The practise of male traditional circumcision is severely challenged with enormous problems ranging from hospitalisation of the initiates as well as deaths of the initiates. The background of the problem is focused in the Eastern Cape Province where the researcher has noted several initiates being treated in hospitals for physical and as well for psychological problems. The objective of this study was to explore and describe newly initiated Xhosa men's experiences of traditional circumcision rites at East London in the Eastern Cape Province and to describe the guidelines for support of these newly initiated Xhosa men by public health professionals. A qualitative explorative, descriptive contextual and phenomenological design was followed. Purposive sampling technique was used to select the participants. Fourteen participants volunteered to participate in the study after they met the eligible criteria. Focused group interviews were used as a method for data collection. Data analysis of the study showed that there are several factors affecting newly initiated men whilst undergoing circumcision rites. These factors can present at any of the three circumcision stages i.e. pre-circumcision, peri-circumcision and post-circumcision. The recommendations of the study strongly suggest a cultural competence in rendering effective health care services to culturally and ethnically diverse clients. All the five constructs of cultural competence are entailed in the support guidelines that have been developed by the researcher. They are cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire. Finally limitation of the study and the need for a further research has been clearly stated. / Health Studies / M.A.

Evidence of male sex work has a history as long as female sex work. There is century old evidence of male Sumarians and Greeks selling sex to other men. Men are today still selling sex to other men. This study showed that the elimination of sex work is practically impossible, and could only be accomplished by the gross denial of basic human rights. Male sex workers have not received the same attention from researchers as have their female counterparts. This is so despite the large numbers of male sex workers in cities all over the world who potentially contribute to the worldwide sexually transmitted infection rates. It is known that wherever indiscriminate sexual activities take place, the risk of transmission of infections are greater. The activities between the male sex worker and his client(s) determine the health problems they are exposed to. The purpose of this research was to determine what transpires between male sex workers and their client(s) in order to provide the sex workers with knowledge to better take care of their own health as well as the health of their clients. A qualitative research design was used to collect data by means of in-depth interviews and participant observation sessions. Research strategies that were also used included: description, ethnography, phenomenology, and the biographic methods of qualitative research. The research revealed that men who have sex with men (MSM) were exposed to forty-nine different preventable sexually transmitted infections including HIV/AIDS, trauma, violence, and alcohol and drug abuse. All these conditions relate to the lifestyle and activities of male sex workers. Recommendations were made regarding the removal of factors that hinder the delivery of programmes on safer sex to MSM. A booklet on safer sex for MSM was compiled by the researcher and distributed to all informants upon completion of the research. The neglected topic of male sex work was highlighted and health practitioners and other decision makers can now use the information in this thesis to make a contribution towards the better management of male sex work in South Africa in the interest of public health. / Health Studies / D.Litt et Phil. (Health Studies)

The study has two separate but related aims, which are to explore the social and health experiences of men who are in polygynous relationships and to develop holistic health and social strategies to support men who are in polygynous relationships. Objectives of the study were to identify the different permutations of polygynous relationships that related to health and social issues; to clarify the social status of men who are in polygynous relationship; to explore and describe the health experiences of men in polygynous relationship; to explore and describe the social experiences of men in polygynous relationship; to explore the spiritual experiences of men who are in a polygynous relationship; to describe and to generate holistic strategies to support men who are in a polygynous relationships. Method: In this study, the researcher used descriptive and interpretive phenomenological processes to develop a range of holistic strategies to support men who were in polygynous relationships. The researcher described the experiences and developed interpretations based on the lived experiences that the men reported. Findings: Polygyny remains the reality within the Bapedi tribe in Sekhukhune area. The practice of polygyny is not only for the affluent as indicated in most literature but is also practiced as a corrective strategy for families who are experiencing marital problems. Polygyny is not viewed as abusive to the women and children but rather beneficial to the women. It helps to reduce the risks of the development of cervical cancer that is predisposed by frequency of sexual intercourse. Polygyny promotes the morals within the communities, as children grow up within the two parents’ environment as opposed to the rising numbers of single parent families. Polygyny practice in the Sekhukhune areas is a voluntary choice and not a forced marital arrangement. Conclusions and recommendations: The researcher recommended policy guidance to support health practitioners with strategies to assist members of polygynous families in need of help. The policy also guides employers to recognise and to register the second or third wife as beneficiaries of the working husband. / Health Studies / D. Litt. et Phil . (Health Studies)

