This study was concerned with the social construction of HIV/AIDS at the policy level in contemporary South Africa, and how such constructions shape the manner in which the epidemic is understood in popular discourse.

AIDS mortality, its linkages as a determinant and consequence of food security and its impact on natural resource utilisation by mainly rural populations, has not been well researched, especially their effects on rural livelihoods. With the high epidemic prevalence and persistent food insecurity, natural resources are and will continue to play a key role as a buffer against stresses and shocks in rural livelihoods. Determining linkages between household food security, adult AIDS mortality, and how these affect natural resource utilisation at the village level was the objective of this research. The overarching goal of sustainable natural resource utilisation in Agincourt Demographic Surveillance Site (DSS) was determined through three research questions outlined as follows; What is the status of food security, AIDS mortality and Natural resource utilisation in Agincourt?; What is the relationship between dependence on natural resources as a source of food and or livelihood to resource degradation?; and What are the household and community drivers of household food security? Statistical analysis was used to evaluate the prevalence of food insecurity and the reliance on natural resources while remote sensing was used to assess resource availability and identification of possible natural resource degradation hotspots. More than half of the population in the DSS is food-secure, in 2004, with an even smaller hungry population in 2007. HIV/AIDS and non-HIV/AIDS adult mortality, analysed at village level are underlying drivers and determinants, affecting availability of income which is a direct driver of food insecurity. Availability of income, through social grants, remittances or wages, and delay or non-receipt of this income results in food insecurity in some households. Food production, affected and constrained by climate variability, is a less stable and less popular means of attaining food. More than half of the Agincourt population utilises natural resources to supplement dietary diversity and household income, although there is a significant reduction in households using natural resources in 2007 compared to 2004. Resource degradation is noted in the village commons especially between the highly food-insecure villages and are identified as environmental degradation hot spots. The identification of synergies among these factors in policy design and for interventions is essential for poverty alleviation, improved health and sustainable utilisation of natural resources and rural livelihoods. Glory be to GOD for making this work possible “Commit your work to the Lord and then your plans will succeed” (Proverbs 16:3) “Material poverty doesn‟t necessarily lead to a lack of capacity for creativeness and Inventiveness. Poor people survival by their wits and have much more to contribute to address complex problems than we tend to credit them with.” Dr. Maphela Ramphele (Destiny Magazine, 2010)

Latino men who have sex with men (MSM) in the United States experience a disproportionate and growing HIV burden. In spite of germinal studies and recent advances reported in the scientific literature, there is a noteworthy gap in our understanding of the factors that influence HIV transmission and acquisition among Latino MSM. The goal of this dissertation is to explore how cultural, spatial, and syndemic contexts influence two HIV-related risk behaviors among Latino MSM: serodiscordant condomless anal intercourse (SDCAI) and number of male causal partners. Specifically, I aimed to assess the how acculturation, neighborhood characteristics, and co-occurring epidemics may each contribute to HIV-related risk among Latino MSM. For this project, I utilized data from the NYCM2M study (R01 HD059729; PI: B. Koblin), a cross-sectional study of the relations among neighborhood environmental characteristics, sexual risk behaviors, anxiety and depression, and alcohol and substance use among urban MSM. First, I examined the association between indices of acculturation and the two HIV-related risk behavior outcomes, in addition to assessing if acculturation moderates the influence of sexual minority stressors and peer condom use norms on those same outcomes. The results indicated that relationships between the two sexual minority stressors and SDCAI were strongest among two groups: English-speaking and foreign-born Latino MSM, groups considered to be high and low, respectively, on acculturation. Second, I examined the ethnicity- and gay-related neighborhood correlates of the HIV-related risk behavior outcomes. The results showed that living in areas with a higher proportion of men reporting experiences of ethnicity-based discrimination and higher levels of gay community connectedness were both associated with an increased likelihood of engaging with 5 or more casual sexual partners, while living in an area with a higher foreign-born population was associated with a lower likelihood of the same. Third, I examined both established and population-relevant syndemic conditions to assess the association between syndemic burden and the HIV-related risk behavior outcomes among Latino MSM, and assessed if outness moderated these potential relationships. The results indicated a significant, positive association between the number of syndemic conditions and SDCAI, but, upon testing for moderation, this relationship only existed among men with high levels of outness about their sexual orientation. The results also showed that having any syndemic conditions, regardless of the number, was associated with having more casual sexual partners. Overall, this dissertation highlights the importance of studying HIV-related risk behaviors through multiple contextual lenses among Latino MSM. Specifically, the results suggest a strong need to attend to how cultural factors, spatial environments, and syndemic factors may shape HIV burden among Latino MSM. Taken together, these studies provide evidence for the development of multi-level, multicomponent HIV-reducing interventions that specifically target the differing needs among subgroups of Latino MSM, rather than treating them as a single, monolithic group for study and intervention.

