M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Introduction Botswana still has the second highest HIV prevalence in the world with little indication of any significant decline. In Botswana, women are disproportionately affected: young women account for more than half (58 %) of the adults living with HIV thus indicating a significant gender disparity in HIV infection. University educated, urban young women aged 19-39 have been identified as group at particularly high risk of HIV infection. Aim This study aimed to assess knowledge and attitudes regarding HIV and AIDS and how such knowledge and attitudes have implications for participation in risky sexual behavior among female University of Botswana students in their first and fourth years of study. Methodology This study was conducted at the University of Botswana (UB) in Gaborone. Data was collected using a selfadministered questionnaire on Knowledge of HIV/AIDS and participation in Risky Sexual Behavior among female students in first and fourth year of studies at University of Botswana. Results The knowledge regarding the “window period” and infectivity during the window period was significantly lower for first year students compared to fourth years. Attitudes towards people with HIV were positive in both groups, while affirmative attitudes towards premarital sex are increasing as the students progress academically. The analyses highlight that the percentage of women who reported having been sexually active the proceeding year was significantly higher among fourth year students (82.6%) than their first year counterparts (56.9 %), (p<0.01), with the number of partners significantly higher among women in their fourth year. Significantly, 3% of first year female students stated that their partners did not want to use a condom while 7 percent of the participants themselves said that that was the case. Amongst fourth year UB female students responding, 4% said that their partners did not want to use a condom, yet 14% participant said that they themselves did not want to use one. Overall, the prevalence of self-reported STI’s was significantly higher among fourth year students when compared with first year students 19 of 155 [12.26% ]vs. 4 of 144 [2.78 %] p<0.01 . Conclusion This study explored the knowledge of HIV/AIDS and participation in risky sexual behavior amongst female students in their first and fourth years at the University of Botswana. The study supported the findings that higher levels of formal education are associated with better knowledge of how to protect oneself from HIV/AIDS transmission. Although many HIV/AIDS prevention campaigns might have contributed to educated women being knowledgeable about how to protect themselves from HIV/AIDS transmission and the importance from abstaining from risky sexual behavior, a small but significant proportion of women still do not use condoms consistently

Doctor of Education - Adult Education / Despite numerous intervention strategies, HIV/AIDS continues to spread and to pose a threat to the socio-economic transformation of South Africa. There is a need for fresh approaches to HIV/AIDS education for adults and youth in South Africa, particularly for those marginalized by society, such as rural black women. The challenge is to devise appropriate, affordable, socially acceptable and sustainable strategies to help people living with HIV/AIDS, especially in the rural communities. The broad objective of the study was to examine ways in which rural ABET centres address the challenges of HIV/AIDS prevention and support in the Limpopo Province of South Africa. A case study approach was used to investigate the ways in which five operational ABET centres addressed the epidemic in their communities. The intentions and actions of the ABET District Co-ordinator (1), Circuit Area Managers (5), Centre Managers (5), educators (10) and learners (80) were studied. Methods used in the collection of data were in-depth, semi-structured interviews, focus groups, critical incident review, and participant observation. The research investigated ways in which ABET centres dealt with HIV/AIDS-related issues, and the attitudes, beliefs and practices of ABET practitioners and learners with respect to HIV/AIDS prevention practices and care issues and how these impacted on the centres’ ability to address HIV/AIDS. The research results show that the human, social, structural and infrastructure constraints currently faced by the centres hinder their ability to play an effective and meaningful role in dealing with the epidemic. Access to knowledge, participation in social networks and entrenched cultural practices all play a role in defining the manner in which the communities have responded to HIV/AIDS. Through an analysis of the environment in which the ABET centres operate, and the varied success of their programmes in addressing HIV/AIDS, recommendations have been drawn up to assist ABET centres to address the pandemic more effectively. The study concludes that ABET centers, through acknowledgment of their role and effective use of resources in collaboration with the available networks can make a meaningful contribution in curtailing the spread of HIV/AIDS and supporting the people affected by HIV/AIDS in the communities in which they operate.

