Background Although the public health impacts of food insecurity and depression on both maternal and child health are extensive, no studies have investigated the associations between food insecurity and postnatal depression or suicidality. Methods We interviewed 249 women three months after they had given birth and assessed food insecurity, postnatal depression symptom severity, suicide risk, and hazardous drinking. Multivariable Poisson regression models with robust standard errors were used to estimate the impact of food insecurity on psychosocial outcomes. Results Food insecurity, probable depression, and hazardous drinking were highly prevalent and co-occurring. More than half of the women (149 [59.8%]) were severely food insecure, 79 (31.7%) women met screening criteria for probable depression, and 39 (15.7%) women met screening criteria for hazardous drinking. Nineteen (7.6%) women had significant suicidality, of whom 7 (2.8%) were classified as high risk. Each additional point on the food insecurity scale was associated with increased risks of probable depression (adjusted risk ratio [ARR], 1.05; 95% CI, 1.02–1.07), hazardous drinking (ARR, 1.04; 95% CI, 1.00–1.09), and suicidality (ARR, 1.12; 95% CI, 1.02–1.23). Evaluated at the means of the covariates, these estimated associations were large in magnitude. Limitations The study is limited by lack of data on formal DSM-IV diagnoses of major depressive disorder, potential sample selection bias, and inability to assess the causal impact of food insecurity. Conclusion Food insecurity is strongly associated with postnatal depression, hazardous drinking, and suicidality. Programmes promoting food security for new may enhance overall psychological well-being in addition to improving nutritional status.

We explore changes in sexual risk behaviour over the first year of antiretroviral therapy (ART) among a cohort of patients in Cape Town South Africa initiating treatment in five public facilities in 2006 and again 1 year later (Time 1 and Time 2). Contemporaneous measures of unprotected sex were also obtained from 2 cross-sectional samples of HIV-positive patients waiting to start ART attending the same facilities. Unprotected sex at last sex among patients on ART decreased significantly from a baseline of 44.7-23.2% one year later, regardless of partner status. After controlling for confounding factors, the observed decrease in unprotected sex among the ART cohort was highly significant in relation to the 2 cross-sectional samples of patients at Time 1 and Time 2 waiting to initiate ART. Findings suggest it is critical to start positive prevention to decrease risky sexual behavior prior to the start of ART within this setting.

No abstract

A cornerstone of sexually transmitted infection (STI) prevention is the identification, tracing, and notification of sex partners of index patients. Although partner notification reduces disease burden and prevents new infections as well as reinfections, studies show that only a limited number of partners are ever notified. Electronic communication technologies, namely, the Internet, text messaging, and phone calls (i.e., e-notification), have the potential to expand partner services. We conducted a systematic review of studies that have investigated the acceptability and utility of e-notification. We identified 23 studies that met the following criteria: (a) 9 studies presented data on the acceptability of technology-based communications for contacting sex partner(s), and (b) 14 studies reported on the utilization of communication technologies for partner notification. Studies found high levels of interest in and acceptability of e-notification; however, there was little evidence for actual use of e-notification. Taken together, results suggest that electronic communications could have their greatest impact in notifying less committed partners who would otherwise be uninformed of their STI exposure. In addition, all studies to date have been conducted in resource-rich countries, although the low cost of e-notification may have its greatest impact in resource-constrained settings. Research is needed to determine the best practices for exploiting the opportunities afforded by electronic communications for expanding STI partner services.

This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known 'hotspots' for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues related to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) was occurring in these cities. Drug users report selling sex for money to buy drugs, and CSWs used drugs before, during and after sex. Most (70%) of the drug-using KIs offered HIV testing accepted and 28% were positive, with rates highest among CSWs and MSM. IDUs reported engaging in needle sharing and needle disposal practices that put them and others at risk for contracting HIV. There was a widespread lack of awareness about where to access HIV treatment and preventive services, and numerous barriers to accessing appropriate HIV and drug-intervention services were reported. Multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. Targeted interventions could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations.

No abstract

A rapid assessment was undertaken with drug using commercial sex workers (CSWs) to investigate practices putting them at risk for contracting HIV. It included key informant (KI) (N = 67) and focus group (N = 10) interviews in locations with a high prevalence of drug use in Cape Town, Durban and Pretoria, South Africa. HIV testing of KIs was conducted. Cocaine, Ecstasy, heroin and methaqualone are used by CSWs prior to, during and after sex. Drugs enhance the sexual experience and prolong sex sessions. Interviews revealed inconsistent condom use among CSWs together with other risky sexual practices such as needle sharing. Among CSWs who agreed to HIV testing, 34% tested positive. Barriers to accessing drug treatment and HIV treatment and preventive services were identified. Interventions recognizing the role of drug abuse in HIV transmission should be prioritized, and issues of access to services, stigma and power relations must be considered.

In the Western Cape, lay counsellors are tasked with supporting antiretroviral (ARV) adherence in public healthcare clinics. Thirty-nine counsellors in 21 Cape Town clinics were trained in Options for Health (Options), an evidence-based intervention based on motivational interviewing (MI). We evaluated counsellors' ability to deliver Options for addressing poor adherence following 5 days training. Audio-recordings of counselling sessions collected following training were transcribed and translated into English. Thirtyfive transcripts of sessions conducted by 35 counsellors were analysed for fidelity to the Options protocol, and using the Motivational Interviewing Treatment and Integrity (MITI) code. Counsellors struggled with some of the strategies associated with MI, such as assessing readiness-to-change and facilitating change talk. Overall, counsellors failed to achieve proficiency in the approach of MI according to the MITI. Counsellors were able to negotiate realistic plans for addressing patients' barriers to adherence. Further efforts aimed at strengthening the ARV adherence counselling programme are needed.