Introduction The purpose of this analysis was to identify social, behavioral and cultural factors associated with HIV infection among the Luo people residing on the southern part of Kenya and Somali in the Eastern part of Kenya. Previous studies have linked higher prevalence of HIV in the Luo community to cultural practice such as widow inheritance, and lack of circumcision among men. Analysis was conducted to determine the difference cultural and behavior practice between the Luo and Somali using Kenya demographic health survey (DHS) data, collected between 2008 and 2009, and used statistical computing Software program(SAS) for analysis. Results There were 6906 participants in this survey, 3023 were males and 3811 females. The minimum age was 15 and the maximum age was 54. About 73% of the Luo were Christian and 25% were Catholic, compared to the Somali who were 99% Muslim. 98% of Somali were circumcised and 99% of the Luo were not circumcised. About 60% of the Luo used condoms compared to the 25% of Somali. Multivariate analysis comparing Luo and Somali showed the Luo were at high risk of getting HIV infection compared to Somali adjusted odds ratio (OR= 13.34;95% Cl 2.19 – 81.11). Conclusion Different risk factors were contributing to higher prevalence of HIV among the Luo community. This study was an observation study, hence the cultural and behavior difference observed cannot be used to established causality due to study design limitation. This study finding can be used to develop future study examining the cultural and behavioral risk factors associated with HIV transmission in Africa.

MSc (Med) Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand / Research Project Title: HIV Prevalence and Factors Associated with HIV Infection in South Africa: Analysis of the Antenatal Clinic Survey Data. Background: In sub-Saharan Africa, the HIV epidemic is commonly monitored through the sentinel surveillance of pregnant women attending antenatal clinics (ANC), which provides important indications for planning and evaluating public-health interventions. Many of such surveillance systems in South Africa reported limited information on factors associated with HIV infection, even though the survey collected information related to a woman’s participation. This is likely to compromise the development of effective preventive programmes that are more focussed. To address this, the 2005 HIV (ANC) surveillance data was used with the objective of increasing the available information on the HIV epidemic in the country and identifying the socio-demographic factors associated with HIV infection in each province. Methodology: The data from the 2005 ANC survey was analysed in depth. The chi-square test was used to test bivariate associations for categorical associations of HIV infection and other associated factors. In addition a logistic regression model was used to explore the association of sociodemographic and other variables with HIV infection in each province. Results: The HIV prevalence reported in this study was similar to earlier reports released by the Department of Health in 2005. That is the overall HIV prevalence is 30.1% (29.5-30.8%) with KwaZulu Natal having the highest (39.1%, 37.5-40.1%) and Western Cape recorded the lowest HIV prevalence of 15.9% (14.1-17.4%).

The male condoms were massively expanded to Africa in 1990s as a result of growing HIV prevalence in most parts of Sub-Saharan Africa. Many transnational non-profit organizations together with national governments were engaged in this expansion of condom distribution. The biggest condom donator are the United States of America which have already provided tens of milliards of dollars to fight against AIDS by distribution of condoms. Was this financial aid used effectively and did the money have the right intended effect? Scientists agree on the statement that the effectiveness of condoms as contraceptives is around 90%. What is the efficiency of using condoms helping against the transmission of the virus HIV, if a single HIV virus cell is much smaller than a sperm cell? With the help of regression analysis using panel data we can give a definite answer to the crucial question -- do condoms help or prevent the spread of HIV virus?

Previous studies based on data from the World Bank have shown a negative association between governance and HIV prevalence. Using the Index of African Governance, this study investigates the correlation between governance and HIV prevalence in all African countries (N = 53) in order to determine which dimension of governance is more predictive of this relationship. No statistically significant association was found between governance and HIV prevalence across the whole spectrum of countries. In the multivariate analysis, the most predictive dimension of governance, “Rule of Law, Transparency and Corruption” was found to be positively associated with HIV prevalence across all African countries (p <.001), Beta =.816 .When grouped by clusters, only two regions (North and West Africa) out of five showed negative significant associations between governance and HIV prevalence. The analysis of socio cultural and geographical factors revealed significant associations with HIV prevalence; religion and HIV prevalence ( p < .003), region, and HIV prevalence ( p < .001). French colonial heritage was found to be negatively associated with HIV prevalence. This study suggests that geographical location and religion predict HIV prevalence rather than governance. International organizations and public health program managers should consider these findings in the implementation of large multi-country and regional HIV programs in Africa.

