MGS / Institute for Gender and Youth Studies / Extensive resources and information are available on HIV/AIDS, but there remain disparities between what is known and actual behavior, particularly among students at tertiary institutions. A lot has been done to create HIV awareness and prevent further infections among male and female students in Higher Education Institutions of South Africa. Despite the availability of information, awareness education and campaigns, free condoms and treatment, the HIV infections continue to increase in South Africa especially amongst the youth. The aim of the study was to investigate the knowledge, attitudes, and perceptions of male and female students at the University of Venda towards the “ABC” strategy for HIV prevention, and how these consequently influence their sexual behavior. Data was obtained from 32 students using a semistructured questionnaire. A non-probability, haphazard sampling technique was used to randomly select the participants. Descriptive statistics and thematic analysis were used for data analysis. The study findings contend that knowledge of HIV and its prevention measures always translates to positive sexual behaviour, as university students were found to be knowledgeable enough, but their attitudes and sexual behaviour were found not to be consistent enough. The researcher recommends future researchers to focus on the factors that hinder sexual abstinence, fidelity in sexual relationships, and condom use amongst Higher Education students, towards creating safer environments for them.

MPH / Department of Public Health / See the attached abstract below

MSc (Microbiology) / Department of Microbiology / See the attached abstract below

MPH / Department of Public Health / Background: Young people in sub-Saharan Africa are most-at risk of HIV infection. This elevated risk in the young black population may be explained by the lack of HIV/AIDS-related knowledge, attitudes towards the epidemic and risky sexual behaviours. Purpose: The aim of the study was to assess the level of knowledge, attitude and behaviour among youth towards HIV infection and to explore the possible aetiological factors associated with the youth’s vulnerability to HIV infection. Methods and materials: This survey adopted a descriptive, cross-sectional design and a quantitative approach.The survey population comprised of all youth aged 15-24 years visiting two Namakgale clinics. An expected sample of (n=152) youths was recruited through convenience sampling. Pretesting of the questionnaire was conducted on 15 youths at Mashishimale Clinic. Data was collected using self-completed questionnaire. The data was captured using Microsoft Excel and then analyzed using the Statistical Package for Social Sciences, version 22. Results: Knowledge on HIV: The majority (77%) of the respondents could distinguish HIV and AIDS and had knowledge that HIV could cause AIDS. The majority of respondents (80%) had knowledge of how HIV was transmitted. The majority of the respondents, (84.9%) knew that HIV/AIDS could not be cured. However, misconceptions about HIV transmission still exist for example, 13.2 % of youth stated that mosquito bites could transmit HIV and whilst 22.4% believed that witchcraft could cause HIV. The main source of HIV information was television (89%). Attitudes towards PLHIV: About 82.9% disagreed that all PLHIV should live away from Namakgale while 72. 4% stated that if their relative had HIV they would care for them. Overall, Namakgale youth held positive attitudes towards PLHIV. Risky sexual behaviours: About 61.8% of females, compared to their male counterparts (38.2%) ever had sex. 61.8% of females compared to 50.0% of males have had sex before their 15th birthday. 36.5% have had 3-5 lifetime sexual partners in comparison to 29.6% of their female counterparts. 44.2% of males did not use condoms at last sex compared to their female counterparts (33.3%). iv Recommendations: There is an urgent need for intensifying awareness campaigns on HIV and AIDS as well as school-based interventions for youths who still harbour myths and misconceptions about HIV transmission. Policy makers and the media should focus more on late adolescents (15- 19 years) risky sexual practices such as intergeneration sex (age group between sexual partners is 10 years or more), transactional sex etc.

