Previous research has shown that excessive cardiovascular reactivity may be important in the development of coronary heart disease. The present study examines the role of masculine cognitive appraisal of stress as a mediator of cardiovascular reactivity in men. The reactivity of men who differed on a measure of cognitive appraisal of masculine gender role stress (MGRS) was compared using the cold-pressor test under conditions of high and low masculine performance challenge. Under conditions of minimal challenge, it was predicted that high and low MGRS men would not differ on reactivity. Under high challenge, high MGRS men were expected to show greater reactivity than low MGRS men. Since coping responses are related to appraisal of stressful situations and impact on cardiovascular reactivity, subjects' coping responses were also assessed. Analysis of results for systolic blood pressure confirmed the major predictions. High MGRS men showed greater systolic blood pressure reactivity than low MGRS men under high challenge and equal or less reactivity under low masculine performance challenge. In general, the high and low MGRS groups did not differ in their use of coping strategies as a function of the high and low challenge condition. The implications of MGRS appraisal for men's health are discussed. / Master of Science

Background: The purpose of this research was to examine how the Three Bridges Community Health Centre conceptualizes and addresses the issue of accessibility for gay men. This research explored the intersection and disjuncture of how accessibility for gay men is understood and practiced from multiple perspectives (staff and clients). It revealed perceived and real barriers and opportunities for gay men in accessing health services, and provides insight into the mechanisms Three Bridges Community Health Centre employs to provide comprehensive health care to a local population that is not easily identifiable. Methods: Case study is the central defining methodological feature of this research. This study applies both inductive and deductive approaches. The data are qualitative, derived from 14 semi-structured interviews, document analysis (25 documents with a total of 398 pages) and participant observation (approximately 33 hours). Analysis and interpretation of the data were accomplished through the various procedures and techniques associated with qualitative data analysis, including the use of a qualitative software package - NUD*IST 4.0. Results: The study revealed twelve main factors that facilitate (and obstruct) accessibility for gay men. They were developing a mission of accessibility for vulnerable populations; assessing gay men's health issues, barriers and needs; utilization of the clinic; delivery of appropriate programs and services; available providers with appropriate knowledge, attitudes and behaviour; cultural accessibility (e.g., gay-friendly environment, multiple languages); geographic accessibility (location); physical accessibility (architecture); financial accessibility (affordability); functional accessibility (convenience); awareness (marketing & publicity of services and location); and partners in accessibility (e.g., community, health authorities, government). Each section of this chapter details how Three Bridges addresses each of these elements (the strengths), the challenges (e.g., time, money and personnel) in addressing these issues, as well as suggestions for improving accessibility. These factors would also be relevant for any primary care setting about to embark upon an examination of how (well) it addresses access for gay men, and other vulnerable populations. Conclusions: Partnerships with community-based agencies and recruitment of queer staff are critical in creating cultural accessibility for queer people. Many of the challenges raised by staff need to be addressed at a policy, region-wide level. Cultural accessibility for queer people also needs to be addressed by other healthcare settings.

