3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Knowledge, attitudes and infection control practices of oral health students when managing patients with HIV/AIDS in Johannesburg, South Africa(2016) Joosab, Zorayda .M.SOral care for patients with HIV/AIDS plays a vital role in improving their nutritional intake, medication tolerance and effectiveness, treatment success rate, as well as quality of life. As the number of people living with HIV/AIDS increases, the possibility of oral healthcare professionals treating more patients with HIV/AIDS will increase and this will result in an increased risk of cross contamination in the dental setting. Aim was to determine the knowledge, attitude and infection control practices of undergraduate dental and oral hygiene students when managing patients with HIV/AIDS. This KAP survey was of a cross-sectional design with an analytical component conducted among 108 dental and oral hygiene students. A validated questionnaire was utilized as a study instrument of choice. A convenience sampling technique was utilized and all students in the target population formed the study sample. Results: The study sample had a mean age of 21 (20 - 23) years, with the majority being females 82 (75.93%) as opposed to 26 (24.07%) males. The average knowledge level of students regarding HIV/AIDS was approximately 55% with a standard deviation of 0.15; the median was 0.55 with a min-max value of (0.2-1.0). [Table2]. Twenty nine per cent of the students (31) had a moderate knowledge level regarding the management of HIV/AIDS patients. Just over half of the cohort, 60(55.56%) of the students had a positive attitude, 44(40.74%) had a passive attitude and 4(3.70%) students had a negative attitude. The infection control practices were of a good quality among the clinical students, with an average of 78.87% (std: 15.61%). Three quarters 53 (76%) of these students had good infection control practice and 17(24%) students had excellent infection control practices. Conclusion: The dental curriculum needs to be appropriately modified, existing learning activities and practical skills should be adapted to ensure future dental practitioners have the clinical competence, in combination with relevant knowledge to provide excellent and appropriate care to patients with HIV/AIDS or any other common transmissible diseases.Item Defining virus-antibody interplay during the development of HIV-1 neutralization breadth to inform vaccine design(2016) Bhiman, Jinal NomathembaHuman Immunodeficiency Virus Type 1 (HIV-1) infects approximately two million people annually, highlighting the need for a preventative vaccine. An effective HIV-1 vaccine will likely need to elicit broadly neutralizing antibodies (bNAbs), which arise naturally in some infected individuals and recognize the envelopes (Env) of multiple HIV-1 strains. Understanding the molecular events that contribute to bNAb development during infection may provide a blueprint for vaccine strategies. Here we investigated the development of a V1V2-directed bNAb lineage in the context of viral co-evolution in an HIV-1 superinfected participant (CAP256). For this, clonally-related monoclonal antibodies (mAbs), with a range of neutralization breadth, were isolated. We determined their developmental pathway from strain-specificity towards neutralization breadth and identified viral variants responsible for initiating and maturing this bNAb lineage. MAbs were isolated by memory B cell culture or trimer-specific single B cell sorting and extensively characterized by Env-pseudotyped neutralization, cell surface-expressed Env binding, electron microscopy and epitope-predictive algorithms. Antibody next-generation sequencing (NGS) at multiple time-points enabled the inference of the unmutated common ancestor (UCA) of this lineage. Viral co-evolution was investigated using Env single genome amplification and V1V2 NGS. A family of 33 clonally-related mAbs, CAP256-VRC26.01-33, was isolated from samples spanning four years of infection. The UCA of this lineage possessed an unusually long heavy chain complementarity determining region 3 (CDRH3), which resulted from a unique recombination event. Surprisingly, this UCA potently neutralized later viral variants that had evolved from the superinfecting virus, which we termed bNAb-initiating Envs. Viral diversification, which peaked prior to the development of neutralization breadth, created multiple immunotypes at key residues in the V1V2 epitope. Exposure to these immunotypes allowed adaptation of some mAbs to tolerate this variation and thus mature towards neutralization breadth. Based on these data, we proposed a four-step immunization strategy which includes priming with bNAb-initiating Envs to engage rare B cells with a long CDRH3; followed by three sequential boosts (including select V1V2 immunotypes) to drive antibody maturation. In conclusion, this study has generated a testable HIV-1 vaccine immunization strategy through the delineation of mAb-virus co-evolution during the development of neutralization breadth.Item Comparison of accuracy of HIV diagnosis between rapid HIV test kits conducted in non-laboratory settings and laboratory-based methods in South Africa(2016) Chidarikire, Thato NellyIntroduction South Africa has the largest absolute number of individuals living with human immuno-deficiency virus (HIV) in the world. The quality assurance (QA) of HIV rapid