Ubuntu-informed counselling

1. Introduction

Version followed: Lumka Qangule's uBuntu-Centred Psychotherapy (PhD thesis, Rhodes University, supervised by Jacqueline Akhurst; the PDF is dated June 2019 and the repository record 2020). This guide follows its structure: the frame adjustments, the uBuntu principles, and the session elements rapport and psychoeducation. Two other named versions appear where relevant: Van Dyk & Nefale's (2005) Ubuntu therapy and Washington's (2025) Ubuntu Psychotherapy. [source: Qangule thesis ToC and abstract; Van Dyk & Nefale 2005 abstract; Cognella page for Washington 2025]

What it is. Ubuntu-informed counselling is not one manualised therapy. It is a family of culturally grounded ways of practising, mostly from South Africa. They keep the ethics of mainstream psychotherapy and change the therapy frame (time, place, money, language, touch, gifts, role, self-disclosure) so it fits clients whose worldview rests on uBuntu. Qangule's model came from an interpretative phenomenological analysis of eight practising amaXhosa psychotherapists, followed by a focus group. Its starting point is that ethical codes are firm but therapy frames are flexible and can be adapted to context. [source: Qangule abstract and ToC sections 2.7 and 5.3–5.4]

Core idea of change. uBuntu rests on umntu ngumntu ngabantu, which Qangule translates as "a person is a person through other people". Its key features are interdependence, respect, spirituality and the primacy of community. [source: Qangule abstract and pp. 8–9, 15–16] Van Dyk & Nefale describe ubuntu as "communality, oneness, cooperation, and sharing". They argue that Western models of illness and healing can clash with African clients and may label their experiences as pathological, so therapy that does not embrace ubuntu may fail some African clients. [source: Van Dyk & Nefale 2005 abstract; as cited in Qangule pp. 3–4, 9] The working assumption is that distress is understood and resolved within relationships: family, community, and in Qangule's model also the vertical, spiritual relationship (the Rhodes news page describes relationships that are "both vertical and horizontal"). Change comes from a culturally congruent relationship with the therapist, from restoring belonging and mutual obligation, and from respecting the client's spiritual explanations. [source: Rhodes news page; mechanism as stated here is partly [synthesis]]

Caution: Qangule's thesis is drawn on only through its title pages, table of contents, Chapter 1 and Chapter 2, plus abstracts and publisher pages for the other versions. The content of Qangule's model chapter (6.3, pp. 173–178), Van Dyk & Nefale's model and its "three dimensions of a human being" figure, and Washington's phases are not drawn on here. The procedures below are built on the sources' named components, and the steps are marked [synthesis]. [uncertain]

2. Framework

What the sources specify.

• Qangule (uBuntu-Centred Psychotherapy). The model chapter has these sections: characteristics of the uBuntu-Centred psychotherapist; uBuntu-Centred sessions (establishing rapport; psychoeducation); a model figure (Fig. 6.2); elements to be mindful of (spirituality); and principles. In the findings, the practice areas are entry points, privacy and informed consent, rapport and touch, confidentiality, African time, advice giving, flexibility, the setting ("taking the service to the people"), gifts and bartering, normalising, psychoeducation, and psychotherapy alongside other systems. No phase sequence or session count was visible. [source: Qangule ToC, sections 5.2–5.5 and 6.3] [uncertain: the content of Fig. 6.2]
• Washington (Ubuntu Psychotherapy, 2025). This version is aimed mainly at African Americans and the African diaspora. It names a five-phase healing paradigm: Remembering, Reminding, Reframing, Revitalizing, Re-normalizing. It focuses on psycho-spiritual alignment and on healing from racial oppression and transgenerational trauma. The publisher page gives no further detail on the phases. [source: Cognella page] [uncertain: what each phase involves was not verified]
• Van Dyk & Nefale (2005). They present "a model for conducting ubuntu therapy". Its content is not drawn on here. [uncertain]

Working structure for this guide [synthesis]. None of the sources prescribes a session count. Use your usual format (weekly sessions of about 50 minutes, individual or with family) and adjust it as described in Section 4.

3. Guiding principles

The principles below come from Qangule's findings (5.7.2) and discussion (6.1.3), from the uBuntu values she cites, and from Van Dyk & Nefale. The one-line practical meanings are my [synthesis] unless tagged otherwise.

