Thesis (MScMedSc (Pathology. Medical Virology))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: In 2007, AIDS caused an estimated 2.1 millions deaths worldwide; about 70% in sub-Saharan Africa. HIV preferentially targets activated CD4 T cells, expressing the major HIV receptor CD4, as well as the major chemokine coreceptors CCR5 and CXCR4. These coreceptors play a prominent role during HIV cell entrance phase, HIV transmission and also disease progression. They have been found to be differentially expressed by CD4 T cell subsets. Tuberculosis coinfection may enhance immune activation in vivo thus accelerating HIV disease progression and has become a major challenge in the control of TB in Africa. Introduction of HAART has reduced disease progression to AIDS, as well as risk of further morbidity and mortality. HAART results in a rapid decline of viral load and an initial increase of peripheral CD4 count, however little is known on the effect of HAART in regulation of coreceptor expression, immune activation status and CD4 T cell subset distribution in HIV infection and HIV/TB coinfection. This study is a cross-sectional analysis of coreceptor expression, immune activation status and CD4 T cell subpopulation distribution in South African HIV and HIV/TB coinfected patients before and after ARV. A total of 137 South African individuals were investigated, comprising 15 healthy normal donors (healthy subgroup), 10 patients with active pulmonary tuberculosis (PTB subgroup), 33 HIV-1 positive patients without active PTB (HIV subgroup), 23 positive patients with active PTB (HIV/PTB subgroup), 36 HIV-1 positive patients on ARV (HIV on ARV subgroup) and 20 HIV-1 positive patients with active PTB on ARV (HIV/PTB on ARV subgroup). CD4 absolute count and plasma viral load were determined for all donors. Freshly isolated PBMC were classified by flow cytometry into the following CD4+ T lymphocyte subsets: naïve (CD45+, CD27+), effector memory (CD45-, CD27-), central memory (CD45-, CD27+), and effector (CD45+, CD27-). Coreceptor expression and activation status was assessed by CCR5, CXCR4 and CD38 expression on CD4 T cell subsets. HIV, TB and HIV/TB coinfection was associated with a decrease in percentage CCR5+ T cells as compared to healthy controls, with the HIV/TB group showing the most extensive decrease. In treatment naive patients, CD4 T cells showed elevated surface expression of CCR5 and CD38 as determined by mean fluorescence intensity in HIV/TB co-infection compared to HIV infection alone. The percentage of antigen-experienced cells was higher in the HIV/TB co-infected group compared to the HIV group. The percentage of naïve T cells was decreased in both the HIV infected and the HIV/TB co-infected groups compared to healthy controls. HIV patients with more than 6 months of ARV showed decreased CCR5 and CD38 surface level expression in the HIV and the HIV/ TB co-infected subgroups. An increased percentage of naïve T cells was observed in the HIV infected subgroup, but not in the HIV/TB subgroup, similarly, a decreased percentage of antigen-experienced cells was observed in the HIV subgroup, but not in the HIV/TB co-infected subgroup. A positive correlation was found between CCR5 and CD38 expression, and CXCR4 and CD38 expression (Spearman coefficient of correlation respectively: r=0.59, p<0.001 and r=0.55, p<0.001). Furthermore we found plasma viral load positively associated with CD38 expression (r=0.31, p<0.001) and percentage activated CCR5+ expressing CD4 T cells positively related to viral load (r=0.31, p<0.001). Percentage naïve CD4 T cells was positively associated with CD4 count (r=0.60, p<0.001) and negatively correlated to viral load (r=-0.42, p<0.001). These results indicate that TB coinfection exacerbates certain aspects of dysregulation of CD4 T cell homeostasis and activation caused by HIV infection. In addition, ARV-associated decrease in coreceptor expression, immune activation status and a normalisation of CD4 T cell subset distribution was observed in HIV infected individuals, but not in HIV/TB coinfection. Despite viral suppression after ARV treatment, the decline in the immune activation marker CD38 and coreceptor CCR5 expression, increase in percentage naïve CD4 T cells and decrease of antigen-experienced cells did not reach the levels displayed in the healthy control group. This may indicate that ongoing (albeit reduced) T cell immune activation may occur in the presence of ARV. Further longitudinal studies are needed to closely monitor immune activation during ARV treatment. This study highlighted an association of TB disease with immune activation in HIV infection, the importance of T-cell activation in HIV pathogenesis and its impact on ARV treatment. Further studies are needed to identify causative factors that may lead to a persistent immune activation status during ARV treatment, and how TB coinfection confounds normal responses to ARV. / AFRIKAANSE OPSOMMING: In 2007 was ongeveer 2.1 miljoen sterftes