published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

India houses the world’s third largest population of people living with Human Immunodeficiency Virus (HIV) who constitute about 6% of the global HIV burden. In about 2008-9, an estimated 1.9 million [95%CI: 1.5 to 2.5] adults were living with HIV in India. The four southern Indian states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu account for about 60% of estimated HIV infections, although they house only 30% of the adult population. I report that most HIV infections in infected couples in the general population of India (85.4% (95%CI: 80.0, 90.7)) were introduced by the male partner. The per-partnership transmission probability of HIV in the general population was low 29.1% (95%CI: 22.5, 35.7) compared to what has been reported for other STIs. Important theoretical facilitating factors for HIV transmission were associated with HIV infection with nearly equal effect sizes in both genders and across HIV–risk settings (multiple partnerships (OR: 2.46 (95%CI: 1.98, 3.06) and STIs (ORHSV-2: 5.60 (95%CI: 3.37, 9.33); ORSyphilis: 4.12 (95%CI: 2.35, 7.25)). The strength of association of STIs with HIV was consistent. Intervention spending on, or coverage of, STI treatment-focused sex work interventions (per 1000 total district population) was associated with a reduced annual risk of either HIV (- 1.7%, 95%CI: -3.3, -0.10) or syphilis (-10.9%, 95%CI: -15.9, -5.8) infection in young pregnant women in the high-burden southern states. A decreased annual risk of syphilis iii among young pregnant women attending public prenatal clinics in the high-burden southern states was associated with a unit increase (per 1000 total district population) of intervention spending (-0.009%, 95%CI: -0.014, -0.004), number of STIs treated (-10.9%, 95%CI: -15.9, -5.8), FSWs reached (-3.0%, 95%CI: -5.2, -0.7) and condoms distributed (-0.034%, 95%CI: - 0.053, -0.015). Male sexual behaviour (non-regular partnerships and use of female sex work) is the dominant driver of HIV transmission in the general population of south India. Ulcerative STIs were strongly associated with HIV infection in south India and interventions aimed at treating STIs and promoting safer sex practices for FSWs and their clients have resulted in reductions in HIV and syphilis incidence and prevalence in the general population of south India.

India houses the world’s third largest population of people living with Human Immunodeficiency Virus (HIV) who constitute about 6% of the global HIV burden. In about 2008-9, an estimated 1.9 million [95%CI: 1.5 to 2.5] adults were living with HIV in India. The four southern Indian states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu account for about 60% of estimated HIV infections, although they house only 30% of the adult population. I report that most HIV infections in infected couples in the general population of India (85.4% (95%CI: 80.0, 90.7)) were introduced by the male partner. The per-partnership transmission probability of HIV in the general population was low 29.1% (95%CI: 22.5, 35.7) compared to what has been reported for other STIs. Important theoretical facilitating factors for HIV transmission were associated with HIV infection with nearly equal effect sizes in both genders and across HIV–risk settings (multiple partnerships (OR: 2.46 (95%CI: 1.98, 3.06) and STIs (ORHSV-2: 5.60 (95%CI: 3.37, 9.33); ORSyphilis: 4.12 (95%CI: 2.35, 7.25)). The strength of association of STIs with HIV was consistent. Intervention spending on, or coverage of, STI treatment-focused sex work interventions (per 1000 total district population) was associated with a reduced annual risk of either HIV (- 1.7%, 95%CI: -3.3, -0.10) or syphilis (-10.9%, 95%CI: -15.9, -5.8) infection in young pregnant women in the high-burden southern states. A decreased annual risk of syphilis iii among young pregnant women attending public prenatal clinics in the high-burden southern states was associated with a unit increase (per 1000 total district population) of intervention spending (-0.009%, 95%CI: -0.014, -0.004), number of STIs treated (-10.9%, 95%CI: -15.9, -5.8), FSWs reached (-3.0%, 95%CI: -5.2, -0.7) and condoms distributed (-0.034%, 95%CI: - 0.053, -0.015). Male sexual behaviour (non-regular partnerships and use of female sex work) is the dominant driver of HIV transmission in the general population of south India. Ulcerative STIs were strongly associated with HIV infection in south India and interventions aimed at treating STIs and promoting safer sex practices for FSWs and their clients have resulted in reductions in HIV and syphilis incidence and prevalence in the general population of south India.

