Magister Public Health - MPH / Background: The HIV / AIDS pandemic have been characterized as the greatest natural challenge ever to confront humanity and one of the great moral causes of our time (World Bank, 2007). Although, the HIV and AIDS pandemic is a global problem, some regions of the world, notably sub-Saharan Africa are hardly hit by the pandemic. Namibia is one of the sub-Saharan African countries which are badly affected by the HIV and AIDS pandemic. It is estimated that about 360 000 Namibians were infected with HIV by 2010. This translates to a national HIV prevalence of (18.8%). The National HIV and AIDS Response Department has designed various interventions and strategies to curb the spread of the HIV. Promotion of male condoms promotion is one of the key strategies being advocated. If used consistently and correctly, male condoms are regarded as an effective preventive tool of HIV transmission. However, changing individual’s sexual behaviors and lifestyle to make condom use part of their sexual life seems to be the challenge. In Namibia most of the research in the area of HIV and AIDS were done among the youth and population aged between 15 – 49 years. Hence, this study looks at older men as a neglected population. Aim: The aim of the current study was to assess knowledge, attitudes and practices of condom use among male employees age 50 (fifty) years and older at a mining company in Southern Namibia. Methodology: A descriptive, cross-sectional survey utilizing quantitative research approach was applied. Data was collected through face-to-face interviewing male employees, age fifty years and older, while at work at the Mine Area 1 (MA1). Data was captured in excel and imported into SPSS version 16.0. Chi-square test was used to determine the association between KAP variables and the socio-demographic characteristics of the respondents. The level of statistical significance was set at 0.05. Results: Among 105 respondents (males, mean age 54.5 years), more than half lived in the singe sex male hostels. Knowledge about condom use was good but there remained a significant number of the respondents whose knowledge was insufficient. A high percentage of the respondents suggested that HIV positive individuals should always use condom every time they have sexual intercourse. Conclusion: This study showed that respondents are not at a high risk of contracting HIV infection due to lack of knowledge on condom use though some of them possessed insufficient knowledge. Thus, to minimize the likelihood of HIV infection targeted interventions including peer education programmes were suggested, and working with the community in the area. Moreover, a more comprehensive knowledge attitude and practice study among mine employees from various sections of the mine would be beneficial to identify the level of risk within the total employee population.

Master of Public Health - MPH / The notification and treatment of sexual partner(s) is a key element in the prevention and control of sexually transmitted infections (STIs). Partner notification interrupts the chain of STI transmission, prevents STI complications and long-term sequelae in the sexual partner(s), and also prevents re-infection of the treated index patient. Partner notification is a recognized component of the syndromic management of STIs in Namibia and yet the partner notification rates in the country remain low - as low as 7% in the district of Windhoek currently. In this district, which has the highest number of STIs cases in Namibia, the specific factors that hinder partner notification have not yet been documented. This study sought to investigate the perceived and experienced barriers to partner notification amongst STI patients attending an urban primary health center in the district. An explorative, qualitative study with eight patients (four males and four females), aged 16 years and over, who presented with a new/recurrent episode or a STI follow up was conducted. The participants were purposively selected with the aid of the deputy nurse in charge of the health center after agreeing to take part in the study. The patients were asked about what they felt were personal, partner-relationship and health services related factors that hindered partner notification. Three health workers working at the health center served as key informants and were asked about barriers to partner notification based on their experience of delivering preventative and curative STI - related services over the past three or more years. Interviews with both patients and key informants were conducted in the health facility, recorded and later transcribed. Content analysis of the transcribed data was conducted to identify recurring themes across the different interviews. The results of the study suggest that the partner notification strategy was not functioning optimally as a result of a number of inter-twined factors. The factors can be categorized into personal barriers, partner-relationship dynamics and health services related barriers. The study found that participants considered there were barriers to partner notification across all these three categories. Commonly reported barriers included the stigma associated with STIs and the cultural and religious norms that do not promote discussion of topics related to sex and sexuality in general. Other barriers such as gender inequality, the fear of a partner's reaction to the notification, feelings of guilt associated with infidelity, the lack of communication between partners and the inability to locate partner(s) were highlighted by participants. Barriers associated with the health services included the lack of health education about the importance of partner notification, the absence of thorough risk reduction counseling, the current method of partner notification that is being utilized and the negative attitudes of health workers. It is suggested that having a greater understanding of these barriers and how to work with them in a health education or counseling sessions will allow health workers to address them more directly with their patients and in turn, hopefully improve the management and outcomes of partner notification strategies in the STI prevention and control program in the Windhoek district and potentially other districts in Namibia.

