Magister Artium - MA / This study focused on acceptability of medical male circumcision (MMC) in Ohangwena region, Namibia. Since the scaling up of this program in public hospitals, no study was done with a specific focus on men who are the target population for this intervention. This study aimed at exploring the role of masculinities in MMC acceptance and specifically focused on circumcised men. To understand this context, I initially focused on general constructions of masculinity as well as the historical background of ritual circumcision which used to be practiced in this region. I spent three months at Engela District Hospital working with the male circumcision (MC) regional coordinator who is also the MC Nurse at the same hospital. Data collection process utilised an ethnographic study design involving qualitative research methods namely participant observation, formal and informal interviews and the use of field notes. Participants included men who visited the hospital for circumcision procedure, health workers and community elders. Findings indicate that, circumcision that is now offered in hospital settings is not a recognised marker of masculinity in Ohangwena. There is also paucity of information regarding traditional circumcision. Since its abolishment in the eighteenth century, little is known about the history of this practice. Contemporary means of being a man in this setting are situated in everyday circumstances and include work, being strong, independent and ability to fulfil family responsibilities. Thus, in this context notions of masculinity do not determine men’s responses to MMC. Instead, men are motivated by health benefits in accepting MMC. MMC’s proven ability to reduce HIV transmission by 60% is the primary reason why most men are willing to be circumcised. Other reasons include genital hygiene and correction of medical conditions related to the foreskin such as ulcers and lacerations. Men’s knowledge and understanding of the relationship between MC and HIV prevention also plays a role in MMC acceptance. Some concerns that were raised by men in relation to this intervention are pain and discomfort, fear of complications, decreased penile sensitivity, transfer of untruthful information and gender of circumciser. I regard these concerns as barriers to MMC acceptance. This thesis also argues that, the manner in which MMC is performed out in public health facilities in not gender sensitive since it is mostly done by women. This act in my view is likely to make men feel emasculated and thus discourage other men from taking up this voluntary service. This study therefore recommends similar research in other contexts to challenge speculations made about the likely impact of MMC on masculinity, because, in my research, uptake of MMC has nothing to do with constructions of manhood. I further recommend provision of standardised equipments and resources including human resources for efficient provision of this program countrywide.

Magister Public Health - MPH / The unprecedented increase in HIV and AIDS cases has trickled down to the already impoverished health sector, thus impacting health workers in various ways. In a shrinking health workforce, HIV/AIDS has created an extra demand and workload, emotional burden and stress among health workers. The study aimed to explore and describe nurses’ workplace stressors and coping strategies with regards to HIV/AIDS environment. The exploratory- descriptive study was qualitative in nature. Geita District Hospital was selected as it is the only health facility in the district that provides in-patient care services related to HIV/AIDS. The study population consisted of all nurses who work with HIV and AIDS patients and the managers providing support to nurses. The researcher interviewed twelve nurses and two key informants. Face to face interviews were conducted and a semi-structured interview guide was utilised to collect data. Thematic content analysis was utilised and themes were derived from the concepts that emerged during the process. Validity and trustworthiness of the study was established through triangulation and member checking. The findings of the study revealed that nurses in HIV/AIDS experience stress from the workplace. Nurses struggled with issues of death and dying, feared occupational exposure and found it difficult to cope with nursing shortage, increased workload and inadequate training. The nurses were generally disturbed by lack of organisational support and the unavailability of resources such as; basic medical supplies and protective equipment. Nurses seemed to be resorting more to positive reappraisal, planful problem solving and seeking social support strategies.

