This research is a qualitative study of a short project set up to explore the uses of a visual arts-based approach for addressing HIV and AIDS through teacher development. It was undertaken at the University of KwaZulu-Natal in the face of the HIV and AIDS pandemic. It responds to the suggestions that teachers need to explore their own understanding, attitudes and perceptions of the disease if they are to deal confidently with the demands it places on them as educators in schools. Thirteen preservice teachers, who had enrolled in a guidance course, used photographs and drawing to capture their views of HIV and AIDS and to construct messages for their peers. Methods for the approach were adapted from the work of Ewald and Lightfoot (2001) and from Wang’s (1999) photo-voice. A visual arts-based approach was chosen for its potential to simultaneously engage the mind, body and emotions (Weber & Mitchell, 2004). Drawing on the conceptual work of Banks (2001), Hall (1997) and Fairclough (1995), the photo texts were then analysed by the researcher who saw them as socially and culturally embedded constructions and was interested in how they were affected by and could have an impact on culture and social discourses. Reflections on the photo texts and their associated processes by both the researcher and pre-service teachers lead to suggestions as to the pedagogic possibilities of using a visual arts-based approach in education to address HIV and AIDS. The thesis concludes with discussion of what a visual arts-based approach can contribute to HIV and AIDS in teacher education and comments on the challenges and limitations of such an approach. / Thesis (PhD.)-University of KwaZulu-Natal, 2006.

HIV infection has risen to pandemic proportions. Interleukin-10 (IL-10), a potent antiinflammatory cytokine has been shown to enhance the establishment and persistence of chronic viral infections through inactivation of effector antiviral immune responses and it may also directly influence HIV-1 replication in cells of diverse lineages. IL-10 promoter polymorphisms have been shown to affect HIV-1 susceptibility and pathogenesis. However, the underlying mechanisms are poorly understood. We investigated the relationship between IL-10 promoter variants, plasma IL-10 levels, and markers of disease outcome in chronically HIV-1-infected individuals. To investigate the mechanistic role of IL-10 and its genetic variants on HIV pathogenesis, we studied markers of activation on B cells, CD4+ and CD8+ T cells, and assessed effects on CD4+ T cell proliferation with and without blockade of the IL- 10 pathway. We used Taqman genotyping assays to genotype three IL-10 promoter single nucleotide polymorphisms (SNPs) in our study cohort. Baseline plasma IL-10 levels were measured using Luminex technology for 112 individuals. Viral load, CD4+ T cell counts and cytotoxic T lymphocyte (CTL) immune responses were measured at baseline. The rate of CD4+ T cell decrease was calculated in 300 individuals with a median follow-up of 25 months. CD38, CD95, Ki67, IgG and PD-1, markers of activation or exhaustion were measured on B cells, and CD38, CD95, Ki67, HLA-DR and PD-1 were measured on CD4+ and CD8+ T cells in a subset of 63 individuals. CD4+ T cell proliferation was measured using Carboxyfluorescein succinimidyl ester (CFSE) assays, following IL-10 receptor blockade in a subset of 31 individuals. The IL-10 -1082G, -592A and -3575 variants were observed at frequencies of 0.3, 0.34 and 0.23 respectively, in our study cohort. Plasma IL-10 levels were significantly higher in the - 1082GG group than in the combined AA/AG group (p=0.0006). There was a significant association between the 592AA genotype and a greater breadth of CTL responses compared to the CC and CA (p= 0.002 and 0.004 respectively). The -592AA genotype associated significantly with an attenuated loss of CD4 cells (p= 0.0496), with -592AA having the least change in CD4 cells per year. The median expression of HLA-DR, a marker of T cell activation was significantly higher in the-1082AA group for CD8 cells (p= 0.047), and the - 592AA group for CD4 T cells (p= 0.01). The median expression of IgG on the surface of B cells was significantly higher in the -1082GG genotype and the -592CC genotype (p=0.0183 and 0.0659 respectively). Overall, IL-10 variants correlated with IL-10 expression and CD4 decline during chronic HIV-1 infection. IL-10 promoter variants may influence the rate of HIV-1 disease progression by regulating IL-10 levels, which in-turn, may affect the breadth of CTL responses. Furthermore, the increased expression of HLA-DR and PD-1 on CD8+ and CD4+ T cells, indicates that lower IL-10 levels are associated with increased immune activation and immune exhaustion. The increased expression of IgG on B cells, suggests that in a setting of lower IL-10, there is possibly a bias towards a Th2 immune response. These data suggest a significant role for IL-10 genetic variants and IL-10 in HIV pathogenesis. Further studies to determine whether and how the IL-10 pathway may be manipulated for therapeutic or vaccine strategies for HIV are warranted. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.

