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 aim of this study was to establish a new understanding of the epidemiology of HIV/AIDS at the municipal level, but at the same time upholding the anonymity of the HIV infected and AIDS sufferers. Innovative research techniques such as the use of GIS (geographic information systems) as a research tool contributed to disclosing the patterns of the HIV pandemic in the Nelson Mandela Metropole that were not obvious or visible before. GIS involved geographic maps that detect the spatial relationship between HIV prevalence rates and vectors that drive the pandemic.

This preliminary study examined the dominant frames used by the New York Times in the coverage of HIV/AIDS in Africa. The study also analyzed the tone of coverage used on HIV/AIDS stories on Africa and the volume of news coverage on the issue from January 2000 to December 2007. The results of the study indicated a dominant human disaster frame in the coverage of HIV/AIDS stories on Africa. Overall tone of coverage was neutral. However, findings indicated more negative tones of coverage than positive. The volume of coverage changed overtime. Ultimately, these media frames carry significant implications for public attitude and policy outcomes / Department of Journalism

The aim of this study was to establish a new understanding of the epidemiology of HIV/AIDS at the municipal level, but at the same time upholding the anonymity of the HIV infected and AIDS sufferers. Innovative research techniques such as the use of GIS (geographic information systems) as a research tool contributed to disclosing the patterns of the HIV pandemic in the Nelson Mandela Metropole that were not obvious or visible before. GIS involved geographic maps that detect the spatial relationship between HIV prevalence rates and vectors that drive the pandemic.

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)

Renewed efforts are needed to address rapidly rising HIV incidence among sexual and gender diverse (SGD) individuals—particularly cisgender gay, bisexual, and other men (MSM) and transgender and nonbinary individuals (TSM) who have sex with men—in Kazakhstan. Intervention research is uniquely positioned to advance HIV prevention through surveying factors shaping the HIV epidemic among MSM and TSM in Kazakhstan, developing and testing the effects of an HIV prevention intervention, and assessing overall social impacts of conducting research. This research proceeded to describe strategies and lessons learned during implementation of a stepped wedge clinical trial of an intervention designed to increase the number of MSM and TSM in the HIV care continuum in Kazakhstan cities of Almaty, Shymkent, and Nur-Sultan. Thus, this three-paper dissertation aimed to: (1) identify psychosocial factors associated with lifetime, past-12-month, and past-6-month HIV testing among a sample of MSM and TSM enrolled in the clinical trial; (2) describe the process of implementing remote training of facilitators for remotely delivering the HIV preventive intervention; and (3) assess social impacts of participating in the clinical trial. MSM and TSM from the study cities were recruited into the clinical trial and administered a structured behavioral survey at their primary visit and at follow-up visits every six months thereafter. After a period of no intervention implementation (‘pre-implementation period’), the intervention was implemented sequentially every six months in the study cities. Among 304 MSM and TSM enrolled in the clinical trial during the pre-implementation period, lifetime and past-12-month HIV testing were positively associated with polydrug use and negatively with sexual transmission HIV risk, and past-6-month HIV testing was negatively associated with sexual risk. The process of developing and implementing remote training of facilitators was guided by a protocol outlining phases involving formative assessment and planning, fundamentals training, and feedback loop and technical assistance. Out of 627 MSM and TSM who completed their primary assessment during the clinical trial, 579 (92%) returned for at least one follow-up visit; of these individuals, 88% reported at least one positive social impact, while 2% reported at least one negative social impact. Findings underscore the value of expanding access to substance use treatment for HIV prevention among MSM and TSM in Kazakhstan, the viability of remote training of facilitators for remote intervention delivery, and the feasibility of conducting HIV prevention research involving MSM and TSM with many benefits and few risks.

