Dissertations / Theses on the topic 'Rural HIV'

Although HIV and AIDS has become a common phenomenon in Zimbabwe and the world over, it still remains a bone of contention for many people with regards to its spread and consequences. Thirty-five years has gone by since the advent of HIV and AIDS in Zimbabwe. A number of factors, such as unprotected sex; handling of AIDS patients without proper and adequate facilities; and the usage of used needles have been accused of influencing the spread of HIV and AIDS in some parts of Zimbabwe. However, factors influencing the spread of HIV and AIDS among the Tonga females are different from what has been said concerning other parts of country .Factors such as cultural practices which are oppressive to females are responsible for fuelling the spread of AIDS pandemic among the Tonga females. In view of this, the study is therefore meant to examine the validity of the claim which presupposes that those cultural practices such as polygamy; marrying of a spouse whose husband is believed to have died of AIDS; child marriage among others, as responsible for the spread of HIV and AIDS among the Tonga females. It is also the study s aim to validate or falsify the assumption that the Tonga females are more vulnerable to HIV and AIDS than their male counterparts. Since the study seeks to establish the plight of the Tonga females of the Pashu community in the context of HIV and AIDS, about 98% of the respondents or participants are females. The reason for this is to maximise a female voice. In other words, more females were interviewed than males. The gathered data during interviews had been analysed. The study findings confirmed the assumed problem of the Tonga females suffering from HIV and AIDS due to the mentioned factors. Presumably the subsequent consequences of HIV and AIDS have necessitated a pastoral oversight to the afflicted females. In some cases, family relationships are broken. Some witchcraft accusations have also caused hatred among some family members. Seemingly pain and suffering in this case has superseded joy. These findings have influenced a recommendation that a further study on specific cultural practices mentioned above be pursued. The study has revealed and addressed the issues affecting the Tonga females in the context of HIV and AIDS.<br>Thesis (PhD)--University of Pretoria, 2015.<br>tm2016<br>Practical Theology<br>PhD<br>Unrestricted

This study was conducted to gain a better understanding of HIV/AIDS-related stigma within religious communities in rural Gujarat, India. This study used the hidden distress model of HIV stigma and the HIV peer education model as conceptual frameworks to examine a rural population sample of 100 participants. Regression analysis was conducted to test if school education had a moderating effect on the relationship between illness as punishment for sin (IPS) and HIV stigma. Religiosity was tested for mediating effects on the relationship between early religious involvement (ERI) and HIV stigma. The results of this study indicated that single unemployed men under the age of 28 were more likely to relate religiosity, IPS, and ERI to HIV stigma. Furthermore, education did not significantly moderate the relationship between IPS and HIV Stigma, and religiosity also did not mediate the relationship between ERI and HIV stigma. However, an additional mediation analysis showed that IPS did mediate the relationship between religiosity and HIV stigma in this study. The results of this study suggested that HIV/AIDS awareness programs may need to focus on young unemployed men because they may be the most susceptible to stigmatic thinking. It can be concluded that IPS was a major contributor in the proliferation of HIV stigma for participants in this study. Further research is needed to understand how belief in an authoritarian God could increase IPS, and how education initiatives may aid in decreasing IPS among inhabitants. This study strived to add to the existing body of knowledge and help improve the lives of those infected with HIV in rural parts of India.

Thesis (M.A. (Research Psychology)) --University of Limpopo, 2010<br>This study measures the relationship between the AIDS risk reduction model (ARRM) variables associated with HIV related risk behaviours on learners from a South African rural community. A cross-sectional study was conducted using 308 learners in a Limpopo rural high school to identify HIV risk behaviours. Data were analyzed using binary logistic regression to test the usefulness of ARRM variables in predicting sexual risk. Sexual risk was measured as; (a) vaginal sex without a condom, (b) anal sex without a condom (c) number of sexual partners in the last twelve months and (d) time taken before having sex with a new partner. Two of the ARRM variables, that is perceived susceptibility and sexual response efficacy, were found to be the most important predictors of HIV related risk behaviours. There is an argent need for effective preventive activities in rural areas, especially through school-based interventions. Key words: ARRM HIV HIV prevention Risk behaviors

Experiences of stigma, including stigma in religious settings, among individuals who are HIV positive have been widely documented. However, research related to stigma has predominantly focussed on urban locations. As a result, stigma incurred via religious settings in non-urban areas has been underexplored. The aim of this study is to uncover the experiences of individuals who are HIV positive with religious institutions, leaders and congregants in the non-urban American South. A total of 22 participants were interviewed. Experiences with stigma were pervasive with participants often describing anticipation of future stigma (often based on past negative experiences), the experience of stigma, and, for some participants, intersectional or layered stigma related to being both gay, or being perceived as gay, and HIV positive. Our findings suggest that the conditions of the non-urban setting in which this research took place made specific contributions to participants’ experiences of stigma.

This thesis aims to describe the uptake and coverage of HIV testing and counselling (HTC) services in a community cohort study in rural Tanzania between 2003 and 2010, and to investigate the impact of HTC on changes in sexual risk behaviour and HIV incidence. Paper A uses data from three HTC services (community outreach HTC (CO-HTC), walk-in HTC (WI-HTC) and antenatal HTC) linked to the community cohort data to compare the characteristics of services users, and found that while WI-HTC was most likely attract HIV-positive individuals, the overall proportion of infected persons diagnosed was greatest at CO-HTC. Rates of repeat testing are important to understand given potential HIV treatment as prevention approaches. Paper B found that small proportions of cohort participants repeat tested between 2003 and 2010, although this improved over time. Paper C presents a quantitative analysis of the impact of CO-HTC on changes in sexual behaviour and HIV incidence, and found moderate associations between HTC use and reductions in some risk behaviours among HIV-negative participants, but no impacts among HIV-positive individuals or reductions in HIV incidence, possibly as a result of small sample sizes and a declining background incidence in the study area. Paper D presents findings from a qualitative study exploring the effectiveness of HIV prevention counselling messages, which showed that relationship dynamics constrained the extent to which HIV-negative women felt able to control their HIVrelated risk, and imbalanced client-counsellor interactions limited communication during counselling sessions. Overall, the findings from the thesis reveal that provision of different HTC models increased the uptake of services, but the proportions of individuals repeat testing were low and there was limited evidence for an impact of HTC on sexual risk reduction. Future research should explore the effectiveness of different HTC modalities in encouraging repeat testing among high risk HIV-negative individuals, influencing sexual behaviour change and linking HIV-positive people to care and treatment.

As HIV/AIDS continues to disproportionately impact men who have sex with men (MSM) (CDC, 2010a), effective and timely prevention strategies for this population must be developed. Specifically, evidence-based interventions that can be easily adapted and have proven effectiveness are needed. Hence, the purpose of the current study was to assess the impact of the Mpowerment Project (Hayes, Rebchook, & Kegeles, 2003), a community level HIV prevention program originally designed for young urban gay men, when adapted for rural gay men. The Mpowerment Project is recognized as evidence- based intervention by the CDC (CDC, 2009b). The current study is an extension of this research, assessing Mpowerment model fidelity and the behavioral and attitudinal changes that occurred among participants. Data were collected from participants in a rural area of southeast Idaho from 2002-2004. Data were collected prior to M-Group participation and at a three months follow-up. The 66 individuals completing the M-Group pre and posttest assessment also attended a minimum of three study events and a maximum of 226 events. Results revealed no significant changes in attitudinal variables and all but one behavioral variable among Rural Mpowerment (R-MP) participants. The one significant behavior change was an increase in reported safer sex discussion among friends, indicating a possible change in the social norm regarding safer sex. Results also indicate that program fidelity was maintained and the Mpowerment Project is adaptable to rural areas. However, there was no indication of attitudinal changes in participants of this study. There were no changes in behavioral variables aside from discussion about safer sex with friends increasing. The lack of evidence-based interventions for rural gay men highlights the need for further research on the community impact of the Mpowerment Project on rural participants.

