Thesis (MPH)--University of Limpopo, 2010. / Background: Antiretroviral therapy led to a revolution in care of patients with HIV/AIDS in a developed world. Treatment is not a cure but it also presented with new challenges of side effects, drug resistance and it also dramatically reduces rate of mortality and morbidity and it also improves quality of life to people living with HIV/AIDS, and it also now considered as manageable chronic diseases. Aim: Aim of the study is to establish and describe reasons for treatment and regimen change in a cohort of HIV positive patients on ART enrolled in the pharmaco-epidemiological survey at Tshepang wellness clinic. Objectives: is to determine reasons for treatment and regimen change, types of treatment and regimen change among patients on ART who are enrolled in pharmacoepidemiological survey at Tshepang wellness clinic. Design and Methods: Study is a retrospective cohort study, and sample size of 301 medical records of a cohort of HIV positive patients on ARVs enrolled in a longitudinal pharmaco-epidemiological survey from November 2006-May 2007 reviewed. Data extraction tool used to collect data and software called SPSS 17.0 used to analyze data and relevant themes were extracted to determine distribution of variables. Results: Results of this study indicated that 91 (85%) were males and (87.8%) 191 were females. Age was grouped as teenagers (15-25yrs), young adults (26-49yrs) and adults (50- 70yrs). Results also shows reasons of treatment and regimen change of which majority of patients 134(44.8%) changed due toxicity followed by 16 (5.4%) who changed because of pregnancy, and the other 4(1.3%) changed because of resistance, and the last 2(0.7%) which are regarded as minorities change because of T.B. Conclusion and Recommendations: Results shows that majority of pharmacovigilance patients were initiated Regimen 1 compared to other regimens. Toxicity appear as the main reason of treatment and regimen change on this study as 140(46.4%) reported toxicities (peripheral neuropathy, lactic acidosis, lipodystrophy and lipoatrophy). Implementation of monitoring of adherence needed for prevention of resistance and virological failure.

Thesis (MPH)--University of Limpopo, 2009. / 􀁸Introduction Northern Uganda is experiencing a lull in a 20 year civil war that had led to the massive displacement of people from their homes. Majority of people living in internally displaced people’s camps are now returning to their homes. The HIV scourge in the region has been fanned by the war, exposing the population to a higher prevalence of 8.4 % as compared to the HIV country average of 6.2%. Government in collaboration with other stakeholders is scaling up antiretroviral therapy in this resource limited, post-conflict setting through the decentralized health care delivery system. Factors that could influence long-term retention in such a setting are as yet poorly understood. Methodology This was a methodological retrospective review of 402 patient clinic cards, ART register and pharmacy records at regional referral hospital, district hospital and health centre IV. A quantitative approach was used to determine the retention rates for clients initiated on antiretroviral therapy at the three levels of care after 3, 6, 12, and 24 months. Predictors for loss to follow-up were derived from demographic and clinical characteristics captured in the clinic records. 􀁸Data management Data was summarized using frequency tables and bar graphs. Analysis was done using EPI-INFO and SPSS computer packages. Bivariate analysis was carried out to evaluate the association between the variables and loss to follow-up. 􀁸ResultsOverall 43.5% of patients were lost to follow-up from the ART programs. The district hospital retained most patients (73.1%), the regional referral hospital (53.7%) and health centre IV retained least (36.6%). Majority of patients were lost to follow-up after 3 completed months and least after 24 completed months. Patients accessing ART at the district hospital were five times more likely to remain in care (OR 0.21 95% CI 0.08, 0.50) and those at the regional hospital 2 times more likely (OR 0.48 95% CI 0.22, 1.07) as compared to those at the health centre. Loss to follow-up was 16 times more likely to occur in the bedridden functional status (OR16.3 95% CI2.0, 132.2) and three times more likely in the ambulant patient compared to those able to work. In this study age, sex, occupation, weight, WHO clinical stage and CD4 lymphocyte count were not predictive of retention on the ART program. 􀁸ConclusionProviding an accessible high quality ART service is feasible in the post-conflict region, as illustrated by the level of retention of patients at Kitgum District Hospital, through task shifting, training, and mentoring of lower cadre health workers. The collaboration of community based organizations to enhance the continuum of care at community level significantly improves retention of patient in the programme. There is need to relax the eligibility criteria and adopt strategies that will promote earlier access to VCT services so that appropriate care is initiated to patients before they are too weak.

