The convergence of compelling evidence that transmission of HIV from a pregnant woman living with HIV to her foetus can be significantly interrupted due to advances in antiretroviral and obstetrical interventions, and worrisome epidemiologic data documenting a rise in HIV infection among Canadian women, spurred the development in Canada and world wide of policies and programmes aimed at increasing the number of pregnant women who are tested for HIV. Responding to innovative therapy reducing perinatal HIV transmission risk by increasing the number of pregnant women who agree to test for HIV is clearly an important prevention objective. However, the process must be accomplished in a way that is of most benefit to the pregnant woman herself and in a way that does not compromise a pregnant woman's rights to the established Canadian principles of HIV counselling and testing. / Working with pregnant women in Ontario, the province with the highest level of HIV infection among Canadian women, this thesis articulates and interprets their experiences of prenatal HIV counselling and testing and details their perspectives on best practices. The pregnant women's evidence-based recommendations for the re-design of prenatal HIV testing programmes are provided. These unique data have important utility for federal and provincial policy makers as HIV counselling and testing policies and programmes that encompass and are grounded in pregnant womens' experiences and perspectives are likely to be maximally acceptable and thereby increase the number of pregnant women who can be apprised of prophylactic treatment to take care of their own health needs as well as those of their unborn children. / In order for pregnant women to increase control over their own health and that of their unborn children, there is clear value in all pregnant women being afforded the opportunity to know their HIV status. However, the voices of the women in this study suggest that the autonomy rights of pregnant women may well be at risk in a programme in which the current emphasis is on potential HIV infection of the foetus rather than on potential or actual infection of the pregnant woman.

No description available.

Thesis (M. Cur.) --University of Limpopo, 2011. / HIV/AIDS is one of the major challenges facing South Africa today. Over 5.5 million people are infected with HIV and the majority of these infections are in the reproductive age group. Since the start of the epidemic, over 12.2 million women worldwide have been infected with HIV (WHO, 2000:10). The risk of women contracting HIV is rising globally. HIV seems to be a major cause of infant mortality. It is estimated that approximately 55% of women in South Africa are HIV-positive (National Department of Health, 2007:7). It is, therefore, important that knowledge and attitudes of women regarding mother-to-child transmission (MTCT) of HIV infection are explored to reduce the high infant mortality rate and the incidence of MTCT of HIV infections, and to develop preventive programmes on HIV and AIDS. In view of these considerations, the objectives of this study were to explore and describe the knowledge and attitudes of women with regard to MTCT of HIV infection and to provide guidelines for the prevention of MTCT of HIV infection. The study was conducted in the rural area of the Ehlanzeni District in the Mpumalanga Province, South Africa at Bourke’s Luck and Elandsfontein clinics. An explorative, descriptive, qualitative research design that is contextual in nature was used. The population consisted of all pregnant women and those in pueperium between 25-40 years of age. Non-probability purposive sampling was used. Participants were selected according to inclusion criteria. Data were collected using semi-structured interviews. The research findings revealed that some participants had knowledge and understanding regarding MTCT of HIV infection while others lacked knowledge and understanding which could impact on MTCT of HIV infection.

Despite significant medical advances in HIV treatment, people living with HIV and substance use (PLWH-SU) remain left behind. Compared to people living with HIV (PLWH) without comorbid substance use, PLWH-SU are less likely to engage in medical care and to achieve viral suppression. As a result, PLWH-SU have more frequent preventable hospitalizations, higher rates of viral transmission, and greater morbidity and mortality. Although there is extensive research that explores ways to enhance PLWH-SU’s engagement in HIV care by improving patient-provider interactions, most have focused on the patient, and none have been effective. Grounded in the sociological theory of habitus, this dissertation attended to the medical provider in the patient-provider dyad and aimed to better understand how medical providers’ perceptions and dispositions towards PLWH-SU are formed, and how these perceptions and dispositions are displayed in the ways medical providers interact with and take care of PLWH-SU. Before engaging with habitus, I first conducted a systematic review on how the theory has been used to study medical providers’ clinical practices. Results of the review show that while existing literature has been limited and unclear in its usage of habitus, these studies are informative, and they demonstrate that habitus can be a suitable theoretical foundation for expanding present approaches to research on medical providers’ clinical interactions with PLWH-SU. Following the systematic review, I developed my conceptual framework of medical providers’ treatment habitus (i.e., medical providers’ dispositions towards caring for PLWH-SU) and estimated a typology of treatment habitus using survey data from 258 medical providers in Miami, Florida, Atlanta, Georgia, and the District of Columbia. My analyses show that among this sample of medical providers, there are four types of treatment habitus towards caring for PLWH-SU, and treatment habitus is associated with multi-level factors (e.g., providers’ race, study site, receipt of substance use disorder training). To further explore how medical providers came to develop and how they understand their own treatment habitus, I conducted conversational interviews with 36 medical providers who had completed the abovementioned survey. These interviews revealed medical providers exhibit a spectrum of treatment habitus that is distinguishable by their intentions (person-centered vs. provider-centered) and their methods (informative vs. directive). The interviews also revealed that there are discrepancies in how medical providers spoke about PLWH-SU and how they described their practices towards caring for PLWH-SU. Specifically, although most providers used negative terms to refer to PLWH-SU, the stigmatizing language was almost never accompanied by recollections of stigmatizing behaviors during clinical interactions with PLWH-SU. Taken together, this dissertation expanded on current knowledge about not only how medical providers act when caring for PLWH-SU, but also why they act the ways they do. Findings from this study contribute to an understudied area of HIV and substance use research and provide insights for the development of novel provider-based interventions that can improve the health of this vulnerable and marginalized population.

