The ability of individuals living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) to effectively manage their health is dependent on the successful acquisition and use of health information. This may be particularly challenging in limited resource settings where numerous barriers may prevent people from finding, understanding, and applying the information that could lead to better health management. In this dissertation, I aimed to explore the health information behavior of HIV positive adults attending Clínica de Familia in La Romana, Dominican Republic. Offering free treatment and services to over 1,600 HIV positive adults makes this one of the largest HIV treatment centers in the Dominican Republic. Initially, an integrative review of the literature was conducted to summarize research that has explored the patient-identified information needs of HIV positive adults in Latin America and the Caribbean and to identify predominant health information needs of these individuals. Then, a retrospective chart review of 201 randomly selected medical records, two focus group discussions, and an adapted version of Wilson’s 1996 model of information behavior were used to develop a 64-item survey to assess health information behavior. The survey was administered during 107 individual interviews with HIV positive adults being seen at the Clinic. Participants were mostly female (60%), Dominican (75%), and lived in La Romana (59%). Approximately half of participants (49%) were married or in a serious relationship and about a third (33%) of participants had all or some of high school education or higher. Responses to information behavior survey items indicated that patients might not understand all of the health information they do receive, cultural variations may influence understanding of viral transmission, and that participants had low levels of health literacy. Data obtained through the surveys were further analyzed to identify patient characteristics associated with active health information seeking, higher information processing and more information use. Significantly associated patient characteristics were: having ever cared for someone who was very sick, age, gender, length of time at the clinic, and comorbidities. Providers at the Clinic as well as those working in underserved areas globally may use these results to advance their knowledge of the ways in which HIV positive adults interact with health information. This enhanced understanding can inform communication and health education programs that provide the information patients need to manage their health in a more usable way. Future research should examine what methods can be used to more effectively provide health information to patients living in constrained resource settings with limited educational backgrounds.

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M.Ed. (Educational Psychology) / Please refer to full text to view abstract

The purpose of this study was to explore HIV/AIDS client experiences with supportive services. The consumption of social services for individuals living with HIV/AIDS has assumed increasing importance. This is a crucial population that requires a multifaceted approach to treatment in order to remain active and productive for longer periods of time.

AIDS has established itself over more than three decades as a major international pandemic3. While initial cases of the disease were documented in 1981 in the USA and Europe, cases in Africa became known at around the same time. It is however probable that the disease existed in Africa long before this time (Pratt, 1986:17). Due to the prominence of the AIDS epidemic and its related opportunistic diseases in South Africa and most acutely in KwaZulu-Natal (Smith, 2002 and South African Department of Health Report 2006) , the associated impact of the need for care of those living with and those affected by the virus has been brought to the fore. The accommodation of these persons occurs in a variety of building forms and types, and may vary depending on the stage within the individual’s health cycle related to the impact of the virus. With the advent of medication, termed anti-retroviral therapy, designed to retard the development of the virus, life expectancy has been extended, but with no confirmed cure and viral resistances, death is inevitable. While those living with the virus may continue to live productive lives for some time, the infirm largely seek care within medical facilities. Should access to formal health services be difficult due to remoteness or a lack of transport, such people are often cared for within the homes of surviving family members – often by children - or by their community. With the largest impact on the population being found within the 20 – 29 age bracket in the late 1990's (Smith, 1999: HIV Positive Results, June 1998), shifting to the 25 – 34 age bracket from 2003 onwards (South African Department of Health Report 2006), tertiary education institutions, through their clinics, have increasingly dealt with the management of student and staff health. Other building types affected by the AIDS epidemic4 include prisons and mortuaries, while care for those remaining behind after the death of family members to AIDS is usually within children’s homes or street shelters. The impact of AIDS on the built environment professions will permeate its way to all involved. Through selected case studies one will observe the impact of the epidemic on existing facilities and examine current methods employed to accommodate the problem. Architects, through the modification of existing structures or through the design of new facilities, are assisting in the struggle. New methods of dealing with the care of patients are being considered as well as alternative and innovative design approaches. This includes the need for flexibility of building layouts and universal design. Most proposals in the researched context require cost effective and workable solutions. Hope for the future lies with the management of the virus through medication, enabling the extension of life expectancies. Architects need to adapt to the incumbent problem while medical researchers develop a workable vaccine to confine HIV/ AIDS to the history books with the likes of Bubonic Plague, Smallpox and Typhus. It is through good architectural design and detailing that Architects can assist in the AIDS fight. This can be achieved firstly through research – gaining an understanding of the AIDS Brief – then designing for the specific needs for the infected and affected. These needs will include comfort, accessibility, anthropometrics, ease of maintenance, affordability, ventilation and illumination conducive to good health, and sustainability. Architects therefore have a major role to play within this epidemic. / Thesis (M.Arch.)-University of KwaZulu-Natal, Durban, 2008.

