ABSTRACT Background: There is a paucity of empirical data on the impact of HIV/AIDS on mortality in the mining industry in the pre-ART era. Such data will provide a baseline against which the efficacy of antiretroviral treatment can be measured into the future. Objectives: To measure all-cause mortality in a population of platinum miners between 1992 and 2002, the impact of HIV/AIDS on mortality in this group and to determine the pattern of other cause-specific mortality. Methods: This was a primary analysis of mortality in an open cohort of male semi- and unskilled workers at a platinum mine. Using Poisson regression, all-cause, HIV/AIDSrelated and other cause-specific mortality rates and rate ratios were calculated by age and calendar year. Results: There were 1986 deaths in the cohort of 29954 subjects who contributed 200657 person years of follow up over the 11 year period of the study. Crude all-cause mortality increased from a base of 5.1 per 1000 person years at risk (pyar) (95% CI 4.2- 6.2) in 1992 to 20.4 per 1000 pyar (95% CI 18.3-22.8) in 2002. Age-adjusted all-cause mortality increased more than three-fold from 1992 to 2002 (RR 3.2, 95% CI 2.5-4.0). The excess mortality was attributed to HIV/AIDS-related deaths which increased from 0% in 1992-1994 to 5.1% of total deaths in 1995 and reached 63.3 % of deaths in 2002. Mortality due to other communicable diseases, non-communicable diseases and injuries remained stable throughout the study period. Conclusion: The impact of the HIV/AIDS epidemic on mortality in this group of platinum mine workers has been profound and comparable to that experienced by the general South African population. The data reported here provide a baseline to measure the impact of antiretroviral treatment on the future course of mortality due to the epidemic.

By the age of 35, Black Men who have Sex with Men (MSM’s) have a one in two chance of HIV infection. Black MSM’s, which represent less than one percent of the US population, is home to nearly a quarter of existing HIV cases, AIDS deaths as well as new HIV diagnosis. As early as 1987 studies were published revealing a paradoxical reality, that although Black MSM’s had no significant difference in risk behavior, there is a much larger HIV Prevalence among this group as nearly one in three Black MSM’s are HIV positive. Consistently and repeatedly, studies have shown Black MSM’s have fewer sexual partners than their White counterparts, and fewer occurrences of unprotected anal intercourse, yet significantly higher rates of HIV Incidence. The theoretical basis for this analysis is the concept Intersectionality, originated by Kimberlé Crenshaw, which states that cohorts comprised of multiple statuses of historic discrimination are qualitatively different from individual cohorts of component status. This qualitative difference requires the analysis of the composite cohort as an independent and unique entity as opposed to only looking at the components that it is made of. Therefore, Black MSM’s are a unique group and cannot be fully understood by looking at Black Men or MSM separately. This is particularly applicable for Black MSM’s because of the: history of oppression as Black Men, history of marginalization as MSM, isolation of Blacks within MSM community, isolation of MSM within the Black community and the history of HIV among Black MSM’s which dates back at least to 1969 (predating the publicly acknowledged epidemic in the White MSM community by 12 years) . This traditional policy analysis evaluated the 2010 National HIV/AIDS Strategy for its effectiveness in addressing HIV/AIDS among Black MSM’s. To accomplish this, a convergence of evidence approach was implemented, utilizing a key document review, qualitative interviews with key stakeholders, as well as quantitative surveys of 300 Black MSM’s. These methods were then applied to each of the four stages of Policy Analysis: agenda setting, formulation, implementation and evaluation. This analysis revealed a landmark policy that has comprehensively improved the Federal response to HIV in the US. Innovations developed and instituted because of this policy included the Community Listening Sessions of the formulation stage, and even more importantly the new metrics that better equip agencies to understand the nature of the epidemic. Further, the results of this study were compared with the August 2014 Kaiser Family Foundation study, which produced a nationally representative survey of Gay and Bisexual men (sampling error ±7%). The findings of this study paralleled and/or magnified those of Kaiser in several key areas. Kaiser found that Men of Color were more likely to know someone with HIV/AIDS and those that do are more likely to say it is a significant personal issue. The results of this study of Black MSM’s expose a sample where 97% knew someone who has/had HIV/AIDS and almost all considered this to be a significant personal issue. Both studies also confirmed the continuing presence of stigma and perceived discrimination by the general public. In both studies, evidence also indicates the opportunity for increasing frequency of HIV testing and the widespread lack of knowledge of PrEP (Pre-Exposure Prophylaxis). Several key recommendations should also be taken from this analysis to improve the policy moving forward. The first is that Black MSM’s should be an independent category for policy targeting. The next is that as Black MSM’s are the only group that is at high risk of infection and also makes up a large portion of the disease, Black MSM’s are a significant hotspot that should be a primary focus of the intervention. Finally, the greatest advances in fighting HIV have come through biomedical progress. Therefore, educating and implementing biomedical innovations such as PrEP should compliment behavioral change as intervention objectives. / 1 / Paul T. Winfield

