Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 73-81).

Objective To determine the reasons for the change or modification in the first line HAART regimen (1a and 1b) in HIV positive patients at the Thusong CCMT site. Methods This study is a quantitative descriptive study using a standardized data collection tool to extract retrospective data from medical records. Subjects Subjects for this study included patients 18 years or older attending the Thusong CCMT site, which were started on HAART regimens 1a or 1b and were on treatment for at least 6 months. The final sample size evaluated was 257 patients. Results There was a high rate (43%) of change or modification of the first line HAART regimen. Majority of the patient’s (72%) had their regimen modified due to side effects of the drugs and only a small number (9.7%) of patients had a complete change in the regimen due to virological failure. Stavudine (d4T) associated lipodystrophy was the most common side effect (45.5%) followed by peripheral neuropathy (16.7%), leading to treatment modification. Conclusion The rate of modification or change of first line HAART regimen, at Thusong CCMT, was fairly high (42.6%), and the most common reason for the modification or change was drug side effect of stavudine (d4T).

M.A. / This study explores attitudes and fears of HIV counsellors towards HIV testing. A social constructionistic perspective was used to realize this objective. The researcher hoped to find out the following:  what attitudes and fears do HIV counselors( who have not tested for HIV), have towards HIV testing?  how the HIV counsellors’ attitudes and fears differ from those of the general population.  the environmental factors affecting their decision, their vulnerability to HIV and what can facilitate their willingness to test.  what strategies can be used (from the HIV counsellors’ point of view), to change those attitudes and alleviate those fears so that all HIV counsellors can be willing to undergo voluntary HIV testing. Tape recorded interviews were conducted with the HIV counsellors who have not tested for HIV. It was evident in the study that there are attitudes and fears towards HIV testing which are common to the HIV counselors and the general population, and those which are peculiar to HIV counselors because of the nature of their job. Also evident in the study is the fact that HIV counsellors are vulnerable to contracting HIV and therefore could reap the benefits of knowing their HIV status by undergoing the HIV test. The researcher together with the HIV counsellors co-designed strategies that will address those attitudes and fears so that HIV counsellors can be encouraged to undergo voluntary HIV testing. Since the study was conducted only in the community clinics, the findings cannot be generalized to all HIV counsellors. The recommendations based on the findings are that a similar study should be done and should cover a much wider and broader context to determine if such a study can yield similar results.

Magister Curationis - MCur / Background: In 2009, approximately 130 000 children in Southern Africa under the age of 15 were newly infected with HIV, with vertical transmission being the most common cause of HIV infection. HIV positive mothers are therefore faced with a unique dilemma about which infant feeding choice to make. Prior to 2006,formula feeding was the recommended feeding choice in an attempt to minimise vertical transmission of HIV. In 2006, the risks associated with formula feeding necessitated a change in the recommendations to allow for either exclusive formula feeding or exclusive breastfeeding. The clinical guidelines were reviewed in 2010, when research on the effectiveness of prevention of mother to child transmission efforts suggested a decrease in such transmissions, even when exclusive breastfeeding. Currently the recommendations focus on the contextual appropriateness of the infant feeding choice. The imminent withdrawal of free formula is a new development within the prevention efforts. Aims and Objectives: This study aimed to describe the infant feeding choices of HIV positive mothers on discharge from a level two hospital, in Cape Town. The study objectives included determining the infant feeding choice and the factors that influence HIV positive mothers’ infant feeding choice on discharge from the hospital. Research Methodology: A descriptive survey study design was used as it lends itself to the description of the new developments regarding prevention of mother to child transmission and the meaning it has for the infant feeding choices made by HIV positive mothers. A quantitative approach was used to establish the specified factors that currently affect HIV mothers’ infant feeding choices. A nonrandom consecutive sampling technique was used. The data collection method took the form of a questionnaire. Data analysis was performed through SPSS 20 to produce descriptive and inferential statistics to establish relationships between the independent and dependent variables. Results and Recommendations: The number of exclusive breastfeeding participants was higher (54%) than the exclusively formula feeding participants (46%), which is in keeping with the institution’s trends for the previous year (2011). Statistical significance was difficult to establish due to the small scale of the study, but clinical significance with the establishment of the factors influencing infant feeding choices was considered. These led to the following recommendations: reorientation of infant feeding counselling towards the criteria of acceptability, feasibility, affordability,sustainability and safety, in view of the withdrawal of free formula and promotion of exclusive breastfeeding as the single infant feeding strategy. Ethical Considerations: Ethical clearance was sought from the Ethics Committee of the University of the Western Cape, Research Committee of the level two hospital and informed consent was obtained from the participants.

