<p>Disclosure of HIV positive status to male partners is well established as a key element in the success of prevention of mother to child transmission of HIV programmes, as it helps improve adherence to ARVs by the women within these programme. However, partner notification rates remain low in the urban areas of Lusaka, Zambia against a high HIV prevalence of 25%. The purpose of this study was to explore the timing of disclosure as part of the process of disclosure amongst women who were part of the PMTCT services at Kaulu health centre in Lusaka. An exploratory descriptive study using qualitative research methods was conducted. 15 women, who were attending the Kaulu health centre PMTCT programme, were requested to participate in a semi-structured interview. The women, who were purposively selected with the aid of the health centre‟s PMTCT focal point nurse, had to have disclosed their HIV positive status to their partner, either before or during the course of their pregnancy or after delivery. To increase rigour,&nbsp / individual interviews were conducted with 5 health workers associated with the PMTCT programme so as to obtain their perspective and experiences on the issue of HIV disclosure amongst their PMTCT patients. Participation in the study was voluntary and all information obtained during the course of the interviews remained confidential and secure. Potential participants were each provided with an explanation of the purpose and process of the study and their informed written consent obtained before the researcher embarked on the interviews. Content analysis of the transcripts was done so as to develop coding categories and identify emerging themes. Disclosure to male partners is an important step in PMTCT and facilitates adherence to HIV care for the family and should be done as early as possible after the woman receives her HIV test result, though there exists a range of alternative times when it can be done. The relationship existing between a couple is very important in determining the timing of when a woman chooses to disclose. PMTCT services need to provide ongoing counselling for HIV positive women during pregnancy and after giving birth that supports, informs and equips them with the necessary skills to make an informed and timely decision about disclosure to a partner. In addition, the PMTCT service providers need to be encouraged to implement couple counselling as a strategy to facilitate disclosure as well as establishment of a peer support network for HIV positive pregnant women. The study findings will be used to contribute to health workers‟ capacity to support women manage the disclosure process to their male partners, thus helping to increase the disclosure rate and also contributing to improving the positive effect of the PMTCT services, in Lusaka, Zambia</p>

<p>Disclosure of HIV positive status to male partners is well established as a key element in the success of prevention of mother to child transmission of HIV programmes, as it helps improve adherence to ARVs by the women within these programme. However, partner notification rates remain low in the urban areas of Lusaka, Zambia against a high HIV prevalence of 25%. The purpose of this study was to explore the timing of disclosure as part of the process of disclosure amongst women who were part of the PMTCT services at Kaulu health centre in Lusaka. An exploratory descriptive study using qualitative research methods was conducted. 15 women, who were attending the Kaulu health centre PMTCT programme, were requested to participate in a semi-structured interview. The women, who were purposively selected with the aid of the health centre‟s PMTCT focal point nurse, had to have disclosed their HIV positive status to their partner, either before or during the course of their pregnancy or after delivery. To increase rigour,&nbsp / individual interviews were conducted with 5 health workers associated with the PMTCT programme so as to obtain their perspective and experiences on the issue of HIV disclosure amongst their PMTCT patients. Participation in the study was voluntary and all information obtained during the course of the interviews remained confidential and secure. Potential participants were each provided with an explanation of the purpose and process of the study and their informed written consent obtained before the researcher embarked on the interviews. Content analysis of the transcripts was done so as to develop coding categories and identify emerging themes. Disclosure to male partners is an important step in PMTCT and facilitates adherence to HIV care for the family and should be done as early as possible after the woman receives her HIV test result, though there exists a range of alternative times when it can be done. The relationship existing between a couple is very important in determining the timing of when a woman chooses to disclose. PMTCT services need to provide ongoing counselling for HIV positive women during pregnancy and after giving birth that supports, informs and equips them with the necessary skills to make an informed and timely decision about disclosure to a partner. In addition, the PMTCT service providers need to be encouraged to implement couple counselling as a strategy to facilitate disclosure as well as establishment of a peer support network for HIV positive pregnant women. The study findings will be used to contribute to health workers‟ capacity to support women manage the disclosure process to their male partners, thus helping to increase the disclosure rate and also contributing to improving the positive effect of the PMTCT services, in Lusaka, Zambia</p>

