Executive Function is conceptualized in this study as the ability to form (the planning functionality obtained through initiation and working memory), maintain (response selection and the ability to self-regulate and inhibit) and switch (cognitive flexibility, mental tracking, organization and sequencing) mental processes in order to effect a positive outcome. The present research is a quasi-experimental study embedded in the Positivist tradition that sets out to empirically evaluate the Executive Function profile of seropositive adolescents (n = 29) emerging from a low socio-economic background and currently on a managed ART programme when compared to a healthy contrast group (based on age, socio-demographic and educational system). As a quantitative study, Executive Function was operationalized through the use of multiple tests of Executive Function such as the Delis-Kaplan Executive Function Colour Word Interference Test (D-KEFS CWIT), the Wisconsin Card Sorting Test (WCST) and the Trail Making Test Part B (TMT-B). As the study formed part of a larger study that included additional neurocognitive tests, including the WISC-R, selected subtests from the WISC-R were used to validate specific arguments relating to the study. The results showed that HIV positive adolescents were inclined to have poorer Executive Function performance especially under situations of higher cognitive load when compared to the unaffected group. The implications of these results are discussed in this research.

In 2009 an estimated 33 million people were living with the Human Immunodeficiency Virus (HIV). Of this global population, 35% live in South Africa. Furthermore, sub-Saharan Africa is home to 80% of the world’s population of HIV-1 positive children and adolescents. The most prominent form of transmission of HIV in children in South Africa is from mother to child. Until 2004, South Africans had limited access to ARV treatment at and after birth due to the government legislation. As a consequence, treatment of HIV in children may only have been initiated after clinical presentation of immune deficiency. Therefore, currently, HIV-1 positive adolescents born during the period of restricted ARV-access may have experienced physical and developmental symptoms associated with the virus including neurological deficits, prior to initiating treatment. This study investigated the current psychomotor functioning, such as psychomotor speed, manual dexterity, graphomotor and visual-motor coordination of a group of low socio-economic HIV-1 positive adolescents in Johannesburg, South Africa, who are now on a managed antiretroviral programme and how this compared to a HIV negative contrast group. A Mann-Whitney U Test indicated a significant difference in mean non-dominant hand performance in the Grooved Pegboard Test between the two groups (U = 738, p < .05), with the HIV positive group performing slower than the HIV negative group. An independent samples t-test indicated a significant difference between groups in the Block Design subtest of the WISC-R [t(88) = -2.93, p < .01] where the HIV positive group performed significantly worse than the HIV negative group. Additionally, a Mann-Whitney U Test revealed a significant difference in number of errors made in the WISC-R Mazes subtest between groups (U = 736.50, p < .05), where the HIV negative group made more errors. Another Mann-Whitney U Test revealed a significant difference between groups in the ROCFT Copy score (U = 534.50, p < .01) where the HIV positive group achieved a significantly lower score than the HIV negative group. Lastly, a Mann-Whitney U Test demonstrated significant differences between the groups in the Trail Making Test A time (U = 445.00, p < .01), Trail Making Test B time (U = 509.00, p < .01), the number of errors made on the Trail Making Test B (U = 729.00, p < .05) and the difference between Trail Making Test B – A time (U = 769.50, p < .05) with the HIV positive group performing slower and making more errors in Part B than the contrast group. The findings of the current study imply that HIV-1 vertically-infected adolescents in Johannesburg, South Africa, on a delayed HAART programme appear to have persisting difficulties in complex psychomotor skills where an integration of functions is required. Furthermore, these results indicate an overall poor psychomotor performance in comparison to international normative data, supporting previous findings. Developmental, remedial and therapeutic recommendations were made.

