Master of Public Health - MPH / 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. / South Africa

Doctor Pharmaceuticae - DPharm / The effect of industrialisation has thrust the pharmaceutical profession into a clinical paradigm where the approcah to pharmaceutical decisions is more disease and patient orientated. Consequently, South African community pharmacies are inundated with requests from the public for advice and treatment on a wide range of medical conditions, including sexually transmitted infections (STI's). Although community pharmacies are often the first port of call for undiagnosed STI, limited diagnostic skills and legally-imposed prescribing restrictions preclude pharmacists from providing the necessary clinical management. The overarching goal of this dissertation was to present objective arguments and evidences (new and existing) around an expanded role for pharmacists in STI partner management. / South Africa

Magister Public Health - MPH / Background: STIs are of major public health concern in developing countries, not least because they facilitate transmission of HIV, but also because they are important causes of mortality and morbidity among African populations, resulting in, among other things, adverse birth outcomes, neonatal and infant infections, ectopic pregnancy, anogenital cancer,infertility, pelvic inflammatory disease, and death. Thus, effective treatment needs to be prompt and accurate to control the spread, and morbidity and mortality of STIs. Even though syndromic approach to the management of STIs is effective, most evaluations have focused on syndromic STI management within STI clinics as opposed to research studies. Partner notification is an integral component of the syndromic approach and is aimed at preventing onward transmission of infection as well as re-infection. It includes informing sexual partners of infected people of their exposure, administering presumptive treatment, and providing advice about the prevention of future infection.Methods: This is a cross sectional descriptive study based on a retrospective review of STI data of study participants in KICoS aged 18 to 34 years. A non probability convenience sampling method was used to recruit study participants. A total of 1,277 participants were prescreened into KICoS of whom 847 were enrolled into this study. Data was collected using CAPI and ACASI questionnaires as well as Teleforms which was analysed in SAS for windows 9.1. Results: Syndromic prevalence of STIs was 5.7% while the aetiological prevalence was 32.8%.Risk factors to STI acquisition included, being female, having multiple sexual partners,having lower than tertiary education, using recreational drugs and being HIV. Agreement between the interviewing methods as well between the syndromic and laboratory diagnosis ranged from fair to substantial. This was also true for the agreement between laboratory and CAPI as well as between the laboratory and ACASI. Sensitivity was generally low while specificity was high. Uptake of contact tracing cards was high though with very low uptake of contact treatment with only 2.1% and 0.4% partners of the syndromically and aetiologically diagnosed participants coming for treatment.Conclusions: STI is a problem in this community and thus there should be more emphasis on risk reduction messages in patient education to mitigate the spread of STIs. The performance of syndromic management was very poor against the aetiological diagnosis thus there needs to further review the use of syndromic diagnosis of STIs in research settings. Partner tracing needs to be intensified since there was very poor partner treatment even with high uptake of contact cards.Acknowledgements: This study would have not been what it was without the immense support I received from many individuals all of whom cannot be mentioned here. I would however want to thank the Dr Wairimu Chege (Principal Investigator, KICoS) for her inspiration and encouragement. I would also like to thank my supervisor, Ernie Kunneke for going through this study with me repeated times including on a ride to the airport. On the same note I would also like to thank my lecturers and student administrators at the SOPH. My gratitude also goes to my colleagues Richard Ndivo, Sherri Pals and Eleanor McLellan-Lemal for all the support they accorded me throughout this research.I would also want to give my heartfelt gratitude to my family. My daughter Akinyi who used to type with me at night, her mother Auma for understanding my late nights up and finally to my Parents Mr and Mrs Gideon and Monica Otieno for understanding the importance of education and taking me to school through all the difficulties. Last but not least I would like to express my gratitude to the almighty God for having seen me through this process.

The role that child sexual abuse can play in girls’ involvement in prostitution, was explored in this study. Freud’s Psycho Analytical Theory, Hirschi’s Social Learning Theory and Lemert’s Labelling Theory were encompassed to formulate a model. This model is known as The Child Sexual Abuse Counter-Active Model and was designed by researcher as a theoretical framework to direct the research and serve as a basis for the interpretation of findings. This model postulates that the stage of psychosexual development wherein the abused finds herself may influence the effects the abuse has on the victim. These effects may be initial in nature or long term, and may play a contributory role in the victim entering into prostitution. The presence of social bonds namely: attachment, involvement, commitment and belief, expressed by significant others or through institutions, towards the victim, can help prevent the manifestation of negative effects within the abused. This in turn may play a conducive role in the individual withdrawing from prostitution. Once the victim of the child sexual abuse has entered into prostitution, the choice to withdraw may be influenced by the individuals’ reaction to labels bestowed upon them by significant individuals, society or institutions. If the abused responds negatively to the labelling, then an internalisation of these negative concepts may prevail and the prostitute accepts this label and remains within prostitution. However, should the labelling be experienced as positive by the prostitute then the withdrawal from prostitution may become a possibility. Thus, the withdrawal from prostitution as well as the initial entrance into prostitution is determined by the afore-mentioned factors all playing a contributory role through their presence in the sexually abused child’s life. From the interpretation of the data accumulated, it appeared that each respondent subjected to child sexual abuse, irrespective of the psychosexual developmental stage wherein the abuse occurred, exhibited initial as well as long term effects. The absence of significant institutions and individuals in attempting to prevent the entrance into prostitution as well as the role played by labelling could all account for the victims’ choice to enter into and remain within prostitution. These findings made it possible to advance practical recommendations with regard to preventing child sexual abuse. A heightening in awareness of the initial and long term effects child sexual abuse carries as well as the education required within the community could help combat this type of abuse. Professionals, professional institutions, parents and victims could also assist to prevent this crime. In addition the findings furthermore highlight subjects, which pose as possibilities for further victimological research. / Dissertation (MA (Criminology))--University of Pretoria, 2007. / Social Work and Criminology / Unrestricted

