A TB é a principal doença oportunista a acometer as pessoas vivendo com HIV/aids (PVHA), sendo a coinfecção TB/HIV um importante desafio para os sistemas de saúde. O estudo objetivou descrever a vigilância da tuberculose latente nas PVHA acompanhadas pelos Serviços de Atenção Especializada ao HIV/aids (SAE) da rede municipal de saúde de Ribeirão Preto- SP, nos anos de 2012 e 2013. Trata-se de um estudo epidemiológico, descritivo, do tipo levantamento. Participaram 33 indivíduos que desenvolveram diagnóstico de tuberculose latente em 2012 e 2013, notificadas no Sistema de Informação \"Quimioprofilaxia TB\", e que viviam com HIV/aids, acompanhadas nos cinco SAE de rede pública municipal de Ribeirão Preto- SP. Para proceder à coleta de dados, inicialmente foi realizado um levantamento das PVHA diagnosticadas com tuberculose latente, a partir do número de indivíduos cadastrados no sistema de informação \"Quimioprofilaxia TB\". Posteriormente, foi utilizado um questionário estruturado contendo 30 questões do qual trabalhou-se com as seguintes seções: I - Dados sociodemográficos; II - Dados sobre o perfil clínico das PVHA - no momento do diagnóstico da TB latente; III- Dados sobre o controle da TB nas PVHA; IV- Dados sobre a situação, estratégias de acompanhamento e o desfecho da TB latente nas PVHA. O estudo foi desenvolvido a partir de fontes secundárias de informação: Sistema de Informação (SI) \"Quimioprofilaxia TB\"; Prontuário Clínico; Sistema Informatizado Hygia-Web e Sistema de Informação de Agravos de Notificação (SINAN). De forma complementar, com apoio de um roteiro específico foi realizada entrevista com o ator chave - coordenador do Programa Municipal de Controle da Tuberculose e do Programa de DST/aids/hepatites virais - com o intuito de caracterizar o cenário com enfoque na descrição das ações de prevenção e controle da TB nas pessoas com HIV/aids. A análise dos dados foi realizada por meio de técnica estatística descritiva. Dos 355 casos identificados no SI Quimioprofilaxia TB, 135 foram notificados em 2012 e 220 em 2013, sendo que 44 ocorrências envolviam as PVHA em seguimento na rede pública municipal de saúde, dos quais 21 (47,7%) pertenciam ao SAE \"C\". Foram excluídos 11 casos devido à não localização de prontuários clínicos e equívocos na classificação de indivíduos que não possuíam o diagnóstico de HIV/aids. Das 33 PVHA consideradas na amostra final do estudo, houve predomínio do sexo masculino (54,5%), faixa etária de 31 a 60 anos (72,7%), economicamente ativos e casados/ união estável (36,4%). Em relação ao perfil clínico, 75,8% tinham a aids como situação diagnóstica, faziam uso da TARV, porém apenas 30,3% tinham registros de retirada mensal de tais medicamentos. A contagem de células de proteção (TCD4+) e carga viral indicava estabilização do HIV/aids na maioria dos sujeitos. Quanto ao controle e desfecho da QT, a maioria (93,9%) dos pacientes realizou o tratamento na modalidade autoadministrada, sendo que 22 (66,7%) finalizaram o tratamento, mas observou-se uma taxa de abandono de 18,1%. Sendo a TB a principal doença oportunista a acometer e ser responsável pelo maior número de mortes associadas às PVHA, torna-se essencial a implementação de estratégias que favoreçam a vigilância da TB latente nas PVHA contribuindo como medida fundamental para o controle da doença ativa. A vigilância dos dados contribui para o planejamento e melhoria das ações e intervenções prestadas. Assim, desafios são lançados no que se refere à integração de ambos programas frente à importância da vigilância e manejo dos agravos no contexto das políticas públicas / TB is the main opportunistic infection to affect people living with HIV/AIDS (PLWHA), and TB/HIV coinfection is a major challenge for health systems. The study aimed to describe the monitoring of latent TB in PLWHA followed by HIV/AIDS Specialized Health Services Specialized (SHS) of Ribeirão Preto-SP, in the years 2012 and 2013. It was an epidemiological descriptive study. Were included 33 individuals who developed diagnosis of latent tuberculosis in 2012 and 2013, reported in the System Information \"TB chemoprophylaxis,\" and living with HIV/AIDS, followed by the five SHS municipal public health network of Ribeirão Preto-SP. For data collection, it was initially conducted a survey of PLWHA diagnosed with latent tuberculosis, from the number of individuals registered in the information system (IS) \"TB chemoprophylaxis.\" After, it was used a structured questionnaire containing 30 questions which were considered the following sections: I - Socio-demographic data; II - Data on the clinical profile of PLWHA - at diagnosis of latent TB; III - Data on the control of TB in PLWHA; IV Data on the situation, monitoring strategies and the outcome of latent TB in PLWHA. The study was developed from secondary sources of information: Information System \"TB chemoprophylaxis\"; Health Record; Computerized Hygia-Web system and Notifiable Diseases Information System (SINAN). As a complement, with the support of a particular script we interviewed the key actor - Municipal Program Coordinator for Tuberculosis Control and STD/AIDS - in order to characterize the scenario focusing on the description of the actions about prevention and control of TB in PLWHA. Data analysis was performed using descriptive statistics technique. Of the 355 cases identified in the IS chemoprophylaxis TB, 135 were reported in 2012 and 220 in 2013, with 44 occurrences involving PLWHA in the follow-up in the municipal public health system, of which 21 (47.7%) belonged to the SHS \"C\". Eleven cases were excluded due to non-location clinical records and errors in the classification of individuals who did not have the diagnosis of HIV/AIDS. Of the 33 PLWHA considered in the final study sample, there was a predominance of males (54.5%), aged 31-60 years (72.7%), economically active and married/common-law marriage (36.4%). Regarding the clinical profile, 75.8% had AIDS as a diagnostic situation, made use of ART, but only 30.3% had monthly removal of records of such drugs. The protective cell count (CD4 +) and viral load indicated stabilization of HIV/AIDS in most subjects. As for the control and outcome of QT, the majority (93.9%) of patients held in the self-administered treatment modality, with 22 (66.7%) completed the treatment but there was a dropout rate of 18.1 %. TB being the main opportunistic disease to affect and be responsible for more deaths associated with PLWHA, it is essential to implement strategies that enhance the surveillance of latent TB in PLWHA contributing as a key measure to control active disease. Surveillance data contribute to the planning and improvement of actions and interventions provided. So challenges are launched with regard to the integration of both programs forward the importance of surveillance and management of diseases in the context of public policy

