This dissertation describes health care delivery in a Ryan White Program (RWP) HIV clinic, with a focus on medical home care, using the Bayesian Case Study Method (BCSM). The RWP funds medical care for uninsured HIV patients and Pappas and colleagues (2014) suggested enhanced HIV care build upon medical home models of care rooted in the RWP. However, little research describes how RWP clinics operate as medical homes. This study developed the BCSM to describe medical home care at a RWP clinic. The BCSM combines a case study framework with Bayesian statistics for a novel approach to mixed method, descriptive studies. Roberts (2002) and Voils (2009) used mixed-method Bayesian approaches and this dissertation contributes to this work. For this study, clinic staff and patients participated in interviews and surveys. I used Bayes’ Theorem to combine interview data, by use of subjective priors, with survey data to produce Bayesian posterior means that indicate the extent to which medical home care was provided. Subjective priors facilitate the inclusion of valuable stakeholder belief in posteriors. Using the BCSM, posterior means succinctly describe qualitative and quantitative data, in a way other methods of mixing data do not, which is useful for decision makers. Posterior means indicated that coordinated, comprehensive, and ongoing care was provided at the clinic; however, accessible care means were lower reflecting an area in need of improvement. Interview data collected for subjective priors captured detailed service delivery descriptions. For example, interview data described how medical and support services were coordinated and highlighted the role of social determinants of health (SDH). Namely, coordinated and comprehensive services that addressed SDH, such as access to housing, food, and transportation, were necessary for patients to focus on their HIV and utilize healthcare. This case study addressed a gap in the literature regarding descriptions of how RWP clinics provide medical home care. For domains with high posterior means, the associated interview data can be used to plan HIV care in non-RWP settings. Future research should describe other RWP HIV medical homes so this information can be used to plan enhanced HIV care across the healthcare system.

Background: In Ethiopia the first case of HIV infection was identified in 1984. Since then HIV/AIDS has created an enormous challenge to several communities, affecting the social and economic well-being of the entire nation. Realizing the enormous consequences of the epidemic, the Ethiopian government deployed tremendous efforts to create HIV awareness in order to bring changes in HIV-related behaviors to reduce the risk of HIV infection. Therefore, it is necessary to assess the role of HIV-related knowledge, attitude and behavior in HIV/AID prevention in Ethiopia. AIM: The aim of the study was to assess the changes in HIV-related knowledge, attitude, and behavior between 2005 and 2011 and its impact on HIV status among Ethiopians. METHODS: The study used a nationally representative sample from the cross sectional years of 2005 and 2011 Ethiopian Demographic and Health Survey (EDHS). Sample sizes of study population were 12,845 in 2005 and 28,532 in 2011. SAS-callable SUDAAN was used provide descriptive characteristics of socio-demographic characteristics and independent variable of HIV-related knowledge, attitude, and behavior. The binary and multivariable logistic regression analysis was conducted to assess changes in HIV-related knowledge, attitude, and behavior and, association between these factors and HIV status. For all results, statistical significant were determined if there were no overlap in the 95% CI of the percentages being compared. RESULTS: There was no difference in correct comprehensive knowledge of HIV between 2005 and 2011. However, there was significant change in knowledge of Mother to Child transmission (MTCT) of HIV, accepting attitude towards people living with HIV (PLWH) and sexual behavior between 2005 and 2011. Respondents who had high level of knowledge of MTCT increased from 40.2% in 2005 to 71.0% in 2011. Likewise, respondents with high level of accepting attitude towards PLWH also increased from 3.9% to 10.8%. Besides, in 2011 fewer people had started sex before the age of 15 years old, and more people knew sources of condoms in comparison to 2005 However the percentage of people who had multiple sexual partners increased from 1.2% to 1.8% between 2005 and 2011 respectively. The study also found significantly protective association between HIV positive status and having low or medium level of knowledge of MTCT of HIV (OR 0.08 or 0.78) and accepting attitude towards people living with HIV (OR 0.12 or 0.48). In contrast, HIV infection was significantly associated with having multiple sexual partners (OR 4.49). Conclusion: Efforts deployed by Ethiopian government and other international organizations in response to HIV/AIDS epidemics have had success in terms of improving MTCT knowledge of HIV, accepting attitude towards PLWH, knowledge of sources of condom and sexual debut between 2005 and 2011. Surprisingly, we did not find an evidence of high level of HIV knowledge to be protective against HIV infection in the current study. Therefore continuous intervention is recommended to seal the gap between knowledge and sexual practices that may influence safer sexual behavioral changes.

