Health Studies / M.A. (Health Studies)

The study sought to explore and describe the breastfeeding practices of Human Immunodeficiency Virus (HIV) positive postnatal clients’ non-commitment to exclusive breastfeeding in George Mukhari Hospital, South Africa. A non-experimental quantitative design was used. Inferences drawn from the study were that HIV positive clients that opted for exclusive breastfeeding did not commit for fear of transmission of HIV to the baby and exclusive breastfeeding was stopped before the recommended 6 months. Most of the respondents’ partners did not come for counselling. There was lack of emotional support by staff after testing. Health education and emotional support of HIV positive clients has to be intensified. / Health Studies / M. A. (Health Studies)

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: HIV infection poses a major obstacle in breastfeeding as it represents the most common way by which children acquire HIV. Exclusive breastfeeding has been discovered as the most effective intervention in preventing mother-to-child transmission of HIV, mortality and promotion of HIV free survival. The main objective was to evaluate the evidence on the effectiveness of exclusive breastfeeding versus formula feeding and/ or mixed feeding in the prevention of HIV-1 transmission from mother to child. To identify the studies, an electronic search was conducted using PUBMED/MEDLINE, CINAHL, CENTRAL and EMBASE databases. Electronic journals, which include the Southern African Journal of HIV medicine (SAJHIV), HIV Medicine Journal and American Journal of Public Health, were also accessed. Manual searches were carried out. In addition, relevant experts were contacted in order to locate more data. There were no limitations with regards to date and language. The review considered studies on infants who were vertically HIV-1 exposed (mother HIV positive during pregnancy, birth and breastfeeding). These infants were exclusively breastfed for six months with administration of antiretroviral prophylaxis and were compared to infants exclusively formula fed. The outcomes measured were vertically acquired HIV infection; mortality and HIV free survival up to 24 months of age. Two reviewers independently selected articles which met the inclusion criteria. They independently extracted the data using a data extraction tool. Disagreements were solved by discussion. Data was then meta-analysed using Rev Man 5.1.0. Methodological quality of each trial was assessed by the reviewers using the Cochrane assessment tool for risk of bias. Two randomised clinical trials and one intervention cohort study (n=2112 infants) comparing exclusive breastfeeding with exclusive formula feeding were included. HIV infection was associated with exclusive breastfeeding as compared with exclusive formula feeding (Risk ratio 1.67, 95% CI 1.26 to 2.23, p=0.0005). Exclusive formula feeding was associated with high mortality from infections (Risk ratio of 0.67 95% CI 0.43 to 0.83, p=0.002 Chi²= 1.30, p=0.52, I²=0%). There were no statistically significant differences in HIV free survival between exclusive breastfeeding and exclusive formula feeding as measured by trialists at 9, 18 and 24 months (Risk ratio 1.19, 95% CI, 0.92 to 1.54, p=0.19, Chi²= 3.15, p=0.21, I²=36 % 3 studies, 1012 infants). None of the studies included reported on mixed feeding. Complete avoidance of breastfeeding is effective in preventing mother-to-child transmission of HIV. HIV infection during breastfeeding might be an indicator of mixed feeding and poor adherence. Formula feeding is only applicable in settings where formula milk is accessible, feasible, acceptable, safe and sustainable (AFASS) because formula feeding carries a high risk of mortality from causes other than HIV. If the AFASS criteria cannot be met, mothers should be encouraged to exclusively breastfeed and ensure that their infants completely adhere to the antiretroviral prophylaxis because they decrease the rate of vertical HIV-1 transmission. / AFRIKAANSE OPSOMMING: MIV besmetting veroorsaak ‘n groot struikelblok vir borsvoeding, omdat dit die mees algemene manier is waarop babas met MIV besmet word. Eklusiewe borsvoeding is as die mees effektiewe intervensie ontdek in die voorkoming van moeder na kind oordrag van MIV, morbiditeit en die bevordering van MIV vrye oorlewing. Die hoofdoelwit is om die effektiwiteit van eksklusiewe borsvoeding teenoor formule-voeding en of gemengde voeding in die voorkoming van MIV oordrag van moeder na kind te evalueer. Elektroniese navorsing is gedoen deur gebruik te maak van PUBMED/MEDLINE, CINAHL, CENTRAL en EMBASE databasisse. Elektroniese joernale wat die Southern African Journal of