Thesis(M Med.(Family Medicine)--University of Limpopo, 2009. / The impact of HIV/AIDS on the health sector and the health professionals that work in it is huge. This impact has contributed to the continuing attrition of health professionals in South Africa. Voluntary Counseling and Testing (VCT) has a central role to play in the response to these problems both at the level of the health sector in general and most especially at the level of the individual health professional. Thus, understanding factors that affect the practice of VCT amongst this group of professionals is crucial in South Africa‟s quest to reverse these negative trends. AIM The aim of this study was to determine the level of knowledge, to access and understand the attitude and practice of VCT for HIV/AIDS amongst the health professionals in a rural district Hospital and to make recommendations in order that appropriate intervention strategies may be instituted. METHODS A descriptive cross-sectional quantitative study design was used in which data was collected using a self-administered questionnaire. The study population included all the health professionals working in the hospital at the time of the study but excluded those who were on leave or absent from duty during the period of data collection. Informed consent was obtained from each participant. Data was captured and analyzed using the SPSS version 15.0 (SPSS Inc, Chicago, Illinois, USA). vi RESULTS There was a very high level of knowledge, a moderately supportive attitude and a moderately high level of practice of VCT amongst the study participants. Divorced/separated respondents to this study had more supportive attitude towards VCT than their single colleagues. Age was found to have a very weak but positive correlation to attitude score. There was no significant difference in knowledge and attitude scores between those who practiced VCT and those who did not. CONCLUSION Health professionals understand the importance of VCT as an HIV preventive behavior but there remains some VCT knowledge, attitude and practice concerns together with other determinants of VCT behavior that needs to be addressed.

Background: Countries in sub-Saharan Africa are scaling up access to Voluntary Counselling and Testing (VCT) services as a strategy for HIV prevention, treatment, care and support. The international and national push to achieve targets for anti-retroviral therapy scale up has emphasised VCT as an entry point to treatment, with follow-up mostly directed at those who test positive. Yet over 60% of those testing are HIV negative. Limited understanding of how HIV voluntary counselling and testing, and receipt of a negative result impact on sexual behaviour has resulted in underdeveloped support for those testing HIV negative. Aims: To gain the perspective of those who have tested HIV-negative on the following: (1) the decision making process that precedes attendance for voluntary counselling and testing; (2) how voluntary counselling and a negative test result influence sexual behavioural intentions and reported subsequent behaviour; and (3) support systems and networks that would enhance the respondent’s ability to remain HIV negative. Method: Qualitative longitudinal study utilising semi-structured interviews, six months apart, with people who have tested negative and three one-off focus group discussions with counsellors. Participants were purposively sampled from VCT centres in two mining towns in Zambia. Interviews were digitally recorded, transcribed verbatim and analysed thematically with the aid of the qualitative data analysis software, Nvivo7. Cross-sectional analysis of all data sets was conducted and paired transcripts were analysed longitudinally to assess change over time. Results: Forty-two HIV-negative people were interviewed, with thirty-one returning for the follow-up interview (74% return rate). VCT was perceived as ‚testing for HIV‛. Before attending VCT most participants had gone through a protracted period of angst, resulting in a resolution to reduce number of partners, use condoms or abstain from sex. Counselling affirmed life choices, rather than initiating them. Although perception of the risk of HIV increased, misconceptions about HIV transmission persisted post-counselling. The negative test result provided impetus and resolve to implement or maintain life change. Themes identified were: (1) recognising personal susceptibility to HIV infection; (2) emotional and cognitive engagement with the problem of testing; (3) a driving need to know status (regardless of test result); and (4) empowerment and being in control providing the ability to plan for the future. Analysis of post-test support needs revealed two further themes: (1) reinforcement of behaviour change through additional knowledge, supportive networks, and life-skills training; and (2) access to recreational activities. There was no reported post-test increase in unsafe sexual behaviour among those that returned for the follow-up interview. Focus group findings reinforced those from interviews. Conclusions: This study has shown that in this population of people who tested HIV-negative: 1. the majority made life changes before attending VCT and used VCT to know their status 2. counselling consolidated pre-test decisions about risk behaviour and testing provided motivation to adopt safer behaviour and to maintain previous low- or no-risk behaviour and 3. there is a felt need for post-testing recreational activities, further HIV/AIDS education and participation in HIV prevention activities. Recommendations include: (1) the promotion of community-based interactive one-to-one and group information, education and communication (IEC) (to aid understanding and progression to the point where testing appears to be of optimum benefit) ; (2) referral to post-test support options such as support groups and inclusion on a text messaging list should be made available; and (3) post-test intervention strategies, for example, provision of result-specific IEC materials and active involvement in prevention activities should be developed and evaluated.

