This study explores the barriers to care women face living with HIV in New Brunswick and Nova Scotia, and also the health and support systems they navigate to improve their wellbeing. Women living with HIV are invisible within the epidemic and often to community sector employees, especially in the Maritime Provinces where men account for the largest number of diagnoses in Canada; this is a central theme in the data. The thesis is rooted in applied medical anthropology and uses qualitative and quantitative methods to capture the changing health priorities of women living with HIV as they navigate the health care systems after diagnosis. This information was used to create maps that show the availability of services in relation to women’s needs, including affordable housing, food security, accessible transportation, and reducing HIV stigma. I examine the efficiency of HIV women’s referral network in both provinces, and the way forward for organizations to meet their long-term health needs, such as widening of outreach activities and improving gendered care. The main findings of this study reveal that the barriers to care women face are not easily overcome by AIDS service organizations. Current support initiatives are no longer relevant to their lives because they are tailored mainly to men, but women increasingly value the referral activities of organizations. Among the most important contributions of this thesis is the envisioning of a women-centered care model that meets their health needs and acknowledges their diverse reality of their experiences. / Thesis / Doctor of Philosophy (PhD)

In this thesis we develop a model which allows us to evaluate Modified Dorfman's and Modified Sterrett's group testing procedures in the presence of false positive classification error that can be used for screening blood for HIV. Performance measures derived are the expected number of tests per sample and the corresponding coefficient of variation. The procedures differ from the original ones by the fact that groups and samples are retested certain number of times before they are classified as positive. Modified Individual testing procedure and the procedure currently used by Canadian Red Cross are also evaluated and all four testing strategies are compared. Numerical analysis illustrates that group testing is more efficient than alternatives. / Thesis / Master of Science (MSc)

In this thesis, I focus on the health-seeking experiences of women diagnosed with HIV in a prevention of mother-to-child transmission (PMTCT) program in Lilongwe, Malawi. Based on ethnographic research, which included participant observation, in-depth interviews, and focus groups with women participating in the program, I explore women's motivations for HIV testing, capacity to engage in health interventions, and the meaning they give to life with HIV. While the PMTCT program is delivered at a local site, it is produced at a local-global intersection where local actors and international processes converge. I utilize critical approaches to medical anthropology to examine the global political and economic context of local life and the PMTCT program. The program is one where lives are at stake; where women learn of their HIV status, available medical interventions, and work to prolong their lives. Women engage in this program because nurses communicate messages of hope in the face of HIV. These messages are the new benefits of HIV in countries with growing opportunities for therapeutic intervention. This thesis contributes to an emerging health/social science literature that seeks to develop successful HIV interventions by focusing on patients ' experiences of HIV and HIV therapies newly available in Africa. Yet, as reported in this study, women experience barriers to the purported benefits because of the dominant health-delivery paradigm. Specifically, its verticality; human resources, counseling, and education limitations; and structural constraints that prevent women's full participation in the program. Successful PMTCT programs will need a more comprehensive approach to health and disease treatment, to provide more than just techno-medical solutions. Successful therapeutic interventions need to not only provide drugs, but also address other barriers to health maintenance. / Thesis / Doctor of Philosophy (PhD)

The purpose of this research was to design and develop a facile synthesis of a series of multi-headed, two-tailed anionic surfactants (3CAm1(n)2) as anti-HIV microbicides, and to compare the biological activities of these compounds to the activities of their straight-acyl chain derivatives. The synthesis requires coupling reaction of dialkylacetic acid (R2CHCOOH) (R2= n-C6H13, n-C7H15, n-C8H17, n-C9H19, n-C10H21) and Behera's amine (H2NC(CH2CH2COOtBu)3). Commercially available diethyl malonate and straight chain alkyl bromide were selected to produce dialkylacetic acid. Sodium methoxide (MeONa) was used as a base to deprotonate the acidic protons of diethyl malonate. The monoalkylmalonate (RCH(COOEt)2) was separated by vacuum distillation and then used as the starting material of the dialkylation step. This modification improved the yields of this reaction by about 10 percent from the routine procedure of introducing both alkyl groups in the same reaction. The Behera's amine was prepared from the nitrotriester (O2NC(CH2CH2COOtBu)3) by Zn° reduction. The Behera's amine was then converted into an HCl salt by using a diluted HCl solution in 1:1 EtOH/H2O. By doing so, lactam impurity can be separated by solid-liquid extraction in hexane with sonication. The Behera's amine HCl salt was then separated and converted back into Behera's amine by Et3N in dry CH2Cl2. Dialkylacetic acid was converted into its sodium salt by using aqueous