Thesis (MSc)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Substance abuse is an imminent danger on the health of both substance users and nonusers. In general, abuse of psychoactive substances is associated with high risk behaviour, mortality and morbidity. The drug use cycle involves inextricably intertwined variants such as production, trading and usage of both licit and illicit addictive substances. The dynamics of substance use involve initiation, addiction, rehabilitation/treatment and quitting/ recovery. In response to supply and abuse of monster drugs, control strategies such as law enforcement and rehabilitation have been stepped up to reduce access to drugs by targeting drug kingpins and harm reduction respectively. In this thesis, we model the factors affecting the prevalence of substance abuse, the effect of drug lords on the prevalence of substance abuse, and the impact of substance abuse on the prevalence of HIV/AIDS. We formulate mathematical models based on systems of autonomous differential equations describing the dynamics of the sub- populations involved in the drug using cycle. We examine the effects of amelioration, rehabilitation/treatment and re- initiation on the prevalence of substance abuse. Our results suggest that, recruitment into rehabilitation and amelioration in the presence of quitting for light users reduce the prevalence of substance abuse; re-initiation and amelioration without quitting for light users increase the prevalence of substance abuse. Our assessment of the impact of drug lords and the effect of law enforcement on drug epidemics shows that, the presence of drug lords seriously constraints the efforts to reduce substance abuse since they increase access to drugs. However, law enforcement if stepped up in response to the population of drug lords, greatly reduces the prevalence of substance abuse. Given the associated influence of drugs on high risky behaviour, as a cofactor for sexually transmitted infections, we assess the influence of substance abuse on the prevalence of Human Immunodeficiency Virus (HIV). Our results show that dissemination of information regarding HIV and drug use reduces HIV prevalence whereas, there is faster spread of the epidemic and high prevalence with increased sexual contact. / AFRIKAANSE OPSOMMING: Dwelmmisbruik is ’n dreigende gevaar vir die gesondheid van beide dwelm gebruikers en nie-gebruikers. In die algemeen, word die misbruik van psigoaktiewe dwelms verbind met hoë risiko gedrag, mortaliteit en morbiditeit. Die dwelmgebruikskringloop behels onlosmaaklik vervlegde variante soos vervaardiging, handel en gebruik van beide wettige en onwettige verslawende middels. Die dinamika van dwelms behels aanvang, verslawing, rehabilitasie/ behandeling en staking/herstel. In reaksie op die misbruik en verskaffing van monster dwelms, is beheer strategieë soos wetstoepassing en rehabilitasie verskerp, om die toegang tot dwelms te verminder, deur onderskeidelik te fokus op dwelmspilfigure en skadebeperking. Die belangrikste doel van hierdie verhandeling is om die faktore te modelleer wat die voorkoms van dwelmmisbruik beïnvloed, die uitwerking van dwelmbase op die voorkoms van dwelmmisbruik, en die trefkrag van dwelmmisbruik op die voorkoms van MIV / VIGS. Ons formuleer wiskundige modelle gegrond op stelsels van outonome differensiaalvergelykings, wat die dinamika beskryf van die sub-bevolkinge wat in die dwelmgebruikskringloop betrokke is. Ons ondersoek die effekte van verbetering, rehabilitasie/behandeling en heraanvang op die voorkoms van dwelmmisbruik. Ons resultate dui dat, werwing tot rehabilitasie en verbetering in die teenwoordigheid van stakende tydelike verbruikers, die voorkoms van dwelmmisbruik verminder; heraanvang en verbetering sonder dat tydelike verbruikers staak, verhoog die voorkoms van dwelmmisbruik. Ons raming van die invloed van dwelmbase en die uitwerking van wetstoepassing op dwelm-epidemies toon dat, die teenwoordigheid van dwelmbase belemmer grotendeels die pogings om dwelmmisbruik te verminder, aangesien hulle toegang tot dwelms verhoog. Nietemin, as die wetstoepassing verskerp word in reaksie op die dwelmbaasbevolking, word die voorkoms van dwelmmisbruik aansienlik verminder. Gegewe die gepaardgaande invloed van dwelms op hoë risiko gedrag as ’n kofaktor vir seksueel oordraagbare infeksies, beraam ons die invloed van dwelmmisbruik op die voorkoms van die Menslike Immunogebreksvirus (MIV). Ons resultate toon dat inligtingverspreiding rakende MIV en dwelmgebruik, MIV-voorkoms verlaag, terwyl daar ’n vinniger verspreiding van die epidemie en hoë voorkoms is, met verhoogde seksuele kontak.

