The lack of a contextualised, relevant communication strategy focusing specifically on HAST diseases in the Limpopo Province was the impetus for this research. The purpose of this study was, therefore, to explore the knowledge, perceptions and utilisation of health facilities for HAST in order to develop an acceptable and effective communication strategy for the Province to address the high rate of HAST diseases. The study followed a qualitative approach guided by the major tenets of the Health Belief Model, namely, to determine modifying factors, individual beliefs and cues for action. An in-depth literature review was followed by focus group interviews with the community members and personal interviews with District and Provincial Deputy Directors. Based on these findings, a communication strategy was drafted and piloted for three months in one of the districts in Limpopo. Further refinement of the communication strategy followed after member-checking and further interviews with directors HAST. The final strategy specifically focused on risk groups with each of the diseases in terms of their beliefs and perceptions. It further resulted in guidelines for health providers in terms of the content and implementation of effective communication strategies within the context of educational, cultural, social and economic factors relevant to Limpopo / Health Studies / D. Litt. et Phil. (Health Studies)

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)

The concept of youth activity centre (YAC) has not yet been evaluated. The purpose of this study was to evaluate the YAC in Botswana. Accordingly, the researcher explored and described the lived experience of young people utilising the YAC as well as the perceptions of service providers at the Mochudi Centre in the Kgatleng District, in Botswana. Furthermore, the objective was to develop and describe guidelines for the facilitation of youth-friendly services (YFS) at YAC. A phenomenological, qualitative, explorative, descriptive and contextual research design was used to extract young people’s experiences and perceptions of service providers. Thirty-two young people and 27 service providers (peer educators and service delivery officers [SDOs]) were purposefully selected. Methods of data collection used were unstructured individual in-depth interviews, focus group discussions and observations in the forms of field notes. The data, mainly tape-recorded interviews and field notes were transcribed verbatim for data analysis. Tesch’s eight-step data analysis model (Creswell 1994:155) was used. One major theme, youth friendliness emerged with three categories, namely: physical, administrative, and psychological aspects of youth-friendly services. All the respondents indicated that they benefited and affirmed they were empowered and better people after using the facility. However, limited access to the facility by the target group due to location, cost of reaching the facility, and attitudes of service providers as well as failure to implement planned activities due to financial and staff shortage were obstacles to youth friendliness of the YAC. Based on the findings and literature review, the researcher developed guidelines to facilitate YFS and improved access to the YAC. Recommendations made are for practise in the YAC, education of SDOs and for further research. / Health Studies / D. Litt. et Phil. (Health Studies)

This study was intended to explore the role male partners play in preventing adolescent pregnancy in the Letlhabile area, of Brits district, which is located in the North West Province. Adolescent males and females whose ages ranged between 13-20 years were included in the sample. The inclusion criteria was determined on the basis of the adolescents who were pregnant and non- pregnant, as well as males who had already became parents and those who hadn't experienced fatherhood. Focus group discussions and individual in-depth interviews were conducted.ObservaJions and the review of existing documents were triangulated to gather valid and reliable information. Quantitative and qualitative data analysis were blended. The findings revealed significant factors that ranged from the reaction of parents and/or partner to the announcement of pregnancy, to issues that impact on consequences of multiple sex partners. The recommendations of this project deal with aspects that include contraception, sexuality education, parental involvement among many relevant policy issues. / Health Studies / M.A. (Nursing Science)

BACKGROUND: Studies done in both developed and developing countries have reported the tendencies of adolescents to engage in risky behaviours. Such behaviours include indulging in early and unsafe sexual activities, having multiple sexual partners, alcohol and drug use and dropping out of school among others. PURPOSE: The main aim of the study was to develop intervention strategies for reducing sexual risk practices among adolescents in Ethiopia. METHODS: A mixed method approach using quantitative and qualitative approaches was employed in order to investigate the risks of sexual practices among urban and rural adolescents in the selected area. A cross-sectional survey was used to gather data quantitatively and focus group discussions were used for the qualitative part of data collection. A total of 449 students and 72 FGD participants were selected for quantitative and qualitative study respectively using systematic random sampling technique. Logistic regression was done to identify possible factors associated with knowledge on emergency contraceptive, condom utilisation, pre-marital sex practices and perception of risky sexual practices. RESULTS: One hundred and seventy (37.9%) respondents had experienced sexual intercourse at the time of the study. The higher proportion (42.6%) of those who had engaged in sexual relationships was from the rural school compared to 33.1% in the urban schools. The proportion of sexually active respondents was higher among males (44.8%) compared to (29%) females. Multiple partners were higher in rural adolescents (44.7%) compared to 31.8% among urban adolescents. Sexually Transmitted Diseases were reported by 28.6% of the sexually active adolescents and the prevalence was higher among males (73.5%) compared to 27% females. 87% of the sexually active adolescents rarely used a condom. CONCLUSION: The study identified a knowledge gap on ASRH which limited adolescents to access reproductive services. Social, cultural and economic factors contributed to adolescent engagement in risky sexual behaviours. Based on the major findings of this study, intervention strategies targeting behavioural, biomedical and structural interventions were proposed. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / Preventing teenagers’ pregnancies and improving teenagers’ reproductive health are important as pregnancies in teenagers still represent an important health challenge in Cameroon. The purpose of this dissertation of a limited scope was to describe the perception of peer educators who underwent the ‘100% young’ peer education training and the effect it had on their own sexual behaviour. A qualitative descriptive, explorative and contextual research design was conducted. Data collection was done using in-depth interviews. Fifteen peer educators were purposively selected. Two questions were asked namely; please describe how you perceived the peer education training that you underwent and, describe how this training affected your own sexual behaviour. Findings revealed that participants had a positive education experience, positive personal growth and for many, that was enough to become mentors for their peers and build awareness. Recommendations propose that interventions such as the ‘100% young’ are urgently required to prevent teenage pregnancy. / Health Studies / M.P.H.

