Magister Artium (Child and Family Studies) - MA(CFS) / The aim of this study was to capture the intensity and incidence of catastrophic health care expenditures in order to describe the degree to which catastrophic health care payments occur among households. Simultaneously, the study set out to assess the extent to which people are made poor or poorer by health spending, i.e. the impoverishing effects of healthcare spending. / South Africa

Cardiovascular disease (CVD) risk behaviors, namely tobacco smoking, hazardous alcohol use, poor diet and sedentary behavior, are more prevalent among people living with HIV (PLWH) than the general population. Qualitative evidence shows that PLWH report adopting unhealthy behaviors as a means of coping with the stress of living with HIV, including the adverse physiological symptoms of HIV infection, the psychological stress of being aware of one’s HIV status, and the physiological and psychological impacts of being on HIV treatment. These observations suggest that being HIV-positive may have a causal influence on CVD risk behaviors and that these causal effects likely differ across stages of the HIV continuum. To date, few quantitative studies have been conducted to examine these causal relationships. The goal of this dissertation was to explore the effects of HIV continuum stage on CVD risk behaviors and assess several plausible stress-coping mechanisms, as motivated by established stress-coping theory. This dissertation consisted of three studies. First, a systematic review was conducted to examine the existing quantitative evidence for the causal effects of HIV continuum stage on CVD risk behaviors. Findings from this review revealed that being HIV-positive is associated with excess smoking and drinking, and that while receipt of a positive HIV diagnosis is associated with short-term improvements in some CVD risk behaviors, these improvements are unlikely to be maintained long-term. Overall, however, the existing studies suffer important methodological limitations, notably inadequate characterization of HIV continuum stage. The second study was an empirical analysis of patterns of self-reported CVD risk behaviors across the HIV continuum among a population-based sample of 4,061 adults aged 40 years and over living in rural Agincourt district in South Africa. Results showed no consistent evidence of an association between HIV continuum stage and hazardous alcohol use or sedentary behavior. However, higher prevalence of smoking was observed specifically among males who were HIV-positive and aware of their status but not on treatment, compared to those who were HIV-negative. There was no evidence of mediation by various measures of physiological and/or psychological stress. The third study was an analysis of whether perceived life expectancy (PLE) modifies the effects of HIV continuum stage on CVD risk behaviors. Observed associations were most prominent among individuals with low PLE and null among those with high PLE. Overall, this dissertation contributed to greater understanding of the relationship between CVD risk behaviors among HIV-infected persons across the HIV continuum. Findings did not support a stress-coping hypothesis; however, PLE was found to be a potentially useful indicator of individuals who are most likely to smoke in the presence of HIV. This dissertation also fills evidence gaps among older adults in sub-Saharan Africa, an under-studied population with high and increasing burdens of both HIV and CVD. As HIV-positive population survive longer on antiretroviral therapy and the prevention of age-related conditions becomes increasingly important, these findings may help inform future research and the development of CVD prevention interventions.

Thesis (M. A. (Clinical Psychology)) -- University of Limpopo, 2016 / In this study, the researcher aimed to discover stigma associated with people living with HIV and AIDS in Mahwelereng, Limpopo province. The researcher sampled five males and five females and they were between the ages of 18 and 35. In-depth interviews were a method of choice during data collection. Thematic content analysis was used to analyse data. The results show negative perceptions towards PLWHA. The community discriminate PLWHA because of fear of being infected, with females being at a higher risk because they are perceived to be promiscuous. Participants also highlighted that black people lack knowledge of how to treat and behave towards HIV/AIDS infected individuals. It is recommended that there should be studies that focus on availability of interventions that aim to combat HIV/AIDS stigma. Lastly, the future studies should explore which race groups have more knowledge and perception about HIV and AIDS. KEY CONCEPTS: Acquired Immune Deficiency Syndrome; Human Immunodeficiency Virus; People Living with HIV and AIDS; Stigma. / National Research Foundation (NRF)

