Master of Public Health - MPH / The notification and treatment of sexual partner(s) is a key element in the prevention and control of sexually transmitted infections (STIs). Partner notification interrupts the chain of STI transmission, prevents STI complications and long-term sequelae in the sexual partner(s), and also prevents re-infection of the treated index patient. Partner notification is a recognized component of the syndromic management of STIs in Namibia and yet the partner notification rates in the country remain low - as low as 7% in the district of Windhoek currently. In this district, which has the highest number of STIs cases in Namibia, the specific factors that hinder partner notification have not yet been documented. This study sought to investigate the perceived and experienced barriers to partner notification amongst STI patients attending an urban primary health center in the district. An explorative, qualitative study with eight patients (four males and four females), aged 16 years and over, who presented with a new/recurrent episode or a STI follow up was conducted. The participants were purposively selected with the aid of the deputy nurse in charge of the health center after agreeing to take part in the study. The patients were asked about what they felt were personal, partner-relationship and health services related factors that hindered partner notification. Three health workers working at the health center served as key informants and were asked about barriers to partner notification based on their experience of delivering preventative and curative STI - related services over the past three or more years. Interviews with both patients and key informants were conducted in the health facility, recorded and later transcribed. Content analysis of the transcribed data was conducted to identify recurring themes across the different interviews. The results of the study suggest that the partner notification strategy was not functioning optimally as a result of a number of inter-twined factors. The factors can be categorized into personal barriers, partner-relationship dynamics and health services related barriers. The study found that participants considered there were barriers to partner notification across all these three categories. Commonly reported barriers included the stigma associated with STIs and the cultural and religious norms that do not promote discussion of topics related to sex and sexuality in general. Other barriers such as gender inequality, the fear of a partner's reaction to the notification, feelings of guilt associated with infidelity, the lack of communication between partners and the inability to locate partner(s) were highlighted by participants. Barriers associated with the health services included the lack of health education about the importance of partner notification, the absence of thorough risk reduction counseling, the current method of partner notification that is being utilized and the negative attitudes of health workers. It is suggested that having a greater understanding of these barriers and how to work with them in a health education or counseling sessions will allow health workers to address them more directly with their patients and in turn, hopefully improve the management and outcomes of partner notification strategies in the STI prevention and control program in the Windhoek district and potentially other districts in Namibia.

Background: The sexually transmitted infections (STIs), chlamydia and gonorrhea, disproportionately affect racial and ethnic minorities. Community attributes like poverty and prevalence of STIs, along with residential segregation and its impact on composition of sexual networks contribute to these disparate rates. The Southeast had the highest rates of chlamydial and gonorrheal infection among the four regions of the United States. Because relationships between race and place can confound national statistics, it is important to examine whether racial disparities within the region are associated with higher rates of infection. Purpose: The study aims to evaluate local geospatial clustering of gonorrhea and chlamydia rates in the Southeast, and their persistence during 2000-2005 and any associations with residential segregation, income inequality, unemployment and uninsured rates, and race. Methods: Using the Local Indicators of Spatial Association tests of spatial clustering, cluster maps were created for each STI outcome and year. Independent sample t-tests were then used to examine the difference in means of each community level variable across counties composing the high-rate clusters and all other counties in the region. Results: Over 60% of counties composing high-rate clusters persisted as high rate clusters over time, and were significantly associated with higher levels of community disadvantage than all other counties (p < 0.01). Overall gonorrhea rates decreased from 2000 to 2005 and chlamydia rates increased, while their associations with community disadvantage remained persistently strong over time. Conclusions: Counties with higher rates of chlamydia and gonorrhea persist over time and experience persistently higher levels of residential segregation and income inequality, as well as higher unemployment and uninsured rates, and higher proportions of blacks in the population. The social environment and segregated sexual networks may play important roles in the persistently high rates of chlamydia and gonorrhea observed for certain regions within the Southeast. Continued surveillance of reportable STIs and their probable predictors is needed in order to better understand the persistent disparities in STI rates across counties in the Southeast.

