A dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Arts (Clinical Psychology) in the Department of Psychology University of Zululand, 2008. / Since the surfacing of HIV and AIDS epidemic in South Africa, various programs were implemented in order to educate and prevent the spread of this devastating disease. The Department of Health in South Africa therefore implemented the Voluntary Counseling Testing (VCT) programs across the country in workplaces, tertiary institutions, clinics as well as in hospitals. However in spite of these attempts current studies indicate that the spread of HIV and AIDS is escalated particularly amongst the people between the ages of eighteen and thirty. With so many available VCT sites and centers that provide information about the disease and an opportunity to test for one's sero-status, one would expect not hear such an increase in new HIV/AIDS infections! In view of the above a qualitative study was therefore undertaken to find out from the twenty five students who took part in this study. The aim of the research study is to find from the students who utilize the VCT program services at the University of Zuluiand their experiences about the program, what they appreciate about it and what can be done in order to ensure an efficient service which is in line with the South African HIV/AIDS Strategic Plan 2000 - 2005.

The health of University students is important as these individuals are central to the future economic sector. Since HIV/AIDS is a major public health threat in South Africa (SA), it is vital to develop health initiatives that aim to reduce the HIV prevalence rate among youth and to promote positive health behaviour. Voluntary Counselling and Testing (VCT) is one such initiative. The National Department of Health (NDoH) recently implemented the „First Things First‟ campaign that aims to promote VCT among youth. In line with the NDoH‟s initiative, this study explored the factors that shape attitudes towards VCT among first year students at the University of the Witwatersrand (WITS). This study was conducted using a combination of quantitative and qualitative research methods. The respondents included 195 first year students out of approximately 220 who participated in a survey and two key informants in the field of HIV/AIDS whom I interviewed. With regards to ethical considerations, the study protected the respondent‟s rights by maintaining anonymity of all survey participants and exercised care that the human rights of individuals and the reputation of WITS as an institution were safeguarded. Based on conceptual models of health behaviour, the study identified factors that shaped students responses to VCT. The results of this study indicate that youth at WITS go for VCT mainly to know their HIV status. This is being triggered by them knowing someone who has either; been for VCT, is living with HIV or passed away due to AIDS. In addition, the free availability and easy accessibility of VCT services on campus and the positive influence of peers through social mobilisation were regarded as key motivations for students accessing VCT. However, some students seem to not access VCT services due to personal fears of rejection, blame and discrimination if they were to be found HIV-positive. The gendered dynamics and nature of clinics together with the poor attitudes of some health service providers were also major barriers to VCT uptake among youth. The findings conclude that many students know that VCT is a necessary and beneficial process. It also found that there are multiple factors that work together in complex ways to shape the reasons why youth choose to „test‟ or not to „test‟ for HIV.

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.

<p><font face="Times New Roman" size="3"><font face="Times New Roman" size="3"> <p align="left">Despite wide acceptance of Voluntary Counselling and Testing (VCT) as a crucial entry point for the prevention, treatment, care and support of HIV-infected persons / the prevalence of testing in Ethiopia remains very low. A review of the literature identifies the set of factors that influence HIV testing of individuals to include socio-economic and demographic factors, knowledge of HIV/AIDS, risk perception, fear of stigma, social capital and the perceived benefit of VCT. By drawing assumptions based on the known literature, this mini-thesis explores the relationship between VCT usage and the above factors in order to explain the status of HIV testing in Moher and Aklil district, Gurage Zone, Ethiopia. The study hopes to address the dearth of material on VCT and contribute to it in a non-clinical and rural context.</p> </font></font></p>

An understanding of individual cognitions that influence both behavioural intentions and the enactment of actual behaviours is provided by the conceptual model of the Theory of Planned Behaviour (TPB). This study used the Theory of Planned Behaviour, with the added variable of perceived risk, to predict Kenyan students’ intention to use HIV voluntary counselling and testing (VCT) centres within the country. We conducted a survey questionnaire with 200 students, aged 13-15 years, within high schools in the Nairobi and Nakuru districts in May 2009. Chi-squared analysis showed no relationships between age, school, school level, knowledge of a VCT centre, or past sexual experience with intention to uptake HIV counselling and testing. Pearson product-moment analysis revealed a small positive correlation between attitude and subjective norm and a medium negative correlation between perceived behavioural control and perceived risk. One-way analysis of variance showed a relationship between perceived behavioural control and intention. Results of block entry logistic regression analysis indicate that perceived behavioural control and perceived risk were significant predictors of intention to use VCT services in the TPB model. The present study suggests that Kenyan teens’ perceived ease/difficulty in performing a specific behaviour is the most influential aspect in predicting their subsequent intention to carry through the behaviour. A theory-based intervention program should focus on reducing practical barriers related to the use of VCT services. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2009-12-04 10:06:25.104

