Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Access to antiretroviral therapy has been gradually increasing in resource limited settings, Zimbabwe included. Despite the increasing access to antiretroviral therapy quite a number of patients are still delaying to seek antiretroviral therapy. The purpose of the study was to examine factors associated with delay in seeking antiretroviral therapy. A survey was conducted at Parirenyatwa Hospital Opportunistic Infections/Antiretroviral Therapy Clinic from September and November 2012. A total of 80 participants starting antiretroviral therapy who met the criteria were included in the study. The inclusion criteria included patients 18 years above but less than 65 years, no prior history of antiretroviral therapy and eligibility for antiretroviral therapy based on CD4 count or World Health Organisation clinical staging. An interviewer administered questionnaire containing demographic, socio-economic and health-facility factors were used to collect data. Four weeks was used as a cut off point for delay in seeking antiretroviral therapy. The majority of participants (60%) delayed seeking antiretroviral therapy and the factors which were associated with delay in seeking antiretroviral therapy included female gender; lack of a partner; low level of education; low socio-economic status; treatment of opportunistic infections; extra laboratory tests on top of the CD4 count tests; not being on Cotrimoxazole Prophylaxis; not being referred for antiretroviral therapy by the testing site; stigma and discrimination. However disclosure was not associated with early seeking of antiretroviral therapy. Health system factors such as attitude of health care workers, shortage of staff and long waiting times were also identified as bottlenecks to patients seeking antiretroviral therapy early. Efforts to increase early starting of antiretroviral therapy should focus on addressing the referral system from testing sites to antiretroviral therapy initiating sites, improving efficiency of antiretroviral initiating sites, increasing point of care HIV & AIDS diagnostics tools and addressing patient‟s concerns such as stigma & discrimination. / AFRIKAANSE OPSOMMING: Toegang tot antiretrovirale terapie Geleidelik is steeds in hulpbron beperkte omgewing, Zimbabwe ingesluit. Ten spyte van die toenemende toegang tot antiretrovirale terapie 'n hele aantal van die pasiënte is nog steeds vertraag antiretrovirale terapie te soek. Die doel van die studie was om faktore te ondersoek wat verband hou met vertraging in die soek van antiretrovirale terapie. 'n Opname is by Parirenyatwa-hospitaal opportunistiese infeksies / antiretrovirale terapie Clinic van September en November 2012. 'N totaal van 80 deelnemers begin antiretrovirale terapie wat met die kriteria wat in die studie ingesluit is. Die insluiting kriterium was pasiënte ouer as 18 jaar maar minder as 65 jaar, geen geskiedenis voor antiretrovirale terapie en in aanmerking kom vir antiretrovirale terapie gebaseer op CD4-telling of Kliniese stadiëring Wêreld Gesondheid Organisasie. Was 'n onderhoudvoerder vraelys met demografiese, sosio-ekonomiese faktore en gesondheid-fasiliteit wat gebruik word om data in te samel. 4 weke is gebruik as die afsny punt vir die vertraging in die soeke na antiretrovirale terapie. Die meerderheid van die deelnemers (60%) antiretrovirale terapie en die faktore wat verband hou met die vertraging in die soek na antiretrovirale terapie is vertraag te soek vroulike geslag, gebrek van 'n vennoot, lae vlak van onderwys, 'n lae sosio-ekonomiese status, behandeling van opportunistiese infeksies; Ekstra laboratoriumtoetse op die top van die CD4-telling toetse nie op Cotrimoxazole Profilakse, nie vir antiretrovirale terapie verwys deur die toets site, stigma en diskriminasie. Egter openbaarmaking wat nie verband hou met die vroeë soek van antiretrovirale terapie. Gesondheid stelsel faktore soos houding van gesondheidsorgwerkers, tekort aan personeel en lang wagtye, is ook geïdentifiseer as knelpunte aan pasiënte op soek na vroeë antiretrovirale terapie Pogings om te vroeg begin van antiretrovirale terapie Verhoog Indien Fokus op die verwysingstelsel van die toets sites tot antiretrovirale terapie Inisiëring sites, verbetering van doeltreffendheid van antiretrovirale Inisiëring sites, Verhoog Punt van Care MIV & VIGS diagnose tools en aanspreek van die pasiënt se Kommer Soos stigma en diskriminasie.

