Thesis (M. Tech.) - Central University of Technology, Free State, 2009

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. / Systematic Theology & Theological Ethics / M.Th. (Theological Ethics)

The study sought to explore and describe the breastfeeding practices of Human Immunodeficiency Virus (HIV) positive postnatal clients’ non-commitment to exclusive breastfeeding in George Mukhari Hospital, South Africa. A non-experimental quantitative design was used. Inferences drawn from the study were that HIV positive clients that opted for exclusive breastfeeding did not commit for fear of transmission of HIV to the baby and exclusive breastfeeding was stopped before the recommended 6 months. Most of the respondents’ partners did not come for counselling. There was lack of emotional support by staff after testing. Health education and emotional support of HIV positive clients has to be intensified. / Health Studies / M. A. (Health Studies)

Thesis (MPhil (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The research was conducted to explore the experiences of people living with Acquired Immunodeficiency Syndrome (AIDS) (PLWAs), especially women, as well as the factors influencing their non-participation in development projects aimed at improving their socio-economic status. The study was conducted amongst PLWAs who are members of the Tembisa Main Clinic and Winnie Mandela Clinic support groups in Tembisa, South Africa. The researcher was motivated to conduct the research because in her work as a social worker she is confronted daily with PWLAs who are from disadvantaged backgrounds and are struggling to make ends meet. Initiatives have been undertaken to try and encourage self–reliance and improve the health status of these women by developing food gardens to provide them with fresh vegetables and possible income sources from these gardens. The reluctance of members of two support groups of PLWAs to stay involved in these projects encouraged the researcher to explore these issues. The researcher consulted various sources to obtain literature on the factors influencing non-participation in development projects. In addition she undertook a qualitative study, wherein twenty participants participated. The data from this study was then interpreted and compared to the literature. The findings of this study highlighted several factors such as discrimination, local beliefs, stigma and lack of support, which influence the non- participation of PWLAs in sustainable development projects. The findings of this research also indicate that developments projects often fail to thrive because of topdown decisions about the projects, the fact that there is no start-up funding available for the projects and participants who become demotivated to participate. The research therefore concludes with recommendations in order to address these problems. / AFRIKAANSE OPSOMMING: Die navorsing is onderneem om die ondervinding van mense, veral vroue, wat met Verworwe Immuniteitsgebrek Sindroom (VIGS) lewe, te ondersoek, asook die faktore wat hulle daarvan weerhou om deel te neem aan ontwikkelingsprojekte wat daarop gemik is om hul sosio-ekonomiese status te verbeter. Die studie is onderneem onder pasiënte wat lede was van ondersteuningsgroepe by Tembisa Hoofkliniek en Winnie Mandela Kliniek in Tembisa, Suid-Afrika. Die navorser is gemotiveerd om die studie te onderneem omdat sy daagliks in haar werk as sosiale werker gekonfronteer is deur mense wat met VIGS lewe, wat uit minder bevoorregte agtergronde kom en wat sukkel om te oorleef. Inisiatiewe is onderneem om hierdie vroue se selfstandigheid te bevorder en om hul gesondheidstatus te verbeter deur groente tuine te ontwikkel om hulle van vars groente te verskaf, asook moontlike inkomstebronne uit hierdie tuine. Die onwilligheid van die lede van twee ondersteuningsgroepe om in hierdie projekte betrokke te bly, het die navorser aangemoedig om hierdie aangeleentheid verder te ondersoek. Die navorser het verskeie bronne geraadpleeg om literatuur te verkry oor die faktore wat die nie-deelname in ontwikkelingsprojekte beïnvloed. Sy het ook kwalitatiewe studie onderneem waaraan twintig respondente deelgeneem het. Die data van hierdie navorsing is daarna geïnterpreteer en met die literatuur vergelyk. Die bevindinge van hierdie navorsing het verskeie faktore uitgelig wat die niedeelname beïnvloed van mense wat met VIGS lewe, soos diskriminasie, plaaslike gelowe, stigma en gebrek aan ondersteuning. Die navorsing het ook bevind dat ontwikkelingsprojekte dikwels nie floreer nie as gevolg van die ‘topdown’ besluitneming oor die projekte en omdat daar nie genoegsame vooraf befondsing beskikbaar is vir die projekte nie en die deelnemers dus demotiveer om verder deel te neem. Die navorsing sluit dus af met voorstelle om hierdie probleme aan te spreek.

