In Europa leiden etwa 120 Millionen aller 18- bis 80-jährigen an einer Hörbehinderung (16% Prävalenz). Die altersassoziierte Innenohrschwerhörigkeit (Age related hearing impairment, ARHI) hat damit Anschluss gefunden an die großen Volkskrankheiten: Ischämische Herzerkrankungen (5,9 %), Demenz (5,8 %), Diabetes mellitus und Cerebralen Erkrankungen (je 5,5 %). Der erste Teil der Arbeit befasst sich mit der Theorie des Hörens und seinen Störungen, der cochleären Durchblutung, den metabolischen Risikofaktoren, der Molekularbiologie und Epigenetik des Innenohres. Obwohl in der Literatur weitgehend Konsens über den Einfluss exogener Faktoren auf ARHI herrscht, wie Diabetes mellitus, Herz-Kreislauferkrankungen (Framingham Studie und CVD), Hypertonie, Rauchen, Body mass index (BMI) und genderspezifische hormonelle Einflüsse, gibt es kaum HNO-ärztliche Studien dazu. Der zweite Teil geht in einer Praxis-Fallstudie an 202 Patienten folgenden Fragen nach: 1. Gibt es zwischen metabolischen Erkrankungen, wie Adipositas, Störungen des Fett- und Glucosestoffwechsels, der Hypertonie und der Zunahme von Innenohrschwerhörigkeiten im Erwachsenenalter klinische Zusammenhänge? 2. Könnte eine erste Ohrsymptomatik Prädikator einer okkulten pathologischen Stoffwechselveränderung sein? 3. Gibt es Möglichkeiten einer Prävention? Im Ergebnis zeigten sich bei Patienten mit ARHI im Verhältnis Männer/Frauen: Störung des Glukosestoffwechsels bei 97 %/84 %, Lipidstoffwechselstörungen bei 76 %/85 %, eine Homocysteinämien bei 70 %/62 %, ein Anstieg des Plasminogen-Aktivator-Inhibitors (PAI) bei 65 %/38 % und eine Harnsäureerhöhung bei 48 %/15 %. Auch bei ersten Ohrsymptomen (Ohrdruck, Tinnitus, einzelne Frequenzsenken) fanden sich in jedem einzelnen Fall metabolische Veränderungen, die entweder allein oder in unterschiedlichen Kombinationen vorlagen. Männern mit metabolisch initiierten KHK-Erkrankung haben als Prädikator häufig eine erektile Dysfunktion. Erste auditorische Symptomen könnten Prädikator okkulter metabolischer Störungen bei Männern und Frauen sein. Anamnestisch unklare Innenohrprobleme sollten daher auf Stoffwechselstörungen untersucht werden, da diese Risikofaktoren darstellen, die leitlinienbasiert zu therapieren sind. Eine Prognose ist in keinem Einzelfall möglich, da die Folgen auf die molekularbiologischen Prozesse im Innenohres individuell nicht erkennbar sind. Doch sahen wir bei einigen Patienten deutliche Verbesserungen der Symptome und einen Hörschwellenanstieg. Andere Patienten zeigten innerhalb des Beobachtungszeitraums keine Änderung der audiogenen Symptomatik. Behandlungen über einen längeren Zeitraum an einer größeren Fallzahl wären daher sinnvoll. Die Ergebnisse könnten als erste sekundärpräventive Behandlung betrachtet werden, die im Einzelfall eine Hörgeräteversorgung entbehrlich machte. Sie stellen einen Beitrag zu Pfisters Empfehlung dar, mit den vorhandenen Erkenntnissen exogener Risikomechanismen, dringend neue therapeutische Präventionsstrategien für die HNO-ärztliche Tätigkeit zu entwickeln, die die neurale und molekulare Basis anstelle der Symptome der Erkrankung fokussieren.

