Estudou-se a experiência de mulheres vivendo com HIV e aids também conviverem com situações de violência por parceiro íntimo, e as repercussões destes entrecruzamentos para o cuidado de sua saúde. Tomamos como referência o conceito de vulnerabilidade já formulado para a AIDS e retrabalhado especificamente para as questões de gênero, permitindo explorar o conceito nas situações de violência doméstica contra as mulheres. Partiu-se do pressuposto que os contextos do HIV/Aids podem gerar situações de violência de mulheres soropositivas e que as representações amorosas, o ideal de conjugalidade e de família podem influenciar no impacto do cuidado da saúde das mulheres. Foram realizadas 20 entrevistas em profundidade com mulheres em acompanhamento do HIV/Aids, inseridas nos Serviços de Saúde da Rede Especializada em DST/Aids da cidade de São Paulo, na modalidade história de vida. Encontraram-se diversos contextos da vulnerabilidade, denominada de gênero, nas narrativas produzidas, na infância, adolescência e fase adulta, reforçando padrões hegemônicos de gênero ao longo dos diferentes ciclos de vida dessas mulheres. O estudo aponta que as experiências do adoecimento na revelação do diagnóstico é o elemento disparador de medos e sofrimentos em decorrência da reação dos parceiros e a das preocupações com os filhos. O diagnóstico do HIV é o momento não só do contato com a doença, mas de desvelar ou reconhecer situações de violência. É a partir das concepções e contextos de vida que as mulheres identificam o modo de se situarem no enfrentamento do HIV e da violência. O cuidado da saúde foi abordado tanto como cuidado de si, quanto na relação com os serviços de saúde, o que mostrou a grande preocupação representada pelas dificuldades que, em função de suas condições de portadoras do HIV, essas mulheres viam para se manterem na condição tradicional de cuidadoras, dentro das referências do padrão social de gênero, quer em torno de seus adoecimentos e expectativas de vida futura, quer para com os filhos. Tais preocupações surgem como justificativas da manutenção da família diante de parceiros violentos. Embora presente, observou-se que o tema violência não é pauta na atenção à saúde da mulher vivendo com HIV e aids, nos serviços de saúde especializados. A vulnerabilidade de gênero destaca-se pela ênfase na condição materna, em que por ela e para ela as mulheres dão significados às suas vidas, ao adoecimento e ao cuidado. / This work studied the experience of women living with HIV and AIDS also live with situations of violence by their intimate partner and the implications of these intersections for their health care. We took as reference the concept of vulnerability already formulated to AIDS and adapted for gender issues, allowing explore it in situations of domestic violence against women. We started from the assumption that the contexts of HIV / AIDS can lead to situations of domestic violence involving HIV positive women and that the representations of love, the ideal of marital and family can influence on health care of these women. We made 20 in-depth interviews with women living with HIV / AIDS, followed on STD / AIDS reference centers of the Municipality of São Paulo, using living history method. We found in the narratives several contexts of the so called gender vulnerability occurred in childhood, adolescence and adulthood, reinforcing hegemonic gender patterns over the different life cycles of these women. The study shows that the fact of the diagnosis disclosure to be made during an illness is the element that triggers fear and suffering in relation to the reaction of the partners and worries with their children. The time of HIV diagnosis is not only the moment of contact with the disease, but also the time to uncover or recognize situations of violence. It is through conceptions and contexts of life that women identify how to locate themselves in the struggle against HIV and violence. Health care was addressed as much as caring for oneself as well in relation with the health services. This approach showed the great concern about the difficulties perceived by these women in order to keep the condition of traditional caregivers within the references of hegemonic social pattern of gender, either about their illnesses and future life expectations either about children. Such concerns arise as a justification for maintaining the family when there is coexistence with a violent partner. Although present, it was observed that violence is not an issue discussed in health care of women living with HIV and AIDS in specialized health services. The vulnerability of gender of these women is distinguished by an emphasis on maternal condition which gives meaning to their lives, illness and care.

