Na infecção pelo HIV o equilíbrio entre antioxidantes e pró-oxidantes e a produção de citocinas encontram-se alterados, causando estresse oxidativo crônico. Presume-se que o estresse oxidativo crônico e a ativação do sistema imunológico favorecem a replicação do vírus através da ativação do NF-kB e a apoptose de células mononucleares do sangue periférico. O objetivo deste estudo foi avaliar o efeito da suplementação, durante 180 dias, com 600mg/dia de N-acetilcisteína (NAC), sobre a carga viral, os níveis de sub-populações de linfócitos, a viabilidade de linfócitos e sobre os níveis séricos de citocinas, proteínas, lipídeos, β2 microglobulina e outros marcadores da ativação do sistema imunológico em pacientes assintomáticos, submetidos ao primeiro tratamento anti-retroviral. Participaram deste estudo, duplo cego controlado por placebo, que teve a duração de 180 dias, 30 indivíduos que iniciaram a terapia anti-retroviral. O grupo estudo foi constituído por 14 indivíduos que além do tratamento anti-retroviral foram suplementados com NAC, enquanto o grupo controle foi constituído por 16 indivíduos que além do tratamento anti-retroviral receberam placebo. Os marcadores avaliados foram determinados no dia anterior ao início do tratamento a que foram submetidos e após 60, 120 e 180 dias. Verificou-se aumento significante dos linfócitos CD4+, da relação CD4/CD8, de linfócitos viáveis, albumina, cisteína e glutationa, bem como diminuição significante dos níveis de TNF-α, IL-8, haptoglobina e α1-glicoproteína ácida, β2-microglobulina, IgA e IgM, nos dois grupos estudados. Os níveis séricos de IL-6, colesterol total, LDL-colesterol, VLDL-colesterol e triglicerídeos não apresentaram alteração significante ao final deste estudo. Concluindo, a suplementação com 600 mg/dia de NAC, em pacientes submetidos ao tratamento anti-retroviral, não proporcionou benefícios adicionais àqueles decorrentes deste tratamento. / In HIV infection, the balance between antioxidants and pró-oxidants and the production of citokines are disturbed leading to a chronic state of oxidative stress and immune activation. It is presumed that HIV takes advantage of the proinflammatory and prooxidative environment to replicate through the NF-kB pathway leading to the apoptosis of peripheral blood mononuc1ear cells. The aim of this work was to study the effect of oral administration of N-acetylcysteine (NAC) 600 mg per day during 180 days on viral load, viability of lymphocytes, cytokines, proteins, lipids, β2-microglobulin and other immune activation markers in asymptomatic patients under their first antiretroviral therapy. This was a double-blind, placebo-controlled study with 30 individuals who started antiretroviral therapy and were followed for 180 days. These individual were divided into two subgroups: the study group consisted of 14 participants who received NAC supplementation, whereas the control group had 16 individuals who received placebo. The studied markers were determined on the day before the beginning of treatment and after 60, 120 and 180 days of treatment. A significant increase was seen for CD4+ lymphocytes, the CD4/CD8 ratio, albumin, cysteine and glutathione; also, a significant reduction was found for levels of TNF-α, IL-8, β2 microglobulin, IgA, IgG, IgM, haptoglobin, and acid α1-glycoprotein as a consequence of antiretroviral treatment. After 180 days of treatment, the levels of total protein, globulins and HDL-cholesterol presented significant alteration on1y in the control group, while the serum levels of IL-6, total cholesterol, LDL-cholesterol, VLDL-cholesterol and triglyceride did not show significant alteration at the end of the present study. In conclusion, the supplementation of HIV-positive patients with 600 mg/day of NAC did not bring additional benefits to those resulting from antiretroviral treatment.

Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2017-03-27T16:53:12Z No. of bitstreams: 1 Santos, Monique Luiza Aguiar dos [Dissertação, 2014].pdf: 5528413 bytes, checksum: ee7fde929572abea4d1a8749c2310571 (MD5) / Made available in DSpace on 2017-03-27T16:53:12Z (GMT). No. of bitstreams: 1 Santos, Monique Luiza Aguiar dos [Dissertação, 2014].pdf: 5528413 bytes, checksum: ee7fde929572abea4d1a8749c2310571 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A síndrome da imunodeficiência humana adquirida (AIDS, acquired immunodeficiency syndrome) é causada pelo vírus da imunodeficiência humana (HIV, human immunodeficiency virus) que infecta as células do sistema imune, destruindo-as ou causando prejuízos ao seu funcionamento. Dentre as enzimas do HIV, a integrase é responsável pela inserção do DNA viral no DNA do hospedeiro. Atualmente, existem apenas três fármacos em uso clínico pertencentes à classe dos inibidores de integrase: raltegravir (um derivado pirimidinona carboxamida), elvitegravir (um derivado quinolina) e dolutegravir (um derivado diazatriciclo carboxamida). Entretanto, diversos casos de resistência a estes fármacos são descritos na literatura e as mutações da enzima responsáveis por este perfil são conhecidas. Neste trabalho foram empregados estudos de relação entre a estrutura química e atividade biológica (SAR) e docking molecular, aplicados a uma série de 68 derivados azaindóis do ácido hidroxâmico sintetizados e avaliados farmacologicamente como inibidores de integrase do HIV (PLEWE et al., 2009; TANIS et al., 2010; JOHNSON et al., 2011). Entre os resultados obtidos, no estudo da relação entre a estrutura química e a atividade biológica foi observado que a ausência do hidrogênio ligado ao oxigênio da porção ácido hidroxâmico leva a perda de atividade biológica. E as simulações de docking molecular revelaram que este oxigênio deve possuir carga parcial -1 para realizar interação iônica com os íons Mg²+ presentes no sítio ativo da enzima integrase que funcionam como cofatores. A complexação dos derivados azaindóis com estes íons leva a inibição enzimática. Os compostos mais ativos, 1c e 21c, foram os que apresentaram melhor perfil de interação com a enzima / The acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) that infects cells of the immune system, destroying them or causing damage to its operation. Among all the HIV enzymes, integrase is responsible for the insertion of viral DNA in the host DNA. Currently, there are only three drugs in clinical use that belong to the class of integrase inhibitors: raltegravir (a pirimidinone carboxamide derivative, elvitegravir (a quinoline derivative) and dolutegravir (a diazatricyclo carboxamide derivative). However, several cases of resistance to drugs of this class are described in the literature, and the mutations of the enzyme responsible for this profile are known. In this work were employed studies of structure activity relationship (SAR) and molecular docking, applied to a series of 68 derivatives of azaindole hydroxamic acid synthesized and pharmacologically evaluated as HIV-1 Integrase inhibitors (PLEWE et al., 2009; TANIS et al., 2010; JOHNSON et al., 2011). Among the results obtained in the study of the relationship between the chemical structure and the biological activity was observed that the absence of hydrogen bound to oxygen of the hidroxamic acid takes to loss of biological activity. And molecular docking simulations showed that this oxygen must have partial charge -1 to perform ionic interaction with Mg²+ ions present in the active site of the integrase enzyme, which act as cofactors. The complexation of azaindole derivatives with these ions takes to enzymatic inhibition. The most active compounds, 1c and 21c, were the ones who presented best profile of interaction with the enzyme

