BACKGROUND Sub-saharan Africa remains to date at the forefront of the HIV/AIDS epidemic. Despite breastfeeding being a significant mode of postnatal HIV transmission it remains the main nutritional source and pillar of child survival for the majority of infants born in Africa. It is therefore, not surprising that considerable research has centred on making breastfeeding safer in terms of HIV transmission. The flash heat treatment method (HTEBM) provides a unique opportunity to safely breastfeed infants but prevent mother-to-child transmission of HIV. Cytotoxic T lymphocyte (CTL) responses have been well documented in HIVinfected adults and children. However, there is a lack of literature on CTL responses in HIV exposed low birth weight infants. This pilot study attempted to examine the association of early neonatal feeding on the clinical outcomes and CTL responses in HIV exposed low birth weight infants. METHODS Seventy-seven patients that fulfilled inclusion and exclusion criteria were enrolled. The clinical outcomes of these patients were evaluated over a 9 month period. Fifty-five of these patients were also investigated for cytotoxic T lymphocyte (CTL) responses by means of the IFNγ ELISpot (megamatrix and confirmation) assays at the 6 weeks, 3, 6,and 9 months follow-up. RESULTS Two HIV-1 infected infants generated a CTL response at a single time point using the ELISPOT matrix screening assay. These responses could not be confirmed and were undetectable at any of the consecutive visits. At the time of detection of responses the infants were fed unheated breastmilk. HIV-1 exposed uninfected infants were unable to elicit a HIV-1-specific CTL response irrespective of feed. With regards to clinical outcomes, infants born o HIV infected mothers with a CD4 count < 500cells/μl were 2x more likely to acquire other infections at birth compared to those infants born to HIV infected mothers with a CD4 count >500cells/μl. Also, infants born to HIV infected mothers with advanced disease (CD4 count 0-200 cells/μl) had a lower birth weight compared to infants born to HIV-1 infected mothers with a CD4 count > 350 cells/μl. We also investigated the feasibility of the flash heat treatment method at birth. While inhospital, 38 HIV-1 infected women fed their infants HTEBM after receiving counseling and support from the nursing staff at the King Edward VIII hospital. The numbers decreased rapidly post hospital discharge, mainly due to mixed feeding. DISCUSSION In conclusion we have shown that it is feasible for HIV infected mothers to heat treat their expressed breastmilk during hospital admission. Furthermore, we were able to demonstrate in this small cohort of patients that the clinical outcomes and growth parameters of infants fed HTEBM were similar to that of infants fed either formula or unheated breastmilk. We were unable to demonstrate HIV-specific responses in the infected infants or the uninfected infants who had been exposed to heat inactivated virus in HTEBM. Our findings indicate that this pilot study was limited in its ability to detect CTL responses in HIV exposed low birth weight infants and further studies are warranted. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

The study aims to understand the response of Christian AIDS organisations to HIV/AIDS related conflicts in Bulawayo-Zimbabwe. Many criticisms have been levelled against these organisations mainly because of their delayed, uninformed and reluctant response to HIV/AIDS issues. The intent of this research is not to criticize but to improve the effectiveness of organisations in responding to conflicts related to HIV/AIDS by suggesting possible responses or interventions. Building on conflict resolution theories, the research tried to explore the issues of HIV/AIDS motivated conflict, explain their causes, their form and nature and identified them among the people living with HIV/AIDS in Bulawayo using the focus group technique. Data was also collected from support group supervisors and organisations. The results suggest that there is a possible link between HIV/AIDS and interpersonal conflict and that HIV/AIDS conflict do occur in Bulawayo and they take many forms. People living with HIV/AIDS are the most affected because they suffer from both the disease and the damage to relationships. It still needs to be proved how destabilisation of relationships contributes to the spread of HIV/AIDS in Bulawayo. The results also suggest that there is no formidable response by organisations to HIV/AIDS related conflicts because they refer cases to other institutions. The paper also identifies many issues hindering the resolution of conflicts and some of them include: lack of knowledge on resolution, lack of awareness and lack of relevant skills among many. The study suggests that conflict resolution should be mainstreamed into HIV/AIDS intervention measures in of Faith-based organisations in Bulawayo. However, awareness and further studies of HIV/AIDS related conflicts are needed if meaningful intervention is to be achieved. / Thesis (M.Com.)-University of KwaZulu-Natal, Westville, 2009.

