When the CHW programme gained global support after the 1978 Alma Ata Declaration, CHW projects, established mostly by individuals or small civic or religious organizations, started emerging in South Africa. From the late 1970s to 1980s, various forms of CHW cadres (e.g. village health workers, lay health workers, first aid workers, etc.) were initiated and CHW programmes started to mushroom in communities around South Africa (Revitalization of Primary Health Care, 2012:51). The key role of CHWs is to provide preventive, promotional, and in some cases, curative services to households and communities. They may also be required to provide services to clients at health facilities at the primary level, either during a consultation or through follow up visits in the home. In recent years, HBC centres have become more structured and in most countries they remain in the forefront of service delivery. Some of their activities include delivery of treatment, care and support to PLWHA (Joint United Nations Programme on HIV/AIDS 2006). The South African government has funded the development of home- and community-based care, the training of caregivers and the provision of HBC kits to caregivers. These are also included in the strategies to improve HIV care and to reduce the burden experienced by the public sector, as well as caring for PLWHA at home.

The South African Government developed policies and guidelines on HBC because HBC was found to be the only solution to the increasing demand on health care services (South African Department of Health, 2001). In South Africa, non-governmental organizations (NGOs) and the government are responsible for training community volunteers to assist families with home care (Uys & Cameron, 2003). The World Health Organization (WHO) (2002) has reported that between 70% and 90% of sick patients are cared for at home. The increasing number of people who are in need of care at home has led to the people in the community to taking responsibility for the care of the sick through volunteerism which is also part of the African culture.

To explore and describe CHWs’ perceptions of health promotion about sexual health communication.

The impact of HIV can be seen through an increase in the number of people living with HIV and AIDS (PLWHA), which has put pressure on hospital staff who are already struggling to cope with their workload. This gave rise to HBC centres with home-based caregivers (HBCGs) to care for the PLWHA. In developing countries, HBC programmes were first initiated and implemented by churches and other faith-based organizations. In South Africa, HBC programmes were largely non-existent, however care groups were started in the early 1970s in the rural villages of Limpopo. Care groups were formed by women and started as a way of mobilizing healthcare practices to promote health, aspects of child care, nutrition, health promotion activities of having toilets, pit toilets and vegetable gardens in the homes and/or households, were some of the health promotion aspects that community nurses worked with in this group of people.

According to DOH (2011), these community-based health workers perform a wide range of functions with titles such as home community-based care workers, VCT counsellors, ART adherence counsellors, DOTS supporters, child and youth care workers, and peer counsellors/educators. The training received by these community-based health workers ranges from 2 weeks to 4 years, some being skills-based programmes and others formal qualifications registered on the National Qualifications Framework (NQF).

Women are always vulnerable and often only get to know about their seropositive status when they become pregnant. Based on antenatal clinic surveillance, South Africa’s HIV epidemic shows no evidence of decline. There were 5.5 million adults living with HIV in 2005 – 5.3 million were adults over the age of 15 years, of whom 3.1 million were women (Friedman, Mthembu, & Bam, 2006). Studies have been documented on the difficulties that men and women perceive in raising the topic of infidelity and condom use within marriage (Akwara, Madise, & Hinde, 2003; Zulu & Chepngeno, 2003). Practising safe sex involves a complicated process of sexual negotiation which requires an element of open communication about sexual issues. How sex is negotiated depends on the construction of risks and trust, both of which differ according to the type of sexual relationship or sexual encounter, as well as the inequality of the gender relations. HIV is on the increase in Vhembe as more PLWHA are discharged back to the PHC services. HBCGs do follow-up support visits of the clients to provide different services like supervising the administration of medicines, assisting in nutrition and hygiene and health promotion. Home-based carers have developed in the rural villages of Vhembe as a way of increasing accessibility to PHC and providing basic health support to communities regarding health promotion.

The study findings revealed that among rural ethnic communities, patriarchy plays a negative impact on sexuality as well as culture, because it is acceptable for men to have extramarital affairs and marry more than one woman. Socio-economic conditions places women at risk of sexually transmitted diseases and HIV/AIDS because they cannot negotiate safe sex or use of condoms because culturally, women when getting into any type of union, it is for child bearing.

The PHCs work in collaboration with CHWs in different villages as ward-based teams. The key figures such as the chiefs and traditional leaders are also included and representatives from the community become ex officio of the Primary Health Care service so that there is continuity of care

The CHWs use different platforms of information sharing such as community meetings, church gatherings and the clinics on matters related to HIV/AIDS. The Health Belief Model (1984) is utilized, and other non-governmental organization are brought into the space to address issues of gender such as “Who is the real man” an organization that supports men to live positively, it has also male volunteers that aims to change attitudes and perceptions of men pertaining to sexual health. People living with HIV/AIDS and Tuberculosis receive support from CHW in relation to adherence, nutrition, follow-up. Women are empowered on taking control of their reproductive health, negotiating and practicing safe sexual intimacy.

• Akwara, P. A., Madise, N. J., & Hinde, A. (2003). Perception of risk of HIV/AIDS and sexual behaviour in Kenya. Journal of Biosocial Science, 35(3), 385–411. doi:10.1017/S0021932003003857.

• Becker, M. H. (Ed.). (1984). The health belief model and personal health behaviour. Thorofare, NJ: Charles B, Slack.

• Department of Health. (2001). National guidelines on home/community based care. Pretoria: Government printers.

• Friedman, I., Mthembu, W., & Bam, N. (2006). The impact of male sexuality on women and children’s health. In P. Ijumba & A. Padarath (Eds.), South African health review (pp. 151–163). Durban: Health Systems Trust.

• Health System Trust. (2012). Literature review. Revitalisation of primary health care. Durban: Health System Trust.

• Ramathuba, D. U. (2012). Exploring gender and cultural factors associated with sexual health communication in the era of HIV/AIDS: Implications for sexual health interventions. Indilinga: African Journal of Indigenous Knowledge Systems, 11(1), 73–82.

• Uys, L., & Cameron, S. (2003). Home-based HIV/AIDS care. South Africa: Oxford University Press.

• World Health Organisation (WHO). (2002). Community home-based care in resource-limited settings. A framework for action. Switzerland: Geneva.

• Zulu, E. M., & Chepngeno, G. (2003). Spousal communication about the risk of contracting HIV/AIDS in rural Malawi. Demographic Research, 1(8), 247–278. doi:10.4054/DemRes.2003.S1.8