<b>Background:</b> Women who inject drugs face vast disparities in health outcomes relative to their counterparts in the general population, most notably in HIV. Intimate partner violence (IPV) victimisation has a detrimental individual effect on women's HIV risk behaviour. Furthermore, IPV often co-occurs with substance use and poor mental health among women in high-income countries, but little is known about the cumulative and interactive effects of these conditions on women's HIV risk behaviour in low- and middle-income countries. This thesis applied an ecological approach guided primarily by syndemics theory to understand influences on women's HIV behavioural outcomes. It examined associations and mechanisms linking IPV, substance use, and depression, with HIV sexual and injecting risk outcomes in the first quantitative study of Indonesian women who inject drugs, the Women Speak Out study. <b>Methods:</b> This study combined community-based participatory approaches and extensive formative research with quantitative survey methods. 731 women, ≥18 years of age, and injecting illicit drugs in the preceding year were recruited using respondent-driven sampling (RDS) from urban settings in Greater Jakarta and Bandung, Indonesia. Network characteristics of the sample were assessed using the RDS software package for Stata 14. Data were analysed using multivariate logistic regressions, marginal effects models, and interaction analyses on the additive and multiplicative scales. The study was conducted in collaboration with the Indonesian Drug User Network. <b>Results:</b> Paper 1: Past-year IPV victimisation doubled the odds of engaging in one or more sexual HIV risk behaviours. Several covariates were associated with higher odds of sexual risk behaviour: HIV-positive status, non-injection crystal methamphetamine (crystal meth) use, low educational attainment, younger age, and being single. Co-occurrence of psychological, physical and/or injurious, and sexual forms of IPV had cumulative effects: sexual risk behaviour was reported by 62% of women who did not experience any form of IPV, but increased to 89% among those exposed to all three forms. Paper 2: Past-year IPV elevated women's odds of receptive syringe sharing. These effects remained after controlling for socio-demographic confounders. Two covariates, injecting illicit pharmaceuticals (vs heroin only) and housing instability and/or homelessness, remained associated with receptive syringe sharing in multivariate analyses. Paper 3: More than 1 in 4 women experienced concurrent IPV, depressive symptoms, and crystal meth use. All three exposures had independent negative effects on HIV sexual risk outcomes. The co-occurrence of all three factors produced a 4-fold increase in rates of survival sex work, 5-fold increase in STI symptomatology, and a 7-fold increase in inconsistent condom use. The joint effect of depressive symptoms and crystal meth use together was greater than the product of the estimated effects of each exposure alone on STI symptomatology, indicating an interaction on the multiplicative scale. Statistically-significant positive additive interaction was detected between IPV victimisation and crystal meth on inconsistent condom use; depression and crystal meth on STI symptomatology and on survival sex work; and IPV and depression on STI symptomatology and survival sex work. <b>Conclusion:</b> This thesis provides new evidence of the individual and cumulative effects of IPV, methamphetamine use, and depression on HIV risk outcomes among Indonesian women who inject drugs. The interaction analyses are the first to empirically test the assertion that these co-occurring conditions interact synergistically to increase drug-using women's HIV risk. This thesis furthers our understanding of how syndemics function within women who inject drugs to produce health disparities, and contributes to the problem theory for HIV risk behaviour in this population. The findings of this study have great public health significance and important implications for future longitudinal research, interventions, and policy.

