HIV and AIDS is still a major problem especially in Sub Saharan Africa. The levels of new infections are still relatively high which implies that the numerous national and international efforts to curb the transmission of HIV are not having the desired effect. Furthermore, the accelerated rate of teenage pregnancy is also indicative of the failure of these efforts. The high teenage pregnancy rate suggests that many teenagers do not practise safe sex. This could be attributed to the many pressures teenagers experience regarding sex and sexuality. Teenage mothers are likely to experience the same or double, the pressure and I was curious to understand their stance on unsafe sex practises especially after having a baby. This research study elicits an understanding of how these young mothers construct, present and negotiate their sexuality within the context of the HIV and AIDS pandemic. Issues of sex and sexuality in relation to gender roles, gender identities, constructions of sexuality and teenage motherhood were investigated. The findings reveal two key points: regret inspires determination to succeed and that love and romance are dominant discourses in the construction of sexual risk among teenage mothers within the context of the HIV and AIDS pandemic. All the teenage mothers in this research study indicated that completion of their studies should have taken priority to motherhood. Even though most of the participants in this study acknowledge that love and romance are essential, they are now more cautious and either abstains from sex or practise safe sex. This research study has found that the hardship and responsibilities associated with motherhood have served to motivate these participants to change their risky sexual behaviour and verifies Burr’s (2003) social constructionist perspective by showing how identity is fluid and context dependent, relying on social interactions and experiences. / Theses (M.Ed.)-University of KwaZulu-Natal, Durban, 2012.

The relationships between post-traumatic growth (PTG), benefit finding, happiness, pessimism and antiretroviral (ART) medication adherence were examined among 10 people living with HIV or AIDS who attended HIV support groups, and were currently prescribed ART medications. Analyses indicated that none of these psychosocial factors were significantly correlated with ART adherence, that the relationships continued to be non-significant after pessimism was partialled out of the analysis, and that participants who reported achieving optimal ART adherence did not significantly differ from participants who reported taking less than optimal ART adherence in regards to PTG, benefit finding, subjective happiness, or pessimism. The results suggest that interventions designed to change these psychosocial factors may not be effective means of improving ART adherence. / Department of Psychological Science

Chapter One introduces the "HIV Stops With Me" campaign, research by communication scholars on how HIV/AIDS messages are channeled, cultural influences, and the target audience of these messages in order to answer: What is the "HIV Stops With Me" campaign saying about individuals infected with HIV?Chapter Two describes the cluster analysis developed by Kenneth Burke. The steps in cluster analysis are: 1) identifying the key terms in the rhetoric, 2) charting the terms that cluster around the key terms, 3) discovering emergent patterns in the clusters, and 4) naming the motive, or situation, based on the meanings of the key terms.Chapter Three is a cluster analysis of the 2002 San Francisco "HIV Stops With Me" campaign. Key terms found in this analysis are "HIV," "sex," "life/living," and "death/dying."Chapter Four contains conclusions pertaining to the analysis of the rhetorical artifact, conclusions for cluster analysis, and future implications for academic scholarship. / Department of Communication Studies

This dissertation is an evaluation of the concept of a minimum core content to the constitutional right to health, with particular reference to HIV-positive persons in South Africa. The analysis involves an assessment of what the minimum core entails; whether such a formulation is necessary in the South African health context; the application of the concept in national and international law; as well as enforcement and implementation in the South African context. An appraisal of the South African social reality reveals the extent of the suffering of HIV-positive individuals and the difficulties experienced in accessing health care, especially for the vulnerable and disempowered. The problem is exacerbated by a critical inadequacy in national jurisprudence which fails to generate certainty in respect of the minimum, basic entitlements of affected people. Such a shortcoming maligns transformative constitutionalism, which requires the judiciary to develop a construction of human rights that accords with the canons of the Constitution. It is argued that one such course of action is the adoption of the minimum core, which prescribes a basic level of human rights that is guaranteed to all people – and which may withstand legislative challenge on the basis of resource constraints or progressive realisation. Reference to international law, in terms of Section 39(1) of the Constitution, assists us to overcome the shortcoming in domestic legislation in this regard. Of particular relevance is covenantal guidance offered by the ICESCR, and its guidelines of interpretation, which include the CESCR General Comments and the WHO recommendations. It is postulated that a minimum obligation to HIV-positive individuals under the right to health encompasses the duty of treatment and prevention and control in respect of the epidemic, on a non-discriminatory basis. Enforcement and implementation of such core obligations must be strictly and timeously effected. Of crucial importance in such a process is a competent judiciary that is able to resist an undue deference to the legislature. A review of court judgments, however, reveals an inadequate judicial approach to the implementation of socioeconomic rights and an appeal is made to the Constitutional Court to re-commit itself to an interpretation of the Bill of Rights that accords with Constitutional values, such as uBuntu. / Thesis (LL.M.)-University of KwaZulu-Natal, Durban, 2014.

