Magister Artium - MA / Due to tremendous stigma attached to HIV/AIDS, revelation of HIV positive sero-status of an individual has become a significant risk in communities of South Africa (Kalichman el al., 2003;Deacon et al., 2004; Kalichman et al., 2005, Simbayi et al., 2007). Several researchers have argued that HIV/AIDS stigma poses severe problems which include that it delays HIV testing;stops people living with HIV and AIDS (PLWHA) from seeking care; inhibits incorporation of prevention behaviours; increases violence against HIV-positive people; and extends beyond PLWHA to families, providers and volunteers. HIV/AIDS stigma is widespread, and it is widely accepted that it does not only reflect but also is exacerbated by co-existing stigmas related to poverty, race, gender, substance use, and sexual behaviour (Parker et al., 2002; Parker & Aggleton, 2003; Holloway, Seaton, Taylor, 2004).This study aimed to understand whether HIV/AIDS as a social construct and those living with HIV/AIDS are understood and responded to differently by males and females and those previously classified by the apartheid divisive policy as African and Coloured participants in the context of their daily encounters. Hence, the study investigated whether there is a relationship between race, gender and HIV/AIDS stigma among participants and whether this relationship is mediated by age, educational level, and participants’ household situation. In addition, the study explored whether gendered stigmatization is subscribed to by participants, while it further sought to assess the extent to which participants were exposed to HIV and AIDS; and whether there were gender and racial differences with respect to participants’ perceptions about PLWHA.Finally, the study scrutinized participants’ perceived levels where they believe interventions to eliminate stigma could be prioritized. This study utilized a survey questionnaire drawn up on the basis of qualitative findings in earlier studies on stigma and HIV/AIDS in both ‘African’ and ‘coloured’ communities. Two hundred participants were recruited through a convenience sampling method in the Mitchell’s Plain area of Cape Town, South Africa. The sample was stratified by ‘race’ and gender with the majority between the age of 35 and 49 years; 50.3 % of the respondents in the sample were males, while 49.7 % were females. The majority of the respondents were Africans of Xhosa speaking descent(49.2 %) and coloureds (48.2 %) with a small proportion of whites (2.5 %). All standard ethical procedures for research with human participants were adhered to and the project was registered with the UWC Research & Ethics Committee. All participants responded on the basis of informed consent and consent forms were signed to confirm ethical assurances. Confidentiality of the data was observed and the data was kept in a locked up and secure place for a period of five years after the study. Completed survey questionnaires were coded, and analyzed quantitatively using the Statistical Package for Social Sciences version 17.0 (SPSS) and SAS.Inferential statistics showed highly significant gender differences in participants’ personal stigmatization. More so, personal stigma attitudes were more likely to be found among older males and with means to support their households. Descriptive results showed these older males were less likely to know someone with HIV. The study acknowledged that HIV and AIDS as well as PLWHA are socially constructed and intersected with existing social inequalities on difference and hence, recommends that interventions to address HIV/AIDS stigma need to take cognizance of the contexts in which it occurs. It seems important to address de-stigmatization efforts at coloured families since descriptive results reflect some denial that HIV is a challenge and/or that PLWHA are stigmatized in families and community at large. Gendered constructions of stigma, while impacting on both men and women (since both appear to be stigmatized differently), are clearly still salient and it is recommended that efforts be continually made to raise the way in which gender, class, racialised and other differences of power are being played in community responses to HIV and those living with HIV/AIDS.

