Submitted in fulfillment of the requirements for the Degree of Master of Technology: Biomedical Technology, Durban University of Technology, 2012. / Antiretroviral therapy (ART) was introduced because it has shown to reverse the Acquired Immunodeficiency syndrome (AIDS), by reducing the HIV replication, allowing the regeneration of the patient’s immune system. ART is given to patients for the rest of their lives as part of HIV clinical care, but the use of ART has shown evidence of metabolic side effects which range from manageable to life threatening complications. Aims and objectives of the study The aim of the study was to investigate whether patients on ART developed metabolic side effects such as pancreatitis, dyslipidaemia and hepatotoxicity. These metabolic side effects were determined by laboratory testing of blood levels of specific biomarkers at stipulated intervals. Any significant change in the blood levels of these specific biomarkers was identified. Methodology : The study included 92 patients who were already selected for the ART programme which is in accordance to the South African National Antiretroviral Therapy Guidelines of 2003 Laboratory blood analysis was conducted. The repeated measures analysis of variance (ANOVA) was used to compare changes in biomarkers over time. The severity of each side effect was assessed by grading each biomarker laboratory result through the use of an established toxicity grading table. Results : It was found that the biomarker blood levels were not significantly altered within 12 months of ART, however, there was a gradual increase of most biomarker values, indicating that abnormalities may be detected after a longer period of treatment. Conclusion : Within 12 months of treatment, life-threatening toxicities were not detected. It may be speculated that if ART is monitored correctly, life-threatening toxicities may be avoided in many patients.

Thesis (PhD)--Stellenbosch Univesity, 2011. / ENGLISH ABSTRACT: It is well established that South African women are disproportionately affected by HIV/AIDS and gender based violence. Research to date has provided evidence for neurocognitive decline in individuals infected with HIV/AIDS and in individuals who have experienced early life trauma. However, many gaps remain in our knowledge about the neurocognitive profile of HIV and childhood trauma in South African women. The present study focused on the neurocognitive effects of HIV infection and childhood trauma, both separately and in combination in South African women. The primary aim of the study was to assess neurocognitive functioning in HIV-positive and matched HIVnegative controls, with and without a history of childhood trauma. Moreover, the study sought to assess the synergistic relationship between HIV and childhood trauma in influencing neurocognitive outcomes, a relationship which has not yet been investigated. A neuropsychological battery sensitive to HIV-related impairments was administered to 83 HIV-positive and 47 matched HIV-negative women with histories of childhood trauma. A history of childhood trauma was assessed using the Childhood Trauma Questionnaire short form (CTQ-SF). Forty eight of the 83 HIV-positive women were exposed to childhood trauma. Among the control subjects, a total of twenty women were exposed to childhood trauma. Findings of the present study revealed neurocognitive deficits in memory and executive functions. Results demonstrated significant HIV effects in memory (HVLT-R learning and delay trials), and executive functions (Halstead Category test). Similarly, a trauma effect was evident in delayed recall (HVLT-R delay). Moreover, results revealed a significant interaction effect between HIV status and trauma status on the WAIS-III Symbol Search Task, a task of psychomotor speed. However, HIV-negative controls with a history of childhood trauma scored the highest on this task. Although this finding was unexpected, it may suggest that psychomotor speed may not be a sensitive or discriminating test of childhood trauma in healthy adults. The present study demonstrated evidence for HIV and trauma effects in the ability domains of learning and delayed recall and executive functions. Although the present study did not find evidence for a synergistic relationship between HIV and trauma, it did provide evidence for both HIV and trauma effects on neurocognition, a finding in keeping with previous studies. Future research should be prospective in nature and should better delineate the nature, severity, and temporal relationship of childhood