Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: STUDY AIM The aim of the study is to explore the psychosocial characteristics of HIV positive clients who are yet to achieve viral load suppression after six months of commencing ARV at Sundumbili CHC in order to plan positive intervention strategies. RESEARCH DESIGN Non-experimental quantitative design was used in carrying out the study. The data was collected through retrieval of information from clinic records and completion of questionnaires to clients on ARV who met the inclusion criteria and consented to participating in the study. A total of 51 adults aged more than 18 years that were initiated in 2010/2011 and still access their treatment at Sundumbili CHC were enrolled into the study. They were selected through convenience sampling. FINDINGS Psychosocial challenges still exist among research participants whose viral load results were not suppressed after six months on ARV. This affected the adherence of some of them to their antiretroviral treatment. CONCLUSION Given the rural nature of Sundumbili and surroundings where the bulk of the patients reside, there are several psychosocial challenges affecting the patients. No known previous study has been undertaken to ascertain the psychosocial characteristics of this group of patients and the impact they may have on viral load suppression after six months of treatment. The study is therefore significant as the findings have provided more insight into the plight of the patients. It is envisaged that the recommendations from the study will assist the relevant management staff in the department in planning and subsequently implementing more positive intervention strategies. The strategies should be targeted at improving the quality of care of the HIV positive clients and attending to their psychosocial needs. / AFRIKAANSE OPSOMMING: STUDIEDOELWIT Die doel van die studie was om ondersoek in te stel na die psigososiale kenmerke van MIV-positiewe kliënte wie se virustellings ná ses maande van antiretrovirale (ARV) behandeling by die gemeenskapsgesondheidsentrum op Sundumbili steeds nie onder beheer was nie, ten einde positiewe intervensiestrategieë te beplan. NAVORSINGSONTWERP ’n Nie-eksperimentele kwantitatiewe ontwerp is gebruik om die studie te onderneem. Die data is ingesamel deur die herwinning van inligting uit klinieklêers sowel as die afneem van vraelyste onder kliënte op ARV’s wat aan die insluitingsmaatstawwe voldoen en tot deelname aan die studie toegestem het. Altesaam 51 volwassenes bo die ouderdom van 18 wat in 2010/2011 met ARV behandeling begin het en dit steeds by Sundumbili-gemeenskapsgesondheidsentrum ontvang, is in die studie opgeneem. Dié groep is deur middel van geriefsteekproefneming gekies. BEVINDINGE Psigososiale uitdagings was steeds te bespeur by navorsingsdeelnemers wie se virustellings nog nie ná ses maande op ARV’s onder beheer was nie. Dit het sommige se behandelingsgetrouheid beïnvloed. GEVOLGTREKKING In die lig van die landelike aard van Sundumbili en omgewing, waar die meeste van die pasiënte woon, kom pasiënte voor verskeie psigososiale uitdagings te staan. Daar is klaarblyklik nog nooit vantevore ’n studie onderneem om die psigososiale kenmerke van hierdie groep pasiënte, en die moontlike impak daarvan op die onderdrukking van virustellings ná ses maande van behandeling, te bepaal nie. Hierdie studie is dus waardevol, aangesien die bevindinge groter insig in die lot van die pasiënte bied. Daar word beoog dat die aanbevelings uit die studie tersaaklike bestuurspersoneel in die Departement van Gesondheid sal help om meer positiewe intervensiestrategieë te beplan en gevolglik in werking te stel. Die strategieë behoort daarop afgestem te wees om die gehalte van sorglewering aan MIV-positiewe kliënte te verbeter en in hul psigososiale behoeftes te voorsien.