diagnostic tests (RDT) has not kept pace with the rate of expanded testing and utilisation of RDT. This has made it difficult to assess the accuracy of testing. In South Africa HIV counselling and testing (HCT) and the use of HIV RDT is the point of entry to HIV prevention, management, care, treatment and support. HCT in public health facilities is delivered mainly through rapid testing by nonprofessional staff. Implementation of QA processes is crucial for accurate diagnosis of HIV. However, accuracy of HCT using rapid test kits in non-laboratory settings in South Africa will remain a challenge unless there is evidence that nonlaboratory rapid HIV testing results are as reliable as the laboratory-based enzyme immunoassays. This study aimed to determine the accuracy of HIV RDT in the context of an intervention. The objectives of the study were: i. To assess the sensitivity and specificity of rapid test kits in two provinces; ii. To assess the sensitivity and specificity of rapid test kits between the two provinces and New Start nongovernmental organisation (NGO) which implemented a more comprehensive quality management system (QMS); iii. To assess the accuracy of HIV RDT in the two provinces; iv. To assess the accuracy of HIV RDT between the two provinces and New Start sites. The hypothesis was ‘the accuracy of HIV diagnosis using HIV RDT kits in nonlaboratory settings in which an intervention has been introduced (internal quality control), also known as IQC, will not be different compared to settings that do not utilize IQC’. Methods In South Africa, the current laboratory-based gold standard for diagnosis of HIV infection in adults in the public sector as recommended by the National Health Laboratory Services (NHLS) Virology expert committee is a serial 2-test algorithm. Thus, a reactive enzyme immunoassay (EIA) test result must be confirmed by a second confirmatory EIA that must be different in terms of antigens and technology. The Expert Committee recommendation is that positive results should be confirmed by a separate sample 14 days later. In the case of HIV rapid testing the national HIV counselling and testing (HCT) policy, 2010, similarly recommends a serial 2-test algorithm for diagnosis where a reactive screening test is confirmed by a different confirmatory test. If the confirmatory test is reactive the diagnosis is positive. If test 1 is non-reactive then the diagnosis is negative. In case of discrepant results an enzyme-linked immunosorbent assay (ELISA) test was recommended as a tiebreaker. A new HIV testing services (HTS) policy was approved in South Africa in 2016 and it further recommended that the first time discrepant results are found, the counsellor must repeat the algorithm and if on repeat, the results are still discrepant, then reflex testing is recommended where the blood (whole blood) of a client is taken to the laboratory for ELISA (NDOH, 2016).This algorithm has replaced the use of Western Blot is South Africa. The rationale for the change was based on the sensitivity and specificity of 3rd and 4th generation ELISAs, workload, costs and expertise. With the introduction of the 3rd and latterly 4th generation EIA tests the above algorithm is in use in South Africa and has replaced the use of the Western blot as a confirmatory test. The rationale for the change is based on earlier detection of HIV infection, workload, costs and expertise. Further developments for a diagnostic algorithm include the use of a fourth generation test and if reactive to use a HIV-1 and HIV-2 discriminatory test and HIV viral load. This study was cross-sectional and compared the performance of HIV RDT in selected sites in Limpopo province that had introduced an intervention viz., an internal quality control (IQC) as part of quality management system (QMS) implementation, and compared to Mpumalanga province that had not introduced the IQC and performed limited QMS activities. The sample size calculated for the study was N = 717. IQC is an independent internal quality control that is used to check that an analytical phase or test precision is optimal. The introduction of routine QMS in Limpopo was through implementation of IQC supported by appropriate training and certification of implementers. IQC was implemented routinely as part of the provincial QA initiatives with the aim of supporting the implementation of HIV RDT in non- laboratory settings. There are other QA measures that may be implemented to support HIV RDT programmes including external quality assessment (EQA) such as proficiency testing (PT) which is a tool used to assess the testing process independently. EQA implementation was however not part of the Limpopo (LP) QMS implementation. Six high volume testing sites comprising of 3 hospitals and 3 clinics were selected per province. This was to avoid the risk of not meeting the required number of participants due to refusals, lack of results and challenges with reporting. In order to mitigate risk, the study was oversampled, where a total of 457 participants from the LP sites were enrolled in the study and results were analysed and compared to those of 361 participants from the Mpumalanga (MP) sites resulting in a total sample size of 818. The analyses included demographics, performance of RT as measured by the number of discordant results, reliability and validity of rapid tests RT as measured by the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) results. The