MPM / Oliver Tambo Institute of Governance and Policy Studies

MSc (Microbiology) / Department of Microbiology

MCur / Department of Advanced Nursing Science / Survival of children with HIV/AIDS has increased considerably with the use of effective antiretroviral therapy. However, the benefits of this therapy are limited by the difficulty of adherence to the treatment. This study sought to explore the role of professional nurses on anti-retroviral therapy adherence among children in Lejweleputswa district: Free State, South Africa. An exploratory descriptive qualitative research design was used to identify and describe role of professional nurses toward anti-retroviral therapy adherence among children. Population for this study included seventeen (17) professional nurses working in four purposively sampled Primary Health Care clinics invited to participate in the study. Four focus group discussions were conducted in which each group had 6 participants. The transcribed data was analysed using the framework approach of data analysis. Professional nurses in Lejweleputswa district report poor knowledge of parents/caregivers of children, perceived poverty, stigma and discrimination, inappropriate care approaches, and parental dynamics as factors influencing poor ART adherence. Recommendations for enhancing children ART adherence levels in Lejweleputswa district included: mainstreaming adherence counselling in children ART and adopting a comprehensive family centered care approach were identified as measures for improving children ART adherence. Other measures included integration of ART services into Primary Health Care (PHC) services, parental empowerment, development of a programme to reduce stigma and discrimination in the community.

MGS / Institute for Gender and Youth Studies / Extensive resources and information are available on HIV/AIDS, but there remain disparities between what is known and actual behavior, particularly among students at tertiary institutions. A lot has been done to create HIV awareness and prevent further infections among male and female students in Higher Education Institutions of South Africa. Despite the availability of information, awareness education and campaigns, free condoms and treatment, the HIV infections continue to increase in South Africa especially amongst the youth. The aim of the study was to investigate the knowledge, attitudes, and perceptions of male and female students at the University of Venda towards the “ABC” strategy for HIV prevention, and how these consequently influence their sexual behavior. Data was obtained from 32 students using a semistructured questionnaire. A non-probability, haphazard sampling technique was used to randomly select the participants. Descriptive statistics and thematic analysis were used for data analysis. The study findings contend that knowledge of HIV and its prevention measures always translates to positive sexual behaviour, as university students were found to be knowledgeable enough, but their attitudes and sexual behaviour were found not to be consistent enough. The researcher recommends future researchers to focus on the factors that hinder sexual abstinence, fidelity in sexual relationships, and condom use amongst Higher Education students, towards creating safer environments for them.

MSc (Microbiology) / Department of Microbiology / See the attached abstract below

MSc (Microbiology) / Department of Microbiology / See the attached abstract below

MA (Sociology) / Department of Sociology / This study aims to investigate the socio-cultural influence towards the risky sexual behaviour of adolescents in eSikhaleni, in context of the prevalence of HIV/AIDS epidemic. The study will adapt a qualitative approach. It is an explanatory study goes beyond simple description to model empirically the phenomenon under study. The participants were drawn from two categories. The participants for the key informant interviews were selected purposively and they include community leaders, high schools principals and life orientation teachers. The adolescent’s learners were selected using a snowball sampling technique. Data was analysed thematically, matrices were created using to content thematic analysis. The responses were grouped thematically. Broad categories were then generated to differentiate and explain the thoughts expressed by the respondents. Invitations to participate on the study were sent to respondents by submitting informed consent electronically and in person. When participants completed the structured interview they were not required to reveal their personal or contact details. The findings of the study reveals that risky sexual behavior amongst adolescents learners is as a result of a number of factors which include the diminishing role of parenting, death of morality in society, poverty and deprivation just to name a few. The recommendations advanced speak to the need for government to have a multipronged strategy of resolving the problem.