Introduction: Little guidance is given to health professionals over how to deal with HIV disclosure complexities in the biomedical setting. Given the paucity of related research in this context, there is also little consideration of the actual effect of HIV disclosure in a given context. Social constructionist theory is an important contribution to disclosure research because it shifts the focus from a biomedical perspective to one that incorporates an individual's experience with HIV infection in a specific context. The task of this study was to develop substantive theory, with the aim of providing a theoretical framework for public health and health care practitioners to better understand HIV disclosure dynamics in the PMTCT setting. Methods: This was a qualitative study which explored the experience of disclosure amongst HIV positive pregnant women in the PMTCT context. Between 5 June – 31 November 2008, a total of 62 participants were recruited from two urban-based PMTCT programmes located within the eThekwini District, KwaZulu-Natal, South Africa. Results: Participants disclosed to two main groups: sexual partners, and family/others. Structural and relationship network factors shaped transmission risk behaviour, subsequent disclosure behaviour and outcomes. The circumstances which placed participants at risk for HIV acquisition also affected the likelihood of disclosure and health behaviour change. HIV and pregnancy diagnoses often occurred concurrently which profoundly impacted on participant's social identities and disclosure behaviour. Current HIV testing protocols within PMTCT settings often recommend disclosure to sexual partners under the assumption that couples will engage in safer behaviours, yet findings from this study indicate that this assumption should be challenged. Discussion: The study findings are synthesized in a conceptual model which offers substantive new theory over the concepts and interrelated factors that were identified to shape HIV disclosure and outcomes in the PMTCT context. The model identifies the following domains: 1) social networks and social support; 2) identity; 3) risk behaviour; 4) HIV and pregnancy diagnoses; and 5) HIV disclosure process to partners and others. Recommendations: Assumed pathways to risk reduction and HIV prevention need to be relooked and reconsidered. The conceptual model provides a proposed framework for future research, intervention design and implementation planning in the PMTCT setting. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.