• Ethics firm, frame flexible. Keep HPCSA-level duties (autonomy, non-maleficence, beneficence, justice, fidelity, confidentiality, consent, competence), but adapt time, place, money, language, touch, gifts, role and self-disclosure. Practice: before any adaptation, ask whether it breaks an ethical duty or only changes the frame. [source: Qangule abstract, 2.5, 2.7]
• Interdependence and interconnectedness. Practice: map the client's family, clan, church and community in session 1, and treat changes in those relationships as therapeutic targets. [source: Qangule 5.7.2.1, 6.1.3.1]
• Respect. Practice: use proper greetings, forms of address and courtesy for elders; ask how the client wishes to be addressed. [source: Qangule 5.7.2.2, 6.1.3.2]
• Spirituality. This covers the vertical relationship with God and ancestors. Practice: ask about the client's spiritual understanding of the problem without pathologising it, and keep it in the formulation. [source: Qangule 5.7.2.4, 6.1.3.3, 6.3.4.1; Rhodes news page]
• Going the extra mile. Practice: be ready to do practical things beyond the 50-minute hour, such as a phone call, a home visit or linking to resources, within ethical limits. [source: Qangule 5.7.2.3]
• Sharing, caring, humility, selflessness, compassion. Practice: take a less hierarchical stance, normalise, and share appropriately. [source: Qangule 5.7.2.5, 6.1.3.4, 6.1.3.7]
• Touch. Practice: a greeting handshake or hug can be part of respectful rapport if the client initiates it and you have considered it. [source: Qangule 5.2.3, 6.1.3.5]
• Gifts and bartering. Practice: refusing a small token can shame the giver. Decide in advance how you will receive gifts and record it. [source: Qangule 5.4.2, 6.1.3.6]
• Community. Practice: the client's welfare includes the community's welfare, and service should be accessible. [source: HPCSA expanded principle 'community', as summarised in Qangule 2.5.3.8]
• uBuntu values: survival, solidarity, compassion, respect, dignity. Practice: protect the client's dignity in every decision, including referrals and family meetings. [source: Engelbrecht & Kasiram 2012 as cited in Qangule p. 16]
• Communality, oneness, cooperation, sharing. Practice: look for solutions that bring people together rather than solutions that only increase individual separation. [source: Van Dyk & Nefale 2005 abstract]
• Guard against uBuntu misrepresentation. Practice: do not use 'ubuntu' to override a client's autonomy or to romanticise community pressure. [source: Qangule heading 5.7.2.6; the meaning given here is [uncertain]]
• Language and culture matter. Practice: offer therapy in the client's language, or use a trained interpreter. [source: Qangule 1.2, 5.1.1, 6.1.4.7]
• Cultural humility rather than identity matching [synthesis]. Non-African therapists can work this way only with consultation and without claiming insider knowledge.

4. Intervention inventory

The list follows the practice areas Qangule's participants described (Ch. 5) and the session elements of her model (6.3). Van Dyk & Nefale's and Washington's components are noted where named. The sources give section headings and short findings, not procedures, so all step-by-step instructions below are [synthesis], built to put the named practice into action within ethical limits. Example language is my own, unless quoted. [source: Qangule ToC 5.2–5.5, 6.1.4, 6.3]

4.1 Entry points and establishing rapport

• Purpose / when: Session 1 and every re-engagement. Rapport is the first element of an uBuntu-Centred session. Clients often come after seeking help from family, church or traditional healers, so how they enter therapy matters. [source: Qangule 5.2.1, 6.3.2.1; 1.5 p. 10]
• Steps [synthesis]: (1) Greet fully and unhurriedly in the client's language where possible, and ask after family before the problem. (2) Ask how they want to be addressed, for example by clan name or title. (3) Ask who sent them, who knows they are here, and what help they have already sought (family, church, healer, clinic), without judging. (4) Briefly say who you are, including something about where you come from if appropriate. (5) Only then invite the presenting concern.
• Example language (illustrative): "Before we talk about what brings you, how is your family? … Who else has been helping you with this so far?"
• Watch for: The client relaxes and uses their own idioms. If a client is uneasy with informality, go back to a more formal style; some clients expect a 'Western' clinical manner.

