The overall aim of this project was to investigate HIV-1 genetic diversity in South Afri ca and to characterise the immune response in mice to a South African subtype C gp120. To investigate the relationship between subtype and mode of transmission, samples were collected from individuals infected by heterosexual and male homosexual transmission from patients attending local HIV/AIDS clinics in Cape Town (n=49) and Bloemfontein (n=4). Isolates were subtyped using heteroduplex mobility assay (HMA) based on the V3-V5 region of the env geneusing reference plasmids (2 B, 2 C and 1 D) representative of local subtypes. HMA identified four env subtypes: A, B, C and D. Subtype B viruses were found in 92.9% (26/28) of the male homosexual/bisexual group and subtype C viruses in 77.2% (17 /22) of the heterosexual group. Subtype B viruses were also identified in two heterosexual patients, one patient infected by blood transfusion and in two patients with. unknown mode of transmission. Subtype D viruses were found in one male homosexual patient and one heterosexual patient and a husband and wife couple were infected with subtype A viruses. A significant association between subtype and mode of transmission (p=<0.0001) was identified, confirming two independent epidemics. To determine the subtype distribution of HIV within urban heterosexual populations throughout South Africa, samples were collected from women attending antenatal clinics in Johannesburg (n=34), Pretoria (n=S) and Durban (n=20). Samples from Bloemfontein (n=24) were taken from individuals attending an HIV/AIDS clinic. All eighty-three samples were subtyped by HMA in the env region as before. The predominant subtype circulating within the urban heterosexual population throughout South Africa was identified as subtype C (92.8%) although subtype B was also detected (7.2%). It may thus be beneficial if a HIV vaccine for South Africa is based on a subtype C model. In addition, a rapid method for identification of HIV-1 gag subtypes was developed based on restriction fragment length polymorphism (RFLP) analysis of 400bp (p17) or 650bp (p17 and 5' p24) long PCR fragments. This strategy was appl i ed to eighty-six samples (Cape Town n=47, Johannesburg n=20, Bloemfontein n=17 and Durban n=2) previously subtyped by either sequence analysis of the gag p17 region (n=31), heteroduplex mobility assay (HMA) based on the env gene (n=76), or both (n=21). RFLP analysis identified two subtype A, twenty-five subtype B, fifty-eight subtype C and one subtype D isolates. There were no discrepancies between RFLP and sequence gag subtypes, demonstrating the reliability of this method and no discordance between gag RFLP subtypes and env HMA subtypes, indicating no recombinant viruses in the genomic regions analysed.

A thesis submitted to the Faculty of Science, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy. Johannesburg, 2013 / Pain is one of the most frequent and debilitating symptoms in human immunodeficiency virus (HIV) infected individuals. With Southern Africa being the region with the highest population of HIV-infected individuals, I set out to determine whether the pain intensity, prevalence and management strategies that have been reported in other, non-African, countries are similar to that in South African patients. South Africa has eleven official languages, with nine of those being native languages. Also, there is a high level of illiterate people in the country, thus, for better assessment of the pain I translated the Wisconsin Brief Pain Questionnaire into five frequently spoken local languages. Using the translated questionnaires I investigated the prevalence, intensity and management of pain in ambulatory HIV-positive outpatients attending a metropolitan (n = 396) or rural (n = 125) clinic. I also assessed whether this pain changes over time in a subset of 92 metropolitan patients. Seventy-two percent of rural participants and 56% of metropolitan participants had pain at the time of the interview, and this pain was moderate to severe in intensity in 60% of affected rural participants and 59% of affected metropolitan participants. In the rural cohort, use of antiretroviral therapy was independently associated with the reduced risk of pain [prevalence ratio (95% CI): 0.7 (0.5-0.9)] while in the metropolitan cohort increasing age was weakly, but independently associated with having pain [prevalence ratio (95% CI): 1.01 (1.005-1.012)]. Pharmacological management of pain was poor, with 29% of rural participants and 55% of metropolitan participants with pain not receiving any treatment. Of those receiving treatment, no participants were receiving strong opioids, and only 3% of metropolitan participants were receiving a weak opioid. On a positive side, the