Abstract not available

In recent years there has been a worldwide recognition of the disparity of HIV treatment available in the West and in Sub-Saharan Africa. The West African nation of Senegal was early to implement measures that allowed for the distribution of highly effective anti-HIV therapy known as Antiretroviral (ARV) therapy to a limited number of patients. This thesis explores how patients living in Senegal who are infected with HIV have engaged in various negotiations to obtain access to treatment and other resources to meet the needs posed by their infection. These negotiations are framed by various historically embedded notions of how to engage relationships in the search for care. Strategies are also shaped by the biopolitically-laden discourse that guides the distribution of ARV therapy. This thesis traces the structure, evolution, and effects of patients' strategic negotiations in response to the introduction of this therapeutic technology.

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.

Voluntary counselling and testing, the cornerstone of HIV/AIDS prevention efforts worldwide, is at the centre of a policy debate rega rding its effectiveness. Informed by social constructionism and drawing on various tools from ethnomethodology and conversation analysis, a sample of twenty-seven vid eotaped simulated counselling interactions in South Africa was analysed. The aim was to assess how the interactional tasks of the voluntary counselling and testing sess ion were worked through by clients and counsellors, and how this was done against the publ ic health and counselling frameworks that inform voluntary counselling and testing pract ice. The goal of the analysis was not to examine practitioners’ competencies, but to exam ine their unfolding actions in the situation and to consider the interactional functio ns these actions might serve. The results show that of the three interactional ta sks of voluntary counselling and testing, information-giving lays the foundation upon which the advice and support goals are realised. It is constructed as critical to client a nd counsellor identities and is a powerful tool through which hope is dispensed. Both the info rmation-giving and support tasks of voluntary counselling and testing combine to manage client distress into more concrete and manageable terms that encourage client coping. Counsellors draw on a range of advice-giving strategies – those that place the onu s of responsibility on the client to those that view the counsellor as the moral guide able to direct client change – in order to encourage clients to reflect on their risk behaviou r. In general, voluntary counselling and testing is framed as a moral activity, and this is most evident in the advice-giving segments. The public health and counselling framewo rks that inform voluntary counselling and testing create a dilemma for counse llors. In practice, counsellors orient towards a directive and health-advising role rather than a non-directive, client-centred counselling role. The implication of this research is that voluntary counselling and testing needs to be defined and framed more clearly – i.e. as a public health intervention with preferred outcomes that draws on a set of client-centred skills. Reconceptualisations of voluntary counselling and testing need to acknowledge the mor al framework under which it operates. Clear implementation guidelines (and training) on what voluntary counselling and testing is and that define its goals more clearly will be useful in assisting counsellors to implement the policies that govern their practice. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

HIV/AIDS Education in Butare- Ville Secondary Schools (Rwanda): Analyzing current Pedagogic Discourse using a Bernsteinian framework. This thesis is concerned with the questions of "the what and how of HIV/AIDS school education". This study is located in three secondary schools in Butare-Ville, Rwanda, which were selected to show the picture of current pedagogic practices of fighting the pandemic in various schools. The first part of the study is concerned with the analysis of National policy of HIV/AIDS education of grade 9. This analysis examines how HIV/AIDS education is planned and integrated in various school subjects and what the Ministry of Education's policy is on how it should be implemented. I examined the instructional and regulative discourses within the national policy. Through curricula of other subjects which integrate into HIV/ AIDS education, I also examined how the knowledge of instruction is organized in terms of vertical and horizontal organization. The second part of the study is concerned with how the National HIV/AIDS Policy of HIV/AIDS education is transmitted in the classrooms in terms of classification and framing. In consideration of how students are educated about the disease, I explored students' grouping in terms of gender for getting knowledge and life skills to protect themselves from the pandemic. The theoretical resources for the analysis are drawn from Bernstein. The contribution of this thesis is two-fold. Firstly, it offers methodological techniques for evaluating of HIV/AIDS discourse with regard to how it is constructed and distributed in the classroom using a Bernsteinian framework. Secondly, the thesis points forward to further research in HIV/AIDS education for change in curriculum and pedagogic practices. / Thesis (M.Ed.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

HIV/AIDS is no longer seen as an individual problem as it also affects the family as a whole. The purpose of this study is to purpose of analysing the mental health of family affected by HIV/AIDS in Rwanda. It should be noted that there were not studies conducted on the mental health of the affected families in Rwanda. A qualitative approach using case study design was used to describe the mental health of affected family in Rwanda. HIV/AIDS-related stressors, emotional reactions of family members and coping strategies they adopt to deal with those stressors and emotional reactions were studied. The effects of those reactions and strategies on the infected family member as well as the entire family were analysed. A purposive sampling was used to select two families from Mwana Ukundwa Association for the study. The findings of the study showed multiple losses, care, and socio-economic demands as the main stressors for both cases. Emotional reactions to those stressors included shock, anger, sadness, hopelessness, depression, fear and shame. Participants reported using both emotional and problem-focused coping strategies. Compassion, caring and showing concern had positive effects on the infected and affected as well as family members, whereas emotional reactions such as anger, unhappiness, and discouragement had negative effects on the entire family. Positive effects of family reactions and strategies to cope were associated with coping strategies such as; having opportunity to talk: to someone, distraction, family relationships, spiritual support, treatment, and socio-economic support. Ineffective strategies included family communication dysfunction due to withdrawal behaviour, alcohol abuse and going to nightclubs. These strategies had negative effects on both infected and affected family members. The results suggest that health professionals such as nurses, doctors and other healthcare providers should use a holistic approach in caring for infected family members. They should not only provided family care, but also include the family in planning to care for the infected family member. This will empower them to play a more effective role in home care-based. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2004.

