SAMMANFATTNING Bakgrund Humant immunbristvirus är en sjukdom som bryter ned immunsystemet som leder till opportunistiska infektioner. Sjukdomen sprids via oskyddade samlag och kontakt med smittat blod. Smittrisken är däremot låg om personen som lever med humant immunbristvirus har en välinställd antiretroviral behandling. Det finns rädslor för sjukdomen och personerna som lever med den. Som följd upplever de personerna diskriminering och stigmatisering i sitt dagliga liv från olika delar av omgivningen. Dåligt bemötande kan komma från närstående, hälso- och sjukvårdspersonal och andra delar av samhället. Syfte Syftet var att beskriva hur personer som lever med diagnosen HIV upplever bemötandet från omgivningen i sitt dagliga liv. Metod Metoden som valdes var en intervjustudie med en kvalitativ innehållsanalys. I studien deltog sex personer med diagnosen humant immunbristvirus. Resultat Bemötandet från familj och vänner ansågs vara positivt då de var förstående och gav deltagarna ett stöd i sin anpassning att leva med HIV. Det upplevdes problematiskt att träffa nya personer i dejtsammanhang och att sjukdomen påverkade deltagarnas sexuella beteende. Vården och bemötandet på infektionskliniker upplevdes som god. Brister beskrevs inom den allmänna sjukvården där personalen ansågs ha bristfällig kunskap om humant immunbristvirus och kunde bemöta deltagarna illa. I det dagliga bemötandet upplevde deltagare att det förekom stigmatisering på grund av fördomar och okunskap kring sjukdomen. Slutsats Fortfarande saknas kunskap om humant immunbristvirus inom vården men också hos allmänheten, vilket medför att det är problematiskt för personer med HIV att träffa nya partners då det finns en rädsla för att bli smittad genom intima möten. Kunskapsnivån hos vårdpersonal förknippas med hur bemötandet upplevs av personer som lever med humant immunbristvirus.

Bakgrund: Humant Immunbristvirus, [HIV] är en pandemi och ett växande folkhälsoproblem. Vidare är HIV en obotlig sjukdom som bryter ned den egna kroppens immunförsvar. HIV-positiva individer är i behov av regelbundna kontroller under en längre livsperiod. Kommunikationen mellan vårdpersonal och HIV-positiva individer är en viktig aspekt för att främja följsamheten till behandling av sjukdomen. Brister i kommunikationen kan resultera i att HIV-positiva individer upplever ett bristande stöd från vårdpersonal. Ett omvårdnadsproblem i form av bristande patientsäkerhet kan uppstå vid bristfällig kommunikation mellan vårdpersonal och HIV-positiva individer. Syfte: Syftet med studien var att belysa hur HIV-positiva individer upplever kommunikationen med vårdpersonal. Metod: Metoden som användes bestod av en litteraturöversikt med kvalitativ ansats och latenta inslag. Analysmetoden som valdes var en innehållsananlys som utgick ifrån Graneheim och Lundmans tolkning av Krippendorrfs modell. Resultat: Litteraturöversikten grundades av två patografier. Kommunikationen med vårdpersonal upplevdes av HIV-postitiva individer som en viktig aspekt gällande HIV-vården. Kommunikationen med vårdpersonalen beskrevs vara präglad av attityder så som rädsla och okunskap relaterat till HIV-diagnosen, vilket var avgörande för hur kommunikationen tolkades och huruvida denna upplevdes som positiv eller negativ. Det framgick önskemål om en kommunikation som var mindre påverkad av vårdpersonalens attityder samt att vårdpersonal skulle visa sympati till HIV-postitiva individer. Slutsats: Då HIV-postitiva individer i flera fall upplevt att kommunikationen från vårdpersonal påverkas av de förekommande attityderna till HIV är även dessa upplevelser i behov av vidare forskning. En ökad medvetenhet och kunskap om hur HIV-positiva individer upplever kommunikationen med vårdpersonal kan således medföra en djupare förståelse för dessa personers tillstånd och kan därmed omvandlas till en resurs i omvårdnadsarbetet.

As an epidemic in the increasingly image-conscious and media-driven twenty-first century, the course of HIV/AIDS has been shaped by both mass media's portrayal of the disease and public perception of it. Russia currently has the highest HIV infection rate outside of Sub-Saharan Africa. In St. Petersburg, HIV infection rates are continuing to rise---the primary mode of transmission is changing from Injection Drug Use (IDU) to heterosexual intercourse, and fastest growing age group of infected persons is 30-40. As the epidemic begins to spill over from IDUs and homosexual communities into the general population, new attitudes are arising within St. Petersburg society and mass media. This paper analyses the role of mass media in HIV/AIDS prevention campaigns around the world, before presenting the author's research on the effects of mass media presentations of HIV on the St. Petersburg population. Through a three-part research study involving in-depth interviews, qualitative surveys, and a media analysis, the author portrays the media landscape in St. Petersburg in 2013 with an eye towards resolving media agendas, government policies, and public attitudes. / text