This study investigated the experiences of paediatric care nurses in a public, resource-poor hospital in Durban, KwaZulu-Natal to. A mixed methods design was used . The quantitative aspect focused on how contextual factors influenced nurses’ perceptions of the hospital ward where they worked. The Moos Ward Atmosphere Scale was used to assess ward environment. The Maslach Burnout Inventory Scale was used to explore the role of various aspects of vicarious job burnout. The study took place in four phases, baseline, pre-intervention, intervention and post-intervention. Quantitative analysis was done to explore possible relationships in burnout and ward atmosphere. A repeated (paired) measures t-test design was used to compare the pre- and post-intervention data, to test if the intervention process had any effect on the ward atmosphere and nurse burnout. As this was a small data set, quantitative analysis was done as an exploration for future research. The qualitative aspect explored how the intervention was utilized; how nurses talked about their issues in the support group and what issues they reported. Thematic analysis was used as the focus of this research was describe the experiences of nursing in a resource-poor setting, with the expectation that this could raise complex and new challenges faced in the context of HIV and AIDS. Although nurses in this study reported many challenges resulting from health sector problems, such as the shortage of staff and resources, they did not achieve high scores on the Maslach Burnout Inventory. The possible reasons for this are explored. The study also revealed that newly employed nurses expressed having more miscommunication problems with caregivers and other staff members. Other themes identified included, lack of HIV and AIDS disclosure, stressors related to the current South African context and trauma as a result of the death of patients and colleagues. / Thesis (M.Soc.Sci.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

This study explores the perceptions of care and support for those with HIV/AIDS by community members within the KwaNgcolosi community who are currently not involved in such care and support, and have no current perceived obligation to do so. The Social Capital framework was used to understand the current community perceptions and dynamics related to current care and support for those who are ill with HIV/AIDS. This was followed with suggestions for how this could be improved, current obstacles to this, and possible personal contributions towards improving the current situation. Data was collected by means of six semi-structured, in-depth focus groups, which were conducted in IsiZulu with the assistance of a translator. These were then transcribed and thematically analysed. Overlapping quantitative data specifically for the themes of social cohesion and trust exists in the form of two social assessment surveys, and so frequency counts were done with applicable survey questions, and compared with data collected from focus group interviews. Focus group discussions revealed a marked difference between perceived ideals of how care and support should be, and what is currently happening within the community. Mistrust and stigma surrounding HIV/AIDS appear to still be prevalent within the community, which hampers community social networks and involvement, and acts as a barrier for those who wish to provide care and support for those who are ill. Triangulation with Social Assessment surveys, revealed a discrepancy between social cohesion as related to HIV/AIDS, and general social cohesion within the KwaNgcolosi community. This social cohesion is not currently leading to collective action, which points to a deficit both in information sharing regarding how to do so, as well as a deficit in Social Bridging. Family members and individuals who are ill may, for various reasons, also prevent community members who wish to become involved, from providing care and support to those who are ill. Reciprocity also affects the social credibility of community initiatives, which are not taken seriously if nothing can be expected in return. Additionally, expectations of economic reciprocity regarding contributions to household expenses negatively affects providing care for family members, who are blamed once they become ill, if they did not contribute to the household while still working. Social norms regarding gendered social and economic expectations also hinder and restrict desires to assist in care and support for those who are ill with HIV/AIDS. The obstacles highlighted by the themes of trust, reciprocity and social norms have resulted in potential barriers to mobilization of social networks, and resources that may be available through these networks. There is a need to provide education to community members according to their perceived contributions, in providing care and support for those with HIV/AIDS, and in keeping with current gendered norms which point towards women undertaking much of the physical aspects of care and support, with men engaging in social and emotional support. However, care should be taken that current destructive gender stereotypes, in which women are expected to undertake primary caregiving roles, are not encouraged and perpetuated. Additionally, education surrounding perceived contributions to HIV/AIDS care and support will increase perceived personal abilities and competence, and act as an enabling factor towards more individuals becoming involved in care and support. Gateways to identified sources for information, such as the Home Based Caregivers and the KwaNgcolosi Clinic should also be tapped, and a flow of information encouraged. However, the current situation is a complex combination of stigma, discrimination and blame towards those who are ill, as well as mistrust from the ill person and their family members, who isolate themselves and block any attempts of care and support from community members. This has resulted in many possibilities and untapped resources within the community. Future initiatives must therefore, from a programme perspective, shift from a focus on current obstacles, to encouraging and developing community members. potential contributions towards care and support for those with HIV/AIDS. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