<p>The main purpose of the study was to assess and explore the knowledge of HIV/AIDS among secondary learners in rural Bergville district of KwaZulu-Natal. A stratified random sample of 100&nbsp / learners was selected from two secondary schools in the area. Data was collected using a questionnaire and interviews were scheduled with the teachers from the selected schools. The&nbsp / questionnaire was administered to a sample of 54 learners from school A and 46 from school B. The mean age was 16, with age range from 13-20. The participants were enrolled for grade&nbsp / 8-12 in both schools. Both qualitative and quantitative data on learners‟ knowledge and perception about HIV/AIDS, condom use and sexual issues including their attitudes towards people living with HIV/AIDS were collected in the questionnaire. Chi-square test was used for statistics purpose to test if the HIV knowledge of learners were associated with gender, culture and&nbsp / religion. Qualitative interviews with 9 teachers from both schools were conducted. The main purpose of the interviews was to investigate the management of HIV/AIDS in public schools in rural&nbsp / areas. Furthermore, to assess the learner‟s attitude towards HIV/AIDS education provided in schools. The results showed that the learners in Bergville district were more knowledgeable of&nbsp / HIV/AIDS through HIV/AIDS education in schools that had limited effect on gender, culture and religion. Quantitative findings presented, indicated no significant differences between those&nbsp / learners attending church and cultural activities that offer&nbsp / HIV/AIDS awareness programmes and those who do not with regard to the knowledge of HIV/AIDS. However, culture stood out to be associated with one item on the knowledge of whether school children can get HIV/AIDS (p-value = 0.04). On average, the level of knowledge of HIV/AIDS between female and male learners was similar. The major findings on both quantitative and qualitative findings confirmed that learners‟ knowledge levels were very high for modes of transmission and prevention of HIV/AIDS. Despite this knowledge, poor&nbsp / behavioural change among learners is a major setback thus increasing high risk of contracting HIV. Adequate knowledge about issues of cure, HIV testing and treatment was of concern in the findings in this study. Furthermore, data from qualitative interviews with the teachers highlighted the lack of multisectoral response to HIV/AIDS in Bergville rural communities which thus&nbsp / compromise the effectiveness in management of HIV/AIDS in schools. In summary, the study revealed some of the challenges faced by teachers and learners in regard to HIV/AIDS education.</p>

<p>Eligibility for antiretroviral therapy (ART) in HIV-infected patients is defined either by a cluster of differentiation antigen 4 (CD4) count of less than 200cells/mm3 or clinical diagnosis of WHO stage III and IV. Therefore, the decision to start ART becomes difficult when CD4 cell count is not available. With limited laboratory infrastructure, the decision to start ART is usually made based on clinical symptoms leading to late commencement of ART. This calls for alternative criteria to see if nail discoloration (ND) correlates with low CD4 count among untreated HIV infected patients. This will serve as a complementary screening tool for identifying asymptomatic ARV naive HIV patients with a CD4 cell count of less than 200cells/mm3 which signifies&nbsp / severe immunosuppression. Study Design and Setting: This was a quantitative cross-sectional descriptive and analytical study involving adult ART na&iuml / ve HIV infected patients in WHO stage I and II. Systematic sampling was used to select the participants from all adult ART na&iuml / ve HIV infected patients attending APIN clinic, located at the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Data Collection: Face-to-face interviews, physical examination and relevant laboratory investigations with selected participants were conducted using a questionnaire guide. Questions on socio-demographic characteristics, clinical data, general physical examinations including finger nail examination and photographing with subsequent laboratory investigations including CD4 count and western blot were employed. Data Analysis: Variables were categorized and data analyzed using descriptive statistics including the frequency, percentage frequency / mean and standard deviation of continuous variables. Association between CD4 count of &le / 200cells/mm3 and ND was tested using the chisquare test with an alpha level of 0.05. Prevalence of ND, sensitivity, specificity, positive predictive and negative predictive values and accuracy of the screening test of ND was calculated. Results: 394 patients had their fingernails photographed and assessed. It was shown that distal banded