Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

Thesis (MSc (Nursing))--Cape Peninsula University of Technology, 2018 / Primary health care (PHC) is a frontline health care approach. It is the point of contact where people are kept well and where their quality of life is improved. All people diagnosed as HIV- positive are retested prior to antiretroviral therapy (ART) initiation to verify their serostatus. ART initiation is seen as a non-emergency treatment that provides many benefits if its initiation is accelerated, for example following up pregnant women after being diagnosed with HIV. However, accelerated initiation may lead clients to start treatment before they are ready to adhere to treatment outcomes. The purpose of this study was to describe the nurse support for young adults during a first antiretroviral therapy visit at an urban primary health care clinic in Malawi. A descriptive phenomenological design was followed at an urban setup in Zomba city, Malawi. The sample was selected through purposive sampling until data saturation was obtained. Individual semi- structured interviews were conducted with young adults aged 19 25 who have visited the clinic for their first ART according to an interview schedule and field notes for around 30 minutes in a private room. The data was analysed using distinctive process and a consensus meeting was held between the researcher and independent coder. The findings of the study could help the PHC services to retain and re-engage the young adults in HIV care and aid the Government of Malawi in achieving its Sustainable Development Goal (SDG) 3. Principles of trustworthiness and ethics were adhered to throughout the research process. Six themes, each with separate categories, emerged from the data analysis on the experience of young adults during their first visit for ART at an urban PHC clinic in Malawi. The results indicated the need for an environment that enhances a client-orientated approach with a focus on holistic well-being. Knowledge management should be used to provide relevant and sufficient information to a newcomer while maintaining ethics under difficult circumstances. The legal environment should have a focus on supporting clients that need comprehensive ART treatment. Motivation of the patient regarding taking antiretroviral treatment (ART) is thus essential. Young adults express the need to be supported by nurses with relevant information, privacy and confidentiality and the trusting client/nurse relationship which could help them to retain in ART care. Recommendations of this study was that nurses should be offered in-service training on youthfriendly programmes which focuses on the health care of young adults during their HIV/ART services. Nurses need to create trusting relationship for the young adults and providing in door game at the waiting area to keep them busy as they are waiting for the services. Nursing managers to lobby for funding to extend the clinic and be role models in providing relevant information to young adults. It was concluded that a first visit was both positive and challenging to the participant s; however, they experienced the health providers on the first visit to be caring and supportive.

M.Med.(Anaesthesia), Faculty of Health Sciences, University of the Witwatersrand, 2008 / BACKGROUND HIV infection is common in South Africa. The disease often remains clinically latent, despite the patient having severe immune compromise. Clinical preoperative assessment may result in patients with this severe systemic disease going unnoticed. OBJECTIVES The primary objective was to determine the relationship between the preoperative physical status of HIV-positive patients presenting for anaesthesia and the CD4- count. The secondary objectives were to determine the prevalence of HIV infection in this group of patients, to determine the prevalence of HIV infection in selected subgroups, to ascertain what proportion of patients presenting for anaesthesia know their HIV status, and to ascertain what proportion of HIVpositive patients are receiving highly active antiretroviral therapy (HAART). METHOD A sample of 350 adult patients presenting for anaesthesia at Chris Hani Baragwanath Hospital was selected. Patients were interviewed preoperatively and were examined, and in doing so their ASA physical status grading was determined. Blood was sampled, and in those who were confirmed HIV-positive, vi a CD4-count was checked. Further data were collected: age, gender, the type, nature, urgency and time of day of surgery, the patient’s knowledge of their HIV status, and whether the patient was receiving HAART or not. RESULTS HIV-positive patients were more likely to be classified as ASA 1 or 2 than ASA 3 or 4 (OR 2.1). HIV-positive patients with CD4-counts above 200 cells.mm-3 were also more likely to be ASA 1 or 2 than ASA 3 or 4 (OR 3.88). However, within the group of HIV-positive patients with CD4-counts below 200 cells.mm-3, significantly more patients were classified as ASA 1 or 2 than ASA 3 or 4 (p<0.0001). Three patients with CD4-counts below 50 cells.mm-3 were classified as ASA 1 or 2. The overall prevalence of HIV infection was 29.4%. Within the various subgroups, the groups with higher disease prevalence rates were females, patients presenting for obstetric surgery, and the younger age groups. The highest prevalence of HIV infection was found in patients aged 30-39 years (43.0%), and the lowest prevalence was found in patients aged 60 years or older (7.7%). CONCLUSIONS Routine clinical preoperative assessment in patients from a population with a high HIV prevalence rate may result in asymptomatic, severe immune compromise secondary to HIV infection being missed in a significant number of patients. Further study into the perioperative outcomes of these patients is warranted.