Masters of Public Health - see Magister Public Health / Introduction: HIV and AIDS continues to be a major public health challenge for Zambia, which has the highest HIV prevalence rate of 13.1% in sub-Saharan Africa. Although individuals living with HIV/AIDS in Zambia have increased access to antiretroviral treatment (ART), not all patients who are initiated on antiretroviral treatment remain in care; with some patients being lost at different points in the continuum of care. The current study aimed to explore the factors affecting retention in care among patients receiving antiretroviral treatment at three primary health facilities in the Kabwe district in Zambia. Methodology: An exploratory qualitative study design was used to explore the patient, health systems and socio-economic factors that underlie retention on ART in three purposefully selected primary health care facilities in Kabwe district. Data was collected through in-depth interviews with 45 ART patients and three focus group discussions with 20 health care providers. The content of the transcribed interviews was analyzed thematically. Findings: The overall retention rate of the ART sites was found to be 65%. The main patient factors that influenced retention in care were side effects of antiretroviral drugs and weight increase as a sign of good health. The social related factors that influenced patient retention in care were stigma and non-disclosure of HIV status, faith healing, use of herbal remedies and alcohol use. The health system factors that contributed to poor retention of patients in care were long waiting times due to staff shortage, high patient load, travel distance to ART centers and transportation cost. Other health system factors reported by participants included shortage of third line ARV drugs and inadequate space in ART clinic. Finally, food shortage and mobility of patients due to employment were some of the identified economic factors that influenced patient retention in care. Conclusions: A large proportion of adult patients initiating ART in Zambia are poorly retained in care because of patient, health system, social and economic factors. In order to improve retention, more nurses and clinical officers should be trained in ART management to improve skills and address staff shortages. It would also be useful for Zambia to introduce community drug distribution points for delivering ARV refills to reduce the workload on the existing ART sites and reduce on the distances that patients have to travel to ART centers. Additionally, efforts should also be made to improve ART care by extending ART clinic days to include all the days of the week except Sundays.

The aim of this study was to investigate the effects of an agency-based HIV/AIDS Education programme on knowledge and attitudes of undergraduate students at the Walter Sisulu University (WSU) in South Africa. Participants were divided into experimental and control groups. A questionnaire was designed, validated and used to assess knowledge and attitudes of students towards HIV/AIDS who went through the HIV/AIDS education programme (HAEP) and those who did not. The questions were derived and based on basic HIV/AIDS information as part of the 'Alternative National Curriculum on Responsibility' (AANCHOR) programme used by first year WSU staff which was used in the United States of America. The study findings indicate that knowledge and attitudes of the students improved after the intervention. After the intervention, the t-test showed that students‟ attitudes on HIV/AIDS were found to be significant (p=0.045) when comparing the pre- experimental and intervention groups. However, the study also found that some participants displayed ignorance on the knowledge of HIV/AIDS and its effects. For example, some students believe that mosquitoes can spread HIV/AIDS. On the basis of findings the researcher recommends that all first year students should be expose to WSU HAEP because it is a necessity for empowerment with social, self- dependent skills (against HIV/AIDS) and self efficacy. Key words: HIV/AIDS, knowledge, attitudes, Education programme, students.

The aim of this research study was to investigate the effects of HIV/AIDS on teachers and learners of one Secondary School in Mthatha District of Eastern Cape, South Africa. The research design used was a case study; both quantitative and qualitative techniques were employed. The research was conducted in one secondary school, where data was collected using the interview schedules and the questionnaires. The teachers and learners were the respondents. Close-ended responses were analysed using Statistical Programme for Social Sciences (SPSS) computer software. Open-ended responses and interviews were analysed manually using sentence analysis, themes, categories and pattern. Interview responses were also analysed and interpreted using descriptions. From the analysis and interpretation of results, the following main findings emerged: HIV/AIDS has a devastating and deadly effect on both learners and teachers such as:-early sick pensions, redeployments, high teacher death rate, high learner death rate and learner absenteeism. Learner and teacher absenteeism trough HIV/AIDS epidemic, learner drop-out from school because of HIV/AIDS, non-fulfillment of future goals by the learners were discovered by the researcher as some of the findings from the study. From the findings it emerged that HIV/AIDS has devastating and deadly effect on both learners and educators. Support on those who are affected by HIV/AIDS epidemic is recommended by the researcher and the strategies that can be used to control HIV/AIDS epidemic.

