Exclusive breastfeeding is one of the infant feeding methods recommended by the World Health Organisation (WHO) in the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV), especially to HIV positive women of low socio economic status. The purpose of the study was to determine and describe the HIV positive mothers’ perceptions towards exclusive breastfeeding in postnatal ward at a particular hospital in Limpopo Province, South Africa. Qualitative exploratory research design was used to explore and describe the HIV positive mothers’ perceptions towards exclusive breastfeeding. A grand tour question in an unstructured interview was used to collect data, followed by probing questions according to participants’ responses. Data were collected from 15 HIV positive mothers aged 18 years and above. They opted for exclusive breastfeeding, and voice recorder and field notes were used to capture data. The seven steps of data analysis, adapted from Colaizzi were used. The findings: Although the benefits of exclusive breastfeeding was known by mothers, some participants had limited knowledge on the importance of exclusive breastfeeding. Some health care providers lack up-to-date information on exclusive breastfeeding. Religious and cultural practices interfere with exclusive breastfeeding. Coping strategies with the feeding options emerged as well. / Health Studies / M.A. (Nursing Science)

This dissertation examines the participation of the church and Christians in the lives of women who are infected and affected by HIV/Aids in South Africa. To this end two Christian facilities; Sparrow Village and St Francis Care Centre, were examined in order to gain insight into the ethical issues of knowledge of patients and caregivers, the prevention measures being taught and the care facilities available to women in the plight in which they find themselves. A partial survey was conducted into the current policies and contributions by the church in an attempt to assess new ways to combat the disease. Medical information was examined as to what the virus is and how it is transmitted and reasons why women are particularly vulnerable to the virus. The dissertation seeks to understand practical ministerial ways in which the church should participate in women’s lives while being sensitive to the cultural, social and political and economic elements involved. / Philosophy, Practical and Systematic Theology / M.Th. (Theological Ethics)

This research was conducted with the aim to evaluate the policy interventions on HIV and AIDS in pregnant women in the Lukhanji sub district of Chris Hani District Municipality. The study would also propose policy improvement strategies towards curbing the spread of HIV and AIDS in pregnant women. In realizing these goals, the entire research process was guided by the research objectives and questions which sought to evaluate policies and strategies relevant to HIV prevalence in pregnant women. The secondary research objectives were accomplished through the review and analysis of the relevant literature and theories. Qualitative research approach was used in determining the findings and conclusions from the study. Data was collected using qualitative research methods and in this case a structured questionnaire was developed and distributed to the study participants. The Questionnaires were handed and discussed with each participant. Demographics, socioeconomic and cultural factors were considered in designing the data collection tool. These factors are known to have an impact on the prevalence of HIV. It has been shown through the study that demographic variables have an effect on HIV prevalence. Hence when considering policy interventions these should be taken into account. All the respondents were given enough time and they provided clear and comprehensive responses to the questionnaire and follow up discussions. The evaluation of the responses showed that various HIV prevention related policies are being implemented within the Lukhanji sub-district. Numerous programmes relating to HIV and AIDS, also specifically covering pregnant women are being rolled out across the sub-district. HIV prevalence in the study population is rated as average to low when comparing with the district, provincial and national statistics. Current data obtained from the study indicates that HIV prevalence stands at 17%. This finding demonstrates the heterogeneity of HIV prevalence when comparing this result with current provincial and national statistics. Evaluation of the different HIV and AIDS programmes that are aligned to provincial and national policy somehow explain the positive outcomes observed in the Lukhanji sub-district The study recommends that more work be done in reaching out to the communities using various communication channels and strategies. This could address the challenges associated with the lack of cooperation with local traditional leaders, because this has been found to have a negative impact on implementation of some programmes such as circumcision. One of the positive findings from the study is the accessibility of health care facilities to the local rural communities. Further research on the subject should be undertaken to ensure continuous evaluation as this topic is viewed as a continuous global issue.