wêreldwyd veroorsaak deur VIGS; ongeveer 70% in Sub-Sahara Afrika. CD4 T selle is die hoof teiken van MIV, aangesien dit die primêre CD4 reseptor, sowel as een of beide van die vernaamste chemokien koreseptore CCR5 en CXCR4 vrystel. Hierdie koreseptore speel ‘n prominente rol wanneer die MIV die sel binnedring, asook tydens MIV oordrag en verloop van die siekte. Dit word ook deur verskillende fraksies van CD4 T selle vrygestel. Gelyktydige TB infeksie mag immuunaktivering in vivo verhoog en dus die siekeproses versnel. MIV het ‘n groot uitdaging geword in die beheer van TB in Afrika. Bekendstelling van HAART het die ontwikkeling van VIGS vertraag, asook die risiko van verdere morbiditeit en mortaliteit. HAART veroorsaak ‘n vinnige afname in virale lading ‘n toename in CD4 telling, hoewel die spesifieke invloed van HAART op die regulering van koreseptor vrystelling, immuunaktivering en verspreiding van CD4 fraksies in MIV en MIV/TB infeksies nog onduidelik is. Hierdie studie het gepoog om koreseptor vrystelling, immuunaktiveringstatus en die verspreiding van CD4 subpopulasies in pasiënte met MIV en MIV/TB voor en na ARV behandeling te ondersoek. ‘n Totaal van 137 Suid-Afrikaanse individue is ondersoek en die studiegroep het bestaan uit 15 normale persone (gesonde subgroep), 10 pasiënte met aktiewe pulmonale TB (PTB subgroup), 33 MIV positiewe pasiënte sonder PTB (MIV subgroep), 23 MIV positiewe pasiënte met aktiewe PTB (MIV/PTB subgroep), 36 MIV positiewe pasiënte op ARV (MIV op ARV subgroep) en 20 MIV positiewe pasiënte met aktiewe PTB op ARV (MIV/PTB op ARV subgroep). Absolute CD4 telling en virale ladings was bepaal vir alle deelnemers. Vars geïsoleerde perifere bloed mononukleêre selle is geklassifiseer deur middel van vloeisitometrie as die volgende CD4 T limfosiet subgroepe: naïewe selle (CD45+, CD27+), effektor geheueselle (CD45-, CD27-), sentrale geheueselle (CD45-, CD27+), en effektor selle (CD45+, CD27-). Koreseptor vrystelling en aktivering was beoordeel volgens CCR5, CXCR4 en CD38 vrystelling op CD4 T sel subgroepe. HIV, TB en MIV/TB ko-infeksie is geassosieer met ‘n afname in die persentasie CCR5+ T selle, vergeleke met gesonde kontroles, waar die MIV/TB subgroep die grootste afname getoon het. In onbehandelde pasiënte het die CD4 T selle verhoogde vrystelling van CCR5 en CD38 op die oppervlakte getoon en dit is bevestig deur die gemiddelde fluoresserende vii intensiteit in die MIV/TB subgroep vergeleke met die subgroep met slegs MIV. Die MIV/TB subgroep het verder ook ‘n verhoogde persentasie totale geheue T selle getoon vergeleke met die MIV subgroep. Die persentasie naïewe T selle was egter verlaag in beide die MIV en MIV/TB subgroepe vergeleke met normale kontroles. MIV pasiënte wat langer as 6 maande op ARV behandeling was in beide die MIV en MIV/TB subgroepe, het ‘n verlaagde vrystelling van CCR5 en CD38 op die oppervlakte van die CD4 selle getoon. ‘n Verhoogde persentasie naïewe T selle het in die MIV subgroep voorgekom, maar nie in die MIV/TB subgroup nie. ‘n Soortgelyke tendens is gevind waar die persentasie totale geheueselle verlaag was in die MIV subgroep, maar nie in die MIV/TB subgroep nie. ‘n Positiewe korrelasie is gevind tussen CCR5 en CD38 vrystelling, asook CXCR4 en CD38 vrystelling (Spearman korrelasie koëffisiënt: r=0.59, p<0.001 en r=0.55, p<0.001 onderskeidelik). Verder het die plasma virale lading ‘n positiewe assosiasie getoon met CD38 vrystelling (r=0.31, p<0.001) en die persentasie geaktiveerde CCR5+ vrystellende CD4 T selle met virale lading (r=0.31, p<0.001). Die persentasie naïewe CD4 T selle het ‘n positiewe assosiasie getoon met CD4 telling (r=0.60, p<0.001) en ‘n negatiewe korrelasie met virale lading (r=-0.42, p<0.001). Volgens hierdie resultate vererger TB ko-infeksie sekere aspekte van die disregulasie van CD4 T selhomeostase en aktivering as gevolg van MIV infeksie. Verder kon ‘n ARVgeassosieerde afname in koreseptor vrystelling, immuunaktivering en normalisering van CD4 T sel fraksies bespeur word in die MIV subgroep, maar nie in die MIV/TB subgroep nie. Ten spyte van virale onderdrukking veroorsaak deur ARV behandeling, het die afname in die immuunmerker CD38 en koreseptor CCR5, toename in die persentasie naïewe CD4 selle en afname in totale geheue CD4 T selle nie die vlakke van die normale kontrolegroep bereik nie. Dit is moontlik dat volgehoue verlaagde T sel immuunaktivering nog steeds mag plaasvind in die teenwoordigheid van ARV. Verdere longitudinale studies is nodig om immuunaktivering tydens ARV behandeling te monitor. Hierdie studie het die belangrikheid van T sel aktivering in MIV patogenese en dit impak daarvan op ARV behandeling beklemtoon. Verdere studies is nodig om moontlike oorsake of bydraende faktore te identifiseer wat tot volgehoue immuunaktivering tydens ARV behandeling kan lei, asook tot mate waartoe TB ko-infeksie kan inmeng met die normale werking van ARV behandeling.