and grey nails were the common types of ND seen with a prevalence of 38%. There was an association between CD4 count &le / 200cells/mm3 and ND (p&lt / 0.0001). CD4 count &le / 200cells/mm3 was a risk factor for developing ND (RR=2.3[1.8-3.6]). The association has a sensitivity of 78%, specificity of 55%, positive predictive value of 50%, and negative predictive value of 80% and accuracy of test 63%. Conclusion: With a significant association (p&lt / 0.0001) and a sensitivity of 78%, ND can be a useful clinical indicator of immune dysfunction mediated by HIV among patients in WHO stage I or II. ND can either be a clinical sign or a symptom in HIV patients with a CD4 of &le / 200cells/mm3 as seen in the study as the specificity and sensitivity of ND compared favourably with other WHO stage III diagnosis. Recommendations: Nail discoloration should complement CD4 count as an additional staging sign to help identify patients likely to benefit from ART especially in resource-limited settings. Finally, all patients with grey or distal banded should be on co-trimoxaxole prophylaxis in line with WHO /national guideline on the use of co-trimoxaxole for all HIV positive patients with a CD4 cell count of &le / 350cells/mm3.</p>

An emergency reaction is required in Africa because HIVIAIDS is a reality which may be regarded as a developing crisis and a catastrophe. Approximately a third of all women in the North-West Province are HIV positive. Because of their vulnerability against HIVIAIDS there arose a need for health service provision to the HIV positive woman to focus specifically on the reduction of the transmission of HIVIAIDS from mother to child. Mother to child transmission is the biggest cause of HIV infection among children. Almost all HIV positive children are infected during pregnancy, labour, childbirth or breastfeeding. Without the necessary preventative measures as many as 25-35% of the children of HIV positive mothers may be infected. The biggest percentage of infections, however, takes place during labour and the birth process. In first world countries the mother has access to choices and facilities to make an informed decision about antiretroviral therapy, as well as the method of birth. In the North-West Province not all these options and facilities are available, and therefore the knowledge and skills of midwives must be deployed to reduce vertical transmission of HIV during the intrapartum practice. It is important that midwives have the necessary knowledge about intrapartum practices and vertical transmission of HIV, in order to distinguish between risky and safe intrapartum practices. The purpose of this research was to determine whether midwives in the Southern region of the North-West Province have sufficient knowledge of intrapartum practices to reduce vertical transmission of HIV, as well as to determine the intrapartum practices in the Southern region of the North-West Province. The ultimate goals, then, were to determine how the national policy should be adapted and implemented in the Southern region of the North-West Province to reduce HIV transmission during intrapartum practices. A quantitive survey design was used. For the data collection a questionnaire and a control list were used. The questionnaire and the control list, which are adapted and based on literature, were submitted to research and subject specialists, after which they were adapted. Permission was obtained for this research from the Department of Health in the North-West Province, the ethics committee of the PU for CHE as well as each provincial hospital in the Southern region in the North-West Province to conduct the research. A purposeful availability sample of midwives working in the Southern region of the North-West Province was used and a random sample was used for auditing the obstetric records. A total of 31 midwives participated as respondents, and 401 obstetrical records were audited. Data analysis was performed by means of a frequency analysis, effect sizes and cross reference. Based on these findings it was concluded that the midwives do have basic knowledge regarding vertical transmission of HIV, but that this knowledge is not reflected in the intrapartum practice. There is uncertainty about certain aspects where the latest research about intrapartum practices are not implemented in practice. Recommendations were accordingly formulated for nursing education, research and practice. This research particularly focused on improving midwives' knowledge about intrapartum practices to reduce the vertical transmission of HIV, so that this knowledge may result in improved intrapartum practice. Recommendations are also made as to how the national policy may be adapted and implemented in the Southern region of the North-West Province. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2004.

