HIV transmission continues to increase for Gay men, especially for those Gay men in nonmonogamous serodiscordant relationships. As the use of PreExposure Prophylaxis (PrEP) increases, much less is known about how PrEP is creating social meaning and transforming the sexual behaviors of HIV negative, non-monogamous Gay men. Accordingly, the purpose of this study was to investigate the meaning making experiences of Gay men in nonmonogamous serodiscordant relationships. Using the Minority Stress Model, Resiliency Theory, and Queer Theory as theoretical frameworks, the research question for the study focused on how HIV negative Gay men who are on PrEP and involved in nonmonogamous serodiscordant relationships navigate their sexual lives. Interpretative Phenomenological Analysis was employed within a purposeful sample of 13 Gay men. The two themes of resiliency and reframing emerged from the descriptive coding, member checking, and triangulation of the data. Of the two themes identified, participants noted pre-PrEP resiliency strategies including looks and trust, while current PrEP strategies included strategic positioning, getting educated about HIV and PrEP, and dating undetectable men. Reframing experiences included marketability, greater feeling of sexual freedom and responsibility, new rules around nonmonogamy, increased sexual confidence, and new masculine terms for condomless anal sex. Findings and recommendations from the study may advance positive social change when researchers and practitioners combat stigma, understand perceived lower risk of HIV transmission through new resiliency techniques, and facilitate the reframing of sex within an individual, relational, and Gay cultural context.

Magister Public Health - MPH / The HIV prevalence rate in Zimbabwe has been estimated at 15% (15 years old and above), which is one of the highest in the world, and HIV/AIDS remains a significant public health problem. The focus of HIV prevention strategies has been on heterosexual transmission since this is the primary driver of the HIV epidemic in Zimbabwe. Heterosexual serodiscordant couples represent an important subpopulation for HIV prevention but are not well studied in Zimbabwe. In Harare almost all serodiscordant couples participating in the HPTN 052 study reported correct and consistent condom use. However, rates of STIs and pregnancies showed that couples in the study continued to have unprotected sex, in-spite of intensive couples’ counselling, quarterly follow up visits and provision of condoms. The aim of this qualitative study was to explore barriers to condom use by these serodiscordant couples in which one partner was on ART in Harare, Zimbabwe. It used a two stage qualitative approach with semi-structured interviews being the primary method of data collection. These interviews were conducted on a sample of five study staff, 15 serodiscordant couples and individuals enrolled in the HPTN 052 study in Harare, Zimbabwe after consent was obtained. Thematic analysis was used to analyse data collected.The study findings showed that partners were in a fairly large age range (30 to 50+ years) with males being slightly older than females. Seven males and five females were HIV positive. Couples had a wide variation in the length of their relationships, from one month to over 15 years as a couple. The study findings also showed that individuals in serodiscordant relationships understood serodiscordance. Problems unique to these couples were identified and broadly categorized as dealing with an HIV positive result, accepting serodiscordance, and difficulty of disclosing serodiscordance to family. Couples also showed understanding of the importance of condom use in a discordant relationship. The most common reason for using condoms was to prevent transmission of HIV to the uninfected partner. The main barriers to condom use were the strong desire to have children, male partner reluctance to use condoms and the influence of the negative partner in determining condom use. Based on these findings, a nuanced approach to prevention strategies, such as condom use and couples counselling and testing, is required. The aim should be to increase understanding of serodiscordance, risk and condom use at all sessions or contacts with couples.

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HIV/AIDS is severely affecting the armed forces in South Africa. Combating HIV/AIDS demands a high level of commitment from the Ministry of Defence and all the Divisions and Services at all levels in the Department of Defence. Prevention practice for HIV/ AIDS is a challenged because the nature and full extent of the impact on the forces, and in particular on serodiscordant couples, are not known. This research study explored the experiences of serodiscordant couples regarding the impact of serodiscordancy on their marriages. The Infectious Disease Clinic engages serodiscordant couples as active participants in dealing with their HIV status. The researcher explored the impact of HIV serodiscordancy on married couples attending the Infectious Disease Clinic at 1 Military Hospital with the intended outcome of informing intervention and prevention strategies and programmes for serodiscordant couples. The study utilised a qualitative research approach and the research design was an instrumental case study. The population for the study was all the married serodiscordant couples in the Infectious Disease Clinic at 1 Military Hospital. The sample consisted of 20 serodiscordant couples attending the Infectious Disease Clinic for at least the past two years. The data was collected through semi-structured interviews. The study concluded that empowerment programmes on HIV/AIDS should include knowledge of, as well as coping skills and guidance for couples dealing with serodiscordancy, including disclosure and discrimination; marital and parenting roles; health management, building of trust; facilitating open and positive communication; and financial management. Based on the conclusions of the study, the main recommendation is that prevention strategies and empowerment programmes for serodiscordant couples should be based on a holistic, well-integrated intervention plan which contextualises strategies and programmes for prevention, treatment, counselling, empowerment and continuous support of the employee, their spouse and their family, including home visits, as required by the serodiscordant couple. Furthermore, it should clearly conceptualise the role of each team member at both the Infectious Disease Clinic and the relevant units of the SANDF, in particular the role of the social worker. / Dissertation (MSW)--University of Pretoria, 2010. / Social Work and Criminology / unrestricted

