Magister Public Health - MPH / The study utilized a qualitative case study design to explore the problem of poor access to ART in Benue State. PLWHAs, policy makers, program managers and health workers were involved in an effort to describe the factors influencing access to ART in the State. Semi structured interviews, exit interviews and focus group discussions were used. To analyse the findings, categorization was done into facilitators and barriers to access, in addition to the ways respondents believe these barriers can be overcome. Other sub-themes were also identified and sorted. Themes were linked to direct quotes from the respondents. Additional literature review was done to review available information on the themes identified. Facilitators of access included free cost and increased number of sites; beneficial effects of ART; disclosure, membership in a support group and having a treatment partner. Barriers included stigma and discrimination; hunger, poverty, transportation and opportunity costs; hospital factors; non-disclosure; inaccurate knowledge and perceptions about HIV and ART; certain religious beliefs and advice; coverage, capping of services and fear of non-availability of ART. In addition to stigma, patients bypass closer ART access points to further away hospitals because of business opportunities; financial assistance; perceived better standard of care and hope that a cure, when found, will be more accessible to patients in bigger hospitals. / South Africa

Magister Public Health - MPH / At the end of 2008, Nigeria had the third largest number of people living with HIV/AIDS(PLWHA) in the world, with an estimated 2.95 million people and an average prevalence rate of 4.6%. According to the 2008 prevalence survey, prevalence rates in Nigeria’s 36 states and capital ranges between 1.0% in Ekiti State, to 10.6% in Benue.In Benue State, as at December 2008, only 12% of those requiring treatment were enrolled in an ART programme and only about half of the 23 Local Government Areas (LGAs) had a health centre providing ART services. There are several possible causes for poor coverage of ART services. This study explores some of the barriers preventing PLWHAs from accessing treatment in Benue State.The study utilized a qualitative case study design to explore the problem of poor access to ART in Benue State. PLWHAs, policy makers, program managers and health workers were involved in an effort to describe the factors influencing access to ART in the State. Semi structured interviews, exit interviews and focus group discussions were used.To analyse the findings, categorization was done into facilitators and barriers to access, in addition to the ways respondents believe these barriers can be overcome. Other sub-themes were also identified and sorted. Themes were linked to direct quotes from the respondents. Additional literature review was done to review available information on the themes identified. Facilitators of access included free cost and increased number of sites; beneficial effects of ART;disclosure, membership in a support group and having a treatment partner. Barriers included stigma and discrimination; hunger, poverty, transportation and opportunity costs; hospital factors; non-disclosure; inaccurate knowledge and perceptions about HIV and ART; certain religious beliefs and advice; coverage, capping of services and fear of non-availability of ART.In addition to stigma, patients bypass closer ART access points to further away hospitals because of business opportunities; financial assistance; perceived better standard of care and hope that a cure, when found, will be more accessible to patients in bigger hospitals.In conclusion, improving health worker attitudes through training; reselection of non-ARV drugs used in HIV management to ensure an uninterrupted supply; highlighting the importance of membership in a support group through patient enlightenment; working with religious leaders to reduce stigma and improve access; income-generating programs for patients; decentralization of ART services and upgrading of primary healthcare centres are important strategies to improve ART access in the state.

