Most children born HIV positive live longer and have more healthy lives since the advent of Anti-Retroviral Therapy (ART), together with the accessibility of Anti-Retroviral Drugs (ARV) to persons living with HIV. However, some of those children find themselves in need of care due to abandonment, orphanhood and / or neglect. In South Africa such children may enter the formal Child and Youth Care System and be placed in centres such as Epworth Child and Youth Care Centre. Due to the complex nature of the consequences of such disclosure or non-disclosure of HIV positive children’s status to them, social service workers are posed with a dilemma. In the absence of clear guidelines and policy around such disclosure, the children concerned may be unaware of their HIV positive status, despite being on a medication regime. The aim of the study was to explore the perceptions of social service workers regarding disclosure of HIV status to children born HIV positive living at Epworth Child and Youth Care Centre in Lambton, Ekurhuleni, South Africa. The study was located within a qualitative research paradigm, and utilised a purposive stratified sample of 15 social service workers form various occupational groupings recruited from Epworth Child and Youth Care Centre. A semi-structured interview schedule was employed as the research tool, with in-depth one-on-one interviews being adopted as a method of data collection. Thematic content analysis was used to analyse the data collected during the interviews. The main findings of the study were that HIV status disclosure is viewed as a complex but essential process as it reinforces children’s ability to adhere to medication regimes and to dispel anxiety and suspicion within themselves and around their status; that non-disclosure may lead to poor or coerced adherence and strains the relationship between the children and the social service workers. Disclosure of children’s HIV positive status can be viewed as complex as it presents both positive and the negative. Recommendations relate to community educative and awareness programmes, policy and practice changes regarding disclosure and none disclosure of children’s HIV positive status, as well as future research.

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In this study, a model of cognitive behavioural therapy (CBT) was developed, implemented and assessed. The aim of this model is to assist HIV-positive women in dealing with internalised and enacted stigma. Since much of the research about therapies developed to deal with HIV-related stigma so far has been done within a western frame of reference, in the current study a model was developed to suit the local South African situation. Women were specifically targeted as they are more vulnerable to HIV/AIDS and are disproportionately affected by the epidemic. Because of culturally determined gender roles, women are not always in a position to take control of their sexual health. Furthermore, because of the negative experiences of HIV diagnosis, the stigma has a negative impact on women’s behaviour. As a result, there is a need for a therapeutic model to assist HIV-positive women in changing the experience of internalised stigma and discrimination. A CBT approach was used in therapy to challenge the women’s dysfunctional beliefs, to change their automatic thoughts and to promote more realistic adaptive patterns of thinking. All of these aimed to assist them in dealing with stigma. Eight therapy sessions (one a week for eight weeks) were planned for each of the women. This research was conducted in two phases. In Phase 1, data was gathered about the experiences of HIV-positive women to gain an understanding of their experiences of HIV-related stigma and discrimination. Various sources of information were used to identify not only the relevant themes contributing to the individual’s experience of internalised stigma, but also possible ways to change them. These sources included a study of the available literature, the researcher's own experience and focus group discussions with other psychologists in practice, and interviews with five HIV-positive women (in the form of case studies). Five women living with HIV/AIDS, who were experiencing difficulties in dealing with stigma, were recruited at Witbank Hospital, where they were interviewed and asked to complete five psychometric instruments. The researcher scrutinised the data gained from the psychometric scales to assess the validity of the instruments to identifying the feelings of the participants the researcher observed in the interviews. Rubin and Rubin's (1995) method was used to analyse the data. The findings that emerged from Phase 1 were used to identify common themes to be addressed in the intervention, for example feelings of powerlessness, feelings of guilt, behavioural implications of stigma, the experience of the reaction of others and uncertainty about the future. These themes were used as guidelines and were adapted according to the specific needs of each of the women seen in therapy so as to address negative feelings and behaviour. Phase 2 focused on the implementation and evaluation of the cognitive behavioural model. A purposive sampling technique was used for this study. The model was tried out with ten HIV-positive women who served as the experimental group. A quasi-experimental design was used, involving a pre-and post-test and a control group consisting of ten other women identified at the same hospital. The scores that the experimental group and the control group obtained before the intervention were compared to verify that the two groups were comparable prior to the intervention. Post-test scores were compared to investigate differences between the groups after the intervention. The process notes of the therapy sessions were analysed by means of qualitative analysis to understand the reactions of the women in therapy. This contributed to the researcher’s understanding of the appropriateness and effectiveness of various therapeutic techniques used with the experimental group. Findings of this research indicate that, when compared to the control group, the experimental group not only experienced less depression, internalised stigma and negative coping, but also higher levels of self-esteem and positive coping after having participated in eight therapy sessions. The study further revealed that being HIV positive and trying to cope with stigma and discrimination involve diverse experiences for women, although there are common themes for all participants. It was recommended that the intervention be altered in future use in the following ways: Those techniques that were found to be more effective with the majority of women (positive cognitive reframing, teaching of coping strategies, homework assignments, decatastrophising and assertiveness training) could probably be used with success in similar conditions. Only the techniques that worked well should be used, and care should be taken not to use too many techniques. Each client should be given the time to question the evidence for her automatic thoughts and to draw her own conclusions about her situation, feelings or thoughts and to grasp the cognitive strategies, rather than to bombard her with many different techniques. The therapist should also relate more to the individual client and adapt the model to her context, rather than to implement the model rigorously. / Thesis (PhD)--University of Pretoria, 2009. / Psychology / unrestricted

