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.

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.

MEd (Educational Management) / Department of Educational Management / See the attached abstract below

The global AIDS pandemic with more than 30 million people being infected, with the greatest impact in sub-Saharan Africa, remains an enormous challenge to all societies including the churches. Especially young Africans, aged 15 to 24, face a high risk of getting infected with HIV. However, multifaceted and contextual preventive measures for this age group have good chances of curbing the epidemic. This dissertation in Practical Theology attempts to explore the potential contribution of Christian curriculum-based AIDS prevention in the Ghanaian context. It does this by relating practical-theological insights to the lifeworld of young people in Ghana. Thus the specific opportunities and limitations of Christian prevention programmes are identified. Their relevance for religious education in Ghana is finally examined in three exemplary curricula with Christian and secular approaches. The findings result in practical recommendations for the design of Christian AIDS prevention programmes within the Ghanaian context. / Practical theology / D. Th. (Practical Theology)

PhD (Public Health) / Department of Public Health / Background: South Africa continues to struggle with the high prevalence of Human Immunedeficiency Virus and Acquired Immune deficiency Syndrome. Young people of the university going age are the most affected by this disease. The higher education sector, particularly teachers, are well placed to mitigate this pandemic through teaching and learning. Despite the fact, that a lot has been written on the need to integrate HIV/AIDS content into curricula very few institutions of higher learning are heeding the call mainly due to lack of guidance on how to integrate HIV/AIDS content. Aim:The aim of the study was to develop a framework that facilitate integration of HIV/AIDS content into university curricula. Methods: This cross-sectional study employed quantitative methodology and was conducted in two phases : Data was collected using different methods such as cross sectional surveys, content analysis and systematic reviews. For cross sectional surveys the target population included teachers and students and they were selected using systematic and purposive sampling respectively. The study setting was University of Venda. Data were analysed using SPSS, version 23. Multiple logistic regression and chi-square tests (χ2) were employed to determine the associations. Results: The thesis comprises five interdependent studies. Study one: A systematic review of peer-reviewed journals and grey literature of HIV/AIDS programmes in higher education was conducted. It was found that HIV/AIDS content was integrated mainly into existing , compulsory, undergraduate modules, health sciences disciplines focused on basic facts about HIV/AIDS. The HIV/AIDS content was taught using classroom based teaching strategies. Study two: A quantitative content analysis, to gauge the extent of HIV/AIDS integration into the curricula in various departments at Univen was conducted. The results of this study suggest that HIV/AIDS content was limited as only 68 modules/courses out of 1979 had HIV/AIDS content in different disciplines across all eight schools at the university. Study three: A survey was conducted to assess the knowledge, attitudes and practices of students towards learning about HIV/AIDS content among 340 students . The study found out that majority of the students possessed high knowledge about HIV/AIDS, though they had misconceptions about HIV transmission routes. Further they supported the introduction of formal teaching and learning about HIV/AIDS in their disciplines and very few students were taught about HIV/AIDS in their studies. Study four: A survey was conducted to assess knowledge, attitudes and practices of teachers towards teaching and learning of HIV/AIDS content in the curriculum among 240 teachers . The results showed that the majority of teachers were knowledgeable about HIV/AIDS , had positive attitudes towards the teaching and learning of HIV/AIDS content in the curriculum and very few taught about HIV/AIDS. Study five: Data from the study findings, literature and analysis of the curriculum were integrated within Information ,Motivation and Behaviour Model to develop the proposed framework for integrating HIV/AIDS content. Conclusion: The purpose of the study was to develop a framework that facilitates the integration of HIV/AIDS content into the undergraduate curriculum. The proposed framework in this study may assist HEIs, faculties and teachers to integrate HIV/AIDS content formally into their curriculum and ensure that various academic departments can integrate HIV/AIDS-related issues into the undergraduate curricula. The framework outlines HIV/AIDS competencies for different levels of study in various disciplines and its adoption may assist HEIs in producing graduates who can survive and work in a world ravaged by HIV/AIDS. In order to implement the proposed framework for integration of HIV/AIDS content into undergraduate curricula, recommendations were made. / NRF

