The development of health systems in sub-Saharan Africa has been seriously challenged in the last two decades by the rise of HIV/AIDS. In this thesis I argue that the interface between health policy and HIV/AIDS in South Africa is poorly understood and that this has been to the detriment of fairly radical health care reforms as well as more general health systems development. The research problem outlined above is two-fold, requiring different types of enquiry and analysis. Firstly, there is a gap in our understanding of the impact of HIV/AIDS on health systems. Empirical evidence is presented from research on health facilities and health management structures in Ugu district, KwaZulu-Natal to address this concern. Secondly, it is asserted that our limited understanding of the impact of HIV/AIDS and the nature of the epidemic have prevented a true appreciation of its significance for health policy. This dimension of the problem is addressed through an analysis of South African health policy from 1994 through to the present, as well as a more theoretical look at the potential future influence of the antiretroviral therapy programme on the health system. Both quantitative and qualitative methodologies are employed in this research to acquire empirical insights. Health service utilisation trends are assessed retrospectively by quantitative analysis of key indicators from district and provincial information systems. Meanwhile, the prospective component of the quantitative research can best be described as repeat cross-sectional surveys of a selection of health facilities in Ugu district. These surveys capture data on the profile of patients seeking care and the resource requirements for managing these patients. Qualitative methodologies (predominantly semi-structured interviews) are used at facility level to gain insight into human resource issues and at the management level to better understand health system functioning in relation to HIV/AIDS. One would expect the increasing HIV prevalence and burden of AIDS illness in South Africa to translate into a higher demand for health care. However, this has not occurred in Ugu district, largely because of difficulties with access to care. Despite this, at lower level health services, namely clinics and district hospitals, HIV-related service provision has outpaced an increase in resources. Specifically, the introduction of the antiretroviral therapy programme and the decentralisation of a range of HIV/AIDS services are causing new strains on the system. In essence, the epidemic has created a need to address barriers to accessing care and to expand support for district health services. HIV/AIDS not only increases the demand for health care, but on the supply side erodes the capacity of the health system to deliver care. My research demonstrates that health care workers in KwaZulu-Natal are being severely impacted by the epidemic, with the nature of their work contributing to both their susceptibly and vulnerability. Not only is HIV/AIDS increasing absenteeism and attrition through escalating morbidity and mortality, but it is also working in more subtle ways to contribute to a range of 'push' factors driving health workers from the public health sector. None of these issues have been addressed because of the narrow definition of 'human resource management', despite the obviously heightened need to monitor attrition trends and develop creative retention strategies. My research looks not only at the impact of HIV/AIDS impact on health services in Ugu district, but also at the impact of the epidemic on higher levels of the health system which constitute management structures. At these levels, the health system is challenged by an urgency to deliver HIV/AIDS services, as well as an increasing involvement of donors and partners such as civil society organisations or faith based organisations. This has resulted in trends towards more centralised control of planning and management and, in some instances, a deflection of resources towards HIV/AIDS issues and programmes. This context has called for a strong focus on capacity development and means to ensure the integration of health programmes. Many of the trends in Ugu district demonstrate the insidious nature of HIV/AIDS impact and give some insight into why these trends have not been adequately addressed by South African health policies. My analysis suggests that despite the appropriateness of the overarching direction of health reforms, some concerns arising from the HIV/AIDS epidemic have received little attention. These include a need to: 1) manage human resource impacts, 2) develop home community based care and establish a continuum of care, and 3) lead and direct the involvement of donors and partners in the health sector. On the other hand, there have been some beneficial policy developments, such as the elimination of user fees for certain services and the attention paid to the way in which a focus on HIV/AIDS care can potentially weaken the health system. Unfortunately, in many instances HIV/AIDS has also widened the gap between policy and implementation and opportunities have been missed to develop the health system in an appropriate manner. The South African antiretroviral therapy programme, launched in 2003, is a source of uncertainty regarding the future development of health policy in the country. My analysis makes use of scenarios to explore the potential future impact of the programme. I consider the ways in which the programme is steering us away from our post-apartheid vision of an equitable and well functioning national health system and towards 'AIDS exceptionalism'. I look to Botswana, the first country in southern Africa to provide antiretroviral therapy in the public health sector, for early lessons as to what we might expect. My case study of this programme suggests that HIV/AIDS care can be integrated with time, so limiting damage to the development of fragile health systems. Only through ongoing reassessment of the South African situation will it become apparent whether such lessons are transferable. Nonetheless, forward thinking should allow us to move from a crisis-orientated response to one that is more strategic. This thesis concludes with four key messages (or recommendations) emerging from both the empirical research and the health policy analysis. Firstly, there is a clear need to establish systems that can provide comprehensive and timely information concerning the impact of HIV/AIDS on public health services. Secondly, trusting relationships have to be built between academics/researchers and health policy makers so that research informs policy. Thirdly, there is a need to (re)establish a shared vision of the national health system and maintain a focus on achieving this vision. Finally, priority programmes and resources allocated to these must be used to strengthen our national health system in creative ways. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

This thesis examines HIV disease natural history and response to antiretroviral treatment (ART) in patients from The TREAT Asia HIV Observational Database (TAHOD), a mulitcentre, prospective observational cohort of HIV-infected patients from countries in the Asia-Pacific region. By September 2005, 2979 patients have been recruited to TAHOD from 15 participating sites. The majority were male (73%), median age 37 years. Chinese (37%), Thai (25%) and Indian (17%) were the main ethnicities. Most patients reported HIV infection through heterosexual (59%) and homosexual contact (23%); 5% injecting drug use. At baseline, 41% of patients were diagnosed with AIDS defining illness, and 77% were being treated with highly active antiretroviral therapy (HAART). Baseline and retrospective data suggest that the overall response to HAART in TAHOD is similar to that seen in western cohorts, with mean CD4 count increase of 115 cells/μL and 69% achieving a viral load less than 400 copies/mL six-month after HAART initiation. Baseline CD4 count was the strongest predictor of short-term disease progression. Prognostic models based on routine clinical data and haemoglobin gave a good estimation of disease progression. The rate of new AIDS defining illness was 26% in the first 90 days after HAART initiation, which may partly be due to immune reconstitution syndrome occurring shortly after treatment. The most frequently used first-line ART combination was stavudine/lamivudine/nevirapine. Approximately 22% of patients receiving this treatment changed or stopped at least one drug in the first year, with adverse effect (including lipodystrophy, hepatitis, rash and peripheral neuropathy) the major reasons. The rates of discontinuation of efavirenz or nevirapine as part of HAART were similar (16 vs. 20/100 person years). Older age and positive HCV antibody were associated with an elevated liver function (ALT) test. Both prevalence of HBV and HCV coinfection with HIV were approximately 10%. The impact of hepatitis coinfection on immunological and virological responses to ART and HIV disease progression was not statistically significant. Both HBV and HCV remained independently associated with elevated ALT in the multivariate models. The overall HIV disease progression and response to ART in TAHOD patients were similar to those seen in the western countries.

[Truncated abstract] Failure to fully reconstitute the immune system is a common clinical problem in HIV patients who were severely immunodeficient before responding to combination antiretroviral therapy (CART). This can manifest as a deficiency in the number or function of CD4+ T-cells and occurs most often in patients who had a nadir CD4+ T-cell count below 100/μl when CART was commenced. Observational studies of large cohorts of HIV patients, such as the D:A:D study, have demonstrated that patients with low CD4+ T-cell counts have increased rates of death compared with patients who have normal CD4+ T-cell counts. Furthermore, individual case studies suggest that impaired recovery of pathogen-specific immune responses during CART is associated with opportunistic infections or disease progression. This thesis addresses possible causes of deficiencies in CD4+ T-cell number or function in HIV patients who were very immunodeficient prior to treatment and are responding (virologically) to CART. Firstly, the role of the thymus in producing naive CD4+ T-cells and the effects of persistent immune activation on the recovery of CD4+ T-cell numbers were assessed in patients with either low or high CD4+ T-cell counts after long-term CART. ... Proportions of antigen presenting cell (APC) subpopulations were examined in HIV patients with low or high CMV-specific CD4+ T-cell responses after long-term CART. HIV patients had significantly lower proportions of plasmacytoid dendritic cells (pDC) than HIV-negative controls. Furthermore, the proportions of pDC were positively correlated with CMV-specific CD4+ T-cell responses in HIV patients. Proportions of myeloid dendritic cells (mDC) were significantly higher in HIV patients than controls, and were also increased in patients with low CMV-specific CD4+ T-cell responses. Proportions of M-DC8+ dendritic cells or CD14+ monocytes did not differ between patients and controls, nor were they associated with CMV-specific CD4+ T-cell responses. Quantitation of cytokine (interferon-α, tumour necrosis factor-α, interleukin (IL) -12, IL-23, IL-15, IL-18 and IL-10) mRNA in unstimulated, purified populations of the APC described above revealed few significant differences between patients with low or high CD4+ T-cell IFN-γ responses to CMV. The only notable difference was the slight elevation of IL-15 mRNA levels in patients compared to controls. Since patients in the high responder group had the highest levels of IL-15 mRNA, this association may reflect the anti-apoptotic properties of IL-15. These studies provide valuable insights into the causes of persistent CD4+ T-cell deficiency and dysfunction in HIV patients on CART and may lead to better monitoring and treatments.

