Master of Science in Epidemiology in the field of Epidemiology and Biostatistics June, 2017 / Background Hepatitis B and ART have been established to cause liver damage. We compared the changes in the levels of Alanine amino Transferase (ALT) in HBV/HIV co-infected and HIV infected women on ART to determine liver disease among women on ART in Lilongwe Malawi using Data from the BAN study. Methods We conducted a secondary data analysis from The BAN study to investigate the changes in the levels of ALT among HIV/HBV co-infected and HIV mono-infected women who were randomised into the maternal ART arm. In brief The BAN study assessed the benefit of nutritional supplementation given to women during breastfeeding, the benefit and safety of antiretroviral medications given either to infants or to their mothers to prevent HIV transmission during breastfeeding and the feasibility of exclusive breastfeeding followed by early, rapid breastfeeding cessation. ALT was monitored up to 48 weeks with an average of 12 follow-ups per individual. Continuous variables i.e. Age, ALT and CD4 count were compared between HIV/HBV co-infected women and HIV mono-infected women using the Wilcoxon rank sum test. Multiple regression analyses were performed using longitudinal data Generalised Linear mixed models to evaluate the relationship between ALT and HIV/HBV co-infection, among HIV-infected women, controlling for ART regimen, CD4 count and visit. All individuals were included in the analysis regardless of the different numbers of follow-up visits. To show the change of ALT levels longitudinal line graphs were used. Predictions of ALT levels per visit were also plotted using margin plots. Results The study subjects comprised of 544 women of whom 5.6% were HIV/HBV co-infected. The age range of the study population was 16-45 years. Median age at enrolment was 26(IQR: 22-29). The median ALT enzyme level of HIV/HBV co-infected individuals was slightly higher at baseline (13 UI/L (10-16) vs 14 UI/L (11-18, p=0.10) and at the last follow-up (17UI/L (14-22) vs 19 UI/L (16-26, p=0.04) compared to HIV mono-infected counterparts. HIV/HBV co-infection women were 3.28 times (1.43-9.03 p= 0.01) more likely to have abnormal ALT, compared to their mono-HIV infected counterparts. Individuals that were initiated on Nelfinavar as first line ART were 3.22 times (1.85-5.59 p=0.001) more likely to have elevated ALT compared to those that were initiated on LPV/r based regimen. Moderately immune suppressed women (CD4 count of between 200 to 500 cells/dl) were 0.38 times less likely to have elevated ALT(0.15-1.00) while women who were severely immune suppressed had 3.51 times more likely to have abnormal ALT . Overall there was an increase in the level of ALT per each subsequent visit. Conclusion Individuals co-infected with HIV/HBV generally had higher levels of ALT compared to HIV mono-Infected individuals and this increased over time. The current study suggests that monitoring of ALT in patients co-infected with HIV/ HBV on ART should be performed regularly, and the caution should be taken when prescribing first line ART. / MT2017

The aim of this cross-sectional study was to determine the difference in development (cognition; receptive and expressive language; and fine and gross motor) of Human Immunodeficiency Virus (HIV) -exposed infected (HEI) infants with the development of HIV-exposed but uninfected (HEU) infants using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Sixty infants were enrolled in the study; 32 (53.33%) HEU infants and 28 (46.67%) HEI infants. The two groups were well-matched for infant demographics, anthropometry at birth, maternal demographics, as well as socioeconomic status. Statistically significant differences were found in anthropometry and development between the HEI and HEU group. The HEI infants had malnutrition, were stunted and had smaller head circumferences than HEU infants. The BSID-III showed that the mean developmental delay for the HEI group was approximately two months below their mean chronological age for all scales (cognitive; receptive and expressive communication; and, fine and gross motor age). The HEI group showed that 64.29% had cognitive delay, 60.71% had language delay and 53.57% had motor delay, all of which was significantly different from the development of the HEU group for all domains (p<0.001). In addition to using the BSID-III, the majority of mothers were able to correctly indicate whether their child was developing at the same, or at a slower rate of development than children of the same age. This study demonstrates that infants who are HIV-exposed and infected are at risk of developmental delay.

