published_or_final_version / Social Work / Master / Master of Social Work

This study focuses on the impact of HIV/AIDS on women in Namibia. Namibia, with a population of only 1.7 million people, is ranked as the seventh highest country in the world in terms of HIV/AIDS infections. The percentage of women living with HIV/AIDS in Namibia accounts for 54% of the total of 68 196 people in the country living with the virus. Women are also diagnosed with the disease at a younger age (30) in comparison to their male counterparts (35 years). Desoite their needs, women living with HIV/AIDS bear a triple burden of caring for those living with HIV/AIDS, caring for themselves and coping with the responses to their infection. There are few focused intervention strategies to support and care for women living with HIV/AIDS in Namibia.

M.Ed. ( Educational Psychology) / This research study shows that young HIV sufferers undergo disturbances involving the mind, body and spirit causing a variety of future adjustment difficulties, problems and coping abilities. This is attributed to fear, loss, grief, guilt, denial, anger, anxiety, depression, stress, physiological changes, pain and hypochondria. This study indicates that they are particularly fearful about being isolated and rejected. They are overwhelmed by thoughts of loss of everything, accompanied by profound feelings of grief. Guilt and self-reproach affect their health further, having an effect on them both physically and mentally. The uncertainty of their future having contracted HIV intensifies anger with themselves as well as others. This also brings about anxiety due to lack of information and appropriate support systems in Soweto...

Submitted in fulfillment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015. / Abstract The HIV pandemic continues to intensify in most countries, especially in Sub­ Saharan Africa, with 1.8 million new people becoming infected with the disease in 2011. Sub- Saharan Africa is the world's worst HIV and AIDS affected region. The intensity of the AIDS pandemic in South Africa creates additional challenges for health workers. Apart from the fact that they could be infected, they have to deal with an increasing number of people who suffer from a fatal disease for which no cure has been found. Nurses are expected to give all the necessary care to these patients. The HIV and AIDS epidemic in South Africa poses challenges for an overburdened health care system. There is limited knowledge about health care perceptions and emotional experiences of providing HIV and AIDS related care and support. It is against this backdrop that the researcher has chosen to explore the experiences of first-year student nurses, caring for HIV and AIDS patients. Aim of the study The purpose of the study was to explore the lived experiences of first-year student nurses, nursing HIV and AIDS patients. Methodology A descriptive phenomenological research design was used to explore the experiences of first-year student nurses, caring for HIV and AIDS patients. The research setting was two colleges of nursing in the uMgungundlovu District that offer the four-year nursing diploma programme. The type of purposeful sampling that was used was criterion sampling, which entailed studying cases which met pre-set criteria. In-depth interviews with the first-year student nurses, who had experienced nursing HIV and AIDS patients, were conducted. The data was analysed manually and put into categories and sub-categories as they emerged. Results The findings revealed that the participants had positive and negative experiences when they provided nursing care to HIV positive patients. The positive experiences were that the participants did not fear meeting HIV positive patients and they were not traumatized. These participants nursed HIV positive patients like any other patient. The participants expressed their feelings as sad and bad. Participants who had negative experiences were shocked, scared and cried when they met HIV positive patients. Six participants reported that they did not know of any facilities available for debriefing and sharing of experiences. The remaining participants identified the group lecturer, group mates, the psychologist and registered nurse in the ward. There was a lesson in class that was dedicated to debriefing and the sharing of experiences. The majority of the participants (n=10) stated that HIV and AIDS was transmitted through contact with infected body fluids and blood. The participants identified similar methods of transmission, which were unprotected sexual intercourse, needle-stick injuries, use of contaminated needles and mother- to- child transmission of HIV and AIDS. The participants were able to correctly identify the modes of transmission, except for one participant who was not sure if HIV and AIDS was transmitted through breast-feeding, due to a lack of knowledge of the modes of transmission. Six participants identified voluntary counselling and testing (VCT) as a support service available for nurses exposed to HIV and AIDS. Three participants verbalised that they did not know of any services available to student nurses. Some participants were not sure if the services were available and accessible and had no idea if the services were available and accessible to the student nurses. There were various problems that were encountered by the participants with regards to accessing the services. These included a lack of privacy, fear of giving information to colleagues, early closure of the clinic and unavailability of the counsellor when needed. Recommendations were made concerning the need for adequate preparation of student nurses in their early training, with regard to VCT, PMTCT, home- based care and support groups. The stigma for HIV and AIDS needs to be adequately addressed. Support for student nurses needs to be provided when dealing with death of HIV and AIDS patients, as a large majority voiced not being able to cope. Conclusion Student nurses who shared their experiences nursing HIV and AIDS patients had positive and negative experiences when they provided nursing care to HIV positive patients. The participants needed the relevant support and counselling to be available when needed. Stigma still exists, even though HIV and AIDS has existed for at least thirty years. / PDF copy unavailable. please refer to hard copy for full text information / M

