A thesis submitted to the Faculty of Science, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy. Johannesburg, 2013 / Pain is one of the most frequent and debilitating symptoms in human immunodeficiency virus (HIV) infected individuals. With Southern Africa being the region with the highest population of HIV-infected individuals, I set out to determine whether the pain intensity, prevalence and management strategies that have been reported in other, non-African, countries are similar to that in South African patients. South Africa has eleven official languages, with nine of those being native languages. Also, there is a high level of illiterate people in the country, thus, for better assessment of the pain I translated the Wisconsin Brief Pain Questionnaire into five frequently spoken local languages. Using the translated questionnaires I investigated the prevalence, intensity and management of pain in ambulatory HIV-positive outpatients attending a metropolitan (n = 396) or rural (n = 125) clinic. I also assessed whether this pain changes over time in a subset of 92 metropolitan patients. Seventy-two percent of rural participants and 56% of metropolitan participants had pain at the time of the interview, and this pain was moderate to severe in intensity in 60% of affected rural participants and 59% of affected metropolitan participants. In the rural cohort, use of antiretroviral therapy was independently associated with the reduced risk of pain [prevalence ratio (95% CI): 0.7 (0.5-0.9)] while in the metropolitan cohort increasing age was weakly, but independently associated with having pain [prevalence ratio (95% CI): 1.01 (1.005-1.012)]. Pharmacological management of pain was poor, with 29% of rural participants and 55% of metropolitan participants with pain not receiving any treatment. Of those receiving treatment, no participants were receiving strong opioids, and only 3% of metropolitan participants were receiving a weak opioid. On a positive side, the pain that South African HIV-infected individuals endure decreases over time. Seventy-eight patients out of the subsample cohort consisting of 92 patients reported pain at the time of the first interview. Of the 78 patients who were in pain at visit 1, 48 were still in pain six months later with 36 of those not prescribed any form of analgesics. Thus I found a decrease in moderate and severe intensity pain to mild and moderate pain, respectively, from visit 1 to visit 2. Of the 78 patients that were in pain at visit 1, only 5% received some form of analgesic therapy. Forty-eight of the 78 patients were still in pain six months later, and of those, 25% were being prescribed some form of analgesics at visit 2. There were no changes in the pain-related interference over a six month period in patients who were in pain at visit 1 and visit 2. Therefore, as it has been reported previously for other developed and developing countries, pain in HIV-positive South Africans is common and is under-treated. Also, there are decreases in the pain intensity, pain prevalence, the number of pain sites over a period of six months. These decreases were evident in patients who were on HAART for the duration of six months as compared to those who were not on HAART for six month.

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree in Master of Science in the School of Molecular and Cell Biology August 2017 / Antiretroviral therapy (ART) drugs such as stavudine (d4T) are known to have off-target side-effects, including the inhibition of DNA polymerase gamma which replicates mitochondrial DNA (mtDNA). ART-induced depletion of mtDNA copy number may cause mitochondrial toxicities such as sensory neuropathy (SN). Genetic variation in DNA polymerase gamma or in other nuclear genes influencing mtDNA replication and mtDNA copy number may therefore contribute to susceptibility to d4T-induced SN. DNA samples from 263 HIV-positive South African adults exposed to d4T were classified as cases with SN (n = 143) and controls without SN (n = 120). A total of 28 single nucleotide polymorphism (SNPs) were chosen in nuclear genes from the mtDNA replication pathway and from a GWAS paper examining SNP association with ART-induced SN (Leger et al. 2014). Genotyping was performed using Sequenom Mass Spectrometry. MtDNA copy number was determined using a qPCR assay. Associations between SN and genetic variants, between genetic variants and mtDNA copy number, and between mtDNA copy number and SN were evaluated in univariate and multivariate models using Plink v1.07 and GraphPad v7. Age and height were significantly different in the cases with SN vs controls without SN. In univariate analyses, three SNPs and two haplotypes were significantly associated with SN, three SNPs were associated with pain intensity and three haplotypes were significantly associated with mtDNA copy number. However, there were no significant associations with SN, pain intensity or mtDNA copy number after correction for multiple SNP testing. No significant difference in mtDNA copy number in cases vs. controls was observed. In conclusion variation in nuclear-encoded mitochondrial genes examined in the current study do not play a role in ART-related mitochondrial complications such as changes in mtDNA copy number, or occurrence of SN. / MT2018

