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.

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)

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)

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)

Indiana University-Purdue University Indianapolis (IUPUI) / Gender differences in the basal function of autonomic cardiovascular control are well documented. Consistent baroreflex (BRx) studies suggest that women have higher tonic parasympathetic cardiac activation compared to men. Later in life and concomitant with menopause, a significant reduction in the capacity of the BRx in females increases their risk to develop hypertension, even exceeding that of age-matched males. Loss of sex hormones is but one factor. In female rats, we previously identified a distinct myelinated baroreceptor (BR) neuronal phenotype termed Ah-type, which exhibits functional dynamics and ionic currents that are a mix of those observed in barosensory afferents functionally identified as myelinated A-type or unmyelinated C-type. Interestingly, Ah-type afferents constitute nearly 50% of the total population of myelinated aortic BR in female but less than 2% in male rat. We hypothesized that an afferent basis for sexual dimorphism in BRx function exists. Specifically, we investigated the potential functional impact Ah-type afferents have upon the aortic BRx and what changes, if any, loss of sex hormones through ovariectomy brings upon such functions. We assessed electrophysiological and reflexogenic differences associated with the left aortic depressor nerve (ADN) from adult male, female, and ovariectomized female (OVX) Sprague-Dawley rats. Our results revealed sexually dimorphic conduction velocity (CV) profiles. A distinct, slower myelinated fiber volley was apparent in compound action potential (CAP) recordings from female aortic BR fibers, with an amplitude and CV not observed in males. Subsequent BRx studies demonstrated that females exhibited significantly greater BRx responses compared to males at myelinated-specific intensities. Ovariectomy induced an increased overall temporal dispersion in the CAP of OVX females that may have contributed to their attenuated BRx responses. Interestingly, the most significant changes in depressor dynamics occurred at electrical thresholds and frequencies most closely aligned with Ah-type BR fibers. Collectively, we provide evidence that, in females, two anatomically distinct myelinated afferent pathways contribute to the integrated BRx function, whereas in males only one exists. These functional differences may partly account for the enhanced control of blood pressure in females. Furthermore, Ah-type afferents may provide a neuromodulatory pathway uniquely associated with the hormonal regulation of BRx function.

Indiana University-Purdue University Indianapolis (IUPUI) / Russian demographic statistics reflect the persistence of a dramatically wide gender gap in life expectancy and mortality over the last decades - about twice that found in the developed world. On average, men in Russia live 12 years less than Russian women, and 14.5 years less than men in Western Europe. This thesis provides an overview and synthesis of the most recently available literature that addresses the persistent gender gap in mortality and life expectancy in Russia. I reviewed the prevalent behavioral and social-structural drivers that explain the causes of higher male mortality in contemporary Russia. Especially, I looked at how the conceptualization of the male social role and related norms that shape masculine behavior contribute to high male mortality in Russia. The study reveals that men’s unhealthy, risky behavior and their higher vulnerability to stress are considered to be linked to their gendered social identity which is created and reproduced by the social-structural context of the Russia’s society.

This study investigated social contextual factors influencing poor uptake of HIV counselling and testing (HCT) services by middle-aged black men in Ratanda, Heidelberg. A qualitative research approach was used 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 and male circumcision and challenges in utilising HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors largely contributed to poor HCT uptake. Moreover 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 Ratanda is recommended. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)

This study investigated social contextual factors influencing poor uptake of HIV counselling and testing (HCT) services by middle-aged black men in Ratanda, Heidelberg. A qualitative research approach was used 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 and male circumcision and challenges in utilising HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors largely contributed to poor HCT uptake. Moreover 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 Ratanda is recommended. / Health Studies / M. A. (Social Behaviour Studies in HIV/AIDS)

Indiana University-Purdue University Indianapolis (IUPUI) / While the majority of chronic pain patients report receiving inadequate care, there is evidence that female and Black patients receive less analgesic medications and treatment for their chronic pain compared to male and White patients, respectively. While treatment disparities have been evidenced in the literature, there is little understanding of provider-factors, such as their decision-making awareness and attitudes, which may contribute to the differences in treatment. This investigation employed quantitative and qualitative procedures to examine the relationship between patient demographics and chronic pain treatment variability, providers’ awareness of these non-medical influences on their decisions, and the extent to which providers’ gender and racial attitudes associate with their treatment decisions. Twenty healthcare trainees made pain treatment decisions (opioid, antidepressant, physical therapy, pain specialty referral) for 16 computer-simulated patients presenting with chronic low back pain; patient sex and race were manipulated across vignettes. Participants then selected among 9 factors, including patient demographics, to indicate which factors influenced their treatment decisions for the simulated patients and completed gender and racial attitude measures. After online study completion, follow-up semi-structured interviews were conducted to discuss the medical/non-medical factors that influence trainees’ clinical treatment decisions. Quantitative analysis indicated that 5%-25% of trainees were actually influenced (p<0.10) by patient sex and race in their treatments, and on the whole, trainees gave higher antidepressant ratings to White than Black patients (p<.05). Fifty-five percent demonstrated concordance, or awareness, between their actual and reported use of patient demographics. Follow-up McNemar’s test indicated trainees were generally aware of the influence of demographics on their decisions. Overall, gender and racial attitudes did not associate with trainees’ treatment decisions, except trainees’ complementary stereotypes about Black individuals were positively associated with their opioid decisions for White patients. During qualitative interviews, aware and unaware trainees discussed similar themes related to sex and racial/ethnic differences in pain presentation and tailoring treatments. We found that (1) a subset of trainees were influenced by patient sex and race when making chronic pain treatment decisions, (2) trainees were generally aware of the influence of patient demographics, and (3) trainees discussed differences in pain presentation based on patients’ sex and ethnic origin. These findings suggest trainees’ are influenced by patient demographics and hold stereotypes about patient populations, which may play a role in their decision-making.