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2017-03-06T13:52:57Z No. of bitstreams: 1 deboradadamtorres_dissert.pdf: 1456783 bytes, checksum: b4e87ed3eb804d6264e41a6cf1606270 (MD5) / Made available in DSpace on 2017-03-06T13:52:57Z (GMT). No. of bitstreams: 1 deboradadamtorres_dissert.pdf: 1456783 bytes, checksum: b4e87ed3eb804d6264e41a6cf1606270 (MD5) Previous issue date: 2015-12-16 / Introduction: Chronic diseases are health problems that persist over time and require constant care and changes in lifestyle. The main chronic diseases is high blood pressure. Alcohol consumption is considered a risk factor for high blood pressure in low doses has shown a cardiovascular benefit. Objectives: analyze the hypertensive and normotensive population, as the knowledge of hypertension, the concept of health, the measurement of PA; and evaluate the association between alcohol consumption and high blood pressure in the adult population of Sao Jose do Rio Preto / SP. Methods: Cross-sectional study in a sample of 1,717 individuals (hypertensive and normotensive) stratified by age group representative of the adult population (≥ 18 years) and urban city of São Jose do Rio Preto / São Paulo, Brazil. The participants answered a semi-structured interview with sociodemographic data, education, blood pressure control, aware of being hypertensive, health concept, monitoring of blood pressure and alcohol consumption. Statistical analysis was done through the Minitab software version 12.22, Maple 9:03, R 2.4.1, using the following statistical tests: Student t test, chi-square test or Fischer's exact test and the significance level adopted was p <0.05. Results: Of 762 classified as hypertensive, aged 18-39 years old, 33% were unaware of hypertension, and the knowledge increased with advancing age. The concept of health there was a decrease in good / excellent responses in young for regular / bad the elderly, most hypertensive reported that would monitor blood pressure, the last blood pressure measurement was less than a month. The study showed association of alcohol consumption and high blood pressure in the adult population analyzed, and the individuals who reported consuming more alcohol were male, with low education level and belonging to lower social classes. It showed cardiovascular protection in individuals who consume alcohol moderately (p = 0.035). Conclusion: These data refer to the population of São José do Rio Preto and reinforce the need to implement health interventions, promoting the knowledge of their health condition, improving the quality of life and thus reducing the rates of morbidity and mortality. / Introdução: As doenças crônicas são problemas de saúde que persistem com o decorrer do tempo e necessitam de cuidados permanentes e mudanças de hábitos de vida. Dentre as principais doenças crônicas não transmissíveis encontra-se a hipertensão arterial. O consumo de álcool, considerado um fator de risco para hipertensão arterial quando em baixas doses tem mostrado um benefício cardiovascular. Objetivos: analisar os indivíduos hipertensos e normotensos da população, quanto ao conhecimento da HAS, o conceito de saúde, a medição da PA; e avaliar a associação entre o etilismo e a hipertensão arterial na população adulta de São José do Rio Preto/SP. Métodos: Estudo transversal, em amostra de 1.717 indivíduos (hipertensos e normotensos) estratificada por faixa etária representativa da população adulta (≥ 18 anos) e urbana da cidade de São José do Rio Preto/São Paulo, Brasil. Os participantes responderam entrevista semi-estruturada com dados sóciodemográficos, escolaridade, controle de pressão arterial, conhecimento de ser hipertenso, conceito de saúde, a monitorização da pressão arterial e consumo de bebida alcoólica. A análise estatística foi feito por meio dos programas Minitab versão 12.22, Maple 9.03, R 2.4.1, utilizando-se os seguintes testes estatísticos: teste t de Student, teste qui-quadrado de Pearson ou teste exato de Ficher e o nível de significância adotado foi p<0,05. Resultados: Dos 762 classificados como hipertensos, na faixa etária de 18 a 39 anos, 33% não tinham conhecimento da hipertensão arterial, sendo que o conhecimento aumentou com o avançar da idade. Quanto ao conceito de saúde observou-se um decréscimo nas respostas boa/excelente nos jovens para regular/péssima nos idosos, maioria dos hipertensos relatou que monitorizava a pressão arterial, sendo a última aferição da pressão arterial foi há menos de um mês. O estudo mostrou associação do etilismo e a hipertensão arterial na população adulta analisada, sendo que os indivíduos que relataram mais consumir bebida alcoólica foram os do sexo masculino, com baixo nível de escolaridade e pertencentes a classes sociais mais baixas. Evidenciou proteção cardiovascular nos indivíduos que consomem moderadamente álcool (p=0,035). Conclusão: Esses dados referem à população de São José do Rio Preto e reforçam a necessidade da implementação de intervenções na saúde, promovendo o conhecimento da sua condição de saúde, melhoria da qualidade de vida e diminuindo, assim as taxas da morbimortalidade.

Background: Vitamin D is known to be associated with inflammatory diseases, but its relationship with allergic diseases is unclear. The study objective is to determine the association of serum vitamin D levels and markers of wheeze, asthma and atopy. Methods: Data (n = 9,463) on serum vitamin D levels and atopy were obtained from 2005-2006 National Health and Nutrition Examination Survey. Serum vitamin D level was categorized into four groups: Normal (≥30ng/ml), Insufficient (21-29ng/ml), Deficient (11-20ng/ml) and Severely Deficient (≤10ng/ml). Atopy was defined as at least 1 positive allergen-specific IgE level measured for a panel of 5 common aeroallergens- cat, dog, house dust mite, cock roach and Alternaria species. Doctor-diagnosed asthma and wheeze in the previous 12 months were assessed by means of questionnaire. Multivariable logistic regression analyses were conducted to investigate the association of serum vitamin D with wheeze, asthma and atopy adjusting for age, sex, race, smoking, outdoor physical activity, body mass index and poverty income ratio. Results: Overall, 15%, 14% and 28% of subjects had wheeze, asthma and atopy, respectively. Approximately 21% had normal serum vitamin D levels, while 35%, 28% and 5% had insufficient, deficient and severely deficient levels. Compared to subjects with normal vitamin D levels, those with insufficient, deficient and severely deficient levels had increased relative odds of wheeze and atopy with highest adjusted estimates in subjects with severe vitamin D deficiency (adjusted odds ratio [OR] 2.31, 95% Confidence Interval [CI] 1.73-3.10 for wheeze; OR 1.49, 95% CI 1.17-1.89 for atopy). Conclusion: Low serum vitamin D levels were found to be associated with wheeze and atopy. Findings contribute to ongoing efforts to understanding the role of vitamin D in atopic diseases.

