People living with HIV and AIDS (PLHIV) suffer from a number of stress-related psychological disorders. The aim of this study was to develop an integrative intervention, which combined Cognitive Behaviour Therapy (CBT), Body-Mind Therapy and Multicultural perspectives to assist health care workers in identifying and treating stressrelated psychological disorders among people living with HIV and AIDS. The study employed an intervention research design using both qualitative and quantitative methods. The quantitative data was collected from PLHIV attending HIV Counselling and Testing (HCT) and Anti-retroviral therapy clinics in the Buffalo City Municipality (BCM) of the Eastern Cape Province. The qualitative data was collected from the health care workers of the selected study sites. Purposive sampling was used to select the study sample. Instruments used included a biographical questionnaire, the Beck Depression Inventory-II (BDI-II), Medical Outcome Study- HIV (MOS-HIV) and focus group interviews to gather data for the development of an intervention model that would address reported stress-related psychological disorders. Findings showed that people living with HIV and AIDS endure stress in their lives on daily basis rather than episodes of severe or clinical depression. Many of the PLHIV are dealing with a number of psychosocial problems that compromise their quality of life and health status. In conclusion, the study illustratively interpreted and discussed the results in relation to the objectives of the study. The study recommends that PLHIV should be exposed to stress management programmes, and health care workers (HCWs) should be offered training in basic counselling skills, stress management and/or debriefing.

The HIV and AIDS pandemic have become not only a health concern but educational and social concern as well. According to Beyers and Hay (2011, p. 99) many school-going children are not only affected by HIV but a large number of adolescents are also either HIV positive or have AIDS. Other researchers argue that education should act as a vaccine against new HIV infections (Kendall and O’Gara, 2007, p. 6). This argument comes with the expectation that all teachers are willing and ready to work with learners made vulnerable by HIV and AIDS; without considering the lived realities of the teachers in relation to HIV and AIDS. While many teachers make a difference in the lives of affected and infected learners through the way in which they deal with the learners concerned, some may not take up the challenge to assist the learners, while others might unknowingly and unintentionally do harm. This study, therefore, aimed at exploring high school teachers’ experiences of working with learners made vulnerable by HIV and AIDS in order to generate guidelines to assist teachers to effectively deal with vulnerable learners in their classrooms.

HIV/AIDS has affected families in a profound and tragic way. Children whose parents have succumbed due to HIV/AIDS related infections have to be cared for by their relatives. This study focused on the experiences of primary caregivers of adolescents who are living with HIV in a semi-rural area of Eastern Cape Province, Grahamstown. There is a dearth of literature that is addressing the well-being, experiences and challenges of primary caregivers of adolescents living with HIV. Adolescence is a complex life stage during which adolescents usually present challenging behaviours and are grappling with moral issues. Caregiving to these youngsters who are burdened with HIV infection places additional demands on caregivers, especially so when they are experiencing poverty and poor social and welfare support. A qualitative study was most appropriate to explore and describe the experiences of adolescents infected with HIV. The population of this study was the primary caregivers of adolescents caring for adolescents with HIV in the area of Grahamstown, who are between 11 to 19 years old. A purposive sample of nine primary caregivers of adolescents living with HIV was selected. Data was collected by conducting individual interviews, using a semi-structured interview schedule. Data was analysed thematically according to prescribed theoretical guidelines. Data was verified by means of guidelines for the truth value, applicability, consistency, and neutrality of the study. The findings of the study indicated that primary caregivers experience that caring for adolescents who are living with HIV places a huge burden due to adolescents' negative behaviour, HIV stigma and discrimination, poor support from their families, being confronted with adolescents' emotional issues that they are not capacitated to deal with, and no adequate community resources to assist them. The challenges primary caregivers experience lead to negative effects on their health status. The findings of the study could be useful for informing intervention programmes that are targeting this group and policy development, and implementation of programmes benefiting both infected adolescents and their primary caregivers.

The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.

