Thesis (M.A. (Clinical psychology) --University of Limpopo, 2009. / The study aimed at assessing and understanding the unmet needs and well-being among people living with HIV/AIDS. People living with HIVAIDS experience many challenges. Challenges may be characterized by medical, social and psychological challenges. Method: A cross sectional design was used. A total of (N = 200) young and adult age ranged from 20-71 years ( = 43.70, SD = 12.420) women (62%) and 75 men (37, 5%) living with HIV/AIDS who attend HIV/AIDS clinic/unit in Polokwane/Mankweng hospital complex was selected with purposive sample. Results: Four hypotheses were tested with one-way ANOVA. The findings indicated that social support (p < .001) and age (p < .04) plays a significant role in the psychological well-being of people living with HIV/AIDS. Medical challenges and gender revealed no significant results. Conclusion: It is concluded that PLWHA attend some form of support groups which will aid in alleviating the psychological distress associated with HIV/AIDS.

Thesis (MA (Clinical Psychology)) --University of Limpopo, 2009 / The aims of the study was to investigate if people living with HIV/AIDS (PLWHA) have access to health care, to determine utilisation patterns and to investigate how gender differences, socioeconomic, geographic location, and cultural beliefs influence access to and the utilisation of health care among PLWHA. Methods: This was a quantitative study based on a cross-sectional design. The study comprised of 200 participants (45% males and 55% females), of which 71% were unemployed. Twenty-eight (28%) survive by the disability grant due to the illness as well as child support grants. Sixty eight (68%) were diagnosed with HIV/AIDS for the duration of 3-5 years. Descriptives, frequencies and ANOVA were employed to analyse data. Results: Participants were found to have access to and to utilise health care services. There was no gender differences found with regard to access to and utilisation of health care, but there was however a significant (p<.05) difference in gender and educational level interaction. Educational level and geographical location were found not to influence the actual access and utilisation rather, it determined the type of health care service utilised. Participants with higher educational levels, and those who reside in urban areas were significantly (p<.05) found to utilise private health care services than primary health care. Cultural beliefs were found not to influence access to and utilise of health care services. Conclusion: Barriers outlined for non-use of primary health care services need immediate attention in order to maximise access to and utilisation of primary health care services by PLWHA.

