<p>Adolescents&rsquo / sexual activity is associated with maternal and child health problems, and sexually transmitted infections including HIV/AIDS. The aim of this study was to assess the sexual behaviour patterns of adolescent schoolgirls and the level of knowledge they have with regard to the prevention and transmission of HIV infection, as well as to determine which factors are associated with their various sexual behaviour patterns. A cross-sectional descriptive survey of 420 adolescent schoolgirls aged 15 to 19 years, from 3 of the 9 secondary schools situated in Petauke District, in rural Zambia, was conducted. The sample of schoolgirls was obtained using a multi-stage systemic sampling technique.</p>

Previous research on Fetal Alcohol Spectrum Disorder (FASD) has identified common physical and behavioural characteristics associated with children who were prenatally exposed to alcohol. The research suggests that many individuals with FASD have experienced involvement with the law, and engaged in inappropriate sexual behaviour. However, there would appear to be a scarcity of research that identifies the life histories of individuals with FASD who have engaged in inappropriate sexual behaviour. Identifying risk and protective factors towards positive outcomes for people with FASD has both individual and societal importance. In order to better understand individuals with FASD, this research paper explores the common characteristics of FASD which may lead to inappropriate sexual behaviour, such as deficits in social skills, self-regulation, and executive functioning. Another important characteristic that is explored in the research paper is how FASD can present as an invisible disability, and the risk associated with treatment of individuals who may not be identified as having organic brain damage, specifically in the criminal justice system. As the research on FASD is limited, this paper also explores the characteristics associated with the general population of people who have engaged in inappropriate sexual behaviour, and people with disabilities who have displayed challenging sexual behaviour. The comparison of populations of people engaging in inappropriate sexual behaviour highlights the importance of the responsivity of interventions. Despite the diagnostic label of “paraphilia” attributed to those who have been convicted of sexual crimes, each individual is a complex being. Responsivity indicates each individual must be holistically understood in order to design services that encourage individual change.

M.A. Faculty of Humanties, School of Social Sciences. University of the Witwatersrand, 2011 / INTRODUCTION: Zimbabwe has witnessed a decline in HIV prevalence in the general population estimated to be 27% in 2001, 19% in 2005, 16% in 2007 and 14% in 2009 (Mapingure et al., 2010). Whilst it is a notable decline the rate is still high. Sexual behaviour change has been reported as key to this HIV prevalence decline. Partner reduction has been advocated as an important strategy in HIV prevention. Understanding the socioeconomic and demographic factors influencing the sexual behaviours that are either sustaining the declining, yet still high, prevalence rates is critical to inform interventions. There is growing interest in the association between individual’s socioeconomic status and sexual risk taking behaviour in sub-Saharan Africa. The general objective was to examine the association between wealth and sexual behaviour among men in Zimbabwe. METHOD: Analysis of data from 7175 sexually active aged 15-54 years who participated in the Zimbabwe’s 2005/06 Demographic and Health Survey was done using logistic regression models and have reported odds ratios (OR) with Confidence intervals. In the multiple logistic regressions, two models were used. Model 1 included variables: wealth, age and education whilst in model 2 we controlled for: marital status, type of residence, region of residence and religion because these socio-demographic factors influence male sexual behaviour. The dependent variables included: unprotected sex at last encounter, multiple and concurrent sexual partnerships in last 12 months. RESULTS: When we controlled for potential confounding effects of education, age, marital status, type of residence, region of residence and religion, men in the middle wealth category of the population were less likely to have engaged in unprotected sex in the last encounter with a nonspousal cohabiting partner (OR 0.41, 95% CI 0.22 to 0.76). Wealth was found to be not statistically significantly associated with multiple and concurrent sexual partnerships. CONCLUSION: Wealthy men in Zimbabwe are less likely to engage in unprotected sex. Wealth’s association with multiple and concurrent sexual partnerships was not confirmed in this study. Equitable distribution of wealth and sound economic policies are critical in improving the general welfare of nationals so as to reduce or eliminate some of the factors that cloud the associations between socioeconomic and demographic factors and sexual behaviours of individuals. Policies and programs that recommend deferral of gratification remain critical in order to reduce number of partners.

