The intervention of Voluntary Counselling and Testing (VCT) for the Human Immunodeficiency Virus (HIV) is rapidly gaining ground as an essential component in the health care system in an effort to combat and confront the spread of this disease. In South Africa where this intervention is gradually being introduced the application of VCT and the benefits and consequences likely to ensue from the application of the procedure were evaluated in-depth using a grounded theory and quantitative approach to describe the psychosocial dynamics. The interactive transfer of information embodied in VCT forms an integral part of the intervention and will continue to do so even when antiretroviral dnugs are uniformly available throughout the South African healthcare service. The way in which the women who will undergo this procedure internalise and respond to the information imparted to them during the counselling is highly significant from an educational and empowering perspective, regardless of the outcome of the test result. The aim of the counselling is primarily to promote a rising consciousness amongst patients and subsequently within their communities in an endeavour to move away from what is termed 'exceptionalism' and towards 'normalisation' of the treatment of HIV/AIDS. Communicating the facts about HIV will help to dispel the myths and stigma which still surround the disease. A convenience sample of one hundred and twelve women were interviewed whilst attending antenatal clinics at four different sites in KwaZulu-Natal. In addition a small cross-sectional sample of service providers and key informants in communities situated near to the chosen sites were interviewed to explore the perceptions of VCT and HIV in the current health service and community environment. The findings revealed that there is to date no mandatory policy which offers VCT routinely at any of the health centres primarily due to the cost of testing, lack of posts for trained counsellors and timeous laboratory facilities. Confusion amongst health personnel regarding current policies of treatment regimens for HIV/AIDS patients, as well as differing opinions about feeding options for infants, can undermine counsellors' confidence to handle complex issues competently from an informed position. Recommendations are that trained counsellor posts with opportunities for updating of current policies, easily accessible laboratory facilities and suitable space for confidential counselling (both oral and visual) be implemented as a priority in the health service. A more comprehensive service should be universally implemented, not just in antenatal and communicable disease clinics for ethical reasons of equity between all members of society. In the same vein the networking and cumulative energy of NGOs, religious groups and health professionals must be harnessed to work synergistically to provide sustainable solutions for those living with HIV and those at risk of becoming infected. / Thesis (M.A.)-University of Natal, Durban, 2001.

Short of a medical breakthrough, counselling is the only available tool to deal with the loss, pain and suffering that AIDS patients' experience. Studies have suggested that although there is a change in society's perception to AIDS, there still exist some negative attitudes and perceptions that occur among a variety of groups, which includes the health care workers. This study aims to investigate the construction of meaning, perceptions, and attitudes of HIV/AIDS among professional and lay counsellors . The researcher will compare lay and professional counsellors' attitudes, perceptions and meanings of AIDS. The Social Representational Theory was used to provide an understanding of how these metaphors and attitudes emerged and still exist. Qualitative methodology was used, which allowed the researcher to gather in - depth data necessary for the study of psychological issues. The study made use of non- probability purposive sampling. Data were collected by use of in-depth interviews. A pilot study was conducted to 'test' the interview schedule. Three lay and three professional , female counsellors were recruited for the interviews. All the interviews were tape recorded and transcribed. Thematic analysis was used to analysis the data. Essentially, the data reflected that there were many emergent metaphors which counsellors used that were similar to the general population. At times, these metaphors impacted on the counselling process. The findings of this study made recommendations in terms of more research around this area is needed, training programmes should include training in peer supervision and it should include more practical exposure to real situations. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2002.

The devastating impact and spread of HIV/AIDS is well recognized throughout the world. HIV/AIDS counselling is one element of Voluntary Testing and Counselling (VCT), a process designed to encourage testing, provide support, care and prevention knowledge. Quality assurance,ongoing training and counsellor support are vital components for VCT to succeed. The implementation of mentorship for HIV/AIDS counsellors is recommended as an appropriate way of addressing current counselling concerns and providing professional and psychsocial support structures to produce benefits for the quality of VCT in the long term. This study aimed at contributing to the limited field of research on the topic of mentorship by conducting an in-depth examination of mentorship in general and in an HIV/AIDS context specifically. A qualitative, interpretative method, using both in-depth interviews and focus groups, was used to address three specific research questions relating to mentorship views of HIV/AIDS counsellors and mentors in KwaZulu-Natal. A grounded theory analytic technique revealed that mentorship provides multiple functions such as guidance and support to counsellors, ongoing training and monitoring counsellor performance, which inevitably contributes to more motivated counsellors and improved quality of work. This study hopes to give greater insight into mentorship, specifically from the perspective of VCT counsellors and mentors, to those key role players and policy makers that are involved in the development of programmes for HIV/AIDS counsellors. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

