Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: STUDY AIM The aim of the study is to explore the psychosocial characteristics of HIV positive clients who are yet to achieve viral load suppression after six months of commencing ARV at Sundumbili CHC in order to plan positive intervention strategies. RESEARCH DESIGN Non-experimental quantitative design was used in carrying out the study. The data was collected through retrieval of information from clinic records and completion of questionnaires to clients on ARV who met the inclusion criteria and consented to participating in the study. A total of 51 adults aged more than 18 years that were initiated in 2010/2011 and still access their treatment at Sundumbili CHC were enrolled into the study. They were selected through convenience sampling. FINDINGS Psychosocial challenges still exist among research participants whose viral load results were not suppressed after six months on ARV. This affected the adherence of some of them to their antiretroviral treatment. CONCLUSION Given the rural nature of Sundumbili and surroundings where the bulk of the patients reside, there are several psychosocial challenges affecting the patients. No known previous study has been undertaken to ascertain the psychosocial characteristics of this group of patients and the impact they may have on viral load suppression after six months of treatment. The study is therefore significant as the findings have provided more insight into the plight of the patients. It is envisaged that the recommendations from the study will assist the relevant management staff in the department in planning and subsequently implementing more positive intervention strategies. The strategies should be targeted at improving the quality of care of the HIV positive clients and attending to their psychosocial needs. / AFRIKAANSE OPSOMMING: STUDIEDOELWIT Die doel van die studie was om ondersoek in te stel na die psigososiale kenmerke van MIV-positiewe kliënte wie se virustellings ná ses maande van antiretrovirale (ARV) behandeling by die gemeenskapsgesondheidsentrum op Sundumbili steeds nie onder beheer was nie, ten einde positiewe intervensiestrategieë te beplan. NAVORSINGSONTWERP ’n Nie-eksperimentele kwantitatiewe ontwerp is gebruik om die studie te onderneem. Die data is ingesamel deur die herwinning van inligting uit klinieklêers sowel as die afneem van vraelyste onder kliënte op ARV’s wat aan die insluitingsmaatstawwe voldoen en tot deelname aan die studie toegestem het. Altesaam 51 volwassenes bo die ouderdom van 18 wat in 2010/2011 met ARV behandeling begin het en dit steeds by Sundumbili-gemeenskapsgesondheidsentrum ontvang, is in die studie opgeneem. Dié groep is deur middel van geriefsteekproefneming gekies. BEVINDINGE Psigososiale uitdagings was steeds te bespeur by navorsingsdeelnemers wie se virustellings nog nie ná ses maande op ARV’s onder beheer was nie. Dit het sommige se behandelingsgetrouheid beïnvloed. GEVOLGTREKKING In die lig van die landelike aard van Sundumbili en omgewing, waar die meeste van die pasiënte woon, kom pasiënte voor verskeie psigososiale uitdagings te staan. Daar is klaarblyklik nog nooit vantevore ’n studie onderneem om die psigososiale kenmerke van hierdie groep pasiënte, en die moontlike impak daarvan op die onderdrukking van virustellings ná ses maande van behandeling, te bepaal nie. Hierdie studie is dus waardevol, aangesien die bevindinge groter insig in die lot van die pasiënte bied. Daar word beoog dat die aanbevelings uit die studie tersaaklike bestuurspersoneel in die Departement van Gesondheid sal help om meer positiewe intervensiestrategieë te beplan en gevolglik in werking te stel. Die strategieë behoort daarop afgestem te wees om die gehalte van sorglewering aan MIV-positiewe kliënte te verbeter en in hul psigososiale behoeftes te voorsien.

