The consequences of the African AIDS epidemic are growing--not just in size--but in complexity. These consequences are no longer just biological; increasingly, they are also social, cultural, economic, and psychological. In this dissertation, I consider one overlooked consequence of the epidemic by asking how HIV infection affects the desire to have children in a context where reproduction is so highly valued. Taking advantage of a unique situation in rural Malawi, where no one knew their HIV status prior to testing being introduced as part of an ongoing longitudinal survey, I use a quasiexperimental design and in‐depth interviews to examine the evidence for an intentional relationship between HIV/AIDS and fertility. Rural Malawians adjust their childbearing desires in response to information about their HIV status. The relationship--both in magnitude and in motivation--is highly gendered. HIV positive women fear that a pregnancy will worsen their disease. Despite this widely shared belief, there remains a lot of ambivalence: women who are positive, or who fear they are positive, want to live normal lives. For some, that means avoiding childbearing as a strategy to delay the symptoms of HIV. For others, it means having children as they would have had despite what they think it might mean for their health. Male fertility preferences are more volatile to information about HIV status. Men see childbearing as futile if they are HIV positive because they anticipate their own death and the death of their future offspring. However, men may be less likely to translate their preferences into action because--after learning they are infected--they are less motivated to stop having children than they are unmotivated to have children. This dissertation shows that rural Malawians adapt their childbearing preferences to information about their HIV status. There are strategies in these adaptations, as well as hope for a future where the conditions of childbearing in an AIDS epidemic might have changed. I conclude by discussing what the findings mean for fertility, fertility theory, and policy. / text

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

The aim of this study was to investigate outcomes of approaches used to mitigate the negative impacts of HIV and AIDS at workplaces in Lesotho using Thetsane Industrial Area as a case study. Garment industries in Lesotho are faced with a serious threat due to the HIV and AIDS prevalence in the country. A huge number of the labour force is leaving firms due to increased morbidity and mortality associated with HIV and AIDS. In view of this, this study investigated approaches used in managing HIV and AIDS in the workplace. In order to optimize the accuracy of the research results, a triangulation research method was utilized. The results indicate production levels to have improved since the advent of the Apparel Lesotho Alliance to Fight AIDS (ALAFA). The findings suggest ALAFA to have taken over the responsibility of HIV and AIDS prevention and management, especially in the garment industries, providing HIV and AIDS victims with all the necessary services needed to keep HIV and AIDS under control. These findings therefore suggest overdependence on ALAFA by the garment industries for HIV and AIDS management. The findings also imply that garment industries had no resources in the form of human capital specializing in the knowledge of HIV and AIDS management from the individual garment industries. Despite the fact that HIV and AIDS still spreads at an alarming rate, the larger implications of this research’s findings, especially relating to the serious challenge faced by the garment industries of losing their labour force to HIV and AIDS, is that the pandemic has lately become manageable given that there are now ARVs and ART to be used as treatment by HIV and AIDS victims. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

The devastating impact and spread of HIV/AIDS is well recognized throughout the world. HIV/AIDS counselling is one element of Voluntary Testing and Counselling (VCT), a process designed to encourage testing, provide support, care and prevention knowledge. Quality assurance,ongoing training and counsellor support are vital components for VCT to succeed. The implementation of mentorship for HIV/AIDS counsellors is recommended as an appropriate way of addressing current counselling concerns and providing professional and psychsocial support structures to produce benefits for the quality of VCT in the long term. This study aimed at contributing to the limited field of research on the topic of mentorship by conducting an in-depth examination of mentorship in general and in an HIV/AIDS context specifically. A qualitative, interpretative method, using both in-depth interviews and focus groups, was used to address three specific research questions relating to mentorship views of HIV/AIDS counsellors and mentors in KwaZulu-Natal. A grounded theory analytic technique revealed that mentorship provides multiple functions such as guidance and support to counsellors, ongoing training and monitoring counsellor performance, which inevitably contributes to more motivated counsellors and improved quality of work. This study hopes to give greater insight into mentorship, specifically from the perspective of VCT counsellors and mentors, to those key role players and policy makers that are involved in the development of programmes for HIV/AIDS counsellors. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

South Africa has one of the highest country HIV/AIDS statistics in the world. The large number of ill individuals has created an unprecedented care work crisis in the country. In the absence of an adequate state supported care work response, the task of caring for people living with HIV/AIDS has fallen on community members. Under-resourced communities often do not have the capacity to engage in such intensive care work, and this shift has resulted in deleterious emotional, physical and financial consequences. This study sought to create greater understanding of the support available and accessible to friends and family members who serve as informal carers of people living with HIV/AIDS. Methodologically, this is a qualitative study. Nine participants from KwaNgcolosi, a periurban area in KwaZulu Natal, were interviewed. A semi-structured interview schedule was directed to elicit participants’ perceptions of the support that is available and accessible to them. Data was thematically analysed. Perceptions of support were understood in the context of the elements of social capital, namely trust, reciprocity, norms and networks, as well as the sociological strata in which these elements function, the bonding, bridging and linking levels. Findings suggest that informal carers perceive low levels of support. Participants reported poor support from local community and extra-community members which include friends and family members, local political and traditional leadership and leadership at a governmental level. Low levels of social capital exist in the community evidenced by lack of reciprocity, norms that isolate the carer, mistrust, lack of control over resources, and weakened networks which inhibit the participants’ pool of human resources. Stigma, discrimination and conditions of extreme poverty were major impediments to the availability and accessibility of beneficial social capital and thus the social support inherent in it. On the converse, the home-based carer (HBC) emerged as the strongest source of assistance to informal carers. The support reportedly received by the HBC 6 include emotional, instrumental and informational assistance. However, these contributions were insufficient, evidenced by the testimony from all participants that they were still experiencing extreme hardships in their care work. The findings suggest that development, project and policy initiatives should focus on empowerment, greater involvement of all stakeholders ranging from individual community members to government policy makers, greater networking and participation and finally that there should be greater investment in the HBC and the informal carer in terms of resources and capacity building. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

