Thesis (MPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Sexually Transmitted Diseases (STDs) constitute a serious health issue because they play a significant role in the transmission of HIV. STDs are associated with increased risk of either acquiring or transmitting HIV because of the breaks and inflammation they cause on the genital lining and the skin. Prevention or treatment of STDs can significantly lower the risk of HIV transmission. The purpose of this study is to identify the socio economic factors in Rustenburg that fuel STDs and which could lead to the transmission of HIV among youth of Rustenburg, and to make suggestions on actions that could be taken to mitigate the effects of STDs and HIV infection in the community. The method used in this study was a qualitative approach. An interview guide with eighteen open-ended questions for semi structured interviews was undertaken amongst Rustenburg youth aged 20 to 35 attending clinic for STDs in two health facilities (Job Shimankane Tabane Hospital and Classic House Clinic) in Rustenburg. The following socio-economic factors: alcohol use, poverty, concurrent multiple sexual partnership, and commercial sex work were found to be contributing to the spread of STDs and HIV in Rustenburg. / AFRIKAANSE OPSOMMING: Seksueel oordraagbare siektes (SOS) bly 'n ernstige openbare gesondheidskwessie as gevolg van die rol wat dit speel in die oordrag van MIV. SOS word geassosieer met 'n verhoogde risiko van beide die verkryging, of oordrag van MIV as gevolg van die breek en inflammasie wat dit veroorsaak op die voering van die geslagsorgane en die vel. Voorkoming of behandeling van seksueel oordraagbare siektes kan die risiko van oordraagbaarheid van MIV aansienlik verminder. Die doel van hierdie studie is om die sosio-ekonomiese faktore in Rustenburg te identifiseer wat seksueel oordraagbare siektes vererger wat kan lei tot die oordrag van MIV-infeksie onder die jeug van Rustenburg, en om voorstelle te maak oor stappe wat geneem kan word om die gevolge van seksueel oordraagbare siektes en MIV-infeksie te verminder in die gemeenskap. Die metode wat in hierdie studie gebruik is, was ‘n kwalitatiewe benadering. 'n Onderhoudgids met agtien ope vrae vir semi-gestruktureerde onderhoude, is onderneem onder die jeug van Rustenburg tussen die ouderdomme van 20-35 wat die kliniek vir seksuele oordraagbare siektes bywoon in twee gesondheidsfasiliteite in Rustenburg, naamlik (Job Shimankane Tabane-hospitaal en Classic House kliniek). Daar is gevind dat die volgende sosio-ekonomiese faktore naamlik die gebruik van alkohol, armoede, verskeie gelyktydige seksuele maats en kommersiële sekswerk, bydra tot die verspreiding van seksueel oordraagbare siektes en MIV in Rustenburg.

Thesis (MTech (Radiography))--Cape Peninsula University of Technology, 2006 / A prospective cohort study was done on Human Immunodeficiency Virus (HIV) infected and uninfected women attending Khayelitsha Midwifery Obstetric Unit (MOU) and Gugulethu MOU from June 2003 to December 2004, primarily to establish whether there is an association between HIV infection and Intra-uterine growth restriction (lUGR). B-Mode real time ultrasound imaging was used to monitor fetal growth from ±22 weeks to 36 weeks gestational age. Birth weight, gestational age at delivery, gender, placental weight, and maternal complications were also included. Maternal factors considered included age, weight parity, singleton versus multiple pregnancy, previous IUGR or preterm delivery, previous fetal abnormality, social habits viz. cigarette smoking, alcohol and drug use, and vascular disease viz. Diabetes, hypertension, renal disease, cardiac disease and collagen disease. A secondary objective was to establish whether the CD4 T-lymphocyte count possibly modulated the presence of IUGR. All HIV infected women were given antiretroviral therapy according to the standard Protocol of the Provincial Government of Western Cape (2002). The research questions were: • Does maternal HIV infection increase the risk of intrauterine growth restriction and associated preterm delivery? • Does the immune status of (CD4 T-lymphocyte count) of HIV infected pregnant women modulate fetal growth? The primary objective of this study was to establish whether there is an association between HIV infection and IUGR, and hence that HIV infection leads to an adverse perinatal outcome. Ultrasound was used as a diagnostic tool to establish normal or abnormal fetal growth patterns. Anecdotal reports from health workers in the obstetric field suggested that IUGR and preterm delivery may be associated with low birth weight infants in HIV infected pregnant women. However, preterm delivery is associated with various other factors including low socio-economic status (poor nutrition), cigarette smoking, drug and alcohol abuse, previous history of preterm delivery, over distention of the uterus (hydramnios, multiple gestation), premature rupture of membranes, cervical incompetence, vaginal infections (bacterial vaginosis) and maternal disease e.g. hypertension, heart disease (Lizzi, 1993: Symmonds, 1992; Odendaal et aI, 2002). HIV is now thought to be an added factor. Afier doing a systematic review and meta-analysis of 31 studies, Brocklehurst and French (1998) reported that there is an association (although not strong) between HIV infection and adverse perinatal outcome in developed countries; but in developing countries, there is an increased risk of infant death. By excluding or controlling for confounding variables that could affect fetal growth, this study aimed to determine whether there is a significant association between HIV and fetal growth by comparing fetal growth in HIV infected and uninfected women from midsecond trimester to the time of delivery. A secondary objective was to establish whether there is an association between the immune status (CD4 T-lymphocyte count) of the mother and IUGR. The immune status of the mother is probably one of the most important factors affecting the fetus and perinatal outcome. As the mother's viral load increases, her immune system is increasingly compromised, resulting in the occurrence of HIV-related diseases, and a concurrent increase in fetal complications. In this study