Magister Artium (Psychology) - MA(Psych) / Student counselling services, typically located within a holistic developmental approach, aim to render comprehensive student services to service users in relation to their psychological, social, educational and spiritual well-being. However, a number of cognitive and affective barriers reportedly reduce the likelihood of young people at universities seeking professional psychological help for personal-emotional problems. Accordingly, the aim of this study, which is located within the Theory of Reasoned Action, was to explore students' attitudes towards utilising student counselling services, as well as their interpretations of the influence of age, gender and education on their attitudes and self-rated knowledge regarding seeking psychological help. The study thereby attempts to provide an understanding of the factors that influence help-seeking behaviours in university students. The research sample consisted of twenty nine students from the Cape Peninsula University of Technology. The data was collected through focus group discussions, which were conducted using an open-ended and participant centred approach to the discussion. The qualitative approach of the study was informed by the theory of social phenomenology. Data gathered from the focus group discussions was thematically analysed. The results suggest that attitudes have a potentially important influence on intentions to seek out psychological counselling. Findings show that students feel shame and guilt when they are struggling psychologically and as a result avoid seeking psychological intervention for fear of being negatively stigmatised. The study revealed that education around mental health disorders and the management thereof was crucial in order for them to be demystified and de-stigmatised, and to facilitate openness in the sharing of these problems, and society's understanding and acceptance of people experiencing psychological disorders. Results also indicate that there is a shift taking place in these attitudes, and suggest ways in which this change can be further facilitated, such as the utilisation of peer helpers who could playa key role in facilitating and reinforcing help seeking behaviour. The outcomes of the study may further contribute to informing universities' goal to provide accessible, quality and effective development and support services to its students.

Magister Public Health - MPH / The aim of the study is to explore the barriers associated with low VCT uptake by the TB patients attending primary health care clinics within the Buffalo City municipality. The study population was drawn from TB patients attending the primary health care facilities in Buffalo city municipality in the Eastern Cape Province. Eight participants were purposively selected to include those who had accepted VCT as well as those who did not.

This study was done to assess the quality of life (QOL) of people living with HIV and AIDS (PLWHA) in Swaziland who are on antiretroviral therapy (ART). No study has been done on QOL of PLWHA in Swaziland who are on ART since it started to be administered in Swaziland in 2001. A qualitative, exploratory, descriptive, and contextual design was used to assess QOL of PLWHA in Swaziland who are on ART. Twenty-four PLWHA were purposely selected to participate in the study. Methods of data collection used were semi-structured individual in-depth interviews, focus group discussions, and observations. The data (tape-recorded interviews and discussions, and field notes) were transcribed verbatim for data analysis. Data analysed was done using Tesch’s framework of data analysis as described in Creswell (2002:256-283). The research findings are reflected, with the six domains of QOL identified through a literature review and validated by nurses’ expertise. These domains are the physiological, psychological, spiritual, socio-economic, cognitive, and environmental domains.The study revealed that PLWHA in Swaziland are faced with many challenges concerning ART, namely: inability to meet their nutrition needs, non-adherence to ART, experience of disfiguring side effects of ARVs, inconsistent condom use, experience of stigma and discrimination, depression, difficulty in accepting and coping with ARVs, lowered self-esteem, a negative influence of some religions on ART, a lack of financial support, poor support systems, poor understanding of ARVs, negative thoughts about HIV and AIDS and ART, an unsatisfactory health care delivery system, a negative influence of culture on ART, and violation of the rights of PLWHA. These challenges negatively influence the QOL of PLWHA and hence the study concluded that PLWHA in Swaziland who are on ART have a poor QOL. Conclusions drawn from the data analysis reveal that PLWHA in Swaziland are powerless to deal with the above challenges and improve their QOL. The researcher, therefore, developed guidelines to empower PLWHA to deal with these challenges and adhere to ART, thus improving their QOL. Recommendations were made with regard to nursing practice, nursing education, and further nursing research. / Health Studies / D. Litt. et Phil. (Health Studies)

This study was done to assess the quality of life (QOL) of people living with HIV and AIDS (PLWHA) in Swaziland who are on antiretroviral therapy (ART). No study has been done on QOL of PLWHA in Swaziland who are on ART since it started to be administered in Swaziland in 2001. A qualitative, exploratory, descriptive, and contextual design was used to assess QOL of PLWHA in Swaziland who are on ART. Twenty-four PLWHA were purposely selected to participate in the study. Methods of data collection used were semi-structured individual in-depth interviews, focus group discussions, and observations. The data (tape-recorded interviews and discussions, and field notes) were transcribed verbatim for data analysis. Data analysed was done using Tesch’s framework of data analysis as described in Creswell (2002:256-283). The research findings are reflected, with the six domains of QOL identified through a literature review and validated by nurses’ expertise. These domains are the physiological, psychological, spiritual, socio-economic, cognitive, and environmental domains.The study revealed that PLWHA in Swaziland are faced with many challenges concerning ART, namely: inability to meet their nutrition needs, non-adherence to ART, experience of disfiguring side effects of ARVs, inconsistent condom use, experience of stigma and discrimination, depression, difficulty in accepting and coping with ARVs, lowered self-esteem, a negative influence of some religions on ART, a lack of financial support, poor support systems, poor understanding of ARVs, negative thoughts about HIV and AIDS and ART, an unsatisfactory health care delivery system, a negative influence of culture on ART, and violation of the rights of PLWHA. These challenges negatively influence the QOL of PLWHA and hence the study concluded that PLWHA in Swaziland who are on ART have a poor QOL. Conclusions drawn from the data analysis reveal that PLWHA in Swaziland are powerless to deal with the above challenges and improve their QOL. The researcher, therefore, developed guidelines to empower PLWHA to deal with these challenges and adhere to ART, thus improving their QOL. Recommendations were made with regard to nursing practice, nursing education, and further nursing research. / Health Studies / D. Litt. et Phil. (Health Studies)