The background. HIV and AIDS is a huge problem in sub-Saharan Africa where an estimated 22.5 million people were living with HIV in 2007.1 South Africa has the worst epidemic in the world.1 There were about 5.5 million people living with HIV and 1000 AIDS deaths daily in South Africa by the end of 2005.17 In 2007 the number of people living with HIV in South Africa increased to 5.7 million.1 The HIV prevalence in Umkhanyakude district, KwaZulu Natal, where Hlabisa subdistrict is situated, amongst public antenatal clinic attenders was 39.8% in 2007.19 AIDS is the cause of 50.0% of deaths in the Hlabisa sub-District.15 In 2003 the South African government decided to provide antiretroviral therapy (ART) in the public health sector, giving hope to thousands of people who are in need of this intervention to improve their quality of life and reduce premature deaths.7,13 However adherence to antiretroviral drugs is essential for successful treatment. Adherence to antiretroviral therapy in South Africa as in other African countries was expected to be low31 (<95.0%), however, in a study that was done in Cape Town during 1996 – 2001, the authors concluded that adherence was high.28 The aim of that study was to identify predictors of low adherence (<95.0%) and failure of viral suppression (>400 HIV copies/mm3). Pill counts and records of treatment refills from pharmacy were used to measure adherence.28 The results revealed no significant difference in adherence between patients on protease inhibitor based regimens and/or those on nonnucleoside based regimens nor with socioeconomic status, sex and HIV stage. Independent predictors of low adherence were English language speaking, age, and three times per day dosing. The following were found to be independent predictors of failure of viral suppression: baseline viral load, <95.0% adherence, age and dual nucleoside therapy.28This study however was done in an urban area before the antiretroviral therapy (ART) roll out in South Africa when the cost of treatment limited the accessibility of ART. These patients may have been different to patients who access free treatment in public health facilities today. Other South African studies have also reported good adherence rates.39,40 In another study in Soweto, South Africa, adherence was high, 88.0% of patients achieved > 95.0% goal, 9.0% achieved 90.0-95.0% adherence and only 3.0% achieved <90.0%.39In a study done at Khayelitsha, adherence was also high, viral load level was < 400 in 88.1%, 89.2%, 84.2%, 75% and 69.7% of patients at 3, 6, 12, 18 and 24 months.40 However, Soweto and Khayelitsha are urban and different from Hlabisa, and it is difficult to generalize these results to the sub-district. This study intended to assess how adherent patients are to antiretroviral therapy in a typical rural district in order to inform policy to enhance adherence to ART. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

