Thesis (PhD)--Stellenbosch Univesity, 2011. / ENGLISH ABSTRACT: It is well established that South African women are disproportionately affected by HIV/AIDS and gender based violence. Research to date has provided evidence for neurocognitive decline in individuals infected with HIV/AIDS and in individuals who have experienced early life trauma. However, many gaps remain in our knowledge about the neurocognitive profile of HIV and childhood trauma in South African women. The present study focused on the neurocognitive effects of HIV infection and childhood trauma, both separately and in combination in South African women. The primary aim of the study was to assess neurocognitive functioning in HIV-positive and matched HIVnegative controls, with and without a history of childhood trauma. Moreover, the study sought to assess the synergistic relationship between HIV and childhood trauma in influencing neurocognitive outcomes, a relationship which has not yet been investigated. A neuropsychological battery sensitive to HIV-related impairments was administered to 83 HIV-positive and 47 matched HIV-negative women with histories of childhood trauma. A history of childhood trauma was assessed using the Childhood Trauma Questionnaire short form (CTQ-SF). Forty eight of the 83 HIV-positive women were exposed to childhood trauma. Among the control subjects, a total of twenty women were exposed to childhood trauma. Findings of the present study revealed neurocognitive deficits in memory and executive functions. Results demonstrated significant HIV effects in memory (HVLT-R learning and delay trials), and executive functions (Halstead Category test). Similarly, a trauma effect was evident in delayed recall (HVLT-R delay). Moreover, results revealed a significant interaction effect between HIV status and trauma status on the WAIS-III Symbol Search Task, a task of psychomotor speed. However, HIV-negative controls with a history of childhood trauma scored the highest on this task. Although this finding was unexpected, it may suggest that psychomotor speed may not be a sensitive or discriminating test of childhood trauma in healthy adults. The present study demonstrated evidence for HIV and trauma effects in the ability domains of learning and delayed recall and executive functions. Although the present study did not find evidence for a synergistic relationship between HIV and trauma, it did provide evidence for both HIV and trauma effects on neurocognition, a finding in keeping with previous studies. Future research should be prospective in nature and should better delineate the nature, severity, and temporal relationship of childhood trauma to neurocognitive outcomes, as well as the mediators and moderators of these outcomes. / AFRIKAANSE OPSOMMING: Dit is alombekend dat Suid-Afrikaanse vroue buite verhouding swaar deur MIV/vigs en geslagsgebaseerde geweld getref word. Navorsing tot dusver lewer bewyse van neurokognitiewe verswakking by individue met MIV/vigs sowel as individue wat vroeg in hulle lewe reeds trauma ervaar het. Tog is daar steeds vele gapings in ons kennis oor die neurokognitiewe profiel met betrekking tot MIV en kindertrauma onder Suid- Afrikaanse vroue. Hierdie studie konsentreer op die neurokognitiewe uitwerking van MIV-infeksie en kindertrauma, afsonderlik sowel as gesamentlik, op Suid-Afrikaanse vroue. Die hoofdoel van die studie was om neurokognitiewe funksionering by MIV-positiewe vroue te bepaal en dit met gepaste MIV-negatiewe kontrolepersone te vergelyk, met én sonder 'n geskiedenis van kindertrauma. Daarbenewens wou die studie die sinergistiese verwantskap tussen MIV en kindertrauma in hul impak op neurokognitiewe uitkomste bepaal – 'n verwantskap wat tot dusver nog nie ondersoek is nie. 'n Neurosielkundige toetsbattery wat gevoelig is vir MIV-verwante swakhede is onder 83 MIV-positiewe vroue en 47 gepaste MIV-negatiewe kontrolepersone met 'n geskiedenis van kindertrauma afgeneem. 'n Geskiedenis van kindertrauma is met behulp van die kort weergawe van die kindertraumavraelys (CTQ-SF) vasgestel. Agt-en-veertig van die 83 MIV-positiewe vroue is as kinders aan trauma blootgestel. Van die kontrolegroep het 20 vroue in hul kindertyd trauma beleef. Die studie het neurokognitiewe tekorte in korttermyngeheue én uitvoerende funksies aan die lig gebring. Die resultate het 'n beduidende MIV-verwante uitwerking op korttermyngeheue (hersiene Hopkins- verbale leer-en-vertragingstoets, oftewel HVLT-R) sowel as uitvoerende funksies (Halstead-kategorietoets) getoon. Eweneens het die studie op 'n duidelike traumaverwante uitwerking op herinneringsvermoë (HVLT-R-vertraging) gedui. Daarbenewens het die WAIS-II- (Wechsler-volwassene-intelligensieskaal) simboolsoekopdrag – 'n psigomotoriese spoedtoets – 'n beduidende wisselwerkingseffek tussen MIV-status en traumastatus getoon. Tog het MIV-negatiewe kontrolepersone met 'n geskiedenis van kindertrauma die beste in hierdie opdrag gevaar. Hoewel hierdie bevinding verrassend was, kan dit daarop dui dat psigomotoriese spoed dalk nie 'n gevoelige of diskriminerende toets van kindertrauma by gesonde volwassenes is nie. Die studie het bewys gelewer van MIV- en traumaverwante uitwerkings op korttermyngeheue en uitvoerende funksies. Hoewel die ondersoek nie bewyse van 'n sinergistiese verwantskap tussen MIV en trauma kon vind nie, het dit wél bevestig dat MIV en trauma neurokognitiewe werking beïnvloed – 'n bevinding wat in pas is met vorige studies. Toekomstige navorsing behoort ondersoekend te wees en die aard, felheid en tydgebondenheid van die verwantskap tussen kindertrauma en neurokognitiewe uitkomste, sowel as die mediator- en moderatorveranderlikes van hierdie uitkomste, beter te omskryf.