Stigmatization and discrimination of PLWHA by some pastors and some church members are challenges and serious problems that are affecting PLWHA in the Reformed Church in Zambia and in other denominations within Zambia. The aim of this research is to explore ways of loving and embracing PLWHA who are already affected with the problem of stigma in the RCZ. The research will help deal with the problems of despising, condemning, rejecting and isolating of PLWHA by some clergy and some church members. The author seeks to develop a pastoral care model that will empower pastors and church members to love and embrace PLWHA in the church. The other aim of this research is to empower the PLWHA with the pastoral care model that has been developed so that they can be able to cope with the problem of shame, rejection and isolation caused by being stigmatized by some pastors and some church members. This research is focused on the traumatic experiences that the PLWHA go through as they continue being members of the church. Their fellowship with God and their fellow church members happen to be affected as some of them discontinue being church members. This research study explored a model of pastoral care in which the affected PLWHA have to be helped to acquire healing after trauma counselling by the pastoral caregivers who are empowered by this research. A model which has been employed in this research includes the one of the shepherding model of Charles Gerkin and of Adams which is on pastoral care as shepherding of flocks which belong to God. The word of God has been used to explore where the researcher wanted to show His love towards his people even when they are under difficulty circumstances. The research has also indicated roles of different groups and individuals who should contribute to the healing of PLWHA who are traumatized by being stigmatized by some pastors and some church members. At the end of this research study, there are concluding remarks which have led to recommendations that readers have to take note of. / Dissertation (MA(Theol))--University of Pretoria, 2010. / Practical Theology / unrestricted

No abstract available. / Dissertation (LLM)--University of Pretoria, 2013. / gm2014 / Centre for Human Rights / unrestricted

PhD (Sociology) / Department of Sociology / The purpose of the study was to investigate the influence of traditional healing practices on anti-retroviral treatment adherence in Vhembe District. This qualitative study used an explorative design to envisage the aim. A cross-sectional snowball sample was used to draw a sample of 9 participants from the 4 municipalities of Vhembe District. The data collection methods were; in-depth interviews, focus group discussions and key informants’ interviews. The 3 data collection techniques ensured triangulation for more complete and well-validated outcomes of the study. The researcher used the Van Manen method to analyse data. Contrary to popular belief that THPs promote non-adherence among people living with HIV/AIDS (PLWHA), the study found out that the majority of Traditional Healing Practitioners (THPs) encourage and positively influence PLWHA to adhere to anti-retroviral treatment. Apart from a minority of participants who claimed to cure HIV/AIDS, the majority acknowledged and admitted that traditional healing practices do not cure HIV/AIDS but it only heals opportunistic infections. As a result, the majority of THPs influences PLWHA to adhere to anti-retroviral therapy (ART). However, the positive influence of THPs is challenged by individual and social-cultural factors that are beyond THPs’ control which influence treatment adherence such as; traditional and cultural beliefs, side effects of ARVs, nurses’ attitude, inconveniences, lack of transport, personal choices, lack of trust in ARVs and fear of loss of the Disability Grant. It is on this backdrop that study findings prompted devising of a model and a 5 phase support program for intervention. / NRF

HIV has remained a public health problem in Nigeria. The purpose of this cross-sectional study was to examine the effect of social support and HIV-related stigma on depression in people living with HIV/AIDS (PLWHA) and to examine the moderating effect of sociodemographic factors, Quality of Life (QOL), and time since HIV diagnosis on this relationship. This study was based on the social cognitive theory. Data were collected from 98 PLWHA attending the antiretroviral clinic of Federal Medical Center, Umuahia, Nigeria. Regression analyses were used to examine the relationships between the variables. Some 24.5% of the study participants were depressed. Significant relationships identified included negative relationships between depression and social support, positive relationships between depression and negative self-image, and a combination of poor social support and HIV-related stigma having synergic effects in predicting depression. Sociodemographic variables, quality of life, and time since HIV diagnosis did not have a moderating effect on the relationship between social support, HIV-related stigma, and depression in PLWHA. There is a need to improve social support and reduce HIV-related stigma in PLWHA in order to improve their mental health. These findings can help in bringing about positive social change by informing the development of public health initiatives aimed at improving the mental health of PLWHA.

