介紹 / 愛滋病在中國男男性行為者中的流行持續增長，而新感染HIV的男男性行為者扮演著重要角色。本民族志研究採用了社會生態模式來探討與新感染HIV的男男性行為者中HIV二代傳播、心理健康、以及使用健康服務相關的問題。研究方法包括深入訪談、焦點小組訪談、非正式訪談和參與觀察。此外還採訪了志願者和醫護人員。資料分析採用主題內容分析法。 / 結果 / 在確診為HIV呈陽性後，大多數的男男性行為者經受過一定程度的心理及精神上的問題。與HIV相關的緊張性刺激影響著他們適應這個確診。HIV與一些重要的心理、社會和文化的條件呈現一種綜合流行。而大多數的男男性行為者通過自身的應變能力逐漸康復，其中一些人甚至體驗到某種程度的成長。人的應變能力是一種基於個人與環境互動的建構。 / 11名（占24.4%）HIV呈陽性的男男性行為者報告發生過無保護的肛交行為。基於性伴侶的不同類型，與無保護肛交行為相關的因素則有所不同。這些無保護的肛交行為往往同時伴隨著物質濫用、對風險的錯誤認識、以及消極的情緒或者心理和精神問題。阻礙無保護肛交行為發生的積極因素包括社會支援、自我保健、自我保護和志願服務。 / 自上而下的公共衛生服務傾向於控制和檢測而不是賦權于男男性行為人群，並且在很大程度上忽視了新感染HIV的男男性行為者的心理和精神健康、性健康、以及自我保健的能力。新感染HIV的男男性行為者的未滿足的需求已經被識別，且他們更願意到男男性行為人群的社區，尤其是感染者小組那裏去尋求服務和支援。但男男性行為人群的草根組織卻缺乏資金和技術的支持。 / 結論 / 新感染HIV的男男性行為者所遭遇的問題都植根於特定的個人際遇以及他們所生活的社會生態系統。是時候採取一種廣泛而綜合的“健康同志社區的觀點、促進自我保健的策略、以及具有文化敏感性和社會效能的措施來預防HIV的二代傳播以及促進新感染HIV的男男性行為者的社會福祉。人類行為的非線性的特徵要求愛滋病健康行為研究從強調生物行為的範式轉移到著重愛滋病的社會根源的範式中來。 / Introduction / Newly diagnosed HIV positive men who have sex with men (NHIVMSM) play an important role in accelerating the high HIV prevalence in China. This ethnographic study, employing a modified social ecological model integrating concepts of adaptation, cognition, affect and action, investigated the inter-related issues on secondary HIV transmission, mental health and services utilization in this population. Methodologies included in-depth interviews, focus groups, informal interviews and participant observations. Moreover, information was also obtained from volunteers and health care workers. Thematic content analysis was performed. / Results / Most respondents commonly experienced psychological or mental health problems (e.g. depressive symptoms and anxiety) after their HIV diagnosis. HIV stressors, such as constraints of being HIV positive, limited information and knowledge of HIV/AIDS, ART and its side effects, associated co-morbidities and significant costs in health care, appeared to shape their adaptation to the diagnosis. Moreover, a syndemic was apparent among NHIVMSM and some influential psycho-social and cultural conditions, such as adversities in their migrants’ life, social suffering as MSM, cultural trauma, stigma and discrimination. Most respondents drew on a range of personal resilience strategies and some respondents testified to have achieved post-traumatic growth. Resilience was presented within a person-situation interactional construct. / Eleven (24.4%) respondents reported practicing unprotected anal intercourse (UAI). Several respondents reported their UAI had occurred in the first few months after their diagnosis when they suffered considerably from uncertainty, perceived stigma and identity struggles. Factors associated with UAI were based on differing partner types, such as fear of losing partners in a context of non-serostatus disclosure in lovers or stable partners, tongzhi (gay) sauna setting and moral judgment in casual partners, and poor economic status in commercial partners. UAI usually happened simultaneously in context of substance use, risk misconceptions, encountering negative emotion or mental health problems. Positive factors against UAI included social support, self-care, self-protection and volunteerism. / The current top-down public health services tended to operate on control and surveillance instead of empowering MSM. This approach largely ignored psychological and mental health, sexual health and self-care capacities among NHIVMSM, whose unmet needs were identified as preferring to obtain services and support from MSM and/or PLWH communities. However, current MSM organizations lacked funding and technical support. Health care providers operated with suboptimal care protocols, training and technical support. Coordination and collaborations among health care institutes and MSM communities were relatively weak. Tailored participatory health care is warranted, such as volunteerism, greater involvement of PLWH, health navigators and building supportive environment and services. / Conclusions / The problems of psychological and mental health, risky sexual behavior (UAI) and health services utilization that NHIVMSM encountered resulted from interactions between personal experiences and the social ecological systems they inhabited. Recommendation drawn include adopting a comprehensive and inclusive “healthy MSM community“ approach and a strategy of facilitating self-care to carry out culturally sensitive and socially effective measures to prevent secondary HIV transmission and to promote wellbeing among NHIVMSM. An emerging theoretical implication is that the nonlinearity of human behaviour requires paradigm shifting from a bio-behavioural emphasis to the social origin of HIV/AIDS. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Haochu. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 425-457). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes includes Chinese. / Abstract (English) --- p.iv / Abstract (Chinese) --- p.vii / Acknowledgements --- p.ix / Table of Contents --- p.xi / List of Tables and Figures --- p.xv / Glossary --- p.xvi / Abbreviation --- p.xviii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.1.1 --- High HIV prevalence and incidence among MSM in China --- p.1 / Chapter 1.1.2 --- Social and cultural environment faced by HIV positive MSM --- p.3 / Chapter 1.2 --- Sexual risk and secondary HIV transmission among HIV positive (and newly diagnosed) MSM --- p.7 / Chapter 1.3 --- Psychological and mental health among HIV positive (and newly diagnosed) MSM --- p.10 / Chapter 1.4 --- Health service utilization among HIV positive (and newly diagnosed) MSM --- p.13 / Chapter 1.5 --- Exploring complexities of secondary HIV transmission through qualitative studies --- p.14 / Chapter 1.6 --- Theories, concepts and the research framework --- p.15 / Chapter 1.6.1 --- Conceptualization of adaptation in medical anthropology --- p.15 / Chapter 1.6.2 --- The social ecological model --- p.17 / Chapter 1.6.3 --- Cognitive adaptation and self-control --- p.19 / Chapter 1.6.4 --- Emotion and motivation are influential in health behaviour --- p.21 / Chapter 1.6.5 --- Action world and its role in health behaviour --- p.24 / Chapter 1.6.6 --- Social control/social order --- p.26 / Chapter 1.6.7 --- Stigma --- p.27 / Chapter 1.6.8 --- Identity control --- p.29 / Chapter 1.6.9 --- Research framework --- p.32 / Chapter 1.7 --- Goals, objectives and research questions --- p.34 / Chapter Chapter 2 --- Methodology --- p.38 / Chapter 2.1. --- Entrée into the field --- p.38 / Chapter 2.1.1 --- The start of the research --- p.38 / Chapter 2.1.2 --- Pilot work --- p.39 / Chapter 2.2 --- The participants --- p.43 / Chapter 2.3 --- Data collection --- p.50 / Chapter 2.4 --- Data analysis --- p.58 / Chapter 2.5 --- Rigour --- p.62 / Chapter 2.6 --- Reflexivity --- p.68 / Chapter 2.7 --- Ethical considerations --- p.75 / Chapter Chapter 3 --- Social circumstances and MSM communities in Shenzhen --- p.78 / Chapter 3.1 --- Population and economic circumstances --- p.78 / Chapter 3.2 --- Shifting political situation --- p.80 / Chapter 3.3 --- A migrant society --- p.87 / Chapter 3.4 --- Shenzhen Culture --- p.93 / Chapter 3.5 --- MSM community and tongzhi subculture --- p.98 / Chapter 3.6 --- The subgroup of HIV positive MSM --- p.113 / Chapter 3.7 --- Public health implications --- p.117 / Chapter Chapter 4 --- Health care system and services related to HIV case detection and follow up --- p.118 / Chapter 4.1 --- Formal health care system --- p.118 / Chapter 4.2 --- Health insurance --- p.125 / Chapter 4.3 --- “Four Free and One Care“ policy --- p.126 / Chapter 4.4 --- Informal health care --- p.127 / Chapter 4.5 --- Services related to HIV case detection and follow up --- p.131 / Chapter Chapter 5 --- Psychological and mental health --- p.142 / Chapter 5.1 --- Negative mental health outcomes --- p.142 / Chapter 5.1.1 --- Depressive symptoms --- p.142 / Chapter 5.1.2 --- Anxiety symptoms --- p.146 / Chapter 5.1.3 --- Factors associated with negative mental health outcome --- p.150 / Chapter 5.1.3.1 --- Individual factors --- p.150 / Chapter 5.1.3.2 --- Interpersonal factors --- p.157 / Chapter 5.1.3.3 --- Cultural factors in community and family --- p.160 / Chapter 5.1.3.4 --- Institutional and structural factors --- p.163 / Chapter 5.2 --- Positive mental health outcomes --- p.166 / Chapter 5.2.1 --- Integrating negative experiences and recovery --- p.166 / Chapter 5.2.2 --- Resources for recovery --- p.169 / Chapter 5.2.3 --- Back to normal functioning --- p.170 / Chapter 5.2.4 --- Post-traumatic growth --- p.172 / Chapter 5.2.5 --- Factors associated with positive mental health outcome --- p.175 / Chapter 5.2.5.1 --- Individual factors --- p.175 / Chapter 5.2.5.2 --- Interpersonal factor --- p.181 / Chapter 5.2.5.3 --- Community-related factors --- p.184 / Chapter 5.2.5.4 --- Institutional factors --- p.187 / Chapter 5.3 --- Public health concern of suicidal ideation --- p.190 / Chapter 5.4 --- Impacts of psychological and mental health --- p.194 / Chapter 5.5 --- Summary of psychological and mental health in a modified socio-ecological mode --- p.195 / Chapter 5.6 --- Discussion --- p.197 / Chapter 5.6.1 --- The emerging of a syndemic in HIV and some psycho-social and cultural conditions --- p.197 / Chapter 5.6.2 --- Powerful social and cultural factors associated with mental health --- p.200 / Chapter 5.6.3 --- Resilience among newly diagnosed HIV positive MSM --- p.208 / Chapter 5.6.4 --- Service implications --- p.213 / Chapter Chapter 6 --- Sexual risk --- p.221 / Chapter 6.1 --- Continued unprotected anal intercourse (UAI) after being diagnosed HIV positive --- p.221 / Chapter 6.2 --- Changes in practising UAI during the study period --- p.222 / Chapter 6.3 --- Factors associated with UAI with non-commercial sex partners --- p.224 / Chapter 6.3.1 --- Individual factors --- p.225 / Chapter 6.3.2 --- Interpersonal factors --- p.229 / Chapter 6.3.3 --- Community-based factors --- p.231 / Chapter 6.3.4 --- Institutional factors --- p.234 / Chapter 6.4 --- UAI with commercial sex partners --- p.235 / Chapter 6.5 --- Comparing factors associated with UAI among commercial and non-commercial partners --- p.238 / Chapter 6.6 --- Reduced risky behaviour after diagnosis --- p.239 / Chapter 6.7 --- Factors associated with condom use --- p.241 / Chapter 6.7.1 --- Individual factors --- p.241 / Chapter 6.7.2 --- Interpersonal factors --- p.246 / Chapter 6.7.3 --- Community factors --- p.248 / Chapter 6.8 --- Other special issues related to risky sexual behaviour --- p.250 / Chapter 6.9 --- Summary of sexual risk in a modified socio-ecological model --- p.261 / Chapter 6.10 --- Discussion --- p.263 / Chapter 6.10.1 --- Prevalence of UAI --- p.263 / Chapter 6.10.2 --- Partner types and UAI --- p.265 / Chapter 6.10.2.1 --- Fear of losing partners in a context of non-serostatus disclosure --- p.266 / Chapter 6.10.2.2 --- Anonymous sexual encounters and moral judgment --- p.267 / Chapter 6.10.2.3 --- Economic barriers --- p.270 / Chapter 6.10.2.4 --- Intrapersonal contexts --- p.271 / Chapter 6.10.3 --- Critical views on some practices --- p.274 / Chapter 6.10.4 --- Emerging positive experiences from Shenzhen --- p.276 / Chapter 6.10.5 --- Service implications --- p.279 / Chapter Chapter 7 --- Health service seeking --- p.285 / Chapter 7.1 --- Problems identified in health service seeking --- p.285 / Chapter 7.2 --- Processes of adaptation --- p.289 / Chapter 7.3 --- Negative factors associated with health service seeking --- p.296 / Chapter 7.3.1 --- Individual factors --- p.296 / Chapter 7.3.2 --- Interpersonal factors --- p.302 / Chapter 7.3.3 --- Community-based factors --- p.304 / Chapter 7.3.4 --- Health care institution-based factors --- p.309 / Chapter 7.4 --- Positive factors associated with health service seeking --- p.319 / Chapter 7.4.1 --- Individual factors --- p.319 / Chapter 7.4.2 --- Interpersonal factors --- p.321 / Chapter 7.4.3 --- Community-based factors --- p.325 / Chapter 7.4.4 --- Factors in the health care institutes--free services --- p.328 / Chapter 7.5 --- Summary of health service seeking in a modified socio-ecological model --- p.329 / Chapter 7.6 --- Discussion --- p.331 / Chapter 7.6.1 --- Problems in health care institutes --- p.331 / Chapter 7.6.1.1 --- The top-down approach -- controlling instead of community building --- p.331 / Chapter 7.6.1.2 --- Problems among health care providers --- p.335 / Chapter 7.6.2 --- Tailored participatory approach to health care and education for HIV positive MSM --- p.339 / Chapter 7.6.3 --- Necessity for developing MSM communities --- p.342 / Chapter 7.6.4 --- Service implications --- p.349 / Chapter Chapter 8 --- Discussion and implications --- p.355 / Chapter 8.1 --- The occurrences of UAI and its hidden meaning --- p.355 / Chapter 8.2 --- Informing the future HIV epidemic among MSM in Shenzhen --- p.357 / Chapter 8.3 --- Difficulties of controlling the HIV epidemic among MSM --- p.361 / Chapter 8.4 --- New HIV prevention approach --- p.368 / Chapter 8.5 --- Critiquing theories for recommended changes --- p.386 / Chapter 8.6 --- Limitations of the study --- p.400 / Chapter 8.7 --- Conclusion --- p.405 / Appendix I to IX --- p.409 / Bibliography --- p.425

HIV, syphilis, malaria, and anaemia are major causes of adverse pregnancy outcomes in sub-Saharan Africa (SSA). Despite global and national policies advocating for screening of these conditions, only HIV testing has achieved good coverage, precluding early detection and appropriate management in pregnancy. Rapid pointof-care tests (POCTs) provide an opportunity to integrate diagnosis and provide timely treatment of these conditions in rural antenatal care (ANC) settings. After an introductory chapter, a review of the literature on these four conditions in pregnancy is presented with a focus on SSA. The thesis then shifts attention to Kenya, a country that embodies many of the disease challenges and health system characteristics of the region. Kenyan ANC policy recommends testing for HIV, syphilis and anaemia and preventive strategies for malaria. The following chapters are comprised of three linked studies conducted in western Kenya, that use different methods to progressively investigate the implementation success of integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at seven peripheral dispensaries. Baseline data confirmed that testing requirements for syphilis, malaria and anaemia are not currently met at dispensary level. We implemented an intervention where test kits were supplied and training plus supervision were provided to enable healthcare workers to conduct integrated POCT for pregnant women. Adoption and fidelity were measured quantitatively using exit interviews, antenatal registers and proficiency scores (Study 1: Integrating point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia in antenatal care at dispensary level in western Kenya: an implementation study) while acceptability, appropriateness and feasibility were assessed qualitatively (Study 2: Exploring healthcare workers and pregnant women’s perspectives on appropriateness, acceptability and feasibility of integrating point-of care testing: A qualitative study). Our findings show that the innovation was highly adopted, meaning almost all pregnant women received the essential tests. This was supported by the qualitative findings where healthcare workers and pregnant women found the innovation acceptable and appropriate. However, fidelity to clinical management guidelines can still be improved. Our qualitative findings provide some explanation for these gaps. One common sentiment among interviews with healthcare workers was that workload was perceived to be a barrier to providing quality care. We explored this further with discrete-event simulation modelling (Study 3: Investigating the operational impact of integrating HIV, syphilis, malaria and anaemia point-of-care testing in antenatal care clinics in western Kenya: a discrete event simulation model) and found the healthcare workers were actually under-utilized. This suggests that nurses should, in theory, have sufficient time to deliver essential ANC services. While integrating POCT addresses one gap, additional interventions to support and supervise healthcare workers are needed to ensure appropriate and high quality of care. An integrated approach to health systems strengthening and more investment in implementation and translation research using multi-methods are needed.