Thesis (MScMedSc) –Stellenbosch University, 2014. / ENGLISH ABSTRACT: HIV-infection is characterized by depletion of CD4+ T-cells from the gut-associated lymphoid tissue (GALT) which causes irreparable gastrointestinal tract damage and subsequent microbial translocation of bacterial products such as lipopolysaccharide (LPS), a component of Gram-negative bacteria, into systemic circulation. HIV infection also affects the functions and relative population sizes of various immune cells, such as monocytes. Monocytes are important innate immune cells as they are often the first cells recruited to sites of infection and inflammation. They then either promote inflammatory processes; elicit adaptive immune responses, through their antigen presenting ability; aid in pathogen and debris clearance or aid in damage repair. This cross-sectional study investigated functional changes to monocytes and monocyte subsets (CD14+CD16- and CD14+CD16+) in HIV+, treatment naïve individuals and healthy uninfected controls, using whole blood assays and isolated monocytes. A number of chemokine receptors associated with function and homing, and specific gut-homing receptors, were investigated. Monocyte activation, apoptotic potential and intracellular monocyte cytokine production were also investigated. All markers were evaluated using multi-parameter flow cytometry. Monocyte responsiveness to in vitro LPS stimulation and expression of the afore-mentioned chemokine receptors to viral load, CD4+ count and CD38/8 T-cell expression was also assessed. During HIV-infection monocytes appeared primed to exit systemic circulation and migrate towards the gut, as seen through elevated CD62-L (p < 0.005) and CCR7 (p < 0.005), whereas the CD14+CD16+ subset was increased (p = 0.0461) and exhibited a higher activation status through increased CD69 expression (p < 0.005) compared to the CD14+CD16- subset. An interesting observation was the significantly increased IL-10 production by the CD14+CD16+ subset (p < 0.005). An elevated CCR5 expression in total monocytes (p < 0.005) was also seen. After LPS stimulation, the HIV+ group displayed unique and significant percentage increases in the total monocyte population. The findings of the current study suggest that monocyte functionality may be retained during HIV-infection and that CD14+CD16+ monocytes play a vital role during HIV-infection evidenced by their preferential expansion and priming for GALT migration. The production of IL-10 by this subset further highlights their importance and emphasizes the need for future studies on the role of these cells in chronic stable HIV-1 infection and whilst disease progresses. / AFRIKAANSE OPSOMMING: MIV-infeksie word gekenmerk deur die uitputting van CD4+ T-selle, veral uit die derm-verwante limfweefsel (GALT). Dit veroorsaak onherstelbare skade aan die spysverteringskanaal en die daaropvolgende mikrobiese translokasie van bakteriële produkte soos LPS, „n komponent van Gram-negatiewe bakterieë, wat gaan binne sistemiese sirkulasie. MIV-infeksie beinvloed die funksies en relatiewe bevolkingsgrootte van verskeie immuun selle, insluitend monosiete. Monosiete is belangrike ingebore immuun selle en is dikwels die eerste selle wat gewerf word na areas van infeksie en inflammasie. Monosiete kan inflammatoriese prosesse bevorder of aanpabare immuunstelsel reaksies ontlok deur middel van hul antigeen aanbiedings vermoë of help met patogeen en puin klaring en skade herstel. In hierdie deursnee-studie het ons veranderinge aan monosiete (CD14+CD16+ en CD14+CD16-) ondersoek in MIV+ behandelde naïef individue en gesonde onbesmette kontroles, deur die gebruik van hele bloed toetse en geïsoleerde monosiete. 'n Aantal chemokine reseptore, wat verband hou met homing en funksie was ondersoek in toevoeging tot spesifieke derm-homing reseptore. Monosiet aktivering, apoptese potensiaal en intrasellulêre monosiet sitokien produksie was ook ondersoek. Alle merkers is ondersoek deur multi-parameter vloeisitometrie. Die beoordeel reaksies van monosiete na in vitro LPS stimulasie en die uitdrukking van die merkers met merkers van algemene immuun aktivering en MIV-siekte patogenese was ook ondersoek. CD14+CD16+ monosiete was gedurende MIV-infeksie verhoog (p-waarde = 0.0461). Daar was 'n hoër algehele monosiet uitdrukking van verskeie chemokine merkers soos CD69 (p-waarde < 0.005) uitdrukking; CD62-L (p-waarde < 0.005), en CCR7 (p-waarde < 0.005) uitdrukking in die CD14+CD16+ subgroep. Daar was ook „n toename in IL-10 produksie, veral in die CD14+CD16+ subgroep (p-waarde < 0.005). Hoewel baie funksionele merker reaksies dieselfde was, het die MIV+ groep „n unieke en beduidende persentasie verhooging in die totale monosiet bevolking getoon. Ons algehele bevindinge dui op 'n voorkeur uitbreiding van CD14+CD16+ monosiete tydens MIV-infeksie. Die CD14+CD16+ monosiet subgroep blyk ook bevoordeel word met betrekking tot voorbereiding vir migrasie na limfknope en die GALT. Die toename in geaktiveer de CD14+CD16+ monosiete op siekte webwerwe is waarskynlik 'n groot bydraende faktor tot aanhoudende immuun aktivering wat op sy beurt virale replikasie bevorder. Hierdie resultate beklemtoon die behoefte om die rol van hierdie selle en in veral die CD14+CD16+ subgroep, in kroniese stabiele MIV-1 infeksie verder te studeer en terwyl siekte bevorder.

