This dissertation, employing an array of theoretical approaches under the rubric of Systems Thinking, explores the reality and experiences of family members that mainly provide care at home for their loved ones who live with or are directly affected by HIV & AIDS. Employing a multidisciplinary approach, the dissertation demonstrates how Systems Thinking, feminist and indigenous knowledge principles can be employed for a better understanding of the contemporary construction of family and experiences of caregivers in an HIV & AIDS context. The discussion of the dissertation is based on data analysed following in-depth interviews with fifteen caregivers of the Bhambayi community. The findings of the study reflect a significant change in the definition and practice of parenting. It was found that HIV & AIDS forces a re-definition of the concept and practice of parenting beyond the traditional boundaries of age, sex and gender. Aligned with this main finding was that parenting practices and coping strategies are largely influenced by a strong commitment to the well-being of the children as well as societal constructs. The thesis of this dissertation is that the HIV & AIDS context and associated gender and cultural stereotypes are principally responsible for a significant shift in the understanding of the concept and practice of parenting within an African context. The study thus submits that a Systems Thinking approach ought to be used by interventionists to better understand and thus contribute towards improving the lives of families or communities in similar circumstance as that of the Bhambayi families. / Thesis (M.Com.)-University of KwaZulu-Natal, Westville, 2009.

Introduction. The use of Highly Active Antiretroviral Therapy (HAART) has shown to reduce the morbidity and mortality and prolongs survival, improving quality of life restoring and preserving immunologic function, maximizing antiretroviral activity and durably suppressing viral load and further preventing vertical HIV transmission. However, their use in Critical Care Units CCU is still controversial as there are still no set standards for how HAART should be applied in these settings (Anderson, 2009). This study was aimed at exploring the perceptions of critical care nurses towards their educational preparedness in managing HIV/AIDS patients admitted to CCU in KwaZulu-Natal. Methodology. Quantitative descriptive research design was used and data collection included a structured questionnaire and open ended questions. Results. The findings of this study indicate that of the critical care nurses who were sampled for this study and had undergone training in HIV/AIDS management, 45% and 25% respectively perceived that they were not educationally prepared to provide services for people living with HIV/AIDS admitted to CCUs. Almost all N=50 (94%) critical care nurses reported that HIV/AIDS management should be incorporated into the critical care nursing programme. Their universal perception N=42 (75%) is that this will improve the standards of nursing care in the critical care field. Over and above lack of training and updated information reported by the respondents, they are still challenged by factors such as advanced level of HIV disease, confidentiality about the disease, knowledge about a HIV/AIDS treatment regimen and emotional challenges. However, there are guiding policies within critical care settings for nurses to utilise in the management of HIV/AIDS and in the care of people who have already been infected. Conclusion and recommendations. In conclusion, more research with a larger scale sample is required to provide appropriate generalisation of the findings of the study. Alternatively a qualitative research study which may provide richer data on the lived experiences of the critical care nurses regarding care of people living with HIV/AIDS is suggested. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

HIV is major public problem in the world and in Sub-Saharan Region in particular. The literature has shown that mental disorders and particularly depression are common among people living with HIV/AIDS, but that little is known about the prevalence of depression and factors associated with it, among people living with HIV/AIDS in Rwanda. A descriptive, cross-sectional study was done to assess the prevalence of depression, the clinical profile and the factors associated with depression among people living with HIV and attending a primary health care centre in Kigali-Rwanda. This study was informed by the stress and vulnerability framework. A questionnaire was used to collect socio-demographic and HIV related medical information, while depression was assessed using the Beck Depression Inventory Scale, with a cut off of less than 10 for no depression and above 10 scoring positive for depression. Respondents were randomly selected from the patient appointment list for patients who were scheduled during the period of data collection and according to the sample selection criteria. The sample consisted of 96 people living with HIV. Permission to conduct the study was requested and obtained from the University of Kwazulu-Natal Ethics Committee, from the CNLS Research and Ethics Committee in Rwanda and from the management of the health care centre to consult patients' files. Data was analyzed using the Statistical Package for the Social Sciences (SPSS for window, 15). Descriptive data was analyzed by means of frequencies, mean and standard deviation. Cross tabulation using Pearson' chi-square test was performed to test the association between sociodemographic factors and HIV related medical information and depression for categorical variables, while t-test for independent simple test was performed for continuous variable. Multi logistic regression analysis was performed to test further association between the above mentioned factors with depression, while controlling for confounders. The results were presented by means of tables, histograms and graphs. The findings of the study revealed that depression is very high among HIV-infected patients attending a primary health care centre in Kigali, with a prevalence of 41.7%. The most frequent depressive symptoms presented were pessimism, fatigability, sad mood; lack of satisfaction, somatic preoccupation, loss of libido, crying spells, work inhibition, irritability, social v withdrawal and loss of appetite. The majority of respondents scored mild to moderate depression, whereas few had moderate to severe depression and only very few scored severe depression. Having considered all other socio-demographic and HIV related medical factors that were studied, being a female, having presented many HIV-related symptoms in the month prior to data collection, and having less than 250 CD4 counts were statistically associated with depression. On the other hand, having high social and family support was a protector factor to depression. Although the results of this study are not generalizable to the Rwandan population living with HIV, they underscore the importance of integrating mental health in HIV/AIDS services for the care of those who present mental problems related to HIV such as depression. / Thesis (MN)-University of KwaZulu-Natal, Durban, 2010.

