Thesis (D. Tech. (Clinical Technology )) - Central University of Technology, Free State, 2013 / The HIV pandemic in South-Africa has created a new form of vulnerability for households with regards to food security and nutritional status which are vital components in the general care of HIV-infected individuals. The risk of nutritional deficiencies and malnutrition are predictors of disease progression and treatment in resource limited settings. Furthermore, HIV affects nutritional status by increasing the energy requirements, reducing food intake, affecting nutrient absorption and metabolism inadequacies due to cytokine activity and diarrhea. Several vitamins and minerals are important in fighting HIV infection because they are required by the immune system and major organs to attack infectious pathogens. Many of these micronutrients have been found to be deficient in HIVinfected persons and several studies were launched worldwide to investigate the feasibility of food assistance and nutrient supplementation. Nutritional supplementation has been advocated in HIV-infected persons especially in lowincome countries such as South Africa. Therefore, a study to evaluate the role of nutritional supplementation in HIV-positive patients becomes necessary, especially in a developing country such as South Africa. It is against this background that the present research was initiated to examine the influence of a nutritional supplement on the immune status and health status of HIVpositive/ AIDS adult individuals. The aim of the investigation was to determine if supplementation with a mixture comprised from specific minerals, vitamins and herbs over a period of one year, affected the haematological status, immune status, viral load and pulmonary function in forty (40) HIV-infected individuals living in the Mangaung Metropolitan, RSA. viii A quantitative, open-labeled, before-after clinical trial was conducted at the Central University of Technology, in Bloemfontein, Free State Province in the RSA. Socio-demographic and dietary intake questionnaires were completed. All data pertaining to anthropometric measurements, haematological status, immune status, viral load and pulmonary function were obtained my means of using standard procedures and technological equipment. The data were subjected to parametric and non-parametric statistical analysis. The results of the present investigation show that the eating pattern of this urbanized group of individuals reflects high energy (KJ) and macronutrient intakes coinciding with sub-optimal intake of Vitamin D and iodine. Of all the haematological variables the only statistical significant changes observed were increases in the median erythrocyte sedimentation rate (ESR) (p=0.0219) and mean cell haemoglobin concentration (MCHC) (p=0.0245) after six months of nutritional supplementation. At 12 months a statistical significant decrease in the median CD/CD8 ratio (p<0.0048), median Hematocrit concentration (p<0.0312), median mean cell volume (MCV) (p<0.0359), and median RDW (p<0.0273) accompanied a statistically significant increase in the MCHC (p<0.0003) at 12 months after supplementation. At 6 months 89% (CI95%: 73%; 96%) of the individuals showed a decline in viral load counts with a median percentage decline of 34% (CI95%: 73%; 96%). At 12 months 85% [CI95%: 68%; 94%] of the individuals show a decrease in viral load counts with a median percentage decline of 62.9% (CI95%: 50%; 78.6%) following the intake of the supplement. The main findings of the present investigation reveal that 68% (50%-81%) of the individuals show a statistical median increase (p=0.0302) of 16.9% (11.5%; ix 36.1%) in the Peak Expiratory Flow (PEF) at six months. A significant decrease (p=0.0484) in the median FEF75 of 28.1% (14%; 35.3%) is observed in 70% (53%-83%) of the individuals after 12 months of exposure to the supplement. No statistical significant changes are observed for FVC, FEV1, FEV1/FVC and FEF50 over the entire trial period. The present results suggest that a significant measurable decrease in viral load in HIV-infected individuals can be obtained by means of subjecting individuals to a nutritional fortification supplement strategy for 6 months or more.

