This study explored factors associated with the reluctance of people living with HIV (PLWH) to disclose their (Human Immunodeficiency Virus (HIV) statuses to their sexual partners at Galeshewe Day Hospital in Kimberley in the Northern Cape. The study was an in-depth interview based qualitative research; and purposive sampling technique was utilised to select 13 PLWH aged between 18 and 45. Among males, factors contributing to the reluctance of disclosure to sexual partners are ignorance, fear of rejection, not knowing where to start when disclosing and secrecy. Despite the complexity of disclosure, all participants understood the importance of disclosing to sexual partners as this will prevent new infections. There is a need for HIV prevention strategies to focus on males particularly, to strengthen disclosure counselling services provided to PLWH and to advocate strongly for partner testing / Health Studies / M.A. (Public Health)

Adherence to antiretroviral therapy is crucial to ensure viral suppression. In the scientific community it is widely accepted that an adherence level of at least 90% is necessary to achieve viral suppression. This study uses pharmacy refill records to describe antiretroviral adherence in HIV-positive patients in Ugu District and to describe pharmacy refill records as reliable monitoring method of antiretroviral therapy. In total, 61 patients’ records were reviewed. Overall, 82% of participants (n=50) achieved an optimum adherence level of at least 90%. Although 38% (n=19) of these participants did not show any related viral suppression. A statistically significant relationship between adherence and viral suppression was not demonstrated. Therefore, pharmacy refill records cannot be recommended as an alternative method of monitoring response to antiretroviral therapy, but laboratory tests including CD4 cell count and or viral load must be combined to pharmacy refill method for monitoring of antiretroviral therapy in HIV-positive patients / Health Studies / M.A. (Public Health)

This study aimed at exploring the developmental profile of HIV positive/AIDS infants and children (three to 35 months) over a period of 11 months in the Nelson Mandela Metropole, utilising the Revised Extended Griffiths Scales of Mental Development (GSMD). The purpose was to generate information about the development of HIV positive/AIDS infants and children, highlighting developmental strengths and weaknesses to ultimately aid the custodians of these children with their interventions. A non-probability purposive sampling method was applied, and a longitudinal profile was generated as participants were assessed twice. Participants were all outpatients at Kwazakhele Day Clinic, Dora Nginza and Livingstone Hospitals in the Nelson Mandela Metropole, and were located for the study through their caregiver’s attendance of an HIV support groups at the Dora Nginza Hospital. Data was analysed statistically using descriptive statistics and Hotelings-T² tests. Results indicated a significant difference between first and second assessment on the General Quotient and on two of the six subscales, namely Eye-Hand Co-ordination (D) and Practical Reasoning (F). It was deduced that development declined or did not improve as participants aged.

South Africa has an estimated 920 000 patients on antiretrovirals (ARVs), the largest number of patients in any country. ARV therapy demands adherence levels in excess of 95% to avoid development of drug resistance, but adherence to ARV therapy is estimated to be only between 50% and 70%. Poor medication adherence is acknowledged as a major public health problem, reducing the effectiveness of therapy and promoting resistance to ARVs. More than two thirds of the South African population have marginal reading skills and this significantly influences a patient’s ability to read and understand health-related information. Patient education materials tailored for the South African population could be a useful aid in facilitating communication with patients and perhaps impact positively on their medicine-taking behaviour. This behaviour is influenced by patient knowledge, beliefs, attitudes and expectations and includes self-management, self-efficacy and adherence. Self-efficacy, which refers to patient confidence in the ability to self-manage medicine taking, is a key factor influencing adherence. This study aimed to develop illustrated patient information leaflets (PILs) and medicine labels for all first-line ARV regimens used in the public health sector in South Africa and, using a randomised control study design, to investigate the impact of these illustrated information materials on knowledge, medication-taking behaviours and health outcomes in HIV/AIDS patients taking ARVs. To achieve this aim, the objectives were to assess HIV/AIDS and ARV-related knowledge, as well as self-efficacy and adherence to ARV therapy; to assess the influence of demographic variables on knowledge, adherence and self-efficacy; to assess the influence of the information materials on knowledge, self-efficacy and adherence and to assess the association of knowledge with health outcomes. Medicine labels and PILs, both English and isiXhosa, were developed for ARV regimens 1a, 1b, 1c and 1d. The 8-item Morisky Medication Adherence Scale (MMAS-8) and HIV Treatment Adherence Self Efficacy Scale (HIV-ASES) instruments for measuring respectively adherence and self-efficacy, were modified to optimize clarity, simplicity and cultural acceptability and were translated into isiXhosa using a multi-stage translation-back translation. The questions and the rating scales, for both the MMAS and HIV-ASES, underwent preliminary qualitative evaluation in focus group discussions. Patients were recruited from local Grahamstown clinics. A pilot study to evaluate applicability of the instruments was conducted in 16 isiXhosa AIDS patients on ARVs and the results from this study informed further modifications to the instruments. One hundred and seventeen patients were recruited for the randomised control trial and were randomly allocated to either control group (who received standard care) or experimental group (who received standard care as well as pictogram medicine labels and the illustrated PIL). Interviews were conducted at baseline and at one, three and six months. Data were analysed statistically using the t-test, chi-squared test and ANOVA (Analysis of Variance) at a 5% level of significance. Correlations were determined using Pearson and Spearman rho correlations. Approval was obtained from Rhodes University Ethical Standards Committee, Settlers Hospital Ethics Committee and the Eastern Cape Department of Health. The results of this research showed that illustrated PILs and medicine labels enhanced understanding of HIV/AIDS and ARV information, resulting in a mean overall knowledge score in the experimental group of 96%, which was significantly higher than the 75% measured in the control group. Variable knowledge scores were measured in three areas: baseline knowledge of general HIV/AIDS-related information was good at 87%, whereas knowledge scores relating to ARV-related information (60%) and side-effects (52%) were lower. These scores improved significantly in the experimental group over the 4 interviews during the 6 month trial duration, whereas in the control group, they fluctuated only slightly around the original baseline score. There was no significant influence of gender on knowledge score, whereas health literacy, education level and age tested (at one and three months) had a significant influence on knowledge. Self-efficacy and adherence results were high, indicating that the patients have confidence in their ability to adhere to the ARV therapy and to practice optimal self-care. Age, gender and education, in most cases, significantly influenced self-efficacy, but were found to have no effect on adherence. The CD4 count improved over the trial duration which may have been influenced by a number of factors, including better knowledge of ARVs and improved adherence. No significant parametric correlation was found between knowledge score and change in CD4 count, however, Spearman's rho showed significance (rs=0.498; p=0.022). Both patients and healthcare providers were highly enthusiastic about the illustrated labels and PILs, and indicated their desire for such materials to be routinely available to public sector HIV/AIDS patients. The isiXhosa version of the PIL was preferred by all the patients. These simple, easy-to-read leaflets and illustrated medication labels were shown to increase understanding and knowledge of ARVs and HIV/AIDS in low-literate patients, and their availability in the first-language of the patients was central to making them a highly useful information source.

