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There is an ever-growing need for clinically focused, culturally relevant research on which nurses can base their practice. However, there may not be a concurrent rise in efforts to strengthen infrastructure needed to promote research in developing and low-income countries. In such cases, nurse researchers must find innovative ways to address and overcome barriers to research. This article presents five exemplars of nurses conducting high-quality nursing research in resource-poor settings in southern and eastern Africa. Furthermore, it suggests strategies to address these barriers, such as piggybacking on larger studies, interdisciplinary collaboration, and partnership with influential stakeholders. These tactics may be used to increase research productivity elsewhere.

HIV-related fatigue is a debilitating and disabling symptom that persists for months and years. In 743 HIV/AIDS patients from Southern Africa, the authors found ratings of HIV-related fatigue to be highly prevalent. The authors conducted a secondary data analysis within the theoretical context of the University of California, San Francisco Symptom Management Model. The analysis focused on 538 patients who reported fatigue to investigate correlates and predictors of fatigue severity in relationship to demographic and HIV/AIDS illness indicators, as well as HIV-specific physical and psychological symptoms. A hierarchical regression model explored the contributions of those five blocks on fatigue severity. Of the 47% of the total variance in fatigue severity, a combination of variables within the health and illness block (6%), the physical symptoms block (7%) and the psychological symptom block (2%) contributed significantly to the increase in fatigue severity scores. Fatigue severity in Southern Africa was moderate, and the factors contributing to the perceived fatigue were most likely related to symptoms of acute HIV disease (such as fever and gastrointestinal problems). In conclusion, fatigue severity is less impacted by demographic or environmental variables but much more by co-occurring symptoms and HIV disease severity. The results of this study imply the need for more research to understand if improvements in water quality and access to food would prevent infection and diarrhea and whether sufficient access to antiretroviral treatments to manage the HIV infection would improve fatigue and co-occurring symptom profiles.

This article is a report of a qualitative evaluation of a course on human immunodeficiency virus/acquired immunodeficiency syndrome carried out jointly by faculty from Botswana and the United States at a university in Botswana. It demonstrates the importance of both international nurse educator expertise in impacting a major pandemic and the use of qualitative methods for course evaluation.

Purpose: To increase understanding of the meaning of quality of life for people living with HIV/AIDS in four countries in sub-Saharan Africa: Botswana Lesotho South Africa and Swaziland. Methods: Using a cross-sectional design and convenience sample we administered a survey and collected data on demographic characteristics measures of severity of illness and perceptions of quality of life. The purposefully selected sample (N=743) consisted of community-based people living with HIV/AIDS in 2002. Based on the Wilson and Cleary framework for organizing variables related to quality of life a hierarchical multiple regression was conducted with quality of life as the dependent variable. Results: The sample of 743 persons was 61.2% female with a mean age of 34 years. Approximately 62% of the sample reported having received an AIDS diagnosis. Ten predictor variables explained 53.2% of the variance in life satisfaction. Those participants with higher life satisfaction scores were less educated had worries about disclosure and finances did not have an AIDS diagnosis or other comorbid conditions had lower symptom intensity had greater functioning and had fewer health worries. None of these participants was taking antiretroviral medications at the time of this study. Conclusions: Several dimensions of the Wilson and Cleary model of quality of life were significantly related to life satisfaction for people living with HIV/AIDS in sub-Saharan Africa. Quality of life for this sample was primarily defined as overall functional ability and control over symptom intensity. These findings are similar to studies in developed countries that have shown the significant relationships among functional abilities symptom control and perceived quality of life. As antiretroviral medications become more available in these areas community members and care providers can help clients realize the possibility of living well with HIV/AIDS and can work with clients to improve functional ability and control symptom intensity to make living well a reality. (authors)

Purpose: Because of the serious threat of HIV/AIDS to students at a university in Botswana, faculty instituted two interventions to change students' HIV/AIDS-related knowledge, attitudes, and behavior: (a) an HIV/AIDS course and (b) the Health and Wellness Centre. The purpose of this study is to evaluate the success of these interventions. Method: A four-group comparison design was created for this study as a method for the qualitative formative evaluation. Data collection was done using the rapid assessment method, in which team interviews of 105 students at the university were conducted. The teams used descriptive, interpretive, and explanatory codes to create themes, which were compared to findings in the literature. Results: Although students indicated significant learning and attitude changes, no major changes in sexually risky behavior were reported. Discussion: Substantive, methodological, and theoretical implications are discussed.

Western studies of adolescent development are beginning to corporate not only the traditional ideas of nature and nurture, but also contextual factors such as culture, ecology and historical time. This article explores how adolescent development is influenced by both a specific culture (Botswana) and a specific ecological situation (the rampant HIV pandemic in that country). A case study of late adolescents living in this pandemic in Botswana helps broaden our traditional views of adolescent development.

Background: Botswana is one of the countries hardest hit by HIV/AIDS. Prevalence rates of 22.8% and 38.6% have been reported for age groups 15–19 and 20–24 years respectively. The government has solicited a concerted effort of all individuals and agencies in both the public and private sector in the fight against HIV/AIDS. Purpose: This report is part of the findings of a study conducted at a university to evaluate students’ perceptions of the effectiveness of two HIV/AIDS initiatives put in place and aimed at changing the students’ knowledge, attitudes and behaviour. Methods: The study utilized the Rapid Assessment Process (RAP). Four teams interviewed: students who had taken the course; students who had used the centre; students who had taken the course and used the centre; and students who have neither taken the course nor used the centre. Initial steps in data analysis involved coding and theme derivation. Findings reported here were from participants who neither participated in the course nor used the centre. Findings: Participants reported the following problems, which were hindering the success of the programmes: problems in the ABC message; permissive campus environment; lack of entertainment; and students’ perceptions about HIV/AIDS and their own vulnerability. Participants came up with suggestions for improving the initiatives. The authors discuss implications of the study findings for the university’s initiatives.

Botswana currently has one of the highest HIV-positive prevalence rates in the world. University students are an important group seriously affected by this pandemic. They represent one of the country's richest resources for the future, and faculty at University of Botswana believe there is a responsibility to educate them in a way that helps them preserve their health and vitality. This article represents a case study of one university faculty's efforts to fight the threat of HIV/AIDS to their student body. This case study reviews the early stages of faculty endeavors beginning with the development of an HIV/AIDS course and continuing through evaluation of the success and failures of the course, as well as current refinements now being made. Because the problem of HIV/AIDS on campus is a common one throughout sub-Saharan Africa, the authors hope that this case study of one faculty's approach may be helpful to those facing the same challenge.

This study describes the symptom experience of 743 men and women living with HIV/AIDS in Botswana, Lesotho, South Africa, and Swaziland. Data were obtained in 2002 by using a cross-sectional design. A survey of participants included 17 sociodemographic items and the 64-item Revised Sign and Symptom Checklist for Persons with HIV Disease. Results indicate a strong correlation between the frequency of reported symptoms and their intensity (r = .84, p.00). Participants who reported having enough money for daily expenses also reported significantly fewer symptoms. There were no significant differences in symptom frequency between men and women or by location of residence. The study showed a complex picture of HIV-related symptoms in all four countries. Because of the high levels of symptoms reported, the results imply an urgent need for effective home- and community-based symptom management in countries where antiretroviral therapy is unavailable to help patients and their families manage and control AIDS symptoms and improve quality of life.

We describe self-reported strategies used by persons living with HIV/AIDS in Botswana, Lesotho, South Africa, and Swaziland to manage common HIV-related symptoms. A questionnaire asked participants to list three to six symptoms they had recently experienced, the care strategies they had used to make them better, where they had learned the strategy, and to rate the perceived effectiveness of the strategy. Data were collected in 2002 from 743 persons. The self-care management strategies were coded into eight categories: medications, complementary treatments, self-comforting, changing diet, seeking help, exercise, spiritual care, and daily thoughts/activities. Overall, participants reported medications as the most frequently occurring management strategy and the most effective. A very small inventory of behavioral strategies was available to participants to help them manage their HIV-related symptoms.

HIV-related stigma is a life-altering phenomenon. The consequence of the stigmatization process sets apart stigmatized person(s) as a distinct category, leading to various forms of disapproval, rejection, exclusion, labeling, stereotyping, and discrimination. Stigma of HIV-positive people in Botswana is a complex social phenomenon associated with the disease itself and the behaviors that lead to infection. This is a synthesis paper based on the literature review on HIV- and AIDS-related stigmatization of HIV-positive people in Botswana and in-depth interviews with people living with HIV and AIDS (PLWHAs). I examine the literature on HIV- and AIDS-related stigmatization and subsequent discrimination and the implications for intervention programs for people living with HIV and AIDS. The findings from the literature and in-depth interviews show that HIV-AIDS-related stigma is deeply embedded in societal structures and culture which promote nonacceptance of those branded HIV positive. This often is reinforced at a practical level by pervasive negative attitudes toward PLWHAs. Recommendations argue for the adoption of Healthy Relationship. This intervention seeks to promote and strengthen decision-making skills among PLWHAs and programs that promote destigmatization of, and tolerant attitudes toward, PLWHAs.