The prevalence of HIV infection in pregnant women is still on the rise despite existing preventive programmes aimed at reducing HIV-transmission. Voluntary counselling and testing during pregnancy is the key entry point in the prevention of mother-to-child transmission (Department of Health, 2000:16; Birdsall et al. 2004:3). Women are often diagnosed as being HIV-positive for the first time when they attend antenatal clinics and consent to HIV testing (UNAIDS, 1997). The objective of this study was to determine the pregnant women's experiences of voluntary counselling and testing (VCT) and to explore and describe the impeding and facilitating factors that played a role in their choice whether or not to consent to HIV testing after having received pre-test counselling. By understanding the impeding and facilitating factors that play a role in the pregnant woman's choice to undergo HIV testing, recommendations could be made to possibly improve the uptake of HIV testing among pregnant women. The population studied in this research consisted of pregnant women making use of antenatal clinics in the Potchefstroom sub-district. Purposive sampling was used to select participants with the assistance of mediators who were working in the local clinics and the hospital. The sample size was determined by data saturation, which was reached after 10 interviews. A qualitative design was used and data was collected by means of semi-structured interviews. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached consensus on the main and sub-themes. The main themes are the facilitating and impeding factors that play a role in the pregnant women's choice to undergo HIV testing. Based on findings, it was concluded that facilitating and impeding factors that play a role in the pregnant woman's choice to HIV testing do indeed exist. Impeding factors identified were: fear of a positive status; fear of stigmatization and discrimination; fear of lack of support; lack of opportunity to consider their choice to undergo HIV testing; lack of trust that confidentiality will indeed be honoured; fear of knowing possible positive HIV-status that can lead to feelings of depression and mental anguish; differences between counsellors' and pregnant women's characteristics. Facilitating factors consist of the desire to be aware of own HIV status; desire to protect the baby; sufficient information and the importance of trust and confidentiality. Recommendations were subsequently made to make HIV counselling and testing services to pregnant women more user-friendly in order to facilitate the pregnant woman in her choice concerning HIV-testing. Heeding these recommendations will possibly lead to more pregnant women's HIV status being known by the time they go into labour. Recommendations were made that pregnant women be counselled for HIV testing during their first antenatal visit and the HIV-testing being offered to them during the second visit. Research findings reveal that most pregnant women need time to consider their choice to undergo HIV testing and to prepare themselves for the test. Most pregnant women felt that they would possibly consent to HIV testing during their second antenatal visit. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

The last few years have seen an increase in the infection rate not only of HIV but also TB. The HIV/AIDS pandemic is increasing rapidly mainly in developing countries with 71 % of infections in the Sub-Saharan region of Africa. South Africa, which forms part of the Sub- Saharan region, has the highest infection rate in the world with 3.2 to 3.4 million people living with HIV/AIDS. People with HIV are especially vulnerable to TB, and HIV pandemic is fuelling an explosive growth in TB cases. The increase in the infection rate of TB and HIV exert increased pressure on health service delivery thus reflecting the serious problem in the country with regard to health service delivery to people co-infected with TB and HlV/AlDS. Health service delivery is also hindered by negative attitudes of health workers that have been reported towards people living with HIV/AIDS. They entertain a biased view of their own risk, considering risk only from occupational exposure and denying the possibility of infection in their private life. These attitudes of health workers decreases the quality of care and support delivered to patient co-infected with TB and HIV. This result in people not disclosing their illness even in cases were treatment is available like TB for the fear of stigmatisation. Hence the problem of stigmatisation escalates into a dilemma for the patient co-infected with TB and HIV. Therefore these patients tend to shy away from health services and isolate themselves due to fear of being stigmatised twice. The need to address TB and HIV together in the light of this dimension is urgent so as to improve the utilization of the health services by people co-infected with Ti3 and HIV. The purpose of this research was to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, to explore and describe the attitudes of health workers towards patients co-infected with TB and HIV, and to formulate guidelines for health workers that will facilitate the health service utilization by patients co-infected with TB and HIV in the Potchefstroom district. The research was conducted in the Potchefstroom district in the North West