Thesis (MA)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: South Africa is one of the countries with the highest HIV prevalence rates worldwide and younger age groups are often disproportionately affected. Knowledge of HIV status is regarded as an important prevention strategy for reducing HIV transmission and infection and it is viewed as a means to access antiretroviral therapy. Routine HIV Counseling and Testing (RCT) can significantly increase knowledge of HIV status, but it is unclear whether RCT will be accepted if offered. The aim of this study was to determine whether the main dimensions of the Health Belief Model (HBM) namely, perceived susceptibility, perceived severity, perceived benefits and perceived barriers can predict acceptance of RCT. A second objective of the study was to determine if the variable of the HBM, namely cue’s to action could significantly contribute to predicting acceptability of RCT. A sample of 1113 students at the University of Stellenbosch in the Western Cape Province of South Africa completed a structured questionnaire, measuring the acceptability of RCT. Multiple regression analysis was used to analyze the data and it was found that the main dimensions of the HBM could explain 25.1% of the variance in acceptance of RCT. It was however found that the variable perceived severity did not make a significant individual contribution to predicting acceptability of RCT. The addition of the variable cues to action also did not make a significant individual contribution to the prediction of RCT. It was therefore found that the HBM could partially, but not in its entirety, predict acceptability of RCT among the student population. Interventions should therefore aim to increase perceived benefits of RCT, reduce perceived barriers to RCT and facilitate correct personal risk assessment in order to increase perceived susceptibility. / AFRIKAANSE OPSOMMING: Suid-Afrika is een van die lande met die hoogste MIV voorkomsyfers wêreldwyd en jonger ouderdomsgroepe word dikwels disproporsioneel geaffekteer. Kennis van MIV status word beskou as ’n belangrike voorkomingstrategie vir die vermindering van MIV oordrag en infektering en dit baan verder ook die weg tot antiretrovirale terapie. Roetine MIV Berading en Toetsing (RBT) kan daarin slaag om kennis van MIV status aansienlik te verhoog, maar dit is egter onduidelik of RBT aanvaar sal word, indien dit aangebied word. Die hoofdoel van hierdie studie was om te bepaal of die hoofdimensies van die Gesondheidsoortuigingsmodel (GOM), naamlik waargenome vatbaarheid, waargenome erns, waargenome voordele en waargenome hindernisse, aanvaarding van RBT sal kan voorspel. ’n Verdere oogmerk van die studie was om te bepaal of die veranderlike van die GOM, naamlik aanwysings tot aksie, ’n beduidende bydrae tot die voorspelling van aanvaarding van RBT kon lewer. ’n Steekproef van 1113 studente aan die Universiteit van Stellenbosch in die Weskaap Provinsie van Suid-Afrika het ’n gestruktureerde vraelys, vir die meting van aanvaarding van RBT, voltooi. Veelvuldige regressie-analise was gebruik om die data te analiseer en daar was bevind dat die hoofdimensies van die GOM 25.1% van die variansie in aanvaarding van RBT kon voorspel. Die veranderlike waargenome erns het egter nie ’n beduidende individuele bydra tot die voorspelling van RBT gelewer nie. Die byvoeging van die veranderlike aanwysings tot aksie het verder ook nie ’n beduidende individuele bydrae tot die voorspelling van RBT gelewer nie. Daar is dus bevind dat die GOM gedeeltelik, maar nie as geheel nie, aanvaarding van RBT onder die studentepopulasie kan voorspel. Intervensies behoort daarom te fokus op die vermeerdering van waargenome voordele verbonde aan RBT, die vermindering van waargenome hindernisse tot RBT en korrekte persoonlike risiko-evaluering vir die verhoging van waargenome vatbaarheid vir MIV.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--Stellenbosch University, 2008. / One of the greatest challenges in the world today is fighting the HIV/AIDS pandemic. Life expectancy in developing countries, especially those in sub-Saharan Africa, decreased to 46 years while in developed countries the average life expectancy is 78 years. World Health Organisation(WHO) indicates that HIV/AIDS, now the world's leading cause of death in adults aged 15 to 59 years, is killing almost 5 000 men and women in this age group, and almost 1 000 of their children, every 24 hours in sub- Saharan Africa. In South Africa today, employees operate in an increasingly complex legal environment with regard to HIV/AIDS in the workplace. Despite the legal protection against employees affected by HI/AIDS and vigorous campaigns to combat HIV/AIDS in support of affected employees, the researcher has observed that management and co-workers show no compassion, empathy or understanding for the needs of these affected employees. An in-depth literature review of quality of life was completed. The goal of this study was to investigate whether the quality of life of the employee affected by HIV/AIDS is adversely affected. The following objectives were set: • To determine the family history of the employee affected by HIV/AIDS • To determine occupational history of the employee affected by HIV/AIDS • To determine the symptoms of the employee affected by HIV/AIDS • To determine the effectiveness of the anti-retroviral treatment programme