In English / The purpose of this study was to establish factors affecting the participation of men working in the informal sector economy of South Africa in HIV counselling and testing (HCT) or voluntary counselling and testing (VCT). This includes the exploration of reasons for acceptance and non-acceptance of HIV testing, knowledge and perceptions about HIV testing and behaviours and attitudes towards HIV testing. Data was collected through a structured questionnaire and a sample of fifty (50) men was purposively selected. It was found that the reasons for acceptance of HIV testing are satisfactory and reasons for non-acceptance are still a concern, and that several issues such as education about HIV testing and HIV in general still need to be addressed. Most of the respondents had undergone testing for HIV, but there is still a stigma attached to HIV testing. / Sociology / M. A. (Social Behaviour Studies in HIV/AIDS)

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This research study looked at the factors that affect HCT in provision of PMTCT services. It explored the socio cultural and personal factors that affect HCT. It also established the knowledge level about HIV/AIDS and PMTCT among pregnant women in Kabwe. The transmission of HIV from mother to child contributes largely to HIV prevalence among children. Efforts to reduce this mode of transmission include increasing number of women who know their HIV status and increasing the number of HIV positive women who when pregnant take instructions and act on them to protect their children from the possibility of infection (Bartlett et al. 2004). Individuals can only know their HIV status once they are tested for HIV. However, there are socio cultural and personal factors among other factors that affect the access of HCT. The aim of this study was to identify socio cultural and personal factors that affect HIV counseling and testing in provision of PMTCT services among pregnant women in Kabwe, in order to make recommendations for the development of an intervention program to help improve uptake of HIV counseling and testing for PMTCT services. Both quantitative and qualitative methodologies were used to conduct this study. Focus Group Discussions were conducted with groups of pregnant women that have never been tested for HIV before and Key Informant Interviews with health care workers (midwives or nurses) to ask them about factors affecting HCT in provision of PMTCT services among pregnant women were used. A retrospective statistical report review was also used to ascertain the accessibility rate for the HIV counseling and testing for PMTCT services. In this light, statistical report review was used to collect the number of pregnant women attending ANC and number of pregnant women receiving HIV testing. The findings of this study revealed that the pregnant women had excellent knowledge about HIV/AIDS and the update of HCT was as good as 91% among pregnant women. The research also revealed domestic violence, accusation of promiscuity by partner, abandonment by partner, and stigma & discrimination as socio factors that affect HCT in provision of PMTCT. Religion, fear disbelief of test results was revealed as personal factors affecting HCT in provision of PMTCT. The research revealed decision making, tradition medicines, and practices as cultural factors affecting HCT in provision of PMTCT. The conclusion was made that fear of abandonment by partner, fear of being accused of being promiscuous by partner, and fear of domestic violence were the main factors why some pregnant women did not accept to take an HIV test during their pregnancies. It is also concluded that most men make decisions for their families. Women in homes have no powers to make decisions, so if the husband refuses her to take a test, the wife just has to comply. It is also concluded that a person’s ability to access health related services is shaped by socio cultural and personal factors among others factors. These findings fit well with the Anderson behavioral model which describes the individual factors as having three elements that relate to the individual’s ability to access and utilize health care services. / AFRIKAANSE OPSOMMING: Hierdie navorsingstudie het gekyk na die faktore wat 'n invloed HCT in die voorsiening van VMTKO dienste. Dit ondersoek die sosio-kulturele en persoonlike faktore wat HCT. Dit het ook die kennis oor MIV / VIGS en VMNKO onder swanger vroue in Kabwe. Die oordrag van MIV van moeder na kind dra grootliks by tot die voorkoms van MIV onder kinders (Bartlett et al. 2004). Pogings om hierdie wyse van oordrag te verminder sluit in toenemende aantal vroue wat hul MIV-status ken en die verhoging van die aantal MIV-positiewe vroue wat toe swanger neem instruksies en reageer op hulle om hul kinders te beskerm teen die moontlikheid van infeksie. Individue kan slegs weet wat hul MIV-status wanneer hulle getoets word vir MIV. Egter, is daar