Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The global targets of zero deaths from AIDS-related illness by the year 2015 can only be met if all HIV infected infants can be diagnosed and initiated on anti-retroviral therapy as early as four to six weeks. WHO/UNICEF reported in 2010 that only 8% of eligible infants were tested worldwide. There seems to be more attention directed towards service delivery and less attention on empowering mothers to make voluntary decision to access the services. The influence of maternal knowledge of infant HIV infection and the impact on the attitude towards knowing the status of their children so early in life remains uncertain. The aim of this study was to explore the knowledge and attitude of the HIV positive mothers to early infant diagnosis in order to make strategic recommendations to the health authorities on how to scale up the services in the various health facilities. A qualitative study was conducted in two health centres in King Sabata Dalindyebo Municipality of Eastern Cape Province, South Africa. This qualitative study drew in-depth interview with twenty-four HIV positive mothers/ exposed infants’ pair attending the immunization clinics. The results obtained were presented to two focus groups for discussion and validation of findings. Thematic analysis explored the emerging themes relevant to the objective of the study and health authorities. The study found that there is a high level of awareness about infant HIV infection. Majority of the participants were aware of MTCT of HIV and the timing of transmission (pregnancy, delivery and breastfeeding). Majority of the participants were aware about the protection offered by maternal exposure to ARVs however, only few participants knew about the risk of transmission despite ARV use. Majority of the participants did not know the right time to bring their infant for HIV test. Majority of the participants never thought about HIV test for their infant as early as six weeks. Majority of the mothers have fears about bringing their infants for HIV test so early. They have concerns about recommending early infant diagnosis to other children in their community due to the perceived disclosure of their own status. The study found that despite good knowledge of mothers about infant HIV infection and prevention methods, the knowledge about early infant diagnosis is lacking. The attitude of the mothers to knowing the status of their infant so early in life is challenging for them. The health authorities have more work to do to empower these mothers with knowledge about early infant diagnosis and early ART initiation to increase the chances of survival of HIV infected infants. / AFRIKAANSE OPSOMMING: Die internasionale mikpunt van geen sterftes weens vigsverwante siektes teen die jaar 2015 kan slegs bereik word as alle MIV-besmette babas reeds op vier tot ses weke gediagnoseer word en antiretrovirale terapie (ART) ontvang. Die WGO/UNICEF het in 2010 berig dat slegs 8% van babas wat getoets moet word, in werklikheid wêreldwyd getoets is. Dit blyk dat meer aandag aan dienslewering en minder aan die bemagtiging van moeders om die vrywillige besluit om van die dienste gebruik te maak, geskenk word. Die invloed van moeders se kennis op MIV-besmetting van babas en die impak op die houding teenoor kennis van die status van hul kinders op so ’n vroeë ouderdom is steeds onbekend. Die doel van hierdie studie was om die kennis en houding van MIV-positiewe moeders rakende vroeë diagnose van babas te ondersoek ten einde strategiese aanbevelings aan die gesondheidsowerhede te maak oor verbetering van die dienste in die onderskeie gesondheidsfasiliteite. ’n Kwalitatiewe studie is in twee gesondheidsentrums in King Sabata Dalindyebo-munisipaliteit in die provinsie Oos-Kaap, Suid-Afrika, onderneem. Dit het diepte-onderhoude met 24 MIV-positiewe moeders/blootgestelde babas wat die immuniseringsklinieke besoek het, behels. Die resultate is aan twee fokusgroepe vir bespreking en bekragtiging van die bevindings voorgelê. Tydens ’n tematiese ontleding is die temas wat aan die lig gekom het wat betrekking het op die doelstellings van die studie en gesondheidsowerhede ondersoek. Daar is gevind dat daar ’n hoë vlak bewustheid van MIV-besmetting van babas is. Die meerderheid van die deelnemers was bewus van moeder-na-kind-oordrag van MIV en die tydsberekening van oordrag (swangerskap, geboorte en borsvoeding). Die meerderheid van die deelnemers was ook bewus van die beskerming wat gebied word deur die moeder se blootstelling aan ART, maar net ’n paar deelnemers het egter geweet van die risiko van oordrag ongeag die gebruik van ART. Die meerderheid van die deelnemers het nie geweet wat die korrekte tyd is om hul baba vir ’n MIV-toets te bring nie. Die meerderheid het nog nooit ’n MIV-toets vir hul baba voor die ouderdom van ses weke oorweeg nie. Die meerderheid van die moeders was bang om hul babas so vroeg reeds vir MIV te laat toets. Hulle is begaan oor die aanbeveling van vroeë diagnose vir ander mense in hul gemeenskap weens die waargenome bekendmaking van hul eie status. Die studie het bevind dat ongeag moeders se grondige kennis van MIV-besmetting van babas en voorsorgmaatreëls, daar ’n gebrek aan kennis oor vroeë diagnose van babas is. Die houding van die moeders teenoor kennis van die status van hul baba op so ’n vroeë ouderdom hou vir hulle ’n uitdaging in. Die gesondheidsowerhede moet hulle daarop toespits om hierdie moeders sonder kennis oor vroeë diagnose van babas en vroeë nakoming van ART te bemagtig ten einde MIV-besmette babas se kanse op oorlewing te verhoog.