Thesis (MScMedSc (Pathology. Medical Virology))--University of Stellenbosch, 2005. / There are currently an estimated 5.3 million people infected with human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS) in South Africa. HIV-1 group M Subtype C is currently responsible for the majority of HIV infections in sub-Saharan Africa (56% worldwide). The Khayelitsha informal settlement, located 30 km outside Cape Town, has one of the highest HIV prevalence rates in the Western Cape. The objective of this study was to investigate the molecular epidemiology of HIV-1 in Khayelitsha using serotyping and genotyping techniques. Patient samples were received from the Matthew Goniwe general health clinic located at site C in Khayelitsha. Serotyping was performed through a competitive enzymelinked immunosorbent assay (cPEIA). RNA was isolated from patient plasma and a two step RT-PCR amplification of the gag p24, env gp41 IDR, env gp120 V3 and pol genome regions performed. Sequences obtained were used for detailed sequence and phylogenetic analysis. Neighbour-joining and maximum likelihood phylogenetic trees were drawn to assess the relationship between the Khayelitsha sequences obtained and a set of reference sequences obtained from the Los Alamos National Library (LANL) HIV database (http://www.hiv.lanl.gov/). Through serotyping and genotyping the majority of HIV strains were characterised as HIV-1 group M subtype C. One sample (1154) was characterised as a possible C / D recombinant strain. In 9 other samples HIV-1 recombination cannot be excluded, as only one of the gene regions investigated could be amplified and characterised in these samples. The gag p24 genome region was found to be more conserved than the env gp41 IDR, with the env gp41 IDR more conserved than the env gp120 V3. The variability of the env gp120 V3 region indicates that patients might be dually infected with variant HIV-1 subtype C strains or quasispecies. Conserved regions identified in the Khayelitsha sequences can induce CD4+ T-cell responses and are important antibody recognition target sites. These conserved regions can play a key role in the development of an effective HIV-1 immunogen reactive against all HIV-1 subtypes. The majority of subtype C viruses were predicted to use CCR5 as their major chemokine co-receptor. The pol sequences analysed indicate that mutations associated with minor resistance to Protease Inhibitors (PIs) might be present in the Khayelitsha community. The identification of resistant mutations is vital for people receiving antiretroviral treatment (ART). It can influence the success of their treatment and delay the onset of AIDS. Serotyping is a quick characterisation method, but not always accurate. With genotyping detailed molecular analysis can be performed. However, with genotyping the success of amplification often depends on viral load. In Southern Africa a subtype C candidate vaccine appears to be the best option for future vaccine considerations. The sporadic detection of non-subtype C and recombinant subtype C viruses remains a concern and will thus have to be closely monitored. Phylogenetic analysis can help to classify and monitor the spread and evolution of these viruses.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Due to a lack of research, which, in turn, resulted in a shortage of applicable literature that focused on the experiences and socio-emotional needs of family members as carers of AIDS-patients, the researcher decided to undertake this research project. The aim of this was to investigate the experiences and socio-emotional needs of family members as AIDS care givers. To lead the research, the researcher made use of a qualitative research approach. Attention was also given to the description of HIV/AIDS, as well as the prevention and treatment of HIV/AIDS. The impact of HIV/AIDS was also given attention, and it was done from an ecological perspective. Within the qualitative research paradigm a phenomenological, explorative, descriptive and contextual research design was utilised. The boundaries for data collection were delineated to the George area. Semi-structured interviews were conducted with family members who acted as primary care givers of AIDS-patients who were recruited by means of purposive sampling and the snowball sampling technique. The data collected were analysed according to the steps for qualitative data analysis as proposed by Tesch (in Cresswell, 1994). To ensure the trustworthiness of the research findings, data verification was executed according to Guba’s model (in Krefting, 1991). The following twelve themes emanated from the process of data analysis: - Knowledge of the disease - Caring for people with AIDS - Risky behaviour - Other people’s reactions - Care givers’ feelings and reactions - Support that was received with the care giving - Effect of the care giving on the relationship