sosiaal-kulturele en persoonlike faktore onder ander faktore wees wat die toegang van HCT. Die doel van hierdie studie was om sosiaal-kulturele en persoonlike faktore wat die MIV-berading en toetsing in die voorsiening van VMTKO dienste onder swanger vroue in Kabwe te identifiseer, ten einde aanbevelings te maak vir die ontwikkeling van 'n intervensie program te help opname van MIV-berading en toetsing vir VMNKO dienste te verbeter. Beide kwantitatiewe en kwalitatiewe metodes is gebruik om hierdie studie uit te voer. Fokusgroepbesprekings is gevoer met groepe van swanger vroue wat nog nooit vir MIV getoets is voor en onderhoude met sleutelinformante met gesondheidsorgwerkersVroedvroue of verpleegsters) is gebruik om hulle te vra oor die faktore wat HCT in voorsiening van PMTCT dienste onder swanger vroue. 'n Retrospektiewe statistiese verslag review is ook gebruik om die toeganklikheid koers vir die MIV-berading en om vas te stel toetsing vir VMNKO dienste. In hierdie lig, is statistiese verslag hersiening gebruik word om die aantal swanger vroue wat die ANC en die aantal swanger vroue MIV-toetsing in te samel. Die bevindinge van hierdie studie het aan die lig gebring dat die swanger vroue het uitstekende kennis oor MIV / VIGS en die update van HCT was so goed as 91% onder swanger vroue. Die navorsing het ook aan die lig gebring huishoudelike geweld, beskuldiging van losbandigheid deur vennoot, verlating deur vennoot, en stigma diskriminasie as sosio faktore wat 'n invloed HCT in die bepaling van die PMTCT. Godsdiens, vrees ongeloof van toetsresultate is geopenbaar as persoonlike faktore wat HCT in die voorsiening van PMTCT. Die navorsing het aan die lig gebring besluitneming, tradisie medisyne, en praktyke as kulturele faktore wat HCT in die voorsiening van PMTCT. Die gevolgtrekking is gemaak dat vrees vir verlating deur vennoot, vrees daarvan beskuldig dat hy van promisku deur vennoot, en die vrees van huishoudelike geweld was die belangrikste faktore waarom sommige swanger vroue nie aanvaar het nie 'n MIV-toets te neem tydens hul swangerskappe. Dit is ook die gevolgtrekking gekom dat die meeste mense besluite neem vir hul families. Vroue in huise het geen magte om besluite te neem, so as die man weier om vir haar 'n toets te neem, die vrou net om daaraan te voldoen. Dit is ook die gevolgtrekking gekom dat 'n persoon se vermoë om gesondheid verwante dienste om toegang te verkry tot gevorm word deur die sosiaal-kulturele en persoonlike faktore onder andere faktore. Hierdie bevindings pas goed met die Anderson gedrags-model wat die individuele faktore beskryf met drie elemente wat betrekking het op die individu se vermoë om toegang te verkry tot en gebruik van gesondheidsorgdienste.

Text in English / The purpose of the study was to explore and describe the perceptions of the HIV positive pregnant mothers regarding the PMTCT Option B+ programme in order to identify and describe gaps; and also help the Swaziland government address these gaps. The study was conducted in one of the public health units in the Manzini Region of Swaziland. The qualitative, exploratory and descriptive research design was used and data collection was done using individual interviews and field notes. Permission was also requested from the participants in order to record the interviews. Population of the study were all cases of HIV positive pregnant mothers enrolled on PMTCT Option B+ programme, and were aged between 18 and 40 years. Number of participants sampled was 20 and only 17 participants were interviewed. Themes of the study were: perceptions of being enrolled on the PMTCT Option B+ programme, understanding about PMTCT Option B+ programme and information needed with regard to PMTCT Option B+ programme, perceptions with the care received from the nurses and their assistance on PMTCT Option B+ programme, effectiveness of the PMTCT Option B+ programme and challenges of taking ARVs. The findings revealed that Option B+ programme was perceived as preventing HIV from mother-to-child. It boosts the mother’s immune system, prevents opportunistic infections and prolongs life. Knowledge and understanding of the programme was displayed by the participants even though challenges such as discrimination and no support by families and partners were mentioned. Improvement of the programme on how to prevent the spread of HIV to babies and strategies to assist participants on how to disclose were recommended. This was found to be having a huge effect on treatment adherence. / Health Studies / M.A. (Health Studies)