of the employee affected by HIV/AIDS A descriptive qualitative research design using the case study method was applied to investigate whether the quality of life of the employee affected by HIV/AIDS was adversely affected. The population of this study were HIV/AIDS-affected employees working at a food and beverage company. Ten employees who gave consent participated in the study. The trustworthiness of this study was assured with the use of Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability. A pre-test study was also completed. All ethical principles were met. Data was collected through an interview using an interview guide designed for use in a semi-structured interview. Data analysed show that the basic needs of the employee affected by HIV/AIDS are not adequately met and that the employee therefore does not experience quality of life. Recommendations include the improvement in public–private partnerships; in-service training and continuous refresher courses for all employees, supervisors and management; employee assistance programmes; involvement of church and communities; support circle; holistic approach in nursing care and further research. The findings play a role in understanding the importance of remaining at work for as long as possible when one is affected by HIV/AIDS. The findings of this study further validate the concepts in basic needs and that QOL is perceived differently by each individual.

Thesis (MA)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: The human immune deficiency virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) have already reached a magnitude in Southern Africa which can hardly be addressed by the existing structures. HIV counselling is considered to be an important preventative and supportive strategy in the battle against HIV. In recent years therefore, urgent attempts have been made to provide HIV/AIDS counselling services throughout South Africa. The researcher had a firsthand experience of such an attempt as manager of HIV counselling services for a NGO working in a peri-urban community. She realised that although the ideal outcome and aims of HIV counselling have been widely documented, very little research has been done on the implementation of these principles in health systems with limited resources. It was thought that a meaningful contribution could be made to the development of HIV counselling services in a specific South African community by critically exploring current HIV counselling services in such a community. This exploration entailed the following: • reviewing the literature on HIV counselling; • clarifying the goal of HIV counselling; • clarifying behaviour change as an outcome of HIV counselling; • exploring the influence of the Stellenbosch context on the content and outcome of HIV counselling; and; • exploring to what extent the goals of HIV counselling (as prescribed by international and national literature) are pursued in the Stellenbosch context. The ecological model and an action research method were used to direct this study. The researcher used her position and experience as manager of the HIV counselling services within a non-governmental organisation to access sources of information. Direct and participatory observations were utilised to gather information regarding the implementation of HIV counselling services in the community. The model of Raeburn and Seymour (1979) and specifically the overview phase have been used as a framework to organise the data and to describe the HIV counselling system in the specific community. The researcher concluded that the theoretical principles that were identified as prerequisites for effective HIV counselling services were often irreconcilable with the management skills, context, infrastructure and aims of the primary health services within the district. It was highlighted that a systemic understanding of the impact of the environment should be considered when future models and outcomes are formulated and implemented. Finally, alternative suggestions for the management, the formulation of outcomes and the utilisation of personnel in HIV counselling in this specific community were discussed. / AFRIKAANSE OPSOMMING: Die Menslike Immuniteitsgebreksvirus (MIV) en Verworwe Immuniteitsgebreksindroom (Vigs) in Suider-Afrika het reeds 'n omvang bereik wat beswaarlik deur die bestaande strukture aangespreek kan word. MIV-berading word beskou as 'n belangrike voorkomende en ondersteunende strategie in die stryd teen MIV. In die laaste paar jaar is dringende pogings dus aangewend om MIV-beradingsdienste in die hele Suid Afrika beskikbaar te stel. Die navorser het eerstehandse ervaring gehad van hierdie inisiatief as bestuurder van MIV -beradingsdienste vir 'n nie-regeringsorganisasie wat werksaam is in 'n semilandelike gemeenskap. Alhoewel die ideale uitkoms en doel van MIV -berading wyd gedokumenteer is, het sy besef dat baie min navorsing gedoen is oor die implementering van hierdie beginsels in gesondheidsisteme met beperkte bronne. Daar is geredeneer dat 'n betekenisvolle bydrae gemaak kan word tot die ontwikkeling van MIV -beradingsdienste binne 'n spesifike Suid-Afrikaanse gemeenskap deur die huidige MIV -beradingsdienste in so 'n gemeenskap krities te verken. Hierdie verkenning het die volgende behels : • literatuur oor MIV -berading te bestudeer; • MIV-berading se doelwitte te verhelder; • gedragsverandering