Dissertation (DPhil)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: The aim of this study was to develop a HIV intervention programme tailored for South African adolescents with visual impairments. A further aim was to pilot and evaluate this tailored programme. This investigation was deemed necessary in the light of the growing HIV pandemic in South Africa, which has proliferated over the last 10 years. Adolescents and young adults are among the most vulnerable to HIV infection, and this does not exclude adolescents with visual impairments. Despite the perceptions among sighted people of asexuality in adolescents with visual impairments, they are a vulnerable group for HIV infection. The motivation for this study is the fact that very little literature is available on HIV/AIDS and people with visual impairments, and that this vulnerable group is marginalized in HIV/AIDS campaigns internationally. As far as we could ascertain, there have been three HIV prevention initiatives for people with visual impairments in South Africa, none of which was fully researched and evaluated, and all of which used existing generic interventions but transcribed into Braille and large print format. The reality is, many adolescents with visual impairments, as is the case with sighted youths, are sexually active, and the absence of research on HIV prevalence and HIV prevention needs in this sector, is conspicuous. An urgent need exists to tailor HIV preventative programmes for this vulnerable sector. The dearth of research on HIV/AIDS and people with visual impairments motivated the choice of a key informant study to investigate the effects that HIV/AIDS and other concomitant issues have on persons with visual impairments, prior to the design of any intervention. A purposive sample of key informants who are working among people with visual impairments on a daily basis, most of whom had visual impairments themselves, was selected. Information gathered from the key informant study was combined with the lessons from a review of available literature on health promotion programmes and HIV prevention programmes in particular to develop an HIV/AIDS intervention programme to be piloted and evaluated for its effectiveness. The design of the programme took account, in addition, of broader contextual issues such as power and gender issues, and the marginalization and stigmatization of disabled people. The theoretical framework which forms the basis of the programme was informed by elements of a number of cognitive theories in the health promotion field, and especially the Informational-Motivational-Behavioural model (IMF). The programme was designed to empower participants and to create an environment of reallife experiences in which they could acquire important negotiation skills, decision-making skills, and practical skills to use condoms and HIV/AIDS knowledge to facilitate attitude and behaviour change. The next objective of this research was to implement the intervention programme of eight sessions designed for adolescents with visual impairments and to investigate the outcome on participants in this study. For this purpose an experimental design, one experimental group and three control groups (n= 56), not randomly assigned, was used to test the effect of the programme on participants in the intervention group compared to the control groups, who received a health promotion programme of four sessions. All participants were learners at the only two schools for learners with visual impairments in the Western Cape Province of South Africa, and they were allocated into treatment or control conditions on the basis of the school grades in which they were already placed. The empirical investigation utilized a questionnaire that was developed and transcribed into Braille as well as large print. Following a small pilot study, the questionnaire was finalized and administered to all four groups (pre-test, to determine baseline differences; post-test, to determine the immediate effect of the programme; and follow-up [3 months later] to determine longer term effectiveness). An analysis was done to assess the internal consistency of the measuring constructs of the questionnaire, and satisfactory internal consistency was found, with Cronbach’s alpha scores ranging between 0.72 and 0.92. Quantitative data were analyzing using multivariate techniques, beginning with a repeated measures MANOVA analysis and, once an overall significant F ratio between variables, time and groups (F=2.009, p<0.05); a significant F ratio between groups and variables (F=4.211, p<0.01), and significant F ratio between time and groups (F=2.611, p<0.01), had been found, we continued with more focused analyses. Baseline results revealed no statistical differences between the four groups. There were statistically significant improvements in knowledge of HIV/AIDS for both the experimental group and two of the control group, but these differences were not maintained at follow up. Significant differences in attitudes towards HIV/AIDS were found for the experimental group and for one of the control groups. Though there were significant changes in both knowledge and attitudes, therefore, it cannot be claimed that the intervention itself was responsible for knowledge and attitudinal change. There was some evidence for diffusion of innovation in terms of