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.

We know that Sweden's HIV communication strategy does not specifically address young women, while Botswana's HIV communication strategy does. The overarching aim of this study is therefore to investigate whether Sweden should and could learn from Botswana with regard to focus on women in the HIV communication strategy. To do so, the methods used are qualitative interviews and focus groups with young women in Sweden and Botswana, expert interviews with representatives from organizations in Sweden and Botswana as well as textual analysis of different HIV prevention strategies from both countries.   The results of this study shows that there seems to be a difference between young women’s risk perception and risk behaviour in Sweden and Botswana, a difference that can partly be explained by hoe respective country work with HIV prevention communication towards this group. This indicates that Sweden could learn from Botswana’s HIV prevention communication concerning how they work with young women as a target group and how gender equality and empowerment of women is part of Botswana’s communication strategy. However, because of the difference in HIV prevalence and because of the limited effect of communication measures, the difference in communication can only be considered a small part of the to why the differences exist.

Background: Women who inject drugs continue to represent a disproportionate percentage of new cases of HIV in Canada (PHAC, 2006). However, in Nova Scotia, HIV has still not been conceptualized as a major health issue, especially among women (Gahagan, Rehman & Baxter, 2006). At the same time, recent research findings suggest that female injection drug users in Nova Scotia are engaging in unsafe injection and sexual practices and often lack access to harm reduction-based programming and resources (Ploem, 2000; PHAC, 2006; Jackson et al., 2010; Parker et al., 2011; Hodder, 2011). In a provincial context of high prevalence of injection drug use and HIV risk behaviours, preventing increasing rates of HIV infection will depend on the development of proactive and gender-informed HIV prevention policies. Purpose: This study had two main aims. First, it aimed to chart the development of provincial HIV prevention and harm reduction policies and to identify how, and if, the policy development processes address the HIV prevention needs of women who inject drugs. Its second aim was to identify key barriers and facilitators to developing HIV prevention policy for women who inject drugs in Nova Scotia. Methods: This study involved a review of key HIV prevention and harm reduction policy documents as well as interviews with 27 key informants directly involved with HIV prevention and/or harm reduction policy decision-making. Findings/Discussion: The existing Nova Scotia-based policy development network, their policies, their processes and the context within which they have functioned over the past ten years do not appear to be supporting the development of HIV prevention and harm reduction policy which addresses the needs of women who inject drugs. Policy committee composition lacked inclusivity and organizations that work directly with women who inject drugs held less influence in policy processes. In addition, gender was not prioritized by decision-makers and therefore not comprehensively addressed in policy content. As a result, the needs of women who inject drugs have not been prioritized in policy processes and subsequently few targeted resources are going to the community-based organizations that provide services to these women.

No description available.

<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>

This thesis is an ethnographic study of the lives of thirty community HIV educators in KwaZulu-Natal, South Africa. Compared to quantitative studies this is a small number, but by keeping the number of participants small it has been possible to obtain an extensive understanding of the lives of each individual, which helps to explain why they make the decisions they do. The reason for choosing community HIV educators as the participants in this study is because it could be stated from the outset that they are well-informed about HIV prevention and, depending on the specific NGO they work for, they have been recipients of either ‘female empowerment’ or ‘responsible masculinity’ programmes. This is significant because early HIV prevention interventions have assumed that providing individuals with HIV awareness and gender equality programmes would lead to the implementation of HIV preventative behaviour. Studying the willingness and ability to implement HIV prevention practices of these particular individuals could therefore help to answer the question whether HIV awareness and gender-related programmes are indeed sufficient to create HIV preventative behaviour change. Furthermore, it was useful to hear from these participants what they experience as enabling and restricting factors when it comes to implementing HIV preventative behaviour. The core research question is: How do community HIV educators in KwaZulu-Natal negotiate HIV prevention in their everyday intimate relationships? The data presented in this thesis was collected during ten months of participant observation amongst community HIV educators whilst they were at work, at home, or out with their peers. To further aid the general understanding of Zulu culture, the researcher lived as part of a Zulu family for six months. The thesis presents several examples of community HIV educators who do not consistently use condoms in their everyday lives despite the fact that they promote the use of condoms. How is it possible that those who speak of being transformed as a result of HIV awareness and female empowerment or responsible masculinity programmes, and who promote condom use in their communities, do not always consistently use condoms in their personal lives? This thesis is concerned with trying to resolve this apparent illogicality. It argues that when individual interventions fail to lead to behaviour change it is because individuals act in relation to other people instead of in isolation. The thesis draws on the work of Bourdieu, particularly his concepts of habitus, field, and capital, to explain how structural factors influence individual practice. This means that the negotiation of HIV prevention is affected by what is generally considered appropriate in terms of existing dispositions. Hence the perception of a particular HIV prevention practice as either appropriate or inappropriate affects the ability of an individual to implement this practice. Examples are provided of how, when it comes to the practice of condom use, which has generally been perceived as inappropriate, structural factors have a restricting effect on HIV prevention. This thesis also provides examples of how, when it comes to the practice of medical male circumcision and virginity testing, which have generally been perceived as appropriate, structural factors actually have an encouraging effect on HIV prevention. As a result this thesis argues that instead of addressing individuals, HIV prevention interventions should address the collective. However, this thesis also argues that an increase in economic, cultural, social, and symbolic capital can suppress the effect of structural factors. To support this argument the thesis attends to individuals who, when they can afford to do so as a result of having capital at their disposal, deviate from collectively determined ideal practice, for example by discreetly negotiating HIV counselling and testing with their sexual partners.

