Harsh Reality is a print resource aimed toward the population of street-involved youth. Created by a working group of street-involved youth in partnership with a research nurse, Harsh Reality is a unique hybrid of factual information, and art and written experienced submitted by street-involved youth themselves. Harsh Reality contains information about a variety of topics, notably sexually transmitted infections and HIV/AIDS. A case study method was used to evaluate aspects of both project process and outcomes. The case study was guided by three areas of study: street-involved youth's perceptions of the resource, retention of specific knowledge outcomes from the resource, and method of resource distribution. The primary sources of data were street-involved youth themselves. Findings of this study include a description of the target audience's perception of the resource, an analysis of specific knowledge uptake, an assessment of various methods of resource distribution, and possible suggestions for future resources.

The demand for forensic social work as a specialist field is increasing rapidly, due to the increasing moral decline of the community and consequent higher demands set to generic social workers. Amendments to existing acts as well as the development of new legislation, lead to more opportunity for the prosecution of the perpetrator, and therefore a higher utilization of the forensic social worker. A need was experienced to do research regarding the gaps experienced by social workers or any other workers who are currently executing forensic assessments with the sexually traumatised child. The aim of the investigation was to determine which gaps social workers experience in the field when assessing a child forensically. A recording procedure was used to obtain qualitative as well as quantitative data. A purposive sampling was used were interviews were held with five participants to obtain the data. A selfdeveloped questionnaire was used as measuring instrument. It is clear from the findings that there are definite gaps within the field of forensic social work and the need of further research within the field of forensic social work in South Africa is highlighted. / Thesis (MA (SW (Forensic))--North-West University, Potchefstroom Campus, 2012.

The purpose of this study was to describe the sexual health knowledge and attitudes of a sample of Saskatchewan post secondary freshmen aged 17-19. Three primary questions guided this research: What do Saskatchewan freshmen know about the general sexual health topics of physiology, contraception, and sexually transmitted infections? What are common attitudes about sexual activity, risk behaviors, and relationships? What were the main sources of sexual health information for these freshmen, and do they express a need for more education and resources? The study design was a qualitative web-based survey. Participants were volunteer freshmen aged 17-19 from the University of Saskatchewan and Saskatoon Institute of Applied Science and Technology, and 515 responded. Sixty-two percent were sexually active. Condoms were seen as helpful (98%) but only 57% saw them as effective for preventing pregnancy. Only 47% saw condoms as effective for preventing HIV/AIDS. Knowledge of reproductive physiology and STI symptoms and consequences were low with an average knowledge score of 26%, while HIV and AIDS knowledge scores averaged 80%. Knowledge of long acting contraceptives was much lower than birth control pills. Human papilloma virus was poorly understood, and many wanted more information about HPV vaccination. Attitudes were mixed about safe sexual activities, with respondents identifying condoms (94%), withdrawal (18%) and anal sex (15%) as safer sex. Condoms were used at last intercourse by 57%. A variety of attitudes were expressed about condom use, sex in relationship, and social pressures. Topics concerning to respondents were sexual violence, HIV/AIDs, STIs, unintended pregnancy, and the influence of alcohol/ drugs on sexual activity. Very few respondents had heard of or accessed sexual health websites designed and promoted to teens. An interest was expressed for more information from doctors and public health nurses, more guest speakers for SBSHE, and easier access to sexual health clinics. The information gathered in this study highlighted many areas for further detailed inquiry, and topics that can be better addressed in physician’s offices and sexual health curriculum. Additionally, the results could guide sexual health educators, policy makers and direct physicians towards collaboration and advocacy projects, and ultimately contribute to long term improvement in sexual health of Saskatchewan teens.