Thesis (Ph.D. (Nursing Science)) -- University of Limpopo, 2018 / Introduction: Health care workers have a pivotal role in the management of Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) and their well-being is consequently crucial as it could impact negatively on the quality of caregiving. With the development of a care and support model, the needs of health care workers can be identified and catered for, and quality patient care will be rendered through well-cared and supported health care workers. Purpose: The purpose of this study was to develop a care and support model for health care providers of patients diagnosed with HIV and AIDS in the public hospitals of the Limpopo Province. A key step in the development of a model for care and support is to explore and describe the experiences of professional nurses regarding care and support they receive while providing care to HIV and AIDS patients in the public hospitals of Limpopo Province Methods: A qualitative, descriptive, exploratory and contextual design was the method used which guided the development of the model. The population of the study were the professional nurses in five public hospitals from each district of the Limpopo Province. These hospitals were selected because they all shared similar characteristics of having clinics where HIV and AIDS patients receive care. The sample was purposively selected. The sample size was 20 professional nurses which was determined by data saturation, meaning that four professional nurses who worked for 24 months or more per public hospital were selected. Data were collected through face-to-face interviews and an audiotape was used to record all unstructured interview sessions conducted. Analysis of data were done through using an open-coding method in accordance with Tech’s qualitative data methodology to develop a model. Results: The research findings revealed emotional and physical strain due to shortage of staff and heavy workload which was exacerbated by staff turnover and high absenteeism. Exhaustion, fatigue, development of work-related vi illnesses and increased level of stress were also challenges experienced which led to increased customer complaints and decreased quality of service provided to patients. Many professional nurses were not trained in the management of patients with HIV and AIDS, but were expected to execute their activities competently. There was also lack of counselling, debriefing sessions, recognition and rewarding systems for the health professionals who were taking care of those patients. Recommendations: This Care and Support Model provides strategies to be used by the managers in public hospitals of Limpopo Province to enhance care and support to health care providers of HIV and AIDS patients. The model should be implemented at various public hospitals throughout Limpopo Province and feedback provided so that it could be further developed and refined. Conclusion: The results indicated that health care providers of HIV and AIDS patients were deprived of the necessary care and support during provision of care to HIV and AIDS patients. A model for care and support as a strategy to assist the managers to offer care and support to health care providers of HIV and AIDS has been developed. The model is a contribution to the nursing management, the government and it serves as a guideline for improving the quality of patient care through well-cared and supported health care workers.

