Master of Science / Department of Family Studies and Human Services / Karen S. Myers-Bowman / Today the HIV/AIDS epidemic is one of the many crises families may face. Many people have died of the disease while others are still living with it. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS, with 24-27% undiagnosed and unaware of their HIV infection. The Centers for Disease Control (CDC) estimates that approximately 40,000 persons become infected with HIV each year (CDC, 2007). Stigmatization and discrimination related to HIV/AIDS is one of the many challenges that individuals and families affected by the disease face. They are unable to get employment, are denied health care, cannot access services in their communities and sometimes lose respect and power as a result of stigma. Stigma and discrimination also have been recognized as one of the main obstacles to HIV/AIDS, testing, prevention and treatment and yet little has been done to combat it. Stigma and discrimination is not only experienced by people living with HIV/AIDS but their family members, close friends, service providers and people that work with them also are stigmatized by association. This report highlights the need for family life educators to expand HIV educational programs to include issues on stigmatization and discrimination. It identifies some of the reasons why people stigmatize, the ways which stigma and discrimination are expressed and the impacts it has on individuals and their family members. Using Bronfenbrenner’s ecological model of human development, this report identifies the need to look at HIV-related stigma and discrimination as a societal problem rather than individual problem, and presents implications for education programs for the general public.

Magister Public Health - MPH / 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 severe immunosuppression. Study Design and Setting: This was a quantitative cross-sectional descriptive and analytical study involving adult ART naïve HIV infected patients in WHO stage I and II. Systematic sampling was used to select the participants from all adult ART naïve 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 ≤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 ≤200cells/mm3 and ND (p<0.0001). CD4 count ≤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<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 ≤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 ≤350cells/mm3. / South Africa

Magister Administrationis - MAdmin / 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 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 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 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 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 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 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 learners attending church and cultural activities that offer 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 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 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. / South Africa

Magister Public Health - MPH / Human Immune-deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is a major public health problem. Globally, the number of new HIV infections is decreasing but the total number of people living with the disease is increasing. An estimated 5.7 million South Africans are currently living with the disease. The life expectancy of people living with HIV (PLHIV) in South Africa has slowly increased due to the availability of Anti-Retroviral Therapy (ART). The progressive "chronicity" of HIV may be associated with a variety of impairments and disabilities for people living with HIV. This emphasising the increasingly important role that physiotherapists play to minimize the disabling impact of the disease and improve quality of life for PLHIV. The aim of study was to determine the HIV/AIDS knowledge, attitudes and the occupational risk perception of physiotherapists practicing in the Eastern Cape Province, South Africa. This study utilized a cross sectional descriptive quantitative survey to collect data. The data was collected via a structured self-administered postal questionnaire. The questionnaires were captured in Microsoft Excel and analysed statistically using CDC Epi-Info version 3.5.1. Data was analysed descriptively and the chi-square test, T-tests and ANOVA was used to identify any statistically significant relationship between variables. The results of the study identified that the physiotherapists in the study have "high" general HIV related knowledge, although major gaps regarding HIV prevention and transmission still exists. The physiotherapists expressed a positive attitude towards PLHIV, while they perceive themselves to be at low risk of HIV transmission risk when managing PLHIV. The physiotherapists with more than 10 years' experience had significantly better HIV related knowledge compared to those with less than 10 years' experience while the attitudes of married physiotherapists towards PLHIV were significantly less favourable than those who were not married. There is a need for intervention strategies to address the HIV knowledge gaps of physiotherapists. Intervention strategies need to address physiotherapists HIV prevention and transmission knowledge.

HIV/Aids has become a household term in South Africa. Most people are aware of the existence of the disease and how it is transmitted. Several people have used this information as the impetus for behaviour change but there are many individuals who have not heeded this call and have not made any significant changes to their lifestyles. This is reflected in South Africa’s high infection rate. It would seem as if, for various reasons, people know how to protect themselves but have not used this knowledge to guard against possible infection. The purpose of this study is to explore the reasons why people have not changed their behaviour and to identify possible techniques that can be used to amend this situation. This will take the form of an intensive three-day prevention workshop where participants will be asked to think critically about their own behaviour. The aim of the programme will be to discuss, demystify and debate ideas. How will this programme be designed? The researcher will make use of focus groups consisting of Technikon students who will offer their thoughts and opinions. Once these focus groups have been conducted the researcher will undertake an intensive analysis of the data and identify certain key issues. A literature review will then follow. Therefore, the foundation of this programme will be based on the ideas of the participants, the researcher’s ideas and some points from formal behaviour change theories. The goal of this study is to add to the already growing body of HIV/Aids prevention literature and to design a programme that is useful and relevant. / Dissertation (MA (Counselling Psychology))--University of Pretoria, 2006. / Psychology / unrestricted

