Thesis (M.Sc. (Environmental Science)) - Rhodes University, 2008.

Text in English and siSwati / The purpose of this study was to develop support guidelines to assist with disclosure of HIV status to HIV infected children by their parents and caregivers in Swaziland. The study explored parents’ and caregivers’ experiences with disclosure, and described the pattern of disclosure for HIV status to infected children. A qualitative descriptive research was conducted. Data were collected through semi-structured with thirteen (13) parents and caregivers who were purposively selected to participate in the study. Data analysis was done using qualitative content analysis. Three themes emerged which were understanding the general concept of disclosure, the pattern followed by parents and caregivers on disclosure of HIV status to infected children and the experiences of parents and caregivers on HIV status disclosure to their children. Based on the findings, support guidelines were formulated to assist parents and caregivers with disclosure of HIV status to their infected children. The outcome of this study is the description of a clear pattern of when, how and what to be disclosed to HIV infected children; as described by the parents and caregivers of the HIV positive children. / Health Studies / M.A. (Nursing Science)

This study sought to explore the views of healthcare workers regarding paediatric anti-retroviral therapy (ART) adherence in Nigeria. An exploratory descriptive qualitative research design was used to identify and describe healthcare workers’ views in Kano and Lagos, Nigeria. Three focus group discussions were held. The transcribed data was analysed using the framework approach of data analysis. Healthcare providers perceived poverty, illiteracy, stigma and discrimination, inappropriate care approaches, and parental dynamics as factors influencing ART adherence. Recommendations for enhancing paediatric ART adherence levels in Nigeria included: mainstreaming adherence counselling in paediatric ART and adopting a comprehensive family centred care approach were identified as measures for improving paediatric ART adherence. Other measures included free ART services, quality improvement in paediatric ART services, parental empowerment and stigma and discrimination reduction programmes. / Health Studies / M.A. (Public Health)

HIV/AIDS epidemic has caused much devastation and has left many children destitute and in need of care and supervision. The present study investigated the psychological impact of caring on non-professional caregivers of HIV/AIDS orphans and children affected by HIV/AIDS. General systems theory stands as the epistemological framework informing the study. The study made use of a qualitative phenomenological approach to explore the lived experiences of eight non-professional caregivers who participated in the study .From the themes that were abstracted it was evident that caring for HIV/AIDS orphans is emotionally, physically and mentally strenuous for the caregivers. It was better recommended that caregivers be given recognition for their challenging work and be included in the planning and development of programmes that affect their caregiving role. Furthermore emotional, psycho-social, and income-generating skills support programmes including training and educational programmes should be implemented. This will alleviate the distress inherent to the caregiving role and to equip them with the necessary skills for handling the demands of their work. / Psychology / M.A. (Clinical Psychology)