Although scholars have written extensively about the effects of interpersonal HIV stigma on people living with HIV/AIDS (PLWHA), there is a dearth of information about the psychological and behavioral impact of structural HIV stigma. The current study builds on previous work investigating the dual roles of structural and interpersonal minority stressors with a national sample of 234 PLWHA by testing an HIV/AIDS-specific expansion of minority stress theory grounded in the psychological mediation framework. Through bivariate correlations and structural equation modeling, the study examined relations between four sets of variables: (1) distal stigma-related stressors (i.e., HIV criminalization by state, HIV-related discrimination), (2) general psychological processes (i.e., social support, cognitive reappraisal), (3) group-specific processes (i.e., HIV criminalization belief, HIV stigma), and (4) mental/behavioral health outcomes (i.e., psychological distress, health-related quality of life). Results provide mixed support for a dual, mediated model of HIV/AIDS minority stress. Findings indicate mixed support for hypothesized associations. HIV criminalization by state yielded a significant negative direct and significant positive indirect association with psychological distress. HIV-related discrimination yielded direct and indirect associations with both health outcomes. With the exception of cognitive reappraisal, mediators demonstrated support for the psychological mediation framework among PLWHA. Implications are discussed in support of future HIV/AIDS minority stress research, as well as clinical and policy interventions.

HIV incidence rates have been on the decline globally, yet certain sub-populations have seen their incidence rates increase, bearing an extraordinary share of the HIV disease burden. In Eastern and Southern Africa, the rate of new HIV infections disproportionately affects adolescent girls and young women (AGYW) with up to three times as many young women ages 15-24 living with HIV as compared to their male peers. These statistics make AGYW a key demographic for action in order to realize an AIDS-free generation. To most effectively intervene, researchers must examine the rationale for higher infection rates among young females. Recent studies have found positive correlation between economic strengthening interventions (such as cash transfers, savings accounts, or financial literacy) and HIV sexual risk among AGYW, however, the majority of the literature to date understands these economic strengthening interventions at the household level, as a mechanism for providing insurance against economic shocks and as an incentive for keeping girls in school, a key predictor of reduced HIV. Fewer studies have sought to understand how increased resources, and power over those resources, affects the thoughts and behaviors of AGYW at the individual level. Does this enhanced agency translate into greater power in intimate relationships? Does she feel more entitled to make decisions over her own body once she has the power to meet her own basic needs? And does agency over her body inevitably translate to fewer HIV risk behaviors? This three-paper dissertation examines data collected with AGYW living in two urban areas, characterized by HIV prevalence. These areas are the sites of a multi-sectoral DREAMS program, a public-private partnership to reduce HIV incidence in ten countries within sub-Saharan Africa. Paper 1 examined the construct of financial agency through the development of a scale, finding variations in experience of financial autonomy between age cohorts with younger adolescents’ autonomy correlated to a higher likelihood of being sexually active and exposure to partner violence. Financial agency was not strongly associated with HIV risk reduction variables at any age. Paper 2 sought to understand the correlational relationships between personal financial agency, sexual relationship power (SRP), and reduced sexual HIV risk for AGYW in Zambia in order to determine if SRP may be a potential mediator between financial agency and sexual HIV risk reduction. Paper 2 found that SRP within sexual relationships did convert to HIV protective behaviors and that while financial agency did correlate with SRP for the oldest cohort, financial agency on its own was not sufficient to reduce sexual HIV risk. Paper 3 explored how AGYW in Zambia understand financial agency as a construct and how it does or does not affect their power in intimate relationships. This study demonstrated that financial independence is an aspiration of AGYW, however, that autonomy is tied up with negative community-based perceptions about what it means to be a woman earning and with control over her own income. Financial independence has promise as a mechanism for sexual HIV risk reduction, specifically the reduction of transactional sex; however, the realities of male sexual privilege may remain an obstacle to risk reduction irrespective of financial decision-making power. Women’s sexual agency was viewed as far greater in non-martial relationships as opposed to within marriage, where religious mores on headship created a power imbalance. Overall, findings from this dissertation contribute empirically to the literature on economic strengthening and HIV prevention for AGYW, providing new insights on the influence of individual financial agency. Findings suggest a nuanced relationship between financial agency and sexual HIV risk reduction, one that is not necessarily linear or positively correlated. HIV prevention programs that wish to incorporate economic strengthening into their multi-sectoral models should consider the influence of gender norms and sexual relationship power which could continue to keep AGYW in positions of vulnerability regardless of their financial autonomy.

