The study sought to identify factors motivating young people aged 14-25 years to use voluntary counseling and testing (VCT) for HIV in Malawi by interviewing 145 young people. The study identified barriers affecting and strategies promoting young people's access to VCT. The research results indicate that young people go for VCT mainly to know their HIV status. The availability of VCT services, and the provision of VCT services by peers motivate young people to access VCT. Some young people do not access VCT services due to fears of being found HIV+ve and because of the poor attitudes of the health service providers. Providing more information about VCT, involving young people as VCT providers, using youth friendly health service providers, providing VCT in a separate room for young people and through mobile services will increase young people's access to VCT services in Malawi. / Health Studies / M.A. (Public Health)

Masters of Science / Background: Infection with HIV results in gradual loss of immunologic functions, especially those mediated by CD4+T helper cells with consequent impairment of the immune response leading to severe manifestations of periodontal disease. The lower the CD4+T lymphocyte cell count or the higher the level of immunosuppression, the higher the incidence of periodontal disease in those patients will be. Putative periodontopathic bacteria namely Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia, commonly referred to as "red complex", and many other bacterial species have been implicated in the initiation and progression of periodontal disease. Objective: The present study tests the association between different CD4+T lymphocyte levels and "red complex" pathogens using BANA, in HIV-positive patients with chronic inflammatory periodontal disease (CIPD). Methods: 120 HIV-positive patients from the infectious disease clinic at Tygerberg hospital participated in the study with a mean age of 33.3 years. The CD4+T lymphocyte counts were obtained from patient's medical records. The six Ramjford teeth were used for evaluating periodontal clinical parameters such as plaque index, gingival index, periodontal probing depth and clinical attachment loss. Subgingival plaque samples were collected and analyzed by the enzymatic BANA test for the detection of the "red complex". Results: The CD4+T lymphocyte mean level was 293.43cells/mm3. Statistically significant associations were found between CD4+T cell counts and probing depth (p= 0.0434) and clinical attachment loss (p= 0.0268). Significant associations were found between BANA with all the clinical indices (p= <0.05). However no association was found between CD4+T cell counts and BANA. Conclusion: HIV-positive patients show a high prevalence of "red complex" pathogens subgingivally. Immunosuppression seems to favour the colonization of these species, resulting in periodontal disease manifestations.

People who have been diagnosed HIV positive often experience distress and anxiety due to uncertainties pertaining to the implications of an HIV positive status. Research has shown that support groups have always been a way for people to cope with the distress and stressful circumstances associated with health conditions such as HIV. This research investigated the role of face to face support groups in the lives of those living with HIV. The primary focus of this research project is to provide an in-depth exploration of HIV positive individuals‟ experiences of being in a support group. The study aims to explore the positive and negative experiences of being in an HIV support group and aims to gain an understanding of the role support plays in the lives of those living with HIV. A qualitative research design was used to explore the above mentioned aim. Semi-structured interviews were conducted with five individuals, (three women and two men) who had experienced HIV support groups. The interviews were transcribed and then analysed according to the principles of interpretative phenomenological analysis (IPA). The findings of this study revealed five super-ordinate themes, which revealed not only the positive and negative experiences of being in a support group, but also the challenges that the participants‟ experienced before joining the group. Getting a sense of the participants‟ experience before joining the group allowed the researcher to get a better understanding of how useful or not the support group has been in helping them deal with the challenges of living with HIV. The themes included: „struggling to survive after diagnosis‟, „struggling to cope: adopting negative coping skills‟, „experiencing a turning-point: a will to survive‟, „attending support group: a sweet experience‟ and lastly, „attending support groups: a bitter experience‟. Findings suggest that for these participants, the advantages outweighed the disadvantages of being in a support group. Therefore this study suggests that face to face support groups are a viable and even necessary option for support. 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 people in their journey to adjust to the consequence of living with HIV.

