Introduction International guidelines endorse the screening of patients for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Chlamydia trachomatis before assisted reproductive techniques (ART). At present no such guidelines exists in South Africa. At the Reproductive and Endocrine Unit (referred to as “the Unit”) of Steve Biko Academic Hospital, all patients with unknown HIV status are counselled and a blood sample is collected during the initial visit for automated laboratory based HIV screening. These HIV results are not available before semen samples are processed. Furthermore, patients are not screened for HBV, HCV and Chlamydia trachomatis. Couples attending the Unit are of a low to middle socio-economic status and experience financial constraints. Moreover, automated laboratory based assays are expensive to perform. Rapid testing is a cost effective and practical method from screening patients, with a 20–30 minute result turnover time. Until screening at the Unit is improved, the possible identification of semen characteristics that could indicate HIV infection would be a useful tool. Materials and Methods The following rapid point-of-care assays were evaluated: Determine® HIV-1/2 combo test (n=100), Determine® HBsAg test (n=100), DIAQUICK HCV kit (n=74), and the DIAQUICK Chlamydia trachomatis kit (n=30). For profiling, parameters from a basic semen analysis of HIV-positive males (n=60) were compared with HIV-negative males (n=60). Information pertaining to CD4 count, antiretroviral treatment and plasma viral load of HIV-positive males were analysed. Results From all patients included in the study, 8% tested positive for HIV. The risk of a female being HIV-positive was 3.73 times higher than for males. In the pilot study to explore rapid testing for HBV and HCV, 1% and 1.4% of patients tested positive respectively. When testing for Chlamydia trachomatis 31.3% of females, but no males tested positive. Comparing semen profiles, no significant differences were found between samples from HIV positive and negative males or between HIV positive males categorised by CD4 cell count (p>0.05). For the HIV-positive group with a detectable plasma HIV viral load (>40 copies/ml), a significant difference was observed in the semen viscosity (p=0.0460). Significant differences were noted in the sperm motility (immotile sperm p=0.0456, progressive sperm p=0.0192) of patients receiving antiretroviral (ARV) therapy. Discussion and Conclusion The use of rapid testing is an acceptable and feasible option for improving current screening protocols at the Unit. The absence of definite alterations in the semen characteristics of HIV-positive men further motivates the need for a simpler, point-of-care screening protocol. The prevalence of HBV was lower than that reported in the general population of South Africa and further investigation is needed. Although the sample size was small, HCV prevalence was similar to that of the general population. One third of females tested positive for Chlamydia trachomatis. The methodology used was possibly not appropriate for males. This study highlighted the need for guidelines that address the specialised needs of ART clinics in resource-limited and developing countries with a high HIV prevalence. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Obstetrics and Gynaecology / unrestricted

Laser application in the field of biological and medical sciences has significantly grown, thereby strengthening the field of Biophotonics. Research conducted in Biophotonics focuses on the concept of using light especially in the visible and near infrared regions of the electromagnetic radiation for the evaluation of living systems. In this thesis new discoveries are presented about low level laser therapy, optical trapping, transmission spectroscopy, luminescence spectroscopy and structured illumination microscopy (SIM), displaying the impact each technique has on HIV infected cells. The results showed that the irradiation of HIV-1 infected TZM-bl cells with low power red laser reduces HIV-1 infection. The outcomes of this study further proved that when irradiation is used in conjunction with efavirenz, an antiretroviral drug, HIV-1 infection could be reduced to undetectable levels in TZM-bl cells. Through the coupling of transmission spectroscopy with optical trapping, and separately, use of luminescence spectroscopy, label free diagnosis of HIV in infected cell samples was achieved. This finding affirms that HIV-1 infection can be detected in a label free manner when using laser based techniques. Furthermore, the photoluminescence spectrometer system was employed to generate a decay curve, which was necessary so as to have some understanding on lifetime of the luminescent signal in infected TZM-bl cells. Finally, in order to confirm that indeed TZM-bl cells were infected, an established super-resolution microscopy system SIM was used to detect HIV-1 infection in TZM-bl cells. Indeed in the infected cells viral molecules p24 and gp41 were detected through SIM, while they were not detected in uninfected cells. In future studies, super resolution microscopy would be coupled to an optical trapping system in order to confirm that each trapped cells is whether infected or uninfected so as to improve HIV diagnosis. / College of Science, Engineering and Technology / Ph. D. (Science, Engineering and Technology)