This research programme endeavours to develop, implement and evaluate an effective method of offering psychosocial support to vulnerable children. Vulnerability is defined by trained community members as including children who are experiencing especially difficult lives. The forms of difficulties experienced by the children has usually been a consequence of the HIV/AIDS pandemic, extreme poverty combined with other psychosocial risk factors, child abuse (especially child sexual abuse) and violence. This community based programme incorporates four phases of intervention, only two of which were the focus of summative evaluation. However, due to the integrated nature of the programme it was necessary to implement and document the various phases of the intervention programme: (i) community selection and mobilisation; (ii) the 5-day Sensitisation Programme (SP) sensitises adult community volunteers to the psychosocial needs of vulnerable children; (iii) the 15-session Structured Group Therapy Programme (SGTP) enables children to work through past adversities and to build resilience within small groups of peers in a programme where community volunteers served as apprentice facilitators under the supervision, guidance and ethical responsibility of qualified psychologists; (iv) community based initiatives to offer on-going of PSS activities to vulnerable children in each of the partnering communities. Nine partnering communities were selected, three township, periurban and rural communities. This programme was not effective in the informal settlements as it was not possible for these communities to place children as a priority. A qualitative summative evaluation of the SP took place using post workshop evaluation questionnaires, focus group discussions conducted by an independent researcher and an audit of the community based initiatives that developed as a result of participation in the SP. The SGTP was summatively evaluated using a 4-way Factorial design with one within-subject and three between-subject conditions: to investigate the age of the subjects, the geographic regions and gender variables. The 741 children formed five experimental and control conditions to conduct various combinations of the above-mentioned phases programmes and to adequately control for the many confounding variables. Pre- and post intervention assessments were conducted by trained community research assistants. The dependent variable measures were the Culture Free Self Esteem Inventory (Battle, 1992), the Trauma Symptom Checklist for Children (Biere & Elliot, 1997), the Reynolds Depression Scale for Children (Reynolds, 1989), the Social Support Scale (Beale Spencer, Cole, Jones, and Phillips Swanson, 1997) and the Connor's Parent Questionnaire Connors, 1998). Multivariate analysis evaluated the effectiveness of the various experimental and control conditions. The results indicate that the SGTP, run in combination with the SP, is an effective intervention strategy in that it alleviates symptoms of self-reported depression and other psychosocial manifestations of distress as well as decreased the number and severity of symptoms reported by primary caregivers, and leads to increased access to perceived social support. The SP and the SGTP conducted independently of each other have limited benefits and as such can be considered to be partially effective. The children who had formed part of the non-vulnerable control group felt left out of the programme and report an increase in symptomatology and decreased access to social support. While this community-based programme can be considered to be an effective method of therapeutic intervention and of offering psychosocial support to vulnerable children, further research is needed to consider the cost-effectiveness, the sustainability and ways in which those children who do not participate can still can benefit. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

A family is a basic unit of society. Among the many functions that are performed by a family, is the task of providing for its children's needs while simultaneously transmitting the society's way of life. The functioning of the family takes place through a parent-child relationship. It is therefore significant for the family to carry out parental tasks in order to give a sense of security, a sense of companion and belonging, a sense of responsibility, sense of purpose and direction to its members. Although there are many factors that pose a threat to family functioning, the scourge of the HIV/AIDS pandemic cannot be underestimated. As the disease has advanced over time, it has negatively impinged on the children's lives. Children are losing their parents to HIV/AIDS opportunistic illnesses and this has resulted in the burgeoning of child-headed households. The phenomenon of a child-headed household presents a shift from a structural family since a significant subsystem of a family (i.e the parental subsystem) is non-existent. The study presents an in-depth investigation into the social functioning of a child-headed household. The aim was to come to a better understanding about issues that surround households that are headed by children. The social institutions with whom the household co-exists have been scrutinised in order to determine the ways in which these institutions impact upon the social functioning of child-headed households. The study highlights that child-headed households are a deviation from the norm and they create a situation where needs of children are unmet and their rights are eroded. The role of social work in mobilising resources to meet the unmet needs and championing for the rights of the children has been investigated. Case studies of ten families were conducted in the three districts of KwaZulu-Natal an area in South Africa that has widely been reported as hardest hit by the pandemic. A research team was constituted which designed a protocol for conducting case studies and collected data. Social workers also participated in the study with an aim of exploring guidelines for social service delivery with regard to a child-headed household. The study found that children are increasingly exposed to aspects of multiple care-giving through lack of parental care and a changing family structure. It was also revealed that the HIV/AIDS pandemic is shattering children's lives and reversing many hard won children's rights. In spite of the transition in the family life cycle, the family remains the central institution in the children's lives. The scourge of HIV/AIDS poses a great challenge to society. Children are left on their own without visible means of support. The problems of children develop into great magnitude in spite of policies that are in place. The findings of the study point to implications for a practice model that is aimed at co-ordinating services for effective service delivery. The researcher has presented suggested guidelines based on the findings of the study. These guidelines include the role of social work in ensuring that the social functioning of the children in child-headed households is enhanced and that social justice for these children is promoted. A protocol for intervention in child-headed households is provided. This would ensure that interventions in bringing about desired change in the lives of the children, produce sustainable results on a significant scale. / Social work / D. Phil.(Social Work)