4.2 Working in the client's language

• Purpose / when: Always. Qangule's clients said they came because she speaks their language, and language is a frame element in its own right. [source: Qangule 1.2 pp. 2–3; 2.7.5.4; 5.1.1; 6.1.4.7]
• Steps [synthesis]: (1) Offer a choice of language at intake. (2) If you do not share it, use a trained interpreter rather than a family member, and brief them on confidentiality. (3) Ask for the client's own word for the problem and use it. (4) Check that you have understood idioms and proverbs before interpreting them.
• Example language (illustrative): "Which language is easiest for you to talk about this in? … What is the word you use at home for what you are going through?"
• Watch for: Switching languages at emotional moments. Note when it happens and invite the client to stay in the language that holds the feeling.

4.3 Culturally adapted informed consent and privacy

• Purpose / when: At intake and whenever family are to be involved. Privacy and informed consent were areas where participants adjusted Eurocentric practice. [source: Qangule 5.2.2, 6.1.4.9; HPCSA consent and confidentiality summarised in Qangule 2.5.2.4–2.5.2.5]
• Steps [synthesis]: (1) Explain consent and confidentiality in plain language, using an analogy where helpful. (2) Ask whether the client usually makes decisions like this alone or with family or elders. (3) If they want family involved, agree in writing what may be shared, with whom, and how. (4) Get the individual adult client's own consent; family agreement does not replace it. (5) Explain the limits of confidentiality (risk to self or others, legal duties).
• Example language (illustrative): "What we talk about stays between us unless you choose to share it, or someone is in danger. Is there anyone in your family you would like included in decisions?"
• Watch for: Consent that is given for the family's sake rather than freely. Check privately with the client.

4.4 Confidentiality negotiated with the family

• Purpose / when: When relatives phone, accompany the client, or expect updates. [source: Qangule 5.2.4]
• Steps [synthesis]: (1) Agree a 'family message' with the client: what relatives may be told, such as general progress or attendance. (2) Respond to relatives with that message only. (3) Offer a joint session rather than separate reports.
• Example language (illustrative): "Your mother may phone. Shall we agree what I can tell her, so she feels included and you still feel safe?"
• Watch for: Disclosures about family members such as abuse or HIV status. These need careful, client-led handling.

4.5 Psychoeducation

• Purpose / when: The second named element of an uBuntu-Centred session. It is used early, because many clients do not know what psychotherapy is or why it involves talking rather than advice or medicine. [source: Qangule 5.5.3, 6.1.4.6, 6.3.2.2]
• Steps [synthesis]: (1) Explain what therapy is, how long a session lasts, what both of you do, and what to expect. (2) Explain the condition in everyday language, linking it to the client's own explanation rather than replacing it. (3) Explain other services such as a medical check, medication or a social worker, and when you would recommend them. (4) Invite questions and repeat the key points at the end.
• Example language (illustrative): "Here we talk so you can find your own way through. I will also share what I know, like an elder might, and we decide together."
• Watch for: Psychoeducation that dismisses the client's explanation. It should sit alongside it.

4.6 Flexible time ('African time')

• Purpose / when: When clients arrive late or early, or attend irregularly, because of transport, work, family obligations or different norms about time. [source: Qangule 5.3.1, 6.1.4.1]
• Steps [synthesis]: (1) At intake, discuss how time is kept and what happens with late arrival. (2) Where your schedule allows, keep a buffer before or after sessions. (3) Treat lateness as information about the client's circumstances before treating it as resistance. (4) Keep the session end predictable unless there is risk.
• Example language (illustrative): "Taxis can be unpredictable. If you are late, come anyway, and we will use the time we have."
• Watch for: Repeated lateness linked to avoidance. Explore it gently (see 5.4).

4.7 Advice giving and guidance

• Purpose / when: When a client asks you directly what to do. Participants adjusted the non-directive stance. Qangule describes a client who asked her to "please choose for me" and clients feeling failed when she declined. She cites the proverb inyathi ibuzwa kwabaphambili (seek direction from those ahead of you). [source: Qangule 1.2 p. 3; 5.3.2; 6.1.4.2]
• Steps [synthesis]: (1) Acknowledge the request as legitimate. (2) Explore what the client has already considered and what elders or family advise. (3) Give guidance as options with reasons, for example "In my experience, people in your situation often…". (4) Make clear the decision stays with the client, and check that it fits their values. (5) Review the outcome next session.
• Example language (illustrative): "You asked what I think. I will tell you honestly, then you decide, because you know your family best."
• Watch for: Dependency, or advice on matters outside your competence such as legal, medical or ritual matters. Refer those.