This dissertation seeks to incrementally explain the impact of individual, interpersonal, and environmental levels of risk upon HIV/STI incidents among heterosexual African American serodiscordant couples residing in four metropolitan cities. Using archival data from a cluster-RCT (Project EBAN) and governmental surveillance reports, analytic methods that can model heterogeneous pathways within and across each level of risk were used. Findings from this dissertation revealed unique patterns and pathways via which African American females in serodiscordant relationships contracted HIV/STI.

The recommended infant feeding method for mothers living with HIV is either exclusive breastfeeding for six months or replacement infant feeding (RIF), while a mixed feeding method carries the greatest health risks for infants. This study focused on identifying the challenges faced by mothers who opted for RIF and the coping strategies they employ. A theoretical framework, based on gender and power, was developed. The study used a qualitative design, with semi-structured in-depth interviews. Using purposive sampling, data was collected at three clinics from 22 participants. The participants reported experiencing challenges related to RIF such as intermittent availability of formula milk at the clinics. Socio-cultural challenges include power inequalities between health care workers and mothers, pressure from family members to breastfeed, stigmatization and discrimination from community members. Coping strategies such as withdrawal from the community and trying to hide RIF from others were not sufficient to meet the challenges experienced. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

The recommended infant feeding method for mothers living with HIV is either exclusive breastfeeding for six months or replacement infant feeding (RIF), while a mixed feeding method carries the greatest health risks for infants. This study focused on identifying the challenges faced by mothers who opted for RIF and the coping strategies they employ. A theoretical framework, based on gender and power, was developed. The study used a qualitative design, with semi-structured in-depth interviews. Using purposive sampling, data was collected at three clinics from 22 participants. The participants reported experiencing challenges related to RIF such as intermittent availability of formula milk at the clinics. Socio-cultural challenges include power inequalities between health care workers and mothers, pressure from family members to breastfeed, stigmatization and discrimination from community members. Coping strategies such as withdrawal from the community and trying to hide RIF from others were not sufficient to meet the challenges experienced. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Magister Public Health - MPH / Human Immune-deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is a major public health problem. Globally, the number of new HIV infections is decreasing but the total number of people living with the disease is increasing. An estimated 5.7 million South Africans are currently living with the disease. The life expectancy of people living with HIV (PLHIV) in South Africa has slowly increased due to the availability of Anti-Retroviral Therapy (ART). The progressive "chronicity" of HIV may be associated with a variety of impairments and disabilities for people living with HIV. This emphasising the increasingly important role that physiotherapists play to minimize the disabling impact of the disease and improve quality of life for PLHIV. The aim of study was to determine the HIV/AIDS knowledge, attitudes and the occupational risk perception of physiotherapists practicing in the Eastern Cape Province, South Africa. This study utilized a cross sectional descriptive quantitative survey to collect data. The data was collected via a structured self-administered postal questionnaire. The questionnaires were captured in Microsoft Excel and analysed statistically using CDC Epi-Info version 3.5.1. Data was analysed descriptively and the chi-square test, T-tests and ANOVA was used to identify any statistically significant relationship between variables. The results of the study identified that the physiotherapists in the study have "high" general HIV related knowledge, although major gaps regarding HIV prevention and transmission still exists. The physiotherapists expressed a positive attitude towards PLHIV, while they perceive themselves to be at low risk of HIV transmission risk when managing PLHIV. The physiotherapists with more than 10 years' experience had significantly better HIV related knowledge compared to those with less than 10 years' experience while the attitudes of married physiotherapists towards PLHIV were significantly less favourable than those who were not married. There is a need for intervention strategies to address the HIV knowledge gaps of physiotherapists. Intervention strategies need to address physiotherapists HIV prevention and transmission knowledge.