Statistics on HIV/AIDS are alarming. Very little is known about how communities are actually coping with this disease and what methods seem to be working to empower them to deal with it. Psychosocial distress is one of the dimensions of the impact of AIDS on children and families, and stresses the necessity to enhance the capacities of extended families and friends to be able to deal with these psychosocial issues. Using qualitative research and a case study as the strategy of inquiry, this dissertation of limited scope explores and describes the factors influencing the capacity of extended families in providing psychosocial support to AIDS orphans. A literature study was done to give a theoretical overview on the following aspects: * AIDS orphans * The extended family and HIV/AIDS To reach the first objective of this study, an empirical study was done and semi-structured interviews were used to obtain information from four extended families in the Mukwe area of the Kavango Region in Namibia. The literature study and the empirical study enabled the researcher to draw conclusions on the factors which influence the capacity of extended families to provide psychosocial support to AIDS orphans. The information was analysed, interpreted and published in this research report so as to reach the other objectives of this study. / Social Work / M. Diac. (Play therapy)

Grandparents fail to communicate sexual matters to the youth. It is their duty to initiate this communication. The escalating numbers of sexually transmitted infections among the youth require grandparents as carers to talk openly. The main purpose of the study was to support grandparents in their communication about sexual matters to the youth. In-depth phenomenological focus group interviews were conducted. Data analysis revealed three themes: grandparents' experience of communication, emotional experience, and the experience of political and social influence. The study developed guidelines for grandparents. The limitations of the study involve the research sample, which was not truly representative of the whole population of East London. The study recommends that all stakeholders be involved in supporting grandparents in their communicating sexual matters to the youth. The researcher recommends further research to describe youth perceptions of communicating sexual matters to grandparents / Health Studies / M.A. (Health Studies)

Women throughout the world are suffering the brunt of HIV/AIDS. They carry the unenviable tag of being the suffering group who are at risk. Women's vulnerability to HIV/AIDS is a subject that has not received adequate attention to date. This empirical study examines the socio-cultural factors and practices that impede upon behavioural change of Zimbabwean women in an era of HIV/AIDS. Firstly, a sample of 1002 women respondents is purposefully drawn from the six major Zimbabwean ethnic groups to participate in this research study. A survey questionnaire is administered to respondents in the age group 18 to 59 years to quantify the levels and magnitude of the HIV/AIDS problem among women. Secondly, fifty in-depth interviews with key informants are conducted to assess the nature of the problem confronting and impeding upon women's quest to attain good reproductive health. Thirdly, six focus group discussions for each of the respective six ethnic groups are conducted with forty-eight mature women to understand broadly the concepts of the study. This study employs a combination of mainly qualitative and some quantitative methods of data collection and analysis, which is called triangulation. Underlying the methodology of this study is an overarching functionalist theoretical perspective, also referring to gender development theory which serves as the basis for data analyses. The main findings of this study include the view that power dynamics, gender roles and cultural practices have impacted negatively on women's quest to attain safe sexual behaviour. The problem of HIV/AIDS remains a complicated and awesome one among Zimbabwe's ethnic groups. For Zimbabwean women the HIV/AIDS problem begins with a total lack of control over sexual lives and behaviour of their husbands especially outside marriage. The women have noted that the majority stay faithful to their husbands and partners according to cultural prescriptions and roles, while their husbands do not comply. Women noted that cultural prescriptions in their various ethnic settings condone male infidelity but expect women to stay faithful to their partners. As a result it is found that women sometimes contract HIV/AIDS straight on their matrimonial beds. / SOCIOLOGY / Thesis (D. Phil. (Sociology))

