It is two decades since the start of the HIV/AIDS pandemic. Since then it has caused the death of millions and untold suffering to many more, especially in sub-Saharan Africa. Yet, while some Christian response soon developed, until a few years ago the majority of churches have struggled to recognise in this disaster a challenge to themselves. The last few years have seen a flurry of activity from churches and Christian agencies in this field. New AIDS ministries are springing up, often in a rather haphazard fashion. This study aims to establish what the response of churches and Christian groups in the Cape Town area is to the HIV/AIDS pandemic. The starting point for the response lies in the perceptions shaping the churches' AIDS discourse, since church activities are to a large degree discourse based. Hence the study starts with an investigation of the relationship between discourse and practice, paying special attention to the common metaphors and discourses used when referring to HIV/AIDS. Since the African context is crucial to the way HIV/AIDS is developing here, questions are posed to these discourses from an African point of view. The study further considers the type of programmes emerging from this discourse. A survey was conducted by questionnaire in the Cape Town area to collect information from 30 Christian service providers end denominations. The aim is to evaluate whether the response is appropriate to the needs, to our African context and to the churches' mission. It is my hypothesis that while the Christian contribution to AIDS services is valuable, it is in many respects not appropriate. To support this hypothesis the study develops criteria for an appropriate AIDS discourse, and based on that for an appropriate practical response to the HIV/AIDS pandemic. These were derived from relevant literature as well as a series of informal interviews with local AIDS activists. Finally, some pointers are given as to how the Christian response to HIV/AIDS could be developed on a solid theological foundation in order to offer a service that is more appropriate to the needs, to our African context and to the churches' mission.

Submitted in fulfilment of the requirements for the degree of MASTER of ARTS in Community Work in the Department of Social Work at the University of Zululand, South Africa, 2003. / This study is about the attitudes of primary care givers who are caring for HIV/ AIDS orphans in the Ingwavuma area. As an evaluative research semi-structured interviews were conducted. A sample of -twenty primary care givers was drawn, 10 files were drawn from the Department of Welfare and Population Development Office and 10 files were drawn from the local non-government organisation called Ingwavuma Orphan Care. Permission to use departmental files was sought from the department concerned. Related literature that focuses on a HIV/AIDS and Orphanhood has been reviewed. Various recommendations have been made based on the findings of the study. The findings indicate that a need exist for training on parenting and coping skills. HIV/AIDS orphans need to be involved in counselling especially on trauma counselling, this can help a lot in improving the relationship between primary care givers and vulnerable children.

Dissertation submitted in partial fulfillment of the requirements for the Degree Master of Arts in Counselling Psychology at the University of Zululand, South Africa, 2003. / The study investigated student behaviour and knowledge related to HIV/AiDS on the University of Zuluiand campus. Because of the social and economic conditions that exist in the country today such research is seen as both urgent and pertinent it is hoped that the study will add to the knowledge base generated by other studies conducted at tertiary institutions throughout South Africa. The study had certain assumptions, which have been supported by the results of the survey, it was postulated that women students wouid be more conservative in sexual behaviour than mate students and that femaies would be more accepting and empathetic towards People living with HiV/AIDS (PLWHA). The study also predicted that there wouid be a segment of the student population who would reveal a dissonance between attitudes, knowledge and behaviours and also that a proportion of students of both sexes would reveal significant gaps in their knowledge about how HIV/AIDS is transmitted. These predictions are underpinned by the results and discussion thereof, which places them within the context of early 21st century South African society.

Submitted in partial fulfillment of the requirements for the MASTER OF EDUCATION (EDUCATIONAL PSYCHOLOGY) UNIVERSITY OF ZULULAND, 2007. / This study investigates the perceptions of South African Police Service officials towards HIV/AIDS at Mthatha Central Accounting Police Station towards HIV/AIDS. Selection of the respondents was done through stratified random sampling. Data was obtained from a sample of 115 police officials. These officials were of different ranks from the level of Constable up to that of the Director of the South African Police Service. Male respondents were in the majority, and Grade 12 was the dominant highest qualification amongst the police officials. The main research instrument was a questionnaire. The questionnaire had three sections: the first was compiling profile, the second poses closed-ended questions generally requiring "yes/no" responses, and the third asks open-ended questions requiring perceptions about HIV/AIDS. Collection of data was done through semi-structured interview schedule. Data were analysed using Excel where tables and graphs were used for closed-ended questions, while themes were formed in the analysis of open-ended questions. The findings of the study revealed that the police officials had different impressions about HIV/AIDS Furthermore, police officials indicated that they would treat cases of HIV/AIDS differently and generally believe that condoms are not reliable

