What are the school experiences of HIV-positive secondary school learners on ARV treatment? Although the provision of life-saving antiretroviral (ARV) treatment is central in the medical and policy response to the HIV pandemic, relatively little research (in the SADC region and in Namibia particularly) attends to people’s experiences and the social effects of taking ARV treatment. This study probed the experiences of high school learners on ARV treatment in Khomas Region, Namibia. As researcher I used a qualitative case study design based mainly on interviews with a purposive, select sample of eight learners at the school where I am a teacher-counsellor. Methods used also included: observations; focus group interviews with eight teachers at the site school; a questionnaire survey with Life Skills teachers from 25 schools in the Khomas Region; and document analysis. Using a theory of health-related stigma and discrimination as well as perspectives on resilience and agency as conceptual and analytical lenses, this study found that only a handful of these learners were living openly with HIV and AIDS. Being both HIV-positive and on ARV medication was a double bind for learners facing pervasive stigma and discrimination in and out of school. Discourses associated with HIV and AIDS, sex, and sexuality shaped people’s response to them and they feared being ‘caught out’. Here the study explores the complex reciprocal relationship between cause and effect in stigma, showing some consequences for these learners: isolation (both voluntary and imposed), mental anguish, depression and suicidal leanings; also (at school) absenteeism, grade repetition and dropout. Distinguishing stigma from discrimination in this study enabled insight into actual practices that constrain learner participation and inclusion in and out of school. Trust between learners on ARVs and teachers proved to be low. Teacher respondents not only felt unequipped to deal with the psychosocial needs of learners on ARVs but also indicated that confronting these needs animated their personal vulnerability (around HIV-related experiences in their own families). However, hopeful patterns also emerged. Some mediatory factors out of school shaped these learners’ experiences and identities positively, with implications for in-school experiences and participation. Some learner journeys reflected shifts from deep despair towards the emergence of voice, positive self-concepts and resilient dispositions. Here, also, this study enters a neglected area of research, showing how the complex interplay of learners’ own agency with social support brought these positive outcomes. Most learners had experienced rejection from immediate family, receiving support rather from community members who became ‘family’. The study thus also raises pressing questions on the nature of support structures (both in and out of school) in contexts shaped by HIV and AIDS, where stigma and discrimination are pervasive and where stable family structures, parental oversight and ‘normal’ progression through school cannot be assumed. It recommends that schools gain better insight into how learners’ circumstances shape their experiences, and develop internal policies, procedures and networks to reduce stigma and discrimination against HIV-positive learners on ARV treatment, as well as. ensuring material, medical, emotional, and psychological support for them.

Magister Public Health - MPH / Background: Adherence is the extent to which a person takes medication as prescribed by health-care providers. It includes both dosing regularity and timing of intake. Antihypertensive medication reduces high blood pressure effectively and reduces the risk of heart failure, renal failure and stroke. Hypertension is considered a public health problem due to its impact of high mortality and morbidity. According to the Namibia Ministry of Health and Social Services a total of 34,826 people, aged 18 years and older in the Windhoek District, were diagnosed with hypertension in 2006-2007; the premature death toll due to uncontrolled hypertension increased from 88 deaths per 1,000 cases in 2006 (MOHSS, 2006) to 301 deaths per 1,000 cases in 2007 (MOHSS, 2007). Despite the availability, accessibility and affordability of medication at clinics and health centers, non-adherence is increasing, especially among the young productive population. The purpose of this study was to gain an understanding into the perceptions of non-adherent hypertension patients in Katutura Township in the Windhoek District about their treatment regimens. The research provided information that can be used by policy-makers in the development of a hypertension policy to improve interventions. Aim: The study aimed to explore the perceptions of non-adherent hypertensive patients in Katutura Township by looking at what they considered to be the factors influencing their non-adherence to antihypertensive medication. Methodology: An explorative qualitative study was conducted, using individual in-depth interviews among eight non-adherent hypertension patients, aged 35 years and older. The eligible respondents were purposively selected. A thematic content analysis of transcribed data was conducted where themes were related to patients‟ perceptions for non–adherence. Results: The results showed that the respondents were not adhering to medication. There were several reasons given for this. An important factor was their limited knowledge about the hypertension disease and medication, in part due to ineffective health education. Other factors included the side effects of the medication as well as the belief that antihypertensive medications are poisonous and addictive. Cultural and religious beliefs were also found to be contributing factors to non-adherence. The findings also revealed that the doctors appeared not to have time to examine patients. The attitudes of the nurses were identified as factors that influence non-adherence. It is reported that they do not listen to patients‟ complaints and patients do not feel respected by them. Additional factors included the cost of traveling to the health center which was considered to be prohibitive, long distances to get to the health center as well as 3-5 hours waiting time at the health center influenced non-adherence. Some respondents claimed that they do not want to mix medication with alcohol so that when they are drinking alcohol, they skip their medications. Lastly, some of the patients earn low income and as they are paid per hour, they cannot afford to take time off from work and this further results in non-adherence to medication. Conclusion: The findings concurred with findings of other research done in developing and developed countries. These included poor interpersonal relationships between health-care providers and patients, a lack of knowledge about hypertension and its treatment; cultural beliefs and traditions, and standards of health care provision. Improvement in communication between health-workers and hypertensive patients may promote better adherence. The study indicates an urgent need to design intervention measures to enhance adherence among hypertension patients.