MA, Faculty of Humanities (Social Anthropology), University of the Witwatersrand, 2001

HN/AIDS in South Africa has grown to very serious proportions. An estimated number of 5.3million South Africans are infected with HIV and the majority of these infections are in the reproductive age group. Based on Annual Antenatal survey 2002,of the total 2.95 million were women aged 15-49, with an estimation of 91271 babies infected through mother to child transmission. Breastfeeding is said to be an ideal food for growth and development of a child. Given that HIV is transmissible through breastfeeding, the paper aims at examining patterns and attitudes towards breastfeeding in the era of HIV/AIDS. A total of 400 respondents drawn from Mafikeng district were interviewed. The majority were aged 20-39, never married, rural, unemployed with high school level of education. Areas of interest were knowledge about HIV/AIDS, patterns of breastfeeding and attitudes towards alternative methods of infant feeding for an HIV positive mother. Previous reports gave clarity to HIV transmission rates at various stages of life. Evidence has shown that rates of transmission are higher in early stages than late stages of life. Few weeks of life from 6-8 weeks may particularly be a period of high risk than ages above three months. Transmission might have occurred during pregnancy, labor or through breastfeeding, whereby data has shown that colostrums have high concentration of Human Immune Virus than mature milk. The study shows that breastfeeding is still regarded as an important infant feeding method that is ideal for child's growth and development but HIV infection is seen as a disturbing factor to successful breastfeeding. Fifty four percent of respondents did not breastfeed exclusively as promoted by UNICEF and WHO; mean duration for exclusive breastfeeding is two months, support is given by SADHS 1998, mean duration for complementary feeding is two months which gives an indication that more infants are at higher risk of contracting the virus should their mothers test positive which in turn gives rise to high infant /childhood morbidity and mortality rates. There is a need to strengthen and expand programmes such as VCT and PMTCT in all communities especially in rural setting where there is lack of pure water supply and proper sanitation. Efforts to reduce the risk of transmission should therefore be centered on promoting the understanding that mixed feeding or breastfeeding with supplementary feeding carries the highest risk of HIV transmission compared to exclusive breastfeeding or exclusive formula feeding. / Thesis (M.Soc.Sc. (Population Studies) North-West University, Mafikeng Campus, 2004

This study deals with the impact of HIV/AIDS on women living in chronic poverty. The question arises: Do we focus on their HIV/AIDS stories only or do we include their other lived experiences? This phenomenological study, on two sets of three generations of women infected and affected by HIV/AIDS and living in poverty, is an attempt at understanding the way the women experience their lifeworlds, not only their HIV/AIDS stories. One set includes a grandmother, her daughter who is living with full-blown AIDS, and her granddaughter, while the other includes a grandmother, her daughter and her granddaughter infected with HIV. The initial focus of the study was on the women’s HIV/AIDS narratives. However as the study progressed, especially during the interviews, it became apparent that the women’s generational poverty or chronic poverty was of greater concern to them than the HIV/AIDS that they were experiencing. Of the six participants, only one woman centred her life story on HIV/AIDS. This finding echoes other studies on HIV/AIDS among poor women: that chronic poverty is more threatening to the women than the risk or reality of AIDS. As a phenomenological researcher my aim was to focus on the participants’ own interpretations of the studied phenomenon. However, this was inadequate in accounting for the role that social structures play in shaping and informing the women’s subjective consciousness and experience. For this reason, I used feminist ideas to understand and interpret the women’s patriarchal experiences.

