Bakgrund och problemformulering: Patienter med blodsmitta riskerar att bli sedda utifrån sin blodsmitta. Det kan bero på stigmatisering och förlegade synsätt som är formade utifrån vårdinrättningarnas vårdkultur. Patienten kan bli identifierad med sin blodsmitta och kan därmed få sämre vårdande möten eller utebliven vård. Fokus skiftas från den primära sökorsaken till blodsmittan i sig. Omvårdnaden som ska bedrivas utifrån Caritas brister på grund av rädsla för blodsmitta och vårdandet kan bli till ett vårdlidande. Syfte: Syftet är att beskriva blodsmittade patienters upplevelse i mötet med vårdpersonal.   Metod: Litteraturöversikt med nio kvalitativa artiklar som analyserats och granskats. Resultat: Presenteras utifrån två huvudteman: Diskriminering och stigmatisering med ett undertema sekretess och attityder med två underteman negativa attityder och positiva attityder. Slutsatser: Blodsmittade patienters upplevelse av vårdpersonalens bemötande innefattade negativa attityder, diskriminering och stigmatisering. Detta resulterade i utebliven behandling, vårdlidande och rädsla för att avslöja sin blodsmitta. Negativa attityder, diskriminering och stigmatisering yttrade sig i form av nedvärdering, utebliven behandling, onödiga hygienrutiner och sämre vård samt omvårdnad. Genom ökad kunskap om blodsmitta kan lidandet lindras för dessa patienter.

Voluntary counselling and testing (VCT) for HIV is a vital tool in HIV prevention and care, available information indicates low uptake among Nigerian adolescents despite effort at combating the scourge of HIV/AIDS. A cross sectional quantitative descriptive study was conducted to describe the knowledge, understand the attitudes and practices of VCT among adolescents of senior high school in Nigeria with the aim of informing VCT services and policies. A systematic random sampling of 100 adolescents was done and data collected by means of structured self-administered questionnaires. The study revealed inadequate knowledge on VCT among the study participants which is probably responsible for their poor VCT uptake. Free VCT services and availability of VCT services within the school are factors that could motivate VCT uptake among the students. There is need to enhance dissemination of VCT information among youth and create youth-friendly VCT services to increase VCT uptake among adolescents / Health Studies / M.A. (Public Health)

Thesis (MA (Psychology))--University of Stellenbosch, 2008. / Few studies have assessed the prevalence of Post-Traumatic Stress Disorder (PTSD) associated with the receipt of an HIV-positive diagnosis and no published studies in South Africa have used a structured clinical interview to assess the above-mentioned. The present cross-sectional study assessed the prevalence of HIV-related PTSD among a sample of recently diagnosed patients attending public health clinics in the Boland region of the Western Cape. The PTSD module of the Composite International Diagnostic Interview (CIDI), together with a battery of self-report instruments assessing symptoms of traumatisation, depression and anxiety were administered to 85 patients who had been diagnosed with HIV in the year preceding data collection. In addition, HIVrelated PTSD and symptomatology were assessed using an adapted version of the PTSD module of the CIDI. The self-report instruments administered were (a) a demographic questionnaire, (b) the Posttraumatic Stress Diagnostic Scale (PDS) which assessed current PTSD symptom severity, and (c) the 25-item Hopkins Symptom Checklist (HSCL-25) which assessed psychological distress, and symptoms and intensity of anxiety and depression. The primary aim of the present study was to determine the prevalence of HIV-related PTSD among a sample of recently diagnosed HIV-positive individuals attending HIV clinics in the Boland region. The second aim was to determine the lifetime prevalence of PTSD among the sample. The third aim was to determine the percentage of the sample that endorsed the DSM-IV’s PTSD A2 criterion and the subsequent HIV-related PTSD symptomatology among those who did and did not meet full criteria for HIV-related PTSD. The fourth aim was to determine the level of psychological distress reported by the sample. The prevalence of lifetime PTSD was 29.4% (95% confidence interval [CI], 20.7% - 39.8%). Sixty-nine of the eighty-five participants (81.2%) endorsed the DSM-IV’s PTSD A2 criterion. Of the total sample, 34 participants (40%) (95% CI, 30.2% - 50.6%) met the full criteria for HIV related PTSD. The majority of participants reported mild PTSD symptom severity (45.8%). Over half the sample (51.4%) experienced clinically significant distress. Of those participants diagnosed with HIV-related PTSD, 82.4% were clinically distressed, and 76.5% and 58.8% experienced high levels of depression and anxiety, respectively. The present study’s findings suggest that receiving an HIV-positive diagnosis and/or being HIVpositive may be considered a traumatic stressor that frequently results in HIV-related PTSD. Findings of the present study indicate the need for adequate support and care for HIV-positive individuals. Given the various barriers to efficient mental health interventions and services in South Africa, there are significant challenges that need to be addressed in order to ensure that the mental health and welfare of HIV-positive individuals are both adequately assessed and appropriately maintained.