This thesis sought to develop an agent-based model that replicates the formation of social and sexual partnerships in real-world settings with an eventual aim of revealing the main drivers of the HIV pandemic in a closed mixed society. Agent-based modelling is a computational modelling approach that allows for the simulation of the actions and interactions of autonomous agents, with the eventual objective of disovering global effects on the system. This modelling technique is less dependent on generalisations and does not average out the behaviour of individuals. Sexual partnerships formed in the model goes through the process of dating, courting and has a chance of developing into marriage as well as the possibility of breaking up or undergo divorce. Sexual partnership formation is based on a likeability index calculated using aspiration, attractiveness and age. Over and above the the sexual relationships we include commercial sex work. Commercial sex work depends mainly on the availability of female sex workers and their clients. We superimpose the spread of HIV on the social and sexual network model. Results from the model reveal that saturation of HIV prevalence is driven by the social and sexual network structure, behaviour change as well as biologic factors. Excluding commercial sex work in the model resulted in a decrease in HIV prevalence and incidence. Dense social networks resulted in a dense sexual network which consequently increased HIV incidence. A change in the infection probability per coital act contributed significantly to a change in incidence and prevalence levels. Model results also show that enrolling all HIV positive agents on antiretroviral therapy (ART) as from 2016 simulation year will help in curbing HIV transmission if zero dropout rate from ART is assumed. Therefore, on concomitant action to avoid dropouts from ART is necessary if full benefits of introducing ART to all HIV positive individuals are to be realised. / Operations Management / D.Phil. (Operations Research)