<p>Interleukin-15 (IL-15) is a cytokine that promotes maintenance and activation of cytotoxic immune cells. Therapeutic IL-15 stimulates these cells to fight cancer and chronic infections, such as Human Immunodeficiency Virus (HIV). Animal models of HIV have demonstrated that IL-15 agonists can suppress the virus, but this was transient and was not observed in all cohorts. We developed a mechanistic mathematical model of IL-15 therapy of HIV to explain these differences in efficacy and to explore solutions. First, the model was applied to evaluate mitigating factors, including immune regulation, viral escape, and drug tolerance, using Akaike Information Criterion.  We found that immune regulatory mechanisms could explain the viral rebound observed with continued IL-15 therapy. Next, the model was expanded to allow it to simultaneously explain both the transient viral suppression noted above and the lack of viral suppression observed in another animal cohort.  In this cohort, the model suggested that higher pre-treatment viral load came with higher activation of immune cells and a balancing regulatory inhibition of cytotoxicity. Finally, we conducted stability analysis at a range of IL-15 therapeutic strengths. While there was an ideal IL-15 strength, monotherapy could not maintain viral levels below what would clinically be considered to be safely controlled. Stable viral control in the model required the combination of IL-15 with blockade of key regulatory pathways. Immune therapy of complex diseases will likely require combinations of medicines that boost the immune response at multiple key points. Mathematical models like this can expedite development of these treatments.</p>

This research project aimed to conduct a strategic analysis of the implementation of a supervised injecting facility (SIF) in Montérégie. Using a mixed design, we first completed a portrait of the injection drug user (IDU) population. We then explored the perceptions of IDU and stakeholders with regard to the relevance of implementing a SIF in the region. Although some similarities were found with the IDU populations of Montreal and the province of Quebec, this population in Montérégie is characterized by a lower frequency of injections in public, less homeless people and lower rates of HIV and HCV infections. Despite these differences, the IDU population in Montérégie was found to have important physical and psychosocial needs. Although the relevance of a SIF in Montérégie is undeniable, improvements regarding the accessibility, continuity and appreciation of the actual services dedicated to IDU remain a priority. / Ce projet de recherche visait à réaliser une analyse stratégique de l’implantation d’un service d’injection supervisée (SIS) en Montérégie. Utilisant un devis mixte, son premier volet consistait à tracer un portrait de la population usagère de drogues par injection (UDI) montérégienne, alors que le second explorait les perceptions des UDI et des acteurs stratégiques œuvrant auprès d’eux quant à l’implantation d’un SIS dans la région. Bien que similaire aux populations UDI montréalaise et du Québec, celle de la Montérégie s’en distingue par le fait qu’elle s’injecte moins souvent dans des lieux publics, qu’elle soit sans domicile fixe à moindre proportion et par ses taux inférieurs d’infection au VIH et au VHC. Elle présente toutefois des besoins physiques et psychosociaux importants. Bien qu’un SIS soit jugé pertinent en Montérégie, une amélioration de l’accessibilité, de la continuité et de l’appréciation de l’offre de services actuelle dédiés aux UDI est considérée comme prioritaire.

The lack of a contextualised, relevant communication strategy focusing specifically on HAST diseases in the Limpopo Province was the impetus for this research. The purpose of this study was, therefore, to explore the knowledge, perceptions and utilisation of health facilities for HAST in order to develop an acceptable and effective communication strategy for the Province to address the high rate of HAST diseases. The study followed a qualitative approach guided by the major tenets of the Health Belief Model, namely, to determine modifying factors, individual beliefs and cues for action. An in-depth literature review was followed by focus group interviews with the community members and personal interviews with District and Provincial Deputy Directors. Based on these findings, a communication strategy was drafted and piloted for three months in one of the districts in Limpopo. Further refinement of the communication strategy followed after member-checking and further interviews with directors HAST. The final strategy specifically focused on risk groups with each of the diseases in terms of their beliefs and perceptions. It further resulted in guidelines for health providers in terms of the content and implementation of effective communication strategies within the context of educational, cultural, social and economic factors relevant to Limpopo / Health Studies / D. Litt. et Phil. (Health Studies)

