M.Cur. / During the time as an infection control professional, there was close contact with patients with Acquired Immunodeficiency Syndrome (AIDS). During this contact period many needs regarding health support were identified. Discrimination and the testing of patients for Human Immunodificiency virus anti·bodies (HIV) without their permission, were the main problem areas. The purpose of the study was to determine the nature and extent of comprehensive health care services for patients with AIDS. The research design is a contextual, exploring and descriptive study. This study was done in the Northern half of economic development area H where 16 health care services were identified. These include clinics, community hospitals, regional- and academic hospitals and the local authority clinic. Private hospitals were not included in the study. Criteria for the nature and extent of comprehensive health care services were based on literature studies. Data was collected by means of structured interviews with nursing professionals in the employ of identified services and patients making use of those services. The results of the research showed various needs in the nature and extent of the comprehensive health care services of the patients with AIDS In order to improve the health care services, recommendations were made and guidelines given to nursing professionals. Recommendations were also made regarding other aspects of the multi·disciplinary team approach. Based upon this study other topics were identified to enable the health care services to provide health care to the patient with AIDS.

Standard economic models often emphasize inputs, outputs and an examination of the structures in order to conduct an economic performance evaluation. This study applies the Institutional and Development Framework (IAD) in the broader context of New Institutional Economics (NIE) in order to examine the transaction costs of delivering Community and Home Based Care and Support (CHBC) to HIV/AIDS sufferers. For purposes of unveiling the empirical reality guiding decision making processes in the CHBC service delivery, comparative qualitative research techniques of normative variable and concept formation have been adopted to draw out the relative institutional influences from the HIV/AIDS national response partnerships. The study identifies the conflict between the predominantly standardized and more rigid formal management techniques adopted by key members of the national response and the informal cultural techniques familiar to the rural communities, and a lack of motivational incentives in the CHBC structures as the key factors against CHBC capacities to draw external funding for service delivery. CHBCs are also weakened by incoherent governance structures at the district level for facilitation of funding and information flow exacerbating the community vulnerability. Rationalization of the institutional arrangements and a clarification of roles from district to community levels, a shift of focus to facilitation of informal techniques and an integration of performance enhancing incentives are the critical policy insights envisaged to spur CHBCs to work better.

Thesis (M. Tech.) -- Central University of Technology, Free State, 2010 / South Africa currently faces one of the highest HIV prevalence rates in the world. As this prevalence rises, the strain placed on its hospitals is likely to increase due to the shortage of beds. The devastating effects of HIV/AIDS initiated the establishment of a hospice which is a non-governmental organisation whose goal is the provision of care for terminally ill patients, either in their homes, in hospitals or in a hospice’s own in-patients wards. Part of the hospice’s mission is to offer palliative care without charge to anyone who requires it. The basic elements of hospice care include pain and symptom management, provision of support to the bereaving family and promoting a peaceful and dignified death. This also includes the provision of cooked foods to the patients using the kitchen facilities of the hospices for this activity. It is well known that the kitchen is particularly important in the spread of infectious disease in the domestic environment due to many activities that occur in this particular setting. Food and water safety is especially important to the persons infected with the human immunodeficiency virus (HIV) or with immunodeficiency syndrome (AIDS).It is estimated that food-borne pathogens (disease–causing agents) are responsible for 76 million illnesses, some resulting in death, in the United States alone every year. In one study of patients with AIDS, two-thirds had diarrhoeal disease and in two-thirds of these, the following enteric pathogens were identified: Salmonella, Shigella, Listeria, Yersnia, Cryptosporidium, Entamoeba histolylica and Campylobacter sp. In an epidemiological study of patients with HIV infection a close association was found between consumption of raw or partially cooked fish and antimicrobial-resistant Mycobacterium avium complex. Antibiotic resistance in food-borne pathogens has become a reality and this poses a serious threat to the medical fraternity since it diminishes the effectiveness of treatment. This study was undertaken to determine the prevalence of foodborne pathogens including bio aerosols isolated from the kitchen surfaces and food handler’s before and after cooking. The antibiotic resistance of the isolated pathogens was further determined to assess their impact on treatment. The following microbiota were isolated: Total viable counts (TVC), Coliforms, Escherichia coli, Staphylococcus aureus, Pseudomonas and presumptive Salmonella. The hospices had high counts of E.coli and S.aureus on the cutting boards for the breakfast session compared to the traditional home based kitchens. It was speculated that this could have originated from crosscontamination via the foodhandler’s hands and the food served. It is evident from the results that hospices lack a management system regarding the prevalence of E. coli as it was present on the cutting boards throughout the food preparation sessions. Gram negative organisms (coliform and P. aeruginosa) were in particular both resistant to oxacillin and this pose a great challenge in this particular setting. This can be addressed by putting emphasis on hygiene as a strategy per se for reducing antibiotic resistance.

