In recent years there has been a worldwide recognition of the disparity of HIV treatment available in the West and in Sub-Saharan Africa. The West African nation of Senegal was early to implement measures that allowed for the distribution of highly effective anti-HIV therapy known as Antiretroviral (ARV) therapy to a limited number of patients. This thesis explores how patients living in Senegal who are infected with HIV have engaged in various negotiations to obtain access to treatment and other resources to meet the needs posed by their infection. These negotiations are framed by various historically embedded notions of how to engage relationships in the search for care. Strategies are also shaped by the biopolitically-laden discourse that guides the distribution of ARV therapy. This thesis traces the structure, evolution, and effects of patients' strategic negotiations in response to the introduction of this therapeutic technology.

The importance of partnerships between marginalised communities and support agencies (from the public sector, private sector and civil society) is a pillar of HIV & AIDS management policy. Such alliances are notoriously difficult to promote and sustain. The thesis presents the findings from a longitudinal, qualitative case study of a project seeking to build partnerships to facilitate local responses to HIV & AIDS in a remote rural community in South Africa. The partnership aimed to empower community stakeholders to lead HIV-prevention and AIDS-care efforts through the support of local government departments, NGOs and the private-sector, and make public services more responsive to local needs. I highlight the value of building longterm relationships with, and ownership of the project by community stakeholders, i/ by involving community stakeholders in partnership building and facilitation from the very beginning of the process, and; ii/ through a compliance with, and respect for community protocols and norms in the process of entry, community engagement, and partnership facilitation. I illustrate how features of the local public sector environment have actively worked against effective community empowerment and partnership. These include a rigid hierarchy, poor communication between senior and junior health professionals, lack of accountability, limited social development skills, and the demoralisation and/or exhaustion of public servants dealing with multiple social problems in under-resourced settings. I outline the obstacles that have prevented private-sector involvement, suggesting a degree of scepticism about the potential for private-sector contributions to development in remote areas. The most effective partners have been the NGOs — run by committed individuals with a keen understanding of social-development principles, flexible working styles and a willingness to work hard for small gains. Despite the challenges, the partnership has achieved many positive outcomes, including the formalization of the partnership and its institutionalization within a permanent government structure. I outline these achievements and discuss the essential role played by an external change agent in facilitating the process of partnership building. I conclude with eight key lessons learnt and recommendations which emerged out of the research. Firstly, partnerships are embedded in and influenced by the contexts within which they are located; secondly, stakeholder organizations must create an enabling environment to encourage and sustain partnership participation; thirdly, capacity building and empowerment of partners is crucial for ensuring ownership and sustainability of the partnership; fourthly, partnerships within resource (human and physical) poor contexts like Entabeni, where skills and resources are scarce, require the services of a dedicated, skilled facilitator or external change agent; fifth, partnership building needs to be guided by regular monitoring and evaluation and a systematic documentation of the process; sixth, relationships based on trust are a central pillar of partnerships; seventh, partnerships are as much about individuals as they are about communities and organizations, and; finally, partnerships can and do work, in-spite of the many challenges that may be encountered. of partnerships between marginalised communities and support / Thesis (Ph.D.)-Universtiy of KwaZulu-Natal, Durban, 2008.

Voluntary counselling and testing, the cornerstone of HIV/AIDS prevention efforts worldwide, is at the centre of a policy debate rega rding its effectiveness. Informed by social constructionism and drawing on various tools from ethnomethodology and conversation analysis, a sample of twenty-seven vid eotaped simulated counselling interactions in South Africa was analysed. The aim was to assess how the interactional tasks of the voluntary counselling and testing sess ion were worked through by clients and counsellors, and how this was done against the publ ic health and counselling frameworks that inform voluntary counselling and testing pract ice. The goal of the analysis was not to examine practitioners’ competencies, but to exam ine their unfolding actions in the situation and to consider the interactional functio ns these actions might serve. The results show that of the three interactional ta sks of voluntary counselling and testing, information-giving lays the foundation upon which the advice and support goals are realised. It is constructed as critical to client a nd counsellor identities and is a powerful tool through which hope is dispensed. Both the info rmation-giving and support tasks of voluntary counselling and testing combine to manage client distress into more concrete and manageable terms that encourage client coping. Counsellors draw on a range of advice-giving strategies – those that place the onu s of responsibility on the client to those that view the counsellor as the moral guide able to direct client change – in order to encourage clients to reflect on their risk behaviou r. In general, voluntary counselling and testing is framed as a moral activity, and this is most evident in the advice-giving segments. The public health and counselling framewo rks that inform voluntary counselling and testing create a dilemma for counse llors. In practice, counsellors orient towards a directive and health-advising role rather than a non-directive, client-centred counselling role. The implication of this research is that voluntary counselling and testing needs to be defined and framed more clearly – i.e. as a public health intervention with preferred outcomes that draws on a set of client-centred skills. Reconceptualisations of voluntary counselling and testing need to acknowledge the mor al framework under which it operates. Clear implementation guidelines (and training) on what voluntary counselling and testing is and that define its goals more clearly will be useful in assisting counsellors to implement the policies that govern their practice. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

