Thesis (MPhil)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: Paarl, in the Western Cape, has been identified as one of the 15 national sites where antiretroviral treatment (ARVs) would be made available to people living with HIV/AIDS. Paarl Hospice initiated a support group for people to deal with this disease in 2003. Since February 2004 Paarl Hospice has been recruiting people from the surrounding informal settlements for ARVs. By means of participant observation I explored how HIV/AIDS-related disclosure experiences unfolded in places, spaces and events associated with the support group in the context of factors enabling and preventing people from accessing Hospice House. I did this by considering the insights drawn from an anthropological approach. I found the meanings of disclosure in the majority of studies to be limited and restricted. Available studies approached disclosure in a top-down fashion by regarding the definition of disclosure as the announcement of HIV-positivity at the time of diagnosis only. These studies have not considered social differences relating to disclosure neither did they focus on the actual process of disclosure. By means of a constructivist approach to grounded theory I seek to broaden the definition of disclosure to account for the range of ways in which disclosure practices take place. I found that disclosure could not be separated from the situational context in which it occurs and that it can only be understood in relation to the circumstances and relationships in which it takes place. In this study, disclosure was an ongoing process, situated somewhere between active, public announcement of an HIV-status and complete secrecy and somewhere between voluntary and involuntary revealing of the disease. / AFRIKAANSE OPSOMMING: Paarl in die Wes-Kaap is geïdentifiseer as een van die 15 nasionale areas waar antiretrovirale medikasie beskikbaar gestel sou word aan mense wat leef met MIV/VIGS. Paarl Hospice het gedurende 2003 ʼn ondersteuningsgroep geїnisieer om aan MIV/VIGS aandag te gee. Sedert Februarie 2004 is Paarl Hospice in die proses om mense te werf uit die omliggende informele behuisingsgebiede vir antiretrovirale behandeling. Met behulp van antropologiese insigte en deelnemende waarneming kon ek nagaan hoe verskillende maniere van MIV/VIGS-verwante bekendmaking ontvou in plekke, ruimtes en gebeurtenisse wat verband hou met die ondersteuningsgroep. MIV/VIGSverwante bekendmaking is ondersoek te midde van inhiberende en fasiliterende faktore wat mense verhoed of aanhelp om Paarl Hospice te besoek. Ek het bevind dat die definisie van bekendmaking in die meeste navorsing gebrekkig is. Beskikbare navorsing het bekendmaking volgens ‘n bo-na-onder-wyse benader as die openbare bekendmaking van ‘n MIV-status na afloop van diagnose alleenlik. Met behulp van ‘n konstruktiewe benadering van die begronde teorie het ek gepoog om die definisie van bekendmaking uit te bou om sodoende die verskeidenheid maniere waarop bekendmaking plaasvind te akkommodeer. Ek het vasgestel dat bekendmaking onlosmaakbaar deel is van die situasionele konteks waarin dit plaasvind en dat dit slegs begryp kan word in verband tot die verhoudings en omstandighede waarin dit plaasvind. In hierdie studie was bekendmaking ʼn voortdurende proses, gesitueer tussen aktiewe openbare bekendmaking en volledige geheimhouding van ʼn MIVstatus, asook tussen volkome vrywillige en onvrywillige bekendmaking van ʼn MIVstatus.

Increasing HIV infection rates affect government employees as much as workers in other places. While government has responded to the evolving crisis with a number of policy documents, little is known about the implementation of such policies in government departments. This study assessed the HIV/AIDS policy in the Department of Labour and identified weakness in the implementation. The results of the study may be used by the Dept. of Labour to improve its implementation if necessary.

HIV/AIDS is a deadly disease that needs to be addressed with immediate effect before serious damage can occur. Because the government has a responsibility over the health of its citizens, everybody expects the government to take a lead in the fight against this epidemic and from the look of things the government's strategies are not making the desired impact on the epidemic. The author attempted to highlight that the South African government has not played a satisfactory role in the fight against this pandemic, which threatens to alter history to a degree not seen in the world.

