Dissertations / Theses on the topic 'HIV research'

Bibliography: leaves 151-161.
There is substantial evidence to indicate that South Africa is facing the prospect of a large number of children, now and in the future, who will be orphaned as a result of the HIV/AIDS pandemic. In all likelihood, these children would have experienced psychological trauma through the illness and death of people close to them, and the social isolation that accompanies HIV-infection and AIDS-related illness and death. The ideal would be for as many of these children as possible to experience some type of family life in which to grow and mature into responsible adults. The aim of the present study was to explore a range of factors that might influence prospective carers' decisions to care for children orphaned by HIV/AIDS. These include features of prospective carers; features of the orphaned child; and forms of assistance that may be required. By means of a postal survey, the present study explored existing adoptive and foster parents' (N=17S) willingness to care for an HIV/AIDS orphan. Results show that close to 69% of respondents indicated a willingness to care for an HIV/AIDS orphan. Although some differences were noted depending on the HIV status of the child and whether the respondent was an adoptive or foster parent, on the whole they also indicated a preferred willingness to care for an HIV-negative female child, up to the age of 6 years old, of the same culture and from the same family as themselves, and without surviving relatives or siblings. Free medical care and schooling for the child were the suggested forms of assistance required. The Theory of Planned Behaviour (Ajzen, 1991), explored in the present study, did predict intentions to care for either an HIV-negative or HIV-positive orphan. However, certain components of the models did not have good predictive ability calling into question the usefulness of the model as a means to explain and predict intention to care for an HIV/AIDS orphan. Implications of the study provide recommendations for persons involved with children orphaned by HIV/AIDS.

Includes bibliographical references.
Sub-Saharan Africa accounts for 69% of the global HIV burden. Due to a variety of social, economic and behavioural factors, mentally ill patients are more likely to engage in high risk sexual behaviours. In turn, co-morbid substance use which is present in up to 75% of mentally ill patients is a leading risk factor for sexual risk behaviours. Worldwide methamphetamines are the most commonly used illicit stimulant. Both injectable and noninjectable methamphetamines have evidenced associations with high risk sexual behaviours. Smoking and inhalation of crystal methamphetamine is the predominant mode of use in South Africa. The use of crystal methamphetamine amongst mentally ill persons in Cape Town has escalated over the last decade. We aimed to determine the occurrence of methamphetamine use and risky sexual practices amongst mentally ill patients. In addition we aimed to explore the associations between methamphetamine use and HIV sexual risk behaviours in a sample of mentally ill inpatients in Cape Town, South Africa.

Despite the current interventions to avert contagions and AIDS-related deaths, sub-Saharan Africa is still the region most severely affected by the HIV/AIDS pandemic, where clade C is the dominant circulating HIV-1 strain. The pol-encoded HIV-1 protease enzyme has been extensively exploited as a drug target. Protease inhibitors have been engineered within the framework of clade B, the commonest in America, Europe and Australia. Recent studies have attested the existence of sequence and catalytic disparities between clades B and C proteases that could upset drug susceptibilities. Emergence of drug-resistant associated mutations and combinatorial explosions due to recombination thwarts the attempt to stabilize the current highly active antiretroviral therapy (HAART) baseline. The project aimed at identifying the structural and molecular mechanisms hired by mutants to affect the efficacies of both FDA approved and Rhodes University (RU)-synthesized inhibitors, in order to define how current and or future drugs ought to be modified or synthesized with the intent of combating drug resistance. The rationale involved the generation of homology models of the HIV-1 sequences from the South African infants failing treatment with two protease inhibitors: lopinavir and ritonavir (as monitored by alterations in surrogate markers: CD4 cell count decline and viral load upsurge). Consistent with previous studies, we established nine polymorphisms: 12S, 15V, 19I, 36I, 41K, 63P, 69K, 89M, and 93L, linked to subtype C wild-type; some of which are associated with protease treatment in clade B. Even though we predicted two occurrence patterns of M46I, I54V and V82A mutations as V82A→I54V→M46I and I54V→V82A→M46V, other possibilities might exist. Mutations either caused a protracted or contracted active site cleft, which enforced differential drug responses. The in silico docking indicated susceptibility discordances between clades B and C in certain polymorphisms and non-polymorphisms. The RU-synthesized ligands displayed varied efficacies that were below those of the FDA approved protease inhibitors. The flaps underwent a wide range of structural motions to accommodate and stabilize the ligands. Computational analyses unravelled the need for these potential drugs to be restructured by (de novo) drug engineers to improve their binding fits, affinities, energies and interactions with multiple key protease residues in order to target resilient HIV-1 assemblages. Accumulating evidences on contrasting drug-choice interpretations from the Stanford HIVdb should act as an impetus for the customization of a HIVdb for the sub-Saharan subcontinent.

Stories about HIV are everywhere. They are told (i.e. constructed), heard (i.e. taken in) and then re-told (i.e. shared). It is when we start asking questions about such stories, that new story "versions" become available; to be told, heard and possibly retold. Given the methodological boundaries connected to HIV research, few research studies are able to utilize the research context to venture beyond the mere collection (i.e. hearing) and re-telling (i.e. sharing) of story experiences. As a result, the hidden, alternative story "versions" which are "awakened" during the research process, may remain untold. Over the course of 4 months, the researcher utilized the existing dialogical space of the therapy context, as a practical platform for researching the dominant, as well as the "absent but implicit" meaning of HIV. Through ongoing dialogical interaction, this research journey set out, to not only hear the dominant stories told about HIV, but also to explore the hidden, preferred alternative story "versions". An adolescent girl living with HIV acquired through mother-to-child transmission, collaborated with the researcher to engage in this journey of therapeutic co-research. With this narrative report, I invite you to become an audience member to this unfolding journey. Throughout this report, I used the word "journey" as a guiding metaphor, situating the act of meaning making as a collaborative ongoing process of co-research, rather than a collection of facts. This research report is a narrative in itself and is subdivided into three parts. Part I includes all chapters written before my journey with the adolescent as co-researcher; part II includes all aspects related to our journey as co-researchers; and part III involves the time period after our journey as co-researchers. In part I, chapter 1, I introduce you to my way of speaking (i.e. narrative language), grounded in my way of seeing (i.e. social constructionist paradigm). In chapter 2, I shared with you my own narrative in making sense of HIV through personal reflective journal entries. By doing so, I acknowledge that I, researcher and therapist also tell stories about HIV through my statements, questions and everyday actions and interactions. In chapter 3, I reviewed academic literature in an attempt to research how adolescent HIV is "authored" (narrated) to the public by various academic discourses. In chapter 4, I reviewed narrative research studies of illness stories, relevant to adolescent HIV. Hereafter I stated my research question, justification, aim, and objectives. In chapter 5, I provide an overview of the research process, as was undertaken for the purpose this journey. In part II, I introduce you to "Gabby" (pseudonym), my co-researcher and co-author of this narrative report. Gabby regularly received ART at the paediatric out-patient unit at Kalafong Tertiary Provincial Hospital at the time of our interaction. In chapter 6, I describe the project phase (chapter6), alongside Gabby's participation. The project phase was situated within a narrative social constructionist frame. It consisted of two sub-phases as a means to transform the therapeutic context to one of therapeutic co-research. The first sub-phase stretched over the course of 3 months as Gabby participated in the Collaborative Storybook Development (CSD) project. The CSD project was based on the narrative therapeutic work of Freedman and Combs (1996) on story construction and development. Each session was video recorded for the purpose of co-reflective discussion during the second sub-phase. Focussed co-reflection sessions formed the second sub-phase, which took place once a week and stretched across an additional 1 month period. The aim of this sub-phase was to collaboratively review how storytelling was employed to make sense of HIV throughout the CSD project. Over the course of four months, the project phase allowed for in-depth co-research into the meaning of HIV. Part III documents the time period following our journey as co-researchers. Chapter 7 is a reintegration (telling) of the new knowledge and practical wisdom constructed during the project phase. Such "telling" is done in the form of a storybook. Chapter 8 sheds some light on the narrative practice of reincorporation (sharing). This involved the sharing of new knowledge with audiences outside of the co-research dyad. In chapter 9, I discussed the ethical considerations undertaken in this research. This is followed by a discussion on the shortcomings and limitations of this journey. Based on the practical wisdom gained from this journey, recommendations are made for future endeavours.
Mini Dissertation (MA)--University of Pretoria, 2016.
Psychology
MA
Unrestricted

HIV/AIDS is a global pandemic that poses a great threat especially in Sub-Saharan Africa where the highest population of those infected with the virus is found. It has far reaching medical, socio-economic and scientific implications. The HIV-1 protease enzyme is a prime therapeutic target that has been exploited in an effort to reduce morbidity and mortality. However problems arise from drug toxicity and drug-resistant mutations of the protease which is a motivation for research for new, safer and effective therapies. Evidence exists to show that there are significant genomic differences in Subtype B and C that have a negative effect on the intrinsic binding of inhibitors. It is imperative to look at all perspectives from epidemiological, molecular to the pharmacological ones so as to achieve rational design of therapeutic agents. This study involved the use of in silico structural analysis of the effects of mutations in the active site. The data was provided by the National Institute of Communicable Diseases consisting of HIV-1 Subtype C protease sequences of 29 infants exhibiting drug-resistance to ritonavir and lopinavir. The major active site mutations causing drug resistance identified in this study were M46I, I54V and V82A using the Stanford HIV database tool. Homology modeling without extra restraints produced models with improved quality in comparison to those with restraints. MetaMQAPII results differed when models were visualized as dimers giving erroneous modeled regions in comparison to monomers. A broader study with a larger dataset of HIV-1 subtype C protease sequences is required to increase statistical confidence and in order to identify the pattern of drug resistant mutations. Homology modeling without extra restraints is preferred for calculating homology models for the HIV-1 subtype C. Further investigations needs to be done to ascertain the accuracy of validation results for dimers from MetaMQAPII as it is designed for evaluation of monomers.

