AIDS is one of the most destructive diseases humankind has ever faced and also brings with it profound social, economic and public health consequences, making it one of the most serious health and development challenges in the world today. Zimbabwe, situated in southeastern Africa, is not spared from the pandemic. It continues to be one of the Sub-SaharanAfrican countries mostly heavily impacted by the AIDS epidemic, with almost 1.2 million people infected and over 1.1 million orphans. It ranks, therefore, as fifth highest in the world in the impact HIV and AIDS has had on the country. The most effective response has been to introduce programmes to reduce the number of new infections. Recent research has demonstrated treatment as a preventative measure to be very effective. This approach involves targeting those who are infected so that they are not able to transmit the disease. The decision that has to be made by an infected person, however, is whether to look for traditional treatment, conventional treatment or a combination of the two. Herbal medicine use is becoming very common in many countries, especially in the developing world, where public health safety has become a concern. It has become common to use herbal medicine concomitantly with allopathic or conventional medicine. The present study focused on investigating perceptions leading to the choice of treatment with the traditional alternative medicines (TAM) as (a)/n alternative or compliment to the conventional or allopathic option. This is a qualitative study that explores and describes participant’s perceptions, beliefs, attitudes and feelings around the use of traditional medicine, within the context of the Integrative Behaviour Model (IBM). Data was collected from 20 people living with HIV and AIDS from urban and rural settings of different ethnicities (Shona and Shangani). The data analysis was informed by The Interpretive Phenomenological Analysis with the aid of NVivo (V.10), a computer-assisted Qualitative Data Analysis Software. As predicted by the IBM, both perceived individual and environmental factors were found to be key in influencing decision-making on the use of TAM by people living with HIV and AIDS. Although there were a number of incidents in which either individual or environmental factors were perceived as independently influencing the TAM-use decision-making process, there was a lot of mutual influence between the environment and the individual. Such mutual causation was abstracted as reciprocal determinism. The IMB model assumed a unidirectional causation in which the environment could affect the individual factors. While the present study identified and demonstrated these environmental effects on the individual, it also identified and presented a reverse causation in which the individual would also affect the environment with respect to motivation for TAM use. Individual factors were psychological properties that drove the individual to use TAM. Attitude, social influence and personal agency emerged as the three dimensions of individual factors. Attitudes helped in identification of orientations that located objects of thought on dimensions of judgment about the use of TAM. Social influence explained social pressure experienced and expected regarding the use of TAM. The study demonstrated the importance of both the descriptive and injunctive norm with participants indicating that they perceived important others to be using traditional medicine and that they felt perceived expectations from others to do the same and hence the motivation to comply. Personal agency pointed to the participants’ capacities to originate and direct actions for the purposes of TAM use. All these constructs were found to be very important as perceived determinants of the behavioral intentions of people living with HIV and AIDS to use traditional medicines. In experiential attitude, generally the respondents showed more perceived positive evaluations of pleasurable experiences in their use of traditional medicines. However, there were other outcome evaluations that seemed to be ambivalent and which appeared to cause a lot of tension. The comprehension of experiential attitude was found therefore found to be trichotomous rather than dichotomous as per the IBM. The effects of the instrumental attitude were revealed in the ratings of the extent to which the use of traditional medicine was perceived as useful or rewarding, with the study revealing high ratings of usefulness. It becomes clear, therefore, that for people living with HIV and AIDS social influence, perceived attitudes and personal agency are important decision-making factors in their use of traditional and alternative medicine. Efforts towards education, integration and behaviour change programmes should design messages targeting these behavioral determinants. Understanding of these perceived determinants is crucial to influencing policy as well as the adoption of health practices through education, marketing and other modes of health promotion.

