Thesis advisor: Kevin J. Mahoney / Recent empirical epidemiological and behavioral research has indicated that some secondary intervention preventions (e.g., condom use, HIV-disclosure, serosorting, etc.) might not be suitable for all HIV-infected gay and bisexual men, particularly for those who engage in multiple episodes of unprotected anal intercourse (UAI). The purpose of this dissertation was to answer the primary research question: What are the psychological, behavioral and contextual factors associated with HIV-infected men who have sex with men (MSM) who engage in risky sexual behavior? A qualitative descriptive approach was used to conduct a content analysis of 14 in-depth, semi-structured interviews and to provide a description of the lives of MSM who do not consistently use traditional secondary risk behavior strategies (e.g., safer-sex negotiation, condom use, etc.) to reduce HIV transmission among sexual partners, particularly those partners who are HIV-uninfected or whose HIV status is unknown. Risky sexual behavior was defined by HIV-infected MSM who had engaged in multiple episodes of UAI in the past three months. These interviews gathered preliminary data on the feasibility and acceptability of secondary HIV behavioral prevention strategies for MSM who engage in very risky sexual behavior. In addition, these data have identified descriptive themes that could be used to augment traditional secondary HIV invention preventions, creating new and specific risk-reduction strategies for this very high-risk group. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

The purpose of this study was to examine general life stressors and emotion-focused and problem-focused coping strategies as prospective predictors of psychological distress in a sample of 209, low-income, urban, HIV-positive, African-American women. A secondary aim was to determine whether coping strategies mediated the relationship between life stressors and psychological distress. This study involved a secondary data analysis from a longitudinal National Institutes of Health (NIH) funded, randomized, family therapy efficacy study (Structural Ecosystems Therapy [SET]; Szapocznik et al., 2004). Participants completed self-report measures, including the Brief Symptom Inventory, Brief Cope (adapted), and Difficult Life Circumstances, as measures of psychological distress, problem-focused and emotion-focused coping, and general life stressors, respectively. These measures were completed at baseline, and at 3, 6, 9, and 18-month follow-up assessments. Results from longitudinal, cross-lagged, path model analyses provided some modest support regarding the hypothesis relating amount of life stressors to subsequent level of psychological distress symptoms. Results of the coping path models failed to support the hypotheses relating problem-focused coping and emotion-focused coping to subsequent distress (Hypotheses 2 and 3). Furthermore, the lack of direct associations between coping strategies and distress prohibited the examination of problem-focused and emotion-focused coping strategies as possible mediators in the relationship between life stressors and psychological distress. Results and implications are discussed.

Human immune deficiency virus (HIV) and Acquire immune deficiency syndrome (AIDS) is a worldwide epidemic that impacts individuals physically, socially, and psychologically, and the rates of HIV/AIDS in youth are rising. Antiretroviral treatments have drastically prolonged life in individuals with HIV/AIDS; however, this type of treatment requires strict medication adherence. Many psychosocial factors impacting antiretroviral adherence have been explored, yet very little has been investigated regarding body image. This study investigated the potential impact of body dissatisfaction on antiretroviral medication adherence in adolescents with HIV. Seventy five male and female youth were administered questionnaires on the constructs of body dissatisfaction and medication adherence. Results support the hypothesis that body dissatisfaction negatively impacts medication adherence; yet, its effect in this sample was small (R2 = .06; F(1,61) =3.87, p =.05). Additionally, it was predicted that gender would moderate the nature of the relation between body dissatisfaction and medication adherence, given the disparate societal presentations of ideal body types among genders. However, within the current sample, gender did not have an effect on this relation. Furthermore, this study was interested in exploring if body dissatisfaction within a population of HIV-infected youth was best explained by specific body dissatisfaction with areas of the body associated with lipodystrophy or lipoatrophy syndromes. Due to a very small presentation of these syndromes in the final sample (n = 4), it was not surprising that body dissatisfaction was not best explained through specific dissatisfaction with these body parts. However, dissatisfaction with muscularity in general, was predictive of general body dissatisfaction regardless of gender. A discussion of these findings is included. This study is one of the first of its kind to explore the potential detrimental effects of body dissatisfaction in HIV infected youth.

