Background. The study explored associations between factors derived from the application of the Theory of Gender and Power (TGP) as they relate to HIV-risk behaviour among Middle Eastern/Arab-Canadians. This area deserves increased attention, as the proportion of HIV incident cases among Canadian women—due to heterosexual transmission—is increasing. Methods. A web-based survey was administered to Middle Eastern/Arab-Canadians who were aged 18-35 years, of Middle Eastern and/or Arab descent, living in Canada, heterosexual, and in a relationship. Multivariate regression analyses were used to assess factors associated with condom-use risk and lifetime number of sexual partners. Analyses were stratified by gender. Results. The study sample consisted of 157 participants, with more female participants (65.38%), and a mean age of 22.71 years. Females were more likely to have an older partner and more likely to be virgins, compared to males. Only a third (27.45%) of sexually active participants in this sample reported using condoms every time they have sex and participants reported a mean of 4.31 lifetime sexual partners. Factors associated with both condom-use risk and lifetime number of sexual partners varied greatly between genders. Among females, having low self efficacy towards practicing safer sex was predictive of condom-use risk. Among males, not being worried about getting HIV was predictive of condom-use risk. Thinking they knew how to use condoms was predictive of having more sexual partners among females, while being low acculturated from Middle Eastern culture was predictive of more partners among males. Conclusions. Factors associated with HIV risk varied greatly between genders among this sample and may contribute to power imbalances within relationships. The application of the TGP to this sample was moderately successful in predicting number of sexual partners among females and condom-use risk among males. However, it was not as successful in predicting condom-use risk among females and number of sexual partners among males. Many factors associated with HIV risk have been identified in this study, and should be used to create interventions designed to increase equality within Middle Eastern/Arab-Canadian relationships. However, many issues are discussed that still need to be addressed in future research.

Purpose: The purpose of this study is to evaluate and compare the extent and potential correlates of sexual risk taking behaviors related to condom use and number of sexual partners among Haitians aged 15 to 49 years old living in the urban and rural areas. Methods: Data were obtained from the 2005-2006 cross-sectional survey conducted by the Demographic Health survey. Our study population (15143) was analyzed based on the Health Belief Model (HBM) theory using a bivariate and multiple logistic regression analysis with SPSS for windows. Results: In both rural and urban areas dwellers had an accurate knowledge of the disease. However, a small proportion in both areas used condoms during their last sexual intercourse. Perceiving the disease's severity was more likely associated with condom use in the urban (OR 1.36, p ≤ .01) and in the rural areas (OR 1.45, p ≤.05). Strong associations have been found between some variables of the HBM and condom use but none have been found associated with zero or one sex partner. Findings were similar in both areas Conclusion: Holistic approach should be considered in the prevention strategy conducted in Haiti to tackle other factors that may contribute in delaying responsible sexual behavior in that country.

<p>Since the early 1980&rsquo / s when the first case of HIV was diagnosed, AIDS remains a serious and threatening health crisis in the world. Sub-Saharan Africa is the region most affected by the HIV/AIDS pandemic having 67 % of the 33 million people infected with HIV globally in 2007. Young people aged 15-24&nbsp / account for an estimated 45% of all new HIV infections worldwide. The study aimed to assess the knowledge and attitudes on HIV/AIDS and sexual&nbsp / behavior among 15-19 year olds in Kenya. A descriptive, cross-sectional survey was conducted among 96 students randomly selected from five public&nbsp / schools in Ngong sub-district. Descriptive and bivariate analysis was conducted using Epi Info 3.3 and SPSS. The main findings indicate that a third&nbsp / (31/96) of respondents were sexually experienced. Knowledge level was however found to be inadequate (below 60 %) indicating a poorly informed sample on knowledge about HIV transmission and prevention. The study showed poor attitudes towards the risk to HIV as only 40 % of both males and females supported the use of condoms even when the sexual partners know each other well. Inaddition, risky sexual behaviors were reported by sexually&nbsp / &nbsp / experienced respondents where condom use in last sexual intercourse was (57 %) among males and (20 %) among females.</p>

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.

