The present study explores Rhodes students' perceptions and attitudes towards HIV/Aids issues. This study focuses on risk behaviour, stigmatisation, social perceptions and voluntary counselling and HIV testing (VCT). There is a lack of research on student attitudes, knowledge and behaviour at Rhodes University. It was therefore deemed pertinent to research this topic in that context. It was envisaged that the study would provide insights to be used in the formulation of improved strategies for HIV/Aids programs and education, ultimately impacting on the exponential increase of the pandemic in the Southern African region. A sample of six hundred and seventy five Rhodes University undergraduates completed a survey and its findings were interpreted in terms of relevant literature. A mixed methods approach using qualitative and quantitative methods was used. A focus group consisting of seven post-graduate students informed the development of the survey along with relevant literature. Four departments from the faculties of Commerce, Humanities, Science and Law were randomly sampled for the survey phase. Statistica was used to calculate descriptive statistics while the chi-square statistic was applied to examine the relationships between the variables. The findings show that the majority of students have high intention levels in planning to use preventative behaviour. However, in practise, this may not be the case. Many students feel that they belong to high or medium risk groups, as opposed to the low-risk groups. In terms of motivation levels, only sixty three percent of students are highly motivated to protect themselves from HIV/Aids and one third of respondents felt that they could not ask their partner to accompany them for an HIV/Aids test. In addition, students who had received VCT were more likely to be positive about the counselling process.

HIV and AIDS are still among the world's most significant public health challenges. Education is widely regarded as an effective response to the pandemic - a “social vaccine” that can increase young people’s awareness of the dangers of HIV infection and thus decrease their vulnerability to HIV and AIDS. Integrating HIV and AIDS awareness across the school curriculum is therefore one of the strategies being implemented to educate learners about the pandemic. There are challenges; however, related to the central goal of integrating HIV and AIDS education and also to the form – in particular, the pedagogical practices - that this might best take. This qualitative case study research investigated teachers’ perspectives, experiences, and levels of preparedness with regard to integrating HIV and AIDS information in the main carrier subjects, mathematics and geography, in some junior secondary schools in Namibia. The study situates debates on curriculum integration and draws on Fogarty’s (1999) models of curriculum integration as a conceptual and analytic tool to examine the nature, form and content of integration. It includes a questionnaire on curriculum integration completed by 53 teachers as well as a component consisting of observations and interviews with four teachers from two schools. The results reveal patterns that also emerge in earlier studies on curriculum integration. This approach is already widely recognized as challenging and problematic in the context of general education. However, this and other studies show that when HIV and AIDS are brought into the arena, additional factors come into play and further complicate the process, because of the sensitivity of this topic. In addition, the task of integrating HIV and AIDS education has been added to an already overcrowded curriculum. Teachers have not been provided with adequate (or any) training with concrete examples that might facilitate their efforts to integrate HIV and AIDS information into subjects like the ones under scrutiny in this study. The picture that emerges from examining the evidence on HIV and AIDS integration against Fogarty’s (1991) 10 models of curriculum integration is one in which teaching practices are ad hoc, opportunistic and haphazard right across the sample. The choice of integration models for implementation of the HIV and AIDS component in these subjects has been largely left to the opportunity, ability and personal inclinations of individual teachers. The results point to a range of responses, with many teachers not teaching HIV and AIDS at all or some hesitantly experimenting with different approaches; all to limited effect in realizing the intended national goals of this curriculum project. The overall pattern also reveals a degree of frustration among the teachers in the sample, who acknowledged and were concerned at the enormity of the HIV and AIDS challenge facing the country. They recognised the motive behind the policy to have the education system play an important role in response to the HIV challenge, but felt frustrated with the social, personal and practical difficulties of actually implementing the policy within the context of poor (or no) training, knowledge, and support.