The consequences of the African AIDS epidemic are growing--not just in size--but in complexity. These consequences are no longer just biological; increasingly, they are also social, cultural, economic, and psychological. In this dissertation, I consider one overlooked consequence of the epidemic by asking how HIV infection affects the desire to have children in a context where reproduction is so highly valued. Taking advantage of a unique situation in rural Malawi, where no one knew their HIV status prior to testing being introduced as part of an ongoing longitudinal survey, I use a quasiexperimental design and in‐depth interviews to examine the evidence for an intentional relationship between HIV/AIDS and fertility. Rural Malawians adjust their childbearing desires in response to information about their HIV status. The relationship--both in magnitude and in motivation--is highly gendered. HIV positive women fear that a pregnancy will worsen their disease. Despite this widely shared belief, there remains a lot of ambivalence: women who are positive, or who fear they are positive, want to live normal lives. For some, that means avoiding childbearing as a strategy to delay the symptoms of HIV. For others, it means having children as they would have had despite what they think it might mean for their health. Male fertility preferences are more volatile to information about HIV status. Men see childbearing as futile if they are HIV positive because they anticipate their own death and the death of their future offspring. However, men may be less likely to translate their preferences into action because--after learning they are infected--they are less motivated to stop having children than they are unmotivated to have children. This dissertation shows that rural Malawians adapt their childbearing preferences to information about their HIV status. There are strategies in these adaptations, as well as hope for a future where the conditions of childbearing in an AIDS epidemic might have changed. I conclude by discussing what the findings mean for fertility, fertility theory, and policy. / text

The following study is a phenomenological inquiry into five white, middle classwomen's experiences living with HIV and AIDS in British Columbia. The purpose, rather than describing AIDS as a medical phenomenon, is to document how being diagnosed HIV positive has affected the women's lives, health, relationships and livelihoods. A context for the women's stories is provided through a critical review of the biomedical model, as well as biomedical and community organizing perspectives on women and AIDS. Mostly verbatim accounts drawn from taped interviews conducted with the five women describes their lives with HIV and AIDS. Experiences surrounding their diagnosis, sources of information about their illness, strategies for coping, management of health, and management of personal and social identities are the themes explored. The women's participation, the role of the researcher, and the work produced are considered parts of an interactive process, demonstrating shared authority between the researcher and participants in the ethnographic process. Documentation of the women's experiences leads to a discussion of the ways in which they successfully manage and control their own health care and well being within the context of larger social forces of sexism, medical bias and stigma. The women are given the last word in the study. In conclusion, a review oftheir situations three years after their initial interviews contributes a significant emotional and descriptive time-depth to the study.

