Dissertation (DPhil)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: The aim of this study was to develop a HIV intervention programme tailored for South African adolescents with visual impairments. A further aim was to pilot and evaluate this tailored programme. This investigation was deemed necessary in the light of the growing HIV pandemic in South Africa, which has proliferated over the last 10 years. Adolescents and young adults are among the most vulnerable to HIV infection, and this does not exclude adolescents with visual impairments. Despite the perceptions among sighted people of asexuality in adolescents with visual impairments, they are a vulnerable group for HIV infection. The motivation for this study is the fact that very little literature is available on HIV/AIDS and people with visual impairments, and that this vulnerable group is marginalized in HIV/AIDS campaigns internationally. As far as we could ascertain, there have been three HIV prevention initiatives for people with visual impairments in South Africa, none of which was fully researched and evaluated, and all of which used existing generic interventions but transcribed into Braille and large print format. The reality is, many adolescents with visual impairments, as is the case with sighted youths, are sexually active, and the absence of research on HIV prevalence and HIV prevention needs in this sector, is conspicuous. An urgent need exists to tailor HIV preventative programmes for this vulnerable sector. The dearth of research on HIV/AIDS and people with visual impairments motivated the choice of a key informant study to investigate the effects that HIV/AIDS and other concomitant issues have on persons with visual impairments, prior to the design of any intervention. A purposive sample of key informants who are working among people with visual impairments on a daily basis, most of whom had visual impairments themselves, was selected. Information gathered from the key informant study was combined with the lessons from a review of available literature on health promotion programmes and HIV prevention programmes in particular to develop an HIV/AIDS intervention programme to be piloted and evaluated for its effectiveness. The design of the programme took account, in addition, of broader contextual issues such as power and gender issues, and the marginalization and stigmatization of disabled people. The theoretical framework which forms the basis of the programme was informed by elements of a number of cognitive theories in the health promotion field, and especially the Informational-Motivational-Behavioural model (IMF). The programme was designed to empower participants and to create an environment of reallife experiences in which they could acquire important negotiation skills, decision-making skills, and practical skills to use condoms and HIV/AIDS knowledge to facilitate attitude and behaviour change. The next objective of this research was to implement the intervention programme of eight sessions designed for adolescents with visual impairments and to investigate the outcome on participants in this study. For this purpose an experimental design, one experimental group and three control groups (n= 56), not randomly assigned, was used to test the effect of the programme on participants in the intervention group compared to the control groups, who received a health promotion programme of four sessions. All participants were learners at the only two schools for learners with visual impairments in the Western Cape Province of South Africa, and they were allocated into treatment or control conditions on the basis of the school grades in which they were already placed. The empirical investigation utilized a questionnaire that was developed and transcribed into Braille as well as large print. Following a small pilot study, the questionnaire was finalized and administered to all four groups (pre-test, to determine baseline differences; post-test, to determine the immediate effect of the programme; and follow-up [3 months later] to determine longer term effectiveness). An analysis was done to assess the internal consistency of the measuring constructs of the questionnaire, and satisfactory internal consistency was found, with Cronbach’s alpha scores ranging between 0.72 and 0.92. Quantitative data were analyzing using multivariate techniques, beginning with a repeated measures MANOVA analysis and, once an overall significant F ratio between variables, time and groups (F=2.009, p<0.05); a significant F ratio between groups and variables (F=4.211, p<0.01), and significant F ratio between time and groups (F=2.611, p<0.01), had been found, we continued with more focused analyses. Baseline results revealed no statistical