Voluntary counselling and testing, the cornerstone of HIV/AIDS prevention efforts worldwide, is at the centre of a policy debate rega rding its effectiveness. Informed by social constructionism and drawing on various tools from ethnomethodology and conversation analysis, a sample of twenty-seven vid eotaped simulated counselling interactions in South Africa was analysed. The aim was to assess how the interactional tasks of the voluntary counselling and testing sess ion were worked through by clients and counsellors, and how this was done against the publ ic health and counselling frameworks that inform voluntary counselling and testing pract ice. The goal of the analysis was not to examine practitioners’ competencies, but to exam ine their unfolding actions in the situation and to consider the interactional functio ns these actions might serve. The results show that of the three interactional ta sks of voluntary counselling and testing, information-giving lays the foundation upon which the advice and support goals are realised. It is constructed as critical to client a nd counsellor identities and is a powerful tool through which hope is dispensed. Both the info rmation-giving and support tasks of voluntary counselling and testing combine to manage client distress into more concrete and manageable terms that encourage client coping. Counsellors draw on a range of advice-giving strategies – those that place the onu s of responsibility on the client to those that view the counsellor as the moral guide able to direct client change – in order to encourage clients to reflect on their risk behaviou r. In general, voluntary counselling and testing is framed as a moral activity, and this is most evident in the advice-giving segments. The public health and counselling framewo rks that inform voluntary counselling and testing create a dilemma for counse llors. In practice, counsellors orient towards a directive and health-advising role rather than a non-directive, client-centred counselling role. The implication of this research is that voluntary counselling and testing needs to be defined and framed more clearly – i.e. as a public health intervention with preferred outcomes that draws on a set of client-centred skills. Reconceptualisations of voluntary counselling and testing need to acknowledge the mor al framework under which it operates. Clear implementation guidelines (and training) on what voluntary counselling and testing is and that define its goals more clearly will be useful in assisting counsellors to implement the policies that govern their practice. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

HIV testing is required for life assurance applications. A written information document distributed at blood collection (venisection) serves as pre-test preparation. This study reviewed the adequacy of the document and explored possible alternative arrangements, by means of three research phases conducted at the point of venisection. Phase 1 used a specifically designed questionnaire which included a demographic section and questions assessing the applicant's appraisal of being adequately prepared, and their understanding and experience of testing. Constructed measures established their state of anxiety at testing and their range of information about HIV/AIDS. Phase 2 consisted of a counselling intervention, followed by the questionnaire used in Phase 1. Phase 3 consisted of semi-structured interviews with nursing personnel and insurance brokers. The phase 1 results indicated that the majority of applicants knew they were having an HIV test, did not feel coerced, had a moderate level of information about HIV and were not overly anxious at testing. The level of information about HIV/AIDS showed a significant correlation with their level of education, and the information document emerged as inadequate preparation. Answers given in Phase 2 differed qualitatively from those in Phase 1. Greater consideration of the impact of a positive result was shown, with increased concern about the implications for other people and anticipated acceptance of a positive result emerged in Phase 2. The personnel interviewed for Phase 3 indicated that they felt ill equipped to offer pre-test preparation. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