a CD4 T-lymphocyte count was used to assess the level of immunodeficiency of all the HIV infected participants. Ideally the test should have been done each time the participant was scanned so that the CD4 T-lymphoc)1e count could be monitored simultaneously with the fetal growth parameters, however due to financial constraints and ethical considerations, one test was done on each HIV infected women. This study was based at two MOU's where different antiretroviral therapy (ARVT) regimens were used. The one MOU offered Zidovudine (ZDV) to mothers from 34 weeks gestation to the onset of labour, and the other MOU offered Nevirapine (NVP) as a single dose to the mother at the onset of labour and to the neonate within 72 hours of birth (Provincial Government Western Cape, 2002). This presented an opportunity to compare two groups of HIV infected women on different regimes. The intention was to establish whether ZDV had an adverse effect on fetal growth and resulted in low birth weight. However, 6 months after the study started a revised Prevention of Mother to Child Transmission (PMTCT) Protocol was implemented where women at both MOU's received the same ARVT i.e. ZDV and NVP. This objective was therefore abandoned due to a change in the PMTCT Protocol in the Western Cape. The study was based at two Midwife Obstetric Units (MOU) in the Western Cape where the prevalence of HIV in pregnant women is relatively high i.e. 20 - 24 % (Mother-to-child transmission Monitoring Team, 2001), viz. Gugulethu MOU and Khayelitsha MOU. A prospective cohort study was done with the intention of recruiting a sample of 400 pregnant women, 200 HIV infected and 200 uninfected. The actual sample size was 415. The study group was 194 HIV infected women and the control group was 221 uninfected women. Confounding variables such as cigarette smoking, alcohol and drug abuse. multiple gestation. grand multipara pregnancy, history of IUGR or preterm delivery. fetal abnormality detected at the time of the first scan in the current pregnancy, and maternal vascular disease - were excluded. Confounding variables such as maternal age, maternal weight and gestational age were controlled. Ultrasound imaging was used as a diagnostic tool to establish normal and abnormal fetal growth patterns. A B-mode real time ultrasound unit was used to confirm the gestation age and rule out any obvious fetal abnormalities at 20-24 weeks gestation. Fetal growth scans were done at 28 weeks, 32 weeks and 36 weeks gestation to compare fetal growth patterns in the study and control groups. Fetal biometry used to monitor fetal growth included biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and estimated fetal weight (EFW). Amniotic fluid index (AFI), placental thickness & placental grading were also included. The following variables were analyzed post delivery: • Gestation age at delivery: Normal term delivery is considered to be at 37 - 42 weeks and premature delivery is considered to be less than 37 weeks gestation. The HIV infected and uninfected groups were compared to assess if there \vas a significant difference in the number of preterm deliveries. • Birth weight: The HIV infected and uninfected groups were compared to assess if there was a significant difference in the number of infants with low birth weight. • Perinatal complications: The HIV infected and uninfected groups were compared to assess if there was a significant difference in the number of perinatal complications and to assess if there was an association between the immune status (CD4 T-lymphocyte count) of HIV infected women and perinatal complications. Appropriate ethical principles in medical research were applied. The participant's autonomy, rights and best interests were always considered a priority. Informed consent was obtained from all the participants. Strict confidentiality was adhered to regarding any data collected throughout the study. The Research Ethics Committees at Cape Peninsula University of Technology and University of Cape Town granted ethics approval for the study. Statistical analysis was performed using the statistical package SPSS 12.0.

Due to its rapid spreading, AIDS has been declared a global epidemic. Especially sub-Saharan Africa has been the most affected by the epidemic. South Africa is no exception to the devastating impact of the epidemic. Over the past few years, HIV-prevention initiatives have been underway on a full scale in an effort to combat the destructive powers of the epidemic in the country. These initiatives appear to have adopted a health-belief approach in their strategies to decrease HIV-infections. This approach to HIV-prevention assumes that the desired behavior change, namely increasing safe sexual practices and decreasing high-risk HIV/AIDS behavior, can be achieved through rational decision-making based on knowledge of the disease and its consequences. The findings of the studies on sexual behavior and HIV/AIDS such as KAPB (knowledge, attitudes, practice and beliefs) studies appear to reaffirm the fact that knowledge alone is neither sufficient nor effective in bringing about the appropriate behavior change to combat HIV/AIDS. These studies point towards a high level of knowledge about AIDS in the general population, yet the ever increasing infection rate remains undeterred. The ANC came to power in 1994 after 10 years of National Party inaction with regard to AIDS. The National AIDS plan, endorsed by incoming minister Dr Nkosazana Dlamini-Zuma, was insufficiently informed by the institutional and social realities of South Africa. Like other policy blueprints of this period, it over-estimated the economic, and especially human, resources at the disposal of incoming government. Moreover, this avowedly multi-sect oral HIV/AIDS plan, designated a “presidential lead project”, was situated in a national department of health in the throes of transformation. Because health is in part a provincial prerogative, AIDS was vulnerable to further administrative obstruction in a second tier of bureaucracy from the previous regime. Competing claims on resources in the poorer provinces, the demands of administrative reconfiguration, and very uneven provincial capacity, further undermined implementations.