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Malaria is a pestilent disease associated with massive socioeconomic burden of sub-Saharan Africa. This disease is caused by a blood infection of the single cellular parasite of the Plasmodium genus. Two enzymes of this parasite have been identified to be essential to the survival of this parasite, notably Spermidine Synthase and Protein Farnesyltransferase. The goal of this dissertation was to search for and synthesise novel inhibitors of these two enzymes with a strong focus towards understanding their structure/activity relationships. To achieve the first goal, molecular modelling was employed. An in-depth discussion is presented to describe the underlying principles relevant to this branch of computational chemistry. This ensures that the experiments using these methods are set-up correctly and results are interpreted within context. Two virtual high-throughput screens were then performed using prepared crystallographic structures of Spermidine Synthase. The first was pharmacophore based method and the second based on LibDock. The database used, containing 7.1 million compounds, was filtered using a custom developed tool prior to screening. Finally, CDOCKER was then used to investigate the activity of potential hit compounds. Spermidine Synthase has a natural affinity for adenosine and this trait was exploited by derivatising analogues to synthesise potential inhibitors of the enzyme. This was to be achieved by the incorporation of both electrophilic and nucleophilic moieties at selected positions, including the use of a high yielding Mitsunobu reaction. A number of additional residues were then synthesised and joined to the adenosine which were proposed to increase the active site occupancy and increase affinity to the enzyme. For the second enzyme targeted for inhibition, Protein Farnesyltransferase, indole was used as a starting scaffold to synthesise potential hits de novo. It was aimed to derivatise the indole at the Nʹ and 3ʹ positions. The crystal structure of one of the intermediates was published. Furthermore, a synthetic sequence which culminated in a palladium catalysed Suzuki coupling was performed. / AFRIKAANSE OPSOMMING: Malaria is ‘n peslike siekte wat geassosieer word met beduinde sosio-ekonomiese implikasies vir sub-Sahara Afrika. Die siekte word veroorsaak deur ‘n bloed infeksie van die enkel sellulêre parasiet van die Plasmodium genus. Twee ensieme, naamlik Spermidien Sintetase en Protein Farnesieltransferase, is geïdentifiseer om noodsaaklik te wees vir die oorlewing van die parasiet. Die doelwit van hierdie verhandeling is die soektog en sintese van oorspronklike inhibeerders van hierdie twee ensieme met ‘n sterk fokus daarop om struktuur/aktiwiteit interaksies te verstaan. Om die eerste doelwit te bereik is molekulêre modellering toegepas. ‘n Indiepte ondersoek word voorgestel om die onderliggende beginsels relevant tot hierdie tak van berekenkundige chemie te beskryf. Dit verseker dat eksperimente wat op hierdie tegnieke berus korrek opgestel word en dat die resultate binne konteks geïnterpreteer word. Twee virtuele hoë-deurset skerms was deurgevoer op voorbereide kristallografiese strukture van Spermidien Sintetase. Die eerste het berus op ‘n pharmakoforiese metode en die tweede op LibDock. ‘n Self-ontwikkelde sagteware gereedskap stuk is gebruik om a databasis van 7.1 miljoen verbindings te filtreer voor dit gebruik is in hoë-deurset skerms. Uiteindelik is CDOCKER gebruik om die potensiele aktiwiteit van “treffer” verbindings te beraam. Spermidien syntetase het ‘n natuurlike affiniteit vir adenosien en hierdie eienskap is benut deur analoeë af te lei na potensiële inhibeerders teen die ensiem. Dit is bewerkstellig deur die insluiting van beide elektrofiliese asook nukleifielese funksionele groepe op gekose posisies. Dit het die gebruik van ‘n hoë opbrengs Mitsunobu reaksie ingesluit. ‘n Aantal ander addisionele residueë is toe gesintetiseer en geheg aan die afgeleide adenosien om die ensiem setel te vul en sodoende die affinitieit te verhoog. Vir die tweede ensiem wat geteiken is vir inhibisie, Protein Farnesieltransferase, is indool benuttig as ‘n begin steier te dien om potensiële treffers de novo te sintetiseer. Dit is geteiken om die indool af te lei op die Nʹ en 3ʹ posisies en die kristal struktuur van een van hierdie tussengangers is gepubliseer. Verder is ‘n sintetiese weg, wat uitgeloop het op ‘n palladium gekataliseerde Suzuki koppeling, uitgevoer.