published_or_final_version / Community Medicine / Master / Master of Public Health

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Wong, Ying Suet. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 120-131). / In English with some Chinese and Japanese; abstract also in Chinese. / Chapter Chapter One: --- Introduction --- p.3 / Literature Review --- p.7 / Structure --- p.10 / Notes on Sources --- p.13 / Chapter Chapter Two: --- Venereal Disease Policies in the Metropole and Their Colonies --- p.15 / The Case of Britain --- p.16 / VD Policy in the Metropole: The case of Britain --- p.16 / VD Policy in the Colonies: The Case of Colonies under Britain --- p.23 / The Case of Japan with Reference of Britain as the Pioneer Policy Maker --- p.28 / Chapter Chapter Three: --- Venereal Disease control in the Metropole --- p.31 / Legislation --- p.32 / Institutions --- p.44 / Education and Social Discussion --- p.49 / Resistance --- p.55 / VD control in the Japanese Military Force --- p.60 / Summary --- p.67 / Chapter Chapter Four: --- Venereal Disease Control in Colonial Taiwan --- p.70 / Legislation --- p.72 / Licensed prostitution system --- p.72 / The VD Prevention Law --- p.79 / Education and Social Discussion --- p.84 / Before the VD Prevention Law in Japan in 1927 --- p.84 / Education and Public Discussion of VD after the promulgation of the VD Prevention Law in 1927 --- p.90 / The Changing Discourse of VD --- p.95 / Summary --- p.100 / Chapter Chapter Five: --- "Sex, Gender, Class, Race and Colonialism" --- p.101 / Taiwanese Women´ةs image: Scapegoating --- p.101 / Medical Development: State Medicine and Local Elites --- p.106 / VD Control in the Military in Taiwan --- p.109 / Summary --- p.111 / Chapter Chapter Six: --- Conclusion --- p.114 / Bibliography --- p.120

Wang, Zixin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 215-223). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese.

This dissertation discusses anti-HIV-1 microbicide research. In particular, it concentrates on microbicide formulation and delivery. Microbicides are anti-HIV-1 agents that when applied in the human vagina or rectum may prevent sexual HIV-1 transmission. Although most of the anti-HIV-1 agents being developed as microbicides are active in vitro, they have proved to be ineffective in vivo. A review of microbicide development over the last decade expounds the view that unsatisfactory microbicide failures may be a result of inefficient delivery systems employed. Thus, necessitating a thorough scientific qualitative and quantitative investigation of important aspects involved in HIV-1 transmission as a prerequisite for microbicide development. In this dissertation it is postulated that intravaginal targeting of HIV-1 increases the chances of microbicide success, wherein vaginal micro-environmental factors including pH would be maintained at HIV-1 prohibitive acidic levels to ward off other sexually transmitted diseases which compromise vaginal epithelial barrier properties. Furthermore, targeting early stages of the HIV-1 infection accompanied by computation and delivery of appropriate microbicide quantities could result in an effective microbicide formulation. In an effort to address microbicide formulation challenges, an intravaginal delivery system able to deliver anti-HIV-1 agents (zidovudine and BP36) over 28 days was formulated. This delivery system is a caplet-shaped composite system comprising zidovudine (AZT) and BP36-loaded pectin-mucin-polyethylene glycol submicrospheres embedded within a poly(D,L-lactide), magnesium stearate, polyvinyl acetate/polyvinylpyrolidone (Kollidon® SR) and poly(acrylic acid) based polymeric caplet matrix. The delivery system was tested in vitro and in vivo in the pig model. X-ray imaging illustrated the delivery system swelling and its matrix contrast fading over time as vaginal fluid permeated the matrix’s core. Plasma, vaginal fluid and tissue drug was detected and quantified using ultra performance liquid chromatography-tandem photodiode array detector. AZT plasma and vaginal fluid concentrations measured on days; 3, 7, 14, 21 and 28 decreased gradually with time. Vaginal tissue AZT concentrations (after 28 days) were higher than plasma AZT concentrations and were in the same range as vaginal fluid AZT concentrations. The herbal extract, BP36, was detected in plasma, vaginal fluid and tissue but was only qualitatively analysed due to its lack of standardization. Histopathological analysis of excised vaginal tissue revealed different scores of abnormalities comprising mild to moderate epithelial proliferation and exocytosis, subepithelial leukocyte influx, perivascular cell cuffing and isolated epithelial erosion, stromal fibrosis and isolated tissue necrosis.

