3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Enrollers’ perceptions of communication during informed consent at a South African tuberculosis research site(2018) Nolle, SamanthaThe informed consent process (ICP) in clinical trials is an interaction of communication: one in which important information should be adequately conveyed by the enroller and sufficiently understood by the potential participant. However, barriers to effective communication are often encountered during the process and result in participants’ comprehension of information being compromised. This study aimed to use qualitative methods to explore the reported experiences of thirteen enrollers involved in the ICP pre- and post- the implementation of a communication training programme in a Human Immunodeficiency Virus (HIV) and tuberculosis (TB) research study in Rustenburg, South Africa. The communication training programme aimed to improve communication processes during the ICP and enhance participant comprehension of information. This study used journaling and FGDs as data collection methods. Inductive thematic analysis was used to explore the reported experiences of enrollers during the ICP, and to identify perceived barriers and facilitators to communication during these interactions. Findings revealed language-, procedure- and participant-related facilitators and barriers. Furthermore, communication and language strategies employed by enrollers to overcome reported barriers were discussed. Several strategies paralleled the communication and language skills taught during the communication skills training. Many of these strategies were found to facilitate communication processes within the enroller-participant interaction, improve understandings of the informed consent form (ICF) and obtain proper informed consent. These findings confirm that enrolment is a complex process impacted by many variables. Keywords: informed consent, communication, enrollers, clinical researchItem Factors that affect and influence condom use among young black men during sexual intercourse(2017) January, Sandra LongHIV/AIDS is a social epidemic that continues to impact the lives of countless young people in Southern Africa and possibly poses one of the biggest threats to adolescent health and sexuality; and is one of the main challenges faced by youth in their transition to adulthood. However, despite the fifteenth year running of the South African government’s HIV/AIDS programme, prevalence rates continue to increase annually pointing to disjuncture between government intervention and the causal mechanisms involved in the spread of HIV/AIDS. Furthermore, literature on men’s sexuality in Southern Africa remains embedded within a ‘predatory masculinity and female vulnerability’ paradigm which results in a gendered analysis of HIV/AIDS and a side-lining of the male perspective which then places young men at a high risk of HIV infection. Therefore, in an attempt to understand the disconnect between literature and high prevalence rates; and to contribute to a better understanding of men’s health and sexuality, a qualitative study using focus group discussions and in-depth interviews was conducted amongst young black heterosexual men (19- 25 years old) to discover the factors that determine condom use among young men living in an RDP housing settlement in Daveyton on the East Rand of Johannesburg. The research findings show that condom use in the sample is predicated upon the young black heterosexual men’s definition of masculinity, the nature of the sexual relationship and sexual partner, and – to a lesser extent - the social accessibility of the condom. As they move from adolescence to adulthood, there is a transition of their understanding of masculinity from one characterized by promiscuous sexual behavior where the use of condoms is seen to diminish the degree of one’s masculinity, to a masculinity fostered by responsible sexual behaviour and accompanied by condom use. The study also found that young men expressed a distance from the supposedly hegemonic view of violent masculinity and male dominance in sexual relationships and that the search for love and the ability to provide for one’s partner was what was most valued in young men’s self -conception of masculinity and sexuality. This then negatively impacted condom usage in romantic relationships as such relationships were perceived to contain less risk and it was assumed that they are predicated on trust; positing love as the biggest barrier to condom use. Furthermore, the study found that although condoms are physically and economically accessible, they are not socially accessible due to the stigma attached to sexual activity among adolescents – which results in a barrier to condom usage. Therefore, findings suggest that the government’s condom promotion programmes - based on the tenets of education (on the subject of pregnancy and sexually transmitted diseases) and physical accessibility of condoms - are largely inconsistent with the factors that determine condom use among young men. This implies that there is a need to develop tailored condom promotion programmes targeted at male sexualityItem A longitudinal study of migration and it relation to AIDS/TB mortality in rural South Africa(2017) Afolabi, Sulaimon AtolagbeBackground: In exploring the relationship between migration and HIV/AIDS, a focus of earlier studies was on the role of the mobile population in the geographical spread of the disease. There has been a shift in this perception and the focus now is on the implications of being a migrant. A body of literature has developed on the risk of migrants contracting HIV, but only a few studies have examined the AIDS/TB mortality risk as a consequence of migration, with the results showing that migrants have higher chance of dying of AIDS/TB compared to their non-migrant counterparts. However, these studies mainly looked at the impact of migration on mortality due to AIDS/TB and did not make provision for the presence of other causes of death. Therefore, this study is geared towards investigating migration as it relates to death caused by AIDS/TB, longitudinally, and in the presence of other causes such as non communicable diseases, other infectious diseases, and external causes of death, in rural South Africa. Specifically, the study addressed the following questions: (i) What is the risk of dying from AIDS/TB among migrants in rural South Africa in the presence of other causes of death? (ii) How does this relationship compare with the relationship between migration and other causes of death? (3) What are possible predictors of the relationship between migration and AIDS/TB in the presence of other causes of death? Method: This research project is part of a longitudinal study of the inhabitants of the Agincourt sub-district, situated in the rural north-eastern part of South Africa. The study utilises the Agincourt Health and Demographic Surveillance System data spanning 12 years, starting from 1st January, 2000 to 31st December, 2011. The main target group for the study is individuals aged 20 to 69 years at the date of analysis. The selected individuals are divided into the following categories: (i) the return migrants who returned after spending a period of time outside the study area; (ii) the in-migrants who moved into the study location for the first time, and (iii) the permanent residents (non migrants). A six month residence threshold period is used to distinguish participants from ordinary visitors. The migration status categorical variable was further expanded from three to five categories with in-migrant and return migrant categories being split to accommodate short and long-term durations of exposure. In the year 2000, the baseline year, a total of 25,621 individuals who met the entry criteria were recruited into the study. For data analysis, a Fine and Gray model is used, which is a variant of a Cox proportional hazard model, to estimate the competing risk of dying among the selected participants by sex. The causes of death (CoD) variable was categorised into the following broad categories: “AIDS/TB”, “Non Communicable Disease”, “External cause” and “Other infectious disease”, with indeterminate causes coded as missing. The five categories of migration serve as the independent variable, with permanent residence acting as the reference group, while the broad Cause of Death categories are the main dependent variables. Other dependent variables are: period, nationality, education and socio-economic status. Results: This first set of results aims to address the question on the risk of AIDS/TB mortality among migrants in rural South Africa in the presence of other causes of death. The findings are that male and female short-term return migrants have significantly higher relative risk of dying of AIDS/TB death when compared to their non-migrants counterparts with sub-hazard ratio (SHR) of 4.87 (95% CI 4.17-5.72; P<0.001) and 5.44 (95% CI 4.64-6.38; P<0.001)) reported for both gender group respectively. For male and female long-term return migrants, their SHR was 1.80 (95% CI 1.43-2.26; P<0.001) and 2.06 (95% CI 1.57-2.70; P<0.001) respectively. The results did not reveal significant results for the in-migrants. The second set of results aims to address the second research question, which is, how does the relationship between migration and mortality caused by AIDS/TB in rural South Africa in the context of other causes of death compare with the relationship between migration and causes different from AIDS/TB. The results show that Short-term return migrants have higher mortality than non-migrants, whatever the four causes of mortality. For instance, the competing risk of death due to AIDS/TB for short-term return migrants compared to non-migrants showed a lower SHR for external cause of death, namely 8.78 (95% CI 5.86-13.16; P<0.05) vis-à-vis non-migrants. This implies that the difference in the relative risk of mortality between migrants and non migrants is even higher for external causes than for AIDS/TB. The same is applicable to the risk of death from other infectious diseases for females, which has a SHR of 4.97 (95% CI 2.50-9.89; P<0.05) in the competing risk model. The relative risk of death due to AIDS/TB for male is 4.87 (95% CI 4.14-5.72 P<0.001) while that of female is 5.44 (95% CI 4.64-6.38; P<0.001); respectively. With regards to the question on the possible predictors of the relationship between migration and AIDS/TB in the presence of other causes of death, it is shown that period is one of the predictors of the relationship between migration and AIDS/TB mortality. And, it is relevant to the study participants who died as a result of AIDS/TB, NCDs and other infectious diseases. In general, the risk dwindles in the latter period when the antiretroviral drugs become available for AIDS/TB. Nationality is also a determinant of the relationship and it is applicable to those who lost their lives due AIDS/TB (female only), NCDs and other infections (female). In all, the Mozambican nationals are less likely to die in comparison with the South Africans. Educational status is a predictor and it relevance cuts across virtually all the causes of death. The dominant pattern that is revealed in this context is that the higher the level of education, the lower the risk of death due to any of the causes. The predictive impact of SES can only be felt among the respondents whose death was due to AIDS/TB and NCDs (female only). Conclusion: With circular labour migration in South Africa showing no evidence of declining and with the attendant mortality risks due to AIDS/TB and other causes, and needs to be carefully considered - in policies aiming to control mortality in South Africa. Disease-induced migration creates burdens not only for the left-behind families in terms of their means of livelihood through loss of remittances, but also for the burden on health care facilities in the rural area. With short-term labour migrants being a high risk group, the success of intervention programmes addressing the problem of HIV infection and the resultant mortality implication, such as ‘treatment as prevention’ programmes, can only be guaranteed by recognising the risks incumbent on this group of people and the influence of the larger communities.