The convergence of compelling evidence that transmission of HIV from a pregnant woman living with HIV to her foetus can be significantly interrupted due to advances in antiretroviral and obstetrical interventions, and worrisome epidemiologic data documenting a rise in HIV infection among Canadian women, spurred the development in Canada and world wide of policies and programmes aimed at increasing the number of pregnant women who are tested for HIV. Responding to innovative therapy reducing perinatal HIV transmission risk by increasing the number of pregnant women who agree to test for HIV is clearly an important prevention objective. However, the process must be accomplished in a way that is of most benefit to the pregnant woman herself and in a way that does not compromise a pregnant woman's rights to the established Canadian principles of HIV counselling and testing. / Working with pregnant women in Ontario, the province with the highest level of HIV infection among Canadian women, this thesis articulates and interprets their experiences of prenatal HIV counselling and testing and details their perspectives on best practices. The pregnant women's evidence-based recommendations for the re-design of prenatal HIV testing programmes are provided. These unique data have important utility for federal and provincial policy makers as HIV counselling and testing policies and programmes that encompass and are grounded in pregnant womens' experiences and perspectives are likely to be maximally acceptable and thereby increase the number of pregnant women who can be apprised of prophylactic treatment to take care of their own health needs as well as those of their unborn children. / In order for pregnant women to increase control over their own health and that of their unborn children, there is clear value in all pregnant women being afforded the opportunity to know their HIV status. However, the voices of the women in this study suggest that the autonomy rights of pregnant women may well be at risk in a programme in which the current emphasis is on potential HIV infection of the foetus rather than on potential or actual infection of the pregnant woman.

Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2008. / Women globally, and especially in sub Saharan Africa, are disproportionately affected by HIV and AIDS. Factors driving the HIV and AIDS pandemics include the oppression of women and gender inequality. Despite an intensified focus on women and girls in an attempt to reduce vulnerability to HIV little real progress has been made. This is in part because the sophisticated analysis of risk, vulnerability and our understanding of the pandemics is not match by equally sophisticated responses to prevention, care, treatment and support. Power over / male domination, evident at every level of society, fuels the pandemics, and makes women vulnerable. Using feminist understandings of power and domination this thesis explores the notion of subverting power. Through a series of case studies the notion of negative and positive power is explored; positive power includes power with, power to and power within. Examples of women’s resistance individually and collectively using the different types of power are highlighted. The thesis demonstrates that that women are not powerless and can and do affect change in their lives in all sites of struggle, that is can increase bodily autonomy, improve intimate relationships and challenge inequality in the households and community. Based on the learnings from the case study a theoretical model that addressed power as problem and solution in the context of HIV and AIDS is presented.

Background: Breastfeeding is known to have benefits both for maternal and child health. Some questions around the benefits and risks of breastfeeding in the presence of HIV infection still remain unclear. Aims: To study the effects of infant feeding mode by HIV-positive mothers, on maternal and child health. In addition, to assess the effect of nutritional supplementation to HIV-positive lactating mothers on nutritional and health status of mothers and their infants and on the quality of breastmilk. Methods: The study had 2 components; a prospective study to examine the impact of infant feeding mode on nutritional and health indices in mothers and their infants and within it a nested randomized controlled clinical trial to study the impact of a daily 50 g soya/peanut based supplement during breastfeeding on the above parameters. The measurements included anthropometry; body composition indicators (using both deuterium dilution and BIA); haematology and biochemical markers; as well as incidence rates of opportunistic infections and clinical disease progression. Breastmilk was analysed for both macro and micronutrients. Cervical screening was offered to all the women. Results: AFASS criteria were fulfilled by 38.7% of the formula feeding mothers. No significant differences between the formula feeding and breastfeeding groups in terms of haematological, immunological and body composition changes were seen. Breastfeeding mothers had significantly lower events with high depression scores (p=0.043). Longer duration of breastfeeding was observed to be significantly associated with a mean increase in CD4 count (74 cells/μL) and better health outcomes. The supplement made no significant impact on any maternal or child outcomes except for a limited effect on mothers with low BMI, where it was significantly associated with preventing loss of lean body mass (p=0.026). Breastfeeding infants had a significantly lower risk of diarrhoea and hospitalisation at 3 months (p=0.006 and 0.014 respectively). Both breastfeeding and longer duration of breastfeeding was significantly associated with better development scores and growth parameters. Supplementation made no impact on breastmilk composition. Of the 86 mothers who agreed for cervical screening, 27.6% had human papilloma virus infection. Conclusions: Breastfeeding is not harmful to the mother despite the presence of HIV infection. On the contrary we observed both breastfeeding and longer breastfeeding duration to be associated with better maternal and child outcomes. Mothers are still choosing formula feeding inappropriately presumably because of the availability of free formula and/or sub-optimal counseling. The new (2010) local PMTCT guidelines based on WHO recommendations should reverse this. Food insecurity was prevalent amongst 32% of our study population, highlighting the need to include sustainable and empowering solutions to encounter this problem. Less sustainable solutions such as nutritional supplementation should be targeted to the malnourished and in emergency situations. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.

