Thesis (Ph. D.)--University of Arizona, 1993.

Thesis (M.S.)--University of Wisconsin-Madison, 1993. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 41-44).

Metodologia: Na primeira parte desse trabalho realizou-se um estudo descritivo sobre aspectos relacionados a aids e sexualidade com a populaÃÃo dos profissionais mÃdicos, enfermeiros e agentes de saÃde das equipes do PSF (programa saÃde da famÃlia) do municÃpio de Fortaleza.O instrumento utilizado para a coleta de dados foi uma adaptaÃÃo do questionÃrio da pesquisa nacional acerca do Comportamento Sexual da PopulaÃÃo Brasileira, elaborado pelo MinistÃrio da SaÃde, no ano de 2000. Na segunda fase da pesquisa foi feito um estudo qualitativo com a formaÃÃo de grupos focais, com esta mesma populaÃÃo, abordando temas relacionados à aids e a sexualidade humana. A partir de um conjunto de referÃncias para os estudos sobre AIDS (os estudos da Antropologia) e levantamentos feitos por estudiosos na Ãrea, chegou-se aos seguintes eixos norteadores: I) as prÃticas sexuais como prÃticas sociais; II) A construÃÃo social das prÃticas sexuais acompanha o dinamismo das culturas e III) as prÃticas sexuais que sÃo prÃticas sociais, sÃo vividas por sujeitos multidimensionais. Resultados da primeira etapa: a pesquisa apontou que a prÃtica sexual entre pessoas do mesmo sexo e a existÃncia de relaÃÃes extraconjugais foi amplamente rejeitada pelos participantes da pesquisa. Apesar de quase todos haverem realizado treinamentos em aids, alguns revelaram que a doenÃa se pode pegar usando banheiros pÃblicos, fazendo-se uso da camisinha masculina ou feminina ou usando o mesmo talher de pessoas contaminadas. A maioria apontou que os preservativos sÃo desagradÃveis mas mesmo assim deve-se usÃ-los para se evitar a aids. Resultados da segunda etapa: O estudo nos revelou uma concepÃÃo mÃtica que envolve aspectos relacionados à doenÃa colocando-a ,quase sempre, como uma coisa do outro; o preservativo por sua vez, adquiriu um status de instrumento de intermediaÃÃo na relaÃÃo de poder; vislumbrando-se, tambÃm, uma concepÃÃo de naturalizaÃÃo nas relaÃÃes interpessoais mediadas por essas relaÃÃes de poder. ConclusÃes: Vimos que as opiniÃes desses profissionais, apesar de todo o arsenal de conhecimentos especÃficos e treinamentos impetrados, sÃo atravessadas por uma forte influÃncia biomÃdica de assepsia dos corpos e por um conjunto de vivÃncias e valores que nÃo se diferenciam muito da populaÃÃo com a qual atuam, levando-se a refletir de que modo se està dando suporte a essa dialogicidade entre o profissional e a comunidade. / Methodology: In the first part of this work a research was carried through became fullfilled a descriptive study on the population of the medical professionals, nurses and health agents who compose the teams of the PSF of the city of Fortaleza. The instrument of collection of data were an adaptation of the questionnaire used in the national research concerning the Sexual Behavior of the Brazilian Population, carried through for the Health department, in the year of 2000. At as a moment a qualitative study with the accomplishment of focal groups was made, with this same population, that approached subjects related to the AIDS and sexuality. After bibliographical survey of the authors who present works of relevance related to the subject we arrive at the following axles that had guided our look had been: I) practical sexual as practical the social ones; Practical II) the social construction of the sexual ones follow the dynamism of the cultures and practical III) the sexual ones are lived by multidimensionais.Resultados citizens of the first stage: the research pointed that practical sexual between people of the same sex and existence of extramarital relations widely it was rejected by the participants of the research. Although almost all to have carried through training in AIDS, some had disclosed that the illness if can catch using public