"May 2004" / Includes bibliographical references (leaves 243-270) / xviii, 270 leaves : ill. (some col.), maps ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, School of Social Sciences, Discipline of Geographical and Environmental Studies, 2004

Thesis (M.S.)--University of Michigan, 1996.

Thesis (M.S.)--University of Michigan, 1996.

Health care service providers in South Africa and elsewhere in the world are increasingly faced with an enormous challenge of modeling their approach to health care to meet the needs and expectations of the diverse societies they serve. The norms and customs that are inherent in these indigenous cultures are fundamental to the day-to-day existence of the people concerned and may hold a key to the understanding of many aspects of their lives, including the understanding of disease, in the case of this thesis, those transmitted sexually. A grounded theory study was used based on its theory of symbolic interactionism to explore the indigenous knowledge and health practices of the Vhavenda in sexually transmitted diseases. Data was collected through in-depth interview with traditional healers and key informants. Snowball sampling was used to idenify key informants as categories continued to emerge. Dara was analyzed using three basic types of coding namely, open coding, axial coding and selective coding. The findings of the study revealed a variety of terms used to identify SDs. Also emerging from the results was that cultural gender roles in the Vhavenda society justify women as sole agents of STDs. In accordance with grounded theory the decriptions of types of diseases, disease patterns, signs and symptoms culminated in "dirt" as the core category. It came out clear that dirt in the form of women'svaginal discharges and moral dirt is the main course of a STDs. It was also evident that strategies for combating STDs will have to take into account popular beliefs and attudes regarding views on STDs as well as the role and influence of traditional healers. Based on the above findings guidelines for designing a module for teaching health professionals has been formulated to aid them in understanding the beliefs and practices of people they serve. / Health Studies / D. Litt et Phil. (Health Studies)

This study explored preparatory students’ perceptions of the risk of contracting the Human Immuno-deficiency Virus (HIV) and sexually transmitted infections (STIs) in Ethopia. It utilised a non-experimental exploratory survey methodology. A range of findings was revealed. Most respondents (67.14%) were knowledgeable about HIV/AIDS and more than half of the respondents knew about STIs. A significant number of respondents (67.1%) were able to describe HIV transmission prevention methods. Twenty one percent of respondents were sexually active and 17.0% of these reported to have used condoms. Twenty nine percent and 4.25% of the respondents had selfperceived risk of contracting HIV infection and STIs respectively. In spite of increased awareness of HIV/AIDS, school youths still engage in high-risk sexual activities and believe that they are unlikely to contract the disease. The study findings have implications for practice, and recommendations are offered for further research / Health Studies / M.A. (Public Health)

Department of Advanced Nursing Science / MCur

Globally, the incidence of infection caused by Neisseria gonorrhoeae is the second highest among the bacterial sexually transmitted infections. In Canada, declining rates during the 1990s suggested progress toward curbing gonorrhea; however, those have been increasing since 1999, with rates in Saskatchewan among the highest in the country. Infection can cause serious complications in men and women, and reported resistance to third-generation cephalosporins could lead to potentially untreatable infections. Increased understanding of gonorrhea transmission dynamics, sexual networks, and predictors of antimicrobial resistance development is needed to inform the development of improved approaches to prevention and treatment. The research presented herein draws upon data from Shanghai, China, and Saskatchewan, Canada, to compare and contrast varying epidemiologic approaches to enhancing understanding of gonorrhea in the two settings. Using traditional statistical approaches, multi-level statistical modeling, social network analysis, and dynamic simulation modeling, questions related to sexual behavior, partner presentation, and antimicrobial resistance development are explored. Each technique is evaluated for its potential contribution to overall understanding of the issues related to the ongoing gonorrhea epidemic, globally, and in Saskatchewan. The relative strengths and limitations of the application of the analytical approaches in the different settings are described. Socio-demographic characteristics provided useful indicators of antimicrobial resistant infection among patients with gonorrhea from Shanghai. Further, socio-demographic characteristics were also useful for predicting presentation of a partner for testing and treatment and the use of condoms during intercourse, among this study population. In Saskatchewan, socio-demographic characteristics were useful in predicting coinfection with gonorrhea and chlamydia at the time of diagnosis as well as repeat infection with gonorrhea. Social network analysis of the Saskatchewan dataset provided little additional understanding of the gonorrhea epidemic in the province. This result was largely related to how STI data are collected and stored in the province. The utility of dynamic simulation modeling to investigate the potential impact of antimicrobial resistance in Saskatchewan was also limited due to the same data constraints. However, the insight gained from the model building process and findings from the working model did offer a starting point for conversations around the best ways to postpone the development of antimicrobial resistance in N. gonorrhoeae in Saskatchewan, as well as contribute additional information about how the ways in which STI data are collected and stored in the province considerably restrict the applicability of otherwise powerful epidemiologic tools. With persistently high rates of disease transmission, and the threat of untreatable infections due to antimicrobial resistance, N. gonorrhoeae remains a substantial public health threat locally and globally. The research presented herein describes various approaches to understanding and controlling this disease, applied in contrasting settings. There are a wide variety of elements that should be considered when choosing the appropriate tool(s) to address gonorrhea in a given population; there is no “one size fits all” solution. The local epidemiology of disease, cultural and behavioural norms, the characteristics of the notifiable disease reporting and information systems, and the availability of suitable data all affect the relative strengths and weaknesses of the available analytic methods and disease control approaches.

