It is estimated that 6742 South African women are diagnosed with cervical cancer and 3681 women die from the disease every year. In 1993, The Centers for Disease Control declared cervical cancer an Acquired Immunodeficiency Syndrome defining illness. Apart from persistent human papillomavirus infection, HIV infection is the most common co-factor contributing to cervical cancer in South Africa. Studies have noted that in HIV positive women, there has been an occurrence of faster progression to more advanced stages of cervical cancer with high cases of treatment failure and recurrence. There is limited literature available regarding the prognosis of HIV positive women who suffer from cervical cancer. Women who are HIV positive and have cervical cancer have not been evaluated in detail regarding their response and adherence to cervical cancer treatment. Standard treatment protocols for this set of patients have not been defined. The aim of this study was to assess how HIV positive women who have been diagnosed with cervical cancer responded and adhered to cervical cancer therapy which includes: curative radiotherapy; curative chemotherapy; concurrent chemoradiation or palliative radiotherapy. The study also evaluated the effects of the concurrent use of antiretrovirals and cervical cancer treatment. This was done to determine whether invasive cervical cancer in women who were HIV positive could be managed using the same treatment protocols as patients who were HIV negative. A historical cohort design was employed for the study. The study was conducted at the Oncology Department of a tertiary level hospital located in the Eastern Cape Province, South Africa. The total sample consisted of 196 medical records of women diagnosed with cervical cancer between 2005 and 2008. One hundred women were HIV negative, 83 were HIV positive and the HIV status of 13 women could not be determined. The records were audited over a period of two years from the date of diagnosis. The term „complete response‟ referred to patients who had no recurrence of cervical cancer and no evidence of metastases after undergoing treatment. At one month following treatment there was a significant difference in the incidence of complete response between the HIV positive patients and the HIV negative patients (Chi2 = 16.4, d.f. = 1, p = 0.00005, Cramer‟s V = 0.31). The significant difference in response to treatment between the HIV positive patients and the HIV negative patients was maintained at six months after treatment (Chi2 = 15, d.f. = 1, p = 0.00011, Cramer‟s V = 0.34), 12 months after treatment (Chi2 = 20.5, d.f. = 1, p = 0.00001, Cramer‟s V = 0.37), 18 months after treatment (Chi2 = 9.8, d.f. = 1, p = 0.00173, Cramer‟s V = 0.28) and 24 months after treatment (Chi2 = 5.0, d.f. = 1, p = 0.02571, Cramer‟s V = 0.26). At each of these intervals, cases of treatment failure and metastases were significantly higher in the HIV positive women than in the HIV negative women. Although there was no significant difference in the incidence of adherence between the HIV negative women, the HIV positive women who were on HAART and the HIV positive women who were not on HAART, there was a significant difference in the incidence of the various reasons for non adherence between the various groups. These reasons included: missed scheduled appointments (Chi2 = 2.9, d.f. = 2, p = 0.02385, Cramer‟s V = 0.31); low blood count (Chi2 = 4.0, d.f. = 2, p = 0.01327, Cramer‟s V = 0.15); radiotherapy induced skin breakdown (Chi2 = 0.6, d.f. = 2, p = 0.04581, Cramer‟s V = 0.16) and radiotherapy induced diarrhoea (Chi2 = 6.9, d.f. = 2, p = 0.03118, Cramer‟s V = 0.19). According to the 2004 National Antiretroviral Treatment Guidelines, cervical cancer patients would fall into the WHO stage IV category of HIV disease thus all patients with confirmed diagnosis of invasive cervical cancer should be commenced on antiretrovirals as soon as the cancer diagnosis is made regardless of their CD4 count. However, in the current study, 13 percent (n= 83) of the HIV positive women were not on antiretrovirals. The study concluded that HIV positive women had a higher incidence of both treatment failure and metastases to cervical cancer treatment. Standard radiotherapy and concurrent chemoradiation cervical cancer treatment protocols should be still be used in both HIV negative patients and HIV positive patients so as not to compromise tumour control. Furthermore, in accordance with the antiretroviral treatment guidelines, all HIV positive patients with cervical cancer should receive antiretrovirals irrespective of their CD4 count.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Disclosure of Human Immune Deficiency Virus (HIV) is still a challenge to people living with the disease because of the discrimination, stigma and judgemental attitudes. Women prefer to keep their illness to themselves and make it a secret. The revealing of HIV status relies on an individual who is living with the illness. The concept of non-disclosure is a vital issue that threatens immediate families in which there are people, especially women battling the non-disclosure of their HIV status. Objectives: The objectives of the study were to explore and describe the experiences of concealing HIV positive status to the immediate family by women living with Human Immunodeficiency Virus at the selected villages in Limpopo Province. Methods: The qualitative and descriptive phenomenological method was followed. Due to saturation, ten women participated after being selected through purposive sampling from the database with the consideration of the inclusion and exclusion criteria. Data was collected through semi-structured interviews in Sepedi. The data was transcribed, translated and analysed through Interpretative Phenomenological Analysis. Results: WLW-HIV continue to manage to live with a secret about their HIV status due to the unpleasant feelings they hold about the illness continue, still pointing fingers and sceptical about disclosing, particularly to their children. They further tell lies about their illness and hide their medications away from the members of their family. The reasons about concealing their status include among others fear of prejudice, lack of trust, fear of abandonment and rejection, fear of blame and humiliation, denial, misconceptions that people still hold about HIV and the view of it as a predicament. Others conceal because of the lack of support and the target of the disclosure. xii Conclusion: The outcomes of the study have uncovered that there is still less awareness by members of the society about HIV/AIDS, which puts pressure on the WLW-HIV to effectively deal with an HIV positive status and disclose to their family members. These factors contribute to concealment and compromise the level of support that WLW-HIV would get from their family members, further impacting negatively on adherence. Keywords: Concealment, HIV/AIDS, Phenomenological study, Stigma and Immediate family.