A magnitude e as modificações resultantes da epidemia de Aids no Brasil levaram o Ministério da Saúde a recomendar, a partir de 2001, a incorporação do diagnóstico sorológico da infecção pelo HIV em serviços de atenção básica da rede pública de saúde, visando a universalidade e a ampliação do acesso da população a esses exames. O processo diagnóstico, no caso da AIDS, envolve para além da simples disponibilização da testagem; cobre demandas de prevenção, profilaxia, tratamento e referências adequadas para o interior do sistema assistencial. O estudo realizado teve por objetivo investigar como vem se dando a oferta deste diagnóstico, previsto de estar acontecendo acompanhado de aconselhamento pré e pós-teste, usando como lócus um conjunto de serviços da rede básica de saúde no Município do Rio de Janeiro. Do tipo descritivo-analítico, o trabalho utilizou-se de uma abordagem metodológica qualitativa, realizando entrevistas semi-estruturadas com vinte e dois profissionais de saúde de diversas categorias, envolvidos nos processos de testagem anti-HIV, e com três gestores, buscando compreender como vem sendo ofertado esse cuidado em saúde. O exame do material obtido permitiu a identificação das seguintes categorias analíticas: oferta do teste na rede de atenção básica e dilemas relacionados a esse processo; ações de aconselhamento que acompanham a testagem; resultados do teste anti-HIV e dificuldades na sua comunicação aos usuários; dimensões estrutural e organizacional e gestão do processo de testagem; capacitação dos recursos humanos. Identificou-se que o processo de oferta do teste anti-HIV se circunscreve frequentemente à representação da doença e é necessária maior interlocução na relação profissional de saúde/usuário, considerando a intersubjetividade dos sujeitos envolvidos. Este processo diagnóstico demanda técnicas como apoio, acolhimento e escuta qualificada das necessidades de saúde, entendidas para além das queixas biológicas dos sujeitos, que nem sempre estão se fazendo presentes nos serviços de atenção investigados. Como desafio premente na oferta do diagnóstico anti-HIV, destaca-se que o aconselhamento deve ser uma ferramenta utilizada e reforçada no contexto dos serviços de saúde que atendem pacientes com DST/Aids. Outro desafio, além da capacitação qualificada dos recursos humanos envolvidos, é necessidade de permanente avaliação do processo de oferta que vem sendo oferecido nos serviços da rede básica, que possibilite repensar as atividades de prevenção, o acolhimento e a escuta, e o compartilhamento de idéias entre profissionais que atuam no cotidiano das unidades de saúde e os gestores locais. A pluralidade de questões no fazer em saúde exige que os serviços de saúde e seus responsáveis promovam novos arranjos para que a oferta do teste anti-HIV, como ação de saúde, seja realizada com base na humanização, na integralidade e no respeito aos direitos de cidadania, contribuindo para que a melhoria do atendimento na rede básica se concretize com qualidade.

Made available in DSpace on 2014-07-29T15:25:16Z (GMT). No. of bitstreams: 1 Dissetacao_marislei.pdf: 1330253 bytes, checksum: 79323fee18b3f3953180f7217a8dfe40 (MD5) Previous issue date: 2011-02-21 / Adherence to antiretroviral therapy reduces the risk of treatment failure, toxicity and resistance, so the therapeutic monitoring is necessary in the treatment of infection by human immunodeficiency virus. The aim of this study was to determine, through clinical and laboratory studies, the compliance of individuals sickened by HIV / AIDS with antiretroviral therapy before and after three nursing interventions. The study design was analytical, descriptive, prospective and quantitative, using data from medical records, interviews and blood sampling for plasma levels of efavirenz by HPLC analysis, including subjects with a diagnosis of HIV / AIDS, attended at the Hospital for Diseases Tropical Goiânia - Goiás and treated with zidovudine/ lamivudine and efavirenz. The results of analysis of data from 15 subjects indicate a socio-demographic profile, predominantly male, young, heterosexual. After nursing intervention, there was a change in 48% of the diagnoses. We also noticed a positive change in the rates of CD4, corresponding to 14%. As viral count, an increase of subjects with undetectable loads of 1 st to 2 nd nursing intervention (20%, or 73.3% to 93.3%). Chromatographic analysis of plasma of the subjects indicated that 60% of them had adequate medication adherence, and 40% increased adhesion between the 1st and 2nd visits by nurses, 10% between the 1st and 3rd and 10% between the 2nd and 3rd queries. The factor that was associated with high concentration rate after adjustment in nursing diagnoses and prescriptions was having difficulty using the antiretroviral in the same time. It was also