published_or_final_version / Community Medicine / Master / Master of Public Health

Human Immunodeficiency Virus (HIV) infection has continued to increase in Hong Kong and China. Since about 2006 the incidence of new HIV infections has significantly increased among homosexual men or men who have sex with men (MSM) while new infections among heterosexuals has remained steady. There are several risk factors that may be contributing to the increasing infection rates among MSM including: source for sexual partners, condom use, location of sexual partners, and how new technology may be effecting the spread of HIV. There are gaps in the literature available on MSM and HIV in Hong Kong; particularly in the methods used to identify individuals for study, and the lack of randomized controlled trials to study public health interventions to stop the spread of HIV in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / abstract / Medical Sciences / Master / Master of Medical Sciences

M.Comm. / In order to reduce financial losses due to the increasing number of AIDS related deaths, insurance companies have to review their current HIV testing requirements. Due to a lack of relevant information, Momentum Life had to conduct a formal study in order to make a proper marketing decision regarding HIV testing requirements. It was therefore imperative to determine the possible scope of changes as well as the impact of the proposed adjustments on both clients and brokers. The purpose of this study was therefore to: determine how brokers feel about the AIDS risk insurance companies have to face; determine how brokers will react to different precautionary methods taken by insurance companies in general and specifically Momentum Life; obtain feedback from brokers with regard to their perception of clients' attitudes towards HIV testing; determine how clients themselves feel about HIV testing as well as retesting; and determine clients' attitudes towards the whole procedure of HIV testing. The empirical research consisted of two phases. Phase 1 was conducted by means of a focus group discussion with four Momentum Life partners and personal and telephone interviews with eight insurance brokers in the Gauteng area. Phase 2 was conducted by means of telephone interviews with 60 Momentum Life clients. A literature study revealed that attitudes consist primarily of three components, namely the affective, cognitive and behavioural components. In order to change clients' attitudes towards HIV testing, life insurance companies need to focus on the cognitive component which consists of knowledge and perceptions that are acquired by direct experiences and information obtained from different sources. However, not all attitudes are susceptible to change. It is therefore important to determine what amount of effort should be spent on trying to change clients' attitudes and how negative attitudes can be handled. The three groups had different opinions about HIV testing based on their own frame of reference. However, within the group there were consensus on most of the issues addressed during the interviews and discussion. In analysing the focus group discussion with the partners it was clear that they approved of HIV testing and retesting, and they believed it has .no negative effect on the marketing activities of brokers or the attitudes of clients towards Momentum Life. However, they believed that Momentum Life could improve its customer service by making the whole procedure of HIV testing more customer friendly. The brokers, on the other hand, were far more negative about HIV testing and believed that it complicates life insurance unnecessarily. Retesting was regarded as unacceptable and they were not prepared to become involved in the administration of retesting. However, the brokers agreed with the partners that they have a responsibility to make the procedure of HIV testing more convenient for the client. Early in the research it was clear that gender, age, language and the fact whether clients have already undergone HIV testing, had no significant effect on clients' attitudes towards HIV testing. HIV testing was regarded as a part of life insurance. However, customer service and convenience still seemed very important to the clients.