The incidence of HIV and AIDS is rising rapidly and has become a serious concern in South Africa. In order to address the HIV and AIDS problem, Community Based Care was introduced to render an effective service to the HIV and AIDS patient. The volunteers receive training to equip them to render a holistic service to the HIV and AIDS patient. The researcher’s concern is that despite the training programme offered, there are still problems regarding the service delivery by the volunteers. Volunteers focus on the physical needs of the HIV and AIDS patient only and do not attend to their psychosocial needs, despite the fact that they are trained to take care of the needs of the HIV and AIDS patient from a holistic approach. Due to this problem, the researcher decided to explore the experiences of the volunteers regarding the implementation of the training programme on HIV and AIDS Community Based Care in order to find answers as to why they do not attend to the psychosocial needs of the HIV and AIDS patient, although they were holistically trained. The research question was formulated as follows: What is the experience of volunteers in the Potchefstroom Municipality regarding the implementation of the training programme on HIV and AIDS Community Based Care? The researcher used a quantitative approach to explore the research question. Twenty (20) volunteers from the two Community Based Care programmes, namely Baptist Children’s Centre and Bambanani Youth Project, were randomly selected for inclusion in the study. The data collection method used was a group questionnaire. Three themes were explored, namely, the content of the training programme, presentation of the training programme and empowerment of the volunteers to render an effective service to the HIV and AIDS patient. The findings showed that volunteers experienced limitations regarding the content and the presentation of the training programme, and much so in the area of attending to the psychosocial needs of the HIV and AIDS patient. They recommended changes to the training programme, based on their experiences in practice. / Dissertation (MSW)--University of Pretoria, 2008. / Social Work and Criminology / unrestricted

This research focuses on the psychosocial factors that affect adherence to highly active antiretroviral therapy (HAART) amongst HIV/AIDS patients at Kalafong Hospital. Even though the development of such regimens has helped turn HIV infection in the United States into a relatively manageable, though still serious chronic disease, compliance remains one of the major challenges in managing medication for those patients living with HIV/AIDS. This is particularly relevant given the high adherence rate (95%) required to obtain a successful long-lasting effect. In South Africa non-compliance to HAART is an under-explored phenomenon. Consequently, an understanding of factors influencing compliance is still incomplete. A qualitative study that investigates non-adherence to medication in HIV/AIDS patients was undertaken at Kalafong Hospital. This study aimed to understand patients’ psychosocial difficulties resulting in non-adherence. The study was approached in terms of the health belief model (HBM), which addresses individual characteristics pertaining to change, the transtheoretical change model (TTM) and the motivational interviewing model (MI), which address both individual and social contexts pertaining to change. The findings are designed for use by healthcare professionals as a proactive compliance enhancement tool. Participants were recruited through referrals by the medical staff to the researcher. The criteria included that participants had relapsed due to non-compliance with drug therapy. Participants that were currently experiencing difficulties with adherence were also included in the study. Males and females aged between 20 and 40 were included in the study. Fifteen participants between the ages of 20 and 40 participated in the study (13 females and two males). The data were collected by means of semi-structured interviews and follow-up unstructured questions. The interviews were audio recorded and field notes were taken. Data were analysed qualitatively. Sixteen themes emerged and were further classified into two categories: individual and social context. The themes were then compared and integrated with the literature. The study concludes that psychosocial factors such as support from family, friends and healthcare workers was found to be of utmost importance in encouraging adherence. Medication can only prolong a patient’s life if the psychosocial context in which the patient is embedded is considered in the treatment plan. / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted

With the worldwide increase in numbers of individuals infected with the human-immune deficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), the need for more information became essential. The devastating influences and fatal outcome of this disease is inevitable. These individuals are confronted with mortality and various disabling conditions. One of these disabling conditions is the possible development of a hearing loss. Loss of hearing sensitivity related to HIV/AIDS is only one of numerous effects the virus may have on humans and their quality of life. Therefore increased awareness of HIV/AIDS and the influences of this disease is inevitable for the modern audiologist. The precise nature and the extent of the influence that HIV/AIDS and antiretroviral therapy (ART) has on the hearing ability of a person are unknown to date. Even though a relationship between hearing loss, HIV/AIDS and the administration of relevant medication is expected, no clear explanation is available to provide the public or clinicians with the necessary information on assessments, interventions and aural rehabilitation techniques. Without being able to identify the specific cause, symptoms and place of lesion of the hearing loss, it will be difficult to ensure appropriate monitoring and treatment. Information regarding the influences of HIV/AIDS and ART on hearing sensitivity had to be established to ensure appropriate intervention and rehabilitation options. The first part of this research project reviews the evidence available regarding the possible influences of HIV/AIDS on hearing. Throughout the research a cross-sectional design with quantitative and qualitative approaches were followed comprising of a structured interview, basic and specialized audiometric battery to obtain the necessary case history, as well as results for these different audiological tests that were conducted. The specialised tests included immittance measurements, distortion-product otoacoustic emission (DPOAE) and auditory brainstem response (ABR). The results of this study were discussed in terms of the three sub aims in accordance with the different audiological tests that were conducted. The results indicated that those participants with ART exposure had a significantly higher incidence of hearing loss. The pure tone averages were mainly found within normal limits but decreased with the progression of the final stages of HIV/AIDS. The high and low frequencies of the audiogram were often affected with loss of hearing sensitivity suggesting the presence of a high and low frequency slope. The final three stages of HIV/AIDS had a significantly higher incidence of bilateral hearing loss. ART exposure were associated with more severe degrees of hearing loss. The DPOAE and ABR indicated that cochlear and retro-cochlear damage existed often among these participants. Only 20% participants had abnormal tympanograms suggestive of conductive pathology. The results revealed that the type of pathology varied across the stages of HIV/AIDS. The conclusions and implications of this study are discussed. Recommendations incorporate the development of HIV/AIDS awareness campaigns that includes audiological information on the possible influences, where to refer or where to seek assistance; issues regarding the improvement of the modern audiologists’ knowledge in terms of the management of the audiological needs of individuals with HIV/AIDS and the application of these results in the industrial setting to utilize when they consider granting compensation claims. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / unrestricted

Orientador: Maria Rita de Camargo Donalisio / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T02:24:43Z (GMT). No. of bitstreams: 1 Oliveira_TiagoFeitosade_M.pdf: 646726 bytes, checksum: 4689e80905264ac5b08fc1258252b586 (MD5) Previous issue date: 2004 / Resumo: A oferta de testes sorológicos tem sido colocada como uma das estratégias de combate à epidemia de HIV/aids. Inicialmente a testagem dava-se apenas nos serviços especializados, os chamados COAS ou CTA mas, devido à magnitude alcançada pela epidemia de HIV/aids, bem como a necessidade de diagnóstico precoce dos casos, fez-se necessário a disponibilização do teste anti-HIV na rede básica de saúde. O aconselhamento tem sido apontado como uma técnica a ser aplicada na oferta e na entrega do resultado do teste. Este se baseia na mudança de comportamento de pessoas e grupos sociais, proporcionando-lhes a oportunidade de adotarem práticas sexuais mais seguras ou reduzindo o dano de um determinado comportamento de risco. Através de pesquisa qualitativa, analisamos a oferta do teste para detecção do HIV nas Unidades de Saúde da Família da rede municipal de saúde de Recife-PE, sob a ótica dos profissionais de saúde. Verificamos que a indicação do referido teste se dá, quase sempre no consultório, durante a consulta clínica. O que motiva a oferta do teste é, geralmente um quadro sindrômico compatível com a aids ou o programa de assistência ao pré-natal. Os profissionais revelaram dificuldades em absorver a demanda espontânea pelo teste. A maioria dos entrevistados desconhece o aconselhamento, quanto técnica para ofertar o exame, reverter comportamentos de risco e dar o resultado do teste anti-HIV. Isso aponta para a necessidade urgente de qualificar a oferta do teste na rede básica, fazendo com que ela seja, de fato, instrumento de combate ao avanço da epidemia do HIV/aids / Abstract: The offering of serologic tests has been placed as one of the strategies in the HIV/AIDS epidemic disease combat. At first, the testate were applied in the specialized services only, the called COAS or CTA, however, with the magnitude reached by the HIV/AIDS epidemy, as well the necessity of a precocious diagnostic to the cases, the availability at the health public service of the anti-HIV test was necessary. The counselling has been pointed as a technique to be applied in the offering and delivery of the test result. That is based in the behaviour changed of social groups and people, providing them the opportunity to adopt safe sexual practices or reducing the damage of determinate risk behaviour. Through the qualitative search, we analyse the test offering to detect the HIV in the Family Health Units in the municipal public health of Recife-PE, under the health professional¿s optics. We realised that the indication of the referred test happens, almost often, in the doctor¿s office during the procedure. What motivate the test offering is, in general, a syndromic diagnostic compatible with AIDS or the pre-natal assistance program. The professions revelled some difficult in absolving the spontaneous demand for the test. The majority of the interviewed does not know the counselling as a technique to offer the exam, revert behaviour risks and give the anti-HIV result. This points to the urgent necessity of qualify the test offering into the public service, turning it to a combative instrument against the HIV/AIDS epidemy advance, indeed. / Mestrado / Saude Coletiva / Mestre em Saude Coletiva