province of South Africa. A qualitative research design was used to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, and to explore and describe the attitudes of health workers toward co-infected patients. A purposive voluntary sampling method was used to select participants who met the set criteria. Two populations were used, that is the patients co-infected with TB and HIV, and the health workers who were involved in their care. In depth unstructured interviews were conducted with the patient population and semi structured interviews with the health worker population using an interview schedule that was formulated from the background literature. Data was captured on an audiotape, and transcribed verbatim. Field notes were taken immediately after each interview. The researcher and a co-coder did data analysis after data saturation was reached and a consensus was reached on the categories that emerged. From the findings of this research it appeared that there were general perceptions by the patients co-infected with TB and HIV that indicated stigmatisation by the health workers. This perceived stigmatisation was reported as being perpetrated by all categories of health workers. Negative behaviours such as the health workers not having time for the patients and being impatient were reported. Lack of sufficient knowledge was related to these behaviours especially amongst lower categories or non-professional health workers. In spite of the above, the researcher also observed that there was a limited number of health workers who were still being perceived as committed and caring by the patients co-infected with TB and HIV. The researcher concluded that the relationship between the health workers and the patients co-infected with TB and HIV was characterised by conflict. The health workers seemed to perceive the patients co-infected with TB and HIV as stubborn, harsh, abuse alcohol, manipulative and not taking responsibility of their illness. These perceptions lead the health workers to have a negative attitude towards these patients and occasionally came across as unsympathetic towards them. On the other hand the researcher observed that there were other health workers who did not present with negative behaviours towards these patients and tried to understand the reasons for their sometimes-unacceptable behaviours. Recommendations are made for the field of nursing education, community health nursing practice and nursing research with the formulation of guidelines for health workers so as to facilitate the utilization of the health services by the patients co-infected with TB and HIV. The guidelines are discussed under three main categories, namely guidelines for the health workers to facilitate the utilization of the health services by the patients co-infected with TB and HIV, guidelines to improve the utilization of the health services more efficiently and adequately by the patients co-infected with TB and HIV, and guidelines to improve the attitudes of the health workers towards the patients co-infected with TB and HIV with the intention of improving the utilization of the health services by these patients. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2006.

<p>Eligibility for antiretroviral therapy (ART) in HIV-infected patients is defined either by a cluster of differentiation antigen 4 (CD4) count of less than 200cells/mm3 or clinical diagnosis of WHO stage III and IV. Therefore, the decision to start ART becomes difficult when CD4 cell count is not available. With limited laboratory infrastructure, the decision to start ART is usually made based on clinical symptoms leading to late commencement of ART. This calls for alternative criteria to see if nail discoloration (ND) correlates with low CD4 count among untreated HIV infected patients. This will serve as a complementary screening tool for identifying asymptomatic ARV naive HIV patients with a CD4 cell count of less than 200cells/mm3 which signifies&nbsp / severe immunosuppression. Study Design and Setting: This was a quantitative cross-sectional descriptive and analytical study involving adult ART na&iuml / ve HIV infected patients in WHO stage I and II. Systematic sampling was used to select the participants from all adult ART na&iuml / ve HIV infected patients attending APIN clinic, located at the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Data Collection: Face-to-face interviews, physical examination and relevant laboratory investigations with selected participants were conducted using a questionnaire guide. Questions on socio-demographic characteristics, clinical data, general physical examinations including finger nail examination and photographing with subsequent laboratory investigations including CD4 count and western blot were employed. Data Analysis: Variables were categorized and data analyzed using descriptive statistics including the frequency, percentage frequency / mean and standard deviation of continuous variables. Association between CD4 count of &le / 200cells/mm3 and ND was tested using the chisquare test with an alpha level of 0.05. Prevalence of ND, sensitivity, specificity, positive predictive and negative predictive values and accuracy of the screening test of ND was calculated. Results: 394 patients had their fingernails photographed and assessed. It was shown that distal banded and grey nails were the common types