HIV medicine (SAJHIV), HIV Medicine Journal and American Journal of Public Health insluit, is ook gebruik. Handnavorsing is ook gedoen, asook relevante data van kenners op die gebied, is verkry. Geen beperking is geplaas op taal of tyd nie. Studies op babas wat blootgestel is aan die MIV-1 (moeder MIV positief gedurende swangerskap en borsvoeding) is in die oorsig oorweeg. Hierdie babas is eksklusief vir 6 maande gerborsvoed, met of sonder anti-retrovirale behandeling, en is vergelyk met eksklusiewe formule-voeding. Die resultaat was dat almal tot op 24 maande gemeet is aan MIV besmetting, mortaliteit en MIV vrye oorlewing. Twee resensente het onafhanklik artikels geselekteer wat aan die ingeslote kriteria voldoen het. Hulle het onafhanklik data geselekteer deur van ’n selekteringsinstrument gebruik te maak. Misverstande is deur besprekings opgelos. Data was daarna gemeet en gemetaanaliseer deur Rev Man 5.1.0. Die metadologiese kwaliteit van elk proeflopie is geassesseer deur die resensente wat gebruik gemaak het van die Cochrane evalueringsinstrument om die risiko van onewewigtigheid uit te skakel. Twee ewekansige kliniese proewe en een intervensie kohort studie (n = 2112 babas) wat eksklusiewe borsvoeding vergelyk met 'n eksklusiewe formule-voeding is ingesluit. MIVinfeksie wat verband hou met 'n eksklusiewe borsvoeding is vergelyk met eksklusiewe formule-voeding (risiko verhouding van 1.67, 95% CI 1.26 tot 2,23, p=0.0005). Eksklusiewe formule-voeding hou verband met 'n hoë mortaliteit van infeksies met ’n risiko verhouding van 0.67, 95% CI 0.43 tot 0.83, p = 0.52, Chi ² = 1.30, p = 0.52, I ² = 0%. Daar is geen statisties beduidende verskille in MIV-vrye oorlewing tussen eksklusiewe borsvoeding en eksklusiewe formule-voeding nie wat deur die proefnemers gemeet is op 9, 18 en 24 maande (risiko verhouding 1.19, 95% CI, 0.92 tot 1.54, p = 0,19, Chi ² = 3,15, p = 0.21, I ² = 36% 3 studies, 1012 babas). Nie een van die ingeslote studies het verslag gedoen oor gemengde voeding nie. Algehele vermyding van borsvoeding is effektief in die voorkoming van Moeder na Kind oordrag van MIV. MIV-infeksie gedurende borsvoeding mag ’n aanduiding van gemengde voeding en swak nakoming wees. Formule voeding is alleenlik van toepassing in situasies waar formule-melk toeganklik, uitvoerbaar, veilig en volhoubaar is, want formule-voeding dra ’n hoë risiko van mortaliteit weens ander oorsake buiten MIV. Indien daar nie aan hierdie kriteria voldoen kan word nie, behoort moeders aangemoedig te word om eksklusief te borsvoed en seker te maak dat hulle babas die antiretrovirale profilaksie getrou neem, want dit verlaag die koers van vertikale MIV-1 oordrag.

Thesis (MMed)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: The vast majority of new Human Immunodeficiency Virus (HIV) infections in infants and young children occur through mother-to-child-transmission (MTCT), either during pregnancy, labour or delivery or by breastfeeding. Without access to perinatal MTCT (PMTCT) programmes approximately 30% of all babies born annually will be infected with HIV. OBJECTIVES The aim was to implement and audit a quality improvement cycle at the Worcester Obstetric Unit, which comprises of Worcester Hospital, a regional hospital in the Western Cape Province and its level one midwife obstetric Unit (MOU), in order to improve the quality of the PMTCT programme. The intervention included the implementation of easy changes and tools in the Antenatal Clinic, Infectious Diseases Clinic and Labour ward. METHODS The files and antenatal records of all HIV positive patients and patients with an unknown HIV status, who delivered at the Worcester Obstetric Unit during January, February and March of 2010 and 2011, were reviewed. All HIV negative patients and patients that had stillbirths and miscarriages were excluded. The pre-interventional findings of 2010 were compared with the post-interventional findings of 2011. RESULTS At the Worcester Obstetric Unit, for the study time period, there were 907 deliveries in 2010, of which 102 (11.2%) patients were HIV positive and 4 (0.4%) had an unknown HIV status compared to 2011, with 865 deliveries of which 108(12.5%) patients were HIV positive and no patients had an unknown HIV status. Significantly more patients were diagnosed with HIV before they fell pregnant than during pregnancy in the 2011 group, when compared with the 2010 group. A CD4 count was done on 94% of patients who were newly diagnosed with HIV and those with an unknown CD4 count result in the 2010 group, compared to 92% in 2011. There was a significant improvement after the intervention in the time it took from when blood was drawn for a CD4 count until the result was followed