Electronic Theses and Dissertations (PhDs)

Permanent URI for this collectionhttps://hdl.handle.net/10539/37996

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    Intersecting Epidemics: The implications of COVID-19 in the utilisation of HIV treatment services among people living with HIV on antiretroviral treatment (ART) in Zimbabwe
    (University of the Witwatersrand, Johannesburg, 2024) Tapera, Talent; Odimegwu, Clifford
    Zimbabwe has been working towards the last mile of controlling the Human Immunodeficiency Virus (HIV) epidemic where keeping people that are living with HIV on antiretroviral therapy (ART) is primarily important. Ensuring they are virally suppressed and can thwart opportunistic infections is key. The advent of COVID-19 potentially posed a threat of derailing or reversing the gains attained in the fight against HIV. Zimbabwe has more than one million people living with HIV (United Nations Programme on HIV and AIDS [UNAIDS], 2020). The question of whether the COVID-19 pandemic intensified barriers and redefined the utilisation of HIV treatment services by people who are living with HIV on ART in Zimbabwe has remained largely unanswered in the literature currently available. Thus, the main purpose of this research was to examine the implications of COVID-19 in the utilisation of HIV care treatment services among people who are living with HIV on ART in Zimbabwe and the factors associated with it. This study defined, the utilisation of HIV treatment services as accessing and taking up a package of services expected to be received by people who are living with HIV on ART such as scheduled ART drug refill collections, viral load monitoring, Tuberculosis (TB) preventative therapy and TB screening. In addition, the study investigated the predisposition of people who are living with HIV in using the COVID-19 vaccine and the reasons behind not getting vaccinated. The study was anchored in the fifth revision of the Andersen behavioural model of healthcare utilisation. This model argues that the use of health services is a based on of three factors classified as (1) predisposing, (2) enabling and (3) need factors. The fifth model version of the model allowed the addition of environmental factors. The dependent variable was the utilisation of HIV treatment services and also COVID-19 vaccination among people living with HIV. As such, it was critical to anchor the study in this framework as it sought to identify the critical factors of utilisation of HIV treatment services and COVID-19 vaccination among people living with HIV. Therefore, following the Anderson model, the predisposing factors for this study were age, sex, marriage, religion, education and COVID-19 vaccination. The enabling factors were COVID-19 lockdown restrictions, COVID- 19 transport stoppages, distance to a health facility, transport cost to a health facility, fear of contracting COVID-19, non-availability of community healthcare services, and COVID-19 related stigma among healthcare workers. The need factors were opportunistic infection during the COVID- 19 period, COVID-19 infection, and contact with a COVID-19 case, while environmental factors were residence and type of health facility.
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    Experiences of Youth in Agrarian Transformation in Rural South Africa: A Case of Greenplanet Primary Cooperative in Orange Farm
    (University of the Witwatersrand, Johannesburg, 2022-03) Chibonore, Wilma Claris; Kariuki, Samuel
    This thesis advanced a qualitative approach to analyse the practices, structures and rationalities that inform youth engagement in agriculture drawing on evidence from Orange Farm in Gauteng Province of South Africa. The study takes off on the premise that there is low generational renewal in agriculture as the older and ageing generation makes the majority of active farmers yet farming holds great potential for creating youth employment whilst youth engagement in agriculture secures food of the future. The study finds that youth (dis)engagement and (dis)interest in farming is directly related to the availability and easy access to everyday support structures particularly those provided by the state and observes that many young people are in fact interested in farming but are currently operating in a structurally disabling environment amidst poor state support which does not allow for growth or access to key resources. The study finds that youth interest in farming exists although these interests are largely skewed towards technologically advanced farming systems and against backward manual farming systems therefore contradicting existing discourse as well as challenging the general narrative and consensus that youths are not interested in farming or that youth interest in farming is waning. The thesis reveals that young farmers understanding, interpretation and engagement with agricultural technology is based on their levels of exposure, location and access to resources. Poverty, structural limitations and marginalization experienced by the youth contribute significantly to their reception and perception of agriculture as a whole. The thesis argues for an agrarian developmental state approach towards the strengthening of agricultural opportunities and the relevant institutional structures and resources such as land, stipends, extension services, training, technology and market allocation to support youth farming in rural South Africa where the economies are generally stagnant and youth unemployment very high. This study observes that young people as active citizens and through utilising individual agency have the capacity to drive their own innovations within the agricultural sector when awarded the platform, opportunity and support to do so. The study reveals that the young farmers are ‘millennials’ who use their youth agency to engage in social networking facilitated by use of social media as a powerful tool for unity and resistance against unfavourable farming environments. Lastly, two contradictory perspectives on the impact of COVID-19 emerge in this study, one of COVID-19 having presented opportunities for growth and success for the young farmers and another of the pandemic having further marginalized and disrupted the already struggling young farmers with both narratives being shaped directly and indirectly by the pre-existing structural challenges. Methodologically, empirical data was mostly gathered through face to face semi-structured interviews, focus groups and conversations with the young farmers with the remainder of interviews having been conducted virtually via Skype, WhatsApp chats and WhatsApp calls upon the emergence of COVID-19 which converged with this study. Participant observation occurred through attending farmers meetings, agriculture tours, engaging in some farming activities on some sites as well as being part of the young farmers WhatsApp group. The thesis also relied on published journals, statistical reports, media reports, policy documents as well as videos from the public hearings regarding the amendment of the South African Constitution to allow for expropriation of land without compensation in order to bolster the empirical findings.