Correct and consistent use of female condom is an effective strategy for the reduction of unintended pregnancy and sexually transmitted infections including HIV/AIDS. The researcher used a non-experimental descriptive quantitative research design to explore the acceptability of female condom among young women aged between 15 and 34 years of age in Jwaneng Township, Botswana. Simple random sampling was used to recruit the respondents. Data were collected using self-administered structured questionnaires from women accessing health care services in the three health facilities in Jwaneng Township. Data were analysed using the SPSS statistical program version 23 for windows. The findings show low utilisation of the female condom. The study highlights the significant challenges regarding availability, shape, material and lack of information about female condom in Jwaneng. Based on the study results, various strategies need to be developed, there might be a need to package health promotion differently for different age groups to effectively promote the female condom. / Health Studies / M.A. (Nursing Science)

O conceito de saúde sexual e reprodutiva (SSR) ganha visibilidade na década de 1990, marcada por ativismo social e pela IV Conferência Internacional sobre População e Desenvolvimento e a IV Conferência Internacional sobre Mulheres, que afirmam a atenção primária à saúde (APS) como prioritária. No Brasil, a APS é considerada estratégica para efetivar políticas de SSR no Sistema Único de Saúde (SUS). Com o objetivo de avaliar a implementação de ações de SSR em serviços de APS, no SUS, no estado de São Paulo (SP), foi desenvolvida avaliação que adota a teoria do trabalho em saúde e a integralidade como referenciais, e utiliza banco de respostas de 2735 serviços ao questionário QualiAB - Avaliação da qualidade da Atenção Básica em Municípios de SP, em 2010. Construiu-se um modelo teórico da avaliação de práticas de SSR na APS - compreendendo os domínios promoção à SSR, prevenção e assistência às doenças sexualmente transmissíveis (DST)/aids, e atenção à saúde reprodutiva, com 25, 43 e 31 indicadores, respectivamente. As respostas dos serviços apontam: pré-natal com início e exames adequados, melhor organização para puerpério imediato do que tardio, planejamento reprodutivo seletivo para alguns contraceptivos; prevenção baseada em proteção específica, limites na prevenção da sífilis congênita, no tratamento de DST, no rastreamento do câncer cervical e mamário; atividades educativas pontuais, com restrita abordagem das vulnerabilidades, e predomínio do enfoque da sexualidade centrado na reprodução. A média geral de desempenho em SSR é 56,84%. O domínio atenção à saúde reprodutiva tem maior participação, seguido por prevenção e assistência das DST/aids e promoção à SSR (teste de Friedman estimou a contribuição no escore; Dunn, a participação relativa). Os três domínios são correlacionados (Spearman > 0,5). Técnica de agrupamento por k-médias mostrou 5 grupos de desempenho: A, B, C, D e E, compostos por 675, 811, 346, 676 e 227 serviços, com médias de 74,71; 61,95; 55,19; 45,57; e 21,56%, respectivamente. Arranjos organizacionais com saúde da família, ou saúde da família com Unidade Básica de Saúde; localização urbana periférica; delimitação da área de abrangência por planejamento; uso de dados de produção e epidemiológicos para organização do trabalho; presença de serviço especializado de atenção à aids no município, são variáveis associadas ao pertencimento do serviço de APS ao grupo A. Ajustadas em modelo de regressão logística, duas variáveis se apresentam independentemente associadas à maior chance de o serviço pertencer ao grupo A: uso de dados de produção e de dados epidemiológicos para organização do trabalho. Os resultados indicam que a implementação das ações de SSR na APS paulista é incipiente e corroboram a hipótese do reconhecimento inadequado da SSR como objeto de trabalho na APS; bem como de definição inapropriada das tecnologias, que limitam a tradução operacional do programa de SSR. Faz-se necessário: rever o objeto SSR para a APS, enfatizando sua abordagem integral; disseminar tecnologias de atenção à SSR; investir em capacitações, sobretudo, de gerências realmente técnicas; e ainda, fortalecer redes regionais temáticas para SSR. O modelo teórico da avaliação construído mostra-se viável e pode ser utilizado em futuras avaliações / The concept of sexual and reproductive health (SRH) gains visibility in the 1990s, a decade characterized by social activism and by the IV International Conference on Population and Development and the IV World Conference on Women, which affirm that primary health care (PHC) is a priority. In Brazil, PHC is considered strategic for the implementation of SRH in the Unified Health System (Sistema Único de Saúde - SUS). An evaluation was developed with the purpose of assessing the implementation of SRH actions in PHC at the SUS units in the state of São Paulo (SP), adopting the theory of work in health and comprehensiveness as references and using response database from 2735 units to the Questionnaire PHC Quality Evaluation in SP Municipalities - QualiAB in 2010. A theoretical model of evaluation for SRH actions in the PHC was designed - comprising the following domains: SHR promotion, prevention and assistance of sexually transmitted disease (STD)/AIDS, and reproductive care, with 25, 43 and 31 indicators, respectively. The responses from the units indicate: early start of antenatal care with proper test delivery, more effective organization for immediate postpartum than for late postpartum, and selective reproductive planning for some contraceptives; predominance of specific protection actions, limits in prevention of congenital syphilis, STD syndromic treatment and cervical and breast screening; occasional education activities with a restricted approach to vulnerabilities, an approach to sexuality predominantly through reproduction. The general performance score for dimension SRH at the units is 56,84%. The Reproductive care domain has a bigger participation in the general score, followed by STD/AIDS prevention/assistance and SRH promotion (Friedman test estimated contribution to the general score; Dunn, relative participation). The three domains are correlated (Spearman > 0,5). K-means clustering method showed 5 performance groups: A, B, C, D and E, consisting of 675, 811, 346, 676 and 227 units, with an average of 74,71; 61,95; 55,19; 45,57; and 21,56%, respectively. Organizational arrangements for work in PHC with family health, or the traditional health center combined with family health; urban outskirts, delimitation of area through management criteria; use of epidemiological and production data for work organization; specialized AIDS care in the municipality, are variables associated with PHC units taking part in group A. Adjusted in logistic regression model, two variables are independently associated to a higher chance of the unit to belong to group A: use of epidemiological and production data for work organization. The results indicate that the implementation of SRH services in PHC in the state of São Paulo is incipient and corroborate with the hypothesis of inadequate recognition of SRH as a PHC object of work; as well as inappropriate definition of technologies, which limit the operational translation of the SRH program. It is necessary to: review the SRH object for the PHC emphasizing its comprehensive approach; disseminate technologies of SRH care; invest in training, mainly in technical management, as well as strengthen thematic regional networks for SRH. The theoretical evaluation model designed is feasible and can be used in future evaluations

This study involves an analysis of accounts of first and subsequent early sexual experiences in a deep rural area of the Eastern Cape in South Africa over the last forty years. Through interviews and focus group discussions, the enculturation of youth into sexual activity in the community of interest is explored. The study looks into sexual experiences from childhood, through early adolescence to adults of up to sixty five years old, allowing an analysis of the changing forms of sexual experimentation and sexual debut in this context. Contextual factors mediating these changes are explored, with special emphasis on the changing regulatory practices around early sexual experiences and the effect thereof on behaviors connected to HIV infection risk. Practices that were previously important mediators of sexual behavior were: anxiety about the social consequences of pregnancy, which was previously a significant disincentive to sexual intercourse; men's previous acceptance of the need to practice non-penetrative forms of sex and girls postponing sexual debut for as long as possible. All these were culturally endorsed, but are now noted to have changed due to changes in the regulatory practices surrounding youth sexuality. The context of early sexual experiences and the surrounding cultural practices have also changed significantly, and this needs to be taken into account in understanding receptivity to condom use messages. Implications for HIV/AIDS prevention are discussed. Among other interventions, the study describes a participatory, community-based, multi-sectoral approach that takes social conditions into account as a way of empowering the community to strengthen its response to the pandemic. This incorporates different sectors of the community, including youth, parents, religious and traditional leaders, and various other structures, services and institutions that make up the community.

