The purpose of this study was to determine the efficacy of infant feeding choices and support provided in the current PMTCT programme in KwaZulu-Natal. A case study format was utilised. Follow-up was done over six months with ten HIV positive women enrolled in the PMTCT programme at St. Apollinaris Hospital. Transcripts of interviews were made, pattern-matching was done, and the process of replication was used to develop a cross-case report as the final analysis of the study. All of the women decided to and intended to exclusively breastfeed for between four and six months at the time of the first interview. There was a poor rate of return for follow-up interviews, therefore the actual feeding practice of half of the women after six weeks could not be determined. The case studies were developed with the information available, and thus conclusions were reached during cross-case analysis. Decision-making ability and the capacity to overcome the barriers to the maintenance of their original feeding choice were related to the women's educational levels, employment status, financial and social circumstances and support systems, knowledge and experience of HIV/AIDS, quality of PMTCT education and support, cultural beliefs, and parenting and family values. The age of respondents and differences in marital status had no obvious correlation to maintenance of feeding choice. Parity and level of education had only a limited effect on maintenance of feeding choice. Cues to mixed feeding included a fatalistic view and a loss of hope for preventing transmission of HIV to their infants. Some of the women did not seem to believe that maintaining a specific infant feeding regime was enough to prevent transmission of HIV to their infants. Fear of stigmatisation due to disclosure of their positive HIV status led to non-disclosure of many women, and this in turn led to a lack of support for their feeding choice. Cues to exclusive feeding included an internal pressure to succeed and so decrease the chances of HIV transmission to her infant. Those women who disclosed their HIV status to a significant other and established a good support system were more likely to maintain their original decision. Although none of the women enjoyed good social circumstances, those who were more financially secure, employed, and who had a stable home environment were more likely to maintain their exclusive feeding regime. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2004.

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

Thesis (MSc (Mathematical Sciences))--University of Stellenbosch, 2011. / Includes bibliography. / ENGLISH ABSTRACT: This thesis takes into account the different levels of infectiousness of the human immunodeficiency virus (HIV) infected individuals throughout their period of infection. Infectiousness depends on the time since infection. It is high shortly after the infection occurs and then much lower for several years, and thereafter a higher plateau is reached before the acquired immunodeficiency syndrome (AIDS) phase sets in. In line with this, we formulated a mathematical model which is structured according to the age of infection. To understand the dynamics of the disease, we first discuss and analyse a simple model in which the age of infection is not considered, but progression of the HIV-AIDS transmission is taken into consideration by introducing three stages of infection. Analysis of these models tells us that the disease can be eradicated from the population only if on average one infected individual infects less than one person in his or her infectious period, otherwise the disease persists. To investigate the reduction of the number of infections caused by a single infectious individual to less than one, we introduce different treatment strategies for a model which depends on the age of infection, and we analyse it numerically. Current strategies amount to introducing treatment only at a late stage of infection when the infected individual has already lived through most of the infectious period. From our numerical results, this strategy does not result in eradication of the disease, even though it does reduce the burden for the individual. To eradicate the disease from the population, everyone would need to be HIV tested regularly and undergo immediate treatment if found positive. / AFRIKAANSE