NaOH solution; the sodium salt was then added to SOCl2 to yield the acyl chloride (R2CHCOCl). The coupling reaction of Behera's amine and acyl chloride was done in dry CH2Cl2 with 2.2 eq Et3N under sonication to give crude (R2CHCONHC(CH2CH2COOtBu)3), which was identified by ¹H NMR. The crude product from coupling reaction was treated with formic acid. The resulting product was the purified and isolated as a white solid by gravity column chromatography in 100:100:0.5 Hexane/EtOAc/AcOH. Five homologues (R2CHCONHC(CH2CH2COOH)3 R2= n-C6H13, n-C7H15, n-C8H17, n-C9H19, n-C10H21) were produced by this method; all were fully characterized by ¹H and ¹³C NMR, IR, and HRMS. Future improvements can be achieved by replacing the carboxylate groups with the other anionic groups, such as sulfate and phosphate, or add making tri-tailed surfactants, and by, exploring other possible way to improve the biological activities. / Master of Science

In the context of decreasing mortality and increasing prevalence, prevention of HIV-transmission represents a public health priority. In the United States, the majority of infections are sexually-acquired, with men who have sex with men and minorities disproportionately affected. Although a number of promising biomedical prevention approaches have emerged over the past decade, a further 20 years could be needed before a suitable product becomes widely available. Evidence from vaccine and microbicide trials has shown that success in one population may not be replicated in another. To understand surprising or unexpected results, investigators need chronologically concordant evidence of both study product adherence and viral exposure. Since exposure to HIV cannot yet be independently verified, in seeking to measure this variable, investigators target the sexual behaviors through which it takes place deriving data for these surrogate measures from study participants' voluntary self-reports. Likely sources of reporting bias and efforts to minimize this phenomenon in the context of HIV-prevention research are critically reviewed in Chapter 1. Research describing the role of cognitive and affective functioning in the preparation of responses to potentially threatening questions is examined. Studies investigating techniques such as the use of colloquial language to facilitate comprehension, or variation in the length of the reference period to enhance recall are explored. Research comparing the effect of mode of administration on the amount of proscribed behavior reported - widely believed to correlate with validity - is reviewed. Contextual factors facilitating versus inhibiting disclosure of sensitive information are examined. Finally, risk-behavior measurement approaches used in selected HIV-prevention trials are inspected. Thereafter, the dissertation focuses on the properties of risk-assessment items, formulated specifically to elicit Global recall over six months, or Event-Specific (episodic) memory for selected recent episodes of limited duration, to capture sexual behaviors or temporally related activities. The capacity of the different questionnaire item formats to elicit responses with sufficient construct validity to serve as proxies for HIV-exposure is examined. Data for these studies are drawn from a large randomized controlled trial of a behavioral intervention to prevent HIV-transmission among men who have sex with men. Using a subset of 1295 cases and controls, models with good discriminant validity for HIV are derived separately for the Global and Event-Specific items. Thereafter, selected items from the two formats are combined to produce a single model with excellent discriminant validity, suggesting that these items can adequately represent true HIV-exposure. Next, a preliminary investigation of the contribution of psychosocial items to the predictive model based on exposure measures is undertaken. Specifically, interaction with exposure measures and the increase in discriminant validity obtained using data derived from constructs of partner type/relationship status, substance use, depressive symptoms and perceived self-efficacy is examined first in stratified analysis and then in logistic regression analysis using the case-control data. Effect-modification is observed for perceived relationship status and non-injection drug use. Evaluation of psychosocial items continues in a cohort study with prospective analysis of follow-up data from all trial participants who returned for at least one follow-up visit. Informed by the case-control study, a series of items representing psychosocial constructs known for their association with HIV-infection are tested for main effects and effect-modification. Evidence of the interaction observed in stratified analyses and confirmed in ordinary logistic regression persists in separate, topic-specific GEE analyses with assorted exposure measures, but abates in repeated measures analyses drawing on all available psychosocial items. Lastly, a single lagged variable indicating primary relationship status of the most recent partner (with respect to the preceding study visit) provides a significant addition to the model. Significant main effects for all except depressive symptoms and perceived self-efficacy and the increase in discriminant validity obtained for the multivariable model versus the `exposure-only' model are sufficient to warrant continued use of these risk-assessment items. Despite good predictive validity demonstrated for the sexual risk-behavior and psychosocial items, some inconsistent reporting between the Global and Event-specific formats is evident. Likely sources of this reporting bias are considered in light of the literature, and strengths and limitations of the overall study are discussed in the closing chapter.

