<p>The devastation caused by the Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS) is having a major impact on both the social and economic environment in South Africa. HIV/AIDS hits at the core of the businesses structure - the bottom line. In the absence of a cure for the disease or an effective vaccine, the challenge for all the stakeholders is how to successfully contain and limit the impact of the disease. Intervention programmes such as awareness, knowledge sharing and sero-prevailance testing have the potential to limit HIV/AIDS infections and reduce high-risk behaviours. Whilst education and awareness programmes have been relatively successful in highlighting the dangers of HIV infection, perception, attitudes and behaviours of employees towards HIV/AIDS have dampened voluntary HIV screening initiatives. Many South African organisations have commendable HIV/AIDS education and awareness programmes, however, a concerning fact is that employees are reluctant to avail themselves to voluntary HIV/AIDS testing. Stigmatising attitudes toward persons living with HIV/AIDS may reduce people&rsquo / s willingness to have themselves tested for the Human Immunodeficiency Virus (HIV). This may increase the risk of transmission. It may also lead to increased absenteeism in the workplace, and workdays lost resulting from excessive sick.<br /> <br /> The aim of the study was to establish what the perceptions and attitudes are of employees at different levels of the organisation with regard to HIV/AIDS testing. A further aim was to identify possible reasons for the poor employee response to voluntary HIV/AIDS testing. It was thus important for this research to gauge employee knowledge, attitude and behaviour toward HIV/AIDS in order for organisations to develop strategies for effective HIV/AIDS counselling and testing programmes.<br /> <br /> The data for this study was collected by means of a self report questionnaire. The questionnaire was administered to a sample of employees across all levels of the organisation using the convenient sample approach to identify the respondents. Two hundred and forty six (246) out of a total of 600 questionnaires distributed were returned, making the response rate a credible 41%.<br /> The Statistical Package for Social Science (SPSS) was used to analyse the data obtained from the questionnaire. Both inferential and descriptive statistical approaches were used to analyse the data. The Analyses Of Variance (ANOVA) was used to determine whether differences exist in the perceptions and attitudes of employees at different levels and groupings in the organisation. Additionally post hoc tests (i.e. the Scheffe test) were applied to all comparisons of means after the analysis of variance.<br /> <br /> The findings of this research are important for the role of HIV/AIDS testing and awareness/preventions strategies implemented in South Africa. It provides more insight as to why employees resist HIV/AIDS testing. It can furthermore assist organisations in developing strategies for implementing effective HIV/AIDS awareness and/or prevention programmes. More specifically, the findings identified ways in which organisations can redesign their intervention programmes so as to encourage a greater number of employees to submit to voluntary HIV/AIDS testing.</p>

A infecção pelo HIV/aids no mundo atinge, desproporcionalmente, determinados grupos sociais, dentre eles a população privada de liberdade. Mediante o impacto da epidemia no âmbito carcerário, organismos internacionais orientam a adoção de estratégias de cuidado, pautadas em evidências científicas, o que determina o impacto positivo no controle do agravo nas prisões. Este estudo objetivou identificar e analisar as evidências científicas disponíveis na literatura sobre a assistência prestada às pessoas que vivem com HIV/aids (PVHA) no âmbito prisional. Trata-se de uma Revisão Integrativa da Literatura, tendo a prática baseada em evidências (PBE) como referencial teórico. No que se refere às etapas de desenvolvimento da revisão integrativa, procedeu-se à seleção dos estudos, por meio da utilização de descritores controlados e palavras-chaves junto às bases de dados LILACS, PUBMED, CINAHL e Web of Science. Dos 894 estudos recuperados, após leitura de forma independente por duas pesquisadoras, derivou-se uma amostra final de 15 estudos. Houve predomínio de pesquisas realizadas nos Estados Unidos, com população masculina, indivíduos afrodescendentes e com história pregressa de mais de um encarceramento ao longo da vida. A população abordada se encontrava em situação de privação de liberdade, contudo, em processo de transição para a comunidade. De modo geral, as estratégias de cuidado prestadas às PVHA em situação de encarceramento, enfocaram a coordenação e a transição para a comunidade, mediante estratégias de gestão de caso com referência e vínculo para serviços de saúde e sociais, planejamento de alta, tratamento de substituição com a utilização