Master of Public Health - MPH / The notification and treatment of sexual partner(s) is a key element in the prevention and control of sexually transmitted infections (STIs). Partner notification interrupts the chain of STI transmission, prevents STI complications and long-term sequelae in the sexual partner(s), and also prevents re-infection of the treated index patient. Partner notification is a recognized component of the syndromic management of STIs in Namibia and yet the partner notification rates in the country remain low - as low as 7% in the district of Windhoek currently. In this district, which has the highest number of STIs cases in Namibia, the specific factors that hinder partner notification have not yet been documented. This study sought to investigate the perceived and experienced barriers to partner notification amongst STI patients attending an urban primary health center in the district. An explorative, qualitative study with eight patients (four males and four females), aged 16 years and over, who presented with a new/recurrent episode or a STI follow up was conducted. The participants were purposively selected with the aid of the deputy nurse in charge of the health center after agreeing to take part in the study. The patients were asked about what they felt were personal, partner-relationship and health services related factors that hindered partner notification. Three health workers working at the health center served as key informants and were asked about barriers to partner notification based on their experience of delivering preventative and curative STI - related services over the past three or more years. Interviews with both patients and key informants were conducted in the health facility, recorded and later transcribed. Content analysis of the transcribed data was conducted to identify recurring themes across the different interviews. The results of the study suggest that the partner notification strategy was not functioning optimally as a result of a number of inter-twined factors. The factors can be categorized into personal barriers, partner-relationship dynamics and health services related barriers. The study found that participants considered there were barriers to partner notification across all these three categories. Commonly reported barriers included the stigma associated with STIs and the cultural and religious norms that do not promote discussion of topics related to sex and sexuality in general. Other barriers such as gender inequality, the fear of a partner's reaction to the notification, feelings of guilt associated with infidelity, the lack of communication between partners and the inability to locate partner(s) were highlighted by participants. Barriers associated with the health services included the lack of health education about the importance of partner notification, the absence of thorough risk reduction counseling, the current method of partner notification that is being utilized and the negative attitudes of health workers. It is suggested that having a greater understanding of these barriers and how to work with them in a health education or counseling sessions will allow health workers to address them more directly with their patients and in turn, hopefully improve the management and outcomes of partner notification strategies in the STI prevention and control program in the Windhoek district and potentially other districts in Namibia.

Background: Patient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in resource-limited settings. Objective: This randomized controlled trial aimed to evaluate the effect of 2 different PN technologies on notification outcomes following syphilis diagnosis among MSM in Peru: A Web-based notification system and patient-delivered partner referral cards. Methods: During 2012-2014, we screened 1625 MSM from Lima, Peru, for syphilis infection and enrolled 370 MSM with symptomatic primary or secondary syphilis (n=58) or asymptomatic latent syphilis diagnosed by serology (rapid plasma reagin, RPR, and Microhemagglutination assay for Treponema pallidum antibody; n=312). Prior to enrollment, potential participants used a computer-based self-interviewing system to enumerate their recent sexual partnerships and provide details of their 3 most recent partners. Eligible participants were randomly assigned to one of 4 intervention arms: (1) counseling and patient-initiated Web-based PN (n=95), (2) counseling with Web-based partner notification and partner referral cards (n=84), (3) counseling and partner referral cards (n=97), and (4) simple partner notification counseling (control; n=94). Self-reported partner notification was assessed after 14 days among 354 participants who returned for the follow-up assessment. Results: The median age of enrolled participants was 27 (interquartile range, IQR 23-34) years, with a median of 2 partners (IQR 1-5) reported in the past month. Compared with those who received only counseling (arm 4), MSM provided with access to Web-based partner notification (arms 1 and 2) or printed partner referral cards (arms 2 and 3) were more likely to have notified one or more of their sexual partners (odds ratio, OR, 2.18, 95% CI 1.30-3.66; P=.003 and OR 1.68, 95% CI 1.01-2.79; P=.045, respectively). The proportion of partners notified was also higher in both Web-based partner notification (241/421, 57.2%; P<.001) and referral card (240/467, 51.4%; P=.006) arms than in the control arm (82/232, 35.3%). Conclusions: Both new Web-based technologies and traditional printed materials support patient-directed notification and improve self-reported outcomes among MSM with syphilis. Additional research is needed to refine the use of these partner notification tools in specific partnership contexts. / Revisión por pares / Revisión por pares