Thesis (MFamMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background: A national roll-out of antiretroviral therapy in the public sector was started in 2004, and Paarl was one of the first sites to start these services in the Western Cape. Operational research is required to guide the continuous improvement of such services. This research aimed to describe the characteristics of the treatment cohort started at TC Newman CDC’s ARV clinic in Paarl, to determine the retention in treatment rate and to assess the clinical and virological outcomes. Methods: A retrospective descriptive and observational study was done at the TC Newman ARV clinic in Paarl. All adult HIV positive patients that were started on antiretroviral therapy in the given time period were included. Patient and treatment data had been collected in an electronic database (e-register) and were extracted and analysed. Results: Starters: Out of the 2469 patients that were enrolled for ARV treatment between February 2004 and December 2010, 2254 started locally (the rest transferred in). 64% of them were female (decreasing rate over the years). Strugglers: By June 2011 51.5% of patients were still on ARVs, 6.9% patients had died, 16.7% had been ‘transferred out’and 24.7% were reported as ‘Lost to Follow-up’. 40% of the attrition of the cohort occurred in the first 6 months, 70% in the first 18 months. Stayers: Of the 1172 patients retained after start at TC Newman CDC, 1023 (87.3%) were still on Regime 1 and 149 (12.7%) on Regime 2. Conclusions: The results of this treatment cohort (mortality, treatment retention and regimen durability) equal those in other published treatment cohorts, although very limited comparable data are available. However, the high ‘lost to follow-up’ rate is of concern and needs further investigation. Changes in the programme structure and environment tend to have an immediate effect on initiation numbers of new patients.

Thesis (MSc (Genetics))--University of Stellenbosch, 2007. / The results of pharmacotherapy can vary both within and between different populations and ethnic groups. Although numerous factors are believed responsible for observed discrepancies in drug response, genetic differences, most often in the form of single nucleotide polymorphisms (SNPs), between individuals and ethnic groups are an important and at times predominant factor. The response to antiretroviral (ARV) drugs for the treatment of human immunodeficiency virus (HIV)-infection is not dissimilar. Marked variations in both ARV efficacy and occurrence of adverse drug reactions (ADRs) have been observed on both an individual and ethnic group level, which are largely attributed to polymorphisms within genes involved in the metabolism and transport of these compounds – such genes include the CYP2B6 and CYP3A4 genes, both members of the cytochrome P450 (CYP) gene superfamily, and the multidrug-resistance 1 (MDR1) gene encoding an efflux transporter protein, phosphoglycoprotein (PGP). An improved understanding of the genetic influences on ARV drug response could lead to improved therapies with fewer side-effects and minimised drug resistance. The main aim of this study was thus to investigate the genetic basis of observed differences in ARV therapy (ART) response in South African ethnic groups. Deoxyribonucleic acid (DNA) samples were collected from 206 HIV-positive individuals of Mixed-Ancestry and Xhosa ethnicity that were currently or prospectively receiving ART. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was employed to screen the A-392G SNP in CYP3A4, the G516T and A785G SNPs in CYP2B6, and the T-129C, C1236T, G2677T/A and C3435T SNPs in MDR1. Hardy-Weinberg equilibrium (HWE) and haplotype analyses were subsequently performed on the resultant SNP genotype and ...

