No abstract available. / Thesis (M.A.)-University of Natal, Durban, 2003.

No abstract available. / Thesis (LL.M.)-University of KwaZulu-Natal, Durban, 2012.

HIV and AIDS is one of the biggest challenges facing South African young people today (Govender, 2010). Young people are at risk, partly through their own behaviour and partly through the attitudes, expectations and limitations of the societies in which they grow up (Panos AIDS Briefing, 1996).The are many HIV prevention programmes developed globally and nationally, specifically for young people but the pandemic still escalates rapidly. The fourth decade now calls for multidimensional approaches when communicating HIV prevention for young people. This thesis explores how young people can contribute to this multidimensional approach through their active participation in the various phases of developing HIV projects. The study does this through a sample of eight youth-focused HIV organisations in KwaZulu-Natal and a sample of students from the University of KwaZulu-Natal, to gain more insight into participation of young people in the development of HIV programmes. Bodymapping, a visual and art-based method, was used to explore young people’s understanding of HIV, their perceptions of HIV programmes and the possibilities of their participation in the developing of further HIV projects. The study used a grounded approach and applied principles of participatory action research to collect data in four phases. The first phase used interviews and focus group discussions with eight sample organisations to give insight into the programmes offered to young people and how they engage and make sense of their participation within these programmes. The second phase draws on previous bodymapping workshops that have been conducted with students from UKZN and young people in various communities to explore the application and relevance of bodymapping. In the third phase, data is presented on two bodymapping workshops conducted, to engage with young people about their contribution to the development of HIV programmes. The final phase draws on two focus group discussions, conducted with bodymapping participants, to examine their experiences and interpretation of the bodymapping process. Some of the key findings indicate that a blanket approach to HIV programmes will not always work, as young people’s sexual behaviour needs to be explored within a wider socio-ecological framework that recognises the inter-relational and interconnected system in which they make their sexual choices. The data indicates that youth and organisations strongly support the importance of participation and the inclusion of participants when developing HIV projects. However, discussions about participation indicated that while young people could identify the importance of participation, they still lacked an understanding of how to participate and how they could learn more about their lived experiences through participation. This was evident in the data where there was a distinction in how participation was defined from those in the UKZN group and those from rural KZN. In understanding what constitutes participation, young people are better positioned to aid the process of developing effective HIV related projects that are participant specific. I argue that bodymapping can be used as a process to initiate and aid the participation of young people in the various phases of developing HIV projects. A three level model for applying bodymapping and planning processes has been developed to encourage participation with young people where the first step ensures that young people define what participation means to them. This becomes the foundation for how communication practitioners and academics make sense and theorise participation from a participant informed perspective. Bodymapping was pivotal in this process of engaging young people in self-reflection and introspection which encouraged a process of dialogue towards better understanding and defining participation from a participant perspective. Bodymapping in this way can be identified as a catalyst that encourages dialogue as part of communication for participatory development. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.

HN/AIDS in South Africa has grown to very serious proportions. An estimated number of 5.3million South Africans are infected with HIV and the majority of these infections are in the reproductive age group. Based on Annual Antenatal survey 2002,of the total 2.95 million were women aged 15-49, with an estimation of 91271 babies infected through mother to child transmission. Breastfeeding is said to be an ideal food for growth and development of a child. Given that HIV is transmissible through breastfeeding, the paper aims at examining patterns and attitudes towards breastfeeding in the era of HIV/AIDS. A total of 400 respondents drawn from Mafikeng district were interviewed. The majority were aged 20-39, never married, rural, unemployed with high school level of education. Areas of interest were knowledge about HIV/AIDS, patterns of breastfeeding and attitudes towards alternative methods of infant feeding for an HIV positive mother. Previous reports gave clarity to HIV transmission rates at various stages of life. Evidence has shown that rates of transmission are higher in early stages than late stages of life. Few weeks of life from 6-8 weeks may particularly be a period of high risk than ages above three months. Transmission might have occurred during pregnancy, labor or through breastfeeding, whereby data has shown that colostrums have high concentration of Human Immune Virus than mature milk. The study shows that breastfeeding is still regarded as an important infant feeding method that is ideal for child's growth and development but HIV infection is seen as a disturbing factor to successful breastfeeding. Fifty four percent of respondents did not breastfeed exclusively as promoted by UNICEF and WHO; mean duration for exclusive breastfeeding is two months, support is given by SADHS 1998, mean duration for complementary feeding is two months which gives an indication that more infants are at higher risk of contracting the virus should their mothers test positive which in turn gives rise to high infant /childhood morbidity and mortality rates. There is a need to strengthen and expand programmes such as VCT and PMTCT in all communities especially in rural setting where there is lack of pure water supply and proper sanitation. Efforts to reduce the risk of transmission should therefore be centered on promoting the understanding that mixed feeding or breastfeeding with supplementary feeding carries the highest risk of HIV transmission compared to exclusive breastfeeding or exclusive formula feeding. / Thesis (M.Soc.Sc. (Population Studies) North-West University, Mafikeng Campus, 2004

No abstract available. / Thesis (Ph.D.)-University of KwaZulu-Natal, Piertermaritzburg, 2010.

