The proportion of HIV-positive people over the age of 50 is increasing rapidly in New York City. An estimated half of those living with HIV are over 50. While many are long-term survivors, reflecting the transformation of HIV from a life-threatening illness to a chronic disease—due to the advent of highly active antiretroviral therapy (HAART) in 1996—others are newly diagnosed or newly infected. However, relatively few studies have examined how older adults with HIV/AIDS are aging well, and whether these strategies are associated with a reduction in risk behaviors. To address these gaps, paper one, using a basic qualitative research methodology and constructivist grounded theory analysis approach, had two related objectives: (1) to explore the lived experience of men over 50 with HIV/AIDS in New York City; (2) to examine the ways in which individuals have aged successfully. Based on the findings of the aforementioned paper, paper two and paper three, using the Research on Older Adults with HIV/AIDS (ROAH) data set, determined if loneliness predicted condomless sex in the past three months and chemsex (paper 2) and if loneliness predicted a reduced CD4 count and substance use in the past three months. Using the three-paper model, the following dissertation sheds new insight into how older adults age well with HIV/AIDS but finds that loneliness does not predict negative health and risk behaviors in this group. The dissertation does, however, highlight other avenues for research, policy and practice based on the results.

This research report is submitted in partial fulfilment of the Master of Arts in Demography and Population Studies at the University of the Witwatersrand, March 2017 / Background: Evidence shows that circumcised men are less likely to be infected with HIV compared to their uncircumcised counterparts. However, critics have argued that adopting male VMMC as part of the comprehensive HIV prevention strategy might lead circumcised men to believe that they are completely protected against HIV. Consequently, this could cause them to neglect other HIV protective measures, such as consistent condom use. This study investigated the association between male circumcision and consistent condom use among sexually active men in South Africa. Methodology: The analyses were done using nationally representative cross-sectional secondary data drawn from the 2012 Third National HIV Communication Survey. The study sampled a total of 1899 single black men who were sexually active and were aged between 16-55 years. The management and analysis of the data were carried out using STATA version 14. Descriptive statistics were computed to describe the levels of male circumcision and consistent condom use in South Africa, and crosstabulations and a Pearson Chi-square test were used to assess associations between patterns of male circumcision and consistent condom use by selected variables. Bivariate and multivariate binomial logistic regressions were used to examine the socio-demographic determinants of male circumcision, as well as the association between male circumcision and consistent condom use. Results: The main findings showed that circumcised men were more likely (OR=1.18; C.I, 1.171 - 1.182) to consistently use condoms, compared to uncircumcised men. Furthermore, place of residence, education, occupation status and socioeconomic status were positively associated with consistent condom use. On the other hand, men who believed that they would get HIV, and those who were older than 24 years were less likely to consistently use condoms. While circumcision rates were lower in all the provinces compared to the Eastern Cape; Kwa-Zulu Natal and North West had the lowest odds of circumcision of all the provinces. However, both these provinces had the highest odds of consistent condom use compared to all the other provinces. Conclusion: This study found a positive association between male circumcision and consistent condom use. The findings revealed that, contrary to concerns that circumcised men may have a false sense of protection and therefore use condoms less consistently, circumcised men were more likely to consistently use condoms compared to uncircumcised men. There is, therefore, no evidence of risk compensation associated with circumcision. As a result, male circumcision should continue to be rolledout nationally, as part of an effective and comprehensive HIV prevention strategy. On the other hand, it is also evident that HIV prevention education targeting men is crucial, as men who believe that they will get infected with HIV and those older than 24 years need to be encouraged to practice safe sexual and HIV protective behaviours such as consistent condom use. / XL2018