Magister Public Health - MPH / Despite the effectiveness and scale-up of antiretroviral treatment (ART), HIV-Associated neurocognitive disorders (HAND) still persist. Currently no gold standard tool exists to detect all forms of HAND, including major and minor cognitive impairments. In light of this, a newly developed screening tool was conceptualised, namely the Quick Paediatric Neurocognitive Screening tool (QPNST). The QPNST has been developed to detect HAND in perinatally HIV-infected children aged 5-10 years.

Thesis (MScMedSc)--Stellenbosch University, 2012. / Bibliography / ENGLISH ABSTRACT: Background: In the era of antiretroviral therapy (ART), the risk of acquired immune deficiency syndrome (AIDS) related deaths has decreased and people living with Human Immunodeficiency Virus (HIV) now have prolonged life spans. However, an increasing trend of non-AIDS associated deaths has been reported despite adequate control of viral loads. HIV infection is established as a chronic inflammatory condition which is associated with an increased risk for thrombosis. Thus HIV infected patients are at a higher risk of developing cardiovascular disease (CVD) and other inflammatory-associated complications. Inflammation is linked with thrombosis and promotes the formation of thrombin, which plays an important role in platelet activation. Furthermore, activated platelets have been shown to play a key role during infection and the inflammatory process, particularly by mediating interactions between cells of innate immunity. Soluble markers of platelet activation have been shown to be increased in HIV-infection. However, these have not been well documented by flow cytometry. P-selectin CD62P is stored in the alpha granules of platelets and is expressed on the surface only upon platelet activation. This facilitates interaction with other blood cells and the endothelium. Activated platelets may play a role in HIV-induced atherosclerosis through the expression and release of mediators that induce endothelial activation and support the adhesion of leukocytes to the inflamed vessel wall. Fibrinogen is a precursor of the blood coagulatory protein fibrin and the degradation of fibrin to D-dimer is a measure of the formation and the subsequent dissolution of blood clots. In HIV infected patients, chronic inflammation induces the up-regulated expression of tissue factor (TF) on monocytes which triggers the activation of the clotting cascade and increases the level of D-dimers. Methods: This pilot study consisted of ART naïve patients and all platelet flow analyses were carried out on whole blood. In this study, a total of 57 adult South Africans were recruited from a clinic in the Western Cape. These included 32 HIV positive patients and 25 HIV negative individuals. The levels of platelet activation and platelet function were investigated using a novel platelet cytometry assay. The method was optimized to ensure minimal platelet activation: no centrifugation or red blood cell (RBC) lysis steps were performed. The platelet-specific markers CD41a and CD42b were used to ensure gating on platelets only. CD62P expression was used to evaluate platelet activation and these levels were correlated with Fibrinogen, hsCRP, Ddimer, CD4 counts and viral load. Furthermore, platelet function was evaluated by investigating the response of platelets to endogenous agonists which included adenosine diphosphate(ADP) and arachidonic acid (AA) at varying concentrations. Results:This study demonstrated higher baseline levels of CD62P expression in treatment naïve HIV positive patients as compared to uninfected controls (mean %CD62P 71.74 ± 2.18 vs control 54.52 ± 2.42; p=<0.0001). In addition it was shown that %CD62P expression correlated directly with platelet counts (r=0.374, p=0.042). Platelet counts showed an inverse correlation with viral loads (give