Orientadores: Eliana Amaral, Maria Yolanda Makuch / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-07T13:33:28Z (GMT). No. of bitstreams: 1 Rossi_AndreadaSilveira_D.pdf: 2215950 bytes, checksum: c190d83a71722140f11b48daa634163e (MD5) Previous issue date: 2010 / Resumo: Objetivo: Identificar quais Serviços de Reprodução Assistida (SRA) e Serviços de Assistência Especializada em HIV e Aids (SAE) do Sistema de Saúde Pública do Brasil, que oferecem atendimento a pessoas vivendo com HIV com desejo reprodutivo e descrever as vivências, informações adquiridas e barreiras encontradas pelos gestores de programas, profissionais de saúde e usuários, relacionados a essa demanda. Metodologia: Estudo descritivo, de corte transversal através de entrevistas telefônicas com 69 gestores dos programas de saúde da mulher (PSM) e 69 de DST/Aids, estaduais e municipais associado a estudo de casos através de entrevistas semi-estruturadas com profissionais e usuários soropositivos de um serviço de reprodução assistida (SRA) e um serviço de atenção especializada em HIV/Aids (SAE) por região geográfica do país. Foi realizada análise descritiva dos dados quantitativos e análise temática do conteúdo para os dados qualitativos. Resultados: Foram realizadas 64 entrevistas com gestores dos PSM, sendo identificado apenas um SRA universitário que atendia casais soropositivos. Nas 63 entrevistas realizadas com gestores dos Programas de DST/Aids, constatou-se que 64% dos SAE estaduais e 73% dos municipais ofereciam orientação reprodutiva. As dificuldades relatadas pelos gestores para não oferecimento de apoio à reprodução incluíram falta de decisão política, de recursos humanos e financeiros. Nas entrevistas com os profissionais dos seis SAE visitados, foi observado que o foco dos atendimentos era na prevenção, principalmente através do uso do preservativo. A falta de encaminhamentos apropriados e a desatualização do conhecimento científico foram frequentes nos relatos dos profissionais dos serviços. A dificuldade em falar sobre o desejo reprodutivo nas consultas foi observada nas falas dos profissionais e também dos usuários. Para os últimos, isso esteve associado ao medo da discriminação e do preconceito. Entretanto, através da 47 entrevistas realizadas com usuários, o desejo de ter filhos foi vivenciado de maneira natural e expresso independentemente de se ter ou não parceiro fixo, mas, para aqueles que possuem parceiros fixos, o fato de não ter filhos da atual união pareceu aumentar a intenção reprodutiva. Conclusão: Os resultados sugerem a existência de demanda reprimida para reprodução de casais vivendo com HIV, a falta de aconselhamento reprodutivo nos SAE e de investimento em SRA que atenda a essa população, havendo um único SRA universitário no país que oferece esse tipo de atendimento. A falta de integração entre os vários setores sugere a ausência de políticas públicas voltadas para o aconselhamento reprodutivo e a necessidade de diretrizes nacionais específicas voltadas para a redução da transmissão do HIV durante todo o contexto reprodutivo / Abstract: Objective: To identify assisted reproductive services(ARS) and specialized HIV/AIDS services within the Brazilian public health system that provide care to people living with HIV who desire a child and describe the experience, the information, and the barriers encountered by program managers, healthcare professionals and users with respect to this demand. Methods: A descriptive, cross-sectional study in which 69 women's healthcare program managers and 69 STD/AIDS program managers at both state and municipal level were interviewed by telephone, in association with a case study conducted through semistructured interviews with professionals and users of one ARS service and one HIV/AIDS service in each geographical region of the country. Descriptive analysis of the quantitative data and thematic content analysis of the qualitative data were performed. Results: Sixty-four interviews were conducted with women's healthcare program managers. Only one university ARS provided care to seropositive couples. Of the 63 interviews carried out with STD/AIDS program managers, 64% of the state and 73% of the municipal HIV/AIDS services were found to offer reproductive counseling. The difficulties offered by managers as reasons for not providing reproductive support included a lack of political decision and of human and financial resources. At the six HIV/AIDS services the professionals revealed that the focus of consultations was on the prevention, lack of appropriate referrals and outdated scientific knowledge were frequently reported. Difficulty in discussing reproductive issues was perceived in the interviews with the professionals and also with the users. In the latter case, this was associated with a fear of discrimination and prejudice. Nevertheless, as shown in the 47 interviews conducted with users, the desire to have a child was experienced as a natural part of life and was expressed irrespective of whether the individual had a steady partner or not; however, in the former case, the fact of not having a child with the individual's current partner appeared to increase the desire for a child. Conclusion: These findings suggest the existence of a repressed demand for reproduction of PLWHA and lack of reproductive counseling was observed at all HIV/Aids specialized services, as well as investment in ART services to be provided to HIV-positive couples, based on the finding that only one university ART service in the country offers this type of care. Lack of integration between the various sectors suggests an absence of public policies on reproductive counseling and a need for specific national guidelines aimed at reducing HIV transmission within the whole context of reproduction / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia

本論文藉由艾德蒙．懷特<已婚男人>愛滋書寫裡、對男同志性愛/死亡在愛滋年代的辨證關係，探討愛滋文學所能扮演的文化功能。第二章、利用傅柯式圓形監獄概念衍生下主體自我內化規訓，討論男同志性愛原先具有的顛覆本質，如何隨著80年代、HIV病毒出現，在生物醫學論述下對男同志進行”再次病理化”的辨證關係。 第三章參考喬瑟夫．凱迪在1993年發表的文章、 分類愛滋書寫為深刻書寫和反深刻書寫，討論<已婚男人>裡愛滋深刻書寫裡、藉由呈現詭異疾病身體來製造驚嚇感、引發讀者對於愛滋議題另一層次的反思。第四章、則是探討<已婚男人>呈現無病徵的衣櫃身體、其造成主體／客體在視覺上/心理上、介於有病/無病的模糊詭譎狀態，可以被視為愛滋文學、一種提供讀者在愛滋年代裡、在絕望中仍可懷抱希望的正面力量。透過以上探討、艾德蒙．懷特＜已婚男人＞豎立愛滋書寫之中、呈現男同志文化與愛滋病複雜關係的傑出作品。 / This study discusses Edmund White’s AIDS writing in his The Married Man, a fiction that depicts the issue of gay sex and death in the age of the Epidemic. In chapter two, I intend to discuss about how biomedical discourse of HIV/AIDS fosters a Focauldian apparatus of panoptical surveillance and self-discipline in relation to gay sex. With the advent of HIV virus, the once subversive lifestyle of gay sex becomes more problematic. In chapter three, I attempt to employ Joseph Cady’s definition of AIDS writings as either immersive or counter-immersive, and argue that Edmund White’s The Married Man should be viewed as an immersive AIDS writing wherein the ugliness of the grotesque body is used as a literary weapon to engender its readers a sense of shock. In chapter four, I contend Austin’s HIV asymptomatic/closet body in The Married Man should be viewed as an ambiguous symbol by which a dialect between hope (future) and despair (no future) is discussed. To conclude, Edmund White’s The Married Man, a subversive text as it is, thus stands as a masterpiece of AIDS writing not only explicitly depicts the history of HIV/AIDS of the 1990s but that promises its gay readers a potentiality of hope for the misty future.