The Constitution of South Africa outlines the way in which the country should be run and lays down different levels of government and their powers. Most importantly it sets out a list of human rights in the Bill of Rights. These rights belong equally to all individuals. Stigmatization and discrimination of people on the basis of their HIV status is a violation of their basic human rights. In South Africa a person can have his or her rights upheld in court if they are violated or threatened by an individual or institution (whether the state, private company or any other organization). Enforcing the rights of people living with HIV/AIDS and/or their families, as well as countering and redressing discriminatory action, is a matter of accessing existing procedural, institutional or other resources that comprise the societal gains of democracy. However, the biggest challenge currently has to do with ordinary people's lack of awareness about their rights, and this pertains particularly to those millions of South Africans living with HIV/AIDS. This study sets out to examine the knowledge levels of para-legals currently advocating for the rights of people living with HIV/AIDS and/or their families in KwaZulu Natal. With an infection rate estimated to be in the region of 36% of the adult population, it is essential that providers of legal advise and advocacy in this province have sound grasp of HIV/AIDS issues. It should be noted that this study attempts to move beyond a documentation of knowledge by exploring what such para-legals perceive their actual needs for more effective management of HIV/AIDS to be. The study seeks to make recommendations towards a better and more relevant training of para-legals, one that is needs-driven and more attuned to the context and lived realities of the people whom they seek to serve. / Thesis (M.Dev.Studies)-University of Natal, Durban, 2004.

There is no abstract available for this thesis. / School of Nursing

Thesis (PhD)--Macquarie University, Division of Linguistics & Psychology, Department of Linguistics, 2003. / Bibliography: p. 397-424. / Introduction -- Models of shared decision-making in medicine -- Framing the study -- The analytic goals of modelling agency -- The context of treatment decision-making in HIV -- Agency and alignment -- Study conclusions and implications. / The quality of doctor-patient communication has been shown to influence treatment uptake, adherence and effectiveness in HIV medicine and elsewhere. Increasingly, it is considered essential that doctors and patients jointly participate in decisions concerning treatment. There is a growing body of literature describing joint decisionmaking and suggesting guidelines for its practice. Few of these studies, however, relate their descriptions of medical decision-making as a social process to the ways in which patterns of verbal interaction realize or foreclose on joint decision-making. -- Dominant models of medical decision-making view shared decision-making as a midpoint between enlightened paternalism and informed choice. Based on a corpus of HIV consultations audio-recorded in Sydney in the late 1990s, this thesis argues that it can be better modelled as a particular type of social process, which differs across a number of dimensions from other styles of medical decision-making, specifiable as contextual parameters of meaning. The thesis then identifies ways in which specific discursive practices realize these contextual parameters. -- A major component of the thesis focuses on agency, and a model is presented in the form of a socio-semantic network, drawing on work by van Leeuwen (1996) and others, which relates a range of grammatical features, not only transitivity patterns, to ways of construing social agency. The thesis then considers the way in which doctors and patients mobilise these and other resources for bringing together potentially conflicting points of view in framing and articulating treatment decisions. Here I draw on notions of mutual alignment (e.g., Goffman 1981) but expand the analysis of what is aligned to account for speakers' implicit discourse orientation, as well as more overt markers. -- Findings emphasise the relationship between representing and enacting agentive roles; the importance of doctors and patients mutually projecting each other's voices; and the variable and iterative character of shared decision-making. The research demonstrates how doctors and patients negotiate a complex, interactionally and symbolically mediated agency, and shows that patients often take the lead in developing more collaborative decision-making practice. There are still institutionally and socially determined limits to the degree of control patients may exercise within the consultation, many of which are of course well founded. / Mode of access: World Wide Web. / xvii, 533, [22] p. ill

HIV/AIDS has been an obstacle to socio-economic development and a major cause of loss of human life. It has also caused vast inequities and frustration to the public health sector. One of the significant efforts made by the public health sector to combat the epidemic is the implementation of a mandatory HIV/AIDS testing policy to scale-up HIV treatment. This dissertation examines the impact of this policy on the human rights of people infected with and affected by HIV/AIDS. Coercive government policies aimed at controlling the AIDS pandemic often infringe on the rights of individuals known to be or suspected of living with HIV/AIDS and this decreases the effectiveness of public health measures. The research methodology involved the study of written literature and a comparative literature study of the law and practice obtaining in South Africa, Uganda and Canada. It revealed that voluntary testing is effective and suitable in South Africa. This dissertation aimed to show that any public health approach that aims to achieve a comprehensive prevention strategy must be consistent with respect for human rights as enshrined in regional and international human rights law. Public health and human rights should, therefore, not be regarded as opposing forces; rather they should be seen as a unified system of protection of human welfare under the Bill of Rights and the Constitution. The solution to the crisis lies not only in testing every single person but also requires a shift of focus to more pressing issues that include gender equality, stigma and discrimination; prioritizing human rights, institutional capacity and resources; and an end to extreme poverty. A human rights-based approach to HIV/AIDS testing, such as the Voluntary Counselling and Testing (VCT) is recommended. Therefore, failure to adhere to the core principles of testing - which are informed consent, counselling and confidentiality of the test result - will only hinder the global fight against HIV/AIDS. The rights of those affected by HIV/AIDS need to be protected in order to address public health imperatives. This can be done through the use of the law as an instrument of social change as well as education and awareness. Key words, HIV/AIDS, mandatory testing, Voluntary Counselling and Testing, public health, human rights-based approach.