Thesis (MPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: This study investigates the employee perceptions towards outsourcing of HIV/AIDS services in a retail working environment. Thirty participants were included using a self-administered questionnaire. The questionnaire assessed attitudinal disposition through questions aimed testing knowledge, preferences and environmental factors influencing perception towards alternative HTC service centres. Results show employees have positive perceptions towards the utilisation of external HTC and welfare services compared to those offered on-site. On-site employer initiated HTC services through mobile testing facilities are perceived as failing to offer privacy, anonymity and security of continued employment as testing outside the employer’s premises would provide. Outsourced services such as public hospitals or clinics are seen to offer better testing environment because of their natural health settings and non-association with the employer whose motives for providing testing services in the workplace are held in suspicion. Ninety four per cent of the employees expressed desire to have HTC services provided in the workplace. Potential utilisation level of such services dropped to 33% among these employees with 50% indicating a desire to use external health services providers. This disparity is explained by the negative environmental and social factors prevailing in the workplace which make access to HTC difficult. Recommendations for improving employee attitudes towards on-site HTC services include implementing educational programs to reduce peer stigma, scepticism to employer motives for initiating health intervention programs and demonstrating fair employment practices which do not associate HIV status with different treatment in the workplace. There is also a need for companies to plan around facilitating employee use of public health facilities even when they have on-site services to promote a perception of holistic care towards employees. / AFRIKAANSE OPSOMMING: Nie beskikbaar.

Submitted in fulfillment of the requirements for the degree of Doctor of Philosophy (PhD) Health Science, Durban University of Technology, Durban, South Africa, 2017. / Background: The HIV pandemic has attracted unprecedented scale-up in resources to curb its escalation and manage those afflicted. Although evidence from developing countries suggests that public health systems have been strengthened as a result of scale-up, only anecdotes exist in other countries. Despite scale-up, the prevalence of HIV/AIDS is still high and the resultant mortality and morbidity demands a refocus. Furthermore, the HIV/AIDS epidemic has severely strained vulnerable health systems in developing countries leading to concerns among policy makers about non-HIV priority services. Although anecdotally, it is clear that HIV scale-up has had profound effects on health systems, available evidence does not allow for an assessment of the impact of such effects on health care access, service delivery or medical outcomes for non- HIV conditions. The aim of this study was to determine the impact of HIV/AIDS scale-up on non-HIV priority services in the former Nyanza Province, Kenya. Additionally we determined the benefits and detriments of HIV programmes, and identified the elements of successful HIV programs and their effect on scale-up and last but not least determined the perceptions, attitudes and experiences of health care staff towards scale-up and integration of health care services. The first part of the main sequential study reviewed practices during scale-up by looking at public health facilities within the Province at Nyanza in Kenya. This looked at health management information systems (HMIS) and routine health facility client records for five years, 2009-2013 with a comparison of trends in 2009 to that in 2013. This data was reviewed in order to show trends in delivery of HIV priority and non-HIV services. The second part of the study utilized a prospective cross sectional survey to determine perceptions, attitudes and experiences xi of facility personnel towards HIV/AIDS scale up. Randomly sampled facilities involved in the delivery of any aspects of HIV diagnosis care and treatment were investigated. Self-administered questionnaires and in-depth interviews were used to obtain information on impact of HIV services on non-HIV priority services on health managerial staff in the facilities and key informants who have shaped scale up. We created a qualitative codebook based on three major themes