Adolescent girls and young women (AGYW; aged 15-24 years) in sub-Saharan Africa, the epicenter of the global HIV epidemic, have carried the primary burden of new HIV infections in this area for almost 40 years. Research has prioritized characterizing the individual predictors of HIV infection among AGYW by creating risk assessment tools that identify high-risk sub-populations for targeted HIV prevention efforts. Despite substantial efforts, there remains a disproportionate disease burden among this vulnerable population, suggesting a need to identify and assess new intervention targets beyond the individual. The objective of this dissertation is to expand our understanding of the complex relationship between the multi-level drivers of HIV infection among AGYW using advanced data science and epidemiologic methods. This dissertation is divided into six chapters, the first of which is an introduction to the dissertation. The second chapter is a scoping review of the extant HIV-related literature that has leveraged data integration methods to combine heterogeneous, multi-level data sources. Chapters 3, 4, and 5 are empirical aims. Chapter 3 describes the development of an integrated dataset that combines information from the Population-based HIV Impact Assessment (PHIA) project, the Population and Housing Census, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) Policy Indicators platform. The resulting dataset captures data at the individual, interpersonal, community, and societal levels across five sub-Saharan African countries: Cameroon, Eswatini, Malawi, Rwanda, and Uganda. Chapter 4 uses the dataset described in Chapter 3 and presents the application of causal discovery algorithms to characterize and graphically depict the pathways among individual, interpersonal, community, and societal risk factors of HIV infection among AGYW to identify the potential underlying causal mechanisms supported by the data. Chapter 5 uses the results from Chapter 4 to assess the impact of increasing the proportion of AGYW who completed secondary education on HIV prevalence using parametric g-formula. This dissertation ends with Chapter 6, which summarizes the dissertation's results and situates the findings within the broader HIV prevention literature. A brief description of the dissertation results follows. The scoping review describes the four types of data integration methods: record linkage, multiple frame methods, imputation-based methods, and modeling techniques. I identified five thematic uses of data integration in the literature that supported the included articles’ study objectives. Those themes included using data integration to 1) describe HIVrelated etiology and prognosis; 2) develop or operationalize an HIV-related databases; 3) characterize sociodemographic, behavioral, clinical, and care risk factors; 4) estimate the population size of key or hard-to-reach populations; and 5) estimate HIV prevalence for key populations or varying geographical units. Then, using one of the described integration techniques, multiple frame methods, I present the process of developing a multi-level and -country integrated dataset that combined data from the PHIA Project, the Population and Housing Census, and the UNAIDS Policy Indicators platform. Additionally, I described the population of AGYW included in this study, as well as the different interpersonal, community, and societal environments they reside in, across Cameroon, Eswatini, Malawi, Rwanda, and Uganda. I then applied the PC causal discovery algorithm to that dataset to elucidate the interconnectedness between individual, interpersonal, community, and societal level risk factors on HIV status among AGYW across each of the countries and overall. Community-level HIV prevalence and interpersonal sexual relationship factors consistently had direct paths to AGYW's HIV status for almost all country analyses. Additionally, there were multiple individual-level factors that had direct paths to AGYW's HIV status, and most of those variables were related to sexual behavior (e.g., number of sexual partners in the last 12 months, age of sexual debut). Additionally, there were multiple indirect paths to HIV status identified across all levels of organization. My last empirical study used the findings from Malawi and applied the parametric g-formula, to assess the impact of three hypothetical scenarios that model how increasing the proportion of AGYW who completed secondary education impacts HIV prevalence. I found that increasing the proportion of AGYW who completed secondary education from about 31% to 100% is associated with about a 26% decreased odds of HIV. The findings highlight the importance of improving educational attainment among AGYW, which will impact their life trajectory, economic prosperity, and overall autonomy. The findings from this dissertation improve the knowledge base informing prevention interventions, thereby advancing the development of interventions that go beyond the individual to reduce the burden of HIV among AGYW. Additionally, the methods used in this dissertation provide an illustrative example of a novel and intersectional approach to assessing the multi-level determinants of health that may expand the current epidemiologic research program.

Although the negative impact of HIV stigma is well documented, a gap exists in exploration of constructs that mediate the relationship between HIV stigma and psychological QOL (PQOL). Self-esteem is often conceptualized as a protective factor. We used PLS-SEM to explore the relationships between HIV stigma, PQOL and self-esteem, where PQOL and self-esteem are latent constructs represented by direct observations. Our hypotheses were supported - stigma is negatively related to self-esteem (as measured by self-blame, forgiveness of self, acceptance without judgment and self-esteem), self-esteem is positively related to PQOL (as measured by depression, mental health, QOL and perceived stress) and when the two aforementioned relationships are controlled for, a previously significant relation between stigma and PQOL changes its value significantly. These findings have implications for interventions designed to mitigate the negative psychosocial effects of stigma in PLH.

