Infection with HIV-2 has important implications for the diagnosis, treatment and management of the infection. The objective of this study was to describe the seroprevalence and molecular epidemiology of HIV-2 in KwaZulu-Natal – the province with the highest HIV prevalence in South Africa, which in turn is the country with the highest HIV prevalence in the world. HIV-1 positive samples were screened using a rapid test for HIV-2. Samples showing antibody positivity were subject to molecular confirmation by PCR and / or serological confirmation by Western blot. There was a large difference in results (10.6% by Western blotting versus 0% by PCR). This discrepancy between molecular and serological confirmation by Western blot. There was a large difference in results (10.6% by Western blotting versus 0% by PCR). This discrepancy between molecular and serological confirmation was attributed to cross-reacting antibodies. The use of rapid tests and Western blots for HIV-2 diagnosis in South Africa, should, therefore, be interpreted with caution. Based on the results of this study, HIV-2 is most probably not present in KwaZulu-Natal. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

HIV is known to affect the epidemiology, transmission, pathogenesis and natural history of HCV infection whilst studies on the effects of HCV on HIV have shown conflicting results and are confounded by the influence of intravenous drug use and anti-retroviral therapy. This study was conducted in KwaZulu-Natal Province in South Africa where HIV is predominantly a sexually transmitted infection. Intravenous drug use is rare in this region and the study population was naive to anti-retroviral therapy. For this study, specimens from selected sentinel sites submitted to a central laboratory for routine HIV testing were screened for anti-HCV IgG antibodies. HIV positive HCV-positive patients were compared to HIV-positive HCV-negative patients in a subgroup of patients within this cohort in order to determine if HCV sero-prevalence was associated with clinical outcomes in a linked anonymous retrospective chart survey. The prevalence of HCV was 6.4% and that of HIV, 40.2%. There was a significantly higher prevalence of HCV among HIV infected patients as compared to HIV negative patients (13.4% vs. 1.73% respectively). HCV-HIV co-infected patients had significantly increased mortality (8.3 vs. 21%). A significant association was found between HCV serostatus and abnormal urea and creatinine levels. Hepatitis B surface antigen seropo-sitivity was not found to be a confounding factor. This study has found that hepatitis C co-infection is more common in HIV positive individuals and is associated with an increased mortality and renal morbidity. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

Background:- The HIV and AIDS epidemic is a major catastrophe that affects millions of people worldwide. Antiretroviral medication combinations have revolutionised HIV treatment since 1996, transforming the virus from a death sentence to a manageable condition. In order to obtain full therapeutic benefits it is vitally important that patients adhere to their prescribed medication. Being informed about the disease and medication contributes to patient adherence and management. Pharmacists are considered to be the most accessible health professional and can help HIV -infected patients deal with barriers to medication access, manage adverse effects and medication interactions, and adhere to medication regimens by appropriate counselling. The public sector is defined as that part of an economy that is controlled by the state. At the study site, which is a public sector facility, the roll out of antiretroviral medication started in 2006. At the time all patients were counselled by trained counsellors, before seeing a doctor. At the pharmacy the medication was collected with no intense counselling by a pharmacist as the patients would have visited the trained counsellors first. Subsequently it was found that there were many queries regarding HIV and AIDS. It was then decided in October 2007, that the pharmacist support the counselling done by the counsellors in that they should reinforce what was said by the counsellors, together with giving detailed information to patients on their health and medication. This study was therefore undertaken to measure pharmacists' role in the management and adherence of HIV infected patients at this institutional facility. Method: The study was undertaken at a public sector health facility using anonymous structured questionnaires and was divided into 3 phases: Pre-Intervention, Intervention and Post-Intervention phases. After obtaining patient consent the questionnaires were administered during the 1st phase. A month later all patients visiting the pharmacy were counselled intensely on various aspects of HIV and the antiretroviral medication. Thereafter patients who took part in phase 1 were asked to participate in the 2nd phase. After obtaining their consent again, the same questionnaire was administered to them. Quantitative variables were compared between pre and post intervention using paired t-tests or Wilcoxon signed ranks tests. Categorical variables were compared using McNemar's chi square test (Binary) or McNemar-Bowker test for ordinal variables. Results: A response rate of 87.5% was obtained with the majority of the patients being female. Almost 70% of the participants were in the age-range of 21-40 years old. The majority of the participants did not have post school education. Most of the participants (95.4%) did not know that HIV is a virus that causes AIDS in the pre intervention phase, but this decreased to 93.7% in the post intervention phase. The participants knowledge of people who have sexually transmitted diseases are least at risk of getting HIV, healthy food will cure HIV and smoking and drinking alcohol will weaken the HIV virus, increased significantly from the pre-intervention phase to the post intervention phase. Knowledge on the modes of transmission either increased or remained unchanged. Overall the mean knowledge score on the disease itself had increased significantly (SD 6.6%) [p<0.01] after the pharmacists' intervention (pre-intervention was 82.1 %, post-intervention was 86.3%). In both phases, over 40% of all patients stored their medication in the cupboard. The majority of the patients took their medication either with or without food at both phases of the study. After the intervention, the frequency of taking medication with a fatty meal or any time they remember was decreased to 0. A significant improvement was noted in the overall knowledge score with regards to medication taking and storage (p<0.05). Conclusion: Pharmacist intervention had a positive impact on HIV infected patients' HIV and AIDS knowledge on the disease and on the antiretroviral medication use and storage. / Thesis (M.Pharm.)-University of KwaZulu-Natal, Durban, 2011.

