This research project examined the changing expectations and knowledge of Managers in the Department of Health who attended the Sexual Health Counselling Project offered by Rhodes University, East London, South Africa. These managers came from contexts in which the hierarchical medical model is firmly entrenched. The Sexual Health Counselling Project, drawing on theoretical principles from Narrative and other theories,presented a challenge to the standard management practices used by the managers. It also challenged how they dealt with clients. This research explored changes in expectations and knowledge prior to and during a two- week training course that the managers attended. A personal awareness and shift in knowledge occurred for many managers who examined their current practices. Some managers, who were firmly entrenched in the hierarchical model,found it difficult to change their ways of working.

Magister Public Health - MPH / The aim of this study was to assess the factors associated with HIV risk behaviours in women in Livingstone, Zambia. A cross-sectional analytical survey using a structured questionnaire was carried out in two sites in Livingstone, which were selected on the basis of differences in socio-economic status. Married women and women in the urban community are at high risk of contracting HIV and every effort should be made to ensure that HIV/AIDS programmes help to reduce their vulnerability to HIV infection. / South Africa

Age affects the human frame at all levels - from the skin which is ravaged by exposure to ultraviolet light and toxic irritants to the immune system which becomes progressively less responsive to antigenic stimuli. Bacteraemia follows a focal infection and thus any change which results in increased infection will result in an increased chance of bacteraemia. Therefore any factors bearing on focal infection will, of necessity influence not only the possibility but also the severity of a bacteraemia.

L’objectif du travail de thèse était d’estimer la morbidité attribuable aux infections d’origine alimentaire en France métropolitaine pour la période 2008 à 2013.Le nombre annuel de cas symptomatiques et de cas hospitalisés ont été estimés pour 21 agents pathogènes (10 bactéries, 3 virus et 8 parasites).La morbidité attribuable aux maladies infectieuse d’origine alimentaire reste élevée en France avec 1 à 2,5 millions de cas survenant chaque année. Parmi celles-ci 14 000 à 21 000 font l’objet d’une hospitalisation.Nous montrons en particulier, comme dans bon nombre de pays développés, que les infections à Norovirus, Campylobacter spp. et Salmonella spp. représentent la majorité des cas et des hospitalisations d’origine alimentaire.Nous estimons pour la première fois la morbidité d’origine alimentaire attribuable au Virus de l’Hépatite E. Celle-ci est considérable, avec environ 50 000 cas, dont 500 cas hospitalisés annuellement.Pour chacun des agents toutes les sources de données potentielles ont été exploitées. Leur nombre et leur qualité sont variables et impactent les estimations présentées dans ce travail.Nos estimations sont essentielles pour l’ensemble des acteurs intervenant dans le domaine de la sécurité sanitaire. Elles permettront la réalisation d’autres travaux, intégrant l’impact sur la qualité de vie et l’impact économique. / The objective of this work was to produce population-based estimates of the burden of foodborne infections in France for the 2008-2013 period.Number if illnesses and hospitalisations were estimated for 21 pathogens (10 bacteria, 3 viruses and 8 parasites).The burden of foodborne infections remains substantial with 1 to 2,5 million of cases and 14000 to 21000 hospitalisations occurring each year. As in other industrialized countries Norovirus, Campylobacter spp. and Salmonella spp. are the leading pathogens and account for the majority of cases and hospitalisations.We estimate for the first time the foodborne burden related to Hepatitis E Virus (HEV). HEV appears to be one of the key pathogens in France, with annually around 50 000 foodborne cases and 500 hospitalisations.Our estimates cannot be compared with prior crude estimates in France to assess illness trends as different methodologies were used. These results are useful to food safety policymakers for the prevention and control of foodborne pathogens. They can inform education campaigns for consumers and provide information for additional research including health states and cost estimates.

