published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

This study aimed to review the use of lay counsellors and rapid HIV tests in a voluntary testing and counselling (VCT) service in the UGU South health district of KwaZulu Natal. The study ran from September 1999 to April 2001. In early 1999, UGU South was selected as a pilot site as part of an international initiative. This initiative aimed to promote testing for HIV by using VCT service as an entry point into a range of HIV/AIDS and TB prevention and care programmes and was termed the ProTEST Initiative. Four such ProTEST sites were developed in South Africa and all offered rapid HIV testing and prophylactic drugs (Isoniazid and Cotrimoxazole) for HIV infected people. VCT was prioritised at all sites, however UGU South was unique in providing lay counsellors. Traditionally a lay counsellor (who is not a trained health care worker), offered only pre and post- test counselling. Lay counsellors had been used in South Africa, however their impact had not been formally assessed. In accordance with the Health Professional Council ruling on testing blood, lay counsellors could not carry out a rapid HIV test procedure. The decision to use lay counsellors in UGU South, was based on a review of the capacity of existing health care workers to expand a VCT service. Ten female lay counsellors, who fulfilled pre-employment selection criteria, were employed. In 1999, VCT was prioritised by the South African Department of Health and a Strategic Plan on HIV/AIDS & STDs was developed. The aim was to test 12.5% of the adult population for HIV before the year 2005. The proposed VCT service was to be based at health facilities and was to utilize existing health care workers. The capacity of existing health care workers to cope with an expansion in VCT services had not been explored. The reasons why clients accessed VCT and the demographic profiles of such clients were poorly understood. The Department of Health also planned to use rapid HIV tests at health facilities. Literature on the use of rapid HIV tests in South Africa was limited. This study aimed to address gaps in knowledge around VCT in South Africa and specific objectives were to: * Assess the capacity of existing health care workers to expand a VCT service *Review the need for rapid HIV tests *Develop and evaluate a training, support and mentorship programme for lay counsellors *Review the reason why clients use a VCT service and the demographic profiles of such clients *Monitor the impact of lay counsellors on numbers of cases of TB diagnosed and treated *Make recommendations for the use of lay counsellors and rapid HIV tests in an expanded integrated HIV/TB Control Programme. The study was prospective, descriptive and was based at ten health facilities in UGU South. The health facilities offered counselling, rapid HIV tests and prophylaxis for HIV infected people (Isoniazid or Cotrimoxazole). The study population was all nurses, lay counsellors and clients involved with the VCT service at these sites. Both qualitative and quantitative methods of study were employed in this study including: *Postal survey * Interviews *Focus group discussion *Review of patient records, literature and questionnaires * Analysis of registers from the National TB Control Programme. Results from three independent reviews clearly indicated that nurses in UGU South did not have the capacity to offer an expanded VCT service due to a heavy workload commitment. The nurses considered that VCT was a necessary service and supported the introduction of lay counsellors. Quantitative reviews concluded that a third of people tested for HIV using a hospital based testing system never returned for their results and that the turn-around time for an HIV test result was as much as three weeks. Rapid HIV tests increased access to an HIV test result and were acceptable to health care workers. There was no review of the opinions of clients on the rapid HIV tests. A training, support and mentorship programme was developed for lay counsellors and both nurses and counsellors considered that the programme was largely effective. The lay counsellors were trained to offer a more comprehensive service than traditional lay counsellors; in particular lay counsellors were expected to screen clients for symptoms of TB disease and support clients taking TB medication. Evaluation of the programme concluded that the content should be more practical and there should be a dedicated supporter for the lay counsellors available at their place of work. Results suggested that access to VCT services increased due to the presence of lay counsellors. The lay counsellors were acceptable to health staff, however there was no review of the opinions of clients on the lay counsellors. Half of the 7 475 people tested were infected with HIV. Most clients were medically referred for VCT and had "AIDS defining" illnesses. The clients who self-referred were ill or knew someone who had died recently. The proportion of clients who self-referred increased and health education was the main reason why people self-presented. More women than men were tested and women were more likely to test HIV positive. Review of the TB registers indicated that the TB Control Programme in UGU South was not optimal. The impact of lay counsellors on numbers of TB cases diagnosed and on treatment could not be determined from this study. Before the use of lay counsellors is expanded, there should further review of the capacity of other health care workers to offer VCT. Issues such as conditions of employment, salaries and a job description for lay counsellors should be clarified. There should be an independent assessment of the quality of counselling offered and a review of the cost of the lay counsellors. The impact of using men and younger lay counsellors should be reviewed. VCT services should be based at clinics, rather than hospitals and consideration should be given to developing freestanding VCT sites. Education programmes on VCT should be expanded beyond health facilities. Prior to expanding the use of rapid HIV tests, there should be a review of the cost of rapid HIV tests and systems should be in place for ordering, delivery and for stock control. The opinions of clients on rapid HIV testing should be ascertained. Consideration should be given to lay counsellors performing the rapid HIV test or an alternative method of testing (not involving blood) should be introduced. There should be ongoing training in TB and monitoring of the TB Control Programme in UGU South. Specific indicators should be developed to monitor the impact of lay counsellors on the diagnosis and treatment of TB and to measure collaboration between HIV/AIDS and TB Control Programmes. / Thesis (M.Med.Sc.)-University of Natal, Durban, 2002.

