Thesis (MA )--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The purpose of this thesis is to assess the impact of HIV and AIDS on democratic consolidation in two democracies in Southern Africa: Botswana and South Africa. Mattes (2003), Barnett and Whiteside (2006) and others warned that in states with high HIV infection levels, the negative impact of the pandemic - especially in terms of socio-economic conditions, budgetary pressures and a loss of human capital in the state and the economy - was potentially so great that it may affect democracy detrimentally. In contrast, some scholars, particularly Anthony Butler (2005a) and Alex de Waal (2006), contended that although the pandemic had negative effects, democracies might survive it and that in some specific ways, democratic consolidation might even benefit from the its consequences. For instance, they argued that in South Africa, the civil society response to the government’s controversial HIV and AIDS policy deepened the institutional framework of democracy. The methodology for the above comparative analysis is based on the application of a minimalist multivariate model which, following the thinking of Bratton and Van de Walle (1997) consists of both institutional and socio-economic factors. Factors are selected for their relevance to democratic consolidation, as argued by scholars such as Linz and Stepan (1996), Przeworski, Alvarez, Cheibub and Limongi (1996), Bratton and Van de Walle (1997) and Leftwich (2000). The chosen factors are the system of government (the relationship between the branches of government); the electoral system; political rights and civil liberties; economic indicators (affluence, economic growth and the reduction of inequality); human development (as measured by the United Nations Development Program) and civil society. This is a descriptive, qualitative, desktop study, using secondary literature in books, as well as articles. There is no empirical component, such as fieldwork, surveys or questionnaires. As stated below, such methodology may be used for further elaboration and refining of the findings of this desktop-based comparative analysis. The main finding is that currently, despite the cost and human implications of the disease, there are no indications that it is directly threatening to destroy the democracies of Botswana or South Africa. This finding differs from the more negative expectations of the scholars mentioned above. It is suggested that the increasing provision and effectiveness of antiretroviral treatment (ART) enables these democracies and their economies to avoid some of the ravages of the disease that seemed inevitable a few years ago. Furthermore, it is suggested that the comparative affluence of the two states in question shields them from some negative effects of HIV and AIDS and that this may be different in poorer Southern African states. This is an issue for further research. Such research should go beyond desktop research to include fieldwork and questionnaires. / AFRIKAANSE OPSOMMING: Die doel van hierdie tesis is om die impak van MIV en VIGS op demokratiese konsolidering in twee Suider-Afrikaanse demokrasieë, Botswana en Suid-Afrika, vas te stel. Mattes (2003), Barnett en Whiteside (2006) en ander het gewaarsku dat die negatiewe uitwerking van die pandemie - veral in terme van sosio-ekonomiese toestande, begrotingsdruk en ’n verlies aan menslike hulpbronne in die staat en ekonomie - potensieel so groot is dat dit demokrasie nadelig sou beïnvloed. In teenstelling hiermee het ander akademici, soos Anthony Butler (2005a) en Alex de Waal (2006), geredeneer dat demokrasieë die pandemie mag oorleef ten spyte van die negatiewe effekte wat dit wel het en dat demokrasieë selfs op sekere wyses by die gevolge daarvan mag baatvind. Byvoorbeeld, het hulle geargumenteer, in Suid-Afrika het die burgerlike samelewing se reaksie op die Mbeki-regering se kontroversiële MIV en VIGSbeleid die institusionele raamwerk van demokrasie verdiep. Die metodologie vir hierdie vergelykende analise is gebaseer op die toepassing van ’n minimalistiese multiveranderlike model. Soos gepostuleer deur Bratton en Van de Walle (1997), wat beide institusionele en sosio-ekonomiese faktore insluit. Faktore is gekies op grond van hulle relevansie tot demokratiese konsolidering (volgens vakkundiges soos Linz en Stepan (1996), Przeworski, Alvarez, Cheibub en Limongi (1996), Bratton en Van de Walle (1997) en Leftwich (2000), asook vir dié se moontlike relevansie tot demokrasieë wat spesifiek deur MIV en VIGS geaffekteer word. Die gekose faktore is die regeringstelsel (die verhouding tussen die uitvoerende, wetgewende en regsprekende gesag), die verkiesingstelsel, politieke regte en burgerlike vryhede, ekonomiese aanwysers (welvaart; ekonomiese groei en die vermindering van ongelykheid), menslike ontwikkeling (soos gemeet deur die Verenigde Nasies se Ontwikkelingsprogram) en die burgerlike samelewing. Hierdie tesis is ’n literatuurstudie van ’n beskrywende, kwalitatiewe aard. Daar is gebruik gemaak van sekondêre literatuur in boeke, asook van artikels. Daar is geen empiriese komponent soos veldwerk en meningspeilings nie. Soos hieronder beklemtoon word, kan empiriese metodes in toekomstige studies gebruik word om op die bevindinge wat hierdie navorsing opgelewer het, uit te brei en dit te verfyn. Die hoofbevinding is dat daar tans, ten spyte van die finansiële en menslike koste van MIV en VIGS, geen aanduiding is dat die siekte ‘n direkte bedreiging inhou vir die voortbestaan van demokrasie in Botswana en Suid-Afrika nie. Hierdie bevinding verskil van die meer negatiewe verwagtinge hierbo uitgespreek. Dit word voorgestel dat die toenemende voorsiening en effektiwiteit van antiretrovirale behandeling hierdie demokrasieë en hulle ekonomieë daartoe in staat stel om gedeeltelik die verwoesting van hierdie pandemie te vermy, iets wat enkele jare gelede nog as onvermydelik beskou is. Verder word die voorstel gemaak dat die impak van die pandemie op armer Suider-Afrikaanse state vergelyk behoort te word met die bevindinge wat hier aangebied word. Sulke toekomstige navorsing behoort nie net literatuurstudie in te sluit nie, maar ook veldwerk en meningsopnames.

Depuis 2013, le traitement « universel » est recommandé en France. Le moment de l’initiation thérapeutique est une question qui reste cependant d’actualité pour les patients se présentant en primo-infection. Cette thèse s’attache à étudier la prise en charge thérapeutique du VIH au stade de la primo-infection (PIV) sous différents angles :1) le suivi par les cliniciens des recommandations d’initiation des traitements antirétroviraux depuis 1996 en fonction de l’évolution de ces recommandations; 2) l’impact d’un traitement ARV transitoire en PIV sur la réponse immuno-virologique lors de la reprise du traitement et 3) l’identification de nouveaux biomarqueurs comme facteurs pronostiques de progression de l’infection VIH. La majorité des travaux présentés dans cette thèse repose sur les données de la cohorte ANRS PRIMO qui comporte environ 1 500 patients infectés par le VIH inclus en PIV entre juin 1996 et décembre 2013, dans 94 hôpitaux français. Tous les patients étaient naïfs de traitement antirétroviral à l'inclusion.La première partie de la thèse analyse la mise en œuvre des recommandations d’initiation du traitement ARV entre 1996 et 2010 par les médecins en France, dans deux situations distinctes : au stade chronique et lors de la primo-infection par le VIH-1. Nous avons montré que les recommandations d’initiation du traitement ARV étaient largement suivies. Néanmoins, il existe un effet d’inertie dans leurs applications lors des changements de recommandation. Il reste à améliorer le délai de mise sous traitement lorsque le taux de CD4 atteint le seuil recommandé. Au stade chronique, le traitement était plus fréquemment initié chez les patients présentant un critère d’initiation dès le diagnostic d’infection par le VIH (96%), que chez les patients qui atteignaient un critère d’initiation au cours du suivi (78%, p<0.001). Nous avons identifié comme facteurs de risque de ne pas être traité en phase chronique malgré une indication de traitement : une charge virale < 5log (versus >5), un plus faible niveau d’éducation et des conditions de vie précaires.L’impact de l’interruption d’un traitement antirétroviral initié en PIV sur la restauration des CD4 après reprise du traitement a été exploré en modélisant l’évolution des CD4 avec des modèles linéaires à effets mixtes avec intercept et pente aléatoires. Les patients qui avaient initié un traitement ARV pendant la phase chronique