Thesis (M Social Work)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: HIV/AIDS is one of the worst pandemics affecting the world today. It cuts across all boundaries and many people are infected as well as affected. The virus has reached all the corners of the globe, but the most hit by it is Africa, especially southern Africa, which carries more than half of the population infected and affected by HIV/AIDS. The top five countries whose populationsare infected with HIV are in southern Africa. Lesotho is amongst the top three on this list and also has problems of poverty and a high unemployment rate. Women and children, who are the target groups that are most affected by poverty, are also those living in rural areas. Thus, being an HIV-positive mother living in the rural areas of Lesotho means one has to deal with poverty, the inaccessibility of services and the psychological impacts of HIV. The aim of the study was to gain a better understanding of the views of health service providers on the need and accessibility of support services for HIV-positive mothers in the rural areas of Lesotho from an ecological perspective. To achieve this aim, the objectives were: to offer an overview of the phenomenon of HIV and describe the psychosocial needs and sociocultural circumstance of HIV-positive mothers in the rural areas of Lesotho, and to discuss the HIV-positive mothers’ need for support services from an ecological perspective. Both quantitative and qualitative research approaches were used. The research utilised exploratory and descriptive design. Purposive sampling was used to select the 30 participants who took part in the study. Data was gathered by means of semi-structured questionnaires that were administered during individual interviews. The questionnaires were formulated on the basis of information retrieved during the literature review. The findings of the study reveal that HIV-positive mothers living in the rural areas of Lesotho have economic, social and cultural circumstance as factors hindering their treatment and prevention of HIV/AIDS. They are also faced with the psychological impacts of HIV, and the findings revealed that disclosure was the key to addressing their problems. The findings also show that most mothers receivedemotional, instrumental, informational and appraisal support from their families at the micro-level of the ecological perspective. The other levels – meso, exo and macro – provided only limited support for the mothers. The recommendations are that these mothers need social support at all levels of the ecological perspective to meet their needs / AFRIKAANSE OPSOMMING: MIV/vigs is een van die ergste pandemies in die moderne wêreld. Dit ken geen grense nie, en vele mense ly hetsy daaraan of daaronder. Die virus het reeds alle uithoeke van die aarde bereik. Tog gaan Afrika, veral Suider-Afrika, die swaarste daaronder gebuk, en word meer as die helfte van die totale populasie wat aan of onder MIV/vigs ly hier aangetref. Die vyf lande met die hoogste MIV-infeksiesyfers ter wêreld is almal in die streek geleë. Lesotho is een van die drie lande boaan hierdie lys, en het terselfdertyd te kampe met die probleme van armoede en ’n hoë werkloosheidsyfer. Vroue en kinders, synde die groepe wat die ergste deur armoede geraak word, woon ook meestal in landelike gebiede. ’n MIV-positiewe moeder in die landelike gebiede van Lesotho moet dus armoede, ontoeganklike dienste sowel as die sielkundige uitwerking van MIV trotseer. Die doel van hierdie studie was om vanuit die ekologiese perspektief ’n beter begrip te vorm van gesondheidsdiensverskaffers se sienings oor die behoefte aan en toeganklikheid van steundienste vir MIV-positiewe moeders in die landelike gebiede van Lesotho. Om hierdie doel te bereik, was die oogmerke om ’n oorsig van die MIV-verskynsel te bied, die psigososiale behoeftes en sosiokulturele omstandighede van MIV-positiewe moeders in die landelike gebiede van Lesotho te beskryf, en die moeders se behoefte aan steundienste vanuit die ekologiese perspektief te bespreek. ’n Kwantitatiewe sowel as ’n kwalitatiewe navorsingsmetode is gevolg, en die navorser het van ’n verkennende en beskrywende ontwerp gebruik gemaak. Doelgerigte steekproefneming is gebruik om die 30 studiedeelnemers te kies. Data is met behulp van semigestruktureerde vraelyste gedurende individuele onderhoude ingesamel. Die vraelyste is opgestel op grond van inligting wat in die literatuuroorsig bekom is. Die studie bevind dat ekonomiese, maatskaplike en kulturele omstandighede MIV/vigs-behandeling en -voorkoming vir MIV-positiewe vroue in die landelike gebiede van Lesotho belemmer. Daarbenewens moet hulle die sielkundige uitwerking van MIV die hoof bied, en die studie dui op openbaarmaking as die sleutel om hul probleme te hanteer. Die bevindinge toon ook dat die meeste moeders emosionele, fisiese, inligting- en bevestigende steun van hul families op die mikrovlak van die ekologiese perspektief ontvang. Die ander vlakke – meso, ekso en makro – bied slegs beperkte steun. Die studie kom tot die gevolgtrekking dat hierdie moeders op alle vlakke van die ekologiese perspektief maatskaplike steun moet ontvang om in hul behoeftes te voorsien.

