Thesis (MTech (Environmental Health and Occupational Studies))--Cape Peninsula University of Technology, 2016 / Currently, the world faces many challenges such as a food shortages, fossil fuel depletion, floods, earthquakes, recession, wars, and climate change. It also faces diseases such as Human Immune Deficiency Virus /Acquired Immune Deficiency Syndrome /Sexually Transmitted Infections and Tuberculosis (HIV/AIDS /STI and TB). This study focused on HIV/AIDS/STI and TB, and the impact of changes in sexual behaviours of student peer educators as a result of peer education programmes offered by the HIV/AIDS Unit at the Cape Peninsula University of Technology (CPUT). Although young people today have a better understanding of risky sexual behaviours, HIV remains a health problem among the youth in South Africa. HIV/AIDS is a disease that affects all sectors of the population- rich and poor, young and adult, educated and uneducated. Tertiary institutions are places where many young female and male students live independently, unsupervised by their parents or guardians, in either private accommodation or student residences. Under these circumstances it may be expected that some students will explore and experience intimacy in their relationships. Hence, universities could play a vital role in shaping students’ attitudes and behaviours towards relationships, safer practices, and respect for others. Given the current absence of a cure or vaccine for HIV/AIDS, peer education should appear as an important tool in HIV prevention strategy. It draws on several well-known behavioural theories and many researchers view peer education as an effective behavioural change strategy. A formal structured Peer Education Programme was initiated and implemented at the HIV/AIDS Unit at Cape Peninsula University of Technology (CPUT) since 2004. This initiative was in line with one of the twelve strategic objectives of the HIV/AIDS Unit at the CPUT. This study therefore, aimed to assess the reflexive effect that the Peer Education Programme had on student peer educators who volunteer their services at the HIV/AIDS Unit at CPUT. It further attempted to assess the effect of the Peer Education Programme on changes in sexual behaviours that could occur amongst student peer educators. The purpose of this programme was to explore peer educators who were based in the HIV/AIDS Unit applying their acquired knowledge and skills; so that they may become role models for their peers by practising what they taught, and not taught what they proposed to practice. The study furthermore, forms on how effective the Peer Education Programme of CPUT’s HIV/AIDS Unit is in changing sexual behaviours of the student peer educators.

Aside from sub-Saharan Africa, the Caribbean is the only region where the number of women and girls living with human immunodeficiency virus (HIV) is greater than that of men and boys. In the Dominican Republic (DR), the number of all diagnosed HIV cases that were women increased from 27% in 2003 to 51% in 2013, which indicates a shift in the burden of HIV from men to women. Women in stable relationships in the DR have risk for HIV and other sexually transmitted infections (STIs) related to high rates of multiple concurrent partners and low condom use among stable partners. Past HIV prevention efforts in the DR have largely focused on encouraging consistent condom use. However, this may not be a feasible solution for women in relationships. In this dissertation, I sought to examine safe sex communication (SSC) as a possible alternative to consistent condom use for HIV/STI prevention among women in stable heterosexual relationships in DR. I began by conducting an integrative literature review and identified multiple relationship, individual, and partner factors related to SSC among Latina women in stable relationships. Then I conducted a mixed methods study guided by the Theory of Gender and Power with women in stable heterosexual relationships who seek care at Clínica de Familia La Romana in the DR. First, I conducted a qualitative descriptive study to describe SSC. Emergent content analysis of eleven interview transcripts following Colaizzi’s method revealed two main themes: (1) Context of sexual risk (i.e., the meaning of safe sex for stable partners, behaviours related to sexual risk, beliefs and attitudes related to sexual risk, confianza (trust) between stable partners, economic power within relationships, and learning to manage safe sex within a stable relationship) and (2) SSC (i.e., reasons to talk about safe sex, methods, content, and outcomes, influential factors, and ideas for improvement). Second, I conducted a cross sectional survey with 100 women to identify psychosocial correlates of SSC. The mean age of women was 35.72 years, average relationship length was 8.5 years, and 46.91% were living with HIV. Logistic regression analysis revealed that lower SSC self-efficacy (OR = 0.20, 95% confidence interval = 0.08 – 0.50) and greater difference in age between partners (OR = 0.91, 95% confidence interval = 0.85 – 0.98) were both significantly related to less SSC. Information from this dissertation can be used to help identify women in the DR who are at risk for poor SSC with their stable partners and guide researchers, health care providers, and other individuals involved in efforts to reduce HIV/STI risk among this population to develop more effective interventions for this population. Future research should determine which safe sex behaviors SSC is related to among Latina women with stable partners, as well as which aspects of SSC can be generalized to women of all Latino subcultures and nationalities. Additionally, more information is needed about the male partner’s role in SSC within their stable relationship and what factors influence partner SSC among Latino men in stable relationships.

