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.

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).

Submitted in partial completion for the degree of PHD in Community Psychology in the University of Zululand, 2006. / HIV/AIDS is the current century's challenge that stares humanity in the eye. The socio-political, economic, spiritual and philosophical dimensions of our society have to face up to this challenge. This brings one to the conclusion that HIV/AIDS is a national disaster and should be dealt with as such. In other words, interventions geared towards combating this epidemic should address all the spheres mentioned above. The main purpose of this study then was to investigate the role of indigenous healers in combating HIV and AIDS. The rationale for looking at the role of indigenous healers was to ensure that their role is highlighted for a joint effort that is necessary for the advocacy, awareness, education, care and medical intervention which is necessary to combat the HIV/AIDS crisis. This challenge goes as far as involving non-medical professionals and stakeholders in the fight against HIV/AIDS. Focus group interviews and individual interviews were conducted with indigenous healers in the Gauteng and North West provinces. The results were analysed thematically. The results are presented in relation to the questions which were posed. The results reflected that traditional healers have demonstrated that they can make a very important contribution to the treatment of HIV/AIDS. However, they feel that they are not receiving a fair opportunity to demonstrate their knowledge and expertise in treating HIV and AIDS. They also lack support from the public, from government policy, and from the modem medical fraternity. There have been efforts by the Minister of Health to incorporate traditional healing and traditional medicine as part of a holistic approach to the treatment and containment of HIV. This strengthens holistic health care ensuring the advocacy, awareness, education, care and medical intervention which is necessary to combat the HIV/AIDS crisis. Traditional healers need support and recognition from the public, the government and the modem medical fraternity. It was also evident from the results that the indigenous healers were very willing to co-operate with biomedical practitioners as shown in the statement below. Traditional healers reported that they did not routinely test their patients for HIV as they had no means of doing that. They were legally required to send their patients for testing through modem medical procedures. Most healers also said that they preferred their patients to be checked using modem medicine, and thereafter they would treat them accordingly. This is because they currently relied only on their ancestors to show them when the patient was positive. What is important to note is that these healers said that the disease was not presented to their bones as HIV/AIDS, but that they were only shown the known symptoms of HIV and then were able to deduce that the person was HIV positive.

In the early days of HIV/AIDS in North America, those most directly affected by the crisis created a social movement to respond to the virus when no one else would. The legacy of activists’ efforts can be seen in the more than seventy-five AIDS service organizations (ASOs) that provide prevention, support, and education to communities across Ontario today. While these organizations were once an important site of advocacy and resistance for people living with HIV/AIDS (PHAs), ASOs are now often viewed as professionalized, bureaucratic and impersonal spaces. Linking theoretical understandings of public pedagogy and the pedagogical potential of space with HIV/AIDS scholarship, I offer a conception of ASOs as more than simply impersonal service providers, but vibrant spaces of community learning. Drawing on interviews with people who work, volunteer, and use services at a small ASO in Kingston, Ontario called HIV/AIDS Regional Services (HARS), I identify three pedagogical assets within the agency’s space that tend to go unrecognized as such. The agency’s drop-in space, artworks created by PHAs that decorate the walls of the office, and HARS’ storefront design are not usually counted as elements of the kind of formal “HIV/AIDS education” that ASOs provide. However, by exploring the learning experiences that are incited by these assets, I argue that we may broaden our understandings of what counts as HIV/AIDS education and of the value of ASOs in their communities. These unacknowledged assets not only enhance peoples’ understanding of issues related to HIV/AIDS, they also work to develop a sense of community and belonging for visitors to the space. In conclusion, I reiterate that while today’s ASOs are surely different than the organizations that activists created in the 1980s, the learning experiences that arise in agencies like HARS demonstrate that community-building and mutual support can remain as integral aspects of ASOs. / Thesis (Master, Cultural Studies) -- Queen's University, 2013-09-20 14:39:55.828

FACULTY OF HUMANITIES School of Literature and Language Studies 9511112w mokope@webmail.co.za / The scourge of HIV/AIDS continues to worsen in the country in spite of efforts made by government and other stakeholders to combat this disease. This is reflected by the everincreasing statistics of new cases of HIV infection that are reported every minute. This rate of infection is believed to be influenced by factors such as cultural constructions that inhibit efforts to educate the populace about the disease. The research focuses on the extent to which cultural ideologies, as reflected in figurative expressions, render the task of educating people about sexually related diseases difficult. Translators seem to prefer figurative instead of literal language when they translate STDs and AIDS-related education materials. The preference of the former renders the message inaccessible to the average target audience. This study neither strives to conscientise and sensitise the doubting Thomases about the danger of HIV/AIDS and STDs nor does it seek a cure or treatment but a new way of communicating about these diseases. Ratzan maintains that “until a vaccine or cure for HIV infection is discovered, communication is all that we have” (1990: 257). This study deals with communication about HIV/AIDS. It is believed that the research’s findings can be used to help reduce the rate of transmission of this life-threatening infectious disease.