In English / The purpose of this study was to establish factors affecting the participation of men working in the informal sector economy of South Africa in HIV counselling and testing (HCT) or voluntary counselling and testing (VCT). This includes the exploration of reasons for acceptance and non-acceptance of HIV testing, knowledge and perceptions about HIV testing and behaviours and attitudes towards HIV testing. Data was collected through a structured questionnaire and a sample of fifty (50) men was purposively selected. It was found that the reasons for acceptance of HIV testing are satisfactory and reasons for non-acceptance are still a concern, and that several issues such as education about HIV testing and HIV in general still need to be addressed. Most of the respondents had undergone testing for HIV, but there is still a stigma attached to HIV testing. / Sociology / M. A. (Social Behaviour Studies in HIV/AIDS)

Research studies have revealed that male circumcision (MC) reduces the transmission of HIV infection from infected women to circumcised men by up to 60% (UNAIDS 2007:2), hence the adoption of MC as an HIV-infection prevention strategy by the United Nations (WHO 2007:2). Botswana, a sub-Saharan African (SSA) country, has HIV as a leading health and developmental challenge. The government adopted male circumcision as one of the strategies to combat the infection. Apparently, not all tribes in Botswana practise male circumcision as part of their culture. The purpose of this study was to develop and describe a model for HIV-infection prevention using MC. Three theory-generating research objectives were used to develop the model, namely to explore and describe perceptions of men regarding the use of MC, to develop and describe a model for MC service delivery, and to develop and describe guidelines for service providers to facilitate delivery of MC. A theory-generating research design which is qualitative, exploratory, descriptive, and contextual was used to develop the model in three phases. Phase 1 involved concept identification, concept definition, and concept classification. Data was collected using focus group discussions and individual in-depth interviews among 38 men aged 18-49 years and analysed according to recommendations made by Tesch (1990), as cited in Creswell (2009:186). Four themes emerged in the study, namely perceived effects on values, perceived source and provision of information, perceived knowledge of benefits of male circumcision, and perceived risks of male circumcision. The concept of “culture congruence” was derived from the themes as the main concept for the development of a “culture-congruent MC model for HIV prevention”. Phase 2 involved a description of the structure and the process of the model, by organising the concepts in relation to one another. The model was also evaluated. Phase 3 of the model involved the development of guidelines to support health service providers to provide MC services in a culture-congruent way in preventing HIV infection. Recommendations made were incorporation of transcultural health care instruction in nursing and medicine curricula, research on secondary audiences, such as women, and application of a culture-congruent MC model among diverse cultures. / Health Studies / D. Litt. et Phil. (Health Studies)