Voluntary Counselling and Testing (VCT) has been predominantly used for diagnostic purposes and it has been suggested VCT could help reduce the spread of the disease by preventing those who test HIV-negative from contracting the disease and also preventing those who are HIV positive from further spreading it by practising safer sex. While there is research focusing on understanding the implications of VCT for HIV positive individuals, little is to be found on the influence of the experience of VCT on the sexual behaviour of individuals who undergo VCT and obtain HIV negative results. Even less is known about the influence of VCT on university students in South Africa. The aim of the study is to explore the perceived influence of VCT on the sexual risk behaviour of HIV negative female University of KwaZulu-Natal students. This qualitative study made use of in-depth interviews conducted with 6 female university students recruited from the HIVAN Support Centre at the University of KwaZulu- Natal, Howard Collage Campus. The findings of this study suggest that VCT is generally perceived as effective in helping to reduce risktaking among HIV negative participants. At the same time participants felt motivated to do what it takes to obtain a negative result on their next test. However, one participants' felt that her negative results could make her vulnerable to pressures from her partner to practice unsafe sex. For VCT to have a positive impact on the sexual behaviour of individuals who test negative, programmes should provide up to date information, as part of pre and post test counselling, in a clear manner to avoid miscommunication and misunderstanding on the part of participants. Further, more support needs to be provided to individuals who are HIV negative in the form of support groups or open forums that encourage young people to discuss what situations put them at risk as well as assist other members of the group to deal with such situations. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

South Africa and the province of KwaZulu-Natal (KZN) has one of the greatest HIV burdens in the world with an estimated 5.7 mHIion people living with HIV/AIDS. One of the interventions that the government introduced to address this situation was the provision of antiretroviral treatment (ART) to those individuals that are eligible for HIV treatment in order to reduce the morbidity and mortality. Despite widespread availability of ART in KZN, children do not access ART to the extent that adults do, and therefore continue to die because of HIV and AIDS. This qualitative study explored the psychosocial and health system factors that influence paediatric access to ART in KZN from parents and caregivers perspectives. The ecological theory and the social cognitive theory was used to formulate an interview schedule used in conducting the in-depth interviews with adults (parents or guardians) who were bringing their children for ARTservices and those attending these services themselves and not their children at Edendale and King Edward Hospitals in KZN. Purposive sampling was used to select clients for interviews and thematic was done in accordance with the aims and objectives of the study. A total of 42 participants were interviewed in this study. The low uptake of child ART was found to be influenced by several psychosocial and economic factors such as the poor knowledge about ART, stigma and disclosure associated with HIV, extent of support provided by parents/caregivers, parent's own ART was a determinant for bringing children for ART, use of traditional / alternative medicines, disintegrated families, especially the issue of multiple caregivers, complexity of paediatric ART, poor referrals of children from community institutions, unsatisfactory service at clinics, and some health policy and legislation with respect to health care for HIV-infected children that had an unintended effect of restricting child access to ART as well as poverty related Issues. Improving knowledge and self-efficacy related to ART, prevention of mother to child transmission ofHIV, re-training of health workers on child issues and addressing stigma and discrimination and other psychosocial and institutional problems and logistics could help to improve the low paediatric uptake of ART. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

The focus of this study was to assess the level of knowledge of HIV/AIDS, and to examine the sexual attitudes and behaviour of adolescents with learning difficulties/disabilities. The sample was obtained from a secondary school in Chatsworth that caters for learners with learning difficulties/disabilities. The study used quantitative methods of data collection . Sixty adolescents with learning disabilities completed questionnaires. The findings indicate that adolescents with learning difficulties/disabilities have good knowledge of HIV/AIDS and subsequently the majority is not engaging in sexual activity. The findings can be used to inform future research on adolescents with learning difficulties/disabilities, as well as to inform future intervention strategies. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

