A research report submitted to the School of Public Health, University of the Witwatersrand in partial fulfillment of the requirements for the degree of Master of Public Health 24th October, 2014 / Background: Male circumcision (MC) has a substantial effect in reducing HIV infections in men by 60 -70% making it one of the best available evidence-based biomedical HIV prevention interventions. Swaziland included Voluntary Medical Male Circumcision (VMMC) as part of its comprehensive HIV prevention package but the national scale up has been constrained by the limited availability of trained physicians, who are the only professionals permitted to perform the surgery. Task-shifting has been proposed as a possible strategy to increase service providers in the face of HIV and AIDS and the human resource for health crisis. Study Aim: The aim of this study was to determine the attitudes of doctors and nurses towards task shifting of male circumcision procedures to nurses in 2012. Methodology: A cross-sectional, descriptive survey was carried out. A self-administered questionnaire with close-ended rating and reverse coded questions was distributed to all nurses and doctors affiliated to the non-governmental organization (NGO), governmental, missionary and privately-run VMMC clinics nationwide. Data from returned questionnaires were entered, cleaned and analyzed using Statistical Package for Social Science (SPSS) version 22 and Microsoft Excel. Analysis of the internal reliability of the questionnaire scale and sub-scales was conducted. The main statistical procedures were descriptive statistics and tests of association. Results: The study recruited 398 participants (25.4% doctors and 74.6% nurses), of which 44.2% were male and 56% were Swaziland nationals. This study found that 80.4% of the participants (doctors and nurses) had a positive attitude towards the reform of task-shifting VMMC to nurses. Nurses had a more positive attitude than doctors (p<0.001), while male nurses had a significantly more positive attitude than female nurses (p<0.001).However, there was no significant difference between the attitudes of male and female doctors (p=0.130). The study found that sex (p=0.001), profession (doctor vs. nurse) (p<0.001), nationality (expatriate vs. local) (p<0.001) and having ever practically performed the surgical procedure (p<0.001) were significantly associated with the participants attitude. However, their primary role (administrator vs. clinician) (p=0.059) and time spent in the VMMC programme (p=0.112) did not significantly influence the participants’ attitude towards the task-shifting policy reform. Conclusions and Recommendations: Doctors and nurses in Swaziland generally have a positive attitude towards task-shifting of male circumcision to nurses. Nurses, males, participants with longer exposure and practical experience in VMMC, older participants and expatriates had even more positive attitudes towards the reform than their counterparts. The findings of the study suggest that the government should consider development of a task-shifting policy after further research that looks into determining attitudes of other stakeholders in VMMC and should also consider strategies to address the special groups that had lower or negative attitudes towards the reform than their counterparts, such as through sensitization campaigns. Feasibility, cost-effectiveness and other practical issues in our setting also need to be taken into consideration, including a possible trial (pilot). The reform should, however, be introduced with consideration of aspects of adequate training, development, supervision and support, administrative regulation, staff motivation and recognition.

A research report submitted to the School of Public Health, University of WItwatersrand in partial completion of the requirements of the degree Master of Public Health : Social and Behaviour change communication / Three randomised control trials in Kenya, Uganda and South Africa have shown that Voluntary Medical Male Circumcision (VMMC) reduces the risk of heterosexual HIV transmission to men by up to 60%. This has resulted in a WHO and UNAIDS recommendation to promote VMMC as part of comprehensive HIV prevention programming. In order for South Africa to achieve its 80% national coverage target of VMMC, significant investment needs to be made in demand creation programming. The Centre for HIV/AIDS Prevention Studies (CHAPS) provides free VMMCs through 28 community based clinics and hospitals in Gauteng, North West and Limpopo Provinces. In 2013, CHAPS demand creation activities have resulted in some increases in demand but CHAPS have committed to exploring additional demand creation opportunities. In terms of reach, mobile telephones are highly prevalent in South Africa, with more than 90% of South African households surveyed in 2011 reporting to have at least one cellular telephone in the home. The ongoing advancement of mobile phones to allow data transfer and internet access also means that more ‘Technology-Poor’ or ‘ICT Have-nots’ will be able to access the ever increasing knowledge content of the internet, participate in digital social-domains and be reached in shorter times and at lower costs.

