A needs assessment during 2000 guided the design of a buddy system in Botswana. Implementation of this care and support system for and by 39 HIV+ve female buddy-client pairs started in 2002. During April and November 2002, levels of disclosure, self-care, support and quality of life of buddy-client pairs and the controls (n = 38) were compared. Orem's self-care theory, Maslow's hierarchy of needs and Cohen and Syme's conceptualisation of social support formed the theoretical framework. By November 2002, clients' disclosure levels, self-care for TB, and antiretroviral therapy adherence had improved. Higher income, higher education and older age predicted higher levels of self-care for antiretroviral therapy. The social support survey reported satisfaction with types of support available in November 2002 (N = 112). Clients' scores for self-care for TB, antiretroviral therapy and social support improved more than those of controls over the study period. The personal resource questionnaire measured perceptions of support: buddies' scores increased more than those of clients. Women on antiretroviral therapy completed the adherence attitudes inventory in April and November 2002 and reported a downward trend in adherence. Findings of the quality of life (SF 36) instrument showed that during the six-month study period, physical and mental health component summary scores improved but remained low (N = 112). During 2003 Botswana's community-based buddy-support programme was adopted by four other countries in Southern Africa in an attempt to enhance the quality of life of HIV+ve women in these countries. / Health Studies / D. Litt. et Phil. (Health Studies)

The study into the socio-economic challenges of HIV and AIDS on widowed women in rural communities of Zimbabwe was carried out in the village of Mukadziwashe. The main aim of the study was to find out the socio-economic challenges that are faced by HIV and AIDS widows. Of particular concern has been role played change agent since the dawn of the HIV and AIDS pandemic and its devastating socio-economic impact on families, especially widows. The findings of this study are based on a sample of limited number (12) widows based in the village of Mukadziwashe in Gutu Central District, as well interviews of key informants who happen to be representatives of change agents in the main. In-depth interviews were the tool used to collect information from the research participants identified above. The findings of the study revealed that widows still suffer from the serious social and economic challenges posed by HIV and AIDS such as cultural oppressions and prevention of women from inheriting their late husbands’ wealth The continued denial of women of their constitutionally enshrined rights is difficult to understand, because many studies have been conducted on this subject. It is reasonable to expect noticeable progress in promoting the rights of women, especially widows. What is apparent in this sad story is the mute role of change agents, be they government, non-governmental or community based, in affirming widows’ rights. Based on these observations, the study strongly recommends the design, implementation and constant monitoring of intervention programmes aimed at women empowerment in general. / Sociology / M.A. (Social Behaviour Studies in HIV and AIDS)

This qualitative study explored and described the experience of African women diagnosed with both HIV/AIDS and cervical cancer in order to gain an understanding of the experience of both illnesses as lived by these women. Phenomenological research methods were employed using in-depth semi-structured interviews. Communication as a strategy facilitating diagnosis, disclosure, acceptance and support for women with HIV/AIDS and cervical cancer emerged as the main theme, followed by the experience of physical symptoms and emotional experiences. The study shows the importance of communication in the management and support of these women attending public health institutions and in the community. For communication to occur the relationship between healthcare professionals and women diagnosed with HIV/AIDS and cervical cancer is very important. Treatment approaches in radiation therapy need to be developed for women diagnosed with HIV/AIDS and cervical. More research is needed in this area (HIV/AIDS and cervical cancer). / Health Studies / M.A. (Public Health)

Power imbalances and gender-based violence (GBV) have increasingly been cited as important determinants putting women at risk of HIV infections. Studies have shown that globally one in every three women has been beaten, coerced into sex or otherwise abused in her lifetime. The study explored working women’s perceptions of power, gender-based violence and HIV-infection risks. A qualitative, explorative study was conducted among female employees in an airline business in Namibia. Five women participated in in-depth, face-to-face interviews. The findings show that all of the participants experienced power imbalances and GBV in their intimate relationships. All of the women reported emotional or psychological abuse, whilst the majority were subjected to economic abuse, followed by physical abuse, and two alleged having been sexually abused. The study concludes with specific recommendations for the development and successful implementation of workplace policy and programmes to protect and promote women’s rights. / Social Work / M.A. (Social Behaviour Studies in HIV/AIDS)