Since, its discovery over three decades ago, HIV has wrecked havoc worldwide. According to the UNAIDS report 2011, at present 34 million people is living with HIV and AIDS vaccine with broadly neutralizing activity still remains elusive. The envelope glycoproteins on the virion surface, is the most accessible component to the host immune system and therefore is targeted for vaccine design. However, the virus has employed various strategies to avoid the host immune response. The extremely high rate of mutations, extensive glycosylation of the envelope glycoprotein, conformational flexibility of the envelope, has made all the efforts aimed to design a broadly neutralizing immunogen futile. In Chapter1, we briefly discuss about the structural and genomic organization of the HIV-1 along with various strategies the virus has employed to evade the immune system. We also present the progress and failures encountered in the past three decades, on the way to design protective HIV vaccine and inhibitors. On the host cell surface, HIV-1 glycoprotein gp120 binds to the cell surface receptor CD4 and leads to the fusion of viral and host cellular membranes. CD4 is present on the surface of T-lymphocytes. It consists of a cytoplasmic tail, one transmembrane region, and four extracellular domains, D1−D4. sCD4 has been used as an entry inhibitor against HIV-1. However, this molecule could not neutralize primary isolates of the virus. Previously, from our lab, we had reported the design and characterization of a construct consisting of the first two domains of CD4 (CD4D12), that binds gp120 with similar affinity as soluble 4-domain CD4 (sCD4). However, the first domain alone (CD4D1) was previously shown to be largely unfolded and had 3-fold weaker affinity for gp120 when compared to sCD4 [Sharma, D.; et al. (2005) Biochemistry 44, 16192−16202]. In Chapter 2, we describe the design and characterization of three single-site mutants of CD4D12 (G6A, L51I, and V86L) and one multisite mutant of CD4D1 (G6A/L51I/L5K/F98T). G6A, L51I, and V86L are cavity-filling mutations while L5K and F98T are surface mutations which were introduced to minimize the aggregation of CD4D1 upon removal of the second domain. All the mutations in CD4D12 increased the stability and yield of the protein relative to the wild-type protein. The mutant CD4D1 (CD4D1a) with the 4 mutations was folded and more stable compared to the original CD4D1, but both bound gp120 with comparable affinity. In in vitro neutralization assays, both CD4D1a and G6A-CD4D12 were able to neutralize diverse HIV-1 viruses with similar IC50s as 4-domain CD4. These stabilized derivatives of human CD4 are useful starting points for the design of other more complex viral entry inhibitors. Most HIV-1 broadly neutralizing antibodies are directed against the gp120 subunit of the env surface protein. Native env consists of a trimer of gp120−gp41 heterodimers, and in contrast to monomeric gp120, preferentially binds CD4 binding site (CD4bs)-directed neutralizing antibodies over non-neutralizing ones. One group of cryo-electron tomography studies have suggested that the V1V2 loop regions of gp120 are located close to the trimer interface and the other group claimed that the V1V2 loop region is far from the apex of the trimer. To further investigate the position of the V1V2 region, in the native envelope trimer, in Chapter 3, we describe the design and characterization of cyclically permuted variants of gp120 with and without the h-CMP and SUMO2a trimerization domains inserted into the V1V2 loop. h-CMP-V1cyc is one such variant in which residues 153 and 142 are the N- and C-terminal residues, respectively, of cyclically permuted gp120 and h-CMP is fused to the N-terminus. This molecule forms a trimer under native conditions and binds CD4 and the neutralizing CD4bs antibodies b12 with significantly higher affinity than wild-type gp120. It binds non-neutralizing CD4bs antibody F105 with lower affinity than gp120. A similar derivative, h-CMP-V1cyc1, bound the V1V2 loop-directed broadly neutralizing antibodies PG9 and PG16 with ~15-fold higher affinity than wild-type JRCSF gp120. These cyclic permutants of gp120 are properly folded and are potential immunogens. The data also support env models in which the V1V2 loops are proximal to the trimer interface. HIV-1 envelope (env) protein gp120 has approximately 25 glycosylation sites of which ~4 are located in the inner domain, ~7-8 in the V1/V2 and V3 variable loops and the rest in the outer domain (OD) of gp120. These glycans shield env from recognition by the host immune system and are believed to be indispensable for proper folding of gp120 and viral infectivity. However, there is no detailed study that describes whether a particular potential n-linked glycan is indispensable for folding of gp120.Therefore, in Chapter 4, using rationally designed mutations and yeast surface display (YSD), we show that glycosylation is not essential for the correct in vivo folding of OD alone or OD in the context of core gp120. Following randomization of the remaining four glycosylation sites, we isolated a core gp120 mutant, which contained a single inner domain glycan and retained yeast surface expression and broadly neutralizing antibody (bNAb) binding. Thus demonstrates that most gp120 glycans are dispensable for folding in the absence of gp41. However in the context of gp160, we show that all core gp120 glycans are dispensable for folding, recognition of bNAbs and for viral infectivity. We also show that deglycosylated molecules can serve as a starting point to re-introduce epitopes for specific glycan dependent bNAbs. Several of these constructs will also be useful for epitope mapping and env structural characterization. Glycosylation of env is known to inhibit binding to germline precursors of known bNAbs. Hence the present results inform immunogen design, clarify the role of glycosylation in gp120 folding and illustrate general methodology for design of glycan free, folded protein derivatives. On the virion surface