Background: Chlamydia is one of the most common STIs in Sweden and young adults (age 15-29 years) are at the highest risk. Chlamydia is classed as a danger to the public disease in Sweden meaning that partner notification is mandatory by law. Chlamydia is also a stigmatised disease which can be an obstacle for many young adults to visit testing practices. The key traits of an ideal treatment towards young adults consist of openness and non-judgmental communication from healthcare professionals. Purpose/aim: The aim of the study was to describe the young adults’ experiences of testing positive for Chlamydia trachomatis. Method: Two databases were used for this study. The searches resulted in 12 articles. The data analysis was conducted through a content analysis. Result: The results illustrate four themes: the worry of judgemental attitudes, the feeling of shame, the feeling of vulnerability and the experience of treatment from healthcare professionals. The young adults experienced shame and worry that their social identities would be threatened by a positive Chlamydia result. They felt discouraged to visit healthcare professionals if they acted judgementally and lacked good communication in their treatment. Conclusion: The feelings of worry and shame are apparent when young adults seek testing and partner notification. The importance of a good treatment from healthcare professionals have positive effects on young adults’ testing practices, and should be furthermore acknowledged in the nurse profession. / Bakgrund: Klamydia är en av de vanligaste könssjukdomarna i Sverige och unga vuxna (15-29 år) är den största riskgruppen. Klamydia anses som en allmänfarlig sjukdom och är smittspårningspliktig. Klamydia är även en stigmatiserande sjukdom vilket kan hindra unga vuxna från att testa sig. Vårdpersonal som bemöter unga vuxna med en öppenhet och icke-dömande kommunikation är det ideala vårdmötet. Syfte: Syftet med studien var att beskriva unga vuxnas upplevelse av ett positivt klamydiabesked. Metod: Litteraturstudien genomfördes med sökningar i två databaser. Sökningarna resulterade i 12 resultatartiklar. Databearbetningen gjordes genom en innehållsanalys. Resultat: Litteraturstudiens resultat illustreras i fyra teman: oro för dömande attityder, känsla av skam, känsla av utsatthet, och upplevelse av vårdpersonalens bemötande. Resultatet visar att unga vuxna kände oro och skam av att få klamydia och hur det påverkade deras sociala identitet i samhället. Välkomnande och icke-dömande bemötande från hälso- och sjukvårdspersonalen var av största vikt för att genomföra smittspårningen. Om inte personalen var tillmötesgående ville inte unga vuxna ta del av undersökningar. Slutsats: Oro och skam är förekommande känslor hos unga vuxna som testar sig för klamydia och smittspårar. Ett bra bemötande från vårdpersonalen har positiva effekter på unga vuxna och bör medvetandegöras ytterligare i sjuksköterskeprofessionen.

Chlamydia trachomatis (CT) can cause infertility and is the most common sexually transmitted infection (STI) of bacterial origin in Europe. Surveys in seven countries estimated a population prevalence of 1.4-3.0 % in people 18 to 44 years. Approximately 87% of those diagnosed in Sweden are 15-29 years. Since 1997, with the exception of 2009-2010, despite all efforts, CT has increased steadily in many European countries including Sweden. That made us investigate risk factors associated with catching STIs, especially CT. In Sweden partner notification is mandatory by law when a patient is diagnosed with CT. Centralised partner notification, performed by a few experienced counsellors, and evaluation of the sexual history for at least 12 months back in time, shows superior results compared to other studies. Phone-interviews are a good option in remote areas. “The Västerbotten model” for partner notification fulfils these criteria and our evaluation has functioned as a model for changing recommendations of partner notification in Sweden. Preventing CT by primary prevention such as information and counselling is, however, still of great importance. We investigated whether it was necessary to test for CT in the throat. We found that patients testing positive for pharyngeal CT neither had more symptoms or signs nor a sexual history that differed from others. We therefore believe that we will find most or all of these patients by conventional testing of urine and cervical/vaginal samples. We wanted to further identify risk factors among patients attending a clinic for sexually transmitted infections to enable individualized care depending on risk. None or inconsistent use of condoms with new/temporary partners in combination with having at least one new/temporary partner within the past 6 months could identify persons with risk behaviour and at increased risk of CT (re)infection. Additional information about whether the condom was used during the whole intercourse did not add any risk of infection. A drop-in reception is a good contribution to an opportunistic screening approach. The rate of CT infected is high and the clinic attracts men and individuals ≥25 years old at risk of infection, groups which usually have a reduced test rate. The mean age was 28 years and 58% of the patients were men. The figure of correct condom usage is very low indicating the need for risk reducing counselling also in this grown-population. Among adult STI patients anxiety was common and depression uncommon. Neither was linked to high risk sexual behaviour nor ongoing CT infection. Hazardous alcohol consumption, however, was common and linked to anxiety and high risk sex. We conclude that preventive work can not only focus on STI prevention, but must consider the high frequency of hazardous alcohol consumption, which probably is contributing to sexual risk behaviour.