MPH / Department of Public Health / Background: Young people in sub-Saharan Africa are most-at risk of HIV infection. This elevated risk in the young black population may be explained by the lack of HIV/AIDS-related knowledge, attitudes towards the epidemic and risky sexual behaviours. Purpose: The aim of the study was to assess the level of knowledge, attitude and behaviour among youth towards HIV infection and to explore the possible aetiological factors associated with the youth’s vulnerability to HIV infection. Methods and materials: This survey adopted a descriptive, cross-sectional design and a quantitative approach.The survey population comprised of all youth aged 15-24 years visiting two Namakgale clinics. An expected sample of (n=152) youths was recruited through convenience sampling. Pretesting of the questionnaire was conducted on 15 youths at Mashishimale Clinic. Data was collected using self-completed questionnaire. The data was captured using Microsoft Excel and then analyzed using the Statistical Package for Social Sciences, version 22. Results: Knowledge on HIV: The majority (77%) of the respondents could distinguish HIV and AIDS and had knowledge that HIV could cause AIDS. The majority of respondents (80%) had knowledge of how HIV was transmitted. The majority of the respondents, (84.9%) knew that HIV/AIDS could not be cured. However, misconceptions about HIV transmission still exist for example, 13.2 % of youth stated that mosquito bites could transmit HIV and whilst 22.4% believed that witchcraft could cause HIV. The main source of HIV information was television (89%). Attitudes towards PLHIV: About 82.9% disagreed that all PLHIV should live away from Namakgale while 72. 4% stated that if their relative had HIV they would care for them. Overall, Namakgale youth held positive attitudes towards PLHIV. Risky sexual behaviours: About 61.8% of females, compared to their male counterparts (38.2%) ever had sex. 61.8% of females compared to 50.0% of males have had sex before their 15th birthday. 36.5% have had 3-5 lifetime sexual partners in comparison to 29.6% of their female counterparts. 44.2% of males did not use condoms at last sex compared to their female counterparts (33.3%). iv Recommendations: There is an urgent need for intensifying awareness campaigns on HIV and AIDS as well as school-based interventions for youths who still harbour myths and misconceptions about HIV transmission. Policy makers and the media should focus more on late adolescents (15- 19 years) risky sexual practices such as intergeneration sex (age group between sexual partners is 10 years or more), transactional sex etc.

MA (Psychology) / Department of Psychology / The aim of the study was to explore the psycho-social experiences of children living with vertically transmitted HIV/AIDS in Messina Hospital, South Africa. The study utilised the qualitative approach, in particular the exploratory research design. The population of the study comprised both male and female children between the ages of 12-17 years, who are receiving care and support at Fountain of Hope Clinic in Messina Hospital. Non-probability sampling, in particular its sub-type, purposive sampling, was used to select the children who participated in the study. Eleven participants (11) were interviewed, and the sample size of the study was guided by data saturation during data collection. Semi-structured, open-ended face to face interviews were used to collect data. In order to analyse data, the researcher adopted thematic content analysis, following Tech’s eight steps of qualitative data analysis. Three main themes emerged from the raw data, namely living with HIV/AIDS infection; challenges of living with HIV/AIDS infection; and coping with HIV/AIDS. Sub-themes emerged from the main themes. Ethical considerations were observed and trustworthiness was ensured in the study. The study results were analysed and recommendations based on the results were formulated to enhance the experiences of children living with vertically transmitted HIV/AIDS. / NRF