In English / The purpose of this study was to establish factors affecting the participation of men working in the informal sector economy of South Africa in HIV counselling and testing (HCT) or voluntary counselling and testing (VCT). This includes the exploration of reasons for acceptance and non-acceptance of HIV testing, knowledge and perceptions about HIV testing and behaviours and attitudes towards HIV testing. Data was collected through a structured questionnaire and a sample of fifty (50) men was purposively selected. It was found that the reasons for acceptance of HIV testing are satisfactory and reasons for non-acceptance are still a concern, and that several issues such as education about HIV testing and HIV in general still need to be addressed. Most of the respondents had undergone testing for HIV, but there is still a stigma attached to HIV testing. / Sociology / M. A. (Social Behaviour Studies in HIV/AIDS)

The study explored, described and explained the current models of voluntary counselling and testing services delivery and analysed the extent to which a given VCT model had influenced uptake of VCT services in the fishing communities along the shores of Lake Victoria, in Wakiso District, with an aim of designing optimal VCT service delivery strategies. The study was therefore exploratory, descriptive and explanatory, and collected both qualitative and quantitative data in a three-phased approach. Phase I involved the Kasenyi fishing community respondents, while phases II and III involved VCT managers and VCT counsellors at the Entebbe and Kisubi Hospitals. The findings indicated that VCT services are generally available onsite at health facilities, and in the field through mobile VCT outreach or home-based VCT services provided at clients’ homes. Both client-initiated and health provider-initiated VCT services are available and services are integrated with other health services. Despite the availability of VCT, only about half of the respondents in phase I had accessed VCT services although almost all indicated a willingness to undergo HIV testing in the near future. The main challenges to service delivery and utilisation included limited funding and staffing as well as limited awareness in target communities. The strategies drawn are based on the need to increase availability, accessibility, acceptability and utilisation of VCT services. / Health Studies / D. Litt. et Phil. (Health Studies)

The study explored, described and explained the current models of voluntary counselling and testing services delivery and analysed the extent to which a given VCT model had influenced uptake of VCT services in the fishing communities along the shores of Lake Victoria, in Wakiso District, with an aim of designing optimal VCT service delivery strategies. The study was therefore exploratory, descriptive and explanatory, and collected both qualitative and quantitative data in a three-phased approach. Phase I involved the Kasenyi fishing community respondents, while phases II and III involved VCT managers and VCT counsellors at the Entebbe and Kisubi Hospitals. The findings indicated that VCT services are generally available onsite at health facilities, and in the field through mobile VCT outreach or home-based VCT services provided at clients’ homes. Both client-initiated and health provider-initiated VCT services are available and services are integrated with other health services. Despite the availability of VCT, only about half of the respondents in phase I had accessed VCT services although almost all indicated a willingness to undergo HIV testing in the near future. The main challenges to service delivery and utilisation included limited funding and staffing as well as limited awareness in target communities. The strategies drawn are based on the need to increase availability, accessibility, acceptability and utilisation of VCT services. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of the study was to describe the determinants and practice of HIV self-testing among health care workers (HCWs) in Nyeri provincial hospital, Kenya. A descriptive cross-sectional study was conducted to determine the rate of HIV self-testing, explore the factors influencing the practice and describe access to HIV psychosocial support, care and treatment. The study was guided by the concepts of the protection motivation theory. Data was collected from 348 HCWs and analysed by means of logistic regression. Results showed that 65.8% of the HCWs had practiced HIV self-testing among themselves. Age, self efficacy and response efficacy were found to be significant predictors of HIV self-testing. Willingness to access HIV psychosocial support (71.3%) and care and treatment (73.9%) was high. Self-testing is highly practiced by HCWs. / HIV self-testing among health care workers at Nyeri Provincial Hospital in Kenya / HIV self-testing among health care workers / Public Health / M.A. (Public Health)

