KwaZulu-Natal has the highest prevalence of HIV in South Africa. The prevalence of dual infection in a normal-risk population in this region is unknown. Dual HIV infection has important implications for diagnosis, treatment response and vaccine development. This cross-sectional study aimed to establish and optimize methods for subtyping and detection of dual infection in KZN. Samples were from chronically-infected patients on ARV treatment within the ARV Rollout Programme, from sites throughout KZN. Subtyping of the samples was performed using HMA. Four samples had indeterminate results by HMA and were then cloned and sequenced. Phylogenetic analysis showed that one of the four samples was a dual infection. This study showed 1/46(2%) samples to be dually infected which suggests that the prevalence of dual infection is low in the sample population. The low prevalence of dual infection reported could be due to the low-risk profile of the sample population. It was concluded that the low prevalence of dual infection is unlikely to have a considerable impact on HIV management. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2007.

BACKGROUND Sub-saharan Africa remains to date at the forefront of the HIV/AIDS epidemic. Despite breastfeeding being a significant mode of postnatal HIV transmission it remains the main nutritional source and pillar of child survival for the majority of infants born in Africa. It is therefore, not surprising that considerable research has centred on making breastfeeding safer in terms of HIV transmission. The flash heat treatment method (HTEBM) provides a unique opportunity to safely breastfeed infants but prevent mother-to-child transmission of HIV. Cytotoxic T lymphocyte (CTL) responses have been well documented in HIVinfected adults and children. However, there is a lack of literature on CTL responses in HIV exposed low birth weight infants. This pilot study attempted to examine the association of early neonatal feeding on the clinical outcomes and CTL responses in HIV exposed low birth weight infants. METHODS Seventy-seven patients that fulfilled inclusion and exclusion criteria were enrolled. The clinical outcomes of these patients were evaluated over a 9 month period. Fifty-five of these patients were also investigated for cytotoxic T lymphocyte (CTL) responses by means of the IFNγ ELISpot (megamatrix and confirmation) assays at the 6 weeks, 3, 6,and 9 months follow-up. RESULTS Two HIV-1 infected infants generated a CTL response at a single time point using the ELISPOT matrix screening assay. These responses could not be confirmed and were undetectable at any of the consecutive visits. At the time of detection of responses the infants were fed unheated breastmilk. HIV-1 exposed uninfected infants were unable to elicit a HIV-1-specific CTL response irrespective of feed. With regards to clinical outcomes, infants born o HIV infected mothers with a CD4 count < 500cells/μl were 2x more likely to acquire other infections at birth compared to those infants born to HIV infected mothers with a CD4 count >500cells/μl. Also, infants born to HIV infected mothers with advanced disease (CD4 count 0-200 cells/μl) had a lower birth weight compared to infants born to HIV-1 infected mothers with a CD4 count > 350 cells/μl. We also investigated the feasibility of the flash heat treatment method at birth. While inhospital, 38 HIV-1 infected women fed their infants HTEBM after receiving counseling and support from the nursing staff at the King Edward VIII hospital. The numbers decreased rapidly post hospital discharge, mainly due to mixed feeding. DISCUSSION In conclusion we have shown that it is feasible for HIV infected mothers to heat treat their expressed breastmilk during hospital admission. Furthermore, we were able to demonstrate in this small cohort of patients that the clinical outcomes and growth parameters of infants fed HTEBM were similar to that of infants fed either formula or unheated breastmilk. We were unable to demonstrate HIV-specific responses in the infected infants or the uninfected infants who had been exposed to heat inactivated virus in HTEBM. Our findings indicate that this pilot study was limited in its ability to detect CTL responses in HIV exposed low birth weight infants and further studies are warranted. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

