To end the HIV epidemic, prevention of new HIV infections will be contingent on preventing at-risk individuals from acquiring HIV and supporting people living with HIV in achieving and sustaining viral suppression throughout their lifetime. The underlying motivation for this dissertation is the recent evidence that new HIV infections can be prevented when people living with HIV achieve and maintain viral suppression. In response, three studies were conducted. The goal of this dissertation was to advance our understanding of HIV viral suppression patterns over time among clinically engaged adults living with HIV and examine current limitations in viral suppression monitoring. First, a systematic review evaluated the existing literature for evidence of longitudinal assessments of viral suppression among people living with HIV. Among 896 publications identified during the database search, 50 publications met the study criteria and were included in the review. Among these studies, 78% were implemented in the United States, 72% assessed viral suppression using viral load results abstracted from clinical medical records, and 22% used surveillance data from HIV-laboratory based reporting. Five distinct longitudinal measurement methods were identified, including (a) estimates requiring more than one viral load within an observation period to be below a suppression threshold; (b) estimates comparing the first and last viral load during an observation period; (c) reporting multiple proportions of participants maintaining viral suppression across an observation period; (d) estimating viremia copy-years and estimating person-time above a suppression threshold, and; (e) other methodology to assess longitudinal viral suppression such as data weighting and group-based trajectory modeling. Half of the studies reported the proportion of individuals with all viral loads below a certain threshold (e.g., ≤200 copies/mL). Most studies (70.0%; 35/50) were published in the last five years (2015 – 2019) and describe viral load data collected between 2013 and 2018, highlighting recent efforts by researchers to describe viral suppression using longitudinal approaches. Next, data from a longitudinal electronic medical record-based prospective cohort study of people living with HIV seeking care in Washington, District of Columbia, were used to describe longitudinal changes in viral suppression and assess the relationship between prior virologic history and virologic failure events during follow-up. Among 3556 participants, 29% did not maintain viral suppression during a five-year period, and instances of viral suppression status fluctuations were observed. Participants with a history of fluctuating viral suppression were found to have a higher rate (RR=2.40; 95% CI: 2.03 – 2.84; P<0.01) of virologic failure events during follow-up, compared to participants with sustained viral suppression before the observation period. Lastly, a third study used the same data source to assess differences between viral suppression estimates derived from different measurement methods and evaluate the impact of data triangulation on longitudinal viral suppression measures. Among 3452 participants (median age 48; 73% cisgender males; 77% non-Hispanic black), 69% had all viral load results suppressed (<200 copies/mL) during a four-year observation period, 28% had both suppressed and unsuppressed viral loads, and 2% had all viral loads unsuppressed. Compared to cross-sectional viral suppression measurement methods, longitudinal measurement methods resulted in lower proportions of virally suppressed participants. Data triangulation added 2293 viral load data points and resulted in lower viral suppression estimates. These findings highlight the need to reconsider current viral suppression measurement methods to improve the accuracy of estimates reported in surveillance reports and epidemiologic studies. Overall, this dissertation addresses important questions related to viral suppression by describing the frequency of viral suppression status fluctuations that occur throughout an extended observation period, quantifying the occurrence of repeated virologic failure events, and comparing several measurement techniques to assess appropriate methods to describe viral suppression over time. Recently, the United States Department of Health and Human Services, together with the White House, set forth the “Ending the HIV Epidemic: A Plan for America” initiative, with a goal to end the HIV epidemic in the United States within the next ten years. To reach this goal, the initiative calls for a 75% reduction in new HIV infections by 2025 and a 90% reduction by 2030. Treating people living with HIV rapidly and effectively with ART is an important strategy to carry out these efforts. This dissertation demonstrates that assessing the ability of people living with HIV to maintain viral suppression over time is also critical.

Women accounted for 20% of the cumulative AIDS cases in the United States as of 2015. Although their incidence of human immunodeficiency virus (HIV) has declined in recent years, the rates of new infections and AIDS diagnoses for women of color have remained high. Women with HIV tend to be more vulnerable than men with this disease. They are more likely to be poor, uninsured, depressed, and homeless; to have experienced interpersonal violence; and to be caregivers. Attention to psychosocial needs and building trust are fundamental to engaging HIV-positive women in care and helping them attain optimal health.

A research report submitted to the Faculty of Human and Community Development, University of Witwatersrand in partial fulfilment of the requirements for the degree of Masters of Arts in the field of Social Development, January 2018 / Human Immunodeficiency Virus (HIV), which leads to Acquired Immune Deficiency Syndrome (AIDS), is one of the world’s greatest health threats and leads to death of millions of people. In 2016, an estimated one million people died of AIDS related causes globally. An estimated 36,7 million people in the world are living with HIV and AIDS. HIV counselling is regarded an integral part of prevention and coping strategies and an effective tool in preventing the spread of HIV and AIDS. HIV and AIDS have negative psycho-social effects to individuals and families. This study investigated counsellor’s knowledge of HIV and AIDS, attitudes towards PLWHA and counselling practices at Non-Governmental Organization (NGOs) operating within Emfuleni Local Municipality. Incorrect knowledge of HIV and AIDS, negative attitudes towards PLWHA and poor practices can negatively affect efforts to curb the pandemic. A non -experimental study was conducted with a sample of 101 HIV counsellors. Data was gathered by a self - administered questionnaire soliciting counsellors responses pertaining to knowledge of HIV and AIDS, attitudes towards PLWA and counselling practices. Data was analysed quantitatively utilising the Statistical Package for Social Scientists (SPSS). A statistical analysis was done to test the significance of relationship between knowledge of HIV and AIDS, attitudes towards PLWA and practices utilizing the demographics of the study group. The majority of respondents 86(84,8%) had good knowledge of HIV and AIDS. There were no significant relationships (P>0,05) between age, race, marital status, qualifications, years of experiences and respondents’ level of knowledge. Attitudes towards PLWHA (87,16%) were positive and were not statistically significantly correlated with HIV and AIDS knowledge and counselling practices. There were significant relationships between qualifications and counselling practices (F = 4,335, P= 0,003). / XL2019

