M.Tech.

M.Tech.

M.A. / The headlines scream of HIV/AIDS being a global pandemic and it is true that HIV has reached every corner of the globe. Never in history has there arisen such a widespread and fundamental threat to human development. Yet it is sub - Saharan Africa that is the hardest hit region and mainland southern Africa that experiences the most severe HIV/AIDS epidemic in the world (Jackson, 2002). Countries like Botswana and South Africa have the highest infection rates with as many as one in three adults affected (Clark, 2002). Millions of children are being orphaned in these regions and years have been knocked off life expectancy. AIDS threatens food security, productivity, human resource availability and development (Jackson, 2002). It severely leaves its mark on the individual and the family, but its impact reaches through to the macro-economic level as well. This is a long term development disaster on a scale never witnessed before and sub -Saharan Africa is bearing the brunt of it. The global pandemic as it is called, is looking more and more like two distinct epidemics – one global and one regional (Jackson, 2002). Two dominant HIVtransmission patterns are described by UNAIDS (2000) today: heterosexual sex throughout sub-Saharan Africa and intravenous drug injecting, together with some sexual transmission among men who have sex with men, everywhere else. It is to be understood though, that these are not exclusive patterns of course, but it matters that these are the predominant modes of transmission. The devastating fact about African HIV/AIDS scenario is that women are several times more likely to be infected than men. Gender inequality is a fundamental driving force of the AIDS epidemic (Women’s Health Weekly, 2000). Biological and social factors make women and girls far more vulnerable to HIV/AIDS than men. Women are anatomically and physiologically much more susceptible and penile penetration puts women at great risk. Socio -culturally, women in (South) Africa tend to wield little power in heterosexual relationships. The socialisation process of both men and women right from childhood, as well as the stereotyping of their roles in society, has exposed women more to HIV infection as compared to their male counterparts (Henderson, 1996). The term gender refers to the widely shared expectations and norms within a society about appropriate male and female behaviour, characteristics and roles. It is a social and cultural construct that differentiates women from men and defines the ways in which women and men interact with each other (Gupta, 2001). In sub-Saharan Africa this very often means that it is unacceptable for a woman to say no to unwanted and unprotected sex unless they want to risk abuse or even violence (Esu-Williams, 2000). Both men and women are socialised to believe that men have a right to have sex regardless of their wives’ consent, even if he had been demonstrably unfaithful and was infected with HIV (Urdang, 2001). This state of affa irs is further exacerbated by the fact that very often the women is economically dependant upon the man. The fact that women are so vulnerable is a vital issue in the spread of HIV/AIDS in sub-Saharan Africa. Women’s rights and needs have to be taken seriously if any kind of slowing of the epidemic is to occur. Equity in all fields – health, education, environment and the economy – are essential if women are to act to protect themselves when it comes to HIV/AIDS (Women’s Health Weekly, 2000). Issues surrounding women and poverty, education, training, health matters, violence, economy, power and decision-making, are issues that will have a major impact on the spread of HIV and AIDS.

M.Cur. / The HIV/AIDS pandemic is posing major challenges to all sectors in South Africa, including the Health sector of the City of Johannesburg. The Health sector of the City of Johannesburg, as a result of the pandemic, is faced with increasing demands on its scarce resources at a time of major reform at local government level including transformation of the health sector. The inhabitants of the City of Johannesburg are particularly vulnerable to high levels of HIV/AIDS infection because of job prospects in the city, a good transport infrastructure, high levels of mobility of the community, the existence of single sex-hostels, marginalised communities living in informal settlements, poverty income inequality. An increase in the prevalence of HIV/AIDS is inevitable, unless a concerted effort is established to curtail the spread of the disease. An impact analysis conducted, revealed that already in the year 2000 an estimated 168 921 HIV infected persons were living in the city (City of Johannesburg, 2001 :21). In high-risk groups, such as attenders to services for the treatment of Sexually Transmitted Infections (STls), prevalence rates as high as 53% among females, and 35.8% among male persons were recorded (SAIMR, 2000:1). The City of Johannesburg, a local government structure, has not formally adopted a strategic plan to address the pandemic. The national and proVincial governments have responded to the pandemic and their 3-5 year strategic plans are known and pUblished. In spite of the absence of an official strategic plan to address the pandemic in the City of Johannesburg, the political will and strategic intentions to address the pandemic have been declared by management. Although all sectors of the City are affected, it is generally assumed that the Health sector would assume the leading role in addressing the pandemic. The objective of this study has thus been to explore and describe a strategy for the management of HIV/AIDS by the Health sector of the City of Johannesburg. The question presented for research was formulated as follows: " What strategy should be adopted by the Health sector of the City of Johannesburg to manage the HIV/AIDS pandemic in future?" An exploratory, descriptive and quantitative research design was utilised. The strategy for the management of HIV/AIDS was formulated according to the UNAIDS "Guide to the strategic planning process for a national response to HIV/AIDS" (1998), and the content validity was determined according to Lynn (1986) "Determination and quantification of Content Validity".

