Section 27(1)(a) of the Constitution of the Republic of South Africa, 1996, entrenches everyone's right of access to health care services. The purpose of this dissertation is to determine the manner in which this right must be interpreted and implemented in order to alleviate poverty to the optimal extent possible, in South Africa. As a point of departure, the relationship between poverty and health, as well as the theoretical basis of poverty, is addressed in terms of soft law. Thereafter, the theoretical basis of the right of access to health care service is analysed and explained from both an international and a South African perspective. This is followed by an investigation into international law. The manner in which the United Nations International Covenant on Economic, Social and Cultural Rights is interpreted and implemented and whether or not this contributes to poverty alleviation, is investigated. This is followed by an analysis of the right in terms of the Constitution and case law. Particular attention is paid to the manner in which the courts interpret the right of access to health care services. It is then determined whether the state is implementing the right in such a manner as to contribute to the optimal alleviation of poverty, in South Africa. Finally, a conclusion is reached and recommendations are made as to ways in which the right can be interpreted and implemented to reduce poverty to the optimal extent possible, in South Africa. / Thesis (LL.M.)--North-West University, Potchefstroom Campus, 2010.

Background: According to the United Nations AIDS Reference Group (2010) and World Health Organization (2010:2), approximately 33 million people in the world had HIV/AIDS in 2009 of which 2.6 million were children. More than 30 million of these individuals resided in low– and middle–income countries. South–Africa had the highest prevalence of HIV/AIDS in the world with an estimated 5.2 million patients in 2009 (Statistics South Africa, 2010:2). Although the prevalence of human immunodeficiency virus (HIV) infection among children is reported to be high, little is known about other medication administrated concomitantly with their antiretroviral drugs. Objective: The general objective of this study was to investigate possible changes in the medicine prescribing patterns of HIV/AIDS and non–HIV/AIDS children. Methods: A quantitative, retrospective drug utilisation review was performed utilising medicine claims data of a South African pharmacy benefit management company. Data for a four–year period (Jan 1, 2005 to Dec 31, 2008) were analysed. The study population consisted of all children <=12 years divided into those receiving ARVs (designated HIV positive) and those without (designated HIV negative). Descriptive statistics such as average mean, standard deviation, t–test, d–values, and two way frequency tables were used to describe the results. Data were analysed using the Statistical Analysis System ® SAS 9.1 ® programme. Results: The study population (children <= 12 years) represented 16.2% (n = 197 323) of the total population in 2005, 15.4% (n = 193 346) in 2006, 15.6% (n = 142 049) in 2007 and 13.3% (n = 98 939) in 2008. Children with HIV/AIDS represented 0.2% (n = 197 323) of the study population in 2005 and increased to 0.4% (n = 98 939) in 2008, whereas the percentage of children without HIV/AIDS decreased from 99.8% (n = 197 323) in 2005 to 99.6% (n = 98 939) in 2008. The total number of HIV/AIDS children that also received other medication concomitantly with their ARVs increased from 96.5% (n = 402) in 2005 to 97.2% (n = 427) in 2008. Males with HIV/AIDS who used other medication represented 52.6% (n = 388) in 2005 and increased to 53.3% in 2008 while female HIV/AIDS patients represented 47.4% in 2005 and decreased to 46.7% in 2008. Prescriptions containing three ARV items represented 69.5% (n = 2 969) of the total number of prescriptions received by HIV/AIDS patients in 2005 and decreased to 67.7% in 2008. The combination of lamivudine, nevirapine and stavudine were the three products that appeared most frequently on prescriptions for HIV/AIDS children in the age group 0 <= 1 years and 1 <= 5 years from 2005 to 2008. In the age group 5 <= 12 years the combination most frequently prescribed was lamivudine, nevirapine and zidovudine. HIV positive children received 6.2 ± 4.62 prescriptions for other medication (non–ARVs) per year during 2005 compared to HIV negative children with 3.9 ± 3.71 (p < 0.0001, d = 0.5). In 2008 HIV positive children received 6.4 ± 5.02 prescriptions per year compared to HIV negative patients who received 4.36 ± 4.05 prescriptions (p < 0.0001, d = 0.5) in 2008. HIV negative children received more central nervous system items, endocrine items and autacoids than HIV positive children, whereas HIV positive children received more respiratory system agents, dermatological, ear, nose throat and antimicrobials items. Conclusion: The study showed that HIV positive children received significantly more prescriptions for other medication per year compared to their HIV negative counterparts. The top pharmacological groups mostly prescribed to both groups were respiratory agents, antimicrobials, analgesics, dermatological and ear, nose and throat items. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2012.

