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Thesis (D. Tech. (Clinical Technology )) - Central University of Technology, Free State, 2013 / The HIV pandemic in South-Africa has created a new form of vulnerability for households with regards to food security and nutritional status which are vital components in the general care of HIV-infected individuals. The risk of nutritional deficiencies and malnutrition are predictors of disease progression and treatment in resource limited settings. Furthermore, HIV affects nutritional status by increasing the energy requirements, reducing food intake, affecting nutrient absorption and metabolism inadequacies due to cytokine activity and diarrhea. Several vitamins and minerals are important in fighting HIV infection because they are required by the immune system and major organs to attack infectious pathogens. Many of these micronutrients have been found to be deficient in HIVinfected persons and several studies were launched worldwide to investigate the feasibility of food assistance and nutrient supplementation. Nutritional supplementation has been advocated in HIV-infected persons especially in lowincome countries such as South Africa. Therefore, a study to evaluate the role of nutritional supplementation in HIV-positive patients becomes necessary, especially in a developing country such as South Africa. It is against this background that the present research was initiated to examine the influence of a nutritional supplement on the immune status and health status of HIVpositive/ AIDS adult individuals. The aim of the investigation was to determine if supplementation with a mixture comprised from specific minerals, vitamins and herbs over a period of one year, affected the haematological status, immune status, viral load and pulmonary function in forty (40) HIV-infected individuals living in the Mangaung Metropolitan, RSA. viii A quantitative, open-labeled, before-after clinical trial was conducted at the Central University of Technology, in Bloemfontein, Free State Province in the RSA. Socio-demographic and dietary intake questionnaires were completed. All data pertaining to anthropometric measurements, haematological status, immune status, viral load and pulmonary function were obtained my means of using standard procedures and technological equipment. The data were subjected to parametric and non-parametric statistical analysis. The results of the present investigation show that the eating pattern of this urbanized group of individuals reflects high energy (KJ) and macronutrient intakes coinciding with sub-optimal intake of Vitamin D and iodine. Of all the haematological variables the only statistical significant changes observed were increases in the median erythrocyte sedimentation rate (ESR) (p=0.0219) and mean cell haemoglobin concentration (MCHC) (p=0.0245) after six months of nutritional supplementation. At 12 months a statistical significant decrease in the median CD/CD8 ratio (p<0.0048), median Hematocrit concentration (p<0.0312), median mean cell volume (MCV) (p<0.0359), and median RDW (p<0.0273) accompanied a statistically significant increase in the MCHC (p<0.0003) at 12 months after supplementation. At 6 months 89% (CI95%: 73%; 96%) of the individuals showed a decline in viral load counts with a median percentage decline of 34% (CI95%: 73%; 96%). At 12 months 85% [CI95%: 68%; 94%] of the individuals show a decrease in viral load counts with a median percentage decline of 62.9% (CI95%: 50%; 78.6%) following the intake of the supplement. The main findings of the present investigation reveal that 68% (50%-81%) of the individuals show a statistical median increase (p=0.0302) of 16.9% (11.5%; ix 36.1%) in the Peak Expiratory Flow (PEF) at six months. A significant decrease (p=0.0484) in the median FEF75 of 28.1% (14%; 35.3%) is observed in 70% (53%-83%) of the individuals after 12 months of exposure to the supplement. No statistical significant changes are observed for FVC, FEV1, FEV1/FVC and FEF50 over the entire trial period. The present results suggest that a significant measurable decrease in viral load in HIV-infected individuals can be obtained by means of subjecting individuals to a nutritional fortification supplement strategy for 6 months or more.