Approximately 29.1% of South African women of childbearing age tested HIV positive during their first antenatal visit in 2006 (DoH, 2007). This rate of HIV amongst the women of childbearing age reinforces the importance of understanding the management of HIV during pregnancy. During antenatal visits the general health of the woman and her unborn baby is assessed and managed. Management includes antiretroviral therapy to the HIV infected women with a CD4 count below 200 cells/mm3, while women with a CD4 count above 200 cells/mm3 receive a single dose of nevirapine with the onset of labour provided to them by their local clinics. Currently, in Potchefstroom, women receive antenatal care at local primary health-care clinics and antiretroviral drugs at the antiretroviral clinic. There is little or no collaboration between the various clinics and the question arises if the needs of the women are being met. The aim of the research was to promote the health of HIV positive pregnant women by providing insight into the needs of these women and to formulate recommendations for antenatal care. The specific objective is to explore and describe the needs of HIV positive pregnant women regarding antenatal care. An explorative, descriptive, contextual design, following a qualitative approach was used during the research. Semi-structured interviews were used to collect data. Interview questions were compiled from the research problems. Before the commencement of data collection, permission was obtained from the district health manager and Potchefstroom Hospital. A total of sixteen (16) HIV positive women were interviewed after informed consent had been obtained. Data analysis was done after each session and themes were categorised according to the women's needs. From the interviews it was found that each woman has her own specific needs regarding antenatal care. The needs of the participants followed a similar pattern and for this reason it could be divided into various categories. These categories include a need for support, a need for education, a need for improved services and a need for a non-judgemental environment. Conclusions were drawn and recommendations were made for nursing practice, nursing education and nursing research. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

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.

Mother-to-child transmission (MTCT) of HIV is the most significant source of HIV infection in young children. As the HI virus has been identified in cell-free and cell-associated compartments of breast milk, it is clear that breast milk is one of the ways in which mother-to-child transmission of HIV can take place in addition to in utero and intrapartum transmission. While breastfeeding carries the risk of HIV transmission, not breastfeeding carries significant health risks for infants and young children, such as an increased risk of diarrhoea and pneumonia, morbidity and mortality. When an HIV-positive mother decides to breastfeed her baby, pasteurisation of expressed breast milk (EBM) could be a possible infant-feeding option to limit transmission of the HI virus through breast milk, since this method has shown to effectively inactivate HIV type 1. Three methods of pasteurisation of human milk were investigated in this study: Holder pasteurisation, flash-heating and Pretoria pasteurisation. The systematic review is a helpful method to summarise the best-quality empirical evidence of the benefits and limitations of a specific method, such as heat treatment, and to provide recommendations for future research. Therefore, the aim of this study was to critically synthesise by means of a systematic review the best available existing evidence and to provide a clear overview of the effectiveness of heat treatment of EBM as an in-home procedure to inactivate the HI virus, and in so doing limit mother-to-child transmission of HIV. This study provides the clinical practitioner with accessible information on the effectiveness of heat treatment of EBM as an in-home procedure in terms of (1) safety, inactivation of the HI virus and retaining the protective and nutritional value of the EBM; (2) feasibility as an in-home procedure; and (3) acceptability by the mothers and their communities. This information could be used to improve clinical practitioners‟ knowledge and include it in their health education to contribute to the prevention of mother-to-child transmission. This study is based on the framework of the model for evidence-based clinical decisions of Haynes, Devereaux and Guyatt (2002). The search strategy was conducted in March/April 2009. The initial search resulted in 574 articles. After thorough screening of potentially relevant studies on heat treatment of EBM, the studies that met the inclusion criteria were critically appraised and scored based on their methodological qualities using standardised instruments. After 6 months, the search was updated. The search obtained 1 article. The final sample involved 12 articles. Conclusions were integrated and synthesised as a basis for developing a clear overview of the best available existing evidence. Finally, the findings of the study were synthesised and the research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, education and research. The bottom-line answer concluded that heat treatment of EBM should be emphasised as a safe alternative for feeding exposed infants (those of an HIV-positive mother, those of uncertain HIV status or during weaning if the mother cannot afford formula or cow‟s milk), but should be supported with appropriate information to the individual mother, her family and the community. Overall it can be concluded that existing evidence of the effectiveness (in terms of safety, feasibility and acceptability) of heat treatment of EBM, particularly Pretoria pasteurisation, used as a simple in-home procedure, is insufficient, and further research is required. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010

