Magister Public Health - MPH / Namibia is one of the countries in the world most affected by HIV/AIDS with the national prevalence of 18.8% in 2010. In 2010, it was reported that an estimated 180,000 Namibians were living with HIV/AIDS; of which 95,000 adult women, 69,000 adult men and 16,000 children. An estimated 6,700 deaths was recorded in 2009 with an estimated number of 70,000 orphans due to the disease. The introduction of anti-retroviral therapy (ART) in public health facilities in Namibia in 2003 has improved the quality of lives of patients with advanced HIV disease, prolonged their lives and enabled them to be economically productive. By 2010 about 90,000 patients were enrolled on ART program in all 34 district hospitals and 3 intermediate referrer hospitals. Adherence to antiretroviral therapy is a key attribute of clinical HIV care and the overall determining factor in gauging the effectiveness of treatment. Good adherence to ART is vital to sustain low viral loads and prevent the development of drug resistant HIV strains. Although the patient retention rate on ART at the Katima Mulilo Hospital was 98.3%, with increased patient uptake to the program in future, there is a need to be aware of factors that influence adherence to ART as such findings could inform the expanded ART program in Caprivi region. An explorative, qualitative study was conducted where in-depth interviews were conducted with 24 ART patients and key informants interviews with 2 health workers. Data were audiotape recorded and transcribed verbatim. Thematic and content analysis of transcribed data was performed.

Magister Artium - MA / This study focused on acceptability of medical male circumcision (MMC) in Ohangwena region, Namibia. Since the scaling up of this program in public hospitals, no study was done with a specific focus on men who are the target population for this intervention. This study aimed at exploring the role of masculinities in MMC acceptance and specifically focused on circumcised men. To understand this context, I initially focused on general constructions of masculinity as well as the historical background of ritual circumcision which used to be practiced in this region. I spent three months at Engela District Hospital working with the male circumcision (MC) regional coordinator who is also the MC Nurse at the same hospital. Data collection process utilised an ethnographic study design involving qualitative research methods namely participant observation, formal and informal interviews and the use of field notes. Participants included men who visited the hospital for circumcision procedure, health workers and community elders. Findings indicate that, circumcision that is now offered in hospital settings is not a recognised marker of masculinity in Ohangwena. There is also paucity of information regarding traditional circumcision. Since its abolishment in the eighteenth century, little is known about the history of this practice. Contemporary means of being a man in this setting are situated in everyday circumstances and include work, being strong, independent and ability to fulfil family responsibilities. Thus, in this context notions of masculinity do not determine men’s responses to MMC. Instead, men are motivated by health benefits in accepting MMC. MMC’s proven ability to reduce HIV transmission by 60% is the primary reason why most men are willing to be circumcised. Other reasons include genital hygiene and correction of medical conditions related to the foreskin such as ulcers and lacerations. Men’s knowledge and understanding of the relationship between MC and HIV prevention also plays a role in MMC acceptance. Some concerns that were raised by men in relation to this intervention are pain and discomfort, fear of complications, decreased penile sensitivity, transfer of untruthful information and gender of circumciser. I regard these concerns as barriers to MMC acceptance. This thesis also argues that, the manner in which MMC is performed out in public health facilities in not gender sensitive since it is mostly done by women. This act in my view is likely to make men feel emasculated and thus discourage other men from taking up this voluntary service. This study therefore recommends similar research in other contexts to challenge speculations made about the likely impact of MMC on masculinity, because, in my research, uptake of MMC has nothing to do with constructions of manhood. I further recommend provision of standardised equipments and resources including human resources for efficient provision of this program countrywide.