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Indiana University-Purdue University Indianapolis (IUPUI) / This study explored the experiences of raising children in the context of living with HIV/AIDS. In the fall of 2007, semi-structured qualitative interviews were conducted with 17 HIV-positive mothers (8 African American and 9 white) living in Indiana. Spillover theory was used to describe the interacting effects of the experience of living with HIV/AIDS and the experience of motherhood on one another. Findings indicate that maternal ideologies critically affected how the women experienced both their HIV-positive status and their mothering experiences. Findings also show that the mothers developed strategies to help them reconcile their valued identity as mothers with a stigmatized identity as HIV-positive women. Recommendations are made regarding directions for future research, social policy, and social service provision.

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Thesis (D. Tech. (Clinical Technology )) - Central University of Technology, Free State, 2013 / The HIV pandemic in South-Africa has created a new form of vulnerability for households with regards to food security and nutritional status which are vital components in the general care of HIV-infected individuals. The risk of nutritional deficiencies and malnutrition are predictors of disease progression and treatment in resource limited settings. Furthermore, HIV affects nutritional status by increasing the energy requirements, reducing food intake, affecting nutrient absorption and metabolism inadequacies due to cytokine activity and diarrhea. Several vitamins and minerals are important in fighting HIV infection because they are required by the immune system and major organs to attack infectious pathogens. Many of these micronutrients have been found to be deficient in HIVinfected persons and several studies were launched worldwide to investigate the feasibility of food assistance and nutrient supplementation. Nutritional supplementation has been advocated in HIV-infected persons especially in lowincome countries such as South Africa. Therefore, a study to evaluate the role of nutritional supplementation in HIV-positive patients becomes necessary, especially in a developing country such as South Africa. It is against this background that the present research was initiated to examine the influence of a nutritional supplement on the immune status and health status of HIVpositive/ AIDS adult individuals. The aim of the investigation was to determine if supplementation with a mixture comprised from specific minerals, vitamins and herbs over a period of one year, affected the haematological status, immune status, viral load and pulmonary function in forty (40) HIV-infected individuals living in the Mangaung Metropolitan, RSA. viii A quantitative, open-labeled, before-after clinical trial was conducted at the Central University of Technology, in Bloemfontein, Free State Province in the RSA. Socio-demographic and dietary intake questionnaires were completed. All data pertaining to anthropometric measurements, haematological status, immune status, viral load and pulmonary function were obtained my means of using standard procedures and technological equipment. The data were subjected to parametric and non-parametric statistical analysis. The results of the present investigation show that the eating pattern of this urbanized group of individuals reflects high energy (KJ) and macronutrient intakes coinciding with sub-optimal intake of Vitamin D and iodine. Of all the haematological variables the only statistical significant changes observed were increases in the median erythrocyte sedimentation rate (ESR) (p=0.0219) and mean cell haemoglobin concentration (MCHC) (p=0.0245) after six months of nutritional supplementation. At 12 months a statistical significant decrease in the median CD/CD8 ratio (p<0.0048), median Hematocrit concentration (p<0.0312), median mean cell volume (MCV) (p<0.0359), and median RDW (p<0.0273) accompanied a statistically significant increase in the MCHC (p<0.0003) at 12 months after supplementation. At 6 months 89% (CI95%: 73%; 96%) of the individuals showed a decline in viral load counts with a median percentage decline of 34% (CI95%: 73%; 96%). At 12 months 85% [CI95%: 68%; 94%] of the individuals show a decrease in viral load counts with a median percentage decline of 62.9% (CI95%: 50%; 78.6%) following the intake of the supplement. The main findings of the present investigation reveal that 68% (50%-81%) of the individuals show a statistical median increase (p=0.0302) of 16.9% (11.5%; ix 36.1%) in the Peak Expiratory Flow (PEF) at six months. A significant decrease (p=0.0484) in the median FEF75 of 28.1% (14%; 35.3%) is observed in 70% (53%-83%) of the individuals after 12 months of exposure to the supplement. No statistical significant changes are observed for FVC, FEV1, FEV1/FVC and FEF50 over the entire trial period. The present results suggest that a significant measurable decrease in viral load in HIV-infected individuals can be obtained by means of subjecting individuals to a nutritional fortification supplement strategy for 6 months or more.