The evaluation of the feasibility and clinical utility of liquid based cytology, human papillomavirus testing and high-resolution anoscopy to screen for anal intraepithelial neoplasia in high-risk groups. Dr Alice Martha Schofield: The University of Manchester for the degree of Doctor of Medicine, January 2016. Background: The increased incidence and natural history of anal cancer in high-risk groups, provides a screening opportunity to detect precancerous lesions, anal intraepithelial neoplasia (AIN), as well as early invasive lesions. The ANALOGY study was performed to strengthen the evidence base required to determine the case for anal screening in terms of the feasibility and clinical utility of liquid based cytology (LBC), high-risk human papillomavirus (HR-HPV) testing and high-resolution anoscopy (HRA) in high-risk groups. Methods: This prospective study offered screening to four cohorts aged over 25 at varying but elevated risk; human immunodeficiency virus (HIV) positive and negative men who have sex with men (MSM), HIV positive women with prior history of abnormal cervical cytology or anogenital warts, HIV negative women who practice anoreceptive sex and transplant recipients (TR). Recruitment commenced in March 2013 and concluded in December 2014, with follow-up until March 2015. All participants underwent testing for HR-HPV, LBC and had HRA performed, sites of abnormality were biopsied. Participants were seen at initial consultation and at a second visit six months later. Immunostaining with Ki67 and p16 antibody was performed on 100 anal tissue biopsies. The cellular positivity of each biomarker were scored by automated and manual methods. H-SCORES of p16 biomarker and block positive staining of AIN2 were quantified and analysed. Results: 409 participants were recruited; 284 MSM (203 HIV positive, 81 HIV negative), nine HIV positive women, four HIV negative women and 112 TR. HR-HPV was highly prevalent in anal samples from MSM (HIV positive 88.0% and HIV negative, 77.8%) and much less so in HIV positive and negative women and TR (19.3%). Despite the high prevalence of cytological abnormality in MSM, almost half of AIN of all grades was associated with negative cytology. AIN3+ on biopsy was found in 4.4% (18/409) of participants; three HIV positive MSM had cancer. One new case of AIN3 was identified at the second visit. Low-grade disease (AIN1/2) was highly prevalent in all groups. Ki67 and p16 biomarker expression increase as the grade of anal disease increased when scored manually. AIN2 histology samples, which demonstrate block positive p16 staining, have an association with an increased H-SCORE.Conclusions: Anal screening in some high-risk groups is clinically feasible in terms of diagnostics with evidence of significant disease prevalence particularly amongst MSM. The high prevalence of HR-HPV infection and frequency of false negative cytology indicates that in terms of sensitivity and specificity, HRA would be the best primary screening tool. The use of Ki67 and p16 in the identification of anal disease appears to have clinical utility, especially in the detection of AIN2; with the majority of samples displaying block p16 staining that corresponded with an increased H-SCORE. The prevalence of AIN3+ in HIV positive MSM lends support for a policy of screening in this group, however limitations of treatment, as well as highly prevalent low-grade lesions of dubious significance, require careful consideration.

M.Cur. / The researcher's occupation as medical services manager at a packaging company regularly brings her into contact with the occupational health nurses employed at the factories. She has become aware that the occupational health nurses often become involved in ethical dilemmas with regards to the handling of HIV -positive people at the workplace in that the interests of the HIV -positive conflict with the interests of the employer. The occupational health nurse finds him/herself acting as intermediary and advocate between the two parties, namely the employer and the HIV -positive person. In spite of the provision of legal norms and ethical standards to regulate the interests of the HN -positive person in the workplace, no guidelines exist as to how these norms and standards should be operasionalised during interaction between the HIV -positive person, the occupational health nurse and the employer. The occupational health nurse is therefore uncertain how to act professionally within laid-down ethical standards with the HIV -positive person at the workplace. The purpose of this study is to describe guidelines and criteria for the operasionalisation of ethical standards for the occupational health nurse regarding the HIV -positive person in the workplace. This objective is obtained through the following aims: • Researching and describing literature with specific reference to current legal and ethical frameworks within the occupational health context regarding interaction with the HNpositive person in the workplace in order to formulate these ethical standards; • Researching and describing problems and solutions for the following target groups regarding the ethical aspects regarding the HN -positive person in the workplace: Occupational health nurses The HN -positive person in the workplace. The design of the research is qualitative, explorative and descriptive. The research was carried out by studying the occupational health nurses and HN -positive people employed by the packaging company countrywide. The occupational health nurses who were involved were obtained from a purposive test sample. The HN -positive people were chosen by making use of a quota test sample. Data obtained from the occupational health nurses was gathered by means of a workshop, and the data from the HN -positive people was obtained through personal interviews. The results of the research identified certain problems and solutions which were experienced by both target groups. These problems and solutions are divided into four sub-categories to illustrate how individual, organisational, health and family-systems are influenced. In order to assist the occupational health nurses to ethically handle the HIV -positive person in the workplace, guidelines and criteria were drawn up for the operasionalisation of the ethical standards. Additional research themes were identified through the study, the goal being to further improve the ethical handling of the HIV-positive person in the workplace, and to give better support to the HIV positive person.

