Despite declining rates since the 1980s, HIV remains a significant public health concern in the US, especially among ethnic and sexual minorities, as well as other marginalized groups. This present dissertation addresses this challenge by using simulated markets to investigate the potential acceptance of HIV vaccines among at-risk population groups in the US. Four experiments were conducted to explore various factors influencing vaccine acceptance. Experiment 1 investigated the impact of vaccine-dependent factors, such as perceived dosage and mode of administration, on HIV vaccine demand. Experiment 2 assessed the effect of cost on the discounting of delayed but effective HIV vaccines. Experiment 3 examined the influence of cost on the discounting of uncertain but effective HIV vaccines. Experiment 4 explored how bundling HIV vaccines with complementary health commodities could enhance vaccine demand. The findings revealed that mucosal administration and a single-dose regimen had the most significant impact on vaccine demand. Additionally, the requirement to pay for vaccines led to more pronounced discounting of both delayed and uncertain vaccines, compared to when they were offered for free. Among the various health commodities examined, eye examinations and mental health counseling had the most significant impact on HIV vaccine demand when bundled. The dissertation also examined the effect of personal and interpersonal covariates on HIV vaccine acceptance. These findings aim to inform public health interventions and policy formulation regarding HIV vaccines, anticipating their widespread availability both in the US and globally.

Yes / This paper reports on the findings of an empirical study that explores the perception of HIV third sector managers in India of their own effectiveness and the contextual factors in which they work. A qualitative methodology with case study design was employed. Semi-structured interviews with 16 Non-Governmental Organisation (NGOs) managers and two focus-group interviews with 16 non-managerial staff were carried out to generate primary data. The paper attempts to contextualise the model ‘parameters of managerial effectiveness’ (Analoui, 1999, 2002), and its related contextual factors in India. The findings identify managerial and leadership factors and influences that impact the effectiveness of NGO managers. It also confirms that, by and large, the framework is applicable to the NGO managers in India given the different context in which they must operate. These differences provided basis for the construction of a modified behavioural model for managerial behavioural analysis and their human resource development (HRD) needs. It provides a basis for HRD policy formulation for designing and implementing adequate training and development (T&D) for NGO managers in the third sector in India. This unique and first-time study contributes to the present stock of theoretical knowledge and understanding of the effectiveness of the managers in a sensitive untouched area within the third sector and organisations in a developing country.

Sport is increasingly being recognised for the contribution it can make to the Millennium Development Goals and, in particular, the response to the HIV/AIDS pandemic. This study is based on Zambia, a low-income country, heavily affected by the HIV/AIDS pandemic in sub-Saharan Africa. The study focuses on National Sports Associations (NSAs), which are quasi- autonomous organisations at meso level of policy analysis. Centring on three NSAs: Football Association of Zambia (FAZ), Zambia Basketball Association (ZBA) and Netball Association of Zambia (NAZ), this study critically analysed the organisational responses of each of the selected cases towards the HIV/AIDS multisectoral approach. The study adopted a case study approach which utilised semi-structured (face-to-face and telephone), interviews, focus group discussions and documentary analysis for data collection. Comparative analysis of all three cases revealed differences in how each case mainstreamed HIV/AIDS based on power, resources and forms of collaboration. Meso-level analysis was utilised to examine workplace HIV/AIDS policy formulation and implementation. In addition, meso-level analysis also helped reveal forms of health-related collaborations with both internal and external agencies. Macro-level theories of the state were useful in examining power relations between the Zambian state and civil society. The application of policy network theory, global health governance, multiple streams framework, and the top-down and bottom-up approaches to policy implementation proved useful in drawing attention to how each NSA case responded differently to the mainstreaming of HIV/AIDS. The political power of football as a national sport and the Association s access to foreign resources enabled FAZ to influence HIV/AIDS policy implementation and build of strong collaborative relationships with government than the ZBA and NAZ. The study concludes that lack of political steer from the top has re-introduced a new foreign top-down approach as those with resources from the Global North influenced policy formulation and implementation within all three cases. The conclusion also found useful the application of post-colonialism and development theories when examining international sport-for-development practices. This finding revealed the power imbalances between Global South practitioners and Global North funding partners.