Educational discourses, practices and institutions are increasingly shaped today by forces and envoys of a globalised world. Research suggests that functional integration into a neo-liberal world economy compels many nation-states to eschew indigenous educational priorities in favour of a globally structured agenda for education. This thesis explores the emergence of new educational policy responses to this agenda, with a particular emphasis on the practice of policy ‘borrowing’. While numerous studies have explored educational issues including curricular convergence and mass schooling in the context of policy borrowing, few have explored health education from a similar theoretical perspective. This thesis applies the Globally Structured Agenda for Education (GSAE) approach to the study of Uganda’s efforts to borrow an abstinence-only educational intervention as the nation’s primary HIV/AIDS prevention strategy. Uganda is regarded by many AIDS researchers and public health professionals as one of the world’s most compelling success stories in the battle against HIV and AIDS. From the early 1990s until 2003, the Ugandan government actively promoted a comprehensive approach to HIV prevention, encouraging Ugandans of all ages to observe the ‘ABCs’ of sexual health (Abstain, Be Faithful, use Condoms). Unlike the vast majority of its sub-Saharan counterparts, Uganda then experienced a rapid and extraordinary decline in rates of HIV prevalence. In 2004, however, the government of Uganda abruptly abandoned the popular ABC approach in favour of ‘policy borrowing’ PEPFAR, the model of sexual health education advocated by the United States. This exclusively promoted the benefits of abstinence until marriage. The sudden shift in education policy and public discourse in Uganda is the focus of this research. Two forms of documentary analysis are used. The first explores the borrowing process in detail, examining the interests and motivations underlying cross-national policy attraction, decision-making, implementation and ultimately, indigenisation in Uganda. The second explores the social, educational and health consequences of an abstinence-until-marriage approach in the context of Uganda’s localised AIDS epidemic. A discourse-historical approach is utilised to examine the ways in which language and rhetoric establish a narrative correlation between premarital abstinence and HIV prevention in Uganda, and to analyse the extent to which public discourse legitimately reflects the social, economic and epidemiological conditions in-country. The findings suggest the discourse on HIV/AIDS prevention in Uganda focuses mainly on (i) the severity of the national epidemic, (ii) the scope, nature and success of the ABC approach, (iii) the virtues of pre-marital abstinence, and (iv) the prophylactic inefficiency of condom use. The various arguments in support of abstinence-until-marriage education are found to be largely motivated by the political ambitions and economic aspirations of key power elites in Uganda. This finding suggests the neo-liberal, capital-driven imperatives of a global education agenda have indeed come to supersede local health needs in Uganda. The study concludes that Uganda’s efforts to halt the spread HIV/AIDS through abstinence-until- marriage education fail to adequately address the prevention needs of the nation’s adolescents and adults. This is evidenced by the fact the largest percentage of HIV-positive persons in Uganda are married, divorced and/or widowed women. Rather than marriage being seen as – in the American model – a ‘safe haven’ from the virus, it is instead the very place where Ugandans are most at risk. This has profound implications not only for education and health policy-making in Uganda, but also raises serious questions about the efficacy and relevance of ‘borrowing’ policies whose origins, ideologies and political contexts emanate from elsewhere.