avaient une meilleure réponse immunologique que les patients reprenant un 2ème traitement après un traitement transitoire en PIV : à 36 mois, les gains en √CD4 cellules/mm3 et en pourcentage de CD4 étaient significativement plus élevés. Cependant, il s’agissait de différences modestes en termes cliniques, qui ne conduisent pas à recommander d’arrêter la recherche clinique sur les arrêts de traitement cherchant à induire des contrôleurs post traitement. Après un état des lieux des mécanismes complexes d’activation/inflammation du système immunitaire pendant la primo-infection nous avons cherché à identifier de nouveaux biomarqueurs prédictifs de l’évolution de l’infection. Le taux de sCD14 (marqueur d’activation monocyte/macrophage et marqueur indirect de translocation microbienne) au moment de la PIV a été identifié comme marqueur potentiel de prédiction du déclin des CD4 et du risque de mortalité d’origine cardio-vasculaire. En conclusion, bien que des progrès considérables aient été réalisés dans la prise en charge du VIH, d'autres études sont nécessaires pour optimiser et adapter le traitement au profil du patient dès les premiers stades de l’infection VIH. / In France, since 2013, HIV treatment has been recommended for all HIV-infected patients independently of their CD4 count. However, when to start anti-retroviral (ARV) treatment is still an issue. This thesis aims to explore the therapeutic management of HIV at the stage of PHI in different aspects: 1) we explored how physicians in France have applied the evolving guidelines for ART initiation since 1996 2) the impact of a transient ARV treatment at PHI on immuno-virological response during 2nd treatment and 3) identification of new biomarkers prognostic of HIV progression.Most of the work presented in this thesis is based on data from the ongoing ANRS PRIMO cohort that enrolled more than 1 500 HIV infected patients enrolled at PHI since June 1996 in 94 French hospitals. All patients were antiretroviral therapy naive at baseline.The first part of the thesis analyzes the implementation of the recommendations of ARV treatment initiation between 1996 and 2010 by physicians in France, in two distinct situations: in the chronic HIV-1 infection and during primary HIV-1 infection. We have shown that the recommendations of ARV treatment initiation were widely followed. Nevertheless, there was inertia in guidelines application when changes in the recommendations took place. The time to treatment when CD4 cell counts reach the threshold to treat can be improved. 96% of the patients initiated ART when they had a CD4 cell count below the threshold to treat at entry, while treatment was less timely initiated when the CD4 threshold was reached during active follow-up (78%, p <0.001).We identified as risk factors for not being timely treated in chronic phase despite an indication for treatment: a viral load <5log (versus> 5), a lower education level and poor living conditions.The impact of ARV interruption after a first treatment initiated at PHI on the CD4 count restoration after resumption was explored by modeling the evolution of CD4 cells with linear mixed effects models with random intercept and slope. Patients who initiated ARV treatment during the chronic phase had a better immune response than patients who initiated a second course treatment after a transient ART at PHI: at 36 months, the gains in √CD4 cells / mm3 and CD4 percentage were significantly higher. However, this difference was clinically modest and further research on treatment interruptions seeking to induce post-treatment controllers is still an issue but only in research settings and under close medical surveillance. After an overview of the complex mechanisms of activation / inflammation of the immune system during primary infection we sought to identify new predictive biomarkers of disease progression. The level of sCD14 (marker of monocyte/macrophage activation and an indirect marker of microbial translocation) at the time of PHI was identified as predictive marker of CD4 decline and of risk of cardio-vascular mortality. In conclusion, although considerable progress has been made in the management of HIV, further studies are needed to optimize and adapt the treatment to the patient profile in the early stages of HIV infection.