Magister Public Health - MPH / According to the Demographic and Health Survey in Zambia the national HIV prevalence among population aged 15-49 years was 14%. In 2002 the Government of Zambia introduced Antiretroviral Therapy (ART) in two of the largest hospitals in Zambia: Lusaka and Ndola hospitals. As many people begin accessing ART in rural areas in Zambia, one of the major challenges is ensuring that those receiving ART adhere to treatment to avoid the emergence of drug resistance and treatment failure. The research therefore set to identify the potential barriers and facilitators to antiretroviral treatment adherence among people living with HIV and AIDS in the rural district of Chongwe,Zambia.A descriptive qualitative study was conducted over a period of three weeks from 11th December to 29th December 2008. The perceptions, opinions and experiences of PLHIV on ART and those of the health workers and treatment supporters were explored through in-depth interviews and focus group discussions. In-depth interviews were conducted with nine persons living with HIV (PLHIV): 5 females and 4 males. Two focus group discussions were conducted with members of 2 different PLHIV support groups from Refunsa and Chimusanya villages served by the ART clinic of St Luke Mission Hospital and another with a group of ART treatment supporters. In addition, interviews were held with five key informants, who were health workers from the ART clinic in St Luke Mission Hospital in Mpanshaya.Reported barriers to adherence among PLHIV in rural areas included experiencing side effects to ART drugs, stopping medication due to improvement in wellbeing, a lack of understanding of the importance of adherence, and forgetting to take their medication due to alcohol consumption. Other barriers included stigma and discrimination, inadequate food to support ART uptake and non disclosure of one’s status for fear of being rejected especially for women who feared rejection in relationships. Another key barrier to adherence was the religious belief held by some PLHIV that one would get healed after being prayed for and therefore discontinued treatment.Key facilitators to adherence identified in the study included getting into a regular routine of taking antiretroviral drugs (ARVs), knowledge of and belief in the efficacy of ART, disclosure of HIV status, access to social support and nutritional support. Other facilitators identified were use of treatment supporters who provided support to PLHIV by providing them with on-going adherence counseling, and making referrals to the ART facility for further support, mobile ART clinics that have brought ART services closer to the rural communities and the adaptation of strategies such as clocks and use of alarms by PLHIV to remind them to take their medication. Although better health resulting from taking ARVs was citied as a barrier to adherence it also acted as a facilitator to adherence as better health motivated PLHIV to continue taking their medication.In conclusion, based on the findings from the study a series of recommendations were made to inform the current ART adherence information and counseling strategies used by the ART facility at St Luke Mission Hospital in Mpanshaya - and other ART programmes being implemented in similar rural health facilities in Zambia. The recommendations included the need for the ART facility to address alcohol abuse among PLHIV taking ART, addressing perceptions on ARVs in the community, reviewing of the counseling programme, caring for treatment supporters, strengthening food security and livelihood opportunities for PLHIV and their families and increasing collaboration between the ART facility and the churches.

Bakgrund: Diabetes typ 1 klassas idag som ett globalt folkhälsoproblem. Det är en obotlig autoimmun sjukdom som oftast framträder i ung ålder. Det största ansvaret ligger på individen att sköta sin egenvård för att undvika akuta och sena komplikationer. Förutsättningarna för att individen ska sköta sin omvårdnad på bästa sätt är att få adekvat information och utbildning från sjukvården. Syfte: Beskriva unga vuxnas upplevelse av att leva med diabetes mellitus typ 1. Metod: Det utfördes en litteraturöversikt där tio vetenskapliga artiklar inkluderades i resultatet. Resultatartiklarna hämtades från databaserna CINAHL Complete och Pubmed och består av både kvalitativa och kvantitativa studier. Resultat: I resultatet framkom tre huvudteman och sju underteman. Det första temat var Attityder gentemot diabetes med Fördelar samt Nackdelar med diabetes som underteman. Andra temat som framkom var Stöd från omgivningen med Stöd från familj och vänner, Stöd från vården samt Stöd från andra som lever med diabetes som underteman. Det sista temat var Upplevelse av egenvård med Vikten av planering samt Svårigheter med egenvård som underteman. Diskussion: I diskussionen diskuteras valet av tillvägagångssätt för att få fram resultatet samt förankring av Dorothea Orems egenvårdsteori i det presenterade resultatet som framkom. / Background: Type 1 diabetes is today classified as a global public health problem. It is an incurable autoimmune disease that usually appears at a young age. The greatest responsibility lies within the individual in taking care of his or her own care to avoid acute and late complications. The conditions for the individual to take care of his/her care in the best way is to obtain adequate information and education from the health care system. Aim: Describe young adults' experience of living with diabetes mellitus type 1. Method: A literature review was carried out in which ten scientific articles were included in the results. The results articles were retrieved from the Cinahl and Pubmed databases and consist of both qualitative and quantitative studies. Results: The result showed three main themes and seven sub-themes. The first theme was Attitudes towards diabetes with Advantages of diabetes and Disadvantages of diabetes as a sub-theme. Other themes that emerged were Support from the environment with Support from family and friends, Support from care and Support from others living with diabetes as a sub-theme. The final theme was Experience of self-care with The importance of planning as well as Difficulties with self-care as a sub-theme. Discussion: The discussion discusses the choice of approach to obtain the result and anchoring Dorothea Orem's self-care theory in the presented result that emerged.