There are few reports on the impact of HIV-1 infection on tuberculosis in children. Microbiologic diagnosis of tuberculosis is difficult and much reliance is placed on the tuberculin skin test, as part of a scoring system, in diagnosing tuberculosis in children. A prospective study, enrolling 168 patients with clinical tuberculosis, was performed between July 1996 and January 1997 at the teaching hospitals attached to the Department of Paediatrics and Child Health, University of the Witwatersrand. Forty-two percent of children with tuberculosis were HIV-1 infected. Extrapulmonary tuberculosis was diagnosed more frequently in HIV uninfected children. Progressive pulmonary tuberculosis, based on radiographic findings, and mortality was higher in HIV-1 infected children with tuberculosis. HIV-1 infected children with pulmonary tuberculosis showed marked hyporeactivity to tuberculin skin testing. Both CD4+ lymphocyte counts and concurrent delayed type hypersensitivity testing, using the "CMI Multitest®”, offered little value in interpreting the tuberculin skin test in HIV-1 infected children with tuberculosis. The findings of the study suggest that aggressive microbiologic investigations coupled with a low threshold of clinical suspicion is essential in diagnosing tuberculosis in children, especially in HIV infected children.

Thesis (M.A.(Clinical Psychology))--University of the Witwatersrand, Faculty of Humanities, 2004 / The aim of the present study was to investigate the relationship between the four dimensions of health locus of control and behaviours that predispose South African youth to HIV infection (HIV risk behaviours). Health locus of control (HLC) represents people's perception regarding controllability of health outcomes; whether health outcomes are controlled by internal or personal factors, powerful others like health care professionals, and chance or fate. Both powerful others health locus of control (PHLC) and chance health locus of control (CHLC) form the fourth dimension of external health locus of control (EHLC). A sample of 84 (n=84) South African young adults, 44 females and 40 males, whose ages ranged from 18 to 24 years old were selected for the study. They were requested to complete two questionnaires: Multidimensional Health Locus of Control and HIV risk behaviour assessment scale. Correlational analyses were done to establish the relationship between HLC and HIV risk behaviour. The findings of the research indicate that participants who scored higher on internal health locus of control (IHLC) tended to score insignificantly lower on HIV risk behaviour scale (r = - 0.17 with p of 0.1242). Participants who scored higher on PHLC scored insignificantly higher on HIV risk behaviour scale (r = 0.17 with p of 0.1195). While participants who scored higher on both CHLC and EHLC tended score significantly higher on HIV risk behaviour scale (CHLC r = 0.40 with P of 0.0001 and EHLC r = 0.37 withp of 0.0005). These results suggest that when both CHLC and EHLC scores go high, the risk of HIV infection also increases. Therefore, youth who have greater CHLC and EHLC tendencies are more likely to engage in behaviour that may predispose them to HIV than those who are high in IHLC. The findings of this study could provide further clarity on why many South African youth continue to engage in behaviour that predispose them to HIV infection. And therefore, to curb the spread of HIV, intervention strategies need to be informed by the understanding of the relationship between HLC and factors that predispose youth to HIV.