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

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-08-25T18:56:22Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação SANTOS, RB.pdf: 1093679 bytes, checksum: 4dfc2476f164e7599ae8b5b618d48793 (MD5) / Made available in DSpace on 2016-08-25T18:56:22Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação SANTOS, RB.pdf: 1093679 bytes, checksum: 4dfc2476f164e7599ae8b5b618d48793 (MD5) Previous issue date: 2014-04-08 / Historicamente o HIV entre os usuários de drogas é transmitido com maior frequência através do compartilhamento de agulhas e seringas. No entanto, drogas como o crack e o álcool estimulam comportamentos sexuais inseguros favorecendo a transmissão do vírus por via sexual. A droga predominante no Nordeste do Brasil é o álcool, no entanto esta região concentra o maior número de usuários de crack do país. Desta forma, acredita-se que existe uma alta prevalência da infecção entre os usuários de drogas, inclusive nas cidades do interior do Nordeste. O objetivo deste estudo foi estimar a prevalência e os fatores associados a infecção pelo HIV em usuários de drogas internados ou em atendimento ambulatorial em cinco centros de reabilitação para dependência química em uma cidade de médio porte na Região Nordeste do Brasil. O delineamento do estudo é de corte transversal analisado como caso-controle. Foi conduzido em cinco centros de reabilitação para dependência química na cidade de Caruaru, Pernambuco, Brasil, no período de novembro de 2012 a novembro de 2013. Participaram da pesquisa 561 usuários de drogas lícitas e ilícitas que estavam internados ou em atendimento ambulatorial, sem limite de idade. Todos foram submetidos a uma entrevista e realização de teste rápido de HIV após assinatura do Termo de Consentimento Livre e Esclarecido ou Termo de Assentimento Livre e Esclarecido. O resultado do estudo identificou que a prevalência do HIV entre os usuários de drogas foi de 4,8%. O sexo feminino foi associado de forma independente com o HIV (p = 0,018; OR = 3,19; IC95% = 1,22 – 8,34), assim como a idade da primeira relação sexual (p = 0,012; OR = 1,17; IC95% = 1,03 – 1,33), a troca de sexo por crack (p = 0,031; OR = 2,81; IC95% = 1,10 – 7,19) e ter parceiro que usa crack (p = 0,035; OR = 3,89; IC95% = 1,10 – 13,7). O álcool é consumido por 96,3% dos participantes, mas não houve associação estatística com o HIV, assim como o uso da maconha (86,5%), do crack (82,5%), da cocaína (65,1%) e drogas injetáveis (10%). Embora os participantes do estudo tenham referido o uso de múltiplas drogas ilícitas durante a vida, percebeu-se a maior prevalência do consumo de crack entre eles. Contudo, esta investigação não mostrou associação isolada do crack ou outra droga em relação à infecção pelo HIV. No entanto, o consumo do crack estimula a prática sexual de risco, troca de sexo por crack e sexo comercial, favorecendo a infecção. Este é o primeiro estudo realizado no município de Caruaru, focando a investigação sorológica e os fatores de risco para HIV entre os usuários de drogas da região. Os achados confirmam a necessidade de implantação ou ampliação de unidades de testagem, aconselhamento e tratamento do HIV entre os usuários de droga no município. / Historically, HIV infection among drug users has generally been transmitted through the sharing of needles and syringes. However, drugs such as crack and alcohol encourage unsafe sexual behaviour, which is responsible for transmitting the virus through sex. Although the predominant drug in the north-eastern region of Brazil is alcohol, this region presents the largest number of crack users in the whole country. Hence, it is believed that there is a high prevalence of infection amongst drug users, including cities in the interior. The aim of this study was to estimate the prevalence and factors associated with HIV infection in inpatient and outpatient drug users at five drug rehabilitation centres in a medium-sized city in north-eastern Brazil. This was a case-control cross-sectional study, and was conducted in five drug rehabilitation centres in the city of Caruaru, in the state of Pernambuco, Brazil, from November 2012 to November 2013. A total of 561 licit and illicit drug users took part in the study. All participants were receiving either inpatient or outpatient care and there was no age limit. All patients underwent an interview and a rapid HIV test after signing the informed consent forms. Results of the study demonstrated that there was a prevalence of HIV among drug users of 4.8%. Females were independently associated with HIV (p=0.018; OR=3.19, 95% CI =1.22 to 8.34), together with age of the first sexual intercourse (p = 0.012; OR =1 17, 95% CI=1.03 to 1.33), the exchange of sex for crack (p=0.031, OR =2.81, 95% CI=1.10 to 7.19) and having a partner who uses crack ( p=0.035; OR=3.89, 95% CI=1.10 to 13.7). Alcohol was consumed by 96.3% of all participants; however, there was no statistical association with HIV, or with the use of marijuana (86.5%), crack (82.5%), cocaine (65.1) and injected drugs (10%). Although study participants reported the use of multiple illicit drugs during their lifetime, they presented with a higher prevalence of crack use. However, the present study did not indicate an isolated association of crack or other drugs in relation to HIV infection. Nonetheless, crack consumption encourages the risks of unprotected sex, sex-for-crack exchanges and commercial sex, thus favouring infection. This has been the first study conducted in the city of Caruaru, which focuses on serological investigation and risk factors for HIV among drug users in the region. The findings confirm the need to implement and expand testing facilities, counselling services and HIV treatment among drug users in the city.