differences between the four groups. There were statistically significant improvements in knowledge of HIV/AIDS for both the experimental group and two of the control group, but these differences were not maintained at follow up. Significant differences in attitudes towards HIV/AIDS were found for the experimental group and for one of the control groups. Though there were significant changes in both knowledge and attitudes, therefore, it cannot be claimed that the intervention itself was responsible for knowledge and attitudinal change. There was some evidence for diffusion of innovation in terms of HIV knowledge from the experimental group and the control group situated at the same school. Changes in reported HIV risk behaviour were not recorded to a significant degree, a fact which may have been attributable in part to small sample size. Qualitative process information was used to get a sense of the experiences of participants and the concomitant issues they discussed during the intervention. The qualitative data revealed a host of contextual factors relevant to issues of HIV/AIDS and sexuality in this group, including experiences of stigmatization as people with visual impairment, negotiating masculinity in the context of visual impairment, gender oppression of women and resistance to this, and a general atmosphere of myths and silences around HIV/AIDS in particular and sexuality in general. Despite the limited impact of the programme, this pilot study revealed important issues for adolescents with visual impairments regarding HIV prevention which require further investigation. Participants in the experimental group indicated that they learned a lot from this programme and suggested that it be given to younger adolescents to enable them to acquire these vital skills prior to active sexual engagement and the involvement in any form of unprotected sex. A number or recommendations are made for further well-documented and evaluated research in this field. / AFRIKAANSE OPSOMMING: Die doel van die studie was om ’n MIV-intervensieprogram te ontwikkel wat op Suid- Afrikaanse adolessente met gesigsgestremdhede gemik is. ’n Verdere doel was om ’n proeflopie van die pasgemaakte program te doen en dit te evalueer. Hierdie ondersoek is nodig geag in die lig van die groeiende MIV-pandemie in Suid-Afrika, wat oor die afgelope tien jaar vinnig versprei het. Adolessente en jong volwassenes tel onder die kwesbaarstes vir MIV-infeksie, en dit sluit nie adolessente met gesigsgestremdhede uit nie. Ongeag die persepsies omtrent aseksualiteit in adolessente met gesigsgestremdhede onder diegene wat nie gesigsgestremd is nie, is eersgenoemde ’n kwesbare groep vir MIV-infeksie. Die motivering vir hierdie studie is die feit dat baie min literatuur vir mense met gesigsgestremdhede beskikbaar is, en dat hierdie kwesbare groep wêreldwyd in MIV/VIGSveldtogte gemarginaliseerd is. Sover ons kon vasstel, was daar drie MIV-voorkomingsinisiatiewe vir mense met gesigsgestremdhede in Suid-Afrika, waarvan nie een ten volle nagevors en geëvalueer is nie, en wat almal bestaande generiese intervensies gebruik het wat in Braille en grootdruk-formaat omgesit is. Die werklikheid is dat baie adolessente met gesigsgestremdhede – nes die geval is met jeugdiges sonder gesigsgestremdhede – seksueel aktief is en dat die afwesigheid van navorsing oor MIV-voorkoms en MIVvoorkomingsbehoeftes in hierdie sektor opvallend is. Daar is ’n dringende behoefte aan pasgemaakte MIV-voorkomende programme vir hierdie kwesbare sektor. Die gebrek aan navorsing oor MIV/vigs en mense met gesigsgestremdhede het die keuse van ’n sleutelinformantstudie gemotiveer om die invloed wat MIV/vigs en ander gepaardgaande kwessies op mense met gesigsgestremdhede het, voor die ontwikkeling van enige intervensie te ondersoek. ’n Doelgerigte steekproef van sleutelinformante wat op ’n daaglikse grondslag onder mense met gesigsgestremdhede werk, waarvan die meeste self gesigsgestremd is, is gekies. Inligting wat van die sleutelinformantstudie verkry is, is gekombineer met die lesse uit ’n oorsig van die bestaande literatuur oor gesondheidsbevorderingsprogramme – in die besonder MIV-voorkomingsprogramme – om ’n MIV/vigs-intervensieprogram te ontwikkel wat as loodsprojek kon dien en wat vir doeltreffendheid geëvalueer kon word. Die ontwerp van die projek het, daarbenewens, ag geslaan op breër kontekstuele kwessies soos mags- en genderkwessies en die marginalisering en stigmatisering van mense met getremdhede. Die teoretiese raamwerk wat die grondslag vir die program vorm, is op elemente van ’n aantal kognitiewe teorieë op die gebied van gesondheidsbevordering, en spesifiek die inligtingmotivering- gedragsmodel geskoei. Die program is ontwerp om deelnemers te bemagtig en om ’n