Introduction: Youth (15-24) have the highest prevalence of sexual transmitted infections (STI) among all the age groups and this has been attributed to high sexual risk behaviour and low condom use in this group. The use of condoms by youth is negotiated through a complex array of personal and social factors. Aim: The aim of this study was to explore the perceptions of Swedish youth on the factors that affect their use of condoms to protect against STI.  Methodology: The data collection was done over a period of 3 months using semi-structured interviews and focus group discussions (FGD) and the collected data was analysed with thematic analysis. Findings: Participants perceived that different factors across intimate social circle, community and access to condoms influence the use of condoms by youth in Sweden. The lack of information from the media, embarrassment as a barrier to obtaining condoms and the influence of parents on condom use were prominent findings. Conclusion: Efforts to improve condom use by youth will benefit from exploring the different factors that inform youth’s perceptions on condom use. Opportunities for improvement identified in this study include the installation of condom vending machines, promoting condom use through the mass media and parents discussing condoms with their children.

D.Litt. et Phil. / The sexual molestation of children is one of the most pressing problems of our times. Considering that as many as one in every four girls, and one in every ten boys are sexually victimized as children, the sexual molestation of children seems to be a common occurrence. Child sexual abuse results in emotional symptoms such as depression, low self esteem, sexual disfunction, impaired health, eating disorders and other emotional disturbances. The vast number of children being subjected to sexual molestation, as well as the cost in terms of human suffering, necessitates studies that focus on determining why certain individuals violate sexual boundaries with children. Mainstream theories and research to date only focus on the conscious functioning of men who sexually molest children. The focus is therefore only on the description of the outward manifestation of symptoms. Research to date does not succeed in describing the mechanisms or processes that culminate in the sexual molestation of children. This study represents a first step in addressing this void in the body of knowledge pertaining to men who sexually molest children. By means of a method of analysis, namely Medical Hypnoanalysis, the subconscious thought patterns of two males, which culminated in the molestation of children, were revealed, described and explained. The problem statement and purpose of the study, namely to reveal, describe and explain the dynamic development and course of the subconscious thought patterns which eventually culminated in the molestation of children, inspired a qualitative multiple case study as a research design. After an in-depth analysis of each individual case, the dynamic development and course of the subconscious thought patterns of the two cases were integrated with each other by means of a cross case analysis. The cross case analysis enabled the researcher to develop detailed explanations, better insight and theories pertaining to the subconscious thought patterns underlying the sexual molestation of children. The cross case analysis was integrated with the theory of Medical Hypnoanalysis to form a general psychological structure consisting of the dynamic development and course of the subconscious thought patterns of men who molest children. The general psychological structure was subsequently integrated with previous literature, which allowed for the development of new theory. This study has found that the absence of love, which was experienced since the prenatal period, and intensified throughout, resulted in the perception of worthlessness. The absence of love led to an insecurity with regards to the self and a feeling of spiritual emptiness, a death-like feeling. Without love a person cannot survive; without love life is just not worthwhile. The subconscious mind is genetically programmed to survive, and is therefore compelled to engineer ways to establish survival. For various reasons, sexual interaction became the proof to the two molesters in this study that they were loved, that they were worthy, and thus alive. Sexual interaction was therefore the way in which survival was established. For both molesters, sexual interaction developed into a compulsion. Their emotional and spiritual survival were threatened whenever they were deprived of sexual interaction. This led to severe anxiety, which was provided by the subconscious mind in order to compel the men to have sexual interaction, and survive. It is this compulsion, together with the fact that both respondents’ emotional development was arrested at an earlier age, which led to the sexual molestation of children. The study was concluded with recommendations to psychologists on how to treat men who molest children.

