In 2008, 1.8 million children under the age of 15 were living with HIV/AIDS in sub-Saharan Africa. The same report estimates that in 2008, there were 390 000 new infections in children below the age of 15 in Sub- Saharan Africa. Children appear to be the generation most affected by the HIV/AIDS epidemic. With the introduction of Highly Active Antiretroviral therapy (HAART) more perinatally infected children are living into adolescence and beyond. They will have to learn to live with a stigmatising, potentially fatal chronic illness. Health care workers can no longer rely solely on traditionally used outcome measures, such as viral loads and CD4+ percentages, to monitor effectiveness of interventions and treatments. Quality of Life (QoL) has been suggested as an additional essential outcome measure in clinical practice and research involving children living with a chronic illness. In this research the concept of Health Related Quality of Life (HRQoL) is evaluated in HIV-infected children using the PedsQL 4.0 Generic Core Scale (child self-reports, ages five-seven). The PedsQL 4.0 Generic Core Scales has been found to be a valid and reliable HRQoL measurement tool in children with chronic diseases, school-going children and children infected with HIV. Domains of Physical, Emotional, Social and School Functioning were evaluated. The children in the comparison group scored significantly higher (p<0.01) indicating a better quality of life. The HIV-infected children scored significantly lower in all four domains, with Physical Functioning being most affected (p<0.01). The children with HIV were found to be shorter (p<0.01) and lighter (p<0.01) than those in the comparison group. This could be a contributing factor to the physical difficulties experienced by the HIV-infected children. No relationship could be established between total scores of HRQoL and CD4+ percentages, viral load and duration of HAART treatment. Demographic data collected indicate that the HIV-infected children were more likely to have a primary caregiver with a lower level of education (p=0.01) and more likely to be receiving a Dependency Care Grant (p=0.05). The HRQoL results of this study are similar to those conducted in other parts of the world. The results stress the need for a multi-disciplinary approach when treating HIV-infected children. It has become essential to focus on the medical, physical and psychosocial functioning of the HIV-infected child thereby promoting participation in the family, school and the broader community.

Background: The inexorable spread of HIV infection across all continents is attributable to many factors, including male sexual behaviour. Such behaviour is often considered recalcitrant to change. Aim: The purpose of this study was to determine if sexual behaviour does or does not change after the diagnosis of HIV infection and to elucidate some of the psychosocial factors that may be operant in this context. Materials and Methods: The research consisted of a structured selfadministered questionnaire designed to measure ten psychosexual and sociosexual parameters in a group of HIV positive men. The questionnaire evaluated parameters at three different time points i.e. before HIV diagnosis, one year after HIV diagnosis and the present (2002). Participants were recruited from patients attending a private HIV treatment centre, in Pretoria, South Africa. Results: 53 participants completed the questionnaire. Descriptive statistics were used to elucidate trends. Statistically significant changes were seen in most studied domains, suggesting that beneficial change in sexual behaviour is possible after a diagnosis of HIV infection. These changes were seen, over time, in all the measured parameters, thus, change appears both possible and sustainable. This change was often detrimental to participants as it impacted negatively on some aspects of their personal and social functioning. Safer sex knowledge was weak in the studied group. Conclusion: The data indicate that change in behaviour is possible after a diagnosis of HIV infection and occurred in the studied population. Some changes were good for public health initiatives; many were detrimental to the psychosexual functioning of participants. Public health officials and other medical practitioners should include interventions aimed at reducing the negative psychosocial impact of HIV diagnosis at every patient encounter, as these changes do not resolve by themselves over time and are detrimental to the quality of life of patients.

