A thesis submitted to the Faculty of Education in fulfillment of the requirements for the degree of Doctor of Education in the Department of Educational Psychology and Special Education at the University of Zululand, 2010. / This study sets out to establish the level of awareness and perception of preventive strategies against HIV/AIDS in two African Universities, Zululand (South Africa) and Ado-Ekiti (Nigeria). Responses to a questionnaire set out in nine sections (125 items) from one thousand four hundred and sixty participants (604 from UNAD; 856 from UNIZULU) were analysed for their socio-demography, sexual activities, awareness, assessment of factors that support spread of HIV/AIDS on campus, risk assessment of students, knowledge of HIV transmission and protection, and perception of preventive strategies. One section also covered the assessment of institutional programmes on HIV/AIDS. The socio-demography revealed that though the two institutions are located in relatively rural/remote places, the socio-economic status were completely different. While UNIZULU respondents were predominantly from rural areas, and from poor families, UNAD respondents were predominantly from middle/high class homes drawn from cities and big towns. The pattern of their sexual activities was also different. While a small, but higher, percentage of UNAD’s respondents have been sexually active from elementary schools, the majority of respondents from UNIZULU have been sexually active from high school with a large proportion being single parents. Most of UNAD’s respondents became sexually active in the university although a small percentage was sexually active when they were in the primary school. Institutional support was much better at UNIZULU though both institutions enjoyed adequate awareness of HIV. However, UNIZULU has facilities for testing and counselling, which was not available at UNAD. UNAD respondents did not have adequate access to male condoms whereas UNIZULU did, but both institutions did not have adequate access to female condoms. Core risk factors common to both institutions are irregular and inconsistent use of condoms, not knowing the HIV status of their partners and of themselves, multiple and concurrent sexual activities, intergenerational relationships cloaked in sex-for-money or favour trade, and having sex under the influence of alcohol or drug. While risky sexual activities were driven mainly by gender, and to a smaller proportion by marital status, number of children, where grown up and family resources, the factors that drive risk at UNIZULU were more complex and included gender, age, marital status, number of children and level of study. Indeed there was evidence that UNIZULU respondents appeared to be more sexually risky as the level of study increased while UNAD’s appeared to be less risky. Recommendations are put forward for the possible use results of this study could be put to make African university campuses sexually safe. / the University of Zululand

In the early days of HIV/AIDS in North America, those most directly affected by the crisis created a social movement to respond to the virus when no one else would. The legacy of activists’ efforts can be seen in the more than seventy-five AIDS service organizations (ASOs) that provide prevention, support, and education to communities across Ontario today. While these organizations were once an important site of advocacy and resistance for people living with HIV/AIDS (PHAs), ASOs are now often viewed as professionalized, bureaucratic and impersonal spaces. Linking theoretical understandings of public pedagogy and the pedagogical potential of space with HIV/AIDS scholarship, I offer a conception of ASOs as more than simply impersonal service providers, but vibrant spaces of community learning. Drawing on interviews with people who work, volunteer, and use services at a small ASO in Kingston, Ontario called HIV/AIDS Regional Services (HARS), I identify three pedagogical assets within the agency’s space that tend to go unrecognized as such. The agency’s drop-in space, artworks created by PHAs that decorate the walls of the office, and HARS’ storefront design are not usually counted as elements of the kind of formal “HIV/AIDS education” that ASOs provide. However, by exploring the learning experiences that are incited by these assets, I argue that we may broaden our understandings of what counts as HIV/AIDS education and of the value of ASOs in their communities. These unacknowledged assets not only enhance peoples’ understanding of issues related to HIV/AIDS, they also work to develop a sense of community and belonging for visitors to the space. In conclusion, I reiterate that while today’s ASOs are surely different than the organizations that activists created in the 1980s, the learning experiences that arise in agencies like HARS demonstrate that community-building and mutual support can remain as integral aspects of ASOs. / Thesis (Master, Cultural Studies) -- Queen's University, 2013-09-20 14:39:55.828

