archives@tulane.edu / Background: Although engagement and retention in HIV care and treatment is a critical issue across populations, it is of particular importance among female sex workers (FSWs) as they are disproportionately affected by HIV due to high rates of sexual risk behaviors and large sexual networks. Drug use is one of the most consistent and salient barriers to successful engagement in HIV care and treatment. For many FSWs, drug use is a common part of their daily lives. While individual-level factors likely explain a substantial portion of variability in drug use behavior, evidence demonstrates that differences in health behaviors and outcomes cannot be fully explained by individual-level factors alone. Previous explorations of drug-related harms have found that neighborhoods and social networks are two important environments that impact substance use behavior and associated health outcomes; yet, there has been little research on the interacting effects of networks and neighborhoods on drug use among FSWs living with HIV. Objective: Using innovative geospatial and social network methods, the purpose of this pilot study was 1) to characterize the physical and social risk environments of a small cohort of FSWs living with HIV in the Dominican Republic (DR), and 2) to examine the association between their daily activity patterns and social relationships on illicit drug use. Methods: A micro-longitudinal observational study design was employed. Data collection activities included: (1) semi-structured questionnaire, (2) daily activity space mapping, (3) daily behavior diary, (4) social network survey; and (5) secondary data. Statistical analysis included spatial mapping, social network analysis, univariate and bivariate means analysis, generalized estimating equations (GEE) with repeated measures, interaction and effect modification. Results: Findings suggest that social networks, specifically drug networks and sex and drug networks, and daily activity path and location-based risk exposures are independently associated with risk of daily drug use, and that network risk profile modifies the association between location-based risk exposure and daily drug use. Results from Paper 1 show that participants exposed to a higher number of risk outlets within 200 meters of their weekly activity paths weighted by time exposed had an increased risk of daily drug use (RRadj: 2.83, 95%CI: 1.14, 7.03). Similarly, per unit increase in risk outlet exposure within 200 meters of sex work locations was associated with an increased risk of daily drug use (RRadj: 1.03, 95%CI: 1.00, 1.05). Paper 2 results indicate that participants with more drug using members and sexual partners who were also drug users in their social networks were 8.89 (95%CI: 2.62, 30.33) and 6.08 (95 CI%: 1.20, 30.92) times more likely to use drugs compared to those with fewer drug using members and sexual partners who used drugs. Finally, paper 3 results suggest that the joint effects of networks and activity space are greater than individual effects alone and that drug network and sex and drug network modify the association between sex work location risk environment exposure and daily drug use. No differences were detected among individuals with large drug and sex and drug networks, but among individuals with small drug and sex and drug networks, per unit increase in risk outlet exposure within 200-meters of sex work locations was associated with an increased risk of daily drug use. Conclusions: This research provides significant information on the overlapping and diverging characteristics of the social factors and physical spaces that shape drug use in the broader context of sex work, HIV, and vulnerability in a low-and middle-income country (LMIC) setting. Findings may be used to inform integrated care interventions that are geographically targeted and address the social processes and structures that influence drug harms and HIV treatment in a highly stigmatized and vulnerable population. / 1 / Erica Ann Felker-Kantor

The aim of this dissertation is to contribute to the development of a strategy for church involvement in the care of vulnerable children in low income households. The extent and nature of the problems caused by HIV/AIDS is inconceivable. Of particular concern is the children affected by HIV/AIDS. There is little consensus as to whether institutionalised care can be replaced by community-based care. The church needs an informed approach for future intervention. Existing research covers the needs of children to a certain extent, but does not have conclusive answers as to how these needs should be met. There is little, if any research examining the totality of the child’s needs. This research will determine what the vulnerable child’s unmet needs are, and get a first indication of the extent to which they are being met in the low-income household. Missiology is the field within which this study is undertaken. A good understanding of mission and the link between mission and the holistic study of the needs of vulnerable children is discussed as basis for further reflection. In an attempt to determine the totality of the child’s needs, the fundamental human needs theory, developed by Manfred A. Max-Neef is used. According to Max-Neef, all human beings have 10 fundamental needs: subsistence, protection, affection, creation, idleness, understanding, participation, identity, freedom and transcendence. These needs can be satisfied by an infinite variety of satisfiers. The findings of the study include: 1. Caregivers perceive the quality of life of vulnerable children to be high, but fieldworkers’ perceive it to be poor; 2. Denial of the vulnerability of children is associated with the denial of the existence of HIV/AIDS in the community; 3. There is a lack of knowledge of the importance of early childhood, accompanied by a lack of parenting skills for optimal early childhood development; 4. Children are not provided with opportunity and skills to manage grief; 5. The protection of children against abuse and crime is questionable, and 6. The needs of the children in the safe-house do not seem to be satisfied more or less holistically than those who live in families, or vice versa. The church can play a pivotal role in addressing the needs of vulnerable children. Apart from providing care herself, the role of the church is to be a catalyst of holistic care: 1. The first task of the church is to develop a thorough and holistic understanding of the total context, such as the fundamental needs of vulnerable children and the roles of different care-givers; 2. The second task is to promote understanding of the nature of vulnerable children’s needs amongst all role-players, and 3. The third task is to facilitate the best possible use of existing resources to satisfy the prevailing fundamental needs. The most important interventions recommended are: 1. Development of skills and knowledge for early childhood development. 2. Development of knowledge and skills in age-appropriate grief management, and 3. Further study to develop integrated community-based, institutional care. / Dissertation (MA (Theology))--University of Pretoria, 2006. / Science of Religion and Missiology / MA / unrestricted

