Dissertations / Theses on the topic 'HIV infections – Economic aspects – Uganda'

This study proposed a modification of the traditional cost-of-illness approach. It considered additional indirect cost parameters that yield a comprehensive cost structure for human capital at a micro level. Although HIV/AIDS is an epidemiological problem, it has enormous direct and indirect economic costs. Arguably, the most important cost associated with HIV/AIDS results from the high rates of morbidity and mortality among working age adults, the vast majority of those infected. These are essentially losses in an economy's existing stock and potential accumulation of human capital, implying lower levels of labor productivity and eventually loss of labor. These impacts are accounted for in existing macroeconomic and microeconomic impact studies. Indirect costs, such as forgone earnings due to illness, are included whereas forgone earnings of caregivers in the household are unaccounted for.

Thesis (MComm)--Stellenbosch University, 2002.
ENGLISH ABSTRACT: South Africa faces one of the world's most severe HIV/AIDS epidemics. Whereas the disease was initially only regarded as a serious health crisis, it is now clear that the epidemic will also have economic repercussions. The objective of this study is to project the extent of the macro-economic impact of HIV/AIDS in South Africa over the next 10 to 15 years. The study commences with a discussion of the key characteristics of HIV/AIDS and the current status of the epidemic in South Africa. The demographic inputs used are based on projections produced by the HIV/AIDS model of Metropolitan Life (the Doyle model). The methodology and key assumptions behind the Doyle model are described briefly, after which the demographic projections are presented and discussed. The paper contains a summary of previous approaches to modelling the economic impact of HIV/AIDS, as well as a presentation and discussion of their simulation results. In reviewing the available literature on the economic impact of HIV/AIDS, it becomes apparent that researchers have not yet reached consensus on the economic impact of HIV/AIDS in South Africa - estimates of the impact on GDP growth range anywhere between a reduction of 0.3 and 2.0 percentage points over the next 10 to 15 years. The approach that is used in modelling the economic impact of HIV/AIDS in this study comprises the following: Firstly, a no-AIDS forecast of the South African economy is generated using the annual macro-econometric forecasting model of the Bureau for Economic Research. Secondly, the channels through which the epidemic would likely impact on the economy are identified and modelled. These include slower growth in the population and the labour force; higher employee benefit contributions by employers and employees; indirect costs to the private and public sectors (e.g. lower productivity and higher recruitment and training costs); and higher health and welfare expenditure by the government, as well as an increase in tax rates. The economic effects of each impact channel are analysed independently, after which the different impact channels are combined in the model for the aggregated AIDS inclusive simulation. The results are presented in the form of comparisons between "no-AIDS" and "AIDS" projections for key economic variables for the period 2001 to 2015. The paper also contains results from a macro-economic sensitivity analysis, in which seven of the key assumptions are altered in order to test the sensitivity of the model to these changes. Simulation results indicate that the epidemic will have a negative impact on economic growth in South Africa - real GDP growth could fall from a projected average of 3.7% over the period 2002-2015 without HIV/AIDS to between 3.4% and 3.1 % per year with HIV/AIDS. In contrast, real per capita GDP growth is projected to be 0.7 to 1.0 percentage points higher compared to a no-AIDS scenario, as the adverse impact of the epidemic on the population will outweigh the negative impact on real GDP.
AFRIKAANSE OPSOMMING: Suid-Afrika staar een van die wêreld se ernstigste MIV/VIGS epidemies in die gesig. Aanvanklik is die siekte slegs as 'n erge gesondheidskrisis beskou, maar vandag is dit duidelik dat die epidemie ook ekonomiese gevolge sal hê. Die oogmerk van hierdie studie is om die omvang van die makro-ekonomiese impak van MIV/VIGS oor die volgende 10 tot 15 jaar in Suid-Afrika te beraam. Die proefskrif begin met 'n bespreking van die belangrikste eienskappe van MIV/VIGS en die huidige stand van die epidemie in Suid-Afrika. Die demografiese insette wat gebruik word, is gebaseer op projeksies van Metropolitan se MIV/VIGS model (die Doyle model). Die metodiek en die sleutel aannames van die Doyle model word kortliks bespreek, waarna die demografiese projeksies aangebied en bespreek word. Die studie bevat 'n opsomming van benaderings wat van te vore gebruik is om die ekonomiese impak van MIV/VIGS te modelleer, asook 'n voorlegging en 'n bespreking van hul resultate. 'n Oorsig van beskikbare literatuur oor die ekonomiese impak van MIV/VIGS bring aan die lig dat daar in werkilikheid nog geen konsensus oor die omvang van die impak op die Suid-Afrikaanse ekonomie bereik is nie. Beramings van die impak op BBP groei oor die volgende 10 tot 15 jaar wissel van 'n vermindering met 0.3 tot 2.0 persentasie punte. Die benadering wat in hierdie studie gevolg word om die ekonomiese impak van HIV/VIGS te modelleer behels die volgende: Eerstens word 'n vooruitskatting van die Suid- Afrikaanse ekonomie sonder MIV/VIGS gegenereer met die hulp van die makroekonometriese vooruitskattings model van die Buro vir Ekonomiese Ondersoek. Die tweede stap behels die identifisering en die modellering van die verskillende kanale waardeur die epidemie moontlik die ekonomie kan affekteer. Dit sluit onder andere die volgende in: stadiger groei in die populasie en die arbeidsmag; hoër bydraes deur werkgewers en werknemers aan werknemer-bystandfondse; indirekte onkostes vir die privaat en openbare sektore (bv. laer produktiviteit en hoër werwings- en opleidings koste); 'n toename in staatsbesteding op gesondheids en welsyns dienste; asook 'n styging in belastingkoerse. Die ekonomiese implikasies van elkeen van die kanale word individueelontleed, waarna die verskillende kanale saamgevoeg word vir die oorkoepelende simulasie. Die resultate word aangebied in die vorm van vergelykings tussen "geen-VIGS" en "VIGS" projeksies vir sleutel ekonomiese veranderlikes oor die periode 2001-2015. Die proefskrif bevat ook 'n voorlegging van die resultate van 'n makro-ekonomiese sensitiviteits ontleding, waarin sewe van die sleutel aannames verander is met die doelom die gevoeligheid van die model vir hierdie veranderinge te bepaal. Die resultate toon dat die epidemie 'n negatiewe uitwerking op ekonomiese groei in Suid-Afrika sal hê - die gemiddelde groeikoers in die reële BBP oor die periode 2001-2015 mag daal van 'n geprojekteerde 3.7% sonder MIV/VIGS tot tussen 3.4% en 3.1 % met MIV/VIGS. In teenstelling toon die resultate dat die gemiddelde groeikoers in per capita reële BBP tussen 0.7 en 1.0 persentasie punte hoër mag wees vergeleke met die "geen-VIGS" scenario. Die toename in per capita BBP groei kan toegeskryf word aan die skerp daling in die groei van die populasie as gevolg van MIV/VIGS.

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The aim of this study was to capture the intensity and incidence of catastrophic health care expenditures in order to describe the degree to which catastrophic health care payments occur among households. Simultaneously, the study set out to assess the extent to which people are made poor or poorer by health spending, i.e. the impoverishing effects of healthcare spending.

The way gender relations influence access to care and treatment particularly access to antiretroviral medicines is a challenge to HIV/AIDS programmes and to the individuals and families with HIV. Gender norms that push women and men to adhere to dominant ideals of femininity and masculinity may restrict women's access to economic resources, health care and fuel the spread of HIV. The aim of this study was to determine the role of gender relations in influencing decision-making for access to antiretroviral medicines between partners and in the family.

The present study was conducted to determine the readiness of management at selected manufacturing organisation in the Buffalo City area to manage the HIV/AIDS epidemic. The study was conducted in the Buffalo City area on manufacturing organisations with a workforce greater than 250. The main aims of the present study were: · To provide an overview of relevant literature concerning theoretical key issues related to the management of HIV/AIDS in the workplace. · To assess the readiness of Buffalo City organisations in managing HIV/AIDS in the workplace, and to identify areas of improvement. · In the light of the findings, make further recommendations to manufacturing organisations to further improve their workplace policy, education and awareness programmes; and the accommodation of HIV-infected employees in the workplace. Another objective of the study was to provide additional research as a tool to assist organisations in managing HIV/AIDS in the workplace and to assist in fighting the HIV/AIDS epidemic in the Buffalo City area. The research process entailed: the selection of a test sample of manufacturing organisations in the Buffalo City area, and selecting an appropriate Human Resource manager or representative from these organisations to complete a structured questionnaire. The research tool used in the study was a questionnaire, which was used to extract relevant information on the demographics, policies, education and the accommodation of HIV/AIDS affected and infected employees in the workplace. The results revealed the following: · 73 percent of the selected manufacturing organisations in the Buffalo City have an HIV/AIDS policy in place; · 87 percent of the organisation indicated that their management are committed to the development and implementation of a HIV/AIDS policy; · management and supervisors in these organisations have not been adequately trained to manage the impact of HIV/AIDS in the workplace; · organisations in the Buffalo City area need to collaborate and share information; and · that very few organisations benchmark against best practices. Future research on HIV/AIDS policy can explore the effective implementation of HIV/AIDS policies in these organisations as well as the effective management of HIV/AIDS in the workplace.

