PhD (Microbiology) / Department of Microbiology / High genetic diversity is a major contributory factor in the development of drug resistance, in addition to challenges in diagnosis and treatment monitoring in the therapeutics of human immunodeficiency virus (HIV) .Within the wide HIV-1 diversity, differences in mutational frequency, disease progression, drug response and transmission amongst HIV-1 subtypes have been shown. In spite HIV-1 subtype C (HIV-1C) being the most prevalent variant globally, none of the available drugs nor screening assays for inhibitory molecules have been developed targeting the genetics of this important subtype. This study therefore aimed to overexpress and biophysically characterize HIV-1C reverse transcriptase and protease to serve as reagents in the development of assays for routine screening of molecules inhibitory to HIV-1C. Heterologous expression of HIV-1C reverse transcriptase and protease isolates that are prevalent in South Africa was carried out in Escherichia coli (E. coli (BL21-DE3). The secondary and tertiary structures of the proteins were determined using, circular dichroism (CD) and fluorescence spectroscopy respectively. Thereafter, interaction studies to delineate interaction properties of natural products for possible inhibition of protease were conducted. Furthermore, in silico studies to determine binding interactions, further confirmed by in vitro binding assays of a pepsin inhibitor homolog (Bm-33) from Brugia malayi , against protease were also conducted. Expressed reverse transcriptase and protease from the globally prevalent HIV-1C were shown to be structurally and functionally intact for application in downstream HIV-1 inhibition assays. Interaction studies on the other hand revealed successful inhibition of the expressed HIV-1C PR with gallotanin. Furthermore, binding interactions of Bm-33 and HIV-1 PR revealed the first intermolecular interactions of the two molecules displaying possible inhibition of HIV-1 PR / NRF

Thesis (Ph.D. (Social Work)) -- University of Limpopo, 2021 / Background information: Persistent poor health outcomes among People Living with HIV and AIDS (PLWH) is a concern for service users and the HIV care system. Since its discovery, different AIDS response strategies were implemented but the level of poor health outcomes among PLWH prompts the need for other dimensions in the AIDS response. Purpose: The purpose of this study was to explore and describe ‘lived experiences’ of PLWH in order to utilise their personal experiences to develop a user- led intervention model. Methods: From a phenomenological orientation, an in-depth interview was used to gather data from seventeen PLWH who are living in communities. Purposive sampling was used to locate the participants. The compiled data collected was then analysed using the Collaizzi’s seven-step data analysis strategy. This was followed by a focus group discussion session which was held with nine of the seventeen participants. Findings: The study found that communities’ meaning of HIV and AIDS is outdated as it is still loaded with stigma and discrimination. Consequently, it alienates PLWH living in communities, and thus compounds poor health outcomes among PLWH. Many PLWH view themselves through their communities’ meaning of HIV and AIDS. the shared meaning of HIV and AIDS by communities created a complex task for PLWH to reconcile their prior meaning of living with HIV and the ‘new’ meaning they acquired post-diagnosis. Due to this, many PLWH experience high levels of intrapersonal and interpersonal challenges. Intrapersonal challenges manifest as self and anticipated stigma while the interpersonal ones result in poor relationships in different setting. It was also found that the availability of antiretroviral treatment significantly changed the meaning of living with HIV and AIDS for many PLWH as it provided tangible medical support to mitigate the impact of HIV and AIDS. In addition, the availability of different types of social support from family and non-family sources reassured and gave them hope for a better life. However, the availability of medical treatment and social support could not completely buffer the intrapersonal and interpersonal challenges experienced by PLWH in their daily lives. They had to continually fight for their social space post diagnosis through activation of two major coping strategies, namely emotion and problem-solving focussed strategies. Significant features of these strategies are that they changed their thinking patterns and engaged in actual activities to improve the quality of their lives. Through these strategies, many PLWH attained relative post traumatic growth. This study found that through their lived experiences, they command personal competence to guide user-led HIV care interventions as they clearly articulated the design, content and approach for user-driven HIV care. Conclusions and recommendations: The psychosocial dimension of living with HIV and AIDS in HIV care is not adequate as many PLWH who are in care experience poor health outcomes long after they have been diagnosed until they received psychosocial support from other PLWH. On this basis, a psychosocial seven-step user-led intervention model was designed to provide psychosocial education, care and support to PLWH, families, support groups and community mobilisation for HIV care. The implementation of a true psychosocial user-led intervention model in the continuum of care which recognises the interaction between the three dimensions of the health condition should be located at the point of entry into HIV care to ensure timeous access by PLWH and their families.

