Background:- The HIV and AIDS epidemic is a major catastrophe that affects millions of people worldwide. Antiretroviral medication combinations have revolutionised HIV treatment since 1996, transforming the virus from a death sentence to a manageable condition. In order to obtain full therapeutic benefits it is vitally important that patients adhere to their prescribed medication. Being informed about the disease and medication contributes to patient adherence and management. Pharmacists are considered to be the most accessible health professional and can help HIV -infected patients deal with barriers to medication access, manage adverse effects and medication interactions, and adhere to medication regimens by appropriate counselling. The public sector is defined as that part of an economy that is controlled by the state. At the study site, which is a public sector facility, the roll out of antiretroviral medication started in 2006. At the time all patients were counselled by trained counsellors, before seeing a doctor. At the pharmacy the medication was collected with no intense counselling by a pharmacist as the patients would have visited the trained counsellors first. Subsequently it was found that there were many queries regarding HIV and AIDS. It was then decided in October 2007, that the pharmacist support the counselling done by the counsellors in that they should reinforce what was said by the counsellors, together with giving detailed information to patients on their health and medication. This study was therefore undertaken to measure pharmacists' role in the management and adherence of HIV infected patients at this institutional facility. Method: The study was undertaken at a public sector health facility using anonymous structured questionnaires and was divided into 3 phases: Pre-Intervention, Intervention and Post-Intervention phases. After obtaining patient consent the questionnaires were administered during the 1st phase. A month later all patients visiting the pharmacy were counselled intensely on various aspects of HIV and the antiretroviral medication. Thereafter patients who took part in phase 1 were asked to participate in the 2nd phase. After obtaining their consent again, the same questionnaire was administered to them. Quantitative variables were compared between pre and post intervention using paired t-tests or Wilcoxon signed ranks tests. Categorical variables were compared using McNemar's chi square test (Binary) or McNemar-Bowker test for ordinal variables. Results: A response rate of 87.5% was obtained with the majority of the patients being female. Almost 70% of the participants were in the age-range of 21-40 years old. The majority of the participants did not have post school education. Most of the participants (95.4%) did not know that HIV is a virus that causes AIDS in the pre intervention phase, but this decreased to 93.7% in the post intervention phase. The participants knowledge of people who have sexually transmitted diseases are least at risk of getting HIV, healthy food will cure HIV and smoking and drinking alcohol will weaken the HIV virus, increased significantly from the pre-intervention phase to the post intervention phase. Knowledge on the modes of transmission either increased or remained unchanged. Overall the mean knowledge score on the disease itself had increased significantly (SD 6.6%) [p<0.01] after the pharmacists' intervention (pre-intervention was 82.1 %, post-intervention was 86.3%). In both phases, over 40% of all patients stored their medication in the cupboard. The majority of the patients took their medication either with or without food at both phases of the study. After the intervention, the frequency of taking medication with a fatty meal or any time they remember was decreased to 0. A significant improvement was noted in the overall knowledge score with regards to medication taking and storage (p<0.05). Conclusion: Pharmacist intervention had a positive impact on HIV infected patients' HIV and AIDS knowledge on the disease and on the antiretroviral medication use and storage. / Thesis (M.Pharm.)-University of KwaZulu-Natal, Durban, 2011.

Short of a medical breakthrough, counselling is the only available tool to deal with the loss, pain and suffering that AIDS patients' experience. Studies have suggested that although there is a change in society's perception to AIDS, there still exist some negative attitudes and perceptions that occur among a variety of groups, which includes the health care workers. This study aims to investigate the construction of meaning, perceptions, and attitudes of HIV/AIDS among professional and lay counsellors . The researcher will compare lay and professional counsellors' attitudes, perceptions and meanings of AIDS. The Social Representational Theory was used to provide an understanding of how these metaphors and attitudes emerged and still exist. Qualitative methodology was used, which allowed the researcher to gather in - depth data necessary for the study of psychological issues. The study made use of non- probability purposive sampling. Data were collected by use of in-depth interviews. A pilot study was conducted to 'test' the interview schedule. Three lay and three professional , female counsellors were recruited for the interviews. All the interviews were tape recorded and transcribed. Thematic analysis was used to analysis the data. Essentially, the data reflected that there were many emergent metaphors which counsellors used that were similar to the general population. At times, these metaphors impacted on the counselling process. The findings of this study made recommendations in terms of more research around this area is needed, training programmes should include training in peer supervision and it should include more practical exposure to real situations. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2002.

