3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Predictors of weight loss in HIV-infected women on antiretroviral therapy in Rwanda.(2014-03-28) Kimenyi, Jean PaulBackground: Highly Active Antiretroviral Treatment (HAART) has reduced the frequency of weight loss/wasting associated with HIV infection. However, weight loss remains a problem, even in the HAART era. Objectives: This study was carried out to assess weight change in a cohort of HIV-infected women on HAART in Rwanda, from 2005 to 2008, and to identify factors that predict weight loss in this cohort. Methods: Data from a cohort of 449 HIV-positive women on HAART enrolled in the Rwanda Women’s Inter-association Study and Assessment (RWISA), starting in May 2005, and followed at six monthly intervals until December 2008, were analysed. The outcome assessed in this study was change in weight, measured in kilograms at 6, 12 and 24 months after HAART initiation. Nutritional status was recorded and laboratory measurements (weight, height and CD4 cell count) were taken prior and after HAART initiation. All covariates were time dependent, except for the history of weight loss which was recorded at baseline only. Generalized Estimating Equation (GEE) using the linear link (Gaussian [normal]), exchangeable covariance structure and robust standard error was used to assess the factors associated with changes in weight (weight loss or weight gain) and to control for potential confounders. Results: Prior to HAART initiation, the mean weight of the study participants was 53.1 kg (SD 9.5). The mean BMI was 21.3 kg/m2 (SD 3.6) and the mean CD4 cell count was 222.9 cells/μL (SD 120.6) [47.6% had CD4 cell counts <200 cells/μL, 52.2% had CD4 cell counts ≥200 cells/μL]. Overall, the participants gained weight from baseline to 12 months after HAART initiation. The mean weight change was 1.9 kg (SD 7.8) (p<0.001) 6 months after HAART initiation, 2.9 kg (SD 5.9) (p <0.001) 12 months after HAART initiation, and 2.4 kg (SD 6.5) (p <0.001) 24 months after HAART initiation. Six months after HAART initiation, 48.3% of participants had gained weight, and 21.0% had lost weight. Twelve months after HAART initiation, 56.9% had gained weight, and 18.3% had lost weight, Twenty-four months after HAART initiation, 56.6% had gained weight, and 22.6% had lost weight. Participants with CD4 cell counts ≤ 200 cells/μL at baseline gained more weight than those with CD4 cell counts > 200 cells/μL at 6, 12 and 24 months after HAART initiation. Participants who were underweight (BMI <18.5 kg/m2) at baseline gained more weight than other participants three months after HAART initiation. Time-dependent diarrhoea for more than two weeks and a CD4 cell count of 200 - 350 cells/μL were significantly associated with weight loss (p≤ 0.05). Others factors, such as time-dependent education level (completion of secondary school), marital status (married legally and status other than married legally or widowed), and increases in CD4 cell counts, were associated with weight gain (p≤ 0.05). Conclusion: Although the majority of participants gained weight during the first 12 months of being on HAART, a significant proportion of participants lost weight while on HAART. The findings on the predictors of weight change in HIV-positive women on HAART can be used to promote weight gain in women who start HAART. Clinicians who take care of HIV-infected patients on HAART should pay attention to those who lose weight, and those who present with diarrhoea or with CD4 cell counts of <350 cells/μL at follow-up visits, since these factors are associated with weight loss in the HAART era.Item The effects of progressive resisted exerxcises on performance-oriented mobility in persons with HIV related poly-neuropathy(2013-03-19) Mkandla, KhumbulaKey words: Peripheral neuropathy, HIV/AIDS, Progressive resisted exercise, Performance oriented mobility, Quality of life. Background: Distal symmetrical poly-neuropathy (DSP) has emerged as one of the major neurological complication associated with HIV/AIDS and antiretroviral therapy. People with DSP commonly have problems with pain, mobility, altered gait and balance all which affect their quality of life. While therapeutic strengthening exercise has been reported to attenuate these impairments in other co-morbid conditions like diabetes mellitus and in HIV/AIDS, there is no evidence available on the effects of exercise on DSP in people living with HIV/AIDS (PLWHA).The purpose of this study was to determine the effects of progressive resisted exercises (PRE) on performance oriented mobility and health related quality of life in (PLWHA) related DSP. Objectives of this study were to determine the effects of PRE on gait, balance and pain levels and establish if there is a relationship between performance-oriented mobility and health-related quality of life in PLWHA related DSP. Methods: In order to fulfil the