Increased awareness of protection against infections such as Hepatitis Band Human Immune-deficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) and other sexually transmitted diseases has led to an increase in the demand for latex gloves and condoms leading to an increase in latex allergy. Besides latex, condoms also contain several undisclosed chemicals including antioxidants, accelerators, emulsifiers, stabilizers, lubricants, and in some cases flavourings and colourants. Though extensive testing is done to evaluate the physical quality of condoms, little information is available regarding the biological safety of condoms. In this study a modification of the direct cell culture testing method that is specified by the American Test Method F813-83 of 1998 was used to determine the cytotoxicity of the surface material of latex condoms prepared at time intervals that represents normal physiological exposure times T2, T4 and T8. The L929 cells were exposed to medium containing increasing amounts of condom washings (0-66%) for 20 hours. After exposure cell number and viability was determined using the Crystal violet (CV) and 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-3H-tetrazolium bromide (MTI) assays respectively. Data was evaluated using a split-plot design with the appropriate Analysis of Variance (ANOVA). The effect of the condom washings on cell morphology and CV staining, MTI metabolism and Neutral red (NR) uptake at a fixed condom washing (16%) and exposure time T8 was evaluated microscopically. Cell membrane integrity was evaluated by Propidium iodide (PI) uptake and with PI staining after fixation and Hoechst 33324 (H33342) staining nuclear structure was evaluated with fluorescence microscopy. Apoptosis induced DNA fragmentation was evaluated by agarose gel electrophoresis. The effects of condom washings at 16% condom washing and exposure times T2, T4 and T8 was further evaluated in the HeLa cell line, a cell line in origin and type closer to that of the cervical lining. Cytotoxicity was evaluated using the CV, MTT and NR assays. In the L929 cell line, condom types Non-lubricated condoms (NLC), Lubricated condoms (LC) and Lubricated and flavoured condoms (LFC) behaved differently over time of exposure and the concentrations of condom washings. LFC were found to induce a decrease in cell number compared to other condom types, followed by LC and NLC revealed increases in cell number. Split-plot analysis, revealed that condom type x time (CT x Time) is significantly different due to the effect observed at T2 for LC. The MTT usually considered being more sensitive than the CV assay showed only toxicity for LFC and not for NLC and LC as with the CV assay. Exposure to LFC revealed significant decrease of 70 % decrease in cell viability at T8. Condom washings, LC, LFC and LFCC had no effect on cell morphology following CV staining. MTT metabolism and NR uptake was reduced and altered cell morphology was observed for L929 cells exposed to LFC and LFCC. Little PI uptake was observed for all cells exposed to condom washings. Condensed nuclei were observed for L929 cells exposed to LFC and LFCC while Hoechst staining revealed peripheral arrangement of DNA with Hoechst 33342 staining. Cell death in L929 cells were found to be mediated by apoptosis with L929 exposed to LFC showing the most damage. All effects of LFC is greater than that observed for LFCC indicating that other factors rather than the number of components present in each type of condom may account for toxicity. Toxicity of condom washings were compared to that found in the L929 cell line using the CV and MTT assays and an additional bioassay the NR assay was included. Condom types, LC, LFC and LFCC had a significant effect on cell viability and lysosomal membrane integrity. Differences observed between the L929 and HeLa cells were due to the increased viability observed for LC and the decrease in membrane integrity for LFC on HeLa cells. With LC and LFC no decrease in cell number and viability was observed as previously reported for the L929 cell line. Although no decreased in cell viability is observed for LFC a decrease of 75% in lysosomal membrane integrity is observed. The increase in cell viability found for HeLa exposed to LC (although statistically not significant) cannot be explained. Changes in cell viability and membrane integrity was only observed for HeLa cells, indicating that the HeLa cell line is more sensitive to the cytotoxic effects of condom washings. Furthermore the NR assay is a more sensitive assay than the MTT assay in detecting the cytotoxic effects of LFC condom washings at low concentrations. These are assays address only the effects of short-term exposure and not possible genotoxic effects that may occur following repeated and long-term exposure as reported in other latex products. / Dissertation (MSc (Anatomy))--University of Pretoria, 2006. / Anatomy / unrestricted