Student Number : 9813645X - PhD thesis - Faculty of Health Sciences / Epidemiological information on sexually transmitted infections (STIs) is necessary to assess the magnitude of the burden of infections, to identify vulnerable population groups, to mobilise resources for intervention activities and to monitor the impact of these activities. In addition, specific STI surveillance systems, such as studies on the relative prevalence of aetiological agents of STI syndromes and their antimicrobial susceptibility patterns, are aimed at improving patient care. The studies included in this thesis were designed and implemented to improve our understanding of the epidemiology of STIs and HIV infection in southern Africa. In all the study populations, we observed that high level STI epidemics preceded the explosive spread of HIV infection among high-risk individuals. The studies reported here also demonstrate the importance of triangulating data collected from different recommended STI surveillance components, using a tiered surveillance approach. The studies reported here also explored the bidirectional interactions of HIV and STIs. We observed that different STIs have shown different magnitudes of interaction with HIV infection. We found particularly strong interactions between genital herpes and HIV. At the individual level, HIV-seropositive patients with genital herpes were more frequently found to have atypical clinical presentations, delays in spontaneous healing, longer duration of HSV shedding and increased association with HIV shedding from ulcer and genital exudates. Mixed infections involving chancroid and genital herpes were found to be common, particularly in HIV-seropositive patients. The effectiveness of syndromic treatment targeting only bacterial causes of genital ulceration was significantly reduced due to persistent ulcerations as a result of co-infection with genital herpes. The successful treatment of herpes in men and women was found to be associated with a decline or cessation in HIV shedding into ulcer exudates or genital fluid. The studies have also shown that HIV plasma viral load is the main determinant for HIV shedding in both men and women presenting with STIs. As was the case with HSV infection, there was a strong association between HIV and HPV infection in both men and women. A higher prevalence of HPV infection was found among HIV-seropositive patients in our study population and this may reflect the higher frequency of recurrences and/or longer duration of infection (i.e. persistency). The studies also found that the biological false positive reactions in syphilis serology (i.e. RPR) are not a common occurrence in our HIV-seropositive study population. On the other hand, syphilis serology could be falsely negative in patients with PCR-confirmed primary syphilis who are co-infected with HIV and other aetiological agents causing GUD. In conclusion, the findings of our studies have supported the bidirectional nature of interactions between conventional STIs and HIV infection in southern Africa.

Background: South Africa faces an unprecedented problem of rape and violence against women and girls – amongst the highest in the world. While the health and social consequences of sexual assault are detrimental, it is not clear how victims of sexual assault respond to these acts. This study therefore examines the levels of reported sexual assault in South Africa in order to establish the extent of the problem. Methods: This study is a secondary data analysis of the 2011 and 2012 Victims of Crime Survey (VOCS) that was conducted by Statistics South Africa. The outcome variable of this study is post-assault behaviour namely, reporting to the police, other reporting to traditional leaders and Chiefs’ as well as seeking medical attention. This variable is then re-categorised into: no-behaviour, one or more behaviours. Descriptive statistics of the study population, the Goodman Lambda test of predictability that provided a predictive association in terms of percentages between the outcome variable and the selected predictor variables, and multivariate analysis using the Multinomial Logistic Regression producing odds ratios to examine whether an association was present or not were used. Results: According to the current study, the rate of sexual assault for 2011 was 11 women per 1000 women aged 15 years and older compared to 5 women per 1000 women aged 15 years and older in 2012. Associations were found between location of a sexual assault and relationship to perpetrator with whether or not a victim engaged in any post-assault behaviour. Interestingly, race, age, income and province were not found to be significantly associated with whether a victim engaged in any post-assault behaviour. The study found that there is an association between the location of an assault as well as the province the victim originates from and the likelihood that a victim will choose to engage in post-assault services at their disposal. Both province and location of an assault were found to be significantly associated with post-assault behaviours at a multivariate level. Conclusion: The current study has found that the majority of victims (64.96%) did not engage in any post-assault behaviour. Other research has examined why this may be the case and found that the fear of being re-victimized by healthcare workers and the criminal justice system, as well as discriminated against by their communities may be important factors associated with reporting a sexual assault. It is therefore recommended that policy makers re-evaluate how to best promote the reporting of a sexual assault through educating women about the health benefits associated with the services, such as treatment for sexually transmitted illnesses including HIV/AIDS as well as provide medical services to treat victims’ possible post-traumatic disorders, stress and anxiety. Educating and training both police officials as well as healthcare workers on how to treat victims of sexual assault may indeed go a long way in promoting victims to report and seek assistance after an incident.