The purpose of this theoretical study was to examine factors associated with the development of attachment relationships for children in long term foster care who Overt demonstrating problematic sexual behaviour. Due to the dearth in available research on this topic, it was necessary to draw from studies in three distinct areas (1) Attachment, (2) Childhood Sexuality, and (3) Placement Stability. In total, the present study examines 13 studies drawn from these three areas, and includes 11 quantitative and 2 mixed method studies. / These studies were chosen for their attention to the middle age child in foster care who was demonstrating problematic sexual behaviour. Due to the lack of attachment studies on fostered middle age children, two infant studies were included with the rationale that middle age children and foster parents engage in a similar attachment process and infant studies would provide direction and context for future studies with older children. In the area of childhood sexuality, clinical samples were also included as they contained large numbers of children who had experienced sexual abuse or who had contact with child protection agencies even if they did not reside in foster care. / Studies were examined along dimensions of sample, methods and findings. The results of this inquiry are then discussed, weaving together the three areas of study to answer two research questions: Is there a relationship between problematic childhood sexual behaviour and the development of a successful attachment relationship with a foster parent? And secondly, is there a particular foster parent attachment profile that promotes attachment security with children who are in care? / Studies reviewed support the hypothesis that problematic childhood sexual behaviour presents challenges to foster parents significant enough to seriously impair the development of a secure attachment and that the foster parent's attachment state of mind will be an important factor in success. Results of the analysis of these questions contribute to an emerging hypothesis that the human sexual system may be intricately woven together with the attachment system, making an attachment analysis of problematic sexual behaviour in children particular relevant. A concluding discussion examines clinical issues which may be targets of intervention and the necessity of future research in this area is proposed.

<p>Curricula should be strengthened by teaching the curability of STIs and the importance of STI treatment to prevent HIV transmission. This study focused on the control of sexually transmitted infections as a key HIV prevention strategy. Sexually transmitted infections act as a strong cofactor in the sexual transmission of HIV. Effective STI management can limit the spread of HIV.</p>

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.

Chlamydia trachomatis infections are among the most frequently reported causes of human sexually transmitted infection. In Australia, the reported rate of infection in 2004 reached 175 per 100,000 population, the highest rate since surveillance of the condition began in 1991. Severe adverse sequelae that commonly occur following progression of the infection from the lower to the upper genital tract include pelvic inflammatory disease, infertility and ectopic pregnancy. However the frequent prevalance of asymptomatic infection makes diagnosis and treatment often late and therefore ineffective against upper genital tract complications. Hence there is a great need to develop a vaccine to protect against the sexual transmission of C.trachomatis. Despite many years of research investigating potential vaccine strategies to prevent sexually transmitted C.trachomatis infections, there remains no commercially available C.trachomatis vaccine. Early research showed that the use of live, attenuated or inactivated whole Chlamydia as a vaccine was not a viable option due to adverse effects caused by immunopathogenic cellular components. The early human vaccine trials that utilized whole chlamydial cells and resulted in exacerbated disease when immunized individuals were re-exposed to Chlamydia have led to the investigation of chlamydial subunit components as potential vaccine antigens. The most widely investigated vaccine candidate antigen is the major outer membrane protein (MOMP) as it is known to be immunogenic and surface exposed. Much research using this antigen has been undertaken with the antigen being delivered as a protein, peptide or DNA, via many mucosal and systemic routes of immunization, and in combination with various vaccine adjuvants. However, at best only partial protection against a chlamydial genital tract infection has been achieved. Only a few alternative candidate antigens have been investigated as potential vaccine targets to protect against chlamydial infections. These include the outer membrane porin PorB, the large cysteine rich outer membrane protein Omp2 and the heat shock proteins DnaK and GroEL. Although other candidate antigens have been predicted in various models of chlamydial infection (Finco et al., 2005; Stemke-Hale et al., 2005; Li et al., 2006), few have been tested for their protective efficacy. The aim of this study was to use expression library immunization to screen the whole C.muridarum genome for novel vaccine candidates capable of protecting against a chlamydial genital tract infection. C.muridarum was selected as the disease model for chlamydial genital tract infection as it has similarities to C.trachomatis in pathogenesis, immune response to infection and gene content and order. Once protective antigens had been isolated from an expression library, these were screened individually for immunogenicity and protective efficacy in the C.muridarum model of infection. An expression library containing over 21,000 recombinant C.muridarum clones was constructed and divided into pools of clones. DNA was extracted from these pools and used to immunize mice through gene gun technology, delivering 1μg of DNA to the abdomen of mice. Following the immunization regime, mice were challenged intra-vaginally with live C.muridarum as this route of infection best resembles the natural route of infection that is responsible for the sexual transmission of C.trachomatis in humans. Four in vivo screens of the C.muridarum expression library, each time using reduced numbers of clones, resulted in the identification of seven novel vaccine antigens that conferred protection against a genital tract challenge infection in mice. These warrant further investigation as vaccine antigens in the development of a vaccine against C.trachomatis infection. The identified antigens include antigens not conventionally believed to be potential vaccine candidates such as hypothetical proteins and housekeeping genes, including a DNA gyrase subunit, TC0462, and the ATP-dependent Clp protease, ATP-binding subunit ClpC, TC0559. Other antigens identified were more traditional, surface exposed vaccine targets that have not been previously investigated as vaccine targets, including a novel outer membrane protein, TC0512, a polymorphic membrane protein, TC0693, and TC0850, a protein of the type three secretion system, a family of proteins that allow gram-negative bacteria to inject virulence related proteins into the cytoplasm of a host cell. All antigens were shown to be partially protective with the putative outer membrane protein TC0512 showing an overall reduction in chlamydial burden of 55% and other antigens showing overall reductions in chlamydial burden of 26 - 44%. These antigens were also either capable of stimulating an immune response, or predicted to contain epitopes that may stimulate strong immune responses and so warrant further investigation as vaccine antigens to protect against chlamydial genital tract infections. The results of this research demonstrate that it is possible to identify novel vaccine targets through screening an expression library in a disease model. This study has identified several novel vaccine targets that are partially-protective against a C.muridarum infection and that are thought to be capable of stimulating strong immune responses. These antigens have high homology with C.trachomatis sequences, indicating that they have potential as vaccine candidates capable of protecting against the serovars of C.trachomatis that cause sexually transmitted infections in humans. Although the protection observed in this study was only partial, the immunization strategy utilised only fragments of the genes, an immunization mechanism known to elicit Th2 type immune responses, and no adjuvant to enhance the immunogenicity of the antigens. Through different immunization routes and in conjunction with adjuvants that stimulate Th1 type immune responses, complete protection against chlamydial genital tract infections may be achieved.