data between Limpopo and Mpumalanga were further analysed together with the data from selected sites from a non-governmental organisation (NGO) called New Start and the performance, reliability and validity of the HIV test results were compared. The main role of New Start was to offer HCT in support of the government priorities and it implemented several different QMS measures for HIV rapid testing, namely, IQC, EQA, PT and re-testing, training for implementers, development and implementation of standard operating procedures (SOPs), and ensuring that all commodities were stored under appropriate conditions including temperature monitoring. In order to determine the validity and reliability of HIV RDT against the gold standard ELISA in Limpopo, Mpumalanga and New Start sites, the rate of discordance, the sensitivity, specificity, PPV and NPV were determined. Logistic regression models were constructed to assess the association between the interventions in the provinces. Crude and adjusted odds ratios were used as a measure of association between exposure and outcome and a 95% precision of estimate was used to ascertain statistical significance. Exposure factors with p<0.05 were considered statistically significant. Results A total of 947 attendees for HCT services in selected sites in Mpumalanga and Limpopo provinces between August and April 2012, were screened and of these, 818 were enrolled into the study according to the study inclusion criteria. There was no significant difference (p=0.05) between the number of participants enrolled in Limpopo (457) as compared to Mpumalanga (361) though Limpopo enrolled more participants than Mpumalanga. All available data from New Start sites for the period 2008 was analysed. The gender, rate of discordance and HIV positivity rate were significantly different between the two provinces (p<0.05). The study showed that the laboratory-based HIV prevalence rate in each setting was 22.9% in Limpopo, 26% in Mpumalanga and 11% in New Start sites. The prevalence rates reported by Shisana, 2014, were 21.8% for Mpumalanga and 13.9% for Limpopo. The rate of discordant HIV test results between the 2 provinces and New Start sites was also measured where discordant results were defined as those that were different between HIV rapid test and the ELISA test. The rate of discordant HIV test results was 5.9% (27) in Limpopo, 11.0% (40) in Mpumalanga p= 0.010 and 1.4% (68) in New Start sites. False negative results accounted for all the discordant results. Logistic regression models were used to estimate the Odds Ratio (OR) and the 95% confidence interval of the association between implementation of QA programme and the HIV test accuracy or the HIV discordance rate. Facilities without a QA intervention programme had an approximately 2-fold increased odds of HIV test discordance compared to facilities with a QA programme in place (crude OR 1.86, 95% CI: 1.10 – 3.12 and adjusted OR 1.90, 95% CI:1.08 - 3.30). This association was statistically significant. The sex and age of the participants was not associated with discordance rate. The sensitivities of the HIV RDT in Limpopo, Mpumalanga and New Start sites were 86% (CI: 83.9-89.4), 72% (CI: 64.2-79.0) and 98% (CI: 97.6-98.4) respectively. In this study, specificity ranged within 99% (CI: 98.9-99.9) in all sites (Provinces and New Start sites). The PPV in Limpopo, Mpumalanga and New Start sites were 98% (CI: 93.2-99.6), 97% (CI: 91.0-99.2) and 93% (CI: 92.3-93.7) respectively, The NPV results in Limpopo were 93% (90.5-95.2), Mpumalanga at 86% (CI:81.3-90.7). For New Start sites, the NPV was 99.6% (CI: 99.4-99.8). The sensitivities and specificities of the sites were used at a national prevalence rate of 18.8% to determine the national PPV and NPV and these were found to be 100% (CI: 100-100) and 91.3% (CI: 89.04-92.96) respectively. Discussion In all three settings the World health Organisation (WHO) recommended sensitivity (>99%) and specificity (>98%) were not met. There was a gradient of sensitivities and specificities that was associated with the extent of QA implementation. Thus, New Start sites with a more extensive set of QA activities had the highest sensitivity; LP with introduction of IQC, had an intermediate sensitivity and MP the lowest. Despite the introduction of an intervention LP was not able to meet the required level of QA implementation compared to New Start. Increased discordance was associated with the extent of implementation of QA as shown by the results of the logistic regression model (crude and adjusted). In this study there was a decline in sensitivity that resulted in some false negative results. To a lesser extent, some false positive results were also identified in New Start sites. In the case of LP and MP the potential contributory factors to false negative results xi would include the extent of QA implementation and training. Further evidence of the relative poor implementation would include the M&E assessments and in the course of the study there lost results, poorly taken and missing specimens that led to data being excluded. Conclusion On the basis of these results, it is concluded that implementation of quality assurance measures is critical to ensure correct diagnosis of rapid HIV testing. Furthermore, implementation of a combination of aspects of QA is urgently required including training of all implementing