The potential of community-based organisations (CBOs) to provide lasting solutions in the field of Human Immune Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has long been recognised. As interest in the role of CBOs has increased, so have attempts to build their capacity and increase their stability and sustainability. Capacity-building initiatives which aim to strengthen CBOs as if they were identical to formal, more established organisations have often proved ineffective, and even at times destructive, because they have ignored the very differences that make CBOs potentially the most effective agents of development change at community level. This study is a qualitative exploration of a new mentoring-based approach to CBO capacity-building, which is currently being used extensively with CBOs in the Eastern Cape of South Africa. The research is inductive, beginning with an exploratory, descriptive and contextual study of the personal experiences and perceptions of CBO leadership team members from four sample CBOs which have graduated from the Barnabas Trust mentoring programme. Data was collected using a combination of face-to-face unstructured interviews and focus group discussion, with the objective of exploring the subjects’ experiences and their perceptions of the impact of the Barnabas Trust mentoring programme on the sustainability of their organisations. The insights and findings arising from the research process are then applied as the basis for a series of recommendations for the adaptation of the Barnabas trust mentoring approach and materials. The findings of this study appear to show that the mentoring-based approach has been an effective strategy for capacity-building towards sustainability for the CBOs in the sample, bringing positive change at the individual, organisational and community levels.

One of the greatest challenges facing sub-Saharan Africa, which incorporates South Africa, is the AIDS pandemic. The devastation wrought by this disease is unsurpassed in recent times. The health and social development structures, already overburdened, are totally overwhelmed by the needs of povertystricken households and communities affected by AIDS. Caregivers attempting to support those affected and infected are also facing unique challenges and demands, particularly relating to dealing with the large numbers of deaths due to this disease. Experiences for these caregivers are likely to be varied, ranging on a continuum from positive to negative, for instance, the recovery of patients versus the death of patients. The objectives of this study are to explore and describe the lived experiences of caregivers working with AIDS patients, particularly patients who die from this disease whilst resident in a formal institution. The research is based on a qualitative, explorative, descriptive and contextual research design. The study is grounded in a phenomenological approach to inquiry. Caregivers working fulltime in a formal institution caring for patients who are dying from AIDS were interviewed in an in-depth, unstructured manner in order to gather spontaneous, rich descriptions of their experiences. Through this study the researcher wants their voices to be heard, the potential richness of their reflections acknowledged and the generated data to be applied to the benefit of the field of HIV/AIDS – both for staff and patients. Thirteen in-depth, unstructured interviews provided saturated data, which was then transcribed and coded to yield the central and sub-themes that were identified in this study. One central theme identified the fact that in their daily duties (at their place of work), caregivers experience various challenges as a result of having to deal with the death and dying of their patients suffering from AIDS. These caregivers face the death of their patients daily, from a disease that causes untold suffering to the patient, family members and to the caregivers themselves, who wish they could prevent the anguish, the pain and the inability of the medical profession to do more than they are at present towards curing this disease. ii By describing the lived experiences of these caregivers by means of the research interviews, the researcher gained a clear picture of the AIDS environment. The information shared by the participants formed the foundation of the broad guidelines that were formulated. These are intended to provide support for the caregivers centering around the equipping of mentors of the caregivers, to enable them to support the caregivers in their daily task of caring for patients dying from AIDS. These caregivers, thus supported, will then be in a position to provide optimal care for these dying patients. These broad guidelines are intended to provide support by focusing firstly on the physical environment in which these caregivers work; secondly in providing education for the caregivers to enable them to fulfill their duties, and thirdly to provide adequate counselling to ensure that they do not succumb to caregiver fatigue/burnout, a constant threat in this type of environment. The study concludes with recommendations regarding the areas of nursing practice, education and research.