Thesis (MCur)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Research and in certain instances the lack of research as well as extensive experience of the researcher in this field of study convinced the researcher that a scientific study / exploration is critical on the different aspects of adolescent sexual health. A study, based on a combination of qualitative and quantitative methods (triangulation), was conducted to identify and describe the factors playing a role in adolescents’ experiencing problems in maintaining their sexual health. Adolescents are at risk of contracting Sexually Transmitted Diseases including HIV/AIDS because of their sexual behaviour. Initiation of early sexual relations contributing to possible multiple sexual partners and failure to consistently use condoms contribute to this risk. Failure to continuously use a reliable contraceptive method also enhances the risk of unintended pregnancies and consequent exposure to the risks involved in termination of pregnancy or the psychological effects of giving the baby up for adoption, the hardship of raising the baby as a single parent or being forced to marry at a young age. Thus the physical-, emotional-, and social well being of the adolescent is at risk when they are not equipped to maintain their sexual health.The study concludes that adolescents that are sexually active and have multiple sexual partners have a higher probability of not maintaining their sexual health. Based on the outcome of this study the researcher feels strongly that the following needs to be addressed in order to promote the maintenance of adolescent sexual health: • Professional nurses need to be trained and sensitized to guide and manage adolescents seeking sexual or reproductive advice; • Sexuality programmes need to be integrated into school curricula; • Positive use of the mass media to promote healthy lifestyles; and • Training programmes for parents and adolescents. / AFRIKAANSE OPSOMMING: Navorsing en in sekere gevalle die gebrek daaraan sowel as ekstensiewe ondervinding van die navorser in die studieveld, het die navorser oortuig dat ‘n wetenskaplike studie / eksplorasie oor die veskillende aspekte van adolessente seksuele gesondheid krities was. ‘n Studie, gebaseer op ‘n kombinasie van kwalitatiewe en kwantitatiewe metodes (triangulasie), was uitgevoer om die faktore wat ‘n rol speel in adolessente se vermoëns om hul seksuele gesondheid te handhaaf, te identifiseer en te bepreek. Adolessente se risiko is hoog om Seksueel Oordraagbare siektes, insluitend MIV/VIGS, op te doen weens hul seksuele gedrag. Die aanvang van vroeë seksuele verhoudings dra by tot moontlike meervoudige seksmaats en die gebrek aan konsekwente gebruik van kondome verhoog die risiko. Gebrek aan die aaneenlopende gebruik van ‘n betroubare kontraseptiewe metode verhoog ook die risiko van ‘n ongewensde swangerskap en gevolglike blootstelling aan die risiko’s verbonde aan terminasie van swangerskap of die psigologiese effekte wat gepaard gaan met aanneming, enkel ouerskap en geforseerde trou op ‘n vroeë ouderdom. Derhalwe word die fisiese-, emosionele- en sosiale welsyn van die adolessent bedreig as hulle nie toegerus is om hul seksuele gesondheid te handhaaf nie.Die gevolgtrekking van die studie is dat adolessente wat seksueel aktief is en meervoudige seksmaats het, ‘n hoër waarskynlikheid het om nie hul seksuele gesondheid te handhaaf nie. Gebaseer op die uitkoms van die studie is die navorser van mening dat die volgende aangespreek moet word ten einde die handhawing van adolessente seksuele gesondheid te bevorder: • Geregistreerde vepleegkundiges moet opgelei en gesensitiseer word om adolessente te hanteer en van leiding te voorsien; • Seksualitiet programme moet in die skool kurrikulum integreer word; • Positiewe gebruik van die massa media om gesonde lewenstyle te bevorder; en • Opleidingsprogramme vir ouers en adolessente.