pain that South African HIV-infected individuals endure decreases over time. Seventy-eight patients out of the subsample cohort consisting of 92 patients reported pain at the time of the first interview. Of the 78 patients who were in pain at visit 1, 48 were still in pain six months later with 36 of those not prescribed any form of analgesics. Thus I found a decrease in moderate and severe intensity pain to mild and moderate pain, respectively, from visit 1 to visit 2. Of the 78 patients that were in pain at visit 1, only 5% received some form of analgesic therapy. Forty-eight of the 78 patients were still in pain six months later, and of those, 25% were being prescribed some form of analgesics at visit 2. There were no changes in the pain-related interference over a six month period in patients who were in pain at visit 1 and visit 2. Therefore, as it has been reported previously for other developed and developing countries, pain in HIV-positive South Africans is common and is under-treated. Also, there are decreases in the pain intensity, pain prevalence, the number of pain sites over a period of six months. These decreases were evident in patients who were on HAART for the duration of six months as compared to those who were not on HAART for six month.

Introduktion: Idag lever 38 miljoner människor med HIV. HIV är ett retrovirus som utmärker sig genom att det lagras i kroppens arvsmassa, vilket gör att infektionen inte kan läka ut utan blir kronisk. Idag finns tillgång till effektiv behandling som gör nivåerna av viruset så låga att personerna inte utgör någon risk att smitta. Trots detta finns det en tydlig stigmatisering i samhället som HIV-positiva personer upplever. Det finns även beskrivet att vårdpersonal har bristande kunskap med oro kring HIV.   Syfte: Syftet var att undersöka hur HIV-positiva personer upplever bemötandet från hälso- och sjukvårdspersonal. Metod: För att genomföra arbetet gjordes en allmän litteraturöversikt där 12 studier av kvalitativ design inkluderades. Studierna kvalitetsgranskades och innehållet analyserades med skapandet av kategorier och teman.  Huvudresultat: Resultatet visade på upplevelsen av både positivt och negativt bemötande. Det negativa bemötandet beskrevs mer, och specialistvården upplevdes ha bättre bemötande. Tre teman identifierades. Temat känslor som beskriver upplevelsen av skuld hos HIV-positiva, samt rädsla som upplevs finnas hos hälso- och sjukvårdspersonal. Temat agerande beskriver HIV-positivas upplevelser av agerande från vårdpersonal, vilka var bristande konfidentialitet, påverkad tillgång till vård och irrelevanta frågor. Det sista temat kompetens handlar om upplevd kunskap och tillgång till information. Slutsats: Deltagarna upplevde att bemötandet hade förbättrats över tid men att stigmatisering och diskriminering fortfarande fanns inom sjukvården. Specialistvården ansågs ha ett bättre bemötande än den övriga sjukvården. Kunskapen om HIV behöver förbättras inom hälso- och sjukvården för att HIV-positiva personer i mindre grad ska uppleva stigmatisering och diskriminering. / Introduction: Today, 38 million people live with HIV. HIV is a retrovirus that is stored in the genome which means that the infection becomes chronic. There is access to effective treatment that makes levels of the virus so low that people are not at risk of infecting others. However, there is a clear stigma in society that HIV-positive people experience. It is also described that healthcare professionals have concerns and a lack of knowledge about HIV. The aim: The aim of this study was to investigate how HIV-positive people experience the treatment from health care professionals. Method: A general literature review was conducted. This included 12 scientific studies of qualitative design, which quality were reviewed and the content analyzed and divided in categories and themes. Results: Both positive and negative experiences were expressed. The negative treatment was described more, and the specialist care was perceived to have better treatment. Three themes were identified. The theme “emotions” describes experiences of guilt in HIV-positive people and fear among healthcare professionals. The theme “action” describes the experiences of actions from healthcare professionals, as lack of confidentiality, the influence on access to care and irrelevant questions. The last theme “competence” describes perceived knowledge and information, often perceived as lacking. Conclusion: The treatment was expressed to be better now than before, but stigma and discrimination still exist. The specialist care was considered to have a better treatment than other types of care. Knowledge about HIV needs to improve for people to not experience such discrimination and stigmatization.

