Objective: Criminal liability for the sexual-transmission of HIV raises complex questions for both clinicians and service-users regarding their responsibilities and legal obligations to disclose information to others. This is the first research study to address the impact of these issues upon everyday clinical and professional management in the UK. The prevalence and incidence of clinical and HIV-legal issues reported by the 107 psychologists sampled are reported. Design: A cross-sectional approach comprising two components was utilised: Firstly, questionnaire survey (Response rate 22%) scoping the experiences of practice issues among psychologists from sexual-health and generic settings. Attitudes towards HIV-prosecutions and various measures of professional self-efficacy were also collected. Secondly, three focus groups (N=15) exploring the impact of practice issues upon clinicians’ likely confidentiality breaking behaviours. Methods: Clinical and legal issues are presented. Further statistical analyses explored the interaction of various demographic, clinical and attitudinal variables upon clinician’s perceived self-efficacy. Focus Group transcripts analysed using Thematic Analysis (Data-driven approach) with eight emergent themes. Results: Although no direct involvements in police investigations reported, two instances of psychology notes being subpoenaed plus multiple ‘near miss’ clinical experiences described. High proportions of sexual-health psychologists experienced HIV-clients disclosing problematic behaviours, including intentional transmission (9%; N=5) and/or ‘reckless’ behaviour (72%). Focus groups expressed high levels of anxiety regarding these scenarios associated to multiple influences (interpersonal, clinician, professional and service factors). Quantitative and qualitative results were triangulated to provide a detailed analysis of how psychologists manage the clinical impact of the issues. Conclusions: Psychologists broadly supported HIV-prosecutions for intentional transmission (81%) but only limited support around ‘reckless’ cases (44%), particularly among those sexual-health experienced. Those ‘critical’ attempted to mitigate the impact of legal issues by proactively raising awareness among HIV-clients and resisting overly-defensive service changes; whereas those ‘less-critical’ were more accepting. Clinical, training and therapeutic implications are briefly considered.

The study has two separate but related aims, which are to explore the social and health experiences of men who are in polygynous relationships and to develop holistic health and social strategies to support men who are in polygynous relationships. Objectives of the study were to identify the different permutations of polygynous relationships that related to health and social issues; to clarify the social status of men who are in polygynous relationship; to explore and describe the health experiences of men in polygynous relationship; to explore and describe the social experiences of men in polygynous relationship; to explore the spiritual experiences of men who are in a polygynous relationship; to describe and to generate holistic strategies to support men who are in a polygynous relationships. Method: In this study, the researcher used descriptive and interpretive phenomenological processes to develop a range of holistic strategies to support men who were in polygynous relationships. The researcher described the experiences and developed interpretations based on the lived experiences that the men reported. Findings: Polygyny remains the reality within the Bapedi tribe in Sekhukhune area. The practice of polygyny is not only for the affluent as indicated in most literature but is also practiced as a corrective strategy for families who are experiencing marital problems. Polygyny is not viewed as abusive to the women and children but rather beneficial to the women. It helps to reduce the risks of the development of cervical cancer that is predisposed by frequency of sexual intercourse. Polygyny promotes the morals within the communities, as children grow up within the two parents’ environment as opposed to the rising numbers of single parent families. Polygyny practice in the Sekhukhune areas is a voluntary choice and not a forced marital arrangement. Conclusions and recommendations: The researcher recommended policy guidance to support health practitioners with strategies to assist members of polygynous families in need of help. The policy also guides employers to recognise and to register the second or third wife as beneficiaries of the working husband. / Health Studies / D. Litt. et Phil. (Health Studies)