Genetic variability within both the HIV-1 coreceptor, CCR5, and its ligand, CCL3L, has been shown to contribute towards differences between individuals in their susceptibility to HIV-1 infection and rate of disease progression. In this study we investigated the extent of genetic variation within the CCR5 gene as well as CCL3L, CCL3La and CCL3Lb gene copy number distribution in two healthy HIV-1 uninfected South African populations, South African Africans (SAA) and South African Caucasians (SAC). The impact of variations within these genes on the expression of CCR5 and CCL3 was subsequently assessed. Furthermore, CCR5 genetic variability, CCL3L gene copy number distribution and the expression of CCR5 and CCL3, was assessed in a similar way in a small cohort of HIV-1 infected long term nonprogressors (LTNPs). Genotyping of the CCR5 gene in SAA (n=41) and SAC (n=46) HIV-1 uninfected individuals revealed a high degree of genetic variation between the two population groups, both in terms of single nucleotide polymorphism (SNP) profiles and CCR5 haplotype distribution. Seven complex putative haplotypes spanning the length of the sequenced region were identified with only one of the identified haplotypes, SAA/C-HHC, common to both study populations. The effect of genetic variability on promoter activity of four different CCR5 promoter regions for three CCR5 haplotypes,SAA-HHA, SAA/C-HHC and SAC-HHE, were evaluated. Results showed variability in (i) promoter activity between different promoter regions tested, (ii) results obtained with different cells used for analysis, and (iii) the haplotype being analysed, thereby highlighting that both the cellular environment as well as genetic variability within the promoter region, have the capacity to influence the efficiency of a promoter and consequently CCR5 expression levels. Haplotype-specific promoter analysis demonstrated the SAA-HHA haplotype to have the strongest promoter activity in THP-1 and K562 cells for both P1A (downstream) and P2 (upstream) promoter regions, while in the other cell lines tested (Jurkat and U937), HHA demonstrated intermediate promoter strength.Differences seen between the haplotypes tested in this study and other published studies may be attributable to additional SNPs being tested in the promoter constructs used in this study. The two population groups differed significantly with regards to cell activation levels, as measured by HLA-DR expression, in CD4+ T cell (P=0.002) and CD56+ NK cell subsets (P<0.001). CCR5 expression, determined both as the number of CCR5 molecules per cell (density) and the percentage of CCR5-expressing cells, was found to differ between SAA and SAC individuals across all peripheral blood cell types. SAA individuals had larger proportions of CCR5-expressing natural killer (NK) cell subsets (P<0.01) but lower CCR5 molecules per cell density on CCR5+CD8+ T cell and CCR5+ NK cell subsets (CD56+, CD16+CD56+ and CD56dim) (all P<0.05) compared to SAC individuals. These differences were maintained even after CCR3D32 heterozygous SAC individuals were included in the analyses. Furthermore, the previously described haplotypes, HHA and HHC, associated with differences in CCR5 expression on different cell subsets between individuals within the same population group. SAA individuals with the HHA haplotype had significantly lower percentages of CCR5-expressing CD8+ T cells compared to SAA individuals that lacked the haplotype (P=0.001). SAC individuals with the HHC haplotype had significantly higher density on NK (CD56+) and CD16+CD56+ NK cell subsets (P=0.030 and P=0.024, respectively) compared to SAC individuals without this haplotype. The latter observation suggests that the protective effect of the HHC haplotype in Caucasians might be explained by higher density of CCR5 expression on NK cells that is not evident in HHC+ SAA individuals, thus highlighting the potential role of CCR5-expressing cells other than CD4+ T cells