Thesis (MBA)--Stellenbosch University, 2004.
ENGLISH ABSTRACT: Why should the Lewis Group be concerned about HIV/AlDS? The answer is quite simple. HIV/AIDS poses a clear and present danger to the twin rationales on which businesses like the Lewis Group are based. The rationales are low-cost labour for own and supply chain purposes, and fast-growing markets. This research focuses more towards the latter and presents a review of the current literature and attempts to estimate the impact of HIV/AIDS on the group's market. Literature on the subject is surprisingly limited (Bloom & Mahal, 200 I: 10) and often dated seen in the light of the fact that it is one of the most oppressing issues in the Southern African business arena today. Amidst a rather slow awakening in the private sector to the effects of HIV/AlDS on markets a lot of resources and time are being spent on research in this area. Although the scope of this research does not encompass the full impact of the epidemic on the company, it provides insight into an area on which very little is known yet. Companies have a high level of control over, and information, about their employees but significantly less about their customers} hence the reason for the use of hypothesising and adopting a tailor-made methodology to quantify prevalence rates and vulnerability. This paper is therefore not a complete assessment of impact of the disease on the group as a whole. AlDS is a bottom line issue for most companies as it impacts on production costs and consumer markets (Ellis & Terwin, 2003: 55). A number of "doom-and-gloom" merchants have come forward with doomsday estimates about the impact of the epidemic on business. As a result, the extent of the problem might have been overstated by some. This sparked a lot of the debates that resulted in many different opinions which have caused a lot of uncertainty. This research will attempt to clarify these issues and fonnulate an unbiased opinion as of the impact of the company. The HIV/AIDS problem is sti ll gathering momentum and prevalence rates are still on the rise. There is currently no cure for HIV / AIDS and chances look diminutive that there will be one within the next decade. If prevention programmes had been successful, this report would never have been written. The problem is aggravated by the fact that the core modes of HN transmission are deeply rooted in social behavioural patterns, value systems and traditional and cultural beliefs. This makes it hard to imagine that the spread of the epidemic will decrease and eventually stop soon (Goldstein, Pretorius, Stuart, 2003). As we are entering a phase where the number of AIDS-related deaths is starting to rise rapidly, it is important to gain sufficient insight into the effect of the disease, especially now that infonnation is becoming more available in the public domain (McClintock & Truen, 2003: 3). AIDS primarily kills young and middle-aged adults during their most productive years. This section of the population is the major source of demand for goods and services. The macro-economic impact of this is expected to influence demand for goods, especially durables, and services. This is aggravated by slower population growth rates that will further slow down the demand for certain goods and services (McClintock & Truen, 2003: 3). HIV/AIDS must be managed proactively. In order to assess and manage this risk, management must have a clear understanding of nature and extent of the risk (Ellis & Terwin, 2003: 1). The Bureau for Economic Research did a survey in 2003 on the impact of HIV/AIDS on business in South Africa. It found that only 8 percent of retail companies surveyed have assessed the impact of the disease on their consumer base (Ellis & Terwin, 2003: 30). A possible reason might be because companies want to see proven input and exit strategies for HIV/AIDS contributions. These are not yet possible for HN/AIDS (Barrett & Ruggie, 2004: 5). The HlV/AIDS prevalence rates estimate for the Lewis Group revealed significantly lower prevalence rates than the national averages. Nevertheless, HlV and AIDS prevalence rates for 2004 are estimated 16.5 percent and 2.5 percent respectively. HIV-prevalence is expected to increase to 17.1 percent and AIDS to 4.7 percent by 2009. There are a number of interventions and strategic responses the company can consider to mitigate the risks entrenched in these estimates. Recommended strategic responses include diversification of profit generators into the higher income group market, focus on areas of growth and building the Lewis Group's brands. It is generally believed that good and responsible corporate citizenship will benefit from involvement in community and charitable projects. The belief is that customers can become predisposed towards the company and that the group can gain goodwill from new and existing customers. It is therefore clear that there are remedies the company can consider to manage and mitigate its risks. It is, however, possible for the company to emerge stronger, more efficient and more competitive if the right responses are implemented.

Thesis (MPhil--Stellenbosch University, 2013.
ENGLISH ABSTRACT: The incidence of HIV/AIDS in Botswana is one of the largest in the world taking its toll on many lives and posing developmental challenges to the nation. Nearly 25% of the population is living with HIV and 14% are newly infected; AIDS is acknowledged as the major cause of death. Most HIV and AIDS studies have been dominated by surveillance, biomedical and ethical methodologies. These approaches failed to stem the tide of HIV infection because they did not follow-up with the tracking of risky behaviours and the underlying causes of the behaviours. This research scrutinized socio-economic factors in relation to the spread of the epidemic. Available literature showed that little or no attention has been paid to the socio-economic backgrounds in which individuals exist in connection with understanding HIV and AIDS. This study used an economic model of risky sexual behaviour to explore the link between socio-economic status and the practice of HIV self-protective/preventive behaviours in Maruapula, Gaborone, Botswana. The research is vital as it goes beyond surveillance in an effort to establish why the community of the study is susceptible to HIV infection. This research l used both collected data and that from BAIS II.
AFRIKAANSE OPSOMMING: Die navorsing is oor die verhouding tussen sosio-ekonomiese status en die praktyk van MIV self-protective/preventive gedrag binne Maruapula distrik. Die doel van die studie is om vas te stel of daar 'n verband tussen sosio-ekonomiese status en die praktyk van MIV-voorkomende gedrag onder die inwoners, van Maruapula, Gaborone, Botswana. Data is ingesamel deur die gebruik van vraelyste en die ontleding van die statistiek het getoon dat die is geen verwantskap tussen sosio-ekonomiese status en die praktyk van MIV self-protective/preventive gedrag onder die inwoners. Aanbevelings gebaseer op die bevindinge is gemaak met betrekking tot MIV-voorkoming in die woongebied in die besonder en in die land in die algemeen.

Thesis (MPhil)--Stellenbosch University, 2005.
ENGLISH ABSTRACT: Despite the seriousness of HIV and AIDS affecting productivity at workplaces, little attention is being paid to the special needs of the infected people in the world of work and the ultimate reality this will have on the companies’ financial health. HIV/AIDS retards economic development and business growth. The epidemic influences the workforce and markets in which business operates. Business must play a leading part in the internal response to HIV/AIDS pandemic. This is both an ethical imperative and the key to business success. Most research conducted on the subject mainly concentrated on the effects of HIV and AIDS on productivity, emphasizing absenteeism as the direct cause of low productivity. The costs of HIV and AIDS will be felt beyond the direct effect of the disease. The indirect costs include the following: The increased costs of recruiting and training, given the extra deaths and disabilities expected. The negative effect on staff morale Loss of time as a result of management and labor meetings to discuss the AIDS crisis as it develops, this resulting in loss of turnover and profits. With the rising prevalence of HIV/AIDS, businesses should be increasingly concerned about the impact of the disease on their organizations-concerns that should be well founded. At the broadest level, businesses are dependent on the strength and vitality of the economies in which they operate. HIV/AIDS raises the costs of doing business, reduces productivity and lowers overall demand for goods and services. The research process in this article focused particularly on workplace issues, which are a key dimension of the relationship between corporations and HIV/AIDS. Data collection was by both structured questionnaires and unstructured interviews, interviews with both management and workers’ representatives and structured questionnaires with the general workforce. The questions asked were open-ended: “Is HIV/AIDS a problem for your company now or in the future?” and “If HIV/AIDS impacted on your company’ financial performance would you act and why?” The research group consisted of four companies in different areas of operations: retail, service and manufacturing and the participants were chosen on the basis of certain inclusive criteria: The number of employees employed. Length of service operation. Willingness to share certain financial information. A qualitative method of data analysis was used in the study and is described in detail. The qualitative research method looks at the subjective meanings attached, descriptions, metaphors, symbols and descriptions of specific cases. It was found that despite the differences from one company to the other, the potential impact of HIV/AIDS on companies’ financials went beyond the direct costs of productivity. As the debate over the availability of cheaper generic anti-retroviral drugs rages in the background, business is faced with the dilemma of significant investment to keep their labour force healthy and alive. This has to be weighed up against the high costs involved in rehiring, retraining and re-incentivising their replacements.
AFRIKAANSE OPSOMMING: Ten spyte van tekens dat MIV en VIGS produktiwiteit in die werkplek affekteer, word daar nog baie min te doen aan die behoeftes van die werkers wat deur die epidemie getref word. Verder, word min aandag geskenk aan die potensiële uitwerking van die epidemie op die finansiële gesondheid van maatskappye. MIV/VIGS vertraag ekonomiese ontwikkeling en besigheidsgroei. Die epidemie het ‘n negatiewe impak op die arbeidsmag en die market waarin besigheid plaasvind. Besigheid moet dus die leiding neem in die interne respons op die MIV/VIGS pandemie. Dit is eties belangrik en die sleutel tot die sukses van besigheid. Die meeste navorsing oor die onderwerp het tot dusver gekonsentreer op die effek van MIV en VIGS op produktiwiteit met die klem op afwesigheid as ‘n direkte oorsaak van lae produktiwiteit. Die koste van MIV en VIGS behels egter veel meer as net die direkte gevolge van die siekte. Die indirekte koste sluit die volgende in: Die koste verbonde aan opleiding en die soeke na nuwe personeel weens sterftes en siekte van personeel. Die negatiewe effek op die moraal van personeel. Verlore tyd as gevolg van bestuurs- en arbeidsvergaderings om die VIGS-krisis te bespreek namate dit ontwikkel en winste negatief beïnvloed. Besigheid behoort meer bekommerd te wees oor die toename in MIV/VIGS gevalle en die impak wat dit op organisasies sal hê. MIV/VIGS verhoog die kostes van besigheid doen, verminder produktiwiteit en verlaag die algemene vraag na goedere en dienste. Die navorsingsbenadering in die artikel fokus op daardie werkplek-aangeleenthede wat ‘n sleuteldimensie is van die verhouding tussen organisasies en MIV/VIGS. Data is ingewin deur middel van gestruktureerde vraelyste en ongestruktureerde onderhoude. Onderhoude is met beide bestuurslui en verteenwoordigers van werkers gevoer, en gestruktureerde vrae met die werkers. Die vrae gestel was oop vrae soos “Is MIV/VIGS `n problem vir u onderneming huidiglik of in die toekoms? En “Indien MIV/VIGS ‘n negatiewe impak het op die onderming se prestasie sal jy optree en waarom?” Die navorsingsgroep het bestaan uit vier ondernemings in die kleinhandels-, dienslewerings-, en vervaardigingssektor. Die deelnemers is gekies op die basis van inklusiwiteit met die volgende criteria: Die getal werkers in diens. Hoe lank is onderneming in besigheid? Die bereidwilligheid om inligting te deel. `n Kwalitatiewe metode van data analise is gebruik wat breedvoerig verduidelik en beskryf word. Die navorsingsmetode kyk veral na subjektiewe betekenisse, omskrywings, metafore, simbole en omskrywings van spesifieke gevalle. Navorsing het getoon dat MIV/VIGS ‘n impak het op ondernemings se finansiële omstandighede en produktiwiteit. Terwyl die debat oor goedkoper generiese anti-retrovirale middele aan die gang is, word ondernemings of besighede konfronteer met die keuse tussen beduidende investering om die arbeidsmag gesond en lewendig te hou of die hoë koste van herindiensneming, heropleiding en insentiewe.