Objectifs : Estimer la prévalence du VIH, ainsi que ses associations avec les facteurs de risque potentiel d’infection, les tendances de 2001 à 2007 de ces indicateurs et décrire les profils de vulnérabilité chez les travailleuses du sexe (TS) et leurs clients potentiels (camionneurs, militaires et miniers) à l’échelle de la Guinée. Méthode : 339 TS et 954 clients potentiels en 2001, 598 et 3401 respectivement en 2007, ont été interviewés puis dépistés pour le VIH, sur l’ensemble du territoire national selon un protocole semblable. Les analyses multivariées ont été faites par la régression log-binomiale. Résultats : Parmi les TS, la prévalence du VIH est passée de 40,7% en 2001 à 34,5% en 2007 (p=0,15). Elle était associée à l’analphabétisme [(rapport de proportion noté RP)=1,41 ; p=0,02 en 2001 et RP = 1,28 ; p = 0,03 en 2007)] et aux antécédents d’infection sexuellement transmissibles (IST) {RP= 1,89 ; p=0,001 en 2001}. Parmi les clients potentiels, les prévalences du VIH étaient de 4,5% chez les miniers et de 7,0% chez les camionneurs en 2001 tandis qu’elles étaient de 5,2% chez les militaires et de 6,4% chez les miniers en 2007. Ces prévalences étaient positivement associées dans au moins un sous groupe ou une enquête aux antécédents d’IST, à la consommation d’alcool, à la déclaration de partenaires sexuelles payantes et négativement, à l’abstinence sexuelle en situation de risque. Les indicateurs de tendance analysés n’étaient ensemble favorables au contrôle de l’épidémie que seulement chez les TS. Conclusion : Le VIH était fortement concentré parmi les TS et dans une moindre proportion parmi leurs clients potentiels. Les plus infectées par le virus étaient les TS analphabètes ainsi que leurs clients potentiels consommateurs d’alcool ou qui avaient des antécédents d’IST. La prévention ciblée doit être renforcée parmi les sous groupes à plus haut risque, conformément à la stratégie recommandée dans les épidémies concentrées. / Objectives: To estimate HIV prevalence, its associations with potential risk factors, and trends from 2001 to 2007, and to describe vulnerability among commercial sex-workers (CSWs) as well as among their potential clients who were truck-drivers, military army and miners from all over the country of Guinea, West Africa. Methods: 339 CSWs and 954 potential clients in 2001, 598 and 3401 respectively in 2007 were interviewed then tested for HIV over all the country. Data were analysed by multivariate log-binomial regression. Results: Among CSWs, HIV prevalence (40.7% in 2001 and 34.5% in 2007; p=0.15) was associated with illiteracy [(Prevalence Ratio noted PR)=1.41; p=0.02 in 2001 and PR=1.28; p=0.03 in 2007) and with sexually transmitted diseases [ (STDs); PR=1.89; p=0.001 in 2001]. HIV prevalence among potential clients (varying from 4.5% to 7.0% in 2001 and from 5.2% to 6.4% in 2007) was positively associated once at least, with sexually transmitted diseases (STDs), alcohol consumption, declaring paying sexual partners and negatively, with reported capacity of restraining from risky sexual intercourse. Trends of indicators analysed were together not favourable for controlling epidemic with the exception of those observed among among CSWs. Conclusion: HIV prevalence was very high and strongly concentrated among CSWs and their potential clients, relatively to data obtained observed in the general population of Guinea. Sexually active networks were also observed, as well as more vulnerable sub-groups among illiterate CSWs and among potential clients who were alcohol consumers, or who declared STD symptoms. Reinforcement of prevention targeting specific sub-groups is needed.