Student Number : 0110645G - MSc research report - School of Public Health - Faculty of Health Sciences / South Africa is one of the countries in sub-Saharan Africa that are severely affected by the HIV/AIDS pandemic. This epidemic has led to high mortality rates, decreased life expectancies, increasing poverty, and overburdened health systems. Objective: To quantify the disease burden related to HIV/AIDS in Leratong Hospital, a level 2 public sector hospital in Gauteng Province of South Africa. In the context of the recent introduction of anti-retroviral therapy programme in the hospital, it is hoped that this study will assist in defining a baseline to which future evaluation of the programme will be compared. Methods: This was a retrospective descriptive study on routinely collected hospital data. The records of all patients admitted into the four medical wards of the hospital in 2001 and 2004 (n=21,029) were analyzed. Data on their socio-demographic characteristics, discharge diagnoses, HIV status, clinical outcome and length of stay in the hospital were extracted and analyzed. Results: More than half (52%) of the patients were aged between 21 and 40 years. Between the two years, the annual total number of admissions to the medical wards decreased by 6.6%, and this was more pronounced in the female wards where the decline was more than 10%. HIV-related diseases accounted for four out of the top five diseases in all patients. The proportion of chronic diseases, such as hypertension, diabetes, congestive cardiac failure and cerebrovascular diseases, decreased from 15.3% in 2001 to 14.3% in 2004. The average length of stay (ALOS) increased from 3.7 days in 2001 to 4.1 days in 2004. Only 14% of all patients consented to HIV testing in the review period. Of these more than 90% were reactive to HIV. Although the proportion who had HIV tests decreased significantly from 16.9% in 2001 to 11% in 2004 (p<0.001), the HIV positive rate increased significantly from 89.1% in 2001 to 92.4% in 2004 (p<0.001). The proportion of patients admitted due to HIVrelated diseases increased significantly from 52% in 2001 to 58% in 2004 (p<0.001). The crude mortality rate for all patients during the two years studied was 13.6%. This increased significantly from 12% in 2001 to 15% in 2004 (p<0.001). Mortality was significantly higher in those patients with documented HIV results and those admitted with HIV-related diseases irrespective of their HIV status. While cause-specific mortality rate due to HIV-associated diseases either increased or remained very high, that due to diabetes mellitus decreased significantly between the two years studied (p=0.02). Patients’ length of stay in the hospital and mortality were both found to be associated with their age group, HIV status, diagnosis and year of admission. The study has demonstrated some changes in the clinical profile of the patients towards a preponderance of HIV-related diseases and crowding out of other chronic non-infectious diseases. Based on these results, it is therefore recommended that all patients should have access to voluntary counseling and testing (VCT) and emphasis should be placed on those diseases with high admission and mortality rates to improve patient care and outcome. Measures should be developed to ensure that patients with chronic noninfectious diseases are not crowded out.

Student Number : 0513068K - MA research report - School of Graduate School - Faculty of Humanities / The aim of this study it to evaluate the Gauteng Government’s attempt to implement a life skills education programme in all primary and secondary schools. A chosen strategy of the National HIV/AIDS/STD Strategic Plan for South Africa: 2000-2005, a universal programme of life skills and HIV/AIDS education in primary and secondary schools was identified as a vital means to contain South Africa’s HIV/AIDS epidemic. Broadly, the life skills and HIV/AIDS education programme is intended to “promote improved health seeking behaviour and [the] adoption of safe sex practices” (DOH, 2000) amongst school going youth. Responsibility for the implementation of this programme in all primary and secondary schools is decentralised to the provincial level. Accordingly, this study seeks to analyse and evaluate the Gauteng Provincial Government’s (GPG) progress in the implementation of the life skills programme. A case study design centered upon documentary analysis and key informant interviews was employed in order to capture the necessary and predominantly qualitative data. These data are analyzed using the conceptual framework developed through the work of Hildebrand and Grindle (1994 in Brijal and Gilson, 1997), and Brijal and Gilson (1997). This study found that numerous implementation deficits arising at the organisational, task network, public sector institutional and external environmental levels combined to hamper implementation of the life skills programme according to the time frames set out within the National Integrated Plan for Children Infected and Affected by HIV/AIDS. Nevertheless, this study also found that political stability in Gauten gprovince was a significant factor promoting steady and progressive programme implementation and expansion. To conclude, this study indicates that policy implementation requires numerous complimentary factors (for instance, a strong level of local service delivery capacity) to be in place in order for public HIV/AIDS policy implementation to be achieved in an efficient and sustainable manner.

