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Ashraf Kagee

Stellenbosch University, Psychology, Faculty Member

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I am Professor of Psychology at Stellenbosch University and co-Director of the Alan Flisher Centre for Public Mental Health. My research areas are common mental disorders, adherence to antiretroviral therapy, stress and trauma, and evidence-based interventions in psychology.
Phone: (27)834433002
Address: Department of Psychology
Stellenbosch University
Private Bag X1
Matieland
7602
South Africa

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Stellenbosch University

Stellenbosch University

University of Stellenbosch

Elisabete Castelon Konkiewitz

Universidade Federal da Grande Dourados

Stellenbosch University

Kaymarlin Govender

Asres Bedaso Tilahune

The University of Sydney

Helen Struthers

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Papers by Ashraf Kagee

Common mental disorders and psychological adjustment among individuals seeking HIV testing: a study protocol to explore implications for mental health care systems

International journal of mental health systems, 2018

In an effort to promote greater access to voluntary counseling and testing for HIV, it has become... more In an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. While it is well established that HIV infection is associated with a range of psychopathology, much of the literature has assumed that it is receipt of an HIV positive diagnosis that causes people to become depressed, traumatized, or develop other psychiatric symptoms. Empirical data about the baseline psychiatric condition and mental health care needs of persons seeking HIV testing is scarce. Understanding the psychological health of persons seeking HIV testing and documenting how psychiatric symptoms develop over time following receipt of an HIV positive diagnosis, has important implications for mental health care systems. We describe a study protocol to investigate: (1) the level of psychological distress and the p...

Suicidal ideation and behaviour among persons seeking HIV testing in peri-urban areas of Cape Town, South Africa: a lost opportunity for suicide prevention

AIDS Care, 2016

Suicidal ideation and behaviour (SIB) are among the psychiatric sequela of HIV/AIDS. Few studies ... more Suicidal ideation and behaviour (SIB) are among the psychiatric sequela of HIV/AIDS. Few studies have however examined the prevalence and correlates of SIB among persons seeking HIV testing. We set out to document the prevalence and correlates of SIB among people seeking HIV testing in peri-urban areas of Cape Town, South Africa. A cross-sectional research design was used to recruit a sample (n=500) of individuals seeking HIV testing. Self-report measures were used to assess two-week prevalence of SIB as well as lifetime prevalence of suicide attempt. A Structured Clinical Interview was used to assess common mental disorders (CMDs). Regression analysis was used to determine if CMD and socio-demographic variables predicted suicidal ideation. The mean age of the sample was 36 years, 51.6% were female and 46.6% were unemployed. The two-week prevalence of suicidal ideation was 24.27% while the two-week prevalence of suicide attempt and suicide plans was 2.8%. Suicidal ideation was not associated with age, gender, employment status, family income or household food insecurity. CMDs were significantly associated with suicidal ideation; individuals with depressive disorders were approximately 5.5 times more likely to report suicidal ideation, while those with generalised anxiety disorder, trauma related disorders and alcohol use disorder were approximately 7, 4.7 and 2.8 times more likely to report suicidal ideation respectively. Results suggest that persons seeking HIV testing may be a well-delineated group of persons at risk of suicide in this region of SA. Contact with the health care system during HIV testing provides an opportunity for targeted suicide prevention interventions in what appears to be a high risk group. Early in the HIV epidemic researchers noted that suicidal ideation and behaviour (SIB) were among the psychiatric sequela of HIV/AIDS (

A pilot study of a nurse-delivered cognitive behavioral therapy intervention (Ziphamandla) for adherence and depression in HIV in South Africa

Journal of health psychology, Jan 26, 2016

Depression is prevalent among people living with HIV in South Africa and interferes with adherenc... more Depression is prevalent among people living with HIV in South Africa and interferes with adherence to antiretroviral therapy. This study evaluated a nurse-delivered, cognitive behavioral therapy intervention for adherence and depression among antiretroviral therapy users with depression in South Africa (n = 14). Primary outcomes were depression, antiretroviral therapy adherence, feasibility, and acceptability. Findings support robust improvements in mood through a 3-month follow up. Antiretroviral therapy adherence was maintained during the intervention period. Participant retention supports acceptability; however, modest provider fidelity despite intensive supervision warrants additional attention to feasibility. Future effectiveness research is needed to evaluate this nurse-delivered cognitive behavioral therapy intervention for adherence and depression in this context.

