Background: HIV prevalence is increasing and more people are being infected despite the messages and the advertising.1 Namibia has one of the highest HIV/AIDS prevalence rates in the world of 21.3% as at end of 2002. Two hundred and ten thousand people were estimated to be living with HIV/AIDS, more than one in five adults.2 Disclosure is very important for the prevention and control of HIV infection and is an essential part of behaviour modification, access and adherence to treatment. Aim: To determine knowledge, attitudes, and practices of HIV positive patients regarding disclosure of HIV results at Betesda clinic in Namibia. Objectives: To determine the participant profile, reasons for disclosure and non disclosure, to explore attitudes, knowledge and to understand practices of HIV positive patients with regard to disclosure of HIV results. Methods: This was a cross-sectional descriptive study done at Betesda clinic a private clinic in Katutura a high density suburb of Windhoek. Two hundred and sixty three HIV positive patients tested after 2004 were entered into the study. Convenience sampling of all willing HIV positive patients was done. A questionnaire was used; a professional interpreter and a counsellor were available. Permission to conduct the study was obtained from Betesda management; ethical clearance was obtained from the Post Graduate Committee and Human Research Committee of the University of the Witwatersrand. Epi Info statistical software package version 3.4.1 July 3 2007 was used to analyze data. An expert statistician was utilized to assist with analyzing data. Results: Two hundred and sixty three respondents were entered into the study. Sixty four percent were males, 41% were married, 28% were single, and 27% were cohabitating. 68% responded positively to what they thought about disclosure. Reasons for disclosure were 32% needed help, 25% partner to go for testing and 20% to let relatives know. Reasons for non disclosure were mainly fear of gossiping 79%. Seventy three percent had disclosed 60% within one week of knowing the results. Seventy three percent had disclosed to their partners, 23% had disclosed to more than one person. People’s reactions were 43% supportive, 29% understood, 9% accepted and 6% angry. Upon disclosure 40% received help, 24% partners were tested, 23% received psychological support and 5% were stigmatized. Disclosure was found to be higher among the married and cohabitating. Conclusion: Knowledge of disclosure was positive; most thought disclosure was important and good. Attitudes and practices towards disclosure were encouraging; people were disclosing but to trusted individuals in the society and fear of stigma was still there but actual stigma was very low.

Reports from the World Health Organization (WHO) indicate tremendous advancement in the fight against HIV/AIDS infection through prevention, provision of high-quality treatment options, and psychosocial services to infected and affected individuals and communities. However, there is still a considerable number of new infections occurring among children, especially in sub-Saharan Africa. Researchers highlight the benefits of HIV status disclosure to children. Yet, there is limited research concerning the ways counselors navigate the process of status disclosure to children with an HIV diagnosis. The purpose of this study was to examine the experiences of counselors regarding status disclosure to children living with HIV in Uganda, and to determine their self-identified training needs. I utilized a phenomenological qualitative research method and conducted individual interviews using a semi-structured interview protocol with 10 counselors from three HIV care centers in the central region of Uganda. Findings indicated six overarching themes including: (1) counselors' roles and responsibilities, (2) impact of age in the disclosure process, (3) motivations for disclosure, (4) challenges and barriers, (5) counselor preparations and trainings for disclosure, (6) and post-disclosure interventions. Study results highlight the critical role played by counselors during the HIV status disclosure process and the need for additional training and support to enable counselors to effectively support children and their caregivers. There is a need to further examine the effectiveness of current HIV status disclosure procedures and post-disclosure support interventions utilized by counselors within HIV care centers in Uganda.