Background: in 1987, the first child with HIV-1 infection was identified in the paediatric wards at King Edward VIII Hospital in Durban. This made paediatricians aware that the epidemic had spread to the children of KwaZulu/Natal. Although information on transmission and natural history was becoming available from developed countries, little was known about the disease in developing countries. It was important to determine transmission rates and disease patterns in the local population, in order to appropriately counsel women, and for management of infected infants. In addition, with resources for laboratory diagnoses being limited in developing countries, much emphasis had to be placed on clinical findings for identification of infected children. In 1989, a retrospective analysis was made of the HIV-infected children seen over a 2-year period, between 1987 and 1989. Nine such children were identified and their clinical and biochemical features were described. It was concluded that HIV infected children presented with an identifiable pattern of signs, fairly similar to that described for children in industrialised countries. With these findings, a prospective study was undertaken, to determine the vertical transmission rate, the factors affecting this rate, and natural history of vertically transmitted I-IIV-1 infection. ix KwaZulu/Natal, being at the epicentre of the epidemic in South Africa, was a natural site for the study. Patients and Methods: a trained research worker was placed in the antenatal clinic at King Edward VIII Hospital for the specific purpose of educating, counselling, and testing of all women attending the clinic. Women attending the clinic for the first time in the index pregnancy were offered HIV testing if informed consent was obtained. Blood for HIV serology was drawn at the same time as sampling for the obligatory syphilis serology. The acceptance rate for sampling was > 95%. The majority of the women attending the clinic were black, and first attendance was generally late, into the third trimester. The same research worker was responsible for post-test counselling which was offered to all the women, not only those who tested positive. This research worker was also responsible for obtaining maternal consent for entering the newborn infant into the study. All newborn infants were seen within 48 hours of birth. At this time they were examined, growth parameters were recorded, and initial blood samples taken. These infants were then followed-up at 1 month, 2 months, 3 months, then at 3-month intervals up to 18 months, then at 6-month intervals. At each visit, a thorough clinical examination was performed, growth measurements taken, and development assessed. Record was made of any interim illness and visits to health centres, and of hospital admissions. Method of feeding was note& and details on immunisation obtained from the child's immunisation card. The children received all the x routine childhood immunisations according to the national regimen, based on WHO recommendations. Mothers were asked to bring the child to the follow up clinic for any problem, so that episodes of illness would not be missed. The women were reimbursed for transport costs to encourage follow up visits. Calculation of transmission rate and classification of infection status were made according to the recommendations of the Ghent workshop. Children were regarded as infected if they were antibody positive at 18 months or had an HIV related death. They were classified as uninfectd if the antibody test was negative at 9 months of age. Those infants who were lost to follow up before the age of nine months whilst still antibody positive and those whose cause of death could not be determined, were classified as indeterminate. The diagnosis of AIDS was based on the WHO criteria. Blood samples were taken at birth, at age one and three months, then at three month intervals to 18 months; thereafter at six month intervals. Sera were tested for HIV1 antibodies by a commercial enzyme-linked immunosorbent assay,ELISA. Samples that tested positive were confirmed by two tests, a Roche Elisa and by an immunoflourescent assay (IFA). A sample was regarded as being positive if both the second ELISA as well as the IFA or the Western Blot tested positive. xi Results: between October 1990 and March 1993, 234 infants and their 229 mothers were entered into the study. Those who did not attend a single follow up after birth were excluded from the study. The final cohort comprised 181 infants, of whom 48 were classified as infected ( including 17 deaths); 93 not infected, and 40 as indeterminate ( including 8 deaths). Maternal Data: about 60% of the mothers were under 30 years of age and were multiparous; 18% tested positive for syphilis serology; 22.9% were anaemic during pregnancy, and 37% were delivered by caesarean section. Most women lived in urban