trauma to neurocognitive outcomes, as well as the mediators and moderators of these outcomes. / AFRIKAANSE OPSOMMING: Dit is alombekend dat Suid-Afrikaanse vroue buite verhouding swaar deur MIV/vigs en geslagsgebaseerde geweld getref word. Navorsing tot dusver lewer bewyse van neurokognitiewe verswakking by individue met MIV/vigs sowel as individue wat vroeg in hulle lewe reeds trauma ervaar het. Tog is daar steeds vele gapings in ons kennis oor die neurokognitiewe profiel met betrekking tot MIV en kindertrauma onder Suid- Afrikaanse vroue. Hierdie studie konsentreer op die neurokognitiewe uitwerking van MIV-infeksie en kindertrauma, afsonderlik sowel as gesamentlik, op Suid-Afrikaanse vroue. Die hoofdoel van die studie was om neurokognitiewe funksionering by MIV-positiewe vroue te bepaal en dit met gepaste MIV-negatiewe kontrolepersone te vergelyk, met én sonder 'n geskiedenis van kindertrauma. Daarbenewens wou die studie die sinergistiese verwantskap tussen MIV en kindertrauma in hul impak op neurokognitiewe uitkomste bepaal – 'n verwantskap wat tot dusver nog nie ondersoek is nie. 'n Neurosielkundige toetsbattery wat gevoelig is vir MIV-verwante swakhede is onder 83 MIV-positiewe vroue en 47 gepaste MIV-negatiewe kontrolepersone met 'n geskiedenis van kindertrauma afgeneem. 'n Geskiedenis van kindertrauma is met behulp van die kort weergawe van die kindertraumavraelys (CTQ-SF) vasgestel. Agt-en-veertig van die 83 MIV-positiewe vroue is as kinders aan trauma blootgestel. Van die kontrolegroep het 20 vroue in hul kindertyd trauma beleef. Die studie het neurokognitiewe tekorte in korttermyngeheue én uitvoerende funksies aan die lig gebring. Die resultate het 'n beduidende MIV-verwante uitwerking op korttermyngeheue (hersiene Hopkins- verbale leer-en-vertragingstoets, oftewel HVLT-R) sowel as uitvoerende funksies (Halstead-kategorietoets) getoon. Eweneens het die studie op 'n duidelike traumaverwante uitwerking op herinneringsvermoë (HVLT-R-vertraging) gedui. Daarbenewens het die WAIS-II- (Wechsler-volwassene-intelligensieskaal) simboolsoekopdrag – 'n psigomotoriese spoedtoets – 'n beduidende wisselwerkingseffek tussen MIV-status en traumastatus getoon. Tog het MIV-negatiewe kontrolepersone met 'n geskiedenis van kindertrauma die beste in hierdie opdrag gevaar. Hoewel hierdie bevinding verrassend was, kan dit daarop dui dat psigomotoriese spoed dalk nie 'n gevoelige of diskriminerende toets van kindertrauma by gesonde volwassenes is nie. Die studie het bewys gelewer van MIV- en traumaverwante uitwerkings op korttermyngeheue en uitvoerende funksies. Hoewel die ondersoek nie bewyse van 'n sinergistiese verwantskap tussen MIV en trauma kon vind nie, het dit wél bevestig dat MIV en trauma neurokognitiewe werking beïnvloed – 'n bevinding wat in pas is met vorige studies. Toekomstige navorsing behoort ondersoekend te wees en die aard, felheid en tydgebondenheid van die verwantskap tussen kindertrauma en neurokognitiewe uitkomste, sowel as die mediator- en moderatorveranderlikes van hierdie uitkomste, beter te omskryf.

Thesis (PhD)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Pregnancy is a vulnerable time in settings such as sub-Saharan Africa, and is associated with exposure to a multitude of physiological, social and psychological risks. High HIV prevalence, and the fact that many women will test for HIV for the first time during their pregnancy, has raised concern about women‘s psychological health during pregnancy. Depression during the antenatal period is of public health concern as it has been shown to be associated with poorer foetal and delivery outcomes, risky behaviours, and poorer uptake of antenatal care. Antenatal depression is a predictor of postnatal depression, and postnatal depression has been associated with poor maternal sensitivity and attachment in mothers which is known to result in increased behavioural and developmental difficulties in children. The aim of this research was to provide a clear, in depth and culturally sensitive understanding of the manifestation of depression in pregnant women in a rural area with high HIV prevalence in South Africa. The research method included a diagnostic assessment of depression in 109 women in their third trimester of pregnancy, and an in-depth qualitative examination of the contextual framework within which HIV testing and depression are experienced with a sub-sample of 56 women. The quantitative results demonstrated that the prevalence of antenatal depression was high (46.7%), with close to half of the women being diagnosed with