Abstract: Background: The global estimated adult and child deaths from HIV/AIDS in 2006 were 2.9 million and those living with HIV stood at 39.5 million. Of the HIV deaths, 72% (2.1 million) occurred in Sub-Saharan Africa (SSA). Two thirds (63%) of all adults and children with HIV globally live in, with its epicenter in Southern Africa. One third (32%) of all people with HIV globally live in Southern Africa and 34% of all deaths due to AIDS in 2006 occurred there. In South Africa, a total of 5.5 million people, including 240,000 children younger than 15 years, were living with HIV in 2005. HIV data gathered in the country’s antenatal clinic surveillance system suggest that HIV prevalence has not yet reached a plateau. There is a continuing trend nationally in HIV infection levels among pregnant women attending public antenatal clinics: from 22.4% in 1999 to 30.2% in 2005 (a 35% increase). Aim: The aim of this study was to assess sexual practices, the prevalence of condom usage and sexually transmitted diseases, and their associations among 930 men and women aged 15-60 years in Orange farm South Africa. Objectives: 1. To determine condom usage among males and females aged 15–60 year old. 2. To determine the number of new partners, short-term partners and unprotected sexual acts in this particular age group of men and women. 3. To assess the prevalence of sexually transmitted diseases in this age group. 4. To assess the relationship between sexual practices and sexually transmitted diseases in this community. Methods: The project was a secondary data analysis of a population-based, cross-sectional study was conducted in Orange Farm, South Africa in 2002. The original study involved 930 men and women respondents. A two-stage random sampling technique was used to select households. A self-weighting random sample of twenty households was chosen from clusters of 15 households. All men and women aged 15 to 60 years, who slept in the selected households the night before the study team’s visit, were eligible for inclusion in the study. The main focus of this secondary study was to analyze the baseline data collected for the level and risk factors for sexually transmitted diseases in this age group. All 930 men and women were included in the analysis. Results: The risk factor under consideration viz: condom usage was not optimal, and the prevalence of sexually transmitted disease is high in this population with HIV prevalence at 21.8%. Women in the age-group 15-24 years were disproportionately more affected by HIV in this community as compared to men. Among the HIV positive respondents, 61.8% had at least single or over 2 non-spousal partners in the last year. At the time of the interviews, 34.7% had never used condoms and 84.3% did not use condoms in any of the sexual episodes of the last month. Conclusion: An important goal is to practice partner reduction and to encourage especially those who are single to use condoms consistently. Further qualitative research on sexual behaviours involving focus group discussions, in-depth interviews or participant observation should be conducted in this community to complement the quantitative methods. They produce results that directly represent how people feel and provide information on behaviour through the observation of events and activities.

MSc (Med), Epidemiology and Biostatistics, University of the Witwatersrand / Introduction This secondary data analysis of a prospective cohort study set out to describe the association between the use of hormonal contraception and sexually transmitted infection (STI) acquisition in a cohort of 752 HIV negative women who were followed up for a year. Methods Outcome variables were measured by standard laboratory tests (PCR for Chlamydia trachomatis (CT) and Neiserria gonorrhoea (NG), culture for Trichomonas vaginalis (TV) and gram stain with Nugent score for Bacterial Vaginosis (BV). Exposure variable information was collected by structured interview. Basic descriptive statistics were applied to describe the characteristics of the cohort, including a comparison of women who used contraception and those who did not. A time series analysis including incidence rates for the outcomes (CT, NG, TV and BV), Kaplan Meier curves for time to event measurement and Cox regression models (univariate and multivariate), for the estimation of risk were applied. Results The analysis found no significant difference between women who use hormonal contraception and those who did not with respect to baseline demographic characteristics. Incidence rates per 100 women years to follow up with 95% confidence intervals were: CT 13 (7 to 17), NG 2 (1 to 4), TV 6 (4 to10), BV 72 (63 to 83). Kaplan Meier curves showed no significant difference in time to event between women who used contraception and those who did not. Adjusted hazard ratios for women who used contraception was 1.12 (0.69 to1.82) for CT, 0.47 (0.17 to 1.30) for NG, 1.06 (0.48 to 2.34) for TV and 0.27 (0.05 to 1.52) for BV. Conclusion This analysis did not reveal any significant associations between the use of hormonal contraception and the acquisition of STIs, however the trends in risks follow those reported in the literature.

Thesis (M.Pharm.)--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Sexually transmitted infections (STIs) are a global concern and more specifically southern Africa has seen a tremendous upsurge in infection rates. KwaZulu-Natal is the province found to have the highest Human Immunodeficiency Virus and STI infection rates. From an ethnobotanical study conducted specifically in northern Maputaland (Mabibi, Tshongwe, Mseleni and Mbazwana), it was found that the lay people most often used plants in various combinations for the treatment of STI related symptoms. The use of these plant combinations were thus antimicrobially investigated and the toxicity properties determined. The dichloromethane: methanol (organic) and aqueous extracts were prepared for each plant in situ using collected ground dried plant material. The plants (individually and in combination) were investigated for toxic potential using the 3-[4,5-dimethyl-2-thiazol-yl]-2,5-diphenyl-2H-tetrazolium bromide (MTT) cellular viability assay on the human kidney epithelial (Graham) cell line. The antimicrobial activities for each sample, as well as for each combination, were then further investigated using the minimum inhibitory concentration (MIC) assay. The six STI pathogens investigated in this study were Candida albicans (ATCC 10321), Ureaplasma urealyticum (clinical strain), Oligella ureolytica (ATCC 43534), Gardnerella vaginalis (ATCC 14018), Trichomonas vaginalis (clinical strain) and Neisseria gonnorhoeae (ATCC 19424).