Thesis (MTh)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: This thesis critically analyses the appropriateness and effectiveness of the ABC model in the HIV/AIDS prevention within the context of Swaziland. According to Louw (2008:423), the ABC model stands for the following: A = Abstinence, B = Be faithful and C = use Condoms. According to Green and Herling (2007:1) the ABC model has gained the attention of many countries. The attempt of this model in HIV prevention was to “aim at empowering people through value-based programs to basically abstain from sex as long as possible, to be faithful to one intimate partner and to use condoms correctly and consistently” (De la Porte 2006:79). The assessment of the HIV/AIDS virus in 1983-1984 came as a shock. It was difficult for the church to know at that time how to respond. Some of the responses pointed to the virus as punishment of God. Gradually the church started to become involved in the pandemic. From a Christian spirituality perspective it was argued that the so called ABC model could be viewed as a means of remedy within a prevention approach. The cultural issues as well as human sexuality factors have been discovered to be an obstacle in the ABC model in playing a progressive role in Swaziland. The cultural factors that prevent the ABC model from accomplishing effective results are listed in the final report of (Whiteside et al. 2006: 18-19): bunganwa (having multiple sexual partners; a cultural practice of male married and unmarried to have many girlfriends); kungenwa (levirate or wife inheritance); a widow is given in marriage to marry the brother of her deceased husband without the consent of the women which exposes women to the HIV virus. This practice is done without the consent of the women. Kujuma (occasional overnight visits between unmarried lovers); kuhlanta (a young girl bearing the children of her infertile sister); kushenda (extramarital relationships); kulamuta (a man having a sexual relationship with a younger sister of his wife); and sitsembu (polygamy, one man with more than one wife); this is a common cultural practice found in many African countries due to gender inequality (Chitando 2009:26). This has led to Swaziland being seriously affected by the HIV/AIDS virus (Rupiya 2006:66). The high rate of infection is frightening in a small country with a population of 1 million. As Bishop M, Mabuza, the Anglican bishop indicated, the nation‟s existence is threatened. (Rosenow 2011: 32). Therefore the researcher proposed a pastoral model which gives dignity to human and adds the spiritual dimension of healing in the pastoral care and counselling. There is an urgent need for church leaders to be empowered to face the HIV/AIDS with knowledge that the pandemic is not a punishment for promiscuous people. The theology of sexuality emphasises the responsibility in every sexual engagement for people to be conscious to whatever decision they take. / AFRIKAANSE OPSOMMING: In hierdie navorsing word die toepaslikheid en effektiwiteit van die ABC model in die voorkoming van MIV/Vigs binne die konteks van Swaziland krities ontleed. Volgens Louw (2008:423) staan ABC (in Engels) vir: A = Onthouding, B = Getrouheid aan een maat en C = Die gebruik van kondome. Die navorser, ‟n geordende predikant van die Evangeliese Lutherse Kerk, bespreek die erns van die voorkoms van die MIV/Vigs-infeksie in Swaziland. Empiries is bewys dat Swaziland een van die lande in Sub-Sahara en die wêreld is met die hoogste infeksiekoers (Rupiya 2006:66). Dit is ernstig in ‟n klein landjie soos Swaziland met ‟n bevolking van slegs 1 129 000. Die pandemie het ‟n impak op alle gemeenskappe in die land en bied‟n groot uitdaging vir die Kerk in Swaziland. Die vraag is hoe die Kerk, in haar pastorale bediening, die ABC model kan gebruik om die globale poging te steun om te verhoed dat MIV/Vigs versprei. Hoe kan die konsep van die ABC model toegepas word sodat die Kerk, as hulpgewende gemeenskap, kan sorg vir die siele van die gemeentelede (cura animarum) en effektief inligting omtrent die ABC model kan versprei en uitreik na MIV-positiewe mense? Die navorser stel voor dat daar verandering moet kom in die gesindheid van die Kerk en dat daar ‟n herkonseptualisasie van die voorkomingstrategie en die Skrifverklaring van menslike seksualiteit moet wees. Die Kerke in Swaziland moet hulle houding verander. Daar moet baie meer openlikheid wees sodat sosio-kulturele kwessies openlik bespreek kan word. Daar moet ‟n kritiese herbepaling wees van die tradisies en die kerkbeleid rondom menslike seksualiteit en hoe dit betrekking het op die MIV/Vigs-pandemie.