<p><strong>Aim </strong>The aim of this study is to investigate the activity participants’ opinions on Kilimanjaro Aids Control Associations’ (KACA) work in combating HIV/AIDS in Moshi, Tanzania, and to examine what they have learnt from participating KACA’s activities. The authors also examined whether the participants thought the activity has influenced on their behaviour.</p><p><strong>Method </strong>The study is an explorative qualitative study with semi-structured interviews. The respondents (20) were purposively selected in order to get balanced representation.</p><p><strong>Results </strong>The majority of respondents were very grateful after being in contact with KACA. According to some of the respondents, KACA supplies needy people with financial as well as mental support. Many of the respondents have been passing on their new knowledge about HIV/AIDS to others, and claimed that they have changed their behaviour.</p><p><strong>Conclusion </strong>Our findings were that the majority of our respondents had positive experiences about KACA’s role in combating HIV/AIDS in the Kilimanjaro area. Almost every respondent claimed they had got new knowledge about HIV/AIDS. The new knowledge led to reduced risk taking behaviour, which we believe can reduce the spread of HIV. Since this study contains 20 respondents, the results can not be generalized.</p>

Aim The aim of this study is to investigate the activity participants’ opinions on Kilimanjaro Aids Control Associations’ (KACA) work in combating HIV/AIDS in Moshi, Tanzania, and to examine what they have learnt from participating KACA’s activities. The authors also examined whether the participants thought the activity has influenced on their behaviour. Method The study is an explorative qualitative study with semi-structured interviews. The respondents (20) were purposively selected in order to get balanced representation. Results The majority of respondents were very grateful after being in contact with KACA. According to some of the respondents, KACA supplies needy people with financial as well as mental support. Many of the respondents have been passing on their new knowledge about HIV/AIDS to others, and claimed that they have changed their behaviour. Conclusion Our findings were that the majority of our respondents had positive experiences about KACA’s role in combating HIV/AIDS in the Kilimanjaro area. Almost every respondent claimed they had got new knowledge about HIV/AIDS. The new knowledge led to reduced risk taking behaviour, which we believe can reduce the spread of HIV. Since this study contains 20 respondents, the results can not be generalized.

Since early after its discovery in 1981, AIDS has often been framed as a sexual disease spread through deviant and hypersexualized populations, perhaps nowhere more so than in Africa. Much has been written about the pandemic in Africa, with the majority of recent attention placed on the sexual transmission of the virus. Omitted from the discourse are other possible avenues of transmission. My thesis hopes to highlight this problem by identifying key works contributing to the sexual discourse, and drawing attention to other possible areas of research which could broaden the scope of research on AIDS in Africa. In this thesis, Edward Saids idea of Orientalism is used as a framework through which to understand the creation of the sexual discourse, arguing that it has become dominant and therefore obstructing alternate avenues of scholarship and investigation. Due to this focus on promiscuity and sex, the literature on the transmission through medical injections was omitted. The focus on sexual transmission as the basis of the pandemic has excluded much discussion on other contributing factors, such as poverty. Arguments for the role of poverty in HIV transmission often centre on sex. For example, women forced into transactional sexual relations or sex work, or movements to urbanization that weaken cultural mores and norms and result in promiscuous sexual relations. The emphasis on the sexual transmission of AIDS in Africa, at the expense of thorough analysis of the non-sexual transmission, has stunted the understanding AIDS, placing blame for the transmission onto Africans themselves, turning AIDS into an African problem.

