Background: Street-involved youth are known to be at a greatly increased risk of HIV and sexually transmitted infections (STIs); however, the role that environmental and structural factors play in driving disease transmission risk among this population has not been thoroughly examined. Methods: The At Risk Youth Study (ARYS) is a prospective cohort of homeless and street-involved youth between the ages of 14 and 26. From September 2005 to October 2006, participants completed a baseline questionnaire which elicited information regarding sexual activity, injection and non-injection drug use, addiction treatment experience, encounters with police and security guards, and health service utilization. Environmental and structural correlates of number of recent sex partners were identified using quasi-Poisson regression. Factors independently associated with consistent condom use were also examined using logistic regression. Results: Among 529 participants, 415 (78.4%) were sexually active during the past six months, of whom 253 (61.0%) reported multiple sex partners and 288 (69.6%) reported inconsistent condom use during this time period. In multivariate logistic regression, homelessness and self-reported structural barriers to accessing health services were inversely associated with consistent condom use. In multivariate analysis, living in a shelter, hostel, or single room occupancy hotel was positively associated with greater numbers of recent sex partners. Structural factors that were associated with number of sex partners included having a warrant or area restriction that affects access to health services, and for males, being accosted by the police. Conclusions: Unstable housing, homelessness, and structural factors related to the criminalization and displacement of street-involved youth were associated with an increased risk of HIV and STI transmission, even after extensive adjustment for sociodemographic and individual level characteristics. These findings suggest that both environmental and structural factors influence the spread of HIV and STIs, and point to the need for environmental-structural interventions to reduce the burden of these diseases among this population. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No description available.

No description available.

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)

Thesis (MSc (Mathematical Sciences))--University of Stellenbosch, 2011. / Includes bibliography. / ENGLISH ABSTRACT: This thesis takes into account the different levels of infectiousness of the human immunodeficiency virus (HIV) infected individuals throughout their period of infection. Infectiousness depends on the time since infection. It is high shortly after the infection occurs and then much lower for several years, and thereafter a higher plateau is reached before the acquired immunodeficiency syndrome (AIDS) phase sets in. In line with this, we formulated a mathematical model which is structured according to the age of infection. To understand the dynamics of the disease, we first discuss and analyse a simple model in which the age of infection is not considered, but progression of the HIV-AIDS transmission is taken into consideration by introducing three stages of infection. Analysis of these models tells us that the disease can be eradicated from the population only if on average one infected individual infects less than one person in his or her infectious period, otherwise the disease persists. To investigate the reduction of the number of infections caused by a single infectious individual to less than one, we introduce different treatment strategies for a model which depends on the age of infection, and we analyse it numerically. Current strategies amount to introducing treatment only at a late stage of infection when the infected individual has already lived through most of the infectious period. From our numerical results, this strategy does not result in eradication of the disease, even though it does reduce the burden for the individual. To eradicate the disease from the population, everyone would need to be HIV tested regularly and undergo immediate treatment if found positive. / AFRIKAANSE OPSOMMING: Hierdie tesis hou rekening met die verskillende aansteeklikheidsvlakke van die menslike immuniteitsgebreksvirus (MIV) deur besmette individue gedurende hulle aansteeklikheidstydperk. Die graad van aansteeklikheid hang af van die tydperk sedert infeksie. Dit is hoog kort nadat die infeksie plaasvind en daarna heelwat laer vir etlike jare, en dan volg n hoer plato voordat uiteindelik die Verworwe-Immuniteitsgebreksindroom (VIGS) fase intree. In ooreenstemming hiermee, formuleer ons n wiskundige model van MIV-VIGSoordrag met n struktureer waarin die tydperk sedert infeksie bevat is. Om die dinamika van die siekte te verstaan, bespreek en analiseer ons eers n eenvoudige model sonder inagneming van die tydperk sedert infeksie, terwyl die progressie van MIV-VIGS-oordrag egter wel in ag geneem word deur die beskouing van drie stadiums van infeksie. Analise van die modelle wys dat die siekte in die bevolking slegs uitgeroei kan word as elke besmette mens gemiddeld minder as een ander individu aansteek gedurende die tydperk waarin hy of sy self besmet is, anders sal die siekte voortduur. Vir die ondersoek oor hoe om die aantal infeksies per besmette individu tot onder die waarde van een te verlaag, beskou ons verskeie behandelingsstrategiee binne die model, wat afhang van die tydperk sedert infeksie, en ondersoek hulle numeries. Die huidige behandelingstrategiee kom neer op behandeling slegs gedurende die laat sta- dium van infeksie, wanneer die besmette individu reeds die grootste deel van die aansteeklikheidsperiode deurleef het. Ons numeriese resultate toon dat hierdie strategie nie lei tot uitroeiing van die siekte nie, alhoewel dit wel die las van die siekte vir die individu verminder. Om die siekte binne die bevolking uit te roei, sou elkeen gereeld vir MIV getoets moes word en indien positief gevind, dadelik met behandeling moes begin.

