Thesis (Ph.D.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Faculty of Nursing. Title from pdf file main screen (viewed on October 10, 2009). Includes bibliographical references.

HIV/AIDS has been an obstacle to socio-economic development and a major cause of loss of human life. It has also caused vast inequities and frustration to the public health sector. One of the significant efforts made by the public health sector to combat the epidemic is the implementation of a mandatory HIV/AIDS testing policy to scale-up HIV treatment. This dissertation examines the impact of this policy on the human rights of people infected with and affected by HIV/AIDS. Coercive government policies aimed at controlling the AIDS pandemic often infringe on the rights of individuals known to be or suspected of living with HIV/AIDS and this decreases the effectiveness of public health measures. The research methodology involved the study of written literature and a comparative literature study of the law and practice obtaining in South Africa, Uganda and Canada. It revealed that voluntary testing is effective and suitable in South Africa. This dissertation aimed to show that any public health approach that aims to achieve a comprehensive prevention strategy must be consistent with respect for human rights as enshrined in regional and international human rights law. Public health and human rights should, therefore, not be regarded as opposing forces; rather they should be seen as a unified system of protection of human welfare under the Bill of Rights and the Constitution. The solution to the crisis lies not only in testing every single person but also requires a shift of focus to more pressing issues that include gender equality, stigma and discrimination; prioritizing human rights, institutional capacity and resources; and an end to extreme poverty. A human rights-based approach to HIV/AIDS testing, such as the Voluntary Counselling and Testing (VCT) is recommended. Therefore, failure to adhere to the core principles of testing - which are informed consent, counselling and confidentiality of the test result - will only hinder the global fight against HIV/AIDS. The rights of those affected by HIV/AIDS need to be protected in order to address public health imperatives. This can be done through the use of the law as an instrument of social change as well as education and awareness. Key words, HIV/AIDS, mandatory testing, Voluntary Counselling and Testing, public health, human rights-based approach.

The primary aim of this study was to determine the effect of an 11-week combined progressive resistance exercise and aerobic exercise programme on the health and well-being of a group of participants sampled from an HIV positive rural population. The study was exploratory and quasi-experimental in nature and utilised quantitative research methods. A total number of 37 participants that met the inclusion criteria were included in the study. The participants were assigned to an experimental group (EG) (n=19) based on their willingness to participate in the exercise intervention and the remainder were assigned to the control group (CG) (n=17). The experimental group participated in an 11-week intervention programme which entailed exercising twice a week for the duration of 60 minutes. The intervention entailed a low cost exercise programme which consisted of aerobic exercises (walking, jogging and stepping) and progressive resistance exercises (own body weight, core exercises and light free weight training). The following variables were measured pre-, mid- and post- intervention, namely: health related fitness components, quality of life, physical activity levels and relevant blood variables. An analysis of data was conducted utilising descriptive and inferential statistics. The outcome of the analyses indicated that the EG did not reveal significantly better post-intervention results than the CG in respect of any of the variables assessed. The CG remained sedentary during the intervention period and revealed either an increase in, or maintenance of the initial scores. The slight variation could have been attributed to the decrease in sample size at mid – and post – testing. At the post-intervention testing phase the majority of the participants available for testing were those who were working and healthy. However, it can be concluded that the overall aims and objectives of the study were achieved despite the attrition of participants during the study and that the subsequent outcome of the study was not expected.

This study aimed at describing and interpreting the changing symbolic meanings of the Acquired Immunodefiency Syndrome (AIDS) which encountering a Human Immunodefiency Virus (HIV)-positive patient introduced into the personal and professional identities of six health care professionals in a subregion of the Eastern Cape. With the exponential increase of HIV/AIDS in South Africa, medical practitioners have become increasingly exposed to HIV infected patients. This study has considered the psychological structures developed by practitioners in an attempt to control and understand their situation in the context of HIV/AIDS. In order to describe these psychological structures the existential phenomenological approaches of L. Binswanger (in Needleman, 1963), A. Giorgi (1975) and F.J.Wertz (1985) were employed. Through these procedures, the structure of the experience of encountering an HIV infected patient was elucidated. This comprised the first goal of this study. The second goal focused on interpreting these descriptions by way of the symbolic meanings and definitions implicit in the structure of this experience. For this latter purpose the approach of symbo1ic interactionism was used, in particu1ar the understandings outlined by H. Blumer (1969). This theory was seen as appropriate in that the encounter between the practitioner and patient was primarily located in interpersonal parameters. The findings were discussed in terms of the two dominant metaphorical frameworks used by the subjects to comprehend the disease - namely the perspectives of society and the biomedical model. These two frameworks were critically evaluated in the context of HIV/AIDS, the needs of HIV infected individuals as well as the needs of the general practitioner. The process of the encounter was found to be very significant for practitioners in terms of their conceptualisations of HIV/AIDS. Old understandings were reinterpreted within the interpersonal context and replaced with more appropriate symbolic metaphors upon which to base practise. This study has revealed these new understandings were limited and constrained with regard to understanding and treating HIV/AIDS in that the subjects were still influenced by the metaphors of the biomedical model. These constraints were examined in the light of both personal and professional meanings and identities. This study concluded by making suggestions for modification of the medical practitioner's role in the context of HIV/AIDS.