in protection from HIV-1 acquisition and disease progression. Despite significant differences in CCL3La (CCL3L chemokine coding) and CCL3Lb (nonchemokine coding) copy number between SAA and SAC populations, no difference in CCL3 production by peripheral blood mononuclear cells (PBMCs) was noted between the two study populations. Assuming equal contribution of CCL3 and each copy of CCL3La to CCL3 production,we found that SAC individuals produced higher levels of CCL3 per functional copy of CCL3La compared to SAA individuals (P<0.001). Although, when SAA and SAC individuals with comparable CCL3La and CCL3Lb gene copy numbers were compared, there was no difference in production per functional copy between the two groups (P=0.974). We also determined CCL3La and CCL3Lb gene copy number for a previously established cohort of HIV-1 intrapartum-infected (IP) and exposed uninfected (EU) infants and found that differences previously seen in cord blood mononuclear cell (CBMC) CCL3 production between IP and EU infants with comparable CCL3L copy numbers could not be attributed to differences in CCL3Lb copy number. The potential role of differences in CCR5 genotype, CCR5 expression, CCL3 genotypes and CCL3 production levels in the control of HIV-1 infection was then examined by comparing a small group (10 SAA and 4 SAC) of LTNPs to the respective background population. No polymorphisms in the CCR5 open reading frame were detected in these LTNP individuals. However, the HHA haplotype frequency was significantly higher in SAC LTNP individuals compared to SAC control individuals (P=0.010). Interestingly, CCR5 density on CD4+ T cells and monocytes was significantly lower in SAA LTNP individuals (P=0.025 and P=0.022, respectively) with a trend towards a similar relationship in CD8+ T cells (P=0.058), while the proportions of CCR5-expressing CD8+ T cells were elevated compared to SAA controls (P=0.043). This latter finding reflects the increased immune activation in these individuals compared to uninfected individuals, as evidenced by increased proportions of HLA-DR-expressing T cells (CD8+ and CD4+, P<0.0001). In addition,PHA-induced CCL3 production by PBMCs was significantly lower in LTNP (SAA and SAC combined) compared to control individuals (P=0.004). SAA LTNP individuals had higher proportions of CD8+ T cells (P<0.0001) and lower proportions of natural killer cells (CD56+,P=0.002) compared to control SAA individuals. Thus, CCL3 production differences may be partially explained by differences in the distribution of immune cell subsets between the two study groups.Furthermore, PBMCs of LTNP individuals with low viral loads (<400 copies/ml) produced CCL3 at lower levels than those from individuals with higher viral loads, irrespective of whether or not the cells were stimulated (P=0.005 and P=0.035, respectively). In summary, this study demonstrates that: (i) two ethnically divergent populations show marked differences in CCR5 genetic variability, cell activation and CCR5 expression which are likely to impact on both susceptibility to HIV-1 infection and the rate of HIV-1 disease progression, (ii) both CCR5 genotypic differences and differences in baseline cellular activation levels appear to be contributing towards the observed differences in CCR5 protein expression, and (iii) the two study populations do not differ with respect to CCL3 production by PBMC cultures which suggests that either the two copy per diploid genome gene, CCL3, may play a significant role in CCL3 production and/or that as yet undefined mechanisms regulate production of CCL3 from variable CCL3L copy number. In addition, a pilot study conducted in a small group of LTNP individuals demonstrates that two major determinants of HIV-1 disease progression, CCR5 and CCL3, are both expressed at lower levels in LTNPs individuals compared to healthy uninfected controls and has identified CCR5 haplotypes which are potentially associated with disease progression.