Background Depression has been found in the literature to be a major problem in people living with HIV/AIDS. Not only does this impact on their daily functioning but has been shown to have negative HIV related outcomes, and result in poorer adherence to antiretroviral medication. The population under study was pregnant at the time of diagnosis. It would seem likely that their risk for depression would be greater than even a general HIV infected population, because of the pregnancy and the fact that they might have concerns around the health and future of the unborn infant. There are a limited number of studies looking at levels of depression over time and possible determinants of this depression even in a general HIV infected population. It was thus felt necessary to establish levels of depression and to establish if there were any factors associated with changes over time in this pregnant population. Method Two hundred and ninety three women were recruited at antenatal clinics in Tshwane from June 2003 and December 2004. They were interviewed at approximately 28 weeks gestational age and were followed for 18 months after the birth. Data included socio demographic variables, a “self efficacy score”, past history of violence, disclosure, CD4 count and knowledge score. Psychological variables included measures of stigma, social support, self esteem and coping. Depression was measured using a modified CES-D (Center for Epidemiological Studies Depression Score) Repeated measures mixed linear analysis was used to assess if there were changes in depression scores over time and if there were factors associated with these changes. Results Two hundred and twenty four women were included in the mixed linear analysis. The mean age of the women was 26.5 years (standard deviation -5.1). Seventy six percent (152) were single with a partner. Seventy six percent (171) had some form of secondary education and 14% (32) had some form of tertiary education. Sixty percent (135) lived in a brick house and 35% (79) had running water in the house. Twenty nine percent (64) had a per capita income below the poverty line. The prevalence of borderline depression (CES-D scores above 12) for this group of women at baseline was 45%. There were significant changes in depression scores over time. This was not a linear relationship (significant quadratic time to interview term p=0.008). This was evidenced by the fall off in scores at 3-9 months followed by a subsequent rise. The factors associated with higher depression scores overall were lower active coping (p=0.004), higher avoidant coping (p=0.003), higher internalised stigma (p=0.001), higher housing scores (0.026), lower self–esteem (0.002), a history of violence (p<0.0001) and having no partner (p=0.005). No factors were associated with changes over time. Conclusion There are significant changes in depression scores over time in this cohort of women Depression scores while falling after the birth of the child as in other cohorts, start to rise again. Although there are no specific factors associated with these changes, overall women who have a history of violence, who have no partner, who live in better housing circumstances, who have poor self esteem, who have high levels of internalized stigma and make use of negative coping strategies are more likely to be depressed. Women who make use of active coping strategies are less likely to be depressed. There are a large number of women at baseline who have scores considered to be diagnostic of borderline depression and because of the potential negative consequences to the woman and child, an intervention aimed at addressing the above issues should be devised. This should start in the antenatal period and carry on beyond this time. Copyright / Dissertation (MSc)--University of Pretoria, 2010. / Clinical Epidemiology / unrestricted

Thesis (Ph. D. (Clinical Psychology)) -- Univesity of Limpopo, 2019 / The aim of the study was to determine the experience of ambiguous loss and grief reactions in adolescents affected by parental diagnosis of HIV/AIDS, and the identification of potential resilience factors that moderate the grieving symptoms. A convenient sample of 159 adolescents ninety-five (95) from families with a parental diagnosis of HIV/AIDS and a control group of sixty-four (64) adolescents whose parent(s) were diagnosed with cancer, participated in the study. The age of the participants from both families fell in the following ranges: 11-14 (n=45), 14-17 (n=65), 17-18 (n=45), 18 and above (n=2). Eighty-nine (89) were females whereas seventy (70) were males. A triangulation method of data collection was used wherein a biographical questionnaire designed by the researcher, a TRIG questionnaire to assess the level of grief in the participants and resilience scales were used in the quantitative phase. The family resilience scales included Family attachment and changeability Index 8 (FACI-8), Family Crisis Orientated Personal Evaluation Scale (F-COPES), Family Hardiness Index (FHI), and Relative and Friend Support Index (RFS). The Pearson correlation was used to identify the significance of potential resilience factors present in the affected families. Regression analysis was used to determine the predictability of variables to show moderating effect of resilience factors on the impact of experience of an ailing member of the family. Interviews were held with the adolescents in the qualitative phase using semistructured interview schedule. The questions elicited qualitative responses on the participants’ feelings towards the illness of the parents, the role they are playing and feelings towards the role, experience of feelings of loss, disclosure and the family qualities perceived to be helping them adapt to the stress of having a sick parent. The results showed that the two groups experienced ambiguous loss in the form of boundary ambiguity marked by enforced role changes following indisposed parent due to ill-health. Both groups of adolescents experienced forms of grief during the ailment of the parent(s). HIV/AIDS affected group experienced delayed grief whilst the control group of cancer affected individuals experienced acute and prolonged grief. Parental disclosure following diagnosis was higher among cancer affected families (75%) than those affected by HIV/AIDS (55%). There was, however, no significant difference between disclosure of disease status and the experience of grief, p=0.0120. Potential resilience factors in both families were F-COPES, FHI, and FACI-8. These factors were also found to have a moderating effect on the experience of grief in the HIV/AIDS affected families, but showed the opposite effect on the experience of grief in the cancer affected families. This shows the uniqueness of the study in the way the HIV/AIDs and Cancer affected families responded differently to the moderation of the resilience factors. The difference in the impact is in line with the shift in the status of HIV/AIDS from being a terminal condition to being manageable and considered chronic in contrast to cancer. The shift was seen occurring also in this study where previously high grief was associated with HIV/AIDS as its diagnosis was regarded as a death sentence. There was high stigma associated with HIV/AIDS diagnosis until recently when it was found to be controllable and also positively impacting on the life expectancy in South Africa that increased from 53 to 64 years post utilization of ARV’s.