Submitted to the Faculty of Education in fulfillment of the requirements for the Master of Education in the Department of Educational Psychology and Special Education at the University of Zululand, South Africa, 2010.<br>One of the most devastating diseases in. modem history as measured in terms of loss of human life is the HIV/AIDS pandemic - Approximately 200 million people have already died. Sub- Sahara Africa is the most affected with South Africa severely affected with an estimated 6 million HIV positive South Africans and 2.5 million already dead from AIDS or related illnesses. This study, located at several primary and secondary schools in the deep rural areas of the Scottsburgh circuit, KwaZulu-Natal, South Africa, was undertaken to investigate the trend that, despite a higher level of knowledge and exposure to information about HIV/AID amongst educators and despite comprehensive campaigns to fight HIV/AIDS, an increasing number of educators are still dying from the disease. In this study it is assumed that knowledge alone is not enough and that attitude change is central to HIV/AIDS prevention since attitudes influence the way in which persons behave. The following research questions are asked: What is the nature of educators' attitudes towards HIV/AIDS, and, are the educators' attitudes towards HIV/AIDS influenced by variables such as age, gender, religion, experience and qualification? Thus the study aims to: determine the nature of educators' attitudes towards HIV/AIDS, and find out whether or not educators' attitudes towards HIV/AIDS are influenced by characteristics such as, gender, age, experience, religion, and qualification. To determine this, a quantitative study was conducted with 71 secondary and primary school educators in the rural area of KwaZulu Natal, Scottsburgh district. The survey, a cross sectional design, involved administering a fixed response questionnaire (Likert scale type) categorized into five scales, which described the nature of educators' attitudes towards HIV/AIDS. The study revealed that there was no significant difference amongst the sampled educators' attitudes towards HIV/ADS, and that these attitudes were mostly negative. This difference was also not influenced by educators' age, gender, qualification, experience or religion. The study found that educators were still discriminating, reluctant to test themselves and disclose their HIV/AIDS status, which may be related to the failure of HIV/AIDS prevention strategies. The campaign to stop the spread of HIV/AIDS in schools and m communities appears to be jeopardized by such attitudes of educators. The following was recommended: the cascading system of training educators did not work and therefore the Department of Education must ensure that every educator has an opportunity to receive training in HIV/AIDS information; that support systems (emotional, psychological, medical) for those educators infected and affected by HFV/AIDS be made available; financial allocations to HIV/AIDS prevention programmes should be increased but with better fmancial control; employment of full-time co-ordinators who are knowledgeable; provision of incentives to encourage educators to test for HIV/AIDS and programmes that provide social skills training needed for behavioural change, as well as those that aim at reducmg stigraatization, ostracism and discrimination of individuals infected. The researcher suggests that an immediate, urgent strategy to address educator attitudes towards the disease is required from the relevant government departments.

Purpose: The purpose of this study is to evaluate and compare the extent and potential correlates of sexual risk taking behaviors related to condom use and number of sexual partners among Haitians aged 15 to 49 years old living in the urban and rural areas. Methods: Data were obtained from the 2005-2006 cross-sectional survey conducted by the Demographic Health survey. Our study population (15143) was analyzed based on the Health Belief Model (HBM) theory using a bivariate and multiple logistic regression analysis with SPSS for windows. Results: In both rural and urban areas dwellers had an accurate knowledge of the disease. However, a small proportion in both areas used condoms during their last sexual intercourse. Perceiving the disease's severity was more likely associated with condom use in the urban (OR 1.36, p ≤ .01) and in the rural areas (OR 1.45, p ≤.05). Strong associations have been found between some variables of the HBM and condom use but none have been found associated with zero or one sex partner. Findings were similar in both areas Conclusion: Holistic approach should be considered in the prevention strategy conducted in Haiti to tackle other factors that may contribute in delaying responsible sexual behavior in that country.

HIV/AIDS is a global pandemic with critical demographic, economic, and social implications. The pandemic is widespread in poor regions of the world, including Southeast Asia where its long-term effects are potentially catastrophic. Despite the major impacts of the epidemic being already felt at the household level in many countries, a lack of recognition of the socioeconomic determinants of HIV infection and the economic and social impacts of HIV/AIDS and their relationship with poverty persists. This is due in part to the lack of systematic studies at the household, community, sectoral, and macro levels. The thesis describes a 'vicious circle' between HIV/AIDS, poverty and high-risk behaviour at the individual level. In the poverty-HIV/AIDS cycle, HIV-infected individuals are especially vulnerable to poverty, the poor are more likely to engage in high-risk behaviour such as commercial sex work, and high-risk behaviour in turn makes people susceptible to HIV infection. The thesis examines whether rural Northeast Thailand exhibits characteristics that support the existence of such a cycle. Four key relationships are considered and tested: (i) the relationship between previous HIV infection and current wealth or poverty; (ii) the relationship betweem wealth or poverty and HIV/AIDS knowledge; (iii) the relationship between previous wealth or poverty and current HIV infection; and (iv) the relationship between previous migration and current HIV infection. All four relationships are shown to hold using survey data from Khon Kaen province in Northeast Thailand. Poverty is shown to increase susceptibility to HIV infection, and HIV/AIDS is shown to reduce wealth and hence increase poverty. Under the circumstances, the hypothesis that rural Northeast Thailand exhibits characteristics that would suggest the existence of a poverty-HIV/AIDS cycle cannot be rejected. This thesis also provides several key contributions to the literature on HIV/AIDS and poverty. First, it provides quantitative and qualitative empirical analysis of the impacts of HIV/AIDS on households in a moderately affected region of Thailand. Second, it provides empirical analysis both on whether wealth and poverty affect the risk of HIV infection, and whether HIV infection affects wealth and poverty. The results from this thesis also provide significant empirical evidence of the importance of rural-urban migration in the spread of HIV in Asia. Finally, the thesis investigates the potential effects on the poverty-HIV/AIDS cycle of an ongoing socio-economic intervention, namely breaking the poverty-HIV/AIDS cycle via intensive rural development.

Thesis (M.P.H.)--Georgia State University, 2008.<br>Title from file title page. Richard Rothenberg, committee chair; John Beltrami, Michael Eriksen, committee members. Electronic text (111 p.) : digital, PDF file. Description based on contents viewed Aug. 22, 2008. Includes bibliographical references (p. 65-73).

