School-based sexual health education is commonly used to promote the sexual health of young people and guide them in their relationships. This thesis reports on research that aimed to provide evidence-based recommendations to optimise the effectiveness of school-based sexual health education in sub-Saharan Africa (sSA). There are six chapters in the thesis. Chapter 1 introduces the thesis, Chapters 2 to 5 consist of four empirical studies, and Chapter 6 provides an overall discussion and looks at the strengths, limitations, and implications of the findings. Chapter 2 is a systematic review and meta-analysis of school-based sexual health education in sSA. It provides some evidence of the interventions in promoting self-reported condom use. However, it shows there are no harmful or beneficial effects with respect to sexually transmitted infections (STI) as evidenced by biomarkers. It highlights the paucity of evaluated interventions using biomedical markers, and reports on the process of evaluation, which limits our understanding of why interventions work or do not work. Features associated with effective interventions are noted. Chapter 3 is a case study involving MEMA Kwa Vijana, an adolescent sexual and reproductive health intervention implemented in Tanzania. This study highlights the influence of structural factors in schools and wider environmental factors on the effectiveness of school-based sexual health interventions. Furthermore, it identifies the social and cultural factors that influence young people’s sexual behaviours and that must be addressed beyond the education and health sectors. Chapter 4 is a multiple case study of seven school-based sexual health interventions implemented in five sub-Saharan African countries. It 4 identifies the design, implementation, and evaluation features that differentiate between effective and ineffective interventions. Chapter 5 is a qualitative study of researchers’ experiences of school-based sexual health education in sSA. This study extends previous work by generating a set of valuable recommendations based on researchers’ experiences of interventions that could improve future interventions in sSA. Overall, this research project demonstrates the potential of school-based sexual health education in promoting sexual health and preventing STIs in sSA. It provides a series of recommendations for the design, implementation, and evaluation of school-based sexual health interventions.

Orientador: Maria Cristina Pereira Lima / Banca: Renata Cruz Soares de Azevedo / Banca: Marli Terezinha Cassamassimo Duarte / Resumo: Estudantes universitários representam um grupo vulnerável aos comportamentos sexuais de risco, na medida em que estão adentrando o mundo dos adultos, estão iniciando sua vida sexual, muitas vezes deixando a casa dos pais pela primeira vez, e estão especialmente expostos a substâncias que aumentam este risco como, por exemplo, o álcool. O objetivo deste trabalho foi investigar a vulnerabilidade sexual entre universitários da área de saúde a partir dos comportamentos sexuais relatados por estes, em particular o uso de preservativos. Trata-se de estudo transversal, com amostra de 695 universitários de cursos da saúde, de ambos os sexos de uma cidade no interior do Estado de São Paulo. Os dados foram coletados a partir de questionários auto preenchidos aplicados nas salas de aula e de atividades. A média de idade foi de 22,1 anos, com predomínio de mulheres (67,3%), pessoas que se autodeclararam da cor branca (78,2%) e solteiros (96,4%). Dos entrevistados, 85,9% referiram já ter iniciado a vida sexual, sendo que 95,6% se declararam heterossexuais. O método anticoncepcional mais utilizado na última relação sexual foram as pílulas anticoncepcionais (57,6%), seguida do preservativo masculino (52,5%). O consumo de bebidas alcoólicas antecedendo as relações sexuais dos últimos dois meses foi relatado por 43,9% dos alunos. O uso do preservativo em todas as relações dos últimos dois meses foi relatada por 42,4%, a respeito do uso na última relação, isto foi 45,0%. No modelo final de regressão logística apenas idade, sexo, beber problemático e o uso de álcool precedendo as relações sexuais dos últimos dois meses permaneceram como fatores associados ao não uso consistente de preservativos. Esta pesquisa aponta a necessidade de implementar políticas públicas que abordem riscos diversos e interligados, como o beber problemático e o baixo uso de preservativos. Tais políticas são necessárias mesmo entre populações ... / Abstract: College students are a vulnerable group in relation to risk sexual behavior, in that they are entering the adult world, starting their sex life, often leaving the parental home for the first time, and are specially exposed to substances that increase this risk, for example, alcohol. The aim of this study was to assess sexual vulnerability among health area students by their sexual behavior selfreported, in particular the use of condoms. A sample of 695 students have participated of this cross-sectional study carried out in a University in São Paulo state. Data were collected from self-administered questionnaire in classrooms and activities. Medium age of students was 22.1 years old. Majority of students was women (67.3%), white (78.2%) and single (96.4%). Of the respondents, 85.9% reported already having begun their sexual life, and 95.6% reported they were heterosexual. The most widely used contraceptive method at last intercourse was oral contraceptives (57.6%), followed by the male condom (52.5%). The consumption of alcoholic beverages preceding intercourse the last two months was reported by 43.9% of students. The use of condoms in all the relations of the past two months was reported by 42.4%, regards the most recent intercourse it was 45.0%. In the final logistic regression model only age, sex, problematic drinking and alcohol use preceding sex the past two months remained associated with inconsistent condom use factors. This research points to the need to implement public policies dealing with various risks and interlinked, as problematic drinking and low condom use. Such policies are necessary even among populations who should present high knowledge about the prevention of sexually transmitted infections and the use contraceptive methods, as college students of health area / Mestre

