HIV-associated lipodystrophy (HIVLD) syndrome is a condition comprising abnormalities in distribution of body fat and metabolism of lipids and glucose that arises in HIV-infected patients on long-term antiretroviral therapy. This thesis describes clinical research into aspects of the natural history and treatment of HIVLD, as well as molecular research into its pathogenesis centred on subcutaneous adipose tissue. Results demonstrate HIVLD to be a treatment-induced syndrome characterised by initial gains in body fat followed by selective, progressive loss of limb fat. Exposure to thymidineanalogue nucleoside reverse transcriptase inhibitors (tNRTI) induces lipoatrophy through mitochondrial dysfunction of which inhibition of mitochondrial RNA expression, rather than mitochondrial DNA depletion, is an early feature. Mitochondrial dysfunction is associated with decreases in expression of peroxisome proliferatoractivated receptor gamma (PPAR??), an adipocyte transcription factor, which helps explain how tNRTI exposure leads to the loss of adipocyte function. Once established, lipoatrophy is characterised by mitochondrial DNA depletion, although this depletion occurs throughout the mitochondrial genome, suggesting an underlying cause other than inhibition of DNA polymerase gamma. HIVLD is a difficult syndrome to treat. Lipoatrophy is resistant to treatment with rosiglitazone, an agonist of PPAR??, which is ineffective in the setting of ongoing tNRTI therapy and mitochondrial dysfunction. Dyslipidaemia is also difficult to treat as use of pravastatin in the setting of ongoing exposure to protease inhibitors results in only modest declines in fasting cholesterol concentrations. Gains in central fat, such as that seen in patients with buffalo hump, are associated with insulin resistance and diabetes, but only occur in a relatively small percentage of treated patients, suggesting a role for genetic factors in its development. Use of strategies such as avoidance of tNRTI in firstline ART, genetic screening to identify those at risk of toxicities and targeted selection of interventions in subgroups of affected patients, may help prevent this syndrome occurring and better treat those patients in which it has already occurred.

Thesis (Ph. D.)--Virginia Commonwealth University, 2007. / Prepared for: Dept. of Psychology. Bibliography: leaves 135-149. Also available online.

Thesis (Ph. D.)--Georgia State University, 2007. / Title from file title page. Irene Weber, committee chair; John Houghton, Giovanni Gadda, committee members. Electronic text (186 p. : ill. (some col.)) : digital, PDF file. Description based on contents viewed Dec. 20, 2007. Includes bibliographical references (p. 166-180).

From July to September, 2002 I spent ten weeks in Kenya conducting full-time research on the macroeconomic impact of HIV/AIDS and community action towards combating the epidemic in locations dominated by members of the Luo tribe in Nyanza Province, Kenya. Gathering data from both the Ministry of Health and non-governmental organizations, I sought to identify the causations and impact of the HIV/AIDS epidemic from a holistic framework. Serving as a pilot study for future research and program evaluation, my research primarily focused on four community-based organizations (CBOs) and Ministry of Health offices located in Kisumu, Nyando, Rachuonyo, and Migori Districts. My research objectives were to explore the cultural and economic variables related to the spread of the HIV/AIDS epidemic, identify which sectors of society were negatively impacted by the epidemic, record community action in response to these impacts, investigate obstacles related to implementation of such interventions, and share research and recommendations with the Ministry of Health and CBOs in Nyanza Province in a way that was meaningful and useful to them. Several qualitative and ethnographic methods were utilized. Participant observation was the principal method used and consisted of a wide range of activities. Additionally, I conducted sixteen formal semi-structured interviews, approximately thirty informal unstructured interviews, and one focus group discussion with nine youth. I found that community-based organizations and the Ministry of Health engaged in a wide variety of activities in response to the HIV/AIDS epidemic including providing Home Based Care to the sick and dying through trained community health workers; training individuals in income-generating activities to provide support for the organizations, the infected and affected, and as a means of prevention of new infections; and providing education to the communities at large. The Ministry of Health and non-governmental organizations also engaged in a significant level of collaborative work to assist each other with their programs and ensure there was no duplication of services. Despite considerable organizational efforts by both the governmental and non-profit sectors, these groups faced a number of different obstacles in their mobilization efforts including limited funding, transportation obstacles in visiting HIV/AIDS clients, and difficulties in convincing individuals to change their behaviors. Individuals interviewed cited a number of factors related to the spread of HIV/AIDS including wife inheritance, wife cleansing, poverty, commercial sex work, and distance marriages. Limited access to voluntary counseling and testing (VCT) services was also an obstacle in a number of communities. Additionally, I found a positive association between access to VCT services, perceptions of people living with HIV/AIDS, and social support for the infected. Based on my findings I concluded that individuals' behavior resulting in the transmission of HIV/AIDS is not solely related to lack of knowledge. Circumstances, especially related to poverty, lead to actions such as exchanging sex for money, distance marriages, early marriages for females, and wife inheritance. In order for HIV/AIDS prevalence to be reduced in Kenya, there must be active participation at all levels and from all sectors of society, including from community members themselves, community-based organizations, the Government of Kenya, and international governmental and non-governmental assistance organizations. Among my recommendations I propose the expansion of voluntary counseling and testing services to make it easier for individuals in rural areas to know their HIV status. I also advocate for a holistic and multisectoral response to HIV/AIDS prevention and support for the infected and affected, including through Home Based Care and social support for the infected, support for AIDS orphans, prevention of mother-to-child transmission, effective HIV/AIDS education, reducing poverty through income-generating activities, making school educations accessible for all children, and improving the overall state of health and access to health facilities for all individuals. / Graduation date: 2004

This study investigated the attitudes of mental health counselors toward persons with Acquired Immunodeficiency Syndrome (AIDS). Three hundred and fifty-eight members of the American Mental Health Counselors Association were mailed a survey packet including an Attitude Towards AIDS Victims scale and an additional two questions assessing comfort with clients with AIDS. Demographic information was also collected. There were 255 useable surveys, for a response rate of 72%. The results of the survey indicated that gender was not a significant independent variable in the attitudes of the mental health counselors. Professional and/or personal contacts with a person with AIDS were highly predictive of positive attitudes. Sexual orientation of the respondent was also highly significant as was personal acquaintance with a gay male or lesbian. Formal AIDS training of one hour or more showed a significant relationship with attitudes of mental health counselors toward persons with AIDS, with the relationship becoming more significant at 11 or more hours. The study indicated that mental health counselors are largely uninvolved in providing mental health treatment to persons with AIDS, with 5% of the subjects providing 70% of the services. Recommendations follow regarding preservice and inservice AIDS training and the need for mental health counselors to be more proactive in the AIDS epidemic. / Graduation date: 1996

Thesis (Ph. D.)--University of Chicago, Dept. of Psychology, Committee on Human Development, June 1999. / Includes bibliographical references. Also available on the Internet.

Sub-Saharan Africa is a region plagued by the spread of HIV/AIDS. While many individuals have devoted their careers to preventing new diagnoses of the disease, one crucial population is often neglected. The purpose of this paper is to analyze the degree to which the psychological needs of those orphaned by HIV/AIDS are addressed in three prominent interventions. After evaluating institutionalization, foster care, and community-based care in Sub-Saharan Africa, a model for effective intervention is proposed.

Thesis (Ed.D.)--University of West Florida, 2007. / Title from title page of source document. Document formatted into pages; contains 237 pages. Includes bibliographical references.

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in Anthropology." Includes bibliographical references (p. 269-275).

Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references. Available also from UMI Company.