L’infection persistante par les papillomavirus (HPV) dits « à haut risque » induit le cancer du col. Chez les femmes infectées par le VIH, les infections par ces HPV oncogènes et les lésions associées, allant des dysplasies au cancer invasif, sont plus fréquentes, plus sévères et de moins bon pronostic que chez les femmes non porteuses du VIH. Etonnamment, alors qu’il a été clairement établi que l’importance de la pathologie liée à HPV est directement proportionnelle au degré d’immunodépression des patientes porteuses du VIH, il n’a pas pu être démontré qu’un traitement antirétroviral efficace contre le VIH permettant d’améliorer l’immunité, diminue l’infection par ces HPV. <p>Entre janvier 2002 et décembre 2012, nous avons constitué une cohorte prospective de dépistage et de suivi de l’infection cervicale par HPV à haut risque incluant plus de 900 femmes traitées à la consultation du Centre de Référence SIDA de l’hôpital Saint-Pierre. Nos résultats montrent que chez ces femmes pour la plupart d’origine Africaine et traitée avec succès pour le VIH depuis plusieurs années, la prévalence et l’incidence de l’infection par HPV oncogène sont beaucoup plus importantes que dans la population belge générale ou que chez les femmes séropositives vivant dans d’autres pays occidentaux. Grâce à un suivi longitudinal de plusieurs années, nous avons pu démontrer que le risque d’être infectée par un HPV oncogène est significativement réduit sous trithérapie anti-VIH sous réserve d’obtenir une charge virale indétectable à <50 cp/ml pendant plus de 3 ans ou une restauration immunitaire à >500 lymphocytes CD4+/µL pendant plus d’un an et demi. Ces résultats ont été confirmés dans l’analyse que nous avons faite sur les nombreuses dysplasies cervicales également retrouvées dans notre cohorte. Enfin, nous avons trouvé que la distribution des génotypes d’HPV de nos patientes est similaire à celle trouvée en Afrique sub-saharienne impliquant que la couverture offerte par les vaccins anti-HPV varie entre moins de 30% pour les vaccins bi- ou quadrivalent actuellement disponibles à 80% pour le vaccin nanovalent en développement. Notre travail met en lumière l’étendue particulièrement importante de l’infection par HPV à haut risque chez les femmes séropositives vivant en Belgique et offre de nouveaux éléments de réflexion afin d’adapter à leurs particularités les recommandations belges et les critères de remboursement à la fois pour le dépistage du cancer cervical et la vaccination anti-HPV.<p>/<p>Persistent infection with human papillomavirus (HPV) called “at high risk” induces cervical cancer. In HIV-positive women, infection with these oncogenic HPV and HPV-induced lesions ranging from cervical dysplasia to invasive cancer are more frequent, more severe and have a worst outcome than in HIV-negative women. An intriguing paradox is that, although it has been clearly demonstrated that high risk HPV infection and associated diseases are increased by progressive immune deficiency, the introduction of efficient therapy against HIV leading to improved immunity has not been associated with a decrease in oncogenic HPV infection or HPV-induced lesions.<p>Between January 2002 and December 2012, we have built a prospective cohort to screen and follow-up cervical infection by high risk HPV in more than 900 women treated for HIV in the AIDS Reference centre of Saint-Pierre Hospital. We have shown that among these women mainly from Sub-Saharan African origin and successfully treated for HIV for several years, the prevalence and incidence rate of high risk HPV are much higher than in the general population from Belgium or in HIV-positive women from other western countries. After several years of longitudinal follow up, we have demonstrated that the risk of infection by oncogenic HPV is significantly reduced by efficient therapy against HIV provided that HIV viral load has been sustainly suppressed below 50 cp/ml for more than 3 years or that immunity has been increased more than 500 CD4+T cells/µl for more than 1.5 years. These results have been confirmed in the analysis on cervical dysplasia which is also very prevalent in our cohort. At last, we have found that the HPV genotype distribution in our population is very similar to the one found in Sub-Saharan Africa. We have estimated that the coverage offered by the vaccines against HPV in our cohort is less than 30% for the currently available bi- or quadrivalent vaccine but reaches 80% with the future nanovalent vaccine. Our results highlight many differences in the HPV infection and associated diseases in HIV-positive women compared to HIV-negative women; these differences should be taken into account to adapt to our specific population the current Belgian guidelines or the reimbursement criteria on cervical screening and on vaccines against HPV. <p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

The focus of this study is on the experiences of a small sample of local women who have been recently diagnosed with HIV. The aim of the research was to give these women an opportunity to express their first-hand, personal accounts of living with HIV. Five isiXhosa-speaking women were recruited and interviewed. These accounts were collected and analysed within in the methodological framework of Interpretative Phenomenological Analysis, a qualitative approach that is becoming increasingly popular in the broad fields of health and clinical psychology. Data was analysed for meaningful units, which were interpreted inductively and hermeneutically, and categorised into super-ordinate themes. Five themes within the participants’ experiences of living with HIV were identified: (1) experiences of diagnosis, (2) experiences of stigma, (3) social support, (4) coping strategies, and (5) HIV as one of many assaults to self. Implicated in these experiences are the ways in which these women have appraised themselves and their situation after an HIV-positive diagnosis, appraisals that are shaped by HIV-related stigma. A variety of negative emotional reactions are common following the diagnosis, often compounded by the direct experiences of HIV-related stigma. Women in the study adopted different kinds of coping strategies based on the resources and social support available to them. Also significant is that for these women who had typically endured a variety of traumatic life events, a positive diagnosis was simply one of many life challenges