This study sought to explore and describe the perceptions and beliefs of physicians about adherence to antiretroviral treatment by patients in the South-East district of Botswana. The Health Belief Model (Naidoo & Willis 2003:222) was adapted to suit and be used in the study. A descriptive, exploratory qualitative design was used. Unstructured interviews and unstructured observation data collection methods were applied. Informed consent was obtained prior to data collection. For triangulation purposes, observations were done following interviews, and data analysis was done by two different people. The findings of the study revealed that the perceptions and beliefs of treating physicians contributed towards adherence. Physicians perceived adherence as an important aspect in the success of antiretroviral treatment. Giving patients correct information, personal motivation, patients' understanding of treatment, traditional and religious beliefs were among other factors perceived by physicians to be impacting on adherence. / Health Studies / M.A. (Public Health)

Voluntary Counselling and Testing (VCT) is vital in the management of HIV/AIDS as it is the first step in treatment, care and behavioural change. Entrenched economic and gender inequities drive an increasingly feminized HIV/AIDS pandemic. This study investigated factors influencing VCT attendance by women in the Glen View high density suburb in Harare. A survey methodology was followed using a semi-structured, self-administered questionnaire that was distributed to randomly selected women of reproductive ages in the area. The analysis showed that VCT usage is low and that factors such as fear of the consequences of testing positive for HIV, such as violence and rejection by male partners are to blame. Importantly, the findings suggest that if the vulnerability of women is not addressed, then increased VCT uptake and better reproductive health outcomes for women are also unlikely. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

This ethnography was undertaken in an AIDS hospice with the objective of understanding the functioning of the Centre holistically, including the experiences of the patients and the role of the Centre in the fight against HIV/AIDS. Organisational anthropology in a clinical setting involved gaining entry and rapport with the staff and patients. The methodology included interviewing and observation. The personnel structure and leadership of the Centre were explored, revealing communication, power and management relations that shape the organisational culture. The staff’s attitude towards their jobs and their commitment to assisting those suffering from AIDS revealed the underpinnings of the organisation. The care that patients receive at the Centre was examined along with adoption of the children and the effects of stigmatisation surrounding HIV/AIDS and its impact on patients and their families. The meaning of illness for patients and their sick role as well as the impact of death from HIV/AIDS are exposed. / Anthropology and Archaeology / M.A. (Anthropology)

HIV/AIDS is a global challenge and its impact is evident. This places a burden on hospitals and health professionals. To ease this burden there are home-based care programmes which, through home-based caregivers, provide patients living with HIV/AIDS with physical and palliative care. However, these HBCGs face various challenges such as poverty, discrimination and stigma when caring for PALHIV, and their own emotional strain, which becomes burdensome without sufficient support from the home-based care centre. The qualitative study undertaken investigates the challenges and coping mechanisms of the HBCGs. Thirteen research participants were drawn from a centre in Mamelodi. Data was gathered through interviews and observations, categorised into themes and analysed. Major findings revealed that social challenges faced by HBCGs include poverty, stigmatisation and discrimination. Emotions experienced by HBCGs include guilt, anger, hopelessness, but they have spiritual reliance through prayer as one of their coping mechanisms. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Besides constituting major obstacle to effectively addressing HIV/AIDS, Stigma has remained among the least understood experiences of PLWHA. Limited knowledge and understanding of HIV/AIDS related S&D has very much contributed to poor implementation and in most cases failure of HIV intervention programmes at national, regional and international levels. Sociological analysis of Stigma in PLWHA lends verifiable insight into the nature, extent and comprehensiveness of HIV/AIDS related Stigma. With 129 participants from Gauteng regions of Ekurhuleni, Sedibeng and West Rand, the study confirms that Stigma and Discrimination (S&D) still thrives, quantifying its magnitude, implications and impacts in the lives of the HIV infected. Inter alia, the findings showcase the complex matrix analysis of emotion and behaviour associated with HIV/AIDS related S&D. Finally, the study offered a comprehensive recommendation on how to address HIV/AIDS related S&D at individual/family, institutional/community and government levels. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is a global problem. Introduction of antiretroviral therapy (ART) came as a relief to people living with HIV and AIDS as it improved their quality of life. However, maintaining high adherence levels to antiretroviral treatment is still a challenge in some settings yet strict adherence to treatment instructions is critical for successful suppression of HIV. A qualitative, descriptive phenomenological research was conducted to explore factors that influence adherence to antiretroviral therapy at Beatrice Road Infectious Disease Hospital (BRIDH). Purposive homogenous sampling was done. Data was collected from twenty patients through in-depth interviews. Study findings identified five main themes that facilitate adherence and these entail knowledge on HIV and AIDS and ART, motivation to live, adherence support networks, good service delivery and factors related to medication / Health Studies / M.A. (Public Health)

