Thesis (Ph.D. (Public Health)) -- University of Limpopo, 2022 / There has a significant rise in the number of HIV-infected adolescents who were missed as children and are diagnosed with perinatally acquired HIV as teenagers. In 2013, perinatally acquired HIV was estimated at around 10 000 infections globally, a figure which ballooned to38 000 by 2017. Adolescents living with perinatal HIV experience emotional upheaval as a result of their positive HIV diagnosis, which is exacerbated by real or perceived negative effects on their relationships, career, and family aspirations. They face the same challenges as other adolescents, along with the added complexity of personal decisions relating to their sexual conduct having a direct impact on the global cause to eradicate HIV/AIDS. An extensive body of literature indicates a need for emotional and psychosocial support as existing management focuses mainly on the physical aspects of infection and treatment. Aim of the study The aim of the study was to explore the challenges faced by adolescents living with perinatal HIV infection and to evaluate the designed user-friendly support programme in response to formative findings of the research in selected clinics and community health centres in the Vhembe District of the Limpopo Province in South Africa. Methodology A mixed-methods sequential exploratory design was employed to fulfil the purpose of the study. Data was collected in two phases. In qualitative phase- a total of 21 participants were interviewed using a semi-structured interview guide. The sample was purposefully selected from adolescents living with HIV/AIDS. In quantitative phase a total of 213 people participated in data collection using a questionnaire. Thematic approach was used to analyse qualitative data using Tesch’s eight steps of qualitative data analysis. Quantitative data was analysed using SPSS version 25. Descriptive statistics was used to explain and summarize data. Fischer’s test was done to establish significance of association between alcohol used, condom use and between age and gender. The results The results revealed that adolescents with perinatally acquired HIV face more challenges. They had psychosocial, emotional and economic challenges more than their peers. The current HIV/AIDS management and care has not yet recognised the specific needs these adolescents have related to their care. They have been incorporated into the general adulthood HIV/AIDS making their transition from childhood adolescence difficult. Suggestions for a mentor, and ARV modification were made and a need for a support programme emerged as one of the major themes

Since its emergence in the U.S., HIV has been a stigmatized illness. People living with HIV (PLH) are a minority and prone to psychological distress and poor mental health outcomes due to HIV-related stigma. PLH who identify with another minority group in addition to being HIV-positive (e.g., gay, African-American) experience multiple forms of oppression or layered stigma. Affirmative social support and resilience are negatively associated with HIV-stigma and are important coping resources for PLH. We used an explanatory sequential mixed methods design study involving a quantitative survey phase and a qualitative interview phase. We explored whether social support and resilience (Positive Psychological Resources) mediate or moderate the relationship between HIV Stigma and Psychological Distress among HIV-positive adults using partial least squares (PLS) path modeling and multiple regressions. Via PLS, we found Positive Psychological Resources partially mediated the relationship between HIV Stigma and Psychological Distress: the path between HIV Stigma and Psychological distress reduced (from t = 5.49, p = .000 to t = 2.39, p = .000) but remained statistically significant. Similarly, via regression, the Sobel test was significant (Sobel = .26, SE = .07, z = 3.63, p = .000). However, moderation was not found (HIV Stigma x Positive Psychological Resources β = .05, t = .66, p = .508). Overall, our quantitative survey and qualitative interview data were consistent. We anticipate that our findings will inform strengths-based therapeutic interventions to mitigate stress and stigma among PLH.