HIV knowledge from the experimental group and the control group situated at the same school. Changes in reported HIV risk behaviour were not recorded to a significant degree, a fact which may have been attributable in part to small sample size. Qualitative process information was used to get a sense of the experiences of participants and the concomitant issues they discussed during the intervention. The qualitative data revealed a host of contextual factors relevant to issues of HIV/AIDS and sexuality in this group, including experiences of stigmatization as people with visual impairment, negotiating masculinity in the context of visual impairment, gender oppression of women and resistance to this, and a general atmosphere of myths and silences around HIV/AIDS in particular and sexuality in general. Despite the limited impact of the programme, this pilot study revealed important issues for adolescents with visual impairments regarding HIV prevention which require further investigation. Participants in the experimental group indicated that they learned a lot from this programme and suggested that it be given to younger adolescents to enable them to acquire these vital skills prior to active sexual engagement and the involvement in any form of unprotected sex. A number or recommendations are made for further well-documented and evaluated research in this field. / AFRIKAANSE OPSOMMING: Die doel van die studie was om ’n MIV-intervensieprogram te ontwikkel wat op Suid- Afrikaanse adolessente met gesigsgestremdhede gemik is. ’n Verdere doel was om ’n proeflopie van die pasgemaakte program te doen en dit te evalueer. Hierdie ondersoek is nodig geag in die lig van die groeiende MIV-pandemie in Suid-Afrika, wat oor die afgelope tien jaar vinnig versprei het. Adolessente en jong volwassenes tel onder die kwesbaarstes vir MIV-infeksie, en dit sluit nie adolessente met gesigsgestremdhede uit nie. Ongeag die persepsies omtrent aseksualiteit in adolessente met gesigsgestremdhede onder diegene wat nie gesigsgestremd is nie, is eersgenoemde ’n kwesbare groep vir MIV-infeksie. Die motivering vir hierdie studie is die feit dat baie min literatuur vir mense met gesigsgestremdhede beskikbaar is, en dat hierdie kwesbare groep wêreldwyd in MIV/VIGSveldtogte gemarginaliseerd is. Sover ons kon vasstel, was daar drie MIV-voorkomingsinisiatiewe vir mense met gesigsgestremdhede in Suid-Afrika, waarvan nie een ten volle nagevors en geëvalueer is nie, en wat almal bestaande generiese intervensies gebruik het wat in Braille en grootdruk-formaat omgesit is. Die werklikheid is dat baie adolessente met gesigsgestremdhede – nes die geval is met jeugdiges sonder gesigsgestremdhede – seksueel aktief is en dat die afwesigheid van navorsing oor MIV-voorkoms en MIVvoorkomingsbehoeftes in hierdie sektor opvallend is. Daar is ’n dringende behoefte aan pasgemaakte MIV-voorkomende programme vir hierdie kwesbare sektor. Die gebrek aan navorsing oor MIV/vigs en mense met gesigsgestremdhede het die keuse van ’n sleutelinformantstudie gemotiveer om die invloed wat MIV/vigs en ander gepaardgaande kwessies op mense met gesigsgestremdhede het, voor die ontwikkeling van enige intervensie te ondersoek. ’n Doelgerigte steekproef van sleutelinformante wat op ’n daaglikse grondslag onder mense met gesigsgestremdhede werk, waarvan die meeste self gesigsgestremd is, is gekies. Inligting wat van die sleutelinformantstudie verkry is, is gekombineer met die lesse uit ’n oorsig van die bestaande literatuur oor gesondheidsbevorderingsprogramme – in die besonder MIV-voorkomingsprogramme – om ’n MIV/vigs-intervensieprogram te ontwikkel wat as loodsprojek kon dien en wat vir doeltreffendheid geëvalueer kon word. Die ontwerp van die projek het, daarbenewens, ag geslaan op breër kontekstuele kwessies soos mags- en genderkwessies en die marginalisering en stigmatisering van mense met getremdhede. Die teoretiese raamwerk wat die grondslag vir die program vorm, is op elemente van ’n aantal kognitiewe teorieë op die gebied van gesondheidsbevordering, en spesifiek die inligtingmotivering- gedragsmodel geskoei. Die program is ontwerp om deelnemers te bemagtig en om ’n omgewing van lewenservaringe te skep waarbinne hulle belangrike onderhandelings-, besluitnemings- en praktiese vaardighede kon ontwikkel om kondoomgebruik te bevorder, asook kennis omtrent MIV/vigs om houdings- en gedragsverandering te fasiliteer. Die volgende doelwit van hierdie navorsing was om die intervensieprogram van agt sessies wat vir adolessente met gesigsgestremdhede ontwerp is, te implementeer en om die resultate ten opsigte van die deelnemers aan die studie te ondersoek. Met hierdie doel voor oë is ’n eksperimentele ontwerp – een eksperimentele groep en drie kontrolegroepe (n=56), wat nie ewekansig toegewys is nie – gebruik om die invloed van die program op deelnemers in die intervensiegroep te toets teenoor dié op die kontrolegroepe, wat aan ’n gesondheidsbevorderings-program van vier sessies deelgeneem het. Alle deelnemers was leerders by die enigste twee skole vir leerders met gesigsgestremdhede in die Wes-Kaap, Suid-Afrika. Hulle is op grond van die skoolgraad waarin hulle reeds geplaas is, aan behandelings- of kontroletoestande toegewys. Die empiriese ondersoek het ’n ontwikkelde vraelys gebruik wat sowel in Braille getranskribeer is as in grootdruk gedruk is. Ná afloop van ’n klein loodsstudie is die vraelys gefinaliseer en aan al vier groepe toegedien (voortoets, om die basisverskille vas te stel; na-toets, om die onmiddellike invloed van die program vas te stel; en opvolg [3 maande later] om doeltreffendheid op langer termyn vas te stel). ’n Ontleding is gedoen om die interne konsekwentheid van die meetkonstrukte van die vraelys te assesseer: voldoende interne konsekwentheid is gevind, met Cronbach se alfapunte wat tussen 0.72 en 0.92 gewissel het. Kwantitatiewe data is met behulp van meervariaattegnieke ontleed. Eers is ’n herhaaldemeting- MANOVA-ontleding gedoen en daarna – nadat ’n algeheel beduidende F verhouding tussen veranderlikes, tyd en groepe (F=2.009, p<0.05); ’n beduidende Fverhouding tussen groepe en veranderlikes (F=4.211, p<0.01) en ’n beduidende F-verhouding tussen tyd en groepe (F=2.611, p<0.01) gevind is – is dit deur meer gefokusde ontledings gevolg. Basislynuitslae het geen statistiese verskille tussen die vier groepe getoon nie. Daar was statisties beduidende verbeteringe in kennis oor MIV/vigs in sowel die eksperimentele groep as die twee kontrolegroepe, maar hierdie verskille is nie met die opvolgtoets volgehou nie. Beduidende verskille in houding jeens MIV/vigs is by die eksperimentele groep en een van die kontrolegroepe gevind. Hoewel daar beduidende veranderinge in sowel kennis as houdings gevind is, kan daar nie beweer word dat die intervensie self vir die kennis- en houdingsveranderinge verantwoordelik was nie. Daar was ’n mate van bewys vir diffusie van innovering wat betref kennis oor MIV van die eksperimentele groep en die kontrolegroep by dieselfde skool. Veranderinge in aangemelde MIV-risikogedrag is nie in ’n beduidende mate aangeteken nie, ’n feit wat gedeeltelik aan die beperkte grootte van die steekproef te wyte kan wees. Inligting uit ’n kwalitatiewe proses is gebruik om ’n indruk te skep van die ervaringe van deelnemers en gepaardgaande kwessies wat hulle tydens die intervensie bespreek het. Die kwalitatiewe data het ’n reeks kontekstuele faktore blootgelê wat vir kwessies van MIV/vigs en seksualiteit in hierdie groep tersaaklik is, met inbegrip van ervaringe van stigmatisering as mense met gesigsgestremdhede, die hantering van manlikheid binne die konteks van gesigsgestremdheid, genderonderdrukking van vroue en weerstand hierteen, asook ’n algemene atmosfeer van mites en stilswye oor MIV/vigs in die besonder en seksualiteit in die algemeen. Ten spyte van die beperkte impak van die program het hierdie loodsstudie belangrike kwessies vir adolessente met gesigsgestremdhede betreffende MIV-voorkoming blootgelê wat verdere ondersoek noodsaak. Deelnemers in die eksperimentele groep het aangedui dat hulle baie uit hierdie program geleer het en het voorgestel dat dit aan jonger adolessente aangebied word om hulle in staat te stel om hierdie noodsaaklike vaardighede te ontwikkel voordat aktiewe seksuele betrokkenheid en betrokkenheid by enige vorm van onbeskermde seks plaasvind. ’n Aantal aanbevelings vir verdere goed gedokumenteerde en geëvalueerde navorsing op hierdie gebied word gemaak.

Submitted in fulfillment of the requirements of the degree of Masters in Public Management, Durban University of Technology, Durban, South Africa, 2016. / South Africa is facing a universe challenge in managing HIV/AIDS epidemic as it is the worst affected country in the world with the largest number of people affected and infected with HIV/AIDS. While significant numbers of stakeholders have come on board to help the South African government fight the disease, the setting up of effective and efficient Monitoring and Evaluation (M&E) systems has been a challenge. The study focussed on Monitoring and Evaluation (M&E) systems of Non-Governmental Organisations (NGOs) managing HIV/AIDS in the uMngeni Local Municipality. NGOs normally operate using resources from funders who in turn requires robust accountability of their fund utilisation. Robust accountability can only be achieved by reporting with the aid of an effective and efficient M&E system. The aim of the study was to evaluate the current M&E systems of NGOs implementing HIV/AIDS programs in the uMngeni Local Municipality; investigate the reporting mechanism of NGOs implementing HIV/AIDS programmes; identify monitoring and evaluation challenges faced by NGOs implementing HIV/AIDS programmes in the uMngeni Local Municipality, KwaZulu Natal; and to make recommendations for the improvement of M&E implemented by NGOs. A questionnaire was distributed to senior managers at NGO’s in the uMngeni Local Municipality, KwaZulu Natal, South Africa. The data collected were analysed with SPSS version 22.0.The results were presented in the form of graphs and cross tabulations, with other figures being used for data collected from open ended questions. The study revealed that NGOs managing HIV/AIDS in the uMngeni Local Municipality face a number of challenges including a lack of statistical skills; a shortage of qualified staff; a lack of M&E knowledge; a dearth of M&E systems within organisations; inadequate resources; a lack of commitment by staff members; poor stakeholder involvement; poor quality data; and a lack of appropriate M&E tools. The results of the study also revealed that NGOs managing HIV/AIDS programmes in the uMngeni Local Municipality were not referring to best practices when