The recommended infant feeding method for mothers living with HIV is either exclusive breastfeeding for six months or replacement infant feeding (RIF), while a mixed feeding method carries the greatest health risks for infants. This study focused on identifying the challenges faced by mothers who opted for RIF and the coping strategies they employ. A theoretical framework, based on gender and power, was developed. The study used a qualitative design, with semi-structured in-depth interviews. Using purposive sampling, data was collected at three clinics from 22 participants. The participants reported experiencing challenges related to RIF such as intermittent availability of formula milk at the clinics. Socio-cultural challenges include power inequalities between health care workers and mothers, pressure from family members to breastfeed, stigmatization and discrimination from community members. Coping strategies such as withdrawal from the community and trying to hide RIF from others were not sufficient to meet the challenges experienced. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

No description available.

Breast-feeding by Human Immunodeficiency Virus (HIV) positive mothers poses a risk of transmitting HIV infection from the mother to the baby. This study attempted to describe and explore the knowledge of antenatal women in Gaborone, Botswana on the transmission of HIV through breast-feeding. The research results, obtained from interview schedules, revealed that the respondents had: a greater knowledge of transmission of HIV in adults than mother-to-child-transmission (MTCT); a moderate understanding of infant feeding methods; poor understanding of the risk of HIV transmission through different infant feeding methods and feelings that infant feeding method reveals ones HIV status, which indicate stigma and discrimination. The study findings may assist health care providers to intensify educational programmes and counselling in the antenatal clinics and communities to reduce MTCT. / Health Studies / M. A. (Health Studies)

Thesis (MMed (Medical Microbiology))--University of Stellenbosch, 2006. / One of the major routes of transmission of human immunodeficiency virus (HIV) in the developing world is vertical transmission from mother to infant – pre-, intra-, or post-partum. In the Western Cape, HIV-1 subtype C is the predominant subtype in the heterosexual population, and this trend was expected to be seen amongst cases of mother-to-child transmission of HIV. The aim of this study was to perform genetic characterisation and phylogenetic analysis of the HIV-1 genome in positive serum/plasma samples obtained from children (age 0 to 18 months) from 2000-2002, and temporally related specimens from their mothers. We obtained 27 suitable pairs of samples taken within 6 months of delivery. From this pool, we obtained 21 infant DNA sequences and 17 maternal sequences, resulting in 16 mother-infant pairs. All patient sequences were identified as HIV-1 subtype C, and, as expected, mother and infant viral sequences clustered together. In some cases where a mother was suspected to have two dominant quasispecies based on the electropherogram, only one sequence was detectable in the infant. Single or multiple amino acid deletions were consistent between mothers and infants, and some pairs showed the same amino acid deletions seen in other pairs.

Thesis (MBA)--Stellenbosch University, 2003. / Some digitised pages may appear illegible due to the condition of the original hard copy / ENGLISH ABSTRACT: After sexual transmission of HIV, mother-to-child (MTCT) transmission is the most common cause of HIV infection in South Africa. The Western Cape government, through the Premier, has committed itself to providing access for all HIV positive women in the province attending antenatal clinics to MTCT prevention programmes by the end of 2003. The MTCT prevention programme is aimed at intervening transmission during pregnancy, during the birth of the baby and post delivery during breast-feeding of the newborn baby. The HIV virus attacks and destroys the cells of the immune system by being incorporated into the reproductive cycle of the cell. Antiretroviral drugs in the fight against HIV target two aspects of this replication cycle of the virus and as such do not halt the infection but slow it down by preventing the replication of the virus. MTCT internationally has been reduced dramatically by the use of antiretroviral drugs (AZT) antenatally, during birth and post-natally for mother and baby. However this regimen was found to be not suitable for resource-poor countries due to the complexity in administration, compliance and costs. Poor countries have developed alternative MTCT prevention programmes based on shorter course regimens and on alternative antiretroviral drugs. MTCT prevention In South Africa initially did not have the support of the national government. However, the -Western Cape Administration had developed a regional programme phasing in MTCT prevention at all state clinics within the province. The cost drivers associated with the MTCT prevention programme include costs associated with