The purpose of the study was to explore factors that influenced safer sex practices in Malawi. A quantitative, explorative, descriptive study was conducted to determine why the prevalence of new HIV infections was still high in Malawi despite. Questionnaires were used to collect data. Sexually active men, women, boys and girls that participated in the Centre for Human Rights and Rehabilitation community awareness activities participated in this study. The study found that demographic, socio-economic and knowledge-related factors influence safer sex practices in Malawi. Various modifying factors played a role in influencing the individuals’ perception of susceptibility, severity, barriers and benefits of practising safer sex. The findings indicated that individuals generally had a broad knowledge of the spread and prevention of HIV. The Health Belief Model was used as theoretical framework for the study / Health Studies

The phenomenon of HIV discordance has been in existence for a long time along with HIV. However, very limited attention has been given to HIV discordance. This phenomenological study aimed at gaining a deeper understanding on the lived experiences of sero-discordant couples in Botswana. Reports show that discordance in Botswana is around 17%. The main objectives of this study were to identify HIV discordant couples living in Botswana and explore their knowledge and understanding of the situation, explore the psychological, social and sexual experiences of the HIV discordant couples and determine its impact in their lives, and examine the meaning they attach to such experiences and challenges they face as well as their coping strategies. A qualitative phenomenological approach using face to face in-depth interviews was used to explore and describe meanings and experience as lived by the HIV discordant couples. The study sample consisted of forty-six (N=46) (twenty-nine (n=29) females and seventeen (n=17) males) participants selected using purposive sampling from three cities in Botswana. The Inclusion criteria were that participants should be aged 21 years and above; with no known diagnosis of mental illness; having been in a discordant relationship for at least six months at the time of data collection; living in Botswana and willing to participate in the study. The findings were that there are three forms of discordance, which are: discordant unaware which are couples who went into the relation unaware of their HIV status. Discordant aware; those who got into the relationship already knowing each other’s HIV status and discordantly discordant which are those with differing HIV status and differing motives of going into the relationship. These are the couples that conceal their status from one another. The results revealed intense emotional/psychological, sexual and social stresses as experienced by couples. HIV discordant goes through three phases of initial shock, conflict and resolution. The researcher recommends the OPEN DESK MODEL to be integrated in the health facilities to encompass the concept of a family or couple and as a unit. / Health Studies / D. Litt. et Phil. (Health Studies)

The phenomenon of HIV discordance has been in existence for a long time along with HIV. However, very limited attention has been given to HIV discordance. This phenomenological study aimed at gaining a deeper understanding on the lived experiences of sero-discordant couples in Botswana. Reports show that discordance in Botswana is around 17%. The main objectives of this study were to identify HIV discordant couples living in Botswana and explore their knowledge and understanding of the situation, explore the psychological, social and sexual experiences of the HIV discordant couples and determine its impact in their lives, and examine the meaning they attach to such experiences and challenges they face as well as their coping strategies. A qualitative phenomenological approach using face to face in-depth interviews was used to explore and describe meanings and experience as lived by the HIV discordant couples. The study sample consisted of forty-six (N=46) (twenty-nine (n=29) females and seventeen (n=17) males) participants selected using purposive sampling from three cities in Botswana. The Inclusion criteria were that participants should be aged 21 years and above; with no known diagnosis of mental illness; having been in a discordant relationship for at least six months at the time of data collection; living in Botswana and willing to participate in the study. The findings were that there are three forms of discordance, which are: discordant unaware which are couples who went into the relation unaware of their HIV status. Discordant aware; those who got into the relationship already knowing each other’s HIV status and discordantly discordant which are those with differing HIV status and differing motives of going into the relationship. These are the couples that conceal their status from one another. The results revealed intense emotional/psychological, sexual and social stresses as experienced by couples. HIV discordant goes through three phases of initial shock, conflict and resolution. The researcher recommends the OPEN DESK MODEL to be integrated in the health facilities to encompass the concept of a family or couple and as a unit. / Health Studies / D. Litt. et Phil. (Health Studies)

