Os Centros de Testagem e Aconselhamento (CTA) disponibilizam a testagem para o HIV e o aconselhamento. Alguns pacientes não retornam para pegar o resultado. Investigou-se características associadas a "falha no retorno" (FNR) no CTA-Betinho, em 2003 e 2004. Conduziu-se um estudo observacional transversal. A FNR foi de 19,4% (n=548). Foram associadas a FNR: faixa etária; faixa etária adolescente; origem do cliente; tipo de orientação; primeiro teste no CTA; CTA-Itinerante; tempo de espera do resultado e tempo de espera maior que 30 dias; resultado HIV reagente. Após análise multivariada, permaneceram: faixa etária adolescente; CTA-Itinerante; tempo de espera do resultado maior que 30 dias; resultado HIV reagente. Aspectos de vulnerabilidade estariam contribuindo para FNR. Procedimentos implantados no CTA poderiam diminuir a FNR. Os resultados condizem com a literatura internacional / The HIV Counseling and Testing Centers (CTC) offer the HIV test and counseling. Some of the patients fail to return for HIV test result delivery. It was investigated characteristics related to failure to return (FTR) at the CTC Betinho in 2003 and 2004. A cross-sectional study was conducted. FTR during the study period was 19.4% (n=548). Variables associated to FTR were: age; teenagers; patient's reference; kind of pretest counseling; first HIV test at the CTA; Itinerant CTA; waiting period for the result; waiting period for the result of more than 30 days; HIV positive test result. After logistic regression, the following variables remained: teenagers; Itinerant CTA; waiting period for the result of more than 30 days; HIV positive test result. FTR could be explained by some issues related to social and individual vulnerability. Procedures could be implemented at CTA to minimize FTR. These results corroborate international studies

A denominada ¨resposta brasileira à epidemia de aids¨ é exemplar pelas suas políticas e iniciativas públicas, incitando continuamente a emergência de desafios à atenção à saúde das pessoas vivendo com HIV. Um deles diz respeito a uma questão polêmica, ainda que pouco debatida no cenário nacional: a comunicação de diagnóstico de HIV aos parceiros sexuais de pessoas soropositivas. Por um lado, essa questão evoca a responsabilidade pelo controle da cadeia de transmissão do HIV. Por outro, há a preocupação com o bem estar psicossocial do paciente em suas relações afetivo-sexuais, conjugais e familiares. O objetivo do presente trabalho foi apreender, através dos discursos de sujeitos envolvidos nessa prática, como essas distintas lógicas - de uma perspectiva coletiva, informada pelos pressupostos da Saúde Pública e de uma tônica no indivíduo e suas singularidades - são operadas e articuladas nas práticas de comunicação de diagnóstico de HIV a parceiros sexuais, em serviços de saúde especializados em DST/aids, do Município de São Paulo. Trata-se de estudo qualitativo, orientado pelos discursos de profissionais de saúde, de membros da Comissão Nacional de Aids, de técnicos em vigilância epidemiológica e pacientes, captados através de grupos, focal e educativo, e de entrevistas individuais em profundidade, com roteiro semi-estruturado, entre 2007-2008. A base teórica para interpretação dos discursos combina aportes conceituais sobre a Esfera Pública e a Teoria da Ação Comunicativa (Habermas), e sobre o Cuidado (Ayres). A comunicação de diagnóstico de HIV aos parceiros sexuais apresenta-se como uma questão que, embora importante, não alcança esferas de debates públicos com os diferentes atores sociais envolvidos. Na prática, a lógica epidemiológica não se materializa nem é almejada sob a forma de ações clássicas da vigilância epidemiológica, como a busca de comunicantes. São valores implicados em seus pressupostos, contrastados com aqueles das esferas privadas e íntimas, que parecem tornar problemática a comunicação de diagnóstico de HIV ao parceiro sexual. Dentre as estratégias utilizadas pelos profissionais, oscila-se entre a ameaça (de cunho policialesco) e a cumplicidade (que trata a comunicação como um problema íntimo). O principal foco dessas iniciativas é minimizar o estigma que cerca o portador do vírus. Da amplitude das interpretações e proposições que consideram o estigma nas práticas de saúde, vislumbra-se que a sua ativa problematização nas situações concretas da atenção pode ser um caminho possível e prático para o seu enfrentamento, por meio da criação de repertórios argumentativos. Esse modo peculiar de fazer face ao estigma pode deslocar as perspectivas, higienista e de regulação jurídica, para horizontes normativos técnica, ética e politicamente relevantes para integrar comunicação de diagnóstico de HIV ao parceiro sexual e atenção à saúde das pessoas vivendo com HIV. / The Brazilian response to the AIDS epidemic outstands for its policies and public initiatives, continuously stimulating the challenges for the healthcare of people living with