On t.p.: Master of Arts (Clinical Psychology) / Thesis (MA)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: Progress has been made in the approach to combating the spread of HIV/AIDS with regards to the Department of Health's presentation of the HIV/AIDS/STD Strategic Plan for South Africa. However, deep concem exists with regards to specific marginalized groups such as disabled persons within the South African sector threatened by the spread of HIV/AIDS. The aim of this paper was to review published academic papers on the specific ways in which disabled people are at risk for contracting HIV/AIDS, and the existence of primary prevention programmes designed and specifically aimed at the disability sector. The roles of non-governmental and other organisations were also looked at. The first section of the review focused on high-risk behaviour among disabled persons for contracting HIV/AIDS. Existing literature covered mainly areas of intellectual disability and psychiatric disability. Disabled persons struggle with the same issues of good education, workers' rights, gender equality, health care and social support and well-being as the general population. These issues are however exacerbated by struggles unique to those living with a disability. Inadequate public and social support increase disabled people's vulnerability to issues such as poverty, lack of resources, and inadequate education, heightening their risk of contracting HIV/AIDS. The second section of the review discusses the area of primary prevention, explaining why prevention programmes should be tailormade for specific needs such as those of disabled persons. Examples of prevention programmes from the literature are looked at, as well as a prevention initiative launched in South Africa. / AFRIKAANSE OPSOMMING: Vooruitgang is gemaak op die gebied van die voorkoming van die verspreiding van MIVNIGS met die bekendstelling van die Departement van Gesondheid se MIVNIGS/STD Strategiese Plan vir Suid-Afrika. Daar is wel steeds kommer oor spesifieke gemarginaliseerde groepe, soos gestremde persone, binne die Suid- Afrikaanse sektor wat bedreig word deur die verspreiding van MIVNIGS. Die doel van die studie was om 'n oorsig te kry van akademiese materiaal wat gepubliseer is oor die spesifieke wyses waarop mense met 'n gestremdheid in gevaar verkeer om MIVNIGS op te doen, asook primêre voorkomingsprogramme wat spesifiek ontwerp en gemik is op die gestremde sektor. Daar is ook gekyk na die rol van nie-regerings- en ander organisasies. Die eerste deel van die studie fokus op hoë risiko gedrag van gestremde persone wat hulle in gevaar mag stel vir die opdoen van MIVNIGS. Bestaande literatuur handel meestaloor die areas van intellektuele gestremdheid en psigiatriese siektes. Gestremde persone moet dieselfde uitdagings oorkom as diegene in die algemene populasie, soos byvoorbeeld die gebrek aan goeie onderwys, arbeidsregte, diskriminasie op grond van geslag, gesondheidssorg, asook sosiale steun en algemene welsyn. Gestremde persone se kwessies word egter vererger deur sekere uitdagings wat uniek is aan 'n lewe met 'n gestremdheid. Gestremde persone ontvang meestalonvoldoende publieke en sosiale steun wat dikwels armoede, gebrek aan hulpbronne en onvoldoende opvoeding tot gevolg het. Laasgenoemde verhoog gestremde persone se kanse om MIVNIGS op te doen. Die tweede deel van die studie bespreek primêre voorkomingsprogramme en waarom dit noodsaaklik is om voorkomingsprogramme te ontwerp wat uitsluitlik gemik is op spesifieke populasies. Daar word dan ook gekyk na voorbeelde van primêre voorkomingsprogramme in die literatuur, asook 'n voorkomingsinisiatief wat in Suid-Afrika geloods is.