bathrooms, becoming use of the masculine or feminine condom in the sexual relation or using the same place setting of contaminated people. The majority pointed that the condoms are ackward but exactly thus it must be used to prevent aid. Results of the second stage: The study in it disclosed a conception to them mythical that involves aspects related to the illness placing it, almost always, as a thing of the other; the condom in turn, acquired a status of instrument of intermediation in the relation of being able; glimpsing also a naturalization in the interpersonal relations mediated by these relations of being able. Conclusions: It was observed that it has a economic difference partner enters the professionals of the team of the PSF thus characterizing a difference of classrooms and sort permeado for intrinsic relations of being able. We saw that the opinions of these professionals, although all the armory of specific knowledge and petitioned training, are crossed by one strong biomedical influence of asepsis of the bodies, characterized for a set of experiences and values that are not differentiated very of the population in general.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Apesar de avanÃos cientÃficos no tratamento ao HIV e de polÃtica pÃblica especÃfica à populaÃÃo infectada, a aids se constitui em sÃrio problema de saÃde, que acomete grupos mais vulnerÃveis. Desta forma, ao tratar de pessoas vivendo com HIV à necessÃrio levar em conta os determinantes sociais relacionados ao processo de saÃde-doenÃa. Objetiva-se analisar a distribuiÃÃo espacial de pacientes com aids no Estado do CearÃ, Brasil, e sua associaÃÃo com determinantes sociais de saÃde. Estudo ecolÃgico transversal, considerou-se indivÃduos com aids, de idade igual ou superior a 13 anos, residentes no CearÃ, notificados entre 2001 e 2011 pelo Sistema de InformaÃÃo de Agravos de NotificaÃÃo. Trabalhou-se com variÃveis sociodemogrÃficas obtidas na Secretaria da SaÃde do Estado, dados socioeconÃmicos, ambientais e de saÃde do Instituto Brasileiro de Geografia e EstatÃstica, do Departamento de InformÃtica do Sistema Ãnico de SaÃde do Brasil e do Departamento de AtenÃÃo BÃsica. ConstruÃram-se indicadores epidemiolÃgicos e sociais baseados no Modelo TeÃrico de DeterminaÃÃo Social sugerido por Whitehead e Dahlgren. Para anÃlise dos dados individuais empregou-se o software SPSS 20.0. Testes foram aplicados para comparaÃÃo das proporÃÃes (exato de Fisher ou qui-quadrado de Pearson), comparaÃÃo de mÃdias (t de Student), correlaÃÃo entre variÃvel dependente e suas regressoras (teste de Pearson) e teste para aferir a normalidade da variÃvel dependente (Shapiro-Wilk). Foram consideradas estatisticamente significantes anÃlises inferenciais de ρ inferior a 0,05. Para dados socioambientais e de saÃde foram utilizados mÃtodos de geoprocessamento e de geoanÃlise. Para identificaÃÃo de aglomerados espaciais, calculou-se taxa mÃdia de aids do perÃodo e relacionada com o mapa vetorial do CearÃ, atravÃs do programa ArcGis10.1. AutocorrelaÃÃo espacial foi verificada pelo Ãndice de Moran. O Modelo de RegressÃo Linear Global foi Ãtil para anÃlise multivariada. Foram construÃdos mapas do risco relativo à formaÃÃo de aglomerados de aids ao longo da sÃrie temporal. Obteve-se aprovaÃÃo do Comità de Ãtica da Secretaria da SaÃde do Estado, sob protocolo n 203.911. A aids à crescente no CearÃ, com maioria masculina, adulta, residente na Capital. Foi observado processo de feminizaÃÃo, juvenizaÃÃo e interiorizaÃÃo da epidemia. O uso de drogas à prevalente entre jovens e pessoas de baixa escolaridade. Ocorre tendÃncia crescente da doenÃa entre pessoas com sete a onze anos de estudo, e diferenÃa estatÃstica significativa entre os sexos. A Rede Social de Apoio e de SaÃde Especializada para aids concentra-se na RegiÃo Metropolitana do Estado. Clusters de aids com altas taxas foi verificada na RegiÃo LitorÃnea e em Ãreas prÃximas à fronteira do PiauÃ, provavelmente