Background Gert Sibande District has the highest HIV prevalence among women attending public antenatal health clinics. Multiple sexual partnerships (MSP) enhance heterosexual HIV transmission, which is the main form of transmission in South Africa. There is need, therefore, to identify important factors associated with MSP for the development of strategic intervention policies and programmes. Objectives To determine the prevalence and associated factors of multiple sexual partnerships (MSP) in men and women in Gert Sibande District (GSD) in 2010. Methods This is a secondary data analysis of data collected through a cross-sectional multi-stage study using cluster probability sampling technique in GSD in 2010. The study collected data on 750 adult men and women aged 16 to 55 years through an interviewer-administered standardised questionnaire. Simple descriptive statistics and chi square analysis were used to determine the prevalence and patterns of the MSP in the study population. Multiple logistic regression models were built to determine factors that were independently associated with MSP. Results The analysis included 592 sexually active respondents: 200 men and 392 women. A fifth of the respondents had had their first sexual encounter before the age of 16 years. Condom use was higher among men than women. Condom use was lowest with most recent partners (56.6%) than in second (74.6%) and third sexual partners (78.6%). Alcohol use was high, with more men (72.0%) than women (33.2%) having ever consumed alcohol (p<0.001) and among these alcohol users, more men (44.5%) than women (8.7%) were involved in risky drinking. The overall reported MSP prevalence was 22.0%, 95% CI: 19 - 25%. Men (44.0%, 95% CI: 37 - 51%) reported significantly higher levels of MSP than women (10.7%, 95% CI: 8 - 12%). Levels of MSP decreased with age and were highest among young adults, men (20 to 24 years) and women (15 to 19 years), those who were never married, and among men in the intermediate socio-economic group. There were significant associations between MSP and underlying socio-demographic factors (age, socio-economic status and marital status), and with intermediate sexual behavioural factors (age at first sex, condom use at last sex), sex under the influence of alcohol and transactional sex in the past 12 months). Among men, young age (AOR 3.0, 95% CI: 1.0 - 9.3) socio-economic status (AOR 3.1, 95% CI: 1.7 - 5.6) predicted having MSP. The strongest positive correlation of MSP among men occurred with the sexual behavioural factors, particularly age at first sex (AOR 9.7, 95% CI: 2.3 - 41.4) and having sex under the influence of alcohol (AOR 4.5, 95% CI: 1.9 - 9.7). There was a 4.5 times likelihood of MSP with transactional sex in the past 12 months. Among women, being never married (AOR 10.9, 95% CI: 1.3 – 90.3), condom use at last sex (AOR 2.4, 95% CI: 1.1 – 5.6), transactional sex in the past 12 months (AOR 12.0, 95% CI: 3.9 – 37.1) and having sex under the influence of alcohol (AOR 9.3, 95% CI: 4.4 – 19.6) were significantly associated with increased odds of MSP. Conclusion The findings of this study showed a high prevalence of MSP compared to the reported prevalence of MSP in the South African national and sub-national surveys (SABSSM, NCS and DHS). The prevalence was ever higher across some sub-groups of the population. The findings highlight the need for interventions that will address socio-economic factors influence MSP in GSD, especially among young adults and unmarried adults of GSD. Among this largely black population, the occurrence of several sexual risk factors, including early age at first sex, transactional sex, and high alcohol use, indicate the need for group-specific interventions. This study also provides a basis for future research to allow for the comparison of changes in MSP levels among adults of GSD and for prevention interventions targeting partner reduction.

A large body of jurisprudence has developed in Canada criminalizing the conduct of HIV positive persons who transmit or expose others to the HIV infection in an equivocal attempt to be seen to be doing something about individuals who are perceived to be driving the HIV epidemic. Convictions have been obtained for charges ranging from aggravated assault to, most recently, murder. The Cuerrier judgement, a landmark decision of the Supreme Court of Canada, left a number of issues unresolved. Given the ambiguities in the decision, this Thesis will address the unfortunate consequences resulting from the Cuerrier’s decision. The conclusion I will attempt to reach is that criminalization is an inadequate strategy to prevent further HIV infection, its increased use in practice is misguided, and counterproductive to public health goals, thus alternatives to the routine criminalization of HIV transmission that may enhance the goals of public health should be considered.

A large body of jurisprudence has developed in Canada criminalizing the conduct of HIV positive persons who transmit or expose others to the HIV infection in an equivocal attempt to be seen to be doing something about individuals who are perceived to be driving the HIV epidemic. Convictions have been obtained for charges ranging from aggravated assault to, most recently, murder. The Cuerrier judgement, a landmark decision of the Supreme Court of Canada, left a number of issues unresolved. Given the ambiguities in the decision, this Thesis will address the unfortunate consequences resulting from the Cuerrier’s decision. The conclusion I will attempt to reach is that criminalization is an inadequate strategy to prevent further HIV infection, its increased use in practice is misguided, and counterproductive to public health goals, thus alternatives to the routine criminalization of HIV transmission that may enhance the goals of public health should be considered.

