Düsseldorf, Universiẗat, Diss., 2004. / Erscheinungsjahr an der Haupttitelstelle: 2003.

Women within African, Caribbean, and Black (ACB) communities are experiencing a higher burden of the HIV epidemic than other groups of women in Canada and a low uptake of HIV testing and counseling. As HIV testing is a well recognized HIV prevention strategy, increasing HIV testing within those most affected by HIV in Canada is a high priority. Therefore, this study gathers and describes the perceptions, experiences, and knowledge of HIV and HIV testing and counseling among women within ACB communities in Ottawa. These perceptions and experiences provide rich context to current barriers to HIV testing and counseling access among these groups of women; context that is utilized to ground recommendations to improve experiences of HIV testing and counseling and to increase the uptake of HIV testing and counseling among ACB women. In essence, this study provides recommendations by ACB women for ACB Women.

Bibliography: p. 209-244. / There is worldwide recognition of the magnitude of the AIDS problem generally and the particular concerns regarding prevention and care which this raises for women. Social constructionist and feminist analyses have done much to extend understanding of the issues beyond the biomedical realm to include social accounts of the constitution of AIDS knowledge, meanings and responses. However, these frameworks have not easily translated into realistic responses to the seeming paradox of women being seen as responsible for HIV prevention, while they lack the power in gender relations to implement safe sex behaviour. Therefore, this thesis aimed to explore in depth the experience and meaning of AIDS for South African women, to map their accounts in relation to existing depictions of the problem, and to identify constraints and opportunities for action which these raised. A further intention was to generate realistic and appropriate prevention options both through and arising from the research process. Preliminary work involved two pilot studies. Firstly in-depth interviews were conducted with HIV-infected women. Then an overview of the status of AIDS prevention and care facilities for women in South Africa was completed by means of interviews with key informants in medical, research and organisational settings. These studies highlighted the complexity of issues involved and confirmed the need for an approach which linked understanding to intervention. The main study aimed to explore the range and interplay of discursive themes which South African women drew on regarding AIDS, and the implications of their positioning in relation to these representations for AIDS interventions.

This project sought to achieve two major aims. First, I aimed to investigate the differences in functional, behavioural, and emotional impairment of HIV-infected, HAART-naive children compared to HIV-negative controls. Second, I aimed to investigate the levels of parental stress, depression, and quality of life related to caring for an HIV-infected child. Currently, there is limited research focusing on each of these topics. Nineteen HIV-positive (9 HAART-naïve and 10 HAART-treated) parent-child dyads and 10 HIV-negative parent-child dyads were recruited. All participants were from socioeconomically disadvantaged backgrounds. Each parent and child completed measures related to the aims of this study. Parents completed measures related to their child’s functional impairment (i.e.: CBCL, CIS, CMS) and questionnaires related to their parental well-being (i.e.: PSI, FRS, FSS, CES-D, WHO QoL). Children completed a comprehensive neuropsychological test battery. Statistical analyses revealed no significant between-group differences in terms of child functional, behavioural, and emotional impairment. These non-significant findings were confirmed by an in-depth qualitative review of three case studies. Statistical analyses also revealed no significant between-group differences with regards to parental stress, depression, and quality of life. The possibility of poor socioeconomic status (SES) explaining the lack of difference is discussed, as well as the possibility of potential protective factors.