The study sought to explore and describe the risk behaviour regarding HIV transmission among youth in Bulawayo, their knowledge of HIV transmission and the sources of information on HIV transmission accessible to them. A quantitative, descriptive exploratory design was used and 238 youth from three secondary schools in Bulawayo, the second largest city in Zimbabwe were the respondents. The Health Belief Model (HBM) was used to facilitate and acquire insight into the risk behaviour among the youth. The inferences drawn from the study were that youth have inadequate knowledge about HIV transmission and therefore do not fully understand their risk of infection. Youth also find shyness and fear of rejection serious barriers to communicating openly about sexuality, sexual and HIV/AIDS issues. The findings of the study have implications for programmes to limit HIV transmission among youth and should assist policymakers and educators in developing and implementing such programmes in order to improve the health of youth in Zimbabwe. / Health Studies / M.A. (Health Studies)

A distressing consequence of the HIV/AIDS pandemic and of the increasing numbers of orphans and decreasing numbers of caregivers is the emergence in ever larger numbers of child-headed households (CHHs). The complexity of issues affecting CHHs and the lack of research on this subject means that CHHs are not well understood. This sometimes prompts support agencies to provide emotionally driven recommendations suggesting that it is better for a child to be in an orphanage than to live in a CHH. This exploratory study, involving heads of 105 CHHs over a 12 month period and 142 participants in various focus group discussions (FGD) and interviews, suggests the need for a change in perspective. It addresses the question of CHH quality of life, coping strategies and household functioning and attempts to bring this into a productive dialogue with community child care activities, NGO and statutory support and child care and protection policies. Research data suggests that the key determining factor contributing towards the creation of a CHH is `pre-parental illness' family conflict. Another contributing factor is that siblings want to stay together after parental death. Quality of life assessments indicate that despite significant adversities, over 69% of CHHs reported a 'medium' to 'satisfactory' quality of life and demonstrate high levels of resilience. As regards vulnerability to abuse, it is found that while CHH members are more vulnerable to external abuse, they experience little within their household. Contrary to public perceptions about CHHs lacking moral values, CHH behaviour might actually be more responsible than non-CHH peer behaviour as their negative experiences appear to galvanize them into adopting responsible behaviour. Community care and neighbourhood support in older townships are better established compared with newer suburbs. Sufficient community care capacity enables CHHs to function, thus avoiding a situation where households disintegrate and household members end up as street children. CHH coping responses seem to be mainly influenced by individual and community factors, and by social, spiritual and material support. The interplay between these and the CHH's ability to engage in the required coping task impacts on the coping outcome at household level. National and international government and non-governmental child service providers in Southern Africa need to recognize that an adequately supported CHH is an acceptable alternative care arrangement for certain children in communities with high adult AIDS mortality and where adult HIV-prevalence exceeds 10%. / Development Studies / D. Ltt. et Phil. (Development Studies)

The researcher investigated the knowledge, attitudes and experiences of people living with the Human Immunodeficiency Virus (HIV) towards antiretroviral treatment (ART) and who are accessing antiretroviral treatment at a public health clinic in Limpopo, South Africa. A qualitative method was used. The research findings revealed five themes: experiences, social support, knowledge, attitudes, unemployment and economic themes of the study. Factors reported influencing optimum adherence were the inability of the patients to take medication at work, laziness of the patients to collect medication, unemployment, economic hardship, poverty and lack of knowledge of employers regarding HIV/AIDS. / Health Studies / M.A. (Social Behaviour Studies in HIV and AIDS)

Women face a greater risk of HIV infection worldwide than men. This study explored socio-economic, cultural and environmental factors influencing young women’s vulnerability to HIV. A quantitative explorative study was conducted among young women in Sunnyside, Pretoria. A sample of 158 young women in the age group 18 to 24 years from all language groups was randomly selected to participate in this study. The findings showed that poverty, peer pressure and multiple sexual partners were the main factors that influenced young women in Sunnyside’s vulnerability to HIV. Behavioural change and social change were recommended as long-term processes, which need to be taken into consideration. Findings from the Sexual Relationship Power Scales show that young women between 18 and 21 years experience physical abuse, emotional abuse, sexual abuse and forced sex in their relationships. The study concluded with specific recommendations for the successful implementation of policy makers and planners to protect women. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)