Using the perspectives of individualism-collectivism, Social Cognitive Theory and other concepts such as gay community attachment, this study focused on issues of homosexual identification, disclosure and sexual risk practices in relation to cross-cultural differences among gay Asian and Caucasian men in Sydney. Mostly recruited from gay social venues, 19 gay Asian men participated in exploratory focus groups discussions, another 201 gay Caucasian and 199 gay Asian men completed an anonymous questionnaire, and a further 10 gay Caucasian and 9 gay Asian men took part in in-depth one-to-one interviews. The major findings were: gay Asian men tended to experience conflict, in being both gay and Asian, related to individualism and collectivism; the gay Asian and Caucasian men differed in various aspects of homosexual practice, but shared certain sexual traits and practices; self-efficacy in safe sex and gay community attachment were key factors associated with gay men???s sexual risk practices (???risk??? being defined as unprotected anal intercourse with any casual partners or with a regular partner whose HIV status was not concordant with the participant???s). This study provides evidence that the inclusion of individualism-collectivism, social cognitive variables and gay community factors in the examination of homosexual identity and practice among men of different cultural backgrounds holds promise. It further suggests that educational programs to encourage safe sex will continue to yield benefits from increasing individual awareness, confidence and ability to effectively deal with situations that could pose risks of HIV transmission.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: World Health Organisation (WHO) and UNAIDS named male circumcision as a key intervention in halting the spread of HIV in Africa. Several countries in sub-Saharan Africa with low levels of male circumcision (MC) and high HIV prevalence are scaling up MC services, Swaziland being one of them. Despite the circumcisions done in Swaziland it seems there is no significant decrease in HIV prevalence which might be due to various reasons. One of the reasons noted was the behaviour of men after circumcision because of the belief of total of immunity. This has led to an increase in high risk behaviour, increased promiscuity, multiple partners, more unsafe sex and failure to use condoms, thereby defeating the own stated purpose. Objectives: 1) To identify the knowledge, attitude and practices (KAP) of circumcised men towards safe sex. 2) To establish the existing knowledge of the relationship between circumcision and HIV prevention. 3) To establish whether men in Swaziland take part in riskier sexual behaviour after or before being circumcised. 4) To make recommendations for the counseling programme. Methodology: A cross-sectional analytical study whereby both qualitative and quantitative methods of data collection was used. Simple random sampling was used to select circumcised men from Mankayane hospital, Mankayane and Holy Rosary high schools and a total of 90(60 adults and 30 teenagers) filled in self- administered questionnaires and also took part in focus group discussions. Purposive sampling was used to choose the MC Counsellors and in-depth interviews were done to complement the information on knowledge, attitudes and practices of men towards safe sex before, during and after circumcision. An observation checklist was also used to check what they included in their counselling sessions. Results: The responses solicited from the men who participated in this study show that there is basic knowledge with regards to safe sex and the value of MC in the prevention of HIV. The pattern in the data however shows that those that were the most recent to undergo medical circumcision had the most varied opinions on the extent to which MC protect one from HIV. There was mixed attitude towards safe sex after circumcision, some wanting to maximise their satisfaction without using protection. The data also points to a pattern were the men have a high relationship turnover and this was more discernible among the teenagers who suggest that the