staff on quality assurance of rapid HIV testing, monitoring and evaluation to assess kit performance through IQC and PT, as well as implementation of the current South African HIV testing Services (HTS) Policy. All PT methods should be explored for implementation and training and certification of implementers must be ensured.Item The implementation of nurse initiated and managed antiretroviral therapy in the City of Johannesburg clinics: perceived facilitators and barriers(2015-09-08) Mophosho, ZaneleIntroduction: Antiretroviral therapy (ART) is a lifesaving clinical intervention for people living with HIV (PLHIV). An important barrier to accessing therapy is the shortage of the health workforce particularly doctors. In order to mitigate the shortage, a nurse driven ART delivery approach known as Nurse Initiated and Managed Antiretroviral Therapy (NIMART) has been implemented in the public sector in South Africa and in other countries. NIMART enables professional nurses to initiate HIV positive persons on ART and manage their care at primary health care clinics. This study sought to explore and describe perceptions of operational managers, facility managers and professional nurses on the facilitators and barriers to the implementation of NIMART in the City of Joburg (CoJ) clinics. Methodology: This was an exploratory descriptive qualitative study which used in-depth interviews with a variety of respondents in order to gain insights into their perceptions of the implementation of NIMART in the CoJ clinics. In total, 26 respondents, comprising of operational managers, facility managers and professional nurses participated in the study. Thematic content analysis was used to analyse data drawing from the Donabedian structure-process-outcome framework. Results: The respondents identified the adequacy of NIMART training and mentoring; the availability and use of NIMART guidelines and the integration of NIMART into Primary Health Care (PHC) services as structural facilitative factors for NIMART implementation. The shortage of the health workforce, shortage of antiretrovirals (ARVs), poor referral feedback, food insecurity and the mobility of patients were identified as key structural and process barriers to the implementation of NIMART. Respondents perceived the improvement in quality of life of NIMART patients and the clinics’ ability to retain patients in care as indicative of the success of iii NIMART implementation. Finally, respondent’s suggestions for improving NIMART implementation in CoJ clinics focussed on improving shortage of the health workforce, improving the availability of ARV drugs and providing opportunities for continuing education for professional nurses. Discussion, conclusion and recommendations: In order to mitigate the barriers identified in this study, recommendations were that the City of Joburg should utilize lower level health care cadres such as nursing assistants and lay counsellors to reduce the professional nurses’ workload and thus improve access to treatment. In addition, the City of Joburg should revise the antiretroviral drug allocations to clinics and revise delivery schedules to ensure that clinics do not run out of ARV drugs. The referral feedback process should be strengthened through the referring clinic and the referral hospital jointly developing referral protocols that should be used by both institutions. Finally, the City of Joburg should consider conducting consultative discussions with professional nurses prior to introduction of new programmes and provide opportunities for regular updates for operational managers, facility managers and professional nurses. Future research could look at the role of PHC qualification in the implementation of NIMART.Item Evaluation of the integration of the comprehensive care management and treatment plan for HIV and AIDS in Ekurhuleni and Sedibeng district health services(2015-09-08) Maboe, Thoko MercyIntroduction HIV and AIDS in South Africa has a considerable disease burden which places an enormous strain on the health care system. The increased workloads brought about by testing and counseling, prevention, treatment, care and support services with a concomitant decrease in the supply of health care workers impacts negatively on the quality of services. Health planners and managers need to implement approaches that enable maximum utilisation of available resources by integrating HIV and AIDS into the normal functioning of existing programmes to address increasing demands for HIV and AIDS services and to strengthen the health care system. Aim and Objectives The aim of the study was to describe the extent of integration of HIV and AIDS services at the different levels of care in the district health system. Method This is a descriptive cross sectional study that used structured pretested interview questionnaires, data review and a facility check list. A stratified random sample of five facilities that were accredited in the district from 2004 – 2007 was used. Fifty two interviews were conducted face to face with facility managers, doctors, nurses, dieticians, social workers, and lay counselors and seventeen self-administered questionnaires were completed by district programme managers. A total of 69 interviews were conducted. Results The study highlighted the fact that most of the facilities (96%) implemented the HIV and AIDS programme without a documented operational plan. Stakeholder