Recent studies reflect increasing levels of HIV infection amongst married women in sub-Saharan Africa. The institution of marriage, which is highly revered within the church and society, is thus now regarded as a 'potential death trap' for many married women. This study examines the drivers of these increasing levels of HIV infection amongst married women in sub-Saharan Africa. It offers a critical reflection of the socio-cultural factors and gender-insensitive theological traditions that expose married women to the vulnerability of HIV infection. In order to observe the sacrosanctity of the marriage institution as well as preserving the dignity of life for many married women in sub-Saharan Africa, the study presents the imago Dei theological motif as a gender-sensitive theological response to the increasing levels of HIV infection among married women. The imago Dei theological motif argues that both men and women equally reflect the divine image of God. This theological motif also brings to the fore the realization that HIV and AIDS is fuelled by conditions of inequality, socio-economic and socio-cultural discrimination, hence the need to promote human dignity for both men and women within our communities in sub-Saharan Africa. Furthermore, emanating from the imago Dei theological motif, the study offers a bold community praxis through the transformation of gender-insensitive theological traditions; the transformation of hegemonic masculinities; and the transformation of gender-insensitive HIV prevention models as practical ways aimed at redressing the vulnerability of married women to the increasing levels of HIV infection. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

The study sought to explore and describe the breastfeeding practices of Human Immunodeficiency Virus (HIV) positive postnatal clients’ non-commitment to exclusive breastfeeding in George Mukhari Hospital, South Africa. A non-experimental quantitative design was used. Inferences drawn from the study were that HIV positive clients that opted for exclusive breastfeeding did not commit for fear of transmission of HIV to the baby and exclusive breastfeeding was stopped before the recommended 6 months. Most of the respondents’ partners did not come for counselling. There was lack of emotional support by staff after testing. Health education and emotional support of HIV positive clients has to be intensified. / Health Studies / M. A. (Health Studies)

Introduction. Previous studies have established that infants born to mothers with advanced HIV disease and co-infections are smaller, premature and have rapidly progressive HIV disease and an early death. King Edward VIIIth Hospital, in Durban, admits many sick mothers and manages a large proportion of low birth weight and ill newborns. On discharge and follow-up, the mortality and morbidity of these infants are known to be high and are related to the prematurity. How much is related to being HIV exposed is still uncertain. Aim. To determine the perinatal transmission rate of HIV-1 and mortality at 12 months in HIV exposed infants that were admitted to and discharged from the Neonatal Unit, in Durban, South Africa. Methods. In this observational study, data from the outpatient charts of HIV exposed infants that required specialised neonatal care and subsequent follow up, between the period November 2007 and December 2009, were collected. Perinatal transmission rates and mortality of these infants were compared with maternal and infant risk factors. Results. Data on 463 HIV exposed, predominantly low birth weight infants are presented. The median maternal CD4 count was 309cells/mm3 with 16.8% of mothers commenced on HAART. Maternal co-infection with TB was found in 19.2% of the cohort. Early HIV transmission occurred in 11.5% of infants and was influenced by the type of ARV exposure (None, 20%; single dose NVP, 14.3%; dual therapy, 10.6%; maternal HAART, 8.5%). The dual therapy regimen for 7 days was more protective than that for 28 days (p=0.045). HIV infection was associated with higher risk of neonatal sepsis (RR 1.6; 95% CI, 1.1-2.3; p=0.015). The mortality for the cohort at 12 months was 10%. Maternal HAART was associated with a lower mortality: 2.95% vs.10.2% (RR 3.0; 95% CI, 0.4-20.5). There was a higher mortality rate in those that were low birth weight (RR 4.2; 95% CI, 1.02-18.8; p=0.037); those that were HIV infected (RR 4.8; 95% CI, 1.9-11.6; p=0.002) and those that were breastfeeding compared to formula feeding (RR 2.7; 95% CI, 1.1-6.8; p=0.038). Discussion. Rates of HIV transmission within the PMTCT programme were similar to that reported by the Department of Health. Early maternal ARVs for PMTCT prophylaxis, prevents HIV transmission. The coverage of maternal HAART was sub-optimal. Breastfeeding was associated with a higher HIV transmission rate and was most likely associated with non-exclusive breastfeeding during neonatal admission. Recommendations. Maternal HAART or ARV prophylaxis should be commenced early in the pregnancy for the best benefits. Meticulous attention should be paid to the feeding practices of high risk HIV exposed infants admitted for specialised neonatal care. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.