La transmission prénatale du VIH de la mère à l’enfant est à l’origine de la majorité des infections à VIH/sida chez les nourrissons. En dépit du risque quasi omniprésent de faire naître des enfants infectés et de l’accès encore très limité aux thérapies antirétrovirales, le nombre des femmes séropositives menant leur grossesse à terme est en augmentation constante en Afrique subsaharienne. Motivée par ce constat empirique, l’étude aborde une gamme des questions juridiques et de bioéthique, pour certaines encore inédites, tiraillées entre désir légitime d’enfant (droit à l’enfant) et devoir de la société de mettre les futurs enfants à l’abri d’un handicap congénital prévisible reconnu comme incurable (droit de l’enfant). Fondamentalement, elle interroge le législateur sur la manière de saisir le risque biologique de transmission maternelle du VIH, sans rompre avec l’équilibre éthique nécessaire entre les droits et libertés fondamentaux de la femme ou mère séropositive et l’intérêt supérieur de l’enfant à naître. À partir de l’exemple du droit congolais et suivant la démarche d’information comparative, l’étude s’attache à démontrer systématiquement que face à la forte probabilité de naître avec le VIH, la protection que les droits africains actuels apportent à l’enfant est insuffisante et, à certains égards, incohérente. Pour y remédier, elle préconise un nouveau paradigme de normativité fondé sur la philosophie de la recherche d’une conciliation éthique, qui n’apparaisse pas manifestement disproportionnée, entre l’autonomie de soi de la femme ou mère séropositive sur son corps et la responsabilité de ses choix en matière de santé de la reproduction. Ainsi, grâce à ses nombreuses propositions innovantes de refonte du droit, cette étude est-elle parvenue à contribuer, significativement, à la recherche d’outils théoriques nécessaires à l’émergence de nouveaux droits africains en ordre de bataille pour des générations futures sans sida. / Prenatal HIV transmission from mother to child is responsible for the majority of HIV / AIDS infections in infants. Despite the almost ubiquitous risk of infected children and still very limited access to antiretroviral therapy, the number of HIV-positive women who complete their pregnancies is increasing steadily in sub-Saharan Africa. Motivated by this empirical observation, the study tackles a range of legal and bioethical questions, some of which are still unpublished, torn between legitimate desire for children (right to the child) and society's obligation to protect future children against a predictable congenital disability recognized as incurable (right of the child). Fundamentally, it questions the legislator on how to capture the biological risk of maternal HIV transmission without breaking the necessary ethical balance between the fundamental rights and freedoms of the HIV-positive woman or mother and the best interests of the unborn child. Using the example of Congolese law and following the comparative information approach, the study seeks to systematically demonstrate that, in the face of the high probability of being born with HIV, the protection that the current African rights bring to the child is insufficient and, in some respects, incoherent. To remedy this, she advocates a new paradigm of normativity based on the philosophy of seeking an ethical reconciliation which does not appear to be manifestly disproportionate between the autonomy of the woman or mother who is HIV-positive on her body and the responsibility of its choices in reproductive health. Thus, thanks to its many innovative proposals for the revision of the law, has this study managed to contribute significantly to the search for theoretical tools necessary for the emergence of new African rights in order of battle for future generations without AIDS.

Indiana University-Purdue University Indianapolis (IUPUI) / Currently, 1.2 million people in the United States are living with HIV (Human Immunodeficiency Virus) infection, while one in eight are unaware of their infection status. The purpose of this study was to test the ability of the expanded ARRM to see if the model contributed something to the research of why people protect themselves from HIV. To add to the research regarding motivating factors of HIV protection, we decided to add two concepts to the ARRM; partner protection and relationship preservation. Findings of the study suggest HIV-positive partners are motivated to using condoms to protect their partners especially when they believe their partners are at risk for contracting HIV. Relationship preservation results illustrated that when people fear of losing their relationship they are willing to do whatever it takes to keep the relationship going, even at the cost of contracting HIV. By extending the ARRM, as well as incorporating HIV status, we now can begin understanding the many motivating factors towards why people are and are not using condoms to protect themselves or their partner.