Background There is now global recognition of the reproductive health rights of all individuals, including people living with HIV (PLHIV). These include inter alia, decisions on the number, spacing and timing of their children. In light of limited information on the reproductive choices of PLHIV at primary health care (PHC) level, the aim of this research study was to develop new knowledge on the reproductive concerns and desires of PLHIV and to determine current services provided for HIV positive individuals in the Ekurhuleni district of Gauteng Province. Methods A cross-sectional study design was used to explore the reproductive choices and the factors influencing these choices among HIV positive patients in the Ekurhuleni district. During 2013, a random sample of HIV positive patients attending community health centres was selected. After informed consent was obtained, trained fieldworkers administered a structured questionnaire that elicited information on socio-demographics, reproductive choices, and knowledge on available reproductive services. Survey data were analysed using STATA version 13. Results The majority of survey participants (n=430) were female (70%) and unemployed (57 %). The mean age of participants was 36 years (SD 8.6): 40.8 years (SD 8.7) for men and 34.5 years (SD7.8) for women. The expressed desire for children was 46% (95% CI: 41.4 – 50.9). In the multiple logistic regression analysis, predictors of desire for children were: age less than 49, marriage or living together, and no biological children. The odds of wanting children was 51.5 [95% CI: 14.8–178.8] times higher for those without children, compared to those with two or more children, while for those less than 25 years, the odds of wanting children was 22.0 [95% CI: 1.9-254] compared to those older than 50 years. Conclusion PHC clinics and health care providers should be capacitated to address the reproductive health needs of PLHIV, and these needs should be reflected in provincial and national policies.

PhD thesis, Faculty of Health Sciences, University of the Witwatersrand, 2008 / This thesis centres around the issues concerning HIV/AIDS and physiotherapy education, curriculum and practice. In particular, this thesis examines which HIV specific content should be included in a physiotherapy curriculum and ultimately presents a conceptual framework for HIV input into the curriculum. There is a vast body of literature available on HIV. For physiotherapists, however, apart from a brief review given by Nixon and Cott (2000) using the ICIDH, no comprehensive literature is available that places information on HIV into a framework that speaks to physiotherapists as part of the rehabilitation fraternity. The literature on impairments is descriptive and buried in the medical model as symptoms. Section one of the literature review placed the literature in such a framework and provided a comprehensive description using the ICF and related aspects that concern physiotherapists. The ICF captures all the elements of current rehabilitation theory and practice and the literature is presented in an ICF framework. In addition, important background information on prevalence, its determinants, treatment approaches and subsequent impacts were reviewed. As most of the literature available still remains in the medical model, the conditions that manifest and from which patients develop impairments, were reviewed. The effects of HIV on body systems are extensive and pervasive. In each body system HIV has direct effects on mature and maturing cells e.g. progenitor cells and mature muscle cells. In the musculoskeletal system HIV impacts on functional systems and organs resulting in pathophysiological changes that manifest as impairments such as muscle wasting. Conditions manifesting in all body systems were reviewed and outlined. Impairments such as pain, breathlessness and proximal muscle weakness were reported in the literature. In addition to impairments, analysis of the literature revealed studies that had found high levels of functional and activity limitations as well as impacts on Health-related Quality of Life in HIV. The literature also presents the current status of physiotherapy interventions. Many studies have reported that exercises are a safe and effective mode of intervention not-withstanding the limitations encountered. The second part of the literature review focussed on aspects concerned with curriculum. Previous studies have focused on establishing baseline knowledge, attitudes and practices (KAP) to HIV and the impact of training programmes on KAP. What the actual content was for health workers, in particular physiotherapists and the approach to incorporating HIV into curricula is a gap in the literature. To inform the overall aim, with context-appropriate HIV content, this study undertook a number of studies in order to obtain the necessary information on HIV, specific to physiotherapy. Therefore the overall approach was a mixed methods one employing both a quantitative and