The supply of Antiretrovirals (ARVs) to HIV/AIDS patients in most of the provinces in South Africa is hindered by various factors such as ineffective and inefficient drug procurement, and drug distribution systems. In the QwaQwa district in the Free State Province, a major barrier to the consistent supply of Highly Active Antiretroviral Treatment was identified to be the lack of an effective and efficient ARV drug distribution system. This resulted in major drug supply shortages in the QwaQwa district. A continuous, uninterrupted supply of ARVs to HIV/AIDS patients is critical to avoid drug resistance and therapy failure. Failure of a patient to respond to treatment results in a deterioration of a patient's health, and ultimately leads to death. The purpose of the study was to determine whether the ARV drug distribution practices at the Manapo Hospital in the QwaQwa district were effective and efficient in the management of ARVs. The distribution practices reviewed were the ordering, transportation, the management of inventory and warehousing, and the distribution of treatment to HIV/AIDS patients. Quantitative exploratory, descriptive and contextual methods were used to determine the relationship between the ARV drug distribution practices and the effective management of the ARVs. The study comprised of a sample size of twenty-one participants. The sample size entailed the Manapo Hospital pharmacists and pharmacist assistants who have been or are currently involved in the distribution of ARVs in the QwaQwa district since the initiation of the ARV rollout programme in 2004. The study revealed that the practices performed in the management of ARVs in the QwaQwa district were neither effective nor efficient in the distribution of ARVs. The recommendations of the study were identified to further ensure the effective and efficient management of the ARV drug distribution system, which will ensure a consistent supply of treatment to HIV/AIDS patients. Guidelines were developed for better circulation, thus meeting the objectives of the research.

Today over 1.1 million people are living with HIV/AIDS in the United States; over the last 4 decades mortality rates have decreased largely made in part because of advancement in awareness and treatment options. Treatment adherence has long been considered a vital component in decreasing HIV/AIDS related mortality and has proven to reduce the risk of transmission. However not all patients take their medicine as prescribed. This research study, sponsored by The North Central Texas HIV Planning Council explored how Patient and Provider communication impacted treatment adherence. By utilizing a mixed-methods approach survey data and semi-structured interviews were used to collect insights from both Patients and Providers. Data gleaned through the interview process provided a perspective that could not be captured by using quantitative methods alone. The results from this research yielded multiple themes related to patient and provider communication with recommendations as to how The North Central Texas HIV Planning Council could address treatment adherence, such as Providers focus on Patients perceived severity based on their understanding of disease and illness; that side-effects remain a concern for patients and should not be dismissed; and finally that the word AIDS is perceived to be more stigmatized and as such organizations providing HIV/AIDS related services should explore alternative names where the word AIDS in not included.

Health communication is a vital part of health care and treatment. For patients living with HIV, effective health communication is crucial. This study aimed at describing health communication from the perspective of HIV-positive patients by uncovering their experiences as they interacted with various medical staff members at Stanger Hospital. Guided by a review of various health communication models, data were collected via individual interviews and non-participant observation. The findings showed that interactive communication was favoured by all the respondents, especially communication that was patient-centred. Such communication encompassed education on how to live and cope with HIV. Obstacles to effective communication such as power differentials, lack of time and privacy at public health care clinics were identified. The study found that the different medical staff members at the clinic to various degrees addressed distinctive communication needs of HIV-positive patients. This study contributed to effectively understating the communication process as a whole. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Volunteer caregivers provide essential services to people in the terminal stages of AIDS and their families. Volunteers are exposed to stress and burnout. This study investigated the relationships between stress, coping strategies, levels of burnout and resilience in this population. Volunteers from Societas ‘O Sosiale (SOS) Children Villages and community based organisation (CBO) partnerships, were selected using non-probability purposive convenience sampling. A total of 110 participants were given the Experience of Work and Life Circumstances Questionnaire (WLQ), Brief-Cope, Maslach’s Burnout Inventory (MBI), a Resilience scale and the Living Standard Measure to complete. Statistical analyses were performed on the data. This includes descriptive statistics, reliability analysis, factor analysis, correlations and multivariate analysis of variance. The study found that volunteer caregivers experience high stress levels and burnout related to stressors outside work, remuneration, personnel policies and high resilience. High burnout is associated with all forms of coping. Further it is shown that training in problem-solving skills, counselling, government and public lobbying for support, registration with relevant professional bodies, furnished offices, reasonable recruitment requirements and compensation are needed to help the care givers avert the effect of stressors and control stress by stopping it from turning to burnout. / Psychology / M.A. (Psychology - Research Consultation)

Using non-experimental descriptive exploratory survey, this study sought to find out factors associated with delayed entry into HIV medical care among HIV positive people who are aware of their status. A quantitative design was used and a structured questionnaire was used as the data collection instrument. Respondents were patients in a hospital’s Opportunistic Infection Department whose hospital records indicated that they were HIV positive during the time of the study. The study found out that as much as 71.6% (n =43) first entered HIV medical care more than 12 months after testing HIV positive while 40% (n = 24) did so as a result of illness. Low education levels, unemployment and being single are associated with delayed entry into HIV medical care. A percentage of the population uses and trusts non-biomedical approaches to dealing with HIV/AIDS. Being diagnosed HIV positive is therefore not necessarily a strong reason enough for one to immediately enter into medical care. Intensive health education needs to be done at work places, health facilities, schools, through print and electronic media, churches and other community settings to equip the population with knowledge of the advantages of early entry into HIV care. / Health Studies / M.A. (Public Health)

Background: Literature has shown that negative attitudes and unwillingness to care for HIV-infected patients are prevailing among healthcare workers. This study aimed to assess the attitudes and willingness of student nurses towards caring for HIV-infected patients in some public hospitals in Gert Sibande district, Mpumalanga. Method: A contextual exploratory quantitative descriptive survey was conducted among student nurses enrolled for a four-year nursing qualification in a nursing college at Mpumalanga province. Self-administered questionnaires were completed after obtaining an informed consent. Results: A total of 122 (70.9%) students participated in this survey. Findings showed that most participants had positive attitudes 66 (52.7%) and were willing 121 (99.1%) to care for HIV-infected patients. Significant associations were revealed between participants’ previous HIV testing (p=0.012), age group (p=0.009), and their willingness to provide care to HIV-infected patients. Conclusion: Results showed a generally positive attitude and willingness by participants to care for HIV-infected patients. / Health Studies / M.A. (Health Studies)

Thesis (MSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Global estimates show that sub-Saharan Africa has the largest portion of HIV cases with South Africa having more people living with HIV than any other country in the world. Moreover, studies have shown a high incidence of intimate partner violence (IPV) among people living with HIV. IPV has been shown to be associated with mental health problems. Considerable empirical studies have demonstrated that HIV is a highly stigmatized disease. In addition, HIV-related stigma has also been shown to be a risk factor for mental health problems among persons living with HIV. However, no empirical studies have examined the combined effect of IPV and HIV-related stigma on mental health. This thesis builds on the existing body of research by examining to what extent the linear combination of IPV (timing and frequency) and HIV related stigma explained variation in symptoms of common mental health disorders in both men and women living with HIV. In addition, theoretical and empirical studies have suggested that social support may serve as a protective factor in the relationship between IPV, HIV-related stigma, and mental health. Yet, despite the increasing attention, no known studies have focused on the mediating or moderating role of social support in the relationship between IPV or HIV-related stigma, and mental health. This thesis examined the extent to which social support played a mediating or moderating role in these relationships. The study used a cross-sectional research design