Background: Literature has shown that negative attitudes and unwillingness to care for HIV-infected patients are prevailing among healthcare workers. This study aimed to assess the attitudes and willingness of student nurses towards caring for HIV-infected patients in some public hospitals in Gert Sibande district, Mpumalanga. Method: A contextual exploratory quantitative descriptive survey was conducted among student nurses enrolled for a four-year nursing qualification in a nursing college at Mpumalanga province. Self-administered questionnaires were completed after obtaining an informed consent. Results: A total of 122 (70.9%) students participated in this survey. Findings showed that most participants had positive attitudes 66 (52.7%) and were willing 121 (99.1%) to care for HIV-infected patients. Significant associations were revealed between participants’ previous HIV testing (p=0.012), age group (p=0.009), and their willingness to provide care to HIV-infected patients. Conclusion: Results showed a generally positive attitude and willingness by participants to care for HIV-infected patients. / Health Studies / M.A. (Health Studies)

Thesis (M Social Work)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The South African government has laws and policies that forbid discrimination against individuals. These policies protect people from being discriminated against in the workplace due to sickness, race and many other factors. Discrimination against people living with HIV/AIDS has caused many people who suffer from this disease not to come forward with their illness because they fear being discriminated against and stigmatised; some even lose their jobs because they are infected with HIV. People infected with HIV are discriminated against not only in the workplace but also in their communities and families. This implies that people living with HIV/AIDS need support from all levels of society in order to live positive lives, which may lead infected people to live longer. This study explored HIV/AIDS as terminal illness and the stressors experienced by people infected with the virus. This was done by examining the support available to people living with HIV/AIDS, as well as identifying the support needed by these people. By adopting an ecological approach to the study, the need for support could be investigated on multiple levels. A combination of a quantitative and qualitative research design was used in the study. Data were gathered by means of a semi-structured interview schedule that was administered during individual interviews with service providers. This allowed for data that were both measurable as well as rich in description to be collected. The questions in the semi-structured questionnaire were based on the information retrieved from the literature review. The findings from the empirical investigation revealed that people living with HIV/AIDS receive limited support from their families, the South African government and society at large. The findings further indicated that informal sources of support such as family, friends and partners are relatively supportive of people living with HIV/AIDS. However, the relationships between people living with HIV/AIDS and their families and partners are often strained, especially when a person first discovers his or her status as HIV positive. Furthermore, people living with HIV/AIDS are stigmatised on multiple levels because of their status. There is stigmatisation from family, friends, in the workplace and in the community. The most important recommendations resulting from the study are that services such as counselling are needed for people living with HIV/AIDS together with their families. This is of particular significance to the South African government, especially the health sector, which needs to improve the health care system. In addition, recommendations emphasise the importance of promoting education and awareness, which could have great value for people living with HIV/AIDS, their families and communities. Knowledge about HIV/AIDS would empower people at all levels to support those who live with the disease and would also be of great value in helping those living with the disease to contribute something of value towards their health condition. / AFRIKAANSE OPSOMMING: Die Suid-Afrikaanse regering beskik oor wette en beleide wat diskriminasie teen individue verbied. Hierdie wette en beleide beskerm mense teen diskriminasie in die werkplek, diskriminasie op grond van siekte, gestremdheid, ras en vele ander redes. Diskriminasie teen mense wat met MIV/vigs leef, laat baie van hulle hul MIV/vigs-status geheim hou omdat hulle diskriminasie en stigmatisasie vrees. Sommige verloor selfs hulle werk wanneer dit rugbaar word dat hulle aan MIV/vigs ly. Diegene met MIV/vigs ervaar egter nie net in die werkplek diskriminasie nie, maar ook in hul gemeenskappe en families. Dít impliseer dat mense met MIV/vigs op alle vlakke ondersteuning nodig het om ’n positiewe lewe te lei en daarmee hul lewensverwagting so ver moontlik te verleng. Hierdie studie het die stresfaktore van terminale MIV/vigs-lyers ondersoek. Daar is voorts ondersoek ingestel na die ondersteuning wat mense met MIV/vigs ontvang, sowel as die ondersteuning wat hulle nodig het. MIV/vigs-lyers se ondersteuningsbehoeftes op etlike vlakke is deur middel van ’n ekologiese navorsingsbenadering bepaal. ’n Kombinasie van ’n kwantitatiewe en kwalitatiewe navorsingsmetodologie is vir die studie gebruik. Data is met behulp van ’n semigestruktureerde vraelys ingesamel, wat gedurende individuele onderhoude met diensverskaffers afgeneem is. Sodoende kon meetbare sowel as hoogs beskrywende data ingesamel word. Die vrae in die semigestruktureerde vraelys was gegrond op die inligting uit die literatuuroorsig. Die bevindinge van die empiriese ondersoek toon dat mense wat met MIV/vigs leef beperkte ondersteuning van hul familie, die Suid-Afrikaanse regering en die groter samelewing ontvang. Die bevindinge dui voorts daarop dat informele ondersteuningsbronne, soos familie, vriende en lewensmaats, betreklik ondersteunend is teenoor diegene met MIV/vigs. Tog is die verhouding tussen MIV/vigs-lyers en hul families en lewensmaats ook dikwels onder druk, veral net nadat die persoon ontdek dat hy/sy MIV-positief is. Daarbenewens word mense met MIV/vigs op verskeie vlakke gestigmatiseer – deur hul familie, vriende, in die werkplek en die gemeenskap. Die belangrikste aanbeveling uit die studie handel oor die behoefte aan dienste soos berading vir mense wat met die virus leef, sowel as vir hul familie. Die aanbeveling behoort veral van belang te wees vir die Suid-Afrikaanse regering, en in die besonder die gesondheidsektor, wat hierdie behoefte in gedagte moet hou om die gesondheidsorgstelsel te verbeter. Ander aanbevelings beklemtoon die belang van meer opvoeding en bewusmaking, aangesien dit uiters waardevol kan wees vir mense met MIV/vigs, hul familie en gemeenskappe. Kennis oor MIV/vigs sal mense op alle vlakke bemagtig om diegene met die virus te ondersteun, terwyl dit MIV/vigs-lyers self ook sal help om hul eie gesondheidstoestand beter te bestuur.