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. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The HIV and AIDS epidemic continues to affect communities worldwide particularly so in South Africa. Youth, also the so-called Coloured youth, continue to remain at risk of infection, in spite of having been exposed to information about HIV and AIDS. This study explores the views of Coloured secondary school youth in a rural town in the Eastern Cape, on HIV and AIDS. Fifteen secondary school learners, both boys and girls, from Grades 10 to 12 were purposively selected. This qualitative study, framed within an interpretivist paradigm, draws on a phenomenological methodology. The data was generated from using drawing and focus group interviews and analysed using thematic analysis. The research adhered to ethical principles and trustworthiness was ensured. Constructivism and Bronfenbrenner’s bio-ecological systems theory were used to frame the study and to make meaning of the findings. In response to the primary research question, What views do Coloured youth attending a secondary school in a rural town have of HIV and AIDS?, five themes emerged, namely: individuals spread HIV, impoverished family life increases youth vulnerability to HIV, youth under pressure from peers knowingly engage in risky behaviour, misconceptions fuel the epidemic, and HIV and AIDS “captures the community in its net”. Drawing on the findings and in response to the secondary research question, What guidelines can be developed to assist educators to facilitate learners taking action against the spread of HIV and AIDS?, several guidelines were developed. They suggest that teachers should use participatory pedagogies to engage secondary school learners when teaching HIV and AIDS, build self-esteem in their learners, assist learners in dealing with peer pressure, engage learners in erasing misconceptions, and enable learners to break free from being “caught in the net” of HIV and AIDS. Collectively these guidelines could enable learners to take action in protecting themselves and their community against the spread of the HI virus. The study concludes that the views that Coloured secondary school learners from a rural town have about HIV and AIDS show their awareness of the realities of the epidemic affecting the individual, the family, the school and their community. They have constructed their views of HIV and AIDS in a way which shows their understanding of the complexities of the epidemic.

Human Immunodeficiency virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is rapidly spreading in the whole world and many adolescents start relationships at a younger age without knowing the danger of the sexually transmitted diseases. Parents should involve themselves in imparting knowledge about HIV/AIDS related information. It is imperative that parents and adolescents should have that relationship of discussing about the dangers of HIV/ AIDS. Adolescents should be taught about the importance of relationships and how to protect themselves against the dreaded disease. The research took the form of a qualitative interpretive case study focusing on a study sample of twenty parents and twelve members of a focus group. Data was collected through semi-structured interviews, document analysis and observations. The study examined the hidden issues or underlying the involvement of parents in imparting HIV/AIDS related information to their adolescents. The study revealed that many parents are aware of the pandemic and they felt it is imperative to discuss with their adolescents. Family life education is very much important even if their adolescents are taught about the HIV/AIDS related information at schools. Government is also involved in ensuring that there are preventative measures against the killer disease. This should be a collective effort by both the parents and teachers. The study further recommends the establishment of a library in order to enhance the literacy levels of parents and educators. It will be very much significant to educate or train the trainers in order to educate even our future generation. HIV/AIDS is incurable, therefore, it is imperative for the Department of education to ensure the literacy levels so that even the department of Health contributes its information to inform everybody about the danger of incurable diseases more specifically HIV/AIDS.