relationships are not built on commitment but possible experimentation. While the study did not have control that tracked uncircumcised men for comparative purposes, the findings point to inconsistent use of condoms among men which heightens the risk of HIV transmission. The results point to a well-structured programme of counseling followed by MC counselors. Conclusion: The study was able to satisfy the aim and objectives. The research process was designed to collect the necessary data and be analysed in a manner that answered the research question. The research target population and subsequent sample represented the geographical scope of the study. The research tools were designed to be easy for the respondents to use. The distribution and collection method was designed to give the respondents less hassle as possible. This had a positive impact on the response rate, which increased the validity of the data collected. Both the literature review and primary research findings affirm that MC without behaviour change is not the panacea for prevention of HIV. / AFRIKAANSE OPSOMMING: Die Wêreldgesondheidsorganisasie (WGO) en UNAIDS het manlike besnydenis as ’n belangrike intervensie uitgewys om die verspreiding van MIV in Afrika te stuit. Verskeie lande in Afrika suid van die Sahara met lae vlakke van manlike besnydenis (MB) en hoë vlakke van MIV is tans besig om MB-dienste uit te brei, en Swaziland is geen uitsondering nie. Ondanks die besnydenis wat in Swaziland gedoen word, blyk daar egter geen beduidende afname in MIV te wees nie. Dít kan aan verskillende redes toegeskryf word. Een daarvan is mans se gedrag ná besnyding vanweë hul oortuiging dat hul geheel en al immuun is. Dit het tot ’n toename in hoërisikogedrag, meer promiskuïteit, veelvuldige bedmaats, meer onveilige seks en ’n gebrek aan kondoomgebruik gelei, wat uiteraard die doel verydel. Oogmerke: 1) Om besnyde mans se kennis, houdings en praktyke met betrekking tot veilige seks te bepaal. 2) Om bestaande kennis oor die verband tussen besnydenis en MIV-voorkoming te bepaal. 3) Om vas te stel of mans in Swaziland voor of ná besnyding geneig is tot meer riskante seksuele gedrag. 4) Om aanbevelings te doen vir die MB-beradingsprogram. Metodologie: ’n Deursnee- analitiese studiebenadering met sowel kwalitatiewe as kwantitatiewe datainsamelingsmetodes is gevolg. Met behulp van eenvoudige ewekansige steekproefneming is mans van Mankayane-hospitaal en tienerseuns van Mankayane- en Holy Rosary-hoërskool gekies. Altesaam 90 respondente (60 volwassenes en 30 tieners) het vraelyste op hul eie ingevul en ook aan fokusgroepbesprekings deelgeneem. Doelbewuste steekproefneming is gebruik om ’n groep MB-beraders te kies, met wie daar diepteonderhoude gevoer is om die inligting oor mans se kennis, houdings en praktyke met betrekking tot veilige seks voor, gedurende en ná besnyding aan te vul. ’n Waarnemingskontrolelys is ook gebruik om af te merk wat die beraders by hul beradingsessies insluit. Resultate: Die antwoorde van die mans wat aan hierdie studie deelgeneem het, toon basiese kennis met betrekking tot veilige seks en die waarde van MB in die voorkoming van MIV. Die patroon in die data toon egter dat diegene wat mees onlangs mediese besnydenis ondergaan het, die mees uiteenlopende menings het oor die mate waarin MB jou teen MIV beskerm. Daar is ’n gemengde houding oor veilige seks ná besnyding: Party mans jaag eenvoudig so veel moontlik bevrediging na, sonder enige beskerming. Die data dui ook op ’n patroon van ’n hoë verhoudingsomset onder die respondente. Dít was veral waarneembaar onder die tieners, wat te kenne gee dat hul verhoudings nie op toewyding gegrond is nie, maar eerder moontlike eksperimentasie. Hoewel die studie geen kontrolegroep met onbesnyde mans vir vergelykende doeleindes gehad het nie, dui die bevindinge op inkonsekwente kondoomgebruik onder mans, wat op sy beurt die risiko van MIV-oordrag verhoog. Die resultate dui voorts daarop dat MB-beraders ’n goed gestruktureerde beradingsprogram volg. Gevolgtrekking: Die studie het in sy doel en oogmerke geslaag. Die navorsingsproses was ontwerp om die nodige data in te samel en te ontleed ten einde die navorsingsvraag te beantwoord. Die navorsing steikenpopulasie en gevolglike steekproef was verteenwoordigend van die geografiese studiebestek. Die navorsingsinstrumente was ontwerp vir maklike gebruik deur respondente. Die verspreidings- en insamelingsmetode is gekies om so min moontlik moeite vir respondente te veroorsaak. Dít het ’n positiewe impak op die reaksiesyfer gehad, wat weer die geldigheid van die ingesamelde data verhoog het. Sowel die literatuuroorsig as die primêre navorsingsbevindinge bevestig dat MB sonder gedragsverandering allermins ’n ‘wondermiddel’ vir MIV-voorkoming is.