env glycoproteins gp120 and gp41 interact via non-covalent interactions and form trimers of heterodimers. Upon binding cell surface receptor CD4 and co-receptor CCR5/CXCR4, gp120 and gp41 undergo a lot of conformational changes, which ultimately lead to the fusion of viral and cellular membranes by formation of six-helix bundle in gp41. High resolution structural information is available for core gp120 and post-fusion six-helix bundle conformation of gp41. However, the structural information about the native gp120:gp41 interface in the native trimer is lacking. In Chapter 5, we describe the design and characterization of various single chain derivatives of gp120 inner doamin and gp41. Among the designed constructs, gp41-id2b is folded but is a mixture of dimer and monomer under native conditions. To facilitate, trimer formation, two trimerization domains (h-CMP and Foldon) were individually fused to the N-terminus of gp41-id2b to generate h-CMP-gp41-id2b and Foldon-gp41-id2b. Although, these molecules were proteolytically more stable than gp41-id2b, they did not form trimer under native conditions. All the single chain derivatives were designed based on the crystal structure of gp120, which was devoid of C1 and C5 domains (PDBID 1G9M). A new set of constructs to mimic the native gp120:gp41 interface will be designed and characterized based on the recently solved crystal structure of gp120 with the C1 and C5 domains (PDBID 3JWD and 3JWO). Helix-helix interactions are fundamental to many biological signals and systems, found in homo- or hetero-multimerization of signaling molecules as well as in the process of virus entry into the host. In HIV, virus-host membrane fusion during infection is mediated by the formation of six helix bundle (6HB) from homotrimers of gp41, from which a number of synthetic peptides have been derived as antagonists of virus entry. Yeast surface two-hybrid (YS2H) system is a platform, which is designed to detect protein-protein interactions occurring through a secretory pathway. In Chapter 6, we describe the use of aYS2H system, to reconstitute 6HB complex on the yeast surface and delineate the residues influencing homo-oligomeric and hetero-oligomeric coiled-coil interactions. Hence, we present YS2H as a platform for facile characterization of hetero-oligomeric interactions and design of antagonistic peptides for inhibition of HIV and many other enveloped viruses relying on membrane fusion for infection, as well as cellular signaling events triggered by hetero-oligomeric coiled coils. However, using this YS2H platform, the native hetero-oligomeric complex of gp120 and gp41 could not be captured. In Appendix 1, we report cloning, expression and purification of PΔGgp120 and ΔGgp120 from methylotrophic yeast Pichia pastoris. PΔGgp120 was purified as a secreted protein. However, in electrophoretic analyses the molecule ran as a heterogeneous smear. Further optimization of the purification protocol and biophysical characterizations of this molecule will be performed in future. In Appendix 2, gp41 variants were expressed on the yeast cell surface as a C-terminally fused protein and its interaction with externally added gp120 was monitored by FACS. The surface expression of the gp41 constructs was poor and they did not show any interaction with gp120.

Les épithéliums muqueux se présentent comme porte d’entrée majeure du virus de l’immunodéficience humaine (VIH) et jouent un rôle critique dans la transmission sexuelle du virus. Les cellules épithéliales et les cellules dendritiques dans les muqueuses pluristratifiés, sont des cibles initiales pour la transmission virale. Il a été déjà montré, sur les muqueuses génitales chez l’homme, que la circoncision réduit plus de 60% acquisition du virus chez l’homme. Les mécanismes d’entrée du VIH au niveau du tractus génital chez l’homme sont tres mal connus et pratiquement pas étudiés. Nous avons émis l’hypothèse selon laquelle le prépuce, qui est enlevé lors de la circoncision, pourrait être une porte d’entrée majeure du virus. Nous avons d’abord montré que le VIH peut pénétrer effectivement au niveau du prépuce ex vivo, la partie interne du prépuce présente plus permissive que la partie externe. De plus, le virus pénètre uniquement dans le prépuce après formation d’une synapse virologique entre la cellule infectée, présente dans les secrétions génitales et la surface muqueuse du prépuce. La formation de la synapse virologique induit le bourgeonnement massif et polarisé de virions dans la fente synaptique; ceux ci pénètrent dans l’épiderme du prépuce. À l’inverse, l’entrée du VIH sous forme de virus libre dans le prépuce est inefficace. Nous avons ensuite caractérisé la séquence des événements initiaux mis en place lors de l’entrée du VIH dans le prépuce interne. La première cellule cible immune est la cellule de Langerhans (LCs), dont le rôle physiologique est de protéger la muqueuse contre les pathogènes qui l’envahissent. Après la capture du virus les LCs migrent vers le derme pour former des conjugués cellulaires avec les cellules T CD4+ du derme. La dynamique de migration de LCs est régulée par de sécrétion de cytokines et chimiokines (RANTEs et MIP- 3alpha) induites par la pénétration du virus dans le tissu. Nous avons ensuite caractérisé les mécanismes de l’immunité mis en jeu au niveau des kératinocytes de l’épiderme lors de la formation de la synapse virologique et évalué comment ces signaux contribuent à l’entrée efficace du virus dans la