Objective: A neglected issue in literature on nutrition and HIV/AIDS is how other health professionals view their role in that arm. The purpose of this study was to understand professional nurses' perception regarding their ability to render effective nutritional care to people living with HIV/AIDS (PLWHA). Design: A qualitative approach was used. Twenty-three, in-depth, semi-structured interviews were conducted with nurses (mean age 38) working in eight (five rural and three urban) Wellness clinics within public hospitals providing antiretroviral therapy (ART) in North West Province, South Africa. Brief structured demographic questionnaires were also administered. All interviews and focus group discussions were recorded for transcription and open-coding. NVivo was used for open coding, whilst descriptive statistics were done using SPSS for windows (version 14, SPSS Inc., Chicago. IL). A research team of professionals and researchers collaboratively analysed data for emerging themes. Results: All the hospitals that participated had at most three nurses, having at least one professional nurse working in the Wellness clinic for PLWHA. More than half of the participants interviewed were diploma holders, eight (35%) were degree holders and three (13%) had certificates in nursing. Five main themes (previously guided by the interview questions) emerged during the analysis of data and these portrayed participants' perceptions regarding their ability to render effective nutritional care to PLWHA. The themes were 1) challenges faced by nurses dealing with PLWHA on a daily basis, 2) concerns of PLWHA, 3) nurses’ perception on the importance of nutrition in HIV/AIDS care, 4) nurses’ perceived ability to deal with nutritional issues in HIV/AIDS, 5) the role of traditional healers, traditional medicine in HIV/AIDS. Thirty five percent of participants mentioned poor socio-economic status of PLWHA as a barrier to the participants to talk about good nutrition to people that are food insecure. Furthermore, 13% of participants indicated that they are constantly facing the dilemma of PLWHA mixing traditional medicines and ART. Participants perceived the following skills to be important in the area of nutrition and HIV/AIDS: communication, listening and knowledge. Although knowledge could be debated as it is not a skill per se, the participants believed that on needs to acquire nutrition knowledge first and then improve on the communication and listening skills with more exposure and training. Ten (41%) of the participants interviewed rated themselves as average, 11 (48%) participants as good whilst only 4%, representing one participant, felt they were very good at giving out nutrition education. Sixty one percent of participants said they would require more knowledge, whilst 39% said they would need to acquire communication and listening skills for them to be able to render effective nutritional cart to PLWHA. In this study, participants perceived nutritional care to PLWHA as their responsibility and that lack of knowledge was influencing their inability to offer this service effectively. All the participants indicated a need for collaboration with nutrition professionals, ill-service training us well as exposure to clear communication channels for nutrition and HIV/AIDS information. Participants were concerned with the lack of policy implementation regarding nutrition and policy documents. Of the 23 participants interviewed, only two (9%) confirmed having seen and rend the South African Guidelines on Nutritional Care for People Living with TB, HIV/AIDS and other Chronic Debilitating Conditions. Conclusion: All participants interviewed believed that nutrition knowledge in the area of HIV/AIDS can be improved if poor people who are infected and affected by HIV/AIDS are food secure. Concerning practice, it is recommended that nutrition and HIV/AIDS as a topic be introduced in both undergraduate mid postgraduate training for nurses. The lack of policy implementation, level of qualification and years spent in the nursing profession may have influenced participants' perception regarding their ability, as well as confidence, to render nutritional care to PLWHA. Possible interventions to improve policy implementation could be the development of user-friendly information, education and communication materials for health institutions as these may serve as constant reminders to health care service providers. It was found that participants' perceptions regarding their ability to render effective nutritional care to PLWHA was affected by a complex number of factors which emerged as themes that need to be addressed. Participants' experience suggests that more research and inquiries are needed into traditional medicines and traditional healing, as the issue of ARVs and traditional medicine is becoming a public health dilemma, riot only to the nurses, but to every stakeholder involved in the field of HIV/AIDS. Furthermore, a need exists for nurse-specific outreach, collaboratively done by nutrition professionals and other stakeholders. This work thus provides a foundation for further exploring ways to improve the ability of other health care workers such as nurses in the nutritional care of PLWHA which will ultimately improve the quality of life of PLWHA. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Objective: A neglected issue in literature on nutrition and HIV/AIDS is how other health professionals view their role in that arm. The purpose of this study was to understand professional nurses' perception regarding their ability to render effective nutritional care to people living with HIV/AIDS (PLWHA). Design: A qualitative approach was used. Twenty-three, in-depth, semi-structured interviews were conducted with nurses (mean age 38) working in eight (five rural and three urban) Wellness clinics within public hospitals providing antiretroviral therapy (ART) in North West Province, South Africa. Brief structured demographic questionnaires were also administered. All interviews and focus group discussions were recorded for transcription and open-coding. NVivo was used for open coding, whilst descriptive statistics were done using SPSS for windows (version 14, SPSS Inc., Chicago. IL). A research team of professionals and researchers collaboratively analysed data for emerging themes. Results: All the hospitals that participated had at most three nurses, having at least one professional nurse working in the Wellness clinic for PLWHA. More than half of the participants interviewed were diploma holders, eight (35%) were degree holders and three (13%) had certificates in nursing. Five main themes (previously guided by the interview questions) emerged during the analysis of data and these portrayed participants' perceptions regarding their ability to render effective nutritional care to PLWHA. The themes were 1) challenges faced by nurses dealing with PLWHA on a daily basis, 2) concerns of PLWHA, 3) nurses’ perception on the importance of nutrition in HIV/AIDS care, 4) nurses’ perceived ability to deal with nutritional issues in HIV/AIDS, 5) the role of traditional healers, traditional medicine in HIV/AIDS. Thirty five percent of participants mentioned poor socio-economic status of PLWHA as a barrier to the participants to talk about good nutrition to people that are food insecure. Furthermore, 13% of participants indicated that they are constantly facing the dilemma of PLWHA mixing traditional medicines and ART. Participants perceived the following skills to be important in the area of nutrition and HIV/AIDS: communication, listening and knowledge. Although knowledge could be debated as it is not a skill per se, the participants believed that on needs to acquire nutrition knowledge first and then improve on the communication and listening skills with more exposure and training. Ten (41%) of the participants interviewed rated themselves as average, 11 (48%) participants as good whilst only 4%, representing one participant, felt they were very good at giving out nutrition education. Sixty one percent of participants said they would require more knowledge, whilst 39% said they would need to acquire communication and listening skills for them to be able to render effective nutritional cart to PLWHA. In this study, participants perceived nutritional care to PLWHA as their responsibility and that lack of knowledge was influencing their inability to offer this service effectively. All the participants indicated a need for collaboration with nutrition professionals, ill-service training us well as exposure to clear communication channels for nutrition and HIV/AIDS information. Participants were concerned with the lack of policy implementation regarding nutrition and policy documents. Of the 23 participants interviewed, only two (9%) confirmed having seen and rend the South African Guidelines on Nutritional Care for People Living with TB, HIV/AIDS and other Chronic Debilitating Conditions. Conclusion: All participants interviewed believed that nutrition knowledge in the area of HIV/AIDS can be improved if poor people who are infected and affected by HIV/AIDS are food secure. Concerning practice, it is recommended that nutrition and HIV/AIDS as a topic be introduced in both undergraduate mid postgraduate training for nurses. The lack of policy implementation, level of qualification and years spent in the nursing profession may have influenced participants' perception regarding their ability, as well as confidence, to render nutritional care to PLWHA. Possible interventions to improve policy implementation could be the development of user-friendly information, education and communication materials for health institutions as these may serve as constant reminders to health care service providers. It was found that participants' perceptions regarding their ability to render effective nutritional care to PLWHA was affected by a complex number of factors which emerged as themes that need to be addressed. Participants' experience suggests that more research and inquiries are needed into traditional medicines and traditional healing, as the issue of ARVs and traditional medicine is becoming a public health dilemma, riot only to the nurses, but to every stakeholder involved in the field of HIV/AIDS. Furthermore, a need exists for nurse-specific outreach, collaboratively done by nutrition professionals and other stakeholders. This work thus provides a foundation for further exploring ways to improve the ability of other health care workers such as nurses in the nutritional care of PLWHA which will ultimately improve the quality of life of PLWHA. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Theoretical work indicates that HIV-1 epidemics in sub-Saharan Africa will cause major demographic changes. The current study assesses the extent to which these changes can already be seen in two rural areas of Manicaland, Zimbabwe and investigates the determinants of the epidemic and its demographic impact. The study utilizes demographic survey methods and qualitative sociological techniques. Data analysis is conducted using statistical packages and is guided by insights generated from mathematical models of the epidemiology and demographic impact of HIV-1 infections. HIV-1 prevalence is high in both areas. Among women, HIV-1 infection is associated with age and marital status. Indirect evidence indicates that religion, education, migration and socio-economic characteristics of husband may also be important determinants. Each of these factors influences the pattern of sexual behaviour. Rates of sexual partner change are heterogeneous for women but appear more homogeneous for men. Mixing patterns are disassortative: men form partnerships with women with high and low rates of partner change. Mortality has undergone a recent upturn, almost certainly associated with HIV-1 infections. Adults aged 20-45 years and men, in particular, are most affected at this (early) stage of the epidemic. Religion is an important local determinant of demographic patterns, whose influence on mortality appears to be changing vua its effect on sexual behaviour and the spread of HIV-1. Orphanhood has increased, but, as yet, there is little change in population structure. Fertility has declined since the late 1970s. It is too early in the AIDS epidemic to see an impact of HIV-1 at the population level. However, some signs of behaviour changes which affect the proximate determinants of fertility were detected. These changes may accelerate the decline in birth rates, especially at younger ages. New demographic projections for Zimbabwe are developed, based on observed trends in HIV- 1 infection and fertility, and underlying behaviour patterns. These indicate substantial further increases in mortality, particularly among women and young children, greatly reduced population growth, relative shortages of young children and older adults, and further increases in orphanhood. Families and communities will require support in facing this slowly unfolding disaster.

This study focused on perceptions and experiences of pregnant women who opted in against those who opted out of voluntary antenatal HIV counseling and testing. The pregnant women's perceptions and experiences were assessed in order to gain insight into their views towards voluntary antenatal counseling and testing.

<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>

The human immunodeficiency virus type 1 (HIV-1) uses a mechanism of genetic recoding known as programmed ribosomal frameshifting to translate the proteins encoded by the pol gene. The pol gene overlaps the preceding gag gene in the -1 reading frame relative to gag. It contains neither a start codon nor an internal ribosome entry site (IRES) to initiate translation of its proteins. Rather the host ribosomes are forced to pause due to tension placed on the mRNA when they encounter a specific secondary structural element in the mRNA. This tension is relieved by disruption of the contacts between the mRNA codons and tRNA anticodons at a �slippery� sequence within the ribosomal decoding centre. Re-pairing of the tRNAs occurs in the new -1 frame after movement of the mRNA backwards by one nucleotide, allowing the ribosome to translate the pol gene as a Gag-Pol polyprotein. A change in ratio of Gag to Gag-Pol proteins affects viral assembly, and most significantly dramatically reduces viral infectivity. The prevailing model for the mechanism of -1 frameshifting has focussed on a pre-translocational event, where slippage occurs when the slippery sequence is within the ribosomal A and P sites. This model precludes a contribution from the codon immediately downstream of the slippery sequence leading into the secondary structural element. I have termed this the �intercodon�. Often at frameshifting sites it is a termination codon, whereas in HIV-1 it is a glycine codon, GGG. When the intercodon within the frameshift element was changed from the wild-type GGG to a termination codon UGA, the efficiency of frameshifting decreased 3-4-fold