Chlamydia trachomatis is a human pathogen of the genital tract and ocular epithelium. It is an obligate intracellular parasite with a unique biphasic development cycle. C.trachomatis infection is the most common bacterial sexually transmitted disease in industrialized nations. Its ability to cause chronic disease makes it a serious economic burden and health threat to developed and developing countries. Although treatable, approximately 70% of C.trachomatis infections are asymptomatic, potentially leading to the development of chronic sequelae. Furthermore, chlamydial genital tract infection has been associated with an increased risk of cervical cancer and human immunodeficiency virus infection. Consequently, the development of an efficacious vaccine is the most convenient, potentially reliable and cost effective option to control chlamydial infection and disease complications. Anti-chlamydial protective immunity is essentially mediated by a T helper, type 1 (Th1), response that is dependent upon the presentation of antigen via major histocompatibility (MHC) class II molecules. While antibody secreting cells are not critical components of the primary effector response, they have been shown to be important for clearance of re-infection. Thus an ideal vaccine would be one capable of inducing both a strong Th1 T cell response and a strong mucosal antibody response. Currently there are very few efficacious vaccine candidates that have been identified and characterized. More specifically, there is only a limited number of known T cell antigens processed and presented by the human leukocyte antigen (HLA) class II molecules. This type of antigen is going to be essential to the development of an efficacious chlamydial vaccine. In this study we have identified a number of unique vaccine candidates using a novel in silico approach. In an attempt to overcome HLA polymorphism the whole chlamydial genome was screened for proteins containing epitopes predicted to bind multiple HLA class II molecules (i.e. predicted ‘promiscuous’ T cell epitopes). A wide range of HLA class II molecules were used in this screen to identify vaccine antigens that could potentially offer broad and ethnically balanced population coverage. This analysis identified a number of novel targets and was validated by the identification of a known chlamydial T cell epitope. A selection of these target proteins was cloned, expressed and purified. Recombinant protein was screened against serum samples from patients with both acute and chronic chlamydial infections. Two novel targets, hypothetical protein CT425 and ribonucleotide reductase small chain protein (NrdB) were identified as being immunoreactive. The in vivo protective efficacy of NrdB was analyzed using a mouse model. CD4+ T cells were harvested from NrdB immunized mice and adoptively transferred to naïve mice, which were subsequently infected at the genital site. NrdB immunization was found to confer a CD4+ T cell driven degree of protection similar to that seen with CD4+ T cells primed from a live challenge. The adjuvants and route of immunization used ensured immunological responses were initiated at both the systemic and local sites of infection. Immunization elicited a predominant Th1 response with primed T cells producing high levels of interferon gamma, an essential requirement for the development of an efficacious chlamydial vaccine. Furthermore, high titres of antigen specific IgG and IgA were produced following immunization, with sera derived antibodies demonstrating neutralization properties. NrdB is a highly conserved chlamydial protein with an essential role in the replication of chlamydiae and could play a central role in a multi-subunit vaccine against chlamydial genital tract infections.