Introduction: South Africa is currently experiencing one of the most severe AIDS epidemics in the world with South Africa‘s public sector under great stress and under-resourced whilst there exists a vibrant private healthcare sector. Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. However not much is known about the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients. In addition these doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. With the availability of antiretroviral drugs only since around 1996, many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients, further it is very important that these doctors constantly update their knowledge and obtain information in order to practise high-quality medicine. Although private sector doctors are the backbone of treatment service in many countries, caring for patients with HIV brings a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients, in the private sector in developing countries, have highlighted some problems with management thus it becomes important to ascertain these doctors‘ training needs together with where these doctors source information on HIV/AIDS to stay updated. In South Africa two thirds of the doctors work in the private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness on the part of private sector doctors in the eThekwini Metro of KwaZulu-Natal, to manage public sector HIV and AIDS patients. Though many studies have been undertaken on HIV/AIDS, fewer have been done in the private sector in terms of the management of this disease which includes doctors‘ adherence monitoring practices, their training needs and sources of information and their willingness to manage public sector patients. A study was therefore undertaken to assess the involvement of private sector doctors in the management of HIV, their training needs and sources of HIV information, the quality of HIV clinical management that they provided, together with their strategies for improving adherence in patients. Further the study assessed factors that affect adherence in patients attending private healthcare, and finally investigated whether private sector doctors are willing to manage public sector HIV infected patients. A literature review of the barriers that prevent doctors from managing HIV/AIDS patients was also undertaken. Method: A descriptive cross sectional study was undertaken using structured self reported questionnaires. All private sector doctors practising in the eThekwini Metro were included in the study. The study was divided into different phases. After exclusions a valid sample of 931 participants was obtained in Phase 1. However only 235 of these doctors indicated that they managed HIV infected patients, of which only 190 consented to be part of Phase 2 of the study. In Phase 2 the questionnaires were administered by trained field workers to the doctors after confirming doctors‘ consent. The questionnaires were thereafter collected, the data captured and analysed using SP55 version 15. Results: Although 235 (71.6%) doctors managed HIV and AIDS patients, 93 (28.4%) doctors did not, and of the latter 48 (51.61%) had not encountered HIV and AIDS patients, twenty five (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst twelve (12.90%) doctors, though they indicated that there were other reasons for not managing HIV infected patients, did not specify their reasons. Two doctors (2.15%) indicated that due to inadequate knowledge they did not manage HIV and AIDS patients. Significantly younger (recently qualified) doctors rather than older (qualified for more years) doctors treated HIV/AIDS patients (p<0.001). Most doctors (76.3%) expressed a need for more training/knowledge on the management of HIV patients. Eighty five doctors (54.5%) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8%) to initiate therapy. Of the doctors 134 (78.5%) initiated therapy at CD4 count < 200cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI +1 NNRTI combination. Doctors who used CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p<0.001). At initiation of treatment 68.5% of the doctors saw their patients monthly and 64.3% saw them 3-6 monthly when stable. The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6% versus 78.8%; p < 0.05) as sources of HIV information. Of the respondents, 78.9% indicated that they monitor for adherence. Comparison of GPs and specialists found that 82.6% of the GPs monitor for adherence compared to 63.6% of the specialists. (p=0.016). Doctors used several approaches with 60.6% reporting the use of patient self reports and 18.3% pill counts. Doctors (68.7%) indicated that their adherence monitoring is reliable, whilst 19.7% stated they did not test the reliability of their monitoring tool. The most common strategy used to improve adherence of their patients was by counseling. Other strategies included alarm clocks, SMS, telephoning the patient, encouraging family support and the use of medical aid programmes. One hundred and thirty three (77.8%) doctors were willing to manage public sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling was the distance from public sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). There was no statistical difference between adherence to treatment and demographics of the respondent patient such as age, gender and marital status. In this study 89.1% of patients were classified as non-adherent and reasons for non-adherence included difficulty in swallowing medicines (67.3%) (p = 0.01); side effects (61.8%) (p = 0.03); forgetting to take medication (58.2%) (p = 0.003); and not wanting to reveal their HIV status (41.8%) (p = 0.03). Common side effects experienced were nausea, dizziness, insomnia, tiredness or weakness. Reasons for taking their medicines included that tablets would save their lives (83.6%); they understood how to take the medication (81.8%); tablets would help them feel better (80.0%); and that they were educated about their illness (78.2%). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusion: All doctors in the private healthcare sector were not involved in the management of HIV/AIDS patients. Doctors indicated that they required more training in the management of HIV/AIDS patients. However private sector doctors in the eThekwini Metro do obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients, with the majority of private sector doctors being compliant with the current guidelines, hence maintaining an acceptable quality of clinical health care. These doctors do monitor for adherence and employ strategies to improve adherence in their patients who do have problems adhering to their treatment due to various factors. Many private sector doctors are willing to manage public sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

