This qualitative exploratory and descriptive study explored and described the experiences of HIV sero-discordant couples post diagnosis at the Perinatal HIV Research Unit in Soweto, Gauteng Province. Data was collected using in-depth interviews with each individual from seven HIV sero-discordant couples. Following thematic analysis, four themes emerged: immediate response to HIV sero-discordant results; challenges in relation to disclosure of HIV sero-status; limited information on HIV sero-discordant; and the impact of HIV sero-discordant on the couples. All these were mainly linked to poor counselling and inadequate support to HIV sero-discordant couples. The findings of this study have both clinical and policy development implications. Recommendations have been put forward for development of contextual relevant HIV Sero-discordant Couple Counselling and support guidelines focusing of enhancing knowledge and skills of health care professionals responsible for counselling and supporting HIV sero-discordant couples. / Health Studies / M. A. (Public Health)

The aim of the study was to explore the accessibility of antiretroviral treatment amongst people living with HIV and AIDS at Public Health Care Facilities in Gert-Sibande Region in Mpumalanga. The study was conducted at a selected Public Health Care facility in Gert Sibande Region at Msukaligwa Municipality in Mpumalanga. The study focused primarily on people attending wellness programmes that are living with HIV and AIDS, receiving antiretroviral treatment in Public Health Care facilities. Research design of the study was exploratory which fundamentally used to explore a new topic or to learn more about issues where little is known. The research approach was purely qualitative methodology which allowed the researcher to explore deeply the perceptions of people living with HIV and AIDS and the capabilities in the provision of antiretroviral treatment at public health care facilities in Msukaligwa municipality of Gert-Sibande Region in Mpumalanga. Qualitative interview is the method that has been used to gather data from 23 participants who took part in the study. Questions of the interview were semi-structured in-depth one-on-one interviews and were used to explore understanding in relation to the accessibility of antiretroviral treatment amongst people living with HIV and AIDS at Public Health Care Facilities in Gert- Sibande Region in Mpumalanga. The findings of the study revealed that, there is good accessibility of antiretroviral treatment at public health care facilities in Msukaligwa Municipality of Gert-Sibande Region in Mpumalanga. There is also an existence of negative staff attitude towards patients and a probable poor service delivery at the referral local clinics. It can be concluded that there is a need to re-look into the current Hospital’s reception filing system and the turnaround time at certain areas of the Hospital and the capacitation of staff at the wellness centre. There is also a need to intensify the established programmes and the encouragement of people on treatment to take their antiretroviral treatment consistently. / Health Studies / M.A. (Social behaviour Studies in HIV & AIDS)

This study investigated the challenges faced by implementers of VCT campaigns for higher education distance learning students. Qualitative and explorative approaches, using a case study, were employed as the research methodology. It has been concluded that the administrative planning procedures of VCT campaigns were not properly followed, which resulted in the following difficulties: defining the roles and responsibilities of stakeholders, using limited resources, and the inability to reach all the students, in order to get them to actively participate in the campaigns. Lack of coordination of HIV and AIDS activities and the absence of monitoring and evaluation also impacted negatively on the success of VCT campaigns. This study recommends that VCT campaigns have a proper task team constituting of experts in VCT campaign operations, in order to strategically plan and coordinate all the campaigns' activities. The implementers should also monitor and evaluate these activities on a regular basis. / Social Work / M.A. (Social Behaviour Studies in HIV/AIDS)

The earlier optimism generated by the efficacy of antiretroviral drugs in human immuno-deficiency virus (HIV) patients has been dissipated in the face of the enormous chal-lenge of maintaining a nearly perfect adherence indefinitely. This study set to determine the influence of HIV adherence self-efficacy and beliefs about medicines on antiretrovi-ral therapy adherence, with the aim of developing a framework for enhancing antiretrovi-ral therapy (ART) adherence through focused intervention on modifiable factors from study variables that are strongly associated with ART adherence. A descriptive correlational design was used to assess the predictive relationships of HIV adherence Self-Efficacy, Beliefs about Medicines and ART adherence among 232 HIV-infected patients in a large public health facility in Pretoria. Participants' medication be-liefs were assessed using the Beliefs about Medicines Questionnaire, HIV adherence self-efficacy was assessed with HIV adherence self-efficacy scale (HIV-ASES) and ART adherence was assessed using the AIDS Clinical Trial Group questionnaire. Pearson correlation analysis was used to assess bivariate associations among the variables, and multiple regression analysis was used to examine the relationships among the inde-pendent variables and ART adherence. Mean adherence for the 232 participants was 95% (SD=13.2). Correlation analysis re-vealed positive bivariate associations between perceived general harm and overuse of medications, and ART adherence (p<0.05); between specific necessity and concerns about ARVs, and perceived general harm and overuse of medications (p<0.05); be-tween HIV adherence self efficacy and ART non-adherence (p<0.05). Multiple regres-sion analysis showed significance for perceived general harm and overuse of medica-tions on ART adherence (F(1;231)=11,583;p<0,001) with perceived general harmful ef-fects and overuse of medications explaining 4.8% of the variance. There was signifi-cance for HIV adherence self-efficacy on ART non-adherence (F(1;41)=4.440; p<0.041), with HIV-ASES explaining 9,8% of the variance. Based on the results, a framework for enhancing ART adherence was developed. Activities in the framework consist of baseline screening for adherence facilitators and barriers using the beliefs about medicine questionnaire and HIV ASES, this is followed by focused interventions on identified barriers of ART adherence / Health Studies / D.Litt. et Phil. (Health Studies)

This study sought to investigate factors that influence adherence to treatment amongst rural people living with HIV and accessing antiretroviral therapy (ART) at Shongwe hospital in Mpumalanga. Both quantitative and qualitative methods were used. From patients’ case files, a sample of twenty-eight respondents was recruited for the completion of questionnaires. A focus group discussion with nine participants was held, followed by qualitative interviews with three key informants. Findings indicated that a complex web of factors unique to each patient’s social context plays a role in determining whether or not patients adhere to their regimens. Obstacles to adherence are poor social support, problems relating to disclosure, unemployment and economic hardship, traditional and religious beliefs, the quality and nature of adherence counselling and treatment side effects. / Sociology / M. A. (Social Behaviour Studies in HIV/AIDS)

There are many inequities that exist in health-care that stem from culture related communication misunderstandings. In most cases where doctors and patients from different cultural and linguistic background interact, doctors use medical language which is different from everyday language used by patients. Patients enter this communication context with anxiety because they depend on the physicians to give them accurate information concerning their health, but they do not always understand all the terms used by physicians to inform them about their conditions. In some cases interpreters are used but their expertise is often inadequate and the interpreting of the patient’s statements to the health staff is also prone to distortion by interpreter / doctor because of the lack of proper understanding of the messages / languages. This may result in a deterioration of the patient’s health condition and unavoidable complications.

Introduction: Adherence to Highly Active Antiretroviral Therapy (HAART) is critical for optimal therapeutic outcomes. A possible factor in adherence is the impact of HAART on sexual functioning. Methods: A mixed methods approach was used. A cohort of 14 people living with HIV/AIDS (PLWHA) in Grahamstown was identified. Two semi-structured interviews and two structured questionnaires were administered. In-depth interviews were conducted with two HIV counsellors in so as to obtain a different perspective on the topics. The theoretical framework used three health behaviour models: the Health Belief Model, Leventhal‘s Common-Sense Model of self regulation and the Transtheoretical model. Results: The participants were between 27 and 49 years old and had been on HAART for between 9 months and 10 years. Six participants were support staff members from Rhodes University and eight from the Raphael Centre – a local NGO which assists PLWHA.In most of the participants HAART was associated with increased libido and improved sexual functioning (sexual activity and sexual enjoyment). The use of alcohol increased risky sexual behaviour. Issues of adherence were seemingly not directly affected by the effects of HAART on sexuality. PLWHA, especially women, face challenges related to their sexuality, some of which are not directly related to their illness and treatment. The fear of transmitting drug resistant HIV or getting re-infected, stigma, disclosure issues,difficulties negotiating for safe sex among women, HAART-related lipodystrophic changes that affect one‘s sense of self and unmet reproductive needs are some of the problems that were reported. The men‘s dislike for condoms was overt and blatant. Discussion: Being diagnosed with HIV and reaching a point where treatment is requiredare life-changing events. Making decisions about one‘s life (including adherence to HAART, alcohol use and knowingly partaking in risky sexual encounters) become all the more significant in the context of AIDS. Intentional non-adherence is informed by the individual‘s assessment of the costs and benefits of taking treatment. Cultural influences,gendered power relations and misconceptions strongly influence sexual behaviours. Conclusion: The general lack of attention among health care providers concerning issues related to PLWHA‘s sexuality and reproductive issues needs to be addressed. Insights fromthe theoretical models should be integrated with empirical findings in designing adherence interventions.

MPH / Department of Public Health / The main entry point for the HIV/AIDS prevention, care and treatment is through HIV Testing Services (HTS). Despite undeniable benefits and increased availability of HIV Testing Services, uptake remains low among students. The aim of this study was to investigate factors contributing to low HIV Testing Services (HTS) among Health Sciences students. Quantitative research method was used to conduct this study. Descriptive quantitative research design was employed. 306 respondents determined by the sample formula were selected through Probability, Systematic sampling technique. Structured questionnaires were used to collect data from respondents. Validity was ensured through content and face validity. Reliability in the form of test-retest reliability were ensured through pre-testing the instrument using 31 respondents from the target population. Data collected was analysed using SPSS version 24. Ethical considerations were ensured throughout the study. The findings of the study showed that out of 306 respondents, 44,1% (n=135) of respondents, comprising 30,7% (n=94) of females and 13,4% (n=41) of males had gone for HIV testing. Respondents had adequate knowledge about HIV Testing Services (HTS) and their attitude towards HIV Testing Services (HTS) was favourable. HIV/AIDS-related stigma, fear of potential HIV positive diagnosis, low perception of HIV infection risk and negative attitude of healthcare service providers were attributed to low uptake of HIV Testing Services (HTS) among respondents. There were recommendations for HIV Testing Services (HTS) workshops, education and awareness campaigns emphasizing the benefits and importance of HIV Testing Services (HTS). The use of various forms of media including campus radio and newsletters to promote the uptake of HIV Testing Services (HTS) among university students was also recommended. / NRF

MSc (Microbiology) / Department of Microbiology

MPM / Oliver Tambo Institute of Governance and Policy Studies