Os primeiros casos de Aids surgiram no início da década de 1980 provocando reações de medo, preconceito e impotência na população e também na comunidade científica. Estudos epidemiológicos indicaram, naquela época, maior incidência de casos entre indivíduos homossexuais estabelecendo, inicialmente, uma relação entre os casos de adoecimento e a conduta de integrantes de grupos historicamente marginalizados. Paralelamente, investigações clínicas demonstraram fragilidade imunológica entre os indivíduos acometidos e conduziram as pesquisas à descoberta de um agente infeccioso, o HIV (Human Immunodeficiency Virus). As mudanças na forma de compreender e descrever a epidemia de HIV/Aids acompanharam estes processos e passaram, por fim, a considerar condições materiais e subjetivas de vida como elementos estruturantes da vulnerabilidade à contaminação. Neste contexto, as relações de gênero e a submissão do feminino são elementos importantes para a discussão da vulnerabilidade entre mulheres e seus efeitos para as práticas de prevenção. Este estudo buscou identificar, no relato de gestantes soropositivas ao HIV, sentidos acerca de suas vivências na(s) relações conjugais, relações familiares e sociais, convivência com a soropositividade, saúde reprodutiva e a experiência da maternidade, analisando-os sob a perspectiva das relações de gênero e da vulnerabilidade feminina. Foram realizadas entrevistas individuais com dez gestantes soropositivas ao HIV em atendimento pré-natal junto ao Ambulatório de Moléstias Infecciosas em Ginecologia e Obstetrícia (AMIGO) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto USP (HCFMRP-USP), serviço público de saúde e referência para a região. Os resultados apontam que dificuldades para distribuição do poder nas relações de gênero e a precarização das condições de vida são elementos estruturantes do processo de vulnerabilização ao contágio por HIV; há ainda rompimento de relações sociais e descontinuidade das perspectivas de vida em decorrência do medo do preconceito e da morte provocados pelo diagnóstico de soropositividade e um esforço para o redimensionamento do cuidado com os filhos, além de estratégias para reorganização da vida que vão se configuram ao longo do processo de enfrentamento ao contágio. Na maioria dos casos analisados, as mulheres reconhecem a si como vítimas da ação de seus parceiros, culpando-os pelo contágio. Aponta-se a necessidade de reestruturação das práticas de saúde no atendimento a mulheres soropositivas ao HIV, considerando a necessidade de fortalecimento de seus recursos cognitivos e afetivos para o enfrentamento das vicissitudes do contágio e consequente ruptura com a naturalização como vítimas. Dentre as estratégias para o fortalecimento destas mulheres, a discussão de sua apropriação do processo do contágio e a problematização do aceite tácito da pretensa superioridade masculina e das exigências do parceiro ou da família, são propostas para que se reconheça a passividade feminina como elemento que vulnerabiliza as mulheres, além de fragilizar práticas preventivas (CAPES). / The first AIDS cases appeared at the begining of 1980s provoking fear reactions, prejudice and impotence on the population and also on the scientific community. Epidemical studies indicated, in that time, a larger number of cases incidence among homosexual individuals demonstrating, at the beginning, a relationship between the illness cases and the group integrals marginal behaviour historically. Parallel, clinical investigations demonstrated immunology weakness among the onset individuals and conducted the researches to find out an infectious agent, HIV (Human Immunodeficiency Virus). Changes on the form of understanding and describing the HIV/AIDS epidemic followed these processes and at the end turned into considering material and subjective conditions of life as structural elements of the vulnerability among women and its effects for the prevention practices. This study searched to identify, concerning to HIV-positive pregnant women, considering their married, family and social relationship life history, familiarity with positive serum, reproductive health and maternity experience, analysing them under a perspective of female gender vulnerability relations. Individual interviews with ten HIV-positive pregnant women, who were pre-natal assisted in a gynaecology and obstetrics infectious deseases ambulatory (AMIGO) in Hospital das Clinicas da Faculadae de Medicina de Ribeirão Preto USP (HCFMRP-USP), a public health service as well as a reference for the region, were carried out. The results show that difficulties to the power distribution on gender relations and precariousness conditions of life are structural elements of HIV vulnerabity; yet there is a break of social relations and life perspectivity discontinuity due to prejudice and fear of death coming from the positivity serum and also an effort to redeem their childrens care, besides strategies to reorganize their lives occurences that will appear together with facing the contagion process. In the majority of the analysed cases, these women recognize themselves as being her partners actions, victims, blaming them for the contagion. Practice structures needs, in health attendance to these women, are pointed out, considering the necessity to reenforce their cognitive and affective resources, in order to face contagion vicissitudes and consequently rapture with the naturalization as victims. Among the strategies to the reenforcement of these women, the discussion of their appropriation contagion process as well as the assumed male superiority tacit acceptance problematic and families and husbands demandings are proposals to female passiviness as an element of women vulnerability, besides weakening preventive practices (CAPES).

