1. HIV/AIDS and Mental Health Issues for Deaf and Hard of Hearing Adolescents in South Africa Sumaya Mall 5 th International AIDS Society Conference, Cape Town 2009

2. Background In 2008, prevalence of HIV/AIDS in South Africa was 10.6% (HSRC, 2009) In 2008, prevalence of HIV/AIDS in South Africa was 10.6% (HSRC, 2009) Co-existing epidemic mental disorders Co-existing epidemic mental disorders Vulnerable populations in this context including adolescents (prevalence is 8.7%, HSRC, 2009) and disabled Vulnerable populations in this context including adolescents (prevalence is 8.7%, HSRC, 2009) and disabled Adolescents with a disability may be particularly vulnerable (Groce, 2007) Adolescents with a disability may be particularly vulnerable (Groce, 2007) Deaf Community (Bisol, 2008) Deaf Community (Bisol, 2008)

3. Background continued… Communication in the Deaf community Communication in the Deaf community HIV/AIDS education for the Deaf community. HIV/AIDS education for the Deaf community. Global uptake of VCT by the Deaf community is low Global uptake of VCT by the Deaf community is low Deaf communities are closed and sexual behaviour patterns are unknown Deaf communities are closed and sexual behaviour patterns are unknown Need for HIV/AIDS prevention programmes that also address mental health Need for HIV/AIDS prevention programmes that also address mental health Need for appropriate theoretical frameworks Need for appropriate theoretical frameworks

4. Aim Overall Aim: Overall Aim: To investigate the associations between common mental disorders, knowledge of HIV/AIDS and high risk sexual behaviour in adolescents who are deaf in South Africa To investigate the associations between common mental disorders, knowledge of HIV/AIDS and high risk sexual behaviour in adolescents who are deaf in South Africa

5. Objectives Theory of Planned Behaviour Theory of Planned Behaviour Qualitative research will pre-empt and inform the development of an appropriate questionnaire to answer the aim. Qualitative research will pre-empt and inform the development of an appropriate questionnaire to answer the aim. Views of policy makers, parents, educators and deaf adolescents themselves will be extracted Views of policy makers, parents, educators and deaf adolescents themselves will be extracted Points of importance to be included in the questionnaire Points of importance to be included in the questionnaire Differences between the deaf adolescents who sign and those that speak will be extracted. Differences between the deaf adolescents who sign and those that speak will be extracted.

6. Motivation and Impact Study will address the role of mental disorders in precipitating high risk sexual behaviour amongst deaf and hard of hearing adolescents Study will address the role of mental disorders in precipitating high risk sexual behaviour amongst deaf and hard of hearing adolescents Study will inform tailored HIV/AIDS prevention programmes for the deaf and hard of hearing. Study will inform tailored HIV/AIDS prevention programmes for the deaf and hard of hearing.

7. Methods Qualitative research through in depth interviews that pre-empts the questionnaire In depth interviews with policy makers, parents, educators and adolescents In depth interviews with policy makers, parents, educators and adolescents Open ended, appropriate interview guides Open ended, appropriate interview guides Pre-existing questionnaire based on Theory of Planned Behaviour; some additions including mental health measurements from CES-D and Beck Depression Inventory Pre-existing questionnaire based on Theory of Planned Behaviour; some additions including mental health measurements from CES-D and Beck Depression Inventory

8. Methods continued… Measuring instruments will be translated into Xhosa and Afrikaans Measuring instruments will be translated into Xhosa and Afrikaans Assistance of sign language interpreter Assistance of sign language interpreter

9. Pilot Study Qualitative interview guides can be piloted Qualitative interview guides can be piloted Quantitative measuring instrument can be piloted at a school for the deaf in Johannesburg Quantitative measuring instrument can be piloted at a school for the deaf in Johannesburg

10. Analysis Qualitative research will be analysed by means of grounded theory/thematic analysis Qualitative research will be analysed by means of grounded theory/thematic analysis Quantitative aspects by STATA Version 8 Quantitative aspects by STATA Version 8 Chi Squared Analysis or independent t tests Chi Squared Analysis or independent t tests Level of significance: p = <0.05 Level of significance: p = <0.05 Independent variables = TPB constructs Independent variables = TPB constructs Dependent variables Dependent variables Univariate/Bi variate analysis will precede multi variate analysis Univariate/Bi variate analysis will precede multi variate analysis

11. Cost 10 000 USD 10 000 USD Including the cost of the sign language interpreter, travel costs, transcription and developing the measuring instrument. Including the cost of the sign language interpreter, travel costs, transcription and developing the measuring instrument.

12. Ethical Considerations Potential Benefits and Harms Potential Benefits and Harms Informed Consent Informed Consent Confidentiality (participants, transcriber, sign language interpreter) Confidentiality (participants, transcriber, sign language interpreter) Reporting of Results Reporting of Results

13. Acknowledgements Alan Flisher Alan Flisher Leslie Swartz Leslie Swartz John Joska John Joska Claudia Bisol Claudia Bisol Sharon Kleintjies Sharon Kleintjies Ashraf Kagee Ashraf Kagee Lesley Henley Lesley Henley