HIV to come out. One of them refers to a polemic issue, yet little debated in the national agenda: the HIV disclosure to sexual partners of HIV positive people. This question claims for the responsibility over HIV transmission control. On the other hand, the patients psychosocial well-being in their sexual-affective, marital and family relationships raises concern. The objective of the present study was to understand, based on the discourses of the subjects involved in this practice, how these distinctive logics the collective perspective based on Public Health concepts and the emphasis on the individual and their singularities are managed in the practices of disclosing HIV infection to sexual partners in STD/AIDS specialized clinics in the city of São Paulo. A qualitative study was carried between 2007-2008 out with health professionals, members of Brazils AIDS Program, surveillance technicians and patients who participated in focus and education groups and answered individual in-depth interviews, both oriented by a semi-structured guide. Public Sphere/ Communicative Action Theory (Habermas) and Comprehensive Care (Ayres) were the theoretical framework of the analysis. HIV disclosure to sexual partners constitutes an issue that, despite relevant, does not reach the public debate domains with the different social actors involved. In practice, the epidemiology logic is neither materialized, nor desired in terms of classic surveillance practices, such as the contact tracing. The contrast of assumptions between public and private spheres seems to be a barrier to HIV disclosure to the sexual partner. The strategies adopted by professionals range from threatening (acting as if they were the police) to complicity (the disclosure is managed as an intimate matter). The main focus of these initiatives is to minimize the stigma towards the seropositive person. From the great variety of interpretations and propositions about stigma in health practices, the constitution of argumentative repertoires that actively question the stigma in concrete situations may be a possible and practical way of facing it. This peculiar way of approaching stigma may change hygienist and law regulated perspectives into normative horizons that are technical, ethical and politically relevant to integrate HIV disclosure to sexual partners and care of people living with HIV.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-01-13T12:18:51Z No. of bitstreams: 1 camiladasilvamarquesbadaro.pdf: 4578785 bytes, checksum: fc34a047bf740989623b1ed177d628f9 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-02-02T12:04:30Z (GMT) No. of bitstreams: 1 camiladasilvamarquesbadaro.pdf: 4578785 bytes, checksum: fc34a047bf740989623b1ed177d628f9 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-02-02T12:04:40Z (GMT) No. of bitstreams: 1 camiladasilvamarquesbadaro.pdf: 4578785 bytes, checksum: fc34a047bf740989623b1ed177d628f9 (MD5) / Made available in DSpace on 2017-02-02T12:04:40Z (GMT). No. of bitstreams: 1 camiladasilvamarquesbadaro.pdf: 4578785 bytes, checksum: fc34a047bf740989623b1ed177d628f9 (MD5) Previous issue date: 2016-09-30 / Objetivou-se desvelar o vivido do cotidiano de adolescentes soropositivos em tratamento com antirretroviral. Trata-se de uma pesquisa de natureza qualitativa de abordagem fenomenológica, fundamentada no referencial teórico-filosóficometodológico de Martin Heidegger. O cenário constituiu-se de um Serviço de Assistência Especializada da Zona da Mata Mineira e os participantes foram dez adolescentes soropositivos com idade entre 12 a 18 anos em tratamento ambulatorial. Para a obtenção das informações utilizou-se a entrevista fenomenológica, por meio da técnica da entrevista aberta e um questionário. Buscou-se nos depoimentos as estruturas essenciais que originaram seis Unidades de Significados: Para os adolescentes é difícil aceitar a doença; Os adolescentes possuem conhecimento sobre sua própria doença, suas formas de transmissão e de prevenção; Cotidiano terapêutico: dificuldades encontradas e as formas de manter a adesão ao tratamento; Para não serem discriminados optam por manter em segredo a ingestão dos Antirretroviral. Este segredo só é compartilhado com a família e pessoas próximas; Os adolescentes conhecem os efeitos que a não adesão causa ao organismo; e A importância do tratamento prestado pelo Serviço de Assistência Especializado é reconhecida pelos adolescentes. A compreensão vaga e mediana permitiu alcançar o fio condutor, que por sua vez, originou o conceito de ser em direção à análise interpretativa. A hermenêutica desvelou que o ser-adolescente portador de HIV leva uma vida normal como qualquer outra; têm bom relacionamento com os colegas, porém sua condição de saúde é mantida em segredo com a família ou poucos amigos; sente raiva, nega, tem dificuldade de aceitar a doença. Os adolescentes conhecem algumas formas de transmissão e prevenção do HIV, mas não