Thesis (MBA)--Stellenbosch University, 2004.
ENGLISH ABSTRACT: HIV infection has increased sharply in SA over the past decade, from almost zero to a level where between 4-6 million citizens are estimated to be HIV positive (i.e. around Il percent of the total population). Given the considerable lag and link between the HIV and AIDS epidemic, the mortality consequences of this exponential increase in HIV infection over the 1990s are more or less matter-of-fact over the coming decade; even drastic interventions can do little to avoid this reality, albeit possibly impactingfurther beyond. The health care industry, and more specifically the pharmaceutical industry, is the only industry that can have a direct impact on the outcome of the epidemic in terms of provision of antiretroviral drugs. More importantly, the decision by multinational companies to provide voluntary licensing to local SA pharmaceutical manufacturers for the manufacturing of generic ARVs has gone a long way into achieving the World Health Organisations' objective of providing an ARV cocktail for less than $1,00 per day. The mam aim of the study is to establish and study the micro-economic effect of HIV/AIDS on a South African pharmaceutical manufacturer and to evaluate their HIV/AIDS Policy with the framework of the mV/AIDS & SID Strategie Plan for South Africa 2000-2005. Both qualitative and quantitative methods were used to obtain data from various key informants, manufacturers and market survey companies. The analysis of quantitative data was done using Excel software and a descriptive analysis method was used to interpret the data. The key findings from the study are that Aspen Pharmacare will experience a 20,8 % HIV prevalence rate in 2005, which will progressively increase to a 25,6 % level in 2015. This prevalence level will be severely experienced in the skilled, semi-skilled and unskilled employment of the company during the 2010 period and will start to stabilise in the latter part of 2015. The AIDS prevalence in the company will increase from a 2,0 % level in 2005 to a 4,4 % level in 2015. This increase is largely due to the increase in the prevalence rates in the semi-skilled and unskilled employees. At a senior management level the forecasted number of employees that will have clinical AIDS after 2010 is between 6 and 8. This clearly indicates that mv/AIDS prevalence at this level is independent of race and is lifestyle dependent. If the company were to have the full responsibility for the provision of benefits, based on the current expected employee benefit structures, the direct cost to company would add 10 % to salary and wages by 2005 and around 20 % by 2010. Indirect costs to company, such as recruitment and training, increased labour turnover, lost skills and intellectual property, etc. are estimated to be 2,5 % by 2005 and 5 % by 2010. With the high HIV/AIDS prevalence rates, especially amongst the unemployed, companies will have to carry the costs of their mv/AIDS patients for longer and register then with Aid for AIDS when it becomes too costly. More importantly employers will have to investigate the cost implication of assisting employee dependents, as this will have a direct impact on the morale of the employees. Aspen Pharmacares' mv/AIDS Policy goes beyond the requirements of the mv/AIDS Strategic Plan for SA in terms of the legal and social requirements. The company also has a Corporate Social Investment division that assists many NGOs, clinics, hospitals and communities. Based on the intellectual property, the pharmaceutical competencies and the continuous dialogue that exists between the pharmaceutical industry and the department of health, the researcher concludes, that pharmaceutical companies have an advantage over nonpharmaceutical companies in dealing with the mv/AIDS issues. The paper concludes by suggesting recommendations that companies can adopt to ensure that their mv/AIDS policy can form a significant component of their skills retention strategy.
AFRIKAANSE OPSOMMING: MIV infeksie het skerp gestyg in SA oor die laaste dekade, vanaf amper geen tot 'n vlak waar tussen 4-6 miljoen inwoners beraam word om MIV positiefte wees (minstens 11% van die totale bevolking). Gegee die aansienlike vertraging en skakel tussen die MIV en VIGS epidemie, word die eksponensiële toename in die sterfte syfer as gevolg van MIV infeksies gedurende die jare negentig as vanselfsprekend aanvaar in die komende dekade. Selfs ingrypende veranderinge kan min doen om hierdie katastrofe te keer. Die gesondheidsorg industrie, en meer spesifiek die farmaseutiese industrie is die enigste industrie wat 'n direkte slag kan slaan om die uitkoms van die epidemie te beinvloed, in terme van voorsiening van antiretrovirale medisyne. Die besluit van die multinasionale maatskappye om vrywillige lisensiëring aan plaaslike farmaseutiese maatskappye te bied, vir die vervaardiging van generiese antiretrovirale medisyne, is een stap vorentoe om by die doelwit van die Wereld Gesondheidsorg Organisasie se doelwit van die voorsiening van 'n daaglikse toediening van antiretrovirale medisyne van minder as $1.00 per dag. Die primêre doelwit van hierdie projek is om te bepaal wat die mikro-ekonomiese effek van MIV/VIGS op 'n Suid Afriakaanse farmaseutiese vervaardiger is en hul MIV/VIGS beleid te evalueer binne die raamwerk van die MIV/VIGS en SOS Strategiese Plan vir SA 2000-2005. Beide kwalitatiewe en kwantitatiewe metodes is gebruik om data te verkry vanaf verskeie bronne, vervaardigers en marknavorsings maatskappye. Die kwantitatiewe inligting was geanaliseer deur gebruik te maak van "Excel" sagteware en 'n beskrywende analitiese metode was gebruik om die data te interpreteer. Die hoof bevindinge van die studie is dat Aspen Pharmacare 'n MIV infeksie vlak van 20.8 % in 2005 sal ondervind, wat progressief sal toeneem tot 25,6 % in 2015. Hierdie infeksie vlak sal in die geskoolde, semi-geskoolde en ongeskoolde arbeid die ergste voorkom gedurende die 2010 periode en sal dan stabiliseer in die latere gedeelte van 2015. Die VIGS infeksie vlak in die maatskappy sal toeneem vanaf 2,0 % in 2005 tot 'n 4,4 % in 2015. Hierdie toename kan toegeskryf word aan die toename in die infeksie vlakke van die semi-geskoolde and ongeskoolde arbeid. Op die senior bestuurs vlak word beraam dat tussen 6 en 8 werknemers VIGS onder lede sal hê na 2010. Hierdie beraming toon duidelik aan dat MIV/VIGS op hierdie vlak onafhankilik van kleurgroup is en direk leefstyl verwant is. Gebaseer op die huidige verwagte werknemer voordele struktuur, en die feit dat die maatskappy volle verantwoordelikheid sou aanvaar vir die voorsiening van voordele, word beraam dat die direkte koste as gevolg van MIV/VIGS 'n toename van 10 % in 2005 en 20 % in 2010 by salarisse en lone sal voeg. 'n Toename van 2,5 % in 2005 en 5 % in 2010 word beraam vir indirekte koste (werwing van personeel, opleiding, ens.)as gevolg van MIV/VIGS. Met die hoë MIV/VIGS infeksievlakke, veral onder werkloses, sal maatskappye die kostes vebonde aan hul MIV/VIGS werknemers vir langer moet verduur en dan later sulke werknemers registreer by "Aid for AIDS" indien dit onbekostigbaar word. Belangriker is die feit dat werknemers die koste implikasie bepaal in die verband, omdat dit 'n direkte invloed sal hê op werknemer selfvertroue. Aspen Pharmacare se MIV/VIGS beleid bied meer as die wettige en sosiale vereistes soos uiteengesit in die MIV/VIGS en SOS Strategiese Plan vir SA 2000-2005. Die maatskappy het ook 'n Korporatiewe Maatskaplike Beleggings afdeling wat 'n bydra lewer by NGOs, klinieke,hospitale en gemeenskappe. Gebaseer op die intelligensie eiendom, die farmaseutiese bekwaamheid en die aanhoudende gesprekvoering wat bestaan tussen die farmaseutiese bedryf en die department van gesondheid, oortuig die navorser dat farmaseutiese maatskappye 'n voordeel het bo nie-farmaseutiese maatskappye in die hantering van die MIV/VIGS strydvraag. Hierdie studie sluit af met aanbevelings wat maatskappye kan toepas om te verseker dat hul MIV/VIGS beleid 'n betekenisvolle komponent van hul bekwaanheids retensie strategie is.

