Includes bibliography. / This thesis is based on a series of interviews with key informants and a census of orphan households in Nguludi Mission Community, Southern Malawi, in 2000. The thesis argues that although HIV/AIDS is a relatively recent phenomenon, any contemporary understanding of the epidemic must be informed by an understanding of the past. The impact of the HIV/AIDS epidemic and the "orphan problem" at the local level, is, therefore, situated within the broader socio-economic context of the history of the region.

Includes abstract. Includes bibliographical references (p. 83-90).

Includes bibliographical references (leaves 91-105). / Media coverage of HIV/AIDS issues influences how the public views the epidemic and people living with HIV/AIDS (PWAs). This dissertation investigates how two key lwge circulation English ianguage newspapers in South Africa frame PWAs. The research examines both the content of selected print media, Sunday Times and Daily Sun, and the context in which journalists work. In relation to the latter, the study adopts a critical political economy perspective of the media which argues that political and economic constraints on media organizations in tension with human agency by journalists and editors impacts on the content of newspapers and other mass media. This thesis examines HIV/AIDS coverage from the beginning of January until the end of April 2005 through the use of content analysis. Most previous research in relation to HIV/AIDS reporting in the print media has concentrated on the poiiticization of coverage during key moments in South Africa’s HIV/AIDS history. This period was deliberately chosen to be both contemporaneous and in order to examine the routine representations of PWAs during 'ordinary times', when HIV/AIDS was not high on the political agenda. Qualitative research in the form of semi-structured in-depth interviews was also conducted with five reporters and editors in order to explore in greater detail issues relating to HIV/AIDS reporting. This research found that the print media in South Africa frames the HIV/AIDS epidemic in a gendered and racialised way. From print media reports examined, the picture painted of PWAs is usually black, female and poor. Official sources continue to dominate coverage, but PWAs are gaining a voice in news reports. The language used in these reports is becoming more positive and empowering, but is still regularly stigmatizing.

Includes bibliographical references (leaves 99-106). / Many evaluations of HIV/AIDS intervention programmes continue to focus on impact and thus overlook the processes through which any given outcomes have been achieved; this has prompted a call for a more consistent focus on what happens during interventions. Therefore, this study endeavours to provide a detailed description and critical analysis of an HIV/AIDS intervention programme. Through adopting a case-based approach, the aim is to illustrate the types of understanding that stand to be gained through the application of process evaluation. A conceptual framework is established which contextualises process evaluation by defining and situating it within the broader framework of programme evaluation; a summary of the main debates in the field of evaluation research is provided. The trends in how other HIV/AIDS intervention programmes have been conceptualised, developed and implemented are discussed, in order to locate the research and to establish criteria for comprehensive evaluation of HIV/AIDS intervention programmes. It is asserted that collectively negotiated social identities shape responses and vulnerability to HIV/AIDS, due to a reciprocally determining relationship between identity, sexual behaviour, and HIV/AIDS. It is argued that an understanding of this complex relationship is essential for those who are evaluating HIV/AIDS intervention programmes. This discussion provides a set of tools for reviewing HIV/AIDS intervention programmes, and advocates that process evaluation should focus not only on the implementation and theoretical orientation of a programme, but also on its proposed pedagogy. In the light of this discussion, a model of process evaluation is developed which is tailored to address the specific challenges posed by HIV/AIDS as a topic for education and which, it is argued, enables the systematic and comprehensive assessment of HIV/AIDS intervention programmes. The model proposes a multi-layered approach to evaluation and incorporates three main categories: processual, theoretical, and pedagogical. The model dictated the guiding questions and data sources that were adopted. Three qualitative research methods were employed. First, using purposive sampling, ten semi-structured interviews were conducted with committee members and volunteers at various stages throughout the programme's first term. Second, participant observations were conducted during and after all committee meetings, general staff meetings and training sessions, and during each of the four lessons. Third, qualitative content analysis was employed to examine the programme's curriculum. The data was analysed largely inductively, but in the light of the theoretical and conceptual frameworks. The findings reveal a number of factors which, it is argued, detract from the intervention's potential for empowerment and the collective renegotiation of social identities (identified as 'key preconditions for programme success' (Catherine Campbell and Catherine MacPhail, 2002:331). These include a lack of structure and theoretical grounding, the absence of a needs-based approach, a lack of ownership, the adoption of a didactic teaching style and the decontextualised nature of the intervention. In addition to providing insight to the specific programme under evaluation, the study contributes to the body of understanding on evaluation research generally through demonstrating and discussing the types of insights that can be gained through the application of process evaluation. The findings demonstrate the way in which process evaluation first, allows for problems to be noticed as they occur and, second, provides the necessary foundation for an evaluation of outcome. It is argued that a process evaluation that takes account processual, theoretical and pedagogical factors has the capacity to respond to the complexity of the HIV/AIDS epidemic and thus can enable the development of more appropriate, comprehensive, and effective HIV/AIDS interventions.