possuem compreensão aprofundada, buscam maneiras de superar as dificuldades da terapia medicamentosa mantendo-se aderentes ao tratamento e saudáveis e reconhecem a importância de serem acompanhados por um serviço especializado. Esta pesquisa apontou a in-visibilidade dos profissionais de enfermagem junto aos adolescentes e que faz-se necessário um cuidado integral e humanizado para se alcançar uma melhor adesão a terapia antirretroviral, tendo em vista melhorar a qualidade de vida e saúde dos adolescentes soropositivos e permitir que os mesmos vivenciem novas possibilidades. / This study aimed to reveal the living of everyday life for HIV-positive adolescents in treatment with antiretroviral. This is a qualitative research phenomenological approach, based on the theoretical-philosophical and methodological framework of Martin Heidegger. The scenario consisted of a Specialized Service at Zona da Mata Mineira and participants were seropositive ten adolescents aged 12 to 18 in outpatient treatment. To obtain the information used to phenomenological interview, through the open technical interview and a questionnaire. He sought in the statements the essential structures that originated six meanings of Units: For adolescents is difficult to accept the disease; Teenagers have knowledge about their own disease, its transmission and prevention; therapeutic daily: difficulties encountered and ways to maintain adherence to treatment; Not to be discriminated choose to keep secret the intake of antiretroviral. This secret is shared only with family and close people; Teenagers know the effects that non-adherence causes the body; and the importance of treatment provided by Specialized Service Centre is recognized by adolescents. The vague understanding and median allowed to achieve the thread, which in turn, originated the concept of being toward the interpretative analysis. The hermeneutics unveiled that the teen be HIV carrier leads a normal life like any other; They have good relationships with colleagues, but his condition is kept secret with family or few friends; feel angry, denies, has difficulty in accepting the disease. Teenagers know some forms of transmission and prevention of HIV, but do not have in-depth understanding, seek ways to overcome the difficulties of drug therapy while remaining compliant with the treatment and healthy and recognize the importance of being accompanied by a specialized service. This research pointed to in-visibility of nursing professionals with adolescents and that it is necessary an integral and humanized care to achieve better adherence to antiretroviral therapy, to improve the quality of life and health of HIV-positive adolescents and allow that these new possibilities to experience.

Orientadores: Marcos Tadeu Nolasco da Silva, Adyléia Aparecida Dalbo Contrera Toro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T15:59:43Z (GMT). No. of bitstreams: 1 Wigman_LilianThais_M.pdf: 2892789 bytes, checksum: 920b6477ff4644fb2fcaeebf84d7fb3a (MD5) Previous issue date: 2012 / Resumo: INTRODUÇÃO: A implantação da Terapia Anti-Retroviral de Alta Atividade (HAART), resultou em importantes mudanças no prognóstico da Síndrome de Imunodeficiência Adquirida (Aids) pediátrica. Apesar disso, as doenças respiratórias ainda constituem significativa causa de morbidade e mortalidade entre esses pacientes. A tosse pode ser produzida por quase todas as doenças respiratórias e é um dos sintomas mais comuns na pediatria. Diante disso, os pacientes imunocomprometidos constituem um grupo importante no planejamento da investigação desse sintoma, pois são suscetíveis a doenças de alto risco, tratáveis, se corretamente identificadas. OBJETIVOS: Determinar a prevalência da tosse crônica na população de crianças e adolescentes infectados pelo HIV em seguimento no Serviço de Imunodeficiência Secundária Pediátrica do HC - UNICAMP. MÉTODO: Foi realizado um estudo observacional, prospectivo, analítico do tipo corte transversal com um componente longitudinal. O grupo de pacientes foi constituído por 118 crianças e adolescentes que apresentaram o diagnóstico de infecção pelo HIV e um grupo controle de 137 crianças em uma escola do município de Campinas. Foi avaliada a presença de tosse crônica e dentre aqueles que apresentavam o sintoma foi aplicado um questionário para sua melhor caracterização. Os pacientes infectados pelo HIV que apresentaram tosse crônica foram seguidos durante um ano. RESULTADOS: A prevalência de tosse crônica (duração maior que 4 semanas) foi de 5,93% no grupo infectado e 5,11% no grupo controle (p = 0,79). Dentre os pacientes com tosse crônica os diagnósticos mais comuns foram rinossinusite, bronquiectasias, rinite alérgica, asma, tuberculose e hipertrofia de adenóides. No grupo infectado pelo HIV, não houve diferenças clínicas, imunológicas ou virológicas entre os pacientes com e sem tosse crônica. CONCLUSÃO: Concluímos que, em uma população