vinculados ao turismo e aos processos migratÃrios. As taxas de aids foram associadas com a maioria dos indicadores socioeconÃmicos estudados. Observou-se relaÃÃo positiva entre aids e desigualdades econÃmicas. Foi verificada associaÃÃo inversa entre o agravo e a atenÃÃo primÃria. Constatou-se risco para clusters de aids primeiramente nos SertÃes do Estado e maior risco relativo em municÃpios do Noroeste Cearense ao longo da sÃrie temporal. Segundo se conclui, a aids no Cearà possui Ãreas de dependÃncia espacial e as disparidades socioeconÃmicas e de acesso à saÃde geram determinaÃÃes preponderantes ao adoecimento pelo HIV. / Despite scientific advances in HIV treatment and the specific public policy for the infected population, aids represents a severe health problem that affects more vulnerable groups. Therefore, when treating HIV-positive people, the social determinants of the health-disease process need to be taken into account. The goal is to analyze the spatial distribution of aids patients in the State of CearÃ, Brazil, and its association with social determinants of health. In this cross-sectional ecological study, individuals with aids aged 13 years or older were considered, who lived in Cearà and had been notified between 2001 and 2011 in the Brazilian Case Registry Database. Sociodemographic variables were used that were collected from the State Health Secretary; socioeconomic, environmental and health data from the Brazilian Institute of Geography and Statistics, from the Informatics Department of the Brazilian Unified Health System and from the Primary Healthcare Department. Epidemiological and social indicators were constructed based on the Theoretical Model of Social Determination suggested by Whitehead and Dahlgren. For individual data analysis, SPSS 20.0 software was employed. Tests were applied for comparison of proportions (Fisherâs exact or Pearsonâs chi-square), comparison of means (Studentâs t), correlation between dependent variable and its regressor variables (Pearson) and a test to verify the normality of the dependent variable (Shapiro-Wilk). Inferential analyses with ρ inferior to 0.05 were considered statistically significant. For socio-environmental and health data, geoprocessing and geo-analysis methods were used. To identify spatial clusters, the mean aids rate for the period was calculated and related to the vector map of CearÃ, using the software ArcGis10.1. Spatial self-correlation was verified through Moranâs index. The Global Linear Regression Model was useful for multivariate analysis. Risk maps were constructed for the formation of aids clusters throughout the time series. Approval was obtained from the Ethics Committee of the State Health Secretary under protocol 203.911. Aids is increasing in CearÃ, with a mostly male, adult population living in the state capital. It was observed that the epidemic is expanding among women, young people and in the interior of the state. Drugs use prevails among young people and people with low education levels. A growing trend of the disease is observed among people with seven to 11 years of education, with a statistically significant difference between the sexes. The Social Support and Specialized Health Network for aids is concentrated in the Metropolitan Region of the State. Aids clusters with high rates were verified in the Coastal Region and in areas close to the border with the State of PiauÃ, probably linked to tourism and migration processes. The aids rates were associated with most of the socioeconomic indicators studies. A positive relation was observed between aids and economic inequalities. An inverse association was verified between the problem and primary care. The risk of clusters was verified primarily in the hinterland of the State and a greater relative risk in cities in the Northeast of Cearà throughout the time series. As concluded, aids in Cearà is marked by areas of spatial dependence and the disparities in socioeconomic and health access conditions produce preponderant determinations for illness caused by HIV.