The world has entered the third decade of the HIV and AIDS epidemic under different times in which the epidemic is treatable. The International Labour Organisation (ILO) (2005) declares HIV and AIDS a developmental crisis destroying developmental gains over generations. Since HIV and AIDS affect the most productive segment of the labour force, it is therefore not only a threat to development but also to the world of work without which development will be sacrificed (ILO, 2001). Collaborative response efforts that seek to mitigate the HIV pandemic by government, business and higher education institutions have been fraught with challenges. The main challenge that beset these efforts is that, in the absence of an HIV vaccine, voluntary counselling and testing remains the gateway to access treatment and care. Regrettably, participation in VCT has been confronted by challenges of low utilisation. This precedes the objectives of this study, which were to explore and describe factors that serve as barriers and facilitators of workplace VCT programmes with the objective to improve participation in these programmes. The current study was a product of a qualitative and exploratory-descriptive research design. A nonprobability convenience sampling method was used to sample participants for this study. The targeted population in this study were the non-academic employees of an academic institution in the Eastern Cape. Data was collected by means of focus group discussions and by using semi-structured interviews. The focus group samples comprised of an equal number of men and women with an overall participation of fifty-six participants. Data obtained was transcribed, thematically analysed and coded using Henning, Van Rensburg, and Smit's (2004) qualitative analysis and interpretation method. Findings of this research revealed that factors that facilitate and inhibit voluntary counselling and testing are psychosocial and cultural by nature. At psychosocial level, participants reported factors that facilitate voluntary counselling and testing to include psychological readiness to go for HIV testing, reassurances of confidentiality of HIV test results and normalising HIV testing (making the process more like that for screening and diagnostic testing). Cultural factors included cultural practices and beliefs such as "intonjane" and traditional circumcision - positive cultural nurturers that could facilitate VCT participation. Results of this study showed a lack of basic knowledge about VCT and fear of knowing one's status, fear of breach of confidentiality, fear of being stigmatised and a lack of trust towards health professional as the major psychosocial factors that serve as barriers to VCT participation. The cultural barriers to VCT pointed to hegemonic masculinity as a socially constructed gender identity that encourages gender inequalities and undermines efforts to improve HIV testing. The study suggested that strategies to increase VCT participation should consider leadership support of VCT programmes, incentivisation of VCT programmes, institutionalisation of HIV and AIDS education and the establishment of integrated wellness services for employees.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2016. / IntroductionMale circumcision refers to the surgical removal of all or parts of the prepuce of the penis. This procedure is undertaken for religious, cultural, social, hygiene or medical reasons (Maibvise and Mavundla 2013: 139). The number of people living with Human Immunodeficiency Virus (HIV) rose from approximately 8 million in the year 1990 to 33 million infections now. Sub-Saharan Africa is the region in the world most affected by HIV/AIDS with 22.4 million people living with the virus in the year ending 2008 (Naidoo et al. 2012: 2). The use of male and female condoms remains a challenge despite decades of promotion. There is evidence that medical male circumcision (MMC) is effective in preventing HIV sexual transmission. Medical male circumcision is a drive that was initiated by the National Department of Health as a strategy to curb HIV infection in South Africa in 2010. Aim of the Study The purpose of the study was to investigate and describe knowledge, attitudes and perceptions of males with regard to medical male circumcision. Methodology A quantitative descriptive survey research method was used to describe the knowledge, attitudes and perceptions of males attending the community health care centers (CHCs) in eThekwini district regarding medical male circumcision. Results Displayed posters motivated 71.4% (n = 329) to have circumcisions. While 65.1% (n = 300) respondents had knowledge about circumcision and HIV, 27.8% (n = 280) perceived that circumcision would interfere with their sexual function and reproduction. A total of 38.8% (n = 179) of respondents indicated that it is good for children to be circumcised. There is a significant positive correlation between age and knowledge (r = 0.135, p = .004). Higher age is correlated with more knowledge. Conclusion This study found that knowledge plays a major role in changing attitudes and perceptions. The more knowledgeable an individual is, the more the chance is of them having a positive attitude towards MMC which could also influence a positive perception of MMC. In order to strengthen male circumcision as an HIV prevention strategy, it is imperative to provide the population that reflected low knowledge and negative attitude with information, education and counselling services. This may help them to change their attitudes and acquire a positive perception of MMC. / M

The study seeks to explore and identify factors that prevent AIDS orphans in presenting themselves for Voluntary Counselling and Testing (VCT). Socio-cultural factors, notably, stigma and the resultant discrimination by community members, have been presented by many researchers as the main aetiological factors that hinder the use of VCT by AIDS orphans. It is on the basis of this that this study was conducted to identify factors that hinder AIDS orphans from accessing VCT. The study used a qualitative approach following an explorative and descriptive, contextual research design and was conducted at Ubuntu Education Fund, Port Elizabeth. Purposive sampling was used to determine a sample of AIDS orphans. Participants of the study had to be orphaned as a result of AIDS, isiXhosa-speaking, between 12-17 years, living in the care of a primary care-giver and had not presented themselves for VCT. Data was collected by means of semi-structured interviews. Semi-structured interviews are suitable in cases where the researcher is interested in an issue that is complex or personal (De Vos, Strydom, Fouche and Deloport, 2005). Data was analyzed according to the framework provided by Tesch (1990) as described in Creswell (2003). The major findings of this study were that people are locked in a ‘poverty-of-the mind cycle’, in respect of HIV and AIDS, and this is exacerbated by educational impoverishment and general poverty. The recommendations that emanated from this study are made from policy and service delivery perspectives. It is recommended that in order for AIDS orphans to access VCT they should be developed and empowered through sustainable programmes that enhance their capacities to the outmost realization of their potential. It is also recommended that health and other professionals should encourage AIDS orphans and community members to present themselves for VCT and thus curb the spread of HIV and AIDS.