Since early after its discovery in 1981, AIDS has often been framed as a sexual disease spread through deviant and hypersexualized populations, perhaps nowhere more so than in Africa. Much has been written about the pandemic in Africa, with the majority of recent attention placed on the sexual transmission of the virus. Omitted from the discourse are other possible avenues of transmission. My thesis hopes to highlight this problem by identifying key works contributing to the sexual discourse, and drawing attention to other possible areas of research which could broaden the scope of research on AIDS in Africa. In this thesis, Edward Saids idea of Orientalism is used as a framework through which to understand the creation of the sexual discourse, arguing that it has become dominant and therefore obstructing alternate avenues of scholarship and investigation. Due to this focus on promiscuity and sex, the literature on the transmission through medical injections was omitted. The focus on sexual transmission as the basis of the pandemic has excluded much discussion on other contributing factors, such as poverty. Arguments for the role of poverty in HIV transmission often centre on sex. For example, women forced into transactional sexual relations or sex work, or movements to urbanization that weaken cultural mores and norms and result in promiscuous sexual relations. The emphasis on the sexual transmission of AIDS in Africa, at the expense of thorough analysis of the non-sexual transmission, has stunted the understanding AIDS, placing blame for the transmission onto Africans themselves, turning AIDS into an African problem.

Bakgrund: I Sverige lever omkring 6200 personer med HIV/AIDS. HIV är ett virus som ger nedsatt immunförsvar. Obehandlad HIV leder slutligen till AIDS. HIV är en inokulationssmitta och är anmälningspliktig. Det finns bromsmediciner som återställer immunförsvarets funktion och patienter lever symptomfritt. Sjuksköterskan möter dessa patienter genom sitt arbete inom hälso- och sjukvården. Sjuksköterskan skall enligt kompetensbeskrivningen, hälso- och sjukvårdslagen samt ICN:s etiska kod behandla alla lika inför vården. Syfte: Studiens syfte var att beskriva sjuksköterskans erfarenheter av att möta HIV/AIDS-positiva patienter i vården. Design: Deskriptiv empirisk studie med kvalitativ ansats genomfördes. Metod: Urvalet bestod av sjuksköterskor som aktivt arbetade med HIV/AIDS-positiva patienter. Sju sjuksköterskor deltog i studien. Datainsamlingen genomfördes med semistrukturerade intervjuer. En provintervju genomfördes för att undersöka om intervjuguiden mötte studiens syfte. Efter intervjuerna genomförts transkriberades materialet och analyserades enligt anvisningar för kvalitativ innehållsanalys enligt Graneheim och Lundman. Fynd: Dataanalysen resulterade i nio kategorier och 37 underkategorier. Sjuksköterskorna arbetar i interprofessionella team kring HIV/AIDS-positiva patienter och möter dessa dagligen. Relationer utvecklas av kontinuerlig kontakt. Sjuksköterskorna möter dessa patienter utan värderingar och har erfarenheter av fördomar från andra kliniker på sjukhusen. Konklusion: I studien framkom att god kunskap kring HIV/AIDS samt erfarenheter att möta patientgruppen är positiva faktorer som påverkar sjuksköterskans omvårdnadsarbete.

HIV är ett virus som leder till försvagat immunförsvar hos smittade personer. De smittade behöver gå på kontinuerliga kontroller och medicinjusteringar vilket innebär att en tät kontakt med hälso- och sjukvården skapas. Sjukdomen är förknippad med stigmatisering och frågeställningen som denna studie utgick ifrån var om sjuksköterskors bemötande mot personer med HIV/AIDS påverkas av stigmatiseringen. Syftet blev således att beskriva om stigmatiseringen av HIV/AIDS-smittade personer påverkar bemötandet från sjuksköterskor gentemot personer med HIV/AIDS i kontakten med vården, ur ett patientperspektiv. Metoden som användes var systematisk litteraturstudie. I resultatet kunde två huvudkategorier urskiljas; positiva upplevelser av bemötandet respektive negativa upplevelser av bemötandet. Den sistnämnanda kategorin var den som dominerade och fynd som utmärkte sig var att sjuksköterskor använde sig av baktaleri, nekade patienter vård, fick patienterna att känna skam och skuld samt att de gjorde skillnad på om patienterna var smittade via blodtransfusioner eller via homosexuellt umgänge. Slutsatsen blev att stigmatiseringen påverkar sjuksköterskors bemötande, dock inte enbart negativt. Vi tror att vår studie kan vägleda sjuksköterskor till ett bättre bemötande och även vara användbar för andra yrkesgrupper som kommer i kontakt med HIV/AIDS-smittade personer.