Characteristics of a Model of Psychological Intervention in the Context of Apartheid in South Africa

Common mental disorders and psychological adjustment among individuals seeking HIV testing: a study protocol to explore implications for mental health care systems

by Jason Bantjes and Ashraf Kagee

International Journal of Mental Health Systems , 2018

Background: In an effort to promote greater access to voluntary counseling and testing for HIV, i... more Background: In an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. While it is well established that HIV infection is associated with a range of psychopathology, much of the literature has assumed that it is receipt of an HIV positive diagnosis that causes people to become depressed, traumatized, or develop other psychiatric symptoms. Empirical data about the baseline psychiatric condition and mental health care needs of persons seeking HIV testing is scarce. Understanding the psychological health of persons seeking HIV testing and documenting how psychiatric symptoms develop over time following receipt of an HIV positive diagnosis, has important implications for mental health care systems. Methods: We describe a study protocol to investigate: (1) the level of psychological distress and the prevalence of common mental disorders among persons seeking HIV testing; (2) the longitudinal development of psychiatric symptoms among persons diagnosed with HIV; and (3) the recommendations that can be made for mental health care systems to support persons seeking HIV testing and those newly diagnosed with HIV. In this longitudinal study quantitative and qualitative data are collected to document participants' psychiatric symptoms, to determine whether they meet diagnostic criteria for a common mental disorder, and to explore the lived experiences of persons receiving an HIV positive test result. Data are collected at three time points; before HIV testing, and then again at 6 and 12 months post-testing. Discussion: Documenting the prevalence of common mental disorders among persons seeking HIV testing, and tracking the psychosocial support needs, psychological adjustment and psychosocial experiences of persons newly diagnosed with HIV, has important implications for the delivery of mental health care services and the design of integrated mental health care systems.

Distress, depression and anxiety among persons seeking HIV testing

by Jason Bantjes and Ashraf Kagee

We investigated psychological distress and symptoms of depression and anxiety among 485 South Afr... more We investigated psychological distress and symptoms of depression and anxiety among 485 South Africans seeking HIV testing. The mean scores of the sample were 45.78 (SD = 16.81) on the Hopkins Symptom Checklist; 15.8 (SD = 12.4) on the Beck Depression Inventory and 12.44 (SD = 13.00) on the Beck Anxiety Inventory, which fell in the elevated, mild and low ranges on these instruments, respectively. For more than a third of participants, symptoms of depression and clinically significant distress were at least moderate and in some cases severe, indicating that they may have benefitted from psychological help. We make the case that symptoms of depression and distress are common among persons seeking HIV testing and are therefore not a consequence of an HIV-positive test result.

A model of caregiver paediatric HIV disclosure decision-making

Many of the over 3 million HIV-positive children will only be told of their status as adolescents... more Many of the over 3 million HIV-positive children will only be told of their status as adolescents. Knowing one’s status may increase treatment adherence, reduce onward HIV transmission, increase trust in caregivers and maximise available support. Yet, deciding whether, what, how and when to tell HIV-positive children about their condition is challenging for caregivers. We systematically review HIV disclosure
theories before presenting a process model of caregiver paediatric HIV disclosure decision-making. The model, consisting of both a pre-intention and a post-intention
stage, integrates individual and contextual determinants. It aims to be situationally specific, broadly applicable and consistent with the empirical literature. Research and
practice implications are discussed.

The Prevalence of Common Mental Disorders Among South Africans Seeking HIV Testing

by Jason Bantjes and Ashraf Kagee

We administered the Structured Clinical Interview for the DSM to 485 persons seeking HIV testing ... more We administered the Structured Clinical Interview for the DSM to 485 persons seeking HIV testing at five community testing centres in South Africa to determine the prevalence of common mental disorders among this population. The prevalence estimates for the various disorders were as follows: major depressive disorder: 14.2 % (95 % CI [11.1, 17.3]); generalised anxiety disorder 5.0 % (95 % CI [3.07, 6.93]); posttraumatic stress disorder 4.9 % (95 % CI [2.98, 6.82]); and alcohol use disorder 19.8 % (95 % CI [16.26, 23.34]). Our findings imply the need to research the integration of screening and referral trajectories in the context of voluntary HIV counselling and testing.