M.Dent.(Community Dentistry), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Title: Knowledge, Attitudes and Practices of caregivers about oral lesions in HIV positive patients in NGOs /CBOs in Region 8, Johannesburg, Gauteng. Background: The HIV pandemic continues to be a major public health problem in South Africa where 11% of people were infected with HIV in 2005(HSRC, 2005).The care and support of these patients as they eventually become ill will necessitate the increase in use of community-based/homebased/ hospice institutions. The City of Johannesburg (CoJ), one of the metropolitan municipalities (local government) in Gauteng Province-SA, has been planning the development and implementation of programmes related to the prevention, care and support for people infected and affected by HIV/AIDS. Care and support has been limited to 18 NGOs/ CBOs. Four of these institutions provide palliative care and are staffed by 64 caregivers. Studies done throughout the world indicate that oral lesions associated with HIV occur in over half of HIV/AIDS patients. These oral lesions seriously impair the oral-health-related-quality of life in affected individuals and necessitate the need to provide services to alleviate them and improve patient comfort. The caregivers in the NGOs/CBOs are therefore pivotal in offering care and support in the management of HIV including the management of oral lesions. In order for the caregivers in the NGOs/CBOs to be able to manage the disease in its entirety; they need optimal knowledge of the infection/illness including the oral manifestations associated with the ailment. Objectives: (1.) To determine the knowledge of the caregivers in the NGOs/CBOs providing palliative care in Region 8, CoJ, Gauteng regarding common oral manifestations associated with HIV. of the caregivers in the NGOs/CBOs . (2.) To assess the attitudes of the caregivers in the NGOs/CBOs providing palliative care in Region 8, CoJ, Gauteng on common oral manifestations associated with HIV. (3.) To determine the practices of the caregivers in the NGOs/CBOs in Region 8, CoJ, Gauteng, pertaining to the common oral manifestations associated with HIV. (4.) To determine the sociodemographic profile of the caregivers providing palliative care in the NGOs/CBOs in Region 8, CoJ, Gauteng. Methods: A descriptive cross-sectional study was conducted where all caregivers providing care and support in the four NGOs/CBOs were invited to participate in the study. Data was collected by a customised questionnaire to obtain information on demographics, knowledge, attitudes and practices on providing for HIV positive patients. Results: The results were grouped according to training in oral health care (TOHC) and no training (NTOHC). The mean age was 43.5 years for TOHC and 30.8 years NTOHC and was statistically significant (p<0.005). There were statistical significant differences in the gender proportions in within groups in the both groups, employment status, work experience as a caregiver and training in general home-based care (p<0.05). Most (72.2%) of those NTOHC had little experience (<1 year) of care giving compared to 41.1% (p=0.03) and 33.3% were providing care without training in homebased care (HBC) compared to 100% (p=0.00). The caregivers trained in oral health care had knowledge levels shown by higher knowledge levels on four of seven variables compared to those who were not trained in oral health care (p< 0.05, Table 3.3 p.21). The majority of caregivers NTOHC reported that caring for the mouth of HIV positive patients is an ‘unpleasant difficult task and poses an infection risk to the caregivers’ while these concerns were expressed by the minority of caregivers TOHC (p<0.05). Practices performed by caregivers NTOHC were appropriate for dry mouth, difficulty in swallowing but was inappropriate for bleeding gums and bad breath while those caregivers TOHC provided appropriate advice/practices for oral thrush, bad breath, bleeding gums, dry mouth with statistical difference. Conclusion: The caregivers TOHC had fairly better knowledge, attitudes and practices regarding oral lesions in HIV compared to those NTOHC. There was strong likelihood of knowledge variables and training in oral health care. Recommendations: Bearing in mind the limitations of KAP surveys and the cross sectional nature of the study, it is recommended that training in oral health care and refresher courses for those trained must be incorporated into the programme of all caregivers working in palliative institutions because it will provide specialised knowledge about oral health and oral lesions in HIV improve their knowledge, attitudes and practices and thus provide a better service to their patients.