BACKGROUND The coverage of HIV/AIDS behavioral surveillance among MSM in China falls far short of what is necessary as the current approach is expensive and time consuming. In addition MSM are difficult to reach in China. Internet-based behavioral surveys have demonstrated a number of advantages compared with the traditional paper-pen method. Chinese MSM are avid users of the Internet. Use of the internet provides an opportunity to access this hard-to-reach population and explore their use of the Internet for sexual purposes as well as to assess risk behaviors among MSM internet users. This thesis aimed to explore the trends in risk behaviors and HIV prevalence among MSM using traditional community-based surveys and Internet surveys, and to analyze the potential of web-based behavioral surveillance among MSM by comparing the differences between Internet and community-based MSM samples, and then to provide insights for the future HIV/AIDS behavioral surveillance, epidemic estimation and prediction as well as health intervention among the Chinese MSM population. METHODS This study has three components. The first focuses on trends in HIV risk behaviors and prevalence among MSM in Harbin in northeast China, based on community-based surveys. Eligible participants were approached by peer recruiters in traditional gay venues and then interviewed by health professionals with a standard questionnaire. Urine samples were collected to screen their HIV status. The second part presents two cross-sectional, Internet-based surveys among MSM in China in 2006 and 2007. The study website was advertised on three selected gay websites using a series of banners, pop-ups and text notifications. After providing consent to the survey, eligible participants were invited to complete an online questionnaire. The third component compares the demographic characteristics and risk behaviors of two samples of Chinese MSM. Participants living in Heilongjiang Province were extracted from the 2006 online survey dataset to compare with the community sample of MSM recruited in Harbin, the capital city of Heilongjiang Province in the same year. KEY FINDINGS Community-based behavioral surveillance Among MSM in Harbin, a trend was observed towards more self-identifying as homosexual (from 58% to 80%) and more living with a male partner (from 12% to 41%) over the study period 2002-06. Although there was a trend towards a reduction in the rate of never using a condom and an increase in the rate of always using condoms during anal sex in the past six months, the prevalence of unprotected anal intercourse (UAI) still remained at high level (from 90% in 2002 to 72% in 2006). Most respondents reported having multiple male sexual partners (≥ 2) in the past six months: 86.5% in 2002, 76.0% in 2004 and 91.6% in 2006. The HIV prevalence (2.2%, 15/674) among MSM in Harbin in 2006 was higher than that in previous survey years (1.3% in 2002 and 0.94% in 2004), but no statistically significant change was detected. Internet-based behavioral surveys Gay website users in China are young and well educated. The majority (85%) have used the Internet to seek sex and meeting sexual partners online, which is one of the most common reasons for visiting gay websites. Traditional gay venues still play an important role in the sex seeking process, especially for MSM who are older and less educated. Gay website users are vulnerable to HIV/AIDS given their high prevalence of UAI (56.6%) and multiple male sexual partners (66.5%). The type of partners plays an important role in determining consistent condom use. An increase in condom use was observed among MSM having sex between commercial partners relative to those having sex with non-regular partners and regular partners. Among the Internet sample, participants who have regular partners are less likely to have sex with females, less likely to have multiple partners and less likely to engage in commercial sex behaviors than those who do not. Comparisons between Internet and community samples There are significant differences in terms of demographic characteristics and risk behaviors between the Internet and community samples of MSM. The Internet sample was significantly younger, more educated and more likely to be students and self identify as homosexual. Among those who had anal sex in the past six months, the Internet sample tended to use condoms less consistently than the community sample. However, using the total sample size as the denominator to calculate the prevalence of UAI, no significant difference between the two samples was observed (AOR 1.02, CI 0.73-1.43, p = 0.905). After adjusting for differences in demographic characteristics, the community sample was more likely to have had sex with females (AOR 2.01, CI 1.22-3.30, p = 0.006) and have had ≥ 6 male partners in the previous six months than the Internet sample (46.1% vs. 20.2%; AOR 4.88, CI 3.51-6.80, p < 0.001). The mean number of male partners for the community sample was 13.5 ± 16.8, whereas it was 6.0 ± 12.2 for the Internet sample. CONCLUSIONS Although there is a trend towards an increase in condom