Counselling Psychology in South Africa

by Jason Bantjes and Ashraf Kagee

The origin and development of counselling psychology in South Africa has been profoundly influenc... more The origin and development of counselling psychology in South Africa has been profoundly influenced by the country’s socio-political history and the impact of apartheid. As a result of this, counselling psychologists in the country face a number of challenges and opportunities for the future. In this paper we provide a portrait of counselling psychology in South Africa by describing the current character of the specialty and the context in which South African psychologists work. We critically discuss the challenges that the specialty faces to meet the country’s mental health care needs, contest the current Scope of Practice; affirm multiculturalism without essentialising or reifying race and ethnicity, and build an evidence base for community interventions in the country. We also consider how, in the future, counselling psychologists in South Africa may make a more meaningful contribution within public health and the country’s health care and education systems.

Social and Behavioral Aspects of Child and Adolescent Participation in HIV Vaccine Trials

by Arvin Bhana, Graham Lindegger, and Ashraf Kagee

Journal of The International Association of Physicians in Aids Care (jiapac), 2005

Recent data indicate that the worldwide rate of HIV infection in adolescents is steadily increasi... more Recent data indicate that the worldwide rate of HIV infection in adolescents is steadily increasing. Internationally, more than 7000 youths between 15 and 24 years of age are infected with HIV daily, resulting in more than 2.5 million new infections annually. Almost two thirds (1.7 million) of these new infections occur in Africa. Estimates in 2000 showed that the number of South Africans between 15 and 49 years of age infected with HIV was 4.7 million. This number equates to a prevalence rate of 15.4% in those younger than 20 years. Adolescents form an important target group not only for preventative efforts but also for HIV vaccine trials. This article focuses on the social and psychological factors that affect adolescent decision making by considering adolescent risk-taking behaviors, problems associated with predicting adolescent behavior, peer relationships and decision making, sexual disinhibition, and the role of family relationships in adolescent decision making.

2015 Using the Beck Anxiety Inventory Among South Africans Living With HIV- Exploratory and Higher Order Factor Analyses

2015 Understanding the experience and manifestation of depression in people living with HIV/AIDS in South Africa

by Ashraf Kagee and Lena Andersen

Understanding the experience of depression in people living with HIV/AIDS (PLWH) could aid in the... more Understanding the experience of depression in people living with HIV/AIDS (PLWH) could aid in the detection and treatment of the disorder. Yet, there is limited knowledge of the subjective experience of depression amongst PLWH in low-and middle-income countries despite high rates of this disorder in this population. In the current study, semistructured interviews were conducted with depressed adults living with HIV attending a primary infectious disease clinic in South Africa. Interview transcripts were thematically analyzed. The construct of depression was consistent with DSM-IV criteria; however, the symptom presentation was distinctive. Somatic symptoms were most prominent in participants' initial presentations because participants perceived them as medically relevant. Affective, cognitive, and behavioral symptoms were not readily reported as participants did not perceive these symptoms as pertinent to their medical treatment. We identified several idioms of distress that could assist in screening for depression in this population. A valid, contextually developed screener for depression in PLWH awaits further investigation. Such a measure could play a key role in formulating a logistically feasible method of detection and treatment for depression in this population.

2015 Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa: Study protocol for a randomized controlled trial

Background: Maternal depression carries a major public health burden for mothers and their infant... more Background: Maternal depression carries a major public health burden for mothers and their infants, yet there is a substantial treatment gap for this condition in low-resourced regions such as sub-Saharan Africa. To address this treatment gap, the strategy of "task sharing" has been proposed, involving the delivery of interventions by non-specialist health workers trained and supervised by specialists in routine healthcare delivery systems. Several psychological interventions have shown benefit in treating maternal depression, but few have been rigorously evaluated using a task sharing approach. The proposed trial will be the first randomised controlled trial (RCT) evaluating a task sharing model of delivering care for women with maternal depression in sub-Saharan Africa. The objective of this RCT is to determine the effectiveness and cost-effectiveness of a task sharing counseling intervention for maternal depression in South Africa.