depression. Presentations of depression most frequently included disturbances in mood, loss of interest and suicide ideation. Symptoms which overlap with common side effects of pregnancy such as loss of energy and weight change did not result in an overestimation of depression. Likewise, very little evidence of the somatisation of depression, or particular cultural barriers to the diagnosis of depression based on DSM-IV criteria was found. Rates of suicide ideation were high and equally common among HIV positive as HIV negative women. Factors significantly associated with depression included living within a family homestead, access to a regular source of income and practical support from a partner. Both income and partner support had a negative association with depression. Living away from a family or parental home had a positive association with depression. The results showed that the Edinburgh Postnatal Depression Scale (EPDS) was effective in identifying depression and that a shorter three item version was as effective as longer versions. A positive score for depressed mood on the EPDS was significantly associated with HIV, suggesting that the EPDS is a good screening tool for elevated psychological risks among HIV positive women post HIV testing. Qualitative results showed that having an unsupportive partner and the occurrence of relationship or familial conflict played an important role in the development of emotional distress during pregnancy and resulted in a high number of unwanted pregnancies. Partner and familial conflict was intertwined with cultural practices which govern the acceptability of childbearing among unmarried women and the social recognition of partnerships and paternal responsibilities. Testing for HIV was considered a stressful life event for all women regardless of their HIV status and was a particularly negative life event for women who tested HIV positive or for women who had concerns over partner infidelity. Disclosure among HIV positive women frequently lead to increased partnership conflict. Qualitative findings suggested that depression and emotional distress after HIV testing did interfere with women‘s ability to engage with prevention messages. Women who were coping well with learning their HIV positive status had high levels of family disclosure and subsequent family support in common. The implication of this research is that it is important that public health programmes screen for depression among childbearing women. These data suggests that a shorter three item version of the EPDS along with screening for partner and family support or conflict would effectively detect most women at high risk for depression. Likewise, public health interventions for women with depression which are implemented in primary health care facilities and in isolation of the partnership and familial context within which depression occurs are not likely to be effective. Further research is needed to establish the precise prevalence of antenatal and postnatal depression in women at high risk for HIV; to validate the effectiveness of a shorter screening tool in resource limited settings; and to establish risk and protective factors, and trimester specific risks which could inform the design of cost effective interventions in poorly resourced settings. / AFRIKAANSE OPSOMMING: Swangerskap in Afrika, suid van die Sahara, is ʼn kwesbare tydperk met blootstelling aan ʼn menigte fisiologiese, sosiale en sielkundige risiko‘s. Die hoë voorkoms van HIV en die feit dat baie vrouens gedurende swangerskap vir die eerste keer vir HIV wil toets, het ‗n besorgdheid oor vrouens se sielkundige gesondheid gedurende swangerskap laat ontstaan. Depressie gedurende die voorgeboortelike periode is van belang vir publieke gesondheid, want daar is bewyse wat dui op ‗n verband tussen depressie en swakker fetale en geboorte resultate, riskante gedrag en verminderde gebruik van voorgeboortelike sorg . Voorgeboortelike depressie is ʼn indikasie van moontlike nageboortelike depressie en nageboortelike depressie word geassosieer met swak moederlike sensitiwiteit en die gebrekkige vorming van ‗n band tussen moeder en kind; wat reeds bewys is om te lei tot verhoogde gedrags- en ontwikkelingsprobleme in kinders. Die doel van hierdie navorsing was om ʼn duidelike, indiepte en kulturele-sensitiewe begrip van die manifestasie van depressie in swanger vroue in ʼn landelike omgewing met hoë HIV voorkoms in Suid Afrika te verkry. Die navorsingsmetode sluit in ʼn simptomatiese beraming van depressie by 109 vroue in hul derde trimester van