Background The role of social capital for promoting health has been extensively studied in recent years but there are few attempts to investigate the possible influence of social capital on HIV prevention,particularly in developing countries. The overall aims of this thesis are to investigate the links between social capital and HIV infection and to contribute to the theoretical framework of the role of social capital for HIV prevention. Methods Key informant interviews with leaders of organizations, networks, social groups and communities and focus group discussions with members and non-members of the social groups and networks were conducted to map out and characterize various forms of social capital that may influenceHIV prevention. A quantitative community survey was carried out in three case communities toestimate the influence of social capital on HIV risk behaviors. A cross-sectional survey was conducted to estimate the HIV prevalence in the urban district representing a high HIV prevalence zone to determine the association between social capital and HIV infection. Main findings In early 1990’s many of the social groups in Kagera region were formed because of poverty and many AIDS related deaths. This formation of groups enhanced people’s social and economic support to group members during bereavement and celebrations as well as provided loans that empowered members economically. The social groups also put in place strict rules of conduct, which helped to create new norms, values and trust, which influenced sexual health andthereby enhanced HIV prevention. Formal organizations worked together with social groups and facilitated networking and provided avenues for exchange of information including healtheducation on HIV/AIDS. Individuals who had access to high levels of structural and cognitive social capital were more likely to use condoms with their casual sex partners compared to individuals with access to low levels. Women with access to high levels of structural social capital were more likely to use condoms with casual sex partners compared to those with low levels. Individuals with access to low levels of structural social capital were less likely to be tested for HIV compared to those with access to high levels. However, there was no association between access to cognitive social capital and being tested for HIV. Individuals who had access to low levels of both structural and cognitive social capital were more likely to be HIV positive compared to individuals who had access to high levels with a similar pattern among men and women. Conclusion This thesis indicates that social capital in its structural and cognitive forms is protective to HIV infection and has played an important role in the observed decline in HIV trends in the Kagera region. Structural and cognitive social capital has enabled community members to decrease number of sexual partners, delay sexual debut for the young generation, reduce opportunities for casual sex and empower community members to demand or use condoms. It is recommended that policy makers and programme managers consider involving grassroots’ social groups and networks in the design and delivery of interventions strategies to reduce HIV transmission.

A pocket of HIV infection has grown to epidemic proportions in a mostly Aboriginal1 community in Northern Alberta. At the start of the research my assumptions were that Aboriginal2 sexuality is affected by political, historical, cultural, psychological, and social factors that underpin the social determinants of health. STI/HIV is a symptom of the marginalized status of Aboriginal peoples who experienced historical trauma due to colonization. As an insider researcher, using an exploratory design I addressed the following questions: 1) is popular theatre a culturally appropriate medium for introducing information to increase knowledge of STI/HIV in an Aboriginal audience? 2) Is popular theatre an effective way to encourage audience members to express their attitudes, knowledge, and behaviours related to sexual health? 3) How are popular theatre and action research methodologically and conceptually appropriate for preventing STI/HIV? 4) How do the influence of elders and a popular theatre practitioner affect the intervention? 5) Can the use of action research and popular theatre influence the attitudes, knowledge, and behaviours to promote healthy sexual choices? 6) Is narrative analysis a good way for Aboriginal people to tell their stories or have their stories told? Completing this exploratory research was financially possible through the Aboriginal Health Strategy. The funds enabled me to recruit a popular theatre practitioner, a group of young Indigenous community members and supportive elders to answer my research questions. The data was obtained through one-to-one interviews, journals, talking circles, and field notes of the community-based theatre and action research process. Due to a lack of time in the field, narrative analysis was not used. Instead I introduced Grandmother Spider and developed a dream catcher that I refer to as the Indigenous Iterative Webbed Circle to analyze the real and fictional stories that led to the community performance of My Peoples Blood. The methods are appropriate and effective if the principles of Community Based Participatory Research and action research are followed by all group members involved in this popular theatre project.