This thesis explores the history of AIDS activism 'from both sides of the bed', by doctors and gay patients, in the 1980s and early 1990s. Such AIDS activism was formed in opposition to dominant racist and homophobic framings of the epidemic and the AIDS-related discrimination that these representations caused. Moreover, links between both groups of AIDS activists have their origins in this period. This history has emerged through oral interviews conducted with AIDS activists and an analysis of archival material held at the South African History Archive and the Centre for Health Policy at the University of the Witwatersrand. Evidence reveals that AIDS activism was politically overshadowed in the 1980s by the overwhelming need to respond to apartheid. Although the Gay Association of South Africa (GASA) resisted AIDS-related homophobia, it was politically conservative, which later led to its demise, and then the creation of new, more militant anti-apartheid gay AIDS activism. By contrast, the anti-apartheid doctor organisations such as the National Medical and Dental Association (NAMDA) and the National Progressive Primary Health Care Network (PPHC) were militantly anti-apartheid, but did not seriously address AIDS in the 1980s. In the early 1990s, in the new transitional context, AIDS activists framed the epidemic in terms of human rights to combat AIDS-related discrimination in AIDS policy. Simultaneously, doctor activists in NAMDA and PPHC mobilised around AIDS in the early 1990s, but both organisations disbanded after 1994. Meanwhile, gay AIDS activists remained prominent in AIDS activism, as some who were living with HIV adopted the strategy of openness about their HIV status. On the other hand, AIDS-related stigma remained widespread in the transition era with important implications for post-apartheid AIDS activism and policy-making. Ultimately, this history has significantly shaped post-apartheid, rights-based AIDS activism and its recent disputes with the government over AIDS policy. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2004.

HIV/AIDS is a deadly disease that needs to be addressed with immediate effect before serious damage can occur. Because the government has a responsibility over the health of its citizens, everybody expects the government to take a lead in the fight against this epidemic and from the look of things the government's strategies are not making the desired impact on the epidemic. The author attempted to highlight that the South African government has not played a satisfactory role in the fight against this pandemic, which threatens to alter history to a degree not seen in the world.

Increasing HIV infection rates affect government employees as much as workers in other places. While government has responded to the evolving crisis with a number of policy documents, little is known about the implementation of such policies in government departments. This study assessed the HIV/AIDS policy in the Department of Labour and identified weakness in the implementation. The results of the study may be used by the Dept. of Labour to improve its implementation if necessary.

The objective of this treatise is to establish whether a right to social security exists in South Africa, which would entitle HIV positive persons in South Africa citizens to medical care. A study was made of various articles in journals and on the Internet to determine the South African government's policy on a right to social security and to providing medical treatment. It was found that South Africa lacks an integrated, holistic approach to social security and does not guarantee the right to social security, merely the right to have access to social security. The same was found with the right to medical care. Although there seems to be a general right to medical care which extends to and includes HIV-positive patients, the state merely guarantees the right to apply for medical treatment but does not guarantee the granting thereof. It is submitted that the Department of Health's refusal to implement a vertical transmission prevention programme and the failure to offer treatment as an alternative, for whatever reason, is "penny wise and pound foolish". In the long run more money is spent dealing with pediatric AIDS. It was further found that although the government attempted to lay a groundwork with the formulation and acceptance of the national AIDS plan, the successful implementation thereof is seriously hindered due to the lack of inter- and intra-departmental collaboration, essential health services and funding.

The ongoing urgency of addressing AIDS in South Africa has kept academics and activists focussed primarily on the immediate crises of AIDS ‘in the present’. This thesis, covering the period 1980 – 1995, examines narratives about, and responses to, AIDS ‘in the past’ and explores the interplay between these narratives and elites in medical and political communities trying to address AIDS during a period of political transition. The thesis begins by examining the hegemonic medico-scientific narratives about AIDS that featured in the South African Medical Journal, an important site of enquiry as AIDS was primarily conceived of as a ‘medical issue’. The SAMJ narratives, which often relied on constructed ‘AIDS avatars’, framed understandings of the syndrome and influenced responses to it by medical and political communities. The first community that the thesis explores is the African National Congress (ANC) in exile, which had to address AIDS in exile communities and prepare health strategies for ‘the new South Africa’. Secondly, the thesis analyses government responses to AIDS and argues that four phases of response can be identified. These phases were characterised by minimum concerns about obtaining information and providing health advice; efforts to gather infection data while exploiting political and public fear; attempts to extend health education and (belatedly) encourage broader engagement; and finally, consultative, democratic ideals. The thesis then examines the National Medical and Dental Association (NAMDA) a progressive medical organisation that worked with the ANC on influential health (and AIDS) strategies. NAMDA members ‘crossed over’ between various medical and political communities and both reinforced and challenged hegemonic AIDS narratives. Finally, the thesis moves from the abstract, via the practical, to the personal and concludes with a detailed account of the experiences of two sexuality activists at the intersections of these communities and narratives. By focussing on these medical and political communities, and analysing the relationships between these communities, the existing AIDS narratives, and individuals, the thesis also reveals the constructions of morality, ‘race’, gender, and sexuality that infused them. In doing this it shows how polemic and politics combined to influence practical responses to, and personal experiences of, AIDS.