to study a convenience sample of 210 people living with HIV in three peri-urban areas in the Western Cape, South Africa. Participants completed a battery of self-report questionnaires that assessed IPV (timing and frequency), HIV-related stigma, social support, and symptoms of common mental health. The results from the hierarchical multiple regression analysis demonstrated that the linear combination of psychological aggression frequency and HIV related stigma explained a significant portion of the variance in symptoms of depression. Likewise, both physical assault timing and psychological aggression timing combined with HIV-related stigma explained a significant portion of variance in symptoms of depression. Psychological aggression timing combined with HIV-related stigma significantly explained variance in symptoms of posttraumatic stress disorder (PTSD). The results from the product-term regression analyses indicated that social support played a mediating role in the relationship between HIV-related stigma and symptoms of PTSD, but not depression. Social support did not moderate the relationship between HIV-related stigma and symptoms of common mental health disorders. In conclusion, the combination of IPV (physical assault and psychological aggression) and HIV-related stigma explained a significant portion of the variance in symptoms of common mental health disorders. Future research is needed for a better understanding of these relationships. A longitudinal experimental design is recommended in order to explore the direction of these relationships and to examine the context in which the IPV, HIV-related stigma, and social support is experienced. / AFRIKAANSE OPSOMMING: Wêreldwye beramings toon dat sub-Sahara Afrika die grootste gedeelte van HIV gevalle te wêreld het, terwyl Suid-Afrika meer mense het wat met MIV leef as enige ander land in die wêreld. Verder het studies getoon dat daar 'n hoë voorkoms van intiemepaargeweld (IPV) is onder mense wat met MIV leef. Daar is al getoon dat IPV verband hou met geestelike probleme. Aansienlike empiriese studies het getoon dat MIV 'n hoogs gestigmatiseer siekte is. Daarbenewens, is daar getoon dat MIV-verwante stigma 'n risiko faktor is vir geestelike probleme onder persone wat leef met MIV. Daar is egter geen empiriese studies wat die gekombineerde effek van IPV en MIV-verwante stigma op geestesgesondheid ondersoek nie. Hierdie tesis bou voort op die bestaande navorsing deur te ondersoek tot watter mate die lineêre kombinasie van IPV (tydsberekening en frekwensie) en MIV-verwante stigma variasie in die simptome van algemene geestesgesondheid afwykings verduidelik in beide mans en vroue wat met MIV leef. Daarbenewens, het teoretiese en empiriese studies voorgestel dat sosiale ondersteuning kan dien as 'n beskermende faktor in die verhouding tussen IPV, MIV-verwante stigma, en geestesgesondheid. Tog, ten spyte van die toenemende aandag, het daar al geen studies gefokus op die bemiddelende of modererende rol van sosiale ondersteuning in die verhouding tussen IPV of MIV-verwante stigma, en geestesgesondheid. Hierdie tesis ondersoek die mate waarin sosiale ondersteuning 'n bemiddelende of modererende rol speel in hierdie verhoudings. Die studie het 'n deursnee-navorsing ontwerp gebruik om 'n gerieflikheidsteekproef van 210 mense wat met MIV leef in drie peri-stedelike gebiede in die Wes-Kaap, Suid-Afrika te bestudeer. Deelnemers het 'n battery van self-verslag vraelyste voltooi wat IPV (tydsberekening en frekwensie), MIV-verwante stigma, sosiale ondersteuning, en simptome van algemene geestesgesondheid geassesseer het. Die resultate van die hiërargiese meervoudige regressie-analise het getoon dat die lineêre kombinasie van sielkundige aggressie frekwensie en MIV-verwante stigma 'n beduidende deel van die variansie in simptome van depressie verduidelik. Net so, het beide fisiese aanranding tydsberekening en sielkundige aggressie tydsberekening gekombineer met MIV-verwante stigma 'n beduidende deel van die variansie in simptome van depressie verduidelik. Sielkundige aggressie tydsberekening gekombineer met MIV-verwante stigma het „n beduidende variansie in simptome van post-traumatiese stresversteuring (PTSV) verduidelik. Die resultate van die produk-term regressie-analises het aangedui dat sosiale ondersteuning 'n bemiddelende rol speel in die verhouding tussen MIV-verwante stigma en simptome van PTSV, maar nie depressie nie. Sosiale ondersteuning het nie die verhouding tussen MIV-verwante stigma en simptome van algemene geestesgesondheid versteurings modereer nie. Ten slotte, die kombinasie van IPV (fisiese aanranding en sielkundige aggressie) en MIV-verwante stigma het 'n beduidende deel van die variansie in simptome van algemene geestesgesondheid versteurings verduidelik. Toekomstige navorsing is nodig vir 'n beter begrip van hierdie verhoudings. 'n Longitudinale eksperimentele ontwerp word aanbeveel om die rigting van hierdie verhoudings te verken en die konteks waarin die IPV, MIV-verwante stigma en sosiale ondersteuning ervaar is te ondersoek.