Stigma is broadly considered as an important obstacle in HIV prevention and treatment. In Mozambique, more PLWHIV have access to treatment than ever. ART increased their QoL and created a new context for stigma production. This cross-sectional study conducted in Northern Mozambique explored a possible association between stigma and QoL. The Berger Stigma Scale and WHOQOL-BREF were used to measure levels of HIV-related stigma and perceived QoL in two groups of PLWHIV receiving ARV, with participation in a HBC programme as the independent variable. The study uncovered a weak to moderate negative correlation between stigma and QoL scores. Statistically significant differences were discovered between the groups’ scores on the Berger Stigma Scale and a higher perceived QoL for PLWHIV in the HBC group on three WHOQOL-BREF subscales and on the overall score. The scores on the social relationships subscale indicated lower perceived QoL for PLWHIV in the HBC group. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

A qualitative study aimed at exploring the nature and extent of the perceived social support available to male prisoners living with HIV at Pretoria Central Prison was conducted. A literature investigation into the life and world of male prisoners, with a focus on the nature and extent of the perceived social support provided to prisoners living with HIV, is presented. Fifteen (15) prisoners were identified by means of non-probability purposive sampling. In-depth interviews were conducted to collect information on how male prisoners living with HIV at Pretoria Central Prison viewed the nature and extent of the social support available to them. The study shows that the research participants living with HIV tended to receive social support from practitioners and other prisoners trained as voluntary caregivers. The study recommends that prisoners living with HIV should have greater access to social support from their significant others. / Social Work / M.A. (Social Behaviour Studies in HIV/AIDS)

This qualitative exploratory and descriptive study explored and described the experiences of HIV sero-discordant couples post diagnosis at the Perinatal HIV Research Unit in Soweto, Gauteng Province. Data was collected using in-depth interviews with each individual from seven HIV sero-discordant couples. Following thematic analysis, four themes emerged: immediate response to HIV sero-discordant results; challenges in relation to disclosure of HIV sero-status; limited information on HIV sero-discordant; and the impact of HIV sero-discordant on the couples. All these were mainly linked to poor counselling and inadequate support to HIV sero-discordant couples. The findings of this study have both clinical and policy development implications. Recommendations have been put forward for development of contextual relevant HIV Sero-discordant Couple Counselling and support guidelines focusing of enhancing knowledge and skills of health care professionals responsible for counselling and supporting HIV sero-discordant couples. / Health Studies / MA (Public Health)

Text in English / The discovery that anti-retroviral therapy (ART) is important for human immunodeficiency syndrome (HIV) prevention has increased interest in factors that influence adherence to HIV treatment. Studies have shown that non-adherence to ART results in drug resistance, morbidity and person-to-person HIV transmission. For persons defaulting on or living risky sexual lives, becoming adherent is a life-saving behavioural change, both for themselves and for their sexual partners. HIV/AIDS programmes are trying different innovations to enhance behavioural outcomes of people living with HIV (PLHIV). This study sought to determine the value of support group participation and based on the findings, to develop an evidence-based model for revitalising caregiver social support competencies. The study was conducted in two phases. In the first phase, a cross-sectional descriptive design was used to compare PLHIV who participate in support group activities with those who do not, in terms of their behavioural outcomes. Multistage probability sampling was used to select study respondents. Data was collected using a selfadministered questionnaire from 1,676 respondents between February and May 2014. Data was analysed using STATA. Data analysis shows that 47% of respondents had once (ever) participated in support group activities while 53% had never. PLHIV who participated in support group activities differed from those who did not in terms of HIV-related stigma (p=<0.001), positive HIV status disclosure (p=0.005), ART adherence (p=0.021), and sexual risk behaviours (p=0.045). PLHIV who participated in support group activities were more likely to have less internal HIV-related stigma, disclose their positive HIV status, adhere to ART and live less risky sexual lives. The two study groups were not different in terms of perceived social support (p=0.28) and external stigma (p=0.250). More PLHIV obtained social support from health workers (66%) and family members (36%) than from PLHIV support groups (16%). The researcher concludes that participating in support group activities positively impacts on behavioural outcomes of PLHIV, but PLHIV support groups are not the only sources of social support. In the second phase, a model for revitalising PLHIV caregiver social support competencies was developed as a recommendation for assuring PLHIV access to holistic care and support. / Health Studies / D. Litt. et Phil. (Health Studies)