between the care giver and the patient - Changes in the care givers’ life because of the care giving of AIDS patients - Experiences regarding the dying process - Needs regarding the caring of the patient - Services that are needed - Advice from the participants to other family members as AIDS care givers. The following recommendations were made based on the conclusions derived from the research findings: Information sessions by Social Workers in collaboration with the different clinics on certain days; a community based project to recruit volunteers to support family care givers on a regular basis; look at facilities, like old age homes and hospices, that can give respite for a week to three weeks; connect family care givers to support groups in the community; make use of the media to give information regarding HIV/AIDS to the broader community; a centralized food and clothes bank from which care givers can draw affordable food and clothes. An application for funding can be done at the Department of Social Development or the Department of Health. Another recommendation that is made is to investigate the possibility of a community based project that provides cleaning and washing services to family members as care givers, as well as the patients. This can even become a job creation project. Other recommendations are: to investigate an alternative form of transport that is wheelchair accessible and patient friendly; to train home based carers to help family members as AIDS care givers; to train home based carers to be of assistance with counseling of patients with regard to their medication; to train home based carers as AIDS care givers to help family members to reach out to other support services or groups; that care givers should be careful about expectations of other people and that they should be confident enough to verbalize their expectations; that Social Workers should investigate if the family member, as AIDS care giver, as well as the patient, gets the necessary support on all levels of the ecological perspective, and if not, he/she must look at ancillary sources and mobilize it to give support to the family care giver as well as to the patient; that professionals need to keep in mind the advice the participants was given to other family members as care givers when they are working with these families. A recommendation was also made to do a follow-up research on the same topic in the White, Indian and Black communities and especially that further emphasis should be placed on their needs, as participation by this population groups were scarce or could not be obtained at all. / AFRIKAANSE OPSOMMING: Weens ‘n gebrek aan navorsing, en gevolglik ook aan literatuur rakende die belewenisse en sosio-emosionele behoeftes van familielede as primêre VIGS-versorgers, het die navorser besluit om hierdie navorsingsprojek te onderneem. Die doel hiermee was om die belewenisse en sosio-emosionele behoeftes van familielede as primêre VIGS-versorgers te verken en te beskryf. Om die navorsing te rig, is ‘n kwalitatiewe navorsingsbenadering vir die doel gebruik. Aandag is ook gegee aan die beskrywing en voorkoms van MIV/VIGS, asook die voorkoming en behandeling van MIV/VIGS. Die impak van MIV/VIGS is ook breedvoerig bespreek en is dit vanuit ‘n ekologiese perspektief gedoen. Binne die kwalitatiewe navorsingsbenadering is daar van ‘n fenomenologiese, verkennende, beskrywende en kontekstuele navorsingsontwerp gebruik gemaak. Die grense vir data-insameling het binne die George-area geval. Semi-gestruktureerde onderhoude is gevoer met familielede wat as primêre VIGS-versorgers optree, en wat deur middel van ‘n doelgerigte steekproeftrekking en die sneeubaltegniek vir deelname aan die navorsing gewerf is. Die ingesamelde data is ontleed aan die hand van die agt stappe van kwalitatiewe data-ontleding van Tesch soos uiteengesit in Creswell (1994). Guba se model soos dit in Krefting (1991:214-221) uiteengesit is, is gebruik om die vertrouenswaardigheid van die navorsingsdata te verifieer. Twaalf temas het na aanleiding van die prosesse van data-ontleding na vore gekom, naamlik: - Kennis van die siektetoestand - Versorging van VIGS-lyers - Risiko-gedrag - Ander mense se reaksie - Versorger se gevoelens en reaksies - Ondersteuning wat ontvang is met die versorging - Effek van pasiënt se versorging op die verhouding tussen versorger en pasiënt - Verandering van versorger se lewe as gevolg van die versorging van die VIGS-lyer - Belewenisse ten op sigte van die sterwensproses - Behoeftes ten opsigte van die versorging van die pasiënt - Dienste wat benodig word - Raad deur deelnemers aan ander familielede as VIGS-versorgers. Voortspruitend uit die navorsingsbevindinge, is tot sekere gevolgtrekkings gekom waaruit die volgende aanbevelings gemaak is: dat inligtingsessies deur maatskaplike werkers in samewerking met die verskillende klinieke op