published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / Paediatrics and Adolescent Medicine / Master / Master of Philosophy

The purpose of this study was to generate a grounded theory explaining the social and psychological processes employed by gay men in living with the threat of Acquired Immunodeficiency Syndrome (AIDS). As members of the high risk group for AIDS, gay men are living with a prolonged threat of unprecedented complexity which has unknown demands on health. An exhaustive preliminary literature review revealed a dearth of theoretical or empirical data addressing this problem. Theory discovery was accomplished using the grounded theory methodology. Two major data collection procedures were utilized: The conduct of increasingly structured interviews of healthy gay men, and an ongoing, progressive literature and media search. Data were sampled theoretically, as guided by the emergent theory. The constant comparative method of analytic induction was used for the analysis of data, in order to identify the elements and structure of the theory. Multiple procedures were incorporated into the analysis to ensure its trackability and credibility. A basic social process, Surviving Survival, was identified as the core category of the theory. Surviving Survival is the continuous process used by gay men to ensure mortal survival as well as outlive the extremity of the AIDS threat. The process is comprised of three subcategories: Vigilance, Safeguarding, and Balancing. The subcategory of Vigilance explains the work of monitoring the threat of AIDS and has both personal and social components. Safeguarding explains the behavior of protecting self and others from the AIDS threat, including AIDS' eventuality. The subcategory of Safeguarding contains Safer Sex, Reassuring Others, and Forecasting. The subcategory of Balancing explains efforts to conserve energy required to sustain affirmation of life and living in spite of the AIDS threat. In continuous interaction, the subcategories of Surviving Survival are interwoven into multiple aspects of gay living. This theory explains the profound impact AIDS has on the mental health of gay men, who both survive and perceive the extremity of the AIDS threat on a daily basis. These findings provide a knowledge base for the nursing discipline in becoming an informed and informing resource for the men who are outliving the threat of AIDS.

The aim of this study was to investigate met and unmet palliative care needs for people living with HIV/AIDS in selected areas in Rwanda. The achieve this aim, the study, firstly, identified the palliative care needs of people living with HIV/AIDS, secondly, it identified the health care services available to meet these needs, and thirdly, it determined the extent to which palliative care needs were met.

The way gender relations influence access to care and treatment particularly access to antiretroviral medicines is a challenge to HIV/AIDS programmes and to the individuals and families with HIV. Gender norms that push women and men to adhere to dominant ideals of femininity and masculinity may restrict women's access to economic resources, health care and fuel the spread of HIV. The aim of this study was to determine the role of gender relations in influencing decision-making for access to antiretroviral medicines between partners and in the family.

With the increase in the number of persons suffering from HIV/AIDS, physiotherapists are often required to treat these patients who present with respiratory and neurological complications. Although physiotherapists are at a lower risk of HIV infection in the workplace than nurses and doctors, it is necessary to determine their knowledge and perceptions of the risks, fears of HIV transmission and their attitudes towards patients with the disease. The aim of the study was to determine the physiotherapists knowledge of, and their attitudes towards patients with HIV/AIDS. It also explored whether the physiotherapists knowledge influences attitudes towards HIV/AIDS patients in Lusaka, Zambia.

This dissertation breaks new ground. It examines the perceptions of older adults towards AIDS prevention. Using the National Health Interview Survey, 1988: AIDS Knowledge and Attitudes Supplement, a modified Health Belief Model is developed. Despite the low number of older adults 55+ with AIDS, some extenuating circumstances increase their risk of AIDS contraction. Older adults have lower levels of knowledge about AIDS, weaker immune systems and receive more blood transfusions. Societal influences include educational neglect at the hands of physicians, healthcare workers and social service personnel. The first stage of the dissertation involved establishing older adults as an at-risk population through an extensive literature review. Next, the data was described utilizing frequencies, correlations and factor analysis. Frequencies clearly indicated that older adults in the data set had low levels of AIDS knowledge and did not view themselves at risk for AIDS contraction. Correlations between the variables were minimal. A modified Health Belief Model was developed and tested. Multiple regression determined that minimal variation in the two dependent variables, "Perceived Effectiveness of Effective Methods to Prevent AIDS Contraction" and "Perceived Effectiveness of Ineffective Methods to Prevent AIDS Contraction" was accounted for by the independent variables. Although F ratios allowed rejection of the two null hypotheses, beta weights were low. Adjusted R^2's accounted for only 21% and 16% respectively of the variation in the dependent variables. Finally, discrepancies in the model were determined and recommendations made for further research. Most health belief models concentrate on individual social-psychological variables. Due to AIDS' societal consequences, it is proposed that societal providers of education: physicians, social service workers and healthcare personnel need to be included in the model. Recommendations were made for additional research into sexual behavior of older adults and exploration of available training of physicians, healthcare and social service professionals. Finally, recommendations were made to provide training and education for both professionals as well as the elderly to prevent their growth into an at-risk population.

Thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology, School of Human and Community Development University of the Witwatersrand, May 2017 / Psychosocial support and wellbeing of orphans and vulnerable children (OVC) in sub-Saharan Africa receive a lot of attention globally. However, great concerns still persist due to a multiplicity of factors that affect the children’s quality of life. This study examines experiences of psychosocial support and wellbeing of these children in Nairobi, Kenya. While there are few existing studies on the effects of HIV and AIDS on OVC in Kenya, most focus on OVC in primary schools and high schools leaving out infants and preschool aged OVC, as is the case in sub-Saharan Africa. Thus, information that details psychosocial experiences and wellbeing of OVC in preschools in Kenya is lacking. This study focused on OVC aged between 5 and 7 years old within a resilience theoretical perspective; investigated their lived experiences, risk exposure, support structures and other adaptive experiences. A total of 57 participants (45 were children and 12 teachers) from ECDE centres in Nairobi County were purposively sampled for the study. Multiple methods utilised included: visual stimulus illustrations, face-to-face and conversational interviews, thematic drawings, focus group discussions questionnaires and infrastructural and supportive resource assessment. Thematic content analysis (TCA) which was informed by phenomenological hermeneutic approach was used to analyse data. Findings consistently showed that, OVC were not only susceptible to numerous risk experiences due to environmental and care factors at home, but also on their way to and from school, and within ECDE centres. Nonetheless, ECDE centres exposed them to cognitive skills, social networks, safety, alternative care, primary health services, nutrition and resilience nurturance. These findings indicate the crucial role of having a collective action in reduction of adverse experiences and improving resources to empower the OVC in urban ECDE centres. Directions for further research could focus on expanded population-based studies examining poverty, malnutrition, resilience and coping resources among preschool children living with, and affected by HIV and AIDS, using creative multiple qualitative approaches. A more critical understanding on variations in sexes is equally important in intervention strategies for this group of OVC. / MT2018

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2016 / According to UNAIDS, there are ~36.9 million people infected with HIV-1 in the world. Of those, 25.8 million live in sub-Saharan Africa and 6.8 million in South Africa. HIV-1 subtype C accounts for over 95% of HIV infections in South Africa. HIV-1 retrovirus acquires mutations rapidly because of the viral reverse transcriptase. Naturally occurring polymorphisms distinguishing wild type C-SA PR from other proteases make it less susceptible to inhibitors. E35D↑G↑S is a C-SA PR variant with a double insertion in the flap region of the protease. The insertions and background mutations may decrease susceptibility to inhibitors as well as alter kinetic parameters due to increased flap flexibility. This study intended to characterise the effect of the mutations and insertions in E35D↑G↑S on structural, kinetic activity and drug susceptibility. Chemically-synthesised E35D↑G↑S autocatalyses rapidly, impeding further characterisation. There was no detectable overexpression of the E35D↑G↑S protease in Escherichia coli BL21 (DE3)pLysS and Rosetta 2® cells. If the protease is catalytically enhanced, attributed cytotoxicity may prevent overexpression of the protein. Increased autocatalytic activity could also prevent crystallisation. Inactive E35D↑G↑S D25A did not overexpress either, indicating that codon harmonisation with the expression host ought to be performed. C-SA PR was shown to be a predominantly beta-sheeted protein using circular dichroism spectroscopy. The KM of the fluorogenic substrate resembling the capsid/ p2 cleavage site for C-SA PR was 22.02 ±4.09 μM. The specific activity, catalytic turnover and catalytic efficiency of the wild-type C-SA PR protease were found to be 35.68 ±1.06 μmole.min-1.mg-1, 12.79 ±0.38 s-1 and 1.17 ±0.055 s-1.μM-1, respectively. The thermodynamics of binding of atazanavir, ritonavir and darunavir to C-SA PR were determined using isothermal titration calorimetry. The binding of atazanavir and ritonavir to C-SA PR is entropically driven and enthalpically opposed. However, the binding of darunavir to C-SA PR was found to be both entropically and enthalpically favourable. The dissociation constants of the inhibitors in the absence of substrate (Kd) are in the pico-molar range and increased by approximately one order of magnitude when saturating concentrations of substrate were introduced. Atazanavir, ritonavir and darunavir have dissociation constants (Kd) of 160.56 ±54.59 pM, 113.34 ±46.47 pM and 10.24 ±6.02 pM, respectively. Darunavir binds significantly tighter. Keywords: C-SA PR, E35D↑G↑S, insertion mutations, protease, autocatalysis, ITC.

Diminished affective behavior is a frequently observed concomitant of cognitive dysfunction in the Human Immunodeficiency Virus (HIV), yet little is known about their relationship. A neuropsychological battery and electroencephalogram (EEG) recording was conducted on 29 HIV+ (Mage = 35.6 years, SD =5.36) and 30 HIV- (Mage =32.9 years, SD =6.39) women recruited from a family AIDS care program in South Florida. Using an emotion regulation paradigm, we compared event-related potentials (ERPs) following cues to view-neutral, view-negative and reappraise-negative images from the International Affective Picture System (IAPS). A group X instruction interaction was found for the P200 and early (400-1000 ms) late positive potential (LPP). Executive function, i.e., frequent task-switching predicted the attenuation of the early and late LPP following cues to up-regulate negative emotions. Greater response inhibition predicted attenuation of the LPP during the down-regulation of negative emotions. These findings suggest limited cognitive resources for the reappraisal of emotions in women with HIV. / by Roger Christopher McIntosh. / Thesis (Ph.D.)--Florida Atlantic University, 2012. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.