Thesis (PhD)--University of Stellenbosch, 2011.<br>ENGLISH ABSTRACT: Pregnancy is a vulnerable time in settings such as sub-Saharan Africa, and is associated with exposure to a multitude of physiological, social and psychological risks. High HIV prevalence, and the fact that many women will test for HIV for the first time during their pregnancy, has raised concern about women‘s psychological health during pregnancy. Depression during the antenatal period is of public health concern as it has been shown to be associated with poorer foetal and delivery outcomes, risky behaviours, and poorer uptake of antenatal care. Antenatal depression is a predictor of postnatal depression, and postnatal depression has been associated with poor maternal sensitivity and attachment in mothers which is known to result in increased behavioural and developmental difficulties in children. The aim of this research was to provide a clear, in depth and culturally sensitive understanding of the manifestation of depression in pregnant women in a rural area with high HIV prevalence in South Africa. The research method included a diagnostic assessment of depression in 109 women in their third trimester of pregnancy, and an in-depth qualitative examination of the contextual framework within which HIV testing and depression are experienced with a sub-sample of 56 women. The quantitative results demonstrated that the prevalence of antenatal depression was high (46.7%), with close to half of the women being diagnosed with depression. Presentations of depression most frequently included disturbances in mood, loss of interest and suicide ideation. Symptoms which overlap with common side effects of pregnancy such as loss of energy and weight change did not result in an overestimation of depression. Likewise, very little evidence of the somatisation of depression, or particular cultural barriers to the diagnosis of depression based on DSM-IV criteria was found. Rates of suicide ideation were high and equally common among HIV positive as HIV negative women. Factors significantly associated with depression included living within a family homestead, access to a regular source of income and practical support from a partner. Both income and partner support had a negative association with depression. Living away from a family or parental home had a positive association with depression. The results showed that the Edinburgh Postnatal Depression Scale (EPDS) was effective in identifying depression and that a shorter three item version was as effective as longer versions. A positive score for depressed mood on the EPDS was significantly associated with HIV, suggesting that the EPDS is a good screening tool for elevated psychological risks among HIV positive women post HIV testing. Qualitative results showed that having an unsupportive partner and the occurrence of relationship or familial conflict played an important role in the development of emotional distress during pregnancy and resulted in a high number of unwanted pregnancies. Partner and familial conflict was intertwined with cultural practices which govern the acceptability of childbearing among unmarried women and the social recognition of partnerships and paternal responsibilities. Testing for HIV was considered a stressful life event for all women regardless of their HIV status and was a particularly negative life event for women who tested HIV positive or for women who had concerns over partner infidelity. Disclosure among HIV positive women frequently lead to increased partnership conflict. Qualitative findings suggested that depression and emotional distress after HIV testing did interfere with women‘s ability to engage with prevention messages. Women who were coping well with learning their HIV positive status had high levels of family disclosure and subsequent family support in common. The implication of this research is that it is important that public health programmes screen for depression among childbearing women. These data suggests that a shorter three item version of the EPDS along with screening for partner and family support or conflict would effectively detect most women at high risk for depression. Likewise, public health interventions for women with depression which are implemented in primary health care facilities and in isolation of the partnership and familial context within which depression occurs are not likely to be effective. Further research is needed to establish the precise prevalence of antenatal and postnatal depression in women at high risk for HIV; to validate the effectiveness of a shorter screening tool in resource limited settings; and to establish risk and protective factors, and trimester specific risks which could inform the design of cost effective interventions in poorly resourced settings.<br>AFRIKAANSE OPSOMMING: Swangerskap in Afrika, suid van die Sahara, is ʼn kwesbare tydperk met blootstelling aan ʼn menigte fisiologiese, sosiale en sielkundige risiko‘s. Die hoë voorkoms van HIV en die feit dat baie vrouens gedurende swangerskap vir die eerste keer vir HIV wil toets, het ‗n besorgdheid oor vrouens se sielkundige gesondheid gedurende swangerskap laat ontstaan. Depressie gedurende die voorgeboortelike periode is van belang vir publieke gesondheid, want daar is bewyse wat dui op ‗n verband tussen depressie en swakker fetale en geboorte resultate, riskante gedrag en verminderde gebruik van voorgeboortelike sorg . Voorgeboortelike depressie is ʼn indikasie van moontlike nageboortelike depressie en nageboortelike depressie word geassosieer met swak moederlike sensitiwiteit en die gebrekkige vorming van ‗n band tussen moeder en kind; wat reeds bewys is om te lei tot verhoogde gedrags- en ontwikkelingsprobleme in kinders. Die doel van hierdie navorsing was om ʼn duidelike, indiepte en kulturele-sensitiewe begrip van die manifestasie van depressie in swanger vroue in ʼn landelike omgewing met hoë HIV voorkoms in Suid Afrika te verkry. Die navorsingsmetode sluit in ʼn simptomatiese beraming van depressie by 109 vroue in hul derde trimester van swangerskap en ʼn indiepte kwalitatiewe ondersoek na die kontekstuele raamwerk waarbinne HIV toetse en depressie ondervind word met ʼn sub-steekproef van 56 vrouens. Die bevinding was dat die voorkoms van voorgeboortelike depressie hoog was, 46.7 %, met feitlik die helfte van die vrouens wat met depressie gediagnoseer is. In die meeste gevalle het die voorkoms van depressie gepaard gegaan met ʼn verandering in gemoedstoestand, ʼn verlies aan belangstelling en selfmoordgedagtes. Simptome wat ooreenstem met algemene newe-effekte van swangerskap, soos verlies aan energie en verandering in gewig, het nie bygedra tot ʼn oorberekening van depressie nie. Soortgelyk is baie min bewyse gevind dat somatosasie van depressie, of spesifieke kulturele grense, tot die diagnose van depressie gebaseer op DSM-IVkriteria bydra. Die oorweging van selfmoord was hoog en algemeen tussen beide HIV-positiewe en HIV-negatiewe vouens. Faktore wat aansienlik met depressie geassosieer word, sluit in om in ʼn familiegroep te bly, toegang tot ʼn vaste bron van inkomste en die praktiese ondersteuning van ʼn lewensmaat. Beide inkomste en die ondersteuning van ʼn lewensmaat het ʼn negatiewe verbintenis met depressive. Om nie by familie of in ʼn ouerhuis te bly nie het ʼn positiewe assosiasie met depressive. Alhoewel HIV-status verband hou met depressie, was dit nie uitermate die geval nie, alhoewel daar ʼn gebrek aan statistiese kragdoeltreffendheid was om die effek van HIV vas te stel, gegee die beperkte grootte van die steekproef. Die resultate het getoon dat die EPDS graderingsinstrument effektief was om depressie te identifiseer en dat ʼn korter driepunt weergawe daarvan net so effektief was soos die langer weergawe. ʼn Positiewe telling vir ʼn depressiewe gemoedstoestand op die EPDS het ʼn betekenisvolle assosiasie met HIV en dui daarop dat die EPDS ʼn goeie graderingsinstrument is vir verhoogde sielkundige risiko by HIV-positiewe vrouens, selfs al is HIV-positiewe vrouens in dié steekproef statistieksgewys nie meer geneig tot depressie as HIV-negatiewe vrouens nie. Kwalitatiewe resultate toon dat ʼn lewensmaat wat nie ondersteunend is nie en die voorkoms van verhoudings- of familiekonflik ʼn belangrike rol speel in die ontwikkeling van emosionele angs gedurende swangerskap en dit het gelei tot ʼn groot aantal ongewenste swangerskappe. Konflik met ʼn lewensmaat en met familie was verweefd met kulturele gebruike wat die aanvaarbaarheid van geboortes onder ongetroude vrouens beheer en die sosiale erkenning van verhoudings en die vader se verantwoordelikhede. ʼn HIV-toets is as ʼn stresvolle lewensgebeurtenis beskou deur alle vroue, ongeag van hulle HIV-status en was ʼn besondere negatiewe lewensgebeurtenis vir vroue wat HIV-positief getoets het of vir vroue wat bekommerd was oor hulle lewensmaats se getrouheid. Onthulling van die HIV-status van positiewe vrouens het gereeld tot verhoogde konflik in verhoudings gelei. Kwalitatiewe bevindings dui daarop dat depressie en emosionele angs na ʼn HIV-toets inmeng met ʼn vrou se vermoë om ag te slaan op voorkomingsboodskappe. Vroue wat die kennis van hulle HIV-positiewe status goed hanteer het, het hoë vlakke van bekendmaking van hulle status en die ondersteuning van hulle familie in gemeen. Die implikasie van die navorsing is dat dit belangrik is vir publieke gesondheidsorgprogramme om te toets vir depressie onder swanger vroue. Die resultate dui daarop dat ʼn korter driepunt weergawe van die EPDS, saam met ʼn ondersoek na die ondersteuning van of konflik met ʼn lewensmaat en familie, effektief kan wees om vroue met ʼn hoë risiko vir depressie te identifiseer. Soortgelyk, publieke gesondheidsingryping in primêre gesondheidsorg fasiliteite vir vroue met depressie wat in isolasie van die lewensmaat en familie konteks, waar depressie voorkom geadministreer word, is onwaarskynlik om te slaag. Bevindings onderskryf die belangrikheid van ondersteuning vir die familie om effektief te kan reageer en herstel van stresvolle faktore soos onbeplande swangerskappe en HIV-diagnose, in ʼn konteks wat swaar deur HIV geaffekteer word, aangesien dit ʼn voorkomende effek op depressie kan hê. Verdere navorsing is nodig om die presiese voorkoms van voorgeboortelike en nageboortelike depressie in vrouens met ʼn hoë blootstelling aan HIV vas te stel; om die sukses van ʼn korter graderingsinstrument in arm omgewings te staaf; en om die risiko en beskermende faktore vas te stel en trimester spesifieke risiko‘s wat die ontwerp van ʼn koste-effektiewe ingryping in gebiede met ontoereikende hulpbronne kan beïnvloed.