Orientador: Pablo Agustin Vargas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-16T16:11:10Z (GMT). No. of bitstreams: 1 Gondak_RogeriodeOliveira_M.pdf: 4633053 bytes, checksum: caf2bde22b30d4aa164517dc0dd6ffaf (MD5) Previous issue date: 2010 / Resumo: A língua de pacientes com AIDS é acometida freqüentemente por infecções oportunistas e neoplasias. O objetivo deste estudo foi quantificar as células de Langerhans (CL) presentes em regiões lesionais e não lesionais na língua de pacientes autopsiados com AIDS em fase avançada, correlacionando a diminuição das CL com a presença de patologias infecciosas em diferentes regiões da língua (anterior, média, posterior e lateral) e comparar estes achados com a língua de pacientes HIV negativos. Foram utilizadas neste trabalho as línguas de 40 pacientes autopsiados com AIDS divididos em 04 grupos (10 com candidose lingual, 10 com herpes lingual, 10 com leucoplasia pilosa oral e 10 sem lesões em língua) e as línguas de 23 pacientes autopsiados (grupo controle) que morreram por outras patologias não associadas à AIDS e que não apresentaram patologias em língua. Realizamos estudo imunoistoquímico com os marcadores HLA-DR, CD1a e CD83 para identificar as CL e quantificá-las por meio de análise histomorfométrica. O índice de positividade foi obtido através da leitura de 7 campos seqüenciados orientados por ocular micrométrica. As células positivas foram contadas para cada um dos anticorpos nas quatro diferentes regiões da língua e os resultados expressos em células positivas por área de epitélio e por comprimento de membrana basal. O anticorpo HLA-DR mostrou a presença média das CL na língua dos pacientes com AIDS (LA=24,28/mm2 e 3,64/mm, LM=24,60/mm2 e 3,68/mm, LP=20,95/mm2 e 3,14/mm, LL=19,84/mm2 e 2,97/mm) e no grupo controle (LA=68,18/mm2 e 10,23/mm, LM=60,73/mm2 e 9,11/mm, LP=62,94/mm2 e 9,44/mm, LL=50,24/mm2 e 7,53/mm). O anticorpo CD1a mostrou a presença média das CL na língua dos pacientes com AIDS (LA=17,30/mm2 e 2,59/mm, LM=21,11/mm2 e 3,16/mm, LP=13,48/mm2 e 2,02/mm, LL=15,55/mm2 e 2,33/mm) e no grupo controle (LA=205,38/mm2 e 30,81/mm, LM=218,36/mm2 e 32,75/mm, LP=167,29/mm2 e 25,09/mm, LL=223,60/mm2 e 33,54/mm). O anticorpo CD83 mostrou a presença média das CL na língua dos pacientes com AIDS (LA=6,19/mm2 e 0,92/mm, LM=6,34/mm2 e 0,95/mm, LP=6,82/mm2 e 1,02/mm, LL=7,14/mm2 e 1,07/mm) e no grupo controle 68,18/mm2 e 10,23/mm, LM=68,46/mm2 e 10,27/mm, LP=69,28/mm2 e 10,39/mm, LL=63,49/mm2 e 9,52/mm), sendo que foram extremamente significantes as diferenças entre ambos os grupos em todas as regiões e anticorpos estudados (p<0,001). Portanto, podemos concluir que as CL estavam degeneradas e diminuídas em número em todas as regiões da língua e em todos os grupos com AIDS em relação ao grupo controle e as lesões infecciosas orais oportunistas não influenciaram na depleção das CL nas línguas / Abstract: The tongues of AIDS patients can be affected by opportunistic infections and neoplasms. Objectives: to quantify and compare the expression of Langerhans cells (LC) in lesional and non lesional areas in the tongue from patients with and without AIDS (control group), using autopsy material. Methods: we analysed the expression of CD1a, HLA-DR and CD83 using immunohistochemistry to identify and quantify LC in the tongues of AIDS patients (n=40), which were divided into 04 groups (10 lingual candidiasis, 10 lingual herpes, 10 oral hairy leukoplakia and 10 none lesions), and 23 tongues from HIV-negative controls. The immunoreactivity rate was obtained after reading at least seven fields sequenced driven ocular micrometer. The positive LC were detected in the lingual surface epithelium in four different regions (anterior, middle, posterior and lateral) and the results expressed as positive cells per area of epithelium and basement