<p><font face="Times New Roman" size="3"><font face="Times New Roman" size="3"> <p align="left">Despite wide acceptance of Voluntary Counselling and Testing (VCT) as a crucial entry point for the prevention, treatment, care and support of HIV-infected persons / the prevalence of testing in Ethiopia remains very low. A review of the literature identifies the set of factors that influence HIV testing of individuals to include socio-economic and demographic factors, knowledge of HIV/AIDS, risk perception, fear of stigma, social capital and the perceived benefit of VCT. By drawing assumptions based on the known literature, this mini-thesis explores the relationship between VCT usage and the above factors in order to explain the status of HIV testing in Moher and Aklil district, Gurage Zone, Ethiopia. The study hopes to address the dearth of material on VCT and contribute to it in a non-clinical and rural context.</p> </font></font></p>

Voluntary counselling and testing (VCT) has become a vital process in combating the spread of HIV/AIDS. Yet little has been published on how students experience the process of VCT. This study sought to describe and understand the experiences of voluntary counselling and testing among four students at Tshwane University of Technology. This research project focussed on students’ experiences when reporting for voluntary counselling and testing. The results were used to make recommendations for strategies to increase the accessibility and uptake of VCT by students. Using a phenomenological approach, tape recorded interviews were conducted with the four students of Tshwane University of Technology (TUT). The data were then categorised into five themes relating to the experience of VCT: emotions, perceptions, actions, thoughts and desires. The results showed that the students were mostly dissatisfied with the VCT clinic’s procedures and the counsellor’s attitudes. Also evident from this study was that counsellors’ professionalism, peer support, and a service that offers both pre- and post-test counselling play a significant role in students’ use of VCT. The findings of this study suggest that the following could be used as strategies to motivate students to utilise VCT services of VCT: (1) increase access and acceptability of VCT for students; (2) ensure access to factual information in the form of counselling; (3) make counselling a priority. / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted

Thesis (MPH.) --University of Limpopo, 2009 / Please refer to the document

Master of Public Health - MPH / Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services. / South Africa

Magister Public Health - MPH / Background: One study on estimating rates of mother to child transmission of HIV (MTCT) in program settings in Zambia showed significant reduction in the MTCT rate with some specific prevention of mother to child transmission of HIV (PMTCT) interventions. Prolonged breastfeeding and mixed feeding practices by HIV positive mothers increased the MTCT rate by more than double by the time the infant reached 6 to12 months of age. Although the study did not assess the quality of PMTCT counselling in antenatal care settings, literature shows that poor quality of counselling on PMTCT reduces the effectiveness of PMTCT interventions. Study aim: To evaluate the quality of PMTCT counselling offered to pregnant women attending antenatal care (ANC) services in four public health facilities in Kitwe, Copperbelt province of Zambia. Study design and data collection: This was a cross sectional descriptive study. Data was generated using qualitative research methods including document analysis and individual interviews with 22 participants using non-participant observations, client exit interviews and focus group discussions (FGDs) to collect data. The study participants were ANC attendees and PMTCT providers. Two FGDs were conducted with a total of 98 counselling observations done and 16 ANC client exit interviews. Client exit interviews were done immediately after the mothers had undergone PMTCT counselling. Results: Content for group health education (GHE) varied across the facilities. Individual pre-test, post-test and follow up counselling sessions were very short and lacked depth. A total of 41 (83.7%) pre-test observations took between 1 and 5 minutes to be conducted. In addition, several key topics including major modes of HIV transmission, MTCT and the "window period" were omitted. The counsellors' interpersonal skills were generally good but they did not consistently summarize the main issues. The 16 mothers interviewed had limited knowledge of PMTCT with only one client knowing all the MTCT modes correctly. Discussion: Quality of PMTCT counselling did not meet expectations. With a lot of key topics omitted, outcomes of PMTCT interventions may not be as good as expected. Facilities are faced with serious staff shortages and limitations with space. The few members of staff available are overworked and are not able to provide quality PMTCT counselling. Conclusion: While the PMTCT uptake was good and clients felt satisfied, the quality of PMTCT counselling is compromised. There is need to improve it and ensure optimal effectiveness of PMTCT services.