This study emerged from the high prevalence rate of HIV and AIDS infection among women in Sub-Saharan Africa, which has no exception to Namibia. Women have been vulnerable to HIV and AIDS let alone on sex related issues since the epidemic emerged, but not research has been done specifically to Okalongo women. The way in which women vulnerable to HIV and AIDS infection were explored by examined social and cultural identities that affect women’s sexual relations in negotiating sex and safe sex. Qualitative study on a sample of fifteen women was conducted in Okalongo. The purpose of this study was to investigate the conceptions and experiences of women in negotiating sex and safe sex with their husband and partners. Feminist theory guided the methodology and analysis of data. I assumed that gender roles andsexuality are socially constructed, shaped by religion, social, political, and economic influences and modified throughout life. Feminist theory assisted in documentary the ways in which the female’s gender and sexuality in Okalongo is shaped by cultural influences and by institutions that disadvantage female and other oppressed groups by silencing their voices. The feminist further guided the discussion of the contradicting messages about women’s sexuality and their experiences, as women complied, conformed and even colluded with their oppression. To address the issue under study, the primary analysis of data from the focus group discussion and individual interview were utilised. The following themes were the heart of analysis: Women Positionality, Normalisation and Compliance, Women Agency and Male Dominance Power, Women Perceptions of Risk, Sex Education in and out of school among Women.In this study the data suggested that women in Okalongo are more vulnerable to their lack of assertiveness, as they have difficult in developing an authoritative voice, they tend to be humble about their achievements and knowledge and to only assertively when concerned about others. The findings supported the literature that women’s vulnerability is strongly influenced and tied by broader forces present in the society. Women’s vulnerability is real and needs to be tackled for any progress to occur in the fight against AIDS. Until factors that constraints and enabling women agency to negotiate sex and safe sex acknowledged and addressed, women will continue to succumb to the HIV pandemic.

This study focussed on determining the knowledge and understanding of Angolan women pertaining to the causes and consequences of HIV/AIDS with the aim of developing an information leaflet about HIV/AIDS for disseminating information to the vulnerable community. A quantitative approach was applied using an exploratory and descriptive design, utilising a self-developed questionnaire to collect the data, from 100 females who accompanied sick children to a specific hospital in Luanda. The findings indicated that even though the respondents were aware of certain key issues in the transmission and consequences of the HIV infection, there were many areas in which a great measure of uncertainty existed such as the causes of the disease, prevention methods, risk factors and precautions to take when living with an HIV positive person. Recommendations were made in view of enhancing the distribution of information regarding the causes and consequences of HIV and AIDS by means of different structures. / HEALTH STUDIES / MA (HEALTH STUDIES)

AIDS-related bereavement counselling programmes / The aim of this study was to determine whether there is a need for specific bereavement counselling programmes for women affected by HIV/AIDS in Indonesia, where death is believed to be fated. Six AIDS-bereaved women were recruited. Data analysis was conducted based on the women's interview transcripts and journal entries. The women experienced at least three traumatic life events. The most challenging experience was learning that they have contracted a disease they knew to be mostly associated with prostitution. Given the short lapse of time between their husbands' deaths and learning about their seropositivity, biographical disruption appeared to have acted as an "analgesic", while concerns to protect their children seemed to have triggered biographical reinforcement. This phenomenon may have brought about a positive bereavement outcome. Specific counselling programmes for women affected by HIV/AIDS are needed, but emphasis should first be placed on improving their wellbeing and their perception of stigma. / Sociology / M.A. (Sociology (Social Behaviour Studies in HIV/AIDS))

HIV/Aids is a worldwide pandemic and as South Africans we are at the epicentre of this global health crisis. The harrowing statistics are useful as a means to quantify a horrific situation; however, what these facts do not do is provide connection amidst the uncertainty surrounding the disease. This research aims to bridge the disconnection and break the silence that weaves a net around the illness and those infected by it. This is done by deconstructing one man’s story of his journey with HIV; by looking at his personal epistemology; and by contextualising his story within his family and within the society in which he lives, South Africa. Finally, it is my reflections and interpretations that form the bridge between a construct of HIV/Aids and a life lived with the disease. / Psychology / M. A. (Clinical Psychology)