omgewing van lewenservaringe te skep waarbinne hulle belangrike onderhandelings-, besluitnemings- en praktiese vaardighede kon ontwikkel om kondoomgebruik te bevorder, asook kennis omtrent MIV/vigs om houdings- en gedragsverandering te fasiliteer. Die volgende doelwit van hierdie navorsing was om die intervensieprogram van agt sessies wat vir adolessente met gesigsgestremdhede ontwerp is, te implementeer en om die resultate ten opsigte van die deelnemers aan die studie te ondersoek. Met hierdie doel voor oë is ’n eksperimentele ontwerp – een eksperimentele groep en drie kontrolegroepe (n=56), wat nie ewekansig toegewys is nie – gebruik om die invloed van die program op deelnemers in die intervensiegroep te toets teenoor dié op die kontrolegroepe, wat aan ’n gesondheidsbevorderings-program van vier sessies deelgeneem het. Alle deelnemers was leerders by die enigste twee skole vir leerders met gesigsgestremdhede in die Wes-Kaap, Suid-Afrika. Hulle is op grond van die skoolgraad waarin hulle reeds geplaas is, aan behandelings- of kontroletoestande toegewys. Die empiriese ondersoek het ’n ontwikkelde vraelys gebruik wat sowel in Braille getranskribeer is as in grootdruk gedruk is. Ná afloop van ’n klein loodsstudie is die vraelys gefinaliseer en aan al vier groepe toegedien (voortoets, om die basisverskille vas te stel; na-toets, om die onmiddellike invloed van die program vas te stel; en opvolg [3 maande later] om doeltreffendheid op langer termyn vas te stel). ’n Ontleding is gedoen om die interne konsekwentheid van die meetkonstrukte van die vraelys te assesseer: voldoende interne konsekwentheid is gevind, met Cronbach se alfapunte wat tussen 0.72 en 0.92 gewissel het. Kwantitatiewe data is met behulp van meervariaattegnieke ontleed. Eers is ’n herhaaldemeting- MANOVA-ontleding gedoen en daarna – nadat ’n algeheel beduidende F verhouding tussen veranderlikes, tyd en groepe (F=2.009, p<0.05); ’n beduidende Fverhouding tussen groepe en veranderlikes (F=4.211, p<0.01) en ’n beduidende F-verhouding tussen tyd en groepe (F=2.611, p<0.01) gevind is – is dit deur meer gefokusde ontledings gevolg. Basislynuitslae het geen statistiese verskille tussen die vier groepe getoon nie. Daar was statisties beduidende verbeteringe in kennis oor MIV/vigs in sowel die eksperimentele groep as die twee kontrolegroepe, maar hierdie verskille is nie met die opvolgtoets volgehou nie. Beduidende verskille in houding jeens MIV/vigs is by die eksperimentele groep en een van die kontrolegroepe gevind. Hoewel daar beduidende veranderinge in sowel kennis as houdings gevind is, kan daar nie beweer word dat die intervensie self vir die kennis- en houdingsveranderinge verantwoordelik was nie. Daar was ’n mate van bewys vir diffusie van innovering wat betref kennis oor MIV van die eksperimentele groep en die kontrolegroep by dieselfde skool. Veranderinge in aangemelde MIV-risikogedrag is nie in ’n beduidende mate aangeteken nie, ’n feit wat gedeeltelik aan die beperkte grootte van die steekproef te wyte kan wees. Inligting uit ’n kwalitatiewe proses is gebruik om ’n indruk te skep van die ervaringe van deelnemers en gepaardgaande kwessies wat hulle tydens die intervensie bespreek het. Die kwalitatiewe data het ’n reeks kontekstuele faktore blootgelê wat vir kwessies van MIV/vigs en seksualiteit in hierdie groep tersaaklik is, met inbegrip van ervaringe van stigmatisering as mense met gesigsgestremdhede, die hantering van manlikheid binne die konteks van gesigsgestremdheid, genderonderdrukking van vroue en weerstand hierteen, asook ’n algemene atmosfeer van mites en stilswye oor MIV/vigs in die besonder en seksualiteit in die algemeen. Ten spyte van die beperkte impak van die program het hierdie loodsstudie belangrike kwessies vir adolessente met gesigsgestremdhede betreffende MIV-voorkoming blootgelê wat verdere ondersoek noodsaak. Deelnemers in die eksperimentele groep het aangedui dat hulle baie uit hierdie program geleer het en het voorgestel dat dit aan jonger adolessente aangebied word om hulle in staat te stel om hierdie noodsaaklike vaardighede te ontwikkel voordat aktiewe seksuele betrokkenheid en betrokkenheid by enige vorm van onbeskermde seks plaasvind. ’n Aantal aanbevelings vir verdere goed gedokumenteerde en geëvalueerde navorsing op hierdie gebied word gemaak.

