Acquired immunodeficiency syndrome (AIDS) remains an epidemic illness with no known cure. Survival time after infection with the human immunodeficiency virus (HIV), has been lengthened considerably. Rates of new infection among the at-risk male homosexual populations have decreased. Prevention is possible through effective, targeted interventions. This study is an exploration of the role or health locus of control, an individual difference construct from the area of social learning theory, in the maintenance of health-oriented behaviours, co-risk indicative behaviours, and high-risk behaviours in a population of adult male homosexuals attending a general medical clinic. The findings result in distinctly different past histories and present patterns of homosexual behaviours among the two serostatus subpopulations. Low internal expectancy of control over health repeatedly relates in distinctive patterns with the areas of level of happiness, condom usage, and hish-risk sexual behaviours. High internal expectancy of control relates significantly to knowledge-related variables. The physician plays a pivotal role as the source of useful information in this at-risk population. The study population as a whole reports accurate knowledge about HIV and AIDS. The men have reduced high-risk behaviours, increased safer sexual behaviours, and implemented the changes advocated. Serostatus differentiates for many high-risk behavioural patterns. There remains a small core of men among the study participants who continue to participate in high-risk sexual behaviours.

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Infection with the human immunodeficiency virus (HIV) is a major cause of morbidity and death globally, and the number of individuals infected with this virus is increasing in many nations. Advanced HIV infection causes immunocompromise that predisposes to opportunistic infections and malignancies that characterise the acquired immunodeficiency syndrome (AIDS). Although the management of many of these AIDS-associated infections and malignancies is by medical means, surgeons play an important role the diagnosis and management of many of these conditions. Furthermore, patients with HIV infection may present with surgical disorders or traumatic injuries that are not related to HIV or AIDS. Health care workers managing patients with HIV infection and AIDS, particularly those involved in performing invasive procedures, are at risk of exposure to this virus in infected blood and body fluids. St. Vincent's hospital, Sydney, is a teaching hospital and major treatment centre for patients with HIV infection and AIDS located in the inner-eastern suburbs of Sydney. Patients with HIV infection who underwent surgical procedures at St. Vincent's hospital during the period 1990 to 1999 were retrospectively reviewed in order to describe the nature of the operative procedures required in the management of these patients. There were 636 patients with documented infection with HIV who underwent 889 surgical procedures at St. Vincent's hospital during the period 1990 to 1999. The number of procedures performed for patients with known HIV infection was increasing during this period. Patients with HIV infection accounted for 1.1% of all surgical procedures performed at this institution during this period. The proportion of total operative cases that patients with known HIV infection represented was seen to be increasing during this period. Surgical procedures were performed during only a small proportion of admissions of patients with HIV infection to St. Vincent's hospital for this period (2.4% of these admissions). The patients were predominantly males in younger age groups. Anorectal procedures for the local treatment of benign conditions were the most common procedures performed for these patients, followed by procedures for the insertion or removal of long-term vascular access devices and other minor general surgical procedures. A large proportion of procedures were performed as day surgery cases (30%). Only a small proportion of cases were for the management of traumatic conditions (3%). A large proportion of patients with HIV infection (26%) underwent more than one procedure during this period, with anorectal disorders a common cause of repeat surgical admission. The operative findings after 498 surgical procedures performed for 360 patients with documented HIV infection during the period 1995 to 1999 were retrospectively reviewed. The number of cases in which AIDS-defining conditions were encountered were recorded, and varied according to the types of procedures performed. Overall, seventy AIDS-defining conditions were found at operation during sixty-five procedures (13% of all procedures for patients with HIV infection). Non-Hodgkin's lymphoma was the most frequently encountered AIDS-defining disorder found at operation, accounting for 41% of such conditions. Kaposi's sarcoma was the next most frequently encountered condition, accounting for 20% of cases followed by cytomegalovirus infection (11%). Procedures in which AIDS-defining conditions were commonly encountered included neurosurgical procedures (20 of 36 procedures were for AIDS-defining conditions), particularly stereotactic brain biopsy. Lymph node excision biopsies had AIDS-defining pathologies seen in 18 of 26 cases, particularly non-Hodgkin's lymphoma. AIDS-defining conditions were diagnosed in only 4% of anorectal procedures, with anal squamous cell malignant lesions a far more frequently observed disorder (diagnosed in 11% of cases). The clinical details of all patients who met the clinical criteria for AIDS who underwent midline laparotomy at St. Vincent's hospital during the period 1987 to 1998 were retrospectively examined. Thirty patients with AIDS underwent thirty laparotomies during this period. AIDS-defining conditions were found at fourteen procedures (47%). Non-Hodgkin's lymphoma was found in eleven of these laparotomies, Kaposi's