The main aim of this thesis is to analyse the impact of HIV/AIDS on the reproductive behaviour of population of South Africa, its four racial groups and its nine provinces since the half of 1980's. Before the analysis of the impact of HIV/AIDS on reproductive behaviour was made, it was shown how big the problem of HIV/AIDS is in South Africa. The HIV incidence and prevalence were used for this purpose. The impact of HIV/AIDS was noticeable from the comparison of levels of fertility between HIV positive and negative women. The impact of HIV/AIDS on reproductive behaviour was further assessed using the decomposition methods and the statistical and epidemiological indicator called population attributable change. The results of analyses revealed the exceptional position of South Africa between other African countries that suffer from HIV/AIDS as well. A regression analysis showed that the growing prevalence of HIV increases the overall level of fertility. At the end of the thesis the projection of fertility till 2030 was made to illustrate the theoretical development of fertility provided that nobody become infected with HIV since the beginning of 2010.

ABSTRACT An Examination of the Differences in Risk Factors and their Association with Variations in HIV Prevalence between Cameroon, Cote d’Ivoire, and Senegal (Under the direction of RICHARD ROTHENBERG, M.D., M.P.H. FACULTY MEMBER) Background: Extensive evidence suggests there are large variations in the prevalence of HIV infection among Sub-Saharan African countries. Some studies associated these variations in HIV prevalence to differences in the rate of HIV spread while others attributed the variations to risky sexual behaviors. The purpose of this study was to examine differences in risk factors for HIV infection between Cameroon, Cote d’Ivoire, and Senegal, to determine the association between HIV status and risk factors within and among countries, and identify best predictive risk factors that help explain variations in HIV prevalence. Methods: A cross-sectional study was conducted using nationally representative data from The Demographic and Health Surveys Program. Population-based samples of adults aged 15-49 representing 21,878 in Cameroon (2011), 14,682 in Cote d’Ivoire (2011-2012), and 20,102 in Senegal (2010-2011) were used in the study. Descriptive analysis and binary logistic regression were performed using IBM Statistical Package for the Social Sciences. Odds ratios and 95% confidence interval were calculated, and models were explored. Results: There are statistically significant (p Conclusion: There are differences in risk factors among the three countries and these differences can explain some of the variations in HIV prevalence. Further research is necessary to help capture variations in HIV prevalence that cannot be explained by differences in risk factors. These findings will help advance prevention efforts. KEYWORDS: HIV, AIDS, risk factors, HIV infection, HIV prevalence, Sub-Saharan Africa

Introduction: HIV remains a leading cause of death globally, with over two-thirds of the cases in sub-Saharan Africa. Zimbabwe, a country located in East Africa, part of Sub-Saharan Africa, ranks in the top five countries with the highest prevalence of HIV in Africa (HIV prevalence in Zimbabwe estimated as 21.4% in 2019). Previous studies demonstrated HIV testing prevalence of 66.9% in East Africa. This study aimed to assess the prevalence of HIV testing amongst women of reproductive age in Zimbabwe, alongside some predictors of HIV testing amongst this population. Methods: Cross-sectional study design using the 2015 Demographic and Health Surveys (DHS) data for women aged 15-49. The prevalence of HIV testing as the outcome variable and the highest educational level, age at first sex, current marital status, and condom use as the predictor variables of interest were assessed. Descriptive statistics (frequencies, percents) and test of significance (using Chi-squared test)were conducted. Bivariate and multivariate logistic regression were completed to assess for the independent relationship between each predictor variable and HIV testing prevalence and, all predictor variables and HIV testing prevalence, respectively. Odds ratio estimates, 95% confidence intervals and p-values werereported. All analyses were performed using the Statistical Analysis System (SAS) version 9.4. The initial sample size included 9955 women. However, the effective sample size used in the statistical analysis was 7130 after accounting for missing variables. Results: About 9 in 10 women in the sample had ever been tested for HIV. Secondary education was the most prevalent highest level of education (64%). About 67% women had their first sex at age 15-19; peak incidence seen at ages 17 and 18 (15.3%). Multivariate analysis showed statistically significant associations between all independent variables and HIV testing (P-value Conclusion: Increasing highest educational level, age at first sex and condom use in Zimbabwe would likely increase the prevalence of HIV testing further. Focused education on the importance of HIV testing before the age of 15 will be beneficial in ensuring HIV testing as soon as sexual intercourse is established. Policy efforts are needed to address these HIV testing predictors. Causality is not implied.

