The aim of this qualitative study was to understand how older women experience their roles as care-givers to HIV/AIDS affected households in the Atteridgeville community and to identify specific problems they encounter. Twelve older women attending three elderly day care centres in Atteridgeville participated in the study. Purposive sampling was done and data was collected through two focus group interviews. Colaizzi‟s seven-step method of data analysis yielded the following four main themes: Caring for adult children with HIV/AIDS, Caring for HIV affected and infected grandchildren, Multiple role players involved in caring for HIV/AIDS persons, The impact on the lives of care-givers. Factors with a positive and negative impact on caring for HIV/AIDS households were identified. The study raises awareness for the need for social workers in Atteridgeville to intervene in assisting older women in their challenging role of caring for HIV/AIDS households / Health Studies / M.A. (Public Health)

Thesis (MPhil)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: On The io" of May 1994 Nelson Mandela was inaugurated as the first democratically elected black president of South Africa. The occasion was regarded, both nationally and internationally, as a triumph for humanity and perfused with a widespread optimism for the future of South Africa. Mandela proclaimed in his inaugural speech that "Never, never and never again shall it be that this beautiful land will experience oppression of one by another .... The sun shall never set on so glorious an achievement." However, now, less than 10 years later the rapidly accelerating and devastating HIV/AIDS epidemic is again 'obscuring the sun'. Those people affected so negatively by the racial, economic and gender injustices of the apartheid past, seem again to be suffering a possible injustice, because of a health and welfare system that is struggling to meet the needs of the HIV affected population. The purpose of this dissertation is to examine the concept of distributive justice in South Africa, within the context of this devastating epidemic. I begin by discussing the Bill of Rights in the South African Constitution. I argue that an acceptable framework for a theory of justice for health care in South Africa, must be worked out against the background of this egalitarian Bill of Rights. I then consider the extent of the HIV epidemic, the effect it is having on the people of South Africa and the consequent implications for health care needs. It is within this context that I examine and compare three theories of distributive justice, namely utilitarianism, John Rawls' theory of "Justice as Fairness" and a libertarian concept of justice, as proposed by Robert Nozick. Utilitarianism is a consequentialist theory that focuses on producing the 'greatest happiness for the greatest number'. I argue that many health policy decisions in South Africa are in fact guided by this principle. However utilitarianism has both strengths and weaknesses which are critically examined. Within the framework of health care policy making, utilitarian justice dictates that rights are derivative and that the welfare of the majority usually takes precedence over the pressing needs of a minority. This issue in particular is discussed. Rawls' theory of "Justice as fairness" is critically discussed next. This theory has been adapted to health care by Norman Daniels, who argues that the Rawlsian principle of "fair equality of opportunity" is a suitable founding principle for health care institutions. Apartheid entrenched a system of 'inequality of opportunity'. Consequently, a theory that focuses on equality of opportunity, has many advantages within the South African context. I examine this theory in detail and provide justification for my assertion that it could be usefully adapted to South African healthcare and the HIV/AIDS epidemic. Finally, I discuss a Libertarian (Nozickian) theory of justice and examine both the strengths and weaknesses of this theory. I attempt to demonstrate why a libertarian system, with it vigorous commitment to moral and economic individualism and belief that one is only entitled to that share of healthcare that can be paid for, would be unjust, if rigorously applied within the post-apartheid South African context. I conclude my dissertation