membrane length. Results: LC showed the following immunoreactivity for CD1a in the tongue of AIDS patients (LA=17.30/mm2 and 2.59/mm, LM=21.11/mm2 and 3.16/mm, LP=13.48/mm2 and 2.02/mm, LL=15.55/mm2 and 2.33/mm), and in the control group (LA=205.38/mm2 and 30.81/mm, LM=218.36/mm2 and 32.75/mm, LP=167.29/mm2 and 25.09/mm, LL=223.60/mm2 and 33.54/mm); HLA-DR (AIDS patients) (LA=24.28/mm2 and 3.64/mm, LM=24.60/mm2 and 3.68/mm, LP=20.95/mm2 and 3.14/mm, LL=19.84/mm2 and 2.97/mm), and the control group (LA=68.18/mm2 and 10.23/mm, LM=60.73/mm2 and 9.11/mm, LP=62.94/mm2 and 9.44/mm, LL=50.24/mm2 and 7.53/mm); CD83 (AIDS patients) (LA=6.19/mm2 and 0.92/mm, LM=6.34/mm2 and 0.95/mm, LP=6.82/mm2 and 1.02/mm, LL=7.14/mm2 and 1.07/mm), and the control group (LA=68.18/mm2 and 10.23/mm, LM=68.46/mm2 and 10.27/mm, LP=69.28/mm2 and 10.39/mm, LL=63.49/mm2 and 9.52/mm). The statistical analysis identified significant differences in the both groups and in all regions, and among the 3 antibodies (p<0.001). Conclusions: LC were degenerated and reduced in number in all regions of the tongue of AIDS patients in relation to the control group and the depletion of LC in the tongues of AIDS patients is not associated with oral opportunistic infections / Mestrado / Patologia / Mestre em Estomatopatologia

A histoplasmose à uma das micoses sistÃmicas oportunistas mais associada à aids na atualidade no Brasil e no mundo. O Cearà à o estado do Brasil com a maior casuÃstica na Ãltima dÃcada da coinfecÃÃo HD/aids. O objetivo deste estudo foi caracterizar a morbimortalidade e sobrevida de pacientes com coinfecÃÃo HD/aids, apÃs o 1 evento de HD,atendidos em unidades de referÃncia para HIV/aids em Fortaleza/CearÃ. Realizou-se uma coorte retrospectiva de pacientes com coinfecÃÃo HD/aids, tendo o 1 episÃdio de HD ocorrido no perÃodo de 2002-2008. Os dados foram coletadas a partir do diagnÃstico de HD atà 31/12/2010. AnÃlise estatÃstica foi realizada por meio do programa STATA 9.0. Foram incluÃdos no estudo 145 pacientes. A maioria era de adultos jovens, com mÃdia de idade de 34,6 anos (IC 95%= 33,2-36,0), do sexo masculino (83,5%), e sem atividade de risco definida para histoplasmose (80%). A prevalÃncia da coinfecÃÃo foi de 38 casos/ano. HD foi 1 infecÃÃo oportunista definidora de aids em 59% dos pacientes. Anfotericina B foi utilizada em 97% dos pacientes como droga de induÃÃo, e itraconazol em 92%, em dose de manutenÃÃo. O tempo mÃdio de seguimento clÃnico foi de 3,38 anos (dp = 2,2; IC 95% = 3,01-3,75); 55,2% dos pacientes necessitaram de novos internamentos; 23,3% apresentaram recidiva da histoplasmose; 31,4% interromperam o uso de antifÃngicos conforme orientaÃÃo mÃdica. A mÃdia do acompanhamento apÃs a interrupÃÃo foi de 2,85 anos (IC 95% = 2,24-3,46). Somente um paciente recidivou apÃs a interrupÃÃo do antifÃngico. Os fatores riscos relacionados à recidiva foram nÃo adesÃo à TARV (p = 0,000), uso irregular de antifÃngico (p= 0,000), nÃo recuperaÃÃo do CD4+ (p = 0,000) e ter aids antes do diagnÃstico de HD (p =0,025). Somente nÃo adesÃo à TARV (OR = 4,96; IC 95% = 1,26-30,10; p = 0,026) foi fator de risco independente para recidiva. Aos 60 meses a probabilidade de remissÃo foi de 67%(IC 95%= 55% -76%). AdesÃo à TARV (94% vs. 51% - p = 0,000), uso regular de antifÃngico (87% vs. 48% - p = 0,000), recuperaÃÃo do CD4+ (83% vs. 45% - p = 0,000) e nÃo ter aids antes da HD (76% vs. 55% - p = 0,035) foram os principais fatores que contribuÃram para manutenÃÃo da remissÃo. Ãbito ocorreu em 30,2% dos pacientes; os fatores relacionados à mortalidade foram nÃo adesÃo ao tratamento da aids (p = 0,000), uso irregular de antifÃngico (p = 0,000), nÃo recuperaÃÃo do CD4+ (p = 0,000), ter tido um novo episÃdio de histoplasmose (p = 0,000) e ter aids antes da HD (p = 0,009). NÃo adesÃo à TARV foi o Ãnico fator de risco independente associado à mortalidade na anÃlise multivariada (OR = 5,24; IC 95% = 1,28-21,38; p = 0,021). A sobrevida