demonstrated significant difference between mean plasma concentrations of efavirenz from the 1st, 2nd and 3rd interventions. Considering the reference measurement of plasma concentrations of efavirenz, the method of accession had a sensitivity and specificity, with high proportion of agreement between the rate of CD4, nursing diagnosis and analysis of the plasma of subjects. Conclusions: the systematization of nursing care and determination of plasma concentrations should be incorporated into the routine outpatient care, for better monitoring of adherence to antiretroviral therapy of individuals sickened by HIV / AIDS. / A adesão à terapia antirretroviral reduz o risco de falha terapêutica, toxicidade e resistência, por isso a monitoração terapêutica é necessária no tratamento da infecção por vírus da imunodeficiência humana. O objetivo deste estudo foi verificar, por meio de estudos clínicos e laboratoriais, a adesão de sujeitos adoecidos por HIV/AIDS à terapia antirretroviral, antes e depois de três intervenções de enfermagem. O estudo foi do tipo analítico, descritivo, prospectivo e quantitativo, utilizando dados dos prontuários, entrevistas e coleta de sangue para dosagens plasmáticas de efavirenz por meio de análise cromatográfica, incluindo sujeitos com diagnóstico para HIV/AIDS, atendidos no ambulatório do Hospital de Doenças Tropicais de Goiânia Goiás e tratados com zidovudina/lamivudina e efavirenz. Os resultados da análise dos dados dos 15 sujeitos indicam um perfil sócio-demográfico, predominantemente masculino, jovem, heterossexual. Após intervenção de enfermagem, houve uma alteração em 48% dos diagnósticos de enfermagem. Observou-se também alteração positiva das taxas de CD4, correspondendo a 14%. Quanto a contagem viral, houve aumento de sujeitos com carga indetectável da 1ª para a 2ª intervenção de enfermagem (20%, ou seja, de 73,3% para 93,3%). A análise cromatográfica dos plasmas dos sujeitos indicou que 60% deles apresentaram adequada adesão ao medicamento, sendo que em 40% aumentou a adesão entre a 1ª e a 2ª consultas de enfermagem, 10% entre a 1ª e a 3ª e 10% entre a 2ª e a 3ª consultas. O fator que se mostrou associado à alta taxa de concentração depois do ajuste nos diagnósticos e prescrições de enfermagem foi ter dificuldades em usar o antirretroviral sempre no mesmo horário. Também foi demonstrada diferença significativa entre as médias das concentrações plasmáticas de efavirenz entre a 1ª, a 2ª e a 3ª intervenções. Considerando referência a mensuração da concentração plasmática do efavirenz, o método da adesão apresentou sensibilidade e especificidade, sendo alta a proporção de concordância entre a taxa de CD4, os diagnósticos de enfermagem e a análise do plasma dos sujeitos. Conclusões: a sistematização da assistência de enfermagem e a dosagem das concentrações plasmáticas devem ser incorporadas à rotina de atendimento ambulatorial, para um melhor acompanhamento da adesão à terapia antirretroviral de sujeitos adoecidos por HIV/AIDS.

De 12 casos de leishmaniose tegumentar (LT) em AIDS, em São Paulo, sete do levantamento retrospectivo (1990 a 2001) e cinco do prospectivo (2001 a 2004), com contato prévio com área endêmica para leishmanioses, 50% eram usuários de drogas injetáveis (1990-2001). Apresentavam média de linfócitos T CD4+ de 77 células/mm3, um era C2 e 11, C3 (classificação de HIV, segundo CDC) e 70% tinha sorologia positiva para leishmanioses. As manifestações de LT em mucosa e pele eram diversificadas: úlcera única ou lesões múltiplas e polimórficas ou disseminadas, incluindo comprometimento genital em 4 casos. Todos receberam tratamento específico para leishmaniose e 50%, HAART. 50% recidivaram e 50% foram a óbito no período, independentemente do uso do HAART / From 12 cases of tegumentary leishmaniasis (TL) in AIDS, from São Paulo, seven from retrospective (1990 a 2001) and five from prospective studies (2001 a 2004), with previous contact with endemic areas for leishmaniasis, 50% were endovenous drug users (1990-2001). Presenting mean 77 CD4+ T cells/mm3, one was C2 and 11 were C3 (HIV classification, according to CDC) and 70% had positive serology for leishmaniasis. Presentation of TL in the skin and mucosa were diversified: single or multiple ulcers and polymorphic or disseminated lesions, including lesions in genital area in 4 cases. All were treated with anti-leishmanial drugs and 50% with HAART. 50% presented relapse and 50% died during follow up period, independently of use of HAART