Master of Public Health - MPH / Background: The repercussions of being HIV positive coupled by the complications of antiretroviral therapy are likely to cause distress, emotional and psychological problems particularly among children infected by the virus. The limited support services for children experiencing distress intensify the urgency to address this challenge. Despite the availability of social workers and nurses' interventions currently in place, the number of children in need of psychological care continues to increase. This is particularly true at Deborah Retief Memorial (DRM) hospital, one of the main antiretroviral therapy facilities in Kgatleng district, Botswana. Method: The purpose of this study was to explore and describe the perceptions of social workers, nurses and caregivers on key factors contributing to psychological distress of HIV positive children. A descriptive, exploratory qualitative study design that employed the use of in-depth interviews was used to conduct this study. Participants included four caregivers of HIV positive children who seek antiretroviral therapy at DRM hospital Infectious Diseases Control Clinic, together with five nurses and two social workers who worked in the same clinic. Conventional content analysis was used to analyse the in-depth interview transcripts. Results: Perceived psychological stressors for HIV positive children included disclosure of HIV status, orphanhood, social problems, lifelong treatment, stigma, poor caregiver-child relationship and lack of caregiver‟s love, care and support. However the caregivers did not fully understand the psychological distress the HIV positive children were experiencing, hence were unable to recognize it in these children. The study highlighted that major challenges faced by the health-workers included lack of qualified personnel, lack of adequate knowledge and skills, and a non-conducive working environment required to effectively assist children with psychological distress. The findings also indicated the need for education and support of caregivers and HIV positive children by the educators, family and health-worker systems. Conclusion: The profile of key stressors of psychological distress, the challenges and support needs suggested by the participants in this study can provide a framework for improving the existing services for HIV positive children with psychosocial problems. This information is important for use in training nurses and social workers involved with children with psychological behaviours.

This study describes hospital nurses' experiences caring for patients with AIDS. A modified version of Speigelberg's phenomenological approach was used which explored the nurses' experiences from their perspective. A total of eight nurses who had cared for patients with AIDS were interviewed. The findings indicated that caring for these patients is stressful. The researcher identified sources of stress as both internal and external. Internal stressors included: (1) fear of contracting AIDS; (2) homophobia; and (3) caring for dying AIDS patients. The two external stressors were patient variables and societal views. Lack of perceived emotional support from nursing administration further increased the stress. These nurses believed this form of support was essential. In order to cope with these experiences, the nurses utilized their usual coping strategies. Common ones were being physically active, relaxing, and talking with others. Different coping strategies were used to deal with the specific stressors. These were identified by the researcher as: (1) rationalization; (2) knowledge-seeking; (3) withdrawal; and (4) involvement. This study's findings emphasize the need for support for all nurses caring for patients with AIDS. Implications for nursing education, practice, and research were identified. / Applied Science, Faculty of / Nursing, School of / Graduate