Thesis (M. A. (Social Work)) -- University of Limpopo, 2004. / The aim of this study was to explore the impact of culture on the prevention and reatment of HIV/AIDS amongst people in low-resourced areas like Malamulele. he study focused on the lifestyles, beliefs, attitudes and perceptions around ultural elements and practices, which might impact negatively on the prevention nd treatment of the HIV/AIDS epidemic. There were three groups of research espondents namely: learners from three high schools in Malamulele, some arents of the learners and the traditional/cultural leaders. The researcher ollected both qualitative and quantitative data. The data was gathered through he use of an interview schedule (questionnaire), focus group discussions and ound-table discussion sessions. The data was presented, analysed and nterpreted by means of tables and charts. t was found that people in low-resourced (rural) areas have little knowledge about HIV/AIDS, causes, symptoms and how the disease is transmitted. Despite the fact that awareness and educational campaigns and programmes are being rendered, people in low-resourced (rural) areas have little knowledge and needed skills about prevention and treatment of the pandemic. Polygamy and extra-marital relations by men is still highly valued and viewed at high esteem. Religious structures seem to be detached to the issue of HIV/AIDS as they mentioned that talking about HIV/AIDS is immoral and against their principles. The study also tried to explore the extent to which people in low-resourced areas view and use condoms as a protective means.

Det finns både skillnader och likheter mellan barn och äldres förhållningssätt tillfysisk aktivitet. Flertalet studier visar att fysisk aktivitet som en del i vardagslivet ärviktigt redan i ung ålder för att bibehålla en fysisk såväl som psykiskt god ochbalanserad hälsa livet ut. Föreliggande studie är av kvalitativ deskriptiv karaktär ochhandlar om att öka kunskap och förståelse om vilken roll FA har för 6–8 årigaskolbarn och idrottsföreningsaktiva personer 65 +, samt hur förhållningsättet till detskiljer de båda grupperna åt. Datainsamlingen baserades på femfokusgruppsintervjuer med idrottsföreningsaktiva 65+ och skolbarn 6–8 år. Empirisktmaterial analyserades utifrån en hermeneutisk ansats som vetenskapsteoretiskutgångspunkt. Resultatet visar att det finns skillnader och likheter mellan de bådagrupperna, vilket delvis ligger grundat i en åldersmässig erfarenhet och intresse(smak), men också utifrån vilka socioekonomiska skillnader och likheter sompåverkar resurstillgänglighet och möjligheter att utöva fysisk aktivitet. / There are differences and similarities between children and the elderly's approachtowards physical activity. Most studies show that physical activity as a part ofeveryday life is important already at a young age in order to maintain a physical aswell as a mentally good and balanced health throughout life. The present study is of aqualitative descriptive character with a purpose to increase knowledge and try tocreate an understanding of what role PA has to 6-8-year-old school children and sportassociation active people 65+, and how the approach towards it differentiates the twogroups. The data collection was based on five focus group interviews with sportsassociation active people 65+ and 6–8-year-old school children. Empirical materialwas analyzed from a hermeneutic approach as a scientific theory premise. The resultshows that there are differences and similarities between the two groups, which ispartly based on an age-related experience and interest (taste), but also on the basis ofwhich socio-economic differences and similarities that affect resource availability andopportunities to exercise physical activity

No abstract available. / Thesis (M.PH.)-University of KwaZulu-Natal, 2004.