South Africa has the most prominent percentage of individuals living with the Human Immunodeficiency Virus (HIV) in the world, with the most prominent form of transmission of HIV in South Africa being vertical mother-to-child transmission. From 1997 until 2004, South Africa had limited access to ARV treatment at and after birth due to the government legislation. As a consequence, treatment of HIV may only have been initiated after clinical presentation of immune deficiency. A paucity of information therefore exists regarding this population in addition to the specific age demographic of adolescents. Adolescents may be negatively influenced by the cortical thinning associated with HIV, and this study therefore aims to investigate the verbal fluency and vocabulary (in English) of 30 bi- or multilingual seropositive adolescents that are currently on a managed anti-retroviral programme in comparison to an HIV-negative contrast group of 70 bi- or multilingual adolescents in South Africa (matched for age, education, and socioeconomic status). The study found that there were no significant results between the HIV-positive and HIV-negative groups on the measures of vocabulary, semantic naming, or phonemic naming in ‘F’ as determined by their performance on the neuropsychological assessments. Significant results were noted between the HIV-positive and HIV-negative groups on the phonemic naming categories of ‘A’ and ‘S’ however, and negative correlations between performance in these categories and current viral load, and viral load at Highly Active Antiretroviral Therapy (HAART) initiation were also noted. This research formed part of a broader study examining the overall neurocognitive effects of HIV-1 infection in adolescents in South Africa.

Approximately 11.5 million Human Immunodeficiency Virus (HIV)-positive individuals were living in South Africa in 2007, many of whom were infected via mother-to-child transmission. The current study aimed to compare the attentional and concentration functioning of 30 seropositive adolescents on managed anti-retroviral (ARV) programmes, with a comparable group of 71 seronegative adolescents. The results showed that the uncorrected errors on trial 1; self-corrected errors on trial 2; time taken, uncorrected and self-corrected errors on trial 3 of the Stroop Colour-Word Interference Test; and the errors on the Trail Making Test Part B were significantly poorer in the seropositive sample. The results also indicated that the clinical variations in the HIV-positive sample, including the age at which ARVs were commenced; duration of ARV treatment; World Health Organisation (WHO) stage at diagnosis; starting and current CD4+ counts; and starting viral load, but with the exception of the current viral load, impacted significantly on test performance.

In 2007 it was reported that an estimated 33 million people worldwide were living with the Human Immunodeficiency Virus (HIV). Of this, 35% (approximately 11.5 million) live in South Africa, most of whom were infected with HIV by mother to child transmission. Due to government legislation, until 2004, South Africans had limited access to Antiretroviral (ARV) treatment at and after birth. As a consequence, treatment of HIV was, at this time, only in government facilities, initiated after the clinical presentation of immune deficiency. This study compared the memory functioning of low socio-economic seropositive adolescents that were on a managed anti-retroviral programme to that of a contrast group that were HIV negative. The groups were matched for age, gender, demographics and educational level. The relative impact of variables such as duration of ARV treatment, drug regimen, WHO stage at diagnosis and CD4+ count were all considered. Performance on a comprehensive neuropsychological battery was compared between the HIV positive group and their typically developing counterparts both in terms of memory functions as well as other cognitive processes that may have an effect on memory. The HIV positive group performed significantly below their HIV negative peers in processing speed, holistic processing, and spatial processing as well as specific visual functions such as visual constructional skills, visual recall ability, disruptions in both storage and retrieval of visuospatial information, and visual spatial working memory. No significant differences were found between the groups on tasks measuring verbal memory and verbal learning ability indicating that the neurocognitive profile of clade C HIV has a different presentation from the other clades. The findings suggest that the preferential effect HIV has on the frontostriatal circuits in the brain impacts memory processes due to the destructive impact of the virus on the myelination of these circuits. As a result of the higher degree of white matter tracts in the right hemisphere, holistic and integrative processing is impaired and visuospatial functions are affected whereas verbal processes are largely spared. The resulting neurocognitive profile is similar to that of nonverbal learning disorders and may benefit from similarly constructed interventions such as placing more emphasis on verbal learning strategies and limiting dependence on visual information for HIV positive pupils.