Orientadores: Lúcia Helena Simões da Costa Paiva, Ana Lúcia Ribeiro Valadares / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T21:45:11Z (GMT). No. of bitstreams: 1 Akl_LiviaDrumond_D.pdf: 1659743 bytes, checksum: 05cc93759e4280105f72769b37386da1 (MD5) Previous issue date: 2015 / Resumo: A terapia antirretroviral (TARV) impactou drasticamente na taxa mortalidade e expectativa de vida de pessoas vivendo com HIV (PVHS), mas tem sido associada a uma série de alterações metabólicas, incluindo a síndrome metabólica (SM). Tal como para as consequências clínicas da SM, existe evidência de que as mulheres são particularmente afetadas negativamente. Objetivos: Determinar a prevalência de SM e fatores associados em mulheres climatéricas com e sem o vírus da imunodeficiência humana (HIV). Métodos: Realizou-se um estudo de corte transversal, entre outubro de 2010 e julho de 2012, em uma amostra com 537 mulheres (273 mulheres climatéricas HIV soropositivas e 264 mulheres climatéricas HIV soronegativas) entre 40 e 60 anos em dois centros de referência no tratamento ambulatorial de HIV. A SM foi diagnosticada de acordo com o critério da IDF, 2006. Foi realizada uma entrevista para avaliação dos fatores sociodemográficos, clínicos, comportamentais e fatores associados com a infecção pelo HIV. Todas foram submetidas à medida do peso corporal, altura, circunferência da cintura, pressão arterial e realizaram coleta de sangue periférico para dosagem de colesterol total e frações, triglicérides, glicemia de jejum e dosagens hormonais. Foram utilizadas a análise bivariada e a análise de regressão múltipla para selecionar os principais fatores associados à SM. Resultados: A média de idade foi de 47,7 anos nas mulheres HIV soropositivas e 49,8 anos nas mulheres HIV soronegativas (p<0,001). A prevalência de SM no grupo soropositivo foi de 46,9% em comparação com 42,2% no grupo soronegativo (p=0,340). A análise bivariada mostrou maior prevalência de SM no grupo HIV soropositivo em mulheres que estavam na pós-menopausa em comparação ao grupo soronegativo (p=0,032), em uso de terapia hormonal (TH) (p=0,040), quando a autopercepção de saúde foi considerada excelente/boa (p=0,011) e em mulheres com índice de massa corporal (IMC) > 25 kg/m² (p=0,005). A análise bivariada somente do grupo HIV soropositivo mostrou associação entre SM e idade ? 50 anos (p=0,002), escolaridade < 8 anos (p=0,003), pós-menopausa (p<0,001), IMC > 25 Kg/m² (p<0,001) e FSH ? 40 mUI/mL (p=0,002). Não houve associação entre SM e o uso de Lopinavir e Indinavir no grupo HIV soropositivo. A análise de regressão múltipla no grupo geral mostrou que os fatores associados a SM foram IMC > 25 kg/m² (RP: 2,34; IC95%%: 1,70-3,21; p<0,001), envelhecimento (RP: 1,05; IC95%%: 1,02-1,07; p<0,001) e uso de TARV (RP: 1,48; IC95%%: 1,13-1,94; p=0,005). A análise múltipla somente do grupo soropositivo mostrou associação entre SM e IMC em kg/m² (RP: 1,09; IC95%%: 1,05-1,13; p<0,001) e dosagem de hormônio folículo estimulante (FSH) ? 40 mUI/mL (RP: 1,66; IC95%%: 1,14-2,40; p=0,008). Conclusão: Não houve associação de SM e infecção pelo HIV. Verificou-se que as mulheres HIV soropositivas tiveram prevalência significativamente maior de SM quando na pós-menopausa, com alto IMC e em uso da TARV. Observa-se a necessidade de uma melhor abordagem de mulheres HIV soropositivas e soronegativas para evitar o ganho de peso e SM / Abstract: Antiretroviral therapy (ART) dramatically impacted mortality and life expectancy in people living with HIV (PLWH), but has been associated with a number of metabolic abnormalities, including metabolic syndrome (MetS). As to the clinical consequences of MetS, there is evidence that females are particularly negatively affected. Objectives: To determine the prevalence of MetS and associated factors in climacteric women with and without human immunodeficiency virus (HIV). Methods: A cross-sectional study between october 2010 and july 2012, in a sample of 537 women (273 HIV seropositive climacteric women and 264 HIV seronegative climacteric women) between 40 and 60 years at two referral centers in the HIV outpatient¿s clinic. MetS was diagnosed according to IDF, 2006. Interviews to assess sociodemographic, clinical, and behavioral factors associated with HIV infection was performed. All women were submitted to body weight, height, waist