Identification of the most prevalent symptoms and sites of pain experienced by AIDS patients at Soweto Hospice, Johannesburg, South Africa

Includes bibliography.The aim of this study was to identify the ten most prevalent symptoms and five of the most common sites of pain in a patient with advanced AIDS. The setting was a Hospice In-Patient and Home Care program in Soweto, Johannesburg, South Africa. Soweto has a population of approximately 3.5 million. The design was a descriptive quantitative analysis using a nurse-led questionnaire to collect data and was completed in 3 different languages. The patients included 103 adult patients with WHO Stage 4 AIDS who were alert enough and willing to participate. Patients with impaired cognitive function were excluded from the study. The main outcome measures included a list of 30 symptoms, 13 site-specific pains, age, gender, worst overall pain and/or symptom and access to antiretroviral therapy. The results were based on the review of data collected from 103 patients between May 2002 and February, 2003. The results showed the mean age of patients to be 35.4 years, females being an average of 4.4 years younger than males. There was a higher number of female respondents (62.63%) compared to males (37.37%). The ten most common symptoms in order of prevalence were pain (98%), loss of weight (81%), loss of appetite (70.87%), low mood (69.9%) weakness (66%), dry skin (56.3%), diarrhoea (53.4%), nausea and vomiting (44.7%), cough (44.7%) and fatigue (42.7%). 34.38% of respondents mentioned pain as being their worst overall symptom. The average number of pains experienced was 2.91. Female respondents reported significantly more anxiety and genital sores and pain. 3.88% of patients had had access to ART. Lower limb pain was the most prevalent pain (66%) followed by mouth pain (50.5%), headache (42.3%), throat pain (39.8%) and chest pain (17.5%). Conclusions drawn were that patients with advanced AIDS suffer significantly from pain and a number of distressing symptoms. In the light of the HIV/AIDS pandemic in SA, and the lack of access to ART, reforms are needed to increase knowledge and education in Palliative Care. There is a need for the development of standard protocols for the palliative management of AIDS-related pain and symptoms and more research into end-of-life care for these patients