The present study is a critical history of the Catholic Church‟s response to HIV and Aids in South Africa, with a special emphasis on KwaZulu-Natal. It attempts to document and reflect on what the church said and did in responding to HIV and Aids between 1984 and 2005. It relies upon both oral and literary sources which were collected between 2006 and 2009. These comprise of oral testimonies of Catholic clerics, lay leaders, and administrators as well as archival sources in the form of correspondence letters, plenary session minutes, magazine articles, and project reports. The study establishes that between 1984 and 1990 the Catholic Church saw Aids as a disease far removed from its sphere yet deserving certain visionary measures. To a larger extent, Aids was ignored. A moral perspective on the Aids disease prevailed throughout the period. However, isolated visionary leaders conducted awareness workshops. Between 1991 and 1999, however, Aids was seen as immediate, a problem closely related to the mission of the Catholic Church. Here Aids was confronted. The predominant theological response was „missiological,‟ expressed through the new pastoral plan, Community Serving Humanity. As a result, the main Aids related activity by the church was the care of PLWHA. Through home-based care and institutionalised care, Catholic local initiatives in responding to the disease mushroomed in the country with the Archdiocese of Durban taking a leading role. Between 2000 and 2005 Aids was seen as imminent in the church, a concept popularised as the „Church has Aids‟. As a result, the period witnessed a concerted effort by the Catholic Church to integrate Aids response into its mainstream activities. In this period, Aids was seen as a human rights issue. Consequently, the Catholic Church endeavoured to address rights to treatment, Aids related stigma, family violence and gender imbalances. „Responsibility in a Time of Aids‟ became a predominant theological concept. The Catholic Church became a pacesetter in care and treatment after securing oversees funding. However, prevention became the church‟s Achilles heel following an unrelenting condom controversy. The availability of large amounts of money and many financial donors led to the NGO-isation of the Catholic Church‟s Aids projects with regard to their identity, activities, and organization. By and large, HIV and Aids had a large impact on the Catholic Church at all levels, both theologically and organizationally. Therefore, the study argues that for the Catholic Church responding to the Aids epidemic was a complex organizational dilemma. On the one hand, the church‟s teachings compelled it to care for the sick with a compassionate love and uphold a naturalist ethical position on sexuality. On the other hand, the Aids disease was associated with what was perceived to be sinful behaviours such as prostitution, homosexuality and heterosexual acts outside marriage. The infected, therefore, were not only „sick‟ but „sinners‟ at the same time. Moreover, the means of HIV prevention advocated by the government and the better part of the society, the use of condoms, was in sharp contrast with the church‟s official teachings. The hierarchy set itself to defend the teachings while majority of the lay leaders and the medical practitioners called for its revision. Generally speaking, the Catholic Church‟s response to the HIV and Aids epidemic in South Africa was entangled by organizational controversies. In spite of warnings by visionary leaders such as Father Ted Rogers and the exemplary leadership of Archbishop Denis Hurley during the mid 1980s, the Catholic organizational focus on HIV and Aids was delayed until 1990. A concern to respond to HIV and Aids in the church increased considerably in the 1990s as attention shifted from the cry for freedom and democracy to the escalating Aids crisis. However, it was during the 2000s that conditions favoured the much needed integrated Aids response. The Aids crisis had become too obvious to ignore given the acute mortality rate. In conclusion the Catholic Church‟s response to HIV and Aids came relatively early with creative and visionary ideas but it was hindered by organizational and theological barriers. The Catholic Church‟s official HIV prevention policy was contradictory and ambiguous. The Catholic Church innovatively used two models, institutionalised care and home-based care, in the treatment and care of PLWHA and Aids orphans, home based care and Aids hospices. The Catholic Church demonstrated an outstanding ability to raise and disburse large amounts of funds, successfully channelling these to service delivery in its response to HIV and Aids. The Catholic Church Aids projects became NGO-ised following the influx of large foreign funds in the years of the 2000s. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