The present study sought to explore the functional changes that occur in the vasculature of HIV positive participants of African origin in Mthatha district of South africa which might lead to increased risk in their cardiovascular system. Available literature shows that arterial stiffness plays an important role in cardiovascular events such as stroke, vasculitis and myocardial infarction. Measurement of (aortic pulse wave velocity; PWV) provides some of the strongest evidence concerning the prognostic significance of large artery stiffening. This study was aimed at investigating the relationship between anthropometry, age, E-Selectin level, cytokine levels, haemodynamic variables, blood counts and blood lipid profile with pulse wave velocity. Some traditional cardiovascular risk factors such as alcohol, and smoking were also taken into account. This was a cross-sectional study comprising of 169 participants (62 males and 107 females). 63 were HIV negative (group A), 54 HIV positive on treatment (group B), and 52 were HIV positive not on treatment (group C). Pulse wave velocity (PWV) was assessed using the Sphygmocor Vx. Statistically, ANOVA was used for variables with normal distribution and non parametric tests were used for variables with skewed distribution. Notable significant differences were seen in the means of the following variables across all the 3 groups. The mean PWV value for group C (7.21±2.17) was greater than that for group B (6.84± 1.17) which in turn was more than group A (6.38±1.67); P=0.037. In participants who are HIV negative, In univariate analysis PWV correlated significantly with the following: Augmentation index; AIx (75): (r=0.850,p=0.004): Systolic aortic blood pressure; Spa: (r=0.635, p<.000); diastolic blood pressure; dbp: (r=0.436, p<0.000); aortic pulse pressure; Ppa: (r=0.472, p=0.000); Mean arterial pressure; MP: (r=0.446 p=<0.00) and age (r=0.606, p<0.000). In participants who are on HAART the following variables were positively correlated with PWV: Ppa: (r=0.338,p=0.012), MP: (r=0.400,p=0.400), monocytes (r=0.320,p=0.047). Neutrophils: (r=0.341,p=0.034), CD4: (r=-0.446,p=0.009). In participants who are HAART naïve and HIV positive the following correlated with PWV Spa: (r=0.369, p=0.012), MP: (r=0.400, r=0.003) Ppa: (r=0.338,p=0.012), waist to hip ratio: (r=0.319, p=0.037), platelets: (r=0.037, p=0.019), triglycerides: (r=0.490, p=0.002). With multiple linear regression Spa, age and triglycerides as the only independent and significant determinants of PWV among HIV negatives R2= 56.9% (adjusted R2=54.7%), model adjusted for gender, anthropometric parameters, HDL-C, TC, LDL-C, haematologic data, haemodynamic data, cytokines, smoking and alcohol. Only MP and waist circumference were identified as the most important and significant independent determinants of PWV in HIV positive participants not on treatment. Age, MP, HDL-C, and triglycerides were identified as the significant independent determinants of the variations of PWV in HIV positive participants on HAART. R2 =57 %(adjusted R2 =53.5%). Model adjusted for gender, anthropometric data, smoking, alcohol, cytokines, adhesion molecules, total cholesterol, LDL-C. Haematological data, CD4 count, and other haemodynamic parameters. For Aix(75) In HIV negatives the multiple linear regression model identified age (positive correlation), height (negative correlation), CD4 (positive correlation) and MP (positive correlation) as the independent and significant determinants of AIx (75) among HIV negatives. Spa and Age were independently and significantly associated with the variations of Aix(75) among HIV positives not on HAART. On the other hand height was negatively and significantly associated with Aix(75) amongst HIV positives not on HAART. After excluding confounding factors, height (negative correlation) age (positive correlation), MP (positive correlation, HDL-C (negative correlation), platelets (positive correlation) alcohol intake (excessive consummation associated with positive correlation) and TNFα (negative correlation) were identified as the independent and significant variables associated with increase in AIx(75) among HIV positive participants on HAART. Conclusion: This study showed that HIV infected patients with or without antiretroviral therapy have increase arterial stiffness which is associated with an increased cardiovascular risk. The sphygmocor is an accurate, non invassive and useful tool in the evaluation of arterial stiffness and its use in clinical practice should be encouraged. PWV and the augmentation index (AIx) are the two major non-invasive methods of assessing arterial stiffness. Life style modification should be incorporated into the management of HIV patients so as the continuous monitoring of their haematological and lipid profile.