sarcoma in two and cytomegalovirus in one. In nine of the patients with AIDS-defining conditions, the post-operative diagnosis was different to that expected pre-operatively. Patients with AIDS-defining conditions found at laparotomy had significantly lower serum albumin concentrations and body weight compared with those with more conventional surgical diagnoses. There was no difference in CD4 T-lymphocyte counts, the number of patients with a history of AIDS-defining conditions or the duration of HIV infection between these two groups. Patients with AIDS-defining conditions diagnosed at laparotomy required significantly longer post-operative hospital stays compared to those with other causes, although there was no difference in the incidence of post-operative complications or deaths occurring in these two groups. There was a high number of patients with post-operative complications seen after laparotomy (thirty-two complications in twenty-one patients; 70% of all patients). Chest infections, systemic sepsis and wound infections were the most frequently encountered post-operative complications. Five deaths occurred within thirty days of operation (17% of patients), and were due to overwhelming systemic sepsis in four cases and from blood loss and coagulopathy in one. The number and the nature of the complications and deaths occurring in patients with AIDS undergoing laparotomy at St. Vincent's hospital is in keeping with previously published reports from other centres. The clinical details of patients with documented HIV infection who underwent biliary tract procedures at St. Vincent's hospital during the period 1989 to 1998 were retrospectively reviewed. Eighteen patients with HIV (fourteen of which met the clinical criteria for AIDS) underwent cholecystectomy; ten for cholecystitis secondary to gallstones, one for mucocoele of the gallbladder due to obstruction of the cystic duct by a gallstone and seven for acalculous cholecystitis. Biliary tract procedures accounted for 24% of all abdominal procedures during this period. Patients were mostly male and in a relatively young age range. Cytomegalovirus infection was found in five cases of acalculous cholecystitis, Cryptosporidia in five and Microsporidia in two. A significantly greater proportion of patients with acalculous cholecystitis had a history of AIDS, and these patients had lower CD4 T-lymphocyte counts, compared with those patients with cholelithiasis. There was no statistical difference in the length of hospital admission or number of complications occurring in these two groups. Patients who had cholecystectomy performed as an elective procedure (n=7) were compared with those who had this procedure performed during admission for acute cholecystitis (n=11), and had a significantly lower duration of post-operative hospital stay. There was no difference in the number of complications occurring in these two groups. Laparoscopic cholecystectomy was performed in eight patients, and was not associated with a significant difference in hospital admission duration or incidence of complications when compared with the ten patients who underwent open cholecystectomy. The medical records of all patients presenting to St. Vincent's hospital during the period 1994 to 1998 with major penetrating wounds (gunshot wounds and stab wounds to the trunk or neck) were retrospectively examined to determine the number of such patients with a documented history of infection with HIV or hepatitis C virus (HCV), or with risk factors for these infections. Of the 148 patients with major penetrating wounds who were managed at St. Vincent??s hospital during this period, 5.4% had documented infection HCV and 1.3% with HIV. Risk factors were documented in thirty-one individuals (21%), with injecting drug use the most commonly recorded (19%). Individuals infected with HIV represent a substantial workload for surgical specialists at St. Vincent's hospital. Surgical procedures were an uncommon cause of admission for patients with HIV infection, but were important in the diagnosis and management of many AIDS-associated conditions and were increasing in number. AIDS-defining conditions accounted for only a small proportion of operative interventions in patients with HIV infection. Surgical procedures required in the management of patients with HIV infection encompassed a broad range of surgical specialties and types of procedures. AIDS-associated opportunistic infections and malignancy were frequently the cause of abdominal procedures in patients with HIV and AIDS. The number of patients with known HIV infection who present for elective and emergency surgical procedures, as well as the high prevalence of documented HIV and HCV in patients with major penetrating wounds at St. Vincent's hospital, reinforces the need for all health care workers to practice strict universal precautions against body fluid exposure at all times.

This study explored the relationship between perceived familial support to self-esteem in gay and bisexual men along a continuum of infection with the AIDS virus. Subjects were primarily obtained from two HIV/AIDS care coordination, education and social support centers. All participants completed the Coopersmith (1967) Self-Esteem Inventory, the Perceived Social Support-Family (PSS-Fa) questionnaire by Procidano and Heller (1983) and a demographic questionnaire. Two hypotheses were proposed: 1) Self-esteem will increase with strength of perceived Perceived Familial Support familial support. 2) Self-esteem will decrease as the stage of HIV infection worsens. Significant support was found for the first hypothesis. The second hypothesis was not supported; however, some reasons are postulated. The continuum of HIV infection and self-esteem as it relates to stages of death and dying are discussed. Implications and suggestions for counseling HIV-infected persons are addressed. / Department of Counseling Psychology and Guidance Services