This study was an attempt to investigate the influence of socio-cultural factors on HIV prevention strategies among HIV discordant couples in Harare, Zimbabwe. HIV sero-discordance is a scenario whereby one partner is HIV-positive and the other is HIV-negative. HIV sero-discordant couples are a unique and vulnerable population that encounters many peculiar challenges. When dealing with this population, researchers have to deal with contradictory ideas and perceptions presented by each partner making up the couples and also understand the relationship in the context of cultural values, norms and the dynamic of power and oppression. In addition to this, the concept of HIV sero-discordance and the frequency of its occurrence are poorly understood in most African communities. Despite the growing evidence of HIV discordance, HIV prevention strategies have largely focused on clinical aspects at the expense of socio-cultural issues that impact on HIV prevention strategies targeted at HIV sero- discordant couples. The study seeks to contribute to the conceptualization and design of intervention programs dealing with sero-discordance. The study is underpinned by the symbolic interactionism theory and was qualitative in design involving 13 HIV discordant couples in heterosexual relationships enrolled in the HIV Preventions Trials Network 052 Study (HPTN 052 Study) being undertaken by the University of Zimbabwe’s department of medicine. The study utilized 2 Focus Group Discussions (FGD) and 10 in-depth interviews (IDI) to collect data. The study’s findings indicate that discordant couples are in fact critical stakeholders in the uptake of all the available HIV prevention strategies. Failure to acknowledge this tenet is self-defeating as evidenced by the perception of viewing condom use within a marriage as humiliating for a woman. The study further noted that practitioners in the HIV prevention domain must guard against over-relying on the scientifically demonstrated efficacy of the strategies. The study recommends that HIV prevention strategies must be socially and culturally acceptable and embedded for them to be more efficacious. / Sociology / M.A. (Social Behaviour Studies in HIV and AIDS)

The study explored the factors influencing the use of voluntary counselling and testing by university students. This was done by undertaking an exploratory and descriptive qualitative study. Focus group discussions and field notes were used to collect data from the participants. Outcomes from the study revealed various factors to the uptake of Voluntary Counselling and Testing (VCT) services by university students namely: the desire to know one‟s HIV status, illness, pregnancy, blood donation, to get a reward, the influence of significant others, the influence of media, awareness campaigns, compulsion, to get a job, curiosity, to be a positive role model and the positive attitude and professional conduct of the health care provider. The study also revealed various challenges to the uptake of VCT services by university students namely: the fear of being diagnosed HIV positive, HIV/AIDS-related stigma and discrimination, the low perception of risk to HIV infection, the lack of student friendly VCT services, the shortage of human and infrastructural resources, the inaccessibility of VCT services, the long waiting period for test results, negative perceptions about VCT, the problems with pre-test counselling and ignorance. Going by the participants‟ suggestions VCT services uptake by university students could be improved by increased resource allocation (incentives, human and infrastructural resources), increased awareness campaigns, and improved counselling and making VCT services more accessible / Information Science / MA (Public Health)

Thesis (MPhil)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: In Namibia the HIV prevalence rate in adults (15 to 45 years of age) is estimated at 18.1%. The first HIV infection in Namibia was reported in 1986 and the epidemic constitutes the biggest developmental challenge for Namibia. Approximately 39 new infections occur every day and approximately 28% of deaths in the country are AIDS-related. The majority of Namibia’s workforce is in the age group of 15 years to 45 years and it can be anticipated that HIV and AIDS will have a major disruptive effect on the country’s workforce as well as its economy over the next two decades. According to the Namibian government, voluntary counselling and testing (VCT) for HIV is one of the most effective methods to prevent the spread of the epidemic. With this in mind, this study aims to evaluate the outcome of voluntary counselling and testing at one workplace in Windhoek, Namibia, to see whether VCT provides education as well as whether VCT is a vehicle to promote awareness, good attitudes, intentions and behaviour change. The main purpose of this outcome evaluation is to determine to what extent voluntary counselling and testing at the workplace has led to HIV-related changes in knowledge, attitudes, behaviour and practises. Although the majority of respondents indicated that their knowledge of HIV had increased after their participation in the VCT programme, upon closer analysis it was evident that participants who had a secondary or higher level of education had more knowledge, or had had more of a knowledge increase, than participants with a primary or lower level of education. From the research findings, it appeared that the voluntary counselling and testing had helped participants to identify their individual risks, as their self-reported risk perceptions with regard to becoming infected with HIV and/or a sexually transmitted disease increased after their participation in the VCT. There was also evidence that participants implemented risk reduction plans after the voluntary counselling and testing, as the percentage of participants who had casual sex partners decreased while the percentage of participants who had not had casual sex