Mitt examensarbete är till lika delar ett sorgearbete liksom ett minnesarbete och ett handens arbete. Det tar avstamp i det tomrum som en förlust lämnar efter sig. I minnet av någon, minnet av en lukt, minnet av en känsla. De suddas ut, bleks och omformas. Via dessa fragment undersöker jag dialogen mellan det analoga och digitala, då och nu. Mitt arbete handlar om omsorg och att föra vidare ett arv. Jag tar upp tråden där min mormor lämnade den.

Health communication is a vital part of health care and treatment. For patients living with HIV, effective health communication is crucial. This study aimed at describing health communication from the perspective of HIV-positive patients by uncovering their experiences as they interacted with various medical staff members at Stanger Hospital. Guided by a review of various health communication models, data were collected via individual interviews and non-participant observation. The findings showed that interactive communication was favoured by all the respondents, especially communication that was patient-centred. Such communication encompassed education on how to live and cope with HIV. Obstacles to effective communication such as power differentials, lack of time and privacy at public health care clinics were identified. The study found that the different medical staff members at the clinic to various degrees addressed distinctive communication needs of HIV-positive patients. This study contributed to effectively understating the communication process as a whole. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This study investigates how the new technology of treatment, i.e. antiretroviral therapy (ART), is incorporated into public health care institutions. The success of this technology ideally relies on the notion of the ‘responsibilised’ patient as one who, simply put, consistently maintains the level of ARV-adherence necessary to suppress the viral load and to avoid drug resistance. The stringent management and continual monitoring of treatment adherence necessary to achieve these outcomes lie beyond the direct control of the health care institution. Given that the institution sees its patients irregularly, a patient’s divergence from treatment guidelines is established only after the fact. The institution takes on a supporting role while it is the patient who, on a day-to-day, dose-by-dose basis manages and monitors themselves, making ART a seemingly individual endeavour and responsibility. This shift in responsibility is compatible with the ‘new contract’ between provider and client, necessitated by ART. Even so, the institution attempts to manipulate the day-to-day behaviours of the patient to conform to those required in order to achieve treatment outcomes. This thesis examines how these different aspects of ART play out within two clinics in the Cape Winelands, and more specifically, the institutional intricacies of managing a disease which requires treatment that is not directly observed. / AFRIKAANSE OPSOMMING: Die studie ondersoek hoe die nuwe tegnologie van behandeling, antiretrovirale behandeling (ARB), in publieke gesondheidsorgklinieke geïntegreer word. Die sukses van hierdie tegnologie hang af van die nosie van die ‘verantwoordelike’ pasiënt wat, eenvoudig gestel, die nodige vlak ARV-gebruik handhaaf om die virale lading te onderdruk en weerstand te voorkom. Die streng kontrole oor die toewyding tot behandeling wat nodig is om hierdie uitkomstes te bereik, lê buite die direkte beheer van die gesondheidsorgkliniek. Aangesien die kliniek sy pasiënte slegs periodiek sien, word ʼn pasiënt se afwyking van behandelingsriglyne eers later gemeet. In hierdie opsig neem die kliniek 'n ondersteunende rol in, terwyl dit die pasiënte is wat op 'n daaglikse, dosis-tot-dosis basis hulself moet handhaaf en monitor. Dit maak ARB 'n oënskynlike individuele onderneming en verantwoordelikheid. Hierdie skuif in verantwoordelikheid is in lyn met die nuwe kontrak tussen die gesondheidsorgdiens en die kliënt, wat deur ARB genoodsaak word. In ieder geval probeer die institusie om die daaglikse gedrag van die pasiënt te manipuleer om te pas by die riglyne wat deur die uitkomstes genoodsaak word. Hierdie tesis ondersoek hoe hierdie verskillende aspekte van ARB binne twee klinieke in die Kaapse Wynland uitspeel, en meer spesifiek, die institusionele bestuur van 'n siekte waarvoor behandeling nie direk geobserveer kan word nie.