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Malaria is a pestilent disease associated with massive socioeconomic burden of sub-Saharan Africa. This disease is caused by a blood infection of the single cellular parasite of the Plasmodium genus. Two enzymes of this parasite have been identified to be essential to the survival of this parasite, notably Spermidine Synthase and Protein Farnesyltransferase. The goal of this dissertation was to search for and synthesise novel inhibitors of these two enzymes with a strong focus towards understanding their structure/activity relationships. To achieve the first goal, molecular modelling was employed. An in-depth discussion is presented to describe the underlying principles relevant to this branch of computational chemistry. This ensures that the experiments using these methods are set-up correctly and results are interpreted within context. Two virtual high-throughput screens were then performed using prepared crystallographic structures of Spermidine Synthase. The first was pharmacophore based method and the second based on LibDock. The database used, containing 7.1 million compounds, was filtered using a custom developed tool prior to screening. Finally, CDOCKER was then used to investigate the activity of potential hit compounds. Spermidine Synthase has a natural affinity for adenosine and this trait was exploited by derivatising analogues to synthesise potential inhibitors of the enzyme. This was to be achieved by the incorporation of both electrophilic and nucleophilic moieties at selected positions, including the use of a high yielding Mitsunobu reaction. A number of additional residues were then synthesised and joined to the adenosine which were proposed to increase the active site occupancy and increase affinity to the enzyme. For the second enzyme targeted for inhibition, Protein Farnesyltransferase, indole was used as a starting scaffold to synthesise potential hits de novo. It was aimed to derivatise the indole at the Nʹ and 3ʹ positions. The crystal structure of one of the intermediates was published. Furthermore, a synthetic sequence which culminated in a palladium catalysed Suzuki coupling was performed. / AFRIKAANSE OPSOMMING: Malaria is ‘n peslike siekte wat geassosieer word met beduinde sosio-ekonomiese implikasies vir sub-Sahara Afrika. Die siekte word veroorsaak deur ‘n bloed infeksie van die enkel sellulêre parasiet van die Plasmodium genus. Twee ensieme, naamlik Spermidien Sintetase en Protein Farnesieltransferase, is geïdentifiseer om noodsaaklik te wees vir die oorlewing van die parasiet. Die doelwit van hierdie verhandeling is die soektog en sintese van oorspronklike inhibeerders van hierdie twee ensieme met ‘n sterk fokus daarop om struktuur/aktiwiteit interaksies te verstaan. Om die eerste doelwit te bereik is molekulêre modellering toegepas. ‘n Indiepte ondersoek word voorgestel om die onderliggende beginsels relevant tot hierdie tak van berekenkundige chemie te beskryf. Dit verseker dat eksperimente wat op hierdie tegnieke berus korrek opgestel word en dat die resultate binne konteks geïnterpreteer word. Twee virtuele hoë-deurset skerms was deurgevoer op voorbereide kristallografiese strukture van Spermidien Sintetase. Die eerste het berus op ‘n pharmakoforiese metode en die tweede op LibDock. ‘n Self-ontwikkelde sagteware gereedskap stuk is gebruik om a databasis van 7.1 miljoen verbindings te filtreer voor dit gebruik is in hoë-deurset skerms. Uiteindelik is CDOCKER gebruik om die potensiele aktiwiteit van “treffer” verbindings te beraam. Spermidien syntetase het ‘n natuurlike affiniteit vir adenosien en hierdie eienskap is benut deur analoeë af te lei na potensiële inhibeerders teen die ensiem. Dit is bewerkstellig deur die insluiting van beide elektrofiliese asook nukleifielese funksionele groepe op gekose posisies. Dit het die gebruik van ‘n hoë opbrengs Mitsunobu reaksie ingesluit. ‘n Aantal ander addisionele residueë is toe gesintetiseer en geheg aan die afgeleide adenosien om die ensiem setel te vul en sodoende die affinitieit te verhoog. Vir die tweede ensiem wat geteiken is vir inhibisie, Protein Farnesieltransferase, is indool benuttig as ‘n begin steier te dien om potensiële treffers de novo te sintetiseer. Dit is geteiken om die indool af te lei op die Nʹ en 3ʹ posisies en die kristal struktuur van een van hierdie tussengangers is gepubliseer. Verder is ‘n sintetiese weg, wat uitgeloop het op ‘n palladium gekataliseerde Suzuki koppeling, uitgevoer.

