Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: HIV infection, substance abuse, and psychiatric disorders are major public health issues in South Africa. Psychiatric disorders and substance-use disorders together have a negative impact on the health outcomes of people living with HIV and AIDS (PLWHA), such as poor adherence to anti-retrovirals (ARVs), HIV disease progression, lower CD4 counts, vulnerability to opportunistic infections, high viral loads, possible drug resistance, and an earlier onset of death. The overall aim of this study was to investigate the relationship between substance abuse practices and the health status and health behaviour of patients attending HIV clinics in the Cape Metropole. The study used a cross-sectional study design for collecting data on hazardous or harmful use of alcohol and problematic drug use, demographic information and health status among patients attending eight HIV clinics in the Cape Metropole. A sub-sample of patients were assessed on the following domains: depression, psychological distress, psychopathology, post-traumatic stress disorder (PTSD), risky sexual behaviour, adherence to ARVs, levels of resilience, levels of social support and patient’s work, family and social functioning. Of the 608, 10% of consecutively selected patients completed an additional psychiatric diagnostic interview (Mini International Neuropsychiatric Interview). The main findings to emerge from this study are: 1. Patients reporting hazardous or harmful use of alcohol and/or drug use are significantly more likely to be non-adherent to ARVs and have lower CD4 counts than their non-substance abusing counterparts 2. Hazardous or harmful use of alcohol has a direct influence on CD4 count resulting in lower CD4 counts and participants being less likely to be on ARVs. 3. Hazardous or harmful use of alcohol has a direct relationship in predicting tuberculosis (TB). 4. Hazardous or harmful users of alcohol and/or problematic drug users are more likely to report psychological distress (anxiety and depression), depression and low levels of family support than their non-using counterparts. 5. Participants who met the criteria for major depression are significantly more likely to be non-adherent to ARVs. 6. Gender, depression, psychological distress, and PTSD were found to be significant determinants of hazardous or harmful use of alcohol. 7. Psychological distress (anxiety and depression) is significant in directly predicting ARV non-adherence. 8. Male participants and those who stopped taking their ARVs were more likely to have lower CD4 counts than female participants and those who did not stop. 9. PTSD was found to predict psychological distress indicating that participants who experienced trauma were more likely to suffer from psychological distress (anxiety and depression) compared to those who did not experience any PTSD. Participants with lower levels of family support were more likely to suffer from psychological distress than those with high levels of family support. / AFRIKAANSE OPSOMMING: MIV infeksie, dwelmmisbruik en geestesversteurings is groot gesondheidskwessies in Suid-Afrika. Geestesversteurings en dwelmmisbruik het gesamentlik 'n negatiewe uitwerking op die gesondheid van mense wat met MIV en VIGS saamleef (PLWHA), soos byvoorbeeld nie-nakoming in die gebruik van antiretrovirale (ARV’s), MIVsiekteverloop, laer CD4-tellings, vatbaarheid vir opportunistiese infeksies, hoë virale ladings, moontlike weerstand teen medikasie en 'n verkorte leeftyd. Die oorkoepelende doel van hierdie studie was om die verhouding tussen dwelmmisbruik en die gesondheidstatus en -gedrag van pasiënte wat MIV klinieke in die Kaapse Metropool besoek, te bestudeer. Die studie het 'n deursnee-ontwerp gebruik om data in te samel oor die nadelige en gevaarlike gebruik van alkohol en problematiese dwelmgebruik, demografiese inligting, en die gesondheidstatus onder pasiënte wat agt MIV klinieke in die Kaapse Metropool besoek het. 'n Subgroep pasiënte geassesseer op die volgende gebiede: depressie, psigologiese angsversteuring, psigopatologie, posttraumatiese stresversteuring (PTSV), riskante seksuele gedrag, nakoming in die gebruik van ARV’s, weerstandigheidsvlakke , vlakke van sosiale ondersteuning, asook pasiënte se werk, familie en sosiale funksionering. Van die 608 deelnemers is 10% van die pasiënte opeenvolgend geselekteer om 'n addisionele diagnostiese psigiatriese onderhoud te ondergaan (Mini International Neuropsychiatric Interview). Die vernaamste bevindinge wat uit die studie gekom het, is: 1. Pasiënte wat nadelige en gevaarlike gebruik van alkohol en/of dwelms rapporteer is beduidend meer geneig om nie die gebruik van ARV’s na te kom nie, en het laer CD4-tellings as hulle eweknieë wat nie dwelms misbruik nie. 2. Die nadelige en gevaarlike gebruik van alkohol het 'n direkte invloed op CD4- tellings wat lei tot laer CD4-tellings en dat pasiënte minder geneig is om op ARV’s te wees. 3. Die nadelige en gevaarlike gebruik van alkohol hou direk verband met die voorspelbaarheid van tuberkulose (TB). 