HIV/AIDS is a global challenge and its impact is evident. This places a burden on hospitals and health professionals. To ease this burden there are home-based care programmes which, through home-based caregivers, provide patients living with HIV/AIDS with physical and palliative care. However, these HBCGs face various challenges such as poverty, discrimination and stigma when caring for PALHIV, and their own emotional strain, which becomes burdensome without sufficient support from the home-based care centre. The qualitative study undertaken investigates the challenges and coping mechanisms of the HBCGs. Thirteen research participants were drawn from a centre in Mamelodi. Data was gathered through interviews and observations, categorised into themes and analysed. Major findings revealed that social challenges faced by HBCGs include poverty, stigmatisation and discrimination. Emotions experienced by HBCGs include guilt, anger, hopelessness, but they have spiritual reliance through prayer as one of their coping mechanisms. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Besides constituting major obstacle to effectively addressing HIV/AIDS, Stigma has remained among the least understood experiences of PLWHA. Limited knowledge and understanding of HIV/AIDS related S&D has very much contributed to poor implementation and in most cases failure of HIV intervention programmes at national, regional and international levels. Sociological analysis of Stigma in PLWHA lends verifiable insight into the nature, extent and comprehensiveness of HIV/AIDS related Stigma. With 129 participants from Gauteng regions of Ekurhuleni, Sedibeng and West Rand, the study confirms that Stigma and Discrimination (S&D) still thrives, quantifying its magnitude, implications and impacts in the lives of the HIV infected. Inter alia, the findings showcase the complex matrix analysis of emotion and behaviour associated with HIV/AIDS related S&D. Finally, the study offered a comprehensive recommendation on how to address HIV/AIDS related S&D at individual/family, institutional/community and government levels. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

This study was conducted to determine retention rate and factors associated with loss to follow-up (LTFU) of adult pre-ART patients in St. Luke hospital, Ethiopia. Cross-sectional study with quantitative and qualitative data collection techniques was used. Review of patient records, focus group discussions and review of program guidelines was conducted to determine level of adherence among pre-ART patients. In addition, pre-ART service quality and perceived reasons for discontinuation was explored. The study revealed that only 38.2% of the 335 patients enrolled in the pre-ART care were retained after 12 months of follow-up in the program. More than half (55.6%), of the LTFU occurred during the first 6 months of follow-up. Fear of discrimination, high transportation cost and mistrust in the pre-ART service were perceived reasons for LTFU. Absences of clear pre-ART service package and implementation guideline were also identified as important factors that may be related to LTFU. The findings call for improved quality of care and a better pre-ART service packaging that will address the gaps identified in order to increase patient retention. / Health Studies / MA (Public Health)

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is a global problem. Introduction of antiretroviral therapy (ART) came as a relief to people living with HIV and AIDS as it improved their quality of life. However, maintaining high adherence levels to antiretroviral treatment is still a challenge in some settings yet strict adherence to treatment instructions is critical for successful suppression of HIV. A qualitative, descriptive phenomenological research was conducted to explore factors that influence adherence to antiretroviral therapy at Beatrice Road Infectious Disease Hospital (BRIDH). Purposive homogenous sampling was done. Data was collected from twenty patients through in-depth interviews. Study findings identified five main themes that facilitate adherence and these entail knowledge on HIV and AIDS and ART, motivation to live, adherence support networks, good service delivery and factors related to medication / Health Studies / M.A. (Public Health)

The humanised Aids patient increasingly finds itself a part of mainstream popular rhetoric. There was a time however, when the Aids patient was no more than a disease ravaged corpse without rights. Conventional histories and analyses tend to gloss over this fact, or argue that the new, authentic patient is a triumph of wisdom over brute ignorance, fear and superstition. Such accounts overlook their own role and the part played by the bio-medical sciences in constructing the Aids patient. This thesis, in contradistinction, traces the Aids patient's portrayal in South African bio-medical discourses, applying to it the work of Michel Foucault. In doing so the dynamic interactions of power and knowledge are brought under the spotlight. / Psychology / M.A. (Psychology)