Magister Public Health - MPH / The unprecedented increase in HIV and AIDS cases has trickled down to the already impoverished health sector, thus impacting health workers in various ways. In a shrinking health workforce, HIV/AIDS has created an extra demand and workload, emotional burden and stress among health workers. The study aimed to explore and describe nurses’ workplace stressors and coping strategies with regards to HIV/AIDS environment. The exploratory- descriptive study was qualitative in nature. Geita District Hospital was selected as it is the only health facility in the district that provides in-patient care services related to HIV/AIDS. The study population consisted of all nurses who work with HIV and AIDS patients and the managers providing support to nurses. The researcher interviewed twelve nurses and two key informants. Face to face interviews were conducted and a semi-structured interview guide was utilised to collect data. Thematic content analysis was utilised and themes were derived from the concepts that emerged during the process. Validity and trustworthiness of the study was established through triangulation and member checking. The findings of the study revealed that nurses in HIV/AIDS experience stress from the workplace. Nurses struggled with issues of death and dying, feared occupational exposure and found it difficult to cope with nursing shortage, increased workload and inadequate training. The nurses were generally disturbed by lack of organisational support and the unavailability of resources such as; basic medical supplies and protective equipment. Nurses seemed to be resorting more to positive reappraisal, planful problem solving and seeking social support strategies.

The present study sought to explore the functional changes that occur in the vasculature of HIV positive participants of African origin in Mthatha district of South africa which might lead to increased risk in their cardiovascular system. Available literature shows that arterial stiffness plays an important role in cardiovascular events such as stroke, vasculitis and myocardial infarction. Measurement of (aortic pulse wave velocity; PWV) provides some of the strongest evidence concerning the prognostic significance of large artery stiffening. This study was aimed at investigating the relationship between anthropometry, age, E-Selectin level, cytokine levels, haemodynamic variables, blood counts and blood lipid profile with pulse wave velocity. Some traditional cardiovascular risk factors such as alcohol, and smoking were also taken into account. This was a cross-sectional study comprising of 169 participants (62 males and 107 females). 63 were HIV negative (group A), 54 HIV positive on treatment (group B), and 52 were HIV positive not on treatment (group C). Pulse wave velocity (PWV) was assessed using the Sphygmocor Vx. Statistically, ANOVA was used for variables with normal distribution and non parametric tests were used for variables with skewed distribution. Notable significant differences were seen in the means of the following variables across all the 3 groups. The mean PWV value for group C (7.21±2.17) was greater than that for group B (6.84± 1.17) which in turn was more than group A (6.38±1.67); P=0.037. In participants who are HIV negative, In univariate analysis PWV correlated significantly with the following: Augmentation index; AIx (75): (r=0.850,p=0.004): Systolic aortic blood pressure; Spa: (r=0.635, p<.000); diastolic blood pressure; dbp: (r=0.436, p<0.000); aortic pulse pressure; Ppa: (r=0.472, p=0.000); Mean arterial pressure; MP: (r=0.446 p=<0.00) and age (r=0.606, p<0.000). In participants who are on HAART the following variables were positively correlated with PWV: Ppa: (r=0.338,p=0.012), MP: (r=0.400,p=0.400), monocytes (r=0.320,p=0.047). Neutrophils: (r=0.341,p=0.034), CD4: (r=-0.446,p=0.009). In participants who are HAART naïve and HIV positive the following correlated with PWV Spa: (r=0.369, p=0.012), MP: (r=0.400, r=0.003) Ppa: (r=0.338,p=0.012), waist to hip ratio: (r=0.319, p=0.037), platelets: (r=0.037, p=0.019), triglycerides: (r=0.490, p=0.002). With multiple linear regression Spa, age and triglycerides as the only independent and significant determinants of PWV among HIV negatives R2= 56.9% (adjusted R2=54.7%), model adjusted for gender, anthropometric parameters, HDL-C, TC, LDL-C, haematologic data, haemodynamic data, cytokines, smoking and alcohol. Only MP and waist circumference were identified as the most important and significant independent determinants of PWV in HIV positive participants not on treatment. Age, MP, HDL-C, and triglycerides were identified as the significant independent determinants of the variations of PWV in HIV positive participants on HAART. R2 =57 %(adjusted R2 =53.5%). Model adjusted for gender, anthropometric data, smoking, alcohol, cytokines, adhesion molecules, total cholesterol, LDL-C. Haematological data, CD4 count, and other haemodynamic parameters. For Aix(75) In HIV negatives the multiple linear regression model identified age (positive correlation), height (negative correlation), CD4 (positive correlation) and MP (positive correlation) as the independent and significant determinants of AIx (75) among HIV negatives. Spa and Age were independently and significantly associated with the variations of Aix(75) among HIV positives not on HAART. On the other hand height was negatively and significantly associated with Aix(75) amongst HIV positives not on HAART. After excluding confounding factors, height (negative correlation) age (positive correlation), MP (positive correlation, HDL-C (negative correlation), platelets (positive correlation) alcohol intake (excessive consummation associated with positive correlation) and TNFα (negative correlation) were identified as the independent and significant variables associated with increase in AIx(75) among HIV positive participants on HAART. Conclusion: This study showed that HIV infected patients with or without antiretroviral therapy have increase arterial stiffness which is associated with an increased cardiovascular risk. The sphygmocor is an accurate, non invassive and useful tool in the evaluation of arterial stiffness and its use in clinical practice should be encouraged. PWV and the augmentation index (AIx) are the two major non-invasive methods of assessing arterial stiffness. Life style modification should be incorporated into the management of HIV patients so as the continuous monitoring of their haematological and lipid profile.