4. Nadelige en gevaarlike gebruikers van alkohol en/of problematiese dwelmgebruikers, is meer geneig om psigologiese angsversteurings (angs en depressie), depressie, en laer vlakke van familieondersteuning te rapporteer as hul niegebruiker-eweknieë. 5. Deelnemers wat aan die kriteria vir ernstige depressie voldoen, is aansienlik meer geneig tot nie-nakoming in die gebruik van ARV’s. 6. Daar is gevind dat geslag, depressie, psigologiese angs en PTSV beduidende bydraende faktore is tot die nadelige en gevaarlike gebruik van alkohol. 7. Psigologiese angsversteurings (angs en depressie) is beduidend om direk die nie-nakoming van ARV’s te voorspel. 8. Manlike deelnemers en diegene wat hul ARV’s gestaak het, was meer geneig om laer CD4-tellings te hê as vroulike deelnemers en diegene wat nie die gebruik van medikasie gestaak het nie. 9. Daar is gevind dat PTSV psigologiese angs voorspel het wat aandui dat deelnemers wat trauma ondervind het, meer geneig was om aan psigologiese angsversteurings (angs en depressie) te ly in vergelyking met diegene wat geen PTSV ervaar het nie. Deelnemers met laer vlakke van familieondersteuning was meer geneig om aan psigologiese angsversteurings te ly as diegene met hoë vlakke van familiebystand.

Background: Literature has shown that negative attitudes and unwillingness to care for HIV-infected patients are prevailing among healthcare workers. This study aimed to assess the attitudes and willingness of student nurses towards caring for HIV-infected patients in some public hospitals in Gert Sibande district, Mpumalanga. Method: A contextual exploratory quantitative descriptive survey was conducted among student nurses enrolled for a four-year nursing qualification in a nursing college at Mpumalanga province. Self-administered questionnaires were completed after obtaining an informed consent. Results: A total of 122 (70.9%) students participated in this survey. Findings showed that most participants had positive attitudes 66 (52.7%) and were willing 121 (99.1%) to care for HIV-infected patients. Significant associations were revealed between participants’ previous HIV testing (p=0.012), age group (p=0.009), and their willingness to provide care to HIV-infected patients. Conclusion: Results showed a generally positive attitude and willingness by participants to care for HIV-infected patients. / Health Studies / M.A. (Health Studies)

This study was conducted to determine retention rate and factors associated with loss to follow-up (LTFU) of adult pre-ART patients in St. Luke hospital, Ethiopia. Cross-sectional study with quantitative and qualitative data collection techniques was used. Review of patient records, focus group discussions and review of program guidelines was conducted to determine level of adherence among pre-ART patients. In addition, pre-ART service quality and perceived reasons for discontinuation was explored. The study revealed that only 38.2% of the 335 patients enrolled in the pre-ART care were retained after 12 months of follow-up in the program. More than half (55.6%), of the LTFU occurred during the first 6 months of follow-up. Fear of discrimination, high transportation cost and mistrust in the pre-ART service were perceived reasons for LTFU. Absences of clear pre-ART service package and implementation guideline were also identified as important factors that may be related to LTFU. The findings call for improved quality of care and a better pre-ART service packaging that will address the gaps identified in order to increase patient retention. / Health Studies / MA (Public Health)

Purpose: The purpose of this study is to assess risk factors associated with TB co-infection in HIV/AIDS patients taking antiretroviral therapy (ART). Methodology: An observational, analytic, case-control and quantitative study was conducted on a randomly selected 367 HIV and AIDS patients of whom 92 of them were TB co-infected. Data collection was done by using self-structured questionnaire. Result: In this study, educational status, waste disposal system, monthly income, contact history with a patient of active tuberculosis or presence of a family member with active tuberculosis, drug adherence, knowledge on tuberculosis prevention and history of exposure to substance were factors independently associated with the occurrence of active tuberculosis among HIV and Aids patients taking ART. Conclusion: The findings highlight the need for on-going educational, informational and other interventions to address the risk factors of tuberculosis in HIV and Aids patients in order to decrease the rate of TB co-infection / Health Studies / M.A. Public Health

Digitized using a Konica Minolta 211 PCL scanner at 300 dpi. / Thesis (MA (Psychology))--University of Stellenbosch, 2006. / Please refer to full text for abstract.