de metadona para dependentes químicos e a Terapia Antirretroviral Diretamente Administrada (DAART) para grupos com baixa adesão ao tratamento, em especial os usuários de drogas. Há que se ressaltarem as investiduras na identificação, sensibilização e engajamento de outros atores-chave, com destaque para egressos do sistema prisional visando a implementação de estratégias educativas, assistenciais e de suporte por pares, bem como a identificação, tentativa de reestabelecimento e fortalecimento de vinculo com a rede de suporte social dos indivíduos privados de liberdade em transição para a comunidade. Destaca-se o papel da enfermagem na viabilização das estratégias de gestão do caso, planejamento de alta, sensibilização e capacitação de atores-chave com potencial de engajamento nas atividades envolvendo o cuidado por pares. Concluiu-se que a assistência no âmbito prisional pautou-se no cuidado ampliado, transcendendo a dimensão clínica do manejo do HIV/aids em si, uma vez que incorporou no bojo das ações desenvolvidas, a identificação e integração de ações e serviços sociais e de saúde, valorizando, deste modo, um processo de cuidar pautado na reinserção social dos sujeitos no período que corresponde ao pré e pós-livramento prisional / The HIV infection affects certain social groups disproportionately, among them the prisoners. By the impact of the epidemic in prisonal ambit, international organizations guide to care strategies, conducted by scientific evidence, which determines the positive impact in controlling the disease in prisons. This study aimed to identify and analyze the scientific evidence available in the literature on assistance provided to people living with HIV/AIDS (PLWHA) in the prison context. This is an integrative review of the literature, and evidence-based practice (EBP) as the theoretical reference. With regard to development stages of the integrative review, we proceeded to the selection of studies, using controlled descriptors and keywords together to databases LILACS, PUBMED, CINAHL and Web of Science. Independently, two investigators read 894 recovered studies and derived a final sample of 15 studies. There was a predominance of researches done in the United States, with male population, Afro-descendant and individuals with a history of more than one life-long imprisonment. The covered population was in a situation of deprivation of liberty. However, they were in transition process to the community again. Generally, the care strategies provided to PLWHA in incarceration situation, focused on the coordination and the transition to the community, through case management strategies with reference and link to health and social services, discharge planning, substitution treatment with the use of methadone for drug addicts and the Directly Administered Antiretroviral Therapy (DAART) for groups with low adherence to treatment, particularly drug users. We have to highlight the investitures in identification, awareness and engagement of other key actors, especially former convicts, aiming the educational strategies implementation, care and support by peers, as well as the identification, attempt to re-establishment and strengthening of bonds with the social support network of private individuals of freedom in transition to the community. Besides, it is important to point the nursing role in the feasibility of case management strategies, discharge planning, sensitization and training of key actors with potential engagement in activities involving peer care. In conclusion, the assistance in the prison context was characterized in the extended care, transcending the clinical dimension of the management of HIV/AIDS itself. It is explained once it had incorporated in the core of the actions taken, the identification and integration of actions and social services and health, valuing, thus, a process of care founded on the social reintegration of the subjects in the period corresponding to the pre and post-prison

A magnitude da epidemia da aids e os desafios em garantir uma rede de atenção que atenda às necessidades das pessoas que vivem com HIV/AIDS justificam a realização do presente estudo, que tem por objetivos: contextualizar a trajetória em busca por cuidados de uma mulher que vive com HIV/AIDS e discutir os nós críticos da integralidade neste percurso. Trata-se de um estudo de caso, qualitativo, exploratório, na perspectiva teórico-conceitual da Integralidade. Utilizou-se a História de Vida Focal e o Itinerário Terapêutico. Para análise dos resultados, utilizou-se análise de discurso proposta por Fiorin. Identificou-se neste percurso que os desafios de conviver com o HIV consistiram em: lidar com o risco da transmissão vertical; conviver com o medo de ter o diagnóstico revelado; e conciliar a rotina de vida com a manutenção da terapia antirretroviral. As fragilidades da integralidade neste percurso consistiram em: predominante visão biológica do adoecimento na Atenção Básica; falta de articulação