Sexual health behaviour and the choices people make are influenced by whole range of factors including social grouping, education, peer pressure and access to services/information. Report on the health of the public in Britain have shown that sexual ill health is unequally distributed across society (Department of Health 2001; Royal College of Nursing 2001). people from socially disadvantaged and marginalised groups experience the highest levels of sexually related illness. Quantitative studies form the main pool of information available in relation to sexual health and risk. They have demonstrated that in some areas of the country the infection rates for STI's are up to twelve times higher in men from black Caribbean communities (Fenton, Johnson et al. 1997; Lacey, Merrick et al. 1997; Low, Daker-White et al. 1997). At present there is very little published qualitative information on the factors affecting sexual health decisions, especially in relation to black Caribbean communities. The research study focuses on black Caribbean men. A qualitative approach is used to identify and explore the key factors influencing the health decisions and risk activities of black Caribbean men in relation to sexual health. Social construction theory provides the theoretical underpinning for this study alongside aspects of feminism, criticalist and ethnicities based approaches. The stereotype of black Caribbean men as sexually insatiable and irresponsible emerged as a key feature of the social scripts associated with their sexual behaviour. The themes 'The nature of the stereotype', 'Living with the stereotype' and 'Hearing the silences' discussed in the data chapters explore the impact of the stereotype on the sexual health decisions of black Caribbean men. The experiences highlighted through the themes expose the importance of the political, social and personal context associated with specific sexual scripts on the sexual health decisions of black Caribbean men. Of key importance in these socially determined scripts are the screaming silences contained within them. The findings are reviewed in the light of current sexual health policies to consider how sexual health services and professionals can best provide for the sexual health needs of black Caribbean men. The thesis adds to current knowledge in sexual health and ethnicities in concluding that the sexual health decisions of black Caribbean men take pace in the context of the real or imagined expectations that society has of them. Individuals sexual decisions therefore occur in light of shared and personal appraisal of socially determined relevant issues. This forms the context in which sexual scripts are given meaning and sexual decisions take place. The study compliments the established pool of quantitative data available linking issues of sexual health and ethnicity in Britain. The findings presented within the thesis reveal a range of issues to initiate further qualitative research in the area and provides a lead for British based thinking on adult sexual health decisions and ethnicity.

BACKGROUND: Over 30% of the British Army‟s Infantry Recruits who underwent training between 1999 and 2003 failed to complete their training. Previous studies have focused predominantly on identifying the cumulative reasons for failure. There is a dearth of research investigating the effect of failure on the individual recruit and what influences their ability to pass training. AIM: The overall aims of this study were: to achieve an understanding of the role that antecedent personal, social and demographic factors play in a British Army recruit‟s ability to complete basic training; to investigate the possibility of identifying predictive factors that would identify infantry recruits who were at risk of being unable to cope with the transition to life in the British Army; and to explore the reasons given by those recruits who failed to complete basic training to develop a more comprehensive understanding of why recruits fail. METHODS: All new army recruits joining the first and second battalion between September 2002 and March 2003 were invited to take part in the study. A biographical questionnaire based on a modified version of the US Army‟s 115 item biographical questionnaire form was self-completed prior to infantry training by all those agreeing to take part in the study. Study participants were monitored weekly throughout their training and the training outcome (pass/fail) was recorded. The data was randomly split into a development dataset (two thirds) and a test dataset (one third). Independent variables were grouped into five categories (Demographic & Physical Measurement, Education, Outdoor Education, Non-Physical Activity and Conduct and Behaviour) and tested univariably and multivariably to examine their association with training outcome in the development dataset using logistic regression. The multivariable model was then used to construct a score and its sensitivity and specificity was tested using the test dataset. All those within the study who failed to complete Infantry recruit training were invited to take part in a qualitative semi-structured exit interview. These interviews were analysed using framework analysis methodology. Findings from both the quantitative and qualitative analysis were integrated to determine whether prediction of failure was practicable and to develop an increased understanding of the impact that antecedent factors and training experiences contributed to training failure. RESULTS: Of the study cohort of 999 recruits 36.2% (n=362) failed. Within the failure group 74.4% (n=269) gave reasons to suggest that this was attributable to difficulties in adapting to life in the British Army Infantry. Factors associated with higher odds of failure were: absence of female siblings (p=0.005), aggressive coping strategies (p=0.013), use of ecstasy (p=0.02), evenings per week spent at the family home (p=0.032), truancy (p=0.039), an increased number of schools attended (p=0.046) and classroom behaviour (p=0.052). The area under the curve on the test dataset was 0.58 (0.501-0.65 95% CI). Analysis of the qualitative data suggested that there was a marked difference between the socio-personal identity of recruits who failed training and the organisational identity of the British Army Infantry. Cognitive dissonance and varying extremes of stress were reported by those recruits that failed during the transition to military life. CONCLUSION: A screening tool constructed from items of the biographical questionnaire was unable to predict failure in training with sufficient accuracy to recommend its routine use for new recruits to British Army Infantry training. This study has identified that there is a lack of fit between military identity and the socio-personal identity of the infantry recruit which results in dissonance and stress during the transition into the military. It is recommended that future studies should focus on how to reduce the psychological impact of the transition into infantry training.