M.A. (Psychology) / The Acquired Immunodeficiency Syndrome not only threatens the world with hitherto unknown rates of mortality and economic ruin, but has also saddled the health sciences with an unprecedented challenge in curing and managing this disease. Herein, the health sciences have not found a cure, and the management of the disease is made extremely difficult because of the unpredictable nature of the interrelationships in biopsychosocial factors inherent in the disease. In order to attempt a description of the complex interrelationships between biopsychosocial factors in this disease, a group of twenty patients in a treatment programme comprising of an exercise and cognitive-behavioural intervention, were subjected to immunologic and psychological assessment before and subsequent to the intervention. The data obtained indicated that none of the interrelationships between psychological and immunological variables predicted by psychoneuroimmunological science existed prior to the intervention. It would appear that the interrelationships between these variables were in total disarray - defeating the object of systematic logical description of biopsychosocial factors in this condition. The post- intervention data suggested a pattern of interrelationships totally within the confines of predicted neuropsychoimmunologic patterns of a biopsychosocial interaction in a disease of immunologic origin. This pattern of predictability would then render possible a treatment programme of a multidisciplinary nature which would bear predictable fruit. It also underscores the necessity of psychological interventions as an adjunct in the treatment of AIDS.

Master of Public Health - MPH / Increasing HIV infection rates affect government employees as much as workers in other places. While government has responded to the evolving crisis with a number of policy documents, little is known about the implementation of such policies in government departments. This study assessed the HIV/AIDS policy in the Department of Labour and identified weakness in the implementation. The results of the study may be used by the Dept. of Labour to improve its implementation if necessary. / South Africa

Approximately 33.4 million people are living with HIV/AIDS. Of those, 97% live in low and middle income countries, with 22.4 million in sub-Saharan Africa. Only 42% of the people who require anti-retrovirals (ARVs) in low to middle income countries are receiving anti-retroviral therapy (ART). There is a need to develop novel and cost effective methods for producing antiretroviral drugs. Stavudine and azidothymidine (AZT) were identified as potential targets because they could both be produced through a common intermediate – 5 methyluridine (5-MU). It has been established that the biocatalytic production of 5-methyluridine is possible through a reaction known as transglycosylation, in a process which has not previously been demonstrated as commercially viable. A selection of biocatalysts were expressed either in recombinant E. coli strains or in the wild type organisms, purified and then screened for their ability to produce 5-MU. A combination of Bacillus halodurans purine nucleoside phosphorylase 1 (BHPNP1) and E. coli uridine phosphorylase (EcUP) gave the highest 5-MU yield (80%). This result represents the first combination of free enzymes from different organisms, giving high yields of 5-MU under high substrate conditions. Both enzymes were purified and successfully characterised. The established pH optimum was pH 7.0 for both enzymes. Temperature optima and stability data for BHPNP1 (70 C and t1/2 at 60 C of 20.8 h) indicated that the biocatalytic step was operating within the capabilities of this enzyme and would operate well at elevated temperatures (up to 60 C). Conversely, the temperature optimum and stability data for EcUP (optimum of 40 C and t1/2 at 60 C of 9.9 h) indicated that the enzyme remained active at 40 C for the duration of a 25 h biotransformation, but at 60 C would only be operating at 20% of its optimum activity and would lose activity rapidly. BHPNP1 and EcUP were used in a bench scale (650 ml) transglycosylation for the production of 5-MU. A 5-MU yield of 79.1% was obtained at this scale with a reactor productivity of 1.37 g.l-1.h-1. Iterative saturation mutagenesis was used to rapidly evolve EcUP for improved thermostability. A moderately high throughput colorimetric method was developed for screening the mutants based on the release of p-nitrophenol upon phosphorolysis of a pyrimidine nucleoside analogue. By screening under 20 000 clones the mutant UPL8 was isolated. The mutant enzyme showed an optimum temperature of 60 C and improved stability at 60 C (t1/2 = 17.3 h). The increase in stability of UPL8 is due to only 2 mutations (Lys235Arg, Gln236Ala). These mutations may have caused an increase in stability due to interactions with other structural units in the protein, stabilization of the entrance to the binding pocket, or by decreasing the flexibility of the α-helix at the N-terminus. Transglycosylation experiments showed that the mutant enzyme UPL8 is a superior catalyst for the production of 5-MU. A 300% increase in reactor productivity was noted when free enzyme preparations of UPL8 was combined with BHPNP1 at 1.5% m.m-1 substrate loading. The high yield of 5-MU (75-80% mol.mol-1) was maintained at 9% m.m-1 substrate loading. A commercially viable productivity of 31 g.l-1.h-1 was thus realised. Further optimisation of the process could produce still higher productivities. Future work in directed evolution of nucleoside phosphorylases is envisaged for improved stability and enhanced substrate range for application to other commercially relevant transglycosylation reactions.

