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The HIV/AIDS pandemic is currently one of the most pressing world-wide concerns regarding the health and well-being of our global population. Due to the lack of a cure, recent efforts have focused on prevention measures for the disease. HIV prevention, particularly with the youth population, has spawned creative programs, such as the use of sport as an educational tool to equip youth with the skills to avoid contracting HIV. Due to the potent effect sport-for-development efforts exhibit on both individual and cultural level change, it can be assumed that HIV prevention sport-for-development programs are worth maintaining. Within the use of sport-for-development programs comes the problem under investigation: the need to establish a uniform method from which to evaluate HIV sport-for-development program effectiveness- specifically in regards to cultural relevance, level of community ownership, and sustainability through partnership resources. In order to address this problem, this analysis used qualitative content analysis to examine the promotional documents of three best practice football-for-development organizations- Grassroot Soccer, Mathare Youth Sports Association, and WhizzKids United. The purpose was to determine whether the Community Organization Health Model (COHM) was reflected in the values promoted through each organization’s electronic promotional material. The content analysis showed a strong qualitative presence of all six of the COHM tenets in the promotional documents, as well as a meaningful theme of expanding partnerships to enhance sustainability. These findings indicate that the tenets of the COHM are valued by best practice football-for-development organizations, which presents the opportunity for this model to be used in creating an evaluation procedure able to bridge cultural differences in programs. Keywords: HIV prevention, football, sport-for-development, evaluation

Thesis (DPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Disabled adolescents are vulnerable to HIV infection particularly in countries like South Africa which has one of the largest HIV epidemics in the world. Like able-bodied adolescents, adolescents with disabilities are at a critical stage of their psychosocial and sexual development. They may be at risk of sexual abuse as perpetrators may believe that they are incapable of defending themselves or reporting the crime to the authorities. Deaf or hard of hearing adolescents are vulnerable to HIV/AIDS due to similar risk factors to other disabled adolescents. They also face difficulties in communicating with hearing people and receiving information in sign language, and they share characteristics with minority ethnic groups, which make them hard to reach for HIV prevention campaigns. There is a paucity of research in South Africa investigating the role of schools for Deaf and hard of hearing adolescents in delivering appropriate HIV and sexuality education to their learners. This thesis is an exploratory study and investigates HIV prevention issues for Deaf or hard of hearing adolescents in South Africa. More specifically, I aim to determine the ways in which participants believe schools, health systems and other organizations contribute or fail to contribute to the HIV/AIDS prevention needs of Deaf and hard of hearing adolescents. The study includes qualitative interviews with employees of Deaf organizations, educators of Deaf and hard of hearing adolescents, parents of Deaf and hard of hearing adolescents and Deaf and hard of hearing adolescents themselves in relation to sexuality and HIV related issues. Results indicate that Deaf organizations have an interest in the HIV prevention needs of the Deaf community and in Deaf schools. However they have experienced obstacles in delivering HIV education to learners. These obstacles include communication barriers as well as the fact that religious environments in some of the schools may not always be experienced as conducive to HIV education. Although all educators of Deaf and hard of hearing adolescents interviewed in the previous phase of the study were aware that their learners are at risk of HIV/AIDS, some educators of Deaf and hard of hearing adolescents were constrained by the same issues of morality and religious conviction discussed in the first phase. Some participants had made efforts to produce appropriate HIV and sexuality materials for Deaf learners. Parents of Deaf and hard of hearing adolescents were affected by communication barriers with their children but seemed unaware of the religious ethos of many of the schools their children attended. The Deaf and hard of hearing adolescents knew they could be at risk of HIV/AIDS. Some displayed poor knowledge of HIV transmission. There are a number of issues to be addressed if schools for Deaf and hard of hearing learners are to provide adequate HIV/AIDS prevention information to their learners. / AFRIKAANSE OPSOMMING: Gestremde adolessente is kwesbaar vir MIV-infeksie veral in lande soos Suid-Afrika wat een van die grootste MIV-epidemies ter wêreld het. Soos nie-gestremde adolessente is gestremde adolessente in 'n kritieke stadium van hul psigososiale en seksuele ontwikkeling. Oortreders van seksuele misbruik mag gestermde adolessente beskou as sagte teikens aangesien daar die persepsie is dat hulle minder in staat is om hulself te verdedig of minder geneig is om `n misdaad by die owerhede te rapporteer. Dowe of hardhorende adolessente is kwesbaar vir MIV / VIGS vir redes war soortgelyk is aan die van ander gestremde adolessente. Dowe of hardhorende adolessente vind dit problematies om met horende (nie-gestremde) mense te komminikeer, inligting in gebaretaal te ontvang, en deel eienskappe met etniese minderheidsgroepe wat dit moeilik maak om hulle deur middel van MIV voorkomingsveldtogte te bereik. Daar is 'n gebrek aan navorsing in Suid-Afrika oor die rol wat skole vir dowe en hardhorende adolessente speel in die lewering van geskikte MIV en seksualiteitsopvoeding. Hierdie proefskrif verken en ondersoek kwessies met betrekking tot MIV-voorkoming onder dowe en hardhorende adolessente in Suid-Afrika. Meer spesifiek was die doel van hierdie studie om vas te stel wat deelnemers se persepsies is oor die bydrae of gebrek aan bydrae van skole, gesondheids-en ander organisasies tot die behoeftes van dowe en hardhorende adolessente wanneer dit kom by die voorkoming van MIV/ VIGS. Gedurende die studie is kwalitatiewe onderhoude met die volgende deelnemers gevoer: die werknemers van organisasies vir dowes; die onderwysers van dowes, ouers van dowe en hardhorende adolessente. Die onderhoude het hoofsaaklik gehandel oor seksualiteit en MIV-verwante kwessies onder gehoor gestremde adolessente. Die studie het bevind dat organisasies vir dowes `n belangstelling toon in die behoeftes van dowe gemeenskappe en skole vir dowes wanneer dit kom by MIV-voorkomming. Hulle het dit egter met tye problematies gevind om leerders op te voed oor MIV weens verskeie hindernisse. Hierdie hindernisse sluit in kommunikasie-hindernisse sowel as die godsdienstige etos wat wat in sommige skole teenwoordig is en wat nie altyd bevorderlik is tot MIV-onderrig nie. Alhoewel al die opvoeders van dowe en hardhorende adolessente gedurende die vorige fase van die studie aangedui het dat hul wel bewus is van leerders se risiko vir MIV/VIGS word sommige van hulle beperk deur bogenoemde kwessies van moraliteit en godsdienstige oortuiging. Sommige deelnemers het daarop gedui dat hul pogings aangewend het om geskikte materiaal te produseer wat spreek tot MIV en seksualiteit onder dowe leerders. Ouers van dowe en hardhorende adolessente was bewus van en word beïnvloed deur kommunikasie-hindernisse, maar was nie bewus van die godsdienstige etos van die skole wat hul kinders bywoon nie. Dowe en hardhorende adolessente was bewus daarvan dat hulle die risiko loop om MIV / vigs op te doen, maar dit blyk dat sommige min kennis dra oor MIV-oordrag. Daar is 'n aantal kwessies wat aangespreek moet word voordat skole vir dowes en hardhorendes instaat sal wees om geskikte MIV/VIGS voorkomingsprogramme aanbied te bied wat voldoen aan die behoeftes van leerders.