M.A. (Psychology) / The Acquired Immunodeficiency Syndrome not only threatens the world with hitherto unknown rates of mortality and economic ruin, but has also saddled the health sciences with an unprecedented challenge in curing and managing this disease. Herein, the health sciences have not found a cure, and the management of the disease is made extremely difficult because of the unpredictable nature of the interrelationships in biopsychosocial factors inherent in the disease. In order to attempt a description of the complex interrelationships between biopsychosocial factors in this disease, a group of twenty patients in a treatment programme comprising of an exercise and cognitive-behavioural intervention, were subjected to immunologic and psychological assessment before and subsequent to the intervention. The data obtained indicated that none of the interrelationships between psychological and immunological variables predicted by psychoneuroimmunological science existed prior to the intervention. It would appear that the interrelationships between these variables were in total disarray - defeating the object of systematic logical description of biopsychosocial factors in this condition. The post- intervention data suggested a pattern of interrelationships totally within the confines of predicted neuropsychoimmunologic patterns of a biopsychosocial interaction in a disease of immunologic origin. This pattern of predictability would then render possible a treatment programme of a multidisciplinary nature which would bear predictable fruit. It also underscores the necessity of psychological interventions as an adjunct in the treatment of AIDS.

The aim of this research project was to determine the effectiveness of DaimlerChrysler South Africa’s efforts in addressing the HIV/AIDS pandemic. The devastating impacts of the HIV/AIDS pandemic have already been felt at the workplace as without further successful interventions, HIV/AIDS mortality at DaimlerChrysler South Africa (DCSA) was expected to peak in 2006. Investment in HIV/AIDS programmes has been proposed as good business practice. The DCSA HIV/AIDS Workplace Programme was thus established to limit the impact and consequences of the HIV/AIDS pandemic on its workers, their families and surrounding communities. The empirical survey, comprising a questionnaire, examined the attitude and perception of employees regarding the effectiveness of the DCSA HIV/AIDS Workplace Programme. The findings of the empirical survey corresponded with the findings of the literature survey in concluding that the DCSA HIV/AIDS Workplace Programme has been successful in effectively addressing the HIV/AIDS pandemic. A few aspects of the Workplace Programme need attention and recommendations have been made in order to contribute to the lowering of HIV/AIDS prevalence rates at DaimlerChrysler South Africa.

M.A. (Psychology) / It is generally accepted that Acquired Immunodeficiency Syndrome is the most serious pandemic ever to threaten South Africa. Within the context of South Africa being an African country, this pandemic is dramatically increasing and establishing a pattern which will not only effect the health services in the future, but will also have a devastating effect on the economy of the country. The greatest impact of the Acquired Immunodeficiency Syndrome is not only on the individual and his health condition, but also on the context within which the individual functions. Within this context, the family is affected and a reciprocal effect takes place, where the manner in which the family of the affected individual deals with his condition, may have a detrimental effect on his illness. To date limited research has been conducted to describe this condition and its impact on the family. This study was undertaken in order to deal with the problem. Two experimental groups were recruited, the reason being that these two experimental groups would largely cover the diversity of the field in which this condition occurs. The first experimental group consisted out of white homosexual males who were diagnosed as having AIDS and the second group consisted out of a group of black heterosexual males who were also diagnosed as having AIDS. Ten psychosocial variables were isolated in order to investigate the impact the Acquired Immunodeficiency Syndrome has on family interaction. These were: depression, alienation, conflict within the family, cohesion within the family, meaningful interaction within the family, social interaction within the family, moral/religious emphasis within the family, impact of the disease on physical ability, the need for sleep and rest, and total sickness impact on the individual. An analysis of the data indicated that both white homosexual male subjects and black heterosexual male subjects displayed significantly more depression, less social interaction, a greater need for sleep and rest, and a decline in physical ability. Furthermore, the analysis also indicated a very serious impact on the individual's ability to function. Of exceptional importance was the fact that white homosexual subjects displayed significantly more alienation and increased conflict within their families than the black heterosexual subjects, while the black heterosexual subjects in turn experienced less significant interaction within their families