That natural resources (NRs) are important to those experiencing adversity, and, especially, vulnerability associated with HIV/AIDS, is well documented, particularly with respect to food and energy security. What is unclear is where HIV/AIDS ranks in terms of its significance in comparison to other household shocks, the role local ecological knowledge may (LEK) play in households' response to shock, a propos the types of coping strategies that are employed. Consequently, this research aims to bridge the knowledge gap between HIV/AIDS and the degree to which it is contributing to the expansion of NR commercialisation and to explore the unknowns surrounding the influence of LEK on people's choice of coping strategy. A two phase study was designed to provide quantitative rigour with qualitative depth. Phase one was an extensive, rapid survey of NR traders within urban and rural settings in five southern Africa countries. The principle objective was to profile the trade, the livelihoods of those involved and their reasons for entering the trade, to ultimately establish to what degree HIV/AIDS may have been a catalyst for this. Almost one third of the sample entered the trade in response to illness and/or death in their households, with 80% of deaths being of breadwinners. The findings illustrated considerable dependence on the sale of NRs; for almost 60% of the sample it was their household's only source of income. There was evidently increased blurring of the lines between rural and urban NR use with a greater diversity of products being traded in urban areas. Phase two involved in-depth interviews and work with a smaller sample at two sites selected based on the findings from the first phase. It incorporated three groups of households; non-trading, inexperienced trading and experienced trading households. Key areas of focus were household shocks, coping strategies employed in response to these and the role LEK may be playing in the choice of coping strategies. Within a two year period, 95% of households registered at least one shock, of which 80% recorded AIDS-related proxy shocks. Non-trading households were significantly worse-off in this regard, while in the case of non-AIDS proxy shocks, there was no such difference between groups. The most frequently employed coping strategy was the consumption and sale of NRs and was of particular importance when households were faced with AIDS proxy shocks. Trading households emerged as having superior levels of LEK in comparison to non-trading households, even for non-traded NRs, suggesting that prior LEK of NRs opened up opportunities to trade in NR as a coping strategy. Further inspection of the latter group however revealed that the portion of non-trading households who traded on a very ad hoc basis actually had comparable levels of LEK to the trading households. Despite the ad hoc trading households' vulnerable state and their disproportionately high level of AIDS proxy measures, they had at their disposal, sufficient LEK to unlock certain key coping strategies, namely the NR trade. In this sense there are apparent linkages between LEK, HIV/AIDS and the expansion of the commercialisation of NRs.

Livelihood stressors in southern Africa, such as HIV/Aids and climate change, do not act in isolation but rather interact concurrently in complex socio-ecological systems with diverse, interrelated and compounded affects. Households experience differential vulnerability to such stressors based on contextual factors such as geographical location, income level and the gender and age of its members. Households’ differential experiences of vulnerability are further defined by the households’ use of their capital stocks: the human, social, natural, financial and physical capital available to the household to form livelihoods and resist the detrimental effects of a stressor. The capital stocks of 340 households were measured in two sites in the Eastern Cape, South Africa, using a household survey. These data were analysed to determine differences between the sites, households with heads of different gender and households of different income levels. Further data relating to the drivers and interactions of stressors over temporal and spatial scales, as well as the perceived value of various forms of capital by different social groups in the two sites, were collected via Participatory Learning and Action (PLA) methods including timelines, mental modelling and pair-wise ranking. Although the two sites have similar levels of income and fall within the same province, many significant differences emerged. The two sites showed different distributions of household head genders and different stressors and perceptions of vulnerability, perhaps owing to differences in their capital stocks, acting alongside the influence of culture and access on a shifting rural-urban continuum. These discrepancies further transpired to reflect crucial differential experiences along gender lines and income levels in each site. Vulnerability was often context specific, not only because of unique drivers of stress in different areas, but also because socio-economic groups and localities often had characteristics that could potentially exacerbate vulnerability, as well as characteristics that can potentially facilitate adaptive capacity. Stressors were found to have depleted multiple forms of capital over time, while new stressors were emerging, raising concerns over the most appropriate means of social protection within these contexts.

Climate change and the HIV/AIDS epidemic are two of the most critical long-term global challenges, especially for Africa and even more so Southern Africa. There is great concern that the poor will be unable to adapt to the impacts of climate variability and change while HIV/AIDS will exacerbate the impacts of such stressors and deepen the insecurities of many communities already affected by this disease. Studies that consider the interlinked effects of climate change and HIV/AIDS along with other multiple stressors are increasingly needed. This study, located in two rural communities in the Eastern Cape Province of South Africa, namely Lesseyton and Willowvale, assessed the responses of vulnerable households to the linked shocks and stressors of climate change and HIV/AIDS. This involved assessing, through household surveys, life history interviews and Participatory Learning and Action (PLA), the way in which multiple stressors interacted and affected vulnerable households, the way in which these households responded to and coped with such shocks and stressors, and the barriers which prevented them from coping and adapting effectively. Unemployment emerged as the dominant stress amongst households. The lack of development and having too few opportunities for employment has limited vulnerable households from being able to invest in assets, such as education or farming equipment. This, in combination with the impacts of increased food and water insecurity from recent drought, has created an extremely vulnerable environment for these households. They rely largely on two important safety-nets, namely social capital and the use of natural and cultivated resources; however the latter has been limited due to the impacts of water scarcity and an inability to farm. It was evident that there was little planned long-term adaptation amongst households and from government. Maladaptive short-term coping strategies, such numerous household members depending on one social grant and transactional sex, were too often relied upon, and although they may have helped relieve the stress of shocks momentarily, they did not provide for the long-term well-being of individuals and households. Poor communication and capacity between the different levels of government and between the government (especially at the local level) and the two rural communities has created an environment full of uncertainty and lacking in advocacy. Local government needs increased human, informational, and financial capacity and a clear delegation of responsibilities amongst the different departments in order for the two communities to benefit from the implementation of support strategies. There is also a great need for educational programmes and capacity development within the two rural communities, particularly based on improved coping and longer-term adaptation strategies in response to climate change in order for households to better prepare themselves for the future.

How should the impact of HIV and AIDS on rural livelihoods be factored into efforts to monitor and stabilise household food security? With both HIV and AIDS and food security at the top of the global development agenda, this is a question posed by many scholars, practitioners, donor agencies and government departments. However, while there is an excess of discourse outlining the theoretical bases for how HIV and AIDS can, and is, radically transforming household food acquisition; there is a lack of empirical evidence from the South African context that demonstrates if, and how, HIV and AIDS changes household-level strategies of food acquisition and intake. This thesis explores the association of household-level mortality, chronic illness and additional child-dependent fostering with household experience of food security and food acquisition strategies, in three rural villages in the Eastern Cape and KwaZulu-Natal Provinces of South Africa. Qualitative and quantitative methods of data-collection were applied to 307 households in the three sites. For twelve months, both HIV and AIDS-afflicted and non-afflicted households were repeatedly visited at 3-month intervals, in order to be assessed for levels of food security, dietary intake and method of food procurement (purchased, cultivated, wild or donated). Overall, HIV and AIDS-afflicted households showed a significantly higher experience of food insecurity, probably attributable to shortages in food quantity. Dietary composition and overall diversity, however, was not significantly different. Although households with chronic illness and recent mortality showed a heightened investment in cultivation sources, the success of these strategies were to a great extent mediated by household income, and the level of medical treatment received by those who were chronically ill. Chronic illness was also associated with more donations, but these required considerable investments in social capital networks. Finally, use of wild leafy vegetables was not associated with household HIV and AIDS status, despite the financial, nutritional and labour-saving properties of these foods. Overall, the study suggests that there was little evidence of long-term planning and strategy in household food security responses. There was no evidence for shifts to labour-saving crops or foods and, in some instances, child labour was being used to ameliorate prime-adult labour deficits. Moreover, given that the vast majority (89.2%) of food groups were sourced through purchase, it is questionable whether investing in diverse food acquisition strategies would be advisable. Unless supported by medical treatment and steady earned household income, policies to promote intensified household agricultural subsistence production in the wake of HIV and AIDS are unlikely to provide households with anything more than short-term safety-nets, rather than long-term, sustainable food security solutions.