qualitative study mix. The first and second studies informed the clinical picture and were both cross-sectional and descriptive. In both studies descriptive statistics were used to analyse data, especially in determining the absence or presence of conditions. Study 1 sought to establish the level of referral to physiotherapy by retrospectively examining the patient records of patients admitted with HIVrelated conditions over a period of one year. Of the 732 patient records reviewed, 139 (19%) had diagnoses considered suitable for physiotherapy and 3% were referred to physiotherapy. Study 2 aimed to establish a relevant overview of the functional and participation limitations of people living with HIV. Two groups of patients were studied i.e. an in-patient group and an outpatient group. The out-patient group was from a well resourced mining out-patient setting. The ICF checklist was utilised to collect the data and statistical analysis was performed to indicate the presence or absence of impairments, activity limitations and participation restrictions. A logistic regression was done to determine the odds of activity, limitation or participation restriction given certain levels of domains. Both groups showed high levels of impairment. For the in-patient group loss of muscle power 75%(n=60) energy and drive 75%(n=60), disturbed sleep 71%(n=56), emotional problems 62%(49), mild-severe pain 80%(66), weight maintenance difficulties and diarrhoea were apparent. In the out-patient mining group memory problems, energy and drive functions 36%(n=18), sleep 24% (n=12) and emotional functions 28% (n=14), seeing 32% (n=17), hearing, vestibularproblems 28%(n=14) and pain 55%(n=28), blood pressure and respiratory problems 24%(n=12), weight maintenance 63%(n=32), sexual functions 22%(n=11) and reduced proximal muscular power 24%(n=12) were encountered. The in-patient group had high levels of activity limitations and participation restrictions, while the out-patient mining group did not. There was association between the different domains and in the in-patient group gender (p=0.02) and marital status (p=0.01) were likely to influence the activity and participation levels and the experience of the environment. The remaining three studies involved aspects related to informing the curriculum component of this thesis. Study 3 audited the universities’ curricular documents to establish what the current curriculum included. Seven of the eight universities that offer physiotherapy training were reviewed and their curricula were generally scanty on information regarding HIV/AIDS. When compared to the areas outlined as a result of the literature review, the study of the patients and focus groups with clinicians and academic staff, revealed some gaps, in particular; the types of conditionsand the influence of HIV on other body systems which are pertinent to the clinical reasoning process for the physiotherapist: The philosophy of care and approach to management and the physiotherapists’ role in HIV prevention, treatment and care were evident gaps. Study 4 sought to develop a framework of HIV content for a physiotherapy curriculum. This was done by integrating the results found so far and verifying and enriching this data by gaining clinicians’ and academics’ insights and perceptions around HIV, based on their clinical and educational experience. Focus group discussions were conducted and a qualitative approach was undertaken for data analysis. A framework for curricula content emerged from this exercise. In study 5 the framework of HIV content was used to develop a questionnaire that was sent out in the Delphi survey to academic staff with the aim to test the level of consensus. Eighty three components of the curriculum under four outcome areas (Appendix 7.2) were sent to 68 academic staff who were identified. Of the 68 academic staff, 58 were available and 47 responded and consented to participate. All but two topics obtained consensus set at 80% and the remaining two obtained consensus in the second round. The final chapter discusses the results of these studies and illustrates how these results on HIV affect and can be applied to the physiotherapy curriculum, when applied to the UNAIDS mainstreaming criteria. Applying the mainstreaming principles to the process of including HIV content into the curriculum, ensures that the process is not done in a piece meal fashion but encompasses all important facets which were identified. The programme, if systematically implemented, could result in a coordinated outcome accounting for all the important facets. A conceptual framework is drawn from the results of this thesis illustrating the three levels of curriculum taxonomy: At the micro level, through the body systems, the meso level through the role of physiotherapy, dealing with internal and external domains and teaching approaches. The macro level is accounted for by the facilitatory activities such as advocacy among clinicians and academics and forming strategic partnerships at all levels.