This qualitative study aimed to explore and describe the experiences of women living with HIV and Aids in Centurion, Gauteng Province. The study was conducted at Lyttleton clinic and 12 women living with HIV and Aids were selected for the study using a non-probability, purposive sampling technique. In-depth, individual semi-structured interviews were used during data collection. A thematic content approach in data analysis yielded the following main themes: experience of being diagnosed HIV positive, disclosure of an HIV positive status, physical signs and symptoms of HIV and Aids, stigma/ emotional stress well experiences in services rendered. The study highlighted the need for a well-established health system, assisting women living with HIV and Aids on how to cope and to raise awareness on HIV and Aids. / Health Studies / M. A. (Public Health)

A qualitative study was undertaken in Pietermaritzburg to unveil the experiences and challenges of WLWHIV as perceived by social workers as well as to explore and describe the experiences of social workers in rendering services to these women. Explorative, descriptive and contextual research designs were employed for the research process. Purposive and snowball sampling techniques were utilised to recruit participants who met the set criteria. Face-to-face semi-structured interviews were conducted with thirteen participants. Data obtained were transcribed and analysed applying Tesch‘s eight steps (Creswell, 2009). Data verification was guided by Guba‘s model (Krefting, 1991). The findings revealed the existence of strained relationships between WLWHIV and their partners and ineffective delivery of social work services to WLWHIV. Based on the findings, it is recommended that specialised training for social workers on issues related to death and dying and services for children of WLWHIV be incorporated in the guidelines for social work practice / Social Work / M.A. (social Work)

Thesis (DPhil (Psychology))—University of Stellenbosch, 2006. / Statistics show that young, heterosexual, low-income women are the fastest growing HIVinfected population in South Africa and in the rest of the world. Despite the rapidly growing numbers of women with HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome), there is a scarcity of research that focuses primarily on how poor minority and disadvantaged women of colour experience being HIV-positive, how these women actually live and cope with their diagnosis. Furthermore, no research studies on minority groups, such as the Coloured women in the Western Cape, exploring these issues have been reported. Consequently, there is an urgent need for research studies in South Africa to explore the range of discourses revealed by low-income and minority women regarding their lives and experiences of HIV/AIDS, in order to generate understanding and knowledge which could contribute to possible interventions, support and care. The present study aimed to: 1) explore the psychosocial concerns and mental health needs of HIV-infected low-income Coloured mothers in everyday life; 2) construct a testable Grounded Theory regarding the illness experience of low-income Coloured mothers; and 3) recommend guidelines for health workers. The study was a systematic analysis and documentation of how the illness (HIV/AIDS) was constructed in narratives of one particular group of women in South Africa. Eleven suitable and willing HIV-infected Coloured mothers were recruited by means of convenience and theoretical sampling. The research study was conducted within a socialconstructionist framework where the focus was on how HIV-infected, low-income Coloured women make sense of their world and illness experience. Grounded Theory was applied within the framework of qualitative research to analyse the data and to explore the participants’ constructions of the illness. As qualitative measure, a semi-structured in-depth interview schedule was developed according to Grounded Theory protocol. To reach the aims of the present study, questions focused on specific behaviours, experiences, thoughts and feelings that related to living with a positive HIV-diagnosis. In the participants’ accounts of their illness experience, two dominant discourses were identified: a discourse of HIV/AIDS, within which the illness was constructed as an stigmatised, incurable and deadly illness; as a shameful illness that someone should be blamed for; and as being associated with secrecy, silence, separation, pain and suffering, loss, and loneliness, as well as a discourse of mothering, what it means to be a “good” woman/mother; constructed as someone that should primarily take care of her children and family, and not be separated from them, or neglect or abandon them through illness or death. It is suggested that the two dominant discourses found in the participants’ accounts of their illness experiences, namely the meaning of HIV/AIDS as an illness (a stigmatised, incurable, and deadly illness, a shameful and blameworthy illness, an illness of secrecy, silence, separation, pain and suffering, loss, and loneliness), and the imperatives of mothering, what it means to be a “good” woman/mother (the primary caregiver of children, someone who is connected, physically strong, healthy and productive, and someone who is able to cope with her caregiving responsibilities even when in distress herself) are irreconcilable. It seems that these distressing and disempowering experiences of being HIV-infected, while also being a primary caregiver and mother of children, caused the participants in the present study severe psychological distress and suffering. Given these discourses and the context of the participants’ lives within their specific socio-economic circumstances, namely their lack of emotional and social support from friends and family, abusive relationships, substance abuse, economic hardships, absence of treatment options, as well as their experience of an incapacitating, incurable, stigmatised illness causing them severe physical and psychological distress, it was argued that the majority of the participants in the present study were in some state of depression and were in need of psychosocial support and mental healthcare.