It is essential that business responds to the threat presented by HIV/AIDS, not only for economic sustainability, but for the sustainability of society at large. Consequently, the National Strategic Plan for HIV&AIDS and STIs for 2007- 2011 has called for the private sector’s involvement in a multi-sectoral response. This research set out to validate the premise that strong and decisive leadership of large scale organisational change is required for a successful business response. The research also sought to identify the reasons for the change and the power bases employed. The research was undertaken in two phases. Ten experts in the HIV/AIDS field were consulted to determine a judgemental sample of ten companies with successful HIV/AIDS workplace interventions. In-depth interviews were conducted with the manager responsible for HIV/AIDS at each company. The interviews were structured around organisational change, leadership and power base theories. The change efforts were found to be motivated by a combination of a moral obligation and humanitarian conscience, and a persuasive business case. That large scale change was indeed required was only realised post event. The output of this research culminated in a model that can be applied in organisations that have implemented, or intend to implement, HIV/AIDS workplace interventions. The model illustrates the elements which have proven successful in HIV/AIDS workplace interventions. It comprises nine stages of change - four dimensions of the strategy for change and four factors that influence change and the leadership thereof. Commitment from the most senior leadership in the organisation was identified as a prerequisite for success, with nine out of ten CEOs being mentioned by name with their contributions acknowledged. It was found that of the five power bases, Legitimate and Expert power were most commonly leveraged and that the use of Coercive/Punitive power to gain compliance was inappropriate in this context. Copyright / Dissertation (MBA)--University of Pretoria, 2010. / Gordon Institute of Business Science (GIBS) / unrestricted

The social, demographic and economic consequences of the HIV/AIDS pandemic are disturbing for South Africa, and the implications for business are great. The objective of this research was to establish the impact of HIV/AIDS on small and medium-sized enterprises in the manufacturing industry as the majority of employees within this industry are semi- and unskilled and it is this level of employee who has been most severely affected by the epidemic. In addition, the research attempts to analyse how companies have responded to the epidemic and lastly, to determine what has facilitated and hindered their response.The research was conducted using structured, face to face interviews with twenty small to medium organisations in central Gauteng employing from 20 to 300 people. The questionnaire addressed the impact of HIV/AIDS on the organisation and the subsequent response to the epidemic.The findings reveal that SME manufacturing organisations are experiencing the impact of HIV/AIDS, yet there is a disconnect between impact and response. The majority of companies are not proactively taking action to manage the consequences of the epidemic. Factors contributing towards the limited response are: negative implications of stigma, lack of information, perceived cost of response, time required to respond and uncertainty about the role of government. It appears that the long-term economic consequences of the epidemic have not been considered by companies when determining the nature and extent of their response. / Dissertation (MBA)--University of Pretoria, 2010. / Gordon Institute of Business Science (GIBS) / unrestricted