Background and Objectives The improved uptake of antenatal Opt-out testing has been documented internationally. In South Africa little is known about the efficiency and die acceptability of Opt-out testing. This study compared VCT with Opt-out testing by measuring the efficiency (defined as uptake of testing, number of women identified as HIV positive and consultation duration of the testing approach) and the acceptability to patients and staff. Methodology We conducted a prospective, quasi-experimental equivalent time-samples clinical trial in which we enrolled a consecutive sample of women who presented at die McCord Hospital antenatal clinic from June to August 2006. The study consisted of 2 phases. During the 6 week intervention period women were offered HIV testing with the Opt-out mediod. During die 6 week control period women were offered midwife-provided VCT. Efficiency was measured in each phase, with 150 participants in the VCT arm and 150 in die Opt-out arm. Participants also completed a survey questionnaire. In depth interviews were conducted with 9 purposefully selected participants from each arm. Two focus group discussions were held with staff. The staff focus group findings were followed-up and validated by conducting in-depdi interviews with die staff members who participated in die focus groups 18 mondis later. Results The uptake of HIV testing during the VCT period was 134/150(89.3%) compared to 147/150(98.0%) in die Opt-out period (p<0.001). The percentage of women identified as being HIV positive during the VCT period was 7.33% (11/150) vs. 12.6% (19/150) during the Opt-out period (p=0.133). Time was saved as a decrease in the duration of midwife consultations from 34 min (VCT) to 26 min (Opt-out) was found with p<0.001. Qualitative analysis revealed Opt-out testing to be an acceptable way of testing. Patients found Opt-out emotionally less distressing than VCT (p<0.05). Staff reported that Opt-out decreased the burden on human resources (only one person needed to facilitate the group and shorter consultations) while it identified more women infected with HIV. Conclusion Opt-out testing is significantly more efficient and acceptable than VCT. Opt-out testing should include a group pre-test information session, adequate and ongoing post-test counselling, to be effective and acceptable. / Thesis (M. Med.)-University of KwaZulu-Natal, Durban, 2008.

This study focuses on women with both pre-eclampsia and Human Immunodeficiency Virus (HIV). Pre-eclampsia is a pregnancy-specific syndrome that occurs after 20 weeks gestation. Thrombocytopenia is the most common haematological abnormality in pre-eclampsia. Further, studies suggest that the immunological mechanism plays some role in the aetiology of pre-eclampsia. The immunological hallmark of HIV infection is a progressive decline in the number of CD4 T lymphocytes and significant haematological abnormalities are also common in HIV-infected individuals i.e. anaemia, thrombocytopenia and leukopenia. The study population comprised of two groups i.e., pre-eclamptic HIV-positive African women and preeclamptic HIV-negative African women as the control group. Samples were analysed for haematological parameters (full blood count) and immunological markers (flow cytometry). There was no statistical significance in the following parameters: RBC, Hb, haematocrit, MCV, MCH, MCHC, platelets, MPV, WBC, lymphocytes, neutrophils, eosinophils, monocytes, basophils and CD8. There was a statistical difference in the CD3 and CD4 counts between both the groups. However, the CD3 and CD4 counts were within the normal range in the HIV-negative pre-eclamptic group and even though CD3 decreased, it was still within the normal range in the HIV-positive pre-eclamptic group, with CD4 decreasing below the normal range in the HIV-positive pre-eclamptic group. This suggests that immune mechanisms involving CD estimations do not play a role in pre-eclampsia since the decrease in the counts can be solely attributed to HIV infection. Results obtained in this study do not show any severe haematological or immunological abnormalities when women have both pre-eclampsia and HIV infection. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2007.