Magister Public Health - MPH / Since the early 1980s when the first case of HIV was diagnosed, AIDS remains a serious and threatening health crisis in the world. Sub-Saharan Africa is the region most affected by the HIV/AIDS pandemic having 67 % of the 33 million people infected with HIV globally in 2007. Young people aged 15-24 account for an estimated 45% of all new HIV infections worldwide. The study aimed to assess the knowledge and attitudes on HIV/AIDS and sexual behavior among 15-19 year olds in Kenya. A descriptive, cross-sectional survey was conducted among 96 students randomly selected from five public schools in Ngong sub-district. Descriptive and bivariate analysis was conducted using Epi Info 3.3 and SPSS. The main findings indicate that a third (31/96) of respondents were sexually experienced. Knowledge level was however found to be inadequate (below 60 %) indicating a poorly informed sample on knowledge about HIV transmission and prevention. The study showed poor attitudes towards the risk to HIV as only 40 % of both males and females supported the use of condoms even when the sexual partners know each other well. Inaddition, risky sexual behaviors were reported by sexually experienced respondents where condom use in last sexual intercourse was (57 %) among males and (20 %) among females. / South Africa

Migrant workers are one of the most rapidly growing populations in the United States (U.S.) and have been significantly affected by HIV/AIDS. More than 9 million people in the U.S., primarily concentrated in Texas, Florida, Washington, California, Oregon, and North Carolina, are migrant farm workers. High prevalence rates are also suspected among migrant worker communities where risky health behaviors appear to be common. Constant mobility, isolation, limited education, substandard housing, and poverty are some of the factors that migrant workers experience and in many cases increases their HIV risk. Recent studies have suggested that ethnic identity or the level of attachment with one’s ethnic group may influence engagement in HIV risk behaviors, a fact that may be important in the development of interventions among ethnic minorities. This study assesses the relationship between ethnic identity and HIV risk behaviors in two different samples; one assesses this relationship at baseline with a total of 431 African American migrant and seasonal workers in Immokalee, Florida. The second analyzes changes in ethnic identity and HIV behaviors in a sample of 270 Hispanic and African American migrant and seasonal workers in Immokalee, Florida. Data from baseline and 6-month follow-up were used in the analyses presented. The results suggest that individuals with higher levels of ethnic identity report lower levels of engagement in some, but not all, of the risky behaviors examined. These findings point to a potentially protective role for ethnic identity among this sample.

