Each year approximately 600 000 infants, most of them in Sub-Saharan Africa are born with HIV infection as a result of mother to child transmission of HIV. Whereas significant progress has been made in reduction of mother to child transmission of HIV in developed countries, the situation remains desperate in developing countries. Progress has been hampered by shortage of staff, facilities, limited access to voluntary counselling and testing and lack of support for women by their partners and communities. The challenge is to increase voluntary counselling and testing uptake during antenatal care. Onandjokwe district in Northern Namibia is currently introducing the Prevention of Mother to Child Transmission Program (PMTCT). It has been found the previous PMTCT programs have failed because they adopted a top down approach where there was no community consultation. This study was conducted to explore the community perceptions, knowledge and attitudes regarding mother to child transmission of HIV through focus group discussions and in-depth interviews of key community members.

Despite the profound impacts of HIV and AIDS on all sectors of South African society, governmental responses to the AIDS epidemic have been inundated with contradiction, conflict and contestation. Though governmental leaders have justified not funding HIV treatment programs because they believe that poverty needs to be dealt with first, social spending has been slashed as part of an adherence to a neo-liberal economic model. Though it would seem that the government would seem to have everything to gain by establishing a cooperative relationship with non-governmental actors regarding the epidemic, the relationship between the government and non-governmental actors has instead been described as nothing short of hostile. Though the government enthusiastically backed Virodene, a supposed treatment for AIDS that turned out to be no more than an industrial solvent, other ‘scientifically backed’ AIDS treatments have been treated with caution and skepticism – to the point where the government even refused to provide funding for programs to prevent mother to child transmission of the virus. And perhaps the most perplexing is that although widely respected for his intellect and cool demeanor, former President Mbeki chose to risk his political career on the AIDS issue by shunning away from the mainstream consensus on the biomedical causes of the epidemic and instead surrounded himself and sought advice from AIDS ‘dissidents’ This thesis will seek explanations for these apparent contradictions. Using Bourdieu’s (1986) typology of capitals, it will build on an argument put forward by Helen Schneider (2002): from the South African government’s perspective, the contestation regarding HIV and AIDS policy and implementation is over symbolic capital, or the right to legitimately hold and exercise political power regarding the epidemic. Though this argument helps explain the conflictual relationship between the government and non-governmental actors regarding the AIDS crisis, in order to understand the perplexing contradictions within the governmental policy response, the political context of policy formation must first be taken into consideration.

The Australian HIV Observational Database (AHOD) is a collaboration of hospitals, sexual health clinics and specialist general practices throughout Australia, established in April 1999. Core data variables collected include demographic data, immunological and virological markers, AIDS diagnosis, antiretroviral and prophylactic treatment and cause of death. The first electronic data transfer occurred in September 1999 followed by six monthly data transfers thereafter. All analyses included in this thesis are based on patients recruited to AHOD by March 2004. By March 2004, 2329 patients had been recruited to AHOD from 27 sites throughout Australia. Of these, 352 (15%) patients were recruited from non-metropolitan clinics. The majority of patients were male (94%), and infected with HIV through male homosexual contact (73%). Almost 90% of AHOD patients are antiretroviral treatment experience, and the majority of patients are receiving triple therapy as mandated by standard of care guidelines in Australia. Antiretroviral treatment use has changed in Australia reflecting changes in the availability of new treatment strategies and agents. The crude mortality rate was 1.58 per 100 person years, and of the 105 deaths, more than half died from HIV-unrelated deaths. The prevalence of HBV and HCV in AHOD was 4.8% and 10.9%, respectively. HIV disease progression in the era of highly active antiretroviral treatment (HAART) among AHOD patients is consistent with what has been reported in developed countries. Common factors associated with HIV disease progression were low CD4 cell count, high viral load and prior treatment with mono or double therapy at the time of commencing HAART. This was demonstrated in AHOD in terms of long-term CD4 cell response, the rate of changing combination antiretroviral therapy and factors predicting death. HBV and HCV coinfection is also relatively common in AHOD, similar to other developed country cohorts. Coinfection does not appear to be serious impediments to the treatment of HIV infected patients. However, HIV disease outcome following HAART does appear to be adversely affected by HIV/HCV coinfection but not in terms of HIV/HBV coinfection. Patients attending non-metropolitan sites were found to be similar to those attending metropolitan sites in terms of both immunological response and survival.

