Resumo: A AIDS caracterizou-se como a mais importante doença no final do século XX. Indicadores epidemiológicos mostram que a AIDS tem comprometido cada vez mais as mulheres, por apresentarem fatores biológicos e sociais que as tornam mais suscetíveis ao risco da contaminação. Os avanços científicos têm proporcionado aumento da expectativa de vida dos portadores, devido à utilização de terapias mais adequadas, assim, a qualidade de vida tem sido uma preocupação freqüente entre os contaminados. Este estudo teve como objetivos avaliar, entre mulheres com infecção pelo HIV: as características sócio-demográficas, epidemiológicas e clínicas, a qualidade de vida por meio da escala HAT-QoL, e a influência das variáveis sócio-demográficas, epidemiológicas e clínicas na qualidade de vida. Para avaliação da qualidade de vida, utilizou-se um instrumento denominado HAT-QoL, desenvolvido para portadores do HIV, que apresenta 42 questões, em nove domínios: atividades gerais, atividade sexual, preocupação com o sigilo sobre a infecção, preocupação com a saúde, preocupação financeira, satisfação com a vida, questões relativas à medicação e confiança no médico. Estudaram-se 73 mulheres com infecção pelo HIV, de dezembro de 2000 a abril de 2001, que realizavam seguimento no Ambulatório Especial de Moléstias Infecciosas e Parasitárias, do Hospital das Clínicas da Faculdade de Medicina de Botucatu-SP. A maioria tinha idade inferior a 39 anos, era de mulheres casada, de donas de casa, e era composta por mulheres que freqüentaram escola por período menor ou igual a oito anos, e que foram quase exclusivamente contaminadas por relação heterossexual. Entre elas, 50,7% tinham aids, as demais infecção pelo HIV. Grande parcela era procedente de municípios com menos de 100.000 habitantes, e sobrevivia com menos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: AIDS represents the most important disease of the end of the 20th century. Epidemiological indicators show that AIDS has been increasingly involving women since they present biological and social factors that render them more susceptible to the risk of contamination. Scientific advances have led to an increased life expectancy for infected patients because of the use of more adequate treatment, so that the quality of life has been a frequent preoccupation among contaminated subjects. The objective of the present study was to assess HIV-infected women in terms of their sociodemographic, epidemiological and clinical characteristics, their quality of life using the HAT-QoL scale, and the influence of the above characteristics on their quality of life. To assess quality of life, we used the instrument denoted HAT-QoL, developed for HIV-infected subjects, which consists of 42 questions divided into nine domains: general activities, sexual activity, preoccupation with secrecy about the infection, preoccupation with health, financial worries, satisfaction with life, questions concerning medication, and trusting one's physician. The study was conducted on 73 HIV-infected women followed up at the Special Infectious and Parasitic Diseases Outpatient Clinic of the University Hospital, Faculty of Medicine of Botucatu, SP. Most women were younger than 39 years, were housewives, had eight years of schooling or less, and had been almost exclusively contaminated through a heterosexual relation. Of these, 50.7% had AIDS, and the remaining ones were infected with HIV. A large proportion came from municipalities with less than 100,000 inhabitants and survived on less than a minimum wage (R$ 151.00 at the time of the study). Approximately 50% of the women had been aware of their disease for at least four years and 83.6% were taking antiretroviral... (Complete abstract click electronic access below) / Orientador: Jussara Marcondes-Machado / Coorientador: Ana Teresa de Abreu Ramos Cerqueira / Doutor

Made available in DSpace on 2014-06-11T19:31:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T20:22:14Z : No. of bitstreams: 1 galvao_mtg_dr_botfm.pdf: 1944693 bytes, checksum: 85f1c2e250a673df331ffc4b7e626ffa (MD5) / A AIDS caracterizou-se como a mais importante doença no final do século XX. Indicadores epidemiológicos mostram que a AIDS tem comprometido cada vez mais as mulheres, por apresentarem fatores biológicos e sociais que as tornam mais suscetíveis ao risco da contaminação. Os avanços científicos têm proporcionado aumento da expectativa de vida dos portadores, devido à utilização de terapias mais adequadas, assim, a qualidade de vida tem sido uma preocupação freqüente entre os contaminados. Este estudo teve como objetivos avaliar, entre mulheres com infecção pelo HIV: as características sócio-demográficas, epidemiológicas e clínicas, a qualidade de vida por meio da escala HAT-QoL, e a influência das variáveis sócio-demográficas, epidemiológicas e clínicas na qualidade de vida. Para avaliação da qualidade de vida, utilizou-se um instrumento denominado HAT-QoL, desenvolvido para portadores do HIV, que apresenta 42 questões, em nove domínios: atividades gerais, atividade sexual, preocupação com o sigilo sobre a infecção, preocupação com a saúde, preocupação financeira, satisfação com a vida, questões relativas à medicação e confiança no médico. Estudaram-se 73 mulheres com infecção pelo HIV, de dezembro de 2000 a abril de 2001, que realizavam seguimento no Ambulatório Especial de Moléstias Infecciosas e Parasitárias, do Hospital das Clínicas da Faculdade de Medicina de Botucatu-SP. A maioria tinha idade inferior a 39 anos, era de mulheres casada, de donas de casa, e era composta por mulheres que freqüentaram escola por período menor ou igual a oito anos, e que foram quase exclusivamente contaminadas por relação heterossexual. Entre elas, 50,7% tinham aids, as demais infecção pelo HIV. Grande parcela era procedente de municípios com menos de 100.000 habitantes, e sobrevivia com menos... / AIDS represents the most important disease of the end of the 20th century. Epidemiological indicators show that AIDS has been increasingly involving women since they present biological and social factors that render them more susceptible to the risk of contamination. Scientific advances have led to an increased life expectancy for infected patients because of the use of more adequate treatment, so that the quality of life has been a frequent preoccupation among contaminated subjects. The objective of the present study was to assess HIV-infected women in terms of their sociodemographic, epidemiological and clinical characteristics, their quality of life using the HAT-QoL scale, and the influence of the above characteristics on their quality of life. To assess quality of life, we used the instrument denoted HAT-QoL, developed for HIV-infected subjects, which consists of 42 questions divided into nine domains: general activities, sexual activity, preoccupation with secrecy about the infection, preoccupation with health, financial worries, satisfaction with life, questions concerning medication, and trusting one’s physician. The study was conducted on 73 HIV-infected women followed up at the Special Infectious and Parasitic Diseases Outpatient Clinic of the University Hospital, Faculty of Medicine of Botucatu, SP. Most women were younger than 39 years, were housewives, had eight years of schooling or less, and had been almost exclusively contaminated through a heterosexual relation. Of these, 50.7% had AIDS, and the remaining ones were infected with HIV. A large proportion came from municipalities with less than 100,000 inhabitants and survived on less than a minimum wage (R$ 151.00 at the time of the study). Approximately 50% of the women had been aware of their disease for at least four years and 83.6% were taking antiretroviral... (Complete abstract click electronic access below)

<b>Background:</b> Women who inject drugs face vast disparities in health outcomes relative to their counterparts in the general population, most notably in HIV. Intimate partner violence (IPV) victimisation has a detrimental individual effect on women's HIV risk behaviour. Furthermore, IPV often co-occurs with substance use and poor mental health among women in high-income countries, but little is known about the cumulative and interactive effects of these conditions on women's HIV risk behaviour in low- and middle-income countries. This thesis applied an ecological approach guided primarily by syndemics theory to understand influences on women's HIV behavioural outcomes. It examined associations and mechanisms linking IPV, substance use, and depression, with HIV sexual and injecting risk outcomes in the first quantitative study of Indonesian women who inject drugs, the Women Speak Out study. <b>Methods:</b> This study combined community-based participatory approaches and extensive formative research with quantitative survey methods. 731 women, ≥18 years of age, and injecting illicit drugs in the preceding year were recruited using respondent-driven sampling (RDS) from urban settings in Greater Jakarta and Bandung, Indonesia. Network characteristics of the sample were assessed using the RDS software package for Stata 14. Data were analysed using multivariate logistic regressions, marginal effects models, and interaction analyses on the additive and multiplicative scales. The study was conducted in collaboration with the Indonesian Drug User Network. <b>Results:</b> Paper 1: Past-year IPV victimisation doubled the odds of engaging in one or more sexual HIV risk behaviours. Several covariates were associated with higher odds of sexual risk behaviour: HIV-positive status, non-injection crystal methamphetamine (crystal meth) use, low educational attainment, younger age, and being single. Co-occurrence of psychological, physical and/or injurious, and sexual forms of IPV had cumulative effects: sexual risk behaviour was reported by 62% of women who did not experience any form of IPV, but increased to 89% among those exposed to all three forms. Paper 2: Past-year IPV elevated women's odds of receptive syringe sharing. These effects remained after controlling for socio-demographic confounders. Two covariates, injecting illicit pharmaceuticals (vs heroin only) and housing instability and/or homelessness, remained associated with receptive syringe sharing in multivariate analyses. Paper 3: More than 1 in 4 women experienced concurrent IPV, depressive symptoms, and crystal meth use. All three exposures had independent negative effects on HIV sexual risk outcomes. The co-occurrence of all three factors produced a 4-fold increase in rates of survival sex work, 5-fold increase in STI symptomatology, and a 7-fold increase in inconsistent condom use. The joint effect of depressive symptoms and crystal meth use together was greater than the product of the estimated effects of each exposure alone on STI symptomatology, indicating an interaction on the multiplicative scale. Statistically-significant positive additive interaction was detected between IPV victimisation and crystal meth on inconsistent condom use; depression and crystal meth on STI symptomatology and on survival sex work; and IPV and depression on STI symptomatology and survival sex work. <b>Conclusion:</b> This thesis provides new evidence of the individual and cumulative effects of IPV, methamphetamine use, and depression on HIV risk outcomes among Indonesian women who inject drugs. The interaction analyses are the first to empirically test the assertion that these co-occurring conditions interact synergistically to increase drug-using women's HIV risk. This thesis furthers our understanding of how syndemics function within women who inject drugs to produce health disparities, and contributes to the problem theory for HIV risk behaviour in this population. The findings of this study have great public health significance and important implications for future longitudinal research, interventions, and policy.