This qualitative study explored and described the experience of African women diagnosed with both HIV/AIDS and cervical cancer in order to gain an understanding of the experience of both illnesses as lived by these women. Phenomenological research methods were employed using in-depth semi-structured interviews. Communication as a strategy facilitating diagnosis, disclosure, acceptance and support for women with HIV/AIDS and cervical cancer emerged as the main theme, followed by the experience of physical symptoms and emotional experiences. The study shows the importance of communication in the management and support of these women attending public health institutions and in the community. For communication to occur the relationship between healthcare professionals and women diagnosed with HIV/AIDS and cervical cancer is very important. Treatment approaches in radiation therapy need to be developed for women diagnosed with HIV/AIDS and cervical. More research is needed in this area (HIV/AIDS and cervical cancer). / Health Studies / M.A. (Public Health)

This qualitative study aimed to explore and describe the experiences of women living with HIV and Aids in Centurion, Gauteng Province. The study was conducted at Lyttleton clinic and 12 women living with HIV and Aids were selected for the study using a non-probability, purposive sampling technique. In-depth, individual semi-structured interviews were used during data collection. A thematic content approach in data analysis yielded the following main themes: experience of being diagnosed HIV positive, disclosure of an HIV positive status, physical signs and symptoms of HIV and Aids, stigma/ emotional stress well experiences in services rendered. The study highlighted the need for a well-established health system, assisting women living with HIV and Aids on how to cope and to raise awareness on HIV and Aids. / Health Studies / M. A. (Public Health)

Thesis (DPhil (Psychology))—University of Stellenbosch, 2006. / Statistics show that young, heterosexual, low-income women are the fastest growing HIVinfected population in South Africa and in the rest of the world. Despite the rapidly growing numbers of women with HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome), there is a scarcity of research that focuses primarily on how poor minority and disadvantaged women of colour experience being HIV-positive, how these women actually live and cope with their diagnosis. Furthermore, no research studies on minority groups, such as the Coloured women in the Western Cape, exploring these issues have been reported. Consequently, there is an urgent need for research studies in South Africa to explore the range of discourses revealed by low-income and minority women regarding their lives and experiences of HIV/AIDS, in order to generate understanding and knowledge which could contribute to possible interventions, support and care. The present study aimed to: 1) explore the psychosocial concerns and mental health needs of HIV-infected low-income Coloured mothers in everyday life; 2) construct a testable Grounded Theory regarding the illness experience of low-income Coloured mothers; and 3) recommend guidelines for health workers. The study was a systematic analysis and documentation of how the illness (HIV/AIDS) was constructed in narratives of one particular group of women in South Africa. Eleven suitable and willing HIV-infected Coloured mothers were recruited by means of convenience and theoretical sampling. The research study was conducted within a socialconstructionist framework where the focus was on how HIV-infected, low-income Coloured women make sense of their world and illness experience. Grounded Theory was applied within the framework of qualitative research to analyse the data and to explore the participants’ constructions of the illness. As qualitative measure, a semi-structured in-depth interview schedule was developed according to Grounded Theory protocol. To reach the aims of the present study, questions focused on specific behaviours, experiences, thoughts and feelings that related to living with a positive HIV-diagnosis. In the participants’ accounts of their illness experience, two dominant discourses were identified: a discourse of HIV/AIDS, within which the illness was constructed as an stigmatised, incurable and deadly illness; as a shameful illness that someone should be blamed for; and as being associated with secrecy, silence, separation, pain and suffering, loss, and loneliness, as well as a discourse of mothering, what it means to be a “good” woman/mother; constructed as someone that should primarily take care of her children and family, and not be separated from them, or neglect or abandon them through illness or death. It is suggested that the two dominant discourses found in the participants’ accounts of their illness experiences, namely the meaning of HIV/AIDS as an illness (a stigmatised, incurable, and deadly illness, a shameful and blameworthy illness, an illness of secrecy, silence, separation, pain and suffering, loss, and loneliness), and the imperatives of mothering, what it means to be a “good” woman/mother (the primary caregiver of children, someone who is connected, physically strong, healthy and productive, and someone who is able to cope with her caregiving responsibilities even when in distress herself) are irreconcilable. It seems that these distressing and disempowering experiences of being HIV-infected, while also being a primary caregiver and mother of children, caused the participants in the present study severe psychological distress and suffering. Given these discourses and the context of the participants’ lives within their specific socio-economic circumstances, namely their lack of emotional and social support from friends and family, abusive relationships, substance abuse, economic hardships, absence of treatment options, as well as their experience of an incapacitating, incurable, stigmatised illness causing them severe physical and psychological distress, it was argued that the majority of the participants in the present study were in some state of depression and were in need of psychosocial support and mental healthcare.