identified from the data: (1) Meaning and importance of HIV scale-up (2) Perspectives of scale-up on service delivery on non-HIV services and (Ministry of State for Planning) Health facility staff awareness. The findings indicate that the interventions that were utilized in the scale-up of HIV in 2009 resulted in significant increases in uptake of the service in 2013 (p<0.01) and total integration of HIV and non-HIV services at all the health facilities thereby contributing to improved health outcomes beyond those specifically addressed by HIV programs. This study has also shown that utilization of both HIV and non-HIV services increased significantly for both years after integrated HIV care was introduced in the health facilities (p<0.01). Notable increases were found for ANC utilization (p=0.09), family planning (p=0.09), screening for tuberculosis and malaria (p<0.01) and provision of support services (p<0.01) to HIV infected people. The scale up of HIV in the region had several human resource policy implications resulting from staff turnover and workload. Stakeholder engagement and sustainability are critical in the sustenance of these initiatives. Strategic alliances between donors, NGOs and the government underpinned the scale-up process. Policies around scale-up and health service delivery were vital in ensuring sustainability of scale- up and service integration. This study has attempted to provide evidence on the impact of HIV scale-up on non-HIV service delivery in three different settings, in two different time periods and it therefore concludes that the evidence is mixed with most of the impact being positive with some aspects that still needs development. It is critical to pursue the integration of HIV and non- HIV services in a strategic and systematic manner so as to maximize the public health impact of these efforts. The proposed model, best practices and practices requiring improvement will be communicated to the relevant ministries to ensure its integration into policy. / D

South African palliative care volunteer caregivers play a crucial role in caring for people living with HIV and Aids, but frequently do not receive the support and respect that they deserve. The current study explored the psychosocial challenges and coping mechanisms of palliative care volunteer caregivers for people living with HIV and Aids. The researcher conducted in-depth interviews with 24 participants who also filled in questionnaires. The aim was to explore their experiences, their challenges, and coping mechanisms. Although these volunteer caregivers shared many positive experiences, they also faced multiple challenges in the workplace, their personal lives, financial challenges as well as psychological and emotional ones. Despite these challenges, the caregivers showed only moderate levels of stress on the stress scale. Recommendations for overcoming these challenges were provided to caregivers, organisations and the Department of Health / Psychology / M. Sc. (Psychology)

The study explored the factors influencing the use of voluntary counselling and testing by university students. This was done by undertaking an exploratory and descriptive qualitative study. Focus group discussions and field notes were used to collect data from the participants. Outcomes from the study revealed various factors to the uptake of Voluntary Counselling and Testing (VCT) services by university students namely: the desire to know one‟s HIV status, illness, pregnancy, blood donation, to get a reward, the influence of significant others, the influence of media, awareness campaigns, compulsion, to get a job, curiosity, to be a positive role model and the positive attitude and professional conduct of the health care provider. The study also revealed various challenges to the uptake of VCT services by university students namely: the fear of being diagnosed HIV positive, HIV/AIDS-related stigma and discrimination, the low perception of risk to HIV infection, the lack of student friendly VCT services, the shortage of human and infrastructural resources, the inaccessibility of VCT services, the long waiting period for test results, negative perceptions about VCT, the problems with pre-test counselling and ignorance. Going by the participants‟ suggestions VCT services uptake by university students could be improved by increased resource allocation (incentives, human and infrastructural resources), increased awareness campaigns, and improved counselling and making VCT services more accessible / Information Science / MA (Public Health)

Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: There is, as yet, no cure for HIV/AIDS, a disease that has affected South African society profoundly. While antiretrovirals (ARVs) are now available and have stemmed the tide of AIDS deaths, medicines alone cannot be seen as a long-term solution. Treatment costs, finite resources, limited health-care capacity, morbidity and the unpleasant side-effects of ARVs, make treatment an untenable solution. The Christian church in South Africa continues to retain a powerful position; it has a significant affiliation; it is present in most geographic areas and inspires trust and confidence. Furthermore, in my view, the church, by its very nature and calling, is mandated not only to demonstrate and provide care, but also to inspire care-giving. In the light of HIV/AIDS, what does care mean? Can it only mean rendering care that is welfarist in nature? Or does the church have the mandate to look beyond immediate suffering, to examine and address those issues that lie at the core of suffering? Research has demonstrated that issues such as poverty, injustice, stigma, discrimination, gender inequality and patriarchy fuel the pandemic. Ultimately, it is the “othering” of people; the failure not to recognise God in another person and our common humanity, that lie at the heart of the problem. These then, I suggest, are the very reasons why the church must address these areas. But that is not all: if HIV/AIDS care is to be rendered in a developmental way, then there must be a thorough understanding of the disease: how is the virus transmitted, how can it be prevented and treated? It is also important to understand that there is not a single global epidemic but many local epidemics; the determinants and risk-factors of these need to be recognised, as must the cultural, economic, political and social contexts that fuel the spread of the disease. The changing nature of society, the effects of globalisation, the evolving nature of care owing to biomedical advances and even the “privatisation” of sex all need to be comprehended. Furthermore, any meaningful rendering of care requires the churches to examine why they should be giving it and the values that underpin such care-giving. I make the case that the churches are required to do nothing less than drive social change in situations of suffering, injustice and abuse. An examination of the history of HIV/AIDS in South Africa illustrates that the churches have often failed to meet up to this calling. An empirical study was conducted as to how the churches render care at a more micro, grassroots level, using a framework propounded by David Korten, who suggests that authentic development must be people-centred, rather than growthcentred. Essentially, development must seek to increase personal and institutional capacities, guided by principles of justice, sustainability and inclusiveness. In these respects, I argue, it accords very strongly with the Christian message. Korten suggests that there are four orientations (or generations) of rendering help but it is only the fourth generation that is truly developmental. Through the use of case study methodology, I sought to examine the manner in which the churches render care, in a region of the Western Cape, outside Cape Town, known as the Helderberg Basin. The area is representative of many peri-urban areas in the Cape: it is predominantly Christian, with a mix of different denominations and racial and socio-economic groupings. It allowed for an assessment of care initiatives afforded by mainline, charismatic and African Independent Churches and in particular, sought to answer the question of whether churches engage with HIV/AIDS in a way that Korten would identify as developmental. From the research, it is clear that the church is hampered by its inability to talk of sex and sexuality; its knowledge of the issues surrounding HIV/AIDS is limited; it has not done a sufficient amount to conscientise its followers; the church has yet to learn to utilise its networks; it lacks technical know-how and is unwilling to engage in the political sphere. Social change is only possible if the church embraces a new vision of how to create a better world. Additionally, I recommend that the church looks to the emerging church movement to achieve radical transformation. / AFRIKAANSE OPSOMMING: MIV/VIGS is ‘n siekte wat Suid-Afrika onmeetbaar beїnvloed en waarvoor daar tot op hede geen genesing is nie. Antiretrovirale middels (ARVs) is weliswaar beskikbaar en het die gety van VIGS sterftes gestuit maar medisyne