The study sought to identify factors motivating young people aged 14-25 years to use voluntary counseling and testing (VCT) for HIV in Malawi by interviewing 145 young people. The study identified barriers affecting and strategies promoting young people's access to VCT. The research results indicate that young people go for VCT mainly to know their HIV status. The availability of VCT services, and the provision of VCT services by peers motivate young people to access VCT. Some young people do not access VCT services due to fears of being found HIV+ve and because of the poor attitudes of the health service providers. Providing more information about VCT, involving young people as VCT providers, using youth friendly health service providers, providing VCT in a separate room for young people and through mobile services will increase young people's access to VCT services in Malawi. / Health Studies / M.A. (Public Health)

Thesis (PhD)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The aim of the current study was to investigate factors that help single-parent families cope with the news that a family member has been diagnosed with HIV. The theoretical model that underpinned the study is the Resiliency Model of Family Stress, Adjustment and Adaptation of McCubbin and McCubbin (1996). A salutogenic perspective offers a view of human suffering that moves away from pathology to focus on factors that support successful coping, hence the focus of the current study on resilience. A cross-sectional survey research design was used, incorporating a combination method inclusive of both a qualitative and quantitative component. A total of 109 families, represented by an adult and a child, answered a qualitative question about what they considered to have helped them cope, and completing a biographical questionnaire and five questionnaires based on the theoretical model. Analyses included the Grounded Theory Method, a qualitative analysis method of Strauss and Corbin (1994; 1998), Pearson correlations and ANOVAs (for a categorical independent variable – employment status) to compute the significance of correlations between a dependent variable and a number of independent variables, and regression analysis. The results of the qualitative investigation revealed that families considered internal strength (or hardiness), social supports, communication, a sense of hope, using denial (both positive and negative behaviours to get on with life despite the presence of hardship), changing or reframing thoughts about the stressor, and material support to have been helpful. The quantitative results supported the qualitative results and showed that family hardiness (working together, viewing stressors as challenges and having a belief in own coping abilities), the availability of social support, supportive communication, use of reframing, accepting help from others and spiritual support all contributed to families functioning well under adverse conditions. It was also shown that inflaming types of communication, such as fighting and doing nothing about a crisis situation, negatively influenced the family functioning. It was interesting to note that family size had a significant, positive correlation with the parents’ views of family functioning, and that the higher the children’s level of education, the lower they rated their family functioning to be. Recommendations for further studies include a focus on resilience in various family types, a focus on families successfully coping with HIV diagnoses in their families, and the development of intervention programmes, inclusive of Cognitive Behaviour Therapy and Acceptance and Commitment Therapy. / AFRIKAANSE OPSOMMING: Die doel van die huidige studie was om ondersoek in te stel na faktore wat enkelouer gesinne met ‘n MIV-gediagnoseerde gesinslid ondersteun het. Die studie is teoreties gebou op McCubbin en McCubbin (1996) se Resiliency Model of Family Stress, Adjustment and Adaptation. Salutogenese bied ‘n siening of waardering van die manier waarop mense terugslae hanteer wat weg beweeg van die tradisionele fokus op patologie om te fokus op faktore wat suksesvolle aanpassing ondersteun ten spyte van die teenwoordigheid van genoemde krisis. Hierdie benadering bepaal dus die fokus op veerkragtigheid of gesinsveerkragtigheid wat hierdie studie rig. ’n Deursnee- steekproefontwerp is vir die navorsing gebruik en het ‘n kwalitatiewe en kwantitatiewe komponent ingesluit. ‘n Totaal van 109 gesinne is bestudeer, elk deur een volwassene en een kind verteenwoordig. Die deelnemers het ‘n kwalitatiewe vraag beantwoord oor wat hulle as ondersteunend