values) Fibrinogen levels correlated with the absolute WCC (r=0.659, p=0.0021); absolute neutrophil count (r=0.619, p=0.0105); absolute monocyte count (0.562, p=0.0235) and hsCRP (r=0.688 p=0.0011). In addition, fibrinogen showed a strong negative correlation with CD4 counts (r=-0.594, p=0.0014) and therefore, may be a valuable marker of both disease progression and risk of thrombosis in treatment naïve HIV positive patients. HsCRP levels correlated with the absolute neutrophil counts (r=0.392, p=0.0005). The HIV Group showed an overall hyper-response to ADP at a concentration 0.025 μM as compared to uninfected controls (62.34 ± 9.7 vs control 36.90 ± 5.7, p=0.0433). Conclusions: In this study we describe a novel Flow Cytometry technique that may be used to evaluate the levels of platelet activation and platelet function in HIV infected patients. In addition we report a cost-effective panel in the form of fibrinogen, WCC and platelets that may be valuable in predicting the progression of HIV infection to AIDS or other inflammatory- associated complications in treatment naïve HIV infected patients. Platelet counts showed an inverse correlation with viral loads and a direct correlation with the level of activated platelets. These findings taken together suggest the potential prognostic value of platelet activation and platelet counts in the context of asymptomatic HIV infected patients. Our findings suggest WCC and Fibrinogen may be used to evaluate the inflammatory profile of individual HIV infected patients. This may have a direct impact on HIV patient management prior to initiation of antiretroviral therapy and valuable in monitoring responses to treatment. Further, we present a novel flow cytometry based platelet functional assay and suggest the use of ADP at a concentration of 0.025 μM to evaluate platelet function optimally in HIV infected patients. The utilization of the novel Flow Cytometry technique as described in this study would add significant value in the assessment of thrombotic risk and disease progression in HIV infected patients and may additionally prove to be of value in other chronic inflammatory conditions. / AFRIKAANSE OPSOMMING: Voorkennis: In die era van antiretrovirale terapie (ART), het die risiko van vigs-verwante sterftes verminder en mense wat nou met volle naam (MIV) leef, het ‘n verlengde lewensduur. Nogtans, word 'n toenemende neiging van nie-vigs geassosieer sterftes berig wat hoofsaaklik toegeskryf word aan trombotiese toestande. MIV-infeksie word as 'n chroniese inflammatoriese toestand beskou met ʼn verhoogde trombose risiko geassosieer word. Dus, MIV-besmette pasiënte het 'n hoër risiko om kardiovaskulêre siekte (CVD) te ontwikkel ongeag of hulle ARV naïef is of op behandeling is nie. Inflammasie word geassosieer met trombose en bevorder die vorming van trombien, wat 'n belangrike rol in plaatjie aktivering speel. Verder, word daar bewys dat geaktiveerde bloedplaatjies 'n belangrike rol speel tydens infeksie en die inflammatoriese proses.Hulle bemiddel interaksies tussen die selle van ingebore immuniteit. Daar word bewys dat oplosbare merkers van plaatjie aktivering verhoog is in MIV-infeksie, maar die bewyse is nie so goed gedokumenteer deur vloeisitometrie nie. P-selectin (CD62P) word gestoor in die alfa korrels van plaatjies en word uitgedruk op die oppervlak slegs wanneer plaatjies geaktivering word; daardeur fasilitering dit die interaksie met ander bloedselle en die endoteel. Geaktiveerde plaatjies kan ook 'n rol in MIV-geïnduseerde aterosklerose speel deur middel van die uitdrukking en vrylating van bemiddelaars wat endoteel aktivering induseer asook die adhesie van leukosiete aan die ontsteekte vat wand ondersteun.. Fibrinogeen, 'n voorloper van die bloed koagulatories proteïen fibrin en die degradasie van fibrin na D-dimeer is' n maatstaf van die vorming en die