Abstract The purpose of this study is to describe and to compare the university students’ attitudes (knowledge, feelings and behaviour) towards HIV/AIDS (Human Immune Deficiency Virus/ Acquired Immune Deficiency Syndrome) in Finland and in Kenya and to find explanatory factors associated with the sexual risk behaviour. For educators, managers and experts in health care and education the results will provide an opportunity to deepen their knowledge and awareness of students’ sexual behaviour. These results may also be used for planning an educational programme for youngsters and young adults in order to promote healthy sexual behaviour. This study is focused on the viewpoint of preventive health care and sexual health promotion. The study is a comparative research with quantitative and qualitative methods. The study group consists of 525 first year students (411 Finnish and 114 Kenyan students) of Oulu University of Applied Sciences, Oulu University and the University of Helsinki in Finland and of MOI University in Kenya. The response rate was 87.5%. The results concerning the attitudes towards HIV/AIDS of the students showed that the Finnish and Kenyan students had a good level of knowledge concerning HIV and AIDS. Most of the information had been obtained from TV, campaigns, newspapers, and information packages. The role of the health care professionals was very small in both countries. The most negative attitudes were found towards homosexuality (25.8% of the respondents) and intravenous drugs users (59.5%). The result showed that the level of knowledge did not have an effect on the level of their beliefs and prejudices of the students. It was common for the respondents to be single during their first study year. No influence was found between the students’ knowledge and the number of their sex partners or the frequency of the sexual activity. Almost the same number of students who reported using prevention always or almost always identified both HIV correctly (43.4%) and incorrectly (45.7%). The situation concerning AIDS was similar. The age and the importance of religion of the students had influence on the use of prevention. / Tiivistelmä Tutkimuksen tarkoituksena on kuvata ja verrata kenialaisten ja suomalaisten korkeakouluopiskelijoiden asenteita (tietoja, tunteita ja käyttäytymistä) HIV/AIDSia (Immuunikatovirus/ Hankittu immuunipuutos-oireyhtymä) kohtaan ja löytää seksuaalista riskikäyttäytymistä selittäviä tekijöitä. Terveydenhuollon ja terveysalan hallinnon ja koulutuksen asiantuntijoille tutkimustulokset antavat mahdollisuuden tutustua ja syventää HIV/AIDSia koskevaa tietouttaan ja tietoisuuttaan. Tuloksia voidaan hyödyntää ennaltaehkäisevän terveydenhuollon suunnittelussa ja koulutuksessa edistämään nuorten ja nuorten aikuisten terveellistä seksikäyttäytymistä. Tutkimuksen lähtökohta on ennaltaehkäisevä toiminta ja erityisesti seksuaaliterveyden edistäminen. Tutkimus on vertaileva tutkimus. Aineisto kerättiin strukturoituja ja avoimia kysymyksiä sisältävällä kyselylomakkeella. Tutkimukseen vastasi yhteensä 525 ensimmäisen lukuvuoden korkeakouluopiskelijaa, 411 suomalaista ja 114 kenialaista opiskelijaa. Vastausprosentti oli 87,5 %. Tulokset osoittivat sekä kenialaisilla että suomalaisilla korkeakouluopiskelijoilla olevan hyvät tiedot HIV/AIDSista. Tärkeimpiä opiskelijoiden nimeämiä tietolähteitä olivat TV, kampanjat, sanomalehdet ja informaatiopaketit. Perheen ja terveydenhuoltohenkilöstön rooli tiedon lähteenä oli vähäinen molemmissa maissa. Negatiivisimmat asenteet kohdistuivat homoseksuaalisuutta ja laskimon sisäisiä huumeiden käyttäjiä kohtaan. Kenialaisten opiskelijoiden ennakkoasenteet HIV/AIDSia kohtaan olivat muita opiskelijoita voimakkaammat ja negatiivisemmat. Tulokset osoittivat, että tiedon laadulla ei ollut merkitystä opiskelijoiden ennakkoasenteisiin. Tulokset osoittivat myös, että ensimmäisen vuoden korkeakouluopiskelijoilla ei ole paljon seksisuhteita. Opiskelijoiden HIV/AIDS-tiedoilla ei ollut yhteyttä seksipartnereiden määrään tai seksuaaliseen aktiivisuuteen. Oikealla tai väärällä HIV/AIDS-tiedolla ei ollut vaikutusta ehkäisyn käyttöön. Lähes sama määrä opiskelijoita, jotka kertoivat käyttävänsä ehkäisyä aina tai lähes aina, määritteli HIVin oikein ja väärin. Tilanne oli samanlainen koskien AIDSia. Oikealla tai väärällä HIV/AIDSia koskevalla tiedolla ei ollut myöskään vaikutusta ennakkoasenteiden voimakkuuteen. Tutkimustulosten perusteella HIV/AIDSin ennaltaehkäisyssä ei pelkkä HIV/AIDS tietotason kohottaminen riitä, vaan on syytä käyttää uusia ja monipuolisia lähestymistapoja.