A Research Report submitted to the Faculty of Health Sciences in Partial fulfilment of the Requirements for the Degree of Master of Science in Epidemiology in the field of Epidemiology and Biostatistics, school of Public Health. The University of the Witwatersrand. Johannesburg, November 2017. / Background Risk perception has serious implications for health if the risk assessment informing the risk perception is accurate and well-reasoned. Gauteng Province is characterised by a high concentration of migrants and this sub-population may find themselves in compromising conditions that might heighten their risk of contracting HIV. HIV risk perception research in South Africa has been carried out on several high-risk populations but not among migrants. The aim of this study was to examine the association between migration status and HIV risk perception as well as to identify the factors associated with HIV risk perception among migrants and non-migrants in Metropolitan areas of Gauteng Province in 2012. Methods This was a secondary data analysis of data collected from a cross-sectional household survey that was conducted to explore the needs and vulnerabilities of the poor urban groups residing in the Metropolitan Municipalities of Gauteng Province in 2012. A total of 1 834 respondents made up of non-migrants, internal and international migrants qualified for this study. Pearson’s chi-square test was used to assess the association between migration and HIV risk perception. Unadjusted and adjusted logistic regression models were fitted to identify factors associated with HIV risk perception. Results Of the total respondents, 55% considered themselves not to be at risk of HIV infection. There was a strong statistical association between migration status and HIV risk perception (p-value = 0.001). Internal migrants (50.4%) were more likely to perceive themselves as being at risk than international migrants (43.4%) and non-migrants (40.3%). Using the 95% Confidence Interval, from the adjusted logistic regression; age (AOR = 0.97; CI: 0.96, 0.98), Metropolitan area (AOR = 1.31; CI: 1.02, 1.68), common perceived health problem as HIV or TB (AOR = 2.03; CI: 1.55, 2.65) and accessibility to HIV information and treatment (AOR = 0.65; CI: 0.45, 0.98) were associated with HIV risk perception. Conclusion This study showed low HIV risk perception among residents of Gauteng Metropolitan area. There is a strong association between migration status and HIV risk perception. Low risk perception despite the presence of HIV risk factors suggests the need for programmes aimed at creating awareness about HIV and promoting adoption of preventive health lifestyle among migrants and non-migrants in Gauteng Metropolitan area. / LG2018

The UK National Guidelines on HIV Testing 2008 recommended that adults in areas where more than 2/1000 people were living with HIV be considered for an HIV test at the point of registration with general practice. The RHIVA2 trial of rapid HIV testing in primary care implemented and evaluated this recommendation across 20 general practices in a single UK borough using a pragmatic cluster randomised controlled trial (RCT) design. This trial, and the policy that underpinned it, reflected two more general developments: first, the move towards population screening to detect and treat disease in early and latent stages and second, the emergence of 'pragmatic' clinical trials that seek to account for complexity and measure interventions in their context of use. This interdisciplinary case study uses multiple methods and theoretical frames to explore what happened in the RHIVA2 trial at both an empirical and a theoretical level. Sub-studies reveal how the trial was justified, enacted and became meaningful as a policy, as a trial, and as an intervention in the lives of patients. My analyses show that two operating logics informed the justification and enactment of the trial and patterned patient and provider experiences. The first, the logic of normalisation for HIV aims to treat HIV infection as a medical condition 'like any other'. This logic emphasises general practice as a site of increased value and position in HIV management and as a space where population screening can be undertaken. Second, the logic of the pragmatic trial aims to measure interventions in the 'real world' but is revealed to produce unintended effects, raising questions about the claims of such trials to generalisability and reproducibility. This thesis demonstrates how contrasting versions of the research event ('multiplicity') can be produced through different modes of inquiry, raising questions about the tension between situated and generalisable findings.

Thesis (MPH)--University of Limpopo, 2010. / Introduction: Men living with HIV and AIDS generally do not participate in support groups even though evidence supports their effectiveness as a source of valuable support for people living with HIV and AIDS PLWHA). Study Aim: The aim of the study was to explore reasons for the reluctance of HIV positive men to attend support groups and examine their perceptions and understanding of the benefits of attending support groups for PLWHA Methods: A qualitative descriptive approach was used for this study. A total of five (5) focus group discussions was conducted with HIV positive males receiving ART from Infectious Disease Clinic (IDC) at King Sabata Dalindyebo Municipality in Mthatha Data analysis: Thematic content analysis was used to analyse data from the focus groups, using Nvivo8 a qualitative soft ware used for data analysis and coding revealed 10 themes with their sub categories. Findings: Findings of the research indicate that participants perceive support groups as being helpful to PLWHA. Participants have a broad and positive understanding of the benefits of participation in support groups. Reported barriers to participate in support groups included lack of access to support groups in local communities which affected the distance travelled to support groups, inconvenient and awkward timing of the support group sessions and attending mixed gender support groups which was not acceptable for participants. Personal reasons for non participation included fear of potential disclosure of HIV status due to lack of confidentiality in support groups and perception that support from families and friends was adequate. Recommendation: The study recommends the introduction of men only support groups facilitated by male to enhance men’s participation in HIV and AIDS programmes, and thus create an enormous contribution in the curb of the spread of the disease.