The study explored the psychosocial needs of Orphans and Vulnerable Children (OVCs) affected by HIV and AIDS in Gokomere, a rural area of Masvingo Province, Zimbabwe. The participants of the study included OVCs, caregivers and members of non-governmental organisations (NGOs) and faith-based organisations (FBOs). The data was gathered using semi-structured in-depth interviews and a focus group discussion. The audio-taped data was transcribed, coded and interpreted to generate themes, categories and sub-categories. The main psychosocial needs of OVCs affected by HIV and AIDS were found to be the need for relationships, succession planning, social protection and emotional and spiritual support. Kinship care emerged to be the most important form of care for OVCs while home-based care and child-headed households emerged as new forms of care for OVCs. This study recommends that coordinated efforts by the government, NGOs/FBOs/CBO and the community at large is needed to address the challenges facing OVCs affected by HIV and AIDS. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)

Text in English / INTRODUCTION: Late in HIV epidemic while HIV program is maturing studies in rich and resource limited setting have shown controversial results with regard to whether childbearing desire and intention are changed after the expansion of ART and PMTCT services. There are few studies in Ethiopia which tried to find out fertility preferences after the decentralized ART and PMTCT services. PURPOSE: The objective of the study is to determine the prevalence of fertility desire, intention and associated factors among HIV positive males and females at health facilities in Hawassa city with chronic HIV care. METHOD: The study used quantitative, observational, analytic and cross-sectional study design. It was structured on Trait-Desire-Intention-Behaviour theoretical frame work. A gender based stratification followed by random sampling method was applied. An interviewer-administered structured data collection approach using the pre-tested questionnaire was applied in the study. The Microsoft Office Excel 2007 and Epi-Info version 3.5.3 were utilized for data analysis. In addition to descriptive statistics, both bivariate and multivariable logistic regressions were used to analyse the data. RESULT: With a respondent rate of 93%, a total of 460 PLHIV participated in the study with equal number of males and females. The majority of the participants were from urban (85%), in relationship (70.9%), and on ART (80%). The reported fertility desire, 43.9% (45.2% in males; 42.6% in females), and fertility intention, 44.9% (46.4% in males; 43.4% in females), were high. The median number of intended children was 2. About 54% of PLHIV were using at least one of the contraceptives with 32.4% of unmet need of family planning. Participants with overall experinece of 2 births or less (AOR: 2.4 95% CI 1.32-4.32; p-value=0.0042), without birth experience after HIV diagnosis (AOR:0.52 95% CI 0.28-0.98; p-value=0.0424) and whose partner also desired for childbearing (AOR: 19.73 95%CI 10.81-35.99; p-value=0.0000) were more likely to intend for a/another child.They wished and planned to get birth because; they did not have a/children before or fear of childless stigma (25.3%), ART could help to have negative child (21.8%), importance of parenthood (17.8%) and the desire of once partner (16.8%). The study participants had consulted health care workers (34.2%), approached their partner or their partner had already approached them (27.6%), tried to get a partner or married (17.6%) and stop using family planning (6%) to get pregnant. CONCLUSION: This study highlights high fertility desire and intention in the background of high unmet need for family planning among PLHIV. A development of comprehensive male partner-involved couple counseling protocol, improving the communication HCWs have with PLHIV to emphasize safer conception methods and strengthening all the components of PMCT integrating with other SRH services at chronic HIV clinic are critical. / Health Studies / M.A. (Public Health)