"This dissertation first explores specific issues highlighting the weaknesses in the legal provisions on women's rights and HIV/AIDS problems and its resulting effect on the obligation of African states to take adequate measures to protect women, especially those living with HIV/AIDS. Secondly, it examines, for purpose of meeting the first objective, into what is provided for by the African regional human rights system through the Charter provisions, declarations and resolutions relating to HIV/AIDS and the Protocol on the Rights of Women. Thirdly, the disseration inquires into the extent to which Mozambique is meeting its obligations to address the problem of discrimination against women and to provide health care to women living with HIV/AIDS. Finally, in the light of the lacunae found within the African regional human rights system in addressing women's rights and HIV/AIDS, this disseration will make recommendations to fill the void and better protect the rights of women in Africa, especially those living with HIV/AIDS. ... The study will consist of five chapters. Chapter one provides the context in which the study is set. It highlights the basis and structure of the study. Chapter two outlines specific issues on the inability of the various legal provisions on women's rights and HIV/AIDS to effectively protect women from the scourge of HIV/AIDS, Chapter three discusses the African regional human rights system. Here specific refernce is made to some provisions of the African Charter relating to the right of women as well as some declarations and resolutions on the HIV/AIDS pandemic. Also references is made to the Protocol on the Rights of Women. Chapter four highlights and addresses the gaps relating to the protection of women from HIV/AIDS in the African regional human rights system and finally chapter five will consist of a summary of the disseration and the conclusions drawn from the entire study. It will also make some recommendations as to how HIV/AIDS should be dealth with both at the regional level (the role of the African Commission) and at the domestic level (the role of the state) in relation to the violation of women's rights." -- Introduction. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2004. / Prepared under the supervision of Mr. Leopoldo de Amaral at the Faculty of Law, Eduardo Mondlane University, Mozambique / http://www.chr.up.ac.za/academic_pro/llm1/llm1.html / Centre for Human Rights / LLM

MSc (Microbiology) / Department of Microbiology

University of Venda / MSc (Microbiology)

Thesis (M.Sc.) -- University of Limpopo, 2016 / Purpose of the study The purpose of this study was to investigate the experiences of couples on disclosure of their HIV-positive status to each other. Research methodology Qualitative, Phenomenology, exploratory descriptive and contextual research was conducted to identify the experiences and to determine the strategies that address non-disclosure of couples on their HIV-positive status. The population comprised 12 participants (six (6) couples). Purposive sampling was used to select eight (8) participants (four (4) couples) who participated in the study. Semi-structured interviews were used to collect data until data saturation was reached. Study findings Data were analysed using Tesch’s open-coding method. Five themes emerged, namely, fear of being HIV-positive, disclosure of HIV-positive status is a difficult process, acceptance of HIV-positive status, relations between partners post knowledge of HIV-positive results and encouragement pertaining to disclosure of HIV-positive status. Strategies were developed to address the experiences identified. Recommendations were made for the Department of Health, clinic staff, future researchers, patients and community members. Conclusion Although couples disclosed their status to one another disclosure was found to be a difficult process. Acceptance of HIV status was also found to be one of the challenges that led to delayed disclosure of the status. Support system from both family and community is a very important factor which might increase HIV status acceptance and disclosure from couples. Keywords: Couples, experiences, disclosure, HIV-positive status.

This study was designed to investigate what course of action therapists and physicians report they would take in reconciling their conflicting duties to maintain confidentiality and protect third parties from harm in HIV-related situations. The physicians surveyed were licensed to practice medicine in Texas and board certified in Internal Medicine. The therapists surveyed were licensed professional counselors in Texas and members of one of three selected divisions within the Texas Counseling Association. A survey instrument developed by the researcher was mailed to 200 subjects randomly selected from each group.