In the context of HIV high infection rate in South Africa, an assumption can be made that there is a high prevalence of HIV-associated neurocognitive disorders or cognitive linguistic deficits. The aim of this study was to determine assess whether highly active antiretroviral therapy (HAART) affected the cognitive – linguistic abilities of individuals living with HIV and AIDS before and after HAART use; and to determine whether their functional performance in terms of engaging in activities of daily living was affected by HAART use. Adults living with HIV and AIDs were recruited through purposive convenience sampling to participate in the study. They were divided into three groups. The experimental and cross sectional group included participants who were HIV infected and initiated HAART. The comparison group included participants who elected not to start HAART. Participants in all three group were assessed using the Cognitive – Linguistic Quick Test and were also required to fill out a structured interview scale at baseline, four and eight months. For the experimental group 55 participants were tested at baseline, 55 at four months and 52 at eight months after HAART initiation. The comparison group included 21 participants who tested at baseline, ten at four months and nine at eight months. The cross sectional group included different participants who recruited at baseline (55) before HAART initiation, then again at four (44) and eight months (42) after HAART initiation. Descriptive analysis revealed that the mean scores for both the Cognitive – Linguistic Quick Test (CLQT) and the structured interview schedule (IS) in all the cognitive domains increased for all three groups from four and eight months after testing. However the severity ratings provided by the CLQT indicated that neurocognitive deficits were still prevalent among the participants after HAART intiation. The most impaired cogntive – linguistic ability was executive functions and the least impaired was language. One way ANOVA analysis on the CLQT and IS revealed that was a signiifcant difference in performance between the three groups at baseline, four and eight months. Repeated measures analysis revealed significant differences or improvements within participants across the three time periods. The greatest improvement was observed from baseline to eight months especially on the CLQT. ANCOVA analysis on the Cognitive- Linguistic Quick Test indicated that education had a major impact on cognitive – linguistic abilities followed by age and CD4 count. However, ANCOVA analysis on the structured interview scale revealed that the effect of time, participant group and to a lesser extent age influenced the participants cognitive – linguistic abilities when it came to perfroming activities of daily living. Quantitave inquiry using content analysis showed that participants in all three groups cited attention, followed by visual and language problems as hindering their abilities to perform activities of daily living. The implications from this study revealed that even though HAART improves cognitive –linguistic abilities, neurocognitive deficits were still prevalent. Therefore findings suggest that health professionals need to monitor the neurocognitive impairments of their patients so as determine levels of functional performance.

Background: The South Africa’s reproductive health policy put more emphasis on dual methods in preventing unwanted pregnancies, sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) transmission. Regardless of such policies, the uptake of voluntary counselling and testing (VCT) services remains a personal choice. Aim: The purpose of the study was to determine the accessibility, acceptance and utilisation of VCT services by women on hormonal contraceptives. Methods: About 134 women obtaining hormonal contraceptives were interviewed in a cross-sectional study. Descriptive and logistic regression analysis was applied to analyse the study data. Results: Respondents displayed positive attitudes towards Human Immunodeficiency Virus (HIV) testing. Unavailability and poor access to in-house VCT services was found to be a barrier for use of these services. Conclusion: There’s a need for provider initiated counselling and testing (PICT) strengthening and integration of VCT services into family planning. / Health Studies / M (Public Health) / 362.104256