This study investigated the social factors influencing the poor uptake of HIV Testing and Counselling (HCT) services by middle-aged black men in Pimville, Soweto. A qualitative research approach was used for this study in which ten men and two key informants were interviewed. Themes explored were the participants’ biographical characteristics, knowledge of HIV and AIDS, health-seeking behaviours, understanding of multiple sexual partnerships, male circumcision, and challenges in using HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors are major reasons for the poor HCT uptake. Despite the men’s high HIV risk perceptions, behaviour change lags behind. Greater efforts to establish a men’s forum to discuss sexual health matters in Pimville are recommended. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Research studies have revealed that male circumcision (MC) reduces the transmission of HIV infection from infected women to circumcised men by up to 60% (UNAIDS 2007:2), hence the adoption of MC as an HIV-infection prevention strategy by the United Nations (WHO 2007:2). Botswana, a sub-Saharan African (SSA) country, has HIV as a leading health and developmental challenge. The government adopted male circumcision as one of the strategies to combat the infection. Apparently, not all tribes in Botswana practise male circumcision as part of their culture. The purpose of this study was to develop and describe a model for HIV-infection prevention using MC. Three theory-generating research objectives were used to develop the model, namely to explore and describe perceptions of men regarding the use of MC, to develop and describe a model for MC service delivery, and to develop and describe guidelines for service providers to facilitate delivery of MC. A theory-generating research design which is qualitative, exploratory, descriptive, and contextual was used to develop the model in three phases. Phase 1 involved concept identification, concept definition, and concept classification. Data was collected using focus group discussions and individual in-depth interviews among 38 men aged 18-49 years and analysed according to recommendations made by Tesch (1990), as cited in Creswell (2009:186). Four themes emerged in the study, namely perceived effects on values, perceived source and provision of information, perceived knowledge of benefits of male circumcision, and perceived risks of male circumcision. The concept of “culture congruence” was derived from the themes as the main concept for the development of a “culture-congruent MC model for HIV prevention”. Phase 2 involved a description of the structure and the process of the model, by organising the concepts in relation to one another. The model was also evaluated. Phase 3 of the model involved the development of guidelines to support health service providers to provide MC services in a culture-congruent way in preventing HIV infection. Recommendations made were incorporation of transcultural health care instruction in nursing and medicine curricula, research on secondary audiences, such as women, and application of a culture-congruent MC model among diverse cultures. / Health Studies / D. Litt. et Phil. (Health Studies)

The study has two separate but related aims, which are to explore the social and health experiences of men who are in polygynous relationships and to develop holistic health and social strategies to support men who are in polygynous relationships. Objectives of the study were to identify the different permutations of polygynous relationships that related to health and social issues; to clarify the social status of men who are in polygynous relationship; to explore and describe the health experiences of men in polygynous relationship; to explore and describe the social experiences of men in polygynous relationship; to explore the spiritual experiences of men who are in a polygynous relationship; to describe and to generate holistic strategies to support men who are in a polygynous relationships. Method: In this study, the researcher used descriptive and interpretive phenomenological processes to develop a range of holistic strategies to support men who were in polygynous relationships. The researcher described the experiences and developed interpretations based on the lived experiences that the men reported. Findings: Polygyny remains the reality within the Bapedi tribe in Sekhukhune area. The practice of polygyny is not only for the affluent as indicated in most literature but is also practiced as a corrective strategy for families who are experiencing marital problems. Polygyny is not viewed as abusive to the women and children but rather beneficial to the women. It helps to reduce the risks of the development of cervical cancer that is predisposed by frequency of sexual intercourse. Polygyny promotes the morals within the communities, as children grow up within the two parents’ environment as opposed to the rising numbers of single parent families. Polygyny practice in the Sekhukhune areas is a voluntary choice and not a forced marital arrangement. Conclusions and recommendations: The researcher recommended policy guidance to support health practitioners with strategies to assist members of polygynous families in need of help. The policy also guides employers to recognise and to register the second or third wife as beneficiaries of the working husband. / Health Studies / D. Litt. et Phil. (Health Studies)