up, the median time decreased from 34 to 8 days (p=0.000001). Significantly more patients qualified for highly active antiretroviral therapy (HAART) after the guidelines were changed and the CD4 cut off was increased to 350 cells/l (p=0.001). Prior the intervention 18 patients did not receive the correct management before delivery due to preventable reasons, compared to one at the MOU. After the intervention this decreased significantly to only one patient at Worcester Hospital and none at the MOU (p=0.000001). Before the intervention adherence to the PMTCT protocol at the MOU was significantly better than at the hospital (p=0.0005) and after the intervention there was no significant difference (p=1.0). CONCLUSION Although the audit and quality improvement cycle was performed at a single hospital, with specific changes geared towards their needs, the basic principles can be applied to any Unit in the country providing a PMTCT service. Educating staff, creating awareness and reminding staff of the basic principles of PMTCT, implementing small changes and streamlining processes and setting specific goals or timelines, can lead to significant improvements in care, which ultimately will lead to a decrease in PMTCT of HIV and HIV related maternal and infant morbidity and mortality. / AFRIKAANSE OPSOMMING: Die oorgrote meerderheid (>90%) van nuwe Menslike Immuniteitsgebreksvirus (MIV) infeksies in babas en jong kinders vind plaas deur middel van moeder-na-kind-oordrag, hetsy gedurende swangerskap, die kraamproses of borsvoeding. Sonder toegang tot perinatale voorkomingsprogramme (PMTCT) sal ongeveer 30% van alle babas jaarliks met MIV geïnfekteer word. DOELWITTE Die doel van die studie was om ‘n gehalteverbeteringsiklus by die Worcester Verloskunde Eenheid, wat bestaan uit Worcester Hospitaal, 'n streekshospitaal in die Wes-Kaapprovinsie en sy vlak een vroedvrou verlossingseenheid (VVE), te implementer en daarna te oudit, om sodoende die gehalte van die PMTCT-program te verbeter. Die intervensie het bestaan uit die implementering van eenvoudige veranderinge en prosesse in die voorgeboortekliniek, infeksiesiekte-kliniek en kraamsaal. METODES Die lêers en voorgeboorte rekords van alle MIV-positiewe pasiënte en pasiënte met 'n onbekende MIV-status, wat gedurende Januarie, Februarie en Maart van 2010 en 2011 verlos het by die Worcester Verloskunde Eenheid, is nagegaan. Alle MIV-negatiewe pasiënte en pasiënte met doodgebore babas en miskrame is uitgesluit. Die pre-intervensie bevindings van 2010 is vergelyk met die post-intervensie bevindings van 2011. RESULTATE By die Worcester Verloskunde Eenheid was daar 907 geboortes gedurende die studietydperk in 2010, waarvan 102 (11,2%) pasiënte MIV-positief was en 4 (0,4%) met ‘n onbekende MIV-status. In 2011 was daar 865 geboortes waarvan 108 (12,5%) pasiënte MIV-positief was en geen met 'n onbekende MIV-status. In die 2011-groep is beduidend meer pasiënte gediagnoseer met MIV voor as tydens swangerskap. In die 2010-groep is daar 'n CD4-telling gedoen vir 94% van nuut gediagnoseerde pasiënte en diegene met 'n onbekende CD4-telling, in vergelyking met 92% in 2011. Daar was 'n beduidende verbetering na die intervensie in die tyd wat dit geneem het vandat bloed getrek is vir 'n CD4-telling totdat die resultaat opgevolg is. Die mediane tyd het verminder vanaf 34 na 8 dae (p = 0.000001). Nadat die riglyne vir kwalifisering vir hoogs aktiewe antiretrovirale terapie (HAART) verander is na ‘n CD4 telling 350 selle/l het daar beduidend meer pasiënte gekwalifiseer vir HAART. By Worcester Hospitaal het 18 pasiënte voor die intervensie nie die korrekte behandeling intrapartum ontvang nie weens voorkombare redes, in vergelyking met slegs een pasiënt by die VVE. Na die intervensie was daar ‘n beduidende afname na slegs een pasiënt by Worcester Hospitaal en geen by die MOU (p = 0.000001). Voor die intervensie was die korrekte uitvoering van die PMTCT-protokol by die MOU beduidend beter as by die hospitaal (p = 0,0005) en na die intervensie was daar geen beduidende verskil (p = 1.0). GEVOLGTREKKING Alhoewel die oudit en gehalteverbeteringsiklus uitgevoer is by 'n enkele hospitaal, met spesifieke veranderinge gerig tot hul behoeftes, kan die basiese beginsels toegepas word in enige eenheid in die land wat ‘n PMTCT diens verskaf. Opvoeding van personeel en bewusmaking rakende die basiese beginsels van PMTCT, klein veranderinge en die vaartbelyning van prosesse by die voorgeboorte klinieke en die stel van spesifieke doelwitte of tydlyne, kan lei tot aansienlike verbeteringe in pasiënte sorg. Dit sal uiteindelik lei tot 'n afname in die MIV oordrag van moeder na kind, asook MIV-verwante morbiditeit en mortaliteit in moeders en kinders.