To end the HIV epidemic, prevention of new HIV infections will be contingent on preventing at-risk individuals from acquiring HIV and supporting people living with HIV in achieving and sustaining viral suppression throughout their lifetime. The underlying motivation for this dissertation is the recent evidence that new HIV infections can be prevented when people living with HIV achieve and maintain viral suppression. In response, three studies were conducted. The goal of this dissertation was to advance our understanding of HIV viral suppression patterns over time among clinically engaged adults living with HIV and examine current limitations in viral suppression monitoring. First, a systematic review evaluated the existing literature for evidence of longitudinal assessments of viral suppression among people living with HIV. Among 896 publications identified during the database search, 50 publications met the study criteria and were included in the review. Among these studies, 78% were implemented in the United States, 72% assessed viral suppression using viral load results abstracted from clinical medical records, and 22% used surveillance data from HIV-laboratory based reporting. Five distinct longitudinal measurement methods were identified, including (a) estimates requiring more than one viral load within an observation period to be below a suppression threshold; (b) estimates comparing the first and last viral load during an observation period; (c) reporting multiple proportions of participants maintaining viral suppression across an observation period; (d) estimating viremia copy-years and estimating person-time above a suppression threshold, and; (e) other methodology to assess longitudinal viral suppression such as data weighting and group-based trajectory modeling. Half of the studies reported the proportion of individuals with all viral loads below a certain threshold (e.g., ≤200 copies/mL). Most studies (70.0%; 35/50) were published in the last five years (2015 – 2019) and describe viral load data collected between 2013 and 2018, highlighting recent efforts by researchers to describe viral suppression using longitudinal approaches. Next, data from a longitudinal electronic medical record-based prospective cohort study of people living with HIV seeking care in Washington, District of Columbia, were used to describe longitudinal changes in viral suppression and assess the relationship between prior virologic history and virologic failure events during follow-up. Among 3556 participants, 29% did not maintain viral suppression during a five-year period, and instances of viral suppression status fluctuations were observed. Participants with a history of fluctuating viral suppression were found to have a higher rate (RR=2.40; 95% CI: 2.03 – 2.84; P<0.01) of virologic failure events during follow-up, compared to participants with sustained viral suppression before the observation period. Lastly, a third study used the same data source to assess differences between viral suppression estimates derived from different measurement methods and evaluate the impact of data triangulation on longitudinal viral suppression measures. Among 3452 participants (median age 48; 73% cisgender males; 77% non-Hispanic black), 69% had all viral load results suppressed (<200 copies/mL) during a four-year observation period, 28% had both suppressed and unsuppressed viral loads, and 2% had all viral loads unsuppressed. Compared to cross-sectional viral suppression measurement methods, longitudinal measurement methods resulted in lower proportions of virally suppressed participants. Data triangulation added 2293 viral load data points and resulted in lower viral suppression estimates. These findings highlight the need to reconsider current viral suppression measurement methods to improve the accuracy of estimates reported in surveillance reports and epidemiologic studies. Overall, this dissertation addresses important questions related to viral suppression by describing the frequency of viral suppression status fluctuations that occur throughout an extended observation period, quantifying the occurrence of repeated virologic failure events, and comparing several measurement techniques to assess appropriate methods to describe viral suppression over time. Recently, the United States Department of Health and Human Services, together with the White House, set forth the “Ending the HIV Epidemic: A Plan for America” initiative, with a goal to end the HIV epidemic in the United States within the next ten years. To reach this goal, the initiative calls for a 75% reduction in new HIV infections by 2025 and a 90% reduction by 2030. Treating people living with HIV rapidly and effectively with ART is an important strategy to carry out these efforts. This dissertation demonstrates that assessing the ability of people living with HIV to maintain viral suppression over time is also critical.

A research report submitted to the Faculty of Human and Community Development, University of Witwatersrand in partial fulfilment of the requirements for the degree of Masters of Arts in the field of Social Development, January 2018 / Human Immunodeficiency Virus (HIV), which leads to Acquired Immune Deficiency Syndrome (AIDS), is one of the world’s greatest health threats and leads to death of millions of people. In 2016, an estimated one million people died of AIDS related causes globally. An estimated 36,7 million people in the world are living with HIV and AIDS. HIV counselling is regarded an integral part of prevention and coping strategies and an effective tool in preventing the spread of HIV and AIDS. HIV and AIDS have negative psycho-social effects to individuals and families. This study investigated counsellor’s knowledge of HIV and AIDS, attitudes towards PLWHA and counselling practices at Non-Governmental Organization (NGOs) operating within Emfuleni Local Municipality. Incorrect knowledge of HIV and AIDS, negative attitudes towards PLWHA and poor practices can negatively affect efforts to curb the pandemic. A non -experimental study was conducted with a sample of 101 HIV counsellors. Data was gathered by a self - administered questionnaire soliciting counsellors responses pertaining to knowledge of HIV and AIDS, attitudes towards PLWA and counselling practices. Data was analysed quantitatively utilising the Statistical Package for Social Scientists (SPSS). A statistical analysis was done to test the significance of relationship between knowledge of HIV and AIDS, attitudes towards PLWA and practices utilizing the demographics of the study group. The majority of respondents 86(84,8%) had good knowledge of HIV and AIDS. There were no significant relationships (P>0,05) between age, race, marital status, qualifications, years of experiences and respondents’ level of knowledge. Attitudes towards PLWHA (87,16%) were positive and were not statistically significantly correlated with HIV and AIDS knowledge and counselling practices. There were significant relationships between qualifications and counselling practices (F = 4,335, P= 0,003). / XL2019