Background: The HIV epidemic has greatly affected sub-Saharan Africa, with the highest prevalence in the world found in Swaziland. One in three pregnant women in Swaziland has HIV. One of the PMTCT strategies is primary prevention of HIV among women who are uninfected. Understanding the reasons why pregnant women continue to seroconvert is the key in meeting this strategy. Purpose: The purpose of this study is to determine the factors associated with seroconversion among pregnant women utilizing Raleigh Fitkin Memorial Hospital in 2012. Objectives: The objectives of this study are to: determine the proportion of HIV non-infected pregnant women who are retested for HIV during pregnancy; determine the gestational age at which pregnant women are retested for HIV; establish the proportion of women who were initially HIV non-infected and seroconverted during pregnancy; and establish the factors associated with seroconversion during pregnancy. Methods: An observational cross-sectional study design with both descriptive and analytic components was carried out at Raleigh Fitkin Memorial Hospital. Systematic sampling was used for the recruitment of 381 pregnant women who were initially HIV non-infected. An interviewer-administered questionnaire and chart review were used to collect demographic and clinical data. The data was analyzed using descriptive and analytic statistics. Results: The results of the study show that demographic factors such as age and educational level are associated with HIV seroconversion during pregnancy. The findings also highlight how partner factors play a role in HIV seroconversion. The results indicate that sexual behaviours 333of the pregnant women contribute greatly to HIV seroconversion. Conclusion: Pregnant women continue to engage in risky sexual behaviours during pregnancy and there is need to strengthen counseling on preventive measures throughout the antenatal care period. There is also need for programs to explore possibility of providing antiretroviral drugs for pre-exposure prophylaxis to all HIV negative women during pregnancy. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

HIV and AIDS is still a major problem especially in Sub Saharan Africa. The levels of new infections are still relatively high which implies that the numerous national and international efforts to curb the transmission of HIV are not having the desired effect. Furthermore, the accelerated rate of teenage pregnancy is also indicative of the failure of these efforts. The high teenage pregnancy rate suggests that many teenagers do not practise safe sex. This could be attributed to the many pressures teenagers experience regarding sex and sexuality. Teenage mothers are likely to experience the same or double, the pressure and I was curious to understand their stance on unsafe sex practises especially after having a baby. This research study elicits an understanding of how these young mothers construct, present and negotiate their sexuality within the context of the HIV and AIDS pandemic. Issues of sex and sexuality in relation to gender roles, gender identities, constructions of sexuality and teenage motherhood were investigated. The findings reveal two key points: regret inspires determination to succeed and that love and romance are dominant discourses in the construction of sexual risk among teenage mothers within the context of the HIV and AIDS pandemic. All the teenage mothers in this research study indicated that completion of their studies should have taken priority to motherhood. Even though most of the participants in this study acknowledge that love and romance are essential, they are now more cautious and either abstains from sex or practise safe sex. This research study has found that the hardship and responsibilities associated with motherhood have served to motivate these participants to change their risky sexual behaviour and verifies Burr’s (2003) social constructionist perspective by showing how identity is fluid and context dependent, relying on social interactions and experiences. / Theses (M.Ed.)-University of KwaZulu-Natal, Durban, 2012.

The focus of this thesis is to look at breastfeeding patterns in KwaZulu-Natal province, South Africa in relation to HIV infected women, who as mothers may, transmit the HIV virus to their child. It seeks to understand in depth the social context of HIV and AIDS in the time of the AIDS pandemic looking at gender culture; powerlessness of women in households in society. These dynamics occurring at such a crucial time and moment of this spiral explosive epidemic reflects a more broader concerted effort to understand and find solutions. This study emerges from a larger research project conducted under the auspices of the Medical Research Council, which was examining the transmission rates of HIV infection in babies born to HIV positive woman for a period of six months, on breastfeeding having given these women nevirapine as well. The study was HIVNET 023, which looked at the use of NVP that was given to breastfed infants in order to reduce MTCT of HIV, Phase 1,11 Study. This work was conducted from 2000 and completed in 2001. This thesis seeks to further explore challenges experienced by these breastfeeding HIV positive women in the public domain (i.e. in the clinics, hospitals as well as in communities), and how these challenges impinge in their daily lives as women. Issues of gender inequality, the social context of culture in the midst of a health crisis, and suggestions for change in the context of clinical practice, make up the bulk of the thesis argument. / Thesis (M.A.)-University of Kwazulu-Natal, 2003.

Assignment (MMed)--University of Stellenbosch, 2006. / Bibliography. Also available via the Internet.

Thesis (M.A.)--University of Toronto, 2005. / Includes bibliographical references (leaves 175-187).