AbstractAnalysing the Impact of Stigma and Discrimination on the Linkages Across the Continuum of HIV Services for Men who have Sex with Men: A Realist ApproachBackground and Aim The world has now entered the third decade of the AIDS epidemic. Men who have sex with men (MSM) continue to be disproportionately affected by HIV/AIDS. Haiti still struggles in its response to this ongoing crisis throughout the continuum of services: disease prevention, treatment, and HIV related stigma, prejudice, and discrimination. Much of the information reported on people living with HIV has come from the general population, but only a few parts of some of those studies have focused on MSM. Therefore, the overall aim of this dissertation was to analyse the impact of stigma and discrimination on the continuum of HIV services for MSM in order to ascertain why, how and under which circumstances MSM are engaged, linked and retained along the care continuum.Methods For this dissertation, data were collected via literature review, electronic medical records, participant observations, focus groups and semi structured interviews with medical students, health care workers and MSM. Using a realist approach based on mixed methods design we sought to address the influence of HIV and sexual stigma on the continuum of HIV services and to identify key mechanisms emerging from the context and leading to the outcomes. Quantitative social and medical data were gathered and analysed to produce descriptive and analytic statistics and qualitative data were analysed thematically regarding the objectives.FindingsResults indicated that MSM experienced stigma in multiple and overlapping layers. MSM described stigmatizing experiences stemming from religious sources, communities, family and friends, and from the medical establishment. From the social construction of heteronormativity in the society, several social and cultural factors, gender norms lie behind the stigma associated with sexual orientation and HIV. Moreover, medical students and healthcare givers still carry discriminatory attitudes towards them despite tailored interventions. Our analysis showed that current service delivery models are less than optimal in linking and retaining MSM, resulting in loss to follow-up in the continuum of care and failure to fully realize the health and prevention benefits. However, multi-level, contextual-based and socially accountable interventions can produce stigma mitigation through personal, health systems’ and contextual mechanisms for better engagement, adherence and retention throughout the continuum.ConclusionsThe results within this dissertation are intended to inform health professionals in the planning and implementation of interventions for better continuum outcomes in Haiti and similar contexts. This thesis provides insight and contextual information for a socially accountable framework of adapted interventions. To end the AIDS epidemic by 2030, Haiti, the Caribbean region and the entire world urgently need to defy expectations to reach the left behind.KeywordsHIV; Continuum of HIV Services; Stigma; Discrimination; Realist Evaluation; Context-Mechanism-Outcome; Social Accountability / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

>Magister Scientiae - MSc / Physiotherapy services for disabled children and their families have conventionally been received at a hospital or school for children with special educational needs in the main towns and cities of South Africa. Community-Based Rehabilitation (CBR) programmes were proposed and established as an additional approach to Institutional-Based Rehabilitation to address the need for accessible resources for these families. In this study the author evaluated two CBR programmes for disabled children and their main caregivers in two separate low socioeconomic peri-urban areas of Cape Town. The programme, a weekly group meeting, included physiotherapy interventions to assist the development and functional abilities of the children by means of activities that the caregivers could include in daily home care. They handled their own children following demonstrations and correction of handling skills by the author. The majority of the caregivers were mothers. Their children, less than 13 years old, were severely intellectually impaired. Some with concomitant physical disabilities. The author implemented the interventions of the CBR programme and she required to understand the impact on the particpants in a study using qualiative research methods. In the pilot programme the attendant members were individually interviewed, after her withdrawal, for their opinions of the outcomes. Evaluation documentation.ofjheir children and CBR programme records were related to the caregivers' responses. From the pilot study experiences the author felt that additional methods of data collection would result in a greater understanding of the impacts of the interventions. Expanded methods of research were utilised in the study of the second group. During the interventions at group meetings the author used field notes to record observations. Participant observation allowed the author to analysis the responses of the participants. Focus group interviews assisted in understanding external factors influencing the participants as well as their needs. Individual interviews, after the closure of the CBR programme, allowed the participants to express their views of the interventions. Documentation of the individual evaluation of each child was related to the views expressed by the caregivers. Common meanings and themes were explored in the analysis of the various data collected. Analysis revealed that interventions of education and training for the caregivers improved their knowledge and understanding of the impairments and disability of their children. The children benefited functionally from their families increased skills and knowledge. Through discussion with other families at group meetings, the caregivers had an understanding of other disabilities in children and developmental outcomes possible for their own child. The caregivers were more confident to address the negative perceptions of disability in their communities. It is recommended that physiotherapists implementing any interventions for disabled children should ensure that the caregivers are partners in planning and selection of interventions and that their needs are addressed. Community participation in Community-Based Rehabilitation programmes was required for the participants to become self-reliant and solve their own needs as well as for the programme to be sustainable. This was demonstrated in only one of the programmes.