Text in English / The South African government provides people living with HIV Temporary Disability Grants to assist them with money when they cannot work due to being disabled by HIV. The toll of the disease has contributed to the inability to be employed among black South Africans. The aim of this exploratory qualitative study was to investigate the challenges experienced by people living with HIV when their Temporary Disability Grants are terminated in the semi-urban area of Gauteng. The temporary disability grant is terminated after six months of receiving it. In-depth interviews were conducted with people who live with HIV who are members of Ekupholeni Mental Health and Trauma Centre support group. Thematic analysis was used to analyse data. The findings of the study revealed that the termination of Temporary Disability Grant affects the running of the households of people living with HIV, causes poor management of the disease, non-adherence to treatment which leads to viral rebound, poor nutrition as a result of poor finances. The findings of this study are significant for the policy review on how long a person should receive the disability grant and the criteria used to apply for a disability grant, and to encourage the people living with HIV to start their own gardening programmes for food supply. Moreover, to encourage the introduction of a Chronic Disease Grant (CDG) for people who live with HIV. / OKUFINYEZIWE Uhulumeni waseNingizimu Afrika uhlinzeka abantu abaphila ne-HIV Izibonelelo Zesikhashana Zabaphila Nokukhubazeka, ama-Temporary Disability Grants, ukubasiza ngemali ngesikhathi bengakwazi ukuthi bayosebenza ngesizathu sokukhubazeka ngenxa ye-HIV. Ubunzima balesi sifo sebubenomthelela wokuthi kube nokungaqasheki kwabantu abamnyama baseNingizimu Afrika. Injongo yalolu cwaningo oluchaza kabanzi kwakuwukuphenya ngezinselelo ezibhekana nabantu abaphila ne-HIV uma Izibonelelo Zesikhashana Zabaphila Nokukhubazeka zinqanyulwa endaweni yasemalokishini aseGauteng. Isibonelelo sesikhashana sabaphila nokukhubazeka sinqanyulwa emva kokutholakala kwaso izinyanga eziyisithupha. Ukuxoxisana okunzulu kwenziwa nabantu abaphila ne-HIV abangamalungu esikhungo Sezempilo Yangokomqondo, Ekupholeni nabayiqembu lokusekelana Lesikhungo Sokuphazamiseka Emqondweni. Ukuhlaziywa kwale ndikimba kwenziwa ukucwaninga imininingwane eyayiqoqiwe. Okwatholwa yisifundo kwaveza ukuthi ukunqanyulwa Kwesibonelelo Sesikhashana Sabaphila Nokukhubazeka kuthikameza ukuqhubeka ngendlela efanele kwamakhaya abantu abaphila ne-HIV, kubangele ukungalawuleki kahle kwesifo, ukungabambeleli ekuphuzweni kwemithi okubangela ukuthi igciwane lihlasele kabusha, ukungadli ngokufanele ngenxa yokuswela imali. Okutholakala kulolu cwaningo kusemqoka ekubuyekezweni kwenqubomgomo yokuthi kumele umuntu anikezwe isibonelelo sokuphila nokukhubazeka isikhathi esingakanani kanye nemigomo esetshenziswayo ukufaka isicelo semali yesibonelelo sokuphila nokukhubazeka, kanye nokukhuthaza abantu abaphila ne-HIV ukuthi baqale izinhlelo zabo zezingadi ukuze bathole ukudla. Ngaphezu kwalokho, ukukhuthaza ukuqala ukusebenzisa Isibonelelo Sezifo Ezingelapheki, i-Chronic Disease Grant (i-CDG) sabantu abaphila ne-HIV. / KGUTSUFATSO Mmuso wa Afrika Borwa o fana ka Dithuso tsa Nakwana ho batho tshwerweng ke HIV le ba Koafetseng ho ba thusa ka tjhelete nakong eo ba sa sebetseng ka lebaka la ho tshwarwa ke HIV le ho koafala. Sekgahla sa kokwana se bakile bothata ba ho hloka mesebetsi ka hara batho ba batsho ka hara Afrika Borwa. Maikemisetso a dipatlisiso tsena ke ho hlahloba diphephetso tseo batho ba phelang ka HIV ba kopanang le tsona nakong eo Dithuso tsa Nakwana tsa ho Kowafala di felang dibakeng tsa seka-ditoropo Gauteng. Dithuso tsa Nakwana tsa ho kowafala di fihla pheletsong ka moea dikgwedi tse tsheletseng ka mora ho di fumantshwa. Di-inthavu tse tebileng di ile tsa tshwarwa le batho ba phelang