Since early 1983, the incidence and prevalence of heterosexually transmitted AIDS among women have increased at an alarming rate. However, due to the conceptualization of AIDS as a "gay male" disease, little research attention has been devoted to the prevention of HIV infection among women. The purpose of the current intervention was to test the utility of extending a behavioral social influence/diffusion of innovation approach to a group of heterosexual women. A randomized experimental field design was used to compare a community intervention (AIDS education materials plus the training of individuals identified as key opinion leaders to serve as peer behavior change agents) with a comparison intervention (AIDS education materials alone). The study was conducted at a small liberal arts college for women. Two dormitories were randomly assigned to either an intervention or comparison condition. Twenty-four women, living in the intervention dormitory, were identified as key opinion leaders among their female peers. These key opinion leaders then received information concerning the basic epidemiology of AIDS and other STDs, misconceptions about the transmission of AIDS/STDs among heterosexual women, gender constraints that impact health behavior change among women, and practical risk reduction strategies. Opinion leaders also received training in specific conversation skills to endorse HIV-protective behavior and to convey a change in normative sexual behavior to women living in the intervention dormitory. At pre- and post-intervention, 580 surveys were collected from both the intervention and comparison dormitories. Using an anonymous identification code, survey data were matched for 192 comparison and intervention participants. The major dependent variables included (a) AIDS/STD risk behavior knowledge, (b) perceived risk, (c) perception of peer norms for HIV-risky and HIV-protective behaviors, (d) stage of health behavior change, (e) intentions to practice safer sex, (f) socially and sexually assertive behavior, (g) HIV-risky sexual behavior, and (h) alcohol and drug use. Condom-taking behavior provided a nonreactive measure of behavioral intentions. A number of direct training effects were found for the key opinion leaders, including an increase in AIDS/STD risk behavior knowledge, conversation skills, and empathic assertion. However, there was no change in behavioral intentions, stage of change, perceptions of peer norms for HIV-protective behavior, or reported HIV-risky behavior. Analysis of covariance on posttest scores, using pretest scores as covariates, showed that, relative to the comparison participants, the intervention participants increased their AIDS/STD risk behavior knowledge and the number of AIDS/STD related peer conversations. No other treatment effects due to diffusion of innovation were found. The rate of risky sexual behavior for the intervention period was relatively low. However, descriptive statistics revealed a pattern of HIV-risky behavior in the current sample suggesting that HIV/STD risk may increase over time as a function of unprotected vaginal and oral intercourse and serial monogamy. The implication of these findings are discussed in terms of future interventions targeting heterosexual women. / Ph. D.

This thesis explores the history of AIDS activism 'from both sides of the bed', by doctors and gay patients, in the 1980s and early 1990s. Such AIDS activism was formed in opposition to dominant racist and homophobic framings of the epidemic and the AIDS-related discrimination that these representations caused. Moreover, links between both groups of AIDS activists have their origins in this period. This history has emerged through oral interviews conducted with AIDS activists and an analysis of archival material held at the South African History Archive and the Centre for Health Policy at the University of the Witwatersrand. Evidence reveals that AIDS activism was politically overshadowed in the 1980s by the overwhelming need to respond to apartheid. Although the Gay Association of South Africa (GASA) resisted AIDS-related homophobia, it was politically conservative, which later led to its demise, and then the creation of new, more militant anti-apartheid gay AIDS activism. By contrast, the anti-apartheid doctor organisations such as the National Medical and Dental Association (NAMDA) and the National Progressive Primary Health Care Network (PPHC) were militantly anti-apartheid, but did not seriously address AIDS in the 1980s. In the early 1990s, in the new transitional context, AIDS activists framed the epidemic in terms of human rights to combat AIDS-related discrimination in AIDS policy. Simultaneously, doctor activists in NAMDA and PPHC mobilised around AIDS in the early 1990s, but both organisations disbanded after 1994. Meanwhile, gay AIDS activists remained prominent in AIDS activism, as some who were living with HIV adopted the strategy of openness about their HIV status. On the other hand, AIDS-related stigma remained widespread in the transition era with important implications for post-apartheid AIDS activism and policy-making. Ultimately, this history has significantly shaped post-apartheid, rights-based AIDS activism and its recent disputes with the government over AIDS policy. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2004.

Thesis (M.Tech.: Biomedical Technology)-Dept. of Biomedical Technology, Durban University of Technology, 2007 xxiii, 244 leaves / In 2004, it was reported that KwaZulu-Natal had the greatest number of HIV infected people, approximately 1.8 million people, of whom an estimated 450 000 were in need of antiretroviral drug therapy based on their Cluster of Differentiation 4 (CD4) counts and clinical status. Studies on the success of antiretroviral drugs in improving the quality of life in HIV infected individuals have been extensively performed and published. However, there are no published data on the effect that immune boosters have in improving the quality of life in such persons. Considering the side effects, toxicity, multi-drug regimens and drug resistance problems associated with antiretroviral therapy, alternative or supplementary therapies may play an important role in improving the quality of life in HIV infected people. Such therapy might help in situations where some patients who qualify for antiretroviral treatment are unable to access them because of several reasons such as long waiting lists, travelling costs, unwilling to take antiretroviral drugs, etc. Some patients have reservations in taking antiretroviral drugs. The stigma associated with the disease may be a major factor. The aim of this study was to investigate the change in the immune status of HIV infected patients that were on the Inochi New Medicine immune booster, as well as, to assess the safety and efficacy of this immune booster in improving the patients’ quality of life.

