京都大学 / 0048 / 新制・課程博士 / 博士(医科学) / 甲第18186号 / 医科博第51号 / 新制||医科||4(附属図書館) / 31044 / 京都大学大学院医学研究科医科学専攻 / (主査)教授 小柳 義夫, 教授 松岡 雅雄, 教授 朝長 啓造 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

MA (Psychology) / Department of Psychology / Background: An estimated 70% of people in Sub-Saharan Africa out of 25 million are living with HIV. HIV is a debilitating disease, however, antiretroviral treatment helps promote effective viral suppression, reduces the risk of transmission and prevents death (WHO, 2013). To ensure positive treatment outcomes, high levels of Anti-Retroviral Therapy (ART) adherence, 95%, is necessary, however, research indicates that 23% of Africans are achieving less than 80% adherence, potentially impacting negatively on prognosis. Aim: The aim of this study was to determine adherence, explore perceptions and behaviour of patients on Antiretroviral Therapy attending Thohoyandou Health Centre, in Vhembe District, Limpopo, South Africa. Methodology: This was a mixed method which employed both quantitative and qualitative research approaches. In quantitative, triangulation was utilised through a questionnaire and patients’ file, simple random sampling was used to select 105 male and female patients aged 18-60 who are on ART at Thohoyandou Health Centre; data were collected and SPSSversion 25 was used to analyse the data through descriptive, cross tabulation and inferential statistics using Chi-square.Qualitative phase – phenomelogical research design was utilised, twenty participants were purposively sampled and individually interviewed, ATLAS. ti program was used to analyse the data collected. Results: 67% of respondents were females, 34% of the respondents’ age range was 50-60 years, 44.8% were single, 48.6% had tertiary education and 69.5% were unemployed. The self-report of ART adherence of 87.6% among patients was indicated, with 19.6% who reported defaulting ART, 14.3% admitted to missing medical appointments. The reasons for missing medical appointments were: forgetfulness, not a convenient time, patient feeling better, transportation challenges and being too sick to attend. The objective evaluation of patients’ CD4 count at baseline revealed that 40.9% of patients had a CD4 count of <200c/mm3, out of 40.9% respondents (15.2%) were those aged between 41-50 years, 31.4% of respondents did not know their CD4 count for various reasons (defaulted on treatment, missed appointments). CD4 count follow-up data after six months revealed that 33% of patients had a CD4 count <200c/mm3 and 39% accounted for unknown CD4 count. vi Three themes emerged from the data, namely: Knowledge of HIV were respondents presented a negaitive and positive perception of ths diagnosis; barriers to ART adherence where sub-themes included discrimination, strigma, rejection, inadequate knowledge about the diagnosis and treatment, side effects; coping strategies where acceptance, religion and social support serve as corner stones for patients. Association was examined and findings did not reveal any significant association between gender, marital status, education, occupation; however, age was significantly associated with non-adherence to ART with X2 = 3.69, df = 1, p = < .002. Recommendations: The study recommends intensification of health education campaign against stigma, discrimination, rejection and other barriers to enhance positive attitude towards HIV patients that wil consequently stimulate adherence and alleviate the burden associated with taking treatment unswervingly. Given the high percentage of infected older respondents, government must also focus its resources to educate illiterate and older people about HIV, adherence and management in order to achieve the golden standardrate of 95% adherence. Strategies to facilitate and normalise adherence among males is indicated. / NRF

MA (Psychology) / Department of Psychology / Background: Given that there is 57.7 million HIV-diagnosed people living in South Africa and the government has established the largest public antiretroviral programme in the whole world but only 53% are adhering. Adherence remains a challenge, due to presence of mental health issues among HIV diagnosed. Aim: The aim of this study was to investigate adherence to antiretroviral therapy and mental health of HIV-diagnosed patients in Vhembe District, Limpopo Province. Methods: This was a mixed method study using a combination of quantitative and qualitative research approaches. In the quantitative approach, triangulation was utilised in the form of a questionnaire and patients records. Simple random sampling was used to select 134, descriptive analysis using SPSS version 25. For the qualitative approach, a phenomenological research designs was considered and convenience sampling was used to select fifteen participants (15). Data was collected using semi-structured interview; responses were analysed using a computer-aided program called, ATLAS ti. Results: The self-report of adherence was 94.8 %, objectively 39.6% of CD4 count <200c/mm3 at baseline and 34.3% CD4 count after six months was found. 16.5% of females and 2% of males defaulted treatment and 14.9% of missed medical appointments 1-6 times. This study also revealed the mental health issues that HIV-diagnosed patients are struggling with after the diagnosis include the stages of grief, stress, depression, anxiety, mistrust, shame, stigma and discrimination. Recommendation: Effective strategies need to be enhanced and tailor made in effort to encourage patients to take ART diligently. The healthcare providers, community members and the government should be made aware of mental health issues. / NRF

Text in English / The purpose of this study was to investigate the role and challenges of AIDS Councils in addressing HIV and AIDS in their communities with regard to community mobilization and advocacy within the broader advocacy function of the South African National AIDS Council (SANAC) and within the framework of the HIV & AIDS and STI Strategic plan for South Africa 2007-2011(NSP). A qualitative research design was applied. Individual face to face interviews were conducted with the respondents who were purposively sampled across the five local municipalities comprising Ehlanzeni District Municipality. Similar studies conducted previously suggest that many AIDS Councils stakeholders and members had a limited understanding of their role, and encountered more challenges in addressing HIV and AIDS in their communities. This study revealed that stakeholders and members seem to have steadily progressed in understanding their role as well as in weathering the various challenges they are confronted with within the AIDS councils. Be that as it may, there still exists some gaps between what is envisaged in both the NSPs (NSP 2000-2005 and NSP 2006-2011) and the current situation in many LACs. Many questions still need to be answered if South Africans are prepared to triumph over the AIDS pandemic. / Sociology / M.A. (Sociology (Social Behaviour Studies in HIV and AIDS))

Text in English / The purpose of this study was to investigate the role and challenges of AIDS Councils in addressing HIV and AIDS in their communities with regard to community mobilization and advocacy within the broader advocacy function of the South African National AIDS Council (SANAC) and within the framework of the HIV & AIDS and STI Strategic plan for South Africa 2007-2011(NSP). A qualitative research design was applied. Individual face to face interviews were conducted with the respondents who were purposively sampled across the five local municipalities comprising Ehlanzeni District Municipality. Similar studies conducted previously suggest that many AIDS Councils stakeholders and members had a limited understanding of their role, and encountered more challenges in addressing HIV and AIDS in their communities. This study revealed that stakeholders and members seem to have steadily progressed in understanding their role as well as in weathering the various challenges they are confronted with within the AIDS councils. Be that as it may, there still exists some gaps between what is envisaged in both the NSPs (NSP 2000-2005 and NSP 2006-2011) and the current situation in many LACs. Many questions still need to be answered if South Africans are prepared to triumph over the AIDS pandemic. / Sociology / M. A. (Sociology (Social Behaviour Studies in HIV and AIDS))