circumference, blood pressure and performed peripheral blood collection for total cholesterol dosage and fractions, triglycerides, fasting glucose and hormone levels. Bivariate analysis and multiple regression analysis to select the main factors associated with MetS were performed. Results: The mean age was 47.7 years in HIV seropositive women and 49.8 years in the HIV seronegative women (p<0.001). The prevalence of MetS in HIV seropositive climacteric women was 46.9% compared to 42.2% in the HIV seronegative group (p=0.340). Bivariate analysis revealed a higher prevalence of MetS in HIV seropositive group in women who were postmenopausal compared to HIV seronegative group (p=0.032), in use of hormone therapy (HT) (p=0.040), when the self-rated health was considered excellent/good (p=0.011) and in women with body mass index (BMI) > 25 kg/m² (p=0.005). The bivariate analysis of such HIV seropositive group showed an association between MetS and age ? 50 years (p=0.002), formal education < 8 years (p = 0.003), being postmenopausal (p<0.001), BMI > 25 kg/m² (p<0.001) and FSH ? 40 mIU/mL (p=0.002). There was no association between MetS and the use of Lopinavir and Indinavir in HIV seropositive group. Multiple regression analysis showed that in the whole group, factors associated with MetS were BMI > 25 kg/m² (PR: 2.34; 95 % CI: 1.70 to 3.21; p<0.001), aging (PR: 1.05; 95 % CI: 1.02 to 1.07; p<0.001) and the use of HAART (PR: 1.48; 95 % CI: 1.13 to 1.94; p = 0.005). Multiple analysis of such HIV seropositive group showed an association between MetS and BMI in kg/m² (PR: 1.09; 95 % CI: 1.05-1.13; p<0.001) and follicle stimulating hormone dosage (FSH) ? 40 mIU/mL (PR: 1.66; 95 % CI: 1.14 to 2.40; p=0.008). Conclusion: There was no association of MetS and HIV infection. It was found that HIV seropositive women had significantly higher prevalence of MetS when being postmenopausal, with high BMI and in use of HAART. There is a need of a better approach to both HIV seropositive and seronegative women to prevent weight gain and MetS / Doutorado / Fisiopatologia Ginecológica / Doutora em Ciências da Saúde

Os bancos de dados atualizados constituídos a partir de informações dos prontuários de pacientes HIV+ são importantes fontes para a realização de pesquisas clínicas e epidemiológicas de forma rápida e eficiente. A elevada variabilidade do HIV-1, resultado, entre outros fatores, da ausência de mecanismos eficientes de reparo durante os estágios da replicação viral, contribui para a emergência de cepas resistentes aos antiretrovirais. O objetivo deste trabalho é desenvolver e implementar um banco dados inteligente utilizando a Rede Neural Artificial Paraconsistente (RNAP), assentada na Lógica Paraconsistente Anotada, para auxiliar o mapeamento de informações contidas nos diversos formulários a fim de apoiar o mapeamento das informações provenientes dos diferentes registros médicos produzidos. O banco de dados será usado principalmente para apoiar o processo de decisão sobre a prescrição da terapia antiretroviral. Os resultados obtidos durante a pesquisa mostram que a técnica pode se tornar uma ferramenta promissora. / Updated databases made from information collected from HIV+ patients are important references to quickly and efficiently design clinical and epidemiologic studies. The high levels of variability of the HIV-1 virus, among other factors, the result of the absence of repair mechanisms during replication, strongly contribute to the establishment of resistance to antiretroviral therapy. The main objective of this study is the design and implementation of an inteligent database using the concept of Paraconsistent Artificial Neural Network (PANN) based on the Paraconsistent Annotated Logic, in order to support the mapping of the information coming from the different medical records produced. The database will be used primarily to support the decision process on the antiretroviral therapy prescription. Results obtained during the research show that the technique may become a promising tool.