Afrikaans text / Die studie ondersoek die leemte aan teoreties gefundeerde riglyne om pleegouers in die bekendmakingsproses van hulle kind se MIV-positiewe status te ondersteun Die studie geskied binne die teoretiese raamwerk van ʼn intervensienavorsingsmodel. In die empiriese navorsing is die vrese en probleme van pleegouers by die bekendmakingsproses ondersoek. Daar is bevind dat hierdie vrese en probleme in ag geneem moet word in die beoogde riglyne. Die kognitiewe ontwikkeling van die kind is deur middel van ʼn literatuurstudie ondersoek om vas te stel watter kennis, denke en inligting die kind op verskillende ouderdomme begryp. Daar is bevind dat kinders wat MIV-positief is, moontlike agterstande ondervind en dat die riglyne gevolglik gebaseer moet word op die toenemende ontwikkeling van die kind, met begrip vir individuele ontwikkelingsverskille. Voorts is bevind dat pleegouers se eie gereedheid ʼn belangrike rol speel. Alhoewel die pleegouer die bekendmakingsproses self moet aanvoer en hanteer is dit belangrik dat die pleegouers deur ʼn interdissiplinêre span ondersteun en begelei sal word. / This study investigates the absence of theoretical grounded guidelines to support foster parents when disclosing paediatric HIV. The study was done within the theoretical framework of an intervention research model. The empirical research investigated the fears and problems experienced by foster parents during the disclosure process. It was found that these fears and problems should be taken into account when compiling guidelines. The child‟s cognitive development was researched by way of a literary study in order to determine what knowledge, thoughts and information the child is able to grasp at different ages. It was found that children who are HIV positive could possibly lag behind and that the guidelines should therefore be based on the accumulative development of the child, with consideration given to individual developmental differences. Furthermore, it was established that foster parents‟ own readiness plays an important role. For this reason the foster parents should be supported and guided by an interdisciplinary team, but that they themselves should take care and execute the process of disclosure. / Social Work / M. Diac. (Spelterapie)

The rising rates of high-risk behaviours, such as substance abuse, unsafe sexual practices and violence in South African schools, have accentuated the need for intervention and prevention programmes in the education system. High-risk behaviour is related to changes and uncertainties at community level. The traditional values and behavioural codes are undermined and there is no corrective action from the community to control this behaviour. This study describes the need for support of adolescents, who are in a state of development and change and whose abilities are increasingly being tested by stress factors from a rapidly changing environment. To meet these needs for support, an experimental peer support programme was implemented in schools. Peer support involves the provision of information about healthy lifestyles and high-risk behaviour, such as substance abuse, crime and HIV/AIDS-related aspects. Through peer support, healthy lifestyles can be modelled, and a forum for the discussion of problems established. Peer supporters can assist their peers in dealing with problems and a context can be created in which new and healthier behavioural patters can develop. Peer support is important because educators and teachers are unable to manage the large number of learners who are experiencing problems and schools offer limited professional psychological support to learners. The objectives mainly entailed the prevention of high-risk behaviour related to HIV/AIDS, crime and substance abuse, as well as the enhancement of learners’ psychological well-being and the social climate in schools. The peer support system was implemented in four experimental schools and four similar schools served as a control group. The schools involved were selected by means of a stratified sampling method. A total amount of 2045 respondents between the ages of 12 and 21 years participated in this study. The peer support system was evaluated in terms of a pre and post-measurement in order to determine the impact of the system on the schools and learners in the schools, and to determine whether the set objectives have been achieved. The hypothesis was that the peer support system would have a positive effect in reducing high-risk behaviour and improving the psychological well-being of learners. A questionnaire was used as a pre and post-measurement tool to determine whether there had been significant changes and/or improvements regarding high-risk behaviour, crime, school climate and psychological well-being in the school system. The experimental and control school communities were compared. Significant differences were found between the experimental group and the control group in terms of behavioural problems in the school, school climate, high-risk sexual behaviour and psychological well-being. Learners’ perception of problem behaviour in the school remained