The socio-economic impact of HIV/AIDS on South Africa has resulted in lower gross domestic product, loss of skills in key sectors such as education, and increased health-care costs in providing access to treatment. Currently active pharmaceutical ingredients (API’s) such as stavudine (d4T) and azidothymidine (AZT) are imported from India and China, while formulation is conducted locally. A strategy was initiated between CSIR Biosciences and LIFElab under the auspices of Arvir Technologies to investigate the feasibility of local antiretroviral manufacture (d4T and AZT) or the manufacture of a key intermediate such as β- thymidine (dT). Several advantages associated with successful implementation of this strategy include ensuring a local supply of API’s, thus reducing reliance on procurement from foreign sources and reducing the effect of foreign exchange rate fluctuations on providing cost effective access to treatment. A local supply source would also reduce the imports and thus aid the balance of payments deficit, and in addition to this, provide stimulus in the local pharmaceutical manufacturing industry (which has been in decline for several decades), resulting in increased skills and employment opportunities. This thesis describes the development of a superior chemo-enzymatic process for the production of β-thymidine (72 percent yield, prior to isolation), a key intermediate in the preparation of anti-retrovirals. Alternative processes based purely on chemical or bioprocess transformations to prepare either 5-methyluridine (5-MU) or dT suffer from several disadvantages: lengthy transformations due to protection/deprotection strategies, low selectivties and product yields (30 percent in the chemical process) and isolation of the product from dilute process streams requiring the use of large uneconomical reactors (bioprocesss). This contributes significantly to the cost of d4T and AZT manufacture. Our novel chemoenzymatic process comprises of a biocatalytic reaction for the production of 5-MU, with subsequent chemical transformation into dT (3 steps) negating and circumventing the limitations of the chemical or bioprocess routes. During the course of this project development, the β-thymidine selling price declined from 175 $/kg (2005) to 100 $/kg (2008). However, the process described in this work is still competitive based on the current β- thymidine selling price of 100 $/kg. The process economics show that with further optimization and increasing the isolated dT yield from 70 percent to 90 percent, the variable cost decreases from 136 $/kg to 110 $/kg. The increase in isolated yield is highly probable, based on solubility data of β-thymidine. The decrease in β-thymidine selling price and technological improvement in dT manufacture should translate into lower API manufacture costs and more cost effective access to treatment. Our novel biocatalytic process producing 5-MU uses a coupled enzyme system employing PNP, Purine Nucleoside Phosphorylase and PyNP, Pyrimidine Nucleoside Phosphorylase. The overall transglycosylation reaction may be decoupled into the phosphorolysis reaction (PNP) and synthesis reaction (PyNP). During the phosphorolysis reaction, guanosine is converted into guanine and ribose-1-phosphate (R-1-P) in the presence of PNP enzyme. The reaction intermediate R-1-P is then coupled to thymine in the presence of PyNP enzyme during the synthesis reaction, producing 5-MU. The process was scaled up from lab-scale to bench-scale (10 - 20 L) and demonstrated to be robust and reproducible. This is evident from the average guanosine conversion (94.7 percent ± 2.03) and 5-MU yield (88.2 percent ± 6.21) and mole balance (104 percent ± 7.61) which were obtained at bench-scale (3 replicates, 10 L). The reaction was carried out at reactor productivities of between 7 – 11 g.L-1.h-1. The integration of the biocatalytic process and chemical processes was successfully carried out, showing that 5-MU produced using our novel biocatalytic process behaved similarly to commercially available 5- MU (ex. Dayang Chemicals, China). A PCT patent application (Ref. No. P44422PC01) on this chemo-enzymatic process has been filed and currently public private partnerships are being explored through Arvir Technologies to evaluate and validate this technology at one ton scale.