Written in Swedish with an English abstract. Polygamy has recently received more and more attention in Sweden due to, among other things, the streams of refugees and globalization. The Swedish norm of marriage is monogamy thus family constellations that go against this sometimes have difficulties to adapt to the Swedish family law. Polygamy is a collective name for marriages where a person is married to several people at the same time. The sex basically does not play a role in the concept of polygamy, but the most common marriage constellation, and the constellation that this essay has delimited itself to, is the one where one man is married to several women. Today, polygamy is mainly practiced in the Muslim countries of Asia and Africa where the Qur'an is an important part of the construction of the countries' legal systems. In order for polygamy to be allowed in Sweden, it is required that the marriage can be recognized according to the law on certain international legal relationships concerning marriage and guardianship (lag om vissa internationella rättsförhållanden rörande äktenskap och förmynderskap). According to the Swedish Tax Agency's (Skatteverket) investigation, there are currently 679 persons registered with one or more spouses in the population register in Sweden; on the other hand, the figure is not considered to reflect reality. When a person dies, there are many things to be organized. Most of these issues in Sweden are regulated in the Inheritance Code (ärvdabalken). But since most of the family law in Sweden is based on the Swedish norm of marriage of monogamy, there are several application problems when the Inheritance Code is to be applied to polygamous marriages. But although the law is mainly designed for monogamy, it is possible to apply the law to polygamous family constellations. Even though it is not designed for this purpose, the law should be considered flexible enough that it can be applied. However, the application of the law creates problems among other things when it comes to the women in the relationship. It is clear that women in polygamous marriages have more uncertainties than women in monogamous marriages when it comes to the right to inherit and survivor`s protection. It is also difficult to presume that the proposal for legislative amendment that are on the table will contribute to strengthening the protection of the women. However, there are many indications that it in general looks good for the children in the marriages. There is really not much that suggests that children whose parents are in polygamous relationships are treated a lot differently when it comes to the right to inherit then children with parents in monogamous marriages. / Polygami har på senare tid uppmärksammats mer och mer i Sverige med anledning av bland annat flyktingströmmar och globalisering. Den svenska äktenskapsnormen är tvåsamhet, monogami vilket således har lett till att familjekonstellationer som går emot denna norm ibland har svårt att anpassas till den svenska familjerätten. Polygami är ett samlingsnamn för äktenskap där en person är gift med flera personer samtidigt.  I grunden spelar könet inte någon betydelse för begreppet polygami men den vanligaste äktenskapskonstellationen, och den konstellation som uppsatsen har avgränsat sig till, är den där en man är gift med flera kvinnor. Idag är polygami främst praktiserat i de muslimska länderna i Asien och Afrika där Koranen är en viktig del av uppbyggnaden av ländernas rättsordningar. För att polygami ska bli tillåtet i Sverige krävs det att äktenskapen kan erkännas enligt lagen om vissa internationella rättsförhållanden rörande äktenskap och förmynderskap. Enligt Skatteverkets utredning finns det idag 679 personer registrerade med en eller flera makar i folkbokföringsdatabasen i Sverige, däremot anses siffran inte spegla verkligheten. När en människa dör är det mycket saker som ska anordnas. De flesta av dessa angelägenheterna i Sverige regleras i ärvdabalken. Men eftersom den till största delen av familjerätten i Sverige utgår från den svenska äktenskapsnormen om tvåsamhet, föreligger det ett flertal tillämpningsproblem när ärvdabalken ska tillämpas på polygama äktenskap. Men trots att lagen i huvudsak är utformad för monogami finns det möjlighet att tillämpa lagen vid polygama familjekonstellationer. Trots att lagen i sig inte är konstruerad för polygama familjer torde den dock vara så flexibel att den går att tillämpa. Tillämpningen av lagen är dock behäftade med problem för bland annat kvinnorna i relationen. Det är tydligt att kvinnor i polygama äktenskap har det mer osäkert än kvinnor i monogama äktenskap när det kommer till arv och efterlevnadsskydd. Att de förslag till lagändring som ligger på bordet kommer bidra till en stärkelse av kvinnornas skydd är även det svårt att förmoda. Mycket tyder dock på att det överlag ser bra ut för barnen i äktenskapen. Det finns egentligen inte mycket som tyder på att barnen i hög utsträckning blir särbehandlade jämte barn i monogama äktenskap.