ka HIV bao e leng ditho tsa sehlopha se tshehetsang sa Ekupholeni Mental Health and Trauma Centre. Manollo ya mookotaba o ile wa sebediswa bakeng sa ho sekaseka lesedi. Tse fumanweng ka hara dipatlisiso tsena di hlahisa hore ho fela ha Dithuso tsa Nakwana tsa Ditjhelete di ama tsamaisong ya malapa a batho ba phelang ka HIV, di baka taolo e fokolang ya bohloko, ho se ikamahanye le phekolo ho etsang hore bohloko bo kgutle hape, phepo e sa lokang e bakwang ke tjhelete e nyane. Tse fumanwanwang ka hara dipatlisiso tsena ke tsa bohlokwa bakeng sa hore maano a shejwe hape mabapi le hore e k aba nako e kae moo mokudi a lokelang ho fumantshwa thuso, mmoho le tsela e sebediswang ho etsa kopo ya dithuso tsa bokowa, le ho kgothalletsa batho ba phelang ka HIV hore ba iqalle manane a temo bakeng sa phepelo ya dijo. Ho feta moo, ho kgothaletsa ho hlahiswa ha Dithuso tsa Mahloko a sa foleng (Chronic Desease Grant) bakeng sa batho ba phelang ka HIV. MANTSWE A SEHLOOHO Bokowa, dithuso tsa bokowa, baamohedi ba dithuso tsa bokowa, batho ba phelang ka HIV le AIDS, ho fela ha dithuso tsa bokowa le phekolo ka dipidisi tsa anthiritrovaerale. / Sociology / M.A. (Sociology (Social Behaviour Studies in HIV and AIDS))

La prise optimale d’un traitement antirétroviral est la clé du succès de ces traitements. Cette prise devrait être d’au moins 95 % des médicaments antirétroviraux prescrits afin de supprimer à long terme la réplication virale et donc de restaurer et de préserver la fonction immunologique. Cependant, les personnes vivant avec le virus de l’immunodéficience humaine (PVVIH) éprouvent des difficultés à adopter et à maintenir ce niveau de prise dans le temps. Bien que certaines interventions aient démontré leur capacité à faciliter ce comportement, au Québec il n’y a pas d’intervention systématique pour soutenir ces personnes dans la prise quotidienne de ces traitements. Le but de cette étude était donc de développer et d’évaluer une intervention pour faciliter le comportement de prise optimale d’un traitement antirétroviral chez des personnes vivant avec le VIH. Pour guider le développement de l’intervention, la démarche appelée « intervention mapping » a été suivie. Le cadre théorique proposé par Godin et ses collègues (2005) qui inclut le sentiment d’efficacité personnelle et les attitudes positives face à la prise optimale d’un traitement antirétroviral a été ainsi utilisé non seulement pour prédire et expliquer le comportement de prise, mais aussi pour élaborer l’intervention. Selon ce modèle, le soutien social, la satisfaction envers les professionnels et le fait de ne pas ressentir d’effets indésirables sont autant de facteurs modifiables associés au sentiment d’efficacité personnelle et aux attitudes positives. L’intervention développée visait l’acquisition et la mobilisation des habiletés nécessaires pour influencer ces facteurs en vue de rehausser le sentiment d’efficacité personnelle et les attitudes positives ainsi que pour faciliter ce comportement. Cette intervention comportait quatre rencontres d’une durée de 45 à 75 minutes, s’échelonnant sur 12 semaines, avec une infirmière iii possédant une expertise en VIH. L’évaluation de l’effet de cette intervention sur le comportement et les variables explicatives a été effectuée à l’aide d’un essai clinique avec répartition aléatoire. La principale variable résultat a été mesurée à l’aide d’un questionnaire autoadministré, de la charge virale et du nombre de CD4. Autant la variable résultat principale que les variables explicatives ont été mesurées avant l’intervention et après celle-ci, soit à 12 et 24 semaines. L’échantillon était constitué de 51, personnes vivant avec le VIH et suivies dans une clinique à Montréal : 23 dans le groupe contrôle et 28 dans le groupe expérimental. Des analyses de variance (ANOVA) à mesures répétées ont été réalisées afin d’analyser l’effet de l’intervention sur