En dépit de nombreuses interventions en santé reproductive en Afrique subsaharienne, la trilogie « IST/VIH/SIDA - grossesses précoces - avortements » persiste à des niveaux très élevés par rapport aux autres parties du monde. Cela indique que les nombreuses interventions en santé reproductive auprès des adolescents et des jeunes ont enregistré peu de succès en ce qui concerne le changement des comportements sexuels. Ces interventions se focalisent souvent sur l’individu, et négligent les environnements sociaux et culturels dans lesquels se forge le vécu de la sexualité chez les jeunes. Un de ces agents de socialisation est la famille, où les individus naissent, grandissent, et sont socialisés selon les valeurs et normes en vigueur. Fort de ce constat, l’objectif principal de la présente thèse est de resituer l’environnement familial au cœur des débats en santé reproductive chez les adolescents et les jeunes en Afrique subsaharienne. Trois questions spécifiques sont examinées dans cette thèse. Premièrement, elle aborde les associations entre les structures familiales et l’entrée en sexualité. Deuxièmement, elle analyse leurs influences sur les connaissances des modes de transmission et des moyens de prévention du VIH/SIDA. Troisièmement, elle cherche à déterminer les forces potentielles dans les familles dites « à risque » (ayant au plus un parent biologique) à partir de la théorie de résilience selon laquelle des facteurs familiaux et contextuels peuvent atténuer les comportements sexuels à risque chez les adolescents et jeunes. Cette thèse démontre substantiellement que vivre avec ses deux parents biologiques, la nature des relations entre parents/tuteurs et le jeune et un niveau élevé du contrôle parental sont significativement associés à de faibles risques des rapports sexuels prémaritaux. Par contre, les unions polygamiques, un statut socioéconomique élevé du ménage, et le fait d’être orphelin augmentent significativement le risque de rapports sexuels prémaritaux. L’étude démontre aussi que l’environnement familial et la communication sur la sexualité, aussi bien avec les parents/tuteurs qu’avec les pairs, jouent un rôle fondamental dans l’acquisition des connaissances correctes des modes de transmission et de prévention du VIH/SIDA. Néanmoins, le rôle des parents/tuteurs sur l’acquisition des connaissances sur le VIH/SIDA s’avère indirect puisqu’elle repose sur une hypothèse implicite. Seule une mesure directe des connaissances des parents sur les modes de transmission et les moyens de prévention peut mieux rendre compte de cette association. Les résultats obtenus à partir de la théorie de résilience indiquent, dans chaque type de familles, que la qualité des relations entre les parents/tuteurs et le jeune est significativement associée à une faible probabilité de comportement sexuel à risque, défini comme étant la cooccurrence de plusieurs partenaires sexuels au cours de 12 derniers mois et de non-utilisation du condom. Par contre, le contrôle parental est associé à une faible probabilité de comportement sexuel à risque seulement dans les familles à deux parents biologiques. Ce résultat suggère que l’influence du contrôle parental baisse une fois que les jeunes ont eu une expérience sexuelle. Les interventions en santé reproductive devraient promouvoir chez les parents/tuteurs les facteurs familiaux susceptibles de réduire les comportements sexuels à risque. / In spite of numerous reproductive health interventions in sub-Saharan Africa, the trilogy “STDs/HIV/AIDS - Unwanted pregnancies - Abortion” remains at the highest rates compared with other regions of the world. In fact, youth-oriented reproductive health programmes did not work adequately in sub-Saharan Africa, as regards changes in risky sexual behaviors. These interventions have often focused on individuals, and have neglected socio-cultural environments in which sexual behaviors are shaped. One of the most influential contexts is the family in which young people are born, grow up, learn and internalize norms and values about socially acceptable behaviors and sexual conduct. In order to fill this gap, this research aims to address the centrality of family structure in reproductive health debate in sub-Saharan Africa where little is known about its potential influences on sexual behaviors. Three issues are of interest in this thesis. Firstly, the study examines the interplay of family structure and premarital sexual intercourse. Secondly, it addresses the role of family structures in shaping accurate and inaccurate HIV/AIDS knowledge of transmission routes and preventive strategies. Thirdly, using the resilience theory, the study aims to determine the strengths within families “at-risk” that can prevent young people from engaging in risky sexual behaviors. The research substantiates that living in two-parent families, higher levels of parent/guardian monitoring, and good parent/guardian-youth relationships are associated with lower rates of premarital sexual intercourse. By contrast, polygamous families, parent/guardian-youth communication about sexuality, higher household socioeconomic status, change in family structure, and orphanhood were significantly associated with higher rates of premarital sexual intercourse. The study also finds that family structure as well as family/peer communication about sexuality is key explanatory variable on which HIV education and prevention efforts should be directed at. A more direct effect of family structure must be addressed in future research, using direct measures of parent/guardian’s HIV knowledge. Finally, using the resilience theory, this thesis finds that good parent/guardian-youth relationships are associated with lower rates of risky sexual behaviors, captured by the co-occurrence of multi-partnership and condom non-use in the last 12 months preceding the surveys, irrespective of the type of family. Parental monitoring showed a protective effect only in two-parent families. This finding suggests that when young people are sexually experienced, parental monitoring becomes less efficient than when they are not. HIV interventions must put emphasis on these factors that help to reduce risky sexual behaviors among young people even among those living in the so-called “at-risk” families.