sekere dae gehou sal word; dat ‘n gemeenskapsprojek van stapel gestuur word om vrywilligers te werf wat op ‘n gereelde basis aan VIGS-versorgers ondersteuning bied; dat daar gekyk word na respite by ouetehuise of ‘n hospice vir ‘n tydperk van ongeveer drie weke om aan versorgers ‘n ruskans te gee; dat versorgers betrek word by ondersteuningsgroepe in die gemeenskap; dat die media gebruik word om inligting oor VIGS aan die breë gemeenskap deur te gee; dat aandag gegee word aan ‘n gesentraliseerde voedsel- en klerebank waarvandaan versorgers voorraad kan onttrek. Aansoek vir befondsing kan gedoen word by Departement Maatskaplike Ontwikkeling of Departement Gesondheid. Verdere aanbevelings wat gemaak kan word, is: dat ‘n gemeenskapsprojek van stapel gestuur word om skoonmaakdienste en hulp met wasgoed was tot die beskikking van die VIGS-versorger te stel wat selfs as ‘n werkskeppingsprojek begin kan word; dat ‘n alternatiewe vorm van vervoer wat deur die familielid en pasiënt benut kan word, en wat geskik is vir pasiënt vervoer, ondersoek sal word; dat opleiding van tuisversorgers as hulp vir familielede as VIGS-versorgers aandag sal kry; dat opleiding van tuisversorgers om behulpsaam te wees met berading van pasiënte rakende hulle medikasie dringende aandag sal geniet; dat familielede as VIGS-versorgers uitreik na ander ondersteuningsbronne vir hulp; dat versorgers versigtig sal wees ten opsigte van verwagtinge van ander, maar dat hulle ook vrymoedigheid sal neem om hulle verwagtinge te verbaliseer; dat die maatskaplike werker sal ondersoek instel of die familielid as primêre VIGS-versorger, sowel as die pasiënt, vanuit al die vlakke van die ekologiese perspektief die nodige ondersteuning geniet, en indien nie, moet daar gekyk word na hulpbronne en dit moet gemobiliseer word ten einde hierdie noodsaaklike ondersteuning te bied; dat die raad wat deur die deelnemers aan die navorsing aan ander familielede as VIGS-versorgers voorsien is, in gedagte gehou sal word wanneer met hierdie families gewerk word. ‘n Aanbeveling is ook gemaak dat opvolg navorsing oor dieselfde onderwerp gedoen word onder die Wit, Indiër en Swart gemeenskappe, en dat veral klem gelê word op hulle behoeftes, aangesien deelname vanuit hierdie bevolkingsgroepe skraal was, of glad nie bekom kon word nie.

Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: There is, as yet, no cure for HIV/AIDS, a disease that has affected South African society profoundly. While antiretrovirals (ARVs) are now available and have stemmed the tide of AIDS deaths, medicines alone cannot be seen as a long-term solution. Treatment costs, finite resources, limited health-care capacity, morbidity and the unpleasant side-effects of ARVs, make treatment an untenable solution. The Christian church in South Africa continues to retain a powerful position; it has a significant affiliation; it is present in most geographic areas and inspires trust and confidence. Furthermore, in my view, the church, by its very nature and calling, is mandated not only to demonstrate and provide care, but also to inspire care-giving. In the light of HIV/AIDS, what does care mean? Can it only mean rendering care that is welfarist in nature? Or does the church have the mandate to look beyond immediate suffering, to examine and address those issues that lie at the core of suffering? Research has demonstrated that issues such as poverty, injustice, stigma, discrimination, gender inequality and patriarchy fuel the pandemic. Ultimately, it is the “othering” of people; the failure not to recognise God in another person and our common humanity, that lie at the heart of the problem. These then, I suggest, are the very reasons why the church must address these areas. But that is not all: if HIV/AIDS care is to be rendered in a developmental way, then there must be a thorough understanding of the disease: how is the virus transmitted, how can it be prevented and treated? It is also important to understand that there is not a single global epidemic but many local epidemics; the determinants and risk-factors of these need to be recognised, as must the cultural, economic, political and social contexts that fuel the spread of the disease. The changing nature of society, the effects of globalisation, the evolving nature of care owing to biomedical advances and even the “privatisation” of sex all need to be comprehended. Furthermore, any meaningful rendering of care requires the churches to examine why they should be giving it and the values that underpin such care-giving. I make the case that the churches are required to do nothing less than drive social change in situations of suffering, injustice and abuse. An examination of the history of HIV/AIDS in South Africa illustrates that the churches have often failed to meet up to this calling. An empirical study was conducted as to how the churches render care at a more