This study explores the perceptions of care and support for those with HIV/AIDS by community members within the KwaNgcolosi community who are currently not involved in such care and support, and have no current perceived obligation to do so. The Social Capital framework was used to understand the current community perceptions and dynamics related to current care and support for those who are ill with HIV/AIDS. This was followed with suggestions for how this could be improved, current obstacles to this, and possible personal contributions towards improving the current situation. Data was collected by means of six semi-structured, in-depth focus groups, which were conducted in IsiZulu with the assistance of a translator. These were then transcribed and thematically analysed. Overlapping quantitative data specifically for the themes of social cohesion and trust exists in the form of two social assessment surveys, and so frequency counts were done with applicable survey questions, and compared with data collected from focus group interviews. Focus group discussions revealed a marked difference between perceived ideals of how care and support should be, and what is currently happening within the community. Mistrust and stigma surrounding HIV/AIDS appear to still be prevalent within the community, which hampers community social networks and involvement, and acts as a barrier for those who wish to provide care and support for those who are ill. Triangulation with Social Assessment surveys, revealed a discrepancy between social cohesion as related to HIV/AIDS, and general social cohesion within the KwaNgcolosi community. This social cohesion is not currently leading to collective action, which points to a deficit both in information sharing regarding how to do so, as well as a deficit in Social Bridging. Family members and individuals who are ill may, for various reasons, also prevent community members who wish to become involved, from providing care and support to those who are ill. Reciprocity also affects the social credibility of community initiatives, which are not taken seriously if nothing can be expected in return. Additionally, expectations of economic reciprocity regarding contributions to household expenses negatively affects providing care for family members, who are blamed once they become ill, if they did not contribute to the household while still working. Social norms regarding gendered social and economic expectations also hinder and restrict desires to assist in care and support for those who are ill with HIV/AIDS. The obstacles highlighted by the themes of trust, reciprocity and social norms have resulted in potential barriers to mobilization of social networks, and resources that may be available through these networks. There is a need to provide education to community members according to their perceived contributions, in providing care and support for those with HIV/AIDS, and in keeping with current gendered norms which point towards women undertaking much of the physical aspects of care and support, with men engaging in social and emotional support. However, care should be taken that current destructive gender stereotypes, in which women are expected to undertake primary caregiving roles, are not encouraged and perpetuated. Additionally, education surrounding perceived contributions to HIV/AIDS care and support will increase perceived personal abilities and competence, and act as an enabling factor towards more individuals becoming involved in care and support. Gateways to identified sources for information, such as the Home Based Caregivers and the KwaNgcolosi Clinic should also be tapped, and a flow of information encouraged. However, the current situation is a complex combination of stigma, discrimination and blame towards those who are ill, as well as mistrust from the ill person and their family members, who isolate themselves and block any attempts of care and support from community members. This has resulted in many possibilities and untapped resources within the community. Future initiatives must therefore, from a programme perspective, shift from a focus on current obstacles, to encouraging and developing community members. potential contributions towards care and support for those with HIV/AIDS. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