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

The purpose of this study is to investigate the right to confidentiality in the context of HIV/AIDS through an interdisciplinary lens. This study indicates that whilst confidentiality is important and should be preserved in order to protect persons living with HIV/AIDS against stigmatisation, discrimination and victimisation, this should be balanced by other equally important interests, such as the protection of public health and individual third parties who may be affected by the intentional or negligent infection of others with HIV. As the consideration of the legal issues relating to confidentiality and privacy cannot be divorced from the social context in which HIV/AIDS plays out in South African communities, the study will examine, amongst others, the victimisation, discrimination and stigmatisation experienced by persons living with HIV/AIDS, followed by a critical exploration of the present legal and ethical framework governing privacy and confidentiality, including medical confidentiality, as well as the duty to disclose a positive HIV-status, in the context of HIV/AIDS. Possible limitations on the right to privacy in this context are also examined, which include, amongst others, a consideration of making HIV/AIDS notifiable diseases in South Africa. The study suggests that it is imperative that legal interventions aimed at curbing the spread of HIV will need to be mindful of the unique social, cultural and economic forces that impact on the duty to disclose a positive HIV-status to partners and other affected third parties. Insights gained from philosophical theories relating to Africanism, individualism, communitarianism and utilitarianism are valuable tools in facilitating a clearer understanding of relevant social and cultural factors that keep South African society locked in the present stalemate with regard to the disclosure of HIV status. / Public, Constitutional, & International law / LLD

The purpose of this study is to investigate the right to confidentiality in the context of HIV/AIDS through an interdisciplinary lens. This study indicates that whilst confidentiality is important and should be preserved in order to protect persons living with HIV/AIDS against stigmatisation, discrimination and victimisation, this should be balanced by other equally important interests, such as the protection of public health and individual third parties who may be affected by the intentional or negligent infection of others with HIV. As the consideration of the legal issues relating to confidentiality and privacy cannot be divorced from the social context in which HIV/AIDS plays out in South African communities, the study will examine, amongst others, the victimisation, discrimination and stigmatisation experienced by persons living with HIV/AIDS, followed by a critical exploration of the present legal and ethical framework governing privacy and confidentiality, including medical confidentiality, as well as the duty to disclose a positive HIV-status, in the context of HIV/AIDS. Possible limitations on the right to privacy in this context are also examined, which include, amongst others, a consideration of making HIV/AIDS notifiable diseases in South Africa. The study suggests that it is imperative that legal interventions aimed at curbing the spread of HIV will need to be mindful of the unique social, cultural and economic forces that impact on the duty to disclose a positive HIV-status to partners and other affected third parties. Insights gained from philosophical theories relating to Africanism, individualism, communitarianism and utilitarianism are valuable tools in facilitating a clearer understanding of relevant social and cultural factors that keep South African society locked in the present stalemate with regard to the disclosure of HIV status. / Public, Constitutional, and International law / LLD

This study is about evaluating the effectiveness of training in syndromic management ofSTDs. The purpose of this study was to fmd out to what extent the STD training programme had been implemented. A stratified sample of twenty-two primary health care clinics in the Port Shepstone region was used. Twenty-two professional nurses rendering STD management in the clinics were observed. Data-gathering was done through a clinic inventory obtained by interviewing the sister-incharge, observation of professional nurses providing treatment to STD patients, interviews with professional nurses to assess their knowledge of the syndromic approach, and exit interviews with patients treated at the clinic. The fmdings suggest that certain areas in the STD training need to be emphasized, such as vaginal speculum and bi-manual examinations. It is recommended that certain negative aspects which hinder effective STD management, like staff shortages and lack of equipment be given attention. / Health Studies / M.A. (Health Studies)

Yes / With the aim of targeting high-risk hidden heterosexual young people for Chlamydia trachomatis (CT) testing, an innovative web-based screening strategy using Respondent Driven Sampling (RDS) and home-based CT testing, was developed, piloted and evaluated. Two STI clinic nurses encouraged 37 CT positive heterosexual young people (aged 16-25 years), called index clients, to recruit peers from their social and sexual networks using the web-based screening strategy. Eligible peers (young, living in the study area) could request a home-based CT test and recruit other peers. Twelve (40%) index clients recruited 35 peers. Two of these peers recruited other peers (n = 7). In total, 35 recruited peers were eligible for participation; ten of them (29%) requested a test and eight tested. Seven tested for the first time and one (13%) was positive. Most peers were female friends (80%). Nurses were positive about using the strategy. The screening strategy is feasible for targeting the hidden social network. However, uptake among men and recruitment of sex-partners is low and RDS stopped early. Future studies are needed to explore the sustainability, cost-effectiveness, and impact of strategies that target people at risk who are not effectively reached by regular health care.