Includes bibliographical references (leaves 85-92)
The availability and free-access of ARV-treatment in South Africa has been a signifier of hope amongst fellow South Africans. This in effect has led to the government's assumption that the disclosure of an HIV/AIDS-infected status would be easier due to the treatment's effectiveness. Disclosing an HIV/AIDS-infected status to the individual/s with whom one cohabits with, has thus been made a policy by the government in order to be able to access ARV-treatment. This study examined the psychological challenges associated with disclosing an HIV/AIDS-infected status to the individuals one lives with, and the possible impact that such challenges have on ARV-treatment adherence.

Kenya has a rich and controversial history of HIV vaccine-related research and incidents between researchers, participants and authorities have highlighted pertinent and endemic ethical, legal, social and political issues. The role of the state during these events and in wider vaccine research is unexamined and misunderstood; yet, the state is a deeply involved and dominant party.
My thesis provides a coherent explanation of the role of the state in vaccine research and links recurrent ethical issues to the multiple and competing interests the state has in this activity. I develop multiple roles for the state as a Facilitator, Guardian, Participant, Regulator, Researcher and Sponsor based on a common understanding of the key parties in biomedical ethics. These roles explain the complex state participation and are developed and shaped by crucial influential factors in the environment surrounding HIV vaccine research.
Le Kenya a une histoire riche et controversée à l'égard de la recherche relative au vaccin contre le VIH. En effet, plusieurs incident et conflits entre les chercheurs, les participants et les autorités mettent en évidence les difficultés éthiques, légales, sociales et politiques de la recherche d'un vaccin. Le rôle de l'Etat au cours de ces évènements et en ce qui a trait a la recherche de vaccin en général est non examine et mal compris, et pourtant, l'Etat est une partie profondément impliquée et dominante.
Ma thèse propose une explication cohérente du rôle de l'E tat dans la recherche d'un vaccin et relie les difficultés éthiques récurrentes aux multiplies intérêts concurrents que l'Etat détient a l'egard de cette activité. En se basant sur une compréhension commune des principales parties impliquées en éthique biomédicale, je développe de multiples rôles pour l'Etat en tant que facilitateur, gardien, participant, régulateur, chercheur et mémé commanditaire de l'activité. Ces rôles, expliquant la participant complexe de l'Etat sont façonnes par des facteurs cruciaux et influents provenant de l'environnement qui entoure la recherche d'un vaccin contre le VIH. En effet, l'implémentation de ces rôles créé un environnement propice aux conflits et aux difficultés éthiques.

Vaginal microbicides are pharmaceutical products in development that are designed to reduce the sexual transmission of HIV in women. They are commonly known as a `woman-controlled technology' and tool for women's empowerment, and form part of a burgeoning field of clinical research into new biotechnologies for HIV prevention. Little work has critically examined how such research and new technologies are produced, and how they in turn contribute to the construction, maintenance or deconstruction of gender relations. Adopting a Foucauldian understanding of power and discourse, and using theoretical insights from science and technology studies (STS), this research explores the coproduction of gender and technology through the case study of vaginal microbicides. 'T'his account of the relations between science, society and technology draws on empirical research conducted in the UK and Zambia with the pharmaceutical industry, trialists, trial participants and trial communities. It interrogates the techniques of power through which transnational scientific networks are mobilised to test new products, such as microbicides, and how these affect scientific practices, knowledges and identities across socio-geographic boundaries. It attends to the potential multiplicity of interventions in diverse contexts, calling into question the presumed stability and singularity of both the randomized controlled trial and vaginal microbicides. This research makes an empirical contribution to knowledge about new biomedical technologies for HIV prevention, detailing the transformation that may occur when technologies travel from their site of development to their site of use. It provides a detailed analysis of the interaction between gender performativity and science in action, challenging the sense of `gendered' technologies for a `feminized' epidemic. Theoretically, it contributes to debates about the role of social theory in public health research and reconstructivist agendas in STS, concluding with a model for greater collaboration between health technology designers, evaluators, critics, and users.

Tesis - Doctor en Ciencias de la Salud - Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Secretaría de Graduados en Ciencias de la Salud, 2013
139 h. : il., 29 cm.
The hepatitis C virus (HCV) is considered one of the major causes of chronic hepatitis, cirrhosis and liver cancer. Co-infection with HIV accelerates the progression of liver disease, increases the efficiency of transmission of HCV by non-parental routes and has been associated with the decrease in the effectiveness of HAART. Worldwide, HCV distribution and its molecular pattern are markedly heterogeneous and are continuously changing, due to cultural changes, associated to new risk behaviors, as well as population movements. The aim of this work was to study the prevalence and genetic diversity of HCV infection in HIV co-infected individuals of Córdoba, evaluate its influence on antiretroviral therapy (HAART) and in HCV transmission, and identify possible changes in HCV genotype distribution pattern of Córdoba in the last 10 years. This study included the following samples obtained from patients of Córdoba: a) 349 serum samples from chronically infected individuals collected between 1999-2009; b) 86 serum samples from HCV/HIV co-infected patients obtained from a total of 558 HIV+ patients, collected in 2 periods between 2003-2007; and c) 37 biological fluid samples of HCV moninfected (n=21) and HCV/HIV co-infected individuals (n=16) [cervical swab (n=16), saliva (n=37), seminal plasma (n=21) and peripheral blood mononuclear cells (n=37)]. RT-nested PCR of the 5’ non-coding region (5’ NC) was used for HCV molecular detection. For genomic characterization and subsequent phylogenetic and viral evolution analysis, non-structural 5B and E1/E2 genomic regions were amplified and sequenced.
El virus de la Hepatitis C es considerado una de las principales causas de hepatitis crónica, cirrosis hepática y cáncer hepático. La coinfección con HIV acelera la progresión de la enfermedad hepática, aumenta la efectividad de la transmisión de HCV por vías no parenterales y ha sido asociada a la disminución de la efectividad de la terapia HAART. A nivel mundial, la distribución y el patrón molecular de HCV son marcadamente heterogéneos y se modifican continuamente debido tanto a cambios culturales, asociados a nuevas conductas de riesgo, como a movimientos poblacionales. El objetivo del presente trabajo fue estudiar la prevalencia y la diversidad genética de la infección por HCV en individuos coinfectados con HIV de Córdoba, evaluar su influencia en la terapia antiretroviral (HAART) y en la transmisión de HCV, y detectar posibles cambios en el patrón regional de distribución de genotipos en los últimos 10 años. En este estudio se incluyeron las siguientes muestras obtenidas de pacientes de Córdoba: a) 349 muestras de suero obtenidas de individuos crónicamente infectados por HCV colectados entre 1999-2009; b) 86 sueros de pacientes coinfectados HCV/HIV obtenidos de un total de 558 pacientes HIV+, colectados en dos periodos entre 2003-2007; y c) 37 muestras de fluidos biológicos de pacientes monoinfectados (n=21) y coinfectados HCV/HIV (n=16) [hisopado cervical (n=16), saliva (n=37), plasma seminal (n=21) y células mononucleares de sangre periférica (n=37)]. Para la detección molecular de HCV se utilizó RT-nested PCR de la región 5’ no codificante (5’ NC), y para la caracterización genómica y posterior análisis filogenético y evolución viral, se amplificaron y secuenciaron las regiones no estructural 5B y E1/E2.
Fil: Farías, Adrián Alejandro. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas Instituto de Virología Dr. José María Vanella; Argentina.

Despite the complex and often highly specific nature of the social aspects of the HIV/AIDS pandemic, many projects working in the field do not base their strategies on local evidence, given the paucity of suitable local-level data as well as the presences of organisational constraints. A project offering HIV testing to farm-based communities in Stellenbosch is a case in point. While no prevalence data exists for this sub-population, the assumption was that there may be high levels of infection, following the organisation's experience of AIDS-related illnesses on these farms and the social conditions on wine farms which were thought to produce vulnerability for infection. Some in the organisation also thought that farm-based communities battled to access healthcare. During the first year of providing voluntary counselling and testing (VCT) on wine farms, however, the Stellenbosch Hospice's Farms Project consistently found lower than expected levels of HIV infection. This gave rise to the question being addressed in this thesis - which is what can be 'known' about HIV prevalence in a sub-population for whom there is no evidence-based prevalence data. In practical terms, if modestly-funded local-level organisations1 were able to undertake accessible forms of research, what would they be able to surmise about HIV prevalence among proposed beneficiaries? Taking an unusual approach to research on prevalence, this study employs a minimally positivist approach to investigate what can be 'known' about HIV prevalence on wine farms in the Stellenbosch area. It does so by 1 This term is used to include various forms of organisations - be they nongovernmental, non-profit or service organisations - which are small, relatively survivalist organisations. It may be a church-based organisation, a large communitybased healthcare organisation or a service organisation like a hospice. I do so to differentiate it from the larger, professionalised non-governmental organisations (NGO) which frequently have research capacity. My notional organisation is also not a community-based organisation (CBO), however, which are largely membership-based and whose access to their locations is usually more organic and embedded, while NPOs are invariably staffed by people who do not necessarily live in the locations in which they are intervening. vi triangulating data from the four sources that such an organisation might use, had they the capacity. These sources are published statistics and published articles, the opinions of local 'experts', and their own organisational data - in this case the first year of Farms Project's results. Significantly this does not include the more conventional surveys and statistical modelling, which is beyond this kind of organisation's capacity. After reviewing publicly available prevalence data and showing that there are none for this sub-sector, this study probes the HIV 'risk' and related prevalence data associated with issues of poverty, gender relations, 'race' and alcohol consumption on Stellenbosch wine farms. In addition it presents prevalence data from a sample of farms as well as reviews HIV 'risk' and prevalence in rural areas nationally. In doing so, it critiques the causal links often made between the kinds of social conditions found on farms and HIV infection. On the basis of the data considered and the methods used, the study finds that levels of HIV infection on farms could be expected to be lower than the average prevalence in the Stellenbosch health sub-district. It cautions, however, that this finding is not conclusive, not least as it was unable to consider some significant social conditions - like the movement of people, and effects of socially conscious farmers and the services they provide. In addition it is not generalisable to other South African farms, given the particularity of wine farms and of the Western Cape. The study concludes by noting the limited value of prevalence data to project design, given the range of factors that can affect it at any time, and that it necessarily masks variation within an area or sub-population. While prevalence is useful as a starting point in project design, it is important to disaggregate where infection lies through an analysis of key social conditions. The study concludes by highlighting the importance of this finer analysis for project design in order to avoid strategies founded on poor assumptions, while recognising the difficulty of this for modest organisations.