Thesis (MPH)--University of Limpopo, 2009. / Background: An understanding of the effectiveness of the hospital-based palliative care programme and the extent to which it changes the way patients are managed in the general medical wards is required, in order to develop evidence-based palliative care guidelines for Public Hospitals on the management of HIV/AIDS patients. Purpose: The study aimed to identify and describe the effectiveness of the Palliative Care programme on the management of HIV/AIDS patients at Chris Hani Baragwanath Hospital. The objectives of the study included to: • Determine the proportion of HIV positive patients admitted into Chris Hani Baragwanath general medical wards accessing services of a hospital-based palliative care team • Identify the care and support needs experienced by HIV positive patients • Compare the frequency of the met and unmet needs of HIV positive patients in those referred as opposed to those not referred to the hospital-based palliative care team Methods: Non-random quota sampling of 50 HIV positive patients confirmed by an ELISA test, and admitted with HIV related illnesses were selected from admission records of medical wards in Chris Hani Baragwanath Hospital. 8 (16%) of the patients were too ill to communicate, 12 (24%) declined the interview and 30 (60%) gave consent to be interviewed. The data was collected using researcher administered questionnaires, and captured on Microsoft Excel 2003. Descriptive statistics were analyzed using STATA 10. Participants were assessed for enrolment into the hospital-based palliative care programme, common palliative care needs experienced and the frequency of identification and provision of palliative care needs provided for patients in the medical wards with focus on physical symptoms, pain, psychosocial problems, integration of care and counselling needs. The group was further divided into those under a palliative care program and those not under palliative care, for further data analysis. Results: Findings revealed that very few patients (27%) with HIV&AIDS were accessing services of the hospital-based palliative care. Significant proportion (67%-77%) of HIV infected patients were experiencing physical symptoms, pain and psychosocial problems requiring palliative care interventions. Further findings revealed that for those participants who were not referred for the palliative care programme, symptoms and pain complaints were not effectively identified and treated by health personnel. Provision of psychosocial and spiritual support was inadequate and that the quality of life for HIV/AIDS patients was compromised due to lack of comprehensive and integrated holistic care. These components were found to be effectively addressed amongst the referred group. iv Conclusion and recommendations: Hospital-based palliative-care has limited effectiveness due to the small size of the team which is working against demands from increasing numbers of HIV positive patients. All health providers working in medical wards need to be trained in palliative care, to develop a capacity to integrate palliative care principles into the routine medical care of HIV/AIDS patients.

Thesis (MSc Virology)--University of Limpopo, 2010. / OBJECTIVES: To date there is no effective and safe vaccine to stop the spread of human immunodeficiency virus (HIV) and provide cross protection among different subtypes. HIV accessory genes were overlooked for many years and recently they are becoming candidates for development of new anti-HIV drugs and vaccines. This is supported by their ability to elicit cytotoxic T lymphocyte response. To date, there are limited studies on accessory genes (nef, vif, vpr and vpu) on South African HIV strains. This study sought to amplify and analyse the sequences of HIV-1 subtype C accessory genes (vif, vpr and vpu) to assess the genetic diversity as well as the motifs and residues associated with key biological functions of these genes. This study further sought to compare the degree of genetic diversity between the accessory and structural genes. METHODS: The study was an exploratory study using stored (-70ºC) HIV positive plasma samples. The study population comprised of 25 HIV positive plasma samples which were already sequenced in the gag and env genes in another study. The samples were drawn from the neighbouring townships of Pretoria: Ga-Rankuwa, Soshanguve, Mamelodi, Laudium, Kalafong, Jubilee and Mabopane. For the purpose of this study, the same samples were amplified, sequenced and characterised in the pol and accessory (vif, vpr and vpu) genes in order to obtain near full length sequences of the HIV isolates from Pretoria region. Six samples were cloned for accessory genes. Five clones from each sample were selected. Sequence analysis was performed for all the PCR amplicons and clones. Base calling for the sequences generated was performed on Chromas Pro program. Computing of phylogenetic tree was performed with MEGA 4 program. ClustalW software was used for sequence alignment and translation of nucleotides to amino acids was performed with BioEdit. The amino acid alignments were analysed on graphic view. RESULTS: All 25 samples were successfully amplified for accessory genes (vif, vpr and vpu) and pol gene. All the 25 pol PCR amplicons were successfully sequenced, while all but one accessory PCR amplicons were successfully sequenced. A number of conserved motifs and residues were observed in all the four genes (vif, vpr, vpu and pol). Vif and vpr showed to harbour most of these conserved motifs and residues; 144-SLQYLA-149 and H71 respectively. In addition, the R77Q mutation associated with long term non-progressors was observed in the vpr gene of 15 sequences. Drug resistant mutations were evaluated in