Thesis (MPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: NACOSA had an eventful history spanning 22 years. The first phase between 1992 and 2001 is labeled Great Expectations as the composite multi-sectoral structure started a groundbreaking initiative on HIV and AIDS in South Africa and believed that the first AIDS plan drafted by them would be implemented as planned. Expectations came to nothing as government struggled to find its feet through a decade of blunders leading to the demise of the structure by end 2001. The next phase between 2001 and 2010 is labeled Starting Over as the Western Cape branch of NACOSA reinvented itself as a community mobilisation network for the province. Within a period of ten years Western Cape NACOSA developed into a successful national network with a large membership fully involved through its networking, capacity building and promoting dialogue functions. The third phase between 2010 and 2015 is labeled Rapid Growth as NACOSA developed into a large training and grant management agency with strong systems providing funding to its members through sub-granting. Networking continued at a slower pace but is still highly important for the organisation. The network contributes to localised social capital through shared learning and collaboration. NACOSA‟s sustainability has been developed through the ability to raise long-term funds for network activities, capacity building of members and coordinated service delivery on the ground. NACOSA also has a culture of identifying and acting fast on opportunities and adapting to change when it is needed. Strategic factors attributing to the success of NACOSA are a sector based approach promoting diversity in its membership; a consistently focused and shared purpose throughout the years; a community agent approach believing in and advocating for community systems strengthening; obtaining a mandate from network members for main strategy changes; strategic partnerships; a strong capacity building approach focussing on organisational and programmatic competencies; not competing with network members but acting as main weaver; creating specialist networks for specific HIV-related causes; a committed representative executive committee and skilled staff; bringing groups together on a regular basis for discussions and strategising; a variety of social media; and a network mindset intent on a culture of learning and building trust between member organisations. / AFRIKAANSE OPSOMMING: NACOSA het 'n gebeurtenisvolle geskiedenis wat strek oor 'n periode van 22 jaar. Die eerste fase tussen 1992 en 2001 word genoem Groot Verwagtinge, verwysende na die saamgevoegde multi-sektorale struktuur wat ontstaan het as die eerste groot MIV en VIGS inisiatief in Suid-Afrika. Hulle het verwag dat hul eerste VIGS-plan geïmplementeer sou word soos wat hulle dit beplan het. Hul verwagtinge het egter skipbreuk gely as gevolg van die regering wat oor die dekade heen hul voete gesleep en foute gemaak het wat uiteindelik gelei het tot die struktuur se ondergang in 2001. Die volgende fase tussen 2001 en 2010 word genoem Oorbegin verwysende na die Wes-Kaap tak van NACOSA wat hulself herskep het as „n gemeenskapsmobiliseringsnetwerk. Wes-Kaap NACOSA het binne tien jaar weer ontwikkel in 'n suksesvolle nasionale netwerk met 'n groot ledetal wat volledig ingeskakel is by die organisasie se netwerk, kapasiteitsbou en bevordering van dialoogaktiwiteite. Die derde fase tussen 2010 en 2015 word genoem Snelle Groei verwysende na NACOSA se ontwikkeling in 'n groot opleidings- en fondsbestuursagentskap met sterk stelsels wat befondsing aan hul lede verskaf. Netwerkskakeling het voortgeduur teen 'n stadiger pas maar is steeds baie belangrik vir die organisasie. Die netwerk dra by tot die bou van plaaslike sosiale kapitaal deur middel van samewerking en saam leer. NACOSA se volhoubaarheid het ontwikkel deur hul vaardigheid om langtermynfondse in te samel vir netwerkaktiwiteite, kapasiteitsbou en gekoördineerde dienslewering op grondvlak. NACOSA het ook 'n kultuur om geleenthede vinnig te identifiseer en daarop te reageer, asook om aan te pas by veranderinge wanneer nodig. Strategiese faktore wat bygedra het tot NACOSA se sukses sluit in 'n wye sektorbenadering met diverse lidmaatskap; 'n konsekwente gedeelde doelwit oor die jare; die bevordering van sterk gemeenskapstelsels; die verkryging van 'n mandaat by netwerklede vir strategie-veranderinge; strategiese vennootskappe; 'n sterk kapasiteitsboubenadering wat fokus op organisatoriese en programmatiese vaardighede; geen kompetisie met lede-organisasies maar eerder die rol van “hoofwewer”; skep van spesialisnetwerke vir spesifieke MIV-verwante kwessies; 'n toegewyde raad en vaardige personeel; gereelde bymekaarbring van groepe vir dialoog en strategie bou; 'n verskeidenheid van sosiale media; en 'n netwerk denkpatroon gefokus op 'n leerkultuur en die bou van vertroue tussen lede.