Sex education through the public school system has been identified by the Centers for Disease Control and Prevention as an excellent vehicle by which HIV prevention education can be presented to students, thereby decreasing the rate of HIV infection among young men who have sex with men (YMSM). However, YMSM continue to be at high risk for HIV infection in the United States despite educational efforts to prevent infection. The purpose of this qualitative study using a phenomenological approach was to explore what impact school-based HIV prevention education had on YMSM in the past, and what effect that education has had on their current sexual behaviors. The theoretical foundation for this study was the health belief model. Individual 1-hour interviews were conducted with 13 YMSM (ages 21-35) who received HIV prevention education in California. Interviews were analyzed for common themes using a phenomenological approach. Results of this study suggest that participants were not utilizing safer techniques taught in the school HIV prevention education because there was a lack of curriculum consistency, LGBTQ content, and classroom management, and the impact of stigma and homophobia on YMSM. These results support the health belief model. Findings support that positive social change can be achieved by providing standardized, all-inclusive, non-judgmental, HIV prevention education program, in a classroom environment where it is safe to receive same-sex sexual information. This should decrease the number of HIV+ test results among YMSM.

abstract: The Centers for Disease Control and Prevention (2017) note that gay, bisexual, and other men who have sex with men (collectively referred to as MSM) face more barriers to accessing health care compared to other men. Such barriers include, lack of cultural- and sexual identity-appropriate medical and support services, concerns about confidentiality, and fear of discussing sexual practices or orientation in a medical setting. In comparison to other MSM populations, Latino MSM (LMSM) report having the least amount of access to health care (McKirnan et al., 2012). The purpose of the present study is to elucidate how individual- (i.e., age, education level, and income level), community- (i.e., social support and neighborhood collective efficacy), and sociocultural-level factors (i.e., immigration status, heterosexual self-presentation, sexual identity commitment, sexual identity exploration, and ethnic identity affirmation and belonging) may relate with perceived access to healthcare. It is hypothesized that ethnic identity affirmation and belonging will moderate relations between the aforementioned predictors and perceived access to health care based on increasing evidence that ethnic identity, or one’s sense of affirmation and belonging to one’s ethnic group, may be a health protective factor. Among a sample of 469 LMSM, this study found that there were several predictors across all three levels (i.e., individual, community, and sociocultural) of perceived access to healthcare. Additionally, data supported evidence that ethnic identity affirmation and belonging (Phinney, 2003) acts as a moderator of other predictors of perceived access to healthcare in this sample. These findings can inform outreach interventions of researchers and healthcare providers about psychosocial and cultural barriers and facilitators of access to healthcare. / Dissertation/Thesis / Masters Thesis Counseling Psychology 2020

MSc (Chemistry) / Department of Chemistry / Surface water is used for domestic and agricultural activities in Musina region and other surrounding areas. This is because of the shortage of potable water. As a result, the people living in the region and its surrounding areas are potentially exposed to hazardous contaminants that may be present in the surface water. It is therefore important to ascertain the quality of the surface water in the region. Surface water samples were collected from Mutale, Nwanedi, Tshipise and Nzhelele rivers. The samples were analysed for anions such as fluoride (F-), chloride (Cl-), nitrate (NO3-), phosphate (PO43-), sulphate (SO42-); cations such as aluminium (Al), calcium (Ca), iron (Fe), potassium (K), magnesium (Mg), sodium (Na) and trace metals such as lithium (Li), vanadium (V), chromium (Cr), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), molybdenum (Mo), cadmium (Cd), thallium (Tl) and lead (Pb) by using analytical techniques such as IC, ICP-OES and ICP-MS. The same samples were also investigated for other parameters such as pH, temperature, EC, TH, TDS, Na % and SAR. The WHO (2008), SANS 241 (2006) and Canadian guideline (2017) were used as a water quality guideline for drinking purposes. Higher concentrations of Li, V, Cr, Ni, Cu, Zn, Al, Ca, Mg, K and Na in river water were detected in rainy season, whereas higher concentrations of As, Mo, K and Fe were recorded in dry season. The concentration of F-, Cd, Tl and Pb showed low contamination level in river samples. The results demonstrated that Tshipise river water was contaminated with high concentration of parameters: TDS (1864.0.8-3372.8 mg L-1), EC (2960.3-5270 mS cm-1), F- (6.403-8.419 mg L-1), SO42- (289.657-326.598 mg L-1), Na (836.690-922.810 mg L-1) and As (10.017-11.267 μg L-1) and relative to the (WHO) water guidelines. Nwanedi river also showed higher values of EC (298.0-699.0) mS cm-1 and TDS (190.3-447.5) mg L-1. In this study, the results indicated that water from Tshipise and Nwanedi river is not suitable for human consumption based on the guidelines of drinking water. The results also indicated that the soil sample had abundance of Ca, Al, Mn and Fe with concentration ranging from 0.13-10595, 0.0084-4.16, 0.0455-1116.5, 2.4-287404 mg Kg-1 respectively. / NRF