Thesis (M Social Work (Social Work))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Young people between the ages of 15 and 24 have been identified as being the most significant target grouping affected by HIV and AIDS in the world. South Africa has one of the highest HIV and AIDS prevalence rates and has adopted two broad strategies to curb the HIV and AIDS pandemic. The first strategy is costly involving anti-retroviral treatment which the government has only been able to roll-out to a very few HIV positive people. Currently in a depressing global economy, international donors are finding it difficult to increase funding for HIV and AIDS, more particularly as the poor countries of Sub-Saharan Africa, particularly in Southern Africa have been mostly affected by the HIV and AIDS pandemic. The second strategy is an HIV and AIDS prevention strategy with the primary aim of keeping citizens free from contracting the HI virus. Although this strategy is a comprehensive strategy where governments embark on large-scale campaigns of raising HIV and AIDS awareness, there is very little scientific evidence that these campaigns have brought about a significant decrease of HIV and AIDS prevalence amongst young people. Raising awareness does not necessarily lead to positive behavioural change. Most young people in South Africa attend high schools where HIV and AIDS life-skills education has been made as a compulsory component of the life orientation curriculum. In South Africa, a National Aids Council has been established in South Africa to co-ordinate HIV and AIDS interventions and develops national HIV and AIDS policies aimed at curbing the spread of HIV and AIDS at a national level, yet the HIV and AIDS prevalence amongst young people has not significantly abated. On their own, governments cannot address all the socio-economic needs of their citizens. Partnership need to be formed with Non-government organisations and a broader range of stakeholders to address the spread of HIV and AIDS. Youth workers from NGOs currently implement HIV and AIDS preventative peer education programmes at high schools as part of the South African government’s broad strategy of HIV and AIDS prevention amongst young people. The purpose of this study was to explore and describe the experiences of youth workers who were employed at NGOs implementing HIV and AIDS preventative peer education programmes at high schools. The researcher used both qualitative and quantitative approaches in the research design. A literature review was conducted to research aspects of the study such as the features of NGOs, high schools as a setting and the role youth workers played when implementing HIV and AIDS preventative peer education programmes. Books, articles, journals, the internet and peer education manuals of NGOs all produced relevant information pertaining to the subject of HIV and AIDS prevention amongst young people. Twenty youth workers from three NGOs that is currently implementing HIV and AIDS preventative peer education programmes was purposively sampled, to be primary respondents of an empirical study. The researcher conceptualised and constructed an interview schedule with pertinent qualitative and quantitative questions based on the literature review. After the questionnaire was piloted with three youth workers, the interviewing process ensued. A considerable amount of time was spent on analysing and interpreting the data. Various themes emerged pertaining to different aspects of the programme. An empirical investigation was concluded with various results. Some of the research findings were in accordance with the literature review which supported the view of several authors that peer education programmes were an effective strategy for HIV and AIDS prevention amongst young people. Based on the literature study and the empirical study, various recommendations were made to improve the implementation of the HIV and AIDS preventative peer education programmes at high schools. One of the most significant revelations of the empirical study was how important the proper selection and recruitment of peer educators were to the success of the peer education programme. The research findings point to a strategy that encourages the nominations of learners from each classroom so that they could represent their classes and deliver lessons in a much more practical way than is currently being done. Another equally important finding was the management role that NGOs need to play in enabling the appropriate resourcing, monitoring, evaluating and improvement of the sustainability of the organisation and subsequently enriching the experience of youth workers who implement effective HIV and AIDS preventative peer education programmes at high schools as part of a broad strategy for HIV and AIDS prevention amongst young people in South Africa. / AFRIKAANSE OPSOMMING: Jong mense tussen die ouderdom van 15 en 24 is geïdentifiseer as die belangrikste groep wat deur MIV en VIGS geraak word. Suid-Afrika het een van die hoogste voorkomskoerse van MIV en VIGS en gebruik twee breë strategieë om die MIV en VIGS-pandemie te beteuel. Die eerste strategie is duur en behels teenretrovirale behandeling, wat die regering nog net aan klein aantal MIV-positiewe mense kon verskaf. In die huidige slegte globale ekonomie word dit vir internasionale skenkers toenemend moeilik om befondsing vir MIV en VIGS-behandeling te verhoog, veral