This study focuses on the process and complexities of disclosure and decision-making amongst HIV-positive ex-offenders. In addition, this study highlights the history and circumstances of HIV infection and how this influences disclosure. The process of disclosure was explored amongst seven HIV positive male ex-offenders who fell in the African racial category. Data was collected through qualitative in-depth interviews and analyzed using thematic analysis. Results revealed that within this target group disclosure initially occurred within prison and thereafter upon release from prison, continues depending on the contextual factors. Because disclosure initially took place within prison, the prison environment was a defining feature during the process of disclosure. Factors that enabled ex-offenders to disclose their HIV status included social support, witnessing of HIV – related deaths amongst other offenders, as well as the challenging nature of the prison environment. Factors that compromised the disclosure process included their access to treatment and a more nutritional diet. Upon release from prison, access to financial and material support and responsibility to significant others were reasons that facilitated the process of disclosure. Overall, stigma was a main barrier that contributed to non - disclosure. These findings highlight that the process of disclosure is a relational factor as it depends largely on the availability and accessibility of significant others. The conclusion that can be drawn from this study is that HIV disclosure is a process that occurs on a continuum whereby there is no clear end-point as ex-offenders weighed up the enabling factors against the barriers before disclosing. Once disclosure had occurred, ex-offenders had to integrate the outcomes and reactions from significant others into their lives. The process of HIV disclosure is also a never – ending process as there are always significant others to disclose to. It is recommended by this study that more research is conducted regarding how prison conditions influence HIVpositive offenders, how HIV-positive ex-offenders can be better re-integrated into the community and how significant others deal with the ex-offenders HIV disclosures.T / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010

As we enter the third decade of a devastating worldwide epidemic, much has been done to stem the flow of HIV/AIDS, in particular within North America and Western European urban centres. However, much is still needed in the developing world. In this study 153 people living with HIV/AIDS in Egypt were interviewed, along with their caregivers. Data were collected on demographics, burden and strain level of caregivers, as well as psychological, psychosocial and health needs. / Using a cross-sectional design, it was found that HIV infection had a negative psychosocial impact on both those infected with and affected by it. Perceived or actual stigma, discrimination, health needs and sexual health status added to this impact. It was also found that caregivers' burden and strain level was higher than a sample of caregivers of renal transplant patients and a sample of caregivers of stroke patients respectively. This suggests that provision of different forms of psychosocial support would help people living with HIV and their caregivers in Egypt cope with the negative impacts of the infection.

This thesis explores the psychosocial dynamics of sexual risk-taking in men who have sex with men, with particular focus on the dilemmas that gay men face in establishing trust in themselves and reasonable trust and intimacy with their sexual partners. As well, the practical function of this study is to analyze past and current social marketing efforts aimed at reducing the spread of HIV/AIDS, and to offer suggestions for how to approach a strategy to reduce HIV incidence in gay men and at the same time bolster efforts to assist men who have sex with men (MSM) in adhering to safer sex guidelines. In part, this thesis uses a sample of participants of the Vanguard Project cohort (St. Paul's Hospital, Vancouver, British Columbia), in order to explore the social meanings attributed by MSM towards sex, risk, intimacy, and attitudes toward HIV/AIDS. Through the use of first-person narratives, this thesis examines the concordance or discordance of MSM beliefs and behaviour with long-standing theoretical models of harm reduction methods concerning sexual risk. The study reveals that, in great measure, due to past life course events, many gay men suffer from a lack of trust in themselves, which results in a tendency to make irrational or unreasonable decisions concerning their long-term sexual health, and a lack of trust in other gay men. As welL through the misguided and often untruthful health models that advocate fewer sexual partners and rely upon the false assumption that all potential sex partners are carriers of contagion, the sense of mistrust has been reinforced. The lack of confidence in self and others further translates into a suspicion of the motives and/or efficacy of social institutions entrusted with community health development and maintenance, rendering their efforts even less effective. Moreover, traditional harm reduction messages, especially 'fear campaigns', often act as a deterrent, rather than as an incentive, to harm reduction. Of more appeal are supportive harm reduction messages delivered by someone whom the recipient trusts, especially when the social meanings of sex, risk, trust and intimacy are, for many gay men, less fixed and more contingent than for the population at large. This means that attempts to modify risky behaviour must acknowledge and negotiate multiple meanings, shifting values and changing social climates, as well as routine epidemiological concerns. The research identifies four key themes within a problematic of trust, risk and intimacy, and delineates the harm reduction social complexities experienced by gay men in the study group; these recurring themes deal with family and early sociahzation, internalized homophobia, contingency and instability of meanings of risk, trust and sex, and the toistworthiness of the messengers of harm reduction strategies. Out of these recurring themes come a number of recommendations for remedial programs aimed at both mid- and long-term reductions in HIV incidence. The recommendations are grounded in the recognition that homophobic and/or dysfunctional social conditions are, to a great extent, implicated in sexual risk behaviour, and therefore must be eliminated or ameliorated before meaningful harm reduction gains can be realized. The discussions with the gay men in the study reveal their need for positive role models and communal social support in their efforts to combat HIV infection, suggesting a need to rethink the meanings of what it is to be gay, a need to redevelop and revitalize what was once a vibrant and cohesive corrimunity, and bearing in mind the lessons of the past, a need to re-approach the task of sternming the tide of HIV infection in ways that are sensitive to the factors that adduce high-risk sexual behaviour.