Dissertation (DPhil)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: The aim of this study was to develop a HIV intervention programme tailored for South African adolescents with visual impairments. A further aim was to pilot and evaluate this tailored programme. This investigation was deemed necessary in the light of the growing HIV pandemic in South Africa, which has proliferated over the last 10 years. Adolescents and young adults are among the most vulnerable to HIV infection, and this does not exclude adolescents with visual impairments. Despite the perceptions among sighted people of asexuality in adolescents with visual impairments, they are a vulnerable group for HIV infection. The motivation for this study is the fact that very little literature is available on HIV/AIDS and people with visual impairments, and that this vulnerable group is marginalized in HIV/AIDS campaigns internationally. As far as we could ascertain, there have been three HIV prevention initiatives for people with visual impairments in South Africa, none of which was fully researched and evaluated, and all of which used existing generic interventions but transcribed into Braille and large print format. The reality is, many adolescents with visual impairments, as is the case with sighted youths, are sexually active, and the absence of research on HIV prevalence and HIV prevention needs in this sector, is conspicuous. An urgent need exists to tailor HIV preventative programmes for this vulnerable sector. The dearth of research on HIV/AIDS and people with visual impairments motivated the choice of a key informant study to investigate the effects that HIV/AIDS and other concomitant issues have on persons with visual impairments, prior to the design of any intervention. A purposive sample of key informants who are working among people with visual impairments on a daily basis, most of whom had visual impairments themselves, was selected. Information gathered from the key informant study was combined with the lessons from a review of available literature on health promotion programmes and HIV prevention programmes in particular to develop an HIV/AIDS intervention programme to be piloted and evaluated for its effectiveness. The design of the programme took account, in addition, of broader contextual issues such as power and gender issues, and the marginalization and stigmatization of disabled people. The theoretical framework which forms the basis of the programme was informed by elements of a number of cognitive theories in the health promotion field, and especially the Informational-Motivational-Behavioural model (IMF). The programme was designed to empower participants and to create an environment of reallife experiences in which they could acquire important negotiation skills, decision-making skills, and practical skills to use condoms and HIV/AIDS knowledge to facilitate attitude and behaviour change. The next objective of this research was to implement the intervention programme of eight sessions designed for adolescents with visual impairments and to investigate the outcome on participants in this study. For this purpose an experimental design, one experimental group and three control groups (n= 56), not randomly assigned, was used to test the effect of the programme on participants in the intervention group compared to the control groups, who received a health promotion programme of four sessions. All participants were learners at the only two schools for learners with visual impairments in the Western Cape Province of South Africa, and they were allocated into treatment or control conditions on the basis of the school grades in which they were already placed. The empirical investigation utilized a questionnaire that was developed and transcribed into Braille as well as large print. Following a small pilot study, the questionnaire was finalized and administered to all four groups (pre-test, to determine baseline differences; post-test, to determine the immediate effect of the programme; and follow-up [3 months later] to determine longer term effectiveness). An analysis was done to assess the internal consistency of the measuring constructs of the questionnaire, and satisfactory internal consistency was found, with Cronbach’s alpha scores ranging between 0.72 and 0.92. Quantitative data were analyzing using multivariate techniques, beginning with a repeated measures MANOVA analysis and, once an overall significant F ratio between variables, time and groups (F=2.009, p<0.05); a significant F ratio between groups and variables (F=4.211, p<0.01), and significant F ratio between time and groups (F=2.611, p<0.01), had been found, we continued with more focused analyses. Baseline results revealed no statistical differences between the four groups. There were statistically significant improvements in knowledge of HIV/AIDS for both the experimental group and two of the control group, but these differences were not maintained at follow up. Significant differences in attitudes towards HIV/AIDS were found for the experimental group and for one of the control groups. Though there were significant changes in both knowledge and attitudes, therefore, it cannot be claimed that the intervention itself was responsible for knowledge and attitudinal change. There was some evidence for diffusion of innovation in terms of HIV knowledge from the experimental group and the control group situated at the same school. Changes in reported HIV risk behaviour were not recorded to a significant degree, a fact which may have been attributable in part to small sample size. Qualitative process information was used to get a sense of the experiences of participants and the concomitant issues they discussed during the intervention. The qualitative data revealed a host of contextual factors relevant to issues of HIV/AIDS and sexuality in this group, including experiences of stigmatization as people with visual impairment, negotiating masculinity in the context of visual impairment, gender oppression of women and resistance to this, and a general atmosphere of myths and silences around HIV/AIDS in particular and sexuality in general. Despite the limited impact of the programme, this pilot study revealed important issues for adolescents with visual impairments regarding HIV prevention which require further investigation. Participants in the experimental group indicated that they learned a lot from this programme and suggested that it be given to younger adolescents to enable them to acquire these vital skills prior to active sexual engagement and the involvement in any form of unprotected sex. A number or recommendations are made for further well-documented and evaluated research in this field. / AFRIKAANSE OPSOMMING: Die doel van die studie was om ’n MIV-intervensieprogram te ontwikkel wat op Suid- Afrikaanse adolessente met gesigsgestremdhede gemik is. ’n Verdere