There appears to be a growing body of literature focusing on PTSD and HIV-related PTSD (the diagnosis of HIV being the significant traumatic event) amongst HIV-positive samples, but only a few African studies that attempt to estimate the prevalence of PTSD amongst HIV-positive people, and even fewer that attempt to estimate the prevalence of HIV-related PTSD. The systemic review presented in this study is currently fully inclusive and is the most up-to-date available. Estimates of the prevalence of PTSD and HIV-related PTSD in South Africa range from 0.7 to 54.1% and, 4.2 to 40% respectively. The current cross-sectional study made use of a mixed-method approach to investigate traumatic life events, PTSD and HIV-related PTSD within a primary health-care centre in KwaZulu-Natal. The quantitative sample consisted of 159 adults (18-50 years) who were compliant on ARV medication. Using the CIDI-PTSD module, the adapted CIDI-PTSD module for HIV, and IES-R, findings indicated that 62% had reported some kind of traumatic event in their lifetime, with 29.6% of participants meeting the criteria for lifetime PTSD, and 40.9% meeting the criteria for lifetime HIV-related PTSD. Altogether, 57.9% of individuals met the criteria for some form of PTSD (either regular PTSD or HIV-related PTSD), and 12.6% met the criteria for both PTSD and HIV-related PTSD. Of the different categories of traumatic events, interpersonal violence has the highest rate of PTSD, followed by a diagnosis of and living with HIV, and then disaster. Furthermore, the IES-R was compared for its usefulness as a screening measure for PTSD against both the CIDI, but results suggest that it is an inferior screening measure to the PDS. The qualitative study consisted of six participants who were examined using IPA methodology informed by the Ehlers and Clark (2000) Model of trauma. Their experiences revealed experiences of stigma, a number of negative appraisals, negative emotions and coping behaviours. Some of the latter might serve as compensatory mechanisms to avoid negative judgements. Hypervigilance seems to be a feature of ARV-compliance that might confer added vulnerability to PTSD and other anxiety disorders.

No Brasil, como em diferentes partes do mundo, observa-se que a epidemia da aids atinge de forma crescente o segmento feminino, apesar das ações para deter sua disseminação. Uma das limitações das intervenções de controle foi a utilização do conceito de risco para nortear as ações preventivas à transmissão do Human Immunodeficiency Virus (HIV), uma vez que não incorporavam a possibilidade de resposta social no seu enfrentamento e eram direcionadas para uma parcela da população, excluindo outros grupos sociais, gerando estigma e discriminação. O conceito de vulnerabilidade surgiu posteriormente ao conceito de risco, tendo como pressuposto que todas as pessoas são vulneráveis ao HIV e que a infecção é determinada por três planos interdependentes - dimensão individual, social e programática. Este trabalho teve como objetivo identificar os elementos da vulnerabilidade feminina ao HIV/AIDS, por meio de uma revisão sistemática da literatura denominada metassíntese. Realizou-se uma busca exaustiva nas bases de diferentes áreas de conhecimento: CINAHL; PubMed, OVID, Web of Science, LILACS, CAPES-BDTD, DEDALUS, no período de 1996 a 2007. Após o teste da estratégia de dados e análise dos estudos foram selecionados 54 estudos realizados na América do Norte, do Sul e Central, África e Ásia. Identificaram-se 44 elementos que, na interação, determinaram a vulnerabilidade feminina ao HIV. O agrupamento desses elementos, segundo sua temática central, resultou em: normas sociais; imigração; contexto do relacionamento estável; condição socioeconômica insuficiente; contexto socioeconômico do país; gestão dos serviços de saúde. Constatou-se que os elementos determinaram a vulnerabilidade da mulher ao HIV de forma semelhante, independente das faixas etárias e do país em que foram desenvolvidos e estiveram presentes ao longo do tempo. As pequenas diferenças nas associações entre os elementos corresponderam às características do contexto social das mulheres estudadas. No entanto, no cálculo do tamanho do efeito por temática, identificou-se que os elementos da vulnerabilidade ao HIV relacionados ao \"contexto do relacionamento sexual estável\", à \"condição socioeconômica insuficiente\" e às \"normas sociais\", influenciaram de forma intensa a vulnerabilidade feminina ao HIV. A metassíntese permitiu identificar os elementos da vulnerabilidade definidos previamente, distribuí-los nas três dimensões e identificar outros, entre os quais se destaca a migração.
In Brazil, as in different parts of the world, it has been observed that the aids epidemic has been growing among the female segment, despite the actions to deter its dissemination. One of the limitations of the interventions of control was the utilization of the risk concept for guiding the preventive actions in the transmission of Human Immunodeficiency Virus (HIV). The risk concept does not incorporate the possibility of social response in its confrontation, and has been directed to only a small parcel of the population thereby, excluding other social groups thus generating stigma and discrimination. The vulnerability concept appears, after the risk concept, having as a predisposition that all people are vulnerable to the HIV and, that infection is determined by three interdependent plans - individual, social and programmatic dimension. This research had as its objective, to identify the elements of female vulnerability to HIV/AIDS, by way of a systematic revision of literature known as metasynthesis. An exhausting search in the bases of different knowledge areas was done: CINAHL; PubMed, OVID, Web of Science, LILACS, CAPES-BDTD, DEDALUS, from 1996 to 2007. After the data strategy test and study analysis, 54 studies performed in North, South and Central America, Africa and Asia were selected. Forty Four elements were identified, that through interaction determined the female vulnerability to the HIV. The grouping of these elements, according their central thematic, resulted in: social norms; immigration; context of a steady relationship; insufficient socioeconomic conditions; socioeconomic context of the country; management of health services. It was evidenced that these elements determined the vulnerability of women to the HIV in a similar manner, independent of the age group and the country where they were performed. They had been present for the duration of the time. The little differences in the associations between the elements corresponded to the characteristics of the social context of the women studied. However, in the calculation of the size of effect for thematic it was identified that the elements of vulnerability to the HIV were related to the \"context of a stable sexual relationship\", \"insufficient socioeconomic conditions\" and \"social norms\" had strongly influenced the female vulnerability to the HIV. Metasynthesis has allowed the identification of the elements of vulnerability previously defined, distributes them in three dimensions and identifies others, of which highlight the migration.

Thesis (MBA (Business Management))--Stellenbosch University, 2008.
The government has identified the need to transform the South African economy from one that is primarily resource based to one that is knowledge-based and has formulated a 10 year plan in order to accomplish this objective. The plan involves the creation and funding of five theme-specific consortium-based centres of competence that focus on the five top national health priorities, linked to the growth of the local pharmaceutical industry. This research study proposed that if collaboration and communication between academic researchers and the biotechnology industry in South Africa was improved it would lead to an increase in the development of innovative products for HIV/AIDS prevention and treatment. The objective of the study was the development of a strategy for a centre of competence for HIV research and development that brings together academic researchers and industry in a public private partnership and that will enable the proposal to be tested. Centre of competence programmes in both developed and developing countries, including Sweden, Austria and Estonia, were reviewed. The success factors for the various programmes were discussed. The strategic planning analysis began by considering the mandate of the CoC for HIV R&D. The requirements and expectations of the DST in establishment of the centres of competence were examined. An analysis of the external environment relevant to the South African biotechnology industry was then performed. This involved a detailed macro-environmental analysis in which political, economic, social, technological and environmental factors were considered. It was followed by an analysis of the current biotechnology industry in South Africa. The industry’s dominant economic features were identified as were its future driving forces. In a competitive environment analysis the South African biotechnology industry was found to be extremely competitive. Two industry issues, price controls and access to capital, were identified and discussed. The industry key success factors identified included access to large and sustained capital, attracting and retaining talented employees, an efficient and high quality regulatory authority, continued government support, productive and appropriate partnerships and skilled intellectual property management. An internal environment analysis was performed which identified competencies and resource strengths of the CoC for HIV R&D, including the high level of academic research in the HIV/AIDS field and expertise in clinical trials of HIV/AIDS products. Competitive deficiencies and resource weaknesses identified included shortages of skills and talent and the lack of co-ordination for funding of HIV/AIDS research. The analysis of the internal environment continued with the examination of the internal value chain of the CoC for HIV R&D. This consisted of discovery, pre-clinical development and clinical development stages. Gaps in the value chain were identified, including the lack of facilities for high-throughput screening of compounds for anti-HIV activity, lack of pre-clinical testing facilities and lack of manufacturing plants capable of producing products for use in clinical trials. The results of the external and internal environment analysis were used in a SWOC analysis and a number of strategies were identified to capitalise on opportunities and to address challenges. A subsequent competitive strength assessment identified a competitive advantage in the formation of the CoC for HIV R&D. In addition a number of strategic issues facing the centre were identified and ways to address or manage the issues were proposed. The strategic planning process was completed by the selection of a strategic approach for the CoC for HIV R&D. The study concluded that a PPP of public and private organisations operating under a corporate strategy of related diversification developed and implemented by the CoC for HIV R&D, would be suitable for testing the Proposal. The study’s conclusion also highlighted the need to ensure that the CoC for HIV R&D receives a long term commitment of funding from public sources, and that is managed by an experienced team with strong leadership skills. Important strategies emerging from the study and specifically from the SWOC analysis were development of a national HIV research plan and funding of the highest priority projects; focusing research funding on research with greatest potential for generation of HIV/AIDS products; and establishment of new technology platforms to fill gaps in the value chain. Finally, a number of recommendations were made for implementation of the results of this study or as the basis for further study.