Thesis (M.A. (Clinical Psychology)) --University of Limpopo, 2013 / Studies have indicated that help-seeking behaviour of people living with HIV is not predictable and linear and may entail the utilization of western medicine, traditional medicine and/or complementary medicine. The aim of this study was to explore pre- and post- HIV diagnosis help-seeking behaviour by patients receiving antiretroviral treatment at Witbank Hospital in Mpumalanga Province (South Africa).A qualitative, descriptive phenomenological approach was utilized in the study. Ten participants (male = 5; female = 5, and aged between 30 and 50 years)diagnosed with HIV and who came to the hospital to collect their treatment and for medical review were interviewed using semi-structured interviews. Interpretive analysis method was used to analyse the data. The results suggest the preference for western medicine pre-and post-HIV diagnosis. The results further suggest that help-seeking behaviour is a dynamic process embedded mainly in the conceptualization of the health problem, perception of its severity, the treatment given, and social support experienced.

Thesis (MPH.) --Univesity of Limpopo, 2014 / Background: The main goal of HAART is to achieve maximal viral suppression. However, with poor adherence to therapy the chances of achieving and maintaining successful viral suppression are decreased, leading to virological failure. And virological failure has been recognized by WHO as one of the early warning signs of drug resistance. This operational research sought to explore virological failure as a treatment outcome to evaluate program performance at a facility level. Methods: Purposive sampling as per inclusion and exclusion criteria was used to retrospectively review clinical records of the first 700 adult HIV positive patients (350 males and 350 females) who initiated antiretroviral treatment between April 2004 and December 2007 at this adult HIV clinic, were followed up for at least 3 years and treated according to the South African government’s National Department of Health 2004 HIV treatment guidelines for adults and adolescents. Major Results: 268 clinical records, 97 (27.71%) male and 171 (58.86%) female records were eligible for inclusion in the study. The proportion of females was higher (63.8%) than males (32.8%) with an average age of 38.95 years. 24 (8.9%) patients in the study sample experienced virological failure during the study period; 11 (11.3%) males and 13 (7.6%) females. Two-thirds (66.6%) of patients who failed to suppress at their first viral load measurement proceeded to develop virological failure. Overall, there was no association of statistical significance between age, sex, baseline CD4 cell count and baseline regimen, and virological failure at various intervals, p> 0.05. Conclusion: It was a challenge to keep patients in care but those that remained in care had good treatment outcomes with only 8.9% developing virological failure. Failure to suppress at first viral load preceded virological failure in the majority of patients.

No description available.

In recent years there has been a worldwide recognition of the disparity of HIV treatment available in the West and in Sub-Saharan Africa. The West African nation of Senegal was early to implement measures that allowed for the distribution of highly effective anti-HIV therapy known as Antiretroviral (ARV) therapy to a limited number of patients. This thesis explores how patients living in Senegal who are infected with HIV have engaged in various negotiations to obtain access to treatment and other resources to meet the needs posed by their infection. These negotiations are framed by various historically embedded notions of how to engage relationships in the search for care. Strategies are also shaped by the biopolitically-laden discourse that guides the distribution of ARV therapy. This thesis traces the structure, evolution, and effects of patients' strategic negotiations in response to the introduction of this therapeutic technology.