4.8 Frame flexibility

• Purpose / when: When the standard frame (fixed place, fixed hour, strict neutrality) blocks access or alienates the client. [source: Qangule 5.3.3, 6.1.4.3; frame elements 2.7.5]
• Steps [synthesis]: (1) Name which frame element you are adjusting (time, place, money, language, clothing, contact, role, self-disclosure, gifts, bartering). (2) Check that the change does not breach an ethical duty. (3) Discuss it with the client and document your reasons. (4) Take it to supervision.
• Example language (illustrative): "Usually we meet here weekly. With your work, shall we try fortnightly at the clinic near you?"
• Watch for: Drift, where small adjustments add up to a blurred role. Review the frame regularly.

4.9 Taking the service to the people (setting)

• Purpose / when: When clinic-based therapy is out of reach because of distance, cost, stigma or mobility. Participants named the setting as a practice issue shaped by uBuntu. [source: Qangule 5.4.1, 6.1.4.4; frame element 'place and space' 2.7.5.2]
• Steps [synthesis]: (1) Consider community venues such as a clinic, school, church hall or home. (2) Assess privacy and safety at the venue first, including who can overhear and how the visit will look to neighbours. (3) Agree a private space and an exit plan. (4) Keep notes and boundaries as you would in the office. (5) For home visits, agree with the client beforehand who will be present.
• Example language (illustrative): "I can come to the clinic in your area on Thursdays. Where would you feel most comfortable talking privately?"
• Watch for: Stigma when neighbours notice. Ask the client how they would like to explain your visits.

4.10 Gifts and bartering

• Purpose / when: When a client offers a gift or proposes payment in kind. Participants described this as uBuntu-influenced, and Qangule writes in Chapter 1 about her own tension over accepting gifts. [source: Qangule 1.2, 2.7.5.9–2.7.5.10, 5.4.2, 6.1.3.6]
• Steps [synthesis]: (1) Set a written policy in advance, for example small, low-value, one-off tokens are accepted graciously and others are discussed. (2) When a gift is offered, receive it respectfully, explore its meaning if appropriate, and record it. (3) For bartering, check your professional board's rules first, and prefer a reduced fee or referral to a free service over goods or labour. (4) Discuss any doubt in supervision.
• Example language (illustrative): "Thank you, this means a lot. I will note it, as I note everything, so our work stays clear."
• Watch for: Gifts that create obligation, gifts of high value, or bartering that turns into a dual relationship. Qangule names fear of the law and of the HPCSA as a concern participants raised (5.5.4).

4.11 Normalising and appropriate self-disclosure

• Purpose / when: To reduce shame and hierarchy, in line with sharing and humility. [source: Qangule 2.7.5.8, 5.4.3, 6.1.4.5]
• Steps [synthesis]: (1) Normalise the reaction ('many people in such circumstances…'). (2) Disclose briefly, only to serve the client, and without shifting the focus to yourself. (3) Return the focus to the client.
• Example language (illustrative): "In my own family we also had to grieve without the proper rituals. It is heavy. How has it been for you?"
• Watch for: Disclosure that burdens the client or invites caretaking.

4.12 Respectful touch within rapport

• Purpose / when: At greetings, partings or moments of grief, where a handshake or hug is the customary form of respect. [source: Qangule 5.2.3, 6.1.3.5; frame element 2.7.5.6]
• Steps [synthesis]: (1) Let the client initiate. (2) Take account of gender, age, trauma history and setting. (3) Keep touch brief and public in kind, such as a greeting. (4) Never use it in place of words when distress is high. (5) Document it if it is unusual.
• Example language (illustrative): "(As the client offers a hand) It is good to see you again."
• Watch for: Any discomfort, or gender and trauma factors. Qangule's findings include gender issues (5.1.2).