Thesis (M.A.)--Indiana University, 2008.
Title from screen (viewed on June 2, 2009). Department of Philosophy, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Richard B. Gunderman. Includes vita. Includes bibliographical references (leaves 39-40).

This qualitative research study focuses explicitly on understanding the experiences and perceptions of urban Aboriginal women living with HIV/AIDS. Stigmatizing attitudes and language have serious impacts upon the lives of HIV-positive Aboriginal women. The ways our society presently addresses the women needs to change. With the insights and assistance of four Aboriginal women living with HIV, this project adds to the presently sparse qualitative literature in this research area. Current research indicates that there are many factors associated with urban Aboriginal women being at higher risk for infection and lower physical and mental health, such as race, socio-economic conditions, isolation, oppression and violence, family history, substance abuse, discrimination, and often the responsibilities of childrearing. However, current research analysis and presentation is insufficient, and more in-depth questions arise. Material was collected using semi-structured, open-ended questioning conversations with the participants. Two guiding research questions were asked: 1) What is it like for you, living with HIV right now? and 2) What would you want other people to learn from your experiences? The women’s stories provide an avenue for participants to voice some of their triumphs and challenges about being an Aboriginal woman living with HIV/AIDS. For the community at large, this is also an opportunity to hear first hand, important information such as this. In this work, I have tried to adhere to the tenets of Indigenous methodologies by allowing the life-stories to resonate as holistic representations. Rather than deconstructing the women’s stories through naturalistic analysis (which continues to categorize and to objectify participants), the stories are viewed through a Health Narrative Topography whereby thematic genres such as Restitution, Chaos, and Quest are illuminated, while also being critically aware of some of the limitations to this framework. Three overarching themes are revealed through the women’s stories: 1) the empowerment and resiliency demonstrated by the participants; 2) the need for cultural competency in a society that continues to stigmatize Aboriginal and HIV-positive women; and, 3) the need for a more holistic approach within society when it comes to education, learning, and healing.

Orientador: Claudinei José Gomes Campos
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A sociedade se questionava, diante de uma nova doença que se disseminava rapidamente, com alta taxa de letalidade, gerava intensas emoções de pânico, medo e de contágio. Aids era uma doença que estava associada a grupos considerados discriminados e marginalizados, como os homossexuais, usuários de drogas injetáveis e as prostitutas. Essa forma de representá-la mobilizou sentimentos e preconceitos. Esta pesquisa estudou o significado da utilização de grupos no contexto ambulatorial, para pessoas que vivem com HIV/Aids, sob a ótica do portador, sendo este um recurso para ajudar e assistir as pessoas em suas necessidades. A população de estudo foi constituída por pacientes do ambulatório de DST/ Aids , envolvidos no processo de grupo junto ao serviço social do HC da Unicamp. Teve como objetivos: Analisar o significado atribuído desta utilização para a vida social do portador, analisar a motivação do portador em relação a sua permanência no grupo pelos depoimentos dos usuários. Para este fim utilizamos a metodologia de pesquisa qualitativa, priorizado o método clínico-qualitativo a fim de abordar a opinião e os valores dos atores. Realizou-se entrevista semi-estruturada com perguntas previamente formuladas e associadas à abordagem livre sobre o tema. Para análise, interpretamos a reprodução da fala dos sujeitos, relacionando-as com as estruturas sociológicas dos enunciados das mensagens presentes, fazendo a análise de conteúdo, articulando os objetivos da pesquisa e a base teórica adotada. Os resultados demonstraram que segundo os entrevistados, a atividade grupal traz reais mudanças para a vida do portador em um âmbito pessoal, psicológico e social.
Abstract: The socyet was questioned before a new disease that was spreading rapidly, with high fatality rate, generated intense emotions of panic and fear of contagion. Aids was a disease that was linked to groups considered discriminated and marginalized groups such as homosexuals, intravenous drug users and prostitutes. This way of representing it mobilized feelings and prejudices. This research studied the meaning of the use of groups in the outpatient context, for people living with HIV / Aids from the perspective of the bearer, being a resource to help and assist people in their needs. The study population consisted of outpatients from the DST/ Aids, involved in social service group with the HC Unicamp. Aimed to assess the meaning assigned to that use to the social life of the bearer, to analyze the patients motivation for staying in the group by testimonials from users. To this end we use the qualitative research methodology, prioritized clinical-qualitative method in order to address the beliefs and values of the actors. Held semi-structured interview with questions related to the previously formulated and free approach on the issue. For analysis, we interpret the speech reproduction of subjects, relating them to the sociological structures of the utterances of these posts, making the content analysis, linking the research objectives and theoretical basis. The results showed that according to those interviewed, the group activity offers real change for the life of a carrier in the personal, psychological and social.
Mestrado
Enfermagem e Trabalho
Mestre em Enfermagem

Human immunodeficiency virus type 1 (HIV-1) is responsible for the acquired immunodeficiency syndrome (AIDS), a leading cause of death worldwide infecting millions of people each year. Despite intensive research in vaccine development, therapies against HIV-1 infection are not curative and the huge genetic variability of HIV-1 challenges drug development. Current animal models for HIV-1 research present important limitations, impairing the progress of in vivo approaches. Macaques require CD8+ depletion or large portions of the genome to be replaced by sequences derived from simian immunodeficiency viruses to progress to AIDS, and the maintenance cost is high. Mice are a cheaper alternative, but need to be 'humanized' and breeding is not possible and knockout experiments are difficult. The development of an HIV-1 clone able to replicate in mice is a challenging proposal. The lack of human co-factors in mice impedes function of the HIV-1 accessory proteins Tat and Rev, hampering HIV-1 replication. The Tat and Rev function can be replaced by constitutive/chimeric promoters, codon-optimized genes and the constitutive transport element (CTE), generating a novel HIV-1 clone able to replicate in mice without disrupting the amino acid sequence of the virus. By minimally manipulating the genomic 'identity' of the virus, we propose the generation of an HIV-1 clone able to replicate in mice to assist in antiviral drug development. My results have determined that murine NIH 3T3 cells are able to generate pseudotyped HIV-1 particles, but they are not infectious. Codon-optimized HIV-1 constructs are efficiently made in human HEK-293T cells in a Tat and Rev independent manner and capable of packaging a competent genome in trans. CSGW (an HIV-1 vector genome) efficiently generates infectious particles in the absence of Tat and Rev in human cells when 4 copies of the CTE are placed preceding the 3’LTR. HIV-1 replication competent genomes lacking tat expression and encoding different promoters are functional during the first cycle of replication when Tat is added in trans. Finally, we developed a replication competent HIV-1 clone lacking tat and rev genes and encoding 4CTEs that could be a future candidate for HIV research. My results shown that the development of an HIV-1 Tat-Rev independent clone could become a candidate for HIV research in a near future, but further investigations are necessary before proposing our model as an alternative yet.

Includes bibliographical references.
This study describes a Participatory Action Research (PAR) project that was conducted in Masiphumelele (an informal settlement near Cape Town) in 2003/2004 with a group of 5 black, HIV positive people. The original aim of the study was to facilitate an empowerment process aimed at helping the participants find some solutions to their problems. PAR is, however, an unpredictable process that is shaped by the participants and thus often reaches entirely different outcomes from the original goals of the process. This study encountered a number of challenges which necessitated a change in the aims and of the study. The most serious challenge was the withdrawal of the participants halfway through the study due to financial reasons. Because of this, it was not possible to reach the original goal of seeking solutions to the participants problems. The research aims were therefore adjusted to the following: • To create an opportunity for a group of people living with HIV/AIDS to engage in a participatory process aimed at self-awareness and empowerment. • To record and analyse this process with the intention of producing insight into the use of PAR in the context of poverty and HIV/AIDS and to identify the challenges involved. At the stage the participants withdrew, the researcher had conducted 5 focus group discussions, which had been recorded and transcribed. In the focus groups, the participants had described their circumstances and their needs and had started to discuss what problems they would like to address. The researcher achieved closure by negotiating with the participants that she would analyse the data and return to give feedback. Two further focus groups were conducted some time later, at which this feedback was given and the participants were asked to comment on their experience of the process. The participants were also consulted on the utilisation of the findings and they decided that they would like to participate in distributing the findings to their community. A number of recommendations for future PAR studies are drawn from this research.

