D.Cur. / The nurses who work in the hospitals are constantly in interaction with the patients. As the HIV infection has now reached the AIDS phase, most people who were infected five to ten years back are now sick due to HIV/AIDS compromised conditions. The statistics inform us that mostly young people are dying. This has reversed nature, in that elders are now burying the youth. The HIV/AIDS infected people who are ill are admitted to general hospitals for health care. At present the patients are cared for in the general wards with other patients who may not be HIV/AIDS infected. In the hospitals they are cared for by the health team, of which the nurses are with these patients for 24 hours a day. This study focused on the interaction between nurses and admitted patients who are HIV/AIDS positive. The patients may have been admitted due to opportunistic diseases or any other illnesses. Most patients with HIV/AIDS suffer from opportunistic diseases, pain and stress. Nurses become aware of the patient’s HIV/AIDS status for health care reasons. Nurses are in most institutions the first contact in health care. Therefore the nurses are engaged in established relationships with patient, families, friends and the community for the purpose of the provision of health care services. These relationships entail interaction. The interaction between the nurse and the patients plays a major role in the care of the patient. This interaction between the nurses and patients entails a number of aspects, such as communication, be it verbal or non-verbal. The latter includes behavioural and affective aspects, such as attitudes, the way care is provided and how the parties feel about the interaction. Nursing is a human interaction. In this interaction the nurse and the patient build a therapeutic relationship, resulting in assistance to facilitate the wellbeing of the patient and rapid recovery. The HIV /Aids infection affects the patient as a whole because of the stigma attached to the disease, therefore the affected patients need to be assisted in order to cope with the illness and its consequences. Therefore the purpose of the study was to: • To explore and describe the nurses’ and patients’ (who are HIV AIDS infected) experience of their interaction. • To develop and describe a model that would assist the nurses to facilitate the promotion of mental health in patients who are HIV/AIDS infected. A theory generation research which is qualitative, descriptive and explorative and contextual in nature was conducted with permission from the Department of Health authorities, hospital authorities, admitted patients with HIV/AIDS, the NGO that looks after the patients in the community after discharge, the nurses who work in the general wards and the University of Johannesburg Ethical and Research committee. Pilot interviews were conducted with one nurse-participant and patientparticipant that met the selection criteria.

M.Tech. (Radiography) / This was a prospective, quantitative comparative study. The aim of the study was to evaluate acute toxicity of radical combination therapy, in the form of radiotherapy and chemotherapy, in HIV +ve patients on HAART and HIV -ve patients for cervical cancer at CDH, Lusaka, Zambia. The specific objectives were to compare acute toxicity in HIV +ve on HAART and HIV -ve patients and to assess the level of severity in the levels of toxicity. The study was conducted from January 2010 to December 2010. A hundred and twenty stage IB₂-IIIB cervical cancer patients were serially recruited and assigned study numbers for identification and confidentiality. Participants received Cisplatin based radical chemoradiation for five to six weeks during which time they were assessed for acute reactions and data was prospectively collected. Four systems namely Genitourinary, Haematopoietic, Skin, and Gastrointestinal were used for the assessment of toxicity in the study. Toxicity was scored using the NCI CTC v2.0. The results of this study showed that, major acute reactions in the CDH study participants were grade 3 leucopoenia (five in each study arm) and one grade 3 acute skin toxicity in the HIV +ve arm. Results also revealed that there were three HIV +ve study participants with grade 3 vomiting and one HIV –ve. There was one grade 3 anaemia in the HIV +ve arm, one grade 3 anaemia in the HIV –ve arm and one grade 4 anaemia in the HIV +ve arm. However, only the incidence of grade 3 leucopoenia in both study arms and vomiting in the HIV +ve study participants was significantly higher. This study demonstrated that radical chemoradiation is well tolerated by HIV +ve patients with intact immunity. Toxicity was usually mild and reversible and no exaggerated toxicities beyond those generally associated with single-agent Cisplatin were observed in the HIV +ve study participants. Therefore, radical chemoradiation in conventional doses can safely be given to cervical cancer HIV +ve patients who are on HAART.