Using the perspectives of individualism-collectivism, Social Cognitive Theory and other concepts such as gay community attachment, this study focused on issues of homosexual identification, disclosure and sexual risk practices in relation to cross-cultural differences among gay Asian and Caucasian men in Sydney. Mostly recruited from gay social venues, 19 gay Asian men participated in exploratory focus groups discussions, another 201 gay Caucasian and 199 gay Asian men completed an anonymous questionnaire, and a further 10 gay Caucasian and 9 gay Asian men took part in in-depth one-to-one interviews. The major findings were: gay Asian men tended to experience conflict, in being both gay and Asian, related to individualism and collectivism; the gay Asian and Caucasian men differed in various aspects of homosexual practice, but shared certain sexual traits and practices; self-efficacy in safe sex and gay community attachment were key factors associated with gay men???s sexual risk practices (???risk??? being defined as unprotected anal intercourse with any casual partners or with a regular partner whose HIV status was not concordant with the participant???s). This study provides evidence that the inclusion of individualism-collectivism, social cognitive variables and gay community factors in the examination of homosexual identity and practice among men of different cultural backgrounds holds promise. It further suggests that educational programs to encourage safe sex will continue to yield benefits from increasing individual awareness, confidence and ability to effectively deal with situations that could pose risks of HIV transmission.

Submitted by Biblioteca Central (biblioteca@unicap.br) on 2018-11-27T18:30:13Z No. of bitstreams: 2 gilclecia_oliveira_lourenço.pdf: 1198962 bytes, checksum: 14772057f1bac3dfe959da10a95f37e7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-11-27T18:30:13Z (GMT). No. of bitstreams: 2 gilclecia_oliveira_lourenço.pdf: 1198962 bytes, checksum: 14772057f1bac3dfe959da10a95f37e7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-04-04 / This study planned to understand the conjugality experience of people with mixed HIV status for HIV/AIDS. It is very important to expand knowledge of sexual-affective relational possibilities affected by the contamination with HIV/AIDS to reflect about intake practices that consider the context and demands of people living with this virus. In this sense, this study is categorized as a qualitative research in which 16 individuals were separately interviewed, 05 of them were HIV-negative and the remaining 11 were HIV-positive, all in serodiscordant relationships. In addition to the semi-structured interview, we also used a Field Journal where several experiences, observations and reflections built along the process of data production were recorded. As an analytical strategy, we used the discursive analysis inspired on Foucault. Reports of the interviewees point to a conjugality experience marked by stigmas, prejudices and conflicts on the understanding of the virus in the lives of the couples and an ongoing surveillance in their daily lives. In serodiscordant couples, sexual relations affected by discourses of risk and prevention, are experienced with fear, doubt and insecurity. Moreover, we noticed that HIV infection comprises tensions and experiences in the dynamics of the couples that cannot be reduced to aspects of sexuality, prevention and risk. The experience of serodiscordant conjugality has complex effects on the couples’ daily lives and involves the development of different strategies required for the construction and/or maintenance of the sexual-affective relationship. It is concluded that the AIDS discourse acts on the individual, producing means to relate, be a couple and be serodiscordant, in a subjectivation process determined by political, regulatory and cultural strategies. However, the experience of serodiscordant conjugality is defined as a complex phenomenon that cannot be explained by causal and simplistic explanations. The individual presented here is active in its subjectivation process, creating means of resistance and subversion that emphasize the disciplinary power of the AIDS discourse. / Este trabalho objetivou compreender a experiência de conjugalidade de pessoas que vivem em situação de sorodiscordância para HIV/aids. Aprofundar o entendimento das possibilidades relacionais afetivas e sexuais atravessadas pelo acometimento do HIV/aids é de fundamental relevância para se pensar práticas de acolhimento que levem em consideração o contexto e as demandas das pessoas que (con)vivem com o vírus. Neste sentido, este estudo se caracteriza como uma pesquisa de natureza qualitativa em que foram entrevistadas, individualmente, dezesseis pessoas, sendo cinco participantes com sorologia negativa e outras onze pessoas soropositivas para HIV, todas em relacionamentos sorodiscordantes. Além da entrevista semidirigida, também fizemos uso de um Diário de Campo, em que foram registradas diversas vivências, observações e reflexões construídas ao longo do processo de produção dos dados. Como estratégia de análise, lançamos mão da analítica discursiva de inspiração foucaultiana. As narrativas dos sujeitos entrevistados apontam para uma experiência de conjugalidade marcada por estigmas, preconceito e conflitos sobre o entendimento da entrada do vírus na vida a dois e uma constante vigilância sobre o cotidiano. Nas díades sorodiscordantes, as práticas sexuais, atravessadas pelos discursos de risco e prevenção, são vivenciadas com medo, dúvida e insegurança. Além disso, percebemos que o acometimento pelo HIV compreende tensões e vivências na dinâmica do par, que não podem ser reduzidas aos aspectos da sexualidade, prevenção e risco. A vivência da conjugalidade sorodiscordante tem efeitos sobre o cotidiano do casal na sua mais diversa complexidade e comporta a organização de diferentes estratégias necessária à construção e/ou manutenção do relacionamento afetivo-sexual. Conclui-se que, o discurso da aids atua sobre os sujeitos, produzindo modos de se relacionar, de ser casal, de ser sorodiscordante, num processo de subjetivação agenciado por estratégias políticas, normativas e culturais. No entanto, a experiência de conjugalidade sorodiscordante se caracteriza como um fenômeno complexo e não passível de explicações causais e simplórias. O sujeito que aqui se apresenta é ativo no seu processo de subjetivação, produzindo modos de resistência e de subversão que tencionam o poder disciplinador do discurso da aids.