Health Studies / M.A. (Health Studies)

M.A. (Psychology) / The Acquired Immunodeficiency Syndrome not only threatens the world with hitherto unknown rates of mortality and economic ruin, but has also saddled the health sciences with an unprecedented challenge in curing and managing this disease. Herein, the health sciences have not found a cure, and the management of the disease is made extremely difficult because of the unpredictable nature of the interrelationships in biopsychosocial factors inherent in the disease. In order to attempt a description of the complex interrelationships between biopsychosocial factors in this disease, a group of twenty patients in a treatment programme comprising of an exercise and cognitive-behavioural intervention, were subjected to immunologic and psychological assessment before and subsequent to the intervention. The data obtained indicated that none of the interrelationships between psychological and immunological variables predicted by psychoneuroimmunological science existed prior to the intervention. It would appear that the interrelationships between these variables were in total disarray - defeating the object of systematic logical description of biopsychosocial factors in this condition. The post- intervention data suggested a pattern of interrelationships totally within the confines of predicted neuropsychoimmunologic patterns of a biopsychosocial interaction in a disease of immunologic origin. This pattern of predictability would then render possible a treatment programme of a multidisciplinary nature which would bear predictable fruit. It also underscores the necessity of psychological interventions as an adjunct in the treatment of AIDS.

M.A. (Psychology) / It is generally accepted that Acquired Immunodeficiency Syndrome is the most serious pandemic ever to threaten South Africa. Within the context of South Africa being an African country, this pandemic is dramatically increasing and establishing a pattern which will not only effect the health services in the future, but will also have a devastating effect on the economy of the country. The greatest impact of the Acquired Immunodeficiency Syndrome is not only on the individual and his health condition, but also on the context within which the individual functions. Within this context, the family is affected and a reciprocal effect takes place, where the manner in which the family of the affected individual deals with his condition, may have a detrimental effect on his illness. To date limited research has been conducted to describe this condition and its impact on the family. This study was undertaken in order to deal with the problem. Two experimental groups were recruited, the reason being that these two experimental groups would largely cover the diversity of the field in which this condition occurs. The first experimental group consisted out of white homosexual males who were diagnosed as having AIDS and the second group consisted out of a group of black heterosexual males who were also diagnosed as having AIDS. Ten psychosocial variables were isolated in order to investigate the impact the Acquired Immunodeficiency Syndrome has on family interaction. These were: depression, alienation, conflict within the family, cohesion within the family, meaningful interaction within the family, social interaction within the family, moral/religious emphasis within the family, impact of the disease on physical ability, the need for sleep and rest, and total sickness impact on the individual. An analysis of the data indicated that both white homosexual male subjects and black heterosexual male subjects displayed significantly more depression, less social interaction, a greater need for sleep and rest, and a decline in physical ability. Furthermore, the analysis also indicated a very serious impact on the individual's ability to function. Of exceptional importance was the fact that white homosexual subjects displayed significantly more alienation and increased conflict within their families than the black heterosexual subjects, while the black heterosexual subjects in turn experienced less significant interaction within their families

This dissertation is a critical, theoretical study focussing is on the contribution that popular music makes towards raising awareness and promoting the prevention of HIV/Aids in Nairobi, Kenya. Towards this end, an analysis of the lyrics and musical gestures of four Kenyan pop music songs is undertaken in order to highlight their communicative capabilities in this regard. These songs, namely, are Lulumbe by Wasike wa Musungu, Juala by Circute and Jo-el, Vuta Pumz by The Longombas, and Dunia Mbaya Chunguze by Princess Jully. The context in which these musical analyses occur is provided in: - An overview of the Kenya of today, in particular that of the diverse and hybrid ethnic, linguistic, musical and cultural practices of Nairobi, and of the various youth cultures in that city, as well as in an overview of the extent of the HIV/Aids pandemic in Kenya, especially amongst the youth of Nairobi, with some reflection on existing interventions. - An overview of current trends in popular music analysis and an explanation of the author’s own eclectic semiotic analytical methodology within this context. The study concludes that a repeating strategy may be discerned on the part of the composers and performers in question, namely, to first engage audiences through language and music with which they are familiar, and then to encourage audiences to confront the unknown and unfamiliar in music and language, but also ultimately in terms of their social practices. The known and the familiar is highlighted both in the lyrics and in the music itself. It includes use of commonlyspoken languages and dialects, popular musical styles typical of the particular sub-culture, and references to the day-to-day experiences of the ordinary person.