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HIV and alcohol prevention programmes to delay sexual initiation and alcohol use by learners have been shown to be effective interventions in high schools. However, the interplay of the interventions and the background characteristics of learners in preventing sexual initiation and alcohol use have not been examined. In this study, we examine the contribution of background characteristics of learners in HIV and alcohol prevention programme. Data were drawn at two time points from a cohort of 1259 and 1076 grade 9 learners. Generalized linear mixed models were used to predict the effects of background characteristics on alcohol consumption and sexual initiation. The results show that alcohol consumption increased from 34.6% to 39.9% between the two points among the learners. Between the two time points, prevalence of sexual intercourse rose from 31.1% to 37.7%. Background characteristics such as increasing age, being a male, absenteeism from school, importance of religion and average grade point predicted alcohol use. Sexual intercourse was significantly associated with increasing age, being a male, absenteeism from school and importance of religion. The study concludes that HIV and alcohol prevention strategy targeting learners should take serious consideration of their background characteristics for a more effective intervention programme.Keywords: Alcohol, HIV, sexual risk behaviours, learners, South Africa

Problem statement: Sexual and reproductive decision-making has emerged as an important health indicator as husbands dominate in family reproductive health issues and continue to be the greatest source of sexually transmitted infections including HIV to their wives. While there is evidence of male dominance in sexual and reproductive health decision, the role of socio-demographic factors on women's control over their sexuality is not well understood. Using the theory of gender and power, it was conceptualized that socio-cultural and socio-economic factors influence women's control over their sexuality. Objectives: The aim of this study was to investigate the extent to which women in marital and cohabiting unions have control over their sexuality and implications on reproductive health. Method: To achieve this purpose sexual and reproductive health decision-making survey of 568 respondents and 33 in-depth interviews was conducted among married and cohabiting women in Mahikeng, South Africa in 2012. Data were collected on respondents' socio-demographic characteristics and reproductive health matters under which the relationship exits. Quantitative data were analyzed using descriptive and logistic regression analyses. Qualitative information was analyzed manually using thematic content analysis approach. Result: The data reveals that unemployed women and those in traditional union were less likely to agree that women can demand or reject sex from their husbands. Rural women and those in arranged marriages showed lack of autonomy in decisions on when to have sex and family size. Gap in knowledge of condom efficiency and the usage seems to stem from lack of spousal communication. Qualitative data revealed that sexual control are intertwined with cultural, religious belief and perception that husbands have sexual right over their wives. Fear of accusation and violence impaired the ability of women to suggest condom use to their partners. Conclusion: It may be concluded that limited control women had over their sexuality (sexual and reproductive health decision-making) stemmed from poor economic status, cultural gender norm and patriarchal dominance. These may have negative implications on women's sexual and reproductive health. Recommendation: Sexual and reproductive health decision-making in marital or cohabiting relationships cut across secular, cultural and religious domain. Government strategy to improve married women's control over sexuality need partnerships of their husbands, traditional and religious leaders which should focus on empowering women with income earning skills and bridging sexual communication gap between couples. Thesis (PhD (Population Studies) North-West University, Mafikeng Campus, 2014

Thesis (PhD (Population Studies) North-West University, Mafikeng Campus, 2014 Problem statement: Sexual and reproductive decision-making has emerged as an important health indicator as husbands dominate in family reproductive health issues and continue to be the greatest source of sexually transmitted infections including HIV to their wives. While there is evidence of male dominance in sexual and reproductive health decision, the role of socio-demographic factors on women's control over their sexuality is not well understood. Using the theory of gender and power, it was conceptualized that socio-cultural and socio-economic factors influence women's control over their sexuality. Objectives: The aim of this study was to investigate the extent to which women in marital and cohabiting unions have control over their sexuality and implications on reproductive health. Method: To achieve this purpose sexual and reproductive health decision-making survey of 568 respondents and 33 in-depth interviews was conducted among married and cohabiting women in Mahikeng, South Africa in 2012. Data were collected on respondents' socio-demographic characteristics and reproductive health matters under which the relationship exits. Quantitative data were analyzed using descriptive and logistic regression analyses. Qualitative information was analyzed manually using thematic content analysis approach. Result: The data reveals that unemployed women and those in traditional union were less likely to agree that women can demand or reject sex from their husbands. Rural women and those in arranged marriages showed lack of autonomy in decisions on when to have sex and family size. Gap in knowledge of condom efficiency and the usage seems to stem from lack of spousal communication. Qualitative data revealed that sexual control are intertwined with cultural, religious belief and perception that husbands have sexual right over their wives. Fear of accusation and violence impaired the ability of women to suggest condom use to their partners. Conclusion: It may be concluded that limited control women had over their sexuality (sexual and reproductive health decision-making) stemmed from poor economic status, cultural gender norm and patriarchal dominance. These may have negative implications on women's sexual and reproductive health. Recommendation: Sexual and reproductive health decision-making in marital or cohabiting relationships cut across secular, cultural and religious domain. Government strategy to improve married women's control over sexuality need partnerships of their husbands, traditional and religious leaders which should focus on empowering women with income earning skills and bridging sexual communication gap between couples. Doctoral

Background: Sexual and reproductive decision-making has emerged as an important health indicator in family reproductive health issues. While there is evidence of male dominance in sexual and reproductive health decisions, the role of socio-demographic factors on women’s decision to use contraception is not well understood. Aim: This study aimed at exploring the socio-demographic factors associated with married women’s decision-making to use contraception. Setting: The study was conducted in Mahikeng local municipality in the Modiri Molema District Municipality. Methods: Data were generated in Mahikeng from married and cohabiting women, aged 18–49 years, from a survey comprising 568 participants. Data were collected on women’s demographic characteristics and contraceptive behaviour. Descriptive, bivariate and multivariate analyses were used to examine factors related to decision-making on contraceptive use. Results: The result revealed that 57% of the participants were currently using contraception and 45% stated jointly-made decision regarding the use of contraception. Decisions on use of contraceptives were associated with education, occupation, religion, duration of union and home language. Other factors associated with decision-making on contraceptive use were perception on husband’s right to sex, use of force for sex and spousal communication about sex. Conclusion: Empowering women to use contraception to meet their fertility desire should aim at improving their socio-economic status and spousal communication. Family planning providers should recognise socio-cultural barriers under which the relationships exist and how women can navigate these contextual factors.