Despite HIV and AIDS knowledge and attitude change programmes, workplace HIV and AIDS-related discrimination persists in workplaces in many sectors, including the education sector. This study set out to investigate why the phenomenon of workplace HIV and AIDS-related discrimination persists; and to predict which factors were responsible and how they related to HIV and AIDS-related discrimination in the workplace. A stratified random sample of 205 teachers; 123 of whom were from 10 schools of varied backgrounds in Bojanala Region of North West Province of South Africa and 82 from schools around Kampala, Central Region of Uganda was drawn. Twenty-seven respondents of the South African sample participated in both the quantitative survey and in-depth interview while the rest responded to a selfadministered questionnaire. Using a stepwise regression analysis, traditional beliefs predicted workplace HIV and AIDS-related discrimination, explained11% of variance in the second model while the third model explained only 2% more – 13% (R square of 0.136) but each of the three models was significant (p-values of 0.000). Attitudes were the second strongest predictor; and only HIV and AIDS-legal knowledge could predict discrimination but not biomedical HIV and AIDS knowledge. In the in-depth interview, incidents of discrimination were reported, possible reasons for HIV and AIDS-related discrimination were reported; and it was found that workers varied in ways of keeping secrets regarding sensitive information such as colleagues’ HIV-positive status, and cited reasons for revealing such information which included malice, jealousy, moral responsibility, anger and loose talks. There are implications for reducing workplace HIV and AIDS-related discrimination which include: Integrating HIV and AIDS-legal knowledge with biomedical HIV and AIDS knowledge, more efforts should be spent in designing and imparting information to reduce traditional beliefs, develop and evaluate instruments to measure traditional beliefs and HIV and AIDS-legal knowledge; and to study more about secret keeping, particularly in regard to workplace HIV and AIDSrelated discrimination. / Industrial & Organisational Psychology / D. Admin. (Industrial and Organisational Psychology)

The purpose of the study was to describe factors contributing to mortality among HIVinfected people on Isoniazid Preventive Therapy (IPT) in Botswana. A quantitative, explorative, descriptive study was used and 80 records of deceased IPT respondents were reviewed through the use of a checklist. The demographic factors, baseline physical examination, hospitalisation and drug history were taken into consideration. Out of the deceased patients, 75% were female. The major findings showed that 100% (N=80), the most highly indicated causes of death were gastroenteritis (18.75%), cryptococcal meningitis (17.5%) andpneumonia (16.25%). Of the patients (28.75%) who died before completing the six months of IPT. The causes of death were gastroenteritis (21.7%), symptoms and signs of bacterial pneumonia (17.4%), cryptococcal meningitis (13%), Pulmonary Tuberculosis (PTB) (13%), septicaemia (13%), and murder (13%). It has been recommended that there should be reorganisation of services of care for HIV-infected persons, such as provision of Cotrimoxazole Prophylaxis Therapy (CPT) and Antiretroviral Therapy (ART) to ensure holistic approach care. The future study should include HIV-infected children on IPT using the same or modified objectives. The conclusion drawn was that disintegrated interventions of IPT, CPT and ART and lack of holistic care for PLHIV lead to opportunistic infections that caused mortality on patients on IPT. / Department of Health Studies / M.A. (Public Health)

This qualitative exploratory and descriptive study explored and described the experiences of HIV sero-discordant couples post diagnosis at the Perinatal HIV Research Unit in Soweto, Gauteng Province. Data was collected using in-depth interviews with each individual from seven HIV sero-discordant couples. Following thematic analysis, four themes emerged: immediate response to HIV sero-discordant results; challenges in relation to disclosure of HIV sero-status; limited information on HIV sero-discordant; and the impact of HIV sero-discordant on the couples. All these were mainly linked to poor counselling and inadequate support to HIV sero-discordant couples. The findings of this study have both clinical and policy development implications. Recommendations have been put forward for development of contextual relevant HIV Sero-discordant Couple Counselling and support guidelines focusing of enhancing knowledge and skills of health care professionals responsible for counselling and supporting HIV sero-discordant couples. / Health Studies / M. A. (Public Health)