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The need for a family therapeutic counselling programme in the management of HIV/AIDS was established by the researcher in 2001 (den Hollander 2001). The focus of this study was to develop the training programme model in family therapeutic counselling for church leaders and lay counsellors. This was accomplished using a variety of samples and research instruments, by firstly exploring the issues and problems facing people and families living with HIV/AIDS and then how best churches could respond as faith-based community organizations. At a theoretical level, this study sought to compare the paradigms of contextual and narrative family therapy with the theory and practice of social work and practical narrative theology, in order to integrate these paradigms into an incorporated response to the HIV/AIDS pandemic. The main research methodology was the Intervention Research Model as adapted from De Vos (2001). This model consists of six phases, consisting of problem analysis and project planning, information gathering and synthesis, design, early development and pilot testing, evaluation and advanced development, and dissemination of the training model. During the analysis phase an extensive literature research, as well as several field studies, both quantitative and qualitative were conducted. During the development phase, three pilot studies were designed and performed, in attempt to accommodate the context specific problems of different families and communities. The results of these two phases indicated a need for pastoral training in family therapeutic counselling, specifically in the areas of mental health, trauma and bereavement and child participation. Importantly, the need to intervene meaningfully to alleviate structural problems such as poverty and food insecurity were clearly indicated, with the study recommendation being for active networking across all stakeholders so that therapeutic counselling may work in tandem with these community based efforts. Recommendations in respect of offering such training are to provide a comprehensive structure of training, supervision and counselling practice. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

Estimation of current levels of human immunodeficiency virus (HIV) incidence is essential for monitoring the impact of an epidemic, determining public health priorities, assessing the impact of interventions and for planning purposes. However, there is often insufficient data on incidence as compared to prevalence. A direct approach is to estimate incidence from longitudinal cohort studies. Although this approach can provide direct and unbiased measure of incidence for settings where the study is conducted, it is often too expensive and time consuming. An alternative approach is to estimate incidence from cross sectional survey using biomarkers that distinguish between recent and non-recent/longstanding infections. The original biomarker based approach proposes the detection of HIV-1 p24 antigen in the pre-seroconversion period to identify persons with acute infection for estimating HIV incidence. However, this approach requires large sample sizes in order to obtain reliable estimates of HIV incidence because the duration of antigenemia before antibody detection is short, about 22.5 days. Subsequently, another method that involves dual antibody testing system was developed. In stage one, a sensitive test is used to diagnose HIV infection and a less sensitive test such is used in the second stage to distinguish between long standing infections and recent infections among those who tested positive for HIV in stage one. The question is: how do we combine this data with other relevant information, such as the period an individual takes from being undetectable by a less sensitive test to being detectable, to estimate incidence? The main objective of this thesis is therefore to develop likelihood based method that can be used to estimate HIV incidence when data is derived from cross sectional surveys and the disease classification is achieved by combining two biomarker or assay tests. The thesis builds on the dual antibody testing approach and extends the statistical framework that uses the multinomial distribution to derive the maximum likelihood estimators of HIV incidence for different settings. In order to improve incidence estimation, we develop a model for estimating HIV incidence that incorporate information on the previous or past prevalence and derive maximum likelihood estimators of incidence assuming incidence density is constant over a specified period. Later, we extend the method to settings where a proportion of subjects remain non-reactive to a less sensitive test long after seroconversion. Diagnostic tests used to determine recent infections are prone to errors. To address this problem, we considered a method that simultaneously makes adjustment for sensitivity and specificity. In addition, we also showed that sensitivity is similar to the proportion of subjects who eventually transit the “recent infection” state. We also relax the assumption of constant incidence density by proposing linear incidence density to accommodate settings where incidence might be declining or increasing. We extend the standard adjusted model for estimating incidence to settings where some subjects who tested positive for HIV antibodies were not tested by a less sensitive test resulting in missing outcome data. Models for the risk factors (covariates) of HIV incidence are considered in the last but one chapter. We used data from Botswana AIDS Impact (BAIS) III of 2008 to illustrate the proposed methods. The general conclusion and recommendations for future work are provided in the final chapter. / Theses (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