The humanised Aids patient increasingly finds itself a part of mainstream popular rhetoric. There was a time however, when the Aids patient was no more than a disease ravaged corpse without rights. Conventional histories and analyses tend to gloss over this fact, or argue that the new, authentic patient is a triumph of wisdom over brute ignorance, fear and superstition. Such accounts overlook their own role and the part played by the bio-medical sciences in constructing the Aids patient. This thesis, in contradistinction, traces the Aids patient's portrayal in South African bio-medical discourses, applying to it the work of Michel Foucault. In doing so the dynamic interactions of power and knowledge are brought under the spotlight. / Psychology / M.A. (Psychology)

Dissertation submitted in fulfilment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2012. / In South Africa, HIV and AIDS workplace programmes have been implemented for more than two decades without any audited and certifiable standards. In 2007, the South African National Standard launched South African National Standard (SANS 16001) 16001 to assist, encourage and support companies to implement minimum standards for HAMS. Companies are now expected to use this standard to improve HIV and AIDS Management System. It therefore, becomes imperative for companies to establish workplace HAMS in line with the set standard. To determine to what extent the company‟s HAMS has been aligned to the SANS 16001, an evaluation of the current management system in relation to the new SANS 16001 system is needed. Aim of the study The aim of the study was to evaluate the implementation of the HIV and AIDS Management System in a Richards Bay Company. Methodology A single case study using a quantitative research design was used to evaluate HAMS in a Richards Bay Company. The sample consisted of all consenting participants who were selected from key position holders in accordance with the requirements of SANS 16001: 2007 and the general workers. These key position holders were comprised of senior managers, middle managers and those employees who play an important role in implementing HAMS. Two different sets of questionnaires were used to collect data. One questionnaire was used to collect data from the managers because they were key role players in HAMS. The second questionnaire was used to collect data from the general workforce. The data from the questionnaire was captured and subsequently analysed using the version 9 of SPSS. Results There was evidence that the company was committed to continuous improvement regarding HIV and AIDS management as indicated by both key position holders and the general workforce.

Submitted in fulfilment of the requirements of the full Degree of Master of Technology: Nursing, Durban University of Technology, 2011. / South Africa is currently at the epicentre of the AIDS epidemic with 5.6 million people living with HIV disease. The province of KwaZulu-Natal has the biggest burden with an antenatal HIV prevalence of 39.5% in 2010. It is estimated that 24.5% of South Africa‟s working age population is HIV positive. Most infected people living with HIV in Africa are between ages 15 and 50 years which is the peak working age. AIDS now causes more deaths and suffering among the 18-44 year age group than any other disease. Organisations clearly present as one of the most effective and significant settings in which to respond to the epidemic. The effective management of HIV and AIDS within organisations is critical in order to reduce the negative consequences of the epidemic on the economy. HIV and AIDS Management Systems (HAMS) within organisations have been implemented for approximately twenty years but they have been largely ineffective, mainly due to poor uptake of services. Therefore, there is a need for HAMS practice to be evaluated in relation to current best practice standards to ensure quality management, continual improvement and successful uptake of services. This qualitative study evaluated one organisation‟s HAMS in relation to SANS 16001 and described employees‟ experiences of HAMS in this setting. The theoretical framework underpinning this study is the Deming cycle which is a well known quality management system methodology. From the results of the study it was apparent that the organisation was aligned with most of SANS 16001 general requirements for HAMS. Employees experienced the intended benefits of prevention, treatment and support from the organisation‟s HAMS.