This purpose of this study was to investigate and examine the attitudes of therapists who treat HIV-positive (HIV+) clients. Specifically, therapists' perceptions of their own preparedness in dealing with specific issues and emotions of HIV+ clients were examined. Also, therapists' evaluation of their own efficacy of specific therapeutic approaches with HIV+ clients was examined. These therapists' perceptions and evaluations of all their clients in general were compared to their HIV+ clients. Comparisons were also made within the two groups.

The goal of the research was to investigate how fathers diagnosed HIV positive experienced disclosure. Gaining an understanding of the issues that fathers’ face regarding their decision whether or not to disclose their status, as well as to whom they decide to disclose their status, will contribute to an understanding of the complexities of disclosure. This information could then be used to set up strategies to assist fathers in dealing with HIV and issues regarding disclosure. This research was undertaken from a phenomenological position, using an interpretive framework. Because the research was qualitative in nature, with the primary objective to understand an individual’s personal and subjective experience, the sample size was restricted to four participants. This provided the opportunity to conduct in-depth interviews. The sampling criteria used to identify participants was the following; fathers, living with their ‘families’, who were residents of Diepsloot, diagnosed HIV positive and with a conversational level of English equivalent to Grade 10. The unique stories of each research participant were systematically presented to illustrate the collection, analysis and synthesis of the data. The phenomenological method of data analysis is ultimately aimed at developing a composite description of the meanings and essences of the fathers’ experiences of disclosure. The main finding of the research was that disclosure of an HIV positive status appears to be an extremely difficult experience. With disclosure comes both relief and a sense of shame and loss of face, which for some of the fathers interviewed, seems to undermine an already fragmented sense of self. For they, like all men, aspire to earn and enjoy respect - from their partners, children, parents, peers and community. However, all the fathers in this research project had the courage to disclose their HIV positive status to others and directly to the researcher. In so doing, they not only earned the researcher’s respect, but were availing themselves of a unique opportunity to talk about something very personal and significant in their lives. It is hoped that their positive experiences of disclosure will encourage others in South Africa to do the same. Copyright / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted

This study addressed the issue of the relationship between psychological well-being and immune function in a sample of HIV seropositive homosexual and bisexual males. A control group of HIV seronegative gay males was included. The study assessed the relationship between various psychological independent variables and immune system functioning over a 24-month time period for the seropositive subjects. Data on depression, coping style, psychosocial stress, and psychomatic symptoms were collected at baseline, as well as data on depression at 12 months and CD4 counts at 6-month intervals over a 2-year period. Preliminary analyses comparing HIV seropositive to HIV seronegative subjects showed differences on four of eight coping style scales, as well as on all of the psychogenic attitudes scales reflecting stress levels. There were no effects of eight coping styles on immune system functioning for the seropositives. However, there were significant relationships among four of six psychogenic attitudes scales (chronic tension, premorbid pessimism, future despair, and somatic anxiety) and immune system functioning for the seropositives. There were also significant effects of three scales measuring psychosomatic symptoms (Allergic Inclination, Gastrointestinal Susceptibility, and Cardiovascular Tendency) for the seropositives. However, there was no effect of level of depression on immune system functioning. The final chapter discusses the findings given the existing body of research. The emphasis is on the need to develop interventions targeting stress levels among persons with AIDS, as well as on conducting further research utilizing carefully constructed longitudinal research designs.

No description available.

The purpose of the present investigation was to examine responses to suicidal ideation by an HIV positive male described as heterosexual/homosexual in a promiscuous/monogamous relationship. Men (101) and women (137) enrolled in introductory psychology courses participated in the study. Participants completed a short demographic questionnaire, read one of four scenarios, and completed the Attitudes and Helping Behavior Scale (AHBS) designed to measure the participantsÆ emotional responses, attributions, and willingness to help the target subject. Present research involved a 2 (sex of subject) x 4 (scenarios) independent groups factorial. Independent ANOVAS were performed to interpret the significance of the main and interaction effects. Results revealed a main effect for gender on total attitude scores on the AHBS. There was no main effect for gender on anger towards the scenario subject as originally hypothesized. Future researchers should utilize a more heterogeneous sample than the present one to obtain more applicable results.