This dissertation had three primary aims. The first aim was to systematically review evidence documenting incidence of sexually transmitted infections (STI) during pregnancy. Eighteen papers were included in the final review which reported incidence of five STIs: chlamydia, gonorrhea, human papillomavirus (HPV), herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus (HIV). The review found that there are very limited data on incidence of STIs during pregnancy and even fewer data comparing risk between pregnant and non-pregnant women. Although data are limited, studies suggest that women continue to acquire STIs during pregnancy, with incidence varying by type of infection, population of interest and geographic setting. Highest incidence was found for HPV and chlamydia although some studies of chlamydia showed low proportions of pregnant women infected. Studies in which partners were known to be infected with HSV-2 and HIV showed higher rates of acquisition in pregnant women compared to studies where partner status was not known. The second aim of this dissertation was to describe the impact of pregnancy on behavioral risk factors and vaginal practices that are associated with increased risk of STI acquisition. Data for this and the following aim came from the Methods for Improving Reproductive Health in Africa (MIRA) study, a randomized clinical trial conducted in South Africa and Zimbabwe 2003-2006. The analysis for the second aim included women in the MIRA trial who had a pregnancy during follow-up. Pregnancy was found to decrease sexual activity, particularly in the third trimester, but women were more likely to report sex without condoms while pregnant. There were lower reports by women during pregnancy of other risk factors for STI acquisition, including anal sex, concurrent sexual relationships and new sex partners. Vaginal wiping and insertion of material into the vagina, potentially important mechanisms for STI acquisition, were also less common during pregnancy. The data from this aim present a complicated picture of risk for STIs during pregnancy as a result of increased unprotected sex but decreased frequency of other known behavioral risk factors. The third and final aim of the dissertation was to measure incidence of four STIs in pregnant and non-pregnant women and to evaluate whether women are at greater risk during pregnancy for acquiring four STIs: chlamydia, gonorrhea, trichomoniasis and HIV. This analysis included 4,549 women 18-50 years of age, 17% (N=766) of whom had a pregnancy during follow-up. In general, women continued to be sexually active but reported less overall sex than non-pregnant women. Report of condom use was lower during pregnancy as were other types of high risk sexual behaviors, such as multiple sexual partners, sex in exchange for drugs or money and anal sex, as well vaginal practices. STI incidence was measured during pregnancy and it was found that women continued to acquire STIs when pregnant. In addition, during periods when women became pregnant, they appeared to be a high risk for acquiring chlamydia, trichomoniasis and HIV. Finally, in examining the association between pregnancy status and STI risk, we found that in multivariable models adjusted for demographic and time-varying self-reported behavioral risk factors and vaginal practices, pregnancy was not associated with increased STI risk. However in visit intervals when women became pregnant, they appeared to be at higher risk for contracting chlamydia compared to non-pregnant periods.

