People who have been diagnosed HIV positive often experience distress and anxiety due to uncertainties pertaining to the implications of an HIV positive status. Research has shown that support groups have always been a way for people to cope with the distress and stressful circumstances associated with health conditions such as HIV. This research investigated the role of face to face support groups in the lives of those living with HIV. The primary focus of this research project is to provide an in-depth exploration of HIV positive individuals‟ experiences of being in a support group. The study aims to explore the positive and negative experiences of being in an HIV support group and aims to gain an understanding of the role support plays in the lives of those living with HIV. A qualitative research design was used to explore the above mentioned aim. Semi-structured interviews were conducted with five individuals, (three women and two men) who had experienced HIV support groups. The interviews were transcribed and then analysed according to the principles of interpretative phenomenological analysis (IPA). The findings of this study revealed five super-ordinate themes, which revealed not only the positive and negative experiences of being in a support group, but also the challenges that the participants‟ experienced before joining the group. Getting a sense of the participants‟ experience before joining the group allowed the researcher to get a better understanding of how useful or not the support group has been in helping them deal with the challenges of living with HIV. The themes included: „struggling to survive after diagnosis‟, „struggling to cope: adopting negative coping skills‟, „experiencing a turning-point: a will to survive‟, „attending support group: a sweet experience‟ and lastly, „attending support groups: a bitter experience‟. Findings suggest that for these participants, the advantages outweighed the disadvantages of being in a support group. Therefore this study suggests that face to face support groups are a viable and even necessary option for support. These findings support previous research and literature in regards to the importance of social support in the form of support groups in effectively assisting HIV positive people in their journey to adjust to the consequence of living with HIV.

Made available in DSpace on 2015-06-17T19:34:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-10. Added 1 bitstream(s) on 2015-06-18T12:49:09Z : No. of bitstreams: 1 000829953.pdf: 382824 bytes, checksum: dd8b4ad1283ed8e9ed431c802abc1f2e (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Fundamento: A AIDS representa importante problema de saúde pública da atualidade, assim como a doença aterosclerótica. Com a maior sobrevida entre os infectados pelo HIV, identificou-se aumento do número de eventos cardiovasculares nessa população. Os preditores e a fisiopatologia da associação HIV e aterosclerose não estão totalmente esclarecidos. Objetivos: Identificar a frequência da aterosclerose subclínica em pacientes HIV positivo, comparando-a com indivíduos controle; associar o diagnóstico de aterosclerose com carga viral, níveis de CD4 e tratamento antirretroviral; associar a presença de aterosclerose com fatores de risco cardiovasculares e escore de risco de Framingham, nos pacientes HIV positivo. Casuística e Métodos: estudo prospectivo, transversal, de casos e controles, que avaliou a presença de aterosclerose subclínica em 264 infectados pelo HIV e em 279 indivíduos do grupo controle. Foi avaliado o grau de espessamento médio-intimal de carótidas (EMIC), presença de placa em artérias carótidas, rigidez arterial através da velocidade de onda de pulso (VOP) e augmentation index (AIx), níveis séricos da PCR de alta sensibilidade, perfil lipídico, glicemia, albumina, hemograma, uréia, creatinina e o risco cardiovascular conforme critérios de Framingham. Resultados: Os pacientes foram, em média, seis anos mais velhos que os controles (43,2±10,5 vs. 37,9±11,5 anos; p<0,001), apresentaram menor frequência de sobrepeso / obesidade (51,1 vs. 63,1%; p=0,005) e maior frequência de tabagismo ativo (43,6 vs. 16,1%; p<0,001). Foram encontradas placas em 37% dos pacientes do grupo HIV e em 4% do grupo controle (p<0,001). Os pacientes com placas eram, em média, 11 anos mais velhos do que aqueles sem placas (51,4±9,21 vs. 40,2±9,40 anos; p<0,001) e apresentaram valores maiores de glicemia de jejum [90 (78; 100) vs. 83 (76,5; 90) mg/dL; p=0,012], colesterol total [200 (178; 244) vs. 181 (156; 208,5) mg/dL; ... / Background: AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated to increased number of cardiovascular events in this population and this association is not fully understood. Objectives: To identify the frequency of subclinical atherosclerosis in HIV-infected patients, compared with control subjects; to analyze the association of atherosclerosis with viral load, CD4 counts and antiretroviral treatment, cardiovascular risk factors and with the Framingham risk score, in HIV-positive patients. Methods: a prospective, cross-sectional, case-control study assessed the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 control subjects. Clinical evaluation included carotid intima-media thickness (IMT) measurement, the presence of plaque in the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), blood levels of hs-CRP, lipids, glucose, albumin, blood count, urea, creatinine and cardiovascular risk according to Framingham risk score criteria. Results: Patients were six years older than controls (43.2±10.5 vs. 37.9±11.5 years; p<0.001). Also presented lower prevalence of overweight / obesity (51.1 vs 63.1%; p=0.005) and higher frequency of active smoking (43.6 vs. 16.1%; p<0.001). Plaques were found in 37% of patients in the HIV group and 4% in the control group (p<0.001). Patients with carotid plaque were on average 11 years older than those without plaques (51.4±9.21 vs. 40.2±9.40 years; P<0.001) and had higher fasting glucose [90 (78, 100) vs. 83 (76.5, 90) mg/dl; p=0.012], total cholesterol [200 (178, 244) vs. 181 (156, 208.5) mg/dL; p<0.001], LDL-c [120.1 (96.2, 148.4) vs. 96.8 (80, 125) mg/dL; p<0.001] and triglycerides [188.5 (125.5, 288.5) vs. 150.5 (108, 226) mg/dL; p=0.010], mean systolic blood pressure 10 mmHg higher (132±21 vs. 121±16 mmHg; p<0.001) and mean diastolic blood pressure 6 mmHg ... / CNPq: PIBIC/16522 / FAPESP: 2010/11860-2