infectada pelo HIV com acesso ao tratamento antirretroviral, a prevalência de tosse crônica foi semelhante à de um grupo-controle saudável o que reforça a importância de assegurar o acesso ao tratamento, permitindo que as crianças e adolescentes cheguem à idade adulta com a preservação de sua saúde e qualidade de vida / Abstract: BACKGROUND: Highly Active Antiretroviral Therapy (HAART) resulted in significant changes in the prognosis of pediatric Acquired Immunodeficiency Syndrome (Aids). However, respiratory tract diseases still represent a significant cause of morbidity and mortality in pediatric Aids patients. Cough is a marker of almost all respiratory diseases, being one of the most common symptoms in pediatrics. Immunossupressed patients are an important group in planning the approach to this symptom, being susceptible to high risk conditions, which are treatable if correctly recognized. OBJECTIVE: To determine the prevalence of chronic (more than four weeks) cough in the cohort of HIV-infected children and adolescents being followed up at the Pediatric Immunodeficiency Clinics of the State University of Campinas Hospital. METHODS: Observational, analytical, prospective, cross-sectional study with a longitudinal arm. Patient group was comprised by 118 HIV-infected children and adolescents, and the control group was constituted by 137 healthy children and teenagers attending a public school. Subjects with chronic cough were evaluated by a standardized questionnaire for better characterization. HIV-infected patients with chronic cough underwent a longitudinal follow-up by a standardized protocol, encompassing a one-year period. RESULTS: The prevalence of chronic cough was 5,93% in the HIV-infected group and 5,11% in the control group (p = 0,79). Between HIV-infected patients with chronic cough, the most common diagnoses were rhinosinusitis, bronchiectasies, allergic rhinitis, asthma, tuberculosis and adenoid hyperthrophy. Within the HIV-infected group, no differences were identified in clinical, immunological or virological variables between patients with or without chronic cough. CONCLUSION: We conclude that, in an HIV-infected population with full access to HAART, the prevalence of chronic cough was similar to the one observed in a healthy control group. This finding reinforces the importance of ensuring the access to therapy, allowing current children and adolescents to reach adult life with a good preservation of their health and quality of life / Mestrado / Pediatria / Mestra em Ciências

Magister Public Health - MPH / Globally, approximately 600,000 infants each year are born with HIV infection in Sub-Saharan Africa as a result of mother to child transmission (MTCT) (UNAIDS, 2001). Whereas there is significant progress in reduction of mother to child transmission of HIV in Uganda, the Western Region of Uganda has low rates of PMTCT service utilization. The progress has been hampered by many factors including low male involvement (MOH, 2005). The main objective of this study was therefore to identify some of the factors that discourage men from participating in PMCT services in this region. The study was conducted in Kibaale District in the Western Region of Uganda for a period of one month in mid 2009. Data was collected using a qualitative methodology. The tools that were used for data collection were key informant in-depth interviews and focus group discussions (FGDs) guides. Data was collected from PMTCT service providers, women of reproductive age group and men whose partners had given birth during the last year (2008). For the focus groups, a purposive sample of men and women who had some children born in 2008, followed by random sampling from the list of potential subjects was used to select participants. The study sample comprised of three FGDs of women who had given birth in year 2008 and male partners of women who had also given birth in 2008. Each FGD consisted of eight participants. One FGD was with women only, the other with men only, while the third was with both men and women.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-21T14:37:18Z No. of bitstreams: 1 rouzelimariacoelhopereira.pdf: 1227583 bytes, checksum: 6bf30204887e8bad003a4c456764d51c (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T18:46:30Z (GMT) No. of bitstreams: 1 rouzelimariacoelhopereira.pdf: 1227583 bytes, checksum: 6bf30204887e8bad003a4c456764d51c (MD5) / Made available in DSpace on 2016-01-25T18:46:30Z (GMT). No. of bitstreams: 1 rouzelimariacoelhopereira.pdf: 1227583 bytes, checksum: 6bf30204887e8bad003a4c456764d51c (MD5) Previous issue date: 2014-07-29 / A expansão da terapia antirretroviral (TARV) vem contribuindo significativamente para a contínua diminuição de novos casos de HIV em todo o mundo. A TARV, além de reduzir o risco de transmissão do vírus, permite que os portadores do HIV tenham maior sobrevida e com mais qualidade. No entanto, apesar