by reiterating my assertion that "Justice as Fair Equality of Opportunity" could be used as a just foundation for a theory of justice for health care in current day, HIV/AIDS affected South Africa. / AFRIKAANSE OPSOMMING: Teorieë van geregtigheid en 'n gesondheidsbeleid vir die VIGS epidemie in Suid Afrika: 'n vergelykende ontleding. Op die 10de Mei 1994 is Nelson Mandela ingehuldig as die eerste demokraties verkose swart president van Suid- Afrika. Die geleentheid is in beide Suid-Afrika en in die buiteland beskou as 'n oorwinning vir humaniteit. Optimisme oor Suid-Afrika se toekoms was oral tasbaar. Mandela het in sy inhuldigingstoespraak verkondig dat dit nooit weer sal gebeur dat hierdie pragtige land sal lyonder die onderdrukking van een oor die ander nie. Hy het gesê dat die son nooit salondergaan op so 'n wonderlike prestasie nie. Nou, minder as tien jaar later, is die verwoestende VIGS epidemie besig om weer die 'son te laat ondergaan'. Dieselffde mense wat alreeds onder apartheid se rasisme en ekonomiese en geslagsongeregtighede gely het, blyk nou weer verontreg te word; hierde keer omdat die gesondheids- en welsynsisteem sukkel om in die behoeftes van die VIGS-geaffekteerde populasie te voorsien. Die doel van hierdie verhandeling is om die konsep van distributiewe geregtigheid in die konteks van die dreigende VIGS epidemie te bespreek. Ek begin met 'n bespreking van die Verklaring van Regte soos vervat in die Suid-Afrikaanse Grondwet. Ek voer aan dat enige aanvaarbare teorie oor geregtigheid in die Suid-Afrikaanse gesondheidsisteem gegrond moet word op hierdie egalitêre Verklaring van Regte. Tweedens kyk ek na die omvang van die VIGS epidemie, die effek wat dit op die HIV-positiewe populasie en hulle familielede het, en die gevolglike implikasies vir gesondheidsbehoeftes. Dit is binne hierdie konteks dat ek drie teorieë van distributiewe geregtigheid ondersoek en vergelyk; naamlik utilitarisme, John Rawls se teorie van "Justice as Fairness", en 'n libertynse konsep van geregtigheid soos voorgestel deur Robert Nozick. Utilitarisme is 'n konsekwensialistise teorie wat beteken dat die regte daad die een is wat in enige situasie die grootste geluk vir die meeste persone sal meebring. Ek voer aan dat baie van die beleidsrigtings wat 'n gesondheidsorg in Suid-Afrika gevolg is, deur hierdie teorie beïnvloed is. Utilitarisme het uiteraard sterk en swak punte en beide kante word krities ondersoek. In 'n gesondheidsorg konteks beteken utilitarisme dat regte altyd afgelei is en dat die welsyn van die meerderheid gewoonlik belangriker is as die van 'n minderheid, selfs wanneer die probleme van die minderheid ernstig en dringend is. Rawls se teorie van geregtigheid word vervolgens krities bespreek. Hierdie teorie is deur Norman Daniels aangepas vir gesondheidsorg. Hy stel voor dat Rawls se beginsel van 'regverdige gelykheid van geleentheid' baie effektief aangepas kan word vir gesondheidsorginstellings. Apartheid het 'n sisteem van ongelyke geleentheids verskans; gevolglik hou 'n teorie wat gelykheid van geleentheid verseker baie voordele vir die Suid- Afrikanse situasie in. Ek bespreek hierdie teorie in detail en poog om my standpunt dat die teorie besonder geskik is vir Suid-Afrikaanse gesondheidsisteem - veral in die konteks van die VIGS epidemie - te regverdig. Laastens bespreek ek die libertynse teorie van geregtigheid soos voorgestel deur Robert Nozick. Ek probeer aantoon waarom hierdie teorie, wat gebaseer is op morele en ekonomiese individualisme en gevolglik aanvoer dat mense geregtig is op gesondheidsorg alleenlik as hulle daarvoor kan betaal, onregverdig is in die Suid-Afrikaanse post-apartheid konteks. Ek sluit hierdie. verhandeling af deur weer te argumenteerdat Rawls se teorie en die beginsel van 'geregtigheid as gelyke geleentheide' uiters geskik is as 'n grondslag vir gesondheidsorg in Suid-Afrika vandag.

Thesis (MPhil (Sociology and Social Anthropology))--Stellenbosch University, 2008. / The purpose of the study is to demonstrate the significance of words and their meaning in knowledge development and perception formulation. Meanings attached to the AIDS epidemic are used to test people’s understanding of this disease. The study is also aimed at demonstrating how false perceptions and wrong concepts are likely to occur if the problem of meaning is not addressed.

