<strong>Background. </strong> Previous evidence suggests that persons who have emigrated from HIV-endemic countries experience higher rates of HIV infection and delayed diagnosis. Despite this evidence, limited research has examined HIV testing in these populations. <br /><br /> <strong>Objectives. </strong> To examine factors associated with HIV testing, as well as motivations underlying testing behaviour, within five East African communities in Toronto. <br /><br /> <strong>Methods. </strong> Secondary data analyses were conducted using cross-sectional data collected in face-to-face interviews with people from Toronto's Ethiopian, Kenyan, Somali, Tanzanian, and Ugandan communities. Logistic regression techniques were employed to assess factors associated with "ever vs. never testing," "repeat vs. non-repeat testing," and "independent vs. directive testing. " Reasons provided for testing and not testing were described. <br /><br /> <strong>Results. </strong> Individuals from all five communities were interviewed (n=270). Males were slightly over-represented (55. 9%). The average age was 35. 7 yrs (range 17-71). Three-quarters (75. 6%) of the sample had been tested for HIV. Two-thirds (65. 7%) of testers had tested more than once and 40. 7% had independently decided to get their most recent test. 71. 1% of testers reporting previous testing for immigration purposes. Testing behaviour varied greatly across communities. Ethnicity was predictive of "ever" and "repeat" testing. Risk behaviour (including multiple sex partners, concurrent sex partners, condom non-use, and/or improper condom use) was overwhelmingly not associated with testing. Fear of exposure through sexual activity was the most frequent reason for independent testing. Immigration authorities were the most common person to initiate directive testing, followed by physicians. Low perceived risk was the most common reason for not testing. <br /><br /> <strong>Conclusions. </strong> Testing rates within this population were quite high and the immigration process heavily impacted upon testing behaviour. Many determinants and motivations of testing have been identified and should be used to inform the design of interventions to promote testing behaviour in these communities. Nevertheless, many gaps have been identified by the current research and should be addressed by future research.

Bakgrund Humant Immunbristvirus (HIV) är en obotlig virussjukdom. Viruset försvagar och bryter ner kroppens immunförsvar. Obehandlat leder sjukdomen till Acquired Immunodeficiency Syndrome (AIDS), då immunförsvaret är helt nedbrutet. Idag lever 30 miljoner människor världen över med sjukdomen och i Sverige finns cirka 6000 personer med HIV/AIDS. Sjukdomen behandlas livslångt med antivirala medel, som skapar förutsättning till ett längre och friskare liv. HIV och AIDS är förknippat med stigmatisering och många personer med HIV och AIDS upplever psykiska och sociala påfrestningar tillsammans med biverkningar från läkemedlen. Hos sjuksköterskan bör en medvetenhet finnas om ett professionellt förhållningssätt och en strävan efter att handla utifrån det. I begreppet ingår självkännedom, självreflektion, kunskap och empati. Karaktären på kommunikationen och bemötandet, vårdpersonal och patienter emellan, har en central roll i vården. Personcentrerad omvårdnad innebär att vårdpersonalen utgår från patientens individuella omvårdnadsbehov. Det, tillsammans med ett professionellt förhållningssätt, skapar möjligheter för vårdpersonal att kunna vårda patienten utifrån hela dess person.  Syfte Syftet med studien var att beskriva faktorer som ur patient- och vårdpersonalperspektiv upplevs som betydelsefulla vid bemötandet av personer med HIV och AIDS.  Metod  En litteraturbaserad studie har genomförts. Sökningar efter artiklar gjordes i databaserna PubMed och Cinahl samt med hjälp av manuell sökning. Slutligen inkluderades 16 vetenskapliga originalartiklar till studien, som alla var peer reviewed. Resultat Under bearbetning av resultatet framkom tre huvudteman. Dessa är Kommunikationens betydelse, Stigmatisering samt Kunskap och utbildning. Vårdrelationen påverkas av ömsesidigheten i kommunikationen och den icke-verbala kommunikationen har en central roll. I bemötandet upplever många patienter stigmatiserande attityder och beteenden. Kvaliteten och effektiviteten av vården försämras när patienterna känner sig ignorerade och kränkta. Det finns en önskan hos patienterna att bli tagna på allvar. I många studier uppger vårdpersonal en positiv inställning till patienterna. När patienten känner närvaro från personalen, upplever de sig bli vårdade utifrån hela sin person. Utbildning kan sänka vårdpersonalens rädsla för att smittas, höja medvetenheten om stigmatiserande attityder och beteenden samt sänka benägenheten att handla utifrån dessa. Kunskap och utbildning påverkar stigmatiserande attityder och beteenden hos vårdpersonal, exempelvis finns brister i vårdpersonals kunskaper om hur HIV smittar. Vårdpersonal uppger en vilja till vidare utbildning om sjukdomen.  Slutsats Kommunikation, stigmatiserande attityder och beteenden samt kunskaper och utbildning påverkar patienternas och vårdpersonals upplevelser av bemötandet. För att bryta mönstret med stigmatiserande attityder och beteenden bör en strävan efter ett professionellt förhållningssätt finnas. Genom en personcentrerad omvårdnad kan fokus flyttas från sjukdomen och patienterna kan vårdas utifrån ett helhetsperspektiv. Vårdpersonal är i behov av mer kunskap och utbildning för att få bort stigmatiseringen kring sjukdomen.