The prevalence and the incidence are two primary epidemiological parameters in infectious disease modelling. The incidence is also closely related to the force of infection or the hazard of infection in survival analysis terms. The two measures carry the same information about a disease because they measure the rate at which new infections occur. The disease prevalence gives the proportion of infected individuals in the population at a given time, while the incidence is the rate of new infections. The thesis discusses methods for estimating HIV prevalence, incidence rates and the force of infection, against age and time, using cross-sectional seroprevalence data for pregnant women attending antenatal clinics. The data was collected on women aged 12 to 47 in rural KwaZulu-Natal for each of the years 2001 to 2006. The generalized linear model for binomial response is used extensively. First the logistic regression model is used to estimate annual HIV prevalence by age. It was found that the estimated prevalence for each year increases with age, to peaks of between 36% and 57% in the mid to late twenties, before declining steadily toward the forties. Fitted prevalence for 2001 is lower than for the other years across all ages. Several models for estimating the force of infection are discussed and applied. The fitted force of infection rises with age to a peak of 0.074 at age 15, and then decreases toward higher ages. The force of infection measures the potential risk of infection per individual per unit time. A proportional hazards model of the age to infection is applied to the data, and shows that additional variables such as partner’s age and the number of previous pregnancies do have a significant effect on the infection hazard. Studies for estimating incidence from multiple prevalence surveys are reviewed. The relative inclusion rate (RIR), accounting for the fact that the probability of inclusion in a prevalence sample depends on the individual’s HIV status, and its role in incidence estimation is discussed as a possible future approach of extending the current work. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The study sought to answer the question, what are the reasons for low utilization of long acting contraceptives among HIV positive women attending the Harare Post-test support services clinic. The study was conducted at Harare Post-test support services clinic from September to December 2012. Data was collected using respondent administered questionnaires. A sample of 30 respondents was used for the study. After data collection, data was grouped, analysed and presented in the form of tables, figures, charts and descriptive statistics. The major findings from the study were that the majority of the women who attend the Harare Post-test support services clinic are within the age groups 35-49yaers. Most of the women are not using and modern contraceptive method. Condoms are used by 17% of the respondents and the long acting contraceptives, Jadelle and IUCD and used by a very low number of women attending the clinic. Fear of side effects is one of the reasons why the women are not suing long acting contraception. Most of the women know that the Jadelle and IUCD are long acting methods of contraception which prevents unintended pregnancy for up to five years for Jadelle and up to ten years for the IUCD. The long acting contraceptives are not available at the post test-support services clinic since the set-up of the clinic is not ideal for the provision of these services, women who need the methods are refereed outside the clinic were the cost to access the services is not affordable for most of the respondents. The conclusion drawn from the study is that women living with HIV have limited knowledge and access the long acting contraceptives at Harare Post-test support services clinic hence are not utilizing the methods. The researcher recommends that all women attending the clinic should be educated on the benefits of using dual protection to protect against unintended pregnancy as well as HIV transmission. A proper referral system should be established so that women referred to other service providers do not pay extra fees to access family planning services at the referral centres. Any IEC material should address the myths and fears related to use of long acting contraception by HIV positive women. The young age group below 35years should also be encouraged to access family planning services through the Post-test support services clinic. / AFRIKAANSE OPSOMMING: Die doel van die studie was om te bepaal wat die redes is vir die lae gebruik van langwerkende voorbehoeding onder MIV positiewe vroue wat die Harare Post-test ondersteuningsdienste kliniek besoek. Data is deur middel van vraelyste onder 30 deelnemers ingesamel. Die resultate het getoon dat die meerderheid van vroue wat die kliniek besoek het tussen die ouderdomme van 35 en 49 was. Meeste van hulle gebruik nie moderne voorbehoeding nie, slegs 17% het aangedui dat hul kondome gebruik. Die langwerkende voorbehoeding Jadelle en IUCD word deur min die van vroue gebruik. ‘n Vrees vir die nadelige uitwerking daarvan is een van die redes waarom hul nie die voorbehoeding gebruik nie. Meeste van die vroue is bewus dat Jadelle en IUCd langwerkede metodes is wat swangerskap voorkom en dat Jadell tot 5 jaar werk en IUCD tot 10 jaar effektief kan wees. Die langwerkende metodes is egter nie by die kliniek beskikbaar nie en vroue wat die metodes verkies word na ander diensverskaffers verwys waar wat vir meeste van die vroue nie bekostigbaar is nie. Daar kan dus van die studie afgelei word dat MIV positiewe vroue beperkte kennis en toegang rakende die langwerkende voorbehoeding het en daarom nie die metodes ten volle benut nie. Die navorser beveel aan dat alle vroue wie die klinkiek besoek ingelig moet word oor die voordele van die tweeledige vorm van beskerming, nie net teen swangerskap nie maar ook teen MIV-infeksie. ‘n Verwysingstelsel moet in plek gestel word sodat die vroue wat na ander diensverskaffers verwys word nie nodig het om ekstra daarvoor te betaal nie. Daar word verder ook voorgestel dat die klinkiek meer inligtig rakende die langwerkende voorbehoeding beskikbaar stel en ook gesinsbeplanningsdienste aanbied.