published_or_final_version / Microbiology / Doctoral / Doctor of Philosophy

published_or_final_version / Public Health / Master / Master of Public Health

Asia has populated with the second largest number of people living with HIV/AIDS. Under the advancement of transportation, the open up of borders between cities and countries, and the process of globalisation, people move from their place of origin to other places for better living conditions and employment opportunities. Mobile people and migrants are identified as the high risk population of HIV infection. Poverty, discrimination, limited access to healthcare and social services, separation with supports and families, being alienated in resident communities, and gender inequalities are the unfavourable conditions which make the migrant population vulnerable to HIV infection. Existing literatures have investigated and examined the potential risk factors among the mobile population. Inconsistencies were found among research but high risk sexual behaviours and poor knowledge and attitude were observed and reviewed within the migrants. However, literatures which compared the people who migrated with other local people in the same population were not yet reviewed systemically. Therefore, this paper aimed to review the articles which compare the migrant group and the non-migrant group in Asian population to identify the association between migration and the risks of HIV infection. A literature search of five databases (PubMed, Medline, Cochrane, CNKI, Wanfang Med Online) was performed and nine articles were eventually selected for review. The migration status of literature was studied as explanatory variable and compared across studies. Outcome variables of interest were grouped into four categories as: demographic characteristics, sexual practices, awareness towards HIV/AIDS, and disease prevalence. To conclude, compared to people who did not migrate, migrants in Asia were more tend to be less educated, have multiple sex partners, engage in high risk sexual intercourse and commercial sex, but their overall condom usage were lower. Also, they had higher risk of sexually transmitted infections and poorer knowledge in HIV/AIDS. / published_or_final_version / Public Health / Master / Master of Public Health

Our research laboratory has recently reported that mucosal priming with a replicating modified vaccinia Tiantan virus (MVTTgpe)-based vaccine elicits durable protection against pathogenic SIVmac239 infection in rhesus monkeys. However, the protective role of vaccine-elicited antibody responses remains poorly understood. Here, a novel yeast surface displayed (YSD) antigen library was established to quantitatively map the antigenic determinants presented by MVTTgpe-based and control vaccines as well as by SIVmac239 infection. The YSD-library allows the mapping of linear and some conformational epitopes as a major technical innovation, as validated by testing SIV-specific mAbs KK65, KK8 and VM-18S. While eight antigenic domains are characterized covering the entire SIVmac239 gp160, the MVTTgpe/Ad5gpe regimen uniquely induces antibody responses against a distinct major antigenic determinant (MAD) in V2 region as compared with the Ad5gpe/Ad5gpe vaccination and SIV infection. This MAD is associated with a higher titer of anti-V2 antibody responses, which inversely correlates with peak viral load. Unexpectedly, the MVTTgpe/Ad5gpe vaccine- challenge. The results showed that instead of recalling B cell memory response to V2, viral infection presents a distinct set of antigenic determinants with anti-V1V2 antibodies primarily directed to V1 region. Moreover, the anti-V1V2 antibody responses disappear in two infected macaques after they enter the stage of simian AIDS. SIVmac239 infection, therefore, can modulate vaccine-elicited B cell immunity by diminishing anti-V2 antibody memory responses in rhesus monkeys. These findings implicated that vaccine efforts with focus on V2 region would require periodic vaccinations to maintain a long-lasting high level of antibody responses for protection. In the absence of an effective vaccine for eliciting HIV-1-specific broadly neutralizing antibodies (bNAbs), passive immunization with bNAbs or Ab-like agents (e.g. immunoadhesin) becomes an attractive alternative for HIV-1 prevention. In this study, we aimed to design, optimize and produce secretory immunoadhesins (IAs) based on gene engineering of existing HIV-1 specific bNAbs for potency and production improvements. IAs are chimeric, antibody-like molecules that combine the functional domain of bNAb with immunoglobulin constant domains, including the hinge and Fc regions. We found that the modified secretory IAs not only preserved the neutralization activity of the parental bNAbs, but also had enhanced expression and smaller molecular size that is suitable for antibody gene-based in vivo delivery. Furthermore, we defined the synergistic effects of five IAs against HIV-1 infection and subsequently engineered two types of bi-specific IAs by combining the functional domains of Hu5A8, a humanized anti-CD4 antibody, and the bNAb PGT128. Significantly, one of the bi-specific IA, namely Bi-IA-Mono, neutralized 100% of the 33 viruses tested, including the transmitted/founder viruses and viruses resistant to both parental IAs. The remarkably enhanced neutralization activity of Bi-IA-Mono, either in potency and breadth, indicated the great potential of modified bi-specific IA to provide complete or nearly complete protection against major HIV-1 subtypes. Overall, our results demonstrated that the engineering of IA and bi-specific IA is an attractive way to improve anti-HIV-1 properties of existing bNAbs, which have significant implications for antibody-based prophylactics in blocking diverse HIV-1 transmissions and infections. / published_or_final_version / Microbiology / Doctoral / Doctor of Philosophy