Although the AIDS epidemic in America began approximately three decades ago, much remains to be learned about the epidemiology of human immunodeficiency virus (HIV) infections in rural America. This study compared profiles of HIV patients at the James H. Quillen Veterans Affairs Medical Center (VAMC) in Mountain Home, TN to those seen at a university-based community HIV care clinic (COM) in Johnson City, TN.

Reproductive tract infections (R TIs), including but not limited to the sexually transmitted infections (STIs), are currently high on the public health agendas of most low-income countries. The reasons for this are manifold, but important contributing factors include the need to control the spread ofIDV, and the high costs to health care systems and infected individuals as a consequence of un- or mis-diagnosed infections. Strategies for the control and management of these infections in resource-poor settings have been advanced at a global policy level: syndromic management of symptomatic men and women is recommended in the absence of comprehensive laboratory facilities. This thesis describes a large cross sectional survey assessing the populationbased prevalence ofRTIs in one rural area of Bangladesh. The prevalence of these infections was determined from random selections of women and men. Patterns of health-care seeking behaviour were analysed, and the correlation between reported 5,ymptoms and the presence of infection was investigated. The prevalence of syphilis in pregnant women, and the incidence of ophthalmia neonatorum were also determined, and the cost-benefit of control strategies for these two problems in this population were investigated. Given that management of symptomatic persons forms a cornerstone of most national RTIISTI control programmes, the study described in this thesis also evaluated the efficacy of the most common syndromic algorithm in use (that for treating women with vaginal discharge). Training requirements for integrating the algorithm at primary health care level are also discussed as part of the findings, and finally the cost-effectiveness of the recommended algorithm was evaluated. Using the results of the five arms of the study, recommendations are advanced for RTIISTI control programmes in areas with similar epidemiological characteristics to those found in the population described in this study. Finally, areas where further research is needed are highlighted in the discussion.

Submitted by Mario BC (mario@bc.ufrpe.br) on 2018-03-15T14:52:13Z No. of bitstreams: 1 Maria do Carmo Maracaja Alves.pdf: 1308868 bytes, checksum: 07784a272d7ff918f14a2d7341cb0fb6 (MD5)<br>Made available in DSpace on 2018-03-15T14:53:36Z (GMT). No. of bitstreams: 1 Maria do Carmo Maracaja Alves.pdf: 1308868 bytes, checksum: 07784a272d7ff918f14a2d7341cb0fb6 (MD5) Previous issue date: 2017-08-31<br>There are increasing notifications of HIV in Brazil, according to data from the Ministry of Health, although the policy of combating it is considered a worldwide model. The notifications in Pernambuco follow the Brazilian statistics, although the South and Southeast have a decrease in this amount. Issues that point to these escalating outcomes may relate directly to a policy of little or no impact. In the Economic Development Theory, the issues of economic growth point to negative externalities, such as disorderly migration and epidemics. In this sense, the objective of this dissertation is the evaluation of the management of the Public Health Policy in municipalities of Pernambuco, selected from indicators inherent to economic growth, such as migrations and notifications of HIV infections. In this study, the specific objectives addressed, in addition to the evolution of the number of infected and the expenses with this preventive and compensatory policy, the administrative management of the health secretariats of the municipalities, through the criterion of content analysis, based on interviews. How did the health secretariats manage the evolution of the HIV epidemic in the municipalities of Caruaru, Petrolina, Igarassu, Cabo de Santo Agostinho and Tamandaré, in Pernambuco, from 2010 to 2014. As a result, it was observed that, even in view of the evolution of the disease, in the municipalities studied, the budget did not follow this growth. Despite recognition of the severity of the epidemic, management, prevention, education and culture, are identified as the main human failures to control the disease, the budget constraint also contributes to the possibility of a less effective policy.<br>São crescentes as notificações por HIV no Brasil, segundo dados do Ministério da Saúde, apesar da Política de seu combate ser considerada um modelo mundial. As notificações em Pernambuco acompanham as estatísticas brasileiras, embora o Sul e o Sudeste venham apresentando decréscimo nesse montante. As questões que apontam para esses resultados crescentes podem se relacionar diretamente com uma política de pouco impacto ou ineficaz. No âmbito da Teoria do Desenvolvimento Econômico, as questões do crescimento econômico apontam externalidades negativas, como a migração desordenada e as epidemias. Neste sentido, o objetivo desta dissertação é a avaliação da gestão da Política Pública de Saúde em municípios pernambucanos, selecionados a partir de indicadores inerentes ao crescimento econômico, tais como as migrações e as notificações de infecções por HIV. Neste estudo, os objetivos específicos trataram, além da evolução do número de infectados e dos gastos com essa política preventiva e compensativa, a gestão administrativa das secretarias de saúde dos municípios, através do critério de análise de conteúdo, baseada em entrevistas. Como se deram as gestões das secretarias de saúde diante da evolução da epidemia de HIV nos municípios de Caruaru, Petrolina, Igarassu, Cabo de Santo Agostinho e Tamandaré, em Pernambuco, no período de 2010 a 2014. Como resultante, observou-se que, mesmo diante da evolução da doença, nos municípios estudados, o orçamento não acompanhou esse crescimento. Apesar do reconhecimento da gravidade da epidemia, pela gestão,a prevenção, a educação e a cultura, são apontados como as principais falhas humanas para o descontrole da doença, a restrição orçamentária também contribui com a possibilidade de uma política menos efetiva.

This thesis contributes to understanding two demographically important phenomena: African ageing, and the ageing of the African HIV epidemic. Building on the body of interpretivist demography that privileges context and meanings, it explores older adults’ experiences of becoming old, sexuality and living with HIV in rural Malawi. The research uses a constructivist grounded theory framework. It is based primarily on data produced using repeat dependent interviews (N=135) with older men and women(N=43). These are supplemented by fieldwork observations, as well as data from a three-month multi-site pilot study, interviews with HIV support groups (N=3), and key informant interviews (N=19) and policy documents. The thesis identified sets of meanings surrounding old age and ways of discussing ageing that, taken together, formed an analytical framework. The framework is focused on the importance of maintaining an ‘adult’ identity and draws insights from sociological and psychological identity theories. The adult identity was aligned with personhood. It was situated within the body-centred livelihood system of rural Malawi, and associated with physical production. Old age was understood to limit productivity and thereby an individual’s adult identity. This thesis argues that ostensibly contradictory narratives about ageing experiences can be understood as rhetorical strategies respondents employed to maintain their adult identities. A central tenet of the thesis is that the adult identity (and its childlike counter identity) influenced older adults’ broader experiences and behaviours. This framework is used to explore ageing, as well as sex and HIV infection. The grounded understandings of older adults’ experiences developed in the thesis are presented against dominant understandings of the situation of older adults documented by the academe and in policy and programmatic arena emerging in Malawi. The findings highlight the centrality of wider experiences of ageing for older adults’ experiences of sex and HIV, as well as the broader importance of identity for understanding demographic behaviours and processes. In addition, they demonstrate how grounded theory and repeat dependent interviewing can be used within demographic studies to produce nuanced analytical accounts of the experiences that are most salient for the population of interest.