as uitkoms van MIV -berading te verhelder; • te eksploreer hoe die Stellenbosch konteks die inhoud en uitkoms van MIV -berading beïnvloed; en • te eksploreer tot watter mate die doelwitte van MIV -berading ( soos voorgeskryf deur internasionale en nasionale literatuur) in die Stellenbosch konteks nagestreefword. Die ekologiese model en 'n aksienavorsingsmetode is gebruik om die ondersoek te rig. Die navorser het haar posisie en ervaring as bestuurder van MIV -beradingsdienste binne 'n nie-regeringsorganisasie gebruik om toegang te verkry tot inligting. Direkte en deelnemende waarneming is gebruik om inligting in te samel rakende die implementering van MIV -beradingsdienste in die gemeenskap. Die model van Raeburn en Seymour ( 1979) en spesifiek die oorsigfase is gebruik as 'n raamwerk om data te organiseer en die MIV -beradingsisteem in die spesifieke gemeenskap te beskryf. Die navorser het tot die gevolgtrekking gekom dat die teoretiese beginsels wat geïdentifiseer is as essensiële voorvereistes vir effektiewe MIV -beradingsdienste in soveelopsigte onversoenbaar is met die bestuursvaardighede, konteks, infrastruktuur en doelwitte wat binne die spesifieke primêre gesondheidsdienste geld. Dit is beklemtoon dat In sistemiese verstaan van die invloed van die omgewing en die inagneming van die sisteem belangrik is wanneer toekomstige doelwitte geformuleer en modelle geïmplementeer word. Alternatiewe voorstelle vir die bestuur van beradingsdienste, die formulering van uitkomsdoelwitte en die benutting van personeel in hierdie dienste is ten slotte bespreek.

The high prevalence of HIV/AIDS in Zambia has led to the development of innovative ways of coping with sickness related to this infection. HIV/AIDS home-based care is one such innovation designed in Chikankata Hospital in 1987. Home-based care depends on the availability of family members and community volunteers in the provision of care and support for People Living with HIV/AIDS (PLWHA).<br /> <br /> This minithesis is based on a qualitative descriptive case study exploring perspectives regarding skills, supervision and support mechanisms for carers in the Chikankata HIV/AIDS Community-Home Based Care (CHBC) program. The study utilized documented research, focus group discussions with carers and structured interviews with local CHBC supervisors, national experts in CHBC, and PLWHA and their families, to collect data from 32 study participants.<br /> <br /> The findings were that CHBC was being delivered by community volunteers with limited involvement from the local health services / that carers were highly motivated, personally and collectively mobilizing resources to meet the needs of CHBC clientele / that local arrangements for training, skills and support of carers were not aligned to national guidelines regarding process, content and duration of programmes / and that carers acquired skills in CHBC through formal and informal training processes and were facing challenges related to inadequate skills, poor infrastructure and extreme poverty in households caring for PLWHA. <br /> <br /> Based on the findings the local arrangements for coordination of CHBC need to be strengthened and linked to formal processes for technical support, financial resources and materials for delivery of CHBC in line with existing guidelines on CHBC. The picture of the real situation of the carers that emerges from this qualitative study might inform the supervising organizations and policymakers on the gaps in the training and support of this crucial cadre in the provision of quality care for People Living with HIV/AIDS (PLWHA) at community level.

Currently, HIV/AIDS is one of the greatest threats to child survival in South Africa. It is estimated that approximately 6000 newborn babies become infected with the HIV virus monthly i.e. approximately 200 babies per day. During a 24 month period (October 1999 &ndash / October 2001), a descriptive prevalence study of the oro-facial manifestations affecting HIV-positive children was conducted in the Cape Peninsula, South Africa. The study population consisted of 268 vertically infected HIV-positive children. The study was motivated by the lack of data regarding oral mucosal lesions in children with vertically acquired HIV-infection.<br /> <br /> The study design was descriptive, and the population included consecutive, vertically infected HIV-positive patients sourced from out-patient clinics, hospital wards and special child-care facilities. The children were examined once consent was obtained from caregivers. The findings were documented using data capturing sheets. The data was captured on the Microsoft Excel program and analysed using the Epi 2000 program. The results indicated that a large proportion of HIV-infected children presented with orofacial manifestations at some stage during the course of HIV-infection. Oro-facial manifestations were observed in 70.1% of the study population. The prevalence of the most commonly observed manifestations were: oral candidiasis, 38.8% / parotid gland enlargement, 10.8% / oral ulceration, 5.6% / molluscum contagiosum, 7.8% / periodontal conditions, 3.4% / and herpes simplex infection, 0.7%.It can be concluded that in this sample of HIV-infected children, the prevalence of orofacial manifestations is higher than, and comparable with the findings of similar studies conducted in other regions of the world.

