Thesis (MPH.) -- University of Limpopo, 2019 / The purpose of this study was to profile selected cardiovascular disease risk factors among HIV patients on ART in Bushbuckridge sub-district. Quantitative, crosssectional research was conducted to describe cardiovascular disease risk factors among HIV patients on ART in Bushbuckridge Sub-district. Data collection was done using researcher-administered questionnaires. Adult HIV patient on ART participated in the study (n=328). The study has highlighted cardiovascular disease risk factors and prevalence of cardiovascular disease risk factors among HIV patients on ART. The findings revealed the prevalence of hypertension is 34.6% among HIV patients on ART and men had a higher prevalence compared to women. There is an increase in body mass index and it is seen mostly among women. Alcohol consumption is highest in the young adults (18 to 24 years) both men and women. Health promotion and policymaking interventions need to improve strategies on management and prevention of cardiovascular disease risk factors. Key concepts HIV, ART, cardiovascular disease risk factors, prevalence, body mass index, Bushbuckridge

This study articulates the lived experiences regarding drug adherence by adolescents in Zimbabwe. The study was conducted in Bulawayo, the second largest city in Zimbabwe to aid understanding the experiences the adolescents go through as they try to live as normal a life as possible despite them having the most stigmatised condition in the country in particular and the world at large. A phenomenological inquiry was undertaken using Wertz’s (1983, 2005, 2011) empirical psychological reflection approach for data analysis, after utilizing purposive, convenience and criterion sampling techniques to select thirteen (13) adolescents who were on ART and were in good health and also willing to take part in the study. Data were generated using in-depth qualitative interviews and the interviews continued until data redundancy was reached. The interview proceedings were digitally audio-recorded in addition to taking field notes and these were transcribed verbatim. Data analysis occurred at idiographic and nomothetic levels according to the principles of Wertz’s empirical psychological reflection. Thematic analysis of the research data revealed six (6) themes namely:  Treatment fatigue.  Delay in getting to know own HIV status.  Stigma  Disability (visual impairment).  Lack of support.  Religious beliefs (church). Wholeness emerged as the single most encompassing and accommodating concept that united the various themes and categories. It further grounded adolescents’ experiences regarding drug adherence and coping with challenges associated with HIV. The findings add substantial knowledge about how adolescents experience drug adherence. Important recommendations are made and guidelines that may be used to increase adolescents’ resilience to challenges of being HIV infected are suggested. / Health Studies / D. Litt. et Phil. (Nursing)

Thesis (Ph.D. (Social Work)) -- University of Limpopo, 2021 / Background information: Persistent poor health outcomes among People Living with HIV and AIDS (PLWH) is a concern for service users and the HIV care system. Since its discovery, different AIDS response strategies were implemented but the level of poor health outcomes among PLWH prompts the need for other dimensions in the AIDS response. Purpose: The purpose of this study was to explore and describe ‘lived experiences’ of PLWH in order to utilise their personal experiences to develop a user- led intervention model. Methods: From a phenomenological orientation, an in-depth interview was used to gather data from seventeen PLWH who are living in communities. Purposive sampling was used to locate the participants. The compiled data collected was then analysed using the Collaizzi’s seven-step data analysis strategy. This was followed by a focus group discussion session which was held with nine of the seventeen participants. Findings: The study found that communities’ meaning of HIV and AIDS is outdated as it is still loaded with stigma and discrimination. Consequently, it alienates PLWH living in communities, and thus compounds poor health outcomes among PLWH. Many PLWH view themselves through their communities’ meaning of HIV and AIDS. the shared meaning of HIV and AIDS by communities created a complex task for PLWH to reconcile their prior meaning of living with HIV and the ‘new’ meaning they acquired post-diagnosis. Due to this, many PLWH experience high levels of intrapersonal and interpersonal challenges. Intrapersonal challenges manifest as self and anticipated stigma while the interpersonal ones result in poor relationships in different setting. It was also found that the availability of antiretroviral treatment significantly changed the meaning of living with HIV and AIDS for many PLWH as it provided tangible medical support to mitigate the impact of HIV and AIDS. In addition, the availability of different types of social support from family and non-family sources reassured and gave them hope for a better life. However, the availability of medical treatment and social support could not completely buffer the intrapersonal and interpersonal challenges experienced by PLWH in their daily lives. They had to continually fight for their social space post diagnosis through activation of two major coping strategies, namely emotion and problem-solving focussed strategies. Significant features of these strategies are that they changed their thinking patterns and engaged in actual activities to improve the quality of their lives. Through these strategies, many PLWH attained relative post traumatic growth. This study found that through their lived experiences, they command personal competence to guide user-led HIV care interventions as they clearly articulated the design, content and approach for user-driven HIV care. Conclusions and recommendations: The psychosocial dimension of living with HIV and AIDS in HIV care is not adequate as many PLWH who are in care experience poor health outcomes long after they have been diagnosed until they received psychosocial support from other PLWH. On this basis, a psychosocial seven-step user-led intervention model was designed to provide psychosocial education, care and support to PLWH, families, support groups and community mobilisation for HIV care. The implementation of a true psychosocial user-led intervention model in the continuum of care which recognises the interaction between the three dimensions of the health condition should be located at the point of entry into HIV care to ensure timeous access by PLWH and their families.