objectives, an assessor-blinded randomized controlled trial was conducted over two studies, with a combined sample of 160 participants sourced from two family care clinics at two central hospitals and ten anti-retroviral therapy dispensing municipal clinics in Harare, Zimbabwe. While the experimental group with 80 participants had an intervention program of PRE sessions of one hour for the lower limbs, done twice per week over 12 weeks, the control group of 80 participants was given advice to walk unsupervised at home. Loss to follow up in this study was at 60% (n=97) and the data was analysed using an intention to treat analysis approach. Results: Participants of an average age of 42.2 years (SD=8.5) constituted of 70.6% (n=113) female participants. Combination antiretroviral therapy containing stavudine, was used by 59% (n=94) of the participants and 59% (n=94) of the participants had moderate to severe neuropathy. Proximal muscles exhibited weakness (hamstring muscles strength = 3.43 kg force (SD=1.5)) when compared to leg muscles (gastrocnemius muscles strength = 12.8 kg force (SD=2.0)). Gait and balance scores did not show differences in effect between the intervention and the control group (95%CI 0.00-0.02, p = 0.8). Similarly there were no differences of effect for muscle strength (95%CI 0.00-0.08, p=0.13-0.8) and pain (95%CI 0.0-0.06, p>0.13). However the effect on quality of life changes were significantly different between the two groups (95%CI 0.00-0.12 p= 0.04). Quality of life was positively associated with gait, odds ratio 1.01 (95%CI 1.00 – 1.04), moderately associated with balance odds ratio 0.68, (95%CI 0.52 – 0.93) negatively associated with pain odds ratio 0.98 (95%CI 0.97 – 0.99). Conclusion: This research study established that progressive resisted exercises have positive effects on the health related quality of life in PLWHA related DSP. However this study did not show a difference of the effects of progressive resisted exercises on performance oriented mobility in PLWHA related DSP when compared to advice to exercise at home. The study findings may not be generalized to all individuals living with HIV/AIDS who have DSP as the participants were from a particular demographic setting. This project may be continued at the participating family care clinics as a roll on of the perceived benefits of exercise for people with HIV related DSP.Item Perceptions regarding HIV status disclosure to children born HIV positive living at Epworth Child and Youth Care Centre in Lambton, Ekurhuleni, South Africa.(2012-07-11) Dube, NkosiyaziMost children born HIV positive live longer and have more healthy lives since the advent of Anti-Retroviral Therapy (ART), together with the accessibility of Anti-Retroviral Drugs (ARV) to persons living with HIV. However, some of those children find themselves in need of care due to abandonment, orphanhood and / or neglect. In South Africa such children may enter the formal Child and Youth Care System and be placed in centres such as Epworth Child and Youth Care Centre. Due to the complex nature of the consequences of such disclosure or non-disclosure of HIV positive children’s status to them, social service workers are posed with a dilemma. In the absence of clear guidelines and policy around such disclosure, the children concerned may be unaware of their HIV positive status, despite being on a medication regime. The aim of the study was to explore the perceptions of social service workers regarding disclosure of HIV status to children born HIV positive living at Epworth Child and Youth Care Centre in Lambton, Ekurhuleni, South Africa. The study was located within a qualitative research paradigm, and utilised a purposive stratified sample of 15 social service workers form various occupational groupings recruited from Epworth Child and Youth Care Centre. A semi-structured interview schedule was employed as the research tool, with in-depth one-on-one interviews being adopted as a method of data collection. Thematic content analysis was used to analyse the data collected during the interviews. The main findings of the study were that HIV status disclosure is viewed as a complex but essential process as it reinforces children’s ability to adhere to medication regimes and to dispel anxiety and suspicion within themselves and around their status; that non-disclosure may lead to poor or coerced adherence and strains the relationship between the children and the social service workers. Disclosure of children’s HIV positive status can be viewed as complex as it presents both positive and the negative. Recommendations relate to community educative and awareness programmes, policy and practice changes regarding disclosure and none disclosure of children’s HIV positive status, as well as future research.Item Dysphagia in a group of adult in-patients living with HIV/AIDS in Gauteng, South Africa.