Background: In Canada, failure to disclose HIV+ status before sex can result in incarceration and status as a registered sex offender for life. In 2012, the Supreme Court of Canada ruled that there is no legal mandate for HIV disclosure before sex if (i) a condom is used and (ii) HIV viral loads are extremely low. There is very little known about how the legal mandate for HIV disclosure might inequitably affect the health and safety of sex workers. Purpose: This study critically interrogates the interplay between the legal mandate for HIV disclosure and the routine health-conscious practices (e.g., HIV testing, condom use) of HIV-negative survival sex workers, with particular attention to inequitable health and safety outcomes. This study also qualitatively investigates the structural and social forces that mediate vulnerability to HIV infection and transmission among sex workers, their clients, and their non-commercial, intimate partners. Method: This study employed an adapted grounded theory approach to conducting and analyzing (n=9) open-ended, in-depth interviews with a convenience sample of currently working and recently exited sex workers who were clients at PEERS, an NGO offering services and support to sex workers in Victoria, Canada. Findings: The criminalization of HIV nondisclosure had no discernable influence on behavioural HIV risk factors or HIV testing. Participants lacked accurate knowledge of the legal mandate for HIV disclosure. HIV-related health literacy was low. Participants strongly supported HIV disclosure as a legal obligation – but only for exacting justice, and not for reliably offering protective health benefits. The uptake of high-risk sexual practices was driven almost exclusively by (i) extreme needs when servicing clients (e.g., drugs, childcare, money) and (ii) the rich symbolism of condomless sex in non-commercial, intimate partnerships. Participants reported differential degrees of entrenchment in the sex trade at various times in their working lives due to extreme needs. Participants emphasized the importance of ongoing HIV testing as a personal responsibility in order to monitor and maintain their sexual health. Participants identified increased uptake of HIV-related knowledge as affording the most significant protective health benefits against HIV infection. Implications: Lower levels of HIV-related health and legal literacies in the sample call for greater scrutiny of the impacts of initiatives such as ‘Seek and Treat for Optimal Prevention of HIV/AIDS’ (or STOP HIV/AIDS®) which target vulnerable populations across British Columba [BC]. Deeply entrenched sex workers have little recourse to exit the sex trade immediately upon receiving an HIV+ test result, especially in under-resourced social assistance milieux. Targeting this population for HIV testing facilitates the creation of a new caste of HIV+ potential criminals, despite the well-established, beneficial health outcomes at the individual and population levels from early commencement of antiretroviral treatment. Conclusion: Survival sex workers require special considerations in HIV pre-test counselling. The empowerment of sex workers can come firstly through the enhancement of HIV-related health – and legal – literacies. Full knowledge of the advantages and disadvantages of HIV testing will allow the consent for HIV testing to be truly informed. New HIV testing guidelines make BC the first province to recommend regular HIV screening for all adults. These guidelines also recommend exclusion of discussions of the criminalization of HIV nondisclosure in pre-test counselling for all patients. Re-thinking the consent for HIV testing among sex workers is crucially important for their immediate health and safety. / Graduate

Submitted in partial fulfillment of the requirements of a Masters degree in Clinical Psychology at the University of Zululand, 2003 / Many myths and stigmas around HIV/AIDS continue to exist, despite various campaigns to educate South Africans about this terminal illness, and therefore an HIV positive diagnosis and the experience of living with it are usually kept secret. In order to facilitate a better understanding of HIV positive South Africans, it seems necessary to research their experiences. This study, using the phenomenological methodology, examined 6 HIV positive participants' written stones about their experiences of living with HIV. From these stories the following main themes emerged: disclosure, denial, stigma, physical symptoms, symbolic representations of HIV/AIDS, medication, depression, anger, and death, and from these themes strategies for survival materialized. The findings of this study show that HIV is often minimized by the infected so that they are able to manage the experience in more publicly acceptable ways, such as by focusing on common physical illnesses, and avoid facing the "emotional baggage" that accompanies this virus. The findings of this study reveal a need for further research in this experiential area as well as campaigns and education around issues such as stigma, medication, and emotional difficulties.

Most children born HIV positive live longer and have more healthy lives since the advent of Anti-Retroviral Therapy (ART), together with the accessibility of Anti-Retroviral Drugs (ARV) to persons living with HIV. However, some of those children find themselves in need of care due to abandonment, orphanhood and / or neglect. In South Africa such children may enter the formal Child and Youth Care System and be placed in centres such as Epworth Child and Youth Care Centre. Due to the complex nature of the consequences of such disclosure or non-disclosure of HIV positive children’s status to them, social service workers are posed with a dilemma. In the absence of clear guidelines and policy around such disclosure, the children concerned may be unaware of their HIV positive status, despite being on a medication regime. The aim of the study was to explore the perceptions of social service workers regarding disclosure of HIV status to children born HIV positive living at Epworth Child and Youth Care Centre in Lambton, Ekurhuleni, South Africa. The study was located within a qualitative research paradigm, and utilised a purposive stratified sample of 15 social service workers form various occupational groupings recruited from Epworth Child and Youth Care Centre. A semi-structured interview schedule was employed as the research tool, with in-depth one-on-one interviews being adopted as a method of data collection. Thematic content analysis was used to analyse the data collected during the interviews. The main findings of the study were that HIV status disclosure is viewed as a complex but essential process as it reinforces children’s ability to adhere to medication regimes and to dispel anxiety and suspicion within themselves and around their status; that non-disclosure may lead to poor or coerced adherence and strains the relationship between the children and the social service workers. Disclosure of children’s HIV positive status can be viewed as complex as it presents both positive and the negative. Recommendations relate to community educative and awareness programmes, policy and practice changes regarding disclosure and none disclosure of children’s HIV positive status, as well as future research.