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2014. / Determining e ective treatment strategies for life-threatening illnesses such as HIV is a signi cant problem in clinical research. Currently, HIV treatment involves using combinations of anti-HIV drugs to inhibit the formation of drug-resistant strains. From a clinician's perspective, this usually requires careful selection of drugs on the basis of an individual's immune responses at a particular time. As the number of drugs available for treatment increases, this task becomes di cult. In a clinical trial setting, the task is even more challenging since experience using new drugs is limited. For these reasons, this research examines whether machine learning techniques, and more speci cally batch reinforcement learning, can be used for the purposes of determining the appropriate treatment for an HIV-infected patient at a particular time. To do so, we consider using tted Q-iteration with extremely randomized trees, neural tted Q-iteration and least squares policy iteration. The use of batch reinforcement learning means that samples of patient data are captured prior to learning to avoid imposing risks on a patient. Because samples are re-used, these methods are data-e cient and particularly suited to situations where large amounts of data are unavailable. We apply each of these learning methods to both numerically generated and real data sets. Results from this research highlight the advantages and disadvantages associated with each learning technique. Real data testing has revealed that these batch reinforcement learning techniques have the ability to suggest treatments that are reasonably consistent with those prescribed by clinicians. The inclusion of additional state variables describing more about an individual's health could further improve this learning process. Ultimately, the use of such reinforcement learning methods could be coupled with a clinician's knowledge for enhanced treatment design.

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree in Master of Science in the School of Molecular and Cell Biology August 2017 / Antiretroviral therapy (ART) drugs such as stavudine (d4T) are known to have off-target side-effects, including the inhibition of DNA polymerase gamma which replicates mitochondrial DNA (mtDNA). ART-induced depletion of mtDNA copy number may cause mitochondrial toxicities such as sensory neuropathy (SN). Genetic variation in DNA polymerase gamma or in other nuclear genes influencing mtDNA replication and mtDNA copy number may therefore contribute to susceptibility to d4T-induced SN. DNA samples from 263 HIV-positive South African adults exposed to d4T were classified as cases with SN (n = 143) and controls without SN (n = 120). A total of 28 single nucleotide polymorphism (SNPs) were chosen in nuclear genes from the mtDNA replication pathway and from a GWAS paper examining SNP association with ART-induced SN (Leger et al. 2014). Genotyping was performed using Sequenom Mass Spectrometry. MtDNA copy number was determined using a qPCR assay. Associations between SN and genetic variants, between genetic variants and mtDNA copy number, and between mtDNA copy number and SN were evaluated in univariate and multivariate models using Plink v1.07 and GraphPad v7. Age and height were significantly different in the cases with SN vs controls without SN. In univariate analyses, three SNPs and two haplotypes were significantly associated with SN, three SNPs were associated with pain intensity and three haplotypes were significantly associated with mtDNA copy number. However, there were no significant associations with SN, pain intensity or mtDNA copy number after correction for multiple SNP testing. No significant difference in mtDNA copy number in cases vs. controls was observed. In conclusion variation in nuclear-encoded mitochondrial genes examined in the current study do not play a role in ART-related mitochondrial complications such as changes in mtDNA copy number, or occurrence of SN. / MT2018

A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in the Political Studies Department, Faculty of Humanities, University of Witwatersrand, Johannesburg, South Africa 8 March 2015 / HIV is the most pressing public health and development challenge facing Botswana. Reducing gender-related vulnerability to HIV is one of the top priorities of the government and its development partners. Civil society organisations (CSOs) have been identified as crucial in these efforts. As a result, civil society has grown in Botswana, in both numbers and size, to deliver services such as home-based care, counselling, and testing. Yet to reduce gendered vulnerability to HIV, social and human development goals must be met in several sectors of society. The focus on HIV-related services has implications in practise, policy, and theory that may compromise long-term development aims and co-opt civil society. This research draws on critical theory and uses action research methods to investigate the role of civil society in Botswana for reducing gendered vulnerability to HIV, now and in the future. The case of Botswana is a crucial one, as it has one of the highest HIV prevalence rates, as well as the resources, both domestic and from