Introdução: Existe crescente interesse em identificar marcadores de risco para eventos cardiovasculares em pacientes com HIV/aids. Atualmente observa-se alteração do perfil epidemiológico desses pacientes, com diminuição da mortalidade por infecção e comorbidades e aumento por eventos cardiovasculares. A elasticidade arterial, principalmente dos pequenos vasos, tem sido investigada como alteração precoce de evento cardiovascular. Objetivo: Avaliar a relação entre elasticidade arterial e outros indicadores de risco cardiovascular como fatores demográficos e socioeconômicos, hábitos de vida, estado nutricional e marcadores inflamatórios. Métodos: Foram selecionados aleatoriamente 132 indivíduos voluntários em tratamento regular com antirretrovirais em ambulatório especializado em HIV/aids, com idade entre 19 e 59 de ambos os sexos. A elasticidade arterial dos grandes vasos (LAEI) e pequenos vasos (SAEI) foi investigada pelo equipamento HDI/ PulseWaveTM CR-2000 Cardio Vascular Profiling System®. Foram determinados colesterol total e frações, triglicérides, proteína C-reativa, fibrinogênio, medidas antropométricas e de avaliação de composição corporal, fumo, consumo de bebidas alcoólicas, uso de drogas, prática de atividade física, além de avaliação de fatores demográficos e socioeconômicos e imunológicos (carga viral, T-CD4, T-CD8). Para investigar a associação entre LAEI e SAEI e outros fatores de risco cardiovascular utilizou-se análise de regressão linear múltipla. Resultados: Em relação à elasticidade dos grandes e pequenos vasos, 71,97 por cento e 32,58 por cento , respectivamente, dos participantes foram classificados com elasticidade normal. Observou-se associação positiva entre LAEI e peso (p<0,001) e associações negativas entre LAEI e prega cutânea subescapular (p<0,001) e linfócitos T-CD4 (p<0,02). Verificou-se associação negativa de LAEI com sexo (p<0,02), mostrando que o sexo feminino está relacionado com menor elasticidade. Houve associação positiva entre SAEI e peso (p<0,001) e associações negativas entre SAEI e prega cutânea subescapular (p<0,001), idade (p<0,01) e linfócitos totais (p<0.01). Conclusão: As alterações de elasticidade arterial em pacientes HIV/aids apresentaram relação com outros fatores de risco cardiovascular. SAEI mostrou-se diminuído na maioria dos participantes, sendo uma alteração que pode identificar a disfunção endotelial antes que a doença se torne clinicamente aparente. A monitoração constante da elasticidade arterial através de método não invasivo pode se tornar uma importante ferramenta na predição e prevenção de eventos cardiovasculares em pacientes HIV/aids / Introduction: There is a growing interest in identifying markers of risk for cardiovascular events in patients with HIV / AIDS. Currently there is a change in the epidemiological profile of patients with reduced mortality from infections and comorbidities and increased cardiovascular events. The arterial elasticity, mainly of small vessels, has been investigated as early alteration of cardiovascular events. Objective: To evaluate the relationship between arterial elasticity and other cardiovascular risk factors such as demographic and socioeconomic factors, lifestyle habits, nutritional status and inflammatory markers. Methods: We randomly selected 132 individuals volunteers, ages between 19 and 59, of both sexes, regularly treated with antiretrovirals in specialized clinics on HIV / AIDS. Arterial elasticity of the large (LAEI) and small (SAEI) vessels were investigated by the equipment HDI/ PulseWaveTM CR-2000 Cardio Vascular Profiling System®. We determined total cholesterol, HDL, triglycerides, C-reactive protein, fibrinogen, and anthropometric assessment of body composition, smoking, alcohol consumption, drug use, physical activity, and evaluation of demographic, socio-economic and immunological (viral load, T-CD4, T-CD8) factors. The association between LAEI and SAEI and other cardiovascular risk factors were assessed by multiple linear regression. Results: Regarding the elasticity of large and small vessels, 71.97 per cent and 32.58 per cent , respectively, of the participants were classified as having normal elasticity. We observed a positive association between LAEI and weight (p <0.001) and negative associations between LAEI and subscapular skinfold (p <0.001) and CD4 counts (p <0.02). There was a negative association of LAEI with gender (p <0.02), showing that female gender is associated with lower elasticity. There was a positive association between SAEI and weight (p <0.001) and negative associations between SAEI and subscapular skinfold (p <0.001), age (p <0.01) and total lymphocytes (p <0.01). Conclusion: Changes in arterial elasticity in patients with HIV / AIDS correlate with other cardiovascular risk factors. SAEI was altered in most participants, a change that can identify endothelial dysfunction before the disease becomes clinically apparent. The constant monitoring of arterial elasticity through noninvasive method may become an important tool in the prediction and prevention of cardiovascular events in HIV / aids patients