Vertical transmission of HIV is still a growing concern in South Africa. Breastfed infants are still at risk as HIV is present in breast milk, leaving HIV-positive mothers unsure of the best feeding option for their infants. However, there are various infant feeding techniques that HIV-positive mothers can use to supplement breastfeeding and flash-heat is one of them. Flash-heat is heat treating expressed breast milk to deactivate HIV for infant feeding. This study explored the possibility of HIV-positive mothers to practice flash-heating method for their infants exclusively for four months as a strategy to prevent vertical transmission of HIV. A descriptive, explorative and contextual design using a mixed method was used to obtain data from mothers in a post natal ward at Tembisa hospital. The mixed method used was useful in identifying the number of HIV-positive mothers who would adopt the flash-heat technique, the characteristics of mothers whom the technique could be promoted to, the factors that influence/affect the choice of infant feeding for these mothers, as well as their feelings associated with the feeding technique. Most (74%) mothers had a positive response to the flash-heat technique compared to 10% who were uncertain. They believed that heat treating their breast milk would result in their infants being HIV-free. In addition they believed that this method was cheaper than formula feeding and expressed positive feelings about touching their breast milk while expressing with no adverse feelings of expressing into a glass jar. Furthermore, findings of this study indicated that HIV-positive mothers in a public health facility would adopt flash-heat as an alternative infant feeding method. Thus practical guidelines to promote this feeding method were proposed. The proposed draft guidelines which promote the use of the flash-heat infant feeding method for HIV-positive mothers in public sector facilities will be communicated to relevant authorities such as the National Department of Health. These guidelines support the new policy shift to exclusive breastfeeding as a child survival strategy in South Africa. / Health Studies / D.Litt. et Phil. (Health Studies)

Thesis (MMed (Medical Microbiology))--University of Stellenbosch, 2006. / One of the major routes of transmission of human immunodeficiency virus (HIV) in the developing world is vertical transmission from mother to infant – pre-, intra-, or post-partum. In the Western Cape, HIV-1 subtype C is the predominant subtype in the heterosexual population, and this trend was expected to be seen amongst cases of mother-to-child transmission of HIV. The aim of this study was to perform genetic characterisation and phylogenetic analysis of the HIV-1 genome in positive serum/plasma samples obtained from children (age 0 to 18 months) from 2000-2002, and temporally related specimens from their mothers. We obtained 27 suitable pairs of samples taken within 6 months of delivery. From this pool, we obtained 21 infant DNA sequences and 17 maternal sequences, resulting in 16 mother-infant pairs. All patient sequences were identified as HIV-1 subtype C, and, as expected, mother and infant viral sequences clustered together. In some cases where a mother was suspected to have two dominant quasispecies based on the electropherogram, only one sequence was detectable in the infant. Single or multiple amino acid deletions were consistent between mothers and infants, and some pairs showed the same amino acid deletions seen in other pairs.