entre UBS, SAE-DST/AIDS e maternidade; falta de fluxos estruturados para a assistência da mulher com HIV na maternidade; e a invisibilidade do trabalho da enfermeira. Como potencialidades da integralidade: as Redes de Sustentação (família e amiga) e Apoio (trabalho, estudo, igreja e alguns profissionais de saúde); e a organização dos serviços ao favorecer acessibilidade à usuária no sistema de serviços de saúde. Concluiu-se que a articulação dos serviços ainda se encontra fragilizada e que está no usuário a centralidade da busca por cuidados, sendo ele e sua família, elos integradores entre os diferentes serviços assistenciais de saúde. Apontou-se a necessária implementação de Linhas de Cuidado na Atenção em HIV/AIDS, a fim de buscar integralidade na organização dos fluxos assistenciais. / The magnitude of the AIDS epidemic and the need for a network of comprehensive care to people living with HIV/AIDS justify the conduct of this study. The study aims were: to contextualize the trajectory in search for care of a woman living with HIV/AIDS and to discuss the critical points of the Comprehensiveness in this trajectory. This was a case-study, qualitative, exploratory, with the theoretical-conceptual of the Comprehensiveness. The method used was the Focused Life History and the Therapeutic Itinerary. The data were analyzed using the Fiorins Technical Discourse. The study identified that there are challenges of living with HIV: afraid of the risk of vertical transmission during pregnancy; to omit the diagnosis of HIV for afraid of prejudice and social isolation; and to reconcile the routine of study, work, care for her daughter and her mother, with the need to remain adhered to antiretroviral therapy. The problems of the Comprehensiveness in this trajectory were: predominantly biological view of illness in Primary Health Care; lack of articulation between Basic Health Units, Reference Units on HIV/AIDS and maternity hospital; lack of structured flows for the assistance of women with HIV in maternity hospital; and invisibility of the nurses work. As potentials Comprehensiveness: networks of support (family, friend, some health workers, church, work and study) and the organization of services to facilitate user access to the system of health services. It was concluded that the articulation of the services is still fragile and that the search for care has centrality in the user of health services. Furthermore, the study concluded that is the user of health services and her family that make link in the network of health services. The study indicated the necessary implementation of Lines of Care in HIV/AIDS Attention, to get Comprehensiveness in the organization of care flows.

Made available in DSpace on 2016-04-28T18:22:38Z (GMT). No. of bitstreams: 1 Vanessa Medina.pdf: 2412967 bytes, checksum: fd442f9d22e56808ca1548cfb5d76964 (MD5) Previous issue date: 2013-02-22 / some authors suggest that patients with acquired immune deficiency syndrome (AIDS) show vocal production disturbances, but there are few reports concerned on voice quality description. Objective: to evaluate the voice quality of subjects with AIDS from a phonetic perspective. Methodology: this study took place at the Institute of Infectology Emílio Ribas and has been properly approved by its ethical committee. 29 subjects were divided into two groups (group 1: research, group 2: reference). Group 1 was composed by 20 subjects with AIDS, 10 male and 10 female, all of them with metabolic alterations (Dyslipidemia) and under antiretroviral therapy. Group 2 was composed of 9 subjects, 5 female and 4 male, all of them with metabolic alterations (Dyslipidemia), without AIDS. The audio samples were recorded and submitted to auditory (Vocal Profile Analysis Scheme for Brazilian Portuguese) and acoustic analysis (ExpressionEvaluator Script running in PRAAT v.10 software). The auditory and acoustic data underwent multivariate statistic analysis (software XLStat). Results: Group 1 (AIDS) revealed predominance of the vocal tract (retracted tongue body, lowered tongue body and pharyngeal constriction), muscular tension (vocal tract hyperfunction) and phonatory settings (creaky voice, harsh voice associated to whisper), differing by gender. From the acoustic point of view, the discriminator power of the acoustic measures was decreased when compared to perceptual descriptions. From the perceptual point of view the period of antiretroviral treatment revealed a relation with voice quality settings. Conclusion: the phonetic approach of voice quality in a group of subjects with AIDS revealed voice quality settings related to pharyngeal constriction and retracted tongue body. From an acoustic perspective, the acoustic measures revealed relevance for the description of the male population with AIDS. The integrated analysis of perceptual and acoustic data revealed correlation between vocal tract, tension and phonatory settings and LTAS long term spectrogram, spectral slope