This study seeks to investigate the practical strategies used by religious organisations in dealing with issues related to HIV/AIDS in Greater Pietermaritzburg. The study comes from the assumption that all religious organisations tend to structure and restructure themselves as a means of responding to and intervening in the problems of society. The study therefore argues that intervention in HIV/AIDS issues is one of the conditions through which restructuring of religious organisation in Greater Pietermaritzburg is currently evident. By way of conclusion then, the study attempts to answer the question as to what extent such interventions are sustainable. The interventions are sustainable in that they are, by and large, undertaken by the grassroots people who are directly affected and infected by HIV/AIDS. However, the interventions are often very variable, ad hoc and haphazard. Thus the study concludes that questions about the sustainability of such interventions still give unclear answers. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001

The HIV and AIDS epidemic has remained one of the leading causes of death in the world and has been destructive in Africa with Sub-Saharan Africa remaining the epidemiological locus of the epidemic. HIV and AIDS hinders development by erasing decades of health, economic and social progress, reducing life expectancy by years and deepening poverty [57].The most urgent public-health problem globally is to devise effective strategies to minimize the destruction caused by the HIV and AIDS epidemic. Due to the problems caused by HIV and AIDS, well defined endpoints to evaluate treatment benefits are needed. The surrogate and true endpoints for a disease need to be specified. The purpose of a surrogate endpoint is to draw conclusions about the effect of intervention on true endpoint without having to observe the true endpoint. It is of great importance to understand the surrogate validation methods. At present the question remains as to whether CD4 count and viral load are good surrogate markers for death in HIV or there are some better surrogate markers. This dissertation was undertaken to obtain some clarity on this question by adopting a mathematical model for HIV at immune system level and the impact of treatment in the form of reverse transcriptase inhibitors (RTIs). For an understanding of HIV, the dissertation begins with the description of the human immune system, HIV virion structure, HIV disease progression and HIV drugs. Then a review of an existing mathematical model follows, analyses and simulations of this model are done. These gave an insight into the dynamics of the CD4 count, viral load and HIV therapy. Thereafter surrogate marker validation methods followed. Finally generalized estimating equations (GEEs) approach was used to analyse real data for HIV positive individuals, from the Centre for the AIDS Programme of Research in South Africa (CAPRISA). Numerical simulations for the HIV dynamic model with treatment suggest that the higher the treatment efficacy, the lower the infected cells are left in the body. The infected cells are suppressed to a lower threshold value but they do not completely disappear, as long as the treatment is not 100% efficacious. Further numerical simulations suggest that it is advantageous to have a low proportion of infectious virions (ω) at an individual level because the individual would produce few infectious virions to infect healthy cells. Statistical analysis model using GEEs suggest that CD4 count< 200 and viral load are highly associated with death, meaning that they are good surrogate markers for death. An interesting finding from the analysis of this particular data from CAPRISA was that low CD4 count and high viral loads as surrogates for HIV survival act independently/additively. The interaction effect was found to be insignificant. Individual characteristics or factors that were found to be significantly associated with HIV related death are weight, CD4 count< 200 and viral load. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

Where HIV/AIDS has had its greatest adverse impact is on TB. People with TB that are infected with HIV are at increased risk of dying from TB than HIV. TB is the leading cause of death in HIV individuals in South Africa. HIV is the driving factor that increases the risk of progression from latent TB to active TB. In South Africa no coherent analysis of the risk determinants of HIV and TB has been done at the national level this study seeks to mend that gab. This study is about estimating risk determinants of HIV and TB. This will be done using the national household survey conducted by Human Sciences Research Council in 2005. Since individuals from the same household and enumerator area more likely to be more alike in terms of risk of disease or correlated among each other, the GEEs will be used to correct for this potential intraclass correlation. Disease occurrence and distribution is highly heterogeneous at the population, household and the individual level. In recognition of this fact we propose to model this heterogeneity at community level through GLMMs and Bayesian hierarchical modelling approaches with enumerator area indicating the community e ect. The results showed that HIV is driven by sex, age, race, education, health and condom use at sexual debut. Factors associated with TB are HIV status, sex, education, income and health. Factors that are common to both diseases are sex, education and health. The results showed that ignoring the intraclass correlation can results to biased estimates. Inference drawn from GLMMs and Bayesian approach provides some degree of con dence in the results. The positive correlation found at an enumerator area level for both HIV and TB indicates that interventions should be aimed at an area level rather than at the individual level. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2009