My focus in this research study is the understanding that young Indian women have of risky sexual behaviour within the context of HIV and AIDS. The main objective of this study is to understand how young Indian women perceive themselves as sexual beings and how aware they are about the HIV and AIDS virus. The influencing factors in my embarking on a study of this nature are two-fold. Firstly, the literature on sexuality of Indian women is limited. According to Bhana and Pattman (2008) the Indian community is not regarded as being problematic therefore not much is known or done with regard to Indian sexualities. Secondly my interest in conducting this research and focusing on young Indian women is that there now appears to be an increase in the number of young Indian women who are indulging in risky sexual behaviour at very early stages in their lives. I have purposefully selected six young Indian women based on their age group which is between 16 - 17, as well as from a specific context which is a secondary school in Phoenix. The sample group is not fully representative of all 16 and 17 year olds but has the potential to provide invaluable information and insight into how young women develop their sexual identities especially within the context of HIV and AIDS. The qualitative research method approach was employed as it provided me with the opportunity to comprehend how these young women understand sexual risk and the reasons why they would engage in risky sexual behaviour. The research design employed was a focus group interview with a 90 minute interactive session as well as individual interviews for each participant which lasted about 60 minutes. My findings reveal that Indian women are agentic and that there are a number of factors that influence and contribute towards an increase in the number of Indian women who are engaging in risky sexual behaviour and becoming sexually active at ages that do not prepare them for the negative consequences of risky sexual behaviour. / Thesis (M.Ed.)-University of KwaZulu-Natal, Durban, 2012.