Highly active antiretroviral therapy (HAART) is currently the only treatment that effectively reduces the morbidity and mortality of individuals infected with Human Immunodeficiency Virus-1 (HIV-1). Standard HAART regimens typically comprise 2 nucleoside reverse transcriptase inhibitors and either one non-nucleoside reverse transcriptase inhibitor or a protease inhibitor. These drugs bind to and inhibit the HIV-1 Reverse Transcriptase and Protease enzymes respectively, thereby suppressing viral replication. The nucleoside reverse transcriptase inhibitors promote mitochondrial (mt) dysfunction by strongly inhibiting mt polymerase gamma (Pol-y) and subsequently, mtDNA replication. In contrast, the non-nucleoside reverse transcriptase inhibitors, efavirenz (EFV) and nevirapine (NVP) do not inhibit Pol-y although EFV has been shown to induce mt depolarisation ( mlow) in vitro at supra-therapeutic concentrations. However, the capacity of non-nucleoside reverse transcriptase inhibitor drugs to induce mt toxicity in vivo previously remained undetermined. The objective of this study was to determine the influence of EFV and NVP on peripheral lymphocyte mt transmembrane potential (Avj/m) and apoptosis in HIV-1-infected patients treated with these non-nucleoside reverse transcriptase inhibitors. Thirty-two HIV-1-infected patients on HAART between 4 and 24 months (12 on EFV, 20 on NVP) and 16 HAART-naive HIV-1-infected patients were enrolled into this study. All participants were black South African patients. Spontaneous peripheral lymphocyte apoptosis and mlow were measured ex vivo by flow cytometry for all patients. CD4 T-helper apoptosis for the EFV and NVP cohorts was 19.38% ± 2.62% and 23.35% ± 1.51% (mean ± SEM), respectively, whereas total lymphocyte mlow was 27.25% ± 5.05% and 17.04% ± 2.98%, respectively. Both parameters for each cohort were significantly lower (P < 0.05) than that of the HAART-naive patients. The NVP cohort exhibited both a significant time dependent increase in peripheral lymphocyte ö¿mlow (P = 0.038) and correlation between Thelper apoptosis and low (P = 0.0005). These trends were not observed in the EFV cohort. This study provides evidence that both EFV and NVP induce peripheral lymphocyte ö¿ m low in HIV-1-infected patients on non-nucleoside reverse transcriptase inhibitor-based HAART, which in the case of NVP is sufficient to induce the apoptosis cascade. / Thesis (M.Med.Sci.)--University of KwaZulu-Natal, 2008.

This dissertation, employing an array of theoretical approaches under the rubric of Systems Thinking, explores the reality and experiences of family members that mainly provide care at home for their loved ones who live with or are directly affected by HIV & AIDS. Employing a multidisciplinary approach, the dissertation demonstrates how Systems Thinking, feminist and indigenous knowledge principles can be employed for a better understanding of the contemporary construction of family and experiences of caregivers in an HIV & AIDS context. The discussion of the dissertation is based on data analysed following in-depth interviews with fifteen caregivers of the Bhambayi community. The findings of the study reflect a significant change in the definition and practice of parenting. It was found that HIV & AIDS forces a re-definition of the concept and practice of parenting beyond the traditional boundaries of age, sex and gender. Aligned with this main finding was that parenting practices and coping strategies are largely influenced by a strong commitment to the well-being of the children as well as societal constructs. The thesis of this dissertation is that the HIV & AIDS context and associated gender and cultural stereotypes are principally responsible for a significant shift in the understanding of the concept and practice of parenting within an African context. The study thus submits that a Systems Thinking approach ought to be used by interventionists to better understand and thus contribute towards improving the lives of families or communities in similar circumstance as that of the Bhambayi families. / Thesis (M.Com.)-University of KwaZulu-Natal, Westville, 2009.