Magister Scientiae - MSc (Mathematics) / 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).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.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.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. / South Africa

Magister Scientiae Dentium - MSc(Dent) / 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 – 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. 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. / South Africa

Magister Artium - MA / This research explored cultural perceptions of HIV & AIDS with students at the University of the Western Cape and attempted to understand how these perceptions of the disease reinforce stigma and stigmatising attitudes towards people living with HIV/AIDS. This study investigated HIV/AIDS stigma as a social phenomenon and analysed the socio-cultural and historical roots of HIV/AIDS stigma. / South Africa

Masters of Public Health - see Magister Public Health / With a prevalence of 14.3% among the 15-49 years age group, HIV/AIDS still constitutes a significant challenge in Zambia. In order to respond to the impact of HIV/AIDS within the workplace, government ministries have developed HIV-focused workplace policies and programmes that provide HIV/AIDS services. However, despite their availability, the number of employees accessing the services, especially those targetting HIV positive workers remains low. The fear (either perceived or real) of disclosing an HIV positive status is one likely reason for the low uptake of services. HIV-positive status disclosure is an important public health goal as it can create opportunities for an individual to access information and social and medical support, and this will affect career and workload related decisions. This exploratory, qualitative study aims to identify and describe the HIV-disclosure experiences of 12 openly HIV-positive Zambian public sector workers living in Lusaka and working in four Zambian Ministries. Both male and female public sector workers were interviewed. The participants’ experiences of disclosing their HIV positive status in the workplace were explored in depth in this study. With the aim of providing those responsible for overseeing and managing the Zambian public sector HIV workplace initiatives with some practical recommendations regarding the disclosure support needed by HIV-positive public sector workers. The study found that whilst participants had an initial fear of disclosing their HIVpositive status in the workplace, their HIV disclosure actually proved to be very beneficial. Not only did it allow their health-related needs (such as accessing medication and visiting a doctor) to be met, but their disclosure also encouraged others to also disclose their status. The recommendations are are aimed at creating a supportive working environment for people living with HIV within the Zambian public service, and offering suggestions to their managers on how best to support the process of disclosure amongst their staff.

Magister Public Health - MPH / Dual protection is protection against unwanted pregnancy, HIV and other sexually transmitted infections and a means of achieving safer sex and birth control (WHO, 2012). It is one of the essential tools promoted by the WHO for preventing unintended pregnancies and sexual transmitted infections among HIV-positive women to reduce dual risk of unintended pregnancies, re-infections and transmission of HIV in the cases of sero-discordant couples. However, the use of dual method use among HIV-positive women in Zimbabwe is poorly described. Hence to fill in the existing research gap, this study aims to explore the factors influencing dual protection use by HIV- positive women participating in a prevention of mother-to-child transmission (PMTCT) program in an urban setting in Zimbabwe. Methodology: A qualitative exploratory study design with a combination of qualitative research methods including interviews and focus group discussions was conducted. A total of five focus group discussions (FGDs) each consisting of 8-12 participants was conducted with a total of 51 women. Five in-depth interviews were conducted with key informants. All interviews and FGDs were audio recorded using a digital voice recorder. The interviews were conducted in Shona and translated into English. Data analysis was done manually using thematic coding. Codes emerged from the data using an inductive approach. Ethical principles of research and rigour were observed throughout the study. Results: Dual protection use was low among the HIV-positive women. Absolutely non-use of contraceptive was reported by some women. The main methods of contraceptives were the pill, depo provera and condoms. Inconsistent condom use was mentioned among the few women who reported using condoms. Many barriers to contraceptives use among HIV-positive women in Zimbabwe were identified. However there were a few facilitating factors too. Health system factors associated with health care workers (HCWs) related factors and service delivery processes were reported as major barriers to contraceptive use. Women expressed negative attitude towards condom use associating them with unfaithfulness. Facilitators of contraceptive use identified were couples' HIV testing and counselling, women's increase in CD4 count result, fear of vertical transmission and HIV sero-discordance between couples. Conclusion and Recommendations: In conclusion, dual protection use among HIV-positive women in this community was low. Health system factors were the main barriers to contraceptives use whilst health related factors were the main facilitators. HIV-positive women still face challenges in accessing and utilisation of contraceptives. Hence the barriers to contraceptive use needs to be addressed at the same time promoting the facilitators.