doel was om ’n proeflopie van die pasgemaakte program te doen en dit te evalueer. Hierdie ondersoek is nodig geag in die lig van die groeiende MIV-pandemie in Suid-Afrika, wat oor die afgelope tien jaar vinnig versprei het. Adolessente en jong volwassenes tel onder die kwesbaarstes vir MIV-infeksie, en dit sluit nie adolessente met gesigsgestremdhede uit nie. Ongeag die persepsies omtrent aseksualiteit in adolessente met gesigsgestremdhede onder diegene wat nie gesigsgestremd is nie, is eersgenoemde ’n kwesbare groep vir MIV-infeksie. Die motivering vir hierdie studie is die feit dat baie min literatuur vir mense met gesigsgestremdhede beskikbaar is, en dat hierdie kwesbare groep wêreldwyd in MIV/VIGSveldtogte gemarginaliseerd is. Sover ons kon vasstel, was daar drie MIV-voorkomingsinisiatiewe vir mense met gesigsgestremdhede in Suid-Afrika, waarvan nie een ten volle nagevors en geëvalueer is nie, en wat almal bestaande generiese intervensies gebruik het wat in Braille en grootdruk-formaat omgesit is. Die werklikheid is dat baie adolessente met gesigsgestremdhede – nes die geval is met jeugdiges sonder gesigsgestremdhede – seksueel aktief is en dat die afwesigheid van navorsing oor MIV-voorkoms en MIVvoorkomingsbehoeftes in hierdie sektor opvallend is. Daar is ’n dringende behoefte aan pasgemaakte MIV-voorkomende programme vir hierdie kwesbare sektor. Die gebrek aan navorsing oor MIV/vigs en mense met gesigsgestremdhede het die keuse van ’n sleutelinformantstudie gemotiveer om die invloed wat MIV/vigs en ander gepaardgaande kwessies op mense met gesigsgestremdhede het, voor die ontwikkeling van enige intervensie te ondersoek. ’n Doelgerigte steekproef van sleutelinformante wat op ’n daaglikse grondslag onder mense met gesigsgestremdhede werk, waarvan die meeste self gesigsgestremd is, is gekies. Inligting wat van die sleutelinformantstudie verkry is, is gekombineer met die lesse uit ’n oorsig van die bestaande literatuur oor gesondheidsbevorderingsprogramme – in die besonder MIV-voorkomingsprogramme – om ’n MIV/vigs-intervensieprogram te ontwikkel wat as loodsprojek kon dien en wat vir doeltreffendheid geëvalueer kon word. Die ontwerp van die projek het, daarbenewens, ag geslaan op breër kontekstuele kwessies soos mags- en genderkwessies en die marginalisering en stigmatisering van mense met getremdhede. Die teoretiese raamwerk wat die grondslag vir die program vorm, is op elemente van ’n aantal kognitiewe teorieë op die gebied van gesondheidsbevordering, en spesifiek die inligtingmotivering- gedragsmodel geskoei. Die program is ontwerp om deelnemers te bemagtig en om ’n omgewing van lewenservaringe te skep waarbinne hulle belangrike onderhandelings-, besluitnemings- en praktiese vaardighede kon ontwikkel om kondoomgebruik te bevorder, asook kennis omtrent MIV/vigs om houdings- en gedragsverandering te fasiliteer. Die volgende doelwit van hierdie navorsing was om die intervensieprogram van agt sessies wat vir adolessente met gesigsgestremdhede ontwerp is, te implementeer en om die resultate ten opsigte van die deelnemers aan die studie te ondersoek. Met hierdie doel voor oë is ’n eksperimentele ontwerp – een eksperimentele groep en drie kontrolegroepe (n=56), wat nie ewekansig toegewys is nie – gebruik om die invloed van die program op deelnemers in die intervensiegroep te toets teenoor dié op die kontrolegroepe, wat aan ’n gesondheidsbevorderings-program van vier sessies deelgeneem het. Alle deelnemers was leerders by die enigste twee skole vir leerders met gesigsgestremdhede in die Wes-Kaap, Suid-Afrika. Hulle is op grond van die skoolgraad waarin hulle reeds geplaas is, aan behandelings- of kontroletoestande toegewys. Die empiriese ondersoek het ’n ontwikkelde vraelys gebruik wat sowel in Braille getranskribeer is as in grootdruk gedruk is. Ná afloop van ’n klein loodsstudie is die vraelys gefinaliseer en aan al vier groepe toegedien (voortoets, om die basisverskille vas te stel; na-toets, om die onmiddellike invloed van die program vas te stel; en opvolg [3 maande later] om doeltreffendheid op langer termyn vas te stel). ’n Ontleding is gedoen om die interne konsekwentheid van die meetkonstrukte van die vraelys te assesseer: voldoende interne konsekwentheid is gevind, met Cronbach se alfapunte wat tussen 0.72 en 0.92 gewissel het. Kwantitatiewe data is met behulp van meervariaattegnieke ontleed. Eers is ’n herhaaldemeting- MANOVA-ontleding gedoen en daarna – nadat ’n algeheel beduidende F verhouding tussen veranderlikes, tyd en groepe (F=2.009, p<0.05); ’n beduidende Fverhouding tussen groepe en veranderlikes (F=4.211, p<0.01) en ’n beduidende F-verhouding tussen tyd en groepe (F=2.611, p<0.01) gevind is – is dit deur meer gefokusde ontledings gevolg. Basislynuitslae het geen statistiese verskille tussen die vier groepe getoon nie. Daar was statisties beduidende verbeteringe in kennis oor MIV/vigs in sowel die eksperimentele groep as die twee kontrolegroepe, maar hierdie verskille is nie met die opvolgtoets volgehou nie. Beduidende verskille in houding jeens MIV/vigs is by die eksperimentele groep en een van die kontrolegroepe gevind. Hoewel daar beduidende veranderinge in sowel kennis as houdings gevind is, kan daar nie beweer word dat die intervensie self vir die kennis- en houdingsveranderinge verantwoordelik was nie. Daar was ’n mate van bewys vir diffusie van innovering wat betref kennis oor MIV van die eksperimentele groep en die kontrolegroep by dieselfde skool. Veranderinge in aangemelde MIV-risikogedrag is nie in ’n beduidende mate aangeteken nie, ’n feit wat gedeeltelik aan die beperkte grootte van die steekproef te wyte kan wees. Inligting uit ’n kwalitatiewe proses is gebruik om ’n indruk te skep van die ervaringe van deelnemers en gepaardgaande kwessies wat hulle tydens die intervensie bespreek het. Die kwalitatiewe data het ’n reeks kontekstuele faktore blootgelê wat vir kwessies van MIV/vigs en seksualiteit in hierdie groep tersaaklik is, met inbegrip van ervaringe van stigmatisering as mense met gesigsgestremdhede, die hantering van manlikheid binne die konteks van gesigsgestremdheid, genderonderdrukking van vroue en weerstand hierteen, asook ’n algemene atmosfeer van mites en stilswye oor MIV/vigs in die besonder en seksualiteit in die algemeen. Ten spyte van die beperkte impak van die program het hierdie loodsstudie belangrike kwessies vir adolessente met gesigsgestremdhede betreffende MIV-voorkoming blootgelê wat verdere ondersoek noodsaak. Deelnemers in die eksperimentele groep het aangedui dat hulle baie uit hierdie program geleer het en het voorgestel dat dit aan jonger adolessente aangebied word om hulle in staat te stel om hierdie noodsaaklike vaardighede te ontwikkel voordat aktiewe seksuele betrokkenheid en betrokkenheid by enige vorm van onbeskermde seks plaasvind. ’n Aantal aanbevelings vir verdere goed gedokumenteerde en geëvalueerde navorsing op hierdie gebied word gemaak.