omdat dit die arm lande van besuide die Sahara en veral Suidelike Afrika is wat die meeste deur die MIV en VIGS-pandemie geraak word. Die tweede strategie is MIV en VIGS-voorkoming, met die primêre doel om te keer dat landsburgers die HI-virus kry. Hoewel hierdie omvangryke strategie is waarvolgens regerings grootskaalse veldtogte onderneem om bewussyn van MIV en VIGS te verhoog, is daar min wetenskaplike bewyse daarvoor dat hierdie veldtogte tot noemenswaardige vermindering in die voorkoms van MIV en VIGS onder jong mense lei nie. ‘n Verhoogde bewussyn lei nie noodwendig tot positiewe verandering in gedrag nie. Verder is die meeste jong mense in hoërskole waar opvoeding in MIV en VIGS-lewensvaardighede verpligte komponent van die lewensoriënteringskurrikulum is. In Suid-Afrika is ‘n Nasionale Vigsraad geskep om MIV en VIGS-bekampingsprogramme te koördineer en om nasionale MIV en VIGS-beleide te ontwikkel wat gemik is op die bekamping van die verspreiding van MIV en VIGS op nasionale vlak. Nietemin het die voorkoms van MIV en VIGS onder jong mense nie noemenswaardig afgeneem nie. Regerings kan nie op hulle eie al die sosio-ekonomiese behoeftes van hulle burgers vervul nie. Vennootskappe met nieregeringsorganisasies (NRO’s) en ‘n breë reeks belanghebbers word benodig om die verspreiding van MIV en VIGS aan te spreek. Jeugwerkers van NRO’s implementeer tans voorkomende portuuropvoedingsprogramme by hoërskole as deel van die Suid-Afrikaanse regering se breë strategie van MIV en VIGSbekamping onder jong mense. Die doel van hierdie studie was om die ervaringe van jeugwerkers betrokke by NRO wat MIV en VIGS-voorkomende portuuropvoedingsprogramme in hoërskole implementeer, te ondersoek en te beskryf. Die navorser het kwalitatiewe en kwantitatiewe benaderings in die navorsingsontwerp gebruik. Literatuurstudie is onderneem om aspekte van die studie na te vors, soos die kenmerke van NRO’s, hoërskole as ligging en die rol van jeugwerkers in die implementering van MIV en VIGS-voorkomende portuuropvoedingsprogramme. Boeke, artikels, tydskrifte, die internet en portuuropvoedingsriglyne van NRO’s het almal relevante inligting verskaf oor die onderwerp van die voorkoming van MIV en VIGS onder jong mense. Twintig jeugwerkers van NRO wat tans MIV en VIGS-voorkomende portuuropvoedingsprogramme aanbied is deur doelgerigte steekproefneming vir empiriese ondersoek geselekteer. Die navorser het ‘n onderhoudskedule gekonseptualiseer en opgestel met pertinente kwalitatiewe en kwantitatiewe vrae wat op die literatuurstudie gebaseer is. Die vraelys is op drie jeugwerkers getoets, waarna daar met die onderhoudvoering voortgegaan is. Baie tyd is gebruik om die data te analiseer en interpreteer. Verskeie temas het na vore gekom wat met verskillende aspekte van die program verband hou. Empiriese ondersoek is onderneem, met verskillende resultate. Sommige van die navorsingsbevindings was in lyn met die literatuurstudie, wat die siening van verskeie skrywers ondersteun het dat portuuropvoedingsprogramme effektiewe strategie is vir die voorkoming van MIV en VIGS onder jong mense. Op die basis van die literatuurstudie en die empiriese studie is verskeie aanbevelings gemaak om die implementering van MIV en VIGS-voorkomende portuuropvoedingsprogramme in hoërskole te verbeter. Een van die belangrikste bevindings van die empiriese studie was hoe belangrik die behoorlike seleksie en werwing van portuuropvoeders in die sukses van portuuropvoedingsprogram is. Die navorsingsbevindings wys ook op strategie wat die nominasie van leerders in elke klaskamer aanmoedig sodat hulle die klasse kan verteenwoordig en lesse op baie meer praktiese manier aanbied as wat tans die geval is. Ewe belangrike bevinding was die bestuursrol wat NRO’s in die instaatstelling van gepaste hulpbronne moet speel, asook in die monitering, evaluering en verbetering van die volhoubaarheid van die organisasie en in die verryking van die ervarings van jeugwerkers soos hulle voortgaan om effektiewe MIV en VIGS-voorkomende portuuropvoedingsprogramme in hoërskole aan te bied as strategie vir die voorkoming van MIV en VIGS onder jongmense in Suid-Afrika.

Each year approximately 600 000 infants, most of them in Sub-Saharan Africa are born with HIV infection as a result of mother to child transmission of HIV. Whereas significant progress has been made in reduction of mother to child transmission of HIV in developed countries, the situation remains desperate in developing countries. Progress has been hampered by shortage of staff, facilities, limited access to voluntary counselling and testing and lack of support for women by their partners and communities. The challenge is to increase voluntary counselling and testing uptake during antenatal care. Onandjokwe district in Northern Namibia is currently introducing the Prevention of Mother to Child Transmission Program (PMTCT). It has been found the previous PMTCT programs have failed because they adopted a top down approach where there was no community consultation. This study was conducted to explore the community perceptions, knowledge and attitudes regarding mother to child transmission of HIV through focus group discussions and in-depth interviews of key community members.

