Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Although VCT has been recognized for its importance in HIV prevention and control, there are several matters of concern surrounding it that potentially limit its uptake. Clients' selective behavior in tandem with service provider and operating environment factors determine uptake of VCT service. This study sought to contribute knowledge on the influence that specialized HIV/AIDS sites have on first time clients' initiative to seek VCT services in comparison with the general health care sites. The study also analyzed factors that determine clients' preference of VCT access point. The study was done within a student population of Nkumba University in Entebbe municipality, Uganda. A sample of students to fill the study questionnaire was selected using a simple random sampling method from a population frame established from a class identified haphazardly. Four focus group discussions were done: two of the groups participants were stratified as students' male and female groups and were selected using convenient sampling from the sampling frame. The other FGDs were done with two groups of nurse counselors – one from a general health care site while the other was from a specialized VCT site, selected purposively. Specialized VCT sites had a higher frequency of first student clients than general health care sites. Results however indicated that though the perception of service providers' attitude and availability of trained councilors affected their choice, there was no significant difference between specialized and general VCT sites in terms of first time clients' preference. Reasons for preference of site differed. Specialized sites were preferred because they are perceived to offer better quality service owing to their concentration on VCT services, but shunned by others for lack disguise. Conversely, respondents revealed that there is disguise at general health j sites which enhances confidentiality and anonymity thereby curbing clients fears of being identified making it easier for first time clients to go to these sites for VCT. / AFRIKAANSE OPSOMMING: Alhoewel vrywillige raadgewing en toetsing (VRT) erken is vir sy belangrikheid met betrekking tot MIV voorkoming en beheer, is daar verskeie kwessies daaraan verbonde wat die gebruik daarvan kan beperk. Kliënte se selektiewe gedrag saam met diensverskaffers en omgewingsfaktore bepaal die gebruik van VRT dienste. Hierdie studie het gepoog om kennis by te dra oor die invloed wat gespesialiseerde MIV/Vigs toetsingsterreine het op eerstelinge se inisiatief om VRT dienste te soek in vergelyking met algemene gesondheidssorgterreine. Die studie het ook faktore geanaliseer wat kliënte se voorkeur van VRT terreine bepaal. Die studie is binne 'n studente populasie van Nkumba Universiteit in Entebbe Munisipaliteit, Uganda, uitgevoer. 'n Steekproef van studente om die vraelyste in te vul is geselekteer deur die eenvoudige toevalmonster metode te gebruik van 'n populasie raam geskep van 'n klas was lukraak geidentifiseer is. Vier fokusgroepe het plaasgevind: twee waar deelnemers as manlike en vroulike studentegroepe gestratifiseerd was en geselekteer deur gerieflike steekproeneming van die steekproefraam. Die ander fokusgroepe was twee groepe van verpleegster beraders – een van 'n algemene gesondheidssorgterrein en die ander van 'n gespesialiseerde VRT terrein, doelbewus geselekteer. Gespesialiseerde VRT terreine het 'n hoër frekwensie van eersteling student-kliente as algemene gesondheidssorgterreine. Uitslae het aangedui dat hoewel die persepsie van diensverskaffers se houdings en beskikbaarheid van opgeleide beraders hul keuse geaffekteer het, dat daar geen betekenisvolle verskil was tussen gespesialiseerde en algemene VRT terreine in terme van eerstelinge se voorkeur. Redes vir voorkeur van terrein het verskil. Gepesialiseerde terreine is verkies weens die persepise dat hulle 'n beter kwaliteit diens lewer weens hul konsentrasie op VRT dienste, maar deur ander vermy was weens gebrek aan vermomming. Omgekeerd het respondente aan die lig gebring dat daar wel vemomming by algemene gesondheidssorg terreine is wat vertroulikheid en anonimiteit verhoog en kliënte se vrese verminder wat dit makliker maak vir eerstelinge om na hierdie terreine vir VRT te gaan.