Thesis (MTh)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Conventional HIV intervention strategies are based on the presupposition that scientific knowledge and appropriate information about HIV will curb the spread of the disease. The dominant approaches to the HIV debate and pandemic focus mostly on the medical, pedagogical and ethical dimensions of the pandemic. Governments are concerned with democratic and human rights and the juridical implications of HIV. This study proposes that a team approach should be followed, with the emphasis on a holistic model of prevention care. In this regard it is hypothesised that the spiritual dimension, emphasising our human quest for meaning, moral decision-making and virtues as related to the transcendent dimension of our being human, should play a substantial role. One of the most burning issues in the pandemic is the phenomenon of stigmatisation. This investigation is in search of an approach that can effectively penetrate the realm of prejudice, blaming, and discrimination. If spirituality can address stigmatisation, antistigma interventions must acknowledge the role of pastoral care with its emphasis on ‘soul care’, values and meaning. The study explores the possibility of extending the traditional understanding of theology as fides quarens intellectum, with its emphasis on knowledge (the rational), to fides quares imaginem, with its emphasis on imagination (the aesthetic dimension of life). Therefore the important presupposition that, due to the aesthetic dimension of faith, care to people living with HIV should include the aesthetic dimension. If one links fides quares imaginem to fides quarens visum new options can be created for Practical Theology. In this regard, the visual dimension of life as represented by media, and specifically film, should be investigated in a HIV prevention strategy. The study thus proposes that a specific form of art, namely film, has potential as an effective antistigma intervention. It is hypothesised that film inherently has a spiritual dimension. This spiritual dimension could be linked to issues that can determine the direction and meaning of life, as well as the understanding of human identity and dignity. In this regard the study wants to determine to what extent film can play a fundamental role in addressing the realm of attitudes, convictions and belief systems. Film is thus suggested as a medium for spiritual intervention in order to bring about change on the level of perceptions. Lesser-educated people are very vulnerable, especially in relation to HIV. The study wants to explore whether film can be an effective medium of addressing, educating and influencing such people at their level. In order to test this, an empirical study was done to assess the effect that film has on HIV stigmatisation within such a group of people. The aim of the empirical research was not to create statistical evidence, but to illustrate certain trends and tendencies. A group of people from Vlaeberg, a rural area outside of Stellenbosch, South Africa, was chosen for the study. In order to empirically explore the potential of film in addressing HIV stigmatisation it was decided to use the film Yesterday, the first South African film to be nominated for an Oscar. The film was chosen for the following reasons: a) it is set within South Africa, depicting vulnerable persons within a rural setting; b) it has a positive, though realistic approach to HIV; c) it depicts the cruelty of stigmatisation; d) it shows how you can assist those with HIV; and e) it is easily understandable. The film was positively received and able to influence the stigmatising perceptions, attitudes and convictions of the target group. The empirical study proved that film has a spiritual dimension and should be used as a medium for spirituality formation. Due to this, it has an important role to play in antistigma interventions. In this regard, the research showed that film can indeed play a decisive role in a HIV prevention strategy and an antistigma intervention. / AFRIKAANSE OPSOMMING: Konvensionele MIV-ingrypingstrategieë word gebaseer op die aanname dat wetenskaplike kennis en geskikte inligting aangaande MIV die verspreiding van die virus sal kan halt. Die dominante benaderings tot die MIV-debat en –pandemie fokus meesal op die mediese, pedagogiese en etiese dimensies van die pandemie. Regerings is bemoeid met die demokratiese regte, menseregte en wetlike implikasies van MIV. Hierdie studie stel voor dat ’n spanbenadering gevolg moet word, waarbinne die fokus sal wees op ’n holistiese model van voorkomende sorg. Die hipotese is dat die spiritualiteits-dimensie ’n substansiële rol moet speel, aangesien dit ons menslike strewe na betekenis, morele besluitneming en waardes, soos dit in verhouding staan tot die transendente dimensie van ons menswees, in ag neem. Een van die kwellende vraagstukke van die pandemie is stigmatisasie. Hierdie navorsing soek ’n benadering wat effektief die gebied van vooroordele, beskuldiging, en diskriminasie kan penetreer. Indien spiritualiteit stigmatisasie kan aanspreek, moet antistigma-ingrypings die rol van pastorale sorg, wat klem lê op ‘sielesorg’, waardes en betekenis, erken. Die studie ondersoek die moontlikheid dat die tradisionele verstaan van teologie as fides quarens intellectum, met die klem op kennis (die rasionele), uitgebrei moet word na fides quares imaginem, met die klem op die verbeelding (die estetiese dimensie van die lewe). Daarom word die belangrike aanname gemaak dat, as gevolg van die estetiese dimensie van geloof, sorg vir dié met MIV die estetiese dimensie moet insluit. As ’n mens fides quares imaginem skakel met fides quarens visum word nuwe moontlikhede ontsluit vir Praktiese Teologie. In hierdie opsig moet die visuele dimensie van die lewe, soos dit uitgebeeld word deur die media en meer spesifiek film, ondersoek word in ’n MIV-voorkomingstrategie. Die studie stel voor dat ’n spesifieke vorm van kuns, naamlik film, potensiaal het as ’n effektiewe antistigma-ingryping. Daarom die hipotese dat film inherent ’n spirituele dimensie het. Hierdie spirituele dimensie kan geskakel word met kwessies wat die rigting en betekenis van lewe kan bepaal, sowel as ons verstaan van menslike identiteit en waardigheid. Gevolglik wil hierdie studie bepaal tot watter mate film ’n fundamentele rol kan speel in die aanspreking van houdings en oortuigings. Film word dus voorgestel as ’n medium vir spirituele ingryping om sodoende verandering te bring op die vlak van persepsies. Mense met minder opvoeding is baie kwesbaar en blootgestel, veral in terme van MIV. Hierdie studie ondersoek of film ’n effektiewe medium kan wees om sulke mense aan te spreek, op te voed en te beïnvloed. Om dit te bepaal is ’n empiriese studie gedoen wat moes vasstel watter effek film het op MIV-stigmatisering binne so ’n groep. Die doel van die empiriese studie was nie om statistiese bewyse te lewer nie, maar om sekere neigings en tendense aan te toon. ’n Groep mense van Vlaeberg, ’n plattelandse area buite Stellenbosch, Suid-Afrika, is gebruik vir die studie. Die film Yesterday is gebruik vir die empiriese ondersoek aangaande die potensiaal wat film het om MIV-stigmatisering aan te spreek. Yesterday is die eerste Suid-Afrikaanse film wat vir ’n Oscar benoem is. Die film is gekies om die volgende redes: a) dit speel af in Suid- Afrika en weerlose mense binne ’n plattelandse omgewing word uitgebeeld; b) dit het ’n positiewe, dog realistiese benadering tot MIV; c) dit beeld die wreedheid van stigmatisering uit; d) dit dui aan hoe ’n mens diegene met MIV kan bystaan; en e) dit is maklik verstaanbaar. Die film was positief ontvang en het die stigmatiserende persepsies, houdings en oortuigings van die groep beïnvloed. Die empiriese studie het bewys dat film ’n spirituele dimensie het en as medium vir spirituele vorming gebruik moet word. Dus het film ’n belangrike rol te speel in antistigma-ingrypings. In hierdie opsig het die navorsing gewys dat film wel ’n deurslaggewende rol in ’n MIV-voorkomingstrategie en ’n antistigma-ingryping kan speel.