Background: Prevention of Mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) remains a significant challenge in resource-poor settings despite the advances in antiretroviral (ARV) treatment. HIV-1 infected individuals are able to achieve viral control naturally, however the underlying mechanisms of immunological control in children remains poorly understood. This study was conducted from 2006 to 2010 to investigate correlates of immune control in HIV-1 clade C infected mother-child pairs in the absence of ARVs. Genotypic and phenotypic viral characteristics, cellular immune responses to HIV-1 and host genetics were characterized and correlated with clinical markers of disease progression. Materials and Methods: To achieve the objectives of the study, three cohorts of mother-child pairs were investigated. The first cohort included 60 untreated mother-child pairs and a further ten uninfected children as controls. The second cohort comprised of ARV treated pairs (n=60). The third cohort consisted of 374 mothers and 374 children (infected, exposed uninfected, HIV negative). Plasma viral loads and absolute CD4+ T cell counts were routinely performed in all three cohorts. HIV-specific CD8+ T cell responses were analyzed by interferon gamma (IFN-γ) enzyme linked immunosorbent spot (ELISpot) assays. Viral replicative fitness was assessed using a green fluorescent protein reporter cell line (GFP).Multi-parameter flowcytometry allowed for the investigation of T cell regulation, exhaustion and activation using CD127/CD25, TIM-3/PD-1 and HLA-DR/CD38 markers respectively. IL-10 promoter single nucleotide polymorphisms (SNPs) at positions -592 and -1082 were determined by TaqMan allelic discrimination assays. Plasma IL-10 levels were measured using a luminex assay. Results: To describe the CTL responses elicited to various regions of the HIV proteome in HIV-infected treatment naïve children. Sixty children under one year of age in the untreated cohort were analyzed for CTL responses spanning the HIV genome, for which only 30 had detectable responses. There was no significant difference in viral load between respondersand non-responders (p=0.2799). The responders predominantly targeted Nef (49%), Gag (17%) and Env (14%) regions. Markers of T cell exhaustion and regulation and theirrelationship to markers of disease progression, were next investigated as these parameters may explain the inability of T cells to effectively control HIV infection. T cell phenotyping compared treated, untreated and uninfected subgroups. In infected children, CD8+ T cells were significantly higher for both the inhibitory marker TIM-3 (p=0.001) and exhaustion marker PD-1 (p=0.0001) compared to uninfected children. Median expression of TIM-3 was higher on CD8+ T cells (46%) compared to CD4+ T cells (20%). TIM-3 and PD-1 expression on T cells were maintained at high levels over time. The frequency of absolute Tregs (p=0.0225) were found to be significantly higher in untreated compared to treated children. HLA-DR+CD38+ on CD8+ T cells were significantly up-regulated in untreated children compared to treated (p=0.002) and uninfected children (p=0.0177). HLA-DR+CD38+ was also significantly higher in children less than 6 months compared to older children on CD4+ (p=0.0437) and CD8+ T cells (p=0.00276). Interestingly, we observed a significant negative correlation between magnitude of CTL response and CD25+CD127- (p=0.0202; r=-0.7333) as well as HLA-DR+CD38+ (p=0.0408; r=-0.5516) on CD8+ T cells. IL-10 is an important immunoregulatory cytokine that has been shown to affect the outcome of chronic viral infections. IL-10 polymorphisms have previously been associated with IL-10 levels and HIV-1 outcomes in adults. Polymorphisms associated with different levels of IL-10 production and their relationship with transmission, markers of disease progression and immune responses were next investigated in this mother-child HIV transmission setting. Genetic analysis of IL-10 in cohort three revealed that HIV-1 acquisition was not associated with either IL10 -592 (AA/CA vs CC) or IL10 -1082 (AA/AG vs GG) single nucleotide polymorphisms (SNPSs). There was a significant association between IL10 -1082 and HIV-1 transmission (p=0.0012). No correlation was observed between IL10 -592 (p=0.4279) or IL10 -1082 SNPs (p=0.6361) and mortality rates in children. IL10 -592C was associated with an elevated magnitude of IFN-γ CD8+ T cell response compared to IL10 -529A (p=0.0071). We found a significant positive correlation between IL-10 plasma levels and viral loads (p=0.0068; r=0.4759) and the ages of the children (p=0.0312; r=0.1737). Conclusion: CD8+ T cell responses and viral fitness did not explain differences in disease progression in selected HIV-1 untreated clade C transmission pairs. T cell activation and regulatory markers influence CTL immune responses resulting in poor clinical outcome. IL10 -1082 polymorphisms may be used as a predictor of HIV-1 transmission. The association between increased IL-10 plasma levels and high viral loads suggest that IL-10 contributes to immune dysfunction in paediatric HIV-1 infection. This study has extended our understanding of immunological and genetic correlates of mother-to-child transmission and disease outcome in ARV naïve (naturally controlling) and HIV treated infected children. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 146-154).