Thesis (MA) -- University of Stellenbosch, 2004. / ENGLISH ABSTRACT: The relentless progression of HfV /AIDS epidemic has made it imperative that measures are put in place to minimise its impact on Small and Medium Enterprises (SME). mv is set to have a significant effect on every facet of the population, and SME is not immune. Business is likely to feel the impact ofmv/AIDS epidemic through reduced productivity, increased absenteeism, increased staff turnover, increased recruitment and training costs, increased cost of employee benefits and poor staff morale. One of the interventions is to implement a mv/AIDS policy and programme, yet a literature search showed that psychological studies of SME in implementing a mv/AIDS policy and programme are limited. The present study utilised the model of the theory of planned behaviour (Ajzen, 1985,1988, 1991), which is an extension of the theory of reasoned action (Fishbein & Ajzen, 1975; Ajzen & Fishbein, 1980). Intention to implement a mv/AIDS policy and programme was predicted by the theory of planned behaviour constructs such as attitude, subjective norm and perceived behavioural control. The theory of planned behaviour was found to be useful in assessing behavioural intention of SME in implementing a mv/AIDS policy and programme. These findings indicate that implementing an intervention like a mv/AIDS policy and programme by SMES is a behavioural intention motivated by attitudes, subjective norms and perceived behavioural control. / AFRIKAANSE OPSOMMING: Die meedoënlose progressie van die HIVNIGS pandemie het dit gebiedend noodsaaklik gemaak om maatreëls daar te stelom die impak daarvan op klein en medium sakeondernemings te minimaliseer. HIVNIGS sal 'n beduidende uitwerking hê op alle vlakke van die bevolking. Klein en medium sakeondernemings is geen uitsondering nie. Die uitwerking van die HIVNIGS pandemie sal tot gevolg hê 'n afname in produktiwiteit; 'n toename in personeelafwesigheid, personeelomset, personeelwerwing en - opleidingskoste, personeelvoordele; en swak personeel moreel. Een manier om die probleem aan te spreek is om 'n HIVNIGS beleid en program te implimenteer. Ongelukkig toon literêre navorsing dat psigologiese studies van klein en medium sakeondernemings om 'n HIVNIGS beleid en program te implimenteer, beperk is. Dié navorsing steun op die teorie van planmatige gedrag (Ajzen, 1985; 1988; 1991), wat 'n verlenging is van die teorie van beredeneerde optrede (Fishbein & Ajzen, 1975; Ajzen & Fishbein, 1980). Die oogmerk met die implimentering van 'n HIVNIGS beleid en program is bepaal deur die teorie van planmagtige gedrag soos waargeneem in geesteshouding, subjektiewe norme en waargenome beheerde gedrag. Daar is gevind dat die teorie van planmagtige gedrag nuttig is om die oogmerke en optrede van werknemers in klein en medium sakeondernemings te bepaal met die implimentering van 'n HIVNIGS beleid en program. Hierdie bevindings toon dat die implimentering en tussenkoms van 'n HIVNIGS beleid en program by klein en medium sakeondernemings'n gedragsoogmerk is wat gemotiveer word deur geesteshoudings, subjektiewe norme en waargenome beheerde gedrag.