Ministering in the face of HIV and AIDS has posed many challenges. The work of ministers before HIV and AIDS experienced many problems which resulted in ministry burnout. HIV and AIDS have increased the demand for ministers because of the sick, the dying and the grieving people. The increase number of funerals means that a minister conducts many funerals over the weekend and sometimes during the week. This is not the only task of the minister; there are other duties such as house visitation, administration matters, counseling, Sunday services, confirmations and teachings in the church. Furthermore, ministers are often most intensively involved with people in times of crisis and distress. This research deals with the ways ministers are coping or not coping with ministry burnout which may be a result of ministering to people suffering from HIV and those dying of AIDS. This study recognises that an understanding of the minister's problems, as well as helping them to cope, by all who are involved in the church as a vocational system is necessary in the face of HIV and AIDS. The major beneficiary of care and support to ministers will be pastoral ministry itself and the church. Interest in this study therefore stems from both academic and pastoral concerns. Academically, one would like to see the discipline of pastoral care making a scientific and academic contribution that is capable of helping ministers. As for the pastoral concern, one believes that this study and similar studies are ways by which ministry can be strengthened and supported. There is need to equip the church to observe, listen to and respond to ministers in pain more knowledgeably and sympathetically. The researcher endeavours to describe these phenomena accurately through narrative type descriptions, interviews and pastoral conversations. Furthermore, Rediger created a model for avoiding burnout called AIM, which has led to a creation of a model to cope with ministry burnout in the face of HIV and AIDS, which is AIMS: A-Awareness, 1- Impose, M-Management, S-Support. The model has been created in the face of the emotional involvement of ministers in HIV and AIDS / Thesis (M.Th.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