sami.alcedo@gmail.com / Background Millions of travellers around the world have gathered together into online communities. The objective is to analyse the factors associated with risky sexual behaviour among travellers. Methods Cross-sectional study was conducted within an online community of travellers using an online survey; we included travellers who had engaged in sexual activity while on their last trip. Risky sexual behaviour was defined as inconsistent condom use (<100%), and the factors associated were evaluated using the prevalence ratio (PR). Results Of the 468 participants, 245 had sex during their last trip. 59.7% did not consistently use condoms, and one out of every four participants reported never using condoms. Having a travel destination of Latin America or the Caribbean was significantly associated with inconsistent condom use. This association was maintained (PR 1.37, CI 95% 1.06–1.77) after adjusting for gender, age, migration, the presence of travel partners, and the use of drugs and alcohol prior to sexual activity. Conclusion An association was observed between travel destination (specifically Latin America or the Caribbean) and risky sexual behaviour. For this reason, tourists should be educated in STI transmission and regional STI and HIV incidences both before and during their travels; public health systems ought to work together with travel agencies, international airports, etc., in order to distribute this information and ensure a responsible travel experience. / Revisión por pares

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As the first exploratory qualitative study on child sexual abuse in the People's Republic of China, this study adopted system-individual-culture-gender-resilience perspectives under social constructionism approach using the family as the unit of study, and extended the research parameters beyond the individual child to other systems. The data was collected through ethnography, family and couple interviews, individual interviews with parents and the abused children, participant and part-participant observation by this researcher in a village in north-eastern China. Six families were selected for the study, each with a 10-year-old daughter who had been sexually abused by the same male teacher for two years, with the said teacher engaging in molestation, masturbation, oral sex, intercourse, etc. on the girls, two of whom were also known to have been physically abused. The researcher conducted the field study between eight and thirteen months after the disclosure (over a six-month period), and sought to understand the family experiences from seven aspects: the disclosure process, the family coping, traumatic experiences (including the abused and their family), the family relational process, the reactions from extra-familial systems, the healing process for the abused, and the need for professional support. / Results indicated that while the entire family was traumatically impacted, there were significant differences in reactions from male and female parents. In responding to "one of their own" being sexually exploited by an outsider, parents made concerted efforts in facing external ramifications, often at the expense of marginalizing the abused daughter and adding an extra burden on the whole family in healing from the trauma. Furthermore, parents were observed to become more protective in the process, providing physical care and material needs, and refraining from mentioning the trauma before the abused. As for emotional support, families varied in their coping at different stages in time. At the initial stage, parents seemed to be overshadowed by shame towards their daughter's loss of chastity. As time went by, they resumed their parenting routine, until eventually the adult-, sibling- and extended family relations constituted a circular impact that would in turn impact on the parent-child relations. The external systems, the family relational reality before disclosure, as well as family financial conditions combined could either facilitate or hinder the family system in seeking change. / The study further analyzed the systems and cultural mechanisms vis-a-vis the traumatic experience and family support, seeking to de-construct the chastity myth in the Chinese rural culture, as well as expert discourses in mainstream western research that focused on a psycho-pathological approach to study trauma. It further challenged the cultural practice of attributing blame to the individuals and their family, and provided recommendations to address the above-mentioned issues. / Western studies on the sexual abuse of children and the resulting trauma on the abused and their families have adopted primarily a psycho-pathological perspective. This has led to the tendency of blaming the victim, the mother and the family. Until now, comparative studies on this subject have not been carried out in a Chinese context. / 龍迪. / 論文(哲學博士)--香港中文大學, 2005. / 參考文獻(p. 464-487). / Adviser: Joyce Ma. / Source: Dissertation Abstracts International, Volume: 67-07, Section: A, page: 2753. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in English. / School code: 1307. / Lun wen (Zhe xue bo shi)--Xianggang Zhong wen da xue, 2005. / Can kao wen xian (p. 464-487). / Long Di.