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The AIDS epidemic has brought out both the best and the worst in people. The disease brings out the best when individuals group together in solidarity to combat the consequences of HIV/AIDS and to support and care for PLWHA. HIV/AIDS also brings out the worst when individuals are stigmatized and ostracized by their loved ones, their family and their communities and discriminated against individually as well as institutionally. This research has reviewed available scientific literature on HIV/AIDS stigma and discrimination. The research has also established HIV/AIDS stigma and discrimination comes in different forms and occurs in different contexts. Stigma and discrimination play a significant role in HIV/AIDS prevention and treatment efforts. Analysis of this research indicates stigma and discrimination has a negative impact on HIV/AIDS prevention and treatment efforts. / AFRIKAANSE OPSOMMING: Die VIGS-epidemie het beide die beste en die slegste in mense. Die siekte bring die beste wanneer individue groep saam in solidariteit die gevolge van MIV / VIGS te bestry en te ondersteun en sorg vir PLWHA. MIV / VIGS bring ook die ergste wanneer individue gestigmatiseer en verstoot deur hul geliefdes, hul familie en hul gemeenskappe en teen gediskrimineer individueel sowel as institusioneel. Hierdie navorsing het hersien dat die beskikbare wetenskaplike literatuur oor MIV / VIGS stigma en diskriminasie. Die navorsing het ook vasgestel dat MIV / VIGS stigma en diskriminasie kom in verskillende vorms voor en kom in verskillende kontekste. Stigma en diskriminasie speel 'n belangrike rol in MIV / VIGS voorkoming en behandeling pogings. Ontleding van hierdie navorsing dui daarop dat stigma en diskriminasie het 'n negatiewe impak op MIV / VIGS voorkoming en behandeling pogings.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Based on the significant evidence from the three African randomized controlled trials, the WHO and UNAIDS recommended in 2007 that medical male circumcision should be a priority HIV prevention intervention. The three randomized trials in Africa demonstrated that adult male circumcision decreases the human immunodeficiency virus (HIV) acquisition in men between 51% to 60%, with long-term protective efficacy. This study intends to document and analyze the effectiveness of three communication interventions used in transferring knowledge about medical male circumcision as an HIV preventative strategy. Furthermore it also aims to determine which communication intervention will have the greatest effect in improving knowledge and understanding about medical male circumcision as an HIV preventative measure for implementation in future health promotion programmes. The research in this comparative study was conducted on a farm in the Overstrand sub-district of the Western Cape Province in South Africa, Haygrove Haven. A total of 30 male employees aged 18 to 45 was randomly selected to participate in the study. The data was collected using a self-administered pre-test questionnaire. In order to compare the pre- and post-test answers, the questions were repeated to determine the knowledge transfer after the respective information and training sessions. Analysis of the data was a simple process and limited to the necessary information to graph the required conclusions by using the computer programme Microsoft Excel 2010. The study looked at the statistical indicators of knowledge, perception and awareness of participants with regards to medical male circumcision as an HIV and AIDS prevention strategy. The findings exhibited that most people knew about MMC but very few had knowledge of the protective effect of the procedure against HIV acquisition and transmission. The study concluded that providing accurate information with fitting communication material at the right literacy levels, peoples’ knowledge of the benefits of medical male circumcision does increase. This will contribute to change the perception and therefore increase the acceptability of the procedure. This conforms to the subject of the WHO and UNAIDS 2007 study and can improve their findings. / AFRIKAANSE OPSOMMING: In 2007 het die WGO en UNAIDS aanbeveel dat mediese manlike besnydenis ‘n prioriteit MIV-voorkomings program moet raak, wat gebaseer is op die beduidende bewyse van drie Afrika gerandomiseerde gekontroleerde proewe. Die drie gerandomiseerde proewe in Afrika toon dat volwasse manlike besnydenis verminder die menslike immuniteitsgebreksvirus (MIV) in mans met 51% tot 60%, met 'n lang-termyn beskermende doeltreffendheid. Hierdie studie is van voorneme om die doeltreffendheid van drie kommunikasie-intervensies wat gebruik word in die oordrag van kennis oor mediese manlike besnydenis as 'n MIV-voorkomende strategie, te dokumenteer en te analiseer. Verder stel dit ook ten doel om te bepaal watter kommunikasie-intervensie die grootste invloed in die verbetering van kennis en begrip oor mediese manlike besnydenis as 'n MIV-voorkomende maatreël, vir implementering in toekomstige gesondheidsbevorderingsprogramme. Die navorsing in hierdie vergelykende studie is uitgevoer op 'n plaas in die Overstrand-sub-distrik van die Wes-Kaap in Suid-Afrika, Haygrove Haven. 'n Totaal van 30 manlike werknemers tussen die ouderdomme 18 tot 45 is lukraak gekies om deel te neem aan die studie. Die data is ingesamel met behulp van 'n self-geadministreerde vraelys waar die pre-toets vrae in die post-toets herhaal word, om die antwoorde met mekaar te vergelyk, om sodoende te bepaal watter opleidingsessie die grootste kennis oordrag laat plaasvind. Ontleding van die data is beperk en so eenvoudig as moontlik om die gevolgtrekkings te maak en grafies deur te gee deur gebruik te maak van die rekenaarprogram Microsoft Excel 2010. Die studie kyk na die statistiese aanwysers van kennis, persepsie en bewustheid van die deelnemers met betrekking tot mediese manlike besnydenis as 'n MIV-en VIGS-voorkoming strategie. Die bevindinge van die studie is dat die meeste mense bewus is van mediese manlike besnydenis, maar baie min kennis gehad het van die beskermende effek van die prosedure teen MIV verkryging en oordrag. Die studie het bevind dat die verskaffing van akkurate inligting met gepaste kommunikasie materiaal op die regte geletterdheidsvlakke, mense se kennis van die voordele van mediese manlike besnydenis kan laat toeneem. Dit is bydraend om ‘n individu se persepsie te verander en dus die aanvaarbaarheid van die prosedure te verhoog. Dit voldoen aan die onderwerp van die WHO en UNAIDS 2007 studie en kan sodoende hul bevindings verbeter.