Ideology is a fundamental aspect of society, and ideological analysis has been applied to the development of explanatory frameworks for understanding structural dominance within social formations. Structural and post-structural conceptions of ideology have focused on macro-ideological phenomena and processes, offering explanation of relations between economic base and super-structure as they interrelate with ideological dominance. Ideologies serve the interests of particular social formations or classes over others, and at the macro-level this has to do with organised thought as it relates to power. This thesis explores the concept of ideology and related concepts of dominance, power and hegemony, through relocating macrolevel understandings and analysis of ideology within analysis of superstructural entities - notably organisations, groups and elites. HIV/AIDS is an ecological phenomenon that is accompanied by processes of sense-making that incorporate ideological dimensions in the public sphere, particularly in relation to social policy and strategy. Ideological discourses about HIV/AIDS have drawn on specific epistemological foundations and world-views, incorporating intersections with parallel ideologies, and in many instances being directed towards achieving expansion and dominance of particular ideas. This ideological strategy incorporates the construction of common sense. Ideological claims are reiterative, but are also related to processes of legitimation that combine structural relations with communicative power. A South African HIV/AIDS programme, LoveLife, is utilised as a case study to demonstrate ideological trajectories over time. The inter-relation between claims about the HIV/AIDS epidemic, claims about impact of the LoveLife programme, and the utility of alliances and structural partnerships in legitimating such claims is explored. These claims-making processes are found to also occur at global level through the active resourcing and facilitation by LoveLife programme's founding funder, the Kaiser Family Foundation. These activities intersect in the development of an ideological bloc that is directed towards expansion and dominance through appropriation of indigenous and global discourse spheres. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

The importance of partnerships between marginalised communities and support agencies (from the public sector, private sector and civil society) is a pillar of HIV & AIDS management policy. Such alliances are notoriously difficult to promote and sustain. The thesis presents the findings from a longitudinal, qualitative case study of a project seeking to build partnerships to facilitate local responses to HIV & AIDS in a remote rural community in South Africa. The partnership aimed to empower community stakeholders to lead HIV-prevention and AIDS-care efforts through the support of local government departments, NGOs and the private-sector, and make public services more responsive to local needs. I highlight the value of building longterm relationships with, and ownership of the project by community stakeholders, i/ by involving community stakeholders in partnership building and facilitation from the very beginning of the process, and; ii/ through a compliance with, and respect for community protocols and norms in the process of entry, community engagement, and partnership facilitation. I illustrate how features of the local public sector environment have actively worked against effective community empowerment and partnership. These include a rigid hierarchy, poor communication between senior and junior health professionals, lack of accountability, limited social development skills, and the demoralisation and/or exhaustion of public servants dealing with multiple social problems in under-resourced settings. I outline the obstacles that have prevented private-sector involvement, suggesting a degree of scepticism about the potential for private-sector contributions to development in remote areas. The most effective partners have been the NGOs — run by committed individuals with a keen understanding of social-development principles, flexible working styles and a willingness to work hard for small gains. Despite the challenges, the partnership has achieved many positive outcomes, including the formalization of the partnership and its institutionalization within a permanent government structure. I outline these achievements and discuss the essential role played by an external change agent in facilitating the process of partnership building. I conclude with eight key lessons learnt and recommendations which emerged out of the research. Firstly, partnerships are embedded in and influenced by the contexts within which they are located; secondly, stakeholder organizations must create an enabling environment to encourage and sustain partnership participation; thirdly, capacity building and empowerment of partners is crucial for ensuring ownership and sustainability of the partnership; fourthly, partnerships within resource (human and physical) poor contexts like Entabeni, where skills and resources are scarce, require the services of a dedicated, skilled facilitator or external change agent; fifth, partnership building needs to be guided by regular monitoring and evaluation and a systematic documentation of the process; sixth, relationships based on trust are a central pillar of partnerships; seventh, partnerships are as much about individuals as they are about communities and organizations, and; finally, partnerships can and do work, in-spite of the many challenges that may be encountered. of partnerships between marginalised communities and support / Thesis (Ph.D.)-Universtiy of KwaZulu-Natal, Durban, 2008.