This dissertation is among the first ethnographic investigations of HIV/AIDS programs in the Middle East and North Africa (MENA) region. Contemporary representations of the region’s HIV/AIDS epidemic often recycle simplistic orientalist tropes, lumping together diverse countries, communities, and histories under the rubric of a shared socio-cultural and religious context. This cultural heritage is presumed to explain both the region’s seemingly unique epidemiological dynamics and its reportedly extreme forms of stigma and taboo. Public health efforts in the region aim to ‘lift the veil’ on HIV risk, and efforts are currently underway across the MENA to bring groups like sex workers and men who have sex with men – considered to be ‘at risk’ by virtue of their sexual behaviors – “out of the shadows” (UNAIDS 2010). Drawing on 26 months (2009 – 2013) of ethnographic research in Morocco, I approach internationally circulating best practices in HIV prevention as technologies of visibility that seek to expose particular bodies to forms of surveillance and management. In the process, I argue, they also serve to highlight certain narratives about risk and vulnerability, and spotlight particular fault-lines in the Moroccan social terrain. What is unique and notable about HIV transmission and prevention in the MENA region, I argue, is not a singular ‘Muslim culture’ steeped in stigma and taboo. Rather, what is remarkable about HIV/AIDS in the region is the way that epidemiological markers of sexual risk, as well as efforts to make that risk visible, become entangled in historically important debates about cultural authenticity, distinctions between public and private, and processes and pressures for social and political change. This research explores tensions between a focus on individual-level HIV risk, on the one hand, and the potential for political action to address the structural factors of collective HIV- related vulnerability, on the other. I ask, how do the new visibilities of HIV/AIDS prevention open up or foreclose possibilities for politicizing risk and vulnerability? Here, my research foregrounds the narratives of women recruited by AIDS organizations, who are largely from precarious socio-economic backgrounds and are often single heads of households. My interlocutors used a variety of discursive strategies to frame their vulnerability in ways that challenged the limited lens of individual sexual risk that HIV/AIDS organizations tended to promote; for example, these women drew on religious discourses to highlight a failed social contract, in which a corrupt class of rich Muslims neglected their duties to the Muslim poor. In this context, my interlocutors attempted to de-exceptionalize sex work by highlighting commonalities with the arduous and exploitative aspects of other forms of low-wage labor, at the intersection of gendered and class-based inequalities. And they spoke about the inadequacies of a healthcare system and a social service sector – which included AIDS organizations – that was not equipped to care for the poorest and most vulnerable. Importantly, this research itself might be understood as a technology of visibility with the power to uncover a particular, socially situated story about HIV/AIDS work in Morocco. Here, I seek to provide, not a sensational tale about Arab-Muslim culture, nor a melodramatic representation of sexual exploitation, but a story of how public health best practices render (in)visible and (de)politicize particular social fault lines in the process of reading and responding to the spread of HIV/AIDS. Through a comparison of the everyday labor of two AIDS organizations, I show how incorporating an ‘ethnographic’ view of the lives of ‘at-risk’ groups can help elucidate socio-structural aspects of risk and vulnerability. Thus, under the right conditions, I suggest that particular institutional forms may, in fact, produce visibilities that harbor the seeds of meaningful participation, activism, and political change.