Thesis (MA)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: The HIV/AIDS pandemic is steadily growing throughout the world. Global estimates have revealed that forty million people are living with HIV/AIDS. Approximately 5.3 millions South Africans have been indicated to be living with the illness and within South Africa HIV/AIDS is having catastrophic effect. The burden of the HIV/AIDS epidemic has not fallen evenly. In South Africa, African women have borne the brunt of the illness. This study presents a focus on developing more effective ways of caring and therefore impacting the health of Black South African women living with HIV. Social support understood broadly as different aspects of relationships in which needs are met and individuals feel cared for, loved and valued (Cobb, cited in Friedland, McColl, & Renwick, 1996) was indicated as having a powerful impact on health. For this reason social support was considered crucial in the development of effective strategies of care. Studies examining the role of social support in the management of chronic illness such as HIV/AIDS underscore the ability of social support to provide a sense of health within illness. From within a South African context, however, a gap in social support research has been apparent. Although frameworks for understanding social support as a broad concept were available, social support research failed to provide adequate foundations for understanding social support in terms that could implicate strategic intervention and contribute to the development of more effective strategies of care. The aim of this study was to develop a deeper understanding of the lived experience of social support for a sample of nine Black South African women living with HIV. The study was conducted qualitatively within a phenomenological paradigm. A phenomenological paradigm encouraged participants, through in-depth interviewing, to provide information based on their own lived experiences of social support. The interviews were then transcribed and analysed using rigorous data analysis methods. Initial findings were presented to the sample and then developed further. Final findings were written up as rich descriptions of the lived experience of social support for the sample. Fourteen themes emerged as comprising constituent aspects of social support. Descriptions of the fourteen themes, including health care professionals, partners, family/children, support groups, meeting others needs, story telling, Memory Box Project, media and books, organisations within the community, activities, the community, being involved in research and spirituality, provide rich understandings of the interpersonal relationships constituting the lived experience of social support for the sample. A polarity was identified in the lived experience of social support. Interactions had the potential to be satisfactory and supportive as well as non-supportive. The research findings are discussed within a greater theoretical body of knowledge and considered in light of three contexts considered influential in impacting the lived experience of social support. The study assisted in the development of a culturally contextual understanding of the lived experience of social support. This understanding has implications for effective intervention strategies seeking to purposefully care for those living with HIV in South Africa / AFRIKAANSE OPSOMMING: Die MIV/vigs-pandemie neem wêreldwyd steeds toe. Internasionale beramings dui daarop dat sowat 40 miljoen mense tans met MIV/vigs saamleef. Altesame 5,3 miljoen Suid-Afrikaners ly na raming aan die siekte en dit het ’n katastrofiese uitwerking. Wat bevolkingsgroepe betref, is die siekte egter nie eweredig versprei nie. In Suid-Afrika is dit die swart bevolkingsgroep, en in die besonder die swart vrou, wat die meeste deur die siekte geaffekteer word. Hierdie studie fokus op die potensiële ontwikkeling van doeltreffender versorgingsmetodes wat dan ook die lewensgehalte sou kon verbeter van swart Suid-Afrikaanse vroue met MIV/vigs. Sosiale steun het ’n sterk invloed op gesondheid. Hierdie steun verwys na die verskillende aspekte van verhoudings wat geaffekteerde individue vervuld, versorg en gelief laat voel (Cobb soos aangehaal in Friedland, McColl, & Renwick, 1996). Daarom word sosiale steun as belangrik beskou in die ontwikkeling van doeltreffende versorgingstrategieë. Verskeie studies oor die rol van sosiale steun in die bestuur van chroniese siektes soos MIV/vigs, bevestig dat sosiale steun ’n deurslaggewende rol speel in die vestiging van ’n gevoel van gesondheid binne ’n siektetoestand. Binne die Suid-Afrikaanse konteks blyk daar egter ‘n gebrek aan navorsing te wees wat betref die rol van sosiale steun. Hoewel daar wel werk beskikbaar is wat die rol van sosiale steun as ’n breë konsep verklaar, bied navorsing op hierdie gebied nog nie ’n geskikte grondslag vir ’n beter begrip van sosiale steun wat betref strategiese intervensie en die bydrae wat dit kan lewer tot doeltreffender versorgingstrategieë nie. Die doel van hierdie studie was om ‘n groter begrip te ontwikkel vir sosiale steun soos beleef deur ’n steekproef van nege swart Suid-Afrikaanse vroue met MIV. Dit studie is kwalitatief uitgevoer vanuit ’n fenomenologiese paradigma. Deur die voer van diepte-onderhoude binne hierdie fenomenologiese paradigma is deelnemers aangemoedig om inligting te verskaf oor hulle eie ervaring van sosiale steun. Die onderhoude is vervolgens getranskribeer en geanaliseer deur middel van streng data-analise-metodes. Daar is terugvoering oor die aanvanklike bevindinge gegee aan die vroue in die steekproef en die data is hierna nog verder ontwikkel. Die finale bevindinge is in die studie weergegee as ’n omvangryke beskrywing van die steekproef se deurleefde ervaring van sosiale steun. Veertien temas is geïdentifiseer wat kernaspekte van sosiale steun omvat. Hierdie temas sluit onder meer in gesondheidsorgwerkers, metgeselle, familie/gesinne/kinders, steungroepe, behoeftevoorsiening, die vertel van stories, die "Memory Box"-projek, die media en boeke, gemeenskapsorganisasies, aktiwiteite, die gemeenskap, betrokkenheid by navorsing, en geesteslewe. ’n Beskrywing van die veertien temas het bygedra tot ’n veel groter begrip van die interpersoonlike verhoudings wat deel uitgemaak het van die deelnemers se beleefde ervaring van sosiale steun. Daar is egter ’n polariteit geïdentifiseer ten opsigte van hierdie beleefde ervaring van sosiale steun. Dit het geblyk dat interaksie potensieel bevredigend en ondersteunend van aard kan wees, maar ook afbrekend. Die navorsingsresultate is verder bespreek binne ‘n uitgebreide teoretiese kennisraamwerk en is beskou in die lig van drie kontekste wat as belangrik geag word betreffende die invloed daarvan op die beleefde ervaring van sosiale steun. Hierdie studie het bygedra tot die ontwikkeling van groter begrip binne kulturele konteks vir die beleefde ervaring van sosiale steun. Hierdie begrip is belangrik vir doeltreffende intervensie.