There appears to be a growing body of literature focusing on PTSD and HIV-related PTSD (the diagnosis of HIV being the significant traumatic event) amongst HIV-positive samples, but only a few African studies that attempt to estimate the prevalence of PTSD amongst HIV-positive people, and even fewer that attempt to estimate the prevalence of HIV-related PTSD. The systemic review presented in this study is currently fully inclusive and is the most up-to-date available. Estimates of the prevalence of PTSD and HIV-related PTSD in South Africa range from 0.7 to 54.1% and, 4.2 to 40% respectively. The current cross-sectional study made use of a mixed-method approach to investigate traumatic life events, PTSD and HIV-related PTSD within a primary health-care centre in KwaZulu-Natal. The quantitative sample consisted of 159 adults (18-50 years) who were compliant on ARV medication. Using the CIDI-PTSD module, the adapted CIDI-PTSD module for HIV, and IES-R, findings indicated that 62% had reported some kind of traumatic event in their lifetime, with 29.6% of participants meeting the criteria for lifetime PTSD, and 40.9% meeting the criteria for lifetime HIV-related PTSD. Altogether, 57.9% of individuals met the criteria for some form of PTSD (either regular PTSD or HIV-related PTSD), and 12.6% met the criteria for both PTSD and HIV-related PTSD. Of the different categories of traumatic events, interpersonal violence has the highest rate of PTSD, followed by a diagnosis of and living with HIV, and then disaster. Furthermore, the IES-R was compared for its usefulness as a screening measure for PTSD against both the CIDI, but results suggest that it is an inferior screening measure to the PDS. The qualitative study consisted of six participants who were examined using IPA methodology informed by the Ehlers and Clark (2000) Model of trauma. Their experiences revealed experiences of stigma, a number of negative appraisals, negative emotions and coping behaviours. Some of the latter might serve as compensatory mechanisms to avoid negative judgements. Hypervigilance seems to be a feature of ARV-compliance that might confer added vulnerability to PTSD and other anxiety disorders.

This study investigated influence strategies used by university students to negotiate condom use. The study examined the seven condom influence strategies (CISs) -withholding sex, direct request, seduction, relationship conceptualizing, risk information, deception, and pregnancy prevention- used by heterosexually active male and female students. The sample comprised of 156 first year students (male=44 and female=112). Statistically significant correlations were found among all the condom influence strategies subscales. Results suggest that the university students influence their partners in all identified condom influence strategies and the risk information strategy holds the most promise of all the strategies.

Educators play an essential role within the education system as role models. Many educators, in addition to being affected by learners living with HIV and AIDS, are themselves living with HIV and struggle to cope. SMTs have to play a role in the provision of psychosocial services. The purpose of this study was to explore the types of psychosocial services provided to ELWHIV by their SMTs in order to gain insight and understanding and to make suggestions on how psychosocial services can be improved. A qualitative study was undertaken in 2008. Fifteen interviews were conducted with ELWHIV and members of SMTs at four primary schools in Bela-Bela, Limpopo Province. The findings reveal that SMTs are failing to implement government policies and are not providing adequate support for ELWHIV. None of the participating schools had a functional AIDS policy. Support structures were found to be inadequate and ineffective. Disclosure was identified as one of the major obstacles to the provision of effective services. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Department of Public Health / MPH

MSc (Microbiology) / Department of Microbiology

Department of Public health / MPH