Master of Public Health - MPH / South Africa is estimated to have one of the highest epidemics of HIV infection. Recent youth studies have found that youth aged 15-24 years are increasingly becoming vulnerable to HIV. Condom use is promoted as one of the key HIV prevention methods in South Africa. Face-to-face structured questionnaire interviews were conducted with a volunteer sample of rural active women and men aged 15-26 years living in 70 villages in the Eastern Cape Province. Most of the participants were recruited in schools. / South Africa

Includes bibliographical references (p. 89-103). / This dissertation serves as a discursive exploration into the underdiscussed topic of heterosexual anal sex and pervading penile-vaginal heteronormativity. To understand the origins and character of the seemingly universal ambivalence towards heterosexual anal intercourse I attempt to situate it historically. There is general ignorance concerning the prevalence of this sexual behaviour, but there exist deep-seated taboos and undertones of immorality and abnormality associated with it. All these factors play a part in individual sexual decision making; an attempt is made at exploring the motivations and personal choices that culminate in an act of heterosexual anal intercourse.

Includes bibliographical references. / Do discourses of "hope" have real and practical consequences when it come to crucial issues such as policy, prevention, stigma, risk perception or funding? The following exploratory and treansdisciplinary study seeks to pull together a wide variety of the theoretical and analytical stances in order to examine the social construction of hope in the context of HIV/AIDS in South Africa. the theoretical framework is built from a base of cultural theory, discourse analysis and theology, and binds these together into a transdisciplinary argument.

The writing of this thesis is to investigate the role that the church play for the people living with HIV and AIDS and are poverty stricken. This investigation takes us both into the role of the Roman Catholic Church of Ndola Diocese and the Copperbelt Presbytery of the United Church of Zambia are doing in the fight against HIV and AIDS and poverty. The problem of HIV and AIDS in Zambia, as well as Africa in general, represents an economic, social, moral, and spiritual problem of great magnitude. Never before in the history of the world have we faced such a pandemic which results in creating poverty among Zambian people. It knows no boundaries, leaving a path of death and destruction to all that treat it lightly. HIV and AIDS have touched every community within the global village. There is not a person that has not pondered on this terrible disease. The researcher’s question through this thesis is to find out the role of the church as it seeks to care for those infected and affected by the HIV and AIDS pandemic. Can the church rise to embrace the enormous economic and social need that HIV and AIDS and poverty presents, can it make a difference in an environment of suffering as it seeks to become a healing community? This thesis is to enhance the response of churches in Zambia to the fight against HIV and AIDS and Poverty. Pastorally, churches have the duty and task to address issues of stigma, discrimination, judgmental tendencies and give pastoral care to people living with HIV and AIDS. This thesis has attempted to explore new theological perspectives and utilise the available ones, which have already been dealing with issues that address HIV and AIDS prevention and care. The study also seeks to encourage church ministers, pastors and lay leaders to provide the much needed leadership in the fight against HIV and AIDS and its accompanying social problems of poverty, injustices, culture and gender inequality. The church has a central role to play in the fight against poverty and impoverishment. As part of the civil society, it has the pastoral responsibility for ensuring that all citizens in Zambia enjoy their full rights. Far from being powerless victims of HIV and AIDS and poverty, the poor in Zambia must be treated with respect and dignity. Nevertheless effective therapy and pastoral care normally transcends all stigma and cultural barriers as it seeks to address the problems of people living with HIV and AIDS. Human beings respond to love, care and shelter, as basic needs. Ross reminds us that “It is only when the church becomes the leading symbol of healing in a situation of HIV and AIDS and poverty then it will be a blessing to all those who are living HIV negative lives and those who struggle to bring care, support, love and comfort to the orphans and widows and more especially to all those living with HIV and AIDS” (Ross 2002:vi). The church should not lag behind, but it should set the pace of showing the love and care for all people with HIV and AIDS and are living in poverty. / Dissertation (MA (Practical Theology))--University of Pretoria, 2006. / Practical Theology / MA / unrestricted