2015 Psychologists’ endorsement of empirically unsupported statements in psychology: Noch Einmal

In this study, 103 South African psychologists were asked to rate the extent to which they believ... more In this study, 103 South African psychologists were asked to rate the extent to which they believed a set of empirically incorrect statements were true or untrue. Of the 50 statements, 14 (28%) received a moderate level of endorsement as being factually correct and 8 (16%) received a high level of endorsement as being factually correct. Significant differences in the percentages of items endorsed were found between master's-and doctoral-level psychologists for five statements. Significant differences in the percentages of items endorsed between clinical and counselling psychologists were found for three statements. These findings are explained by noting that there is no consensus among psychologists about whether psychology is a strictly scientific discipline and whether it gives rise to scientific facts about human behaviour. Relatedly, it is possible that South African psychology curricula are not sufficiently focused on the empirical and scientific evidence that informs psychological knowledge. Also, psychology as taught in undergraduate programmes is characterised by a diversity of theory. Consequently, no consensus on theoretical understandings of human behaviour appears to be in sight. Finally, popular and folk understandings of psychology overlap to some extent with empirical psychology, but what makes intuitive sense may not be empirically accurate. Some suggestions are offered for the curricula psychology of departments at South African universities.

2015 Experiences of participating in an antiretroviral treatment adherence club

In an effort to streamline the management of large numbers of patients receiving antiretroviral t... more In an effort to streamline the management of large numbers of patients receiving antiretroviral therapy (ART) in South Africa, adherence clubs were introduced in some districts in the Western Cape since 2008. Adherence clubs are group clinic visits of approximately 30 ART users who receive group adherence counselling and obtain a supply of medication. We sought to document the experiences of patients attending adherence clubs and health care workers (HCW's) at clinics where clubs were operating. Participants were six ART adherence club members and seven HCW's, which included HIV nurses, medical doctors, pharmacists and counsellors. Data in the form of one-on-one interviews were collected at the Infectious Diseases Clinic of a large district hospital in a peri-urban area in the Western Cape region of South Africa. The interviews covered ART users' experiences of the clubs, advantages and challenges that arose in the context of the club-based method of providing treatment, and the concerns faced by ART users and HCW's with regard to the clubs. The data were analysed using thematic analysis. There were clear benefits to the introduction of adherence clubs, most importantly the reduced amount of time ART users needed to spend at the clinic. Yet, various problems also emerged, the most important one being the logistical problems associated with the timely and correct delivery of drugs. These benefits and disadvantages are discussed in the context of providing ART services to large numbers of patients in post-apartheid South Africa.

2015 Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: A multi- stakeholder perspective

Poor adherence to antiretroviral therapy (ART) contributes to the development of drug resistance.... more Poor adherence to antiretroviral therapy (ART) contributes to the development of drug resistance. HIV-infected children, especially those 5 years and under, are dependent on a caregiver to adhere to ART. However, characteristics of the caregiver, child, regimen, clinic and social context affect clinic attendance and medication-taking, both of which constitute adherent behaviour. We conducted nine interviews and three focus groups to determine how doctors, nurses, counsellors, traditional healers and caregivers understood the barriers and facilitators to ART adherence among children residing in rural South Africa. The data were transcribed, translated into English from isiZulu where necessary, and coded using Atlas.ti version 7. Results were interpreted through the lens of Bronfenbrenner's Ecological Systems Theory. We found that at the micro-level, palatability of medication and large volumes of medication were problematic for young children. Characteristics of the caregiver including absent mothers, grandmothers as caregivers and denial of HIV amongst fathers were themes related to the micro-system. Language barriers and inconsistent attendance of caregivers to monthly clinic visits were factors affecting adherence in the meso-system. Adherence counselling and training were the most problematic features in the exo-system. In the macro-system, the effects of food insecurity and the controversy surrounding the use of traditional medicines were most salient. Increased supervision and regular training amongst lay adherence counsellors are needed, as well as regular monitoring of the persons attending the clinic on the child's behalf.