MIV/VIGS is 'n mediese toestand wat verreikende gevolge vir die individu en sy omgewing inhou. Dit het 'n direkte fisiologiese impak, asook diverse psigososiale en neurologiese gevolge op die persoon (Lowenthal, 1997). Die mees algemene enkele neurologiese komplikasie van VIGS staan bekend as VIGS-demensiekompleks (VDK) (Cournos&Bakalar, 1999). VDK word gekenmerk deur kognitiewe en motoriese disfunksie sowel as gedragsveranderinge en gemoedsversteurings of affekversteurings in verskillende grade (Price, 1996). Ten spyte van die waardevolle literatuur reeds beskikbaar oor die neurologiese, kognitiewe, motoriese en psigologiese impak van VDK, is daar steeds beperkte data oor die gevolglike invloed daarvan op kommunikasievaardighede en die individu se ervaring daarvan (Zuniga, 1999). Om hierdie rede blyk daar 'n gaping te wees in die effektiewe doelgerigte behandeling van hierdie afwyking (Druck, 2002). Die doel van hierdie studie is om ondersoek in te stel na die individu met VDK se subjektiewe siekte-ervaring met betrekking tot moontlike kommunikasiepatologie, sowel as om die rol van die spraak-taalterapeut met betrekking tot individue met VDK te definieer. Daar is van 'n enkelgevallestudie, nie-eksperimentele, beskrywende opnameontwerp gebruik gemaak. Die navorsingsdeelnemer se narratiewe is ontlok deur middel van natuurlike gesprekvoering en 'n oudiobandopname is daarvan gemaak. Die narratief is getranskribeer en die volgende drie metodes is gebruik om dit volledig en omvattend te analiseer: 1.)Plotanalise, 2.) Strukturele storie-analise volgens Labov (1982) se strukturele benadering, en 3.) Holistiese inhoudsanalise. Uit die plotanalise het dit duidelik geword dat die betrokke narratief regessief van aard is. Tydens die bespreking van die meta-narratiewe het verskeie aspekte van hierdie individu met VDK se persoonlike siekte-ervaring na vore gekom wat betref die invloed daarvan op haar vermoë om steeds haar lewenskwaliteit te handhaaf deur aan haar alledaagse lewensaktiwiteite te kan deelneem. Die ICFkomponente is as raamwerk gebruik om die verkreë inligting op 'n sinvolle wyse voor te stel. Dit wil verder voorkom of die siekte-ervaring nie tot spesifieke aspekte van menslike funksionering, onder andere kommunikasiefunksies, beperk kan word nie. Die ervaring van haar kommunikasieprobleme maak deel uit van haar algehele siekte-ervaring wat binne die konteks van haar alledaagse lewensaktiwiteite en deelname daarin plaasvind. Die identifikasie en analise van die temas het dit verder duidelik gemaak dat narratiewe 'n effektiewe metode is om insig te verkry in die individu met VDK se konteks en ervaring daarvan. 'n Geheelbeeld van die individu se funksionele vaardighede, konteks en emosionele ervarings en behoeftes is verkry, sonder om haar bloot te stel aan formele toeste en evalueringsinstrumente wat haar onbevoeg en minderwaardig kan laat voel. Die verkreë resultate impliseer ook dat die individu met VDK se siekte-ervaring sentraal is tot sy of haar mate van deelname aan alledaagse lewensaktiwiteite asook ervaring van kwaliteit van lewe. Die waarde van narratiewe in die terapeutiese behandelingsproses het ook in hierdie studie duidelik geword. Narratiewe kan suksesvol aangewend word om 'n verbeterde insig in die individu met VDK se lewe en behoeftes te verkry. ENGLISH : HIV/AIDS is a medical condition that has far-reaching consequences for the individual and his or her environment. It has a direct physiological impact, as well as diverse psychological and neurological effects on the individual (Lowenthal, 1997). The most common single neurological complication of AIDS is known as AIDS Dementia Complex (ADC) (Cournos&Bakalar, 1999). ADC is associated with cognitive and motor dysfunction as well as behavioural changes and mood disorders of different degrees (Price, 1996). Despite all the valuable literature already available on the neurological, cognitive, motor and psychological impact of ADC, there is still limited data on the consequential influence thereof on the communication skills and the individual's experience and treatment of this (Zuniga, 1999). Therefore there seems to be a gap in the effective goal-directed treatment of this disorder. (Druck, 2002). The aim of this study is to investigate the subjective illness experience of the individual with ADC in terms of possible communication difficulties, and to define the role of the speech-language therapist in this regard. A single case study, non-experimental, descriptive research design was used. The research participant’s narrative was elicited by means of natural conversation and recorded on audio tape. The narrative was transcribed and analysed, using the following three methods: 1.) Plot analysis, 2.) Structural story analysis according to Labov’s (1982) structural approach, and 3.) Holistic content analysis. According to the plot analysis this was a regressive narrative. During the discussion of the meta-narratives, different aspects of the research participant's personal illness experience were identified as regards the influence thereof on her ability to maintain her quality of life through participating in everyday living activities. The ICF components were used as framework to present the results obtained in a meaningful manner. It also became apparent that the illness experience cannot be isolated to specific human functions, such as communication. The experience of her communication problems is part of her complete illness experience, which takes place in the context of her everyday living activities and participation therein. The identification and analysis of themes also indicated that the narrative is an effective method to gain insight into the individual’s context and experience thereof. A holistic view could be obtained of the individual’s functional skills, context and emotional experience and needs, without subjecting her to formal tests and evaluation instruments which might leave her feeling incompetent and inferior. The results obtained imply that the individual with ADC’s illness experience is central to the extent to which he or she participates in everyday life activities as well as to the quality of life experienced. The value of narratives in the therapeutic treatment process also became apparent. Narratives can successfully be applied to gain better insight into the life and needs of the individual living with ADC. / Dissertation (M (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / unrestricted