MDent, Faculty of Health Sciences, Universiyt of the Witwatersrand / Introduction: HIV associated parotid lymphoepithelial lesions in children are not well documented. Most studies have concentrated on the adult population. Objectives: The present study aimed to document the disease, its risk factors and anti-retroviral treatment outcome in children. Materials and methods: The study was conducted at 2 HIV and AIDS facilities weekly over a 6 month period. “Parotid swellings” in children below 13 years were analysed. A retrospective medical chart review was conducted. Results: Seventy-one children were included; 47 with swelling (Group 1) and 24 without swelling (Group 2). Thirty-nine had parotid swelling of 1or both glands, 6 had submandibular and parotid swelling and 2 with only submandibular swelling. Twenty-six children in Group 1 were receiving HAART, 19 reported a reduction in size of lesion, 6 reported no effect and only 1 had the lesion after 11 months of HAART. Conclusion: Parotid lymphoid proliferation in children is more common than previously reported. The prevalence of this lesion could not be determined as not all children with parotid swelling presenting at the clinics were included in the study. Children with lower viral loads showed an increased risk of developing parotid lymphoid proliferation. The parotid lesions responded well to HAART but did not completely resolve.

Student Number : 9910519W - M Med research report - School of Public Health - Faculty of Health Sciences / Introduction: This study sought to determine the costs of providing health care to HIV/AIDS patients in a tertiary level hospital in Gauteng Province. The study also determined what the implications were for the hospital in terms of planning and resource allocation. Methodology Study design: Retrospective Record Review Study Period: 03 May 2005 – 15 June 2005 Study setting: Chris Hani Baragwanath Hospital, Gauteng. Study population: Medical & Pediatric inpatient discharges and deaths Results: 1185 records reviewed (812 HIV positive) HIV positive patients were staying longer than others and costing the hospital more as well. Those on ARV therapy cost the most. Conclusion: More resources were being spent on HIV/AIDS patients. Increased lengths of stay and expenditure on drugs and investigations were the reasons for higher costs compared to HIV negative inpatients. Identifying ways of reducing admission and other costs must be seen as strategies in reducing the financial burden of HIV/AIDS to the facility.

By the age of 35, Black Men who have Sex with Men (MSM’s) have a one in two chance of HIV infection. Black MSM’s, which represent less than one percent of the US population, is home to nearly a quarter of existing HIV cases, AIDS deaths as well as new HIV diagnosis. As early as 1987 studies were published revealing a paradoxical reality, that although Black MSM’s had no significant difference in risk behavior, there is a much larger HIV Prevalence among this group as nearly one in three Black MSM’s are HIV positive. Consistently and repeatedly, studies have shown Black MSM’s have fewer sexual partners than their White counterparts, and fewer occurrences of unprotected anal intercourse, yet significantly higher rates of HIV Incidence. The theoretical basis for this analysis is the concept Intersectionality, originated by Kimberlé Crenshaw, which states that cohorts comprised of multiple statuses of historic discrimination are qualitatively different from individual cohorts of component status. This qualitative difference requires the analysis of the composite cohort as an independent and unique entity as opposed to only looking at the components that it is made of. Therefore, Black MSM’s are a unique group and cannot be fully understood by looking at Black Men or MSM separately. This is particularly applicable for Black MSM’s because of the: history of oppression as Black Men, history of marginalization as MSM, isolation of Blacks within MSM community, isolation of MSM within the Black community and the history of HIV among Black MSM’s which dates back at least to 1969 (predating the publicly acknowledged epidemic in the White MSM community by 12 years) . This traditional policy analysis evaluated the 2010 National HIV/AIDS Strategy for its effectiveness in addressing HIV/AIDS among Black MSM’s. To accomplish this, a convergence of evidence approach was implemented, utilizing a key document review, qualitative interviews with key stakeholders, as well as quantitative surveys of 300 Black MSM’s. These methods were then applied to each of the four stages of Policy Analysis: agenda setting, formulation, implementation and evaluation. This analysis revealed a landmark policy that has comprehensively improved the Federal response to HIV in the US. Innovations developed and instituted because of this policy included the Community Listening Sessions of the formulation stage, and even more importantly the new metrics that better equip agencies to understand the nature of the epidemic. Further, the results of this study were compared with the August 2014 Kaiser Family Foundation study, which produced a nationally representative survey of Gay and Bisexual men (sampling error ±7%). The findings of this study paralleled and/or magnified those of Kaiser in several key areas. Kaiser found that Men of Color were more likely to know someone with HIV/AIDS and those that do are more likely to say it is a significant personal issue. The results of this study of Black MSM’s expose a sample where 97% knew someone who has/had HIV/AIDS and almost all considered this to be a significant personal issue. Both studies also confirmed the continuing presence of stigma and perceived discrimination by the general public. In both studies, evidence also indicates the opportunity for increasing frequency of HIV testing and the widespread lack of knowledge of PrEP (Pre-Exposure Prophylaxis). Several key recommendations should also be taken from this analysis to improve the policy moving forward. The first is that Black MSM’s should be an independent category for policy targeting. The next is that as Black MSM’s are the only group that is at high risk of infection and also makes up a large portion of the disease, Black MSM’s are a significant hotspot that should be a primary focus of the intervention. Finally, the greatest advances in fighting HIV have come through biomedical progress. Therefore, educating and implementing biomedical innovations such as PrEP should compliment behavioral change as intervention objectives. / 1 / Paul T. Winfield