Les recommandations de l’OMS sur la prise en charge des enfants nés de mères infectées par le VIH évoluent en fonction des nouvelles données scientifiques souvent issues d’essais thérapeutiques. Leur application en routine, surtout dans les pays à ressources limitées, devrait prendre en compte les contraintes opérationnelles locales pour guider les pratiques. Ce travail de thèse a été développé dans cette optique, avec pour objectif d’évaluer l’ensemble du processus de prise en charge de ces enfants avant l’âge de sept mois, depuis le dépistage précoce de l’infection VIH jusqu’à la mise en œuvre du traitement antirétroviral (ARV) systématiquement proposé dès le diagnostic de l’infection VIH, et leurs réponses aux vaccins administrés dans le Programme Elargi de Vaccination (PEV). Ce travail est issu de l’analyse des données collectées dans deux enquêtes : la cohorte ANRS-PEDIACAM initiée en 2007 et toujours en cours, menée dans trois hôpitaux urbains du Cameroun, et l’enquête transversale ACIP-EPIPEV, menée de novembre 2004 à Mai 2005 dans cinq hôpitaux du Cameroun et de la République Centrafricaine. Nos résultats ont montré que le diagnostic précoce du VIH et l’initiation des ARV chez les nourrissons étaient faisables et largement acceptés en routine dans les services de pédiatrie urbains. Parmi les nourrissons nés de mères séropositives inclus dans PEDIACAM, 89,7% ont été ramenés pour le test VIH à un âge médian de 1,5 mois (IQ : 1,4-1,6) et 83,9% ont complété le processus de diagnostic en revenant chercher les résultats du test avant l’âge de 7 mois. Les facteurs associés au processus incomplet reflétaient plus la qualité des soins prénataux et l’urgence du contexte obstétrical que les conditions environnementales. Parmi les nourrissons infectés par le VIH, 83,5% ont initié les ARV avant l’âge de 7 mois. Mais le processus d’initiation précoce des ARV a été considéré comme suboptimal chez environ un tiers d’entre eux. Les facteurs associés à ce retard étaient liés au système de soins, à la gestion des prélèvements et des résultats du test VIH. Enfin, dans l’étude EPIPEV, nous avons observé des proportions plus faibles de réponses vaccinales adéquates chez les enfants infectés que non infectés par le VIH, nés de mères séropositives. Cette différence était plus marquée pour le vaccin contre la rougeole (20% vs 60%). Le niveau de réponse observé chez les enfants non infectés nés de mères séropositives était néanmoins faible par rapport à celui attendu chez les enfants en population générale. Ce dernier résultat suggérerait que l’exposition au VIH pendant la grossesse pourrait entrainer un dysfonctionnement immunologique, même en l’absence de transmission du VIH à l’enfant. L’ensemble de ces travaux nous ont permis de cibler certains aspects pour améliorer le processus de prise en charge précoce des nourrissons exposés au VIH, portant sur l’organisation des sites, l’application effective des recommandations établies et la mise en place d’une coordination active. / The world health organization (WHO) recommendation updates regarding care of HIV-infected children reflects new scientific findings in clinical trials. Their implementation in routine practice, especially in resource-limited countries, should consider local operational constraints in order to direct good clinical practice guidelines. We put in place this work in order to evaluate the early care process of HIV-exposed infants aged less than 7 months including: early diagnosis of HIV, initiation of antiretroviral therapy (ART), and immune responses to vaccines administered by the Expanded Program on Immunization (EPI). Our data were collected from two surveys: the current ANRS-PEDIACAM cohort which started in 2007, in three urban hospitals located in Cameroon, and the ACIP-EPIPEV cross sectional study conducted from November 2004 to May 2005, in five urban hospitals based in Cameroon and the Central African Republic. Our results strongly suggested that both early HIV diagnosis and initiation of ART in infants were feasible and well accepted in “real pediatric world urban settings”. Among HIV-exposed infants enrolled in the PEDIACAM study, 89.7% were tested for HIV at a median age of 1.5 months and 83.9% completed the process by returning for the result before 7 months of age. Incomplete process was associated to factors related to the quality of antenatal care and obstetrical emergency than environmental ones. Among HIV-infected infants