Les travailleuses du sexe (TS) restent fortement affectées par l’infection au VIH et jouent un rôle clé dans sa propagation dans la population générale. Cependant la couverture antirétrovirale chez ces dernières reste toujours faible en Afrique en générale, et de l’Ouest et du centre en particulier. En lien avec les recommandations de l’ONUSIDA qui étendent l’accès au traitement antirétroviral à toute personne séropositive indépendamment de son taux de CD4, nous avons lancé ce projet de démonstration du traitement précoce du VIH comme méthode de prévention afin d’évaluer l’acceptabilité, la faisabilité, et l’utilité d’ajouter cette stratégie au paquet actuel de traitement et de prévention chez les TS au Bénin. Tout en évaluant l’acceptabilité et la faisabilité, nous avons mis l’accent sur la réponse au traitement notamment l’adhérence et la suppression de la charge virale, la restauration des taux de CD4 et l’émergence de résistance au traitement. L’étude a inclus 107 TS qui ont été suivies entre 12 et 24 mois. À la fin du suivi, seules 64 sont restées dans l’étude, donnant un taux de rétention de 59,8%. La restauration des taux de CD4 au-delà de 500 cells/μl a été atteinte chez plus de 70% des participantes, tandis que la moyenne géométrique de la charge virale est passée de 12372 copies/ml au début de l’étude à 105,1 copies/ml (p<0,0001) à 12 mois; 95,1 copies/ml (p<0,0001) à 24 mois et à 187,3 copies/ml à l’ensemble des visites finales (p=0,003). De plus, la charge virale supprimée (<1000 copies/ml) ou indétectable (<40 copies/ml) était fortement associée à l’augmentation du niveau d’adhésion thérapeutique auto-rapportée (p de tendance =0,048 et 0,004 respectivement). Plusieurs participantes ont montré des génotypes de résistance au début de l’étude, cependant aucune de ces dernières ayanteu une visite finale n’a montré de résistance clinique lors de cette dernière visite. Compte tenu de la mobilité de ce groupe, des efforts sur la rétention et l’adhérence au traitement, et une collaboration régionale entre les cliniques ISTs dédiées aux TS pourraient faciliter l’implantation et l’impact positif du traitement précoce comme méthode de prévention dans la sous-région. / Female sex workers (FSW) remain highly affected by HIV and play a critical roleinits spread towards the general population, however, antiretroviral treatment coverage in this group still remains very low in west and central African countries. In line with the UNAIDS recommendations extending antiretroviral treatment to all HIV-infected individuals regardless their CD4 count, we carried out this demonstration project of early HIV treatment as prevention (TasP) aiming to assess the acceptability, feasibility, and utility of adding this strategy to the current prevention and treatment packageamong FSW in Cotonou, Benin. While assessing both acceptability and feasibility, we focused on treatment response including CD4 count restoration, adherence to treatment and viral suppression, and emergence of drug resistance. The study included 107 FSW who were followed between 12 and 24 months. At the end of the follow-up 64 remained in the study giving a retention rate of 59.8%. CD4 count recovery above 500 cells/μl was reached in more than 70% of participants. The geometric mean viral load decreased from 12372 copies/ml at baseline, to 105.1 copies/ml (<.0001) at 12 months; 95.1 copies/ml (p <.0001) at 24 months and 187.3 copies/ml at all final visits (p = 0.003). In addition, both suppressed (<1000 copies/ml) and undetectable (<40 copies/ml) viral loads were strongly associated with increasing levels of adherence to treatment (p for trend =0.048 and 0.004 respectively). Resistance mutations were detected in several participants at baseline, but none of those who had a final visit showed clinical resistance. Given the mobility in this group of population, efforts on retention and adherence to treatment, and regional collaboration between FSW-dedicated clinics could facilitate the implementation and positive impact of early treatment as prevention in this population.

Call number: LD2668 .T4 1933 B33 / Master of Science

A crisis is unfolding because of the deaths among people in the labour force. It is expected that business, government and labour address the problem of HIV and AIDS. An intervention such as, introduction of policies and strategies would help in the awareness of the epidemic to the society as a whole. This study looks at the effect of HIV on gender inequality and its implications in the labour sector. There are large social and economic gaps between women and men in Malawi, and these inequalities have played a central role in the spread of HIV; hence it is imperative to consider women when developing HIV workplace policies, because they seem to be hit harder with the epidemic than men. Empowering women to refrain from risky relationships and protecting themselves and asserting their rights would decrease the high HIV prevalence percentage for women. The study use annual Labour participation rate, female (% of female population ages 15+) and annual labour participation rate, male (% of male population ages 15+) data obtained from (www.tradingeconomics.com) and annual Prevalence of HIV, total (% of population ages 15-49) obtained from World Bank over the period of 1980 to 2009. Prior to doing the regression analysis, the time series data is tested for stationarity using correlograms and the Augmented Dickey Fuller (ADF) test on each data set. The results suggest that there is a negative relationship between HIV/AIDS and labour on both genders for this period and that there is a gap on the effect of AIDS on women and men in the labour sector. The time series data is found to be 1(2), intergrated of order 2. The HIV data is regressed onto the labour data, using Ordinary Least Squares (OLS). Following the regression line is the Engel-Granger method which is used to test for cointegration. Other tests include diagnostic tests and stability tests / Thesis (M.Sc.(Computer Science) North-West University, Mafikeng Campus, 2011

published_or_final_version / abstract / Surgery / Doctoral / Doctor of Philosophy

published_or_final_version / Nursing Studies / Master / Master of Nursing