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This study examined social support landscapes of People living with HIV/AIDS (PLWHA) in Winnipeg, Manitoba through secondary analysis of the Positive Prevention Study (PPS) data. Descriptive, univariate, and multivariate analyses were utilized to investigate prospective associations between demographics, measures of positively/negatively perceived social support, sexual and substance use related transmission behaviours. The PPS (2009), a cross sectional study, interviewed 135 Manitoban PLWHA about their experiences. The majority reported at least some positively perceived social support. Ongoing transmission behaviours were reported regardless of time since diagnosis. Several key demographic variables and measures of social support were found to be associated with risk behaviours in simple and multivariate analyses. Recommendations: strengthen capacity of health care providers to continue risk prevention education beyond time of diagnosis, bolster peer led knowledge transferring prevention programs, focus upon those most at risk of continued transmission behaviour, and ensure continued existence of successful support programming. / May 2016

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Objective: Childhood abuse (CA) is commonly associated with increased frequency of high-risk behaviours (HRB) in adolescence. Similarly, research has highlighted links between CA and blunted responses to reward. To date, little attention has been devoted to examine if altered reward processes may also be linked to increased engagement in HRB. To explore this hypothesis, this systematic review collated research that investigated the relationship among CA, reward processes and HRB. Specifically, the review addressed the question: Are HRB associated with altered reward processes in children and adults with a history of CA? Method: Behavioural and neurobiological studies on CA, reward processing and HRB in children and adults were selected from multidisciplinary and subject-specific databases published prior to the 1st of March 2016. The systematic literature search yielded 271 records with 198 non-duplicated results. Screening of 14 full-text publications led to five eligible studies synthesized in this review. Results: Results confirmed impaired reward learning and increased HRB in those with a history of CA. Associations of blunted anticipatory or consummatory reward processing and HRB in individuals with CA remained inconclusive. Conclusions: Reward learning appears to be associated with CA. Further research is required to explore the relationship between reward processes and HRB. Understanding CA from a neurodevelopment perspective is a critical step to developing effective intervention strategies to reduce HRB. Empirical Paper: Abstract Objective: Following childhood abuse (CA), adolescence often sees the onset of depression and high-risk behaviour (HRB). Despite the prevalence, little is known about underlying neurobiological factors linking CA and HRB. To address this gap, I examined if anticipatory and consummatory reward processing in adolescents with CA predict frequency of HRB, irrespective of depressive symptoms. Methods: Thirty-seven adolescents (M=17.08 years; SD = 1.86) participated in the study: 13 females with CA and current major depressive disorder (MDD), eight females with MDD and no CA, and 16 individuals with no CA and no MDD for comparison (control group). Adolescents completed the Card-Guessing paradigm to assess reward processing, while undergoing a magnetic resonance imaging scan. Neural region-of-interest responses in the striatum and pallidum were assessed during anticipatory and consummatory reward phases. Hierarchical regression models investigated if neural responses to reward were altered based on exposure to CA and if altered neural responses predicted higher use of HRB. Results: Data showed that (1) depressed adolescents engaged more frequently in HRB irrespective of history of CA, (2) anticipatory and consummatory reward processes were not altered based on a history of CA, and (3) blunted activation in right pallidum in anticipation of rewards predicted HRB irrespective of depressive symptoms. Conclusion: Although the current study did not confirm changes in reward processing following CA, blunted reward ‘wanting’ was linked to more frequent HRB. Findings are relevant to theories highlighting the critical role of the pallidum in perceiving cues as rewarding and in initiating goal-directed actions to obtain rewards.

Magister Artium (Social Work) - MA(SW) / A qualitative study was conducted to explore and describe the factors that hinder parent involvement in the High Five Life Skills Programme for at risk children. Parent involvement remains a challenging phenomenon, which affects not only the child, as an individual, but also the family in society. However, although parenting children is perceived to be an important responsibility, parents do not receive any formal training on how to be good parents. An explorative and descriptive research design was utilised. Data collection was done by means of semi-structured interviews and focus group discussions, with the parents/guardians and children in the High Five Life Skills Programme, as well as the teachers, who refer children to the programme. The method of non-probability sampling, employed in this study was purposive sampling. The sample was selected on the basis of the researcher’s own knowledge, as well as the purpose of the study. Data were analysed using the nine steps proposed by Creswell. The results highlighted six barriers that hindered parent involvement in the High Five Life Skills Programme, namely, Low self-esteem of parents/caregivers and children; Lack of communications between all relevant parties - caregivers, teachers and the facilitators of the High Five Life Skills programme; Lack of role models: Parents’ not being role models as their own negative behaviour hindered their involvement; Lack of an emotional bond between parents and children, coupled with absent fathers; Lack of parents’ parental skills and support networks; and the lack of resources and support with transport to and from meetings, as well as child care for younger siblings. The participants, especially the children, freely expressed themselves, and contributed to the results; thereby assisting the researcher to explore the barriers that hinder parent involvement in the High Five Life Skills Programme. It is anticipated that the results of this current study will form a basis for the High Five Life Skills Programme to develop strategies that respond to the needs of the parents and children involved in the programme.