PhD Faculty of Health Sciences, University of the Witwatersrand, 2009. / HIV/AIDS was discovered almost a quarter of a century ago and has so far claimed the lives of more than 25 million people worldwide. Developing countries remain disproportionately affected, with sub-Saharan Africa contributing more than two-thirds of infections globally. Sexual transmission is the primary route of HIV/AIDS acquisition, and women bear the greatest burden of this pandemic. We are now at a stage where biotechnological advances are needed that can either cure HIV/AIDS, stimulate the immune system to produce anti-HIV-antibodies by vaccination, or prevent HIV infections. One of these advances has been the development of various microbicides. However, a lack of effective drug delivery systems for these agents has remained as a rate-limiting step towards successful HIV prevention. In an attempt to overcome this problem, this study aimed at designing and developing a novel intravaginal bioadhesive polymeric device (IBPD) as a delivery system to effectively deliver a microbicide {polystyrene sulfonate (PSS)} and antiretroviral (ARV) {3'-azido-3'-deoxythymidine (AZT)} combination to the vagina. The development of a successful intravaginal microbicidal drug delivery system requires the design of a formulation to deliver the microbicide-ARV combination in a safe, effective, and consistent manner. The first step therefore was to undertake extensive preliminary screening studies on various polymeric materials using a one variable at a time (OVAT) approach to find suitable polymers for developing an IBPD. Initially 18 biodegradable and biocompatible polymers were employed to produce 62 formulations that were further screened through the OVAT approach to result in 15 lead formulations. Two major concerns of this study were the attainment of satisfactory residence time of the IBPD in the vagina as well as the ability of the IBPD to contain and release the microbicide-ARV in a controlled manner. Therefore, optimization of the IBPD was based on these two requirements for which proper matrix integrity was a pre-requisite. Artificial neural networks (ANNs), a computational technique that is able to simulate the neurological processing ability of the human brain through mathematical modeling, was employed for optimization. The ANN approach confirmed that 5 of the 18 studied polymers could be suitable for the development of an optimized IBPD. To finally attain good vaginal retention for the developed delivery system, extensive bioadhesivity testing was undertaken on the optimized device. Thorough in vitro and ex vivo bioadhesivity analysis was conducted using physicomechanics and computational structural modeling. Allyl penta erythritolcrosslinked poly acrylic acid (APE-PAA) appeared to contribute most to the bioadhesivity. Apart from being employed as a matrix component, PAA was further used as a coating agent to achieve extended bioadhesivity within the posterior fornix of the vagina. Since prolonged release and suitable permeation of the microbicide-ARV across the vaginal tissue was a critical requirement of this study, the device was designed to provide a controlled and prolonged drug release. Prolonged release for up to 72 days was achieved. Furthermore, the design was constructed to ensure that the released drug could permeate into the vaginal tissue and be retained substantially. This was determined by measuring drug flux through ex-vivo permeation studies using freshly excised pig vaginal tissue in a Franz Diffusion Cell (FDC) apparatus. The ultimate aim of the study was to have the IBPD well accommodated in the vagina for successful prevention of STIs and HIV infection. Achievement of this aim was ensured by undertaking extensive in vivo studies in Large White pig model. The IBPDs were inserted under anaesthesia into the posterior fornix of the vagina, using a novel applicator. To detect the retention of the IBPDs and determine their sequential biodegradation pattern in the vagina, X-ray imaging was employed, using radio-opaque Barium Sulphate (BaSO4). To demonstrate that the developed drug delivery system acted locally and was only minimally absorbed systemically, blood samples were taken from the jugular vein of each pig at pre-determined time intervals and subjected to UPLC analysis. The drug content in the vaginal tissue at the end of the study was also determined. Histopathological evaluation was carried out on vaginal epithelium to access the potential for toxicity of the IBPDs. The drug content analysis revealed that greater amounts of AZT and PSS were retained in the vaginal tissue with relatively small quantities (AZT:17%; PSS:13%) crossing into the systemic circulation. The results from the toxicity studies showed that the IBPDs were safe for use. This suggests that the developed drug delivery system (the IBPD) may be suitable for application in the prevention of STIs and HIV infections.

Includes abstract. Includes bibliographical references (leaves 77-84).

Word processed copy. / Includes bibliographical references (leaves 84-98). / Until recently, the national implementation of a public sector Antiretroviral Therapy (ART) programme in South Africa seemed financially impossible. Drastically reduced prices for Antiretrovirals (ARVs) combined with substantial donor funding and the long-awaited adoption of a national treatment plan, have, however, shifted the debate. Now the question is not so much should universal ART be provided by government but, rather, is it possible to implement in severely resource-constrained environments and, if so, what are the best ways to deliver these services.

Incudes bibliographical references. / The thesis is based on the story of a 36 year old HIV positive middle class black Zimbabwean woman, Maidei Chivi (pseudonym). Maidei is well educated, financially secure and wields enormous power both within her family and at her workplace. She therefore, unlike many women, does not fall into the typical HIV victim category, characterised by poverty, coerced sex and desperation. Maidei's story demonstrates that economic security does not necessarily result in women taking decision making roles during sex.

Includes bibliographical references.

Testing is widely acknowledged to be a useful and necessary secondary tool of Human Immunodeficiency Virus (HIV) prevention. It is the method by which to identify people who are living with the virus, so that their behaviour may be modified and medical condition treated in order to prevent further infection. Unfortunately, many persons in South Africa (SA) remain undiagnosed and therefore unaware of their HIV-positive status. This thesis explores why it is necessary to test for HIV in SA, where the incidence of the virus remains the highest in the world. Voluntary Counselling and Testing (VCT) or the âopt-inâ approach has been adopted as the norm or âsine qua nonâ. The efficacy of this method will be interrogated and shortcomings identified. The most notable is that few people in SA undergo an HIV test in order to learn their status. When they do, it is often late in the progression of opportunistic infections, requiring hospitalisation that increases pressure on an already over-stretched healthcare system. Reasons for the poor uptake of VCT are explained, including pervasive stigma and deficiencies in leadership of SAâs HIV and AIDS response. The expansion of testing is a proposed response to the challenge of persons remaining undiagnosed, and includes the acceleration of âopt-outâ or routine HIV testing (RHT) among SAâs high prevalence population. This model offers an HIV test routinely to persons attending government healthcare settings with an illness or for a routine check-up. Although the provider initiates the test, consent is necessary in order to proceed and there is an option to decline. While the key focus of this thesis is routine HIV testing, other approaches are explored in brief, including mandatory testing, mobile clinics and wellness screening. The thesis argues that if SA is to achieve the HIV and AIDS and STI National Strategic Plan (NSP) target of increasing the number of adults who have ever had a test to 70 percent by 2011, new approaches to testing, and especially opt-out, will need to be explored and more widely adopted. Key words: HIV/AIDS; Voluntary Counselling and Testing (VCT); Routine HIV Testing (RHT); Routinely Recommended Testing (RRT); Opt-out Testing; Provider-Initiated Testing and Counselling (PITC).