of ND seen with a prevalence of 38%. There was an association between CD4 count &le / 200cells/mm3 and ND (p&lt / 0.0001). CD4 count &le / 200cells/mm3 was a risk factor for developing ND (RR=2.3[1.8-3.6]). The association has a sensitivity of 78%, specificity of 55%, positive predictive value of 50%, and negative predictive value of 80% and accuracy of test 63%. Conclusion: With a significant association (p&lt / 0.0001) and a sensitivity of 78%, ND can be a useful clinical indicator of immune dysfunction mediated by HIV among patients in WHO stage I or II. ND can either be a clinical sign or a symptom in HIV patients with a CD4 of &le / 200cells/mm3 as seen in the study as the specificity and sensitivity of ND compared favourably with other WHO stage III diagnosis. Recommendations: Nail discoloration should complement CD4 count as an additional staging sign to help identify patients likely to benefit from ART especially in resource-limited settings. Finally, all patients with grey or distal banded should be on co-trimoxaxole prophylaxis in line with WHO /national guideline on the use of co-trimoxaxole for all HIV positive patients with a CD4 cell count of &le / 350cells/mm3.</p>

<p>The main purpose of the study was to assess and explore the knowledge of HIV/AIDS among secondary learners in rural Bergville district of KwaZulu-Natal. A stratified random sample of 100&nbsp / learners was selected from two secondary schools in the area. Data was collected using a questionnaire and interviews were scheduled with the teachers from the selected schools. The&nbsp / questionnaire was administered to a sample of 54 learners from school A and 46 from school B. The mean age was 16, with age range from 13-20. The participants were enrolled for grade&nbsp / 8-12 in both schools. Both qualitative and quantitative data on learners‟ knowledge and perception about HIV/AIDS, condom use and sexual issues including their attitudes towards people living with HIV/AIDS were collected in the questionnaire. Chi-square test was used for statistics purpose to test if the HIV knowledge of learners were associated with gender, culture and&nbsp / religion. Qualitative interviews with 9 teachers from both schools were conducted. The main purpose of the interviews was to investigate the management of HIV/AIDS in public schools in rural&nbsp / areas. Furthermore, to assess the learner‟s attitude towards HIV/AIDS education provided in schools. The results showed that the learners in Bergville district were more knowledgeable of&nbsp / HIV/AIDS through HIV/AIDS education in schools that had limited effect on gender, culture and religion. Quantitative findings presented, indicated no significant differences between those&nbsp / learners attending church and cultural activities that offer&nbsp / HIV/AIDS awareness programmes and those who do not with regard to the knowledge of HIV/AIDS. However, culture stood out to be associated with one item on the knowledge of whether school children can get HIV/AIDS (p-value = 0.04). On average, the level of knowledge of HIV/AIDS between female and male learners was similar. The major findings on both quantitative and qualitative findings confirmed that learners‟ knowledge levels were very high for modes of transmission and prevention of HIV/AIDS. Despite this knowledge, poor&nbsp / behavioural change among learners is a major setback thus increasing high risk of contracting HIV. Adequate knowledge about issues of cure, HIV testing and treatment was of concern in the findings in this study. Furthermore, data from qualitative interviews with the teachers highlighted the lack of multisectoral response to HIV/AIDS in Bergville rural communities which thus&nbsp / compromise the effectiveness in management of HIV/AIDS in schools. In summary, the study revealed some of the challenges faced by teachers and learners in regard to HIV/AIDS education.</p>

An emergency reaction is required in Africa because HIVIAIDS is a reality which may be regarded as a developing crisis and a catastrophe. Approximately a third of all women in the North-West Province are HIV positive. Because of their vulnerability against HIVIAIDS there arose a need for health service provision to the HIV positive woman to focus specifically on the reduction of the transmission of HIVIAIDS from mother to child. Mother to child transmission is the biggest cause of HIV infection among children. Almost all HIV positive children are infected during pregnancy, labour, childbirth or breastfeeding. Without the necessary preventative measures as many as 25-35% of the children of HIV positive mothers may be infected. The biggest percentage of infections, however, takes place during labour and the birth process. In first world countries the mother has access to choices and facilities to make an informed decision about antiretroviral therapy, as well as the method of birth. In the North-West Province not all these options and facilities are available, and therefore the knowledge and skills of midwives must be deployed to reduce vertical transmission of HIV during the intrapartum practice. It is important that midwives have the necessary knowledge about intrapartum practices and vertical transmission of HIV, in order to distinguish between risky and safe intrapartum practices. The purpose of this research was to determine whether midwives in the Southern region