HIV in the UK in the 1980s was concentrated within men who have sex with men (MSM) and people who inject drugs (PWID) but heterosexual sex is now the most frequently reported risk behaviour. As these risk groups are associated with different virus populations, this is reflected in the subtype diversification of the UK epidemic, which was historically dominated by subtype B. I have made use of a national database of HIV sequences collected during routine clinical care, which also contains data on age, sex, route of exposure & ethnicity. The 2014 release of the UK HIV Drug Resistance Database contained data from over 60,000 patients. In this thesis, I first describe the development of novel tools that rapidly and automatically identify HIV clusters within phylogenetic trees containing tens of thousands of sequences because they represent transmission chains within the larger infected population. I use these tools to compare the HIV subtype B epidemics in the UK and Switzerland, which had both been described separately but using different approaches. Working with Swiss colleagues, I was able to analyse the epidemics in exactly the same way without having to share sensitive data. I found clustering in the UK to be much higher at relaxed thresholds than in Switzerland (34% vs 16%) indicating that the UK database is more likely to capture transmission chains. Down sampling revealed that this pattern is driven by the larger size of the UK epidemic. At tighter cluster thresholds, the epidemics were very similar. I next use these tools to analyse the spread of emerging subtypes A1, C, D and G in the UK. I found both risk group and cluster size to be predictive of cluster growth, which I tested using simulations and a GLM. Growth of MSM and crossover clusters was significantly higher than expected for subtypes A1 and C, indicating that crossover from heterosexuals to MSM has contributed to their expansion within the UK. Numbers were small for subtypes D and G but the proportion of new diagnoses linking to MSM and crossover clusters was similar to A1 and C, suggesting that the same pattern may be emerging for D and G. I conclude by evaluating the accuracy of a method previously described by our group to generate transmission networks from HIV sequences. The interpretation of clustering patterns from phylogenetic trees is difficult because of the absence of a standardised statistical framework. In contrast, a body of work exists that relates disease transmission to networks. Using large simulated datasets, I developed algorithms which eliminate improbable links. I then reconstructed improved UK transmission networks for subtypes A1, B and C and compare network metrics (such as the degree distribution) between risk groups. Together with other evidence, this thesis demonstrates that the UK HIV epidemic continues to be driven by transmission among MSM. The UK epidemic is no longer compartmentalised and the crossing over of subtypes across risk groups has been facilitated by MSM also having sex with women.

The goal of my master thesis is to introduce the subject of criminal liability for spreading the HIV virus and to prompt the discussion of the expediency level of current legislation. Furthermore, it is also to introduce individual concepts of punishment for spreading the HIV virus and offer alternatives which are in this context self-evident. My thesis begins with the introduction, it then continues with three general chapters, two analytic chapters and a conclusion. The introduction presents the core sources of work and the methodology. The second chapter following the introduction is the explanation of the basic general connections to the phenomena of HIV and AIDS, in regards to new research which concerns curing and preventing the spread of the HIV infection, along with the historical context in which the debate about HIV and AIDS evolved, especially in Czechoslovakia, more specifically the Czech Republic. Furthermore it lists individual concepts of understanding this issue in specific countries as practical examples. The third chapter introduces the legislation that establishes the criminal liability for spreading HIV. I paid special attention to domestic legislation and particularly the law concerning public health, and the Criminal Code. The fourth chapter introduces in greater detail...

Background: Street-involved youth are known to be at a greatly increased risk of HIV and sexually transmitted infections (STIs); however, the role that environmental and structural factors play in driving disease transmission risk among this population has not been thoroughly examined. Methods: The At Risk Youth Study (ARYS) is a prospective cohort of homeless and street-involved youth between the ages of 14 and 26. From September 2005 to October 2006, participants completed a baseline questionnaire which elicited information regarding sexual activity, injection and non-injection drug use, addiction treatment experience, encounters with police and security guards, and health service utilization. Environmental and structural correlates of number of recent sex partners were identified using quasi-Poisson regression. Factors independently associated with consistent condom use were also examined using logistic regression. Results: Among 529 participants, 415 (78.4%) were sexually active during the past six months, of whom 253 (61.0%) reported multiple sex partners and 288 (69.6%) reported inconsistent condom use during this time period. In multivariate logistic regression, homelessness and self-reported structural barriers to accessing health services were inversely associated with consistent condom use. In multivariate analysis, living in a shelter, hostel, or single room occupancy hotel was positively associated with greater numbers of recent sex partners. Structural factors that were associated with number of sex partners included having a warrant or area restriction that affects access to health services, and for males, being accosted by the police. Conclusions: Unstable housing, homelessness, and structural factors related to the criminalization and displacement of street-involved youth were associated with an increased risk of HIV and STI transmission, even after extensive adjustment for sociodemographic and individual level characteristics. These findings suggest that both environmental and structural factors influence the spread of HIV and STIs, and point to the need for environmental-structural interventions to reduce the burden of these diseases among this population.