This dissertation focuses on how important factors such as gender inequalities and gender vulnerabilities contribute to fuelling the spread of HIV/AIDS. The study focuses on a community in Phoenix, called Clayfield. The study examines aspects of masculinity, sexual relations, socio-economic vulnerabilities and domestic violence and demonstrates how these elements predispose women and girls to HIV infection. As a result of gender inequalities and imbalances, women are vulnerable to HIV infection. The study also explores how risky behaviour, by both men and women, can escalate women's vulnerability to the disease. The central argument engages discussion on crucial issues around gender imbalances and vulnerabilities. The study concludes with recommendations pertinent to challenging present gender-based initiatives and interventions, and suggests possible gender-sensitive strategies that could assist in curbing the spread of the disease. / Thesis (LL.M.)-University of KwaZulu-Natal, Westville, 2007.

By knowing the incidence of an infectious disease, we can ascertain the high risk factors of the disease as well as the e ectiveness of awareness programmes and treatment strategies. Since the work of Hugo Muench in 1934, many methods of estimating the force of infection have been developed, each with their own advantages and disadvantages. The objective of this thesis is to explore the di erent compartmental models of infectious diseases and establish and interpret the parameters associated with them. Seven models formulated to estimate the force of infection were discussed and applied to data obtained from CAPRISA. The data was agespeci c HIV prevalence data based on antenatal clinic attendees from the Vulindlela district in KwaZulu-Natal. The link between the survivor function, the prevalence and the force of infection was demonstrated and generalized linear model methodology was used i to estimate the force of infection. Parametric and nonparametric force of infection models were used to t the models to data from 2009 to 2010. The best tting model was determined and thereafter applied to data from 2002 to 2010. The occurring trends of HIV incidence and prevalence were then evaluated. It should be noted that the sample size for the year 2002 was considerably smaller than that of the following years. This resulted in slightly inaccurate estimates for the year 2002. Despite the general increase in HIV prevalence (from 54.07% in 2003 to 61.33% in 2010), the rate of new HIV infections was found to be decreasing. The results also showed that the age at which the force of infection peaked for each year increased from 16.5 years in 2003 to 18 years in 2010. Farrington's two parameter model for estimating the force of HIV infection was shown to be the most useful. The results obtained emphasised the importance of HIV awareness campaigns being targeted at the 15 to 19 year old age group. The results also suggest that using only prevalence as a measure of disease can be misleading and should rather be used in conjunction with incidence estimates to determine the success of intervention and control strategies. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

Introduction Willingness to participate in clinical trials is a crucial element in recruitment of suitable participants for intervention trials. Measurement of willingness to participate assists in determining community preparedness for clinical trials, such as HIV vaccine trials. Therefore, researchers have developed a Clinical Research Involvement Scale (CRIS) to assess willingness to participate modelled on the Theory of Reasoned Action. The CRIS was tested in the USA and was noted that it would benefit from additional testing in other populations. Aim The purpose of this study is to determine whether racial differences exist in willingness to participate and explore potential factors associated with willingness to participate in HIV prevention research. Methods A cross sectional analytic study was conducted. The CRIS was administered to university students aged 18-45 at the University of KwaZulu-Natal in South Africa. The CRIS was administered online with a demographic questionnaire to facilitate evaluation of possible associations between willingness to participate and age, gender, relationship status, parity, religion, education status, student status, employment status and access to private health care. Participation was once-off at the time of completing the scale. Results The study enrolled 636 participants, two thirds being female. An effective sample size of 509 was considered for analysis after data was cleaned for accuracy and completeness. The results indicated that all students across all race groups were willing to participate in HIV prevention research. However, when considering factors that affected willingness to participate, statistically significant differences were noted. Based on the differences amongst these factors, Black students expressed greater intention to participate compared to White and Indian students. The CRIS was deemed a reliable instrument in this population; however in its current structure it did not show strong validity. Validity improved if the factors of motivation to comply and outcome evaluations were removed in this population. Discussion The study findings are specific to students of the University of KwaZulu-Natal and cannot be generalized to other populations. The racial differences in factors that affect willingness to participate indicate differences in risk perception and seeking access to better quality healthcare. Recommendations The CRIS should be used in other student populations to assess its validity. (350 words) / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