Philosophiae Doctor - PhD / The continued success of antiretroviral programmes in the treatment of HIV is dependent on access to a cost-effective HIV drug resistance test (HIV-DRT). HIVDRT involves sequencing a fragment of the HIV genome and characterising the presence/absence of mutations that confer resistance to one or more drugs. HIV-DRT using conventional DNA sequencing is prohibitively expensive (~US$150 per patient) for routine use in resource-limited settings such as many African countries. While the advent of ultra deep pyrosequencing (UDPS) approaches have considerably reduced (3-5 fold reduction) the cost of generating the sequence data, there has been an even more significant increase in the volume of data generated and the complexity involved in its analysis. In order to address this issue we have developed Seq2Res, a computational pipeline for HIV drug resistance test from UDPS genotypic data. We have developed QTrim, software that undertakes high throughput quality trimming of UDPS sequencing data to ensure that subsequently analyzed data is of high quality. The comparison of QTrim to other widely used tools showed that it is equivalent to the next best method at trimming good quality data but outperforms all methods at trimming poor quality data. Further, we have developed, and evaluated, a computational approach for the analysis of UDPS sequence data generated using the novel Primer ID that enables the generation of a consensus sequence from all sequence reads originating from the same viral template, thus reducing the presence of PCR and sequencing induced errors in the dataset as well as reducing. We see that while the Primer ID approach does undoubtedly reduce the prevalence of PCR and sequencing induced errors, it artificially reduces the diversity of the subsequently analysed data due to the large volume of data that is discarded as a result of there being an insufficient number of sequences for consensus sequence generation. We validated the sensitivity of the Seq2Res pipeline using two real biological datasets from the Stanford HIV Database and five simulated datasets The Seq2Res results correlated fully with that of the Stanford database as well as identifying a drug resistance mutations (DRM) that had been incorrectly interpreted by the Stanford approach. Further, the analysis of the simulated datasets showed that Seq2Res is capable of accurately identifying DRMs at all prevalence levels down to at least 1% of the sequence data generated from a viral population. Finally, we applied Seq2Res to UDPS resistance data generated from as many as 641 individuals as part of the CIPRA-SA study to evaluate the effectiveness of UDPS HIV drug resistance genotyping in resource limited settings with a high burden of HIV infections. We find that, despite the FLX coverage being almost three times as much as that of the Junior platform, resistance genotyping results are directly comparable between both of the approaches at a range of prevalence levels to as low as 1%. Further, we find no significant difference between UDPS sequencing and the "gold standard" Sanger based approach, thus indicating that pooling as many as 48 patient's data and sequencing using the Roche/454 Junior platform is a viable approach for HIV drug resistance genotyping. Further, we explored the presence of resistant minor variants in individual's viral populations and find that the identification of minor resistant variants in individuals exposed to nevirapine through PMTCT correlates with the time since exposure. We conclude that HIV resistance genotyping is now a viable prospect for resource limited setting with a high burden of HIV infections and that UDPS approaches are at least as sensitive as the currently used Sanger-based sequencing approaches. Further, the development of Seq2Res has provided a sensitive, easy to use and scalable technology that facilitates the routine use of UDPS for HIV drug resistance genotyping.