The Republic of Botswana (2011a) recognises behaviour change as the only long term solution to the HIV and AIDS epidemic that has become a leading health and development challenge for the country. The study aimed to examine how Talk Back, an interactive HIV and AIDS educational programme on Botswana television, capacitates the school community to deal with challenges brought about by the HIV and AIDS epidemic. The study was based on recordings of 2014 Term One theme— ‘Paediatric care and support: challenges and implications in the teaching and learning environment. The study conducted a content analysis of Talk Back to determine behaviour change communication categories employed in producing the programme. All aspects of the Talk Back programme were also analysed to establish communication strategies employed in the presentation of content. Talk Back employed communication approaches such as panel discussions of matters related to HIV and AIDS by various specialists, video clips to present content, and viewers phoning in to interact with the panellists. A number of the callers identified challenges; the most common identified challenge was that parents tended not to disclose their children’s HIV status to the children due to the negative social stigma attached to HIV and AIDS. Although Talk Back provides a forum for interactive behaviour change communication, some listeners questioned the use of technical language.

A quantitative, descriptive and comparative study was conducted to determine the attitudes of young people aged 15-25 years towards the “ABC” strategy in the prevention of HIV/AIDS in Francistown, Botswana. Differences between two age groups and gender were determined. Structured questionnaire was used and 241 young people participated in the study. Data were analysed with SPSS version 13.0, guided by the Health Belief Model. The findings revealed that young people did not perceive the seriousness and severity of the HIV/AIDS when it came to the practice of “ABC” strategy. Young people’s cue to action was very high but their confidence to adopt and practice the “ABC” strategy were low. They had adequate knowledge of the benefits of abstinence and condoms but they perceived barriers towards the use of condom. The differences between the two age groups, 15-19 and 20-25 years and between the males and females were not statistically significant. / Public Health / M.A. (Public Health)

A quantitative, descriptive and comparative study was conducted to determine the attitudes of young people aged 15-25 years towards the “ABC” strategy in the prevention of HIV/AIDS in Francistown, Botswana. Differences between two age groups and gender were determined. Structured questionnaire was used and 241 young people participated in the study. Data were analysed with SPSS version 13.0, guided by the Health Belief Model. The findings revealed that young people did not perceive the seriousness and severity of the HIV/AIDS when it came to the practice of “ABC” strategy. Young people’s cue to action was very high but their confidence to adopt and practice the “ABC” strategy were low. They had adequate knowledge of the benefits of abstinence and condoms but they perceived barriers towards the use of condom. The differences between the two age groups, 15-19 and 20-25 years and between the males and females were not statistically significant. / Public Health / M.A. (Public Health)

Thesis (MPhil--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The incidence of HIV/AIDS in Botswana is one of the largest in the world taking its toll on many lives and posing developmental challenges to the nation. Nearly 25% of the population is living with HIV and 14% are newly infected; AIDS is acknowledged as the major cause of death. Most HIV and AIDS studies have been dominated by surveillance, biomedical and ethical methodologies. These approaches failed to stem the tide of HIV infection because they did not follow-up with the tracking of risky behaviours and the underlying causes of the behaviours. This research scrutinized socio-economic factors in relation to the spread of the epidemic. Available literature showed that little or no attention has been paid to the socio-economic backgrounds in which individuals exist in connection with understanding HIV and AIDS. This study used an economic model of risky sexual behaviour to explore the link between socio-economic status and the practice of HIV self-protective/preventive behaviours in Maruapula, Gaborone, Botswana. The research is vital as it goes beyond surveillance in an effort to establish why the community of the study is susceptible to HIV infection. This research l used both collected data and that from BAIS II. / AFRIKAANSE OPSOMMING: Die navorsing is oor die verhouding tussen sosio-ekonomiese status en die praktyk van MIV self-protective/preventive gedrag binne Maruapula distrik. Die doel van die studie is om vas te stel of daar 'n verband tussen sosio-ekonomiese status en die praktyk van MIV-voorkomende gedrag onder die inwoners, van Maruapula, Gaborone, Botswana. Data is ingesamel deur die gebruik van vraelyste en die ontleding van die statistiek het getoon dat die is geen verwantskap tussen sosio-ekonomiese status en die praktyk van MIV self-protective/preventive gedrag onder die inwoners. Aanbevelings gebaseer op die bevindinge is gemaak met betrekking tot MIV-voorkoming in die woongebied in die besonder en in die land in die algemeen.