Thesis (MBA (Business Management))--University of Stellenbosch, 2008.
AFRIKAANSE OPSOMMING: Menslike immuungebrekvirus (MIV) en Verworwe immuniteitsgebrek sindroom (VIGS) is een van die grootste uitdagings waarvoor werkgewers vandag te staan kom, en behoort die stukrag te wees vir ’n deeglike ondersoek om die voorkoms van hierdie toestand in die werkplek so akkuraat as moontlik te bepaal. So ’n ondersoek kan lig werp op toekomstige demografiese arbeidsmagtendense en verwante koste, byvoorbeeld verlies aan produktiwiteit en dienslewering weens afwesigheid, ’n toename in aftredes, en stygende sieke- en pensioenfondseise wat waarskynlik ingedien sal word. Daarbenewens kan so ’n ondersoek die werkgewer in staat stel om noukeuriger vir die toekoms te beplan, vanuit die oogpunt van finansies sowel as menslike hulpbronne. Daar is egter ’n neiging by werkgewers om MIV/VIGS steeds as ’n maatskaplike of samelewingsprobleem eerder as ’n besigheidspesifieke risiko te beskou. Onkunde is meestal die rede hiervoor. Werkgewers neig om weg te skram van direkte risikobestuur, dikwels met die argument dat dit die regering se plig is om MIV/VIGS-opleiding en gesondheidsorg te voorsien. Sodoende word die bestaande verhouding van ‘ekwilibriumkonvergensie’ tussen die staat, sakesektor en arbeid verydel. MIV/VIGS moet soos ander groot geïdentifiseerde sakerisiko’s beskou, gemeet en proaktief bestuur word, net soos met wisselkoers wisselvalligheid, politieke en infrastrukturele risiko’s, en persoonlike en batesekuriteit. Hoewel hierdie risikofaktore dwarsoor die wêreld bestaan, en sommiges in ander wêrelddele groter is, het hul gekombineerde uitwerking veral in Suider-Afrika ernstige implikasies vir investering en die koste om hier sake te doen. Soos alle ander sakerisiko’s moet die hantering daarvan multidimensioneel wees: • Identifiseer, meet en bestuur die risiko; plaas MIV/VIGS eerste op die direksie se agenda. • Stel senior beamptes aan om die risiko te bestuur. • Evalueer bestuurstrukture en intervensie stappe gereeld. • MIV/VIGS opleiding is die sleutel, vir bestuurslede sowel as werknemers. Risikobestuur moet holisties wees. So byvoorbeeld is dit nutteloos om gesondheidsorg sonder proaktiewe pasiëntebestuur te voorsien. En net soos wat behandelingsplanne sonder befondsing sinloos is, is dit futiel om goed befondsde voordeelplanne te skep as behandeling nie toeganklik is nie. Die doel van hierdie studie is om die proses wat Old Mutual (SA) gevolg het om die voorkoms van MIV onder sy 13 000 permanente werknemers landwyd te eksploreer. Die statistiese uitkoms sal dan gebruik word om te bepaal of Old Mutual (SA) wel sy doelwitte in terme van werknemersgelykheid sal bereik en behou, gegewe die MIV/VIGS pandemie. Vooruitskouings oor die implikasies van MIV/VIGS vir Old Mutual (SA) moet met die nodige omsigtigheid benader word, alhoewel hierdie studie aandui dat dit moontlik implikasies kan inhou vir werkverskaffing in die toekoms, gegewe die wetlike vereistes vir die verskeie aangewese groepe. MIV/VIGS lei nie net tot siekte, ongeskiktheid en dood onder Old Mutual (SA) se werknemers nie. Tesame met ernstige ekonomiese en emosionele ontwrigting vir hul gesinne, verhoog dit ook die koste om in Suid-Afrika sake te doen. Hierdie koste sluit die volgende in: • verhoogde gesondheidsorgkoste; • meer eise vir aftree-, pensioen- en doodsvoordele; • laer produktiwiteit namate afwesigheid van die werk styg weens siekte, hetsy eie of siek familielede na wie omgesien moet word; en • verhoogde koste vir personeelwerwing, arbeidsomset en opleiding weens die verlies van ervare personeel.
ENGLISH ABSTRACT: Human Immunodeficiency Virus infection and the Acquired Immune Deficiency Syndrome (HIV/AIDS) is one of the greatest challenges facing employers today, and should provide the impetus for a thorough investigation among employees in order to arrive at an estimate of HIV prevalence within the workplace. Such an investigation could shed light on future demographic workforce trends as well as related costs, e.g. loss in productivity and service delivery due to absenteeism, increased retirement and a rise in medical aid and pension fund claims that the employer is likely to encounter. Furthermore, this investigation could enable the employer to plan better for the future – both from a financial and human resources viewpoint. In the ‘real’ world though, employers still perceive HIV/AIDS as a social or community problem rather than a business specific risk. Employers, largely through ignorance, tend to shy away from direct risk management – often using the argument that it is the government’s responsibility to provide HIV/AIDS education and healthcare. In this way they nullify the existing ‘equilibrium convergence’ relationship between the state, business and labour. HIV/AIDS must be measured and proactively managed and should be regarded in the same light as other major identified business risks, e.g. personal and asset security, exchange rate volatility, and political and infrastructure risks. While it is true that all of these particular risk factors exist across the globe, and may be greater in other parts of the world, nowhere else do they seem to combine with such severe implications to deter investment and raise the cost of doing business than in Southern Africa. As for any other business risk, the response should be multi-dimensional: • Identify, measure and manage; place HIV/AIDS at the top of board agendas. • Appoint senior executives to manage the risk. • Regularly evaluate management structures and interventions. • HIV/AIDS education is key to both management and employees. Risk management should be holistic. For example, providing healthcare without proactive patient management is pointless. Similarly, treatment plans without funding are futile, and well-funded benefit plans without practical access to treatment are a waste of time. The aim of this study is to explore the process Old Mutual (SA) followed in estimating the HIV prevalence among its 13 000 permanent employees nationally. The resultant statistics would then be used to project whether or not Old Mutual (SA) will be able to achieve and sustain its employment equity targets, given the HIV/AIDS pandemic. Predictions on the implications of HIV/AIDS for Old Mutual (SA) should be approached with due caution, although this study suggests that it could probably seriously impact on shortages in the supply of labour in future, given the legislative requirements for the various designated groupings. HIV/AIDS not only causes illness, disability and death among Old Mutual (SA) employees, coupled with severe economic and emotional disruption for their families, it also increases the cost of doing business in South Africa. These costs include: • increased healthcare expenses; • increased retirement, pension and death benefit claims; • decreased productivity as worker absenteeism rises owing to personal illness, or absence from work to care for sick relatives; and • increased recruitment, labour turnover and training costs due to loss of experienced workers.

Wild foods are an integral component of the household food basket, yet their quantified contribution to food security relative to other sources in the context of HIV/AIDS, climate change and variability remains underexplored. This study was carried out in Willowvale and Lesseyton which are rural communities in the Eastern Cape province of South Africa. Willowvale is a relatively remote, medium-rainfall coastal community, while Lesseyton is a peri-urban low rainfall inland community. Qualitative and quantitative methods were used to collect data from 78 HIV/AIDS afflicted households with 329 individuals and 87 non-afflicted households with 365 individuals in the two study sites. Households were visited quarterly over 12 months to assess food acquisition methods, dietary intake and quality, and levels of food security, and to determine strategies employed by households to cope with droughts. The wild foods investigated were wild meat, wild birds, wild fish, wild mushrooms, wild leafy vegetables and wild fruits. Diets were moderately well-balanced and limited in variety, with cereal items contributing 52 % to total calorie intake. Mid-upper arm circumference measurements showed that all respondents were adequately nourished. The bulk of the food consumed by households was purchased, with supplementation from own production, wild vegetables and wild fruits. In Willowvale, wild vegetables comprised 46 % of overall vegetable consumption for afflicted households and 32 % for non-afflicted households, while own fruit production comprised 100 % of fruit consumption. In Lesseyton, wild vegetables comprised only 6 % and 4 % of vegetable consumption for afflicted and non-afflicted households, while wild fruit comprised 63 % and 41 % for afflicted and non-afflicted households. More than 80 % of respondents from both afflicted and non-afflicted households had sufficient daily kilocalories, although the majority of afflicted households felt they were food insecure and sometimes collected wild foods as one of their multiple coping strategies. Hunting and gathering of wild foods was associated with site, household affliction status, gender, age and season. More than 80 % of respondents ate wild vegetables and said they were more drought tolerant than conventional vegetables, making them the most consumed wild food and approximately 16 % of respondents ate wild birds, making them the least consumed wild food. Approximately 14 % of respondents from afflicted households in Willowvale sold wild fish, whilst 34 % of respondents from afflicted households and 7 % from non-afflicted households sold wild fruits in Lesseyton. Strategies adopted by households to cope with droughts were different between the two study sites, and households in Willowvale used a wider range of strategies. Given the devastating effects of HIV/AIDS coupled with the drawbacks of climate change and variability on food security, wild foods represent a free and easy way for vulnerable households to obtain food.

The US Bureau of the Census (1999) projected that by 2004, 14 million people in sub-Saharan Africa will develop full blown AIDS, making this region by far the largest disease burden in the world (World Health Organization, 2002). The United Nations AIDS Programme judged South Africa to have the leading number of people living with HIV/AIDS worldwide (World Health Organisation, 2002). To date there has been extensive research conducted on the socio-economic impacts of HIV/AIDS on families in Africa. However an area of investigation that has remained largely underreported is the inquiry into the psychological impacts of HIV/AIDS on elderly caregivers. In African families older women increasingly have to provide care to their adult children with AIDS and their orphaned grandchildren. However few research studies have assessed the experience of parental caregiving and its psychological impacts on these women. This qualitative research study hypothesised that the role of primary parental caregiver in fact causes a range of psychologically distressing states, which serve to compromise the psychological well-being of these caregivers. To investigate this hypothesis three Xhosa speaking women living in informal settlements in Grahamstown, in the Eastern Cape Province of South Africa were selected for the study. The women were interviewed by means of semi-structured interviews, which consisted of questions related to their caregiving experiences, their experiences of loss, their choice of coping strategies, the role of support networks and their experiences of foster care responsibilities. The interviews were transcribed and analysed using a grounded hermeneutic approach. The research results confirmed the working hypothesis. The research revealed that although it was considered culturally appropriate for older women to care for their children and grandchildren, their caregiver roles caused significant psychological distress. Their distress was related to: emotional and physical exhaustion, complicated grief reactions and ongoing emotional and physical upheaval related to foster care responsibilities. Based on the results, the research recommendations emphasised the need for continual awareness of the psychological implications of caregiving for older African women with the aim to preserve their capacity to function as the primary caring resource to families struck by HIV/AIDS.