Made available in DSpace on 2017-06-01T18:29:28Z (GMT). No. of bitstreams: 1 virginia_cavalcanti_pinto.pdf: 1069106 bytes, checksum: f6f00d97cd306ee345a04d5bb77a30f0 (MD5) Previous issue date: 2016-03-08 / According to Foucault, sexuality is an historical device, which means that it has been composed through the history as a social invention of a particular time. The establishment of sexuality starts from the development in the discursive field about sex that includes the knowledge about it, as well its regulation through real productions. This work seeks to question the discourse of students, parents and teachers of high school, about the treatment of the issues of sexuality in school. The participants in this qualitative research study were mothers, teachers and students in a state public high school in Recife-PE, who were observed and interviewed. They received a visual stimulus with images of people and symbols, with different possibilities of interpretation on the theme sexuality and then heard a prompt question: how are the sexuality issues circulating in the school? Discussions were filmed only for analysis purposes, protecting the participant s identity. The construction of the data indicated, among other things, that the speeches about this topic surroundedbythe participants in the school environment prioritize a sexuality crossed by the medical discourse, especially regarding to the preventive aspects. In addition, sex is treated as something that brings predominantly negative consequences to the young people and not a healthy part of life, especially in adolescence discoveries period. Although the discussion about sexuality has been considered by the National Curriculum Parameters (PCNs) as a cross-cutting issue, when questioned about who should deal with the topic in schools, teachers tend to delegate this task to a professional outside the school environment, especially the psychologist. At school these discussions take place predominantly in Biology classes and students emphasize the importance of this space to ask questions. They state that they don t have the opportunity to talk about it at home openly. The low frequency of parents/guardians in this school initially hindered the composition of the groups. In addition, only the mothers participated in this study, although the invitation was made also to other guardians. The discussion about sexuality and its consequences at school aims to contribute to new perspectives on the topic, as well as closer the dialogue between parents, teachers and students. Therefore, their speeches would not present themselves as isolated truths of each group, but interact opening the debate to a field of possibilities that contribute positively to the experience of sexuality of the students. / Para Foucault a sexualidade é um dispositivo histórico , ou seja, se constitui no movimento da história, sendo uma invenção social de um determinado tempo. Sua constituição se dá a partir das construções no campo discursivo sobre o sexo que abarca os saberes sobre ele, bem como sua normatização e regulação social através das produções de verdade. Este trabalho busca problematizar os discursos de alunos, mães e professores do Ensino Médio, acerca do tratamento dado às questões de sexualidade na escola. Para isto, tomou para participantes mães, professores e alunos de uma escola pública da rede estadual de ensino de nível médio da cidade do Recife. Trata-se de uma pesquisa de natureza qualitativa que utiliza como técnicas a observação participante e a entrevista de grupo focal. Os grupos foram formados por professores, mães e alunos da referida escola. Os participantes receberam um estímulo visual de imagens, de pessoas e símbolos, com variadas possibilidades de interpretação sobre o tema sexualidade e em seguida ouviram uma pergunta disparadora: como as questões sobre sexualidade circulam na escola? As discussões foram filmadas apenas para fins de análise, resguardando-se o sigilo total sobre a identidade dos participantes. A riqueza da discussão desse grupo heterogêneo possibilitou a aproximação do assunto com a realidade vivenciada pelos participantes. A construção dos dados indicou, entre outras questões, que os discursos de saber sobre a temática que perpassam os participantes no ambiente escolar priorizam uma sexualidade atravessada pelo discurso médico biologizante, especialmente no que diz respeito aos aspectos preventivos. Além disto, o sexo é tratado como algo que traz consequências predominantemente nocivas ao jovem e não como algo saudável que faz parte da vida, sobretudo no período de descobertas da adolescência. Os participantes referem que os discursos que circulam na escola sobre a temática são contraditórios: ora são incentivadores de uma prática da sexualidade, pois entendem que falar sobre o assunto é estimular a prática sexual, ora visam apenas à prevenção de doenças. Apesar da discussão sobre sexualidade ser considerada pelos Parâmetros Curriculares Nacionais (PCNs) como um tema transversal, quando questionados a respeito de quem deveria tratar o tema nas escolas, os professores tendem a delegar esta tarefa a um profissional exterior ao ambiente escolar, sobretudo ao psicólogo. Na escola estas discussões acontecem, predominantemente, nas aulas de biologia e os alunos reforçam a importância deste espaço para tirar dúvidas, pois afirmam não conseguir dialogar abertamente sobre o assunto em casa. Não é comum a frequência dos pais/responsáveis nesta escola, fato que dificultou inicialmente a composição dos grupos. Além disso, em sua formação, contamos apenas com a participação de mães, apesar do convite ter sido feito, também, aos pais. A discussão sobre a sexualidade e seus desdobramentos na escola visa contribuir para novas perspectivas de trato sobre o tema, além de aproximar o diálogo entre pais, professores e alunos de modo que seus discursos não se apresentem como verdades isoladas de cada grupo, mas que possam interagir abrindo o debate para um campo de possibilidades que contribua positivamente para a vivência da sexualidade dos alunos.