managing M&E systems for their programmes. Recommendations were drafted using the findings of the research, literature reviewed and best practices for monitoring and evaluating HIV/AIDS programmes. It is highly recommended that through more effective capacity building, NGOs managing HIV/AIDS programmes in the uMngeni Local Municipality will be able to improve existing M&E systems. Designing of the M&E plan along with stakeholder involvement is also crucial in managing HIV/AIDS M&E systems. The allocation of adequate resources for M&E activities should be prioritised for approximately ten percent of the total programme budget. Indicators should be carefully selected and aligned to collect relevant data. NGOs managing HIV/AIDS in the uMngeni Local Municipality could also monitor and evaluate programme activities on a regular basis. They should also have a standard of operation procedure (SOP) for data quality management. Emphasis on programme data quality could also be an action point for effective management of HIV/AIDS M&E system and this can be further strengthened by conducting data quality audits. Finally, NGOs managing HIV/AIDS programmes in the uMngeni Local Municipality should disseminate M&E findings to stakeholders and use data to make informed programme decisions. / M

Thesis (MTh)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The HIV and AIDS epidemic has affected the whole South African society, including the church. The dilemma of adequate reaction to the effects of HIV andAIDS on the pastoral responsibilities of the church is posing serious questions to the church in South Africa as it deals with the care of those affected by the epidemic. The HIV and AIDS epidemic is challenging the church to re-investigate its own traditional way of help and support and to realise that the Christian faith community needs to be part of the team-approach in the fight against HIV and AIDS.A holistic approach to healing will lead us to a new and different understanding of the diakonia of the church (nuwe en anderverstaan van diakonaat). This study will investigate how care can be administered in such a way that it becomes meaningful to both the infected, affected and those involved in administering care. It will require an ecclesiology that is informed, formulated and structured from the bottom-up rather than the traditional top-down approach. It will be what we can call a ―base-community‖ ecclesiology. This thesis will therefore, in the light of the challenges that the HIV and AIDSepidemic presents, put forward an ecclesiology formulated on the ground, a grassroots ecclesiology other than the official or traditional formal ecclesiology: an ecclesiology not only directed towards the members of the specific church (membership diakonia), but an ecclesiology focused on the broader community in which the church is located: a communal diakonia. This thesis argues that in light of the HIV and AIDSepidemic, this is a wake-up call for a new ecclesiology that will lead to the kind of diaconate described above. A bold new manner of ecclesiological being/structure is required: a new openness, frankness, boldness (parrhēsia) in dealing with HIV and AIDS. This parrhēsiawill come from the empowered members of the church as they become the caregivers in the community. Home-based care as it is practised at present runs the risk of a one-sided approach with its main focus on the physical wellbeing of the person. An ecclesiology of grassroots care and identity-formation is needed to fill this void. The research investigates how a theology of affirmation can be integrated into the system/practice of home-based care to become a meaningful part of the help or assistance given to the individual and his/her household. Furthermore, the study explores how pastoral care and counselling to the HIV positive person and his/her household can be enriched through the application of a paradigm of praxis to the least in society in home-based diakonia by applying a theology of affirmation, so as to affirm and restore dignity, give meaning to life and the process of death and ultimately provide answers to the quest for identity and affirmation through an ecclesiology of grassroots care. This study is also a call for a paradigm shift with regard to ecclesiology and diakonia in the South African church that may have a profound effect on the church in South Africa. This shift must happen in three areas: 1. The church must become actively involved in home-based care as part of its ministry and calling to the world amidst the HIV and AIDSepidemic. The church can no longer be a bystander or advisor, or at best a supporter of government and civil actions. Every congregation needs to become active within the community they serve through joint/combined and innovative ways with other churches in their areas in establishing an ecclesiology of grassroots care. 2. The diakonia of the church must change. Every member must realise their full potential of utilising their Holy Spirit gifts and fruit in order to serve/minister in the Kingdom of God. Diakonia can no longer be the responsibility of a few ordained or commissioned for the diaconate. The whole church must become active in service to their community and those living around the church. The church needs to break the chains of membership-diakonia and open the arms of Christian