Thesis (M. A. (Clinical Psychology)) -- University of Limpopo, 2015 / The purpose of this study was to find out if athletes who participate in soccer and rugby are aware of the risk of HIV infection in contact sports. The sample consisted of male rugby (n=23) and soccer (30) players registered at the University of Limpopo (Turfloop campus). The research was a quantitative in approach with a cross sectional survey design. A qualitative element, in the form of open-ended questions, made the study more holistic as participants were able to express their thoughts freely. Quantitative data were analysed using descriptive statistics (frequencies, percentage and bar-graphs). Thematic Content Analysis was used to analyse the qualitative data obtained from open-ended questions. Thirteen themes were gleaned from the data namely, prevention, well-being, medical assistance, confidentiality, discrimination, fear and anxiety, emotional support, strategy, participation, mandatory testing, risk and relationship ambiguity. Results of the study, both qualitative and quantitative, generally supported previous research in that there are gaps in HIV knowledge, although not statistically significant. Relationship behaviour in terms of an HIV positive diagnosis reflected ambiguity amongst the participants with some participants stating they would tell their partners but many being unsure or not prepared to tell their partners about their status for fear of the relationship ending.

The study focus on socio-legal dimension of medical data surveillance in the workplace on the example of the South African workplace response to HIV/AIDS. The strating point is the problem of growing data gathering and monitoring as an institutional feature of the information/surveillance society. Studying the problem in the context of workplace aims at indicating possibilities for social partners to respond to the new developments in the area of workplace surveillance and HIV/AIDS management in particular. The empirical data has been drawn from document analysis and interviews with trade union and business representatives from South Africa, involved in developing workplace response to HIV/AIDS. Particularly, the study is interested in identifying ways in which trade unions can make personal data treatment a trade union issue.

Submitted in fulfillment of the requirements of the Master of Arts in Counselling Psychology in the Department of Psychology, Faculty of Arts at the University of Zululand, South Africa, 2011. / A convenience sample of 10 HIV-positive lay counsellors from Africa International Research Centre, Mtubatuba, Zululand, participated in the study of humour therapy evaluation. Humour therapy was used as an intervention strategy, which took place in a group format. Three humour therapy sessions were conducted per week over a period of two weeks. Beck’s Anxiety Inventory was the chosen standardized instrument used to pre- and post-test anxiety levels of the participants. Individual interviews were also used to evaluate participants’ perceptions of humour therapy (pre- and post-intervention). Ninety percent of the participants found humour therapy to be effective, with the exception of one participant who on pre- and post-assessment had equal measurements, indicating no improvement or negative effects. A self-help tool was given to participants to utilize for a period of three months following the humour therapy intervention. Three of the ten participants chose not to use the self-help tool. Out of the seven participants who did make use of the tool, five found it helpful (maintained decreased anxiety levels), while two did not find it useful.