Magister Artium - MA / This study investigated the societal perception of refugee men as being a risk group, being polluted and the consequent risk of HIV infection they might face. It also determined the factors that could expose them to the risk of HIV infection while living in exile in South Africa. / South Africa

The present study presents three individual cases; all three clients had endured a traumatic event, namely rape, and all three met the criteria for PTSD. Despite the fact that each of the clients was initially assessed as being a suitable candidate for psychological treatment, none of the cases proceeded to the therapy phase of treatment. A number of obstacles, both personal and contextual, were encountered during treatment implementation, preventing or limiting a successful outcome of psychological treatment in each case. An examination of these cases highlights a few of the many obstacles frequently faced when delivering psychological treatment to the South African context. In so doing, this research provides an opportunity to consider the possible reasons for the limited documentation of treatment efficacy within the South African context, as well as to enhance our understanding of and sensitivity towards the cultural and contextual factors playing a role in psychological treatment.

Approximately 33.4 million people are living with HIV/AIDS. Of those, 97% live in low and middle income countries, with 22.4 million in sub-Saharan Africa. Only 42% of the people who require anti-retrovirals (ARVs) in low to middle income countries are receiving anti-retroviral therapy (ART). There is a need to develop novel and cost effective methods for producing antiretroviral drugs. Stavudine and azidothymidine (AZT) were identified as potential targets because they could both be produced through a common intermediate – 5 methyluridine (5-MU). It has been established that the biocatalytic production of 5-methyluridine is possible through a reaction known as transglycosylation, in a process which has not previously been demonstrated as commercially viable. A selection of biocatalysts were expressed either in recombinant E. coli strains or in the wild type organisms, purified and then screened for their ability to produce 5-MU. A combination of Bacillus halodurans purine nucleoside phosphorylase 1 (BHPNP1) and E. coli uridine phosphorylase (EcUP) gave the highest 5-MU yield (80%). This result represents the first combination of free enzymes from different organisms, giving high yields of 5-MU under high substrate conditions. Both enzymes were purified and successfully characterised. The established pH optimum was pH 7.0 for both enzymes. Temperature optima and stability data for BHPNP1 (70 C and t1/2 at 60 C of 20.8 h) indicated that the biocatalytic step was operating within the capabilities of this enzyme and would operate well at elevated temperatures (up to 60 C). Conversely, the temperature optimum and stability data for EcUP (optimum of 40 C and t1/2 at 60 C of 9.9 h) indicated that the enzyme remained active at 40 C for the duration of a 25 h biotransformation, but at 60 C would only be operating at 20% of its optimum activity and would lose activity rapidly. BHPNP1 and EcUP were used in a bench scale (650 ml) transglycosylation for the production of 5-MU. A 5-MU yield of 79.1% was obtained at this scale with a reactor productivity of 1.37 g.l-1.h-1. Iterative saturation mutagenesis was used to rapidly evolve EcUP for improved thermostability. A moderately high throughput colorimetric method was developed for screening the mutants based on the release of p-nitrophenol upon phosphorolysis of a pyrimidine nucleoside analogue. By screening under 20 000 clones the mutant UPL8 was isolated. The mutant enzyme showed an optimum temperature of 60 C and improved stability at 60 C (t1/2 = 17.3 h). The increase in stability of UPL8 is due to only 2 mutations (Lys235Arg, Gln236Ala). These mutations may have caused an increase in stability due to interactions with other structural units in the protein, stabilization of the entrance to the binding pocket, or by decreasing the flexibility of the α-helix at the N-terminus. Transglycosylation experiments showed that the mutant enzyme UPL8 is a superior catalyst for the production of 5-MU. A 300% increase in reactor productivity was noted when free enzyme preparations of UPL8 was combined with BHPNP1 at 1.5% m.m-1 substrate loading. The high yield of 5-MU (75-80% mol.mol-1) was maintained at 9% m.m-1 substrate loading. A commercially viable productivity of 31 g.l-1.h-1 was thus realised. Further optimisation of the process could produce still higher productivities. Future work in directed evolution of nucleoside phosphorylases is envisaged for improved stability and enhanced substrate range for application to other commercially relevant transglycosylation reactions.