participation on planning was limited at less than 30% across all levels of services within the district. Budgeting and resource allocation operated independently from the district and facility financial systems resulting in parallel systems. Technical support and programme reviews by the district and provincial managers were weak and irregular. Support of HIV and AIDS services was mainly given by facility management. The district`s monitoring and evaluation systems were not in place. The referral systems between the facilities and community structures were not well established. Lay counselors skills on PMTCT and nutrition was rated the lowest and compromised the implementation of an integrated approach. HIV and AIDS services were not implemented at well baby clinics. Conclusions The findings of this study suggests that the HIV and AIDS services have developed into separate vertical administrative and reporting systems operating differently from the mainstream services and not supporting the strengthening of the health care system and therefore not capable of achieving the intended goal of the programme.Item Exploring perceptions about community dialogues on multiple and concurrent partership in Zimbabwe.(2014-04-23) Majonga, CarolineSince it was first discovered in the early 80s, HIV and AIDS has been a major cause of death the world over, most especially in Africa. Southern African, in particular, has the highest HIV prevalence rates in the world (UNAIDS, 2010) . The practice of multiple and concurrent partnerships (MCP) was identified as a key driver of HIV infection in this Region (SADC, 2006). It is against this backdrop that in 2009, a Zimbabwean organisation, Action Institute for Environment Health and Development Communication (Action), embarked on an HIV prevention campaign to encourage safer sexual behaviours by promoting the reduction in MCP. The social mobilisation component of the campaign was rolled out in partnership with five community-based organisations (CBOs), through which Action identified and trained community based peer educators on how to use its multimedia products as tools to facilitate dialogues around MCP. The dialogues were introduced in order to enable communities to discuss why they engage in MCPs and to determine for themselves the best ways to reduce their vulnerability to HIV.Item The knowledge, attitude and practice among primary health care nurse practitioners regarding oral health and oral HIV lesions in QE II and Roma health service areas in Maseru, Lesotho(2012-03-15) Prithiviraj, Thamotharampillai GerardAlthough the nursing sector has not been spared the effects of human resource shortages and Human Immune-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) crisis in Lesotho, it still remains the backbone of the primary health care delivery. There is a well-established linkage between oral health and HIV/AIDS with many of the early symptoms of HIV manifesting in the oro-facial region. However, the lack of oral health personnel at primary health care levels in Lesotho makes Primary Health Care Nurse Practitioners (PHCNPs) often the first health care providers to consult, manage and refer patients with such oral lesions. Aim: To assess the “knowledge, attitude and practice” (KAP) of the PHCNPs regarding oral health and oral HIV lesions in Queen Elizabeth II (QE II) and Roma health service areas (HSA) of Maseru district in Lesotho. Objectives: To assess the demographic profile of PHCNPs in the target health facilities, their knowledge, attitude and practice regarding oral health and oral HIV lesions. Methods and Materials: The research was a descriptive cross-sectional survey. A convenience sample of 57 primary health care nurse practitioners (PHCNPs) from QE II and Roma health service areas were identified. During their monthly PHC meeting, a questionnaire was administered to assess the knowledge, attitude and practice regarding oral health and oral HIV lesions. The information gathered was both quantitative and qualitative. Data was entered and analysed using the SPSS statistical package. Results: The response rate was 87.7%. There was 100% consensus regarding the importance of oral health to the total well being of individuals. The majority of the PHCNPs recognised oral candidiasis (OC) (94.7%), bleeding gums (87.7%), herpes lesions (71.9%) and dental caries (75.4%). Lesions such as acute necrotizing ulcerative gingivitis (ANUG) (40.3%), angular cheilitis (AC) (56.1%) and apthous ulcerations (24.6%) were also recognised but to a lesser extent. The respondents associated OC (84%), herpes (61%), AC (54%), Oral Hairy Leukoplakia (OHL) (49%), Kaposi‟s‟ sarcoma (KS) (49%) with HIV/AIDS. OC was the most common lesion associated with HIV. Some lesions commonly seen in the clinics such as apthous ulceration and ANUG were not significantly associated with HIV (18% and 33%, respectively). The majority of PHCNPs (81%) indicated that they had knowledge about oral HIV lesions. Twenty nine 6 respondents (50.8 %) reported having received this knowledge through training institutions. Mass media (Radio (53%), TV (40%), and newspapers/magazines (49%)) was one of the major sources of information. Forty-four PHCNPs (77.2%) saw only Zero or one (0-1) HIV patients with oral lesions. Similarly, 15.8 % and 7% of the PHCNPs saw 11 to 20 and more than 20 (21+) HIV patients with oral lesions, respectively. The two thirds of the