and health expenses worldwide. In the last decades, there has been an exceptional amount of experimental, epidemiological, and clinical studies confirming a close relationship between magnesium deficit and high blood pressure. Multiple mechanisms may help to explain the bulk of evidence supporting a protective effect of magnesium against hypertension and its complications. Hypertension increases sharply with advancing age, hence older persons are those most affected by its negative consequences. They are also more frequently at risk of magnesium deficiency by multiple mechanisms, which may, at least in part, explain the higher frequency of hypertension and its long-term complications. The evidence for a favorable effect of magnesium on hypertension risk emphasizes the importance of broadly encouraging the intake of foods such as vegetables, nuts, whole cereals and legumes, optimal dietary sources of magnesium, avoiding processed food, which are very poor in magnesium and other fundamental nutrients, in order to prevent hypertension. In some cases, when diet is not enough to maintain an adequate magnesium status, magnesium supplementation may be of benefit and has been shown to be well tolerated.

scholarly journals Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans

2017 ◽  
Vol 190 ◽  
pp. 20-28 ◽  
Author(s):  
Lindsay C. Kobayashi ◽  
M. Maria Glymour ◽  
Kathleen Kahn ◽  
Collin F. Payne ◽  
Ryan G. Wagner ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Later Life ◽  
Population Based ◽  
Rural South ◽  
Population Based Study ◽  
South Africans ◽  
Childhood Deprivation

HIV Ascertainment through Repeat Home-based Testing in the Context of a Treatment as Prevention Trial (ANRS 12249 TasP) in Rural South Africa

2014 ◽  
Vol 30 (S1) ◽  
pp. A287-A287 ◽  
Author(s):  
Joseph Larmarange ◽  
Éric Balestre ◽  
Joanna Orne-Gliemann ◽  
Collins Iwuji ◽  
Nonhlanhla Okesola ◽  
...  
Keyword(s):  
South Africa ◽  
Prevention Trial ◽  
Treatment As Prevention ◽  
Rural South ◽  
Home Based ◽  
Rural South Africa

scholarly journals Progress towards the 2020 targets for HIV diagnosis and antiretroviral treatment in South Africa

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Leigh F. Johnson ◽  
Rob E. Dorrington ◽  
Haroon Moolla
Keyword(s):  
South Africa ◽  
Antiretroviral Treatment ◽  
Routine Data ◽  
Hiv Positive ◽  
Western Cape ◽  
Hiv Diagnosis ◽  
Public And Private ◽  
North West ◽  
South Africans ◽  
Northern Cape

Background: The UNAIDS targets for 2020 are to achieve a 90% rate of diagnosis in HIVpositive individuals, to provide antiretroviral treatment (ART) to 90% of HIV-diagnosed individuals and to achieve virological suppression in 90% of ART patients.Objectives: To assess South Africa’s progress towards the 2020 targets and variations in performance by province.Methods: A mathematical model was fitted to HIV data for each of South Africa’s provinces, and for the country as a whole. Numbers of HIV tests performed in each province were estimated from routine data over the 2002–2015 period, and numbers of patients receiving ART in each province were estimated by fitting models to reported public and private ART enrolment statistics.Results: By the middle of 2015, 85.5% (95% CI: 84.5% – 86.5%) of HIV-positive South African adults had been diagnosed, with little variation between provinces. However, only 56.9% (95% CI: 55.3% – 58.7%) of HIV-diagnosed adults were on ART, with this proportion varying between 50.8% in North West and 72.7% in Northern Cape. In addition, 78.4% of adults on ART were virally suppressed, with rates ranging from 69.7% in Limpopo to 85.9% in Western Cape. Overall, 3.39 million (95% CI: 3.26–3.52 million) South Africans were on ART by mid- 2015, equivalent to 48.6% (95% CI: 46.0% – 51.2%) of the HIV-positive population. ART coverage varied between 43.0% in Gauteng and 63.0% in Northern Cape.Conclusion: Although South Africa is well on its way to reaching the 90% HIV diagnosis target, most provinces face challenges in reaching the remaining two 90% targets.

scholarly journals Switching to a fibre-rich and low-fat diet increases colonic folate contents among African Americans

2019 ◽  
Vol 44 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Yen-Ming Chan ◽  
Susanne Aufreiter ◽  
Stephen J. O’Keefe ◽  
Deborah L. O’Connor
Keyword(s):  
African Americans ◽  
Animal Studies ◽  
Western Diet ◽  
Future Research ◽  
Low Fat ◽  
Rural South ◽  
South Africans ◽  
Low Fat Diet ◽  
High Fibre ◽  
Dietary Switch