Bakgrund: Diabetes typ 2 är en kronisk global folksjukdom. Rökning och fetma är exempel på riskfaktorer som leder till utveckling av sjukdomen. Grundbehandling är egenvård som inkluderar att äta en hälsosam kost, fysisk aktivitet samt följsamhet till eventuell medicinering. Stöd och information från sjuksköterskan respektive närstående kan hjälpa patienten att delta i egenvård för att uppnå välbefinnande och undvika framtida komplikationer relaterad till sjukdomen. Syfte: Syftet var att beskriva patienters upplevelser av att leva med diabetes typ 2. Metod: Tio kvalitativa artiklar inkluderades. Dessa identifierades utifrån systematiska sökningar i databaserna Cinahl Complete och Medline. De inkluderade artiklarnas resultat, som svarade på denna översikts syfte, sammanställdes och tenatiserades baserat på skillnader och likheter. Resultat: Dataanalysen resulterade i fyra teman: Känslomässiga reaktioner, Svårigheter att genomföra livsstilsförändringar, Svårigheter med självmedicinering och Behov av stöd från hälso- och sjukvården. Diskussion: Resultatet visar att livsstilsförändringar och egenvård relaterat till diabetes typ 2 kan upplevas stressande och utmanande. Personer med diabetes typ 2 beskriver att de uppskattar att få  information och stöd från vårdpersonal samt närstående för att hantera sjukdomen och förbättra sitt välbefinnande. Resultatet diskuteras utifrån Orem teori om egenvård och sjuksköterskans arbete inom diabetesvården. / Background: Diabetes type 2 is a chronic global disease. Smoking and obesity are examples of risk factors that may lead to the development of the disease. The basic treatment is self-care which includes eating a healthy diet, exercising regularly and compliance with self-medications. Support and information from the nurse and family members can help the patient to participate in self-care to achieve well-being and avoid future complications related to the disease. Aim: The purpose was to describe patients' experiences of living with type 2 diabetes. Method: Ten qualitative articles were included. These were identified on the basis of systematic searches in the Cinahl Complete and Medline databases. The results of the included articles, which corresponded to the aim of this literature review, were compiled and themed based on differences and similarities. Results: The data analysis identified four themes: Emotional reactions, Difficulties to implement lifestyle changes, Difficulties with self-medication and Need for support from health care. Discussion: The results show that lifestyle changes and self-care related to diabetes type 2 can be experienced as stressful and challenging. People with diabetes type 2 describe that information and support from healthcare professionals and family members helps them to manage the disease and improve their well-being. The results are discussed on the basis of Orem’s theory of self-care as well as the nurse`s work in diabetes care.