Thesis (MPH)--University of Limpopo, 2009. / Background In order to provide an assessment of experiences of patients on the Comprehensive HIV and AIDS Care Management and Treatment (CCMT) programme it is essential to ascertain how accessible the CCMT programme is, moreover, is it is critical to determine the level of quality and the extent in which patients are satisfied with service provided. The study investigated and described the experiences of patients on the Comprehensive HIV and AIDS Care Management and Treatment (CCMT) programme. Purpose The purpose of the research was addressed within a quantitative approach applying descriptive designs. A self-administered questionnaire was used to collect the data that fit the objectives of the research. In this study the population applied to patients who lives in the vicinity of Tshwane District, Pretoria West and Kalafong Hospitals; Method Systematic random sampling consisted of 402 patients on the CCMT programme in three hospitals namely Tshwane District, Pretoria West and Kalafong Hospitals. Eligible participants were those who were 18 years and older and have been on the CCMT programme for 6 months or longer. Data was captured on Microsoft Excel 2007 and descriptive statistics was analysed with Stata 10. Results In this study 415 interviews were secured in all three hospitals, A total of 415 questionnaires were distributed in all three hospitals where a response of 97% was obtained, which compares favorably with the experience of other researchers. Conclusion The study reveals that the CCMT programme in Tshwane District, Pretoria West, and Kalafong hospitals is being implemented in accordance with what has been prescribed in the operational plan for the comprehensive HIV and AIDS Care, Management and Treatment for South Africa as it is accessible, of good quality with patients that are generally satisfied with service provided. Key terms: HIV and AIDS, health care, accessibility, quality, management, guidelines.

Thesis (MPH))--University of Limpopo (Medunsa Campus), 2010. / Introduction: HIV-positive parents taking antiretroviral therapy are faced with the difficult decision of whether and what details to share about their HIV status with their children. They need to decide if, when, and how they will disclose their illness to their children. Many reasons have been identified which influence parents’ decision to disclose their HIV status to their children. Aim and objectives: The aim of the study was to explore parental decision and experiences of disclosing or not disclosing their HIV status to children and to explore strategies used by non-disclosed parents to conceal their HIV status from their children. Methodology: Using a qualitative approach, six focus group discussions were conducted with a sample of disclosed and non- disclosed biological parents of children aged between 7-18 years. Participants were recruited from a wellness clinic at the Dr George Mukhari where they routinely collect antiretrovirals. A total of 44 parents (13 biological fathers and 31 mothers) were recruited and participated in two focus groups with disclosed parents, three with non disclosed parents and a pilot focus group interview with disclosed and non disclosed parents. Findings: Disclosure to children was difficult and occurred within a context influenced by death, dying and discrimination. Despite parents being on ARVs, fear of death and dying continues to influence disclosure to children. HIV related practices like taking ARVs and child feeding practices predisposes parents to stigma and discrimination and was major reason for non-disclosure to children, family and neighbours. Whereas previously, prior to the availability of ARVs, parents disclosed to prepare children to face parental death, now disclosure occurs for children to support parents in adherence and when they are sick. The need for support is not surprising given that for parents who disclosed immediately, disclosure was prompted by ill health. The primary reason parents delayed disclosure is because they do not know how to tell the child. One other concern was that disclosure will makes children responsible for caring for parents. By delaying disclosure parents were protecting their children mostly from being hurt, from social rejection and discrimination and from fear of mother’s death. Conclusion: Regardless of whether parents had disclosed or not disclosed the decision to disclose was difficult and emotional for parents, and is influenced by various factors. Due to stigma and discrimination disclosure in most families is often treated as a secret; parents do everything possible to protect their HIV status. Common strategies used to protect their HIV status include hiding antiretrovirals, removing labels from ARV bottles, use of different packages for ARVs, taking medication privately and substituting TB for HIV. Parents believed that by delaying disclosure they were protecting their children from consequences of disclosure. Most children reacted positively to disclosure and were protective and supportive to parents, while some non disclosed children became suspicious of parental status. Recommendations: There is need for the development of health service practices that would protect HIV positive people taking ARVs from stigma and discrimination. Most HIV positive parents currently on ARVs have seronegative and seropositive children. They therefore need to develop strategies to discuss managing HIV illness especially with their seropositive children who also need to have their diagnosis disclosed. It is imperative that disclosure guidelines are developed to guide parents in disclosing HIV to children. Key words: Parental, disclosure, non disclosure, HIV positive, children, qualitative research.