Thesis (MBA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: No disease in modern times has created as much fear and panic as HIV/AIDS - undoubtedly one of the most formidable public health problems facing South Africa today. Traditionally, HIV/AIDS has not been regarded as a workplace issue, except for "high-risk" professions such as surgeons, dentists and emergency medical technicians. The stark reality is that HIV/AIDS will have an impact on all sectors of society and all aspects of human activity throughout South Africa. Because of the nature of the spread of the disease, it hits predominantly sexually active people. These are the people that make up the workforce. It can therefore be expected that HIV/AIDS will impact directly on the patterns of employment in South Africa. Furthermore, the economic consequences of the epidemic will result in pressures on the South African economy, which again will influence employment. Apart from affecting the general population, HIV/AIDS will have a direct impact on businesses in various areas. HIV/AIDS will also have a significant impact at community level that will, in turn, impact on businesses. If business in South Africa is to survive, these impacts have to be managed so that productivity can be maintained and costs can be contained. The objective of this study is to explore the impact of HIV/AIDS on employment by examining the South African labour market. From the study, it is clear that South Africa is certain to experience severe consequences arising from the HIV/AIDS epidemic. Even without taking the immense impact of HIV/AIDS into account, there are various problems facing the' South African labour market. Specific problems discussed are unemployment, low productivity and a shortage of skills. These are not the only problems associated with the South African labour market, but the extent of these problems is further exacerbated by the impact of HIV/AIDS. All sectors of the society need to be mobilised into action. This action must encompass both prevention of the spread of the disease, as well as caring for the sick and dying. / AFRIKAANSE OPSOMMING: Geen ander siekte in die moderne tyd het al soveel vrees en paniek geskep as MIV/VIGS nie ongetwyfeld een van die mees formidabele gemeenskapsgesondheidsprobleme wat Suid-Afrika huidiglik in die gesig staar. Oorspronklik was MIV/VIGS slegs met die werksplek geassosieer in terme van "hoë-risiko" beroepe soos dokters, tandartse en nood mediese personeel. Die naakte waarheid is dat MIV/VIGS 'n impak sal hê op alle sektore en aspekte van die samelewing in Suid-Afrika. As gevolg van die aard van die verspreiding van die siekte, tref dit hoofsaaklik seksueel aktiewe persone. Hierdie persone is die lewensaar van die arbeidsmag. Dit kan dus verwag word dat MIV/VIGS 'n direkte impak op werkverskaffingspatrone in Suid-Afrika sal hê. Die ekonomiese gevolge van die epidemie sal verdere druk veroorsaak op die Suid-Afrikaanse ekonomie, wat op sy beurt werkverskaffing sal beïnvloed. Buiten die impak van MIV/VIGS op die algemene bevolking, sal die siekte ook in verskeie areas van die besigheidsektor 'n uitwerking hê. Verder sal MIV/VIGS 'n aansienlike impak op gemeenskapsvlak hê, wat op sy beurt weer 'n uitwerking sal hê op besighede. As besighede in Suid-Afrika wil oorleef, moet hierdie aanslae so bestuur word dat produktiwiteit gehandhaaf word en kostes onder beheer gehou word. Die oogmerk van hierdie studie is om die impak van MIV/VIGS op werkverskaffing te ondersoek deur na die Suid-Afrikaanse arbeidsmark te kyk. Van die studie is dit duidelik dat Suid-Afrika ernstige konsekwensies as gevolg van die MIV/VIGS epidemie kan verwag. Selfs sonder om die ontsaglike impak van MIV/VIGS in ag te neem, is daar verskeie probleme wat die Suid-Afrikaanse arbeidsmark in die gesig staar. Spesifieke probleme wat bespreek word is werkloosheid, lae produktiwiteit en 'n tekort aan gespesialiseerde vaardighede. Alhoewel hierdie nie die enigste probleme is wat met die Suid-Afrikaanse arbeidsmark geassosieer word nie, word die spesifieke probleme vererger deur die impak van MIV/VIGS. Wat vereis word is dat alle sektore van die samelewing moet oorgaan tot aksie. Hierdie aksie moet beide die voorkoming van die verspreiding van die siekte, sowel as die versorging van die siekes en sterwendes omvat.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: HIV/AIDS is considered as a global problem with the number of people living with HIV infection continuing to increase. At the end of 2007 HIV/AIDS had already claimed 25 million lives. Of all new HIV infections 71% were diagnosed in the Sub-Saharan region in 2008, remaining the worst affected region globally. UNAIDS (2008:43) indicated that heterosexual intercourse remained the main origin for HIV infection in the Sub-Saharan region. Therefore the researcher is of the opinion that prevention strategies should focus mainly on sexual transmission of the disease. HIV/AIDS affects mainly people between the ages 15-24 years, notably the age group of most of the learners in Higher Education Institutions (HEIs). Lesotho, a country in the Sub- Saharan region, presents with the third highest HIV adult prevalence (23.2%) in the world and in the region. In an attempt to address the prevailing situation, Lesotho has a number of programmes geared towards addressing HIV/AIDS in the country. However, all these attempts exclude the learners in HEIs, yet the majority of learners are found within the most affected age group. It is also to be noted that Higher Education provides the bedrock for socio-economic and political development in Africa. Some studies have identified insufficient knowledge as being at the root of the increasing HIV infections among youth. However, other studies have shown that there is adequate knowledge among the young people, but still a challenge remains and that is to facilitate changes in behavioural patterns as a component to be linked to the knowledge. Studies conducted in other African countries have shown that there are anti-AIDS programmes and clubs for learners in HEIs where learners are involved in the fight against HIV/AIDS. No publication indicating the same for Lesotho’s HEIs could be found, except for the National University of Lesotho (NUL) that only launched its HIV/AIDS policy for learners in 2009. The researcher is of the opinion that HEIs in Lesotho are not doing enough to combat HIV/AIDS and hence intends to focus on HEIs in Lesotho. This study had two objectives namely:  To determine the knowledge of learners in a specific HEI in Lesotho regarding HIV/AIDS prevention and care.  