This phenomenological study was designed to understand the lived experiences of a purposive sample of 9 participants from local villages in Nairobi, Kenya, who had sexual behaviors that contributed to higher HIV risk exposure. Past studies have provided information about the increased rates of HIV infection; however, little has been done to identify the solutions for minimizing the negative impact of HIV among concurrent partnerships. The study investigated the role of high risk cultural practices among participants in married and cohabitating unions. The conceptual framework of the study was gender and power theory, which addresses the complex sexual relationships between men and women. Semi-structured, open-ended questions were used to obtain data from 4 males and 5 females between the ages of 28 and 46 who had been sexually active for more than 12 months. Data was collected on participants' cultural perspectives on condom use, HIV risk behaviors, and sexual morality. The interviews were transcribed and reviewed for consistent patterns of high risk sexual behaviors prior to coding. Through the use of NVivo, seven emergent themes were common among the participants. Findings from the small scale sexual risk behavioral data showed that among these participants, condom use and partner fidelity in unequal partnerships were low. The study also indicated the importance of developing an HIV intervention that focuses on gender and power in long-term sexual partnerships. The implications for positive social change included awareness that gender inequality exists among concurrent unions and formulating an effective cultural HIV prevention strategy for couples.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-10-13T17:51:41Z No. of bitstreams: 1 Renata Brum Viana.pdf: 2775743 bytes, checksum: 694a001141ee4e17b797383b429dc43a (MD5) / Made available in DSpace on 2016-10-13T17:51:41Z (GMT). No. of bitstreams: 1 Renata Brum Viana.pdf: 2775743 bytes, checksum: 694a001141ee4e17b797383b429dc43a (MD5) Previous issue date: 2014 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Este estudo pretendeu conhecer e analisar a história de vida de casais sorodiscordantes para o HIV frente ao desejo de reprodução. Desta forma , nossos objetivos nesta pesquisa foram: Identificar quais os sentimentos que emergem em pessoas em situação de sorodiscordância para o HIV frente ao desejo de reprodução; Analisar o desejo de reprodução das pessoas em situação de sorodiscordância para o HIV; Discutir o conhecimento das pessoas em situação de sorodiscordância para o HIV sobre os métodos reprodutivos. A metodologia utilizada neste estudo foi uma pesquisa qualitativa, descritiva, usando a técnica de história de vida, onde o entrevistado foi convidado a contar sua história a partir de uma questão norteadora. Os entrevistados foram estimulados a falarem o que viesse à sua mente, como resposta à questão norteadora. O cenário foi um ambulatório de HIV/AIDS de um Hospital Universitário do Estado do Rio de Janeiro. Os sujeitos foram pacientes do ambulatório, a maioria frequentadora de um grupo ,com reuniões realizadas quinzenalmente pela enfermeira do setor. Foram entrevistados 19 pacientes. As entrevistas foram realizadas individualmente, na sala onde o grupo acontecia, gravadas em MP4 e depois transcritas na íntegra. Para análise e discussão dos conteúdos duas categorias foram construídas. Na primeira categoria aparecem os depoimentos e discussão sobre a gestação, o desejo de ter ou não ter filhos. Na segunda categoria os depoimentos sobre as técnicas reprodutivas e os direitos reprodutivos dos casais sorodiscordantes foram agrupados e discutidos. Através do estudo a autora pode observar que a formação de novos casais sorodiscordantes vem aumentando , juntamente com a cronicidade da doença , com a potencialidade do aumento da expectativa e da qualidade de vida que os portadores do vírus passaram a ter, após o advento dos tratamentos antiretrovirais. Estes casais, em sua maioria em idade reprodutiva, verbalizam seu desejo de reprodução,. E entendem que o atendimento a esse desejo seja possível . Entretanto, diante do HIV, compreendem esse processo de forma complexa principalmente para o psicológico e para o social. Dificuldades com as relações familiares, com amigos, e com revelação ou não de sua soropositividade para o parceiro é frequente, e remetem à persistência do estigma da doença. A dificuldade