la prise optimale d’un traitement antirétroviral et les autres variables intermédiaires dans le temps. Les résultats montrent une tendance positive (p = 0,056) quant à l’obtention d’une charge virale indétectable dans le groupe intervention. Ainsi, 43,8 % plus de personnes du groupe expérimental comparativement au groupe contrôle (78,6 % versus 34,8 %) avaient une charge virale indétectable à 12 semaines et 32,8 % de plus à 24 semaines (89,3 % versus 56,5 %). Bien qu’aucun effet significatif ait été trouvé en regard des variables explicatives, probablement à cause d’un manque de puissance statistique, les légères augmentations observées dans le groupe expérimental sont cohérentes avec le modèle théorique utilisé (Godin & al., 2005). Cette étude contribue à l’avancement des connaissances en proposant une intervention pour faciliter la prise optimale d’un traitement antirétroviral chez des personnes vivant avec le VIH. / The key to the success of antiretroviral treatment is optimal treatment taking. At least 95% of prescribed antiretroviral treatments (ARV) have to be taken to achieve long-term suppression of viral replication and so restore and preserve immunologic functioning. However, people living with acquired immunodeficiency virus (PLHIV) have problems adopting and sustaining this level of medication taking over time. Although some interventions have demonstrated they can facilitate this behaviour, in Quebec there are no systematic interventions to support PLHIV in daily treatment taking. The goal of this study was to develop and evaluate an intervention to facilitate optimal antiretroviral-treatment-taking behaviour among people living with HIV. Development of the intervention was guided by an approach known as “intervention mapping.” Accordingly, the theoretical framework put forward by Godin and his colleagues (2005), which includes the factors of self-efficacy and attitudes, was used not only to predict and explain treatment-taking behaviour but also to develop the intervention. In the model, self-efficacy and attitudes are associated with a number of modifiable factors: social support, satisfaction with health professionals and not feeling adverse effects. The goal of the intervention was therefore the acquisition and mobilization of skills in order to affect these factors and, consequently, enhance self-efficacy and positive attitudes towards taking one’s ARV treatment, thus facilitating the desired behaviour. The individualized intervention was structured as four 45- to 75-minute meetings held over a 12-week period with a nurse who had expertise in HIV. A randomized trial was conducted to evaluate the effect of the intervention on behaviour and on the explanatory variables. A self-administered questionnaire, viral load and CD4 count were used to measure the principal outcome variable. vi Measurements of the principal outcome and the explanatory variables were made before the intervention and at 12 weeks and at 24 weeks post-intervention. The sample comprised 51 people living with HIV who were being followed at a clinic in Montreal: 23 in the control group and 28 in the experimental group. Data were subjected to repeated measures analysis of variance (ANOVA). The intervention was found to have a positively trend (p = 0.056) in terms of achieving an undetectable viral load : 43.8 % more persons of the experimental group compared with the group control (78.6 % versus 34.8 %) had an undetectable viral load at 12 weeks and 32.8 % more at 24 weeks (89.3 % versus 56.5 %). Probably the lack of statistical power meant no significant effect was found on the explanatory variables, but the small increases observed in the experimental group are consistent with the theoretical model (Godin et al., 2005). This study contributes to knowledge by proposing an intervention to facilitate optimal antiretroviral-treatment taking among PLHIV.