Human immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is a major health concern in the United States, as well as globally (CDC, 2001). Certain ethnic groups in the United States have more reported HIV/AIDS cases then others. In particular, African American adults and adolescents are disproportionately affected by HIV/AIDS. For that reason, there is a great need for prevention/intervention work within this population to decrease the growing number of HIV/AIDS cases. One prevention effort is the Youth Empowerment Project, which is an HIV/AIDS prevention program targeted to reduce risky behaviors in a Midwest African American adolescent population. A total of three hundred and ninety-four youth between the ages of 12-17 participated in this program over the course of three years. Participants were exposed to safer sex skill building, condom use negotiation with a partner, selfefficacy skills, and general refusal skills. This study examined the differences in self-efficacy of the participants and investigated the relationships found between self-efficacy and reported condom use. Participants were randomly assigned to either an HIV/AIDS safer sex class or a health promotion class. No significant differences in self-efficacy were found between the two groups. However, female participants were found to have higher self-efficacy than male participants. Reported sexual activity was low for this population, so no significant findings were discovered between selfefficacy and condom use. / Thesis (Ph.D.)--Wichita State University, College of Liberal Arts and Sciences, Dept. of Psychology. / "July 2006." / Includes bibliographic references (leaves 44-51)

Background HIV/AIDS has always been a concern since it first came up in 1981 in the field of medicine and public health. The trend of overall HIV epidemic has slow down through over 30 years fighting against the disease. Yet, being the largest population nowadays, young people still face high risk of HIV/AID. Sexual transmitted diseases, similar with HIV infection, are also a serious concern in young people. Peer education is widely used in the sexual education in young people. No review focused on the school-based peer education while most young people received their sexual education in schools. This systematic review aims to evaluate the effectiveness of school-based peer education on HIV/STD prevention and evaluate the factors that are likely to influence the effect of school-based peer education. Method Searching through PubMed and Cochrane Library, a literature review was carried out on the relevant articles about the evaluation of school-based peer education in developing and developed countries around the world from 2000-01-01 to 2014-05-31. Findings 10 experimental studies were chosen in this review, including 3 randomized controlled trials. Among 10 studies, 8 found significant improved about the general knowledge of HIV/STD and all studies showed positive change in attitude and risk perception in the peer-led education. However, no studies found significant effect of peer education on the behavioral change regarding condom use, postponing sexual intercourses and the reduction of sexual partners, etc. The interaction of peer education and the quality of peer-educators plus other demographical factors such as socioeconomic status and religions may influence the effect of school-based peer-led education. Conclusion School-based peer education was demonstrated to be effective on the prevention of HIV/STD in knowledge and attitude improvement, similar with other kinds of peer education. Peer educators and interactions between educators and educatees play important roles in the peer education. Yet, the effect of school-based education still requires long-term assessment. / published_or_final_version / Public Health / Master / Master of Public Health

To date, the HIV/AIDS pandemic remains a global disaster. The sheer scale of the pandemic and the limited success of prevention programmes in controlling its spread have necessitated an urgent need for the development of a safe, effective and affordable HIV preventive vaccine. However, perceptions of HIV vaccines and the relationships between HIV/AIDS knowledge, perceived risk and existing views on HIV vaccines are minimum characteristics required to make future HIV vaccines a worthwhile public health tool. This study reports findings among representatives of the ethnic groups aged between 18 and 49 in the Rustenburg community of Bojanala district (N = 351). The study utilized some of the data collected by the Aurum Institute of Health Research representative household survey that forms part of a range of HIV vaccine preparedness studies in the Bojanala area, Rustenburg. Descriptive statistics were applied to all items. Independent samples T- tests and Analysis of variances (ANOVAs) were used to compare means. Correlational statistics (Pearson‘s product moment) was used to explore relationships between pairs of variables. A standard multiple regression analyses was applied to assess and explore the factor(s) that predict the likelihood that respondents would report supportive perceptions for HIV vaccines while the hierarchical model fitted was done to control for the influence of demographic variables. About 74% of the study participants had good knowledge of HIV/AIDS-related issues and the same percentage of respondents identified self and their community to be at risk of HIV/AIDS infection (measured as fatalism regarding risk of contracting HIV infection). Positive view-points regarding participation in vaccine trials and belief in a future HIV vaccine to protect from contracting HIV infection was reported by almost 90% of the study participants. Meanwhile, a majority (60%) had low levels of knowledge on HIV vaccines. The results of standard and hierarchical multiple regressions showed that knowledge on HIV/AIDS transmission, prevention and treatment (in particular) are the best predictors of perceptions of an HIV vaccine. Furthermore, with the exception of the duo of perceived HIV risk and perceptions of HIV vaccine, positive correlations were found among knowledge, perceived HIV risk and vaccine perceptions, as well as among these and exposure to the media. Race (being Black in particular) and low levels of education seem to be profound challenges facing HIV/AIDS related issues, particularly perceived HIV risk. The findings from this study have implications for strategies in HIV prevention, viz. education, service delivery, advocacy and policy among others at institutional, national, regional, and global level in both public and private sectors. Political will, unprecedented collaborative effort among stakeholders and review of the existing Expanded Programme of Immunization schedule are all required to make the future HIV vaccine globally available. In addition, deductions highlight several key areas where research is urgently needed. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010.