Philosophiae Doctor - PhD / Sexually transmitted infections (STIs) are a problem for both developed and developing countries. Sub-Saharan Africa has the highest rates in the 15-49 years old group. The discovery that these infections playa vital role in the transmission of HIV raised their profile and made their control one of the central strategies of stopping the HIV/AIDS epidemic. In response to the challenge of improving the quality of care for people infected with STIs in the public health sector, the South African Ministry of Health adopted the syndromic management approach, recommended by the World Health Organisation as suitable for resource-poor settings, for use in primary health care clinics. In addition to providing guidelines on clinical management of STIs, the syndromic approach requires health providers to counsel and educate patients about STIs, encourage patients to complete treatment even if symptoms abate, promote condom use and the treatment of all sexual partners. While the management guidelines are clear and detailed around the diagnostic and medication issues, the processes of education and counseling are not as clearly outlined. Furthermore, although the syndromic approach is a viable way of providing good quality care to larger sections of the population than could be serviced through dedicated STI clinics, it requires health providers working in primary health care clinics, most of whom are professional nurses, to perform some tasks for which they may not be adequately trained. This study evaluated the quality of care for persons infected with ST!s by examining the extent to which the syndromic approach was being implemented in primary health care clinics. Interviews, using semi-structured interview schedules, were conducted with ST! patients and health providers in twenty-four clinics located in four provinces. In depth qualitative interviews were also conducted with a sub-sample of the patients. For further triangulation the methods of participant observation, through the use of simulated patients, and focus group discussions with various community groups were used. The findings of the study indicate that although primary health care clinics in South Africa are well-resourced, the management of patients with ST!s is inadequate. Adherence to the various aspects of syndromic management was poor. Similar to other studies in South Africa, the attitudes of health providers towards patients with ST!s were found to be problematic, a finding that has implications for health-seeking behaviours. The thesis argues that a large part of the problem is related to the multiple roles that nurses have to play in primary health care settings, as well as the content and methodology of the training of nurses who manage ST! patients. It further argues for the constitution of the basic health team at primary health clinics to be multi-disciplinary, and for a multi-disciplinary input in the training of health providers.

Background: Selected factors place Dominican female adolescent and adults at risk for sexually transmitted infections (STIs) such as Chlamydia, causative organism Chlamydia trachomatis, and Gonorrhea, causative organism Neisseria gonorrhoeae. The purpose of this study was to determine the prevalence of Chlamydia and Gonorrhea among adolescent and adult females that utilize the clinic in Veron, Dominican Republic. Clinical standards of care for these STIs and educational programs for prevention were developed from the data gathered from this study. Significance at 0.05 ά of the relationship of educational level, management of risk factors and other selected independent variables on prevalence rate of Chlamydia and Gonorrhea in the clinic population of Veron, Dominican Republic were determined. The objectives of the study were to 1) determine the prevalence of adolescent and young adult females diagnosed with Gonorrhea and Chlamydia who visit the clinic for prenatal visits, annual pap smear exams and gynecological complaints; 2) determine the extent to which educational level is a predictor of positive diagnosis or risk for infection of Chlamydia and Gonorrhea and; 3) determine which selected demographic and risk factors are associated with positive test results for Gonorrhea and Chlamydia. Methods: All adolescent and adult females ages 15 years and older visiting the clinic in Veron for prenatal exams, pap smear exams and gynecological complaints between January 28, 2008 – March 3, 2008 were invited to participate in this prevalence study. Of the 90 invited, the accepting sample was 90 who signed an informed consent form. Prior to STI testing each patient completed a verbal interview and questionnaire on sociodemographic characteristics as well as knowledge, attitudes, and beliefs related to Chlamydia and gonorrhea, sexual experiences and behaviors and illicit drugs use. Specimens collected from the endocervical canal of each female were tested and results provided within two hours, followed by immediate treatment by a licensed Dominican physician and follow-up care based on the guidelines and standards of care. The data were analyzed using descriptive statistics, chi square, t-test and logistic regression. Results: A total of ninety women participated in the study. Chlamydia was detected in 6.7% of the patient population and Gonorrhea was detected in 22.2% of the patient population. Co-infection of both Chlamydia and Gonorrhea was present in 2 cases. Among the positive Chlamydia tests results, 50% had less than a six-year education and 50% had more then six years of education. In addition, 83.3% of the patients with positive Chlamydia results answered "yes", they could read and 16.6% stated they could not read, while 83.3% of the patients with positive Chlamydia results stated they could write and 16.6% stated they could not write (P>0.05). Among the patients that tested positive for Gonorrhea, 55% stated they had less than six years of formal education and 45% had more than six years of formal education (P>0.05). There were 75% of the patients that tested positive for Gonorrhea that stated they could read and 25% who stated they could not read (P>0.05); while 85% of the patients with positive Gonorrhea results stated they could write and 15% stated they could not write (P> 0.05). Conclusion: Educational level and other selected demographic characteristics and risk factors in this study are not a significant predictor of positive diagnosis or risk of infection for Chlamydia or Gonorrhea. We cannot conclude that specific risk factors are associated with positive test results for Gonorrhea and Chlamydia. For the physicians involved in the clinical decision-making regarding the female patients at the Veron clinic, more data are needed to determine appropriate populations for screening of Gonorrhea and Chlamydia as well as appropriate educational tools on sexually transmitted infections. / Ph. D.