To explore the needs of learners in a specific HEI in Lesotho regarding HIV/AIDS prevention and care. This mixed method study was conducted, comprising of both quantitative and qualitative designs. Quantitative phase used a questionnaire for determining the knowledge of learners. The questionnaire was adopted from a study that was performed to determine knowledge of South African educators in public schools with some modifications. The qualitative phase was used to explore the needs of the learners through the focus group discussions with the leaders of the learners. Sample was drawn from the entire population using stratified random sampling for the quantitative phase. The qualitative phase used the purposive sampling to obtain in-depth information concerning learners’ needs. Quantitative data was analysed through the use of statistical package for social sciences (SPSS) and qualitative data was analysed using the thematic analysis and open-coding. All ethical principles were adhered to especially the principle of respect for persons. The findings from the quantitative phase of the study showed that learners had adequate knowledge regarding HIV/AIDS prevention and care and the findings from the qualitative phase showed the various needs of the learners with regards to prevention and care of HIV/AIDS in a specific HEI in Lesotho. Recommendations have been proposed based on the findings from the two phases of the study. Limitations observed by the researcher have also been identified. In conclusion the objectives of the study were met and the research questions had been answered. / AFRIKAANSE OPSOMMING: MIV/Vigs word as ‘n internasionale probleem erken, siende dat daar ‘n verhoging in die toename van MIVgeïnfekteerde indiwidue tans is . Einde 2007 het MIV/Vigs het reeds 25 miljoen lewens ge-eis . In 2008 is 71% van al die nuwe MIV-infeksies in die Sub-Sahara streek gediagnoseer, wat aandui dat die streek die mees geaffekteerde streek tans is. UNAIDS (2008:43) het aangedui dat heteroseksuele omgang die hoofoorsaak van MIV-oordrag in die Sub-Sahara-streek is. Laasgenoemde het daartoe gelei dat die navorser van mening is dat voorkomende strategieë meestal op seksuele oordrag van die siekte moet fokus. MIV/Vigs affekteer meestal mense in die ouderdomsgroep 15-24, opmerklik is dit die ouderdomsgroep waarby meesste leerders in Hoëronderwysinstellings (HOI) is. Lesotho, ‘n land in die Sub-Sahara-streek, het tans die derde-hoogste MIV-voorkoms (23.2%) in die wêreld en in die streek. Lesotho het verskeie programme ontlont om MIV/Vigs te bekamp in ‘n poging om die huidige situasie te beredder . Nieteenstaande sluit al die programme leerders in HOI uit, alhoewel die leerders in die ouderdomsgroep van die mees-geaffekteerde groep val. Dit is ook duidelik dat Hoëronderwys die fondasie vir sosio-ekonomiese- en politieke ontwikkeling in Afrika verskaf. Sommige studies het onvoldoende kennis as die wortel van die verhoging van MIV-infeksies onder die jeug geïdentifiseer. Ander studies, daarenteen, wys dat kennis voldoende is onder jeug, alhoewel veranderinge in gedragspatrone om by die kennis aan te sluit ‘n uitdaging bly. Studies uit ander Afrikalande dui daarop dat daar anti-Vigs programme en klubs is waarby HO leerders betrokke is om teen die verspreiding van MIV/Vigs te veg. Geen publikasies in hierdie verband word in Lesotho aangetref nie, behalwe ‘n MIV/Vigs-beleid wat in 2009 deur “National University of Lesotho’ (NUL) gepubliseer is. Dus is die navorser van mening dat HOI nie genoeg doen om MIV/Vigs te beveg nie, daarom fokus sy op HOI in Lesotho. Hierdie studie het twee doelstellings ten doel gehad, naamlik om die leerders in ‘n sekere HOI in Lesotho se kennis aangaande MIV/Vigs voorkoming en sorg te bepaal en die behoeftes van die leerders aangaande MIV/Vigs voorkoming en sorg te verken. ‘n Studie met beide kwantitatiewe- en kwalitatiewe metodes is gebruik om die doelstellings te verwesenlik. In die kwantitatiewe fase is ‘n vraelys gebruik om leerders se kennis te bepaal. Die vraelys is verkry uit ‘n vorige studie wat in RSA gedoen is, maar aangepas om in die Lesotho-konteks te gebruik. Gedurende die kwalitatiewe fase is fokusgroep besprekings met die leiers van die leerders gehou om die behoeftes indiepte te verken. Die steekproef was uit die totale populasie getrek deur van gestratifiseerde streekproefneming gebruik te maak in die kwantitatiewe fase en ‘n doelgerigte steekproefneming is in die kwalitatiewe fase te gebruik. Die navorser het ‘n kwantitatiewe data-analise sagteware (SPSS)gebruik om kwantitatiewe data te ontleed en tematiese- oopkodering is gedurende die kwalitatiewe fase gebruik. Etiese kode is ten volle gerespekteer, veral die respek vir mense gedurende navorsing. Bevindinge van die kwantitatiewe fase het bewys dat leerders voldoende kennis aangaande die voorkoming en sorg van MIV/Vigs besit en die kwalitatiewe bevindinge het die behoeftes van leerders met betrekking tot die voorkoming en sorg van MIV/Vigs in ‘n spesifieke HOI in Lesotho geopenbaar. Die aanbevelings is gemaak, gebaseer op die bevindinge uit die twee fases. Beperkinge in die studie is uitgelig. Ter afsluiting is die doelstellings in die studie bereik en die navorsingsvrae beantwoord.