This thesis presents data on two separate areas relevant to the prevention of HIV and sexually transmitted infection (STI) transmission in homosexual men. These data arise from the community-based Health in Men (HIM) cohort of HIV-negative homosexual men in Sydney. First, the association of circumcision status with HIV and STIs was examined. Older age, ethnicity and country of birth were demographic factors independently associated with circumcision status. Self-report was a valid measure of circumcision status in this population. Overall, being circumcised was associated with a non-significant reduced risk of HIV seroconversion in the HIM cohort (HR 0.76, 95% CI 0.41-1.41, p=0.381). Among the one-third of participants predominantly practising the insertive role in anal intercourse (AI), being circumcised was associated with a significantly reduced risk of HIV infection (HR 0.15, 95% CI 0.03-0.80, p=0.026). Circumcised HIM participants also had a lower risk of incident syphilis (HR 0.35, 95% CI 0.15-0.84, p=0.019), however circumcision status had no significant effect on the remainder of prevalent and incident STIs examined. Second, risk factors for pharyngeal gonorrhoea and chlamydia were investigated. The BD ProbeTec nucleic acid amplification test (NAAT) had a positive predictive value (PPV) for pharyngeal gonorrhoea diagnosis of only 30.4% (95% CI 25.2-36.1%) when compared to a previously validated NAAT targeting the gonococcal porA pseudogene. Pharyngeal gonorrhoea was common in HIM, mostly occurred without concurrent anogenital infection and may frequently spontaneously resolve. Infection was independently associated with younger age (p-trend=0.001), higher number of male partners (p-trend=0.002), contact with gonorrhoea (p<0.001) and insertive oro-anal sex with casual partners (p-trend=0.044). Pharyngeal chlamydia was less common but a high prevalence/incidence ratio suggested that infection may persist in the pharynx for long periods. Pharyngeal chlamydia was independently associated with receptive penile-oral sex with casual partners (p-trend=0.009). In conclusion, circumcision may have a role as an HIV prevention intervention among the subgroup of homosexual men who predominantly practise insertive rather than receptive AI. Regular screening of the pharynx including a validated supplemental NAAT for gonorrhoea diagnosis may prevent much transmission to anogenital sites, whereas chlamydia occurs too infrequently in the pharynx to recommend routine screening in homosexual men.