The main research of the study was: How is integrated communication applied in the UKZN AIDS Programme at Westville Campus? The following six subsidiary research questions were formulated to address this topic:  How is communication aligned with the strategic focus in the UKZN AIDS Programme?  How consistent are messages and media used in and outside the UKZN AIDS Programme?  What is the status of infrastructure for integration within the UKZN AIDS Programme?  What is the status of internal stakeholder orientation and differentiation in the UKZN AIDS Programme?  What are the mechanisms put in place to coordinate communication efforts and action within the UKZN AIDS Programme?  What is the status of free flow of information within the UKZN AIDS Programme? A qualitative research design was conducted using field and survey research. These two research methods may be used for descriptive, exploratory, and explanatory research (Mouton 1996:232). Descriptive and exploratory field and survey research were used to ascertain the integrated communication applied in the UKZN AIDS Programme. Data was collected from sixteen UKZN AIDS Programme employees and eight students using semi-structured focus group and in-depth interviews respectively. Data collected was analysed using thematic analysis a technique that involves identifying, analysing and reporting in detail patterns or themes within data.The study found that the UKZN AIDS Programme focuses mostly on the University as its main stakeholder. Therefore, there is little emphasis on employees and students. Besides, the study revealed that there is poor alignment of the programme’s communication strategy with the programme’s strategy. To achieve the UKZN AIDS Programmes’ strategic objectives and mission, there is need to reassess the efforts of the programme and re-strategise. Findings on the consistency of messages and media in the UKZN AIDS Programme reveal that all communications are managed by senior employees and consistent in terms of programme identity by using the university identity, and website messages. The status of the consistency of messages and media in the programme can be improved if a comprehensive approach can be used in communicating internal messages. Findings on the consistency of messages and media in external communication show that the programme tries to communicate different prevention messages using channels favoured by students. However, channels such as drama and peer educators have weaknesses that need to be addressed in addition to employing diverse communication channels. Findings show that some of the messages communicated are relevant in the sense that they address students’ sexual risk behaviour while others are not as they are off tangent such that they address issues students are not concerned about. In addition, findings show that peer educators were not exemplary in their work while drama programmes did not allow students to actively participate in the prevention activities. On infrastructure for integration, the study found that there is infrastructure and several prospects for information sharing in the programme created by information technology though not fully explored. With regards the free flow and sharing of information, the study established that the required systems for communication exist but not adequately utilised. Findings on the co-ordination of communication efforts and actions to promote integrated communication show flaws. Departments in the programme function in silos due to lack of cross-functional planning. The integrated communication conceptual framework used in the study was useful in making the study successfully ascertain integrated communication applied by the UKZN AIDS Programme. The conceptual framework can therefore be used to underpin any research topic on health integrated communication. / Communication Science / MA (Communication) / 1 online resource (v, 222 leaves)

Assignment (MPhil)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: The aim of this study was to investigate practical methods of monitoring AIDS related wasting and lipodystrophy in a resource-poor clinical setting with HIV infected women as the population group of interest. Measurement of body composition changes using anthropometry is both cost- and time-efficient. Various different skinfolds were taken and two different equations (the equations of Pollock et al. (1975) and Durnin and Womersley (1974) for calculating body fat were used to determine the most promising method or methods of monitoring body composition changes in a clinical setting. Detailed anthropometric measurements were performed, as well as selected measurements for haematological parameters and quality of life (QoL) for a group of 8 participants on antiretroviral