daaropvolgende ontbinding van bloedklonte. Kroniese inflammasie in MIVbesmette pasiënte, induseer die op-gereguleerde uitdrukking van weefsel faktor (TF) op monosiete wat die aktivering van die stolling kaskade inisieer en die D-dimere vlakke verhoog. Metodes: Hierdie loodsstudie bestaan uit ART naïewe pasiënte en al die plaatjie vloei ontleding was op vol bloed uitgevoer. In hierdie studie, 'n totaal van 57 volwasse Suid-Afrikaners was van' n kliniek in die Wes-Kaap gewerf. Dit sluit 32 MIV-positiewe pasiënte en 25 MIV negatiewe individue in. Die vlakke van plaatjie aktivering en plaatjie funksie was ge ondersoek deur middel van 'n nuwe plaatjie sitometrie toets. Die metode was geoptimaliseer om minimale plaatjie aktivering te verseker: dus geen sentrifugering of volle naam (RBS) liseer stappe was gebruik nie. Die plaatjie-spesifieke merkers, CD41a en CD42b was gebruik om te verseker dat slegs bloedplaatjes gekies word. Die uitdrukking van CD62P was gebruik vir die evaluering van plaatjie aktivering en hierdie vlakke was gekorreleer met fibrinogeen, hsCRP, D-dimeer, CD4- tellings en virale lading. Verder, was plaatjie funksie geëvalueer deur die reaksie van plaatjies aan endogene agoniste wat ADP en AA by wisselende konsentrasies insluit te ondersoek. Results: Hierdie studie het getoon hoër basislyn vlakke van CD62P uitdrukking in behandeling naïewe MIV-positiewe pasiënte in vergelyking met onbesmette beheermaatreëls (beteken% CD62P 71,74 ± 2,18 vs beheer 54,52 ± 2,42, p <0.0001). Daar is ook getoon dat% CD62P uitdrukking direk gekorreleer met plaatjie tellings (r = 0,374, p = 0,042). Plaatjie tellings het 'n omgekeerde korrelasie met virale ladings (gee waardes) fibrinogeen vlakke korreleer met die absolute WCC (r = 0,659, p = 0,0021), absolute neutrofiel telling (r = 0,619, p = 0,0105); absolute monosiet telling (0,562, p = 0,0235) en hsCRP (r = 0,688 p = 0,0011). Daarbenewens, fibrinogeen het 'n sterk negatiewe korrelasie met 'n CD4-tellings (r = -0,594, p = 0,0014) en daarom kan 'n waardevolle merker van beide die siekte en die risiko van trombose in behandeling naïewe MIV-positiewe pasiënte. HsCRP vlakke gekorreleer met die absolute neutrofiel tellings (r = 0,392, p = 0,0005). Die MIV-groep het 'n algehele hiper-reaksie op die ADP by 'n konsentrasie 0,025 μM in vergelyking met onbesmette beheermaatreëls (62,34 ± 9,7 vs beheer 36,90 ± 5.7, p = 0,0433). Gevolgtrekkings: In hierdie studie beskryf ons 'n roman vloeisitometrie tegniek wat gebruik kan word om die vlakke van Plaatjie aktivering en plaatjie funksie in die MIV-besmette pasiënte te evalueer. Verder het ons 'n verslag van 'n koste-effektiewe paneel in die vorm van fibrinogeen, WCC en plaatjies wat waardevol kan wees in die voorspelling van die vordering van MIVinfeksie tot VIGS of ander inflammatoriese-verwante komplikasies in die behandeling naïewe MIV-besmette pasiënte. Plaatjie tellings het 'n omgekeerde korrelasie met die virale laste en 'n direkte verband met die vlak van geaktiveerde bloedplaatjies. Hierdie bevindinge saam, dui op die moontlike prognostiese waarde van Plaatjie aktivering en die plaatjie tel in die konteks van die asimptomatiese MIV-geïnfekteerde pasiënte. Ons bevindinge dui daarop WCC en fibrinogeen kan gebruik word om die inflammatoriese profiel van individuele MIV-geïnfekteerde pasiënte te evalueer. Dit kan 'n direkte impak op MIV pasiënt vooraf aan die inisiasie van antiretrovirale terapie en waardevolle in die monitering van die reaksie op behandeling. Verder bied ons 'n roman vloeisitometrie gebaseer plaatjie funksionele toets en dui op die gebruik van die ADP teen 'n konsentrasie van 0,025 μM plaatjie funksie optimaal te evalueer in MIVgeïnfekteerde pasiënte. Die benutting van die roman vloeisitometrie tegniek soos beskryf in hierdie studie sal 'n beduidende waarde toevoeg in die beoordeling van die die trombotiese risiko en die siekte in MIV-geïnfekteerde pasiënte en kan addisioneel bewys van waarde te wees in 'n ander chroniese inflammatoriese toestande. / National Reserach Foundation