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Men might benefit from opportunities specific to their needs in improving access to HIV care. This is a group vulnerable to higher morbidity and mortality than their female counterparts, due not only to poor or delayed health seeking behaviour and the culture of blame for the transmission of HIV, but probably due to neglect, inadequate or poor support by the current policies, by a gender biased research agenda, by the international research community and global health funders. Objectives: The objectives of this current study were: - to explore the reasons for poor health seeking behaviour amongst African men seeking HIV care in KZN; - to establish the health care practitioners’ views about the reasons for the perceived poor health seeking behaviour amongst African men accessing HIV services in KZN; - to inform guidelines in improving access to HIV services by African men Methodology In-depth interviews were employed as the method of obtaining lived experiences, perspectives and opinions of men living with HIV and that of their health care practitioners. Results It was found that men still feared the diagnosis of being HIV positive, even with the advent of highly active anti-retroviral therapy (HAART) and the advances in managing this disease. Several reasons for this fear emerged with the common theme being the doom of impending death, social stigma and fear of abandonment as well as social marginalization. Conclusions We cannot expect to attract men to predominantly female orientated settings within health faculties. Special attempts need to be made to reach out to men in places they are comfortable being in. Messages should be clear and concise about the effectiveness of low cost, available treatment for HIV; and that early diagnosis improves health outcomes. Cultural sensitive interventions are needed that are suitable, in generating a clearer understanding of health management options and motives. / AFRIKAANSE OPSOMMING: Mans kan voordeel trek uit geleenthede wat spesifiek op hul behoeftes in die verbetering van toegang tot MIV-sorg. Dit is 'n groep kwesbaar vir hoër morbiditeit en mortaliteit as hul vroulike eweknieë, nie net die gevolg swak of vertraagde gesondheid gedrag en die kultuur van die blaam vir die oordrag van MIV, maar waarskynlik as gevolg van verwaarlosing, onvoldoende of swak ondersteuning deur die huidige beleid , deur 'n geslag bevooroordeeld navorsing agenda, deur die internasionale navorsing gemeenskap en globale gesondheid-befondsers. Doelstellings: Die doelwitte van die huidige studie was: - die gesondheidsorg-praktisyns se siening oor die redes vir die waargenome swak gesondheid gedrag onder-Afrikaanse mans toegang tot MIV-dienste in KZN tot stand te bring; - die redes vir swak gesondheid gedrag onder-Afrikaanse mans wat MIV-sorg in KZN te verken en - riglyne te stel in die verbetering van toegang tot MIV-dienste deur swart mans Metodes In-diepte onderhoude is gebruik as die metode van die verkryging van geleefde ervarings, perspektiewe en menings van mense wat met MIV en dié van hul gesondheidsorg praktisyns. Bevindings Daar is bevind dat mans nog bang was vir die diagnose van MIV-positief is, selfs met die koms van hoogs aktiewe antiretrovirale terapie (HAART) en die vooruitgang in die bestuur van hierdie siekte. Verskeie redes vir hierdie vrees na vore gekom met die gemeenskaplike tema synde die straf van die naderende dood, sosiale stigma en vrees vir verlating, sowel as sosiale negatief. Gevolgtrekkings Ons kan nie verwag om mense te lok om oorwegend vroulike georiënteerde instellings in gesondheid fakulteite. Spesiale pogings moet aangewend word om uit te reik na die mans in plekke waar hulle gemaklik is. Boodskappe moet duidelik en bondig oor die doeltreffendheid van lae koste, beskikbare behandeling vir MIV, en dat die vroeë diagnose verbeter gesondheid uitkomste. Kulturele sensitiewe intervensies word benodig wat geskik is, in die skep van 'n beter begrip van gesondheid opsies en motiewe.

The practise of male traditional circumcision is severely challenged with enormous problems ranging from hospitalisation of the initiates as well as deaths of the initiates. The background of the problem is focused in the Eastern Cape Province where the researcher has noted several initiates being treated in hospitals for physical and as well for psychological problems. The objective of this study was to explore and describe newly initiated Xhosa men's experiences of traditional circumcision rites at East London in the Eastern Cape Province and to describe the guidelines for support of these newly initiated Xhosa men by public health professionals. A qualitative explorative, descriptive contextual and phenomenological design was followed. Purposive sampling technique was used to select the participants. Fourteen participants volunteered to participate in the study after they met the eligible criteria. Focused group interviews were used as a method for data collection. Data analysis of the study showed that there are several factors affecting newly initiated men whilst undergoing circumcision rites. These factors can present at any of the three circumcision stages i.e. pre-circumcision, peri-circumcision and post-circumcision. The recommendations of the study strongly suggest a cultural competence in rendering effective health care services to culturally and ethnically diverse clients. All the five constructs of cultural competence are entailed in the support guidelines that have been developed by the researcher. They are cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire. Finally limitation of the study and the need for a further research has been clearly stated. / Health Studies / M.A.