Thesis (M Social Work)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The South African government has laws and policies that forbid discrimination against individuals. These policies protect people from being discriminated against in the workplace due to sickness, race and many other factors. Discrimination against people living with HIV/AIDS has caused many people who suffer from this disease not to come forward with their illness because they fear being discriminated against and stigmatised; some even lose their jobs because they are infected with HIV. People infected with HIV are discriminated against not only in the workplace but also in their communities and families. This implies that people living with HIV/AIDS need support from all levels of society in order to live positive lives, which may lead infected people to live longer. This study explored HIV/AIDS as terminal illness and the stressors experienced by people infected with the virus. This was done by examining the support available to people living with HIV/AIDS, as well as identifying the support needed by these people. By adopting an ecological approach to the study, the need for support could be investigated on multiple levels. A combination of a quantitative and qualitative research design was used in the study. Data were gathered by means of a semi-structured interview schedule that was administered during individual interviews with service providers. This allowed for data that were both measurable as well as rich in description to be collected. The questions in the semi-structured questionnaire were based on the information retrieved from the literature review. The findings from the empirical investigation revealed that people living with HIV/AIDS receive limited support from their families, the South African government and society at large. The findings further indicated that informal sources of support such as family, friends and partners are relatively supportive of people living with HIV/AIDS. However, the relationships between people living with HIV/AIDS and their families and partners are often strained, especially when a person first discovers his or her status as HIV positive. Furthermore, people living with HIV/AIDS are stigmatised on multiple levels because of their status. There is stigmatisation from family, friends, in the workplace and in the community. The most important recommendations resulting from the study are that services such as counselling are needed for people living with HIV/AIDS together with their families. This is of particular significance to the South African government, especially the health sector, which needs to improve the health care system. In addition, recommendations emphasise the importance of promoting education and awareness, which could have great value for people living with HIV/AIDS, their families and communities. Knowledge about HIV/AIDS would empower people at all levels to support those who live with the disease and would also be of great value in helping those living with the disease to contribute something of value towards their health condition. / AFRIKAANSE OPSOMMING: Die Suid-Afrikaanse regering beskik oor wette en beleide wat diskriminasie teen individue verbied. Hierdie wette en beleide beskerm mense teen diskriminasie in die werkplek, diskriminasie op grond van siekte, gestremdheid, ras en vele ander redes. Diskriminasie teen mense wat met MIV/vigs leef, laat baie van hulle hul MIV/vigs-status geheim hou omdat hulle diskriminasie en stigmatisasie vrees. Sommige verloor selfs hulle werk wanneer dit rugbaar word dat hulle aan MIV/vigs ly. Diegene met MIV/vigs ervaar egter nie net in die werkplek diskriminasie nie, maar ook in hul gemeenskappe en families. Dít impliseer dat mense met MIV/vigs op alle vlakke ondersteuning nodig het om ’n positiewe lewe te lei en daarmee hul lewensverwagting so ver moontlik te verleng. Hierdie studie het die stresfaktore van terminale MIV/vigs-lyers ondersoek. Daar is voorts ondersoek ingestel na die ondersteuning wat mense met MIV/vigs ontvang, sowel as die ondersteuning wat hulle nodig het. MIV/vigs-lyers se ondersteuningsbehoeftes op etlike vlakke is deur middel van ’n ekologiese navorsingsbenadering bepaal. ’n Kombinasie van ’n kwantitatiewe en kwalitatiewe navorsingsmetodologie is vir die studie gebruik. Data is met behulp van ’n semigestruktureerde vraelys ingesamel, wat gedurende individuele onderhoude met diensverskaffers afgeneem is. Sodoende kon meetbare sowel as hoogs beskrywende data ingesamel word. Die vrae in die semigestruktureerde vraelys was gegrond op die inligting uit die literatuuroorsig. Die bevindinge van die empiriese ondersoek toon dat mense wat met MIV/vigs leef beperkte ondersteuning van hul familie, die Suid-Afrikaanse regering en die groter samelewing ontvang. Die bevindinge dui voorts daarop dat informele ondersteuningsbronne, soos familie, vriende en lewensmaats, betreklik ondersteunend is teenoor diegene met MIV/vigs. Tog is die verhouding tussen MIV/vigs-lyers en hul families en lewensmaats ook dikwels onder druk, veral net nadat die persoon ontdek dat hy/sy MIV-positief is. Daarbenewens word mense met MIV/vigs op verskeie vlakke gestigmatiseer – deur hul familie, vriende, in die werkplek en die gemeenskap. Die belangrikste aanbeveling uit die studie handel oor die behoefte aan dienste soos berading vir mense wat met die virus leef, sowel as vir hul familie. Die aanbeveling behoort veral van belang te wees vir die Suid-Afrikaanse regering, en in die besonder die gesondheidsektor, wat hierdie behoefte in gedagte moet hou om die gesondheidsorgstelsel te verbeter. Ander aanbevelings beklemtoon die belang van meer opvoeding en bewusmaking, aangesien dit uiters waardevol kan wees vir mense met MIV/vigs, hul familie en gemeenskappe. Kennis oor MIV/vigs sal mense op alle vlakke bemagtig om diegene met die virus te ondersteun, terwyl dit MIV/vigs-lyers self ook sal help om hul eie gesondheidstoestand beter te bestuur.

