How may the mental health of socially deprived HIV/AIDS affected communities be supported in an era of ‘global mental health’? To date, ‘community’ efforts have been informed by a largely biomedical and epidemiological body of evidence, distracting attention from lived realities, local contexts and their abilities to frame understandings of mental distress and treatment. This thesis seeks to contribute a productive critique of the Global Mental Health field, by expanding on some of the missing dimensions in their conceptualisations of health and healing. Through a focus on social psychological processes of community, knowledge and social change, it formulates a series of suggestions for how the Movement for Global Mental Health (MGMH) and other policy actors can build on their existing efforts, through establish health enabling contexts where communities actively participate in addressing mental distress, and tackling the contexts that constitute distress in locally relevant ways. The thesis reports on a case study of KwaNagase (Manguzi), an HIV-affected rural community in KwaZulu-Natal, South Africa. It takes interest in the intersection of three respective groups, exploring how they understand, cope with, and work together in efforts to support mental well-being: 1) poor HIV/AIDS affected women experiencing mental distress; 2) community level supports (local NGOs and traditional healers); and 3) public health services (primary health sector). Data was collected over a three month period using multiple methods. In-depth individual interviews (n = 43) were triangulated by a motivated ethnography (Duveen and Lloyd, 1999) that explored local cultural, structural and symbolic contexts of community that frame understandings of mental health and delivery of care. Grounded thematic analyses identified that women’s understandings of mental distress were shaped by experiences of poverty, violence and HIV, which in turn, limited their ability to meet normative expectations linked to gender roles of ‘mother’ and ‘wife’. Indigenous psychosocial coping strategies employed by women to tackle the aforementioned drivers of distress were underpinned by the presence or absence of social psychological resources that optimise health and well-being: agency, partnerships, critical thinking and solidarity. Primary mental health care actors’ (NGOs and formal health service actors) understandings of women’s distress were informed by an awareness of the structural and symbolic issues facing women in everyday life, aligning with the women’s own understandings. Their best practices highlighted efforts to establish receptive social spaces – a critical dimension of health enabling contexts but were limited by symbolic and structural barriers such as stigma among providers, and general under-resourcing of the sector. To overcome the limits facing community mental health services in Manguzi and similar contexts, the thesis concludes by highlighting a series of suggested actions to bolster identified community mental health competencies, and provides a tool kit of recommended strategies to support existing public sector efforts to promote mentally healthy communities.

Thesis (M. A. (Social Work)) -- University of Limpopo, 2004. / The aim of this study was to explore the impact of culture on the prevention and reatment of HIV/AIDS amongst people in low-resourced areas like Malamulele. he study focused on the lifestyles, beliefs, attitudes and perceptions around ultural elements and practices, which might impact negatively on the prevention nd treatment of the HIV/AIDS epidemic. There were three groups of research espondents namely: learners from three high schools in Malamulele, some arents of the learners and the traditional/cultural leaders. The researcher ollected both qualitative and quantitative data. The data was gathered through he use of an interview schedule (questionnaire), focus group discussions and ound-table discussion sessions. The data was presented, analysed and nterpreted by means of tables and charts. t was found that people in low-resourced (rural) areas have little knowledge about HIV/AIDS, causes, symptoms and how the disease is transmitted. Despite the fact that awareness and educational campaigns and programmes are being rendered, people in low-resourced (rural) areas have little knowledge and needed skills about prevention and treatment of the pandemic. Polygamy and extra-marital relations by men is still highly valued and viewed at high esteem. Religious structures seem to be detached to the issue of HIV/AIDS as they mentioned that talking about HIV/AIDS is immoral and against their principles. The study also tried to explore the extent to which people in low-resourced areas view and use condoms as a protective means.

