Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2009. / This thesis is about children who are vulnerable in the context of HIV/AIDS. The epidemic leaves children vulnerable in a number of ways. The education sector is confronted with vulnerable children and this has caused the roles and responsibilities of teachers to be extended. The research is aimed at determining whether teachers see a role for themselves in this context that extends beyond formal education and also to find out how teachers view this role. The research was conducted at three schools in the Llingelethu community in Malmesbury: a pre-primary school (the Siphumeze Educare Centre), a primary school (Naphakade Primary School) and a high school (Naphakade Secondary School). The research determined that teachers do feel that they have a role in this context, but there were also those who felt that other role players must rather fulfil this role. One of the most important findings of the research was that teachers often view their role in the context of HIV/AIDS in a limited way. In this regard, teachers often think only in terms of children who are infected by die virus, while not taking into account children who are affected in other ways. Teachers, as well as schools, also often still focus on their role in HIV/AIDS prevention. A further aim of the research was to determine which challenges prevent teachers from playing an extended role in the lives of vulnerable children. The participants in the research identified various challenges, including those that are a result of keeping HIV status secret, because of stigma and a lack of trust. A further challenge that was identified is a lack of background information about learners, sometimes as a result of the fact that teachers do not come from the community. Factors that make it difficult for teachers to conduct follow up work were also identified, as well as emotional exhaustion and other facors that prevent teachers from playing an extended role. A lack of support was also identified by participants as a challenge and different dimensions of support were identified.

A research report submitted to the Faculty of Humanities, School of Social Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts in the field of Demography and Population Studies. November 2016. / Introduction: South African men practice both traditional and voluntary medical male circumcision. Voluntary Medical Male Circumcision (VMMC) was introduced as a health intervention strategy against HIV/AIDS. On the other hand, traditional male circumcision (TMC) is a ritual that marks the rite of passage into manhood. TMC has been identified as a public health hazard associated with high numbers of complications and even deaths. The South African government has launched and promotes the VMMC programme. The programme aims to reach a target of 80% coverage in order to effectively reduce HIV infections in the country. However, TMC remains a popular practice. In 2009, the National HIV Community Survey reported that 67% of men were traditionally circumcised, while 33% had been circumcised medically. This study aims to identify factors associated with VMMC, in order to inform the current programme. Furthermore, this study will add to the body of knowledge regarding VMMC and TMC, as previous literature has focused on identifying factors associated with circumcision status rather than the choice of circumcision type (VMMC vs TMC). Objective: The aim of this study was to the identify levels of circumcision status and circumcision types (VMMC vs TMC). Furthermore, this study aimed to examine the relationship between demographic, socio-economic, cognitive and environmental factors associated with VMMC and TMC in South Africa. Methodology: The study used data from the Third National HIV Communication Survey, 2012. The study sample is 6 828 473 males aged 16-55 years who underwent VMMC or TMC. The first step of the analysis was descriptive, using cross tabulations and graphs. Finally, multivariate analysis was employed using binary logistic to examine the relationship between VMMC and TMC with demographic, socio-economic, cognitive and environmental factors. Results Fifty-one percent (51%) of circumcised males were circumcised medically, while 49% were traditionally circumcised. As expected; ethnic groups known to practice TMC were less likely to choose VMMC. In terms of socioeconomic variables, education was significantly associated with whether males were medically circumcised (p<0.05; CI1.66=5.11). Availability of VMMC at the health facility significantly influenced the males choice of selecting VMMC as the type of circumcision to undergo (p<0.05; CI 0.43=0.79). / GR2017