Background: Many HIV/AIDS patients experience pain. This is often associated with advanced HIV/AIDS infection and side effects of treatment. In sub-Saharan Africa, pain management for people with HIV/AIDS is suboptimal. With survival extended as a direct consequence of improved access to antiretroviral therapy, the prevalence of HIV/AIDS related pain is increasing. As most care is provided at home, the management of pain requires patient and family involvement. Pain education is an important aspect in the management of pain in HIV/AIDS patients. Aim: The aim of this study was to evaluate the effects of a pain educational intervention on pain severity and pain related outcomes among patients with HIV/AIDS and their family carers. Methods: Two systematic reviews were conducted: (1) to examine the evidence base of the effectiveness of educational interventions delivered to people living with HIV/AIDS on pain severity, pain interference, quality of life, knowledge of pain management, and (2) To examine the evidence base of the effectiveness of educational interventions delivered to their family carers on knowledge of pain management, quality of life and carer motivation. A randomised controlled trial was conducted at the HIV and palliative care clinics of two public hospitals in Malawi. To be eligible, patient participants had a diagnosis of HIV/AIDS (stage III or IV). Carer participants were individuals most involved in the patient’s unpaid care. Eligible participants were randomised to either: (1) a 30-minute face–to-face educational intervention covering pain assessment and management, augmented by a leaflet and follow-up telephone call at two weeks; or (2) usual care. Those allocated to the usual care group receive the educational intervention after follow-up assessments had been conducted (wait-list control group). The primary outcome was average pain severity measured by the Brief Pain Inventory. Secondary outcomes were pain interference, patient knowledge of pain management, patient quality of life. Carer outcomes were; carer knowledge of pain management, caregiver motivation and carer quality of life. Follow-up assessments were conducted eight weeks after randomisation by nurses’ blind to allocation. Results: Systematic review Eight published randomised controlled trials of educational interventions among patients with HIV/AIDS were identified. Only one study examined the effect on pain severity but the results were not statistically significant. Three studies reported positive effects in improving severity and frequency of symptoms, three reported improvement in quality of life and two studies found improvement in knowledge. Seven published studies of family carers of HIV/AIDS patients were identified. Only three of which were randomised controlled trials. Five of these reported that educational interventions were effective in reducing psychosocial outcomes. Two studies reported that the interventions improved knowledge outcomes among family carers of HIV/AIDS patients. Trial Of the 182 patients/carers dyads randomised; 167 patients and 157 carers completed the trial. At follow-up, patients in the intervention group experienced a greater decrease in average pain severity score 21.25 (mean difference 21.25, 95% confidence interval 16.7 to 25.8; P <0.001). Patients in the intervention group reported, less pain interference (mean difference 24.5, 95% confidence interval 19.61 to 29.38; P<0.001), had improved knowledge of pain management (mean difference 20.39, 95% confidence interval 17.51 to 23.27; P<0.001), and a better quality of life (mean difference 28.76, 95% confidence interval 24.62 to 32.91; P<0.001). At follow-up carers in the intervention group had improved knowledge (mean difference 20.32, 95% confidence interval 17.37 to 23.28; P<0.001), greater motivation (mean difference 7.64, 95% confidence interval 5.15 to 10.13; P<0.001) and better quality of life (mean difference 34.16, 95% confidence interval 30.15 to 38.17; P<0.001). Conclusion: Current evidence of educational interventions among HIV/AIDS and family carers on pain severity is inconclusive and based on a relatively small number of studies, many of which have methodological problems. A relatively simple form of pain education is effective in reducing pain and improving outcomes for patients with HIV/AIDS and their carers. Greater attention needs to be given to incorporating this into the routine care of people with HIV/AIDS in sub-Saharan Africa. Trial registration: Current Controlled Trials ISRCTN72861423.