D.Cur. (Psychiatric Nursing) / Malawi has a population of 9 million people with AIDS the leading cause of death in the age group of 20 • 40. The HIV prevalence rate, estimated at 23% in urban areas and 8% in rural areas, is one of the highest in the world (AIDSEC, 1994: I). Evaluation of counselling practices showed poor results with counsellors feeling ineffective and inadequate. Patients are mostly tested on medical indication but testing is increasingly refused by patients who do not see the benefit of knowing their HIV status. The counselling practice as it is known in the Western world is a foreign concept for patients living in rural Malawi. The high stigma of AIDS complicates support of the patients. The goal of this research study is to describe a model of counselling that would meet the needs of an AIDS patient in a rural community in Malawi. A qualitative research design that is explorative, descriptive and contextually specific to rural Malawi was used for the study. In order to describe a counselling model it was important to understand the illness experience of HIV reactive patients. The patients are seen in group context congruent with the African culture and therefore the experience of the primary care giver of AIDS patients is also examined. The experience of counsellors of AIDS patients is explored as the other major factor in the phenomenon examined. In the first phase of the study in-depth phenomenological interviews were conducted with identified groups. Focus interviews were conducted with a hundred AIDS patients to identify the needs and resources of the patients and to compile a demographic profile. Focus group discussions were conducted with counsellors for more complete comprehension. Data analysis and a literature control were undertaken. In the second phase of the study theory generation was used in order to develop a counselling model for AIDS patients and guidelines for implementing the model were generated. Based on the results of the analysis the major concept enable was identified as the essence of a model for counselling AIDS patients in rural Malawi.

The study examined correlates of HIV perceived risks and protective strategies among adolescents in rural Malawi i.e. whether there was an association between socio demographic characteristics of adolescents and subsequent HIV perceived risks and protective strategies. Age at sexual debut is a variable of interest in this study. The objectives were to investigate whether age at first sexual intercourse does influence adolescents’ individual’s risk perceptions of HIV and protective strategies, i.e. does age at first sex set a precedence in the thinking of adolescentswith regards HIV risks and protective strategies such as condom use. Data: This study uses cross sectional data from Wave 3 of a wider study, the Malawi Diffusion and Ideational Change Project (MDICP).The MDICP is a joint collaboration between researchers from the Population Studies Centre at the University of Pennsylvania and the University of Malawi‘s College of Medicine and Chancellor College. In this study, a multiple regression analysis on the cross sectional data from the 2004 wave 3of the Malawi Diffusion and Ideational Change Project was done. The focus of this study is on the relationship between age at first sexual intercourse and the individual‘s perception of risk of HIV/AIDS and protective strategies, it examines if there is an association between the two factors. Descriptive analysis: Descriptive statistics to obtain the frequencies of the main variables of interest such as the background characteristics of respondents (gender, marital status, mean age at sexual debut, education, economic status of household) were computed in order to better understand the population under study. Multivariate Analysis: Three separate models were employed; two multinomial regression analysis measuring worry and likelihood of infection against socio demographic variables and a binary logistic regression measuring condom use and the socio demographic variables. Relative Risk Ratios were used to interpret the multinomial logistic regression output while odds ratios were used to interpret the logistic output. Results: Consistent with existing literature, results indicate that early age at first sex is a predictor of HIV risk perceptions and protective strategies. Age at first sex does set a precedence in the future thinking of adolescents with regards to how they perceive HIV risks, as well as how they perceive protective strategies against HIV-particularly condom use. This study confirms that age at first sex alongside with other socio demographic variables are significantly associated with HIV risk perceptions HIV and condom use, while other factors may matter, such as gender, region, HIV knowledge, religion or educational level. Limitations: The information on age at first sexual encounter was based exclusively on respondent’s self–reports. This data collection method often has limitations that are attributed to the tendency for people to under-report socially unacceptable behaviours (e.g. having multiple sex partners) and to over-report socially acceptable behavior. The other limitation is that the study lacks longitudinal data to allow a more in-depth analysis of trends in HIV/AIDS-related indicators. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

The purpose of the study was to explore factors that influenced safer sex practices in Malawi. A quantitative, explorative, descriptive study was conducted to determine why the prevalence of new HIV infections was still high in Malawi despite. Questionnaires were used to collect data. Sexually active men, women, boys and girls that participated in the Centre for Human Rights and Rehabilitation community awareness activities participated in this study. The study found that demographic, socio-economic and knowledge-related factors influence safer sex practices in Malawi. Various modifying factors played a role in influencing the individuals’ perception of susceptibility, severity, barriers and benefits of practising safer sex. The findings indicated that individuals generally had a broad knowledge of the spread and prevention of HIV. The Health Belief Model was used as theoretical framework for the study / Health Studies