A thesis submitted to the Faculty of Humanities, University of Witwatersrand, Johannesburg, South Africa in fulfilment of the requirements of the Degree of Doctor of Philosophy in the field of Demography and Population Studies. / Background: In exploring the relationship between migration and HIV/AIDS, a focus of earlier studies was on the role of the mobile population in the geographical spread of the disease. There has been a shift in this perception and the focus now is on the implications of being a migrant. A body of literature has developed on the risk of migrants contracting HIV, but only a few studies have examined the AIDS/TB mortality risk as a consequence of migration, with the results showing that migrants have higher chance of dying of AIDS/TB compared to their non-migrant counterparts. However, these studies mainly looked at the impact of migration on mortality due to AIDS/TB and did not make provision for the presence of other causes of death. Therefore, this study is geared towards investigating migration as it relates to death caused by AIDS/TB, longitudinally, and in the presence of other causes such as non communicable diseases, other infectious diseases, and external causes of death, in rural South Africa. Specifically, the study addressed the following questions: (i) What is the risk of dying from AIDS/TB among migrants in rural South Africa in the presence of other causes of death? (ii) How does this relationship compare with the relationship between migration and other causes of death? (3) What are possible predictors of the relationship between migration and AIDS/TB in the presence of other causes of death? Method: This research project is part of a longitudinal study of the inhabitants of the Agincourt sub-district, situated in the rural north-eastern part of South Africa. The study utilises the Agincourt Health and Demographic Surveillance System data spanning 12 years, starting from 1st January, 2000 to 31st December, 2011. The main target group for the study is individuals aged 20 to 69 years at the date of analysis. The selected individuals are divided into the following categories: (i) the return migrants who returned after spending a period of time outside the study area; (ii) the in-migrants who moved into the study location for the first time, and (iii) the permanent residents (non migrants). A six month residence threshold period is used to distinguish participants from ordinary visitors. The migration status categorical variable was further expanded from three to five categories with in-migrant and return migrant categories being split to accommodate short and long-term durations of exposure. In the year 2000, the baseline year, a total of 25,621 individuals who met the entry criteria were recruited into the study. For data analysis, a Fine and Gray model is used, which is a variant of a Cox proportional hazard model, to estimate the competing risk of dying among the selected participants by sex. The causes of death (CoD) variable was categorised into the following broad categories: “AIDS/TB”, “Non Communicable Disease”, “External cause” and “Other infectious disease”, with indeterminate causes coded as missing. The five categories of migration serve as the independent variable, with permanent residence acting as the reference group, while the broad Cause of Death categories are the main dependent variables. Other dependent variables are: period, nationality, education and socio-economic status. Results: This first set of results aims to address the question on the risk of AIDS/TB mortality among migrants in rural South Africa in the presence of other causes of death. The findings are that male and female short-term return migrants have significantly higher relative risk of dying of AIDS/TB death when compared to their non-migrants counterparts with sub-hazard ratio (SHR) of 4.87 (95% CI 4.17-5.72; P<0.001) and 5.44 (95% CI 4.64-6.38; P<0.001)) reported for both gender group respectively. For male and female long-term return migrants, their SHR was 1.80 (95% CI 1.43-2.26; P<0.001) and 2.06 (95% CI 1.57-2.70; P<0.001) respectively. The results did not reveal significant results for the in-migrants. The second set of results aims to address the second research question, which is, how does the relationship between migration and mortality caused by AIDS/TB in rural South Africa in the context of other causes of death compare with the relationship between migration and causes different from AIDS/TB. The results show that Short-term return migrants have higher mortality than non-migrants, whatever the four causes of mortality. For instance, the competing risk of death due to AIDS/TB for short-term return migrants compared to non-migrants showed a lower SHR for external cause of death, namely 8.78 (95% CI 5.86-13.16; P<0.05) vis-à-vis non-migrants. This implies that the difference in the relative risk of mortality between migrants and non migrants is even higher for external causes than for AIDS/TB. The same is applicable to the risk of death from other infectious diseases for females, which has a SHR of 4.97 (95% CI 2.50-9.89; P<0.05) in the competing risk model. The relative risk of death due to AIDS/TB for male is 4.87 (95% CI 4.14-5.72 P<0.001) while that of female is 5.44 (95% CI 4.64-6.38; P<0.001); respectively. With regards to the question on the possible predictors of the relationship between migration and AIDS/TB in the presence of other causes of death, it is shown that period is one of the predictors of the relationship between migration and AIDS/TB mortality. And, it is relevant to the study participants who died as a result of AIDS/TB, NCDs and other infectious diseases. In general, the risk dwindles in the latter period when the antiretroviral drugs become available for AIDS/TB. Nationality is also a determinant of the relationship and it is applicable to those who lost their lives due AIDS/TB (female only), NCDs and other infections (female). In all, the Mozambican nationals are less likely to die in comparison with the South Africans. Educational status is a predictor and it relevance cuts across virtually all the causes of death. The dominant pattern that is revealed in this context is that the higher the level of education, the lower the risk of death due to any of the causes. The predictive impact of SES can only be felt among the respondents whose death was due to AIDS/TB and NCDs (female only). Conclusion: With circular labour migration in South Africa showing no evidence of declining and with the attendant mortality risks due to AIDS/TB and other causes, and needs to be carefully considered - in policies aiming to control mortality in South Africa. Disease-induced migration creates burdens not only for the left-behind families in terms of their means of livelihood through loss of remittances, but also for the burden on health care facilities in the rural area. With short-term labour migrants being a high risk group, the success of intervention programmes addressing the problem of HIV infection and the resultant mortality implication, such as ‘treatment as prevention’ programmes, can only be guaranteed by recognising the risks incumbent on this group of people and the influence of the larger communities. / XL2018