Thesis (Ph. D. (Sociology)) -- University of Limpopo, 2014. / This study investigated the challenges to antiretroviral therapy adherence. Qualitative and quantitative research methodologies were applied in the study. Purposive sampling was used to select clients on antiretroviral therapy, convenience sampling was applied to select clients who participated in the focus group discussions and health care workers and lay counsellors were selected through the simple random sampling method. In-depth interviews were conducted with 31 clients on antiretroviral therapy at 8 health facilities, 2 focus group discussions comprising of 7 members each were conducted at two health facilities, medical records of all respondents on antiretroviral therapy were reviewed and a stigma scale was administered. A questionnaire was distributed amongst 17 health care workers and lay counsellors. Most of the respondents who participated in this study were females. Data gathered in this study confirmed that women are more vulnerable to HIV than men. The majority of the respondents were poor African people. The predominant language amongst the respondents was the Xitsonga language; hence the world-view of the Va-Tsonga people was assessed. HIV and AIDS cause many social problems in communities. Some of the major findings are that: Literacy levels were found to be very low as most of the respondents pointed out that they had only obtained grade 7 or below. However, this did not have an impact on treatment adherence. Some respondents indicated that they were unemployed; the majority said they were employed. Even though the stigma and discrimination experienced by the respondents was very low, the few who experienced it had very traumatic and cruel experiences perpetrated by their own family members and people in the community. In terms of disclosure, data indicates that most people prefer disclosing to their mothers as they feel that they will get support. The majority of the respondents disclosed to female family members and they were supported by the people they disclosed to. viii Social support is very crucial for people who are on antiretroviral therapy (ART), most of the respondents indicated that they had treatment supporters. Institutional support was very minimal in that most pointed out that they did not belong to any support groups. There were some who did not even know about the existence of any support groups at the health facilities where they were receiving their treatment. Most of the respondents indicated that they disclosed to their colleagues and others had not as they feared that they would lose their jobs. Those who had disclosed indicated that they needed support from their colleagues and employers with regard to compliance with their clinic appointments. Most of the respondents had sexual partners, and had also disclosed to their sexual partners, and disclosure was almost immediately after being diagnosed HIVpositive. There are those who had not disclosed to their sexual partners as they feared rejection or violent reaction. There were sero-discordant couples amongst the respondents who supported each other regarding adherence. Most of the respondents indicated that they had taken care of a family member living with HIV. HIV prevalence also varies amongst health facilities. Strategies employed by health facilities to monitor and evaluate HIV and AIDS programmes differ. Health Care Workers and lay counsellors provided contrasting information. Primary Health Care facilities have been accredited to provide ART, however the down-referral system seems to be failing as some clinics now have more clients on ART than hospitals. Health Care Workers and counsellors also need to be familiarized with the World Health Organization (WHO) standards. The level of adherence acceptable for an individual on ART is 95%; there is however health facilities that indicated the adherence level far below the required level.

Thesis (MPH.) -- University of Limpopo, 2015 / Background: The introduction of Antiretroviral Therapy (ART) has shown a tremendous reduction in HIV-related mortality and morbidity in people living with HIV / AIDS. Adherence to ART is the key to a successful treatment outcome. This study investigates the adherence of people living with HIV who are on ART. Since high levels of adherence of more than 95% are required to achieve effective suppression of the viral load, the researcher finds it very important to establish whether the people are pursuing what is expected of them. While the use of ART has brought much excitement and hope to both patients and medical practitioners in the world, it has also brought many new questions and challenges, including adherence issues. Adherence is, therefore, essential to achieve the success of ART. Aim: The main objective was to determine which factors influence adherence to ART among HIV and AIDS patients. Methods: This study utilised a quantitative cross-sectional descriptive design that was conducted at the Kwa-Thema Clinic, Ekurhuleni District, Gauteng Province. Data was collected using a structured questionnaire with open- and closed-ended questions where a total of 290 respondents were interviewed. Data was analysed using SPSS software version 22 and the analysed data was presented by means of charts, graphs, and frequency tables. Results: The findings indicated that the adherence to ART at the Kwa-Thema Clinic was 77%. Factors that were significantly associated with adherence were gender ((χ2 = 3.78, df = 1, p < 0.05).), level of education ((χ2 = 3.52, df = 3, p = 0.032), co-treatment of HIV and other infections (χ2 = 5.46, df = 4, p = 0.019).), ability to follow ART ((χ2 = 12.82, df = 1, p = 0.000 < 0.05), and types of ARV drugs. Recommendation: To enhance ART adherence the study recommends intensification of health education campaign against stigma and gender discrimination. Providing feedback to the patients by the healthcare providers regarding the benefits of ART is important. ix Conclusion: It was concluded that the adherence to ART at the Kwa-Thema Clinic was sub-optimal (less than 95%) at 77% but comparable to the adherence levels in other developing countries.