micro, grassroots level, using a framework propounded by David Korten, who suggests that authentic development must be people-centred, rather than growthcentred. Essentially, development must seek to increase personal and institutional capacities, guided by principles of justice, sustainability and inclusiveness. In these respects, I argue, it accords very strongly with the Christian message. Korten suggests that there are four orientations (or generations) of rendering help but it is only the fourth generation that is truly developmental. Through the use of case study methodology, I sought to examine the manner in which the churches render care, in a region of the Western Cape, outside Cape Town, known as the Helderberg Basin. The area is representative of many peri-urban areas in the Cape: it is predominantly Christian, with a mix of different denominations and racial and socio-economic groupings. It allowed for an assessment of care initiatives afforded by mainline, charismatic and African Independent Churches and in particular, sought to answer the question of whether churches engage with HIV/AIDS in a way that Korten would identify as developmental. From the research, it is clear that the church is hampered by its inability to talk of sex and sexuality; its knowledge of the issues surrounding HIV/AIDS is limited; it has not done a sufficient amount to conscientise its followers; the church has yet to learn to utilise its networks; it lacks technical know-how and is unwilling to engage in the political sphere. Social change is only possible if the church embraces a new vision of how to create a better world. Additionally, I recommend that the church looks to the emerging church movement to achieve radical transformation. / AFRIKAANSE OPSOMMING: MIV/VIGS is ‘n siekte wat Suid-Afrika onmeetbaar beїnvloed en waarvoor daar tot op hede geen genesing is nie. Antiretrovirale middels (ARVs) is weliswaar beskikbaar en het die gety van VIGS sterftes gestuit maar medisyne kan nie alleen as die langtermyn oplossing gesien word nie. Behandelingskoste, beperkte hulpbronne en vermoë om gesondheidsorg te lewer, morbiditeit en die negatiewe newe-effekte van ARVs bring mee dat slegs mediese behandeling ‘n onhoudbare oplossing is. Die Christelike kerk in Suid-Afrika behou steeds ‘n magsposisie; dit het ‘n beduidende lidmaatskap asook ‘n teenwoordigheid in meeste dele van die land en boesem vertroue en sekerheid in. Dié kerk is na my mening gemandateer deur haar besondere aard en roeping om nie alleen sorg te bewys en te voorsien nie maar ook om versorging aan te moedig. Maar wat beteken sorg, gegewe die aard van MIV/VIGS? Kan dit slegs die lewering van welsyngerigte sorg beteken? Of sou die kerk die mandaat hê om verder as onmiddellike lyding te kyk en ondersoekend die kwessies wat aan die wortel van lyding lê, aan te spreek? Navorsing het aangetoon dat kwessies soos armoede, onreg, stigma, diskriminasie, geslagsongelykheid en patriargie die epidemie aanvuur. Uiteindelik is dit die objektivering (“othering”) van mense - dit is die onvermoë om God nie in ‘n ander persoon en ons gemeenskaplike mensheid te herken nie - wat die hart van die probleem is. Ek betoog dat hierdie die redes is waarom die kerk hierdie kwessies moet aanspreek. Om ondersoek in te stel of en tot watter mate die kerk sorg verskaf in verband met MIV/VIGS het ek die raamwerk van David Korten gebruik. Dié raamwerk stel voor dat outentieke ontwikkeling mensgesentreerd eerder as groeigesentreed sal wees. Ontwikkeling moet essensieel streef na ‘n toename van persoonlike en institusionele vermoë, gerig deur beginsels van geregtigheid, volhoubaarheid en inklusiwiteit. Ek toon aan dat hierdie beginsels baie sterk ooreenkom met die Christelike boodskap. Korten stel vier hulplewerende oriëntasies (ook genoem generasies) voor maar dit is eintlik slegs die vierde generasie van hulp wat werklik ontwikkelingsgerig is. Maar dit is nie al nie. Indien MIV/VIGS versorging ontwikkelingsgerig gaan wees, moet dit gegrond wees op ‘n diepgaande verstaan en kennis van die siekte soos onder andere, hoe die virus versprei word en hoe die siekte voorkóm en behandel kan word? Dit is ook belangrik om te verstaan dat daar nie slegs ‘n enkele globale epidemie is nie maar verskeie lokale epidemies. Die veroorsakende en risiko faktore van hierdie epidemies moet daarom geїdentifiseer word en so ook die kulturele, ekonomiese, politieke en sosiale konteks wat die verspreiding van hierdie siekte aanhelp. Die veranderende aard van gemeenskappe, die effek van globalisering, die ontwikkelende aard van gesondheidsorg vanweë die vooruitgang in die mediese wetenskap en die “privatisering” van seks moet alles in ag geneem word. Betekenisvolle versorging vereis dat kerke ondersoek instel na waarom die versorging aangebied word en die waardes onderliggend daaraan. Ek stel die saak dat daar van kerke verwag word om sosiale