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Safe Male circumcision (SMC) divides people for or against it, depending upon their attitudes. The Ministry of health (MOH) has built capacity in the country for rapid scale up of the program since 2009. However, despite the efforts, the number of men circumcised is lagging behind set targets. We do not know to what extent attitudes of the managers at national and district levels do influence this underperformance? The effectiveness of the managers at workplace at large will depend on their attitudes towards SMC. Managers with positive attitudes bring at workplace energy, creativity and momentum to fulfill the work objectives and goals. Objectives: The objectives of the study were to; 1) establish the current situation of SMC implementation in Botswana, 2) establish the required attitudes for managers towards SMC program, 3) establish the attitudes of SMC managers at all levels toward SMC program, 4) determine the gap between the required attitudes and SMC managers’ current attitudes toward SMC, and 5) Provide recommendation for reinforcing positive attitudes toward SMC program. Methods: The study used an explorative qualitative design. It was carried out at the Ministry of health headquarters and in ten districts in Botswana. A total of 26 SMC program managers were interviewed using a semi-structured interview guide. Results: The study found that the managers were confirming to positive attitudes toward the program as prescribed by the MOH’s standards. Data revealed a positive trend in scaling up of the program albeit lagging behind set targets. Conclusion: This study looked at the desired attitudes of SMC managers should posses and the level of attitudes currently have towards the program. It was not easy to link attitude and performance of individuals. High turnover rate of SMC officers was a worrisome finding that calls for further study. / AFRIKAANSE OPSOMMING: Agtergrond: Na gelang van hul houdings, is die meeste mense hetsy sterk ten gunste van of heftig gekant teen veilige manlike besnydenis (VMB). Die Ministerie van Gesondheid is reeds sedert 2009 besig met vermoëbou-inisiatie we om die VMB-program vinnig uit te brei. Ondanks hierdie pogings, is die aantal mans wat ingevolge dié program besny word egter veel minder as die vasgestelde teikens. Dit is nie bekend in watter mate die houdings van VMB-programbestuurders op nasionale en distriksvlak hierdie onderprestasie beïnvloed nie. Die algehele doeltreffendheid waarmee dié bestuurders die program in werking stel, sal immers grootliks afhang van hul houdings jeens VMB. Bestuurders met ’n positiewe houding sal energie, kreatiwiteit en stukrag aan die werkplek verleen ten einde die programoogmerke en -doelwitte te verwesenlik. Oogmerke: Die oogmerke van die studie was: 1) om die huidige stand van VMB-inwerkingstelling in Botswana te bepaal; 2) om te bepaal watter houdings bestuurders behóórt te hê jeens die VMB-program; 3) om te bepaal watter houdings bestuurders op alle vlakke wél het jeens die VMB-program; 4) om vas te stel in watter mate bestuurders se vereiste houdings en huidige houdings jeens VMB verskil; en 5) om aanbevelings te doen vir die versterking van positiewe houdings jeens die VMB-program. Metode: Die studie het van ’n verkennende kwalitatiewe ontwerp gebruik gemaak. Dit is by die hoofkantoor van die Ministerie van Gesondheid sowel as in tien gesondheidsdistrikte in Botswana onderneem. Onderhoude aan die hand van ’n semigestruktureerde onderhoudsgids is met altesaam 26 VMB-programbestuurders gevoer. Resultate: Die studie bevind dat die bestuurders wél positiewe houdings jeens die program toon soos wat die standaarde van die Ministerie van Gesondheid vereis. Data dui op ’n positiewe tendens in die uitbreiding van die program, al word die vasgestelde teikens nie bereik nie.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: World Health Organisation (WHO) and UNAIDS named male circumcision as a key intervention in halting the spread of HIV in Africa. Several countries in sub-Saharan Africa with low levels of male circumcision (MC) and high HIV prevalence are scaling up MC services, Swaziland being one of them. Despite the circumcisions done in Swaziland it seems there is no significant decrease in HIV prevalence which might be due to various reasons. One of the reasons noted was the behaviour of men after circumcision because of the belief of total of immunity. This has led to an increase in high risk behaviour, increased promiscuity, multiple partners, more unsafe sex and failure to use condoms, thereby defeating the own stated purpose. Objectives: 1) To identify the knowledge, attitude and practices (KAP) of circumcised men towards safe sex. 2) To establish the existing knowledge of the relationship between circumcision and HIV prevention. 3) To establish whether men in Swaziland take part in riskier sexual behaviour after or before being circumcised. 