The African continent has been hit the hardest by the HIV/AIDS epidemic which has seen more women becoming infected than men (Hunter, 2003; UNAIDS, 2004). This has been attributed to the permissible nature of the African culture which is lenient on male promiscuity (Foreman, 1999; Colvin 2000; Leclerc-Madlala 2001; Dube 2003). African women are not only vulnerable to infection but are also vulnerable to negative disclosure experiences when they disclose their status to sexual partners. This double impact of culture has not been addressed by past researches (UNAIDS 2004). The present research thus attempts to fill that gap. It explores the interplay between culture and HIV transmission as well as the interplay between culture and disclosure experiences. The study’s setting is Magunje Township, a rural village in Mashonaland Central province in Zimbabwe. Taking into consideration the limitations of the present analysis, data gathered indicates that African women are vulnerable to both HIV infection and negative disclosure experiences. Their vulnerability also hampers prevention and treatment efforts as it makes them decide to keep their status a secret from sexual partners for fear of losing the financial income tied to sexual partners. The present researcher concludes with some suggestions for policy makers and programme implementers, highlighting the importance of focusing on HIV/AIDS status disclosure as a prevention and treatment method in the absence of a cure for HIV.

Cryptosporidiosis is an infection caused by Cryptosporidium; a protozoan parasite that infects the gastrointestinal tract. The infection is of major public health concern in both developed and developing countries. Faecal samples were collected from 160 in-patient adults, with complaint of diarrhoea, admitted at Victoria hospital in Alice, Nkonkobe Municipality. Twenty apparently healthy subjects were included as controls. All diarrhoea positive patients were interviewed to record socio-demographic information, water supply and animal contact. Initial screening was carried out by microscopy and ELISA to detect positive Cryptosporidium. Genomic DNA was extracted from microscopically positive samples and a PCR reaction was perform to amplify the (18S) SSUrRNA gene for further identification and epidemiology of Cryptosporidium. Data were analysed using Pearson‘s χ2 and Fisher‘s exact test to assess the univariate association between Cryptosporidium infection and the possible risk factors. Of the 180 subjects screened for cryptosporidial infection, Cryptosporidium antigen was detected in 122 giving an overall prevalence of 67.8 percent. In HIV-positive diarrhoea patients, prevalence increased with ages; between 31-43 (mean age 36.5 yr) and 70-82 (mean age 75.8 yr) had a higher prevalence (100 percent) of the antigen than 18-30 (mean age 23.2 yr) and 83-95 (mean age 88.8 yr) (50.0 percent) in HIV-positive diarrhoea patients (P > 0.05). In HIV-negative diarrhoea patients, prevalence was highest in the 18-30 (mean age 23.2 yr) (87.5 percent) and least (35.7 percent) in those aged 83-95 (mean age 88.8 yr) (P > 0.05). Cryptosporidium antigen was higher in females than in males. Of 115 females (mean age 46.7yr) who participated in the study, antigen was detected in 90 (78.2 percent) against 32 (71.1 percent) of 45 males (mean age 42.6yr). None of the 20 apparently healthy control subjects was found to be infected with Cryptosporidium. Cryptosporidium was detected in 27 HIV-positive and 97 HIV-negative diarrhoea patients by any one of the techniques. Antigen detection by ELISA 14 showed the highest positivity 96 (76.8 percent) in HIV- negative and 26 (74.3 percent) in HIV- positive diarrhoea patients. PCR detected eighty-nine (71.2 percent) cases in HIV-negative and 23 (65.7 percent) in HIV-positive patients with diarrhoea. Only 13 (37.1 percent) HIV-positive and 34 (27.2 percent) HIV-negative diarrhoea patients were found positive for Cryptosporidium by modified ZN. No significant difference was observed in sensitivity of antigen detection by ELISA and PCR (96.9 percent) in HIV-negative diarrhoea patients, respectively. Specificity of the staining technique was 88.9 percent in HIV-positive and 96.6 percent in HIV-negative diarrhoea patients. No significant difference was found in specificity of antigen detection by ELISA and PCR in HIV-positive and HIV-negative diarrhoea patients, respectively. Positive predictive value of ZN staining in both HIV-positive and HIV-negative diarrhoea patients (92.3 and 96.9 percent) was statistically higher than ELISA and PCR. No significant difference was observed in negative predictive value of ZN technique for detection of Cryptosporidium between HIV-positive and HIV- negative diarrhoea patients. Differences found in prevalence rates due to water source, suggest that the high infection rates of specific groups are associated with their exposure to the contaminated water supply. The results indicate that Cryptosporidium infection is highly prevalent in adult faecal specimens in the Nkonkobe Municipality, an indication of active infection that is likely to emerge as major human pathogen in this location due to socioeconomic changes which favour transmission. However, sequencing analysis is required to differentiate between Cryptosporidium genotypes in the various outbreaks