Introduction: Oil/gas communities across Northeastern British Columbia are experiencing rapid in-migration of young, primarily male workers in response to an economic ‘boom’ in the oil/gas sectors. Accompanying the ‘boom’ has been a rise in rates of sexually transmitted infections (STIs) among young people, with Chlamydia rates among youth in the Northeast exceeding the provincial average by 22%. Previous research indicates that socio-cultural and structural determinants of youth sexual behaviour and access to STI testing are important for understanding youth sexual health disparities – and represent key targets for STI prevention efforts. No other research has explored STIs in this rapidly developing, under-resourced context. Therefore, objectives of this thesis were to: (1) Examine how socio-cultural and structural features related to the oil/gas ‘boom’ affect the sexual behaviour of young people in Fort St. John (FSJ), BC; (2) Gather the perspectives of youth and their service providers on the socio-cultural and structural barriers to STI testing in FSJ; (3) Develop recommendations to improve the accessibility of STI testing. Results: Participants identified 4 main ways in which the socio-cultural and structural conditions created by the ‘boom’ affect sexual behaviours, fuelling the spread of STIs in FSJ: mobility of oil/gas workers; binge partying; high levels of disposable income; and gendered power dynamics. As well, 5 key barriers to STI testing among youth were identified: limited opportunities for access; geographic inaccessibility; local social norms; limited information; and negative interactions with providers. Discussion: These data indicate that the conditions fostered by the ‘boom’ in FSJ exacerbate sexual health inequalities among young people. They can be more widely contextualized as an example of the unintended – but not unexpected – health and social implications of a resource-extraction ‘boom’, illustrating the fallacy of ‘development’ as representing uniformly positive ‘progress’. Recommended actions include STI prevention and testing service delivery models that incorporate a locally tailored public awareness campaign, outreach to oil/gas workers, condom distribution, expanded clinic hours and drop-in appointments, specialized training for health care providers, and intersectoral partnerships between public health, non-profit organizations, and industry. An ongoing knowledge translation internship has been undertaken to implement some of these recommendations.

Background: Adolescents and young adults aged 15 to 24 acquire nearly half of all new STDs in the United States, yet they represent only 25% of the sexually active population. Young men and women in this age group have the highest rates of chlamydia, gonorrhea, and syphilis, especially in the African American population. Adolescent risk factors include having a history of pregnancy or STDs, being arrested or incarcerated, substance abuse, early sexual debut and having 4 or more lifetime sexual partners. Protective behaviors such as parental involvement, school enrollment, and consistent condom use have been associated with decreased incidence of STDs. The purpose of this study is to observe changes in adolescent behaviors and experiences that are known risk factors for acquiring sexually transmitted diseases. The aim is to identify the time at which STD prevention interventions may be administered most effectively. In addition, the study aims to identify relevant themes and content that may be useful in creating interventions targeted to different age groups and genders. Methods: This study utilizes primary data collected between 1999 and 2003 by Dr. Rothenberg and colleagues for a community-based network study of low-income African American adolescents living in a working class neighborhood in Southwest Atlanta. Two descriptive analyses were conducted: a period analysis in which all participants ages 15 to 18 who completed any or all of three interviews were included; and a cohort analysis, which included only participants who completed three interviews and who were 15, 16, 17 or 18 years of age at the time of the first interview. Univariate analysis was used to describe each variable and the resulting frequencies and percentages were reported. Results: In both period and cohort analyses, higher proportions of older adolescents (ages 17 and 18) reported engaging in risky behaviors including drinking alcohol, using marijuana, having sex and having multiple sexual partners, compared to younger adolescents (ages 15 and 16). Males reported higher proportions of engaging in risky behaviors than females, but also higher proportions of condom use. The proportion of participants diagnosed with one or more STDs decreased at each interview. In the cohort analysis, the proportion of participants who perceived their STD risk as “medium” or “high” increased over time. Conclusions: The findings suggest that as adolescents mature they engage in a greater variety of risky behaviors known to have a positive association to STD diagnosis. Period analyses, which have usually been done to study the sexual behaviors of adolescents, may give aberrant results that are clearer when the population is studied as a cohort. Future studies are needed to more precisely identify the period during which adolescents experience rapid changes in their risk behaviors.