Child sexual abuse in its various guises is a phenomenon that has been part and parcel of society for centuries. It is only in the last few decades, however, that professional and societal interest in this social tragedy has been triggered, and continues to increase. The consequences and impact of child sexual abuse are far-reaching. Not only are individual victims marred by its consequences, but so too does it profoundly affect family systems and societies. As a result of professional interest in this field which has been fuelled by the popular media, the cloak of social secrecy which has covered this previously taboo subject has been shed. Although still hugely under-reported, sometimes even denied and buried by some individuals and societies, it is now widely acknowledged that child sexual abuse is a stark reality. Definitions of this phenomenon abound, with some definitions being more descriptive than others. The grooming process often forms an integral part of child sexual abuse. Through purposefully constructed relationships with their victims, sex offenders make their victims feel responsible for, complicit in and guilty about the abuse. The child is therefore tricked into keeping the abuse a secret. Often the child may not realise that what is happening is in fact abusive. Through grooming the abusive behaviour is normalised and the child may believe that it is part of an affectionate and caring relationship with the offender. The victim often gets lost in the labyrinth of confusion created by a web of deceit, which may result in consensual sexual activities between the child and the sex offender, a fact which is widely acknowledged. Consent is often raised as a defence when sex offenders are charged with and prosecuted for their crimes, more specifically in relation to victims who are over the age of twelve years and more frequently in relation to victims who are sixteen years and older. This consent, however, ought not to be valid for purposes of any sexual activities between such adults and children. Consent is often given as a consequence of the unique dynamics of the grooming process and the imbalance of power and authority. Furthermore, the child’s level of understanding and life experience, as shaped by the grooming process, may also have an important impact on ostensible consent given. South African courts, in accordance with international trends, have apparently started acknowledging the impact of the grooming process on consent given by children in sexual abuse cases. Some courts, as of late, are prepared to more readily reject the defence of consent in such cases. It is noteworthy that this trend has started to develop in South Africa even prior to the commencement of the Criminal Law (Sexual Offences and Related Matters) Amendment Act 32 of 2007. This act defines consent for purposes of the newly created offences, and also stipulates the circumstances in which ostensible consent does not comply with the definition. This definition does not differ materially from the “traditional” approach to consent that was applied prior to the commencement of this act. Furthermore, a number of new offences were created, amongst them the offence of sexual grooming of children. Courts can therefore no longer ignore the existence of the grooming phenomenon and the impact thereof in child sexual abuse cases.

In 1981, a number of reports of death from immune system failure began to cause alarm in medical circles. The Human Immunodeficiency Virus (HIV) was identified as the cause of a condition known as Acquired Immune Deficiency Syndrome (AIDS). To date, there is no cure for AIDS, and as a result it is perceived as the deadliest medical condition of the century. While intensive research remains focused on development of a vaccine, there has been a strong move toward a more preventative approach that is holistic in nature, and encompasses behavioural and social components as being of equal importance. Going hand in hand with HIV/AIDS are Sexually Transmitted Infections (STIs). STIs are increasing around the world and in South Africa at a remarkable rate. Like HIV/AIDS, STIs are also transmitted during sex, more specifically through body contact during sex. Research has identified adolescents as a group that is particularly vulnerable to HIV and STI infection. Life-skills programmes use experiential learning to engage learners and are particularly popular because they empower individuals to make responsible, well thought out decisions based on well developed values and beliefs. There are however, various variables and agents that impact upon the success of HIV/AIDS and STI education. It is therefore suitable to adopt a biopsychosocial approach to underlie a HIV/AIDS and STI life-skills programme. Health models, such as the AIDS Risk Reduction Model, based on this approach should take into consideration important psychological variables to cope with changes in behaviour, as well as prepatory behaviours inclined towards preventing risky behaviour. The Ubuntu Education Fund is a non-government, international organisation that offered a life skills programme in HIV/AIDS, STIs, Rape and Child Abuse to learners in Grades 6 - 9. This study focused on HIV/AIDS and STIs. The sample size was 260 learners from the Nelson Mandela Metropolitan Region. A quasiexperimental one group pre-and post-test design was used to determine if there was a difference between the knowledge of these learners pre- and post- the life skills programme. The results of the study indicate that there was a small increase in knowledge after the life-skills programme intervention. In some schools there was even a decrease in knowledge. This study suggests that the life-skills programme was flawed and that it needs to be reviewed. The implications of these findings are discussed with suggestions for future interventions.

Child sexual abuse is a worldwide phenomenon that takes a major toll in squatter camps in South Africa. The conditions under which the squatters live promote and aggravate the abuse. Sadly, the victims hit hardest by the abuse are the children. The negative effects caused by the abuse lead to problems in the educational tasks of these children. This study proposes that teachers can play a significant role in assisting them to overcome their problem. The aim of this study was to: • investigate the perceptions of teachers of the problem of the sexual abuse of children coming from squatter camps; • empower teachers with strategies that will help to alleviate the problem; and • formulate some recommendations on dealing with the situation in the classroom. The literature was reviewed with the aim of substantiating a compact theoretical basis for the study. Various aspects were discussed, such as • the different definitions of child sexual abuse; • short- and long-term effects of the abuse; and • contributory factors of child sexual abuse. This study followed a qualitative design, which is interpretive, naturalistic, descriptive, holistic and exploratory in nature. The participants, chosen purposefully for this study, were ten teachers, teaching children coming from a squatter camp in the Motherwell Township of Nelson Mandela Bay. Themes that emerged from the transcripts of the interviews were: • Sexual abuse has a negative effect on children and causes them to develop problems. • Teachers can play a significant role in assisting learners who are sexually abused. • There are various reasons why sexual abuse is prevalent in squatter camps. The recommendations made are based on the findings of this study and propose to empower teachers so that they will be able to make a difference in the lives of their abused learners.