PHCNPs (67%) said they would not advise patients to seek care from Traditional Health Practitioners (THP) due to their lack of trust and confidence in the practices, knowledge and the patient management of the THPs. However, 16% of them reported that they would refer because they thought traditional medicine boosts the immune system. Only seven respondents (12.3%) routinely washed their hands with antiseptics. However, 44 of respondents (77.2 %) cleaned their instruments with bleach and disinfectants. The majority (89.5%) washed their hands with water and soap. Forty three respondents (75.4%) wore gloves during examination. Routine use of facemasks was limited to only 12 respondents (21.1 %). Ninety eight percent of the PHCNPs stated that they would like to learn to manage oral lesions at health centres. The majority (79%) of the respondents said that they would like to receive more training on the management of oral lesions through workshops. Conclusions: There was an observable correlation between PHCNPs self-assessment of oral health knowledge and the objective knowledge as assessed by ability to identify the oral lesions on a chart ( 2 –sided Fischer‟s test-0.000-0.261).This needs to be confirmed by undertaking a study with a larger sample size. OC was the most common lesion associated with HIV as reported by the PHCNPs. The majority of the participants (94.7%) identified OC and associated it (84%) with HIV infection. The finding indicated that with training and/or mentoring, PHCNPs are likely to confidently diagnose oral HIV lesions. PHCNPs showed a positive attitude towards learning more about the oral manifestations of HIV/AIDS. PHCNPs should be utilised more effectively in the diagnosis and management of HIV/AIDS.Item HIV as an internal object : the subjective experience of HIV infection in women on ARVs.(2012-03-13) Gordon, Tiffany AmandaHIV/AIDS research has proven crucial in an effort to prevent and manage this epidemic. However, there is little research being done in an attempt to understand the internal worlds of those living with HIV/AIDS. The purpose of this research was to begin to explore the relationship that exists between the person living with HIV/AIDS and the virus, as an internal object, inside them. This study focused on 6 women who were on Anti-Retroviral Medication (ARVs), and who have been diagnosed for at least one year. The participants’ mental representations of the virus as an object inside them was explored, as well as how they experienced and viewed the triangular relationship that exists between themselves, the HI Virus, and the ARVs. This exploratory research utilised a qualitative framework in order to understand and explore these relationships and perceptions, with psychoanalytic theory being used a lens through which to view the data that emerged. In depth semi-structured interviews were conducted with the participants, and the corpus of data was analyzed using a thematic content analysis. In addition, the participants were asked to draw the virus inside their bodies. These were analyzed using a technique devised by Paola Luzzatto (1987) in a study exploring the internal world of drug-abusers. For the purpose of this study, a variation of the same art therapy technique was used in that the participants were asked the ‘draw the virus in their bodies’. Whilst the drawings allowed for insight into the internal worlds of the participants, the drawings were also used as a point of departure. For most of the women, HIV was drawn using a red crayon, whilst the ARVs were drawn in either yellow or green. As depicted in the drawings, post diagnosis the HIV/red seemed to cover most of the body, but later when the ARVs/green was added, more of a balance was achieved. Results show that for these women, HIV was often perceived as dangerous and criminal, whilst the ARVs were often associated with security. From the perspective of Kleinian theory, the perception of the HIV and the ARVs seemed to be dependent upon the position from where they were functioning: either a paranoid-schizoid or a depressive position.Item South African volunteer perceptions : an exploratory study into the perceptions of female white South African volunteers working with black children orphaned by AIDS.(2012-02-10) Nichas, TraceyThis study explored the perceptions of ten White female South African volunteers working with black children diagnosed HIV positive and/or orphaned by AIDS. A qualitative research strategy was used in order to explore the participants’ perceptions of the role that racial dynamics and everyday racism play in their work as volunteers. Ten participants over the age of 18 years, that have been volunteering for a minimum of one month and that volunteer for a minimum of one hour a week at an organisation in Johannesburg, were interviewed. The data were transcribed and analysed using thematic content analysis and the findings were interpreted using a framework drawn from critical race theory and critical Whiteness studies. Notions of everyday racism were evidenced in the findings of the study. These findings challenge traditional notions in a novel way by expanding the current understanding of the racial dynamics at play in a country working towards equality. In doing so, the study raises theoretical and practical implications for efforts aimed to address racism in South Africa.
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