The overall aim of this study was to understand the determinants of VCT uptake in the general population of Nigeria’s federal capital territory of Abuja. Uptake of VCT still remains low despite increased availability of VCT information and services in Abuja, Nigeria. A quantitative cross-sectional study was undertaken with 180 respondents from Abuja, using an adaptation of the Health Belief Model as conceptual framework, to elucidate the social demographics of respondents, their HIV/VCT knowledge, their perceptions of VCT facility design, societal support for VCT, and how HIV stigma shapes the phenomenon of VCT uptake in Abuja, Nigeria. The key findings were that a better understanding of HIV prevention, a perception of support from community and religious leaders, and access to HIV test services in government facilities are positive predictors of higher VCT uptake. Poor personal risk assessment and the cost of HIV testing were identified as the key barriers to VCT access. / Health Studies / M.P.H.

Volunteer caregivers provide essential services to people in the terminal stages of AIDS and their families. Volunteers are exposed to stress and burnout. This study investigated the relationships between stress, coping strategies, levels of burnout and resilience in this population. Volunteers from Societas ‘O Sosiale (SOS) Children Villages and community based organisation (CBO) partnerships, were selected using non-probability purposive convenience sampling. A total of 110 participants were given the Experience of Work and Life Circumstances Questionnaire (WLQ), Brief-Cope, Maslach’s Burnout Inventory (MBI), a Resilience scale and the Living Standard Measure to complete. Statistical analyses were performed on the data. This includes descriptive statistics, reliability analysis, factor analysis, correlations and multivariate analysis of variance. The study found that volunteer caregivers experience high stress levels and burnout related to stressors outside work, remuneration, personnel policies and high resilience. High burnout is associated with all forms of coping. Further it is shown that training in problem-solving skills, counselling, government and public lobbying for support, registration with relevant professional bodies, furnished offices, reasonable recruitment requirements and compensation are needed to help the care givers avert the effect of stressors and control stress by stopping it from turning to burnout. / Psychology / M.A. (Psychology - Research Consultation)

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

The study explored the factors influencing the use of voluntary counselling and testing by university students. This was done by undertaking an exploratory and descriptive qualitative study. Focus group discussions and field notes were used to collect data from the participants. Outcomes from the study revealed various factors to the uptake of Voluntary Counselling and Testing (VCT) services by university students namely: the desire to know one‟s HIV status, illness, pregnancy, blood donation, to get a reward, the influence of significant others, the influence of media, awareness campaigns, compulsion, to get a job, curiosity, to be a positive role model and the positive attitude and professional conduct of the health care provider. The study also revealed various challenges to the uptake of VCT services by university students namely: the fear of being diagnosed HIV positive, HIV/AIDS-related stigma and discrimination, the low perception of risk to HIV infection, the lack of student friendly VCT services, the shortage of human and infrastructural resources, the inaccessibility of VCT services, the long waiting period for test results, negative perceptions about VCT, the problems with pre-test counselling and ignorance. Going by the participants‟ suggestions VCT services uptake by university students could be improved by increased resource allocation (incentives, human and infrastructural resources), increased awareness campaigns, and improved counselling and making VCT services more accessible / Information Science / MA (Public Health)

Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: There is, as yet, no cure for HIV/AIDS, a disease that has affected South African society profoundly. While antiretrovirals (ARVs) are now available and have stemmed the tide of AIDS deaths, medicines alone cannot be seen as a long-term solution. Treatment costs, finite resources, limited health-care capacity, morbidity and the unpleasant side-effects of ARVs, make treatment an untenable solution. The Christian church in South Africa continues to retain a powerful position; it has a significant affiliation; it is present in most geographic areas and inspires trust and confidence. Furthermore, in my view, the church, by its very nature and calling, is mandated not only to demonstrate and provide care, but also to inspire care-giving. In the light of HIV/AIDS, what does care mean? Can it only mean rendering care that is welfarist in nature? Or does the church have the mandate to look beyond immediate suffering, to examine and address those issues that lie at the core of suffering? Research has demonstrated that issues such as poverty, injustice, stigma, discrimination, gender inequality and patriarchy fuel the pandemic. Ultimately, it is the “othering” of people; the failure not to recognise God in another person and our common humanity, that lie at the heart of the problem. These then, I suggest, are the very reasons why the church must address these areas. But that is not all: if HIV/AIDS care is to be rendered in a developmental way, then there must be a thorough understanding of the disease: how is the virus transmitted, how can it be prevented and treated? It is also important to understand that there is not a single global epidemic but many local epidemics; the determinants and risk-factors of these need to be recognised, as must the cultural, economic, political and social contexts that fuel the spread of the disease. The changing nature of society, the effects of globalisation, the evolving nature of care owing to biomedical advances and even the “privatisation” of sex all need to be comprehended. Furthermore, any meaningful rendering of care requires the churches to examine why they should be giving it and the values that underpin such care-giving. I make the case that the churches are required to do nothing less than drive social change in situations of suffering, injustice and abuse. An examination of the history of HIV/AIDS in South Africa illustrates that the churches have often failed to meet up to this calling. An empirical study was conducted as to how the churches render care at a more micro, grassroots level, using a framework propounded by David Korten, who suggests that authentic development must be people-centred, rather than growthcentred. Essentially, development must seek to increase personal and institutional capacities, guided by principles of justice, sustainability and inclusiveness. In these respects, I argue, it accords very strongly with the Christian message. Korten suggests that there are four orientations (or generations) of rendering help but it is only the fourth generation that is truly developmental. Through the use of case study methodology, I sought to examine the manner in which the churches render care, in a region of the Western Cape, outside Cape Town, known as the Helderberg Basin. The area is representative of many peri-urban areas in the Cape: it is predominantly Christian, with a mix of different denominations and racial and socio-economic groupings. It allowed for an assessment of care initiatives afforded by mainline, charismatic and African Independent Churches and in particular, sought to answer the question of whether churches engage with HIV/AIDS in a way that Korten would identify as developmental. From the research, it is clear that the church is hampered by its inability to talk of sex and sexuality; its knowledge of the issues surrounding HIV/AIDS is limited; it has not done a sufficient amount to conscientise its followers; the church has yet to learn to utilise its networks; it lacks technical know-how and is unwilling to engage in the political sphere. Social change is only possible if the church embraces a new vision of how to create a better world. Additionally, I recommend that the church looks to the emerging church movement to achieve radical transformation. / AFRIKAANSE OPSOMMING: MIV/VIGS is ‘n siekte wat Suid-Afrika onmeetbaar beїnvloed en waarvoor daar tot op hede geen genesing is nie. Antiretrovirale middels (ARVs) is weliswaar beskikbaar en het die gety van VIGS sterftes gestuit maar medisyne kan nie alleen as die langtermyn oplossing gesien word nie. Behandelingskoste, beperkte hulpbronne en vermoë om gesondheidsorg te lewer, morbiditeit en die negatiewe newe-effekte van ARVs bring mee dat slegs mediese behandeling ‘n onhoudbare oplossing is. Die Christelike kerk in Suid-Afrika behou steeds ‘n magsposisie; dit het ‘n beduidende lidmaatskap asook ‘n teenwoordigheid in meeste dele van die land en boesem vertroue en sekerheid in. Dié kerk is na my mening gemandateer deur haar besondere aard en roeping om nie alleen sorg te bewys en te voorsien nie maar ook om versorging aan te moedig. Maar wat beteken sorg, gegewe die aard van MIV/VIGS? Kan dit slegs die lewering van welsyngerigte sorg beteken? Of sou die kerk die mandaat hê om verder as onmiddellike lyding te kyk en ondersoekend die kwessies wat aan die wortel van lyding lê, aan te spreek? Navorsing het aangetoon dat kwessies soos armoede, onreg, stigma, diskriminasie, geslagsongelykheid en patriargie die epidemie aanvuur. Uiteindelik is dit die objektivering (“othering”) van mense - dit is die onvermoë om God nie in ‘n ander persoon en ons gemeenskaplike mensheid te herken nie - wat die hart van die probleem is. Ek betoog dat hierdie die redes is waarom die kerk hierdie kwessies moet aanspreek. Om ondersoek in te stel of en tot watter mate die kerk sorg verskaf in verband met MIV/VIGS het ek die raamwerk van David Korten gebruik. Dié raamwerk stel voor dat outentieke ontwikkeling mensgesentreerd eerder as groeigesentreed sal wees. Ontwikkeling moet essensieel streef na ‘n toename van persoonlike en institusionele vermoë, gerig deur beginsels van geregtigheid, volhoubaarheid en inklusiwiteit. Ek toon aan dat hierdie beginsels baie sterk ooreenkom met die Christelike boodskap. Korten stel vier hulplewerende oriëntasies (ook genoem generasies) voor maar dit is eintlik slegs die vierde generasie van hulp wat werklik ontwikkelingsgerig is. Maar dit is nie al nie. Indien MIV/VIGS versorging ontwikkelingsgerig gaan wees, moet dit gegrond wees op ‘n diepgaande verstaan en kennis van die siekte soos onder andere, hoe die virus versprei word en hoe die siekte voorkóm en behandel kan word? Dit is ook belangrik om te verstaan dat daar nie slegs ‘n enkele globale epidemie is nie maar verskeie lokale epidemies. Die veroorsakende en risiko faktore van hierdie epidemies moet daarom geїdentifiseer word en so ook die kulturele, ekonomiese, politieke en sosiale konteks wat die verspreiding van hierdie siekte aanhelp. Die veranderende aard van gemeenskappe, die effek van globalisering, die ontwikkelende aard van gesondheidsorg vanweë die vooruitgang in die mediese wetenskap en die “privatisering” van seks moet alles in ag geneem word. Betekenisvolle versorging vereis dat kerke ondersoek instel na waarom die versorging aangebied word en die waardes onderliggend daaraan. Ek stel die saak dat daar van kerke verwag word om sosiale verandering te stuur waar mense swaarkry, onregverdig behandel en misbruik word. ‘n Ondersoek na die geskiedenis van MIV/VIGS in Suid-Afrika illustreer dat kerke dikwels misluk het om aan hierdie roeping gehoor te gee. In opvolging van die bostaande argumente het ek navorsing uitgevoer oor hoe kerke sorg op ‘n mikro of voetsool-vlak aanbied. Hiervoor het ek die genoemde mensgesentreerde ontwikkelingsraamwerk van David Korten gebruik. ‘n Gevalstudie benadering is gevolg in die Helderbergkom wat geleë is in ‘n streek van Wes- Kaapland buite Kaapstad. Hierdie gebied is verteenwoordigend van baie buitestedelike gebiede van die Kaap: dit is oorwegend Christelik en sluit ‘n verskeidenheid van denominasies, rasse en sosio-ekonomiese groeperings in. Die gebied maak ‘n oorsig moontlik van die sorg-inisiatiewe van hoofstroom, charismatiese en Afrika onafhanklike Kerke, en in die besonder van ‘n identifikasie daarvan of kerke betrokke by MIV/VIGS dit doen op ‘n wyse wat Korten sou tipeer as ontwikkelingsgerig. Uit hierdie navorsing het dit duidelik geword dat die kerk gekniehalter word deur ‘n onvermoë om oor seks en seksualiteit te praat; die kerk se kennis beperk is wanneer dit kom by kwessies wat handel oor MIV/VIGS; dit nie genoeg doen om lidmate bewus te maak van VIGS kwessies nie; dit nog veel te leer het oor hoe om netwerke aan te wend; dit tegniese kennis kort en onwillig is om met sake van politieke belang om te gaan. Sosiale verandering is alleen moontlik indien die kerk ‘n nuwe visie voorhou oor hoe om ‘n beter wêreld te skep. Ek beveel ten slotte aan dat die kerk let op die ontluikende kerkbeweging om radikale transformasie te verwesenlik.