Made available in DSpace on 2014-06-11T19:29:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-04-02Bitstream added on 2014-06-13T18:59:13Z : No. of bitstreams: 1 brumatti_pap_me_fran.pdf: 442197 bytes, checksum: a3ddbc67e29611579ef172cd02818236 (MD5) / El presente estudio trata del perfil socio-demográfico y del mundo del trabajo de las personas portadoras del virus HIV/ SIDA, usuarias del Programa Municipal de DST/ SIDA de Catanduva/ SP. Inicialmente se discute la centralidad de trabajo en la vida del hombre y la enfermedad como una de las expresiones del problema social, foco del trabajo de la asistente social. En seguida problematiza el avance y como se enfrenta la epidemia de SIDA en Brasil y en el mundo, considerando el estigma que la enfermedad acarrea. El trabajo de campo fue realizado a partir de la definición de criterios para la selección de los sujetos: ser portador del vírus HIV, estar en control con los profesionales del Programa, y pertenecer al rango de edad entre los 25 a 49 años de edad. Con la ayuda de la asistente social y de la psicóloga del referido servicio, fueron aplicados cuestionarios a 45 sujetos: 28 hombres y 17 mujeres. Las cuestiones abordararon aspectos socio-demográficos (naturalidad, lugar de residencia, escolaridad), tiempo de diagnóstico y tratamiento con medicamentos ARV, percepción de las condiciones de salud para el trabajo, tipo de ocupación de los sujetos, historia de contribución al Seguro Social, licencias de trabajo para tratamiento de salud, renta actual y vivencia de situaciones de prejuicios o discriminación en el ambiente de trabajo debido a la situación sorológica. Los resultados demostraron que la gran mayoría de los sujetos es natural de la microregión de Catanduva y presenta baja escolaridad, siendo que gran parte de ellos tiene conocimientos de la sorologia positiva para el vírus HIV hace más de 6 años y usa medicamentos ARV. Muchos perciben una mejoría de las condiciones de salud después de haber iniciado el tratamiento, incluso para poder realizar el mismo trabajo que tenían en la época del diagnóstico, pero esto no garantiza el acceso al trabajo...(Complete abstract, click electronic access below) / O presente estudo trata do perfil sócio-demográfico e do mundo do trabalho de pessoas portadoras do vírus HIV/AIDS, usuárias do Programa Municipal de DST/AIDS de Catanduva/SP. Inicialmente discute-se a centralidade do trabalho na vida do homem e a doença como uma das expressões da questão social, foco do trabalho do assistente social. Em seguida problematiza o avanço e o enfrentamento da epidemia de AIDS no Brasil e no mundo, considerando o estigma que a doença carrega. O trabalho de campo foi realizado a partir da definição de critérios para a seleção dos sujeitos: ser portador do vírus HIV, estar em acompanhamento dos profissionais do Programa, e pertencer à faixa etária de 25 a 49 anos de idade. Com o auxílio da assistente social e da psicóloga do referido serviço, foram aplicados questionários a 45 sujeitos: 28 homens e 17 mulheres. As questões abordaram aspectos sócio-demográficos (naturalidade, local de moradia, escolaridade), tempo de diagnóstico e tratamento com medicações ARV, percepção das condições de saúde para o trabalho, tipo de ocupação dos sujeitos, história de contribuição com a Previdência Social, afastamentos do trabalho para tratamento de saúde, renda atual e vivência de situações de preconceito ou discriminação no ambiente de trabalho em decorrência da situação sorológica. Os resultados demonstram que a grande maioria dos sujeitos é natural da micro-região de Catanduva e apresenta baixa escolaridade, sendo que grande parte deles tem conhecimento da sorologia positiva para o vírus HIV há mais de 6 anos e faz uso de medicamentos ARV. Muitos percebem melhoria das condições de saúde após início do tratamento, inclusive para realizar o mesmo trabalho da época do diagnóstico, o que não significa garantia de acesso ao trabalho. Grande parte dos sujeitos, em algum momento contribuiu com a Previdência Social. Entre as ocupações mais afetadas pela epidemia destacam-se os pedre.

Department of Advanced Nursing Science / MCur

PhDH / Department of Public Health / Background: Since the introduction of three-tiered systems appointments, there are a large number of missed appointments among Human immunodeficiency virus-positive clients on Antiretroviral. However, no one knows why these clients missed their scheduled times. Missing of appointments predicts poor adherence and is associated with poor clinical outcomes. Objectives: The proposed study aimed at developing a strategy for reducing the missing of appointments among adults on Antiretroviral Therapy in the Limpopo Province, South Africa. The objectives of the study are to determine patients’ behaviour, the socio-environmental and economic factors that contribute to the missing of appointments and develop strategies to enhance compliance with appointments by Human immunodeficiency virus-positive clients on Antiretroviral therapy in the Limpopo Province. Method: A qualitative research design was used to address the study objectives. Non-probability purposive sampling was used to sample health care centres in Limpopo Province, patients, Professional Nurses and Community Health Workers. Individual interview and focus group discussions strengthened the triangulation of data obtained from the participants. Creswell’s model provided details for data analysis and interpretation. Trustworthiness and Ethics: Measures to ensure data quality, such as credibility, dependability, conformability and transferability, were observed. The researcher ensured compliance with ethical standards to protect the rights of the participants. Approval for this study was obtained from the University of Venda Research Ethics Committee and the Limpopo Department of Health Research Ethics. Results: The study revealed various factors that contribute to the missing of appointments by Human immunodeficiency virus positive-clients on Antiretroviral Therapy. Specific socioeconomic, behavioural, environmental and health service-related factors appear to prevent adherence to appointments. These factors include a lack of family support and client engagement, the absence of financial means, and cultural and religious beliefs. Lack of client involvement in planning their care and poor referral of clients to community health workers were ranked high as being the most contributing factors to clients missing their appointments. Strategy development: Phase 2 of this study dealt with the development of the strategy aimed at reducing the missing of appointment by adults on Antiretroviral Therapy based on the findings of the study. The strengths, weaknesses, opportunities and threats matrix was triangulated in Political, Environmental, Social, Technological and Legal analysis to develop this approach to reduce the missing of appointments among adults on Antiretroviral therapy. A transtheoretical framework illustrated how to implement the strategy. Validation of the developed strategy ensured that the system is free of errors and checked the applicability of the strategies utilising a quantitative design. A simple random sampling approach was used to select the population to participate in this study using the questionnaire developed by the researcher. Almost all respondents agreed that the strategy would facilitate reduced missing appointments by adults on Antiretroviral therapy. Recommendations: Clients involvement and engagement throughout the process of a treatment plan is essential to identify some of the barriers that might contribute to poor adherence to appointment by clients on Antiretroviral therapy. Community health workers and nurses should be capacitated with knowledge and skills to identify the clients at risk of defaulting treatment and appointments and provide counselling that will facilitate behaviour modifications. / HWSETA