The aim of this qualitative study was to understand how older women experience their roles as care-givers to HIV/AIDS affected households in the Atteridgeville community and to identify specific problems they encounter. Twelve older women attending three elderly day care centres in Atteridgeville participated in the study. Purposive sampling was done and data was collected through two focus group interviews. Colaizzi‟s seven-step method of data analysis yielded the following four main themes: Caring for adult children with HIV/AIDS, Caring for HIV affected and infected grandchildren, Multiple role players involved in caring for HIV/AIDS persons, The impact on the lives of care-givers. Factors with a positive and negative impact on caring for HIV/AIDS households were identified. The study raises awareness for the need for social workers in Atteridgeville to intervene in assisting older women in their challenging role of caring for HIV/AIDS households / Health Studies / M. A. (Public Health)

The main aim of this study was to explore the extent of freedom or lack thereof in the relationships of HIV positive pregnant women and their partners. These women were attending antenatal care in two Soweto clinics, run by the Perinatal HIV Research Unit. A semi-structured interview schedule was developed and used as the data collection tool. A theoretical framework based on Amartya Sen's theory of Development as Freedom and Isabel Apawo Phiri's theological reflections on women's freedom, was used to analyze data collected from the participants of the study. The ideas of the two theorists complemented each other with regard to the sources of "unfreedom" for women from an economic point of view and from the cultural and religious points of view. Sen highlighted lack of basic freedoms and human rights as the core causes of lack of freedom, which is both a primary means and principal ends of development. Phiri advocated for the liberation of women from the oppressive cultural and religious practices brought about by patriarchy. Removal of all those key sources of unfreedom would provide an ideal situation in which women would be less vulnerable to HIV infection. The analysis of the participants' responses in this study suggested a lack of freedom in their relationships with the fathers of their unborn babies. This had an adverse effect in their ability to disclose their HIV positive status, negotiate safer sex and contraception. Economic dependency on the partners was found to be the major cornerstone that kept women in bondage in their relationships. The churches in Soweto did not seem to have any plausible impact in the lives of the participants and as a result all of them had very loose links with the church. This was another major gap in the initiatives to reduce HIV infection which challenges the churches in Soweto to strengthen their prophetic ministry in terms of women's freedom and their dignity both in the church and in society. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2007

Wild foods are an integral component of the household food basket, yet their quantified contribution to food security relative to other sources in the context of HIV/AIDS, climate change and variability remains underexplored. This study was carried out in Willowvale and Lesseyton which are rural communities in the Eastern Cape province of South Africa. Willowvale is a relatively remote, medium-rainfall coastal community, while Lesseyton is a peri-urban low rainfall inland community. Qualitative and quantitative methods were used to collect data from 78 HIV/AIDS afflicted households with 329 individuals and 87 non-afflicted households with 365 individuals in the two study sites. Households were visited quarterly over 12 months to assess food acquisition methods, dietary intake and quality, and levels of food security, and to determine strategies employed by households to cope with droughts. The wild foods investigated were wild meat, wild birds, wild fish, wild mushrooms, wild leafy vegetables and wild fruits. Diets were moderately well-balanced and limited in variety, with cereal items contributing 52 % to total calorie intake. Mid-upper arm circumference measurements showed that all respondents were adequately nourished. The bulk of the food consumed by households was purchased, with supplementation from own production, wild vegetables and wild fruits. In Willowvale, wild vegetables comprised 46 % of overall vegetable consumption for afflicted households and 32 % for non-afflicted households, while own fruit production comprised 100 % of fruit consumption. In Lesseyton, wild vegetables comprised only 6 % and 4 % of vegetable consumption for afflicted and non-afflicted households, while wild fruit comprised 63 % and 41 % for afflicted and non-afflicted households. More than 80 % of respondents from both afflicted and non-afflicted households had sufficient daily kilocalories, although the majority of afflicted households felt they were food insecure and sometimes collected wild foods as one of their multiple coping strategies. Hunting and gathering of wild foods was associated with site, household affliction status, gender, age and season. More than 80 % of respondents ate wild vegetables and said they were more drought tolerant than conventional vegetables, making them the most consumed wild food and approximately 16 % of respondents ate wild birds, making them the least consumed wild food. Approximately 14 % of respondents from afflicted households in Willowvale sold wild fish, whilst 34 % of respondents from afflicted households and 7 % from non-afflicted households sold wild fruits in Lesseyton. Strategies adopted by households to cope with droughts were different between the two study sites, and households in Willowvale used a wider range of strategies. Given the devastating effects of HIV/AIDS coupled with the drawbacks of climate change and variability on food security, wild foods represent a free and easy way for vulnerable households to obtain food.