Black-Canadian populations are disproportionately affected by HIV/AIDS. In particular, Black-Canadian youth are noted to be at a greater risk of HIV infection due to their sexual risk behaviours. Many international studies indicate that open parent-youth sex communication may counter the potentially negative impact of peers, mass media and inadequate sexual health education programs on youth sexual risk behaviour. However, there is a paucity of Canadian studies on Black-Canadian parent-youth sex communication and ways to enhance this communication. As such, a qualitative based exploratory study was conducted using a community based research approach to determine the state of Black-Canadian parent-youth sex communication in Toronto, Ontario. Data was collected through 17 Key Informant interviews; that is individuals who work in Black Toronto communities and are knowledgeable about the subject matter. The results noted several factors which affect Black-Canadian parent-youth sex communication such as religion and cultural taboos surrounding the discussion of sexual health. The impact of these factors along with potential implications of this study on Black-Canadian populations and recommendations to enhance Black-Canadian parent- youth sex communication are discussed. / UOIT

Philosophiae Doctor - PhD / Background: There is consensus internationally and among South African researchers that engagement in health risk behaviours amongst the youth is a concern from a public health perspective. It is evident that much health risk behaviours are established during adolescence, and may continue into adulthood, affecting health and wellbeing in later life, and some preventable health behaviours may be contributory causes of morbidity and mortality. Research into the development t of programmes can play a major role in reducing health risk behaviour amongst the youth and also provide a key learning opportunity should this be driven with bigger impetus by the building of research knowledge. Research knowledge needs to inform all stakeholders as to the best evidence-based possibilities that can assist in creating the behavioural change that is envisaged. This study therefore aimed to design, evaluate the feasibility of, and implement, a comprehensive youth development programme that will help to equip learners with the skills to change health risk behaviour in selected schools in the Paarl area, through input from all the stakeholders. The objectives of the study were to 1) obtain baseline information of grade 8 –10 learners about the health risk behaviours they engage in, and the extent to which learners manage personal situations; 2) explore the views of stakeholders regarding the type of health risk behaviours learners engage in, and reasons for engaging; 3) To determine the content of school-based interventions reported in literature, and its effectiveness in reducing or delaying these behaviours amongst the youth; 4) To design a youth development programme based on the views of the stakeholders and literature; 5) To evaluate the feasibility of the youth development programme designed in objective 4; 6) To implement a youth development programme. Method: This study adopted Intervention Mapping as a framework that translated into a five phase study. Each phase informed the next and the findings culminated in the proposed youth development programme for grade 8-10 learners in the Paarl area. Phase 1 used a survey to obtain baseline information about the health risk behaviours that youth engage in and the extent to which learners manage personal situations. The survey was administered using the face-face method and included a demographic questionnaire, the Youth Risk Behaviour Surveillance Survey and the Life Effectiveness Questionnaire. Descriptive statistics such as Frequencies and cross tabulations were performed, as well as inferential statistics including Multiple Regression analysis and Chi-square tests. Phase 2 entailed concept mapping using focus groups and individual interviews with stakeholders to determine their perceptions of the health risks learners engage in and the reasons for their behaviours. The sample included learners, teachers, and community representatives. Thematic analysis was conducted with transcriptions of the focus groups. Phase 3 entailed a systematic review of the literature reporting on interventions aimed at delaying and or preventing engagement in health risk behaviours amongst youth. Phase 4 entailed the triangulation of the findings from the first three phases into a draft programme. Phase 5 included a Delphi study with life skill trainers and experts in the field of health risk programming for adolescents. The Delphi survey was conducted in two rounds. After the feedback in round one, revisions were made to the draft programme to develop the final programme. Results: The results in phase 1 resonated with the