Despite good intentions and commitment from health providers, it is difficult for HIV positive pregnant women to access Prevention of Mother to Child Transmission of HIV (PMTCT) services (Skinner et al 2005:115). The aim of this research was to find out the extent to which socio-economic and cultural factors influence access to and utilization of PMTCT services. It appeared that despite having a legal plan and framework to ensure that PMTCT services are available and free, the realities confronting HIV positive women in South Africa as suggested by the literature contradicted this objective. Inevitably, these contradictions were identified as some of the main factors contributing to lack of access and inadequate utilization of PMTCT services. These factors were identified through a review of fifteen studies selected based on their relevance to the research aim. The findings were presented according to the following themes: Functioning of clinics, adherence to ART, uptake of VCT and infant feeding practices. According to research evidence, the major socio-cultural factors influencing access and utilization of PMTCT services include fear of stigma and discrimination which are related to cultural norms and practices. The socio-economic factors include transport costs, lack of food, medicines and formula milk which are all related to poverty and unemployment. The research also found that health system constraints such as long waiting times in clinics, stock-outs of formula milk, medicines and test kits influenced the utilization of PMTCT services by HIV positive women.

Submitted in fulfillment of requirements for the Degree of Masters in Technology: Nursing, Durban University of Technology. 2013 / This study investigated the factors that impact on the utilisation of voluntary HIV counselling and testing (VCT) service at a wellness centre in a higher education institution. Purpose: The purpose of the study was to identify factors that impact on the utilisation of VCT service in a higher education institution. Methodology: A quantitative descriptive survey research design was used to describe the phenomenon and to establish relationships between variables. Participants were selected randomly in order to obtain a broad representative sample in three strata. A formal structured close-ended questionnaire was used to collect data. The questionnaire was designed to focus on variables such as demographic data, environmental factors, enabling factors, predisposing and behavioural factors. Findings: No significant relationship was identified between knowledge of HIV, AIDS and VCT and high school attended in rural, township and urban areas. There was no significant relationship between environmental factors and utilisation of VCT. There was no association between predisposing factors such as risk of VCT and perceived benefits of VCT utilisation. There was no relationship between knowledge and consistency of condom use and utilisation of VCT. The majority of respondents stated that the VCT service was not user friendly and the attitude of the staff toward students was poor. There was no significant relationship between accessibility of VCT service and utilisation of VCT. There was a lack of utilisation of campus VCT services and the majority of respondents utilised other services. Conclusion: The study showed that respondents who knew about availability of VCT were likely to have used the facility. Respondents who showed positive / Durban University of Technology