The aim of this research was to investigate the HIV knowledge and risk behaviours of students as well as to deteremine whether the youth are aware of and utilising loveLife services. This was demonstrated with the HIV knowledge and risky behaviours of respondents using loveLife as their source of HIV information. Data was gathered by administering open-ended and close-ended questionnaires to 152 South African students aged 18—25 years old studying at Johannesburg, Braamfontein tertiary institutions. These questionnaires were structured to include the following information: the demography , condom attitude scale, the current and previous sexual behaviours, socio-sexual orientation index (SOI), self-efficacy for protective sexual behaviours scale, HIV and AIDS knowledge and understanding questionnaire,as well as the loveLife exposure, participation and response questionnaire. The data analysis techniques included statistical techniques of frequency counts, cross tabulations, Chi Square tests of associations, Point Biserial correlations, two independent t-test and Mann-Whitney U test, which were applied to all quantitative data; whereas thematic content analysis was applied to the open-ended questionnaire (qualitative data). Results revealed that young people are aware of loveLife services but are not utilising them. Respondents generally had good but biased HIV knowledge and increased HIV sexual risk behaviours. However, insignificant associations were found between awareness and utilisation of loveLife services and HIV knowledge and understanding, and sexual risk behaviours. The implications of the current study and recommendations for future studies are discussed.

Many researchers have documented the trend of decreasing financial support from donors for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) responses in Ethiopia. Less information is available regarding the correlation between trends of HIV prevalence and external funding and ways to address the impact that funding scarcity could cause. The purpose of this study was to examine the trend of HIV prevalence and donor funding levels, analyzing how the 2 are correlated, and opportunities to improve responses. Using the proximate determinant framework, the research questions examined the changes in HIV prevalence in Ethiopia during the past 10 years; the association between the trends of HIV prevalence, funding levels, and services provided; and the effect of different characteristics on the trend of the prevalence. A paired sample t-test, time series forecasting, Pearson correlation, chi-square test, and multiple regression were employed using a secondary data of sampled 1,067 people from the Demographic and Health Surveys and data from donors. Results indicated that the change in prevalence was statistically significant (t [10] = 4.59, p = .001), and correlated with the funding levels(r (10) = .635*, p = .027), a significant relationship between funding level and type of services, Ï?2 (2, N = 1067) = 1425.7, p <.001 and a significant regression equation to predict HIV prevalence (F (9, 1056) = 12.639, p < .001). The results from this study could be used to inform the Ministry of Health of Ethiopia and HIV project implementers to plan for domestic sustainable financing initiatives, invest based upon evidence-based HIV prevention strategies that could most directly impact quality of life and guide future research.