Thesis (MPH)--University of Limpopo (Medunsa Campus), 2011. / Background: South Africa hosts the largest number of pregnant HIV-positive women, accounting for almost 15% of the global total. Many amongst these HIV-positive pregnancies are unplanned and may be related to reproductive unmet needs, sexual risky behaviours, and/or community, contextual and individual factors that may determine and/or make these HIV-infected women to fall pregnant. The occurrence of an HIV-positive pregnancy in our region implies however the practice of unprotected sex, and is associated with the risk of reinfection with a different strain of HIV as well as with the risk of HIV transmission to an uninfected male partner and to the offspring. Knowing the demographic profile of HIV-infected women who become pregnant and experience parenthood as well as the circumstances of occurrence of their pregnancies is necessary for developing policies and interventions aimed at addressing the reproductive needs of this subpopulation, thus preventing HIV-positive unintended pregnancies as well as the horizontal and vertical transmission of HIV. Objectives: This study had three objectives. The first objective was to describe the demographic profile of pregnant HIV-positive women attending antenatal care (ANC) in public sector clinics in Postmasburg, South Africa. The second study objective was to determine the proportion of these pregnant HIV-infected women who were aware of their HIV-positive status prior to the occurrence of their current pregnancy. Lastly, the third objective sought to describe the circumstances of occurrence of their current pregnancy. Methodology: We used a quantitative descriptive design to collect data on 41 consecutive pregnant HIV-positive women who attended ANC at three public sector clinics in Postmasburg, from September to December 2010. Participants were administered a structured pre-tested questionnaire in their home language by trained interviewers. The study instrument was designed to collect data related to participants‘ socio-demographic characteristics, the time-period of HIV- v positive diagnosis relative to their current pregnancy, and the circumstances of occurrence of their current pregnancy. Results: The analyses of the study results showed that pregnant HIV-positive women attending ANC in Postmasburg were likely to be young (mean age, 27.71 ± 5.72 years), never married (56.10%), Afrikans (65.9%) and Setswana speakers (58.52%) of low socioeconomic status, with no or one child (65.85%). The majority of participants (63.4%) were from a predominantly informal settlement; 78% were unemployed while 61% were either devoid of any income or were living with Rands 500 or less. Sex mixing was common in the 15-19 years-old, involving 80% of respondents of this age category. Most of respondents (78.05%) became aware of their HIV-positive diagnosis during their current pregnancy that was unplanned in 73.17%. The study findings also revealed low levels of pregnancy intendedness (31.71%), hormonal contraceptives use (24.9%) and condoms uptake (34.15%), with high rates of condoms failure among users (87.12%). Respondents also reported other circumstances of occurrence of their current pregnancy, including, irregular condoms use (14.29% of condom users), partner refusal to use condom (10%), stopping contraceptives use because of side effects (50% of users), partner‘s pressure (12% of participants), coerced sex (2.4%) and having had sex under the influence of alcohol (2.4%). Conclusion: These results highlight the need for improving the reproductive health services that are offered to HIV-positive individuals. Integrating PMTCT and Family planning services, training health workers in issues related to the reproductive rights and reproductive health of HIV-infected individuals, systematically offering HIV counseling and testing to women of childbearing age who come into contact with health facilities for any reason and adequately informing HIV-positive women of childbearing age about available reproductive options, planned conception and safer motherhood, are necessary for preventing unintended HIV-positive pregnancies as well as the horizontal and vertical transmission of HIV.