Deficiencies in immune responses can lead to increases in the rate of infections and chronic diseases, such as cancer. Critical to the adaptive immune response is the activation of the T helper (Th)/CD4+ cell, the subsequent production of interleukin 2 (IL-2), expression of IL-2 and transferrin receptors (IL-2R, TfR) and transcription of genes resulting in DNA synthesis and T cell clonal expansion. The CD4+ lymphocyte response is impaired with ageing. Recent evidence suggests that moderate, regular aerobic training may increase the responsiveness of CD4+ lymphocytes to antigenic and mitogenic challenge, and thereby improve immune function in the older individual. Large volumes of chronic endurance training, and also high intensity training, may adversely affect the immune response, leading to immunosuppression and increased risk of infections. Impaired immune function and increased rates of URTI are found in athletes who undergo large volumes of training, often at high intensity. Purpose: To investigate if long-term aerobic training improved the immune response in men and women aged 65 to 75 years and, and to investigate if long-term endurance training depressed the immune response in male athletes aged 23 to 36 years. Methods:T helper lymphocyte proliferation was assessed monthly, by inducing the expression of CD25 (IL-2R ) and CD71 (transferrin) receptors with phytohemagglutinin (PHA). Percentage of CD4+ cells positive for the receptors, and the receptor density, were measured using two colour flow cytometry. Concentrations of intracellular calcium (Ca2+) and iron (Fe3+) were also measured monthly to determine the effect of endurance training on intracellular Ca2+ ([Ca2+]i) and Fe3+ ([Fe3+]i) within the CD4+ lymphocyte signal transduction pathway. Results: After twelve months of moderate aerobic training the percentage of CD4+ lymphocytes positive for CD25 increased in males aged 65 to 75 years, but not in females. There was no training effect on the density of CD25 in either gender, nor was there a training-induced increase in [Ca2+]i, total intracellular [Ca2+] from endoplasmic reticulum stores ([Ca2+]t) or [Fe3+] in this age group. Significant month to month variations in leucocyte, erythrocyte and haemoglobin concentration, mean corpuscular haemoglobin concentration, haematocrit, platelets, CD25 expression, CD71 expression, [Ca2+] and [Fe3+] were documented for both trained and untrained male and female groups. Aerobic capacity increased significantly with training for both men and women, with increases in peak, peak power and peak ventilation (p less than 0.05). Twelve months of chronic endurance training produced significantly lower haemoglobin, mean corpuscular haemoglobin and platelet concentration for six ([Hb]) and nine months ([MCHC], platelets) of the year in Ironman-distance triathletes, compared to sedentary males aged 23 to 36 years. There was no evidence of immunosuppression in the trained group, with no significant differences between groups in the percentage of CD4+ cells positive for CD25. The trained group showed a significantly higher density of CD25 receptors in October, January and June, suggesting a better immune response during these months. Endurance training did not effect [Ca2+] or [Fe3+]. The trained group did not show a reduced leucocyte concentration, and reported significantly fewer cases of URTI in twelve months than their sedentary counterparts. The 23 to 36 years age group showed seasonal changes in haematological and immunological indices similar to older individuals, indicating that autumn, late winter and late spring are periods of reduced immuno-competency. Conclusion: Twelve months of moderate intensity training significantly increased functional capacity in older men and women, and the percentage of CD4+ lymphocytes expressing CD25 in older men, thereby improving the lymphoid immune response. Twelve months of endurance training significantly increased CD25 density in CD4+ lymphocytes in Ironman triathletes compared to sedentary young males. The monthly changes in immune variables in young and older subjects suggested that autumn, late winter and late spring might be periods where individuals were more at risk of succumbing to infections due to decreased lymphocyte responsiveness. Summer months appeared to be a period of increased lymphocyte responsiveness and proliferation.

Background: There are over 300 Primary Immunodeficiency diseases (PID) that are a result of a genetic or idiopathic dysfunction of any aspect of the immune system. These conditions result in a higher frequency of infections, autoimmune conditions, or malignancies. Moderate intensity exercise is thought to help the immune system, while high intensity exercise may have a negative impact on immune function. The impact of exercise on individuals with an impaired immune system due to PID is not yet understood. Purpose: The purpose of this study was to investigate whether a low to moderate intensity exercise program would have an effect on stress, fatigue, and quality of life (QoL) for individuals diagnosed with PID. Methods: 34 participants were included in this eight-week, mixed-methods, randomized controlled trial, either as part of the control group, or as part of the exercise intervention group. Participants completed pre- and post-study outcome measures, reflective journaling, and a post-study interview. Results: There were no statistically significant differences between the groups for the outcome measures, infection incidence, or need for non-routine medical care. There was a clinically significant decline in the Physical Component Summary score of the SF-36v2 for the control group at the end of the study. The scores for the SF-36v2, for all participants, were below normative scores for all domains, at the beginning and end of the study. Four main themes emerged from the qualitative interviews: living with a ‘new normal’, the challenges of living with a chronic disease, facing the stigma of a chronic disease, and wanting to exercise, but were too exhausted to do so. Conclusions: Individuals with a diagnosis of PID have lower QoL scores as compared to population norms. They face high levels of stress, overwhelming fatigue, social isolation, and decreased emotional well-being. Exercise programs for this patient population did not result in increased infections or need for non-routine medical care but did result in emotional implications that need to be considered. Healthcare providers need to address emotional well-being and provide coping strategies. Exercise programs should be designed with a slow, methodical ramp-up to avoid increasing fatigue or stress, while exercise goals must be highly achievable and realistic. Physical therapists should collaborate with other healthcare professionals for a more holistic and interprofessional approach to working with patients with a diagnosis of PID.