Thesis (MPhil)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: Voluntary Counseling and Testing (VCT) is considered an important component of the South African government’s response to the HIV/AIDS pandemic. Despite of this, the numbers of South Africans who have accessed VCT remains low. Pregnant women in antenatal clinics remain the primary recipients of HIV testing since it is routinely offered to them at antenatal clinics. Figures from antenatal clinics constitute the most important source of HIV/AIDS statistics in South Africa. Targeting women at antenatal clinics perpetuate the stereotypes that women are solely responsible for reproductive health issues or, that they are to be blame for the mounting HIV infections. These beliefs exacerbate the culminating violence against women. According to observation, active involvement of male youth in reproductive health at the Rosedale Clinic situated in Uitenhage, a town in the Eastern Cape, appears to be very limited. This might be as a result of traditional beliefs declaring reproductive health a primarily female domain. Active involvement of males in reproductive health is considered to have positive health outcomes both for themselves, and their partners. The purpose of this study is thus to encourage males served by the Rosedale clinic to become more actively involved in one aspect of reproductive health, namely voluntary counseling and testing (VCT). The study aims to find out which factors constitute barriers and enablers to VCT acceptance by male youth. Semi-structured, face-to- face interviews were conducted in September 2006 with eighteen males, 18 to 25 years, to determine from their perspective what constitute barriers and enablers to HIV test acceptance by males. These participants were recruited from two well-known rugby clubs in Uitenhage, located in the Eastern Cape. In addition, a focus group discussion was conducted with four males recruited at a graduate development programme hosted in Uitenhage in order to explore common themes emerging from interviews and the discussion. A pervasive, psychologically rooted fear; and possible low perception of risk emerge from this study as main barriers to HIV testing. Negative perceptions regarding service delivery in the public health sector constitute another barrier to HIV testing. The possibility of teasing, a common phenomenon amongst rugby players but not exclusive to them, exacerbates peer pressure thus possibly contributing to low levels of HIV test acceptance among these males. Increased HIV test acceptance is associated with increased opportunities of exposure to HIV testing opportunities, for example at awareness campaigns. Access to medical aid and income is also associated with an increased likelihood of HIV testing since most males prefer accessing HIV testing services in the private sector. Convenience and ease of access to HIV testing services are important when these males consider going for HIV testing. / AFRIKAANSE OPSOMMING: Vrywillige Berading en MIV Toetsing, een aspek van reproduktiewe gesondheid, word beskou as ‘n belangrike komponent van die Suid-Afrikaanse regering se strategie teen MIV/VIGS. Ongeag van hierdie feit is ‘n groot aantal Suid-Afrikaners nog nie getoets vir MIV nie. Swanger vrouens word op ‘n daaglikse basis hierdie toets aangebied as deel van roetine ondersoeke. Syfers vanaf pre-natale klinieke vorm die hoofbron van Suid- Afrika se HIV/VIGS statistieke. Die feit dat swanger vrouens die hoofteikengroep is vir MIV toetsing dra by tot stereotipes wat daartoe lei dat vrouens primêr verantwoordelik is vir die behoud van reproduktiewe gesondheid; en dat hulle beskou word as die hoofverdagtes in die toenemende oordrag van MIV. Laasgenoemde beskuldiging vererger geweld teen vrouens. Volgens waarneming by Rosedale publieke kliniek geleë in Uitenhage, ‘n dorp in die Oos-kaap, is veral jeugdige mans se betrokkenheid in reproduktiewe gesondheid uiters minimaal. Dit kan moontlik wees omdat reproduktiewe gesondheid tradisioneel as ‘n vroulike domein beskou word. Aktiewe betrokkenheid van beide mans en vrouens in reproduktiewe gesondheid het positiewe gesondheidsuitkomste vir beide partye tot gevolg. Die doel van hierdie studie is dus om jongmans wie deur die Rosedale kliniek bedien word aan te moedig om meer sigbaar te word in reproduktiewe gesondheidskwessies; met die oog op een aspek daarvan naamlik, vrywillige berading en MIV toetsing. Die studie poog dus om uit te vind watter struikelblokke jeugdige mans weerhou van MIV toetsing en; watter faktore mans aanmoedig om vir die toets te gaan. Semi-gestruktureerde, aangesig-tot- aangesig onderhoude is in September 2006 met 18 mans, vanaf die ouderdomme 18 tot 25 jaar, gevoer. Hierdie mans was tydens die studie rugbyspelers vanuit twee welbekende rugbyklubs op die dorp. ‘n Addisionele fokus groep is verder gevoer met manlike studente wie ten tye van die studie aan ‘n ontwikkelingsprogram vir gradueerders deelgeneem het op die dorp. Hierdie fokusgroep is geloods om soortgelyke temas vanuit die onderhoude en die bespreking te ondersoek. Die studie toon dat ‘n diepgewortelde, sielkundige vrees; en moontlike lae bewustheid van persoonlike risiko die twee vernaamste struikelblokke is vir MIV toetsing. Negatiewe sienings rakende die publieke gesondheidssektor kan moontlik bydrae tot weerstand teen MIV toetsingsdienste. Tergery, ‘n bekende verskynsel onder rugbymans, maar nie slegs beperk tot diè groep nie, dra by tot groepsdruk en weerhou moontlik menige mans van MIV toetsing. Diegene in die studie wie alreeds vir MIV getoets is geniet toenemende blootstelling aan MIV toetsingsgeleenthede; bv tydens bewusmakingsveldtogte geloods òf by die werk òf tersiêre instellings. Toegang tot ‘n mediese fonds; en ‘n inkomste is moontlike bepalende faktore sienende dat meeste respondente gesondheidsdienste in die privaatsektor verkies. Gerieflike toegang tot MIV toetsingsdienste word deur sommige mans as belangrike beskou wanneer hulle MIV toetsing oorweeg.