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: In the light of the roll-out of the national combined school-health program which will include the availability of condoms to learners, this study was undertaken to determine what the perceptions of learners and educators are regarding the provision of condoms to learners at Malibu High School in Eerste River, Cape Town as a prevention strategy. The learners’ knowledge levels on HIV and AIDS were also tested. Questionnaires were handed out to learners as well as Life Orientation educators. The findings of the study revealed that the learners’ knowledge levels on HIV and AIDS are reasonably high and that parents are more involved as originally perceived to be. Learners seem to think that the provision of condoms by schools is a good idea. The educators’ views differ. The educators feel that the knowledge levels are low and that there is no visible parental or community involvement regarding HIV and AIDS. They see this as separate to their function. Educators are unanimous in their response that the provision of condoms by schools is not a good idea at all. They feel that it would send out the wrong message to learners. From the study, it became apparent that the Education department still needs to do a lot to get schools on board for the roll-out of the school-health program. A lot needs to be done regarding the training of and support to the educators. A few recommendations are listed in order for the school to effectively address the HIV and AIDS issues at the school in order to reduce its impact. / AFRIKAANSE OPSOMMING: Die toekomstige uitrol van die nasionale gekombineerde skole-gesondheidsprogram sluit die verskaffing van kondome aan leerders in. Hierdie studie was dus hiervolgens onderneem om juis uit te vind wat die persepsies van leerders sowel as die opvoeders van Malibu Hoërskool in Eersterivier, Kaapstad is rakende die verskaffing van kondome aan leerders. Die leerders se kennisvlakke rakende MIV en VIGS was ook getoets. Vraelyste was uitgehandig aan beide die leerders en die Lewensoriëntering-opvoeders. Die bevindinge van die studie weerspiëel egter dat die kennisvlakke van leerders taamlik hoog is en dat ouers eitlik meer betrokke is as wat aanvanklik waargeneem was. Leerders is van mening dat die voorsiening van kondome aan hulle deur skole eintlik ‘n goeie idée is. Die opvoeders se menings verskil egter. Die opvoeders is van mening dat die leerders se kennisvlakke laag is en dat daar egter geen sigbare ouer- en gemeenskapsbetrokkenheid bestaan nie. Opvoeders sien hierdie as apart van hul opvoedingsfunksie. Opvoeders voel dat die verskaffing van kondome aan leerders by skole nie ‘n goeie idée is nie. Volgens hulle sal dit egter die verkeerde boodskap aan leerders deurgee. Volgens die bevindinge van die studie is dit dus baie duidelik dat die Onderwysdepartement nóg baie moet doen om skole aan boord te kry rakende die uitrol van die skole-gesondheidsprogram. Baie moet gedoen word rakende die opleiding van en ondersteuning aan opvoeders in hierdie verband. ‘n Paar aanbevelings word voorgelê om die skool in staat te stel om die MIV en VIGS-kwessies effektief aan te spreek om sodoende die impak daarvan by die skool te verminder.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Reproductive health of people living with HIV/AIDS is a significant public health issue because of its associated risks of HIV transmission to both, the baby and the sexual partner. Provision of effective contraceptive to HIV-positive women is a proven prevention strategy, and can help prevent unintended pregnancy and other sexually transmitted infections. Unmet need for contraception in developing world and rates of unintended pregnancies among women living with HIV remain highly prevalent. The objectives of this study were to identify the current knowledge of HIV-positive women on existing contraceptive methods, determine their current contraceptive practices, identify barriers to contraception use, and provide recommendations on how contraception uptake can be improved among these women in Kasane. A cross-sectional study using qualitative technique was used among twenty five (25) participants