Department of Public Health / MPH

MCur / Department of Advanced Nursing Science / Survival of children with HIV/AIDS has increased considerably with the use of effective antiretroviral therapy. However, the benefits of this therapy are limited by the difficulty of adherence to the treatment. This study sought to explore the role of professional nurses on anti-retroviral therapy adherence among children in Lejweleputswa district: Free State, South Africa. An exploratory descriptive qualitative research design was used to identify and describe role of professional nurses toward anti-retroviral therapy adherence among children. Population for this study included seventeen (17) professional nurses working in four purposively sampled Primary Health Care clinics invited to participate in the study. Four focus group discussions were conducted in which each group had 6 participants. The transcribed data was analysed using the framework approach of data analysis. Professional nurses in Lejweleputswa district report poor knowledge of parents/caregivers of children, perceived poverty, stigma and discrimination, inappropriate care approaches, and parental dynamics as factors influencing poor ART adherence. Recommendations for enhancing children ART adherence levels in Lejweleputswa district included: mainstreaming adherence counselling in children ART and adopting a comprehensive family centered care approach were identified as measures for improving children ART adherence. Other measures included integration of ART services into Primary Health Care (PHC) services, parental empowerment, development of a programme to reduce stigma and discrimination in the community.

MSc (Microbiology) / Department of Microbiology / See the attached abstract below

MPH / Department of Public Health / Background: Young people in sub-Saharan Africa are most-at risk of HIV infection. This elevated risk in the young black population may be explained by the lack of HIV/AIDS-related knowledge, attitudes towards the epidemic and risky sexual behaviours. Purpose: The aim of the study was to assess the level of knowledge, attitude and behaviour among youth towards HIV infection and to explore the possible aetiological factors associated with the youth’s vulnerability to HIV infection. Methods and materials: This survey adopted a descriptive, cross-sectional design and a quantitative approach.The survey population comprised of all youth aged 15-24 years visiting two Namakgale clinics. An expected sample of (n=152) youths was recruited through convenience sampling. Pretesting of the questionnaire was conducted on 15 youths at Mashishimale Clinic. Data was collected using self-completed questionnaire. The data was captured using Microsoft Excel and then analyzed using the Statistical Package for Social Sciences, version 22. Results: Knowledge on HIV: The majority (77%) of the respondents could distinguish HIV and AIDS and had knowledge that HIV could cause AIDS. The majority of respondents (80%) had knowledge of how HIV was transmitted. The majority of the respondents, (84.9%) knew that HIV/AIDS could not be cured. However, misconceptions about HIV transmission still exist for example, 13.2 % of youth stated that mosquito bites could transmit HIV and whilst 22.4% believed that witchcraft could cause HIV. The main source of HIV information was television (89%). Attitudes towards PLHIV: About 82.9% disagreed that all PLHIV should live away from Namakgale while 72. 4% stated that if their relative had HIV they would care for them. Overall, Namakgale youth held positive attitudes towards PLHIV. Risky sexual behaviours: About 61.8% of females, compared to their male counterparts (38.2%) ever had sex. 61.8% of females compared to 50.0% of males have had sex before their 15th birthday. 36.5% have had 3-5 lifetime sexual partners in comparison to 29.6% of their female counterparts. 44.2% of males did not use condoms at last sex compared to their female counterparts (33.3%). iv Recommendations: There is an urgent need for intensifying awareness campaigns on HIV and AIDS as well as school-based interventions for youths who still harbour myths and misconceptions about HIV transmission. Policy makers and the media should focus more on late adolescents (15- 19 years) risky sexual practices such as intergeneration sex (age group between sexual partners is 10 years or more), transactional sex etc.