It is estimated that 6742 South African women are diagnosed with cervical cancer and 3681 women die from the disease every year. In 1993, The Centers for Disease Control declared cervical cancer an Acquired Immunodeficiency Syndrome defining illness. Apart from persistent human papillomavirus infection, HIV infection is the most common co-factor contributing to cervical cancer in South Africa. Studies have noted that in HIV positive women, there has been an occurrence of faster progression to more advanced stages of cervical cancer with high cases of treatment failure and recurrence. There is limited literature available regarding the prognosis of HIV positive women who suffer from cervical cancer. Women who are HIV positive and have cervical cancer have not been evaluated in detail regarding their response and adherence to cervical cancer treatment. Standard treatment protocols for this set of patients have not been defined. The aim of this study was to assess how HIV positive women who have been diagnosed with cervical cancer responded and adhered to cervical cancer therapy which includes: curative radiotherapy; curative chemotherapy; concurrent chemoradiation or palliative radiotherapy. The study also evaluated the effects of the concurrent use of antiretrovirals and cervical cancer treatment. This was done to determine whether invasive cervical cancer in women who were HIV positive could be managed using the same treatment protocols as patients who were HIV negative. A historical cohort design was employed for the study. The study was conducted at the Oncology Department of a tertiary level hospital located in the Eastern Cape Province, South Africa. The total sample consisted of 196 medical records of women diagnosed with cervical cancer between 2005 and 2008. One hundred women were HIV negative, 83 were HIV positive and the HIV status of 13 women could not be determined. The records were audited over a period of two years from the date of diagnosis. The term „complete response‟ referred to patients who had no recurrence of cervical cancer and no evidence of metastases after undergoing treatment. At one month following treatment there was a significant difference in the incidence of complete response between the HIV positive patients and the HIV negative patients (Chi2 = 16.4, d.f. = 1, p = 0.00005, Cramer‟s V = 0.31). The significant difference in response to treatment between the HIV positive patients and the HIV negative patients was maintained at six months after treatment (Chi2 = 15, d.f. = 1, p = 0.00011, Cramer‟s V = 0.34), 12 months after treatment (Chi2 = 20.5, d.f. = 1, p = 0.00001, Cramer‟s V = 0.37), 18 months after treatment (Chi2 = 9.8, d.f. = 1, p = 0.00173, Cramer‟s V = 0.28) and 24 months after treatment (Chi2 = 5.0, d.f. = 1, p = 0.02571, Cramer‟s V = 0.26). At each of these intervals, cases of treatment failure and metastases were significantly higher in the HIV positive women than in the HIV negative women. Although there was no significant difference in the incidence of adherence between the HIV negative women, the HIV positive women who were on HAART and the HIV positive women who were not on HAART, there was a significant difference in the incidence of the various reasons for non adherence between the various groups. These reasons included: missed scheduled appointments (Chi2 = 2.9, d.f. = 2, p = 0.02385, Cramer‟s V = 0.31); low blood count (Chi2 = 4.0, d.f. = 2, p = 0.01327, Cramer‟s V = 0.15); radiotherapy induced skin breakdown (Chi2 = 0.6, d.f. = 2, p = 0.04581, Cramer‟s V = 0.16) and radiotherapy induced diarrhoea (Chi2 = 6.9, d.f. = 2, p = 0.03118, Cramer‟s V = 0.19). According to the 2004 National Antiretroviral Treatment Guidelines, cervical cancer patients would fall into the WHO stage IV category of HIV disease thus all patients with confirmed diagnosis of invasive cervical cancer should be commenced on antiretrovirals as soon as the cancer diagnosis is made regardless of their CD4 count. However, in the current study, 13 percent (n= 83) of the HIV positive women were not on antiretrovirals. The study concluded that HIV positive women had a higher incidence of both treatment failure and metastases to cervical cancer treatment. Standard radiotherapy and concurrent chemoradiation cervical cancer treatment protocols should be still be used in both HIV negative patients and HIV positive patients so as not to compromise tumour control. Furthermore, in accordance with the antiretroviral treatment guidelines, all HIV positive patients with cervical cancer should receive antiretrovirals irrespective of their CD4 count.