How dietary patterns impact colonic bacterial biosynthesis of vitamins and utilization by humans is poorly understood. Our aim was to investigate whether a reciprocal dietary switch between rural South Africans (traditionally high fibre, low fat) and African Americans (Western diet of low fibre, high fat) affects colonic folate synthesis. Colonic evacuants were obtained from 20 rural South Africans and 20 African Americans consuming their usual diets at baseline. For 2 weeks thereafter, rural South Africans were provided with a Western diet (protein, 27%; fat, 52%; carbohydrate, 20%; and fibre, 8 g/day) and African Americans were provided with a high fibre, low-fat diet (protein, 16%; fat, 17%; carbohydrate, 63%; and fibre, 43 g/day). Colonic evacuants were again collected. No difference between groups at baseline in the folate content of 3-h evacuants was observed. The high-fibre, low-fat diet consumed by African Americans during the intervention produced a 41% increase in mean total folate content compared with baseline values (p = 0.0037). No change was observed in rural South Africans consuming a Western diet. Mean total folate content of colonic evacuants was higher among African Americans at the end of the dietary switch (3107 ± 1811 μg) compared with rural South Africans (2157 ± 1956 μg) (p = 0.0409). In conclusion, consistent with animal studies, switching from a Western diet to one higher in fibre and lower in fat can be expected to result in greater colonic folate content. Future research should confirm that these observations are not transitory and understand the contribution of transit-time to the findings.

High-yielding seeds in unyielding environments: Examining the learning process of maize and bean producers in eastern and midwestern Uganda

2021 ◽  
Vol 50 (4) ◽  
pp. 418-440 ◽  
Author(s):  
Claris Riungu ◽  
Harro Maat ◽  
Marrit Van Den Berg
Keyword(s):  
Focus Group ◽  
Learning Process ◽  
Negative Consequences ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Environmental Learning ◽  
The Social ◽  
Using Data ◽  
Selection Of

This paper examines the learning process by which farmers come to a decision to use newly introduced seeds which were promoted through demonstration plots in midwestern and eastern regions of Uganda. Framed as social and material interactions, we investigated the learning process of the demonstration plots using data from focus group discussions, interviews and a survey amongst 983 individuals. The results reveal several constraints that impede learning, resulting in an overall low awareness and adoption of the introduced seeds. Some of the most prominent constraints resulted from the selection of location and demonstration plot host, the distance of agro-dealers, at district headquarters, limited interactions amongst farmers and irregular involvement of farmers in the demonstrations. Moreover, the prominent role of agro-dealers at field days suggests that informing farmers about where to buy seeds was considered more important than explaining farmers how to grow these seeds profitably. This commercial focus of field days and demonstrations plots had negative consequences for the social learning. This paper contributes to the learning and adoption literature by showing that interactions amongst actors can improve or reduce the balance between didactic, social and environmental learning.

Manifestations of Internalized Ageism in Older Adult Learning

2021 ◽  
Vol 90 (2) ◽  
pp. 169-182
Author(s):  
Marvin Formosa
Keyword(s):  
Adult Learning ◽  
Older Adult ◽  
Older Persons ◽  
Negative Impact ◽  
Psychosocial Interventions ◽  
Buffer Zone ◽  
Middle Aged ◽  
Third Age ◽  
Age Cohort ◽  
Self Differentiation

While ageism can be understood as an unconscious defence mechanism against a feeling of apprehension toward ageing on behalf of young and middle-aged groups, older persons themselves are not exempt from such internalized and implicit psychological machinations. Internalized ageism constitutes an insidious form of ageism that compels older adults to embrace social norms that devalue or marginalize same-aged peers by either acting in ways that reinforce the youth norm by battling the visible markers of ageing such as grey hair and wrinkles or denying any commonality and camaraderie with same-aged peers. This article explores that interface between internalized ageism and older adult learning by analyzing one of its hallmark institutions, the University of the Third Age (U3A), in the context of psychosocial interventions that are utilized by older people to defuse or counterbalance the noxious effects of negative self-perceptions of ageing. Research evidence demonstrated that U3A members generate counter-stereotypes by constructing a “third age” mental imagery and positioning themselves firmly in it while also practicing self-differentiation strategies to ameliorate or even prevent the negative impact of internalized ageism on their self-esteem and confidence. The U3A not only functions to meet the expressive and coping needs of older persons but also serves as a safe haven and buffer zone for older persons to stretch their middle-aged identity and at the same time distance themselves from being labelled as members of the “old age” cohort.

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