partners, to mobilise a comprehensive response. The combination of these factors has afforded the opportunity to gain insights to inform civil society theory and development approaches in both policy and practise to improve the HIV response and civil society’s role in it. Through a literature review, interviews with key informants, a survey, and a workshop, this research found that the HIV response in Botswana is addressing many of the issues suggested by global development partners, such as UNAIDS, at the policy level, though implementation is lacking, especially concerning male involvement in gender programming. It found that efforts to meet the immediate needs are in place, but the long-term strategic interests are only incrementally addressed. This suggests that HIV is causing a development deficit. Additionally, the roles that CSOs serve in the response are focussed on serving these immediate needs, making it increasingly difficult for the response to effect broader social change to achieve gender equality and development. Civil society is taking on more responsibility in the public sector, which puts it in a vulnerable position. Its role needs to be reconceptualised in the HIV response and in development more broadly. This research proposes theoretical and policy implications to inform civil society-state relations; approaches to address complicated social development issues, such as genderbased violence; and offers an 18-point analytical framework to address operational and programmatic capacities in civil society. The framework offers a new category for the dynamic analysis of civil society organisations while working with the state called ‘civil agents’. It also describes the bridge function that CSOs serve when working with key populations, such as sexual minorities, in criminalised settings. Together these theoretical and policy implications can contribute to the understanding of civil society in the HIV response, and gender equity in the context of the post-2015 global development agenda. Key words: Civil Society Organisations, Non-governmental Organisations, HIV, Gender, Botswana, Development, Critical Theory, Action Research / MT2016

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Genetics. Johannesburg, South Africa 2017 / Background: Stavudine (d4T) use is associated with the development of sensory neuropathy (SN), several mechanisms may underlie d4T-induced toxicity, including: (1) Inter-patient genetic variability in the genes modulating the deoxynucleotide triphosphate (dNTP) pool sizes. (2) Variation in intracellular ARV drug concentrations due to genetic variation in drug transporters. In our study we examined the genetic variation in four stavudine transporter genes and seven genes regulating the deoxythymidine triphosphate (dTTP) synthesis and their associations with d4T-induced SN or CD4+ T cell count or mtDNA copy number. Methods: We examined a cohort of HIV-positive South African (SA) adults exposed to d4T, including 143 cases with SN and 120 controls without SN. 26 single nucleotide polymorphisms (SNPs) from the literature were chosen, prioritised on being tagSNPs with minor allele frequency >5% in Kenyan Luhya (a proxy population for the SA Black population); SNP functional effects and suitability for multiplex analysis on the genotyping platform. Genotyping was performed using Sequenom mass spectrometry. A qPCR assay was used to measure the mtDNA copy number. Association of sensory neuropathy, CD4+ T cell count and mtDNA copy number with genetic variants was evaluated using PLINK. Results: All 26 SNPs were in Hardy-Weinberg equilibrium (HWE) in both the cases and controls. SNP rs8187758 of the SLC28A1 transporter gene and a 3-SNP haplotype ABCG2 were significantly associated with CD4+ T cell count after correction for multiple testing (p = 0.043 and p=0.042 respectively), but were not significant in multivariate testing. No SNP remained significantly associated with SN or mtDNA copy number, after correction for multiple testing. Conclusion: Variation in genes encoding molecular transporters of d4T may influence CD4+ T cell counts after ART. This study presents a positive step towards achieving personalized medicine in SA. / MT 2018

Resource allocation theory, Polich (2007) suggests cortical measures may attenuate when processing demands increase. Thirteen HIV-negative women (M = 36.5) and 15 HIV-positive women (M = 36.1) infected were instructed to view neutral and negative IAPS images and then to detect rare tones in a subsequent auditory oddball task. A 2 x 2 ANOVA for the auditory P3 did not indicate a main effect for picture valence however an interaction was found between picture valence and serostatus at location Fz, F(1,24) = 18.99, p<.001. During the visual ERP sequence an interaction between valence and serostatus was found at the Pz location, F(1,24) = 18.99, p<.001, meaning the late positive potential (LPP) was not modulated between viewing neutral and negative images in HIV-positive women. These findings suggest that the manifestation of HIV in women may alter the neural processing of emotions, though not to the detriment of a subsequent cognitive task. / by Roger C. McIntosh. / Thesis (M.A.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.