Co-infection with a sexually transmitted infection (STI) is both an indicator of behavioural risk, as well as an indicator of increased risk for infection with HIV. This is a cross-sectional, descriptive study. The overall aim of the study is to profile the demographic data, health seeking behaviour, sexual risk behaviour and HIV awareness and willingness to test in a sample of STI clinic attendees in order to inform intervention programmes aimed at reducing the burden of disease in this group, thereby reducing HIV risk. It is hypothesised that those individuals who are poorly informed about key prevention information (particularly regarding the biological susceptibility to HIV infection when co-infected with an STI), who are poorly motivated due to poor attitudes towards or lack of social norms in favour of prevention behaviour, and who lack some key behaviour skills (like skills for identifying STIs early, or negotiating safer sexual practises) will be less likely to be able to initiate and maintain specific prevention behaviours. Data are collected using a structured questionnaire and analysed in relation to the Information-Motivation Behavioural Skills (IMB) model of HIV prevention behaviour. This model was specifically developed to provide a conceptual framework for the design, implementation and assessment of targeted and empirically focussed interventions to change sexual risk behaviour in HIV. Components of the IMB model that are identified as important in contributing to risk of infection in this group are identified. Finally, recommendations regarding the form and content of an intervention in this group are made. The study concludes that STI clinics may be excellent environments within which to implement HIV risk reduction pehavioural interventions which currently may be missed opportunities. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

The incidence of HIV cannot be separated from social relationships. Therefore different forms of social relationships are bound to have different impacts; different identities may result in varied degrees of spread of HIV (Kirumira, 2004:158). Gender issues are increasingly being recognised as having a critical influence on the HIV epidemic in southern Africa. Gender inequalities fuel the HIV and AIDS pandemic, rendering females more vulnerable to HIV infection than males. This is shown clearly by HIV prevalence which is reported to be higher among young females than young males (Human Science Research Council, 2005:33). This thesis concerns a three-phase study that I conducted amongst a group of school-going boys and girls in Northern KwaZulu-Natal. The purpose of the study was to conduct a gender-based life building skills programme to expose and sensitise school-going youth to the complexities of gender, sexuality and cultural issues, sex education, the language of sex, rights issues, gender equality and mutual respect, sexual decision-making and HIV prevention. I conducted the first or orientation phase, using a quantitative approach, to determine baseline data prior to conducting the intervention phase of this study. Phase Two was the intervention phase, conducted to collect data during the gender-based skills building intervention programme. Action research is the qualitative research method that guided the intervention programme, involving the youth in a process of gradual change. Phase Three was undertaken using a quantitative approach, to collect data from all the leaners who participated in this study. This phase aimed to evaluate the impact of the intervention programme. The baseline study found that boys demonstrate their manhood by becoming sexually experienced. They do so at an earlier age than females, thus making them more vulnerable to sexually transmitted infections (STIs) including HIV infection. The results of this multi-phased study confirmed existing knowledge about gender, sexual risk-taking and HIV transmission and generated some surprising findings. There was an increase in condom use of more than 90% of learners who reported they were sexually active after the intervention. There was an increase in one-partner relationships. After the intervention, girls better understood their sexual rights and were better able to negotiate for condom use with their partners. Gender power imbalances remained but boys understood better that girls had rights. They continued to believe in the importance of being heterosexually active as a key constituent of their masculinity but it appears that they will be more mindful of girls' desires and rights. Recommendations for various stakeholders, collaboration programmes, curriculum issues and for further research have been highlighted. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.