ten opsigte van hulle eie krisishantering beskou het, en het ook ‘n biografiese vraelys en vyf vraelyste wat verskillende aspekte van die teoretiese model gemeet het, voltooi. Die deelnemers se response is ontleed deur middel van Strauss en Corbin (1994; 1998) se Grounded Theory Method vir die kwalitatiewe komponent; Pearson se korrelasies en ANOVA’s (ten opsigte van ‘n katogoriese onafhanklike veranderlike – werkstatus) is gebruik om die korrelasies tussen die afhanklike en ‘n aantal onafhanklike veranderlikes te bereken en regressie-ontledings is gedoen. Die kwalitatiewe resultate het aangedui dat die volgende faktore deur die gesinne beskou is as ondersteunend van hulle vermoë om krisisse te hanteer: innerlike sterkte, sosiale ondersteuning, kommunikasie, ‘n gevoel van hoop, die gebruik van ontkenning (beide positiewe en negatiewe gedrag om met die lewe aan te gaan ten spyte van die swaarkry), verandering van of herbesinning oor die stressor, en materiële ondersteuning. Die kwantitatiewe bevindinge het die kwalitatiewe resultate ondersteun en getoon dat gesinsgehardheid (saamwerk, beskouing van stressors as uitdagings en ‘n vertroue in eie vermoëns), die beskikbaarheid van sosiale ondersteuning, ondersteunende kommunikasie, die gebruik van herbesinning, aanvaarding van hulp van ander en geestelike ondersteuning almal gehelp het om die gesin onder ongunstige toestande goed te laat funksioneer. Daar is ook gevind dat opruiende soorte kommunikasie, soos baklei en niks oor ‘n krisissituasie te doen nie, ‘n negatiewe invloed op gesinsfunksionering gehad het. Dit was interessant om te vind dat gesinsgrootte positief met die ouers se beskouing van gesinsfunksionering gekorreleer het, terwyl ‘n hoër vlak van opvoeding onder die kinders gekorreleer het met ‘n laer skatting van gesinsfunksionering. Aanbevelings vir verdere navorsing sluit in ‘n fokus op gesinsveerkragtigheid in verskillende gesinstipes, ‘n fokus op gesinne wat ‘n MIV-diagnose in die gesin suksesvol hanteer, en die ontwikkeling van ingrypingsprogramme gebaseer op die beginsels van Kognitiewe Gedragsterapie en Acceptance and Commitment Therapy.

Thesis (MSc)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: As the only effective treatment for HIV/AIDS, adherence to antiretroviral therapy (ART) is critical for successful treatment outcomes. Despite its open availability since the national rollout in 2004, adherence to ART has remained sub-optimal and the number of individuals shifted to the more expensive second-line therapy on steady increase. The literature reports more commonly on individual, psychological, and behavioural barriers to treatment. However, there has been a vast interest in the structural barriers that prohibit adherence to ART. In previous research, my colleagues and I identified the following structural barriers to treatment adherence: stigma-related barriers, the disincentives associated with disability grants, poor relationships with clinic staff, lack of privacy at clinics for counselling and treatment, transport difficulties in travelling to the clinic, long patient waiting times, food insecurity, substance abuse and the absence of substance abuse programmes, and migration. The data were arrived at by means of triangulated qualitative interviews obtained from patients, patient advocates, doctors, and nurses. Together, these qualitative data formed phase 1 of this study. The next step or phase 2, in this research was to develop a valid and reliable quantitative instrument based on these qualitative data. Therefore the primary aim of the study presented in this thesis was to identify the underlying factor structure of four scales aimed at measuring adherence at two levels namely, adherence to clinic attendance, and adherence to pill-taking. After sampling a group of almost 300 persons living with HIV (PLWH) four valid and reliable scales assessing structural barriers to adherence to ART were derived at with Cronbach alpha coefficients ranging from 0.87 to 0.91. For each scale, a general or higher order factor was determined by means of hierarchical transformation suggesting that the items on each of the scales were dominated by a single underlying factor. The findings of this research suggest that it is possible to assess the structural barriers to adherence that PLWH face on a daily basis. With a proper means, such as these scales, to assess structural barriers to adherence to ART clinicians may be able to identify patients who are likely to default and provide adequate attention to the most distressing barriers. / AFRIKAANSE OPSOMMING: Antiretrovirale terapie (ART) is die