Introdução: A Síndrome da Imunodeficiência Adquirida (SIDA) é uma doença infecciosa causada por um retrovírus chamado Human Immunodeficiency Virus - HIV. Os principais alvos do HIV são as células que exibem a molécula CD4 e as células gliais do Sistema Nervoso Central (SNC) possuem estas moléculas. Uma das alterações possíveis de acontecer em virtude da infecção pelo HIV é a alteração de linguagem, pois o processamento desta ocorre no SNC. Dentre todas as dimensões da linguagem a semântica é a parte que compreende o significado das palavras tanto na compreensão quanto na produção. Esta dimensão pode influenciar o processo da leitura. Objetivo: Comparar o desempenho entre crianças portadoras de HIV por transmissão vertical e crianças com baixo risco para o HIV em atividades de vocabulário receptivo e na leitura de palavras e pseudopalavras e quanto aos Recursos do Ambiente Familiar (RAF) que podem estar envolvidos com o aprendizado, identificar: a relação entre a gravidade da doença com o vocabulário receptivo e com a leitura, considerando o nível de CD4 e da carga viral (CV), a classificação CDC (Centers for Disease Control), adesão ao tratamento e tempo de uso da medicação; a classificação econômica das crianças portadoras de HIV e sua relação com RAF e o desempenho em vocabulário receptivo e leitura. Método: A população estudada foi de 11 crianças com HIV e 20 crianças com baixo risco para HIV, com idades entre 8 anos e 10 anos. Para a avaliação foi utilizado o Teste de Vocabulário por Figuras USP (TVfusp-139o) e o Teste de Competência de Leitura de Palavras e Pseudopalavras (TCLPP). Foi realizada a classificação econômica das crianças e a avaliação do RAF através de dois questionários respondidos pelos responsáveis, considerando que estes fatores podem estar envolvidos com a aprendizagem escolar. Resultados: Houve diferença entre os grupos para as variáveis RAF e o vocabulário, sendo que o grupo com baixo risco para o HIV apresentou desempenho significativamente superior ao grupo com HIV. As perguntas relacionadas aos passeios que a criança realizou, presença de brinquedos, jornais, livros e revistas em casa foram as que diferiram. Não houve diferença para a variável leitura. Não teve correlação entre as variáveis clínicas e laboratoriais e o vocabulário. Embora não significativa, houve correlação positiva entre a classificação CDC e leitura. Conclusão: Crianças portadoras de HIV apresentam desempenho inferior em vocabulário e o RAF significativamente inferior; não foi encontrada diferença em leitura. Os recursos do ambiente familiar que possivelmente podem contribuir para o aprendizado escolar é a presença de objetos, brinquedos, livros e revistas em casa e passeios; todas as variáveis laboratoriais e clínicas não apresentaram correlação significativa com o desempenho em vocabulário; a maior parte nos portadores de HIV encontravam-se na classificação econômica C ou D (82,1%). Houve correlação positiva com a classificação econômica, RAF e leitura. / Introduction: Acquired Immune Deficiency Syndrome (AIDS) is an infectious disease caused by a retrovirus called Human Immunodeficiency Virus - HIV. The main targets of HIV are the cells that display the CD4 molecule and the glial cells of the Central Nervous System (CNS) possess these molecules. One of the possible changes to occur due to HIV infection is the language change, as the processing of this occurs in the CNS. Of all the dimensions of language, semantics is the part that understands the meaning of words in both comprehension and production. This dimension can influence the reading process. Objective: To compare the performance of HIV-infected children by vertical transmission and children with low HIV risk in activities of receptive vocabulary and reading of words and pseudowords and Family Environment Resources (RAF) that may be involved in learning , To identify: the relationship between the severity of the disease with the receptive vocabulary and reading, considering CD4 and viral load (CV), CDC (Centers for Disease Control) classification, adherence and time of medication use; The economic classification of children with HIV and their relationship with RAF and o, performance in receptive and reading vocabulary. Method: The study population was 11 children with HIV and 20 children with low HIV risk, aged 8 years and 10 years. For the evaluation we used the Vocabulary Test for Figures USP (TVfusp-139o) and the Test of Competence of Reading of Words and Pseudowords (TCLPP). The economic classification of the children and the RAF evaluation were performed through two questionnaires answered by those responsible, considering that these factors may be involved with school learning. Results: There was a difference between the groups for the RAF and vocabulary variables, and the group with low HIV risk presented a significantly superior performance to the HIV group. The questions related to the trips that the child performed, the presence of toys, newspapers, books and magazines at home were the ones that differed. There was no difference for the reading variable. There was no correlation between clinical and laboratory variables and vocabulary. Although not significant, there was a positive correlation between the CDC classification and reading. Conclusion: HIV-positive children have lower vocabulary performance and significantly lower RAF; no difference was found in reading; the resources of the family environment that can possibly contribute to the school learning are the presence of objects, toys, books and magazines at home and walks realized in the last 12 months; all laboratory and clinical variables did not show a significant correlation with vocabulary performance, ie there was no correlation between viral load, CD4 cell count, CDC score, adherence and medication with vocabulary performance; the majority of those with HIV were in the economic classification C or D (82.1%); there was a positive correlation for the economic classification and the RAF score and the economic classification and performance in reading and strong tendency between the economic classification and the vocabulary.