This study identified factors influencing the practice of HIV prevention behaviours amongst Tanzania youths. Structured interviews with in-school youths (n=222) and out-of school youths (n=150); and focus groups discussions with 25 youths were conducted to collect data. Although the level of HIV/AIDS awareness was 97.6% and 58.5% of the youths had positive attitudes towards HIV prevention, only 50.8% practised at least one mode of HIV prevention. Factors which promoted HIV prevention practices included positive attitudes towards specific preventive behaviours and the individual’s self-efficacy to enact such behaviours. The barriers against the practice of HIV prevention behaviours included the lack of comprehensive knowledge about HIV/AIDS and HIV prevention, socio-economic issues such as unemployment, influx of mobile populations, loss of cultural values, negative social norms, peer pressure, alcohol abuse and the lack of adequate HIV preventive services. / Health Studies / M.A. (Public Health)

Quantitative, descriptive research, using self-completion questionnaires, was conducted to determine the level of HIV/AIDS knowledge of the learners in Sefhare. The sample, comprising 92 learners, was selected from forms 1-3. Of the learners, 53.4% knew what HIV/AIDS stand for, but only 13.6% said AIDS is caused by HIV and only 4.5% said AIDS is an incurable disease. The ABC of protecting oneself against HIV (abstain from sex, be faithful to one sex partner, use condoms) was mentioned by merely 57.6% of the learners. The learners’ lack of knowledge should be addressed by school HIV/AIDS programmes offered at schools in Botswana. As 81.5% of the learners were willing to be tested for HIV, this service should be made available with simultaneous confidential personal HIV/AIDS education, irrespective of the HIV test results. Teachers’ and parents’ HIV/AIDS knowledge should also be updated regularly. / Health Studies / M.A. (Public Health)

Aims: The study was aimed at exploring adolescents‟ level of knowledge of HIV/AIDS and the influence this knowledge has on their sexual behaviour. Methods: In total, 20 in- depth interviews were conducted from a group of 20 (both males and females) secondary school learners. The interviews were audio taped with consent from participants. Results: The results of the study showed that participants possess basic knowledge of HIV/AIDS, including methods of prevention and transmission. No serious misconceptions about modes of transmission of HIV were found in this study. Although, participants reported condom use, no sexual intercourse with multiple concurrent partners and no intergenerational sexual relationships, the findings revealed some risk factors such as early sexual debuts, early dating, multiple sexual partnerships. Conclusions: The aforesaid sexual behaviours and the sexual activeness among learners is a cause for angst. Thus, these findings highlighted the need for a comprehensive approach to sexual reproductive health education by all interested parties in order to enhance and sustain behaviour change among young people. / Health Studies / M.A. (Public Health)