Summaries in English and Shona / Introduction Despite wide spread information and knowledge of HIV and AIDS transmission, High school teenage girls continued to engage in risky sexual behaviour in Tshwane, a District of Gauteng Province of South Africa. Age-parity relationships between High school teenage girls and older men known as “Sugar Daddies” or “Blessers”, who showered High school teenage girls with money and expensive gifts, were believed to be spreading HIV. High school teenage girls failed to negotiate condom use due to lack of autonomy, coupled with sexual violence, resulting in HIV transmission. Consequently, Tshwane became one of the highest HIV burdened cities in South Africa. Purpose of the study This study explored and described the High school teenage girls’ knowledge and perceptions of the risks of human immunodeficiency virus and acquired immune deficiency syndrome in Tshwane, a District of Gauteng Province of South Africa. Method The study used a quantitative approach. The data were collected using questionnaires. The population comprised of all girls aged 15 to 19 at a selected High school. The sample consisted of 109 girls. Systematic sampling was used. The study was conducted in the school hall of a selected High school. Data were analysed using SPSS version 23 program. Results Generally, the High school teenage girls’ HIV knowledge was very high (84.4%) as compared to their knowledge on AIDS (3.7%). Only 10.1% of the High school teenage girls knew what the window period entailed. They were aware of HIV preventive measures evidenced by abstinence ranking first (1) and had the highest score of five (5). 17.4% of the High school teenage girls doubted the usefulness of the condom in combating HIV infection. Health care workers were easily accessible (30.3%). The television was the most available mass media (92%). The radio was most preferred (31%). High school teenage girls preferred to discuss HIV related information with their peers and friends (50%). 42% of the High school teenage girls preferred to discuss sex related topics with parents or guardians. Those who were below 18-years were 7.2 times less likely to have sex. 90% of the 19-year-old girls had had sex. Therefore, High school teenage girls’ perception of HIV risk was low because they continued to be involved in concurrent multiple relationships although 90% of those involved were using condoms. Conclusion Although High school teenage girls proved that they had knowledge of HIV and AIDS, they still had a low perception of HIV risk because they were involved in concurrent multiple sexual relationships with older men. / Habedi, Debbie Kgomotso / Kunyangwe vane ruzivo rwechirwere cheshura matongo, vasikana vane makore ari pakati pegumi nematatu negumi nemapfumbamwe vari kuenderera mberi nekuita unhu unoita kuti vabatwe nechirwere cheshuramatongo (AIDS). Vasikana ava vari kudanana nevarume vakuru kuvadarika vamwe masadzimba zvinoita kuti vatapurirwe utachiona hweHIV zvinoita kuti vasikana vane hutachiona uhwu vawandise muguta reTshwane, mudunhu reGauteng munyika yeSouth Africa. Vanasikana ava vanopuwa mari nekutengerwa mbozhanhre nenguvo zvinodhura nekudya tunonaka. Nekuda kwekuti varume vanesimba rehudzvinyiriri nekuvarwisa, muAfrica, vasikana ava havakwanisi kushandisa makondomu kuzvidzivirira kubva kuhutachiona hweHIV. Ndosaka guta reTshwane raita mukurumbira munyika yeSouth Africa nekuti vanasikana vane hutachiona hweHIV vari kuwandisa. Gwaro iri rinoongorora nekutsanangura ruzivo uye maonero evanasikana huipi hwechirwe cheshuramatongo muguta guru reTShwane, mudunhu reGauteng. Munyika yeSouth Africa. Mafambiro Egwaro Gwaro iri riri kuongorora nekutsanangura ruzivo nemaonerwo anoitwa hutachiona hweHIV nechirwere cheshuramatongo nevasikana vari pakati pemakore gumi nemakore matatu nevanegumi nemakore mapfumbamwe pachikoro chesekonari chakasarudzwa mugutu guru reTshwane, mudunhu reGauteng, munyika yeSouth Africa. Vasikana vaka pindura mibvunzo pamusoro peruzivo rwavaiva narwo uye zvakanyangara zvinoita kuti vabatwe nehutachiona hweHIV. Vasikana zana nevapfumbamwe ndivo vakapindura mibvunzo. Vasikana vakapindura mibvunza yaiva pamapepa muhoro yepachikoro pavo. Zvakabuda Muchidzidzo Zvakaonekwa kuti vasikana vane ruzivo rwechirwere cheshuramatongo asi vane zvimwe zvinhu zvavasinga nzwisisi pamusoro pechirwere ichi zvekuzvidzivirira. Vasikana havakwanisi kupa mutsauko wehutachiona (HIV) nechirwere cheshuramatongo (AIDS). Vanasikana vazhinji vanofunga kuti hutachiona hweHIV hunotapurirwana pakutsvodana uye pakushandisa zvimbuzi. Vasikana vazhinji havakwanisi kutsanangura nguva inogara hutachina hweHIV mumuviri hwusati hwaonekwa kuti hurimo. Vasikana havana chokwadi chekuti makondomu anogona kudzivirira hutachiona hweHIV kuti hwusapinda mumuviri nguva dzebonde. Vadzidzisi vechikoro ndivo vakasarudzwa kuti vane ruzivo rwechirwere cheshuramatongo. Vasikana havafariri kudzidziswa nezve chirwere cheshuramatongo nevabereki vavo. Vanofarira kukurukura nezvechirwere ichi nevanhu vezera ravo. Vasikana vasingagari nevabereki vavo vanoita bonde kudarika vanogara nevabereki vavo uye vanoita bonde nevadiwa vazhinji vamwe vacho varume vakuru madzisaimba. Vasikana vanotaridza kusatya kubatwa nechirwere chishuramatongo nemhaka yehunhu wawo hwakashata hweku danana nevarume vazhinji uye kusashandisa makondomu nguva dzebonde. Mhendero Zvidzidzo zvinopiwa vasikana zvinechekuita nezvepabonde zvinofanira kuongororwa zvipamhidzirwe kuti vasikana vagone kuzvidzivirira kuchirwere cheshuramatongo. Madzimudzangara netelevhizhoni zvino kurudzirwa kudzidzisa mitambo nedzimbo dzinodzidzisa pamusoro pekudzivirira chirwere cheshuramatongo. Vabereki vanofanira kudzidziswawo kuti vagone kudzidzisa vana vavo kuti vagone kuzvidzivirira kuti vasabatwa nechirwere ichi. Vanasikana vanofanirwa kudzidziswa kushandisa makondomu pese pavanoita bonde. Makondomu anofanira kuiswa pachena paano kwanisa kuwonekwa nevasikana. / Health Studies / M.P.H. (Health Studies)