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

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Dentistry. Johannesburg, 2018. / Background: Accurate HIV diagnosis is critical and can be life-saving. A Rapid Test (RT) is considered key to HIV prevention and management. Some studies have found RT to be comparable with ELISA whilst others have reported on lower sensitivity. Aim and study design: The aim of this retrospective comparative descriptive study was to evaluate the sensitivity and specificity of the Tri-line HIV rapid test device in comparison to ELISA on patient records from Wits Oral Health Centre (WOHC) between 2014 and 2016 Method: The study population comprised records of patients older than18 months who had Tri-Line HIV RT and blood drawn for ELISA on the same day. Descriptive analysis of the data was carried out. Results: The sensitivity of Tri-line was 80% (CI: 59-93%) and specificity was 100% (CI: 83-100%). The PPV was 100% (CI: 83-100%) and NPV was 80% (CI: 65-90%). ROC area of 0.9 at 95% CI was determined. Conclusion: Due to a low sample size in this study a definitive conclusion could not be drawn. However on the basis of the results obtained, although the tri-line RT showed lower sensitivity it was shown to be a clinically useful test. / LG2018

MSc (Med), Dept of Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand / BACKGROUND: Human Immunodeficiency Virus (HIV) is a global epidemic with growing numbers of people on highly active anti‐retroviral therapy (HAART) programmes. Effectiveness of treatment needs to be monitored to ensure the uncompromised well being of patients. This is currently done using both Viral Load (VL) and CD4 cell counts for HAART initiation and follow‐up. Although VL is the best predictor of disease progression it is often too expensive for monitoring patients in resource‐limited settings. There is thus a need for a cheaper, more accessible alternative to monitor long term patient response to therapy. METHODS: This study evaluated the use of a recently described flow cytometric assay of CD38 expression (previously developed at the Johannesburg Flow Cytometry Reference Laboratory) in a cohort of HIV+ patients failing 1st line therapy, who were subsequently enrolled onto 2nd line HAART. CD38 and CD8 were “piggy ‐backed” onto the PLG/CD4 protocol and mean fluorescence intensity (MFI) of the CD8/38 expression was monitored longitudinally. Patterns of CD38 expression were compared to 1st line treatment observations to establish equivalence in the predictive power of CD38 expression of fluctuation in viral load on 2nd line treatment patients. In addition, the effect of sample age on assay accuracy was tested before implementation of the CD38 assay at a secondary testing site. RESULTS: The patterns observed in the cohort of 2nd line therapy patients mirrored patterns previously seen in 1st line therapy with 55% of patients showing a continuous decline in CD38 MFI that mimicked changes in VL. The remaining 33% of patients had non‐specific increases in CD38 MFI without concurrent increases in VL and one patient showed irregular VL and CD38 MFI (non‐responder). The CD38 assay showed acceptable accuracy and reproducibility up to 48 hours after venesection (%CV<5%). Implementation at the secondary testing site was successful with 98% similarity (%CV<5%) compared to the reference laboratory. CONCLUSION: CD38 monitoring of 2nd line therapy patients showed comparable patterns to observations in 1st line therapy patients. The assay proved stable over time and easy to implement at another PLG/CD4 testing facility. As such, the CD38 assay offers a cost‐effective, reliable real time supplementary test to long‐term VL monitoring of HIV infected patients on the national ART programme.

SAMMANFATTNING Bakgrund   I Sverige uppskattas cirka 6000 personer leva med sjukdomen HIV och cirka 500 nya fall rapporteras varje år. Viruset kan överföras och smitta personer på olika sätt. Det kan ske genom sexuella kontakter, blodöverföring eller genom mor till barn. Det kan ta flera år från smittotillfället tills dess att personen upplever symtom till följd av att immunförsvaret är nedsatt. Det finns inte någon behandling som kan bota HIV, det finns däremot läkemedel som kan bromsa förökningen av viruset. HIVpositiva riskerar att bli utstötta och diskriminerade av familj, på arbetsplatsen och i samhället.  Många håller diagnosen för sig själva och berättar för få personer. Flera symtom vid en hivinfektion kan påverka livskvaliteten negativt. Undervisning om sjukdomen krävs för att patienten ska ha möjlighet att förstärka, anpassa eller förändra sina förutsättningar. Syfte   Syftet var att beskriva hur undervisning om sjukdomen HIV kan påverka livskvaliteten för HIVpositiva personer utifrån undervisarens perspektiv. Metod   En kvalitativ forskningsmetod valdes för att besvara syftet. Till intervjuerna inkluderades personer som arbetar med att undervisa personer som lever med sjukdomen HIV. En semistrukturerad intervjuguide utformades med övergripande ämnesområden. Sju intervjuer genomfördes. Resultat   Samtliga informanter upplevde att HIV-positivas delaktighet vid undervisningen krävdes för att informationen skulle nå fram till de HIV-positiva personerna. Informanterna hade olika tillvägagångssätt att undervisa om sjukdomen, gemensamt var att lära hivpositiva att leva med HIV. Informanterna upplevde att med en ökad kunskap om sjukdomen fick personerna en bättre självkänsla och kunde på det viset acceptera sin situation som hivpositiv. Undervisningstillfällena gav möjlighet att träffa andra personer som var hivpositiva och en samhörighet uppstod personerna emellan. Det gav tillfälle att få berätta om sjukdomen och dela med sig av sina upplevelser. Slutsats   Resultatet visade att undervisarnas upplevelse var att undervisning om sjukdomen HIV påverkade hivpositivas livskvalitet positivt. Undervisningen kunde ge bättre självkänsla, strategier att hantera och acceptera sjukdomen, bidra till att inte bli påverkad av fördomar, minska oro och ångest samt bidra till en känsla av samhörighet. Samtliga informanter betonade att mer information skulle behövas till allmänheten för att HIV skulle bli en sjukdom som blev lättare att leva med.   Nyckelord: HIV-positiva, Livskvalité, undervisning, Samhörighet, HIV.