Young people in South Africa, particularly females, are at great risk of acquiring HIV, and heterosexual sex is the predominant mode of HIV transmission. In order to curb the epidemic the Department of Health encourages all sectors in the society, including religious institutions, to respond effectively. The present thesis seeks to increase the understanding of the role of Christian communities in prevention of HIV for young people. Three denominations in KwaZulu-Natal were selected to reflect the diversity of Christian churches in South Africa: the Roman Catholic Church, the Evangelical Lutheran Church in Southern Africa, and the Assemblies of God. Using qualitative interviews the first paper explores how religious leaders (n=16) deal with the conflict between the values of the church and young people’s sexuality. Study II reports on attitudes to HIV prevention for young people among religious leaders (n=215) using questionnaire survey data. Study III investigates how young people (n=62) reflect on messages received from their churches regarding premarital sex by analysing nine focus group discussions. In the fourth paper, based on questionnaire survey data, we report on young people’s (n=811) experiences of relationships with the opposite sex and their perceived risk of HIV infection. The view that young people in churches are sexually active before marriage was common among religious leadership. The majority of religious leaders also reported that they are responsible for educating young people about HIV prevention. Religious leaders who had received training on HIV were more likely to run a life skills programme for young people, however they were ambivalent about prevention messages. Young people reported premarital sexual abstinence as the main HIV prevention message from their churches. The majority responded that they had received information about HIV in church. To be in a relationship was common, more so for males for whom multiple relationships also were viewed more acceptable. To perceive themselves at risk of HIV infection was common. Further training for religious leaders is needed to enable them to manage the conflict between the doctrine of the church and their willingness to assist young people in the transition into adulthood. / Faculty of Medicine

The project described in this thesis was designed to investigate HIV preventive behaviour in heterosexual adolescents from a social-cognitive perspective. The project consisted of three studies. The design of each study was guided by a theory of human decision making, the Theory of Reasoned Action (TRA), and its extension, the Theory of Planned Behaviour (TPB). In the first phase, an elicitation study was conducted in which characteristics of the population were identified. This study consisted of a series of semi-structured interviews in which participants' sexual behaviours, beliefs and normative influences were elicited. This information was required in order to enable studies two and three to target beliefs and behaviours relevant to the population being examined. In the second study, a large-scale survey of 417 university aged adolescents was conducted. This study was designed, primarily, to examine quantitatively the determinants of safe sex intentions and behaviours within the targeted population. Determinants of behaviour examined were those included in the TRA/TPB. Hierarchical multiple regression analyses were conducted to determine the amount of variance in safe sex intentions and behaviours accounted for by TRA/TPB variables. In addition, a number of methodological issues related to criticisms of the TRA/TPB in the context of prediction of sexual behaviours were investigated. These issues included the utility of examining preference for alternative safe sex strategies in accounting for non-use of condoms, the importance of considering behaviour change as a process rather than an outcome, the importance of heat of the moment decision-making in the prediction of condom use behaviour, and the importance of consistent specification of partner type in survey instruments examining condom use behaviour. The third phase of the project consisted of an intervention study designed to modify HIV-risk related beliefs and behaviours. Design and evaluation of the intervention were guided by the TRA/TPB. The intervention was conducted using 102 participants, randomly assigned to intervention or control conditions. Methodological issues examined in study 2 were further explored in this study. Overall, it was found that the Theories of Reasoned Action and Planned Behaviour provided a useful framework for understanding, predicting, and modifying HIV-related sexual behaviours. The theories were found to explain between 67 and 73% of variance in condom use intentions, and between 52 and 55% of variance in behaviour. The theories were also found to be applicable to other safe sex behaviours with 50% of variance accounted for in monogamy intentions, and 34% of variance explained in behaviour, and 40% of the variance in non-penetrative sexual intentions, but only 6% of variance in non-penetrative sexual behaviour explained. In addition, a behaviour modification intervention based on the theories was found to lead to change in both predictor variables and behaviours, relative to controls. These changes were maintained over a 6-month follow-up period. That is, a series of mixed factorial Analyses of Variance revealed that the percentage of encounters in which a condom was used was significantly greater for the four weeks prior to follow-up compared with the four weeks prior to the intervention. In addition, the number of 'slip-ups' into unsafe behaviours was found to be significantly less. Change in TRA/TPB predictor variables which accompanied these behavioural changes included increased perceptions of behavioural control, more positive attitudes towards sexuality and safe sex behaviours, and more positive normative perceptions. These results were seen to provide strong support for the theories of reasoned action and planned behaviour and for their relevance to the study of HIV-preventive behaviour. However, prediction of safe sex behaviours was found to be enhanced in most cases by consideration of the methodological issues explored in each study. Thus, it was found that consideration of safe sex strategies other than condom use and the type of partner with whom the behaviour was occurring were important in both the prediction and evaluation of efforts to modify condom use behaviour. In addition, prediction of condom use behaviour and evaluation of intervention effects were enhanced by the consideration of behaviour change as a stage-like process, rather than as an all or nothing outcome. Results relating to the importance of heat of the moment decision making were less clear, and further research is recommended to clarify the issue. Overall, these results have important implications for safe sex education, and should be considered in efforts to modify unsafe behaviour as well as efforts to evaluate the effects of this modification.