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Two parallel processes contributed to the formation of the International HIV/AIDS Alliance (the Alliance) in 1993 – one under the auspices of the World Health Organisation and its “NGO Support Programme” and the other being the coming together in 1991 of a group of donors under the auspices of the Rockerfeller Foundation in an attempt to define a mechanism that would channel funds to community groups in the South. It was a difficult period of the HIV epidemic – communities were struggling to cope with the effects of HIV, science was unable to advance its efforts to find a vaccine and progress into different forms HIV treatment was moving slowly. The two processes came together almost fortuitously, as key individuals were involved one way or another in both processes, and the work that had been done complemented and justified the need to combine energies, resources and creativity into making this mechanism work. The oral history brings to life some of the discussions and events that took place during the development of the Alliance. It provides insights into what key individuals were thinking, or how they acted during important, and at times frustrating, discussions. Because so little is captured about the conception phase (1991 – 1993), the oral history focusses on capturing the reflections and memories of those who were involved during this period, to ensure that history accurately reflects what happened – or at least offers real and lived perspectives. The case study reviews the start-up phase (1994 – 1996) and provides insights and perspectives into key decisions and the all-important external evaluation, which was a turning point for the organisation. The external evaluation led to and informed the scale-up period (1997 – 2000) and the oral history reflects on a number of key themes that shaped the organisations work and laid the foundation for its next ten years. / AFRIKAANSE OPSOMMING: Twee parallelle prosesse het bygedra tot die vorming van die Internasionale HIV/AIDS Alliance (The Alliance ) in 1993 - een onder die vaandel van die Wêreld Gesondheid Organisasie en die " NGO Support Program " en die ander is die bymekaar kom van 'n groep skenkers onder die coordinatie van die Rockerfeller Foundation in 1991. Hulle het saamgekom in 'n poging om 'n meganisme te definieer wat fondse sal kanaliseer naar gemeenskap groepe in die Suid. Dit was 'n moeilike tyd die MIV-epidemie - gemeenskappe sukkel met die gevolge van MIV , wetenskap was nie in staat om hulle pogings om 'n entstof teen MIV en vooruitgang in behandeling het stadig gevorder. Die mondelinge geskiedenis bring aan die lewe 'n paar van die besprekings en gebeure wat plaasgevind het tydens die ontwikkeling van die Alliance. Dit bied insig in wat individue dink , of hoe hulle opgetree het tydens belangrik , en by tye frustrerend, besprekings. Omdat daar so min gevang oor die konsepsie (1991 - 1993), fokus die mondelinge geskiedenis op die vaslegging van die refleksies en herinneringe van diegene wat gedurende hierdie tydperk betrokke was. Die gevallestudie gee ‘n oorsig van die begin fase (1994 - 1997) en bied insigte en perspektiewe in belangrike besluite en die eksterne evaluering , wat 'n keerpunt vir die organisasie was. Die eksterne evaluering het gelei tot die “scale up” tydperk (1997 - 2000) en die mondelinge geskiedenis weerspieël op 'n aantal van die belangrikste temas wat die grondslag gelê vir sy volgende tien jaar.