Background: Prevention of Mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) remains a significant challenge in resource-poor settings despite the advances in antiretroviral (ARV) treatment. HIV-1 infected individuals are able to achieve viral control naturally, however the underlying mechanisms of immunological control in children remains poorly understood. This study was conducted from 2006 to 2010 to investigate correlates of immune control in HIV-1 clade C infected mother-child pairs in the absence of ARVs. Genotypic and phenotypic viral characteristics, cellular immune responses to HIV-1 and host genetics were characterized and correlated with clinical markers of disease progression. Materials and Methods: To achieve the objectives of the study, three cohorts of mother-child pairs were investigated. The first cohort included 60 untreated mother-child pairs and a further ten uninfected children as controls. The second cohort comprised of ARV treated pairs (n=60). The third cohort consisted of 374 mothers and 374 children (infected, exposed uninfected, HIV negative). Plasma viral loads and absolute CD4+ T cell counts were routinely performed in all three cohorts. HIV-specific CD8+ T cell responses were analyzed by interferon gamma (IFN-γ) enzyme linked immunosorbent spot (ELISpot) assays. Viral replicative fitness was assessed using a green fluorescent protein reporter cell line (GFP).Multi-parameter flowcytometry allowed for the investigation of T cell regulation, exhaustion and activation using CD127/CD25, TIM-3/PD-1 and HLA-DR/CD38 markers respectively. IL-10 promoter single nucleotide polymorphisms (SNPs) at positions -592 and -1082 were determined by TaqMan allelic discrimination assays. Plasma IL-10 levels were measured using a luminex assay. Results: To describe the CTL responses elicited to various regions of the HIV proteome in HIV-infected treatment naïve children. Sixty children under one year of age in the untreated cohort were analyzed for CTL responses spanning the HIV genome, for which only 30 had detectable responses. There was no significant difference in viral load between respondersand non-responders (p=0.2799). The responders predominantly targeted Nef (49%), Gag (17%) and Env (14%) regions. Markers of T cell exhaustion and regulation and theirrelationship to markers of disease progression, were next investigated as these parameters may explain the inability of T cells to effectively control HIV infection. T cell phenotyping compared treated, untreated and uninfected subgroups. In infected children, CD8+ T cells were significantly higher for both the inhibitory marker TIM-3 (p=0.001) and exhaustion marker PD-1 (p=0.0001) compared to uninfected children. Median expression of TIM-3 was higher on CD8+ T cells (46%) compared to CD4+ T cells (20%). TIM-3 and PD-1 expression on T cells were maintained at high levels over time. The frequency of absolute Tregs (p=0.0225) were found to be significantly higher in untreated compared to treated children. HLA-DR+CD38+ on CD8+ T cells were significantly up-regulated in untreated children compared to treated (p=0.002) and uninfected children (p=0.0177). HLA-DR+CD38+ was also significantly higher in children less than 6 months compared to older children on CD4+ (p=0.0437) and CD8+ T cells (p=0.00276). Interestingly, we observed a significant negative correlation between magnitude of CTL response and CD25+CD127- (p=0.0202; r=-0.7333) as well as HLA-DR+CD38+ (p=0.0408; r=-0.5516) on CD8+ T cells. IL-10 is an important immunoregulatory cytokine that has been shown to affect the outcome of chronic viral infections. IL-10 polymorphisms have previously been associated with IL-10 levels and HIV-1 outcomes in adults. Polymorphisms associated with different levels of IL-10 production and their relationship with transmission, markers of disease progression and immune responses were next investigated in this mother-child HIV transmission setting. Genetic analysis of IL-10 in cohort three revealed that HIV-1 acquisition was not associated with either IL10 -592 (AA/CA vs CC) or IL10 -1082 (AA/AG vs GG) single nucleotide polymorphisms (SNPSs). There was a significant association between IL10 -1082 and HIV-1 transmission (p=0.0012). No correlation was observed between IL10 -592 (p=0.4279) or IL10 -1082 SNPs (p=0.6361) and mortality rates in children. IL10 -592C was associated with an elevated magnitude of IFN-γ CD8+ T cell response compared to IL10 -529A (p=0.0071). We found a significant positive correlation between IL-10 plasma levels and viral loads (p=0.0068; r=0.4759) and the ages of the children (p=0.0312; r=0.1737). Conclusion: CD8+ T cell responses and viral fitness did not explain differences in disease progression in selected HIV-1 untreated clade C transmission pairs. T cell activation and regulatory markers influence CTL immune responses resulting in poor clinical outcome. IL10 -1082 polymorphisms may be used as a predictor of HIV-1 transmission. The association between increased IL-10 plasma levels and high viral loads suggest that IL-10 contributes to immune dysfunction in paediatric HIV-1 infection. This study has extended our understanding of immunological and genetic correlates of mother-to-child transmission and disease outcome in ARV naïve (naturally controlling) and HIV treated infected children. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.

My study is an exploration of four women educators' experiences of living "openly" with HIV in their respective workplaces. All four women were from the different geographical demarcations ofthe Ethekweni region. I used in-depth interviews , as outlined by Seidman (1999), to learn more about the experiences of the four women. The key findings of my study were (l) the evidence of HIV/AIDS-related stigma and discrimination against people living with HIV, (2) the inclusion of people living with HIV, shown by employers and colleagues and (3) the emergence of a new generation that is better informed, receptive and supporti ve of people living with HIV. / Thesis (M.Ed.) - University of Kwazulu-Natal, 2005.

