The aim of this qualitative study was to explore the vulnerability to HIV of rural male youth with regard to their beliefs, sexual attitudes and behaviour. The study took place in the Waterberg, a district of Limpopo in South Africa, and provided insight into and understanding of the youths’ attitudes to and intentions regarding HIV prevention and their perceptions of how they were influenced by the Boys2Men programme. The Theory of Reasoned Action and the Social Constructionist Theory provided a framework for the study. Nine participants between the ages of 19 and 26 were purposefully selected, and data was collected via individual face-to-face and focus group interviews. A number of semi-structured questions were used to guide the study, and data captured from the interviews was analysed by thematic content analysis. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

In many South African communities, socially constructed masculinity norms that promote unequal gender relations and high risk sexual behaviour are key contributing factors to HIV transmission. Following a qualitative approach, using in-depth interviews, this study engaged graduates of the Tavern Intervention Programme (TIP) in Gauteng to explore and describe their perceptions of traditional and modern masculinities, as well as their experience of the TIP. The findings indicated that, while there are differences between traditional and modern men, several masculinity practices, such as unequal gender relations, inconsistent use of condoms, infrequent accessing of HIV testing opportunities and entitlement to multiple partners endure as potential barriers to HIV prevention. Additionally, peer groups reinforce and reward HIV risk behaviour among modern men. Participants did, however, report changes in perceptions and behaviour regarding gender relations and HIV prevention as a result of their participation in the TIP. This study concluded that the role the TIP played in providing these men with an environment where alternative masculinity behaviour could be explored and supported was of particular value in terms of changes in their perceptions of masculinities, gender relations and HIV prevention. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

<p>This thesis is an analysis of how international policies on HIV prevention can be understood through a postcolonial perspective and how these prevention strategies are reflected nationally and locally in Babati, Tanzania. To gain knowledge of these aims I have focused on UNAIDS and the US’ government policies to get an idea of where the international discourse about HIV prevention stands. My empirical data in Babati is collected by semi-structural interviews with people who work with HIV prevention. I have used Chandra Talpade Mohanty’s understanding of Third World women, together with Jenny Kitzinger theory about women in HIV discourses and Karen M Booth’s view of how international policies are trying to empower women to reduce their risk of HIV infection. To assist my analysis I have focused on three notions, which are recurring in the HIV prevention discourse, these are: empowerment of women, condom use and sexual behaviour. These notions help to establish the HIV discourse and later I have compared the results with my theoretical framework and empirical findings. My final conclusion is that international policies on HIV prevention can be seen as imperialistic as they are promoting a certain change in sexual behaviour, such as reduction of partners and abstinence until marriage.</p>

This study sought to increase knowledge as it relates to HIV-prevention for older adults, especially for MSM who are HIV-negative. In participating in this study, participants shared their experiences, stories and feelings related to their exposure to HIV and HIV-prevention initiatives. Using a Traditional Grounded Theory method, 22 interviews with older MSM were conducted with the aim of producing a theory that explained how these men lived prior to HIV, the different ways they responded to the onset of the virus, how they have lived their lives over the last three decades, and the extent to which the virus continues to impact their lives.

The current project involved three studies designed to examine which characteristics of persuasive communications change condom use attitudes. Study 1 investigated the effect of message type (affective versus cognitive) and source (male versus female) on attitude change among a sample of African American women attending college. In Study 1 (N = 146), the affective message and female source produced the most positive change in condom use attitudes. Study 2 examined whether message type and source were associated with favorable condom attitudes in a community sample and whether these findings differed from a college sample. Twenty-seven women participated in group discussions and completed measures of attitudes and intentions. Similar to Study 1, the pattern of means in Study 2 showed the affective message delivered by the female source resulted in the most positive condom use attitude change. These results were not significant likely due to the small sample. Focus groups were also conducted to better understand the types of condom use messages African American women find effective. Several themes emerged: condom used primarily for pregnancy prevention; negative condom use attitudes; communicating messages through internet, TV, and radio; creating fun, catchy, and informative messages; using celebrities and peers to deliver messages; and increasing the frequency of messages to equal importance of topic. The third study assessed the effectiveness of an attitude change pilot intervention that was based on the results of Studies 1 and 2. The study used a 2 (intervention vs. control) X 3 (pretest, posttest, follow-up) mixed factorial design to examine whether women’s attitudes changed after a pilot session and whether the change persisted over time. African American women (N = 115) were recruited through Craigslist and community agencies. There were no significant differences across time for the intervention and the control group. Reasons for the lack of an effect in Study 3 are discussed. Taken together, these studies provide evidence that, under certain conditions an affective message delivered by a female source can change attitudes toward using condoms. The results of these studies could potentially enhance existing interventions by renewing a focus on changing attitudes as well as behavior.