identified, 83.5% started ART before 7 months of age. However, ART initiation was considered as suboptimal in approximately one third of them. Risk factors associated with this delay were related to the care delivery system, including delays in sample collection and turn around procedures. Finally, the EPIPEV study showed that antibody levels to EPI vaccines in HIV-uninfected children born to HIV-infected mothers were higher compared to levels in HIV-infected children (60% vs 20% concerning measles vaccine), but lower than the levels described for children born to HIV-uninfected mothers. This result suggested an immunological dysfunction of HIV-exposed children which occurred during pregnancy and could affect their survival. Overall, our studies contributed in providing findings that could help in improving early care in HIV-exposed infants. These include the structural and functional organization of health structures, the effective implementation of current recommendations, and of active coordination.

Health communication is a vital part of health care and treatment. For patients living with HIV, effective health communication is crucial. This study aimed at describing health communication from the perspective of HIV-positive patients by uncovering their experiences as they interacted with various medical staff members at Stanger Hospital. Guided by a review of various health communication models, data were collected via individual interviews and non-participant observation. The findings showed that interactive communication was favoured by all the respondents, especially communication that was patient-centred. Such communication encompassed education on how to live and cope with HIV. Obstacles to effective communication such as power differentials, lack of time and privacy at public health care clinics were identified. The study found that the different medical staff members at the clinic to various degrees addressed distinctive communication needs of HIV-positive patients. This study contributed to effectively understating the communication process as a whole. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

La miniaturisation croissante des systèmes électroniques implique de réduire la taille des composants électroniques, en particulier des composants passifs (condensateurs, résistances et inductances), notamment les condensateurs, volumineux et de surcroît nombreux. Pour répondre à cette attente, une des options est d’intégrer « enterrer » les couches capacitives dans le circuit imprimé à base de matériaux composites céramique/polymère. Dans un premier temps, plusieurs types de matériaux composites à base de nanoparticules de céramique (BaTiO3 et BaSrTiO3) et de polyester pour des condensateurs enterrés sont développés. Ensuite, la permittivité ε’ et les pertes diélectriques des composites sont évaluées dans les gammes de fréquences entre [10 kHz – 10 MHz] et [1 GHz – 5 GHz]. En vue d’intégrer ces composants à l’intérieur du circuit imprimé parfois souple et flexible, le comportement piézoélectrique des composites est évalué. La mesure du courant de fuite permettant d’effectuer une analyse qualitative des matériaux composites a été également effectuée.Au niveau de l’étude des condensateurs enterrés dans le circuit imprimé, deux structures de tests ont été réalisées : l’une montée en parallèle et l’autre en série. L’étude est réalisée sur deux gammes de condensateurs. La première est à base de matériau composite stable en fréquence et la seconde varie avec la fréquence. Pour cela, une méthode originale qui permet d’extraire la variation de la permittivité εr (f) à haute fréquence a été développée. La méthode se repose principalement sur l’utilisation des résultats de mesure de la permittivité relative du condensateur en basse fréquence, et les résultats de la valeur de la fréquence de résonance obtenue en simulation électromagnétique.Enfin, pour améliorer la fréquence de fonctionnement des condensateurs enterrés, des règles de conception permettant de comprendre l’influence des vias de connexions et de la géométrie des électrodes sur la fréquence de résonance du dispositif de test sont étudiées. / The increasing miniaturization of electronic systems involves reducing the size of electronic components, in particular passive components (capacitors, resistors and inductors), including capacitors, large and many more. To meet this expectation, one of the options is to integrate "bury" the