Thesis (MSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: With a cure for HIV and AIDS still absent, non-nucleoside reverse transcriptase inhibitors (NNRTIs) play a major role in the current antiretroviral treatments used, which have shown to improve and prolong the lives of HIV patients significantly. However, with rapid mutations of the HI virus, the use of these drugs is becoming limited, thereby highlighting the need for the development of new NNRTIs. Previous work by our research team has led to the development of a cyclopropyl-containing indole-based compound with an inhibition activity (IC50 value) of 0.1 μM, as determined in an in vitro single-cycle, non-replicative phenotypic assay. Therefore, in this project, we focussed on enhancing the intermolecular interactions of our compound to three major areas in the NNRTI binding pocket, namely the Tyr181, the Val179, and the Lys101 binding pockets. Hereby we were able to obtain both improved and lower potencies, with our most active compound having an inhibition activity (IC50 value) of 1 nM. For the interaction to the Tyr181 binding pocket, we were thus unable to synthesise a heterocyclic ring system onto our molecule as opposed to the previously used phenyl ring. Secondly, for the interaction to the Lys101 binding pocket we were able to synthesise a tetrazole ring system and an amide functionality onto the 2-position of the indole. Lastly, in our quest to synthesise the cyclopropyl moiety onto our compound for the interaction in the Val179 binding pocket, we were able to investigate the full inhibition effect of this interaction by synthesising a similar compound with no interaction in this binding pocket. Moreover, we were able to synthesise a new compound with a methoxy moiety for this interaction with an inhibition activity (IC50 value) of 1 nM. With this compound only being submitted for efficacy evaluation as a racemic compound mixture, this opened a new door for research possibilities for our team. / AFRIKAANSE OPSOMMING: In die awesigheid van 'n geneesmiddel vir MIV en VIGS, speel nie-nukleosied omkeerbare transkripsie inhibitore ("NNRTIs")'n groot rol in die huidige antiretrovirale behandeling. Ongelukkig ondergaan die MI virus mutasies, wat dus die gebruik van hierdie antiretrovirale middels beperk. Hierdie beklemtoon dus die noodsaaklikheid vir die ontwikkeling van nuwe "NNRTIs". Vorige werk wat deur ons navorsings groep verrig is, het gelei tot die ontwikkeling van "n siklopropiel bevattende indol verbinding, met "n inhibisie aktiwiteit ("IC50" waarde) van 0.1 μM. Gevolglik, het ons in hierdie projek gefokus om die intermolekulêre interaksies van hierdie verbinding in drie hoof areas in die "NNRTI" bindings ruimte te verbeter, genaamd die Tyr181, die Val179, en die Lys101 bindings ruimtes. Hierdie projek het dus beide verbeterde en ook laer inhibisie aktiwiteits resultate gelewer, waar die mees aktiewe verbinding 'n inhibisie aktiwiteit ("IC50" waarde) van 1 nM behaal het. Vir die interaksie na die Tyr181 bindings ruimte, was ons dus onsuksesvol om 'n heteroaromatiese ring te sintetiseer as plaasvervanger vir die oorspronklike feniel ring. Tweedens, vir die interaksie na die Lys101 bindings ruimte, was ons in staat om 'n tetrazol ring en 'n amied funksionaliteit aan die 2-posisie van die indol te sintetiseer. In ons stryd om die siklopropiel ring aan ons verbinding te sintetiseer vir die interaksie in die Val179 bindings ruimte, was ons in staat om die volledige effek van hierdie interaksie te bepaal deur 'n soortgelykke verbinding te sintetiseer met geen interaksie in die Val179 bindings ruimte nie. Daarenbowe, het ons 'n verbining gesintetiseer met 'n inhibisie aktiwiet ("IC50" waarde) van 1 nM, waarvan die aktiwitiet van slegs die rasemiese mengsel van die verbinding bepaal is. Hierdie vinding het dus 'n nuwe navorsings deur vir ons groep geopen.