Orientador: Beatriz Bojikian Matsubara / Coorientador: João Carlos Hueb / Banca: Katashi Okodhi / Banca: Luis Cuadrado Martin / Banca: Walter Tavares / Banca: Wolney de Andrade Martins / Resumo: Fundamento: A AIDS representa importante problema de saúde pública da atualidade, assim como a doença aterosclerótica. Com a maior sobrevida entre os infectados pelo HIV, identificou-se aumento do número de eventos cardiovasculares nessa população. Os preditores e a fisiopatologia da associação HIV e aterosclerose não estão totalmente esclarecidos. Objetivos: Identificar a frequência da aterosclerose subclínica em pacientes HIV positivo, comparando-a com indivíduos controle; associar o diagnóstico de aterosclerose com carga viral, níveis de CD4 e tratamento antirretroviral; associar a presença de aterosclerose com fatores de risco cardiovasculares e escore de risco de Framingham, nos pacientes HIV positivo. Casuística e Métodos: estudo prospectivo, transversal, de casos e controles, que avaliou a presença de aterosclerose subclínica em 264 infectados pelo HIV e em 279 indivíduos do grupo controle. Foi avaliado o grau de espessamento médio-intimal de carótidas (EMIC), presença de placa em artérias carótidas, rigidez arterial através da velocidade de onda de pulso (VOP) e augmentation index (AIx), níveis séricos da PCR de alta sensibilidade, perfil lipídico, glicemia, albumina, hemograma, uréia, creatinina e o risco cardiovascular conforme critérios de Framingham. Resultados: Os pacientes foram, em média, seis anos mais velhos que os controles (43,2±10,5 vs. 37,9±11,5 anos; p<0,001), apresentaram menor frequência de sobrepeso / obesidade (51,1 vs. 63,1%; p=0,005) e maior frequência de tabagismo ativo (43,6 vs. 16,1%; p<0,001). Foram encontradas placas em 37% dos pacientes do grupo HIV e em 4% do grupo controle (p<0,001). Os pacientes com placas eram, em média, 11 anos mais velhos do que aqueles sem placas (51,4±9,21 vs. 40,2±9,40 anos; p<0,001) e apresentaram valores maiores de glicemia de jejum [90 (78; 100) vs. 83 (76,5; 90) mg/dL; p=0,012], colesterol total [200 (178; 244) vs. 181 (156; 208,5) mg/dL;... / Abstract: Background: AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated to increased number of cardiovascular events in this population and this association is not fully understood. Objectives: To identify the frequency of subclinical atherosclerosis in HIV-infected patients, compared with control subjects; to analyze the association of atherosclerosis with viral load, CD4 counts and antiretroviral treatment, cardiovascular risk factors and with the Framingham risk score, in HIV-positive patients. Methods: a prospective, cross-sectional, case-control study assessed the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 control subjects. Clinical evaluation included carotid intima-media thickness (IMT) measurement, the presence of plaque in the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), blood levels of hs-CRP, lipids, glucose, albumin, blood count, urea, creatinine and cardiovascular risk according to Framingham risk score criteria. Results: Patients were six years older than controls (43.2±10.5 vs. 37.9±11.5 years; p<0.001). Also presented lower prevalence of overweight / obesity (51.1 vs 63.1%; p=0.005) and higher frequency of active smoking (43.6 vs. 16.1%; p<0.001). Plaques were found in 37% of patients in the HIV group and 4% in the control group (p<0.001). Patients with carotid plaque were on average 11 years older than those without plaques (51.4±9.21 vs. 40.2±9.40 years; P<0.001) and had higher fasting glucose [90 (78, 100) vs. 83 (76.5, 90) mg/dl; p=0.012], total cholesterol [200 (178, 244) vs. 181 (156, 208.5) mg/dL; p<0.001], LDL-c [120.1 (96.2, 148.4) vs. 96.8 (80, 125) mg/dL; p<0.001] and triglycerides [188.5 (125.5, 288.5) vs. 150.5 (108, 226) mg/dL; p=0.010], mean systolic blood pressure 10 mmHg higher (132±21 vs. 121±16 mmHg; p<0.001) and mean diastolic blood pressure 6 mmHg ... / Doutor