Thesis (M. Cur.) --University of Limpopo, 2011. / HIV/AIDS is one of the major challenges facing South Africa today. Over 5.5 million people are infected with HIV and the majority of these infections are in the reproductive age group. Since the start of the epidemic, over 12.2 million women worldwide have been infected with HIV (WHO, 2000:10). The risk of women contracting HIV is rising globally. HIV seems to be a major cause of infant mortality. It is estimated that approximately 55% of women in South Africa are HIV-positive (National Department of Health, 2007:7). It is, therefore, important that knowledge and attitudes of women regarding mother-to-child transmission (MTCT) of HIV infection are explored to reduce the high infant mortality rate and the incidence of MTCT of HIV infections, and to develop preventive programmes on HIV and AIDS. In view of these considerations, the objectives of this study were to explore and describe the knowledge and attitudes of women with regard to MTCT of HIV infection and to provide guidelines for the prevention of MTCT of HIV infection. The study was conducted in the rural area of the Ehlanzeni District in the Mpumalanga Province, South Africa at Bourke’s Luck and Elandsfontein clinics. An explorative, descriptive, qualitative research design that is contextual in nature was used. The population consisted of all pregnant women and those in pueperium between 25-40 years of age. Non-probability purposive sampling was used. Participants were selected according to inclusion criteria. Data were collected using semi-structured interviews. The research findings revealed that some participants had knowledge and understanding regarding MTCT of HIV infection while others lacked knowledge and understanding which could impact on MTCT of HIV infection.

The HIV and AIDS epidemic has remained one of the leading causes of death in the world and has been destructive in Africa with Sub-Saharan Africa remaining the epidemiological locus of the epidemic. HIV and AIDS hinders development by erasing decades of health, economic and social progress, reducing life expectancy by years and deepening poverty [57].The most urgent public-health problem globally is to devise effective strategies to minimize the destruction caused by the HIV and AIDS epidemic. Due to the problems caused by HIV and AIDS, well defined endpoints to evaluate treatment benefits are needed. The surrogate and true endpoints for a disease need to be specified. The purpose of a surrogate endpoint is to draw conclusions about the effect of intervention on true endpoint without having to observe the true endpoint. It is of great importance to understand the surrogate validation methods. At present the question remains as to whether CD4 count and viral load are good surrogate markers for death in HIV or there are some better surrogate markers. This dissertation was undertaken to obtain some clarity on this question by adopting a mathematical model for HIV at immune system level and the impact of treatment in the form of reverse transcriptase inhibitors (RTIs). For an understanding of HIV, the dissertation begins with the description of the human immune system, HIV virion structure, HIV disease progression and HIV drugs. Then a review of an existing mathematical model follows, analyses and simulations of this model are done. These gave an insight into the dynamics of the CD4 count, viral load and HIV therapy. Thereafter surrogate marker validation methods followed. Finally generalized estimating equations (GEEs) approach was used to analyse real data for HIV positive individuals, from the Centre for the AIDS Programme of Research in South Africa (CAPRISA). Numerical simulations for the HIV dynamic model with treatment suggest that the higher the treatment efficacy, the lower the infected cells are left in the body. The infected cells are suppressed to a lower threshold value but they do not completely disappear, as long as the treatment is not 100% efficacious. Further numerical simulations suggest that it is advantageous to have a low proportion of infectious virions (ω) at an individual level because the individual would produce few infectious virions to infect healthy cells. Statistical analysis model using GEEs suggest that CD4 count< 200 and viral load are highly associated with death, meaning that they are good surrogate markers for death. An interesting finding from the analysis of this particular data from CAPRISA was that low CD4 count and high viral loads as surrogates for HIV survival act independently/additively. The interaction effect was found to be insignificant. Individual characteristics or factors that were found to be significantly associated with HIV related death are weight, CD4 count< 200 and viral load. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