capacitive layers based on ceramic / polymer composites in the PCB. In a first step, several types of composite materials based on nanoparticle ceramic (BaTiO3 and BaSrTiO3) and polyester for buried capacitors are developed. Then, the permittivity ε' and the dielectric losses of the composites are measured in the ranges of frequencies between [10 kHz - 10 MHz] and [1 GHz - 5 GHz]. To integrate these components within the PCBs sometimes soft and flexible, the piezoelectric behavior of composites is evaluated. The measurement of leakage current to perform a qualitative analysis of composite materials was also made.At the level of the study of buried capacitors in the circuit board, two test structures were carried out: one mounted in parallel and the other in serial. The study is produced in two ranges of capacitors. The study is conducted on two capacitors ranges. The first case, the relative permittivity does not depend on the frequency while in the second case the frequency dependence is taken into account. For this, an original method which allows to extract the permittivity εr(f) variation in high-frequency was developed. The method is mainly based on the use of measurement results of the relative permittivity of low-frequency capacitor, and the results of resonance frequency value obtained by 3D HFSS electromagnetic simulation. Finally, to improve the operating frequency of the buried capacitors, design rules allowing understand the influence of the vias and geometry of electrodes on the resonant frequency of the structures are studied.

L'une des principales barrières à la prise en charge optimale des patients sous traitement antirétroviral est l'accès limité aux tests de charge virale (CV) et de génotypage particulièrement en milieu décentralisé. Ces tests ne sont généralement disponibles qu'au niveau des structures sanitaires centrales de grandes villes et le plasma en est l'échantillon de référence. Or, son transfert des régions périphériques vers les laboratoires de références est difficile, voire impossible. Pour rapprocher les patients du laboratoire, nous avons démontré la possibilité d'assurer un suivi virologique complet (CV et génotypage) à partir des DBS collectés et acheminés dans des conditions de terrain. Nous avons également pour la première fois, documenté la réponse virologique au traitement antirétroviral et la diversité génétique du VIH-1 chez des patients adultes suivis en milieux décentralisés au Sénégal, au Mali et en Guinée Conakry. Globalement, malgré les défauts d'observance au traitement souligné, les résultats de nos travaux ne montrent pas de différences significatives dans la survenue de l'échec virologique entre patients suivis dans les structures sanitaires centrales et périphériques, ceci quelque soit le pays considéré. Au Sénégal, chez les enfants nés de mères séropositives, la résistance vis à vis des INNTI était plus prépondérante, probablement du fait de l'utilisation systématique de la Névirapine durant la PTME. Par ailleurs, aucune mutation de résistance aux inhibiteurs d'intégrase n'a été observée malgré des taux de résistance élevés chez des patients en échec de première et deuxième ligne de traitement. Nos travaux confirment également une grande diversité génétique des sous-types viraux avec cependant la prédominance du CRF02_AG dans la sous région Ouest Africaine. Ces travaux de thèse mettent en évidence la faisabilité et la pertinence du DBS comme support pour le suivi virologique des patients en milieux décentralisés. Son utilisation a permis de montrer d'autre part des taux d'échecs virologiques élevés indiquant la nécessité de renforcer l'adhérence au traitement. Enfin, nos résultats soulignent l'utilité de prendre davantage en considération les profils de résistance pour initier un traitement de relais. / One of the major barriers to the optimal care of patients undergoing antiretroviral therapy is the limited access to viral load (VL) and genotyping tests, especially in remote areas. These technologies are usually available only at central health facilities in larger cities and plasma is the reference sample. However, plasma or whole blood samples shipment from remote areas to reference lab faces several constraints or even impossible. In order to bring closer patients to reference lab, we have demonstrated the ability of DBS (Dried Blood Spots) collected and shipped in field conditions to provide complete virological monitoring (VL and