Development aid in most of the developing countries can sometimes compromise the principles of public service broadcasting (PSB). This may be true when reflected against the tension between donor financed programmes in Malawi and the mandate of Television Malawi (TVM). Although the donor intentions are noble, the strings attached to the funding are sometimes retrogressive to the role of PSBs. A case in point is how donors dictate terms on the HIV/Aids communication strategies at TVM. Producers receive money from donors with strings attached on how the money should be used and accounted for. If producers deviate they are sanctioned through withholding funding, shifting schedules and reducing the funding frequency. The donors also dictate who to interview on what subject, how to conduct capacity building. Some scholars have researched much on the impact of commercialisation of the media. This study is a departure from these traditional interferences; it interrogates the interest of philanthropy tendencies by international donors in the three chosen HIV/Aids programmes broadcast by TVM. The study investigates the extent of pressure exerted by donors on the producers of HIV/Aids programmes in Malawi. Thus, the study seeks to illicit specifics in the power relationship between the donor and the producer hence the study employs the political economy of development aid as applied to the public service broadcasting and communication for development. The study employed qualitative research methods and techniques (in-depth interviews, case study and document analysis). The study reveals how donor ideologies dominate the Aids messages-content output of the texts constructed. The study argues that cultural alienation of the Malawian audiences retards efforts of donors in combating HIV infection rate.

Multilevel models account for different levels of aggregation that may be present in the data. Researchers are sometimes faced with the task of analysing data that are collected at different levels such that attributes about individual cases are provided as well as the attributes of groupings of these individual cases. Data with multilevel structure is common in the social sciences and other fields such as epidemiology. Ignoring hierarchies in data (where they exist) can have damaging consequences to subsequent statistical inference. This study applied multilevel models from frequentist and Bayesian perspectives to the Swaziland Demographic and Health Survey (SDHS) data. The first model fitted to the data was a Bayesian generalised linear mixed model (GLMM) using two estimation techniques: the Integrated Laplace Approximation (INLA) and Monte Carlo Markov Chain (MCMC) methods. The study aimed at identifying determinants of HIV in Swaziland and as well as comparing the different statistical models. The outcome variable of interest in this study is HIV status and it is binary, in all the models fitted the logit link was used. The results of the analysis showed that the INLA estimation approach is superior to the MCMC approach in Bayesian GLMMs in terms of computational speed. The INLA approach produced the results within seconds compared to the many minutes taken by the MCMC methods. There were minimal differences observed between the Bayesian multilevel model and the frequentist multilevel model. A notable difference observed between the Bayesian GLMMs and the the multilevel models is that of differing estimates for cluster effects. In the Bayesian GLMM, the estimates for the cluster effects are larger than the ones from the multilevel models. The inclusion of cluster level variables in the multilevel models reduced the unexplained group level variation. In an attempt to identify key drivers of HIV in Swaziland, this study found that age, age at first sex, marital status and the number of sexual partners one had in the last 12 months are associated with HIV serostatus. Weak between cluster variations were found in both men and women.
Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Every day more people in Africa are infected with HIV despite prevention efforts. These new infections and those already infected are not evenly spread throughout the continent. Substantial variations in HIV prevalence exist within and between countries. Understanding these variations helps understand what is driving the epidemic and this understanding in turn helps in the design of more appropriate interventions to prevent its further spread. This thesis builds on existing work by attempting to develop a more comprehensive theory of what role income plays in the spread of HIV. To this end the Theory of the Dual Role of Income in the Spread of HIV is outlined and explained. It uses the concepts of relative and absolute income, borrowed from elsewhere in the health economics literature, to separate the different effects income has on individual and group risk of HIV infection. The theory hypothesises that, while higher levels of absolute income (income independent of others) offer protection against infection via better access to health care and information, higher relative income (the income of an individual relative to other members of their social or reference group) increases risk of infection either as a result of more sexual partners or higher risk partners. The theory in no way argues that HIV infections are not related to poverty, but rather that the relationship is, somewhat more complicated and non-linear than often suggested. The explanatory power of the theory is examined with the use primarily of two data sets: firstly using data collected from antenatal clinics in two South African provinces linked with census data and secondly with data on a large South African company. While these data are not ideal, the results from the analysis are in line with the expectations based on the theory. The theory and the results of the analysis presented in this thesis support the argument that environments in which decisions are made and actions taken are important in determining risk of HIV infection. This argument suggests that prevention efforts need to do more then provide information.
Thesis (M.Com.)-University of Natal, Durban, 2002.

A quantitative study was conducted to determine the socio-economic outcomes for the beneficiaries of the Expanded Child Survival Initiative in Uganda. The population comprised of all orphans and vulnerable children who were trained under the Expanded Child Survival Initiative of which a sample of 102 respondents were included in the structured data collection process. The outcomes that were explored were employment, income, assets and family support to siblings and other dependants by the primary beneficiaries. The findings show that the outcomes of the Expanded Child Survival Initiative were positive and benefited socio economic lives of the respondents and their family members. The majority of the respondents were using the skills obtained from the training and were employed. The employment provided a source of income and the income earned facilitates the respondents in providing the basic needs of the family members. They were able to provide adequately for most of their basic needs. The findings also show that the respondents had accumulated some assets. A number of factors influenced the utilisation of the newly acquired skills including having tool kits, start-up capital and business management skills. It is recommended that training providers should provide start-up support to the apprentices in order to facilitate them to utilise the skills obtained from apprenticeship trainings.
Public Health
Thesis (M.A. (Public Health))

HIV / AIDS in the South African present context remains fraught with obstacles and challenges. The previous regime's willingness to turn a blind eye to the problem, combined with the present government's confused response has accelerated the disease and it's devastating impact to pandemic proportions. This has placed additional pressure on other sectors to respond. While civil society challenges government's delaying tactics and seeks to ease the plight of those living with HIV, the business sector is being called upon to act, in the interests of the stability of the national economy and it's own survival. Business is identified, locally and abroad, as the most relevant environment for intervention because of it's unique capacity to impact on both the workforce and the consumer market simultaneously. Business however exists for the purpose of making a profit. This is in itself an area of study that requires investigation: how does business meet the pressure to 'do the right thing' and protect its own best interests? This study will consider how some businesses have shifted the burden of AIDS, while others have prepared to meet the costs associated with implementing any interventions. The primary objective of this study is to investigate the impact of HIV / AIDS on the business sector with an assessment of the risk faced by business in the immediate and long-term. It further seeks to analyse business's current response in the context of international best practice standards. Case studies of Workplace HIV / AIDS Programmes are used to identify and analyse successful interventions that may be utilised in the South African context. While there are a few outstanding examples of workplace interventions being implemented in South Africa, there is some concern that too many companies are processing HIV / AIDS as a paper exercise without the commitment and care required for change. The impact of the disease on a physical level is compounded by stigmatization and fear. Issues of discrimination and intolerance permeate the environment in which employers are required to implement programmes that shift knowledge, attitudes and behaviour around HIV / AIDS. The secondary objective of this study is to test the emerging hypothesis that the face-to-face or one-on-one intervention is the most effective in successfully changing knowledge and attitudes about HIV / AIDS and can therefore influence a long-term change in behaviour. This study seeks to provide guidelines and recommendation for companies willing to implement HIV / AIDS workplace interventions by presenting an overview of the options available and indicating where best to invest limited resources. While the nature and scope of the study is by no means conclusive and remains open to ongoing social and medical research, it remains relevant in that it is placed in the context of timeless best practice.
Thesis (M.B.A.)-University of Natal, Durban, 2003.