muqueuse du prépuce interne chez l’homme, ex vivo. À l’aide d’un modèle cellulaire de muqueuse simplifiée basé sur des kératinocytes primaires humains ex vivo, nous avons montré que les protéines d’enveloppe du VIH , gp120 mais pas gp41, et les molécules d’adhésion (intégrines LFA-1, leurs ligands ICAM-1 and -3) contrôlent la formation de la synapse virologique. La synapse virologique induit au niveau des kératinocytes l’activation de la voie NF- B indépendentmmment de MyD88 après activation du Toll-like-receptor 4 (TLR4) exprimé par les kératinocytes. En recherchant quelle cytokine pouvait être induite par cette signalisation, nous avons montré que la synapse virologique induit la sécrétion par les kératinocytes d’une cytokine produite par les cellules non-hématopoïétiques, la thymic stromal lymphopoietin (TSLP). La TSLP est un chemoattracteur des cellules myéloïdes comme les cellules LCs et peut induire leur maturation. Nous avons ensuite montré que, sur des explants de prépuce humain ex vivo, la synapse virologique induit bien la sécrétion de TSLP, laquelle en premier lieu attire les LCs qui expriment le TSLP-récepteur vers la surface du tissus induisant leur maturation. Les LCs peuvent ensuite migrer dans l’autre sens vers le derme. La sécrétion des cytokines comme RANTEs, MIP-3alpha, qui sont impliquées lors de la pénétration effective du virus dans les tissus n’a pas de rôle dans la signalisation induite par la formation de la synapse virologique proprement dite. Les kératinocytes de l’épiderme du prépuce interne, grâce à leur réponse innée TSLP induite par la synapse virologique ont un rôle déterminant dans l’entrée du VIH dans le prépuce. Ainsi, en réponse de la synapse virologique, les kératinocytes secrètent du TSLP après activation de la voie de NF- B dépendante de MyD88. (...) / The mucosal epitheliums are presented as a major portal of HIV-1, and play a critcal role for the sexual transmission of HIV-1. Epithelial cells, and dendritic cells in the pluristratified mucosa, are the initial targets of viral transmission. It has already been shown, in the genital mucosa in men, circumcision reduces by more than 60 % of virus acqusition by men. The entry mechanisms of HIV-1 in the male urogenital tracts are poorly understood and not pratically studied. We suggested that foreskin, removal by circumcision surgery, could be a major portal of HIV-1 entry. We first showed that HIV-1 could enter efficiently ex vivo inner foreskin mucosa, the inner part of foreskin which is more permissive than the outer part. More over, virus penetrates only after the viral synapse (VS) formation between HIV-1-infected cells and foreskin epidermis, in the presence of genital secretion on the surface of foreskin mucosa. The formation of VS induces massive and polarized budding of HIV-1 particles within the synaptic cleft. The virions therefore penetrate into the foreskin epidermis. Inversely, cell-free virus entry is inefficient in the foreskin. Next, we characterized the initial events of HIV-1 VS formation in the inner foreskin. The first cell type that HIV-1 encounters is Langerhans cells (LCs), whose physiological role is to protect the mucosa against invasive pathogens. After capture of virus, LC migrates towards the dermis to form intercellular conjugates with dermal CD4+ T cells. The dynamic of LC migraiton is regulated by the secretion of cytokines in the mucosa, induced by HIV-1 entry, including RANTEs and MIP-3alpha. We then characterized the mechanisms of foreskin epidermal keratinocyte (KC), activated innate immunity during the VS formation and the signaling pathway contributed to the efficient entry of HIV-1 via inner foreskin mucosa. Using a simplified mucosal model based on human primary foreskin keratinocytes, we demonstrated that HIV-1 envelope protein, gp120, but not gp41 and the adhesion molecules (integrins LFA-1, ICAM-1/-3), contribute to the VS formation. VS induces at the KC level the activation of NF- B pathway by I B and p65 molecules, after activation of TLR4 expressed on KCs. By searching for which cytokine could be induced by this signalisation, we then showed that VS induced the secretion by KC of one cytokine, which is produced by the non-hematopoetic cells, thymic stromal lymphopoietin (TSLP). TSLP is an chemoattractant for myeloid cells like LCs, and could induce LC maturation. We then showed, using the foreskin explants that, VS induces the secretion of TSLP, which first attracts LC expressing constitutively TSLP receptors to the apical surface of foreskin, inducing its maturation. These matured LCs then migrate to another direction towards the dermis. The secretion of cytokines such as RANTEs and MIP-3alpha, involved in the HIV-1 efficient entry has no roles in the signaling induced by VS formation as mentioned above. The Inner foreskin keratinocytes, due to the innate response of TSLP induced by VS, have a determinant role in the HIV-1 entry into the foreskin. Likewise, in response to VS, KCs secrete TSLP after NF- B activation dependent on regulator MyD88. The secreted TSLP, in addition to four different proinflammatory cytokines and chemokines (IL-6, IL-8, MIG, and MMP-9) allows virus to attract LCs to the foreskin surface, to capture the virus present in the synaptic cleft in order to facilite efficient transmission at the level of foreskin mucosa. Likely to the conventional immune cells, KCs, in one hand protects the foreskin mucosa and in another, is hijacked to facilitate HIV-1 transmission.