Voluntary counselling and testing, the cornerstone of HIV/AIDS prevention efforts worldwide, is at the centre of a policy debate rega rding its effectiveness. Informed by social constructionism and drawing on various tools from ethnomethodology and conversation analysis, a sample of twenty-seven vid eotaped simulated counselling interactions in South Africa was analysed. The aim was to assess how the interactional tasks of the voluntary counselling and testing sess ion were worked through by clients and counsellors, and how this was done against the publ ic health and counselling frameworks that inform voluntary counselling and testing pract ice. The goal of the analysis was not to examine practitioners’ competencies, but to exam ine their unfolding actions in the situation and to consider the interactional functio ns these actions might serve. The results show that of the three interactional ta sks of voluntary counselling and testing, information-giving lays the foundation upon which the advice and support goals are realised. It is constructed as critical to client a nd counsellor identities and is a powerful tool through which hope is dispensed. Both the info rmation-giving and support tasks of voluntary counselling and testing combine to manage client distress into more concrete and manageable terms that encourage client coping. Counsellors draw on a range of advice-giving strategies – those that place the onu s of responsibility on the client to those that view the counsellor as the moral guide able to direct client change – in order to encourage clients to reflect on their risk behaviou r. In general, voluntary counselling and testing is framed as a moral activity, and this is most evident in the advice-giving segments. The public health and counselling framewo rks that inform voluntary counselling and testing create a dilemma for counse llors. In practice, counsellors orient towards a directive and health-advising role rather than a non-directive, client-centred counselling role. The implication of this research is that voluntary counselling and testing needs to be defined and framed more clearly – i.e. as a public health intervention with preferred outcomes that draws on a set of client-centred skills. Reconceptualisations of voluntary counselling and testing need to acknowledge the mor al framework under which it operates. Clear implementation guidelines (and training) on what voluntary counselling and testing is and that define its goals more clearly will be useful in assisting counsellors to implement the policies that govern their practice. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

Primarily, this dissertation examined the extent to which churches have potential in preventing HIV/AIDS. Set in rural KwaZulu-Natal an area marked with both high levels of HIV prevalence and high religious participation, the study used the concept of social space as a framework within which the contribution of churches towards the prevention of further spread of the HIV infection can be understood. Unlike recent studies which have consistently shown that the contribution of churches in the prevention of further spread of HIV infection is likely to emanate from the churches‘ teaching on morality, this study has argued that the contribution of churches in minimizing risky sexual behaviours is likely to emanate from how churches balance their teachings on moral issues and the subsequent practice of social control on the one hand and the provision of social support on the other. This is particularly so because in African settings where behaviour is largely influenced by the prevailing circumstances within society, and where churches are significantly entrenched in the lives of individuals providing a variety of social support services, there is a strong likelihood that churches will have an impact on their adherents‘ behaviour as well. The social space concept, therefore, defines churches not only as institutions enforcing the moral code which churches emphasise but also as caring and integrating forces, providing social support for their members in time of need. The study investigated four churches representing three Christian religious denominations: the Mainline, the Pentecostal and the African Independent churches. In investigating these churches, it used two types of data: The Africa Centre Demographic surveillance Systems (ACDIS) data collected between 2002 and 2004 and the Ethnographic data collected in 2006 consisting of a total of 96 in-depth interviews, 11-13 services of each church type selected, 6-8 church- related activities (or groups in each church), 3 informal discussions with community members and a set of 2 conversational data from each church. The analysis is done in two parts. The first part of the analysis (Chapter Five) focuses on the existing quantitative ACDIS data, examining whether there exists a relationship between church affiliation, participation in church activities and sexual behaviours. The second part uses ethnographic data in order to provide explanations of the observed relationship. Overall, the study found that unlike church affiliation which had no influence on individual sexual behaviour, individuals who participated regularly in church activities were less likely to engage in behaviour that would put them at risk of acquiring the HIV infection. The study found, however, that there existed denominational differences and that churches where participation was high were the same churches likely to influence protective behaviour. The explanation provided from qualitative findings suggested that the ability of these churches to minimise risky sexual behaviour was found in the Intensive Social Spaces that churches and their members constructed. The study concluded that the ability of churches to minimise risky sexual behaviours resulted from an individual negotiating losing the benefits provided by fellow members of the church when she/he ceases to be a member. / Thesis (Ph.D.)-University of KwaZulul-Natal, Durban, 2013.