The aim of this study was to explore, describe and interpret the experiences of Immunodeficiency Human Virus (HIV) infected mothers regarding exclusive breastfeeding in the first six months of the infant’s life. This was a qualitative study with phenomenology as a design as the study was about lived experiences. The sample consisted of HIV infected mothers aged 18 years and above who opted for exclusive breastfeeding for the first six months of their infant’s lives. Purposive sampling was used. Data was collected through one to one semi structured interviews of fifteen mothers of babies aged six to twelve months. The study revealed that mothers had both positive and negative experiences which were influenced by among others; the level of support the mothers received, disclosure of HIV status and health education received at the health facility. The findings of the study revealed a low level of understanding of the Infant and Young Child Feeding Policy by health professionals / Health Studies / M.A. (Health Studies)

Bakgrund: På världsbasis lever 36,7 miljoner människor med sjukdomen Humant Immunbrist Virus (HIV). Då forskningen och behandlingen gått framåt från att vara en dödlig till kronisk sjukdom med rätt behandling, kan patienter idag leva ett helt liv. Trots detta bemöts patientgruppen många gånger med stigmatiserande attityder då kunskapen om sjukdomen visat sig vara bristfällig hos hälso-och sjukvårdspersonal. Syftet: Var att beskriva hur patienter med diagnosen HIV upplever bemötandet inom hälso-och sjukvården, samt att granska undersökningsgrupperna i de inkluderade artiklarna. Metod: Litteraturstudie med deskriptiv design. Sökningar utfördes i PubMed och CINAHL. Totalt 14 artiklar med kvalitativ design och två med mixad metod, där endast den kvalitativa delen presenteras i resultatet. Analysmetoden som användes till studien var Evans beskrivande modell. Resultat: Två huvudteman identifierades i studien kunskapsnivå och attitydernas betydelse i mötet. Studien visade att kunskapsnivån har betydelse för bemötandet. Patienterna upplevde att när personal hade högre kompetens och positivare attityder resulterade det i bättre bemötande. Däremot okunskap hos personalen visade sig i form av negativa attityder och rädsla för patientgruppen,vilket resulterade i onödigt lidande och inget förtroende för vården. Undersökningsgruppen presenterades utifrån ålder, kön, antal år med HIV samt geografisk tillhörighet. Slutsatser: Negativa attityder i form av stigmatisering och diskriminering återstår inom hälso-och sjukvården av HIV positiva patienter. Positiva attityder visade sig vara starkt sammankopplat med kunskapsnivån hos personalen. Ämnet behöver därför belysas för att omvårdnaden ska utvecklas och ett professionellt förhållningssätt upprätthållas. / Background: In global basis 36, 7 million people living with the disease Human Immuno deficiency Virus (HIV). As the research and treatment progressed from being a fatal to chronic disease, with proper treatment, patients can now live a full life. Despite this the patient group are treated many times with stigmatizing attitudes as knowledge of the disease shown to be deficient among healthcare personnel. Purpose: Was to describe how patients diagnosed with HIV experiencing the meeting with healthcare personnel, as well as to review the study groups in the included articles. Method: Literature study with descriptive design. Searches were carried out in PubMed and CINAHL. A total of 14 articles with qualitative design and two with mixed method, where only the qualitative part is presented in the results. The analytical method used for this study was Evans descriptive model. Findings: Two main themes were