The US Bureau of the Census (1999) projected that by 2004, 14 million people in sub-Saharan Africa will develop full blown AIDS, making this region by far the largest disease burden in the world (World Health Organization, 2002). The United Nations AIDS Programme judged South Africa to have the leading number of people living with HIV/AIDS worldwide (World Health Organisation, 2002). To date there has been extensive research conducted on the socio-economic impacts of HIV/AIDS on families in Africa. However an area of investigation that has remained largely underreported is the inquiry into the psychological impacts of HIV/AIDS on elderly caregivers. In African families older women increasingly have to provide care to their adult children with AIDS and their orphaned grandchildren. However few research studies have assessed the experience of parental caregiving and its psychological impacts on these women. This qualitative research study hypothesised that the role of primary parental caregiver in fact causes a range of psychologically distressing states, which serve to compromise the psychological well-being of these caregivers. To investigate this hypothesis three Xhosa speaking women living in informal settlements in Grahamstown, in the Eastern Cape Province of South Africa were selected for the study. The women were interviewed by means of semi-structured interviews, which consisted of questions related to their caregiving experiences, their experiences of loss, their choice of coping strategies, the role of support networks and their experiences of foster care responsibilities. The interviews were transcribed and analysed using a grounded hermeneutic approach. The research results confirmed the working hypothesis. The research revealed that although it was considered culturally appropriate for older women to care for their children and grandchildren, their caregiver roles caused significant psychological distress. Their distress was related to: emotional and physical exhaustion, complicated grief reactions and ongoing emotional and physical upheaval related to foster care responsibilities. Based on the results, the research recommendations emphasised the need for continual awareness of the psychological implications of caregiving for older African women with the aim to preserve their capacity to function as the primary caring resource to families struck by HIV/AIDS.

Adolescent sexual health has been identified as a significant health and development problem facing South Africa. Limited amounts of research on sexual interactions have been undertaken, with information on adolescents’ romantic relationships being particularly scarce. Qualitative research needs to foster an understanding of the dynamics of sexual interactions in specific settings, and with emphasis in the past on cognitive health psychology models, very little is thus known about how adolescents negotiate and make sense of their sexual experiences. This highlights the need to investigate the complexities of human sexuality in a contextual manner. In response, this study explores the lived experiences of four young black women as they negotiate their agency and sexuality in a local context. By way of in-depth qualitative interviews, which were analysed for recurrent themes using interpretative phenomenological analysis, this project examines the participants’ experiences regarding sex, relationships, communication, sexual health care, as well as HIV and pregnancy prevention. The results reveal that communication about sexuality in the participants’ homes was limited if not absent altogether. When seeking sexual health care, they found clinic nurses to be judgemental and rude. Regarding sexuality and HIV education, the participants stressed the need for outside educators to teach in more practical ways to increase efficacy. In their dating relationships, most participants revealed their boyfriends had a great deal of influence over their sexual initiation. Unwanted pregnancy surfaced as a greater fear than HIV in their accounts due to pressure to finish their education and attain well-paying jobs in the future. The participants felt unable to stop their boyfriends’ infidelity and had limited agency when facing sexual demands. Their accounts revealed that they negotiate their agency in an atmosphere of coercion and the threat of rape. However, areas of agency included their consistent condom use even when facing pressure to have unprotected sex, and their active accessing of sexual health services for hormonal contraception. These insights serve to better inform sexual and reproductive health education and intervention programmes for young women. Moreover, educators, researchers and programme developers alike may gain useful insights from the personalised accounts derived from this study.