FACULTY OF HUMANITIES School of Literature and Language Studies 9511112w mokope@webmail.co.za / The scourge of HIV/AIDS continues to worsen in the country in spite of efforts made by government and other stakeholders to combat this disease. This is reflected by the everincreasing statistics of new cases of HIV infection that are reported every minute. This rate of infection is believed to be influenced by factors such as cultural constructions that inhibit efforts to educate the populace about the disease. The research focuses on the extent to which cultural ideologies, as reflected in figurative expressions, render the task of educating people about sexually related diseases difficult. Translators seem to prefer figurative instead of literal language when they translate STDs and AIDS-related education materials. The preference of the former renders the message inaccessible to the average target audience. This study neither strives to conscientise and sensitise the doubting Thomases about the danger of HIV/AIDS and STDs nor does it seek a cure or treatment but a new way of communicating about these diseases. Ratzan maintains that “until a vaccine or cure for HIV infection is discovered, communication is all that we have” (1990: 257). This study deals with communication about HIV/AIDS. It is believed that the research’s findings can be used to help reduce the rate of transmission of this life-threatening infectious disease.

Student Number : 0110645G - MSc research report - School of Public Health - Faculty of Health Sciences / South Africa is one of the countries in sub-Saharan Africa that are severely affected by the HIV/AIDS pandemic. This epidemic has led to high mortality rates, decreased life expectancies, increasing poverty, and overburdened health systems. Objective: To quantify the disease burden related to HIV/AIDS in Leratong Hospital, a level 2 public sector hospital in Gauteng Province of South Africa. In the context of the recent introduction of anti-retroviral therapy programme in the hospital, it is hoped that this study will assist in defining a baseline to which future evaluation of the programme will be compared. Methods: This was a retrospective descriptive study on routinely collected hospital data. The records of all patients admitted into the four medical wards of the hospital in 2001 and 2004 (n=21,029) were analyzed. Data on their socio-demographic characteristics, discharge diagnoses, HIV status, clinical outcome and length of stay in the hospital were extracted and analyzed. Results: More than half (52%) of the patients were aged between 21 and 40 years. Between the two years, the annual total number of admissions to the medical wards decreased by 6.6%, and this was more pronounced in the female wards where the decline was more than 10%. HIV-related diseases accounted for four out of the top five diseases in all patients. The proportion of chronic diseases, such as hypertension, diabetes, congestive cardiac failure and cerebrovascular diseases, decreased from 15.3% in 2001 to 14.3% in 2004. The average length of stay (ALOS) increased from 3.7 days in 2001 to 4.1 days in 2004. Only 14% of all patients consented to HIV testing in the review period. Of these more than 90% were reactive to HIV. Although the proportion who had HIV tests decreased significantly from 16.9% in 2001 to 11% in 2004 (p<0.001), the HIV positive rate increased significantly from 89.1% in 2001 to 92.4% in 2004 (p<0.001). The proportion of patients admitted due to HIVrelated diseases increased significantly from 52% in 2001 to 58% in 2004 (p<0.001). The crude mortality rate for all patients during the two years studied was 13.6%. This increased significantly from 12% in 2001 to 15% in 2004 (p<0.001). Mortality was significantly higher in those patients with documented HIV results and those admitted with HIV-related diseases irrespective of their HIV status. While cause-specific mortality rate due to HIV-associated diseases either increased or remained very high, that due to diabetes mellitus decreased significantly between the two years studied (p=0.02). Patients’ length of stay in the hospital and mortality were both found to be associated with their age group, HIV status, diagnosis and year of admission. The study has demonstrated some changes in the clinical profile of the patients towards a preponderance of HIV-related diseases and crowding out of other chronic non-infectious diseases. Based on these results, it is therefore recommended that all patients should have access to voluntary counseling and testing (VCT) and emphasis should be placed on those diseases with high admission and mortality rates to improve patient care and outcome. Measures should be developed to ensure that patients with chronic noninfectious diseases are not crowded out.