This research paper is designed to introduce a sexual education programme that can be adapted for Mountain of Fire Global Ministries (MFGM), to guide the youth in their safer sexual practices in the era of HIV and AIDS. In view of this, the research paper will build upon other sexual education programmes such as S- safer practices, A- available medication, V- voluntary counseling and testing, E- empowerment through education (“SAVE”), A- abstain, B- be faithful, C- condomize (ABC) and others (INERELA+ 2008:1). Setting the stage to understand the challenge in South Africa for safer sexual practices among youth, the researcher saw it fit to conduct research in his local community of Wentworth. The intention of the research was to get a basic understanding of the HIV and AIDS prevalence among youth and the type of education they were receiving from the local organizations. The interviews conducted in the research demonstrated that there was more of an authoritarian or top-down rather than a grass roots bottom-up approach used by the organizations, which gave the impression that the type of curriculum used was obsolete. The researcher felt that addressing the need for safer sexual practices among youth would have been more effective if the approach was through dialogue. Youth may have felt insecure, believing that some of their needs, inputs or experiences could not be discussed in a top-down approach. Organizations that appeared to be condescending, as well as more superior and intellectually equipped, may have made youth feel inferior and inadequate. The outcome of this approach may have created mixed feelings between the organizations and the youth. A lack of understanding, on behalf of the educating organizations, as to what the youth really required in education on safer sexual practices and what they were experiencing personally, eventually could have led to the youth treating the education lightly. On the other hand, from a Christian education perspective, this research paper ascertained that the youth were being squeezed into a mould where safer sexual practices were not considered. Christian education strongly discourages the practice of sex outside of marriage and teaches that abstaining from sex until marriage is the only commendable way. This type of education creates a distancing and has a great impact on the lives of youth, especially those who are sexually active. Somehow if they do engage in sexual activity, they feel isolated, inferior, unaccepted and inadequate to grow spiritually. The change in their attitude and behavior results from continuous pulpit caution, instead of precaution, on how to manage safe or safer sexual practices. Christian education continues to place fear on the youth about premarital sex and the youth often feel that they are responsible for the consequences that derive from negligence. This research uncovered that Christian education adopted a top-down instead of a bottom-up approach, thus denying the youth the opportunity to express themselves with their experiences and needs when it came to safe or safer sexual practices. In view of the hierarchical approaches of some organizations and Christian education, the youth find themselves under difficult circumstances, whereby they are not given the opportunity to relieve themselves of some of the pressures they face when it comes to safe and safer sexual practices. In light of this struggle to find common ground, Paulo Freire in his book Pedagogy of the oppressed (2003:71-83) introduces some positive methods, such as dialogue, that can broker a relationship between the facilitator and the participants. In addition to this, the International Network of Religious persons with and affected by AIDS (INERELA+) has compiled a “SAVE” Toolkit (2012) that the researcher has included in the research paper, as a guide to walk alongside Freire‟s philosophy of dialogue. This will help to bridge the gap between the facilitators and the participants, and assist them in finding a common ground as they search for social transformation in the context of safer sexual practices. The interviewees mentioned in the research showed a great deal of experience and knowledge, but they were limited in the ABC method they used to educate youth on HIV and AIDS. This method did not cater for those who were beyond this stage, such as those who had contracted the virus. Since the “SAVE” Toolkit is more user friendly, incorporating both the ABC method and reproductive health for those who have contracted the virus to live a positive lifestyle, to blend it with dialogue improves its effectiveness. This proved to be an important finding in the research in terms of the hypothesis which promotes a sexual education programme for safer sexual practices among youth. This will eventually assist youth to develop mindsets that enable them to be more responsible in their sexual behavior. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

<p>The aim of this study was to capture the intensity and incidence of catastrophic health care expenditures in order to describe the degree to which catastrophic health care payments occur among households. Simultaneously, the study set out to assess the extent to which people are made poor or poorer by health spending, i.e. the impoverishing effects of healthcare spending.</p>

The current study aims to determine physical activity levels among people living with HIV treated with high active antiretroviral therapy in Kigali, Rwanda. A cross-sectional design using quantitative method was used. The participant’s levels of physical activity participation and their association with anthropometric profiles were measured, using a structured selfadministered questionnaire adapted from the Sub-Saharan Africa Activity Questionnaire. Based on a scientific calculation, 407 clients passing through the clinics were included in the study. A convenient sample of people attending the clinics approached to participate voluntarily in the study. The findings of the current study highlighted the lack of motivation, lack of time and fear of worsening the disease amongst the strong barriers to physical activity participation. The current study recommends education about the benefits of physical activity participation and encouragement of patient treated with high active antiretroviral therapy in Rwanda to be emphasized on to improve their lives.

<p>Disclosure of HIV positive status to male partners is well established as a key element in the success of prevention of mother to child transmission of HIV programmes, as it helps improve adherence to ARVs by the women within these programme. However, partner notification rates remain low in the urban areas of Lusaka, Zambia against a high HIV prevalence of 25%. The purpose of this study was to explore the timing of disclosure as part of the process of disclosure amongst women who were part of the PMTCT services at Kaulu health centre in Lusaka. An exploratory descriptive study using qualitative research methods was conducted. 15 women, who were attending the Kaulu health centre PMTCT programme, were requested to participate in a semi-structured interview. The women, who were purposively selected with the aid of the health centre‟s PMTCT focal point nurse, had to have disclosed their HIV positive status to their partner, either before or during the course of their pregnancy or after delivery. To increase rigour,&nbsp / individual interviews were conducted with 5 health workers associated with the PMTCT programme so as to obtain their perspective and experiences on the issue of HIV disclosure amongst their PMTCT patients. Participation in the study was voluntary and all information obtained during the course of the interviews remained confidential and secure. Potential participants were each provided with an explanation of the purpose and process of the study and their informed written consent obtained before the researcher embarked on the interviews. Content analysis of the transcripts was done so as to develop coding categories and identify emerging themes. Disclosure to male partners is an important step in PMTCT and facilitates adherence to HIV care for the family and should be done as early as possible after the woman receives her HIV test result, though there exists a range of alternative times when it can be done. The relationship existing between a couple is very important in determining the timing of when a woman chooses to disclose. PMTCT services need to provide ongoing counselling for HIV positive women during pregnancy and after giving birth that supports, informs and equips them with the necessary skills to make an informed and timely decision about disclosure to a partner. In addition, the PMTCT service providers need to be encouraged to implement couple counselling as a strategy to facilitate disclosure as well as establishment of a peer support network for HIV positive pregnant women. The study findings will be used to contribute to health workers‟ capacity to support women manage the disclosure process to their male partners, thus helping to increase the disclosure rate and also contributing to improving the positive effect of the PMTCT services, in Lusaka, Zambia</p>