D.Cur. (Psychiatric Nursing) / Malawi has a population of 9 million people with AIDS the leading cause of death in the age group of 20 • 40. The HIV prevalence rate, estimated at 23% in urban areas and 8% in rural areas, is one of the highest in the world (AIDSEC, 1994: I). Evaluation of counselling practices showed poor results with counsellors feeling ineffective and inadequate. Patients are mostly tested on medical indication but testing is increasingly refused by patients who do not see the benefit of knowing their HIV status. The counselling practice as it is known in the Western world is a foreign concept for patients living in rural Malawi. The high stigma of AIDS complicates support of the patients. The goal of this research study is to describe a model of counselling that would meet the needs of an AIDS patient in a rural community in Malawi. A qualitative research design that is explorative, descriptive and contextually specific to rural Malawi was used for the study. In order to describe a counselling model it was important to understand the illness experience of HIV reactive patients. The patients are seen in group context congruent with the African culture and therefore the experience of the primary care giver of AIDS patients is also examined. The experience of counsellors of AIDS patients is explored as the other major factor in the phenomenon examined. In the first phase of the study in-depth phenomenological interviews were conducted with identified groups. Focus interviews were conducted with a hundred AIDS patients to identify the needs and resources of the patients and to compile a demographic profile. Focus group discussions were conducted with counsellors for more complete comprehension. Data analysis and a literature control were undertaken. In the second phase of the study theory generation was used in order to develop a counselling model for AIDS patients and guidelines for implementing the model were generated. Based on the results of the analysis the major concept enable was identified as the essence of a model for counselling AIDS patients in rural Malawi.

It is an accepted practice in any business organisation that the opportunities and threats facing organisations must be examined and plans drawn up to take advantage of the opportunities and to deal effectively with the treats. Surely HIV/AIDS is one of the greatest threats and challenges that organisations in South Africa are facing. The study is an exploratory research into an important issue facing many organisations today and is adequately supported by a proper and detailed literature study supported by an empirical study on the relevant research topic. A number of interviews were also conducted to determine what specific viewpoints, suggestions and limitations there were, or could be, toward the evaluation of existing structures and strategies and what alternative actions could be used and implemented, to effectively manage as well as control the disease and its various impacts within the workplace. The literature review within the scope and limitations of the study, therefore, concentrated on the specific nature and various impacts of AIDS as a starting point, followed by a detailed investigation why organisations need to implement sufficient action programmes, policies and strategies. The reality is that AIDS know no gender, race or class boundaries but is actually influenced by socio-economical factors such as poverty, violence and rapid urbanisation, with the potential to disrupt economic stability and growth for the country. The empirical part of the study consisted of a questionnaire that was completed by various respondents (organisations) which included a minimum number of 500 employees and more within the area of study. The objective was to establish if current structures within organisations, are effective and suitable enough or lacking. The research finding clearly indicated the various impacts that organisations are currently facing and what specific action programmes, policies and strategies needs to be implemented. It was the intention of this study to cover a wide variety of aspects related to the impact of AIDS within the workplace, so that proper insight and clear understanding of the epidemic and its nature could be formulated with all its facets and various impacts on the organisation land its resources. / Thesis (DCom (Business Management))--University of Pretoria, 2001. / Business Management / unrestricted

published_or_final_version / Social Work / Master / Master of Social Work

Thesis (Ph.D.(Educational Psychology)) --University of Limpopo, 2015. / The aim of this study was to adapt an HIV and AIDS intervention programme that may change the knowledge, attitudes and behaviour of adolescents in Mpumalanga high schools. Mixed-method of qualitative and quantitative designs were used to achieve the objectives. The qualitative design consisted of peer mentors (N=141) who were interviewed in the focus group to provide information pertaining to the HIV and AIDS intervention that may change the knowledge, attitudes and behaviour of vulnerable adolescents in Mpumalanga high schools. The quantitative design consisted of Grade 8 learners (N=1 085) who were used in the evaluation of the adapted HIV and AIDS intervention. Eeducators (N=11) piloted and monitored the administration of the adapted HIV and AIDS intervention. Results from the qualitative study suggested a four unit HIV and AIDS intervention programme with the following aims: (a) to empower adolescents to respond to risky behaviours, (b) to enable adolescents in Mpumalanga to acquire necessary knowledge, attitudes and skills that will protect adolescents from HIV and AIDS infection, (c) the programme must also aim at the development of self-in-society and (d) an abridged programme that will run for one school term that is more suitable. Results from quantitative evaluation revealed that the adapted HIV and AIDS intervention managed to increase, slightly, the acquisition of the knowledge and behaviour of participants, although the significant tests indicated that the observed rate of increase was statistically not significant at 0.05 levels. No impact was found on attitudes scales. It was recommended that the support of both adolescents and parents is vital for the success of any of any HIV and AIDS intervention programme. Opening of the community youth friendly health clinics with highly trained practitioners was also recommended as an essential element in HIV and AIDS prevention. Key concepts: Adolescents, Attitudes, Behaviour, HIV and AIDS intervention, Knowledge and Knowledge attitudes-behaviour practices.