Student Number : 0513068K - MA research report - School of Graduate School - Faculty of Humanities / The aim of this study it to evaluate the Gauteng Government’s attempt to implement a life skills education programme in all primary and secondary schools. A chosen strategy of the National HIV/AIDS/STD Strategic Plan for South Africa: 2000-2005, a universal programme of life skills and HIV/AIDS education in primary and secondary schools was identified as a vital means to contain South Africa’s HIV/AIDS epidemic. Broadly, the life skills and HIV/AIDS education programme is intended to “promote improved health seeking behaviour and [the] adoption of safe sex practices” (DOH, 2000) amongst school going youth. Responsibility for the implementation of this programme in all primary and secondary schools is decentralised to the provincial level. Accordingly, this study seeks to analyse and evaluate the Gauteng Provincial Government’s (GPG) progress in the implementation of the life skills programme. A case study design centered upon documentary analysis and key informant interviews was employed in order to capture the necessary and predominantly qualitative data. These data are analyzed using the conceptual framework developed through the work of Hildebrand and Grindle (1994 in Brijal and Gilson, 1997), and Brijal and Gilson (1997). This study found that numerous implementation deficits arising at the organisational, task network, public sector institutional and external environmental levels combined to hamper implementation of the life skills programme according to the time frames set out within the National Integrated Plan for Children Infected and Affected by HIV/AIDS. Nevertheless, this study also found that political stability in Gauten gprovince was a significant factor promoting steady and progressive programme implementation and expansion. To conclude, this study indicates that policy implementation requires numerous complimentary factors (for instance, a strong level of local service delivery capacity) to be in place in order for public HIV/AIDS policy implementation to be achieved in an efficient and sustainable manner.

Introduction: Prevention of mother-to-child-transmission of HIV is a priority public health problem in Africa as pregnant women and their children are the most vulnerable. In South Africa, a prevention of mother to child transmission of HIV (PMTCT) programme has been implemented in antenatal clinics to reduce paediatric HIV/AIDS. It is necessary to assess the uptake of this programme by pregnant women. Objectives The purpose of this study was to determine the uptake of the PMTCT programme in the antenatal clinics of Sedibeng district. Using data coming from all the antenatal clinics (ANC) at a primary health care levelin Sedibeng for 2005 and 2006, we determined the proportion of ANC attendees who accepted to be counselled, the proportion of these who accepted to be tested for HIV, the proportion of these who came back for results and the proportion who were HIV positive. Nevirapine (NVP)uptake was determined as well among HIV positive women and babies born to HIV positive women. Methods Data collection was by a record review of PMTCT records from all antenatal clinics in the district. To determine maternal uptake of PMTCT, data were extracted from antenatal clinics monthly collation sheets for 2005 and 2006. Nevirapine uptake for the babies born to HIV positive mothers was determined in one facility: data were v - collected in the midwife obstetric unit of the community health centre from both the Nevirapine register and the mothers’ delivery records. Results A total of 8010 women attended in Sedibeng antenatal clinics in 2005 and 10217 in 2006. In 2005 95 % of attendee women accepted to be counselled among whom 91% accepted to be tested for HIV. In 2006 93% women accepted to be counselled among whom 91% accepted to be tested. Almost all tested women came back for results: 99% came back for results in 2005 and 98% in 2006. The proportion of HIV positive women in the attendees population was 23% in 2005 and 24% in 2006. Nevirapine was dispensed to only 600 per 1000 HIV positive women in 2005 and 539 per 1000 HIV positive women in 2006. From June 2005 to May 2006 only 59% of babies born to an HIV positive mother received NVP. Discussion and conclusion The study showed a good uptake of voluntary counselling and HIV testing in Sedibeng district antenatal clinics. But a low proportion of HIV positive women and HIV-exposed babies received NVP. There was probably a loss of follow up of women between ANC visits and delivery. Nevirapine uptake must be improved in Sedibeng antenatal clinics and further investigations need to be done to understand the factors influencing uptake.