HIV is major public problem in the world and in Sub-Saharan Region in particular. The literature has shown that mental disorders and particularly depression are common among people living with HIV/AIDS, but that little is known about the prevalence of depression and factors associated with it, among people living with HIV/AIDS in Rwanda. A descriptive, cross-sectional study was done to assess the prevalence of depression, the clinical profile and the factors associated with depression among people living with HIV and attending a primary health care centre in Kigali-Rwanda. This study was informed by the stress and vulnerability framework. A questionnaire was used to collect socio-demographic and HIV related medical information, while depression was assessed using the Beck Depression Inventory Scale, with a cut off of less than 10 for no depression and above 10 scoring positive for depression. Respondents were randomly selected from the patient appointment list for patients who were scheduled during the period of data collection and according to the sample selection criteria. The sample consisted of 96 people living with HIV. Permission to conduct the study was requested and obtained from the University of Kwazulu-Natal Ethics Committee, from the CNLS Research and Ethics Committee in Rwanda and from the management of the health care centre to consult patients' files. Data was analyzed using the Statistical Package for the Social Sciences (SPSS for window, 15). Descriptive data was analyzed by means of frequencies, mean and standard deviation. Cross tabulation using Pearson' chi-square test was performed to test the association between sociodemographic factors and HIV related medical information and depression for categorical variables, while t-test for independent simple test was performed for continuous variable. Multi logistic regression analysis was performed to test further association between the above mentioned factors with depression, while controlling for confounders. The results were presented by means of tables, histograms and graphs. The findings of the study revealed that depression is very high among HIV-infected patients attending a primary health care centre in Kigali, with a prevalence of 41.7%. The most frequent depressive symptoms presented were pessimism, fatigability, sad mood; lack of satisfaction, somatic preoccupation, loss of libido, crying spells, work inhibition, irritability, social v withdrawal and loss of appetite. The majority of respondents scored mild to moderate depression, whereas few had moderate to severe depression and only very few scored severe depression. Having considered all other socio-demographic and HIV related medical factors that were studied, being a female, having presented many HIV-related symptoms in the month prior to data collection, and having less than 250 CD4 counts were statistically associated with depression. On the other hand, having high social and family support was a protector factor to depression. Although the results of this study are not generalizable to the Rwandan population living with HIV, they underscore the importance of integrating mental health in HIV/AIDS services for the care of those who present mental problems related to HIV such as depression. / Thesis (MN)-University of KwaZulu-Natal, Durban, 2010.

The relationships between post-traumatic growth (PTG), benefit finding, happiness, pessimism and antiretroviral (ART) medication adherence were examined among 10 people living with HIV or AIDS who attended HIV support groups, and were currently prescribed ART medications. Analyses indicated that none of these psychosocial factors were significantly correlated with ART adherence, that the relationships continued to be non-significant after pessimism was partialled out of the analysis, and that participants who reported achieving optimal ART adherence did not significantly differ from participants who reported taking less than optimal ART adherence in regards to PTG, benefit finding, subjective happiness, or pessimism. The results suggest that interventions designed to change these psychosocial factors may not be effective means of improving ART adherence. / Department of Psychological Science

Chapter One introduces the "HIV Stops With Me" campaign, research by communication scholars on how HIV/AIDS messages are channeled, cultural influences, and the target audience of these messages in order to answer: What is the "HIV Stops With Me" campaign saying about individuals infected with HIV?Chapter Two describes the cluster analysis developed by Kenneth Burke. The steps in cluster analysis are: 1) identifying the key terms in the rhetoric, 2) charting the terms that cluster around the key terms, 3) discovering emergent patterns in the clusters, and 4) naming the motive, or situation, based on the meanings of the key terms.Chapter Three is a cluster analysis of the 2002 San Francisco "HIV Stops With Me" campaign. Key terms found in this analysis are "HIV," "sex," "life/living," and "death/dying."Chapter Four contains conclusions pertaining to the analysis of the rhetorical artifact, conclusions for cluster analysis, and future implications for academic scholarship. / Department of Communication Studies