Orientador: Marli Teresinha Cassamassimo Duarte
Resumo: Justificativa: Apesar de todos os esforços no combate ao tabagismo, em diversos países a prevalência de tabagistas na população com HIV/aids é elevada, aumentando a taxa de mortalidade nestes indivíduos, pois estes estão mais suscetíveis aos perigos do tabaco do que as pessoas não infectadas. O consumo do cigarro pode estar associado a diversos fatores como: baixo nível socioeconômico e de escolaridade, uso de drogas ilícitas e álcool, sintomas de depressão e falta de acesso aos serviços de saúde. O tabagismo é fator de risco que pode ser modificado e evitado. No Brasil há escassez de estudos de prevalência nas pessoas que vivem com HIV/aids, mas a hipótese é que este número também seja elevado. Objetivos: Analisar a prevalência do tabagismo em pessoas infectadas pelo HIV/aids; avaliar o grau de dependência da nicotina; avaliar o estágio de motivação relacionado à cessação de fumantes; analisar fatores associados ao tabagismo; compreender as representações sociais do tabaco em pessoas que vivem com HIV/aids tabagistas. Metodologia: O estudo foi realizado em duas etapas. A etapa I tratou-se de estudo exploratório e transversal e a II de estudo qualitativo. Foi desenvolvido no Serviço de Ambulatórios Especializados de Infectologia “Domingos Alves Meira”, que atende uma região de 30 municípios, com pacientes infectados pelo HIV/aids. Os dados foram obtidos por meio da aplicação de formulários a uma amostra calculada de 200 pacientes e participaram da etapa II do estudo 38 pacien... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Justification: Despite all efforts in the fight against smoking, in several countries the prevalence of smokers in the population with HIV / AIDS is high, increasing the mortality rate in these individuals since they are more susceptible to tobacco dangers than non-smokers. infected. Cigarette smoking may be associated with several factors such as low socioeconomic status and schooling, use of illicit drugs and alcohol, symptoms of depression and lack of access to health services. Smoking is a risk factor that can be modified and avoided. In Brazil, there is a shortage of prevalence studies among people living with HIV / AIDS, but the hypothesis is that this number is also high. Objectives: To analyze the prevalence of smoking among people infected with HIV / AIDS; evaluate the nicotine dependence degree; evaluate the stage of motivation related to smoking cessation; analyze associated smoking factors; understand the social representations about tobacco among smokers with HIV / AIDS. Methodology: The study was carried out in two stages. Stage I was an exploratory and cross-sectional study, and the second was a qualitative study. It was developed in the Specialized Outpatient Clinic of Infectious Disease "Domingos Alves Meira", wich serves a region of 30 counties with patients infected by HIV / AIDS. The data were obtained through the application of forms to a calculated sample of 200 patients and participated in stage II of the study 38 smokers, whose sample was obtained by s... (Complete abstract click electronic access below)
Doutor

Aquesta tesi doctoral versa sobre epidèmies simultànies i la interacció biològica i epidemiològica en espai, població i temps en països de escassos recursos. Aquesta tesi aborda la implementació de diferents models assistencials per cobrir les necessitats de les poblacions afectades. La tesi s’ organitza com a compendi de 6 publicacions (4 articles publicats i 2 en procés de publicació) sobre infeccions de transmissió sexual (ITS), VIH i tuberculosi (TB). Hi ha dues parts diferenciades, la part de ITS/VIH i la part de VIH/TB amb l’ VIH com a nexe d’ unió. Les dues publicacions de la part de ITS/VIH son conseqüència de la feina de camp realitzada a Guatemala al 2012, i les 4 publicacions (2 articles publicats i 2 en procés de publicació) de la part de VIH/TB es deriven de estudis a Malawi, i treball de camp realitzat a Guatemala durant el 2013-2015 i Moçambic durant el 2017-2019. La primera part de la tesi analitza el maneig clínic i epidemiològic d les ITS i VIH a Guatemala i l’efectivitat de la integració a nivell comunitari dels serveis assistencials en ITS/VIH amb l’ objectiu de disminuir la prevalença de ITS/VIH en poblacions de risc. Es discuteix la importància de la integració de dades biològiques i conductuals per a la vigilància epidemiològica i el maneig clínic, posant especial èmfasi l’ obtenció de dades precises per guiar l’ ús efectiu dels recursos en la implementació de estratègies de prevenció i control. La segona part de la tesi avalua les activitats de col·laboració recomanades en TB/VIH; una línia de recerca és la integració de serveis assistencials de TB i VIH i el seu impacte sobre la incidència de TB i la mortalitat de persones amb VIH; l’ altre línia de investigació és la recerca activa de casos de TB (estratègia recomanada per la organització mundial de la salut), a través de la avaluació de les avantatges i desavantatges de 2 proves diagnostiques de TB per a la seva implementació com a proves ràpides en centres de salut de països amb escassos recursos.
Esta tesis doctoral versa sobre epidemias simultáneas y sus interacciones biológicas y epidemiológicas en espacio, poblaciones y tiempo en países con escasos recursos. Esta tesis aborda cómo distintos modelos asistenciales pueden ser implementados para cubrir las necesidades de salud de las poblaciones afectadas. Esta tesis se organiza como compendio de 6 publicaciones (4 artículos publicados y 2 en proceso de publicación) sobre infecciones de transmisión sexual (ITS) y VIH (Virus de la inmunodeficiencia humana), y sobre VIH y tuberculosis (TB). Hay dos partes diferentes: la parte ITS/VIH y la parte VIH/TB con el VIH como nexo de unión. Las 2 publicaciones de la parte de ITS/VIH se derivan del trabajo de campo realizado en Guatemala en el 2012 y las 4 publicaciones, (2 artículos publicados y 2 en proceso), de la parte de VIH/TB se derivan de estudios en Malawi y trabajo de campo realizado en Guatemala durante el 2013-2015 y Mozambique durante el 2017-2019. La primera parte de la tesis analiza la cascada de cuidados del VIH en Guatemala durante 2005-2012 y la efectividad de la integración a nivel comunitario de servicios asistenciales en ITS/VIH con el objetivo de disminuir la prevalencia de ITS/VIH en poblaciones de alto riesgo. Se discute la importancia de la integración de datos biológicos y de conducta sexual para, tanto la vigilancia epidemiológica como el manejo clínico de ITS/VIH, poniendo especial énfasis en la importancia de obtener datos precisos para guiar el uso efectivo de recursos en la implementación de estrategias de prevención y control en salud pública. La segunda parte de la tesis evalúa la implementación de actividades colaborativas recomendadas en TB/VIH. Por un lado, se discute el efecto de la integración de modelos asistenciales en TB y VIH y su impacto sobre la incidencia de TB y la mortalidad en personas viviendo con VIH. Por otro lado, se discute la búsqueda activa de casos de TB, [(estrategia recomendada por la organización Mundial de la Salud (OMS)], a través de la evaluación riesgos y beneficios de 2 pruebas diagnósticas para su implementación como pruebas diagnósticas rápidas en centros de salud de países con escasos recursos.
This thesis research is about the burden of co-occurring epidemics affecting resource-constrained settings and the forces driving them into and excess burden of disease morbidity and mortality. This thesis research presents and discusses models to effectively deliver health care according to the needs of the populations attended and available resources. This thesis is organized as a compendium of six publications (4 peer reviewed published papers and 2 manuscripts submitted for publication) related to human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) and to HIV and tuberculosis (TB). There are 2 differentiated parts: the STIs/HIV part and the HIV/TB part with HIV infection as a link for both parts. Two publications for the STIs/HIV part arise from field work studies in Guatemala in 2012 and 4 publications (2 published manuscripts and 2 submitted manuscripts) for the HIV/TB part arise from data from Malawi, and the field work performed in Guatemala during 2013-2015 and Mozambique during 2017-2019. The first part of the thesis analyses the cascade of HIV care in Guatemala for 2005-2012 and the effectiveness of integrated, community-based STIs/HIV joint interventions to decrease prevalence trends in STIs/HIV in key populations. The importance of integrated STIs/HIV biological and behavioural surveillance for clinical management and programmatic health care delivery performance is also discussed. Finally, it is emphasized the need of accurate data to inform and guide public health policies and interventions to effectively allocate resources for prevention and control strategies. The second part of this thesis evaluates recommended TB/HIV collaborative activities and interventions. One line of research is the assessment of current models of TB/HIV services integration using TB incidence and mortality outcomes in people living with HIV (PLHIV). The other line of research is one of the three “I’s” of the World Health Organization’s (WHO) three “I’s” strategy, that is, intensified TB case finding; two diagnostic tests for TB screening in PLHIV are presented as well as discussion about their risks and benefits to be implemented as point-of-care (POC) tests in health care centres in resource-constrained settings.

Bakgrund: HIV (Human Immunodeficiency Virus) är en sjukdom som påverkar människors immunförsvar. Ca 30–35 miljoner människor lever med HIV i världen. HIV är en sjukdom som påverkar de drabbade både psykiskt och fysiskt. Syfte: Att beskriva vuxna patienters upplevelser av att leva med HIV med fokus på psykiska och fysiska aspekter samt beskriva hur undersökningsgruppen ser ut i de valda artiklarna. Metod: En beskrivande litteraturstudie baserat på 10 vetenskapliga artiklar med kvalitativ ansats. Databasen Cinahl användes till litteratursökningen. Huvudresultat: Resultatet i denna litteraturstudie visade att människor som lever med HIV känner rädsla, depression, oro och stress över att leva med sjukdomen. Känslorna kopplas till upplevelser av stigmatisering och diskriminering från vården och samhället. Människorna som lever med HIV är ofta rädda för hur de blir bemötta av allmänheten. Fysiska symtom som till exempel trötthet påverkar människor som lever med HIV negativt, och förmågan att leva ett normalt liv blir förhindrat. I litteraturstudien presenteras undersökningsgruppen tydligt utifrån vad författarna till de granskade studierna beskrivit. Slutsats: HIV-positiva personer kan mötas i alla vårdinsatser. Känslor av bland annat skuld och skam förekommer ofta hos personer med HIV. Som sjuksköterska är bemötandet av människor med HIV väldigt viktigt.
Background: HIV (Human Immunodeficiency Virus) is a disease that affect the human immune system. Around 30–35 million people are living with HIV in the world. HIV affects people, both mentally and physically. Aim: To describe adults/adult patients experiences of living with HIV, focusing on mental and physical aspects, and to describe how the study group looks in the selected studies. Method: A descriptive literature study, based on 10 scientific articles with qualitative approach. The database that was used to find the articles was Cinahl. Main Results: The result of this literature study shows that people living with HIV daily feel emotions of fear, depression, anxiety and stress due to living with the disease. The emotions connect directly to experiences of stigmatization and discrimination within the healthcare and community. People living with HIV are often afraid how other people will react their disease. Physical symptoms like fatigue affect their everyday life negative, and the ability to live a normal life is prevented. The study group is clearly presented based on what the authors of the audited studies describes. Conclusion: HIV-positive people can be found in all healthcare facilities. Emotions of guilt and shame often occure with people who are living with HIV. As a nurse, the attitude towards people with HIV is very important.