the HIV tests, costs for pre- and post-test counselling, costs for the antiretroviral drugs and costs for substitute feeding to replace breast-feeding to prevent viral transmission during breast-feeding. Depending on the option exercised, costs can be calculated per HIV positive baby averted. As regards substitute feeding, which is a substantial cost driver and a major disadvantage to the newborn baby as regards protection from common childhood diseases such as diarrhea, research from Tanzania showed that ARV therapy during childbirth could suppress HIV transmission through breast-feeding during the first few weeks after childbirth, thus enabling an optimal combination of breast-feeding in the first few crucial weeks of the newborn's life for the protective benefits of breast-milk and formula feeding thereafter to ensure protection for the infant from HIV transmission through breastfeeding. The data were subjected to a sensitivity or a "what-if' analysis usmg an Excel spreadsheet. Costs per HIV averted were calculated for each assumed parameter in the model that was developed. As regards prevalence, the MTCT prevention programme is most cost effective at the lower levels of the seroprevalence of HIV in the population served. If the seroprevalence is above the "cross-over" or "optimal" point for the regimen an alternative regimen should be assessed. As regards levels of identification and number accepting intervention the principle of an economy of scale applies and therefore, a level of 100 percent in both cases should be targeted. This will be dependent on wide scale advertisements and support for the programme with active efforts to destigmatise the infection. Innovative programmes such as the mothers-to-mothers-to-be (M2M2B) programme must be encouraged. / AFRIKAANSE OPSOMMING: Na seksuele oordraging van HIV is moeder tot kind (MTK) oordraging die algemeenste rede van HIV infeksie in Suid Afrika. Die Wes-Kaapse regering, deur die Premier, het hulself verbind om toegang vir alle HIV positiewe vroue in die provinsie, wat voorgeboorte klinieke bywoon, tot MTK voorkomingsprogramme voor die einde van 2003 moontlik te maak. Die MTK voorkomingsprogram is gerig op die tussenkoms van transmissie gedurende swangerskap, gedurende die geboorte en die nasorg tydens die borsvoeding periode van die pasgebore baba. Die HIV virus val die selle van die immuun sisteem aan en' vernietig dit. Die virus word geïnkorporeer tot die reproduksie siklus van die sel. Antiretrovirale wat teen die virus gerig is, is gerig teen twee aspekte van die replikasie siklus van die virus en sodoende sal die medikasie die infeksie nie staak nie, maar eerder vertraag as gevolg van die voorkoming van die replikasie. Moeder-tot-kind infeksie is internasionaal drasties verminder deur die gebruik van antiretrovirale (AZT) gedurende die tydperk voor geboorte, gedurende die geboorte en gedurende nasorg van die moeder en baba. Hierdie regimen is egter nie altyd moontlik in arm lande nie vanweë die kompleksiteit van die administratiewe toepassing en kostes. Arm lande het alternatiewe MTK voorkomingsprogramme ontwikkel, gebaseer op korter kursusse en alternatiewe antiretrovirale. Die voorkoming van MTK infeksie in Suid-Afrika het eers nie die ondersteuning van die nasionale regering geniet nie. Die Wes-Kaapse Adminstrasie het onafhanklik van die nasionale regering, streeksprogramme ontwikkel vir die infasering van MTK voorkoming in alle klinieke in die Provinsie. Die kostedrywers wat met MTK voorkomingsprogramme geassosieer word, sluit in die koste van HIV toetse, koste van voor-en-na toets berading, koste van die antiretrovirale en alternatiewe voeding om virale transmissie te voorkom gedurende die tydperk van borsvoeding. Afhangende van die opsies wat gebruik is, kan die koste van elke baba wat nie HIV opdoen nie, bereken word. Sover dit alternatiewe voeding aangaan, wat 'n belangrike kostedrywer is en 'n nadeel vir elke baba is sover dit teen beskerming van algemene kindersiekte soos diarrhea gaan het navorsing in Tanzanië bewys dat ARV terapie gedurende geboorte ook HIV transmissie deur borsvoeding gedurende die eerste paar weke na geboorte onderdruk wat 'n optimale kombinasie van borsvoeding in die eerste paar kritiese weke van die nuutgebore baba se lewe vir die beskermende voordele van moedersmelk en formulêre voeding daarna te versterk met beskerming van die baba teen HIV transmissie deur borsvoeding. Deur die gebruik van 'n Excel werkblad en 'n "wat as" metode van analiese koste van HIV opdoen in bereken word vir elke aanvaarding. Sover dit voorkoms betref is die MTK voorkomingsprogramme die mees effektief hoe laer die "seroprevalence" van HIV in die populasie gedien word. As die "seroprevalence" hoër as die optimale punt is, moet 'n ander metode bereken word. Sover dit die mate van identifisering en hoeveelheid die tussenkoms aanvaar in 'n mate van 100 persent moet in beide gevalle die mikpunt wees. Dit sal afhang van grootskaalse advertensies en ondersteuning van die programme met bedrywige pogings om die' infeksie te destigmatiseer. Nuwe programme soos die moeder tot nuwe moeder (M2M2B) program moet aangemoedig word.