Assignment (M. Div.)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: HIV/AIDS has a great impact on lives of all South Africans – but especially on women. HIV/AIDS also presents the greatest threat and danger to the ones living in poverty and without sufficient education and independence in relationships –that mostly includes South African women. In a first chapter I will discuss the connection between poverty and HIV/AIDS as well as between HIV/AIDS and the status of women in South Africa. In a second chapter I want to discuss a feminist ecclesiology of memory and hope and how it is presented by the catholic feminist theologian Elizabeth A. Johnson. In a third chapter I want to use the feminist ecclesiology of memory and hope to link it with the context of South Africa. In that last part I want to give a framework of the effect that a feminist ecclesiology of memory and hope could have on the South African society. / AFRIKAANSE OPSOMMING: HIV/VIGS het 'n groot impak op die lewe van alle Suid-Afrikaners - veral op die lewens van vroue. HIV/VIGS is ook een van die grootste bedreigings en gevare vir mense wat in armoede leef en geen toegang het tot voldoende onderrig en onafhanklikheid in verhoudings nie. Vroue word weereens die meeste geimpakteer. In die eerste hoofstuk sal ek hierdie verhouding tussen armoede en HIV/VIGS bespreek sowel as tussen HIV/AIDS en die status van vroue in Suid-Afrika. In die tweede hoofstuk wil ek die boek aangaande ’n feministiese ekklesiologie deur die katolieke feministiese teoloog Elizabeth A. Johnson bespreek. In die derde hoofstuk wil ek hierdie feministiese ekklesiologie van herinnering en hoop gebruik en dit toepas op die konteks van Suid-Afrika. In die laaste hoofstuk wil ek 'n raamwerk oor die effek wat hierdie feministiese ekklesiologie van herinnering en hoop op die Suid-Afrikaanse gemeenskap kan hê, weergee.