The phenomenon of HIV discordance has been in existence for a long time along with HIV. However, very limited attention has been given to HIV discordance. This phenomenological study aimed at gaining a deeper understanding on the lived experiences of sero-discordant couples in Botswana. Reports show that discordance in Botswana is around 17%. The main objectives of this study were to identify HIV discordant couples living in Botswana and explore their knowledge and understanding of the situation, explore the psychological, social and sexual experiences of the HIV discordant couples and determine its impact in their lives, and examine the meaning they attach to such experiences and challenges they face as well as their coping strategies. A qualitative phenomenological approach using face to face in-depth interviews was used to explore and describe meanings and experience as lived by the HIV discordant couples. The study sample consisted of forty-six (N=46) (twenty-nine (n=29) females and seventeen (n=17) males) participants selected using purposive sampling from three cities in Botswana. The Inclusion criteria were that participants should be aged 21 years and above; with no known diagnosis of mental illness; having been in a discordant relationship for at least six months at the time of data collection; living in Botswana and willing to participate in the study. The findings were that there are three forms of discordance, which are: discordant unaware which are couples who went into the relation unaware of their HIV status. Discordant aware; those who got into the relationship already knowing each other’s HIV status and discordantly discordant which are those with differing HIV status and differing motives of going into the relationship. These are the couples that conceal their status from one another. The results revealed intense emotional/psychological, sexual and social stresses as experienced by couples. HIV discordant goes through three phases of initial shock, conflict and resolution. The researcher recommends the OPEN DESK MODEL to be integrated in the health facilities to encompass the concept of a family or couple and as a unit. / Health Studies / D. Litt. et Phil. (Health Studies)

A quantitative and descriptive type of study design was followed using structured self-administered questionnaires distributed among 84 conveniently selected male adolescent learners from Nanogang Community Junior Secondary School (NCJSS) in Gaborone. The purpose of this study was to describe factors that influence the uptake of safe male circumcision (SMC) as a human immune-deficiency virus (HIV) prevention strategy among male adolescent learners. The study findings show that protection from HIV and other sexually transmitted infections (STIs) was found to be the main reason for adolescent learners undergoing male circumcision (MC) (p<.01). Reasons such as maintenance of genital hygiene, culture, religion, and the enhancement of sexual pleasure were not found to be significant factors. Misconceptions such as the belief that girls do not like circumcised partners were found to be the main reason for adolescent learners not undergoing MC (p<.05). A number of factors which were claimed in previous studies to be obstacles for the uptake of MC, such as surgical complications, peer pressure, stigma, and discrimination, were not found to be major obstacles / Health Studies / M.A. (Public Health)

The phenomenon of HIV discordance has been in existence for a long time along with HIV. However, very limited attention has been given to HIV discordance. This phenomenological study aimed at gaining a deeper understanding on the lived experiences of sero-discordant couples in Botswana. Reports show that discordance in Botswana is around 17%. The main objectives of this study were to identify HIV discordant couples living in Botswana and explore their knowledge and understanding of the situation, explore the psychological, social and sexual experiences of the HIV discordant couples and determine its impact in their lives, and examine the meaning they attach to such experiences and challenges they face as well as their coping strategies. A qualitative phenomenological approach using face to face in-depth interviews was used to explore and describe meanings and experience as lived by the HIV discordant couples. The study sample consisted of forty-six (N=46) (twenty-nine (n=29) females and seventeen (n=17) males) participants selected using purposive sampling from three cities in Botswana. The Inclusion criteria were that participants should be aged 21 years and above; with no known diagnosis of mental illness; having been in a discordant relationship for at least six months at the time of data collection; living in Botswana and willing to participate in the study. The findings were that there are three forms of discordance, which are: discordant unaware which are couples who went into the relation unaware of their HIV status. Discordant aware; those who got into the relationship already knowing each other’s HIV status and discordantly discordant which are those with differing HIV status and differing motives of going into the relationship. These are the couples that conceal their status from one another. The results revealed intense emotional/psychological, sexual and social stresses as experienced by couples. HIV discordant goes through three phases of initial shock, conflict and resolution. The researcher recommends the OPEN DESK MODEL to be integrated in the health facilities to encompass the concept of a family or couple and as a unit. / Health Studies / D. Litt. et Phil. (Health Studies)