and fundamental frequency (f0) measures. The descriptions of voice quality settings, from the perceptual perspective, were relevant to characterize the voice quality of the studied group, as well as for revealing the association with the duration of antiretroviral therapy / apesar de alguns estudos sugerirem que pacientes com a Síndrome da Imunodeficiência Adquirida (SIDA) apresentam alterações nas estruturas envolvidas na produção vocal, não há relatos de descrições de qualidade vocal neste grupo. Objetivo: avaliar, do ponto de vista fonético, a qualidade vocal de indivíduos portadores da Síndrome da Imunodeficiência Adquirida (AIDS), por meio da descrição de correlatos acústicos e perceptivos. Metodologia: o estudo foi realizado no instituto de infectologia Emílio Ribas, com aprovação do comitê de ética. O grupo estudado constou de 29 indivíduos, sendo divididos em dois grupos (grupo pesquisa e grupo referência). O grupo de pesquisa foi constituído por 20 indivíduos portadores de SIDA, 10 homens e 10 mulheres com presença de alterações metabólicas (dislipidemia) e uso de medicamento antirretroviral. O grupo controle foi composto por nove indivíduos, cinco mulheres e quatro homens que apresentaram alteração metabólica: dislipidemia sem a presença de SIDA. As amostras de áudio foram coletadas e submetidas a análise perceptivo-auditiva (roteiro VPAS - PB) e acústica (script ExpressionEvaluator aplicável ao software Praat v.10). Os dados perceptivo-auditivos e acústicos foram analisados por meio de análise estatística de natureza multivariada (software XLStat). Resultados: o grupo estudado (SIDA) revelou o predomínio de ajustes do trato vocal (corpo de língua recuado, corpo de língua abaixado e constrição faríngea), ajustes de tensão muscular (hiperfunção de trato vocal) e ajustes fonatórios (voz crepitante, escape de ar associado a voz áspera), diferenciados por gêneros. Do ponto de vista acústico, o valor segregatório das medidas acústicas foi inferior às descrições perceptivas. O tempo de medicação revelou relação com as manifestações de qualidade vocal do ponto de vista perceptivo. Conclusão: do ponto de vista fonético, foram destacados na população com SIDA os ajustes de qualidade vocal de constrição faríngea e de corpo de língua recuado. Do ponto de vista acústico, as informações de medidas acústicas revelaram relevância para descrição da população SIDA do gênero masculino. A análise integrada de dados perceptivos e acústicos revelou a maior correlação de ajustes de trato vocal, de tensão e fonatórios a medidas acústicas de LTAS- espectro de longo termo, declínio espectral e frequência fundamental- f0. As descrições de ajustes de qualidade vocal por meio perceptivo foram relevantes para caracterizar a qualidade vocal do grupo estudado, bem como revelaram associação com o tempo de medicação

Magister Psychologiae - MPsych / Globally, and especially in Sub-Saharan Africa the advent of HIV and AIDS has created new inequalities within already challenged health care systems. Chronic illnesses have often been associated with increased prevalence of psychological symptoms. Both national and international studies have found a strong association between psychiatric morbidity and HIV and AIDS. Furthermore, studies have found that social support contributes to positive adjustment of individuals infected with HIV and provides a buffer against the effects of anxiety. The aim of this study was therefore to examine anxiety and social support in adults diagnosed with HIV or AIDS at a public health clinic in the Western Cape. The objectives in relation to the aim were: (1) To determine the prevalence of anxiety in adults diagnosed with HIV or AIDS. (2) To determine the degree of social support, as a component of quality of life,in adults diagnosed with HIV or AIDS. (3) To examine the relationship between anxiety and social support in adults diagnosed with HIV or AIDS. The broad theoretical framework that guides this study is the bio-psycho-social model. A cross-sectional design was used in which 70 participants were recruited using a purposive sampling method. Participants were assessed using well-validated self-administered questionnaires: Hospital Anxiety and Depression Scale(HADS) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 17.1. Correlational and inferential statistics were conducted. The findings of this study indicated that participants in this study had higher levels of anxiety (28%) when compared to the general population (15.8%). Participants in this study, indicated a 59% enjoyment and satisfaction with social support, which indicates satisfaction with social support some of the time. There was however no significant relationship between anxiety and social support in this study. HIV intervention efforts should include screening HIV positive individuals for the presence of psychiatric symptoms. Interventions should also include encouraging HIV positive individuals to maintain and expand their social networks.