Agency theory would predict that, given the presence of large or powerful shareholders in a company, agency costs would be reduced. Excessive executive compensation can be regarded as being an externality problem that stems from the agency problem. Agency theory would also then predict that executives in companies with large shareholders would receive less compensation and a larger proportion of long-term incentive-based compensation than companies with smaller shareholders. The validity of these two hypotheses has been tested using a unique cross-sectional, time series dataset and two statistical techniques. The first set of tests involve the construction of multiple regression models in order to provide evidence as to whether Chief Executive Officer (CEO) compensation is affected by institutional shareholders. The second method, using statistical tests of differences between means, involves separating the sample into two sub-samples, namely management- and owner-controlled firms, to ascertain whether these two groups remunerate their CEOs differently to each other, thus testing the hypotheses in an alternative manner to the regression models. This report examines whether the presence of institutional shareholders affects the level and mix of CEO compensation for 50 companies listed on the JSE Securities Exchange over the five-year period 2002-2006. Original findings on the value of share options awarded to CEOs are presented, along with the trends in the level and mix of CEO compensation. Further research findings also include trends in the level of institutional ownership of listed companies over this period. The results of both the regression models and tests for differences of means provide statistical evidence in support of the assertion that the presence of institutional shareholders do not have an effect on either the level or mix of CEO compensation. Suggested reasons for this result range from shareholder apathy, to not considering executive remuneration to be a significant enough issue for institutional shareholders, and finally to the suggestion that institutional shareholders perceive the level and mix of compensation paid to South African CEOs to be a fair reflection of their value to their company.

Wang, Zixin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 215-223). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese.

Magister Public Health - MPH / Voluntary Medical Male Circumcision (VMMC) has been proven to reduce heterosexual HIV transmission to men by approximately 60%. It has been argued that achieving 80% circumcision coverage among males aged 15–49 years within five years and maintaining this coverage rate in subsequent years, could avert 3.4 million new HIV infections within 15 years and generate treatment and care savings of US$16.5 billion. As a result the South African Government plans to circumcise 4.3 million males aged 15 and 49 years by the 2015/2016 financial year. However, in the Western Cape the uptake for circumcision has been poor. While there is not a great deal of knowledge out there about the reasons for the uptake (or lack thereof) of VMMC in the Western Cape, current research focus on Xhosa males predominantly. However, there is limited research on circumcision among the "Coloured" population of the Western Cape. As the "Coloured" population is the largest group in the Western Cape, this gap in research and knowledge is worth noting. The current study aimed to explore the barriers to and enablers of uptake of VMMC among "Coloured" males between the ages of 15 and 49 years in the Cape Town Metropolitan Municipality. Methodology: The study adopted a qualitative design; semi-structured interviews were conducted with seven key informants, and two focus group discussions with men who had undergone VMMC and men who had chosen not to volunteer to undergo VMMC. Thematic analysis was used to analyse the data. Results: The key enablers to uptake of VMMC were: the desire for improved hygiene; the reduction in the risk of contracting other STIs; the reduction in the risk of contracting HIV; the role of partners and family members who can encourage males to access services; the perceived improvement in the males' sexual experience and performance; and cultural reasons and religious injunction. On the other hand the key barriers that discouraged "Coloured" participants from accessing the services include: fear, particularly the fear of pain; the experience of the health services and the role of health staff; the six week healing period in which males cannot have sex; the unwillingness to alter the body that they were born with; role of partners and family as discouragers of uptake; the influence of gangsterism on the ability of males to access services offered on a different gang's 'turf'; and, substance abuse. The recommendations in this study focus largely on the need to expand the coverage of VMMC in the Cape Town Metropolitan Municipality and to increase the uptake among "Coloured" males between the ages of 15 and 49 years. . These recommendations essentially involve the need to break down the barriers and to accentuate the enablers. To this end social mobilisation campaigns should not focus solely on HIV prevention but rather on hygiene and improved sexual experience and appearance as well as the cultural and religious aspects. With regard to the barriers it is essential that any social mobilisation engages with the fear of pain. On method to do this would be through the introduction and expansion of the PrePex™ device. The fear that circumcision could impact on sexual performance and the fear of embarrassment and discomfort the whole process would potentially bring would need to be allayed. In addition it is essential that the health services and health staff are orientated and trained in a way that ensures that the process of circumcision is as easy as possible for the clients. / National Research Foundation

MAAS / Centre for African Studies / The aim of the study was to examine the challenges experienced at male initiation schools in the Eastern Cape Province, Mthatha District. It is alleged that during the month of June every year, some boys die at initiation schools mostly in Eastern Cape Province. One of the reasons of the cause of death is because some of them attend illegal initiation schools. The overall objectives were to explore the role of initiation schools, to assess the regulations that govern the opening and running of initiation schools, to identify palliatives that can be put in place to curb negative implications at initiation schools. The study was founded on the following theoretical framework to attain its findings; the socio-cultural theory. This study utilised the qualitative research design. Data collection methods included one-on-one interviews, un-structured interviews and focus groups. The study informants were selected using purposeful sampling technique and snow-balling sampling. The study of examining the challenges experienced at male initiation schools submits appropriate recommendations which may help in the effective indigenous knowledge management, curb unethical practices and challenges associated with the running of male initiation schools and sharing strategies in South Africa, other African countries and the world at large, particularly communities that still follow the cultural practice of male initiation. The study recommends that parliamentary legislative framework (policy) on initiation rite should be standardised and promulgated. Also, traditional leadership must have the powers over all matters of initiation rite and initiation schools in particular. Lastly, the study recommends that for future research, the use of male researchers would be advisable to allow more probing.