Gender is inherent in all patriarchal cultures given that women and girls in these societies are relegated to a significantly lower status than men and boys. Many researchers acknowledge the importance of addressing gender inequality in order to adequately understand and address HIV and AIDS transmission and prevention. However, there remains in this area a more direct focus on the specific cultural attitudes and practices that expose women and girls to HIV infections. Professionals in the educational field need to specifically address gender norms and roles and their influence on young people’s sexual behaviour, particularly, with regards to risky behaviour that often has consequences for women and young girls. Sexuality is part and parcel of young girls’ experiences through adulthood which is manifested in personal friendships, relations and social interaction. These encounters constitute sites within which sexual identities are developed, practiced and actively produced through processes of negotiation. As a result of societal influences, these encounters vary immensely between boys and girls because gender inequality has a significant impact on choices available to women and girls, which are often constrained by coercion and violence. Drawing on qualitative research conducted in a high school in KwaMashu, North of Durban, in KwaZulu-Natal, the study investigated ways in which young girls (16-17) give meaning to sexuality, sexual risks and how gender is embedded within these meanings. The study answered three critical questions: What do young girls regard as risky sexual behaviour? Why do young girls engage in risky sexual activities? How is gender connected to sexual risk? Data came from participants’ focus group discussions and indepth interviews with 12 young girls. The study revealed that through social and cultural practices some young girls construct complex gendered relations of domination and subordination that position boys and girls differently, often creating gender inequalities and sexual vulnerability for those gendered as girls. Young girls’ vulnerability is characterised by confusing experiences coupled with silences from their parents’ side about sexuality. The distinctive experiences are complex tensions and contradictions surrounding constructions of sexuality that are predicated upon unequal power and gender relations characterised by coercion, ukuthwala and the control of young girls’ sexuality and gendered experiences that put young girls at risk of contracting HIV and AIDS. The study recommends that parents must communicate with young people (boys and girls) about sexuality. There should be policies that are put in place by all the education stakeholders to address issues of sexuality and gender imbalances within schools. This will help young people to develop the skills needed to adequately negotiate safe sex, avoid risky behaviour and coercive situations, help young people to maintain healthy relationships and address vulnerabilities and promote gender equality and equity in our society. / Thesis (M.Ed.) - University of KwaZulu-Natal, Edgewood, 2011.

The thrust of this dissertation is concerned with investigating beneficiary communities‟ participation in HIV/AIDS communication through community radio stations. The aim is to understand the presence and access of targeted community voices in the dialogue against HIV/AIDS. The research focused on a single case study of a community radio station that is based in Platfontein, Kimberley in the Republic of South Africa. X-K FM is a community radio station under the auspices of the South African Broadcasting Corporation (SABC) and its primary target audiences are !Xun and Khwe communities of Platfontein. It is the only formal communication channel that targets these San community members in their respective mother tongues. The study approaches communication at a nuance level in that it evaluates participation possibilities between communicators and the communicated. In its third decade, the Human Immunodeficiency Virus is one of many challenges facing sub-Saharan Africa and the Republic of South Africa is no exception. This dissertation attempts to understand participation and access of civil voices in the strategies of prevention, care, support and treatment of HIV/AIDS. On a broader level, the dissertation seeks to understand the possibilities of bottom-up approaches in communicating about HIV/AIDS. In analysing the beneficiary community participation at X-K FM, the research was underpinned by the theory of Jurgen Habermas: The Structural Transformation of the Public Sphere – An Inquiry into a Category of Bourgeois Society. The data was gathered using semi-structured interviews, as well as simple and partial participant observation. The study concludes that the radio station has provided some avenues to facilitate the process of beneficiary community participation in HIV/AIDS communication content. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Durban, 2012.