MCur / Department of Advanced Nursing Science / Background: Adolescent sexual health is fundamental to the physical and emotional health, and well-being of individuals, couples, and families, as well as the social and economic development of communities and countries. The purpose and the aim of this study was to explore and describe the community’s perceptions of adolescent sexual health in Mutale Municipality, Vhembe District of Limpopo Province. Methodology: The research design of this study was qualitative, explorative, descriptive and contextual in nature. The population comprised of every adult community member or resident of Tshiungani Village. Both genders were included in the sample. Parents and guardians of adolescents made up the sample. Data were collected by means of in-depth face-to-face interviews. Data were analysed qualitatively using Teschs’ qualitative analysis. Findings: The study involved six themes, six categories and nineteen sub-themes. The community expressed concerns related to degradation of cultural norms and values, change in family structure, effects of media, politics, religion and poverty as affecting adolescent sexual health. Conclusion: The study explored and described the perceptions of community members regarding adolescent sexual health although the findings could not be generalized as it represents only part of the population. Recommendations: The study recommended intense sexual health education and promotion at early primary phase, career guidance to enhance and promote selfesteem, parental and community involvement in assisting and engaging adolescents with life skills within communities.

MSc (Mathematcs) / Department of Mathematics and Applied Mathematics / Infectious diseases remain a major public health concern. Well-known for causing sickness and death, enormous pain and suffering, increased time spent on patient care and huge economic losses due to lost production. Infectious diseases continue to be a scourge without equal. In this work, we address the following research question: Can we use a multiscale model of HIV/AIDS transmission dynamics to assess the comparative effectiveness of health interventions that are implemented at different scale domains? To achieve the set objectives of the study, we use multiscale modelling approach, a new and emerging computational high-throughput technique for mathematically studying problems that have many characteristics across several scales. To be more specific, we perform three tasks in addressing the research question. First, we develop a within-host submodel and use it to show it’s associated limitations which only a multiscale model can resolve. Second, we develop a between-host submodel and use it to motivate the need for multiscale modelling of the HIV/AIDS disease system. Finally, we link the two submodels to produce a nested HIV/AIDS multiscale model that affords us the opportunity to compare effectiveness of five preventive and treatment HIV/AIDS health interventions. Analysis of the multiscale model shows that it is possible to jointly study two key aspects (immunology and epidemiology) of infectious diseases. The multiscale model provides the means for making meaningful comparative effectiveness on available preventive and treatment health interventions. Consequently, we employ the multiscale model to show that impact of HIV/AIDS packages increases as more interventions are integrated into the packages. Specifically, the study shows that combined HAART and male circumcision is more effective than an intervention involving HAART alone. Overall, our study successfully illustrates the utility of multiscale modelling methodology as a tool for assessing the comparative effectiveness of HIV/AIDS preventive and treatment interventions. For purposes of informing public health policy, we use the study results to infer that condom use, male circumcision and pre-exposure prophylaxis are more effective in controlling the transmission dynamics of HIV/AIDS at the start of the epidemic as compared to when the disease is endemic in the community while the converse is also true for HAART. / NRF

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)