Objectives. Explore and describe the impact of premature life-threatening illness, stigma, multiple loss of significant others, decreased vocational choice and mobility and decreased financial security among young gay men living with AIDS. It was hypothesized that young gay men with AIDS and the elderly experience similar physical, social, and psychological changes, but the cognitive adaptation to these changes are hindered by the non-normative timing of these events. / Methods. Thirty-two self-identified gay men with AIDS between the ages of 22 to 44 years were recruited from an out-patient clinic in Montreal. These participants were asked to complete a comprehensive questionnaire, which assessed the respondent's daily stress, impact of HIV, health-related quality of life, ways of coping, multiple loss, dependency on informal and formal supports, and preparation for death. Quantitative methods were used to analyse the data. / Results. The hypothesis was confirmed. Respondents reported relatively low levels of health-related quality of life, significant concern over health and financial security, considerable multiple loss, increased dependency on informal and formal supports, proportionally greater use of active coping strategies, and significant concern about discrimination. / Conclusions. A comprehensive method of intervention which addresses all of the biopsychosocial aspects to care is proposed. It is suggested that a coordinated multidisiciplinary approach to clinical and research endeavors should be adopted to address the multidimensional obstacles facing young gay men with AIDS.

HIV/AIDS care needs to be comprehensive and holistic (UNAIDS, 2002). Counselling has proved to be one of the most effective behavioral tools in the global anti-HIV/AIDS fight by equipping people mentally, emotionally, psychologically and socially for the disease (Anon, 2000). Over the past two decades researchers identified cultural factors, race, gender and class as leading inequitable treatments in general counselling situations (Coleman, 1995). This challenge happened to be the same in HIV/AIDS counselling, especially because the counselor work with sensitive information. Nurses who forms the back-bone of HIV/AIDS counselling, are all trained on a Western model of HIV/AIDS counselling. Herbst (1990) also pointed out that knowledge concerning cultures and subcultures and its implications has become a major issue for the nurse to deliver health care in South Africa. Faced with the history of South Africa and the diverse cultures it was my personal experience as a professional nurse, counselor and researcher while I was working on the *Ufe health train, that the knowledge of culture is one of the most important factors of HIV/AIDS counselling. This motivated me to embark on this research. This research aims at providing an analytical description of the experience of counselling for African (Batswana) counselees and their counselors with specific reference to HIV/AIDS counselling with view to improve this interaction. The objectives of this research was to: a) analyse the counselling done by Western and African counsellors in the health system, with a particular focus on HIV/AIDS counselling, b) establish how acceptance and decision-making is promoted, understanding of the counselee is established and psychosocial support is given, and c) develop a middle -range theory that describes appropriate HIV/AIDS counselling for African counselees. Glaser's (1965; 1967; 1992) grounded theory approach was used to guide this research. Multiple data collection methods were used, which took place concurrently with the descriptive analysis. Glaser's conceptual analysis paradigm for qualitative data analysis was utilised. Based on the results of this research the importance of an HIV/AIDS counselling approach for Africans is emphasised. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

Thesis (M. Admin) North-West University, Mafikeng Campus, 2006

This paper explores the experience of nurses who work both as Primary Health Care Providers and counsellors trained in the narrative model of counselling in primary health care settings. Five focus groups were conducted in both Xhosa and English. Discourse analysis was used as a method of analysing the data. Training nurses in the narrative counselling model introduced an alternative discourse, which was experienced as contradicting their usual way of working. Two dominant discourses were the “not knowing” approach, assumed by the narrative model of counselling, and the “knowing” stance, assumed by health education. The institutionalised construction of counselling by doctors and matrons, and their power versus the power of the nurse counsellors was also cited as sources of conflict. Despite the tensions, narrative model of counselling seems to be offering new positions, which may benefit people living with HIV and improve HIV/AIDS activities in the Primary Health Care (PHC) context.