Appendix B (leaves 217-218), Appendix M (leaves 239-247) and Appendix O (leaves 253-259) in English and Amharic / The purpose of this research was to develop HIV testing Health Belief Scale (HTBS) that contains the constructs of Health Belief Model (HBM), and also to analyse HIV testing intention and behaviour among university students. The mixed method approach was used in phases. First, Literature review and in-depth interviews were conducted to develop item pool for HTBS, which was followed by content validity assessment by experts. In the second phase, a pilot survey was conducted on randomly selected 318 university students to refine the HTBS using item analysis and Exploratory Factor Analysis (EFA). Lastly, cross-sectional survey was conducted on representative sample of 612 students in order to further refine the HTBS using Confirmatory Factor Analysis (CFA) and also analyse predictors of HIV testing intention and behaviour. A total of 61 items was written for the HTBS and 23 of these were generated from the in-depth interviews. Content validity assessment by three experts indicated that the average content validity index (CVI) for the 61 items was 91.2% which was more than the recommended cut off point of 90%. The HTBS, after experts review, contained 64 items. EFA indicated that a five factor model which was roughly consistent with HBM was identified and 44 items were retained based on factor loading and reliability analysis. The Cronbach’s alpha for all the six constructs of HBM and HIV testing intention in the HTBS were >0,70. (susceptibility, benefit, self-efficacy and HIV testing intention) fitted the sample data based on chi-square test. However, all the seven constructs demonstrated RMSEA value of less than 0.08 and GFI value of >0.90 indicating acceptable fit. The final HTBS was reduced to 39 items based on factor loading and reliability assessment. All the constructs demonstrated a Cronbach’s alpha value >0.70 except for perceived susceptibility and cues to action. Analysis of multiple linear regression indicated that class year, perceived benefit, perceived self-efficacy and cues to action were significant predictors of HIV testing intention. However, only marital status and cues to action were significant predictors of recent history of HIV testing through analysis of binary logistic regression. / Health Studies / D.Litt. et Phil. (Health Studies)

Summaries in English, Afrikaans and Zulu / South Africa is facing an ongoing public health crisis with increasing and alarming human immunodeficiency virus (HIV) statistics. Farmworkers in South Africa are highly vulnerable and susceptible to HIV. This study involved the farmworker community on a farm in the North West province of South Africa. The purpose of this study was to explore the perceptions and acceptance of home-based HIV counselling and testing (HBHCT) in a rural farming community, using an interactive World Café method to stimulate creative discussions around questions that matter. Thirty-one farmworkers participated in the World Café. This study had an explorative approach and qualitative design. The study did not investigate the number of HIV infections or sexual practices on the farm, and did not offer an HIV test or any other medical treatment to any participant. Data were collaboratively analysed by the researchers and the participants. Content analysis of data was conducted. The findings indicated that majority of the farmworkers had a positive perception of HBHCT, and that there was a serious need for HIV prevention and intervention in this community. Some concerns were raised among the participants regarding the confidentiality of HBHCT, attention should therefore be paid to these concerns. More research is needed to establish linkage to care after HBHCT. It remains unclear whether the migrant farmworker population would be effectively linked to HIV care and treatment without legal identification documentation. The acceptance of HBHCT in the farming community by farmers, should be explored. The study found that there would be a high level of acceptability if HBHCT were to be offered to farmworkers in this region. This study created insight into the HIV care and prevention needs of the local farmworker community, as well as highlighted the barriers the farmworkers face in attending primary healthcare (PHCs) clinics for HIV testing. / Suid-Afrika staar ’n voortdurende openbare gesondheidskrisis in die gesig met toenemende en onrusbarende menslike immuungebrekkige virus (MIV)-statistieke. Plaaswerkers in Suid-Afrika is uiters kwesbaar en vatbaar vir MIV. Hierdie studie het die plaaswerkergemeenskap van ’n plaas in die Noordwes-provinsie van Suid-Afrika geteiken. Die doel van hierdie studie was om die sieninge en aanvaardingsvlakke van tuis-gebaseerde MIV-berading en -toetsing (TSMBT) te ondersoek, deur gebruik te maak van die “World Café”-metode om kreatiewe bespreking rondom belangrike vrae te stimuleer. Een-en-dertig plaaswerkers het deelgeneem aan die “World Café”. Hierdie studie het nie die aantal MIV-infeksies of seksuele praktyke op die plaas ondersoek nie, en ook nie ’n MIV toets of enige ander mediese behandeling vir enige deelnemer aangebied nie. Die studie het gevind dat die meerderheid van die plaaswerkers ’n positiewe persepsie van TSMBT gehad het, en dat daar ’n dringende behoefte aan MIV-voorkoming en - ingryping