(2012-07-03) Alborough, KimAims: The aims of this research were to describe the signs and symptoms of dysphagia in people who are living with HIV/AIDS and to see what participant variables such as CD4 count, age and diagnosis affect dysphagia. Methods: This study was a descriptive, cross-sectional, quasi non-experimental design. The sampling method that was used for this research was non-probability and convenient. These patients were referred to the speech therapy and audiology department from various multidisciplinary team members for dysphagia assessments. There were 106 participants in total. Eighty participants underwent only a clinical bedside assessment and 26 underwent a bedside assessment as well as a modified barium swallow. The Mann Assessment of Swallowing Ability (MASA) was used to conduct the clinical bedside assessments and a modified barium swallow (MBS) was used as an objective measure. The data was analysed using both descriptive and inferential statistics. These tests included the Wilcoxon signed rank test, Spearman Rho test, Kruskal-Wallis and Mann Whitney U-test. Results: Descriptively, the results revealed that participants with neurological conditions appeared to present with more severe signs and symptoms of dysphagia. The results from the Wilcoxon signed rank test showed that participants with a neurological disorder experienced more severe signs and symptoms of dysphagia, except with laryngeal elevation. The Wilcoxon signed rank test also showed that older participants experienced more dysarthria and oral transit difficulties. The results from the Kruskal-Wallis test highlighted that participants with a lower CD4 count had more significant respiration and voice difficulties. The results from the Mann-Whitney U test showed that participants who were on a HAART regimen experienced increased difficulty in the pharyngeal phase and aspirated more frequently. The Spearman-Rho test results showed that the MASA was seen as a valid bedside assessment tool for assessing adult dysphagia in an acute hospital setting. Discussions: Dysphagia does occur in the HIV/AIDS population in South Africa in participants who have neurological conditions as well as opportunistic infections. The SLP needs to play a key role in the assessment and management of these patients. The MASA is a good assessment tool to use in settings where objective measures are not available.Item Knowledge of HIV/AIDS, related attitudes and participation in risky sexual behaviour among first and fourth year female students at the University of Botswana.(2012-02-16) Cavric, GordanaIntroduction Botswana still has the second highest HIV prevalence in the world with little indication of any significant decline. In Botswana, women are disproportionately affected: young women account for more than half (58 %) of the adults living with HIV thus indicating a significant gender disparity in HIV infection. University educated, urban young women aged 19-39 have been identified as group at particularly high risk of HIV infection. Aim This study aimed to assess knowledge and attitudes regarding HIV and AIDS and how such knowledge and attitudes have implications for participation in risky sexual behavior among female University of Botswana students in their first and fourth years of study. Methodology This study was conducted at the University of Botswana (UB) in Gaborone. Data was collected using a selfadministered questionnaire on Knowledge of HIV/AIDS and participation in Risky Sexual Behavior among female students in first and fourth year of studies at University of Botswana. Results The knowledge regarding the “window period” and infectivity during the window period was significantly lower for first year students compared to fourth years. Attitudes towards people with HIV were positive in both groups, while affirmative attitudes towards premarital sex are increasing as the students progress academically. The analyses highlight that the percentage of women who reported having been sexually active the proceeding year was significantly higher among fourth year students (82.6%) than their first year counterparts (56.9 %), (p<0.01), with the number of partners significantly higher among women in their fourth year. Significantly, 3% of first year female students stated that their partners did not want to use a condom while 7 percent of the participants themselves said that that was the case. Amongst fourth year UB female students responding, 4% said that their partners did not want to use a condom, yet 14% participant said that they themselves did not want to use one. Overall, the prevalence of self-reported STI’s was significantly higher among fourth year students when compared with first year students 19 of 155 [12.26% ]vs. 4 of 144 [2.78 %] p<0.01 . Conclusion This study explored the knowledge of HIV/AIDS and participation in risky sexual behavior amongst female students in their first and fourth