unchanged in the experimental group, whilst the control group’s measurements became statistically significantly (p<0,05) more negative over time. A statistically significant difference at the 5% significance level was found between the control group’s pre and post-measurements regarding learners’ experience of the school climate. The control group’s experience had become more negative at post-measurement, whilst the experimental group’s experience had remained unchanged over time. A statistically significant difference was found between the experimental and control groups (p<0,001) in respect of the level of sexual experience. The number of sexually experienced learners in the control group had increased at post-measurement, whilst the level of learners’ sexual experience had remained constant in the experimental group. Furthermore, a significant increase (p<0,001) was found in the level of sexual activity among the control group during the last 30 days, but not in the experimental group. This implicates that the intervention has had a preventative effect that counters the normal tendency of increased sexual activity with age. More than 60% of learners viewed their friends as sexually experienced. The perceived group norm for the experimental group remained the same over 18 months, whereas a significant increase (p<0,001) was found in the control group. No decrease was found in the psychological well-being of learners in the experimental group at post-measurement, whereas that of the control group had decreased significantly (p<0,05). No statistically significant differences were found for substance abuse and personal control of risk among learners. Although many other variables could play a role in these changes, the conclusion can be made that the peer support system probably had a preventative effect in schools. The study further indicates that approximately two thirds of all learners had been aware of the system and about 40% had used it. The peer system was generally evaluated as positive and the biggest problems were related to the implementation and organization of the system, as well as the confidentiality of information. Recommendations have been made regarding the improvement of project implementation. If enhanced co-operation from school staff can be obtained during implementation of the intervention, the peer support system could function better and a bigger impact in schools could be achieved. In conclusion, it is important that intervention programmes be promoted efficiently in schools in order to facilitate optimal functioning. / Dissertation (MA (Research Psychology))--University of Pretoria, 2006. / Psychology / unrestricted

The effects of HIV/AIDS and subsequent opportunistic infections and/or associated conditions on the development of infected children are substantial. Considerable delays and/or disorders in communication development have been noted in the HIV/AIDS infected child, as well as the need for Early Communication Intervention (ECI) services for this population. A dearth of locally relevant data regarding the speech, language and hearing development of HIV/AIDS infected children within the South African context currently exists. The objective of this study was to describe the characteristics of a group of HIV/AIDS infected children being managed at an outreach clinic of regional hospital in Gauteng. A cross-sectional, retrospective, non-experimental, descriptive, quantitative research design was used in this study. The main objective was achieved by analysing the clinic records of 203 children infected with HIV/AIDS between the ages of 0 – 5 years 11months through the use of a pre-designed checklist. A questionnaire completed by four medical doctors practicing at the HIV/AIDS clinic within the hospital was also used. This allowed for the perceptions and practices of the medical doctors to be described. Results revealed that the majority HIV/AIDS infected children being managed at the outreach clinic were significantly immunocompromised and diagnosed with Stage III or Stage IV HIV/AIDS infection. Furthermore, results indicated the presence of several opportunistic infections and HIV/AIDS associated conditions (such as Tuberculosis, Candidiasis and Encephalopathy). A positive finding was that 76% of the HIV/AIDS infected children (n=153) were receiving Highly Active Antiretroviral Therapy (HAART) at the time of data collection. The most outstanding finding was that very few of the children with HIV/AIDS being managed at the outreach clinic were recorded as having speech, language and/or hearing delays and/or disorders. Similarly, referrals to other professionals as recorded in the children’s hospital records seemed to be limited to Social Workers and Dietitians, with only one child recorded as being referred to a Speech-Language Therapist and Audiologist for further management. It was unclear whether more children were in fact referred for additional intervention by other professionals and this was simply not recorded in the children’s records, or whether these referrals were in fact not made. Results from the questionnaires completed by the medical