identified in the study, knowledge level and attitude of the significance of the meeting. The study showed that the level of knowledge is important for the meeting. Patients experienced that when personnel had higher skills and more positive attitudes this resulted in better treatment. In contrast, ignorance of the personnel turned out in the form of negative attitudes and fear of the patient group, resulting in unnecessary suffering and no confidence in health care. The study group presented based on age, sex, number of years with HIV and geographic affiliations. Conclusions: Negative attitudes in the form of stigma and discrimination remains in health care of HIV positive patients. Positive attitudes were shown to have a strong correlation level with expertise of the health care personnel. The subject needs to be highlighted in order to developing care and maintain a professional attitude.

The aim of this study was to explore, describe and interpret the experiences of Immunodeficiency Human Virus (HIV) infected mothers regarding exclusive breastfeeding in the first six months of the infant’s life. This was a qualitative study with phenomenology as a design as the study was about lived experiences. The sample consisted of HIV infected mothers aged 18 years and above who opted for exclusive breastfeeding for the first six months of their infant’s lives. Purposive sampling was used. Data was collected through one to one semi structured interviews of fifteen mothers of babies aged six to twelve months. The study revealed that mothers had both positive and negative experiences which were influenced by among others; the level of support the mothers received, disclosure of HIV status and health education received at the health facility. The findings of the study revealed a low level of understanding of the Infant and Young Child Feeding Policy by health professionals / Health Studies / M. A. (Health Studies)

Στην παρούσα μεταπτυχιακή εργασία αξιολογήθηκε η συνδυαστική θεραπευτική φαρμακευτική αγωγή των HIV οροθετικών ασθενών βασιζόμενη σε 2 δείκτες: 1) στο ιϊκό φορτίο VL (Varial Load, copies/ml) που εκφράζει τις συγκεντρώσεις του RNA του HIV στο αίμα και 2) στον αριθμό των CD4 Τ-λεμφοκυττάρων (κύτταρα/mm3) που εκφράζει των αριθμό των κυττάρων τα οποία βοηθούν τον ασθενή να καταπολεμήσει την λοίμωξη. Συγκεντρώθηκαν δεδομένα από 278 ασθενείς και 32 ‘παλιούς’, από όλη την Ελλάδα, για το χρονικό διάστημα 1990-2006 (Πανεπιστημιακό Νοσοκομείο Ρίο). Για καθέναν από τους ασθενείς ελήφθησαν δεδομένα σε φύλλα του excel, μη κατηγοριοποιημένα, και για καθέναν υπήρχαν από 20 έως 100 μετρήσεις. Μια τόσο εκτεταμένη συγκέντρωση δεδομένων για HIV οροθετικούς ασθενείς γίνεται για πρώτη φορά στην Ελλάδα. Η θεραπεία για τον HIV περιλαμβάνει συνήθως 3 ή περισσότερα φάρμακα (HAART). Στην παρούσα μελέτη χρησιμοποιήθηκαν 3 κατηγορίες αντιρετροϊκών φαρμάκων: 1. Νουκλεοσιδικοί αναστολείς της ανάστροφης μεταγραφάσης (NRTIs) (ομάδα πράσινη), (10 φάρμακα) 2. Mη νουκλεοσιδικοί αναστολείς της ανάστροφης μεταγραφάσης (NNRTIs) (ομάδα κίτρινη), (3 φάρμακα) 3. Αναστολείς των πρωτεασών (PIs) (ομάδα μπλέ) (11 φάρμακα) Οι ασθενείς ανάλογα με την αγωγή της πρώτης θεραπείας τους κατηγοριοποιήθηκαν σε ομάδες (4) και σε υποομάδες με βάση τα επιμέρους φάρμακα κάθε ομάδας: Ομάδα πράσινη (ΝRTIs) (72 ασθενείς) Ομάδα πράσινη- μπλε (ΝRTIs-PIs) (139 ασθενείς)και 8 επιμέρους υποομάδες Ομάδα πράσινη- κίτρινη (ΝRTIs-NΝRTIs) (35 ασθενείς)και 2 επιμέρους υποομάδες Ομάδα πράσινη-κίτρινη-μπλε (ΝRTIs-NΝRTIs- PIs) (3 ασθενείς) Οι ασθενείς των ομάδων και υποομάδων μελετήθηκαν ξεχωριστά, χωρισμένοι σε μη-πεπειραμένους (naïve) και σε πεπειραμένους (experienced). Η αξιολόγηση της θεραπείας των ασθενών (κατά ομάδες και υποομάδες) έγινε με βάση:  το % ποσοστό που πέτυχαν ‘μη-ανιχνεύσιμο’ VL≤50, καθώς και VL≤200 και VL≤500, ανά τρείς μήνες (διαγραμματική παρουσίαση).  