Thesis (Master of Health Policy and Administration)--Washington State University, May 2006. / Includes bibliographical references (p. 39-45).

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 114-122).

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 188-204).

Magister Artium - MA / The effects of the spread of HIV/AIDS place a great burden on women and children, who will probably suffer most in terms of social and economic deprivation. Since HIV/AIDS is linked to social taboos such as sexuality, drug use and death, there are enormous levels of ignorance, denial, fear and intolerance in most communities. These prejudices lead to the stigmatisation and discrimination of people who are living with HIV/AIDS. Moreover the illness, as it is sexually transmitted, has been conflated with sexual excess, lack of morals, and those already stigmatised such as sex workers with associated discourses of blame, shame and guilt. Generally, responses to HIV and those living with HIV have served to reflect, legitimise and reproduce broader social inequalities on the basis of sexual orientation, gender, race and class. Stigma is the reason why many people who are living with HIV/AIDS, choose not to disclose their status and seek apposite assistance. This study explored the stigma experienced by a group of women who are living with HIV/AIDS and to develop a deeper understanding of whether these experiences are complicated by social responses. / South Africa

This research project examined the changing expectations and knowledge of Managers in the Department of Health who attended the Sexual Health Counselling Project offered by Rhodes University, East London, South Africa. These managers came from contexts in which the hierarchical medical model is firmly entrenched. The Sexual Health Counselling Project, drawing on theoretical principles from Narrative and other theories,presented a challenge to the standard management practices used by the managers. It also challenged how they dealt with clients. This research explored changes in expectations and knowledge prior to and during a two- week training course that the managers attended. A personal awareness and shift in knowledge occurred for many managers who examined their current practices. Some managers, who were firmly entrenched in the hierarchical model,found it difficult to change their ways of working.

This qualitative study explored the use of Reiki in improving the quality of life of people living with HIV (PLWH). A purposive sample of seven participants consented to the study. Reiki attunement, self healing and data collection were done over a six-month period. An idiographic approach was used. The participants were interviewed, then underwent Reiki attunement, performed self healing for 21-30 days and were interviewed again. Responses suggest that Reiki therapy had positive outcomes. Illnessspecific symptom relief, increased levels of energy, improved sleeping patterns, decreased anxiety and depression, spiritual awakening and a better ability to handle stressful situations were reported. Reiki therapy enabled the participants to reappraise living with HIV, deal with anger, depression and self-blame. These positive changes led to some of them seeking employment, leaving destructive personal relationships and reconnecting with family members. The researcher strongly recommends further research in this area. / Sociology / (M.A. (Social Behavioural Studies HIV/AIDS))

M.A. / The challenge of HIV/AIDS is a global issue, instead of decreasing the number of people infected with the disease the number is increasing. Fortunately we have men and women who are volunteers to fight the increase of this pandemic. These heroes are the voluntary caregivers who are the mainstay of people with AIDS. However the fact that the caregivers suffer from loneliness and social isolation related to stigma and discrimination cannot be ignored. Voluntary caregivers can benefit form the opportunity to express basic emotions concerning, financial, emotional and physical issues and open line of communication should be in place. Providing an avenue foe emotional expression may enhance both physical and mental health to voluntary AIDS Caregivers. The qualitative study undertaken to explore the experiences of AIDS patients and their families regarding the home based care as service delivery. An explorative and qualitative design was used to determine the experiences of the AIDS caregivers, and aids patients concerning the support that they receive. AIDS patients and the families were selected from the organisations that are funded by the Department of Social Development in the Free State, Bloemfontein area. Pilot study was conducted prior to the commencement of the study comprising of ten participants in each group. Participants were requested to give information during the interviews. Data was collected and analysed and it was in followed by the literature control. The findings did not differ significantly in emotional and social aspects. The researcher drew conclusion and recommendations. Limitations were discussed. / Dr. Oliphant Ms. A. Vermeulen / M.A.