4) To make recommendations for the counseling programme. Methodology: A cross-sectional analytical study whereby both qualitative and quantitative methods of data collection was used. Simple random sampling was used to select circumcised men from Mankayane hospital, Mankayane and Holy Rosary high schools and a total of 90(60 adults and 30 teenagers) filled in self- administered questionnaires and also took part in focus group discussions. Purposive sampling was used to choose the MC Counsellors and in-depth interviews were done to complement the information on knowledge, attitudes and practices of men towards safe sex before, during and after circumcision. An observation checklist was also used to check what they included in their counselling sessions. Results: The responses solicited from the men who participated in this study show that there is basic knowledge with regards to safe sex and the value of MC in the prevention of HIV. The pattern in the data however shows that those that were the most recent to undergo medical circumcision had the most varied opinions on the extent to which MC protect one from HIV. There was mixed attitude towards safe sex after circumcision, some wanting to maximise their satisfaction without using protection. The data also points to a pattern were the men have a high relationship turnover and this was more discernible among the teenagers who suggest that the relationships are not built on commitment but possible experimentation. While the study did not have control that tracked uncircumcised men for comparative purposes, the findings point to inconsistent use of condoms among men which heightens the risk of HIV transmission. The results point to a well-structured programme of counseling followed by MC counselors. Conclusion: The study was able to satisfy the aim and objectives. The research process was designed to collect the necessary data and be analysed in a manner that answered the research question. The research target population and subsequent sample represented the geographical scope of the study. The research tools were designed to be easy for the respondents to use. The distribution and collection method was designed to give the respondents less hassle as possible. This had a positive impact on the response rate, which increased the validity of the data collected. Both the literature review and primary research findings affirm that MC without behaviour change is not the panacea for prevention of HIV. / AFRIKAANSE OPSOMMING: Die Wêreldgesondheidsorganisasie (WGO) en UNAIDS het manlike besnydenis as ’n belangrike intervensie uitgewys om die verspreiding van MIV in Afrika te stuit. Verskeie lande in Afrika suid van die Sahara met lae vlakke van manlike besnydenis (MB) en hoë vlakke van MIV is tans besig om MB-dienste uit te brei, en Swaziland is geen uitsondering nie. Ondanks die besnydenis wat in Swaziland gedoen word, blyk daar egter geen beduidende afname in MIV te wees nie. Dít kan aan verskillende redes toegeskryf word. Een daarvan is mans se gedrag ná besnyding vanweë hul oortuiging dat hul geheel en al immuun is. Dit het tot ’n toename in hoërisikogedrag, meer promiskuïteit, veelvuldige bedmaats, meer onveilige seks en ’n gebrek aan kondoomgebruik gelei, wat uiteraard die doel verydel. Oogmerke: 1) Om besnyde mans se kennis, houdings en praktyke met betrekking tot veilige seks te bepaal. 2) Om bestaande kennis oor die verband tussen besnydenis en MIV-voorkoming te bepaal. 3) Om vas te stel of mans in Swaziland voor of ná besnyding geneig is tot meer riskante seksuele gedrag. 4) Om aanbevelings te doen vir die MB-beradingsprogram. Metodologie: ’n Deursnee- analitiese studiebenadering met sowel kwalitatiewe as kwantitatiewe datainsamelingsmetodes is gevolg. Met behulp van eenvoudige ewekansige steekproefneming is mans van Mankayane-hospitaal en tienerseuns van Mankayane- en Holy Rosary-hoërskool gekies. Altesaam 90 respondente (60 volwassenes en 30 tieners) het vraelyste op hul eie ingevul en ook aan fokusgroepbesprekings deelgeneem. Doelbewuste steekproefneming is gebruik om ’n groep MB-beraders te kies, met wie daar diepteonderhoude gevoer is om die inligting oor mans se kennis, houdings en praktyke met betrekking tot veilige seks voor, gedurende en ná besnyding aan te vul. ’n Waarnemingskontrolelys is ook gebruik om af te merk wat die beraders by hul beradingsessies insluit. Resultate: Die antwoorde van die mans wat aan hierdie studie deelgeneem het, toon basiese kennis met betrekking tot veilige seks en die waarde van MB in die voorkoming van MIV. Die patroon in die data toon egter dat diegene wat mees onlangs mediese besnydenis ondergaan het, die mees uiteenlopende menings het oor die mate waarin MB jou teen MIV beskerm. Daar is ’n gemengde houding oor veilige seks ná besnyding: Party mans jaag eenvoudig so veel moontlik bevrediging na, sonder enige beskerming. Die data dui ook op ’n patroon van ’n hoë verhoudingsomset onder die respondente. Dít was veral waarneembaar onder die tieners, wat te kenne gee dat hul verhoudings nie op toewyding gegrond is nie, maar eerder moontlike eksperimentasie. Hoewel die studie geen kontrolegroep met onbesnyde mans vir vergelykende doeleindes gehad het nie, dui die bevindinge op inkonsekwente kondoomgebruik onder mans, wat op sy beurt die risiko van MIV-oordrag verhoog. Die resultate dui voorts daarop dat MB-beraders ’n goed gestruktureerde beradingsprogram volg. Gevolgtrekking: Die studie het in sy doel en oogmerke geslaag. Die navorsingsproses was ontwerp om die nodige data in te samel en te ontleed ten einde die navorsingsvraag te beantwoord. Die navorsing steikenpopulasie en gevolglike steekproef was verteenwoordigend van die geografiese studiebestek. Die navorsingsinstrumente was ontwerp vir maklike gebruik deur respondente. Die verspreidings- en insamelingsmetode is gekies om so min moontlik moeite vir respondente te veroorsaak. Dít het ’n positiewe impak op die reaksiesyfer gehad, wat weer die geldigheid van die ingesamelde data verhoog het. Sowel die literatuuroorsig as die primêre navorsingsbevindinge bevestig dat MB sonder gedragsverandering allermins ’n ‘wondermiddel’ vir MIV-voorkoming is.