Stigma and discrimination (SAD) attached to Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been recognised as a major obstacle to HIV prevention, treatment, care and support throughout the world. SAD is more devastating when it occurs in health care settings where it is least expected. Health care providers (HCPs) are supposed to provide physical, social and psychological support to people living with HIV (PLWHA) but HIV and AIDS-related SAD has been extensively documented among the HCPs. Different studies have pointed out that there are three major actionable causes of HIV-related SAD in health care settings. These are lack of awareness among HCPs, fear of casual contacts and associating the SAD to immoral behaviour. The main objective of the current study is to determine the magnitude of HIV and AIDS-related SAD and its associated factors in hospitals and then to propose appropriate SAD reduction-intervention strategy in the health care settings. The study employed pre-test-post-test design with non-equivalent control group. Two paradigms were used in this study including quantitative and qualitative approaches. The sampling method for the quantitative part of the study was probability sampling in which the respondents were randomly selected using stratified sampling technique. The study was able to determine the magnitude of HIV and AIDS-related SAD among the HCPs. Moreover, the study has identified the factors that are attributed to the prevalence of SAD in the hospitals. The major factors identified for causing the SAD in the hospitals were sex, age, work experience, low level of knowledge, negative attitudes and percieved risk of HIV infection of some HCPs toward the PLWHA. The intervention made on the respondents in the treatment group was able to reduce the overall prevalence of the SAD among the HCPs. The study suggests that to reduce the SAD, HIV and AIDS-related trainings before and after graduation is critical to improve the knowledge, attitudes and practices of the HCPs. Besides, ensuring the availability of the protective supplies in hospitals is crucial in reducing the fear of HIV infection among the HCPs while providing care for HIV positive patients. Effective implementation of the hospital policies, strategies, guidelines and protocols along with good institutional support is also vital in creating safe and user-friendly hospitals for PLWHA. / Health Studies

M.Ed. / Over the past decade, the HIV/AIDS pandemic has had a devastating effect on many communities and families in South Africa. Many families have already lost, and many more will lose, primary caregivers to the disease. This could have a serious impact on the living conditions and emotional wellbeing of families, and especially of children and adolescents. As an intern educational psychologist working in the Eldorado Park community, the researcher became aware of the difficulties and needs experienced by families that are affected by HIV/AIDS. This study therefore aims to identify the needs of families affected by HIV/AIDS, in order to assist the educational psychologist by making recommendations for weaving a circle of care to support them, within an asset-based approach. To accomplish this, the study utilised a participatory research approach within a critical theoretical paradigm and case study design. Purposeful selection was employed and as the study is concerned with HIV/AIDS which requires the utmost confidentiality, the families were identified with the help of home-based care workers. The researcher interviewed three families and eight home-based care workers in the Eldorado Park community. Detailed data analysis and interpretation of the needs highlighted during these interviews revealed a number of common themes, which are indicative of the needs of families affected by HIV/AIDS in the Eldorado Park area. These families expressed a need for awareness, love and understanding from their communities. They also wish to have greater understanding and support from schools, as well as expressing the need for opportunities to share their experiences and raise community awareness by speaking at schools and churches, and through support groups. Families furthermore require assistance with the great economic difficulties they face, largely due to illness and unemployment. A need to gain greater access to medical care, social grants and burial societies, was expressed. Difficulties with transport and documentation seemed to create a major barrier in this regard. The need for psychological and spiritual counselling as well as legal advice was highlighted. The study provides recommendations and a practical asset map to assist the educational psychologist in weaving a circle of care for families affected by HIV/AIDS. / Mrs. Helen Krige Dr. Elzette Fritz

No description available.

Submitted in fulfillment of the requirements for the degree of Masters of Health Sciences in Clinical Technology, Durban University of Technology, Durban, South Africa, 2016. / Introduction: The immediate post-cardiopulmonary bypass (CPB) immune responses and organ injuries in immune- compromised patients remain poorly documented. We conducted a prospective clinical study to determine whether or not human immunodeficiency virus (HIV) seropositive patients generate higher acute systemic inflammatory response and suffer greater myocardial injury, compared to HIV seronegative patients. Methodology: Sixty-one consecutive patients i.e. Thirty HIV seropositive patients and Thirty-one seronegative, undergoing elective cardiac valve(s) replacement were enrolled, over a period of nine months from a single center hospital, after informed consent was acquired. The C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) were used as biomarkers of acute inflammatory response, and cardiac troponin I (cTnI) as a biomarker for measuring postoperative myocardial injury. Single tests were measured preoperatively and postoperatively, in both groups, and these were compared and correlated to perioperative events and CPB parameters. Results: The mean age group was similar between the HIV seropositive and negative group (37.8 and 37.1 years, respectively). Preoperatively both groups had relatively equal CRP levels (p=0.388), ESR levels (p=0.817) and cTnI (p=0.489). The CPB events and durations were significantly different between the two groups, CPB duration (p=0.021). Other CPB events include, clamp aortic duration (p=0.026), CPB blood transfusion (p=0.013), CPB total urine output (p=0.035) and CPB peak lactate (p=0.040). Postoperatively we observed significant increased biomarkers level in both groups, with no significant difference between the groups: mean CRP (p=0.115), mean ESR (p=0.214) and cTnI (p=0.363). We observed a significant negative correlation between the mean change in CRP levels and mechanical ventilation (r=- 0.548, p=0.002) in the seropositive group, but not in the uninfected group (r=0.025, p=0.893). The correlation between the difference in CRP and ICU stay was not significant between in both group (r=-0.231, p=0.229 and r=0.25, p=0.975, respectively). A significant positive correlation between postoperative cTnI and the inotropic support duration (r=0.384, p=0.040) was seen in the seropositive groups, but not in the negative group (r=0.092, p=0.622). Furthermore we observed a significant drop in CD4 cells postoperatively (p=<0.001) in the HIV seropositive group. Antiretroviral treatment appeared to influence the degree of change in CD4 cells postoperatively. Conclusion: We conclude that HIV positive patients’ postoperative reactions to cardiac surgery supported by CPB are similar to those of HIV seronegetive patients. We further report non-paralleling correlations between the biomarkers and perioperative events; however these do not seem to affect the overall outcomes between the two groups. / M