swangerskap en ʼn indiepte kwalitatiewe ondersoek na die kontekstuele raamwerk waarbinne HIV toetse en depressie ondervind word met ʼn sub-steekproef van 56 vrouens. Die bevinding was dat die voorkoms van voorgeboortelike depressie hoog was, 46.7 %, met feitlik die helfte van die vrouens wat met depressie gediagnoseer is. In die meeste gevalle het die voorkoms van depressie gepaard gegaan met ʼn verandering in gemoedstoestand, ʼn verlies aan belangstelling en selfmoordgedagtes. Simptome wat ooreenstem met algemene newe-effekte van swangerskap, soos verlies aan energie en verandering in gewig, het nie bygedra tot ʼn oorberekening van depressie nie. Soortgelyk is baie min bewyse gevind dat somatosasie van depressie, of spesifieke kulturele grense, tot die diagnose van depressie gebaseer op DSM-IVkriteria bydra. Die oorweging van selfmoord was hoog en algemeen tussen beide HIV-positiewe en HIV-negatiewe vouens. Faktore wat aansienlik met depressie geassosieer word, sluit in om in ʼn familiegroep te bly, toegang tot ʼn vaste bron van inkomste en die praktiese ondersteuning van ʼn lewensmaat. Beide inkomste en die ondersteuning van ʼn lewensmaat het ʼn negatiewe verbintenis met depressive. Om nie by familie of in ʼn ouerhuis te bly nie het ʼn positiewe assosiasie met depressive. Alhoewel HIV-status verband hou met depressie, was dit nie uitermate die geval nie, alhoewel daar ʼn gebrek aan statistiese kragdoeltreffendheid was om die effek van HIV vas te stel, gegee die beperkte grootte van die steekproef. Die resultate het getoon dat die EPDS graderingsinstrument effektief was om depressie te identifiseer en dat ʼn korter driepunt weergawe daarvan net so effektief was soos die langer weergawe. ʼn Positiewe telling vir ʼn depressiewe gemoedstoestand op die EPDS het ʼn betekenisvolle assosiasie met HIV en dui daarop dat die EPDS ʼn goeie graderingsinstrument is vir verhoogde sielkundige risiko by HIV-positiewe vrouens, selfs al is HIV-positiewe vrouens in dié steekproef statistieksgewys nie meer geneig tot depressie as HIV-negatiewe vrouens nie. Kwalitatiewe resultate toon dat ʼn lewensmaat wat nie ondersteunend is nie en die voorkoms van verhoudings- of familiekonflik ʼn belangrike rol speel in die ontwikkeling van emosionele angs gedurende swangerskap en dit het gelei tot ʼn groot aantal ongewenste swangerskappe. Konflik met ʼn lewensmaat en met familie was verweefd met kulturele gebruike wat die aanvaarbaarheid van geboortes onder ongetroude vrouens beheer en die sosiale erkenning van verhoudings en die vader se verantwoordelikhede. ʼn HIV-toets is as ʼn stresvolle lewensgebeurtenis beskou deur alle vroue, ongeag van hulle HIV-status en was ʼn besondere negatiewe lewensgebeurtenis vir vroue wat HIV-positief getoets het of vir vroue wat bekommerd was oor hulle lewensmaats se getrouheid. Onthulling van die HIV-status van positiewe vrouens het gereeld tot verhoogde konflik in verhoudings gelei. Kwalitatiewe bevindings dui daarop dat depressie en emosionele angs na ʼn HIV-toets inmeng met ʼn vrou se vermoë om ag te slaan op voorkomingsboodskappe. Vroue wat die kennis van hulle HIV-positiewe status goed hanteer het, het hoë vlakke van bekendmaking van hulle status en die ondersteuning van hulle familie in gemeen. Die implikasie van die navorsing is dat dit belangrik is vir publieke gesondheidsorgprogramme om te toets vir depressie onder swanger vroue. Die resultate dui daarop dat ʼn korter driepunt weergawe van die EPDS, saam met ʼn ondersoek na die ondersteuning van of konflik met ʼn lewensmaat en familie, effektief kan wees om vroue met ʼn hoë risiko vir depressie te identifiseer. Soortgelyk, publieke gesondheidsingryping in primêre gesondheidsorg fasiliteite vir vroue met depressie wat in isolasie van die lewensmaat en familie konteks, waar depressie voorkom geadministreer word, is onwaarskynlik om te slaag. Bevindings onderskryf die belangrikheid van ondersteuning vir die familie om effektief te kan reageer en herstel van stresvolle faktore soos onbeplande swangerskappe en HIV-diagnose, in ʼn konteks wat swaar deur HIV geaffekteer word, aangesien dit ʼn voorkomende effek op depressie kan hê. Verdere navorsing is nodig om die presiese voorkoms van voorgeboortelike en nageboortelike depressie in vrouens met ʼn hoë blootstelling aan HIV vas te stel; om die sukses van ʼn korter graderingsinstrument in arm omgewings te staaf; en om die risiko en beskermende faktore vas te stel en trimester spesifieke risiko‘s wat die ontwerp van ʼn koste-effektiewe ingryping in gebiede met ontoereikende hulpbronne kan beïnvloed.