enigste effektiewe behandeling teen MIV/Vigs. Behandeling met hierdie terapie kan slegs suksesvol voltooi word indien die medikasie ononderbroke en gereeld geneem word. Alhoewel medikasie vrylik beskikbaar was sedertdien die nasionale bekendstelling in 2004, het die aantal individue wat na duurder tweede lyn terapie oorgegaan het toegeneem. Die volhoubaarheid van ART was dus nie optimaal nie. Dit kan toegeskryf word aan individuele -, sielkundige - en gedragstruikelblokke tydens behandeling wat tans baie aandag geniet in die literatuur. Om by te voeg, strukturele hindernisse tot ART geniet ook tans baie aandag. Met hierdie as agtergrond, was die primêre doel van die studie om die onderliggende faktor struktuur van vier skale wat strukturele hindernisse tot ART op twee vlakke meet, naamlik getroue kliniek bywoning en neem van medikasie, te indentifiseer. Ons het met vorige navorsing die volgende strukturele hindernisse tot ART geidentifiseer: stigma-verwante hindernisse, hindernisse wat verband hou met ongeskiktheidstoelaes, swak verhoudings met kliniek personeel, die gebrek aan privaatheid by klinieke in terme van berading en behandeling, vervoerprobleme, lang wagtye vir pasiënte, voedselonsekerheid, dwelmmisbruik en die afwesigheid van middelmisbruik-programme, asook migrasie. Data aangaande bogenoemde strukturele hindernisse is ingesamel deur middel van kwalitatiewe onderhoude met pasiënte, pasiënt-advokate, dokters en verpleegsters (fase 1). Gedurende fase 2 van hierdie studie is 'n geldige en betroubare kwantitatiewe instrument op grond van hierdie kwalitatiewe data ontwikkel. 'n Steekproef van ongeveer 300 MIV-geinfekteerde individue het deelgeneem. Vier geldige en betroubare skale is ontwikkel ten opsigte van die assessering van strukturele hindernisse in terme van gereelde gebruik van antiretrivale middels, met Cronbach alpha koëffisiënte tussen 0.87 en 0.91. Vir elke skaal is 'n algemene of hoër-orde faktor bepaal deur middel van hiërargiese transformasie wat daarop dui dat die items op elk van die skale gekenmerk is deur 'n enkele onderliggende faktor. Ons bevindinge dui daarop dat dit moontlik is om die strukturele hindernisse wat MIV individue daagliks tot ART ondervind te meet. Met die gebruik van hierdie skale sal klinici dus in staat wees om pasiënte te identifiseer wat moontlik van ART sal afwyk of die terapie sal staak met die klem op mees onstellende hindernisse.

Thesis (MA)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: South Africa is one of the countries with the highest HIV prevalence rates worldwide and younger age groups are often disproportionately affected. Knowledge of HIV status is regarded as an important prevention strategy for reducing HIV transmission and infection and it is viewed as a means to access antiretroviral therapy. Routine HIV Counseling and Testing (RCT) can significantly increase knowledge of HIV status, but it is unclear whether RCT will be accepted if offered. The aim of this study was to determine whether the main dimensions of the Health Belief Model (HBM) namely, perceived susceptibility, perceived severity, perceived benefits and perceived barriers can predict acceptance of RCT. A second objective of the study was to determine if the variable of the HBM, namely cue’s to action could significantly contribute to predicting acceptability of RCT. A sample of 1113 students at the University of Stellenbosch in the Western Cape Province of South Africa completed a structured questionnaire, measuring the acceptability of RCT. Multiple regression analysis was used to analyze the data and it was found that the main dimensions of the HBM could explain 25.1% of the variance in acceptance of RCT. It was however found that the variable perceived severity did not make a significant individual contribution to predicting acceptability of RCT. The addition of the variable cues to action also did not make a significant individual contribution to the prediction of RCT. It was therefore found that the HBM could partially, but not in its entirety, predict acceptability of RCT among the student population. Interventions should therefore aim to increase perceived benefits of RCT, reduce perceived barriers to RCT and facilitate correct personal risk assessment in order to increase perceived susceptibility. / AFRIKAANSE OPSOMMING: Suid-Afrika is een van die lande met die hoogste MIV voorkomsyfers wêreldwyd en jonger ouderdomsgroepe word dikwels disproporsioneel geaffekteer. Kennis van MIV status word beskou as ’n belangrike voorkomingstrategie vir die vermindering van MIV oordrag en infektering en dit baan verder ook die weg tot