OPSOMMING: Hierdie tesis hou rekening met die verskillende aansteeklikheidsvlakke van die menslike immuniteitsgebreksvirus (MIV) deur besmette individue gedurende hulle aansteeklikheidstydperk. Die graad van aansteeklikheid hang af van die tydperk sedert infeksie. Dit is hoog kort nadat die infeksie plaasvind en daarna heelwat laer vir etlike jare, en dan volg n hoer plato voordat uiteindelik die Verworwe-Immuniteitsgebreksindroom (VIGS) fase intree. In ooreenstemming hiermee, formuleer ons n wiskundige model van MIV-VIGSoordrag met n struktureer waarin die tydperk sedert infeksie bevat is. Om die dinamika van die siekte te verstaan, bespreek en analiseer ons eers n eenvoudige model sonder inagneming van die tydperk sedert infeksie, terwyl die progressie van MIV-VIGS-oordrag egter wel in ag geneem word deur die beskouing van drie stadiums van infeksie. Analise van die modelle wys dat die siekte in die bevolking slegs uitgeroei kan word as elke besmette mens gemiddeld minder as een ander individu aansteek gedurende die tydperk waarin hy of sy self besmet is, anders sal die siekte voortduur. Vir die ondersoek oor hoe om die aantal infeksies per besmette individu tot onder die waarde van een te verlaag, beskou ons verskeie behandelingsstrategiee binne die model, wat afhang van die tydperk sedert infeksie, en ondersoek hulle numeries. Die huidige behandelingstrategiee kom neer op behandeling slegs gedurende die laat sta- dium van infeksie, wanneer die besmette individu reeds die grootste deel van die aansteeklikheidsperiode deurleef het. Ons numeriese resultate toon dat hierdie strategie nie lei tot uitroeiing van die siekte nie, alhoewel dit wel die las van die siekte vir die individu verminder. Om die siekte binne die bevolking uit te roei, sou elkeen gereeld vir MIV getoets moes word en indien positief gevind, dadelik met behandeling moes begin.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2016. / IntroductionMale circumcision refers to the surgical removal of all or parts of the prepuce of the penis. This procedure is undertaken for religious, cultural, social, hygiene or medical reasons (Maibvise and Mavundla 2013: 139). The number of people living with Human Immunodeficiency Virus (HIV) rose from approximately 8 million in the year 1990 to 33 million infections now. Sub-Saharan Africa is the region in the world most affected by HIV/AIDS with 22.4 million people living with the virus in the year ending 2008 (Naidoo et al. 2012: 2). The use of male and female condoms remains a challenge despite decades of promotion. There is evidence that medical male circumcision (MMC) is effective in preventing HIV sexual transmission. Medical male circumcision is a drive that was initiated by the National Department of Health as a strategy to curb HIV infection in South Africa in 2010. Aim of the Study The purpose of the study was to investigate and describe knowledge, attitudes and perceptions of males with regard to medical male circumcision. Methodology A quantitative descriptive survey research method was used to describe the knowledge, attitudes and perceptions of males attending the community health care centers (CHCs) in eThekwini district regarding medical male circumcision. Results Displayed posters motivated 71.4% (n = 329) to have circumcisions. While 65.1% (n = 300) respondents had knowledge about circumcision and HIV, 27.8% (n = 280) perceived that circumcision would interfere with their sexual function and reproduction. A total of 38.8% (n = 179) of respondents indicated that it is good for children to be circumcised. There is a significant positive correlation between age and knowledge (r = 0.135, p = .004). Higher age is correlated with more knowledge. Conclusion This study found that knowledge plays a major role in changing attitudes and perceptions. The more knowledgeable an individual is, the more the chance is of them having a positive attitude towards MMC which could also influence a positive perception of MMC. In order to strengthen male circumcision as an HIV prevention strategy, it is imperative to provide the population that reflected low knowledge and negative attitude with information, education and counselling services. This may help them to change their attitudes and acquire a positive perception of MMC. / M

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.