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--Stellenbosch University, 2009. / ENGLISH SUMMARY: The objective of this study was to determine the current situation regarding policy development and implementation in a selected sample of South African organisations. The researcher used the survey method to determine how many organisations do have HIV/AIDS workplace policies in place, and if not, why not. It was found that only a small percentage of respondents confirmed to not have an HIV/AIDS workplace policy at their respective workplaces. A reason for concern is that almost a quarter of the respondents were not sure whether their workplace had a policy or not. Larger organisations (> 500 employees) were more inclined to have polices and the highest percentage of organisations that have policies were from KwaZulu Natal, the province with the highest HIV/AIDS prevalence in the country. / AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die huidige situasie rakende MIV/VIGS beleidsontwikkeling en implementering in „n gekose groep van Suid-Afrikaanse organisasies te ondersoek. Die navorser het „n opname gedoen om te bepaal hoeveel organisasies MIV/VIGS beleide het, en indien nie, hoekom nie. Daar is gevind dat slegs „n klein persentasie van respondente bevestig het dat hul onderskeie werkplekke nie „n MIV/VIGS beleid het nie. Daar is egter rede tot kommer rakende byna „n kwart van die respondente wie nie seker was of hul werkplek „n beleid het of nie. Groter organisasies (> 500 werknemers) was meer geneig om beleide te hê, en die hoogste persentasie van organisasies met beleide was van KwaZulu Natal, die provinsie met die hoogste voorkoms van MIV/VIGS in die land.

Thesis (MPhill)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The mining industry having been identified as a particularly vulnerable sector to the potentially devastating effects of HIV and AIDS, it became clear that proper management thereof is essential if we are to mitigate these. Two-hundred-and-seventy-nine of the 720 patient files from the mine‟s wellness clinic were reviewed for clinical appropriateness. These files were scrutinised to evaluate adherence to treatment guidelines. The review was conducted using the wellness clinic‟s treatment guidelines, adapted from the South African HIV Clinicians Society (SAHIVCS) 2008 guidelines asking the four questions: “when to start therapy”, “what therapy to start”, “co-existence of other illnesses”, “when to change therapy”. The guidelines were largely adhered to as far as starting the right type of therapy at the right time. “When to start therapy” was adhered to in 97.1 percent of the cases, “when to start” in 99.6 percent. However evaluation of “co-existence of other illnesses” came in at a rather low figure of 45.5 percent. Although the need for change of therapy was very low (2.5 percent), 57.5 percent of those who needed a change in therapy were prolonged on failing regimens for periods of more than three months. / AFRIKAANSE OPSOMMING: Die mynindustrie in Suid-Afrika is as 'n uiters kwesbare sektor geïdentifiseer en behoorlike bestuur van hierdie sektor is van kritieke belang in die suksesvolle bestuur van MIV/Vigs in Suid-Afrika. Die mediese inligting van 279 pasiënte is vir die doel van die studie ontleed en die mate waartoe pasiënte getrou hou by behandelingsriglyne is in die studie ge-evalueer. Die ontleding was gebasseer op die 2008 welwees kliniese riglyne van die South African HIV Clinicians Society (SAHIVCS). Die studie bevind dat pasiënte in 'n groot mate by die kliniese riglyne gehou het en dat die datum waarop met behandeling begin is in bykans 97% van die gevalle ooreenkomstig die riglyne was. Die grootste bron van kommer was die groot relatief groot aantal gevalle waar die invloed van ander siektetoestande nie behoorlik in ag geneem is nie en die MIV/Vigs medikasie nie dienooreenkomstig aangepas is nie. Voorstelle word in die studie gemaak vir aksies wat geneem behoort te word om 'n groter mate van voldoening aan die riglyne te bewerkstellig.