Thesis (MPA)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: South Africa has the world’s highest adult HIV infection rate in the world. Experts estimate that over 1 500 people are being infected with the HIV virus per day in South Africa. The virus is undoubtedly having a negative impact on the labour population of the country and will ultimately affect the productivity of South Africa. The Constitution of South Africa, Act 108 of 1996, firmly denounces any form of unfair discrimination. The White Paper on Defence charges the South African National Defence Force (SANDF) to be an operationally ready force. The potentially crippling effect HIV and AIDS can have on the effectiveness of SANDF is an area that needs to be researched. The military environment is unique in that it is considered to be a high-risk organisation in terms of HIV infection. Overseas deployment, male-dominated environments, risk-taking ethos and monthly income are all elements that accelerate the spread of HIV within the SANDF. The SANDF is a dominant member of the Southern African Development Community (SADC) and is involved in Peace Support Operations (PSO) throughout the African continent. This military intervention is predicted to increase with time. HIV in sub-Saharan Africa has infected over 30 million people – many with little or no primary health care. The South African coastline is nearly 3 000km in length with six world-class harbours. These are strategic points that contribute to South Africa’s economic prosperity on the African continent. It is the SA Navy’s role to ensure that these harbours are well-guarded. The personnel responsible for patrolling the waters of the South African coastline need to be exposed to the proper training to be competent at this task. Military training needs to prepare learners in the event of combat. This simulation of the combat environment may lead to injuries that heighten the threat of HIV transmission. SANDF training units traditionally discharge those members who are medically unable to complete the mental and physical requirements of the course. The Military Training for Officers Part One (MTO1) course of the SA Navy is no different. HIV has created a new dynamic in that medical confidentiality protects the status of those people who are infected. Current SANDF policy does not offer sufficient guidelines to training units when dealing with learners who are infected with HIV. Human rights are constitutionally protected and unfair discrimination of any form is prohibited. The SANDF still needs to be operationally deployable and uniform members with HIV hinder this requirement. The question really is: is it fair discrimination to disallow/remove uniform members from the MTO1 course if they are HIV positive? The purpose of this research is to establish what the best practises would be in managing HIV positive learners in the military training environment. The work environment would have to be researched to determine whether or not the threat of HIV transmission exists. Learners would be approached to determine if they felt they were at risk during training exercises. The training staff who execute the training exercises would need to be asked if they felt endangered or exposed to HIV infection during these exercises. Military medical personnel who deal with either training or HIV in their everyday jobs would then review this data. The social stigma surrounding HIV is one of the challenges within this research design. The ethics and legality of mandatory HIV testing in the SANDF is an area that has sparked reaction from human rights movements. The compromising of human rights for the sake national security is an area of proportionality that raises new debates with the advent of HIV. There are various alternatives of managing HIV within the SANDF that should be considered. The current SANDF HIV policy is, at best, vague when dealing with specific training issues. This research intends on making policy-makers within the SANDF aware of the need to make definitive policy decisions to ensure that HIV does not compromise the effectiveness of the SANDF. / AFRIKAANSE OPSOMMING: Die hoogste volwasse HIV infeksie in die wêreld, kom tans in Suid Afrika voor. Deskundiges is van mening dat daar daagliks in Suid Afrika meer as 1500 mense met die virus besmet word. Die virus het ‘n definitiewe negatiewe impak op die Suid Afrikaanse arbeidsmark, en sal onomwonde die produktiwiteit van Suid Afrika beinvloed. Die Suid Afrikaanse Grondwet, Wet 108 van 1996 verbied onomwende enige vorm van onbillike diskriminasie. Die Witskrif ten opsigte van Verdediging verwag van die Suid Afrikaanse Nasionale Weermag (SANW) om 'n operasioneel voorbereide mag te wees. Die potensiële krippelende effek wat HIV/VIGS op die effektiwiteit van die SANW kan hê is ‘n area wat indiringende navorsing benodig. Die militere omgewing is uniek in die opsig dat dit beskou word as ‘n hoë risisko organisasie in terme van HIV infeksie. Internationale ontplooiings, manlik-georiënteerde omgewings, risiko-bepalende faktore, en maandelikse inkomste is almal elemente wat die verspreiding van HIV binne die SANW verhoog. Die SANW is die dominante lid van die Suider Afrikaanse Ontwikkelings Gemeenskap en is betrokke in vredes ondersteunnings operasies binne Afrika. Die word in die vooruitsig gesien dat die bogenoemde intervensies met tyd sal toeneem. In die Sub-Saharastreek