AFRIKAANS: In hierdie studie is daar gelet op MIV en VIGS en die geslagsrolle van die Noord-Sotho/Tswana-sprekende vrou in die Limpopo Provinsie. Daar is spesifiek gefokus op watter MIV- en VIGS-verbandhoudende risiko’s voorkom rondom die geslagsrolle van die Noord-Sotho/Tswana-sprekende vrou in die Limpopo Provinsie. Sewe relevante geslagsrolle van die vrou is geïdentifiseer vir ondersoek, en het die vrou as individuelewese, seksuelewese, huweliksmaat, moeder, versorger, enkelouer en broodwinner ingesluit. Verbandhoudende aspekte van hierdie rolle is ook ondersoek en het mishandeling van die vrou, die vrou se opvoeding, geloof, kultuur, gesondheid, geslag en spesifieke beradingsbehoeftes ingesluit. Waar geslag ‘n sosiale- en kulturelestruktuur is en ook kultuur-spesifiek is, was dit van belang om die vrou se geslagsrolle en die verbandhoudende aspekte daarvan binne die vrou se relevante kulturelekonteks te ondersoek. Die navorsingsmetodologie vir hierdie studie is duidelik omskryf en uiteengesit, waarna verskeie literatuurhoofstukke volg. Die literatuurhoofstukke fokus op MIV en VIGS as medieseverskynsel en die beradingsaspekte wat daarmee verband hou. In die literatuurhoofstukke is daar ook gelet op die Afrika-kultuur en geslagsrolvorming, waarna die sewe geslagsrolle van die vrou en die verbandhoudende aspekte daarvan bespreek is. Die literatuurhoofstukke voorsien die nodige agtergrond wat aanduidend is van spesifieke MIV-risiko’s wat deur Afrika-vroue in hul geslagsrolle beleef word. Navorsingsbevindings vir hierdie kwalitatiewe studie is met behulp van tabelle voorgestel wat volledig bespreek is, ten einde te bepaal watter spesifieke MIV-risiko’s deur Noord-Sotho/Tswana-sprekende vroue in die Limpopo Provinsie beleef word. Navorsingsbevindings vir hierdie kwalitatiewe studie is met behulp van tabelle voorgestel wat volledig bespreek is, ten einde te bepaal watter spesifieke MIV-risiko’s deur Noord-Sotho/Tswana-sprekende vroue in die Limpopo Provinsie beleef word. Hierdie bevindings het getoon dat Noord-Sotho/Tswana-sprekende vroue in die Limpopo Provinsie veral kwesbaar is vir MIV waar hierdie vroue ‘n tekort aan mag het om te onderhandel vir veilige seksuele-omgang en kondoomgebruik. ‘n Raamwerk vir kultuursensitiewe MIV- en VIGS-berading is ontwikkel, en bestaan uit inligting bekom vanuit die empiriese ondersoek, praktykervaring asook die navorser se kennis van relevante literatuur. Die raamwerk vir kultuursensitiewe MIV- en VIGS-berading is op wyses aangebied wat as gepas beskou word vir die spesifieke probleme of behoeftes van die vrou, en bestaan uit afmerklyste, kolomme en gevallestudies. Die raamwerk is ook saamgestel sodat dit deur die maatskaplike werker, MIV-berader en ander lede van die multidissiplinêrespan benut kan word tydens hulpverlening aan MIV-positiewe Noord-Sotho/Tswana-sprekende vroue. Ten slotte is ‘n algemene samevatting, gevolgtrekkings en aanbevelings gemaak na aanleiding van relevante bevindings vanuit die studie. Die navorsingsvraag vir hierdie studie in geheel is beantwoord deurdat die empiriese ondersoek sowel as die raamwerk vir kultuursensitiewe MIV- en VIGS-berading, die MIV- en VIGS-verbandhoudende risiko’s rondom die geslagsrolle van die Noord-Sotho/Tswanasprekende MIV-positiewe vrou in die Limpopo Provinsie duidelik geïdentifiseer en logies gegroepeer het, en gevolgtrekkings en aanbevelings gebied het. Hierdie studie het getoon dat elk van die vrou se sewe geslagsrolle, asook die verbandhoudende aspekte daarvan, verband hou met spesifieke MIV-risiko’s wat op fisiologiesesosiale-, psigologiese-, ekonomiese- en kulturele vlak beleef word deur Noord-Sotho/Tswana-sprekende vroue in die Limpopo Provinsie. ENGLISH: This study considered HIV and AIDS and the gender roles of Northern Sotho/Tswana speaking women in the Limpopo Province. Specific focus was placed on HIV and AIDS related risks surrounding the gender roles of Northern Sotho/Tswana speaking women in the Limpopo Province. Seven relevant gender roles were identified for investigation; these include women as individual beings, sexual beings, wives, mothers, caregivers, single parents and breadwinners. Related aspects of these roles were also investigated and include the abuse of women, education, religion, culture, health, gender and specific counselling needs. It was of importance to examine gender roles and the related aspects in the woman’s relevant cultural context