medication (ART group) and 6 participants who were not on treatment (TN group). New variables namely, intra-abdominal indicator (IAI) and a percent of ideal body mass to percent of ideal arm circumference ratio (%IBW:%IAC) were investigated as possible indicators of lipodystrophy. Although measurements were taken at various timepoints, three specific time-points were chosen for data-analysis for the ART group and two time points for the TN group. These three time-points were, baseline (on the day of recruitment for TN participants and within one month before the initiation of treatment for ART participants), short-term (2 to 12 weeks after treatment initiation or the baseline measurement or for the ART and the TN participants) and long-term (within one and a half year of treatment initiation for the ART group). ART and TN participants did not differ for many variables at baseline. The major differences between ART and TN were in measured and derived variables of the arm, especially percent of ideal arm circumference (%IAC) and upper arm fat area (UAFA), which were significantly lower in the ART group. CD4+ and QoL improved significantly for the ART participants from baseline to long-term. This was not associated with changes in muscle mass, but rather some fat mass variables. Participants on antiretroviral medication exhibited changes relating to abdominal obesity. It was concluded that antiretroviral therapy contributed greatly to the QoL of the participants and it probably aided in the recovery from wasting for at least one participant in this study. Measures of the arm can be used in a rural clinical setting to effectively monitor patients with regard to AIDS related wasting. The new variables IAI and %IBW:%IAC could be helpful in the monitoring of lipodystrophy and should be investigated in future research. / AFRIKAANSE OPSOMMING: Die doelwit van hierdie studie is om praktiese metodes te ondersoek om VIGS-verwante uittering en lipodistrofie te meet in ‘n plattelandse kliniese omgewing (waar hulpbronne dikwels beperk is) met MIV ge-infekteerde vroue as populasiegroep. Die gebruik van antropometrie om veranderinge in liggaamssamestelling te meet is beide koste- en tydeffektief. Verskeie velvoumetings is geneem en twee verskillende vergelykings (die vergelykings van Pollock et al. (1975) en Durnin en Womersley (1974)) is gebruik om liggaamsvetinhoud te bereken, met die doel om ‘n belowende metode te vind om veranderinge in liggaamssamestelling te meet in ‘n kliniese omgewing. Verskeie antropometriese metings is geneem, sowel as uitgesoekte hematologiese en lewenskwaliteitmetings (QoL) vir ‘n groep van agt deelnemers wat antiretrovirale medikasie ontvang het (ART groep) en ses deelnemers wat nie hierdie behandeling ontvang het nie (TN groep). Nuwe veranderlikes (binnebuikindikator (IAI) en die verhouding van persentasie van ideale liggaamsmassa tot persentasie van ideale armomtrek (%IBW:%IAC)) is ondersoek as moontlike aanwysers van lipodistrofie. Drie spesifieke tydpunte vir die ART groep en twee tydpunte vir die TN groep is gekies uit die verskeie tydpunte waarby metings geneem is, nl. basislyn (gedefinieer as die dag wat TN deelnemers in die studie opgeneem is en 0 tot 4 weke voor die begin van behandeling vir die ART deelnemers), korttermyn (2 tot 12 weke nadat behandeling begin is of na die basislyn meting) en lang-termyn (binne een en ‘n half jaar nadat behandeling begin is vir die ART groep). By die basislyn tydpunt het min van die ART en TN deelnemers se gemete veranderlikes verskil. Die ART en TN groepe het hoofsaaklik verskil ten opsigte van veranderlikes wat betrekking het op die arm, veral persentasie van ideale armomtrek (%IAC) en bo-arm vetarea (UAFA). Hierdie twee veranderlikes was beduidend laer in die ART groep as in die TN groep. CD4+ seltelling en lewenskwaliteit tellings het beduidend verbeter vir die ART deelnemers van die basislyn tot die lang-termyn tydpunt. Hierdie veranderinge is nie samehangend met veranderinge in spiermassa nie, maar eerder met sommige vetmassa veranderlikes. Deelnemers wat antiretrovirale medikasie ontvang het, het veranderinge getoon wat gedui het op ‘n verhoogde neerlegging van vet in die buikarea. Ten slotte is bevind dat antiretrovirale medikasie bygedra het tot die verbeterde lewenskwaliteit van die deelnemers en dat dit waarskynlik ook die omkeer van uittering van ten minste een deelnemer aangehelp het. Daar is ook bevind dat armverwante metinge gebruik kan word in die plattelandse kliniese omgewing om pasiënte suksesvol te monitor ten opsigte van VIGSverwante uittering. Die nuwe veranderlikes, IAI en %IBW:%IAC kan moontlik gebruik word om lipodistrofie-verwante veranderings te meet en die gebruik van hierdie veranderlikes behoort ondersoek te word in verdere navorsing.

Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: There is, as yet, no cure for HIV/AIDS, a disease that has affected South African society profoundly. While antiretrovirals (ARVs) are now available and have stemmed the tide of AIDS deaths, medicines alone cannot be seen as a long-term solution. Treatment costs, finite resources, limited health-care capacity, morbidity and the unpleasant side-effects of ARVs, make treatment an untenable solution. The Christian church in South Africa continues to retain a powerful position; it has a significant affiliation; it is present in most geographic areas and inspires trust and confidence. Furthermore, in my view, the church, by its very nature and calling, is mandated not only to demonstrate and provide care, but also to inspire care-giving. In the light of HIV/AIDS, what does care mean? Can it only mean rendering care that is welfarist in nature? Or does the church have the mandate to look beyond immediate suffering, to examine and address those issues that lie at the core of suffering? Research has demonstrated that issues such as poverty, injustice, stigma, discrimination, gender inequality and patriarchy fuel the pandemic. Ultimately, it is the “othering” of people; the failure not to recognise God in another person and our common humanity, that lie at the heart of the problem. These then, I suggest, are the very reasons why the church must address these areas. But that is not all: if HIV/AIDS care is to be rendered in a developmental way, then there must be a thorough understanding of the disease: how is the virus transmitted, how can it be prevented and treated? It is also important to understand that there is not a single global epidemic but many local epidemics; the determinants and risk-factors of these need to be recognised, as must the cultural, economic, political and social contexts that fuel the spread of the disease. The changing nature of society, the effects of globalisation, the evolving nature of care owing to biomedical advances and even the “privatisation” of sex all need to be comprehended. Furthermore, any meaningful rendering of care requires the churches to examine why they should be giving it and the values that underpin such care-giving. I make the case that the churches are required to do nothing less than drive social change in situations of suffering, injustice and abuse. An examination of the history of HIV/AIDS in South Africa illustrates that the churches have often failed to meet up to this calling. An empirical study was conducted as to how the churches render care at a more micro, grassroots level, using a framework propounded by David Korten, who suggests that authentic development must be people-centred, rather than growthcentred. Essentially, development must seek to increase personal and institutional capacities, guided by principles of justice, sustainability and inclusiveness. In these respects, I argue, it accords very strongly with the Christian message. Korten suggests that there are four orientations (or generations) of rendering help but it is only the fourth generation that is truly developmental. Through the use of case study methodology, I sought to examine the manner in which the churches render care, in a region of the Western Cape, outside Cape Town, known as the Helderberg Basin. The area is representative of many peri-urban areas in the Cape: it is predominantly Christian, with a mix of different denominations and racial and socio-economic groupings. It allowed for an assessment of care initiatives afforded by mainline, charismatic and African Independent Churches and in particular, sought to answer the question of whether churches engage with HIV/AIDS in a way that Korten would identify as developmental. From the research, it is clear that the church is hampered by its inability to talk of sex and sexuality; its knowledge of the issues surrounding HIV/AIDS is limited; it has not done a sufficient amount to conscientise its followers; the church has yet to learn to utilise its networks; it lacks technical know-how and is unwilling to engage in the political sphere. Social change is only possible if the church embraces a new vision of how to create a better world. Additionally, I recommend that the church looks to the emerging church movement to achieve radical transformation. / AFRIKAANSE OPSOMMING: MIV/VIGS is ‘n siekte wat Suid-Afrika onmeetbaar beїnvloed en waarvoor daar tot op hede geen genesing is nie. Antiretrovirale middels (ARVs) is weliswaar beskikbaar en het die gety van VIGS sterftes gestuit maar