Thesis (PhD (Business Management))--Stellenbosch University, 2008. / Research to guide marketing practitioners in social issue-related communication remains underexplored. The increases in various social problems have caused practitioners to return to fear appeals as motivation to influence individuals to think and behave in a certain way. The HIV/AIDS pandemic is a major concern worldwide, as well as in South Africa, and some marketing communication campaigns do not seem to be producing the expected results. During 2007, an alarming 33.2 million people worldwide were infected with HIV. The African continent, and specifically sub-Saharan Africa, is still hardest hit by this pandemic. The high level of new HIV infections occurring daily in South Africa reflects the difficulties faced by HIV/AIDS education and prevention campaigns. Approximately 5.41 million people were living with HIV in 2006. This equates to about 11 percent of the total population and approximately 1 000 AIDS deaths occur every day. The social climate in South Africa has not been conducive to safe sexual messages, and there is a continuing need to encourage safe sexual behaviour, and awareness of the detrimental effects of HIV/AIDS. An estimated 60 percent of all new HIV/AIDS infections in South Africa occur in people between the ages of 15 and 25 years, with young women being more at risk of contracting HIV/AIDS than young men. This trend implies that the impact of the HIV/AIDS epidemic will be felt extensively in the next decade. Additionally, HIV/AIDS prevention programmes for the youth are not having the intended effect to promote partner reduction, consistent condom use and prompt treatment for sexually transmitted infections. These factors confirm that HIV/AIDS marketing communication programmes are of central importance in slowing down the spread of the disease among South African adolescents. Marketing communication is evolving to an era of tailored messages targeted at individuals and more sophisticated segmentation of target audiences. South African young adults reside in a country with diverse racial groups and cultural backgrounds. The more knowledge about their feelings and fears about HIV/AIDS become available, the more effective marketing communication can be developed. Overall marketing communication campaigns must be tailored to the specific needs of adolescents and the promotion of safer sexual behaviour should be at the core of HIV/AIDS programmes, since they are embarking on their sexual lives and are therefore open to behavioural change interventions. This study investigated whether the use of fear increases the likelihood of adopting appropriate behaviour pertaining to HIV/AIDS. Fear, attitude towards the advertisements, severity, susceptibility and efficacy were examined to ascertain the influence of fear appeals. Findings provide encouraging evidence for the persuasive power of fear appeals. Fear appeals can be a strong motivator if accompanied by high efficacy messages, to improve knowledge and to influence attitudes about HIV/AIDS. Susceptibility to the disease among adolescents also influences behaviour, and the importance of individual factors, including racial characteristics and personality, was confirmed. The empirical results of the study reveal that together with message factors like message content and media usage, the goal of changing adolescents’ sexual behaviour in the midst of the HIV/AIDS pandemic can be achieved.