All over the world HIV/ AIDS has created a new stigma and discrimination, bigotry and ignorance that have resulted in a new class of outcasts. AIDS 2000 will break the silence on this affront to human dignity. This was the theme of the XIII Annual AIDS Conference held in Durban in 2000. Fours years later, there is little evidence of this reality. There are communities of people living with HIV/ AIDS that still live lives cloaked in secrecy. HIV/ AIDS is not losing momentum. HIV/ AIDS has infected 50 million, and killed 16 million since the epidemic began (The Mercury,19 May 2000). In Africa, HIV positive women now outnumber infected men by two million. Recognition of the potentially devastating effects the disease could have, took place very slowly, in Africa. It is only since the middle to late nineteen eighties that a general understanding has established itself in society of how imp ortant the fight against HIV/ AIDS will be. In South Africa the dramatic transition to democracy in the early nineteen nineties meant that political considerations had to be given priority. In 1997, the KwaZulu Natal (KZN) cabinet launched an initiative to bring public attention to the effects the epidemic would have on our society. In 1999 this was followed up with the Cabinet's AIDS Challenge 2000 strategy which was to have been be funded to the extent of R20 million per year (The Mercury, 19 May 2000). HIV / AIDS has established itself at pandemic levels in the province of KZN (The Mercury, 19 May 2000). Uno fficial figures of people living with HIV/ AIDS stand at 40%. This has huge implications for education as it is stated that there will be at least 750 000 orphans- children with no parents in KZN by 2010 (The Mercury, 19 May 2000). This means that educators who are already burdened with responsibility will have to respond in direct and indirect ways to the pandemic. The researcher in this study has lived in Umhlatuzana, a suburb on the outskirts of Chatsworth for the past twenty years. I teach History and Life skills at a secondary school in Chatsworth. Since the introduction of Outcomes Based Education in 2000, HIV/ AIDS has become a part of the Life Orientation programme. My interest in HIV/ AIDS grew with the launch of the Government initiated Tirisano project - an HIV/ AIDS awareness initiative . As HIV-AIDS coordinator, my duties included teaching learners about HIV/ AIDS awareness and about the causes and prevention of HIV/ AIDS through responsible behaviour. Accordingly, I have set up a school HIV/ AIDS committee made up of both learners and staff, drafted and implemented a School AIDS Policy and held workshops at school. As the HIV/ AIDS coordinator I have attended many training workshops and seminars in and around Chatsworth. This exposure to issues concerning HIV/ AIDS, together with available literature has led me to conclude that HIV/ AIDS is still very much a taboo subject, even among so called 'enlightened educators'. Due to the scarcIty of available literature regarding Indians! living with HIV/ AIDS and according to The Mail and Guardian, because media representations and billboards depict Black, White or Coloured but no Indian repr esentations of people living with HIV/ AIDS, many Indians still think that it is someone else's disease, or 'that sickness' (02 December 2003). While stud ying the module 'Diversity and Education' at Masters level, I began to understand that being an HIV/ AIDS coordinator was much more than teaching learners about HIV / AIDS awarene ss of prevention and modes of transmission. The module 'Diversity and Education' was designed to develop a deeper understanding of the critical issues and skills required to create safe and inclusive schools for learners and educators who are living with and are affected by HIV/ AIDS. Through the Diversity and Education module I developed a raised understanding of the negative impact of HIVism on the lives of people living with HIV/ AIDS. According to Francis, HIVism refers to the negativetreatment meted out to people living with HIV/ AIDS (2004). Altho ugh the Department of Education has to be applauded in creating an awareness of the epidemic, there is concern that an important area of HIV/ AIDS has been neglected: The issues regarding human rights and HIV/ AIDS. It was especially during the Diversity and Education sessions togeth er with related literature that I discovered that globally, many women have negative experiences of living with HIV/ AIDS. An article that appeared in the Sunday Tribune, Herald (07 December 2003) prompted my research . It was a stolY of an Indian woman, Theresa Naidoo, who was HIV positive. In her story she communicates her experiences of betrayal, prejudice and discrimination. Her sto ry has inspired the research er to explore the experiences of other Indian women living with HIV/ AIDS. The researcher contac ted the Chatswo rth HIV/ AIDS coordinator, Kogie David, who is based at the Chatsworth Child and Family Welfare Centre . She coordinates the HIV/ AIDS counselors in the Chatsworth district. The researcher explained the nature of her research study and was informed that there were many women like Theresa, living with HIV/ AIDS. / Thesis (M.Ed.) - University of KwaZulu-Natal, 2005.