Com o advento da terapia antiretroviral houve um aumento significativo na sobrevida e qualidade de vida dos portadores do HIV/aids. Esta nova realidade traz novas possibilidades de conviver com a aids, sendo a sorodiscordância uma delas. Este estudo teve como finalidade descrever e analisar o impacto da sorodiscordância na vida afetivo-sexual de portadores do HIV/aids que convivem com parceria heterossexual com status sorológico discordante. Como referencial teórico utilizou-se o conceito da vulnerabilidade. O local de estudo foi o ambulatório especializado no atendimento do HIV/aids do Hospital das Clínicas da Faculdade de Medicina da Ribeirão Preto-SP. Os dados foram coletados através de entrevista individual gravada e organizados e analisados com base na Análise de Prosa de André (1983). A partir dos dados emergiram nove temas: A percepção da invulnerabilidade, A descoberta da soropositividade ao HIV, Via de Infecção, Revelação do diagnóstico para o parceiro, A sexualidade, Vulnerabilidade da parceria sexual, Uso do preservativo, Saúde Sexual e Reprodutiva, A convivência. Os casais sorodiscordantes enfrentam inúmeros desafios após a descoberta de soropositividade em um dos parceiros, precisando desenvolver estratégias para o manejo de dificuldades para a vivência da sexualidade, para a manutenção do sexo seguro até a convivência com o parceiro soronegativo. Estas dificuldades não são de responsabilidade exclusiva do casal, cabendo aos profissionais de saúde assumirem a sua responsabilidade social no enfrentamento destes desafios impostos pela sorodiscordância. Ficou evidente que a necessidade de acolher também o parceiro soronegativo no atendimento e que os casais sorodiscordantes merecem atenção específica dos serviços de saúde. A falta de serviços de saúde específicos a casais sorodiscordantes é um dos fatores que aumenta a vulnerabilidade do parceiro soronegativo, quando este não é evidenciado no atendimento e quando as questões trazidas pela sorodiscordância não são abordadas adequadamente. Apontamos a necessidade de alternativas assistenciais, promovendo uma mudança na prática assistencial vigente, centrada no modelo biológico. A assistência a estes indivíduos deve ser realizada por equipes interdisciplinares que contemple os aspectos da dimensão afetivo-sexual trazidos pela sorodiscordância, sendo necessária capacitação e sensibilização dos profissionais de saúde envolvidos no atendimento. A equipe de enfermagem ocupa um importante papel na assistência ao portador do HIV/aids e suas ações devem transcender os aspectos clínicos e terapêuticos, incluindo a sexualidade, a prevenção e manutenção de sexo seguro, que se apresentam como expressivos componentes de risco entre parceiros sorodiscordantes. / The appearance of antiretroviral therapy brought about a significant increase in the survival and quality of life of HIV/aids patients. This new reality entails new possibilities for living with aids, one of which is serodiscordance. This study aimed to describe and analyze the impact of serodiscordance on the affective and sexual life of HIV/aids patients whose heterosexual partner has a different HIV status. The concept of vulnerability was used as a theoretical reference framework. This study was carried out at the specialized HIV/aids care clinic of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas, Brazil. Data were collected through individual interviews, which were recorded. Data organization and analysis was based on Prose Analysis by André (1983), which gave rise to nine themes: perception of the invulnerability, the discovery of HIV seropositivity, infection way, revealing the diagnosis, sexuality in mixed-status couples after discovering HIV/aids infection, vulnerability of the seronegative partner, use the condom; reproductive health, relationship. After discovering seropositivity in one of the partners, mixed-status couples face countless challenges and need to develop coping strategies for difficulties related to sexual activities, maintaining safe sex and living with