M.Ed. (Educational Psychology) / Please refer to full text to view abstract

D.Litt. et Phil. / HIV/AIDS is an epidemic of grand proportions sweeping through South Africa and the world at large. The statistics reveal that HIV/AIDS particularly in South Africa is fast becoming a major health crisis and psychological emergency. It is one of the most challenging, perplexing and alarming realities of recent times. Because of its terminal nature and the distant possibility of cure, infection with the disease to date provides death as the only available option. This in turn has enormous ramifications on multiple levels inter alia personal, societal, economic and political levels. These ramifications are potentially devastating. Furthermore, because of its common sexual mode of transmission, it is a disease that confronts individuals and society at large with some of the most vicious forms of prejudice and injustice, often leaving those living with the disease shamed and alone. This is confounded by the fact that it is a disease that follows no precedent for coping both on a personal and societal level, leaving society and the individuals living with HIV/AIDS helpless and hopeless. It therefore is a disease and experience that necessitates urgent exploration and investigation. The literature review attempts to present the frame of reference from which to understand and contextualise the experience of living with HIV specifically focusing on the biological (Ungvarski & Flaskerud, 1999; Webb, 1997), psychosocial (Antonovky, 1979; Carson & Green, 1992; Cohen & Willis; 1985; Hedge, 1991; Nicholas & Webster, 1993; Ragsdale & Morrow, 1990; Zich & Temoshok; 1987) personal (Kubler-Ross, 1969; Tegius, 1992), cultural (Fee & Fox, 1988; Ungvarski & Flaskerud, 1999; Van Dyk, 2001), gendered (Glover-Walton, 2001; Lawson, 1999; Wilton, 1997) and political (Grundlingh, 2001; Webb, 1997) experience of HIV/AIDS. It explores the impact of diagnosis on identity and psychosocial development (Tegius & Ahmed, 1992) and attempts to explore ways of coping with the experience (Cohen & Willis, 1985; Folkman & Lazarus, 1980; Lazarus & DeLongis, 1983). Further it examines the social constructions that shape and guide the personal experience of the disease (Dansky, 1994; Sontag, 1991). It explores the intersection and influence of culture, gender and politics on the experience of living with HIV/AIDS (Brandt, 1988b). The literature review further explores the experience of meaning making from a religious (Baumeister, 1991; Yalom, 1980), existential (Frankl, 1965; Frankl , 1967; Frankl , 1969; Frankl, 1978; Frankl, 1984; Fromm, 1949; May, 1967; Yalom, 1980) and cultural perspective (Hammond-Tooke, 1989; Kiernan, 1981; Louw, 1994). It examines the philosophy of existentialism, as well as elucidates various developmental frameworks of meaning (Erikson, 1963; Fowler, 1981; Kohlberg, 1984; Mezirow, 1991; Reker, 1991). Western and African worldviews in relation to meaning making are examined exploring the intersection of culture with personal meaning systems (Marsella & White, 1982). Meaning in suffering, specifically focusing on meaning in illness, is examined (Janoff-Bulman, 1992; Toombs, 1992). The literature review reveals that most of the research on people living with HIV/AIDS is focused on medical factors describing transmission and biology. Only a small number of theoretical studies and empirical research have begun to explore how people living with HIV/AIDS cope. Research on the exploration of the idiosyncratic meanings and experiences of people living with HIV/AIDS is very limited. Research on the lived experience and meaning making of HIV particularly within the South African context has to an extent been ignored and neglected. Furthermore, much past research has focused on the experience of HIV/AIDS in poverty-stricken communities and ignored the experience of HIV/AIDS for middle class individuals. The present investigation of the lived experience of HIV within a phenomenological framework, seeks to address these gaps. It seeks to provide an understanding of the lived experience of HIV as well as explore the meaning making process for middle class individuals living with HIV. The phenomenological system of inquiry is employed as a mode of research in an effort to study the experience of middle class people between the ages of 30 and 39 years, who are living with and potentially making meaning of their experience of being HIV positive. Because an in-depth understanding of such an experience is most suitably accessed through a qualitative approach, a phenomenological research method was chosen, in an attempt to gain access to the idiosyncratic, lived experience of the participants. Four people living with HIV were accessed through the media and through ‘word of mouth’ referrals. Individual interviews were held that lasted between one hour to an hour and a half. Interviews were recorded and transcribed verbatim, providing