The aim of this research was to investigate the different methods incorporating HIV/AIDS education into formal academic curricula at the University of Natal. This research aimed to flag up examples of ways of incorporating HIV/AIDS into the different curricula, and also to look at some of the obstacles the different academic departments may have encountered in trying to incorporate such education into their curricula. I had guessed that a variety of HIV/AIDS awareness programmes, initiatives and education were being undertaken at the university and that on the whole students and staff were well aware of the basic information regarding the disease. What I wanted to look at in particular was how the university was responding to HIV/AIDS within the curricula. Were academic curricula being altered in any way to allow for the impact of HIV/AIDS and how was this being undertaken? The key issues to be addressed and the main questions posed by this research were: • What are the different ways that HIV/AIDS education is incorporated into academic curricula? • What do lecturers consider to be the specific links between their subject matter and HIV/AIDS? • What is the purpose of such education? Why are lecturers choosing to incorporate HIV/AIDS education into their programmes? • What aspects of HIV/AIDS are being covered within the programmes? • How do lecturers attempt to get students to relate disciplinary knowledge to HIV/AIDS in order to inform future decision-making? • What are the main positive features of the current HIV/AIDS programmes being undertaken? • What are the main difficulties/concerns encountered by the different schools in incorporating HIV/AIDS education into the curricula? Through examining different schools within the university it was hoped to come up with a variety of different and innovative ways that HIV education can be incorporated into the curricula. This research started with a search of the HIVAN database to find lecturers with programmes that are undertaking some form of HIV/AIDS education. From this initial search I gained a number of contacts, who were then able to direct me to further contacts within the university. I ended up with an initial sample of seventeen lecturers based across fourteen schools or programmes and spanning seven faculties. The sample included lecturers from the faculties of Community & Development, Human Sciences, Law, Management Studies, Engineering, Medical Sciences, and Education. (See appendix I) For this research I used a number of methods of data collection. The first data collection method used was to carry out semi-structured interviews with the lecturers in the sample. This method was the prime method and the vast majority of the data was collected using this method. The following methods were mainly used for triangulation purposes although a number of new insights were made from these. The second method used then was to review printed material made available to me from a number of the lecturers interviewed. This was mainly course outlines but in a small number of cases also included reports on the HIV/AIDS modules. The third method used was to observe a number of the chosen programmes and following this observation to interview students about the HIV/AIDS education. (See appendix 11 Interview Questionnaires) Initially I have presented the findings of this research by documenting and summarizing the responses to each research question. In order to make for an easy overview of the findings for the reader I have drawn up a table under each research question, these tables list the responses to the research questions. I then go on to look at the different models this research has shown for teaching HIV/AIDS education. I have taken each model in turn and shown how it works in practice through giving a detailed description of the example cases. Following this I have attempted to outline the main features of these HIV/AIDS programmes and to document the main insights emerging. Looking back at the literature reviewed in this field, I have then attempted to review the responses in terms of what was said in the literature regarding HIV/AIDS education. I have also outlined the questions and surprises brought to light by this study and have attempted to draw some conclusions regarding the teaching of HIV/AIDS within academic curricula. Finally, in the light of the findings, I have made recommendations for future work in this field. It was impossible from this study to say which programmes work better than others with regards to the teaching of HIV/AIDS education. What I have merely attempted to do is to describe the methods and approaches used at present in order that others wishing to undertake similar programmes may review these. / Thesis (M.Ed.)-University of Natal, Durban, 2002.

This research emerges within the context of rapidly rising levels of Human Immunodeficiency Virus (HIV) infection amongst young adults and the escalation of deaths from the Acquired Immunodeficiency Syndrome (AIDS). This study critically examines the commonly used theories and models that guide HIV/AIDS communication campaigns. However, it notes that the broad ranging theories and models used during HIV/AIDS preventative and care campaigns emphasise communication linearity and individualism and therefore fail to acknowledge culture. In view of the multiplicity of cultural and language groups that exist in South Africa, culture plays a crucial role in HIV/AIDS communication interventions. Failure to acknowledge the cultural context in campaign theory has various negative implications. One is that, because these theories and models are linear, they are sender-oriented. The recipients are therefore unable to identify with the message as they are divorced from the context of its production. Furthermore, because of a lack of engagement by the recipient in the development of messages, retention of knowledge is minimal and this leads to a lack of acceptance of the message. Clearly then, there exists a need for these theories and models to be re-articulated so that they are less linear and individualistic, but rather more flexible so that they may be adapted for application within various cultural contexts. This study suggests that one of the ways of alleviating campaign linearity and including culture is by borrowing Paulo Freire's (1990) underlying principles of participation and incorporating them into communication campaign theory in the form of audience participation. Communication campaign theory would therefore include audience participation as a central component during its planning, implementation and evaluation phases. The appropriateness of this suggestion is demonstrated by applying it to and evaluating a HIV/AIDS awareness campaign targeted at young adults at a tertiary institution in KwaZulu Natal. / Thesis (M.A.)-University of Natal, Durban, 2002.