Realizou-se um estudo descritivo conduzido no Hospital de Clínicas de Porto Alegre, no período de outubro de 2001 a outubro de 2002, com pacientes HIV positivos e anêmicos. Objetivo: avaliar a associação entre anemia e o perfil nutricional em uma amostra de pacientes HIV+ . Métodos: Foram incluídos 34 pacientes maiores de 18 anos, sendo todos pacientes diagnosticados com anemia. Foram analisados exames laboratoriais, avaliação da ingestão alimentar (recordatório alimentar de 24h), freqüência alimentar e coleta dos parâmetros antropométricos dos pacientes. Resultados: O recordatório alimentar de 24 horas demonstrou a deficiência na ingestão de folato pela maioria dos pacientes; enquanto que vitamina B12 e ferro estiveram de acordo com as RDA’s. Conclusão: A causa da anemia nestes pacientes talvez não tenha sido em função desta deficiente ingestão de folato, ainda mais por se tratar de um estudo descritivo. Ressalta-se a importância do profissional para o acompanhamento nutricional destes pacientes, para a promoção de um adequado estado nutricional e qualidade de vida. / Was develop a descritive study conducted in the Porto Alegre Clinics’ Hospital, from october 2001 to October 2002, with positive HIV and anemics patients. Objectives: Evaluate the association between anemia and nutritional status in positive HIV patients. Methodology: Were included 34 patients under 18 years old, all diagnosed with anemia. Laboratorial exams, evaluation of food intake (24h register), questionary of food intake frequence and anthropometrics data were collected. Results: The 24h register food intake showed the deficiency in folate intake by most of patients ,while vitamine B12 and iron intake were accorded RDA’s. Conclusions: The etiology of anemia in these patients maybe wasn´t cause by this folate deficiency, also because this was a describe study. The presence of a professional appears to be important for the nutritional treatment of these patients, to develop a health nutrional status and quality of life.

O presente estudo objetivou analisar as ações e serviços de saúde ofertados por equipes de saúde prisional para o cuidado às pessoas que vivem com HIV/aids nas unidades prisionais nos municípios de Ribeirão Preto e Serra Azul-SP. Trata-se de um estudo descritivo, do tipo inquérito, realizado entre agosto e novembro de 2015 com pessoas privadas de liberdade vivendo com HIV, encarceradas por mais de seis meses nas unidades prisionais estudadas. Os dados, coletados por meio de entrevistas, foram analisados através de técnicas estatísticas descritivas, bem como mediante a construção de indicadores de oferta que correspondiam ao valor médio obtido pela somatória de todas as respostas de todos os entrevistados para cada pergunta e dividido pelo total de respondentes, sendo categorizados como satisfatórios (>3,5 a 5,0), regulares (> 2,5 a 3,5) e insatisfatórios (1,0 a 2,5). Para comparação do desempenho na oferta de ações e serviços de saúde entre as unidades prisionais realizou-se análise de variância (ANOVA) com teste de Tukey. Esse teste foi realizado quando atendidos os pressupostos de homocedasticidade pelo teste de Levene. A normalidade não foi testada, uma vez que n>=30. Para as análises que indicaram violação dos critérios para o uso da ANOVA, foi realizado o teste de Kruskall-Wallis com teste de comparação múltipla. O nível de significância estatística adotado foi de 5%. Participaram da pesquisa 85 apenados vivendo com HIV, a maioria do sexo masculino (82,4%), entre 23 - 39 anos (56,4%), pardos (45,9%) e com baixa escolaridade (70,6%) (ensino fundamental I ou II) O indicador composto de oferta das ações e serviços de saúde prestados pelas equipes de saúde prisionais obteve média geral de 2,63 (dp 1,8), classificado como regular. Os cuidados gerais de saúde, os atendimentos médicos, de equipe de enfermagem, prontidão no atendimento , orientações sobre a tuberculose, disponibilização de exames sorológicos e divulgação de informações foram avaliados de modo regular. Os indicadores relacionados ao atendimento com psicólogos, dentistas e assistentes sociais, e as demais atividades envolvendo orientações em saúde foram classificados como insatisfatórios. A disponibilidade de preservativos, vacinas e exames de escarro para tuberculose foram avaliados como satisfatórios. O manejo do HIV/aids nas prisões configura-se um desafio ao SUS, na organização de um subsistema com atribuições compatíveis com as prerrogativas da atenção primária à saúde. Entretanto, as condições organizacionais das prisões, violações de direitos humanos, processo de trabalho com equipes incompletas de saúde responsáveis pelo manejo de um agravo que exige aplicações de distintas densidades tecnológicas impõe obstáculos à concretude da integralidade do cuidado às pessoas que vivem com HIV no contexto prisional / The present study aimed to analyze the health actions and services offered by prison health teams to care for people living with HIV/aids in prison units in the cities of Ribeirão Preto and Serra Azul-SP. This is a descriptive inquiry study, conducted from August to November 2015 with people deprived of freedom living with