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Introduction: Intimate Partner Violence (IPV), also called domestic violence, is defined as any physical, psychological, or sexual violence, and emotional violence perpetrated by an intimate partner (CDC, 2016). Sexual violence or rape is defined as a sexual act committed against someone without that person’s freely-given consent (CDC, 2017). IPV is experienced among heterosexual women globally, although this phenomenon is not unique to this population. IPV also disproportionately affects young gay, bisexual, and other men who have sex with men (MSM) (Stults et al., 2016). The purpose of this study is to examine the association between IPV victimization and the increased risk of HIV and other health outcomes among YBMSM. Methods: The 6-month follow-up was conducted in Jackson, MS. A total 600 YBMSM were eligible to participant in the study. The participants were recruited from two local clinics that were focused on diagnosing and treating STI’s. Also, recruiters promoted the opportunity to enroll in the study through social media, attending bars, and nightclubs. Inclusion criteria were: 1) assigned male at birth; 2) self-identification as Black/African American; 3) 15-29 years of age; 4) attending the clinic to be tested for HIV or other STIs, 5) having engaged in anal sex with a male partner at least once in the past 6 months, and 6) the ability to speak and comprehend English. Results: The overall study sample consisted of 600 YMSM. All participants were identified as African–American. The average age of the sample was 22.6 years (SD=±3.2). Bottoms were more likely to experience rape (AOR=1.7,CI 1.1,2.6; p=.02). YBMSM who experienced IPV since enrolling in the study, as compared to those who did not experience IPV, were more likely to use marijuana, alcohol, crack, and painkillers (AOR=7.7 ,CI 5.1,11.7; p= Conclusion: These findings suggest that IPV and Rape shows a significant association with decreased condom use, decreased condom negotiation, sexual position, drug use and HIV risk among YBMSM in Jackson, MS.

Idag belyser forskning att sexuellt överförbara infektioner (STI) och oönskade graviditeter ökar då ungdomar brister i kondomanvändning vid sex. Det är viktigt att förebygga sexuellt överförbara infektioner som behöver antibiotikabehandlas genom preventivt arbete. Minskas antibiotikaanvändningen främjas en hållbar utveckling. Genom en pilotstudie med tvärsnittsdesign under 2016, undersöktes om samband fanns mellan gymnasieungdomars känsla av sammanhang via mätinstrumentet (SOC) och deras självtillit vid kondomanvändning via mätinstrumentet (CUSES). Pilotstudien genomfördes i ett par klasser i ett fåtal skolor i mellersta Sverige. Studien innefattar 107 deltagare, 63 unga män, 41 unga kvinnor och en uppgav hen som kön. Åldersspannet på deltagarna ligger mellan 16-21 år. Pilotstudien visar att det inte fanns något samband mellan känsla av sammanhang och ungdomarnas självtillit vid kondomanvändning. Däremot visar resultatet att ungdomar med hög grad av känsla av sammanhang använde kondom vid sex i större utsträckning. Vi anser att det behövs studier som fokuserar på salutogena faktorer för att främja ungdomars sexuella- och reproduktiva hälsa samt deras kondomanvändning och därigenom minska STI och antibiotikaanvändning och på så sätt möjliggöra en mer hållbar utveckling. / Research today illustrates that sexually transmitted diseases and unwanted pregnancies are increasing as adolescent’s use of condoms during sex is inadequate. It is important to prevent sexually transmitted diseases that needs to be treated with antibiotics. We can accomplish this through preventative work. By decreasing the use of antibiotics we are withholding a sustainable development. During the spring and late summer of 2016 a pilot study was made with a cross section design that analyzed if there was any connection between young people’s sense of coherence and their self-efficacy on condom use. The pilot study was performed in a number of classes at a few different schools in the middle of Sweden. The study implicated 107 participants’, 63 young men and 41 young women and one defining the sex as hen. The age range among the participants was between 16-21. The pilot study showed that there is no connection between high sense of coherence and self-efficacy on condom use. Although it did show that young people with a higher sense of coherence were using condoms in a greater occurrence. We believe it is necessary that more studies should focus on a salutogenic approach to promote adolescent´s sexual and reproductive health as well as their condom use. By doing so we can reduce sexually transmitted diseases and the use of antibiotics and this will result in a more sustainable development.