O trabalho voltado à saúde tem recebido uma atenção especial em dois enfoques: a humanização do atendimento e a formação de equipes multidisciplinares. A primeira propõe a valorização da dimensão psicossocial do atendimento, processo amplo, complexo, que passa pela quebra de protocolos, como a relação de autoridade entre profissional e paciente; a formação de equipes multidisciplinares encontra dificuldades inerentes ao caráter racional das ciências especializadas, que fragmenta o saber, perdendo a visão de totalidade. Promover a humanização e o trabalho multidisciplinar, foi a proposta de uma equipe atuando em uma academia de ginástica, criada para atender portadores de HIV/Aids. Formada por alunos e profissionais da Educação Física, Fisioterapia, Nutrição e Psicologia, a equipe reunia-se para discutir aspectos técnicos e psicossociais referentes ao atendimento. O presente estudo teve como objetivo identificar elementos relacionados à apropriação do trabalho, produção de conhecimento derivado do atendimento prestado, e seus desdobramentos para a formação do profissional envolvido. Entrevistas individuais, realizadas junto aos participantes da equipe, permitiram a identificação de conteúdos referentes à avaliação do trabalho realizado, cujos significados foram, posteriormente, agrupados em categorias temáticas: a) Integração, cujos conteúdos se referiam à interação na equipe e desta com as pessoas atendidas; b) Produção do Conhecimento, envolvendo elementos para a construção do saber dentro da equipe, enquanto produto da apropriação da experiência informal ou acadêmica; c) Avaliação, enquanto crítica e autocrítica sobre o trabalho realizado, em função de metas não atingidas ou relacionadas ao trabalho multidisciplinar; d) Perspectivas, ou propensões para a continuidade das atividades, sejam no programa ou na carreira profissional. Tais categorias temáticas, enquanto elementos subsidiários á criação de um background para o atendimento humanizado em saúde, apontam para necessidades de mudanças importantes nos processos de formação em saúde, envolvendo formas de apropriação do trabalho no interior das equipes multidisciplinares. / The work directed to health has received special attention in two approaches: the humanization of health service and the formation of multidisciplinary teams. The first one is considered to ad value to the psychosocial service, a wide and complex process which goes through protocol breaks, such as, the relation between professionals and patients; the formation of multidisciplinary teams finds difficulties inherent to the rational aspect of specialized sciences, that breaks up knowledge, losing the global vision. To promote the humanization and multidisciplinary approach was the proposal of a team working in a health club, established to take care of HIV/Aids patients. Created by students and professionals from Physical Education, Physiotherapy, Nutrition and Psychology, the team congregated itself to discuss technical and psychosocial aspects referring to the service. The present study had as a purpose, to identify elements related to the appropriation of work, knowledge production derived from the service, and its developments to the formation of involved professionals. Individual interviews, carried through the team´s participants, allowed the identification of contents referred to the evaluation of work covered, whose meanings were, later, grouped in thematic categories: a) Integration, whose contents related to the teams interaction and its interaction with the people taken care of; b) Knowledge production, involving elements to the construction of knowledge in the team, while a result of the appropriation of informal academic experience; c) Evaluation, while critical and self-critical on the carried work, either as a matter of unreached goals or not related to multidisciplinary work; d) Perspectives, or propensities for the continuity of the activities, either in the program or in the professional career. Such thematic categories, while subsidiary elements to the creation of a humanized service background in health, point to necessary and important changes in the process of health formation, involving forms of appropriation work inside the multidisciplinary teams.