het die HIV virus reeds 30 miljoen mense geïnfekteer – baie met min, of geen primêre gesondheidsorg tot hul beskikking. Die Suid Afrikaanse kuslyn is bykans 3 000 km in lengte, met ses wereldstandaard hawens, geleë langs die kuslyn. Laasgenoemde is strategiese punte wat bydra tot die ekonomiese vooruitgang binne die Afrika kontinent. Dit is die SA Vloot se verantwoordelikheid om toe te sien dat die hawens goed bewaak word. Die personeel verantwoordelik vir die patrolering van die waters langs die Suid Afrikaanse kuslyn moet blootstelling kry aan voldoende opleiding om die taak te kan verrig. Militêre opleiding moet leerders voorberei vir die moontlikheid van konflik. Hierdie simulering van die gevegs/konflik omgewing mag lei tot beserings wat die risiko ten opsigte van HIV verspreiding mag verhoog. Die SANW opleidingseenhede, het tradisioneel lede ontslaan wat nie aan die fisiese en geestelike vereistes van die kursus kon voldoen nie. Die Militêre opleiding vir Offisiere Deel Een kursus (MOO1) binne die SA Vloot is presies dieselfde. HIV het ‘n nuwe dinamika veroorsaak naamlik, mediese vertroulikheid, wat die status van geaffekteerde lede beskerm. Huidige SANW beleid verskaf onvoldoende riglyne aan opleidingseenhede vir die hantering van leerders wat die HIV virus onder hande het. Mense-regte word konstitusioneel beskerm en enige vorm van diskriminasie word verbied. Daar word egter steeds van die SANW verwag om operasioneel ontplooibaar te wees, en uniform lede met HIV verhinder hierdie bepaling. Die vraag is: Is dit billike diskriminasie om lede wat HIV positief is van die MOO1 kursus te verwyder? Die doel van hierdie navorsing is om te bepaal wat die beste praktyke sou wees in die bestuur van HIV-positiewe leerders in die militêre opleidings omgewing. Die werksomgewing sal nagevors moet word om te bepaal of die bedreiging van HIV-verspreiding bestaan aldan nie. Leerders sal genader moet word om te bepaal of hul ter eniger tyd gedurende opleidingsoefeninge gevoel het dat die risisko van blootstelling te hoog was. Die opleidings staflede wat die opleidings oefeninge oorsien sal gevra moet word of hul ter enige tyd bedreig of blootgestel gevoel het tot HIV infeksie. Militêre mediese personeel wat daagliks met opleiding of deur middel van hul daaglikse werk met HIV te doen het sal die data hersien. Die sosiale stigma ten opsigte van HIV-toetsing is een van die uitdagings binne hierdie navorsings onderwerp. Die etiek en regsgeldigheid van verpligte HIVtoetsing binne die SANW is ‘n area wat geweldige reakise ontlok het van menseresgte bewegings. Die kompromittering van menseregte ten gunste van nasionale sekuriteit is ‘n area van proportionaliteit wat nuwe debatering openbaar in die koms van HIV. Daar is verskeie alternatiewe vir die bestuur van HIV binne die SANW, wat oorweeg kan word. Die huidige SANW HIV beleid is, ten beste, uiters vaag met die hantering van spesiefieke opleidingsgeleenthede. Die navorsing beoog om beleidsmakers binne die SANW bewus te maak van die behoefte om definitiewe besluite te verseker dat HIV nie die effektiwitet van die SANW beinvloed nie.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: An association between maternal human immunodeficiency virus (HIV) infection and Necrotizing Enterocolitis (NEC) in preterm infants has been reported. The impact of probiotics in an HIV-exposed very low birth weight (VLBW) infant on the occurrence of NEC is uncertain at present; however it is known that probiotics have protective effects against inflammation and prevent NEC. Postnatal growth restriction is a major issue in preterm, especially extremely-low-birth-weight (ELBW) infants and probiotics have been found to improve feeding tolerance in preterm infants. Human milk oligosaccharides (HMO) also known as the prebiotics of human milk, are known to have bifidogenic and anti-adhesive effects. Infants that receive human milk show a reduced incidence of NEC compared to those who receive infant formula. Very little is known about the composition of breast milk in the HIV-infected mother. Objective: The primary objective of the study was to assess the effect of probiotics on the incidence and severity of NEC in high-risk infants born to HIV-positive and HIV-negative women. The secondary objectives were to assess the effect of probiotic administration on feeding tolerance and growth outcomes of HIV-exposed but uninfected preterm infants, to describe the HMO composition of HIV-infected mothers breast milk and lastly to determine if HMO composition affects the incidence of NEC in HIV-exposed preterm very low birth weight infants. Patients and Methods: A randomized, double blind, placebo controlled trial was conducted for the period July 2011 to August 2012. HIV-exposed and HIV-unexposed premature (<34 weeks gestation) infants with a birth weight of ≥500g and ≤1250g were randomized to receive either a probiotic or a placebo. The probiotic consisted of 1x109 CFU, L. rhamnosus GG and B. infantis per day and was administered for 28 days. NEC was graded according to Bell’s criteria. Anthropometrical parameters and daily intakes were monitored. Breats milk samples were analysed for oligosaccharide content. Results: 74 HIV-exposed and 110 HIV-unexposed infants were enrolled and randomized (mean birth-weight, 987g; mean gestational 28.7 weeks). The incidence of death and NEC did not differ significantly between the