Submitted in fulfillment of the requirements of the degree of Masters in Public Management, Durban University of Technology, Durban, South Africa, 2016. / South Africa is facing a universe challenge in managing HIV/AIDS epidemic as it is the worst affected country in the world with the largest number of people affected and infected with HIV/AIDS. While significant numbers of stakeholders have come on board to help the South African government fight the disease, the setting up of effective and efficient Monitoring and Evaluation (M&E) systems has been a challenge. The study focussed on Monitoring and Evaluation (M&E) systems of Non-Governmental Organisations (NGOs) managing HIV/AIDS in the uMngeni Local Municipality. NGOs normally operate using resources from funders who in turn requires robust accountability of their fund utilisation. Robust accountability can only be achieved by reporting with the aid of an effective and efficient M&E system. The aim of the study was to evaluate the current M&E systems of NGOs implementing HIV/AIDS programs in the uMngeni Local Municipality; investigate the reporting mechanism of NGOs implementing HIV/AIDS programmes; identify monitoring and evaluation challenges faced by NGOs implementing HIV/AIDS programmes in the uMngeni Local Municipality, KwaZulu Natal; and to make recommendations for the improvement of M&E implemented by NGOs. A questionnaire was distributed to senior managers at NGO’s in the uMngeni Local Municipality, KwaZulu Natal, South Africa. The data collected were analysed with SPSS version 22.0.The results were presented in the form of graphs and cross tabulations, with other figures being used for data collected from open ended questions. The study revealed that NGOs managing HIV/AIDS in the uMngeni Local Municipality face a number of challenges including a lack of statistical skills; a shortage of qualified staff; a lack of M&E knowledge; a dearth of M&E systems within organisations; inadequate resources; a lack of commitment by staff members; poor stakeholder involvement; poor quality data; and a lack of appropriate M&E tools. The results of the study also revealed that NGOs managing HIV/AIDS programmes in the uMngeni Local Municipality were not referring to best practices when managing M&E systems for their programmes. Recommendations were drafted using the findings of the research, literature reviewed and best practices for monitoring and evaluating HIV/AIDS programmes. It is highly recommended that through more effective capacity building, NGOs managing HIV/AIDS programmes in the uMngeni Local Municipality will be able to improve existing M&E systems. Designing of the M&E plan along with stakeholder involvement is also crucial in managing HIV/AIDS M&E systems. The allocation of adequate resources for M&E activities should be prioritised for approximately ten percent of the total programme budget. Indicators should be carefully selected and aligned to collect relevant data. NGOs managing HIV/AIDS in the uMngeni Local Municipality could also monitor and evaluate programme activities on a regular basis. They should also have a standard of operation procedure (SOP) for data quality management. Emphasis on programme data quality could also be an action point for effective management of HIV/AIDS M&E system and this can be further strengthened by conducting data quality audits. Finally, NGOs managing HIV/AIDS programmes in the uMngeni Local Municipality should disseminate M&E findings to stakeholders and use data to make informed programme decisions. / M

Thesis (MTh)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Conventional HIV intervention strategies are based on the presupposition that scientific knowledge and appropriate information about HIV will curb the spread of the disease. The dominant approaches to the HIV debate and pandemic focus mostly on the medical, pedagogical and ethical dimensions of the pandemic. Governments are concerned with democratic and human rights and the juridical implications of HIV. This study proposes that a team approach should be followed, with the emphasis on a holistic model of prevention care. In this regard it is hypothesised that the spiritual dimension, emphasising our human quest for meaning, moral decision-making and virtues as related to the transcendent dimension of our being human, should play a substantial role. One of the most burning issues in the pandemic is the phenomenon of stigmatisation. This investigation is in search of an approach that can effectively penetrate the realm of prejudice, blaming, and discrimination. If spirituality can address stigmatisation, antistigma interventions must acknowledge the role of pastoral care with its emphasis on ‘soul care’, values and meaning. The study explores the possibility of extending the traditional understanding of theology as fides quarens intellectum, with its emphasis on knowledge (the rational), to fides quares imaginem, with its emphasis on imagination (the aesthetic dimension of life). Therefore the important presupposition that, due to the aesthetic dimension of faith, care to people living with HIV should include the aesthetic dimension. If one links fides quares imaginem to fides quarens visum new options can be created for Practical Theology. In this regard, the visual dimension of life as represented by media, and specifically film, should be investigated in a HIV prevention strategy. The study thus proposes that a specific form of art, namely film, has potential as an effective antistigma intervention. It is hypothesised that film inherently has a spiritual dimension. This spiritual dimension could be linked to issues that can determine the direction and meaning of life, as well as the understanding of human identity and dignity. In this regard the study wants to determine to what