HIV, detained for more than six months in the studied prison units. The data collected through interviews was analyzed using descriptive statistical methods, as well as the construction of offer indicators that corresponded to the mean value obtained by the sum of all answers of all interviewed for each question and divided by the sum of total respondents. They were classified as satisfactory (>3.5 to 5.0), regular (>2.5 to 3.5) and unsatisfactory (1.0 to 2.5). To compare the performance of the offer of health actions and services between the prison units, the analysis of variance (ANOVA) with Tukey\'s test was conducted. This test was performed when the homoscedasticity assumptions where met, verified by Levene\'s test. The normality was not tested considering n>=30. For analyses indicating a violation of criteria applied to use ANOVA, Kruskall-Wallis\'s test with a test of multiple comparisons was used. The adopted level of significance was 5%. In the study, 85 imprisoned living with HIV participated in the study, the majority was male (82.4%), between 23-29 years (56.4%), brown (45.9%) and with low education level (70.6%) (elementary school I or II). The indicator composed of health actions and services provided by prison health teams obtained the general mean of 2.63 (sd 1.8), classified as regular. The general health care, the medical appointments, the nursing team, attention readiness, orientations for tuberculosis, availability of serological tests, and disclosure of information were assessed as regular. The indicators related to appointments with psychologists, dentists, and social workers, and other activities involving health orientations were classified as unsatisfactory. The availability of contraceptives, vaccines and sputum exams for tuberculosis were satisfactory. The management of HIV/aids in prisons is a challenge for SUS, in the organization of a subsystem with attributions compatible with the prerogatives of the primary health care. However, the organizational conditions of prisons, violations of human rights, work processes with incomplete health teams responsible for the management of a disease requiring distinct applications of technological densities, imposes obstacles to the concreteness of the integrality of care to people who live with HIV in a prisonal context

Thesis (M.S.W.)--McGill University, 1998. / Includes bibliographical references (leaves 117-127).

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1574. Adviser: Lu-Yu Hwang. Includes bibliographical references.

Development of a suitable animal model of AIDS is much needed in AIDS research to study infection and pathogenesis as well as to evaluate methods of prevention and treatment of HIV infection. Small animals such as rodents are attractive candidates for AIDS research due to the availability of various inbred and genetically engineered strains, extensive knowledge or their immune system, especially in mice, and the relative ease of breeding and maintaining animal colonies. Transgenic small animal models carrying entire HIV genome or selected genes have been instrumental to understand functions of HIV genes in vivo and their role in HIV pathogenesis. The type of cells in which HIV genes are expressed seems to be an import prerequisite for the study of HIV gene functions in transgenic mice. Mice constitutively expressing the entire HIV-1 genome or HIV-1 nef gene in CD4 + T cells and in the cells of macrophage/dendritic lineage develop an AIDS-like disease very similar to AIDS disease in humans. Similarly, expression of Nef in adult mice, using inducible system, results in the AIDS-like disease. This disease is characterized by thymic atrophy, impaired thymocyte maturation, loss of CD4+ T cells, increased activation and turnover of T cells, which can occur in the absence of lymphypenia, and non-lymphoid organ disease involving the lungs and kidneys. Susceptibility of adult mice to the pathological effects of Nef suggests that the AIDS-like disease in the constitutively expressing Nef Tg mice is not due to developmental defects caused by early expression of Nef. This model highlights the important role of Nef in HIV-1 pathogenesis. The high similarity in the disease in these Tg mice with human AIDS strongly suggest that these mice are a relevant model to study AIDS. This study further evidence that mouse cells can support functions of Nef and these Tg mice represent a unique model to study Nef functions in vivo in the context of the primary immune system. Moreover, the inducible Nef Tg model has given us the ability to control the level and time of expression of Nef which was impossible to do in the previously reported constitutive Nef Tg mouse models. These mice will be useful to study immune reconstitution since Nef expression can be turned off after withdrawal from dox.