The World Health Organisation Commission for the Social Determinants of Health (CSDH, 2008) report calls upon the need to consider the social determinants of health, including migration in health planning. Unfortunately, the introduction of Pre Exposure Prophylaxis (PrEP) in South Africa is being framed as a stand-alone intervention without incorporating the social determinants of health i.e. migration and structural drivers of HIV, despite numerous evidence of failure of one-dimensional HIV approaches. The study aimed to explore the attitudes and knowledge (s) of HIV prevention amongst young, internal migrant, Black self-identifying gay men and its implications for PrEP. This study used an interpretive qualitative approach by conducting 12 in-depth interviews with both men who have sex with men (MSM) who self-identify as gay individuals and experts working in the field of HIV. Social determinants of health like migration and homophobic attitudes both within the health care system and beyond could impact the uptake of PrEP and continuity access for PrEP among MSM who self-identity as gay within the context of circular migration. Likewise, the study highlights structural drivers of HIV that if left unaddressed could also have a bearing on PrEP as an HIV intervention vis-à-vis PrEP uptake and continuity to PrEP access within a context of circular migration. Using Weiss (1979) interactive model, the study points out the need for all actors involved in policy making to take into account evidence, such as empirical data, best practices, insights from various stakeholders as a basis upon which South Africa’s PrEP policy/programme can be based on. / A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts (Development Studies), November 2017 / GR2018

Co-infection with a sexually transmitted infection (STI) is both an indicator of behavioural risk, as well as an indicator of increased risk for infection with HIV. This is a cross-sectional, descriptive study. The overall aim of the study is to profile the demographic data, health seeking behaviour, sexual risk behaviour and HIV awareness and willingness to test in a sample of STI clinic attendees in order to inform intervention programmes aimed at reducing the burden of disease in this group, thereby reducing HIV risk. It is hypothesised that those individuals who are poorly informed about key prevention information (particularly regarding the biological susceptibility to HIV infection when co-infected with an STI), who are poorly motivated due to poor attitudes towards or lack of social norms in favour of prevention behaviour, and who lack some key behaviour skills (like skills for identifying STIs early, or negotiating safer sexual practises) will be less likely to be able to initiate and maintain specific prevention behaviours. Data are collected using a structured questionnaire and analysed in relation to the Information-Motivation Behavioural Skills (IMB) model of HIV prevention behaviour. This model was specifically developed to provide a conceptual framework for the design, implementation and assessment of targeted and empirically focussed interventions to change sexual risk behaviour in HIV. Components of the IMB model that are identified as important in contributing to risk of infection in this group are identified. Finally, recommendations regarding the form and content of an intervention in this group are made. The study concludes that STI clinics may be excellent environments within which to implement HIV risk reduction pehavioural interventions which currently may be missed opportunities. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

HIV/AIDS is an epidemic that is in one way or another affecting humankind and particularly the African continent. Due to its devastating nature, many strategies and interventions are being employed at different levels and by different groups of people to fight it. Evaluation has been a component of these projects, but few have been subjected to systematic monitoring and evaluation that provides a foundation for the development and implementation of further projects. This is partly due to the fact that project implementation and evaluation can be rendered complex by several factors, such as the choice of methodologies, donor satisfaction and the very nature of interventions and evaluations themselves. Taking a situation where the aim of a project and its evaluation is to bring about social change, as is the case with many HIV/AIDS interventions, this study sought to investigate approaches that could be considered meaningful, useful and valuable. In order to carry out the investigation of this study, the approach taken was an in-depth analysis of a few cases (in anticipation of greater achievement of insight), rather than broader survey types of perspectives. The study also concentrated on a review of the literature and on validation of documentary and interview evidence provided by beneficiaries, managerial staff and evaluators of communication-based HIV/AIDS. Results of the study highlighted the fact that community-based factors, such as education, poverty, culture, beliefs, gender, crime and age, influenced social change (with respect to HIV/AIDS) in varying ways and depending on the communities concerned. The different ways in which these factors influenced social change within specific communities were noted to have