Introduction. Previous studies have established that infants born to mothers with advanced HIV disease and co-infections are smaller, premature and have rapidly progressive HIV disease and an early death. King Edward VIIIth Hospital, in Durban, admits many sick mothers and manages a large proportion of low birth weight and ill newborns. On discharge and follow-up, the mortality and morbidity of these infants are known to be high and are related to the prematurity. How much is related to being HIV exposed is still uncertain. Aim. To determine the perinatal transmission rate of HIV-1 and mortality at 12 months in HIV exposed infants that were admitted to and discharged from the Neonatal Unit, in Durban, South Africa. Methods. In this observational study, data from the outpatient charts of HIV exposed infants that required specialised neonatal care and subsequent follow up, between the period November 2007 and December 2009, were collected. Perinatal transmission rates and mortality of these infants were compared with maternal and infant risk factors. Results. Data on 463 HIV exposed, predominantly low birth weight infants are presented. The median maternal CD4 count was 309cells/mm3 with 16.8% of mothers commenced on HAART. Maternal co-infection with TB was found in 19.2% of the cohort. Early HIV transmission occurred in 11.5% of infants and was influenced by the type of ARV exposure (None, 20%; single dose NVP, 14.3%; dual therapy, 10.6%; maternal HAART, 8.5%). The dual therapy regimen for 7 days was more protective than that for 28 days (p=0.045). HIV infection was associated with higher risk of neonatal sepsis (RR 1.6; 95% CI, 1.1-2.3; p=0.015). The mortality for the cohort at 12 months was 10%. Maternal HAART was associated with a lower mortality: 2.95% vs.10.2% (RR 3.0; 95% CI, 0.4-20.5). There was a higher mortality rate in those that were low birth weight (RR 4.2; 95% CI, 1.02-18.8; p=0.037); those that were HIV infected (RR 4.8; 95% CI, 1.9-11.6; p=0.002) and those that were breastfeeding compared to formula feeding (RR 2.7; 95% CI, 1.1-6.8; p=0.038). Discussion. Rates of HIV transmission within the PMTCT programme were similar to that reported by the Department of Health. Early maternal ARVs for PMTCT prophylaxis, prevents HIV transmission. The coverage of maternal HAART was sub-optimal. Breastfeeding was associated with a higher HIV transmission rate and was most likely associated with non-exclusive breastfeeding during neonatal admission. Recommendations. Maternal HAART or ARV prophylaxis should be commenced early in the pregnancy for the best benefits. Meticulous attention should be paid to the feeding practices of high risk HIV exposed infants admitted for specialised neonatal care. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.

The prevalence and the incidence are two primary epidemiological parameters in infectious disease modelling. The incidence is also closely related to the force of infection or the hazard of infection in survival analysis terms. The two measures carry the same information about a disease because they measure the rate at which new infections occur. The disease prevalence gives the proportion of infected individuals in the population at a given time, while the incidence is the rate of new infections. The thesis discusses methods for estimating HIV prevalence, incidence rates and the force of infection, against age and time, using cross-sectional seroprevalence data for pregnant women attending antenatal clinics. The data was collected on women aged 12 to 47 in rural KwaZulu-Natal for each of the years 2001 to 2006. The generalized linear model for binomial response is used extensively. First the logistic regression model is used to estimate annual HIV prevalence by age. It was found that the estimated prevalence for each year increases with age, to peaks of between 36% and 57% in the mid to late twenties, before declining steadily toward the forties. Fitted prevalence for 2001 is lower than for the other years across all ages. Several models for estimating the force of infection are discussed and applied. The fitted force of infection rises with age to a peak of 0.074 at age 15, and then decreases toward higher ages. The force of infection measures the potential risk of infection per individual per unit time. A proportional hazards model of the age to infection is applied to the data, and shows that additional variables such as partner’s age and the number of previous pregnancies do have a significant effect on the infection hazard. Studies for estimating incidence from multiple prevalence surveys are reviewed. The relative inclusion rate (RIR), accounting for the fact that the probability of inclusion in a prevalence sample depends on the individual’s HIV status, and its role in incidence estimation is discussed as a possible future approach of extending the current work. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The study sought to answer the question, what are the reasons for low utilization of long acting contraceptives among HIV positive women attending the Harare Post-test support services clinic. The study was conducted at Harare Post-test support services clinic from September to December 2012. Data was collected using respondent administered questionnaires. A sample of 30 respondents was used for the study. After data collection, data was grouped, analysed and presented in the form of tables, figures, charts and descriptive statistics. The major findings from the study were that the majority of the women who attend the Harare Post-test support services clinic are within the age groups 35-49yaers. Most of the women are not using and modern contraceptive method. Condoms are used by 17% of the respondents and the long acting contraceptives, Jadelle and IUCD and used by a very low number of women attending the clinic. Fear of side effects is one of the reasons why the women are not suing long acting contraception. Most of the women know that the Jadelle and IUCD are long acting methods of contraception which prevents unintended pregnancy for up to five years for Jadelle and up to ten years for the IUCD. The long acting contraceptives are not available at the post test-support services clinic since the set-up of the clinic is not ideal for the provision of these services, women who need the methods are refereed outside the clinic were the cost to access the services is not affordable for most of the respondents. The conclusion drawn from the study is that women living with HIV have limited knowledge and access the long acting contraceptives at Harare Post-test support services clinic hence are not utilizing the methods. The researcher recommends that all women attending the clinic should be educated on the benefits of using dual protection to protect against unintended pregnancy as well as HIV transmission. A proper referral system should be established so that women referred to other service providers do not pay extra fees to access family planning services at the referral centres. Any IEC material should address the myths and fears related to use of long acting contraception by HIV positive women. The young age group below 35years should also be encouraged to access family planning services through the Post-test support services clinic. / AFRIKAANSE OPSOMMING: Die doel van die studie was om te bepaal wat die redes is vir die lae gebruik van langwerkende voorbehoeding onder MIV positiewe vroue wat die Harare Post-test ondersteuningsdienste kliniek besoek. Data is deur middel van vraelyste onder 30 deelnemers ingesamel. Die resultate het getoon dat die meerderheid van vroue wat die kliniek besoek het tussen die ouderdomme van 35 en 49 was. Meeste van hulle gebruik nie moderne voorbehoeding nie, slegs 17% het aangedui dat hul kondome gebruik. Die langwerkende voorbehoeding Jadelle en IUCD word deur min die van vroue gebruik. ‘n Vrees vir die nadelige uitwerking daarvan is een van die redes waarom hul nie die voorbehoeding gebruik nie. Meeste van die vroue is bewus dat Jadelle en IUCd langwerkede metodes is wat swangerskap voorkom en dat Jadell tot 5 jaar werk en IUCD tot 10 jaar effektief kan wees. Die langwerkende metodes is egter nie by die kliniek beskikbaar nie en vroue wat die metodes verkies word na ander diensverskaffers verwys waar wat vir meeste van die vroue nie bekostigbaar is nie. Daar kan dus van die studie afgelei word dat MIV positiewe vroue beperkte kennis en toegang rakende die langwerkende voorbehoeding het en daarom nie die metodes ten volle benut nie. Die navorser beveel aan dat alle vroue wie die klinkiek besoek ingelig moet word oor die voordele van die tweeledige vorm van beskerming, nie net teen swangerskap nie maar ook teen MIV-infeksie. ‘n Verwysingstelsel moet in plek gestel word sodat die vroue wat na ander diensverskaffers verwys word nie nodig het om ekstra daarvoor te betaal nie. Daar word verder ook voorgestel dat die klinkiek meer inligtig rakende die langwerkende voorbehoeding beskikbaar stel en ook gesinsbeplanningsdienste aanbied.

My focus in this research study is the understanding that young Indian women have of risky sexual behaviour within the context of HIV and AIDS. The main objective of this study is to understand how young Indian women perceive themselves as sexual beings and how aware they are about the HIV and AIDS virus. The influencing factors in my embarking on a study of this nature are two-fold. Firstly, the literature on sexuality of Indian women is limited. According to Bhana and Pattman (2008) the Indian community is not regarded as being problematic therefore not much is known or done with regard to Indian sexualities. Secondly my interest in conducting this research and focusing on young Indian women is that there now appears to be an increase in the number of young Indian women who are indulging in risky sexual behaviour at very early stages in their lives. I have purposefully selected six young Indian women based on their age group which is between 16 - 17, as well as from a specific context which is a secondary school in Phoenix. The sample group is not fully representative of all 16 and 17 year olds but has the potential to provide invaluable information and insight into how young women develop their sexual identities especially within the context of HIV and AIDS. The qualitative research method approach was employed as it provided me with the opportunity to comprehend how these young women understand sexual risk and the reasons why they would engage in risky sexual behaviour. The research design employed was a focus group interview with a 90 minute interactive session as well as individual interviews for each participant which lasted about 60 minutes. My findings reveal that Indian women are agentic and that there are a number of factors that influence and contribute towards an increase in the number of Indian women who are engaging in risky sexual behaviour and becoming sexually active at ages that do not prepare them for the negative consequences of risky sexual behaviour. / Thesis (M.Ed.)-University of KwaZulu-Natal, Durban, 2012.