ABSTRACT Background: Previous studies have shown that HIV prevalence rates are relatively high while condom use is low in migrant communities in South Africa (Zuma 2003, Weltz 2007, IOM 2008). This study seeks to investigate factors associated with condom use in selected commercial farms in Limpopo and Mpumalanga provinces of South Africa. Methodology: This study is a secondary data analysis of the Integrated Biological and Behavioural Surveillance Survey (IBBSS) implemented by the International Organisation for Migration (IOM) in 2010 among 2,810 farm workers. The study population comprises all sexually active non-South African nationals who have worked on the farm from a period of less than one year to over ten years. Majority of the migrants are from Zimbabwe, Mozambique and Swaziland. The outcome variable is condom use at the last intercourse while the explanatory variables include sex, age, marital status, financial stability, sexual abuse, condom availability, transactional sex, attending an HIV function and period worked on the farm. Data analysis was undertaken in three stages. Firstly, univariate analysis of the variables was done to provide descriptive statistics of the study population. The second stage was bivariate analysis producing unadjusted odds ratios to examine the association between each of the predictor variables and the outcome variable. The final stage was multivariate analysis using logistic regression and producing odds ratios to examine the association of more than one predictor variable with the outcome variable. Results: The results show that access to free condoms, having sex while drunk, financial stability and living arrangements with spouse are the factors associated with condom use among migrant farm workers in Limpopo and Mpumalanga. Among migrant men financial stability and access to free condoms were significant while among women, marital status, having attended an HIV function, having sex while drunk and living arrangements with spouse are the significant factors associated with condom use. Unexpectedly, socioeconomic factors such as transactional sex, forced sex and demographic factors such as age, proved to be insignificantly associated with condom use. Conclusion: It was noted that condom use levels and determinants vary between male and female migrants. Although men portrayed exhibiting more high risk sexual behavior, women proved to be more vulnerable. Policies and programmes targeting migrant farm workers should be gender sensitive.

Context: This study seeks to examine the relationship between female genital cutting (FGC) and the sexual behavior of women in Kenya and Nigeria. Although research evidence has shown that female genital cutting is a serious problem in many countries and needs to be eradicated, prevalence in many countries remains high. One of the reasons given for the continuation of this harmful practice, despite widespread global campaigns against it, is that it is deemed an essential aspect of grooming the female child in preparation for marriage. It is supposed to control female sexuality thereby ensuring that a girl remains a virgin until marriage and it enhances her chances of marriage. Little research has been carried out to evaluate how far FGC tempers the sexual behavior of women. Methods: The study uses the Kenya Demographic and Health Survey of 2008/09 as well as the Nigeria Demographic and Health Survey of 2008. The population being examined is sexually active women who knew about circumcision and were thus asked if they had been circumcised or not to which the response was either yes or no. The sample size for Kenya is 5 187 women while in Nigeria it is 12 253 women. The study hypothesis is that there is a difference in the sexual behaviour of women who are circumcised and those who are not circumcised. Multiple linear regression, logistic regression as well as Poisson regression were used examine the effect of selected predictor variables on sexual behaviour. The outcome variable is sexual behavior which was measured using age at first intercourse as well total lifetime number of sexual partners. Findings: The study results suggest that there is no association between female genital cutting and the sexual behaviour of women in Kenya and Nigeria. There was no difference in the age at which women first engage in sexual intercourse and in the number of sexual partners for women who were circumcised and those who were not. Thus there is no scientific evidence that the practice of FGC could control the sexual activities of women. Conclusions: Female genital cutting does not have any effect on the sexual behaviour of women in Kenya and Nigeria. There is no difference in the sexual behaviour of women who are circumcised and those who are not circumcised in both countries. This is an indication that FGC does not serve the purpose it is purported to serve and should therefore be eradicated.

ABSTRACT HIV has been linked to many risk factors such as sexual behaviour, gender, gender based violence, poverty, migration, conflicts, sexually transmitted diseases and circumcision. In this project, the role played by migration was particularly underscored. The aim of the study was to estimate and to compare the prevalence of HIV infection among migrants and non-migrants and to investigate whether migration leads to increased high risk sexual behaviour among migrant workers aged between 14 and 35 years from Limpopo Province. This study was based on a secondary data analysis from a large community intervention study. A random sample of 2860 participants were selected in a cross sectional study after pair matching a community of villages set for an intervention. Data were collected using a questionnaire in English with a version in Sotho. HIV test was performed on oral fluid using Vironostika HIV Uniform oral fluid. The study was approved by Wits University and Informed consent was previously obtained by the original study. Stata was used for the statistical analyses of the data. This study found that the HIV prevalence among migrants was not statistically different from the prevalence among non-migrants (10.04% versus 10.97%; p = 0.662), that the slight association between migration and HIV infection was not significant (Adjusted OR = 1.19; 95% CI: 0.7 – 2.01) (p = 0.520). There was no association between migration and sexual behaviour such as sexual experience, age at first sexual relationship, have ever had sexual relationship and used a condom. However the study showed an association between migration and the number of sexual partners. These striking findings suggest that migration does not always lead to an increased risk of HIV infection even though it can lead to an increase of number of sexual partners. The study concludes that migration did not prove to be a risk factor for HIV infection. However, other underlying structural factors need to be examined for a better understanding of the conditions that lead to HIV infection. It recommends interventions that cover information (Knowledge, attitude and belief), risk perception and change of sexual behaviour.