partners in the previous six months increased. It can be concluded that the general attitude amongst employees towards HIV-positive people is relatively non-discriminatory. However, it seems that the VCT was not as successful in transferring information and education on HIV amongst employees with lower education levels than amongst their peers with higher levels of education, and employees with primary or lower education levels appear not to have benefited much from the intervention in terms of an increase in knowledge. It is recommended that voluntary counselling and testing be provided to the employees at the company on a regular basis, not only because employees have requested it, but also to monitor whether the voluntary counselling and testing for HIV at the company has had the desired effects on the employees, especially with regard to effecting an increase in knowledge, a reduction of stigma and discriminatory attitudes, and the desired behaviour change amongst participants. / AFRIKAANSE OPSOMMING: In Namibië word die MIV voorkomssyfer onder volwassenes (ouderdom 15 tot 45 jaar) op 18,1% geskat. Die eerste MIV-geval in Namibië is in 1986 aangemeld en vertoonwoordig die land se grootste ontwikkelingsuitdaging met ongeveer 39 nuwe infeksies daagliks en ongeveer 28% van sterftes in die land wat VIGS-verwant is. Die meerderheid van Namibië se werksmag val in die ouderdomsgroep 15 tot 45 jaar en daar kan verwag word dat MIV en VIGS oor die volgende twee dekades grootskaalse ontwrigting op die land se werksmag sowel as sy ekonomie gaan veroorsaak. Volgens die Namibiese regering is vrywillige berading en toetsing (VBT) een van die mees doeltreffende metodes om die verspreiding van die epidemie te verhoed. Gedagtig hieraan het hierdie navorsingsprojek dit ten doel om die uitkomste van vrywillige berading en toetsing by een werksplek in Windhoek, Namibië, te evalueer ten einde te bepaal of VBT opvoedkundig is en of dit bewuswording, gesonde houdings, voornemens en gedragsverandering bevorder. Die hoofdoelwit van hierdie uitkomsevaluering is om die mate waartoe vrywillige berading en toetsing tot verandering in kennis, houding, gedrag en praktyke gelei het, te bepaal. Alhoewel die meerderheid respondente aangedui het dat hulle kennis na VBT verbeter het, het dit by nadere ondersoek geblyk dat deelnemers wat sekondêre of hoëronderwys gehad het, oor meer kennis beskik het of hul kennis meer uitgebrei het as respondente wat slegs 'n primêre of laer vlak van onderwys gehad het. Uit die navorsingsbevindings blyk dit dat daar onder deelnemers aan vrywillige berading en toetsing 'n toename in die self-aangemelde risiko-persepsie van besmetting met HIV en/of geslagsoordraagbare siektes na hul deelname aan VBT was. Daar was ook bewyse dat deelnemers na die vrywillige berading en toetsing risikoverminderingsplanne geïmplementeer het, omdat daar 'n afname was in die persentasie deelnemers wat informele seksmaats gehad het, sowel as 'n toename in deelnemers wat geen informele seksmaats in die vorige ses maande gehad het nie. Daar kan tot die slotsom gekom word dat werknemers se houding teenoor MIV-positiewe mense oor die algemeen betreklik nie-diskriminerend is. Dit blyk egter asof VBT ten opsigte van die oordrag van inligting en opvoeding oor MIV aan werknemers met laer vlakke van onderwys nie so geslaagd was nie omdat werknemers met primêre of 'n laer vlak van opleiding nie veel by die ingrypaksie gebaat het in terme van ‘n toename in kennis nie. Daar word aanbeveel dat vrywillige berading en toetsing op 'n gereelde grondslag aan werknemers by die maatskappy aangebied moet word, nie bloot omdat werknemers daarvoor gevra het nie, maar ook om te bepaal of vrywillige berading en toetsing vir MIV by die maatskappy die gewenste uitwerking op die werknemers gehad het, veral met betrekking tot die uitbou van kennis, 'n afname in stigmatisering en diskriminerende houdings, en 'n toename in die gewenste gedragsverandering onder deelnemers. / jfl2011 / Imported from http://etd.sun.ac.za

Thesis (M Social Work)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The South African government has laws and policies that forbid discrimination against individuals. These policies protect people from being discriminated against in the workplace due to sickness, race and many other factors. Discrimination against people living with HIV/AIDS has caused many people who suffer from this disease not to come forward with their illness because they fear being discriminated against and stigmatised; some even lose their jobs because they are infected with HIV. People infected with HIV are discriminated against not only in the workplace but also in their communities and families. This implies that people living with HIV/AIDS need support from all levels of society in order to live positive lives, which may lead infected people to live longer. This study explored HIV/AIDS as terminal illness and the stressors experienced by people infected with the virus. This was done by examining the support available to people living with HIV/AIDS, as well as identifying the support needed by these people. By adopting an ecological approach to the study, the need for support could be investigated on multiple levels. A combination of a quantitative and qualitative research design was used in the study. Data were gathered by means of a semi-structured interview schedule that was administered during individual interviews with service providers. This allowed for data that were both measurable as well as rich in description to be collected. The questions in the semi-structured questionnaire were based on the information retrieved from the literature review. The findings from the empirical investigation revealed that people living with HIV/AIDS receive limited support from their families, the South African government and society at large. The findings further indicated that informal sources of support such as family, friends and partners are relatively supportive