Magister Curationis - MCur / HIV stigma is still affecting People Living with HIV (PLHIV) despite biomedical and structural interventions to reduce this phenomenon. Stigma, particularly health facility related stigma, experienced by PLHIV is reported to fuel poor access to services. As a result, considerable interventions to reduce the stigma among PLHIV have been proposed. However, poor HIV indicators are still reported. Little is reported about PLHIV’s lived experiences of stigma, especially at health facilities, which might be the contributor to poor health outcomes. Hence, this study sought to explore and describe the stigma experienced by PLHIV at a health facility in Khayelitsha Sub-District, Cape Town, South Africa. A qualitative approach, using an exploratory design was followed. Participants were purposively selected, and unstructured interviews were conducted. In total, 15 participants were anticipated to be interviewed. However, saturation occurred after 12 participants were interviewed, but the researcher went further to interview 14 participants. Audiotaped interviews were transcribed verbatim by the researcher (those in English) and assistant researchers (isiXhosa and Afrikaans). Data were then organised and entered into ATLAS.Ti version 8, a Computer Assisted Qualitative Data Analysis Software (CAQDAS) used for analysis of large sets of data. An independent coder was given raw data, and the two outcomes were discussed to reach a consensus on generated themes. The supervisor reviewed the analysed data. Rigour was ensured through the criteria of credibility, dependability, transferability and conformability. The ethical clearance for this study was obtained from the Biomedical Research Ethics Committee (BMREC) at the University of the Western Cape and the City of Cape Town. Six themes emerged from the data because of participants’ experience of stigma at the facility. These include: existence of stigma triggers, participants’ experience of stigma at the clinic, direct stigmatising behaviour, and PLHIV’s characterisation of stigma types, PLHIV’s directed health outcomes, and activism as a secondary health outcome. The results of the study revealed that stigma was perpetuated in the health facility in numerous forms. These were: physical demarcation of the facility, negative behaviour of nurses towards People living with HIV and incompetence of the nurses. This gave rise to recommendations in nursing practice, to policymakers and a need for further research on the topic.

HIV and AIDS which was discovered in the 1980s is causing havoc in many developing countries and Sub-Saharan continent is the hardest hit. Pratt (2008:8) highlights that “the number of people living with the disease is concentrated in the industrially developing world, mostly in those resource deprived countries least able to afford the care of HIV-infected people”. Zimbabwe is one of the SADC countries with the highest statistics of HIV and AIDS. Women account for the largest number of people infected by the pandemic and this could be as a result of the social and cultural norms which oppress women and their position in society. Antiretrovirals (ARV’s) are the life-long drugs given to HIV-infected people to slow the progression of the disease. There are different types of ARV regimens. Zimbabwe introduced the ART roll-out in 2004, however the ART users face multiple obstacles in accessing ARVs. The study targets women because