Background: Unintended pregnancy and sexually transmitted infections among young people are priority public health issues in the UK. Social marketing is the preferred Government approach to intervention despite limited evidence on efficacy. There is need to understand its applicability and effectiveness in addressing the specified sexual health issues. Methods: Three studies were carried out, of which the first was a systematic review of 12 studies assessing the effectiveness of social marketing in reducing unintended teenage pregnancies. The second and third were consumer research applications examining factors associated with Long Acting Reversible Contraceptive (LARC) use and Chlamydia screening respectively. The second study involved analysing five ONS Contraception survey datasets while the third involved analysing Havering PCT Chlamydia screening records and qualitative data from 28 participants. Data were analysed using Stata.10 and Framework statistical packages and maps drawn using MapInfo.10.5. Results: The systematic review showed that nine studies achieved significant effects on at least one of the specified outcomes (reduced pregnancy rates and related behaviour changes). The second study showed that the NICE guidelines published in 2005 successfully addressed the disparity in LARC uptake previously experienced by women aged below 20. The third study identified females and non-white participants as more likely to take Chlamydia tests. Motivating factors for testing included convenient access to kits and fear of infertility, while barriers included ignorance and fear of results. Conclusions: Social marketing appears to be effective in reducing unintended teenage pregnancies but evidence is limited to particular outcomes and context. Consumer research provides vital intelligence about target populations necessary for designing effective interventions and addressing inequalities. However to assess its influence on outcomes, studies that feature all social marketing components are required. Overall there is need for more studies that specifically utilize social marketing principles to enable more robust evaluations.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

India houses the world’s third largest population of people living with Human Immunodeficiency Virus (HIV) who constitute about 6% of the global HIV burden. In about 2008-9, an estimated 1.9 million [95%CI: 1.5 to 2.5] adults were living with HIV in India. The four southern Indian states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu account for about 60% of estimated HIV infections, although they house only 30% of the adult population. I report that most HIV infections in infected couples in the general population of India (85.4% (95%CI: 80.0, 90.7)) were introduced by the male partner. The per-partnership transmission probability of HIV in the general population was low 29.1% (95%CI: 22.5, 35.7) compared to what has been reported for other STIs. Important theoretical facilitating factors for HIV transmission were associated with HIV infection with nearly equal effect sizes in both genders and across HIV–risk settings (multiple partnerships (OR: 2.46 (95%CI: 1.98, 3.06) and STIs (ORHSV-2: 5.60 (95%CI: 3.37, 9.33); ORSyphilis: 4.12 (95%CI: 2.35, 7.25)). The strength of association of STIs with HIV was consistent. Intervention spending on, or coverage of, STI treatment-focused sex work interventions (per 1000 total district population) was associated with a reduced annual risk of either HIV (- 1.7%, 95%CI: -3.3, -0.10) or syphilis (-10.9%, 95%CI: -15.9, -5.8) infection in young pregnant women in the high-burden southern states. A decreased annual risk of syphilis iii among young pregnant women attending public prenatal clinics in the high-burden southern states was associated with a unit increase (per 1000 total district population) of intervention spending (-0.009%, 95%CI: -0.014, -0.004), number of STIs treated (-10.9%, 95%CI: -15.9, -5.8), FSWs reached (-3.0%, 95%CI: -5.2, -0.7) and condoms distributed (-0.034%, 95%CI: - 0.053, -0.015). Male sexual behaviour (non-regular partnerships and use of female sex work) is the dominant driver of HIV transmission in the general population of south India. Ulcerative STIs were strongly associated with HIV infection in south India and interventions aimed at treating STIs and promoting safer sex practices for FSWs and their clients have resulted in reductions in HIV and syphilis incidence and prevalence in the general population of south India.