HIV incidence rates have been on the decline globally, yet certain sub-populations have seen their incidence rates increase, bearing an extraordinary share of the HIV disease burden. In Eastern and Southern Africa, the rate of new HIV infections disproportionately affects adolescent girls and young women (AGYW) with up to three times as many young women ages 15-24 living with HIV as compared to their male peers. These statistics make AGYW a key demographic for action in order to realize an AIDS-free generation. To most effectively intervene, researchers must examine the rationale for higher infection rates among young females. Recent studies have found positive correlation between economic strengthening interventions (such as cash transfers, savings accounts, or financial literacy) and HIV sexual risk among AGYW, however, the majority of the literature to date understands these economic strengthening interventions at the household level, as a mechanism for providing insurance against economic shocks and as an incentive for keeping girls in school, a key predictor of reduced HIV. Fewer studies have sought to understand how increased resources, and power over those resources, affects the thoughts and behaviors of AGYW at the individual level. Does this enhanced agency translate into greater power in intimate relationships? Does she feel more entitled to make decisions over her own body once she has the power to meet her own basic needs? And does agency over her body inevitably translate to fewer HIV risk behaviors? This three-paper dissertation examines data collected with AGYW living in two urban areas, characterized by HIV prevalence. These areas are the sites of a multi-sectoral DREAMS program, a public-private partnership to reduce HIV incidence in ten countries within sub-Saharan Africa. Paper 1 examined the construct of financial agency through the development of a scale, finding variations in experience of financial autonomy between age cohorts with younger adolescents’ autonomy correlated to a higher likelihood of being sexually active and exposure to partner violence. Financial agency was not strongly associated with HIV risk reduction variables at any age. Paper 2 sought to understand the correlational relationships between personal financial agency, sexual relationship power (SRP), and reduced sexual HIV risk for AGYW in Zambia in order to determine if SRP may be a potential mediator between financial agency and sexual HIV risk reduction. Paper 2 found that SRP within sexual relationships did convert to HIV protective behaviors and that while financial agency did correlate with SRP for the oldest cohort, financial agency on its own was not sufficient to reduce sexual HIV risk. Paper 3 explored how AGYW in Zambia understand financial agency as a construct and how it does or does not affect their power in intimate relationships. This study demonstrated that financial independence is an aspiration of AGYW, however, that autonomy is tied up with negative community-based perceptions about what it means to be a woman earning and with control over her own income. Financial independence has promise as a mechanism for sexual HIV risk reduction, specifically the reduction of transactional sex; however, the realities of male sexual privilege may remain an obstacle to risk reduction irrespective of financial decision-making power. Women’s sexual agency was viewed as far greater in non-martial relationships as opposed to within marriage, where religious mores on headship created a power imbalance. Overall, findings from this dissertation contribute empirically to the literature on economic strengthening and HIV prevention for AGYW, providing new insights on the influence of individual financial agency. Findings suggest a nuanced relationship between financial agency and sexual HIV risk reduction, one that is not necessarily linear or positively correlated. HIV prevention programs that wish to incorporate economic strengthening into their multi-sectoral models should consider the influence of gender norms and sexual relationship power which could continue to keep AGYW in positions of vulnerability regardless of their financial autonomy.

This dissertation examines the political economy of HIV biomedical prevention research—largely designed in the global North but conducted in the global South—and its implications for people of diverse genders and sexualities. As a recognized global leader in HIV biomedical prevention research among people categorized as men who have sex with men (MSM) and transgender women, Peru offers a key site in which to explore the increasing focus on gender and sexual identity as a strategic area for extractive research practices. This phenomenon has become particularly visible in the epidemic’s 4th decade, which has emphasized the pursuit of biomedical prevention strategies. Building on nine years of previous experience working inside HIV biomedical prevention studies, this project involved 24 months of ethnographic research, including participant observation; 110 interviews with scientists, study staff, and research subjects; 10 focus groups; and analyses of relevant scientific publications. This study presents four key findings. First, US and Peruvian researchers’ historical and continued entanglement primed Peru to become a hotbed of HIV biomedical prevention research. In this context, population categories imported from the global North have served as powerful tools to sustain a booming local research market, which produces data that aligns with the global demands of the HIV industry. Second, on the ground, research begets more research rather than institutionalized HIV prevention technologies, creating a sustained enterprise in which issues of compensation, value, and labor shape the science. The commodification of gender and sexually diverse identities operates here in two ways: as a mechanism to access particular kinds of bodies and associated HIV risk data, and as a mechanism by which to claim expertise in the HIV prevention research industry for both researchers and community members. Third, Peruvians classified as MSM and transgender women are afforded only temporary access to cutting-edge strategies to prevent HIV, limited to study participation. The result is a sustained pool of people in need of HIV care primed to support the HIV biomedical research economy. Finally, this project illuminates a key paradox within the industry’s contemporary focus on gender and sexual diversity in HIV prevention science. This focus creates the impression that progressive health politics marked the field, while obscuring and absolving ongoing forms of exploitation and unequal gains embedded within it.

AIDS mortality, its linkages as a determinant and consequence of food security and its impact on natural resource utilisation by mainly rural populations, has not been well researched, especially their effects on rural livelihoods. With the high epidemic prevalence and persistent food insecurity, natural resources are and will continue to play a key role as a buffer against stresses and shocks in rural livelihoods. Determining linkages between household food security, adult AIDS mortality, and how these affect natural resource utilisation at the village level was the objective of this research. The overarching goal of sustainable natural resource utilisation in Agincourt Demographic Surveillance Site (DSS) was determined through three research questions outlined as follows; What is the status of food security, AIDS mortality and Natural resource utilisation in Agincourt?; What is the relationship between dependence on natural resources as a source of food and or livelihood to resource degradation?; and What are the household and community drivers of household food security? Statistical analysis was used to evaluate the prevalence of food insecurity and the reliance on natural resources while remote sensing was used to assess resource availability and identification of possible natural resource degradation hotspots. More than half of the population in the DSS is food-secure, in 2004, with an even smaller hungry population in 2007. HIV/AIDS and non-HIV/AIDS adult mortality, analysed at village level are underlying drivers and determinants, affecting availability of income which is a direct driver of food insecurity. Availability of income, through social grants, remittances or wages, and delay or non-receipt of this income results in food insecurity in some households. Food production, affected and constrained by climate variability, is a less stable and less popular means of attaining food. More than half of the Agincourt population utilises natural resources to supplement dietary diversity and household income, although there is a significant reduction in households using natural resources in 2007 compared to 2004. Resource degradation is noted in the village commons especially between the highly food-insecure villages and are identified as environmental degradation hot spots. The identification of synergies among these factors in policy design and for interventions is essential for poverty alleviation, improved health and sustainable utilisation of natural resources and rural livelihoods. Glory be to GOD for making this work possible “Commit your work to the Lord and then your plans will succeed” (Proverbs 16:3) “Material poverty doesn‟t necessarily lead to a lack of capacity for creativeness and Inventiveness. Poor people survival by their wits and have much more to contribute to address complex problems than we tend to credit them with.” Dr. Maphela Ramphele (Destiny Magazine, 2010)

The study explored, described and explained the current models of voluntary counselling and testing services delivery and analysed the extent to which a given VCT model had influenced uptake of VCT services in the fishing communities along the shores of Lake Victoria, in Wakiso District, with an aim of designing optimal VCT service delivery strategies. The study was therefore exploratory, descriptive and explanatory, and collected both qualitative and quantitative data in a three-phased approach. Phase I involved the Kasenyi fishing community respondents, while phases II and III involved VCT managers and VCT counsellors at the Entebbe and Kisubi Hospitals. The findings indicated that VCT services are generally available onsite at health facilities, and in the field through mobile VCT outreach or home-based VCT services provided at clients’ homes. Both client-initiated and health provider-initiated VCT services are available and services are integrated with other health services. Despite the availability of VCT, only about half of the respondents in phase I had accessed VCT services although almost all indicated a willingness to undergo HIV testing in the near future. The main challenges to service delivery and utilisation included limited funding and staffing as well as limited awareness in target communities. The strategies drawn are based on the need to increase availability, accessibility, acceptability and utilisation of VCT services.
Health Studies
D. Litt. et Phil. (Health Studies)

In South Africa commercial agriculture employs approximately 8.5% of the national workforce. Therefore, information about commercial farmers’ perceptions of and management responses to the HIV/AIDS pandemic are likely to be of interest to policy makers and non-governmental organisations (NGOs) in the health sector, as well as practitioners in rural development and commercial agriculture. HIV/AIDS affects businesses such as commercial farms by decreasing productivity, increasing costs and therefore decreasing overall profitability. Farm business’ responses to the challenges posed by HIV/AIDS may advantage or disadvantage farm workers. For example, farm workers are highly vulnerable to burden-shifting activities (practices which reduce the cost of HIV/AIDS to the employer, such as the outsourcing of low-skilled jobs). However, farm businesses may also play a substantial role (e.g., by providing formal adult education or access to clinics) in addressing the HIV/AIDS epidemic in rural commercial farming areas of KwaZulu-Natal and in South Africa generally. This study presents an analysis of KwaZulu-Natal commercial farmers’ perceptions of and management responses to the HIV/AIDS pandemic. This analysis identifies the farm, business and personal characteristics of the various respondents. It is important to know this information because it assists in understanding why commercial farmers are responding as they are, which will in turn assist in future HIV/AIDS policy planning. The analysis is based on a postal census survey of Kwanalu (KwaZulu-Natal Agricultural Union) commercial farmer members in April and May 2007. Results suggest that, on average, Kwanalu members are highly concerned about the impact of HIV/AIDS on their businesses. A majority of respondents perceived HIV/AIDS to negatively affect the current and future profitability of farming, increase labour absenteeism and staff turnover rates, and reduce labour productivity. An analysis of variance (ANOVA) of the data shows that respondents’ management responses to the HIV/AIDS pandemic varied by farm size and enterprise type, but include paying higher than average wage rates to attract and retain healthy and productive workers, multi-skilling staff to provide back-up skills, and mechanisation to defer costs of HIV/AIDS. Respondents tended to believe that effective HIV/AIDS treatment and prevention programmes require an integrated approach between government, employers and employees. Two response indexes were calculated: (1) ranking by adopters only (only those who use a certain response are included) and (2) ranking by all respondents (a response is not used by a respondent automatically scores zero). The response indexes showed that resource-intensive HIV/AIDS services such as provision of antiretrovirals (ARVs) and nutritional supplements are ranked high by actual adopters, but relatively low overall (as only a small proportion of respondents are adopting these strategies) in the ranking by all respondents. Burden-shifting practices (e.g. mechanisation) are ranked relatively high in both rankings, indicating that respondents rate them as important in managing HIV/AIDS, and that many respondents are utilising them. Relatively inexpensive HIV/AIDS services (e.g. informal communication) are ranked low by actual adopters but high on the overall index as many respondents are using them (but doubt their effectiveness). A linear regression analysis was conducted on principal components from the response indexes to identify characteristics of “high” and “low” responders and of those who utilise burden shifting activities or HIV/AIDS services. The characteristics of “high” responders are that they perceive HIV/AIDS to impact on costs; they employ a high proportion of skilled labour; and they have high turnovers and high debt servicing obligations. Responders who employ large amounts of labour (particularly permanent labour); who perceive HIV/AIDS as the responsibility of the employer; who are older and more experienced; and who have a relatively high debt: asset ratio tend to use HIV/AIDS services to manage the impacts of HIV/AIDS. Many respondents already play an important but inexpensive role in HIV/AIDS prevention and treatment through encouraging voluntary HIV testing and providing staff with information and transport to clinics. Policy makers should take this into consideration when formulating HIV/AIDS policies to combat the pandemic.