The following study is a phenomenological inquiry into five white, middle classwomen's experiences living with HIV and AIDS in British Columbia. The purpose, rather than describing AIDS as a medical phenomenon, is to document how being diagnosed HIV positive has affected the women's lives, health, relationships and livelihoods. A context for the women's stories is provided through a critical review of the biomedical model, as well as biomedical and community organizing perspectives on women and AIDS. Mostly verbatim accounts drawn from taped interviews conducted with the five women describes their lives with HIV and AIDS. Experiences surrounding their diagnosis, sources of information about their illness, strategies for coping, management of health, and management of personal and social identities are the themes explored. The women's participation, the role of the researcher, and the work produced are considered parts of an interactive process, demonstrating shared authority between the researcher and participants in the ethnographic process. Documentation of the women's experiences leads to a discussion of the ways in which they successfully manage and control their own health care and well being within the context of larger social forces of sexism, medical bias and stigma. The women are given the last word in the study. In conclusion, a review oftheir situations three years after their initial interviews contributes a significant emotional and descriptive time-depth to the study.

In recent years there has been a worldwide recognition of the disparity of HIV treatment available in the West and in Sub-Saharan Africa. The West African nation of Senegal was early to implement measures that allowed for the distribution of highly effective anti-HIV therapy known as Antiretroviral (ARV) therapy to a limited number of patients. This thesis explores how patients living in Senegal who are infected with HIV have engaged in various negotiations to obtain access to treatment and other resources to meet the needs posed by their infection. These negotiations are framed by various historically embedded notions of how to engage relationships in the search for care. Strategies are also shaped by the biopolitically-laden discourse that guides the distribution of ARV therapy. This thesis traces the structure, evolution, and effects of patients' strategic negotiations in response to the introduction of this therapeutic technology.

Despite impressive advances in biomedical science, the resurgence of infectious diseases poses an emerging threat to global public health. These developments underscore the importance of considering the relationship between biological and social change. This dissertation uses the epicentre of the HIV epidemic in West Africa---Abidjan, Cote-d'Ivoire---as a case study to show how epidemics are "crystallizations" of local biological and social factors. The Abidjan epidemic is accounted for in terms of the city's sexual modernity, rather than the common view that migration and prostitution explain the proportions the epidemic took there early on. This view supports recent epidemiological work demonstrating the importance of networks rather than behaviour in determining the scope of HIV epidemics. This sexual modernity has a complex genealogy that stretches back through the modernisation drive of the postcolonial state to colonial practices of government, including colonial strategies for containing tropical diseases, which shaped how Africans engaged with the modern world. As a result, sexuality became an important strategy for self-fashioning. With the advent of the economic crisis of the 1980s, sexuality became increasingly permeable to economic relations. Likewise, with the crisis, the city's therapeutic economy, heavily weighted towards the consumption of biomedicines, shifted resort for illness from the public health sector to the informal economy. This may have led to inappropriate treatment of sexually transmitted infections and increased re-use of needles, fuelling the epidemic further. Contemporary efforts to address the epidemic demonstrate how "bio-social" crystallizations can further effect social and biological change. The interface between local groups and international organisations is a site where transnational discourses of "empowerment" of people with AIDS, predicated on a western model of "self-help," encounter the local reality of poverty and illn

Ideology is a fundamental aspect of society, and ideological analysis has been applied to the development of explanatory frameworks for understanding structural dominance within social formations. Structural and post-structural conceptions of ideology have focused on macro-ideological phenomena and processes, offering explanation of relations between economic base and super-structure as they interrelate with ideological dominance. Ideologies serve the interests of particular social formations or classes over others, and at the macro-level this has to do with organised thought as it relates to power. This thesis explores the concept of ideology and related concepts of dominance, power and hegemony, through relocating macrolevel understandings and analysis of ideology within analysis of superstructural entities - notably organisations, groups and elites. HIV/AIDS is an ecological phenomenon that is accompanied by processes of sense-making that incorporate ideological dimensions in the public sphere, particularly in relation to social policy and strategy. Ideological discourses about HIV/AIDS have drawn on specific epistemological foundations and world-views, incorporating intersections with parallel ideologies, and in many instances being directed towards achieving expansion and dominance of particular ideas. This ideological strategy incorporates the construction of common sense. Ideological claims are reiterative, but are also related to processes of legitimation that combine structural relations with communicative power. A South African HIV/AIDS programme, LoveLife, is utilised as a case study to demonstrate ideological trajectories over time. The inter-relation between claims about the HIV/AIDS epidemic, claims about impact of the LoveLife programme, and the utility of alliances and structural partnerships in legitimating such claims is explored. These claims-making processes are found to also occur at global level through the active resourcing and facilitation by LoveLife programme's founding funder, the Kaiser Family Foundation. These activities intersect in the development of an ideological bloc that is directed towards expansion and dominance through appropriation of indigenous and global discourse spheres. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