Thesis (MPH.) --University of Limpopo, 2011 / Objectives: To assess the extent of HIV and AIDS related stigma among health care professionals, to identify factors that cause attitudes and perception towards HIV and AIDS related stigma and to determine if HIV and AIDS influence stigma. Study design: A descriptive cross sectional survey. Settings: Tshilidzini Hospital in Limpopo Province, South Africa. Subjects: A total of two hundred and sixty five health care professionals participated in the study. The study employed convenience sampling, when collecting data. The majority of health care professionals were females (77.7%). The average age of participants was 39.5 years with a standard deviation of 9.6. Outcome measures: Subject’s demographic information was determined by use of questionnaire. Age, gender educational level and race were included. Attitudes and perception towards HIV and AIDS patients were also assessed. Analysis: Data were analyzed by SPSS windows version 15.0. Means and frequencies were calculated. ANOVA and T test were employed to assess the comparison of attitudes between health care professionals. Findings: The results showed that the majority of health care professionals do not have negative attitudes towards people living with HIV and AIDS. Out of 265 health care professionals, 69% agreed that they needed to eliminate shame and rejection associated with HIV and AIDS, and 84% indicated that they needed more training to be more sensitive to the needs of people living with HIV and AIDS.Conclusion: Findings from the study showed high positive attitudes and perception among health care professionals towards people living with HIV and AIDS. Government should make provision of protective clothing a priority to reduce the perceived risk of HIV infection. Government should also introduce HIV and AIDS education at the primary level of health care.

Thesis (Ph.D. (Psychology)) -- University of Limpopo, 2012 / The aim of the study is to determine factors contributing to HIV and AIDS stigma among young adults at Polokwane municipality in the Capricorn district of Limpopo Province, South Africa. A total number of 325 participants were involved in the survey and five focus groups were involved in the qualitative study. The participants’ ages were between 18 and 25 years. Biographical information entailing 14 items was used. Ten questions were used in five focus groups. For the survey, a nine-item stigma questionnaire was used as an independent variable. Dependent variables were the following scales: HIV knowledge, knowing a person with HIV and AIDS, family communication and perceived HIV and AIDS risk. The quantitative analysis shows that knowledge of HIV and AIDS, acquaintance with People Living with HIV and AIDS (PLWHA), gender and socio-economic status, as well as stigmatisation of people living with HIV and AIDS, significantly influence stigmatisation of PLWHA. On the other hand, knowledge of one’s own status, affiliation to religion, family communication, perceived risk and cultural attachment played a limited role in the stigmatisation of people living with HIV and AIDS. In view of the above findings, efforts need to be made to review programmes that are undertaken to create awareness about HIV and AIDS to improve HIV transmission knowledge. Constant interaction among PLWHA should be encouraged since this serves as a buffer to combat stigmatisation of PLWHA. There is a need for further research on gender, to explore in-depth reasons for stigmatisation of PLWHA, especially from females. Research also needs to be done in future to determine the factors that influence people from a high socio-economic level to stigmatise of PLWHA.

Thesis (MPA) --University of Limpopo, 2007 / HIV and AIDS pandemic poses a threat to both poor and rich communities alike. Communities face a developmental challenge as HIV and AIDS kills the lives of people who should improve their socio-economic position. It destroys both the Constitutional rights to life and human dignity. This is seen when people get sick and lose their potential to contribute to the development of their communities. The Fetakgomo communities, in the Limpopo Province, face the same challenge of fighting the pandemic for their social and economic development without sufficient resources. This study focuses on the socio-economic impact of HIV and AIDS on community development in Fetakgomo Municipality, Limpopo Province. Fetakgomo communities are situated about ± 90 km, South of Burgersfort. These communities are mostly poor and rural. The researcher used non-probability purposive sampling for this study. Three communities were selected and their leaders were chosen to participate in the study. Through qualitative research, the qualitative data were obtained through person to-person interviews and focus group interviews. The results of the study indicate that the social lives of community members are disrupted through death from the pandemic. In the two communities – Ga-Nchabeleng and Mohlaletse – there are orphans who are created by the pandemic. There is also a problem of lack of social cohesion created by prejudice around the disease, which raises a challenge in fighting the pandemic in the three villages. The issue of confidentiality compounds the situation in fighting the pandemic among members of the three communities as people are not open to talk freely about the impact of the pandemic on their lives. Economically, the pandemic is impacting on a few families that lose their incomes and are unable to buy electric services. The final results indicate that the impact of the pandemic is arguably very low. The communities are shown not to be doing enough to fight the impact of the pandemic. Even if the three communities are economically poor, the pandemic does not have serious impact on their material possessions. There is no real economic impact as members of the three communities are poor and at the same time a few families are affected in terms of losing their incomes. The impact of the pandemic is only experienced on the social lives where it breeds prejudice and secrecy among the people.