A fragmentação do trabalho em saúde, atualmente, tem sido muito estudada. Os estudos apontam que esta além de esvaziar o trabalho de sentido, gerando conseqüências emocionais para os profissionais, trás repercussões na vida dos pacientes, uma vez que, entre outras coisas, prioriza os aspectos técnicos do atendimento em detrimento dos aspectos psicossocias. Considerando que a infecção ao HIV trás desdobramentos psicossociais na vida da pessoa contaminada, a atuação voltada para estes aspectos torna-se primordial. Assim sendo, este estudo tem como objetivo recuperar a síntese do processo de trabalho em HIV/Aids a partir dos profissionais envolvidos neste processo. Dentro da abordagem de pesquisa qualitativa foram realizadas 10 entrevistas com profissionais da Unidade Especial de Tratamento de Doenças Infecciosas do HC de Ribeirão Preto. Estas foram semi-estruturadas e realizadas segundo procedimentos de evocação-enunciação-verificação. As falas dos profissionais foram agrupadas conforme as semelhanças de seus conteúdos temáticos e analisadas à luz do materialismo histórico. Os dados mostraram que três Elementos constituem a síntese do processo de trabalho em HIV/Aids: Elementos de Competência Psicossocial; Elementos de Controle Sócio-Político e Administrativo; Elementos de Competência Técnica. Embora os profissionais estudados tenham privilegiado em suas reflexões os Elementos de Competência Psicossocial, a dicotomia entre habilidade técnica e competência psicossocial se faz presente na atuação. Todavia com novas configurações, pois não há a negação destes aspectos e estes não pareceram ser relegados a segundo plano. No entanto, as reflexões apontaram a dificuldade da atuação contemplando plenamente estes aspectos. Estas dificuldades embora tenham como fundamento a fragmentação do saber, conseqüentemente associam-se a estruturação do serviço que se liga às formas protocolares de controle do trabalho em todos os seus níveis. Desta forma, o trabalho se dá a partir da complementariedade de abordagens. Esta fragmentação, além de prejudicar a qualidade do atendimento prestado, dificulta o sentimento de apropriação do trabalho por parte do profissional. Assim sendo, consideramos que a sistematização da aprendizagem informal decorrente da atuação seria uma das alternativas para esta questão. Esta tornaria os profissionais mais ativos no processo de trabalho o que favoreceria a apropriação deste e tornaria a equipe de trabalho mais coesa, uma vez que juntos, os profissionais estariam construindo sua práxis. Além disto, este estudo nos deu a visibilidade que, em algumas situações, a relação estabelecida entre profissional e paciente propicia esta aprendizagem. No entanto, sabemos que a implementação de tal proposta não será fácil, haja visto que rompe com o modelo de atuação vigente e com a estruturação do ensino em saúde, no qual o saber é compartimentado não havendo espaço na atuação para os sentimentos dos profissionais nem dos pacientes. No entanto, observamos que estes sentimentos, entre outras coisas, tem que ser o pano de fundo da atuação. Desta forma, consideramos também, que se faz necessária a discussão em grupo dos sentimentos suscitados pela atuação, pois estes seriam socializados e discutidos entre pessoas que passam pelas mesmas vivências. Isto minimizaria os desdobramentos destes na vida dos profissionais e favoreceria a atuação voltada para os aspectos psicossociais. / Nowadays the fragmentation of health work has been studied a lot. Studies point out that besides giving no sense to work, fragmentation brings emotional consequences to healthcare professionals and results in changes into patients life, because it privileges the technical aspects of care in detriment of psychosocial aspects. Considering that HIV infection results in many psychosocial problems to people living with HIV/Aids, it is primordial to give more attention to these aspects. Therefore, this study aims the recuperation of HIV/Aids work process synthesis considering first all professionals who are involved in this process. Qualitative analysis was the methodological strategy and it included 10 healthcare professionals of Special Unit of Infectious Diseases of HC of Ribeirão Preto. The analysis was semi-structured and according to procedures of evocation- enunciation- verification. The discourses of the professionals were grouped according to thematic contents, and analyzed by historical materialism. Data showed that three Elements constitute work process synthesis in HIV/Aids: Elements of Psychosocial Competency; Elements of Administrative and Socio-Political Control; Elements of Technical Competency. Although the healthcare professionals showed emphasis on reflections about Elements of Psychosocial Competency, the dichotomy between technical skill and psychosocial competency is presented in the during work, but it brings different aspects because there is no denial of any of them, and they do not seem to be relegated as a second place. However, the reflections indicate difficulties in fully consider these aspects during patients care. Although these difficulties are based on fragmentation of knowledge, consequently it is associated with service structure which is linked to work control protocols. The fragmentation impairs patient treating quality and raises objections to healthcare professionals feelings of misappropriation of their job. In such case, we consider that the systematization of informal learning according to work practice would be one of the alternatives, which would result into more functional healthcare professionals and cohesive work teams, and they would be building together their praxis. Furthermore, this study shows that, in some situations, the relationship between patient and healthcare professionals favors this learning. Nevertheless, we are aware that such implementation is not an easy task, because it is not according to the model in vigor, nor to health teaching structure that does not take account patients or professionals feelings. These feelings, among other issues, must be considered during healthcare professionals work. So, we consider the necessity of a group discussion about feelings raised by the work practice, because they would be discussed and socialized among people who have experienced the same situations. This would minimize the problems faced by these healthcare professionals and it would favor psychosocial aspects during work practice.

ABSTRACT Background: HIV/AIDS is a worldwide disease and exists documented in over 150 countries. There are 25 million infected people with HIV/AIDS in Africa, those stands for almost 71 % of all infected people around the world. This study is an opportunity to take a more important part of the care process that gives an overview of nurse’s experiences. Aim: The aim of this study was to describe registered nurses experiences of caring for patients with HIV/ AIDS in Dar es Salaam. Method: The study is empirical and it took place at Muhimbili National Hospital and Buguruni Health Center in Dar es Salaam, Tanzania. A convenient sample of seven nurses with experiences of caring for patients with HIV/AIDS participated in this study. Their experiences were investigated through interviews. Interviews were analysed with qualitative content analysis. Results: Three categories were formulated as the: Importance with a cooperative relationship, importance with confirmatory meetings and Challenges and stressful work condition. The sub-categories were counted as six and formulated as To achieve good cooperation, To create a close relationship, To obtain confirmation as a nurse, Striving to strengthen the patient through education, To manage heavy workload and stress and To manage difficult meetings. Cooperation and close relations are of great importance when it comes to nurse’s experience of caring for patients living with HIV / AIDS. To perceive confirmation and management maintain the high quality of caring. Conclusions: The nurses who participated in the study described their experiences in the care of patients with HIV/AIDS as confirmatory, cooperative and developing. Despite this, these nurses faces intractable challenges and encounters experienced tough and stressful.

The objective of this thesis is to undertake a cost analysis of an HIV/AIDS prevention programme targeting vulnerable groups in Benin. The AIDS-3 project (Projet Sida 3), a project targeting Female Sex Workers (FSWs), which was implemented from 2001 to 2005, is used as a case study to see how costs vary with location, volume of activities, and HIV prevalence rate. Activities and delivery modes were documented, and cost data have been collected both retrospectively (data on previous “Projet Sida 3” costs already available) and prospectively, using an ingredients-based costing methodology to consider both the financial and economic costs. Output measures were compiled directly from the intervention, and are related to the efficient delivery of different components of the intervention. Average cost per output or per outcome was estimated and cost variation within and between health centres over time was assessed. Results reveal that only the volume of activity is a prominent factor that affects the average cost. The location of the project and the experience of the staff also affect costs as well, but their significance is low. Field work activities that are more efficient in urban areas than in rural communities appear to be paramount in the fight against HIV as far as costs are concerned. / HIV/AIDS Cost analysis

In 2010, the government of British Columbia (B.C.) dedicated $48 million to stop the spread of HIV. The STOP HIV/AIDS pilot project promotes the uptake of HIV testing in the general population, and the use of antiretroviral therapy amongst those living with HIV/AIDS. This project operates with the rationale of ‘treatment as prevention’ (TasP), meaning that antiretroviral therapy is beneficial for the person living with HIV/AIDS, and has the secondary benefit of reducing the spread of HIV in the general population. Public health discourses are constructed via particular worldviews and involve the creation and delineation of societal problems. Undertaking a discourse analysis, I identify eight dominant discourses of TasP and STOP HIV/AIDS that include: provincial and international support for TasP and lack of federal leadership in HIV/AIDS; TasP, a ‘paradigm shift’ and a ‘game changer;’ TasP as beneficial to the individual and society; human rights and harm reduction; proof and certainty; failure of current prevention efforts; risk discourses; and, finally, universal treatment. I also identify five alternative discourses: holistic understanding/social determinants of health; stigma and discrimination; rights discourse: GIPA, informed consent and self-determination; coercion/criminalization and alternative risk discourse. Through a lens of governmentality, I explicate two overarching and simultaneous discursive strategies in realizing the objective of decreasing the spread of HIV in B.C. The first strategy acts on individuals living with HIV/AIDS, encouraging individuals to take up antiretroviral therapy. The second strategy acts on the general population, informing the population that HIV is a problem, and that treating people living with HIV/AIDS is the best way to protect society as a whole. There are various techniques within these two strategies. These discursive events have immense consequences for the uptake of health policies and programs by the public. The dominant and alternative discourses of TasP impact HIV policy and practice and specifically the individuals living with HIV and AIDS who are the subjects and targets of these initiatives. / Graduate