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Associations Between Sexual Risk Behaviours, and Certain Beliefs and Perceptions About Antiretroviral Therapy in Botswana

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Wilfrid Laurier University Scholars Commons @ Laurier Theses and Dissertations (Comprehensive) 2019 Associations between sexual risk behaviours, and certain beliefs and perceptions about antiretroviral therapy in Botswana Wayne Gill [email protected] Follow this and additional works at: https://scholars.wlu.ca/etd Part of the Health Policy Commons Recommended Citation Gill, Wayne, "Associations between sexual risk behaviours, and certain beliefs and perceptions about antiretroviral therapy in Botswana" (2019). Theses and Dissertations (Comprehensive). 2219. https://scholars.wlu.ca/etd/2219 This Dissertation is brought to you for free and open access by Scholars Commons @ Laurier. It has been accepted for inclusion in Theses and Dissertations (Comprehensive) by an authorized administrator of Scholars Commons @ Laurier. For more information, please contact [email protected]. Dissertation Associations between sexual risk behaviours, and certain beliefs and perceptions about antiretroviral therapy in Botswana Author: Wayne Gill Submitted in partial fulfillment of the requirements for Doctor of Philosophy in Global Governence At The School of International Policy and Governance Wilfred Laurier University © Copyright Wayne Gill 2019 Abstract This study explored the association between sexually risky behaviour among individuals and their beliefs and perceptions regarding antiretroviral therapy or ART. Specifically, the paper examined the treatment optimism aspect of ART- that HIV is a less serious threat due to the availability of ART. In order to test this notion, the paper compared the behavior of those people who were HIV positive with those who were HIV negative. A second population subset also included in the comparative analyses were those aware of their HIV status and those unaware. To underline the prevalence of treatment optimism, the study also considered the link between ART, sexual risk behaviours and circumcision status following the 2009 implementation of the voluntary medical male circumcision (VMMC) programme in Botswana. The study leveraged secondary quantitative data from the Botswana AIDS Impact Survey, 2013 (BAIS IV) and included data from participants who completed an individual questionnaire; were aged 15-64 years old and had sexual experience. Findings from the BAIS IV showed statistically significant evidence to support treatment optimism especially among individuals who were unaware of their status. On the contrary, the co-relation between circumcision and treatment optimism were less conclusive. Interestingly, there were statistically significant relations “between treatment optimism among individuals who were circumcised,” as well as uncircumcised men. Those who were HIV-positive counter the treatment optimism argument as findings indicate that they were practicing sexual risk reduction. Findings from this paper can inform public health interventions by tailoring approaches that target specific sub-populations in the community. ii Dedication This dissertation is dedicated to Rita White, who was one of the bravest and most courageous people that I have known, leading by example and strength of spirit in her own exceptional way - Joshua 1:9. Acknowledgements The author would like to thank the Ministry of Health, National AIDS Coordinating Agency and Statistics Botswana for their support and use of the BAIS IV data. I would also like to acknowledge and thank my PhD Supervisory Committee members: Dr. Alan Whiteside: Professor, Wilfrid Laurier University and Balsillie School of International Affairs Waterloo, Ontario; Dr. Susan Horton: Professor, School of Public Health and Health Systems, University of Waterloo; and Dr. Zitha Mokomane: Associate Professor, Department of Sociology, University of Pretoria, South Africa for their helpful comments and insightful assistance. I would also like to thank Dr. Eduard Beck: Honorary Professor, London School of Hygiene & Tropical Medicine for his support. I would also like to thank all of my professors, staff and colleagues at the Balsillie School of International Affairs. I am so grateful for the support of my soul mate Barbara during this long journey. Your encouragement, patience, and understanding made this happen. To my son Jacob, I appreciate your love and support. Thank you so much. Statement of originality The work contained in this thesis has not been previously submitted for a degree or diploma at any other higher education institution. To the best of my knowledge and belief, the thesis contains no material previously published or written by another person except where due references are made. iii Table of Contents Abstract .............................................................................................................................................. ii Dedication .......................................................................................................................................... iii Acknowledgements ............................................................................................................................ iii Statement of originality ..................................................................................................................... iii Chapter 1 – Introduction ................................................................................................................... 1 1.1. Background .............................................................................................................................. 1 1.1.1 Context ............................................................................................................................... 2 1.1.2 ART and High Risk Sexual Behaviour ................................................................................. 6 1.2. Is ART replacing traditional prevention strategies in Botswana? ........................................... 8 1.2.1. Botswana .......................................................................................................................... 9 1.2.2. Rationale of the study .................................................................................................... 13 1.2.3. Academic Contribution .................................................................................................. 14 1.2.4. Societal Contribution ..................................................................................................... 14 1.3. Analytical Framework ........................................................................................................... 15 1.4. Literature Review .................................................................................................................. 16 1.4.1. ART ................................................................................................................................. 16 1.4.2. VMMC ............................................................................................................................ 18 1.5. Research aim and objectives ................................................................................................ 19 1.5.1. Research questions ........................................................................................................ 19 1.6. Research methodology ......................................................................................................... 20 iv 1.7. Research limitations ............................................................................................................. 22 1.8. Dissertation outline ............................................................................................................... 22 1.9. References ............................................................................................................................. 25 Chapter 2: Awareness of HIV status, treatment optimism and ART in Botswana .......................... 35 Abstract ........................................................................................................................................ 35 2.1. Introduction .......................................................................................................................... 36 2.2. Analytical Framework ........................................................................................................... 37 2.3. Methods ................................................................................................................................ 37 2.3.1. Data sources .................................................................................................................. 37 2.3.2. Measures ....................................................................................................................... 38 2.4. Ethical statement .................................................................................................................. 40 2.5. Results ................................................................................................................................... 40 2.5.1. Description of the sample .............................................................................................. 40 2.5.2. Awareness and knowledge of ART ................................................................................ 43 2.5.3. Personal beliefs about ART ............................................................................................ 43 2.5.4. Regression analysis .......................................................................................................
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