Thesis (MA)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Optimal adherence to antiretroviral medication is essential for effective treatment of the human immunodeficiency virus (HIV), and ensuring high levels of adherence has proven to be a major challenge in the fight against HIV. As funding for antiretroviral treatment (ART) programs is limited, ensuring optimal adherence is critical, not only to decrease patient mortality and improve quality of life, but also to make these ART programs financially sustainable. In recent years a small but growing body of literature on the associations between social support, common mental disorders and adherence to ART has emerged. This thesis builds on the burgeoning body of studies by seeking to test the associations between level of perceived social support, symptoms of common mental disorders, and adherence to ART among a South African sample of ART users. The study investigated a convenience sample of 101 patients living with HIV, and receiving ART from a state funded HIV clinic in the Overberg region of the Western Cape, South Africa. A cross-sectional survey design was used to gather self-report data on the level of perceived social support, severity of symptoms of common mental disorders, and adherence to ART. Bivariate correlations demonstrated significant negative associations between perceived social support and severity of symptoms of common mental disorders, specifically symptoms of depression, anxiety and posttraumatic stress disorder (PTSD). Biserial correlations and logistic regression analysis indicated an inverse relationship between severity of symptoms of depression and self-reported ART adherence. However, when symptoms of anxiety and PTSD were included as predictors, the association between symptoms of depression and self-reported ART adherence was no longer significant. Furthermore, no significant relationships were found between self-reported ART adherence and symptoms of anxiety and PTSD. Follow-up research is recommended to gain a better understanding of these relationships. A longitudinal experimental research design is recommended to determine the direction of causality with regard to the association between symptoms of depression and adherence to ART. / AFRIKAANSE OPSOMMING: Optimale nakoming van antiretrovirale medikasie is noodsaaklik vir effektiewe behandeling van die menslike immuniteitsgebreks virus (MIV), en een van die groot uitdagings in die stryd teen MIV is om hoë vlakke van nakoming te verseker. Aangesien die beskikbare fondse vir antiretrovirale behandeling (ARB) beperk is, is dit van kritiese belang om optimale nakoming te verseker, nie net om sterftes te verminder en lewenskwaliteit te verbeter nie, maar ook om ARB programme finansieël volhoubaar te maak. In die afgelope jare, het daar 'n klein maar groeiende liggaam van literatuur oor die assosiasies tussen sosiale ondersteuning, algemene geestesversteurings, en nakoming van ARB na vore gekom. Hierdie proefskrif bou voort op die groeiende liggaam van studies deur om die verhoudings tussen waargenome sosiale ondersteuning, simptome van algemene geestesversteurings, en nakoming van ARB onder 'n Suid-Afrikaanse steekproef van ARB gebruikers te toets. Die studie het ondersoek gedoen op 'n gerieflikheidsteekproef van 101 pasiënte wat MIV positief is, en ARB ontvang by 'n staats befondse MIV-kliniek in die Overberg-streek van die Wes-Kaap, Suid-Afrika. 'n Deursnee-opname ontwerp is gebruik om self-verslag data te kry oor die vlak van waargenome sosiale ondersteuning, simptome van algemene geestesversteurings, en nakoming van ARB. Tweeveranderlike korrelasies het gedui op 'n beduidende negatiewe verhouding tussen waargenome sosiale ondersteuning and simptome van algemene geestesversteurings, spesifiek simptome van depressie, angs en post-traumatiese stresversteuring (PTSS). Biseriale korrelasies and logistieke regressie-analise het 'n beduidende inverse verhouding tussen simptome van depressie and self-gerapporteerde ARB nakoming getoon. Die verhouding tussen simptome van depressie and self-gerapporteerde ARB nakoming was egter nie meer beduidend na die symptome van angs en PTSS as voorspellers ingesluit was nie. Verder was daar geen beduidende verhoudings gevind tussen self-gerapporteerde ARB nakoming en simptome van angs en PTSS nie. Verdere navorsing word aanbeveel om 'n beter begrip van hierdie verhoudings te verkry. 'n Longitudinale eksperimentele ontwerp word aanbeveel om vas te stel wat die rigting van oorsaaklikheid is ten opsigte van die verhouding tussen simptome van depressie en nakoming van ARB.

Thesis (MA (Psychology))--University of Stellenbosch, 2006. / Family resilience refers to the ability of families to return to normal family functioning or even to reach higher levels of functioning after experiencing adversity. The focus of the present study was to identify resiliency factors in single parent families with an adult HIV infected child. The Resiliency Model of Family Stress, Adjustment and Adaptation (McCubbin & Thompson, 1991) served as the theoretical framework in the design and the execution of the research. Both qualitative and quantitative measures were used in this cross-sectional survey research design. Twenty five single parents and their HIV Positive children ...