Thesis (MBA (Business Management))--University of Stellenbosch, 2008. / AFRIKAANSE OPSOMMING: Menslike immuungebrekvirus (MIV) en Verworwe immuniteitsgebrek sindroom (VIGS) is een van die grootste uitdagings waarvoor werkgewers vandag te staan kom, en behoort die stukrag te wees vir ’n deeglike ondersoek om die voorkoms van hierdie toestand in die werkplek so akkuraat as moontlik te bepaal. So ’n ondersoek kan lig werp op toekomstige demografiese arbeidsmagtendense en verwante koste, byvoorbeeld verlies aan produktiwiteit en dienslewering weens afwesigheid, ’n toename in aftredes, en stygende sieke- en pensioenfondseise wat waarskynlik ingedien sal word. Daarbenewens kan so ’n ondersoek die werkgewer in staat stel om noukeuriger vir die toekoms te beplan, vanuit die oogpunt van finansies sowel as menslike hulpbronne. Daar is egter ’n neiging by werkgewers om MIV/VIGS steeds as ’n maatskaplike of samelewingsprobleem eerder as ’n besigheidspesifieke risiko te beskou. Onkunde is meestal die rede hiervoor. Werkgewers neig om weg te skram van direkte risikobestuur, dikwels met die argument dat dit die regering se plig is om MIV/VIGS-opleiding en gesondheidsorg te voorsien. Sodoende word die bestaande verhouding van ‘ekwilibriumkonvergensie’ tussen die staat, sakesektor en arbeid verydel. MIV/VIGS moet soos ander groot geïdentifiseerde sakerisiko’s beskou, gemeet en proaktief bestuur word, net soos met wisselkoers wisselvalligheid, politieke en infrastrukturele risiko’s, en persoonlike en batesekuriteit. Hoewel hierdie risikofaktore dwarsoor die wêreld bestaan, en sommiges in ander wêrelddele groter is, het hul gekombineerde uitwerking veral in Suider-Afrika ernstige implikasies vir investering en die koste om hier sake te doen. Soos alle ander sakerisiko’s moet die hantering daarvan multidimensioneel wees: • Identifiseer, meet en bestuur die risiko; plaas MIV/VIGS eerste op die direksie se agenda. • Stel senior beamptes aan om die risiko te bestuur. • Evalueer bestuurstrukture en intervensie stappe gereeld. • MIV/VIGS opleiding is die sleutel, vir bestuurslede sowel as werknemers. Risikobestuur moet holisties wees. So byvoorbeeld is dit nutteloos om gesondheidsorg sonder proaktiewe pasiëntebestuur te voorsien. En net soos wat behandelingsplanne sonder befondsing sinloos is, is dit futiel om goed befondsde voordeelplanne te skep as behandeling nie toeganklik is nie. Die doel van hierdie studie is om die proses wat Old Mutual (SA) gevolg het om die voorkoms van MIV onder sy 13 000 permanente werknemers landwyd te eksploreer. Die statistiese uitkoms sal dan gebruik word om te bepaal of Old Mutual (SA) wel sy doelwitte in terme van werknemersgelykheid sal bereik en behou, gegewe die MIV/VIGS pandemie. Vooruitskouings oor die implikasies van MIV/VIGS vir Old Mutual (SA) moet met die nodige omsigtigheid benader word, alhoewel hierdie studie aandui dat dit moontlik implikasies kan inhou vir werkverskaffing in die toekoms, gegewe die wetlike vereistes vir die verskeie aangewese groepe. MIV/VIGS lei nie net tot siekte, ongeskiktheid en dood onder Old Mutual (SA) se werknemers nie. Tesame met ernstige ekonomiese en emosionele ontwrigting vir hul gesinne, verhoog dit ook die koste om in Suid-Afrika sake te doen. Hierdie koste sluit die volgende in: • verhoogde gesondheidsorgkoste; • meer eise vir aftree-, pensioen- en doodsvoordele; • laer produktiwiteit namate afwesigheid van die werk styg weens siekte, hetsy eie of siek familielede na wie omgesien moet word; en • verhoogde koste vir personeelwerwing, arbeidsomset en opleiding weens die verlies van ervare personeel. / ENGLISH ABSTRACT: Human Immunodeficiency Virus infection and the Acquired Immune Deficiency Syndrome (HIV/AIDS) is one of the greatest challenges facing employers today, and should provide the impetus for a thorough investigation among employees in order to arrive at an estimate of HIV prevalence within the workplace. Such an investigation could shed light on future demographic workforce trends as well as related costs, e.g. loss in productivity and service delivery due to absenteeism, increased retirement and a rise in medical aid and pension fund claims that the employer is likely to encounter. Furthermore, this investigation could enable the employer to plan better for the future – both from a financial and human resources viewpoint. In the ‘real’ world though, employers still perceive HIV/AIDS as a social or community problem rather than a business specific risk. Employers, largely through ignorance, tend to shy away from direct risk management – often using the argument that it is the government’s responsibility to provide HIV/AIDS education and healthcare. In this way they nullify the existing ‘equilibrium convergence’ relationship between the state, business and labour. HIV/AIDS must be measured and proactively managed and should be regarded in the same light as other major identified business risks, e.g. personal and asset security, exchange rate volatility, and political and infrastructure risks. While it is true that all of these particular risk factors exist across the globe, and may be greater in other parts of the world, nowhere else do they seem to combine with such severe implications to deter investment and raise the cost of doing business than in Southern Africa. As for any other business risk, the response should be multi-dimensional: • Identify, measure and manage; place HIV/AIDS at the top of board agendas. • Appoint senior executives to manage the risk. • Regularly evaluate management structures and interventions. • HIV/AIDS education is key to both management and employees. Risk management should be holistic. For example, providing healthcare without proactive patient management is pointless. Similarly, treatment plans without funding are futile, and well-funded benefit plans without practical access to treatment are a waste of time. The aim of this study is to explore the process Old Mutual (SA) followed in estimating the HIV prevalence among its 13 000 permanent employees nationally. The resultant statistics would then be used to project whether or not Old Mutual (SA) will be able to achieve and sustain its employment equity targets, given the HIV/AIDS pandemic. Predictions on the implications of HIV/AIDS for Old Mutual (SA) should be approached with due caution, although this study suggests that it could probably seriously impact on shortages in the supply of labour in future, given the legislative requirements for the various designated groupings. HIV/AIDS not only causes illness, disability and death among Old Mutual (SA) employees, coupled with severe economic and emotional disruption for their families, it also increases the cost of doing business in South Africa. These costs include: • increased healthcare expenses; • increased retirement, pension and death benefit claims; • decreased productivity as worker absenteeism rises owing to personal illness, or absence from work to care for sick relatives; and • increased recruitment, labour turnover and training costs due to loss of experienced workers.