areas, and 16% chose to bottle-feed exclusively. Vertical Transmission Rate and Factors affecting this Rate: the median vertical transmission rate was 34%, (95% confidence intervals, CI 26%-42%). This figure is similar to that found in most parts of Africa, but much higher than those for Europe and USA. The maternal factors found to be associated with an increased risk of transmission were vaginal deliveries and a low haemoglobin level during pregnancy. Breastfeeding, Transmission, and Outcome: breastfeeding was found to have an increased risk of transmission, by 15 % (CI 1.8-31.8). On assessing growth and morbidity, it was noted that breastfed infants were not protected against such common childhood infections as pneumonia and diarrhoea, and that failure to thrive occurred with equal frequency in both those breastfed as well as those receiving artificial feeds. Newborn Data: when comparing newborn data between those infants who were subsequently found to be infected with those who were uninfected, it was found that there were no major differences between these groups with regard to growth parameters and neonatal complications. However, those infants with rapidly progressive disease (those who died within 24 months), were noted to have lower mean birth weights and lengths, a higher frequency of low birth weights, and tended to have more neonatal problems. Clinical Manifestations: the first differences between the infected and the uninfected infants generally manifested from about 3 months of age. HIV infected children were identifiable by higher frequencies of thrush, lymphadenopathy, skin rash, and hepatosplenomegaly in the early stages, and later on with a higher tendency to neurological and developmental abnormalities, as well as of diarrhoea. Pneumonia was found with equal frequencies in both the infected and uninfected children. The HIV infected child could be distinguished fairly early in life by the combination of the manifestations described above. Progression to AIDS: AIDS was diagnosed in 44% of all the infected children during the study period. Ninety five percent of these children were identified by 12 months of life, showing a rapid progression of the disease Longitudinal Growth: when longitudinal growth parameters were analysed in this cohort, it was found that HIV infected children were stunted from as early as 3 months of age, and remained below the international standards into early childhood. Infected children were also found to be malnourished (i.e. weight for age below international means), from an early age, and this persisted throughout early childhood. Of note, the uninfected childrens' weights, although comparable to international means initially, dropped after the first year of life. However, both groups did not have significant wasting, when compared to international means. Mortality: there were 25 known deaths during the study period. Of these, 17 were classified as HIV-related, and 8 as indeterminate. The mean age at death was 10.1 months, with 83% of all the HIV-related deaths occurring within the first year of life. The commonest diagnoses at the ti me of death were diarrhoea, pneumonia, and failure to thrive; also, thrush was common, as were neurological abnormalities. / Thesis (MD)-University of Natal, Durban, 1999.

Since the 1994 International Conference on Population and Development there has been a shift away from meeting demographic targets towards meeting the reproductive goals of individual men and women. Partially as a response to the increase in the level of HIV infection, and the associated high levels of STIs, there has been an increasing focus on integrating HIV/STI services within mainstream Maternal Child Health and Family Planning programmes. Thus clients attending clinics that provide integrated services have the opportunity to receive multiple services during a single visit to a facility. The aim of this research was to evaluate the process of integrating FPIMCH and STI/HIV services in urban and rural areas within KwaZulu-Natal, using data gathered form semi structured interviews with clients leaving the health facilities. The research also examined the overall quality of care received within the integrated clinics. The results show that clients rarely receive a range of services on a single visit, despite the integration of services. In most cases, clients do receive the services for which they attended the health facility. However the study found that providers are missing important opportunities to inform, educate and counsel clients on a variety of reproductive health matters. This is important if we are to avoid the negative consequences of an unwanted pregnancy and STIs (including HIV/AIDS). It was also found that the overall quality of care within integrated clinics was low amongst all clients attending the facility. / Thesis (M.Dev.Studies)-University of Natal, Durban, 2003.