Thesis (Ph. D. (Social Work)) --University of Limpopo, 2018 / Despite the laudable progress on HIV and AIDS interventions encountered in South Africa, new HIV infection remains a challenge. Limpopo Department of Agriculture is not an exception as far as new HIV infections are concerned, regardless of the intervention efforts made. This study aimed at exploring on perceptions of LDA employees on social-behavioural and structural core drivers of HIV infection. Qualitative research methodologies were applied. A purposive sample of twenty participants (10 men and 10 women) was selected from Department of Agriculture, Mopani District, Limpopo Province. Constructivism and structuralism theoretical framework were used to navigate the study. Semi-structured, face-to-face interviews were designed. Data was collected through interviews, audio-recorded and transcribed. Eight steps of data analysis were followed as proposed by Creswell. Guidelines for the prevention of new HIV infection were developed. Some of the major findings are that: the socio-behavioural core drivers that place all partners at risk of contracting new HIV infections is the Multiple Sexual Partnerships (MSPs). Age-disparate relationships in a workplace were also socio-behavioural drivers of new HIV infection. Young women and men who enter into age-disparate relationships have intention of obtaining permanent employment. Patriarchy was found to be amongst the structural core drivers of new HIV infections. The fact that men are not tested involuntarily is viewed as a structural barrier towards eliminating the spread of new HIV infections. Stigma has been also found to be a core driver of new HIV infections. Some conclusions made are: MSPs is a closed sexual network system, characterised by “secrecy” and “trust”. Despite some reforms purporting to improve women’s status, patriarchal domination is still at its toll. Unsymbolised stigma remains a threat towards elimination of the spread of HIV infections. The major recommendations are that working women still require empowerment in number of areas of their social functioning, and the leadership involvement in the fight against the spread of new HIV infections.

AIMS: HIV diagnoses among men who have sex with men (MSM) in New Zealand increased from the year 2001. The aim of the thesis was to improve understandings of the causes of the increase, in order to inform HIV prevention and identify further research needs. METHODS: Epidemiological data on HIV and AIDS diagnoses among MSM in New Zealand were examined using information from the AIDS Epidemiology Group. A programme of regular behavioural surveillance among MSM was also designed and conducted. RESULTS: Between 1996-2005, HIV diagnoses among MSM by antibody testing where HIV infection was acquired in New Zealand revealed two distinct phases: A very low period between 1997 to 2000 in which around 21 diagnoses were recorded annually; and a resurgent period from 2001 to 2005 where annual HIV diagnoses experienced a sustained rise to 66 at the end of 2005. New adjusted estimates indicated that known prevalent HIV cases among MSM in New Zealand increased from 437 to 588 between 1995 and 2000 (35%), and from 588 to 965 (64%) between 2000 and 2005. This reflected diverging trends from the mid-1990s: Ongoing new HIV infections among MSM which accelerated from the year 2000; and decreased deaths from AIDS due to improved antiretroviral treatments. Unless the growing number of MSM with HIV is counterbalanced by a decrease in the rate of secondary transmission from positive individuals, it will increase the number of new HIV infections. Contrary to this, when expressed as diagnosed incidence-to-prevalence pool ratios (IPRs), the average annual rate of secondary transmission was found to be increasing over time. The behavioural surveillance programme in Auckland surveyed 812 MSM in 2002, 1220 in 2004, and 1228 in 2006. An online module in 2006 additionally surveyed 2141 MSM, 647 of whom lived in Auckland. There were no overall changes in HIV testing over the three offline surveys, suggesting that the increase in HIV diagnoses was not an artefact of testing patterns. There were also no widespread changes in the rate of unprotected anal sex with casual sex partners, or partners described as a "fuckbuddy" or a "boyfriend", among the overall offline samples. However, the proportion of MSM recruited offline who had recently engaged in sex with a man met through the Internet increased significantly from 2002 to 2004 (from 26.6% to 44.8%). When MSM surveyed online in 2006 were examined, they exhibited riskier behaviours compared to offline-recruited respondents. For example, rates of non-condom use and sexual partner concurrency were especially high, and testing rates were lower. CONCLUSION: It is likely that moderate changes involving increases in unprotected sex for some MSM, and alterations to sexual networks and sexual connectivity, have combined to push the reproductive rate of HIV beyond the new epidemic threshold set by the increase in longevity from the mid-1990s. These changes need not have been great if the reproductive rate of HIV was already situated close to the epidemic tipping point. In this case, a resurgent outbreak of HIV may even have been triggered by apparently small and subtle shifts in factors influencing HIV spread.