Maternal HIV-disclosure to an adolescent is a controversial issue especially when considering the suitable time and context in which disclosure should take place. Furthermore there have been other considerations such as the adolescent’s emotional maturity as well as gender issues which have played a role in regards to determining whether the adolescent would be able to understand and cope effectively post-disclosure. These considerations formed the basis of this study’s aim and objectives which primarily focused on taking into account the developmental aspects apparent in the adolescent phase. These include adolescent’s relations with their mother, their peers and the meaning attached to having an education and career in their lives. For purposes of this study it was deemed important to actually explore with the adolescent’s the meaning they uphold pertaining to maternal HIVdisclosure. This differs from previous research which has focused predominantly on accessing adolescent’s experiences via their parents and in particular, their mothers. Data of only three participants was included following in-depth interviews being conducted. Data was analysed via Interpretive Phenomenological Analysis (IPA) which enabled an enhanced understanding and meaningful interpretation of the adolescent’s experiences following maternal HIV-disclosure. From the findings it became apparent that most concerns had already been addressed and were similar when compared to previous research that had been conducted. However one notable different finding was that instead of adolescent’s acting in ways that would lead to them self-sabotaging their lives they instead portrayed themselves to be living in a responsible manner. It became apparent rather that it was the adolescent’s mother rather that became more inclined to engage in self-sabotaging behaviours.

This research explores the lived experience of being a vertically or prenatally-infected HIV-positive adolescent. It looks specifically at how the participants experience intimacy, sex and sexuality. HIV/AIDS remains a global pandemic and vertically-infected adolescents are a growing new demographic. However, there is a poverty of research, and therefore interventions and support, for this demographic. This qualitative research conducted six individual, in-depth, semi-structured, psychoanalytic research interviews with three participants. The interviews were structured around projective drawings that the participants did in the course of each interview. The interviews were transcribed and analysed using psychodynamic object relations theory and organised through interpretative phenomenological analysis. Every effort was made to ensure that the research was conducted ethically and validly. The analysis found that the participants' experience of intimacy has resulted in a self that is constantly under threat. This in turn has negatively impacted on the participants' experience of sex and sexuality. The implication of this research is that more in-depth research needs to be done into this demographic so that better interventions and support may be offered.

Adolescence is a significant period of change in physical and psychosocial development of human beings. Being HIV positive and growing up on a dynamically multifaceted HAART treatment, adds to the complexity of adolescence. This study was aimed at exploring the nature of experiences of adolescents who are on long-term Highly Active Antiretroviral Therapy (HAART) in Tembisa, Gauteng province. The study is based on a qualitative research method using in-depth semi-structured open-ended interviews and a focus group for data collection. The sample consisted of seven individual adolescent participants, three parents, guardians and caregivers, as well as 11 health care professionals. The thematic data analysis and the phenomelogical analysis methods were used to analyse data qualitative data while descriptive statistics were used to analyse quantitative biographical data. The study findings cover the negative and positive experiences and the perceived role of HAART treatment over a long period of time. The predominant themes identified from adolescent participants were disclosure of HIV positive status and the stigma surrounding a positive status, early childhood experience of parental death, challenges of taking HAART treatment, factors influencing adherence and non-adherence to HAART treatment, and lastly, the impact of religion on HAART treatment adherence. The findings suggest that adolescents who are on HAART treatment over an extended period of time experience drug fatigue. Drug fatigue has far-reaching implications for the health of an adolescent, as it has a higher likelihood that poor adherence or even complete refusal to take HAART treatment will occur. Poor adherence or refusal to take HAART treatment will most likely lead to cross infection and further spread of HIV and AIDS. A recommendation was made to include the establishment of a youth and adolescent-friendly centre by the hospital – one that is designated for the provision of tailored adolescent services and sensitive to adolescent developmental stages so as to minimise the likelihood of infected adolescents falling through the health care cracks. The introduction of a hospital-based school, an education unit run by dedicated and qualified facilitators focusing on aiding hospitalised learners with catch-up scholarly programmes, was a further recommendation. It was further recommended that reproductive health care needs of adolescents who grow up on HAART treatment be given attention in further research. / Psychology / Ph.D. (Psychology)