India houses the world’s third largest population of people living with Human Immunodeficiency Virus (HIV) who constitute about 6% of the global HIV burden. In about 2008-9, an estimated 1.9 million [95%CI: 1.5 to 2.5] adults were living with HIV in India. The four southern Indian states of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu account for about 60% of estimated HIV infections, although they house only 30% of the adult population. I report that most HIV infections in infected couples in the general population of India (85.4% (95%CI: 80.0, 90.7)) were introduced by the male partner. The per-partnership transmission probability of HIV in the general population was low 29.1% (95%CI: 22.5, 35.7) compared to what has been reported for other STIs. Important theoretical facilitating factors for HIV transmission were associated with HIV infection with nearly equal effect sizes in both genders and across HIV–risk settings (multiple partnerships (OR: 2.46 (95%CI: 1.98, 3.06) and STIs (ORHSV-2: 5.60 (95%CI: 3.37, 9.33); ORSyphilis: 4.12 (95%CI: 2.35, 7.25)). The strength of association of STIs with HIV was consistent. Intervention spending on, or coverage of, STI treatment-focused sex work interventions (per 1000 total district population) was associated with a reduced annual risk of either HIV (- 1.7%, 95%CI: -3.3, -0.10) or syphilis (-10.9%, 95%CI: -15.9, -5.8) infection in young pregnant women in the high-burden southern states. A decreased annual risk of syphilis iii among young pregnant women attending public prenatal clinics in the high-burden southern states was associated with a unit increase (per 1000 total district population) of intervention spending (-0.009%, 95%CI: -0.014, -0.004), number of STIs treated (-10.9%, 95%CI: -15.9, -5.8), FSWs reached (-3.0%, 95%CI: -5.2, -0.7) and condoms distributed (-0.034%, 95%CI: - 0.053, -0.015). Male sexual behaviour (non-regular partnerships and use of female sex work) is the dominant driver of HIV transmission in the general population of south India. Ulcerative STIs were strongly associated with HIV infection in south India and interventions aimed at treating STIs and promoting safer sex practices for FSWs and their clients have resulted in reductions in HIV and syphilis incidence and prevalence in the general population of south India.

This study explored the reliability of disclosures of sexual abuse from preschool children. The study assumed the following: firstly the greater the level of trauma experienced by the child, the lower the reliability of the disclosure. Secondly, if the child had been severely threatened it was less likely that their disclosure would be reliable. Thirdly it was assumed that the more supportive the family was of the child's disclosure, the more reliable the disclosure would be. Fourthly, the study assumed that an important factor regarding reliability of a child's disclosure was the quality of the therapeutic relationship. Lastly it was assumed that the techniques used would be secondary in importance if compared with the therapeutic relationship . The research questions asked how techique, social worker and child-related variables affected the reliability of a child's disclosure of sexual abuse, and if there was a relationship between the variables and the child's ability to disclose reliably. The research included both qualitative and quantitative data and methodology. The research process was twofold. Firstly child, social worker and technique-related variables were identified from the case studies and the relationship between these variables described . Secondly, the effects of these variables on the participants' reliability in relating their sexual abuse experiences were explored. Thirty participants were selected through systematic random sampling. Participants were male and female between the ages of two and six years. The collective case study method was used and data was obtained from case records and analysed through content analysis. Qualitative and quantitative methods were used. The results reflected a relationship between the above mentioned variables. It seemed that child-related variables were important and could affect the child's ability to disclose reliably. However social worker-related variables seemed to be able to positively mediate the negative effects of some of the child-related variables. Technique-related variables seemed to be closely related to the-quality of and the specific stage of the therapeutic relationship. Techniques could be successfully used where a trusting relationship existed between the social worker and the child. / Thesis (M.A.)-University of Natal, Durban, 2002.

The aim of the study was to explore and describe the experiences of children who have been raped. It is a known fact that children are raped every day in South Africa, but how the consequences are experienced by the child victims of rape is another matter. Specifically, the researcher wanted to determine whether these children receive the support that is their constitutional right and whether or not they are subjected tc secondary victimization. The sampling strategy employed was purposive sampling. This type of sampling wai selected, as the researcher was looking for a particular type of participant, that is, children who had disclosed rape. The sample consisted of six female children between the ages of 5 and 17years. Participants' parents were consulted for their consent at c counseling centre for abused children in Durban, where participants attended group counseling and individual sessions. The data were collected by means of semi-structured interviews and analyzed usin^ thematic analysis. Unstructured interviews were tape recorded and transcribed. Thesi transcriptions were coded for descriptive themes and were analyzed using thematic conten analysis. The research findings suggest that children have mixed views regarding the quality of the help they receive; some had positive experiences and some had negative experiences. Despite the fact that most participants experienced a sense of being interrogated and had feelings of being not involved during discussions, two participants reported that although rape is an atrocious experience there were positive consequences for them. For example, getting attention from significant people in their lives was one of their positive experiences. It was the experience of the researcher that there is a lack of research pertaining to the experiences of children who are rape victims, especially research focusing on the quality of support that rape victims ought to receive. Further research is recommended to clarify and measure the prevalence of typical feelings and experiences of children who have been raped / Thesis (M.A.)-University of KwaZulu-Natal, 2007.