a seronegative partner. Not only the couple is responsible for these difficulties. Health professionals should assume their social responsibility in facing the challenges imposed by serodiscordance. We observed that seronegative partners have to be included in care activities, and that mixed-status couples deserve specific attention from health services. The lack of specific health services for mixed-status couples is one of the factors responsible for increased vulnerability of the seronegative partner, when (s)he does not appear in care and no adequate treatment is given to serodiscordance-related issues. We point towards the need for care alternatives with a view to promoting a change in current care practices, which focus on the biological model. Care for these persons has to be realized by interdisciplary teams and consider the affective and sexual aspects caused by serodiscordance, which leads to the need for increased training and awareness of the health professionals involved. The nursing team plays an important role in HIV/aids care and its actions have to go beyond clinical and therapeutic aspects and including sexuality, prevention and safe sex maintenance, which reveal to be important risk components in mixed-status couples.

As transformações da epidemia do HIV/Aids, principalmente em relação aos avanços na qualidade de vida de pessoas soropositivas, têm gerado novas ações frente à doença. A Estratégia de Saúde da Família (ESF) se configura como uma política pública de atenção primária, que tem como proposta central a reorientação do sistema de saúde, com ênfase na produção do cuidado integral. O Agente Comunitário de Saúde (ACS) emerge, neste contexto, como um ator importante na interface entre a comunidade e o serviço de saúde. O presente estudo tem como objetivo descrever os sentidos produzidos em grupo com agentes comunitárias de saúde acerca do HIV/Aids. Para tal, foram realizadas três entrevistas grupais de sessão única, com três equipes de agentes comunitários de saúde de três Núcleos de Saúde da Família da cidade de Ribeirão Preto, SP, Brasil. Os grupos foram áudio-gravados e transcritos na íntegra. Foi efetuada a escolha de uma sessão de entrevista em grupo para a análise em profundidade. Esta sessão foi analisada à luz do construcionismo social, que considera que as realidades e sentidos são construídos através da relação entre as pessoas, sendo a linguagem entendida em seu caráter performático, como uma prática social. Para o processo de análise, inicialmente, foi realizada uma imersão no material transcrito. Após refletir sobre alguns dos possíveis sentidos, foi escolhido um tema como foco, a saber: os processos de negociação e construção de sentidos sobre o trabalho do agente comunitário de saúde em HIV/Aids. Através deste, buscou-se dar visibilidade aos processos conversacionais, com ênfase nas interações, negociações de sentidos e construções, atenta ao potencial de transformação dos enunciados. Nas considerações finais dois aspectos foram delimitados a partir de reflexões sobre a construção do trabalho no nível da atenção primária no que diz respeito ao HIV/Aids, a saber: (a) a possibilidade de olhar para as vozes sociais presentificadas no grupo e nas ações em saúde, contribuindo para reflexões sobre os sentidos construídos acerca do HIV/Aids e da sexualidade; (b) as mudanças a partir da interação e das negociações dos sentidos, no que se refere às questões de gênero e prevenção. A possibilidade de negociação dos sentidos pôs em diálogo a diversidade, bem como a importância de se considerar a multiplicidade em saúde. Esta análise permitiu a descrição de alguns sentidos referentes ao HIV/Aids no contexto da Estratégia de Saúde da Família. Consideramos que, ao analisar os discursos em grupo com profissionais agentes comunitárias de saúde, estamos contribuindo para reflexões sobre as ações na atenção primária no que tange ao trabalho com HIV/Aids. / The changes that the HIV/AIDS epidemic has undergone especially in relation to the improvements on the quality of life of seropositive people have generated new actions in relation to the disease. The Family Health Strategy (FHS) is characterized as a primary care public policy aimed at reorienting the health system emphasizing the production of the complete care. In this context, the Communitarian Health Agent (CHA) emerges as an important actor in the interface between community and health service. The objective of the present study is to describe meanings produced by the group with communitarian health agents in relation to HIV/AIDS. To do