use among MSM in China, they are vulnerable to HIV/AIDS infection given their high prevalence of UAI and multiple sexual partners. Public sector officials at all levels need to recognize this risk for HIV transmission. Health promotion and behavioral interventions should be enforced and scaled up to meet the need for controlling HIV transmission among MSM in China. Since the Internet has become a risk environment for MSM and the online MSM population is significantly different from the traditional community MSM group, online MSM should be included as a risk group in national HIV sentinel and behavioral surveillance and the coverage of surveillance for this specific group should be expanded to better understand the health promotion needs of this community as part of an HIV/AIDS strategy in China. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1339648 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

Background: The purpose of this research was to examine how the Three Bridges Community Health Centre conceptualizes and addresses the issue of accessibility for gay men. This research explored the intersection and disjuncture of how accessibility for gay men is understood and practiced from multiple perspectives (staff and clients). It revealed perceived and real barriers and opportunities for gay men in accessing health services, and provides insight into the mechanisms Three Bridges Community Health Centre employs to provide comprehensive health care to a local population that is not easily identifiable. Methods: Case study is the central defining methodological feature of this research. This study applies both inductive and deductive approaches. The data are qualitative, derived from 14 semi-structured interviews, document analysis (25 documents with a total of 398 pages) and participant observation (approximately 33 hours). Analysis and interpretation of the data were accomplished through the various procedures and techniques associated with qualitative data analysis, including the use of a qualitative software package - NUD*IST 4.0. Results: The study revealed twelve main factors that facilitate (and obstruct) accessibility for gay men. They were developing a mission of accessibility for vulnerable populations; assessing gay men's health issues, barriers and needs; utilization of the clinic; delivery of appropriate programs and services; available providers with appropriate knowledge, attitudes and behaviour; cultural accessibility (e.g., gay-friendly environment, multiple languages); geographic accessibility (location); physical accessibility (architecture); financial accessibility (affordability); functional accessibility (convenience); awareness (marketing & publicity of services and location); and partners in accessibility (e.g., community, health authorities, government). Each section of this chapter details how Three Bridges addresses each of these elements (the strengths), the challenges (e.g., time, money and personnel) in addressing these issues, as well as suggestions for improving accessibility. These factors would also be relevant for any primary care setting about to embark upon an examination of how (well) it addresses access for gay men, and other vulnerable populations. Conclusions: Partnerships with community-based agencies and recruitment of queer staff are critical in creating cultural accessibility for queer people. Many of the challenges raised by staff need to be addressed at a policy, region-wide level. Cultural accessibility for queer people also needs to be addressed by other healthcare settings. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

Submitted by Biblioteca Central (biblioteca@unicap.br) on 2018-10-04T18:42:45Z No. of bitstreams: 2 fernanda_azevedo_lima.pdf: 2240991 bytes, checksum: bd47c577028df724ffa125f0575a331e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-10-04T18:42:45Z (GMT). No. of bitstreams: 2 fernanda_azevedo_lima.pdf: 2240991 bytes, checksum: bd47c577028df724ffa125f0575a331e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-06-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The purpose of this thesis was to problematize how men build subjectively with prostate cancer being crossed by different real discourses about masculinity. There for, a qualitative empirical research was carried out, with eleven subjects diagnosed with this type of cancer and using the urology services of two hospitals: a private one and a public one settled down in the city of Recife. Some ethnographic resources were used, from the following instruments: the Narrative Interview and the Field Diary. The results were analyzed through Foucault's Enunciative or his Discursive Analysis, which aims to understand a set of conditions of existence that make possible the construction of a datum phenomenon. This author problematized his objects of study, starting from the historical conditions in which they emerged and understood the subject as an inhabitant crossed by the relations of knowledge, power and the ethics of a historical moment. In this thesis, the concept of hegemonic masculinity was considered, holding