Alors que les politiques de santé sont passées au cours des dix dernières années d'un traitement de la procréation en contexte VIH comme une « exception » à un discours de « normalisation », la thèse vise à comprendre les conditions et les effets de cette évolution. L'enquête ethnographique a été conduite sur une période de dix ans auprès de personnes vivant avec le VIH sous thérapie antirétrovirale, de femmes vivant avec le VIH ayant eu une expérience de procréation, et de professionnels de santé intervenant en PTME dans deux structures de santé de la reproduction au Sénégal. Cette étude met en lumière un « système moral » de la prévention du VIH, contradictoire à certains égards, qui offre aux femmes peu de moyens socialement acceptables pour se protéger du risque VIH. La procréation peut être perçue comme une stratégie pour réaffirmer une identité féminine, tester la capacité d'un corps « normalisé » par les ARV à enfanter sans transmettre le VIH, raffermir les liens conjugaux en souffrance et réduire les risques de stigmatisation sociale. Ces logiques ne sont pas toujours comprises par des professionnels de santé « spécialistes du VIH » souvent débordés dans la prise en charge médicale et psychosociale des PvVIH, qui soutiennent peu ces processus. Les hommes vivant avec le VIH apparaissent isolés, fragiles, voire « oubliés » . Ce travail montre les multiples usages sociaux de la procréation : objet d'émulation, de résistance, de souffrance et de rivalité pour les femmes VIH et leurs conjoints. Parallèlement à la normalisation « décrétée » par les instances de santé publique, les femmes vivant avec le VIH se sont réapproprié la possibilité de procréer. / Since the last decade has seen a transition from treating childbearing in the context of HIV as an “exception” to a discourse of “normalization,” this dissertation aims to understand the conditions and effects of this change. This ethnographic survey was conducted over a period of ten years among people living with HIV receiving antiretroviral therapy, women living with HIV who experienced childbearing and healthcare professionals working in PMTCT in two reproductive health facilities in Senegal. This study sheds lights on a “moral system” for HIV prevention, contradictory in some respects, that provides women few socially acceptable means to protect themselves from the risk of HIV. Childbearing may be perceived as a strategy to reaffirm female identity, test the capacity of a body made “normal” by ARVs to give birth without transmitting HIV, strengthening strained marital bonds, and reducing the risk of social stigmatization. Men living with HIV appear isolated, fragile, unsupported, and even “forgotten” relative to childbearing while they themselves are suffering or are affected by the situations of their wives or families. Health professionals now integrate HIV counseling and testing in their practices but continue to project attitudes of “exception” about treating PLHIV and pregnant HIV-Positive women. This study shows the various social uses of childbearing : a subject leading to emulation, resistance, suffering, and rivalry for women living with HIV and their spouses. Alongside the normalization “decreed” by public health officials, women living with HIV have reclaimed the possibility to procreate.

Background Heroin dependence is associated with increased risk of the transmission of blood-borne viral (BBV) infections such as HIV, as a result of unsafe injecting practices. Opioid Substitution Treatment (OST) Programmes including Methadone Maintenance Treatment (MMT) programmes are a recommended way of addressing heroin dependence with the dual aims of reducing both heroin use and associated harms. However, OST programmes, particularly in prison settings, are often unavailable, in spite of large numbers of prisoners with heroin dependence and the high risk of HIV transmission in the prison setting. Little is currently known about the delivery of OST programmes within prison settings. A systematic literature review conducted within this study revealed that there are only a small number of studies from middle and lower-income countries and the perspectives of the range of stakeholders are often underrepresented. Aim and setting of this study This aim of this study was to understand the role of Methadone Maintenance Treatment (MMT) programmes within the context of HIV prevention programmes and to identify barriers and facilitators that influence the implementation, routine delivery and sustainability of methadone programmes in Indonesian prisons. Study design Three prison settings were selected as part of a qualitative case study. These comprised: a narcotics prison that provided methadone, a general prison that provided methadone, and a general prison, where there was no methadone programme. This allowed the exploration of multiple perspectives of prisoners and the diverse range of staff involved in the implementation of programmes. Interview and observational data were supplemented by data from medical case notes. Qualitative data underwent thematic analysis, with the help of framework analysis for data management. Principal findings This study found that there were many misconceptions about methadone programmes. HIV infection was not recognised as a problem and prison staff, healthcare staff and prisoners alike lacked understanding of the roles of methadone programmes. Prisoners participating in programmes were often stigmatised, while many prisoners believed methadone withdrawal was dangerous and could lead to death. These factors all contributed to low level participation, observed in both prisons with methadone programmes. Lack of confidentiality and associated stigmatisation as well as inappropriate assessment criteria also contributed to this, as did a lack of support systems. A reduction in international funding and a shift in national drug policy priorities away from the provision of methadone to drug-free Therapeutic Community (TC) programmes, together with a failure to embed methadone programmes within the daily prison routine currently pose challenges to effective implementation, delivery and programme sustainability. Conclusion Educating policy makers and practitioners could improve understanding of the roles of methadone programmes and increase support for programme delivery within prisons. It is therefore recommended that Indonesian government and prison policy focuses on ensuring effective delivery and sustainability of methadone programmes for people with heroin dependence in the prison setting.