aos 60 meses foi de 68% (IC 95% = 57%-76%). Pacientes com adesÃo à TARV (92% vs. 54% - p = 0,000) e sem episÃdio de recidiva (77%vs. 32% - p = 0,000), tiveram melhor probabilidade de sobrevida. Uso regular de antifÃngico (84% vs. 50% - p = 0,000) , ter tido recuperaÃÃo do CD4+ (89% vs. 54% - p = 0,000) e nÃo ter tido aids antes da HD (75% vs. 57% - p = 0,021) tambÃm foram fatores associados a uma melhor sobrevida. Portanto, verificou-se nesse estudo, elevada prevalÃncia de HD em pacientes com aids nessa regiÃo do Brasil, com altas taxas de recidiva e Ãbito. AdesÃo à TARV foi o Ãnico fator de risco independente associado aos desfechos, recidiva e Ãbito. A melhor sobrevida ocorreu em pacientes aderentes à TARV / Histoplasmosis is one of the most opportunistic systemic mycoses associated with AIDS today in Brazil and worldwide. Cearà is the state of Brazil with the largest case in the last decade this co-infection. The objective of this study was to characterize the survival and morbimortality of patients with co-infection HD/AIDS after the 1st HD event, served in in units of a reference for HIV/AIDS in Fortaleza/CearÃ. Retrospective cohort study of patients with co-infection HD/AIDS, when the first HD episode occurred between 2002-2008. The data were collected from the diagnosis of HD until 12/31/2010. Statistical analysis was performed using STATA 9.0 program. The study included 145 patients. The majority were young adults with median age of 34.6 years (95%CI = 33.2-36.0), males (83.5%) and without risk activity associated with histoplasmosis (80%). The prevalence of co-infection was of 38 cases/year. HD was first defining opportunistic infection of AIDS in 59% of the patients. Amphotericin B was used in 97% of patients as induction drug and itraconazole in 92% on maintenance dose. The average clinical follow-up was 3.38 years (sd=2.2,95%CI= 3.01 to 3.75); 55.2% of patients needed for new admissions; 23.3% presented relapse of histoplasmosis; 31.4% discontinued the use of antifungal as medical advice. The average follow-up after the interruption was 2.85 years (95%CI= 2.24 to 3.46). Only one patient relapsed after stopping the antifungal. Risk factors related to relapse were not adhering to ART (p 0.000), irregular use of antifungal (e.g. 0.000), non-recovery of CD4 (p 0.000) and have AIDS before diagnosis of HD (0.025). Non-adherence to ART (OR 4.96; 95% CI = 1.26- 30.10; p = 0.026) was the only independent risk factor for relapse. To 60 months the likelihood of remission was 67% (95%IC = 55% -76%). Join the ART (94% vs. 51% - p = 0.000), regular use of antifungal (87vs. 48 - p = 0.000), recovery of CD4+ (83% vs. 45% â p =0.000) and not having AIDS before the HD (76% vs.55% - p = 0.035) were the main factors that contributed to maintenance of remission. Death occurred in 30.2% of patients; mortalityrelated factors were not adherence to treatment of aids (p = 0.000), irregular use of antifungal medication (p = 0.000), non-recovery of CD4+ (p = 0.000), have had a new episode of histoplasmosis (p = 0.000) and have AIDS before the HD (p = 0.009). Patients with adherence to ART (92% vs. 54% - p = 0,000) and without relapse episode (77% vs. 32% - p = 0,000), had better chances of survival. Regular use of secondary prophylaxis as a maintenance therapy in HD was a factor associated with lower probability of progression to death (p=0.000). The survival at 60 months was of 68% (95%CI = 57%-76%). Regular use of antifungal (84% vs. 50% - p = 0.000), have had CD4+ recovery (89% vs. 54% - p = 0.000)and not have had AIDS before the HD (75% vs. 57% - p = 0.021) also were factors associated with better survival. Therefore, it was found in this study, high prevalence of HD in patients with AIDS in this region of Brazil, with high rates of relapse and death. Join the ART was the only independent risk factor associated with outcomes, relapse and death. The best survival occurred in patients adhering to ART.