Thesis (MPhil)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: One of the consequences of HIV/AIDS is the large number of orphans and vulnerable children (OVC). Most OVC care givers in African communities are elders. The elders use their meagre pension hand out to support their OVC grandchildren. The Ministry of Gender Equality and Child Well Fare (MGECW) has responded to the financial burden of the OVC care-givers by issuing different social grants to the OVC. Due to preventing factors not all OVC are receiving these grants. The Namibian Government has formulated different policies protecting the rights of OVC. However, not all stakeholders are implementing these policies which lead to the OVC`s rights being compromised. This study was conducted in Omusati Region in Namibia to determine the factors that prevent some of the OVC care-givers from accessing the social grants and other benefits entitled to the OVC under their care. Data for this study have been obtained from four sources, using four different data collection methods. In depth interview have been used to collect data from twelve Community Childcare Workers (CCW) in the (MGECW) administering the OVC`s grants applications at twelve Constituencies. Some information was obtained using structured questionnaire from twenty four teachers dealing with OVC at twelve schools in twelve Constituencies. The officials from the Ministry of Home Affairs and Immigration (MHAI) have been engaged in focus group discussion to provide valuable information to this study. Literature has also been reviewed to shed more light on the subject under investigation. This study discovered that there are various impediments preventing the care-givers from obtain the OVC social grants. Lack of documents, transport costs and long distances coupled with cumbersome process of processing grants applications and issuing national documents are among the preventing factors. This project has been concluded with recommendations which if implemented will smoothen the process of grants accessibility. / AFRIKAANSE OPSOMMING: Een van die gevolge van MIV/Vigs is die groot aantal weeskinders en kwesbare kinders (OVC). OVC sorg gewers in Afrika-gemeenskappe is die ouderlinge. Die oudstes gebruik hul karige pensioen hand uit hul OVC kleinkinders te ondersteun. Die Ministerie van Geslagsgelykheid en Kinderwelsyn Wel Fare (MGECW) het gereageer op die finansiële las van die OVC versorgers deur die uitreiking van verskillende maatskaplike toelaes aan die OVC. As gevolg van die voorkoming van faktore nie alle OVC hierdie toekennings ontvang. Die Namibiese regering het verskillende beleide wat die beskerming van die regte van die OVC geformuleer. Egter nie alle belanghebbendes die implementering van hierdie beleid wat lei tot die OVC se regte word gekompromitteer. Hierdie studie is uitgevoer in die Omusati-streek in Namibië om die faktore wat verhoed dat sommige van die OVC versorgers van toegang tot die maatskaplike toelaes en ander voordele geregtig op die OVC onder hul sorg te bepaal. Data vir hierdie studie is verkry uit vier bronne, deur gebruik te maak van vier verskillende data-insamelingsmetodes. In diepte onderhoud is gebruik om data van twaalf Gemeenskap Kindersorg Werkers (CCW) te versamel in die (MGECW) die administrasie van die OVC se toelaes aansoeke op twaalf Kiesafdelings. Sommige inligting is verkry met behulp van gestruktureerde vraelys uit 24 onderwysers die hantering van OVC by twaalf skole in twaalf Kiesafdelings. Die amptenare van die Ministerie van Binnelandse Sake en Immigrasie (MHAI) is besig met die fokusgroepbespreking om waardevolle inligting te verskaf aan hierdie studie. Literatuur is ook hersien om meer lig te werp op die onderwerp wat ondersoek word. Hierdie studie het ontdek dat daar verskeie struikelblokke wat verhoed dat die versorgers van die OVC maatskaplike toelaes te verkry. Gebrek van dokumente, vervoerkoste en lang afstande, tesame met 'n omslagtige proses van die verwerking van toelaes aansoeke en die uitreiking van nasionale dokumente is onder die voorkoming van faktore. Hierdie projek is afgesluit met aanbevelings wat, indien dit geïmplementeer word, die toegang to toelaes sal verbeter.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Medical male circumcision (MMC) has emerged as one of the Human Immunodeficiency Virus (HIV) prevention methods for HIV negative men engaged in heterosexual contact. Many studies have documented its efficiency in reducing the risk of contracting HIV infection in men. Because of that, Zimbabwe like other countries in the Southern Africa region, with generalised HIV infections is finding ways to scale-up MMC in non-circumcised communities. This study searched for knowledge, perceptions and attitudes of males in Bindura urban towards MMC. Bindura is the capital city of the Mashonaland Central Province of Zimbabwe. This town has diverse people with different social backgrounds who economically depend on the surrounding mines and commercial farms. Given the enormous differences in culture, religion, social and value systems among these people it was of particular importance to understand how they perceive medical male circumcision. Methodology: The study was conducted using quantitative data collection method. Random selection was done to choose respondents and age was used to determine eligibility to the study. The qualifying age was 18-49 and a sample size of 60 was considered to be appropriate taking into consideration financial and time associated with large samples. Structured questionnaire with open-ended and closed questions were used to gather data. Likert scale was used on some questions to determine perceptions and attitudes of respondents. The questionnaires used to solicit information did not require respondent to provide his name for purposes of maintain confidentiality but contained identification number. In some cases, Chi-square test for independence was conducted to test for associations between demographic characteristics and observed