PhD (Health Sciences) / Department of Advanced Nursing Science / Background: Family-centred approaches to Prevention of Mother-to-Child Transmission (PMTCT) interventions present an important direction for sustainability and prevention of pediatric infections while improving overall family health. Despite numerous opportunities to sustain and expand the existing PMTCT interventions, Mother-to-Child Transmission (MTCT) still occurs. This is evidenced by the number of under-five children who are admitted in hospital being infected by the Human Immunodeficiency Virus (HIV) between the ages of 6 weeks to 18 months, whereas the Polymerase Chain Reaction (PCR) results was non-reactive at six weeks. Purpose: The purpose of this study was to develop a strategy to enhance family-centered interventions for PMTCT sustainability in the selected districts of Limpopo Province, South Africa. Phase 1: The study was conducted in phases. In Phase 1, which was empirical, the following objectives: to explore the risks that contribute to MTCT between the ages of 6 weeks and 18 months; to explore the perceptions of family members regarding family support in PMTCT interventions; and to explore the factors that affect the provision of family support in PMTCT interventions. Phase 2: was development of the strategy and validation of the strategy. Methods: The exploratory sequential mixed method was used to conduct the study, where qualitative data were collected and analyzed first; followed by collecting, analyzing and interpreting the quantitative data. The population comprised the following groups: mothers of babies between 6 weeks and 18 months who are living with HIV/AIDS, family members were represented by male partners, grandmothers or mother’s in_-law and health care professionals working at the PHC Heath Centers v or clinics rendering PMTCT services. In the qualitative design, participants were selected by non-probability purposive sampling and data were collected through one-to-one interview and focus group discussions. Data were analyzed utilizing the open-coding method. In the quantitative design, participants were selected by using simple random sampling and data were collected by means of self-administered survey questionnaires with structured close-and open-ended questions. The population were midwives from Capricorn, Mopani and Vhembe districts PHC clinic. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), Version 22 and descriptive statistics. In Phase 2, findings from the data were used to develop an intervention strategy. The strategy was developed through the use of Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis. The developed strategy was validated by using a quantitative design. / NRF