MSC (Med),Population-Based Epidemiology, Faculty of Health Sciences, University of the Witwatersrand, 2007 / Objective To compare risk factors between HIV-positive concordant and discordant couples. Study design This is a cross-sectional secondary data analysis study using data from Africa Centre Demographic Information System (ACDIS) database (June 2003 to December 2004) and data from the first round of population-based HIV surveillance conducted by the Africa Centre for Health and Population Studies. Methods Eighty-five HIV-positive concordant couples (both partners were HIV-positive) and 73 discordant couples (one partner was HIV-positive and other partner HIV-negative) were identified and selected from the first round of population-based HIV surveillance conducted from June 2003 to December 2004 in Hlabisa Demographic Surveillance System site. Partners health and sexual behaviour data were collected together with the blood sample for HIV test during the same round. Socio-economic and demographic data of partners were obtained from the ACDIS database and were collected within the same period (June 2003 to December 2004). The behavioural, biological, demographic and socio-economic risk factors for HIVpositive concordance and transmission within discordant couples were analysed. Circumcision and area of residence respectively were the biological and demographic factors considered. Number of household assets was used as a proxy for socioeconomic status. The behavioural factors considered were male condom-use, sexual debut (age at first sex), number of lifetime partners and premarital partners. The age and educational level of partners were considered as potential confounders. 5 RESULTS The uncircumcised men were more likely to be in HIV-positive concordant couples than to be in discordant couples (OR =10.8, 95% CI [1.93 – 60.30], p=0.007). Partners living in urban area were 4.7 times more at risk of being in a HIV-positive concordant relationship than to be in discordant relationship (OR=4.7, 95% CI [2.09 - 10.39], p<0.001). Male not using condom on regular basis with female partners, early sexual debut, greater number of premarital partners, household assets and lifetime partners were found not to be significantly associated with HIV-positive concordance. Conclusion There are several biologic, socio-economic, demographic and behavioural risk factors for HIV-positive concordance. However, identifying some of them might be used to address transmission of HIV among discordant couples through intervention programs. Although cross-sectional studies are not ideal for establishing temporality, this study corroborates the findings of other studies that living in urban areas and circumcision are associated with HIV transmission.

MSc (Med), Bioethics and Health Law, Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Disclosure of HIV status has been considered an important public health issue for some 20 years. Yet the ethical issues surrounding the disclosure of positive HIV status have not been examined comprehensively. This report examines the ethics behind the disclosure of HIV-positive status primarily or individuals to their sex partners, and for health care practitioners to a patient’s sex partner when the patient is unwilling to disclose. Relevant rights and ethical principles are analysed, including the rights to: self-preservation; privacy and confidentiality; and the bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice. Historic and contemporary individual rights that people living with HIV (PLHIV) have regarding disclosure are emphasised, especially in adverse circumstances, where ethics can support non-disclosure based on the right to selfpreservation. Rights declarations and current disclosure guidelines for health care practitioners from several international and South Africa medical organisations also are reviewed. Of key importance to disclosure decisions are the specific situations of individuals in climates rife with stigma toward, and discrimination against, PLHIV, existing more or less worldwide. The potential negative impacts of disclosure are the basis for disclosure decisions of PLHIV. Research study results show that the negative impacts of disclosure can be severe for individuals, ranging from divorce or abandonment to community ostracism and even to murder. Relevant current theories of social justice related to HIV disclosure also are discussed. A conclusion is reached that, by decreasing stigma and discrimination against PLHIV and protecting individual rights related to HIV disclosure, prevention behaviours will be practised more widely, including ‘positive prevention’ by PLHIV and higher rates of disclosure. The eventual result will be the longterm public health goal of decreased spread of HIV.

Thesis (Ph. D. (Social Work)) --University of Limpopo, 2018 / Despite the laudable progress on HIV and AIDS interventions encountered in South Africa, new HIV infection remains a challenge. Limpopo Department of Agriculture is not an exception as far as new HIV infections are concerned, regardless of the intervention efforts made. This study aimed at exploring on perceptions of LDA employees on social-behavioural and structural core drivers of HIV infection. Qualitative research methodologies were applied. A purposive sample of twenty participants (10 men and 10 women) was selected from Department of Agriculture, Mopani District, Limpopo Province. Constructivism and structuralism theoretical framework were used to navigate the study. Semi-structured, face-to-face interviews were designed. Data was collected through interviews, audio-recorded and transcribed. Eight steps of data analysis were followed as proposed by Creswell. Guidelines for the prevention of new HIV infection were developed. Some of the major findings are that: the socio-behavioural core drivers that place all partners at risk of contracting new HIV infections is the Multiple Sexual Partnerships (MSPs). Age-disparate relationships in a workplace were also socio-behavioural drivers of new HIV infection. Young women and men who enter into age-disparate relationships have intention of obtaining permanent employment. Patriarchy was found to be amongst the structural core drivers of new HIV infections. The fact that men are not tested involuntarily is viewed as a structural barrier towards eliminating the spread of new HIV infections. Stigma has been also found to be a core driver of new HIV infections. Some conclusions made are: MSPs is a closed sexual network system, characterised by “secrecy” and “trust”. Despite some reforms purporting to improve women’s status, patriarchal domination is still at its toll. Unsymbolised stigma remains a threat towards elimination of the spread of HIV infections. The major recommendations are that working women still require empowerment in number of areas of their social functioning, and the leadership involvement in the fight against the spread of new HIV infections.