ABSTRACT The ubiquitous effect of HIV/AIDS on workplaces in South Africa has increased the pressure on large companies to implement effective responses to the disease. As companies have begun to explore workplace interventions, several theoretical guidelines or codes of practice have come into existence and with this, the concept ‘best practice’ has been brought into the spotlight. With limited precedent to establish what ‘best practice’ really means, contemporary HIV/AIDS literature has yet to establish a clear understanding of the concept. As a result, critical questions have been raised around the value of ‘best practice’ in the workplace programmes of large South African companies and there has been a call for ‘best practice’ interventions to be more precisely defined. The research had two primary objectives. The first was to establish a greater level of understanding regarding the meaning of ‘best practice’ and of the specific interventions that make-up successful workplace programmes. The second was to determine the value of the ‘best practice’ in promoting and managing effective workplace programmes. The research employed an interpretive analysis as part of a qualitative methodology over a period of ten months. An in-depth thematic analysis of fourteen codes and guidelines and several ‘best practice’ documents formed the basis of interview research instruments. Data was collected during a series of thirty-nine in-depth interviews across twenty-one large companies and fifteen workplace HIV/AIDS experts, consultants and service providers. A focused research questionnaire - based on overlapping content in the codes and guidelines - was used to establish views regarding specific workplace interventions and to verify the existence of nine principal components of successful workplace programmes. The investigation of a wide range of perceptions and organisational factors found to affect the uptake and continuity of ‘best practice’ allowed for a greater understanding of the concept ‘best practice’ within the context of workplace HIV/AIDS programmes and enabled the development of a generic conceptual framework for companies to use in evaluating ‘best practice’ interventions. Within this, the research identified a specific need for renewed focus on the measurable outcomes and intensified efforts in promoting the continuous improvement of workplace HIV/AIDS intervention

Abstract This dissertation explores four key questions within the HIV/AIDS paradigm1 and the impact it is having on orphans and vulnerable children in the district of Quthing, Lesotho. These questions are: What is the status of social safety nets? How are communities surviving with the growing number of orphans and vulnerable children? What might be the early warning signs of community breaking points as a new category of child-headed household emerges? What are the human drivers of the pandemic in terms of behaviour and attitudes towards HIV/AIDS, orphans and vulnerable children, and sex; and in terms of reasons why people are not heeding the warning signs and adopting behaviour change? The findings of the dissertation reveal that communities are overwhelmed with the demands placed on them to support orphans and vulnerable children to the point where culture, traditions, and society at large are showing early warning signs of irreversible strain. Despite the efforts of government, donors, the humanitarian sector and the communities themselves, awareness of HIV/AIDS is not translating into behavioural change and as such the spread of the virus continues unabated among the youngest and most vulnerable groups. 1 The set of assumptions, concepts, values, and practices that constitutes a way of viewing reality for the community that shares them, especially in an intellectual discipline. ii

Student Number :0318744F - MA research report - School of Arts - Faculty of Humanities / Title: LIVING DANGEROUSLY Subtitle: HIV/Aids, masculinity and the post-apartheid generation: A case study AIM: to investigate via the story of one young South African man the complexity of dealing with HIV/Aids in South Africa. RATIONALE: With the ending of apartheid and the rise of HIV/Aids, there has been a clear crisis of masculinity in the wake of social change. Government response to the epidemic has been ambiguous. Fana Khaba, aka Yfm DJ Khabzela, was the first young black celebrity to publicly declare he had Aids. I plan to follow his story and to look at HIV/Aids campaigns and to examine why they are not working. METHODOLOGY: Through a literature review, an examination of statistics and public health messaging on HIV/Aids and my investigation into the life of Fana Khaba, I will show the complexities currently not being considered in the compilation of public health messaging. The reason I chose to follow the story of Fana Khaba is because I am a South African deeply concerned about HIV/Aids. I found his life compelling because it encapsulated so much of the rapid and intense culture shift that followed the arrival of democracy in 1994. And because his life echoed that of a pivotal generation in the apartheid struggle: the generation who grew up in Soweto in the seventies and eighties and came to adulthood with democracy. The so-called “lost generation” who later became known as the “Y generation”, they are deeply affected by the pandemic. I intend to show that Fana Khaba was a hugely popular iconic figure for the generation because he spoke to their aspirations and their anxieties. I will argue that because his life experience resonated so strongly with this generation, it is reasonable to draw more general lessons from it. The chief executive officer of Yfm was a friend of mine and, through him, I am able to gain access to Khabzela, his family, friends and colleagues at Yfm. This is an exceptional opportunity to gain an inside view of a life not readily available to relative outsiders such as myself. Clearly there is an ethical issue here. I will at all times keep my interviewees informed about the purpose of my research. I hope to help shed light on this anguished, important and under-debated sphere of life in South Africa.. The format I choose is part investigative journalism, part biography. The reason for this is that I have worked as a journalist for 25 years so all my skills and training point me in that direction. I wanted to make it accessible in order to reach as many people as possible. The narrative-biographical form is conducive to this because it is easy to engage with. In order to give the narrative tension and focus, I shall repeatedly employ the central question of why Fana Khaba refused to take the anti-retrovirals which might have saved his life.

MSc (Med), Bioethics and Health Law, Faculty of Health Sciences, University of the Witwatersrand / South Africa, like many other developing nations, is faced with the challenge of mobilising resources to fight the HIV/AIDS pandemic. There is a huge budget gap between the ideal and actual funding provided to achieve universal access to highly active antiretroviral therapy (HAART), which leads to the inevitable rationing of HAART. Although healthcare spending has been increasing in South Africa, new demands are being placed on the HAART roll out programmes. This is particularly due to the emergence of HIV drug resistance (HIVDR). Because non-adherence to HAART is strongly linked to drug resistance, this is a major threat to any successful HAART programme. In the face of restricted resources, this research report looks at some of the ethical and economic implications of non-adherence to HAART. I suggest that there is merit in considering that HAART be restricted only to adherent patients.