The main research of the study was: How is integrated communication applied in the UKZN AIDS Programme at Westville Campus? The following six subsidiary research questions were formulated to address this topic:  How is communication aligned with the strategic focus in the UKZN AIDS Programme?  How consistent are messages and media used in and outside the UKZN AIDS Programme?  What is the status of infrastructure for integration within the UKZN AIDS Programme?  What is the status of internal stakeholder orientation and differentiation in the UKZN AIDS Programme?  What are the mechanisms put in place to coordinate communication efforts and action within the UKZN AIDS Programme?  What is the status of free flow of information within the UKZN AIDS Programme? A qualitative research design was conducted using field and survey research. These two research methods may be used for descriptive, exploratory, and explanatory research (Mouton 1996:232). Descriptive and exploratory field and survey research were used to ascertain the integrated communication applied in the UKZN AIDS Programme. Data was collected from sixteen UKZN AIDS Programme employees and eight students using semi-structured focus group and in-depth interviews respectively. Data collected was analysed using thematic analysis a technique that involves identifying, analysing and reporting in detail patterns or themes within data.The study found that the UKZN AIDS Programme focuses mostly on the University as its main stakeholder. Therefore, there is little emphasis on employees and students. Besides, the study revealed that there is poor alignment of the programme’s communication strategy with the programme’s strategy. To achieve the UKZN AIDS Programmes’ strategic objectives and mission, there is need to reassess the efforts of the programme and re-strategise. Findings on the consistency of messages and media in the UKZN AIDS Programme reveal that all communications are managed by senior employees and consistent in terms of programme identity by using the university identity, and website messages. The status of the consistency of messages and media in the programme can be improved if a comprehensive approach can be used in communicating internal messages. Findings on the consistency of messages and media in external communication show that the programme tries to communicate different prevention messages using channels favoured by students. However, channels such as drama and peer educators have weaknesses that need to be addressed in addition to employing diverse communication channels. Findings show that some of the messages communicated are relevant in the sense that they address students’ sexual risk behaviour while others are not as they are off tangent such that they address issues students are not concerned about. In addition, findings show that peer educators were not exemplary in their work while drama programmes did not allow students to actively participate in the prevention activities. On infrastructure for integration, the study found that there is infrastructure and several prospects for information sharing in the programme created by information technology though not fully explored. With regards the free flow and sharing of information, the study established that the required systems for communication exist but not adequately utilised. Findings on the co-ordination of communication efforts and actions to promote integrated communication show flaws. Departments in the programme function in silos due to lack of cross-functional planning. The integrated communication conceptual framework used in the study was useful in making the study successfully ascertain integrated communication applied by the UKZN AIDS Programme. The conceptual framework can therefore be used to underpin any research topic on health integrated communication. / Communication Science / MA (Communication) / 1 online resource (v, 222 leaves)