Mother-to-child transmission (MTCT) of HIV is the most significant source of HIV infection in young children. As the HI virus has been identified in cell-free and cell-associated compartments of breast milk, it is clear that breast milk is one of the ways in which mother-to-child transmission of HIV can take place in addition to in utero and intrapartum transmission. While breastfeeding carries the risk of HIV transmission, not breastfeeding carries significant health risks for infants and young children, such as an increased risk of diarrhoea and pneumonia, morbidity and mortality. When an HIV-positive mother decides to breastfeed her baby, pasteurisation of expressed breast milk (EBM) could be a possible infant-feeding option to limit transmission of the HI virus through breast milk, since this method has shown to effectively inactivate HIV type 1. Three methods of pasteurisation of human milk were investigated in this study: Holder pasteurisation, flash-heating and Pretoria pasteurisation. The systematic review is a helpful method to summarise the best-quality empirical evidence of the benefits and limitations of a specific method, such as heat treatment, and to provide recommendations for future research. Therefore, the aim of this study was to critically synthesise by means of a systematic review the best available existing evidence and to provide a clear overview of the effectiveness of heat treatment of EBM as an in-home procedure to inactivate the HI virus, and in so doing limit mother-to-child transmission of HIV. This study provides the clinical practitioner with accessible information on the effectiveness of heat treatment of EBM as an in-home procedure in terms of (1) safety, inactivation of the HI virus and retaining the protective and nutritional value of the EBM; (2) feasibility as an in-home procedure; and (3) acceptability by the mothers and their communities. This information could be used to improve clinical practitioners‟ knowledge and include it in their health education to contribute to the prevention of mother-to-child transmission. This study is based on the framework of the model for evidence-based clinical decisions of Haynes, Devereaux and Guyatt (2002). The search strategy was conducted in March/April 2009. The initial search resulted in 574 articles. After thorough screening of potentially relevant studies on heat treatment of EBM, the studies that met the inclusion criteria were critically appraised and scored based on their methodological qualities using standardised instruments. After 6 months, the search was updated. The search obtained 1 article. The final sample involved 12 articles. Conclusions were integrated and synthesised as a basis for developing a clear overview of the best available existing evidence. Finally, the findings of the study were synthesised and the research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, education and research. The bottom-line answer concluded that heat treatment of EBM should be emphasised as a safe alternative for feeding exposed infants (those of an HIV-positive mother, those of uncertain HIV status or during weaning if the mother cannot afford formula or cow‟s milk), but should be supported with appropriate information to the individual mother, her family and the community. Overall it can be concluded that existing evidence of the effectiveness (in terms of safety, feasibility and acceptability) of heat treatment of EBM, particularly Pretoria pasteurisation, used as a simple in-home procedure, is insufficient, and further research is required. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010