da elevada eficácia deste tratamento a efetividade do mesmo tem sido prejudicada em virtude das dificuldades encontradas pelos pacientes em cumpri-lo adequadamente. Sendo assim, estimular a adesão à TARV com a promoção do uso racional de antirretrovirais, participação de uma equipe multidisciplinar na assistência, entre outras medidas faz-se uma necessidade iminente. Assim, o presente estudo objetivou estabelecer a relação entre cada classe terapêutica usada nos tratamentos de HIV em pacientes assistidos pelas Unidades de Dispensação de Medicamentos (UDM) do Centro de Atenção à Saúde da Universidade Federal de Juiz de Fora (UFJF) e o comportamento de adesão aos mesmos, na tentativa de identificar fatores que levam a não adesão ao tratamento e propor ações que promovam o uso racional dos medicamentos. Os dados relativos ao perfil sociodemográfico e dispensação de antirretrovirais a 291 pacientes atendidos na UDM entre janeiro de 2009 e dezembro de 2010 e a evolução destes pacientes em 2013, foram analisados descritivamente e pelo teste do qui-quadrado empregando o software Statistical Package for the Social Sciences (SPSS) versão 14. Os mesmos pacientes foram reavaliados em 2013, a fim de se observar o desfecho terapêutico e a evolução dos pacientes participantes deste estudo. O perfil dos pacientes foi traçado como sendo a maioria do sexo masculino, na faixa etária entre 41 e 50 anos, solteiros, com 8 a 11 anos de estudo e residentes em Juiz de Fora. A maioria dos pacientes (60,8%) foi considerada como não aderentes ao tratamento a associação zidovudina + lamivudina + efavirenz foi a mais precrita (39,9% dos pacientes). A maior frequência de adesão (57,6%) se deu com as terapias compostas por inibidor de transcriptase reversa nucleosídeo-nucleotídeo + inibidor da transcriptase reversa não nucleosídeo. O maior índice de não adesão (64,3%) se deu entre os pacientes que usavam a composição inibidor de transcriptase reversa nucleosídeo-nucleotídeo + inibidor de protease .A reavaliação feita em 2013 revelou que 8,6% dos pacientes do inicio do estudo abandonaram o tratamento após 2011 e não houve diferença significativa entre este abandono e a não adesão observada na primeira fase do estudo. Também, não houve diferença significativa no número de óbitos e na mudança de tratamento comparando-se o grupo dos aderentes e não aderentes. Dos 291 pacientes, 87,3% deram seguimento à TARV, mesmo aqueles cujas retiradas de medicamentos eram irregulares na primeira fase do estudo. Os demais abandonaram o tratamento ou evoluíram à óbito. Diante do alto índice de não adesão (60,8%) encontrado na UDM, ressalta-se a importância de se estimular a realização de pesquisas de novos fármacos e formas farmacêuticas mais eficazes, com menos efeitos colaterais e economicamente viáveis para TARV e, por fim, subsidiar a elaboração dos consensos em terapia ARV e protocolos de Assistência Farmacêutica em DST/HIV/AIDS. / The expansion of antiretroviral therapy (ART) has contributed significantly to the ongoing decline in new HIV cases worldwide. Besides reducing the risk of transmitting the virus, antiretroviral therapy allows HIV patients to survive longer and have a better quality of life. However, despite the high efficacy of this treatment, its effectiveness has been hampered given the difficulties patients experience in properly adhering to it. Therefore, encouraging the adherence to ART by promoting rational use of antiretrovirals, as well as the participation of a multidisciplinary team in such care, among other measures, is an imminent need. Thus, the present study aimed to establish the relationship between each therapeutic class used in HIV treatments in patients assisted by the Drug Dispensing Units (UDM) of the Secondary Service Center of the Federal University of Juiz de Fora, state of Minas Gerais (UFJF-MG) as well as patients’ adherence behavior, in an attempt to identify factors which lead to non-adherence to the treatment and to propose actions in order to promote the rational use of medicines. Data concerning the socio demographic and the dispensation of ARVs to 291 patients assisted by the DMU between January 2009 and December 2010 and the evolution of these patients in 2013 were analyzed by means of descriptive statistics and the chi-square test by using the Statistical Package for the Social Sciences (SPSS) version 14. The same patients were reassessed in 2013 in order to observe the therapeutic outcomes and patients’ progress with regards to their participation in this study. The profile of patients was outlined as being most man, aged between 41 and 50 years old, single, with 8-11 years of study and living in the city of Juiz de Fora, state of Minas Gerais, Brazil. Most patients (60.8%) were considered as non-adherent to the treatment and the combination zidovudine + lamivudine + efavirenz was the most prescribed (39.9% of patients). The highest rate of adherence (57.6%) occurred with therapies composed of nucleotide-nucleotide reverse transcriptase inhibitor + non-nucleoside reverse transcriptase inhibitor. The highest rate of non-adherence (64.3%) occurred among patients using nucleotide-nucleotide reverse transcriptase inhibitor + protease inhibitor. The reassessment done in 2013 revealed that 8.6% of patients from the beginning of the study dropped out of treatment after 2011 and there was no significant difference between abandonment and non-adherence observed in the first phase of the study. Also, there was no significant difference in the number of deaths and treatment changes when compared with the group of patients who adhered and the ones who did not adhere to the treatment. Out of the 291 patients, 87.3% adhered to the ART, even those whose medication withdrawals were irregular in the first phase of the study. The others either dropped out of treatment or developed to death. Given the high rate of non-adherence (60.8%) found in the UDM, the importance of encouraging the development of studies on more effective new drugs and dosage forms, with fewer side effects and that are economically viable, and finally, to subside the elaboration of consensus regarding ARV therapy and Pharmaceutical Care protocols for STD / HIV / AIDS should be emphasized.

This study presents a qualitative analysis of the dichotomy between official HIV and AIDS policy and its implementation in a Human Rights based, United Nations (UN) agency, located in South Africa. The study demonstrates that although HIV and AIDS policy is an intrinsic part of the commitment of this large organisation, the implementation of the policy, in the form of a Workplace Wellness Programme supported by budgetary resources, is weak and incomplete. The thesis integrates detailed vignettes in drawing attention to how personnel in the South Africa office perceive and experience the implementation of HIV and AIDS policy. Additionally, the voices of bureaucrats are also integrated in an effort to interrogate management attitudes and mindsets on matters of policy and treatment of staff. The study explores staff members’ sense of being stigmatised and discriminated, when living with the virus and their responses to it. In this, I bring a personal perspective to the study, by relating my own views of living with a potentially life-threatening disease to the views of the participants in the workplace in which the study is conducted. Classical Weberian and contemporary accounts of ‘bureaucracy’ and the organisational ‘rule book‘ are drawn upon. It is argued that whilst the value systems and politics of managers in the United Nations system lead them to be defined as progressive, some of the practices within their own institutions are contradictory, indifferent and manipulative leading to the perpetuation of discrimination and anxiety amongst HIV-positive staff. Thus, human agency and ingenuity supersedes organisational structure and the rigour of organisational policies and rules. The contradictions highlighted necessitate a careful scrutiny of organisational dynamics, within the wider international development scenario, and organisational introspection within individual UN offices vis-à-vis HIV and AIDS policy implementation. It is envisaged that the study will induce the commissioning of a larger study carried out by an independent body and funded by the United Nations, enabling the validation and enhancement of the argument presented in the case study and provide more recommendations for the way forward for the United Nations. / Thesis (DPhil)--University of Pretoria, 2010. / Sociology / unrestricted

Magister Chirurgiae Dentium (MChD) / MChD (Oral Pathology) minithesis, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, University of Western Cape Among malignant lesions, lymphoma ranks second only to squamous cell carcinoma in frequency of occurrence in the head and neck. Lymphomas in HIV patients' are second in frequency to Kaposi's sarcoma as AIDS-defining tumours. About 50% of lymphomas in HIV patients are extranodal and more than half of these occur in the head and neck area. The number, variety and diagnostic complexity of lymphoma cases that have primarily arisen in the head and neck region has steadily increased in the surgical pathology service of the National Health Laboratory Services (NHLS) - Tygerberg. This observation is particularly relevant in the context of increasing HIV infection rates in the population of South Africa as demonstrated by a study in 2006 conducted by the Medical Research Council of South Africa. This is a retrospective study using the records of cases of head and neck lymphomas diagnosed at NHLS-Tygerberg over the last five years. The aim of this study is to investigate the prevalence of head and neck lymphomas (HNL) at NHLS-Tygerberg from January 2002 to December 2006. The objective of this study is to determine the frequency