<p>The spreading of HIV/AIDS has a gendered dimension. In this essay I focus on the gender roles that create different spheres for the sexes and how they are connected to the spreading of HIV/AIDS. The construction of masculinity hinders the HIV preventing efforts due to the social demands of having several partners and the dislike of using condoms. Sometimes it also results in gender-based violence. The female gender role narrows the possibilities for women to protect themselves. The women are struck harder by the disease because they are in a disadvantageous position in society where they have few means of economic independence and no control over their own bodies in their sexual relationships. The key is to change the gendered domain and the attitudes toward both men and women.</p>

No description available.

<p>This study formed part of the broad theme on the impact of HIV and AIDS on school-going learners sponsored by the Dynamics for Building a Better Society programme of the University of the Western Cape and the VLIR Partnership. HIV and AIDS poses a unique challenge to society in that it is a private disease transmitted mainly through unprotected sex that still has no known cure. A challenge to society invariably challenges schools. Primary school principals are obligated to respond because learners in the 5 to 14 year age range provide an opportunity for education, advocacy, prevention, treatment and support. This study aimed to contribute to a better understanding of school leaders and their responsibility towards HIV and AIDS and poverty.</p>

Magistro darbo objektas – ŽIV/AIDS problematika žiniasklaidoje. Darbo tikslas – ištirti ir nustatyti ŽIV/AIDS problematikos nagrinėjimo žiniasklaidoje ypatumus. Darbo uždaviniai: atskleisti ŽIV/AIDS problematikos, kontrolės ir prevencijos sąsają; ištirti žiniasklaidos vaidmenį pateikiant ŽIV/AIDS problematiką, jos įtaką visuomenės nuomonei ir informacijos sklaidai; išnagrinėti ŽIV/AIDS problematikos pateikimo Lietuvos žiniasklaidoje tendencijas; išanalizuoti ir palyginti ŽIV/AIDS problematikos nagrinėjimo žiniasklaidoje privalumus ir trūkumus, remiantis ŽIV/AIDS srities specialistų nuomone. Išanalizavus mokslinę literatūrą, atlikus ŽIV/AIDS problematikos nagrinėjimo žiniasklaidoje tyrimą remiantis kiekybinės turinio analizės ir kokybinio ekspertų interviu metodais, teigtina – ŽIV/AIDS problematika, kontrolė ir prevencija yra glaudžiai susiję dalykai ir reikia bendro vientiso požiūrio į jų sprendimą. Žiniasklaida atlieka svarbų daugialypį vaidmenį nušviečiant ŽIV/AIDS problematiką – tai yra žiniasklaida ne tik atspindi trupalaikį ir planuojamą poveikį turinčią informaciją bet ir linkusi domėtis ir gilintis į ŽIV/AIDS problematiką, prisidėti prie ŽIV/AIDS prevencijos siekių įgyvendinimo, įtakoti visuomenės grupių socializacijos procesus, padėti „apsibrėžti realybę“, pažintinius aspektus, kas yra pasiekiama žinant jos įtaką visuomenės nuomonei. Žiniasklaida, veikianti kaip svarbus socializacijos proceso agentas, yra linkusi įtakoti ilgalaikius poveikio efektus, prisidėti... [toliau žr. visą tekstą] / Because of it‘s importance in public life, mass media has incomparable opportunity to inform and educate general population on HIV/AIDS issues and protect from danger to get infected with HIV. Therefore, it is important to find out and assess peculiarities of HIV/AIDS coverage in mass media. This aim was pursued by the following work tasks: to display relations among HIV/AIDS topic, control and prevention; to evaluate the role of mass media in covering this topic; to research the trends of HIV/AIDS coverage in Lithuanian mass media; to analyse and compare advantages and shortcomings of the topic coverage in mass media by means of specialists’ opinion. Work object was HIV/AIDS coverage in mass media. Analysis of scientific printed matters and available research results allow to conclude that HIV/AIDS topic, control and prevention are tightly related as these issues require general integral point of view. Role of mass media and its impact onto prevention of epidemics and reduction of prevalence is obvious, possible potential to perform this role is also well-seen. Quantitative content analysis and quality expert interview used to assess HIV/AIDS coverage in mass media resulted into following conclusions: professional HIV/AIDS coverage in mass media depends on comprehensive complex point of view, and not only on attention and possibilities of the mass media but also on effective cooperation with interested institutions and population groups to affect targeted dissemination of... [to full text]