Thesis (MScMedSc)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Introduction: Reactivation of human cytomegalovirus (HCMV) infection in individuals infected with human immunodeficiency virus (HIV) may lead to life-threatening end-organ diseases (EOD). The EOD becomes clinically apparent when a critical number of cells in the affected organs become damaged as a consequence of HCMV-infection. Treatment of the HCMV-associated disease at this point may not be effective. Therefore, early detection of HCMV reactivation may be useful to guide pre-emptive therapy. Aim: The aim of this study was to determine whether there is a point at which the HCMV-specific cellular immune response breaks down, as determined by the interferon-gamma (IFN-γ) enzyme-linked immunospot (ELISPOT) assay, and HCMV reactivation occurs in HIV-positive, antiretroviral therapy (ART)-naïve individuals in a South African setting. This was done in relation to the CD4+ T cell count and the HCMV viral load as determined by real-time polymerase chain reaction (qPCR). Materials and methods: Fifty-two (52) HIV-infected, ART-naïve subjects were recruited from primary healthcare centres that they attended for the management of their HIV infection. Heparinised blood samples were collected to quantify the HCMV-specific cellular immune response using the IFN-γ-ELISPOT assay and to determine the HCMV IgG serostatus. Ethylenediaminetetraacetic acid (EDTA) blood samples were collected for the determination of the CD4+ T cell counts and the HCMV viral loads. Results: All 52 subjects recruited were confirmed to be HIV-HCMV co-infected based on their HCMV IgG serostatus. The results of 34 subjects with completed data sets were analysed. The CD4+ T cell counts of these subjects ranged from 10 to 784 cells/μl. Twenty-two (22) (65%) subjects had positive HCMV IFN-γ-ELISPOT results with 94% having no detectable HCMV viral loads. All subjects (28) with a CD4+ T cell count above 100 cells/μl had undetectable HCMV viral loads. Two of the six subjects with CD4+ T cell counts <100 cells/μl had detectable HCMV viral loads. There was no statistically significant association between the CD4+ T cell counts and the HCMV IFN-γ-ELISPOT results. Conclusion: No specific point could be determined when there is loss of integrity of the HCMV-specific cellular immune response in HIV-positive individuals. Low CD4+ T cell counts did not correlate with HCMV IFN-γ-ELISPOT results suggesting that the HCMV-specific cellular immunity did not necessarily break down at low CD4+ T cell counts. Nevertheless, a CD4+ T cell count above 100 cells/μl appeared to be protective against viraemia as determined by the HCMV viral load qPCR. The IFN-γ-ELISPOT assay was employed as a tool to determine the integrity of the HCMV-specific cellular immune response in HIV-positive individuals. However, the IFN-γ-ELISPOT assay should be used in conjunction with the CD4+ T cell count and the HCMV viral load qPCR to determine when there is loss of integrity of the HCMV-specific cellular immune response and HCMV reactivation occurs. This may assist clinicians in their choice of management and appropriate pre-emptive treatment in the HIV-HCMV co-infected individual at a risk for HCMV reactivation. / AFRIKAANSE OPSOMMING: Inleiding: Heraktivering van menslike sitomegaalvirus (MSMV) in menslike immuniteitsgebreksvirus (MIV)-MSMV ko-geïnfekteerde individue kan lei tot dodelike end-orgaan siektes (EOS). Die EOS word klinies duidelik wanneer 'n kritieke aantal selle in die organe beskadig raak as gevolg van die MSMV-infeksie. Behandeling van die MSMV-verwante siekte op hierdie punt mag moontlik nie meer effektief wees nie. Daarom kan die vroeë opsporing van MSMV heraktivering nuttig wees in die gebruik van voorkomende terapie. Doel: Die doel van hierdie studie is om die punt te bepaal wanneer die MSMV-spesifieke sellulêre immuun reaksie afgebreek word met behulp van die interferon gamma (IFN-γ) ensiem-gekoppelde immunospot (ELISPOT) toets en MSMV heraktivering voorkom in MIV-positiewe, antiretrovirale terapie (ART)-naïewe individue in' n Suid-Afrikaanse instelling. Dit word gedoen in verhouding met die CD4+ T sel telling en die MSMV virale lading. Materiale en metodes: Twee-en-vyftig (52) MIV-geïnfekteerde, ART-naïewe pasiënte is vanaf primêre gesondheidsentrums, wat hul bywoon vir die behandeling van hul MIV infeksie, genader. Gehepariniseerde bloedmonsters is gebruik om die MSMV-spesifieke sellulêre immuun reaksie met behulp van die IFN-γ-ELISPOT toets en die MSMV IgG serostatus te bepaal. Etileendiamientetra-asynsuur (EDTA) bloed monsters is versamel vir die bepaling van hul CD4+ T sel telling en hul MSMV virale lading met behulp van die ―real-time‖ polimerase kettingreaksie (qPKR) waardes. Resultate: Al 52 pasiënte is bevestigde MIV-MSMV ko-infeksies, gebasseer op hul serologiese status. Die resultate van 34 pasiënte met voltooide data is ontleed. Die CD4+ T sel tellings van hierdie pasiënte het gewissel 10-784 selle/μl. Twee-en-twintig (22) (65%) pasiënte het positiewe MSMV IFN-γ-ELISPOT resultate met 94% wat ‗n negatiewe qPKR resultate. Alle pasiënte (28) met 'n CD4+ T-seltelling bo 100 selle/μl het' n negatiewe qPKR resultate. Twee van die ses pasiënte met 'n CD4+ T-seltelling <100 selle/μl het waarneembare MSMV virale ladings oor die qPKR. Daar was geen statisties beduidende assosiasie tussen die CD4+ T sel tellings en die MSMV IFN-γ-ELISPOT resultate nie. Gevolgtrekking: Geen spesifieke punt wanneer die MSMV-spesifieke sellulêre immuun reaksie afgebreek word kon in MIV-positiewe