The purpose of the study was to explore factors that influenced safer sex practices in Malawi. A quantitative, explorative, descriptive study was conducted to determine why the prevalence of new HIV infections was still high in Malawi despite. Questionnaires were used to collect data. Sexually active men, women, boys and girls that participated in the Centre for Human Rights and Rehabilitation community awareness activities participated in this study. The study found that demographic, socio-economic and knowledge-related factors influence safer sex practices in Malawi. Various modifying factors played a role in influencing the individuals’ perception of susceptibility, severity, barriers and benefits of practising safer sex. The findings indicated that individuals generally had a broad knowledge of the spread and prevention of HIV. The Health Belief Model was used as theoretical framework for the study / Health Studies

Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)

Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: With the existence of many HIV and AIDS service providers especially at Local Authority Level which is government closer to the people, multi sector coordination of service provision becomes crucial. Therefore, this study undertook to assess the effectiveness of coordination of HIV and AIDS service provision in Salima District Council in Malawi. The researcher used the following methods to collect data: qualitative method, through a questionnaire where data was collected from the District AIDS Coordinating Committee (DACC) responsible for multi sector coordination at district level; and qualitative method, through focus Group Discussions that enabled collection of data from targeted sector heads from government, non- governmental organisations, Faith Based Organisations and Private Sector. The research found that Salima District Council has the necessary structural set-up to coordinate HIV and AIDS Response. In keeping with the three – one principle, Salima District Council has managed to develop one coordination body, one action framework and one M&E framework. The availability of the one action framework and one M&E framework (LAHARF) and that these are annually replicable, shows a level of coordination is available and it is working. Lack of adequate funding for HIV interventions and lack of involvement of DACC in planning process by most service providers are major challenges. It is thus recommended that Salima District Council should put in place a deliberate policy that makes it mandatory for all organizations working in the district to participate in planning and or share their plans with the district council. The Council should also ensure that strategic policy and guidelines documents are readily available to service providers for use when planning HIV and AIDS interventions. / AFRIKAANSE OPSOMMING: Wanneer daar baie diensverskaffers op Plaaslike bestuursvlak is word die koördinering van MIV/Vigsdienste baie belangrik. Die doel van hierdie studie was die bepaling van die doeltreffendheid van die koördinering van MIV/Vigsdienste in die Salima Distriksraad in Malawi. Data in ingewin deur gebruik te maak van kwantitatiew metodes en „n gestruktureerde vraelys is vir dataversameling gebruik. Ten einde nog eer data in te samel is fokusgroepe gebruik binne die Regeringsorganisasies, Nie-regeringsorganisasies, die privaatsektor en geloofsgeörienteerde organisasies. Die studie het bevind dat die nodige strukturele opset wel binne die Salima Distriksraad bestaan. Die Salima Distriksraad het ook daarin geslaag om „n enkele koördineringsliggaam te vestig en die studie het bevestig dat hierdie koördineringsliggaam inderdaar funksioneel is. Daar is egter nog steeds „n gebrek aan voldoende fondse en die nie-betrokkendheid van sekere van die diensverskaffers is steeds „n uitdaging. Voorstelle vir die verbetering van die betrokkendheid van al die diensverskaffers word in die studie aan die hand gedoen.

Certain individual and institutional factors such as knowledge about stigma and discrimination, fear of infection, social judgement, legal and policy environment act as actionable drivers and facilitators of HIV-related stigma and discrimination. These factors may hinder the utilisation and quality of care provided to people living with HIV. Purpose: The purpose of the study was to establish the actionable drivers and facilitators that determine the different forms of HIV-related stigma and discrimination among healthcare professionals at a district hospital in Malawi. Methods: The study used a descriptive correlational study. Data was collected through self-administered questionnaire. Data were analysed using SPPS and STATA 12. Fisher's Exact Test was used to conclude the association and binary logistic regression was used to model the degree of the statistical relationships. Results: The results showed statistically significant relationship between knowledge of stigma and discrimination, social judgement and awareness of workplace policy and HIV-related stigma and discrimination. Recommendations: Interventions aimed at increasing knowledge about HIV-related stigma, reducing social judgement, reinforcing HIV-related workplace policies are needed to reduce HIV-related stigma and discrimination in healthcare settings. / Health Studies / M. Ph. (Health Studies)