antiretrovirale terapie. Roetine MIV Berading en Toetsing (RBT) kan daarin slaag om kennis van MIV status aansienlik te verhoog, maar dit is egter onduidelik of RBT aanvaar sal word, indien dit aangebied word. Die hoofdoel van hierdie studie was om te bepaal of die hoofdimensies van die Gesondheidsoortuigingsmodel (GOM), naamlik waargenome vatbaarheid, waargenome erns, waargenome voordele en waargenome hindernisse, aanvaarding van RBT sal kan voorspel. ’n Verdere oogmerk van die studie was om te bepaal of die veranderlike van die GOM, naamlik aanwysings tot aksie, ’n beduidende bydrae tot die voorspelling van aanvaarding van RBT kon lewer. ’n Steekproef van 1113 studente aan die Universiteit van Stellenbosch in die Weskaap Provinsie van Suid-Afrika het ’n gestruktureerde vraelys, vir die meting van aanvaarding van RBT, voltooi. Veelvuldige regressie-analise was gebruik om die data te analiseer en daar was bevind dat die hoofdimensies van die GOM 25.1% van die variansie in aanvaarding van RBT kon voorspel. Die veranderlike waargenome erns het egter nie ’n beduidende individuele bydra tot die voorspelling van RBT gelewer nie. Die byvoeging van die veranderlike aanwysings tot aksie het verder ook nie ’n beduidende individuele bydrae tot die voorspelling van RBT gelewer nie. Daar is dus bevind dat die GOM gedeeltelik, maar nie as geheel nie, aanvaarding van RBT onder die studentepopulasie kan voorspel. Intervensies behoort daarom te fokus op die vermeerdering van waargenome voordele verbonde aan RBT, die vermindering van waargenome hindernisse tot RBT en korrekte persoonlike risiko-evaluering vir die verhoging van waargenome vatbaarheid vir MIV.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--Stellenbosch University, 2008. / One of the greatest challenges in the world today is fighting the HIV/AIDS pandemic. Life expectancy in developing countries, especially those in sub-Saharan Africa, decreased to 46 years while in developed countries the average life expectancy is 78 years. World Health Organisation(WHO) indicates that HIV/AIDS, now the world's leading cause of death in adults aged 15 to 59 years, is killing almost 5 000 men and women in this age group, and almost 1 000 of their children, every 24 hours in sub- Saharan Africa. In South Africa today, employees operate in an increasingly complex legal environment with regard to HIV/AIDS in the workplace. Despite the legal protection against employees affected by HI/AIDS and vigorous campaigns to combat HIV/AIDS in support of affected employees, the researcher has observed that management and co-workers show no compassion, empathy or understanding for the needs of these affected employees. An in-depth literature review of quality of life was completed. The goal of this study was to investigate whether the quality of life of the employee affected by HIV/AIDS is adversely affected. The following objectives were set: • To determine the family history of the employee affected by HIV/AIDS • To determine occupational history of the employee affected by HIV/AIDS • To determine the symptoms of the employee affected by HIV/AIDS • To determine the effectiveness of the anti-retroviral treatment programme of the employee affected by HIV/AIDS A descriptive qualitative research design using the case study method was applied to investigate whether the quality of life of the employee affected by HIV/AIDS was adversely affected. The population of this study were HIV/AIDS-affected employees working at a food and beverage company. Ten employees who gave consent participated in the study. The trustworthiness of this study was assured with the use of Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability. A pre-test study was also completed. All ethical principles were met. Data was collected through an interview using an interview guide designed for use in a semi-structured interview. Data analysed show that the basic needs of the employee affected by HIV/AIDS are not adequately met and that the employee therefore does not experience quality of life. Recommendations include the improvement in public–private partnerships; in-service training and continuous refresher courses for all employees, supervisors and management; employee assistance programmes; involvement of church and communities; support circle; holistic approach in nursing care and further research. The findings play a role in understanding the importance of remaining at work for as long as possible when one is affected by HIV/AIDS. The findings of this study further validate the concepts in basic needs and that QOL is perceived differently by each individual.