This survey was designed to identify the incidence and scope of depression, satisfaction with life, self-efficacy and perceived access to medical care for those who are infected with the HIV virus. It also determined whether or not factors such as sexual orientation, ethnicity and socioeconomic status are intervening variables with respect to mental health issues. Subjects were recruited through a purposive sample from South Florida. A total of 871 surveys were used in the analysis. The overall response rate was nearly 90%. The incidence of depression was found to be higher than 75% across all stages of HIV infection. Furthermore, the incidence of depression increased as HIV disease progressed. Satisfaction with life and for the most part, self efficacy were found to decrease slightly as HIV disease progressed. Significant variance in depression, life satisfaction and self efficacy were found across stages of HIV infection. No significant differences between groups that were HIV infected, were found for depression, life satisfaction and self efficacy. The severity of depression was found to vary significantly with self efficacy, life satisfaction and access to medical care but not with socioeconomic status. Life satisfaction was found to vary significantly with socioeconomic status, depression and self efficacy but not with access to medical care, Self-efficacy was found to vary significantly with socioeconomic status, depression and life satisfaction but not with access to medical care. Gender and ethnicity were not found to be significant precedent variables in depression for HIV infected individuals. Sexual orientation was found to be a significant precedent variable for depression, life satisfaction and self efficacy.

Rape survivors often have two traumatic events to deal with. In addition to the actual rape experience, survivors commonly need to deal with hearing the results of human immunodeficiency virus (HIV) testing (which is standard practice after rape in South Africa). The relationship between these two traumatic events in terms of the survivors specific traumatic stress symptoms have not been well explored in the literature. The primary aim of this study was therefore an exploration of the relationship between receiving an HIV test result and the traumatic stress symptoms of rape survivors. In order to contextualise the main aim, an exploration of the relationship between demographic variables, knowledge of HIV status and early traumatic stress symptoms was also completed. The initial sample consisted of 97 South African rape survivors, however, only 45 participants returned for the second part of the study. This quantitative study utilised an exploratory descriptive design using the Harvard Trauma Questionnaire-Revised (HTQ-R) to measure the traumatic stress symptoms of rape survivors. The results of the first part of the study indicated that there was no significant difference between participants’ demographic factors in relation to their knowledge of HIV status or their overall traumatic stress symptom severity. Significant differences on individual traumatic stress symptoms indicated a relationship between not knowing one’s HIV status and dissociation after a rape incident, as well as a relationship between rape survivors who knew their HIV status is positive and emotional dysregulation. The results of the second part (and main analysis) of the study indicated that most participants presented with less severe overall traumatic stress severity after receiving their HIV test results (irrespective of their status before and after hearing their results). However, participants whose HIV status was unknown and who received a positive test result reported more severe overall traumatic stress compared to those whose HIV status was unknown and received a negative test result. Some inter-group differences on individual symptoms were HIV TEST RESULT TRAUMATIC STRESS RAPE SURVIVORS noted that highlight the possibility that dissociative and an intrusion/hyperarousal subtypes may be at work to explain some of the differences seen.

Due to the increasing availability of ART (antiretroviral therapy),HIV is starting to be seen as a chronic disease. This has several effects on families, one of which is the need to disclose their HIV status to children who were born with the illness. Potential barriers and available support structures with regards to paediatric HIV disclosure need to be considered before specific guidelines can be given to caretakers and health care providers. This study aimed to explore and describe the patterns of paediatric HIV disclosure or non-disclosure using a sample of caretakers or parents of children/adolescents who were born with HIV. The Disclosure Decision Making Model (DDMM) was used as a framework to understand the decision-making process that leads to either disclosure or non-disclosure. Qualitative data was gathered by means of in-depth, semi-structured interviews, conducted in English. Ten participants were recruited from a community health care centre that offers HIV counselling and testing in the Nelson Mandela Bay Health District. Data gathered was transcribed and analysed using thematic analysis. Lincoln and Guba’s model was used to determine the trustworthiness of the data. The two themes that emerged from the study were (1) caretakers wish to disclose HIV status to the child but identified barriers to doing this and, (2) caretakers identified factors that helped them to disclose the child’s status. This study provides a more in-depth understanding of the factors that influence disclosure in a resource-limited setting in the Eastern Cape.