2009 Participation in HIV Vaccine Trials

2008 Mental Health and Physical Health (Including HIV/AIDS)

2008 The Quest for Relevance: Counseling Psychology in South Africa

2007 Researching the Effects of Political Detention: Some thoughts from South Africa

Common mental disorders and psychological adjustment among individuals seeking HIV testing: a study protocol to explore implications for mental health care systems

International journal of mental health systems, 2018

In an effort to promote greater access to voluntary counseling and testing for HIV, it has become... more In an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. While it is well established that HIV infection is associated with a range of psychopathology, much of the literature has assumed that it is receipt of an HIV positive diagnosis that causes people to become depressed, traumatized, or develop other psychiatric symptoms. Empirical data about the baseline psychiatric condition and mental health care needs of persons seeking HIV testing is scarce. Understanding the psychological health of persons seeking HIV testing and documenting how psychiatric symptoms develop over time following receipt of an HIV positive diagnosis, has important implications for mental health care systems. We describe a study protocol to investigate: (1) the level of psychological distress and the p...

Suicidal ideation and behaviour among persons seeking HIV testing in peri-urban areas of Cape Town, South Africa: a lost opportunity for suicide prevention

AIDS Care, 2016

Suicidal ideation and behaviour (SIB) are among the psychiatric sequela of HIV/AIDS. Few studies ... more Suicidal ideation and behaviour (SIB) are among the psychiatric sequela of HIV/AIDS. Few studies have however examined the prevalence and correlates of SIB among persons seeking HIV testing. We set out to document the prevalence and correlates of SIB among people seeking HIV testing in peri-urban areas of Cape Town, South Africa. A cross-sectional research design was used to recruit a sample (n=500) of individuals seeking HIV testing. Self-report measures were used to assess two-week prevalence of SIB as well as lifetime prevalence of suicide attempt. A Structured Clinical Interview was used to assess common mental disorders (CMDs). Regression analysis was used to determine if CMD and socio-demographic variables predicted suicidal ideation. The mean age of the sample was 36 years, 51.6% were female and 46.6% were unemployed. The two-week prevalence of suicidal ideation was 24.27% while the two-week prevalence of suicide attempt and suicide plans was 2.8%. Suicidal ideation was not associated with age, gender, employment status, family income or household food insecurity. CMDs were significantly associated with suicidal ideation; individuals with depressive disorders were approximately 5.5 times more likely to report suicidal ideation, while those with generalised anxiety disorder, trauma related disorders and alcohol use disorder were approximately 7, 4.7 and 2.8 times more likely to report suicidal ideation respectively. Results suggest that persons seeking HIV testing may be a well-delineated group of persons at risk of suicide in this region of SA. Contact with the health care system during HIV testing provides an opportunity for targeted suicide prevention interventions in what appears to be a high risk group. Early in the HIV epidemic researchers noted that suicidal ideation and behaviour (SIB) were among the psychiatric sequela of HIV/AIDS (

A pilot study of a nurse-delivered cognitive behavioral therapy intervention (Ziphamandla) for adherence and depression in HIV in South Africa

Journal of health psychology, Jan 26, 2016

Depression is prevalent among people living with HIV in South Africa and interferes with adherenc... more Depression is prevalent among people living with HIV in South Africa and interferes with adherence to antiretroviral therapy. This study evaluated a nurse-delivered, cognitive behavioral therapy intervention for adherence and depression among antiretroviral therapy users with depression in South Africa (n = 14). Primary outcomes were depression, antiretroviral therapy adherence, feasibility, and acceptability. Findings support robust improvements in mood through a 3-month follow up. Antiretroviral therapy adherence was maintained during the intervention period. Participant retention supports acceptability; however, modest provider fidelity despite intensive supervision warrants additional attention to feasibility. Future effectiveness research is needed to evaluate this nurse-delivered cognitive behavioral therapy intervention for adherence and depression in this context.

