2 Declaration I, the undersigned, hereby declare that the work contained in this thesis is my own work and that I have not previously submitted it to any other university for degree purpose. Signature: ___________________ Dr Kanku3 Abstract Background

IntroductionReligion is important in most African communities, but faith-based HIV prevention programmes are infrequent and very rarely evaluated.ObjectiveThe aim of this study was to evaluate the effectiveness of a church-based peer education HIV prevention programme that focused on youth.DesignA quasi-experimental study design compared non-randomly chosen intervention and control groups.SettingThis study was conducted in the Cape Town Diocese of the Anglican Church of Southern Africa.ParticipantsThe intervention group of 176 teenagers was selected from youth groups at 14 churches and the control group of 92 from youth groups at 17 churches. Intervention and control churches were chosen to be as similar as possible to decrease confounding.InterventionThe intervention was a 20-session peer education programme (Fikelela: Agents of Change) aimed at changing risky sexual behaviour among youth (aged 12–19 years). Three workshops were also held with parents.Primary and secondary outcome measuresThe main outcome measures were changes in age of sexual debut, secondary abstinence, condom use and numbers of partners.ResultsThe programme was successful at increasing condom usage (condom use score 3.5 vs 2.1; p=0.02), OR 6.7 (95% CI 1.1 to 40.7), and postponing sexual debut (11.9% vs 21.4%; p=0.04) absolute difference 9.5%. There was no difference in secondary abstinence (14.6% vs 12.5%; p=0.25) or with the number of partners (mean 1.7 vs 1.4; p=0.67) and OR 2.2 (95% CI 0.7 to 7.4).ConclusionAn initial exploratory quasi-experimental evaluation of the Agents of Change peer education programme in a church-based context found that the age of sexual debut and condom usage was significantly increased. The study demonstrated the potential of faith-based peer education among youth to make a contribution to HIV prevention in Africa. Further evaluation of the effectiveness of the programme is, however, required before widespread implementation can be recommended.

The South African National Development Plan expects the family physician to be a leader of clinical governance within the district health services. The family physician must also help to strengthen the services through leadership in all his/her other roles as a clinician, consultant, capacity-builder, clinical trainer and champion of community-orientated primary care. In order to deliver on these expectations the nine training programmes must ensure that they prepare registrars appropriately for leadership and clinical governance. Currently training programmes differ considerably in what they teach and in workplace-based training and assessment. This article reports on a national process to reach consensus on what training is required for family physicians in this area. The process outlined the key conceptual principles and competencies required for leadership, clinical and corporate governance; it culminates in a new set of learning outcomes for the training of family physicians.

Background: Faith-based organisations (FBOs) are potentially an important role-player in HIV prevention, but there has been little systematic study of their potential strengths and weaknesses in this area.Objectives: To identify the strengths and weaknesses of FBOs in terms of HIV prevention. The questions posed were, (1) ‘What is the influence of religion on sexual behaviour in Africa?’,and (2) ‘What are the factors that enable religion to have an influence on sexual behaviour?’.Method: A literature search of Medline, SABINET, Africa Wide NIPAD and Google Scholar was conducted.Results: The potential for Faith-based organisations to be important role-players in HIV prevention is undermined by the church’s difficulties with discussing sexuality, avoiding stigma, gender issues and acceptance of condoms. It appears that, in contrast with high-income countries, religiosity does not have an overall positive impact on risky sexual behaviour in Africa. Churches may, however, have a positive impact on alcohol use and its associated risky behaviour, as well as self-efficacy. The influence of the church on sexual behaviour may also be associated with the degree of social engagement and control within the church culture.Conclusion: Faith-based organisations have the potential to be an important role player in terms of HIV prevention. However, in order to be more effective, the church needs to take up the challenge of empowering young women, recognising the need for their sexually-active youth to use protection, reducing judgemental attitudes and changing the didactical methods used.

<strong>Background:</strong> HIV/AIDS makes the largest contribution to the burden of disease in South Africa and consistent condom use is considered a key component of HIV-prevention efforts. Health workers see condoms as a straightforward technical solution to prevent transmission of the disease and are often frustrated when their simple advice is not followed.<p><strong>Objectives:</strong> To better understand the complexity of the decision that women must make when they are asked to negotiate condom use with their partner.</p><p><strong>Method:</strong> A literature review.</p><p><strong>Results:</strong> A key theme that emerged included unequal power in sexual decision making, with men dominating and women being disempowered. Women may want to please their partner, who might believe that condoms will reduce sexual pleasure. The use of condoms was associated with a perceived lack of &lsquo;real&rsquo; love, intimacy and trust. Other factors included the fear of losing one&rsquo;s reputation, being seen as &lsquo;loose&rsquo; and of violence or rejection by one&rsquo;s partner. For many women, condom usage was forbidden by their religious beliefs. The article presents a conceptual framework to make sense of the motivational dilemma in the mind of a woman who is asked to use a condom.</p><p><strong>Conclusion:</strong> Understanding this ambivalence, respecting it and helping women to resolve it may be more helpful than simply telling women to use a condom. A prevention worker who fails to recognise this dilemma and instructs women to &lsquo;simply&rsquo; use a condom, may well encounter resistance.</p><p><strong>How to cite this article:</strong> Mash R, Mash B, de Villiers, P. &lsquo;Why don&rsquo;t you just use a condom?&rsquo;: Understanding the motivational tensions in the minds of South African women. Afr J Prm Health Care &amp; Fam Med. 2010;2(1), Art. #79, 4 pages. DOI: 10.4102/phcfm.v2i1.79</p>