This thesis focuses on prejudice located at the intersections of sexuality and nationality. Drawing on mixed qualitative research sessions involving men who are ‘LGBTI migrants' from African countries, and who are living in South Africa, the thesis offers three overarching points of focus. Firstly, it contextualises and critiques historical state structures and attitudes which shape understandings of identity in South Africa. Secondly, it analyses everyday experiences of xenophobia and homophobia, as experienced by ‘LGBTI' people who have migrated to the country for a variety of reasons. Finally, it locates these experiences within the structures identified and, based on participant-led discussions, offers a framework for understanding and suggestions for meaningful intervention. Using an overarching critical perspective of intersectionality and queer necropolitics I argue that contemporary South Africa fosters an image of inclusivity and exceptionalism that is vastly at odds with reality. In everyday spaces ‘LGBTI migrants' are often forced to ‘switch' between being either African or LGBTI. However, I argue that through journey-derived questioning of both Africanness and Queerness these processes of switching foreground hope and action. These are rooted in values of solidarity and community which extend, for fleeting moments, beyond labels and beyond geographic boundaries. Through a reconciled merging of these seemingly opposed subjectivities I argue that insight is offered into life beyond, yet within, national structures. In this way the participants exhibit an ‘African Queerness/Queer Africanness' which shifts them beyond necropolitical death and towards transcontinental life. I ultimately argue that this may be harnessed as a tool to intellectually, and practically, render Africa as a site of (African) queer potentiality. I suggest that LGBTI migrants, through their embodiment of a specific transcontinental future, are pioneers in revealing this potentiality.