Characteristics of a Model of Psychological Intervention in the Context of Apartheid in South Africa

Common mental disorders and psychological adjustment among individuals seeking HIV testing: a study protocol to explore implications for mental health care systems

by Jason Bantjes and Ashraf Kagee

International Journal of Mental Health Systems , 2018

Background: In an effort to promote greater access to voluntary counseling and testing for HIV, i... more Background: In an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. While it is well established that HIV infection is associated with a range of psychopathology, much of the literature has assumed that it is receipt of an HIV positive diagnosis that causes people to become depressed, traumatized, or develop other psychiatric symptoms. Empirical data about the baseline psychiatric condition and mental health care needs of persons seeking HIV testing is scarce. Understanding the psychological health of persons seeking HIV testing and documenting how psychiatric symptoms develop over time following receipt of an HIV positive diagnosis, has important implications for mental health care systems. Methods: We describe a study protocol to investigate: (1) the level of psychological distress and the prevalence of common mental disorders among persons seeking HIV testing; (2) the longitudinal development of psychiatric symptoms among persons diagnosed with HIV; and (3) the recommendations that can be made for mental health care systems to support persons seeking HIV testing and those newly diagnosed with HIV. In this longitudinal study quantitative and qualitative data are collected to document participants' psychiatric symptoms, to determine whether they meet diagnostic criteria for a common mental disorder, and to explore the lived experiences of persons receiving an HIV positive test result. Data are collected at three time points; before HIV testing, and then again at 6 and 12 months post-testing. Discussion: Documenting the prevalence of common mental disorders among persons seeking HIV testing, and tracking the psychosocial support needs, psychological adjustment and psychosocial experiences of persons newly diagnosed with HIV, has important implications for the delivery of mental health care services and the design of integrated mental health care systems.

Distress, depression and anxiety among persons seeking HIV testing

by Jason Bantjes and Ashraf Kagee

We investigated psychological distress and symptoms of depression and anxiety among 485 South Afr... more We investigated psychological distress and symptoms of depression and anxiety among 485 South Africans seeking HIV testing. The mean scores of the sample were 45.78 (SD = 16.81) on the Hopkins Symptom Checklist; 15.8 (SD = 12.4) on the Beck Depression Inventory and 12.44 (SD = 13.00) on the Beck Anxiety Inventory, which fell in the elevated, mild and low ranges on these instruments, respectively. For more than a third of participants, symptoms of depression and clinically significant distress were at least moderate and in some cases severe, indicating that they may have benefitted from psychological help. We make the case that symptoms of depression and distress are common among persons seeking HIV testing and are therefore not a consequence of an HIV-positive test result.

A model of caregiver paediatric HIV disclosure decision-making

Many of the over 3 million HIV-positive children will only be told of their status as adolescents... more Many of the over 3 million HIV-positive children will only be told of their status as adolescents. Knowing one’s status may increase treatment adherence, reduce onward HIV transmission, increase trust in caregivers and maximise available support. Yet, deciding whether, what, how and when to tell HIV-positive children about their condition is challenging for caregivers. We systematically review HIV disclosure
theories before presenting a process model of caregiver paediatric HIV disclosure decision-making. The model, consisting of both a pre-intention and a post-intention
stage, integrates individual and contextual determinants. It aims to be situationally specific, broadly applicable and consistent with the empirical literature. Research and
practice implications are discussed.

The Prevalence of Common Mental Disorders Among South Africans Seeking HIV Testing

by Jason Bantjes and Ashraf Kagee

We administered the Structured Clinical Interview for the DSM to 485 persons seeking HIV testing ... more We administered the Structured Clinical Interview for the DSM to 485 persons seeking HIV testing at five community testing centres in South Africa to determine the prevalence of common mental disorders among this population. The prevalence estimates for the various disorders were as follows: major depressive disorder: 14.2 % (95 % CI [11.1, 17.3]); generalised anxiety disorder 5.0 % (95 % CI [3.07, 6.93]); posttraumatic stress disorder 4.9 % (95 % CI [2.98, 6.82]); and alcohol use disorder 19.8 % (95 % CI [16.26, 23.34]). Our findings imply the need to research the integration of screening and referral trajectories in the context of voluntary HIV counselling and testing.