years at the University of Botswana. The study supported the findings that higher levels of formal education are associated with better knowledge of how to protect oneself from HIV/AIDS transmission. Although many HIV/AIDS prevention campaigns might have contributed to educated women being knowledgeable about how to protect themselves from HIV/AIDS transmission and the importance from abstaining from risky sexual behavior, a small but significant proportion of women still do not use condoms consistentlyItem Knowledge, attitudes and practices of HIV positive patients regarding disclosure of HIV results at Betesda Clinic Namibia(2012-01-17) Tom, PenelopeBackground: HIV prevalence is increasing and more people are being infected despite the messages and the advertising.1 Namibia has one of the highest HIV/AIDS prevalence rates in the world of 21.3% as at end of 2002. Two hundred and ten thousand people were estimated to be living with HIV/AIDS, more than one in five adults.2 Disclosure is very important for the prevention and control of HIV infection and is an essential part of behaviour modification, access and adherence to treatment. Aim: To determine knowledge, attitudes, and practices of HIV positive patients regarding disclosure of HIV results at Betesda clinic in Namibia. Objectives: To determine the participant profile, reasons for disclosure and non disclosure, to explore attitudes, knowledge and to understand practices of HIV positive patients with regard to disclosure of HIV results. Methods: This was a cross-sectional descriptive study done at Betesda clinic a private clinic in Katutura a high density suburb of Windhoek. Two hundred and sixty three HIV positive patients tested after 2004 were entered into the study. Convenience sampling of all willing HIV positive patients was done. A questionnaire was used; a professional interpreter and a counsellor were available. Permission to conduct the study was obtained from Betesda management; ethical clearance was obtained from the Post Graduate Committee and Human Research Committee of the University of the Witwatersrand. Epi Info statistical software package version 3.4.1 July 3 2007 was used to analyze data. An expert statistician was utilized to assist with analyzing data. Results: Two hundred and sixty three respondents were entered into the study. Sixty four percent were males, 41% were married, 28% were single, and 27% were cohabitating. 68% responded positively to what they thought about disclosure. Reasons for disclosure were 32% needed help, 25% partner to go for testing and 20% to let relatives know. Reasons for non disclosure were mainly fear of gossiping 79%. Seventy three percent had disclosed 60% within one week of knowing the results. Seventy three percent had disclosed to their partners, 23% had disclosed to more than one person. People’s reactions were 43% supportive, 29% understood, 9% accepted and 6% angry. Upon disclosure 40% received help, 24% partners were tested, 23% received psychological support and 5% were stigmatized. Disclosure was found to be higher among the married and cohabitating. Conclusion: Knowledge of disclosure was positive; most thought disclosure was important and good. Attitudes and practices towards disclosure were encouraging; people were disclosing but to trusted individuals in the society and fear of stigma was still there but actual stigma was very low.Item HIV/AIDS prevention interventions in Mozambique as conflict of cultures : the case of Dondo and Maringue Districts in Sofala Province.(2012-01-10) Monteiro, Ana Piedade ArmindoThe purpose of this thesis is to report on issues concerning the continuous spread of HIV/AIDS in Mozambique in spite of the HIV/AIDS prevention interventions that are in place. This research was conducted in Dondo and Maringue districts, both situated in the Sofala Province. Sofala Province had higher prevalence that was 25 percent higher than the national average of 16.2 percent. An ethnographic research methodology was used in order to understand the reasons behind the continuous escalation of HIV/AIDS. It was significant for one to get to know the people that live in Dondo and Maringue, especially their daily lives, including their cultural practices as the driving force in people’s behaviour and the manner in which people make sense of their daily lives. It was important to understand their cultural practices, because of their relevance to the issue of HIV/AIDS in terms of the manner in which cultural practices influence people in decision-making about their social life, which escalate to the issue of health practices. Although the concept of HIV/AIDS is acknowledged in Dondo and Maringue, xirombo and phiringaniso were continuously used as local concepts in health issues and practiced as indigenous knowledge together with kupitakufa, kupitamabzwade, and kupitamoto rituals, and these practices were extended in