South Africa has an estimated 920 000 patients on antiretrovirals (ARVs), the largest number of patients in any country. ARV therapy demands adherence levels in excess of 95% to avoid development of drug resistance, but adherence to ARV therapy is estimated to be only between 50% and 70%. Poor medication adherence is acknowledged as a major public health problem, reducing the effectiveness of therapy and promoting resistance to ARVs. More than two thirds of the South African population have marginal reading skills and this significantly influences a patient’s ability to read and understand health-related information. Patient education materials tailored for the South African population could be a useful aid in facilitating communication with patients and perhaps impact positively on their medicine-taking behaviour. This behaviour is influenced by patient knowledge, beliefs, attitudes and expectations and includes self-management, self-efficacy and adherence. Self-efficacy, which refers to patient confidence in the ability to self-manage medicine taking, is a key factor influencing adherence. This study aimed to develop illustrated patient information leaflets (PILs) and medicine labels for all first-line ARV regimens used in the public health sector in South Africa and, using a randomised control study design, to investigate the impact of these illustrated information materials on knowledge, medication-taking behaviours and health outcomes in HIV/AIDS patients taking ARVs. To achieve this aim, the objectives were to assess HIV/AIDS and ARV-related knowledge, as well as self-efficacy and adherence to ARV therapy; to assess the influence of demographic variables on knowledge, adherence and self-efficacy; to assess the influence of the information materials on knowledge, self-efficacy and adherence and to assess the association of knowledge with health outcomes. Medicine labels and PILs, both English and isiXhosa, were developed for ARV regimens 1a, 1b, 1c and 1d. The 8-item Morisky Medication Adherence Scale (MMAS-8) and HIV Treatment Adherence Self Efficacy Scale (HIV-ASES) instruments for measuring respectively adherence and self-efficacy, were modified to optimize clarity, simplicity and cultural acceptability and were translated into isiXhosa using a multi-stage translation-back translation. The questions and the rating scales, for both the MMAS and HIV-ASES, underwent preliminary qualitative evaluation in focus group discussions. Patients were recruited from local Grahamstown clinics. A pilot study to evaluate applicability of the instruments was conducted in 16 isiXhosa AIDS patients on ARVs and the results from this study informed further modifications to the instruments. One hundred and seventeen patients were recruited for the randomised control trial and were randomly allocated to either control group (who received standard care) or experimental group (who received standard care as well as pictogram medicine labels and the illustrated PIL). Interviews were conducted at baseline and at one, three and six months. Data were analysed statistically using the t-test, chi-squared test and ANOVA (Analysis of Variance) at a 5% level of significance. Correlations were determined using Pearson and Spearman rho correlations. Approval was obtained from Rhodes University Ethical Standards Committee, Settlers Hospital Ethics Committee and the Eastern Cape Department of Health. The results of this research showed that illustrated PILs and medicine labels enhanced understanding of HIV/AIDS and ARV information, resulting in a mean overall knowledge score in the experimental group of 96%, which was significantly higher than the 75% measured in the control group. Variable knowledge scores were measured in three areas: baseline knowledge of general HIV/AIDS-related information was good at 87%, whereas knowledge scores relating to ARV-related information (60%) and side-effects (52%) were lower. These scores improved significantly in the experimental group over the 4 interviews during the 6 month trial duration, whereas in the control group, they fluctuated only slightly around the original baseline score. There was no significant influence of gender on knowledge score, whereas health literacy, education level and age tested (at one and three months) had a significant influence on knowledge. Self-efficacy and adherence results were high, indicating that the patients have confidence in their ability to adhere to the ARV therapy and to practice optimal self-care. Age, gender and education, in most cases, significantly influenced self-efficacy, but were found to have no effect on adherence. The CD4 count improved over the trial duration which may have been influenced by a number of factors, including better knowledge of ARVs and improved adherence. No significant parametric correlation was found between knowledge score and change in CD4 count, however, Spearman's rho showed significance (rs=0.498; p=0.022). Both patients and healthcare providers were highly enthusiastic about the illustrated labels and PILs, and indicated their desire for such materials to be routinely available to public sector HIV/AIDS patients. The isiXhosa version of the PIL was preferred by all the patients. These simple, easy-to-read leaflets and illustrated medication labels were shown to increase understanding and knowledge of ARVs and HIV/AIDS in low-literate patients, and their availability in the first-language of the patients was central to making them a highly useful information source.

Cognisant of the fact that counselling has become an essential aspect of dealing with HIV/AIDS in South Africa, the researcher aimed to explore the stressors experienced by HIV/AIDS counsellors. It was envisioned that the results obtained would both help to improve the counselling services provided at Settlers Hospital, and assist other organisations to do so. The research focused on how the participants dealt with the dual roles of non-directive listening and the more prescriptive advice-giving, the stressors they experienced and the support structures they had, or needed, to assist them in being more effective HIV/AIDS counsellors. The sample consisted of four HIV/AIDS counsellors working at Settlers Hospital, Grahamstown. The co-ordinator of HIV/AIDS at the hospital was interviewed for collateral information. A qualitative, multiple case study was undertaken. In-depth, semi-structured interviews were used to collect the data which were recorded and transcribed and then constructed into coherently organised personal narratives of each participant’s experiences. A composite description of all the results was arrived at through the use of a reading guide which reduced the data into a thematic content analysis. The analysed data served to present an understanding of the counsellors’ experiences and to enable recommendations to be made which could assist them in pursuing their work more effectively. The findings of this study indicate that HIV/AIDS counselling is an emotionally stressful occupation. Contributory factors include the twofold role of promoting prevention and serving as empathic listeners. Other stressors derive from issues of confidentiality and stigma concerning HIV/AIDS, counsellors’ identification with clients’ experiences and the demographics of HIV/AIDS in South Africa. Situational stressors which arise from working as both nurses and counsellors in a public health institution were also identified. Recommendations are made to alleviate the counsellors’ stress in the form of facilitated emotional support groups, professional supervision, managerial support to improve the working environment, and ongoing in-service training.