This thesis examines HIV disease natural history and response to antiretroviral treatment (ART) in patients from The TREAT Asia HIV Observational Database (TAHOD), a mulitcentre, prospective observational cohort of HIV-infected patients from countries in the Asia-Pacific region. By September 2005, 2979 patients have been recruited to TAHOD from 15 participating sites. The majority were male (73%), median age 37 years. Chinese (37%), Thai (25%) and Indian (17%) were the main ethnicities. Most patients reported HIV infection through heterosexual (59%) and homosexual contact (23%); 5% injecting drug use. At baseline, 41% of patients were diagnosed with AIDS defining illness, and 77% were being treated with highly active antiretroviral therapy (HAART). Baseline and retrospective data suggest that the overall response to HAART in TAHOD is similar to that seen in western cohorts, with mean CD4 count increase of 115 cells/μL and 69% achieving a viral load less than 400 copies/mL six-month after HAART initiation. Baseline CD4 count was the strongest predictor of short-term disease progression. Prognostic models based on routine clinical data and haemoglobin gave a good estimation of disease progression. The rate of new AIDS defining illness was 26% in the first 90 days after HAART initiation, which may partly be due to immune reconstitution syndrome occurring shortly after treatment. The most frequently used first-line ART combination was stavudine/lamivudine/nevirapine. Approximately 22% of patients receiving this treatment changed or stopped at least one drug in the first year, with adverse effect (including lipodystrophy, hepatitis, rash and peripheral neuropathy) the major reasons. The rates of discontinuation of efavirenz or nevirapine as part of HAART were similar (16 vs. 20/100 person years). Older age and positive HCV antibody were associated with an elevated liver function (ALT) test. Both prevalence of HBV and HCV coinfection with HIV were approximately 10%. The impact of hepatitis coinfection on immunological and virological responses to ART and HIV disease progression was not statistically significant. Both HBV and HCV remained independently associated with elevated ALT in the multivariate models. The overall HIV disease progression and response to ART in TAHOD patients were similar to those seen in the western countries.

This study is concerned with corporate policy on IllV/AIDS. This was investigated by speaking to key-informants from fifteen enterprises in KwaZulu Natal. They were asked about their policies and programmes and what they had put in place to combat this epidemic. The rational choice model was used as a framework for analysis ofthe policies. This model is discussed in the first part ofthe study and was chosen as it seems to reflect the dominant policy outlook in South Africa and may shape the way that organisations .respond. The second part of the project is the report and discussion of the findings. It is a presentation ofthe responses given by the key informants regarding their perceptions and understanding of the problem of IllV/AIDS as well as the policies .of their companies regarding the same. Mostofthe companies in the study did not have policies specific to. IDV/AIDS. Some had general guidelines and treated HIV/AIDS as any major illness. There seemed to be denial, especially among the management, of the seriousness of the disease despite evidence ofits significant impact within the various organisations. There were few to no resources set aside formv/AIDS programmes and interventions and this seems important in defining the IllV/AIDS problem as one of the future rather than the present In the third part of this project, the theoretical framework and the findings were linked. There was an attempt to answer the question ofhow rational the policy process is within the companies in the study and .whether the responses of these organisations can be understood in the context ofthe rational choice model. It seems that this model does aid in understanding of the policy process when there is a realisation· that it interacts with other human mctors to create what we observe. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