Background: After three decades, Human Immunodeficiency Virus (HIV) continues to pose significant threats globally. The efforts to curb the HIV epidemic have required investment in research, with clinical trials being a major focus, to develop HIV prevention, treatment, and cure interventions. A large portion of such research has been undertaken within low income settings, due to the high burden of HIV and the availability of willing volunteers within this setting. HIV research calls for the implementation of ethical research practice which is informed by policy guidelines. However, current policies are largely informed by inputs from high income countries, and lack the voices of those closely involved in research implementation. In order to contribute to ethics policy development in HIV research, it is essential to involve different stakeholders by exploring their experiences/views on the issue. Existing research in this field has mainly explored experience of recruitment and trial conduct, while very little has been done on trial closure, indicating a significant evidence gap worth exploring. This research therefore sought to illuminate, explore and understand the significant issues regarding the care of HIV positive drug trial participants during closure of HIV clinical trials, within a low income setting, specifically, Uganda. Study aim: The study aimed to explore how care is perceived and enacted in HIV drug trial closure in Uganda, by addressing the following specific objectives: 1. From the perspective of research participants and research staff, to explore the views, opinions and understandings of the ethical/legal/moral post-trial obligations in HIV drug trials. 2. From the perspective of research staff, to explore the experiences, practices and processes related to care for HIV drug post-trial participants in a low income setting. 3. From the perspective of research participants, to explore the experiences of care at trial closure. 4. From the perspective of research participants, to explore the experiences of transitioning from HIV research to care/community. Methodology: The study adopted an interpretive-constructivist approach, and employed a social constructivist grounded theory methodology. The study included a total of 21 trial participants and 22 research staff from three different HIV drug trials, in two Ugandan research institutions. In addition, relevant ethical documents were reviewed from two of the included trials. Data collection and analysis followed the principles of grounded theory, with data collection and preliminary analysis being undertaken concurrently, and earlier data informing subsequent data collection. Data collection strategies included individual interviews, focus group discussions, and key informant interviews. Data was collected over a period of 10 months, from October 2014 to August, 2015. NVivo10 software was used to manage the data. Ethical approval was received from the University of Nottingham UK and The AIDS Support Organization (TASO) Uganda, Research Ethics Committees (RECs). The study was registered with the Uganda National Council for Science and Technology (UNCST), as SS 3608. Permission to conduct the research was granted by the respective research institutions, and written informed consent was received from all respondents. Findings: The findings showed that trial closure was often stressful for HIV positive participants in Uganda, and often resulted in negative psychological, socio-economic and health impacts. The negative effects mainly resulted from being stopped from accessing research related health care, which was of a significantly higher quality, and the inability to find alternative care to match the research standards. The main concerns which arose during the transition process of participants from HIV drug trials to usual care facilities include: the loss of the quality care and valued relationships in research, the need to find and link to alternative care facilities, the need to meet the increased financial needs, and worries about the effects/outcomes of research participation. These concerns demanded a range of additional care and supportive strategies from researchers (and other stakeholders). A conceptual model, the model of ‘Facilitated Transition’ was developed, which summarises the findings of this research and provides a diagrammatic representation of the research findings, showing the links and relationships between the different elements. The research established that the transition of HIV positive trial participants from research to usual care facilities is a process, which appears to consist of three overlapping phases. These phases include: The pre-closure phase which represents events occurring before the actual trial closure but that underpin post-trial care, the trial closure phase which is the active phase of the closure, in which trial participants are prepared and exited from the trials, and the post-trial phase which represents the events occurring after trial participants have been linked to post-trial care facilities until 12 months later. These phases are demarcated by specific time points, which reflect how the transition process evolves, proceeds and concludes. At the various phases of the process, specific concerns (care needs) arise, being influenced by the participants’ previous care experiences and perceptions, plus their health and socio-economic positions. Specific actions are required to proactively facilitate trial participants during these phases. These actions are underpinned by the perceived ethical and moral responsibilities of the researchers, and are principally aimed at establishing a continuum of HIV care and treatment after trial closure, promoting positive care experiences for trial participants during the transition, and enabling the settlement and adaptation of trial participants to care in the public healthcare system. Conclusions: This is the first known study to investigate perspectives on post-trial care among HIV positive trial participants in a low income setting, from those closely engaged in the research process. This study has provided novel contributions in the area of HIV research ethics and post-trial care in general. The study has established that trial closure involving HIV positive participants raises significant ethical, moral and practical concerns in the Ugandan context. The findings further demonstrated that current post-trial care practice does not meet all the care needs of the HIV positive trial participants. Existing ethical recommendations on post-trial care place an emphasis on the need to ensure access to trial drugs and provision of trial results, where as less attention is given to other important aspects, as revealed in this research. To meet the post-trial care needs of HIV positive participants in Uganda, a comprehensive trial closure strategy is required. In addition to the already existing aspects of post-trial care, the new strategy should aim to: (i) address the financial needs of trial participants through financial assessment, support and empowerment, (ii) provide practical support during linkage to post-trial care, and (iii) offer post-trial follow-up to monitor and support the participants. Implementing these recommendations may require involvement of various stakeholders, including researchers, ethics authorities, research funders and donors, public healthcare workers, families, trial participants, and the community. Recommendations for future research: Further research is required to ascertain the rates of linkage to care, and to assess the health outcomes of post-trial participants following trial exit. In addition, a study to target the views of other stakeholders, such as the public healthcare facility workers, the family, and ethics authorities on post-trial care may be essential to understand better the ways in which to support HIV positive trial participants in Uganda. Furthermore, a longitudinal prospective study on a larger sample is required to test the model proposed in this research. And finally, there is need to deliberate more on the ethical and moral implications of financial benefits in HIV research involving HIV positive participants in a low income setting.

Research has identified a strong correlation between HIV/AIDS and gender-based violence, yet few studies centre the experiential knowledge of HIV sero-positive women and practitioners. This thesis, based on fieldwork conducted in the Gambia, is grounded in data on HIV positive women's experiences of violence and practices of resistance, revealing context specific complexities and challenges. Data collection methods included diaries, focus groups and in-depth individual interviews with a participant group of sixty sero-positive women in six Gambian HIV Support Societies, and twenty field practitioners working in the areas of violence and HIV/AIDS. I argue in this thesis that there are intersecting underlying factors (patriarchy, gerontocracy and structural violence) that contribute to women's experiences of violence and abuse that render them vulnerable to HIV. In addition, that alongside the more visible gendered violences which intersect with HIV/AIDS. Accounts of women living with HIV revealed that stigma is discreditable and discredited attributes. It contends that stigma should be seen as an ‘everyday' practice of normalised violence, which has very harmful emotional, psychological, economic and physical effects. The research also suggests that violence against women in the context of HIV is not limited solely to male perpetrators. In the Gambia there has been limited success in the translation of women's rights agendas into concrete and effective interventions, partly due to a lack of attention to socio-cultural context and the lived experiences of HIV positive women. The thesis concludes that culturally specific, integrated health and social justice approaches are necessary, which are grounded in women's everyday practices of agency and resistance, and which in particular address the fear of dethronement (loss of power, privileges and prestige) amongst men and older members of society.

To date, traditional behavioral interventions have done little to reduce the prevalence and transmission of HIV among African American men who have sex with men (AAMSM), a highly at risk group. Some researchers theorize that the lack of success may be because these interventions do not address contextual factors among AAMSM. Community-based participatory research (CBPR) is one approach to research with the potential to lead to effective interventions in the future. CBPR is a collaborative, mixed-methods and multidisciplinary, approach to scientific inquiry, which is conducted with, and within, the community. The current study follows the CBPR approach to engage and develop a relationship with the African American communities in the Dallas/Fort Worth Metroplex. Contextual issues were discussed in order to identify emerging themes regarding HIV health related issues among AAMSM to provide the groundwork for continued CBPR research and future interventions with AAMSM in the Dallas/Fort Worth Metroplex. To accomplish this goal, researchers began the CBPR process by conducting interviews and focus groups with a sample of approximately 62 (34 from key informant interviews, 28 from focus groups [gender balanced]) AIDS service organization leaders and workers, advocates, medical doctors and community members with first-hand knowledge of HIV health issues in the AAMSM community. Transcripts of these interviews and focus groups were analyzed to identify emerging themes at the societal (religious doctrine, African American Culture, age-related norms and stigma), community (education, religious views/policy and community norms) and individual (disclosure, personal identity, sexual behavior/risk, accessing care and communication) levels. This data was used to create a holistic narrative report that will be used to direct the community advisory board (CAB) and guide future research and interventions.