This study explores how subjectivities and emotionality of teachers are inextricably linked with their teaching praxis in the spaces of the HIV and AIDS classroom. A post-structuralist perspective and narrative approach are adopted. The landscape of HIV and AIDS education forms the backdrop or overarching rationale for this study. Despite conflicting debates around the role of teachers and schools in HIV and AIDS education, this study aimed to explore the complexities and challenges facing teachers in mitigating HIV and AIDS education. The broad question this study aimed to explore is: How do teachers’ life experiences, subjectivities and emotionality influence their teaching about HIV and AIDS education? Data was gathered from timelines, semi-structured interviews, classroom observations, scenario analysis and critical lessons from five teachers. A purposeful sample of five teachers, who volunteered and were teaching HIV and AIDS education, was selected from three primary schools in a Midlands town in KwaZulu-Natal, South Africa. The contexts of the schools ranged from rural, semi-rural to urban. Foucauldian concepts of technologies of power/knowledge, technologies of the self and ethics of care were employed to analyse teachers’ subjectivities. Hargreaves theory of the emotional practice of teaching and Zembylas’s genealogies of emotions served as the analytical framework to make sense of emotionality of teachers. The co-constructed narratives of teachers were analysed using holistic content narrative analysis which uncovered seven clusters of meaning: diverse lives, multiple subjectivities; subjectivities and teaching; HIV and AIDS knowledge and teaching; spatial dynamics; relationships; emotions and feelings and cultural complexities. A key insight of this study is that teachers constituted multiple, dynamic and conflicting subjectivities. ‘Compassionate’, ‘supportive’ and ‘knowledgeable’ subjectivities were identified. Teachers enacted these multiple subjectivities drawing on their personal and professional experiences, HIV and AIDS knowledge and community and department of education support. Significantly, teachers resisted tensions and negotiated conflicting subjectivities to create critical reflective or labyrinthine spaces within their classrooms. I argue that spatial dynamics and teachers’ spatial praxis emphasise how power, HIV and AIDS knowledge, subjectivities and space are inextricably linked. Further analysis of teachers’ narratives highlighted discourses of responsibility, expertise, collaboration and sexuality. Most importantly, this study emphasises the complex and critical role of teachers in mediating HIV and AIDS education. A further insight is that teachers experience both positive and negative emotions when teaching about HIV and AIDS education, highlighting teaching as an emotional practice. Patterns of closeness in socio-cultural, moral and political emotional geographies and patterns of distance in professional and physical emotional geographies were displayed in teachers’ relationships. I argue that teachers negotiate their emotions and subjectivities when teaching about HIV and AIDS drawing on technologies of emotion. Of significance, cultural and religious myths as well as stigma and discrimination presented major challenges which teachers had to address. Key findings were categorised as: conflicting subjectivities and resistance; spatial praxis in labyrinthine spaces; technologies of emotion and demystifying cultural and religious myths.The implications of these findings are crucial for policy makers, teacher educators and teachers when implementing curricular and pedagogic changes in the complex spaces of the HIV and AIDS classroom. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2014.

Each year approximately 600 000 infants, most of them in Sub-Saharan Africa are born with HIV infection as a result of mother to child transmission of HIV. Whereas significant progress has been made in reduction of mother to child transmission of HIV in developed countries, the situation remains desperate in developing countries. Progress has been hampered by shortage of staff, facilities, limited access to voluntary counselling and testing and lack of support for women by their partners and communities. The challenge is to increase voluntary counselling and testing uptake during antenatal care. Onandjokwe district in Northern Namibia is currently introducing the Prevention of Mother to Child Transmission Program (PMTCT). It has been found the previous PMTCT programs have failed because they adopted a top down approach where there was no community consultation. This study was conducted to explore the community perceptions, knowledge and attitudes regarding mother to child transmission of HIV through focus group discussions and in-depth interviews of key community members.