verandering te stuur waar mense swaarkry, onregverdig behandel en misbruik word. ‘n Ondersoek na die geskiedenis van MIV/VIGS in Suid-Afrika illustreer dat kerke dikwels misluk het om aan hierdie roeping gehoor te gee. In opvolging van die bostaande argumente het ek navorsing uitgevoer oor hoe kerke sorg op ‘n mikro of voetsool-vlak aanbied. Hiervoor het ek die genoemde mensgesentreerde ontwikkelingsraamwerk van David Korten gebruik. ‘n Gevalstudie benadering is gevolg in die Helderbergkom wat geleë is in ‘n streek van Wes- Kaapland buite Kaapstad. Hierdie gebied is verteenwoordigend van baie buitestedelike gebiede van die Kaap: dit is oorwegend Christelik en sluit ‘n verskeidenheid van denominasies, rasse en sosio-ekonomiese groeperings in. Die gebied maak ‘n oorsig moontlik van die sorg-inisiatiewe van hoofstroom, charismatiese en Afrika onafhanklike Kerke, en in die besonder van ‘n identifikasie daarvan of kerke betrokke by MIV/VIGS dit doen op ‘n wyse wat Korten sou tipeer as ontwikkelingsgerig. Uit hierdie navorsing het dit duidelik geword dat die kerk gekniehalter word deur ‘n onvermoë om oor seks en seksualiteit te praat; die kerk se kennis beperk is wanneer dit kom by kwessies wat handel oor MIV/VIGS; dit nie genoeg doen om lidmate bewus te maak van VIGS kwessies nie; dit nog veel te leer het oor hoe om netwerke aan te wend; dit tegniese kennis kort en onwillig is om met sake van politieke belang om te gaan. Sosiale verandering is alleen moontlik indien die kerk ‘n nuwe visie voorhou oor hoe om ‘n beter wêreld te skep. Ek beveel ten slotte aan dat die kerk let op die ontluikende kerkbeweging om radikale transformasie te verwesenlik.

Thesis (M Social Work (Social Work))--Stellenbosch University, 2008. / South Africa is experiencing a serious HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) epidemic, with millions of its people living with the disease and dying from related diseases. As there is no cure as yet, counselling as a form of intervention is one of the most powerful ways to address the psychosocial aspects of HIV/AIDS. The motivation for this study was the lack of research concerning skills needed by counsellors in counselling HIV/AIDS patients who are on antiretroviral treatment (ART) or are about to commence antiretroviral treatment. To add to the knowledge that is lacking, the study was approached by means of both quantitative and qualitative research methods. The purpose of the research was explorative and descriptive. The discussion on the literature that was studied provides an overview of the implications of HIV/AIDS for the individual and the family, and of the psychosocial implications, in addition to describing antiretroviral treatment and the nature of HIV and adherence counselling processes and skills. A sample of 16 adherence counsellors who were between the ages of 27 and 57 years was interviewed. These adherence counsellors were employed by Sothemba Aids Action, placed at the different ART sites, trained at the Aids, Training, Information and Counselling Centre (ATTIC) and have gained one or more years’ experience in HIV/AIDS counselling. A semi-structured questionnaire was used as research instrument. It contained both open- and closed-ended questions. All the interviews took place at the clinics where the counsellors were employed or worked. The results of the study showed that an equal number of respondents from two different ethnic groups were interviewed; all the participants had received high school education; and a few obtained tertiary level qualifications. They all received training in basic counselling skills and adherence counselling skills. A few indicated additional training in Voluntary Counselling and Testing (VCT), as well as Prevention of Mother-to-child Transmission Counselling (PMTC). A minority of counsellors indicated making use of a translator and that their experience was that the message was always misinterpreted. All the adherence counsellors indicated a need for further training involving social problems and counselling of children at different ages and stages of development. It was also found that the adherence counsellors lack skills in counselling intervention processes and in intervention. All the adherence counsellors raised concerns regarding their working conditions and salaries. In light of the above it is recommended that patients be counselled in their preferred language, that all counsellors receive the same training in counselling and in the additional areas where they experience a shortcoming. Data on HIV/AIDS and adherence counselling, including the views of counsellors and patients are limited. It is recommended that more research be done on HIV/AIDS and adherence counselling, including the different disciplines that are involved and the views of patients about services rendered to them by those in the different disciplines, and counsellors.