Despite the advances in antiretroviral therapy (ART) a disproportionate number of people living with HIV (PLWH) remain limited in their access and use of health care and treatment, including racial/ethnic minorities, persons with mental health and substance use disorders and persons experiencing homelessness or unstable housing. Patient navigation programs have emerged as a potential effective and efficient use of resources to reach and engage these vulnerable populations as part of the HIV service delivery system. This dissertation contains three chapters that aim to identify and assess the performance and mechanisms for navigation programs working with PLWH who experience homelessness and co-occurring substance use and mental health disorders. Study 1, Developing a Reliable and Valid Composite Measure of Effectiveness for HIV Navigation Programs for PLWH who are homeless/unstably housed, describes the development of a multidimensional outcome measure to assess the performance of navigation programs for this population. The composite measure was comprised of seven indicator variables: linkage to care, retention in care and adherence to treatment, patient experience of care, physical and mental health related quality of life and housing stability. Using multivariate analyses, a 3 item measure of retention, adherence, and housing stability was found to have high goodness of fit and strong predictive association with viral suppression. Study 2, Classifying Components of HIV Navigation Programs for PLWH who are homeless/unstably housed, used a latent-class analysis to identify common patterns of activities, modalities of communication, location of work, and staff composition among highest utilizers of services. Results showed that types of activities, work setting and modality of contact were significantly associated with increased retention in care. No difference in activity, staffing patterns, work setting or modality of communication of navigation programs were found on viral suppression rates. Study 3, An Economic Evaluation of HIV Navigation Programs Working with PLWH who are Homeless/Unstably housed assessed costs and net benefits of these navigation programs overall and in subpopulations. Cost utility and net benefit analyses performed indicated that navigation programs for PLWH who are homeless/unstably housed are a potential efficient investment of resources at various willingness-to-pay thresholds. Navigation programs provide a myriad of services for PLWH who are homeless/unstably housed and must be flexible in their approach to address the multiple medical and psychosocial needs of this population. The results of this dissertation provide information for improving the design, measuring performance and costs and benefits of navigation programs as part of the HIV service delivery system for PLWH who experience homelessness. / 2020-06-30T00:00:00Z

A dissertation submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor Of Philosophy (D.Phil) in the Department of Psychology at the University Of Zululand, 2017 / In South Africa, one of the most distressing concerns of many people living with HIV/AIDS is the stigma attached to this diagnosis. This intense stigma is psychologically traumatic, even leading to levels of depression. Religion or spirituality has come to be one of the most essential and effective coping strategies to live with the pandemic and depression as its consequence. This study sought to establish the impact of religion/spirituality on people living with HIV/AIDS using a convenient sample in South Africa. Using quantitative research methods, the study used the Beck Depression Inventory (BDI-II) to assess the severity of depression on HIV/AIDS victims. The BDI-II is presently one of the most commonly used scales for rating depression to indicate the level of distress the respondent is experiencing. To assess spirituality among people living with HIV, the Religious Coping (RCOPE) was used to measure the coping measures used by people living with HIV and AIDS. The results of the study established that, in both samples, respondents having a HIV positive status with depression levels within the spiritual/religious cohort, are different from those of the nonspiritual/religious cohort. Expressed differently, spirituality or religion seems to have a calming effect on the respondents to the extent that it lessens their level of depression. Furthermore, it was established that there is a considerably strong inverse relationship between religion/spirituality and depression. In fact, the correlation coefficient is -0.89 suggesting a near perfect negative relationship between the variables. In other words, as one’s spirituality/religious quotient increases, one’s depression levels decreases. The study concludes that, spirituality and religiousness plays an important role in the lives of patients with depression and HIV, and is the corner stone of coping strategies and longevity. Moreover, the study recommends that physicians should consider fusing in spirituality coping strategies in treating depressed HIV positive patients.