love to everyone in need, even those who hates us. 3. Perhaps the biggest challenge is the call to change our way of being church in South Africa: our ecclesiology. We must admit that we have come to love the church more than we love God and that we forgot that God so loved the world not the church! This realisation will make it possible to become open to the proposal of this thesis: that we become church from the bottom up, that we start to practice a grassroots ecclesiology. / AFRIKAANSE OPSOMMING: Die MIV en VIGS epidemie het ʼn invloed op die ganse Suid Afrikaanse samelewing, insluitend die kerk. Die dilema van voldoende reaksie op die gevolge van MIV en VIGS op die pastorale verantwoordelikheid van die kerk stel enstige vrae aan die kerk in haar versorging van diegene wat deur die epidemie geaffekteer word. Die MIV en VIGS epidemie daag die kerk uit tot ʼn herondersoek van tradisionele maniere van hulpverlening en ondersteuning asook tot ʼn gewaarwording dat die Christelike geloofsgemeenskap deel moet vorm van ʼn span verband in die stryd teen MIV en VIGS. ʼn Holistiese benadering tot genesing sal lei tot ʼn nuwe en ander verstaan van diakonaat. Hierdie studie is dus ʼn ondersoek na hoe sorg op so ʼn wyse bedien kan word dat dit betekenisvol vir beide die geinfekteerde, ge-affekteerde en diegene betrokke in die hulpverlening kan wees. So ʼn benadering vereis ʼn ekklesiologie wat belig, geformuleer en gestruktureer word vanaf grondvlak in plaas van die tradisionele bo-na-onder benadering. Ons kan so ʼn benadering ʼn basis-gemeenskap (―base-community‖) ekklesiologie noem. Hierdie tesis sal dus, in die lig van die uitdagings wat die MIV en VIGS epidemie stel, ʼn ekklesiologie geformuleer op grondvlak (―a grassroots ecclesiology‖) anders as die amptelike of tradisioneel formele ekklesiologie aanbied: ʼn ekklesiologie wat nie slegs gerig is op lidmate van ʼn spesifieke kerk (lidmaatskap-diakonia) nie, maar ʼn ekklesiologie gefokus op die breë gemeenskap waarin die gemeente haarself bevind: ʼn gemeenskaps-diakonia. Die argument in die tesis is dat die MIV en VIGS epidemie ʼn wekroep is tot ʼn nuwe ekklesiologie wat mag lei tot die soort diakonia hierbo beskryf. ʼn Brawe, nuwe manier van ekklesiologie word dus vereis: ʼn nuwe openheid, waaragtigheid, moedigheid (parrhēsia) in die wyse waarop ons met MIV en VIGS omgaan. Hierdie parrhēsia sal tot stand kom deur die bemagtigde lede van die kerk soos wat hulle versorgers van die gemeenskap word. Tuisversorging soos wat dit tans bedryf word, loop die risiko van ʼn eensydige benadering wat hoofsaaklik konsentreer/fokus op die fisieke gesondheid van die persoon. Ons benodig n voetsoolvlak-ekklesiologie wat gerig is op identiteits-formering en –bevestiging om hierdie gaping te vul. Die navorsing ondersoek dus hoe ʼn teologie van bevestiging (theology of affirmation) geintegreer kan word in die sisteem of bedryf van tuisversorging om sodoende ʼn beduidende deel van die hulpverlening of bystand aan die individu en sy/haar huishouding uit te maak. Verder ondersoek die navorsing hoe pastorale sorg en berading aan die MIV en VIGS positiewe persoon en sy/haar huishouding verryk kan word deur die toepassing van ʼn paradigma van praksis (diakonia) aan die minste in die samelewing deur tuisversorging en die toepassing van ʼn teologie van bevestiging, sodat menswaardigheid opnuut bevestig of/en herstel kan word; die lewe en die proses van sterwe en dood betekenisvol kan wees, en daar uiteindelik antwoorde gevind kan word in die soeke na identiteits-bevestiging deur ʼn diakonia vanuit n ekklesiologie op voetsoolvlak. Die navorsing is ook ʼn oproep tot ʼn paradigma-skuif met betrekking tot ekklesiologie en diakonia in die Suid Afrikaanse kerk wat verreikende gevolge vir die kerk in Suid Afrika inhou. Hierdie skuif moet in drie areas plaasvind: 1. Die kerk moet aktief betrokke word in tuisversorging as deel van haar bediening en roeping in die wêreld temidde van die MIV en VIGS epidemie. Die kerk kan nie langer voortgaan om toeskouer of raadgewer, of ten beste ʼn ondersteuner van staats- en siviele aksies te wees nie. Elke gemeente moet aktief binne haar gemeenskap dien deur gesamentlike en innoverende aksies ten opsigte van versorging en hulpverlening met ander kerke in die selfde area/gebied sodat ʼn grondvlak ekklesiologie tot stand gebring word. 2. Die diakonia van die kerk moet verander. Elke lid moet sy/haar potensiaal besef en die gawes en vrug van die Heilige Gees aanwend in diens van die Koninkryk. Diakonia mag nie langer die verantwoordelikheid van ʼn paar bevestigdes of gekommandeerdes vir diakonie wees nie. Die hele kerk moet diensbaar word in die gemeenskap en diegene wat rondom die kerk bly. Die kerk moet dus die kettings van lidmaat-diakonia breek en hul arms van Christelike liefde oopmaak vir elke persoon in nood, selfs diegene wat ons haat. 3. Miskien is die grootste uitdaging die oproep om die wyse waarop ons kerk bedryf in Suid Afrika te verander: ons ekklesiologie. Ons sal moet erken dat ons die kerk meer lief het as vir God en dat ons vergeet het dat God die wêreld liefhet en nie net die kerk nie! Hierdie gewaarwording sal dit moontlik maak om onsself ontvanklik te kan maak vir die voorstel van die tesis: dat ons kerk word van die grond-af-op in plaas van kerk van-bo-af—dat ons begin om ʼn voetsoolvlak ekklesiologie in werking te stel.

Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2009. / This thesis is about children who are vulnerable in the context of HIV/AIDS. The epidemic leaves children vulnerable in a number of ways. The education sector is confronted with vulnerable children and this has caused the roles and responsibilities of teachers to be extended. The research is aimed at determining whether teachers see a role for themselves in this context that extends beyond formal education and also to find out how teachers view this role. The research was conducted at three schools in the Llingelethu community in Malmesbury: a pre-primary school (the Siphumeze Educare Centre), a primary school (Naphakade Primary School) and a high school (Naphakade Secondary School). The research determined that teachers do feel that they have a role in this context, but there were also those who felt that other role players must rather fulfil this role. One of the most important findings of the research was that teachers often view their role in the context of HIV/AIDS in a limited way. In this regard, teachers often think only in terms of children who are infected by die virus, while not taking into account children who are affected in other ways. Teachers, as well as schools, also often still focus on their role in HIV/AIDS prevention. A further aim of the research was to determine which challenges prevent teachers from playing an extended role in the lives of vulnerable children. The participants in the research identified various challenges, including those that are a result of keeping HIV status secret, because of stigma and a lack of trust. A further challenge that was identified is a lack of background information about learners, sometimes as a result of the fact that teachers do not come from the community. Factors that make it difficult for teachers to conduct follow up work were also identified, as well as emotional exhaustion and other facors that prevent teachers from playing an extended role. A lack of support was also identified by participants as a challenge and different dimensions of support were identified.

Thesis (PhD (Physics))--Stellenbosch University, 2009. / ENGLISH ABSTRACT: This dissertation investigates certain key aspects of mathematical modeling of HIV and TB epidemics in South Africa with particular emphasis on data from a single well-studied community. Data collected over a period of 15 years (1994 to 2009) in Masiphumelele, a township near Cape Town, South Africa are used to develop a community-level mathematical model of the local HIV-TB epidemic. The population is divided into six compartments and a system of di®erential equations is derived to describe the spread of the dual epidemic. Our numerical results suggest that increased access to antiretroviral therapy (ART) could decrease not only the HIV prevalence, but also the TB noti¯cation rate. We present a modeling framework for studying the statistical properties of °uctuations in models of any population of a similar size. Viewing the epidemic as a jump process, the method entails an expansion of a master equation in a small parameter; in this case in inverse powers of the square root of the population size. We derive two-time correlation functions to study the correlation between di®erent types of active TB events, and show how a temporal element could be added to the de¯nition of TB clusters, which are currently de¯ned solely by DNA type. We add age structure to the HIV-TB model in order to investigate the demographical impact of HIV-TB epidemics. Our analysis suggests that, contrary to general belief, HIV-positive cases are not making a substantial contribution to the spread of TB in Masiphumelele. We develop an age-structured model of the HIV-TB epidemic at a national level in order to study the potential impact of a proposed universal test and treat program for HIV on dual HIV-TB epidemics. Our simulations show that generalized ART could signi¯cantly reduce the TB noti¯cation rate and the TB-related mortality rate in the short term. The timescale of the impact of ART on HIV prevalence is likely to be longer. We study the potential impact of more conventional control measures against HIV. Guidance for possible future and/or additional interventions emerge naturally from the results. We advocate a reduction in intergenerational sex, based on our ¯nding that 1.5-2.5 standard deviation in the age di®erence between sexual partners is necessary to create and sustain a major HIV epidemic. A simulation framework is developed to help quantify variance in age-structured epidemic models. The expansion technique is generalized to derive a Fokker-Planck equation. Directions for future work, particularly in terms of developing methods to model °uctuations and validate mixing assumptions in epidemiological models, are identi¯ed. / AFRIKAANSE OPSOMMING: Hierdie proefskrif ondersoek aspekte van die wiskundige modelering van HIV en TB epi- demies in Suid Afrika en fokus ook op 'n spesi¯eke gemeenskap. Data wat oor 'n periode van 15 jaar ingesamel is (1994 tot 2009) in Masiphumelele, 'n woonbuurt naby Kaapstad, Suid Afrika word gebruik om 'n wiskundige model te skep wat HIV-TB in die gemeen- skap modeleer. Die populasie word in ses kompartemente verdeel en 'n stel di®erensiaal vergelykings word afgelei om die verspreiding van di¶e epidemies te ondersoek. Ons nu- meriese resultate toon aan dat verhoogde toegang tot antiretrovirale behandeling (ARB) die potensiaal het om HIV prevalensie die TB koers beduidend te laat daal. Ons ontwikkel 'n raamwerk waarmee die statistiese eienskappe van °uktuasies ondersoek kan word in enige populasie van dieselfde grootte. Die metode ontwikkel 'n meester vergelyking vir die on- derliggende geboorte-dood stogastiese proses en brei dit uit in terme van 'n klein parameter; in di¶e geval in inverse magte van die vierkantswortel van die populasie grootte. Die twee-tyd korrelasie funksies word afgelei, en word gebruik om die korrelasie tussen verskillende tipes van TB episodes te bestudeer, asook om