Bakgrund: Polycystiskt ovariesyndrom (PCOS) är en endokrin sjukdom som drabbar kvinnor i fertil ålder. PCOS har en mängd symtom som påverkar patientens mående genom förändrat utseende och infertilitet. Trots detta framgår det att förhållningssättet gentemot patientgruppen är komplex.  Syfte: Syftet med studien var att beskriva kvinnors upplevelse av att leva med polycystiskt ovariesyndrom. Metod: En kvalitativ litteraturstudie som inkluderar nio originalartiklar. Data analyserades med kvalitativ innehållsanalys med stöd från Graneheim och Lundman. Resultat: Tre kategorier med åtta subkategorier presenteras. De tre kategorierna är kvinnans kontakt med sjukvården, kvinnans upplevda självbild samt sjukdomens roll i samlivet. Resultatet indikerar att gemensamt för kvinnorna är en känsla av frustration och sorg kring symtomen övervikt, ansiktsbehåring och infertilitet. Slutsats: Det är av vikt med fortsatt forskning för att kunna implementera tydligare riktlinjer kring handhavandet av patientgruppen och tillika mer djupgående omvårdnadsåtgärder redan innan diagnostisering, för minskat lidande. / Background: Polycystic ovary syndrome (PCOS) is an endocrine disease that affects fertile women. PCOS has a variety of symptoms that affects the patient's mood through altered appearance and infertility. Despite this, it appears that the approach to the patientgroup is complex. Aim: The aim of this study was to describe women’s experience of living with polycystic ovary syndrome. Method: A qualitative literature review that includes nine original articles. Data were analyzed by a qualitative content analysis with support in Graneheim and Lundman. Results: Three categories with eight subcategories are presented. The three categories are the woman’s contact with healthcare, the woman’s perceived self-image and the role of the disease in cohabitation. The results indicate that common to the women is a feeling of frustration and sadness around the symptoms of obesity, facial hair and infertility. Conclusions: Continued research is important to be able to implement clearer guidelines for the management of the patient group and more in-depth nursing measures already within diagnosis, for reduced suffering.

Långvarig, icke-malign smärta är ett utbrett problem och påverkar många aspekter i livet. Behandling av långvarig smärta är komplext och kräver ett samarbete mellan flera professioner för att uppnå god effekt. Sjuksköterskor har en viktig roll i att stödja och delaktiggöra patienten i att hitta strategier för att bibehålla god livskvalitet.  Syftet var att beskriva patienters upplevelse av hur livskvaliteten påverkas vid långvarig smärta. Litteraturstudien utgår från en induktiv ansats med tio vetenskapliga originalartiklar i resultatet, samtliga artiklar har kvalitativ ansats. Innehållet i artiklarna har analyserats och granskats enligt innehållsanalys och tillslut bildat tre teman: psykisk påverkan, förändrad självbild och begränsade sociala kontakter. Resultatet visar att personers upplevelse av påverkan på livskvalitet vid långvarig smärta är starkt sammankopplat med sociala kontakter, strategier för smärthantering och stöd från anhöriga. Personer med långvarig smärta upplever ofta psykisk påverkan och förändrad självbild, samt begränsade sociala kontakter. Det sociala stödet är av betydande roll för personer med smärta och direkt avgörande för hur personerna hanterar och lever med smärta. / Chronic, non malign pain is a wide problem and affects many aspects in life. The treatment of chronic pain is complex and requires a collaboration between several professionals to achieve good effects. Nurses have an important role in supporting and engaging the patient in finding strategies to maintain good quality of life. The aim of this study was to describe people's experiences of how quality of life is affected in the case of chronic pain. This literature study is based on an inductive approach with ten original articles in the result, all articles have a qualitative approach. The content of the articles has been analyzed and reviewed according to content analysis, and formed three themes: psychological impact, altered self-image and limited social contacts. The result shows that people’s experiences of the impact on quality of life in the case of chronic pain is strongly linked to limited social contacts, pain management and support from relatives. People with chronic pain often experience psychological impact and altered self-image, as well as impaired social contacts. Social support is important for people with chronic pain and directly determines how people both handle and live with pain.

Magister Curationis - MCur / The pandemic of HIV is the most severe health challenge affecting children across the world and it is estimated that more than 90% of all HIV infections in children result from Mother to Child Transmissions (MTCT). The global target of <2% MTCT risk of HIV has still not been achieved despite the duration of the implementation of the programme and its great progress. The prevention of mother to child transmission (PMTCT) programme is a programme developed to enable health care practitioners to provide essential care to mothers in order to prevent the transmission of the virus to their infants.