In South Africa 1 000 people die of AIDS everyday and 100 000 more people require ARVs every year. There is therefore an urgent need to provide access to ARVs andother essential medicines. The South African Constitution requires the government totake reasonable measures to ensure access to health care. The government has cited financial constraints as the major ohstacle to fulfilling this constitutional imperative. In an effort to stretch their budgetary resource other medium-income countries have used measures such as compulsory licences, voluntary licences and parallel importation. These measures, provided for in the TRIPS Agreement and the Doha Declaration, are available under South African legislation but have not been properly implemented due to a lack of political will. The proper use of compulsory licences by the South African government is vital because all twelve of the ARVs on the World Health Organisation's Essential Medicines List are protected in South Africa by our patent laws. However, in order to issue compulsory licences more easily and quickly the South African Legislature will need to pass legislation which clarifies the ambiguities contained in TRIPS and the Doha Declaration. Other methods to lower the price of medicines include the segmentation of the South African market in order to facilitate differential pricing. The State must balance its use of such measures with programmes to incentivise research and development into neglected diseases and HIV/AIDS. Such programmes will also assist the State's capacity to conduct its own research and development into new medicines, whilst bolstering its domestic pharmaceutical manufacturing capacity. The ultimate solution to South Africa's access to medicine problem is to create a pharmaceutical manufacturing industry capable of producing the most complex medicines, so as to lessen its dependence on drug manufacturers reducing their prices. The way to create a sophisticated pharmaceutical manufacturing capacity is to use the flexibilities in TRIPS and to uphold South Africa's high patent standards. The Constitutional Court's involvement is essential in order to force the State to implement its own policies so as to provide access to affordable medicines. / Thesis (LL.M.)-University of KwaZulu-Natal, Durban, 2008.

The purpose of this study was to determine teacher engagement with HIV/AIDS education in primary school. Since the emergence and acknowledgement of the HIV/AIDS epidemic in South Africa, the national education department's policy has advanced HIV/AIDS education as a priority. The new curriculum has opened up opportunities for HIV/AIDS education to be inserted in the curriculum especially in the learning area Life Orientation in the primary school, which previously did not exist. There is a paucity of research documenting teachers' experiences on the implementation of the HIV/AIDS curriculum. The manner in which teachers engage with the HIV/AIDS curriculum is not known. This study focused on 9 teachers in the intermediate and senior phases in a particular primary school in KwaZulu Natal who have had experience in the implementation of the HIV/AIDS curriculum over the past four years in their school. A survey questionnaire was administered to all educators in the study. The three intermediate educators participated in face-to-face interviews as well as a focus group discussion. An interview was conducted with the member of the management team who was part of the sample. The results from the survey, interviews and focus group discussion suggest that teachers were strongly implementing the HIV/AIDS curriculum in their classrooms while experiencing some practical challenges. This study also suggests that the educators found the Department Of Education's implementation plan suppressive. All three intermediate phase teachers used creative methods to assist in the implementation of the curriculum. The respondents claimed that the workshops and meetings that they had attended were invaluable to them. They however preferred seeing the community more closely involved in the fight against HIV/AIDS, as this was not an issue confined to the school exclusively. Teachers would also liked to have had HIV/AIDS education implemented across the curriculum, as the task to empower learners in this regard was a mammoth one. The unique and challenging experiences of teachers implementing the HIV/AIDS curriculum must be documented before any theoretical positions can be articulated about the implementation of HIV/AIDS education in primary schools in South Africa. This study has contributed to research on the implementation of HIV/AIDS education in primary school by providing some insight into a group of educators' experiences. / Thesis (M.Ed.) - University of KwaZulu-Natal, Durban, 2004.