The HIV/AIDS pandemic continues to be one of the most devastating global health pandemics in history. With women accounting for approximately 60% of all new HIV infections, preventative strategies that provide women with the ability to protect themselves is imperative. To this end, identifying natural factors expressed in the female genital tract (FGT) capable of inhibiting HIV may prove to be novel candidates for female-controlled microbicide preventative strategies. The work in this thesis examined the differences in CVL (cervicovaginal lavage) composition between HESN (HIV-exposed seronegative) women and HIV-susceptible women. Distinct differences in the female genital tract proteomes, and HIV inhibitory activity exhibited by CVL, were observed among women highly exposed to HIV compared to women at lower exposure. Furthermore, while HESN women as a group did not demonstrate stronger inhibitory effects compared to susceptible women from the Pumwani cohort, it was apparent that CVL from individual women was capable of inhibiting HIV consistently over longitudinal analysis. From the antiproteases that were identified as over-expressed within the CVL of HESN women, Serpin B1 exhibited the strongest and most consistent HIV inhibitory activity. The mechanism for this activity does not appear to be directly against HIV but rather through effects exerted on HIV target cells. Specifically, Serpin B1 alters the proliferative capacity and induces early apoptotic markers on these cells. Proteomic pathway analysis of the proteins over-expressed following treatment, suggests that Serpin B1 may up-regulate the expression of proteins associated with inhibition of the mTOR pathway. This inhibition may be caused by induction of increased production of ROS (reactive oxygen species) by macrophages or through Granzyme A activity, and subsequent dysfunction of the mitochondria, potentially inducing an autophagic state. However, this would need to be confirmed with further molecular studies. These results defined a potential mechanism of HIV inhibition for Serpin B1. Hence, the overabundance of Serpin B1 in the CVL of HESN women may, in fact, be contributing to their protective phenotype against HIV infection. These findings suggest that Serpin B1 could be considered as a candidate in future microbicides. However, these findings must be validated in in vivo models. / February 2017

This study investigated the attitudes of graduate social work students toward providing services to persons with HIV/AIDS. The following areas were addressed: attitudes of social work graduate students toward providing services to persons with AIDS; similarities between the attitudes of first year students and the attitudes of second year students toward providing social work services to persons with AIDS, the relationship between fear of AIDS transmission and services to AIDS clients, the relationship between knowledge about AIDS and services to AIDS clients and the relationship between moral beliefs about AIDS and services to AIDS clients. The research design employed in this study, was correlational, a form of descriptive methodology. Sixty-one students responded to a self-administered questionnaire. Five different types of services were presented to the students in the form of vignettes. These services were individual counseling, group leadership, a home visit assignment, transportation and advocacy type services. The results of the study indicated, (a) statistically significant correlation between the attitude of social work students toward providing transportation to clients with AIDS (b) statistically significant correlation between the attitude of first year students and the attitude of second year students toward providing transportation to persons with AIDS (c) no significant relationship was found to exist between fear of AIDS transmission and the different types of services (d) a significant relationship between knowledge of AIDS and group leadership; and, (e) a significant relationship between moral beliefs about AIDS and advocacy services.