Department of Microbiology / PhD (Microbiology) / Human herpes virus type 8 (HHV-8), also known as Kaposi’s sarcoma associated herpes virus (KSHV), is the etiologic agent of Kaposi’s sarcoma (KS), and AIDS related Kaposi’s sarcoma (AIDS-KS). HHV-8 which is a member of the Herpesviridae family, exhibits extensive genetic diversity globally. In endemic regions, infection with HHV-8 occurs very early on in life, which is an indication of both environmental and vertical routes of transmission. The advent of HIV leads to the classification of an AIDS-KS defining condition in HIV infections. This suggests that in regions where HIV and HHV-8 are endemic, KS may become common in a mature HIV epidemic. Just like the prevalence of HIV in Northern South Africa is generally high as in most regions of the country, as the HIV epidemic matures in South Africa, it is important to understand the burden and distribution of HHV-8 infection, and the likely genotypes infecting the population. The main objective of the thesis was to establish the epidemiology and infecting genotypes of HHV-8 in Northern South Africa (Limpopo Province), where no data exists. First, a systematic review of the literature was carried out for the entire African continent to determine the seroprevalence and genotype distribution of HHV-8 in all African countries (n=53). In this review, Sudan and South Sudan were considered as one country. Articles were searched using the PRISMA guideline and exported using an article grid. More than two-thirds (64%) of the studies reported on seroprevalence, 29.3% on genotypes; and 9.5% were on both seroprevalence and genotypes. About 45% (24/53) of the African countries had data on HHV-8 seroprevalence exclusively, and more than half (53%) had data on either seroprevalence or genotypes. Almost half (47%) of the countries had no data on HHV-8 infection. There was high heterogeneity in the types of tests and interpretation algorithms used in determining HHV-8 seropositivity across the different studies. Generally, seroprevalence ranged from 2.0% in a group of young children in Eritrea to 100% in a small group of individuals with KS in the Central Africa Republic and a larger group of KS in individuals in Morocco. Approximately, 16% of all the studies reported on children. The difference in seroprevalence across the African region was not significant (95% CI, X2 =0.86; p =0.35), although specifically, a relatively significant ETTA MASHU ELIZABETH, PHD IN MICROBIOLOGY|UNIVERSITY OF VENDA, 2019|VIII level of infection was observed in HIV-infected children. About 38% of the countries had data on K1 genotypes A, A5, B, C, F and Z which occurred at frequencies of 5.3%, 26.3%, 42.1%, 18.4%, 5.3% and 2.6% respectively. Twenty-three percent of the countries had data for K15 genotypes, whereas genotypes P, M and N occurred at frequencies of 52.2%, 39.1% and 8.7% respectively. Data on HHV-8 inter-genotype recombinant is scanty. Our finding suggests that HHV-8 is endemic on the entire African continent, and in HIV endemic regions, but there is need for a harmonized testing protocol for better understanding of HHV-8 seropositivity. HHV-8 genotype A5 and B for K1 gene and genotype P and M for K15 gene are the most predominant genotypes in Africa. The review, for the first time, has provided information on HHV-8 burden on the entire African continent, and suggests that vaccine development efforts for Africa should focus on genotypes B and P. The second component of the investigation focused on the burden of HHV-8 in an HIV population in Northern South Africa (Limpopo Province). Plasma from 3501 HIV infected individuals from 5 districts in Limpopo Province were assessed for antibodies to both the lytic antigen (ORFK8.1) and the latent antigen (ORF73). The distribution of infection was analyzed based on demographic, socioeconomic, and immunological parameters. Statistical inferences for significant differences were determined by Chisquare at a confidence interval of 95%. P-values less than 0.05 were considered significant. About 19.0% of the study population was positive for antibodies to either the lytic or latent antigens or both. Prevalence of antibodies to the lytic antigen was significantly higher than prevalence of antibodies to the latent antigen (17.3% vs 4.1%; p=0.0001). Significant differences were observed for age groups, racial population groups, districts and year of sample collection (p=<0.0001, p=<0.0001, p=<0.0001 and p=0.0385) respectively. Associations were found between both antigens in comparison to the different variables such as age group, racial population groups and districts (R2 value ranging between 0.886 and 1.0). The burden of HHV-8 has now been established for the first time in Northern South Africa. The third aspect of the investigation was a meta-analysis of HHV-8 seroprevalence in Southern Africa in order to understand the impact of geographical location (urban vs rural) on infection. The analysis revealed a significant association between urban settings and HHV-8 infection (p=0.0001). ETTA MASHU ELIZABETH, PHD IN MICROBIOLOGY|UNIVERSITY OF VENDA, 2019|IX The fourth component of the thesis examined the detection of HHV-8 antigen through polymerase chain reaction (PCR) in 534 participants in HIV infected and HIV noninfected populations. A selection of mouthwash DNA samples were subjected to Next Generation Sequencing (NGS) for subsequent genotype inference. Mouth wash samples were obtained from each consenting individual before eating or smoking, and their DNA was purified. A 233bp fragment of the ORF26 gene of HHV-8 was amplified by PCR. HHV-8 was detected in 150 of the 534 participants (28.1%). A significant difference in detection was observed for gender, HIV status, district and the level of education (p=0,0003; p=0.0094; p=0.0002 and p=0.0095) respectively. Consensus sequences were derived from NGS reads for 13 samples. The genotyping results revealed that genotype Q, B, E and N are the genotypes predominant in the study population. As such no mixed infections were detected. Therefore, from the investigations foregoing have demonstrated for the first time the following: (1) HHV-8 is endemic in the entire African continent, which suggest a coendemicity in regions already endemic for HIV; (2) HHV-8 is endemic in Northern South Africa; (3) Urban settings in Southern Africa are associated with high HHV-8 infection; (4) HHV-8 genotypes Q, B, E and N may be predominant in Northern South Africa, with B and P common on the entire African continent. Hence, studies should focus on the generation of full length HHV-8 genomes of the common genotypes to support the selection of genes for vaccine design and development. / NRF