Submitted in partial fulfillment of the requirements for the Degree of PhD (Community Psychology), Faculty of Arts, University of Zululand, 2008. / HIV and AIDS present a catastrophic public health threat that is reaching crisis proportions among adolescents and young adults. There is a need to educate pre adolescent female learners before they reach puberty, as females are especially at risk of contracting HIV because of the interplay of biological, economic and cultural factors. This study explored the nature and extent of the pre-adolescent female learner's knowledge, attitudes and skills regarding HIV and AIDS. An experimental research design, namely, a no-treatment group design with pre test and posttest was applied. An HIV and AIDS prevention intervention programme was designed and implemented. The objectives were to help learners acquire knowledge, attitudes and skills to make informed decisions and practice health promoting behaviours. Life skills, sex and sexuality education and HIV and AIDS as a gendered epidemic were addressed. The science and art of health education was used to frame the intervention and ensured that the learner not only received the correct message but also incorporated it into her repertoire of behaviour. The findings of the study highlighted five critical areas that were vital within an HIV and AIDS education intervention. Firstly, pre adolescent female learners were very interested in sex and sexuality and information on physiological changes during puberty must be disseminated. The issue of morality was attached to sex and sexuality and this reinforced the biopsychosocial and cultural factors that came into play. The importance of peer education was emphasised, as parents were reticent to address these issues. It was found that basic information on all dimensions of HIV and AIDS education was still a powerful tool. It was vital to incorporate more than the ABC messages and look at the social constructs of health promotion and focus on critical thinking and an education for liberation. A manual with a set of guidelines was formulated and presented to educators for use with preadolescent female learners. This would help reduce the casualties of HIV and AIDS, as early intervention would protect a vulnerable group in society.

Thesis (M. Ed. Educational management) -- Central University of technology, Free State, 2012 / The purpose of the study was to investigate Life Skills as an intervention strategy in the fight against HIV/AIDS among the teenagers at Senakangwedi Senior Secondary School in Botshabelo, Free State. Life Skills as an intervention strategy were implemented in one secondary school in Free State Province in Motheo District. A cohort of 30 learners and 10 educators from secondary schools in Botshabelo, Free State Province participated in the study. The respondents comprised of 10 learners from Grade 10, 10 from grade 11 and 10 learners from Grade 12 as well as ten educators. Learners were between the ages of 15 and 20 years. Between these ages their cognitive development allows them to be more aware of Life Skills as an intervention strategy to combat HIV/AIDS at school. Thus, it was easy for them to verbalise Life Skills as an intervention strategy to fight HIV/AIDS. Due to their ages, their operational thinking allowed them to develop hypotheses about the possible outcomes of problems and to evaluate these outcomes comparatively. Educators were controlled by the level of their education, being respondents with a diploma or university degree. Comparatively learners who are 18 years of age were themselves concerned as they were heads of households. To arrive at the reported findings the study used the qualitative research approach methodology. This qualitative approach enabled the researcher to access information relating to the learners’ and educators' perceptions about HIV/AIDS. A life history approach was adopted in conducting the interviews to obtain a holistic understanding of participants’ life events in relation to their home environment. The interview guide covered such dimensions as family background and schooling. In the interviewing process, the researcher used the techniques of crystallisation and confrontation to enhance the clarity and trustworthiness of the narratives. In cases of ambiguity, the researcher asked the respondents for detailed and concrete examples and, in case of inconsistence, for further clarification and re-interpretation. The interview data were later transcribed for data analysis. The grounded theory approach was adopted to analyse the interview data, through which the categories of learner’s perceived motivations emerged naturally from their narratives. The evolving process comprised the following steps: (1) careful and repeated reading of transcriptions; (2) open content coding to signify any units of meaningful narratives in the passages. Ethical approval to conduct the study was sought and obtained from participating respondents and institutions. The results showed that most learners in the sample are orphans as result of AIDS and that many households are now headed by teenagers who have had to take on parental responsibilities. The results showed that Life Skills reduce teenage pregnancy and absenteeism at school. According to the results, life skills changed the behaviour of the learners and their attitude towards HIV/AIDS and therefore, learners should be educated about HIV/AIDS, teenage pregnancy and its prevention, as a strategy to reduce HIV/AIDS in schools. Life Skills is fundamental in empowering learners to live meaningful lives in a society that demands rapid transformation that enhances the community. The pandemic undermines the efforts of poverty reduction, part of the manifesto of the African National Congress (ANC) led Government; which aims at improving economic growth. In addition, the study revealed that learners feel free to talk to one another and that coaching by a Life Skills educator, assists in ensuring that HIV/AIDS-related topics are discussed with ease. The results showed that most learners agree that Life skills empower them with a sound and helpful background to prevent HIV/AIDS. Furthermore, learners admitted that the Life Skills programme effectively empowered them with the necessary knowledge to make informed decisions regarding sexuality. From the study a few valuable lessons were learned by the learners’ as an awareness of the pandemic and its consequences for their lives.