No description available.

The objective of the proposed research study was to answer the following research questions: Do clients in their respectful stages of diagnosis place more emphasis on certain psychological issues than others? And if so, can we identify the specific psychological issues that were considered to be most significant and unique across the stages of the HIV/AIDS continuum? To test these research questions, 37 homosexual men falling in three specific stages of the infection were surveyed. These three stages included: (1) HIV+ asymptomatic, (2) HIV+ chronic symptomatic, and (3) AIDS diagnosis. The HIV/AIDS Client Concern (HACC) questionnaire was developed to assess the significance clients placed on certain psychological issues and, was administered to all the subjects. The statistical analyses revealed that clients' level of diagnosis influenced how much emphasis they placed on what they considered to be significant psychological issues. More specifically, clients in the asymptotic group reported a higher concern with issues surrounding confidentiality of their HIV/AIDS status than the AIDS diagnosis group. The chronic symptomatic group, on the other hand, was significantly more concerned with issues regarding feelings of guilt/shame, shock, depression, fear, loneliness, and anxiety of infecting other people through casual contact than the other groups. In addition, the AIDS diagnosis group was most concerned with issues surrounding the planning of their future care in comparison with the asymptomatic group. A more detailed analysis of each questions' content and its significance as well as the implications such results have for both researchers and practitioners alike will be discussed.

HIV is among the highly infectious and pathogenic diseases with a high mortality rate. The spread of HIV is in uenced by several individual based epidemiological factors such as age, gender, mobility, sexual partner pro le and the presence of sexually transmitted infections (STI). CD4+ count over time provided the rst surrogate marker of HIV disease progression and is currently used for clinical management of HIV-positive patients. The CD4+ count as a key disease marker is repeatedly measured among those individuals who test HIV positive to monitor the progression of the disease since it is known that HIV/AIDS is a long wave event. This gives rise to what is commonly known as longitudinal data. The aim of this project is to determine if the patients' weight, baseline age, sex, viral load and clinic site, in uences the rate of change in CD4+ count over time. We will use data of patients who commenced highly active antiretroviral therapy (HAART) from the Center for the AIDS Programme of Research in South Africa (CAPRISA) in the AIDS Treatment Project (CAT) between June 2004 and September 2006, including two years of follow-up for each patient. Analysis was done using linear mixed models methods for longitudinal data. The results showed that larger increase in CD4+ count over time was observed in females and individuals who were younger. However, upon tting baseline log viral load in the model instead of the log viral at all visits was that, larger increase in CD4+ count was observed in females, individuals who were younger, had higher baseline log viral load and lower weight. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

<p>This research study attempted to highlight an in-depth exploration of my own classroom practice as a teacher at a high school in the Western Cape. A key goal of this research study was the quest for professional development and the development of an HIV/AIDS literacy programme for curriculum development.</p>