Health Studies / M.A. (Health Studies)

Thesis (MBA)--Stellenbosch University, 2006. / ENGLISH ABSTRACT: HIV/AIDS is one of the most devastating pandemics the world has ever faced. SubSaharan Africa remains the region most affected where more two thirds of the total HIV positive population resides. Despite this region trying to grapple with many negative factors like political unrest, draughts, armed conflict, it now also have to content with HIV/AIDS. HIV/AIDS has already killed ten times more Africans than all of the armed conflicts on the African continent combined (The Washington Quarterly, 2001:191-196). Many of the Sub-Saharan countries are renowned for unemployment and poverty which can be partly be alleviated by economic growth. Studies by Bonnel (2000) concluded that a typical Sub-Saharan country with a 20% HIV/AIDS prevalence rate, would suffer a 2.6% reduction in GDP growth per annum. This indicates that South Africa, where an estimated S.5 million HIV positive people resides (the most in globe) and ever increasing HIV prevalence, is in a serious predicament. There are many interacting variables causing the negative socioeconomic decline. At organisational level direct and indirect costs attributable to HIV, results in a severe decline of profitability and jeopardises sustainable economic activity. Direct costs include costs for medical treatment, health insurance, funeral expenses, retirement and disability and costs to manage HIV in the workplace. Indirect costs include absenteeism and loss of productivity, retraining and recruiting of employees to fill deceased employees' places etc. Although South African organisations acknowledge and predict that HIV/AIDS will have an ever-increasing negative impact on their business, the response to dealing with this issue has been insufficient. The deficient response could be partly ascribed to a lack of guidance, deficient proof of cost effectiveness with no real measurement for the outcomes of intervention programs. This study will critically evaluate a KAPB (knowledge, attitude, perception and behaviour) survey as a second-generation HIV surveillance tool that could address these organisational concerns. KAPB surveys have advantages like providing guidance and increasing cost effectiveness of HIV programs, benchmarking interventions and providing a platform for communication design and feedback to stakeholders. These benefits should motivate organisations to initiate programs that address HIV at an organisational level. KAPB surveys evaluate four employee factors related to HIV - knowledge, attitudes, perception and sexual behaviour. This report will critically evaluate the appropriateness of measuring these factors and some tools used to measure these factors. Further elaboration of the methodology during the execution of a KAPB survey will highlight the current best practices identified in literature. The report will also highlight the obstacles and ways of negotiating them when conducting a KPAB survey. The study will conclude that a well -executed KAPB survey through its many benefits should motivate and assist organisations in designing and implementing HIV/AIDS programs. / AFRIKAANSE OPSOMMING: HIV is een van die ernstigste pandemies wat die wereld al ooit beleef het. Die state in die Sub-Sahara streek is die ergste geaffekteer en meer as twee derdes van die totale HIV positiewe populasie kom in die gebied voor. Die streek wat deurgaans geteister word deur politieke onrus, droogte, oorlog, moet nou ook probeer tred hou met MIV /VIGS. MIV/VIGS het tot op hede alreeds tien keer meer mense gedood as al die oorloë op die Afrika continent saam (The Washington Quarterly, 2001: 191-196). Die meeste van die state in Sub-Sahara word gekenmerk deur werkloosheid en armoede wat deels verlig kan word deur ekonomiese groei. Studies deur Bonnel (2000) het getoon dat die tipiese staat in Sub-Sahara, met 'n 20% MIV insidensie 'n vermindering van tot 2.6% groei in die GDP kan ondervind. Dit voorspel dat Suid-Afrika met 'n voorspelde 5.5 miljoen HIV positiewe inwoners (die meeste in die wereld) ekonomiese noodlot in die oog staar. Daar is verskeie faktore wat saamwerk om die negatiewe ekonomiese 'effek van MIV/VIGS te bewerkstellig. Organisasies se ekonomiese vooruitgang en oorlewing word bedreig deur direkte en indirect kostes van MIV. Direkte kostes wat organisasies moet aangaan sluit in mediese behandeling, mediese fonds bydraes, begrafnis onkostes, aftrede en ongeskiktheidspensioenbetalings. Indirekte kostes sluit in afwesighede, verlies aan produktiwiteit en die heropleiding en werwing van werknemers wat afgestorwe werknemers se plek moet neem. Ten spyte van die feit dat organisasies erken en voorspel dat MIV/VIGS 'n negatiewe impak op die ekonomies welvaart van organisasies sal hê, het weining van die organisasies aksie geneem om die probleem aan te spreek. 