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The global epidemic of HIV continues with an estimated 2.2 million children under 15 years of age worldwide living with HIV and 640 000 newly infected in 2004 (WHO, 2009). HIV crosses the blood–brain barrier which may lead to neuronal damage and death. There is controversial evidence within available research on effects of HIV on cognitive and motor development in children because of the limitations imposed by study designs, study populations and study methodological quality. The aims of the review were: - To conduct a systematic review of published research to establish the effects and the prevalence of HIV infection on cognitive and motor development in children. - To critically appraise the methodological quality of published research regarding cognitive and motor development of HIV infected children. The objectives of the review were: - To assess evidence on the cognitive and motor development of HIV-1 infected children - To describe anthropometric outcomes including: weight for age, weight for height, height for age and head circumference in children with a HIV infection. - To assess the methodological quality of studies on the cognitive and motor development of HIV infected children. The following databases were searched for identification of articles; MEDLINE, Google Scholar, AIDSTRIALS, AIDSLINE and CINHAL. The search time frame included published works from inception to July 2011 without language restrictions. Analytical observational trials that assessed at least one outcome (cognitive or motor development or 1 of the anthropometric outcomes) between HIV positive and HIV negative children aged 5 years and below or children with a mean age of less than 5 years were employed. Two review authors independently searched for eligible studies, evaluated methodological quality and extracted the data. Meta-analysis was carried out using Rev Man 5.1 using the risk ratio for categorical data and standard mean difference for continuous data. Fifteen studies with a total of 3 086 participants met the inclusion criteria. HIV infected children were 2.45 times at higher risk of developing cognitive developmental delay than HIV negative children (RR, 95% CI, 1.95, 3.07, P < 0.00001). Infected children scored - 0.54 less than HIV negative children (SMD 95% CI, -0.70, -0.39, 97, p < 0.00001) for cognitive development and -0.68 in motor development (SMD 95% CI, -0.82, -0.55, p< 0.00001). The risk of motor developmental delays was 2.95 times in HIV positive compared with HIV negative children (RR 95% CI, 2.19, 3.99, p < 0.00001). HIV infected children are slower in aspects of cognitive and motor development compared to their HIV negative counterparts. They also showed delays in anthropometric outcomes; weight for age and height for age. Study design influenced results of the studies with children scoring more on cross sectional than cohort studies. There is still need to develop culturally appropriate or standardise neurodevelopment tools as most African studies still rely on international tools. More evidence is needed on the effectiveness of HAART in reducing cognitive and motor delay. / AFRIKAANSE OPSOMMING: Die wêreldwye MIV epidemie duur voort met ongeveer 2.2 miljoen kinders onder 15 jarige ouderdom wat wêreldwyd met MIV leef en 640 000 onlangs in 2004 geïnfekteerd (WHO, 2009). MIV strek oor die bloed-brein grens wat kan lei tot neuronale skade en die dood. Daar is kontroversiële bewys binne beskikbare navorsing oor die effek wat MIV het op kognitiewe en motoriese ontwikkeling in kinders, vanweë die beperkinge wat geplaas word deur studie ontwerpe, studie bevolkings en studie metodologiese kwaliteit. Die doelwitte van die oorsig is om - ‘n sistematiese oorsig van gepubliseerde navorsing te doen om sodoende die effek en voorkoms van MIV infeksie op kognitiewe en motoriese ontwikkeling by kinders vas te stel - ’n kritiese waardering van die metodologiese kwaliteit van gepubliseerde navorsing te doen ten opsigte van die kognitiewe en motoriese ontwikkeling van MIV geïnfekteerde kinders. Die doelwitte van die oorsig is om - assessering te doen van die bewyse van kognitiewe en motoriese ontwikkeling by MIV-1 geïnfekteerde kinders - antropometriese uitkomste te beskryf, insluitend: gewig vir ouderdom, gewig vir hoogte, hoogte vir ouderdom en omtrek van die hoof by kinders met ’n MIV infeksie - die metodologiese kwaliteit te assesseer van studies op die kognitiewe en motoriese ontwikkeling van MIV geïnfekteerde kinders. Die volgende databasisse is nagevors vir die identifisering van artikels: MEDLINE, Google Scholar, AIDSTRIALS, AIDSLINE en CINHAL. Die tydraamwerk vir navorsing het gepubliseerde werk ingesluit vanaf aanvang tot Julie 2011 sonder taalbeperkings. Analitiese waarneembare toetse wat ten minste een uitkoms geassesseer het (kognitiewe of motoriese ontwikkeling of 1 van die antropometriese uitkomste) tussen MIV positiewe en MIV negatiewe kinders van 5 jarige ouderdom en jonger, of kinders met ’n gemiddelde ouderdom van minder as 5 jaar is betrek. Twee oorsig outeurs het onafhanklik vir geskikte studies gesoek, metodologies geëvalueer en data getrek. Meta-analise was uitgevoer deur gebruik te maak van Rev Man 5.1 met behulp van die risiko-ratio vir kategoriese data en die standaard gemiddelde verskil vir aaneenlopende data. Vyftien studies met ’n totaal van 3 086 deelnemers met die insluitingskriteria. MIV geïnfekteerde kinders het 2.45 keer ’n hoër risiko gehad om kognitiewe ontwikkelingsvertraging te ontwikkel as MIV negatiewe kinders (RR, 95% CI, 1.95, 3.07, P< 0.0000). Geïnfekteerde kinders het ’n -0.54 telling behaal, minder as MIV negatiewe kinders (SMD 95% CI, -0.70, -0.39,97 p < 0.00001) vir kognitiewe ontwikkeling en -0.68 vir motoriese ontwikkeling (SMD 95% CI, -0.82, -0.55, p< 0.00001). Die risiko van motoriese ontwikkelingsvertragings was 2.95 keer by MIV positiewe in vergelyking met MIV negatiewe kinders (RR 95% CI, 2.19, 3.99. p < 0.00001). MIV geïnfekteerde kinders is stadiger in aspekte van kognitiewe en motoriese ontwikkeling in vergeyking met hulle MIV negatiewe eweknieë. Hulle het ook vertragings getoon in antropometriese uitkomste; gewig vir ouderdom en hoogte vir ouderdom. Studie ontwerpe het uitslae beïnvloed van die kinders wat ’n hoër telling behaal het met deursnee as in kohort studies. Daar is nog ’n behoefte om kultureel geskikte of gestandaardiseerde neuro-ontwikkelingsinstrumente te ontwikkel, omdat die meeste Afrika-studies nog steeds staat maak op internasionale instrumente. Meer bewyse is nodig aangaande die effektiwiteit van HAART om kognitiewe en motoriese vertraging te verminder.