M.Phil. (Labour Relations) / The aim of this study was to investigate the impact of Aids in the workplace from a legal point of view and to isolate some of the most important areas where legal regulation could become problematical. In general it was found that the best way to deal with Aids is to try and prevent it by eliminating ignorance as far as .possible and to bring the disease into the open by means of the early distribution of facts through proper education and counselling and especially the formulation and implementation of a sympathetic Aids policy. This should prevent litigation on the basis of the unfair labour practice concept in the industrial court to a large extent. The legal position regarding problem areas such as confidentiality, testing, the value and regulation of screening, the freedom to employ, dismissal, termination and safety was analysed both in terms of existing South African law and also by comparison with developments internationally. It was found that a high premium is placed on security of employment and that Aids victims should not be discriminated against, but treated objectively like other cases of serious illness.

M.A. / The challenge of HIV/AIDS is a global issue, instead of decreasing the number of people infected with the disease the number is increasing. Fortunately we have men and women who are volunteers to fight the increase of this pandemic. These heroes are the voluntary caregivers who are the mainstay of people with AIDS. However the fact that the caregivers suffer from loneliness and social isolation related to stigma and discrimination cannot be ignored. Voluntary caregivers can benefit form the opportunity to express basic emotions concerning, financial, emotional and physical issues and open line of communication should be in place. Providing an avenue foe emotional expression may enhance both physical and mental health to voluntary AIDS Caregivers. The qualitative study undertaken to explore the experiences of AIDS patients and their families regarding the home based care as service delivery. An explorative and qualitative design was used to determine the experiences of the AIDS caregivers, and aids patients concerning the support that they receive. AIDS patients and the families were selected from the organisations that are funded by the Department of Social Development in the Free State, Bloemfontein area. Pilot study was conducted prior to the commencement of the study comprising of ten participants in each group. Participants were requested to give information during the interviews. Data was collected and analysed and it was in followed by the literature control. The findings did not differ significantly in emotional and social aspects. The researcher drew conclusion and recommendations. Limitations were discussed. / Dr. Oliphant Ms. A. Vermeulen / M.A.

Theses (MPH.) -- University of Limpopo, 2017 / INTRODUCTION: Since the introduction of Anti-retroviral therapy, People Living With HIV/AIDS (PLWHA) now live longer and present with various opportunistic neuro-musculoskeletal and cardio-pulmonary conditions among other complications. This has led to a surge in the number of patients that visit the physiotherapy department presenting with many complications which include mobility problems, neurological deficits, muscle weakness and developmental delay in children among others as experienced by the researcher in the work place. AIM: To determine the knowledge of physiotherapists with regard to HIV/AIDS and their attitude towards HIV/AIDS patients in the Kingdom of Swaziland. METHOD: In this study a quantitative, descriptive cross-sectional survey was used to determine the knowledge and attitudes of Physiotherapists in the management of HIV/AIDS in the Kingdom of Swaziland. RESULTS: The results of the study revealed that physiotherapists in the Kingdom of Swaziland have a good knowledge and a positive attitude towards people living with HIV/AIDS. Amongst other attributes that were looked at in the study it was reported that 100% of the participants were knowledgeable on the complications associated with HIV/AIDS and 94% of the physiotherapists reported that they are familiar with complications that will benefit from physiotherapy. On the attributes related to attitude of physiotherapist towards HIV/AIDS patients the study found that 100% of the physiotherapists reported that they would take precautions and continue seeing the patients. There was no statistical significant relationship between years of experience and attitude (Pearson chi-square =0.25, p-value =0.61), familiarity with commonly used ARVS (Pearson chi square =1.13, p-value =0.76) and familiarity with Universal Precautions (Pearson chi-square =2.55, p-value =0.46).There was no statistically significant relationship between knowledge and attitude (Pearson chi square =1.000, p-value =0.61). CONCLUSION: The study revealed that the physiotherapists have good knowledge on HIV/AIDS and they also have positive attitude towards managing People Living with HIV/AIDS at their respective departments. There is need for the physiotherapy training schools to include HIV/AIDS in their curricula since some of the schools of physiotherapy where the participants trained did not include it during their time of training and the practising physiotherapists need continuing health education on HIV/AIDS. There is a need for the work setting libraries where physiotherapists work to have current books and journals for the physiotherapists to update themselves on issues pertaining to HIV/AIDS and internet access in the departments. The physiotherapists are also encouraged to take the initiative to utilise the libraries in their work settings and get information on HIV/AIDS. Keywords: Knowledge; attitudes; Physiotherapists; HIV/AIDS; Patients