MSc (Microbiology) / Department of Microbiology / Background: Patients on antiretroviral (ART) are expected to be at least 95% adherent to their treatment, as this will increase their chances of achieving treatment success (maximum and durable suppression of HIV-1 viral load); non-adherence may lead to the development of HIV drug resistance, which may lead to virologic failure and treatment failure. Therapeutic drug monitoring (TDM) has been reported to be the most efficient method to assess treatment adherence in HIV individuals, since it quantifies the concentration of ARTs in biological matrices. This is very effective when using a robust technique such as liquid chromatography tandem mass spectrometry (LCMS/MS), which has played a significant role in the evaluation and interpretation of bioavailability, bioequivalence and pharmacokinetic data. Even with patient adherence, various intra-individual factors have an influence on the expression and function of the genes responsible for the transport (MDR1) and metabolism (CYP2B6) of Efavirenz (EFV). This may lead to single nucleotide polymorphisms (SNPs) in these genes, and this may affect the way antiretrovirals (ARVs) are metabolized. The aim of this study was to evaluate the EFV concentration in plasma to assess patient adherence to treatment and correlate this with genomic occurrences in human and viral genes. Hypothesis: The concentration of ARVs in patient plasma can be used to estimate adherence to treatment; while ARVs’ transport and metabolism can affect bioavailability in a patient’s system. Research Question: Can EFV concentration in plasma be used to estimate patient adherence to treatment? Can transport and metabolism of EFV affect their bioavailability in the patient’s system? Objectives: To determine EFV concentration in plasma to assess patient adherence to treatment and correlate this with genomic occurrences in human genes and viral genes. Methodology: Twenty blood samples were collected from HIV positive individuals before treatment initiation (baseline) and between six to twelve months following treatment initiation (follow-up). The concentration of EFV in patient plasma was measured by LC-MS/MS technique. To infer other factors influencing patient pharmacokinetics output, drug resistance and human genetic characteristics were analyzed. A 1.65kb fragment of the HIV-1 Pol gene was amplified and sequenced to determine drug resistant mutations; while 363bp and 289bp of the MDR-1 and CYP2B6 human genes respectively, were also amplified and sequenced to determine polymorphisms in the transport and metabolism genes. Obtained sequences were manually edited and analyzed using Geneious Version 11.1.5 software. The Stanford HIV Drug Resistance database was used for drug resistant mutation (DRMs) analysis and MDR1 and CYP2B6 test sequences were compared with variant reference sequences to detect the presence of any SNPs. Results: The plasma EFV concentration at baseline and follow-up range was as follows: 0 – 1183ng/ml and below limits of quantification (BLQ) to 15,670ng/ml, respectively. At baseline, 0ng/ml is the expected plasma EFV concentration for patients about to commence treatment; however, two out of twenty patients had 769.9 and 1,183ng/ml drug levels in their system. Post treatment, plasma EFV levels in patients are expected to range from 1,000 – 4,000ng/ml, however, of the twenty patients, two had <1,000ng/ml, and three patients had >4,000ng/ml in their plasma. For Pol amplification, 35% (7/20) were positively amplified at baseline and 25% (5/20) were positively amplified from the follow-ups; 100% (20/20) samples were amplified for both CYP2B6 and MDR1 genes. Detection of drug resistance in the baseline Pol sequences revealed the absence of major mutations in both NRTI and NNRTI drug classes. The G516T polymorphism was present in 15% of the study participants while the homozygous GG and heterozygous GT genotype was present in 25% and 40% of the study participants, respectively. Allele determination was impossible in 20% of the samples, due to the poor nature of the sequence. The homozygous TT variant polymorphism at position 3435 was absent in the entire population, however, the CC and CT genotype was present in 15% and 85% of the study participants respectively. Analysis of EFV concentration in close proximity with the human genetic characteristics reveals that the presence of a Single Nucleotide Polymorphism affects the pharmacokinetic output observed. Discussion and Conclusion: Post treatment, 90% of the study participants indicate adherence to treatment, with only 10% of them having lower than expected EFV concentrations, implying they were non-adherent to their treatment. However, because plasma drug concentrations only reflect a patient’s adherence pattern for a few hours to at most two days, the adherence patterns of these individuals cannot be concluded with certainty. Using plasma EFV as a biomarker to evaluate adherence to treatment in HIV seropositive individuals is a feasible technique, however, its application in non-research settings is still a drawback due to the cost of the method. Characterizing patient inter-individual differences should be taken into consideration, especially since any polymorphism in their transporter and metabolizing genes may influence their overall treatment success. / NRF