Sub-Saharan Africa bears 70% of the global HIV burden with KwaZulu-Natal (KZN) identified as the epicenter of this pandemic. HIV related nephropathy (HIVRN) exceeds any other causes of kidney diseases responsible for end stage renal disease, and has been increasingly recognized as a significant cause of morbidity and mortality. There is nonetheless a general lack of surveillance and reporting for HIVRN exists in this geographical region. Consequentially, the aim of this study was to outline the histopathogical spectrum of HIVRN within KZN. Moreover, from a pathology standpoint, it is important to address whether HIVRN was a direct consequence of viral infection of the renal parenchyma or is it a secondary consequence of systemic infection. Additionally, an evaluation of the efficacy of Highly Active Anti-Retroviral Therapy (HAART) in combination with angiotensin converting enzyme inhibitors (ACE-I) was performed via a genetic appraisal of localized replication of HIV-1 in the kidney, ultrastructural review and immunocytochemical expression of a podocyte maturity and proliferation marker pre and post-HAART. Blood and renal biopsies were obtained from 30 children with HIV related nephropathy pre- HAART, followed-up clinically for a period of 1 year. This cohort formed the post-HAART group. Clinical and demographic data were collated and histopathology, RT-PCR, sequencing, immunocytochemistry and transmission electron microscopy was performed. The commonest histopathological form of HIVRN in children (n = 30) in KZN was classical focal segmental glomerular sclerosis (FSGS) presented in 13(43.33%); mesangial hypercellularity 10(30%); mesangial, HIV associated nephropathy 3(11%) and minimal change disease 2(6.67%). Post-HAART (n = 9) the predominant pathology was mesangial hypercellularity 5(55.56%); FSGS 3(33.33%) and sclerosing glomerulopathy 1(11.11%). This study also provides data on the efficacy of HAART combined with ACE-I. The immunostaining pattern of synaptopodin, Ki67 and p24 within the glomerulus expressed as a mean field area percentage was significantly downregulated in the pre-HAART compared to the post-HAART group respectively (1.14 vs. 4.47%, p = 0.0068; 1.01 vs.4.68, p < 0.001; 4.5% vs 1.4%, p = 0.0035). The ultrastructural assessment of all biopsies conformed to their pathological appraisal however, features consistent with viral insult were observed. Latent HIV reservoirs were observed within the podocyte cytoplasm but was absent in mesangial or endothelial cells. Real-Time polymerase chain reaction assays provided evidence of HIV-1 within the kidney. Sequence analysis of the C2-C5 region of HIV-1 env revealed viral diversity between renal tissue to blood. In contrast to a collapsing type of FSGS that occurs in adults, the spectrum of paediatric nephropathy in treatment-naive children within KwaZulu-Natal was FSGS with mesangial hypercellularity. Additionally, our study demonstrates podocyte phenotype dysregulation pre- HAART and reconstitution post therapy. Evidence of ultrastructural viral reservoirs within epithelial cells is supported by a genetic appraisal confirming the ubiquitous presence of HIV DNA in renal tissue. Moreover, sequence analysis showed viral evolution and compartmentalization between renal viral reservoirs to blood. Finally, the interplay of viral genes and host response, influenced by genetic background, may contribute to the variable manifestations of HIV-1 infection in the kidney in our paediatric population. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.

The focus of this thesis is to look at breastfeeding patterns in KwaZulu-Natal province, South Africa in relation to HIV infected women, who as mothers may, transmit the HIV virus to their child. It seeks to understand in depth the social context of HIV and AIDS in the time of the AIDS pandemic looking at gender culture; powerlessness of women in households in society. These dynamics occurring at such a crucial time and moment of this spiral explosive epidemic reflects a more broader concerted effort to understand and find solutions. This study emerges from a larger research project conducted under the auspices of the Medical Research Council, which was examining the transmission rates of HIV infection in babies born to HIV positive woman for a period of six months, on breastfeeding having given these women nevirapine as well. The study was HIVNET 023, which looked at the use of NVP that was given to breastfed infants in order to reduce MTCT of HIV, Phase 1,11 Study. This work was conducted from 2000 and completed in 2001. This thesis seeks to further explore challenges experienced by these breastfeeding HIV positive women in the public domain (i.e. in the clinics, hospitals as well as in communities), and how these challenges impinge in their daily lives as women. Issues of gender inequality, the social context of culture in the midst of a health crisis, and suggestions for change in the context of clinical practice, make up the bulk of the thesis argument. / Thesis (M.A.)-University of Kwazulu-Natal, 2003.