MSc, Population-Based Field Epidemiology, Faculty of Health Sciences,University of the Witwatersrand / Introduction: The spread and prevalence of the HIV epidemic has resulted in extensive demographic, social and economic impacts among families in the communities affected in Sub Saharan Africa which increase with the severity and duration of the epidemic. The dramatic increase in adult mortality attributable to HIV/AIDS in households in these communities may increase the number of households that do not survive as a functional and cohesive social group in the years to come. The migration of household members and possible dissolution of these households are the challenges stemming from the epidemic. We therefore require rigorous empirical research on the socioeconomic effects of HIV/AIDS in order to develop appropriate strategies to mitigate these impacts and ultimately improve living standards in these communities. This report describes the extent at which these impacts are felt by a rural community using data from the Rufiji HDSS in rural Tanzania. Design: The study will use a longitudinal study design to identify antecedent events and dynamics and trans-temporal aspects in establishing the effects HIV/AIDS, and particularly how adult deaths from the disease determine migration of individual household members, controlling for other individual level and household factors. Objectives: The main objectives of the study include the description of the adult mortality patterns in the area with an emphasis on the HIV/AIDS related adult deaths, the description of the socioeconomic and demographic characteristics of households experiencing these adult deaths; the characterisation of the members migrating from the households as a result of these adult deaths or otherwise. We also estimate the proportion of household members migrating following the deaths of adult members and further compare these rates of migrations from households experiencing adult HIV/AIDS, Non-HIV/AIDS deaths and where there is no experience of death. Methods: Migrating individuals from 4,019 households that experienced at least one adult death were compared with migrating individuals from other households experiencing Non-HIV/AIDS deaths and those from households without deaths. A total of 32, 787 households were included in the study. An adult death was defined as a death of a household member aged 18 years and above. Those aged 60+ years were considered elderly deaths. A total of 4,603 adult deaths were recorded over the period 1st January 2000 to 31st December 2007. The mortality trends were shown by the rates calculated by Kaplan-Meier survival estimates expressed per 1000 PYO. Migration rates were computed while the association between adult mortality and out-migration of household members was assessed using Cox proportional Hazard model controlling for other individual level and household level factors. Results: Adult deaths increase by about 9% the chance of a child, male or female, to migrate within or without the DSA while HIV/AIDS adult deaths increase by a further 19 percentage point the risk of 5 the child to migrate out of the DSA. The results also show that HIV/AIDS adult deaths enhance the risk of adult female internal migration by 6% (adj. HR 1.06; 95% CI 0.91-1.23, p-value 0.01) but is not significantly associated with adult male migration. Non-HIV/AIDS adult deaths also enhance the risk for female internal migration by 5% albeit hardly significantly (adj. HR 1.05; 95% CI 1.0-1.10, pvalue 0.05) but decreases the chance of male internal migration by 13% (adj. HR 0.87; 95% CI 0.81- 0.93, p-value 0.01). Additionally, HIV/AIDS adult death is strongly associated with out-migration of adults, whatever the gender. They predispose female out-migration to 19% (adj. HR 1.19; 95% CI 1.09-1.30, p-value <0.001) and male migration to 30% increased risk (adj. HR 1.30; 95% CI 1.16-1.45, p-value <0.001). This gender difference is however non-significant (the confidence intervals overlap). Non-HIV/AIDS adult death has the inverse effect on out-migration, and the gender difference is significant: 18% increased risk for males (adj. HR 1.18 95% CI 1.14-1.22, p-value <0.001) and 29% for females (adj. HR 1.29; 95% CI 1.26-1.33, p-value <0.001). Conclusion: Adult deaths have a positive impact on out-migration, with some variation by gender. The effect of HIV/AIDS death on out-migration is not very different from other deaths‟ effect.

MSc (Med), Population-Based Field Epidemiology, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Background: Cluster detection analysis could be an appropriate approach to identify critical AIDS mortality locations for public health intervention. Methods: GIS and Kulldorff’s spatial scan statistic was used to investigate statistically significant AIDS mortality clusters (p 0.05). SaTScan was used to perform the spatial analysis scanning while MapInfo was used as a visualizing tool. Mortality data between 2000- 2006 were analyzed. Results: AIDS exhibit strong spatial clustering tendencies as measured by the Kulldorff’s spatial scan statistic method. Conclusion: Further work is needed to understand the underlying mechanisms responsible for the spatial clustering.

Stigma is multi-faceted and intersects with other damaging forms of social suffering. The evolving nature of HIV stigma is particularly evident in HIV communities, where community members adopt hegemonic views of biomedicine and incorporate them into their shared social space. I argue that such structural discrimination is a product of embracing “biomedical moralities,” where older community members adopt biomedically defined medical management as the standard of conduct. Such standards of living become so pervasive that HIV stigma nearly functions as a form of structural violence producing negative stereotypes of members who do not demonstrate “correct” ways of living with HIV. Such “biomedical moralities” lie at the nexus of community formation, contingent identities, and perceived stigma that members of HIV communities enact and embody. In this work I propose a newly identified stigma-linked syndemic which is thought to contribute to HIV spread, pose challenges for HIV medication adherence, and promote known syndemic interactions between HIV and other STIs. Through ethnographic research I present HIV communities’ experiences with stigma and how that can worsen overall health effects. I suggest that such research highlights needed improvements in anti-stigma campaigns and calls for an expansion of existing stigma-related HIV syndemics research.

Boston University. University Professors Program Senior theses. / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-02