implications on interventions dealing with them. As such, an in-depth assessment of these different ways with respect to specific groups of people was encouraged in order to have a meaningful, useful and valuable HIV/AIDS intervention. The theory of active participation of targeted communities was also propagated in an HIV/AIDS intervention. It was noted that when active participation is encouraged in a project at both implementation and evaluation, taking the example of an HIV/AIDS project that intended achieving group knowledge acquisition, awareness, attitude change, skills acquisition, effective functioning and sustainability, such participation would contribute to: • Override to a great extent, limitations arising from socio-demographic differences (project locations and gender, language, age and race of implementers, evaluators and beneficiaries), in the attainment of project objectives. • Override to a great extent, limitations arising from differences in forms of evaluation (internal versus external evaluators), in the assessment of project objectives. • Create an enabling environment for higher attainment of project objectives in comparison to a situation where active participation is encouraged only at implementation (and not at evaluation). It was further discovered from this study that when beneficiaries are excluded from participating in the planning, action-planning and result-feedback stages of a project and its evaluation, dissatisfaction is experienced on the part of these beneficiaries as well as missed opportunities for useful contributions. The degree and quality of beneficiary involvement in project implementation and evaluation was seen to generate beneficiary excitement and a general sense of project acceptance: all of which was noted to create an enabling environment for the making of proper choices and decisions. Finally, difficulty in accessing traditional evaluations and people's feeling of shame and ineffectiveness was noted in the work (in the area of collecting data pertaining to traditional evaluation). This pointed to possible compromise of meaningfulness, usefulness and value of traditional evaluations. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

As the second decade of AIDS draws to a close, researchers and others involved in the AIDS effort have come to appreciate that complex interactions between social, cultural, biological and economic forces are involved in shaping the epidemiological course of the disease. Nevertheless, the process by which these variables interact and affect each other remains poorly understood, with many of the shaping forces yet to be fully explored. In South Africa, the sociocultural matrix in which the AIDS epidemic is embedded and its role in shaping the interpretation and experience of AIDS have not been fully analyzed. This thesis represents an attempt to elucidate the finer nuances of some commonly-held local beliefs, perceptions, symbolic representations, ethnomedical explanatory models and mythologies associated with AIDS. These associations are viewed as directly informing the way in which Zulu-speaking people are experiencing and responding to HIV/AIDS in KwaZulu Natal, currently home to 1/3 of the country's estimated 3 million HIV infected people. In particular, the focus is on the gender patterning of AIDS, with ethnographic data drawn from extensive field experience at St Wendolin's Mission, a peri-urban settlement in the Marianhill district of Durban. The shared perception of women as naturally 'dirty', as sexually 'out of control' and suspected of using witchcraft in new ways, are identified and discussed as key conceptual strands contributing to the sociocultural construction of HIV/AIDS in that community. It is argued that these notions are metaphorically joining and combining in ways that 'gender' the AIDS epidemic and simultaneously 'demonize' women. The central tenet of this thesis is that HIV/AIDS is fundamentally associated with women as a female caused and transmitted disease that can and does affect men. The author argues that the gendered construction of AIDS in St Wendolin's is a reflection of patriarchal resistance to women's changing roles and expectations that represent an overstepping of culturally defined moral boundaries. Deeply embedded ways of thinking associated with notions of gender are viewed as germane to the disempowerment of women that ultimately impedes the fight against HIV/AIDS. The thesis concludes with a discussion on the opportunity which the current AIDS epidemic presents for wider sociocultural transformation, and how this might be achieved through an AIDS 'education for liberation' based on the philosophies of Paulo Freire. / Thesis (Ph.D.)-University of Natal, Durban, 1999.