Master of Science / Department of Family Studies and Human Services / Candyce S. Russell / The risk of HIV infection continues to be high in the United States, with women being one of the most vulnerable populations. Medical tests to determine an HIV-positive diagnosis and to subsequently chart the progression of the disease and the effectiveness of the medications are central to the lives of these women. This paper will focus on how women find meaning in these test results and how these meanings affect the way they view their lives and their relationships. Women are also often in particularly vulnerable positions, and this paper will discuss how they deal with this disproportionate lack of power both before and after HIV infection. It is important to therapists working with these women to have an understanding of how women make meaning of both their HIV test results and power differentials. The implications for therapy include helping the client and her family members understand this new situation and the meanings it has for their lives and relationships.

Master of Public Health - MPH / Adolescents' sexual activity is associated with maternal and child health problems, and sexually transmitted infections including HIV/AIDS. The aim of this study was to assess the sexual behaviour patterns of adolescent schoolgirls and the level of knowledge they have with regard to the prevention and transmission of HIV infection, as well as to determine which factors are associated with their various sexual behaviour patterns. A cross-sectional descriptive survey of 420 adolescent schoolgirls aged 15 to 19 years, from 3 of the 9 secondary schools situated in Petauke District, in rural Zambia, was conducted. The sample of schoolgirls was obtained using a multi-stage systemic sampling technique. / South Africa

Philosophiae Doctor - PhD / The aim of this study was to develop guidelines for an HIV/AIDS support programme for teachers. In order to achieve this goal, Intervention Research: Design and Development model by Rothman and Thomas (1994) was adopted to guide the research process. Intervention research is a form of applied qualitative research utilized by researchers to design and develop interventions to ameliorate social problems. Intervention research: design and development model has six phases and unique operational steps to follow in each phase. The researcher adopted the first three phases to facilitate the design of the guidelines to assist with development of a programme to support teachers. Problem analysis and project planning is the first phase. In this phase, the aim was to understand the experiences of HIV/AIDS among teachers and in schools. Information was gathered from HIV/AIDS coordinators, principals, teachers living with HIV. / South Africa

Magister Public Health - MPH / HRQOL of HAART recipients at the Kagera region hospital was generally lower than that of the general population. However, their general health perceptions and mental health status were comparable to those of the general population, suggesting effectiveness of HAART in improving some subjective experiences of HIV morbidity. Chronic diseases were the main factor negatively affecting HRQOL of recipients.