Despite HIV and AIDS knowledge and attitude change programmes, workplace HIV and AIDS-related discrimination persists in workplaces in many sectors, including the education sector. This study set out to investigate why the phenomenon of workplace HIV and AIDS-related discrimination persists; and to predict which factors were responsible and how they related to HIV and AIDS-related discrimination in the workplace. A stratified random sample of 205 teachers; 123 of whom were from 10 schools of varied backgrounds in Bojanala Region of North West Province of South Africa and 82 from schools around Kampala, Central Region of Uganda was drawn. Twenty-seven respondents of the South African sample participated in both the quantitative survey and in-depth interview while the rest responded to a selfadministered questionnaire. Using a stepwise regression analysis, traditional beliefs predicted workplace HIV and AIDS-related discrimination, explained11% of variance in the second model while the third model explained only 2% more – 13% (R square of 0.136) but each of the three models was significant (p-values of 0.000). Attitudes were the second strongest predictor; and only HIV and AIDS-legal knowledge could predict discrimination but not biomedical HIV and AIDS knowledge. In the in-depth interview, incidents of discrimination were reported, possible reasons for HIV and AIDS-related discrimination were reported; and it was found that workers varied in ways of keeping secrets regarding sensitive information such as colleagues’ HIV-positive status, and cited reasons for revealing such information which included malice, jealousy, moral responsibility, anger and loose talks. There are implications for reducing workplace HIV and AIDS-related discrimination which include: Integrating HIV and AIDS-legal knowledge with biomedical HIV and AIDS knowledge, more efforts should be spent in designing and imparting information to reduce traditional beliefs, develop and evaluate instruments to measure traditional beliefs and HIV and AIDS-legal knowledge; and to study more about secret keeping, particularly in regard to workplace HIV and AIDSrelated discrimination. / Industrial & Organisational Psychology / D. Admin. (Industrial and Organisational Psychology)

The complex problems of the twenty-first century cannot be effectively addressed with twentieth century top-down bureaucratic governance alone because of limited stakeholder participation in collective decision making and/or implementation. The somewhat limited stakeholder participation in the policy process, especially, that of target populations, can impact generating viable solutions to complex problems. Collaborative governance has emerged as a promising alternative to traditional management in addressing contemporary complex problems. Collaborative governance is thus a type of governance that promotes joint participation of state and non-state stakeholders in decision making and/or implementation by using agreed upon processes of engagement to collectively address problems. Such governance is especially beneficial for addressing the challenges posed by the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). This dissertation uses the collaborative governance concept to explicate the efforts of HIV Health Services Planning Councils in Broward County and Palm Beach County of South Florida with the purpose of accentuating how collaborative governance works in providing various categories of services to meet the needs of people with AIDS (PWAs), as part of the implementation of the Ryan White CARE Act. The study focuses on critical variables of collaborative governance such as facilitative leadership and institutional design, the collaborative process variables such as trust building, commitment to the process and shared understanding, and outputs such as allocation priorities of the Councils. This study employed mixed methods in collecting data from various relevant sources. / The combined findings from surveys, interviews, observations and document reviews were essential to knowledge and understanding of collaborative governance of the respective Councils. The results revealed more similarities than differences between the Councils in their efforts towards addressing the HIV/AIDS problem. The Councils are similar in all variables of collaborative governance with few exceptions relative to facilitative leadership and institutional design. The differences were relative to membership, number of committees, amount allocated for various service categories and number of clients served. Furthermore, the Councils were slightly different in reaching consensus on subjects of deliberation. On the average, Palm Beach County's Council make decisions by consensus relatively easily when compared with the Broward County's Council. Nonetheless, both Councils are consensus-oriented and strive to make decision by consensus as evidenced by unanimous votes or simple majority votes on various subjects of deliberation. In addition, representation and participation of target populations in collaborative governance have contributed to the empowerment of those target populations. The study contributes to the literature by developing a conceptual model for HIV/AIDS collaborative governance for producing outputs to help meet needs of target populations. Also, the study contributes to collaborative governance theorizing by drawing a nexus between variables of collaborative governance and by complementing the existing non-linear perspective of collaborative process for collective problem solving. Collaborative governance involving state and non-state stakeholders thereby enhances efforts of public managers by harnessing resources to effectively manage and/or address complex problems for the benefit of society. / by James K. Agbodzakey. / Vita. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