Thesis (MBA (Business Management))--University of Stellenbosch, 2008. / AFRIKAANSE OPSOMMING: Menslike immuungebrekvirus (MIV) en Verworwe immuniteitsgebrek sindroom (VIGS) is een van die grootste uitdagings waarvoor werkgewers vandag te staan kom, en behoort die stukrag te wees vir ’n deeglike ondersoek om die voorkoms van hierdie toestand in die werkplek so akkuraat as moontlik te bepaal. So ’n ondersoek kan lig werp op toekomstige demografiese arbeidsmagtendense en verwante koste, byvoorbeeld verlies aan produktiwiteit en dienslewering weens afwesigheid, ’n toename in aftredes, en stygende sieke- en pensioenfondseise wat waarskynlik ingedien sal word. Daarbenewens kan so ’n ondersoek die werkgewer in staat stel om noukeuriger vir die toekoms te beplan, vanuit die oogpunt van finansies sowel as menslike hulpbronne. Daar is egter ’n neiging by werkgewers om MIV/VIGS steeds as ’n maatskaplike of samelewingsprobleem eerder as ’n besigheidspesifieke risiko te beskou. Onkunde is meestal die rede hiervoor. Werkgewers neig om weg te skram van direkte risikobestuur, dikwels met die argument dat dit die regering se plig is om MIV/VIGS-opleiding en gesondheidsorg te voorsien. Sodoende word die bestaande verhouding van ‘ekwilibriumkonvergensie’ tussen die staat, sakesektor en arbeid verydel. MIV/VIGS moet soos ander groot geïdentifiseerde sakerisiko’s beskou, gemeet en proaktief bestuur word, net soos met wisselkoers wisselvalligheid, politieke en infrastrukturele risiko’s, en persoonlike en batesekuriteit. Hoewel hierdie risikofaktore dwarsoor die wêreld bestaan, en sommiges in ander wêrelddele groter is, het hul gekombineerde uitwerking veral in Suider-Afrika ernstige implikasies vir investering en die koste om hier sake te doen. Soos alle ander sakerisiko’s moet die hantering daarvan multidimensioneel wees: • Identifiseer, meet en bestuur die risiko; plaas MIV/VIGS eerste op die direksie se agenda. • Stel senior beamptes aan om die risiko te bestuur. • Evalueer bestuurstrukture en intervensie stappe gereeld. • MIV/VIGS opleiding is die sleutel, vir bestuurslede sowel as werknemers. Risikobestuur moet holisties wees. So byvoorbeeld is dit nutteloos om gesondheidsorg sonder proaktiewe pasiëntebestuur te voorsien. En net soos wat behandelingsplanne sonder befondsing sinloos is, is dit futiel om goed befondsde voordeelplanne te skep as behandeling nie toeganklik is nie. Die doel van hierdie studie is om die proses wat Old Mutual (SA) gevolg het om die voorkoms van MIV onder sy 13 000 permanente werknemers landwyd te eksploreer. Die statistiese uitkoms sal dan gebruik word om te bepaal of Old Mutual (SA) wel sy doelwitte in terme van werknemersgelykheid sal bereik en behou, gegewe die MIV/VIGS pandemie. Vooruitskouings oor die implikasies van MIV/VIGS vir Old Mutual (SA) moet met die nodige omsigtigheid benader word, alhoewel hierdie studie aandui dat dit moontlik implikasies kan inhou vir werkverskaffing in die toekoms, gegewe die wetlike vereistes vir die verskeie aangewese groepe. MIV/VIGS lei nie net tot siekte, ongeskiktheid en dood onder Old Mutual (SA) se werknemers nie. Tesame met ernstige ekonomiese en emosionele ontwrigting vir hul gesinne, verhoog dit ook die koste om in Suid-Afrika sake te doen. Hierdie koste sluit die volgende in: • verhoogde gesondheidsorgkoste; • meer eise vir aftree-, pensioen- en doodsvoordele; • laer produktiwiteit namate afwesigheid van die werk styg weens siekte, hetsy eie of siek familielede na wie omgesien moet word; en • verhoogde koste vir personeelwerwing, arbeidsomset en opleiding weens