Ph.D. (Social Work) / Please refer to full text to view abstract

Ph.D. / The Acquired Immunodeficiency Syndrome (AIDS) has taken on pandemic proportions world wide, providing the health care system with the greatest challenge since its existence. At present, infection with the Human Immunodeficiency virus (HIV) is incurable, fatal and dangerously contagious influencing the health of the public as well as exerting profound effects on political, social and economic circumstances of the world. The challenge was and still is, to develop an effective treatment method for Human Immunodeficiency Virus (HIV) infection and /or Clinical AIDS. Up to the present time no effective treatment method has been found, as the retroviral agents typically only cause a temporary inhibition of the progression of the HIV and not a permanent cessation of the activity of the virus. In the absence of any pharmacological treatment, behavioral interventions and in particular biopsychosocial interventions utilizing cognitive-behavioral therapy and ergometric aerobic exercise take on particular importance as adjunctive treatment methods, especially during the asymptomatic and early symptomatic HIV, (CDC stages 2 and 3 and WR stages 2-4 A), but non-Clinical AIDS stages. Adding Electromyographic-feedback assisted relaxation training to the above therapeutic modalities increased the likelihood of addressing specific physiological variables associated with HIV-seropositivity, and served as a direct operant intervention in indirectly enhancing immune system functioning, through psychophysiological mechanisms or by means of the relaxation effect which it produces. In South-Africa the HIV\ AIDS situation is further compounded by a number of social and economic factors in a society expressing rapid political changes against a background of apartheid. Herein, issues of poverty, violence, proper medical care for HIV sufferers, especially in the rural areas where antiviral medications and other health services are not easily accessible, inadequate housing and unemployment place even greater burdens on the already under-served HIV sufferer. With the above aspects in mind and considering the seriousness of the AIDS pandemic in South-Africa as well as the absence of effective pharmacological agents in curing this disease, an 8-week combined biopsychosocial treatment intervention utilizing individualised cognitive-behavioral therapy, aerobic exercise and Electromyographic-feedback assisted relaxation training was developed. The objective of this research was to determine whether the combined biopsychosocial treatment intervention that had been developed would serve as a successful adjunctive treatment method to the present pharmacological treatments, especially during the asymptomatic and early symptomatic stages of HIV-infection where the apparent sluggishness of immunological functioning may be most amenable to interventions that enhance effector functions and communication between CD4 T-lymphocytes, CD8 T-lymphocytes, macrophages and B cells via increases in lymphokine production. The intervention further aimed to decrease depression, physiological tension and anxiety and fatigue levels, as well as increase vigor-activity levels important in the overall health status of HIV-seropositive patients. The intervention was implemented on a group of South- African asymptomatic and early symptomatic (CDC stages 2 and 3 and WR stages 2-4 A) HIV- seropositives. The results of the research revealed no statistically significant between-group differences in any of the cellular immune measurements. Clinically and statistically significant withingroup differences were however found in baseline to post-test measures of total lymphocyte counts in subjects of the experimental group. Statistically significant between-group differences were also found in the tension-anxiety, depression-dejection, fatigue-inertia and vigor-activity levels of experimental subjects as compared to control group subjects. The study further found that subjects who recorded lower depression and tension-anxiety levels at baseline and post-intervention phases had higher CD4 -T lymphocyte counts and therefore, increased resistance to HIV-related infections and diseases. The study also revealed significant within-group differences in terms of the baseline to post-test relaxation effect of the EMG-feedback assisted relaxation training, as well as clinically significant within-group increases in the CD4-T lymphocyte counts of experimental subjects who experienced this relaxation effect.