Το ποσοστό των ασθενών που δεν πέτυχαν VL≤50.  Τον μέσο χρόνο που πέτυχε VL≤50 το 50% των ασθενών (ταχύτητα ανταπόκρισης στη θεραπεία).  Τη συσχέτιση των τιμών VLέναρξης και CD4έναρξης που είχαν οι επιτυχημένοι ασθενείς κατά την έναρξη της θεραπείας (κατηγοριοποίηση σε κλίμακες), καθώς και του CD4 την στιγμή επίτευξης VL≤50, με ταυτόχρονο υπολογισμό των %μεταβολών των VL και CD4. Με βάση τα παραπάνω προέκυψαν τα ακόλουθα: Η λήψη αποκλειστικά NRTIs (ποσοστό αποτυχίας VL≤50 78,5%) ήταν λιγότερο αποτελεσματική σε σχέση με συνδυαστική αγωγή NRTIs-ΡIs (επιτυχία 81,8%), ή με NRTIs-NNRTIs (επιτυχία 81,6%). Για να δράσει η αγωγή με αποκλειστικά NRTIs, απαιτείται μεγαλύτερο διάστημα, στο οποίο μπορεί η τιμή του VL να ελαττωθεί <500, αλλά είναι λιγότερο πιθανό να πέσει <200. Μεταξύ των NRTIs-PIs & NRTIs-NNRTIs λαμβάνοντας υπόψη και τον χρόνο που πέτυχε το 50% των ασθενών, η αγωγή NRTIs-NNRTIs ήταν πιο αποτελεσματική αφού επιτεύχθηκε VL≤50 σχεδόν στο 1/3 του χρόνου. Όσον αφορά τις επιμέρους υποομάδες (NRTIs-PIs & NRTIs-NNRTIs) οι naïve ασθενείς έφταναν ταχύτερα σε μη ανιχνεύσιμα επίπεδα VL σε σχέση με τους experienced (μικρότερη ταχύτητα ανταπόκρισης), με όλα τα ΡΙs που συνδυαζόταν με NRTIs, και είχαν μικρότερα ποσοστά αποτυχίας. Οι experienced ασθενείς (ποσοστά αποτυχίας 11 έως 87%) είχαν ως πιο επιτυχημένες αγωγές την πράσινο-μπλε4 (NRTIs-NLF), την πράσινο-μπλε3 (NRTIs-IND), ακολουθούμενη από την πράσινο-μπλε5 (NRTIs-SAQ) και λιγότερο επιτυχημένη την πράσινο-μπλε1 (NRTIs-RIT), ενώ για τις πράσινο-μπλε8 (ΝRTIs-ΑΒΤ), πράσινο-μπλε1,2 (ΝRTIs-RIT-ΙΝV) και πράσινο-μπλε1,3 (ΝRTIs-RIT-ΙΝD) δεν προέκυψαν ασφαλή συμπεράσματα. Στους naïve ασθενείς υπήρχαν διαφορές στην ταχύτητα ανταπόκρισης ανάλογα με τον ληφθέντα PI. Ταχύτερη ανταπόκριση παρατηρήθηκε με την αγωγή της πράσινο-κίτρινο (συνδυασμός NRTIs-EFV & NRTIs-VIR). Όσον αφορά την αγωγή NRTIs-ΡΙ, πιο αποτελεσματική ήταν η πράσινο-μπλέ4, ακολουθούμενη από την πράσινο-μπλέ5, ενώ αντίθετα οι συνδυασμοί πράσινο-μπλέ8 και πράσινο-μπλέ2 ήταν οι λιγότερο επιτυχημένοι. Υψηλή τιμή του CD4έναρξης και χαμηλή του VLέναρξης βοηθά στην επίτευξη VL≤50. Οι περισσότεροι naïve ασθενείς είχαν χαμηλό VLέναρξης 1.000-10.000 και υψηλό CD4έναρξης (όπως και οι περισσότεροι experienced) 300-550. Οι naïve ασθενείς της πράσινο-μπλε2 (μεγαλύτερα ποσοστά αποτυχίας) είχαν σχετικά χαμηλό VLεν (<50.000) και CD4εν>100. Οι ασθενείς της πράσινο-μπλε4, είχαν τα μεγαλύτερα ποσοστά επιτυχίας πιθανόν λόγω χαμηλού VLεν (1.000-50.000) και υψηλού CD4εν (300-750 και >750). Το 85% των ασθενών της πράσινο-μπλε5 (επιτυχημένη), είχαν VLεν <10.000 και μάλιστα όταν ήταν <1.000 η ταχύτητα ανταπόκρισης ήταν η μισή σε σχέση με όταν ήταν 1.000-10.000. Οι ασθενείς της πράσινο-μπλε8, (επιτυχημένοι ακόμα και στις υψηλές κλίμακες VLεν), είχαν μεγάλο χρόνο ανταπόκρισης. Οι περισσότεροι (n=20) ασθενείς της πράσινο-κίτρινο3, είχαν VLεν 1.000-50.000 και υψηλό CD4εν 300-550 και πέτυχαν σε μεγαλύτερο χρόνο απ’ ότι της πράσινο-κίτρινο1. Για τους experienced ασθενείς της πράσινο-μπλε2, αν και υπήρχαν ευνοϊκές συνθήκες (VLεν 1.000-50.000 και CD4εν 300-550) είχαν μεγάλο ποσοστό αποτυχίας. Οι ασθενείς της πράσινο-μπλε5 (επιτυχημένη) είχαν VLεν<10.000 και όταν το CD4εν ήταν 550-750, η ταχύτητα ανταπόκρισης ήταν 4 φορές μεγαλύτερη. Οι επιτυχημένοι ασθενείς της πράσινης ομάδας κατά την επίτευξη VL≤50 (Μ.Ο.~47 μήνες) είχαν CD4 κατά ~33% αυξημένο σε σχέση με το CD4εν. Οι επιτυχημένοι ασθενείς της πράσινο-μπλε είχαν CD4 όταν VL≤50 (Μ.Ο.~27 μήνες) αυξημένο κατά ~125% σε σχέση με το CD4εν και VLεν~80πλάσιο (Μ.Ο.~86.000). Οι επιτυχημένοι ασθενείς της πράσινο-κίτρινο είχαν επίσης ανάλογο αριθμό CD4εν, αλλά ο Μ.Ο. CD4 όταν VL≤50 ήταν μικρότερος (αυξημένος κατά 21,6% έναντι 125%). Πέτυχαν σε μόλις κατά Μ.Ο. 15 μήνες, έχοντας πολύ υψηλό Μ.