Thesis (M.A.) / INTRODUCTION: Cervical cancer exists as the second most common cancer among women world wide, and in numerous countries is the leading type of female cancer. Specifically, Zambia has one of the highest mortality rates and cervical cancer incidence rates. The goal of this study is to analyze the published literature on preventative techniques for cervical cancer in resource-deprived areas of sub-Saharan Africa by focusing on the correlation between the Human Papilloma Virus (HPV), Acquired Immunodeficiency Syndrome (AIDS), and cervical cancer; the accuracy and feasibility of “screen and treat” clinics; and socio-economic and geographical barriers. RESULTS: Correlations exists between the prevalence of HIV, HPV, and cervical cancer in sub-Saharan Africa, and a clear association exists between HPV and cervical cancer. The deliverance of HPV vaccines as well as educational programs has helped to improve this medical problem. Main screening methods for cervical cancer include the Pap smear, naked eye visual inspection of the cervix after the application of either diluted acetic acid (VIA), Lugol’s iodine (VILI), or with a magnifying device (VIAM), colposcopy, and tests for HPV markers. Studies indicate that the VILI screening test has the highest level of sensitivity with the LEEP method also of importance. The procedure is relatively low cost and is easy to implement when excising lesions. Major risk factors and determinants of cervical cancer can help to explain the underlying barriers of access to care. Women’s misconceptions regarding cervical cancer, gender inequality in African nations, socio-economic status, and foreign aid all play major roles the cervical cancer screening process. A lack of proper education, especially among women in sub-Sahara Africa, has led to misconceptions about the causes of cervical cancer. Studies have found that some women associated cervical cancer with prostitution, a Satanic curse, and other bad behavior. Gender inequality also plays a significant role since the Zambia government had reported that a husband would have absolute rights over children and reproductive rights over his wife once he had made payments for a bride. Geographical barriers also exist as the terrain in Zambia is swamp-like and heavy flooding throughout the year is common. After flooding occurs, communities become physically separated. Furthermore, there are correlations between high incidence rates of cervical cancer and high poverty as it has been shown that the largest number of people living on less than $1.25 dollars per day is that of sub-Saharan Africa. DISCUSSION: Studies have indicated that virtually all of cases of cervical cancer are caused by HPV, implying that HPV testing and detection would largely prevent the progression of lesions. Ultimately, this would reduce the high incidence rate of cervical cancer in Zambia and in other Sub-Saharan African countries. In areas where cytology programs are either non-existent or not efficient, HPV testing approaches should be evaluated and implemented, and they should be based off of the HIV/AIDS infrastructure that has already been established. In regards to the screening approaches, VIAM and VIA are the only two tests that are also practical, affordable, and available. Affordability is the major concern when implementing screening programs in sub-Saharan Africa; for this reason, either VIAM and VIA would arguably be the best options as long as they were effective. VIA would be considered the most appropriate method in terms of screening procedures as the method has the advantage of giving immediate results that can be applied to large populations. Lastly, the lack of proper education, including sex education, has in part led to drastic misconceptions about the causes of cervical cancer. Women hold negative beliefs about cervical cancer since they associate it with being unclean and view it as a reflection of bad behavior. Geographical barriers also play a role; the physical inaccessibility of the clinic discourages women to come to the clinic for screenings. Home visits by physicians and/or the utilization of community health workers may help to eliminate this particular barrier of access. This strategy would be especially beneficial to residents of rural areas since they are more likely to live farther away from institutionalized clinics and screen and treat facilities and are also more likely to be in a state of extreme poverty.