Background: Despite the prevalence of HIV/AIDS stabilizing and slightly decreasing in certain provinces, there are a number of People Living With HIV/AIDS (PLWHA) in South Africa. Many people seek help at primary health clinics and hospitals and receive chronic care at these facilities. Caring for these chronic patients and new patients entering the health system can be stressful to the health professionals who are involved. Many studies that have been conducted have focused on the clinical aspects of individual patients, while few studies have focused on the experiences and stressors of health professionals looking after PLWHA. To ensure quality of care for patients with HIV/AIDS, it is important to understand the experiences of health professionals looking after HIV/AIDS patients and how stressful experiences may influence their attitude towards these patients. Aim: The aim of this study is to report the factors health professionals perceive as occupational stressors caring for people living with HIV/AIDS in the public health sector of the Nelson Mandela Metropolitan Municipality. Research design and Methodology: A quantitative, descriptive and non-experimental research design was followed. A pilot study was conducted to determine the clarity of questions, effectiveness of the instructions, completeness of the response sets, the time required to complete the questionnaires and the success of the data collection. The primary method of data collection was self-administered questionnaires. The questionnaires were dispatched to 30 health professionals at the public health facilities in the Nelson Mandela Metropolitan Municipality. A descriptive statistical analysis was done using a Statistical Package. This revealed the following findings. Findings: The following are the findings that were perceived to be occupational stressors: organizational factors, job design factors, career and promotional factors, role-related factors and cultural factors. iv Conclusion and recommendations: There are occupational stressors that affect health care professionals working in an HIV/AIDS setting. The following are the recommendations to rectify or to improve the situation: • Improve the communication of goals and objectives; • Redesign the job; • Human-resources development ; • Improvement of salaries; • Career planning and mentoring; and • Sensitisation of employees to cultural differences.

South Africa has the highest number of people living with HIV/AIDS in the world. The estimated 5,7 million South Africans that are living with HIV need comprehensive and holistic care. Psychosocial support is a vital aspect of care for HIV positive people. Support groups have been identified as a basic form of psychosocial support. The aim of this study was to evaluate the role of support groups in the lives of HIV positive people in East London, Eastern Cape. A qualitative study design was implemented using focus group interviews to explore the role of HIV support groups. The research questions were designed to elicit responses pertaining to the needs, expectations and experiences of HIV positive support group attendees. Activities conducted in support groups as well as the attitude of support group members towards recruiting other HIV positive people to join the group were also explored. Findings revealed that the benefits of attending a support group included emotional and psychological support, sense of belonging to a “family”, assistance with disclosure issues, gaining information about HIV and treatment as well as material benefits such as food parcels and job opportunities. The greatest need of support group attendees was assistance in obtaining a Social Support or Disability Grant. A few negative experiences were reported which included: unfulfilled promises by people outside of the group, unfair allocation of grants and food parcels, as well as negative group dynamics at times. Support group members agreed that even though there were few negative experiences, the benefits clearly outweighed the negative experiences. Most participants agreed that they would recommend the support group to other HIV positive people so that they could also enjoy the stated benefits. In summary, the study concluded that support groups are very helpful in the lives of HIV positive people.

M.A. / The researcher has undertaken a social constructionist research project that aims to explore the narratives of therapists who work with HIV-positive clients in the South African context. The researcher hoped to generate information regarding the: difficulties or challenges that are peculiar to this type of therapy and the impact of this therapy on the professional and personal lives of the therapist. The initial part of the dissertation covers an investigation of the literature regarding HIV/AIDS and HIV-related therapy. This literature reveals that mental health workers and psychologists experience considerable stress and 'burn-out' related to the many difficult issues provoked by HIV-positive clients. The theoretical foundations of postmodernism and social constructionist research are also described. In line with the researcher's epistemology, the methodology was qualitative in nature and made use of unstructured interviews. The narratives of the participants were then subjected to a qualitative or thematic analysis. The results of the study are presented in terms of the significant themes in the participants' accounts. It is evident in the narratives of the research participants that there are peculiar difficulties in therapy with HIV-positive clients. Also evident are the significant effects that this work has on the therapists' professional and personal beliefs, attitudes, philosophies and behaviour. Finally the results are discussed and a critical evaluation of the study is offered. The objective of the research is not to generalise the findings to all Clinical Psychologists who work with HIV-positive clients. A recommendation based on the findings is that therapists considering working with HIV-positive clients familiarise themselves with the issues that this therapy raises.