responses. Comparison of responses between the age groups 18-29 and 30-49 years were also done to determine if there were some differences in representations of respondents in observed responses. Results: The study aimed to assess knowledge, perceptions and attitudes of males in Bindura urban towards MMC and barriers they were confronting in accessing MMC. Respondents showed high level of awareness about HIV/AIDS intensity in Zimbabwe. Male circumcision (MC) was perceived by the majority of respondents as important in curbing HIV infections. A significant proposition of respondents regarded medical reasons as the most common reason why people undergo MC. However respondents demonstrated poor knowledge or understanding of other strategies that must be used in conjunction with MC. Risks associated with operation, its cost and protection of confidentiality and consideration of family concerns were considered by respondents as barriers to MMC. Availability of accurate information about MMC and easing of access to MMC services were considered to be very important facilitating factors. Religious and cultural reasons and stigma from peers and friends were considered non barriers. Statistically significant associations were only detected between MMC being motivated by medical reasons and demographic characteristics of age and marital status and also an association between education level and stigma as a barrier for MMC. The study failed to show a significant association between other observed responses and demographic characteristics. / AFRIKAANSE OPSOMMING: Agtergrond: Mediese manlike besnyding (MMB) het na vore gekom as een van die metodes vir die voorkoming van die oordrag van die menslike immuniteitsgebreksvirus (MIV) deur MIV-negatiewe mans betrokke by heteroseksuele kontak. Baie studies het reeds die doeltreffendheid daarvan ten opsigte van die vermindering van die risiko van MIV-infeksie by mans gedokumenteer. As gevolg daarvan is Zimbabwe, soos ander lande in die Suider-Afrika-streek met algemene MIV-infeksies, op soek na maniere om MMB by onbesnyde gemeenskappe uit te brei. Hierdie studie wou kennis, persepsies en gesindhede van manlike persone in die Bindura-stadsgebied ten opsigte MMB bepaal. Bindura is die hoofstad van die sentrale provinsie Masjonaland in Zimbabwe. Hierdie stad word bewoon deur diverse mense met verskillende maatskaplike agtergronde wat ekonomies van die omliggende myne en kommersiële plase afhanklik is. Gegewe die groot verskille in kultuur, godsdiens, maatskaplike en waardestelsels onder hierdie mense, was dit van besondere belang om te begryp hoe hulle mediese manlike besnyding verstaan. Metodologie: Die studie het van die kwantitatiewe data-insamelingsmetode gebruik gemaak. Ewekansige seleksie is gebruik om respondente te kies en ouderdom is gebruik om geskiktheid vir deelname aan die studie te bepaal. Die kwalifiserende ouderdom was 18-49 jaar en ʼn monstergrootte van 60 is geskik beskou in ag geneem finansiële beperkinge en tyd verbonde aan groot monsters. ʼn Gestruktureerde vraelys met oop en geslote vrae is gebruik om data in te samel. ʼn Likert-tipe skaal is by sommige vrae gebruik om persepsies en gesindhede van respondente te bepaal. Die vraelyste wat gebruik is om inligting te ontlok, het dit nie vir respondente nodig gemaak om hulle name te verskaf nie ten einde vertroulikheid te verseker, maar het ’n identifikasienommer bevat. In sommige gevalle is die chi-kwadraattoets vir onafhanklikheid gedoen om te toets vir verbande tussen demografiese eienskappe en response wat waargeneem is. Vergelyking van response tussen die ouderdomsgroepe 18-29 en 30-49 jaar is ook gedoen om te bepaal of daar enige verskille in verteenwoordigings van respondente in die waargenome response was. Resultate: Die studie wou kennis, persepsies en gesindhede ten opsigte van MMB by manlike persone in die Bindura-stadsgebied en hindernisse waarvoor hulle te staan kom ten einde toegang tot MMB te verkry, bepaal. Respondente het ʼn hoë vlak van bewustheid omtrent die intensiteit van MIV/VIGS in Zimbabwe getoon. Manlike besnyding (MB) is deur die meerderheid respondente as belangrik by die beperking van MIV-infeksies beskou. ʼn Beduidende aantal respondente het mediese redes gesien as die algemeensien rede waarom mense MB ondergaan. Respondente het egter swak kennis of begrip van ander strategieë wat tesame met MB gebruik moet word, getoon. Risiko’s geassosieer met die operasie, die koste daarvan en beskerming van vertroulikheid en agting vir die familie se bekommernisse is deur respondente as hindernisse met betrekking tot MMB beskou. Beskikbaarheid van akkurate inligting omtrent MMB en vergemakliking van toegang tot MMB-dienste is gesien as baie belangrike fasiliterende faktore. Godsdienstige en kulturele redes en stigmatisasie deur portuurs en vriende is nie as hindernisse beskou nie. Statisties beduidende verbande is slegs tussen MMB gemotiveer deur mediese redes en demografiese eienskappe van ouderdom en huwelikstatus bespeur en ook ʼn verband tussen opvoedingspeil en stigma as ʼn hindernis vir MMB. Die studie het nie daarin geslaag om ʼn beduidende verband tussen ander waargenome response en demografiese eienskappe aan te toon nie.