The aim of the study was to explore nurses' experiences, attitudes and perceptions regarding the care of patients with the Acquired Immunodeficiency Syndrome (AIDS) before and after the introduction of Anti-Retroviral Therapy (ART) in a rural KwaZulu-Natal hospital .. A secondary aim was to investigate psychosocial stressors that nurses experience and the support they receive in this regard. A qualitative study was conducted and three focus group discussions were conducted before the introduction of ART and five individual interviews were used for in-depth exploration of the health care workers' perceptions of caring for AIDS patients after the introduction of ART. Special attention was paid to nurses' experiences with AI DS patient care and with attention to stress and coping. The AACN Synergy Model was used as a broad theoretical framework for the study to guide the exploration regarding the influence of both nurse and patient characteristics influence the care process within a rural South African context. The findings suggested that before the introduction of ARV-therapy most patients had limited knowledge and understanding of HIV/AIDS disease and its processes. They and other significant others who could be a family member or even friends were marginally involved in the care process. Voluntary Counseling and Testing (VCT) seemed to impact negatively on this situation, and patients were not willing to test and disclose their status to health workers. The knowledge around HIV/AIDS among nurses seemed to be inadequate due to the lack of support and training. They reported being inadequately equipped to deal effectively with caring for their AIDS patients. After the introduction of ARV-therapy, greater involvement of patients on ARV treatment was noted. The participation of significant others in patient management also improved possibly due to their involvement as treatment associates, a requirement of the ART programme. However, the nurses still reported inadequate knowledge not only around AIDS in general but also pertaining ART as well as in the provision of psychosocial support to their patients. The study also revealed that the Synergy Model for patient care, which compares the patient characteristics to nurse competencies can be used to gain insight into patient care and its demands. This model has also suggested weaknesses in nurses' training that need attention. Nurses are expected to use insight into patients needs to improve their competencies to meet the challenges of AIDS patient care and to fulfill their mandate as the key stakeholders on patient care. Lazarus and Folkman's (1984) views on stress and coping were useful in identifying the nurses' coping strategies. The study highlighted specific areas in need of intervention. Formal and informal teaching for both nurses and the patients on HIV and AIDS management needs to be introduced. Patients and families' involvement in decision making and HIV/AIDS disease management should be expanded. HIV counseling and all its components, which are pre- and post-counseling as well as on-going disease management counseling needs to be re-evaluated. There is a need to advocate for a more patient orientated counseling rather than test orientated counseling. Psychosocial support to nurses should be a priority to help them cope with their stressful AIDS caring work. Advocacy for a worker friendly Employee Assistance Program (EAP) should be encouraged by the managers of the institution. Intra-disciplinary and inter-disciplinary communication needs to be improved through innovative strategies. The address of the AI DS stigma within the healthcare system remains a priority and this aspect needs to be incorporated at different levels i.e. basic training, in counseling and within the psychosocial support efforts directed at nurses. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

This study examines the experience of individuals who participated or did not participate in the caregiving process for a family member who died within approximately the past three years of an AIDS-related illness. The focus of this study is on the adjustment of the caregivers and non-caregivers after the death of the PWA. It was hypothesized that due to their direct involvement in the caregiving process, caregivers would differ significantly from non-caregivers on a number of measures designed to evaluate adjustment. It was hypothesized that caregivers would report better overall adjustment than non-caregivers.Participants completed the Symptom Checklist 90 (SCL-90; Derogatis, Lipman, & Covi, 1973), as well as a semi-structured interview about their experiences. A two-tailed t-test revealed no significant differences between groups. However, effect sizes computed for these variables revealed moderate to large diff ererences between caregivers and non-caregivers on the somatization and interpersonal subscales of the SCL-90. Comparisons to a standardization sample showed that caregivers differed significantly on all subscales from that standardization sample: Non-caregivers differed only on the depression and interpersonal sensitivity subscales. Analysis of the interview data revealed a significant difference in reported stress, with caregivers reporting significantly more stress during the illness of the PWA than non-caregivers. Effect sizes were computed for nine other interview categories; these suggested that caregiversreported substantially less social withdrawal, fewer feelings of guilt, fewer problems resolving issues with the PWA, substantially more physical illness, and more life affirming statements than their non-caregiver counterparts. Several other noteworthy trends that emerged in the interview portion of the study are discussed.Small sample size and pre-existing characteristics of the participants are explored as possible factors affecting the outcome of the study. More controlled studies exploring the adjustment of caregivers and non-caregivers are needed in order to better understand the possible differences that may exist between caregivers and non-caregivers in terms of adjustment after the death of their loved one from an AIDS-related illness. / Department of Psychological Science