they are a vulnerable group in society, specifically in Zimbabwe. Women have been subjected to stigma, discrimination, violence, humiliation, degradation and psychological torture when they are identified as being HIV positive. Some are neglected and deserted by their partners and families after disclosure, as a result many are too scared to disclose their status to families. The country’s political and economic situation has a major impact on the HIV positive women’s access to ARV treatment. This is compounded with the social and cultural norms and values of the people. The focus of this study is on the challenges experienced by HIV positive women with regard to accessing ARV treatment in Zimbabwe. This study strived to understand the challenges HIV positive women encounter in adhering and accessing to ARV treatment. The goal was to explore the challenges experienced by HIV positive women with regard to accessing ARV treatment in Zimbabwe. The research question of the study was: What are the challenges experienced by HIV positive women with regard to accessing ARV treatment in Zimbabwe? This study used a qualitative approach with a collective case study research design. The population for this study was the African women from Zimbabwe who were infected with HIV and AIDS. Non-probability purposive sampling was utilised in this study to select the sample of 10 women who were living with HIV and AIDS in Masvingo District, Zimbabwe and who were accessing ART. Specific criteria for sampling was used to select clients of two NGO’s in Masvingo district of Zimbabwe: Batanai HIV and AIDS Service Organisation and the Reformed Church in Zimbabwe Community Based AIDS Program. Semi-structured one-to-one interviews were used to collect data. The researcher sought permission of the participants to voice record their interviews and the researcher transcribed them personally. The data gathered was analysed and theme and sub-themes were generated from the data. The research findings were presented thereafter by providing a profile of research participants followed by thematic analysis of the themes and sub-themes from the transcriptions. Literature control and verbatim quotes were used to support these themes and sub-themes. The following are the themes from this study: Theme One- Information regarding HIV and AIDS, Theme Two- Information on ARV treatment, Theme Three- Societal and HIV positive women’s views on HIV and AIDS, Theme Four- Experiences of being an HIV positive woman and Theme Five- Needs identified by HIV positive women. The conclusions of this study reflect that HIV positive women experience some challenges in adhering and accessing ARV treatment. Disclosure, stigma and discrimination, traditional and faith healer’s diagnosis of HIV and AIDS, access to medication for Opportunistic Infections, food shortage, distance to ARV sites, the availability and change of ARV regimens were amongst some of the factors which made access to ARV treatment a challenge. Recommendations from this study can be used by HIV and AIDS stakeholders to understand the challenges and experiences by HIV positive women better. The social workers can also use the recommendations to find ways to make their services known to the communities and also improve their intervention and support to these women. / Dissertation (MSW (Health Care))--University of Pretoria, 2014. / lk2014 / Social Work and Criminology / MSW (Health Care) / Unrestricted

