This study sought to investigate factors that influence adherence to treatment amongst rural people living with HIV and accessing antiretroviral therapy (ART) at Shongwe hospital in Mpumalanga. Both quantitative and qualitative methods were used. From patients’ case files, a sample of twenty-eight respondents was recruited for the completion of questionnaires. A focus group discussion with nine participants was held, followed by qualitative interviews with three key informants. Findings indicated that a complex web of factors unique to each patient’s social context plays a role in determining whether or not patients adhere to their regimens. Obstacles to adherence are poor social support, problems relating to disclosure, unemployment and economic hardship, traditional and religious beliefs, the quality and nature of adherence counselling and treatment side effects. / Sociology / M. A. (Social Behaviour Studies in HIV/AIDS)

Background: The South Africa’s reproductive health policy put more emphasis on dual methods in preventing unwanted pregnancies, sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) transmission. Regardless of such policies, the uptake of voluntary counselling and testing (VCT) services remains a personal choice. Aim: The purpose of the study was to determine the accessibility, acceptance and utilisation of VCT services by women on hormonal contraceptives. Methods: About 134 women obtaining hormonal contraceptives were interviewed in a cross-sectional study. Descriptive and logistic regression analysis was applied to analyse the study data. Results: Respondents displayed positive attitudes towards Human Immunodeficiency Virus (HIV) testing. Unavailability and poor access to in-house VCT services was found to be a barrier for use of these services. Conclusion: There’s a need for provider initiated counselling and testing (PICT) strengthening and integration of VCT services into family planning. / Public Health / M.P.H. (Public Health)

Stigma and discrimination (SAD) attached to Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been recognised as a major obstacle to HIV prevention, treatment, care and support throughout the world. SAD is more devastating when it occurs in health care settings where it is least expected. Health care providers (HCPs) are supposed to provide physical, social and psychological support to people living with HIV (PLWHA) but HIV and AIDS-related SAD has been extensively documented among the HCPs. Different studies have pointed out that there are three major actionable causes of HIV-related SAD in health care settings. These are lack of awareness among HCPs, fear of casual contacts and associating the SAD to immoral behaviour. The main objective of the current study is to determine the magnitude of HIV and AIDS-related SAD and its associated factors in hospitals and then to propose appropriate SAD reduction-intervention strategy in the health care settings. The study employed pre-test-post-test design with non-equivalent control group. Two paradigms were used in this study including quantitative and qualitative approaches. The sampling method for the quantitative part of the study was probability sampling in which the respondents were randomly selected using stratified sampling technique. The study was able to determine the magnitude of HIV and AIDS-related SAD among the HCPs. Moreover, the study has identified the factors that are attributed to the prevalence of SAD in the hospitals. The major factors identified for causing the SAD in the hospitals were sex, age, work experience, low level of knowledge, negative attitudes and percieved risk of HIV infection of some HCPs toward the PLWHA. The intervention made on the respondents in the treatment group was able to reduce the overall prevalence of the SAD among the HCPs. The study suggests that to reduce the SAD, HIV and AIDS-related trainings before and after graduation is critical to improve the knowledge, attitudes and practices of the HCPs. Besides, ensuring the availability of the protective supplies in hospitals is crucial in reducing the fear of HIV infection among the HCPs while providing care for HIV positive patients. Effective implementation of the hospital policies, strategies, guidelines and protocols along with good institutional support is also vital in creating safe and user-friendly hospitals for PLWHA. / Health Studies

Text in English / The discovery that anti-retroviral therapy (ART) is important for human immunodeficiency syndrome (HIV) prevention has increased interest in factors that influence adherence to HIV treatment. Studies have shown that non-adherence to ART results in drug resistance, morbidity and person-to-person HIV transmission. For persons defaulting on or living risky sexual lives, becoming adherent is a life-saving behavioural change, both for themselves and for their sexual partners. HIV/AIDS programmes are trying different innovations to enhance behavioural outcomes of people living with HIV (PLHIV). This study sought to determine the value of support group participation and based on the findings, to develop an evidence-based model for revitalising caregiver social support competencies. The study was conducted in two phases. In the first phase, a cross-sectional descriptive design was used to compare PLHIV who participate in support group activities with those who do not, in terms of their behavioural outcomes. Multistage probability sampling was used to select study respondents. Data was collected using a selfadministered questionnaire from 1,676 respondents between February and May 2014. Data was analysed using STATA. Data analysis shows that 47% of respondents had once (ever) participated in support group activities while 53% had never. PLHIV who participated in support group activities differed from those who did not in terms of HIV-related stigma (p=<0.001), positive HIV status disclosure (p=0.005), ART adherence (p=0.021), and sexual risk behaviours (p=0.045). PLHIV who participated in support group activities were more likely to have less internal HIV-related stigma, disclose their positive HIV status, adhere to ART and live less risky sexual lives. The two study groups were not different in terms of perceived social support (p=0.28) and external stigma (p=0.250). More PLHIV obtained social support from health workers (66%) and family members (36%) than from PLHIV support groups (16%). The researcher concludes that participating in support group activities positively impacts on behavioural outcomes of PLHIV, but PLHIV support groups are not the only sources of social support. In the second phase, a model for revitalising PLHIV caregiver social support competencies was developed as a recommendation for assuring PLHIV access to holistic care and support. / Health Studies / D. Litt. et Phil. (Health Studies)