M.Com. (Business Management) / HIV/AIDS infection is becoming one of the greatest threats the world has had to face the past century. opinions on the subject vary from doomsday scenarios to those that feel that it will just pass as another storm in a teacup, without having any real effect on society. since the indications are there that it is especially the economically active that are exposed to the infection, top management cannot take the chance of ignoring the issue. Unfortunately this seems to be the case in South Africa, with the awakening of the new South Africa, new economic and political opportunities are openlng up for the country. Business leaders cannot allow AIDS to jeopardise these opportunities. Because HIV/AIDS can take more than ten years before becoming visible, most societies, firms and even governments are still only paying lip service in dealing with the matter. AIDS has devastating economic consequences for affected individuals and their families. If the experience of other countries, and current trends in south Africa are any indication, there is likely to be increasing discrimination in the work place, resulting in large numbers of those who are HIV positive losing their jobs. The burden on families who have to care for, and bury people dying of Aids, and consequently those who lose breadwinners, will be enormous. This will be aggravated by unemployment, by inadequate social support services and transfer payments, by discrimination of access to insurance and housing, and by the predicted inability of the health services to offer adequate care to affected individuals, and support of their families. HIV/AIDS is a reality for any work environment. It is therefore of vital importance for management to take cognisance of the important aspects in dealing with the problem. A formal AIDS policy is the only effective solution to prevent discriminatory practices in the workplace. Finally, and most importantly, the AIDS epidemic in south Africa will be a terrible, and enormous human tragedy, through the potentially avoidable loss of hundreds of thousands, and ultimately, millions of lives. In this study, the major implications of AIDS to be considered in company policy, dealing with the AIDS problem in the workplace and in particular the mining industry, are dealt with.

This research was encouraged by the need for Christian religious-ethical principles for counselling of HIV/Aids patients and their families within a multi-religious environment. During his lifetime the researcher was a member of Professional Family Care, a multi-religious and multi-disciplinary organization assisting HIV/Aids patients in Middelburg, Mpumalanga. The aim of the study is to highlight the sexual ethos of people from a Christian ethical perspective by means of the example of the character Samson in the book of Judges (Jd 13-16), in order to derive sexual-ethical principles for counselling. The hypothesis is that an ethical relationship exists between the rebelliousness in Samson’s life, and his sexual conduct. A similar relationship can be identified in our current society as a result of the negligence of healthy religious-ethical norms. A socio-rhetorical approach has been applied to explore various textures found in the Samson saga. After a discussion of Old Testament ethics as a subject, emphasis was laid on analysing the intra-textual, ideological, social and cultural, and holiness structures of the Samson saga. HIV/Aids as a social problem is discussed, primarily by means of relevant statistics. Professional Family Care implements an eco-systemic model, viz. an integrated approach involving medical professions, social workers, and religious leaders from all the religions involved. The principles of this approach are explained. After the religious-ethical perspectives of various religions have been highlighted, final conclusions are drawn. The ethical conduct of individuals normally mirrors the dominant ideological framework of the society in which they live. The sexual-ethical conduct of Samson, within its context, and the ethical principles, which can be deduced from that for the current context of Middelburg, Mpumalanga, clearly indicate that a relationship exists between the violation of sexual-ethical norms of the society as well as the consequences thereof for individuals and the broader community. In the light thereof both the positive and negative conduct of Samson have been implemented to formulate basic principles for counselling. / Prof. Johan Coetzee

D.Litt. et Phil. (Sociology) / Reid and Walker (2005) suggest that black South African men are ‘behaving differently’. Added to this Budlender (2008) has found that South African men are more likely to engage in unpaid community care work than conventional wisdom suggests. Part of this community work involves black men acting as AIDS caregivers. It is imperative to gain knowledge about masculine caregivers as the informal health care sector bears the brunt of the HIV pandemic. The fragmented and over-burdened public health system simply cannot absorb the 15-20% of HIV infected South Africans. Coovadia et.al. (2009) point to a lacuna in the scholarship regarding community health workers (CHW) in South Africa. My study of black masculine caregivers, located in the world of informal AIDS care, hopes to fill this gap. Yet, I do something more for I tackle the conventional wisdom that suggests South African men are different and exceptional if they conduct feminised care work. The emotions involved in care processes are the basis upon which society may feminise care work. My argument is also premised upon forging links between the past and the present. As such, I focus upon determining the extent to which emotional labour that may be exhibited by historical and contemporary black men. I make use of W.E.B. Du Bois’ (1903) notion of double-consciousness to show how the normalising society, surrounding masculine care, impacts this category of black men. In so doing, I not only forge links between past and present by means of doubleconsciousness, but I perform an intersectional analysis of emotional labour, and the context, in which it occurs. In so doing, I show how double-consciousness is an intersectionally-forged mechanism for Foucault’s (1978) biopower, and one that has become reinvented in present day South Africa. In this way I augment the works of Du Bois (1903) and Foucault (1978) for both did not give primacy to gender as a construct. It is essentially this view of black men, involved in AIDS care that contributes to the originality of this work. This historical-sociological investigation relied upon the linking of cases. I conducted historical research upon two cases: ‘houseboys’ in colonial Natal (1850 – 1928) and mine hospital ‘ward boys’ (1931 – 1959). Contemporary cases were constructed to reflect the world of AIDS and cancer care. The 13 original cases were compressed into seven case categories and based on triangulated survey and interview data (29 AIDS and 18 cancer caregivers were interviewed; while 195 community workers involved in AIDS care were surveyed in 2005/6; follow-up interviews were conducted with 11 caregivers across all case categories in 2010).