Acquired immunodeficiency syndrome (AIDS) is a major problem in our current society. There are over 35 million of the population that are currently living with human immunodeficiency virus (HIV), and the number of HIV-infected patients are still rising every year in spite of our efforts to control it. Furthermore, within the AIDS affected population, opportunistic infection is a major cause of complications and is the number one cause of death. The HIV trans-activator (Tat) protein plays a major role in the AIDS pathogenesis. HIV-1 Tat is known to cause dysregulation of cytokines such as TNF-α, IL-6, and IL-10 in AIDS patients. In this study we recognized a proto-oncogene, c-Myc, could regulate the cytokine dysregulation caused by HIV-1 Tat in primary blood monocyte derived macrophages (PBMac). By knocking down the expression of c-Myc with gene specific small-interfering RNA (siRNA), we demonstrated that c-Myc may be critical for the expression of the pro-inflammatory cytokines TNF-α and IL-6. HIV-1 Tat was subsequently found to regulate the expression of c-Myc via the activation of dsRNA-activated protein kinase (PKR), ERK1/2 and p38 mitogen-activated protein kinase (MAPK). Furthermore, c-Myc regulation of the pro-inflammatory cytokines was demonstrated to have a role in AIDS related opportunistic infections. HIV-1 Tat was shown to increase the intracellular growth of Mycobacteria avium complex (MAC) within PBMac. This increase in MAC growth was in turn found to be regulated by TNF-α expression controlled by c-Myc. HIV-1 Tat was also demonstrated to induce the expression of RIG-I, a common pattern recognition receptor of double stranded RNA viruses, in PBMac. RIG-I is known to activate the viral immune responses such as the type-I interferon (IFN) and pro-inflammatory cytokine pathways. This induction of RIG-I by HIV-1 Tat was found to be regulated by c-Myc, as well as through other signalling kinases such as p38 MAPK and PKR. Tat induction of RIG-I ultimately led to the induction of IFN-α2 and IFN-β through the expression and nuclear translocation of the interferon regulatory factor-7 (IRF-7). This alteration in type-I IFN expression regulated by HIV-1 Tat and RIG-I was also found to play a role against AIDS related opportunistic infections. HIV-1 Tat is known to increase the infectivity of Kaposi’s sarcoma-related herpesvirus (KSHV), a common opportunistic viral infection. We were able to demonstrate that this increase in KSHV infectivity was regulated by RIG-I and type-I IFN induced by HIV-1 Tat. Lastly, this study also demonstrated how HIV-1 Tat was able to manipulate the expression of IL-8 induced by KSHV in PBMac. HIV-1 Tat was able to mediate the production of IL-8 induced by KSHV by altering the phosphorylation of the p38 MAPK and the signal transducer and activator of transcription-1 (STAT-1). Taken together, the results of this study showed how c-Myc and RIG-I may be able to play critical roles in HIV-1 Tat induced cytokine dysregulation. Furthermore, the importance of these pathways is further demonstrated in their roles in regulating the immune responses against opportunistic infections in AIDS patients. / published_or_final_version / Paediatrics and Adolescent Medicine / Doctoral / Doctor of Philosophy

Not available / text

Thesis (DTech. in the Dept. of Drama and Film Studies.)--Tshwane University of Technology, 2012. / When theatre officially was acknowledged as an interventionist tool in the fight against HIV/AIDS in South Africa in 1996, economic and political evils of apartheid of the past. Unfortunately, as statistics have revealed, this has not been the case, as HIV prevalence levels have continued to rise in all sections of society. In trying to understand the reasons for theatre's failed attempts at changing peoples' sexual behaviour, scholars have identified the non-centrality of cultural norms of target audiences as one of the principal causes.it was hoped that it would effectively and efficiently deal with raising the awareness levels of the South African population of the dangers of HIV, and the consequences of risky sexual behaviour given its immense contribution in creating awareness about the social Health communication experts have agreed that health intervention strategies seem to be controlled by people who do not understand the complexity of the behaviour of their target audiences. Health behaviour theorists have also indicated the need to re-examine intervention approaches by paying more attention to the culture of the target population. This study therefore, investigated the inclusion/non-inclusion of cultural norms of target audiences in the design of theatre's dramatic performances which serves as its intervention instrument. This was done through an examination of three theatre groups' HIV/AIDS campaigns in three provinces of South Africa. Using qualitative study methods, the study probed into whether the cultural values of the communities concerned are encapsulated in the plays performed by the groups to spread awareness of HIV/AIDS.