HIV/AIDS is a highly stigmatizing condition that dramatically influences the social relations of those infected with the disease (Herek & Glunt, 1988; Kalichman, 2000). Stigmatized individuals experience interpersonal rejection because of their stigma and this rejection can heighten dispositional sensitivity to rejection (Downey & Feldman, 1996). Increased sensitivity to interpersonal rejection has been shown to decrease relationship satisfaction and lead to relationship dissolution (Downey, Freitas, Michaelis, & Khouri, 1998). Few studies have examined the influence of stigmatization on romantic relationships and little is known about the romantic relationships of people living with HIV/AIDS. The current study examined the role of rejection sensitivity as a mediator in the association between HIV/AIDS stigma and romantic relationship satisfaction. A diverse sample of HIV-positive participants was recruited from Vermont and neighboring states. Participants completed measures of perceived stigma, rejection sensitivity and satisfaction with their current romantic relationship. Disclosure concerns and enacted, or personalized, stigma predicted decreased relationship satisfaction. Rejection sensitivity did not mediate the relationship between stigma and relationship satisfaction. Results suggest that both rejection sensitivity and perceived stigma independently influence relationship satisfaction. The implications of the influence of stigma on romantic relationships are discussed.

Magister Curationis - MCur / HIV stigma is still affecting People Living with HIV (PLHIV) despite biomedical and structural interventions to reduce this phenomenon. Stigma, particularly health facility related stigma, experienced by PLHIV is reported to fuel poor access to services. As a result, considerable interventions to reduce the stigma among PLHIV have been proposed. However, poor HIV indicators are still reported. Little is reported about PLHIV’s lived experiences of stigma, especially at health facilities, which might be the contributor to poor health outcomes. Hence, this study sought to explore and describe the stigma experienced by PLHIV at a health facility in Khayelitsha Sub-District, Cape Town, South Africa. A qualitative approach, using an exploratory design was followed. Participants were purposively selected, and unstructured interviews were conducted. In total, 15 participants were anticipated to be interviewed. However, saturation occurred after 12 participants were interviewed, but the researcher went further to interview 14 participants. Audiotaped interviews were transcribed verbatim by the researcher (those in English) and assistant researchers (isiXhosa and Afrikaans). Data were then organised and entered into ATLAS.Ti version 8, a Computer Assisted Qualitative Data Analysis Software (CAQDAS) used for analysis of large sets of data. An independent coder was given raw data, and the two outcomes were discussed to reach a consensus on generated themes. The supervisor reviewed the analysed data. Rigour was ensured through the criteria of credibility, dependability, transferability and conformability. The ethical clearance for this study was obtained from the Biomedical Research Ethics Committee (BMREC) at the University of the Western Cape and the City of Cape Town. Six themes emerged from the data because of participants’ experience of stigma at the facility. These include: existence of stigma triggers, participants’ experience of stigma at the clinic, direct stigmatising behaviour, and PLHIV’s characterisation of stigma types, PLHIV’s directed health outcomes, and activism as a secondary health outcome. The results of the study revealed that stigma was perpetuated in the health facility in numerous forms. These were: physical demarcation of the facility, negative behaviour of nurses towards People living with HIV and incompetence of the nurses. This gave rise to recommendations in nursing practice, to policymakers and a need for further research on the topic.