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Genetics. Johannesburg, South Africa 2017 / Background: Stavudine (d4T) use is associated with the development of sensory neuropathy (SN), several mechanisms may underlie d4T-induced toxicity, including: (1) Inter-patient genetic variability in the genes modulating the deoxynucleotide triphosphate (dNTP) pool sizes. (2) Variation in intracellular ARV drug concentrations due to genetic variation in drug transporters. In our study we examined the genetic variation in four stavudine transporter genes and seven genes regulating the deoxythymidine triphosphate (dTTP) synthesis and their associations with d4T-induced SN or CD4+ T cell count or mtDNA copy number. Methods: We examined a cohort of HIV-positive South African (SA) adults exposed to d4T, including 143 cases with SN and 120 controls without SN. 26 single nucleotide polymorphisms (SNPs) from the literature were chosen, prioritised on being tagSNPs with minor allele frequency >5% in Kenyan Luhya (a proxy population for the SA Black population); SNP functional effects and suitability for multiplex analysis on the genotyping platform. Genotyping was performed using Sequenom mass spectrometry. A qPCR assay was used to measure the mtDNA copy number. Association of sensory neuropathy, CD4+ T cell count and mtDNA copy number with genetic variants was evaluated using PLINK. Results: All 26 SNPs were in Hardy-Weinberg equilibrium (HWE) in both the cases and controls. SNP rs8187758 of the SLC28A1 transporter gene and a 3-SNP haplotype ABCG2 were significantly associated with CD4+ T cell count after correction for multiple testing (p = 0.043 and p=0.042 respectively), but were not significant in multivariate testing. No SNP remained significantly associated with SN or mtDNA copy number, after correction for multiple testing. Conclusion: Variation in genes encoding molecular transporters of d4T may influence CD4+ T cell counts after ART. This study presents a positive step towards achieving personalized medicine in SA. / MT 2018

Thesis (MCur.) -- University of Limpopo, 2015 / The purpose of this study was to determine the experiences of students in disclosing their HIV-positive status at the University of Limpopo, Turfloop Campus. A qualitative, descriptive, phenomenological design was used to explore, describe, and understand the experiences of the students with regard to the disclosure of their HIV-positive status. A group of 20 students who belonged to the support group were purposively sampled. Semi-structured interviews were conducted for data collection until saturation was reached. Data analysis was conducted according to Techs open-coding method. The study highlights the potential factors that might hinder access to HIV prevention, management, care, and support programmes. The findings reveal that there is a marked societal shift in the perception and understanding of HIV, resulting in disclosure being a less difficult responsibility. However, rejection by sexual partners has also been revealed. This rejection is one of the negative consequences that might hamper future disclosure. It is recommended that counsellors should be highly skilled in counselling HIV-positive people, especially about issues of disclosure. An HIV disclosure model will greatly support the work of these counsellors.

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

The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.

Thesis (M. A. (Clinical Psychology)) -- University of Limpopo, 2016 / In this study, the researcher aimed to discover stigma associated with people living with HIV and AIDS in Mahwelereng, Limpopo province. The researcher sampled five males and five females and they were between the ages of 18 and 35. In-depth interviews were a method of choice during data collection. Thematic content analysis was used to analyse data. The results show negative perceptions towards PLWHA. The community discriminate PLWHA because of fear of being infected, with females being at a higher risk because they are perceived to be promiscuous. Participants also highlighted that black people lack knowledge of how to treat and behave towards HIV/AIDS infected individuals. It is recommended that there should be studies that focus on availability of interventions that aim to combat HIV/AIDS stigma. Lastly, the future studies should explore which race groups have more knowledge and perception about HIV and AIDS. KEY CONCEPTS: Acquired Immune Deficiency Syndrome; Human Immunodeficiency Virus; People Living with HIV and AIDS; Stigma. / National Research Foundation (NRF)

PhD (Advanced Nursing Sicence) / Department of Advanced Nursing Science

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 ...

As the economic hub of South Africa, Johannesburg attracts cross-border migrants in search of improved livelihoods; over half the population of some of its inner-city suburbs are made up of cross border migrants. Globally as well as locally, foreigners have been blamed for the spread of diseases such as HIV. As a result, they have suffered challenges in accessing public healthcare, particularly antiretroviral treatment (ART) for HIV. Studies have shown that despite these challenges - foreigners experienced better ART outcomes than nationals. There is a need to explore the ways in which cross border migrants use to access and to stay on treatment, given the wide-range of challenges that they face during their stay in Johannesburg. Semi-structured interviews with five nurses and ten cross-border migrants currently receiving ART, along with non-participant observations, were used to collect data from two public clinics in inner-city Johannesburg. Analysis suggests that the family network in the country of origin remains critical, as cross border migrants are not disclosing their status in the city in which they live, but do so to their families in their countries of origin. Data shows that when it comes to accessing and staying on treatment, cross-border migrants go to the clinic every month as do nationals; ask for more treatment from nurses when going home temporarily; eat healthily; but hide when taking medication, and negotiate confidentiality and trust within their families in countries of origin. Some are found to access treatment in their countries of origin while staying in Johannesburg. Despite the lack of social networks in the inner city, this data suggests that cross-border migrants are successful in accessing and continuing with ART. There is need for future research to look at social networks for internal migrants, so as to compare results.