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: The vast majority of new Human Immunodeficiency Virus (HIV) infections in infants and young children occur through mother-to-child-transmission (MTCT), either during pregnancy, labour or delivery or by breastfeeding. Without access to perinatal MTCT (PMTCT) programmes approximately 30% of all babies born annually will be infected with HIV. OBJECTIVES The aim was to implement and audit a quality improvement cycle at the Worcester Obstetric Unit, which comprises of Worcester Hospital, a regional hospital in the Western Cape Province and its level one midwife obstetric Unit (MOU), in order to improve the quality of the PMTCT programme. The intervention included the implementation of easy changes and tools in the Antenatal Clinic, Infectious Diseases Clinic and Labour ward. METHODS The files and antenatal records of all HIV positive patients and patients with an unknown HIV status, who delivered at the Worcester Obstetric Unit during January, February and March of 2010 and 2011, were reviewed. All HIV negative patients and patients that had stillbirths and miscarriages were excluded. The pre-interventional findings of 2010 were compared with the post-interventional findings of 2011. RESULTS At the Worcester Obstetric Unit, for the study time period, there were 907 deliveries in 2010, of which 102 (11.2%) patients were HIV positive and 4 (0.4%) had an unknown HIV status compared to 2011, with 865 deliveries of which 108(12.5%) patients were HIV positive and no patients had an unknown HIV status. Significantly more patients were diagnosed with HIV before they fell pregnant than during pregnancy in the 2011 group, when compared with the 2010 group. A CD4 count was done on 94% of patients who were newly diagnosed with HIV and those with an unknown CD4 count result in the 2010 group, compared to 92% in 2011. There was a significant improvement after the intervention in the time it took from when blood was drawn for a CD4 count until the result was followed up, the median time decreased from 34 to 8 days (p=0.000001). Significantly more patients qualified for highly active antiretroviral therapy (HAART) after the guidelines were changed and the CD4 cut off was increased to 350 cells/l (p=0.001). Prior the intervention 18 patients did not receive the correct management before delivery due to preventable reasons, compared to one at the MOU. After the intervention this decreased significantly to only one patient at Worcester Hospital and none at the MOU (p=0.000001). Before the intervention adherence to the PMTCT protocol at the MOU was significantly better than at the hospital (p=0.0005) and after the intervention there was no significant difference (p=1.0). CONCLUSION Although the audit and quality improvement cycle was performed at a single hospital, with specific changes geared towards their needs, the basic principles can be applied to any Unit in the country providing a PMTCT service. Educating staff, creating awareness and reminding staff of the basic principles of PMTCT, implementing small changes and streamlining processes and setting specific goals or timelines, can lead to significant improvements in care, which ultimately will lead to a decrease in PMTCT of HIV and HIV related maternal and infant morbidity and mortality. / AFRIKAANSE OPSOMMING: Die oorgrote meerderheid (>90%) van nuwe Menslike Immuniteitsgebreksvirus (MIV) infeksies in babas en jong kinders vind plaas deur middel van moeder-na-kind-oordrag, hetsy gedurende swangerskap, die kraamproses of borsvoeding. Sonder toegang tot perinatale voorkomingsprogramme (PMTCT) sal ongeveer 30% van alle babas jaarliks met MIV geïnfekteer word. DOELWITTE Die doel van die studie was om ‘n gehalteverbeteringsiklus by die Worcester Verloskunde Eenheid, wat bestaan uit Worcester Hospitaal, 'n streekshospitaal in die Wes-Kaapprovinsie en sy vlak een vroedvrou verlossingseenheid (VVE), te implementer en daarna te oudit, om sodoende die gehalte van die PMTCT-program te verbeter. Die intervensie het bestaan uit die implementering van eenvoudige veranderinge en prosesse in die voorgeboortekliniek, infeksiesiekte-kliniek en kraamsaal. METODES Die lêers en voorgeboorte rekords van alle MIV-positiewe pasiënte en pasiënte met 'n onbekende MIV-status, wat gedurende Januarie, Februarie en Maart van 2010 en 2011 verlos het by die Worcester Verloskunde Eenheid, is nagegaan. Alle MIV-negatiewe pasiënte en pasiënte met doodgebore babas en miskrame is uitgesluit. Die pre-intervensie bevindings van 2010 is vergelyk met die post-intervensie bevindings van 2011. RESULTATE By die Worcester Verloskunde Eenheid was daar 907 geboortes gedurende die studietydperk in 2010, waarvan 102 (11,2%) pasiënte MIV-positief was en 4 (0,4%) met ‘n onbekende MIV-status. In 2011 was daar 865 geboortes waarvan 108 (12,5%) pasiënte MIV-positief was en geen met 'n onbekende MIV-status. In die 2011-groep is beduidend meer pasiënte gediagnoseer met MIV voor as tydens swangerskap. In die 2010-groep is daar 'n CD4-telling gedoen vir 94% van nuut gediagnoseerde pasiënte en diegene met 'n onbekende CD4-telling, in vergelyking met 92% in 2011. Daar was 'n beduidende verbetering na die intervensie in die tyd wat dit geneem het vandat bloed getrek is vir 'n CD4-telling totdat die resultaat opgevolg is. Die mediane tyd het verminder vanaf 34 na 8 dae (p = 0.000001). Nadat die riglyne vir kwalifisering vir hoogs aktiewe antiretrovirale terapie (HAART) verander is na ‘n CD4 telling 350 selle/l het daar beduidend meer pasiënte gekwalifiseer vir