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Reproductive health of people living with HIV/AIDS is a significant public health issue because of its associated risks of HIV transmission to both, the baby and the sexual partner. Provision of effective contraceptive to HIV-positive women is a proven prevention strategy, and can help prevent unintended pregnancy and other sexually transmitted infections. Unmet need for contraception in developing world and rates of unintended pregnancies among women living with HIV remain highly prevalent. The objectives of this study were to identify the current knowledge of HIV-positive women on existing contraceptive methods, determine their current contraceptive practices, identify barriers to contraception use, and provide recommendations on how contraception uptake can be improved among these women in Kasane. A cross-sectional study using qualitative technique was used among twenty five (25) participants at Kasane Primary Hospital. In-depth interviews were conducted with the help of research assistants for data collection. Excel Microsoft Office Software was used for socio-demographics data entry and analysis, and qualitative data were analysed manually using descriptive statistics. Main reasons for low uptake of contraception were desire for children, partner refusal, side effects, and socio-cultural and religious factors. Contraception prevalence was 56 % and condom was the most used contraceptive method (36%). whereas the rate of unintended pregnancies was 60% . Knowledge of contraception was high (100%) but limited proportion of participants (12%) had an expended understanding of contraception as a HIV prevention strategy. Most women living with HIV prefer to space, limit or stop childbearing but do not use any contraceptive method and found themselves with unintended pregnancy. Despite the good knowledge about contraception among participants, the uptake remained low. About half (44%) of the women interviewed were not on any contraceptive method. The choice to use contraception interferes with many factors and the desire to fulfil the primary reproductive intention of men and women, including those living with HIV, mostly override this choice. There is need for a strategic integrated approach that conveys HIV prevention messages and discusses the importance of planning a pregnancy. Thus promoting dual protection among women living with HIV. / AFRIKAANSE OPSOMMING: Die voortplantingsgesondheid van mense wat met MIV/vigs leef, is ‘n belangrike openbaregesondheidskwessie, aangesien voortplantingsgesondheid verband hou met die gevaar van MIV-oordrag na babas sowel as seksmaats. Daar is al bewys dat ander seksueel oordraagbare siektes sowel as onbeplande swangerskappe voorkom word as doeltreffende voorbehoedmiddels verskaf word aan vroue wat MIV-positief is. Dit behoefte aan voorbehoeding in ontwikkelende lande bly egter baie dikwels agterweë, en ‘n groot persentasie vroue wat met MIV leef, raak onbepland swanger. Die doel met hierdie ondersoek is om vas te stel wat vroue wat MIV-positief is, tans oor bestaande voorbehoeding weet, watter voorbehoedingsmetodes hulle tans gebruik en watter struikelblokke daar vir die gebruik van voorbehoeding is, en om voorstelle te maak oor hoe ʼn groter persentasie van hierdie vroue in Kasane oortuig kan word om voorbehoedmiddels te gebruik. ‘n Deursnee-studie wat met behulp van kwalitatiewe tegnieke by die Kasane Primêre Hospitaal uitgevoer is, het vyf en twintig (25) deelnemers betrek. Met die hulp van navorsingsassistente is diepte-onderhoude gevoer om inligting in te samel. Microsoft Office se Excel-sagteware is gebruik om sosio-demografiese inligting in te voer en te ontleed, en kwalitatiewe inligting is met verwysing na beskrywende statistiek met die hand ontleed. Die vernaamste redes vir die trae gebruik van voorbehoeding was die begeerte na ‘n kind, die teenstand van seksmaats, die newe-effekte, en sosio-kulturele en godsdienstige oorwegings. Daar is bevind dat 56% van die deelnemers voorbehoeding gebruik, dat kondome die algemeenste voorbehoedmiddel is (36%) en dat 60% van alle swangerskappe ongewens was. Die deelnemers was almal oor voorbehoeding ingelig (100%), maar slegs ‘n klein persentasie (12%) het ook geweet dat voorbehoedmiddels ‘n voorkomingstrategie vir MIV-infeksie is. Die meeste vroue wat met MIV leef, verkies om swangerskappe te versprei, te beperk of te verhoed, maar gebruik geen voorbehoedmiddels nie en het dus onbepland swanger geraak. Hoewel die deelnemers goed ingelig was oor voorbehoeding, het min van hulle dit gebruik. Ongeveer die helfte (44%) van die vroue met wie onderhoude gevoer is, het geen voorbehoeding gebruik nie. Die keuse om ‘n voorbehoedmiddel te gebruik, word beïnvloed talle ander faktore, en mans en vroue se primêre begeerte om voort te plant – ook al leef hulle met MIV – weeg gewoonlik swaarder as hierdie keuse. Daar is ‘n behoefte aan ‘n strategiese, geïntegreerde benadering wat boodskappe oor MIV-voorkoming oordra en wat tuisbring hoe belangrik dit is om swangerskappe te beplan. Sodoende sal vroue wat met MIV leef, tweedoelige beskerming kry.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Safe Male circumcision (SMC) divides people for or against it, depending upon their attitudes. The Ministry of health (MOH) has built capacity in the country for rapid scale up of the program since 2009. However, despite the efforts, the number of men circumcised is lagging behind set targets. We do not know to what extent attitudes of the managers at national and district levels do influence this underperformance? The effectiveness of the managers at workplace at large will depend on their attitudes towards SMC. Managers with positive attitudes bring at workplace energy, creativity and momentum to fulfill the work objectives and goals. Objectives: The objectives of the study were to; 1) establish the current situation of SMC implementation in Botswana, 2) establish the required attitudes for managers towards SMC program, 3) establish the attitudes of SMC managers at all levels toward SMC program, 4) determine the gap between the required attitudes and SMC managers’ current attitudes toward SMC, and 5) Provide recommendation for reinforcing positive attitudes toward SMC program. Methods: The study used an explorative qualitative design. It was carried out at the Ministry of health headquarters and in ten districts in Botswana. A total of 26 SMC program managers were interviewed using a semi-structured interview guide. Results: The study found that the managers were confirming to positive attitudes toward the program as prescribed by the MOH’s standards. Data revealed a positive trend in scaling up of the program albeit lagging behind set targets. Conclusion: This study looked at the desired attitudes of SMC managers should posses and the level of attitudes currently have towards the program. It was not easy to link attitude and performance of individuals. High turnover rate of SMC officers was a worrisome finding that calls for further study. / AFRIKAANSE OPSOMMING: Agtergrond: Na gelang van hul houdings, is die meeste mense hetsy sterk ten gunste van of heftig gekant teen veilige manlike besnydenis (VMB). Die Ministerie van Gesondheid is reeds sedert 2009 besig met vermoëbou-inisiatie we om die VMB-program vinnig uit te brei. Ondanks hierdie pogings, is die aantal mans wat ingevolge dié program besny word egter veel minder as die vasgestelde teikens. Dit is nie bekend in watter mate die houdings van VMB-programbestuurders op nasionale en distriksvlak hierdie onderprestasie beïnvloed nie. Die algehele doeltreffendheid waarmee dié bestuurders die program in werking stel, sal immers grootliks afhang van hul houdings jeens VMB. Bestuurders met ’n positiewe houding sal energie, kreatiwiteit en stukrag aan die werkplek verleen ten einde die programoogmerke en -doelwitte te verwesenlik. Oogmerke: Die oogmerke van die studie was: 1) om die huidige stand van VMB-inwerkingstelling in Botswana te bepaal; 2) om te bepaal watter houdings bestuurders behóórt te hê jeens die VMB-program; 3) om te bepaal watter houdings bestuurders op alle vlakke wél het jeens die VMB-program; 4) om vas te stel in watter mate bestuurders se vereiste houdings en huidige houdings jeens VMB verskil; en 5) om aanbevelings te doen vir die versterking van positiewe houdings jeens die VMB-program. Metode: Die studie het van ’n verkennende kwalitatiewe ontwerp gebruik gemaak. Dit is by die hoofkantoor van die Ministerie van Gesondheid sowel as in tien gesondheidsdistrikte in Botswana onderneem. Onderhoude aan die hand van ’n semigestruktureerde onderhoudsgids is met altesaam 26 VMB-programbestuurders gevoer. Resultate: Die studie bevind dat die bestuurders wél positiewe houdings jeens die program toon soos wat die standaarde van die Ministerie van Gesondheid vereis. Data dui op ’n positiewe tendens in die uitbreiding van die program, al word die vasgestelde teikens nie bereik nie.

A quantitative and descriptive type of study design was followed using structured self-administered questionnaires distributed among 84 conveniently selected male adolescent learners from Nanogang Community Junior Secondary School (NCJSS) in Gaborone. The purpose of this study was to describe factors that influence the uptake of safe male circumcision (SMC) as a human immune-deficiency virus (HIV) prevention strategy among male adolescent learners. The study findings show that protection from HIV and other sexually transmitted infections (STIs) was found to be the main reason for adolescent learners undergoing male circumcision (MC) (p<.01). Reasons such as maintenance of genital hygiene, culture, religion, and the enhancement of sexual pleasure were not found to be significant factors. Misconceptions such as the belief that girls do not like circumcised partners were found to be the main reason for adolescent learners not undergoing MC (p<.05). A number of factors which were claimed in previous studies to be obstacles for the uptake of MC, such as surgical complications, peer pressure, stigma, and discrimination, were not found to be major obstacles / Health Studies / M.A. (Public Health)