The purpose of this study was to describe the experiences that HIV and AIDS patients who are on Community Home Based Care Programme have in the Lilongwe district of Malawi. Finally; concrete propositions were developed for the implementation of quality community and home based care programmes in Malawi. A qualitative research design using an interpretive phenomenology was used. The study took place in semi-rural and urban areas of Lilongwe district using patients from 3 major organizations dealing with people living with HIV and AIDS. Purposive sampling technique was used to choose the sample and a total of 15 in-depth interviews were conducted. Data was analyzed using ATLAS ti version 5. Findings revealed that the majority of the participants were concerned that they were living with HIV and AIDS. Most of them expressed anxiety, worries and fears of death. Another majority complained about the burden of opportunistic infections. Almost half of the participants felt guilty bringing misery to their families and complained of stigma and discrimination. However, a minority group of participants felt that to live with HIV and AIDS is not the end of life. Relatives were mentioned as the main care providers to HIV and AIDS patients. However, they were also cited high as a source of stigma. Conclusions were made that women and girls are at the highest risk as they bear the burden of care. It was therefore recommended that the Government of Malawi and all Non Governmental Organizations should develop women social economic status through promotion of education, provision of loans and provision of Gender Sensitive trainings. Formal training for care of HIV and AIDS patients should be introduced to all primary caregivers to render quality care in the homes and therefore this study has developed and pre-tested an educational program for this group. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to describe the experiences that HIV and AIDS patients who are on Community Home Based Care Programme have in the Lilongwe district of Malawi. Finally; concrete propositions were developed for the implementation of quality community and home based care programmes in Malawi. A qualitative research design using an interpretive phenomenology was used. The study took place in semi-rural and urban areas of Lilongwe district using patients from 3 major organizations dealing with people living with HIV and AIDS. Purposive sampling technique was used to choose the sample and a total of 15 in-depth interviews were conducted. Data was analyzed using ATLAS ti version 5. Findings revealed that the majority of the participants were concerned that they were living with HIV and AIDS. Most of them expressed anxiety, worries and fears of death. Another majority complained about the burden of opportunistic infections. Almost half of the participants felt guilty bringing misery to their families and complained of stigma and discrimination. However, a minority group of participants felt that to live with HIV and AIDS is not the end of life. Relatives were mentioned as the main care providers to HIV and AIDS patients. However, they were also cited high as a source of stigma. Conclusions were made that women and girls are at the highest risk as they bear the burden of care. It was therefore recommended that the Government of Malawi and all Non Governmental Organizations should develop women social economic status through promotion of education, provision of loans and provision of Gender Sensitive trainings. Formal training for care of HIV and AIDS patients should be introduced to all primary caregivers to render quality care in the homes and therefore this study has developed and pre-tested an educational program for this group. / Health Studies / D. Litt. et Phil. (Health Studies)

In this study, a model of cognitive behavioural therapy (CBT) was developed, implemented and assessed. The aim of this model is to assist HIV-positive women in dealing with internalised and enacted stigma. Since much of the research about therapies developed to deal with HIV-related stigma so far has been done within a western frame of reference, in the current study a model was developed to suit the local South African situation. Women were specifically targeted as they are more vulnerable to HIV/AIDS and are disproportionately affected by the epidemic. Because of culturally determined gender roles, women are not always in a position to take control of their sexual health. Furthermore, because of the negative experiences of HIV diagnosis, the stigma has a negative impact on women’s behaviour. As a result, there is a need for a therapeutic model to assist HIV-positive women in changing the experience of internalised stigma and discrimination. A CBT approach was used in therapy to challenge the women’s dysfunctional beliefs, to change their automatic thoughts and to promote more realistic adaptive patterns of thinking. All of these aimed to assist them in dealing with stigma. Eight therapy sessions (one a week for eight weeks) were planned for each of the women. This research was conducted in two phases. In Phase 1, data was gathered about the experiences of HIV-positive women to gain an understanding of their experiences of HIV-related stigma and discrimination. Various sources of information were used to identify not only the relevant themes contributing to the individual’s experience of internalised stigma, but also possible ways to change them. These sources included a study of the available literature, the researcher's own experience and focus group discussions with other psychologists in practice, and interviews with five HIV-positive women (in the form of case studies). Five women living with HIV/AIDS, who were experiencing difficulties in dealing with stigma, were recruited at Witbank Hospital, where they were interviewed and asked to complete five psychometric instruments. The researcher scrutinised the data gained from the psychometric scales to assess the validity of the instruments to identifying the feelings of the participants the researcher observed in the interviews. Rubin and Rubin's (1995) method was used to analyse the data. The findings that emerged from Phase 1 were used to identify common themes to be addressed in the intervention, for example feelings of powerlessness, feelings of guilt, behavioural implications of stigma, the experience of the reaction of others and uncertainty about the future. These themes were used as guidelines and were adapted according to the specific needs of each of the women seen in therapy so as to address negative feelings and behaviour. Phase 2 focused on the implementation and evaluation of the cognitive behavioural model. A purposive sampling technique was used for this study. The model was tried out with ten HIV-positive women who served as the experimental group. A quasi-experimental design was used, involving a pre-and post-test and a control group consisting of ten other women identified at the same hospital. The scores that the experimental group and the control group obtained before the intervention were compared to verify that the two groups were comparable prior to the intervention. Post-test scores were compared to investigate differences between the groups after the intervention. The process notes of the therapy sessions were analysed by means of qualitative analysis to understand the reactions of the women in therapy. This contributed to the researcher’s understanding of the appropriateness and effectiveness of various therapeutic techniques used with the experimental group. Findings of this research indicate that, when compared to the control group, the experimental group not only experienced less depression, internalised stigma and negative coping, but also higher levels of self-esteem and positive coping after having participated in eight therapy sessions. The study further revealed that being HIV positive and trying to cope with stigma and discrimination involve diverse experiences for women, although there are common themes for all participants. It was recommended that the intervention be altered in future use in the following ways: Those techniques that were found to be more effective with the majority of women (positive cognitive reframing, teaching of coping strategies, homework assignments, decatastrophising and assertiveness training) could probably be used with success in similar conditions. Only the techniques that worked well should be used, and care should be taken not to use too many techniques. Each client should be given the time to question the evidence for her automatic thoughts and to draw her own conclusions about her situation, feelings or thoughts and to grasp the cognitive strategies, rather than to bombard her with many different techniques. The therapist should also relate more to the individual client and adapt the model to her context, rather than to implement the model rigorously. / Thesis (PhD)--University of Pretoria, 2009. / Psychology / unrestricted