com o uso da camisinha, método contraceptivo e de barreira ao avanço do vírus, também aparece. Os profissionais de saúde, por falta de capacidade técnica apropriada, têm dificuldade em lidar com as questões relacionadas a sexualidade e, consequentemente, de construir em conjunto com os usuários formas de negociação e erotização do preservativo, que podem tornar seu uso mais frequente, prazeroso e eficaz. O diálogo deve ser horizontal, buscando conhecer as necessidades e dificuldades dos casais, para que as informações sejam fornecidas de maneira clara e precisa. Nos últimos anos, o Brasil foi um dos países com maior número de novos casos de infectados pelo HIV. O país apresenta cenário epidemiológico semelhante ao do resto do mundo, no qual aproximadamente 80% das pessoas com HIV estão em idade reprodutiva. Mesmo assim há dificuldades em encontrar literatura sobre o assunto, principalmente em português, pois pouco se produz sobre o tema no Brasil. Esta pesquisa pretende contribuir para construção desse conhecimento, discutindo o desejo de reprodução entre casais sorodiscordantes para o HIV. / This study sought to understand and analyze the life history of serodiscordant couples facing the desire to reproduce. Thus, our goals in this research were: Identifying the feelings that emerge in people suffering from HIV serodiscordance who desire to reproduce; Analyzing the desire to reproduce of serodiscordant people; Discussing the knowledge of people who suffer from HIV serodiscordance about reproductive methods. The methodology used in this study was a qualitative, descriptive research, using the life history technique, where the respondent was asked to tell their story after a guiding question. Those interviewed were encouraged to talk about whatever came to mind, in response to the guiding question. The setting was an outpatient unit for HIV / AIDS at the University Hospital of the State of Rio de Janeiro. The subjects were outpatients, the majority attending a group, with fortnightly meetings held by the sector's nurse. 19 patients were interviewed. The interviews were conducted individually, in the room where the group gathered, recorded in MP4 and then transcribed verbatim. For analysis and discussion of the content, two categories were constructed. In the first category, there is the testimonies and discussions about pregnancy and the desire to have or not have children. In the second category, the testimonies on reproductive techniques and reproductive rights of serodiscordant couples were grouped together and discussed. Through the study the author can observe that the number of new serodiscordant couples is increasing along with the chronic nature of the disease, with the potential of increasing life espectancy and life quality that carriers of the virus have been given after the advent of antiretroviral treatments. These couples, mostly of reproductive age, verbalize their desire to reproduce. And understand that the fulfillment of this desire is possible. However, in the face of HIV, have a complex understanding of the process, especially considering the psychological and social aspects. Difficulties with family relationships, with friends, and with or without revealing their HIV positive status to the partner is common, and refer to the persistence of the stigma of the disease. The difficulty with the use of condoms, a contraceptive method and barrier to the advance of the virus, also appears. Health professionals, due to lack of appropriate technical capabilities, have difficulty in dealing with issues related to sexuality and, consequently, in building together with the users forms of negotiation and eroticization of condoms, which can make its use more frequent, enjoyable and effective. The dialogue should be horizontal, seeking to know the needs and difficulties of couples, so that the information is provided in a clear and precise manner. In recent years, Brazil was one of the countries with the highest number of new incidences of HIV. The country features an epidemiological situation similar to the rest of the world, in which approximately 80% of people with HIV are of reproductive age. Yet it is difficult to find literature on the subject, especially in Portuguese, for little is written about the subject in Brazil. This research aims to contribute in building this knowledge, discussing the desire of reproduction among serodiscordant couples.