AIDS-related bereavement counselling programmes / The aim of this study was to determine whether there is a need for specific bereavement counselling programmes for women affected by HIV/AIDS in Indonesia, where death is believed to be fated. Six AIDS-bereaved women were recruited. Data analysis was conducted based on the women's interview transcripts and journal entries. The women experienced at least three traumatic life events. The most challenging experience was learning that they have contracted a disease they knew to be mostly associated with prostitution. Given the short lapse of time between their husbands' deaths and learning about their seropositivity, biographical disruption appeared to have acted as an "analgesic", while concerns to protect their children seemed to have triggered biographical reinforcement. This phenomenon may have brought about a positive bereavement outcome. Specific counselling programmes for women affected by HIV/AIDS are needed, but emphasis should first be placed on improving their wellbeing and their perception of stigma. / Sociology / M.A. (Sociology (Social Behaviour Studies in HIV/AIDS))

The study was about the process evaluation of the development of the YOUNG WORKERS CAMPAIGN (YWC) Programme to document and analyses the involvement and participation of stakeholders in the development process. The purpose of the study was on the assessment of stakeholder participation and involvement in the development of the YWC to maximise the effectiveness, acceptability and sustainability of the intended programme. Informant interviews, focus group interviews and document analysis were the primary means of collecting data for this research study. The main findings are as follows: Few of the stakeholders were involved in the conceptualisation phase of the YWC Programme and their roles in the development process were not clearly described. Stakeholder analysis was not done and their involvement in decision-making was limited. In order to address the problem of participation, YWC stakeholders should pass through a process of stakeholder analysis, that is, they should be assessed in terms of contribution and value-adding to the development process. / Sociology / M.A. (Social Behaviour Studies HIV/AIDS)

The study was about the process evaluation of the development of the YOUNG WORKERS CAMPAIGN (YWC) Programme to document and analyses the involvement and participation of stakeholders in the development process. The purpose of the study was on the assessment of stakeholder participation and involvement in the development of the YWC to maximise the effectiveness, acceptability and sustainability of the intended programme. Informant interviews, focus group interviews and document analysis were the primary means of collecting data for this research study. The main findings are as follows: Few of the stakeholders were involved in the conceptualisation phase of the YWC Programme and their roles in the development process were not clearly described. Stakeholder analysis was not done and their involvement in decision-making was limited. In order to address the problem of participation, YWC stakeholders should pass through a process of stakeholder analysis, that is, they should be assessed in terms of contribution and value-adding to the development process. / Sociology / M.A. (Social Behaviour Studies HIV/AIDS)

The researcher investigated the knowledge, attitudes and experiences of people living with the Human Immunodeficiency Virus (HIV) towards antiretroviral treatment (ART) and who are accessing antiretroviral treatment at a public health clinic in Limpopo, South Africa. A qualitative method was used. The research findings revealed five themes: experiences, social support, knowledge, attitudes, unemployment and economic themes of the study. Factors reported influencing optimum adherence were the inability of the patients to take medication at work, laziness of the patients to collect medication, unemployment, economic hardship, poverty and lack of knowledge of employers regarding HIV/AIDS. / Health Studies / M.A. (Social Behaviour Studies in HIV and AIDS)

AIDS-related bereavement counselling programmes / The aim of this study was to determine whether there is a need for specific bereavement counselling programmes for women affected by HIV/AIDS in Indonesia, where death is believed to be fated. Six AIDS-bereaved women were recruited. Data analysis was conducted based on the women's interview transcripts and journal entries. The women experienced at least three traumatic life events. The most challenging experience was learning that they have contracted a disease they knew to be mostly associated with prostitution. Given the short lapse of time between their husbands' deaths and learning about their seropositivity, biographical disruption appeared to have acted as an "analgesic", while concerns to protect their children seemed to have triggered biographical reinforcement. This phenomenon may have brought about a positive bereavement outcome. Specific counselling programmes for women affected by HIV/AIDS are needed, but emphasis should first be placed on improving their wellbeing and their perception of stigma. / Sociology / M.A. (Sociology (Social Behaviour Studies in HIV/AIDS))

AIM The purpose of this study was to explore and describe factors that contribute to the non-initiation of Antiretroviral Therapy (ART) amongst Pre-Antiretroviral Therapy eligible patients and to make recommendations for health care workers to enhance early initiation of pre-ART-eligible patients for primary health care facilities in Swaziland. METHOD A qualitative design was applied in rural primary health care (PHC) facilities in the Hhohho region of Swaziland. The target population for this study included nurses who have successfully completed the National Nurse Led Antiretroviral Therapy Initiation in Swaziland (NARTIS) training, and who actively initiated ART to eligible patients in rural PHC facilities. Data was collected through semi-structured interviews and field notes. Purposive, convenient sampling was applied. Eleven respondents were interviewed for the study, and data was collected until data saturation was reached. Data from transcripts and field notes was analysed and categorised with thematic analysis through Tesch’s open coding process. RESULTS The study identified the following three predominant themes: 1) systematic enablers of prompt ART initiation, 2) barriers to prompt ART initiation, 3) sources of support. Categories included public health care (PHC) factors, community level factors, the interdependence of the health care system, patient centred barriers, individual patient agency, and NARTIS nurse support. CONCLUSION The recommendations for health care workers that emerged from the study included continued HIV treatment scale-up and decentralisation to grass roots levels, aggressive treatment prioritisation among pre-ART patients, building the capacity of the local health care system and continued research initiatives. It is hoped that recommendations emerging from the findings of this study will have positive implications for programming and practice regarding the initiation of ART for eligible pre-ART patients in Swaziland. / Health Studies / M. PH.