medisyne kan nie alleen as die langtermyn oplossing gesien word nie. Behandelingskoste, beperkte hulpbronne en vermoë om gesondheidsorg te lewer, morbiditeit en die negatiewe newe-effekte van ARVs bring mee dat slegs mediese behandeling ‘n onhoudbare oplossing is. Die Christelike kerk in Suid-Afrika behou steeds ‘n magsposisie; dit het ‘n beduidende lidmaatskap asook ‘n teenwoordigheid in meeste dele van die land en boesem vertroue en sekerheid in. Dié kerk is na my mening gemandateer deur haar besondere aard en roeping om nie alleen sorg te bewys en te voorsien nie maar ook om versorging aan te moedig. Maar wat beteken sorg, gegewe die aard van MIV/VIGS? Kan dit slegs die lewering van welsyngerigte sorg beteken? Of sou die kerk die mandaat hê om verder as onmiddellike lyding te kyk en ondersoekend die kwessies wat aan die wortel van lyding lê, aan te spreek? Navorsing het aangetoon dat kwessies soos armoede, onreg, stigma, diskriminasie, geslagsongelykheid en patriargie die epidemie aanvuur. Uiteindelik is dit die objektivering (“othering”) van mense - dit is die onvermoë om God nie in ‘n ander persoon en ons gemeenskaplike mensheid te herken nie - wat die hart van die probleem is. Ek betoog dat hierdie die redes is waarom die kerk hierdie kwessies moet aanspreek. Om ondersoek in te stel of en tot watter mate die kerk sorg verskaf in verband met MIV/VIGS het ek die raamwerk van David Korten gebruik. Dié raamwerk stel voor dat outentieke ontwikkeling mensgesentreerd eerder as groeigesentreed sal wees. Ontwikkeling moet essensieel streef na ‘n toename van persoonlike en institusionele vermoë, gerig deur beginsels van geregtigheid, volhoubaarheid en inklusiwiteit. Ek toon aan dat hierdie beginsels baie sterk ooreenkom met die Christelike boodskap. Korten stel vier hulplewerende oriëntasies (ook genoem generasies) voor maar dit is eintlik slegs die vierde generasie van hulp wat werklik ontwikkelingsgerig is. Maar dit is nie al nie. Indien MIV/VIGS versorging ontwikkelingsgerig gaan wees, moet dit gegrond wees op ‘n diepgaande verstaan en kennis van die siekte soos onder andere, hoe die virus versprei word en hoe die siekte voorkóm en behandel kan word? Dit is ook belangrik om te verstaan dat daar nie slegs ‘n enkele globale epidemie is nie maar verskeie lokale epidemies. Die veroorsakende en risiko faktore van hierdie epidemies moet daarom geїdentifiseer word en so ook die kulturele, ekonomiese, politieke en sosiale konteks wat die verspreiding van hierdie siekte aanhelp. Die veranderende aard van gemeenskappe, die effek van globalisering, die ontwikkelende aard van gesondheidsorg vanweë die vooruitgang in die mediese wetenskap en die “privatisering” van seks moet alles in ag geneem word. Betekenisvolle versorging vereis dat kerke ondersoek instel na waarom die versorging aangebied word en die waardes onderliggend daaraan. Ek stel die saak dat daar van kerke verwag word om sosiale verandering te stuur waar mense swaarkry, onregverdig behandel en misbruik word. ‘n Ondersoek na die geskiedenis van MIV/VIGS in Suid-Afrika illustreer dat kerke dikwels misluk het om aan hierdie roeping gehoor te gee. In opvolging van die bostaande argumente het ek navorsing uitgevoer oor hoe kerke sorg op ‘n mikro of voetsool-vlak aanbied. Hiervoor het ek die genoemde mensgesentreerde ontwikkelingsraamwerk van David Korten gebruik. ‘n Gevalstudie benadering is gevolg in die Helderbergkom wat geleë is in ‘n streek van Wes- Kaapland buite Kaapstad. Hierdie gebied is verteenwoordigend van baie buitestedelike gebiede van die Kaap: dit is oorwegend Christelik en sluit ‘n verskeidenheid van denominasies, rasse en sosio-ekonomiese groeperings in. Die gebied maak ‘n oorsig moontlik van die sorg-inisiatiewe van hoofstroom, charismatiese en Afrika onafhanklike Kerke, en in die besonder van ‘n identifikasie daarvan of kerke betrokke by MIV/VIGS dit doen op ‘n wyse wat Korten sou tipeer as ontwikkelingsgerig. Uit hierdie navorsing het dit duidelik geword dat die kerk gekniehalter word deur ‘n onvermoë om oor seks en seksualiteit te praat; die kerk se kennis beperk is wanneer dit kom by kwessies wat handel oor MIV/VIGS; dit nie genoeg doen om lidmate bewus te maak van VIGS kwessies nie; dit nog veel te leer het oor hoe om netwerke aan te wend; dit tegniese kennis kort en onwillig is om met sake van politieke belang om te gaan. Sosiale verandering is alleen moontlik indien die kerk ‘n nuwe visie voorhou oor hoe om ‘n beter wêreld te skep. Ek beveel ten slotte aan dat die kerk let op die ontluikende kerkbeweging om radikale transformasie te verwesenlik.