Where HIV/AIDS has had its greatest adverse impact is on TB. People with TB that are infected with HIV are at increased risk of dying from TB than HIV. TB is the leading cause of death in HIV individuals in South Africa. HIV is the driving factor that increases the risk of progression from latent TB to active TB. In South Africa no coherent analysis of the risk determinants of HIV and TB has been done at the national level this study seeks to mend that gab. This study is about estimating risk determinants of HIV and TB. This will be done using the national household survey conducted by Human Sciences Research Council in 2005. Since individuals from the same household and enumerator area more likely to be more alike in terms of risk of disease or correlated among each other, the GEEs will be used to correct for this potential intraclass correlation. Disease occurrence and distribution is highly heterogeneous at the population, household and the individual level. In recognition of this fact we propose to model this heterogeneity at community level through GLMMs and Bayesian hierarchical modelling approaches with enumerator area indicating the community e ect. The results showed that HIV is driven by sex, age, race, education, health and condom use at sexual debut. Factors associated with TB are HIV status, sex, education, income and health. Factors that are common to both diseases are sex, education and health. The results showed that ignoring the intraclass correlation can results to biased estimates. Inference drawn from GLMMs and Bayesian approach provides some degree of con dence in the results. The positive correlation found at an enumerator area level for both HIV and TB indicates that interventions should be aimed at an area level rather than at the individual level. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2009

Thesis (MPhil (Industrial Psychology. School of HIV/AIDS Management))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: This study examines the level of HIV/AIDS Knowledge, attitudes towards HIV/AIDS as well as practices amongst the employees of Telkom SA Ltd. Furthermore it also aims to determine the effectiveness of the Peer Education programme within the company as well as the role that promoters are playing in encouraging Peer Educators to do awareness in the workplace on the one hand and encouraging their subordinates to attend such programmes on the other hand. A total of 80 employees were invited to participate in the survey. At the end of the survey period, which ran from 2 to 21 February 2009, it was found that a total of 66 employees responded by completing the on-line survey. This represents a return of 82,5%. While the survey results shows a remarkably high level of HIV/AIDS knowledge amongst the responds, it could not be conclusively proven that it was as a result of attending HIV/AIDS workplace awareness programmes. However, it can be said that this knowledge was sufficient to: Enable employees to make informed decisions about their own sexual behaviour Peer Educators were confident that their knowledge levels were sufficient to educate their peers. The results also show quite a high level of disinvolvement on the part of promoters with regard to HIV/AIDS workplace issues. Finally this study also contains a range of recommendations and suggestions which were derived from the findings. / AFRIKAANSE OPSOMMING: Hierdie studie ondersoek the vlak van MIV/VIGS Kennis, houdings teenoor MIIV/VIGS sowel as die gebruike van die werknemers van Telkom SA Bpk. Dit poog ook om die effektiwiteit van die Portuur Voorligtingsprogram binne die maatskappy te ondersoek sowel as om te bepaal watter rol toesighouers speel om enersyds Portuur Voorligters aan te moedig in bewusmakings sessies in die werkplek te reel en om andersyds die rol wat toesighouers speel om hulle ondersgeskiktes aan te moedig om sodanige sessies by te woon. ‟n Totaal van 80 werknemers was genooi om die navorsing mee te maak. Aan die einde van die navorsingstydperk, wat vanaf 2 tot 21 Februarie 2009 geloop het, was daar bevind dat ‟n totaal van 66 werknemers die aan-lyn vraelys voltooi het. Hierdie syfer verteenwoordig ‟n opbrengs van 82,5%. Onderwyl die resultate ‟n merkwaardige hoë vlak van MIV/VIGS kennis onder die respondente getoon het, kon dit nie onteenseglik bewys word dat dit as gevolg van die bywoning van MIV/VIGS werkplek bewusmakings sessies was nie. Ten spyte van die voorgenoemde, kan daar egter met sekerheid gesê word dat hierdie kennis genoegsaam is om: Werknemers in staat te stel om ingeligte besluite te neem oor hulle eie seksuele gedrag Portuur Voorligters in staat te stel om hulle gelykes voldoende op te voed by wyse van bewusmakings sessies. Die resultate het ook ‟n hoë mate van onbetrokkenheid van toesighouers getoon ten opsigte van MIV/VIGS werkplek angeleenthede. Hierdie studie bevat ook „n reeks van aanbevelings en voorstelle wat voortspruit uit die bevindinge.