This thesis examines aspects of the prevention of sexually transmitted diseases (STDs) in the Australian community, with a particular emphasis on HIV/AIDS in the context of general practice (or primary care settings). The work has four broad aims: i) To describe the primary prevention of sexually transmitted diseases, following from the arrival of the HIV/AIDS pandemic in Australia ii) To describe HIV/STD risk behaviour iii) To summarise previously known evidence of interventions to reduce risk and to raise awareness of HIV and other sexually transmitted diseases iv) To contribute new evidence addressing the potential of the general practitioners' role in HIV/STD prevention The first chapter gives a brief review of the history of HIV/AIDS from its discovery in the United States of America to its appearance in Australia and New Zealand, and discusses the Australian response strategies, both initial and continuing, to confine the epidemic. Specifically, the arrival of HIV/AIDS gave rise to increasing awareness of sexually transmitted diseases, which hitherto, although sometimes chronic, were rarely fatal. The public health risk of HIV necessitated swift government action and led to wider acceptance of publicity about sexual behaviour. Although the thesis does not concentrate solely on HIV, this is still an emphasis. This chapter provides useful background to ensuing chapters. Chapter Two provides an overview of behavioural risk in sexually transmitted diseases. It gives a review of risk factor prevalence studies, and introduces risk behaviour and cognitive models of behaviour change, as applied to STD risk. Sexual behaviour is a complex social interaction, usually involving more than one person, and relying on the personality and behaviour patterns intrinsic to the individuals taking part. It is therefore perhaps more challenging to alter than behaviour which is undertaken alone, being dependent on the behaviour and intentions of both parties. Moreover, comprehensive assessment of sexual risk behaviour requires very detailed information about each incident. Its private nature makes accurate data difficult to obtain, and sexual risk behaviour is, correspondingly, difficult to measure. Chapter Three reviews the effectiveness of interventions tested in primary health care settings to reduce sexual risk behaviour. The candidate uses a replicable method to retrieve and critique studies, comparable with standards now required by the Cochrane Collaboration. From 22 studies discussed, nine health interventions were short, 'one-shot', efforts owing to limited time, resources and other practical constraints. This review demonstrates the scarcity of interventions with people who may be perceived as 'low-risk'. Only four interventions were carried out in community health centres and two in university health clinics. One of the university interventions showed no change in sexual behaviour in any of three arms of the intervention (Wenger, Greenberg et al 1992) while the other showed an increase in condom use in both groups, although the intervention group's self-efficacy and assertiveness also improved (Sikkema, Winett & Lombard 1995). The rationale for the intervention, where given, is described. Chapter Four analyses the content, format and quality of sexual health information brochures available in New South Wales at the time of the candidate's own planning for an interventional study. One of the most effective ways to disseminate information widely is by the use of educational literature, especially when the subject material is potentially sensitive or embarrassing to discuss in person. In this chapter, the candidate reviews the literature available at the time of designing the intervention used in Chapter Five. Readability, attractiveness, clarity and the accurate presentation of facts about sexually transmitted disease risk are examined for each pamphlet. Forty-seven pamphlets were scored according to the Flesch formula, and twenty-four of these scored in the 'fairly' to 'very difficult' range. There was, therefore, a paucity of easy-to-read material on these subjects. Chapter Five evaluates a general practitioner-based counselling intervention to raise awareness of sexually transmitted diseases and to modify HIV/STD risk behaviour. While adults aged 18-25 are less likely than older cohorts to have a regular general practitioner or to visit often, most people visit a general practitioner at least once a year. This could provide an opportunity for the general practitioner to raise preventive health issues, especially with infrequent attendees. As the effectiveness of an opportunistic intervention about sexual risk behaviour was yet to be tested, the candidate designed an innovative randomised controlled trial to raise awareness of risk and increase preventive behaviour. The participation rate was 90% and 76% consented to followup; however the attrition rate meant that overall only 52% of the original participants completed the follow-up questionnaire. The intervention proved easy and acceptable both to GPs and to patients, and risk perception had increased at three months' follow-up; however this occurred in both the control (odds ratio 2.6) and the intervention group, whose risk perception at baseline was higher (odds ratio 1.3). In order to establish some markers of risk in the general population, Chapter Six analyses data resulting from questions on sexual behaviour asked in the Central Sydney section of the NSW Health Survey. The candidate advocated for inclusion of relevant questions to determine some benchmarks of sexual risk behaviour and to provide an indication of condom use among heterosexuals. Although limited in scope as a result of competing priorities for questions in the survey, results demonstrate that, while a small percentage of people were at risk, those with higher levels of partner change or of alcohol use were the most likely to always use condoms. Specifically, 100% of those with more than four new partners in the last 12 months had used condoms with every new partner. In addition, 'heavy' alcohol users were more likely to report condom use every time with new partners (odds ratio 0.34). To furnish data to inform future planning of educational activities for general practitioners, Chapter Seven presents the results of a survey of Central Sydney general practitioners' opinions and current practices in HIV risk reduction with in the broader context of sexually transmitted disease prevention. The general practitioner is in an ideal position to provide information and advice, especially if future research affirms the impact of such advice on STD risk behaviour. General practitioners in this study said they would be slightly more likely to discuss sexual health matters with young patients than with older ones (p=0.091), but this was not significant. The most cited barrier to discussing sexual health was inadequate remuneration for taking time to do so (over 50% gave this reason). The next most cited obstacle was difficulty in raising the subject of STDs or HIV in routine consultations, but this reason was given by less than half the sample. Forty-six percent had participated in continuing medical education programs in STDs, HIV/AIDS, or hepatitis diagnosis or management; 32% of GPs had patients with HIV, and 55% of all GPs indicated they would like more training in management and continuity of care of HIV patients. Approximately half (51%) wanted more training in sexuality issues, including sexual dysfunction. Chapter Eight reviews the whole thesis and discusses future directions for the research agenda.

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Adolescents engaging in sexual risk behaviours may experience negative psychological and social outcomes, and there can be consequent interference with the accomplishment of developmental tasks. Identified risk influences for sexual risk behaviour range from intrapersonal factors to social normative behaviours and contextual/environmental issues. This study focuses on two areas of intrapersonal factors namely, self-esteem and selfefficacy in understanding sexual behaviours in a sample of school going adolescents. The sample was made up of learners who were in grades nine, ten and eleven from a school in the Durban Metropolitan area (N=259). The results of the study indicated that adolescents who had never engaged in sexual intercourse (primary abstinence) have higher self-esteem and self-efficacy than those adolescents who had previously engaged in sexual intercourse. Also, the findings indicated that that there is no association between levels of self-esteem and self-efficacy, and sexual risk behaviours in relation to the dimensions of condom use, number of sexual partners and age of sexual debut of those who are sexually active. These findings are essentially supportive of the fact that involvement in the sexual domain is mediated by self-esteem and self-efficacy for adolescents who are not sexually active. Intervention programmes should be aimed at increasing self-esteem and self-efficacy at a primary school level, prior to sexual debut, to delay the age of sexual debut, thereby protecting against sexual risk behaviours. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.