Submitted by Paulo Junior (paulo.jr@fgv.br) on 2010-05-13T21:02:37Z No. of bitstreams: 1 Cláudia Hoirisch.pdf: 1193444 bytes, checksum: 18921b0201a6008cb606c1dcc39797a0 (MD5) / Approved for entry into archive by Paulo Junior(paulo.jr@fgv.br) on 2010-05-13T21:03:02Z (GMT) No. of bitstreams: 1 Cláudia Hoirisch.pdf: 1193444 bytes, checksum: 18921b0201a6008cb606c1dcc39797a0 (MD5) / Made available in DSpace on 2010-05-14T12:29:32Z (GMT). No. of bitstreams: 1 Cláudia Hoirisch.pdf: 1193444 bytes, checksum: 18921b0201a6008cb606c1dcc39797a0 (MD5) Previous issue date: 2010-03-24 / The scope of this study is to evaluate the implementation process of the Compulsory License in the case of the antiretroviral efavirenz. This research is descriptive in nature and the medium of investigation was the case study. It was conducted during the months of October through December 2009 with semi-structured interviews containing open-ended questions with a group of Public Health policy makers and managers residing in the states of Rio de Janeiro, Sao Paulo and the Federal District who participated in the compulsory license process. These individuals were allowed to express themselves without any constraints in such a way that they could produce discourses. The Collective Subject Discourse (CSD) technique was then used for analysis of the discourses. The results revealed that Brazil has the technological capability to develop and produce antiretrovirals within a reasonably short period of time. The results further showed that the Compulsory License helped to curb spending on antiretrovirals and that the measure can be used to ensure access by the public to high-cost and strategic antiretroviral drugs for the Brazilian public health service (Unified Health System – SUS) in an environment with limited funds, whenever an impasse is reached in negotiations for price reductions with transnational pharmaceutical laboratories. / O objetivo deste estudo é avaliar o processo de implementação da Licença Compulsória no caso do anti-retroviral efavirenz. Esta pesquisa é de caráter descritivo, o meio de investigação foi o estudo de caso e foi conduzido com entrevistas semi-estruturadas contendo questões abertas para um conjunto de atores representativos da área da Saúde Pública que participaram do processo da licença compulsória residentes nos estados do Rio de Janeiro e São Paulo e no Distrito Federal durante os meses de outubro a dezembro de 2009. Permitiu-se que esses indivíduos se expressassem mais ou menos livremente de forma que eles produzissem discursos. Para a análise dos discursos, utilizou-se a técnica do Discurso do Sujeito Coletivo (DSC). Os resultados demonstraram que o Brasil possui capacitação tecnológica para desenvolver e produzir anti-retrovirais em um prazo relativamente curto. Os resultados mostram ainda que a Licença Compulsória ajudou a refrear os gastos com anti-retrovirais e que o instrumento pode ser utilizado para garantir o acesso da população a medicamentos anti-retrovirais de alto custo e estratégicos para o Sistema Único de Saúde em um ambiente de recursos limitados sempre que se chegar a um impasse na negociação para redução de preços com os laboratórios farmacêuticos transnacionais.

Uganda has experienced 1.6 million deaths to HIV/AIDS related illness. Introduction of free-ART in rural hospitals that bear the burden od AIDS reduces adults morbidity and mortality. The study design was a quantitative, retrospective and descriptive design through data mining of medical records. In the six years, hospital admissions decreased by 16.7% and the median age at death increased by seven years. Hospital admissions decreased from three to seven deaths per 100 admissions per month. Male and female mortality was 1:1.6 and females in the 15-34 age group had a 37% higher likeliness of dying in hospital compared to males. Deaths from sub-countries with an ART site reduced by 4% to 8.6%. The data revealed that despite ART coverage of 60%, mortality rates showed a rising trend. Free access to ART's over three years did not make any observable changes to overall mortality. Therefore, ART access contributed to a decline in overall hospital admissions, an increase in median age at time of death and a reduction in deaths from sub-counties with an ART site. There was no reduction in overall hospital mortality rate. / M.A. (Public Health) / Health Studies

No description available.

No description available.

The researcher investigated the knowledge, attitudes and experiences of people living with the Human Immunodeficiency Virus (HIV) towards antiretroviral treatment (ART) and who are accessing antiretroviral treatment at a public health clinic in Limpopo, South Africa. A qualitative method was used. The research findings revealed five themes: experiences, social support, knowledge, attitudes, unemployment and economic themes of the study. Factors reported influencing optimum adherence were the inability of the patients to take medication at work, laziness of the patients to collect medication, unemployment, economic hardship, poverty and lack of knowledge of employers regarding HIV/AIDS. / Health Studies / M.A. (Social Behaviour Studies in HIV and AIDS)