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This study was an attempt to investigate the influence of socio-cultural factors on HIV prevention strategies among HIV discordant couples in Harare, Zimbabwe. HIV sero-discordance is a scenario whereby one partner is HIV-positive and the other is HIV-negative. HIV sero-discordant couples are a unique and vulnerable population that encounters many peculiar challenges. When dealing with this population, researchers have to deal with contradictory ideas and perceptions presented by each partner making up the couples and also understand the relationship in the context of cultural values, norms and the dynamic of power and oppression. In addition to this, the concept of HIV sero-discordance and the frequency of its occurrence are poorly understood in most African communities. Despite the growing evidence of HIV discordance, HIV prevention strategies have largely focused on clinical aspects at the expense of socio-cultural issues that impact on HIV prevention strategies targeted at HIV sero- discordant couples. The study seeks to contribute to the conceptualization and design of intervention programs dealing with sero-discordance. The study is underpinned by the symbolic interactionism theory and was qualitative in design involving 13 HIV discordant couples in heterosexual relationships enrolled in the HIV Preventions Trials Network 052 Study (HPTN 052 Study) being undertaken by the University of Zimbabwe’s department of medicine. The study utilized 2 Focus Group Discussions (FGD) and 10 in-depth interviews (IDI) to collect data. The study’s findings indicate that discordant couples are in fact critical stakeholders in the uptake of all the available HIV prevention strategies. Failure to acknowledge this tenet is self-defeating as evidenced by the perception of viewing condom use within a marriage as humiliating for a woman. The study further noted that practitioners in the HIV prevention domain must guard against over-relying on the scientifically demonstrated efficacy of the strategies. The study recommends that HIV prevention strategies must be socially and culturally acceptable and embedded for them to be more efficacious. / Sociology / M.A. (Social Behaviour Studies in HIV and AIDS)

Background AIDS remains one of the world’s most serious health challenges affecting more females than men. The differences in the spread of Human Immunodeficiency Virus (HIV) among gender groups stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power. It could also be due to the females’ status in society which could be justified by lower economic and decision making ability. Purpose The purpose of this study was to explore and describe the role of gender in the spread of HIV among women of reproductive age in Ethiopia; with the view of developing gender sensitive HIV and AIDS prevention strategies. Methods The study used sequential mixed method with quantitative and qualitative paradigm. During first phase of the study, health facility based descriptive cross-sectional study design was used. Data was collected from 422 respondents using a structured questionnaire. Forty participants were recruited by purposive sampling from representatives working in reproductive health or related fields. Results About 83.2% of respondents reported that sexual intercourse discussion should be initiated by male partners. This showed that majority of respondents were dependent on their male partners in decision-making regarding sexual matters in their relationship. Multiple sexual partners were common among the respondents. One third of the respondents reported to have had intercourse with more than one partner during the past twelve months of the study period. Higher proportion of respondents (61.4%, n=259) had never used condom during sexual intercourse with their partner/s. As a result these risky sexual practices are a potential threat for spread of HIV and AIDS among women. Thus developed guidelines would alleviate the existing problems through implementation of strategies of HIV and AIDS prevention to enhance women’s status at household and different administrative structure level. Conclusion Gender disparities in relation to negotiating sexual relations among the study respondents were found to be still relevant. The culture that has placed men at the helm of leadership in sexual matters is strongly upheld and that includes who recommends use of preventive measures and who regulates when and how to enter into a sexual relationship. Guidelines for gender sensitive prevention strategies if applied appropriately would educate women and men to make decision about what directly affects their health / Health Studies / D. Litt. et Phil. (Health Studies)

This study was an attempt to investigate the influence of socio-cultural factors on HIV prevention strategies among HIV discordant couples in Harare, Zimbabwe. HIV sero-discordance is a scenario whereby one partner is HIV-positive and the other is HIV-negative. HIV sero-discordant couples are a unique and vulnerable population that encounters many peculiar challenges. When dealing with this population, researchers have to deal with contradictory ideas and perceptions presented by each partner making up the couples and also understand the relationship in the context of cultural values, norms and the dynamic of power and oppression. In addition to this, the concept of HIV sero-discordance and the frequency of its occurrence are poorly understood in most African communities. Despite the growing evidence of HIV discordance, HIV prevention strategies have largely focused on clinical aspects at the expense of socio-cultural issues that impact on HIV prevention strategies targeted at HIV sero- discordant couples. The study seeks to contribute to the conceptualization and design of intervention programs dealing with sero-discordance. The study is underpinned by the symbolic interactionism theory and was qualitative in design involving 13 HIV discordant couples in heterosexual relationships enrolled in the HIV Preventions Trials Network 052 Study (HPTN 052 Study) being undertaken by the University of Zimbabwe’s department of medicine. The study utilized 2 Focus Group Discussions (FGD) and 10 in-depth interviews (IDI) to collect data. The study’s findings indicate that discordant couples are in fact critical stakeholders in the uptake of all the available HIV prevention strategies. Failure to acknowledge this tenet is self-defeating as evidenced by the perception of viewing condom use within a marriage as humiliating for a woman. The study further noted that practitioners in the HIV prevention domain must guard against over-relying on the scientifically demonstrated efficacy of the strategies. The study recommends that HIV prevention strategies must be socially and culturally acceptable and embedded for them to be more efficacious. / Sociology / M.A. (Social Behaviour Studies in HIV and AIDS)