愛滋感染者為深受社會烙印且處於社會邊緣的族群，在面對自身權力遭受侵犯時，往往難以看到該人口群為自己或社群發聲與行動，因此，本研究希冀瞭解愛滋感染者的權能表現以及可能的影響因素，藉此達致感染者權能的激發。 本研究採取問卷調查法，以目前台灣的愛滋感染者為主要的受訪者，抽樣方法為立意抽樣，主要透過非營利組織、監所等管道發放問卷，整份問卷主要由受訪者自填或訪員協助填答的方式進行，共回收379份有效問卷。而納入檢驗愛滋感染者權能表現的相關因素主要有個人基本資料、生活滿意度、愛滋內在烙印、參與類型、愛滋知識與服藥狀況；本研究透過獨立樣本T檢定與變異數分析檢驗自變項與依變項的雙變項相關，並透過多元迴歸分析的方式，進行多變項的檢定。 研究結果發現：一、愛滋感染者整體權能表現分布在尚可至中度，且社會政治權能表現最高，但實踐權能的參與行動卻偏低。二、愛滋感染者的生活滿意度位於稍微不滿意至中立的分配，且對於整體生活狀態滿意，但是不滿意過去的生命經驗。三、愛滋感染者的內在烙印程度較高，深受愛滋內在烙印影響者，權能相對較低。四、讓感染者自覺能夠影響他人者，權能表現相對較高。五、愛滋感染者對於愛滋知識的認識有助於權能提昇。六、多元迴歸分析當中，生活滿意度、社區代表參與、愛滋知識與服藥順從度為主要影響感染者權能的因素，共能解釋36％的變異量。 本研究依據研究結果，針對實務工作者、未來研究者以及愛滋感染者進行相關的建議。期許實務工作者能協助感染者權能提昇的執行，研究者能夠繼續探索相關影響因素，而愛滋感染者可以相信自己具有權能的能力。 / People living with HIV/AIDS(PLWHA) are marginalized by HIV social stigma, and we are hardly to see this population speak and act for their right, even through their right or power is violated. For this reason, I hope to find out the performances and the factors of empowerment of PLWHA. As the results, we can empower this population by the right strategies. The method to carry out this study was using a survey, which held by purposive sampling. People who infected HIV in Taiwan are the main sample size. The participation in this study was contacted by Non-government organizations, prisons and drug abuser center of correction agency, expecting to respond anonymously by them or interviewer. In the end, 379 questionnaires were analyzed. The instrument consist of six main parts, including demographic, satisfaction with life scale, HIV internal stigma, participation types, HIV/AIDS knowledge scale and reported compliance with medication. To address this issue, t-test and analyses of variance were used to detect bivariate analysis between dependent and independent variables. In order to clarify the explanatory power of variables, a multiple regression analysis was done. All research revealed, the total empowerment is moderate, and social-political empowerment is the highest, but PLWHA seldom participate in activities. Second, participation didn’t satisficate with their life, especially what they got in the past. Third, PLWHA had higher internal stigma score, which was negatively correlated with lower empowerment. Forth, PLWHA who can affect others had higher empowerment score. Fifth, HIV/AIDS knowledge was shown significant associated with empowerment of PLWHA. Sixth, multiple regression analysis shows that satisfaction with life scale, community participation, HIV/AIDS knowledge and reported compliance with medication were important factors of empowerment, accounting for 36% variance. Suggestions were given to pratical workers, future researchers and PLWHA: we hope pratical worker can help to raise the empowerment of PLWHA, researcher can keep finding more empowerment factors in the future, and PLWHA can believe they have empower ability to strive for their right.

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.

