The overall objective of the study was to investigate the relationship between male circumcision status and HIV infection in men from Salima district in Malawi. A cross-sectional survey-based study of men aged 15 years or more was conducted at three sites in Salima district, each of which targeted 90 participants, half of whom were circumcised and the other half uncircumcised. These participants had already decided on their own to visit HIV Testing and Counseling centres at these sites to know their HIV serostatus. Consenting men were drawn into the study using quota sampling, interviewed through a structured questionnaire in local language and tested for HIV during January and March 2011. Measures of association were performed using analysis of contingency tables and Pearson’s chi-square tests or Fisher’s exact tests for comparison of proportions in STATA version 11.0 and PASW Statistics 18.0 software. Unadjusted odds ratios were used to approximate the direction and strength of association. Further, a multivariable logistic regression model was fit to determine which other variables were significantly associated with HIV infection. The study was approved by University of Fort Hare Interim Research Ethics Committee and National Health Sciences Research Committee in Malawi. The overall prevalence of HIV infection was 11.5 percent. However, it was less than half in circumcised males (7.4 percent) compared with uncircumcised counterparts (15.6 vi percent). While Fisher’s exact test revealed a borderline statistically significant association between male circumcision status and HIV infection (p 0.055), Pearson’s chi-square test showed a stronger significant association between the two variables ( p 0.036). The strength of the association was manifested by the odds of HIV infection being roughly 0.43 times lower for circumcised males than their uncircumcised counterparts with a 95 percent confidence interval of (0.20 0.96). Although the association was maintained after controlling for some variables, it lost statistical significance when adjusted for other variables. A multivariable logistic regression revealed that three other variables had significant associations with HIV infection and these were: falling in the age group of 25 years or more (OR 4.69; p 0.020), having had sex with an HIV positive partner (OR 12.15; p 0.000) and having contracted a sexually transmitted infection (OR 3.25; p 0.032). Male circumcision status is significantly related to HIV infection. Although the study involved a small sample size and undertaken in one district in Malawi, the finding is consistent with existing clinic-based findings in literature that indicate a lower risk of HIV infection in circumcised males than in uncircumcised males. Consequently, male circumcision could be considered if it can prove to be a public health intervention in the Malawi context aimed at reducing the risk of uncircumcised males becoming infected by HIV.

There are important disparities between how HIV transmission, prevention, and mitigation are addressed within sub-Saharan Africa (SSA) and how they are understood by the international aid agencies that design and implement interventions to combat AIDS in this region. Contending that local responses to the AIDS epidemic hinge on a religious framework, this dissertation examines the relationship between religion and HIV risk at both the individual and collective levels in the setting of rural Malawi - a religiously diverse country with high levels of both religious participation and HIV prevalence. This dissertation advances the Durkheimian idea that participation in harmful behaviors is reduced in places where particular religions or religious rituals are widely practiced. Specifically, it addresses the associations between religion and (1) HIV prevention, (2) actual HIV status, and (3) perceived obligations to support families affected by AIDS. The relationships are assessed by employing multiple methodologies and data sources including participant observation data from religious services, in-depth interviews with religious leaders and lay people, and large-scale survey data. This dissertation provides the first empirical assessment of what religious leaders in SSA say and do about HIV in their communities and shows that many have assumed an activist role in combating the epidemic. The relevant practices religious leaders engage in include: preaching explicitly about AIDS on a regular basis, privately advising members to use condoms, actively policing the sexual behavior of their members -- visiting those suspected to be at risk of contracting the disease and to confront them about their sexual behavior, and advising divorce as a strategy for HIV prevention in cases where a member is likely to be infected by an unfaithful spouse. By synthesizing insights from demographic studies of contextual effects on sexual behavior with the notion of "moral communities" from the sociology of religion, this dissertation emphasizes the importance of conceptualizing religion as a supra-individual phenomenon with important implications for the health of populations.