it as a discourse, according to Foucault, who reckons it a set of knowledges that function as truths. The results of this study point to a thin line between subjection and resistance to the discourses that circulate in our society, in the way these men are constituted and in the positions of subject that they assume. When it comes to health care, our interviewees assume positions of subject dependent on their own women, crossed by speeches that it is from the "nature" of the woman to take care of husbands and children. On the other hand, the strong man's discourse is used to ground the position of male domination about the female. Speeches about what they are allowed to do to be considered "males" lead these men not wanting to perform the rectal examination. They narrate the fear that, in making such an examination, they become "familiarized", which is associated with homosexuality. However, the discourses that circulate in a certain society, and ours is no exception, are multiple and almost always contradictory. The presence of programs that encourage human health care, PNAISH and the Campaign Blue November Campaign, call men to self-monitoring, and configure control and power over their lives (biopower and biopolitics). These discourses emerge as imperatives in building a culture of health care and, thus, other seemingly contradictory subject positions are assumed, it is 'obligatory' to take care of health and to be healthy. In addition, when medical guidance is not engaging in sex, it leads them to a reductionist understanding of human sexuality; sex is understood only as intercourse. It indicates a vigilant, normalized and controlled sexuality, with "truths" imposed by diverse knowledge, without problematizing these discourses. Finally, it was found that, despite cancer, being culturally a stigmatized disease associated with death, it was possible for some of these men to resist, not only believing in the possibility of cure, but constructing other ways of existing, an aesthetics of existence. / O objetivo desta tese foi problematizar como os homens se subjetivam tendo câncer de próstata sendo atravessados por diferentes discursos de verdade sobre a masculinidade. Para isso, realizou-se uma pesquisa empírica qualitativa, com onze sujeitos diagnosticados com esse tipo de câncer e que estavam utilizando os serviços de urologia de dois hospitais: um particular e um da rede pública da cidade do Recife. Utilizaram-se alguns recursos etnográficos, a partir dos seguintes instrumentos: a Entrevista Narrativa e o Diário de Campo. Os resultados foram analisados por meio da Análise Enunciativa ou Discursiva de Foucault, a qual visa compreender um conjunto de condições de existência que possibilitam a construção de um dado fenômeno. Este autor problematizava seus objetos de estudo, a partir das condições históricas em que eles emergiam e compreendia o sujeito como habitante atravessado pelas relações de saber, poder e da ética de um momento histórico. Trabalhou-se, nesta tese, com o conceito de masculinidade hegemônica, considerando-a um discurso, de acordo com Foucault, que o considera um conjunto de saberes que funcionam como verdades. Os resultados deste estudo apontam para uma tênue linha entre sujeição e resistência aos discursos que circulam em nossa sociedade, no modo como estes homens se constituem e nas posições de sujeito que assumem. Quando se trata dos cuidados com a saúde, nossos entrevistados assumem posições de sujeito dependentes de suas mulheres, atravessados pelos discursos de que é da “natureza” da mulher cuidar de maridos e filhos. Por outro lado, o discurso do homem forte é usado para embasar a posição de dominação masculina sobre o feminino. Discursos sobre o que lhes é permitido fazer para serem considerados “machos”, levam estes homens a não querer realizar o exame de toque retal. Narram o receio de, ao fazer tal exame, ficarem “acostumados”, o que é associado à homossexualidade. Porém, os discursos que circulam em uma sociedade, e a nossa não é exceção, são múltiplos e quase sempre, contraditórios. A presença de programas que incentivam os cuidados com a saúde do homem, PNAISH e a Campanha Novembro Azul, convocam os homens à autovigilância, e configuram controle e poder sobre suas vidas (biopoder e biopolíticas). Estes discursos emergem como imperativos na construção de uma cultura de cuidados com a saúde e, desta forma, outras posições de sujeito, aparentemente contraditórias, são assumidas, é “obrigatório” cuidar da saúde e ser saudável. Além disso, quando a orientação médica é a de não praticar sexo, leva-os a um entendimento reducionista da sexualidade humana, sexo é entendido apenas como o coito. Isso aponta para uma sexualidade vigiada, normatizada e controlada, “verdades” impostas por saberes diversos, sem problematização desses discursos. Por fim, percebeu-se que, apesar do câncer ser, culturalmente, uma doença estigmatizada associada à morte, foi possível, para alguns desses homens, resistir, não somente acreditando na possibilidade de cura, mas construindo outros modos de existir, uma estética da existência mais própria.