Child Welfare organisations in South Africa, including KwaZulu-Natal, are being faced with various challenges. Since 1994, after the first democratic elections in South Africa, a major shift toward the developmental welfare approach was advocated in the White Paper for Social Welfare (Department of Welfare, 1997), in the provision of welfare services and programmes. The South African AIDS epidemic shows no signs of halting. At present, South Africa has the largest number of individuals living with the virus in a single country, with an estimated 5.3 million infections (UNAIDS, 2005). KwaZulu-Natal is ranked fourth. South Africa is facing an unprecedented AIDS crisis. The increasing numbers of HIV infected adults and children are having a devastating impact on child welfare organisations. Child Welfare organisations were already under-resourced, overstretched and overburdened, even before the AIDS epidemic emerged. The consequences of apartheid, especially in terms of mass poverty and HIV/AIDS add a further problem on an already divided and somewhat 'abnormal' society. In addition, the shift from the welfarist tradition of social work practice to the developmental paradigm has serious implications on the functioning of child welfare organisations, which are unable to cope with the existing caseloads. Hence there is a need to address the challenges and for specialised services in the arena of HIV/AIDS. The purpose of this study was to investigate the responses of child welfare organisations in KwaZulu-Natal to the challenges of HIV/AIDS. The ecosystems perspective provided the theoretical framework within which the study was conducted. This perspective guided the selection of the study samples and the analysis of data. The study adopted a descriptive design, and the triangulated research paradigm incorporating both the quantitative and qualitative methods, as this was the most appropriate approach for the study's focus, objectives and research questions. By combining these two methods, a general overall audit was achieved in addition to obtaining rich, in-depth information. Fifty-five child welfare organisations in KwaZulu-Natal constituted the main sample for the quantitative study. Personal in-depth interviews were conducted with 5 senior social work personnel from the child welfare organisations. There were conclusive findings in this study that indicated that overall, child welfare organisations in the KwaZulu-Natal region are making concerted efforts to respond to the challenge of HIV/AIDS in the broad areas of policy implementation and modification, specific programmes for children, special facilities for children affected by HIV/AIDS, awareness and prevention programmes and community projects. However difficulties in these areas were also experienced in the specific areas of providing adequate care, support and counselling with regard to children and families infected and affected by HIV/AIDS, staff inadequacy and training and facilities for pre and post test counselling. Some of the factors that have been responsible for impeding the overall success can be attributed to: high staff turnover, high caseloads, burnout and stress, lack of adequate resources, inadequate funding, lack of government support, poverty and inefficiency in the social security system. Recommendations for further research and for policy and practice are detailed. / Thesis (M.A.)-University of KwaZulu-Natal, 2006.

Thesis (Dr.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2006. / Includes bibliographical references (leaves 114-126).