MSc (Med), Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand / Background. South Africa is currently experiencing one of the most severe AIDS epidemics in the world. The major challenge lies in prompt identification and early initiation of treatment in those eligible for HAART. Clinical staging has previously been recommended for use in settings where CD4 + count testing is not available. We conducted secondary data analysis to determine whether clinical symptoms and signs are useful in predicting the need for HAART initiation (CD4 + count < 200 cells/μL) in South Africa. Methods. Screening data from a randomized controlled trial in women who were HIV positive were analysed. All participants were interviewed using a structured questionnaire to elicit symptom history and then physical examination was done. Participants were staged using WHO criteria. Blood was drawn for CD4 + testing. The association between signs and symptoms and a CD4 + < 200 cells/μL was assessed using logistic regression. Results. Among 589 HIV infected women aged between 18 and 58 years, 90% were assessed as WHO clinical stages I/II. The median CD4 + count was 403 cells/μL (IQR: 273-586). Among women who were WHO stage I/II, 13% had CD4 + count < 200 cells/μL and required HAART. The WHO clinical staging had a low sensitivity (4%) but high specificity for detecting those that require treatment. Conclusion: In a setting where asymptomatic patients are diagnosed with HIV, clinical assessment can not replace CD4 + count testing as a method of identifying those that need treatment.

MSc(Med), Population-based Field Epidemiology, Faculty of Health Sciences, University of the Witwatersrand, 2009

Student Number : 9803027N - MA research report - School of Psychology - Faculty of Humanities / The recent introduction of antiretroviral treatment (ART) to the public health sector has meant that for millions of Human Immunodeficiency Virus (HIV)-positive patients this deadly disease has been transformed into a chronic condition. There has been much research done internationally on adherence to ART but in South Africa there has been little investigation in this area. This study aimed to bridge this gap by exploring expert and patient opinions and recommendatio ns regarding adherence to antiretroviral medication. To attain this, four experts and seven patients were interviewed using a semistructured interview schedule. The experts had worked within the HIV field for at least two years while the patients had been chosen from public antiretroviral roll-out programmes and had been on ART for at least six months. These interviews were audio recorded and transcribed. The transcriptions were then explored for themes using thematic content analysis. These themes were categorised and discussed under four broad categories: patients’ perceptions of barriers to adherence, patients’ recommendations for improving adherence, experts’ perceptions of barriers to adherence and experts’ recommendations for improving adherence.

Student Number : 7809567 - MSc dissertation - School of Therapeutic - Faculty of Health Sciences / HIV/AIDS in Sub-Saharan Africa has resulted in a major increase in the number of HIV infected children and orphans. HIV infected children are at risk of developmental delays and growth impairments which is further compromised by poor living conditions. Institutionalisation is not the preferred method of caring for children in need, however, it does provide a stable environment, shelter, nutrition and medical care. Objective: To compare the anthropometric measurements and neurodevelopment of HIV infected and HIV uninfected children who were vertically infected, not on antiretroviral treatment and residing in institutions in Gauteng, South Africa. Method: A comparative, longitudinal study of 16 HIV infected and 24 HIV uninfected children between the ages of 16 and 42 months. The Bayley Scale of Infant Development II (MDI and PDI) was used to evaluate neurodevelopment. The children’s mean z-scores for weight-for-age, height-for-age, weight-forheight and head circumference-for-age were calculated. Evaluations were carried out at two time points, seven months apart. Results: The HIV infected children scored significantly lower than HIV uninfected children at both time points, in neurodevelopmental (MDI p<0.02 and p<0.00; PDI p<0.00 and p<0.00) and anthropometric measurements for-age (weight p<0.00 and p<0.01; height p<0.00 and p<0.00; head circumference p<0.00 and p<0.07). Both groups (HIV infected and HIV uninfected) showed a significant improvement over time regarding to their weight-for-age (p<0.00; p<0.01) and head circumference-for-age (p<0.01 and p<0.08). The height-forage showed no significant improvement in the HIV infected group (p>0.2) but did in the HIV uninfected group (p<0.03). There was a severe delay in the mental abilities of both the HIV infected and HIV uninfected children and the motor abilities of the HIV infected children, which did not change over time, but the motor abilities of the HIV uninfected children did improve significantly. Conclusion: The HIV virus affects the neurodevelopment and growth of HIV infected children. Both groups showed an improvement over time in their growth particularly weight-for-age indicating that they may have benefited from their institutionalisation.