Con este trabajo he pretendido estudiar los aspectos culturales, sociales, religiosos, sexuales, económicos y políticos que impiden a las mujeres embarazadas con condición de VIH / SIDA positiva participar en el programa de prevención de la transmisión de VIH / SIDA de madre a hijo en un proyecto de Médicos Sin Frontera Suiza en el barrio y hospital de Chamanculo de Maputo en Mozambique. La información fue recogida de diferentes fuentes: materiales y artículos publicados en revistas y libros de antropología médica, ciencias sociales, médicas, informes de agencias internacionales, de ONG´S internacionales y locales o de los mass media mozambiqueños u otros relevantes. No hay métodos propios de las disciplinas, usé técnicas de investigación cualitativa y métodos cuantitativos. Las medidas de salud publica tomadas para prevenir la transmisión de VIH / SIDA de madre a hijo deben ser aplicadas al padre y a la madre, el aumento del SIDA pediátrico es una consecuencia dramática de las insuficiencias del programa de prevención de madre a hijo. La revelación de la condición de VIH al compañero / a es una estrategia de prevención de la epidemia que debe ser cuidadosamente evaluada y aplicada a los dos miembros de la pareja, tratando de evitar las consecuencias negativas a las personas que abren su condición de VIH en todo el mundo y en especial en Mozambique. / This Thesis intend to study the cultural, social, religious, economical, sexual and political aspects that prevent HIV / AIDS positive pregnant woman with a seroestatus of HIV positive participate in the HIV / AIDS PMTCT programs in a project of Doctors Without Border Switzerland at the Chamanculo hospital and neighborhood of Maputo in Mozambique. The information was collected from different sources: Materials, articles published in Medical Anthropology and social sciences journals and books, WHO, UNAIDS agencies, International and local NGO and other relevant media report. There are not specific methods of the disciplines; I used qualitative research techniques and quantitative methods. The public health measures taken to prevent HIV / AIDS mother to child transmission should be applied to the father and the mother to child prevention program. The increased of HIV / SIDA Pediatric cases is a dramatic consequence of the insufficient work done in the program to prevent mother to child transmission. The disclosure of HIV condition to the partner is a prevention strategy of the epidemic that should be carefully evaluated and applied to the two members of a couple, attempting to avoid the negative consequences to the persons that try to disclosure of HIV condition in all over the world and specially in Mozambique.

No description available.

Background: Street-involved youth are known to be at a greatly increased risk of HIV and sexually transmitted infections (STIs); however, the role that environmental and structural factors play in driving disease transmission risk among this population has not been thoroughly examined. Methods: The At Risk Youth Study (ARYS) is a prospective cohort of homeless and street-involved youth between the ages of 14 and 26. From September 2005 to October 2006, participants completed a baseline questionnaire which elicited information regarding sexual activity, injection and non-injection drug use, addiction treatment experience, encounters with police and security guards, and health service utilization. Environmental and structural correlates of number of recent sex partners were identified using quasi-Poisson regression. Factors independently associated with consistent condom use were also examined using logistic regression. Results: Among 529 participants, 415 (78.4%) were sexually active during the past six months, of whom 253 (61.0%) reported multiple sex partners and 288 (69.6%) reported inconsistent condom use during this time period. In multivariate logistic regression, homelessness and self-reported structural barriers to accessing health services were inversely associated with consistent condom use. In multivariate analysis, living in a shelter, hostel, or single room occupancy hotel was positively associated with greater numbers of recent sex partners. Structural factors that were associated with number of sex partners included having a warrant or area restriction that affects access to health services, and for males, being accosted by the police. Conclusions: Unstable housing, homelessness, and structural factors related to the criminalization and displacement of street-involved youth were associated with an increased risk of HIV and STI transmission, even after extensive adjustment for sociodemographic and individual level characteristics. These findings suggest that both environmental and structural factors influence the spread of HIV and STIs, and point to the need for environmental-structural interventions to reduce the burden of these diseases among this population.

Philosophiae Doctor - PhD / The objective of this study was to determine if introducing acceptance and commitment therapy in the prevention of mother to child HIV transmission (PMTCT) program using weekly mobile phone messages would result in improved mental health status of HIV-positive, pregnant women in Nigeria. The study used a quantitative approach using a Solomon four-group (two intervention and two control groups) randomised design to evaluate the impact of an acceptance and commitment therapy program. The study population was 132 randomly selected (33 per site), HIV-positive pregnant women attending four randomly selected PMTCT centres in Nigeria. Two were Intervention and two were Control sites which functioned as Intervention and Control groups. The intervention groups were exposed to one session of acceptance and commitment therapy with weekly value-based health messages sent by mobile phone for three months during pregnancy. The control groups received only post-HIV test counselling.