The intervention of Voluntary Counselling and Testing (VCT) for the Human Immunodeficiency Virus (HIV) is rapidly gaining ground as an essential component in the health care system in an effort to combat and confront the spread of this disease. In South Africa where this intervention is gradually being introduced the application of VCT and the benefits and consequences likely to ensue from the application of the procedure were evaluated in-depth using a grounded theory and quantitative approach to describe the psychosocial dynamics. The interactive transfer of information embodied in VCT forms an integral part of the intervention and will continue to do so even when antiretroviral dnugs are uniformly available throughout the South African healthcare service. The way in which the women who will undergo this procedure internalise and respond to the information imparted to them during the counselling is highly significant from an educational and empowering perspective, regardless of the outcome of the test result. The aim of the counselling is primarily to promote a rising consciousness amongst patients and subsequently within their communities in an endeavour to move away from what is termed 'exceptionalism' and towards 'normalisation' of the treatment of HIV/AIDS. Communicating the facts about HIV will help to dispel the myths and stigma which still surround the disease. A convenience sample of one hundred and twelve women were interviewed whilst attending antenatal clinics at four different sites in KwaZulu-Natal. In addition a small cross-sectional sample of service providers and key informants in communities situated near to the chosen sites were interviewed to explore the perceptions of VCT and HIV in the current health service and community environment. The findings revealed that there is to date no mandatory policy which offers VCT routinely at any of the health centres primarily due to the cost of testing, lack of posts for trained counsellors and timeous laboratory facilities. Confusion amongst health personnel regarding current policies of treatment regimens for HIV/AIDS patients, as well as differing opinions about feeding options for infants, can undermine counsellors' confidence to handle complex issues competently from an informed position. Recommendations are that trained counsellor posts with opportunities for updating of current policies, easily accessible laboratory facilities and suitable space for confidential counselling (both oral and visual) be implemented as a priority in the health service. A more comprehensive service should be universally implemented, not just in antenatal and communicable disease clinics for ethical reasons of equity between all members of society. In the same vein the networking and cumulative energy of NGOs, religious groups and health professionals must be harnessed to work synergistically to provide sustainable solutions for those living with HIV and those at risk of becoming infected. / Thesis (M.A.)-University of Natal, Durban, 2001.

There are two dominant approaches to counselling for sexual risk reduction In South Africa. The TASO model which is based on client centred principles, informs much of vCT counsellors' training. More recently, the (ARRM) AIDS Risk Reduction Model which includes a cognitive behavioural component to counselling for sexual risk reduction has been introduced. A sample of vCT counsellors who have been trained using the ARRM were interviewed to develop an understanding of their experiences of using this approach. These participants provide a vCT service to clients in the midlands of the province of KwaZulu-Natal. A central finding was that although counsellors experienced the cognitive behavioural approach as having good potential for effecting sexual behaviour change, numerous barriers were identified to applying the approach within the South African context. Counsellors were also critical of the TASO model as a model for counsell ing for sexual risk reduction. Elements of the cognitive behavioural approach they experienced as useful included its potential for changing cognitions (misconceptions and myths in communities), the collaborative nature of the approach, negotiating strategies for risk reduction, use of a problem solving approach, follow-up and monitoring of behaviour. Barriers identified included contextual constraints such as poverty, gender power differentials and cultural practices. Also identified as a barrier was the dominance of the biomedical approach within the health care system. Despite identifying barriers to the application of this approach, counsellors remained optimistic that cognitive behavioural approaches could be adapted to the life context of their clients and that this could be facilitated through further training and mentoring. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007.