Chlamydia Trachomatis and Neisseria Gonorrhoeae rank as the two most commonly reported sexually transmitted diseases (STDs) in the United States. Under limited budget, publicly funded clinics are not able to screen and treat the two diseases for all patients. They have to make a decision as to which group of population shall go through the procedure for screening and treating the two diseases. Therefore, we propose a cubic integer programming model on maximizing the number of units of cured diseases. At the same time, a two-step algorithm is established to solve the cubic integer program. We further develop a web-server, which immediately make recommendation on identifying population groups, screening assays and treatment regimens. Running on the empirical data provided by the Centers for Disease Control and Prevention, our program gives more accurate optimal results comparing to MS Excel solver within a very short time.

It is an important step in clinical practice to discriminate real diseased patients from healthy persons. It would be great to get such discrimination from some common information like personal information, life style, and the contact with diseased patient. In this study, a score is calculated for each patient based on a survey through generalized linear model, and then the diseased status is decided according to previous sexually transmitted diseases (STDs) records. This study will facilitate clinics in grouping patients into real diseased or healthy, which in turn will affect the method clinics take to screen patients: complete screening for possible diseased patient and some common screening for potentially healthy persons.

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.

Since the 1994 International Conference on Population and Development there has been a shift away from meeting demographic targets towards meeting the reproductive goals of individual men and women. Partially as a response to the increase in the level of HIV infection, and the associated high levels of STIs, there has been an increasing focus on integrating HIV/STI services within mainstream Maternal Child Health and Family Planning programmes. Thus clients attending clinics that provide integrated services have the opportunity to receive multiple services during a single visit to a facility. The aim of this research was to evaluate the process of integrating FPIMCH and STI/HIV services in urban and rural areas within KwaZulu-Natal, using data gathered form semi structured interviews with clients leaving the health facilities. The research also examined the overall quality of care received within the integrated clinics. The results show that clients rarely receive a range of services on a single visit, despite the integration of services. In most cases, clients do receive the services for which they attended the health facility. However the study found that providers are missing important opportunities to inform, educate and counsel clients on a variety of reproductive health matters. This is important if we are to avoid the negative consequences of an unwanted pregnancy and STIs (including HIV/AIDS). It was also found that the overall quality of care within integrated clinics was low amongst all clients attending the facility. / Thesis (M.Dev.Studies)-University of Natal, Durban, 2003.

Harsh Reality is a print resource aimed toward the population of street-involved youth. Created by a working group of street-involved youth in partnership with a research nurse, Harsh Reality is a unique hybrid of factual information, and art and written experienced submitted by street-involved youth themselves. Harsh Reality contains information about a variety of topics, notably sexually transmitted infections and HIV/AIDS. A case study method was used to evaluate aspects of both project process and outcomes. The case study was guided by three areas of study: street-involved youth's perceptions of the resource, retention of specific knowledge outcomes from the resource, and method of resource distribution. The primary sources of data were street-involved youth themselves. Findings of this study include a description of the target audience's perception of the resource, an analysis of specific knowledge uptake, an assessment of various methods of resource distribution, and possible suggestions for future resources.