Department of Microbiology / PhD (Microbiology) / Human herpes virus type 8 (HHV-8), also known as Kaposi’s sarcoma associated herpes virus (KSHV), is the etiologic agent of Kaposi’s sarcoma (KS), and AIDS related Kaposi’s sarcoma (AIDS-KS). HHV-8 which is a member of the Herpesviridae family, exhibits extensive genetic diversity globally. In endemic regions, infection with HHV-8 occurs very early on in life, which is an indication of both environmental and vertical routes of transmission. The advent of HIV leads to the classification of an AIDS-KS defining condition in HIV infections. This suggests that in regions where HIV and HHV-8 are endemic, KS may become common in a mature HIV epidemic. Just like the prevalence of HIV in Northern South Africa is generally high as in most regions of the country, as the HIV epidemic matures in South Africa, it is important to understand the burden and distribution of HHV-8 infection, and the likely genotypes infecting the population. The main objective of the thesis was to establish the epidemiology and infecting genotypes of HHV-8 in Northern South Africa (Limpopo Province), where no data exists. First, a systematic review of the literature was carried out for the entire African continent to determine the seroprevalence and genotype distribution of HHV-8 in all African countries (n=53). In this review, Sudan and South Sudan were considered as one country. Articles were searched using the PRISMA guideline and exported using an article grid. More than two-thirds (64%) of the studies reported on seroprevalence, 29.3% on genotypes; and 9.5% were on both seroprevalence and genotypes. About 45% (24/53) of the African countries had data on HHV-8 seroprevalence exclusively, and more than half (53%) had data on either seroprevalence or genotypes. Almost half (47%) of the countries had no data on HHV-8 infection. There was high heterogeneity in the types of tests and interpretation algorithms used in determining HHV-8 seropositivity across the different studies. Generally, seroprevalence ranged from 2.0% in a group of young children in Eritrea to 100% in a small group of individuals with KS in the Central Africa Republic and a larger group of KS in individuals in Morocco. Approximately, 16% of all the studies reported on children. The difference in seroprevalence across the African region was not significant (95% CI, X2 =0.86; p =0.35), although specifically, a relatively significant ETTA MASHU ELIZABETH, PHD IN MICROBIOLOGY|UNIVERSITY OF VENDA, 2019|VIII level of infection was observed in HIV-infected children. About 38% of the countries had data on K1 genotypes A, A5, B, C, F and Z which occurred at frequencies of 5.3%, 26.3%, 42.1%, 18.4%, 5.3% and 2.6% respectively. Twenty-three percent of the countries had data for K15 genotypes, whereas genotypes P, M and N occurred at frequencies of 52.2%, 39.1% and 8.7% respectively. Data on HHV-8 inter-genotype recombinant is scanty. Our finding suggests that HHV-8 is endemic on the entire African continent, and in HIV endemic regions, but there is need for a harmonized testing protocol for better understanding of HHV-8 seropositivity. HHV-8 genotype A5 and B for K1 gene and genotype P and M for K15 gene are the most predominant genotypes in Africa. The review, for the first time, has provided information on HHV-8 burden on the entire African continent, and suggests that vaccine development efforts for Africa should focus on genotypes B and P. The second component of the investigation focused on the burden of HHV-8 in an HIV population in Northern South Africa (Limpopo Province). Plasma from 3501 HIV infected individuals from 5 districts in Limpopo Province were assessed for antibodies to both the lytic antigen (ORFK8.1) and the latent antigen (ORF73). The distribution of infection was analyzed based on demographic, socioeconomic, and immunological parameters. Statistical inferences for significant differences were determined by Chisquare at a confidence interval of 95%. P-values less than 0.05 were considered significant. About 19.0% of the study population was positive for antibodies to either the lytic or latent antigens or both. Prevalence of antibodies to the lytic antigen was significantly higher than prevalence of antibodies to the latent antigen (17.3% vs 4.1%; p=0.0001). Significant differences were observed for age groups, racial population groups, districts and year of sample collection (p=<0.0001, p=<0.0001, p=<0.0001 and p=0.0385) respectively. Associations were found between both antigens in comparison to the different variables such as age group, racial population groups and districts (R2 value ranging between 0.886 and 1.0). The burden of HHV-8 has now been established for the first time in Northern South Africa. The third aspect of the investigation was a meta-analysis of HHV-8 seroprevalence in Southern Africa in order to understand the impact of geographical location (urban vs rural) on infection. The analysis revealed a significant association between urban settings and HHV-8 infection (p=0.0001). ETTA MASHU ELIZABETH, PHD IN MICROBIOLOGY|UNIVERSITY OF VENDA, 2019|IX The fourth component of the thesis examined the detection of HHV-8 antigen through polymerase chain reaction (PCR) in 534 participants in HIV infected and HIV noninfected populations. A selection of mouthwash DNA samples were subjected to Next Generation Sequencing (NGS) for subsequent genotype inference. Mouth wash samples were obtained from each consenting individual before eating or smoking, and their DNA was purified. A 233bp fragment of the ORF26 gene of HHV-8 was amplified by PCR. HHV-8 was detected in 150 of the 534 participants (28.1%). A significant difference in detection was observed for gender, HIV status, district and the level of education (p=0,0003; p=0.0094; p=0.0002 and p=0.0095) respectively. Consensus sequences were derived from NGS reads for 13 samples. The genotyping results revealed that genotype Q, B, E and N are the genotypes predominant in the study population. As such no mixed infections were detected. Therefore, from the investigations foregoing have demonstrated for the first time the following: (1) HHV-8 is endemic in the entire African continent, which suggest a coendemicity in regions already endemic for HIV; (2) HHV-8 is endemic in Northern South Africa; (3) Urban settings in Southern Africa are associated with high HHV-8 infection; (4) HHV-8 genotypes Q, B, E and N may be predominant in Northern South Africa, with B and P common on the entire African continent. Hence, studies should focus on the generation of full length HHV-8 genomes of the common genotypes to support the selection of genes for vaccine design and development. / NRF