This thesis examines HIV disease natural history and response to antiretroviral treatment (ART) in patients from The TREAT Asia HIV Observational Database (TAHOD), a mulitcentre, prospective observational cohort of HIV-infected patients from countries in the Asia-Pacific region. By September 2005, 2979 patients have been recruited to TAHOD from 15 participating sites. The majority were male (73%), median age 37 years. Chinese (37%), Thai (25%) and Indian (17%) were the main ethnicities. Most patients reported HIV infection through heterosexual (59%) and homosexual contact (23%); 5% injecting drug use. At baseline, 41% of patients were diagnosed with AIDS defining illness, and 77% were being treated with highly active antiretroviral therapy (HAART). Baseline and retrospective data suggest that the overall response to HAART in TAHOD is similar to that seen in western cohorts, with mean CD4 count increase of 115 cells/μL and 69% achieving a viral load less than 400 copies/mL six-month after HAART initiation. Baseline CD4 count was the strongest predictor of short-term disease progression. Prognostic models based on routine clinical data and haemoglobin gave a good estimation of disease progression. The rate of new AIDS defining illness was 26% in the first 90 days after HAART initiation, which may partly be due to immune reconstitution syndrome occurring shortly after treatment. The most frequently used first-line ART combination was stavudine/lamivudine/nevirapine. Approximately 22% of patients receiving this treatment changed or stopped at least one drug in the first year, with adverse effect (including lipodystrophy, hepatitis, rash and peripheral neuropathy) the major reasons. The rates of discontinuation of efavirenz or nevirapine as part of HAART were similar (16 vs. 20/100 person years). Older age and positive HCV antibody were associated with an elevated liver function (ALT) test. Both prevalence of HBV and HCV coinfection with HIV were approximately 10%. The impact of hepatitis coinfection on immunological and virological responses to ART and HIV disease progression was not statistically significant. Both HBV and HCV remained independently associated with elevated ALT in the multivariate models. The overall HIV disease progression and response to ART in TAHOD patients were similar to those seen in the western countries.

HIV testing is required for life assurance applications. A written information document distributed at blood collection (venisection) serves as pre-test preparation. This study reviewed the adequacy of the document and explored possible alternative arrangements, by means of three research phases conducted at the point of venisection. Phase 1 used a specifically designed questionnaire which included a demographic section and questions assessing the applicant's appraisal of being adequately prepared, and their understanding and experience of testing. Constructed measures established their state of anxiety at testing and their range of information about HIV/AIDS. Phase 2 consisted of a counselling intervention, followed by the questionnaire used in Phase 1. Phase 3 consisted of semi-structured interviews with nursing personnel and insurance brokers. The phase 1 results indicated that the majority of applicants knew they were having an HIV test, did not feel coerced, had a moderate level of information about HIV and were not overly anxious at testing. The level of information about HIV/AIDS showed a significant correlation with their level of education, and the information document emerged as inadequate preparation. Answers given in Phase 2 differed qualitatively from those in Phase 1. Greater consideration of the impact of a positive result was shown, with increased concern about the implications for other people and anticipated acceptance of a positive result emerged in Phase 2. The personnel interviewed for Phase 3 indicated that they felt ill equipped to offer pre-test preparation. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