The purpose of this research was to explore HIV/AIDS stigma in the workplace, with a special focus on the stigmatised. The sample consisted of 10 HIV/AIDS positive employees. A qualitative interview schedule was designed. The interview guide was used to facilitate one-on-one interviews with each participant. An analysis of the data revealed that the majority of the participants were shunned by family, friends and partners. Others were too ashamed or afraid to reveal their positive status. The majority of the participants did not feel comfortable revealing their positive status to their line managers and to their co-workers. All participants felt that others viewed people living with HIV/AIDS as dirty and unclean and many had been exposed to stigmatising behaviours towards them due to their HIV/AIDS positive status. As a coping mechanism, most participants noted that they would walk away if stigmatised against. Recommendations were made to address HIV/AIDS stigma in the workplace. / Industrial & Organisational Psychology / M. A. (Industrial and Organisation Psychology)

The study aimed to develop an in-depth understanding of the challenges faced by social workers rendering Occupational Social Work (OSW) services, particularly in establishing and maintaining workplace support groups for employees living with HIV and AIDS. The study used a qualitative research approach, aided by exploratory, descriptive and contextual research design. Data was collected from eight participants with semi-structured interviews and was analyzed by applying eight steps for data analysis as proposed by Tesch, cited in Creswell (2003:191). Data verification was done by applying Guba’s model (in Krefting, 1991). The themes, which emerged from the interviews, were: the recruitment of members in workplace support groups and the challenges faced by social workers rendering OSW services. The findings indicate that, critical as their roles may be, social workers experience numerous challenges when providing workplace HIV and AIDS support groups. These include HIV and AIDS disclosure, management, organisational and logistical challenges / Social Work

Purpose of the study - Identify predictors of mortality and develop a related care plan for patients who are on antiretroviral therapy (ART) in Gondar, Ethiopia. Design - A quantitative, retrospective cohort study was conducted analysing medical records of HIV patients who presented to Gondar University Hospital (GUH), Gondar, and started ART between 1 January 2007 and 30 June 2010. Results - In defining the predictors of mortality, the findings in bivariate analysis revealed: female sex, CD4 cell count ≤ 50/μl, CD4 cell count 51-199/μl, a haemoglobin concentration ≤8g/dl, a history of oral candidiasis, tuberculosis and Cryptococcus meningitis were all statistically significant. A female sex, CD4 cell count ≤ 50/μl and CD4 cell count 51-199/μl maintain their significance level in the multivariate analysis. Conclusions - The study therefore recommends that clinicians and case managers be vigilant of these predictors of mortality while managing HIV patients who are on ART / Health Studies / M.A. (Public Health)