te wys hoe 'n tydselement aan die de¯nisie van TB groeperings gegee kan word. Di¶e word tans slegs d.m.v DNA tipe geklassi¯seer. Ouderdom- struktuur word aan die model toegevoeg om die demogra¯ese impak van HIV-TB epidemies te bestudeer. Ons analise toon aan dat, anders as wat algemeen aanvaar word, maak HIV- positiewe gevalle nie 'n groot bydrae tot die verspreiding van TB in Masiphumelele nie. Ons ontwikkel 'n ouderdom-gestruktureerde model van HIV-TB op nasionale vlak en gebruik die model om die potensiÄele impak van 'n universele toets- en behandel strategie op die HIV-TB epidemies te ondersoek. Ons simulasies toon aan dat algemene ARB waarskynlik 'n groot impak op die TB aanmeldings koers asook die TB-verwante mortaliteits koers kan h^e binne 'n relatiewe kort tydperk. Die impak op HIV prevalensie sal eers oor 'n veel langer periode duidelik word. Ons ondersoek ook die moontlikheid van meer konvensionele beheermaa- treels. Ons ontmoedig tussengenerasie seksuale omgang, gegrond op ons bevinding dat 'n standaard afwyking van 1.5-2.5 in die ouderdoms verskil tussen seksuele vennote, nodig is om 'n HIV epidemie van stapel te stuur en te onderhou. Ons ontwikkel 'n simulasie raamwerk om variansie in ouderdomgestruktureerde modelle te benader. Die uitbreidingstegniek word veralgemeen om 'n Fokker-Planck vergelyking af te lei. Ons identi¯seer probleme in die on- twikkeling van metodes om interaksie patrone en °uktuasies te modeleer in epidemiologiese modelle as opgawe vir toekomstige werk.

Policy is a rule to guide decisions and achieve rational outcomes while advocacy is a strategy to influence architects of decision making or policy makers when they make regulations and laws, distribute resources, and make other decisions that affect peoples' lives. The principal aims of policy advocacy as postulated by Kervatin in 1998 are to create policies, reform policies, and ensure policies are implemented. This study examines the role of civil society in policy advocacy, using the Treatment Action Campaign (TAC) as an example. Therefore, the study uses a content analysis method of data collection and analysis to explicate the various advocacy strategies employed by the Treatment Action Campaign to advocate for access to HIV/AIDs treatment in post-apartheid South Africa. The policy advocacy strategies of the TAC were investigated pertaining to the implementation of health policy on HIV/AIDS in South Africa. There are a variety of advocacy strategies employed by civil society organisations, such as discussing problems directly with policy makers, delivering messages through the media, or strengthening the ability of local organisations to advocate. These strategies are known as advocacy tools for planning successful advocacy initiatives. Most of them are clearly reflected in the case of the TAC organisation, which employed these strategies and others to advocate for HIV/AIDS policy change. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

A thesis submitted to the Faculty of Humanities, University of Witwatersrand, Johannesburg, South Africa in fulfilment of the requirements of the Degree of Doctor of Philosophy in the field of Demography and Population Studies. / Background: In exploring the relationship between migration and HIV/AIDS, a focus of earlier studies was on the role of the mobile population in the geographical spread of the disease. There has been a shift in this perception and the focus now is on the implications of being a migrant. A body of literature has developed on the risk of migrants contracting HIV, but only a few studies have examined the AIDS/TB mortality risk as a consequence of migration, with the results showing that migrants have higher chance of dying of AIDS/TB compared to their non-migrant counterparts. However, these studies mainly looked at the impact of migration on mortality due to AIDS/TB and did not make provision for the presence of other causes of death. Therefore, this study is geared towards investigating migration as it relates to death caused by AIDS/TB, longitudinally, and in the presence of other causes such as non communicable diseases, other infectious diseases, and external causes of death, in rural South Africa. Specifically, the study addressed the following questions: (i) What is the risk of dying from AIDS/TB among migrants in rural South Africa in the presence of other causes of death? (ii) How does this relationship compare with the relationship between migration and other causes of death? (3) What are possible predictors of the relationship between migration and AIDS/TB in the presence of other causes of death? Method: This research project is part of a longitudinal study of the inhabitants of the Agincourt sub-district, situated in the rural north-eastern part of South Africa. The study utilises the Agincourt Health and Demographic Surveillance System data spanning 12 years, starting from 1st January, 2000 to 31st December, 2011. The main target group for the study is individuals aged 20 to 69 years at the date of analysis. The selected individuals are divided into the following categories: (i) the return migrants who returned after spending a period of time outside the study area; (ii) the in-migrants who moved into the study location for the first time, and (iii) the permanent residents (non migrants). A six month residence threshold period is used to distinguish participants from ordinary visitors. The migration status categorical variable was further expanded from three to five categories with in-migrant and return migrant categories being split to accommodate short and long-term durations of exposure. In the year 2000, the baseline year, a total of 25,621 individuals who met the entry criteria were recruited into the study. For data analysis, a Fine and Gray model is used, which is a variant of a Cox proportional hazard model, to estimate the competing risk of dying among the selected participants by sex. The causes of death (CoD) variable was categorised into the following broad categories: “AIDS/TB”, “Non