Child sexual abuse (CSA) is a problem of increasing intensity both internationally and within the context of South Africa. While various studies have investigated the post-rape experiences of CSA survivors, few have studied these experiences from a child-centred perspective. The current study thus seeks to explore the personal views of children and their ways of seeing the world in relation to their helpful and harmful experiences in the aftermath of disclosure. The sample was taken from an NGO, located on the south coast of KwaZulu-Natal, which deals specifically with issues affecting abused children. The sample consisted of 20 child rape survivors, between the ages of 5 and 17. Qualitative interviews were conducted in isiZulu by a trained Counselling Psychologist, who served the role of both interviewer and counsellor. Interview transcripts were translated into English and analyzed thematically. Data were organized within an ecosystemic framework in an attempt to conceptualize experiences at various systemic levels. Results indicate varying helpful and harmful experiences with regard to familial, community, institutional, and broader macrosytemic levels of influence. Harmful experiences at the institutional level appeared to have to do with the lack of information shared with the children as to the nature of the proceedings, and what was expected of them, rather than with the post-rape medical examination. Reactions of significant others, in particular the primary caregiver, were found to have a significant impact upon the child’s own feelings towards the sexual abuse. Fear of revictimization, disbelief regarding the minimum punishment afforded to the perpetrator, and feelings of being tricked, deceived, and let down by the perpetrator, were other common themes within the data. / Thesis (M.Soc.Sci.)-University of KwaZulu-Natal, Durban, 2010.

Child abuse continues to be a major challenge in South Africa. Much of the research has focused on helping children who have been abused and more recently focus has been placed on the perpetrator. Understanding the needs of the mother of the abused child has largely been neglected. This study explored how mothers of abused children are also affected by the child's trauma and how her survival contributes to the healing of the family. Using a qualitative research approach, data was gathered from case files, groupwork notes and in-depth interviews with eight women whose children had been abused. A feminist approach guided the study. This research described the experiences of women and provided insight into their struggles and triumphs as they assisted their children in the healing process. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, 2005.

Introduction: Oil/gas communities across Northeastern British Columbia are experiencing rapid in-migration of young, primarily male workers in response to an economic ‘boom’ in the oil/gas sectors. Accompanying the ‘boom’ has been a rise in rates of sexually transmitted infections (STIs) among young people, with Chlamydia rates among youth in the Northeast exceeding the provincial average by 22%. Previous research indicates that socio-cultural and structural determinants of youth sexual behaviour and access to STI testing are important for understanding youth sexual health disparities – and represent key targets for STI prevention efforts. No other research has explored STIs in this rapidly developing, under-resourced context. Therefore, objectives of this thesis were to: (1) Examine how socio-cultural and structural features related to the oil/gas ‘boom’ affect the sexual behaviour of young people in Fort St. John (FSJ), BC; (2) Gather the perspectives of youth and their service providers on the socio-cultural and structural barriers to STI testing in FSJ; (3) Develop recommendations to improve the accessibility of STI testing. Results: Participants identified 4 main ways in which the socio-cultural and structural conditions created by the ‘boom’ affect sexual behaviours, fuelling the spread of STIs in FSJ: mobility of oil/gas workers; binge partying; high levels of disposable income; and gendered power dynamics. As well, 5 key barriers to STI testing among youth were identified: limited opportunities for access; geographic inaccessibility; local social norms; limited information; and negative interactions with providers. Discussion: These data indicate that the conditions fostered by the ‘boom’ in FSJ exacerbate sexual health inequalities among young people. They can be more widely contextualized as an example of the unintended – but not unexpected – health and social implications of a resource-extraction ‘boom’, illustrating the fallacy of ‘development’ as representing uniformly positive ‘progress’. Recommended actions include STI prevention and testing service delivery models that incorporate a locally tailored public awareness campaign, outreach to oil/gas workers, condom distribution, expanded clinic hours and drop-in appointments, specialized training for health care providers, and intersectoral partnerships between public health, non-profit organizations, and industry. An ongoing knowledge translation internship has been undertaken to implement some of these recommendations.