Efforts by the Federal Republic of Nigeria and international nongovernmental agencies to reduce the impact of HIV in Nigeria have not yielded the anticipated results. This study focused on the association between attitude, religious beliefs, knowledge of HIV, sexual risk behavior, and HIV epidemiology in rural and urban Nigeria. This quantitative study used social-cognitive theory and problem theory. The study was based on the Nigerian Demographic and Health Survey (NDHS) 2013 data including a sample of 33,006 participants. Specific covariates including gender, sexual partners over the past years, age at first sexual encounter, socioeconomic status, and literacy level were obtained from the sample. Two hypotheses from each research question were tested to guide the study methodology. Linear regression results suggested that knowledge, attitude, location, and religion predicted sexual risk behavior. Muslims showed the least sexual risk behaviors compared to other religions while more positive attitudes and more knowledge increased sexual risk behaviours. Location had no significant impact on sexual risk behavior. Spearman correlation results depicted a relationship between knowledge and sexual risk behaviors of urban and rural Nigerians separately. More knowledge depicted an increase in sexual risk behaviors. The study results may be useful to Ministry of Health and program planners in constructing culturally based HIV interventions. The significant relationship between knowledge, attitude towards sex, and religious practices may be incorporated with theoretical knowledge on social-cognitive variables to enhance further understanding of the way in which individuals may engage in preventive behaviors to reduce HIV and its effects in Nigeria. Reductions in the spread of HIV/AIDS would lead to a healthy and more productive society.

A disparity of resources for HIV-infected persons exists in rural areas. Unlike any other chronic illness, HIV has no immediate medical intervention until significant disease progression occurs. Lack of curative treatment for a disease process known to induce irrevocable damage to the immune system causes distress, anxiety, and uncertainty. Presently, no theory exists to aid health professionals understand and provide appropriate interventions for these individuals. Considering the negative effects of stress and illness on immune function and the inadequacy of health care services, the purpose of this study was to identify experiences of HIV-infected persons in rural areas. S scURVIVAL D scISTANCING, described experiences by which HIV-infected persons in rural areas balanced limits and accepted the reality of living with chronic illness. Migration of HIV-infected persons, in addition to those indigenous to rural areas, added to challenges in determining health care needs of those infected and needs of those affected by HIV.

Theoretical work indicates that HIV-1 epidemics in sub-Saharan Africa will cause major demographic changes. The current study assesses the extent to which these changes can already be seen in two rural areas of Manicaland, Zimbabwe and investigates the determinants of the epidemic and its demographic impact. The study utilizes demographic survey methods and qualitative sociological techniques. Data analysis is conducted using statistical packages and is guided by insights generated from mathematical models of the epidemiology and demographic impact of HIV-1 infections. HIV-1 prevalence is high in both areas. Among women, HIV-1 infection is associated with age and marital status. Indirect evidence indicates that religion, education, migration and socio-economic characteristics of husband may also be important determinants. Each of these factors influences the pattern of sexual behaviour. Rates of sexual partner change are heterogeneous for women but appear more homogeneous for men. Mixing patterns are disassortative: men form partnerships with women with high and low rates of partner change. Mortality has undergone a recent upturn, almost certainly associated with HIV-1 infections. Adults aged 20-45 years and men, in particular, are most affected at this (early) stage of the epidemic. Religion is an important local determinant of demographic patterns, whose influence on mortality appears to be changing vua its effect on sexual behaviour and the spread of HIV-1. Orphanhood has increased, but, as yet, there is little change in population structure. Fertility has declined since the late 1970s. It is too early in the AIDS epidemic to see an impact of HIV-1 at the population level. However, some signs of behaviour changes which affect the proximate determinants of fertility were detected. These changes may accelerate the decline in birth rates, especially at younger ages. New demographic projections for Zimbabwe are developed, based on observed trends in HIV- 1 infection and fertility, and underlying behaviour patterns. These indicate substantial further increases in mortality, particularly among women and young children, greatly reduced population growth, relative shortages of young children and older adults, and further increases in orphanhood. Families and communities will require support in facing this slowly unfolding disaster.

The HIV and AIDS epidemic continues to affect communities worldwide particularly so in South Africa. Youth, also the so-called Coloured youth, continue to remain at risk of infection, in spite of having been exposed to information about HIV and AIDS. This study explores the views of Coloured secondary school youth in a rural town in the Eastern Cape, on HIV and AIDS. Fifteen secondary school learners, both boys and girls, from Grades 10 to 12 were purposively selected. This qualitative study, framed within an interpretivist paradigm, draws on a phenomenological methodology. The data was generated from using drawing and focus group interviews and analysed using thematic analysis. The research adhered to ethical principles and trustworthiness was ensured. Constructivism and Bronfenbrenner’s bio-ecological systems theory were used to frame the study and to make meaning of the findings. In response to the primary research question, What views do Coloured youth attending a secondary school in a rural town have of HIV and AIDS?, five themes emerged, namely: individuals spread HIV, impoverished family life increases youth vulnerability to HIV, youth under pressure from peers knowingly engage in risky behaviour, misconceptions fuel the epidemic, and HIV and AIDS “captures the community in its net”. Drawing on the findings and in response to the secondary research question, What guidelines can be developed to assist educators to facilitate learners taking action against the spread of HIV and AIDS?, several guidelines were developed. They suggest that teachers should use participatory pedagogies to engage secondary school learners when teaching HIV and AIDS, build self-esteem in their learners, assist learners in dealing with peer pressure, engage learners in erasing misconceptions, and enable learners to break free from being “caught in the net” of HIV and AIDS. Collectively these guidelines could enable learners to take action in protecting themselves and their community against the spread of the HI virus. The study concludes that the views that Coloured secondary school learners from a rural town have about HIV and AIDS show their awareness of the realities of the epidemic affecting the individual, the family, the school and their community. They have constructed their views of HIV and AIDS in a way which shows their understanding of the complexities of the epidemic.

This thesis is based on a mixed methods study with a sequential exploratory design, and is about the fertility preferences of women living in rural South Africa. The quantitative secondary analysis utilises the South African Demographic and Health Surveys of 1998 and 2003, and the qualitative ethnographic fieldwork was carried out in a rural area of KwaZulu-Natal province, South Africa, in 2011 and 2012. The fieldwork included ethnographic field notes and maps generated through participatory mapping exercises, 63 semi-structured interviews with women of different generations and 6 key informant interviews. The thesis examines women’s landscapes of fertility and focuses on intergenerational understandings of fertility preferences, migration and the HIV/AIDS pandemic. The thesis identified that women’s landscapes of fertility are subject to change over time and differ between women of different generations. Older women’s landscapes of fertility are influenced by understandings of the importance of continuity of family whilst those of younger women are synonymous with their experiences of increasing autonomy and agency, caused by escalating modernity. For younger women, migration was a key issue within their landscapes of fertility and their migration later affected their mothers who became migratory followers of their daughters. This is a reversal of typical paradigms of migration, as it identifies that women from different generations can be migratory followers or leaders. It was found that HIV influenced women’s landscapes of fertility due in part to the South African, changing socio-political responses to the disease. The thesis contributes to geographical and anthropological understandings about change in women’s fertility preferences over time in the context of societal change. The thesis also identifies the value of ethnographically informed understandings of fertility preferences as a key indicator of demographic change and population shifts.