The importance of partnerships between marginalised communities and support agencies (from the public sector, private sector and civil society) is a pillar of HIV & AIDS management policy. Such alliances are notoriously difficult to promote and sustain. The thesis presents the findings from a longitudinal, qualitative case study of a project seeking to build partnerships to facilitate local responses to HIV & AIDS in a remote rural community in South Africa. The partnership aimed to empower community stakeholders to lead HIV-prevention and AIDS-care efforts through the support of local government departments, NGOs and the private-sector, and make public services more responsive to local needs. I highlight the value of building longterm relationships with, and ownership of the project by community stakeholders, i/ by involving community stakeholders in partnership building and facilitation from the very beginning of the process, and; ii/ through a compliance with, and respect for community protocols and norms in the process of entry, community engagement, and partnership facilitation. I illustrate how features of the local public sector environment have actively worked against effective community empowerment and partnership. These include a rigid hierarchy, poor communication between senior and junior health professionals, lack of accountability, limited social development skills, and the demoralisation and/or exhaustion of public servants dealing with multiple social problems in under-resourced settings. I outline the obstacles that have prevented private-sector involvement, suggesting a degree of scepticism about the potential for private-sector contributions to development in remote areas. The most effective partners have been the NGOs — run by committed individuals with a keen understanding of social-development principles, flexible working styles and a willingness to work hard for small gains. Despite the challenges, the partnership has achieved many positive outcomes, including the formalization of the partnership and its institutionalization within a permanent government structure. I outline these achievements and discuss the essential role played by an external change agent in facilitating the process of partnership building. I conclude with eight key lessons learnt and recommendations which emerged out of the research. Firstly, partnerships are embedded in and influenced by the contexts within which they are located; secondly, stakeholder organizations must create an enabling environment to encourage and sustain partnership participation; thirdly, capacity building and empowerment of partners is crucial for ensuring ownership and sustainability of the partnership; fourthly, partnerships within resource (human and physical) poor contexts like Entabeni, where skills and resources are scarce, require the services of a dedicated, skilled facilitator or external change agent; fifth, partnership building needs to be guided by regular monitoring and evaluation and a systematic documentation of the process; sixth, relationships based on trust are a central pillar of partnerships; seventh, partnerships are as much about individuals as they are about communities and organizations, and; finally, partnerships can and do work, in-spite of the many challenges that may be encountered. of partnerships between marginalised communities and support / Thesis (Ph.D.)-Universtiy of KwaZulu-Natal, Durban, 2008.

No abstract available. / Thesis (M.A.)-University of Natal, Durban, 2003.

No abstract available. / Thesis (LL.M.)-University of KwaZulu-Natal, Durban, 2012.