Magister Public Health - MPH / The reproductive health of women is hugely dependent on the involvement of their male partners. Men also serve as gatekeepers to women’s access to reproductive health services. Male involvement is an important recommendation for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) program as their participation in antenatal care and HIV testing has been found to decrease infant HIV infection and increase HIV free survival. Male involvement is not just about promoting men to accompany their partners to antenatal clinic, but for men to provide supportive roles in their families, and also to bring men into HIV preventive and care services. Male involvement in PMTCT is defined as the fathers’ active involvement in attending antenatal care services and HIV testing during the antenatal period as well as the couple’s acceptance of PMTCT if the mother is found to be HIV positive. Men are traditionally not directly involved in their partner’s health in many sub-Saharan countries, although they most often make decisions about use of services. They may provide financial support but attending health services with their partner is not seen as part of the male’s role. There are therefore huge challenges in efforts to get men involved in reproductive health services and there is a need to better understand how to promote male involvement in different settings. Male involvement in PMTCT was adopted by the Zambian Government in 1999 but not much is known on how best to initiate and develop male involvement in their partner’s health.

Estudou-se a experiência de mulheres vivendo com HIV e aids também conviverem com situações de violência por parceiro íntimo, e as repercussões destes entrecruzamentos para o cuidado de sua saúde. Tomamos como referência o conceito de vulnerabilidade já formulado para a AIDS e retrabalhado especificamente para as questões de gênero, permitindo explorar o conceito nas situações de violência doméstica contra as mulheres. Partiu-se do pressuposto que os contextos do HIV/Aids podem gerar situações de violência de mulheres soropositivas e que as representações amorosas, o ideal de conjugalidade e de família podem influenciar no impacto do cuidado da saúde das mulheres. Foram realizadas 20 entrevistas em profundidade com mulheres em acompanhamento do HIV/Aids, inseridas nos Serviços de Saúde da Rede Especializada em DST/Aids da cidade de São Paulo, na modalidade história de vida. Encontraram-se diversos contextos da vulnerabilidade, denominada de gênero, nas narrativas produzidas, na infância, adolescência e fase adulta, reforçando padrões hegemônicos de gênero ao longo dos diferentes ciclos de vida dessas mulheres. O estudo aponta que as experiências do adoecimento na revelação do diagnóstico é o elemento disparador de medos e sofrimentos em decorrência da reação dos parceiros e a das preocupações com os filhos. O diagnóstico do HIV é o momento não só do contato com a doença, mas de desvelar ou reconhecer situações de violência. É a partir das concepções e contextos de vida que as mulheres identificam o modo de se situarem no enfrentamento do HIV e da violência. O cuidado da saúde foi abordado tanto como cuidado de si, quanto na relação com os serviços de saúde, o que mostrou a grande preocupação representada pelas dificuldades que, em função de suas condições de portadoras do HIV, essas mulheres viam para se manterem na condição tradicional de cuidadoras, dentro das referências do padrão social de gênero, quer em torno de seus adoecimentos e expectativas de vida futura, quer para com os filhos. Tais preocupações surgem como justificativas da manutenção da família diante de parceiros violentos. Embora presente, observou-se que o tema violência não é pauta na atenção à saúde da mulher vivendo com HIV e aids, nos serviços de saúde especializados. A vulnerabilidade de gênero destaca-se pela ênfase na condição materna, em que por ela e para ela as mulheres dão significados às suas vidas, ao adoecimento e ao cuidado. / This work studied the experience of women living with HIV and AIDS also live with situations of violence by their intimate partner and the implications of these intersections for their health care. We took as reference the concept of vulnerability already formulated to AIDS and adapted for gender issues, allowing explore it in situations of domestic violence against women. We started from the assumption that the contexts of HIV / AIDS can lead to situations of domestic violence involving HIV positive women and that the representations of love, the ideal of marital and family can influence on health care of these women. We made 20 in-depth interviews with women living with HIV / AIDS, followed on STD / AIDS reference centers of the Municipality of São Paulo, using living history method. We found in the narratives several contexts of the so called gender vulnerability occurred in childhood, adolescence and adulthood, reinforcing hegemonic gender patterns over the different life cycles of these women. The study shows that the fact of the diagnosis disclosure to be made during an illness is the element that triggers fear and suffering in relation to the reaction of the partners and worries with their children. The time of HIV diagnosis is not only the moment of contact with the disease, but also the time to uncover or recognize situations of violence. It is through conceptions and contexts of life that women identify how to locate themselves in the struggle against HIV and violence. Health care was addressed as much as caring for oneself as well in relation with the health services. This approach showed the great concern about the difficulties perceived by these women in order to keep the condition of traditional caregivers within the references of hegemonic social pattern of gender, either about their illnesses and future life expectations either about children. Such concerns arise as a justification for maintaining the family when there is coexistence with a violent partner. Although present, it was observed that violence is not an issue discussed in health care of women living with HIV and AIDS in specialized health services. The vulnerability of gender of these women is distinguished by an emphasis on maternal condition which gives meaning to their lives, illness and care.

<p>The main purpose of the study was to assess and explore the knowledge of HIV/AIDS among secondary learners in rural Bergville district of KwaZulu-Natal. A stratified random sample of 100&nbsp / learners was selected from two secondary schools in the area. Data was collected using a questionnaire and interviews were scheduled with the teachers from the selected schools. The&nbsp / questionnaire was administered to a sample of 54 learners from school A and 46 from school B. The mean age was 16, with age range from 13-20. The participants were enrolled for grade&nbsp / 8-12 in both schools. Both qualitative and quantitative data on learners‟ knowledge and perception about HIV/AIDS, condom use and sexual issues including their attitudes towards people living with HIV/AIDS were collected in the questionnaire. Chi-square test was used for statistics purpose to test if the HIV knowledge of learners were associated with gender, culture and&nbsp / religion. Qualitative interviews with 9 teachers from both schools were conducted. The main purpose of the interviews was to investigate the management of HIV/AIDS in public schools in rural&nbsp / areas. Furthermore, to assess the learner‟s attitude towards HIV/AIDS education provided in schools. The results showed that the learners in Bergville district were more knowledgeable of&nbsp / HIV/AIDS through HIV/AIDS education in schools that had limited effect on gender, culture and religion. Quantitative findings presented, indicated no significant differences between those&nbsp / learners attending church and cultural activities that offer&nbsp / HIV/AIDS awareness programmes and those who do not with regard to the knowledge of HIV/AIDS. However, culture stood out to be associated with one item on the knowledge of whether school children can get HIV/AIDS (p-value = 0.04). On average, the level of knowledge of HIV/AIDS between female and male learners was similar. The major findings on both quantitative and qualitative findings confirmed that learners‟ knowledge levels were very high for modes of transmission and prevention of HIV/AIDS. Despite this knowledge, poor&nbsp / behavioural change among learners is a major setback thus increasing high risk of contracting HIV. Adequate knowledge about issues of cure, HIV testing and treatment was of concern in the findings in this study. Furthermore, data from qualitative interviews with the teachers highlighted the lack of multisectoral response to HIV/AIDS in Bergville rural communities which thus&nbsp / compromise the effectiveness in management of HIV/AIDS in schools. In summary, the study revealed some of the challenges faced by teachers and learners in regard to HIV/AIDS education.</p>

<p>Eligibility for antiretroviral therapy (ART) in HIV-infected patients is defined either by a cluster of differentiation antigen 4 (CD4) count of less than 200cells/mm3 or clinical diagnosis of WHO stage III and IV. Therefore, the decision to start ART becomes difficult when CD4 cell count is not available. With limited laboratory infrastructure, the decision to start ART is usually made based on clinical symptoms leading to late commencement of ART. This calls for alternative criteria to see if nail discoloration (ND) correlates with low CD4 count among untreated HIV infected patients. This will serve as a complementary screening tool for identifying asymptomatic ARV naive HIV patients with a CD4 cell count of less than 200cells/mm3 which signifies&nbsp / severe immunosuppression. Study Design and Setting: This was a quantitative cross-sectional descriptive and analytical study involving adult ART na&iuml / ve HIV infected patients in WHO stage I and II. Systematic sampling was used to select the participants from all adult ART na&iuml / ve HIV infected patients attending APIN clinic, located at the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Data Collection: Face-to-face interviews, physical examination and relevant laboratory investigations with selected participants were conducted using a questionnaire guide. Questions on socio-demographic characteristics, clinical data, general physical examinations including finger nail examination and photographing with subsequent laboratory investigations including CD4 count and western blot were employed. Data Analysis: Variables were categorized and data analyzed using descriptive statistics including the frequency, percentage frequency / mean and standard deviation of continuous variables. Association between CD4 count of &le / 200cells/mm3 and ND was tested using the chisquare test with an alpha level of 0.05. Prevalence of ND, sensitivity, specificity, positive predictive and