both protease and RT regions. Nine samples had one or two drug resistant mutations i.e T74S, L10I, V179D, E138A/D, Y318F,Y181C and K108N. Phylogenetic analysis confirmed the 25 HIV positive samples to be HIV-1 subtype C in both structural and accessory genes. The genetic diversity of HIV-1 subtype C was compared between accessory (vif, vpr and vpu) and structural (pol, gag and env) genes. The gag and env sequences were available from a previous project (Musyoki, 2009). The gag and vif gene sequences were highly conserved (89% to 96% and 88% to 96%, respectively), as compared to vpr gene (84% to 94%), the pol gene (79% to 95%), the env gene (83% to 93%) and finally the vpu gene (73% to 92%). CONCLUSION: This study found that amplification of clones was more sensitive as compared to direct samples and analysis of clone sequences was more clear than analysis of direct PCR products. Functional motifs and residues observed in all accessory genes were highly conserved. Vif was more conserved, followed by vpr and vpu, respectively. Genetic analysis of pol gene revealed that there were drug resistant strains in circulation. This indicates that the patients were infected with drug resistant viruses; this cannot be verified from the study population. And that most of the strains in this study had mutations associated with long term non-progressors (LTNP’s). However, it is not known whether these patients were indeed LTNP’s. Comparison of genetic diversity between structural and accessory genes demonstrated that, gag, vif and vpr were more conserved than pol, env and vpu.

Thesis (MPH))--University of Limpopo (Medunsa Campus), 2011. / Botswana was the first country in Africa to aim to give antiretroviral treatment to all its HIV positive deserving citizens in 2001. This brought about a significant improvement in survival and quality of life of HIV infected patients as well as a dramatic decrease in the incidence of opportunistic infections. However, although many reports about metabolic abnormalities and abnormal body fat distribution among people on ART have been published elsewhere, little is known about this in Botswana. The purpose of this study was to investigate the prevalence and factors associated with development of metabolic syndrome among people with HIV on ART at the IDCC Clinic at Princess Marina Hospital, Gaborone, Botswana. Methods This was a cross-sectional study based on patient interviews and review of records. A structured questionnaire and a data collection form were used to collect data on demographic, socioeconomic, lifestyle, clinical and laboratory data. Metabolic Syndrome was defined using the International Diabetes Federation (IDF) criteria. Patients who consented to participate were interviewed and their records were reviewed to collate data. Only patients that had been on treatment from January to December 2010 were included. Results A total of 190 subjects participated in the study, 141 (74.2%) females and 49 (25.8%) males. The age of the participants ranged from 24 to 71 with a median age of 40.5 years (IQR: 35 – 49). The overall prevalence of metabolic syndrome in this study was 11%. Metabolic syndrome was associated with traditional risk factors such as hypertension and high triglycerides; but with some unique features such as age, current employment and current NRTI use were also identified. In the bivariate analysis to identify the determinants of metabolic syndrome, the odds for developing MS were higher among participants who were married, employed, on a salary and used ART regimens containing NRTIs. High cholesterol, fasting blood glucose and triglycerides were also associated with the development of metabolic syndrome. There was a significant association with age as people over 45 years were significantly shown to have metabolic syndrome than the younger ones. The median age of participants who had metabolic syndrome was higher at 45 years (IQR: 39 – 53 years) that those without metabolic syndrome at 40 years (IQR: 34 – 48). Married participants were 13 times more likely to develop MS than their unmarried counterparts [OR (95%CI)]: 13 (1.91 - 88.35), p=0.009]. Participants who were employed and had a salary as their source of income were 27.54 times more likely to develop MS although the difference was not statistically significant. The type of regimen affected the prevalence of metabolic syndrome; in fact Up to 17 of the 21 participants with metabolic syndrome used a combination of drugs with NRTIs and NNRTIs as well as PI in 8 cases. So the use of a protease inhibitor based ART regimen increased the odds of developing MS by 51.57 times [OR (95%CI)]: 51.57 (1.55 – 1709.64), p=0.027]; while in case of NRTIs the odds were 78.53 times more for the likelihood to develop MS [OR (95%CI)]: 78.53 (1.10 – 5565.50), p=0.044]. Although there was no significant association between the duration of ART and the development of metabolic syndrome; the median duration of ART among participants with metabolic syndrome was higher at 68 months (IQR: 51 – 80) compared to those without metabolic syndrome at 56 months (IQR: 40 – 68). With regard to sex, 16.3% of the male participants had metabolic syndrome compared to 9.2% among the females; but the difference was not statistically significant. Conclusion In conclusion, the prevalence of metabolic syndrome was low, affecting only 11% of the study participants. The factors associated with the occurrence of the syndrome were the male sex, the long duration on treatment, being married, employed, and over 45 years old. The most significant factors were being on NRTIs and PIs containing regimens. These findings suggest that patients on antiretroviral treatment with the above characteristics should be monitored regularly for metabolic syndrome.