Humant immunbristvirus (HIV) är ett globalt folkhälsoproblem som kan utvecklas till sjukdomen Acquired Immune Deficiency Syndrome (AIDS) vid obehandlad infektion. Antiretrovirala läkemedel (ART) gör det möjligt för personer med HIV att leva ett långt och friskt liv trots sin diagnos. Det medför ett behov av regelbunden kontakt med sjuksköterskor där förhållningssättet och upplevelser kan spela roll i hur omvårdnaden utformas. Sjuksköterskor ska arbeta utifrån ett holistiskt synsätt och respektera mänskliga rättigheter, behandla alla jämlikt, visa lyhördhet samt medkänsla. Syfte: Syftet var att belysa sjuksköterskors upplevelser i samband med omvårdnaden av patienter med HIV. Metod: En allmän litteraturstudie gjordes med induktiv ansats där åtta kvalitativa och en kvantitativ artikel valdes. Data bearbetades utifrån en innehållsanalys. Resultat: Resultatet visade att sjuksköterskorna hade både positiva och negativa upplevelser av omvårdnaden av patienter med HIV. Upplevelserna sjuksköterskorna hade var rädsla, stress, självstigmatisering och diskriminering samt arbetsglädje. Kunskap och stöd upplevdes ha betydelse i samband med omvårdnaden av patienter med HIV. Slutsats/konklusion: Sjuksköterskorna hade negativa upplevelser i början av arbetet vilket kunde påverka relationen mellan sjuksköterskor och patienter. Sjuksköterskornas kunskap om HIV samt deras upplevda emotionella, praktiska och organisatoriska stöd bidrog till arbetsglädje vilket i sin tur var viktigt för kvalitén på omvårdnaden. / Human immunodeficiency virus (HIV) is a global public health problem that can develop into the disease Acquired Immune Deficiency Syndrome (AIDS) in case of untreated infection. Antiretroviral therapy (ART) makes it possible for people with HIV to live a long and healthy life despite their diagnosis. This entails a need for regular contact with the nurses, where their approach and experiences can play a role in how the care is formed. The nurses shall work from a holistic approach and respect human rights, treat everyone equally, show responsiveness and compassion. Aim: The aim was to illustrate the nurse's experiences in connection with the care of patients with HIV. Method: A general literature study was done with an inductive approach where eight qualitative and one quantitative article were selected. The data was then processed based on a content analysis. Results: The results showed that the nurses had both positive and negative experiences of caring for patients with HIV. The experiences that the nurses had were fear, stress, self-stigmatization and discrimination and job satisfaction. Knowledge and support perceived to be of meaning in the care for patients with HIV. Conclusion: The nurses had negative experiences at the beginning of the work which could affect the relation between nurses and patients. The nurses ́ knowledge of HIV and their perceived emotional, practical and organizational support contributed to job satisfaction, which in turn was important for the quality of the care.

Background: Since Human immunodeficiency virus (HIV) was first identified, it has been associated with stigmatization in society. Receiving an HIV diagnosis has been perceived as challenging for both the individual and their relatives. Therefore, support from healthcare professionals is essential to promote health and alleviate suffering. Nurses are currently the largest professional group that encounters people living with HIV, as they work closest to the patient.  Aim: To highlight how people living with HIV experience the treatment by healthcare professionals in the healthcare system. Method: A qualitative literature review where 11 articles were included and analyzed using a manifest thematic analysis approach by Braun and Clarke (2006). Results: Two themes and four sub-themes were identified. The first theme was Stigma and discrimination against patients, with sub-themes being Patients' experiences of healthcare professionals' negative attitudes and the Staff's reluctance to care for patients. The second identified theme was Patients' experiences of healthcare professionals' incompetence and competence, with sub-themes being Inadequate knowledge and information provided to patients and Positive experiences of healthcare professionals' treatment. Conclusions: People living with HIV are subjected to violations and stigmatization within healthcare related to healthcare professionals' lack of knowledge. Further research is needed on how healthcare professionals' education can improve healthcare and how patients experience nurses' treatment within healthcare.