Thesis (M. A. (Clinical Psychology)) -- University of Limpopo, 2015 / The purpose of this study was to find out if athletes who participate in soccer and rugby are aware of the risk of HIV infection in contact sports. The sample consisted of male rugby (n=23) and soccer (30) players registered at the University of Limpopo (Turfloop campus). The research was a quantitative in approach with a cross sectional survey design. A qualitative element, in the form of open-ended questions, made the study more holistic as participants were able to express their thoughts freely. Quantitative data were analysed using descriptive statistics (frequencies, percentage and bar-graphs). Thematic Content Analysis was used to analyse the qualitative data obtained from open-ended questions. Thirteen themes were gleaned from the data namely, prevention, well-being, medical assistance, confidentiality, discrimination, fear and anxiety, emotional support, strategy, participation, mandatory testing, risk and relationship ambiguity. Results of the study, both qualitative and quantitative, generally supported previous research in that there are gaps in HIV knowledge, although not statistically significant. Relationship behaviour in terms of an HIV positive diagnosis reflected ambiguity amongst the participants with some participants stating they would tell their partners but many being unsure or not prepared to tell their partners about their status for fear of the relationship ending.

Includes bibliographical references (leaves 76-85). / [No title page] This study underscores the need to tackle the escalating HIV /AIDS pandemic in Zimbabwe through a developmental and human rights based approach. In particular it focuses on second generation rights because of their emphasis on the social welfare of individuals. Second generation rights relate to the living conditions of people in society, attempting to ensure that individuals have adequate standard of living. This is achieved through the provision of adequate food, clothing, income, housing, medical care and other essential social services. While acknowledging that behaviour change is an essential element in fighting HIV/AIDS since the virus is spread mostly through sexual contact, the study recognises that it is of limited effect if factors that constrain the ability of individuals to alter their behaviour are not addressed. The study thus recommends the upholding of second-generation rights as an effective compliment to behaviour change strategies. Without mechanisms that facilitate change and build a conducive environment for such a transformation, the HIV/AIDS pandemic will continue to rage on. The research is a qualitative study conducted with a single case study. Zimbabwe is used as a case study as it provides a unique example of a country that has managed to lower its HIV/AIDS prevalence. However, it is now faced with an overwhelming challenge of increasing or at least sustaining this downward trend of the epidemic. Unfortunately, due to an economic and political melt-down the country is suffering a serious humanitarian crisis that has impoverished the community, encouraging risky sexual coping strategies and severely undermined the countries health delivery system, all which work to threaten the success achieved so far in the battle against HIV/AIDS.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Despite evidence that Human Immunodeficiency Virus (HIV) is not transmitted through casual contact, people continue to demonstrate behaviors which indicate a fear of casual-contact transmission. This has been identified as contributing to the social isolation experienced by people with AIDS. This study was undertaken to determine the relationships among AIDS Knowledge (AK), Perceived Susceptibility (PS) to casual-contact transmission of HIV and Social Distance (SO), or the degree of hesitancy to interact with people with AIDS in casual-contact situations. The study was conducted in a Vermont community; an area with a low incidence of AIDS. Sixty eight subjects, from a random, digit-dialing sampling technique, were interviewed by telephone. Instrumentation consisted of: an AIDS Knowledge Tool, a six-item tool to measure PS to casual-contact transmission of HIV, a six-item SD scale to measure the level of casual-contact at which the individual would hesitate to interact with a person with AIDS, and demographic information. The scales measuring PS and SD were developed by the investigator. A negative, significant relationship was observed between AK and PS, and a positive, significant relationship was found between PS and SD. The relationship between AK and SD did not reach significance levels. A subscale of 9 Transmission-Related AIDS Knowledge items was developed and was found to have a stronger, negative relationship with PS, and a negative, significant relationship with SD. It was concluded that the findings, despite the methodological limitations, warranted further study with a larger, more diverse sample and to further develop instrumentation. The association between TransmissionRelated AK and both PS and SD indicates that education programs, specifically related to transmission may impact people's fears of casual contact transmission and their distancing behavior. / 2031-01-01