Thesis M. Med.(Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / Background The use of HAART in HIV/AIDS patients has been recognised worldwide to improve the quality of life and survival prospects. Neverthess, factors such as WHO clinical stage III-IV, CD4< 200, VL> 100,000, anaemia, blood transfusion, malnutrition, male gender, intravenous drug use, drug toxicity, HAART experienced by patients, hospitalization, older age and depression have been reported to be associated with negative outcomes whereas, in contrast, white ethnicity, adherence > 90%, antiretroviral naïve subjects, longer period of viral suppression, younger age, and female gender have been reported to be associated with positive clinical outcomes. Methods The researcher conducted a descriptive retrospective study of 78 systematically selected patients who initiated HAART during the period of 5 June 2007 to 5 December 2008. Data regarding demographics, nutritional status, patients’ opportunistic infections, patients’ use of ARV drugs and HAART regimens, side effects and adverse events, baseline and follow up measurements of CD4 cell count, VL, ALT and Hb were collected at initiation, 6 and 12 months of HAART and analysed, utilizing descriptive statistics. Results Of the 78 patients recruited for the study, 60 (77%) were females and 18 (23%) males, 77 (98.8%) black and 1 (1.2%) coloured. The majority of patients belonged to the two age-groups 26-35 years (35.9%), and 36-45 (37.2%). The majority of patients [73/78 (93.4%)] were unemployed and residents of Vryburg town. Nutritionally, 17/78 (21.8%) patients were underweight. Clinically, 79.4% were classified as WHO clinical stage III - IV. The mean weight improved in both sex at 6 and 12 months of HAART respectively, from 57.5kg (SD 8.0) to 63.0kg (SD 13.0) and 65.2kg (SD 4.5) for males. 12 Conclusion The administration of HAART to patients attending ARV clinic at Vryburg District Hospital was followed by better clinical outcomes in terms of weight gain, correction of anaemia, increase in CD4 and achievement of virological suppression. Female gender, VL > 100,000 copies/ml, Younger age (< 46 years) and good adherence were found to have positive influence on clinical outcomes.