at Kasane Primary Hospital. In-depth interviews were conducted with the help of research assistants for data collection. Excel Microsoft Office Software was used for socio-demographics data entry and analysis, and qualitative data were analysed manually using descriptive statistics. Main reasons for low uptake of contraception were desire for children, partner refusal, side effects, and socio-cultural and religious factors. Contraception prevalence was 56 % and condom was the most used contraceptive method (36%). whereas the rate of unintended pregnancies was 60% . Knowledge of contraception was high (100%) but limited proportion of participants (12%) had an expended understanding of contraception as a HIV prevention strategy. Most women living with HIV prefer to space, limit or stop childbearing but do not use any contraceptive method and found themselves with unintended pregnancy. Despite the good knowledge about contraception among participants, the uptake remained low. About half (44%) of the women interviewed were not on any contraceptive method. The choice to use contraception interferes with many factors and the desire to fulfil the primary reproductive intention of men and women, including those living with HIV, mostly override this choice. There is need for a strategic integrated approach that conveys HIV prevention messages and discusses the importance of planning a pregnancy. Thus promoting dual protection among women living with HIV. / AFRIKAANSE OPSOMMING: Die voortplantingsgesondheid van mense wat met MIV/vigs leef, is ‘n belangrike openbaregesondheidskwessie, aangesien voortplantingsgesondheid verband hou met die gevaar van MIV-oordrag na babas sowel as seksmaats. Daar is al bewys dat ander seksueel oordraagbare siektes sowel as onbeplande swangerskappe voorkom word as doeltreffende voorbehoedmiddels verskaf word aan vroue wat MIV-positief is. Dit behoefte aan voorbehoeding in ontwikkelende lande bly egter baie dikwels agterweë, en ‘n groot persentasie vroue wat met MIV leef, raak onbepland swanger. Die doel met hierdie ondersoek is om vas te stel wat vroue wat MIV-positief is, tans oor bestaande voorbehoeding weet, watter voorbehoedingsmetodes hulle tans gebruik en watter struikelblokke daar vir die gebruik van voorbehoeding is, en om voorstelle te maak oor hoe ʼn groter persentasie van hierdie vroue in Kasane oortuig kan word om voorbehoedmiddels te gebruik. ‘n Deursnee-studie wat met behulp van kwalitatiewe tegnieke by die Kasane Primêre Hospitaal uitgevoer is, het vyf en twintig (25) deelnemers betrek. Met die hulp van navorsingsassistente is diepte-onderhoude gevoer om inligting in te samel. Microsoft Office se Excel-sagteware is gebruik om sosio-demografiese inligting in te voer en te ontleed, en kwalitatiewe inligting is met verwysing na beskrywende statistiek met die hand ontleed. Die vernaamste redes vir die trae gebruik van voorbehoeding was die begeerte na ‘n kind, die teenstand van seksmaats, die newe-effekte, en sosio-kulturele en godsdienstige oorwegings. Daar is bevind dat 56% van die deelnemers voorbehoeding gebruik, dat kondome die algemeenste voorbehoedmiddel is (36%) en dat 60% van alle swangerskappe ongewens was. Die deelnemers was almal oor voorbehoeding ingelig (100%), maar slegs ‘n klein persentasie (12%) het ook geweet dat voorbehoedmiddels ‘n voorkomingstrategie vir MIV-infeksie is. Die meeste vroue wat met MIV leef, verkies om swangerskappe te versprei, te beperk of te verhoed, maar gebruik geen voorbehoedmiddels nie en het dus onbepland swanger geraak. Hoewel die deelnemers goed ingelig was oor voorbehoeding, het min van hulle dit gebruik. Ongeveer die helfte (44%) van die vroue met wie onderhoude gevoer is, het geen voorbehoeding gebruik nie. Die keuse om ‘n voorbehoedmiddel te gebruik, word beïnvloed talle ander faktore, en mans en vroue se primêre begeerte om voort te plant – ook al leef hulle met MIV – weeg gewoonlik swaarder as hierdie keuse. Daar is ‘n behoefte aan ‘n strategiese, geïntegreerde benadering wat boodskappe oor MIV-voorkoming oordra en wat tuisbring hoe belangrik dit is om swangerskappe te beplan. Sodoende sal vroue wat met MIV leef, tweedoelige beskerming kry.

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.