HIV-1 is a global pandemic with about 39 million people infected. In India, 2.9 million people are infected and about 2 lakh new infections have been reported last year. To date, there is no cure for HIV/AIDS. Current treatment, which is associated with serious side effects, only delays the onset of AIDS and death. Thus, HIV/AIDS is responsible for a global health concern imposing significant healthcare costs, especially in low- and middle-income regions such as India and Africa, and a marked loss of quality of life to infected individuals. Understanding factors impacting vaccine design and drug development via mathematical modelling of HIV-1 transmission, evolution and pathogenesis and discerning the subtype and region specific differences are a crucial part of the overall strategy of reducing the burden of HIV/AIDS. The strain dominant in India is HIV-1 subtype C (HIV-1C). Treatment guidelines have largely been based on studies on HIV-1 subtype B (HIV-1B), dominant in the west. In this thesis, we have attempted to understand the dynamics of the spread of HIV-1C, leading to new guidelines and intervention strategies applicable to India. We have for the first time estimated the basic reproductive ratio, R0, of HIV-1 subtype C (HIV-1C), a proxy for its fitness and virulence, using clinical data of infected patients from India. We employed measurements of viral load decay dynamics during treatment and estimated R0, and the critical efficacy, εc, for successful treatment of HIV-1C infection. Clinical data showed that the viral load in patients in India was significantly higher than in the west. Yet, in 6 months following the start of treatment, 87.5% had undetectable viral load, indicating an excellent response to ART, comparable to the west. We analyzed the clinical data using a mathematical model and estimated the median R0 to be 5.3. The corresponding εc was ∼0.8. These estimates of R0 and εc are smaller than current estimates for HIV-1B, suggesting that HIV-1C exhibits lower in vivo fitness compared to HIV-1B, which allows successful treatment despite high baseline viral loads. New treatment guidelines thus emerge that are less stringent than in the west. HIV-1C is far more prevalent globally than HIV-1B. This is surprising in light of our findings above of a lower fitness of HIV-1C than HIV-1B. To understand this observation, we next developed a mechanistic paradigm of HIV-1 transmission. HIV-1 has been hypothesized to optimize its transmission potential (TP) in an infected population by modulating its steady state viral load (VSS), a robust marker of virulence. The mechanism of this optimization is paradoxical and poorly understood given that HIV-1 mutates rapidly in vivo in response to selection pressure by the host immune system. We hypothesize that the HIV-1 TP is not solely a function of VSS as proposed earlier, but a function of two variables - VSS and R0, which function such that R0 is optimized within an infected individual in response to the immune system while VSS is optimized across individuals such that transmission is optimized. On this TP(VSS, R0) landscape, we find that HIV-1C lies closer to the optimum than HIV-1B, suggesting an explanation for the global spread of HIV-1C. This leads to the intriguing implication that the lower virulence of HIV-1C may be because it has evolved more along the TP(VSS, R0) landscape than HIV-1B. Lastly, we examined the role of recombination on HIV-1 adaptation. Following transmission, HIV-1 adapts in the new host by acquiring mutations that allow it to escape from the host immune response at multiple epitopes. It also reverts mutations associated with epitopes targeted in the transmitting host but not in the new host. Moreover, escape mutations are often associated with additional compensatory mutations that partially recover fitness costs. It is unclear whether recombination expedites this process of multi-locus adaptation. To elucidate the role of recombination, we constructed a detailed population dynamics model that integrates viral dynamics, host immune response at multiple epitopes through cytotoxic T lymphocytes, and viral evolution driven by mutation, recombination, and selection. Using this model, we computed the expected waiting time until the emergence of the strain that has gained escape and compensatory mutations against the new host’s immune response, and reverted these mutations at epitopes no longer targeted. We found that depending on the underlying fitness landscape, shaped by both costs and benefits of mutations, adaptation proceeds via distinct dominant pathways with different effects of recombination, in particular distinguishing escape and reversion. Specifically, recombination tends to delay adaptation when a purely uphill fitness landscape is accessible at each epitope, and accelerate it when a fitness valley is associated with each epitope. Our study points to the importance of recombination in shaping the adaptation of HIV-1 following its transmission to new hosts, a process central to T cell-based vaccine strategies.