Introduction. HIV positive men who have sex with men (HIVMSM), facing severe stigma and many stressors, have high prevalence of mental health problems, such as depression. However, there is a lack of mental health promotion and treatment services targeting HIVMSM in China. The Three Good Things (TGT) exercise is one of the commonly used positive psychology interventions; its benefits in reducing depression have been scientifically proven in many disease groups. Yet, TGT has not been applied among HIVMSM. In addition, social support has shown to be protective of depression. The emergence of electronic social media allows for integration of social networking and TGT exercise among HIVMSM. / Objectives. This study aimed to evaluate the efficacy of a one-month online intervention combining TGT with social networking (TGT-SN) versus a control of dissemination of information in reducing depressive symptoms among HIVMSM in Chengdu, China. / Methods. A randomized controlled trial design was applied. A total of 205 HIVMSM were recruited and randomly assigned to the TGT-SN (N=100) or control group (N=105) by four well-trained peer fieldworkers. Self-administered surveys were given to all participants at baseline, at the end of the 1-month intervention (T1), and at the 3-month (T2) and 6-month (T3) post-intervention follow-ups. The intervention was delivered via “QQ”, the most widely used Chinese social networking service. Participants in TGT-SN group were divided into four “QQ” groups, each the size of 20-30 persons. Participants in TGT-SN were asked to post three things they experienced that they feel grateful about daily onto the QQ platform and share them with members of their group. They were also asked to read others’ messages and give positive and encouraging feedbacks to those messages. Members of the control group received information about mental health promotion from research assistants via QQ once a week during the one-month intervention period. The primary mental health outcome was probable case of mild to severe depression measured by Center for Epidemiologic Studies Depression Scale (CES-D). Secondary psychological outcomes include depressive symptoms, anxiety, positive and negative affect, life satisfaction, subjective happiness, gratitude level, and perceived social support. Generalized Estimating Equation models were fit. Structural equation modeling was applied for mediation analysis. / Results. Among all participants, the prevalence of probable mild, moderate, and severe depression were, respectively, 14.6%, 9.3%, and 35.6% at baseline. All baseline background characteristics and outcome measures were balanced (statistically non-significant) between the two groups. Based on data obtained at T1, T2 and T3 that were analyzed by GEE model, there was a significant main effect of TGT-SN on reducing depression (B=-2.35, 95% CI=-4.53, -0.16, p=0.035), indicating significantly lower depression score in the intervention group as compared with