Background Nutrition and food security are important for maintaining a strong immune system and good general heath of People Living with HIV/AIDS (PLHA). The main aim of this study was to survey the nutritional status, habitual diet, dietary knowledge and demographic characteristics of PLHA in Nepal. A second aim of this study was to explore the voices of PLHA and policy level people on the current and possible future nutrition intervention programmes for PLHA in Nepal. Methods Using mixed methods (quantitative and qualitative) research techniques, 601 (M: 314 and F: 287) HIV positive people from the Kathmandu valley and Terai highway regions of Nepal were recruited and completed the study. All participants completed an interviewer administered questionnaire. This questionnaire includes an assessment of habitual food intake using a newly developed and validated 45-item semi-quantitative food frequency questionnaire. The validity of the FFQ was previously assessed against the 24-h multiple pass dietary recall in a sub-sample of the study population. Socio-economic and demographic information, dietary/nutritional knowledge, height, weight, waist circumferences and skinfold thickness were also collected. Finally, reported food intake was converted into energy and selected nutrient intakes (fat, protein, carbohydrate, iron, vitamin A and vitamin C) by linking with a newly compiled nutrient database of 116 food items for Nepal. Nutritional knowledge and perceptions of the current Nepalese nutritional supplementation and possible alternative interventions were explored using qualitative techniques. Four focus group discussions (FDG) and 11 in-depth interviews were carried out with PLHA and key local stakeholders respectively. Results The newly designed semi-quantitative FFQ can retrospectively assess the group mean intake for energy, protein, fat, carbohydrate, iron, carotene and vitamin C as there was no significant difference for reported intakes (all p > 0.2), but mean fat intake was significantly lower when determined by the FFQ than the 24-h recall (p < 0.001). The average age of participants was 33.8±6.4 years (mean ±SD) and 29% were classified as underweight (BMI < 18.5kg/m2). The study population typically ate a plant-based diet and intake of animal products was low, the energy intake of men and women was 1960±195 and 1880±261 kcal/d mean (±SD) respectively. Fat, protein and carbohydrate contributed 12%, 10% and 79% to total energy intake respectively. Iron and vitamin A intakes also tended to be lower than recommended, whereas vitamin C intake was satisfactory. Most participants (82%) believed that PLHA need a special diet but less than half of those reported changing their diet after diagnosis. A major reason for this was restricted income: 46% of participants reported being unable to afford sufficient food for the whole year, and 57% of those reported borrowing food for more than four months a year. Participants from FGD and in-depth interviews were not satisfied with the daily food and nutrient intake by HIV positive people. The Nepalese government currently provides a nutritional supplement for PLHA mainly for those who are on anti-retroviral treatment (ART). However, this was not satisfactory with the majority of volunteers reporting suffering negative health effects, including diarrhoea and vomiting, after consuming the supplement. Similarly, poor quality packaging, storage, delivery and lack of nutritional expertise and education were frequently reported problems for the proper implementation of the existing supplement. The participants suggested a nutrition intervention, based on a locally produced supplement, combined with dietary education and were highly motivated to support the development, implementation and evaluation of a new intervention. Conclusion Food and nutrient intakes by PLHA in Nepal were not adequate and did not meet dietary recommendations. Overall, the quality of the current nutritional supplement is poor and not suitable for ensuring maintenance of PLHA health. A nutrition intervention trial based on locally produced fortified mixed grain flour was favoured by PLHA and key stake holders. However, further research is needed to improve the nutritional status of PLHA in Nepal. Therefore, the evidence identified by this study could be used to inform the design of a new intervention. However, further research is recommended to clarify the issues.

A group multicomponent positive affect intervention for individuals with HIV was conducted with seven participants accessing an inner-city charity providing support for this population. The intervention ran over eight weeks and included a number of skills which have previously been found to improve positive affect. Outcomes were measured using quantitative scales of affect and mindfulness, and qualitative follow-up interviews. Following the intervention, positive affect and mindfulness significantly increased, and a variety of other subjective changes were also reported, although more sessions or booster sessions may have maintained these changes more effectively. These findings are in keeping with previous studies exploring the impact of multicomponent interventions with chronically ill populations. The limitations of these findings are discussed, and suggestions are made for future research, including having a larger number of participants and more carefully controlled studies.