The incidence of the Human Immunodeficiency Virus (HIV) is highest in the southern states of the United States (US), with adolescents in this region being one of the most affected populations in the country. A limited amount of information is available on adolescent HIV risk behaviors in the southern states, specifically focusing on race and gender. The purpose of this study was to use the Centers for Disease Control and Prevention’s National Youth Risk Behaviors Survey (YRBS) for high school students in the southern states for 2011 and 2013 to examine the influence of race and gender on 1) early sexual initiation, 2) number of sexual partners, and 3) condom use. Descriptive statistics and multiple logistic regression was used for the analysis. A total of 6,244 (6.7%) students reported early sexual initiation, 13,121 (14.1%) reported having multiple sex partners, and 11,820 (41.1%) reported condom use in southern states for 2011 and 2013. Minority males were greater than 10 times more likely to engage in early sexual initiation compared to white females (OR-10.40; 95% Confidence Interval (CI)-9.03-11.98). Minorities and males were more likely to have multiple sex partners compared to whites and females (OR- 1.84; CI-1.73-1.95, OR-2.20; CI-2.07-2.34, respectively). Minority males were over 2 times more likely to use condoms compared to white females (OR-2.04; CI-1.87-2.23). There was a statistically significant association between the three sexual health behaviors and psychosocial factors, such as dating violence, forced sex, body weight perception, and substance use before sex. Gender and race along with psychosocial factors were associated with HIV risk behaviors for high school students in the southern states. These preliminary findings could potentially be used to target HIV/AIDS awareness and preventative actions to populations affected by the HIV burden in the southern states.

One in every 4 people living with the Human Immunodeficiency Virus (HIV) are women. The leading cause of infection is heterosexual contact. The purpose of this quantitative, correlational study was to examine the relationship between gender ratio perception and masculine ideology and a woman's decision to use condoms during her sexual activity. The theory of gender and power and the theory of planned behavior served as the theoretical frameworks for this study. The perceptions of gender ratios, as measured by the Gender Ratio Imbalance Beliefs and Behaviors Scale (GRIBBS) subscale, GRIBeliefs, and masculine ideologies, as measured by the Gender Role Beliefs Scale (GRBS), served as independent variables, while condom use behaviors, as measured by the Gender Ratio Imbalance Beliefs and Behaviors Scale (GRIBBS) subscale, GRIBehaviors, served as the dependent variable. Covariates included demographic factors, as well as behavioral factors. A purposeful, convenience sample (n=55) via the Walden University research pool was utilized, enabling researchers to use readily available data that represented college educated women. Descriptive statistics, independent t-tests, correlational analysis, as well as multiple linear regression were used to examine the aforementioned perceptions of study participants. Correlation analyses and multiple regression indicated no statistically significant correlations between gender ratio imbalance, masculine ideology, and condom use, while controlling for race, employment status, religion, religious devoutness, sexual orientation, relationship status, STD history (self), and partner STD history. Social change is indicated via the results illustrating the possible empowerment of women regarding their sexual health.