In South Africa, both the number of people entering prison, and the number of people infected with HIV, are steadily increasing. While reliable statistics are not available on the number of HIV+ prisoners, the characteristics of the typical prisoner are those of a demographic group at high risk for HIV infection. As a result, many prisoners will already be HIV positive upon entering the prison. Additionally, the prison environment creates many situations of high risk behaviour for HIV transmission, which means there is also an as yet undetermined portion of inmates who will contract HIV while incarcerated. The current government policy is to provide HIV testing and condoms in conjunction with counselling, although poor design and implementation of this policy has limited its impact. In addition to issues of HIV infection and transmission, the government must address the needs of prisoners who have developed full-blown AlDS and will likely die as a result while imprisoned. AIDS is already the leading cause of death for prisoners in many countries, as well as in South Africa Adequate medical care, proper nutrition, and early release for those in the late stages of AIDS, are the international standards for minimum humane treatment of these prisoners. Today, crippling bureaucracy prevents the humanitarian release of dying· prisoners from South African prisons. Reliable data on the nature and extent of HIV/AIDS infection in South African prisons has yet to be obtained, owing to the closed nature of the prison administration. In order to design and implement effective policies, the secrecy surrounding the prison system must be eliminated so that further research and study may take place. Unlinked, anonymous HIV testing should be undertaken on a sample of the prison population so that accurate information and projections about HIV/AIDS in prison may become available. Until the government allows the issue to be quantified, the design and implementation of better policies will not be possible. The best HIV/AIDS policies are those which recognise the impact of prisoners' health on public health in general. Because the prisoner population consists of a core transmitter group, the pnson provides a critical intervention opponunity for the prevention of HIV infection in the greater community Further research on this issue should therefore focus on the evaluation, design, and implementation of intervention programs Intervention in the prison environment should include targeted education and use of existing gang structures to engender behavioural change The issues of HIV/AIDS in prison are compounded by issues of prison reform in general. The conditions in South Africa prisons are unconsitutional, and exacerbate the problems presented by HIV/AlDS. The most pressing problem in South African prisons is overcrowding; a problem which the Department of Correctional Services is all but powerless to address. Just as HIV/AIDS in the general community requires a multi-sectoral solution, so too does HIV/AIDS in the correctional setting. The Department of Correctional Services must re-evaluate both its policies and its entire policy making process in order to address HIV/AIDS in South African prisons. / Thesis (M.A.)-University of Natal,Durban, 2001.

This study explores the subjective experiences of persons who have been informed of a positive HIV antibody test and, from their point of view, explains the meaning and impact that HIV discovery has on their quality of life. In this qualitative narrative study, a racially specific, low-income sample of 10 HIV-infected men and women shared their stories of living with the virus during in-depth interviews. Findings of a multi-staged narrative analysis suggest that for people like those in this study, stigma associated with mv infection results in the concealment of the diagnosis by the individual for fear of being labeled as deviant from the rest ofthe community. Secondly, the tragic manner in which these respondents narrated HIV discovery signifies the negative impact the disease has on their quality of life. Lastly, there is evidence for the effectiveness ofthe primary health-care services on the HIV positive patients. Implications for these findings are elaborated. / Thesis (M.Soc.Sc.)-University of Natal, Pietermaritzburg, 2000.

The overall objectives of the study are to analyse the economic impact of HIV/AIDS on income-earning urban households and in so doing to develop a methodology for HIV/AIDS household surveys. The study started with 125 households in the first wave. Of these, 113 households were followed over 4 waves (2), over a 12-month period, and across two cohorts referred to as affected (3) and non-affected (4) households. Data on the household were collected from the financial head (5) using the diary method. The methodology for this study was done after a review of 33 HIV/AIDS economic studies conducted around the world. The study obtained buy-in and support from various stakeholders in government, nongovernment organisations, community, academic and funding institutions as from people living with HIV/AIDS. Due to the comprehensive design of the research instrument, the study is able to draw relationships between the various facets of the household and the possible influence that HIV/AIDS has on them. Methodologically, the study found that there are "hidden" costs of morbidity and mortality that needs to be quantified. The costs of health care and funerals are higher in the affected cohort, as expected, due to the frequency of illness or death and not necessarily because there are cost differences as a result of whether a household member has HIV/AIDS or not. The key finding is that affected households re-organise themselves in terms of household size, composition and structure as well as through transfers in, income from grants and other non-market sources, especially to pay for funeral costs. Surviving members are affected not only socially and economically but also psychologically and the needs of this group should not be ignored. (2) Each visit is referred to as a wave (3) Affected household is a household where at least one person is HIV positive (4) Non-Affected household is a household where the index case is HIV negative and no other members presented with an HIV/AIDS-related symptom (5) The person responsible for the finances in the household. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