individue bepaal word nie. Lae CD4+ T sel tellings het nie ooreengestem met die MSMV IFN-γ-ELISPOT resultate nie en dui daarop dat die MSMV-spesifieke sellulêre immuniteit nie noodwendig afgebreek word teen 'n lae CD4+ T sel tellings nie. Tog blyk 'n CD4+ T-seltelling bo 100 selle/μl om beskerming teen viremie te bied. Die meriete van die gebruik van die IFN-γ-ELISPOT toets die integriteit van die MSMV-spesifieke sellulêre immuun response in MIV-positiewe individue te bepaal, is waargeneem in die opgehoopte data. Tog kan die gebruik van die IFN-γ-ELISPOT toets in samewerking met die CD4+ T sel telling en die MSMV virale lading meer voordelig in die bepaling van 'n punt wanneer die MSMV-spesifieke sellulêre immuun reaksie afbreek en herstel plaasvind. Dit kan help om klinici in hul keuse van bestuur en gepaste voorkomende behandeling in die MIV-MSMV mede-geïnfekteerde individu op 'n risiko vir herstel.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Background & rationale: South Africa is faced with the major challenge of HIV/AIDS. Every South African has a vital role to play in managing this public health problem. One of the best ways of managing it is by informing and educating the communities about HIV/AIDS, as the communities lack knowledge about it. Problem statement: Due to the increase in the number of patients infected with HIV/AIDS, an informal caregiver’s programme was introduced to ensure that patients are better cared for at home, in a familiar environment and by their family members. Purpose and objectives: The purpose of the study was to evaluate the effect of an informal caregiver’s programme on the care of patients with HIV/AIDS. The objectives included evaluating the effect of care, physically, socially, spiritually, emotionally, information and educational support given. Methodology: A phenomenological research design was applied to evaluate the effects of an informal caregiver’s programme implemented for the care of patients infected with HIV/AIDS at Mfuleni Township in the Cape Metropolitan area. Population and sampling: The population of this study were HIV/AIDS infected patients who were participating in the informal caregiver’s programme. Ten of these patients, who gave consent, participated in the study. Reliability, validity & pilot study: The trustworthiness of this study was assured with the use of Lincoln and Guba criteria of credibility, transferability, dependability and conformability. A pre-test study was also completed. Ethical considerations: Ethical approval was obtained from the Stellenbosch University and the required consent from the individual participants. Data collection, analysis and results: Data was collected through an interview using an interview schedule based on the objectives. Data was analysed and the findings show that the care given to patients infected by HIV/AIDS at home through an informal caregiver’s programme has a positive outcome. Recommendations and conclusion: On the spot training of participants and their family members is recommended. The community health workers form a very strong support base for the participants. / AFRIKAANSE OPSOMMING: Agtergrond en rasionaal: Suid-Afrika kom te staan voor ’n reuse uitdaging t.o.v. HIV/VIGS. Elke Suid-Afrikaner het ’n belangrike rol te speel in die beheer van hierdie openbare gesondheidsprobleem. Een van die beste maniere om dit te beheer, is om gemeenskappe in te lig en op te voed aangaande MIV/VIGS, aangesien daar ’n gebrek aan kennis hieromtrent is. Probleemstelling: Weens die toename in die aantal pasiënte wat deur MIV/VIGS geaffekteer word, is ’n informele versorgingsprogram daarop ingestel om te verseker dat pasiënte beter tuis versorg word in ’n bekende omgewing en deur hul familielede. Doel en doelwitte: Die doel van hierdie studie was om die effek van ’n informele versorgingsprogram in die versorging van pasiënte met MIV/VIGS te evalueer. Die doelwitte is uiteengesit om die effek van die versorging wat gegee is, te evalueer met verwysing na die fisiese, sosiale, geestelike, emosionele, inligting en opvoedingsondersteuning te evalueer. Metodologie: ’n Fenomenologiese navorsingsontwerp is toegepas om die effekte te evalueer van ’n informele versorgingsprogram wat geïmplementeer is vir die versorging van pasiënte wat deur MIV/VIGS geaffekteer is in die Mfuleni woonbuurt in die Kaapse Metropolitaanse area te evalueer. Bevolking en steekproef: Die bevolking van hierdie studie is MIV/VIGS geaffekteerde pasiënte wat deelgeneem het aan die informele versorger se program. Tien van hierdie pasiënte wat toestemming verleen het, het deelgeneem aan hierdie studie. Betroubaarhied, geldigheid en loodsondersoek: Die betroubaarheid van hierdie studie is verseker deur die gebruik van Lincoln en Guba se kriteria van geloofwaardigheid, oordraagbaarheid, afhanklikheid en ooreenstemmigheid. ’n Aanvoortoets is ook voltooi. Etiese oorwegings: Etiese goedkeuring is van die Stellenbosch Universiteit en die vereiste toestemming van die individuele deelnemers verkry. Dataversameling, analise en uitslae: Data is ingesamel deur gebruik te maak van ’n onderhoudskedule wat gebaseer is op die doewitte. Data is geanaliseer en die bevindinge het bewys dat versorging wat by die huis deur ’n informele versorgingsprogram aan pasiënte gegee word wat met MIV/VIGS geaffekteer is, ’n positiewe uitkoms het. Aanbevelings en gevolgtrekkings: Op-die-plekopleiding van HIV geïnfekteerde pasiente en hul familielede word aanbeveel. Die gemeenskap se gesondheidswerkers bied ’n sterk ondersteuningsbasis aan die deelnemers.