A la fin des années 1980, à l'apparition des premiers cas d'infection au VIH, l'Eglise Ethiopienne Orthodoxe Täwahedo (EOTC-Ethiopian Orthodox Täwahedo Church) s'est officiellement impliquée dans la lutte contre le sida au côté du Gouvernement éthiopien. Par ailleurs, dans les années 1990, les fidèles de l'Eglise éthiopienne ont commencé à se rendre sur des sites d'eau bénite dans l'espoir d'y guérir miraculeusement de l'infection. A partir de 2004, l'EOTC a reçu des subventions américaines au titre de la promotion de l'abstinence et de la fidélité. Deux ans après, les traitements contre le sida étaient distribués gratuitement et largement, entrant en conflit avec la cure par l'eau bénite traditionnellement exclusive de tout autre thérapeutique. Cette étude, combinant socio-anthropologie de la santé et de la religion, s'intéresse à la manière dont le christianisme éthiopien – dans ses composantes institutionnelle (EOTC) et rituelle (Eglise éthiopienne) – s'investit dans la lutte contre l'épidémie. En retour, elle interroge la manière dont les subventions américaines à l'EOTC et la distribution des antirétroviraux constituent des facteurs de changement pour cette religion pluriséculaire. L'analyse révèle que le christianisme éthiopien n'est traditionnellement pas l'instance en charge de l'encadrement sexuel des fidèles. L'importance du recours par les fidèles infectés au VIH à la cure par l'eau bénite témoigne de la place qu'occupe, dans cette religion, le pardon et la rédemption. Mots clef : EOTC, VIH/sida, PEPFAR, miracle, prévention des nouvelles infections au VIH, prise en charge des PVVIH, eau bénite. / At the end of the 1980's, while the first HIV/AIDS cases appeared, together with the Ethiopian Government the Ethiopian Orthodox Täwahedo Church (EOTC) committed officially itself to the fight against HIV/AIDS. In the 1990s, followers of the Ethiopian Church on their side started to dedicate themselves to holy water ritual hoping to be cured miraculously of HIV/AIDS. In 2004, the EOTC started to receive American subventions in order to promote abstinence and faithfulness among its followers. Two years later, antiretroviral treatments began to be largely and freely distributed entering in conflict with the spiritual values of the holy water cure, which excludes any other kind of therapy. This study, combining health and religion socio-anthropology approaches focuses on the way the Ethiopian Christianity in its two components – both institutional (EOTC) and ritual (Ethiopian Church) – involved itself in the fight against the epidemic. Furthermore, it addresses the way americans' grants and antiretroviral treatments became factors of change in this particular ancient Church. The analysis shows that traditionally, the Ethiopian Christianity is not a body in charge of regulating its followers' sexual behaviour. It is significant that followers infected by HIV seek healing through holy water cure for it reveals that in this religion, the emphasis is being put on forgiveness and redemption. Within the sociology of religious facts, this approach brings to light the fact that the Ethiopian Christianity is a religion of forgiveness, and thus that it will focus more on healing than prevention.

MPH / Department of Public Health / Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) place a significant burden on the caregivers for people living with HIV/AIDS (PLWHA). Caring for PLWHA is usually carried out by community members who are recruited from the same community as the PLWHA. These community members are trained to provide services as volunteer caregivers. The caregivers face various challenges in the process of giving care to PLWHA, often inadequately assisted by relatives, friends, neighbours, private individuals, grassroots traditional and political leaders. This results in caregivers being overwhelmed by their responsibilities, making their coping process even more difficult. The aim of this study was to explore the challenges experienced by community home-based caregivers (CHBCGs) caring for people living with HIV/AIDS at Tsianda Village, in Makhado Municipality, South Africa. This study adopted a qualitative explorative design. The population for this study were all CHBCGs caring for PLWHA. Non probability purposive sampling was used to select the community home-based caregivers working at Tsianda Community Home-based care organisation. In-depth interviews, using a semi-structured interview guide, was conducted by the researcher and a voice recorder were used to record data from participants. Data saturation was reached at the 11th participant. This is when the participants were no longer giving new information. The data collected from the study were analysed thematically. The following themes emerged from data analysis: Challenges for community home-based caregivers, perceived support for community home-based caregivers, coping strategies for community home-based caregivers. Measures to ensure trustworthiness and the code of ethics to protect the rights of the participants was applied and observed. The findings of the study revealed that community home-based caregivers experience various challenges which have a negative impact on their personal life, as well as their physical and psychological wellbeing. Community home-based care also uses different strategies to cope with these challenges. It was concluded that the community home-based caregivers are experiencing serious shortages of personal protective equipment, which makes them work with the fear of being infected with the diseases. It is recommended that the DOH should take it into consideration to provide the CHBCG’s organization with enough personal protective equipment for their safety and working without fear of being infected with deadly viruses. / NRF