MDent, Faculty of Health Sciences, Universiyt of the Witwatersrand / Introduction: HIV associated parotid lymphoepithelial lesions in children are not well documented. Most studies have concentrated on the adult population. Objectives: The present study aimed to document the disease, its risk factors and anti-retroviral treatment outcome in children. Materials and methods: The study was conducted at 2 HIV and AIDS facilities weekly over a 6 month period. “Parotid swellings” in children below 13 years were analysed. A retrospective medical chart review was conducted. Results: Seventy-one children were included; 47 with swelling (Group 1) and 24 without swelling (Group 2). Thirty-nine had parotid swelling of 1or both glands, 6 had submandibular and parotid swelling and 2 with only submandibular swelling. Twenty-six children in Group 1 were receiving HAART, 19 reported a reduction in size of lesion, 6 reported no effect and only 1 had the lesion after 11 months of HAART. Conclusion: Parotid lymphoid proliferation in children is more common than previously reported. The prevalence of this lesion could not be determined as not all children with parotid swelling presenting at the clinics were included in the study. Children with lower viral loads showed an increased risk of developing parotid lymphoid proliferation. The parotid lesions responded well to HAART but did not completely resolve.

PhD, Faculty of Law, Commerce and Management, University of the Witwatersrand, 2009. / The global health revolution of the last 50 years has generated significant health gains in terms of increased life expectancy and reduced maternal mortality. South Africa, an upper middle income country, has performed poorly along the same development indicators. Development gains for women and children won over two decades are now being reversed, largely due to HIV/AIDS. This is in spite of the evidence that lifesaving antiretroviral medication can prolong life and enhance quality of life. Using a joint capabilities and health equity lens, this thesis seeks to understand a critical development problem in South Africa – premature mortality in pregnant women and children attributed to HIV – an infectious disease that is both preventable and treatable. The research identifies key barriers faced by pregnant and postnatal women with HIV who seek (freely available) access to PMTCT (prevention of mother to child HIV transmission) and ART (antiretroviral therapy) programmes in the public health sector. The study considers whether disparities in, and missed opportunities for, preventing and treating HIV in these population groups comprise avoidable, systematic and unfair health inequities. The implications for the capabilities of women and children with HIV in this country are also explored. Qualitative research methods are employed to investigate the research concern. Semi-structured interviews with 83 women comprise the mainstay of the field research. Interviews with 37 caregivers of children with HIV, together with patient files and interviews with key informants, supplement the data collection. Research was undertaken in two sites in two provinces: Eastern Cape and Gauteng. Each site constitutes a bounded case study. A rural-urban perspective is put forward – with attention to equity considerations in access to maternal-child HIV services. The study evinces a host of avoidable factors in the operational delivery of ART/PMTCT, along a range of intervention points in the continuum of care: including the antenatal, labour, postnatal and pediatric wards. While some of these factors are influenced by individual behaviour, the vast majority are directly linked to the health system – illuminating the ways in which the health system serves as a social determinant of health (SDH), and often restricting, constraining, and ironically, preventing people from obtaining the interventions and information they need to improve their health. iii By connecting the empirical findings related to ART/PMTCT within the health system to the capabilities and health equity literatures, an understanding of disparities in access to, and delivery of, such services – and their importance in shaping health, development and health outcomes of these population groups – becomes clearer. As a consequence, strengthening the public health system is a necessary first step to ensuring at least some of the minimum conditions that allow people to be healthy. As an entry point, there is great scope for systems’ interventions that would address the shortfall in health for black South Africans and deprivations in their health capability. At the same time, the research reveals that – owing to the contribution of social determinants of health (e.g., factors that impact on health such as living and working conditions, but lie outside the realm of healthcare) to health status: good health is not achieved solely by access to and provision of good healthcare. This reality underscores the importance of health as a central capability; and good health as a normative social goal. In the capability view, the moral concern for state and society is the reduced capability of individuals due to health inequities that are socially-constructed, and in turn, changeable. Recommendations to address modifiable factors related to effective ART/PMTCT provision in these facilities are put forward, with a set of suggestions for future research in maternal, child and women’s health in South Africa.