The objectives of this research were investigate the lived experiences of school-going learners who are HIV-positive; and develop ecosystemic management strategies to help learners who are HIV-positive. The literature research investigation revealed that HIV/AIDS is not just a health problem but also attacks the education system itself. Demand for education is dropping and changing, many educators are ill and dying, and the trauma of loss associated with HIV/AIDS is entrenched in South African classrooms. The HIV/AIDS pandemic has a traumatic impact on all educators and learners. The work of educators both those who are HIV positive and those who have developed full-blown AIDS will be compromised by periods of illness. The pandemic thrives on sexual violence, male domination and child abuse in South Africa. It is the ecosystemic paradigm that helps in seeing the connecting link between family-school-community-society-world or school and peers and this helps in providing a more useful synergistic focus than trying to work in isolation with discrete segments of a microsystem for example, with an individual in isolation. Management strategies for dealing with HIV/AIDS include the notion that achieving sustainability requires bringing together a variety of legitimate stakeholders, drawing on a variety of accepted bodies of knowledge, to negotiate a learning path based on a series of conflict resolutions within ecological constraints. Continual learning based on free flow of information and mutual respect, and investment in effective management of HIV/AIDS are keys to success. The empirical research investigation revealed that psychologically disturbed, emotional well-being, spiritual well-being, physical well-being, social life, their scholastic performance, daily routine, there is a change in their behaviour or health after the HIV- positive status has been revealed, they fear of death, their academic performance at school is affected by absenteeism and lack of concentration, there is absence of strategies to assist learners who are absent frequently because of illness, they loose valued level of functioning, lack assistance at school, fear being discriminated or ridiculed, there is absence v of measures to deal with discrimination at school, there is a lack of information on HIV/AIDS, learners fear disclosing to friends and teachers, there is a lack of communication between parents and infected learners about issues regarding HIV/AIDS. Educators are also affected emotionally, spiritually and physically. They become affected socially and they do not cope with the impact of HIV. The level of communicating the HIV/AIDS pandemic within the schools is low, the principals are not doing much as leaders to supplement this low level of communicating about HIV/AIDS, school policies on HIV/AIDS in these schools do not address issues of support for learners and educators who are incapacitated because of HIV/AIDS, there is no monitoring tool used in these schools to ensure HIV-policy adherence, principals in these schools do not ensure that educators teach learners about matters pertaining to HIV/AIDS, health programmes in these schools do not assist learners living with HIV/AIDS within the school and the level of accepting and accommodating infected learners and the personnel in these schools is low. The level of involvement of community members in matters pertaining to HIV/AIDS in these schools is low. An ecosysternic management system is proposed in this research vi / Thesis (M.Ed.)--North-West University, Vaal Triangle Campus, 2008.