Background: The South Africa’s reproductive health policy put more emphasis on dual methods in preventing unwanted pregnancies, sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) transmission. Regardless of such policies, the uptake of voluntary counselling and testing (VCT) services remains a personal choice. Aim: The purpose of the study was to determine the accessibility, acceptance and utilisation of VCT services by women on hormonal contraceptives. Methods: About 134 women obtaining hormonal contraceptives were interviewed in a cross-sectional study. Descriptive and logistic regression analysis was applied to analyse the study data. Results: Respondents displayed positive attitudes towards Human Immunodeficiency Virus (HIV) testing. Unavailability and poor access to in-house VCT services was found to be a barrier for use of these services. Conclusion: There’s a need for provider initiated counselling and testing (PICT) strengthening and integration of VCT services into family planning. / Public Health / M.P.H. (Public Health)

Stigma and discrimination (SAD) attached to Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been recognised as a major obstacle to HIV prevention, treatment, care and support throughout the world. SAD is more devastating when it occurs in health care settings where it is least expected. Health care providers (HCPs) are supposed to provide physical, social and psychological support to people living with HIV (PLWHA) but HIV and AIDS-related SAD has been extensively documented among the HCPs. Different studies have pointed out that there are three major actionable causes of HIV-related SAD in health care settings. These are lack of awareness among HCPs, fear of casual contacts and associating the SAD to immoral behaviour. The main objective of the current study is to determine the magnitude of HIV and AIDS-related SAD and its associated factors in hospitals and then to propose appropriate SAD reduction-intervention strategy in the health care settings. The study employed pre-test-post-test design with non-equivalent control group. Two paradigms were used in this study including quantitative and qualitative approaches. The sampling method for the quantitative part of the study was probability sampling in which the respondents were randomly selected using stratified sampling technique. The study was able to determine the magnitude of HIV and AIDS-related SAD among the HCPs. Moreover, the study has identified the factors that are attributed to the prevalence of SAD in the hospitals. The major factors identified for causing the SAD in the hospitals were sex, age, work experience, low level of knowledge, negative attitudes and percieved risk of HIV infection of some HCPs toward the PLWHA. The intervention made on the respondents in the treatment group was able to reduce the overall prevalence of the SAD among the HCPs. The study suggests that to reduce the SAD, HIV and AIDS-related trainings before and after graduation is critical to improve the knowledge, attitudes and practices of the HCPs. Besides, ensuring the availability of the protective supplies in hospitals is crucial in reducing the fear of HIV infection among the HCPs while providing care for HIV positive patients. Effective implementation of the hospital policies, strategies, guidelines and protocols along with good institutional support is also vital in creating safe and user-friendly hospitals for PLWHA. / Health Studies