Thesis (MPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The impact of HIV/AIDS has affected all categories of people in society, including children under the age of five. This segment of the population depends entirely on adults and older children in order for them to survive. This research endeavoured to investigate the extent to which under-five HIV positive children access ART in Siavonga District in the Southern Province of Zambia. The necessity of such information for all cannot be over-emphasised as this category of the population under study is among the most neglected when it comes to issues of HIV/AIDS. Under-five HIV positive children need special attention in order for them to enjoy their right to survival and development. In terms of methodology, the research took an interpretive approach as it employed the qualitative methodology in its endeavours, in order to get an in-depth understanding of people’s views on the topic under research. Different interview schedules were used to collect data from community members, Community Health Workers (CHW), Home-based Care Providers (HBCP), staff of the Ministry of Health and District AIDS Task Force (DATF). The findings of this research addressed all the objectives but one. This research revealed that almost all the community members in Siavonga District had general knowledge about HIV/AIDS and the need for under-five HIV positive children accessing antiretroviral therapy. However, their attitudes and practices varied when it came to the application of this knowledge. According to respondents, the major challenges that under-five HIV positive children were facing when it came to accessing ART were as follows: food insecurity, followed by access to health facilities and social matters. Others included stigma and discrimination, long distances to health facilities, inadequate disposable income at household level and negative attitudes by some people who think that it is a waste of time and resources to give too much attention, including ART to under-five HIV positive children whom according to them will die soon. However, the majority of respondents indicated that there was need to accept these children like any other as they too had the right to live; hence, they needed care and support which included facilitating their access to ART. This research was an eye opener to all duty bearers to recognize and acknowledge the importance of under-five HIV positive children’s access to ART. This will contribute towards enhancing the will to step up efforts for this intervention. From the findings, it is evident that there is need for income generating activities to provide disposable income to people of Siavonga District so that they give appropriate support, particularly to children who are infected or affected by HIV/AIDS. Furthermore, more resources are required from NGOs, government and other stakeholders to enhance not only sensitization on the importance of the target population’s access to ART, but also provision of these ART services. All relevant stakeholders should heed the call to aggregate information for under-five HIV positive children in question so as to specially target interventions accordingly. / AFRIKAANSE OPSOMMING: Die impak van MIV/Vigs raak alle kategoriee van mense in die samelewing, insluitende kinders jonger as vyf jaar oud. Die segment van die bevolking is heeltemal afhanklik van volwassenes en ouer kinders om te oorleef. Hierdie navorsing poog om die omvang van kinders jonger as vyf, wie MIV positief is, se toegang tot antiretrovirale terapie (ART) in die Siavonga Distrik van die suidelike provinsie van Zambia te ondersoek. Die noodsaaklikheid van sodanige inligting vir alle sektore in die samelewing kan nie oorbeklemtoon word nie, aangesien hierdie kategorie van die bevolking een van die mees verwaarloosde is wanneer dit kom by MIV/Vigs verwante kwessies. Kinders jonger as vyf wie MIV positief is, moet spesiale aandag ontvang sodat hulle reg op oorlewing en ontwikkeling kan geskied. In terme van die metodologie het die navorsing ‘n beskrywende benadering gevolg om die kwalitatiewe metode in sy poging, ten einde ‘n in-diepte begrip van mense se standpunte oor die onderwerp onder navorsing te kry. Verskillende onderhoude is gebruik om data in te samel van gemeenskapslede, gesondheidswerkers in die gemenskap, tuisversorgers, personeel van die Ministerie van Gesondheid en Distriks vigs-taakspan. Die bevindinge van hierdie navorsing het al die doelwitte, behalwe een, aangespreek. Die navorsing het getoon dat byna al die gemeenskapslede in Siavonga Distrik algemene kennis het oor MIV/Vigs en die behoefte van kinders jonger as vyf se toegang tot ART. Hul houdings en praktyke verskil egter in die toepassing van hierdie kennis. Volgens die respondente is die grootste uitdagings wat kinders jonger as vyf ondervind wanneer dit kom by toegang tot ART is voedselonsekerheid, gevolg deur toegang tot gesondheidsfasiliteite en sosiale aangeleenthede. Ander sluit in stigma, diskriminasie, lang afstande na gesondheidsfasiliteite, onvoldoende besteebare inkomste op huishoudelike vlak en negatiewe houdings van sommige mense wat dink dat dit ‘n vermorsing van tyd en hulpbronne is om aan kinders jonger as vyf te spandeer, aangesien, die kinders in elk geval (volgens hulle) binnekort sal sterf.Die meerderheid van die respondente het aangedui dat dit nodig is om hierdie kinders soos enige ander kind te aanvaar en dat hulle ook die reg het om te leef: daarom dat hulle sorg en ondersteuning benodig, wat die fasilitering van hul toegang tot ART insluit. Hierdie navorsing het weer die klem geplaas op die belangrikheid van kinders jonger as vyf se toegang tot ART. Dit is duidelik dat daar ‘n behoefte is aan inkomste-genererende aktiwiteite en om besteebare inkomste aan die mense van Siavonga Distrik te voorsien, sodat hulle toepaslike ondersteuning kan bied, veral aan kinders wat deur MIV/Vigs geraak word. Verder is meer hulpbronne nodig van nie-regeringsorganisasies, die regering en ander belanghebbendes, nie net om die belangrikheid van die teikenbevolking se toegang tot ART nie, maar ook vir voorsiening van hierdie ATR dienste.