The study examined correlates of HIV perceived risks and protective strategies among adolescents in rural Malawi i.e. whether there was an association between socio demographic characteristics of adolescents and subsequent HIV perceived risks and protective strategies. Age at sexual debut is a variable of interest in this study. The objectives were to investigate whether age at first sexual intercourse does influence adolescents’ individual’s risk perceptions of HIV and protective strategies, i.e. does age at first sex set a precedence in the thinking of adolescentswith regards HIV risks and protective strategies such as condom use. Data: This study uses cross sectional data from Wave 3 of a wider study, the Malawi Diffusion and Ideational Change Project (MDICP).The MDICP is a joint collaboration between researchers from the Population Studies Centre at the University of Pennsylvania and the University of Malawi‘s College of Medicine and Chancellor College. In this study, a multiple regression analysis on the cross sectional data from the 2004 wave 3of the Malawi Diffusion and Ideational Change Project was done. The focus of this study is on the relationship between age at first sexual intercourse and the individual‘s perception of risk of HIV/AIDS and protective strategies, it examines if there is an association between the two factors. Descriptive analysis: Descriptive statistics to obtain the frequencies of the main variables of interest such as the background characteristics of respondents (gender, marital status, mean age at sexual debut, education, economic status of household) were computed in order to better understand the population under study. Multivariate Analysis: Three separate models were employed; two multinomial regression analysis measuring worry and likelihood of infection against socio demographic variables and a binary logistic regression measuring condom use and the socio demographic variables. Relative Risk Ratios were used to interpret the multinomial logistic regression output while odds ratios were used to interpret the logistic output. Results: Consistent with existing literature, results indicate that early age at first sex is a predictor of HIV risk perceptions and protective strategies. Age at first sex does set a precedence in the future thinking of adolescents with regards to how they perceive HIV risks, as well as how they perceive protective strategies against HIV-particularly condom use. This study confirms that age at first sex alongside with other socio demographic variables are significantly associated with HIV risk perceptions HIV and condom use, while other factors may matter, such as gender, region, HIV knowledge, religion or educational level. Limitations: The information on age at first sexual encounter was based exclusively on respondent’s self–reports. This data collection method often has limitations that are attributed to the tendency for people to under-report socially unacceptable behaviours (e.g. having multiple sex partners) and to over-report socially acceptable behavior. The other limitation is that the study lacks longitudinal data to allow a more in-depth analysis of trends in HIV/AIDS-related indicators. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

Standard economic models often emphasize inputs, outputs and an examination of the structures in order to conduct an economic performance evaluation. This study applies the Institutional and Development Framework (IAD) in the broader context of New Institutional Economics (NIE) in order to examine the transaction costs of delivering Community and Home Based Care and Support (CHBC) to HIV/AIDS sufferers. For purposes of unveiling the empirical reality guiding decision making processes in the CHBC service delivery, comparative qualitative research techniques of normative variable and concept formation have been adopted to draw out the relative institutional influences from the HIV/AIDS national response partnerships. The study identifies the conflict between the predominantly standardized and more rigid formal management techniques adopted by key members of the national response and the informal cultural techniques familiar to the rural communities, and a lack of motivational incentives in the CHBC structures as the key factors against CHBC capacities to draw external funding for service delivery. CHBCs are also weakened by incoherent governance structures at the district level for facilitation of funding and information flow exacerbating the community vulnerability. Rationalization of the institutional arrangements and a clarification of roles from district to community levels, a shift of focus to facilitation of informal techniques and an integration of performance enhancing incentives are the critical policy insights envisaged to spur CHBCs to work better.

A quantitative, descriptive, explorative survey was conducted to explore and describe factors contributing to underutilisation of HIV testing services among tuberculosis patients and clients in Malawi. Sampled were 282 participants attending an outpatient clinic. A self administered questionnaire was used. The findings revealed that 80.5% of the respondents perceived themselves susceptible to HIV infection, 55% believed there were negative consequences of HIV Testing and Counselling (HTC), 87.6% perceived HTC had benefits, most of the respondents (76.8%) mentioned the benefit of knowing the HIV status helping one to plan life, 65% believed in themselves, that they could accept and undergo HIV testing with ease. The study recommends that all HTC providers be thoroughly trained in knowledge and skills to offer services with confidentiality and avoid stigma and discrimination of those found HIV positive. The importance and benefits of HTC should be emphasised in all behaviour communication messages / Health Studies / M.A. (Public Health)