Child mortality can be used to measure the level of social development as well as the health status of children (Hill 1991). By world regions, sub-Saharan Africa maintains the highest rates of under-five mortality. Current under-five mortality is estimated at 76 deaths per 1,000 live births (Hug, Sharrow, Zhong et al. 2018). In Zambia, under-five mortality reached a peak of 197 in 1996 and is currently estimated at 60 (Hug, Sharrow, Zhong et al. 2018). On the world health agenda, reducing child mortality has been made a priority, especially for low income countries that remain the most affected. Among the targets of the Sustainable Development Goals (SDGs) is reduction of neonatal mortality to at least 12 deaths per 1,000 live births and under-five mortality to 25 deaths by 2030 (United Nations 2015). HIV/AIDS is one of the leading causes of mortality in Zambia and has contributed to the slow decline of under-five mortality (Garenne and Gakusi 2006). Children under the age of five years get infected with HIV mainly through vertical transmission (Fishel, Ren, Barrère et al. 2014). In the absence of treatment, vertical transmission of HIV is high and can range between 15 and 45 per cent, reducing below 5 per cent with effective interventions (Barral, Oliveira, Lobato et al. 2014). Despite vertical transmission being the main pathway through which children get infected with HIV, little research has been done to determine the significance of maternal HIV status on under-five mortality in Zambia. The aim of the study was, therefore, to determine the extent to which mortality of children with HIV-positive mothers differs from that of children with HIV-negative mothers. The Zambia Demographic and Health Survey (ZDHS) data for 2007 and 2014 which contain HIV serotesting data were used. Survival analysis using Poisson regression was used to model the influence of maternal HIV status taking into account confounding factors. The results of the study indicate that maternal HIV status was significantly associated with child mortality in both survey periods but by 2013/14 the influence of maternal HIV status had reduced and was insignificant for children born within one year of the 2013/14 survey. The reduction in the risk of dying between the inter-survey period may be as a result of increased coverage of prevention of mother-to-child transmission (PMTCT) and antiretroviral therapy (ART) services over the years. In order to reach universal coverage, there is need for increased provision of PMTCT and ART treatments and support for HIV strategies such as the 90 90 90 target.

HIV/AIDS has presented humanity with various challenges, one of which is the manner in which it has affected family structure and patterns. Parental illness and eventual death due to the HIV/AIDS pandemic is escalating. One of the major challenges of HIV/AIDS in southern Africa is the increase in the number of orphaned and vulnerable children. As a result new family forms are emerging such as the "skip-generation" family in which children or adolescent siblings head the family. It is anticipated that HIV/AIDS in South Africa will progressively increase the number of such families. During this time of profound family change, the family as an institution has remained remarkably resilient. The present study utilised the Family Resilience Framework and the Resiliency Model of Family Stress, Adjustment and Adaptation to explore and describe the resilience of HIV/AIDS’ adolescent headed families. A qualitative, exploratory-descriptive research design, which was assessed against Guba’s (1985) model of trustworthiness, was employed and the participants were sampled using non-probability purposive sampling. The Masizakhe Community Project volunteers (an AIDS Community Project in Kwazakhele, Port Elizabeth receiving support from the iThemba AIDS Foundation) assisted in identifying participants according to the predetermined inclusion criteria. The sample consisted of four female, adolescent heads of HIV/AIDS’ affected households, who volunteered at the Masizakhe Community Project and resided in Kwazakhele. The data that was collected via audio-recorded semi structured interviews were transcribed verbatim and subjected to Interpretive Phenomenological Analysis. Family resilience factors that emerged included intrafamilial strengths (family cohesion, organisation, hardiness, and adaptability); social support resources (especially from the community project, friends, and community members); family appraisal processes; and problem solving and coping strategies. Extended family support was partial and largely financial. The findings from this study provided insights into the resilience of adolescent-headed families; provided guidance for the development of intervention programmes to assist these families; and affirmed the existing strengths of the families. Furthermore, it has contributed to the research and literature on family resilience and formed the foundation for future research projects.

Includes abstract.
Includes bibliographical references.
Finding and treating cases [of tuberculosis] in the community before they present to health facilities, a strategy known as active-case-finding is gaining momentum as a way to decrease the infectious pool. This can be achieved through door-to-door community surveys using a TB symptom-screening questionnaire, and is an economical and practical tool to employ in poor, high burden areas. However, unlike for the high risk group of people infected with HIV, there is a lack of evidence supporting the adaptation of a symptom screening tool in the other high risk groups. In 2010, a TB prevalence survey was conduceted in 24 high TB and HIV burden communities in Zambia and the Western Cape, South Africa. This prevalence survey served as the endpoint for the Zambia and South Africa TB and AIDS Reduction study (ZAMSTAR). This survey made use of a questionnaire the collected, among other information, data regarding individual TB symptom reporting, HIV status, diabetes mellitus status and cigarette smoking.

Uganda has registered more than a million deaths since the HIV virus was first offi¬cially reported in the country over 3 decades ago. The governments in partnership with different groups have implemented different programmes to address the epidemic. The support from different donors and reduction in prices of treatment resulted in the focus on antiretroviral therapy access to those affected. Presently only a quarter of the approximately 1 million infected by HIV in Uganda are undergoing antiretroviral therapy. The number of patients pause a challenge in monitoring of therapy given the overall resource needs for health care in the country. Furthermore the numbers on antiretroviral therapy are set to increase in addition to the stringent requirements in tracking and monitoring of each individual patient during therapy. This research aimed at developing a framework for adopting knowledge engineering in information systems for monitoring HIV/AIDS patients. An open source approach was adopted due to the resource constrained context of the study to ensure a cost effec¬tive and sustainable solution. The research was motivated by the inconclusive literature on open source dimensional models for data warehouses and data mining for monitor¬ing antiretroviral therapy. The first phase of the research involved a situational analysis of HIV in health care and different health care information systems in the country. An analysis of the strengths, weaknesses and opportunities of the health care system to adopt knowledge bases was done. It proposed a dimensional model for implementing a data warehouse focused on monitoring HIV patients. The second phase involved the development of a knowledge base inform of an open source data warehouse, its simulation and testing. The study involved interdisciplinary collaboration between different stakeholders in the research domain and adopted a participatory action research methodology. This involved identification of the most appropriate technologies to foster this collabora¬tion. Analysis was done of how stakeholders can take ownership of basic HIV health information system architecture as their expertise grow in managing the systems and make changes to reflect even better results out of system functionality. Data mining simulations was done on the data warehouse out of which two machine learning algorithms (regression and classification) were developed and tested using data from the data warehouse. The algorithms were used to predict patient viral load from CD4 count test figures and to classify cases of treatment failure with 83% accu¬racy. The research additionally presents an open source dimensional model for moni¬toring antiretroviral therapy and the status of information systems in health care. An architecture showing the integration of different knowledge engineering components in the study including the data warehouse, the data mining platform and user interac-tion is presented.