Aim: The aim of this study was to investigate the educational shortcomings as evident in the literature reviewed with the intention of developing intervention/s thus contributing to practice, management, research and education. Background: Literature identifies many limitations in psychosocial support to families of patients in ICU. Little is known about the continued educational support the ICU nurses receive, formally and informally, to empower them to provide psychosocial support to the families of ICU patients. Methodology: The mixed method (concurrent triangulation design), was adopted using the survey for both the quantitative and qualitative approach. In-depth interviews, conversations, participative observation and the review of documents were used to collect data. Collection of data occurred simultaneously. A research instrument and guide were used to obtain quantitative and qualitative data respectively. Setting: Purposive sampling was used for the selection of hospitals within which the chosen ICUs were located and the educational institutions which provided the formal education and training to ICU nurses who worked in these hospitals. Participants: The qualitative arm involved interviews with a purposively selected sample of critical care nurses. Saturation was reached after nine interviews. A sample size of 34 (n=34) was used in the quantitative arm of the study. Convenience sample was used. Data Analysis: A mixed method approach was adopted. The study applied a thematic analysis according to the qualitative analysis described by Creswell 2007. Descriptive statistics were used to summarize data and findings were presented in tables and graphs. The SPSS version 15.0 and STATA statistical package calculate non – parametric tests between selected study variables. Findings: The main themes derived from the qualitative analysis and confirmed by the statistical data demonstrated the manner in which continued education preparation was inadequate, the lack of specific clinical accompaniment, the lack of direction in terms of the philosophy of the units, ICU nurses being left on their own to obtain educational preparation. The results indicated that the lack of continued informal education at the unit and hospital level influenced the ICU nurses’ lack of implementation of psychosocial support to families of ICU patients. Statistical results and qualitative themes were converged and integrated during data analysis. Jamerson et al.’s (1996) model of family experience was used to contextualise the findings. Recommendations: Recommendations arising from the study were made for improvements in nursing practice, nursing management, nursing education and future nursing research. A practice checklist was formulated and expert opinion was sought using the Nominal Group Technique. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

The main purpose of this study was to examine nurses' attitudes toward caring for patients with Acquired Immune Deficiency Syndrome (AIDS). The study also compared the attitudes of nurses who had cared for AIDS patients with the attitudes of nurses who had not cared for AIDS patients. Educational background was also examined to see if education influences attitudes. The Ajzen-Fishbein Model of Reasoned Action was the framework used for this study.A descriptive design was used for the purpose of gaining more information regarding nurses' attitudes toward caring for patients with AIDS. A random sample of all registered nurses in the state of Indiana was used for this study. The data obtained were analyzed using frequency distributions, independent t-tests, and analysis of variance.Nurses in general are sill uncomfortable with caring for AIDS patients. Between 40% and 50% of nurses are fearful of contracting the AIDS virus and fearful of putting their family at risk. On the other hand, approximately the same percentage are comfortable caring for AIDS patients. Furthermore, nurses believe that health care agencies should care for AIDS patients, but believe that nurses should have the right to refuse to care for AIDS patients.Results of this study indicated that educational background does not influence nurses' attitudes toward caring for patients with AIDS. However, as nurses have more experience caring for patients with AIDS, they appear to develop more positive attitudes. / School of Nursing