findings in the existing body of literature with regards to the health risk behaviours that learners engaged in. Smoking, drinking, sexual activity, drug use, physical inactivity, crime and violence were the most prominent HRBs reported by learners in this sample. Regression analyses indicated that the combination of the LEQ`s life skill domains (Time management, Achievement, Emotional control, Social competence, Active initiative, Self-confidence, Intellectual flexibility and Task leadership) significantly explained between 25% and 56% of the variance in the health risk behaviours (smoking, drinking, drug use, sexual activity). Gendered patterns in engagement with drinking, drug use and risky sexual behaviour was empirically supported by the results of Chi square tests. Drinking and drug use was significantly more prevalent with male learners whilst risky sexual behaviour was significantly more prevalent amongst female learners. Results from phase 2, represented by a concept map suggested that the development of programme content should start with contextual relevance achieved by understanding the range of HRBs youth engage in. This in turn allows for an exploration of the pathways in which engagement has come about. The second and third quadrants illustrate this through their focus on the reasons why youth engage in HRBs and the places where they are exposed to HRBs respectively Once the content has addressed what they do and why they do it, the process of skills development can commence to combat engagement in HRBs. The resultant concept map has four quadrants where each quadrant represents a concept map that corresponded to the themes identified was conceptualized as interacting with one another. During the systematic review process it was identified that effective interventions included the following elements: multi-theoretical approaches, multiple HRBs as targets, gender differentiation, and life skills. In phase 4 a concept map was created that assisted with the design of the programme. The findings from the Delphi study ratified the components included and determined that it was feasible. The recommendations included independent facilitators who have been trained in a specific skill set, avoiding the blurring of the boundary between teachers and facilitators, and a distinction between grades for the purposes of conceptualizing and presenting the programme. This resulted in the researcher augmenting the proposed programme to include independent facilitators; peer mentors; a staggered or tiered programme. These augmentations were substantial and made an immediate implementation not feasible. The scope of the revisions for developing a tiered or staggered programme was adopted as a recommendation, but was outside the scope of the present study in fulfilment of the requirements for a doctoral degree. Thus the final or revised programme only represents the initial level for grade 8 learners and the development process will continue using the same methodology in post-doctoral research. These include the development and accreditation of the training resources, selection and training of faciltators, and the clarification of the relative standing of facilitators in the school environment. Discussion: Health risk behaviour engagement, the factors influencing that engagement and the development of a diverse youth development programme to delay, reduce or prevent it is in itself very complex. Add to it the fact that the youth live in an ever-changing environment where negative role modelling and exposure to health risk behaviour is an everyday occurrence. Structures have been identified in this study that can play a vital role in designing a youth development programme, as well as build on existing programmes. This study incorporated intervention mapping as a participatory design using both quantitative and qualitative methodologies that speak to a high level of rigour and methodological coherence. The study yielded a rich data base with clear directives for future research that will make a significant contribution to the attempts to impact youth development programming and health risk behaviour amongst adolescents. Conclusion: The findings of this study suggest that a multi-theoretical approach to programming that includes gender differentiation and the targeting of multiple HRBs is likely to be more effective in the reduction, delay and prevention of health risk behaviour amongst learners in grade 8-10. The resultant programme is tiered or staggered and differentiates between grades in conceptualization and implementation of the programme. The study presented the programme for the first tier with grade 8 learners and made clear recommendations for the way forward. The study makes an important contribution in its use of participatory methodology that includes stakeholder participation to create a more robust and comprehensive programme.