Magister Public Health - MPH / Viewing the provision of TB-HIV integrated services from the perspectives of TB/HIV clients can help to identify ways to enhance the provision of these services. The aim of this study was to assess the provision of TB/HIV services including PMTCT from clients perspectives in order to make recommendations on ways to enhance the provision of TB/HIV/PMTCT services at facility and community level. Method: Secondary data analysis was undertaken on a survey that was part of a cross-sectional study conducted in 2008 in Sisonke district, a rural district of KwaZulu Natal province, South Africa. Exit interviews were completed by 274 clients accessing TB, HIV and PMTCT services in 10 selected facilities in Sisonke district. A questionnaire that had both closed and open-ended questions was used for exit interviews. Ethical clearance of the study was originally obtained from the Ethics Committee of the University of the Western Cape. The researcher sought permission from the custodian/owner (primary researcher) of the data. The researcher also adhered to maintaining data integrity including the confidentiality procedures as defined in the primary study. In analysing the data it was checked completeness and internal consistency. The quantitative part of the data was stratified, cleaned and coded. The qualitative part of the data was reviewed repeatedly and clustered. The measures of central tendency like frequency, means, median and standard deviation were used for continuous data while categorical data were analysed with frequency and proportions. The Chi-square test was used to assess the association between depend and independent variables. Results: The results of this study show that the respondents preferred accessing integrated TB-HIV/PMTCT services. Most of the respondents, especially a majority of younger respondents comprising of PMTCT (66.7%), HIV (29.8%) and TB (30.8%) categories reported that they were educated on HIV matters. Also, most of the younger respondents (18 – 30 years) among the PMTCT category (74.3%) and most of the older respondents (older than 30 years) of the pre ART & ART category (71.2%)reported that they were educated about TB matters.In general, the majority ( 90 %) of the respondents preferred TB/HIV/PMTCT services to be provided at the same place but a small majority (42%) of the respondents preferred to be seen the same clinicians. Most (68%) of the PMTCT younger (18-30 years) respondents preferred to receive TB-HIV integrated care at their homes while 70% and 68% of HIV and TB older respondents (>30 years) preferred to receive TB and HIV services at their homes. Viewing the advantages,disadvantages and barriers for accessing TB/HIV/PMTCT integrated services, there is a proportionate distribution in the responses amid the categories though the female respondents comparatively take the lead in reporting about their experiences in accessing TB/HIV/PMTCT integrated services. In this study, majority of the respondents demonstrated that they access good integrated TB-HIV/PMTCT services both at the facilities level and at home. Providing integrated TB-HIV/PMTCT services is widely accepted. Majority of the respondents especially the younger females preferred to continue receiving TB-HIV integrated care at their homes in comparison with older respondents. Conclusion: Most of the respondents comprised of females aged less than 30 years. These respondents like the services provided by the TB-HIV integrated services and want it sustained. They prefer the facilities to be in the same location. However, they prefer to consult different clinicians for the two different health conditions. The respondents also preferred to have HIV test at the same facility and to be visited at home by community health workers in support of the provision of TB/HIV/PMTCT care.

Magister Public Health - MPH / Introduction: Zambia is among the countries in the sub-Saharan African region most severely affected with HIV/AIDS. Approximately 1.2 million (14%) Zambians were living with HIV in 2010. Zambia introduced antiretroviral therapy (ART) in the public sector in 2002, starting with two pilot sites, and rolling it out throughout the country in 2004 and 2005. To date,approximately 350,000 people have accessed HIV treatment. The long-term success of ART programs depends on optimal adherence to ART by patients.In 2010 Livingstone General Hospital (LGH), the setting for the current research had over 7,000 enrolled for HIV care of whom 3,880 patients were on ART. By the end of June 2011, it was reported that 343 patients in this hospital were between 2 to 30 days late for their medication refill appointments. This meant that these patients had missed more than one dose, and thus not meeting the required 95% of medication for viral suppression. This study explored the barriers to medication adherence experienced by ART patients at Livingstone General Hospital (LGH). Methodology: An exploratory qualitative study was conducted. Six focus group discussions(FGD) were conducted with 42 patients on ART, and follow up semi-structured interviews with 7 patients identified during the FGDs. FGDs and semi-structured interviews were audio-tape recorded and transcribed verbatim. Thematic and content analysis of transcribed data was done. Results: The study found that the barriers to ART adherence included socio-economic factors such as poverty, use of traditional complementary and alternative medicines (TCAM) and religious beliefs. Patient related factors reported to negatively affect adherence were HIV related-stigma and discrimination, alcohol use, low literacy and education levels, busy daily schedules and forgetfulness. Regimen related factors included experiencing side effects to medication and complexity of treatment regimen. Negative staff attitudes, traveling long distances to health facility, long waiting times, lack of confidentiality, poor health information and poor patient-health provider relationships were the health system factors that negatively impacted on ART adherence. Conclusion: The combination and complexity of factors affecting adherence identified in this study have posed a challenge to adherence to ART. People have been forced to make adjustments to their routine lives in order to accommodate ART. The most problematic factor identified was the use of TCAM in combination with ART or as replacement of ART.