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 langtermyn beskermende doeltreffendheid. Hierdie studie is van voorneme om die doeltreffendheid van drie kommunikasieintervensies 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 pretoets 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 VIGSvoorkoming 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 (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The advent of anti-retroviral therapy (ART) has bought hope and reprieve in a previously hopeless situation where there was no available drug to combat the virus with the result that AIDS deaths from chronic, untreated HIV infection became the major cause of morbidity and mortality especially in sub-Saharan Africa where the disease burden is highest. Since March 19, 1987, when the FDA approved Zidovudine for the treatment of AIDS, there has been great improvement in the prognosis and quality of life of HIV infected persons especially in sub- Saharan countries like Nigeria where the burden of HIV disease is high. Even though the treatment of HIV looked promising to all HIV sufferers, there were strict requirements for taking the ARVs, that meant patients had to be able to take the medication more than 95% of the prescribed time. The requirements also involved strict dietary restrictions that further made adherence to these medications very difficult indeed. In addition, the potential for side effects of the medications and its requirement for life-style modifications like abstinence from excess alcohol made sticking to the required regimen very cumbersome and rather patient unfriendly. Therefore, as the use of ARVs became more popular and effective, so did the problem of nonadherence continue to fester and deteriorate even further. Therefore, the problem of lack of optimum adherence to ARVs is one that potentially threatens all the gains of the discovery and use of potent, life-saving ARVs. Hence, there is now a need to look at how best to improve adherence to ARVs in the most innovative, cost-effective and patient-friendly manner. This study argues for the use of simple, locally-driven adherence strategies that overcome the low literacy and excessive alcoholism that are major factors preventing optimal adherence to ARVs amongst patients. / AFRIKAANSE OPSOMMING: Die intrede van anti-retrovirale behandeling het hoop en genade gebring aan ‘n voorheen hopelose situasie waar daar geen behandeling beskikbaar was om die virus te beveg nie, wat daartoe gelei het dat VIGS, as gevolg van MIV-infeksie wat nie behandel is nie, die grootste oorsaak van sterftes in veral Sub-Sahara Afrika is. Sedert 19 Maart 1987, wanneer Zidovudine goedgekeur is vir die behandeling van VIGS, is daar ‘n groot verbetering in die prognose en kwaliteit van lewe van MIV-geinfekteerde mense, veral in Sub-Sahara lande soos Nigerië waar die voorkoms van MIV hoog is. Hoewel de behandeling van MIV vir alle MIV-lyers belowend gelyk het, was daar streng vereistes vir die neem van anti-retrovirale behandeling. Daar was ook streng dieetkundige beperkinge wat die getrouheid tot die behandeling bemoeilik het. Die moontlike newe-effekte van die behandeling en nodige leefstyl veranderinge, soos byvoorbeeld weerhouding van oormatige alkohol gebruik, maak die behandeling redelik pasiënt onvriendelik. Soos die anti-retrovirale behandeling meer gewild en effektief geraak het, het die probleem van ongetrouheid ook toegeneem. Die probleem rondom ongetrouheid tot behandeling bedreig alles wat deur die behandeling gebied kan word. Daar is nou ‘n behoefte daaraan om getrouheid tot anti-retrovirale behandeling te bevorder in die mees innoverende, koste-effektiewe en pasiënt vriendelike manier. Die studie beveel eenvoudige, plaaslik gedrewe getrouheid-strategieë aan wat optimale getrouheid aan behandeling sal verseker.