dealing with HIV/AIDS. The acceptance of the Western medical interpretation of HIV/AIDS was low among the people in Dondo and Maringue. This reality is due to the preservation of local cultural knowledge in dealing with diseases. As a result, local medical concept and rituals becomes a challenge to the Western medical interpretation of HIV/AIDS and its health prevention and intervention strategies. In the context of Western medical interpretation of diseases the above local cultural practices are used as '" " resistance against the western medical interpretations HIV/AIDS concepts. These cultural practices have preferences among local people in dealing with, and promoting HIV/AIDS health prevention interventions when compared with the public biomedical HIV/AIDS concept and the general biomedical practices. In conclusion this thesis suggests that there is a need for integration of these cultural practices within the Western medical interpretation, prevention and intervention strategies in dealing with the HIV/AIDS pandemic and its concerns at a local level.Item Exploring race talk and HIV among South African youth.(2011-11-03) Mendes, Jacqueline H.This research was an explorative study of the race talk present in discourse when discussing HIV/AIDS and aimed to explore the discourses drawn on by participants during discussions around HIV and AIDS, to explore whether these discourses differed in one-to-one interviews with the author (private talk) compared with those in focus group discussions (public talk) and to investigate how learners navigated race during discussions around HIV/AIDS. The sample was made up of 26 grade 11 learners at a private school in Johannesburg. Data collection was conducted using three focus group discussions (FGD) and several individual one-on-one interviews. Both the interviews and focus groups were conducted using a semi-structured interview guide and recorded on Mp3 players. The data was transcribed using several conversation analysis transcription conventions and later analysed using discourse analysis. An important methodological innovation of this research was its use of HIV/AIDS discussion to capture race discourse. Seven broad themes were analysed and discussed in the research and included (a) HIV/AIDS and the ‘Other’, (b) Race and ‘common sense’, (c) Navigating the perception of racism, (d) Race Trouble and location, (e) Race, Education and Government (f) Race and Apartheid and (g) Public talk Vs. Private talk While this research was mainly exploratory and attempted to investigate as many instances of ‘race talk’ as possible, as well as offer various feasible explanations for the learners’ use of race talk, it was suggested that it may be necessary to explore the possibility of expanding on existing theories to explain the use of race talk among black learners to ‘Other’ people of the same race. Furthermore, while this research did not specifically set out to explore the implications that the intersections between race and HIV/AIDS could have for education, it was suggested that the attachment of apartheid meanings to race (and HIV/AIDS) could lead to learners’ reluctance to critically engage with historical and contemporary texts or avoid discussing issues around HIV/AIDS.Item Men, masculinities and sexual and reproductive health in Botswana.(2011-04-12) Rakgoasi, Serai DanielThis thesis investigates the role of masculinities on men’s sexual and reproductive health in Botswana. Botswana is currently in the throes of a severe heterosexually driven HIV/AIDS epidemic that has eroded some of the developmental gains the country had achieved since independence. A unique feature of Botswana’s HIV epidemic is the rapid and phenomenal increase in infection and prevalence rates in the face of good levels of knowledge of HIV prevention and an early and comprehensive HIV prevention strategy that guaranteed access to free HIV prevention and treatment services, including ARV treatment. The lack of effectiveness of the country’s HIV efforts and subsequent increase in infection rates have been blamed on men’s risky sexual behavior and lack of support of their partners’ decisions to utilize these services. In fact, quantitative studies on men’s sexual behavior and HIV such as the Botswana AIDS Impact Surveys show that men are less likely to use VCT services and more likely to engage in risky sexual behavior that increases risk of HIV infection to themselves and their partners. While studies provide the evidence that implicates men in the rapid growth Botswana’s HIV epidemic, the studies provide little or no explanation of factors that motivate men’s behavior in reproductive health. This lack of insights on factors that motivate men’s behavior leads to stereotypes about male promiscuity and may contribute to the lack of effectiveness of HIV prevention strategies. The current HIV epidemic has thus thrust heterosexual masculinities