there is a growing body of research on men who have sex with men (MSM) and risk factors for HIV in South Africa. However, in order to develop more appropriate and relevant interventions to reduce the transmission of HIV amongst MSM and MSMW, there was a need to deepen our understanding of sexual risk behaviour and protective practices. The aim of the study was to explore the sexual risk and protective behaviour of men who have sex with men and women in Soweto, South Africa.

A thesis completed by published work, Submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa 24 May 2017. / Introduction: Prevention of mother-to-child transmission (PMTCT) has potential to eliminate new HIV infections among infants. Yet, in many settings in sub-Saharan Africa, women are unable to adhere to PMTCT recommendations due to social constraints. One such factor may be intimate partner violence (IPV), or any actions taken by a relationship partner that cause physical, sexual, or psychological harm. Despite theoretical and empirical rationale for understanding the links between IPV and PMTCT adherence, few studies in the extant literature have explored this association. Methods: This thesis draws upon four distinct studies that interface using an overall mixed method study design. The first study is a systematic review of the literature around women’s experience of lifetime IPV and adherence to anti-retroviral treatment (ART). The second study is formative qualitative research with pregnant women, health workers, and other local stakeholders that explores how IPV may be related to PMTCT in the urban Johannesburg setting. The third study is a deeper qualitative examination of women living with both IPV and HIV, aiming to understand the mechanisms that link partner violence to PMTCT behaviors using a social constructionist lens. The final study is a quantitative cohort study nested within a randomized control trial testing an intervention for IPV in pregnancy. Using regression techniques and structural equation modeling, I aim to determine the association between IPV and ART adherence in pregnancy and postpartum and identify pathways that mediate the relationship between partner violence and PMTCT. Results: This doctoral research contributes several new findings to the extant literature around PMTCT. I find that IPV is related to ART adherence among HIV-positive women in extant literature, with meta-analysis showing significantly worse odds of ART uptake, self-reported adherence, and viral suppression among women reporting lifetime IPV. In one of first of studies among women in sub-Saharan Africa, I learn that impact of IPV on ART adherence in pregnancy and postpartum is marked. I identify several mechanisms through which IPV influences PMTCT adherence. Mental health emerges as a robust pathway linking IPV to worse adherence in both qualitative and quantitative papers. Partner non-disclosure due to IPV can impede adherence, or women can navigate this challenge through hiding their HIV status or medication. Women experiencing IPV may attend fewer antenatal clinic visits, leading to worsened adherence. An unexpected finding was that women in our qualitative and quantitative studies were resilient and used strategies to adhere despite IPV. Motherhood seems to be a central feature of women who are resilient to the effects of IPV on adherence. Conclusion: The findings of this research have implications for research, policy, and practice. Research should incorporate social factors, such as IPV, into future studies testing PMTCT adherence interventions. Clinical practice and HIV programs should recognize that partner-level dynamics such as IPV may drive persistent gaps in PMTCT coverage. HIV policy urgently needs to incorporate ethical and safety considerations for women who experience IPV around the time of pregnancy. Women living with recent or past IPV are highly resilient and often want to protect their own health and that of their children. Only by recognizing and addressing their experience within the context of HIV care can future PMTCT programs and studies ensure maternal and infant health. / MT2017

Thesis (M.A. (Research Psychology)) --University of Limpopo, 2010 / This study measures the relationship between the AIDS risk reduction model (ARRM) variables associated with HIV related risk behaviours on learners from a South African rural community. A cross-sectional study was conducted using 308 learners in a Limpopo rural high school to identify HIV risk behaviours. Data were analyzed using binary logistic regression to test the usefulness of ARRM variables in predicting sexual risk. Sexual risk was measured as; (a) vaginal sex without a condom, (b) anal sex without a condom (c) number of sexual partners in the last twelve months and (d) time taken before having sex with a new partner. Two of the ARRM variables, that is perceived susceptibility and sexual response efficacy, were found to be the most important predictors of HIV related risk behaviours. There is an argent need for effective preventive activities in rural areas, especially through school-based interventions. Key words: ARRM HIV HIV prevention Risk behaviors