HIV-exposed and unexposed groups but a significantly higher NEC incidence was found in the control group. There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z-scores for length and head circumference at day 28 than the unexposed group (p<0.01 and p=0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups. Our results show significantly higher absolute concentrations of 2’-fucosyllactose, laco-N-tetraose and lacto-N-fucopentaose 1 and higher relative abundance of 3’-sialyllactose, difucosyl-lacto-N-tetraose and fucosyl-disialyllacto-N-hexaose in HIV-infected compared to -uninfected Secretor women. DSLNT concentrations were significantly lower in the breast milk of mothers whose infants developed NEC compared to infants without NEC. Conclusion: Probiotic supplementation reduced the incidence of NEC in the premature infants; however results failed to show a lower incidence of NEC in HIV-exposed premature infants. Probiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV-exposure. The data confirms previous reports that HIV-infected mothers have higher 3’sialyllactose milk concentrations. Most intriguing though, the data also indicates that low levels of DSLNT in the mother’s milk increase the infant’s risk for NEC, which is in accordance with results from previously published animal studies and warrants further investigation. / AFRIKAANSE OPSOMMING: Inleiding: ʼn Verwantskap tussen moederlike menslike immuniteitsgebreksvirus (MIV) en nekrotiserende enterokolitis (NEK) in premature babas is aangemeld. Die impak van probiotika in ʼn MIV-blootgestelde baie lae geboortemassa (BLGM) baba op die voorkoms van NEK is tans nog onseker, maar dit is wel bekend dat probiotika ʼn beskermende effek het teen inflammasie en die voorkoms van NEK. Nageboortelike groei beperkings is ʼn groot probleem in premature, veral ekstreme lae geboortemassa (ELGM) babas. Daar is gevind dat probiotika voeding toleransie in premature babas kan verbeter. Menslike melk oligosakkariede (MMO), ook bekend as die prebiotika van menslike melk, is bekend om bifidogeniese en anti-kleef effekte te hê. Babas wat moedersmelk ontvang toon ʼn verlaagde voorkoms van NEK in vergelyking met diegene wat baba formule melk ontvang. Baie min inligting is bekend oor die samestelling van borsmelk in die MIV-positiewe moeder. Doel: Die primêre doel van die studie was om die effek van probiotika op die voorkoms en die graad van NEK in hoë risiko babas van MIV-positiewe en MIV-negatiewe vroue te bepaal. Die sekondêre doelwitte was om die effek van probiotika op voeding verdraagsaamheid en groei uitkomste van MIV-blootgestelde, maar nie- geinfekteerde premature babas te evalueer sowel as die MMO samestelling van MIV-positiewe moeders se borsmelk te beskryf en laastens om die invloed van die MMO samestelling op die voorkoms van NEK in baie lae geboortegewig MIV-blootgestelde premature babas te beskryf. Pasiënte en Metodes: ʼn Gerandomiseerde, dubbelblinde, plasebo-beheerde studie is vir die tydperk Julie 2011 tot Augustus 2012 onderneem. MIV-blootgestelde en nie-blootgestelde premature (<34 weke) babas met 'n geboorte gewig van ≥500g en ≤1250g was ewekansig verdeel om probiotika of plasebo te ontvang. Die probiotika het bestaan uit 1x109 kolonie vormende eenhede, L. rhamnosus GG en B. infantis per dag en is toegedien vir 28 dae. NEK is gegradeer volgens Bell se kriteria. Antropometriese parameters en daaglikse inname is gemonitor. Borsmelk monsters is geanaliseer vir oligosakkaried inhoud. Resultate: 74 MIV-blootgestelde en 110 MIV-nie-blootgestelde babas is ingesluit en ewekansig ingedeel (gemiddelde geboorte gewig, 987g, gemiddelde gestasie 28,7 weke). Die voorkoms van die sterftes en NEK het nie beduidend verskil tussen die MIV-blootgestelde en nie-blootgestelde groepe nie, maar 'n beduidende verskil is gevind vir NEK voorkoms tussen die studie en die kontrole groep. Daar was geen verskil in die gemiddelde daaglikse gewigstoename tussen die behandelings groepe of MIV-blootstelling nie. Die MIV-blootgestelde groep het beduidend hoër z-tellings vir lengte en kopomtrek op dag 28 getoon teenoor die nie-blootgestelde groep (p <0.01 en p = 0,03, onderskeidelik). Daar was geen verskille in die voorkoms van voeding onverdraagsaamheid en abdominale distensie tussen die twee groepe nie. Ons resultate dui op aansienlik hoër absolute konsentrasies van 2'-fucosyllactose, laco-N-tetraose en lakto-N-fucopentaose 1 en hoër relatiewe voorkoms van 3'-sialyllactose, difucosyl-lakto-N-tetraose en fucosyl-disialyllacto-N-hexaose in MIV-positiewe vroue in vergelyking met-negatiewe Sekretor vroue. DSLNT konsentrasies was aansienlik laer in die melk van moeders wie se babas NEK ontwikkel het in vergelyking met babas sonder NEK. Gevolgtrekking: Probiotika aanvullings verminder die voorkoms van NEK in premature babas, maar die resultate kon nie ʼn laer voorkoms van NEK in MIV-blootgestelde premature babas bewys nie. Probiotiese aanvulling het geen invloed op groei uitkomste of die voorkoms van voeding onverdraagsaamheid in MIV-blootstelling getoon nie. Die data bevestig vorige verslae wat aandui dat MIV-besmette moeders hoër 3'sialyllactose borsmelk konsentrasies het. ʼn Interessante aspek is dat lae vlakke van DSLNT in die moeder se melk beduidend is van ʼn verhoogde risiko vir NEK, wat in ooreenstemming is met die resultate uit voorheen gepubliseerde dier studies en regverdig verdere ondersoeke.