Currently, the Caribbean has the second highest new cases of HIV infection, only after Sub-Saharan Africa. Women are becoming disproportionally more at risk for HIV/AIDS, mainly through heterosexual contact. The purpose of this dissertation study was to evaluate HIV knowledge, attitudes, and sexual risk behaviors among Trinidadian women. A sample of 113 participants was recruited for this study. The Theory of Planned Behavior (TPB) and Purnell Model of Cultural Competence were used to guide this study. Data were gathered using the HIV Knowledge Questionnaire (HIV-KQ-18), Condom Attitude Scale (CAS), Safe Sex Behavior Questionnaire (SSBQ), and a demographic questionnaire. Data were analyzed using statistical analysis software package (SPSS) version 22. Descriptive and Frequencies, Pearson product-moment correlation coefficient (r), one-way between groups ANOVA, and Multiple Regression analyses were implemented to assess HIV knowledge, attitudes about condom use, religious beliefs, level of education, and substance use among Trinidadian women. The results of this study indicated that level of education and race/ethnic backgrounds were associated with HIV knowledge among Trinidadian women. Religious beliefs had a negative correlation with attitudes about condom use. Also, there was a positive correlation between attitudes about condom use and safer sexual behaviors. The empirical knowledge obtained from this study can be used to provide a baseline for healthcare providers and policy makers to develop culturally aware, gender-relevant interventions to decrease the rate of HIV infection among Trinidadian women.

<p><font face="Times New Roman" size="3"><font face="Times New Roman" size="3"> <p align="left">In this study, the two most dominant sexual discourses were the male sexual drive discourse and the have/hold discourse. These discourses, together with traditional gender constructions, made condom negotiation difficult for women. Nevertheless, the discourses and constructions were also resisted and challenged. This study was limited by its focus on heterosexual women and the negotiation of condom use. Future studies which explore alternate forms of safe sex, sexual orientation and allow men&rsquo / s experiences to emerge would provide greater insight.</p> </font></font></p>

<p>Background: In Namibia, studies showed that HIV/AIDS affects youth, especially the under 24 years age group. At the same time the pregnancy rate is also high by age 19. Interestingly, in&nbsp / Andara district several reports from staff working in the reproductive services have indicated that adolescent girls, who would seem to be taking responsibility in one sphere of their sexual lives&nbsp / by protecting themselves against unwanted pregnancy, were however not using condoms to protect themselves from HIV infection. Study Aim and Objectives: To describe the knowledge, attitude and behaviour related to HIV/AIDS amongst female adolescents who are accessing the primary health care (PHC) services for contraception. Specific objectives were to describe the&nbsp / knowledge of female adolescents who are accessing the PHC services for contraception about the modes of transmission and prevention of HIV/AIDS, to assess their attitude with regards to&nbsp / condom use, abstinence and being faithful to one uninfected partner, also to determine the significance of association between age and knowledge, attitudes and behaviour, between their&nbsp / education level and knowledge, attitudes and behaviour and the significance of association between knowledge of HIV prevention strategies and&nbsp / behaviour of female adolescents accessing&nbsp / &nbsp / PHC services for contraception in the district. Setting: The study was conducted in Andara district, North East of Namibia. Methods: Descriptive cross-sectional KAB study. Sample: All female&nbsp / adolescents who are accessing PHC services for contraception selected from multistage simple random sampling in 5 facilities and systematic sampling at facility level in Andara. All married&nbsp / women within this age range were excluded in the study. Data collection tool: An interviewer-administered standardised questionnaire was used to collect the data. Data analysis and&nbsp / Interpretations: Epi Info software 2002 was used for data analysis. The results were presented using descriptive statistics including means, 95% confidence intervals and percentages and&nbsp / this information was shown in tables, bar and pie charts. Cross-tabulations of knowledge, attitude and behaviour scores against demographic variables were performed. P-values &lt / 0.05 were&nbsp / &nbsp / considered statistically significant. Results: 76.5% knew that unprotected sexual intercourse was the main way of getting HIV/AIDS, 77.3% knew that people could protect themselves by&nbsp / abstaining from sexual intercourse and 64.5% knew that people could protect themselves by having one uninfected faithful sexual partner. Out of 192 respondents who stated that unprotected&nbsp / sexual intercourse was the main way of HIV/AIDS transmission, 25.5% used condom every time they had sexual intercourse, 10.9% used condom almost every time they had sex, 41.1% used&nbsp / condom sometimes and 22.4% never used condom. Older girls and those who were in higher grades at school had more knowledge that could protect them from HIV infection. Later sexual&nbsp / debut is associated with increased&nbsp / condom usage at sexual debut. Conclusions: The general HIV knowledge of respondents and their knowledge of how to&nbsp / protect themselves from HIV infection were disappointing given that this&nbsp / study was conducted in health facilities. In this study we also see that knowledge does not always translate into the appropriate behaviour. The health services need to evaluate the targeting and&nbsp / effectiveness of their HIV educational messages and develop skills that will support behaviour change.&nbsp / </p>