Communicable Disease”, “External cause” and “Other infectious disease”, with indeterminate causes coded as missing. The five categories of migration serve as the independent variable, with permanent residence acting as the reference group, while the broad Cause of Death categories are the main dependent variables. Other dependent variables are: period, nationality, education and socio-economic status. Results: This first set of results aims to address the question on the risk of AIDS/TB mortality among migrants in rural South Africa in the presence of other causes of death. The findings are that male and female short-term return migrants have significantly higher relative risk of dying of AIDS/TB death when compared to their non-migrants counterparts with sub-hazard ratio (SHR) of 4.87 (95% CI 4.17-5.72; P<0.001) and 5.44 (95% CI 4.64-6.38; P<0.001)) reported for both gender group respectively. For male and female long-term return migrants, their SHR was 1.80 (95% CI 1.43-2.26; P<0.001) and 2.06 (95% CI 1.57-2.70; P<0.001) respectively. The results did not reveal significant results for the in-migrants. The second set of results aims to address the second research question, which is, how does the relationship between migration and mortality caused by AIDS/TB in rural South Africa in the context of other causes of death compare with the relationship between migration and causes different from AIDS/TB. The results show that Short-term return migrants have higher mortality than non-migrants, whatever the four causes of mortality. For instance, the competing risk of death due to AIDS/TB for short-term return migrants compared to non-migrants showed a lower SHR for external cause of death, namely 8.78 (95% CI 5.86-13.16; P<0.05) vis-à-vis non-migrants. This implies that the difference in the relative risk of mortality between migrants and non migrants is even higher for external causes than for AIDS/TB. The same is applicable to the risk of death from other infectious diseases for females, which has a SHR of 4.97 (95% CI 2.50-9.89; P<0.05) in the competing risk model. The relative risk of death due to AIDS/TB for male is 4.87 (95% CI 4.14-5.72 P<0.001) while that of female is 5.44 (95% CI 4.64-6.38; P<0.001); respectively. With regards to the question on the possible predictors of the relationship between migration and AIDS/TB in the presence of other causes of death, it is shown that period is one of the predictors of the relationship between migration and AIDS/TB mortality. And, it is relevant to the study participants who died as a result of AIDS/TB, NCDs and other infectious diseases. In general, the risk dwindles in the latter period when the antiretroviral drugs become available for AIDS/TB. Nationality is also a determinant of the relationship and it is applicable to those who lost their lives due AIDS/TB (female only), NCDs and other infections (female). In all, the Mozambican nationals are less likely to die in comparison with the South Africans. Educational status is a predictor and it relevance cuts across virtually all the causes of death. The dominant pattern that is revealed in this context is that the higher the level of education, the lower the risk of death due to any of the causes. The predictive impact of SES can only be felt among the respondents whose death was due to AIDS/TB and NCDs (female only). Conclusion: With circular labour migration in South Africa showing no evidence of declining and with the attendant mortality risks due to AIDS/TB and other causes, and needs to be carefully considered - in policies aiming to control mortality in South Africa. Disease-induced migration creates burdens not only for the left-behind families in terms of their means of livelihood through loss of remittances, but also for the burden on health care facilities in the rural area. With short-term labour migrants being a high risk group, the success of intervention programmes addressing the problem of HIV infection and the resultant mortality implication, such as ‘treatment as prevention’ programmes, can only be guaranteed by recognising the risks incumbent on this group of people and the influence of the larger communities. / XL2018

Thesis (M. Cur.) --University of Limpopo, 2011. / HIV/AIDS is one of the major challenges facing South Africa today. Over 5.5 million people are infected with HIV and the majority of these infections are in the reproductive age group. Since the start of the epidemic, over 12.2 million women worldwide have been infected with HIV (WHO, 2000:10). The risk of women contracting HIV is rising globally. HIV seems to be a major cause of infant mortality. It is estimated that approximately 55% of women in South Africa are HIV-positive (National Department of Health, 2007:7). It is, therefore, important that knowledge and attitudes of women regarding mother-to-child transmission (MTCT) of HIV infection are explored to reduce the high infant mortality rate and the incidence of MTCT of HIV infections, and to develop preventive programmes on HIV and AIDS. In view of these considerations, the objectives of this study were to explore and describe the knowledge and attitudes of women with regard to MTCT of HIV infection and to provide guidelines for the prevention of MTCT of HIV infection. The study was conducted in the rural area of the Ehlanzeni District in the Mpumalanga Province, South Africa at Bourke’s Luck and Elandsfontein clinics. An explorative, descriptive, qualitative research design that is contextual in nature was used. The population consisted of all pregnant women and those in pueperium between 25-40 years of age. Non-probability purposive sampling was used. Participants were selected according to inclusion criteria. Data were collected using semi-structured interviews. The research findings revealed that some participants had knowledge and understanding regarding MTCT of HIV infection while others lacked knowledge and understanding which could impact on MTCT of HIV infection.

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.