Magister Curationis - MCur<br>Globally, tuberculosis (TB) and AIDS are the leading causes of morbidity and mortality of people, particularly in many developing countries. South Africa is among those countries with a high double burden of TB and HIV infections in the world. Although policy guidelines have been developed to mitigate the problems of TB and HIV coinfection, there are still challenges with their implementation. The aim of this study was to analyse the implementation of the integrated TB and HIV policy in a rural sub-district of the Western Cape. The study applied a descriptive survey method to collect data from 60 respondents selected using an all-inclusive sampling strategy. A self-reporting questionnaire was used, and data were analysed using the Statistical Package for Social Sciences (SPSS) program version 23. Descriptive statistics are presented with graphs and percentages. All ethical principles were adhered to. The results showed that 86% of the respondents were female nurses, 59% were registered nurses, and the rest were enrolled and assistant nurses. The general view of participants was that implementation of the integrated TB and HIV policy was poor, as only 25% (11) felt that they have sufficient knowledge and skills to implement it, while 50% (22) did not feel equipped to implement the integrated policy. These perceptions of inadequacy were justified by a lack of sufficient training, with only 32% of the respondents having attended training on integrated TB and HIV management. The nurses’ responses on actual practices ranged from poor to sufficient, and example being the management of HIV-positive TB patients with CD4 count of <100/μl, where 27.9% were unsure when to initiate antiretroviral therapy and 44.7% were unsure when isoniazid prophylaxis could not be given to HIVpositive patients. However, the findings indicated that TB and HIV policy guidelines were 86% and 85.7% accessible respectively. The study concluded that nurses do not implement the integrated TB and HIV policy guidelines sufficiently, mainly due to lack of adequate training which resulted in limited knowledge thus poor practice. It is recommended that a continuous staff capacity development programme, which includes suitable pre-service and in-service training in TB and HIV/AIDS management be developed and implemented as it has the potential to address the current knowledge and skills gaps which impact on implementation of the integrated TB and HIV policy.

Social support for people living with HIV in rural America remains a considerably understudied aspect of HIV/AIDS prevention. People living with HIV/AIDS (PLHA) require extensive support in order to remain in care, and reduce their viral suppression, and other disease complications. Without support, the likelihood that PLHA will refrain from or drop out of treatment options is gravely heightened, which consequently poses a significant threat for efforts to eliminate HIV as a public health issue. Using a mixed-method approach to Social Network Analysis, this study examines the principal role that social support plays in a person’s likelihood to adhere to care and consequently, attain viral suppression. Specifically, it looks at the roles of the family, friends, partners/spouses, and healthcare providers. The study also explores how social relations serve as mediators to stigma and discrimination, especially for disproportionate groups. Closely linked to social support availability is the perceived level of significance of the type of support that is available to the subjects. The study therefore goes further to explore the subjects’ perception of the support they receive (emotional, informational, and instrumental) and their satisfaction with it. This is imperative in that it sheds light on the role that the subjects’ social relations plays in their retention in care. This research again takes an interdisciplinary approach by exploring the contribution of both communication and health communication strategies to effect behavioral change. It contributes to research on HIV/AIDS health equity, and infectious disease management. It also contributes to efforts to identify strategies to control the spread of HIV by proposing efficient ways to optimize social support through the stages of the Care Continuum and consequently, facilitate an increase in the number of people who attain viral suppression. Keywords: Social Network Analysis; Social Support; Rural HIV; PLHA; Stigma.

Philosophiae Doctor - PhD<br>Background: The Human Immunodeficiency virus (HIV) has become a global public health challenge amid the growing concern of adolescent risky sexual behaviour, influenced by biological and psycho-social factors. There is an increasing demand for adolescent sexual risk reduction interventions, especially in sub-Saharan Africa which remains the hub of HIV epidemic worldwide. Sport-based HIV prevention programme has been identified as one of the interventions, in addition to other approaches to provide young people with appropriate HIV knowledge and skills to either delay or reduce risk-taking behaviour. Despite the potential of sport-based programme for sexual risk reduction, there is limited information on how to adapt it to meet adolescent needs in terms of design, contents, and delivery. This information is necessary to provide sufficiently strong evidence to support widespread implementation of sport-based programme, especially in rural African schools. Therefore, the study aimed to measure the impact of a sport-based HIV prevention intervention in the reduction of HIV related sexual risk behaviour among rural high school learners aged 13-18. Method: The overall study design was a concurrent mixed method, utilizing both the quantitative and qualitative approach. The population for the quantitative and the qualitative studies was made up of two high schools in a predominantly “Coloured” community in Ceres. Two classes each were randomly selected from grades 8-10 in both intervention and control school. The intervention was developed through a process of focus group discussions with the Grassroot Soccer (GRS) staff and it was guided by the Social Cognitive Theory. The intervention was delivered to grade 8-10 learners by GRS peer facilitators using the GRS generation skillz curriculum that consists of 12-week sessions in the intervention school. Quantitative data were analysed with multivariate statistical techniques and qualitative data with thematic analysis approach. Results: The data that assessed the behavioural and protective factors to understand why learners in rural schools engage in risky sexual behaviour showed that about 27.2% of the learners reported being sexually active. Of the sexually active learners, 48.7% reported engaging in sex by 14 years or younger and nearly 42.2% reported multiple sexual partners with significant higher proportion of boys than girls. Nearly 55.2% of the sexually active learners reported irregular condom use and 46.3% did not use a condom at the last sexual encounter. The majority of the learners (87%) did not know their HIV status. Being male (OR = 6.60;95% C I = 1.62 – 26.84) and peer influence (OR = 3.01; 95% CI = 1.97-4.60) were the strongest predictors of reporting sexual intercourse and early sexual activities before the age 15 respectively. Though the knowledge of HIV was low, those with greater knowledge of HIV were more likely to use a condom at last the sexual encounter (OR = 1.22; 95% C I =1.03-1.44). The learners who participated in sport-based intervention were 1.43times likely to report higher self-efficacy to refuse sex compared to the control group (OR = 1.43; 95% C.I =1.07-1.92).The process evaluation indicated that the sport-based intervention was well received among the learners as it gave them free space to freely express themselves. Conclusion: The findings have shown that sport-based intervention can be successfully implemented in school and is a promising approach to reduce risks associated with risky sexual behaviour in learners. However, the quality of the programme delivery was hampered by irregular session‟s schedule and language of instruction. The process suggests for a longer exposure period and because of social-cultural diversity, learners must be provided with the ownership of the programme in schools.

Primarily through a case study of the Petauke District this thesis examines the perceptions of local men and women as a basis for examining the significance of the social construction of masculinity for the transmission of HIV/AIDS in heterosexual marriages in rural Zambia. Further, it explores participants' perceptions regarding two possibly key dimensions to the transmission of HIV/AIDS in heterosexual marital relationships in rural Zambia. These are the interconnections between masculinity and gender based violence as a factor in the risk of infection, and male attitudes to the use or neglect of condoms as a measure of protection against the risk of HIV/AIDS transmission. This case study is set primarily in a postmodern social constructionist theoretical context. This provides a sensitive means of registering the variety of concepts, perceptions, interpersonal interactions and broader social conditions which feed into masculinity as a social construction. It also facilitates a fine-grained analysis of how notions of masculinity are both context-specific and shift across time. While largely focusing on the illustrative significance of stakeholders' accounts in Petauke District, the study also provides an account of wider socio-economic conditions and the spread of HIV/AIDS, as a backdrop, and a critique of salient features of current health promotion responses. The case study uses qualitative methods, involving the use of individual interviews and focus group discussions with a sample of thirty men and thirty women, respectively, who were previously or are currently married. A thematic approach is used to analyse the data collected in the field. The study findings reveal that study participants perceive Petauke district to be undergoing a process of social transformation and it is thus on a 'cultural crossroads'. This is as a result of the growing influence of the media, education, intermarriages and social mobility. This has given birth to new social values which all have an influence on the social construction of masculinity. Challenging traditional and contemporary hegemonic modes of masculinity is perceived as one of the main tools that should be used to address the association between the social construction of masculinity and the risk of HIV/AIDS transmission in heterosexual marital relationships. This includes addressing the intersection between domestic violence and the risk of HIV/AIDS infection and promoting the use of condoms against the risk of infection in marital relationships. The study concludes by drawing out the implications for health promotion policy and practice. It discusses the need for health promotion to work with male and female stakeholders, and undertake programmes that have as a key strategy the deconstruction of harmful beliefs and ideologies associated with masculinity, in order to address male HIV/AIDS risk taking behaviour in marital relationships in rural Zambian communities.

