Magister Curationis - MCur / Globally, tuberculosis (TB) and AIDS are the leading causes of morbidity and mortality of people, particularly in many developing countries. South Africa is among those countries with a high double burden of TB and HIV infections in the world. Although policy guidelines have been developed to mitigate the problems of TB and HIV coinfection, there are still challenges with their implementation. The aim of this study was to analyse the implementation of the integrated TB and HIV policy in a rural sub-district of the Western Cape. The study applied a descriptive survey method to collect data from 60 respondents selected using an all-inclusive sampling strategy. A self-reporting questionnaire was used, and data were analysed using the Statistical Package for Social Sciences (SPSS) program version 23. Descriptive statistics are presented with graphs and percentages. All ethical principles were adhered to. The results showed that 86% of the respondents were female nurses, 59% were registered nurses, and the rest were enrolled and assistant nurses. The general view of participants was that implementation of the integrated TB and HIV policy was poor, as only 25% (11) felt that they have sufficient knowledge and skills to implement it, while 50% (22) did not feel equipped to implement the integrated policy. These perceptions of inadequacy were justified by a lack of sufficient training, with only 32% of the respondents having attended training on integrated TB and HIV management. The nurses’ responses on actual practices ranged from poor to sufficient, and example being the management of HIV-positive TB patients with CD4 count of <100/μl, where 27.9% were unsure when to initiate antiretroviral therapy and 44.7% were unsure when isoniazid prophylaxis could not be given to HIVpositive patients. However, the findings indicated that TB and HIV policy guidelines were 86% and 85.7% accessible respectively. The study concluded that nurses do not implement the integrated TB and HIV policy guidelines sufficiently, mainly due to lack of adequate training which resulted in limited knowledge thus poor practice. It is recommended that a continuous staff capacity development programme, which includes suitable pre-service and in-service training in TB and HIV/AIDS management be developed and implemented as it has the potential to address the current knowledge and skills gaps which impact on implementation of the integrated TB and HIV policy.

Magister Public Health - MPH / The threat that HIV/AIDS poses to most institutions, including the Parliament of the Republic of South Africa, can potentially be decreased by reducing stigma and discrimination. Parliament’s Policy on HIV and AIDS provides protection for people living with HIV and AIDS (PLWHA) against stigma and discrimination. The purpose of this study was to explore employee perceptions of HIV/AIDS stigma in the Parliament of the Republic of South Africa in order to inform improved anti-stigma strategies and interventions. This exploratory qualitative crosssectional study used individual interviews and focus group discussions among Parliamentary employees to examine perceptions of: HIV/AIDS related stigma in the workplace, the effectiveness of Parliament’s HIV/AIDS response strategy, and how HIV/AIDS-related stigma might be effectively addressed. A total of 49 respondents participated in: a) 19 individual interviews across five employment grades (A-Band to E-Band). b) 4 focus group discussions of 6- 9 people each. Data was analysed using thematic analysis. Five main themes were identified, as well as additional sub-themes. The main themes were: the actual acts of discrimination (enacted stigma), concerns related to disclosure, assumptions and preconceptions about causes and signs of HIV infection, concerns about psychological impact and lack of knowledge and education. Discrimination was generally described as being treated differently, as well as prejudice and negative attitude to a person with HIV/AIDS. More specifically, it was understood as labelling those who are HIV positive negatively and ostracizing them. Gossip and lack of confidentiality were the main barriers to disclosure and testing while weight loss and long term sick leave were interpreted as classic signs of a person who is HIV positive in Parliament. Fear played a major role in these respondents’ accounts of HIV/AIDS related stigma, while the perceived widespread ignorance was attributed to lack of information, knowledge and education. Respondents perceived Parliament’s HIV/AIDS response strategy to be ineffective. They suggested more awareness and training, establishment of support groups, involvement of PLWHA and involvement of Senior Management in addressing HIV/AIDS related stigma in Parliament.

This study explores how HIV-positive teachers within a specific social context understand, interpret and act on HIV and Life Skills policy. My aim was to illuminate the experiences of teachers living with AIDS and how their experiences affect the ways in which they understand and act on government policy. As a constructivist, I worked on the premise that people’s experiences can best be understood by interacting with them and listening to them. I chose a narrative research design because it allowed me to explore and understand the perceptions and complexity of my research partners’ experiences, and to faithfully present and represent the stories told by teachers living with AIDS. I used the data collected from the teachers’ stories to write narratives that gave a first person account of the experiences of each teacher. To express my own voice in the text I created a column on the side of each page where I recorded my own experience of the process of the inquiry. I used inductive analysis in order to make sense of the field data. Rather than beginning with a theory, inductive analysis allowed me to expose the dominant and significant themes in the raw data without imposing preconceptions on the data. Three distinct themes emerged from the analysis, and formed my conceptualisation of the experiences of teachers living with AIDS: a) conflict between teacher as role model and ideal citizen, and teacher as an HIV-positive person; b) HIV illness and its impact on the body of the teacher; c) teachers as emotional actors. The main findings from the study suggest that in a context with AIDS there are limits to what education policy can achieve if it remains out of touch with a real world in which school is attended by children and teachers whose bodies are either infected or affected by the HIV virus. This is substantiated by the fact that while the HIV/AIDS policy is about bodies and about emotions, it is blind to the bodies and the emotions of those implementing it. I contend that it is this oversight that creates the wide gap between policy intentions and outcomes. Secondly the study highlights the uniqueness of HIV/AIDS education policy and its implementation which, unlike other education policies, powerfully brings to the fore the emotions of the implementers. I conclude the study by suggesting that the policy-making process be reconstructed to inscribe the real bodies and real emotions of the teachers into the policy, to shift from a purely prevention mode to one that looks at the whole prevention-to-care continuum and acknowledges that a significant majority of school pupils and teachers are infected and affected. / Thesis (PhD)--University of Pretoria, 2009. / Education Management and Policy Studies / unrestricted