The present study examined psychosocial variables as predictors of psychological distress and well-being in gay men with Human Immunodeficiency Virus (HIV) and the Acquired Immunodeficiency Syndrome (AIDS). The psychosocial variables investigated included communal and agentic personality variables, social support, as well as social hindrance, and self-determination variables. The total sample comprised 126 gay men. Forty-eight were seropositive for the HIV infection, 40 received a diagnosis of AIDS, and 38 were seronegative for the HIV infection. The participants with HIV and AIDS were recruited from Immunodeficiency clinics and the HIV$-$ participants were friends and acquaintances of the HIV+ and AIDS participants. The three groups of participants completed questionnaires assessing stable personality traits such as dependency and self-criticism, intimacy, affiliation, achievement, and power strivings, perceived and received social support, social hindrance of personal strivings, and levels of self-determination such as introjective and identified striving motivation. / Multiple hierarchical regression analyses were conducted to assess the predictive utility of each independent variable in predicting psychological distress and well-being. Perceived social support, striving intimacy, and striving achievement were found to be negatively associated with distress and positively associated with well-being across the three groups. Dependency, self-criticism, social hindrance, social hindrance of striving power, and introjective striving motivation were positively associated with distress and negatively with well-being. When all significant independent variables were entered in a regression analysis and simultaneously predicted the outcome variables, perceived social support, self-criticism and social hindrance of strivings significantly predicted psychological distress, and perceived social support, self-criticism, identified and introjective striving motivation predicted psychological well-being. Several independent variables were stronger predictors of distress in the HIV+ group than in the AIDS group: striving power, social hindrance of striving power, dependency, and perceived social support. Results suggest that the HIV+ group is distinct psychologically from the AIDS group. The self-concept theory and the cognitive adaptation theory were discussed in order to explain these group differences. The findings of the present study highlight the important impact psychosocial variables can have on the psychological adjustment of gay men with HIV and AIDS.

The high prevalence of HIV/AIDS in Zambia has led to the development of innovative ways of coping with sickness related to this infection. HIV/AIDS home-based care is one such innovation designed in Chikankata Hospital in 1987. Home-based care depends on the availability of family members and community volunteers in the provision of care and support for People Living with HIV/AIDS (PLWHA).<br /> <br /> This minithesis is based on a qualitative descriptive case study exploring perspectives regarding skills, supervision and support mechanisms for carers in the Chikankata HIV/AIDS Community-Home Based Care (CHBC) program. The study utilized documented research, focus group discussions with carers and structured interviews with local CHBC supervisors, national experts in CHBC, and PLWHA and their families, to collect data from 32 study participants.<br /> <br /> The findings were that CHBC was being delivered by community volunteers with limited involvement from the local health services / that carers were highly motivated, personally and collectively mobilizing resources to meet the needs of CHBC clientele / that local arrangements for training, skills and support of carers were not aligned to national guidelines regarding process, content and duration of programmes / and that carers acquired skills in CHBC through formal and informal training processes and were facing challenges related to inadequate skills, poor infrastructure and extreme poverty in households caring for PLWHA. <br /> <br /> Based on the findings the local arrangements for coordination of CHBC need to be strengthened and linked to formal processes for technical support, financial resources and materials for delivery of CHBC in line with existing guidelines on CHBC. The picture of the real situation of the carers that emerges from this qualitative study might inform the supervising organizations and policymakers on the gaps in the training and support of this crucial cadre in the provision of quality care for People Living with HIV/AIDS (PLWHA) at community level.

Currently, HIV/AIDS is one of the greatest threats to child survival in South Africa. It is estimated that approximately 6000 newborn babies become infected with the HIV virus monthly i.e. approximately 200 babies per day. During a 24 month period (October 1999 &ndash / October 2001), a descriptive prevalence study of the oro-facial manifestations affecting HIV-positive children was conducted in the Cape Peninsula, South Africa. The study population consisted of 268 vertically infected HIV-positive children. The study was motivated by the lack of data regarding oral mucosal lesions in children with vertically acquired HIV-infection.<br /> <br /> The study design was descriptive, and the population included consecutive, vertically infected HIV-positive patients sourced from out-patient clinics, hospital wards and special child-care facilities. The children were examined once consent was obtained from caregivers. The findings were documented using data capturing sheets. The data was captured on the Microsoft Excel program and analysed using the Epi 2000 program. The results indicated that a large proportion of HIV-infected children presented with orofacial manifestations at some stage during the course of HIV-infection. Oro-facial manifestations were observed in 70.1% of the study population. The prevalence of the most commonly observed manifestations were: oral candidiasis, 38.8% / parotid gland enlargement, 10.8% / oral ulceration, 5.6% / molluscum contagiosum, 7.8% / periodontal conditions, 3.4% / and herpes simplex infection, 0.7%.It can be concluded that in this sample of HIV-infected children, the prevalence of orofacial manifestations is higher than, and comparable with the findings of similar studies conducted in other regions of the world.

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.

<p>People's attitudes towards people living with HIV/AIDS remain a major community challenge. There is a need to generate a climate of understanding, compassion and dignity in which people living with HIV/AIDS (PLWHA) will be able to voluntarily disclose their status and receive the support and respect all people deserve. However, many people expereince discrimination because they have HIV/AIDS. In a certain area in Khayelitsha, a township in Cape Town, a young woman was killed after disclosing the HIV status after being raped by five men. While many previous studies have focused on the external stigma in the general population, there is a dearth of studies on stigma among PLWHA themselves and hence the aim of the present study was to investigate stigma attached to HIV/AIDS from the perspective of PLWHA.</p>