The effects of the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS)-related stigma in Ndweni preclude learning and the humane treatment of people living with HIV or AIDS (PL WHA). This is because stigma contributes to the isolation, marginalization and vulnerability, all of which do more harm than good to people infected and affected. Countering HIV and AIDS-related stigma implies addressing, among other things, the private contexts within which it occurs. While redress mechanisms may have effected systematic change, HIV prevention and AIDS-related education would interrupt the cycles of ignorance, prejudice, violence and sexism that exist at both school and community levels. This study of the Ndweni Primary School and the surrounding community focuses on the HIV and AIDS-related stigma and its effect on learners. The findings reveal that HIV prevention and AIDS-related education is being marginalized by both educators at Ndweni Primary and members of the community. Although the learners gained some knowledge from occasional interaction with personnel from Ndweni Child Welfare, Ndweni Clinic, and volunteers, they retained most of their parents' views on HIV and AIDS. Within Ndweni Community, people do talk about the epidemic, but this is always in secret hushed tones and indirectly to PL WHA, waiting for them to 'break the silence' and disclose their status. The findings reveal, furthermore, the interconnectedness between poverty, prejudice and ignorance, violence and gender politics to the HIV and AIDS stigma. I used social justice theories of oppression by Freire (1970), Hardiman and lackson (1970) and others that focus directly on marginalization of PL WHA as well as of HIV and AIDS information. My recommendations include research into foster care birth documentation for placement of orphans within the education system and a merging of both educational and social institutions to keep a documented track of children who get lost once they transfer from schools or relocate to other areas. This thesis can be regarded as a step forward in the empowering process of creating knowledge and an understanding of HIV prevention and AIDS- related education at both the school and community levels, not only in Ndweni, but for all communities like Ndweni. / Thesis (M.Ed.)-University of Kwazulu-Natal, 2005.

The rapid rate, at which HIV/AIDS is being spread, is changing the face of modern society. The alarming statistics revealed by research, bears testimony to this fact. According to Bennell (2003), the total number of HIV/AIDS maternal and two-parent orphans for subSaharan Africa is expected to increase from 9.85 million in 2001 to 18.67 million in 201 0. Education has a pivotal role to play in effectively dealing with the effects of the pandemic, as well as in creating awareness among learners on HIV/AIDS preventative education. The chief medium through which ideas are conveyed and awareness is raised, is through the use of language. The focus of this dissertation was to critically explore the language used by educators within the context of HIV/AIDS Education , at primary school level. This was done in two ways. The first was conducting an in-depth analysis of documents pertinent to HIV/AIDS Education, in an attempt to ascertain which themes, concepts and terms frequently feature in these various documents. The second was exploring these themes, concepts and terms with regard to how these were perceived and understood by the participants in the study. The translation of the meanings the participants attached to these concepts and terms, and how these translated into learning activities within the classroom context, received attention during classroom and lesson observations. A case-study design within the qualitative mode of inquiry was employed. Document analysis, observation and in-depth interviews were used to obtain data pertaining to the area of study. Three Life Orientation educators, from a suburban, co-educational school in the Kwa - Zulu Natal area, participated in the study. The Critical Discourse Analysis framework informed the study. The study also explored the usage of non-verbal signs and suggestions to convey meaning and understanding among learners. The participants' predispositions, ideologies and pre-conceived notions of what was appropriate, in terms of themes explored within the context of HIV/AIDS education, were also examined in light of any bearing these might have had in the process of facilitating understanding among learners. Due consideration was given to contextual factors, and how these might have influenced the processes of creating meaning and understanding among learners. The findings revealed by this research, provide valuable insights into some of the interpretations of some of the terms and concepts that are commonly associated with HIV/AIDS by educators. In addition, they present the possibility of alternate meanings of these terms and concepts, suggesting that multiple meanings are possible within the context of HIV/AIDS education. The implications of this study for classroom practice are numerous. / Thesis (M.Ed.) - University of Kwazulu-Natal, 2006.