Despite HIV and AIDS knowledge and attitude change programmes, workplace HIV and AIDS-related discrimination persists in workplaces in many sectors, including the education sector. This study set out to investigate why the phenomenon of workplace HIV and AIDS-related discrimination persists; and to predict which factors were responsible and how they related to HIV and AIDS-related discrimination in the workplace. A stratified random sample of 205 teachers; 123 of whom were from 10 schools of varied backgrounds in Bojanala Region of North West Province of South Africa and 82 from schools around Kampala, Central Region of Uganda was drawn. Twenty-seven respondents of the South African sample participated in both the quantitative survey and in-depth interview while the rest responded to a selfadministered questionnaire. Using a stepwise regression analysis, traditional beliefs predicted workplace HIV and AIDS-related discrimination, explained11% of variance in the second model while the third model explained only 2% more – 13% (R square of 0.136) but each of the three models was significant (p-values of 0.000). Attitudes were the second strongest predictor; and only HIV and AIDS-legal knowledge could predict discrimination but not biomedical HIV and AIDS knowledge. In the in-depth interview, incidents of discrimination were reported, possible reasons for HIV and AIDS-related discrimination were reported; and it was found that workers varied in ways of keeping secrets regarding sensitive information such as colleagues’ HIV-positive status, and cited reasons for revealing such information which included malice, jealousy, moral responsibility, anger and loose talks. There are implications for reducing workplace HIV and AIDS-related discrimination which include: Integrating HIV and AIDS-legal knowledge with biomedical HIV and AIDS knowledge, more efforts should be spent in designing and imparting information to reduce traditional beliefs, develop and evaluate instruments to measure traditional beliefs and HIV and AIDS-legal knowledge; and to study more about secret keeping, particularly in regard to workplace HIV and AIDSrelated discrimination. / Industrial and Organisational Psychology / D. Admin. (Industrial and Organisational Psychology)

Thesis (M. Tech.) -- Central University of Technology, Free State, 2010 / South Africa currently faces one of the highest HIV prevalence rates in the world. As this prevalence rises, the strain placed on its hospitals is likely to increase due to the shortage of beds. The devastating effects of HIV/AIDS initiated the establishment of a hospice which is a non-governmental organisation whose goal is the provision of care for terminally ill patients, either in their homes, in hospitals or in a hospice’s own in-patients wards. Part of the hospice’s mission is to offer palliative care without charge to anyone who requires it. The basic elements of hospice care include pain and symptom management, provision of support to the bereaving family and promoting a peaceful and dignified death. This also includes the provision of cooked foods to the patients using the kitchen facilities of the hospices for this activity. It is well known that the kitchen is particularly important in the spread of infectious disease in the domestic environment due to many activities that occur in this particular setting. Food and water safety is especially important to the persons infected with the human immunodeficiency virus (HIV) or with immunodeficiency syndrome (AIDS).It is estimated that food-borne pathogens (disease–causing agents) are responsible for 76 million illnesses, some resulting in death, in the United States alone every year. In one study of patients with AIDS, two-thirds had diarrhoeal disease and in two-thirds of these, the following enteric pathogens were identified: Salmonella, Shigella, Listeria, Yersnia, Cryptosporidium, Entamoeba histolylica and Campylobacter sp. In an epidemiological study of patients with HIV infection a close association was found between consumption of raw or partially cooked fish and antimicrobial-resistant Mycobacterium avium complex. Antibiotic resistance in food-borne pathogens has become a reality and this poses a serious threat to the medical fraternity since it diminishes the effectiveness of treatment. This study was undertaken to determine the prevalence of foodborne pathogens including bio aerosols isolated from the kitchen surfaces and food handler’s before and after cooking. The antibiotic resistance of the isolated pathogens was further determined to assess their impact on treatment. The following microbiota were isolated: Total viable counts (TVC), Coliforms, Escherichia coli, Staphylococcus aureus, Pseudomonas and presumptive Salmonella. The hospices had high counts of E.coli and S.aureus on the cutting boards for the breakfast session compared to the traditional home based kitchens. It was speculated that this could have originated from crosscontamination via the foodhandler’s hands and the food served. It is evident from the results that hospices lack a management system regarding the prevalence of E. coli as it was present on the cutting boards throughout the food preparation sessions. Gram negative organisms (coliform and P. aeruginosa) were in particular both resistant to oxacillin and this pose a great challenge in this particular setting. This can be addressed by putting emphasis on hygiene as a strategy per se for reducing antibiotic resistance.