The purpose of this study was to investigate coping strategies employed by low-income households of Sweetwaters KwaZulu-Natal, who have members who are infected with HIV in ensuring food security when dealing with HIV/AIDS. This study was based on households who have members living openly with HIV/AIDS and who were members of a support group of HIV positive people. This study was conducted between July 2003 and June 2004. Focus group meetings were conducted with a support group of 26 members (Philani Support Group). Questionnaires, group discussions and observations were used to collect data from households. In order for the study to investigate coping strategies, the following sub-problems were investigated to measure changes before and after illness or death in household: changes in finances, changes in food habits, social aspect of studied household which included infrastructure (housing, roads, water, sanitation and energy); external and internal support. There were no major differences in coping strategies, but the structure, resources and size of households informed their coping strategies. Food was the centre of all activities of households. As the ability of the household to produce food or earn income decreased, the need for food increased. Government social grants have been shown to be the main resource for coping (they enabled households to cope or survive). It is recommended that low-income households affected by HIV/AIDS and totally dependent on grants should be helped not to develop a dependency syndrome by implementing strategies that will encourage active participation and deal with passiveness that exists within low-income households of Sweetwaters affected by HIV/AIDS. As this study indicates that there are no resources on which concerned households depend, it suggests a greater need for capital to boost the household and strategies for households to be able to sustain themselves.
Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

The study into the socio-economic challenges of HIV and AIDS on widowed women in rural communities of Zimbabwe was carried out in the village of Mukadziwashe. The main aim of the study was to find out the socio-economic challenges that are faced by HIV and AIDS widows. Of particular concern has been role played change agent since the dawn of the HIV and AIDS pandemic and its devastating socio-economic impact on families, especially widows. The findings of this study are based on a sample of limited number (12) widows based in the village of Mukadziwashe in Gutu Central District, as well interviews of key informants who happen to be representatives of change agents in the main. In-depth interviews were the tool used to collect information from the research participants identified above. The findings of the study revealed that widows still suffer from the serious social and economic challenges posed by HIV and AIDS such as cultural oppressions and prevention of women from inheriting their late husbands’ wealth The continued denial of women of their constitutionally enshrined rights is difficult to understand, because many studies have been conducted on this subject. It is reasonable to expect noticeable progress in promoting the rights of women, especially widows. What is apparent in this sad story is the mute role of change agents, be they government, non-governmental or community based, in affirming widows’ rights. Based on these observations, the study strongly recommends the design, implementation and constant monitoring of intervention programmes aimed at women empowerment in general.
Sociology
M.A. (Social Behaviour Studies in HIV and AIDS)

Many poor households in South Africa rely on social grants for their survival, forcing the government to spend on the programme, to the detriment of other socioeconomic programmes necessary for poverty alleviation and economy growth. This study investigated the impact of the South African social assistance policies and programmes on the human capacity development of beneficiaries, especially households affected by HIV/AIDS, residing in informal settlements. Following a qualitative approach, exploratory and case study techniques were used to collect and analyse data. In-depth interviews and observations at research sites uncovered rich data elucidated by social capital theory and the capability approach. The thesis commenced with social assistance as implemented in OECD and BRICS countries, including South Africa. The notion of human capacity development, as linked to social assistance, poverty alleviation and economic growth, was presented. Conditional social programmes directed at human capacity development via educational assistance were contrasted with universal social assistance systems. Findings revealed that South Africa, despite its low level of economic growth, has a welldeveloped, selective social assistance system. Social grants assist beneficiaries to meet urgent needs, such as food and transport to hospital and for job seeking. It is insufficient to meet other basic needs, including capacity development. There is a shortage of educational facilities and training programmes in poor communities, which sometimes exclude adult men and youth without Grade 12. There is no guarantee of a job or business opportunities for graduates from skills development centres. Many who have completed their training are placed in entry-level jobs that earn salaries below the social grant exit requirements. Recommendations to increase the array of social grant instruments and to introduce conditional grants for vulnerable adults were made. In particular, the provision of scholarships to needy youths and adults was recommended, augmented by more educational facilities in poor communities, more training programmes, and the establishment of structures that will provide decent job placement and business opportunities for graduates. Urgent provision of decent housing for the poor and improvements in public health infrastructure, roads, water and electricity, in order to facilitate the human development of needy people is further needed.
Development Studies
Ph. D. (Development Studies)

The researcher investigated the knowledge, attitudes and experiences of people living with the Human Immunodeficiency Virus (HIV) towards antiretroviral treatment (ART) and who are accessing antiretroviral treatment at a public health clinic in Limpopo, South Africa. A qualitative method was used. The research findings revealed five themes: experiences, social support, knowledge, attitudes, unemployment and economic themes of the study. Factors reported influencing optimum adherence were the inability of the patients to take medication at work, laziness of the patients to collect medication, unemployment, economic hardship, poverty and lack of knowledge of employers regarding HIV/AIDS.
Health Studies
M.A. (Social Behaviour Studies in HIV and AIDS)

The aim of the study was to offer solutions for the enhancement of Indonesia’s HIV and AIDS policy and to suggest future possibilities. In the process, the gendered nature of the epidemic was explored. In light of the relatively lower rates of employment among Indonesian women, this study also sought to gain insights into the possible reasons for many women appearing to be attached to domesticity. In the first phase of the study, interviews with stakeholders in HIV and AIDS prevention were conducted, followed by a Delphi exercise involving 23 HIV and AIDS experts. In the second phase, 28 women from various ethnicities were interviewed, including those in polygamous and contract marriages. The overall results were interpreted through the lens of complexity theory. Fewer than half of the proposed objectives were approved by the experts in the Delphi round. These were interventions mainly aimed at the risk groups while most objectives relating to education about HIV and AIDS and safer sex for the general public failed to obtain consensus. Reasons for the lack of consensus were differences in perceptions associated with human rights, moral reasoning, the unfeasibility of certain statements and personal conviction about the control of the epidemic. Emphasis on men’s and women’s innate characteristics; men’s role as breadwinner; women’s primary role as wife, mother and educator of their children; and unplanned pregnancies emerged as major themes from the qualitative phase. While the adat and Islam revival movements may have endorsed the ideals of the New Order state ideology, Javanese rituals regarded as violating Islam teachings were abandoned. Ignorance about safer sex and HIV and AIDS was also established. Interpretation of the results through the lens of complexity theory revealed that the national HIV and AIDS policy needs to encompass interventions for the general population, which would include comprehensive sex education in schools and media campaigns focusing on women. It was found that women’s vulnerability to HIV and their penchant for domesticity appear to be associated with their perceived primary role as wife and mother, as promoted by the adat-based New Order state ideology.
Sociology
D. Litt. et Phil. (Sociology)

Background and purpose. The purpose of the study was to determine the costs incurred on the average length of stay (ALOS) on patients with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) related illnesses admitted in hospital and whether there are any other significant costs involved. Method. A quantitative approach was used to collect data; analysed; interpretation and report writing. Purposive sampling and data collection was done using data collection sheet. This was a retrospective cost analysis data from in-patients records (record review) of ages from 15 years to 49 years both gender. Data analysis and presentation of information was presented by the use of tables; different types of graphs and the interpretation thereof. Results. The study found that males (63%) with HIV Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) related illnesses had longer average length of stay in a hospital compared to females. However, females illustrated higher in-patient costs but majority of patients had costs of between R0–R17 500. Patients with longer hospital stay (>3 days of hospitalisation) had higher in-patient costs. Conclusion. The findings also showed that in-patient care costs were directly proportional to length of stay with higher costs for HIV and AIDS patient management care. Our findings are consistent with other studies regarding higher economic implications of care for HIV infected persons being almost as twice as people who are HIV negative due to longer periods of hospitalisation.
Health Studies
M.A. (Public Health)

HIV and AIDS related deaths have left numerous children heading households as the number of adults dying from this pandemic increased significantly. The goal of this study was to gain an in-depth understanding of the experiences, challenges and coping resources of AIDS-orphans heading households in an urban area in Free State using a qualitative study. The research revealed that the level of suffering faced by these children began with their parents’ illness. This was further worsened by the death of the parents. These children are in most instances not absorbed by their extended families as the traditional safety nets are stretched to their limits. Children heading households were forced to take up adult responsibilities prematurely and as such encounter challenges on daily basis. The study concluded that the child headed families are a reality in South Africa and need lots of support from the government and local communities.
Social Work
M.A. (Social Work)