negative predictive values and accuracy of the screening test of ND was calculated. Results: 394 patients had their fingernails photographed and assessed. It was shown that distal banded and grey nails were the common types of ND seen with a prevalence of 38%. There was an association between CD4 count &le / 200cells/mm3 and ND (p&lt / 0.0001). CD4 count &le / 200cells/mm3 was a risk factor for developing ND (RR=2.3[1.8-3.6]). The association has a sensitivity of 78%, specificity of 55%, positive predictive value of 50%, and negative predictive value of 80% and accuracy of test 63%. Conclusion: With a significant association (p&lt / 0.0001) and a sensitivity of 78%, ND can be a useful clinical indicator of immune dysfunction mediated by HIV among patients in WHO stage I or II. ND can either be a clinical sign or a symptom in HIV patients with a CD4 of &le / 200cells/mm3 as seen in the study as the specificity and sensitivity of ND compared favourably with other WHO stage III diagnosis. Recommendations: Nail discoloration should complement CD4 count as an additional staging sign to help identify patients likely to benefit from ART especially in resource-limited settings. Finally, all patients with grey or distal banded should be on co-trimoxaxole prophylaxis in line with WHO /national guideline on the use of co-trimoxaxole for all HIV positive patients with a CD4 cell count of &le / 350cells/mm3.</p>

The prevalence of HIV infection in pregnant women is still on the rise despite existing preventive programmes aimed at reducing HIV-transmission. Voluntary counselling and testing during pregnancy is the key entry point in the prevention of mother-to-child transmission (Department of Health, 2000:16; Birdsall et al. 2004:3). Women are often diagnosed as being HIV-positive for the first time when they attend antenatal clinics and consent to HIV testing (UNAIDS, 1997). The objective of this study was to determine the pregnant women's experiences of voluntary counselling and testing (VCT) and to explore and describe the impeding and facilitating factors that played a role in their choice whether or not to consent to HIV testing after having received pre-test counselling. By understanding the impeding and facilitating factors that play a role in the pregnant woman's choice to undergo HIV testing, recommendations could be made to possibly improve the uptake of HIV testing among pregnant women. The population studied in this research consisted of pregnant women making use of antenatal clinics in the Potchefstroom sub-district. Purposive sampling was used to select participants with the assistance of mediators who were working in the local clinics and the hospital. The sample size was determined by data saturation, which was reached after 10 interviews. A qualitative design was used and data was collected by means of semi-structured interviews. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached consensus on the main and sub-themes. The main themes are the facilitating and impeding factors that play a role in the pregnant women's choice to undergo HIV testing. Based on findings, it was concluded that facilitating and impeding factors that play a role in the pregnant woman's choice to HIV testing do indeed exist. Impeding factors identified were: fear of a positive status; fear of stigmatization and discrimination; fear of lack of support; lack of opportunity to consider their choice to undergo HIV testing; lack of trust that confidentiality will indeed be honoured; fear of knowing possible positive HIV-status that can lead to feelings of depression and mental anguish; differences between counsellors' and pregnant women's characteristics. Facilitating factors consist of the desire to be aware of own HIV status; desire to protect the baby; sufficient information and the importance of trust and confidentiality. Recommendations were subsequently made to make HIV counselling and testing services to pregnant women more user-friendly in order to facilitate the pregnant woman in her choice concerning HIV-testing. Heeding these recommendations will possibly lead to more pregnant women's HIV status being known by the time they go into labour. Recommendations were made that pregnant women be counselled for HIV testing during their first antenatal visit and the HIV-testing being offered to them during the second visit. Research findings reveal that most pregnant women need time to consider their choice to undergo HIV testing and to prepare themselves for the test. Most pregnant women felt that they would possibly consent to HIV testing during their second antenatal visit. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.