This thesis examines health care choices patients make when illness and misfortune occur. Research on health seeking behaviour was conducted in Katutura (the African township outside of Windhoek in Namibia) during 1996 and 1997. Due to the availability of a wide range of health care options from both the western and the traditional medical systems, utilisation of traditional medicine represents a conscious choice by patients and is not due to a lack of other alternatives. The use of traditional medicine can therefore be attributed to social, cultural, and personal factors rather than access, cost, and distance to modern health care facilities. A set of theoretical postulates is constructed to explain health seeking behaviour, including western and African concepts of ill health, which integrates both macro and micro-level analysis. Through macro-level analysis, this model postulates that western and traditional medical systems are able to exist within a single society due to the presence of co-existing ideologies (Medical Systems Theory). This model further postulates that social change is a significant attribute of post-colonial Namibian society (Post-colonial Theory). Rapid social change causes social disequilibrium leading to insecurities within the population which increase traditional health care utilisation, especially due to witchcraft accusation. Thus, macro-level theories are used to explain the existence and form of health care alternatives in Katutura; while micro-level analysis is used to examine how people make rational health care choices based on individualised variables within the enabling and constraining umbrella of Namibia's social structure. These variables include the individual's means, goals, desires, and environment of physical and social objects. Health seeking behaviour is influenced by the individual's previous experiences (history), personal constraints, and access to information. Based on data from the 1996 Tradition and Health Survey administered as part of the research for this dissertation, a model for health seeking behaviour is developed to guide the analysis of qualitative data. This model postulates that different patterns of utilisation depend on perceived causes, reasons and origins (aetiology) as well as manifestations of illness. Some illnesses are perceived of as clearly African and some are seen to be clearly western (both of these perceptions result in a single utilisation pattern). Some illnesses have a social/spiritual aetiology but universally recognised manifestations (resulting in a simultaneous utilisation pattern), and some illnesses are of indeterminate aetiology until treatment begins (resulting in a multi-faceted utilisation pattern). In addition to a utilisation pattern based on the aetiology and manifestation of illness, previous health seeking experiences influence, to a certain extent, subsequent health care choices; whereby the failure of one medical system to produce satisfactory results can cause health seekers to shift to another treatment regimen. In Katutura choices patients make are also influenced, to a certain extent, by the urban nature of the health seeking environment. Urban patients seek traditional medicine for a range of social/spiritual aetiologies, due to rapid social change and the experience of new and threatening situations. Urban patients also have more knowledge and experience with the western concept of contagious transmission as opposed to the traditional concept of social/spiritual contamination. In addition, health seeking patterns vary slightly between the different ethnic groups in Katutura. Traditional aetiological beliefs of the different ethnic groups in Katutura are reflected in current cultural beliefs about the cause of illness.

Existing travel patterns in Windhoek are influenced by the past land use policy of restricted urban development in the former townships ofKatutura and Khomasdal. Thus residents in these townships are faced with longer distances to reach quality urban servtces. This thesis examined the impact on travel demand of changes in land use policies aimed at stimulating growth in the two areas using the HLFM computer model. The results showed that, policy induced land use changes may stimulate population and employment growth in the neglected areas, but with no effects on the present travel patterns. The model needs to be refined to fit the peculiarity of the study area. Nevertheless, information provided in the thesis could be used in assessing areas where development trends will go if any ofthe land use policy tested in the study is adopted. / Geography / M.A. (Geography)

Existing travel patterns in Windhoek are influenced by the past land use policy of restricted urban development in the former townships ofKatutura and Khomasdal. Thus residents in these townships are faced with longer distances to reach quality urban servtces. This thesis examined the impact on travel demand of changes in land use policies aimed at stimulating growth in the two areas using the HLFM computer model. The results showed that, policy induced land use changes may stimulate population and employment growth in the neglected areas, but with no effects on the present travel patterns. The model needs to be refined to fit the peculiarity of the study area. Nevertheless, information provided in the thesis could be used in assessing areas where development trends will go if any ofthe land use policy tested in the study is adopted. / Geography / M.A. (Geography)