Orientador: Lenice do Rosário de Souza / Coorientador: Hélio Amante Miot / Banca: Marli Terezinha Cassamassimo Duarte / Banca: Walter Belda Junior / Resumo: A infecção pelo HPV é a DST mais comum no mundo. Dos 630 milhões de casos novos anuais, trinta milhões são relacionados a verrugas anogenitais. Embora a forma subclínica seja mais comum, o aparecimento de condilomas também está associado à diminuição da imunidade causada pelo HIV. Tendo em vista as altas taxas de prevalência da coinfecção HPV/HIV, principalmente entre homens que fazem sexo com homens, os objetivos deste trabalho foram analisar a prevalência de verrugas anogenitais em homens portadores de HIV/aids e identificar fatores associados. Estudo transversal, descritivo e analítico com 159 homens atendidos em serviço de referência de Botucatu (SP). Dados sociodemográficos, comportamentais e clínicos foram relacionados ou não à presença de verrugas anogenitais. Após análise hierárquica dos dados, as variáveis com valor de p menor do que 0,2 foram incluídas no modelo logístico multivariado não condicional. Foram diagnosticados 49 (31,0%) pacientes HIV+ com verrugas anogenitais, cuja média de idade foi de 44,6 ± 9,6 anos. Os principais fatores associados às verrugas foram: escolaridade menor que ou igual a oito anos; maior tempo de diagnóstico do HIV; tratamento antirretroviral irregular; baixas contagens de linfócitos T CD4+. Verrugas anogenitais são prevalentes e relacionadas à imunossupressão da infecção pelo HIV. Ações como o cuidado integral do paciente e educação e prevenção em saúde colaboram para diagnóstico precoce e diminuição da vulnerabilidade a DSTs / Abstract: HPV infection is the most usual STD in the world responsible for 630 million new cases annually, of which 30 million are related with anogenital warts. Although subclinical form is the most common, warts are also associated with reduction of HV-related immunity. There are high rates involving prevalence of the association HIV/HPV around the world. Following this point of view the aim of this study was analyze the prevalence of wart in HIV-infected men and describe the associated factors. cared by a reference service in the Botucatu city - São Paulo/Brazil. Sociodemographic, behavioral and clinical data were collected by an individual interview and medical records. There were 49 (31,0%) HIV-infected men with anogenital warts with mean age of 44,6 ± 9,6 years. The main associated factors were: have up to 8 years of study; longer duration of HIV-infection; irregular treatment to HIV-infection; lower counts of lymphocytes T CD4+. Genital warts are prevalent and are associated with HIV- infection magnitude. Actions such as the complete care over the patients, increasing the education and prevention in health system could help to do a previously, diagnosis and decreasing the vulnerability to STD / Mestre

The purpose of this study was to examine the effectiveness and exposure of an implementation strategy, which included a 4-day in-class training with two follow-up technical assistance calls, on mediating factors hypothesized to be positively associated with staff’s intention to use a five-session, couples-based HIV and other sexually transmitted prevention intervention. The Consolidated Framework for Implementation Research (CFIR) guided the study aims and analysis of the direct effect of exposure to the implementation strategy and 3 factors hypothesized to mediate the implementation strategies’ effect on intention to implement a couples-based intervention. Individual staff characteristics and an organizational process variable informed by Social Cognitive Theory (SCT), the Diffusion of Innovation Theory and Theory of Planned Action were examined. Two hundred and fifty-three staff, predominantly African American and Latina, from 80 organizations, were recruited from HIV service agencies, clinics and community-based organization from New York City and other regions of New York State. They were randomized by agency to either a multimedia condition or a traditional paper-based version of the couples-based intervention and received the implementation strategy 4-day, in-class intervention training followed by a technical assistance phone call at 3 and 6-months post training. Findings suggest that greater exposure to the implementation strategy in days and contacts was significantly associated with an increase in staff’s intention to implement the intervention at six months. Further, while a statistically significant effect of the implementation strategy dose on the mediators examined was not detected, the implementer’s experience of these mediators defined as self-efficacy for couples-based implementation, positive perception of the intervention’s characteristics and the perceived availability of an organizational intervention Champion was found to be significantly associated with the outcome variable intention to implement, and also was found to reduce the dosage effect of the implementation strategy on intention. Further examination of the implementation strategy’s content and dosage is needed to identify how increased intention to utilize an intervention at 6 months and 12 months following training and technical assistance may be enhanced through greater attention to and measurement of these mediators in addition to the implementation strategy dosage effect. Of note, the dosage effect on intention was found to diminish at the 12 month follow-up period suggesting the importance of timely support and planning prior to and post implementation strategies to increase utilization of an innovation. Implications for HIV prevention theory, and social work research, practice and policy are discussed.