Bestimmung der Prävalenz medikamentenresistenter HIV-Infektionen bei therapienaiven Patienten in der Viktoriasee-Region in Tansania Seitdem HIV im Jahr 1983 als Ursache des „acquired immundeficiency syndrome“ (AIDS) isoliert wurde, hat sich viel in der Therapie dieser Infektion getan. Trotzdem handelt es sich um eine Erkrankung, welche bisher nicht geheilt werden kann. Da der weitaus größere Anteil der betroffenen Menschen in strukturschwachen Ländern lebt, ist die größte Herausforderung, eine flächendeckende Therapie weltweit zu etablieren und diese für jeden zugänglich zu machen. Aufgrund der hohen Mutationsrate des HI-Virus, kommt es zur schnellen Resistenzentwicklung. In strukturschwachen Ländern wie Tansania ist eine Resistenztestung vor Therapiebeginn aktuell aufgrund fehlender Infrastruktur sowie geringer finanzieller Mittel nicht denkbar. Deshalb wird nach WHO-Empfehlung eine standardisierte Dreifachkombination, in der Regel Tenofovir, Lamivudin und Efavirenz, angewendet, ohne vorher eine Resistenztestung vorzunehmen. In regelmäßigen Nachuntersuchungen wird anhand von Viruslast und CD4-Zahl der Erfolg der begonnenen Therapie gemessen und nur bei einem Versagen dieser eine Umstellung vorgenommen. Bereits im Jahr 2011 wurde von unserer Arbeitsgruppe (Kasang, Kalluvya et al.) nachgewiesen, dass eine deutlich höhere Prävalenz für Primärresistenzen von HI-Viren gegenüber antiretroviraler Therapie bestand, als zuvor angenommen. Betrachtet wurden dabei alle Patienten, welche neu als HIV-positiv getestet wurden und nun therapiert werden sollten. Neu war, dass auch ältere Patienten (>25 Jahre) mit einbezogen wurden. Aufgrund der hohen Prävalenz an Primärresistenzen (19%) nahm man an, dass durch antiretrovirale Therapie entstandene resistente Viren zwischen Partnern direkt übertragen werden können. In der vorliegenden Arbeit sollte durch die Untersuchung einer größeren Patientengruppe dieser These nachgegangen werden. Untersucht wurde das Plasma von 114 Patienten (> 25 Jahre), welche unmittelbar vor dem Start einer antiretroviralen Therapie standen und bisher therapienaiv waren. Zur Bestimmung von möglicherweise vorliegenden Resistenzen erfolgte im S3-Labor zunächst die Isolierung der Virus-RNA aus dem Plasma. Diese wurde anschließend in DNA umschrieben, amplifiziert, aufgereinigt und sequenziert. Die Sequenzen wurden online durch die „HIV DRUG RESISTANCE DATABASE“ der Stanford University im Hinblick auf den Subtyp der reversen Transkriptase (RT), der Protease sowie auf Resistenzen gegenüber den gängigen aniretroviralen Medikamenten analysiert mit folgenden Ergebnissen: 1. Die Prävalenz für eine Primärresistenz gegenüber antiretroviralen Medikamenten betrug 21,5 % 2. Die Medikamente der Triple-Therapie waren in der untersuchten Gruppe mit einer Prävalenz von 10,53 % betroffen. 3. Diese Ergebnisse sind besorgniserregend und bestätigen die von Kasang, Kalluvya et al. aufgestellte These Für den weitaus größeren Teil der untersuchten Patienten wäre jedoch die Triple-Therapie ohne kostspielige und aufwendige Resistenztestung ausreichend gewesen. Vorderstes Ziel bleibt somit die finanziellen Ressourcen weiterhin Zugänglichkeit der medikamentösen Behandlung zu nutzen, da dies die beste Methode ist, die Ausbreitung dieser Pandemie einzudämmen. Dennoch werden in den nächsten Jahren weiterhin Untersuchungen mit noch größeren Patientenzahlen nötig sein, um die Wirksamkeit des aktuellen Therapieregimes ständig zu überprüfen und gegebenenfalls eine Anpassung vorzunehmen. / Determining the prevalence of drug-resistant HIV infections in treatment-naive patients in the Lake Victoria region of Tanzania Since HIV was identified as the cause of AIDS, there has been significant progress on the therapy of this disease although there is no cure. Most frequently those affected live in economically underdeveloped countries. Against this backdrop, the challenge is to establish a comprehensive therapy worldwide and make it available for everyone. Due to the