This study employed a qualitative hermeneutic methodology to compare and explore the stress faced by families caring for a family member with cancer or HIV/AIDS. Four 'Indian' families, two with a family member with cancer and two with a family member with HIV/AIDS, were purposiveiy sampled through NGOs in Pietermaritzburg and Durban. Generally it appeared that the illnesses brought about a range of stressors in families including fmancial and care-related stressors, role changes, difficulties accessing medical treatment, uncertainty and the psychological responses of family members. The impact of these on families was mediated by the families' abilities, social support, a variety of meaning factors and stigma. It did however, appear that families caring for a family member with HIV/AIDS had to cope with several additional burdens including coping with a more prolonged and variable period of illness, fears of infection, increased difficulties accessing medical treatment, less social support and stigma. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2002. / Konrad Schrenk

Submitted in fulfillment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015. / Abstract The HIV pandemic continues to intensify in most countries, especially in Sub­ Saharan Africa, with 1.8 million new people becoming infected with the disease in 2011. Sub- Saharan Africa is the world's worst HIV and AIDS affected region. The intensity of the AIDS pandemic in South Africa creates additional challenges for health workers. Apart from the fact that they could be infected, they have to deal with an increasing number of people who suffer from a fatal disease for which no cure has been found. Nurses are expected to give all the necessary care to these patients. The HIV and AIDS epidemic in South Africa poses challenges for an overburdened health care system. There is limited knowledge about health care perceptions and emotional experiences of providing HIV and AIDS related care and support. It is against this backdrop that the researcher has chosen to explore the experiences of first-year student nurses, caring for HIV and AIDS patients. Aim of the study The purpose of the study was to explore the lived experiences of first-year student nurses, nursing HIV and AIDS patients. Methodology A descriptive phenomenological research design was used to explore the experiences of first-year student nurses, caring for HIV and AIDS patients. The research setting was two colleges of nursing in the uMgungundlovu District that offer the four-year nursing diploma programme. The type of purposeful sampling that was used was criterion sampling, which entailed studying cases which met pre-set criteria. In-depth interviews with the first-year student nurses, who had experienced nursing HIV and AIDS patients, were conducted. The data was analysed manually and put into categories and sub-categories as they emerged. Results The findings revealed that the participants had positive and negative experiences when they provided nursing care to HIV positive patients. The positive experiences were that the participants did not fear meeting HIV positive patients and they were not traumatized. These participants nursed HIV positive patients like any other patient. The participants expressed their feelings as sad and bad. Participants who had negative experiences were shocked, scared and cried when they met HIV positive patients. Six participants reported that they did not know of any facilities available for debriefing and sharing of experiences. The remaining participants identified the group lecturer, group mates, the psychologist and registered nurse in the ward. There was a lesson in class that was dedicated to debriefing and the sharing of experiences. The majority of the participants (n=10) stated that HIV and AIDS was transmitted through contact with infected body fluids and blood. The participants identified similar methods of transmission, which were unprotected sexual intercourse, needle-stick injuries, use of contaminated needles and mother- to- child transmission of HIV and AIDS. The participants were able to correctly identify the modes of transmission, except for one participant who was not sure if HIV and AIDS was transmitted through breast-feeding, due to a lack of knowledge of the modes of transmission. Six participants identified voluntary counselling and testing (VCT) as a support service available for nurses exposed to HIV and AIDS. Three participants verbalised that they did not know of any services available to student nurses. Some participants were not sure if the services were available and accessible and had no idea if the services were available and accessible to the student nurses. There were various problems that were encountered by the participants with regards to accessing the services. These included a lack of privacy, fear of giving information to colleagues, early closure of the clinic and unavailability of the counsellor when needed. Recommendations were made concerning the need for adequate preparation of student nurses in their early training, with regard to VCT, PMTCT, home- based care and support groups. The stigma for HIV and AIDS needs to be adequately addressed. Support for student nurses needs to be provided when dealing with death of HIV and AIDS patients, as a large majority voiced not being able to cope. Conclusion Student nurses who shared their experiences nursing HIV and AIDS patients had positive and negative experiences when they provided nursing care to HIV positive patients. The participants needed the relevant support and counselling to be available when needed. Stigma still exists, even though HIV and AIDS has existed for at least thirty years. / PDF copy unavailable. please refer to hard copy for full text information / M