PhD (Psychology) / Department of Psychology / Background: South Africa has world’s highest prevalence of HIV-positive people with approximately 7.06 million HIV-positive people with 110 000 HIV- related deaths reported by Statistics South Africa in 2017. South Africa has expanded access to anti-retroviral therapy services, from urban centers to resource-constrained rural communities. The rate of loss, however, to follow-up for patients on anti-retroviral treatment continues to increase. Aim of the Study: The aim of this study was to determine patient and nurse perspectives on loss to follow up among HIV-positive patients in Sekhukhune District of Limpopo Province, South Africa. The findings of the study guided the development of a proposed strategy to decrease loss to follow up among HIV-positive patients. Method: A qualitative research design was used with non-probability purposive sampling and with probability systematic sampling. The sample of patients comprised 30 HIV-positive people classified as lost to follow-up from clinics with high prevalence rates of lost to follow-up patients. Eight nurses, four from clinics with high rates and four from clinics with low lost to follow-up rates comprised the sample of nurses. Semi-structured interviews were conducted using the study research questions as a guide. Eight interviews were conducted with nurse clinic managers and 30 with the patients. Content analysis was used to analyze the data. Results: The key themes that emerged from the study included patients’ and nurses` perspectives on factors contributing to loss to follow up among HIV- positive patients; and Patients’ and nurses’ perspectives on strategies that would address barriers to loss to follow up among HIV- positive patients. Sub-themes on patients’ and nurses’ perspectives on factors contributing to loss to follow up among HIV- positive patients included: Lack of understanding of anti-retroviral treatment; fearful to disclose HIV status; lack of confidentiality; negative side effects; use of traditional medicine; self-transfer from one clinic to another. Patients’ and nurses’ elicited the strategies that would assist patients to remain in care and to take antiretroviral treatment consistently. The strategies included: providing patients with health education; working as a team; implementing social support group programme; providing nurses with in-service education on ethics and ethos. Informed by various intervention models in HIV care: Information Motivational Behavioural model; Health Belief Model; Social Action Theory and Social Cognitive Theory; I proposed a strategy that may reduce the rate of non-adherence and loss to follow up among patients with HIV in Limpopo Province. / HWSETA

MA (Psychology) / Department of Psychology / Background: An estimated 70% of people in Sub-Saharan Africa out of 25 million are living with HIV. HIV is a debilitating disease, however, antiretroviral treatment helps promote effective viral suppression, reduces the risk of transmission and prevents death (WHO, 2013). To ensure positive treatment outcomes, high levels of Anti-Retroviral Therapy (ART) adherence, 95%, is necessary, however, research indicates that 23% of Africans are achieving less than 80% adherence, potentially impacting negatively on prognosis. Aim: The aim of this study was to determine adherence, explore perceptions and behaviour of patients on Antiretroviral Therapy attending Thohoyandou Health Centre, in Vhembe District, Limpopo, South Africa. Methodology: This was a mixed method which employed both quantitative and qualitative research approaches. In quantitative, triangulation was utilised through a questionnaire and patients’ file, simple random sampling was used to select 105 male and female patients aged 18-60 who are on ART at Thohoyandou Health Centre; data were collected and SPSSversion 25 was used to analyse the data through descriptive, cross tabulation and inferential statistics using Chi-square.Qualitative phase – phenomelogical research design was utilised, twenty participants were purposively sampled and individually interviewed, ATLAS. ti program was used to analyse the data collected. Results: 67% of respondents were females, 34% of the respondents’ age range was 50-60 years, 44.8% were single, 48.6% had tertiary education and 69.5% were unemployed. The self-report of ART adherence of 87.6% among patients was indicated, with 19.6% who reported defaulting ART, 14.3% admitted to missing medical appointments. The reasons for missing medical appointments were: forgetfulness, not a convenient time, patient feeling better, transportation challenges and being too sick to attend. The objective evaluation of patients’ CD4 count at baseline revealed that 40.9% of patients had a CD4 count of <200c/mm3, out of 40.9% respondents (15.2%) were those aged between 41-50 years, 31.4% of respondents did not know their CD4 count for various reasons (defaulted on treatment, missed appointments). CD4 count follow-up data after six months revealed that 33% of patients had a CD4 count <200c/mm3 and 39% accounted for unknown CD4 count. vi Three themes emerged from the data, namely: Knowledge of HIV were respondents presented a negaitive and positive perception of ths diagnosis; barriers to ART adherence where sub-themes included discrimination, strigma, rejection, inadequate knowledge about the diagnosis and treatment, side effects; coping strategies where acceptance, religion and social support serve as corner stones for patients. Association was examined and findings did not reveal any significant association between gender, marital status, education, occupation; however, age was significantly associated with non-adherence to ART with X2 = 3.69, df = 1, p = < .002. Recommendations: The study recommends intensification of health education campaign against stigma, discrimination, rejection and other barriers to enhance positive attitude towards HIV patients that wil consequently stimulate adherence and alleviate the burden associated with taking treatment unswervingly. Given the high percentage of infected older respondents, government must also focus its resources to educate illiterate and older people about HIV, adherence and management in order to achieve the golden standardrate of 95% adherence. Strategies to facilitate and normalise adherence among males is indicated. / NRF