since gender is seen as a social and cultural construct and is also culture-specific. The research methodology for this study was clearly defined and outlined. The literature chapters focussed on HIV and AIDS as medical phenomenon and related counselling aspects. The literature chapters also considered the African culture and gender role development, the seven gender roles of women and aspects related to these. The literature chapters provided the necessary background which is indicative of the specific HIV risks which are experienced by African women in their gender roles. Research findings for this qualitative study were presented using tables which were fully discussed in the study in order to determine the specific HIV risks experienced by Northern Sotho/Tswana speaking women in the Limpopo province. These findings showed that Northern Sotho/Tswana speaking women in the Limpopo Province are particularly vulnerable to HIV as these women experience a lack of power to negotiate for safe sex and condom use. A framework for culturally sensitive HIV and AIDS counselling was developed and consists of information obtained from the empirical investigation, practical experience and the researcher’s knowledge of relevant literature. The framework for culturally sensitive HIV and AIDS counselling was presented in a manner which is suited to the specific problems and needs of these women and consists of tick-mark lists, columns and case studies. The framework was also compiled in such a manner that it may be utilised by the social worker, HIV counsellor and other members of the multidisciplinary team during the counselling of HIV positive Northern Sotho/Tswana speaking women. A general summary, conclusions and recommendations were finally made following the relevant findings of the study. The research question for this study was fully answered in that the empirical investigation as well as the framework for culturally sensitive HIV and AIDS counselling identified, logically grouped and made conclusions and recommendations about the HIV and AIDS related risks surrounding the gender roles of Northern Sotho/Tswana speaking women in the Limpopo Province. This study showed that each of the seven gender roles of women as well as the related aspects of these roles are associated with specific HIV risks which are experienced on a physiological, social, psychological, economical and cultural level by Northern Sotho/Tswana speaking women in the Limpopo Province. / Thesis (PhD)--University of Pretoria, 2011. / Social Work and Criminology / PhD / Unrestricted

Le virus de l’immunodéficience humaine de type 1 (VIH-1) est l’agent étiologique du SIDA, un rétrovirus complexe encodant les protéines accessoires : Nef, Vif, Vpr et Vpu. La fonction principale de ces protéines est de moduler l’environnement cellulaire afin de promouvoir la réplication virale. Les travaux présentés dans cette thèse portent sur la protéine virale Vpr, une protéine bien connue pour son activité d’arrêt du cycle cellulaire en phase G2/M dans les cellules en division et pour l’avantage réplicatif qu’elle confère au virus durant l’infection de cellules myéloïdes. Les évènements sous-jacents à ces deux activités restent pour l’heure mal compris. Le but des travaux regroupés dans cet ouvrage est d’identifier de nouveaux facteurs cellulaires pouvant éventuellement expliquer les activités de Vpr précédemment décrites. Pour ce faire, nous avons utilisé une approche d’identification des partenaires de proximité par biotinylation, appelée BioID. L’avantage du BioID est de permettre un marquage in cellulo des protéines à proximité de la protéine d’intérêt. La mise en place et la caractérisation de cette approche font l’objet de la première section de cette thèse. En utilisant cette approche, nous avons défini un réseau de 352 partenaires cellulaires de la protéine Vpr. Parmi ces partenaires de Vpr, plusieurs sont organisés sous forme de complexes ou réseaux protéiques incluant notamment le complexe promoteur de l’anaphase/cyclosome (APC/C) et les centrosomes. Étant donné que le complexe APC/C est l’un des principaux régulateurs du cycle cellulaire, nous avons décidé d’analyser sa relation avec Vpr. Nous avons découvert que Vpr formait un complexe non seulement avec APC1, une sous-unité essentielle du complexe APC/C, mais aussi avec les coactivateurs (CDH1 et CDC20) de ce complexe. Nous avons par la suite démontré