Many severe clinical conditions encountered in Africa involve the effects of iron overload on diseases (AIDS, TB etc) and vital organs (e.g., liver). To intervene successfully in the HIV pandemic, knowledge of AIDS pathogenesis and factors that stimulate or inhibit viral replication are crucial. Iron overload is believed to cause serious damage during HIV infection. Indeed, it is believed that the metal is required by infected cells to synthesize viral particles. The consequences of excess iron in vivo include the stimulation of microorganism growth, an increase in oxidative stress and an impairment of immune system function. Iron chelation have been reported to modulate some of these effects. In a project designed to assess the effect of in vitro iron overload (also synonymously referred to as iron loading) on HIV infection, cells (HIV-infected and controls) were directly loaded with iron and desferrioxamine (DFO, an iron chelator) respectively or combined. We then performed experiments to investigate the effects of these chemicals on host cell defenses and viral replication. Effective iron loading of all cell lines used was confirmed by emission spectroscopy. Through viability assays using tetrazolium salts, flow cytometric analysis of apoptosis and necrosis using Annexin-V, and specialised ELISAS; the effect of iron loading on host cell viability, survival or death and cytokine production was studied. The effect of iron loading on virus infectivity was also investigated by looking at core protein (p24) levels and reverse transcriptase (RT) activity. Prior to the start of the bioassays, several dyes were compared during identical procedures to find an effective and consistently functional dye assay for the assessment of cell growth/viability or proliferation. Viability assays provided a qualitative picture of events while flow cytometric analysis allowed us to compare viability with specific types of cell death (apoptosis/necrosis). Excess iron in the form of 500ƒÝM FeSO4-7H2O in addition to serum iron was found to be non-toxic to cells alone but detrimental to HIV-infected cells. Equimolar amounts of DFO inhibited cell growth, cytokine production and viral replication. Our results indicate that Fe loading stimulates viral replication. Iron chelation on the other hand decreased HIV replication suggesting a possible area for further therapy research using iron chelators in situations of iron loading in the presence of HIV/AIDS. / Dr. Debra Meyer

M.Tech. / Since its discovery in 1983, millions of people worldwide have been infected with the human immunodeficiency virus (HIV). HIV is a singlestranded retrovirus belonging to the Lentivirinae subfamily of retroviruses and is responsible for the acquired immune deficiency syndrome (AIDS) (Haslett et al, 2002). The infection results in a wide range of clinical manifestations related to defective cell-mediated immunity (Beers and Berkow, 1999). At the end of the twentieth century, over 21 million individuals worldwide had died from AIDS, over 34 million were living with the HIV infection, and over 95% of HIV-infected persons resided in developing nations (Klatt, 2005). At present, 40 million people worldwide are infected with HIV/AIDS of which more than 26 million reside in Africa (Treatment Access, 2005). Sutherlandia frutescens, a medicinal plant from South Africa has documented anti-cancer and antiviral activity. One of the active compounds of this plant is L-canavanine, a cytokine-inducible nitric oxide synthase (iNOS) inhibitor (Van Wyk and Gericke, 2000). In minute doses, the iNOS inhibitor may stimulate nitric oxide (NO) release to counteract retrovirus replication. This study aimed to ascertain the effect of Sutherlandia frutescens 200CH on CD4 cell counts and symptomatology in persons infected with HIV. Study parameters involved recording of vital signs, symptomatology and CD4 analysis at three separate consultations over a ten-week period. All information was collected and collated for statistical or descriptive analysis. The research study was carried out on a random sample size of twenty-six participants, between the age of seventeen and fifty years over a period of ten weeks. Participants included both genders and had been previously diagnosed HIV-positive. Persons using antiretroviral treatment or falling into Category C as specified in the Centres for Disease Control Classification (Appendix B), were excluded from the sample group. Participants acted as own controls for the study with the use of a CD4 analysis baseline reading at the first consultation. Participants were then assessed at mid-term (week 5) and final consultations (week 10) during the study. Sutherlandia frutescens 200CH, in granule form, was taken sublingually once a day for two weeks, with participants then taking no medication for three weeks until the mid-term consultation. The treatment regimen was repeated in the second half of the study. Physical examinations to assess vital signs and opportunistic infections, completion of a health status questionnaire and report-back sessions were conducted at all consultations to determine a general symptomatic picture of research participants. Blood samples taken at all consultations were analysed for CD45+ white cell count, CD4 percentage of lymphocytes and absolute CD4 cell count. The McNemar test and a One Factor Repeated Measure (ANOVA) test were used to give statistical results and to form a profile analysis. Analysed results show that treatment with Sutherlandia frutescens 200CH significantly improves several common signs and symptoms experienced by HIV positive people, including oral candidiasis, fever and skin rashes; a number of other pathologies showed improvement, but not to a statistically significant level. The analysis of CD4 cell counts demonstrated a significant decrease of absolute CD4 cell counts during the course of the study, even in the presence of a stable CD4 percentage. Statistical analysis also indicated a lack of consistency in change of CD4 percentage and absolute CD4 between participants, as well as a lack of correlation between change of CD4 percentage and absolute CD4 changes. As NO was not tested directly no assumption can be made as to how these results might have been influenced. Further research into the use of Sutherlandia frutescens in the treatment of HIV is none the less to be recommended given its reported large number of medicinal properties and its extensive use as an herbal supplement in HIV treatment in South Africa.