A dissertation submitted in partial fulfillment of the requirements for the degree of Masters of Arts (Counselling Psychology) in the Department of Psychology University of Zululand, 2005. / Programmes addressing psychosocial needs of children orphaned by HIV/AIDS already exist in Sub-Saharan countries (Germann, 2002), yet in South Africa, few if any, of the relief programmes take cognisance of psychological support. Failure to provide psychological support to children orphaned by HIV/AIDS may have negative, long lasting effects like mental illness, crime, street children and these can in turn result in dysfunctional societies. Thus the aims of the present study were to report on findings concerning available psychosocial intervention programmes and to provide information about the effectiveness of these programmes. Using purposive sampling to select research respondents, the researcher collected data personally. A questionnaire was administered to 19 female caregivers at Emoyeni Hospice in Northern Kwa-Zulu Natal to evaluate psychological support intervention in their programmes. The questionnaire was translated to Zulu in order to avoid any misunderstanding. Qualitative and quantitative data analysis was used in order to conclude about the state of psychological interventions for children orphaned by HIV/ AIDS at Emoyeni. Research findings led to the following conclusions: • Care-givers at Emoyeni Hospice do include the component of psychological intervention support in their intervention programme. • The care-givers at Emoyeni Hospice still need to be helped to recognize the importance of letter writing, and facilitating remembrance of the deceased parent/ parents as a technique of psychological intervention. The present study revealed that caregiyers consider spiritual and physical support as important aspects for inclusion in the psychological intervention programme in order to maximize psychological well-being.

A thesis submitted to the Faculty Arts in fulfilment of the requirements for the Degree of Masters in Social Work in the Department of Social Work at the University of Zululand, South Africa, 2016 / The study was about work related conditions affecting community caregivers on HIV/AIDS positive people at eMondlo Township, which is approximately 28 kilometres from Vryheid town in KwaZulu-Natal. Vryheid is located in the Northern part of KwaZulu-Natal province and forms part of the Zululand District Municipality. It has a population predominated of black people. Mondlo Township is the area that was established in 1963 as an exclusive African settlement through the process of forced removals according to the Apartheid Law of Group Areas Act of 1950. Many of whom individuals had freehold title to their land and residence were also removed from so-called “black spots” as well as farms surrounding Vryheid. The researcher’s intention was to establish how community caregivers are affected by their work, explore how community caregivers feel about their work related conditions and outline the consequences experienced by community caregivers. Community caregivers provide long term care to the community despite the challenges they encounter when executing their duties. The study was conducted at eMondlo Township using twenty four (24) participants from three different public health clinics. Eight (8) respondents were selected proportionally from these clinics. The researcher used qualitative research design. Content analysis was used to analyze data. Findings of the study indicated that the community caregivers are affected by their work. Various challenges have been identified, namely, shortage of resources, lack of substantial food, poor service from clinics officials, travelling long distances on foot, lack of debriefing and less salary. These findings show that the community caregivers are depressed. They have accepted living with the burden of caregiving, whereas it is slowly damaging their self-esteem and affecting their lives. The study indicates that community caregivers are now doing their work simply because they are passionate and are attached to their patients. Even the little salary they earn is the only income they have to support their families which sometimes end up being used in performing their work.

A dissertation submitted to the Faculty of Arts in partial fulfillment of the requirements for the Degree of Master of Arts in Clinical Psychology in the Department of Psychology at the University Of Zululand, 2017 / Virginity testing stands at the forefront in South Africa’s battle against the spread of HIV/AIDS. Most of rural communities uphold and insist that Black South African girls must remain virgins until marriage, with a belief that virginity is the greatest defense against the spread of HIV/AIDS. In South Africa, virginity testing is mainly practiced in KwaZulu-Natal and the Eastern Cape (Scorgie, 2002). Although this custom contributes meaning and value to most traditional people, it has been heavily criticized and also challenged by the community. The objectives of the study include the following: (a) to explore the experiences encountered by virginity testers, both positive and negative experiences, (b) to find out under which circumstances virginity testers do their work. A qualitative study was carried out in the rural areas of Mubatuba, KwaZulu-Natal. Eight female participants were used in the study, with the ages ranging between 40 and 64. Snowball sampling method was used to recruit participants. The bits and pieces of the collected data were coded into meaningful patterns and analyzed using content thematic analysis. The study managed to shed light on the perspectives of virginity testers. While it is seen by virginity testers as an effective tool for prevention of pregnancy and HIV/AIDS infections in rural areas, rape has become a big problem. While promoting virginity testing one should also look and think about issues related to the safety and security of both young girls and virginity testers.