Efforts to improve inclusion in research have included mandating the recruitment of ethnic minorities and women into NIH funded studies. However, little research has been completed on who attends such interventions. This is particularly worrisome in populations for which attendance to interventions can have dire consequences. HIV is a public health concern for pregnant women in substance using communities, as pregnant women are much less likely to use condoms during intercourse to prevent HIV. Group modular HIV prevention interventions have long been the standard for HIV prevention. However, little attention in research on HIV prevention interventions RCTs has been focused on attendance to these interventions. This study examined predictors of intervention and control group attendance in a randomized controlled trial comparing a 5-session Safer Sex Skill Building (SSB) intervention to a 1-session HIV education control group in a sample of pregnant women at risk for prenatal substance use. This study identified psychosocial and mental health variables associated with both 1 session control group and 5-session SSB intervention attendance as well as endeavored to identify the number of sessions necessary to attend to achieve an adequate dose in treatment. Findings include younger age and marital status as being predictive of participation in the one session HE control group and having a trade, skill, or profession as being predictive of participation in the five session SSB intervention group. Further research is needed to understand what factors may impact five-session SSB group attendance.

Despite increases in HIV awareness, prevention and treatment, little is known about the contributing factors to medication adherence among adherent Black women with HIV. Understanding the protective factors that improve medication adherence and CD4 cell count for Black HIV+ women is essential and necessary to improve the treatment outcomes for this understudied population. The purpose of this study was to examine the relationship between spirituality, social support, trust in physician, and medication adherence among HIV+ Black women. While this study was not designed to test the influence on medication adherence, it was hypothesized that increased levels of spirituality, social support and trust in physician would positively relate to adherence. In this study, medication adherence was measured by 1) self-report on The AIDS Clinical Trial Group (ACTG) Adherence Questionnaire and 2) CD4 T-cell count. Baseline data was collected from 82 Black women in the Miami-Dade community and participants were administered the Spiritual Well-Being Scale (SWB), the Social Support Questionnaire (SSQ), and the Trust in Physician Scale (TPS). The results of this study indicate that medication adherence is not related to spiritual well-being, social support, or trust in physician. However, a significant positive correlation between spiritual well-being and trust in physician was found. Findings suggest that additional research is needed to explore the multifarious nature of the factors that enhance medication adherence for this population. Implications for research and practice are discussed with respect to the inclusion of spirituality, social support and trust in physician components within prevention and intervention programs designed to increase adherent behaviors among Black HIV+ women.

<p>This study assessed the knowledge, attitudes and practices about MC as an HIV prevention intervention among adult males presenting for HIV Voluntary Counselling and Testing (VCT) services at Onandjokwe District Hospital in northern Namibia. A high level of knowledge of MC, particularly its potential to reduce the risk of HIV infection, STIs and enhance penile hygiene exists among VCT attendees in Onandjokwe District Hospital. MC will most likely to be accepted in this study area, especially when it is implemented to reduce the risk of HIV infection. The study recommends a comprehensive education and information program targeting males and their partners and a training for traditional and medical circumcisers to ensure a high quality of MC services.</p>

<p>This study assessed the knowledge, attitudes and practices about MC as an HIV prevention intervention among adult males presenting for HIV Voluntary Counselling and Testing (VCT) services at Onandjokwe District Hospital in northern Namibia. A high level of knowledge of MC, particularly its potential to reduce the risk of HIV infection, STIs and enhance penile hygiene exists among VCT attendees in Onandjokwe District Hospital. MC will most likely to be accepted in this study area, especially when it is implemented to reduce the risk of HIV infection. The study recommends a comprehensive education and information program targeting males and their partners and a training for traditional and medical circumcisers to ensure a high quality of MC services.</p>