Background: Breastfeeding amongst HIV-infected and HIV-exposed mother-infant dyads is a wide-ranging and persistent field in which more investigation is needed. The literature widely recognizes the multifactorial and syndemic nature of HIV and infant feeding, specifically pertaining to maternal and other breastfeeding-associated risks. Findings differed regarding breastfeeding and general developmental outcomes amongst HIV-exposed and HIV-infected infants when compared with HIV-unexposed infants. Evidence, however, suggests slight neurodevelopmental differences in HIV-exposed infants when compared with HIV-unexposed infants, suggesting possible feeding differences. Recent literature also indicated a lack of knowledge among allied health care staff regarding evidence-based counselling content to be provided to mothers concerning single option feeding, breastfeeding outcomes and risks in HIV-affected mother-infant dyads in South Africa. Owing to these varied findings related to HIV-affected mother-infant dyads, synthesising of knowledge regarding HIV, infant breastfeeding outcomes and associated risk factors is warranted. Objective: To critically appraise recent literature regarding breastfeeding outcomes and associated risks in HIV-infected and HIV-exposed infants using the PRISMA-P statement guidelines. Method: Five electronic databases were systematically searched to obtain English publications from the last ten years pertaining to breastfeeding outcomes and associated risks of HIV-infected and HIV-exposed infants and children. Grey literature sources were also included. Data were extracted according to various data items and were synthesised using thematic synthesis. Results: Of the initial 7151 sources identified, 42 articles were deemed eligible for final inclusion. The final selection included 19 cohort studies and two expert committee reports, classified as grey literature. The remaining 21 studies compromised of case-control, cross-sectional, and randomized controlled trial studies. The following themes were identified from the review objectives: breastfeeding outcomes, breastfeeding risk factors, infant growth and developmental outcomes and barriers and facilitators to feeding decisions. Most studies focused on HIV-exposed infants’ growth and developmental outcomes. Exclusive breastfeeding was confirmed to have the best outcomes for all infants, regardless of their HIV status, which in turn supports national and international policies. The most prevalent factors that made it difficult for mothers to breastfeeding were maternal factors affecting decision-making for breastfeeding, followed by biological risk factors. Conclusion: Knowledge regarding breastfeeding outcomes in HIV-exposed and HIV-infected infants remains lacking and further research is necessary. This review emphasised that the majority of HIV-affected mother-infant dyads reside in sub-Saharan Africa, illustrating that health professionals, especially those in sub-Saharan Africa (SSA), have to look beyond their traditional assessment and management focuses to include the factors that can impact successful exclusive breastfeeding. Addressing both infants’ needs and maternal HIV-related needs and risks on macro, meso, and microsystem levels is necessary. / Dissertation (MA (Speech-Language Pathology))--University of Pretoria, 2021. / Speech-Language Pathology and Audiology / MA (Speech-Language Pathology) / Unrestricted

HIV-related disclosure concerns are associated with higher rates of concealment and poorer well-being, including poorer health related HIV quality of life (HIV-QOL). Little research, however, has examined whether gender differences exist in the links between HIV disclosure concerns and HIV-QOL. We expected that disclosure concerns and gender would be associated with HIV-QOL, such that the relationship between disclosure concerns and poorer HIV-QOL to be stronger in women living with HIV (WLWH) than in men living with HIV (MLWH). One hundred and forty MLWH (n = 102) and WLWH (n = 38) completed an online questionnaire consisting of measures regarding their demographics, disclosure concerns (HIV-stigma scale), and HIV-QOL (HIV-AIDS-Targeted Quality of Life Instrument). Results suggested that more disclosure concerns were associated with poorer HIV-QOL, but in general, men and women did not differ in their levels of HIV-QOL. As expected, interactions emerged between gender and disclosure concerns such that disclosure concerns were associated with increased health worries and poorer sexual functioning for WLWH but not for MLWH. Interventions should acknowledge the differing needs and experiences of WLWH in order to improve HIV-QOL and increase longevity.

We examined the links between HIV-stigma, loneliness and sleep quality in 181 people living with HIV (PLWH) who completed an online self-report questionnaire. Results suggested that the indirect effect of stigma on poorer sleep through increased loneliness was significant. Researchers will address implications for research on stigma and health.

We hypothesized that higher levels of self-compassion among people living with HIV (PLWH) would be related to lower levels of loneliness, which in turn would be associated with better psychological well-being (lower levels of depression and negative affect and higher positive affect). 106 PLWH completed an online survey that measured demographic variables, self-compassion, loneliness, and psychological well-being. Mediation analyses revealed that loneliness mediated the relationship between self-compassion and depression and negative affect, but not positive affect. These findings indicate that encouraging self-compassion may have a positive effect on psychological well-being among people living with HIV by reducing loneliness.