Thesis (MA)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: The human immune deficiency virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) have already reached a magnitude in Southern Africa which can hardly be addressed by the existing structures. HIV counselling is considered to be an important preventative and supportive strategy in the battle against HIV. In recent years therefore, urgent attempts have been made to provide HIV/AIDS counselling services throughout South Africa. The researcher had a firsthand experience of such an attempt as manager of HIV counselling services for a NGO working in a peri-urban community. She realised that although the ideal outcome and aims of HIV counselling have been widely documented, very little research has been done on the implementation of these principles in health systems with limited resources. It was thought that a meaningful contribution could be made to the development of HIV counselling services in a specific South African community by critically exploring current HIV counselling services in such a community. This exploration entailed the following: • reviewing the literature on HIV counselling; • clarifying the goal of HIV counselling; • clarifying behaviour change as an outcome of HIV counselling; • exploring the influence of the Stellenbosch context on the content and outcome of HIV counselling; and; • exploring to what extent the goals of HIV counselling (as prescribed by international and national literature) are pursued in the Stellenbosch context. The ecological model and an action research method were used to direct this study. The researcher used her position and experience as manager of the HIV counselling services within a non-governmental organisation to access sources of information. Direct and participatory observations were utilised to gather information regarding the implementation of HIV counselling services in the community. The model of Raeburn and Seymour (1979) and specifically the overview phase have been used as a framework to organise the data and to describe the HIV counselling system in the specific community. The researcher concluded that the theoretical principles that were identified as prerequisites for effective HIV counselling services were often irreconcilable with the management skills, context, infrastructure and aims of the primary health services within the district. It was highlighted that a systemic understanding of the impact of the environment should be considered when future models and outcomes are formulated and implemented. Finally, alternative suggestions for the management, the formulation of outcomes and the utilisation of personnel in HIV counselling in this specific community were discussed. / AFRIKAANSE OPSOMMING: Die Menslike Immuniteitsgebreksvirus (MIV) en Verworwe Immuniteitsgebreksindroom (Vigs) in Suider-Afrika het reeds 'n omvang bereik wat beswaarlik deur die bestaande strukture aangespreek kan word. MIV-berading word beskou as 'n belangrike voorkomende en ondersteunende strategie in die stryd teen MIV. In die laaste paar jaar is dringende pogings dus aangewend om MIV-beradingsdienste in die hele Suid Afrika beskikbaar te stel. Die navorser het eerstehandse ervaring gehad van hierdie inisiatief as bestuurder van MIV -beradingsdienste vir 'n nie-regeringsorganisasie wat werksaam is in 'n semilandelike gemeenskap. Alhoewel die ideale uitkoms en doel van MIV -berading wyd gedokumenteer is, het sy besef dat baie min navorsing gedoen is oor die implementering van hierdie beginsels in gesondheidsisteme met beperkte bronne. Daar is geredeneer dat 'n betekenisvolle bydrae gemaak kan word tot die ontwikkeling van MIV -beradingsdienste binne 'n spesifike Suid-Afrikaanse gemeenskap deur die huidige MIV -beradingsdienste in so 'n gemeenskap krities te verken. Hierdie verkenning het die volgende behels : • literatuur oor MIV -berading te bestudeer; • MIV-berading se doelwitte te verhelder; • gedragsverandering as uitkoms van MIV -berading te verhelder; • te eksploreer hoe die Stellenbosch konteks die inhoud en uitkoms van MIV -berading beïnvloed; en • te eksploreer tot watter mate die doelwitte van MIV -berading ( soos voorgeskryf deur internasionale en nasionale literatuur) in die Stellenbosch konteks nagestreefword. Die ekologiese model en 'n aksienavorsingsmetode is gebruik om die ondersoek te rig. Die navorser het haar posisie en ervaring as bestuurder van MIV -beradingsdienste binne 'n nie-regeringsorganisasie gebruik om toegang te verkry tot inligting. Direkte en deelnemende waarneming is gebruik om inligting in te samel rakende die implementering van MIV -beradingsdienste in die gemeenskap. Die model van Raeburn en Seymour ( 1979) en spesifiek die oorsigfase is gebruik as 'n raamwerk om data te organiseer en die MIV -beradingsisteem in die spesifieke gemeenskap te beskryf. Die navorser het tot die gevolgtrekking gekom dat die teoretiese beginsels wat geïdentifiseer is as essensiële voorvereistes vir effektiewe MIV -beradingsdienste in soveelopsigte onversoenbaar is met die bestuursvaardighede, konteks, infrastruktuur en doelwitte wat binne die spesifieke primêre gesondheidsdienste geld. Dit is beklemtoon dat In sistemiese verstaan van die invloed van die omgewing en die inagneming van die sisteem belangrik is wanneer toekomstige doelwitte geformuleer en modelle geïmplementeer word. Alternatiewe voorstelle vir die bestuur van beradingsdienste, die formulering van uitkomsdoelwitte en die benutting van personeel in hierdie dienste is ten slotte bespreek.