Today over 1.1 million people are living with HIV/AIDS in the United States; over the last 4 decades mortality rates have decreased largely made in part because of advancement in awareness and treatment options. Treatment adherence has long been considered a vital component in decreasing HIV/AIDS related mortality and has proven to reduce the risk of transmission. However not all patients take their medicine as prescribed. This research study, sponsored by The North Central Texas HIV Planning Council explored how Patient and Provider communication impacted treatment adherence. By utilizing a mixed-methods approach survey data and semi-structured interviews were used to collect insights from both Patients and Providers. Data gleaned through the interview process provided a perspective that could not be captured by using quantitative methods alone. The results from this research yielded multiple themes related to patient and provider communication with recommendations as to how The North Central Texas HIV Planning Council could address treatment adherence, such as Providers focus on Patients perceived severity based on their understanding of disease and illness; that side-effects remain a concern for patients and should not be dismissed; and finally that the word AIDS is perceived to be more stigmatized and as such organizations providing HIV/AIDS related services should explore alternative names where the word AIDS in not included.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Disclosure of Human Immune Deficiency Virus (HIV) is still a challenge to people living with the disease because of the discrimination, stigma and judgemental attitudes. Women prefer to keep their illness to themselves and make it a secret. The revealing of HIV status relies on an individual who is living with the illness. The concept of non-disclosure is a vital issue that threatens immediate families in which there are people, especially women battling the non-disclosure of their HIV status. Objectives: The objectives of the study were to explore and describe the experiences of concealing HIV positive status to the immediate family by women living with Human Immunodeficiency Virus at the selected villages in Limpopo Province. Methods: The qualitative and descriptive phenomenological method was followed. Due to saturation, ten women participated after being selected through purposive sampling from the database with the consideration of the inclusion and exclusion criteria. Data was collected through semi-structured interviews in Sepedi. The data was transcribed, translated and analysed through Interpretative Phenomenological Analysis. Results: WLW-HIV continue to manage to live with a secret about their HIV status due to the unpleasant feelings they hold about the illness continue, still pointing fingers and sceptical about disclosing, particularly to their children. They further tell lies about their illness and hide their medications away from the members of their family. The reasons about concealing their status include among others fear of prejudice, lack of trust, fear of abandonment and rejection, fear of blame and humiliation, denial, misconceptions that people still hold about HIV and the view of it as a predicament. Others conceal because of the lack of support and the target of the disclosure. xii Conclusion: The outcomes of the study have uncovered that there is still less awareness by members of the society about HIV/AIDS, which puts pressure on the WLW-HIV to effectively deal with an HIV positive status and disclose to their family members. These factors contribute to concealment and compromise the level of support that WLW-HIV would get from their family members, further impacting negatively on adherence. Keywords: Concealment, HIV/AIDS, Phenomenological study, Stigma and Immediate family.

The purpose of this study was to explore and describe the determinant factors affecting adherence to antiretroviral therapy among HIV infected patients in Addis Ababa, Ethiopia. A cross-sectional study design was used and data were collected by interviewing 290 study participants from two health facilities using structured questionnaire. The research finding revealed 80.0% of the study participants had optimal combined adherence to dose, schedule and dietary instructions in the past three days. And, the non adherence rate was 20.0%. In multivariate analysis only WHO clinical stage, change of ARV medication, knowledge about HIV disease and ART, and use of reminders were found to be independently associated with adherence to antiretroviral therapy. The most common reasons for missing HIV medications in the past one month were forgetfulness (35.1%), being busy with other things (17.5%), and running out of pills (10.5%). Adherence improving interventions should be emphasized to address multi-faceted problems. This study recommends setting of convenient appointment schedule, disclosure of one's HIV status, maintaining confidentiality of patient-related information, enhancing patient-provider relationship, use of reminders including SMS text messages, and engagement of PLHIV in adherence improving interventions through peer support, and providing regular health education to the PLHIV to improve adherence of patients to ART / Health Studies / M.A. (Public Health)

A Thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy in Community Psychology in the Department of Psychology at the University of Zululand, 2007. / The major aim of the study was to determine whether broad-based initiatives, such as community based stigma reduction intervention programmes (later) based on the findings of the study, could have an impact on the uptake of HIV-testing and disclosure rate. The total sample comprised of 15 females and 15 males that were chosen from one of the support groups based at one of the selected Hospitals in KwaZulu-Natal Province. With the assistance of the hospital officials, the researcher was able to use the purposive sampling technique in selecting the respondents. From the themes, it became evident that people living with HIV and AIDS are faced with an important dilemma regarding whether or not they should reveal the HIV-positive status to significant others, in-depth interviews with the focus groups produced the following themes as accounts of emotional observations: isolation, social stigma, anger, revenge and depression. In the light of the findings of the study, a need arose for the establishment of an intervention programme aimed at addressing the common barriers associated with HIV disclosure. Community Psychology in particular, played a major role in shaping this study because of its action focus on groups. / National Research Fund (NRF)

Thesis submitted in fulfillment of the requirements for the award of the Degree of Doctor of Philosophy in Library and Information Science at the University of Zululand, 2005. / The impact of HIV/AIDS (human immunodeficiency virus/ acquired immune deficiency syndrome) is devastating worldwide especially among tertiary institutions whose constituencies are within the age bracket between 15-45 years. Unfortunately there is still no cure for the disease, and one way of controlling the rampant nature of the pandemic is through educational and enlightening interventions backed by appropriate information. The aim of the study was to assess the framework, nature and scope of the institutional response as well as the appropriateness of HIV/AIDS information dissemination interventions developed and employed by institutions of higher learning in South Africa for the prevention of the spread of the pandemic. The study was informed by theoretical framework grounded on the Diffusion of Innovations theory. Both qualitative and quantitative research design and methodologies were employed largely through survey, observation and document analysis. The study targeted HIV/AIDS service providers, health centers and institutional libraries within all public universities and technikons in South Africa. The respondents within institutions were identified largely through non-probability sampling techniques such as snowball and purposive sampling. The study mapped out the HIV/AIDS response of the higher education sector in relation to programmes offered and strategies and methods that are used to manage the pandemic and disseminate information. The findings reveal that the response of the higher education sector to HIV/AIDS is not uniform, but there is a positive move towards strong management of HIV/AIDS and information diffusion. Secondly, it is observed that the disease has some impact on institutional mandates such as teaching, learning, research and community service. Unexpectedly, the study confirmed widely held views that are also reported in related studies, that the response of academic institutions to the disease is still characterized by silence, denial, discrimination and stigma as most institutions do not address the disease openly. Thirdly, it was established that in those institutions where there is an AIDS Centre the response seemed to be more systematic and well guided as compared to those that relied on the services of the health centre. Fourthly, there was no distinction made in terms of the nature and strength of the institutional response between service providers that had higher academic qualifications and those that did not have. Most highly qualified respondents though had other academic responsibilities, dealt with HIV/AIDS as additional job. Fifthly, it was easy to distinguish between historically advantaged and disadvantaged institutions, as the tatter had interventions that were underdeveloped and limited in scope and depth. Similarly, universities as compared to technikons demonstrated more intense interventions and better resource provision. Sixth, in most institutions management supports the institutional HIV/AIDS management and response. This involvement was evident through observation on the nature of the response, capacity buildings and resources on the ground. However, it was sadly observed that this executive commitment to HIV/AIDS seemed to be overridden by other priorities such as the reconfiguration and reconstruction of the sector. Further, noted that all institutions have HIV/AIDS policies, but some of them have not implemented these policies. Seven, though the Higher Education HIV/AIDS Programme is coordinating the HIV/AIDS response within the whole sector, it does not seem to have all the answers for the systemic problems that are cropping up. Eight, HiV/AlDS information is disseminated by the institutional libraries, HIV/AIDS service providers and health centers. Mostly, information is disseminated in print form while other modem media seemed to be underutilized and repackaging is not extensively done due, partly, to shortage of resources and capacities. The study found strong link between the theoretical models earlier mentioned and results of the study. Specifically, these theories confirmed the importance of the content of HIV/AIDS messages and the value of horizontal and vertical communication strategies. The study recommends that the institutional response needs to be revamped and redesigned to improve the traditional information dissemination strategies that are used by most academic institutions. Information dissemination strategies should be designed in line with current trends in socio-cultural and political lifestyles of young people. However, though there are still flaws and inefficiencies, the sector is responding positively to the epidemic and efforts are being made to synchronize and coordinate the systemic response. The study recommends further research on feasibility, applicability and effectiveness of the centralized coordination of the higher education HIV/AIDS response. It also recommends that the higher education sector should be more involved in the initiative of the Higher Education HIV/AIDS Programme to make valuable contributions based on experiential encounters. Similarly, strategies should be rapidly implemented to redress past imbalances in relation to strengthening capacities and resources of previously disadvantaged institutions to enable them to deal effectively with the disease. Other issues have been unearthed and a model for effective HIV/AIDS management and information diffusion in the sector suggested.