Introduction: Adverse childhood experiences (ACEs) have been linked with negative physical and mental health outcomes in adulthood. A limited amount of literature has discussed the impact of individual ACEs on HIV risk behaviors using nationally representative data. Objective: This study investigated how ACEs impact HIV risk behaviors using cross-sectional data from the 2011 and 2012 Behavioral Risk Factor Surveillance System (BRFSS). Methods: Data were obtained from BRFSS for 2011 and 2012. Only states that answered the optional ACE questionnaire were included in the study. All ten ACEs were categorized into abuse (parents physically hurt you in any way or parents swore, insulted or put you down), household dysfunction (lived with anyone mentally ill, lived with parental alcoholic, lived with parental drug abuser, had a parent incarcerated, parents beat each other, or parents were divorced or separated) and childhood sexual abuse (forced to have sex, forced to touch sexually, or forced to be touched sexually). The number of individuals in each category were then categorized based on if they said yes to HIV risk behaviors: used intravenous drugs in the past year, been treated for a sexually transmitted or venereal disease in the past year, and/or given or received anal sex without a condom in the past year. Sociodemographic factors were assessed including race (White, Black, Hispanic, or Other), sex, income (<$15,000, $15,000-<$25,000, $25,000-<$35,000, $35,000-<$50,000, and >$50,000), education (high school education or less and some college or more), age (18-34, 35-54, and 55+) and marital status (currently married or widowed and never married, divorced or separated). Weighted multiple logistic regression analyses were used to examine the association between ACEs and HIV risk behaviors controlling for sociodemographic characteristics. Results: The unweighted sample size was 151,289. The final adjusted sample size was 58,622. Majority of those who said yes to HIV risk behaviors were among the ages of 18-34 (7.92%) compared to other age categories. Adults with an income of <$15,000 had a higher prevalence of saying yes to HIV risk behaviors compared to all other income categories (6.30% vs. 4.85% vs. 3.87% vs. 3.12% vs 2.33%). Adults who experienced growing up with a parent in jail or had a parent who abused drugs had a higher prevalence of saying yes to HIV risk behaviors (11.18% and 11.14% respectively). Of the 4.34% of adults who were forced to have sex as a child, 12.17% said yes to HIV risk behaviors. All ACEs were significantly associated with HIV risk behaviors (P<0.0001). Multiple logistic regression analysis show that adults who grew up with parents who abused drugs (Odds Ratio (OR)= 1.74, 95% Confidence Interval (CI)= 1.72-1.74) or were forced to have sex as a child (OR=1.70, 95% CI=1.68-1.72) were more likely to have HIV risk behaviors. Not being currently married or widowed increased the odds of HIV risk behaviors by 2.31 times (OR= 2.31, 95% CI= 2.30-2.33). Conclusions: ACEs were positively associated with HIV risk behaviors. Longitudinal studies are warranted to confirm the causal relationship. Educational and prevention measures may be considered to address this public health problem.

Thesis (M.A.) (Development Studies) --University of Limpopo, 2009. / HIV/AIDS poses a challenge to every person, community and organization to such an extent that nearly every organization should have some policies and programmes to deal with the epidemic. The church as one of the organizations seems to be exempted from the fight against the disease whereas it is the only organization that is more in touch with people in the community than any other organization. The purpose of this study is to explore the role that churches can play in HIV/AIDS prevention in order assist the Bushbuckridge churches on how they can fight against HIV/AIDS so as to help reduce the high rate of infections as well as stop the new infections.