This descriptive study aimed to assess the Infant and Young Child Feeding (IYCF) policy implementation in the Prevention of Mother-to-Child Transmission of HIV (PMTCT) among healthcare workers in the Nelson Mandela Bay Municipality public health care facilities. A convenience sampling method was used to gather information from nurses (n=32) rendering maternal and child health services in nineteen permanent Nelson Mandela Bay public health care facilities (MOU’s, paediatric sections, well baby clinics and PMTCT sites). Recommendations included to the need develop indicators for measuring the IYCF policy objectives and regularly collect data on infant and young child feeding, standardising infant feeding education given by peer educators / lay counsellors from various organisations, capacity building and training of staff on IYCF and scaling up monitoring and evaluation of the IYCF policy impact.

This study explored and described the strategies used by nurses to manage newly diagnosed HIV positive pregnant women who do not return to the clinic within a month following diagnosis, for continuity of care. The main aim was to prevent mother-to-child transmission of HIV (PMTCT). Method: The study sites were two accredited antiretroviral- ante-natal care (ARV-ANC) clinics at the Dimbaza community health centre (CHC) and the East London Hospital Complex (ELHC) which comprises of Cecilia Makiwane and Frere hospitals, in the Buffalo City Metropolitan Municipality (BCM). The majority of health personnel at these clinics are professional nurses. An in-depth semi structured interview guide was used to collect data through focus group interviews from professional nurses who work in these units. They were required to share their experiences about intervention strategies used for newly diagnosed HIV- positive, pregnant women who fail to return for continuity of care within a month after diagnosis. Results: Follow up of these women is done by tracking them (by calling them; calling the clinic nearest to their homes and doing home visits). Decentralisation of further management and care to the nearest clinic was also cited, especially for the patients who stay far from these accredited sites. Family support was also mentioned as a strategy to intervene for the non-compliant patients. Challenges: The challenges that were encountered with these interventions include wrong contact details, wrong addresses and being evasive when visited at home. Another challenge cited was related to the stigma attached to the diagnosis and the tracking devices used, for example, the car as it is familiar to the community it serves. Despite known benefits for early initiation of HIV treatment newly diagnosed HIV- positive, pregnant women continue to refrain from accessing care after diagnosis, thus posing a risk to the transmission of HIV to the baby and further comprising their own health. They miss out on general HIV management and ante-natal care. Conclusion: The identified intervention strategies used by nurses to follow up newly diagnosed HIV- positive, pregnant women need to be reinforced and strategies put in place to control the related challenges for a better response by the patients.

This study will look at the possible interpretations and implementation methods that a state may adopt in accordance with internationally recognised standards and best practices. This will be in light of the special context of Africa and specifically as regards the disposition of women in the HIV and AIDS pandemic. The author critically analyse article 14(1)(e)of the African Women’s Protocol and establish possible interpretations that best advance the public health goal of arresting the spread of HIV in Africa / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2008. / A Dissertation submitted to the Faculty of Law University of Pretoria, in partial fulfilment of the requirements for the degree Masters of Law (LLM in Human Rights and Democratisation in Africa). Prepared under the supervision of Dr. Patrice E. Vahard of the Faculty of Law, Addis Ababa University / http://www.chr.up.ac.za/ / Centre for Human Rights / LLM

Thesis in English, Annexure E: Consent form (leaf 81) as well as KABP Survey Questionnaire (leaves 87-91) in English and SiSwati. / The purpose of the study was to assess knowledge, explore attitudes and determine practices of breastfeeding mothers living with HIV regarding post-natal PMTCT interventions and services. The study was quantitative and descriptive in nature, utilising a retrospective cohort design. The study sample included breastfeeding mothers living with HIV, who attended the King Sobhuza II public health unit in the Manzini region of Swaziland. A written questionnaire was administered to a non-random sample of 90 consecutively selected mothers living with HIV attending the above-cited public health unit for post-natal health purposes. The overall study results revealed that the majority of breastfeeding mothers living with HIV in the afore-mentioned region (77.8%) presented high levels of knowledge on PMTCT, and 90% demonstrated a positive attitude; while a further 90% also demonstrated positive behaviour towards PMTCT. However, stigma and discrimination among family members, non-disclosure of HIV status to sexual partners; as well as poverty and fear of future drug-resistance are the cause of non-adherence to ARV prophylaxis. Furthermore, inconsistent condom use, mixed-feeding methods and wet-nursing also emerged as other contributing factors to the increase of post-natal mother-to-child transmission of HIV among breastfeeding mothers living with HIV. / Health Studies / M.A. (Nursing Science)