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The vulnerability of female adolescents to HIV/AIDS has been widely documented with little effort being made to investigate the obstacles that these female adolescents actually face in translating HIV knowledge and attitudes into HIV preventive behaviours. The researcher randomly selected 120 school going female adolescents aged between 14-19, from six secondary schools in the Gweru District in an effort to assess their levels of knowledge on HIV/AIDS and their attitudes towards HIV prevention. The study aimed to uncover the obstacles the female adolescents face in practicing HIV preventive sexual behaviours. Inferences drawn from the study point to the fact that although female adolescents may have high levels of knowledge on HIV/AIDS and positive attitudes towards HIV prevention, there are cultural and religious values that promote male dominance in patriarchal societies and female docility thereby leaving little or no room for females to negotiate HIV prevention in sexual relationships. Poverty- driven economic dependency on men, orphan hood, peer pressure, lack of support from parents and guardians on issues to do with their sex and sexuality, lack of skills to be assertive and negative attitudes of health service providers were some of the barriers the female adolescents face as they try to pave their way in to safe motherhood. / AFRIKAANSE OPSOMMING: Die kwesbaarheid van vroulike adolessente aan MIV/vigs is wyd gedokumenteer met min moeite wat gemaak word die struikelblokke te ondersoek dat hierdie vroulike adolessente werklik gesig in die vertaling van MIV kennis en gesindhede in MIV voorkomende gedrag. Die navorser lukraak gekies 120 skoolgaande vroulike adolessente tussen die ouderdomme van 14-19, van ses sekondêre skole in die Gweru-distrik in 'n poging om hulle vlakke van kennis oor MIV / vigs en hul houding teenoor MIV-voorkoming te evalueer. Die studie is daarop gerig om die struikelblokke ontbloot die vroulike adolessente gesig in die beoefening van MIV voorkomende seksuele gedrag. Gevolgtrekkings waartoe die studie verwys na die feit dat alhoewel vroulike adolessente kan 'n hoë vlakke van kennis oor MIV / vigs en 'n positiewe houding teenoor MIV-voorkoming, is daar kulturele en godsdienstige waardes wat die bevordering van manlike oorheersing in patriargale samelewings en vroulike handelbaarheid daardeur sodat daar min of geen ruimte vir vrouens MIV-voorkoming in seksuele verhoudings te onderhandel. Armoede-gedrewe ekonomiese afhanklikheid van mans, wees kap, groepsdruk, gebrek aan ondersteuning van ouers en voogde op die kwessies te doen het met hul seks en seksualiteit, gebrek aan vaardighede om selfgeldend en negatiewe houdings van gesondheid diensverskaffers is 'n paar van die hindernisse die vroulike adolessente gesig soos hulle probeer om hul weg te baan in 'n veilige moederskap.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The researcher conducted an explorative, qualitative study to identify the perceptions and experiences of stigma and discrimination among people living with HIV and AIDS in order to establish strategies within ARV Clinic to deal with the situation and eliminate this as a barrier to access the services. The study population included 5 men and 5 women who access health services at Oshakati ARV Clinic and have been on ARVs for more than one year, aged 20-60 years old. The study participants were selected using a purposive sampling approach and interviewed in the ARV clinic. The study found that participants have experienced enacted and internal stigma and discrimination related to their HIV status within their community and families. They however did not perceive or report any experiences of stigma and discrimination in the ARV clinic. Possibility exists that the participants might not be well empowered to detect acts of stigma and discrimination in the health care environment. / AFRIKAANSE OPSOMMING: Die navorser het 'n verkennende, kwalitatiewe studie uitgevoer om die waarnemings en ervarings van stigma en diskriminasie tussen mense wat met MIV en VIGS leef, vas te stel met die doel om strategieë te bepaal binne die ARV kliniek om die situasie te hanteer en die hindernes om dienste te bekom te verwyder. Die studiepopulasie het bestaan uit 5 mans en 5 vroue wat die gesondheidsdienste van die Oshakati ARV kliniek gebruik en wat ARV’S vir meer as een jaar gebruik en tussen die ouderdomme van 20-60 jaar is. Die deelnemers is gekies met 'n doelgerigte steekproeftrekking-benadering en onderhoude is gevoer in die ARV-kliniek. Die studie het bevind dat die deelnemers interne stigma en diskriminasie wat verband hou met hul MIV-status binne hul gemeenskap en families ondervind het. Hulle het egter nie aangedui dat hulle stigma en diskriminasie ervaar het by die ARV-kliniek nie. Die moontlikheid bestaan dat die deelnemers nie goed bemagtig is om dade van stigma en diskriminasie in gesondheidsdienste te kan identifiseer nie.