Human immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is a major health concern in the United States, as well as globally (CDC, 2001). Certain ethnic groups in the United States have more reported HIV/AIDS cases then others. In particular, African American adults and adolescents are disproportionately affected by HIV/AIDS. For that reason, there is a great need for prevention/intervention work within this population to decrease the growing number of HIV/AIDS cases. One prevention effort is the Youth Empowerment Project, which is an HIV/AIDS prevention program targeted to reduce risky behaviors in a Midwest African American adolescent population. A total of three hundred and ninety-four youth between the ages of 12-17 participated in this program over the course of three years. Participants were exposed to safer sex skill building, condom use negotiation with a partner, selfefficacy skills, and general refusal skills. This study examined the differences in self-efficacy of the participants and investigated the relationships found between self-efficacy and reported condom use. Participants were randomly assigned to either an HIV/AIDS safer sex class or a health promotion class. No significant differences in self-efficacy were found between the two groups. However, female participants were found to have higher self-efficacy than male participants. Reported sexual activity was low for this population, so no significant findings were discovered between selfefficacy and condom use. / Thesis (Ph.D.)--Wichita State University, College of Liberal Arts and Sciences, Dept. of Psychology. / "July 2006." / Includes bibliographic references (leaves 44-51)

Background. The study explored associations between factors derived from the application of the Theory of Gender and Power (TGP) as they relate to HIV-risk behaviour among Middle Eastern/Arab-Canadians. This area deserves increased attention, as the proportion of HIV incident cases among Canadian women—due to heterosexual transmission—is increasing. Methods. A web-based survey was administered to Middle Eastern/Arab-Canadians who were aged 18-35 years, of Middle Eastern and/or Arab descent, living in Canada, heterosexual, and in a relationship. Multivariate regression analyses were used to assess factors associated with condom-use risk and lifetime number of sexual partners. Analyses were stratified by gender. Results. The study sample consisted of 157 participants, with more female participants (65.38%), and a mean age of 22.71 years. Females were more likely to have an older partner and more likely to be virgins, compared to males. Only a third (27.45%) of sexually active participants in this sample reported using condoms every time they have sex and participants reported a mean of 4.31 lifetime sexual partners. Factors associated with both condom-use risk and lifetime number of sexual partners varied greatly between genders. Among females, having low self efficacy towards practicing safer sex was predictive of condom-use risk. Among males, not being worried about getting HIV was predictive of condom-use risk. Thinking they knew how to use condoms was predictive of having more sexual partners among females, while being low acculturated from Middle Eastern culture was predictive of more partners among males. Conclusions. Factors associated with HIV risk varied greatly between genders among this sample and may contribute to power imbalances within relationships. The application of the TGP to this sample was moderately successful in predicting number of sexual partners among females and condom-use risk among males. However, it was not as successful in predicting condom-use risk among females and number of sexual partners among males. Many factors associated with HIV risk have been identified in this study, and should be used to create interventions designed to increase equality within Middle Eastern/Arab-Canadian relationships. However, many issues are discussed that still need to be addressed in future research.

This study examined contextual influences on the relationship between peer norms for condom use and risky sexual behavior among African-American men who have sex with men. Analyses assessed the moderating effects of socio-demographic, socio-contextual, and health-related variables. One thousand forty African-American men, who have sex with men, ages 17 to 25 years, were surveyed as part of the Community Intervention Trial for Youth (CITY) from 1999 to 2002 in Atlanta, Georgia. Findings supported the hypothesis that participants who engaged in unprotected insertive anal intercourse, socio-contextual variables moderated the relationship between peer norms and risky sexual behavior. Findings also supported the hypothesis that participants who engaged in unprotected receptive anal intercourse, both socio-demographic variables and a health variable moderated the relationship between peer norms and risky sexual behavior. Findings have implications for intervention, policy, and research, including a need for interventions that recognize the contexts of influence that shape African-American MSM sexual behavior and that support norms for consistent condom use in both steady and casual sexual relationships.