This dissertation has made an attempt at exploring the psychological factors that motivates individuals into opting for or against undertaking an HIV-test. The Health Belief Model is used to ascertain its predictive powers towards the motivation for undertaking such a test. Literature on HIV-testing indicates non-exploration of voluntary HIV-testing, as opposed to massive reporting on mandatory HIV-testing. Therefore, the focus of this dissertation is on voluntary HIV-testing. The sample used for the study. comprised of antenatal mothers who were offered HIV/Aids education and then presented with an option of either undertaking the HIV-test, or not. The results of the study indicate that the Health Belief Model has failed in its predictive powers towards motivations for or against HIV-testing. However, the study provided valuable psychological factors that are associated with the decision to undertake the HIV-test, which will be important for future research on HIV/Aids and on the control in the spread of the disease. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 1999.

This thesis examines HIV disease natural history and response to antiretroviral treatment (ART) in patients from The TREAT Asia HIV Observational Database (TAHOD), a mulitcentre, prospective observational cohort of HIV-infected patients from countries in the Asia-Pacific region. By September 2005, 2979 patients have been recruited to TAHOD from 15 participating sites. The majority were male (73%), median age 37 years. Chinese (37%), Thai (25%) and Indian (17%) were the main ethnicities. Most patients reported HIV infection through heterosexual (59%) and homosexual contact (23%); 5% injecting drug use. At baseline, 41% of patients were diagnosed with AIDS defining illness, and 77% were being treated with highly active antiretroviral therapy (HAART). Baseline and retrospective data suggest that the overall response to HAART in TAHOD is similar to that seen in western cohorts, with mean CD4 count increase of 115 cells/μL and 69% achieving a viral load less than 400 copies/mL six-month after HAART initiation. Baseline CD4 count was the strongest predictor of short-term disease progression. Prognostic models based on routine clinical data and haemoglobin gave a good estimation of disease progression. The rate of new AIDS defining illness was 26% in the first 90 days after HAART initiation, which may partly be due to immune reconstitution syndrome occurring shortly after treatment. The most frequently used first-line ART combination was stavudine/lamivudine/nevirapine. Approximately 22% of patients receiving this treatment changed or stopped at least one drug in the first year, with adverse effect (including lipodystrophy, hepatitis, rash and peripheral neuropathy) the major reasons. The rates of discontinuation of efavirenz or nevirapine as part of HAART were similar (16 vs. 20/100 person years). Older age and positive HCV antibody were associated with an elevated liver function (ALT) test. Both prevalence of HBV and HCV coinfection with HIV were approximately 10%. The impact of hepatitis coinfection on immunological and virological responses to ART and HIV disease progression was not statistically significant. Both HBV and HCV remained independently associated with elevated ALT in the multivariate models. The overall HIV disease progression and response to ART in TAHOD patients were similar to those seen in the western countries.

The overall aim of this study was to understand the determinants of VCT uptake in the general population of Nigeria’s federal capital territory of Abuja. Uptake of VCT still remains low despite increased availability of VCT information and services in Abuja, Nigeria. A quantitative cross-sectional study was undertaken with 180 respondents from Abuja, using an adaptation of the Health Belief Model as conceptual framework, to elucidate the social demographics of respondents, their HIV/VCT knowledge, their perceptions of VCT facility design, societal support for VCT, and how HIV stigma shapes the phenomenon of VCT uptake in Abuja, Nigeria. The key findings were that a better understanding of HIV prevention, a perception of support from community and religious leaders, and access to HIV test services in government facilities are positive predictors of higher VCT uptake. Poor personal risk assessment and the cost of HIV testing were identified as the key barriers to VCT access. / Health Studies / M.P.H.