This project critically examines the question Are HIV/AIDS prevention campaigns more effective at engaging gay men if they use colloquial language and sexually explicit imagery? by investigating the impact of sexually explicit campaigns on the Sydney gay community. The project approaches the question in three parts: 1. A review of literature exploring the circumstances in which and for what reasons sexually explicit HIV/AIDS campaigns are produced. 2. An analysis of seven interviews with producers of HIV prevention campaigns exploring how, why, where and for what reasons explicit campaigns are produced. 3. An analysis of eight interviews with homosexually active Sydney men exploring how HIV prevention campaigns are viewed, consumed and understood. The interviews were in-depth, semi-structured and conducted over one hour per interviewee. The findings are dominated by two interrelated and at times conflicting themes. First, that there is a strongly held belief by campaign producers that the most effective HIV prevention campaigns targeting gay men are produced by the community and reflect that community and as a result must at times be sexually explicit. Second, that it is no longer sufficient for HIV prevention campaigns to rely on explicit sex to attract attention. In an environment where visual images, and sexually explicit visual images especially, are becoming more accessible, and media and communication is more prevalent and complex, safe sex campaigns are forced to deliver ever more sophisticated and stimulating creative materials in order to maintain the engagement of gay men. The interviews revealed that both campaign producers and consumers participated in the production of a visual literacy of safe sex campaigns. This literacy was necessary to both effectively produce and comprehend the campaigns. The interviews showed that while HIV prevention campaigns that use sexually explicit language and imagery can be highly effective at engaging gay men, the success of sexually explicit campaigns is contextual that is, dependent on where, to whom and in what circumstances the materials are delivered. The audience??s accumulation of knowledge and cultural experience when viewing the campaigns, in other words their safe sex campaign literacy, significantly influenced their capacity to understand, appreciate and be engaged with sexually explicit HIV prevention campaigns.

This thesis presents data on incidence and risk factors for individual sexually transmissible infections (STIs) and STIs as risk factors for HIV acquisition in a community-based cohort of HIV negative homosexual men in Sydney. Nearly half of men aged under 25 years were seronegative to hepatitis A and B infection. The prevalence of hepatitis C (HCV) was 0.85%, which was close to that of the general population. HCV infection was strongly associated with injecting drug use (OR 60.43, 95% CI 6.70-544.79), and sexual transmission was not demonstrated in this cohort. There was a nearly 40 fold increase in syphilis notifications in inner Sydney between 1999 and 2004. The stable incidence of 0.6% per year in the HIM cohort suggests that it was disproportionately affecting HIV positive men. Oral sex was an important transmission route and about one third of cases were asymptomatic. The incidence of urethral and anal gonorrhoea was 3.78 and 3.19 per 100 person-years, and for urethral and anal chlamydia it was 7.98 and 5.20. In addition to unprotected anal intercourse (UAI), insertive oral sex was related to urethral infections and anal infections were associated with non-intercourse anal sexual practices. The prevalence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) was 75% and 23% respectively. Sexual contact not only with men, but with women, was significantly associated with both infections. Among those susceptible at baseline, the incidence for HSV-1 and HSV-2 was 5.58 and 1.45 per 100 person-years. Oral sex was associated with incident HSV-1 infection and certain non-intercourse anal sexual practices were significantly associated with incident HSV-2 infection. HIV incidence was 0.94 per 100 person-years. It was significantly associated with a higher number of episodes of receptive UAI with a partner of unknown HIV status (p trend&lt0.001) or a partner known to be HIV positive (p trend&lt0.001). After controlling for sexual behaviour, HIV seroconversion was significantly associated with anal gonorrhoea (HR 12.68, 95% CI 3.66-44.00). The association with anal warts and prevalent HSV-1 infection was of borderline significance. These data will inform intervention designs targeting STIs which aim to prevent HIV in homosexual men.