in an in vivo assay in cultured human cells. This result mimicked previous data in the group within bacterial cells and cultured monkey COS-7 cells. Changing the first nucleotide of the intercodon to each of the three other bases altered frameshifting to varying degrees, but not following expected patterns for base stacking effects. Such a result would support a post-translocational model for -1 frameshifting. It suggested that the intercodon might be within the ribosomal A site before frameshifting, and that the slippery sequence was therefore within the P and E sites. This was investigated by modulating the expression of decoding factors for the intercodon - the release factor eRF1 and cognate suppressor tRNAs when it was either of the UGA or UAG termination codons, and tRNA[Gly] for the native GGG glycine codon. These were predicted to affect frameshifting only if slippage were occurring when the ribosomal elongation cycle was in the post-translocational state. Overexpression of tRNA[Gly] gave inconsistent effects on frameshifting in vivo, implying that its concentration may not be limiting within the cell. When eRF1 was overexpressed or depleted by RNAi, significant functional effects of decreased or increased stop codon readthrough respectively were documented. Expression of suppressor tRNAs increased readthrough markedly in a stop codon-specific manner. These altered levels of eRF1 expression were able to modulate the +1 frameshifting efficiency of the human antizyme gene. Overexpression of eRF1 caused significant reduction of frameshifting of the HIV-1 element with the UAG or UGA intercodon. Depletion of the protein by contrast had unexplained global effects on HIV-1 frameshifting. Suppressor tRNAs increased frameshifting efficiency at the UAG or UGA specifically in a cognate manner. These results strongly indicate that a post-translocational mechanism of frameshifting is used to translate the HIV-1 Gag-Pol protein. A new model (�almost� post-translocational) has been proposed with -1 frameshifting occurring for 1 in 10 or 20 ribosomal passages during the end stages of translocation, because of opposing forces generated by translocation and by resistance to unwinding of the secondary structural element. With translocation still incomplete the slippery sequence is partially within the E and P sites, and the intercodon partially within the A site. The nature of the intercodon influences frameshifting efficiency because of how effectively the particular decoding factor is able to bind to the partially translocated intercodon and maintain the normal reading frame.

Thesis (PhD)--University of South Australia, 2001.

HIV-associated lipodystrophy (HIVLD) syndrome is a condition comprising abnormalities in distribution of body fat and metabolism of lipids and glucose that arises in HIV-infected patients on long-term antiretroviral therapy. This thesis describes clinical research into aspects of the natural history and treatment of HIVLD, as well as molecular research into its pathogenesis centred on subcutaneous adipose tissue. Results demonstrate HIVLD to be a treatment-induced syndrome characterised by initial gains in body fat followed by selective, progressive loss of limb fat. Exposure to thymidineanalogue nucleoside reverse transcriptase inhibitors (tNRTI) induces lipoatrophy through mitochondrial dysfunction of which inhibition of mitochondrial RNA expression, rather than mitochondrial DNA depletion, is an early feature. Mitochondrial dysfunction is associated with decreases in expression of peroxisome proliferatoractivated receptor gamma (PPAR??), an adipocyte transcription factor, which helps explain how tNRTI exposure leads to the loss of adipocyte function. Once established, lipoatrophy is characterised by mitochondrial DNA depletion, although this depletion occurs throughout the mitochondrial genome, suggesting an underlying cause other than inhibition of DNA polymerase gamma. HIVLD is a difficult syndrome to treat. Lipoatrophy is resistant to treatment with rosiglitazone, an agonist of PPAR??, which is ineffective in the setting of ongoing tNRTI therapy and mitochondrial dysfunction. Dyslipidaemia is also difficult to treat as use of pravastatin in the setting of ongoing exposure to protease inhibitors results in only modest declines in fasting cholesterol concentrations. Gains in central fat, such as that seen in patients with buffalo hump, are associated with insulin resistance and diabetes, but only occur in a relatively small percentage of treated patients, suggesting a role for genetic factors in its development. Use of strategies such as avoidance of tNRTI in firstline ART, genetic screening to identify those at risk of toxicities and targeted selection of interventions in subgroups of affected patients, may help prevent this syndrome occurring and better treat those patients in which it has already occurred.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed Feb. 6, 2008). Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.