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The accessibility of anti-retroviral drugs to patients and families affected by HIV and AIDS, and the affordability of these drugs, have been challenges to the Du Noon community in the Cape Peninsula. The aim of the study was to assess the effectiveness of primary health care services in addressing HIV/AIDS in the light of these challenges. The focus was on patients registered on the ARV programme and who were receiving treatment at Du Noon Clinic. Interviews were conducted with 15 groups of 10 patients each using a patient questionnaire. During these interviews qualitative and quantitative data were gathered and secondary data was used for quantitative analysis. The results that the data analysis yielded are in keeping with the hypothesis that the HIV/AIDS programme is effective in meeting the needs of the HIV/AIDS patients of Du Noon. After content analysis of qualitative data, two themes related to patient satisfaction emerged: positive and negative feelings that were categorised as satisfied and not satisfied with the service. Most often noted was the feeling of satisfaction with the services rendered at the clinic and that the staff were helpful. The staff rendering the service were also satisfied with the kind of service offered to the patients, but were dissatisfied with the allocation of resources. An increase in enrolment figures of patients was noted in the statistical analysis for the period 2004-2008 with 1,018 patients registered. The statistics illustrate the linear tendency in the enrolment of patients, which indicated the accessibility and affordability of the service. / AFRIKAANSE OPSOMMING: Geredelike toegang tot en die bekostigbaarheid van anti-retrivorale middels (ARM’s) vir pasiënte en families wat deur MIV en VIGS aangetas is, is ‘n uitdaging vir die Du Noon-gemeenskap in die Kaapse Skiereiland. Die doel van die studie was om die doeltreffendheid van primêre gesondheidsorgdienste te bepaal wanneer MIV/VIGS aangespreek word. Die fokus is op geregistreerde pasiënte wat die ARM-program volg en behandeling by die Du Noon Kliniek ontvang. Met behulp van ‘n pasiëntevraelys was onderhoude met 15 groepe van 10 pasiënte elk gevoer. Tydens hierdie onderhoude is kwalitatiewe data versamel en vir kwantitatiewe analise was sekondêre data aangewend. Die resultate wat uit die data analise verkry was, strook met die hipotese dat die MIV/VIGS-program doeltreffend is om die behoeftes van die pasiënte en die gemeenskap van Du Noon aan te spreek. Nadat ‘n inhoudsanalise van die kwalitatiewe data onderneem was, het twee temas rakende positiewe en negatiewe gevoelens – gekategoriseer as tevrede en nie tevrede nie – ten opsigte van die gelewerde diens na vore getree. Veral die gevoel van tevredenheid teenoor die diens gelewer by die kliniek en die personeel as behulpsaam, is opgemerk. Die personeel wat die diens lewer, was ook tevrede met die diens wat aan die pasiënte gelewer word, maar was ontevrede oor die toekenning van hulpbronne. By die statistiese analise is ‘n toename in die inskrywingsgetalle deur pasiënte waargeneem. Toename in inskrywingsgetalle deur pasiënte is gemerk in statistiese analise van 2004 - 2008, met 1,018 pasiënte geregistreer. Die statistiek het die lineêre tendens toegelig ten aansien van die inskrywing van pasiënte wat die toeganklikheid en bekostigbaarheid van die diens uitbeeld.