The diploma thesis deals with the ratification process of the WHO Framework Convention on Tobacco Control in the Czech Republic. The proposal of ratification was denied by the Senate of the Parliament of the Czech Republic in 2005 and it was postponed. The debate was renewed in 2011 when the proposal was approved by both chamber of the Parliament of the Czech Republic and subsequently in May 2012 it was signed by the President of the Czech Republic. The thesis investigated different views of Members of Parliament on the ratification of the framework convention. To fulfil the aims of the thesis the Framework analysis method is used. The method reveals the competing frames in 2005 and 2011. Both periods are then compared. The author also tried to understand why the proposal in 2005 was denied and she offered one of the possible interpretations. The thesis is supplemented by chapters which describe the Framework Convention on Tobacco Control and the development of the ratification process. These parts use the interviews made with experts in the research area.

Background. Despite the prevalence of sex work and strip clubs across Canadian urban geographies, few studies explore the occupational health and safety outcomes related to indoor male sex work, let alone male stripping whereby men dance for men. Moreover, the sexual service negotiation process in the sex work industry remains to be explored. In knowing that sexual practices with high HIV/STI rates occur in strip clubs (e.g., condomless oral, vaginal, and anal sex), as well as widespread psychoactive substance use among strippers, the purpose of this study was to explore the cultural features of male strippers’ work that impact their health and safety outcomes. Methodology. For this study, we recruited 14 male strippers working with male clients in a Canadian city. Critical ethnography was our espoused methodology. Through field observations, informal conversations, questionnaires, and semi-structured qualitative interviews, we explored the process of sexual transactions between strippers and clients. We used a postmodern angle to interpret our findings through the works of Deleuze, Guattari, and Foucault. Findings. The male strip club is a social matrix produced by the intersection of motivational forces: the motivation to gain money, pleasure, or intimacy, and the motivation to abide by socio-cultural and legal norms. It is upon a matrix of financial necessity and socio-cultural and legal constraints that sex work transactions unfold in the club. Moreover, the club’s health and safety conditions and strippers’ transaction outcomes result from intersecting motivations. Finally, sexual service negotiation is a process of configuring motivational forces between social agents. The motivation for financial gain revealed itself to be the strongest and most consistent force; the focus on capital gain generated asymmetrical connections between strippers, clients, and business entrepreneurs, resulting in specific health and safety outcomes. Conclusion. The Canadian legal and political context surrounding male sex work negatively impacts male strippers’ occupational health and safety conditions by disabling safe connections with clients. Further, the emphasis on money-making activities encourages strippers to value financial gain over their physical and mental integrity. In short, the male strip club work environment is configured in a manner whereby capital gain is prioritized and strippers’ health and safety is undermined.