This study focuses on the history of the Roman Catholic, Anglican and United Methodist churches reaction to HIV and AIDS in Manicaland province, Zimbabwe between 1985 and 2005. It attempts to document and analyse what the three so called ‗mainline‘ churches did and failed to do in responding to a new epidemic. The findings that culminated in this work were obtained mainly from primary written and oral sources that were collected between 2009 and 2011. These comprise oral testimonies of Christians from the Roman Catholic, Anglican and United Methodist churches including bishops and lay members of the churches. In addition, information from medical personnel serving at the churches‘ healthcare as well as that from officers serving in the National AIDS Council (NAC) and the Zimbabwe Association of Church-Related Hospitals (ZACH) were incorporated. Primary written sources include statements issued by the church leaders, the synod and annual conference resolutions, the minutes of parish council meetings, the ad clerums, reports by the church HIV and AIDS structures among others. The study establishes that HIV and AIDS, which emerged in Zimbabwe in the early 1980s, definitely affected the church and also seeks to show that the churches‘ reactions in turn had an influence on the epidemic. The state came out to publicly acknowledge AIDS in Zimbabwe in 1985 and two years later the Zimbabwe Catholic Bishops‘ Conference became the first ecclesiastical body to issue a statement on HIV and AIDS in 1987. In 1989 the churches issued a collective statement under the Heads of Christian Denominations (HOCD) in Zimbabwe, which publicised their views on the Christian response to AIDS. The messages were largely moralistic in nature and the churches maintained this stance throughout the period of study. However, it has also been established that the church healthcare centres were involved in accessing condoms to people living with HIV (PLHIV) and other members of the public. Throughout the twenty-two years covered by this study the church healthcare system made an impact on the epidemic through offering treatment to PLHIV. The input of the church healthcare system underwent a three phased evolutionary process: the complementary stage between 1985 and 1994, the church paralleling of the state healthcare system from 1995 to 1999, and replacement of the responsibility of the government in healthcare between 2000 and 2007. Generally, the responses have been subdivided into three phases, which were the early years: from 1985 to 1994, the middle years lasting between 1995 and 1999 and finally the later years falling between 2000 and 2007. The individual churches appear to have been involved in responding to HIV and AIDS with the same motive of serving humanity starting with their followers and moving beyond. Within the Roman Catholic Church the intervention such as care of PLHIV and orphans and vulnerable children (OVC) became a national and diocesan priority that witnessed the birth of the Mutare Community Home Care project in 1992. The new initiative grew stronger over the years and expanded from nine to nineteen stations covering the province. The Anglican Church launched its institutional AIDS care initiatives between 1999 and 2006. The main thrust was on training of Anglicans in responding to the epidemic and the establishment of AIDS care and treatment centres in selected rural areas. Within the United Methodist Church, the thrust was on care of orphans and vulnerable children and home-care at the station, circuit and annual conference levels. All the three churches received donor funding for HIV and AIDS interventions and this became important at a time when the state healthcare and welfare systems were unable to provide care and support to people infected and affected by the epidemic. The study argues that indeed HIV and AIDS like other earlier epidemics such as Black Death in Europe and influenza in Southern Africa is a historical phenomenon which received mixed responses from the community including Christians. It brought to light some of the negative reactions such as denial, stigma and discrimination and yet the epidemic also drew in Christian communities, individuals and institutions to show compassion by caring for people affected and infected by HIV and AIDS. At the institutional level bishops were in a dilemma of maintaining the moral teaching of the church on sexuality and yet they were also expected to be flexible in finding practical ways of preventing HIV. There were other dynamics such as culture, which prevented people from using condoms. The church followers made a very essential contribution in mitigating the effects of the epidemic by being the army of caregivers to people infected and affected by HIV and AIDS. Despite their unique dedication to caring for AIDS clients, women were the most affected by the epidemic because of the patriarchal nature of the churches and the cultural perceptions of gender and sexuality. It is hoped that the churches will draw on this history to shape future HIV and AIDS interventions. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