Philosophiae Doctor - PhD / The quantitative findings indicated high levels of HIV/AIDS knowledge, self-concept and self-efficacy. Risky sexual behaviour was measured in terms of condom use and the number of sexual partners in the 12 months prior to the study with males reporting significantly more risky sexual behaviour. More males (70% vs. 43 % females) reported no condom use when engaging in sex. More males (62 % vs. 28 % females) reported having had two or more sexual partners in the 12 months prior to the study. Results also suggested that an increase in knowledge of HIV/AIDS would predict an increase in the use of condoms particularly for males. Lower self-efficacy seemed to predict an increase in the number of sexual partners for males. The focus group discussions highlighted students' views of HIV/AIDS knowledge in relation to their sexual practices, attitudes and sexual decision-making. Influences such as personal factors (self-concept and self-efficacy), social factors (e.g. peer influences, gender, and status) and environmental factors (e.g. media) were investigated. Participants also commented on the effectiveness of HIV/AIDS campaigns and the adequacy in provision of health services at college and community level. From the findings, guidelines were developed which may be used to reflect on current intervention programmes and may be considered when developing future interventions programmes, policies, or campaigns in promoting safer sexual practices amongst youth as a means of addressing the HIV/AIDS pandemic. / South Africa

HIV and AIDS pandemic have been declining in South Africa. HIV and AIDS affect individuals, families, organizations and the communities at large. While the roll out of the antiretroviral treatment (ART) has brought much excitement and hope to both patients and the health practitioners, it has also brought challenges (Maskew, Macphail, Menez & Rubel, 2007:853). In order for ART to be effective patients need to adhere to antiretroviral treatment, thus adherence is a critical component of ART. Patients who discontinue treatment are at high risk of illness and death because of AIDS related diseases or developing drug resistant virus. With a better understanding of the reasons for defaulting antiretroviral treatment interventions can be designed to improve adherence to antiretroviral treatment. Thus the purpose of this study was to explore the reasons why HIV and AIDS infected patients default antiretroviral treatment because adherence to ART is of utmost important. Within the context of qualitative and applied research the researcher utilized the collective case study design. Semi structured interviewing was used as data collection method to elicit qualitative information on the reasons why patients default ART. The main research question that was put forward to all participants was: What are your reasons for defaulting ART? The participants in this study were patients who have default their ART during 2012. By using systematic sampling fourteen participants from Thekganang ARV Clinic in Seshego District Hospital, Limpopo province, were selected to form a sample for this study. Some conclusions based on the findings were that: The participants were knowledgeable about the basic facts of HIV and AIDS and they had a good understanding about the importance of adherence even though they defaulted their antiretroviral treatment. The use of ART may also be challenging to individuals. The findings of this study were that not all participants in the study experienced challenges with taking ART. Those who experienced challenges included fear of disclosing HIV status, fear of stigmatization and physical challenges due to ill health. Regarding the reasons for defaulting ART, participants’ reasons for defaulting antiretroviral treatment were similar although some of the reasons applied to only one participant. Participants’ reasons for treatment default were classified into socio-economic factors, patient related, psychological related and medication related factors. Socio- economic factors included shortage of food in the household and lack of money for transport to attend clinic appointments. Patient related factors included substance abuse, lost appointment cards, participants were too busy with personal issues and relocation to another area of residence. Psychological factors that contributed to non-adherence to treatment were depression and denial. Medical related factor voiced was that participant was too confused about the drug regimen. Most participants were satisfied with the services in Thekganang ARV clinic although some participants raised concerns about staff attitudes and long queue. The findings will assist the hospital management and the clinic staff to make informed decisions about the management of defaulters in the clinic. The study was concluded with the relevant recommendations to the ART facilities. The recommendations included implementation of the multi-disciplinary centred approach, establishing patient education programmes and on-going support services to patients who fail to adhere to treatment. Future research studies should determine the prevalence of drug resistant HIV patients in the ART facilities and the development of a systematic method of capturing ‘‘lost to follow up’’ patients who pass away within hospitals. / Dissertation (MA)--University of Pretoria, 2014. / lk2014 / Social Work and Criminology / MA / Unrestricted