This thesis aimed to investigate, first, the potentially traumatic effects of AIDS-related bereavement on HIV/AIDS aid workers in South Africa; second, the resources that aid workers utilise in order to cope with their work; and third, differences in the experiences of local versus international aid workers. HIV/AIDS work is associated with various stresses and burnout is commonly observed among HIV/AIDS caregivers. Care of HIV/AIDS aid workers, however, has been largely overlooked; research has typically focused on the experiences of professional health workers, and often outside of an African setting. This present study, therefore, addressed these limitations with the use of participant observation ethnography and ethnographic interviewing. A period of one year was spent with an organisation in South Africa that provides care for vulnerable children in need and affected by HIV/AIDS. Openended semi-structured interviews were conducted with 63 male and female local and international staff and volunteers. The interviews were analysed using discourse analysis (DA), a methodology novel within HIV/AIDS and trauma research and particularly suitable for investigating language, social context and interaction, and identities, which are factors found to be important in HIV/AIDS work. Participants’ discourses were analysed to identify how they construct their identities, concepts such as HIV/AIDS and tuberculosis, events they experienced, and how they made sense of these phenomena. The main finding of this study was that contemporary HIV/AIDS aid work involves new challenges that have surpassed AIDS-related bereavement as the most prominent concern. The main challenges reported by participants involved the inability to control HIV/AIDS treatment and consequently inability to prevent, or control, AIDS-related death as a result of patient non-compliance. Participants further constructed HIV contraction as controllable and, therefore, avoidable, and used this micro discourse on control to counter HIV-related stigma, particularly stigma they experienced as HIV/AIDS aid workers. This rhetorical technique, however, rather maintains the macro discourse on HIV-related stigma by maintaining the blame component of the disease. Two identity constructions emerged in participants’ discourses. First, the characteristics inherent in the child identity suggested that loss is not merely a matter of death but also sadness for and on behalf of children for their various losses. Second, the caregiver identity prescribed how ‘proper’ and ‘genuine’ HIV/AIDS caregivers are expected to behave. The prescriptive nature of this identity can explain burnout among HIV/AIDS caregivers. The rewards of caregiving, however, can act as a buffer against difficult or traumatic experiences inherent in HIV/AIDS work. Managerial support and global belief systems that allow finding meaning were further identified as important coping resources for HIV/AIDS aid workers. Finally, differences between local and international participants, in terms of how they conceptualise phenomena and consequently have different needs, emphasise the role of culture in the experiences of HIV/AIDS aid workers. In the thesis I further discuss these findings in light of theories of social psychology, such as the Just World hypothesis, Cognitive Dissonance, and Identity Control Theory and Self-Categorization Theory. I conclude that although AIDS-related death no longer is a prominent issue, care of HIV/AIDS aid workers should not be overlooked. Contemporary HIV/AIDS work simply involves new challenges and traumas, and it is important that such work is continuously researched to identify evolving needs.

This study serves two aims, to shed light on the rule of darura in Islamic law and to examine the justification for the Harm Reduction Programme in Malaysia using the said rule. In an attempt to fathom the real understanding of this rule, I have employed two methods: a critical approach to the darura theoretical discussions and an analysis of darura cases presented in fiqhi treatises. The study demonstrates that the usuliyun have formulated a narrow scope of darura theory although the applications of the rule in fiqhi treatises suggest other ways in which the principle can be applied. The jurists tend to apply the rule in a much wider sense in the various fiqhi works, either in true and factual cases or in hypothetical ones. This research also finds that the modern jurists have expanded the application not only to protect the necessity of an individual person but to protect the necessity of the public at large. It can also be suggested that the rule of darura has provided measures derogating obligations; however, this must only be to the extent required by the exigencies of the situation. A rigorous understanding of this rule is crucial for the field of Islamic law in order to avoid any possible abuse. Based on the above understanding of darura, this study finally investigates whether darura can justify the Harm Reduction Programme in Malaysia. This programme has been promulgated to reduce HIV/AIDS cases by providing drug users with methadone, syringes and needles. The programme was assessed thoroughly using the legal requirements and preconditions of darura. Having examined the philosophy, its modus operandi and jurists' attitude towards drugs, the study concludes that this programme is justified from a shari`a perspective on the basis of necessity. However, strict precautions and regulations need to be continuously employed throughout this controlled programme to avoid any abuse which might impair its legality. The research also aims to enhance the public's understanding of the rule of darura and to improve the collaboration between Malaysian government and religious groups in minimising HIV/AIDS and drug cases in Malaysia.