In the context of HIV high infection rate in South Africa, an assumption can be made that there is a high prevalence of HIV-associated neurocognitive disorders or cognitive linguistic deficits. The aim of this study was to determine assess whether highly active antiretroviral therapy (HAART) affected the cognitive – linguistic abilities of individuals living with HIV and AIDS before and after HAART use; and to determine whether their functional performance in terms of engaging in activities of daily living was affected by HAART use. Adults living with HIV and AIDs were recruited through purposive convenience sampling to participate in the study. They were divided into three groups. The experimental and cross sectional group included participants who were HIV infected and initiated HAART. The comparison group included participants who elected not to start HAART. Participants in all three group were assessed using the Cognitive – Linguistic Quick Test and were also required to fill out a structured interview scale at baseline, four and eight months. For the experimental group 55 participants were tested at baseline, 55 at four months and 52 at eight months after HAART initiation. The comparison group included 21 participants who tested at baseline, ten at four months and nine at eight months. The cross sectional group included different participants who recruited at baseline (55) before HAART initiation, then again at four (44) and eight months (42) after HAART initiation. Descriptive analysis revealed that the mean scores for both the Cognitive – Linguistic Quick Test (CLQT) and the structured interview schedule (IS) in all the cognitive domains increased for all three groups from four and eight months after testing. However the severity ratings provided by the CLQT indicated that neurocognitive deficits were still prevalent among the participants after HAART intiation. The most impaired cogntive – linguistic ability was executive functions and the least impaired was language. One way ANOVA analysis on the CLQT and IS revealed that was a signiifcant difference in performance between the three groups at baseline, four and eight months. Repeated measures analysis revealed significant differences or improvements within participants across the three time periods. The greatest improvement was observed from baseline to eight months especially on the CLQT. ANCOVA analysis on the Cognitive- Linguistic Quick Test indicated that education had a major impact on cognitive – linguistic abilities followed by age and CD4 count. However, ANCOVA analysis on the structured interview scale revealed that the effect of time, participant group and to a lesser extent age influenced the participants cognitive – linguistic abilities when it came to perfroming activities of daily living. Quantitave inquiry using content analysis showed that participants in all three groups cited attention, followed by visual and language problems as hindering their abilities to perform activities of daily living. The implications from this study revealed that even though HAART improves cognitive –linguistic abilities, neurocognitive deficits were still prevalent. Therefore findings suggest that health professionals need to monitor the neurocognitive impairments of their patients so as determine levels of functional performance.

Thesis (M.Sc. (Physiology)) -- University of Limpopo, 2021 / The purpose of this study was to investigate the effect of cART on renal function and assess the association between renal function and cardiovascular risk factors in a black rural HIV-positive population in Limpopo Province, Mankweng district. We have conducted a cross-sectional study which included both male and female cART-treated patients (n=84), cART-naïve patients (n=27) and HIV-negative controls (n=44). We have measured biomarkers of renal function (plasma cystatin C, clusterin, retinol binding protein 4 [RBP4]) and determined the estimated glomerular filtration rate (eGFR) using the chronic kidney disease-epidemiology collaboration formula (CKD-EPI). We have also measured blood pressure (BP), body mass index (BMI) and fasting blood glucose (FBG). The prevalence of renal dysfunction was similar among the study groups. A significant difference in RBP4 was found among the groups after controlling for covariates (age, gender, alcohol consumption, BMI, systolic blood pressure and FBG) (F (2, 146) = [4.479], p=0.010). The significant difference in RBP4 was specifically observed between the cART-treated and cART-naïve groups (p=0.008). Cystatin C, clusterin and eGFR were not significantly different among the study groups after controlling for the covariates. The cardiovascular risk factors age (β=0.207; p=0.039), CD4+ T-cell count (β=-0.236; p=0.040), and duration of cART (β=0.232; p=0.043) were independently associated with cystatin C. The use of cART independently associated with RBP4 (β=0.282; p=0.004). Age (β=-0.363; p=0.001), CD4+ T-cell count (β=0.222; p=0.034) and duration of cART (β=-0.230; p=0.034) independently associated eGFR. Renal dysfunction is common in this HIV-positive population, with similar rates as the HIV-negative population. Plasma cystatin C as a promising alternative renal biomarker need to be re-evaluated in this HIV-positive population. RBP4 may be a more promising renal function biomarker in the HIV-positive population. Cardiovascular risk factors are associated with renal dysfunction in this rural HIV-positive population and CD4+ T-cell count may be an independent predictor for renal function.