Magister Psychologiae - MPsych / The aim of this study was to explore how HIV positive people understand and describe their experience of taking antiretroviral treatment consistently in a strictly organised regimen. Eight participants were recruited from Ikhwezi Clinic. The participants were interviewed using an in depth interview guide. A Phenomenological data analysis was employed through which six themes emerged. The themes are forgetting and memory aids, fitting treatment into daily routine, belief in effectiveness of medication, experiences of side effects, disclosure and social support and relationship with the health care provider. The health belief model and the self-efficacy theory were applied in the study. These theories helped to understand that the decision to take treatment is not only based on the individual experiences and beliefs but the interaction with the social and environmental factors as well. Family, community and health care factors are all interconnected and play a vital role in the decision to commence and continue with HAART. The study revealed that PLWHA can adhere to antiretroviral medication if they believe in the benefits of doing so. Furthermore it became clear that experiences of men and women differ when it comes to HAART. The involvement of the inlaws as experienced by the women in this study had a negative influence in the participants' adherence routine. Further studies are needed to explore the influence of culture in decision making by women with regards to their health.

Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

More people living with HIV/AIDS reside in South Africa than any other country in the world, and the nation faces colossal challenges in broadening its response to the now-mature and widespread HIV epidemic (WHO, 2005:1). According to South Africa's Medical Research Council, HIV/AIDS has now become the single largest cause of death in South Africa (Dorrington et a/., 2001:6) and has triggered a prominent transferal in the pattern of mortality from the elderly to the young, particularly among young women (Dorrington, 2001:4). The routine treatment of HIV/AIDS with antiretroviral drugs has transformed HIV-infection from an unvaryingly rapidly terminal illness to a somewhat expensive treatable, chronic disease. Triple therapy or highly active antiretroviral therapy (three-drug combinations of ARVs or HAART) in particular have had paramount impacts on HIV-related morbidity and mortality in settings where these drugs are generally accessible. Objectives of ARV treatment are "maximum, durable suppression of viral load, restoration and/or preservation of immune function, improvement of quality of life and reduction of HIV related morbidity and mortality" (Martinson et a/., 2003:236; Martinez et a/., 2007:251; Hellinger, 2006:1; Kumarasamy, 2004:3). The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that a total of 111 827 South Africans were accessing free antiretroviral treatment in the 200 public health sector facilities across 53 districts and a further 60 000 via the private sector by late December 2005 (UNAIDS, 2005:1). The objective of this study was to review, analyse and interpret the usage and prescribing patterns of antiretroviral drugs in a section of the South African private health care sector for the period 1 January 2005 to 31 December 2006 by utilising a medicine claims database of a pharmacy benefit management company, and to investigate the costs associated with these drugs by performing a quantitative, retrospective drug utilisation review. It was found that the prevalence as well as the total medicine cost of ARV medicine items had increased during the study period but the average number of ARV medicine items per prescription as well as both the average cost per ARV medicine item and the average cost per ARV prescription decreased during the study period. Original innovator ARV medicine items and original ARV medicine items with no generic were found to be relatively expensive in comparison with ARV medicine items in general. Conversely, generic ARV medicine items were ascertained to be relatively inexpensive with reference to ARV medicine items in general. It was perceived that the average cost of ARV medicine items and prescriptions for both genders decreased from 2005 to 2006, while there was an increase in the prevalence of medicine items and prescriptions claimed for both female and male patients. The prevalence and cost of all types of ARV medicine items were found to be higher for female patients in general. It was also established that the prevalence of patients receiving antiretroviral treatment in the private health care sector peaks at the age of >30 to 244 years, in comparison with the lower age of >25 to 239 years in the public health care sector. ARV medicine items claimed for patients in the age group >35 to 239 years represented the highest percentage of the total medicine cost incurred during both study years for all ARV medicine types. The majority of ARV medicine items were prescribed by general medical practitioners, and most ARV medicine items were dispensed by community or private institutional pharmacies. It was determined that combinations of 2NRTI + NNRTI were prescribed with the highest frequency, which is compliant with traditional HAART or 'triple therapy' regimens. Lastly, it was found that none of the top 20 prescriptions for one, two and six ARV medicine items were compliant with the National Antiretroviral Treatment (ART) Guidelines. The majority of the top 20 prescriptions for three ARV medicine items (92.67 per cent during 2005 and 89.94 per cent during 2006) were compliant with the National ART Guidelines. Finally, less than half of the top 20 prescriptions for four ARV medicine items (49.60 per cent during 2005 and 36.11 per cent during 2006) were compliant with the National ART Guidelines. Only 5.56 per cent and 3.92 per cent of the top 16 prescriptions for five ARV medicine items were compliant with the National ART Guidelines during the two study years respectively / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