HIV prevention programs in schools are acknowledged as one of the best prospects for controlling the world HIV epidemic. Epidemiological evidence indicates that deaths world-wide from AIDS are yet to peak. Although HIV notifications and AIDS deaths in the total Australian population have decreased', there has been an increase in rates in the Australian Indigenous population. There is also some evidence of complacency in HIV prevention vigilance in Australia which indicates a need for continued focus on prevention programs. The knowledge levels, attitudes toward HIV risk, and risk-taking behaviours of young Australians place them at risk of exposure to HIV. Appropriate prevention programs can be delivered to these vulnerable young people through the school setting. Programs delivered in schools have been shown to have a positive effect and teachers are vital to the delivery of these education programs. Without appropriate training, however, teachers may not optimise the outcomes of these programs. While it would be desirable for teachers to be trained in HIV prevention education in pre-service training this has not been the case in Western Australia (WA). When there is not an opportunity for pre-service training, professional development programs can be implemented to provide additional training required by teachers. Traditionally this professional development has been provided through workshops. These face-to-face delivery methods, however, do not always adequately serve the needs of all teachers, and in particular the needs of teachers in rural and remote areas. In an attempt to address the needs of these teachers, alternate methods of professional development delivery may be appropriate. The aim of this study was to test an alternate method of delivery. / The study designed, disseminated and evaluated the implementation of a flexible learning professional development program for teachers of HIV education. The program was based on print-based distance learning, supported by a video and tutors. Five objectives were developed for the study. These objectives were: Objective One - To determine factors associated with teachers' enrolment in the Protect Yourself Program (PYP). Objective Two - To determine the association between factors related to entry characteristics, social integration, external attribution, academic integration and incompatibility and amount of PYP completed. Objective Three - To determine the association between amount of PYP completed and factors related to the teaching of HIV lessons. Objective Four - To examine the context in which intervention and comparison group teachers were operating for this study. Objective Five - To evaluate the process of teacher recruitment to PYP, satisfaction with the flexible learning methodology, satisfaction with the PYP materials and completion of PYP. A comprehensive theoretical framework was constructed to guide the development of the empirical study and the professional development program, as little evidence was found in the literature of similar empirically evaluated studies. This framework incorporated: Adult Learning Theory; the Model of Student Progress; the PRECEDEPROCEED Model; the Health Promoting Schools Framework; Diffusion of Innovation and the Communication Behaviour Change Model. The study was conducted in two parts. Firstly, an exploratory study was conducted which provided a basis upon which to implement the second, larger empirical study. / A quasi-experimental study design was implemented due to restrictions placed upon the study by the WA Department of Health, the funding agency. The study sample was made up of teachers from government and independent, primary and second schools in WA. In total, 126 teachers were recruited to the intervention group and enrolled in the professional development program, and 128 to the comparison group, who completed some of the evaluation instruments, but did not participate in a professional development program. The professional development intervention program incorporated four comprehensive work modules, which were delivered in print form. A video and tutorial support supplemented the print materials. To evaluate the professional development program, seven instruments were developed. From these instruments five categories of variables were created, namely demographic, contextual, teacher characteristics, process and dependent. These variables were developed as single item variables, scales or indices. Quantitative data were analysed using the Statistical Package for the Social Sciences and a combination of univariate, bivariate, and multivariate techniques (logistic regression and analysis of covariance) were conducted. Qualitative data were analysed for themes. A binary logistic regression was conducted to evaluate Objective One: to determine factors associated with teachers’ enrolment in PYP. The analysis identified four factors which were associated with enrolment in PYP. / The teachers most likely to enrol in PYP had no pre-service training in health education and did not consider themselves to be a specialist or coordinator of health education. The majority of program participants had been teaching health education for between three and seven years and displayed a high level of acceptance of the flexible learning methodology. Objective Two: to determine the association between factors related to entry characteristics, social integration, external attribution, academic integration and incompatibility and amount of PYP completed was evaluated using a nominal logistic regression analysis with the intervention group sample only. Completion of the PYP program by participants was related to circumstances which were often beyond the control of the program, such as events occurring in a teacher’s personal life. However, teachers who showed a preference for flexible learning were found to be more successful in completing the program. The effects of PYP were measured by Objective Three: to determine the