Ο. VLεν (~129.000) και με ποσοστό επιτυχίας ανάλογο με αυτό της πράσινο-μπλέ ομάδας (~81,6%). Οι επιτυχημένοι naïve ασθενείς των υποομάδων πράσινο-μπλε, που είχαν τις υψηλότερες τιμές VLεν κατά σειρά αποτελεσματικότητας ήταν: Π-Μπλέ1,3(3 ασθενείς)> Π-Μπλέ1>Π-Μπλέ8. Τα CD4 των επιτυχημένων ασθενών της πράσινο-μπλέ4 την στιγμή που πέτυχαν (Μ.Ο.~22 μήνες), ήταν τα πιο υψηλά (Μ.Ο. 720). Οι επιτυχημένοι ασθενείς της πράσινο-μπλέ5 είχαν τις χαμηλότερες τιμές VLεν (Μ.Ο.~ 7.000) και CD4 την στιγμή που πέτυχαν υψηλά (Μ.Ο. ~600). Οι επιτυχημένοι ασθενείς των υποομάδων πράσινο-κίτρινο, είχαν υψηλές τιμές VL έναρξης (Μ.Ο.~130.000). Οι επιτυχημένοι experienced ασθενείς που είχαν τις υψηλότερες τιμές VLεν ήταν της πράσινο-μπλέ1 (Μ.Ο.~162.000), (αποτυχία~62%), της πράσινο-μπλέ2 (αποτυχία~87%) (Μ.Ο.~90.000), καθώς και των επιτυχημένων πράσινο-μπλέ3 και πράσινο-μπλέ4 (Μ.Ο.~86.000-130.000), ενώ της επιτυχημένης πράσινο-μπλέ5 είχαν χαμηλό VLεν (Μ.Ο.~3.000). / -

"Elections form a key component of democratic governance. Democracy denotes a political system that, among other things, allows citizens to freely choose their government over time through credible, legitimate and acceptable elections; a system which accords them adequate participation in national affairs and a system in which the national affairs are run in a transparent and accountable manner. Democracy as a concept rests upon the consideration that a political leadership in a country must be chosen through an electon governed by fair rules under which social groups and political forces may compete on equal terms. Research has shown that HIV and AIDS may have adverse effects on democracy in Southern Africa. Electoral systems, voter participation, electoral management and administration and political institutions are among the areas of democratisation most affected by HIV/AIDS. ... Chapter one introduces the topic, the research questions to be answered by the research and the research methodology. It also contains a brief literature survey of the research on this topic so far. Chapter two sets out the legal framweork, it gives an analysis of states obligations to ensure political participation based on international and regional standards. The rights of HIV/AIDS infected and affected persons to participate in government and the meaning of [the] right to vote is discussed. The application of the international law obligations to promote and fulfill [uman rights] are discussed and the question 'Do governments have a duty to set up special mechanisms to address the HIV/AIDS pandemic within the electoral context?' is answered. Chapter three is an examination of the relationship between HIV/AIDS and political participation. A brief overview of current electoral statistics and statistics of the trend of the HIV/AIDS pandemic are given. The chapter examines the possible reasons for lack of participation by HIV/AIDS infected and affected persons. Chapter four is a critical analysis of some responses that can be adopted to address the situation. It focuses on mechanical and structural reforms to the electoral process: amending electoral laws and policies to include postal, proxy and other special voting mechanisms; providing for specific legal obligations, for example to have mobile registration and polling stations, to ensure that there is a polling station within a specific distance so that people do not have to walk far and stand in long queues in order to vote. The failure to meet such obligations must have specific legal consequences. Chapter five suggests a more controversial reform of lowering the voting age to address the impact of HIV/AIDS on democracy and children. Chapter six [includes the] conclusion and recommendations." -- Introduction. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2005. / Prepared under the supervision of Dr. Naz K. Modirzadeh at the Department of Law, American University in Cairo, Egypt / http://www.chr.up.ac.za/academic_pro/llm1/dissertations.html / Centre for Human Rights / LLM