Thesis (M. Med.(Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / A study on Factors associated with non-disclosure of HIV positive status to sexual partners by adult patients attending the VCT clinic at Nhlangano health centre, Swaziland. Aim: To describe the factors associated with non-disclosure of known HIV sero-positive status to sexual partners by adult patients attending the VCT clinic at Nhlangano health center, Swaziland. Design:- Cross-sectional study using questionnaire administered by a trained research assistant. Setting:- Nhlangano health center VCT clinic, Nhlangano town in the Shiselweni region, Southern Swaziland. Study population:- All adult patients above the age of 18 years who had undergone HIV testing, who knew their positive HIV status and had follow up visits at the VCT clinic of Nhlangano health centre, from November 2005 (when the centre started rendering VCT service) till the beginning of the data collection, in September, 2008. Results:-The vast majority (89.1%) disclosed their positive HIV status to their sexual partners and 94.6% believed that letting their sexual partner/s know about their HIV status was very important. In terms of knowing the HIV status of their partners, 55.4% knew the HIV status of all of their sexual partners and 44.6% knew only the status of the regular partner/s. With regard to condom use, 96.7% believed that using condoms helps them to prevent transmission of HIV and 91.3% expected that letting their partners know about their HIV status would help them use condom IV more frequently. Only 53.3% said they would insist on condom use even if their partner is not willing to use. Conclusion:-  The rate of positive HIV status disclosure to sexual partner found in this study compared to many studies done in other settings is considerably high. This is encouraging especially considering the existing very high prevalence of HIV infection in the country. Despite this though, knowing partner's HIV status was relatively lower. Therefore, people are more likely to share their HIV status with a partner than insist that the partner does the same.  Even though the study was done only amongst patients attending VCT, it is important to note that the majority of the patients had positive attitudes about HIV status disclosure to a partner, and believed in the importance of letting their sexual partner/s know about their HIV status. Patients understood the unethical nature of engaging into sexual intercourse without disclosing their positive HIV status to their partner. It is possible to conclude that factors which contributed to these positive results should be implemented at a larger scale, namely creating awareness, health education, good counseling and follow up of treatment.  Awareness of the importance of condom use in preventing HIV transmission (including the fact that disclosure of HIV status to a partner enhances its better use) was impressively high amongst almost all participants. But it is worrisome that only half of the participants said they would insist on condom use irrespective of their partners’ willingness to use it or not. V  The variables that were found to be independently associated with disclosure to a partner comparing those who disclosed with those who did not were gender, age, marital status, education, number of sexual partners, and stage of the HIV condition.

Thesis (MPH)--University of Limpopo (Medunsa Campus), 2011 / Background and aim: Smear-negative pulmonary tuberculosis (SNPTB) has become an increasingly important clinical and public health problem, especially in areas that are affected by the dual infection of TB and human immunodeficiency virus (HIV) (Mello et al, 2006; WHO, 2006; Harries et al, 1998). There are recommended guidelines for diagnosing SNPTB to reduce misdiagnosis in sub-Saharan Africa, but there is little information on whether these guidelines are followed correctly (Harries et al, 1998). The aim of this study was to investigate the clinical diagnosis of SNPTB in HIV-positive patients at Athlone Hospital in Botswana. Methods: This was a quantitative, descriptive study which used two sources of data and data collection methods: a 4 year retrospective records review and questionnaires for clinicians. All clinicians responsible for treating HIV-positive patients (n=8) were asked to complete a questionnaire on self-reported (1) compliance with the guidelines (2) use of other methods to diagnose SNPTB and (3) reasons for not complying with the guidelines. All records on SNPTB in HIV-positive patients from 2006 to 2009 (n=281) were reviewed to establish the compliance and use of other methods to exclude other respiratory infections. Results: The response rate for clinicians was 87.5% (7/8). All clinicians (100% [7/7]) reported (a) always complying with using chest x-rays (CXRs), but (b) only sometimes complying with using 3 sputum results. Most clinicians (a) considered the duration of cough before making a diagnosis of SNPTB (57.1% [4/7]), and (b) placed patients on a trial of broad spectrum antibiotics before starting PTB treatment (85.7% [6/7]). The main reasons for non-compliance were: the inability of patients to submit sputum (100% [7/7]), delays in the laboratory (71.43% [5/7]), and lack of feedback from Botswana National Tuberculosis Program (BNTP) (57.14% [4/7]). Only 2.1% (6/281) of the records showed that other methods were used to rule out other respiratory infections, and overall compliance with the recommended guidelines was only 13.5% (40/281). Conclusion: The compliance with the recommended guidelines in making a diagnosis of SNPTB was very poor in this study. The unavailability of user-friendly and fast diagnostic methods resulted in many cases being treated for SNPTB with inadequate investigations.

Thesis ( MPH ) -- University of Limpopo, 2011.