The Social Assistance Act of No. 59 of 1992 was put into place to help in assisting poverty stricken people of South Africa by offering social grants to an aged, disabled person or a war veteran. Due to the devastating effect of HIV/AIDS, people living with HIV/AIDS were entitled to social assistance. However, grave problems exist for this group of persons to access social assistance such as the qualifying criteria for the disability grant being complicated by the medical nature of HIV/AIDS, taking anti-retroviral therapy and problems in the administration procedures. Compounding these, is that rural areas are underdeveloped and lack infrastructure to accommodate adequate service provision. This study aimed to increase understanding of access to social assistance by people living with HIV/AIDS in the rural area of Vulindlela in KwaZulu-Natal, South Africa. The study researched this by hearing the voices of both the service providers (key informants) and people living with HIV/AIDS (patient respondents) by conducting a qualitative study based on a descriptive research design. Data was collected by means of semi-structured, in depth-interviews for both the service providers as well as patient respondents in this study. Findings revealed that the voices of people living with HIV/AIDS were not heard and further that they were not even aware of their rights and entitlements to social security. In fact, in many instances people died without having had any access to their grants whilst others had to wait months before receiving their grants. Findings emphasized the need for education, training and retraining for service providers, recipients and educational institutions as HIV/AIDS poses a major challenge in our society and as it is an ever changing phenomenon. Using an ecosystemic frame of reference, recommendations were multi-fold and included better networking and collaboration amongst the different bodies that are involved in grant administration and revisiting qualifying criteria. Other recommendations included strategies to deal with corruption, the development of pressure and lobbying groups and staff shortages. Given the time it takes to plan and implement changes and given the life threatening nature of HIV and AIDS, a key recommendation was for a newly introduced grant exclusively for the people living with the virus, to lessen the burden of meeting qualifying criteria and thus give dignity to and improve life quality. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

South Africa has the highest burden of HIV and AIDS in the world, yet most of these infected people are unaware of their HIV status. HIV voluntary counselling and testing is shown to have manifold benefits in improving the quality and duration of life of those infected with HIV as well as preventing the spread of infection to HIV negative people. There is a clear need for research into this area. This study therefore investigates the relationship between the social network correlates of HIV testing behaviour amongst a sample of the student population of the University of Kwa-Zulu Natal, Pietermaritzburg campus, using social network analysis and the theories of social learning and social influence as the lens through which to interpret the results. This was an empirical study using data that was collected using an anonymous, self-complete, all-of-campus student survey. Five hundred and sixty-six participants completed the survey. This study employed a cross sectional design and is based on a secondary data analysis of a larger project. The data were analysed using a stepwise multiple regression. The findings show that social network size and residential diversity of participants‟ social networks were significantly associated with VCT uptake. Participants with the smallest network size were more likely to have tested for HIV than those with the largest network size, while those with the most residentially diverse networks were more likely to have tested than those with the least diverse networks. The findings suggest that some aspects of students‟ social networks influenced the likelihood of having tested for HIV, but social learning and social influence are not bound exclusively to an enabling or constraining role on VCT uptake. In order to better understand their influence, the prevailing social norms and information within a social network need to be established. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

As we enter the third decade of a devastating worldwide epidemic, much has been done to stem the flow of HIV/AIDS, in particular within North America and Western European urban centres. However, much is still needed in the developing world. In this study 153 people living with HIV/AIDS in Egypt were interviewed, along with their caregivers. Data were collected on demographics, burden and strain level of caregivers, as well as psychological, psychosocial and health needs. / Using a cross-sectional design, it was found that HIV infection had a negative psychosocial impact on both those infected with and affected by it. Perceived or actual stigma, discrimination, health needs and sexual health status added to this impact. It was also found that caregivers' burden and strain level was higher than a sample of caregivers of renal transplant patients and a sample of caregivers of stroke patients respectively. This suggests that provision of different forms of psychosocial support would help people living with HIV and their caregivers in Egypt cope with the negative impacts of the infection.