Master of Public Health - MPH / For more than two decades now, the acquired immune deficiency syndrome (AIDS) and its etiological agent, the human immunodeficiency virus (HIV), has been a growing challenge that affects all segments of the global population. Voluntary HIV counseling and testing (VCT) is one of the many prevention and control strategies adopted globally and by the Government of the Republic of Zambia. VCT is the process by which an individual undergoes counseling to enable him/her to make an informed choice about being tested for the human immunodeficiency virus (HIV). This decision must be entirely the choice of the individual and he or she must be assured that the process will be confidential. VCT is a key component of both HIV prevention and care programs. Although VCT is increasingly available in Zambia through public health facilities, VCT only or stand-alone sites and mobile counseling and testing services, there is still great reluctance among many people to be tested. Aim: This study explored factors affecting the utilization of VCT services in Mwense District, Zambia. Methodology: An explorative, qualitative study was conducted. Data was collected through focus group discussions with community members, and key informant interviews with lay counselors and health care workers. Thematic analysis of transcribed data was done to elucidate knowledge and awareness of HIV/AIDS and VCT services, factors facilitating uptake and barriers to utilization of VCT services and suggestions for improving VCT uptake. Results: The study found that HIV/AIDS was recognized as a major problem in the communities and that participants were aware of the availability and benefits of HIV counseling and testing services. The main reasons for seeking an HIV test included facilitating sexual behavior change to avoid infection, re-infection or infecting others with HIV. Facilitators to uptake of VCT services include accessing information on HIV/AIDS and other care and support services such as prevention of mother to child interventions, peer and social support systems, home-based care and early treatment with antiretroviral therapy if one is HIV positive. Community members indicated that VCT was an entry point to reaching out to the family and community for on-going counseling, which would lead to reduction in HIV/AIDS stigma and discrimination. Several barriers to VCT were identified by the participants. At individual level, barriers included: the fear of the ramifications of a positive test; fear of HIV/AIDS stigma and discrimination; doubt about the existence of HIV and AIDS; and fear of loss of control of life circumstances and destiny. Health facility level barriers included concerns about confidentiality of HIV-test results, familiarity with service providers, lack of promotional activities of the VCT services, shortage of testing logistics and commodities, and human resource shortages both in terms of numbers and confidence to promote VCT services. Community levels barriers included cultural beliefs and customs, gender imbalances, religious beliefs and stigma. Conclusions: There is urgent need for community sensitization about VCT and its benefits in HIV/AIDS control.

Magister Artium (Social Work) - MA(SW) / Botswana is experiencing high levels of HIV prevalence rate at 16.9% among the general population, 4.5% among adolescents aged 10-14 and 4.7% among adolescents aged 14-19. Adolescents are in a critically stage between childhood and adulthood and undergo a lot of developmental changes physically, sychologically and emotionally. The scourge of HIV/AIDS has also brought with it multiple challenges to adolescents as those who are HIV positive have to adhere to all the health requirements of being HIV positive and at the same time being pressurised by the societal expectations. Stigmatisation and discrimination are experienced as barriers against the fight towards HIV which is seen a major factor among adolescents. The aim of the study was to explore and describe adolescents’ perceptions and experiences of anti-retroviral therapy at a tertiary hospital in Francistown, Botswana. The study followed a qualitative research approach with an exploratory descriptive research design. Purposive sampling was used to recruit participants. Participants were school going adolescents aged between 13 and 19 years, who are on antiretroviral therapy and going for reviews at a tertiary hospital in Francistown, Botswana. Data were gathered though face to face semi structured interviews with each of the 24 participants. Data were analysed thematically. The following four themes emerged during the analysis: i. “ARVs control but don’t cure”; ii. “Why did it happen to me?-the reality of using ARVs”; iii. “I don’t want to take them for the rest of my life”; and iv. “No man is an island”, which addressed the research objectives. The findings led to the conclusion that, despite the fact that HIV has been around for over two decades and ARVs has been around for more than a decade, adolescents living with HIV still faces challenges such as stigmatisation due to social as well as clinical factors and adjusting to a lifelong treatment which made it difficult for them to adhere to their treatment. However, adolescents are happy as they are living a healthy and a fruitful life as a result of the ARVs. Ethical considerations were adhered too. Furthermore the findings of the study could assist the Ministries of Health, Education, Local Government and Rural Development to address these challenges experienced by the adolescents in the development of social programmes to improve the livelihood of the adolescents living with HIV/AIDS.