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The accessibility of anti-retroviral drugs to patients and families affected by HIV and AIDS, and the affordability of these drugs, have been challenges to the Du Noon community in the Cape Peninsula. The aim of the study was to assess the effectiveness of primary health care services in addressing HIV/AIDS in the light of these challenges. The focus was on patients registered on the ARV programme and who were receiving treatment at Du Noon Clinic. Interviews were conducted with 15 groups of 10 patients each using a patient questionnaire. During these interviews qualitative and quantitative data were gathered and secondary data was used for quantitative analysis. The results that the data analysis yielded are in keeping with the hypothesis that the HIV/AIDS programme is effective in meeting the needs of the HIV/AIDS patients of Du Noon. After content analysis of qualitative data, two themes related to patient satisfaction emerged: positive and negative feelings that were categorised as satisfied and not satisfied with the service. Most often noted was the feeling of satisfaction with the services rendered at the clinic and that the staff were helpful. The staff rendering the service were also satisfied with the kind of service offered to the patients, but were dissatisfied with the allocation of resources. An increase in enrolment figures of patients was noted in the statistical analysis for the period 2004-2008 with 1,018 patients registered. The statistics illustrate the linear tendency in the enrolment of patients, which indicated the accessibility and affordability of the service. / AFRIKAANSE OPSOMMING: Geredelike toegang tot en die bekostigbaarheid van anti-retrivorale middels (ARM’s) vir pasiënte en families wat deur MIV en VIGS aangetas is, is ‘n uitdaging vir die Du Noon-gemeenskap in die Kaapse Skiereiland. Die doel van die studie was om die doeltreffendheid van primêre gesondheidsorgdienste te bepaal wanneer MIV/VIGS aangespreek word. Die fokus is op geregistreerde pasiënte wat die ARM-program volg en behandeling by die Du Noon Kliniek ontvang. Met behulp van ‘n pasiëntevraelys was onderhoude met 15 groepe van 10 pasiënte elk gevoer. Tydens hierdie onderhoude is kwalitatiewe data versamel en vir kwantitatiewe analise was sekondêre data aangewend. Die resultate wat uit die data analise verkry was, strook met die hipotese dat die MIV/VIGS-program doeltreffend is om die behoeftes van die pasiënte en die gemeenskap van Du Noon aan te spreek. Nadat ‘n inhoudsanalise van die kwalitatiewe data onderneem was, het twee temas rakende positiewe en negatiewe gevoelens – gekategoriseer as tevrede en nie tevrede nie – ten opsigte van die gelewerde diens na vore getree. Veral die gevoel van tevredenheid teenoor die diens gelewer by die kliniek en die personeel as behulpsaam, is opgemerk. Die personeel wat die diens lewer, was ook tevrede met die diens wat aan die pasiënte gelewer word, maar was ontevrede oor die toekenning van hulpbronne. By die statistiese analise is ‘n toename in die inskrywingsgetalle deur pasiënte waargeneem. Toename in inskrywingsgetalle deur pasiënte is gemerk in statistiese analise van 2004 - 2008, met 1,018 pasiënte geregistreer. Die statistiek het die lineêre tendens toegelig ten aansien van die inskrywing van pasiënte wat die toeganklikheid en bekostigbaarheid van die diens uitbeeld.

Thesis (MBA)--University of Stellenbosch, 2010. / Since the first case was discovered in Africa in the late 80s, the HIV/AIDS epidemic has gradually increased at alarming proportions worldwide especially in sub-Saharan Africa which prompted the United Nations' World Health Organisation to declare it a global pandemic. This research undertakes to highlight the current composition of care given for HIV and Aids, and the strengths and weaknesses of such programmes. The aim of this is to establish a better home based care programme in Swakopmund, Namibia, for improving the quality of care as well as living conditions for the infected and affected. For this initiative to be of the highest quality there is need to pay special attention to various regional and national HIV/AIDS programmes and policies. As the HIV/AIDS epidemic continues to spread, organisations and communities are now considering engaging more programmatic approaches as sub-Saharan countries are looking for scaled-up responses and national strategies for home based care. Policy-makers and senior administrators must be involved in developing and monitoring home based care programmes, and the people who manage and run the programmes must share information and feedback with senior administrators. In this sense, policy and action are interrelated as each partner learns from and guides the other. The researcher saw the need to involve community members and home based care-givers in a participatory process to research this topic and engage them in a process on how to improve the programmes that already exist. 52 Pages.

HIV and AIDS are now being considered as a chronic disease. As people live longer the possibility of physical disability increases. This study aimed to investigate the nature of physical disability among HIV/AIDS adults cared for by the Makeni home-based carers in Lusaka, Zambia. Disability was measured based on the World Health Organisation International Classification of Functioning, Disability and Health. This study demonstrated that mostly mild impairments and mild to moderate activity limitations and participation restrictions exists among patients in the Makeni home-based care programme. This study concluded that physiotherapists and other health professionals will have to be more involved in the community home-based programs that are suited for people living with HIV/AIDS so that they are also provided with clinical assessments and rehabilitation services.

HIV and AIDS are now being considered as a chronic disease. As people live longer the possibility of physical disability increases. This study aimed to investigate the nature of physical disability among HIV/AIDS adults cared for by the Makeni home-based carers in Lusaka, Zambia. Disability was measured based on the World Health Organisation International Classification of Functioning, Disability and Health. This study demonstrated that mostly mild impairments and mild to moderate activity limitations and participation restrictions exists among patients in the Makeni home-based care programme. This study concluded that physiotherapists and other health professionals will have to be more involved in the community home-based programs that are suited for people living with HIV/AIDS so that they are also provided with clinical assessments and rehabilitation services.

This ethnography was undertaken in an AIDS hospice with the objective of understanding the functioning of the Centre holistically, including the experiences of the patients and the role of the Centre in the fight against HIV/AIDS. Organisational anthropology in a clinical setting involved gaining entry and rapport with the staff and patients. The methodology included interviewing and observation. The personnel structure and leadership of the Centre were explored, revealing communication, power and management relations that shape the organisational culture. The staff’s attitude towards their jobs and their commitment to assisting those suffering from AIDS revealed the underpinnings of the organisation. The care that patients receive at the Centre was examined along with adoption of the children and the effects of stigmatisation surrounding HIV/AIDS and its impact on patients and their families. The meaning of illness for patients and their sick role as well as the impact of death from HIV/AIDS are exposed. / Anthropology and Archaeology / M.A. (Anthropology)