There is a very limited literature examining transport and access to health care, especially in the South African context. The existing literature does not provide an analysis of the influence of transport on access to health care and the utilisation of referrals by the patients. In the context of the HIV/AIDS and Tuberculosis epidemics which have already increased the demand for health care and utilisation of referrals, transport is a critical issue to take into account with regard to access to health care. The case study presented in this dissertation examines the influence of transport (either public or private) on patient's access to health care facilities, particularly the referrals and Emergency Medical services (EMS). The findings are based on a sample of 30 EMS providers, 15 clinic and hospital nurses, doctors and senior administrators, as well as 200 patients (clients) seeking health care in the three clinics which were chosen as study sites. Using qualitative and quantitative methods, this study focuses on patients seeking health care as well as those who provide health care routinely at clinics and hospitals and in emergencies. The focus of interest was transport needs and services and its role in patient access in the context of HIV/AIDS and TB epidemics. Findings of this study confirm research undertaken in other developing contexts. They show that in rural and some remote urban settlements, transport is a serious barrier to equitable access to health care. Race and locality combine to generate a hierarchy of access to care in South Africa. The study concludes that there is a need to reallocate resources in the health sector in order to increase access. Transport needs have to be taken into account when access to services is planned. And alternative models of health care provision in the context of the epidemics have to be conceived, emphasising the provision of well-equipped and resourced primary health care facilities. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