This descriptive study aimed to determine the knowledge, attitudes and practices about AIDS among Sexually Transmitted Disease (STD} clinic attenders in the Cape Peninsula. A questionnaire containing open and closed questions in the appropriate language (English, Afrikaans or Xhosa) was administered by trained clinic staff to 306 patients in 9 of the 29 STD Clinics in the region. The study was requested by the local authorities to initiate and improve AIDS education programmes within the STD clinics. 306 patients were interviewed in 9 clinics. The median age of attenders was 25 years. The median period of residence in the peninsula was 7 years. Knowledge of AIDS is reasonably good when tested by true/false questions but much worse when tested by open questions. Knowledge bears little relationship to practice. There is inadequate awareness of the asymptomatic carrier state, the incurability of AIDS and ways to prevent AIDS. Sexual practice is high risk. Condom use is extremely low especially in the African areas where only 9,6% used a condom in the past year. Prostitution is perceived to be a common occurrence in attenders' communities. There is a low perception of risk to self. The most important beliefs militating against condom use are that they are unacceptable to partners and peer group. More information about AIDS was requested by 90% of patients and a strong preference was expressed for programmes to be conducted in the patient's home language. This study supports the urgent need for an AIDS education and counselling programmes for patients with STD's in the region. Recommendations include the need to address the emotions, attitudes and beliefs that affect behaviour as well as to convey knowledge. Condom acceptability poses a major problem that will need to be addressed. Patients with STDs represent an extremely important core group for HIV transmission to others in the community and need specific attention and resources.

The Human Immunodeficiency Virus (HIV) which causes Acquired Immunodeficiency Syndrome (AIDS) has caused a global scare with mainly poor African countries suffering the greatest burden. Treatment of HIV is more of palliation rather than cure such that there is no room for treatment interruption if treatment goals are to be met. Antiretroviral treatment is associated with short term and long term side effects which have the potential to negatively impact on the high levels of adherence to treatment that is required to maintain virological suppression and may eventually lead to development of drug resistance and treatment failure. This research aims to identify the extent to which these side effects, through possible poor adherence, impact on treatment successes by measuring the risk that side effects contribute towards treatment failure. Methods Secondary data analysis was conducted on a cohort of patients who initiated ART between 2004 and 2010 at a large tertiary facility in Johannesburg. Patients who were switched to second line ART due to treatment failure were identified. Assessment of side effects on adherence was done. The hazards of side effects among patients switching and not switching to second line were calculated using Cox proportional hazards regression adjusting for other socio-demographic and clinical predictors for treatment failure. Interaction between side effects, gender, age and that of side effects and adherence was investigated. Time dependent covariates were also investigated. Confounding was controlled using multivariate Cox regression analysis. Results There were 5285 patients in the baseline cohort with multiple entry points who contributed 16035 person-years of follow up. The cohort consisted of 63.2% females and 36.8% males. Of these 85.9% were initiated on stavudine (d4T)- based regimen, 7.1% on tenofovir (TDF), 6.3% on zidovudine (AZT)-based regimen and 0.7% on other regimens. The median and mean time at risk per subject was 2.2 and 2.3 years respectively. A total of 770 episodes of side effects due to first line ART were experienced with some patients recording multiple side effects at different time points. Adherence data were found to be missing and incoherent in some of the regimen dosages and could not be used to objectively compare patients. There were 430 patients who were switched to second line ART due to treatment failure. Relative to the group of no side effects, the adjusted hazard ratios for mild, moderate and severe side effects were 1.40 (95% CI=0.94-2.09) p=0.10; 1.72 (95% CI=1.35-2.20) p<0.01 and 1.24 (95% CI=0.65-2.35) p=0.52 respectively. Therefore, overally side effects did not seem to play a role in the time to switch to second line ART. Sex, baseline CD4 cell count, the period during which ART was initiated and the time between date of testing HIV positive and date of initiating were significantly associated with the time to switching to second line ART. Conclusion The study informs that side effects overally may not play a significant role in switching patients from first line to second line ART with the exception of moderate side effects. However, patients who experience side effects should be closely monitored and adequately counselled to help them cope with the side effects so that optimal adherence levels are maintained. Availability of adherence scores or additional information on pills that should have been taken on periods during which pills were reported to have been missed would have made the research more valuable by allowing objective comparison of adherence among patients.