Background. Meaning of working studies suggest that working, beyond providing an opportunity to make money, contributes to an employee’s identity, fulfilment, self-esteem and other important psychological needs. The Meaning of working model offers one approach to explore how social and cultural norms shape what work means to individuals. The current study is situated within in the context of the recent global financial crisis which has caused turmoil in many organisations including those in the non-profit sector. The study explores the meanings workers in AIDS care non-profit organisations in the midst of the crisis and the subsequent socio-economic context. Aim. This is an interpretative phenomenological study which aims to explore how workers in AIDS care organisations make sense of their work within a unique socio-economic context occasioned by the financial crisis. Method. The study was conducted in semi-rural areas and townships of Durban Metropolis and the vicinity. Using a snowballing technique, project managers, HBC facilitators and a nurse (N=14) were recruited and interviewed using a topic guide containing semi-structured questions drawn from Westwood and Lok (2003) MOW model. Findings. Findings suggest that due to the financial crisis these organisations have undergone restructuring causing them to apply various strategies including social entrepreneurship strategies in order to survive. It was also found that participants generally regard working as central to their lives and complementary to other important life roles due to the fundamental nature of AIDS care work being linked to religion, community and family. Findings also caution that due to the high value they attach to working, there are various negative consequences for worker’s well-being and health which should be considered by health care policy makers. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

There is a very limited literature examining transport and access to health care, especially in the South African context. The existing literature does not provide an analysis of the influence of transport on access to health care and the utilisation of referrals by the patients. In the context of the HIV/AIDS and Tuberculosis epidemics which have already increased the demand for health care and utilisation of referrals, transport is a critical issue to take into account with regard to access to health care. The case study presented in this dissertation examines the influence of transport (either public or private) on patient's access to health care facilities, particularly the referrals and Emergency Medical services (EMS). The findings are based on a sample of 30 EMS providers, 15 clinic and hospital nurses, doctors and senior administrators, as well as 200 patients (clients) seeking health care in the three clinics which were chosen as study sites. Using qualitative and quantitative methods, this study focuses on patients seeking health care as well as those who provide health care routinely at clinics and hospitals and in emergencies. The focus of interest was transport needs and services and its role in patient access in the context of HIV/AIDS and TB epidemics. Findings of this study confirm research undertaken in other developing contexts. They show that in rural and some remote urban settlements, transport is a serious barrier to equitable access to health care. Race and locality combine to generate a hierarchy of access to care in South Africa. The study concludes that there is a need to reallocate resources in the health sector in order to increase access. Transport needs have to be taken into account when access to services is planned. And alternative models of health care provision in the context of the epidemics have to be conceived, emphasising the provision of well-equipped and resourced primary health care facilities. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

More than three decades after the outbreak of the AIDS pandemic, sub-Saharan Africa is home to the largest epidemic in the world. Over 70% of infected people live in this region and are aged 15–49 years. Given that it is at this age that young adults are more likely to start families, their death as a result of AIDS gives rise to the crisis of AIDS-orphaned children. Several studies show that the number of AIDS orphans is on the rise and can reach up to 18 million throughout the continent. Generally, patients expect to be admitted in formal health care facilities for adequate treatment but the absence of cure and an increasing number of infected make it difficult for them to be treated as in-patients. In order to fill the gap, the elderly care for AIDS patients and take on the parenting role of AIDS orphans. However, there is not much information on the implications of caregiving on the well-being of the elderly. This dissertation aims at shedding light on this issue – using data from an informal settlement in the province of KwaZulu-Natal – in order to highlight the risks to the health of elderly caregivers. The elderly are the primary caregivers to thousands of AIDS patients and AIDS-orphaned children across sub-Saharan Africa. Their caregiving activities are strenuous and repetitive on a daily basis. Through qualitative data collected from 14 elderly caregivers, this project found that their well-being was compromised by several caregiving activities and the expectations placed upon them were unbearable. The vulnerability of caregivers was emphasized by the high number of dependents that resulted in lowered standard of living. There was also the risk of contracting HIV during caregiving since the elderly were not able to afford protective equipment. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.