and types of HNL and to determine, if possible, an association between the incidence of HNL and the HIV status of the patients. Trends of prevalence in terms of gender, referral centres, HIV status, age of patients and site of presentation are also examined. The results of this study show an increase in the number of patients with HNL from January 2002 to December 2006. A significant increase is noted in the number of HIV positive patients documented each year, from 17% in 2002 to 33% in 2006. Western Cape- urban (WC-U) remains the largest referral center. A notable increase is seen, each year, in the number of patients referred to Tygerberg-NHLS from the Eastern Cape (EC) and Western Cape- rural (WC-R) areas. A significant number of HIV positive patients are referred from the Eastern Cape and Western Cape rural areas. The average age of disease presentation in the HIV positive group of patients is 35 years with the unknown group being 46 years and the HIV negative group being 54 years. The main categories of lymphoma that presented in HIV positive patients are plasmablastic lymphoma (PBL) and diffuse large B-celllymphoma (DLBCL), which together form 56% of cases. 26% of cases are Hodgkin's lymphoma (HL); the second largest group of HNL cases. Burkitt's lymphoma (BL) consists of 8% of cases. 7% of cases are T-cell lymphomas. 3% of cases are Mantle zone lymphomas. No cases of SLL and Follicular lymphomas (FL) are described in this group of patients. DLBCL and HL form 27% each of the cases in patients with a negative HIV status. A significant number of Follicular lymphomas (15%), small lymphocytic lymphoma (SLL) (9%), MALT (7%), and T-cell lymphomas (8%) are identified. No PBL are seen in this group of patients. The incidence of HNL at NHLS-Tygerberg has increased over the last five years. This trend parallels that seen in other developing countries such as Tanzania, Nigeria, Thailand and India. This increase is possibly due to an increase in the number of referrals to our center, an increase in the overall population of the Western Cape, an increase in the number of HIV positive patients and the high incidence of EBV infection in the general population of the Western Cape. Social issues, such as poverty, lack of adequate education, female dependence on partners, rural communities and the non-availability of anti-retroviral drugs (ARV) and highly active anti-retroviral therapy (HAART) to most of the population that require these drugs, are considered major contributing factors. A trend is noted in the increased number of female patients diagnosed each year with HNL. A predominance of DLBCL was identified in our series. This is consistent with previous reports and studies on HNL. The number of biologically aggressive lymphomas, such as DLBCL, Plasmablastic and Burkitt's lymphomas diagnosed each year, has also significantly increased. These were prevalent mainly in the HIV positive group of patients who were also younger compared to the HIV negative patients. The documented findings of this study will serve as a guideline for the estimation of head & neck lymphoma burden and risk assessment at NHLS- Tygerberg.

Student Number : 0106135V - MA research report - School of Human and Communitiy Development - Faculty of Humanities / The mass media persistently thrusts the awareness of risk of HIV/AIDS into our lives. The question is: how do people respond to this increased awareness and how do people cope with living in what has been termed ‘the risk society’? This can only be investigated within a given social and cultural context, in order to examine how individuals make sense of a perceived imminent crisis. This research has highlighted the prominent phenomenon of a widespread sense of personal invulnerability when faced with risk: the ‘not me’ dynamic in response to the negative Social Representations that surround this disease. Social representations Theory is a useful psychological framework as it approaches the study of perceptions of HIV risk by highlighting the emotional factors which are key to the human responses of risk while at the same time concentrating on the role of cognitive processing in the development of representations of social phenomena. The results from the HIV Knowledge, Perceptions & Practices questionnaire survey in this cross-sectional study with 200 Johannesburg university students indicate that while the large majority of the participants know a great deal about HIV, this knowledge is highly impacted upon by the Social Representations that exist around this virus. It is believed that the Social Representations surrounding HIV (death, pollution, the evil perpetrator etc.) can act as a barrier between intellectual knowledge of HIV and the related behaviour to reduce the risk of infection by distorting one’s perception of susceptibility of infection through the process of ‘othering’.

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