South Africa is estimated to have one of the highest epidemics of HIV infection. Recent youth studies have found that youth aged 15-24 years are increasingly becoming vulnerable to HIV. Condom use is promoted as one of the key HIV prevention methods in South Africa. Face-to-face structured questionnaire interviews were conducted with a volunteer sample of rural active women and men aged 15-26 years living in 70 villages in the Eastern Cape Province. Most of the participants were recruited in schools.

MPH, Faculty of Health Sciences, University of the Witwatersrand, 2009. / Introduction Patient retention and loss to follow-up in the antiretroviral programmes in South Africa and indeed the world is important as failures to reduce these lead to higher drug resistances and treatment failures. In the light of the few drugs available to treat HIV and AIDS it is imperative that patients lost to follow-up be traced and brought back into the programme. The objectives of the study were to quantify the number of patients enrolled in the programme between 01st June 2004 and 31st December 2004; determine the demographic profile of enrolled patients with regard to age; sex; education; employment and area of residence; to determine compliance and defaulter rates at every monthly appointment up to 6 months of follow-up and to describe follow-up systems in place for tracking patients on ARVs; identifying those who fail to comply with scheduled appointments; and ensuring complianceand finally to identify challenges faced by the hospitals in tracking patients on ARV therapy. Material and Methods The two hospital chosen were the first public hospitals to rollout antiretroviral treatment in Ekurhuleni in 2004. This was a descriptive study involving review of health facility records and primary data collection through key informant interviews at two district hospitals in Ekurhuleni. The study reviewed mechanisms employed by the two hospitals in tracking those patients who started on the programme during the first six months of the ARV programme (June 2004 to December 2004). Results The two hospitals had after six months of starting with the rollout a combined number of 378 patients on treatment. Far East Rand Hospital (FERH) had registered 208 5 patients and Natalspruit (NSH) had 170 patients on their register. Most of the patients started on treatment were from Townships (82%), and 81% of all patients started on treatment were unemployed. The male(33.7%) to female (62.7) ratio was 1:2. Even though on average 90% of patients at both hospitals kept their first six appointment, defaulter rates at FERH was 23,2% and NSH was sitting at 33,1%. Discussion Our results show tha the two hospitals fall short on achieving the requierements by the Departmentof Health’s HIV plan that states under Priority Area 2, point 6.2, that accredited facilities must have the capacity to increase the retention of children and adults on ART – actively trace people on ART who are more than a month late for clinic/pharmacy appointment. The hospitals do not have proper tracking mechanisms in place, they lack important resources like transport, telephones and get wrong addresses. Based on the evidence we have gathered the hospitals’ defaulter rates and loss to follow-up are a concern but they are also not far off when compared to other places and countries whose defaulter rates are 20% on average. Conclusion and Recommendation Retention of patients in the programmes is an essential health imperative. It is therefore necessary that we make the following improvements to our hospital programmes: Make resources like telephone and transport available to healthcare workers; employ a dedicated team of workers doing only patient tracing and followup; invest in technology that would alert health care workers immediately a patient misses an appointment and finally educate the patients themselves of the importance of adherence to treatment and follow-up.

Limited research has been conducted on children’s understanding of HIV/AIDS despite its widespread practice in South Africa today. This study aimed to explore this area, specifically investigating institutionalised children’s understanding of HIV/AIDS Increased mortality rates have been seen as a result of the pandemic. In addition, children are seen as vulnerable to the impact of HIV/AIDS. While some children are directly affected by HIV/AIDS, having lost their parents to the epidemic, other children are infected with the virus. Taking this into account, it was deemed useful to explore how children have made sense of HIV/AIDS. The participants for the current study were between the ages of 8 and 14 years, and they were drawn from a children’s institution in a black community within South Africa. The participants engaged in story telling and drawing as means of communicating their understanding of HIV/AIDS. They participated in the following activities: Draw A Person (DAP), Kinetic Family Drawing (KFD), Draw a picture of a person infected with HIV/AIDS, Drawing a picture of HIV/AIDS, and completing Incomplete Sentences in relation to their understandings of HIV/AIDS. They also answered relevant questions in relation to all their drawings. Thematic content analysis was used to analyse data, together with methods adopted from a study conducted by Wiener and Figueroa (1998). It was found that children have a basic understanding of HIV/AIDS, based on information they obtained from their educators, guardians, peers, and the media. Prominent themes arising from the findings are as follows: the visibility of HIV infection, the impact of HIV on relationships, HIV changing lives, preoccupation with death and dying, confusion about HIV/AIDS, and HIV and Morality. Generally, respondents were found to have a negative perception of HIV/AIDS. It was also found that although respondents seem to have some understanding of HIV/AIDS regarding modes of transmission, and ways of preventing transmission, confusion about HIV/AIDS was dominant.