kan nie alleen as die langtermyn oplossing gesien word nie. Behandelingskoste, beperkte hulpbronne en vermoë om gesondheidsorg te lewer, morbiditeit en die negatiewe newe-effekte van ARVs bring mee dat slegs mediese behandeling ‘n onhoudbare oplossing is. Die Christelike kerk in Suid-Afrika behou steeds ‘n magsposisie; dit het ‘n beduidende lidmaatskap asook ‘n teenwoordigheid in meeste dele van die land en boesem vertroue en sekerheid in. Dié kerk is na my mening gemandateer deur haar besondere aard en roeping om nie alleen sorg te bewys en te voorsien nie maar ook om versorging aan te moedig. Maar wat beteken sorg, gegewe die aard van MIV/VIGS? Kan dit slegs die lewering van welsyngerigte sorg beteken? Of sou die kerk die mandaat hê om verder as onmiddellike lyding te kyk en ondersoekend die kwessies wat aan die wortel van lyding lê, aan te spreek? Navorsing het aangetoon dat kwessies soos armoede, onreg, stigma, diskriminasie, geslagsongelykheid en patriargie die epidemie aanvuur. Uiteindelik is dit die objektivering (“othering”) van mense - dit is die onvermoë om God nie in ‘n ander persoon en ons gemeenskaplike mensheid te herken nie - wat die hart van die probleem is. Ek betoog dat hierdie die redes is waarom die kerk hierdie kwessies moet aanspreek. Om ondersoek in te stel of en tot watter mate die kerk sorg verskaf in verband met MIV/VIGS het ek die raamwerk van David Korten gebruik. Dié raamwerk stel voor dat outentieke ontwikkeling mensgesentreerd eerder as groeigesentreed sal wees. Ontwikkeling moet essensieel streef na ‘n toename van persoonlike en institusionele vermoë, gerig deur beginsels van geregtigheid, volhoubaarheid en inklusiwiteit. Ek toon aan dat hierdie beginsels baie sterk ooreenkom met die Christelike boodskap. Korten stel vier hulplewerende oriëntasies (ook genoem generasies) voor maar dit is eintlik slegs die vierde generasie van hulp wat werklik ontwikkelingsgerig is. Maar dit is nie al nie. Indien MIV/VIGS versorging ontwikkelingsgerig gaan wees, moet dit gegrond wees op ‘n diepgaande verstaan en kennis van die siekte soos onder andere, hoe die virus versprei word en hoe die siekte voorkóm en behandel kan word? Dit is ook belangrik om te verstaan dat daar nie slegs ‘n enkele globale epidemie is nie maar verskeie lokale epidemies. Die veroorsakende en risiko faktore van hierdie epidemies moet daarom geїdentifiseer word en so ook die kulturele, ekonomiese, politieke en sosiale konteks wat die verspreiding van hierdie siekte aanhelp. Die veranderende aard van gemeenskappe, die effek van globalisering, die ontwikkelende aard van gesondheidsorg vanweë die vooruitgang in die mediese wetenskap en die “privatisering” van seks moet alles in ag geneem word. Betekenisvolle versorging vereis dat kerke ondersoek instel na waarom die versorging aangebied word en die waardes onderliggend daaraan. Ek stel die saak dat daar van kerke verwag word om sosiale verandering te stuur waar mense swaarkry, onregverdig behandel en misbruik word. ‘n Ondersoek na die geskiedenis van MIV/VIGS in Suid-Afrika illustreer dat kerke dikwels misluk het om aan hierdie roeping gehoor te gee. In opvolging van die bostaande argumente het ek navorsing uitgevoer oor hoe kerke sorg op ‘n mikro of voetsool-vlak aanbied. Hiervoor het ek die genoemde mensgesentreerde ontwikkelingsraamwerk van David Korten gebruik. ‘n Gevalstudie benadering is gevolg in die Helderbergkom wat geleë is in ‘n streek van Wes- Kaapland buite Kaapstad. Hierdie gebied is verteenwoordigend van baie buitestedelike gebiede van die Kaap: dit is oorwegend Christelik en sluit ‘n verskeidenheid van denominasies, rasse en sosio-ekonomiese groeperings in. Die gebied maak ‘n oorsig moontlik van die sorg-inisiatiewe van hoofstroom, charismatiese en Afrika onafhanklike Kerke, en in die besonder van ‘n identifikasie daarvan of kerke betrokke by MIV/VIGS dit doen op ‘n wyse wat Korten sou tipeer as ontwikkelingsgerig. Uit hierdie navorsing het dit duidelik geword dat die kerk gekniehalter word deur ‘n onvermoë om oor seks en seksualiteit te praat; die kerk se kennis beperk is wanneer dit kom by kwessies wat handel oor MIV/VIGS; dit nie genoeg doen om lidmate bewus te maak van VIGS kwessies nie; dit nog veel te leer het oor hoe om netwerke aan te wend; dit tegniese kennis kort en onwillig is om met sake van politieke belang om te gaan. Sosiale verandering is alleen moontlik indien die kerk ‘n nuwe visie voorhou oor hoe om ‘n beter wêreld te skep. Ek beveel ten slotte aan dat die kerk let op die ontluikende kerkbeweging om radikale transformasie te verwesenlik.