Black women in historically challenged communities in South Africa carry the burden of triple oppression: (a) the social engineering policies synonymous with apartheid have marginalised women economically and socially, (b) patriarchy, embedded in cultural and religious discourses, has rendered women voiceless and powerless and (c) HIV/AIDS targets the most vulnerable: women and children. Not only are women carrying the brunt of HIV infections, but they also carry the extra burden of caring for the sick and the orphaned. The main aim of this research was to reach a holistic understanding of the untold stories of women in historically challenged communities, infected and/or affected by HIV/AIDS, and specifically about their experiences of care and the lack of care. The two secondary aims were: 1) to research alternative ways and means of making the unheard stories known in South African society; and 2) to disseminate research findings on the stories of these women in such a way that developmental policies could be influenced to enhance alternative, holistic stories of care in the South African society. A family of three women and a translator participated as co-researchers with the writer in this research experience. The researcher reflected on the research experience with volunteers from two home-based care programs in the community. The researcher uses drama as metaphor to document her ‘colourful’ research experience and to make sense of the many intricate and intertwined narratives and discourses, documented over a period of six months in her research diary, through recorded interviews, through her participation with the co-researchers and through the ethnography she had engaged in. The research experience has found that to be able to ‘care someone else into existence’; it is paramount that you as carer experience ‘empowering care’ yourself. ‘Empowering care’ is not possible if injustice prevails. This research experience challenges Government to investigate the ethical implications of the policy of placing the burden of care for the dying and the orphans on the shoulders of women in historically challenged communities. / Thesis (PhD (Practical Theology))--University of Pretoria, 2005. / Practical Theology / unrestricted

HIV/AIDS-related stigma and discrimination (S&D), lack of social support, poverty, and gender inequalities have been identified as factors in the increased prevalence rate of HIV transmission in Enugu, Nigeria, especially among women ages 15 to 49 years. Despite the funding of reduction programs, HIV/AIDS-related S&D remain a major driving force in the increased rate of new HIV cases in Enugu. This study addressed a perceived need for behavioral change intervention approaches that span all societal factors to reduce the HIV infection rate in Enugu Nigeria. The study was guided by Goffman's (1963) social S&D theory. The sample was composed of 132 women living with HIV/AIDS WLWHA ages 21 to 54 years, purposefully sampled from the 4 HIV and AIDS comprehensive initiatives care centers in Enugu, Nigeria. Fifteen WLWHA were interviewed and 114 participated in an online survey. The descriptive statistics and a multiple linear regression analysis and comparison revealed a convergent significant relationship between the S&D determinants (social, political, psychological, environmental, and cultural) and HIV/AIDS-related S&D towards WLWHA in Enugu F (4,109) = 45.09, p

This study aimed at exploring the influence of the home environment of women that were on the prevention of mother-to-child transmission (PMTCT) programme for HIV/AIDS. A qualitative descriptive study was conducted to explore the home environment for the psycho-social support that was available for women on the PMTCT programme and the influence this had on compliance to the programme. Data collection was done using a semi-structured interview guide, with a sample size of 14 participants (n=14). The data was then coded and grouped into categories and major themes. The findings revealed that the common barriers that prevented full disclosure of an HIV positive status included stigma and discrimination, fear of social isolation and financial dependence. A major constraint that affected the women’s full utilisation of the PMTCT preventative strategies and their adherence to treatment was the poor acceptance of people living with HIV in the family and community / Health Studies / M.A. (Health Studies)

This study aimed at exploring the influence of the home environment of women that were on the prevention of mother-to-child transmission (PMTCT) programme for HIV/AIDS. A qualitative descriptive study was conducted to explore the home environment for the psycho-social support that was available for women on the PMTCT programme and the influence this had on compliance to the programme. Data collection was done using a semi-structured interview guide, with a sample size of 14 participants (n=14). The data was then coded and grouped into categories and major themes. The findings revealed that the common barriers that prevented full disclosure of an HIV positive status included stigma and discrimination, fear of social isolation and financial dependence. A major constraint that affected the women’s full utilisation of the PMTCT preventative strategies and their adherence to treatment was the poor acceptance of people living with HIV in the family and community / Health Studies / M.A. (Health Studies)