HIV/AIDS epidemic has caused much devastation and has left many children destitute and in need of care and supervision. The present study investigated the psychological impact of caring on non-professional caregivers of HIV/AIDS orphans and children affected by HIV/AIDS. General systems theory stands as the epistemological framework informing the study. The study made use of a qualitative phenomenological approach to explore the lived experiences of eight non-professional caregivers who participated in the study .From the themes that were abstracted it was evident that caring for HIV/AIDS orphans is emotionally, physically and mentally strenuous for the caregivers. It was better recommended that caregivers be given recognition for their challenging work and be included in the planning and development of programmes that affect their caregiving role. Furthermore emotional, psycho-social, and income-generating skills support programmes including training and educational programmes should be implemented. This will alleviate the distress inherent to the caregiving role and to equip them with the necessary skills for handling the demands of their work. / Psychology / M.A. (Clinical Psychology)

Afrikaans text / Die studie ondersoek die leemte aan teoreties gefundeerde riglyne om pleegouers in die bekendmakingsproses van hulle kind se MIV-positiewe status te ondersteun Die studie geskied binne die teoretiese raamwerk van ʼn intervensienavorsingsmodel. In die empiriese navorsing is die vrese en probleme van pleegouers by die bekendmakingsproses ondersoek. Daar is bevind dat hierdie vrese en probleme in ag geneem moet word in die beoogde riglyne. Die kognitiewe ontwikkeling van die kind is deur middel van ʼn literatuurstudie ondersoek om vas te stel watter kennis, denke en inligting die kind op verskillende ouderdomme begryp. Daar is bevind dat kinders wat MIV-positief is, moontlike agterstande ondervind en dat die riglyne gevolglik gebaseer moet word op die toenemende ontwikkeling van die kind, met begrip vir individuele ontwikkelingsverskille. Voorts is bevind dat pleegouers se eie gereedheid ʼn belangrike rol speel. Alhoewel die pleegouer die bekendmakingsproses self moet aanvoer en hanteer is dit belangrik dat die pleegouers deur ʼn interdissiplinêre span ondersteun en begelei sal word. / This study investigates the absence of theoretical grounded guidelines to support foster parents when disclosing paediatric HIV. The study was done within the theoretical framework of an intervention research model. The empirical research investigated the fears and problems experienced by foster parents during the disclosure process. It was found that these fears and problems should be taken into account when compiling guidelines. The child‟s cognitive development was researched by way of a literary study in order to determine what knowledge, thoughts and information the child is able to grasp at different ages. It was found that children who are HIV positive could possibly lag behind and that the guidelines should therefore be based on the accumulative development of the child, with consideration given to individual developmental differences. Furthermore, it was established that foster parents‟ own readiness plays an important role. For this reason the foster parents should be supported and guided by an interdisciplinary team, but that they themselves should take care and execute the process of disclosure. / Social Work / M. Diac. (Spelterapie)