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, 2016 / Implementing HIV and AIDS education in schools has for some time faced challenges in South Africa. Although much has been achieved in terms of policy, the implementation thereof has remained questionable. Monitoring and evaluation has the ability to determine the achievement of policy or program implementation, and therefore offer insights into necessary reforms. The main aim of the study was to assess the quality of the implementation of HIV and AIDS education in schools and determine the facilitators and barriers to the implementation and whether the teachers’ levels of HIV and AIDS knowledge influenced the quality of the implementation. The study utilised the elements of both the Contextual Interaction Theory (CIT) and the Monitoring and evaluation framework as the conceptual framework. Data about the implementation of HIV and AIDS education in schools were collected using both the positivism and interpretivism paradigms. Life-Skills and Life Orientation teaching teachers from both primary and secondary schools were selected using a systematic procedure of selecting every fifth school from an alphabetical list of schools in the Umhlathuze district. Teachers completed questionnaires that had been piloted with 25 Life-Orientation teaching teachers in a workshop, and the Life-Skills and Life Orientation subject advisors participated in the in-depth interviews. The quantitative data was analysed using SPSS version 22 and recorded interviews were transcribed, coded and analysed using thematic analysis. The results showed that 82.7% teachers teaching Life-Skills and Life Orientation implemented HIV and AIDS education, although not to satisfactory standards. Teacher characteristics that influenced quality implementation were time, confidence, support, capability, comfort, and knowing the contents of HIV and AIDS policy. The study further revealed that whilst teachers had an overall ‘above average’ knowledge of HIV and AIDS, they had serious knowledge gaps. The reported barriers to implementation included lack of appropriate knowledge, lack of support and resources, no provision for content, Life Orientation subject overload and lack of monitoring. Based on these findings recommendations were made on how the Department of Basic Education (DBE) may structure the HIV and AIDS education as a separate subject with succinct content for different levels and strengthen the monitoring of the implementation. The study also came up with the framework for the monitoring of the implementation of HIV and AIDS education in schools that schools and district offices could utilise.

A dissertation submitted to the Faculty of Education in fulfilment requirement for the Degree of Master of Education in the Department of Educational Psychology and Special Education at the University of Zululand, South Africa, 2005. / The aim of the study was to conduct a formative investigation into the effectiveness of "Wildfire" as a preventative intervention for HIV/AIDS. "Wildfire" is an experiential activity-based psycho-educational workshop/game that guides participants through the process of 'exposure' to HIV/AIDS, voluntary counseling and testing (VCT). It stimulates discussions and active reflections while imparting knowledge and information that goes beyond preventative awareness campaigns. The target population was Grade 9 learners. A representative sample of rural and township school contexts in the East London area of the Eastern Cape constituted the sites for intervention. The schools selected constituted a convenience sample and learner participation was voluntary, depending on parental permission. A total of 104 learners participated, 95 in the "Wildfire" intervention and 9 in the control group. The methodology applied included a pre- and post-test questionnaire, behavioural observations and verbal responses during the intervention, as well as focus-group notes arising from the debriefing after "Wildfire". The findings indicated that "Wildfire" was an effective and powerful psycho-educational tool for mediating an in-depth understanding of issues around HIV/AIDS and personal vulnerability for adolescents. The triangulation of methods provided evidence that the intended learnings of "Wildfire" were internalized to both group and individual levels. Furthermore, these points of planned learning were sustained over time. "Wildfire" provided psycho-social, emotional and cognitive 'maps' for individuals about how quickly HIV/AIDS can be spread, how to manage 'exposure* and how to treat those infected with the virus. The study was situated within practices of primary health care and prevention of HIV/AIDS. Its relevance to answering research needs and corroborating current research findings has been discussed. The utility of the study for practical purposes, was that it informed the current and future practices of an NGO and provided information for the Education Department which could enrich the effectiveness of its current HIV/AIDS education in a cost-effective way.

Thesis advisor: Laura Tanner / Illness touches all of us, both directly and indirectly, and to respond to a reality with physical and psychological ramifications, we turn to diagnosis for answers. The role of diagnosis is to place a name upon a bodily disorder, giving a patient some idea of what has gone wrong in his or her body, and how life may change. At its essence, diagnosis renders a mysterious set of symptoms into a tangible, understandable disease that can, ideally, be recognized and treated. Yet this perspective can seem strangely simplistic. How can a single word or phrase encapsulate the variable and far-reaching effects of illness on the complicated lives we live? And what are the effects of the application of the phrase to a patient’s life: a comforting awareness, an estrangement from healthy society, or something in between? / Thesis (BA) — Boston College, 2018. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: English.