South Africa has a severe HIV/AIDS epidemic and the majority of the people infected are in the economically active age group. The education sector is particularly affected by HIV/AIDS because both the demand for and supply of educators are affected. Women make up a great majority of the teaching fraternity and their vulnerability to HIV and AIDS will be discussed. The focus of this study is on educators living with HIV and AIDS in the province of Kwa-Zulu Natal in South Africa. Educators are perceived as ‘icons of morality’ hence their difficulty in disclosing their HIV status. This study offers an insight into the lives of the educators in this study, and explores how educators managed their lives and the disease on a daily basis at home and in particular at school. The participants for this study were obtained through convenience sampling given the sensitive nature of the study. Through the use of a life-story approach, all five participants, (current and previous) are educators and were interviewed over a period of time. Focus group discussions were also done in selected areas with school management teams (SMTs), to ascertain attitudes towards and support for educators living with HIV. During these many interviews with my research participants, I listened to their life experiences, felt their grief and trauma, and really understood their feelings of hopelessness. During these interactions, I was able to gather first hand information on the plight of educators living with HIV and AIDS, their voices spoke of their psychological emotions, and this confirmed that the general public and more especially the school fraternity needed to be educated about the disease, in order to dispel the myths and stigma surrounding HIV and AIDS. The grounded theory approach was used to analyse the data collected. Apart from the analysis of data, the life story interview of each participant is included in this thesis. The lack of support and the secrecy that has become imperative on issues around HIV and AIDS has brought about un-savory labels like ‘us’ and ‘them.’ The data also emphasized the importance of schools and the school community to work together in order to manage HIV and AIDS. The adherence and effectiveness of school policies concerning HIV and AIDS in terms of the constitution are also discussed. In conclusion the voices in this thesis have highlighted the importance of HIV/AIDS empowerment and support, individual empowerment equals the antithesis of vulnerability. HIV/AIDS can be looked upon as a serious chronic ailment which can be handled with medication and a safe healthy lifestyle, with the express hope of keeping our educators in the classroom in a good state of health for longer. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

This thesis is a participatory research study that was conducted amongst twenty-two, 15 to 20-year-old youth with disabilities in the Umgungundlovu district of KwaZulu-Natal, South Africa. The aim of the thesis was to investigate how Zulu-speaking youth with physical and sensory impairments bring into discourse issues surrounding love, relationships, sex and HIV & AIDS in the construction of their sexual identities. As part of this process, three youth with disabilities were trained as co-researchers. In this context, a further aim of this thesis was to make evident what youth with disabilities learn through undertaking sexuality research. Using a post-structural framework, with particular emphasis on queer theory, a key argument of this thesis is that power emerges through the networks of relations in the study. This thesis also troubles the linear discourse of empowerment and the relationships between adults and young people in sexuality and HIV & AIDS research. The thesis adopted a qualitative methodology and used a participatory research design. Data was collected through the use of focus group discussions, individual interviews and participatory rural appraisal (PRA) techniques such as drawings and timelines. The co-researchers were responsible for carrying out the focus group discussions and individual interviews with other disabled youth, as well as being involved in some aspects of the data analysis of this thesis. Data were analysed using a multi-levelled process that combined both content analysis and discourse analysis. The findings make evident that youth with disabilities are sexual beings who continually re-construct their sexual identities in the context of the discourses available to them. Furthermore, the findings demonstrate that, in constructing their sexual identities, youth with disabilities do so within the intersectionality of complementary and contentious discourses of gender, culture, modernity, ableism and adultism. In relation to the co-researchers, it was found that being part of the study provided a dialogical space allowing them to develop new self-positions, which they were able to apply to their personal lives outside the research arena. The thesis recommends the training of youth with disabilities as peer educators in sexuality and HIV & AIDS pedagogy. It also strongly argues for the need to review current teacher education curriculum in South Africa in order to take cognisance of the sexuality of youth with disabilities and their vulnerability to HIV & AIDS. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.