que Vpr induisait la dégradation d’APC1 et que celle-ci pouvait être prévenue par une double-mutation N28S-G41N de Vpr. Cette dégradation d’APC1 ne semblerait pas être reliée aux activités précédemment décrites de Vpr. Ces travaux font l’objet de la seconde section de cette thèse. Enfin, dans une troisième section, des travaux effectués en collaboration et analysant la relation entre les centrosomes et Vpr sont présentés. Cette thèse identifie 200 nouveaux partenaires de Vpr, ouvrant la porte à l’exploration de nouvelles cibles et activités de Vpr. Elle décrit également une nouvelle cible de Vpr : le complexe APC/C. Globalement nos résultats contribuent à une meilleure compréhension de la façon dont le VIH-1 manipule l’environnement cellulaire de l’hôte à travers la protéine virale Vpr. / Human immunodeficiency virus (HIV-1) is the AIDS causal agent. This complex retrovirus encodes several accessory proteins; namely Nef, Vif, Vpr and Vpu; whose functions are to manipulate the cellular host environment in order to favor HIV-1 viral replication. This thesis focused on Vpr whose main activities are to induce a cell cycle arrest in the G2/M phase in dividing cells and to provide a replicative advantage to HIV-1 during infection of myeloid cells such as macrophages. The cellular mechanisms underlying these two activities are up to now misunderstood. The main goal of the work presented in this thesis is to identify new cellular factors that could potentially explain the previously described Vpr activities. To do so, we used the proximity labelling approach called BioID. The main strength of BioID is to tag in cellulo partners of the protein of interest. The development as well as optimization of the BioID approach is presented in the thesis first section. Using BioID, we defined a network containing 352 cellular partners in close proximity with the viral protein Vpr. Amongst these cellular partners, several were organized into protein complexes or networks such as the anaphase promoting complex/cyclosome (APC/C) or the centrosome. Given that APC/C is a cell cycle master-regulator, we analyzed the interplay governing Vpr and APC/C interactions. We first demonstrated that Vpr could form a complex containing the scaffolding subunit APC1. APC/C coactivators, namely CDH1 and CDC20, could also be found in association with Vpr. We next showed that Vpr was inducing APC1 degradation and that Vpr residues N28 and G41 were essential to this activity. Surprisingly, the APC1-Vpr interplay does not relate to previously described Vpr activities. This work is presented in the second section of this thesis. Lastly, in the third section, a work done in collaboration analyzed the interplay between Vpr and the centrosomes. In this thesis we identified 200 new potential partners of Vpr, opening the doors to discover novel Vpr targets and activities. This thesis also defined APC/C as new Vpr target. Taken together our results allow a better understanding on how HIV-1 modulates the cellular environment by using the viral accessory protein Vpr.

Text in English / Teenage pregnancy remains a major social, economic and health challenge in South Africa. The consequences of unplanned teenage pregnancies are devastating. The current study explored the impact of teenage pregnancy on disadvantaged adolescents in Mpumalanga. Fourteen adolescent girls were selected, using the purposive sampling technique. The objectives were to explore the experiences of adolescence, as well as their knowledge of various methods of preventing teenage pregnancy, and how they cope with the pregnancy. The study further explored programmes that are available to assist with teenage pregnancies in the community. Data was collected using in-depth one on one interviews to allow the researcher a platform to ask open-response questions. The data was thematically analysed by carefully categorising and expanding significant themes that emerged from the participant’s responses. The study revealed that lack of knowledge about sex and contraceptives, unhealthy coping strategies, lack of support from parents and peer pressure are all effects of teenage pregnancy and the reasons for participating in unprotected sexual activities. Recommendations for overcoming these challenges were provided to the community, schools and government organisations as guidelines in the establishment of youth programmes. / Psychology / M.A. (Psychology)