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: With the existence of many HIV and AIDS service providers especially at Local Authority Level which is government closer to the people, multi sector coordination of service provision becomes crucial. Therefore, this study undertook to assess the effectiveness of coordination of HIV and AIDS service provision in Salima District Council in Malawi. The researcher used the following methods to collect data: qualitative method, through a questionnaire where data was collected from the District AIDS Coordinating Committee (DACC) responsible for multi sector coordination at district level; and qualitative method, through focus Group Discussions that enabled collection of data from targeted sector heads from government, non- governmental organisations, Faith Based Organisations and Private Sector. The research found that Salima District Council has the necessary structural set-up to coordinate HIV and AIDS Response. In keeping with the three – one principle, Salima District Council has managed to develop one coordination body, one action framework and one M&E framework. The availability of the one action framework and one M&E framework (LAHARF) and that these are annually replicable, shows a level of coordination is available and it is working. Lack of adequate funding for HIV interventions and lack of involvement of DACC in planning process by most service providers are major challenges. It is thus recommended that Salima District Council should put in place a deliberate policy that makes it mandatory for all organizations working in the district to participate in planning and or share their plans with the district council. The Council should also ensure that strategic policy and guidelines documents are readily available to service providers for use when planning HIV and AIDS interventions. / AFRIKAANSE OPSOMMING: Wanneer daar baie diensverskaffers op Plaaslike bestuursvlak is word die koördinering van MIV/Vigsdienste baie belangrik. Die doel van hierdie studie was die bepaling van die doeltreffendheid van die koördinering van MIV/Vigsdienste in die Salima Distriksraad in Malawi. Data in ingewin deur gebruik te maak van kwantitatiew metodes en „n gestruktureerde vraelys is vir dataversameling gebruik. Ten einde nog eer data in te samel is fokusgroepe gebruik binne die Regeringsorganisasies, Nie-regeringsorganisasies, die privaatsektor en geloofsgeörienteerde organisasies. Die studie het bevind dat die nodige strukturele opset wel binne die Salima Distriksraad bestaan. Die Salima Distriksraad het ook daarin geslaag om „n enkele koördineringsliggaam te vestig en die studie het bevestig dat hierdie koördineringsliggaam inderdaar funksioneel is. Daar is egter nog steeds „n gebrek aan voldoende fondse en die nie-betrokkendheid van sekere van die diensverskaffers is steeds „n uitdaging. Voorstelle vir die verbetering van die betrokkendheid van al die diensverskaffers word in die studie aan die hand gedoen.

Certain individual and institutional factors such as knowledge about stigma and discrimination, fear of infection, social judgement, legal and policy environment act as actionable drivers and facilitators of HIV-related stigma and discrimination. These factors may hinder the utilisation and quality of care provided to people living with HIV. Purpose: The purpose of the study was to establish the actionable drivers and facilitators that determine the different forms of HIV-related stigma and discrimination among healthcare professionals at a district hospital in Malawi. Methods: The study used a descriptive correlational study. Data was collected through self-administered questionnaire. Data were analysed using SPPS and STATA 12. Fisher's Exact Test was used to conclude the association and binary logistic regression was used to model the degree of the statistical relationships. Results: The results showed statistically significant relationship between knowledge of stigma and discrimination, social judgement and awareness of workplace policy and HIV-related stigma and discrimination. Recommendations: Interventions aimed at increasing knowledge about HIV-related stigma, reducing social judgement, reinforcing HIV-related workplace policies are needed to reduce HIV-related stigma and discrimination in healthcare settings. / Health Studies / M. Ph. (Health Studies)

A quantitative, descriptive, explorative survey was conducted to explore and describe factors contributing to underutilisation of HIV testing services among tuberculosis patients and clients in Malawi. Sampled were 282 participants attending an outpatient clinic. A self administered questionnaire was used. The findings revealed that 80.5% of the respondents perceived themselves susceptible to HIV infection, 55% believed there were negative consequences of HIV Testing and Counselling (HTC), 87.6% perceived HTC had benefits, most of the respondents (76.8%) mentioned the benefit of knowing the HIV status helping one to plan life, 65% believed in themselves, that they could accept and undergo HIV testing with ease. The study recommends that all HTC providers be thoroughly trained in knowledge and skills to offer services with confidentiality and avoid stigma and discrimination of those found HIV positive. The importance and benefits of HTC should be emphasised in all behaviour communication messages / Health Studies / M.A. (Public Health)

Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)

Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)