Background: Street-involved youth are known to be at a greatly increased risk of HIV and sexually transmitted infections (STIs); however, the role that environmental and structural factors play in driving disease transmission risk among this population has not been thoroughly examined. Methods: The At Risk Youth Study (ARYS) is a prospective cohort of homeless and street-involved youth between the ages of 14 and 26. From September 2005 to October 2006, participants completed a baseline questionnaire which elicited information regarding sexual activity, injection and non-injection drug use, addiction treatment experience, encounters with police and security guards, and health service utilization. Environmental and structural correlates of number of recent sex partners were identified using quasi-Poisson regression. Factors independently associated with consistent condom use were also examined using logistic regression. Results: Among 529 participants, 415 (78.4%) were sexually active during the past six months, of whom 253 (61.0%) reported multiple sex partners and 288 (69.6%) reported inconsistent condom use during this time period. In multivariate logistic regression, homelessness and self-reported structural barriers to accessing health services were inversely associated with consistent condom use. In multivariate analysis, living in a shelter, hostel, or single room occupancy hotel was positively associated with greater numbers of recent sex partners. Structural factors that were associated with number of sex partners included having a warrant or area restriction that affects access to health services, and for males, being accosted by the police. Conclusions: Unstable housing, homelessness, and structural factors related to the criminalization and displacement of street-involved youth were associated with an increased risk of HIV and STI transmission, even after extensive adjustment for sociodemographic and individual level characteristics. These findings suggest that both environmental and structural factors influence the spread of HIV and STIs, and point to the need for environmental-structural interventions to reduce the burden of these diseases among this population. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

M.A. (Social Work) / Please refer to full text to view abstract

The topic of the study is The Impact of HIV/AIDS and STIs in Secondary Schools in the Limpopo Province. The impact of HIV/AIDS and STDs on educators and learners in secondary schools is problematic. These epidemics are associated with an increase in absenteeism, requests for time off, emotional problems, changes in attitudes, overload on the side of teachers, unexpected deaths, increasing demands being made on medical aid schemes, as well as disability and malfunctioning of people and structures. The standard of education is deteriorating because of these diseases. Similarly, there is the need for managing the effects of these epidemics. This study employs participatory action research. The quantitative method is utilized in the study. The questionnaire is used as an instrument of measurement. The most important findings are as follows: • There is an increase in absenteeism for both learners and educators. • Learners’ performance is deteriorating. • Participation of learners in sport and extra-mural activities is decreasing. • Teachers’ productivity is deteriorating. • Depression is taking its toll both among learners and educators. • There is a high rate of dropouts. / Dr. M.C. van Loggerenberg

Background: Sexually transmitted diseases (STD's) have a major impact on sexual and reproductive health worldwide. Each year, the World Health Organization (WHO) estimates 448 million new cases of curable STD's are diagnosed. The emergence of drug resistance in STD related microorganisms and potential side effects demand the discovery of newer drugs. The exploration of newer anti-microbial substances from natural sources may serve as promising alternatives. In this study, twelve medicinal plant species used traditionally in the treatment of STD's are investigated in this regard. Methods: Ethanol plant extracts and three flavonoids were evaluated for their antimicrobial properties against one fungi and three bacteria, through the micro-dilution assay. To determine the anti-inflammatory activities of the extracts and compounds, the inhibitory effect was measured on the pro-inflammatory enzyme lipoxygenase, 15-LOX. Extracts were further evaluated for their inhibitory effect on the supercoiling activity of bacterial DNA gyrase by using the DNA gyrase kit. The extracts and compounds were lastly investigated for their anti-HIV activities against recombinant HIV-1 enzyme using non-radioactive HIV-RT colorimetric assay. Results: Acacia karroo and Rhoicissus tridentata extracts showed good antimicrobial activity with MIC values ranging between 0.4 and 3.1 mg/ml. Extracts of Jasminum fluminense, Solanum tomentosum and flavonoid 2 and 3 had good anti-inflammatory activity with IC50 less than the positive control quercetin (IC50 = 48.86 ug/ml). Extracts of Diospyros mespiliformis, Peltophorum africanum, Rhoicissus tridentata and flavonoids 1 and 2 showed the best inhibitory activity against the bacterial DNA gyrase. A. karroo and flavonoid 3 exhibited moderate HIV RT inhibition activity of 66.8 and 63.7 % respectively. R. tridentata and Terminalia sericea had the best RT inhibition activity (75.7 and 100 %) compared to the positive control doxorubicin (96.5%) at 100 ug/ml concentration. Conclusion: The observed activities may lead to new multi-target drugs against sexually transmitted diseases. / Dissertation (MSc)--University of Pretoria, 2017. / Plant Science / MSc / Unrestricted