Includes abstract. / Includes bibliographical references (leaves 92-97). / Medical pluralism and the co-existence of a variety of different medical systems within a chosen context are common features in southern Africa as in the rest of the developing world. How do the different systems or practices interact? How does the dual systems of healing impact on the HIV and AIDS national mitigation programmes. The study assumes that the existence of different kinds of medical practices in the same community over a long period of time is an indication of the reality of medical pluralism in Swaziland. It questions its conflicting impact on the public health messages for managing the epidemic. The existence of different healers e.g. faith healers, medical doctors and traditional healers and herbalists is a significant aspect of health seeking behaviours among the larger population in Swaziland (only 22% of Swaziland is urbanized). The people‟s attitude towards and reception of the states public health policies and public health messages are heavily interpreted along and in view of the highly respected traditional medical health care systems. This phenomena also covers the people‟s spiritual and emotional health care systems and points of references and health seeking behaviours. The study also reflects upon the bias by a number of postcolonial writing towards traditional healing driven by colonialists‟ impressions and local rulers left in charge thereafter. The study also refers to the bias of a number of African leaders and governments who readily give support to bio-medical doctors and are not equally supportive to the structures that support traditional healing and yet a bigger size of the population is mostly reliant upon traditional medical care. In southern Africa self-medication is documented as an integral part of the health care system. This research project reflects extensively on the attitude of traditional and developing communities towards ARVs, ART and biomedical interventions at a time of HIV and AIDS in southern Africa. The study concludes that there are no cultural barriers for the traditional healers to collaborate with the bio-medicine practitioners; however there seems to be a lot of „public health‟ constraints for the medical doctor to working collaboratively with the traditional healer. Is this a one sided conflict, tension, bias?

Includes bibliographical references (leaves 121-124). / Government and other NGOs want private sector companies to assist in countering the effects of HIV/AIDS by introducing interventions which follow generic outlined developed by the State and other institutions. The programmes are mainly aimed at the Human Rights of those who are HIV+, and do not have a commercial element. The assumption is that these programmes provide a cost benefit which outweighs the costs of a programme.

Includes bibliographical references (leaves 73-81). / Despite exceptionally high HIV prevalence rates, South Africa experiences prohibitively low levels of HIV testing. Considered to be a key element in the prevention of HIV transmission and a necessary gateway for providing care and treatment for those who are infected, widespread ignorance of HIV status has become a mounting concern in countries with high prevalence rates. Strategies for increasing testing rates have most commonly focused on testing and treatment services, such as the availability and accessibility of clinics offering voluntary counselling and testing (VCT), the number of trained nurses and health practitioners able to administer HIV tests, the possibility of instituting routine HIV testing to increase coverage, and the provision of highly active antiretroviral treatment (HAART) in the event of a positive diagnosis. These efforts seek to either increase access to testing through infrastructural improvements or encourage testing by highlighting its function as a gateway to accessing medical services to manage HIV infection and future transmission. In a departure from these strategies, this thesis considers the physical, social, and psychological ramifications of living with HIV - and not simply issues of access, treatment, and prevention - in order to understand HIV testing practices. Qualitative in-depth interviews were conducted with 15 young adults (6 mole and 9 female) living in Cape Town, South Africa. Semi-structured in-depth interviews collected information about: 1) knowledge and sources of knowledge about HIV/AIDS, as well as how this knowledge changes over time; 2) beliefs and attitudes towards HIV and HIV testing, including corresponding health-seeking behaviours; 3) personal stories about HIV testing, including reasons for and reactions to testing; and 4) possible strategies to encourage HIV testing in the future. Study participants identified three broad threats that were perceived to be experienced by HIV positive people and explained how the HIV test served to either mitigate or expose an individual to these threats. Physical threats posed by HIV, such as opportunistic infections or death, encouraged HIV testing as it was only through testing that these potential threats could be mitigated. Conversely, an HIV test exposed an individual to social and psychological threats. The social threats of living with HIV included exclusion, rejection by family and friends, and social shame. Psychological threats included mental destruction, depression, and stress, among others. Where social and psychological threats were perceived to be strong, testing was actively avoided. The findings of this study are that the decision to voluntarily test for HIV can be explained through a balance of the physical, social, and psychological threats that may be managed or catalysed through an HIV test. When study participants perceived physical threats to outweigh perceived social and psychological threats of living with HIV, they were biased towards testing. When they viewed social and psychological threats to outweigh physical threats, they were biased against testing. This focus on the perceived threats of living with HIV highlights the need to have a comprehensive approach to AIDS and HIV, rather than merely focusing on the clinical diagnosis and treatment of symptoms; enhanced infrastructural resources and the opportunity for mitigation of the physical threats alone do not encourage HIV testing.