at the centre of HIV prevention efforts and provides an opportunity for research to interrogate the role of heterosexual masculinities in reproductive health, especially HIV transmission and prevention. The thesis employs qualitative data to provide in-depth appreciation of the prevalent masculine norms and beliefs and to highlight contextual factors and processes that shape and give rise to various masculinities. It further uses quantitative data to provide measures of levels of men’s masculine and gender role beliefs that may influence HIV prevention and transmission and to test the association between masculinities and men’s sexual and reproductive health attitudes and practices. The results show that men’s sense of identity is socially constructed, and revolves around the notion of superiority to women, independence and having and being in control of the family. However, men face many challenges to the realization of this masculine ideal. Men’s perceived difficulty or failure to live up to socially constructed Men, Masculinities and Sexual and Reproductive Health in Botswana vii notions of masculinities affects their experience of sexual and reproductive health programs, especially women’s empowerment and HIV prevention programs. By their nature, these programs tend to challenge men’s dominance of women’s decision on sexuality, and are therefore experienced as a threat to some men’s sense of identity. Quantitative results indicate an association between masculinities and sexual and reproductive health. While men’s sense of masculinities is not the overriding factor determining their sexual and reproductive health attitudes and practices, the results show a strong association traditional masculine beliefs and negative sexual and reproductive health beliefs and practices. However, there is also strong evidence that men and masculinities are responding to contextual factors, such as the HIV epidemic, which has become a specific stress on the local construction of masculinities. In focus group discussions, many men challenged traditional masculine norms, beliefs and practices that increase their vulnerability to HIV infection and those that either encourage or condone violence within intimate relationships. Significantly high proportions of men had positive attitudes towards HIV prevention programs. It is evident that now more than ever (and thanks to the HIV/AIDS epidemic) many men are ready to question the predominant masculine norms, beliefs and practices that increase their vulnerability to infection and disease. These voices of change represent a window of opportunity for research and programs can meaningfully engage with men and masculinities on issues of sexuality, gender roles, sexual and reproductive health and HIV/AIDS prevention and transmission. There is need for future research and interventions to move away from focusing exclusively on individual models of preventive health behaviors to more multilevel, cultural and contextual explanations. Taking account of multilevel, cultural and contextual factors that shape masculinities and men’s sense of identity will ensure increased effectiveness of sexual and reproductive health programs, especially HIV/AIDS prevention programs. On the other hand, failure to account for cultural and contextual factors that shape individuals’ behavior will only ensure that the shortcomings of such intervention program will continue to be blamed on the individual.Item Lymphoid proliferation of the parotid gland in paediatric patients with HIV infection(2011-04-07) Kungoane, TsholofeloIntroduction: HIV associated parotid lymphoepithelial lesions in children are not well documented. Most studies have concentrated on the adult population. Objectives: The present study aimed to document the disease, its risk factors and anti-retroviral treatment outcome in children. Materials and methods: The study was conducted at 2 HIV and AIDS facilities weekly over a 6 month period. “Parotid swellings” in children below 13 years were analysed. A retrospective medical chart review was conducted. Results: Seventy-one children were included; 47 with swelling (Group 1) and 24 without swelling (Group 2). Thirty-nine had parotid swelling of 1or both glands, 6 had submandibular and parotid swelling and 2 with only submandibular swelling. Twenty-six children in Group 1 were receiving HAART, 19 reported a reduction in size of lesion, 6 reported no effect and only 1 had the lesion after 11 months of HAART. Conclusion: Parotid lymphoid proliferation in children is more common than previously reported. The prevalence of this lesion could not be determined as not all children with parotid swelling presenting at the clinics were included in the study. Children with lower viral loads showed an increased risk of developing parotid lymphoid proliferation. The parotid lesions responded well to HAART but did not completely resolve.