ABSTRACT: Worldwide, social responses to the HIV/AIDS epidemic have been largely negative, with widespread revulsion to the illness manifesting in hatred, discrimination, rejection, exclusion, marginalisation and fear of those infected, such that witch-hunts, harsh criminal legislation, seclusion camps and other extreme reactions to the illness have been seen (Cameron, 2005). South Africa, despite having enacted a number of laws and policies to protect the rights of people living with HIV/Aids, has not been immune from the negative social response to the disease, with many HIV-positive South Africans having recounted stories of how being HIV-positive has led to alienation from family and friends, difficulties in accessing education and healthcare services, job loss, emotion and verbal abuse, and even physical violence (Campbell, 2003; Preston- Whyte, 2004; Stadler, 2004; Stein, 2004). Negative social responses to HIV/AIDS can be seen as having a detrimental effect on the ability of affected communities to deal with the challenges posed by the disease. For example, fear of the shame and disgrace attached to HIV/AIDS is often at the root of the failure of people to undergo testing, to reveal their HIVpositive status, to seek out treatment and routinely take medication. Cases have been cited of HIV-positive women who continue to breastfeed, despite the knowledge that this may endanger their child, in order to avoid being identified as having HIV, and of HIV-positive people who continue to engage in unprotected sex, for the same reason (Campbell, 2003; Preston-Whyte, 2004). Thus, it is important to tackle the challenge represented by negative social responses to people infected with HIV/AIDS. In order to do so, it is necessary to understand the nature, causes and consequences of responses to the disease. Towards this, this research study has attempted to examine the factors shaping negative social responses to HIV/AIDS among a selected group of white South Africans. Factors that emerged as influential include notions of blame, deviance and morality, as well as pre-existing prejudices, particularly along racial lines.