The purpose of this study was to investigate coping strategies employed by low-income households of Sweetwaters KwaZulu-Natal, who have members who are infected with HIV in ensuring food security when dealing with HIV/AIDS. This study was based on households who have members living openly with HIV/AIDS and who were members of a support group of HIV positive people. This study was conducted between July 2003 and June 2004. Focus group meetings were conducted with a support group of 26 members (Philani Support Group). Questionnaires, group discussions and observations were used to collect data from households. In order for the study to investigate coping strategies, the following sub-problems were investigated to measure changes before and after illness or death in household: changes in finances, changes in food habits, social aspect of studied household which included infrastructure (housing, roads, water, sanitation and energy); external and internal support. There were no major differences in coping strategies, but the structure, resources and size of households informed their coping strategies. Food was the centre of all activities of households. As the ability of the household to produce food or earn income decreased, the need for food increased. Government social grants have been shown to be the main resource for coping (they enabled households to cope or survive). It is recommended that low-income households affected by HIV/AIDS and totally dependent on grants should be helped not to develop a dependency syndrome by implementing strategies that will encourage active participation and deal with passiveness that exists within low-income households of Sweetwaters affected by HIV/AIDS. As this study indicates that there are no resources on which concerned households depend, it suggests a greater need for capital to boost the household and strategies for households to be able to sustain themselves. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

In South Africa commercial agriculture employs approximately 8.5% of the national workforce. Therefore, information about commercial farmers’ perceptions of and management responses to the HIV/AIDS pandemic are likely to be of interest to policy makers and non-governmental organisations (NGOs) in the health sector, as well as practitioners in rural development and commercial agriculture. HIV/AIDS affects businesses such as commercial farms by decreasing productivity, increasing costs and therefore decreasing overall profitability. Farm business’ responses to the challenges posed by HIV/AIDS may advantage or disadvantage farm workers. For example, farm workers are highly vulnerable to burden-shifting activities (practices which reduce the cost of HIV/AIDS to the employer, such as the outsourcing of low-skilled jobs). However, farm businesses may also play a substantial role (e.g., by providing formal adult education or access to clinics) in addressing the HIV/AIDS epidemic in rural commercial farming areas of KwaZulu-Natal and in South Africa generally. This study presents an analysis of KwaZulu-Natal commercial farmers’ perceptions of and management responses to the HIV/AIDS pandemic. This analysis identifies the farm, business and personal characteristics of the various respondents. It is important to know this information because it assists in understanding why commercial farmers are responding as they are, which will in turn assist in future HIV/AIDS policy planning. The analysis is based on a postal census survey of Kwanalu (KwaZulu-Natal Agricultural Union) commercial farmer members in April and May 2007. Results suggest that, on average, Kwanalu members are highly concerned about the impact of HIV/AIDS on their businesses. A majority of respondents perceived HIV/AIDS to negatively affect the current and future profitability of farming, increase labour absenteeism and staff turnover rates, and reduce labour productivity. An analysis of variance (ANOVA) of the data shows that respondents’ management responses to the HIV/AIDS pandemic varied by farm size and enterprise type, but include paying higher than average wage rates to attract and retain healthy and productive workers, multi-skilling staff to provide back-up skills, and mechanisation to defer costs of HIV/AIDS. Respondents tended to believe that effective HIV/AIDS treatment and prevention programmes require an integrated approach between government, employers and employees. Two response indexes were calculated: (1) ranking by adopters only (only those who use a certain response are included) and (2) ranking by all respondents (a response is not used by a respondent automatically scores zero). The response indexes showed that resource-intensive HIV/AIDS services such as provision of antiretrovirals (ARVs) and nutritional supplements are ranked high by actual adopters, but relatively low overall (as only a small proportion of respondents are adopting these strategies) in the ranking by all respondents. Burden-shifting practices (e.g. mechanisation) are ranked relatively high in both rankings, indicating that respondents rate them as important in managing HIV/AIDS, and that many respondents are utilising them. Relatively inexpensive HIV/AIDS services (e.g. informal communication) are ranked low by actual adopters but high on the overall index as many respondents are using them (but doubt their effectiveness). A linear regression analysis was conducted on principal components from the response indexes to identify characteristics of “high” and “low” responders and of those who utilise burden shifting activities or HIV/AIDS services. The characteristics of “high” responders are that they perceive HIV/AIDS to impact on costs; they employ a high proportion of skilled labour; and they have high turnovers and high debt servicing obligations. Responders who employ large amounts of labour (particularly permanent labour); who perceive HIV/AIDS as the responsibility of the employer; who are older and more experienced; and who have a relatively high debt: asset ratio tend to use HIV/AIDS services to manage the impacts of HIV/AIDS. Many respondents already play an important but inexpensive role in HIV/AIDS prevention and treatment through encouraging voluntary HIV testing and providing staff with information and transport to clinics. Policy makers should take this into consideration when formulating HIV/AIDS policies to combat the pandemic.