Social capital, or social cohesion or group connectedness, can influence both HIV risk behavior and substance use. Because recent immigrants undergo a change in environment, one of the consequences can be a change in social capital. There may be an association among changes in social capital, and HIV risk behavior and substance use post immigration. The dissertation focused on the interface of these three variables among recent Latino immigrants (RLIs) in South Florida. The first manuscript is a systematic review of social capital and HIV risk behavior, and served as a partial background for the second and third manuscripts. Twelve papers with a measure of social capital as an independent variable and HIV risk as the dependent variable were included in the analysis. Eleven studies measured social capital at the individual level, and one study measured social capital at the group level. HIV risk was influenced by social capital, but the type of influence was dependent on the type of social capital and on the study population. Cognitive social capital, or levels of collective action, was protective against HIV in both men and women. The role of structural social capital, or levels of civic engagement/group participation, on HIV risk was dependent on the type of structural social capital and varied by gender. Microfinance programs and functional group participation were protective for women, while dysfunctional group participation and peer-level support may have increased HIV risk among men. The second manuscript was an original study assessing changes in social capital and HIV risk behavior pre to post immigration among RLIs in South Florida (n=527). HIV risk behavior was assessed through the frequency of vaginal-penile condom use, and the number of sexual partners. It was a longitudinal study using secondary data analysis to assess changes in social capital and HIV risk behavior pre immigration to two years post immigration, and to determine if there was a relationship between the two variables. There was an 8% decrease in total social capital (p ˂ .05). Reporting of ‘Never use’ of condoms in the past 90 days increased in all subcategories (p ˂ .05). Single men had a decrease in number of sexual partners (p ˂ .05). Lower social capital measured on the dimension of ‘friend and other’ was marginally associated with fewer sexual partners. The third manuscript was another original study looking at the association between social capital and substance use among RLIs in South Florida (n=527). Substance use with measured by frequency of hazardous alcoholic drinking, and illicit drug use. It was a longitudinal study of social capital and substance-use from pre to two years post immigration. Post-immigration, social capital, hazardous drinking and illicit drug use decreased (p˂.001). After adjusting for time, compared to males, females were less likely to engage in hazardous drinking (OR=.31, p˂.001), and less likely to engage in illicit drug use (OR=.67, p=.01). Documentation status was a moderator between social capital and illicit drug use. ‘Business’ and ‘Agency’ social capital were associated with changes in illicit drug use for documented immigrants. After adjusting for gender and marital status, on average, documented immigrants with a one-unit increase in ‘business’ social capital were 1.2 times more likely to engage in illicit drug use (p˂.01), and documented immigrants with one-unit increase in ‘agency’ social capital were 38% less likely to engage in illicit drug use (p˂.01). ‘Friend and other’ social capital was associated with a decrease in illicit drug use among undocumented immigrants. After adjusting for gender and marital status, on average, undocumented immigrants with a one-unit increase in ‘friend and other’ social capital were 45% less likely to engage in hazardous drinking and 44% less likely to use illicit drugs (p˂.01, p˂.05). Studying these three domains is relevant because HIV continues to be a public health issue, particularly in Miami-Dade County, which is ranked among other U.S. regions with high rates of HIV/AIDS prevalence. Substance use is associated with HIV risk behavior; in most studies, increased substance use is associated with increased chances of HIV risk behavior. Immigration, which is the hypothesized catalyst for the change in social capital, has an impact on the dynamic of a society. Greater immigration can be burdensome on the host country’s societal resources; however immigrants are also potentially a source of additional skilled labor for the workforce. Therefore, successful adaption of immigrants can have a positive influence on receiving communities. With Florida being a major receiver of immigrants to the U.S, this dissertation attempts to address an important public health issue for South Florida and the U.S. at large.

There is a high HIV prevalence rate for Black women in Virginia; however, few scholars have examined how sexual assertiveness and self-esteem against HIV vary within this group. Black women who have low levels of self-esteem may increase their risk for HIV. The purpose of this quantitative cross-sectional study was to determine if four aspects of sexual assertiveness (sexual initiation, sexual refusal, HIV/AIDS/STD communication, and contraception/STD prevention) differed across demographic categories and were associated with self-esteem in a diversified group of Black women living in Virginia. A cross-sectional survey was conducted with a community-based sample of 117 adult Black women. The social cognitive theory was the framework that guided this study. ANOVAs were used to determine differences in means of the four sexual assertiveness subscales across the demographic categories (age, sexual orientation, income, education, and relationship status. HIV, AIDS, and sexual transmitted disease communication assertiveness mean scores were significantly higher among higher income Black women (padj=.016) and Black women with a college versus a high school degree (padj=.047). Moreover, Pearson bivariate correlation results showed self-esteem was significantly positively associated with all but one measure (sexual initiation) of sexual assertiveness. Health educators can use the findings of this study to create education initiatives that focus on building self-esteem and sexual assertiveness behaviors among Black women as an HIV/AIDS prevention method.