HIV-positive, Asian Pacific Islander (API) men who have sex with men (MSM) experience triple minority stigma including HIV, sexual orientation, and minority ethnicity. To date, there is no research that examines the influence of cultural factors, level of acculturation, social determinants of health, and other confounding variables (e.g., age, education, level of income, and length of time since diagnosis) on HIV-positive disclosure behaviors, attitudes, and intentions to casual sexual partners for API MSM. The theoretical framework for this study was based on Hofstede's original cultural values and Triandis's cultural dimensions. In this 2-phase, mixed methods, sequential explanatory study, 24 API MSM participants who are members of Fridae and other API organizations in the United States completed an anonymous online survey and 8 participants in Southern California completed in-depth semistructured phenomenological qualitative interviews. None of the regressions produced significant findings at the requested significance level (i.e., p < 0.5). The findings from the 2 phases of the study were integrated to facilitate a deeper, richer, and better understanding and explanation of those results than either approach alone. This mixed methods study was unique because it addressed an under-researched and poorly understood population of API MSM. The findings from this study have implications for positive social change for practitioners to incorporate culturally sensitive counseling strategies and for policymakers to develop or modify existing HIV preventive health education and health promotion programs for HIV-positive API MSM to negotiate safer sex behaviors, improve well-being, provide informed choice, and protect life that would promote competent quality care.

Philosophiae Doctor - PhD / The study assessed the linkages between HIV infection and intimate partner violence (IPV) during pregnancy and after HIV status disclosure in a context where HIV testing has become almost mandatory through the provider-initiated counselling and testing approach and non-disclosure of HIV status to sexual partners has been criminalised in many countries including Zimbabwe. The study also explored women’s experiences of and health workers’ perceptions of IPV during pregnancy.

HIV/AIDS continues to pose some of the most significant social, political and legislative challenges globally. This project explicates the text-mediated processes by which many HIV-related laws are becoming created transnationally though the use of omnibus HIV model laws. A model law is a particular kind of regulatory text with a set of relations of use. Model laws are designed to be taken, modified and used by stakeholders in the creation of state laws. Because they are already framed in legislative language, model laws are worded in ways that can be expeditiously activated and translated into state law. The problematic of this inquiry arises from the activities of a constellation of legislative actors including human rights lawyers, policy analysts, academics and activists who have worked to critique aspects of the United States Agency for International Development/Action for West Africa Region (USAID/AWARE) Model Law (2004) and subsequent state laws this text has inspired across West and Central Africa. I argue that mapping the origin and uptake of this omnibus guidance text is optimally achieved through a sustained analytic commentary on the institutional genre of “best practice”. Explicating the coordinating function of this textual genre is central to understanding the rapid spread of HIV/AIDS laws across at least 15 countries in West and Central African between 2005-2010. The work processes of legislative creation, challenge and reform under investigation demand an interrogation of complex ruling apparatuses regulated by text, talk and capital relations. The USAID/AWARE Model Law is rife with contestation: from its name, scope, funding source and process of development, dissemination and domestication to its legislative content and role in protecting or violating women’s rights and public health objectives. Many of the policy actors critiquing this USAID-funded initiative have been engaged in the development of alternative HIV-related model laws and the shaping of a global anti-criminalization discourse to respond to the increasing use of criminal law governance strategies to prosecute HIV-related sexual offenses and the rise in new HIV-specific criminal laws in and beyond sub-Saharan Africa. This study maps relations that rule, and makes processes of power understandable in terms of everyday transnational work activities organized by the language of law. My research method is informed by the critical research strategy of institutional ethnography. This complex legislative process was made visible through participant observation, archival research, textual analysis and informant interviews with national and international stakeholders. This has involved research in Canada, the United States, Switzerland, Austria, South Africa and Senegal (2010-2011). / Graduate