The study sought to explore and describe the breastfeeding practices of Human Immunodeficiency Virus (HIV) positive postnatal clients’ non-commitment to exclusive breastfeeding in George Mukhari Hospital, South Africa. A non-experimental quantitative design was used. Inferences drawn from the study were that HIV positive clients that opted for exclusive breastfeeding did not commit for fear of transmission of HIV to the baby and exclusive breastfeeding was stopped before the recommended 6 months. Most of the respondents’ partners did not come for counselling. There was lack of emotional support by staff after testing. Health education and emotional support of HIV positive clients has to be intensified. / Health Studies / M. A. (Health Studies)

Introduction. Previous studies have established that infants born to mothers with advanced HIV disease and co-infections are smaller, premature and have rapidly progressive HIV disease and an early death. King Edward VIIIth Hospital, in Durban, admits many sick mothers and manages a large proportion of low birth weight and ill newborns. On discharge and follow-up, the mortality and morbidity of these infants are known to be high and are related to the prematurity. How much is related to being HIV exposed is still uncertain. Aim. To determine the perinatal transmission rate of HIV-1 and mortality at 12 months in HIV exposed infants that were admitted to and discharged from the Neonatal Unit, in Durban, South Africa. Methods. In this observational study, data from the outpatient charts of HIV exposed infants that required specialised neonatal care and subsequent follow up, between the period November 2007 and December 2009, were collected. Perinatal transmission rates and mortality of these infants were compared with maternal and infant risk factors. Results. Data on 463 HIV exposed, predominantly low birth weight infants are presented. The median maternal CD4 count was 309cells/mm3 with 16.8% of mothers commenced on HAART. Maternal co-infection with TB was found in 19.2% of the cohort. Early HIV transmission occurred in 11.5% of infants and was influenced by the type of ARV exposure (None, 20%; single dose NVP, 14.3%; dual therapy, 10.6%; maternal HAART, 8.5%). The dual therapy regimen for 7 days was more protective than that for 28 days (p=0.045). HIV infection was associated with higher risk of neonatal sepsis (RR 1.6; 95% CI, 1.1-2.3; p=0.015). The mortality for the cohort at 12 months was 10%. Maternal HAART was associated with a lower mortality: 2.95% vs.10.2% (RR 3.0; 95% CI, 0.4-20.5). There was a higher mortality rate in those that were low birth weight (RR 4.2; 95% CI, 1.02-18.8; p=0.037); those that were HIV infected (RR 4.8; 95% CI, 1.9-11.6; p=0.002) and those that were breastfeeding compared to formula feeding (RR 2.7; 95% CI, 1.1-6.8; p=0.038). Discussion. Rates of HIV transmission within the PMTCT programme were similar to that reported by the Department of Health. Early maternal ARVs for PMTCT prophylaxis, prevents HIV transmission. The coverage of maternal HAART was sub-optimal. Breastfeeding was associated with a higher HIV transmission rate and was most likely associated with non-exclusive breastfeeding during neonatal admission. Recommendations. Maternal HAART or ARV prophylaxis should be commenced early in the pregnancy for the best benefits. Meticulous attention should be paid to the feeding practices of high risk HIV exposed infants admitted for specialised neonatal care. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.