Counselling Psychology in South Africa

by Jason Bantjes and Ashraf Kagee

The origin and development of counselling psychology in South Africa has been profoundly influenc... more The origin and development of counselling psychology in South Africa has been profoundly influenced by the country’s socio-political history and the impact of apartheid. As a result of this, counselling psychologists in the country face a number of challenges and opportunities for the future. In this paper we provide a portrait of counselling psychology in South Africa by describing the current character of the specialty and the context in which South African psychologists work. We critically discuss the challenges that the specialty faces to meet the country’s mental health care needs, contest the current Scope of Practice; affirm multiculturalism without essentialising or reifying race and ethnicity, and build an evidence base for community interventions in the country. We also consider how, in the future, counselling psychologists in South Africa may make a more meaningful contribution within public health and the country’s health care and education systems.

Social and Behavioral Aspects of Child and Adolescent Participation in HIV Vaccine Trials

by Arvin Bhana, Graham Lindegger, and Ashraf Kagee

Journal of The International Association of Physicians in Aids Care (jiapac), 2005

Recent data indicate that the worldwide rate of HIV infection in adolescents is steadily increasi... more Recent data indicate that the worldwide rate of HIV infection in adolescents is steadily increasing. Internationally, more than 7000 youths between 15 and 24 years of age are infected with HIV daily, resulting in more than 2.5 million new infections annually. Almost two thirds (1.7 million) of these new infections occur in Africa. Estimates in 2000 showed that the number of South Africans between 15 and 49 years of age infected with HIV was 4.7 million. This number equates to a prevalence rate of 15.4% in those younger than 20 years. Adolescents form an important target group not only for preventative efforts but also for HIV vaccine trials. This article focuses on the social and psychological factors that affect adolescent decision making by considering adolescent risk-taking behaviors, problems associated with predicting adolescent behavior, peer relationships and decision making, sexual disinhibition, and the role of family relationships in adolescent decision making.

2015 Using the Beck Anxiety Inventory Among South Africans Living With HIV- Exploratory and Higher Order Factor Analyses

2015 Understanding the experience and manifestation of depression in people living with HIV/AIDS in South Africa

by Ashraf Kagee and Lena Andersen

Understanding the experience of depression in people living with HIV/AIDS (PLWH) could aid in the... more Understanding the experience of depression in people living with HIV/AIDS (PLWH) could aid in the detection and treatment of the disorder. Yet, there is limited knowledge of the subjective experience of depression amongst PLWH in low-and middle-income countries despite high rates of this disorder in this population. In the current study, semistructured interviews were conducted with depressed adults living with HIV attending a primary infectious disease clinic in South Africa. Interview transcripts were thematically analyzed. The construct of depression was consistent with DSM-IV criteria; however, the symptom presentation was distinctive. Somatic symptoms were most prominent in participants' initial presentations because participants perceived them as medically relevant. Affective, cognitive, and behavioral symptoms were not readily reported as participants did not perceive these symptoms as pertinent to their medical treatment. We identified several idioms of distress that could assist in screening for depression in this population. A valid, contextually developed screener for depression in PLWH awaits further investigation. Such a measure could play a key role in formulating a logistically feasible method of detection and treatment for depression in this population.

2015 Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa: Study protocol for a randomized controlled trial

Background: Maternal depression carries a major public health burden for mothers and their infant... more Background: Maternal depression carries a major public health burden for mothers and their infants, yet there is a substantial treatment gap for this condition in low-resourced regions such as sub-Saharan Africa. To address this treatment gap, the strategy of "task sharing" has been proposed, involving the delivery of interventions by non-specialist health workers trained and supervised by specialists in routine healthcare delivery systems. Several psychological interventions have shown benefit in treating maternal depression, but few have been rigorously evaluated using a task sharing approach. The proposed trial will be the first randomised controlled trial (RCT) evaluating a task sharing model of delivering care for women with maternal depression in sub-Saharan Africa. The objective of this RCT is to determine the effectiveness and cost-effectiveness of a task sharing counseling intervention for maternal depression in South Africa.