HAART. By Worcester Hospitaal het 18 pasiënte voor die intervensie nie die korrekte behandeling intrapartum ontvang nie weens voorkombare redes, in vergelyking met slegs een pasiënt by die VVE. Na die intervensie was daar ‘n beduidende afname na slegs een pasiënt by Worcester Hospitaal en geen by die MOU (p = 0.000001). Voor die intervensie was die korrekte uitvoering van die PMTCT-protokol by die MOU beduidend beter as by die hospitaal (p = 0,0005) en na die intervensie was daar geen beduidende verskil (p = 1.0). GEVOLGTREKKING Alhoewel die oudit en gehalteverbeteringsiklus uitgevoer is by 'n enkele hospitaal, met spesifieke veranderinge gerig tot hul behoeftes, kan die basiese beginsels toegepas word in enige eenheid in die land wat ‘n PMTCT diens verskaf. Opvoeding van personeel en bewusmaking rakende die basiese beginsels van PMTCT, klein veranderinge en die vaartbelyning van prosesse by die voorgeboorte klinieke en die stel van spesifieke doelwitte of tydlyne, kan lei tot aansienlike verbeteringe in pasiënte sorg. Dit sal uiteindelik lei tot 'n afname in die MIV oordrag van moeder na kind, asook MIV-verwante morbiditeit en mortaliteit in moeders en kinders.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This qualitatively oriented Practical Theological research journey, informed by the philosophical ideas of postmodern, contextual, participatory and feminist theologies, postmodern and social construction epistemologies was based on a participatory action research through the therapeutic lens of narrative inquiry. The thesis is about the spiritual problems and spiritual needs of people living with HIV and AIDS and how they can be addressed as part of a holistic approach to their care within the primary healthcare delivery system in Zimbabwe. The research curiosity was prompted by the HIV and AIDS policy in Zimbabwe that advocates for a holistic approach to the care of HIV and AIDS patients within the primary health care delivery system. The recognition that healthcare has to be holistic for the best outcome for patients creates an expectation that spiritual care will also be incorporated into clinical practice. However there is a puzzling blind spot and a strange silence about the spiritual problems and spiritual needs of people living with HIV and AIDS within the HIV and AIDS policy. This has had the effects of reducing intervention programmes to purely medical, psychological and sociological. This research sought to correct such an approach by highlighting the role of spiritual care in the healing process of people living with HIV and AIDS as part of the holistic approach to their care. The core information, on which this research is based, comes from the experiences of people living with HIV and AIDS who are receiving care within the primary health care delivery system in Zimbabwe. It sweeps away statistics and places those questing for spiritual healing at the core of the study. All the participants in the study affirmed that the why me questions as a summation of their indescribable and unimaginable spiritual pain felt in the spirit were directed to God. They confirmed that their spiritual problem was spiritual pain and their spiritual need therefore was spiritual healing from the spiritual pain of which God is believed to be the healer. The belief that God is the ultimate healer of the spiritual pain stood out from the midst of problem saturated narratives of spiritual pain and suffering as the unique outcome to reconstruct the alternative problem free stories of healing. The research opted for an approach that is informed by the experiences of people living with HIV and AIDS. In the light of the stories shared by the participants in this study, it became evident that there is an existing need within the Primary Health Care delivery system in Zimbabwe to provide spiritual care to people living with HIV and AIDS. The research aimed at co-creating a spiritual care approach in which those living with HIV and AIDS as well as those working with them can be empowered to re-author the stories of patients‟ lives around their self preferred images. The narrative approach was explored in this research as a possible therapeutic approach that could be used to journey pastorally with people living with HIV and AIDS in a non-controlling, non-blaming, non-directive and not knowing guiding manner that would permit the people living with HIV and AIDS to use their own spiritual resources in a way that can bring spiritual healing to their troubled spirits. The research also emphasizes the position of the people living with HIV and AIDS which they can inhabit and lay claim to the many possibilities of their own lives that lie beyond the expertise of the pastoral caregiver. The strong suggestion emerging from this study is that a spiritual care approach to healing must of necessity be integrated into the holistic approach to the care of people living with HIV and AIDS in Zimbabwe. The wish of participants that their spiritual well-being be considered in their health care adds momentum to this suggestion. Hence the research argues for the inclusion of a spiritual and pastoral approach to spiritual healing which links the patient‟s spirituality and pastoral care. The research does not claim to have the solutions or quick fix miracle to the complicated spiritual pain of people living with HIV and AIDS and neither claims to have the power to bring any neat conclusions to the spiritual healing of people living with HIV and AIDS. However, the research has the potential to stimulate a new story of