Thesis (MSc)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Successful antiretroviral therapy (ART) depends on appropriate use of antiretroviral agents; which ultimately prevents replication of Human Immunodeficiency Virus (HIV) thus delaying clinical progression of the disease. This study explored how HIV status disclosure affects adherence to antiretroviral therapy at Mamelodi Hospital, using a convenience sampling method with a sample size of 50 adults above 18 years who were on treatment for a minimum of two years prior to the study. An interview protocol was used to uncover patients’ demographics, sexual orientation, and HIV status disclosure, adherence to antiretroviral drugs, drug side effects, how often they missed their doses and how HIV status disclosure / non-disclosure affected their adherence to treatment. Patients’ medical records were assessed to validate and correlate the information obtained from the interviews. The scientific test results used were the CD4count and Viral loads which are used to monitor the HIV/AIDS disease progression. All partakers involved in the study made their HIV status known and reported taking their medicines regularly. The patients’ CD4 count and VL were verified, the CD4 count has shown an upward trend while the VL load showed a downward trend in keeping with patients who are adhering to ART. The majority of participants (54% or 27 patients) reported they had never skipped taking their medication. The participants also reported they had taken their medicine in front of other people and they constituted 74% (37) of the group. Of this 74%, 78.38% (29 patients) said it was because they had disclosed their status. This observation supports the fact that if you have disclosed your HIV status, you have better chances of adhering to prescribed medication. Findings from the study at Mamelodi Hospital revealed that for as long as one has disclosed their HIV status, the outcome of treatment adherence will be better. The only shortfall noted was lack of partakers who did not divulge their HIV status thus a comparison could not be done. It was acknowledged that some participants in the study might have reported disclosure of their HIV status to be in good favour of the researcher to create an impression that they are adhering to their medication. The study has confirmed the existence of a relationship between HIV status disclosure and adherence to ART. / AFRIKAANSE OPSOMMING: Suksessvolle antiretrovirale terapie (ART) hang af van die toepaslike gebruik van antiretrovirale middels, wat replikase van die MI-virus verhoed, en dus die kliniese vordering van die siekte vertraag. Hierdie studie het ondersoek hoe die bekendmaking van MIV-status die gehoorsaamheid tot ART beïnvloed het by die Mamelodi Hospitaal. ‘n Gerieflikheid-streekproef met ‘n groote van 50 volwassenes bo 18 jaar is gebruik en die deelnememers moes ten minste vir twee jaar voor die studie reeds op behandeling gewees het. Data is deur middel van onderhoude ingesamel, met die doel om pasiënte se demografiese inligting, seksuele orientasie, MIV-status, gehoorsaamheid tot ART en newe-effekte van ART in te samel. Pasiënte se mediese rekords is nagegaan om die inligting wat uit die onderhoude verkry is te bevestig. Die wetenskaplike toetse wat gebruik is, was die CD4-telling en virale lading wat gebruik word om MIV/Vigs te monitor. Al die deelnemers het hul MIV-status bekend gemaak en aangedui dat hul hul medikasie gereeld gebruik. Die pasiënte se CD4-tellings en virale lading is bevestig, die CD4-tellings het ‘n opwaartse neiging getoon terwyl die virale lading ‘n afwaartse neighing getoon het. Die meerderheid van die deelnemers (54%) het aangedui dat hul nog nooit hul medikasie oorgeslaan het nie. 74% van die deelnemers het aagedui dat hul hul medikasie voor ander mense neem - hul noem dat dit as gevolg van die feit is dat hul hul status bekend gemaak het. Dit ondersteun die feit dat mense wie hul status bekend maak beter kanse het om gehoorsaam hul medikasie te gebruik. Die studie by die Mamelodi Hospitaal toon dat solank mense hul MIV-status bekend maak, hul meer gehoorsaam is teenoor die gebruik van hul medikasie. Die studie bevestig dus die verband tussen bekendmaking van MIV-status en gehoorsaamheid tot ART.