Exclusive breastfeeding is one of the infant feeding methods recommended by the World Health Organisation (WHO) in the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV), especially to HIV positive women of low socio economic status. The purpose of the study was to determine and describe the HIV positive mothers’ perceptions towards exclusive breastfeeding in postnatal ward at a particular hospital in Limpopo Province, South Africa. Qualitative exploratory research design was used to explore and describe the HIV positive mothers’ perceptions towards exclusive breastfeeding. A grand tour question in an unstructured interview was used to collect data, followed by probing questions according to participants’ responses. Data were collected from 15 HIV positive mothers aged 18 years and above. They opted for exclusive breastfeeding, and voice recorder and field notes were used to capture data. The seven steps of data analysis, adapted from Colaizzi were used. The findings: Although the benefits of exclusive breastfeeding was known by mothers, some participants had limited knowledge on the importance of exclusive breastfeeding. Some health care providers lack up-to-date information on exclusive breastfeeding. Religious and cultural practices interfere with exclusive breastfeeding. Coping strategies with the feeding options emerged as well. / Health Studies / M.A. (Nursing Science)

This dissertation examines the participation of the church and Christians in the lives of women who are infected and affected by HIV/Aids in South Africa. To this end two Christian facilities; Sparrow Village and St Francis Care Centre, were examined in order to gain insight into the ethical issues of knowledge of patients and caregivers, the prevention measures being taught and the care facilities available to women in the plight in which they find themselves. A partial survey was conducted into the current policies and contributions by the church in an attempt to assess new ways to combat the disease. Medical information was examined as to what the virus is and how it is transmitted and reasons why women are particularly vulnerable to the virus. The dissertation seeks to understand practical ministerial ways in which the church should participate in women’s lives while being sensitive to the cultural, social and political and economic elements involved. / Philosophy, Practical and Systematic Theology / M.Th. (Theological Ethics)

This research was conducted with the aim to evaluate the policy interventions on HIV and AIDS in pregnant women in the Lukhanji sub district of Chris Hani District Municipality. The study would also propose policy improvement strategies towards curbing the spread of HIV and AIDS in pregnant women. In realizing these goals, the entire research process was guided by the research objectives and questions which sought to evaluate policies and strategies relevant to HIV prevalence in pregnant women. The secondary research objectives were accomplished through the review and analysis of the relevant literature and theories. Qualitative research approach was used in determining the findings and conclusions from the study. Data was collected using qualitative research methods and in this case a structured questionnaire was developed and distributed to the study participants. The Questionnaires were handed and discussed with each participant. Demographics, socioeconomic and cultural factors were considered in designing the data collection tool. These factors are known to have an impact on the prevalence of HIV. It has been shown through the study that demographic variables have an effect on HIV prevalence. Hence when considering policy interventions these should be taken into account. All the respondents were given enough time and they provided clear and comprehensive responses to the questionnaire and follow up discussions. The evaluation of the responses showed that various HIV prevention related policies are being implemented within the Lukhanji sub-district. Numerous programmes relating to HIV and AIDS, also specifically covering pregnant women are being rolled out across the sub-district. HIV prevalence in the study population is rated as average to low when comparing with the district, provincial and national statistics. Current data obtained from the study indicates that HIV prevalence stands at 17%. This finding demonstrates the heterogeneity of HIV prevalence when comparing this result with current provincial and national statistics. Evaluation of the different HIV and AIDS programmes that are aligned to provincial and national policy somehow explain the positive outcomes observed in the Lukhanji sub-district The study recommends that more work be done in reaching out to the communities using various communication channels and strategies. This could address the challenges associated with the lack of cooperation with local traditional leaders, because this has been found to have a negative impact on implementation of some programmes such as circumcision. One of the positive findings from the study is the accessibility of health care facilities to the local rural communities. Further research on the subject should be undertaken to ensure continuous evaluation as this topic is viewed as a continuous global issue.