Like other developing countries in sub-Saharan Africa, South Africa is faced with the following social welfare issues: teenage pregnancies, high HIV rates, sexually transmitted diseases (STDs), and a high number of abortions. South Africa is dealing with the repercussions of risky sexual behaviour of female youth on a daily basis and these include: youth with STDs, teenage pregnancies, HIV infection, cervical cancer, abortion, and youth selling their bodies for money. All of these can lead to serious health risks. There are psychological and behavioural factors associated with the risk of STDs like Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) (Gebregiorgis, 2000:15). Gebregiorgis reported that understanding sexual risk behaviours is one of the most important issues in preventing the spread of HIV and AIDS. Doing so will result in the design and implementation of health education programmes with the view of preventing these infections, or at least minimising their occurrence (Damtie, 2013:1). Very limited research has been done on this topic in South Africa and Africa. A need for a similar study was recommended in Ethiopia, where it was stated that no published empirical studies were available on factors relating to sexual risk behaviours in rural districts such as the Enemay District, East Gojjam Zone of Ethiopia (Anemaw, 2009:5). Hence, this study will explore and describe factors that may influence female youths to engage in unsafe sexual behaviours. The focus of the study was on the risky sexual behaviour of female youth in rural and urban areas. The goal of the study was to explore and describe the nature and consequences of risky sexual behaviour of female youth in rural and urban areas. The research question of this study was: do female youth in urban and rural areas have insight regarding the nature and consequences of their risky sexual behaviour? A qualitative approach was followed with a case study research design, as the researcher wanted to compare cases in urban and rural areas. The population was school-going females aged between 18 and 20 years in Gauteng province. There were two targeted groups of population. The first one was in Kameeldrift Village, Hammanskraal in Tshwane Municipality, Gauteng province, classified as a rural area. The second population was in Tembisa, Ekurhuleni Municipality, Gauteng province, classified as an urban area. In this study non-probability, purposive sampling was used to generate a sample. The criteria for sampling participants were as follows: ? Female youth between the ages of 18 and 20 years old. ? Female youth who are sexually active, as they request contraceptives at the clinic. ? Female youth who are from Ivory Park in Tembisa and Kameeldrift Village in Hammanskraal, both in Gauteng. Twelve participants, namely six female youth from a rural area and six from an urban area, who were at the above-mentioned clinics to access family planning within the above-mentioned age groups were chosen for the study. Semi-structured interviews were conducted with participants individually. Interviews were voice recorded with the permission of the participants and were transcribed by the researcher. The data was analysed by the researcher and themes and sub-themes were generated. The research findings were presented by providing a profile of the research participants and presenting a thematic analysis of the themes and sub-themes, including literature and verbatim quotes from the transcriptions to support the findings. The themes included the following: Theme 1 Knowledge of female youth regarding reproductive health; Theme 2 Knowledge of preventative measures and prevention of pregnancy; Theme 3 Sexual risk behaviour and exploration of multiple sexual partners or concurrent partners; Theme 4 Consequences of risky sexual behaviour; and Theme 5 Attitudes experienced as a result of consequences of risky sexual behaviour. The conclusions of this study reflect that that a limited understanding of reproductive health is a contributing factor to the sexual risk behaviour displayed by female youths in both rural and urban areas. It was further concluded that fear of dealing with the consequences of risky sexual behaviour does not prevent female youth from early sexual debut. Another conclusion is that early sexual debut is the biggest factor to risky sexual behaviour, as the majority of participants started engaging in sexual activities very early in life while they were not mature enough to negotiate safer sex practices. Recommendations of this study can be used by professionals working with female youth in the health field in order to understand the dynamics involved, such as the biological, psychological, and social influences that result in the sexual behaviour of female youth. These will address the complex issues related to environmental influences that shape risky sexual behaviour of female youth. / Mini Dissertation (MSW)--University of Pretoria, 2016. / Social Work and Criminology / MSW / Unrestricted

The study investigates how the church in Zambia can effectively facilitate change toward reducing HIV-risky behaviour. The researcher posits that an intricate connection exists between HIV-risky behaviour and the socio-cultural context of majority people groups in Zambia. He further argues that much risky behaviour is imbedded in pervasive socio-cultural norms and traditions propelled by a worldview which essentially resists transformation. From an insider’s perspective the researcher will design a praxis model for transforming Zambian worldview facets with regard to HIV/AIDS predisposing behaviours in order to achieve enduring HIV risk reduction. The study reviews current literature on HIV behavioural change theories and models to understand where the theories have taken all the stakeholders, including theological praxis. The study will demonstrate the link between Zambian cultural worldviews and trends in sexual behaviour which, arguably, facilitates the proliferation of HIV risky behaviour. The study culminates in designing an evangelical theological praxis/model for transforming relevant cultural worldviews toward changing HIV risky behaviour in Zambia. / Thesis (PhD)--University of Pretoria, 2010. / Practical Theology / unrestricted

Master of Public Health - MPH / South Africa is overwhelmed by the increase of substance abuse among adolescents. Having consulted the literature, South Africa is not the only country faced with this problem. It raises concerns with regard to the social health of adolescents in this country. In order to develop effective intervention strategies to reduce the wide spread abuse of substances, it is important to first understand how adolescents perceive this problem. In this study the perceptions of boys will be explored with regard, to substance abuse among adolescents.