Thesis (PhD)--Stellenbosch University, 2015
ENGLISH ABSTRACT : In 2010, young people aged 15–24 years accounted for 42% of new HIV infections globally. In 2009, about five million (10%) of the total South African population was estimated to be aged 15–19 years. Current South African national sero-prevalence data estimate the prevalence of HIV to be 5.6% and 0.7% among adolescent girls and boys aged 15–19 years, respectively. HIV infections are mainly transmitted via sexual transmission. Adolescent sexuality is multi-faceted and influenced at multiple levels. In preparing to enroll adolescents in future biomedical HIV prevention trials, particularly prophylactic HIV vaccine trials, it is critical to provide counseling services appropriate to their needs. At the time of writing, there was no developed psychosocial intervention in South Africa for use among adolescent vaccine trial participants. Thus, the aim of the present study is to adapt and pilot-test a psychosocial intervention, namely, the Centers for Disease Control and Prevention (CDC) risk reduction counseling intervention of Project Respect, an intervention tasked at being developmentally and contextually appropriate among potential adolescent participants in HIV biomedical trials in the future. To achieve this overall aim, I qualitatively explored adolescent sexuality and risk factors for HIV among a diverse sample of participants aged 16–18 from Soweto. Thereafter, I developed a composite HIV risk scale in order to measure the variance in HIV risk among the sample of adolescents studied. The study followed a two-phased, mixed method research design and was informed by ecological systems theory and integrative model of behavioral prediction. The aim of Phase 1, split into phases 1a and b, was to conduct focus group discussions (FGDs) and to undertake a cross-sectional survey, respectively, to determine psychological (for example, self-esteem and depression), behavioral (specifically, sexual behavior) and social (specifically, social support, parent-adolescent communication) contexts that placed adolescents at risk for HIV infection. Phase 1a was qualitative, with data collected via nine FGDs: three involved parents of adolescents, four involved adolescents aged 16–18 years and two counselors. Nine key themes related to adolescent sexuality and risks for HIV acquisition were identified, namely: (1) dating during adolescence; (2) adolescent girls dating older men; (3) condom use amongst adolescents; (4) teenage pregnancies; (5) views about homosexuality; (6) parent-adolescent communication about sexual health; (7) the role of the media; (8) discipline and perceived government influence; and (9) group sex events. Phase 1b was quantitative and the data were collected via a cross-sectional survey to investigate the variance of risk for HIV. For Phase 1b, the sample consisted of 506 adolescents with a mean age of 17 years (interquartile range [IQR]: 16–18). More than half the participants were female (59%, n = 298). I used a three-step hierarchical multiple regression model to investigate the variance in risk for HIV. In step 3, the only significant predictors were “ever threatened to have sex” and “ever forced to have sex”, the combination of which explained 14% (R2 = 0.14; F (12, 236) = 3.14, p = 0.00). Depression and parentadolescent communication were added to steps 2 and 3, respectively, with both variables insignificant in these models. In Phase 2, I adapted and pilot tested the CDC risk reduction counseling intervention. The intervention was intended to be developmentally and contextually appropriate among adolescents from Soweto aged 16–18 years, viewed as potential participants in future HIV biomedical trials. Participants in Phase 2 were aged 16–18 years; the sample was mainly female (52%, n = 11) and most (91%, n = 19) were secondary school learners in grades 8 to 12. Participants provided feedback about their experiences of the adapted counseling intervention through in-depth interviews. I identified three main themes in this regard, namely: benefits of HIV testing services, reasons for seeking counseling and HIV testing services, and participants’ evaluation of the study visits and counseling sessions. The adapted CDC risk reduction counseling intervention was found to be acceptable with favorable outcomes for those adolescents who participated in the piloting phase. This study adds to the literature on risks for HIV among adolescents in Soweto, South Africa, by considering multiple levels of influence. Reaching a more complete understanding of ecological factors contributing to sexual risk behaviors among adolescents in the pilot-study enabled the development of a tailored counseling intervention. The findings showed the adapted CDC risk reduction counseling intervention to be feasible and acceptable among adolescents likely to be participants and eligible to participate in future HIV biomedical prevention trials. Thus, this study provides a much needed risk reduction counseling intervention that can be used among adolescents, an age group likely to participate in future HIV vaccine prevention research.
AFRIKAANSE OPSOMMING : In 2010 het jongmense tussen die ouderdomme van 15 en 24 jaar 42% van nuwe MIV-infeksies wêreldwyd uitgemaak. In 2009 was omtrent 5 miljoen mense (10%) van die Suid-Afrikaanse bevolking tussen 15 en 19 jaar oud. Volgens data oor die huidige Suid-Afrikaanse nasionale sero-voorkoms, word die voorkoms van MIV onderskeidelik op 5.6% en 0.7% onder tienermeisies en -seuns tussen die ouderdomme van 15 tot 19 jaar beraam. MIV-infeksies word hoofsaaklik deur seks oorgedra. Adolessente seksualiteit het baie fasette en word op verskeie vlakke beïnvloed. Ter voorbereiding van die werwing van adolessente vir toekomstige biomediese proewe, veral proewe oor profilaktiese MIVentstowwe, is dit van kritiese belang dat beradingsdienste verskaf word wat geskik is vir hul behoeftes. Op die tydstip wat hierdie tesis geskryf is, het daar nog geen psigososiale intervensie in Suid-Afrika bestaan vir gebruik onder adolessente deelnemers aan entstofproewe nie. Daarom is die doel van hierdie studie om ʼn psigososiale intervensie ‒ die Centers for Disease Control and Prevention (CDC) se Projek Respek, ʼn beradingsintervensie vir die vermindering van risiko ‒ aan te pas en met ʼn loodsprojek te toets. Hierdie intervensie is geskik vir die ontwikkelings- en kontekstuele vlak van adolessente deelnemers aan toekomstige MIV- biomediese proewe. Ten einde hierdie oorkoepelende doelwit te bereik, het ek adolessente seksualiteit en die risikofaktore vir MIV onder ʼn diverse steekproef deelnemers tussen die ouderdomme van 16 en 18 jaar van Soweto kwalitatief ondersoek. Daarna het ek ʼn saamgestelde MIV-risikoskaal ontwikkel om die variansie van MIV-risiko onder die groep adolessente te meet. Die studie se navorsingsontwerp het uit twee fases en gemengde metodes bestaan, en is gebaseer op ekologiesestelsel-teorie en die integrerende gedragsvoorspellingsmodel. Die doel van fase 1, wat in fases 1a en 1b verdeel is, was om onderskeidelik fokusgroepbesprekings te hou en om ʼn deursnitopname te doen om die sielkundige kontekste (byvoorbeeld elemente van selfbeeld en depressie), gedragskontekste (spesifiek seksuele gedrag) en sosiale kontekste (spesifiek sosiale ondersteuning en ouer-adolessent-kommunikasie) te bepaal waarin adolessente die risiko loop om MIV-infeksie op te doen. Fase 1a was kwalitatief en data is deur middel van nege fokusgroepbesprekings ingesamel: drie met die ouers van adolessente, vier met adolessente tussen 16 en 18 jaar oud en twee met beraders. Nege sleuteltemas is geïdentifiseer wat verband hou met adolessente seksualiteit en risiko’s om MIV op te doen: (1) verhoudings tydens adolessensie, (2) tienermeisies wat verhoudings met ouer mans het, (3) die gebruik van kondome onder adolessente, (4) tienerswangerskappe, (5) sienings oor homoseksualiteit, (6) ouer-adolessent-kommunikasie oor seksuele gesondheid, (7) die rol van die media, (8) dissipline en die ervaarde regeringsinvloed en (9) groepseksgeleenthede. Fase 1b was kwantitatief en data is deur middel van ’n deursnitopname ingesamel om die variansie van risiko vir MIV te ondersoek. Vir Fase 1b het die steekproef bestaan uit 506 adolessente met ’n gemiddelde ouderdom van 17 jaar (interkwartielwydte [IKW]: 16–18). Meer as die helfte van die deelnemers was vroulik (59%, n = 298). Ek het ’n hiërargiese meervoudige regressiemodel met drie stappe gebruik om die variansie van risiko vir MIV te ondersoek. Die enigste beduidende voorspellers in stap 3 was “ooit gedreig om seks te hê” en “ooit geforseer om seks te hê”. Die kombinasie hiervan het 14% (R2 = 0.14; F (12, 236) = 3.14, p = 0.00) verklaar. Depressie en oueradolessent- kommunikasie is onderskeidelik in stappe 2 en 3 bygevoeg, en albei veranderlikes was onbeduidend in hierdie modelle. In Fase 2 het ek die CDC se intervensie vir die verlaging van risiko aangepas en met ’n loodsprojek getoets. Die intervensie was bedoel om geskik te wees vir die ontwikkelings- en kontekstuele vlakke van 16- tot 18-jarige adolessente van Soweto wat beskou is as potensiële deelnemers aan toekomstige MIV- biomediese proewe. Deelnemers in Fase 2 was 16 tot 18 jaar oud, die steekproef was hoofsaaklik vroulik (52%, n = 11) en die meeste van die deelnemers (91%, n = 19) was in grade 8 tot 12 op hoërskool. Deelnemers het tydens indringende onderhoude terugvoering oor hulle ervarings van die aangepaste beradingsintervensie verskaf. Ek het drie hooftemas in hierdie verband geïdentifiseer, wat die volgende insluit: voordele van MIV-toetsingsdienste, redes waarom berading en MIV-toetsingsdienste verlang word, en die deelnemers se evaluering van die studiebesoeke en beradingsessies. Daar is bevind dat die aangepaste beradingsintervensie van die CDC aanvaarbaar was en gunstige uitkomste gelewer het vir die adolessente wat aan die loodsfase deelgeneem het. Hierdie studie dra by tot die literatuur oor MIV-risiko’s vir adolessente in Soweto, Suid-Afrika, deur meervoudige invloedsvlakke te oorweeg. Die feit dat ’n meer volledige begrip tydens die loodsondersoek verkry is van die interaksie van die ekologiese faktore wat tot seksuele risikogedrag onder adolessente bydra, het die ontwikkeling van ʼn doelgemaakte intervensie deur berading moontlik gemaak. Die bevindings het getoon dat die aangepaste beradingsintervensie van die CDC lewensvatbaar en aanvaarbaar is vir gebruik onder adolessente wat waarskynlik geskikte deelnemers aan toekomstige biomediese proewe oor MIV-voorkoming kan wees. Hierdie studie verskaf dus ʼn noodsaaklike beradingsintervensie om die MIV-risiko onder adolessente ‒ ʼn ouderdomsgroep wat waarskynlik aan toekomstige biomediese navorsing oor MIV-voorkoming sal deelneem ‒ te verminder.

Thesis (MSc)--University of Stellenbosch, 2007.
ENGLISH ABSTRACT: While research and population surveys in HIV/AIDS are well established in developed countries, Sub-Saharan Africa is still experiencing scarce HIV/AIDS information. Hence it depends on results obtained from models. Due to this dependence, it is important to understand the strengths and limitations of these models very well. In this study, a simple mathematical model is formulated and then extended to incorporate various features such as stages of HIV development, time delay in AIDS death occurrence, and risk groups. The analysis is neither purely mathematical nor does it concentrate on data but it is rather an exploratory approach, in which both mathematical methods and numerical simulations are used. It was found that the presence of stages leads to higher prevalence levels in a short term with an implication that the primary stage is the driver of the disease. Furthermore, it was found that time delay changed the mortality curves considerably, but it had less effect on the proportion of infectives. It was also shown that the characteristic behaviour of curves valid for most epidemics, namely that there is an initial increase, then a peak, and then a decrease occurs as a function of time, is possible in HIV only if low risk groups are present. It is concluded that reasonable or quality predictions from mathematical models are expected to require the inclusion of stages, risk groups, time delay, and other related properties with reasonable parameter values.
AFRIKAANSE OPSOMMING: Terwyl navorsing en bevolkingsopnames oor MIV/VIGS in ontwikkelde lande goed gevestig is, is daar in Afrika suid van die Sahara slegs beperkte inligting oor MIV/VIGS beskikbaar. Derhalwe moet daar van modelle gebruik gemaak word. Dit is weens hierdie feit noodsaaklik om die moontlikhede en beperkings van modelle goed te verstaan. In hierdie werk word ´n eenvoudige model voorgelˆe en dit word dan uitgebrei deur insluiting van aspekte soos stadiums van MIV outwikkeling, tydvertraging by VIGS-sterftes en risikogroepe in bevolkings. Die analise is beklemtoon nie die wiskundage vorme nie en ook nie die data nie. Dit is eerder ´n verkennende studie waarin beide wiskundige metodes en numeriese simula˙sie behandel word. Daar is bevind dat insluiting van stadiums op korttermyn tot ho¨er voorkoms vlakke aanleiding gee. Die gevolgtrekking is dat die primˆere stadium die siekte dryf. Verder is gevind dat die insluiting van tydvestraging wel die kurwe van sterfbegevalle sterk be¨ınvloed, maar dit het min invloed op die verhouding van aangestekte persone. Daar word getoon dat die kenmerkende gedrag van die meeste epidemi¨e, naamlik `n aanvanklike styging, `n piek en dan `n afname, in die geval van VIGS slegs voorkom as die bevolking dele bevat met lae risiko. Die algehele gevolgtrekking word gemaak dat vir goeie vooruitskattings met sinvolle parameters, op grond van wiskundige modelle, die insluiting van stadiums, risikogroepe en vertragings benodig word.