Three recent Randomised Controlled Trials (RCTs) have been able to deduce that Medical Male Circumcision (MMC) can reduce a heterosexual man’s chances of acquiring HIV through vaginal sexual intercourse by approximately 60% (Auvert et al. 2005; Gray et al. 2007; Bailey et al. 2007). In 2010, based on WHO recommendations, South Africa commenced a nationwide roll-out of MMC services. However, in the wake of these findings have come concerns that decreases in men’s perceived risk of contracting HIV could spark increases in risky sexual behaviour (risk compensation), in turn, driving up HIV incidence as opposed to abating it (Cassell et al. 2006). Accordingly, the World Health Organisation has identified social change communication as one of the ten key elements critical to the success of a wide scale MMC roll out (WHO & UNAIDS, 2010). Aside from creating demand, the role of MMC health communication efforts in crafting messages delineating the scope of MMC’s protective ability is paramount; especially in South Africa, a country hamstrung by a weak public health sector that can ill afford any regression in the fight against HIV and AIDS. This thesis provides a small-scale qualitative study that investigates both the motivating and discouraging factors impacting on men’s choices to undergo MMC, as well as exploring how and what ‘key messages’ of Medical Male Circumcision media and information initiatives are being received. In this way, my study hopes to bring insight into not only risk compensation associated with MMC, but also to provide a glimpse into the condition of health communication for MMC in the South African context. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Durban, 2012.

As the burden of HIV and AIDS ncreases in different communities of the world today, new organizations are being formed to help mitigate its impact. The current study assessed whether Christian fa th-based organizations (FBOs) were making any contribution to mitigate the impact HIV and AIDS in Pietermaritzburg area using a case study of the ESSA Christi AIDS Programme (ECAP). ECAP has been involved in training churches in HI and AIDS awareness, home-based and orphan care, assisting churches to initiate c urch-related projects, and facilitating the Church and AIDS course to the theology s udents at the Evangelical Seminary of Southern Africa (ESSA). The population of this study comp ised twenty (20) ESSA graduates who took the HIV and AIDS course between 19 9 and 2000. The self-administered questionnaire was sent to all twenty to assess hether they experienced any change in their thinking, attitude and behaviour to'jards people with AIDS as a result of taking the Church and AIDS course, and wHat HIV and AIDS-related activities they were involved in. An interview schedule with two phases, was used to collect data. The first phase elicited data from six (6) ECAP stakeholders to establish a brief historical background of ECAP. The second hase elicited data from ten (l0) church ministers in whose churches ECAP conduc ed its training to assess whether the ECAP's training programmes made any di erence in their attitude and behaviour towards people with AIDS, and what HIV a AIDS projects they started as a result of getting being trained. Although the study could not ge eralize the results because of the case study methodology, the results showed th t ECAP was making significant contribution to the fight against AIDS epidemic no only in the communities of Pietermaritzburg but also in other countries where the EISA graduates were working. However, lack of enough human and financial resour es is affecting ECAP's efficiency. Based on the findings in this study, recommen tions have been made to ECAP's method of recruiting churches for training, enues for training and its approach to HIV prevention methods. / Thesis (M.Th.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.