2015 Psychologists’ endorsement of empirically unsupported statements in psychology: Noch Einmal

In this study, 103 South African psychologists were asked to rate the extent to which they believ... more In this study, 103 South African psychologists were asked to rate the extent to which they believed a set of empirically incorrect statements were true or untrue. Of the 50 statements, 14 (28%) received a moderate level of endorsement as being factually correct and 8 (16%) received a high level of endorsement as being factually correct. Significant differences in the percentages of items endorsed were found between master's-and doctoral-level psychologists for five statements. Significant differences in the percentages of items endorsed between clinical and counselling psychologists were found for three statements. These findings are explained by noting that there is no consensus among psychologists about whether psychology is a strictly scientific discipline and whether it gives rise to scientific facts about human behaviour. Relatedly, it is possible that South African psychology curricula are not sufficiently focused on the empirical and scientific evidence that informs psychological knowledge. Also, psychology as taught in undergraduate programmes is characterised by a diversity of theory. Consequently, no consensus on theoretical understandings of human behaviour appears to be in sight. Finally, popular and folk understandings of psychology overlap to some extent with empirical psychology, but what makes intuitive sense may not be empirically accurate. Some suggestions are offered for the curricula psychology of departments at South African universities.

2015 Experiences of participating in an antiretroviral treatment adherence club

In an effort to streamline the management of large numbers of patients receiving antiretroviral t... more In an effort to streamline the management of large numbers of patients receiving antiretroviral therapy (ART) in South Africa, adherence clubs were introduced in some districts in the Western Cape since 2008. Adherence clubs are group clinic visits of approximately 30 ART users who receive group adherence counselling and obtain a supply of medication. We sought to document the experiences of patients attending adherence clubs and health care workers (HCW's) at clinics where clubs were operating. Participants were six ART adherence club members and seven HCW's, which included HIV nurses, medical doctors, pharmacists and counsellors. Data in the form of one-on-one interviews were collected at the Infectious Diseases Clinic of a large district hospital in a peri-urban area in the Western Cape region of South Africa. The interviews covered ART users' experiences of the clubs, advantages and challenges that arose in the context of the club-based method of providing treatment, and the concerns faced by ART users and HCW's with regard to the clubs. The data were analysed using thematic analysis. There were clear benefits to the introduction of adherence clubs, most importantly the reduced amount of time ART users needed to spend at the clinic. Yet, various problems also emerged, the most important one being the logistical problems associated with the timely and correct delivery of drugs. These benefits and disadvantages are discussed in the context of providing ART services to large numbers of patients in post-apartheid South Africa.

2015 Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: A multi- stakeholder perspective

Poor adherence to antiretroviral therapy (ART) contributes to the development of drug resistance.... more Poor adherence to antiretroviral therapy (ART) contributes to the development of drug resistance. HIV-infected children, especially those 5 years and under, are dependent on a caregiver to adhere to ART. However, characteristics of the caregiver, child, regimen, clinic and social context affect clinic attendance and medication-taking, both of which constitute adherent behaviour. We conducted nine interviews and three focus groups to determine how doctors, nurses, counsellors, traditional healers and caregivers understood the barriers and facilitators to ART adherence among children residing in rural South Africa. The data were transcribed, translated into English from isiZulu where necessary, and coded using Atlas.ti version 7. Results were interpreted through the lens of Bronfenbrenner's Ecological Systems Theory. We found that at the micro-level, palatability of medication and large volumes of medication were problematic for young children. Characteristics of the caregiver including absent mothers, grandmothers as caregivers and denial of HIV amongst fathers were themes related to the micro-system. Language barriers and inconsistent attendance of caregivers to monthly clinic visits were factors affecting adherence in the meso-system. Adherence counselling and training were the most problematic features in the exo-system. In the macro-system, the effects of food insecurity and the controversy surrounding the use of traditional medicines were most salient. Increased supervision and regular training amongst lay adherence counsellors are needed, as well as regular monitoring of the persons attending the clinic on the child's behalf.

2009 Participation in HIV Vaccine Trials

2008 Mental Health and Physical Health (Including HIV/AIDS)

2008 The Quest for Relevance: Counseling Psychology in South Africa

2007 Researching the Effects of Political Detention: Some thoughts from South Africa