high mutation rate of the HI virus, resistance develops quickly. In structurally weak countries such as Tanzania, resistance testing before the start of therapy is currently inconceivable due to the lack of infrastructure and low financial resources. Therefore, according to WHO recommendations, a standardised triple combination, usually tenofovir, lamivudine and efavirenz, is used without prior resistance testing. In regular follow-up examinations, the success of the therapy started is measured on the basis of viral load and CD4 count, and a change is only made if this fails. As early as 2011, our research group (Kasang, Kalluvya et al.) demonstrated that there was a significantly higher prevalence of primary resistance of HI viruses to antiretroviral therapy than previously assumed. All patients who were newly tested as HIV-positive, and were now to be treated, were considered. What was new was that older patients (>25 years) were also included. Due to the high prevalence of primary resistance (19%), it was assumed that resistant viruses resulting from antiretroviral therapy can be transmitted directly between partners. In the present study, this hypothesis was investigated by examining a larger group of patients. The plasma of 114 patients (> 25 years) who were about to start antiretroviral therapy and who had been therapy-naive so far was examined. To determine the possible presence of resistance, the virus RNA was first isolated from the plasma in the S3 laboratory. This was then transcribed into DNA, amplified, purified and sequenced. The sequences were analysed online by the "HIV DRUG RESISTANCE DATABASE" of Stanford University with regard to the subtype of the reverse transcriptase (RT), the protease and resistance to the common antiretroviral drugs with the following results: 1. The prevalence for primary resistance to antiretroviral drugs was 21.5 %. 2. Triple therapy drugs were affected with a prevalence of 10.53% in the group studied. 3. These results are worrying and confirm the thesis put forward by Kasang, Kalluvya et al. However, for the vast majority of patients studied, triple therapy would have been sufficient without costly and time-consuming resistance testing. The primary goal therefore remains to continue to use the financial resources for accessibility of drug treatment, as this is the best method to contain the spread of this pandemic. Nevertheless, further studies with even larger numbers of patients will be necessary in the coming years in order to constantly monitor the effectiveness of the current treatment regime and make adjustments if necessary.

This study examined associations between the prevalence of HIV testing and factors or behaviors that influence HIV testing in U.S.A. 9th to 12th graders using the 2017 Youth Risk Behavior Surveillance Survey (YRBSS) data. Selection criteria was based on a positive report of sexual debut (Ever had sex? Yes/No). Outcome of interest was having ever tested for HIV. Independent risk factors included age, sex, grade, race, condom use, age at first sexual intercourse, number of lifetime sexual partners, use of contraceptives, use of drug or alcohol before last sexual activity and several other factors. Chi-square and logistic regression analyses were conducted to evaluate factors associated with HIV screening participation. HIV testing prevalence was 20.34%. Females (53.97%) were more likely to participate in HIV screening test than males (67.37% females versus 32.63% males) and had higher odds of testing (OR: 2.229; p <.0001). Those in 11th and 12th grade, aged greater than 16 and with multiple sexual partners had higher rates of HIV testing. Strongest associations with HIV testing were older age at 1st sexual intercourse, odds ratio (OR): 0.413; (p ≤.0001), having three or more sexual partners (OR: 2.023; p ≤.0001), being female (OR: 2.021; p ≤.0001), use of contraceptives (OR: 1.828; p ≤.0001) and describing grades in school as mostly A’s or B’s (OR: 0.696; p ≤.001).