Introduction:Rwanda is one of the countries in Sub-Saharan Africa with the most remarkable health achievements. However, Rwanda is still one of the countries with a high unmet need (34%) and high prevalence of unintended pregnancies. Objective: To examine the association between literacy and unmet need for contraception among women in reproductive age in Rwanda. Research design and methods: A cross-sectional study based on secondary data, derived from the Demographic and Health Survey (DHS) program. The study population was women in reproductive age (15- 49 years old) who lived in Rwanda. It included 13217 females out of the 13497 after the exclusion of females who are not residents of Rwanda, who are blind or visually impaired and who are need language card. The methodology involved cross tabulations, bivariate and multivariate logistic analyses. Results: There was a significant bivariate association between literacy and unmet need for contraception (OR=1.28; 95% CI 1.17-1.40; p < .001), in which literate females where more likely to have an unmet need for contraception. There was no association between literacy and unmet need when controlling other factors. Others factors such as age, current marital status and province had a strong impact on the unmet need for contraception in the adjusted analysis. Conclusions: Literacy may be associated with the outcome, however, socio-economic factors have a stronger influence on the dependent variable. Regulations, policies and other features such as socio-cultural norms may differ from country to country, therefore it is important to consider the current situation of each country.

Vietnam is a populous nation experiencing rapid social and economic transition. These changes, in combination with the spread of sexually transmitted infections such as HIV/AIDS, are compromising the reproductive health of young Vietnamese. Access to reliable reproductive health information is limited and social taboos prevent young people from talking openly about this topic. A huge number of young people living in Vietnam thus find themselves without access to relevant, accurate, non-threatening and unbiased information about sexuality and sexual health. The research outlined in this thesis approaches the issue of sexual health information provision for young people living in Vietnam from a participatory action research foundation. A key focus is investigation of the ways in which young people living in Vietnam can be included in the development of online sexual health communication tools by, for and about young Vietnamese. As part of this investigation, this thesis describes research conducted with young Vietnamese in Australia and Vietnam to identify and elucidate their reproductive health information needs, as situated within the contemporary Vietnamese socio-cultural context. The research was undertaken in order to determine how an online resource might meet these needs. This exploratory process involved the utilisation of a range of research methods to determine the website's optimal content, style, features and tone in relation to the Vietnamese context and requirements of its target users. It is hoped that the record of discovery resulting from this research journey will contribute to the existing body of knowledge on online health communication and participatory approaches to the development of context-sensitive health and behaviour-change communication.

Vietnam is a populous nation experiencing rapid social and economic transition. These changes, in combination with the spread of sexually transmitted infections such as HIV/AIDS, are compromising the reproductive health of young Vietnamese. Access to reliable reproductive health information is limited and social taboos prevent young people from talking openly about this topic. A huge number of young people living in Vietnam thus find themselves without access to relevant, accurate, non-threatening and unbiased information about sexuality and sexual health. The research outlined in this thesis approaches the issue of sexual health information provision for young people living in Vietnam from a participatory action research foundation. A key focus is investigation of the ways in which young people living in Vietnam can be included in the development of online sexual health communication tools by, for and about young Vietnamese. As part of this investigation, this thesis describes research conducted with young Vietnamese in Australia and Vietnam to identify and elucidate their reproductive health information needs, as situated within the contemporary Vietnamese socio-cultural context. The research was undertaken in order to determine how an online resource might meet these needs. This exploratory process involved the utilisation of a range of research methods to determine the website's optimal content, style, features and tone in relation to the Vietnamese context and requirements of its target users. It is hoped that the record of discovery resulting from this research journey will contribute to the existing body of knowledge on online health communication and participatory approaches to the development of context-sensitive health and behaviour-change communication.