Doctor of Philosophy / Department of Family Studies and Human Services / Karen S. Myers-Bowman / The purpose of this study was to conduct a phenomenological inquiry into the impact HIV/AIDS-related stigma has on People Living with HIV/AIDS (PLHA) and their family members in Ghana and the overall relationship family members have with PLHA. The study explored the concept of stigma in the Ghanaian context, ways in which it is expressed, factors influencing HIV- related stigma and its consequences on both PLHA and their family members. Strategies that PLHA and their family members consider for effective HIV- related stigma prevention were also explored. The study further explored some of the gender- biased nature of HIV- related stigma in Ghana. Data was gathered qualitatively through interviews with five PLHA and their discordant family members. Interviews were transcribed and translated into English, coded and analyzed. After inductively establishing themes and categories, final confirmatory analysis was deductively established, by using the Bronfenbrenner’s ecological model and Symbolic interaction theory to affirm the authenticity and appropriateness of the inductive content analysis. The study found that HIV- related stigma begins with serostatus disclosure. Stigma is manifested in myriad contexts including the family, community, healthcare institutions and gender. The major factors influencing stigma are insufficient knowledge of HIV transmission, fear and misconception of HIV created by the media, cultural and religious factors as well as poverty. Family members experienced similar stigma as PLHA, such as loss of jobs, loss of social network, loss of identity and self stigma. However extreme impacts such as suicidal thoughts were only experienced by PLHA. The impact of HIV- related stigma is worst for women because of beliefs and values relating to gender- role expectations. While women accept and support their husbands when they have HIV/AIDS, women are often neglected and abandoned by their husbands. To address this stigma, participants suggested house to house education, financial support from the government, revision of educational content especially discontinuation of negative images of HIV/AIDS used by the media. Implications for this study in the areas of research, practice and policy are provided.

The phenomenon of stigmatisation in the transmission of HIV/AIDS was highlighted in this study, and considered from a social constructionist perspective. The lived experiences of 20 participants were explored in the context of a stigma reduction programme. Perceived meanings attached to stigma, and its influence on participant behaviour was revealed through narratives. The influence of the programme on participant meaning making and perceptions was also revealed, and found that the meaning of stigma remained unchanged, and therefore stigma was not reduced. Not discounting the therapeutic platform of the programme in enabling co-construction of new perspectives which enabled coping mechanisms for participants in dealing with their circumstances. It is recommended that studies such as this be used to assist future stigma reduction programmes to identify their roles in meaning making regarding stigma, with the premise in mind that if meaning shifts, experiences will shift. / Psychology / M.A (Psychology)

The phenomenon of stigmatisation in the transmission of HIV/AIDS was highlighted in this study, and considered from a social constructionist perspective. The lived experiences of 20 participants were explored in the context of a stigma reduction programme. Perceived meanings attached to stigma, and its influence on participant behaviour was revealed through narratives. The influence of the programme on participant meaning making and perceptions was also revealed, and found that the meaning of stigma remained unchanged, and therefore stigma was not reduced. Not discounting the therapeutic platform of the programme in enabling co-construction of new perspectives which enabled coping mechanisms for participants in dealing with their circumstances. It is recommended that studies such as this be used to assist future stigma reduction programmes to identify their roles in meaning making regarding stigma, with the premise in mind that if meaning shifts, experiences will shift. / Psychology / M.A (Psychology)