Objective.Humans differ substantially with respect to susceptibility to human immunodeficiency virus type 1 (HIV-1) infection and disease progression. This heterogeneity is attributed to the interplay between the environment, viral diversity, immune response and host genetics. This study focused on host genetics. We studied the association of single nucleotide polymorphisms (SNPs) in peptidyl prolyl isomerase A (PPIA), transportin 3 (TNPO3) and PC4 or SFRS1 interacting protein 1 (PSIP1) genes with HIV-1 infection and disease progression. These genes code for Cyclophilin A (CypA), Transportin-SR2 (TRN-SR2) and Lens epithelium derived growth factor/p75 (LEDGF/p75) proteins respectively, which are all validated HIV replication cofactors in vitro. Methods. One SNP A1650G in the PPIA gene was genotyped in 168 HIV-1 negative and 47 acutely infected individuals using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). 6 intronic and 2 exonic haplotype tagging (ht) SNPs (rs13242262; rs2305325; rs11768572; rs1154330; rs35060568; rs8043; rs6957529; rs10229001) in the TNPO3 gene, 4 intronic ht SNPs (rs2277191, rs1033056, rs12339417 and rs10283923) and 1 exonic SNP (rs61744944, Q472L) in the PSIP1 gene were genotyped in 195 HIV-1 negative and 52 acutely infected individuals using TaqMan assays. The rs1154330, rs2277191, rs12339417 and rs61744944 were further genotyped in 403 chronically infected individuals. CypA and LEDGF/p75 messenger RNA (mRNA) expression levels in peripheral blood mononuclear cells (PBMCs) were quantified by real-time reverse transcriptase polymerase chain reaction (RT-PCR). The impact of the Q472L mutation on the interaction of LEDGF/p75 with HIV-1 integrase (IN) was measured by AlphaScreen. Results. The minor allele (G) of SNP A1650G (1650G) in the promoter region of PPIA was significantly associated with higher viral load (p<0.01), lower CD4+ T cell counts (p<0.01) and showed a possible association with rapid CD4+ T cell decline (p=0.05). The 1650G was further associated with higher CypA expression post HIV-1 infection. The minor allele (G) of rs1154330 in the intron region of TNPO3 was associated with faster HIV-1 acquisition (p<0.01), lower CD4+ T cell counts, higher viral load during primary infection (p<0.05) and rapid CD4+ T cells decline (p<0.01). The minor allele (A) of rs2277191 (rs2277191A) in the intron region of PSIP1 was more frequent among seropositives (p=0.06). Among individuals followed longitudinally, rs2277191A was associated with higher likelihood of HIV-1 acquisition (p=0.08) and rapid CD4+T cell decline (p=0.04) in the recently infected (primary infection) cohort. In contrast, the minor allele (C) of rs12339417 (rs12339417C) also in the intron region of PSIP1 was associated with higher CD4+ T cell counts during primary infection. The rs12339417C was also associated with slower rate of CD4+ T cell decline (p=0.02) and lower mRNA levels of LEDGF/p75 (p<0.01). Seroconverters had higher preinfection mRNA levels of LEDGF/p75 compared to nonseroconverters (p<0.01) and these levels decreased after HIV-1 infection (p=0.02). The Q472L mutation showed approximately 2-fold decrease in the association constant (Kd), suggesting stronger binding to HIV-1 integrase. Our findings demonstrate, for the first time, that genetic polymorphisms in the TNPO3 and PSIP1 genes may be associated with susceptibility to HIV-1 infection and the disease progression. These data provide in vivo evidence that TRN-SR2 and LEDGF/p75 are important host cofactors for HIV-1 replication. This is also the first study to show the association of genetic polymorphisms in the PPIA gene with disease outcome in a population (South African) with high burden of HIV-1 infection. Conclusions. Genetic variation in HIV-1 replication cofactors may be associated with disease outcome in a South African population. These data strongly support the role of these HIV replication cofactors in disease pathogenesis in vivo and suggest that these factors are possible targets for therapeutic interventions. However, these data will need to be replicated in larger cohorts to confirm the effect of these genetic variants. Further studies on how to target these factors in antiviral strategies are needed. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.