A dissertation submitted to the Faculty of Humanities, in fulfilment of the requirements for the degree of Masters of Arts in Journalism and Media Studies at the University of the Witwatersrand in 2016 / The research set out to investigate how the Voluntary Medical Male Circumcision (VMMC) programme in South Africa facilitated stakeholder participation in its communication processes to improve the uptake of services in the context of national targets. Studies reviewed have highlighted challenges in the implementation of the participatory model to achieve communication goals. This qualitative study used document analysis, in-depth interviews and Focus Group Discussions (FGDs) for data collection. The research has revealed other limiting factors including unequal opportunities to influence decisions as a result of varying levels of authority and access to mediated public spheres. While those with power end up being further empowered through participatory approaches in terms of voice and visibility, the representation of the inputs of the lower level stakeholder group is limited to head count. A five-day visit to a VMMC clinic in Alexandra Township attributes marginalisation by exclusion from decision-making processes as one of the reasons for people’s inability to translate knowledge into the positive public response. The study was inconclusive about the influence of the model on the actual service uptake because the purpose was to provide a textual description of the participants’ experiences and not the impact. / XL2018

Renewed efforts are needed to address rapidly rising HIV incidence among sexual and gender diverse (SGD) individuals—particularly cisgender gay, bisexual, and other men (MSM) and transgender and nonbinary individuals (TSM) who have sex with men—in Kazakhstan. Intervention research is uniquely positioned to advance HIV prevention through surveying factors shaping the HIV epidemic among MSM and TSM in Kazakhstan, developing and testing the effects of an HIV prevention intervention, and assessing overall social impacts of conducting research. This research proceeded to describe strategies and lessons learned during implementation of a stepped wedge clinical trial of an intervention designed to increase the number of MSM and TSM in the HIV care continuum in Kazakhstan cities of Almaty, Shymkent, and Nur-Sultan. Thus, this three-paper dissertation aimed to: (1) identify psychosocial factors associated with lifetime, past-12-month, and past-6-month HIV testing among a sample of MSM and TSM enrolled in the clinical trial; (2) describe the process of implementing remote training of facilitators for remotely delivering the HIV preventive intervention; and (3) assess social impacts of participating in the clinical trial. MSM and TSM from the study cities were recruited into the clinical trial and administered a structured behavioral survey at their primary visit and at follow-up visits every six months thereafter. After a period of no intervention implementation (‘pre-implementation period’), the intervention was implemented sequentially every six months in the study cities. Among 304 MSM and TSM enrolled in the clinical trial during the pre-implementation period, lifetime and past-12-month HIV testing were positively associated with polydrug use and negatively with sexual transmission HIV risk, and past-6-month HIV testing was negatively associated with sexual risk. The process of developing and implementing remote training of facilitators was guided by a protocol outlining phases involving formative assessment and planning, fundamentals training, and feedback loop and technical assistance. Out of 627 MSM and TSM who completed their primary assessment during the clinical trial, 579 (92%) returned for at least one follow-up visit; of these individuals, 88% reported at least one positive social impact, while 2% reported at least one negative social impact. Findings underscore the value of expanding access to substance use treatment for HIV prevention among MSM and TSM in Kazakhstan, the viability of remote training of facilitators for remote intervention delivery, and the feasibility of conducting HIV prevention research involving MSM and TSM with many benefits and few risks.

Thesis (D. Tech.) -- Central University of Technology, Free State, 2009

Thesis (M. Tech.) -- Central University of Technology, Free State, 2007 / Cerebrovascular disease and coronary heart disease (CHD) are of the most important causes of morbidity and mortality amongst South Africans. The risk factor prevalence for stroke and CHD becomes altered by changes in lifestyle, including diet. In general it is suggested that lifestyle management should be the first choice when having to treat patients with increased cardiovascular risk. The prudent low-fat, high-fibre diet is regarded as an apparently healthy diet. It is suspected that this diet is effective for the control of known coronary risk factors as well as raised clotting factors. Research studies have shown the addition of dietary fibre to the diet as a promising therapeutic agent for the limited control of known coronary risk factors. The physiological effects of dietary fibre in humans are significantly influenced by the degree to which fibre is fermented in the colon. Fermentation results in the production