spirituality as a vital resource in the healing process of people living with HIV and AIDS and ignoring it may defeat the purpose of a holistic approach to the care of people living with HIV. The re-authoring of alternative stories is an ongoing process but like in all journeys, there are landmarks that indicate achievements, places of transfer or starting new directions or turning around. Hence this research process may be regarded as a landmark that indicated a new direction in the participants‟ journey towards spiritual healing. / AFRIKAANSE OPSOMMING: Hierdie kwalitatief-georiënteerde Praktiese Teologie navorsingsreis, geïnformeer deur die filosofiese idees van postmoderne, kontekstuele, deelnemende en feministiese teologie, postmoderne en sosiale konstruksie epistemologie, is gebaseer op deelnemende aksie-navorsing deur die terapeutiese lens van narratiewe ondersoek. Die tesis handel oor die spirituele probleme en navorsingsbehoeftes van mense wat met MIV en vigs leef en hoe dit aangespreek kan word as deel van ʼn holistiese benadering tot hul sorg binne die primêre gesondheidsorg-diensleweringstelsel in Zimbabwe. Die navorsing-belangstelling het ontwikkel na aanleiding van die MIV en vigs beleid in Zimbabwe wat ʼn holistiese benadering tot die sorg van MIV en vigs pasiënte in die primêre gesondheidsorg-diensleweringstelsel bepleit. Die erkenning dat gesondheidsorg holisties moet wees om die beste uitkoms vir pasiënte te bied, skep ʼn verwagting dat spirituele sorg ook by kliniese praktyk ingesluit sal word. Daar is egter in die HIV en vigs beleid ʼn raaiselagtige blinde kol, ʼn vreemde stilte oor die spirituele probleme en spirituele behoeftes van mense wat met MIV en vigs leef. Die gevolg is dat intervensie-programme gereduseer word tot slegs mediese, sielkundige en sosiologiese programme. Hierdie navorsing streef om dié benadering reg te stel deur die beklemtoning van die rol van spirituele sorg in die heling-proses van mense wat met MIV en vigs leef as deel van die holistiese benadering tot hul sorg. Die kerninligting waarop hierdie navorsing gegrond is, vloei voort uit die ervarings van mense wat leef met MIV en vigs en sorg ontvang binne die primêre gesondheidsorg-diensleweringstelsel in Zimbabwe. Dit vee statistiek van die tafel af en plaas diegene wat soek na spirituele heling, in die hart van die ondersoek. Al die deelnemers aan die ondersoek het bevestig dat hul “Waarom ek?” vrae, as opsomming van hul onbeskryflike, ondenkbare geestelike pyn, aan God gerig is. Hulle het bevestig dat hul spirituele probleem spirituele pyn is, en dat hul spirituele behoefte dus spirituele genesing is van die spirituele pyn, die pyn waarvan geglo word dat God die geneser is. Die geloof dat God die opperste geneser is, het uitgestaan te midde van die probleem-deurdrenkte narratiewe van spirituele pyn en lyding as die unieke uitkoms om alternatiewe probleem-vrye verhale van heling te herkonstrueer. Die navorsing het ʼn benadering gekies wat geïnformeer is deur die ervarings van mense wat leef met MIV en vigs. In die lig van die verhale wat die deelnemers aan die studie gedeel het, het dit duidelik geword dat daar ʼn behoefte is dat spirituele sorg ook aan mense wat leef met MIV en vigs verskaf word in die primêre gesondheidsorg-diensleweringstelsel in Zimbabwe. Die doel van die navorsing was om saam ʼn spirituele sorg benadering te skep waarin diegene wat met MIV en vigs leef, sowel as diegene wat met hulle werk, bemagtig kan word om die stories van pasiënte se lewens te herskryf in terme van pasiënte se verkose beelde. Die narratiewe benadering is in hierdie studie ondersoek as ʼn moontlike terapeutiese benadering wat gebruik kan word om pastoraal te reis met mense wat leef met MIV en vigs op ʼn manier wat nie kontroleer, beskuldig, voorskryf of weet nie, maar wat mense wat met MIV en vigs leef eerder begelei en toelaat om hul eie spirituele bronne te gebruik op ʼn manier wat spirituele genesing vir hul gekwelde siele kan bring. Die navorsing beklemtoon ook die posisie van mense wat leef met MIV en vigs waarin hulle spirituele moontlikhede, areas van hul lewens kan eien en bewoon, moontlikhede wat buite die bereik van pastorale versorgers lê. Uit hierdie studie vloei ʼn sterk suggestie dat ʼn spirituele benadering tot genesing noodwendig geïntegreer moet wees in die holistiese benadering tot die sorg van mense wat leef met MIV en vigs in Zimbabwe. Deelnemers se wens dat hul spirituele behoeftes ook in hul gesondheidsorg oorweeg word, gee aan dié suggestie verdere momentum. Derhalwe argumenteer hierdie navorsing ten gunste van die insluiting van ʼn spirituele en pastorale benadering tot spirituele genesing wat die pasiënt se spiritualiteit en pastorale sorg verbind. Die studie maak nie daarop aanspraak dat dit antwoorde of ʼn wonderbare kits-oplossing bied vir die gekompliseerde spirituele pyn van mens wat leef met MIV en vigs nie, of spirituele genesing netjies afsluit nie. Die navorsing het egter wel die potensiaal om ʼn nuwe verhaal te stimuleer van spiritualiteit as ʼn deurslaggewende bron in die genesingsproses van mense wat leef met MIV en vigs. Om spiritualiteit te ignoreer, mag dalk die doel verydel van ʼn holistiese benadering tot die sorg van mense wat met MIV en vigs leef. Die herskryf van alternatiewe verhale is ʼn voortdurende proses, maar soos alle reise, is daar landmerke wat prestasies aandui, en ook punte van verplasing, rigtingverandering of selfs ommekeer. Hierdie navorsing kan beskou word as ʼn landmerk van ʼn verandering van rigting in deelnemers se reis na spirituele genesing.