Abstract Powerful and diverse countertransference reactions in psychotherapy group work with HIV positive children can be understood to indicate a site of mourning in the life of the group. Data from six interviews with five individuals conducting broadly psychodynamic group work with HIV positive children was analysed according to Thematic Content Analysis. The countertransference responses of the participants are understood as communications of the group unconscious, as well as expressions of the participants’ own unresolved unconscious difficulties. Working with HIV positive children confronts the participants with mortality and activates their earliest losses. A sense of strangeness and displacement, denial, idealisation, feelings of persecution, fantasies of rescue, rage, despair and hopelessness emerge in the countertransference and can be considered indicative of defences against mourning. These defences alternate with an engagement with the work of mourning and are represented in the countertransference as the relinquishment of omnipotence, awareness of fusion, containment, the recognition of the child’s resilience and uniqueness and the promotion of the child’s autonomy and expression. These findings may facilitate containment for therapists working with HIV positive children by offering an explanation of powerful and diverse countertransference responses as indicating a site of mourning, thereby promoting increased receptivity to unexpressed grief in therapy with these children.

Mothers living with HIV (MLH) are the focus of this narrative study. HIV is increasingly seen as a chronic illness because of medical advances in its treatment. Much research with HIV positive mothers is situated within the dominant biomedical discourse focusing more on outcome rather than experience and, while valuable, it fails to provide insight into their subjective experiences. In Ireland, women represent a third of the newly diagnosed HIV population (O’Donnell, Moran and Igoe 2013), many of whom have children, and migrant African-origin women represent a significant percentage of these new diagnoses. However, no research has examined contemporary maternal HIV experiences within an Irish context. This is an important fact considering the changing nature of HIV and that most HIV positive women are prescribed Highly active antiretroviral treatment (HAART) during their pregnancies and so give birth to HIV negative babies. This study explores the HIV maternal experience as the psychosocial impact of being HIV positive persists even though it is increasingly seen as a chronic illness. The original contribution to knowledge of this thesis is to provide insight into the experiences of mothers living with HIV in Ireland. My study involved adopting a narrative approach to interviewing a purposive sample of eleven HIV positive mothers living in Ireland who were at different points on the motherhood trajectory, and were from both high and low HIV prevalence countries. The analysis of this study’s narratives drew on a combination of theoretical perspectives including HIV stigma frameworks (Campbell et al., 2007, Herek 2002), social capital theory (Putnam 1995), medicalisation and HIV normalisation. The interviews reveal the centrality of being a mother to the study participants and how being HIV positive affects mothering. Being an HIV positive mother means protecting children from HIV from the moment of diagnosis , during and after pregnancy; minimising the impact of HIV in everyday life; having an awareness of the persuasiveness of HIV stigma; and managing HIV disclosure. Peer support was a significant factor for these mothers and all were members of an HIV support organisation in Dublin. Linking the findings of this study to wider theoretical literature allows for a greater understanding of the lives of HIV positive mothers in the HIV normalisation era and accentuates the multidimensional impact of maternal HIV infection.

MMed(Obstetrics and Gynaecology) / Introduction Against the high background rate of HIV among our antenatal clinic attendees, 30.3% in Gauteng in 2007, and the importance of cancer of the cervix as a health issue; this study was undertaken to determine the rate of abnormality found in cervical smears performed on HIV positive women attending the postnatal clinic at Johannesburg Hospital. The degree of abnormality and where possible its management, was reviewed. Secondly it was determined whether the immune status, namely the WHO clinical stage, CD4 cell count and viral load, correlated with the Pap smear results. Lastly patients were also analyzed according to the treatment received for HIV and their Pap smear results. Patients and Methods The study is a retrospective record review. All the patients who attended the postnatal clinic (PNC) between October 2005 and the end of July 2006, who had a Pap smear, were included. Follow-up test results were collected to the end of June 2007. A total of 324 patients attended the clinic in the study time period, of which 248 (76.5%) had a Pap smear done and 76 (23.5%) did not. iv Results The main results of interest were as follows – 131 patients (52.8%) had normal Pap smears, 64(25.8%) had LGSIL, 32 (12.9%) had HGSIL, 10 (4.0%) had ASCUS and 11 (4.4%) had Pap smears that could not be classified. In total 47.2% of the Pap smears were abnormal. There was one case of malignancy developing after an abnormal Pap smear. Patients with abnormal Pap smears tended to have a lower mean CD4 cell count while the viral load and WHO Stage did not appear to have an impact on the final analysis of the Pap smears. Conclusion The rates of cervical abnormality in HIV sero-positive patients attending the Johannesburg Hospital postnatal clinic are much higher (47.2%) than would be expected in the general population (10%), with a significant portion requiring follow-up investigation and management. It is however preferable to deal with cervical cytological abnormalities comprehensively during the screening phase rather than trying to manage a potential increase in cervical cancer cases.