Thesis (MPhil)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: In Namibia the HIV prevalence rate in adults (15 to 45 years of age) is estimated at 18.1%. The first HIV infection in Namibia was reported in 1986 and the epidemic constitutes the biggest developmental challenge for Namibia. Approximately 39 new infections occur every day and approximately 28% of deaths in the country are AIDS-related. The majority of Namibia’s workforce is in the age group of 15 years to 45 years and it can be anticipated that HIV and AIDS will have a major disruptive effect on the country’s workforce as well as its economy over the next two decades. According to the Namibian government, voluntary counselling and testing (VCT) for HIV is one of the most effective methods to prevent the spread of the epidemic. With this in mind, this study aims to evaluate the outcome of voluntary counselling and testing at one workplace in Windhoek, Namibia, to see whether VCT provides education as well as whether VCT is a vehicle to promote awareness, good attitudes, intentions and behaviour change. The main purpose of this outcome evaluation is to determine to what extent voluntary counselling and testing at the workplace has led to HIV-related changes in knowledge, attitudes, behaviour and practises. Although the majority of respondents indicated that their knowledge of HIV had increased after their participation in the VCT programme, upon closer analysis it was evident that participants who had a secondary or higher level of education had more knowledge, or had had more of a knowledge increase, than participants with a primary or lower level of education. From the research findings, it appeared that the voluntary counselling and testing had helped participants to identify their individual risks, as their self-reported risk perceptions with regard to becoming infected with HIV and/or a sexually transmitted disease increased after their participation in the VCT. There was also evidence that participants implemented risk reduction plans after the voluntary counselling and testing, as the percentage of participants who had casual sex partners decreased while the percentage of participants who had not had casual sex partners in the previous six months increased. It can be concluded that the general attitude amongst employees towards HIV-positive people is relatively non-discriminatory. However, it seems that the VCT was not as successful in transferring information and education on HIV amongst employees with lower education levels than amongst their peers with higher levels of education, and employees with primary or lower education levels appear not to have benefited much from the intervention in terms of an increase in knowledge. It is recommended that voluntary counselling and testing be provided to the employees at the company on a regular basis, not only because employees have requested it, but also to monitor whether the voluntary counselling and testing for HIV at the company has had the desired effects on the employees, especially with regard to effecting an increase in knowledge, a reduction of stigma and discriminatory attitudes, and the desired behaviour change amongst participants. / AFRIKAANSE OPSOMMING: In Namibië word die MIV voorkomssyfer onder volwassenes (ouderdom 15 tot 45 jaar) op 18,1% geskat. Die eerste MIV-geval in Namibië is in 1986 aangemeld en vertoonwoordig die land se grootste ontwikkelingsuitdaging met ongeveer 39 nuwe infeksies daagliks en ongeveer 28% van sterftes in die land wat VIGS-verwant is. Die meerderheid van Namibië se werksmag val in die ouderdomsgroep 15 tot 45 jaar en daar kan verwag word dat MIV en VIGS oor die volgende twee dekades grootskaalse ontwrigting op die land se werksmag sowel as sy ekonomie gaan veroorsaak. Volgens die Namibiese regering is vrywillige berading en toetsing (VBT) een van die mees doeltreffende metodes om die verspreiding van die epidemie te verhoed. Gedagtig hieraan het hierdie navorsingsprojek dit ten doel om die uitkomste van vrywillige berading en toetsing by een werksplek in Windhoek, Namibië, te evalueer ten einde te bepaal of VBT opvoedkundig is en of dit bewuswording, gesonde houdings, voornemens en gedragsverandering bevorder. Die hoofdoelwit van hierdie uitkomsevaluering is om die mate waartoe vrywillige berading en toetsing tot verandering in kennis, houding, gedrag en praktyke gelei het, te bepaal. Alhoewel die meerderheid respondente aangedui het dat hulle kennis na VBT verbeter het, het dit by nadere ondersoek geblyk dat deelnemers wat sekondêre of hoëronderwys gehad het, oor meer kennis beskik het of hul kennis meer uitgebrei het as respondente wat slegs 'n primêre of laer vlak van onderwys gehad het. Uit die navorsingsbevindings blyk dit dat daar onder deelnemers aan vrywillige berading en toetsing 'n toename in die self-aangemelde risiko-persepsie van besmetting met HIV en/of geslagsoordraagbare siektes na hul deelname aan VBT was. Daar was ook bewyse dat deelnemers na die vrywillige berading en toetsing risikoverminderingsplanne geïmplementeer het, omdat daar 'n afname was in die persentasie deelnemers wat informele seksmaats gehad het, sowel as 'n toename in deelnemers wat geen informele seksmaats in die vorige ses maande gehad het nie. Daar kan tot die slotsom gekom word dat werknemers se houding teenoor MIV-positiewe mense oor die algemeen betreklik nie-diskriminerend is. Dit blyk egter asof VBT ten opsigte van die oordrag van inligting en opvoeding oor MIV aan werknemers met laer vlakke van onderwys nie so geslaagd was nie omdat werknemers met primêre of 'n laer vlak van opleiding nie veel by die ingrypaksie gebaat het in terme van ‘n toename in kennis nie. Daar word aanbeveel dat vrywillige berading en toetsing op 'n gereelde grondslag aan werknemers by die maatskappy aangebied moet word, nie bloot omdat werknemers daarvoor gevra het nie, maar ook om te bepaal of vrywillige berading en toetsing vir MIV by die maatskappy die gewenste uitwerking op die werknemers gehad het, veral met betrekking tot die uitbou van kennis, 'n afname in stigmatisering en diskriminerende houdings, en 'n toename in die gewenste gedragsverandering onder deelnemers. / jfl2011 / Imported from http://etd.sun.ac.za