Thesis (MBA)--Stellenbosch University, 2003 / ENGLISH ABSTRACT: National and international studies on the impact of the HIVand AIDS epidemie, create a picture of serious negative effects on the South African economy, together with immense suffering and despair for her people. The untimely death of millions of people due to a disease is totally unnatural and basically unimaginable and it is therefore not surprising that people, organisations and government tend to shy away from the problems. Businesses drive growth and development, mobilise investment, nurture innovation, provide employment, develop skills, pay taxes and provide returns to investors. Outside the political arena businesses is the only group that do have the capacity and resources to make a major and effective contribution to the fight against the HIV and AIDS epidemic. This study provides a theoretical introduction to HIV and AIDS but more importantly it indicates that the business world has woken up to the threat of the HIV and AIDS epidemic and are reacting to it. The study concludes that the battle is not won as yet. There is room for improvement and major enhancements are required to current strategies and programmes to make it more effective. Eskom was selected as the case study to substantiate the abovementioned opinions and conclusions. / AFRIKAANSE OPSOMMING: Nasionale en internasionale studies oor die impak van die MIV en VIGS-epidemie dui op die ernstige negatiewe gevolge vir die Suid-Afrikaanse ekonomie. Dit veroorsaak ook geweldige lyding en wanhoop onder mense. Die ontydige dood van miljoene mense weens 'n siekte is heeltemal onnatuurlik en ondenkbaar. Dit is daarom geen wonder nie dat mense, organisasies en die regering daarvan wegskram. Sakeondernemings dryf groei en ontwikkeling, mobiliseer beleggingsmoontlikhede, moedig vernuwing aan, skep werkgeleenthede, ontwikkel vaardighede, betaal belasting en verskaf 'n opbrengs aan beleggers. Buite die politieke arena is sakeondernemings die enigste groep wat die kapasiteit en hulpbronne het om op grootskaal 'n doeltreffende bydrae te lewer tot die bekamping van die MIV en VIGS epidemie. Die studie is 'n teoretiese inleiding tot MIV en VIGS. Die belangrikste aspek wat na vore kom, is dat sakeondernemings wakker geskrik het oor die bedreiging van MIV en VIGS en dat hulle daarop reageer. Die studie kom tot die gevolgtrekking dat die geveg nog nie gewen is nie. Daar is baie ruimte vir verbetering en grootskaalse veranderinge is nodig om die huidige strategieë en programme meer doeltreffend te maak. Eskom is as gevallestudie gebruik om bogenoemde menings en gevolgtrekkings te ondersteun.

Thesis (DTh (Practical Theology and Missiology))--Stellenbosch University, 2008. / ENGLISH ABSTRACT: This work is about a missiological praxis for the creation of 'Circles of Hope' as an entry point for faith based organisations and, particularly, local churches in Zambia for an effective battle in the fight against HIV (Human Immunodeficiency Virus). The HIV pandemic is one of the worst tragedies to have befallen humankind in the 21st century. Lost to many people is the fact that it does not affect all regions of the globe equally. Figures show that over 70% of PLWHA (people living with HIV) are in sub Saharan-Africa while most affected are young and therefore, in theory, energetic. With an overall HIV prevalence rate of 16% and a life expectancy of 34 years, HIV has severely impacted the lives of Zambians across the country. Stigma remains one of the most significant challenges in Zambia across the prevention-to-care continuum. The wider environment of these effects and statistics has provided for us the wider contextual situation. The Church in Zambia and, indeed, in the entire sub-Saharan African region cannot afford to hide its head in the sand anymore. The impact of HIV is being felt at all levels of society. This has posed a threat to economic progress and human development by attacking the most economically productive age group and reversing gains in life expectancy and child survival. The increasing burden on health budgets has stretched national and community resources to the limit, leaving no room for complacency or pretence about the magnitude of the problem. Since some members of the Church are positively infected, we can safely say of the Church: the body of Christ has HIV. HIV is a national disaster. It cannot be managed without mobilising all the sectors within a nation. The Church in Zambia needs to make HIV prevention a matter of compelling priority. The Church is an instrument for the missional praxis of the triune God. Theology in this work is not so much a scientific endeavour that begins and ends with analysing contexts and texts, rather it is an imaginative way of finding new answers to the new situation brought about by the presence of HIV (Hendriks, 2004: 30). In this work the researcher contends that measures are required to develop strong theological reflections and education which would result in the establishment of Circles of Hope in all local congregations. These Circles of Hope would act as a fountain for promoting behavioural change, support action for safer sexual behaviour, and combat stigmatisation and discrimination against people with known HIV infection. There must be appropriate theological reflections that