A quantitative, descriptive, explorative survey was conducted to explore and describe nurses’ perceptions of disclosure to children of their HIV positive status in Addis Ababa. 100 nurses working in six conveniently sampled health centres participated by completing a self-administered questionnaire. The findings revealed that the majority of participants were of the opinion that children have the right to know their HIV status, participate in their own treatment, and that disclosure contributes towards improved adherence. Forty-one of the participants said that it is nurses’ role to support caregivers in the disclosure process. But 56.3% felt they lacked the training to disclose to children that they are infected with HIV. Accordingly, it is recommended that relevant and applied training is required to equip nurses with the knowledge and skills to disclose to children their status. The importance of nurses’ proactive role in disclosure to children of their HIV status needs to be emphasised. / Health Studies / M.A. (Public Health)

Master of Public Health - MPH / The World Health Organisation recommendations for breastfeeding in the general population, including mothers living with HIV, emphasise breastfeeding within one hour of birth, exclusive breastfeeding (EBF) during the first six months of life, and continued breastfeeding for up to two years or beyond. However, only 34.8% of infants worldwide are exclusively breastfed for the first six months of life, and as a result, about 1.4 million infants lose their lives due to undernutrition. In South Africa, only 31.6% of infants are exclusively breastfed for the first six months. Despite the benefits of exclusive breastfeeding, many mothers living with HIV do not initiate breastfeeding or discontinue breastfeeding prematurely. It is, therefore, crucial to determine the barriers inhibiting the uptake of EBF and factors promoting mothers living with HIV to adopt exclusive breastfeeding.

Bakgrund: Ätstörningen anorexia nervosa innebär en intensiv rädsla för viktuppgång, som resulterar i att den som insjuknat successivt förlorar kroppsvikt genom att försätta kroppen i svält. Sjuksköterskans centrala roll i omvårdnaden av patienter med anorexia nervosa är att förmedla hopp, samt bemöta patienter med öppenhet, trygghet, respekt och förståelse. Syfte: Syftet var att beskriva kvinnors upplevelser av att leva med anorexia nervosa. Metod: Metoden omfattar en systematisk litteraturstudie där dataanalysen utfördes genom att identifiera kategorier och meningar i resultatartiklarnas textinnehåll, som svarade på studiens syfte. Resultat: Vid granskning av resultatartiklarnas förekommer ett tydligt mönster av återkommande beskrivningar av hur kvinnor med anorexia nervosa upplever sin livsvärld. Kvinnors upplevelser av att leva med anorexia nervosa utgjordes av tre övergripande kategorier: “en strategi för att hantera livets negativa känslor och upplevelser”, “den inre konflikten och inre rösten” och “självhat”. Konklusion och implikation: Ett patientperspektiv skapar förutsättning att utveckla sjuksköterskans medvetenhet och kunskap om ätstörningens psykologiska och emotionella aspekter. Det skapar förutsättning att utföra en personcentrerad omvårdnad utifrån patientens upplevelser, behov och förutsättningar. / Background: The eating disorder anorexia nervosa is an intense fear of gaining bodyweight, causing the patient to successively lose weight by starvation. The central role of the nurse in treatment of anorexia nervosa is to convey hope, and to meet the patient with openness, safety, respect, and understanding. Aim: The purpose was to describe the experiences of women living with anorexia nervosa. Method: A systematic study of literature was conducted by identifying categories and reoccurring phrases in article contents that relate to the study’s purpose. Results: The reviewed articles show a clear pattern of reoccurring descriptions of the experiences of women living with anorexia nervosa. These experiences can be classified into three main categories: “a strategy for dealing with negative feelings and experiences”, “the inner voice and conflict”, and “self-hatred”. Conclusion and implication: A patient perspective creates the conditions for developing the nurse's awareness and knowledge of the psychological and emotional aspect of the eating disorder. It creates the conditions to perform a personcentred care on the patient's experiences, needs and basis.