Research report in partial fulfillment of the degree of MPH, Faculty of Health, University of the Witwatersrand / Background and Study Question: Adolescents are a high-risk group for HIV/AIDS infection and illness in South Africa. Despite substantial prevention efforts, high risk behaviour among adolescents continues. Several organisations have engaged in sports activities to reach out to adolescents and educate them in life-skills and HIV prevention. There is, however, very little published research on the effectiveness of such interventions. Grassroots Soccer (GRS) is one of the emerging organisations in the field of using sports for HIV prevention. Financed by De Beers’ corporate social responsibility initiative it operates in several South African mining communities. This study evaluates the HIV prevention programme in Musina, Limpopo Province run by GRS. The research focuses on the processes and the outcomes of the organisation’s activities to determine barriers and facilitators to implementation of the GRS activities and to measure changes in HIV-related knowledge, self efficacy, and attitude of the beneficiaries. Methods: A mixed-methods study design was used incorporating qualitative and quantitative approaches. The qualitative component of the study was based on key informant interviews and a document review. Qualitative interviews were analysed using a four-step systematic approach; documents were analysed by iterative reading. Quantitative data was collected by GRS through selfadministered pre- and post-intervention questionnaires. Secondary data analysis was carried out using statistical software SPSS (Version 17.0). Results: The GRS programme managed to improve beneficiaries’ knowledge, attitude, and self-efficacy concerning HIV prevention. In doing that, GRS achieved its core objective. The increases, however, are modest and only significant for knowledge gain. Many beneficiaries did not increase their overall scores in the pre- and post-test questionnaire; the recognition of alcohol and drugs as risk factors for HIV/AIDS is relatively low. Furthermore, the programme operates in a difficult context with insufficient community involvement, constraint resources, and inadequate monitoring and evaluation. Volunteer retention is a major challenge, and there is a disjuncture between the GRS’ theoretical approach and the practical implementation in Musina. Although the programme is considered a success by key informants, these factors combined with a lack of support from GRS and De Beers pose challenges to the programme’s approach, its operations, and ultimately its sustainability. Conclusion and Recommendations: The GRS provides a promising approach to HIV prevention. The programme in Musina however falls behind the potential of the organisation and the needs of the community. It needs to be more locally integrated, receive additional resources, and have better monitoring and evaluation. Programme activities ought to move beyond knowledge transfer and be closer to the actual GRS approach based on Bandura’s Social Cognitive Theory, focusing on 12 to 14 year-olds, and include income generating activities. Further research should focus on actual programme implementation, longer term follow-up of beneficiaries, and assess the impact of the programme.

Student Number : 9910519W - M Med research report - School of Public Health - Faculty of Health Sciences / Introduction: This study sought to determine the costs of providing health care to HIV/AIDS patients in a tertiary level hospital in Gauteng Province. The study also determined what the implications were for the hospital in terms of planning and resource allocation. Methodology Study design: Retrospective Record Review Study Period: 03 May 2005 – 15 June 2005 Study setting: Chris Hani Baragwanath Hospital, Gauteng. Study population: Medical & Pediatric inpatient discharges and deaths Results: 1185 records reviewed (812 HIV positive) HIV positive patients were staying longer than others and costing the hospital more as well. Those on ARV therapy cost the most. Conclusion: More resources were being spent on HIV/AIDS patients. Increased lengths of stay and expenditure on drugs and investigations were the reasons for higher costs compared to HIV negative inpatients. Identifying ways of reducing admission and other costs must be seen as strategies in reducing the financial burden of HIV/AIDS to the facility.