This research presents an understanding of the teaching and learning practices in the context of HIV/AIDS education in the intermediate phase. Against a milieu of change and restructuring in education is the HIV/AIDS education curriculum which teachers are expected to deal with in schools. From an identity perspective, I try to understand how teaching practices which are adopted by teachers in the teaching of HIV/AIDS education either challenges or perpetuates the status of HIV/AIDS in society. Therefore the focus of this study is primarily the teacher. By employing Samuel's Forcefield Model as a structure for this study, I demonstrate how the choices that the teacher makes in teaching practice, are shaped by a range of diverse forces, which are frequently in conflict with each other. In this study I want to understand how teachers are engaging with their new roles and multiple responsibilities (as described in The Norms and Standards for Teacher Educators) when teaching HIV/AIDS education in the intermediate phase - given that this aspect is a relatively new dimension to the curriculum. From a methodological perspective, the collection and analysis of data were consistent with the Hermeneutic research paradigm. For the purpose of this study interviews and questionnaires were used to collect data from educators. Furthermore, in order to present a more holistic picture of the teacher and to ascertain to what extent, what the teacher teaches is actually what the learner learns, data was also collected from learners via observations, conversations and through an analysis of drawings and poems. It must be emphasised that although learners in this study play a pivotal role as sources of data, they are not the unit of analysis for this study. Thus the major part of this thesis focuses on the teacher. The findings of this study indicate that the guiding principles of a teacher's life, such as race, religion and culture are important forces that mould what, why and how teachers teach HIV/AIDS education in the intermediate phase. On the other hand, the forces that mould learners' experiences of HIV/AIDS education is determined by the social environment that the learner lives in. The forces that shape what the teacher does are not the same as the forces that shape what the learner learns. The concept of 'othering' is predominant in the interactions between teachers and learners and teachers are socially distanced from learners, parents and the child's social environment. Hence the 'caring and sharing' as espoused by teachers is not being articulated in practice. / Thesis (M.Ed.)-University of Kwazulu-Natal, 2005.

Using Soft Systems Methodology, this dissertation presents an evaluation of the incidence of HIV/AIDS among ABET educators and learners in the Lebombo Ward Centres. The researcher aims to recommend ways and means that it is hoped could decrease the alarmingly high death rate of educators and learners in this part of northern KwaZulu-Natal. The painful physical and emotional effects of the virulent HIV/AIDS pandemic, and also the longterm consequences for both individuals and their families, are making many ABET educators' lives extremely complex and difficult. Many ABET Centres are facing teething problems connected to HIV/AIDS because centre managers and tutors do not have sufficient knowledge, skills and resources to be able to cope proactively and resourcefully with the difficulties that confront them. The unabated spread of HIV/AIDS in this particular area (Lebombo) is damaging and ravaging the society and undermining education at large. The researcher also wants to contribute towards a stage being reached, both by the education authorities and by individuals within the society, at which relevant and effective ways and means can be found to understand better the underlying factors that are feeding this scourge, to transmit requisite knowledge more effectively, and to introduce measures that will begin to turn around the tragically high incidence of HIV/AIDS in this area. Further, the researcher will point to, and explore, social issues and social behaviours that are impacting negatively on the spread of HIV/AIDS, such as sexual abuse of schoolgirls by educators, the widespread practising of unprotected sex by educators, the disregard for human rights that this entails, continuing gender-based prejudices, the prevalence of superstition, and the tendency among many people to disregard warnings about HIV/AIDS. / Thesis (M.Com.)-University of KwaZulu-Natal, 2008.