Background In South Africa, as part of specified governance requirements, clinic committees were established to provide management oversight at Primary Health Care facilities. In order for them to better understand their roles they needed training. Facilitators in the district were selected to participate in the 'PHC Facility Governance Structures Trainer-of-Facilitator (ToF) Learning Programme’ in order to train the clinic committees. This study assessed the training of facilitators. Methods This retrospective single case study used qualitative methods and was guided by the Illuminative Evaluation Framework. It assessed whether the aims, objectives and methodology of the training programme was clearly conveyed by the trainers, whether this was understood by the participants and whether the participants were able to transfer the training programme as intended to the clinic committees. Qualitative data were collected through key informant interviews and focus group discussions, face to face and telephonically. These were complimented by a document and literature review. Study participants were purposively selected based on their involvement in the development, facilitation or training of the programme. Interviews were conducted in English, with semi-structured open ended questions pertaining to participants’ perceptions and understanding of the training, and whether the ToF Learning Programme was delivered to the clinic committees. After participants signed consent forms interviews were audio recorded and transcribed verbatim. Data analysis was done manually and guided by the methodology presented by Ritchie and Lewis. Results A total of 13 participants participated in the study and 23 (national, provincial and partner) documents were reviewed. Despite the different perceptions and understandings of the ToF Learning Programme its overall goal was achieved. Participants’ capacity was strengthened and they trained the clinic committees. The document review showed inconsistency across legislations with regards to clinic committees. Conclusion The ToF Learning Programme has reached its overall goal despite the deviation in the process of delivery and can be recommended for implementation

Includes abstract. / Includes bibliographical references. / While the frequent positioning of men's sexual behaviours as driving the HIV epidemic in South Africa has generated much interest in men's sexuality, much research to date has presented men as a homogenous group, or treats male sexuality as a set of isolated, individually driven behaviours. As a result, the current body of knowledge provides only a partial basis for meeting men's sexual and reproductive health (SRH) needs and addressing HIV-prevention among men. A narrative approach, which foregrounds the diversity and meaning in participant's lived experiences, was used in this study to examine the subjective and social impact of dominant norms of masculinity on South African men's sexual behaviours and gendered attitudes. This was expected to yield more nuanced, and contextualised understandings of men's SRH, with practical consideration for what means of men's sexual health can be enhanced. Fifty sexual-history interviews and ten focus group discussions with men, and twenty-five sexual-history interviews with women, were conducted with participants purposely sampled from three age categories (aged 18–24, 25–54, and 55+ years), a range of language and racial backgrounds, and urban and rural sites across five provinces in South Africa. The interviews were structured to elicit accounts of early knowledge of sex and sexual experimentation and to explore the range of sexual relationships and experiences among men and women throughout their adulthood. Participants' engagement with the risk of sexually transmitted infections, including HIV, and their reproductive health management were also explored. The data were analysed using the principles of thematic and narrative analysis, with NVivo software used for data management. The data appreciates the diversity and fluidity in men and women's lived experiences while recognising the social and cultural norms that structure sexuality. The narratives reveal a number of footholds for understanding how individual men both conform to and resist gender norms that can be damaging to their SRH. Such findings provide insights to inform how programmes and services could better engage men in HIV prevention and care. Especially, the study points to the value of a narrative approach to more deeply understand men's sexual risk and agency and the social structures, meanings and experiences that underlie it.

Background: Contraception remains the cornerstone of the global strategy to prevent unintended pregnancy, as well as horizontal and perinatal/postnatal HIV transmission in women living with HIV (WLHIV), including female adolescents living with HIV (ALHIV). Although increased data and research on WLHIV contraception has provided opportunities to strengthen contraception services in HIV programmes, little is known about ALHIV contraceptive behaviours and needs, as well influences on their access to and utilisation of contraceptive services to inform the design of strategies that would enhance optimal contraceptive services in ALHIV programmes. Methods: A mixed-methods design included a cross-sectional study of female ALHIV (n=303) through a questionnaire survey, and semi-structured in-depth interviews with both system- and service delivery-level providers (N=19). Quantitative data were analysed using Stata 15. Quantitative analyses include descriptive statistics and regression modelling, including multinomial and multivariate logistic regressions. Thematic analysis of qualitative data was conducted using Nvivo 11. Quantitative and qualitative data were triangulated in the interpretation of results. Results: Contraceptive prevalence (83.5%) is extremely high among all the female ALHIV and even higher among sexually active female ALHIV (86.8%), and contraceptive prevalence rates are at least 20% higher than the South Africa Demographic and Health Survey (SADHS) rate for the general population of female adolescents or sexually active female adolescents. The rate of unmet need for contraception (23.6%) remains considerable. Contraceptive prevalence is also high among both female with peri/postnatally acquired HIV (pALHIV) and horizontally acquired HIV (hALHIV). The majority of current contraceptive users relied on injectables (60.5%), followed by condoms alone (27.7%), then long-acting reversible contraceptives [LARC](9.1%) and hormonal pills (2.7%). Almost 1 in 5 (18.8%) female ALHIV had an unintended pregnancy. When contraceptive use consistency was restricted to the three months preceding the survey, levels of consistent condom use and dual-method use were 37.9% and 20.6%, respectively. Also, the quantitative data shows multiple barriers and facilitating factors for contraceptive uptake among female ALHIV. Overall, both the quantitative and qualitative data generally found that the receipt of contraceptive provision and use are similar between female pALHIV and hALHIV; however, the quantitative data suggest that pALHIV were more likely to experience unintended pregnancies compared to hALHIV. Though the quantitative data lack information on the particular hormonal method associated with HIV-specific safety concerns, there is evidence suggesting that the concern about HIV-specific hormonal contraceptive-related risks does not impact hormonal contraceptive uptake among ALHIV. Furthermore, adolescent-friendly services (AFS) appear to have been reasonably well-mainstreamed into routine care in the Cape Town context at least, to the extent that standalone youth clinics do not appear to provide significant added value to contraception-related outcomes among female ALHIV. The qualitative data highlighted preponderance of injectable contraception, inconsistent contraceptive use, fears about the intrauterine device (IUD) use, positive and negative provider attitudes to contraceptive services for ALHIV, and provider competency and training, among others. Conclusion: Overall, the thesis supports socioecological-based approaches to contraceptive care for female ALHIV as well as mainstreaming AFS within public sector facilities. Moreover, potential risk-reducing interventions, such as a client-centred approach to contraceptive care, are needed to improve pALHIV's risk of unintended pregnancies.

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