in hierdie gemeenskap is. Bekommernis is uitgespreek deur die deelnemers rakende die konfidensialiteit van TSMBT, dus moet aandag hieraan geskenk word. Die studie het gevind dat daar ’n hoë vlak van aanvaarding van TSMBT sal wees as dit aan die plaaswerkers in hierdie streek gebied word. Hierdie studie skep insig in die MIVsorg- en -voorkomingsbehoeftes van die plaaslike plaaswerkergemeenskap, en beklemtoon die hindernisse vir plaaswerkers om die primêre gesondheidsorgkliniek te besoek vir MIV-toetsing. / INingizimu-Afrika ibhekene nokuqhubeka kokukhula kwenkinga yezempilo, kanye nokudlondlobala okushaqisayo kwezibalo zegciwane lesandulela ngculazi (HIV). Abasebenzi basemapulazini eNingizimu-Afrika ibona abasengozini enkulu yokutheleleka ngegciwane lesandulela ngculazi. Lolucwaningo lwenziwe emphakathini wabasebenzi basemapulazini esifundazweni sase-North West eNingizimu-Afrika. Inhloso yalolucwaningo bekuwukubona imibono kanye nezinga lokwamukela ukululekwa nokuhlolela igciwane lesandulela ngculazi emakhaya(i-HBHCT) emphakathini wasemapulazini kusetshenziswa Isizinda sokucobelelana ngolwazi (i- World Cafe) ukukhuthaza izingxoxo ezakhayo nokubuza imibuzo esemqoka. Bangama- 31 abasebenzi basepulazini ababambe iqhaza esizindeni sokucobelelana ulwazi (i- World Cafe). Lolucwaningo aluzange luphenye izibalo zabantu abatheleleke ngegciwane lesandulela ngculazi kanye nezinga labo lokuzibandakanya ocansini, futhi aluzange lunike abebebambe iqhaza ithuba lokuhlolela igciwane lesandulela ngculazi(HIV) kanye nokulashwa kwanoma iluphi uhlobo. Imiphumela iveze ukuthi iningi labasebenzi basemapulazini babe nemibono emihle mayelana nosizo lokululekwa nokuhlolela igciwane lesandulela nngculazi (HIV) emakhaya (HBHTC), futhi kunesidingo esikhulu sokuthi kungenelelwe kulomphakathi ukuze kuvikelwe igciwane lesandulela ngculazi (HIV). Kube nokukhathazeka kwababebambe iqhaza mayelana nezimfihlo zokulekelelwa ngokwelulekwa kanye nokuhlolela igciwane lesandulela ngculazi emakhaya(HBHCT),ngalokhoke kufanele kubhekelelwe lokho kukhathazeka. Ucwaningo luveza ukuthi kuzokwamukelwa ukuqala usizo lokwalulekwa nokuhlolela igciwane lesandulela ngculazi (HBHCT) kubasebenzi basemapulazini kulesisifundazwe. Lolucwaningo luveze ngokujulile izidingo zokunakekela kanye nokuvikela igciwane lesandulela ngculazi (HIV) emphakathini wabasebenzi basemapulazini kulendawo, laphinde lwaveza nezithiyo (Barriers) abasebenzi basemapulazini abahlangana nazo mabevakasha emitholampilo (PHCs) ukuyohlola igciwane lesandulela ngculazi. / Health Studies / M.P.H. (Public Health)

Appendix B (leaves 217-218), Appendix M (leaves 239-247) and Appendix O (leaves 253-259) in English and Amharic / The purpose of this research was to develop HIV testing Health Belief Scale (HTBS) that contains the constructs of Health Belief Model (HBM), and also to analyse HIV testing intention and behaviour among university students. The mixed method approach was used in phases. First, Literature review and in-depth interviews were conducted to develop item pool for HTBS, which was followed by content validity assessment by experts. In the second phase, a pilot survey was conducted on randomly selected 318 university students to refine the HTBS using item analysis and Exploratory Factor Analysis (EFA). Lastly, cross-sectional survey was conducted on representative sample of 612 students in order to further refine the HTBS using Confirmatory Factor Analysis (CFA) and also analyse predictors of HIV testing intention and behaviour. A total of 61 items was written for the HTBS and 23 of these were generated from the in-depth interviews. Content validity assessment by three experts indicated that the average content validity index (CVI) for the 61 items was 91.2% which was more than the recommended cut off point of 90%. The HTBS, after experts review, contained 64 items. EFA indicated that a five factor model which was roughly consistent with HBM was identified and 44 items were retained based on factor loading and reliability analysis. The Cronbach’s alpha for all the six constructs of HBM and HIV testing intention in the HTBS were >0,70. (susceptibility, benefit, self-efficacy and HIV testing intention) fitted the sample data based on chi-square test. However, all the seven constructs demonstrated RMSEA value of less than 0.08 and GFI value of >0.90 indicating acceptable fit. The final HTBS was reduced to 39 items based on factor loading and reliability assessment. All the constructs demonstrated a Cronbach’s alpha value >0.70 except for perceived susceptibility and cues to action. Analysis of multiple linear regression indicated that class year, perceived benefit, perceived self-efficacy and cues to action were significant predictors of HIV testing intention. However, only marital status and cues to action were significant predictors of recent history of HIV testing through analysis of binary logistic regression. / Health Studies / D.Litt. et Phil. (Health Studies)