Background HIV/AIDS has always been a concern since it first came up in 1981 in the field of medicine and public health. The trend of overall HIV epidemic has slow down through over 30 years fighting against the disease. Yet, being the largest population nowadays, young people still face high risk of HIV/AID. Sexual transmitted diseases, similar with HIV infection, are also a serious concern in young people. Peer education is widely used in the sexual education in young people. No review focused on the school-based peer education while most young people received their sexual education in schools. This systematic review aims to evaluate the effectiveness of school-based peer education on HIV/STD prevention and evaluate the factors that are likely to influence the effect of school-based peer education. Method Searching through PubMed and Cochrane Library, a literature review was carried out on the relevant articles about the evaluation of school-based peer education in developing and developed countries around the world from 2000-01-01 to 2014-05-31. Findings 10 experimental studies were chosen in this review, including 3 randomized controlled trials. Among 10 studies, 8 found significant improved about the general knowledge of HIV/STD and all studies showed positive change in attitude and risk perception in the peer-led education. However, no studies found significant effect of peer education on the behavioral change regarding condom use, postponing sexual intercourses and the reduction of sexual partners, etc. The interaction of peer education and the quality of peer-educators plus other demographical factors such as socioeconomic status and religions may influence the effect of school-based peer-led education. Conclusion School-based peer education was demonstrated to be effective on the prevention of HIV/STD in knowledge and attitude improvement, similar with other kinds of peer education. Peer educators and interactions between educators and educatees play important roles in the peer education. Yet, the effect of school-based education still requires long-term assessment. / published_or_final_version / Public Health / Master / Master of Public Health

The high levels of HIV prevalence amongst young people in sub-Saharan African countries, have led to the clarion call for researchers to investigate the determinants to young people's sexual risk-taking behaviour while others are exploring the usage of entertainment education (EE) so that effective prevention and interventions may be developed. One critical aspect is that research efforts so far have been hampered by the adoption of models and perspectives that are narrow and do not adequately capture the complexity associated with young people's sexual experiences. The distinctiveness of this study is therefore grounded in the focus on the risky sexual practices students engage in and their underlying risk and protective multisystemic factors and their response to the EE interventions, in particular the Scrutinise Campus Campaign. Thus, using the Problem Behaviour Theory, Reception Theory and the Social Cognitive Learning Theory, this study investigates the phenomena of students' sexual risk behaviour and their response to the Scrutinise Campus campaign. The study is situated within the interpretative paradigm. It used a hermeneutic phenomenological methodology underpinned by in-depth interviews, focus group discussions, participant observation and field notes to draw data for this study. The study sample included students and the Scrutinise Campus Campaign officers. Findings of this study sustain the conclusion that students' sexual risk behaviour is influenced by interrelated, interactional and transactional factors from the multisysternic factors: biological, environmental/social, behavioural and personality domains that either instigate or buffer against students' sexual risk behaviour. However, Scrutinise Campus campaign's messages do not fully address students' sexual risk practices and their underlying factors as experienced by students. It is critical to employ a comprehensive and continuum of EE interventions that are broad in scope arid target factors from multiple systems of influence including the multisystemic factors. Most significantly, sources of protective influence should not be ignored when designing and implementing EE prevention programmes and, to the extent possible, both risk arid protective factors should be addressed in the interventions. This may help to effectively address students' sexual-risk taking behaviour in universities. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.

M.Cur. / HIV and AIDS education as a prevention strategy is priority number one in the National Strategic Plan for South Africa. Prevention of illnesses is also an integral part of primary health care (Department of Health, 2007: 10). There are different role players offering age-appropriate HIV and AIDS education to primary school learners, such as educators (within the Life Orientation programme), school health nurses (as part of health promotion) and non-governmental organisation (NGO) peer educators who visit schools per invitation or as part of their programme. Knowledge of collaboration amongst different role payers is necessary in order to pool the complementary strengths and maximise the positive impact of education on adolescents’ sexual behaviour. The design used in this research is quantitative and descriptive in nature. The respondents were clustered according to categories, namely school health nurses, primary school educators and NGO peer educators. As school health nurses (n=8) and peer educators (n=15) constituted a small population, they were all included in the study. Systematic random sampling was used to select respondents from the population of educators (N=75: n=42). A developed questionnaire was distributed to the consenting respondents who met the inclusion criteria. A checklist was also developed to review policies and guidelines used as a framework for providing HIV and AIDS education to learners by role players. A pilot study was conducted. The Statistical Package for Social Science (SPSS14.0) for Windows was used to analyse the data.