MPH, Faculty of Health Sciences, University of theWitwatersrand, 2011 / Introduction: In South Africa, over 25% of all babies born each year are exposed to HIV. The high antenatal HIV sero-prevalence rates coupled with high levels of maternal morbidity and mortality advocate for high quality maternal and child health care, which should include resilient PMTCT programs. This study aimed to explore infant feeding practices selected by HIV-positive women enrolled on a PMTCT program and describe some of the reasons for their choices, within the first 6 months postpartum. The study also reports on infant feeding practice and HIV status of the infant. Methodology: The study was a cross-sectional study which was carried out within the Perinatal Research Unit at Chris Hani Baragwanath hospital in Soweto. A sample of 200 women enrolled in the PMTCT program was interviewed, using a semi-structured questionnaire, during April 2007 – June 2007. Results: The study revealed that 84.5% of the study population had received infant feeding counseling. There was a high rate of exclusive formula feeding (EFF=84.5%), with lower exclusive breastfeeding (EBF=14%) and mixed feeding (MF=1.5%) rates. The corresponding HIV transmission rates were EFF – 26% (n=44/169); EBF – 75% (n=21/28); MF – 100% (n=3/3). The study demonstrated that babies born to mothers who did not receive information on infant feeding were twice as likely to be HIV positive (OR=2.43), which was statistically significant. The study also showed that the timing of the counseling was critical – all mothers who received counseling 6 weeks or more after delivery had HIV-positive babies. The overwhelming majority of women (78%) indicated that they would breast feed their babies if they were HIV-negative. Conclusion: The study demonstrated the vital role of infant feeding counseling in antenatal care and PMTCT programs. It illustrated that it was critically important that all HIV-infected women receive infant feeding counseling as soon as possible after the HIV diagnosis is made, prior to delivery and highlighted the importance of reinforcement of infant feeding choice at every antenatal care visit, for every woman. 5 The key recommendations focus on the need for: • Improved Antenatal care for all pregnant women • Improved care for HIV-positive pregnant women • Improvements in infant feeding counseling for HIV positive women • Integration of Maternal, Child health and PMTCT programs • Intensification of ongoing prevention efforts • The need for further research to: o identify some of the reasons HIV positive women choose certain infant feeding modalities throughout the country, and the challenges associated with these; and o critically evaluate the training that health care workers and counselors receive, regarding infant feeding counseling.