More people living with HIV/AIDS reside in South Africa than any other country in the world, and the nation faces colossal challenges in broadening its response to the now-mature and widespread HIV epidemic (WHO, 2005:1). According to South Africa's Medical Research Council, HIV/AIDS has now become the single largest cause of death in South Africa (Dorrington et a/., 2001:6) and has triggered a prominent transferal in the pattern of mortality from the elderly to the young, particularly among young women (Dorrington, 2001:4). The routine treatment of HIV/AIDS with antiretroviral drugs has transformed HIV-infection from an unvaryingly rapidly terminal illness to a somewhat expensive treatable, chronic disease. Triple therapy or highly active antiretroviral therapy (three-drug combinations of ARVs or HAART) in particular have had paramount impacts on HIV-related morbidity and mortality in settings where these drugs are generally accessible. Objectives of ARV treatment are "maximum, durable suppression of viral load, restoration and/or preservation of immune function, improvement of quality of life and reduction of HIV related morbidity and mortality" (Martinson et a/., 2003:236; Martinez et a/., 2007:251; Hellinger, 2006:1; Kumarasamy, 2004:3). The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that a total of 111 827 South Africans were accessing free antiretroviral treatment in the 200 public health sector facilities across 53 districts and a further 60 000 via the private sector by late December 2005 (UNAIDS, 2005:1). The objective of this study was to review, analyse and interpret the usage and prescribing patterns of antiretroviral drugs in a section of the South African private health care sector for the period 1 January 2005 to 31 December 2006 by utilising a medicine claims database of a pharmacy benefit management company, and to investigate the costs associated with these drugs by performing a quantitative, retrospective drug utilisation review. It was found that the prevalence as well as the total medicine cost of ARV medicine items had increased during the study period but the average number of ARV medicine items per prescription as well as both the average cost per ARV medicine item and the average cost per ARV prescription decreased during the study period. Original innovator ARV medicine items and original ARV medicine items with no generic were found to be relatively expensive in comparison with ARV medicine items in general. Conversely, generic ARV medicine items were ascertained to be relatively inexpensive with reference to ARV medicine items in general. It was perceived that the average cost of ARV medicine items and prescriptions for both genders decreased from 2005 to 2006, while there was an increase in the prevalence of medicine items and prescriptions claimed for both female and male patients. The prevalence and cost of all types of ARV medicine items were found to be higher for female patients in general. It was also established that the prevalence of patients receiving antiretroviral treatment in the private health care sector peaks at the age of >30 to 244 years, in comparison with the lower age of >25 to 239 years in the public health care sector. ARV medicine items claimed for patients in the age group >35 to 239 years represented the highest percentage of the total medicine cost incurred during both study years for all ARV medicine types. The majority of ARV medicine items were prescribed by general medical practitioners, and most ARV medicine items were dispensed by community or private institutional pharmacies. It was determined that combinations of 2NRTI + NNRTI were prescribed with the highest frequency, which is compliant with traditional HAART or 'triple therapy' regimens. Lastly, it was found that none of the top 20 prescriptions for one, two and six ARV medicine items were compliant with the National Antiretroviral Treatment (ART) Guidelines. The majority of the top 20 prescriptions for three ARV medicine items (92.67 per cent during 2005 and 89.94 per cent during 2006) were compliant with the National ART Guidelines. Finally, less than half of the top 20 prescriptions for four ARV medicine items (49.60 per cent during 2005 and 36.11 per cent during 2006) were compliant with the National ART Guidelines. Only 5.56 per cent and 3.92 per cent of the top 16 prescriptions for five ARV medicine items were compliant with the National ART Guidelines during the two study years respectively / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

This thesis, 'Living with HIV/AIDS: An ethnography of care in Western Kenya', is based upon 18 months of ethnographic fieldwork carried out in Central Nyanza, Kenya, between 2005-2007. It studies practices of care against the backdrop of the HIV/AIDS epidemic, which has impacted the region severely. The thesis explores how home and hospital are established as domains of care through practice. It draws upon ethnographic material collected from within a District Hospital, a Community-Based Organisation and people's homes. The thesis follows practices of care across divergent domains of social life to consider how practices of care within Luo networks of kinship and relatedness intersect with governmental interventions to manage HIV/AIDS. The thesis describes two governmental projects introduced to administer HIV/AIDS care in this region. It considers Home-Based Care, an HIV/AIDS response in which Community Health Workers are trained to support particular aspects of care at home, focusing on the practices of care employed by Community Health Workers as they visit sick people at home and attend organisational meetings. The thesis also describes the landscape of HIV care in the District Hospital, including the delivery of antiretroviral therapy. The focus here is on the relationships between caring practices in the hospital and at home, and the divergent responsibilities to care experienced by hospital staff and family members. The main argument of the thesis is that care is a particularly useful analytical tool for anthropology because practices of care take place across many different domains of social life, cutting across the boundaries that have formed the traditional focus of anthropological study. Studying practices of care illuminates the production of bounded domains of social life whilst simultaneously drawing attention to similarities of practice across different domains. Care provides a way of understanding the complex social landscape that has developed as people in Western Kenya endeavour to live with HIV/AIDS.

yes / This briefing presents research on a small project on the use of a rights-based approach by groups of People Living with HIV/AIDS (PLWHA) in Northern Tanzania. It concludes that with support the groups were able to use the 2008 HIV/AIDS act to claim their rights to tackle stigma and access ARV medication. However, the fulfillment of these rights is limited by chronic poverty and structural weakness of the state.