This study was conducted to investigate the role of natural killer cell surface receptors, KIRs and their cognate HLA ligands in preventing HIV-1 acquisition and disease progression in HIV-1 exposed infants. Using DBS stored for 8 years from 21 pregnant South African women we evaluated 3 methods of gDNA extraction with and without whole genome amplification (WGA) to characterize immune-related genes: IL-10, KIR and HLA class I. However, IL-10 SNP typing was only for testing the quality of gDNA. QIAamp DNA mini kit yielded the highest gDNA quality (p<0.05; Wilcoxon Signed Rank Test) with sufficient yield for subsequent analyses. In contrast, WGA was not reliable for SSP-PCR analysis of KIR2DL1, KIR2DS1, KIR2DL5, and KIR2DL3 or high resolution HLA genotyping using a sequence-based approach. A cohort of 370 infants; 124 HIV-1 perinatally infected, 120 exposed uninfected and 126 unexposed healthy infants was used for KIR and HLA genotyping. After adjustment for viral load and multiple comparisons, the frequency of HLA-Cw*04:01 allele was likely to be associated with susceptibility to mother-to-child acquisition of HIV-1 in exposed infected (EI) infants (p=0.05; Logistic Regression analysis). HLA-A*23:01 was likely to be associated with decreased CD4 T lymphocyte count in HIV-1 infected infants (p=0.01; ANOVA), whereas HLA-B*81 tended to be associated with higher CD4 T lymphocyte count (p=0.04, ANOVA). We speculate that HLA-Cw*04:01 interacts with KIR2DL1 and inhibit NK cell responses which predispose the infants to HIV-1 infection. KIR2DS1 and KIR2DL5 were both associated with faster HIV-1 disease progression. Identified protective HLA-class I alleles could be used to present viral epitopes to either NK cells via KIRs or CTLs and enhance immune activation which may promote resistance to HIV-1 infection. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2012.

Introduction. The Human Immunodeficiency Virus (HIV) is the main contributor to rising child mortality in South Africa. Although prevention of mother-to-child transmission programmes have been implemented in the country, little is known about the clinical and loss to follow-up outcomes of infants born to HIV-infected women attending these programmes. Purpose. The purpose of the study was to describe the clinical and loss to follow-up outcomes of HIV-exposed infants whose mothers had received antiretroviral therapy or prophylaxis during their pregnancy at the Prevention of Mother-to-Child Transmission programme at McCord Hospital. Furthermore, maternal socio-demographic characteristics associated with these outcomes were determined. Methods. An observational retrospective cohort study design was used. The study population consisted of infants whose mothers had received antiretroviral prophylaxis or therapy at McCord Hospital, and were delivered at McCord Hospital, and/or were brought back to McCord Hospital, following delivery from 1 May 2008 to 31 May 2009. Results. Data on 265 infants was analysed. Of the 220 infants who were tested, the HIV transmission risk was 2.7% (n=6; 95% Cl: 1.0% to 5.8%) at 6 weeks of age. Overall, 40.4% of infants in the cohort were lost to follow-up (n=105, 95% Cl: 34.4 to 46.6). In the multivariable model (n=253), late booking for first antenatal visit at or after 28 weeks of gestation (adjusted hazard ratio (AHR) 2.3; 95% Cl: 1.0 to 5.1, p=0.044) was a risk factor for loss to follow-up. Compared to having an emergency caesarean section, having an elective caesarean section (AHR 1.9; 95% Cl: 1.1 to 3.5) or normal vaginal delivery (AHR 2.5; 95% Cl: 1.4 to 4.5) was significantly associated with loss to follow-up of infants. Discussion. The substantial attrition of infants born to HIV-infected mothers in the Prevention of Mother-to-Child Transmission programme at McCord Hospital undermined the goals of the programme, and underestimated the effect of infectious disease morbidity, mortality and HIV transmission risk associated with these infants. Recommendations. Counselling mothers on the health benefits to their HIV-exposed infants of attending the follow-up clinic and tracing of infants who have been lost to follow-up is vital to the operational effectiveness of the Prevention of Mother-to-Child Transmission programme at McCord Hospital. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The global targets of zero deaths from AIDS-related illness by the year 2015 can only be met if all HIV infected infants can be diagnosed and initiated on anti-retroviral therapy as early as four to six weeks. WHO/UNICEF reported in 2010 that only 8% of eligible infants were tested worldwide. There seems to be more attention directed towards service delivery and less attention on empowering mothers to make voluntary decision to access the services. The influence of maternal knowledge of infant HIV infection and the impact on the attitude towards knowing the status of their children so early in life remains uncertain. The aim of this study was to explore the knowledge and attitude of the HIV positive mothers to early infant diagnosis in order to make strategic recommendations to the health authorities on how to scale up the services in the various health facilities. A qualitative study was conducted in two health centres in King Sabata Dalindyebo Municipality of Eastern Cape Province, South Africa. This qualitative study drew in-depth interview with twenty-four HIV positive mothers/ exposed infants’ pair attending the immunization clinics. The results obtained were presented to two focus groups for discussion and validation of findings. Thematic analysis explored the emerging themes relevant to the objective of the study and health authorities. The study found that there is a high level of awareness about infant HIV infection. Majority of the participants were aware of MTCT of HIV and the timing of transmission (pregnancy, delivery and breastfeeding). Majority of the participants were aware about the protection offered by maternal exposure to ARVs however, only few participants knew about the risk of transmission despite ARV use. Majority of the participants did not know the right time to bring their infant for HIV test. Majority of the participants never thought about HIV test for their infant as early as six weeks. Majority of the mothers have fears about bringing their infants for HIV test so early. They have concerns about recommending early infant diagnosis to other children in their community due to the perceived disclosure of their own status. The study found that despite good knowledge of mothers about infant HIV infection and prevention methods, the knowledge about early infant diagnosis is lacking. The attitude of the mothers to knowing the status of their infant so early in life is challenging for them. The health authorities have more work to do to empower these mothers with knowledge about early infant diagnosis and early ART initiation to increase the chances of survival of HIV infected infants. / AFRIKAANSE OPSOMMING: Die internasionale mikpunt van geen sterftes weens vigsverwante siektes teen die jaar 2015 kan slegs bereik word as alle MIV-besmette babas reeds op vier tot ses weke gediagnoseer word en antiretrovirale terapie (ART) ontvang. Die WGO/UNICEF het in 2010 berig dat slegs 8% van babas wat getoets moet word, in werklikheid wêreldwyd getoets is. Dit blyk dat meer aandag aan dienslewering en minder aan die bemagtiging van moeders om die vrywillige besluit om van die dienste gebruik te maak, geskenk word. Die invloed van moeders se kennis op MIV-besmetting van babas en die impak op die houding teenoor kennis van die status van hul kinders op so ’n vroeë ouderdom is steeds onbekend. Die doel van hierdie studie was om die kennis en houding van MIV-positiewe moeders rakende vroeë diagnose van babas te ondersoek ten einde strategiese aanbevelings aan die gesondheidsowerhede te maak oor verbetering van die dienste in die onderskeie gesondheidsfasiliteite. ’n Kwalitatiewe studie is in twee gesondheidsentrums in King Sabata Dalindyebo-munisipaliteit in die provinsie Oos-Kaap, Suid-Afrika, onderneem. Dit het diepte-onderhoude met 24 MIV-positiewe moeders/blootgestelde babas wat die immuniseringsklinieke besoek het, behels. Die resultate is aan twee fokusgroepe vir bespreking en bekragtiging van die bevindings voorgelê. Tydens ’n tematiese ontleding is