Abstract 1: A multi-level assessment of disproportionate population sex ratios and high-risk sexual behaviors among STD clinic patients Low male-to-female sex ratios in a population may influence high-risk sexual behaviors, such as multiple sex partners and inconsistent condom use, which facilitate the transmission of STDs. This study used multi-level modeling to assess whether population sex ratios were associated with these two individual-level behaviors. All analyses were stratified by gender. Interview data were collected from patients (N = 9,203, 48% male) attending participating STD clinics. Interviews included information on socio-demographics and sexual behavior, including number of sex partners in the previous 3 months and condom use at last sex. The sex ratio per census tract was obtained from the U.S. Census Bureau. There was no association between sex ratio and multiple sex partners or condom use for either men or women. That is, we found no evidence that a shortage of men in census tracts was associated with increased engagement in high-risk sexual behavior.   Abstract 2: A multi-level assessment of neighborhood vacancy rates and high-risk sexual behaviors among STD clinic patients The “broken windows” theory posits that physical neighborhood deterioration, and its association with reduced social cohesion, can lead to changes in individual behaviors. Thus individuals living in neighborhoods with high levels of deterioration may be more likely to engage in high-risk sexual behaviors. This study used multi-level modeling to evaluate the extent to which high residential vacancy rates increased the likelihood of individuals having multiple sex partners. Interview data, including data on patient demographics and sexual behaviors, were collected from patients (N = 6,347, 52% male) attending participating STD clinics in the Richmond, Virginia area from 2008-2010. Neighborhood vacancy rates were obtained from the U.S. Census Bureau. Fifty-one percent of men and 36% of women reported having 2 or more sex partners in the previous 3 months. Men who lived in census tracts with high vacancy rates were slightly more likely to report multiple sex partners (53.9%) compared to men who lived in low vacancy tracts (49.7%). In multi-level models, there was no association between high vacancy rates and having multiple sex partners among either women (OR = 0.98; 95% CI: 0.79, 1.20) or men (1.18; 95% CI: 0.99, 1.42). That is, we found no evidence that increased neighborhood deterioration, as measured by high residential vacancy rates, was associated with increased risk of having multiple sex partners among STD clinic patients.   Abstract 3: Residential segregation and gonorrhea rates in U.S. metropolitan statistical areas The residential segregation of black populations, often in areas of high economic disadvantage and low social status, may play a crucial role in the observed racial inequities in STD rates. An ecological analysis of 2005-2009 average gonorrhea rates was performed across 277 U.S. metropolitan statistical areas (MSAs). The black isolation index and Gini index of income inequality were used as proxy measures for racial and economic residential segregation respectively, derived from 2005-2009 U.S. Census estimates. We used logistic regression modeling to produce estimates of odds ratios (OR) and 95% confidence intervals (CI) for the association between a high black isolation index and Gini index, both independently and in combination, on gonorrhea rates in MSAs. Effect measure modification was assessed by calculating the relative excess risk due to interaction (RERI) between the two indices. Compared to MSAs with low levels of racial segregation, MSAs with high levels of racial segregation had increased odds of high gonorrhea rates (adjusted OR 5.54; 95% CI: 2.29-13.44). Adjustment for potential confounders did not noticeably impact the relationship between the Gini index and gonorrhea, with higher levels of income inequality predicting higher gonorrhea rates (adjusted OR = 2.47; 95% CI: 1.21-5.03). In combined models, the influence of racial residential segregation on gonorrhea rates was stronger than that of income inequality-based segregation; there was no evidence of additivity or a multiplicative interaction. Residential segregation by race or income equality may be a key component in the perpetuation of high rates of gonorrhea and other STDs among black populations in the U.S.