[Truncated abstract] HIV infection compromises the ability of the host to mount effective immune responses. In untreated HIV disease, immune activation drives high rates of cell turnover and apoptosis, ultimately leading to abnormal and dysregulated cellular function. Immune activation may also induce the expansion of CD4+ regulatory T (Treg) cell populations capable of suppressing anti-HIV responses. Treatment with antiretroviral therapy (ART) allows the recovery of CD4+ T cell numbers in most patients. Persistent deficiencies in the number and function of CD4+ T cells seen in a proportion of individuals may reflect elevated numbers of Treg cells or an imbalanced regulatory-to-effector cytokine milieu. Furthermore, some patients develop paradoxical illnesses associated with the recovery of cellular function, known as immune restoration disease (IRD). The first part of this thesis addresses the role of CD4+ Treg cells in untreated and treated HIV disease. The second part addresses the phenotype of immune cells that express IL-10 and its receptor in untreated and treated patients, and the role of IL-10 in mycobacterial IRD. Firstly, several cell surface markers were evaluated to find a flow cytometry assay that could be used routinely to identify CD4+ Treg cells in HIV-infected patients. I tested CD25, GITR, CTLA-4, NRP-1 and LAG-3, but their expression did not mirror the expression of FoxP3, an intracellular transcription factor specific to CD4+ Treg cells (Chapter 2). Two published studies then described the use of CD127 to identify CD4+FoxP3+ Treg cells in humans. Using CD127, I determined the proportions and numbers of CD4+ Treg cells in untreated HIV-infected patients and in patients in their first year of ART. Proportions of CD4+ Treg cells correlated with the proportions of activated (HLA-DRHI) CD4+ T cells and with plasma HIV RNA levels in untreated patients, but showed an inverse correlation with CD4+ T cell count. In both untreated and treated patients, the proportions and numbers of FoxP3+ cells that expressed CD8 were significantly higher than in uninfected donors. This was clearest in patients with CD4+ T cell counts below 300/'L (Chapter 3). This body of work suggests that the frequencies of CD4+ Treg cells are directly related to the level of HIV-associated immune activation. Phenotyping of FoxP3+CD4+ Treg cells in untreated and treated patients and in uninfected donors revealed that co-expression of CD45RO, CD28, CTLA-4 and markers of activation were similar in all HIV-infected patients and controls. ii FoxP3+CD8+ T cells exhibit lower levels of CD45RO, CD28 and CTLA-4, but higher expression of PD-1 and CD57 (Chapter 4). This suggests that FoxP3+CD8+ T cells may have a reduced functional capacity. It is unclear whether they have regulatory activity by virtue of FoxP3 expression. ... Both patients produced higher levels of IFN? compared with IL-10 in response to mycobacterial antigens. In contrast, patients who experienced uneventful immune reconstitution produced higher levels of IL-10 (Chapter 6). Part 1 of this thesis highlights the importance of using specific cellular markers to identify CD4+ Treg cells, and confirms CD127 as a valuable marker for routine monitoring of blood Treg cells. Part 2 of this thesis demonstrates the important regulatory role of IL-10 in patients receiving ART.

Copies of author's previously published works inserted. / Bibliography: leaves 230-282. / 291 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Covers clinical data relating to trials with two antiretroviral agents, didanosine and foscarnet, conducted at St Stephen's clinic, London, discussing aspects of their therapetic efficacy, effect on survival, clinical and laboratory tolerability. / Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 1995

<p>Syftet med studien var att öka kunskapen om och förståelsen för hiv-smittade narkomaner i kriminalvård. Den övergripande frågeställningen löd; Hur beskriver ett mindre urval av hiv-smittade narkomaner i föremål för kriminalvård sina tankar och känslor kring sin sjukdom och sin livssituation? Studien var av kvalitativ design och den vetenskapliga positionen av hermeneutisk karaktär. Det empiriska materialet bestod av intervjuer med fem hiv-smittade narkomaner i kriminalvård. Tre teman var grundläggande i intervjuerna; Tankar, känslor och reaktioner kring hiv-diagnosen, Existentiella frågor, drivkraft och copingstrategier samt Bemötande i och utanför kriminalvården. Studiens teoretiska perspektiv; kristeori, existentialistisk teori, upplevelseteori och hälsoteori, valdes i syfte att nå en ökad förståelse för intervjupersonernas upplevelse av sin livssituation. Studiens resultat och analys visade att hiv-smittan fått olika konsekvenser för de intervjuade. För tre personer blev livet bättre genom sjukdomen; två av dem menade att de annars skulle varit döda. För de övriga två innebar sjukdomen i stället att döden kommit närmare och grusat alla förhoppningar om ett bättre liv. Tolkningen visade att en möjlig förklaring till de olika förhållningssätten kunde bero på skillnader i vilken inre privat betydelse sjukdomen haft för de intervjuade, samt i vilken mån de lyckats komma igenom krisen.</p>