extent film can play a fundamental role in addressing the realm of attitudes, convictions and belief systems. Film is thus suggested as a medium for spiritual intervention in order to bring about change on the level of perceptions. Lesser-educated people are very vulnerable, especially in relation to HIV. The study wants to explore whether film can be an effective medium of addressing, educating and influencing such people at their level. In order to test this, an empirical study was done to assess the effect that film has on HIV stigmatisation within such a group of people. The aim of the empirical research was not to create statistical evidence, but to illustrate certain trends and tendencies. A group of people from Vlaeberg, a rural area outside of Stellenbosch, South Africa, was chosen for the study. In order to empirically explore the potential of film in addressing HIV stigmatisation it was decided to use the film Yesterday, the first South African film to be nominated for an Oscar. The film was chosen for the following reasons: a) it is set within South Africa, depicting vulnerable persons within a rural setting; b) it has a positive, though realistic approach to HIV; c) it depicts the cruelty of stigmatisation; d) it shows how you can assist those with HIV; and e) it is easily understandable. The film was positively received and able to influence the stigmatising perceptions, attitudes and convictions of the target group. The empirical study proved that film has a spiritual dimension and should be used as a medium for spirituality formation. Due to this, it has an important role to play in antistigma interventions. In this regard, the research showed that film can indeed play a decisive role in a HIV prevention strategy and an antistigma intervention. / AFRIKAANSE OPSOMMING: Konvensionele MIV-ingrypingstrategieë word gebaseer op die aanname dat wetenskaplike kennis en geskikte inligting aangaande MIV die verspreiding van die virus sal kan halt. Die dominante benaderings tot die MIV-debat en –pandemie fokus meesal op die mediese, pedagogiese en etiese dimensies van die pandemie. Regerings is bemoeid met die demokratiese regte, menseregte en wetlike implikasies van MIV. Hierdie studie stel voor dat ’n spanbenadering gevolg moet word, waarbinne die fokus sal wees op ’n holistiese model van voorkomende sorg. Die hipotese is dat die spiritualiteits-dimensie ’n substansiële rol moet speel, aangesien dit ons menslike strewe na betekenis, morele besluitneming en waardes, soos dit in verhouding staan tot die transendente dimensie van ons menswees, in ag neem. Een van die kwellende vraagstukke van die pandemie is stigmatisasie. Hierdie navorsing soek ’n benadering wat effektief die gebied van vooroordele, beskuldiging, en diskriminasie kan penetreer. Indien spiritualiteit stigmatisasie kan aanspreek, moet antistigma-ingrypings die rol van pastorale sorg, wat klem lê op ‘sielesorg’, waardes en betekenis, erken. Die studie ondersoek die moontlikheid dat die tradisionele verstaan van teologie as fides quarens intellectum, met die klem op kennis (die rasionele), uitgebrei moet word na fides quares imaginem, met die klem op die verbeelding (die estetiese dimensie van die lewe). Daarom word die belangrike aanname gemaak dat, as gevolg van die estetiese dimensie van geloof, sorg vir dié met MIV die estetiese dimensie moet insluit. As ’n mens fides quares imaginem skakel met fides quarens visum word nuwe moontlikhede ontsluit vir Praktiese Teologie. In hierdie opsig moet die visuele dimensie van die lewe, soos dit uitgebeeld word deur die media en meer spesifiek film, ondersoek word in ’n MIV-voorkomingstrategie. Die studie stel voor dat ’n spesifieke vorm van kuns, naamlik film, potensiaal het as ’n effektiewe antistigma-ingryping. Daarom die hipotese dat film inherent ’n spirituele dimensie het. Hierdie spirituele dimensie kan geskakel word met kwessies wat die rigting en betekenis van lewe kan bepaal, sowel as ons verstaan van menslike identiteit en waardigheid. Gevolglik wil hierdie studie bepaal tot watter mate film ’n fundamentele rol kan speel in die aanspreking van houdings en oortuigings. Film word dus voorgestel as ’n medium vir spirituele ingryping om sodoende verandering te bring op die vlak van persepsies. Mense met minder opvoeding is baie kwesbaar en blootgestel, veral in terme van MIV. Hierdie studie ondersoek of film ’n effektiewe medium kan wees om sulke mense aan te spreek, op te voed en te beïnvloed. Om dit te bepaal is ’n empiriese studie gedoen wat moes vasstel watter effek film het op MIV-stigmatisering binne so ’n groep. Die doel van die empiriese studie was nie om statistiese bewyse te lewer nie, maar om sekere neigings en tendense aan te toon. ’n Groep mense van Vlaeberg, ’n plattelandse area buite Stellenbosch, Suid-Afrika, is gebruik vir die studie. Die film Yesterday is gebruik vir die empiriese ondersoek aangaande die potensiaal wat film het om MIV-stigmatisering aan te spreek. Yesterday is die eerste Suid-Afrikaanse film wat vir ’n Oscar benoem is. Die film is gekies om die volgende redes: a) dit speel af in Suid- Afrika en weerlose mense binne ’n plattelandse omgewing word uitgebeeld; b) dit het ’n positiewe, dog realistiese benadering tot MIV; c) dit beeld die wreedheid van stigmatisering uit; d) dit dui aan hoe ’n mens diegene met MIV kan bystaan; en e) dit is maklik verstaanbaar. Die film was positief ontvang en het die stigmatiserende persepsies, houdings en oortuigings van die groep beïnvloed. Die empiriese studie het bewys dat film ’n spirituele dimensie het en as medium vir spirituele vorming gebruik moet word. Dus het film ’n belangrike rol te speel in antistigma-ingrypings. In hierdie opsig het die navorsing gewys dat film wel ’n deurslaggewende rol in ’n MIV-voorkomingstrategie en ’n antistigma-ingryping kan speel.