Condom use is promoted as an effective method for prevention and contraception for people who practice or are at risk of practicing high-risk sexual behaviors. According to the UNAIDS (2009) report, condoms are the only resource available to prevent the sexual spread of the HI-Virus; and with regard to family planning, the same report proposes that condoms expand the choices, have no medical side effects, and thus provide dual protection against pregnancy and disease. However, in Africa as elsewhere in the world, condom use has been fiercely debated. The debates on the accessibility, availability and distribution of condoms in schools are not new nor are they uncontested. In Namibia, the HIV and AIDS policy in education does not explain how, when and by whom condoms should be made available to learners. This leaves it to schools to decide on how (and whether) to make condoms available to learners. As a result, individual school‘s choices not only vary, but are mediated by different factors that are not always in the best interest of learners who, as the foregoing discussion suggests, continue to participate in behaviour that, amongst other things, puts them at risk of HIV infection and falling pregnant. Relying on Foucault‘s theory of discourses, this study investigated the dominant discourses that shape learner, teacher, parent religious and traditional leader and traditional healer perspectives, responses, and experiences with regard to the accessibility, availability, and distribution of condoms in school. The study was conducted in nine schools in Kavango Region in Namibia using a mixed methods approach. The study used triangulation in the data collection process through the use of questionnaires where 792 learners participated in this component, and focus group discussions and individual interviews targeting four groups namely, learners, teachers, parents and religious leaders, traditional leaders and traditional healers. The quantitative data were analyzed using the Statistical Packages for Social Sciences (SPSS), and findings from the focus group discussions and individual interviews were analyzed identifying themes and patterns and then organizing them into coherent categories with sub-categories. The study revealed that the majority of adult participants opposed the idea of making condoms available in schools; advocating abstinence instead. This was despite evidence on the prevalence of sexual activity amongst youth in the community. Reasons had to do with various competing and hierarchized discourses operating to shape participant beliefs, perspectives, and responses in a highly regulated and surveilled social and cultural context. Put differently, the dominant discourses invoked a particular sexual subject; authorized and legitimated who invoked such a subject; who was and was not allowed to speak on sexual matters; as well as how sexual matters were brought into the public space of schools. Such authorization and legitimation regulated the discursive space in which discussions on sexual health, safe sex, and resources such as condoms were permitted; with negative consequences for the sexual well-being of youth in Kavango Region. The study also highlighted the tension between freedom, choice, and rights, showing how complex in fact is decision to make condoms available in school. On the one hand, teenagers positioned themselves as capable subjects who had the right to exercise choice over their sexual lives. Requesting parent consent was thus viewed as a violation of this right to choose. Such a position displayed authority and agency by learners that was pitted against views amongst adults in this study that positioned youth as having no agency. In their view, youth (a) were still children and thus innocent and pure, (b) ought to abstain, and (c) were difficult to control given the modern context. Adults believed that early sexual involvement by learners did not result from lack of vigilance and control on their part, but rather from exposure to modern social mores. The study concluded that (a) schools remain difficult spaces not only for mediating discussions of sex and sexuality, but also for providing resources to mitigate sexual risk amongst leaners, (b) in highly regulated societies, dominant religious discourses are produced and reproduced in and through existing institutions such as family, church, and schools; highlighting how these serve to normalize beliefs and perspectives, (c) the dominant discourses shaping communities in which schools find themselves remain inconsistent with school discourses that are shaped by modernist conceptions of childhood and youth, and (b) adult choices to sanction and obstruct schools from making condoms available (and in the case of teachers, not accessible and distributable) put the very children at risk that they propose to be protecting.

MPH / Department of Public Health

Department of Public Health / MPH

MPH / Department of Public Health / Antiretroviral treatment (ART) roll-out presents new opportunities and challenges for nurse-initiated-andmanaged antiretroviral treatment (NIMART) trained nurses in the primary health care (PHC) facilities. Nurses have had central role in the management of the human immunodeficiency virus (HIV) since the disease was first reported. The purpose of this study was to explore and describe the challenges confronting professional nurses implementing the NIMART programme in PHC facilities under Thulamela B Municipality, Vhembe District. This study used a qualitative approach in which the interview was used as a data collection technique. The target population comprised professional nurses who were trained in NIMART and who were implementing the programme. Probability sampling, in particular its sub-type, the simple random sampling technique, was used to select fifteen PHC facilities within the sub-District. The non-probability purposive sampling technique was used to select the NIMART-trained professional nurses in Thulamela B sub-District. The sample size was determined by data saturation. Data were collected from the participants through semi-structured interviews, observations and field notes to assist in transcription. A digital recorder was used to log individual responses during the interview sessions. Data from the digital recordings were transcribed verbatim. Results were analysed and interpreted thematically. This study establsihed that nurses were facing several challenges such as shortages of infrastructure and medication, lack of support from management and non-NIMART-trained nurses and discrimination. The NIMART programme was poorly supported in terms of nurse training as nurses indicated that they faced problems in performing tasks such as obtaining blood from children. Doctors were also reported to not fully supporting the NIMART programme. NIMART-trained nurses were optimistic with the implementation of the programme dispite the challenges they faced. To overcome some of the challenges faced at workplaces, nurses devised mechanisms such as allocating different times for collecting tablets and review, and group education for those consulting. It was also established that nurses provided support to each other. Nurses were reported to be using their own transport to collect drugs from the local pharmacy store. Recommendations that emanated from the discussion of the findings and the conclusions of this study are likely to have implications and applications for supporting and advancing the NIMART programme.

