The findings attest to the benefits of having trusted, safe needle exchange services that not only reduce risk behaviours that prevent infections, such as HIV and hepatitis C, but also open the door to other services. This finding is particularly important given that the majority of those interviewed were homeless and living in poverty. The need for both fixed sites and the integration of harm reduction services as part of a broader network of primary health-care services was reinforced.

Care and support should play a critical role in assisting people who are HIV-positive to understand the need for prevention and to enable them to protect others. Differences in sexual risk reduction among 154 newly diagnosed HIV-positive individuals from semi-urban Tanzania were examined using a randomized control design, which assigned a control group to regular health services and an experimental group to enhanced care and support. Data were collected at baseline, three months and six months on self-reported sexual risk behaviours, disclosure of serostatus, reproductive health and psychosocial support. Over the six-month period, significant risk reduction occurred among both groups, with most of the behaviour change occurring during the first three months, e.g. 86 respondents (56%) reported condom use at last intercourse at 3 months compared with 24(16%) at baseline (p = 0.05). Extra care and support did not lead to increased risk reduction among the experimental group. The study population as a whole significantly changed their behaviour, suggesting that in the short term, learning one is HIV-positive has an impact on risk reduction.

In Uganda, AIDS patients are increasingly cared for at home by women in their traditional role of family caregiver. This transcultural nursing study utilized Leininger's (1991) Culture Care Theory to discover the meanings, patterns, and expressions of AIDS caregiving for Baganda women. Ethnonursing, supported by life history and Leininger's (1988, 1990, 1991, 1993) Sunrise Model, was used to discover care among 12 key and 25 general Baganda informants providing AIDS caregiving to family members at home. In-depth interviews were conducted with informants selected from home-based nursing care programs in the Rakai/Masaka and Kampala areas. Data were analyzed using Leininger's (1990) Phases of Ethnonursing Analysis for Qualitative Data. Six major themes were identified. The findings highlighted the struggle of Baganda women to provide care and love for family members with AIDS, identified intergenerational care as essential for survival and prevention of HIV infection, and offered insight into improving the quality of life for those who are HIV positive. Care knowledge from these findings can be used to provide culturally congruent nursing care to Baganda families who are affected by AIDS through the three modes of action and decision of the theory.

IntroductionIn 2008, one of the oldest fixed site needle exchanges in a large urban city in Canada was closed due to community pressure. This service had been in existence for over 20 years.Case DescriptionThis case study focuses on the consequences of the switch to mobile needle exchange services immediately after the closure and examines the impact of the closure on changes in risk behavior related to drug use, needle distribution and access to services The context surrounding the closure was also examined.Discussion and EvaluationAfter the closure of the fixed site exchange, access to needle exchange services decreased as evidenced by the sharp decline in numbers of clients reached, and the numbers of needles distributed and collected monthly. Reports related to needle reuse and selling of syringes suggest changes in risk behaviors. Thousands of needles remain unaccounted for in the community. To date, a new fixed site has not been found.ConclusionClosing the fixed site needle exchange had an adverse effect on already vulnerable clients and reduced access to comprehensive harm reduction services. While official public policy supports a fixed site, politicization of the issue has meant a significant setback for harm reduction with reduced potential to meet public health targets related to reducing the spread of blood borne diseases. This situation is unacceptable from a public health perspective.

Newman's theory of health as expanding consciousness was used to explore the patterns and their meaning for people living with chronic hepatitis C. A hermeneutic dialectic method was used to engage nine participants who had been diagnosed with hepatitis C. Patterns and themes were identified and included struggling to overcome, transcending the illness, and wanting to give back. Despite their struggles, all participants moved on to a higher level of consciousness through transformative changes in their lives.