PhD thesis, Faculty of Health Sciences, University of the Witwatersrand, 2008 / This thesis centres around the issues concerning HIV/AIDS and physiotherapy education, curriculum and practice. In particular, this thesis examines which HIV specific content should be included in a physiotherapy curriculum and ultimately presents a conceptual framework for HIV input into the curriculum. There is a vast body of literature available on HIV. For physiotherapists, however, apart from a brief review given by Nixon and Cott (2000) using the ICIDH, no comprehensive literature is available that places information on HIV into a framework that speaks to physiotherapists as part of the rehabilitation fraternity. The literature on impairments is descriptive and buried in the medical model as symptoms. Section one of the literature review placed the literature in such a framework and provided a comprehensive description using the ICF and related aspects that concern physiotherapists. The ICF captures all the elements of current rehabilitation theory and practice and the literature is presented in an ICF framework. In addition, important background information on prevalence, its determinants, treatment approaches and subsequent impacts were reviewed. As most of the literature available still remains in the medical model, the conditions that manifest and from which patients develop impairments, were reviewed. The effects of HIV on body systems are extensive and pervasive. In each body system HIV has direct effects on mature and maturing cells e.g. progenitor cells and mature muscle cells. In the musculoskeletal system HIV impacts on functional systems and organs resulting in pathophysiological changes that manifest as impairments such as muscle wasting. Conditions manifesting in all body systems were reviewed and outlined. Impairments such as pain, breathlessness and proximal muscle weakness were reported in the literature. In addition to impairments, analysis of the literature revealed studies that had found high levels of functional and activity limitations as well as impacts on Health-related Quality of Life in HIV. The literature also presents the current status of physiotherapy interventions. Many studies have reported that exercises are a safe and effective mode of intervention not-withstanding the limitations encountered. The second part of the literature review focussed on aspects concerned with curriculum. Previous studies have focused on establishing baseline knowledge, attitudes and practices (KAP) to HIV and the impact of training programmes on KAP. What the actual content was for health workers, in particular physiotherapists and the approach to incorporating HIV into curricula is a gap in the literature. To inform the overall aim, with context-appropriate HIV content, this study undertook a number of studies in order to obtain the necessary information on HIV, specific to physiotherapy. Therefore the overall approach was a mixed methods one employing both a quantitative and qualitative study mix. The first and second studies informed the clinical picture and were both cross-sectional and descriptive. In both studies descriptive statistics were used to analyse data, especially in determining the absence or presence of conditions. Study 1 sought to establish the level of referral to physiotherapy by retrospectively examining the patient records of patients admitted with HIVrelated conditions over a period of one year. Of the 732 patient records reviewed, 139 (19%) had diagnoses considered suitable for physiotherapy and 3% were referred to physiotherapy. Study 2 aimed to establish a relevant overview of the functional and participation limitations of people living with HIV. Two groups of patients were studied i.e. an in-patient group and an outpatient group. The out-patient group was from a well resourced mining out-patient setting. The ICF checklist was utilised to collect the data and statistical analysis was performed to indicate the presence or absence of impairments, activity limitations and participation restrictions. A logistic regression was done to determine the odds of activity, limitation or participation restriction given certain levels of domains. Both groups showed high levels of impairment. For the in-patient group loss of muscle power 75%(n=60) energy and drive 75%(n=60), disturbed sleep 71%(n=56), emotional problems 62%(49), mild-severe pain 80%(66), weight maintenance difficulties and diarrhoea were apparent. In the out-patient mining group memory problems, energy and drive functions 36%(n=18), sleep 24% (n=12) and emotional functions 28% (n=14), seeing 32% (n=17), hearing, vestibularproblems 28%(n=14) and pain 55%(n=28), blood pressure and respiratory problems 24%(n=12), weight maintenance 63%(n=32), sexual functions 22%(n=11) and reduced proximal muscular power 24%(n=12) were encountered. The in-patient group had high levels of activity limitations and participation restrictions, while the out-patient mining group did not. There was association between the different domains and in the in-patient group gender (p=0.02) and marital status (p=0.01) were likely to influence the activity and participation levels and the experience of the environment. The remaining three studies involved aspects related to informing the curriculum component of this thesis. Study 3 audited the universities’ curricular documents to establish what the current curriculum included. Seven of the eight universities that offer physiotherapy training were reviewed and their curricula were generally scanty on information regarding HIV/AIDS. When compared to the areas outlined as a result of the literature review, the study of the patients and focus groups with clinicians and academic staff, revealed some gaps, in particular; the types of conditionsand the influence of HIV on other body systems which are pertinent to the clinical reasoning process for the physiotherapist: The philosophy of care and approach to management and the physiotherapists’ role in HIV prevention, treatment and care were evident gaps. Study 4 sought to develop a framework of HIV content for a physiotherapy curriculum. This was done by integrating the results found so far and verifying and enriching this data by gaining clinicians’ and academics’ insights and perceptions around HIV, based on their clinical and educational experience. Focus group discussions were conducted and a qualitative approach was undertaken for data analysis. A framework for curricula content emerged from this exercise. In study 5 the framework of HIV content was used to develop a questionnaire that was sent out in the Delphi survey to academic staff with the aim to test the level of consensus. Eighty three components of the curriculum under four outcome areas (Appendix 7.2) were sent to 68 academic staff who were identified. Of the 68 academic staff, 58 were available and 47 responded and consented to participate. All but two topics obtained consensus set at 80% and the remaining two obtained consensus in the second round. The final chapter discusses the results of these studies and illustrates how these results on HIV affect and can be applied to the physiotherapy curriculum, when applied to the UNAIDS mainstreaming criteria. Applying the mainstreaming principles to the process of including HIV content into the curriculum, ensures that the process is not done in a piece meal fashion but encompasses all important facets which were identified. The programme, if systematically implemented, could result in a coordinated outcome accounting for all the important facets. A conceptual framework is drawn from the results of this thesis illustrating the three levels of curriculum taxonomy: At the micro level, through the body systems, the meso level through the role of physiotherapy, dealing with internal and external domains and teaching approaches. The macro level is accounted for by the facilitatory activities such as advocacy among clinicians and academics and forming strategic partnerships at all levels.

Thesis (M.A.) (Development Studies) --University of Limpopo, 2009. / HIV/AIDS poses a challenge to every person, community and organization to such an extent that nearly every organization should have some policies and programmes to deal with the epidemic. The church as one of the organizations seems to be exempted from the fight against the disease whereas it is the only organization that is more in touch with people in the community than any other organization. The purpose of this study is to explore the role that churches can play in HIV/AIDS prevention in order assist the Bushbuckridge churches on how they can fight against HIV/AIDS so as to help reduce the high rate of infections as well as stop the new infections.

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. / 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 (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.