Uganda has experienced 1.6 million deaths to HIV/AIDS related illness. Introduction of free-ART in rural hospitals that bear the burden od AIDS reduces adults morbidity and mortality. The study design was a quantitative, retrospective and descriptive design through data mining of medical records. In the six years, hospital admissions decreased by 16.7% and the median age at death increased by seven years. Hospital admissions decreased from three to seven deaths per 100 admissions per month. Male and female mortality was 1:1.6 and females in the 15-34 age group had a 37% higher likeliness of dying in hospital compared to males. Deaths from sub-countries with an ART site reduced by 4% to 8.6%. The data revealed that despite ART coverage of 60%, mortality rates showed a rising trend. Free access to ART's over three years did not make any observable changes to overall mortality. Therefore, ART access contributed to a decline in overall hospital admissions, an increase in median age at time of death and a reduction in deaths from sub-counties with an ART site. There was no reduction in overall hospital mortality rate. / M.A. (Public Health) / Health Studies

The purpose of the study was to determine the effect of antenatal health education on postnatal care (PNC) among Human Immunodeficiency Virus (HIV) positive women in Francistown city, Botswana. This study followed a quantitative research paradigm. Data was collected with the aid of a questionnaire from eligible women who consented in writing to participate in the study. Forty-five percent (45%) (n=45) HIV positive women came with babies for 6 weeks PNC and 55% (n=55) brought 8 weeks old babies either for weighing or for the two months immunisation from 28 April to 10 June 2014. The responses regarding the source of health education received were as follows: 40% lay counselors, 31% midwives, 15% doctors, 5% nurses without midwifery, 5% cadre unknown, 2% both lay counselors and midwives, 1% by a health education assistant and 1% was not health educated at all. Conclusion: The study revealed that HIV positive pregnant women received health education from different cadres of health and mostly by lay counselors. Literature indicates that lay counselors may give health information but at a very superficial level. / Health Studies / M.A. (Health Studies)

The purpose of the study was to determine the effect of antenatal health education on postnatal care (PNC) among Human Immunodeficiency Virus (HIV) positive women in Francistown city, Botswana. This study followed a quantitative research paradigm. Data was collected with the aid of a questionnaire from eligible women who consented in writing to participate in the study. Forty-five percent (45%) (n=45) HIV positive women came with babies for 6 weeks PNC and 55% (n=55) brought 8 weeks old babies either for weighing or for the two months immunisation from 28 April to 10 June 2014. The responses regarding the source of health education received were as follows: 40% lay counselors, 31% midwives, 15% doctors, 5% nurses without midwifery, 5% cadre unknown, 2% both lay counselors and midwives, 1% by a health education assistant and 1% was not health educated at all. Conclusion: The study revealed that HIV positive pregnant women received health education from different cadres of health and mostly by lay counselors. Literature indicates that lay counselors may give health information but at a very superficial level. / Health Studies / M. A. (Health Studies)

The study examined the correlations between gender, ethnicity, socio-economic status, self-reported mode of exposure to HIV, the types of coping strategies utilized, social support, perceived stress, preventive resources, depression, and disease progression among 79 HIV+ patients, eleven of which were Spanish speaking, seen at a federally and city funded HIV/AIDS clinic. The first aim was to demonstrate that there is a linear relationship between gender, ethnicity, the manner in which one copes with the HIV infection (utilizing problem-focused strategies versus emotion-focused strategies), and the progression of HIV as measured by each participant’s CD4 count. The second aim of the study was to show that the higher the frequency of seeking medical support at the HIV/AIDS clinic, the lower the rate of HIV progression as measured by the CD4 count. The third aim of the study was to demonstrate that there is a significant difference in the types of coping strategies utilized by differing ethnicities to combat the stress related to HIV. Findings indicated that among the 78 participants who completed the surveys, housing status (homeless versus having a home), intravenous drug use (IVDU), Escape-Avoidance behavior, Positive Reappraisal, the perception of having familial support, and the perception of mastery were all significantly correlated with the difference in the CD4 count initially obtained at the time of the interview and the CD4 count that was obtained again 3 through 15 months later. Of the 17 of the total 78 participants who did not return to the clinic consistently, housing status was found to be significantly correlated with the difference in the CD4 count initially obtained at the time of the interview and the CD4 count that was obtained again 3 through 8 months later. Of the 61 of the 78 participants who did return to the clinic consistently, IVDU, the perception of family as supportive, the perception of having sources of comfort, the perception of the ability to scan the environment as a resource, the perception that one recognizes the opportunity to prevent stress, perceived control, the perception that one has control, the perception that one has efficacy, the perception that one can master tasks, and the perception that one can maintain self-direction were all significantly correlated with the difference in the CD4 count initially obtained at the time of the interview and the CD4 count that was obtained again 9 through 15 months later. Therefore, there was a significant difference between those patients who returned for consistent medical treatment at the clinic versus those who attended the clinic infrequently. The issues pertaining to the adherence of medical treatment as well as attempts to buffer the positive coping strategies that facilitate adherence are of critical importance to current prevention measures. In addition, it was found that there were significant differences in the manner in which differing ethnicities coped with the stressors related to HIV. The study revealed that among the 25 black men and women, coping by accepting responsibility, and coping by positively reappraising situations were predictive of ethnicity. Among the 21 Hispanic men and women and the 31 white men and women who participated in the study, none of the coping strategies were predictive of ethnicity. The identification of the differential manners in which each ethnicity copes with the stressors related to HIV has the potential to bolster both HIV treatment and prevention efforts. Further research needs to be conducted in order to further explore these important issues. / text