The focus of this study was on the experiences of a small sample of local women who are HIVpositive and are living in poverty. The researcher was interested in exploring the psychological and social experiences of these women using Interpretive Phenomenological Analysis. This research aimed at giving these women a voice to express their first-hand, personal accounts of living with HIV in poverty. Data was analysed for meaningful units, which were interpreted inductively and hermeneutically, and categorised into super-ordinate themes. Six themes within the participants' experiences of living with HIV were determined, namely: (I) experiences of diagnosis, (2) disclosure experiences, (3) stigma, (4) ARV experiences, (5) experiences of social support and (6) poverty. This research found that after an HIV-positive diagnosis, most women experience a variety of emotional reactions. These reactions however seem to change overtime into positive acceptance of the HIV diagnosis. Most of the women in this study preferred to use partial disclosure than to fully disclose their HJV-positive status openly to families, friends and to their community. Reasons for not using full disclosure included fear of discrimination and stigma, which included a fear of being rejected or being blamed for their status and a fear of losing relationships. It was also evident from the findings that most of the women had experienced stigma directly and therefore partial disclosure was used as a coping mechanism to protect the self from further harm. It was also revealed that stigma not only has a negative impact on disclosure but also on social support and ARV experiences. Because ofHIV-related stigma, lack of social support was a struggle that almost all the women in this study had experienced. Lack of understandings about their medication also had a negative impact of the ARV experiences. Stigmas along with poverty are the major struggles that HIV -positive women have to deal with in their day to day living. The findings of this study reveal a need for further research in this experiential area as well as campaigns and education around issues such as stigma, medication, and emotional difficulties associated with HIV.

Introduction: Adherence to Highly Active Antiretroviral Therapy (HAART) is critical for optimal therapeutic outcomes. A possible factor in adherence is the impact of HAART on sexual functioning. Methods: A mixed methods approach was used. A cohort of 14 people living with HIV/AIDS (PLWHA) in Grahamstown was identified. Two semi-structured interviews and two structured questionnaires were administered. In-depth interviews were conducted with two HIV counsellors in so as to obtain a different perspective on the topics. The theoretical framework used three health behaviour models: the Health Belief Model, Leventhal‘s Common-Sense Model of self regulation and the Transtheoretical model. Results: The participants were between 27 and 49 years old and had been on HAART for between 9 months and 10 years. Six participants were support staff members from Rhodes University and eight from the Raphael Centre – a local NGO which assists PLWHA.In most of the participants HAART was associated with increased libido and improved sexual functioning (sexual activity and sexual enjoyment). The use of alcohol increased risky sexual behaviour. Issues of adherence were seemingly not directly affected by the effects of HAART on sexuality. PLWHA, especially women, face challenges related to their sexuality, some of which are not directly related to their illness and treatment. The fear of transmitting drug resistant HIV or getting re-infected, stigma, disclosure issues,difficulties negotiating for safe sex among women, HAART-related lipodystrophic changes that affect one‘s sense of self and unmet reproductive needs are some of the problems that were reported. The men‘s dislike for condoms was overt and blatant. Discussion: Being diagnosed with HIV and reaching a point where treatment is requiredare life-changing events. Making decisions about one‘s life (including adherence to HAART, alcohol use and knowingly partaking in risky sexual encounters) become all the more significant in the context of AIDS. Intentional non-adherence is informed by the individual‘s assessment of the costs and benefits of taking treatment. Cultural influences,gendered power relations and misconceptions strongly influence sexual behaviours. Conclusion: The general lack of attention among health care providers concerning issues related to PLWHA‘s sexuality and reproductive issues needs to be addressed. Insights fromthe theoretical models should be integrated with empirical findings in designing adherence interventions.