that of control group. Nonetheless, such significant effect became non-significant (B=-1.67, 95% CI=-3.79, 0.46, p=0.124) when controlled for baseline depression score. Significant differences were also found between the TGT-SN and the control group in anxiety symptoms (B=-1.14, 95% CI=-2.06, -0.22, p=0.016) and negative affect (B=-2.08, 95% CI=-3.62, -0.55, p=0.008). The effect of TGT-SN on reducing depression was most evident at T3. Structural equation modeling indicated that gratitude and negative affect fully mediated the effect of TGT-SN in reduction of depression and anxiety (mediation effect=-0.17, 95% CI=-0.30, -0.04, p<0.05) at T3. / Conclusions. TGT-SN is a feasible, acceptable, sustainable, and scalable intervention to improve mental health among HIVMSM. It is warranted to increase awareness and policy support for mental health services for people living with HIV (PLWH). Mental health services should be integrated into the HIV/AIDS care system as a key component. Future translational studies are needed to further investigate the efficacy and effectiveness of the intervention in other groups of PLWH and in other cultures and countries. / 研究背景：艾滋病在男男性接觸（men who have sex with men, MSM）人群中的感染率正在以前所未有的速度在我國蔓延。艾滋病陽性的男男性接觸（HIV positive men who have sex with men, HIVMSM）人群面臨極大的壓力，心理疾病（例如抑鬱症）的患病率很高。但是，目前我國對HIVMSM人群的心理健康服務比較缺乏。“三件好事情”是最被廣泛使用的能有效降低抑鬱症的積極心理學干預。這項練習要求參與者每天寫下三件令他們感到高興或者感激的事情。“三件好事情”這兩練習還沒有在HIVMSM 人群中應用。此外，社會支持對抑鬱症有保護作用。電子社交網絡是一種潛在的有效的平台，可以將調查對象（HIVMSM）的“好事情”相互傳遞，加強“三件好事情”的效果。 / 研究目的：本研究的目的是在中國成都市使用隨機對照研究評估積極心理學結合社會網絡干預對減少HIVMSM人群抑鬱症的效果。 / 研究方法：本研究採用隨機對照試驗。四名同伴調查員共招募205位HIVMSM，其中100人被隨機分配到“三件好事情結合電子社交網絡組（TGT-SN）”，105人被分配到對照組。所有參與本研究的調查對象將在隨機分組之前完成基線調查（T0），並在一個月的干預結束時（T1）、干預結束后三個月（T2）、十二個月（T3）時完成隨訪調查。 / TGT-SN干預通過騰訊QQ實施。騰訊QQ是在中國最被普遍使用的社交網絡。TGT-SN組的調查對象將被分配到4個QQ組，每組20-30人。TGT-SN干預要求調查對象在一個月的干預期，每天需要完成以下三個任務：i）每天回想當天發生的三件或以上令自己開心、感激的事情，并將這三件好事情發佈到各自的QQ群留言板；ii）每天閱讀本QQ群其他組員發佈的三件好事情；iii）每天對組員發佈的三件好事情進行正面的積極的評論。被隨機分配到對照組的調查對象在一個月的干預期內，每週收到一條有關心理健康促進的信息。 / 本研究的主要結果為抑鬱症狀，採用美國國立衛生研究院流行病學研究中心抑鬱量表。次級結果包括焦慮症狀、正性和負性情緒、生活滿意度、主觀幸福感、感恩心理、以及社會支持。分析採用廣義估計方程模型（GEE）。中介效應分析採用結構方程模型。 / 研究結果：所有調查對象中，59.5%有輕度到重度抑鬱症（CESD≥16）。TGT-SN和對照組基線所有的背景變量及結果變量均無顯著性差異。基於對T1、T2和T3數據的GEE模型分析，相比于對照組，TGT-SN對降低抑鬱症有顯著主效應（B=-2.35, 95% CI=-4.53, -0.16; p=0.035）。但是此顯著主效應在控制基線抑鬱症狀后變為不顯著（B=-1.67, 95% CI=-3.79, 0.46, p=0.124）。相比于對照組，TGT-SN對降低焦慮症狀（B=-1.29, 95% CI=-2.22, -0.36; p=0.007）和負性情緒（B=-2.24, 95% CI=-3.73, -0.74; p=0.003）也有顯著效果。TGT-SN對降低抑鬱症的效果在T3最為顯著。結構方程模型表明，負性情緒和感恩心理對TGT-SN干預降低T3時抑鬱症和焦慮症的效果中發揮完全中介效應（中介效應=-0.17, 95%置信區間=-0.30, -0.04; p<0.05）。 / 研究結論：TGT-SN能有效減少HIVMSM人群的心理健康問題（例如抑鬱症和焦慮症），並且是可行的和被HIVMSM所接受的干預措施。TGT-SN練習的實施成本較低並且不需要心理學專家的參與，因此可以在資源有限的國家和地區（例如中國）推廣實施。未來需要更多的研究來評估TGT-SN干預在其他艾滋病病毒感染者人群中以及其它國家的效力和效果。" / Li, Jinghua. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 136-149). / Abstracts also in Chinese; some appendixes in Chinese. / Title from PDF title page (viewed on 06, October, 2016). / Li, Jinghua. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.