M.Ed. / Over the past decade, the HIV/AIDS pandemic has had a devastating effect on many communities and families in South Africa. Many families have already lost, and many more will lose, primary caregivers to the disease. This could have a serious impact on the living conditions and emotional wellbeing of families, and especially of children and adolescents. As an intern educational psychologist working in the Eldorado Park community, the researcher became aware of the difficulties and needs experienced by families that are affected by HIV/AIDS. This study therefore aims to identify the needs of families affected by HIV/AIDS, in order to assist the educational psychologist by making recommendations for weaving a circle of care to support them, within an asset-based approach. To accomplish this, the study utilised a participatory research approach within a critical theoretical paradigm and case study design. Purposeful selection was employed and as the study is concerned with HIV/AIDS which requires the utmost confidentiality, the families were identified with the help of home-based care workers. The researcher interviewed three families and eight home-based care workers in the Eldorado Park community. Detailed data analysis and interpretation of the needs highlighted during these interviews revealed a number of common themes, which are indicative of the needs of families affected by HIV/AIDS in the Eldorado Park area. These families expressed a need for awareness, love and understanding from their communities. They also wish to have greater understanding and support from schools, as well as expressing the need for opportunities to share their experiences and raise community awareness by speaking at schools and churches, and through support groups. Families furthermore require assistance with the great economic difficulties they face, largely due to illness and unemployment. A need to gain greater access to medical care, social grants and burial societies, was expressed. Difficulties with transport and documentation seemed to create a major barrier in this regard. The need for psychological and spiritual counselling as well as legal advice was highlighted. The study provides recommendations and a practical asset map to assist the educational psychologist in weaving a circle of care for families affected by HIV/AIDS. / Mrs. Helen Krige Dr. Elzette Fritz

No description available.

Submitted in fulfillment of the requirements for the degree of Masters of Health Sciences in Clinical Technology, Durban University of Technology, Durban, South Africa, 2016. / Introduction: The immediate post-cardiopulmonary bypass (CPB) immune responses and organ injuries in immune- compromised patients remain poorly documented. We conducted a prospective clinical study to determine whether or not human immunodeficiency virus (HIV) seropositive patients generate higher acute systemic inflammatory response and suffer greater myocardial injury, compared to HIV seronegative patients. Methodology: Sixty-one consecutive patients i.e. Thirty HIV seropositive patients and Thirty-one seronegative, undergoing elective cardiac valve(s) replacement were enrolled, over a period of nine months from a single center hospital, after informed consent was acquired. The C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) were used as biomarkers of acute inflammatory response, and cardiac troponin I (cTnI) as a biomarker for measuring postoperative myocardial injury. Single tests were measured preoperatively and postoperatively, in both groups, and these were compared and correlated to perioperative events and CPB parameters. Results: The mean age group was similar between the HIV seropositive and negative group (37.8 and 37.1 years, respectively). Preoperatively both groups had relatively equal CRP levels (p=0.388), ESR levels (p=0.817) and cTnI (p=0.489). The CPB events and durations were significantly different between the two groups, CPB duration (p=0.021). Other CPB events include, clamp aortic duration (p=0.026), CPB blood transfusion (p=0.013), CPB total urine output (p=0.035) and CPB peak lactate (p=0.040). Postoperatively we observed significant increased biomarkers level in both groups, with no significant difference between the groups: mean CRP (p=0.115), mean ESR (p=0.214) and cTnI (p=0.363). We observed a significant negative correlation between the mean change in CRP levels and mechanical ventilation (r=- 0.548, p=0.002) in the seropositive group, but not in the uninfected group (r=0.025, p=0.893). The correlation between the difference in CRP and ICU stay was not significant between in both group (r=-0.231, p=0.229 and r=0.25, p=0.975, respectively). A significant positive correlation between postoperative cTnI and the inotropic support duration (r=0.384, p=0.040) was seen in the seropositive groups, but not in the negative group (r=0.092, p=0.622). Furthermore we observed a significant drop in CD4 cells postoperatively (p=<0.001) in the HIV seropositive group. Antiretroviral treatment appeared to influence the degree of change in CD4 cells postoperatively. Conclusion: We conclude that HIV positive patients’ postoperative reactions to cardiac surgery supported by CPB are similar to those of HIV seronegetive patients. We further report non-paralleling correlations between the biomarkers and perioperative events; however these do not seem to affect the overall outcomes between the two groups. / M