Thesis (MPhil (Industrial Psychology))--University of Stellenbosch, 2006. / This research paper investigates the need for emotional and psychosocial support for people infected and affected by HIV and AIDS in the workplace. Most employees infected and affected by HIV and AIDS, as well as their families, often need assistance to cope with stigma, rejection, and discrimination, as well as having to adjust to the diagnosis, to confront the fear of losing independence, and to prepare themselves for the changes that might happen to their lives. Hence, through counseling and support, they can have more knowledge about HIV and AIDS and reduced fears and misconceptions about living with HIV and AIDS. Some research organizations, such as the Perinatal HIV Research Unit, do provide emotional and psychosocial support, and advice for people infected and affected by HIV and AIDS. An attitude survey was conducted with about 400 employees at the Unilever Company in Boksburg, Johannesburg, in September and October 2005 to determine whether emotional and psychosocial support could play a role in motivating people infected and affected by HIV and AIDS to live positively with the virus, in eliminating related stigma and fears. Employees from this organization were chosen as the population for this survey as a prevalence study and VCT was carried out with them in August and September 2005, so they knew and trusted the councilors who were giving results to them and they had established a relationship with them. I booked appointments for follow-up counseling sessions of 45 minutes after VCT (Voluntary Counseling and Testing) and then told them about the support group at their workplace. The findings indicate that there is indeed a need for emotional and psychosocial support for people infected and affected by HIV and AIDS in the workplace. Among other findings, respondents, especially those infected, reported that they had learned that being HIV positive is not the end of the world but the beginning as long as you look after yourself you can live a normal and productive life for many years, as long as you take extra care of yourself. Most of the affected respondents reported that they had never done an HIV test before due to their own fear of the prognosis. Having acquired more facts about HIV and AIDS, those that had not been tested stated that they now planned to do so. Both groups – those who tested negative and those who tested positive – reported that they also learned about the importance of disclosing your one’s status as a means of getting support.

Uganda has experienced 1.6 million deaths to HIV/AIDS related illness. Introduction of free-ART in rural hospitals that bear the burden od AIDS reduces adults morbidity and mortality. The study design was a quantitative, retrospective and descriptive design through data mining of medical records. In the six years, hospital admissions decreased by 16.7% and the median age at death increased by seven years. Hospital admissions decreased from three to seven deaths per 100 admissions per month. Male and female mortality was 1:1.6 and females in the 15-34 age group had a 37% higher likeliness of dying in hospital compared to males. Deaths from sub-countries with an ART site reduced by 4% to 8.6%. The data revealed that despite ART coverage of 60%, mortality rates showed a rising trend. Free access to ART's over three years did not make any observable changes to overall mortality. Therefore, ART access contributed to a decline in overall hospital admissions, an increase in median age at time of death and a reduction in deaths from sub-counties with an ART site. There was no reduction in overall hospital mortality rate. / M.A. (Public Health) / Health Studies

Text in English / This qualitative descriptive phenomenological study explored the experiences of HIV positive women utilising PMTCT services at a central hospital in Zimbabwe. Data was collected using in-depth interviews of fifteen participants. The interviews were audio recorded and transcribed verbatim. Using the Interpretive Phenomenological Analysis framework for data analysis, two super-ordinate themes emerged, namely resources for provision of PMTCT services and approaches and nature of PMTCT care. The study revealed challenges experienced by HIV positive women emanating from material, financial and human resource related constraints in the PMTCT setting. The resource challenges negatively affected access and utilisation of PMTCT services. A practice model, whose purpose is to enhance the quality and utilisation of PMTCT services, was developed and described. The model was evaluated using Chin and Krammer (2011) criteria plus a modified form of the Delphi technique. These findings have implications for effective PMTCT service provision. The key lessons learnt for programmatic improvement were that in order to provide quality and accessible PMTCT services the health care system will need to be well resourced. There is need to strengthen the health care system in line with HIV related programmatic changes. / Health Studies / D. L.itt. et Phil. (Health Studies)

AIDS-related bereavement counselling programmes / The aim of this study was to determine whether there is a need for specific bereavement counselling programmes for women affected by HIV/AIDS in Indonesia, where death is believed to be fated. Six AIDS-bereaved women were recruited. Data analysis was conducted based on the women's interview transcripts and journal entries. The women experienced at least three traumatic life events. The most challenging experience was learning that they have contracted a disease they knew to be mostly associated with prostitution. Given the short lapse of time between their husbands' deaths and learning about their seropositivity, biographical disruption appeared to have acted as an "analgesic", while concerns to protect their children seemed to have triggered biographical reinforcement. This phenomenon may have brought about a positive bereavement outcome. Specific counselling programmes for women affected by HIV/AIDS are needed, but emphasis should first be placed on improving their wellbeing and their perception of stigma. / Sociology / M.A. (Sociology (Social Behaviour Studies in HIV/AIDS))