doctors working with the pediatric HIV/AIDS population within the outreach clinic were significant. Findings indicated that the majority of the respondents believed that HIV/AIDS infected infants were more at risk for developmental and communicative delays and/or disorders than the general population, and that this population would likely benefit from Speech-Language Therapy and/or Audiology intervention services. Respondents indicated that medical doctors working with the pediatric HIV/AIDS population were often not adequately informed regarding the effects of HIV/AIDS on communication development and that they would benefit from further training in this regard. The need for further research regarding the characteristics of the pediatric HIV/AIDS population, particularly on a larger sample, was described. This would assist in the development of a guideline for ECI service delivery for children infected with HIV/AIDS. The need for further training of other professionals regarding the effects that HIV/AIDS has on the communication development of the infected child, to assist with necessary referrals and teamwork, was also highlighted. AFRIKAANS : Suid-Afrika is een van die lande ter wêreld, wat die hoogste voorkoms van Menslike Immuniteitsgebrekvirus/ Verworwe Immuniteitsgebreksindroom (MIV/VIGS), toon - met die pediatriese populasie op die voorfront van hierdie epidemie. Die effek wat MIV/VIGS en opeenvolgende opportunistiese infeksies en/of ander geassosieerde toestande op die ontwikkeling van kinders het, is verreikend. Internasionale literatuur beskryf agterstande en/of akwykings in die kommunikasie ontwikkeling van kinders wat met MIV/VIGS geinfekteer is. Die behoefte vir Vroeë Kommunikasie Intervensie (VKI) vir hierdie populasie word ook gemeld. Daar bestaan egter slegs ‘n beperkte hoeveelheid relevante, plaaslike literatuur met betrekking tot die spraak-, taal- en gehoorontwikkeling van kinders met MIV/VIGS binne die Suid-Afrikaanse konteks. Die doelwit van hierdie studie was om die kenmerke van ‘n groep kinders, wat met MIV/VIGS besmet is en by ‘n streekshospitaal in Gauteng behandel word, te beskryf. ‘n Kwantitatiewe, nie-eksperimentele, terugwerkende, dwarsdeurige, beskrywende navorsingsontwerp is gebruik. Die hoofdoelwit was bereik deur die kliniekrekords van kinders wat met MIV/VIGS besmet is, te analiseer deur van ‘n vooraf-ontwerpte merklys gebruik te maak. Data is ook ingesamel deur middel van vraelyste wat deur mediese dokters, wat by MIV/VIGS klinieke binne die hospitale werk, voltooi is. Dit het toegelaat dat die persepsies en praktyke van die mediese dokters ook beskryf kon word. Resultate het getoon dat die meerderheid kinders met MIV/VIGS, wat by klinieke behandel word, se immuunsisteme ernstig onderdruk was en dat hulle met stadium III of stadium IV van MIV/VIGS gediagnoseer was. Die resultate het verder ook die voorkoms van verskeie opportunistiese infeksies en MIV/VIGS geassosieerde toestande aangedui. ‘n Positiewe bevinding was dat 76% van die kinders (n=153), wat met MIV/VIGS geinfekteer was, tydens die proses van data-insameling reeds Hoogsaktiewe Antiretrovirale Terapie (HAART) ontvang het. Die mees uitstaande bevinding was dat slegs ‘n geringe hoeveelheid kinders met MIV/VIGS by die kliniek, as met ‘n agterstand en/of afwyking in spraak, taal en/of gehoor, aangeteken is. Beperkte verwysings na ander professionele persone is ook in die kliniekrekords opgemerk. Verwysings was beperk tot Maatskaplike Werkers en Dieëtkundiges. Daar was slegs een aantekening van ‘n kind wat vir behandeling na ‘n Spraak- en Taalterapeut en Oudioloog verwys is. Dit is egter onduidelik of daar werklik meer verwysings na ander professionele persone gemaak is, maar net nie in die kinders se kliniekrekords aangedui is nie, of dat daar werklik min verwysings na ander professionele dissiplines gemaak is. Bykomend, was die resultate van voltooide vraelyste deur mediese dokters, wat met die pediatriese MIV/VIGS populasie in die kliniek werk, insiggewend. Bevindings dui aan dat die meerderheid proefpersone, wat aan die studie deelgeneem het, van mening is dat kinders wat met MIV/VIGS besmet is wel ‘n hoër risiko toon vir ontwikkelings- en kommunikasie agterstande en/of afwykings in vergeleke met die algemene populasie. Die proefpersone is verder ook van mening dat hierdie populasie wel van spraak- en taalterapie en/of oudiologiese intervensie sal baatvind. Proefpersone het verder aangedui dat mediese dokters, wat met die pediatriese MIV/VIGS populasie werk, nie ten volle ingelig is omtrent die effek van MIV/VIGS op kommunikasie ontwikkeling en dat hulle van verdere opleiding sal baatvind. Die behoefte vir verdere navorsing in die veld van pediatriese MIV/VIGS en kommunikasie ontwikkeling, binne die Suid-Afrikaanse konteks, word in hierdie studie beskryf. Dit sal as riglyn vir VKI dienslewering aan hierdie populasie dien. Daar is ook ‘n groot behoefte vir verdere opleiding van ander mediese professionele persone met betrekking tot pediatriese MIV/VIGS en die effek wat die op die kind se kommunikasie ontwikkeling het. / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted