Background: Adolescents in Botswana, especially women, face many sexual and reproductive health (SRH) challenges including high maternal mortality, sexually transmitted infections (STIs) including HIV, and unintended pregnancies, despite available SRH services. The youth friendly service (YFS) concept has been initiated and various strategies developed to address adolescents concerns. However, services remain underutilized and barriers to accessing services still exist. Aim: The aim of this study was to determine patterns of utilization of sexual and reproductive health services by adolescents attending senior secondary schools in Gaborone in 2012. The specific objectives were to: identify SRH services utilized by adolescents in the district; identify factors associated with adolescent utilization of YFS in the district; and determine barriers and facilitators to utilization of available YFS by adolescents. Design: This was a health systems research, which was conducted through an observational study, with descriptive and analytic components. Methods: 506 adolescents attending at the three (3) senior secondary schools in Gaborone were sampled through a simple random sampling strategy in each school. Parental consent and assent from participants was requested before respondents completed a self-administered questionnaire which was designed for the data collection. The questionnaire was pilot tested prior to the study. SPSS version 16 was used to analyse the data. A chi-squared test and logistic regression were used investigate association, and a p-value <0.05 was considered as statistically significant. Results: The findings of this study revealed that utilization of SRH by adolescents was low and the level of awareness of youth friendly services was also low. The study revealed that utilization of SRH was higher among female adolescents compared to their male counterparts. The study identified factors which hinder adolescents YFS utilization, which include: location of the facility, no interest in YFS, staff attitudes and behaviours, and inconvenient hours of operation. Conclusion: Identifying patterns of utilization of SRH services by adolescents attending senior secondary schools in Gaborone can help strengthen programmes at all levels of service delivery and the country at large. The Botswana Ministries of Health, and Education and Skills Development can re-orientate, or develop new initiatives that will deal with barriers to access and assist adolescents to fully utilize the available services. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2014.

In the absence of a cure and/or vaccine, the best approach to HIV is to focus on prevention. However, preventative measures that are presently available in Nigeria do not target persons with intellectual disability despite their vulnerability to HIV infection. This study sought to compare the HIV knowledge, attitudes, and sexual practices of mildly/moderately intellectually impaired learners (IIL) and mainstream learners (ML) in Nigeria; to explore the contextual factors informing these, as well as both groups‗ exposure to HIV education. It also tested the relevance of the I-Change Model in predicting sexual abstinence among learners with intellectual disability. Findings can assist in developing tailored HIV prevention education for Nigerian learners with intellectual impairment. This cross-sectional, comparative study utilised mixed methods to investigate HIV knowledge, attitudes, and sexual practices among mildly/moderately IIL and ML in Nigeria. Mildly/moderately IIL (300) and ML (300) within the age range of 12-19 years in special and regular schools completed a questionnaire based on the I-Change Model. Focus group discussions and in-depth interviews were used with learners to explore contextual factors informing their HIV knowledge, risk perception, sexual behaviours and access to HIV education and services. Key informant interviews were used as independent sources of the same information with their teachers. Learners with intellectual impairment were less aware of HIV/AIDS than their non-disabled peers (p < 0.001), had lower HIV knowledge scores (p < 0.001) and lower HIV risk perception scores (p < 0.001). Sexual experience was reported by 79 (26.3%) of the IIL sample compared to 48 (16.0%) of the ML sample (p = 0.002). Girls with intellectual disability were 3.71 times more likely to report a history of sexual abuse than non-disabled girls (p = 0.041). Inconsistent condom use with casual partners (p < 0.001) and non-use of condoms during the last sexual activity (p < 0.001) was higher in IIL. The I-Change Model was most effective in predicting sexual abstinence among IIL, particularly regarding factors related to motivation and intention. Intellectually impaired learners were more vulnerable to HIV infection due to neglect, poverty, sexual abuse/exploitation, stigmatisation, pressure from non-disabled peers, denial of HIV education, and inaccessible HIV-related services. Teachers only provided them with sexuality and HIV education when sexual activity was suspected and/or from age 18. The content of such education comprised mainly warnings, misinformation and corporal punishment to instil fear and desexualise them. Thus, this group of learners was limited in the way they experienced and expressed their sexuality. Unlike with their non-disabled peers, teachers attributed sexual activity among IIL solely to natural urges without emotional involvement. Contrary to teachers‘ opinions, some IIL were involved in symbiotic, loving relationships with their II peers. In addition, those that were not yet in such relationships expressed the desire to find non-discriminatory partners in the future. They explored their sexuality through intimate relationships, sexual intercourse, peeping at the opposite sex, pornography, and masturbation. Condoms were less available to IIL than ML, and they lacked the self-efficacy to use them. They were also less available to II girls than II boys. Female learners with intellectual impairment often had older sexual partners due to sexual abuse/exploitation, unlike their non-disabled peers, who embarked on such relationships for financial/material gains. The findings of this study indicated that IIL were sexual beings, just like their non-disabled peers, and at higher risk of HIV infection than the latter. Stigma and discrimination are the root causes of all the disadvantages/barriers that IIL experience in accessing HIV information, education and related services. Therefore, there is the need to put stigma reduction strategies in HIV response to safeguard the health of IIL. In addition, there is a need for the development of a gender-sensitive, tailored sexuality and HIV/AIDS educational format for learners with intellectual disability in Nigeria. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.

The study aimed at investigating the impact of alcohol on the sexual behaviour of male adolescents, with the purpose of establishing whether a relationship exists between alcohol use and risky sexual behaviour (i.e. multiple partners, unprotected, and unplanned sex) by adolescent males. Data was collected by means of an anonymous, self-administered questionnaire. The sample consisted of 176 male high school learners, aged between 14 and 25, from one school in the Nkonkobe Municipality, Eastern Cape Province. The Statistical Package for Social Sciences (SPSS) was used to obtain data analyses which included descriptive statistics and cross-tabulation (with specific reference to Chi-square analysis), and all procedures were performed at 0.05 level of significance with 95% Confidence Interval. A relationship between alcohol use and risky sexual behaviour was found to exist. A statistically significant correlation was found in support of the alcohol/risky sex hypothesis. Another significant finding was the increase noted in safer sex practises among adolescents. Finally, the findings were correlated to implications.

PhD (Public Health) / Department of Public Health / The well-being of adolescents’ population is a major concern to policy makers, educators and researchers all over the world. Research has shown that adolescents engage in deviant and risky sexual behaviour, and such behaviour may have consequences for their present or future health. Likewise, it has been shown that adolescents are also known to conform to societal norms if they are given proper guidance. In the light of this, the present study proposed to explore and explain the influence of family dynamics in the occurrence of adolescents deviant and sexual risk behaviour. This study involved a sequential explorative, descriptive and analytic mixed method design, combining both qualitative and quantitative research approaches. The study was divided into three (3) phases. Phase 1 was purely qualitative in nature, where a total of 10 parents and 13 adolescents were engaged in an in-depth interview. Phase 2 was quantitative in nature, using a cross-sectional analytic design involving 388 adolescents, while Phase 3 was the development of a public health intervention to mitigate the influence of family dynamics on adolescent deviant and sexual risk behaviour. The qualitative data were analysed using thematic content analysis, while the quantitative data were analysed using the Statistical Package for Social Sciences (SPSS) version 22. The Chi-square test, Fisher’s exact test, multinomial and binary logistic regression were used to compare differences between the dependent and independent variables. The level of statistical difference was set at p<0.05. Couple conflicts was a common finding in the study. In addition, many families suffered severe financial constraints and some parents were disconnected from their children physically, emotionally and financially (particularly the fathers). Adolescents claim that the age difference between them and their parents remains a barrier to communication, in addition, some participants claimed that they received little or no sex education from their parents. The present study found a high level of recent physical violence (30%), alcohol (52.9%) and drug use (10%) among participants. The level of sexual activity in this study was high, with 60.1% of the participants being sexually active and 23.1% having been pregnant. In addition, only 35.6% using condoms regularly. There was gender difference among participants on the following variables: cigarette smoking, teenage pregnancy and having multiple sexual partners. Furthermore, participants differed significantly across age group on the following variables: cigarette smoking, sexual activity, having friends who are sexually active, reported pregnancy and currently having iii a relationship. However, ‘relationship with mother’ was the family dynamic variable that recorded a wider effect on deviant and sexual risk behaviour. Furthermore, age, duration of stay in the community, living with siblings, relationship with mother, having enough money at home, being supported emotionally at home and parental love for each other, were predictors of deviant and sexual risk behaviour in the present study. There was also low level of risk perception and low level of skill for self-protection among the participants. As part of the objectives of the present study, the study findings were used to develop an evidence-based public health programme targeted at vulnerable adolescents and adolescents at high risk for deviant and sexual risk behaviour. It is hoped that this programme will be able to empower parents and caregivers to apply better parenting practices to forestall undue exposure of adolescents to factors that contribute to deviant and sexual risk behaviour. The present study demonstrated that although adolescents have the propensity for deviant behaviours, many may transit to adulthood without much adverse sequelae even in the face of harsh family social and economic adversities. However, a proportion of the adolescent population in this community remains vulnerable due to the effects of family de-structuring, poverty and unemployment. / NRF