The dissertation seeks to investigate, examine, and critically analyse the reasons why Pietermaritzburg churches lack gender sensitivity in combating HIV/AIDS. The dissertation's focus is on Springs of Hope Support Group Project (SOH) - a support group that seeks to meet the felt needs amongst the HTV positive people around Pietermaritzburg. Amongst other motivations, the dissertation was undertaken as a contribution to the church in its fight against the spread of HIV/AIDS in South Africa. The methodology that was used involved field and library research as well as observations of other HIV/AIDS support groups. The primary source of this dissertation consists of interviews that were conducted among SOH members, NGOs workers, and Church ministers. Chapter one is an introduction to the whole dissertation and includes an introduction to chapter one, experiences of African women, the story of Ann Ntombela, the background of the study, statements of the problems and motivations, objectives of the study, research hypothesis/promises, significance of the study, the theoretical frameworks, critical reviews of existing literature, research methodology, research ethics, expected results, limitation of the study and a summary and conclusion. Chapter two deals with the negative effects of colonialism and failure of development on African women. Its objective is to unearth the factors behind the deplorable social, political, and economic position of African women before HIV was reported. It seeks to find out why the plight of African women has worsened since the coming of colonialism and the start of development efforts. Chapter three deals with gender. It relates the effects of development failure to the plight of African women. Matters of marginalization, exploitation and oppression of African women are dealt with at length. Chapter four focuses on HIV/AIDS infection, transmission, prevention, cure and treatment. It also tackles the matter of the vulnerability of African women to HIV/AIDS at length by relating chapter two to the realities that facilitates the infection of the virus especially on women. Chapter five deals with the field research and formulation of a gender sensitive approach to combating HIV/AIDS. It also seeks to formulate 'a church based gender sensitive approach' as the way forward in combating the spread of HIV/AIDS amongst African women in Pietermaritzburg. This chapter elaborates on how the church should reposition itself in order to be relevant and effective to women who are HIV positive. Chapter six is the conclusion of this dissertation. It includes a summary, a theological reflection and conclusion of the whole dissertation. / Thesis (M.Th.)-University of KwaZulu-Natal, PIetermaritzburg, 2004.

This study explored and described the strategies used by nurses to manage newly diagnosed HIV positive pregnant women who do not return to the clinic within a month following diagnosis, for continuity of care. The main aim was to prevent mother-to-child transmission of HIV (PMTCT). Method: The study sites were two accredited antiretroviral- ante-natal care (ARV-ANC) clinics at the Dimbaza community health centre (CHC) and the East London Hospital Complex (ELHC) which comprises of Cecilia Makiwane and Frere hospitals, in the Buffalo City Metropolitan Municipality (BCM). The majority of health personnel at these clinics are professional nurses. An in-depth semi structured interview guide was used to collect data through focus group interviews from professional nurses who work in these units. They were required to share their experiences about intervention strategies used for newly diagnosed HIV- positive, pregnant women who fail to return for continuity of care within a month after diagnosis. Results: Follow up of these women is done by tracking them (by calling them; calling the clinic nearest to their homes and doing home visits). Decentralisation of further management and care to the nearest clinic was also cited, especially for the patients who stay far from these accredited sites. Family support was also mentioned as a strategy to intervene for the non-compliant patients. Challenges: The challenges that were encountered with these interventions include wrong contact details, wrong addresses and being evasive when visited at home. Another challenge cited was related to the stigma attached to the diagnosis and the tracking devices used, for example, the car as it is familiar to the community it serves. Despite known benefits for early initiation of HIV treatment newly diagnosed HIV- positive, pregnant women continue to refrain from accessing care after diagnosis, thus posing a risk to the transmission of HIV to the baby and further comprising their own health. They miss out on general HIV management and ante-natal care. Conclusion: The identified intervention strategies used by nurses to follow up newly diagnosed HIV- positive, pregnant women need to be reinforced and strategies put in place to control the related challenges for a better response by the patients.

Department of Advanced Nursing Science / MCur

This qualitative study aimed to explore and describe the experiences of women living with HIV and Aids in Centurion, Gauteng Province. The study was conducted at Lyttleton clinic and 12 women living with HIV and Aids were selected for the study using a non-probability, purposive sampling technique. In-depth, individual semi-structured interviews were used during data collection. A thematic content approach in data analysis yielded the following main themes: experience of being diagnosed HIV positive, disclosure of an HIV positive status, physical signs and symptoms of HIV and Aids, stigma/ emotional stress well experiences in services rendered. The study highlighted the need for a well-established health system, assisting women living with HIV and Aids on how to cope and to raise awareness on HIV and Aids. / Health Studies / M. A. (Public Health)