Thesis advisor: Summer S. Hawkins / Thesis advisor: David Takeuchi / Adolescence is a critical developmental stage where the health behaviors and choices that adolescents make have the potential to affect their long-term health and well-being (Centers for Disease Control and Prevention, 2014). This dissertation contributes three distinct studies on the contextual influences that shape adolescents' health behaviors. The first study, "The Role of Psychosocial Conditions on Sexually Transmitted Infection (STI) Risk among U.S. Young Adults," grounded in life course and syndemics theory, utilized logistic regressions to examine the role of co-occurring psychosocial conditions (childhood sexual abuse and physical abuse; depression and illicit drug use in adolescence) on STI infection (chlamydia and trichomoniasis) and sexual risk behaviors among U.S. young adults. Multiple co-occurring psychosocial conditions had an additive effect on sexual risk behaviors but no effect was observed on STIs. The second study, "Sexually Transmitted Infections and Neighborhood Poverty: The Role of Individual Resilience and Social Connectedness," utilized resilience and ecological systems theory, and logistic regressions to test if individual resilience and social connectedness (maternal, peer, and school) moderate the association between concentrated neighborhood poverty and STIs (chlamydia and trichomoniasis) among U.S. young adults. The study's main finding is that youth who reported more school connectedness and lived in high concentrated poverty in adolescence were less likely to test positive for chlamydia but were more likely to test positive for trichomoniasis. Utilizing a similar framework, "Sleeping in a Digital World: The Role of Excessive Media Use on Sleep Inadequacy Among U.S. Adolescents," examined family and neighborhood determinants that shape adolescent sleep behaviors. Grounded in the ecological systems theory and social learning theory, logistic regressions, stratified by age (aged 10-12 vs. 13-17), were used to examine the associations between excessive media use and sleep inadequacy. The study found that among older adolescents, sleep inadequacy was associated with excessive computer use. Older adolescents who watched television excessively and had media present in the bedroom were more likely to be sleep inadequate. Together, these three studies shed light on the different contextual environments in which adolescents experience health risks and resilience and will help to inform interventions that promote adolescent health and well-being. / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Verhandeling voorgele ter nakoming van die vereistes vir die graad Magister educationis in die Derartement Opvoedkundige Sielkunde aandie Universiteit van Zululand. Eng = Submitted to the Faculty of Education for the requirements of the Master of Educational Psychology at the University of Zululand, South Africa, 2006. / Afr: Die navorsingsondersoek is onderneem om nie-mishandelende ouers se belewing van hul seksueel getraumatiseerde kinders te bepaal omdat relatief min navqrsing internasionaai daaroor gedoen is en feitiik geen navorsing daaroor in Suid-Afrika beskikbaar is nie. Daar bestaan nie ooreenstemming onder kundiges oor wat as seksuele misbruik beskou word nie en die mening word gehuldig dat 'n definisie daarvan 'n mynveld van vooroordele, voorafopgestelde menings en misleidende inligting is. In hierdie studie word die konsep seksuele traumatisering gebruik. In die literatuurstudie is die rouproses as 'n kategorie gei'dentifiseer waaronder die volgende subkategoriee" resorteer skok en ongeloof, ontkenning, woede, skuldgevoelens en selfverwyt, skaamte en angs, blaam, vrees, depressie, verdriet en ambivalensie. Die ander geidentifiseerde kategoriee is die effek wat die seksueel getraumatiseerde kinders het op hul ouers se werk, kognitiewe dissonansie, sekondere traumatisering, herviktimitisering weens verskyning in die hof en posttraumatiese stresversteuring. Terme soos "gesond", "tipies", "nonnaal" en "funksioneel", wat afwisselend gebruik word, dra by tot die problematiek rondom die beskrywing van 'n gesin. Die terme funksionele en disfonksionele gesinne word vanuit die algemene sisteemteorie se perspektief vir die doeleindes van hierdie studie aanvaar. Belewing, as 'n konsep waarop die studie gebou is, maak 'n belangrike deel daarvan uit, aangesien