Quantitative, descriptive research, using self-completion questionnaires, was conducted to determine the level of HIV/AIDS knowledge of the learners in Sefhare. The sample, comprising 92 learners, was selected from forms 1-3. Of the learners, 53.4% knew what HIV/AIDS stand for, but only 13.6% said AIDS is caused by HIV and only 4.5% said AIDS is an incurable disease. The ABC of protecting oneself against HIV (abstain from sex, be faithful to one sex partner, use condoms) was mentioned by merely 57.6% of the learners. The learners’ lack of knowledge should be addressed by school HIV/AIDS programmes offered at schools in Botswana. As 81.5% of the learners were willing to be tested for HIV, this service should be made available with simultaneous confidential personal HIV/AIDS education, irrespective of the HIV test results. Teachers’ and parents’ HIV/AIDS knowledge should also be updated regularly. / Health Studies / M.A. (Public Health)

The UNAIDS report on the global AIDS epidemic (2010:9-11), stated that for the estimated 33.3 million people living with HIV, sub-Saharan Africa has a staggering 22 500 000: South Africa having the highest figure of 5 600 000. The question arises: Why has HIV/AIDS spread faster in Africa than on any other continent, despite similar international strategies? The challenge in Africa is that several HIV/AIDS beliefs and misconceptions distorting management of HIV/AIDS. South African learners receive HIV/AIDS education from the school culture, community, government and the international community, whereas they should be partners in collaborative education: yet, they are not. The research finding indicated that for effective educational strategies, education managers should be aware of these different voices affecting HIV/AIDS education. Education managers should be the main voice in dealing with this menacing epidemic. Countries that have approached HIV/AIDS scientifically and speak with one voice successfully reduced their HIV/AIDS statistics. / Educational Leadership and Management / M. Ed. (Education Management)

This study explored film as a supplementary aid in teaching adults about HIV/AIDS in the Igueben area of Edo State (Nigeria). It drew on the theory and practice of film to enhance the awareness of HIV/AIDS campaign strategies in ways that are not possible with other teaching aids. The findings of the study supported the literature, which indicates that unlike film,reading materials are not accessible to illiterate adults in rural communities. Two hundred (200) participants were used in the first approach (quantitative), while fifteen (15) illiterate adults were purposively selected from the area to participate in the second approach (qualitative). The research was undertaken within an interpretivist framwork in the sense that it was a communal process informed by participating illiterate adults, and was sensitive to the role of context (Alvermann, D.E., & Mallozzi, C.A. 2010). The study confirmed the role of film, particularly Nigerian movies, in promoting information and education on HIV/AIDS. The findings highlighted the need for on-going education about HIV/AIDS and its treatment, especially among the rural illiterate. The study, in summary established that the programmes offered by HIV/AIDS organisers (governmental and nongovernmental) would be more effective if film is included in the campaign against the disease. / Curriculum and Instructional Studies / D. Ed. (Didactics)