Thesis (Ph. D. (Sociology)) -- University of Limpopo, 2014. / This study investigated the challenges to antiretroviral therapy adherence. Qualitative and quantitative research methodologies were applied in the study. Purposive sampling was used to select clients on antiretroviral therapy, convenience sampling was applied to select clients who participated in the focus group discussions and health care workers and lay counsellors were selected through the simple random sampling method. In-depth interviews were conducted with 31 clients on antiretroviral therapy at 8 health facilities, 2 focus group discussions comprising of 7 members each were conducted at two health facilities, medical records of all respondents on antiretroviral therapy were reviewed and a stigma scale was administered. A questionnaire was distributed amongst 17 health care workers and lay counsellors. Most of the respondents who participated in this study were females. Data gathered in this study confirmed that women are more vulnerable to HIV than men. The majority of the respondents were poor African people. The predominant language amongst the respondents was the Xitsonga language; hence the world-view of the Va-Tsonga people was assessed. HIV and AIDS cause many social problems in communities. Some of the major findings are that: Literacy levels were found to be very low as most of the respondents pointed out that they had only obtained grade 7 or below. However, this did not have an impact on treatment adherence. Some respondents indicated that they were unemployed; the majority said they were employed. Even though the stigma and discrimination experienced by the respondents was very low, the few who experienced it had very traumatic and cruel experiences perpetrated by their own family members and people in the community. In terms of disclosure, data indicates that most people prefer disclosing to their mothers as they feel that they will get support. The majority of the respondents disclosed to female family members and they were supported by the people they disclosed to. viii Social support is very crucial for people who are on antiretroviral therapy (ART), most of the respondents indicated that they had treatment supporters. Institutional support was very minimal in that most pointed out that they did not belong to any support groups. There were some who did not even know about the existence of any support groups at the health facilities where they were receiving their treatment. Most of the respondents indicated that they disclosed to their colleagues and others had not as they feared that they would lose their jobs. Those who had disclosed indicated that they needed support from their colleagues and employers with regard to compliance with their clinic appointments. Most of the respondents had sexual partners, and had also disclosed to their sexual partners, and disclosure was almost immediately after being diagnosed HIVpositive. There are those who had not disclosed to their sexual partners as they feared rejection or violent reaction. There were sero-discordant couples amongst the respondents who supported each other regarding adherence. Most of the respondents indicated that they had taken care of a family member living with HIV. HIV prevalence also varies amongst health facilities. Strategies employed by health facilities to monitor and evaluate HIV and AIDS programmes differ. Health Care Workers and lay counsellors provided contrasting information. Primary Health Care facilities have been accredited to provide ART, however the down-referral system seems to be failing as some clinics now have more clients on ART than hospitals. Health Care Workers and counsellors also need to be familiarized with the World Health Organization (WHO) standards. The level of adherence acceptable for an individual on ART is 95%; there is however health facilities that indicated the adherence level far below the required level.

Thesis (MPH.) -- University of Limpopo, 2015 / Background: The introduction of Antiretroviral Therapy (ART) has shown a tremendous reduction in HIV-related mortality and morbidity in people living with HIV / AIDS. Adherence to ART is the key to a successful treatment outcome. This study investigates the adherence of people living with HIV who are on ART. Since high levels of adherence of more than 95% are required to achieve effective suppression of the viral load, the researcher finds it very important to establish whether the people are pursuing what is expected of them. While the use of ART has brought much excitement and hope to both patients and medical practitioners in the world, it has also brought many new questions and challenges, including adherence issues. Adherence is, therefore, essential to achieve the success of ART. Aim: The main objective was to determine which factors influence adherence to ART among HIV and AIDS patients. Methods: This study utilised a quantitative cross-sectional descriptive design that was conducted at the Kwa-Thema Clinic, Ekurhuleni District, Gauteng Province. Data was collected using a structured questionnaire with open- and closed-ended questions where a total of 290 respondents were interviewed. Data was analysed using SPSS software version 22 and the analysed data was presented by means of charts, graphs, and frequency tables. Results: The findings indicated that the adherence to ART at the Kwa-Thema Clinic was 77%. Factors that were significantly associated with adherence were gender ((χ2 = 3.78, df = 1, p < 0.05).), level of education ((χ2 = 3.52, df = 3, p = 0.032), co-treatment of HIV and other infections (χ2 = 5.46, df = 4, p = 0.019).), ability to follow ART ((χ2 = 12.82, df = 1, p = 0.000 < 0.05), and types of ARV drugs. Recommendation: To enhance ART adherence the study recommends intensification of health education campaign against stigma and gender discrimination. Providing feedback to the patients by the healthcare providers regarding the benefits of ART is important. ix Conclusion: It was concluded that the adherence to ART at the Kwa-Thema Clinic was sub-optimal (less than 95%) at 77% but comparable to the adherence levels in other developing countries.