South Africa has a severe HIV/AIDS epidemic and the majority of the people infected are in the economically active age group. The education sector is particularly affected by HIV/AIDS because both the demand for and supply of educators are affected. Women make up a great majority of the teaching fraternity and their vulnerability to HIV and AIDS will be discussed. The focus of this study is on educators living with HIV and AIDS in the province of Kwa-Zulu Natal in South Africa. Educators are perceived as ‘icons of morality’ hence their difficulty in disclosing their HIV status. This study offers an insight into the lives of the educators in this study, and explores how educators managed their lives and the disease on a daily basis at home and in particular at school. The participants for this study were obtained through convenience sampling given the sensitive nature of the study. Through the use of a life-story approach, all five participants, (current and previous) are educators and were interviewed over a period of time. Focus group discussions were also done in selected areas with school management teams (SMTs), to ascertain attitudes towards and support for educators living with HIV. During these many interviews with my research participants, I listened to their life experiences, felt their grief and trauma, and really understood their feelings of hopelessness. During these interactions, I was able to gather first hand information on the plight of educators living with HIV and AIDS, their voices spoke of their psychological emotions, and this confirmed that the general public and more especially the school fraternity needed to be educated about the disease, in order to dispel the myths and stigma surrounding HIV and AIDS. The grounded theory approach was used to analyse the data collected. Apart from the analysis of data, the life story interview of each participant is included in this thesis. The lack of support and the secrecy that has become imperative on issues around HIV and AIDS has brought about un-savory labels like ‘us’ and ‘them.’ The data also emphasized the importance of schools and the school community to work together in order to manage HIV and AIDS. The adherence and effectiveness of school policies concerning HIV and AIDS in terms of the constitution are also discussed. In conclusion the voices in this thesis have highlighted the importance of HIV/AIDS empowerment and support, individual empowerment equals the antithesis of vulnerability. HIV/AIDS can be looked upon as a serious chronic ailment which can be handled with medication and a safe healthy lifestyle, with the express hope of keeping our educators in the classroom in a good state of health for longer. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

This qualitative research sought to examine the actual impact of HIV/AIDS on the human security of households in Bulawayo. The two research questions in this study where, how does HIV/AIDS affect the seven areas of human security? and has the economic crisis in Zimbabwe increased the impact of HIV/AIDS on households? This study utilized both primary and secondary data in which the later was consulted in constructing the literature review and to address specific aims one and two. These specific aims were: to assess the human security conditions in Zimbabwe and to examine the potential impact of HIV/AIDS on human security. Data was gathered in the form of two focus group discussions held in Bulawayo with faith-based support groups and also in the form of in-depth interviews with households which were not connected to the faith based support groups in Bulawayo. A total of 29 participants took part in this research representing 29 households. 19 of these households were represented in the two focus group discussions while the remainder of, 10 households were represented in the in-depth interviews. Human security is presented as different from traditional security in that the later seeks to protect nations from external threats while the former seeks to protect people from both external and internal threats such as threats of chronic diseases, hunger, unemployment, crimes, social conflicts, political repressions, environmental hazards and HIV/AIDS. These threats can be natural, manmade or both. Human security was assessed in light of the seven areas of threats to human security which are economic, food, health, environment, personal, community, and political security. Four major themes emanated from this research these being: the financial, health, nutritional and societal impacts of HIV/AIDS on the households in Bulawayo, chief of these being the financial impact in form of increased expenditure, reduced income and diverted investments of households. This study came up with recommendations that aim at reducing and ultimately eradicating the impact of HIV/AIDS on households these being economic empowerment, food aid, ARVs provisions, training in survival skills and orphan care. The major challenge was given to individuals, families, society and NGOs especially the FBOs to take the lead in implementing these recommendations as the government is not yet in a position to do so. / Thesis (M.Com.)-University of KwaZulu-Natal, Westville, 2009.

Mode of access: World Wide Web. / Thesis (Ph. D.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references (leaves 207-219). / Electronic reproduction. / Also available by subscription via World Wide Web / xiii, 219 leaves, bound 29 cm