Includes bibliographical references (leaves 84-102). / HIV positive adolescents are becoming a progressively more sizeable and prominent sub-group in the South African HIV/AIDS epidemic. As HAART becomes increasingly available, vertically infected children can be expected to survive into adolescence and adulthood. Additionally, sexual transmission of HIV remains a problem, and incidence and prevalence rates among South African youth are high. Experience from the developed world indicates that providing effective care and treatment for youth can be a challenging task. In light of the antiretroviral rollout in South Africa, this exploratory study aimed to identify the experiences and needs of adolescents growing up in care or on treatment for HIV in the Western Cape. To this end, a review of the existing literature on the psychosocial aspects of HIV infection in adolescents was undertaken. Relevant articles were identified, summarized and entered into a database, and particular attention was given to research conducted in the context of sub-Saharan Africa. Additionally, focus groups interviews were conducted with 26 young people attending an adolescent infectious diseases clinic at a tertiary hospital in the Western Cape. Focus groups proceeded according to a pre-set discussion guide and investigated participants' current life experinces, views on the future and self-perceived needs. All interviews were recorded, translated into English, and transcribed, and data were coded and analyzed using NVivo qualitative data analysis software. The study revealed that the psychosocial issues associated with HIV infection in adolescents coalesce around five central themes: knowledge and understanding about personal serostatus, mental health, network of support, treatment management, and healthy behaviour. These issues present challenges to HIV positive adolescents in the present, and affect their outlook on the future. Findings reveal that despite the fact that young seropositive South Africans live in a country where social contexts, available resources and healthcare systems differ markedly from those in developed countries, they share similar concerns and face many of the same challenges as other HIV positive young people around the world. Future studies should investigate each of the five identified themes in greater depth by determining the contextual correlates of individual views, experiences and needs.

Includes bibliographical references (leaves 51-56). / When addressing the global HIV/AIDS pandemic, it is necessary to identify risk factors which are shared by populations, as well as those which may place populations uniquely at risk. Although Canada is a developed country, its Aboriginal population shares socio-economic characteristics with the world's developing populations. This thesis explores the shared risk factors among the Aboriginal population in Canada, where the HIV/AIDS epidemic is increasing despite relatively low national prevalence rates, and South Africa's African population, where the HIV/AIDS epidemic is particularly acute. The present analysis compares the profile of the African South African HIV/AIDS epidemic with risk factors that also occur among Aboriginal people. The results of this analysis show that the Aboriginal population has an epidemic risk profile that is similar to that of African South Africans. This points to the potential for a rapid increase of HIV/AIDS among Aboriginal people, as has been the case in the African South African population over the past two decades.

Includes bibliographical references (p. 83-97). / Includes abstract. / This thesis considers the power of United States popular media to construct both conceptions of "Africa" and knowledge of HN / AIDS among exchange students in Cape Town, South Africa. Arguing that the reification of myths about Africa influenced respondents' arrival stories and initial experiences, I exhibit how being in South Africa produced very different associations, particularly with regard to intimate relationships. Drawing on theoretical work that looks at the tendency to imagine disease as a product of "foreign" or "other" people, and building on respondents' imaginary Africa, the conceptual linking of Africa to AIDS is highlighted in their discussions of expectations. The linking of HN / AIDS to Africa affects respondents decision to study in South Africa, as well as their initial interactions; highlighting the tendency of respondents to describe their motivation for studying in South Africa a result of a sense of "responsibility" they feel to "save" Africans from AIDS. Respondents' urge to "save" is in tension with their initial tendency to distance themselves from HIV / AIDS in Africa through an imaginary matrix of immunity exhibited through rhetorics of difference. Evolving from respondents' motivation to "save," a discussion of "moral tourism" and ''voluntouring'' is explored. The thesis argues that the combination of voluntary services and living in Cape Town has the ability to change perceptions that were previously used as explanation for high levels of contraction rates of HIV / AIDS on the African continent and particularly in sub-Saharan Africa.