Thesis (MA)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: This paper provides an overview and critical evaluation of current (1990-2001) research into Human Immune-deficiency Virus (HIV) and Acquired Immuno-deficiency Syndrome (AIDS), with particular reference to factors affecting quality of life (QOL) among those living with the disease. A brief look at the importance of optimal QOL when faced with a life crisis such as HIV/AIDS, leads to a discussion of factors influencing QOL in HIV/AIDS. These factors include coping styles, mental adjustment, social support, stigmatization, socio-economic and socia-cultural factors, gender, depression as well as disease progression. The overview is informed by prominent research trends and a critical look at the current understanding of factors impacting on the QOL of people living with HIV/AIDS. Recommendations are made on issues that need further clarification, while future research orientations are also suggested. In the absence of satisfactory treatment strategies or a cure for HIV/AIDS, as well as the evidence of a potentiall0 to 12 year life expectancy, there is a pressing need for a better understanding of factors that influence QOL. There is strong support for the notion that QOL directly impacts on disease progression and therefore also on the quality and quantity of survival time. It follows that a better understanding of the nature and determinants of QOL for HIV patients will yield valuable intervention guidelines within a biopsychosocial framework. / AFRIKAANSE OPSOMMING: Hierdie artikel bied 'n oorsig en kritiese evaluering van onlangse (1990-2001) navorsing in die veld van Menslike Immuniteitsgebrek Virus (MIV) en Verworwe Immuniteitsgebrek Sindroom (VIGS), met besondere verwysing na faktore wat bydra tot die lewenskwaliteit van geïnfekteerde indiwidue. Die belangrikheid van optimale lewenskwaliteit teen die agtergrond van 'n lewenskrisis soos 'n MIV-diagnose, word kortliks bepsreek. Daarop volg In bespreking van faktore wat In invloed het op lewenskwaliteit in HIV/AIDS. Hierdie faktore sluit in hanteringstyl, psigiese aanpasbaarheid, sosiale ondersteuning, stigmatisering, sosio-ekonomies en sosio-kulturele faktore, geslag, depressie asook siekteverloop. Die oorsig word gerugsteun deur prominente navorsingstendense asook 'n kritiese blik op huidige perspektiewe op faktore wat 'n impak het op die lewenskwaliteit van mense wat leef met MIVjVIGS. Aanbevelings word gemaak aangaande aspekte waaroor verdere helderheid verkry moet word, asook oor toekomstige navorsingsvraagstukke. Gegewe die afwesigheid van voldoende behandelingstrategieë of selfs 'n geneesmiddel vir MIV, tesame met die bewys van 'n 10 tot 12 jaar potensiële lewensverwagting, bestaan daar 'n dringende noodsaaklikheid vir grondiger insig in faktore wat lewenskwaliteit beïnvloed. Daar is sterk steun vir die uitgangspunt dat lewenskwaliteit 'n direkte impak het op siekteverloop en derhalwe ook op die duur en kwaliteit van oorlewingstyd. Verbeterde kennis oor die aard en determinante van lewenskwaliteit in MIV-pasiënte sal dus waardevolle inligting kan verskaf in terme van toepaslike riglyne vir intervensies binne 'n biopsigososiale raamwerk.

published_or_final_version / Social Work / Master / Master of Social Work

This research explored cultural perceptions of HIV&amp / AIDS with students at the University of the Western Cape and attempted to understand how these perceptions of the disease reinforce stigma and stigmatising attitudes towards people living with HIV/AIDS. This study investigated HIV/AIDS stigma as a social phenomenon and analysed the socio-cultural and historical roots of HIV/AIDS stigma.