Note:<br>AIDS Service Organizations (ASOs) have a central role in providing HIV/AIDS related services to rural communities in Ontario, Canada. To date, very little information has been published on the experience of people employed by ASOs who work in rural Canadian communities. In an effort to learn more about this important topic, this research explored the challenges, risks and benefits people in the field associate to their work. Using A. Giorgi (1985) and B. Giorgi (2006) phenomenological method a purposive sample of three participants were interviewed on two separate occasions. From 179 significant statements, 23 themes emerged to be part of three categories that included: Rural Communities, AIDS Service Organizations, and Workers' Experiences. Through the unfolding of the participants' experiences it became apparent that HIV / AIDS remains a complex phenomenon that is influenced by the structural aspects of Society.<br>Les organismes offrant des services dans le domaine du VIH/SIDA jouent un rôle central dans l'offre de services en matière de VIH/SIDA auprès des communautés rurales de l'Ontario, au Canada. Jusqu'à présent, très peu d'infonnation a été publiée sur l'expérience vécue par les gens employés par ces organismes dans les communautés rurales canadiennes. Afin d'en apprendre davantage sur ce sujet d'un grand intérêt, la présente recherche a pour but d'explorer les défis, les risques et les bénéfices que ces gens perçoivent dans leur travail. En se basant sur une méthode phénoménologique de A. Giorgi (1985) et de B. Giorgi (2006), un échantillon de trois participants a été ciblé. Pour ce qui est des entrevues, elles ont été conduites auprès de chaque participant à deux occasions différentes. Les 179 commentaires des participants qui étaient pertinents ont pennis d'identifier 23 thèmes qui ont été divisés en trois catégories: les communautés rurales, les organismes offrant des services dans le domaine du VIH/SIDA et l'expérience vécue par les gens employés par ces organismes. En parcourant l'expérience décrite par les participants, il est apparu évident que le VIH/SIDA demeure un phénomène complexe qui est grandement influencé par les structures et les caractéristiques de la société.

Thailand is a nation of some 60 million people, 2 million of whom are estimated to be HIV/AIDS infected and, of those who are infected, 80-90% were infected through heterosexual intercourse and 10-20% are women. In this research, the author discusses the situation in some detail.The experiences of HIV/AIDS infected Thai wives and widows in the rural north of the country are studied.A major contributing factor is the differential constructions of male and female status and sexuality in traditional Thai culture.These constructions are rooted in Theravada Buddhism, ancient mythology and folklore. Data was obtained from 24 participants in Chiangmai Province. The findings of the study revealed several problems with which participants were confronted and the processes they used to address them.It is suggested in the findings that any serious therapeutic interventions and interventionist research studies must be congruent with traditional Thai culture<br>Doctor of Philosophy (PhD)

Thesis (PhD) -- University of Western Sydney, 2001.<br>"Thesis submitted for the degree of Doctor of Philosophy, University of Western Sydney, School of Nursing, Family and Community Studies." Bibliography: leaves 219-254.

There has been limited success in tackling the spread of the HIV epidemic among young people, despite years of interventions. This research contributes to an understanding of why intervention success has been limited by examining HIV prevention among young people in the rural Eastern Cape of South Africa. Shifting the focus from the specifics of individual interventions, it draws on the theoretical work of Foucault to examine how young people and their sexuality are being constructed and understood within policy discourse, and how this relates to young people’s own everyday experiences of the virus. In doing so it highlights both the disjuncture between these understandings, and the ways in which, despite this, young people are engaging with policy narratives in often unexpected ways. Using qualitative approaches the research was carried out in four rural communities. Repeat dependent interviews (n=108) were conducted with young people (n=56) over a 10 month period. These were supplemented by participant observation, key informant interviews (n=15), and analysis of policy documentation. The study finds that the ways in which evidence is used to make knowledge claims about young people and their engagement with the virus is problematic. It argues that the dominance of particular forms of knowledge within policy processes work to exclude those forms of knowledge which are grounded within young people’s everyday lived experiences of their sexuality and the virus. As a result, in claiming to ‘know’ young people, this decontextualized knowledge works to construct a particular subject position of youth in which agency is ascribed to fit within dominant gendered and medicalised narratives of the virus. These constructions are in stark contrast to how young people themselves understand and perform their own sexual identities, which are spatially and temporally located. The research finds that young people come to construct and perform their, often multiple, identities in ways which reflect their subjective interaction with the context of their daily lives. It finds that young people’s narratives of sexuality and HIV are embedded in discourses of pleasure and poverty, and are shaped by a complex web of social and gender relations. Despite this disjuncture, the research finds that young people are not simply ignoring, but rather are engaging, with these policy narratives in complex ways, as they become part of their context of interaction. Drawing upon Long’s interface model the research finds that as policy narratives come to intersect with young people’s lifeworlds, new forms of knowledge and social practice are produced. Within this interface ‘youth’ as an identity emerges as an asset which young people can draw upon and utilise to make sense of their situation, as well as provide access to opportunities. At the same time young people appropriate the policy narratives of individual responsibility and the medicalised discourse of HIV to rationalise, and make sense of, their own risk taking behaviours. The thesis' methodological contribution examines research practices themselves as sites of knowledge production about young people. Turning the analytical lens on my own work, as well as that of others, it examines the challenges in conducting such research and the ways in which it can serve to reproduce the narratives it seeks to uncover. In going beyond identifying the disjuncture between policy narratives of youth sexuality, and those that young people construct for themselves, the research generates new insights on how we think about young people, their identities and behaviours, in relation to the virus. By moving from the specifics of interventions themselves to the assumptions and conceptualisations which underpin them, it draws attention to the importance, and problematic nature, of what we do know, what we can know, and the implications of these knowledge processes in the everyday lives of young people. In doing so it generates a number of key implications for policy and future research.

Traditionally, in Nigeria women play a subservient role in relation to men. While a man can practice polygamy by marrying many wives, women cannot marry more than one husband at a time. Although researchers have documented the effects of polygamy on the spread of HIV/AIDS, little is known about the experiences of polygamy by Nigerian women who stopped practicing polygamy by immigrating to the United States without their husbands. It is important to know the experiences of these women as they pertain specifically to the spread of HIV/AIDS so as to develop a preventive intervention for HIV/AIDS among Nigerian women in polygamy. The purpose of this phenomenological study was to explore the perspectives on HIV/AIDS held by 10 Nigerian women who practiced polygamy in Nigeria before immigrating to the United States. Recruitment was done through purposive sampling at a faith-based organization. Guided by the health belief model, interview transcripts from the 10 women were analyzed to reveal recurrent themes that expressed the women's lived experiences in polygamy with their perspectives on HIV/AIDS. Findings revealed that these women had a basic knowledge of the risk of contracting HIV/AIDS by engaging in polygamy but needed to comply with the terms of sexual encounters as dictated by their husbands; therefore, they were at risk for HIV/AIDS. The results of this study can be used to increase awareness among Nigerian women in polygamy and Nigerian health policy makers regarding the transmission of HIV/AIDS and the preventive measures available for HIV/AIDS. Understanding the experiences of women in polygamy may lead to greater understanding of the impact of polygamy on HIV/AIDS and may help to decrease the prevalence of this disease.