die verlies van ervare personeel. / ENGLISH ABSTRACT: Human Immunodeficiency Virus infection and the Acquired Immune Deficiency Syndrome (HIV/AIDS) is one of the greatest challenges facing employers today, and should provide the impetus for a thorough investigation among employees in order to arrive at an estimate of HIV prevalence within the workplace. Such an investigation could shed light on future demographic workforce trends as well as related costs, e.g. loss in productivity and service delivery due to absenteeism, increased retirement and a rise in medical aid and pension fund claims that the employer is likely to encounter. Furthermore, this investigation could enable the employer to plan better for the future – both from a financial and human resources viewpoint. In the ‘real’ world though, employers still perceive HIV/AIDS as a social or community problem rather than a business specific risk. Employers, largely through ignorance, tend to shy away from direct risk management – often using the argument that it is the government’s responsibility to provide HIV/AIDS education and healthcare. In this way they nullify the existing ‘equilibrium convergence’ relationship between the state, business and labour. HIV/AIDS must be measured and proactively managed and should be regarded in the same light as other major identified business risks, e.g. personal and asset security, exchange rate volatility, and political and infrastructure risks. While it is true that all of these particular risk factors exist across the globe, and may be greater in other parts of the world, nowhere else do they seem to combine with such severe implications to deter investment and raise the cost of doing business than in Southern Africa. As for any other business risk, the response should be multi-dimensional: • Identify, measure and manage; place HIV/AIDS at the top of board agendas. • Appoint senior executives to manage the risk. • Regularly evaluate management structures and interventions. • HIV/AIDS education is key to both management and employees. Risk management should be holistic. For example, providing healthcare without proactive patient management is pointless. Similarly, treatment plans without funding are futile, and well-funded benefit plans without practical access to treatment are a waste of time. The aim of this study is to explore the process Old Mutual (SA) followed in estimating the HIV prevalence among its 13 000 permanent employees nationally. The resultant statistics would then be used to project whether or not Old Mutual (SA) will be able to achieve and sustain its employment equity targets, given the HIV/AIDS pandemic. Predictions on the implications of HIV/AIDS for Old Mutual (SA) should be approached with due caution, although this study suggests that it could probably seriously impact on shortages in the supply of labour in future, given the legislative requirements for the various designated groupings. HIV/AIDS not only causes illness, disability and death among Old Mutual (SA) employees, coupled with severe economic and emotional disruption for their families, it also increases the cost of doing business in South Africa. These costs include: • increased healthcare expenses; • increased retirement, pension and death benefit claims; • decreased productivity as worker absenteeism rises owing to personal illness, or absence from work to care for sick relatives; and • increased recruitment, labour turnover and training costs due to loss of experienced workers.

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.