MPH / Department of Public Health / Background: South Africa presently has a very high HIV burden. It has adopted the UNAIDS “90-90-90 targets” to curb its HIV burden. This target aims to attain sustained viral suppression in 90% of all persons receiving antiretroviral therapy. This is supported by several studies. Studies to observe if patients are achieving and sustaining viral suppression in Limpopo, South Africa, are few. Objective: To investigate the viral and immunologic responses of patients in Vhembe District to highly active antiretroviral therapy (HAART) between the 1st of January 2004 and 31st of July 2016. Methodology: This was a retrospective medical record review conducted in Vhembe District in rural Limpopo. It included the medical records of 1247 individuals from Thohoyandou Community Health Centre. Analysis was done using SPSS 24.0. To model the factors associated with virologic and immunologic responses, each independent variable was tested for association with the dependent variable (viral suppression and CD4 count increase of ≥ 50 cells/μL from baseline to 6 months). The independent variables included age, year of initiation, gender, marital status, baseline BMI, haemoglobin, clinical stage and estimated creatinine clearance. The Pearson Chi square (X2) was used for all categorical independent variables and the t-test, for all continuous independent variables, to test for association. The estimate used was a 95% confidence interval, and a p-value of < 0.05 was considered significant. Results: The study showed that 52.6% of individuals were in clinical stage I at baseline. Viral suppression (viral load < 50 copies/ml) at 6 months was 64% (n = 648), 72% (n =193) at 60 months and 94% (n = 16) at 132 months. Fifty-nine percent had consistent viral suppression for a period of at least 6 months. Consistent viral suppression (viral load < 50 copies/ml on at least one consecutive occasion without any intervening viral load > 50 copies/ml) for at least 54 months was only 14%, while 2.3% had a delay in switching from a failing regimen. The mean CD4 count at baseline was 227 cells/μL, and 538 cells/μL at 60 months. The mean CD4 cell count increase from baseline to 6 months was 190 cells/μL. The immuno-virologic discordance was 27%. Patients with higher baseline CD4 count and females were significantly (p = 0.001 and 0.031 respectively) more likely to achieve viral suppression at 6 months. Those below 45 years and females were v significantly (p = 0.011 and 0.043 respectively) more likely to achieve adequate CD4 count increase at 6 months. Conclusions: The proportion of individuals with viral suppression in the District increased from 6 months onwards, and is fairly adequate. However, sustainability of viral suppression, once attained, is low. Adequate immunologic response, however, seems high. Males and age group above 45 years appear to have poorer responses to HAART.

MPH / Department of Public Health / Background: The provision of antiretroviral treatment for people living with HIV/AIDS has encountered many challenges associated with poor adherence in South African and other countries in Africa as a whole including globally. Taking ARVs Properly has shown to reduce viral load to a level where the virus becomes undetectable and these results in an increase of CD4 count cells. These decreases chances of oppotunistic infections but it requires a proper adherence and compliance to treatment which seems to be difficult to most patients on ART. Purpose: The study investigated factors contributing to clients defaulting antiretroviral treatment. Methodology: A qualitative explorative cross-sectional study design was conducted at Matoks in Capricon District, in the months of May, June and July 2017. A purposive sampling method was used to select 19 respondents whom where willing to voluntrily participate in the study from a population of People Living With HIV/AIDS (PLWHV). An indepth face to face interview was used to collect data, guided by a central question and probing. It was then analyzed by the use of eight steps of Tesch. Results: The findings revealed that women were more defaulters than men. Shortages of antiretroviral treatment and most clients were unable to collect ART on time due to lack of transport to the clinic and the long distance from their perspective homes to the clinic. Socio economic conditions and indegenious health beliefs were some of factors identified. Recommendations: extensive health education and promotion should be intensified to reach all community members of Matoks and PLWHA in terms of HIV/AIDS care and consistent taking of treatment that clients who live far away from the clinic will be able to collect the ARV treatment nearer to their place of residents. / NRF