of the North-West Province have sufficient knowledge of intrapartum practices to reduce vertical transmission of HIV, as well as to determine the intrapartum practices in the Southern region of the North-West Province. The ultimate goals, then, were to determine how the national policy should be adapted and implemented in the Southern region of the North-West Province to reduce HIV transmission during intrapartum practices. A quantitive survey design was used. For the data collection a questionnaire and a control list were used. The questionnaire and the control list, which are adapted and based on literature, were submitted to research and subject specialists, after which they were adapted. Permission was obtained for this research from the Department of Health in the North-West Province, the ethics committee of the PU for CHE as well as each provincial hospital in the Southern region in the North-West Province to conduct the research. A purposeful availability sample of midwives working in the Southern region of the North-West Province was used and a random sample was used for auditing the obstetric records. A total of 31 midwives participated as respondents, and 401 obstetrical records were audited. Data analysis was performed by means of a frequency analysis, effect sizes and cross reference. Based on these findings it was concluded that the midwives do have basic knowledge regarding vertical transmission of HIV, but that this knowledge is not reflected in the intrapartum practice. There is uncertainty about certain aspects where the latest research about intrapartum practices are not implemented in practice. Recommendations were accordingly formulated for nursing education, research and practice. This research particularly focused on improving midwives' knowledge about intrapartum practices to reduce the vertical transmission of HIV, so that this knowledge may result in improved intrapartum practice. Recommendations are also made as to how the national policy may be adapted and implemented in the Southern region of the North-West Province. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2004.

The prevalence of HIV infection in pregnant women is still on the rise despite existing preventive programmes aimed at reducing HIV-transmission. Voluntary counselling and testing during pregnancy is the key entry point in the prevention of mother-to-child transmission (Department of Health, 2000:16; Birdsall et al. 2004:3). Women are often diagnosed as being HIV-positive for the first time when they attend antenatal clinics and consent to HIV testing (UNAIDS, 1997). The objective of this study was to determine the pregnant women's experiences of voluntary counselling and testing (VCT) and to explore and describe the impeding and facilitating factors that played a role in their choice whether or not to consent to HIV testing after having received pre-test counselling. By understanding the impeding and facilitating factors that play a role in the pregnant woman's choice to undergo HIV testing, recommendations could be made to possibly improve the uptake of HIV testing among pregnant women. The population studied in this research consisted of pregnant women making use of antenatal clinics in the Potchefstroom sub-district. Purposive sampling was used to select participants with the assistance of mediators who were working in the local clinics and the hospital. The sample size was determined by data saturation, which was reached after 10 interviews. A qualitative design was used and data was collected by means of semi-structured interviews. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached consensus on the main and sub-themes. The main themes are the facilitating and impeding factors that play a role in the pregnant women's choice to undergo HIV testing. Based on findings, it was concluded that facilitating and impeding factors that play a role in the pregnant woman's choice to HIV testing do indeed exist. Impeding factors identified were: fear of a positive status; fear of stigmatization and discrimination; fear of lack of support; lack of opportunity to consider their choice to undergo HIV testing; lack of trust that confidentiality will indeed be honoured; fear of knowing possible positive HIV-status that can lead to feelings of depression and mental anguish; differences between counsellors' and pregnant women's characteristics. Facilitating factors consist of the desire to be aware of own HIV status; desire to protect the baby; sufficient information and the importance of trust and confidentiality. Recommendations were subsequently made to make HIV counselling and testing services to pregnant women more user-friendly in order to facilitate the pregnant woman in her choice concerning HIV-testing. Heeding these recommendations will possibly lead to more pregnant women's HIV status being known by the time they go into labour. Recommendations were made that pregnant women be counselled for HIV testing during their first antenatal visit and the HIV-testing being offered to them during the second visit. Research findings reveal that most pregnant women need time to consider their choice to undergo HIV testing and to prepare themselves for the test. Most pregnant women felt that they would possibly consent to HIV testing during their second antenatal visit. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.