HIV/AIDS research has proven crucial in an effort to prevent and manage this epidemic. However, there is little research being done in an attempt to understand the internal worlds of those living with HIV/AIDS. The purpose of this research was to begin to explore the relationship that exists between the person living with HIV/AIDS and the virus, as an internal object, inside them. This study focused on 6 women who were on Anti-Retroviral Medication (ARVs), and who have been diagnosed for at least one year. The participants’ mental representations of the virus as an object inside them was explored, as well as how they experienced and viewed the triangular relationship that exists between themselves, the HI Virus, and the ARVs. This exploratory research utilised a qualitative framework in order to understand and explore these relationships and perceptions, with psychoanalytic theory being used a lens through which to view the data that emerged. In depth semi-structured interviews were conducted with the participants, and the corpus of data was analyzed using a thematic content analysis. In addition, the participants were asked to draw the virus inside their bodies. These were analyzed using a technique devised by Paola Luzzatto (1987) in a study exploring the internal world of drug-abusers. For the purpose of this study, a variation of the same art therapy technique was used in that the participants were asked the ‘draw the virus in their bodies’. Whilst the drawings allowed for insight into the internal worlds of the participants, the drawings were also used as a point of departure. For most of the women, HIV was drawn using a red crayon, whilst the ARVs were drawn in either yellow or green. As depicted in the drawings, post diagnosis the HIV/red seemed to cover most of the body, but later when the ARVs/green was added, more of a balance was achieved. Results show that for these women, HIV was often perceived as dangerous and criminal, whilst the ARVs were often associated with security. From the perspective of Kleinian theory, the perception of the HIV and the ARVs seemed to be dependent upon the position from where they were functioning: either a paranoid-schizoid or a depressive position.

From the early 1990s, rates of HIV infection increased dramatically in South Africa and by the early 2000s, AIDS emerged as the main cause of death for adult South Africans. During the first half of the 2000s, the South African government’s response to this crisis was inadequate, marked by denial and delays in implementing prevention and treatment, resulting in thousands of preventable deaths. Yet, apart from the challenges posed by the predominantly urban-based Treatment Action Campaign (TAC), the absence of a social response to this crisis is notable, especially in rural settings. This scenario forms the broad backdrop to this ethnographic study that draws on participant observation and interviews undertaken over a three-year period (2002-2005) in KwaBomba village previously in the Gazankulu Homeland, now located in the Bushbuckridge municipality of the South African lowveld. An ethnographic perspective provides an intimate vantage point from which to view peoples’ experiences of the AIDS epidemic and their responses in context. This perspective draws attention to gaps in public health and biomedical understandings of the epidemic and suggests alternatives to these understandings. In Bushbuckridge, mortality and morbidity due to AIDS became visible in the late 1990s and early 2000s. Households were incapable of dealing with the burden of illness and death while the health services were often unwilling and ill-prepared. HIV prevention campaigns based on individual behaviour change were not well suited to a context in which HIV spread through sexual networks. Despite widespread awareness of the threat of AIDS, the disease was subjected to public censorship and AIDS suffering was concealed. Public discourses of AIDS were hidden within gossip and rumour and articulated as witchcraft suspicions and accusations. Although these discourses appear to deny and suppress the reality of AIDS, I suggest that they are active attempts to deal with the AIDS crisis: gossip and rumour allocate blame and construct a local epidemiology through which the epidemic can be surveilled; interpreting AIDS as witchcraft creates the possibility of avenging untimely death. These discursive forms are critical in informing individual and social responses to the AIDS epidemic. While the absence of public acknowledgement of AIDS as a cause of illness and death suggests denial and fatalism and appears to limit public action, subaltern discourses create shared secrets to manage the AIDS epidemic at the local level. Furthermore, these discourses may constitute a form of resistance against biomedical models of causality. Ethnographic enquiry at the local level offers a nuanced understanding of social responses to the AIDS epidemic. By examining forms of expression that lie outside the domain of public health, the thesis reveals how these constitute significant forms of social action in response to the epidemic. / Thesis (PhD)--University of Pretoria, 2012. / Anthropology and Archaeology / unrestricted