This research was conducted on a section of mine employees ranging from skilled to the least skilled mine workers in Goldfields Mine, Carltonville. The aim of the study was to assess HIV/AIDS employees’ perceptions of social work counselling services in the workplace. The researcher was employed at the Department of Social Services and Population Development where she attended weekly to HIV/AIDS employees who had been referred for treatment without providing any form of counselling within the workplace. Researcher’s subsequent research at Goldfields Mine was designed to probe what the affected employees’ perceptions of a social work counselling service was. The gathering of data during research comprised conducting interviews with the use of semi-structured interview schedules. Ten (10) male employees from Goldfields were used during the study. Purposive sampling was employed. Findings reveal that although counselling was provided at Goldfields Mine, Carltonville, a minority of employees indicated that the current counselling programme (workplace programme) is not adequate and that more time should be provided by management for counselling during working hours. / Dissertation (Magister Artium(Social Work))--University of Pretoria, 2007. / Social Work and Criminology / unrestricted

Midwives recommend antenatal HIV testing in pregnancy for all women. However,limited information is available on the experience of testing HIV positive in pregnancy.This thesis explored women’s experiences of receiving a positive HIV test resultfollowing antenatal screening in United Kingdom (UK). Black Africa women have highlevels of HIV infection in the UK and notably all participants were African in origin.The theoretical basis for the study was hermeneutic phenomenology, proposed byHeidegger (1962) and further guided by van Manen (1990), exploring essence andmeaning of this lived experience. Thirteen women were recruited and participated in asemi-structured interview. Participants were recruited from two NHS sites, several HIVsupport organisations and a national advert, in order to obtain diversity of this livedexperience.The emergent phenomenon is transition and transformation of “being,” as womenintegrated HIV into their lives. As women transformed with the HIV diagnosis theybalanced major themes. The major themes consisted of shock and disbelief; anger andturmoil; loss of old self; stigma and confidentiality issues and acceptance and resilience.Primary and secondary themes included: extreme reaction on being given a diagnosiswith a cultural belief that they would die; disbelief as the result was unexpected;sadness and loss of their old self; turmoil wanting to terminate the pregnancy; isolationfrom significant others; breakdown of their relationship and considering suicide and selfharm. Most reported the pervasiveness of stigma, and how they managed both thisstigma and HIV in their lives; growing resilience was apparent with time. Copingstrategies included keeping HIV “secret” and their child or children becoming the primefocus of life, with less importance on self.This study gives midwives a unique understanding of the complexities for womentesting HIV positive and supports Bonanno (2009) and Kübler Ross’ (1969 & 2005)findings on personal loss. Additionally this study provides a unique insight into thephenomenon of transition and transformation for women who tested positive inpregnancy and explores the factors and impact of testing HIV positive. The impact of anHIV diagnosis is culturally difficult for African women and had major implications andchallenges for their future life. Midwives are crucial in supporting and improving theexperience of women when they test HIV positive.

As part of the Serithi project a longitudinal study of HIV positive women diagnosed during pregnancy, support groups for HIV-positive women were established in Mamelodi and Atteridgeville (Tshwane). Eighty-eight women participated in these groups during 2005, with the groups being facilitated by Masters Psychology students. This study explores therapeutic processes in these support groups. Yalom’s therapeutic factors were used as the underlying theory. These are factors that Yalom advances as therapeutic processes in understanding group psychotherapy. The process notes of the Masters Student facilitators, together with the interviews that were conducted with the women after the support group experience, were analysed to identify therapeutic processes that manifested themselves in the support group experience. Qualitative methods were used to collect data and thematic analysis was utilised to analyse the data. The research results revealed that support groups are therapeutic, in the sense that ten of the twelve therapeutic factors advanced by Yalom proved to have been made manifest, or demonstrated, within these groups. These are: altruism, group cohesion, interpersonal learning input, interpersonal learning output, guidance, identification, family re-enactment, instillation of hope and existential factors. The women reported having felt a sense of relief from being part of a group of people who experienced similar issues. They also reported that they learnt from each other. This gave them hope and an understanding that, even though there may be people going through the same problems as they are, they still need to face life alone. The women reported feeling a sense of self-worth from helping others, which contributed to rebuilding their self-esteem. These results indicate that support groups can be therapeutic for the people involved. They can be used to guide support group facilitators with regards to what to look for when facilitating groups. They can also assist policy makers in developing guidelines for the facilitation of support groups in order for the participants to obtain maximum benefit from their support group experience. / Dissertation (MA)--University of Pretoria, 2009. / Psychology / unrestricted