No abstract available. / Thesis (LL.M.)-University of KwaZulu-Natal, Durban, 2012.

Background: Worldwide, it is poor women who are at greatest risk of cervical cancer. These patterns are resonated in South Africa where black women, particularly in rural areas are at heightened risk for cervical cancer. The rate of morbidity and mortality due to cervical cancer has increased and in the year 2000, deaths as a result of cervical cancer in South Africa exceeded maternal deaths. This increase in morbidity and mortality has been associated with the emergence of HIV and AIDS. Cancer of the cervix was listed as an HIV-related opportunistic infection and an AIDS defining illness by the Centers for Diseases Control in 1993. This research documents the challenges of implementing cervical cancer services in the context of HIV. It explores structural, gender, societal, social exclusion and practical barriers to implementing these services. Methodology: The study was conducted using qualitative methods of enquiry which employed in-depth interviews to collect data from participants. Interviews were held with government officials, Section Nine institutions, non -governmental organisations working in the fields of cervical cancer and HIV/AIDS. Results: The study found that South Africa does not have a comprehensive policy to address cervical cancer in women living with HIV neither does it have plans to enact such a policy. It found that cervical cancer was a marginalised disease. It also found that cervical cancer does not always form part of health priorities as it falls outside women as mothers‟ brackets. The study found that the social status and the level of participation and active citizenship of women living with HIV might be one of the reasons for lack of prioritisation of cervical cancer policies. Conclusion: Cervical cancer is a marginalised disease because it affects women outside of their reproductive roles, can be defined as an STI and it affects women who live in the margins of society. Cervical cancer marginalisation could be linked to the discourse of lack of political will, advocacy and action in relation to women‟s health. Policies need to be nuanced from the perspectives of women living with HIV. / Thesis (M.Dev.Studies)--University of KwaZulu-Natal, Durban, 2013.

By knowing the incidence of an infectious disease, we can ascertain the high risk factors of the disease as well as the e ectiveness of awareness programmes and treatment strategies. Since the work of Hugo Muench in 1934, many methods of estimating the force of infection have been developed, each with their own advantages and disadvantages. The objective of this thesis is to explore the di erent compartmental models of infectious diseases and establish and interpret the parameters associated with them. Seven models formulated to estimate the force of infection were discussed and applied to data obtained from CAPRISA. The data was agespeci c HIV prevalence data based on antenatal clinic attendees from the Vulindlela district in KwaZulu-Natal. The link between the survivor function, the prevalence and the force of infection was demonstrated and generalized linear model methodology was used i to estimate the force of infection. Parametric and nonparametric force of infection models were used to t the models to data from 2009 to 2010. The best tting model was determined and thereafter applied to data from 2002 to 2010. The occurring trends of HIV incidence and prevalence were then evaluated. It should be noted that the sample size for the year 2002 was considerably smaller than that of the following years. This resulted in slightly inaccurate estimates for the year 2002. Despite the general increase in HIV prevalence (from 54.07% in 2003 to 61.33% in 2010), the rate of new HIV infections was found to be decreasing. The results also showed that the age at which the force of infection peaked for each year increased from 16.5 years in 2003 to 18 years in 2010. Farrington's two parameter model for estimating the force of HIV infection was shown to be the most useful. The results obtained emphasised the importance of HIV awareness campaigns being targeted at the 15 to 19 year old age group. The results also suggest that using only prevalence as a measure of disease can be misleading and should rather be used in conjunction with incidence estimates to determine the success of intervention and control strategies. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

No abstract available. / Thesis (Ph.D.)-University of KwaZulu-Natal, Piertermaritzburg, 2010.