Thesis (M.B.A.)-Business Studies Unit, Durban Institute of Technology, 2005 xii, 127 leaves / The knowledge, attitude and training needs of line managers at the South African Sugar Association (SASA) with regards to the management of HIV/AIDS infected employees. Background: The rapid spread of HIV/AIDS is having an increasingly adverse impact on the operations of companies. Due to the changing environment in which line managers have to operate as a result of HIV/AIDS, line managers will increasingly be faced with handling HIV/AIDS infected employees and all the issues surrounding this epidemic. The research investigates the knowledge, attitude and training needs of line managers in SASA with regards to the management of HIV/AIDS infected employees. Objective: The goals of the research are; 1). To ascertain the prevailing level of knowledge, attitude and training needs of line managers at SASA with regards to the management of HIV/AIDS infected employees. 2). To establish the relationship between the biographic variables and knowledge, attitude and training needs with regards to the management of HIV/AIDS infected employees. / M

by Joe Chan Bing Hang. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 48-54). / Abstracts in English and Chinese; questionnaire in Chinese. / ABSTRACT --- p.i / ACKNOWLEDGEMENTS --- p.ii / TABLE OF CONTENTS --- p.iii / Chapter CHAPTER I - --- INTRODUCTION --- p.1 / Chapter CHAPTER II - --- METHOD --- p.23 / Chapter CHAPTER III - --- RESULTS --- p.29 / Chapter CHAPTER IV - --- DISCUSSION --- p.38 / REFERENCES --- p.48 / APPENDIX --- p.55

The phenomenon of HIV discordance has been in existence for a long time along with HIV. However, very limited attention has been given to HIV discordance. This phenomenological study aimed at gaining a deeper understanding on the lived experiences of sero-discordant couples in Botswana. Reports show that discordance in Botswana is around 17%. The main objectives of this study were to identify HIV discordant couples living in Botswana and explore their knowledge and understanding of the situation, explore the psychological, social and sexual experiences of the HIV discordant couples and determine its impact in their lives, and examine the meaning they attach to such experiences and challenges they face as well as their coping strategies. A qualitative phenomenological approach using face to face in-depth interviews was used to explore and describe meanings and experience as lived by the HIV discordant couples. The study sample consisted of forty-six (N=46) (twenty-nine (n=29) females and seventeen (n=17) males) participants selected using purposive sampling from three cities in Botswana. The Inclusion criteria were that participants should be aged 21 years and above; with no known diagnosis of mental illness; having been in a discordant relationship for at least six months at the time of data collection; living in Botswana and willing to participate in the study. The findings were that there are three forms of discordance, which are: discordant unaware which are couples who went into the relation unaware of their HIV status. Discordant aware; those who got into the relationship already knowing each other’s HIV status and discordantly discordant which are those with differing HIV status and differing motives of going into the relationship. These are the couples that conceal their status from one another. The results revealed intense emotional/psychological, sexual and social stresses as experienced by couples. HIV discordant goes through three phases of initial shock, conflict and resolution. The researcher recommends the OPEN DESK MODEL to be integrated in the health facilities to encompass the concept of a family or couple and as a unit. / Health Studies / D. Litt. et Phil. (Health Studies)

This study was conducted to investigate the role of natural killer cell surface receptors, KIRs and their cognate HLA ligands in preventing HIV-1 acquisition and disease progression in HIV-1 exposed infants. Using DBS stored for 8 years from 21 pregnant South African women we evaluated 3 methods of gDNA extraction with and without whole genome amplification (WGA) to characterize immune-related genes: IL-10, KIR and HLA class I. However, IL-10 SNP typing was only for testing the quality of gDNA. QIAamp DNA mini kit yielded the highest gDNA quality (p<0.05; Wilcoxon Signed Rank Test) with sufficient yield for subsequent analyses. In contrast, WGA was not reliable for SSP-PCR analysis of KIR2DL1, KIR2DS1, KIR2DL5, and KIR2DL3 or high resolution HLA genotyping using a sequence-based approach. A cohort of 370 infants; 124 HIV-1 perinatally infected, 120 exposed uninfected and 126 unexposed healthy infants was used for KIR and HLA genotyping. After adjustment for viral load and multiple comparisons, the frequency of HLA-Cw*04:01 allele was likely to be associated with susceptibility to mother-to-child acquisition of HIV-1 in exposed infected (EI) infants (p=0.05; Logistic Regression analysis). HLA-A*23:01 was likely to be associated with decreased CD4 T lymphocyte count in HIV-1 infected infants (p=0.01; ANOVA), whereas HLA-B*81 tended to be associated with higher CD4 T lymphocyte count (p=0.04, ANOVA). We speculate that HLA-Cw*04:01 interacts with KIR2DL1 and inhibit NK cell responses which predispose the infants to HIV-1 infection. KIR2DS1 and KIR2DL5 were both associated with faster HIV-1 disease progression. Identified protective HLA-class I alleles could be used to present viral epitopes to either NK cells via KIRs or CTLs and enhance immune activation which may promote resistance to HIV-1 infection. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2012.