Abstract The purpose of this study is to describe and to compare the university students’ attitudes (knowledge, feelings and behaviour) towards HIV/AIDS (Human Immune Deficiency Virus/ Acquired Immune Deficiency Syndrome) in Finland and in Kenya and to find explanatory factors associated with the sexual risk behaviour. For educators, managers and experts in health care and education the results will provide an opportunity to deepen their knowledge and awareness of students’ sexual behaviour. These results may also be used for planning an educational programme for youngsters and young adults in order to promote healthy sexual behaviour. This study is focused on the viewpoint of preventive health care and sexual health promotion. The study is a comparative research with quantitative and qualitative methods. The study group consists of 525 first year students (411 Finnish and 114 Kenyan students) of Oulu University of Applied Sciences, Oulu University and the University of Helsinki in Finland and of MOI University in Kenya. The response rate was 87.5%. The results concerning the attitudes towards HIV/AIDS of the students showed that the Finnish and Kenyan students had a good level of knowledge concerning HIV and AIDS. Most of the information had been obtained from TV, campaigns, newspapers, and information packages. The role of the health care professionals was very small in both countries. The most negative attitudes were found towards homosexuality (25.8% of the respondents) and intravenous drugs users (59.5%). The result showed that the level of knowledge did not have an effect on the level of their beliefs and prejudices of the students. It was common for the respondents to be single during their first study year. No influence was found between the students’ knowledge and the number of their sex partners or the frequency of the sexual activity. Almost the same number of students who reported using prevention always or almost always identified both HIV correctly (43.4%) and incorrectly (45.7%). The situation concerning AIDS was similar. The age and the importance of religion of the students had influence on the use of prevention. / Tiivistelmä Tutkimuksen tarkoituksena on kuvata ja verrata kenialaisten ja suomalaisten korkeakouluopiskelijoiden asenteita (tietoja, tunteita ja käyttäytymistä) HIV/AIDSia (Immuunikatovirus/ Hankittu immuunipuutos-oireyhtymä) kohtaan ja löytää seksuaalista riskikäyttäytymistä selittäviä tekijöitä. Terveydenhuollon ja terveysalan hallinnon ja koulutuksen asiantuntijoille tutkimustulokset antavat mahdollisuuden tutustua ja syventää HIV/AIDSia koskevaa tietouttaan ja tietoisuuttaan. Tuloksia voidaan hyödyntää ennaltaehkäisevän terveydenhuollon suunnittelussa ja koulutuksessa edistämään nuorten ja nuorten aikuisten terveellistä seksikäyttäytymistä. Tutkimuksen lähtökohta on ennaltaehkäisevä toiminta ja erityisesti seksuaaliterveyden edistäminen. Tutkimus on vertaileva tutkimus. Aineisto kerättiin strukturoituja ja avoimia kysymyksiä sisältävällä kyselylomakkeella. Tutkimukseen vastasi yhteensä 525 ensimmäisen lukuvuoden korkeakouluopiskelijaa, 411 suomalaista ja 114 kenialaista opiskelijaa. Vastausprosentti oli 87,5 %. Tulokset osoittivat sekä kenialaisilla että suomalaisilla korkeakouluopiskelijoilla olevan hyvät tiedot HIV/AIDSista. Tärkeimpiä opiskelijoiden nimeämiä tietolähteitä olivat TV, kampanjat, sanomalehdet ja informaatiopaketit. Perheen ja terveydenhuoltohenkilöstön rooli tiedon lähteenä oli vähäinen molemmissa maissa. Negatiivisimmat asenteet kohdistuivat homoseksuaalisuutta ja laskimon sisäisiä huumeiden käyttäjiä kohtaan. Kenialaisten opiskelijoiden ennakkoasenteet HIV/AIDSia kohtaan olivat muita opiskelijoita voimakkaammat ja negatiivisemmat. Tulokset osoittivat, että tiedon laadulla ei ollut merkitystä opiskelijoiden ennakkoasenteisiin. Tulokset osoittivat myös, että ensimmäisen vuoden korkeakouluopiskelijoilla ei ole paljon seksisuhteita. Opiskelijoiden HIV/AIDS-tiedoilla ei ollut yhteyttä seksipartnereiden määrään tai seksuaaliseen aktiivisuuteen. Oikealla tai väärällä HIV/AIDS-tiedolla ei ollut vaikutusta ehkäisyn käyttöön. Lähes sama määrä opiskelijoita, jotka kertoivat käyttävänsä ehkäisyä aina tai lähes aina, määritteli HIVin oikein ja väärin. Tilanne oli samanlainen koskien AIDSia. Oikealla tai väärällä HIV/AIDSia koskevalla tiedolla ei ollut myöskään vaikutusta ennakkoasenteiden voimakkuuteen. Tutkimustulosten perusteella HIV/AIDSin ennaltaehkäisyssä ei pelkkä HIV/AIDS tietotason kohottaminen riitä, vaan on syytä käyttää uusia ja monipuolisia lähestymistapoja.

Bakgrund: Hiv är en utbredd infektion och flera miljoner blir smittade varje år. Stigmatisering kring infektionen finns fortfarande kvar. Hälsa definieras som mer än frånvaro av sjukdom och lidande behöver inte vara fysisk. Syfte: Syftet med studien var att beskriva personers erfarenheter av att leva med hiv. Metod: En kvalitativ innehållsanalys baserad på sex självbiografier. Resultat: Fyra huvudteman framkom då analysprocessen genomfördes: svårt att förlika sig, behov av stöd, fördomarna tog stor plats i livet och behov av kontroll. Diskussion: Det är viktigt att sprida korrekt kunskap om hiv för att stigmatisering och fördomar av infektionen ska minska. Det är stigmatiseringen som skapar känslor av skam och isolering hos hivpositiva. Slutsats: Stigmatiseringen kring infektionen och rädslan att utveckla aids skapar mest ångest hos personer som lever med hiv. Dessa personer känner även en rädsla för att bli lämnade ensamma på grund av sin infektion. De upplever ett starkt behov av att få stöd.