Introduction: Stigma associated with HIV/AIDS creates a barrier to prevention, care and treatment of HIV/AIDS. It further restricts PLWHA from learning about their status, disclosing their status, adopting safe behaviour and accessing services such as antiretroviral treatment. Disclosure of HIV status and a reduction in stigma may contribute to the decrease in new HIV cases. Purpose: The purpose of the study was to develop a community-based framework that would encourage people living with HIV/AIDS to disclose their HIV status and reduce the stigma associated with the disease. Method: This study used the action research method to explore the experiences of stigma and disclosure of HIV status and to develop a community based framework with PLWHA who encouraged disclosure and promoted the reduction of stigma in a community-based setting. The research setting was Bhambayi, an informal settlement in the district of Inanda. Non-probability purposive sampling was used. In-depth interviews with PLWHA that had disclosed their HIV status and focus group discussions with family members, adult children and community members were conducted. Findings: The data was analyzed manually and the following categories and subcategories emerged. The categories were experience of disclosure, stigmatizing reactions, lifestyle changes after disclosure and supports to reduce stigma. Some of the sub-categories were ‘opens out the illness’, gossiping and pointing fingers, discrimination against PLWHA by family and community, changes in relationships, community awareness and formation of support groups. The findings revealed that PLWHA that had disclosed their HIV status had changed their lifestyles. Recommendations were made on the need for nurses to develop community engagement projects and establish partnerships in order to reach out to communities regarding HIV/AIDS. Incorporate HIV/AIDS stigma and discrimination into the current nurses’ curriculum. The need for research is expressed on the evaluation of the framework and conducting similar research in larger communities. Conclusion: PLWHA who had disclosed their HIV-status shared their experience of being HIV-positive and encouraged other people to get tested. The community-based framework to facilitate disclosure and reduce stigma among PLWHA can be operationalised in other informal community-settings. / Theses (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

AIM The aim of the study was to conduct a process evaluation of the implementation of the HIV/AIDS counselling and treatment program (HCT) for employees to ensure the delivery of standardised, high quality and ethical HIV counselling and testing services at a selected Regional Hospital in KwaZulu-Natal. METHOD A quantitative, non-experimental descriptive evaluative design was used to conduct the study. The study consisted of a two (2) questionnaire survey of a sample of 140 participants; One for the staff working in the HCT clinic (n=8) to evaluate the implementation of the HCT activities and the other for the staff that are employed at the selected public hospital (n=132) to evaluate their knowledge, attitudes and practise towards the HCT program. A checklist of the venue was also completed to evaluate the resources available at the HCT clinic. Informed consent was obtained from each participant. SPSS version 19 was used for data analysis. RESULTS The study revealed that the implementation practises of the HCT program were not according to the National Policy for HIV Counselling and Testing Guidelines (Department of Health, 2009) with regards to the availability of resources at the HCT clinic such as HIV test kits, chairs, gloves and sharps containers were available. Privacy was maintained while resources including condoms; directions such as posters to the clinic; pamphlets and reading material were unavailable. Nurse’s knowledge and attitude was neutral. There were no correlations between nurses that attended a HIV course and those that did not. The distribution of knowledge was the same across all categories of experience and level of education. The majority of nurses had an HIV test voluntarily and found out the results. The finding of the study does not indicate whether or not the HIV test was done at the staff HCT clinic or elsewhere. A small minority reported that they tested for employer and insurance purposes. A significant proportion of participants did not test because they were afraid that a person they know may test them and tell others and also because they did not think that the medical and nursing staff kept their testing information confidential. CONCLUSIONS AND RECOMMENDATIONS For the HCT program to be successfully implemented, resources and supplies must be available at the HCT clinic should an employee wish to use its services. It is recommended that funds be made available and budgeted for to increase the supplies of HIV test kits; provide condoms, books, pamphlets and reading material at the clinic. The researcher also recommends courses be offered to nurses that are interested; include HIV/AIDS courses in the curriculum of nurses attending the college; provide in-service education/training for employees regarding the HCT program, its resources and activities; provide anti-retro viral treatment (ART) to employees at the HCT clinic in order to decrease untimely AIDS deaths. / Thesis (M.N.)-Unversity of KwaZulu-Natal.

South Africa has one of the highest prevalence of HIV infections in the world. Sexual transmission is the primary mode of transmission across the country’s population. Misinformation about AIDS, negative attitudes to HIV testing and AIDS’ stigmatizing beliefs represent potential barriers to seeking HIV testing. Youth between 15-24 years have the greatest risk of HIV infection but only 37% of students at the University of KwaZulu-Natal (UKZN) had undertaken HIV counselling and testing (HCT) according to the HEAIDS (2008) report. Prevention of HIV and behaviour change includes knowledge about, and adequacy of, HIV counselling and testing (HCT) resources on campuses. The aim of this study was to investigate students’ perceptions about HCT at UKZN and make recommendations regarding improvements. An observational, analytical, cross-sectional study of UKZN undergraduate students on the five campuses was conducted. Participants completed anonymous self-administered questionnaires. Of 965 surveyed students, 663 (71%) had tested for HIV among whom 545 (58%) were females and 501(52%) were 20-25 years. Fear of positive results, perceived low risk of acquiring the infection and having confidence in his/her partner influenced student HIV testing behaviour (p<0.001). A significant difference was also found in positive attitudes towards HCT on campus between people who had tested (median score 20) and people who had not tested (median score 18) (p < 0.05). Since one third of students at UKZN had not tested for HIV, HCT at UKZN needs to be advertised more effectively so as to increase HIV testing by students on campuses. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

MPH / Department of Public Health