Workplaces are required by law to provide HIV and AIDS workplace programmes to educate and prevent the spread of HIV, and stigmatisation and discrimination against workers infected or affected by HIV and AIDS. This study was a descriptive cross-sectional study conducted in the public and private sector at Mt Fletcher in the Eastern Cape Province. It aimed at assessing the availability and implementation of HIV and AIDS workplace programmes at Mt Fletcher. The study’s objectives were: to assess knowledge of HIV and AIDS among employees; to determine the availability of HIV and AIDS psychosocial programmes; to assess the employees’ knowledge on HIV and AIDS workplace guidelines that prevent stigma and discrimination. This was a quantitative study. A self-administered questionnaire was used to collect data. A total of 81 respondents from both public and private sectors participated in the study. Stratified random sampling was used to select participating workplaces. Simple random sampling was used to select respondents. The findings indicated that both public and private sector workplaces have HIV and AIDS programmes. However, all private sector workplaces at Mt Fletcher had no onsite clinic as required, but use the local public HIV and AIDS clinics. However, 24% of public and 23% of private sector employees had no knowledge of the existence of the HIV and AIDS programmes at their workplaces. About 13% of public and 10% of private sector employees indicated that stigmatisation and discrimination against people living with HIV and AIDS was a problem in the workplace. They also indicated that they would not disclose their HIV status to their employers because they were afraid of losing their jobs. The lack of disclosure further disadvantages workers living with HIV as they do not get the support they deserve from their employers. Furthermore, lack of support, stigma and discrimination have an impact on the performance and productivity of the infected and affected employees and therefore affecting the expected output of their workplaces.