<p>Since the Human Immunodeficiency Virus (HIV) that causes Acquired Immune Deficiency Syndrome (AIDS) was discovered in the 1980s, the condom has scientifically proven to be the only technological device that can prevent transmission of the virus during sexual intercourse. This technical approach to the HIV has strongly emphasized that prevention is only possible if the condom is properly used. However, as a technological artifact the condom has shown that its use is laden with values. The question of values on condoms has brought in a heated debate on the moral justifications of its use. In Malawi, just as in other African countries, the Faith Community has rejected the Governmentsplea to promote condoms as the preventive measure against the virus.The Faith Community has emphasized on abstinence and mutual faithfulness as the only reliable means to the prevention of HIV/AIDS. The main argument from the Faith Community is that condoms promote promiscuity. Nevertheless, the Government agrees with the Faith Community on abstinence and mutual faithfulness, but still insists on condom use as a preventive measure against the virus. The Government argues that the condom is the only proven technical approach to the HIV prevention and therefore it should be promoted. T</p><p>he main purpose of this study is to attempt an ethical analysis of the arguments for and againstcondom use as the preventive measure against HIV. In this case, the study tries to analyse the Government and Faith Community stands on condoms. In relation to the arguments for and againstcondom use, the study also touches such areas as: the concept of rights and condom use, ethics of condom advertisement, African cultural values versus condom use and the implications of condom use on behaviour change. From the study, it has been argued that condoms should be promoted. The argument comes from that understanding that AIDS has plundered Africa than any war or disease in human history, and therefore, it needs to be stopped. In this case, such theories as, Utility, Love, Autonomy, Rights and umunthu moral conscience have been used to support the argument.</p>

Since the Human Immunodeficiency Virus (HIV) that causes Acquired Immune Deficiency Syndrome (AIDS) was discovered in the 1980s, the condom has scientifically proven to be the only technological device that can prevent transmission of the virus during sexual intercourse. This technical approach to the HIV has strongly emphasized that prevention is only possible if the condom is properly used. However, as a technological artifact the condom has shown that its use is laden with values. The question of values on condoms has brought in a heated debate on the moral justifications of its use. In Malawi, just as in other African countries, the Faith Community has rejected the Governmentsplea to promote condoms as the preventive measure against the virus.The Faith Community has emphasized on abstinence and mutual faithfulness as the only reliable means to the prevention of HIV/AIDS. The main argument from the Faith Community is that condoms promote promiscuity. Nevertheless, the Government agrees with the Faith Community on abstinence and mutual faithfulness, but still insists on condom use as a preventive measure against the virus. The Government argues that the condom is the only proven technical approach to the HIV prevention and therefore it should be promoted. T he main purpose of this study is to attempt an ethical analysis of the arguments for and againstcondom use as the preventive measure against HIV. In this case, the study tries to analyse the Government and Faith Community stands on condoms. In relation to the arguments for and againstcondom use, the study also touches such areas as: the concept of rights and condom use, ethics of condom advertisement, African cultural values versus condom use and the implications of condom use on behaviour change. From the study, it has been argued that condoms should be promoted. The argument comes from that understanding that AIDS has plundered Africa than any war or disease in human history, and therefore, it needs to be stopped. In this case, such theories as, Utility, Love, Autonomy, Rights and umunthu moral conscience have been used to support the argument.

Millions of people in the world are infected by HIV/AIDS or/and other Sexually Transmitted Infections, STIs. Ethiopia is, with its population on almost 94 million people, one of the worst affected countries. One of the methods that are used in the prevention work in order to combat the spread of HIV/AIDS and STIs in Ethiopia is Social Marketing, a concept that adopts traditional marketing techniques in order to obtain social change. This inductive study explores how three various Ethiopian organizations are utilizing Social Marketing in their HIV/AIDS and STI prevention work throughout Ethiopia, how the concept can be used to achieve attitudinal- and behavioral change by people, as well as if the organization’s various Social Marketing projects strive to provide vulnerable groups of the Ethiopian society with empowerment, and if so, in what ways. The empirical material was collected through six qualitative interviews and two focus group discussions during an eight-week long stay in Ethiopia during March-May, 2012. The findings of this study have been analyzed through theories about human behavior with a focus on behavior change, as well as various definitions and concepts of empowerment. The study’s result shows that Social Marketing can be utilized in several ways in the HIV/AIDS and STI prevention work in Ethiopia to obtain attitudinal- and behavior changes, for instance by using various commercial techniques, street campaigns, information/education/behavioral change materials, as well as trainings, outreach work and peer education, which aims to educate people about HIV/AIDS, STIs, condoms and condom use. The organization’s joint Social Marketing project “Wise Up-program” includes Drop In Centers and Cooperative Activity for sex workers. The findings of this essay shows that these projects do strive to provide vulnerable groups of the Ethiopian society with empowerment, psychologically as well as economically.