South Africa is one of the countries hardest hit with the Human Immunodeficiency Virus (HIV) and Acquired Immuno Deficiency Syndrome (AIDS) epidemic. In response to the epidemic, the South African government adopted the Comprehensive HIV & AIDS Care, Management and Treatment programme strategic plan (CCMT) in 2000 (1) and developed the Operational Plan for CCMT for antiretroviral therapy rollout in 2003 (2). In order to monitor the progress of the implementation of CCMT, the National Department of Health (NDOH) adopted the Monitoring and Evaluation (M & E) framework in 2004 (3). The aim of this study was to assess the HIV & AIDS programme in Grahamstown‘s public sector health care system by using the national M & E indicators of the HIV & AIDS programme. The national M & E framework was used as the data collection tool and available information was collected from various sources such as the District Health Office (DHO), Primary Health Care (PHC) office, accredited antiretroviral sites and the provincial pharmaceutical depot. Group interviews were conducted with key stakeholder health care professionals at the District Health Office, Primary Health Care office, Settlers Hospital and the provincial Department of Health personnel. A one-on-one interview was conducted with the Deputy Director of HIV & AIDS Directorate, monitoring and evaluation in the National Department of Health. Available indicators such as budget and expenditure including antiretroviral procurement; human resources; nutrition-related indicators; prevention care and treatment indicators were collected. A group interview was conducted to document current practices, or where there was a lack of documentation, for indicators such as traditional medicines and pharmacovigilance. Most of the national M & E indicators are not required to be collected or collated by the district because the reporting format designed by the provincial Department of Health is different. Facilities, districts and provinces in South Africa are at different levels of implementation of the antiretroviral programme and hence a common format of the M & E indicators is not used by all provinces. Uniform data collection is not achieved due to human resources‘ constraints and other challenges such as continued use of manual reporting systems by the clinics. Districts are expected to report according to the formats drawn up by the provincial Department of Health (DOH) and there is a lack of awareness regarding the national M & E document amongst the Grahamstown Health Care Professionals. There is a need for training on the use of the M & E national framework so that the HCPs at the primary and secondary levels of the health care system are proficient with the process of M & E, and can provide inputs as well as take ownership of the process. The establishment of an M & E unit in Grahamstown is essential so that data collection and submission of the HIV & AIDS programme in the public sector according to the National M & E framework is addressed. However, despite all constraints and challenges in the public sector health care system in Grahamstown, available human and financial resources are being used effectively to maintain the HIV & AIDS programme.

The purpose of this study was to explore and identify factors that either facilitate or inhibit individuals volunteering for HIV-testing. The target group was comprised of Xhosa first-language construction workers in a company with an HIV/AIDS workplace policy and programme. This programme provides basic education and awareness about HIV/AIDS. This education includes information about where to access voluntary counselling and testing (VCT) services. Interpretive qualitative research was undertaken in order to explore the beliefs, perceptions and intentions of the target group in regard to the utilisation VCT services. Data was collected using an unstructured interview guide. The data was analysed using Tesch’s approach to content analysis. Concerns about validity and reliability were engaged throughout the research process and supported further by using researcher reflexivity and an independent researcher. The independent researcher analysed data separately and only after discussion and consensus being found between the two researchers were final categories and codes agreed upon and data analysis considered complete. Findings revealed that an HIV/AIDS workplace programme has a positive impact on the health-seeking behaviour of workers in the construction company used in this research. Respondents knew how HIV/AIDS is transmitted, how to prevent transmission and where to find HIV-testing treatment and support. In this case HIV-testing services can easily be accessed further facilitating respondents volunteering for HIV-testing. It was also found that family, friends and churches support HIV-testing behaviour by providing education, guidance and support to respondents encouraging behaviour change. On the other hand, respondents held that community members who had not benefited from an HIV/AIDS workplace programme such as theirs are exposed daily to the devastating effects of HIV leading to AIDS deaths and live in fear of the disease. Debilitating illness and eventual death is equated with an HIV-positive diagnosis which causes community members to believe it is better not to volunteer for HIV-testing than to ascertain one’s HIV-status. The HIV/AIDS workplace policy and xv programme on the other hand is seen to have provided respondents with HIV/AIDS knowledge enabling them to overcome their fear of an HIV-positive diagnosis and to volunteer for regular HIV-testing.