Background AIDS remains one of the world’s most serious health challenges affecting more females than men. The differences in the spread of Human Immunodeficiency Virus (HIV) among gender groups stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power. It could also be due to the females’ status in society which could be justified by lower economic and decision making ability. Purpose The purpose of this study was to explore and describe the role of gender in the spread of HIV among women of reproductive age in Ethiopia; with the view of developing gender sensitive HIV and AIDS prevention strategies. Methods The study used sequential mixed method with quantitative and qualitative paradigm. During first phase of the study, health facility based descriptive cross-sectional study design was used. Data was collected from 422 respondents using a structured questionnaire. Forty participants were recruited by purposive sampling from representatives working in reproductive health or related fields. Results About 83.2% of respondents reported that sexual intercourse discussion should be initiated by male partners. This showed that majority of respondents were dependent on their male partners in decision-making regarding sexual matters in their relationship. Multiple sexual partners were common among the respondents. One third of the respondents reported to have had intercourse with more than one partner during the past twelve months of the study period. Higher proportion of respondents (61.4%, n=259) had never used condom during sexual intercourse with their partner/s. As a result these risky sexual practices are a potential threat for spread of HIV and AIDS among women. Thus developed guidelines would alleviate the existing problems through implementation of strategies of HIV and AIDS prevention to enhance women’s status at household and different administrative structure level. Conclusion Gender disparities in relation to negotiating sexual relations among the study respondents were found to be still relevant. The culture that has placed men at the helm of leadership in sexual matters is strongly upheld and that includes who recommends use of preventive measures and who regulates when and how to enter into a sexual relationship. Guidelines for gender sensitive prevention strategies if applied appropriately would educate women and men to make decision about what directly affects their health / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / Intimate Partner Violence (IPV) is a major problem among women of child-bearing age in Uganda. This study explored the IPV experiences of women living in urban slums and their health needs in order to assist in developing strategies to prevent and respond to IPV. This was a cross-sectional explanatory study using a mixed methods approach among women aged 20-45 years in Kabalagala slums, Kampala, Uganda. The quantitative survey data was collected using a structured questionnaire while qualitative data was collected using in-depth interviews. Quantitative data were collected from a random sample of 372 women and qualitative data from a purposive sample of 48 women with IPV experiences. The quantitative data was analysed using STATA (version 11), and the qualitative data was coded and analysed manually into thematic content. The study revealed a high overall lifetime prevalence of IPV. The different IPV forms prevalent in the study population included psychological (99.7%), economic (93%), physical (92%) and sexual (88%). Physical violence in the last one year was 91%. The qualitative findings revealed the manifestations of IPV in this context. Furthermore, the physical and psychological health impacts of IPV included but were not limited to injuries; chronic pain and complications; HIV infection; low self-esteem; stress and fear of death, and loss of relationships. The researcher proposed three strategies to prevent and respond to IPV, namely implementing economic empowerment and poverty reduction programmes for women; strengthening the legal and justice system to respond appropriately to the problem of IPV, and improving the social and institutional support including training of health workers to prevent and respond to IPV. The proposed regulation of substance and alcohol use would also contribute to reducing IPV prevalence and scaling-up the response. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / Intimate Partner Violence (IPV) is a major problem among women of child-bearing age in Uganda. This study explored the IPV experiences of women living in urban slums and their health needs in order to assist in developing strategies to prevent and respond to IPV. This was a cross-sectional explanatory study using a mixed methods approach among women aged 20-45 years in Kabalagala slums, Kampala, Uganda. The quantitative survey data was collected using a structured questionnaire while qualitative data was collected using in-depth interviews. Quantitative data were collected from a random sample of 372 women and qualitative data from a purposive sample of 48 women with IPV experiences. The quantitative data was analysed using STATA (version 11), and the qualitative data was coded and analysed manually into thematic content. The study revealed a high overall lifetime prevalence of IPV. The different IPV forms prevalent in the study population included psychological (99.7%), economic (93%), physical (92%) and sexual (88%). Physical violence in the last one year was 91%. The qualitative findings revealed the manifestations of IPV in this context. Furthermore, the physical and psychological health impacts of IPV included but were not limited to injuries; chronic pain and complications; HIV infection; low self-esteem; stress and fear of death, and loss of relationships. The researcher proposed three strategies to prevent and respond to IPV, namely implementing economic empowerment and poverty reduction programmes for women; strengthening the legal and justice system to respond appropriately to the problem of IPV, and improving the social and institutional support including training of health workers to prevent and respond to IPV. The proposed regulation of substance and alcohol use would also contribute to reducing IPV prevalence and scaling-up the response. / Health Studies / D. Litt. et Phil. (Health Studies)