Background Nutrition and food security are important for maintaining a strong immune system and good general heath of People Living with HIV/AIDS (PLHA). The main aim of this study was to survey the nutritional status, habitual diet, dietary knowledge and demographic characteristics of PLHA in Nepal. A second aim of this study was to explore the voices of PLHA and policy level people on the current and possible future nutrition intervention programmes for PLHA in Nepal. Methods Using mixed methods (quantitative and qualitative) research techniques, 601 (M: 314 and F: 287) HIV positive people from the Kathmandu valley and Terai highway regions of Nepal were recruited and completed the study. All participants completed an interviewer administered questionnaire. This questionnaire includes an assessment of habitual food intake using a newly developed and validated 45-item semi-quantitative food frequency questionnaire. The validity of the FFQ was previously assessed against the 24-h multiple pass dietary recall in a sub-sample of the study population. Socio-economic and demographic information, dietary/nutritional knowledge, height, weight, waist circumferences and skinfold thickness were also collected. Finally, reported food intake was converted into energy and selected nutrient intakes (fat, protein, carbohydrate, iron, vitamin A and vitamin C) by linking with a newly compiled nutrient database of 116 food items for Nepal. Nutritional knowledge and perceptions of the current Nepalese nutritional supplementation and possible alternative interventions were explored using qualitative techniques. Four focus group discussions (FDG) and 11 in-depth interviews were carried out with PLHA and key local stakeholders respectively. Results The newly designed semi-quantitative FFQ can retrospectively assess the group mean intake for energy, protein, fat, carbohydrate, iron, carotene and vitamin C as there was no significant difference for reported intakes (all p > 0.2), but mean fat intake was significantly lower when determined by the FFQ than the 24-h recall (p < 0.001). The average age of participants was 33.8±6.4 years (mean ±SD) and 29% were classified as underweight (BMI < 18.5kg/m2). The study population typically ate a plant-based diet and intake of animal products was low, the energy intake of men and women was 1960±195 and 1880±261 kcal/d mean (±SD) respectively. Fat, protein and carbohydrate contributed 12%, 10% and 79% to total energy intake respectively. Iron and vitamin A intakes also tended to be lower than recommended, whereas vitamin C intake was satisfactory. Most participants (82%) believed that PLHA need a special diet but less than half of those reported changing their diet after diagnosis. A major reason for this was restricted income: 46% of participants reported being unable to afford sufficient food for the whole year, and 57% of those reported borrowing food for more than four months a year. Participants from FGD and in-depth interviews were not satisfied with the daily food and nutrient intake by HIV positive people. The Nepalese government currently provides a nutritional supplement for PLHA mainly for those who are on anti-retroviral treatment (ART). However, this was not satisfactory with the majority of volunteers reporting suffering negative health effects, including diarrhoea and vomiting, after consuming the supplement. Similarly, poor quality packaging, storage, delivery and lack of nutritional expertise and education were frequently reported problems for the proper implementation of the existing supplement. The participants suggested a nutrition intervention, based on a locally produced supplement, combined with dietary education and were highly motivated to support the development, implementation and evaluation of a new intervention. Conclusion Food and nutrient intakes by PLHA in Nepal were not adequate and did not meet dietary recommendations. Overall, the quality of the current nutritional supplement is poor and not suitable for ensuring maintenance of PLHA health. A nutrition intervention trial based on locally produced fortified mixed grain flour was favoured by PLHA and key stake holders. However, further research is needed to improve the nutritional status of PLHA in Nepal. Therefore, the evidence identified by this study could be used to inform the design of a new intervention. However, further research is recommended to clarify the issues.