Title on printed copy differs slightly from ETD. Title on printed copy: A critical analysis of HIV/AIDS policy development and implementation at selected Ugandan universities / The main objectives of the study were to analyse the process involved in HIV/AIDS policy development and implementation at two selected universities in Uganda. The rationale for the study was to describe the policy development process and to identify how such institutional policies can be planned, operationalised, monitored and evaluated. The study used a qualitative approach which involved key informant interviews and focus group discussions. The selected institutions were Makerere University Kampala (MUK)and Mbarara University of Science and Technology (MUST). The findings show that MUST have a comprehensive HIV/AIDS Institutional Policy (HIP) which followed several stages during policy development. The basic stages identified were policy formulation, policy adoption, policy implementation and policy evaluation. The findings also show that MUST have a comprehensive implementation plan. In contrast, MUK had no record of the HIV/AIDS institutional policy development process. However, MUK had implemented the policy successfully through the University Hospital and Gender Mainstreaming Division. / Social Work / M.A. (Social Behaviour Studies in HIV/AIDS)

The aim of this study was to assess the extent on how effective was the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV) infection at Oshakati District Health Centre. Explanatory survey was used to conduct the research. A total of 160 nurses experienced in prevention of mother-to-child transmission and women who attended antenatal care and post natal care services participated in the study. Respondents expressed unsatisfactory with the promoting involvement of male partners, high quality voluntary counselling and testing services, couple counselling and testing, integration of Highly Active Antiretroviral Therapy services, administration of short course of Zidovudine to pregnant mothers and the provision of antiretroviral drugs to infants. Therefore, promoting involvement of male partners, couple counselling and testing, administration of short course of Zidovudine to pregnant mothers and educating women about exclusive breastfeeding prior to delivery are some of recommendations for effective prevention of mother-to-child transmission of HIV infections. / Health Studies / (M.A. (Public Health))

Title on printed copy differs slightly from ETD. Title on printed copy: A critical analysis of HIV/AIDS policy development and implementation at selected Ugandan universities / The main objectives of the study were to analyse the process involved in HIV/AIDS policy development and implementation at two selected universities in Uganda. The rationale for the study was to describe the policy development process and to identify how such institutional policies can be planned, operationalised, monitored and evaluated. The study used a qualitative approach which involved key informant interviews and focus group discussions. The selected institutions were Makerere University Kampala (MUK)and Mbarara University of Science and Technology (MUST). The findings show that MUST have a comprehensive HIV/AIDS Institutional Policy (HIP) which followed several stages during policy development. The basic stages identified were policy formulation, policy adoption, policy implementation and policy evaluation. The findings also show that MUST have a comprehensive implementation plan. In contrast, MUK had no record of the HIV/AIDS institutional policy development process. However, MUK had implemented the policy successfully through the University Hospital and Gender Mainstreaming Division. / Social Work / M.A. (Social Behaviour Studies in HIV/AIDS)

MCur / Department of Advanced Nursing Science / Survival of children with HIV/AIDS has increased considerably with the use of effective antiretroviral therapy. However, the benefits of this therapy are limited by the difficulty of adherence to the treatment. This study sought to explore the role of professional nurses on anti-retroviral therapy adherence among children in Lejweleputswa district: Free State, South Africa. An exploratory descriptive qualitative research design was used to identify and describe role of professional nurses toward anti-retroviral therapy adherence among children. Population for this study included seventeen (17) professional nurses working in four purposively sampled Primary Health Care clinics invited to participate in the study. Four focus group discussions were conducted in which each group had 6 participants. The transcribed data was analysed using the framework approach of data analysis. Professional nurses in Lejweleputswa district report poor knowledge of parents/caregivers of children, perceived poverty, stigma and discrimination, inappropriate care approaches, and parental dynamics as factors influencing poor ART adherence. Recommendations for enhancing children ART adherence levels in Lejweleputswa district included: mainstreaming adherence counselling in children ART and adopting a comprehensive family centered care approach were identified as measures for improving children ART adherence. Other measures included integration of ART services into Primary Health Care (PHC) services, parental empowerment, development of a programme to reduce stigma and discrimination in the community.