'n Moontlike rede vir die onvoldoende aksie kan toegeskryf word aan die tekort aan leiding, bewyse vir kostedoeltreffendheid en geen werklike maatstaf om die programme se resultate te evalueer. Hierdie studie sal KGPG (kennis, gevoelens, persepsie ' en gedrag) studies as 'n tweede generasie MIV opname, krities evalueer. KGPG studies bied verskeie voordele soos om leiding vir HIV programme te bied en verbeterde koste effetiwiteit van MIV programme te bewerkstellig. KGPG studies voorsien ook 'n maatstaf om MIV programme te evalueer en 'n kommunikaise platvorm tussen aandeelhouers. Hierdie voordele sal moontlik organisasies motiveer om aksie te neem en MIV in die organisasie aan te spreek. KGPG studies evalueer vier werknemer faktore met betrekking to MIV /VIGS. Die vier faktore is kennis, gevoelens, persepsie en seksuale gedrag. Die verslag sal die vier faktore krities evalueer vir toepaslikheid en ook fokus op die instrumente wat die faktore evalueer. Aanbevelings sal ook gemaak word ten opsigte van die korrekte en beste metodes wat gevold moet work tydens 'n KGPG studie. Die struikelblokke wat ondervind kan word tydens 'n KGPG studie asook hoe om dit te oorkom sal bespreek word. Die verslag sal bewys dat 'n KGPG studie wat uitgevoer word in Iyn met die beste praktyk baie waarde kan toevoeg tot organisasies ten opsigte van die beplanning en uitvoering van programme om MIV/VIGS te bekamp.

This study was undertaken to investigate the relationship between Natural Killer cells and HLA-G at the placental barrier in HIV-I infected pregnant women and to establish the significance, if any, to in utero infection. Fifty-five HIV -I infected pregnant women were recruited into the study after consent was obtained. Blood samples were collected from both mothers and babies for viral loads and CD4+ cell counts. Placental samples were obtained from pregnancies at delivery and examined by immunoperoxidase immunohistochemistry methods using monoclonal antibodies to p24 antigens and Natural Killer (CD56+) cells. HLA-G expression was quantified using real-time polymerase chain reaction. Analysis of viral loads and CD4+ cell counts were undertaken in categories. No significant association was observed between the viral load of mothers and their CD4+ cell counts. Eighteen percent of the women in this study population had 5 log viral loads with a transmission rate of 0.27(95% Cl, 0.15 - O. 39). Maternal viraemia was significantly associated with transmission of infection to babies (p = 0.047). The odds ratio indicated that for every 1 log increase in maternal viral load the babies were 3.1 times more likely to acquire the infection (Exp (B) = 3.137 (95%CI, 1.015-9.696). Furthermore, the study found that a higher number of female babies were infected than males. Although not statistically significant the odds ratio indicated that female babies were 3.1 times more likely to become infected than males (Exp (B) = 3.110 (95%CI, 0.819-11.808). We report here the results of immunohistochemistry for p24 antigens and NK (CD56+) cells and compare them to the immunological responses of both mothers and babies at birth. HIV-1 antigens were detected in 94.5% of all placentas by immunohistochemistry. Infiltration of CD56+ was found in 98% of placental tissue. The analysis revealed that the presence of p24 antigens in placental tissue was not influenced by maternal viral load or CD4+ cell counts. Lower median NK cell values were observed in placentas of mothers with infected babies as compared with the uninfected cluster. Although not statistically significant, the risk of vertical transmission was increased 3.4 times more in placentas which had lower NK cell values. According to the odds ratio, babies CD4+ counts were affected by every 1 log increase in mother's viral load. Overall, maternal viral load emerged as a strong predictor for risk of infection from infected mothers to their infants. Our analysis indicated that female babies were 3.7 times more likely to acquire the infection than males. Using data obtained from real-time PCR we investigated the relationship between maternal viral load and the quantity of HLA-G expression (p = 0.045; 95%CI 1.029- 11.499). Logistic regression models revealed that mother's viral load was the strongest risk factor for vertical