Background: Nurses work closely with patients to improve care and alleviate suffering among PLHIV. However, the segregation of MSM in society and the criminalization of same-sex behaviours have caused great havoc causing deaths and suffering in developing countries for more than three decades since the scourge of HIV/AIDS emerged. Aim: The study aimed to illuminate the caring encounters in nursing management of HIV/AIDS among MSM living in Nairobi, Kenya. Method: Five semi-structured interviews were conducted to nurses and data analysed through thematic analysis. Results: Four themes were constructed; the importance of holistic care approach, operanalization of empowerment, the need for sensitization, and living in segregation. Eight sub-themes were formulated: achieving positive patient ́s wellbeing, effective nurse-patient relationship, improving health awareness, provision of social support, conflicts of values, judgmental nurses, rejection of MSM in the society, and rampant discrimination of MSM. Conclusion: Sensitized nurses on MSM sexual behaviours provide holistic care and empower MSM in the management of HIV/AIDS, unlike the ones who still hold onto homophobic prejudice based on religious, cultural and personal beliefs. The study recommends the training of nurses to be aware of the harmful societal attitudes, beliefs, rejection, and discrimination that hinders the effective management of HIV/AIDS. / Bakgrund: Sjuksköterskor arbetar nära medpatienterna för att förbättra omvårdnad och lindra lidandet bland de som lever med HIV/AIDS. Dock orsakar segregeringen av MSM i samhället och kriminaliseringen av samkönat sexbeteende avsevärt kaos vilket orsakar död och lidande i utvecklingsländer i mer än tre decennier sedan plågan av HIV/AIDS börjande. Syfte: Studien syftar till att belysa bemötande vid omvårdnaden vid hanteringen av HIV/AIDS bland MSM som bor i Nairobi, Kenya. Metod: Fem semistrukturerade intervjuer utfördes med sjuksköterskor och data analyserades medelst tematisk analys. Resultat: Fyra teman identifierades: vikten av holistiskt tillvägagångssätt vid omvårdnad, operalisering av bemyndigande, behovet av sensibilisering, och att leva i segregering. Åtta underteman formulerades: att uppnå positivt välbefinnande hos patienter, effektiva sjuksköterska-patient-förhållanden, förbättra hälsomedvetenhet, tillhandahållande av socialt stöd, värdekonflikter, fördömande sjuksköterskor, förkastande av MSM i samhället, och utbredd diskriminering av MSM. Slutsats: Sensibiliserade sjuksköterskor avseende sexuella beteenden hos MSM tillhandahåller holistisk omvårdnad och bemyndigar MSM i hanterandet av HIV/AIDS, till skillnad från de som håller fast vid homofobiska fördomar baserade på religiösa, kulturella och personliga övertygelser. Studien rekommenderar att utbildningen av sjuksköterskor uppmärksammar skadliga sociala attityder, övertygelse, förkastelse, och diskriminering som hindrar effektiv hantering av HIV/AIDS.

Female genital cutting is a problem that has taken several dimensions and continues to be practiced despite enormous efforts and resources invested by governments,non-governmental organizations (NGOs) and other stakeholders to ensure that the practice is discontinued worldwide. This study was conducted with the primary objective of assessing the views and perceptions of NGOs on the practice of female genital cutting in Nigeria. The study also examines efforts by civil society and the Nigerian government towards combating and eliminating the practice of FMC in Nigeria. Aside from the systematic literature review, a case study of ten NGOs were interviewed on the telephone. Findings indicate that girls being kept pure as virgins, protection of girls' reproductive potential, increase in fertility, aiding marriageability, traditional practice, and keeping with lineage practice are responsibile for the practice in Nigeria. Few theories were reviewed, and research questions were designed in line with the theories. The approaches include the Functionalist theory, cultural relativism, social theory and Feminism.

Background: Understanding concentrated areas with high rates of opioid use disorder (OUD) allows for improved placement of Narcan access points through syringe services programs (SSPs). People Who Inject Drugs (PWID) have lower risk of contracting infectious diseases the closer they are to SSPs. Tennessee law prohibits SSPs within 2000ft of a school or park, impacting the placement of SSPs in non-urban areas. Testing factors related to SSP siting placement within a system dynamic model can better determine the relationship between PWID risk environment and SSP access and utility. Methods: We identified areas of greatest need for harm reduction interventions within a non-urban Tennessee county with Emergency Medical Services (EMS) Narcan administrations data (Aim 1). We then created a Google map to determine a theoretical ideal location for an SSP. We then applied the current legal restrictions to SSP placement to find the next-closest legal location (Aim 2). We then developed a theoretical system dynamic model of SSP access and utility and Risk Environment (Aim 3). Results: We determined “EMS Zone 1” has a higher rate of EMS Narcan administrations than most EMS zones in the county and a higher rate compared to the whole county (Aim 1). We located a theoretical SSP location with shorter walk, drive, and public transportation times compared to the existing location. The closest legal SPP location still had an improvement in travel times but lacked other utility factors (Aim 2). Our theoretical model indicates that laws limiting SSP placement increase the distance PWID travel to SSPs. The distance of support services to SSP sites has a negative relationship with risk environment and to accessibility and utility of SSPs (Aim 3). Conclusion: County-level geographic data is too crude to determine true “hot spots” of OUD. This new method using EMS data can provide entities a process for determining the best location for SSPs. Identifying measures of utility/accessibility for PWID can identify improved locations for SSPs but legal restrictions may lower utility/accessibility of SSPs especially for non-urban PWID. Current “Policy” or “Structural” level factors as described by the Social Ecological Model negatively impact PWID risk environment. Structural” or “Policy” and “Community” level interventions among state, city, and county governments have the highest potential to positively impact PWID risk environment.