L’infection persistante par les papillomavirus (HPV) dits « à haut risque » induit le cancer du col. Chez les femmes infectées par le VIH, les infections par ces HPV oncogènes et les lésions associées, allant des dysplasies au cancer invasif, sont plus fréquentes, plus sévères et de moins bon pronostic que chez les femmes non porteuses du VIH. Etonnamment, alors qu’il a été clairement établi que l’importance de la pathologie liée à HPV est directement proportionnelle au degré d’immunodépression des patientes porteuses du VIH, il n’a pas pu être démontré qu’un traitement antirétroviral efficace contre le VIH permettant d’améliorer l’immunité, diminue l’infection par ces HPV. <p>Entre janvier 2002 et décembre 2012, nous avons constitué une cohorte prospective de dépistage et de suivi de l’infection cervicale par HPV à haut risque incluant plus de 900 femmes traitées à la consultation du Centre de Référence SIDA de l’hôpital Saint-Pierre. Nos résultats montrent que chez ces femmes pour la plupart d’origine Africaine et traitée avec succès pour le VIH depuis plusieurs années, la prévalence et l’incidence de l’infection par HPV oncogène sont beaucoup plus importantes que dans la population belge générale ou que chez les femmes séropositives vivant dans d’autres pays occidentaux. Grâce à un suivi longitudinal de plusieurs années, nous avons pu démontrer que le risque d’être infectée par un HPV oncogène est significativement réduit sous trithérapie anti-VIH sous réserve d’obtenir une charge virale indétectable à <50 cp/ml pendant plus de 3 ans ou une restauration immunitaire à >500 lymphocytes CD4+/µL pendant plus d’un an et demi. Ces résultats ont été confirmés dans l’analyse que nous avons faite sur les nombreuses dysplasies cervicales également retrouvées dans notre cohorte. Enfin, nous avons trouvé que la distribution des génotypes d’HPV de nos patientes est similaire à celle trouvée en Afrique sub-saharienne impliquant que la couverture offerte par les vaccins anti-HPV varie entre moins de 30% pour les vaccins bi- ou quadrivalent actuellement disponibles à 80% pour le vaccin nanovalent en développement. Notre travail met en lumière l’étendue particulièrement importante de l’infection par HPV à haut risque chez les femmes séropositives vivant en Belgique et offre de nouveaux éléments de réflexion afin d’adapter à leurs particularités les recommandations belges et les critères de remboursement à la fois pour le dépistage du cancer cervical et la vaccination anti-HPV.<p>/<p>Persistent infection with human papillomavirus (HPV) called “at high risk” induces cervical cancer. In HIV-positive women, infection with these oncogenic HPV and HPV-induced lesions ranging from cervical dysplasia to invasive cancer are more frequent, more severe and have a worst outcome than in HIV-negative women. An intriguing paradox is that, although it has been clearly demonstrated that high risk HPV infection and associated diseases are increased by progressive immune deficiency, the introduction of efficient therapy against HIV leading to improved immunity has not been associated with a decrease in oncogenic HPV infection or HPV-induced lesions.<p>Between January 2002 and December 2012, we have built a prospective cohort to screen and follow-up cervical infection by high risk HPV in more than 900 women treated for HIV in the AIDS Reference centre of Saint-Pierre Hospital. We have shown that among these women mainly from Sub-Saharan African origin and successfully treated for HIV for several years, the prevalence and incidence rate of high risk HPV are much higher than in the general population from Belgium or in HIV-positive women from other western countries. After several years of longitudinal follow up, we have demonstrated that the risk of infection by oncogenic HPV is significantly reduced by efficient therapy against HIV provided that HIV viral load has been sustainly suppressed below 50 cp/ml for more than 3 years or that immunity has been increased more than 500 CD4+T cells/µl for more than 1.5 years. These results have been confirmed in the analysis on cervical dysplasia which is also very prevalent in our cohort. At last, we have found that the HPV genotype distribution in our population is very similar to the one found in Sub-Saharan Africa. We have estimated that the coverage offered by the vaccines against HPV in our cohort is less than 30% for the currently available bi- or quadrivalent vaccine but reaches 80% with the future nanovalent vaccine. Our results highlight many differences in the HPV infection and associated diseases in HIV-positive women compared to HIV-negative women; these differences should be taken into account to adapt to our specific population the current Belgian guidelines or the reimbursement criteria on cervical screening and on vaccines against HPV. <p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