This thesis explores the history of AIDS activism 'from both sides of the bed', by doctors and gay patients, in the 1980s and early 1990s. Such AIDS activism was formed in opposition to dominant racist and homophobic framings of the epidemic and the AIDS-related discrimination that these representations caused. Moreover, links between both groups of AIDS activists have their origins in this period. This history has emerged through oral interviews conducted with AIDS activists and an analysis of archival material held at the South African History Archive and the Centre for Health Policy at the University of the Witwatersrand. Evidence reveals that AIDS activism was politically overshadowed in the 1980s by the overwhelming need to respond to apartheid. Although the Gay Association of South Africa (GASA) resisted AIDS-related homophobia, it was politically conservative, which later led to its demise, and then the creation of new, more militant anti-apartheid gay AIDS activism. By contrast, the anti-apartheid doctor organisations such as the National Medical and Dental Association (NAMDA) and the National Progressive Primary Health Care Network (PPHC) were militantly anti-apartheid, but did not seriously address AIDS in the 1980s. In the early 1990s, in the new transitional context, AIDS activists framed the epidemic in terms of human rights to combat AIDS-related discrimination in AIDS policy. Simultaneously, doctor activists in NAMDA and PPHC mobilised around AIDS in the early 1990s, but both organisations disbanded after 1994. Meanwhile, gay AIDS activists remained prominent in AIDS activism, as some who were living with HIV adopted the strategy of openness about their HIV status. On the other hand, AIDS-related stigma remained widespread in the transition era with important implications for post-apartheid AIDS activism and policy-making. Ultimately, this history has significantly shaped post-apartheid, rights-based AIDS activism and its recent disputes with the government over AIDS policy. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2004.

Social science research on HIV and AIDS has tended to focus on the statistics regarding the spread of the pandemic and the prevention awareness campaigns. However, there has not been much research on the impact that the pandemic has on families and communities at large. Furthermore, although there are international studies very little research has been conducted on caregivers’ education and training locally. Therefore, the current study was done to bridge the gap between literature and practice by conveying findings that are based on a local South African context. The study was conducted in Mpophomeni Township, in Kwazulu-Natal. The research participants consisted of twelve home-based caregivers. The purpose of the study was to explore the informal learning experiences of home-based caregivers from a non-governmental organisation, Siyasiza, in KwaZulu-Natal. The study tried to establish what informed the informal learning experiences of caregivers. The study further investigated how the informal learning experiences were made explicit to inform further learning and also tried to find out what caregivers did with shared information to inform their practices. In order to achieve the objectives of the study a basic qualitative research design was deemed most suitable. The situated and experiential learning theories informed the study and were also used as lenses in the thematic analysis of data collected through observation, focus group discussions and in depth interviews. The findings of the study showed that caregivers’ informal learning experiences were informed by both intrinsic and extrinsic factors. The loss of own family members influenced caregivers to join the community home-based caregiving initiative to assist families affected by the pandemic. Furthermore, caregivers’ informal learning experiences were driven by career-directed ambition, exemplary learning and second chance learning. The findings further indicated that, for some caregivers, once new information was obtained, it was compared with the related prior knowledge, looked at for similarities or differences, and the value added to the previous experiences was determined. The study also found that caregivers valued and appreciated the information sharing sessions which improved their future practices and so made their jobs a bit easier. Lastly, the study found that caregivers played a huge role in supporting the families affected by HIV and AIDS since they mediated between homes and hospital by providing basic health services. / Thesis (M.Ed.)-University of KwaZulu-Natal, Pietermaritzburg, 2014.

Background: Literature has shown that negative attitudes and unwillingness to care for HIV-infected patients are prevailing among healthcare workers. This study aimed to assess the attitudes and willingness of student nurses towards caring for HIV-infected patients in some public hospitals in Gert Sibande district, Mpumalanga. Method: A contextual exploratory quantitative descriptive survey was conducted among student nurses enrolled for a four-year nursing qualification in a nursing college at Mpumalanga province. Self-administered questionnaires were completed after obtaining an informed consent. Results: A total of 122 (70.9%) students participated in this survey. Findings showed that most participants had positive attitudes 66 (52.7%) and were willing 121 (99.1%) to care for HIV-infected patients. Significant associations were revealed between participants’ previous HIV testing (p=0.012), age group (p=0.009), and their willingness to provide care to HIV-infected patients. Conclusion: Results showed a generally positive attitude and willingness by participants to care for HIV-infected patients. / Health Studies / M.A. (Health Studies)