This research reports on narratives of people whose lives had been infected and affected by the devastating disease - HIV/AIDS. The core information, on which this study is based, comes from experiences of those infected and/or affected by HIV/AIDS as well as from caregivers. It sweeps away statistics and places those seeking to offer help in the midst of those seeking to be helped. This mutual subject-to-subject relationship becomes the stage on which research/therapy, interviews and conversations are conducted. This study therefore opts for an approach that is informed by the experiences of those infected and/or affected and that addresses the realities of their lives. Care and/or lack of care is identified as a phenomenon, which is a direct reflection on how therapy (research) is done by those providing the care and perceived by those receiving the care. In the light of the experiences (stories) shared by the companions, it became evident that there is an existing need for alternative therapeutic ways, which seeks to embrace a therapeutic approach, which will minimize the external authority, or power of the therapist and at the same time maximizes the authority of those seeking therapy. The Narrative approach is explored as a possible therapeutic approach that could be used to empower those infected and/or affected pastorally in a less¬knowledgeable fashion that is not-controlling, not-manipulative, not¬-authoritative and not-knowing - as "guiding" metaphor which will permit the infected and/or affected to use their own thinking, understanding, emotions, creativity and own resources in a way that best fits them in bringing meaning to their own lives. The entire study seeks to emphasise the importance of a therapeutic approach, which seeks to symbolically embrace the "clouded" story of the infected and affected in a story of God's hope. In this approach the therapist simply becomes aware of the presence of a person(s) for whom the devastating reality of HIV/AIDS is an every day reality. This research does not claim to have the solutions or quick fix miracle answer to the complex HIV/AIDS phenomenon, and it neither claims to have the power to bring any neat conclusion to the HIV/AIDS story, but rather have the potential to stimulate a new story of hope and purpose in the lives of the infected and affected. This research emphasises a position where the infected and affected can inhabit and lay claim to the many possibilities of their own lives that lie beyond the knowledge, assumptions, expectations, goals and understandings of the therapist. A position in which the therapist simply becomes available to talk, listen and support. A position that will empower those infected and affected to tell: • the story of need as broadly as possible, • the story of the past, • the future story in the story of the past, • the reinterpreted story of the past, • the imagined story of the future. (Muller 1999:84) / Thesis (PhD (Practical Theology))--University of Pretoria, 2006. / Practical Theology / unrestricted

People living with HIV and AIDS (PLHIV) suffer from a number of stress-related psychological disorders. The aim of this study was to develop an integrative intervention, which combined Cognitive Behaviour Therapy (CBT), Body-Mind Therapy and Multicultural perspectives to assist health care workers in identifying and treating stressrelated psychological disorders among people living with HIV and AIDS. The study employed an intervention research design using both qualitative and quantitative methods. The quantitative data was collected from PLHIV attending HIV Counselling and Testing (HCT) and Anti-retroviral therapy clinics in the Buffalo City Municipality (BCM) of the Eastern Cape Province. The qualitative data was collected from the health care workers of the selected study sites. Purposive sampling was used to select the study sample. Instruments used included a biographical questionnaire, the Beck Depression Inventory-II (BDI-II), Medical Outcome Study- HIV (MOS-HIV) and focus group interviews to gather data for the development of an intervention model that would address reported stress-related psychological disorders. Findings showed that people living with HIV and AIDS endure stress in their lives on daily basis rather than episodes of severe or clinical depression. Many of the PLHIV are dealing with a number of psychosocial problems that compromise their quality of life and health status. In conclusion, the study illustratively interpreted and discussed the results in relation to the objectives of the study. The study recommends that PLHIV should be exposed to stress management programmes, and health care workers (HCWs) should be offered training in basic counselling skills, stress management and/or debriefing.