Background: Sexually transmitted infection (STI) rates represent a significant health disparity among young adult African American women. A major factor contributing to this issue is inconsistent condom use. This is especially a challenge for the state of Georgia, which has a high incidence of STI among the southern states. STI prevention counseling delivery through primary care providers is the primary recommendation from the Centers for Disease Control and Prevention and U.S. Preventive Services Taskforce. However, knowledge, attitudes, and practices of STI prevention counseling by advanced practice registered nurses (APRN) who care for young adult African American women are unknown in Georgia.Purpose: This doctor of nursing practice project investigated knowledge, attitudes, and practices of STI prevention by Georgia APRNs caring for young adult African American women on an outpatient basis and determined congruency of their counseling with primary prevention guide-lines. Methods: The design was descriptive cross-sectional. An online survey using Qualtrics software was distributed via professional listservs and postal mail to eligible Georgia APRNs currently in practice. Participants' knowledge of STI, STI prevention, and current practice guidelines and recommendations were assessed using knowledge questionnaires including true/false and multiple choice questions. Participants' attitudes regarding STI prevention counseling with young African American women and current APRN behaviors, in relation to current practice guidelines, were measured using Likert-type scales. Outcomes: The final sample size included 22 participants. Forty initiated the survey, ten did not meet eligibility criteria, six ended the survey during eligibility screening, and two ended the survey after completing less than seven percent of it. In general, participants were knowledgeable of STI and the majority of participants were knowledgeable of the CDC and USPSTF guidelines. The majority of participants felt comfortable discussing sexual practices with patients and providing feedback and advice on reducing STI risk behavior. However, the majority of participants did not believe that their current practice setting actively supported their delivery of STI prevention counseling. Overall, participants' practices were more congruent with the CDC guidelines compared to the USPSTF guidelines. This was reflected in knowledge and practice behaviors, specifically assessing for STI, providing feedback on risk behavior, and advising on behavior change with STI-infected patients and those at risk for STI. Fewer chose the USPSTF as their established practice guideline. This was revealed in practice behaviors pertaining to 'high-risk' counseling, as few tended to set goals for STI risk behavior change, document behavior goals, refer to STI resources, or follow up with referrals made to other STI risk reduction programs. Practice implications: Although overall APRN knowledge of STI was high, there were some knowledge deficits relating to appropriate barrier methods for viral-based STI and high-risk sexual behaviors associated with HBV. There was also a lack of knowledge and practice behaviors of the USPSTF STI prevention counseling guidelines. Therefore, future studies and interventions should aim to educate APRNs about these knowledge and practice insufficiencies.

Background: Adverse childhood experiences (ACEs) are a major public health problem in the US, and have been linked to risky sexual behavior and psychopathology. However, studies examining the link between the wide range of ACEs and sexual health outcomes and behaviors, and the associated mediational role of psychopathology are lacking. Objectives: The main objectives of this dissertation project were: 1) To determine the association between ACEs and sexual health outcomes and behaviors (early sexual debut, intimate partner violence (IPV) perpetration, and HIV/STIs); 2) To examine the disparities among selected populations; and 3) To assess the mediational role of psychopathology in the association between ACEs and sexual health. Methods: Data were obtained from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to determine the association between ACEs (neglect, physical/psychological abuse, sexual abuse, witnessing parental violence, and parental incarceration/psychopathology) and early age at sexual debut by sex and sexual orientation. Structural equation modeling (SEM) was used to determine the mediational role of psychopathology (PTSD, substance abuse, and depression) in the association between ACE constructs and IPV perpetration, and the role of psychopathology, early sexual debut and IPV perpetration in the association between ACEs and HIV/STIs. Results: The association between ACEs and early sexual debut was generally stronger for women and sexual minorities. Among men, PTSD mediated the association between sexual abuse and IPV perpetration (z=0.004, p = 0.018). However, among men and women, substance abuse mediated the association between physical/psychological abuse and IPV perpetration: z=0.011, p=0.036 and z=0.008, p=0.049, respectively. Among men, PTSD mediated abuse (physical/psychological, and sexual) and parental incarceration/psychopathology; substance abuse mediated abuse and neglect; depression and early sexual debut mediated abuse; and IPV perpetration mediated sexual abuse, and HIV/STIs. Among women, substance abuse mediated neglect and physical/psychological abuse, and depression mediated physical/psychological abuse and HIV/STIs. Conclusions: Intervention and prevention programs geared towards preventing sexual health outcomes and behaviors should employ a life course approach and address ACEs. Treatment components addressing PTSD, substance abuse, and depression should also be added to IPV perpetration and HIV/STI prevention programs.