Understanding how inputs influence program outcomes is a key step in designing and implementing quality youth programs to support positive development. While developmental processes are assumed to be universal for all populations, youth who face additional challenges in their development (such as those with chronic illness) may have unique experiences in youth programs. Using Developmental Systems Theory as the guiding theory, the purpose of this study was to understand the developmental context for youth with HIV/AIDS at a barrier-free camp. This study addressed the specific questions: (1) what were the developmental outcomes experienced by youth as a result of attending camp; and (2) what were the processes that facilitated youth development at camp? An interpretive case study employing observations, focus groups, and interviews was used to investigate the research questions. Findings show that camp plays a major developmental role in the lives of youth with HIV/AIDS. Four thematic outcomes of camp emerged: (1) experiencing caring people, (2) developing a sense of belonging, (3) feeling reprieve and recreation, and (4) increasing knowledge, attitudes, and skills. The four themes were strongly linked together, being nested within each other in a temporal order. When campers experienced caring people, they had a sense of belonging. These two relationship-based outcomes opened a space for feelings of reprieve (from responsibilities and stigma at home) and recreation (to engage in fun activities) at camp, and this relaxed space provided an opportunity for increasing knowledge, attitudes, and skills. Processes that contributed most to the campers? experiences of caring people were long-term relationships, outside of camp support, exposure and storytelling, and Teen Talk (an educational workshop). Processes contributing to campers? development of a sense of belonging were acculturation into the camp; an educational activity called Teen Talk, medication taking, grieving, aging out of camp, and storytelling. Processes contributing to campers? experiences of reprieve and recreation were camp activities (including Teen Talk); planning for the needs of campers, accessibility, and freedom from worry. Processes contributing to campers? development of knowledge, attitudes, and skills were education through Teen Talk, and non-Teen Talk education. Implications for theory, research, and practice are discussed.

The purpose of this study was to examine the knowledge and perceptions of Eastern African refugees regarding HIV/AIDS and its interventions in metropolitan Atlanta, Georgia. The study was guided by the following research questions 1) What did Eastern African refugees know about HIV/AIDS and its importance? 2) How did Eastern African refugees and their families learn about HIV/AIDS prevention and treatment? 3) How did Eastern African refugees perceive HIV/AIDS and those suffering from HIV/AIDS in their families and communities? 4) What were the perceptions of Eastern African refugees regarding participation in the interventions offered by public and private organizations? Study participants were refugees from Somalia and southern Sudan who had settled in metropolitan Atlanta The sample of 80 participants was selected based on age, immigration status, and willingness to share information about sex and sexuality. To collect data, the researcher used a structured survey instrument that was administered in a face-to-face interview format with the 80 participants. Qualitative and quantitative analyses of participant responses were conducted Six themes emerged from the qualitative analysis, namely: Knowledge, Openness, Stigma, Attitude, Willingness, and Trust. Participants indicated basic knowledge of HIV/AIDS and its transmission. They also exhibited openness in discussing HIVIAIDS. However, participant responses manifested strong stigma against HIV/AIDS and its victims. Participants who had lived longer in the United States showed negative attitudes towards HIV/AIDS treatment, the healthcare system, and service providers. There was willingness to contribute towards HIV/AIDS interventions and community services. Participants exhibited mistrust towards health institutions, sources of HIV/AIDS information, and the context of the HIV/AIDS information. Results from the quantitative analysis indicated a strong and positive correlation between knowledge and openness Stigma against HIV/AIDS disease and victims was strongly correlated with knowledge, openness, and attitude. Attitude positively correlated with openness and with knowledge, while trust was moderately correlated to knowledge. The study findings confirm previous research among similar populations that reported limited knowledge of HIV/AIDS, entrenched stigma about the disease and its victims, negative attitudes and mistrust towards health institutions and service providers as well as the potency of the duration factor regarding immigrants resettlement process.