4.13 Working with spirituality and ancestral explanations

• Purpose / when: When the client explains their distress through ancestors, a calling, or spirits. Qangule discusses ukuthwasa (an ancestral calling to become a healer) and amafufunyana (possession by evil spirits). She notes both can be misdiagnosed under the DSM. Spirituality is the named 'element to be mindful of' in her model. [source: Qangule 1.2 pp. 3–4, 1.4 p. 8, 6.1.3.3, 6.3.4.1]
• Steps [synthesis]: (1) Ask respectfully about the client's own explanation and what their family and healers say. (2) Do not argue with it or endorse it. Hold it as meaningful, and record it in the formulation alongside your clinical assessment. (3) Assess carefully for psychosis, mood disorder, substance use and medical causes, and do not attribute everything to culture. (4) If a calling is suspected, discuss with the client whether consulting a traditional healer or elder is part of their path, and how your work would continue alongside it.
• Example language (illustrative): "What do you and your family understand is happening? … How can our work here sit alongside what the elders advise?"
• Watch for: Mistaking a cultural experience for a disorder, or the reverse. Get consultation from a colleague familiar with the culture when unsure.

4.14 Psychotherapy alongside other systems (healers, churches, clinics)

• Purpose / when: When the client is also seeing traditional healers, faith leaders or medical services. Participants recommended that psychotherapy work with other systems. [source: Qangule 5.5.5; 1.5 p. 10]
• Steps [synthesis]: (1) Ask about all current helpers. (2) With the client's consent, contact them, or advise the client how to coordinate. (3) Check for interactions such as herbal remedies alongside medication, and refer to a doctor for that question. (4) Agree roles so that the client is not caught between helpers.
• Example language (illustrative): "You see the pastor and the inyanga too. Would it help if we all knew a little of what each is doing?"
• Watch for: Conflicting instructions, or a client who feels judged for using multiple systems.

4.15 Involving family and community (interdependence in action)

• Purpose / when: When the problem or its solution lies in relationships. The principle of interdependence comes from Qangule and Van Dyk & Nefale, and a paper by others is titled Ubuntu-Oriented Therapy: Prospects for Counseling Families Affected with HIV/AIDS. [source: Qangule 5.7.2.1, 6.1.3.1; Van Dyk & Nefale 2005 abstract] [uncertain: the authors and content of the HIV/AIDS paper]
• Steps [synthesis]: (1) Draw a genogram that includes deceased members and elders. (2) Ask the client whom they want to invite. (3) Run a joint session with ground rules: speaking in turn, respect for elders, and a client-safe agenda. (4) Look for shared responsibilities and roles to restore, such as caring arrangements or reconciliation. (5) Debrief individually afterwards.
• Example language (illustrative): "Who in your family would you like to stand with you in this?"
• Watch for: Power imbalances (gender, age, a perpetrator in the room). Do not hold joint sessions where there is abuse.

4.16 Responding to poverty and 'going the extra mile'

• Purpose / when: When socio-economic hardship drives or blocks the work. Participants described poor socio-economic backgrounds, and going the extra mile is one of the uBuntu principles in the findings. [source: Qangule 5.1.4, 5.7.2.3, 6.1.4.8]
• Steps [synthesis]: (1) Screen for basic needs: food, housing, grants, transport money. (2) Refer to a social worker or community resources, or help the client make contact. (3) Adjust fees, or refer to free services. (4) Keep the therapy space for the psychological work as well.
• Example language (illustrative): "Before we go on, let us make sure you can get here. Has the grant application been done?"
• Watch for: Therapist burnout and over-involvement. Use supervision.

4.17 Washington's five-phase healing paradigm (diaspora version)

• Purpose / when: With clients of African descent outside Africa where transgenerational and racial trauma is central. [source: Cognella page]
• Steps: The phases are named as Remembering, Reminding, Reframing, Revitalizing and Re-normalizing. Their content is not drawn on here, so do not apply them without the book. [uncertain]
• Example language: none given.
• Watch for: The diaspora context differs from South African uBuntu practice, so do not merge the two without care [synthesis].

Not covered: the content of Van Dyk & Nefale's ubuntu therapy model and their 'three dimensions of a human being' (Qangule Fig. 3.4), and Qangule's model figure 6.2 and her listed principles (6.3.5). No further techniques are invented here. [uncertain]

5. Handling problems

Qangule's findings name several tensions: advice-seeking, gifts, touch, consent and privacy, and fear of the HPCSA. The responses below are mostly [synthesis].