Introduction: Diffuse large B-cell lymphoma, not otherwise specified (DLBCL NOS) is subdivided according to the cell-of-origin (COO) classification into germinal centre B-cell (GCB) and activated B-cell (ABC) subtypes, each with different molecular profiles and clinical behaviour. This study aims to describe the pattern of the COO subtypes, the proportion of Epstein-Barr virus (EBV) co-infection, and their influence on survival outcomes in a setting of high HIV prevalence. Materials and Methods: This retrospective cohort study included patients diagnosed with de novo DLBCL NOS at our tertiary academic centre in Cape Town, South Africa over a 14-year period. Immunohistochemical stains were performed for COO classification, according to the Hans algorithm. Tumour EBV co-infection was established by EBV-encoded ribonucleic acid in situ hybridisation (EBER-ISH) staining. The effect of the COO subtypes and EBV co-infection on overall survival were described by means of univariate, bivariate and multivariate analyses. Results: A total of 181 patients with DLBCL NOS were included, which comprised 131 HIV-uninfected and 50 HIV-infected patients. There was an equal distribution of GCB and ABC subtypes in the HIV-infected and HIV-uninfected groups. EBV co-infection was detected in 16% of the HIV-infected cases and in 7% of the HIV-uninfected cases (p=0.09). There was no significant difference in the incidence of EBV co-infection between the GCB and ABC subtypes (p=0.67). HIV-infected patients with CD4≥150 cells/mm3 had similar survival to HIV-uninfected patients (p=0.005). Multivariate regression analysis showed that in the HIVinfected group with marked immunosuppression (CD4 <150 cells/mm3), there was significantly poorer overall survival compared to the HIV-uninfected group (HR 2.4, 95% CI 1.3–4.1). There were no statistically significant differences in overall survival by DLBCL COO subtype. Conclusions: There was no difference in the proportion of DLBCL COO subtypes, regardless of HIV status. EBV co-infection was more common in the HIV-infected group, but less than described in the literature. Unexpectedly, there were no significant differences in survival outcomes between the GCB and ABC subtypes. Higher CD4 counts in the HIV-infected group had good survival outcomes, while lower CD4 counts predicted adverse survival outcomes. Further research is needed to explore the genetic mutational landscape of HIVassociated DLBCL.

Human Immunodeficiency Virus 1 (HIV-1) is a lentivirus that forms persistent latently infected reservoirs that are the remaining major hurdle for current HIV-1 treatments. APOBEC3 (A3) proteins are intrinsic retroviral restriction factors that introduce GA mutations during reverse transcription, while Reverse Transcriptase (RT) introduces on average 2-3 mutations every reverse transcription cycle due to a lack of proofreading ability. The goal of this research is to characterize the infectivity and activation of mutated HIV-1 viruses that display reduced transcription upon infection, viruses that we term latency prone viruses (LPVs). We hypothesize that GA transition mutations in the HIV-1 Long Terminal Repeat (LTR) region of the LPVs introduced through Reverse Transcriptase and low levels of A3 protein activity can create HIV-1 sequences that display a reversible, latency-like phenotype. Variable levels of transcription and promoter activation were seen among the LPVs when tested against four classes of Latency Reversing Agents (LRAs). Subsequently, three tested LPVs demonstrated an initial latency-like phenotype before rebounding in infectivity. This project demonstrates for the first time that HIV-1 latency is not simply a byproduct of the infection timing and cellular conditions, but that replication-competent HIV-1 latent viruses can also be created through sublethal mutagenesis of their viral promoter sequence introduced through A3 and RT exposure. The characterization of the complete mechanism of HIV-1 latency induction, maintenance, and reversal is critical in the development of sterilizing and functional cures for HIV-1 infection.