die temas wat aan die lig gekom het wat betrekking het op die doelstellings van die studie en gesondheidsowerhede ondersoek. Daar is gevind dat daar ’n hoë vlak bewustheid van MIV-besmetting van babas is. Die meerderheid van die deelnemers was bewus van moeder-na-kind-oordrag van MIV en die tydsberekening van oordrag (swangerskap, geboorte en borsvoeding). Die meerderheid van die deelnemers was ook bewus van die beskerming wat gebied word deur die moeder se blootstelling aan ART, maar net ’n paar deelnemers het egter geweet van die risiko van oordrag ongeag die gebruik van ART. Die meerderheid van die deelnemers het nie geweet wat die korrekte tyd is om hul baba vir ’n MIV-toets te bring nie. Die meerderheid het nog nooit ’n MIV-toets vir hul baba voor die ouderdom van ses weke oorweeg nie. Die meerderheid van die moeders was bang om hul babas so vroeg reeds vir MIV te laat toets. Hulle is begaan oor die aanbeveling van vroeë diagnose vir ander mense in hul gemeenskap weens die waargenome bekendmaking van hul eie status. Die studie het bevind dat ongeag moeders se grondige kennis van MIV-besmetting van babas en voorsorgmaatreëls, daar ’n gebrek aan kennis oor vroeë diagnose van babas is. Die houding van die moeders teenoor kennis van die status van hul baba op so ’n vroeë ouderdom hou vir hulle ’n uitdaging in. Die gesondheidsowerhede moet hulle daarop toespits om hierdie moeders sonder kennis oor vroeë diagnose van babas en vroeë nakoming van ART te bemagtig ten einde MIV-besmette babas se kanse op oorlewing te verhoog.

The purpose of this Qualitative study was to explore HIV related stigma experienced by women enrolled in the Prevention of Mother to Child (PMTCT) prgramme in the EThekwini District, Kwazulu Natal. Descriptriptive phenomenology informed the study design, data collection and analysis. Despite increasing access to Prevention of Mother to Child Transmission initiatives, including anti-retroviral drugs, the Stigma of being HIV positive, particularly for women, largely outweigh the potential gains from available treatments. HIV/AIDS related stigma drives the epidemic underground and is one of the main reasons that people do not wish to know their HIV status Purposeful sampling was used to select seven women attending PMTCT programme in the EThekwini District. These women were selected in four clinics in the District. Data was collected through in-depth interviews lasting about 45 minutes to an hour. These interviews were tape recorded and later transcribed to aid analysis. The Colaizzi method of data analysis was utilized. Four themes emerge from the data, each with three to eight subthemes confirming the experiences and presence of stigma during programme participation. All participants reported incidence of being stigmatized, particularly in the Health care setting. They took great strides to keep their HIV status confidential to a point of going against programme directives to ensure secrecy of their status thus avoid HIV related stigma. Number of recommendations were made in relation to the PMTCT programme and if accepted will assist in mitigating stigma in HIV related stigma in the PMTCT progarmme and thus reduce vertical transmission. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Breast-feeding by Human Immunodeficiency Virus (HIV) positive mothers poses a risk of transmitting HIV infection from the mother to the baby. This study attempted to describe and explore the knowledge of antenatal women in Gaborone, Botswana on the transmission of HIV through breast-feeding. The research results, obtained from interview schedules, revealed that the respondents had: a greater knowledge of transmission of HIV in adults than mother-to-child-transmission (MTCT); a moderate understanding of infant feeding methods; poor understanding of the risk of HIV transmission through different infant feeding methods and feelings that infant feeding method reveals ones HIV status, which indicate stigma and discrimination. The study findings may assist health care providers to intensify educational programmes and counselling in the antenatal clinics and communities to reduce MTCT. / Health Studies / M. A. (Health Studies)