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

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2016-08-30T16:40:54Z No. of bitstreams: 1 Renata Braga Rolim Vieira.pdf: 971231 bytes, checksum: c9b53c975bef7738c2cc62bacf5c408d (MD5) / Made available in DSpace on 2016-08-30T16:40:54Z (GMT). No. of bitstreams: 1 Renata Braga Rolim Vieira.pdf: 971231 bytes, checksum: c9b53c975bef7738c2cc62bacf5c408d (MD5) Previous issue date: 2016-05-31 / Introduction: AIDS is considered a chronic disease and, nowadays, approximately 36.9 million people with the disease live in the world. In Brazil, since the beginning of the epidemic to the present day, 798,366 AIDS cases have been reported. In pregnant women, the HIV detection rate showed an upward trend over the past decade. Objective: to analyze the knowledge of HIV / AIDS, according to sociodemographic characteristics of pregnant women in the city of Sousa- PB. Methodology: This was a cross sectional study with a quantitative approach, conducted with 164 pregnant women, stratified by 26 basic health units in the city of Sousa-PB. The dependent variable was the knowledge about HIV / AIDS and as independent variables sociodemographic characteristics (age, socioeconomic classification, marital status, education, religion, race / color and working condition). The variables were described as frequencies and proportions. The differences among proportions were analyzed using the chi-square tests of Pearson and Fisher exact. Results: Based on the results, the profile of the study participants were pregnant women with a mean age of 26.13 years, most of them married, with incomplete elementary school, mulatto, religious (Catholic) and unemployed. It was found that, regarding HIV prevention, 74.4% considered that sexual intercourse with faithful and uninfected partner reduces the risk of HIV, 60.4% agreed that pregnant women with proper treatment prevents vertical HIV transmission and 62.2% believed appropriate treatment does not reduce risk of horizontal transmission. Age and education enhanced that older pregnant women, with higher education level showed increased knowledge on HIV / AIDS. Conclusion: There are gaps in knowledge on the vertical and horizontal transmission of the interviewed mothers. More effective measures to promote sex education in schools, universities and communities, emphasizing the importance of practicing safe sex, knowledge for the prevention and transmission of HIV are extremely necessary, as well as prenatal care quality, to increase knowledge among the general population and, thus, decrease the number of cases of HIV / AIDS in Brazil and worldwide. / Introdução: A Aids é considerada uma doença crônica e atualmente estima-se que vivem no mundo 36,9 milhões de pessoas com a doença. No Brasil, desde o início da epidemia até os dias atuais, foram notificados 798.366 casos de Aids. Nas gestantes, a taxa de detecção do HIV apresentou tendência de aumento nos últimos dez anos. Objetivo: Este estudo teve como objetivo analisar o conhecimento sobre HIV/Aids, segundo características sociodemográficas de gestantes do município de Sousa- PB. Metodologia: Estudo transversal, com abordagem quantitativa. O mesmo foi realizado com amostra de conveniência de 164 gestantes estratificadas pelas 26 unidades básicas de saúde do município de Sousa-PB. A variável dependente foi o conhecimento sobre HIV/Aids e como variáveis independentes as características sociodemográficas (idade, classificação socioeconômica, estado civil, escolaridade, religião, raça/ cor e condição de trabalho). As variáveis foram descritas por frequências e proporções. As diferenças entre proporções foram analisadas por meio dos testes de Qui-quadrado de Pearson e Exato de Fisher. Resultados: A média de idade das gestantes foi de 26,13 anos, a maioria delas casadas, com ensino fundamental incompleto, cor parda, religiosas (católica) e desempregadas. Verificou-se que em relação à prevenção de HIV: 1- 74,4% considerou que relação sexual com parceiro fiel e não infectado reduz o risco de HIV, 2- 60,4% concordou que gestante com tratamento adequado evita transmissão vertical HIV e 3- 62,2% acreditavam que tratamento adequado não reduz risco de transmissão horizontal. A idade e a escolaridade mostraram que as gestantes mais velhas e com mais anos de estudos apresentaram um maior conhecimento para o HIV/Aids. Conclusão: Há lacunas no conhecimento relativo à transmissão vertical e relação sexual das gestantes entrevistadas. São necessárias ações mais eficazes para promoção da educação sexual nas escolas, universidades e nas comunidades, enfatizando a importância da prática do sexo seguro, do conhecimento para a prevenção e transmissão do HIV, bem como uma assistência pré-natal de qualidade visando aumentar o conhecimento entre a população em geral e assim diminuir o número de casos de HIV/Aids no Brasil e no mundo.

[Abstract]: Since the 1990s, the discourse of security has undergone profound change. Rather than merely pertaining to a more traditional, narrow interpretation of security primarily focusing on nation-states instead of people, a human dimension, known as human security has been added. While such discussions on human security have attempted to encompass threats to humanity as a whole, interpretations of such threats have largely failed to recognise the exceptional threats faced by women. Although threats found in analytical discussions of human security do relate to women, it is imperative that a sharper focus be placed on the additional threats women face in terms of their security; ones that might become blurred in general discourse, such as economic, educational and employment disparities, gender discrimination, substandard healthcare, restricted access to healthcare facilities, human trafficking and male violence.This dissertation seeks to provide a gendered analysis of human security, using women in China as its focus. To provide a focused examination, it takes a global source of human insecurity, HIV/AIDS, and examines why women in China are increasingly at risk from HIV/AIDS. In addition to assessing the impact that this pandemic poses for their security, it also attempts to investigate the social impacts HIV/AIDS is having on women in China and what measures the government has put in place to halt the spread of HIV/AIDS. The extent and nature of the role played by intergovernmental organisations (IGOs), non-governmental organisations (NGOs) and international non-governmental organisations (INGOs) in China’s HIV/AIDS epidemic is also explored. This research was prompted by the limited nature of a gendered analysis in the mainstream human security literature, and the need to identify the unique threats to human security faced by women. The realisation that the ‘disempowered status’ of women increases their vulnerability to HIV/AIDS, and that HIV/AIDS is becoming a major source of insecurity for many women around the world (and in China in particular), provides a relevant focus for such an investigation.

This thesis was undertaken to assess the characteristics of individuals who smoke crack cocaine and to examine the health-related risks and healthcare needs of this population. A literature review of 147 published articles was conducted to synthesize evidence regarding behaviours associated with crack use and to assess the risks of disease transmission through crack smoking behaviours. Qualitative interviews were subsequently conducted with thirty Ottawa residents who smoke crack to learn about their experiences with healthcare and harm reduction services. Results identified barriers related to accessing primary healthcare and drug treatment programming among people who smoke crack and gaps within existing harm reduction services. Individuals who smoke crack represent a marginalized population who are often missed through traditional health promotion and harm reduction programming. There is a need for increased coverage of current programming and a reduction of factors which currently hinder the delivery and effectiveness of crack-specific harm reduction programs.