Thesis (Ph. D. (Medical Sciences)) -- University of Limpopo, 2016<br>Refer to document<br>The Belgium Development Co-operation through VLIR-UOS, The University of Limpopo,and The Flemish Universities

Parenting Stress (PS) has been shown to negatively impact on various areas of child development. Additionally, clinically significant levels of PS have been shown to be fairly stable over time and thus unlikely to decrease without intervention. Understanding factors that contribute to PS is therefore important for developing preventative interventions. Despite this, PS has largely been understudied, particularly in low- and middle-income countries (LMICs). The present study aimed to explore PS among 1535 caregivers of primary school-aged children in rural KwaZulu-Natal. The data were collected by experienced fieldworkers, in interviewer style, over three visits, and underwent checks for completeness and quality assurance, prior to data entry. The analysis for the present study included using logistic regression techniques to examine contributing caregiver, child and family factors, as well as content analysis to examine caregivers’ most prominent concerns about their children. Around 16% of this sample were experiencing clinically significant PS. The following factors were found to increase risk of PS: the mother becoming HIV infected post-pregnancy, the family experiencing recent food insecurity, the child exhibiting internalizing or externalizing behaviours and the child having academic or other problems at school. Two factors were linked to a reduced likelihood of PS, namely the child being helped to learn shapes and sizes at home and maternal participation in a breastfeeding study. The content analysis revealed that caregivers most frequently reported having psychosocial concerns about their children, including specific personality traits such as low levels of conscientiousness and poor self-regulation. These findings illustrate the need for early intervention and support for mothers and children in LMICs. Furthermore, this research showed the impact of parental HIV and the need for comprehensive life-course approaches to curb future adversities for HIV infected women and families.

With more than 33 million people living with HIV/AIDS, and an infection rate that is increasing rather than falling among high-risk groups, the 30-year history of the AIDS epidemic has been characterised as ‘islands of success in a sea of failure.’ Given the lack of a medical cure for the disease, the world has looked to social marketing campaigns to promote behaviour change that would decrease infection rates. Under the best of circumstances, change is difficult, and health behaviour change, especially when it relates to sex and politics, is even more challenging, so social marketers have a difficult task that calls on every technique at their disposal. There is an increasing expectation that HIV/AIDS social marketing interventions will yield measurable results, and that involves fully understanding the AIDS landscape, marketing theory and practice, and the evolving medical picture relating to the pandemic. This research explores links between social marketing and HIV/AIDS while mapping their marketing connections to both the conventional and alternative medical communities. To better understand the HIV/AIDS landscape, early research focused on three diverse countries— Mexico, Uganda, and the United States—selected for their significant cultural, economic, and political differences. Given the multiple social perspectives and fields of knowledge involved in this project, a transdisciplinary approach using mixed research methods was selected. Mixed methods for collecting and presenting data included case studies, content analysis, semistructured interviews, a quantitative survey, and in-depth reaction interviews. Through analysis of 18 social marketing campaigns in the three countries selected for study, the content, focus, purpose, and implications of the controlled public dissemination of HIV/AIDS information were examined. Key informants with professional and academic credentials in the areas of marketing, advocacy, and HIV/AIDS medicine were interviewed to learn rationales behind the campaigns and to explore political and economic factors that affect HIV/AIDS health activism. The last major phase of information gathering surveyed more than 340 patients at a clinic in Houston, Texas, to ascertain their knowledge and perceptions about HIV/AIDS treatment and prevention information. After the survey data was compiled, reaction interviews from key informants provided additional input. Informed by this wealth of secondary and primary research, an Integrated Social Marketing Conversation (Marcon) Model was created to demonstrate that social marketing campaigns should be localised and customer centred, with participants engaging in an ongoing conversation at every stage. The communication model offers valuable guidelines for more effective dissemination of HIV/AIDS prevention and treatment information to high-risk, high-interest target audiences such as HIV-positive people and the organisations that work with that subculture. Because this research crosses so many boundaries and addresses an actual need, it should be of interest to a wide variety of individuals and organisations in both academic and professional fields. From marketers to medical practitioners to activists associated with HIV/AIDS issues, this project’s findings will apply to their concerns. Also, HIV/AIDS organisations — both government agencies as well as private groups — should find information in this work that addresses their ongoing efforts. While investigating existing models for HIV/AIDS communication, it became evident that most research and communication models have focused on how HIV/AIDS prevention programmes are working and what is effective, but little has been done in regards to treatment options and information. For that reason, the integrated social marcon model presented in this thesis is an important addition to the body of practical literature on this topic. Finally, the volatility of the issues examined here and the contacts made during five years of work offer multiple possibilities for follow-up research and fieldwork with opportunities to make a positive contribution in the battle against the HIV/AIDS pandemic.

This ethnographic study explored factors that facilitate or hinder women's participation in health promotion and HIV prevention in the Mt. Selinda area of rural Zimbabwe. Rates of HIV and AIDS in Zimbabwe are among the highest in the world and increasing most quickly among young females. A purposeful convenience sample of 11 Ndau women (key participants) was interviewed twice. Seventeen key informants and four focus groups offered further perspectives. The resulting narrative presents a picture of Ndau women's existence that is difficult and oppressive. Females are socialized early to be workers and mothers within a context of limited voice, subservience, violence, and economic powerlessness. Application of a health promotion framework reinforced the reality that these women are generally unable to use measures for HIV prevention. Socio-cultural and economic factors of gender inequality were analyzed through an ecological approach, showing that cultural beliefs and practices, along with national and international forces, support and sustain gender inequality. If there is to be change in the AIDS crisis, the study's findings suggest that HIV prevention strategies should be integrated within a participatory community development model that includes opportunities for both men and women to carry out gender analysis. While health professionals must understand and be sensitive to culture and context, existing unjust and inequitable structures at all levels of society must be examined and challenged.

This thesis is based on research on the epidemiology and prevention of HIV among adults in rural Masaka district, Uganda (1989-2010). Arising from this research are 10 published papers, which I have used to explore three research questions: (i) what are the trends in HIV prevalence and incidence in rural Uganda? (ii) what are the key determinants of these trends? (iii) what new strategies could be used to prevent HIV infection in this population? The studies involved four adult cohorts: a general population cohort to monitor HIV prevalence and incidence trends through annual household and serological surveys; an STD/behavioural intervention cohort; a cohort for HIV vaccine preparedness studies; and a cohort of HIV-negative women in discordant couple relationships to evaluate HIV biomedical interventions. The findings from the published papers are summarised. Additional analyses were conducted to include prevalence and incidence data up to 2008. The time trends were examined using a proximate-determinants framework. A comparison of the observed trends was also made with other available national data as well as data from two other African countries. There was a significant decline in HIV prevalence for all ages in the 1990s followed by an increase in the 2000s. Similarly, HIV incidence declined significantly in the 1990s in all adults although there were no clear trends in the 2000s. A net outflow of HIV positive migrants, mortality among HIV positive individuals and a decrease in risky sexual behaviour in the 1990s seem to have been important factors in explaining the decline. The increase in prevalence in the 2000s is explained partly by improved survival due to ART and possibly complacency leading to increased risky sexual behaviour. Two HIV intervention trials (of STDlbehaviour change and a phase 3 vaginal microbicide) are also discussed. Neither trial showed any effect on HIV transmission. To explain the findings from these trials, a conceptual framework for discussing negative results from HIV prevention trials has been used. The possible explanation for the negative results was that the concepts were right but the actual interventions were "inert" or insufficient to demonstrate impact. There was also evidence that there were deficiencies in the design and delivery of the school-based component of the behavioural intervention. In recognition that the epidemic continues unabated, I have addressed priorities for future HIV prevention research on biomedical and behavioural interventions. The cohorts established and research capacity built will continue to provide new opportunities for monitoring and preventing the transmission of HIV in this population.