Zimbabwe is one of the priority countries nominated by the World Health Organisation and the Joint United Nations Programme on HIV and AIDS to adopt and implement voluntary medical male circumcision (VMMC) because of its high rate of HIV prevalence and its low level of male circumcision. VMMC, which was introduced in Zimbabwe in 2009, is a new HIV prevention method which reportedly offers partial protection of about 60 percent for circumcised males with respect to contracting HIV through sexual relations. The other key prevention method, namely the use of condoms consistently and correctly, has a protection rate of up to 95 percent. As a result, because of only partial protection, medically-circumcised men are encouraged to use condoms to decrease the chances of HIV infection. Concerns though have been raised about the possibility of risk compensation by circumcised males by way of increases in unsafe or risky sexual practices subsequent to circumcision and arising from perceptions of reduced risk through VMMC. This compensation may take the form of condom use aversion including when involved with concurrent sexual partners. If risk compensation does take place, this would lead to increases in HIV transmissions affecting not only the circumcised men but their sexual partners as well. The supposed effectiveness of VMMC as a HIV prevention method has been subjected to significant criticism and, as yet, no significant study has been undertaken in Zimbabwe on the relationship between VMMC, condom use, concurrent sexual partners and risk compensation. Based on a study of twenty-five medically-circumcised males in Harare, the capital of Zimbabwe, this thesis seeks to understand and explain the relationship between voluntary medical male circumcision and risky sexual practices with particular reference to condom use amongst men engaged in concurrent sexual partnerships. While the thesis finds evidence of risky sexual practices subsequent to circumcision, risk compensation does not seem to be particularly prevalent.

The Department of Health in South Africa, as in many countries, has developed a policy guideline and recommendations for feeding of infants of HIV positive mothers. This is aimed at providing midwives with detailed and sound information about HIV and infant feeding practices based on current understanding of HIV and exclusive breastfeeding for the first six months of the infant’s life. The policy states that breastfeeding is a significant and preventable mode of HIV transmission to infants and there is an urgent need to educate, counsel and support women and families, so that they can make decisions about how best to feed infants in the context of HIV (http://www.doh.gov.za/aids/doc/feeding/html.2005-03-07). Speaking to midwives from the Provincial Hospitals in the Nelson Mandela Metropole, the researcher became aware of the midwives’ often-expressed unhappiness about the new policy from the Department of Health on exclusive breastfeeding. Midwives complained about the dilemma with which they are faced regarding infant feeding practices. They could not understand the advocacy of exclusive breastfeeding, when breastfeeding is recognised as one of the modes of Mother-to-Child Transmission (MTCT) of HIV. The aim of the study was to help, support and encourage midwives to implement the policy of exclusive breastfeeding. The objectives of the study were to: • Explore and describe the experiences and perceptions of midwives related to promoting exclusive breastfeeding in HIV positive first-time mothers. • Make recommendations to the Department of Health regarding the support and help that can be given to midwives to encourage their implementation of the exclusive breastfeeding policy. The researcher made use of a qualitative, phenomenological, descriptive, explorative and contextual design. Permission for conducting the research was iv obtained from relevant authorities, and participants were asked to sign a consent form before the researcher proceeded with the study. Collection of data was done by means of unstructured interviews using an audiotape recorder. Once data was saturated, the interviews were transcribed verbatim and analysed, using the steps described by Tesch’s (1990 in Creswell, 1994: 153) method of descriptive analysis. Field notes were also taken to record non-verbal communication during the interviews. In order to ensure trustworthiness of the study, the ethical principles of Guba’s model (in Krefting, 1991:215), namely truth-value, applicability, consistency and neutrality were used. The services of an independent coder were utilised and a consensus meeting was held between the researcher and the independent coder in order to discuss the identified themes. Prior to the consensus meeting, the independent coder was provided with interview transcripts and a protocol to guide the data analysis. Following the data analysis, a literature control was undertaken to highlight the similarities and differences found in the data analysis. Three themes with sub-themes were identified. The participants expressed positive views on the policy of exclusive breastfeeding in HIV positive first-time mothers. They were satisfied with the policy and viewed the policy of exclusive breastfeeding as an effective contribution to feeding options of babies born of HIV positive first-time mothers. However, the participants identified several factors hindering the effective implementation of the policy of exclusive breastfeeding in HIV positive first-time mothers. Factors identified were staffshortages, lack of cooperation among staff members regarding promotion of exclusive breastfeeding, lack of information regarding the CD4 count of patients on admission in the ward, cultural beliefs, lack of training among staff members and inadequate counseling facilities to ensure privacy and confidentiality for mothers. Participants also experienced a variety of emotions related to exclusive breastfeeding such as happiness, confidence, helplessness, frustration, worry and concern, stress and exhaustion. Based on the findings of the study, guidelines were developed and recommendations made concerning nursing practice, nursing education and nursing research.