Includes bibliographical references / Introduction: Tuberculosis (TB) notification in South Africa has increased six fold over the last two decades mainly because of the Human Immunodeficiency Virus (HIV) epidemic. Globally, it was estimated that 73% of the TB cases were co-infected with HIV with more than 25% of this global co-infection burden being in South Africa alone. In 2012, globally 1.3 million deaths occurred due to TB; moreover 0.3 million were HIV-associated TB death. In 2010 TB was the leading cause of natural deaths in the population aged 15 to 24 years accounting for 14% of the total deaths in South Africa. In 2013 the proportion of patients with TB who were co-infected with HIV was extremely high at 62%.The outcome of co-infected patients was poorer than the outcome of HIV negative TB patients. However, there is little information available on the risk factors associated with TB treatment outcomes and the influence of co-infection. Method: A cross sectional study analysed Electronic TB Register (ETR.net) data from the Metro East Geographic Service Area (GSA) of the Cape Town Metro district. The dataset included adult patients aged 15 years or more, who initiated TB treatment between 1st July 2011 and 30th June 2012. In the descriptive analysis we analysed death separately but for the regression we merged death with unfavourable treatment outcome. Relative risks were used for measures of association. Univariate and multivariate analyses were performed using a generalized linear regression model. Statistically significant variables in the univariate analysis were included in the multivariate analysis. Findings: TB case notification in Eastern GSA was 922 per 100 000 population. Of the 12672 TB patients registered, 50% were co-infected with HIV. The incidence of death in co-infected was 5% versus 3% in uninfected, treatment success 67% versus 73% and unfavourable treatment outcome 28% versus 24%. The Khayelitsha sub-district had the highest proportion of the TB burden (37%) and of co-infection (65%). Fourteen percent of patients had extra-pulmonary TB (EPTB), 66% of whom were co-infected with HIV. In the multivariate analysis HIV (RR 1.2), retreatment (RR 1.4) and sputum smear microscopy not done (RR 1.4) were significantly associated with unfavourable treatment outcome. The sub districts Eastern (RR 0.9) and Northern (RR 0.7) were less likely to develop unfavourable outcome compared to Khayelitsha. In the stratified analysis, retreatment (RR 1.3) and smear not done (RR 1.3) were significant risk factors for an unfavourable treatment outcome in co-infected patients. Amongst HIV negative patients retreatment (RR 1.6) and smear not done (RR 1.6) were significant risk factors for an unfavourable treatment outcome. Conclusions: The incidence of TB is extremely high in the Eastern GSA of Cape Town however the prevalence of co-infection varies across the sub-districts. Although treatment outcomes have been improving, co-infection, retreatment and smear microscopy not done pre-treatment were factors significantly associated with an unfavourable treatment outcome. Eastern and Northern sub-districts were significantly more likely to have favourable treatment outcomes compared to Khayelitsha, where both TB incidence and HIV co-infection were greatest.