M.Sc. / Therapeutic and preventative treatment are continually being sought to cease or curtail the worldwide HIV-1 epidemic. At present, therapeutic drug strategies such as highly active anti-retroviral therapy (HAART) have been particularly successful in slowing disease progression and reducing the incidence of AIDS and AIDS related mortality (Detels et al., 1998; Mocroft et al., 1998; Palella et al., 1998). However, the high costs, intricate dosing regimens and limited availability of the HAART drugs (Butera, 2000) has restricted its efficacy in developing and third world countries. As such, available and future drugs will remain inaccessible to the regions that are profoundly affected by the epidemic. An effective vaccine presents a viable solution to the HIV-1 epidemic in these countries. Approximately 70 vaccines are presently in various stages of clinical trials, the majority of which are subtype B specific (Johnston and Flores, 2001). This prevents their use in the predominantly subtype C infected sub-Saharan region of Africa, which accounts for 50% of the global HIV / AIDS population and includes South Africa, statistically the country with the highest number of people living with HIV / AIDS of any country in the world (UNAIDS, 2002). Presently there is no HIV-1 vaccine, regardless of subtype, in clinical use. This owes to several difficulties that hinder the progression of vaccine development, including the lack of predictive animal models, the establishment of viral latency and the difficulty involved in overcoming HIV-1 genetic diversity (Klein, 1999). The expansive HIV-1 genetic variation exhibited by HIV-1 is attributed to a high number of errors made by the reverse transcriptase (RT) enzyme (Coffin, 1992) and the absence of RT proofreading mechanisms during HIV-1 replication (Roberts et al., 1988; Bebenek et al., 1989). The HIV-1 nucleotide sequence drift is most frequently observed in the envelope (env) gene and expressed in env gene products (Shafer et al., 1999). Expression of the variable genome results in the production of progeny strains that are not identical to the parent strain (i.e. HIV-1 exists as a quasispecies within each seropositive individual and between individuals) and contributes to the diverse collection of viral strains in global circulation that vary across and within subtypes. Thus, for an HIV-1 vaccine to be efficient and truly functional it would be required to target this observed hypervariability and be effective against a multitude of currently circulating strains, exhibit cross-clade specificity and remain viable despite the emergence of variant strains. In this study we describe the design, synthesis and immunological ability of a multiple epitope immunogen (MEI) that mimics the hypervariability observed within the third variable (V3) loop of the envelope gp120 region of HIV-1 subtype C. Conjugation to a multiple antigenic peptide (MAP) produces a four -branched (b4) tetrameric peptide construct, designated MEIV3b4. This construct was characterized by theoretical and analytical techniques, tested in a variety of immunological assays and assessed for its potential as a candidate vaccine component. The construct was comparatively analysed through evaluation of three comparison peptides, two of which are hypervariable and based on the V3 region, the other representing a conserved region of HIV-1 envelope. The V3 peptides, named b-MEI-s and poly-L-MEI, differ from the MEIV3b4 construct in that they are less variable and less branched or conjugated to a traditional carrier rather than to a MAP system, respectively. The conserved peptide, designated CCD4 allowed for comparative evaluation between conserved and variable peptides as potential vaccine components. / Dr. Debra Meyer

M.Tech.

Magister Commercii - MCom / This study proposed a modification of the traditional cost-of-illness approach. It considered additional indirect cost parameters that yield a comprehensive cost structure for human capital at a micro level. Although HIV/AIDS is an epidemiological problem, it has enormous direct and indirect economic costs. Arguably, the most important cost associated with HIV/AIDS results from the high rates of morbidity and mortality among working age adults, the vast majority of those infected. These are essentially losses in an economy's existing stock and potential accumulation of human capital, implying lower levels of labor productivity and eventually loss of labor. These impacts are accounted for in existing macroeconomic and microeconomic impact studies. Indirect costs, such as forgone earnings due to illness, are included whereas forgone earnings of caregivers in the household are unaccounted for. / South Africa

Master of Public Health - MPH / This study focused on perceptions and experiences of pregnant women who opted in against those who opted out of voluntary antenatal HIV counseling and testing. The pregnant women's perceptions and experiences were assessed in order to gain insight into their views towards voluntary antenatal counseling and testing. / South Africa

Magister Artium - MA / This study was concerned with the social construction of HIV/AIDS at the policy level in contemporary South Africa, and how such constructions shape the manner in which the epidemic is understood in popular discourse. / South Africa

Magister Educationis - MEd / This research study attempted to highlight an in-depth exploration of my own classroom practice as a teacher at a high school in the Western Cape. A key goal of this research study was the quest for professional development and the development of an HIV/AIDS literacy programme for curriculum development. / South Africa