Thesis (MTh)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: In South Africa young women in the age group 10 – 24 are the largest group infected with HIV. Those most at risk are young women living in South African townships where a multitude of factors reinforce the possibility of them becoming infected. Once infected, they are often abandoned or left alone, with no support system. This thesis uses the following four tasks of Practical Theology, - the descriptive-empirical task: Priestly listening, - the interpretive task: Sagely wisdom, - the normative task: Prophetic discernment and - the pragmatic task: Servant leadership, to analyze how pastoral group care could help these young women. The problem is investigated and set into the reality of Khayelitsha, a township in Cape Town. By offering young women the possibility of belonging to a peer group, they are met within their cultural and social system. As the members of the group are all HIV positive, the stigma which often prevents people from socializing or talking about their sickness, is removed. The important role of the leader of such a group is also investigated. / AFRIKAANSE OPSOMMING: In Suid-Afrika is jong vroue in die ouderdomsgroep 10 – 24 jaar díe groep wat die hoogste aantal MIV infeksies het. Die hoogste risiko om deur die MI virus aangesteek te word, is by jong vroue wat in ‘n Suid-Afrikaanse township lewe. ‘n Verskeidenheid faktore speel saam om hulle kwesbaarheid te verhoog. Sodra dit bekend word dat hulle die MI virus dra, word hulle dikwels verwerp en sonder enige ondersteuning alleen gelaat. Na aanleiding van die volgende vier take van Praktiese Teologie nl.: - die beskrywend-empiriese taak: Priesterlike luister, - die interpreterend-hermeneutiese taak: Verstandige wysheid, - die normatiewe taak: Profetiese onderskeiding en - die pragmatiese taak: Dienskneg leierskap., word hierdie problem ondersoek binne die raamwerk van Khayelitsha, ‘n township van Kaapstad. Die tesis argumenteer dat pastorale groepssorg ‘n gepaste wyse is waarbinne daar na hierdie jong vroue omgesien kan word. Deur aan hulle die moontlikheid te bied om aan ‘n portuurgroep te behoort, kan hulle binne hulle eie sosiale en kulturele raamwerk tereg kom. Aangesien die lede van die groep almal MIV positief is, word die stigma, wat dikwels mense verhinder om te sosialiseer of om oor hulle siekte te praat, verwyder. Die belangrike rol van die leier van so ‘n groep word ook ondersoek.

First eleven leaves not numbered / The purpose of this study was to identify, explore and describe the potential contributing factors of the upsurge of HIV among children aged three to eighteen months in the Mangaung Metropolitan area of the Free State Province in South Africa. The study was conducted at five primary healthcare facilities and one hospital in the Mangaung metropolitan municipality of the Free State Province with sixty randomly selected mothers of children testing HIV-positive for the first time between the ages of three and eighteen months. The convergent mixed-methods research design was opted for, according to which both qualitative and quantitative data were collected at the same health facilities selected by means of cluster sampling. The review of medical records, unstructured interviews, and structured questionnaires were used for qualitative and quantitative data collection, while random cluster sampling was used for participant selection. Thematic data analysis was applied for the interpretation of recurrent patterns of qualitative and quantitative data. The study results revealed that mothers were well-informed about the prevention of mother-to-child-transmission. The main factors that contributed to more children testing HIV positive after the routine tests were conducted at ten weeks included non-adherence factors to PMTCT prescripts mainly by mothers, such as: babies were not brought to the clinics for testing and immunisations at ten weeks, and that mothers acquired HIV infection during the breastfeeding period. Some other potential contributing factors were late antenatal booking which lead to the delay in initiation of antiretroviral treatment, nonadherence to antiretroviral therapy during pregnancy, and mixed feeding. The themes that emerged from the qualitative data were psychological factors, emotional factors, socioeconomic factors, missed opportunities, risky behaviour, as well as women disempowerment; while some mothers were left with unanswered questions. The results of the qualitative part complemented the quantitative findings as they uncovered the factors that led to the deviation from the PMTCT prescripts by the mothers. The study’s recommendations include PMTCT psychological assessment and counselling; partner and community involvement; women empowerment; and that couple testing at antenatal and postnatal clinics should be a national policy subjected to protracted monitoring and evaluation processes. / Health Studies / D. Litt. et Phil. (Health Studies)

This qualitative study aimed to explore and describe the experiences of women living with HIV and Aids in Centurion, Gauteng Province. The study was conducted at Lyttleton clinic and 12 women living with HIV and Aids were selected for the study using a non-probability, purposive sampling technique. In-depth, individual semi-structured interviews were used during data collection. A thematic content approach in data analysis yielded the following main themes: experience of being diagnosed HIV positive, disclosure of an HIV positive status, physical signs and symptoms of HIV and Aids, stigma/ emotional stress well experiences in services rendered. The study highlighted the need for a well-established health system, assisting women living with HIV and Aids on how to cope and to raise awareness on HIV and Aids. / Health Studies / M. A. (Public Health)