The high prevalence of HIV/AIDS in Zambia has led to the development of innovative ways of coping with sickness related to this infection. HIV/AIDS home-based care is one such innovation designed in Chikankata Hospital in 1987. Home-based care depends on the availability of family members and community volunteers in the provision of care and support for People Living with HIV/AIDS (PLWHA).<br /> <br /> This minithesis is based on a qualitative descriptive case study exploring perspectives regarding skills, supervision and support mechanisms for carers in the Chikankata HIV/AIDS Community-Home Based Care (CHBC) program. The study utilized documented research, focus group discussions with carers and structured interviews with local CHBC supervisors, national experts in CHBC, and PLWHA and their families, to collect data from 32 study participants.<br /> <br /> The findings were that CHBC was being delivered by community volunteers with limited involvement from the local health services / that carers were highly motivated, personally and collectively mobilizing resources to meet the needs of CHBC clientele / that local arrangements for training, skills and support of carers were not aligned to national guidelines regarding process, content and duration of programmes / and that carers acquired skills in CHBC through formal and informal training processes and were facing challenges related to inadequate skills, poor infrastructure and extreme poverty in households caring for PLWHA. <br /> <br /> Based on the findings the local arrangements for coordination of CHBC need to be strengthened and linked to formal processes for technical support, financial resources and materials for delivery of CHBC in line with existing guidelines on CHBC. The picture of the real situation of the carers that emerges from this qualitative study might inform the supervising organizations and policymakers on the gaps in the training and support of this crucial cadre in the provision of quality care for People Living with HIV/AIDS (PLWHA) at community level.

Currently, HIV/AIDS is one of the greatest threats to child survival in South Africa. It is estimated that approximately 6000 newborn babies become infected with the HIV virus monthly i.e. approximately 200 babies per day. During a 24 month period (October 1999 &ndash / October 2001), a descriptive prevalence study of the oro-facial manifestations affecting HIV-positive children was conducted in the Cape Peninsula, South Africa. The study population consisted of 268 vertically infected HIV-positive children. The study was motivated by the lack of data regarding oral mucosal lesions in children with vertically acquired HIV-infection.<br /> <br /> The study design was descriptive, and the population included consecutive, vertically infected HIV-positive patients sourced from out-patient clinics, hospital wards and special child-care facilities. The children were examined once consent was obtained from caregivers. The findings were documented using data capturing sheets. The data was captured on the Microsoft Excel program and analysed using the Epi 2000 program. The results indicated that a large proportion of HIV-infected children presented with orofacial manifestations at some stage during the course of HIV-infection. Oro-facial manifestations were observed in 70.1% of the study population. The prevalence of the most commonly observed manifestations were: oral candidiasis, 38.8% / parotid gland enlargement, 10.8% / oral ulceration, 5.6% / molluscum contagiosum, 7.8% / periodontal conditions, 3.4% / and herpes simplex infection, 0.7%.It can be concluded that in this sample of HIV-infected children, the prevalence of orofacial manifestations is higher than, and comparable with the findings of similar studies conducted in other regions of the world.

In South Africa, which has the largest HIV infected population world-wide, more than 5 million individuals presently live with HIV and AIDS (Evian, 2002:20; LINAIDS, 2004:19). These HIV-infected patients in turn affect the family structure within which they find themselves in a specific community. According to Saleeby (1992:54) and Barnett and Blaikie (1992:34), several families in South Africa are affected by the challenges posed by AIDS. This research forms part of the group research project, Tswaragano, which deals with an investigation into the competencies, abilities and strengths of the family of the HIV-positive patient while supporting the patient at home (Wessels, 2003:54). Problems such as unemployment, poverty, crime and changed demands in the community where these families live and increased challenges place a tremendous amount of stress on the families (Saleeby, 1992:54; Barnett & Blaikie, 1992:34). A vicious circle of AIDS and poverty is clearly confirmed and it has been found that people who live with HIV and AIDS need more support than health care alone (Booysen et al,. 