Psychiatry

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Browsing Psychiatry by Subject "Africa"

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    The cultural perspective of therapeutic relationship ‐ a viewpoint from Africa
    (Acta Psychiatrica Scandinavica, 1985) Kilonzo, Gad P.
    Therapeutic relationship has been considered an important ingredient of all psychotherapies. In communities in which no familiar conventions of such a relationship are available, the therapeutic encounter poses very different problems from those in the West, where such conventions freely prevail. This study has been carried out by five therapists representing three widely disparate cultures, but all working together in Tanzania. It brings together their perceptions of these problems and the strategies they employed to resolve them while working with African patients. In their view, in spite of great disparity between the world view behind Western psychotherapy and that of African communities, it is not impossible to forge a therapeutic relationship if empathic understanding and cultural sensitivity are added to the attitude of acceptance. After all, the therapist must attract and keep the patient before he can expect anything from him. The authors describe how this can be done with African patients.
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    Flashblood: blood sharing among female injecting drug users in Tanzania
    (Addiction, 2010) Kilonzo, Gad P.
    Aims This study examined the association between the blood‐sharing practice of ‘flashblood’ use and demographic factors, human immunodeficiency virus (HIV) status and variables associated with risky sex and drug behaviors among female injecting drug users. Flashblood is a syringe‐full of blood passed from someone who has just injected heroin to someone else who injects it in lieu of heroin. Design A cross‐sectional study. Setting Dar es Salaam, Tanzania. Participants One hundred and sixty‐nine female injecting drug users (IDUs) were recruited using purposive sampling for hard‐to‐reach populations. Measurements The association between flashblood use, demographic and personal characteristics and risky sex and drug use variables was analyzed by t‐test and χ2 test. The association between flashblood use and residential neighborhood was mapped. Findings Flashblood users were more likely to: be married (P  = 0.05), have lived in the current housing situation for a shorter time (P  < 0.000), have been forced as a child to have sex by a family member (P  = 0.007), inject heroin more in the last 30 days (P  = 0.005), smoke marijuana at an earlier age (P  = 0.04), use contaminated rinse‐water (P  < 0.03), pool money for drugs (P  < 0.03) and share drugs (P  = 0.000). Non‐flashblood users were more likely to live with their parents (P  = 0.003). Neighborhood flashblood use was highest near downtown and in the next two adjoining suburbs and lowest in the most distant suburbs. Conclusions These data indicate that more vulnerable women who are heavy users and living in shorter‐term housing are injecting flashblood. The practice of flashblood appears to be spreading from the inner city to the suburbs.
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    HIV/AIDS and injection drug use in the neighborhoods of Dar es Salaam, Tanzania
    (Drug and Alcohol Dependence, 2006) Kilonzo, Gad P.
    This study examines the intersection between needle-sharing practices and HIV recovered from used syringes collected from 73 heroin injection drug users (IDUs) in Dar es Salaam, Tanzania, between October 2003 and January 2004. To extract blood residue, syringes were flushed and 10 microliters of solution mixed with 120 microliters of a latex solution was placed on a Capillus HIV-1/2 slide. Thirty-five (57%) of the useable syringes tested positive for HIV antibodies. Results varied significantly: 90% of syringes tested HIV positive in a mixed-income neighborhood 2 kilometers from the city center: 0% of syringes tested HIV positive in the outlying areas. In addition, semistructured interviews were conducted with 51 IDUs. The interviews were content coded and codes were collapsed into emergent themes regarding syringe-use practices. Injecting is a recent practice, particularly among heroin users in neighborhoods far from the city center. Sharing syringes has resulted in a high proportion of used syringes containing HIV-positive blood residue. Geographic distance is an indicator of recent adoption of IDU in neighborhoods and correlates strongly with the distribution of syringes containing HIV-positive blood residue. Keywords." Heroin; Injection; Needle sharing; HIV risk; Africa; Urban
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    Traditional African Mourning Practices Are Abridged in Response to the AIDS Epidemic: Implications for Mental Health
    (Transcultural Psychiatry, 1999) Kilonzo, Gad P.
    This paper examines the psychological significance of traditional African mourning practices in the context of the HIV/AIDS epidemic. In Tanzania, untimely multiple losses through AIDS increasingly force communities to forgo traditionally prescribed mourning practices and rituals. An increase in psychiatric and psychological problems associated with incomplete mourning and unresolved grief has been observed in clinical settings. This may be due to the psychosocial inadequacy of these abridged mourning processes. It is unlikely that western forms of grief counseling can replace traditional mourning rituals, at least in terms of psychological efficacy. An approach is suggested that permits a wider elaboration of cultural psychic processes through the creation of new rituals.