Livelihood stressors in southern Africa, such as HIV/Aids and climate change, do not act in isolation but rather interact concurrently in complex socio-ecological systems with diverse, interrelated and compounded affects. Households experience differential vulnerability to such stressors based on contextual factors such as geographical location, income level and the gender and age of its members. Households’ differential experiences of vulnerability are further defined by the households’ use of their capital stocks: the human, social, natural, financial and physical capital available to the household to form livelihoods and resist the detrimental effects of a stressor. The capital stocks of 340 households were measured in two sites in the Eastern Cape, South Africa, using a household survey. These data were analysed to determine differences between the sites, households with heads of different gender and households of different income levels. Further data relating to the drivers and interactions of stressors over temporal and spatial scales, as well as the perceived value of various forms of capital by different social groups in the two sites, were collected via Participatory Learning and Action (PLA) methods including timelines, mental modelling and pair-wise ranking. Although the two sites have similar levels of income and fall within the same province, many significant differences emerged. The two sites showed different distributions of household head genders and different stressors and perceptions of vulnerability, perhaps owing to differences in their capital stocks, acting alongside the influence of culture and access on a shifting rural-urban continuum. These discrepancies further transpired to reflect crucial differential experiences along gender lines and income levels in each site. Vulnerability was often context specific, not only because of unique drivers of stress in different areas, but also because socio-economic groups and localities often had characteristics that could potentially exacerbate vulnerability, as well as characteristics that can potentially facilitate adaptive capacity. Stressors were found to have depleted multiple forms of capital over time, while new stressors were emerging, raising concerns over the most appropriate means of social protection within these contexts.

Climate change and the HIV/AIDS epidemic are two of the most critical long-term global challenges, especially for Africa and even more so Southern Africa. There is great concern that the poor will be unable to adapt to the impacts of climate variability and change while HIV/AIDS will exacerbate the impacts of such stressors and deepen the insecurities of many communities already affected by this disease. Studies that consider the interlinked effects of climate change and HIV/AIDS along with other multiple stressors are increasingly needed. This study, located in two rural communities in the Eastern Cape Province of South Africa, namely Lesseyton and Willowvale, assessed the responses of vulnerable households to the linked shocks and stressors of climate change and HIV/AIDS. This involved assessing, through household surveys, life history interviews and Participatory Learning and Action (PLA), the way in which multiple stressors interacted and affected vulnerable households, the way in which these households responded to and coped with such shocks and stressors, and the barriers which prevented them from coping and adapting effectively. Unemployment emerged as the dominant stress amongst households. The lack of development and having too few opportunities for employment has limited vulnerable households from being able to invest in assets, such as education or farming equipment. This, in combination with the impacts of increased food and water insecurity from recent drought, has created an extremely vulnerable environment for these households. They rely largely on two important safety-nets, namely social capital and the use of natural and cultivated resources; however the latter has been limited due to the impacts of water scarcity and an inability to farm. It was evident that there was little planned long-term adaptation amongst households and from government. Maladaptive short-term coping strategies, such numerous household members depending on one social grant and transactional sex, were too often relied upon, and although they may have helped relieve the stress of shocks momentarily, they did not provide for the long-term well-being of individuals and households. Poor communication and capacity between the different levels of government and between the government (especially at the local level) and the two rural communities has created an environment full of uncertainty and lacking in advocacy. Local government needs increased human, informational, and financial capacity and a clear delegation of responsibilities amongst the different departments in order for the two communities to benefit from the implementation of support strategies. There is also a great need for educational programmes and capacity development within the two rural communities, particularly based on improved coping and longer-term adaptation strategies in response to climate change in order for households to better prepare themselves for the future.

Indiana University-Purdue University Indianapolis (IUPUI) / Currently, 1.2 million people in the United States are living with HIV (Human Immunodeficiency Virus) infection, while one in eight are unaware of their infection status. The purpose of this study was to test the ability of the expanded ARRM to see if the model contributed something to the research of why people protect themselves from HIV. To add to the research regarding motivating factors of HIV protection, we decided to add two concepts to the ARRM; partner protection and relationship preservation. Findings of the study suggest HIV-positive partners are motivated to using condoms to protect their partners especially when they believe their partners are at risk for contracting HIV. Relationship preservation results illustrated that when people fear of losing their relationship they are willing to do whatever it takes to keep the relationship going, even at the cost of contracting HIV. By extending the ARRM, as well as incorporating HIV status, we now can begin understanding the many motivating factors towards why people are and are not using condoms to protect themselves or their partner.