Introduction: The high prevalence of HIV in South Africa was confirmed by Department of Health (2005) which reported an HIV prevalence rate of 40.7 percent amongst antenatal clinic attendees at public facilities in KwaZulu-Natal in 2004. Abstinence is one of the strategies used by many different cultures where young unmarried people are encouraged to abstain from sex until marriage, to prevent young girls from getting pregnant and acquiring sexually transmitted infections (STIs). Aim: The aim of this study was to investigate African rural high school learners' choice of sexual abstinence and to compare abstinent versus non-abstinent African rural high school learners in order to be able to develop tailored educational messages. Abstinence was defined as not having penetrative sex, since this is the accepted definition of abstinence in Zulu culture. Objectives: a) To investigate the prevalence of abstinence from sexual intercourse amongst African rural high school learners, b) To assess demographic, psychosocial, and economic determinants of abstinence from sexual intercourse, c) To make recommendations about abstinence interventions. Method: A descriptive cross-sectional study was carried out in a rural area (Ugu District in southern KwaZulu-Natal). One class of Grade 9 learners, ages 14-20 years, was selected from each often randomly selected rural high schools. An anonymous selfreporting semi-structured questionnaire used the I-Change model to investigate demographic and economic information, attitudes, social influences, self-efficacy and intentions towards sexual abstinence. Chi square and T-tests were used for bivariate analysis and Logistic regression was used to develop a model for abstinence from sexual intercourse. Results: A total of 454 learners participated with a mean age of 16.76 years (SD 1.41) age range 14-20 years. Of the sample 208 (45.8%) were male and 246 (54.2%) female. The majority were Christian (84.6% (n=384)) and of this population, 28.3% (n=127) reported that they had 'ever had sex'. Furthermore, 24.5% (n=91) of learners reported that they were currently sexually active. Fifty six percent (n=252) of learners reported that they abstained from sex. When comparing learners reporting abstinence (n= 252) with those not abstinent (n= 202), abstinent learners were significantly more often females, who had never had sex (p / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2007.

Submitted in fulfillment of the requirements for the Degree of Master of Technology: Biotechnology, Department of Biotechnology and Food Technology, Faculty of Applied Sciences, Durban University of Technology, South Africa,2009. / Nearly half of all individuals living with HIV worldwide at present are woman and the best current strategy to prevent sexually transmitted HIV is antiretrovirals (ARVs). Microbicides are ARV’s which directly target viral entry and avert infection at mucosal surfaces. However, most promising ARV entry inhibitors are biologicals which are costly to manufacture and deliver to resource-poor areas. Microbicides formulated as simple gels, which are currently not commonly used in ARV therapy, show immense potential for use in prevention and treatment of multidrug-resistant viral infections in developing countries. Among the most potent HIV entry inhibitory molecules are lectins, which target the high mannose N-linked glycans which are displayed on the surface of HIV envelope glycoproteins. Of the microbicides, the red algal protein griffithsin (GRFT) has potent anti-HIV inhibitory activity and is active by targeting the terminal mannose residues on high mannose oligosaccharides. It has a total of 6 carbohydrate binding sites per homodimer, which likely accounts for its unparalleled potency. The antiviral potency of GRFT, coupled with its lack of cellular toxicity and exceptional environmental stability make it an ideal active ingredient of a topical HIV microbicide. v Scytovirin (SVN) is an equally potent anti-HIV protein, isolated from aqueous extracts of the cyanbacterium, Scytonema varium. Low, nanomolar concentrations of SVN have been reported to inactivate laboratory strains and primary isolates of HIV- 1. The inhibition of HIV by SVN involves interactions between the protein and HIV-1 envelope glycoproteins gp120, gp160 and gp41. Current recombinant production methods for GRFT and SVN molecules are unfortunately hampered by inadequate production capacities. This project therefore aimed to determine if these molecules can be produced in plant cell culture systems. The transgenic tobacco cell culture system was evaluated to determine if it can be an alternative, cost effective production system for these molecules. Results of the study show that the microbicide genes can be cloned into plant transformation vectors, used to successfully transform SR1 tobacco cell lines and adequately produce 3.38ng and 10.5ng of GRFT and SVN protein respectively, per gram of SR1 tobacco callus fresh weight. The promising results attained in this study form the basis for further work in optimising plant cell based production systems for producing valuable anti-HIV microbicides, a possible means to curbing the elevated HIV infection rates worldwide.