What are the school experiences of HIV-positive secondary school learners on ARV treatment? Although the provision of life-saving antiretroviral (ARV) treatment is central in the medical and policy response to the HIV pandemic, relatively little research (in the SADC region and in Namibia particularly) attends to people’s experiences and the social effects of taking ARV treatment. This study probed the experiences of high school learners on ARV treatment in Khomas Region, Namibia. As researcher I used a qualitative case study design based mainly on interviews with a purposive, select sample of eight learners at the school where I am a teacher-counsellor. Methods used also included: observations; focus group interviews with eight teachers at the site school; a questionnaire survey with Life Skills teachers from 25 schools in the Khomas Region; and document analysis. Using a theory of health-related stigma and discrimination as well as perspectives on resilience and agency as conceptual and analytical lenses, this study found that only a handful of these learners were living openly with HIV and AIDS. Being both HIV-positive and on ARV medication was a double bind for learners facing pervasive stigma and discrimination in and out of school. Discourses associated with HIV and AIDS, sex, and sexuality shaped people’s response to them and they feared being ‘caught out’. Here the study explores the complex reciprocal relationship between cause and effect in stigma, showing some consequences for these learners: isolation (both voluntary and imposed), mental anguish, depression and suicidal leanings; also (at school) absenteeism, grade repetition and dropout. Distinguishing stigma from discrimination in this study enabled insight into actual practices that constrain learner participation and inclusion in and out of school. Trust between learners on ARVs and teachers proved to be low. Teacher respondents not only felt unequipped to deal with the psychosocial needs of learners on ARVs but also indicated that confronting these needs animated their personal vulnerability (around HIV-related experiences in their own families). However, hopeful patterns also emerged. Some mediatory factors out of school shaped these learners’ experiences and identities positively, with implications for in-school experiences and participation. Some learner journeys reflected shifts from deep despair towards the emergence of voice, positive self-concepts and resilient dispositions. Here, also, this study enters a neglected area of research, showing how the complex interplay of learners’ own agency with social support brought these positive outcomes. Most learners had experienced rejection from immediate family, receiving support rather from community members who became ‘family’. The study thus also raises pressing questions on the nature of support structures (both in and out of school) in contexts shaped by HIV and AIDS, where stigma and discrimination are pervasive and where stable family structures, parental oversight and ‘normal’ progression through school cannot be assumed. It recommends that schools gain better insight into how learners’ circumstances shape their experiences, and develop internal policies, procedures and networks to reduce stigma and discrimination against HIV-positive learners on ARV treatment, as well as. ensuring material, medical, emotional, and psychological support for them.

There appears to be a growing body of literature focusing on PTSD and HIV-related PTSD (the diagnosis of HIV being the significant traumatic event) amongst HIV-positive samples, but only a few African studies that attempt to estimate the prevalence of PTSD amongst HIV-positive people, and even fewer that attempt to estimate the prevalence of HIV-related PTSD. The systemic review presented in this study is currently fully inclusive and is the most up-to-date available. Estimates of the prevalence of PTSD and HIV-related PTSD in South Africa range from 0.7 to 54.1% and, 4.2 to 40% respectively. The current cross-sectional study made use of a mixed-method approach to investigate traumatic life events, PTSD and HIV-related PTSD within a primary health-care centre in KwaZulu-Natal. The quantitative sample consisted of 159 adults (18-50 years) who were compliant on ARV medication. Using the CIDI-PTSD module, the adapted CIDI-PTSD module for HIV, and IES-R, findings indicated that 62% had reported some kind of traumatic event in their lifetime, with 29.6% of participants meeting the criteria for lifetime PTSD, and 40.9% meeting the criteria for lifetime HIV-related PTSD. Altogether, 57.9% of individuals met the criteria for some form of PTSD (either regular PTSD or HIV-related PTSD), and 12.6% met the criteria for both PTSD and HIV-related PTSD. Of the different categories of traumatic events, interpersonal violence has the highest rate of PTSD, followed by a diagnosis of and living with HIV, and then disaster. Furthermore, the IES-R was compared for its usefulness as a screening measure for PTSD against both the CIDI, but results suggest that it is an inferior screening measure to the PDS. The qualitative study consisted of six participants who were examined using IPA methodology informed by the Ehlers and Clark (2000) Model of trauma. Their experiences revealed experiences of stigma, a number of negative appraisals, negative emotions and coping behaviours. Some of the latter might serve as compensatory mechanisms to avoid negative judgements. Hypervigilance seems to be a feature of ARV-compliance that might confer added vulnerability to PTSD and other anxiety disorders.

Against the backdrop of the growing problem of AIDS orphans in South Africa and greater sub-Saharan Africa, this qualitative enquiry examines the lives of three South African orphaned children living with HIV / AIDS in a children's home in Cape Town. It aims to generate rich, child-centred descriptions of some of the significant experiences of the children's lives. Drawings, dialogue and narrative were employed to generate the primary data. This was supplemented by collateral interviews and other relevant records, e.g. medical and biographical. Existential-phenomenological theory informed the approach to data collection and analysis. Each child produced a series often to twelve impromptu drawings over a period often weeks. These drawings and transcripts of the children's verbal descriptions of their drawings were extensively analysed. Significant themes for each participant as well as themes common to all three were identified. Some of the central themes emerging include loss, abandonment, death, disease awareness and coping. The children's ability to develop adaptive coping mechanisms and resilience in the face of traumatic loss and terminal illness was a particularly outstanding feature of the findings. Recommendations are made regarding future research to address the lack of qualitative, child-focused investigations as well as appropriate interventions for addressing the psychosocial needs of orphaned children living with HIV/AIDS.

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