MA (Psychology) / Department of Psychology / Background: Given that there is 57.7 million HIV-diagnosed people living in South Africa and the government has established the largest public antiretroviral programme in the whole world but only 53% are adhering. Adherence remains a challenge, due to presence of mental health issues among HIV diagnosed. Aim: The aim of this study was to investigate adherence to antiretroviral therapy and mental health of HIV-diagnosed patients in Vhembe District, Limpopo Province. Methods: This was a mixed method study using a combination of quantitative and qualitative research approaches. In the quantitative approach, triangulation was utilised in the form of a questionnaire and patients records. Simple random sampling was used to select 134, descriptive analysis using SPSS version 25. For the qualitative approach, a phenomenological research designs was considered and convenience sampling was used to select fifteen participants (15). Data was collected using semi-structured interview; responses were analysed using a computer-aided program called, ATLAS ti. Results: The self-report of adherence was 94.8 %, objectively 39.6% of CD4 count <200c/mm3 at baseline and 34.3% CD4 count after six months was found. 16.5% of females and 2% of males defaulted treatment and 14.9% of missed medical appointments 1-6 times. This study also revealed the mental health issues that HIV-diagnosed patients are struggling with after the diagnosis include the stages of grief, stress, depression, anxiety, mistrust, shame, stigma and discrimination. Recommendation: Effective strategies need to be enhanced and tailor made in effort to encourage patients to take ART diligently. The healthcare providers, community members and the government should be made aware of mental health issues. / NRF

HIV/Aids is a worldwide pandemic and as South Africans we are at the epicentre of this global health crisis. The harrowing statistics are useful as a means to quantify a horrific situation; however, what these facts do not do is provide connection amidst the uncertainty surrounding the disease. This research aims to bridge the disconnection and break the silence that weaves a net around the illness and those infected by it. This is done by deconstructing one man’s story of his journey with HIV; by looking at his personal epistemology; and by contextualising his story within his family and within the society in which he lives, South Africa. Finally, it is my reflections and interpretations that form the bridge between a construct of HIV/Aids and a life lived with the disease. / Psychology / M. A. (Clinical Psychology)

Since the discovery of HIV/AIDS in the late 1980s, the pandemic has become the leading cause of death in South Africa and one of the leading causes worldwide. South Africa has the largest number of people infected with HIV/AIDS in the world. South African teachers, in particular, have experienced unparalleled challenges as a result of HIV/AIDS. This qualitative research study was designed to explore how principals handle the sensitive HIV/AIDS-related issues affecting teachers in schools in South Africa’s Gauteng Province. The study was carried out within the constructivist paradigm. The narrative inquiry research design within the qualitative research approach was used with purposive and network sampling of participants. The sample consisted of ten handpicked principals and eight teachers living with HIV/AIDS accessed through network sampling from around the province. Data were collected through narrative interviews and the compilation of a reflective diary. The data were analysed according to the qualitative content analysis method. Consent was elicited from participants with confidentiality, anonymity and trust maintained throughout the study. The participants’ most common responses were that teachers living with HIV/AIDS are faced with the dilemma of disclosure and stigma and discrimination. This research showed that principals are experiencing a range of challenges due to teachers living with HIV/AIDS. The goals of quality education are often defeated because of the challenges surrounding teachers living with HIV/AIDS. Once teachers succumb to the opportunistic illnesses associated with HIV/AIDS, their productivity deteriorates. Principals were clear about the inadequacy that they experience in responding to HIV/AIDS-related issues amongst teachers. They lack the training and management skills to develop long-term strategies to mitigate the impact of HIV/AIDS on teaching and learning. Teacher absenteeism is rife, causing drastically detrimental effects to teaching and learning programmes and posing serious challenges to principals, who are not equipped with the required information and resources. It was evident in this research study that infected teachers often fail to take responsibility or disclose their status; instead, they look to principals for solutions to their HIV/AIDS-related problems. / Educational Leadership and Management / D. Ed. (Education Management)

HIV/Aids is a worldwide pandemic and as South Africans we are at the epicentre of this global health crisis. The harrowing statistics are useful as a means to quantify a horrific situation; however, what these facts do not do is provide connection amidst the uncertainty surrounding the disease. This research aims to bridge the disconnection and break the silence that weaves a net around the illness and those infected by it. This is done by deconstructing one man’s story of his journey with HIV; by looking at his personal epistemology; and by contextualising his story within his family and within the society in which he lives, South Africa. Finally, it is my reflections and interpretations that form the bridge between a construct of HIV/Aids and a life lived with the disease. / Psychology / M. A. (Clinical Psychology)