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The study sought to answer the question, what are the reasons for low utilization of long acting contraceptives among HIV positive women attending the Harare Post-test support services clinic. The study was conducted at Harare Post-test support services clinic from September to December 2012. Data was collected using respondent administered questionnaires. A sample of 30 respondents was used for the study. After data collection, data was grouped, analysed and presented in the form of tables, figures, charts and descriptive statistics. The major findings from the study were that the majority of the women who attend the Harare Post-test support services clinic are within the age groups 35-49yaers. Most of the women are not using and modern contraceptive method. Condoms are used by 17% of the respondents and the long acting contraceptives, Jadelle and IUCD and used by a very low number of women attending the clinic. Fear of side effects is one of the reasons why the women are not suing long acting contraception. Most of the women know that the Jadelle and IUCD are long acting methods of contraception which prevents unintended pregnancy for up to five years for Jadelle and up to ten years for the IUCD. The long acting contraceptives are not available at the post test-support services clinic since the set-up of the clinic is not ideal for the provision of these services, women who need the methods are refereed outside the clinic were the cost to access the services is not affordable for most of the respondents. The conclusion drawn from the study is that women living with HIV have limited knowledge and access the long acting contraceptives at Harare Post-test support services clinic hence are not utilizing the methods. The researcher recommends that all women attending the clinic should be educated on the benefits of using dual protection to protect against unintended pregnancy as well as HIV transmission. A proper referral system should be established so that women referred to other service providers do not pay extra fees to access family planning services at the referral centres. Any IEC material should address the myths and fears related to use of long acting contraception by HIV positive women. The young age group below 35years should also be encouraged to access family planning services through the Post-test support services clinic. / AFRIKAANSE OPSOMMING: Die doel van die studie was om te bepaal wat die redes is vir die lae gebruik van langwerkende voorbehoeding onder MIV positiewe vroue wat die Harare Post-test ondersteuningsdienste kliniek besoek. Data is deur middel van vraelyste onder 30 deelnemers ingesamel. Die resultate het getoon dat die meerderheid van vroue wat die kliniek besoek het tussen die ouderdomme van 35 en 49 was. Meeste van hulle gebruik nie moderne voorbehoeding nie, slegs 17% het aangedui dat hul kondome gebruik. Die langwerkende voorbehoeding Jadelle en IUCD word deur min die van vroue gebruik. ‘n Vrees vir die nadelige uitwerking daarvan is een van die redes waarom hul nie die voorbehoeding gebruik nie. Meeste van die vroue is bewus dat Jadelle en IUCd langwerkede metodes is wat swangerskap voorkom en dat Jadell tot 5 jaar werk en IUCD tot 10 jaar effektief kan wees. Die langwerkende metodes is egter nie by die kliniek beskikbaar nie en vroue wat die metodes verkies word na ander diensverskaffers verwys waar wat vir meeste van die vroue nie bekostigbaar is nie. Daar kan dus van die studie afgelei word dat MIV positiewe vroue beperkte kennis en toegang rakende die langwerkende voorbehoeding het en daarom nie die metodes ten volle benut nie. Die navorser beveel aan dat alle vroue wie die klinkiek besoek ingelig moet word oor die voordele van die tweeledige vorm van beskerming, nie net teen swangerskap nie maar ook teen MIV-infeksie. ‘n Verwysingstelsel moet in plek gestel word sodat die vroue wat na ander diensverskaffers verwys word nie nodig het om ekstra daarvoor te betaal nie. Daar word verder ook voorgestel dat die klinkiek meer inligtig rakende die langwerkende voorbehoeding beskikbaar stel en ook gesinsbeplanningsdienste aanbied.