The study examines the role religious institutions play in responding to health crises in the community with particular focus on mV/AIDS. The thesis argues for the importance of focusing on health outcomes rather than the traditional "economic" models for assessing health sector in time of AIDS crisis. Health outcomes measures: good practice, increases accountability of services, quantifies the values of interventions where traditional research data may be impractical or lacking. It even assists in determining resource allocations and help to monitor and improve standards of care. This opens the door to focus on religious institutions, where selecting and measuring outcomes could be deeply connected to a community's or institution's mission and be able to describe a specific desirable result or quality of institution's services. The role of religious institutions has not been well recognized in dealing with health issues, and in particular within the religious community itself. Religious communities have not recognized their enormous assets, which they could mobilize in an effort to create good health conditions while facing the challenges of the HIV / AIDS pandemic and other diseases. The study examines the involvement of a local Anglican Church, St Paul's in health in the urban context of Pietermartzburg, KwaZulu-Natal. The asset-based approach guides the study in capturing the basic notion that assets carry value and may be used to create greater value. The research findings show that the worshippers of St Paul's Anglican Church seem to have little understanding of their religious asset portfolio, which can be used effectively to improve the health conditions and health prospects of those in need in order to build healthy communities. The study argues that religious congregations and other faith-based organizations can play a vital role in local public health systems and community-based health improvements initiatives. In addition, faith communities can act as conveners and mobilizers of community residents and other faith-based groups around issues of health policy and interventions for health promotion and disease prevention (e.g. nutrition, care, VCT, etc.). / Thesis (M.Th.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

The onset and rapid spread of the HIV/AIDS pandemic in Sub-Saharan Africa has challenged and continues to challenge the church in its doctrine as well as its practical ministries. The Evangelical Lutheran Church in Namibia has been no exception. The disease challenges the theological and pastoral disciplines, especially in the area of contextuality. This thesis is developed at the very site of the struggle to care for the infected and affected individuals and families in the ten Evangelical Lutheran Church parishes in the Oshana Region, Namibia. Healing and caring for the sick is the primary mission of this church. Therefore, the quest of this study is to investigate how ELCIN through pastoral care and counselling helps HIV/AIDS infected and affected family members cope with their situation. The study concentrated mainly on ten ELCIN parishes in the Oshana Region, Namibia. Chapter one is an introduction to the whole thesis. Included is the statement of the problem, the methodology used to collect data and the literature review. Chapter two deals with pastoral care and counselling of HIV/AIDS infected and affected families. The African understanding of heath and illness is also considered as well. Chapter three is about the Church and HIV/AIDS in the Oshana Region, Namibia. This chapter investigates the responses of ELCIN's pastors towards HIV/AIDS affected families in the Oshana Region, and how they understand HIV/AIDS biblically. Chapter four deals with the impact of HIV/AIDS on affected families in Oshana Region, Namibia. This chapter discusses how HIV/AIDS affects the family members, nurses, and community ministers and how pastoral care and counselling help the widowers, widows, orphans, caregivers of orphans and nurses to take care of orphans. This is the main chapter of this thesis. Chapter five is about data analysis, recommendations and research findings using the Christian theoretical framework of Mwaura, van Dyk, Msomi, Snidle and Welsh, and Dube. Chapter six is the conclusion of the whole thesis. / Thesis (M.Th.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.