genotyping). We also documented for the first time, virological outcome of ART and HIV-1 genetic diversity in adult patients followed up in decentralized settings in Senegal, Mali and Guinea Conakry. Overall, despite the low treatment adherence noted sometimes, our findings show no significant differences in the occurrence of virological failure among patients followed up in the central and peripheral health facilities, whatever the country. In Senegal, no integrase inhibitors associated DRM has been found despite the high rate of resistance in patients failing first and second-line treatment. Furthermore, among children born to HIV infected mothers, NNRTI-associated drug resistant mutations (DRM) were more predominant, probably because of systematic use of Nevirapine in MTCT. Our studies also confirm the high genetic diversity of viral subtypes, with the dominance of CRF02_AG in West Africa. This work presented here highlights the feasibility and relevance of DBS as support for the virological monitoring of patients in decentralized settings in West Africa. Furthermore, its use showed high rate of virological failure indicating the need to reinforce adherence to treatment. Finally, our results highlight the utility to considering carefully drug resistance patterns before switching to another ART regimen.

The diploma thesis deals with the analysis of problems of unevenly stratified air flow in air handling units and subsequent optimization with respect to speed ratios, energy efficiency and legislative requirements. Methods of solving the problem are theoretical and experimental, while the theoretical part deals with air distribution by means of air-conditioning fans with a focus on their aerodynamics, pressure conditions and other requirements, which are an integral part of properly designed equipment. In the experimental part of the thesis was applied a proposal of an innovative technical approach to a specific model of air conditioning assembly, which was implemented in the laboratories of the Institute of Building Services.

HIV/AIDS is severely affecting the armed forces in South Africa. Combating HIV/AIDS demands a high level of commitment from the Ministry of Defence and all the Divisions and Services at all levels in the Department of Defence. Prevention practice for HIV/ AIDS is a challenged because the nature and full extent of the impact on the forces, and in particular on serodiscordant couples, are not known. This research study explored the experiences of serodiscordant couples regarding the impact of serodiscordancy on their marriages. The Infectious Disease Clinic engages serodiscordant couples as active participants in dealing with their HIV status. The researcher explored the impact of HIV serodiscordancy on married couples attending the Infectious Disease Clinic at 1 Military Hospital with the intended outcome of informing intervention and prevention strategies and programmes for serodiscordant couples. The study utilised a qualitative research approach and the research design was an instrumental case study. The population for the study was all the married serodiscordant couples in the Infectious Disease Clinic at 1 Military Hospital. The sample consisted of 20 serodiscordant couples attending the Infectious Disease Clinic for at least the past two years. The data was collected through semi-structured interviews. The study concluded that empowerment programmes on HIV/AIDS should include knowledge of, as well as coping skills and guidance for couples dealing with serodiscordancy, including disclosure and discrimination; marital and parenting roles; health management, building of trust; facilitating open and positive communication; and financial management. Based on the conclusions of the study, the main recommendation is that prevention strategies and empowerment programmes for serodiscordant couples should be based on a holistic, well-integrated intervention plan which contextualises strategies and programmes for prevention, treatment, counselling, empowerment and continuous support of the employee, their spouse and their family, including home visits, as required by the serodiscordant couple. Furthermore, it should clearly conceptualise the role of each team member at both the Infectious Disease Clinic and the relevant units of the SANDF, in particular the role of the social worker. / Dissertation (MSW)--University of Pretoria, 2010. / Social Work and Criminology / unrestricted