Thesis (MPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The impact of HIV/AIDS has affected all categories of people in society, including children under the age of five. This segment of the population depends entirely on adults and older children in order for them to survive. This research endeavoured to investigate the extent to which under-five HIV positive children access ART in Siavonga District in the Southern Province of Zambia. The necessity of such information for all cannot be over-emphasised as this category of the population under study is among the most neglected when it comes to issues of HIV/AIDS. Under-five HIV positive children need special attention in order for them to enjoy their right to survival and development. In terms of methodology, the research took an interpretive approach as it employed the qualitative methodology in its endeavours, in order to get an in-depth understanding of people’s views on the topic under research. Different interview schedules were used to collect data from community members, Community Health Workers (CHW), Home-based Care Providers (HBCP), staff of the Ministry of Health and District AIDS Task Force (DATF). The findings of this research addressed all the objectives but one. This research revealed that almost all the community members in Siavonga District had general knowledge about HIV/AIDS and the need for under-five HIV positive children accessing antiretroviral therapy. However, their attitudes and practices varied when it came to the application of this knowledge. According to respondents, the major challenges that under-five HIV positive children were facing when it came to accessing ART were as follows: food insecurity, followed by access to health facilities and social matters. Others included stigma and discrimination, long distances to health facilities, inadequate disposable income at household level and negative attitudes by some people who think that it is a waste of time and resources to give too much attention, including ART to under-five HIV positive children whom according to them will die soon. However, the majority of respondents indicated that there was need to accept these children like any other as they too had the right to live; hence, they needed care and support which included facilitating their access to ART. This research was an eye opener to all duty bearers to recognize and acknowledge the importance of under-five HIV positive children’s access to ART. This will contribute towards enhancing the will to step up efforts for this intervention. From the findings, it is evident that there is need for income generating activities to provide disposable income to people of Siavonga District so that they give appropriate support, particularly to children who are infected or affected by HIV/AIDS. Furthermore, more resources are required from NGOs, government and other stakeholders to enhance not only sensitization on the importance of the target population’s access to ART, but also provision of these ART services. All relevant stakeholders should heed the call to aggregate information for under-five HIV positive children in question so as to specially target interventions accordingly. / AFRIKAANSE OPSOMMING: Die impak van MIV/Vigs raak alle kategoriee van mense in die samelewing, insluitende kinders jonger as vyf jaar oud. Die segment van die bevolking is heeltemal afhanklik van volwassenes en ouer kinders om te oorleef. Hierdie navorsing poog om die omvang van kinders jonger as vyf, wie MIV positief is, se toegang tot antiretrovirale terapie (ART) in die Siavonga Distrik van die suidelike provinsie van Zambia te ondersoek. Die noodsaaklikheid van sodanige inligting vir alle sektore in die samelewing kan nie oorbeklemtoon word nie, aangesien hierdie kategorie van die bevolking een van die mees verwaarloosde is wanneer dit kom by MIV/Vigs verwante kwessies. Kinders jonger as vyf wie MIV positief is, moet spesiale aandag ontvang sodat hulle reg op oorlewing en ontwikkeling kan geskied. In terme van die metodologie het die navorsing ‘n beskrywende benadering gevolg om die kwalitatiewe metode in sy poging, ten einde ‘n in-diepte begrip van mense se standpunte oor die onderwerp onder navorsing te kry. Verskillende onderhoude is gebruik om data in te samel van gemeenskapslede, gesondheidswerkers in die gemenskap, tuisversorgers, personeel van die Ministerie van Gesondheid en Distriks vigs-taakspan. Die bevindinge van hierdie navorsing het al die doelwitte, behalwe een, aangespreek. Die navorsing het getoon dat byna al die gemeenskapslede in Siavonga Distrik algemene kennis het oor MIV/Vigs en die behoefte van kinders jonger as vyf se toegang tot ART. Hul houdings en praktyke verskil egter in die toepassing van hierdie kennis. Volgens die respondente is die grootste uitdagings wat kinders jonger as vyf ondervind wanneer dit kom by toegang tot ART is voedselonsekerheid, gevolg deur toegang tot gesondheidsfasiliteite en sosiale aangeleenthede. Ander sluit in stigma, diskriminasie, lang afstande na gesondheidsfasiliteite, onvoldoende besteebare inkomste op huishoudelike vlak en negatiewe houdings van sommige mense wat dink dat dit ‘n vermorsing van tyd en hulpbronne is om aan kinders jonger as vyf te spandeer, aangesien, die kinders in elk geval (volgens hulle) binnekort sal sterf.Die meerderheid van die respondente het aangedui dat dit nodig is om hierdie kinders soos enige ander kind te aanvaar en dat hulle ook die reg het om te leef: daarom dat hulle sorg en ondersteuning benodig, wat die fasilitering van hul toegang tot ART insluit. Hierdie navorsing het weer die klem geplaas op die belangrikheid van kinders jonger as vyf se toegang tot ART. Dit is duidelik dat daar ‘n behoefte is aan inkomste-genererende aktiwiteite en om besteebare inkomste aan die mense van Siavonga Distrik te voorsien, sodat hulle toepaslike ondersteuning kan bied, veral aan kinders wat deur MIV/Vigs geraak word. Verder is meer hulpbronne nodig van nie-regeringsorganisasies, die regering en ander belanghebbendes, nie net om die belangrikheid van die teikenbevolking se toegang tot ART nie, maar ook vir voorsiening van hierdie ATR dienste.