PhD (Psychology) / Department of Psychology / Background: South Africa has world’s highest prevalence of HIV-positive people with approximately 7.06 million HIV-positive people with 110 000 HIV- related deaths reported by Statistics South Africa in 2017. South Africa has expanded access to anti-retroviral therapy services, from urban centers to resource-constrained rural communities. The rate of loss, however, to follow-up for patients on anti-retroviral treatment continues to increase. Aim of the Study: The aim of this study was to determine patient and nurse perspectives on loss to follow up among HIV-positive patients in Sekhukhune District of Limpopo Province, South Africa. The findings of the study guided the development of a proposed strategy to decrease loss to follow up among HIV-positive patients. Method: A qualitative research design was used with non-probability purposive sampling and with probability systematic sampling. The sample of patients comprised 30 HIV-positive people classified as lost to follow-up from clinics with high prevalence rates of lost to follow-up patients. Eight nurses, four from clinics with high rates and four from clinics with low lost to follow-up rates comprised the sample of nurses. Semi-structured interviews were conducted using the study research questions as a guide. Eight interviews were conducted with nurse clinic managers and 30 with the patients. Content analysis was used to analyze the data. Results: The key themes that emerged from the study included patients’ and nurses` perspectives on factors contributing to loss to follow up among HIV- positive patients; and Patients’ and nurses’ perspectives on strategies that would address barriers to loss to follow up among HIV- positive patients. Sub-themes on patients’ and nurses’ perspectives on factors contributing to loss to follow up among HIV- positive patients included: Lack of understanding of anti-retroviral treatment; fearful to disclose HIV status; lack of confidentiality; negative side effects; use of traditional medicine; self-transfer from one clinic to another. Patients’ and nurses’ elicited the strategies that would assist patients to remain in care and to take antiretroviral treatment consistently. The strategies included: providing patients with health education; working as a team; implementing social support group programme; providing nurses with in-service education on ethics and ethos. Informed by various intervention models in HIV care: Information Motivational Behavioural model; Health Belief Model; Social Action Theory and Social Cognitive Theory; I proposed a strategy that may reduce the rate of non-adherence and loss to follow up among patients with HIV in Limpopo Province. / HWSETA

The AIDS epidemic affects the capacity of the South African public service to deliver essential services. In response, the Department of Economic Development, Environment and Tourism in Limpopo implemented its HIV/AIDS workplace policy in 2003. This research evaluated the extent to which resources were allocated towards the implementation of the workplace policy, to effectively respond to the impacts of HIV/AIDS on the workplace. A combined quantitative and qualitative approach was used. Data was collected through face-to-face interviews of 43 officers involved in the implementation of the workplace policy, using a semi-structured questionnaire. The results indicated that the resources allocated for the workplace HIV/AIDS policy, namely budget, human resources and materials, were inadequate, with district offices being worse affected. / Social Work / M.A. (Social Behaviour Studies in HIV/AIDS)

This research focused on the experiences of HIV disclosure to significant others amongst people living with HIV. The aim of the research was to explore how people living with HIV experience disclosure of their HIV positive status to their significant others. The social constructionist perspective was utilized to gain a deeper understanding of the experience of HIV positive status disclosure to significant others. The study’s sample comprised of five participants who were recruited using purposive sampling strategy. Data was collected with using face to face semi structured interviews. Themes were extracted and analysed using thematic content analysis. An analysis was made as to whom participants choose to disclose to, the reaction of the people they disclosed to, as well as their reasons for disclosing. Results were reported as the participants’ experiences and noted as is or unadulterated. / Psychology / M.A. (Psychology)

The purpose of the study was to identify factors associated with the HIV transmission rate in 18 to 24 month-old children enrolled in the PMTCT programme at two selected City of Tshwane clinics. Mother-to-child transmission of HIV during labour and breastfeeding accounts for 40% of all HIV infection in children. The prevention of mother-to-child transmission of HIV programme is one effective strategy to reduce the rate of HIV infection in children. The HIV transmission rate was low at six weeks of age but increases at 18 to 24 months of age due to several factors. The researcher selected a descriptive retrospective correlational research design. A structured questionnaire was used to collect data from 60 mothers of children aged 18 to 24 months on the PMTCT programme and a data-collection form to collect data from 152 clinic records of children of the same age on the programme. The study found that the PMTCT guidelines were not properly adhered to by the nurses and the respondents. Prophylactic treatment was not provided as required and mixed feeding was prominent. The uptake of HIV test at 18 to 24 months was low compared to at 6 weeks. The transmission rate was high at 18 to 24 months compared to at 6 weeks. No factors were associated with the transmission rate / Health Studies / M.A. (Public Health)