the information from which intra-individual analyses and discussions were carried out on each participant. The analyses rendered an understanding of the participants’ idiosyncratic experience of living with and making meaning of HIV. An inter-individual analysis and integration was then undertaken. Common themes arising from the inter-individual analysis of the participants’ responses related to feelings of being overwhelmed and bewildered by contradictions and perplexity of life with HIV. The participants described finding balance and voice to their experience through the world of work. Thus, in exploring the experience of HIV with others they noted that their sense of self, both physically and psychically, had been profoundly transformed. In turn this impacted their experience of others, which formed an integral part of living with HIV. From a biological perspective the participants noted that through the use of medication, vitamins, exercise and correct diet they had found a means of gaining control over their situation. Nonetheless they felt unable to hold onto the hope of a possible cure. When describing the experience of becoming HIV positive the participants relayed a process of overwhelming and intense feelings. They noted that they had felt ambivalent feelings towards their infectors but in time were able to forgive them. In disclosing their HIV positive status to those close to them the participants described feelings of shame and fear of rejection. They noted that while they did experience rejection from some, they also experienced deep care and support from others close to them. Invariably they noted that becoming HIV positive impacted their ways of being in relationships as it also impacted their way of knowing and being generally in the world. They described feeling fearful of the future and saddened by the experiences of loss and limitation on many levels. Furthermore, they became sensitised to a sense of limited time and in turn became more aware of their inevitable death. Thus in tackling their fears of death the participants noted that they had begun preparing for death and in some way gaining a sense of control. In making sense of their experience and death the participants noted that they had experienced a need to celebrate life and focus on the here and now. They further noticed that in celebrating life they had rediscovered spirituality and religion. They noted a greater sense of depth and compassion in their lives, and felt that they may find a sense of purpose and meaning through helping others. Finally, in elucidating their experience of living with HIV they noted that in many ways the influences of culture, economics and gender had mediated their individual experience of being HIV positive. It is important to note that these central themes of the phenomenon of meaning making and HIV are generated and influenced by broader contexts. The individual with HIV is a being-in-the-world with physical, psychological and social domains, all of which influence and shape his/her experience, the meanings he/she derives from it and the decisions he/she makes in regards thereof. The value of this research lies primarily in its ability to gain an in-depth understanding and insight into the lived experience of people with HIV, particularly within the South African context. The responses of the participants provided insight into and emphasis on the inextricable link between the personal and the political, as it displayed how economics determine access to resources and inevitably determine the experience of living with HIV. For the participants economics was the determining factor in terms of the possibility of using anti-retroviral medication, which invariably determined their prognosis. This has huge implications for public and political policy. Furthermore, the research suggested that living with HIV was very different to life with other terminal diseases, as it is bound up with very potent, social and private constructions of shame, stigma and prejudice. This has implications for public and social education around HIV/AIDS. The participants suggested that becoming HIV positive forced them to relook and re-examine their own stereotypes, transforming their experiences of self and others. The strength of the study lies in the use of a phenomenological framework, as it provided access to a rich, broad and deep description of the subjective experience. However while the qualitative research paradigm yielded fundamental insight into the subjective experiences of the meaning making and HIV, it was unable to quantify these experiences or establish the strength of correlation and causality between variables. These limitations may be circumscribed through the use of both quantitative and qualitative methods in future research. Furthermore, follow up studies should be done to explore continual patterns or newly emergent trends providing a fuller picture of the experience.