Human Immunodeficiency Virus (HIV) positive patients are at increased risk for developing mental health problems when compared with the general population. The identification and management of symptoms of mental illness in HIV-positive patients is thus crucial in reducing the risk to developing severe mental illness. The severe mental illness may lead to poor adherence to anti retro-viral drugs resulting in increased morbidity and mortality. The primary health care nurses are largely responsible for managing the treatment of HIV-positive patients as they spend the greatest degree of their time with these patients as compared to other health care professionals. Consequently it is important for primary health care nurses to identify symptoms of mental illness. However, it was unclear to the researcher, a professional psychiatric nurse, as to the level of knowledge among primary health care nurses concerning symptoms of mental illness in HIV-positive patients. Therefore, the aim of this study was to determine the knowledge of primary health care nurses regarding symptoms of mental illness in HIV-positive patients attending primary health care services. In addition, recommendations were developed for primary health care nurses for the purpose of improving their competence in the identification of symptoms of mental illness in HIV-positive patients attending primary health care services. The researcher has utilised quantitative, explorative, descriptive and contextual design. Bloom’s Taxonomy was used as a theoretical lens, to explore the primary health care nurse’s knowledge regarding symptoms of mental illness in HIV-positive patients. The study was conducted in the primary health care services situated in the Nelson Mandela Metropolitan area. The research population consisted of the primary health care nurses working with HIV-positive patients in these primary health care services. The researcher utilised census survey to recruit participants. A structured questionnaire, with 3 sections was used in this study. The necessary principles of reliability and validity were exercised to ensure research of the highest quality. The data was analysed by using descriptive and inferential statistics. All ethical considerations pertaining to beneficence, maleficence, justice, autonomy and obtaining permission from relevant structures to conduct the study were strictly adhered to.

In South Africa, just like in any other country within the African continent, traditional healing remains an integral part of many communities and this is not just restricted to the rural communities only, as is sometimes assumed. The main aim of this research was to explore the approaches of traditional healers in the treatment of HIV/AIDS in the Chris Hani District Municipality, Eastern Cape. The following research objectives were followed regarding the approaches of traditional healers in the treatment of HIV/AIDS: (i) to assess how traditional healers and people living with HIV/AIDS in Tsengiwe village understand HIV/AIDS, (ii) to investigate the reasons people living with HIV/AIDS consult traditional healers in Tsengiwe village, (iii) to assess Tsengiwe village traditional healers’ treatment strategies for HIV/AIDS, (iv) to establish how traditional healers view their role in the treatment of HIV/AIDS in Tsengiwe village. A qualitative research design was utilized, using in-depth interviews with traditional healers and focus group discussions with caregivers and people living with HIV/AIDS respectively. A type of non-probability sampling known as purposive sampling was used. A total of sixteen (16) participants were interviewed. The findings in this research revealed the following themes: (i) HIV/AIDS is incurable and it is understood by symptoms, (ii) belief system entrenched in traditional healing, (iii) cleansing rituals and traditional medicinal remedies and, (iv) strengthening relations between stakeholders. While traditional healers expressed a willingness to work with biomedical professionals in the management of HIV/AIDS, caregivers and people living with HIV/AIDS preferred going to clinics and hospitals for treatment. Furthermore, people living with HIV/AIDS in this research never admitted to consulting traditional healers for their ailments, only saying that they choose to self-medicate.