Quantitative, descriptive research, using self-completion questionnaires, was conducted to determine the level of HIV/AIDS knowledge of the learners in Sefhare. The sample, comprising 92 learners, was selected from forms 1-3. Of the learners, 53.4% knew what HIV/AIDS stand for, but only 13.6% said AIDS is caused by HIV and only 4.5% said AIDS is an incurable disease. The ABC of protecting oneself against HIV (abstain from sex, be faithful to one sex partner, use condoms) was mentioned by merely 57.6% of the learners. The learners’ lack of knowledge should be addressed by school HIV/AIDS programmes offered at schools in Botswana. As 81.5% of the learners were willing to be tested for HIV, this service should be made available with simultaneous confidential personal HIV/AIDS education, irrespective of the HIV test results. Teachers’ and parents’ HIV/AIDS knowledge should also be updated regularly. / Health Studies / M.A. (Public Health)

Aims: The study was aimed at exploring adolescents‟ level of knowledge of HIV/AIDS and the influence this knowledge has on their sexual behaviour. Methods: In total, 20 in- depth interviews were conducted from a group of 20 (both males and females) secondary school learners. The interviews were audio taped with consent from participants. Results: The results of the study showed that participants possess basic knowledge of HIV/AIDS, including methods of prevention and transmission. No serious misconceptions about modes of transmission of HIV were found in this study. Although, participants reported condom use, no sexual intercourse with multiple concurrent partners and no intergenerational sexual relationships, the findings revealed some risk factors such as early sexual debuts, early dating, multiple sexual partnerships. Conclusions: The aforesaid sexual behaviours and the sexual activeness among learners is a cause for angst. Thus, these findings highlighted the need for a comprehensive approach to sexual reproductive health education by all interested parties in order to enhance and sustain behaviour change among young people. / Health Studies / M.A. (Public Health)

The researcher investigated the knowledge, attitudes and experiences of people living with the Human Immunodeficiency Virus (HIV) towards antiretroviral treatment (ART) and who are accessing antiretroviral treatment at a public health clinic in Limpopo, South Africa. A qualitative method was used. The research findings revealed five themes: experiences, social support, knowledge, attitudes, unemployment and economic themes of the study. Factors reported influencing optimum adherence were the inability of the patients to take medication at work, laziness of the patients to collect medication, unemployment, economic hardship, poverty and lack of knowledge of employers regarding HIV/AIDS. / Health Studies / M.A. (Social Behaviour Studies in HIV and AIDS)

The study sought to describe HIV/AIDS knowledge and attitude among teachers in Abuja, Nigeria. The study noted that teachers were knowledgeable about HIV/AIDS and poor HIV/AIDS attitude persist. Among the respondents, statistically significant relationship exist between education qualification and knowledge of MTCT of HIV during pregnancy; between geographic location and the knowledge to clarify misconception about HIV transmission; between gender and the knowledge of condom use; and between the receipt of HIV/AIDS information or training on FLHE curriculum and the procedural knowledge of discussing / teaching sexuality and HIV/AIDS issues with fellow teachers or students. However, there is no statistical significant relationship between the teachings of HIV/AIDS issues and the feeling that HIV/AIDS education promotes sexual promiscuity. / Health Studies / MA (Public Health)

The study sought to describe HIV/AIDS knowledge and attitude among teachers in Abuja, Nigeria. The study noted that teachers were knowledgeable about HIV/AIDS and poor HIV/AIDS attitude persist. Among the respondents, statistically significant relationship exist between education qualification and knowledge of MTCT of HIV during pregnancy; between geographic location and the knowledge to clarify misconception about HIV transmission; between gender and the knowledge of condom use; and between the receipt of HIV/AIDS information or training on FLHE curriculum and the procedural knowledge of discussing / teaching sexuality and HIV/AIDS issues with fellow teachers or students. However, there is no statistical significant relationship between the teachings of HIV/AIDS issues and the feeling that HIV/AIDS education promotes sexual promiscuity. / Health Studies / MA (Public Health)