Submitted in fulfillment of the requirements for the Degree in Master of Health Sciences (Nursing), Durban University of Technology, Durban, South Africa, 2016. / Background South Africa, especially KwaZulu-Natal remains heavily burdened with HIV and AIDS. Timely HIV testing is the cornerstone to HIV prevention in terms of early diagnosis and access to treatment, care and support services. Factors that influence delayed HIV testing must be investigated and reported to inform plans that are directed at improving implementation of HIV testing services and access to care, treatment and support services for people living with HIV. Purpose of the study This study was aimed at identifying factors that lead to delayed HIV testing in a sample of people attending a Primary Health Care clinic in KwaZulu-Natal, South Africa. Methodology A descriptive qualitative design was used in this study. The population in this study was HIV positive patients who had recently tested for HIV and received their first CD4 count result of 350 mm3 or less. Purposive sampling, which is a type of non-probability sampling, was used to select the study participants from the population. Semi structured interviews using an interview schedule were used to collect data. Data was collected until data saturation was reached. Results The data was analysed by means of content analysis and raw data was coded and sorted into sub categories and categories. The underlying meaning of categories was formulated into one overarching theme: Testing for HIV is daunting and embedded with issues of stigma, denial and a fear of knowing one’s positive status. Conclusion To encourage early HIV testing before HIV positive people become noticeably ill requires efforts directed at change of attitude and improvement of support for HIV positive people in families, communities and health service institutions. Community forums to be actively involved in eliminating the stigma and discrimination associated with HIV positive people by creating awareness of these matters and encouraging community and family support for people with HIV. / M

M.Cur. / The purpose of this study is to identify the midwives experience in doing the delivery or a HIV-positive patient. Because the incidence of AIDS is increasing in the heterosexual population and thus the women in their reproductive years, it is important for the midwife to know how feelings for the HIV-positive patient. It is the midwife who has to give counselling and support to tho HlV-positive patients and in doing so, she herself must get counselling end support. Unstructured in-depth interviewB wore held with r Ivo midwives on one occasion. Each midwife should have done at least one delivery of a HIV-positive patient. The experiences of the midwives was then combined and a literature control was done to consult other authors' findings on the heath workers experience of HIV positive patients. Recommendations were made at the end of the study concerning applications to practice, education, further research and the counselling of the midwife.

D.Cur. / The nurses who work in the hospitals are constantly in interaction with the patients. As the HIV infection has now reached the AIDS phase, most people who were infected five to ten years back are now sick due to HIV/AIDS compromised conditions. The statistics inform us that mostly young people are dying. This has reversed nature, in that elders are now burying the youth. The HIV/AIDS infected people who are ill are admitted to general hospitals for health care. At present the patients are cared for in the general wards with other patients who may not be HIV/AIDS infected. In the hospitals they are cared for by the health team, of which the nurses are with these patients for 24 hours a day. This study focused on the interaction between nurses and admitted patients who are HIV/AIDS positive. The patients may have been admitted due to opportunistic diseases or any other illnesses. Most patients with HIV/AIDS suffer from opportunistic diseases, pain and stress. Nurses become aware of the patient’s HIV/AIDS status for health care reasons. Nurses are in most institutions the first contact in health care. Therefore the nurses are engaged in established relationships with patient, families, friends and the community for the purpose of the provision of health care services. These relationships entail interaction. The interaction between the nurse and the patients plays a major role in the care of the patient. This interaction between the nurses and patients entails a number of aspects, such as communication, be it verbal or non-verbal. The latter includes behavioural and affective aspects, such as attitudes, the way care is provided and how the parties feel about the interaction. Nursing is a human interaction. In this interaction the nurse and the patient build a therapeutic relationship, resulting in assistance to facilitate the wellbeing of the patient and rapid recovery. The HIV /Aids infection affects the patient as a whole because of the stigma attached to the disease, therefore the affected patients need to be assisted in order to cope with the illness and its consequences. Therefore the purpose of the study was to: • To explore and describe the nurses’ and patients’ (who are HIV AIDS infected) experience of their interaction. • To develop and describe a model that would assist the nurses to facilitate the promotion of mental health in patients who are HIV/AIDS infected. A theory generation research which is qualitative, descriptive and explorative and contextual in nature was conducted with permission from the Department of Health authorities, hospital authorities, admitted patients with HIV/AIDS, the NGO that looks after the patients in the community after discharge, the nurses who work in the general wards and the University of Johannesburg Ethical and Research committee. Pilot interviews were conducted with one nurse-participant and patientparticipant that met the selection criteria.