• The client wants you to decide for them, and feels failed when you won't. The source describes this experience (Qangule 1.2). Response [synthesis]: do not just refuse. Offer guidance with reasons (4.7), bring in trusted elders' views, and keep the final choice and its review with the client.
• Family pressure overrides the client's wishes. Response [synthesis]: hold a separate individual session; restate the consent agreement (4.3–4.4); in joint sessions, protect the client's voice; where there is coercion, abuse or forced marriage, apply safeguarding duties. Interdependence never cancels an adult's autonomy (Qangule 2.5.1.1).
• Ancestral calling or spirit explanation versus psychiatric illness. Response [synthesis]: run both explanations side by side; complete a full mental state and risk assessment; arrange a medical review for psychosis, mania or organic signs; consult a culturally knowledgeable colleague; with consent, coordinate with the healer (4.13–4.14). Qangule warns of DSM misdiagnosis (1.2), and the opposite error, missing a treatable illness, is also a risk [synthesis].
• Lateness and missed sessions. Response [synthesis]: first ask about transport, money, work and family duties (4.6, 4.9, 4.16). If the pattern continues once those are addressed, explore avoidance gently and agree a workable rhythm.
• Rupture over a declined gift or touch. Response [synthesis]: name it, express appreciation for the intention, explain your reason in relational rather than rule-bound terms, and repair. Adopting a clear policy in advance prevents most of these ruptures (4.10, 4.12).
• Overwhelm, grief and trauma (common where HIV/AIDS, violence and loss are present). Response [synthesis]: slow down, ground the client in present relationships and supports, involve chosen family supports, and use your standard trauma-stabilisation methods before any trauma processing.
• Suicide or self-harm risk. Response [synthesis, following standard practice]: follow your usual structured risk assessment and safety planning. With consent, or when legally required, bring in family and community supports. Lethal-means counselling covers safe storage and removal only. Note that shame towards the family or ancestors can be both a risk factor and a protective factor, so ask about both.
• Dual relationships in small communities. Response [synthesis]: where meeting outside sessions is unavoidable, agree in advance how you will greet each other in public, avoid business or barter dealings, and document your reasoning.
• Fear of regulatory sanction (raised by participants: Qangule 5.5.4). Response [synthesis]: write a rationale for each frame adaptation, take it to supervision, and check it against current HPCSA (or your own board's) rules.
• 'uBuntu' used to silence the client or excuse harm (cf. Qangule 5.7.2.6, content not covered). Response [synthesis]: uBuntu values such as dignity and respect apply to the client too. Name coercion when you see it.
• The therapist does not share the client's culture. Response [synthesis]: ask instead of assuming, use interpreters and cultural consultants, avoid essentialising ('all Xhosa clients…'), and remember that some clients prefer a conventional Western frame.
• Gender issues (Qangule 5.1.2, content not covered). Response [synthesis]: ask the client whether they would prefer a therapist of a particular gender, and take extra care about touch and family meetings.

Sources

Sources:

• An investigation of the experiences of psychotherapists regarding Ubuntu in their psychotherapy practice: an IPA (Qangule, Rhodes University; thesis PDF). Only the front matter, table of contents and Chapters 1–2 could be read; the PDF could not be read beyond about p. 35.
• Repository record, Qangule 2020 and the full item record
• Congratulations Dr Lumka Qangule (Rhodes University Psychology news)
• The Split-Ego Experience of Africans: Ubuntu Therapy as a Healing Alternative (abstract record)
• Ubuntu Psychotherapy (Cognella publisher page)
• Psychology and Ubuntu: therapeutic meetings in a South African context (Gylseth 2008, record). Used for background only.

Books and papers cited:

• Qangule, L. S. (2019/2020). An investigation of the experiences of psychotherapists regarding uBuntu in their psychotherapy practice: An interpretative phenomenological analysis. PhD thesis, Rhodes University.
• Van Dyk, G. A. J., & Nefale, M. C. (2005). The split-ego experience of Africans: Ubuntu therapy as a healing alternative. Journal of Psychotherapy Integration, 15(1), 48–66. Only the abstract is drawn on.
• Washington, K. (2025). Ubuntu Psychotherapy. Cognella. Only the publisher page is drawn on.
• Engelbrecht & Kasiram (2012), and Nwoye (2015), as cited in Qangule. Not drawn on.
• Ubuntu-Oriented Therapy: Prospects for Counseling Families Affected with HIV/AIDS in sub-Saharan Africa (NISC). Its authors and year are unverified. [uncertain]