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This study, which was conducted from 1 to 31 October 2012, was aimed at describing the main factors that influence adolescent adherence to antiretroviral treatment in three selected health facilities of Palapye Health District. During the one-month data collection period, 30 adolescents were interviewed using semi-structured interview tools. Different factors influencing adolescent adherence to antiretroviral treatment were highlighted and adherence to such treatment was measured using the method of calculating the percentage of returned pills. The mean adherence level for the entire sample was 76.96%, with common factors contributing to poor adherence among adolescents being found to be the poor processing of disclosure, stigma, the accessibility of health facilities, due distance and waiting time, the nature of social support, and feelings toward taking antiretroviral. Thus, by addressing adolescent adherence to antiretroviral treatment, adolescent-adherence counselling before and during treatment is to be shaped, insisting on the preparation of young patient caregivers for the process of disclosure; the reinforcement of positive messages during consultations; insistence on the importance of disclosing HIV status to others; the implementation of the antiretroviral dispensing outreach at health posts; and exerting effort to reduce the waiting time at health facilities prioritising young patients and adolescents. / AFRIKAANSE OPSOMMING: Hierdie studie, wat vanaf 1 tot 31 Oktober 2012 onderneem is, het ten doel gehad om die hooffaktore te beskryf wat adolessente se getrouheid met antiretrovirale behandeling in drie gekose gesondheidsfasiliteite in die Palapye-gesondheidsdistrik beïnvloed. Semigestruktureerde onderhoude is gedurende die maand lange datainsamelingstydperk met 30 adolessente gevoer. Die studie dui op verskillende faktore wat adolessente se getrouheid met antiretrovirale behandeling beïnvloed, welke getrouheid gemeet is aan die hand van die persentasie teruggestuurde pille. Die gemiddelde getrouheidsvlak vir die algehele steekproef was 76,96%. Algemene faktore wat oënskynlik tot swak behandelingsgetrouheid onder adolessente bydra, is die swak verwerking van MIV-statusonthulling, stigma, die toeganklikheid van gesondheidsfasiliteite, reisafstand en wagtyd, die aard van maatskaplike steun, en gevoelens oor die gebruik van antiretrovirale middels. Hierdie ondersoek na adolessente se getrouheid met antiretrovirale behandeling behoort adolessentberading oor behandelingsgetrouheid voor én gedurende behandeling te rig. Die klem moet in die besonder val op die voorbereiding van die versorgers van jong pasiënte om die onthullingsproses beter te hanteer; die versterking van positiewe boodskappe gedurende konsultasies; die belang van MIV-statusonthulling aan ander; die inwerkingstelling van uitreikaksies om voorskrifte vir antiretrovirale middels by sogenaamde ‘gesondheidstasies’ te resepteer, en daadwerklike pogings om die wagtyd by gesondheidsfasiliteite te verkort, met voorrang aan jong pasiënte en adolessente.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Health statistics on adolescents in Namibia indaicate high incidences of teenage unwanted pregnancies, unsafe abortions, baby dumping, maternal ill health, early marriages and STIs including HIV. These are indicators of underutilisation of adolescent friendly health services (AFHS) by adolescents as education on these problems are covered in it. Although Government has made some strides to esure implementation starts, there is a recognisable lack of its adoption by health workers. The aim of this study was to establish the reasons for the slow adoption of AFHS practices by health workers at Katutura Health Centre. A quantitative non-experimental cross-sectional descriprive research approach was used in this study. Evidence using both primary data collected in the field through self-administered semi-structured questionnaires (with both open and closed questions) and secondary data collected in the literature review was employed . A census of the entire population of health workers was prefered over sampling. A total of 56 health workers accepted to participate in the study and the questionnaire, 46 of which returned it within a stipulated three weeks data collection period. Descriptive statistics was utilised together with frequencies, mean and basic collection. Eighty two percent of the sample participated in the study of which 67% respondents were female and 33% were male. The majority of the respondents (78.3%) had tertiary education. The results indicated: AFHS were not known to the majority of health workers; there is slow adoption of AFHS; and the programme introduction could have been done better. Factors significantly associated with adoption of AFHS are knowledge of such services, sex, level of education, job position, work experience and effective implementation of the programme. A probability value of p<0.05 was adopted. The programme is well appreciated despite concerns of lack of training and proper implementation. Key recommendations were on staff recruitment, retention and training of health workers; creation of space for implementing AFHS and marketing the programme. The system is in place, what is left is to tighten some loose ends and programme is up and running. / AFRIKAANSE OPSOMMING: Gesondheid statistieke oor die jeug in Namibië verwys na hoë voorkoms van ongewenste tiener swangerskappe en onveilige aborsies, weg gooi van babas, swak moederlike gesondheid, vroeë huwelike en seksueel oordraagbare siektes, insluitend MIV. Dit is aanwysers van die onderbenutting van jeug vriendelike gesondheidsdienste (AFHS) deur die jeug, as die onderwys op hierdie probleme gedek word. Hoewel die regering 'n paar implementerings begin het, is daar 'n beduidende gebrek van aanneming deur gesondheidswerkers. Die doel van hierdie studie was om die redes vas te stel vir die stadige aanvaarding van AFHS praktyke deur gesondheidswerkers by Katutura Gesondheids Sentrum. 'n Kwantitatiewe, nie-eksperimentele navorsingsbenadering is gebruik in hierdie studie. Bewyse uit beide primêre data wat ingesamel is in die veld deur middel van self-geadministreerde semi-gestruktureerde vraelyste (met beide oop en geslote vrae) en sekondêre data wat ingesamel is in die literatuuroorsig was gebruik. 'n Sensus van die hele bevolking van gesondheidswerkers is verkies in plaas van steekproefneming. 