Purpose: To compare the presenting symptoms and the outcomes of root canal therapy between HIV positive and HIV negative endodontic patients over a 6-12 month period. Methods: Fifty-nine HIV negative and 46 HIV positive patients presented for endodontic treatment. Signs and symptoms were noted and compared for both groups of patients, together with demographic data and CD4 counts for the HIV positive patients. Endodontic procedures were evaluated after an 18-month period. Endodontic treatment was assessed using clinical factors (palpation, percussion, sensitivity to hot and cold, swellings, excessive bleeding), and radiographic factors (periapical radiolucency, root resorption, periodontal ligament space). Results: There was no statistically significant difference in the preoperative presenting symptoms of endodontic infections/conditions between HIV positive and HIV negative patients. The prevalence of radiographic caries in the presenting teeth was only 24% in the HIV positive patients compared with 95% in the HIV negative patients. For the HIV positive patients, the treatment time required to resolution of the endodontic infection was nearly twice (113 minutes) that of the HIV negative patients (52 minutes). Amongst the HIV positive patients still experiencing symptoms at 18 months, pain was more severe in those patients with lower CD4 counts (significance at the 90% level of confidence). Conclusion: Within the limitations of this study the following conclusions emerge: 1. Although the success rate was lower over the period of this study in HIV positive patients, the rate is sufficiently high to warrant treatment. 2. Patients who are HIV positive may present with more severe symptoms and during treatment more bleeding may be expected. 3. In keeping with best practice for immuno-compromised patients, it would be advantageous to put HIV positive patients on antibiotic cover during treatment. 4. The process of anachoresis may explain the high incidence of endodontic infections in teeth with no history of trauma or caries in the HIV positive group.

The purpose of this three-paper dissertation is to address existing gaps in the literature by examining the intersections of gender-based violence (intimate and non-intimate partner) (GBV) among key-affected populations, defined as women engaged in sex trading in intimate relationships, HIV-positive women, and/or low-income, substance-involved women. This dissertation includes three papers that examine: 1) IPV and recent sex trading among a sample of substance-involved women in intimate sexual relationships in New York City; 2) the prevalence and correlates of GBV among a sample of HIV-positive women in Kazakhstan; and 3) the synergistic effects of IPV, HIV, and substance use on mental health (depression and suicidality) among a sample of high-risk women in relationships in Kazakhstan. This dissertation is guided by the ecological systems framework, intersectionality, and syndemic theory. Key findings from the dissertation highlight the pervasive nature of GBV among vulnerable women who engage in high-risk behaviors and/or live in high-risk settings. Specifically, key findings from papers one and two show higher than average prevalence of GBV among women who engage in sex trading as well as HIV-positive women. Findings from this dissertation also suggest that women who report depression, individual and partner sexual and drug risk-behaviors, and HIV-related stigma are more likely to report GBV than those who do not; and that women who have higher levels of social support and food security are less likely to report GBV and poor mental health. Findings also have several implications for GBV and HIV prevention/intervention efforts within the U.S. and in Kazakhstan, including scaling up efforts to address GBV by multiple perpetrators, stigma, trauma and mental health, drug and sexual risk among couples, and food stability.

The ability of individuals living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) to effectively manage their health is dependent on the successful acquisition and use of health information. This may be particularly challenging in limited resource settings where numerous barriers may prevent people from finding, understanding, and applying the information that could lead to better health management. In this dissertation, I aimed to explore the health information behavior of HIV positive adults attending Clínica de Familia in La Romana, Dominican Republic. Offering free treatment and services to over 1,600 HIV positive adults makes this one of the largest HIV treatment centers in the Dominican Republic. Initially, an integrative review of the literature was conducted to summarize research that has explored the patient-identified information needs of HIV positive adults in Latin America and the Caribbean and to identify predominant health information needs of these individuals. Then, a retrospective chart review of 201 randomly selected medical records, two focus group discussions, and an adapted version of Wilson’s 1996 model of information behavior were used to develop a 64-item survey to assess health information behavior. The survey was administered during 107 individual interviews with HIV positive adults being seen at the Clinic. Participants were mostly female (60%), Dominican (75%), and lived in La Romana (59%). Approximately half of participants (49%) were married or in a serious relationship and about a third (33%) of participants had all or some of high school education or higher. Responses to information behavior survey items indicated that patients might not understand all of the health information they do receive, cultural variations may influence understanding of viral transmission, and that participants had low levels of health literacy. Data obtained through the surveys were further analyzed to identify patient characteristics associated with active health information seeking, higher information processing and more information use. Significantly associated patient characteristics were: having ever cared for someone who was very sick, age, gender, length of time at the clinic, and comorbidities. Providers at the Clinic as well as those working in underserved areas globally may use these results to advance their knowledge of the ways in which HIV positive adults interact with health information. This enhanced understanding can inform communication and health education programs that provide the information patients need to manage their health in a more usable way. Future research should examine what methods can be used to more effectively provide health information to patients living in constrained resource settings with limited educational backgrounds.