This study addresses the hitherto limited research on sexually abusive children and youths in New Zealand (NZ). It encompasses children (12 years or younger) and youths (13 to 19 years) referred to the three largest specialised community sexual offender treatment programmes in Auckland, Wellington, and Christchurch over a 9½ year period. Additionally, three special populations are considered: female sexually abusive youth, youth with ‘special needs’ and children (12 years and under). To increase our understanding of the individual, offending and family characteristics of these children and youths in specialised community treatment programmes in New Zealand Study One audited client’s clinical files (N = 702). Consistent with international research, New Zealand children and youth who engaged in sexually abusive behaviours not only presented with sexually abusive behaviour(s) but also had other psychological and behavioural issues. These included a history of childhood sexual and physical abuse (38%, n = 263 and 39%, n = 272 respectively), behavioural (63%, n = 442) and mental health problems (65%, n = 457), drug and alcohol misuse (22%, n = 156) and a history of suicide ideation or deliberate self-harm (27%, n = 187). They often had poor social skills (46%, n = 326) and had struggled to establish appropriate peer relationships (44%, n = 306). Many of the children and youth came from multi-problem and chaotic family backgrounds (e.g., 55%, n = 387 of parents were divorced or separated, 38%, n = 267 were exposed to domestic violence and 32%, n = 222 had family member(s) with a substance abuse problem) and had experienced numerous out-of-home placements (57%, n = 389). Factors associated with resiliency were also investigated. It was found that children and youth primarily victimised male and female children (12 years or younger) (70%, n = 1407), who were acquaintances (57%, n = 1295) or relatives (32%, n = 730). Very few victimised strangers (7%, n = 86 of victims were strangers). They engaged in both ‘hands on’ (e.g., penetrative acts) and ‘hands off’ offences (e.g., voyeurism). Study Two was a naturalistic treatment outcome study to explore treatment outcomes and involved 682 sexually abusive children and youth who attended three specialised community treatment programmes in New Zealand. The main outcome of interest was sexual recidivism (prevalence rate of re-offending during the follow-up period) with secondary outcome variables of general and violent recidivism. The follow-up period ranged from 1 year to 10 years (mean 4.5 years, SD = 2.2). Three groups were compared: the ‘Comparison’ group (referral or assessment only, n = 300), ‘Treatment Dropout’ group (those who prematurely terminated their involvement in treatment, n = 165) and the ‘Treatment Completer’ group (those successfully completing treatment, n = 217). To allow for triangulation of offences that were dealt with through the youth and adult justice system’s recidivism data were collected from multiple sources (Child, Youth and Family , Youth Court, and Police criminal charges and convictions data). Post-treatment sexual, general (nonsexual and non-violent) and violent recidivism are reported from each data source as well as overall sexual, general and violent recidivism. Sexual, general and violent re-offending that occurred while the children and youths were attending treatment are also presented. Changes in behavioural problems and the psychological functioning of sexually abusive children and youth between assessment and the end of treatment (as assessed by the Child Behavior Checklist, Youth Self Report and Millon Adolescent Clinical Inventory) contribute additional outcome measures. This naturalistic outcome study found that the treatment programmes were effective in reducing sexual recidivism amongst sexually abusive children and youth who completed treatment compared with those who did not complete treatment. Less than 3% (2.8%, n = 8) of Treatment Completers sexually re-offended compared with 6% (n = 17) of the Comparison group and 10% (n = 16) of the Treatment Dropout group. Treatment Dropouts were found to be at highest risk of sexual, general and violent recidivism. Recidivism for the three special populations (children, females and ‘special needs’ youth) are also presented. The results from the psychological measures indicate a general pattern of reduction in behavioural and psychological problems between assessment and end of treatment. Logistic regression analysis was used in Study Three (N = 682) to explore factors associated with the risk of sexual and nonsexual (violent and general offending) re-offending post-treatment and dropping out of treatment. The factor predictive of sexual recidivism risk was having three or more victims and was associated with a decreased risk of sexual recidivism. Older age at first known sexual offence was associated with increased chance of nonsexual recidivism. Dropping out of treatment and having a history of nonsexual offending were associated with a decreased risk of nonsexual recidivism. Older age at referral and having no external mandate to attend treatment were associated with increased risk of youth dropping out of treatment. A history of mental health problems was associated with a decreased risk of treatment dropout. Conclusions This is the first study of the characteristics and treatment outcomes of sexually abusive children and youth in New Zealand. Its strengths include the large sample size, length of the follow-up period, use of a comparison group and data triangulation to determine recidivism. This study, therefore, compares favourably with international studies. This research enhances understanding of the individual, family and offending characteristics of sexually abusive youth in New Zealand as well as children, females and special needs youth. The Cognitive Behavioural Theory (CBT) based approach of the community programmes in New Zealand was found to be effective in reducing recidivism amongst children and youths who completed treatment. Specific recommendations relevant to treatment programmes and statutory agencies around programme development, referral processes and identification of sexually abusive children and youth are made. Directions for future research are also discussed. These include research exploring outcomes, other than recidivism, for those attending the Maori programmes, possible exploration of typologies within New Zealand sexually abusive children and youth, and subsequent follow-up research. / University of Auckland Doctoral Scholarship