Sexually transmitted infections (STIs) are a common health problem in all populations; however, female adolescents are at increased risk for acquiring STIs and their complications. Their increased risk of acquiring STIs is due to their behavior, anatomy. and lack of knowledge about STIs. STIs have many complications in women. Some complications include: pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, and infertility. The purpose of this integrative review is to identify current sexual behaviors of female adolescents, and to find strategies at preventing or reducing STIs within this population. Nurses and other health care providers need to know the current statistics of STIs in adolescent females, and need to understand their current sexual behaviors in order to implement effective preventative strategies.

Background: Social networks, norms, and discussions about sexual health may inform sexual practices, influencing risk of human immunodeficiency virus (HIV) or sexually transmitted infection (STI) acquisition. To better understand social networks of Peruvian men who have sex with men (MSM) and transgender women (trans women), we examined key social network members (SNMs), participant perceptions of these network members’ opinions toward sexual health behaviors, and associations between network member characteristics and condomless anal intercourse (CAI). Methods: In a 2017 cross-sectional study, a convenience sample of 565 MSM and trans women with HIV-negative or unknown serostatus was asked to identify three close SNMs; describe discussions about HIV and STI prevention with each; and report perceived opinions of condom use, HIV/STI testing, and partner notification of STIs. Generalized estimating equations evaluated relationships between SNM characteristics, opinions, and discussions and participant-reported CAI. Results: Among participants who identified as MSM, 42.3% of key SNMs were perceived to identify as gay. MSM “never” discussed HIV and STI prevention concerns with 42.4% of heterosexual SNMs, but discussed them “at least once weekly” with 16.9 and 16.6% of gay- and bisexual- identifying SNMs, respectively. Among participants who identified as trans women, 28.2% of key SNMs were perceived as heterosexual; 25.9%, as bisexual; 24.7%, as transgender; and 21.2%, as gay. Trans women discussed HIV/STI prevention least with cis-gender heterosexual network members (40.2% “never”) and most with transgender network members (27.1% “at least once weekly”). Participants perceived most of their close social network to be completely in favor of condom use (71.2% MSM SNMs, 61.5% trans women SNMs) and HIV/STI testing (73.1% MSM SNMs, 75.6% trans women SNMs), but described less support for partner STI notification (33.4% MSM SNMs, 37.4% trans women SNMs). Most participants reported CAI with at least one of their past three sexual partners (77.5% MSM, 62.8% trans women). SNM characteristics were not significantly associated with participant-reported frequency of CAI. Conclusions: Findings compare social support, perceived social norms, and discussion patterns of Peruvian MSM and trans women, offering insight into social contexts and sexual behaviors. Trial registration: The parent study from which this analysis was derived was registered at ClinicalTrials.gov (Identifier: NCT03010020) on January 4, 2017. / National Institutes of Health / Revisión por pares

To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p <.01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79–8.04), partner concurrency (4.42, 1.19–16.40), and participant alcohol (4.71, 1.82–12.17) or drug use (5.38, 2.22–13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01–7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use. / Revisión por pares

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)