Orientadores: Maria Marluce dos Santos Vilela, Irene Lorand-Metze / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-03T15:47:16Z (GMT). No. of bitstreams: 1 Meira_DenilsonGuimaraes_M.pdf: 2162239 bytes, checksum: 61b897a51139a0db914d0d9f0c90e1c7 (MD5) Previous issue date: 2003 / Resumo: Anemia, neutropenia, linfopenia, plaquetopenia e pancitopenia são freqüentes no curso da infecção pelo vírus da imunodeficiência humana (HIV). A etiologia é multifatorial: uso de drogas mielossupressoras, invasão da medula por infecções oportunistas ou neoplasias, carências nutricionais, destruição periférica e interferência direta do HIV na hematopoiese. O vírus HIV não infecta os progenitores na medula óssea. Sua ação se dá pela infecção de células auxiliares do estroma, o que acarreta desregulação da produção de citocinas e fatores de crescimento de colônias, e alterações no microambiente. O exame da medula pode auxiliar no esclarecimento etiológico das citopenias. Muitos trabalhos descrevem as alterações de medula óssea em pacientes adultos infectados pelo HIV, porém apenas 3 descrevem as alterações em crianças. Nossos objetivos foram descrever as alterações no mielograma de um grupo de crianças infectadas pelo HIV com citopenias periféricas, e verificar a contribuição desse estudo no esclarecimento das etiologias das citopenias. Reavaliar as indicações da coleta de aspirado de medula em crianças com Aids e citopenias. Comparar carga viral e subpopulações linfocitárias no sangue e na medula óssea, em pacientes com ou sem terapia antiretroviral. Foram incluídas 8 crianças com Aids e citopenias e avaliados os aspectos clínicos, mielograma, carga viral e subpopulações linfocitárias na medula, hemograma, carga viral e subpopulações linfocitárias no sangue. Todas as crianças foram caracterizadas como progressoras rápidas da infecção pelo HIV. Foram divididas em 2 grupos, em uso (Grupo 2) ou não (Grupo 1) de antiretrovirais. Grupo 1: três pacientes tiveram diagnóstico de anemia de doença crônica, 1 invasão da medula por MAC e 1 neutropenia secundária à infecção pelo HIV. Grupo 2: um paciente teve diagnóstico de neutropenia secundária à infecção pelo HIV, 1 púrpura trombocitopênica imune e 1 mielotoxicidade por pirimetamina. Não houve diferença entre carga viral no sangue e na medula em todos os pacientes. Foram encontradas correlações diretas entre: linfócitos periféricos e CD19 na medula; carga viral e CD3 total; carga viral e relação CD4/CD8; relação CD4/CD8 na medula e relação granulócitos/eritrócitos na medula (rel G/E). A carga viral no sangue e na medula e a rel G/E foram mais elevadas no Grupo 1.Os dados encontrados são semelhantes aos descritos na literatura em crianças infectadas pelo HIV. O estudo da medula óssea foi útil para o esclarecimento etiológico das citopenias em todos os pacientes, principalmente quando se suspeitou de infecção oportunista e no diagnóstico diferencial de plaquetopenia. Houve correlação entre alterações nos linfócitos da medula óssea e as alterações hematológicas no sangue periférico / Abstract: Anaemia, neutropenia, lymphopenia, thrombocytopenia and pancytopenia are common in HIV infection. The causes are many: drugs, neoplasm infiltrating bone marrow, infection, bad nutrition, increased destruction and direct action of HIV within bone marrow. There is evidence to indicate that the hematopoietic stem cell (CD34+) is resistent to the infection by HIV. The multiple cells that comprise the microenvironment of the marrow (stroma) are infectable by HIV, resulting in decreased production of various hematopoietic growth factors and abnormalities of marrow stroma. Examination of bone marrow may help the diagnosis of the cytopenias. Several studies describe the abnormalities in adult HIV-infected patients, but only 3 describe these abnormalities in children.The aim of this study was to describe the abnormalities in bone marrow aspirates in a group of HIV-infected children with cytopenias, and verify the diagnostic utility of bone marrows sampling in this group. Review the indications of collecting bone marrow aspirates in HIV-infected children with cytopenias. Compare viral load and lymphocyte subsets in blood and in the marrow, in patiens under or not antiretroviral therapy. There were included 8 HIV ¿infected children with cytopenias and studied clinical aspects, bone marrow aspirates, viral load and lymphocyte subsets in the bone marrow; complete blood count, viral load and lymphocyte subsets in blood. The children were divided in 2 groups, with and without antiretroviral therapy. Group 1 (without antiretroviral therapy): 3 patients had the diagnosis of chronic disease anaemia, 1 bone marrow infiltration by MAC, and 1 neutropenia because of direct action of HIV infection. Group 2 (under retroviral therapy): 1 patient had the diagnosis of neutropenia because of direct action of HIV infection, 1 immune thrombocytopenic purpura, and 1 pancytopenia because of adverse effects of pyrimethamine. There were no differences between viral load in blood and marrow. There were some direct correlations between: blood lymphocytes and CD19 in the marrow; viral load and CD3; viral load and CD4/CD8 ratio; CD4/CD8 ratio in the marrow and G/E ratio. The viral load and G/E ratio were more elevated in group 1.The results were similar to that found in the literature for HIV-infected children. The study of marrow aspirates was useful for etiologic diagnostic of cytopenias in all patients, especially when there were suspected oportunist infections and in the differential diagnosis of thrombocytopenia. There were correlations between alterations in lymphocyte subsets in the marrow and hematologic abnormalities / Mestrado / Pediatria / Mestre em Saude da Criança e do Adolescente

Magister Artium - MA / The term, risk-taking, has often been used to describe some of the behaviours and their associated negative outcomes occurring during adloscence. Statistics have shown that South Africa has one of the highest rates of HIV/AIDS infection in the world, with most infections occurring during adolescence. The central aim in this study was to explore the relationship between current constructions of masculinity and risk-taking behaviours among a group of young South African men. It was an exploratory study, focused on exploring how young men construct their masculinities, and how this intersects with or impacts on adolescent male risk-taking behaviours. A key conclusion drawn at the end of this project was that some traditional notions of manhood still held sway, and these tied in strongly with how these participants constructed their masculinity. / South Africa

Master of Public Health - MPH / South Africa is estimated to have one of the highest epidemics of HIV infection. Recent youth studies have found that youth aged 15-24 years are increasingly becoming vulnerable to HIV. Condom use is promoted as one of the key HIV prevention methods in South Africa. Face-to-face structured questionnaire interviews were conducted with a volunteer sample of rural active women and men aged 15-26 years living in 70 villages in the Eastern Cape Province. Most of the participants were recruited in schools. / South Africa