MSc (Mathematcs) / Department of Mathematics and Applied Mathematics / Infectious diseases remain a major public health concern. Well-known for causing sickness and death, enormous pain and suffering, increased time spent on patient care and huge economic losses due to lost production. Infectious diseases continue to be a scourge without equal. In this work, we address the following research question: Can we use a multiscale model of HIV/AIDS transmission dynamics to assess the comparative effectiveness of health interventions that are implemented at different scale domains? To achieve the set objectives of the study, we use multiscale modelling approach, a new and emerging computational high-throughput technique for mathematically studying problems that have many characteristics across several scales. To be more specific, we perform three tasks in addressing the research question. First, we develop a within-host submodel and use it to show it’s associated limitations which only a multiscale model can resolve. Second, we develop a between-host submodel and use it to motivate the need for multiscale modelling of the HIV/AIDS disease system. Finally, we link the two submodels to produce a nested HIV/AIDS multiscale model that affords us the opportunity to compare effectiveness of five preventive and treatment HIV/AIDS health interventions. Analysis of the multiscale model shows that it is possible to jointly study two key aspects (immunology and epidemiology) of infectious diseases. The multiscale model provides the means for making meaningful comparative effectiveness on available preventive and treatment health interventions. Consequently, we employ the multiscale model to show that impact of HIV/AIDS packages increases as more interventions are integrated into the packages. Specifically, the study shows that combined HAART and male circumcision is more effective than an intervention involving HAART alone. Overall, our study successfully illustrates the utility of multiscale modelling methodology as a tool for assessing the comparative effectiveness of HIV/AIDS preventive and treatment interventions. For purposes of informing public health policy, we use the study results to infer that condom use, male circumcision and pre-exposure prophylaxis are more effective in controlling the transmission dynamics of HIV/AIDS at the start of the epidemic as compared to when the disease is endemic in the community while the converse is also true for HAART. / NRF

MSc (Microbiology) / Department of Microbiology / Background: Antiretroviral treatment (ART) has grown to be one of the most effective tool in the fight to control HIV/AIDS morbidity and mortality worldwide. However, due to the emergence of drug resistant HIV, ART efficacy can be jeopardized. Drug resistant HIV strain has a potential of becoming a major public threat, as its limit treatment options on people living with HIV. With several findings worldwide reporting drug resistant HIV to be currently being transmitted to ART-naïve persons, measures have been taken to genotype drug resistant HIV prior to treatment initiation. However, in resource limited countries such measures are not executed especially in public sectors due to the costs associated with the required assays for genotyping. Objective: The objectives of the study was to establish a deep sequencing protocol (Next Generation Sequencing-NGS) using an Illumina MiniSeq Platform and subsequently apply it to genotype HIV in chronically infected drug naïve persons for resistance mutations and viral genotypes Methods: HIV positive Individuals without any exposure to ART (Treatment-naive) were recruited. Partial pol fragment (complete protease and ~1104bp reverse transcriptase) were amplified and purified. Libraries were prepared using Nextera XT library preparation kit, fragmented, tagmented, pooled and denatured then sequenced with Illumina MiniSeq instrument. Consensus sequences were derived, aligned and phylogenetically analysed. The Stanford HIV Drug Resistance Algorithm was used to infer the presence of drug resistant mutants, at the viral minority and majority population levels. Results and discussion: An NGS protocol to generate nucleotide sequences for drug resistance inference was established. No major drug resistance mutations were detected against protease, reverse transcriptase inhibitors in the study subjects investigated. Nevertheless, V179D change was observed in one patient (8.3%). V179D has been shown to impact a low-level resistance to NNRTI. On the other hand, several secondary and unusual mutations at known drug sites were detected even at minority threshold level of <20%. Conclusion: No major drug resistance mutations was detected in the drug naïve study population. This finding suggests that there is no risk of treatment failure to the investigated subjects, however it is important to assess the potential phenotypic v | P a g e significance of the identified secondary resistance mutations in the context of HIV-1 subtype C. The established NGS protocol should be applied in subsequent HIV drug resistance studies. / NRF