The study is an inquiry of sexual networks in the Johanne Marange apostolic community. The study is a conceptual shift in the study of HIV transmission, with focus moving beyond the individual and beyond the principles of desire, pleasure and procreation to a study of sexual networks which are social structures. The study identifies the type of sexual networks and further investigates the determinants of sexual networks in Marange community. Sexual networks are simply webs of sexual relations in a community or society and these webs of relations act as transmission highways for HIV. The study discusses all the complex interactions between the domain of society that is religion, culture, history and environment of the Marange community and uncovers how these aspects of society have influenced the shape and structure of sexual networks in the community. The study also emphasizes the importance of understanding sexual network structure as it influences the efficiency of HIV transmission and aims to contribute to a better understanding of sexual networks and HIV transmission.

No description available.

Thesis (MSc (Psychology))--Stellenbosch University, 2008. / As part of the South African government’s strategy to support those with HIV/AIDS and their relatives, HIV/AIDS service points have been established at Public Health Facilities. An increasing number of HIV-positive children and their caretakers receive treatment here. Indirectly the paediatric patients’ uninfected caretakers and the adult patients’ children also come into contact with the Public Health System during visits. The HIV-positive and uninfected children and caretakers form a heterogeneous HIV/AIDS-affected population, which may experience particular fears due to their particular circumstances. Circumstance-particular coping strategies may be necessary. Children do, however, also experience normative childhood fears and their coping strategies display developmental characteristics. Direct and indirect learning experiences furthermore may contribute to children’s experience of fear. The participants were 40 HIV/AIDS-affected children (M = 9.4 years; HIV-positive = 30.0%) and their caretakers (N = 34; M = 36.7 years; HIV-positive = 76.5%) who had been in contact with the Public Health System of the Western Cape Province, South Africa. There were five sub-objectives. Regarding the children the objectives were to consider, against the background of normative literature, whether the target group was a special population regarding their (1) fears and (2) coping strategies. Furthermore the objective was (3) to get to know the children’s world through their learning experiences. Concerning the caretakers the objectives were to explore their personal (4) fears and (5) coping strategies. In addition the caretakers’ perceptions about their children’s fears and coping strategies were gathered. The study was explorative and a mixed methodological research model was used. Data were gathered through individual interviews. The children also completed the Goodenough-Harris Drawing Test (GHD) and the caregivers a demographic questionnaire. Data were analysed by using a combination of qualitative and quantitative strategies. The children reported normative childhood fears, mainly of wild animals. A substantial minority of the children reported fears connected to crime, an unsafe transport system, death, illness, and HIV/AIDS and special circumstances were therefore identified. The children’s coping strategies were circumstance-specific and problem-focused avoidance reported most. Living in a modern society these children’s fears have also been influenced by for instance television. The fears and coping strategies reported by the children and their care-takers’ perceptions thereof, concurred. The caretakers’ personal fears mainly were connected to psycho-social needs and social roles, which stand central during adulthood. Specifically fears about the children’s welfare were reported most. The caretakers reported crime and animalrelated fears similar to their children. A search for social support as well as preventative action were the coping strategies that were reported most. A noteworthy preventative-action strategy seemed to be healthy eating habits, given the controversy about natural products being used as HIV/AIDS treatment within the South African context. The findings were integrated within a systems-theoretical framework. The fears and coping strategies of the HIV/AIDSaffected children and their caretakers were interpreted to be the result of an interaction between their personal characteristics and their social environment.