There is a need for understanding the stories behind domestic violence and HIV/AIDS in women. Many research studies focus on the interaction between domestic violence and risky behaviours for HIV/AIDS infection and have ignored the experiences of women who are caught up in these situations. This study aims at exploring the experiences of HIV-positive women who are victims of domestic violence and tries to understand their feelings regarding their HIV status and the violence. Factors that contribute to the spread of HIV in women are also explored. It is argued that domestic violence and other socio-cultural factors are the driving forces behind the high incidence of HIV/AIDS in women. These factors also contribute to the continuation of dominant themes of domestic violence. The emerging stories further indicate that cultural factors situate women in positions that limit their ability to make decisions in the relationship, including sexual decisions. In the context of domestic violence, it not only becomes difficult for women to cope with their HIV diagnosis, but their positive HIV status also leads to the continuation of domestic violence. Copyright / Dissertation (MA)--University of Pretoria, 2010. / Psychology / unrestricted

As HIV/AIDS continues to disproportionately impact men who have sex with men (MSM) (CDC, 2010a), effective and timely prevention strategies for this population must be developed. Specifically, evidence-based interventions that can be easily adapted and have proven effectiveness are needed. Hence, the purpose of the current study was to assess the impact of the Mpowerment Project (Hayes, Rebchook, & Kegeles, 2003), a community level HIV prevention program originally designed for young urban gay men, when adapted for rural gay men. The Mpowerment Project is recognized as evidence- based intervention by the CDC (CDC, 2009b). The current study is an extension of this research, assessing Mpowerment model fidelity and the behavioral and attitudinal changes that occurred among participants. Data were collected from participants in a rural area of southeast Idaho from 2002-2004. Data were collected prior to M-Group participation and at a three months follow-up. The 66 individuals completing the M-Group pre and posttest assessment also attended a minimum of three study events and a maximum of 226 events. Results revealed no significant changes in attitudinal variables and all but one behavioral variable among Rural Mpowerment (R-MP) participants. The one significant behavior change was an increase in reported safer sex discussion among friends, indicating a possible change in the social norm regarding safer sex. Results also indicate that program fidelity was maintained and the Mpowerment Project is adaptable to rural areas. However, there was no indication of attitudinal changes in participants of this study. There were no changes in behavioral variables aside from discussion about safer sex with friends increasing. The lack of evidence-based interventions for rural gay men highlights the need for further research on the community impact of the Mpowerment Project on rural participants.

Youth, the World Bank argues, need to become a constituency for reform in developing countries. This case study responds to this challenge by investigating adolescent students' understanding of the relationship between health literacy, HIV/AIDS, and gender in the context of Uganda. The four questions investigated are: (i) What kind of health literacy, HIV/AIDS, and gender-related information is accessible to Ugandan adolescent secondary school students? (ii) In the students' view, what are the factors contributing to health and HIV/AIDS related challenges faced by young people in Uganda today? (iii) According to these students, what is the impact of the debate on gender equality in the fight against health epidemics including HIV/AIDS? and (iv) What do these students consider to be the way forward for Uganda to achieve better health and improve life chances for all? The theoretical framework includes critical pedagogy and indigenous knowledge systems, as well as integrative gender frameworks. Each contributes a different but complementary understanding of adolescent students' perspectives on the issues under investigation. Data were collected in a qualitative study from January 2005 — May, 2007. The data corpus includes: student journals, reflective reports, artifacts/documents, life history interviews, questionnaires, informal ethnographic conversations, focus group discussions and critical inquiry discussions. In response to each of the research questions, the major findings were as follows: i) The students' understanding of the relationship between health literacy, HIV/AIDS, and gender were in part influenced by the media, and in part their own experiences. ii) Poverty and peer pressure impact young people's health practices. iii) Young people want gender equality debates to have a focus on marginalized males as well as females. iv) Youth suggest that education, fair trade, and better health care services are important in the attainment of the "better health for all" goal in Uganda. The study concludes that marginalized groups, especially youth, need opportunities to develop a united voice and be active participants in reform processes. Further, new analysis frameworks are needed to understand the gender/power relations in Uganda. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate