Après intégration dans le génome cellulaire de l’hôte, l’expression des rétrovirus dépend d’éléments agissant en cis localisés dans la longue répétition terminale 5’ (LTR5’) et la région leader, de facteurs de transcription cellulaires et viraux agissant en trans ainsi que de l’organisation chromatinienne du provirus intégré. Notre laboratoire a précédemment identifié dans le génome du rétrovirus HIV-1 (Human Immunodeficiency Virus type 1) une région intragénique importante (nt 4079-6026, où nt +1 est le début de U3 dans le LTR5’) composée du fragment 5103, du site hypersensible aux nucléases SH7 et du fragment 5105. Lors de ce travail, nous avons caractérisé physiquement et fonctionnellement différents sites de liaison pour des facteurs de transcription cellulaires localisés dans la région intragénique du virus HIV-1, dont trois sites de liaison pour le facteur inductible AP-1, dans des expériences de retard de migration sur gel et de transfection transitoire. Nous avons montré l’importance de ces trois sites AP-1 pour la réplication virale au niveau transcriptionnel dans des expériences d’infection et d’immunoprécipitation de la chromatine. De plus, nous avons caractérisé l’activité transcriptionnelle associée à la région intragénique du virus HIV-1. D’autre part, la structure nucléosomale du provirus intégré et les modifications épigénétiques associées jouent un rôle crucial pour l’expression des rétrovirus. La répression transcriptionnelle du rétrovirus oncogène BLV (Bovine Leukemia Virus) lui permet d’échapper au système immunitaire de son hôte bovin et favorise ainsi l’apparition de tumeurs. Dans ce contexte, nous avons montré que la méthylation de l’ADN au niveau du promoteur viral permet le maintient de la latence transcriptionnelle. En effet, la méthylation des dinucleotides CpGs localisés dans le LTR5‘ empêche le recrutement in vivo des facteurs de transcription activateurs CREB/CREM/ATF. Nous avons également montré que l’activation transcriptionnelle de l’expression du BLV par la combinaison PMA/ionomycine s’accompagne d’un remodelage chromatinien rapide mais transitoire au niveau du promoteur viral par des expériences de marquage indirect des extrémités et d’immunoprécipitation de chromatine. Nous avons ensuite démontré l’importance du site de liaison pour le facteur de transcription PU.1 et de la E-box 4 qui lie USF-1/-2, tous deux localisés dans la région dont l’accessibilité aux nucléases s’accroît après traitement des cellules, pour l’activation transcriptionnelle de l’expression virale par cette combinaison d’inducteurs. En conclusion, notre travail devrait permettre une meilleure compréhension des mécanismes transcriptionnels et épigénétiques régulant l’expression des rétrovirus HIV-1 et BLV. / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

Les facteurs de transcription de la famille Rel/NF-κB régulent l’expression d’un grand nombre de gènes impliqués dans les réponses immunitaires et inflammatoires ainsi que dans la régulation de la prolifération et de la survie cellulaire. Le caractère transitoire de l’activation de NF-κB est donc crucial pour poterger les cellules de l’autoxicité due à une trop forte expression des gènes cibles de ce facteur de transcription. Dans le cadre de notre thèse de doctorat, nous avons étudié les mécanismes moléculaires régulant la cinétique d’activation de NF-κB, en accordant une attention toute particulière au complexe kinase IKK, qui semble être le regulateur clef de l’activation de NF-κB. Nos résultats suggèrent que p300 pourrait réguler la durée d’activation des IKKs d’une part par acétylation directe, et d’autre part, indépendamment de son activité HAT, en stabilisant les IKKs et donc en prolongeant leur demie-vie et par conséquent leur activation.<p>Certains virus utilisent la voie de signalisation NF-κB afin de promouvoir leur propre réplication. C’est le cas du virus HIV-1 (Human Immunodeficiency Virus type 1), qui contient dans son promoteur deux sites de liaison pour NF-κB. Notre laboratoire a précédemment montré que l’utilisation du TNFα en combinaison avec la TSA, active l’expression virale de manière synergique. L’administration combinée d’un activateur du facteur NF-κB et d’un inhibiteur de désacétylases pourrait, en présence d’une thérapie anti-HIV-1 efficace, être envisagée dans le but d’éliminer les cellules réservoirs infectées de manière latente. L’utilisation thérapeutique du TNFα ou de la TSA étant inenvisageable en raison de leur toxicité, nous avons étudié l’effet d’autres substances ayant un plus grand potentiel thérapeutique et nous avons apporté une preuve de principe du potentiel thérapeutique de la coadministration de plusieurs activateurs viraux (inhibiteurs de HDACs[HDACIs]+inducteurs de la voie NF-κB) pour réduire le pool des réservoirs cellulaires infectés de manière latente.<p> / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

Malgré de nombreux progrès thérapeutiques, la seule réelle option thérapeutique des malades atteints d’une cirrhose terminale ou d’hépatite aiguë fulminante est la transplantation hépatique, cependant limitée par la pénurie d’organes. De même, la prise en charge des pathologies pancréatiques aigues et chroniques consiste essentiellement en traitements supportifs et des complications.<p>La réaction inflammatoire au cours des maladies hépatiques et pancréatiques joue un rôle majeur dans l’évolution de ces maladies car elle influence la sévérité de l’affection aiguë et se complique fréquemment de fibrose et de cirrhose. <p>Les chimiokines constituent une famille de peptides possédant des propriétés chimiotactiques et activatrices sur les leucocytes, et de ce fait jouent un rôle primordial dans la réaction inflammatoire en recrutant des cellules inflammatoires vers un site lésé. Les chimiokines exercent leurs activités en se liant à une famille de récepteurs à 7 hélices transmembranaires situés sur les leucocytes. <p>Le CCR5 est un récepteur pour les chimiokines CCL3 (MIP-1α), CCL4 (MIP-1β), CCL5 (RANTES) et CCL8 (MCP-2). Le CCR5 joue un rôle important de corécepteur dans l’infection par le virus de l’immunodéficience humaine. Chez l’humain, il existe une mutation relativement fréquente du CCR5, appelée CCR5Δ32, qui confère chez les patients homozygotes pour la mutation une protection presque complète contre l’infection par le virus de l’immunodéficience humaine. Plus récemment, la mutation CCR5Δ32 a été rapportée comme étant associée à certaines maladies hépatiques et des traitements expérimentaux chez l’homme par inhibiteurs du CCR5 ont entraînés des cas d’hépatotoxicité sévère. De même, il a été rapporté que l’expression pancréatique de CCR5 était augmentée chez les patients atteints de pancréatite chronique. Cependant, le rôle du récepteur CCR5 et de ses ligands dans la pathogénie des maladies hépatiques et pancréatiques n’est pas connu.<p>Dans un premier temps, nous avons démontré dans un modèle expérimental d’hépatite médiée par les lymphocytes T qu’il existe une production hépatique de CCL3, CCL4 et CCL5 au cours de la maladie et que le foie des souris malades est caractérisé par une infiltration accrue de cellules CCR5+. En utilisant des souris CCR5-déficientes, nous avons ensuite montré que l’absence de CCR5 est associée à une maladie plus sévère, à une production accrue de cytokines pro-inflammatoires et des chimiokines liant le CCR5 (CCL3, CCL4 et CCL5), ainsi que par un recrutement plus important de cellules inflammatoires, particulièrement des cellules CCR1+. Nous avons ensuite montré que la production accrue des ligands du CCR5 joue un rôle important dans l’exacerbation de la maladie observée chez les souris CCR5-déficientes, puisque leur neutralisation réduit fortement la sévérité de la maladie ainsi que le recrutement hépatique de cellules inflammatoires.<p>Dans un second temps, nous avons étudié l’expression et le rôle du CCR5 et de ses ligands dans un modèle murin de pancréatite aiguë sécrétagogue, induite par des injections répétées d’un analogue de la cholécystokinine. Précocément après l’induction de la maladie, nous avons observé une augmentation de l’expression de CCL2 (MCP-1), CCL3 et CCL4 alors que l’augmentation d’expression de CCL5 est observée plus tardivement au cours de la maladie. Nous avons ensuite montré que les souris CCR5-déficientes développent une pancréatite plus sévère, ainsi qu’une production accrue de CCL2, CCL3 et CCL4, et un infiltrat inflammatoire plus marqué que les souris ‘’wild-type’’. Nous avons également montré que la production accrue de ces chimiokines joue un rôle dans l’exacerbation de la pancréatite aiguë chez les souris CCR5-déficientes. En effet, la neutralisation simultanée de ces chimiokines par des anticorps monoclonaux réduit significativement la sévérité de la maladie pancréatique chez ces souris. De même, la neutralisation simultanée des ligands du CCR5 chez des souris wild-type réduit également la sévérité de la pancréatite aiguë, suggérant un rôle de ces molécules dans la pathogénie de la pancréatite aiguë.<p>En conclusion, nous avons montré que l’absence du récepteur CCR5 augmente la susceptibilité aux maladies inflammatoires hépatiques et pancréatiques expérimentales. Le développement d’inhibiteurs du CCR5 dans l’arsenal thérapeutique contre le virus de l’immunodéficience humaine devra tenir compte de ces données, d’autant plus que des cas d’hépatotoxicité sévère ont été récemment rapportés avec certains inhibiteurs en développement et que l’association du virus de l’immunodéficience humaine avec la présence de maladies hépatiques est fréquente. Enfin, ces travaux ouvrent de nouveaux champs d’investigation au niveau de l’étude d’association du CCR5Δ32 avec les maladies inflammatoires pancréatiques et hépatiques, et des perspectives thérapeutiques ciblant CCL3, CCL4 et CCL5. <p><p><p> / Doctorat en sciences médicales / info:eu-repo/semantics/nonPublished

Submitted in fulfilment of the requirements for the Degree of Doctor in Public Management, Durban Universit of Technology, 2017. / HIV-AIDS has infected more than 37 million individuals globally and has resulted in approximately 35 million HIV-AIDS related deaths globally since its discovery 35 years ago. HIV-AIDS remains a global and local health crisis as, despite innovative and accessible HIV-AIDS prevention efforts, the disease continues to spread. UNAIDS estimated over 2 milliion new HIV-AIDS infections with 700 000 of these infections occurring in young African women in 2015, revealing that the burden of HIV-AIDS is far from over (UNAIDS, 2016). As more individuals become infected with HIV-AIDS, more infected individuals are living longer, productive lives due to the international rollout and scale-up of life-saving antiretroviral (ARV) therapy aimed at halting disease progression. In 16 years, the world has initiated over 16 million HIV-infected individuals onto ARV programmes across the world aimed at preserving first line drug effectiveness of treatment, less resistance and lower mortality and morbidity rates( UNAIDS, 2016). This number is set to double as countries across the globe take bold steps to provide ARV treatment for all, based on latest WHO guideline changes. The initiative of ARV roll out for all HIV-positive individuals globally, brings with it the challenges and complexities of infrastructure support, resource allocation, uninterrupted drug supply, global access and clinical training requirements for HIV-AIDS programmes across the globe. Quality management systems with monitoring and evaluation frameworks in particular play a pivotal role in planning, allocating and utilising resources for optimal health benefits.This research study reviews available data on the prevalence of quality management systems in HIV-AIDS healthcare and identifies gaps and smart practises towards recommendations for comprehensive global HIV-AIDS standards development. This research study aims to propose a conceptual monitoring and evaluation framework derived from quality management systems for management of HIV-AIDS private sector programmes that can be used in both public and private healthcare sectors through analysis of current conceptual frameworks in the HIV-AIDS healthcare and the HIV-AIDS programmes within the South African context of HIV-AIDS healthcare provision. / D

Magister Artium - MA (Anthropology/Sociology) / This research critically analysed Muslim approaches to five women with HIV/AIDS in Cape Town focussing particularly on the approach of 'Positive Muslims' - an awareness-raising and support group for Muslims living with HIV/AIDS. The central question of this thesis dealt with the impact of the norms, values and practices of Cape Muslims on the approach of Positive Muslims to women living with HIV/AIDS. It is suggested that while norms and values articulated in religious texts inform the ideological approach of the organisation's AIDS prevention model. This is due to the pragmatic approach adopted by Postive Muslims which recognises that the articulated norms and values do not always conform to the practices of Cape Muslims. / South Africa

Magister Public Health - MPH / Human Immune-deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is a major public health problem. Globally, the number of new HIV infections is decreasing but the total number of people living with the disease is increasing. An estimated 5.7 million South Africans are currently living with the disease. The life expectancy of people living with HIV (PLHIV) in South Africa has slowly increased due to the availability of Anti-Retroviral Therapy (ART). The progressive "chronicity" of HIV may be associated with a variety of impairments and disabilities for people living with HIV. This emphasising the increasingly important role that physiotherapists play to minimize the disabling impact of the disease and improve quality of life for PLHIV. The aim of study was to determine the HIV/AIDS knowledge, attitudes and the occupational risk perception of physiotherapists practicing in the Eastern Cape Province, South Africa. This study utilized a cross sectional descriptive quantitative survey to collect data. The data was collected via a structured self-administered postal questionnaire. The questionnaires were captured in Microsoft Excel and analysed statistically using CDC Epi-Info version 3.5.1. Data was analysed descriptively and the chi-square test, T-tests and ANOVA was used to identify any statistically significant relationship between variables. The results of the study identified that the physiotherapists in the study have "high" general HIV related knowledge, although major gaps regarding HIV prevention and transmission still exists. The physiotherapists expressed a positive attitude towards PLHIV, while they perceive themselves to be at low risk of HIV transmission risk when managing PLHIV. The physiotherapists with more than 10 years' experience had significantly better HIV related knowledge compared to those with less than 10 years' experience while the attitudes of married physiotherapists towards PLHIV were significantly less favourable than those who were not married. There is a need for intervention strategies to address the HIV knowledge gaps of physiotherapists. Intervention strategies need to address physiotherapists HIV prevention and transmission knowledge.

The focus of this study is on the experiences of a small sample of local women who have been recently diagnosed with HIV. The aim of the research was to give these women an opportunity to express their first-hand, personal accounts of living with HIV. Five isiXhosa-speaking women were recruited and interviewed. These accounts were collected and analysed within in the methodological framework of Interpretative Phenomenological Analysis, a qualitative approach that is becoming increasingly popular in the broad fields of health and clinical psychology. Data was analysed for meaningful units, which were interpreted inductively and hermeneutically, and categorised into super-ordinate themes. Five themes within the participants’ experiences of living with HIV were identified: (1) experiences of diagnosis, (2) experiences of stigma, (3) social support, (4) coping strategies, and (5) HIV as one of many assaults to self. Implicated in these experiences are the ways in which these women have appraised themselves and their situation after an HIV-positive diagnosis, appraisals that are shaped by HIV-related stigma. A variety of negative emotional reactions are common following the diagnosis, often compounded by the direct experiences of HIV-related stigma. Women in the study adopted different kinds of coping strategies based on the resources and social support available to them. Also significant is that for these women who had typically endured a variety of traumatic life events, a positive diagnosis was simply one of many life challenges

The issues of capacity and capacity development in the response to HIV and AIDS is a topic of intense academic interest and is on the agenda of development practitioners, particularly as these issues are linked to community HIV and AIDS competence and sustainability of civil society organisations and community capacity. The capacity development model of the Southern African AIDS Trust is one of the more illuminating examples of capacity development of civil society organisations for the enhancement of community HIV and AIDS competence in southern Africa. The thesis examines the conceptualisation and implementation of the Southern African AIDS Trust's capacity development model in order to identify and understand the multi-dimensional factors that influence the success and sustainability of HIV and AIDS responses. It argues that, even though the conceptualisation, formulation and implementation of the model were appropriate and yielded acceptable benefits to communities in relation to HIV and AIDS, the sustainability of the model depended fundamentally on the availability of requisite resources. The dependence on external resources, the availability of which is in large part beyond the control of the Southern African AIDS Trust and its community-based beneficiaries, undercuts the sustainability of the model and the programmes delivered through it. Community capacities and community-based HIV and AIDS responses are sustainable only to the extent that communities have sufficient resources to build capacities and develop responses, or can leverage and negotiate external inputs. The degeneration of capacity in intermediary organisations (such as Southern African AIDS Trust) that support community competence undermines models that at first sight seem suitable for effective capacity enhancement with regard to HIV and AIDS programmes. In this regard, the thesis also focuses on the organisational crisis within Southern African AIDS Trust and the ramifications this had for community HIV and AIDS competence.

HIV-1 is the causative agent for AIDS and has been a major focus of research for the past two decades. Though there is a combination therapy in place known as the “Highly Active Anti-Retroviral Therapy” (HAART), its usefulness is confounded by the generation of escape mutants, a host of side effects, and its prohibitive cost. The most useful alternative would be the prevention of infection by vaccination. Vaccine research has been focused on the use of recombinant protein sub-units of the virus or combinations thereof to elicit a neutralizing response against the virus. These approaches have mostly resulted in a failure to generate broadly cross reactive neutralizing response against primary strains of the virus. The work reported herein is aimed at designing a rigidified version of gp120/gp120 derivatives and understanding the scope of the various antigenic regions in gp120 in generating a neutralization response. Chapter one discusses some general features of the virus and the immune system. The general nature of AIDS, its spread and its immunological characteristics are also described in this chapter. Chapter two discusses the design and NMR structural analysis of gp120 bridging sheet peptide mimics in methanol and water. The structure of gp120 can be loosely divided into two domains (the outer domain and the inner domain) that are linked together by a discontinuous four stranded antiparallel beta sheet known as the bridging sheet. The bridging sheet is known to overlap with the coreceptor binding site of gp120 and hence is a suitable target for designing virus-entry inhibitors. 17b, a neutralizing antibody isolated from an infected individual, is known to bind to this region of gp120. Our aim in this part of the work was to design a four stranded antiparallel beta sheet, based on the sequence of the bridging sheet, that would contain most of the residues involved in 17b binding. NMR and CD studies confirmed that the peptide was well structured in methanol but the structure was largely lost on addition of aqueous solvent. A small population of the peptide was found to be well-folded in aqueous solution. Chapter three discusses the design and characterization of a gp120-CD4D12 single chain. It is well known that the conformation of gp120 changes upon binding CD4 to expose cryptic epitopes, known as CD4i epitopes. In this work we report the generation of a single chain gp120-CD4 construct that has the cryptic epitopes exposed. The construct bound to 17b, a conformation specific antibody against the bridging sheet of gp120, a cryptic epitope, as well as a non-covalent complex of gp120:CD4D12. There was also very insignificant secondary structural change in gp120 upon complex formation with CD4D12 as observed by CD spectroscopy. Immunological studies with DNA and protein vaccination in guinea-pigs indicated that though 17b like antibodies are generated after immunization, they did not contribute towards the neutralization of primary isolates of the virus. It was also observed that it was the anti-CD4D12 antibodies that were responsible for the neutralization by the sera. These studies indicated towards the inability of the bridging sheet to generate effective neutralization response in case of vaccination with gp120/CD4 complexes. Chapter four discusses the design of a mimic of the gp120/CD4 complex. Since it was seen from our previous work that gp120/CD4 complexes generate a large fraction of antiCD4 antibodies and hence are unsuitable for vaccination purposes, we generated a construct with the minimal binding region of CD4. The small fragment of CD4 spanning from 21st residue to 64th residue was inserted in the V1/V2 loop of gp120. The insertion site was designed based on the region of gp120 closest to this fragment and capable of tolerating insertions. This protein did not bind to 17b as well as gp120/CD4 complex but showed a higher binding compared to full length gp120. Further immunological characterization with this protein revealed that it was not capable of generating neutralizing antibodies against the virus. Chapter five discusses the design and execution of a SPR based solution phase competition experiment to find the solution phase binding constant of CD4 and CD4 analogs to gp120. A major problem during the analysis of binding data obtained by SPR is the accurate determination of Rmax, a parameter needed to obtain an accurate equilibrium dissociation constant. In this chapter we have developed a binary as well as a ternary solution phase SPR based assay to accurately determine a solution phase equilibrium binding constant. The binding constants were determined for gp120 binding to CD4D12 and other CD4 analogs. To confirm the validity of the assay, a control antigen:antibody interaction whose equilibrium dissociation constant has been determined by other methods has been used as a test case. Chapter six discusses the design and characterization of V3 peptides inserted in the loop regions of E. coli Thioredoxin (Trx). Trx has earlier been used to display random peptide libraries between the 33rd and the 34th residue. We have constructed three constructs where the peptide has been inserted between the 33rd and 34th residue, between the 74th and 75th residue and between the 84th and 85th residue. The insertion between 74th and 75th position (74V3Trx) was found to be superior to the other two and would be a suitable alternative for display of a random peptide library. The binding of these constructs to 447-52D, a V3 peptide specific antibody was characterized. These were also characterized immunologically, and 74V3Trx was found to generate weakly neutralizing activity against the MN strain of HIV-1. Competition experiments with 447-52D with these sera indicated that there were antibodies generated that could compete out 447-52D binding to gp120 but not in sufficient concentration to provide broad neutralization. Appendix 1 discusses the rational design of disulfides to stabilize proteins based on the analysis of naturally occurring disulfides. In our attempts to design a rigidified version of gp120 we had designed disulfides in gp120 based on its crystal structure. Many of these were disulfides that would span antiparallel adjacent strands. In order to improve the design principles, we analyzed naturally occurring disulfides that span antiparallel adjacent strands and characterized them in terms of their positional preference in a beta sheet. It was found that these disulfides mostly occur on edge strands and are found exclusively between non-hydrogen bonded registered pairs of adjacent antiparallel strands. Mutagenesis on Thioredoxin was performed to verify our results. It was found that disulfides designed between the non-hydrogen bonded pairs of antiparallel strands could significantly stabilize the protein whereas the ones between hydrogen bonded pairs destabilized the protein.

Orientador: Maria Rita de Camargo Donalisio / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T02:24:43Z (GMT). No. of bitstreams: 1 Oliveira_TiagoFeitosade_M.pdf: 646726 bytes, checksum: 4689e80905264ac5b08fc1258252b586 (MD5) Previous issue date: 2004 / Resumo: A oferta de testes sorológicos tem sido colocada como uma das estratégias de combate à epidemia de HIV/aids. Inicialmente a testagem dava-se apenas nos serviços especializados, os chamados COAS ou CTA mas, devido à magnitude alcançada pela epidemia de HIV/aids, bem como a necessidade de diagnóstico precoce dos casos, fez-se necessário a disponibilização do teste anti-HIV na rede básica de saúde. O aconselhamento tem sido apontado como uma técnica a ser aplicada na oferta e na entrega do resultado do teste. Este se baseia na mudança de comportamento de pessoas e grupos sociais, proporcionando-lhes a oportunidade de adotarem práticas sexuais mais seguras ou reduzindo o dano de um determinado comportamento de risco. Através de pesquisa qualitativa, analisamos a oferta do teste para detecção do HIV nas Unidades de Saúde da Família da rede municipal de saúde de Recife-PE, sob a ótica dos profissionais de saúde. Verificamos que a indicação do referido teste se dá, quase sempre no consultório, durante a consulta clínica. O que motiva a oferta do teste é, geralmente um quadro sindrômico compatível com a aids ou o programa de assistência ao pré-natal. Os profissionais revelaram dificuldades em absorver a demanda espontânea pelo teste. A maioria dos entrevistados desconhece o aconselhamento, quanto técnica para ofertar o exame, reverter comportamentos de risco e dar o resultado do teste anti-HIV. Isso aponta para a necessidade urgente de qualificar a oferta do teste na rede básica, fazendo com que ela seja, de fato, instrumento de combate ao avanço da epidemia do HIV/aids / Abstract: The offering of serologic tests has been placed as one of the strategies in the HIV/AIDS epidemic disease combat. At first, the testate were applied in the specialized services only, the called COAS or CTA, however, with the magnitude reached by the HIV/AIDS epidemy, as well the necessity of a precocious diagnostic to the cases, the availability at the health public service of the anti-HIV test was necessary. The counselling has been pointed as a technique to be applied in the offering and delivery of the test result. That is based in the behaviour changed of social groups and people, providing them the opportunity to adopt safe sexual practices or reducing the damage of determinate risk behaviour. Through the qualitative search, we analyse the test offering to detect the HIV in the Family Health Units in the municipal public health of Recife-PE, under the health professional¿s optics. We realised that the indication of the referred test happens, almost often, in the doctor¿s office during the procedure. What motivate the test offering is, in general, a syndromic diagnostic compatible with AIDS or the pre-natal assistance program. The professions revelled some difficult in absolving the spontaneous demand for the test. The majority of the interviewed does not know the counselling as a technique to offer the exam, revert behaviour risks and give the anti-HIV result. This points to the urgent necessity of qualify the test offering into the public service, turning it to a combative instrument against the HIV/AIDS epidemy advance, indeed. / Mestrado / Saude Coletiva / Mestre em Saude Coletiva