transmission. No statistically significant correlation was noted with HLA-G and viral transmission. However, the odds ratio indicated that the risk of infection increased by 1.3 with every 1 fold increase in HLA-G expression. An analysis of mother-to-child transmission rates by gender revealed that the odds ratio for transmission was 3.4 times more in female babies than in males. We then investigated the relationship between maternal viraemia and HLA-G expression. A positive correlation between maternal viral load and placental HLA-G was observed (p = 0.038). When gender susceptibility to HLA-G expression was explored a statistically significant association was observed in placental tissue of mothers with infected and uninfected male babies and HLA-G expression (p = 0.013). To conclude, the analysis found that HLA-G was up regulated 3.95 times more in placental tissue of mothers with infected babies than in mothers with uninfected babies. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

This dissertation elicits focuses on sexual misconceptions which pose challenges to HIV/AIDS prevention and control among African adolescent girls in Umlazi Township, Durban. The study springs from the realisation that mere misconceptions related to sexuality could instigate risky behaviour resulting in HIV infection, and ultimately, result in premature death related to AIDS-related illnesses. Due to their physiological vulnerability, adolescent women are among a group at highest risk for contracting HIV in South Africa The study seeks, therefore, to understand how sexual misconceptions predispose girls to HIV infection against the context of gender, sexuality and reproductive health. The latter three issues are shaped by myriad forces working against the adolescent group. The study concludes with recommendations focused on challenging and removing sexual misconceptions with gender-sensitive interventions. / Thesis (M.A.)-University of KwaZulu-Natal, 2006.

HN/AIDS in South Africa has grown to very serious proportions. An estimated number of 5.3million South Africans are infected with HIV and the majority of these infections are in the reproductive age group. Based on Annual Antenatal survey 2002,of the total 2.95 million were women aged 15-49, with an estimation of 91271 babies infected through mother to child transmission. Breastfeeding is said to be an ideal food for growth and development of a child. Given that HIV is transmissible through breastfeeding, the paper aims at examining patterns and attitudes towards breastfeeding in the era of HIV/AIDS. A total of 400 respondents drawn from Mafikeng district were interviewed. The majority were aged 20-39, never married, rural, unemployed with high school level of education. Areas of interest were knowledge about HIV/AIDS, patterns of breastfeeding and attitudes towards alternative methods of infant feeding for an HIV positive mother. Previous reports gave clarity to HIV transmission rates at various stages of life. Evidence has shown that rates of transmission are higher in early stages than late stages of life. Few weeks of life from 6-8 weeks may particularly be a period of high risk than ages above three months. Transmission might have occurred during pregnancy, labor or through breastfeeding, whereby data has shown that colostrums have high concentration of Human Immune Virus than mature milk. The study shows that breastfeeding is still regarded as an important infant feeding method that is ideal for child's growth and development but HIV infection is seen as a disturbing factor to successful breastfeeding. Fifty four percent of respondents did not breastfeed exclusively as promoted by UNICEF and WHO; mean duration for exclusive breastfeeding is two months, support is given by SADHS 1998, mean duration for complementary feeding is two months which gives an indication that more infants are at higher risk of contracting the virus should their mothers test positive which in turn gives rise to high infant /childhood morbidity and mortality rates. There is a need to strengthen and expand programmes such as VCT and PMTCT in all communities especially in rural setting where there is lack of pure water supply and proper sanitation. Efforts to reduce the risk of transmission should therefore be centered on promoting the understanding that mixed feeding or breastfeeding with supplementary feeding carries the highest risk of HIV transmission compared to exclusive breastfeeding or exclusive formula feeding. / Thesis (M.Soc.Sc. (Population Studies) North-West University, Mafikeng Campus, 2004