Purpose To evaluate the impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal. Objectives The objectives of the study were to determine knowledge, attitudes, beliefs, perceptions and practices of secondary school learners regarding sexually transmitted infections at baseline and post-exposure to Laduma; assess intended behaviour change regarding sexually transmitted infections and condom use as well as the awareness of skills to achieve such behaviour; assess learners' perceived vulnerability to sexually transmitted infections; assess comprehension, acceptability and appeal of the photonovella among learners and to assess whether learners can identify with the characters and situations in the photo-novella. Design This was an experimental study design. Setting Nineteen randomly selected secondary schools in the Midlands district of KwaZulu-Natal. Subjects Grade 11 learners, n = 1168, from randomly selected schools that were further randomised into intervention and control groups. Outcome Measures The learners had to complete three sets of questionnaires that elicited information about their biographical profile, knowledge, attitudes, beliefs, perceptions and practices regarding sexually transmitted infections, intention to change their behaviour with regard to sexually transmitted infections and condom use, as well as their skills to achieve such behaviour, their perceived vulnerability to sexually transmitted infections and their perceptions of Laduma. All of these outcomes were assessed at baseline (Tl), following the learners' exposure to Laduma (T2, three weeks after the baseline), as well as six weeks later (T3) in the case of the intervention group. With respect to the control group they had to answer the baseline questionnaire on all three occasions. Results The mean age of the respondents was 16.8 years with almost two thirds of the learners being between the ages of 15 - 18 years. Seventy percent were primarily Zulu speaking. Learners reported feeling personally scared of getting a sexually transmitted infection with 17.8% responding that they thought they could get a sexually transmitted infection in the next two years. There was a significant gender difference between male and female learners in their topics of communication to friends, parents and partners regarding HIV/AIDS, condom use, having sex or not having sex (p < 0.01). Although learners had adequate knowledge about the spread of sexually transmitted infections at baseline, the mean scores for the spread for the group exposed to Laduma differed significantly from the mean scores of the control group, both immediately after the intervention (p < 0.01) and six weeks thereafter (p < 0.001). Learners in the intervention group responded more positively towards condom use at time 2 (T2) than the control group and maintained this change six weeks later. Sexual activity and condom use at time 3 (T3) was not influenced by the intervention but was significantly predicted by past sexual activity (p< 0.001) and past condom use (p < 0.001) respectively. At time 3 (T3) significantly more learners in the intervention group intended to have sex with a condom (65.1 %) compared to the control group (52.3%, p < 0.05). Overall learners had a positive response to Laduma and appreciated it as a health education intervention. Conclusion and Recommendation The findings of this study provided important information about adolescent sexuality on a range of outcomes related to knowledge, attitudes and sexual behaviour. The findings also provided information on learners' gender differences about what they communicate and to whom, as well as their sexual behaviour. After a single reading of Laduma learners showed an increase in knowledge about the spread of sexually transmitted infections, a change in their attitude to condom use as well as an increased intention to practice safer sex. Laduma did not influence communication about sexually transmitted infections, sexual behaviour nor condom use. These are complex behaviours and indicate that interventions focussing on preventive sexual behaviour need to move beyond awareness and information dissemination towards being more intensive and skills focussed. Such interventions need to address the gaps between knowledge and practice and be facilitated in a context that supports such implementation. The specific recommendations made from the findings of this study therefore include, the development of a systematic health promotion programme that addresses the issues related to personal vulnerability, knowledge related to treatment of and protection against sexually transmitted infections as well as skills that promote safer sexual choice. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2005.

Thesis (Ph.D.) -- University of Adelaide, Dept. of History, 2001. / Includes bibliographical references (leaves 280-305).

The overall aim of this study was to evaluate quality of STI services in Umjindi local municipality. A concrete objective was to investigate the health system issues that may have a negative impact in the provision of quality STI service in the local municipality. These include accessibility of the STI services to the community, training of health workers in syndromic management, availability of necessary equipment and supplies for STI management, turn-around time for blood results and infrastructure of the facilities.

The overall aim of this study was to evaluate quality of STI services in Umjindi local municipality. A concrete objective was to investigate the health system issues that may have a negative impact in the provision of quality STI service in the local municipality. These include accessibility of the STI services to the community, training of health workers in syndromic management, availability of necessary equipment and supplies for STI management, turn-around time for blood results and infrastructure of the facilities.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Eighty-nine single, sexually active, heterosexual college students (ages 17-24) participated in one of two intervention conditions. Experimental groups were taught skills specific to condom use and sexual communication via a multimedia presentation. Control groups viewed a video on an unrelated topic. Individuals in the experimental conditions were expected to show higher levels of self-efficacy, greater knowledge concerning diseases, and improved attitudes about condoms immediately following the intervention. They were also expected to report safer sexual practices at the one month follow-up. Findings reveal that improved attitude and knowledge scores did not translate into behavioral changes.

Wang, Zixin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 215-223). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese.

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Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.