touch on the work of the reign of God. A relevant HIV theology will necessarily involve the laity, will watch out for fundamentalist views, will be biblical in nature and will draw from Trinitarian understanding. The basis of moving from a theology of punishment to that of care, truth, freedom, justice and peace is the theology of community and companionship. This reflection is an attempt to have constructive interpretation of the present realities brought about by a time of HIV. One can only discern God‘s will for the present situation through critical and sensitive leadership in order to bring about genuine healing. The role of the local church and networking activities are essential commodities to realise a vision of a Zambia that is HIV competent. This then is the new ministerial strategy being spearheaded by the 'Circles of Hope' programme of the Council of Churches in Zambia. It is a challenge for Zambian churches. / AFRIKAANSE OPSOMMING: Die navorsing handel oor ʼn missiologiese begronde praksis vir die skepping van 'Kringe van Hoop' as 'n beginpunt vir geloofsgebaseerde organisasies en spesifiek die plaaslike kerk in Zambië in hulle stryd teen MIV (Menslike Immuniteits Virus). Die MIV pandemie is een van die ergste tragedies wat die mensdom in die 21ste eeu getref het. Wat baie mense nie altyd besef nie, is dat dit nie oral in die wêreld dieselfde impak het nie. Statistiek wys daarop dat meer as 70% van alle MIV positiewe mense Suid van die Sahara woon. Die meerderheid van die geïnfekteerdes is jonk met baie potensiaal. 16% van die bevolking in Zambië is MIV positief en het 'n lewensverwagting van 34 jaar. Die uitwerking hiervan raak die land en al sy mense. Naas voorkoming en versorging bly een van die grootste uitdagings wat die gemeenskap in Zambië moet aanspreek stigmatisering. Die groter konteks Suid van die Sahara vorm die agtergrond van elke land se spesifieke probleme. Ook Zambië en met name die kerk in Zambië sal die feite in die oë moet kyk. Die pandemie is 'n bedreiging vir ekonomiese vooruitgang en menslike ontwikkeling omdat dit die ekonomies mees produktiewe ouderdomsgroep afmaai, lewensverwagting verlaag en kindersterftes laat toeneem. Die toenemende las op die gesondheidsbegroting het die nasionale en gemeenskapshulpbronne grootliks uitgeput. Die omvang van die probleem kan op geen manier meer ontken en negeer word nie. Aangesien baie lidmate MIV positief is, kan 'n mens goedskiks verklaar dat die liggaam van Christus MIV het. Dit is ʼn nasionale tragedie. Die pandemie kan nie bestry word sonder dat al die sektore van die samelewing daarteen gemobiliseer is nie. Die kerk in Zambië moet die voorkoming van MIV as 'n uiters noodsaaklike prioriteit beskou. Die Kerk is 'n instrument vir die missionêre praksis van die drie-enige God. Die navorsing beskou teologie nie as 'n wetenskaplike onderneming wat bloot handel oor 'n analise van kontekste en tekste nie. Teologie is iets waarin jy handelend en verbeeldingryk toetree tot die aanspreek van 'n veelbewoë situasie en antwoorde probeer vind op die probleme (Hendriks, 2004: 30). Die navorsing werk met die hipotese dat die probleem vanuit 'n teologiese hoek benader moet word sodat teologiese beginsels die praktykteorie van Kringe van Hoop in plaaslike gemeentes sal onderskraag. Die studie voorsien dat die Kringe van Hoop die hoof dryfveer sal wees wat gedragsverandering sal bevorder, veiliger seksuele gedrag sal aanmoedig, en die stryd teen die stigmatisering en diskriminasie sal voer. Gepaste teologiese refleksie oor die heerskappy van God is noodsaaklik. 'n Revelante HIV teologie sal gewone lidmate insluit, sal bedag wees op fundamentalistiese sieninge, sal bybels wees en sal gebaseer wees op ʼn trinitariese godsbegrip. Die teologiese basis vir die wegbeweeg van 'n teologie van straf/oordeel na een van versorging, waarheid, vryheid, geregtigheid en vrede, is geleë in gemeenskap en kameraadskap. Hierdie refleksie is 'n poging om in 'n tyd van HIV 'n konstruktiewe interpretasie te gee van die huidige realiteite. Kritiese en sensitiewe leierskap behoort in die huidige situasie te poog om God se wil te soek om die gebrokenheid van 'n MIV siek gemeenskap aan te spreek. Die rol van die plaaslike kerk en netwerkingsaktiwiteite is onontbeerlik vir die realisering van die visie van ʼn Zambië sonder MIV. Die 'Kringe van Hoop'-program van die Zambiese Raad van Kerke is 'n bedieningstrategie wat die MIV pandemie wil aanspreek en wat die kerk in Zambië uitdaag om mee te doen.

Studies on the impact of HIV/AIDS on health workers conducted in the health sector in different countries in Southern Africa have shown that health workers are affected and infected by HIV/AIDS. This has affected the provision of care rendered by nurses negatively. The high workload emanating from increased numbers of patients contributed to the situation. As a result, a number of nurses suffer from stress related illnesses caused by many factors such as fear of contracting the HIV virus. Low staff morale has also been observed among nurses. The aim of this study was to study nurses perceptions, views and suggestions on the impacts of HIV/AIDS on the provision of health care in terms of increased workload, stress, low morale and fear of contracting HIV/AIDS in two medical wards and a TB ward in one regional hospital in Namibia.