Submitted in Partial fulfillment of the Requirements for the Masters Degree in Social Work at the University of Zululand, 2010. / KwaZulu-Natal is at the heart of Aids pandemic, with HIV prevalence figures consistently higher than other provinces.The basic purpose of this research is to assess the impact of Thandukuphila HIV/AIDS Community Based - Care Centre on the lives of HIV/AIDS infected and affected people (beneficiaries), which is situated in a rural township established on the precincts of a vast tribal area in the northern part of Kwazulu-Natal province. This HIV/AIDS Community Based - Centre was initiated as a response by some community members, initially it was church based, the church was challenged by the difficult health problems and social situations experienced by some of their community people, who were being devastated by the disease, HIV/AIDS, both inside the township and the neighboring rural area. In–depth interviews were utilized to seek more information from these knowledgeable individuals regarding their own and other peoples’ experiences, who are beneficiaries of Thandukuphila and, also those involved in many other ways. A purposive sample of nine participants’ from Thandukuphila CBO, which is situated at Enseleni was purposefully selected for the study. All participants were beneficiaries of Thandukuphila Community based care centre. These individuals were identified for their potential to elicit valuable information since they are beneficiaries of the programme. The individuals were also identified according to the criteria for inclusion. There were four groups of participants: i) PLWA, ii) OVC, iii) Caregivers/Volunteers, iv) Committee members. The review of literature gives some detailed analytical views on the prevalence of the pandemic HIV/AIDs in Kwa-Zulu Natal. The aspect of community –home based care is discussed, for the role it is playing as well as the contribution it is making, albeit, in a limited manner because of resources, expertise and support from formal authority structures. The narrative discussion intertwines quotations with the author’s interpretations. Also in data analysis the researchers “seek to identify and describe patterns and themes from the perspective of the participants” Creswell (1994:167). Throughout the study report the research hints at limitations the organization has to contend with and these are briefly indicated in a nutshell towards the end. The set objectives for the study were achieved. The findings indicated that Thandukuphila Community Based -Care Centre has a positive and significant impact on the lives of HIV/AIDS infected and affected people, who are beneficiaries of the program. However, it is the researcher’s informed opinion that responsible Government Departments need to put more effort on assisting since they have professional personnel, in monitoring and evaluating the standard of services rendered by these Community Based Care Centres.

Submitted in partial completion for the degree of PHD in Community Psychology in the University of Zululand, 2006. / HIV/AIDS is the current century's challenge that stares humanity in the eye. The socio-political, economic, spiritual and philosophical dimensions of our society have to face up to this challenge. This brings one to the conclusion that HIV/AIDS is a national disaster and should be dealt with as such. In other words, interventions geared towards combating this epidemic should address all the spheres mentioned above. The main purpose of this study then was to investigate the role of indigenous healers in combating HIV and AIDS. The rationale for looking at the role of indigenous healers was to ensure that their role is highlighted for a joint effort that is necessary for the advocacy, awareness, education, care and medical intervention which is necessary to combat the HIV/AIDS crisis. This challenge goes as far as involving non-medical professionals and stakeholders in the fight against HIV/AIDS. Focus group interviews and individual interviews were conducted with indigenous healers in the Gauteng and North West provinces. The results were analysed thematically. The results are presented in relation to the questions which were posed. The results reflected that traditional healers have demonstrated that they can make a very important contribution to the treatment of HIV/AIDS. However, they feel that they are not receiving a fair opportunity to demonstrate their knowledge and expertise in treating HIV and AIDS. They also lack support from the public, from government policy, and from the modem medical fraternity. There have been efforts by the Minister of Health to incorporate traditional healing and traditional medicine as part of a holistic approach to the treatment and containment of HIV. This strengthens holistic health care ensuring the advocacy, awareness, education, care and medical intervention which is necessary to combat the HIV/AIDS crisis. Traditional healers need support and recognition from the public, the government and the modem medical fraternity. It was also evident from the results that the indigenous healers were very willing to co-operate with biomedical practitioners as shown in the statement below. Traditional healers reported that they did not routinely test their patients for HIV as they had no means of doing that. They were legally required to send their patients for testing through modem medical procedures. Most healers also said that they preferred their patients to be checked using modem medicine, and thereafter they would treat them accordingly. This is because they currently relied only on their ancestors to show them when the patient was positive. What is important to note is that these healers said that the disease was not presented to their bones as HIV/AIDS, but that they were only shown the known symptoms of HIV and then were able to deduce that the person was HIV positive.