Infection with the human immunodeficiency virus (HIV) is a major cause of morbidity and death globally, and the number of individuals infected with this virus is increasing in many nations. Advanced HIV infection causes immunocompromise that predisposes to opportunistic infections and malignancies that characterise the acquired immunodeficiency syndrome (AIDS). Although the management of many of these AIDS-associated infections and malignancies is by medical means, surgeons play an important role the diagnosis and management of many of these conditions. Furthermore, patients with HIV infection may present with surgical disorders or traumatic injuries that are not related to HIV or AIDS. Health care workers managing patients with HIV infection and AIDS, particularly those involved in performing invasive procedures, are at risk of exposure to this virus in infected blood and body fluids. St. Vincent's hospital, Sydney, is a teaching hospital and major treatment centre for patients with HIV infection and AIDS located in the inner-eastern suburbs of Sydney. Patients with HIV infection who underwent surgical procedures at St. Vincent's hospital during the period 1990 to 1999 were retrospectively reviewed in order to describe the nature of the operative procedures required in the management of these patients. There were 636 patients with documented infection with HIV who underwent 889 surgical procedures at St. Vincent's hospital during the period 1990 to 1999. The number of procedures performed for patients with known HIV infection was increasing during this period. Patients with HIV infection accounted for 1.1% of all surgical procedures performed at this institution during this period. The proportion of total operative cases that patients with known HIV infection represented was seen to be increasing during this period. Surgical procedures were performed during only a small proportion of admissions of patients with HIV infection to St. Vincent's hospital for this period (2.4% of these admissions). The patients were predominantly males in younger age groups. Anorectal procedures for the local treatment of benign conditions were the most common procedures performed for these patients, followed by procedures for the insertion or removal of long-term vascular access devices and other minor general surgical procedures. A large proportion of procedures were performed as day surgery cases (30%). Only a small proportion of cases were for the management of traumatic conditions (3%). A large proportion of patients with HIV infection (26%) underwent more than one procedure during this period, with anorectal disorders a common cause of repeat surgical admission. The operative findings after 498 surgical procedures performed for 360 patients with documented HIV infection during the period 1995 to 1999 were retrospectively reviewed. The number of cases in which AIDS-defining conditions were encountered were recorded, and varied according to the types of procedures performed. Overall, seventy AIDS-defining conditions were found at operation during sixty-five procedures (13% of all procedures for patients with HIV infection). Non-Hodgkin's lymphoma was the most frequently encountered AIDS-defining disorder found at operation, accounting for 41% of such conditions. Kaposi's sarcoma was the next most frequently encountered condition, accounting for 20% of cases followed by cytomegalovirus infection (11%). Procedures in which AIDS-defining conditions were commonly encountered included neurosurgical procedures (20 of 36 procedures were for AIDS-defining conditions), particularly stereotactic brain biopsy. Lymph node excision biopsies had AIDS-defining pathologies seen in 18 of 26 cases, particularly non-Hodgkin's lymphoma. AIDS-defining conditions were diagnosed in only 4% of anorectal procedures, with anal squamous cell malignant lesions a far more frequently observed disorder (diagnosed in 11% of cases). The clinical details of all patients who met the clinical criteria for AIDS who underwent midline laparotomy at St. Vincent's hospital during the period 1987 to 1998 were retrospectively examined. Thirty patients with AIDS underwent thirty laparotomies during this period. AIDS-defining conditions were found at fourteen procedures (47%). Non-Hodgkin's lymphoma was found in eleven of these laparotomies, Kaposi's sarcoma in two and cytomegalovirus in one. In nine of the patients with AIDS-defining conditions, the post-operative diagnosis was different to that expected pre-operatively. Patients with AIDS-defining conditions found at laparotomy had significantly lower serum albumin concentrations and body weight compared with those with more conventional surgical diagnoses. There was no difference in CD4 T-lymphocyte counts, the number of patients with a history of AIDS-defining conditions or the duration of HIV infection between these two