die ouers se belewing as skakel dien met hul seksueel getraumatiseerde kind. Wat verantwoordbare hulpverlening en steun aan seksueel getraumatiseerde kinders en hul gesinne betref, vind staatstrakture dit vanwee finansiele tekorte moeilik om hul ontwerpprotokolle te implementeer. Sommige instellings (nie-regeringsorganisasies) kwyt hulle goed van hul taak betreffende hulpverlening en steun aan seksueel getraumatiseerde kinders en hul ouers. Eng:= The research was undertaken to determine the experiences of non-abusive parents who have to deal with their sexually traumatised child. Internationally, there is relatively little research done on the subject and, in South Africa, almost none. Experts have failed to agree on the concept of sexual abuse. The opinion is that definitions thereof often include prejudices, predetermined meanings, and misleading information. In this study, the concept of sexual traumatisation is used. In the literacy review, the grief process has been identified as a category that consists of the following subcategories: shock and disbelief, denial, anger, guilt feelings, self-recrimination, shame and anxiety, inappropriate blame, depression, sadness, and ambivalence. The other identified categories are the effect of the sexually abused children on their parents' work, cognitive dissonance, secondary traumatisation, revictimisation due to court appearance, and posttraumatic stress disorder. Terms like "health", "types", "normal" and "functional", which are used interchangeably, contribute towards the problematic nature of describing a family. For this study, the terms "functional" and "dysfunctional families" was adopted from the perspective of the general systems theory. Experience, as a concept on which the study was built, forms an important part thereof, since the parents' experiences serve as a link with their sexually traumatised child. Regarding responsible and effective therapeutic intervention and programmes for sexually traumatised children and their families, state structures find it difficult to implement their design protocols due to financial constraints. Some institutions (non-governmental organisations) are doing well in their task of therapeutic intervention and support to sexually traumatised children and their families.

Submitted in partial fullfillment of the requirements of a Masters degree in Clinical Psychology University of Zululand, 2003. / Research shows that prevention campaigns have been successful in raising awareness about AIDS and even in teaching people how to protect themselves, i.e. "Abstain, Be Faithful, Condomise" where they have failed dismally is in convincing people especially the youth of today as to how to apply it. The aim of the study was to investigate qualitatively the sexual practices of adolescents in relation to sexually transmitted diseases and acquired immuno-deficiency syndrome. The study investigated the determinants of condom using behaviour amongst school going adolescents, in the Durban and Verulam metropolitan region of Kwa-Zulu Natal. The motivation for the study was contexualised within the preventative health model which views the consistent and correct use of condoms as a primary strategy in preventing the spread of STD's and HIV/AIDS. In South Africa the health promotion campaigns focusing on safe sex practices and condom use have met with limited success as evidenced in this study. The sexual behaviour of adolescents is a key factor in influencing HIV transmission and sexually transmitted diseases. The reason for this behaviour is that most youths are inconsistent condom users and those who become sexually active at an early stage, run a greater risk to being exposed to HIV and STD's, both because of multiple partners and increased episodes of unprotected sex. The results indicate that on a very superficial level, South African adolescents possess good knowledge about transmission and prevention. The reason for this is that in order to produce behavioural changes, education programmes on sex and AIDS should include cognitive and behavioural skills training, addressing interpersonal problem solving, planning and assertive communication. Furthermore the under-resourced health sector, inaccessible health facilities, poor education and preventative measures do not empower the youth to make health choices responsibly It is envisaged that the recommendations from the research would ensure that existing health facilities are accessible to the youth today. Family planning clinics which are decentralised and offer a youth day programme in respect of sexuality education and proper use of contraceptives and condoms, ensuring full confidentiality. It is further hoped that this research would show that prevention and education messages are more effectively conveyed to the youth in South Africa, emphasising cognitive and behavioural skills training, with the co-operation and co-ordinated efforts of all departments and non governmental organisation, as well as by those infected themselves.