Introduction: Decentralization of antiretroviral therapy (ART) services faces decreasing quality when increasing ART coverage. This study compares nurse initiated and managed patients to doctor managed patients under these circumstances, using retention in care as a crude measure of quality of care. Methods: This was an observational retrospective cohort study. A simple data abstraction tool was used to collect baseline patient data from medical records of HIV positive patients (N=871) initiating ART at Mbabane Government Hospital and four of its outreach clinics, between 1st January and 30th June 2011. Descriptive summary statistics and comparison of the two cohorts using multivariate analysis was done. Results There was no statistically significant difference in retention rates between the doctors and nurses cohorts at 69.1% and 70.9%, respectively (P was 0.56). After adjusting for sex, haemoglobin, CD4 cell count, weight and WHO stage, the odds of being retained in care were similar between the two groups, adjusted OR: 1.11(95% CI: 0.72, 1.69), with a p value of 0.64. Haemoglobin and weight were positively associated with retention in care, while male sex was negatively associated with retention in care. Discussion: The similar retention rates between the two cohorts suggest that in terms of retention in care the service provided by the nurses was comparable to that provided by doctors. This is important to ART program managers as they scale-up ART decentralization. Conclusion: Task-shifting of ART initiation from doctors to nurses is feasible as nurse initiated and managed antiretroviral therapy is comparable to doctor initiated and managed treatment. / Dissertation (MSc)--University of Pretoria, 2014. / gm2014 / Clinical Epidemiology / unrestricted

Submitted in fulfillment of the requirements for the Degree in Master of Health Sciences (Nursing), Durban University of Technology, Durban, South Africa, 2016. / Background South Africa, especially KwaZulu-Natal remains heavily burdened with HIV and AIDS. Timely HIV testing is the cornerstone to HIV prevention in terms of early diagnosis and access to treatment, care and support services. Factors that influence delayed HIV testing must be investigated and reported to inform plans that are directed at improving implementation of HIV testing services and access to care, treatment and support services for people living with HIV. Purpose of the study This study was aimed at identifying factors that lead to delayed HIV testing in a sample of people attending a Primary Health Care clinic in KwaZulu-Natal, South Africa. Methodology A descriptive qualitative design was used in this study. The population in this study was HIV positive patients who had recently tested for HIV and received their first CD4 count result of 350 mm3 or less. Purposive sampling, which is a type of non-probability sampling, was used to select the study participants from the population. Semi structured interviews using an interview schedule were used to collect data. Data was collected until data saturation was reached. Results The data was analysed by means of content analysis and raw data was coded and sorted into sub categories and categories. The underlying meaning of categories was formulated into one overarching theme: Testing for HIV is daunting and embedded with issues of stigma, denial and a fear of knowing one’s positive status. Conclusion To encourage early HIV testing before HIV positive people become noticeably ill requires efforts directed at change of attitude and improvement of support for HIV positive people in families, communities and health service institutions. Community forums to be actively involved in eliminating the stigma and discrimination associated with HIV positive people by creating awareness of these matters and encouraging community and family support for people with HIV. / M

M.Cur. / The purpose of this study is to identify the midwives experience in doing the delivery or a HIV-positive patient. Because the incidence of AIDS is increasing in the heterosexual population and thus the women in their reproductive years, it is important for the midwife to know how feelings for the HIV-positive patient. It is the midwife who has to give counselling and support to tho HlV-positive patients and in doing so, she herself must get counselling end support. Unstructured in-depth interviewB wore held with r Ivo midwives on one occasion. Each midwife should have done at least one delivery of a HIV-positive patient. The experiences of the midwives was then combined and a literature control was done to consult other authors' findings on the heath workers experience of HIV positive patients. Recommendations were made at the end of the study concerning applications to practice, education, further research and the counselling of the midwife.