M.Tech. (Radiography) / This was a prospective, quantitative comparative study. The aim of the study was to evaluate acute toxicity of radical combination therapy, in the form of radiotherapy and chemotherapy, in HIV +ve patients on HAART and HIV -ve patients for cervical cancer at CDH, Lusaka, Zambia. The specific objectives were to compare acute toxicity in HIV +ve on HAART and HIV -ve patients and to assess the level of severity in the levels of toxicity. The study was conducted from January 2010 to December 2010. A hundred and twenty stage IB₂-IIIB cervical cancer patients were serially recruited and assigned study numbers for identification and confidentiality. Participants received Cisplatin based radical chemoradiation for five to six weeks during which time they were assessed for acute reactions and data was prospectively collected. Four systems namely Genitourinary, Haematopoietic, Skin, and Gastrointestinal were used for the assessment of toxicity in the study. Toxicity was scored using the NCI CTC v2.0. The results of this study showed that, major acute reactions in the CDH study participants were grade 3 leucopoenia (five in each study arm) and one grade 3 acute skin toxicity in the HIV +ve arm. Results also revealed that there were three HIV +ve study participants with grade 3 vomiting and one HIV –ve. There was one grade 3 anaemia in the HIV +ve arm, one grade 3 anaemia in the HIV –ve arm and one grade 4 anaemia in the HIV +ve arm. However, only the incidence of grade 3 leucopoenia in both study arms and vomiting in the HIV +ve study participants was significantly higher. This study demonstrated that radical chemoradiation is well tolerated by HIV +ve patients with intact immunity. Toxicity was usually mild and reversible and no exaggerated toxicities beyond those generally associated with single-agent Cisplatin were observed in the HIV +ve study participants. Therefore, radical chemoradiation in conventional doses can safely be given to cervical cancer HIV +ve patients who are on HAART.

Magister Scientiae - MSc (Mathematics) / The high prevalence of HIV/AIDS in Zambia has led to the development of innovative ways of coping with sickness related to this infection. HIV/AIDS home-based care is one such innovation designed in Chikankata Hospital in 1987. Home-based care depends on the availability of family members and community volunteers in the provision of care and support for People Living with HIV/AIDS (PLWHA).This minithesis is based on a qualitative descriptive case study exploring perspectives regarding skills, supervision and support mechanisms for carers in the Chikankata HIV/AIDS Community-Home Based Care (CHBC) program. The study utilized documented research, focus group discussions with carers and structured interviews with local CHBC supervisors, national experts in CHBC, and PLWHA and their families, to collect data from 32 study participants.The findings were that CHBC was being delivered by community volunteers with limited involvement from the local health services; that carers were highly motivated, personally and collectively mobilizing resources to meet the needs of CHBC clientele; that local arrangements for training, skills and support of carers were not aligned to national guidelines regarding process, content and duration of programmes; and that carers acquired skills in CHBC through formal and informal training processes and were facing challenges related to inadequate skills, poor infrastructure and extreme poverty in households caring for PLWHA.Based on the findings the local arrangements for coordination of CHBC need to be strengthened and linked to formal processes for technical support, financial resources and materials for delivery of CHBC in line with existing guidelines on CHBC. The picture of the real situation of the carers that emerges from this qualitative study might inform the supervising organizations and policymakers on the gaps in the training and support of this crucial cadre in the provision of quality care for People Living with HIV/AIDS (PLWHA) at community level. / South Africa

Magister Artium - MA / This research explored cultural perceptions of HIV & AIDS with students at the University of the Western Cape and attempted to understand how these perceptions of the disease reinforce stigma and stigmatising attitudes towards people living with HIV/AIDS. This study investigated HIV/AIDS stigma as a social phenomenon and analysed the socio-cultural and historical roots of HIV/AIDS stigma. / South Africa

This survey was designed to identify the incidence and scope of depression, satisfaction with life, self-efficacy and perceived access to medical care for those who are infected with the HIV virus. It also determined whether or not factors such as sexual orientation, ethnicity and socioeconomic status are intervening variables with respect to mental health issues. Subjects were recruited through a purposive sample from South Florida. A total of 871 surveys were used in the analysis. The overall response rate was nearly 90%. The incidence of depression was found to be higher than 75% across all stages of HIV infection. Furthermore, the incidence of depression increased as HIV disease progressed. Satisfaction with life and for the most part, self efficacy were found to decrease slightly as HIV disease progressed. Significant variance in depression, life satisfaction and self efficacy were found across stages of HIV infection. No significant differences between groups that were HIV infected, were found for depression, life satisfaction and self efficacy. The severity of depression was found to vary significantly with self efficacy, life satisfaction and access to medical care but not with socioeconomic status. Life satisfaction was found to vary significantly with socioeconomic status, depression and self efficacy but not with access to medical care, Self-efficacy was found to vary significantly with socioeconomic status, depression and life satisfaction but not with access to medical care. Gender and ethnicity were not found to be significant precedent variables in depression for HIV infected individuals. Sexual orientation was found to be a significant precedent variable for depression, life satisfaction and self efficacy.