Thesis (M.Cur.) --University of Limpopo, 2013 / Previous research about people living with HIV and AIDS has highlighted social support as an important determinant of health outcomes; i.e. perceived support to be associated with adjustment and coping in relation to HIV diagnosis, as well as its potentially chronic and disability course . The purpose of the study is to determine the effects of HIV and AIDS on the socio-economic status of people infected with HIV and AIDS at the village of Ga-Mathabatha in the Capricorn District of the Limpopo Province, South Africa. In this study, a qualitative, descriptive, exploratory and contextual design is used. A non-probability purposive sampling technique was used to carefully select the sample based on the knowledge that the participants had about the phenomena studied. Semi-structured, one-on-one, in-depth interview with a schedule guide were conducted until saturation of data was reached. To initiate each interview, a central question was was asked: “Describe the effects that HIV and AIDS have on your socio-economic status”. Participants were given an opportunity to describe their experiences with regard to the effects of HIV and AIDS on their socio-economic status. Field notes of semi-structured, one-to-one, in-depth interview session were recorded. A voice recorder was used to capture all the semi-structured, one-to-one, in-depth interviews. The recorded interviews were transcribed verbatim, using Tesch’s qualitative data analysis method. Trustworthiness was ensured by using Guba’s model criteria; i.e. credibility, transferability, confirmability, and dependability. The results indicate that HIV and AIDS have an effect on the socio-economic status of HIV-positive people. Ethical standards for nurse researchers were adhered to, namely permission to conduct the study was obtained from the Medunsa Research and Ethics Committee. Permission to conduct the research project was granted by the Limpopo Turfloop Campus, Limpopo Provincial Department of Health and Social Development, and the ART clinic management at the Ga-mathabatha Relebogile Wellness and ART Clinic. To ensure confidentiality and anonymity, written informed consent was obtained from each participant before he/she could participate in the study. The quality of the research was also insured. Five themes and their sub-themes, and the literature control are presented in the discussion of the research findings. The findings of this study have a central story line which reveals that participants are sharing similar experiences in terms of socio-economic factors after they have tested HIV-positive which are related to several factors; including the involvement of family and friends in their care, changes encountered which affect their social life, household income, and their living conditions. The following five themes and their sub-themes have emerged during data analysis: Theme 1: Different sources of income of HIV-positive people; Theme 2: Living conditions of HIV-positive people; Theme 3: Consequences related to HIV and AIDS disease progression; Theme 4: Support and care to HIV-positive people; and Theme 5: Disclosure versus non-disclosure of HIV-positive status. The results of this study are limited to the Relebogile Wellness and ART Clinic in the Ga-Mathabatha area of the Capricorn District in the Limpopo Province, South Africa. The study findings cannot be generalised to all clinics that are issuing ARVs in the Capricorn District. Study conclusions emphasise the fact that there is a need for HIV and AIDS positive patients to receive continuous support from family, friends, and the community with the purpose of enabling them to cope emotionally, socially, and economically. It also reveals the importance of participants to take their treatment as prescribed with the aim of improving their immune systems. The recommendations emphasise the fact that there is a need for HIV and AIDS patients to receive continuous support from family, friends, and the community with the purpose of enabling them to cope emotionally, socially, and economically. TERMINOLOGY Human Immunodeficiency Virus (HIV) HIV is a virus which has a known and distinct capacity to cause Acquired Immune Deficiency Syndrome once it has entered the body. It attacks a person’s immune system (Kaushik, Pandey & Pande, 2006:43) Acquired Immunodeficiency Syndrome (AIDS) It is the fourth stage of HIV infection and it is usually characterised by a CD4 count of less than 200. It is not a specific illness but rather a collection of illnesses that affect the body to such an extent that the weakened immune system struggles to respond effectively (Kaushik et al., 2006:43) Effects Effects are consequences that are brought about by a cause (Kaushik, Pandey & Pande, 2006:56). Examples of effects are changes in the health status, and standard of living of a population as a result of a programme, project or activity. In this study, effects refer to changes in the socio-economic status of a population that have occurred as a result of the breadwinner in a family who has become unable to go to work due to a weakened immune system that results from HIV and AIDS. Epidemic It is the occurrence of cases of an illness (or an outbreak) in a specific population with a frequency clearly in excess of the normal probability (Giesecke, 2007:19). In this study, an epidemic refers to the effect HIV and AIDS has on the population. Socio-economic status Socio-economic status refers to the standardised way of grouping a population in terms of parental occupation, income, power, prestige, and education (Kirsh, 2006:287). In this study, socio-economic status defines a person’s monthly income, education, and occupation. Family A group of people living together in a permanent arrangement, separated from the rest of the world by the walls of the family dwelling and by societal guarantees of family privacy (Bachmann & Booyens, 2006:4). In this study, a family denotes those people who are living under the same roof with a breadwinner who is HIV-positive.