association between amount of PYP completed and factors related to the teaching of HIV lessons. Three of the six factors considered by this objective returned a significant association with program dose. Teacher perceived access to HIV education resources was found to be positively related to the dose of materials a participant completed. / Participants who completed a high dose of the program considered HIV resources to be relatively easier to access than participants completing a low dose. Teachers who completed a high dose of PYP reported being more comfortable to teach HIV lessons than teachers completing a mid dose. In addition, intervention group teachers showed a significant change in comfort with their ability to teach HIV lessons and specified HIV topics to Years 8, 9, and 10 classes and intervention group teachers of Year 8 students thought the HIV topics were less important for this level of students. The final variable to show a significant change over time when dose of the program was considered was teacher sexual conservativeness. Both high and mid dose participants reported being less sexually conservative than low or no dose participants from pre to midtest. The context of the teachers participating in the PYP study was investigated through Objective Four: to examine the context in which intervention and Comparison group teachers were operating for this study. Two factors were found to be associated with gender, six with school location and eleven with level of teaching. These associations provided important contextual information for interpreting the findings of the study. Objective Five evaluated the process of teacher recruitment to PYP, satisfaction with the flexible learning methodology, satisfaction with the PYP materials and completion of PYP. The recruitment strategies implemented for PYP were effective in having teachers from government and independent schools in WA recruited to PYP. / However, more than 90% of the intervention group were from government schools. Schools encouraged more than one teacher from a school to enrol, with nine primary schools, four district high schools, one community high school, one secondary college, four senior high schools and one combined independent primary and high school enrolling more than one teacher in the program. The flexible learning methodology was reported to be suitable for the needs of teachers who enrolled in PYP, as they felt comfortable with the learning methodology and appreciated the opportunity to choose when and where they completed the program. The opportunity for face-to-face contact, however, was still preferred by some teachers. The materials within the program were considered to be appropriate and useful. The writing style and activities were well received and the efforts of the tutors were welcomed by the majority of the intervention group. One third of teachers who enrolled in PYP completed at least some of the materials, but less than 10% completed the entire program. The most frequent suggestions made for increasing program completion rates were to set dates for completion of the program modules and to allow time release to complete the program. At baseline, this research showed that teachers considered it important for their students to have access to HIV education, but many of these teachers did not feel comfortable providing HIV education for their students. / As positive effects were observed in the PYP program of impact of program dose on factors affecting the implementation of HIV education, it would appear that flexible learning professional development was a suitable alternative to face-to-face professional development. Teachers' acceptance of flexible learning professional development as an alternate methodology, however, appears to be in its infancy and will require more empirical research. Future research, study design improvements and intervention design improvements can be informed by the following recommendations. Future research Recommendation 1: There be more rigorous investigation of flexible learning as a methodology for provision of professional development for teachers of health education. Recommendation 2: The status of claiming credit for professional development toward postgraduate qualifications for teachers continue to be investigated. Recommendation 3 : Further research be undertaken to evaluate available technologies and their acceptance by teachers as a delivery method for flexible learning professional development. Study design improvements Recommendation 4: design limitations of the PYP study. Future research be designed to overcome the study Intervention design improvements Recommendation 5: The findings of the PYP study and suggestions made by PYP participants be used to improve future health education professional development programs.

<p>This study investigates the content and nature of the HIV and AIDS &ldquo / discourses&rdquo / of teachers, which I have identified as a knowledge gap in the existing HIV and AIDS education literature that, presumably, is informing practice. The argument is that, without an understanding of teachers&rsquo / HIV and AIDS discourses, we will continue to speculate about why HIV education often does not have the effect we expect of it &ndash / reduced HIV infection, reduced risk behaviour, reduced teenage pregnancies &ndash / and why it has been regarded as a failure by many. The public media often expose rampant teenage sexual behaviour, such as abortions, pregnancies, and an addiction for electronically generated pornographic materials, causing consternation and sending shockwaves through schools and society. These reports attest to the kind of risky sexual behaviour which makes children vulnerable to HIV infection. In spite of more than twenty years of HIV and AIDS education, teachers and society at large remain uncertain and uncomfortable about teenage sexual behaviour, HIV infection and the inability of adults to protect young people from sexual exploitation.</p>