This thesis sets out to describe and discuss male street prostitution as it occurs in Durban. The aim is to examine to what degree male street prostitutes are at risk of HIV infection, and make appropriate recommendations for HIV intervention. The field data, gathered through participant observation, revealed significant differences between the two research sites, refiecting broader race and class divisions in the South African society. At the same time, the in-depth case studies of the individual participants suggest that they share similar socio-economic life histories characterised by poverty and dysfunctional families, and hold similar world-views. The research was conducted within a social constructionist framework, guided by theories of human sexuality. Yet, sexuality was not the framework within which the male street prostitutes in Durban attached meaning to their profession. Professing to be largely heterosexual, the respondents engaged in homosexual sexual acts without considering themselves to be homosexual, reflecting and amplifying the fluid nature of human sexuality. It was, however, within an economic framework that the male street prostitutes who participated in this study understood and interpreted their profession. The sexual aspect of their activities was far less important than the economic gain to them, and prostitution was interpreted as a survival strategy, A significant finding of this research is that male street prostitutes in Durban face a considerably higher risk of exposure to HIV from their non-paying sexual partners (lovers) than from their paying sex partners (clients). The research participants all had a good knowledge of HIV and the potential danger of transmission whilst engaging in unsafe commercial sex. In their private love lives, the participants were less cautious about exposing themselves and their partners to HIV infection, hence the conclusion that the respondents face a greater threat of HIV infection from their lovers than from their clients. Finally, male street prostitutes, like female street prostitutes, do however face some risk of HIV infection as a result of their involvement with commercial sex. The illegal nature of their activities is considered to contribute to an environment conducive to the transmission of HIV, and this thesis argues for a change in the legal status of commercial sex work as a primary component of HIV intervention in this vulnerable group of men and women. / Thesis (M.A.)-University of Natal, Durban, 2000.

Thesis (MMil)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: HIV/AIDS is spreading through Africa in epidemic proportions. Hundreds and thousands of people are infected on a daily basis. This pandemic destroys the emotional and physical strength of individuals. In Sub-Saharan Africa there is an estimated 28,1 million people living with HIV/AIDS. The military forces of Africa are not immune to this. Growing concern has shifted the focus of HIV/AIDS to the armed forces because they generally have higher levels of HIV/AIDS than the civilian population. Within the military it is critical that HIV/AIDS be managed in a manner that retards the spread of the virus as well as the negative impact that it has. The cornerstone of combat efficiency within the SANDF is its infantry section, a group of people forming the basis for the rest of the operational force structure that is deployed within an operational area. The deployment areas are dangerous and unstable and are conducive to the spread of HIV/AIDS. When forces are deployed within the operational area, they forge a bond built on trust, loyalty and a confidence in each other's work capability. HIV/AIDS impacts on this capability and results in an environment characterised by low morals, discrimination and stigma. The important element is to make soldiers aware of the implications of HIV/AIDS, and the perceptions that exist about people living with the disease. The success lies in the correct management in terms of prevention and protection. A clear understanding of the disease is the most important element in starting an effective prevention programme. People have to understand that HIV/AIDS is not only a medical problem, but also has far-reaching social and security implications. It not only affects the infected but also their families, relatives and friends. The infection has an enormous social impact that should not be underestimated. If left unchecked, HIV/AIDS will cripple the SANDF. implications. It not only affects the infected but also their families, relatives and friends. The infection has an enormous social impact that should not be underestimated. If left unchecked, HIV/AIDS will cripple the SANDF. / AFRIKAANSE OPSOMMING: MIVNIGS word tans in Afrika deur duisende mense versprei en bereik epidemiese vlakke. Hierdie virus val die mens se fisiese en geestelike krag aan. In Afrika benede die Sahara is daar omtrent 28,1 miljoen mense wat met MIVNIGS leef. Die militêre mag van Afrika is nie imuun teen die stryd. Grootskaal se kommer is gefokus op die gewapende magte van Afrika omdat die militêr geneig is om meer MIVNIGS positiewe mense te hê as die siviele omgewing. Binne die militêr is dit krities dat MIVNIGS op so "n manier bestuur word dat die verspreiding van hierdie siekte belemmer word. Die infanterie seksie is die hoeksteen van vuurkrag effektiwieteit binne die SANW. Hierdie seksie is die fondament van die operasionele mag wat binne operasionele gebiede ontplooi word. Hierdie gebiede word gekenmerk deur gevaar en onstabiliteit wat die verspreiding van MIVNIGS vergemakiIk. Wanneer hierdie mag ontplooi word, is dit op die beginsel van vertroue in mekaar, lojaliteit en in "n geloofwaardigheid in mekaar se werksvermoë. MIVNIGS impak direk op hierdie beginsels en veroorsaak "n omgewing wat deur lae morele waardes, diskriminasie en negatiewe persepsies gekenmerk word. Dit is belangrik dat die soldaat ingelig word oor die persepsies en impak wat MIVNIGS moontlik kan hê. Die korrekte bestuur sal die mate van sukses bepaal hoe hierdie virus gehanteer kan word. "n Volle begrip sal die deurslaggewende beginsel wees in die effektiewe beheer van MIVNIGS word. Mense moet verstaan dat MIVNIGS nie net "n mediese probleem is maar dat dit ook "n verreikende effek het op die sekuriteit en sosiale dele van ons lewens. Dit impak ook op die families van die wat siek is, en die impak moet nie onderskat word nie. Die SANW sal tot sy knie gebring word sou hierdie virus onbepaald voortgaan.