Studies on knowledge, attitudes and practices among healthcare workers involved in HIV and AIDS care have often revealed the lack of knowledge about HIV and AIDS. Nurses‘ knowledge may compromise the quality of care and attitudes towards patients living with HIV/AIDS. Special nursing knowledge and skills have been suggested as a prerequisite for taking care of patients with HIV. The purpose of this study was to assess nurses‘ knowledge, attitudes and practices towards patients with HIV and AIDS in Kumasi, Ghana. A quantitative cross-sectional study was conducted among 247 nurses at five selected health facilities in Kumasi. Data was collected by means of a structured self-administered questionnaire and analysed using SPSS version 23.0. Results were presented using charts and tables. Knowledge of HIV and AIDS was satisfactory but some of the nurses still hold erroneous beliefs and misconception about HIV transmission. A majority demonstrated favourable attitudes. Nurses had fears of contracting the virus, which resulted in the display of negative attitudes by some. Their practice of universal precautions was satisfactory; however, there was evidence of noncompliance among some of them. More studies should be conducted throughout the country to further assess nurses‘ knowledge, attitude and practices towards HIV and AIDS / Health Studies / M.A. (Nursing Science)

Background: Despite advances in HIV medication, many people living with HIV (PLWH) do not link to care upon diagnosis, do not remain engaged if linked, and do not achieve viral suppression through consistent ART adherence. Not achieving viral suppression is associated with low CD4-cell counts, preventable hospitalizations, frequent emergency room usage, risk of developing a drug resistance, and excess morbidity and mortality. Despite extensive literature that explores barriers to care, these disparities remain, particularly among racial, ethnic and sexual minority groups. Mistrust of health care systems and/or providers is thought to provide a partial explanation for why racial and ethnic minority groups are less likely to access outpatient HIV care. One form of health-related mistrust, referred to as “conspiracy beliefs” in the literature and in popular culture, is particularly associated with racial and ethnic minority people. HIV-related “conspiracy beliefs” can include the ideas that the government created HIV to target specific minority groups, that antiretroviral medication is used to experiment on vulnerable groups, or that a cure is being withheld or delayed by pharmaceutical companies and/or the government. Although many studies have assessed the prevalence of such beliefs, little is known about the possible relationship between endorsing these ideas and engagement from HIV care/ART adherence among PLWH. Moreover, the extant literature has provided equivocal findings that point to the need for further research on the relationship between these beliefs and managing one’s HIV. Methods: Over the course of one year, 27 semi-structured, in-depth interviews were conducted with low income PLWH of color living in the NYC area that are currently, or were recently, disengaged from outpatient HIV medical care. Additionally, a brief questionnaire was administered to obtain demographic and engagement/medication adherence data to describe the sample of participants. Findings: This analysis revealed the variation, texture and diversity related to people’s beliefs about the origin and treatment of HIV. Beliefs about the pharmaceutical industry and the government highlighted both the racism and classism experienced by low income who belong to racial and ethnic minority groups. Notably, HIV care providers did not appear to be perceived as part of the government-pharmaceutical power complex. This suggests that while many people may endorse these types of ideas, endorsement does not necessarily directly impact engagement in care. However, endorsing positive beliefs about the efficacy of ART, and the belief that HIV can be a chronic disease if treated consistently, helped participants remain adherent or desire to re-commit to taking it consistently. Participants also appreciated, and desired, providers that engaged in patient-centered medicine. Recommendations: It may be that public health does not necessarily need to endeavor to dislodge origin or pharmaceutical/cure-related beliefs; rather, interventions can focus on building trust between health care providers and populations that have been experienced both historically and ongoing marginalization. Participants’ emphasis on wanting to manage their ART-related challenges with their providers suggests that HIV providers have an instrumental role in not only lowering viral loads and achieving viral suppression, but also helping their patients feel agentic and able to manage their HIV. Implementing patient-centered medicine will also engender trust, thereby helping patients internalize the belief that consistent engagement and ART adherence makes HIV a chronic, manageable illness.