Magister Curationis - MCur / Background: In the South Africa, the number of HIV- positive pregnant women is rising and has resulted in more than 70,000 babies being born with HIV infection annually since the year 2000. In response to the escalating number of HIV-positive pregnant women, the Department of Health of South Africa, decided, in 2002, to implement the Prevention of Mother to Child Transmission (PMTCT) programme at 18 pilot sites in the country. An effective PMTCT programme could reduce the incidences of maternal and child mortalities in the country. An evaluation of the effectiveness of the PMTCT programme that was done in 2010 showed that, although the programme was rendered effectively during pregnancy and labour, there were still irregularities that appeared, especially during the postnatal period. Khayelitsha was the first pilot site in South Africa to provide Antiretroviral Therapy and initiate the Nurse Initiated Management of Antiretroviral Therapy (NIMART) at primary care level in the public sector. Midwives are the health professionals who render the PMTCT services to HIV-positive mothers and their babies until six weeks post-delivery. They have managed to test almost 100% of pregnant women during the antenatal period and the HIV-positive women were started on the PMTCT programme during their first visit. Aim: The aim of this study was to explore the challenges that midwives faced in rendering care to postnatal HIV-positive mothers enrolled in the PMTCT programme at the Khayelitsha Community Health Clinic in the Western Province of South Africa. Method: An exploratory design and qualitative approach was followed. The study population consisted of midwives who were rendering PMTCT services to HIV-positive mothers and their infants during the postnatal period. Purposive sampling was conducted until data saturation was reached. Six participants were included in the sample. The participants were informed about the study by means of an Information Sheet, advised that the study was voluntary and reminded that they could withdraw from the study at any time, without prejudice. In-depth, unstructured individual interviews were conducted with each of the participants. With the permission of participants, an audio tape recorder was used during the interviews to collect data, while the researcher took field notes to supplement and verify the voice recordings, after the interviews. The seven steps of Colaizzi were used to analyse the data. Six themes and sixteen sub-themes emerged during the data analysis. Trustworthinesswas maintained by using the criteria of Guba’s model, i.e. credibility, transferability, conformability and dependability. Permission to conduct the study was obtained from the appropriate ethical committees; the Department of Health, the Khayelitsha Community Health Clinic, as well as, the Senate Research Committee of the University of the Western Cape. Participants were asked to sign Informed Consent forms before participating in the study. The ethical principles of privacy, anonymity, withdrawal, confidentiality and consent were strictly adhered to. Findings: The study found several challenges faced by midwives while implementing the PMTCT programme during the postnatal period. These challenges included: the shortage of NIMART-trained staff attending to the high number of clients per day; the lack of manpower with data base systems to trace mothers who did not come back after delivery; and mothers who did not come back for postnatal appointments because of denial, non-disclosed HIV status and socioeconomic reasons. Furthermore, the participants also reported on midwives experiencing ‘burnout’ as a result of the hectic working environment at the Khayelitsha Community Health Clinic. Recommendations: There is an urgent need for all midwives in the MOU’s to be NIMART-trained. NIMART should be standardize and be the part of the curriculum that taught in all the tertiary institutions and be updated in a yearly basis as part of the in-service training or education for all practising midwives. The South African Government should introduce home visits in the PMTCT programme. Data-bases of all MOU’s and facilities that offer PMTCT services need to be synchronized and these MOU’s and facilities should all follow the same PMTCT guidelines. Further research should be done on the same topic at other clinics and MOU’s that render the PMTCT programme in the Western Cape.

People who have been diagnosed HIV positive often experience distress and anxiety due to uncertainties pertaining to the implications of an HIV positive status. These individuals are often reluctant to seek counselling and treatment due to the fear of being rejected and discriminated against (Parker, et al., 2002). There are limited formal networks for HIV support and psychological help in the South African context. Considering this, structured support groups were implemented for recently diagnosed HIV positive pregnant women. These women were recruited from ante natal clinics in Atteridgeville and Mamelodi as part of the Serithi project. Six support groups were implemented and facilitated by various experts including Masters students, of whom the researcher was part. This project is part of the larger study of the Serithi project in which interviews were conducted with three hundred and seventeen HIV positive pregnant women from disadvantaged locations of Tshwane. Based on these interviews, a support group intervention was developed. This research forms part of the evaluation of the support group intervention. The aim of this study was to explore the experiences of women who attended the support groups. Women who had attended 7-10 sessions were selected and interviewed individually using semi-structured interviews. With the permission of the participants, the discussions were tape recorded and transcribed. The data was analyzed, using qualitative research methods, from an interpretative phenomenological approach. This involved systematically studying meanings, themes and general descriptions of experiences by the research participants. The main findings in this study showed that women who participated in support groups adopted positive coping and behaviour that is conducive to their livelihood, learned more about HIV and AIDS, seem to have a positive future outlook and are overall empowered. These findings support previous research and literature in regards to the importance of social support in the form of support groups in effectively assisting HIV positive women in their journey to adjust to psychosocial consequence of the disease. / Dissertation (MA)--University of Pretoria, 2012. / Psychology / unrestricted