of short-chain fatty acids (SCFAs); acetate, propionate and butyrate. The aim of this study was to examine the possible effects of different combinations of short-chain fatty acids on some metabolic risk markers. In this study a group of westernised African male volunteers was recruited and randomly assigned to three groups. Group one received a placebo. Group two received a supplement containing 50% acetate and 50% propionate. Group three received a SCFA supplement in the ratio of 70% acetate, 15% propionate and 15% butyrate. Supplementation was sustained for a period of six weeks. Blood samples were drawn during the different visits. At baseline the study group represented a group of black African men without any apparent metabolic or physical abnormalities. All measured variables fell within the normal range. In the placebo group, there was a statistically significant decrease in plasma fibrinogen levels from baseline to the end of supplementation. In the acetatepropionate supplement study group a statistically significant decrease in factor VIII (from 91.1 ± 11.2 to 90.9 ± 8.3%, respectively), and ATIII (from 114.3 ± 13.1 to 108.34 ± 9.5%), as well as a statistically significant decrease in low-density lipoprotein cholesterol (LDL-C) from 3.10 ± 0.79 to 2.64 ± 0.73 mmol/L. The significant increase in %HDL-C from 26.3 ± 6.5 to 30.2 ± 9.3% should also be noted. Both triglycerides (8%) and plasma fibrinogen (2%) showed a statistically significant increase. However, these changes are of no clinical significance. For the high-acetate supplement study group (with the addition of butyrate), a statistically significant decrease in factor VII (from 102.5 ± 13.7 to 101.1 ± 6.4%), VIII (from 92.6 ± 12.8 to 87.6 ± 6.0%), ATIII (from 109.2 ± 16.0 to 103.0 ± 9.9%) as well as fibrin monomer concentration (from 13.9 ± 2.2 to 12.1 ± 3.6 mg/L), were measured. Fibrin network compaction increased significantly from 14.2 ± 4.6 to 13.7 ± 4.0%. Other changes include a statistically significant increase in the serum-TC of 4.2%. From the results it is evident that the acetate-propionate supplement, with exclusion of butyrate, has a beneficial effect on metabolic parameters when compared to a highacetate- propionate supplement. The results do provide evidence of a possible therapeutic application for the propionate-acetate containing supplement. The specific mechanism should, however, still be investigated. It can be concluded from this study that acetate, propionate and butyrate each have different effects on human metabolism. It is evident that the use of a mixture of acetate and propionate may have a beneficial effect on patients at risk of developing CVD. Further studies that investigate the optimum ratio of these two products may lead to the development of a naturally derived therapeutic product for the prevention or treatment of CVD in black African men, as well as the population at large.

The aim of this study was to investigate the vitamin B-6 status of Saudi adult males and compare the status between rural and urban subjects. Fifty-one adult male subjects were recruited from urban (n=31) and rural (n=20) populations of Riyadh. These subjects were reclassified to cigarette smokers (n=19), water pipe smokers (n=5) and non-smokers (n=27). The study also investigated the intake of macronutrients and selected micronutrients. In addition, the study investigated other health indicators including Body Mass Index (BMI), hematocrit, hemoglobin, plasma alkaline phosphatase activity and albumin concentration, urinary creatinine and urea nitrogen excretion. The mean of vitamin B-6 intake, B-6 to protein ratio, plasma pyridoxal phosphate (PLP) concentration and urinary 4-PA excretion in urban group were 2.18 ± 0.62 mg/day, 0.022 ± 0.008 mg/g, 39.3 ± 18.0 nmol/L and 4.6 ± 2.3 μmol/day, respectively. In rural group, these measures were 2.15 ± 0.65 mg/day, 0.021 ± 0.004 mg/g, 40.5 ± 14.6 nmol/L and 4.4 ± 2.3 (μmol/day, respectively. These measures indicated adequate status with no significant difference between the two groups. The mean intake of calcium, folate, vitamin D, zinc and dietary fiber was lower than recommendation of the Dietary Reference Intakes (DRI) in both groups. Health indicators were within normal range except for BMI, which indicated a prevalence of overweight and obesity in both urban (27.1 ± 5.5 Kg/m²) and rural (28.2 ± 6.0 Kg/m²) subjects. Comparison of the three smoking groups showed that the water pipe smokers compared to cigarette smokers and non-smokers groups had significantly higher mean intake of vitamin B-6 (2.51 ± 0.73 mg/day), which resulted in higher concentrations of plasma PLP, pyridoxal (PL), red blood cells PLP and urinary 4-PA (54.9 ± 23.1 nmol/L, 21.5 ± 10.0 nmol/L, 33.7 ± 8.5 nmol/L and 6.9 ± 4.7 μmol/day, respectively). Cigarette smokers had significantly lower concentration of plasma PLP (30.9 ± 12.5 nmol/L) compared to non-smokers (40.0 ± 12.9 nmol/L) without a significant difference in vitamin B-6 intake. Hematocrit and hemoglobin were significantly higher in smokers (50 ± 3% and 167 ± 11 g/L, respectively) compared to non-smokers (48 ± 3% and 160 ± 9 g/L, respectively). The results of this study suggest that vitamin B-6 status of adult males in Riyadh is adequate with no urban vs. rural variation. / Graduation date: 2004