<strong>Background:</strong> Sub-Saharan Africa is home to 85% of the world's HIV-positive adolescents: an estimated 1.3-2.2 million 10-19 year olds. Adolescents living with HIV face multiple sexual and reproductive health risks: unwanted pregnancies and the risk of mother-to-child-transmission, risk of infecting partners, co-infection with other STIs, and the rising but undocumented risk of re-infection by potentially resistant HI-virus strains. Using contraception, especially condoms, is particularly challenging for all adolescents. It is even more difficult for HIV-positive adolescents due to HIV-related factors such as learning their HIV-positive status, withholding or disclosing their HIV-status to sexual partners, and accessing services in the home, clinics, and schools. This thesis aims to understand which factors shape sexual risk-taking among HIV-positive adolescents to inform the development of interventions that promote safe sexual practices in this population. <strong>Methodology:</strong> This thesis applies a socio-ecological model to investigate factors associated with sexual risk-taking among HIV-positive adolescents. It consists of three stand-alone papers: a systematic review and two quantitative papers based on a cross-sectional epidemiological and aetiological study of unprotected sex among HIV-positive adolescents and community controls in South Africa. Paper 1 is a systematic review of rates, correlates, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Paper 2 looks at associations between HIV-status knowledge and disclosure and protective sexual practices in the cross-sectional study sample. Paper 3 explores the relationship between various social protection provisions and unprotected sex among HIV-positive adolescents. The candidate co-developed and conducted a community-traced study of adolescents in the Eastern Cape, in South Africa: 1,060 HIV-positive adolescents and 467 community controls. HIV-positive 10-19 year old adolescents were recruited from 53 government facilities in a health sub-district with antenatal HIV prevalence of over 30%. 90.1% of the eligible sample was traced, with only 4.1% refusing to take part. Community controls were neighbouring or co-habiting 10-19 year old adolescents, 92% of whom agreed to take part. Voluntary informed consent was obtained from adolescents and caregivers in the language of their choice: English or Xhosa. Questionnaires were administered by trained research assistants using mobile devices (tablets) with adolescent-friendly graphic content to ensure participant interest and reduce participant burden through skip-patterns. The systematic review (Paper 1) included studies located through electronic databases and grey literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies reporting on HIV-positive participants (10-24 year old) included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older sexual partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy). Only studies conducted in sub-Saharan Africa were included. The candidate and a second author independently piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and correlates, no meta-analyses was conducted. The systematic review informed the analyses conducted for the two quantitative papers. Analyses for Papers 2 and 3 used condom use at last sexual encounter (dichotomised either as safe sex/abstinence or unprotected sex) as the outcome, controlling for a series of covariates. Analyses used SPSS 22 and STATA 11. For each paper, the hypothesised factors were entered as independent variables in multivariate logistic regressions controlling for potential confounders. Based on the findings of the systematic review, gender moderation analyses was run entering a 2-way interaction term of gender*correlate in multivariate logistic regressions, controlling for covariates. Marginal effect models explored the effect of combinations of risk/ protective factors. Predicted probabilities for safe sex/ unprotected sex were computed for different two- and three-way combinations of the independent variables, controlling for covariates significantly associated with the outcome. Paper 2 tested the effect of three types of disclosure on protective sexual practices: (i) knowledge of one's own HIV-positive status, (ii) disclosing one's HIV-status to a partner, and (iii) knowing a partner's HIV-status. It compared HIV-positive status aware adolescents (n=794) with the rest of the sample (n=733). Paper 3 investigated associations between nine types of social protection provisions and unprotected sex. In line with UNICEF's definition, social protection was defined as any provision aimed at preventing, reducing and eliminating economic and social vulnerabilities to poverty and deprivation among HIV-positive adolescents. The nine social protection provisions tested by the analyses included ‘cash' and ‘care' factors accessed in the home, school, and community. <strong>Results: Paper 1 – ‘Sexual Risk-Taking among HIV-Positive Adolescents and Youth in Sub-Saharan Africa: A systematic review of prevalence rates, risk factors, and interventions.'</strong> The systematic review (Chapter 4) found that, despite their heightened vulnerabilities and high rates of sexual risk-taking, there is a dearth of evidence on interventions which may help HIV-positive adolescents engage in safe sexual practices. The review included 35 studies, four of which were interventions aiming to reduce sexual risk-taking. The quality of the included studies was low with most studies (k=31) reporting findings from cross-sectional data. HIV-positive adolescents and youth reported high rates of sexual risk-taking, however findings were inconsistent about potential factors associated with sexual risk-taking. Factors consistently associated with sexual risk-taking in multivariate analyses included: food insecurity, living alone, living with a partner, and gender-based violence. No significant associations were reported for: rural residence, informal housing, anxiety, religious guidance, STI prevention knowledge, poor birth outcomes, orphanhood, parental monitoring, having a supportive family, social support, maternal education level, poverty, disclosing one's HIV-status to a partner, time on ART, ART adherence, receiving care at a hospital, opportunistic infections. However, most of the above associations were reported by only one study, therefore further analyses is needed to build the evidence base on potential determinants of sexual risk-taking among HIV-positive adolescents and youth. The included interventions consist of three individual- and group-based psychosocial interventions evaluated in three small-scale trials (n<150) and one large trial of combination interventions for HIV-positive orphaned adolescent girls (n=710). Three of these interventions had positive effects in reducing sexual risk-taking: an individual based 18-session counselling intervention in Uganda, a support group intervention in South Africa, and a combination intervention in Zimbabwe. <strong>Quantitative data analyses of cross-sectional study data:</strong> Overall, adolescents in the full sample (n=1,527) reported high rates of sexual activity (34.9%) and high rates of unprotected sex (22%), with adolescent girls reporting higher rates of unprotected sex than boys (33% vs. 7%).

Thesis (Ph. D. (Psychology)) -- University of Limpopo, 2016. / Exploring the lived experiences of People Living with HIV/AIDS in relation to stigma and discrimination was the purpose of this qualitative research underpinned by Jungian Phenomenology. The study was qualitative in nature with a non-probability sample of fifteen participants aged from twenty tree to sixty four years. The setting was a rural and the research took place at a designated HIV/AIDS clinic in Limpopo. Semi-structured interviews, in the vernacular, were constructed so that the in-depth, lived experience of the participants relating to stigmatisation and discrimination could be ascertained. The participants’ responses were organised through the application of the Jungian metaphors and presented as themes which were presented in English. The archetypes of the Self, Shadow and Persona were highlighted as dominant metaphors with the Animus playing an important. These were followed by archetypes which represented more marginal roles in the participants’ personality development namely, the Anima, Hero, Caregiver, Innocent and Orphan. Everyone has the desire to develop a well-rounded socially acceptable and fulfilling personality, whose development process is accompanied by the generation and maturation of various archetypal traits. Once this is achieved, the process of personal individuation is completed and an individual is able to experience their true Self and live a fulfilling and authentic (honest) life. HIV infection and HIV related stigma generate archetypal traits which tend to impede the personality development of individuals. As a result they were not able to merge their personality development into an integrated unit and emerge as spiritual and deep-thinking beings.

MSc (Microbiology) / Department of Microbiology

See the attached abstract below