'n Totaal van 56 gesondheidswerkers het aanvaar om deel te neem aan die studie en die vraelys, waarvan 46 teruggedien is binne die vasgestelde tydperk van drie weke se data-invorderingstermyn. Beskrywende statistiek is gebruik saam met frekwensies, gemiddelde en basiese versameling. Tagtig en twee persent van die steekproef het deelgeneem aan die studie, waarvan 67% respondente vroulik en 33% manlik was. Die meerderheid van die respondente (78,3%) het tersiêre opleiding. Die resultate het aangedui: AFHS is nie bekend aan die meeste van gesondheidswerkers nie, en daar is stadige aanneming van AFHS; en die program inleiding kon beter gedoen gewees het. Faktore wat beduidend verband hou met die aanneming van AFHS is kennis van sodanige dienste, geslag, vlak van onderwys, werk posisie, werkervaring en doeltreffende implementering van die program. 'n Waarskynlikheid waarde van p <0,05 is aangeneem. Die program is goed waardeer ten spyte van kommer aan 'n gebrek van opleiding en behoorlike implementering. Belangrikste aanbevelings was op die personeel werwing, behoud en die opleiding van gesondheidswerkers; skepping van ruimte vir die implementering van AFHS en bemarking van die program. Die stelsel is in plek, wat oorbly om gedoen te word, is om 'n paar los punte te versterk en die program is aan die gang.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Scaling up of male circumcision in Namibia is running at a low pace. People need to understand the role that male circumcision plays in the prevention of HIV acquisition. Therefore, it is important to increase knowledge among individuals in order to make them acquire positive attitudes and perceptions towards male circumcision as an HIV preventive strategy. Method: This research study investigated the perceptions of men and women towards male circumcision as an HIV prevention intervention in the Windhoek District. A total number of 250 respondents were conveniently selected for participation in the study, of which 50% were males and another 50% represented females. All respondents were 18 years and older. A quantitative method of sampling was employed with the use of anonymous questionnaires. Data were captured and analyzed using SPSS version 20. Results: Most respondents (76.8%) reflected good knowledge about male circumcision and positive attitude (93.6%) towards male circumcision and its benefits but there were still a proportion of respondents (23.2%) who are not knowledgeable about the benefits of MC, and 6.4% of the respondents have negative attitude towards MC, whilst a large proportion of 53.2% have negative perceptions towards MC and its benefits. The study also found that there is an association between knowledge and perceptions of 0.250 at p-value < 0.05, as well as an association between attitudes and perceptions 0.213, p-value <0.001. Conclusion: It was concluded that knowledge plays a major role on attitude and perception changing. The more knowledgeable an individual is, the more the chances of them of having positive attitudes towards MC, which could also influence positive perceptions towards MC. In order to strengthen male circumcision as an HIV prevention strategy, it is imperative to provide the population that reflected low knowledge and negative attitudes with information, education and counselling services. This may help to make them change their attitudes towards MC and acquire positive perceptions towards it. On barriers, the relevant authorities should come up with a strategy to eliminate barriers in order to facilitate acceptability among non-circumcised groups. / AFRIKAANSE OPSOMMING: Agtergrond: Die opskaling van manlike besnyding in Namibië word teen ‘n stadige pas uitgevoer. Mense moet die rol verstaan wat manlike besnyding in die voorkoming van MIV speel. Dit is daarom belangrik om hierdie kennis onder individue te vermeerder ten einde hulle te bemagtig om positiewe houdings en persepsies teenoor manlike besnyding as MIV-voorkoming strategie te bekom. Metode: Hierdie navorsingstudie het die persepsies van mans en vroue teenoor manlike besnyding as MIV-voorkoming ingryping in die Windhoek streek ondersoek. ‘n Aantal van 250 deelnemers is geselekteer vir deelname aan die studie, waarvan 50% manlik en 50% vroulik was. Alle deelnemers was 18 jaar en ouer. ‘n Kwantitatiewe metode en anonieme vraelyste is vir steekproefneming gebruik. Data is vasgelê en ontleed met behulp van SPSS weergawe 20. Resultate: Die meerderheid van die respondente (76.8%) het goeie kennis van manlike besnyding en ‘n positiewe houding (93.6%) teenoor manlike besnyding getoon, maar daar was ‘n deel van die respondente (23.2%) wat nie ingelig was oor die voordele van manlike besnyding nie, en 6.4% van die respondente het ‘n negatiewe houding teenoor manlike besnyding gehad, terwyl ‘n groot deel van 53.2% negatiewe persepsies van manlike besnyding en die voordele daarvan gehad het. Die studie het ook bevind dat daar ‘n verband is tussen kennis en persepsies van 0.250 teen p-waarde < 0.05, sowel as ‘n verband tussen houdings en persepsies 0.213, p-waarde <0.001. Gevolgtrekking: Daar is tot die gevolgtrekking gekom dat kennis ‘n belangrike rol speel in die verandering van houdings en persepsies. Hoe meer ingelig ‘n individu is, hoe beter is die kanse dat hulle ‘n positiewe houding teenoor manlike besnyding sal hê, wat ook positiewe persepsies van manlike besnyding kan beïnvloed. Ten einde manlike besnyding as MIV-voorkoming strategie te versterk is dit noodsaaklik om die bevolking wat min kennis en negatiewe houdings getoon het met inligting, opvoeding en berading te verskaf. Dit kan help om hul houding teenoor manlike besnyding te verander en om meer positiewe persepsies daarvan te ontwikkel. Met betrekking tot hindernisse moet die relevante owerhede vorendag kom met ‘n strategie om die struikelblokke uit te skakel ten einde aanvaarbaarheid van manlike besnyding onder groepe wat nie besny is nie, te fasiliteer.