Vertical transmission of HIV is still a growing concern in South Africa. Breastfed infants are still at risk as HIV is present in breast milk, leaving HIV-positive mothers unsure of the best feeding option for their infants. However, there are various infant feeding techniques that HIV-positive mothers can use to supplement breastfeeding and flash-heat is one of them. Flash-heat is heat treating expressed breast milk to deactivate HIV for infant feeding. This study explored the possibility of HIV-positive mothers to practice flash-heating method for their infants exclusively for four months as a strategy to prevent vertical transmission of HIV. A descriptive, explorative and contextual design using a mixed method was used to obtain data from mothers in a post natal ward at Tembisa hospital. The mixed method used was useful in identifying the number of HIV-positive mothers who would adopt the flash-heat technique, the characteristics of mothers whom the technique could be promoted to, the factors that influence/affect the choice of infant feeding for these mothers, as well as their feelings associated with the feeding technique. Most (74%) mothers had a positive response to the flash-heat technique compared to 10% who were uncertain. They believed that heat treating their breast milk would result in their infants being HIV-free. In addition they believed that this method was cheaper than formula feeding and expressed positive feelings about touching their breast milk while expressing with no adverse feelings of expressing into a glass jar. Furthermore, findings of this study indicated that HIV-positive mothers in a public health facility would adopt flash-heat as an alternative infant feeding method. Thus practical guidelines to promote this feeding method were proposed. The proposed draft guidelines which promote the use of the flash-heat infant feeding method for HIV-positive mothers in public sector facilities will be communicated to relevant authorities such as the National Department of Health. These guidelines support the new policy shift to exclusive breastfeeding as a child survival strategy in South Africa. / Health Studies / D.Litt. et Phil. (Health Studies)

Background: Non-disclosure of HIV positive status to a partner threatens to reverse gains made in prevention of mother-to-child transmission (PMTCT) in resource limited settings. Determining the association between non-disclosure and infant HIV acquisition is important to justify focussing on disclosure as a strategy in PMTCT programmes. Objective: To determine the association between non-disclosure of HIV positive status to a partner and mother-to-child transmission (MTCT). Methods: Using a matched case-control design, we compared 34 HIV positive infants to 146 HIV negative infants and evaluated whether the mothers had disclosed their HIV status to their partner. Results: Non-disclosure was more frequent among cases (overall, 16.7%; cases, 52.8%; controls 7.6%), p<0.001 and significantly associated with MTCT (aOR 8.9 (3.0-26.3); p<0.0001), with male partner involvement partially mediating the effect of non-disclosure on MTCT. Conclusions: There is a need for PMTCT programs to focus on strategies to improve male partner involvement and partner disclosure without compromising the woman’s safety. / Health Studies / M. (Public Health)

Thesis (MMed (Medical Microbiology))--University of Stellenbosch, 2006. / One of the major routes of transmission of human immunodeficiency virus (HIV) in the developing world is vertical transmission from mother to infant – pre-, intra-, or post-partum. In the Western Cape, HIV-1 subtype C is the predominant subtype in the heterosexual population, and this trend was expected to be seen amongst cases of mother-to-child transmission of HIV. The aim of this study was to perform genetic characterisation and phylogenetic analysis of the HIV-1 genome in positive serum/plasma samples obtained from children (age 0 to 18 months) from 2000-2002, and temporally related specimens from their mothers. We obtained 27 suitable pairs of samples taken within 6 months of delivery. From this pool, we obtained 21 infant DNA sequences and 17 maternal sequences, resulting in 16 mother-infant pairs. All patient sequences were identified as HIV-1 subtype C, and, as expected, mother and infant viral sequences clustered together. In some cases where a mother was suspected to have two dominant quasispecies based on the electropherogram, only one sequence was detectable in the infant. Single or multiple amino acid deletions were consistent between mothers and infants, and some pairs showed the same amino acid deletions seen in other pairs.