Worldwide, the Human Immunodeficiency Virus (HIV) pandemic has proven to be a health care challenge from the perspective of testing and treatment, including how to create sustainable positive prevention, prevention after becoming HIV positive, that is culturally relevant and gender sensitive. South Africa has been severely affected by the HIV and AIDS epidemic and the agricultural sector is no exception. This statement is supported by the findings of the International Organisation for Migration (IOM) study. According to an IOM study, the HIV prevalence rate among farm workers in the country is about 40%, the highest ever recorded in Southern Africa. A study conducted in Limpopo and Mpumalanga farms revealed that the prevalence of the twenty-three farms was 39, 5% which is twice the UNAIDS (Joint United Nations Programme on HIV and AIDS) national prevalence percentage of 18, 1% in South Africa. The researchers of this study could not pin-point a single factor causing this high rate of HIV infection on these farms. A multitude of factors, such as multiple and concurrent partnerships, transactional sex, irregular condom use, presence of sexually transmitted infections and sexual violence. The research also showed that almost half of the women working on farms around these provinces are HIV positive, compared to only a third of the male workforce. Purpose: The purpose of this study was to explore and describe the role of culture and gender in the spread of HIV and AIDS among farm workers in South Africa; with the view of developing culture and gender sensitive HIV and AIDS prevention strategies. descriptive and explorative qualitative approach was adopted. In depth individual semi-structured interviews were used to explore and describe the role of culture and gender in the spread of HIV and AIDS among farm workers. Purposive and convenient sampling methods were used to select participants who met the inclusion criteria in the Tshitwani and Barota farming community in the Vhembe District, Limpopo Province, South Africa. Religious and cultural beliefs were believed to be fuelling the spread of HIV among farm workers. Multiple sexual partners and inconsistent condom usage was common among participants. It was evident that stigma and social isolation leading to non- disclosure had adverse repercussions as some participants stated that they would spread HIV intentionally. Powerlessness and lack of decision-making by female farm workers was common as they were dependent on their male partners to make decisions regarding sexual matters in their relationship. Conclusion: More HIV prevention programmes tailored to dispel fears about stigma and correct myths about HIV-transmission should reach ordinary men and women in order to curb the spread of HIV among farm workers. The researcher believes that the strategies that emanate from this study would be applied in other settings other than the farming community. / Health Studies / D. Litt. et Phil. (Health Studies)

This study investigated the social factors influencing the poor uptake of HIV Testing and Counselling (HCT) services by middle-aged black men in Pimville, Soweto. A qualitative research approach was used for this study in which ten men and two key informants were interviewed. Themes explored were the participants’ biographical characteristics, knowledge of HIV and AIDS, health-seeking behaviours, understanding of multiple sexual partnerships, male circumcision, and challenges in using HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors are major reasons for the poor HCT uptake. Despite the men’s high HIV risk perceptions, behaviour change lags behind. Greater efforts to establish a men’s forum to discuss sexual health matters in Pimville are recommended. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

This quantitative descriptive cross sectional study explored factors influencing sexual risk behaviours among youths in senior secondary schools in Ethiopia. Data were collected using structured questionnaires. Religious attachment, living with friends, living alone, parental control, level of parental education, peer pressure and number of friends who had experienced sex were some of the factors noted to influence youths to engage in sexual risk behaviours. The findings of this study have implications for both practice and policy development. They will enable healthcare workers to identify youths at risk of engaging in sexual risk behaviours and subsequently motivate them using health promotion strategies to engage in safe sexual practices. Adopting such an approach will prevent or at least minimise risk of youths being infected with sexually transmitted diseases, such as HIV/AIDS. / Health Studies / M.A. (Health Studies)

Since 2015, the Swedish government has invested more money in the post-partum care to make it more accessible. The number of Swedish qualitative studies, which highlight women's experiences of sexological support after childbirth since 2015, is limited. This means that we do not know how adequate the government's investments have been in terms of patients' access to sexological support after childbirth. The purpose of the study is to gain an increased understanding of what sexological support, from healthcare, people feel they need after childbirth. The author has conducted ten qualitative semi-structured interviews with respondents who had a vaginal birth in the last two years. Analyzed through Merleau-Ponty's (1945/2006) and Ahmed's (2014) phenomenological theories the results show that the respondents' sexual health was affected by the interaction of the changes in their physical body and life situation. These aspects were also influenced by their partner and the post-partum care. During the follow-up, several respondents felt that their midwife focused too much on their physical body instead of changes related to their sexual health. Participants expressed a need for more information and confirmation regarding the physical, psychological, and social changes that affected their sexual health. The participants also wished to have more sexological support for their partner. This result indicates that the government's investment in the post-partum care has not been sufficient in terms of sexual health after childbirth, which means that parts of this care remain unavailable. Key words: childbirth, partner, post-partum, postnatal care, sexual health, sexual function, sexual satisfaction, sexological support.

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