Correct and consistent condom usage remains a pivotal strategy in reaching the target set by the South African government to reduce new HIV infections by 50% in the next 5 years. Studies have found that there has been an increase in condom usage by some categories of the population, but usage has not yet reached the desired levels in order to meet the target. This article reports on the findings of a study on condom usage in eight communities in the North West Province, which was part of a wider HIV and AIDS programme evaluation commissioned by the North West Provincial Department of Health. The main aim was to assess accessibility to condoms, and knowledge, attitudes and practices around condom use by four sampled communities in the North West Province. Eight focus group discussions were held and 50 households were interviewed.The study found positive results regarding accessibility and awareness of condoms. However, this often did not lead to the desired behavioural change of using condoms in risky sexual interactions. The majority of respondents still resisted condom usage, used condoms inconsistently, or were not in a position to negotiate protected sexual intercourse. The main reasons reported for this were: reduced pleasure, perceived and real physical side-effects, myths, lack of information, status, financial reasons, distrust in the efficacy of condoms, family planning, cultural reasons, gender-related reasons and trust. Many of the barriers to consistent condom use cannot be overcome by strategies that target the individual. Interventions need to address underlying developmental factors such as the non-biological factors that increase the susceptibility of women to HIV infection. As this falls outside of the scope of the mandate of the Department of Health, various partnerships with other key role players need to be established and/or strengthened, such as with local government, non-governmental organisations and faith-based organisations. Keywords: HIV and AIDS, condoms, behavioural change, South Africa, development. RésuméLe bon et consistant usage du préservatif reste une stratégie pivot en vue d' étendre l' objectif du gouvernement sud-africain de réduire les nouvelles infections par le VIH de 50% dans les 5 ans à venir. Les études ont montré qu'il y a eu une augmentation de l'usage de préservatifs parmi certaines catégories de la population. En revanche, cet usage n'a pas encore éteint le niveau désiré afin de satisfaire l' objectif prévu. Cet article présente les résultats d'une étude sur l'usage du préservatif dans huit communautés de la Province du Nord-Ouest. Cette étude a fait partie d'un programme étendu d' évaluation du VIH/SIDA commandé par le Département provincial de Santé du Nord-Ouest. Le but fut d' évaluer l'accessibilité des préservatifs et la connaissance, les attitudes et les coutumes entourant l'usage du préservatif auprès de quatre communautés échantillons dans cette Province. Au total, huit discussions de groupes de foyer ont eu lieu et 50 foyers ont été interviewés.L' é...

BackgroundSouth Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue.MethodsThe Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care.ResultsResponse rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae.ConclusionSpecific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

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