of people living with HIV/AIDS. However, the relationships between people living with HIV/AIDS and their families and partners are often strained, especially when a person first discovers his or her status as HIV positive. Furthermore, people living with HIV/AIDS are stigmatised on multiple levels because of their status. There is stigmatisation from family, friends, in the workplace and in the community. The most important recommendations resulting from the study are that services such as counselling are needed for people living with HIV/AIDS together with their families. This is of particular significance to the South African government, especially the health sector, which needs to improve the health care system. In addition, recommendations emphasise the importance of promoting education and awareness, which could have great value for people living with HIV/AIDS, their families and communities. Knowledge about HIV/AIDS would empower people at all levels to support those who live with the disease and would also be of great value in helping those living with the disease to contribute something of value towards their health condition. / AFRIKAANSE OPSOMMING: Die Suid-Afrikaanse regering beskik oor wette en beleide wat diskriminasie teen individue verbied. Hierdie wette en beleide beskerm mense teen diskriminasie in die werkplek, diskriminasie op grond van siekte, gestremdheid, ras en vele ander redes. Diskriminasie teen mense wat met MIV/vigs leef, laat baie van hulle hul MIV/vigs-status geheim hou omdat hulle diskriminasie en stigmatisasie vrees. Sommige verloor selfs hulle werk wanneer dit rugbaar word dat hulle aan MIV/vigs ly. Diegene met MIV/vigs ervaar egter nie net in die werkplek diskriminasie nie, maar ook in hul gemeenskappe en families. Dít impliseer dat mense met MIV/vigs op alle vlakke ondersteuning nodig het om ’n positiewe lewe te lei en daarmee hul lewensverwagting so ver moontlik te verleng. Hierdie studie het die stresfaktore van terminale MIV/vigs-lyers ondersoek. Daar is voorts ondersoek ingestel na die ondersteuning wat mense met MIV/vigs ontvang, sowel as die ondersteuning wat hulle nodig het. MIV/vigs-lyers se ondersteuningsbehoeftes op etlike vlakke is deur middel van ’n ekologiese navorsingsbenadering bepaal. ’n Kombinasie van ’n kwantitatiewe en kwalitatiewe navorsingsmetodologie is vir die studie gebruik. Data is met behulp van ’n semigestruktureerde vraelys ingesamel, wat gedurende individuele onderhoude met diensverskaffers afgeneem is. Sodoende kon meetbare sowel as hoogs beskrywende data ingesamel word. Die vrae in die semigestruktureerde vraelys was gegrond op die inligting uit die literatuuroorsig. Die bevindinge van die empiriese ondersoek toon dat mense wat met MIV/vigs leef beperkte ondersteuning van hul familie, die Suid-Afrikaanse regering en die groter samelewing ontvang. Die bevindinge dui voorts daarop dat informele ondersteuningsbronne, soos familie, vriende en lewensmaats, betreklik ondersteunend is teenoor diegene met MIV/vigs. Tog is die verhouding tussen MIV/vigs-lyers en hul families en lewensmaats ook dikwels onder druk, veral net nadat die persoon ontdek dat hy/sy MIV-positief is. Daarbenewens word mense met MIV/vigs op verskeie vlakke gestigmatiseer – deur hul familie, vriende, in die werkplek en die gemeenskap. Die belangrikste aanbeveling uit die studie handel oor die behoefte aan dienste soos berading vir mense wat met die virus leef, sowel as vir hul familie. Die aanbeveling behoort veral van belang te wees vir die Suid-Afrikaanse regering, en in die besonder die gesondheidsektor, wat hierdie behoefte in gedagte moet hou om die gesondheidsorgstelsel te verbeter. Ander aanbevelings beklemtoon die belang van meer opvoeding en bewusmaking, aangesien dit uiters waardevol kan wees vir mense met MIV/vigs, hul familie en gemeenskappe. Kennis oor MIV/vigs sal mense op alle vlakke bemagtig om diegene met die virus te ondersteun, terwyl dit MIV/vigs-lyers self ook sal help om hul eie gesondheidstoestand beter te bestuur.

Thesis (MBA)--University of Stellenbosch, 2010. / Since the first case was discovered in Africa in the late 80s, the HIV/AIDS epidemic has gradually increased at alarming proportions worldwide especially in sub-Saharan Africa which prompted the United Nations' World Health Organisation to declare it a global pandemic. This research undertakes to highlight the current composition of care given for HIV and Aids, and the strengths and weaknesses of such programmes. The aim of this is to establish a better home based care programme in Swakopmund, Namibia, for improving the quality of care as well as living conditions for the infected and affected. For this initiative to be of the highest quality there is need to pay special attention to various regional and national HIV/AIDS programmes and policies. As the HIV/AIDS epidemic continues to spread, organisations and communities are now considering engaging more programmatic approaches as sub-Saharan countries are looking for scaled-up responses and national strategies for home based care. Policy-makers and senior administrators must be involved in developing and monitoring home based care programmes, and the people who manage and run the programmes must share information and feedback with senior administrators. In this sense, policy and action are interrelated as each partner learns from and guides the other. The researcher saw the need to involve community members and home based care-givers in a participatory process to research this topic and engage them in a process on how to improve the programmes that already exist. 52 Pages.

<p>This thesis examined to what extent the current legislation protects the HIV positive employee against unfair discrimination and dismissal. The study gave short medical background to HIV/AIDS and introduced HIV discrimination by giving the historical background to HIV related discrimination. From this, the extent of stigmatization against this group was introduced.</p>