2004:817-826). It is evident from the literature that, although information regarding HIV and AIDS is conveyed during pre- and post-HIV and AIDS test counselling, the transmission of information is not necessarily successful (Parker et al., 1998:18). A question which hence arises is whether the HIV positive patient and his family who support him at home fully grasp the necessary information. Greeff and Du Plessis (2001:2) confirm that health workers in the North-West Province do not convey the information effectively. Several factors probably contribute to defective information transfer between the health worker and the patient. One factor is that if the environment within which information is conveyed is not comfortable and mutual respect and trust between the health worker and the HIV positive patient is limited, the interpretation of information on HIV and AIDS is impaired (Allender & Spratley, 2001:163). A further aspect that should be taken into consideration is that HIV and AIDS-related information can be understood and internalised by the HIV positive patient in different ways, since several interpretation possibilities exist for information that is conveyed (Parker et al., 1998:20). Health workers who convey the information to the patient does however not always determine whether the HIV positive patient understands and internalises the information correctly (Parker et al., 1998:21). The facts mentioned above not only limit the HIV positive patient's understanding but also eventually the understanding of the family who have to support the HIV positive patient at home, regarding HIV and AIDS. The family can be seen as a primary core support resource for the HIV positive patient (Uys, 1999:2), and limited understanding impairs support at home (Hartman, 1981:10). With this is meant that the family is the "social service agency in meeting the social, educational and health care needs" of its members. The aim of this research was to investigate and describe the understanding of the HIV positive patient and the family regarding HIV and AIDS-related information. Guidelines were formulated to promote the understanding of the family of the HIV positive patient regarding HIV and AIDS-related information with the view to empower the family of the HIV positive patient in order to be able to support the patient at home. The research design was quantitative and descriptive by nature. It entails a pilot study in the Kagiso district, Vryburg area (Bophirima) of the North-West Province. The actual research study was performed in the Primary Health Clinics in the Potchefstroom district of the southern area of the North-West Province. Purposive sampling was performed (Burns & Grove, 2001:376; Brink, 1996:141; Abramson & Abramson, 1999:70; Bainbridge, 1989:46). Selected health workers acted voluntarily as go-betweens to identify HIV positive patients and their families who are prepared to participate in the research and who answer to the criteria, and to assist in filling out the questionnaires. The questionnaires were analysed by means of the frequency method with the assistance of the Statistical Consultation Services of the North-West University, Potchefstroom Campus and reported on by means of tables and graphs (Brink, 1996:499; Burns & Grove, 1997:430). From the research it was found that, although information transfer regarding HIV and AIDS does take place, there still are many voids in respect of the understanding of this information and this pertains to HIV positive patient as well as the families. The researcher has come to the conclusion that the proposed guidelines in order to empower families of the HIV-positive patients to support these patients at home therefore is obvious and important. Furthermore, the researcher is of opinion that families midst the difficult circumstances will realise their own strengths if they could acquire the necessary knowledge and skills. Recommendations were made for nursing education, for the practice of the community nurse as well as for nursing research. Guidelines were formulated to empower the family of the HIV positive patient to be able to support the patient at home. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

There is evidence that some sub-Saharan African individuals suspect that they are HIV positive before diagnosis but delay being tested for HIV. This increases the likelihood of being diagnosed late (with a severely compromised immune system), a phenomenon that has been observed in sub-Saharan Africans diagnosed in the UK. Late diagnosis has negative personal and public health consequences. There is a lack of understanding of the psychological processes associated with delayed HIV-testing. This study used a Grounded Theory methodology. It aimed to produce a theoretical model to explain the psychological processes associated with delayed HIV testing in sub-Saharan Africans in the UK but also how these processes changed over time and contributed to the decision to test. Seven HIV-positive sub-Saharan African individuals from a London HIV clinic and one from a HIV charity were interviewed about their experiences. Analysis led to the development of a theoretical model of delayed HIV testing. This model consisted of three theoretical codes: moving in and out of uncertainty about HIV infection; preferring not to know HIV status; and making the decision to test for HIV. Participants' HIV risk perception fluctuated and was characterised by uncertainty. This, in combination with a preference to not know their HIV status due to a number of feared consequences of being HIV-positive, deterred them from testing. Participants' thoughts and feelings about knowing their HIV status changed over time. These changes were that they: wanted certainty, had hope of being HIV-negative and/or a hope for treatment and life and preparing for and accepting a potentially positive result. The findings can inform interventions to reduce delayed testing and suggest: a) intervening with ambivalence on an individual level and b) promoting awareness of HIV c) promoting the benefits of testing/costs of not testing at a population level. The findings are discussed in relation to existing research and theory. Strengths and limitations of the study are discussed, as are clinical implications and suggestions for future research.