Despite significant research and inroads with the human immunodeficiency virus (HIV), disparities in HIV infection continue to widen for African American (AA) men who have sex with men (MSM). In recent times, cultural competence has been receiving increased attention as a possible factor to enhance the quality of health messaging and lessening HIV disparities. However, there is a dearth of research specifically dedicated to AA MSM and culturally competent HIV health messages. To address this gap, this qualitative research was designed to investigate the self-perceived cultural competency among HIV counselors. The theoretical framework for the project was the PEN-3 cultural model. The interview participants for the study were 10 HIV interventionists employed with health institutions that partially or entirely specialize in HIV prevention in the Richmond, Virginia, area. The analysis of the data was aided by a phenomenology analytical approach. The results revealed that cultural competence training can be one effective means to enhance the quality of health messages targeting AA MSM. This investigation has social change implications, especially in the context of developing sustainable HIV prevention interventions focused on integrating culture, thereby reducing HIV disparities in the Richmond metropolitan area. The findings may also lend insight into the various ways that health establishments can engage in culturally relevant prevention and position themselves to be leaders in informing the development of culturally competent HIV prevention messages that will aid in the acceleration of changing longstanding, ineffective prevention approaches targeting AA MSM.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The HIV/AIDS pandemic has led to millions of deaths; disability for the sufferers and multiple socioeconomic effects on HIV infected and affected individuals. Among the factors affecting people living with HIV/AIDS that may contribute to HIV related disability is mental illness such as HIV related manias and depression. ‘HIV counselors’ make up part of the team at the forefront of HIV treatment and management in Uganda but little is known about their perceptions of mental illness. This study therefore sought to explore the perceptions of mental illness among HIV counselors in Uganda. A qualitative study was conducted. Ten individual interviews and three focus group discussions were carried out among 31 HIV counselors. They were selected from five HIV treatment centers in Kampala district, Uganda. An interview guide based on Kleinman’s explanatory model of illness with case vignettes depicting depression, alcohol abuse, mania, and psychosis were used to facilitate discussion. Data was thematically analyzed. HIV counselors exhibited some knowledge concerning depression among HIV positive clients, with some viewing the symptoms of depression as “understandable sadness” arising from the HIV client’s psychosocial reality which is rife with poverty, stigma and lack of social support. Counselors also reported that some of their client’s physical symptoms were a result of their emotional problems. Mania and psychosis were attributed to religious beliefs and witchcraft; and in some cases disease progression or HIV drugs. Chronic alcohol abuse, despite continuous counseling was seen as a waste of the counselor’s time in face of overwhelming numbers of clients per day. Such clients, along with clients with suicidal ideations were often threatened or ignored. Counselors agreed that they needed training on assessment of mental illness, and how difficult cases could be referred. / AFRIKAANSE OPSOMMING: Die MIV/VIGS pandemie het al miljoene sterftes tot gevolg gehad; ook ongeskiktheid vir die lyers en veelvuldige sosio-ekonomiese gevolge vir individue met MIV sowel as ander individue wat daardeur geraak word. Van die faktore wat ‘n uitwerking op mense het wat leef met MIV/VIGS en wat kan bydra tot HIV ongeskiktheid, is geestesversteurings soos HIV verwante manies en depressie. “MIV-voorligters” is deel van ‘n span wat aan die voorpunt staan van die behandeling en bestuur van MIV in Uganda, maar min is bekend oor hulle persepsies van geestesversteuring. In die onderhawige studie is MIV-voorligters in Uganda se persepsies van geestesversteuring ondersoek. ‘n Kwalitatiewe studie is onderneem. Tien individuele onderhoude en drie fokusgroepbesprekings is gedoen onder 31 MIV-voorligters. Hulle is geselekteer uit vyf MIV-behandelingsentrums in die Kampala-distrik, Uganda. ‘n Onderhoudskedule gebaseer op Kleinman se verklarende siektemodel, bestaande uit karakterskets-gevallestudies wat depressie, alkoholmisbruik, manie en psigose uitbeeld, is gebruik om die besprekings te fasiliteer. Die data is tematies ontleed. MIV-voorligters het getoon dat hulle in ‘n mate oor kennis beskik ten opsigte van depressie by MIV-positiewe kliënte. Sommige voorligters het die simptome van depressie beskou as “verstaanbare droewigheid” wat voortspruit uit die MIV-kliënt se psigososiale werklikheid, bestaande uit armoede, stigma en ‘n gebrek aan sosiale ondersteuning. Voorligters het ook gerapporteer dat sommige kliënte se fisiese simptome die gevolg is van emosionele probleme. Manie en psigose is toegeskryf aan godsdienstige oortuigings and toordery; en in sommige gevalle aan progressie van die siekte of MIVmedisyne. As gevolg van die feit dat voorligters daagliks oorlaai word met kliëntgetalle, is kliënte wat kronies alkohol gebruik beskou as ‘n vermorsing van voorligters se tyd, ten spyte van voortdurende voorligting. Sulke kliënte, tesame met kliënte wat selfmoordneigings getoon het, is dikwels gedreig of geïgnoreer. Voorligters was dit eens dat hulle opleiding benodig in die assessering van geestessiekte asook leiding oor hoe om moeilike gevalle te verwys.