The HIV prevalence in Zimbabwe is one of the highest globally, standing at 14.5% for the ages 15-64 years, and notably 16.7% for women and 12.4% for men. The urban areas have a slightly higher prevalence rate than the rural areas in Zimbabwe. A phenomenological study was carried out whose objective was to formulate guidelines to improve HIV and AIDS communication for women in Zimbabwe, as a key contribution in mitigating the HIV epidemic. The study took place in Harare and Bulawayo, which house most of the urban population. Young urban women aged 20-29 years who have lived in either city for at least the last 12 months, were interviewed using face-to-face in-depth interviews (n=25) and eight focus group discussions took place (n=62). Purposive, convenience, cluster and snow-balling sampling were used. Key informants were purposively sampled, using the snowball method; in-depth face-to-face interviews were held (n=5). The key informants, who provided expert knowledge on the study topic, comprised NGO and government entities in HIV and AIDS communication work. Colaizzi’s method of analysis was used. The UNAIDS Communication Framework for HIV and AIDS gave the direction for the study. It highlights the context in which people live in, and emphasizes that, unlike previous communication models, knowledge alone is inadequate to effect behaviour change. The context is comprised of government policy, culture, socioeconomic status, spirituality and gender relations, with emphasis on the community and regional cooperation, in Africa’s case. The themes for the study were Communication, HIV and AIDS knowledge, Perceptions and belief, and Urban women’s context.The key findings were: mass communication generates awareness for HIV and AIDS while interpersonal communication has a role to play in translating awareness into behaviour change; the knowledge level on HIV and AIDS of young urban Zimbabwean women is high; their risk perception is low; the context they live in is primarily a patriarchal one and one of urban poverty and this makes them vulnerable to HIV infection. It is envisaged that the guidelines, informed by the study and literature, will assist the government and its partners in HIV and AIDS communication strategy and implementation. / Health Studies / D. Litt. et Phil. (Health Studies)

The South African Council of Churches (SACC) played an extremely crucial role during the struggle against apartheid. The role of the SACC was first and foremost to provide a voice for the voiceless. It managed, among other tasks, to actively fill the void left by movements banned by the illegitimate apartheid government. As a result of its fight against the inequalities that existed in South Africa, its work adopted a political character. In the aftermath of post-apartheid South Africa, the SACC was left with the task of redefining its role within South African society and civil society, specifically. The euphoric sentiment in the mid-1990s was in part reflected in the SACC. However, the conclusion reached by the Council in 1995 was that it would also play a role of 'critical solidarity' which essentially meant that it would not shy away from attacking the government when the need arose. Since 1994, the South African government has implemented a number of policies that do not appear to be in the immediate interest of the majority of South African citizens atld have brought church and state into conflict. This thesis attempts to tackle three issues which are pertinent to the South African situation and which shed light on state-civil society interactions. These issues are HIV I Aids, the question of odious debt and the Zimbabwe crisis. By using both primary and secondary sources, the SACC's responses to government's handling of these matters will be compared with the responses of the South African Catholic Bishops Conference in order to determine their relationships with government. The conclusion of this investigation is that the SACC has in fact managed to maintain a position of critical solidarity. It has been faced with numerous challenges with regard to maintaining the fragile boundary of alliance with government on the one hand, and becoming anti-government on the other. However, by forming alliances with other civil society actors as well as fostering a relationship with government in order to facilitate mediation this dissertation argues that the SACC has become an essential member of South Africa's vibrant civil society.