The focus of this study is on the experiences of a small sample of local women who have been recently diagnosed with HIV. The aim of the research was to give these women an opportunity to express their first-hand, personal accounts of living with HIV. Five isiXhosa-speaking women were recruited and interviewed. These accounts were collected and analysed within in the methodological framework of Interpretative Phenomenological Analysis, a qualitative approach that is becoming increasingly popular in the broad fields of health and clinical psychology. Data was analysed for meaningful units, which were interpreted inductively and hermeneutically, and categorised into super-ordinate themes. Five themes within the participants’ experiences of living with HIV were identified: (1) experiences of diagnosis, (2) experiences of stigma, (3) social support, (4) coping strategies, and (5) HIV as one of many assaults to self. Implicated in these experiences are the ways in which these women have appraised themselves and their situation after an HIV-positive diagnosis, appraisals that are shaped by HIV-related stigma. A variety of negative emotional reactions are common following the diagnosis, often compounded by the direct experiences of HIV-related stigma. Women in the study adopted different kinds of coping strategies based on the resources and social support available to them. Also significant is that for these women who had typically endured a variety of traumatic life events, a positive diagnosis was simply one of many life challenges

It is estimated that 6742 South African women are diagnosed with cervical cancer and 3681 women die from the disease every year. In 1993, The Centers for Disease Control declared cervical cancer an Acquired Immunodeficiency Syndrome defining illness. Apart from persistent human papillomavirus infection, HIV infection is the most common co-factor contributing to cervical cancer in South Africa. Studies have noted that in HIV positive women, there has been an occurrence of faster progression to more advanced stages of cervical cancer with high cases of treatment failure and recurrence. There is limited literature available regarding the prognosis of HIV positive women who suffer from cervical cancer. Women who are HIV positive and have cervical cancer have not been evaluated in detail regarding their response and adherence to cervical cancer treatment. Standard treatment protocols for this set of patients have not been defined. The aim of this study was to assess how HIV positive women who have been diagnosed with cervical cancer responded and adhered to cervical cancer therapy which includes: curative radiotherapy; curative chemotherapy; concurrent chemoradiation or palliative radiotherapy. The study also evaluated the effects of the concurrent use of antiretrovirals and cervical cancer treatment. This was done to determine whether invasive cervical cancer in women who were HIV positive could be managed using the same treatment protocols as patients who were HIV negative. A historical cohort design was employed for the study. The study was conducted at the Oncology Department of a tertiary level hospital located in the Eastern Cape Province, South Africa. The total sample consisted of 196 medical records of women diagnosed with cervical cancer between 2005 and 2008. One hundred women were HIV negative, 83 were HIV positive and the HIV status of 13 women could not be determined. The records were audited over a period of two years from the date of diagnosis. The term „complete response‟ referred to patients who had no recurrence of cervical cancer and no evidence of metastases after undergoing treatment. At one month following treatment there was a significant difference in the incidence of complete response between the HIV positive patients and the HIV negative patients (Chi2 = 16.4, d.f. = 1, p = 0.00005, Cramer‟s V = 0.31). The significant difference in response to treatment between the HIV positive patients and the HIV negative patients was maintained at six months after treatment (Chi2 = 15, d.f. = 1, p = 0.00011, Cramer‟s V = 0.34), 12 months after treatment (Chi2 = 20.5, d.f. = 1, p = 0.00001, Cramer‟s V = 0.37), 18 months after treatment (Chi2 = 9.8, d.f. = 1, p = 0.00173, Cramer‟s V = 0.28) and 24 months after treatment (Chi2 = 5.0, d.f. = 1, p = 0.02571, Cramer‟s V = 0.26). At each of these intervals, cases of treatment failure and metastases were significantly higher in the HIV positive women than in the HIV negative women. Although there was no significant difference in the incidence of adherence between the HIV negative women, the HIV positive women who were on HAART and the HIV positive women who were not on HAART, there was a significant difference in the incidence of the various reasons for non adherence between the various groups. These reasons included: missed scheduled appointments (Chi2 = 2.9, d.f. = 2, p = 0.02385, Cramer‟s V = 0.31); low blood count (Chi2 = 4.0, d.f. = 2, p = 0.01327, Cramer‟s V = 0.15); radiotherapy induced skin breakdown (Chi2 = 0.6, d.f. = 2, p = 0.04581, Cramer‟s V = 0.16) and radiotherapy induced diarrhoea (Chi2 = 6.9, d.f. = 2, p = 0.03118, Cramer‟s V = 0.19). According to the 2004 National Antiretroviral Treatment Guidelines, cervical cancer patients would fall into the WHO stage IV category of HIV disease thus all patients with confirmed diagnosis of invasive cervical cancer should be commenced on antiretrovirals as soon as the cancer diagnosis is made regardless of their CD4 count. However, in the current study, 13 percent (n= 83) of the HIV positive women were not on antiretrovirals. The study concluded that HIV positive women had a higher incidence of both treatment failure and metastases to cervical cancer treatment. Standard radiotherapy and concurrent chemoradiation cervical cancer treatment protocols should be still be used in both HIV negative patients and HIV positive patients so as not to compromise tumour control. Furthermore, in accordance with the antiretroviral treatment guidelines, all HIV positive patients with cervical cancer should receive antiretrovirals irrespective of their CD4 count.