groups. Patients with AIDS-defining conditions diagnosed at laparotomy required significantly longer post-operative hospital stays compared to those with other causes, although there was no difference in the incidence of post-operative complications or deaths occurring in these two groups. There was a high number of patients with post-operative complications seen after laparotomy (thirty-two complications in twenty-one patients; 70% of all patients). Chest infections, systemic sepsis and wound infections were the most frequently encountered post-operative complications. Five deaths occurred within thirty days of operation (17% of patients), and were due to overwhelming systemic sepsis in four cases and from blood loss and coagulopathy in one. The number and the nature of the complications and deaths occurring in patients with AIDS undergoing laparotomy at St. Vincent's hospital is in keeping with previously published reports from other centres. The clinical details of patients with documented HIV infection who underwent biliary tract procedures at St. Vincent's hospital during the period 1989 to 1998 were retrospectively reviewed. Eighteen patients with HIV (fourteen of which met the clinical criteria for AIDS) underwent cholecystectomy; ten for cholecystitis secondary to gallstones, one for mucocoele of the gallbladder due to obstruction of the cystic duct by a gallstone and seven for acalculous cholecystitis. Biliary tract procedures accounted for 24% of all abdominal procedures during this period. Patients were mostly male and in a relatively young age range. Cytomegalovirus infection was found in five cases of acalculous cholecystitis, Cryptosporidia in five and Microsporidia in two. A significantly greater proportion of patients with acalculous cholecystitis had a history of AIDS, and these patients had lower CD4 T-lymphocyte counts, compared with those patients with cholelithiasis. There was no statistical difference in the length of hospital admission or number of complications occurring in these two groups. Patients who had cholecystectomy performed as an elective procedure (n=7) were compared with those who had this procedure performed during admission for acute cholecystitis (n=11), and had a significantly lower duration of post-operative hospital stay. There was no difference in the number of complications occurring in these two groups. Laparoscopic cholecystectomy was performed in eight patients, and was not associated with a significant difference in hospital admission duration or incidence of complications when compared with the ten patients who underwent open cholecystectomy. The medical records of all patients presenting to St. Vincent's hospital during the period 1994 to 1998 with major penetrating wounds (gunshot wounds and stab wounds to the trunk or neck) were retrospectively examined to determine the number of such patients with a documented history of infection with HIV or hepatitis C virus (HCV), or with risk factors for these infections. Of the 148 patients with major penetrating wounds who were managed at St. Vincent??s hospital during this period, 5.4% had documented infection HCV and 1.3% with HIV. Risk factors were documented in thirty-one individuals (21%), with injecting drug use the most commonly recorded (19%). Individuals infected with HIV represent a substantial workload for surgical specialists at St. Vincent's hospital. Surgical procedures were an uncommon cause of admission for patients with HIV infection, but were important in the diagnosis and management of many AIDS-associated conditions and were increasing in number. AIDS-defining conditions accounted for only a small proportion of operative interventions in patients with HIV infection. Surgical procedures required in the management of patients with HIV infection encompassed a broad range of surgical specialties and types of procedures. AIDS-associated opportunistic infections and malignancy were frequently the cause of abdominal procedures in patients with HIV and AIDS. The number of patients with known HIV infection who present for elective and emergency surgical procedures, as well as the high prevalence of documented HIV and HCV in patients with major penetrating wounds at St. Vincent's hospital, reinforces the need for all health care workers to practice strict universal precautions against body fluid exposure at all times.

No description available.

<p><font face="Times-Roman"> <p align="left">According to the findings of this study, childcare workers caring for HIV-positive children working in a residential care setting, have similar experiences and challenges to nurses, community-based caregivers and primary caregivers, such as coping with loss and contagion fear. Nonetheless, caring for HIV-positive children poses unique challenges for the caregiver, calling for flexibility and situation-dependent coping strategies.</p> </font></p>