so, three one-session group interviews with three communitarian health agents team from three Family Health Units of the city of Ribeirão Preto, SP, Brazil were performed. The groups were audio-recorded and transcribed in full. One group-interview session was selected for a deep analysis. This session was analyzed at the light of the social constructionism, which considers that the realities and meanings are constructed based on relation between people, and that language is understood within its performative character as a social practice. For the analysis process, an immersion into the transcribed material was initially performed. After reflecting on some of the possible meanings, a topic of interest was selected, namely: the negotiation and construction process of meanings in relation to the work of the HIV/AIDS communitarian health agent. Through this process, one searched to make the conversational processes clear by emphasizing interactions, negotiations of meanings and constructions in relation to the enunciations? change potential. In the final considerations, two aspects were delimited based on reflections on the construction of the work at the primary care level in relation to HIV/AIDS namely: (a) the possibility of looking at social voices present in the group and in the health actions, thus contributing for the reflections on the meanings about HIV/AIDS and sexuality; (b) the changes based on the interaction and on the negotiations of meanings in relation to matters of gender and prevention. The possibility of negotiating meanings has recalled diversity as well as the importance of considering multiplicity in health. This analysis has enabled the description of some meanings in relation to HIV/AIDS in the Family Health Strategy context. We consider that, when group conversations are analyzed with communitarian health agent professionals, we are contributing for reflections on primary care actions in relation to those who live with HIV/AIDS.

Tendo em vista o objetivo geral de analisar o perfil epidemiológico da epidemia de Aids, numa abordagem espaço-temporal dos casos de infecção por HIV e dos óbitos por Aids no município de São Paulo, de 1996 a 2007, o presente estudo usa um delineamento ecológico transversal. A unidade de análise é o Distrito Administrativo. A partir desta unidade são calculados os riscos relativos de se infectar por HIV e de ir a óbito por Aids no período definido. A análise temporal é feita a partir das situações dos anos 1996, 2000, 2004 e 2007, para cada gênero, que indicará a situação do momento e a tendência ao longo do tempo. A análise estatística espacial auxilia a localizar distritos de risco significativamente acima e/ou abaixo da média do município. Foram utilizados os dados referentes a óbitos por Aids por Distrito Administrativo Residencial do município de São Paulo para o período de 1996 a 2007, por gênero e faixa etária da OMS (Organização Mundial de Saúde), obtidos no SINAM do sítio do PRO-AIM (Programa de Aprimoramento da Informação de Mortalidade). Os dados referentes aos totais de população por distrito, ano, gênero e mesmas faixas etárias foram obtidos no sítio da Fundação SEADE. Para o ano 2000, os dados correspondem ao Censo do IBGE e para os demais, às estimativas populacionais desta Fundação. Correspondeu à base cartográfica digital do IBGE setores Censitários para o Município de São Paulo, ano 2000. Foram calculados os riscos relativos (RR) do período e para cada ano para cada distrito administrativo para a infecção por HIV e mortalidade por Aids, por gênero e total da população. O RR foi calculado utilizando-se o programa SaTScan. Os endereços foram geocodificados com o programa Maptitude, a partir da base de logradouros do município de São Paulo, utilizando-se o endereço (rua e número) e o CEP. Os agrupamentos espaciais foram mapeados usando-se a técnica corocromática. Os mapas de agrupamentos mostram os agrupamentos de risco alto em vermelho e de risco baixo, em azul. A evolução da epidemia teve grandes modificações, antes era uma doença que atingia a população de classe alta, hoje o panorama do HIV/Aids nos mostra que a população menos favorecida do ponto de vista socioeconomico é mais afetada devido a falta de informações e preparo para lidar com as medidas preventivas. Pode-se afirmar que a distribuição espaço-temporal da mortalidade por Aids e infecção por HIV caminham de maneira muito semelhante. Em ambos, ocorrem agrupamentos espaciais significativos na região central e casos abaixo do esperado nas regiões centro-sul, sudeste e sul. / Given the overall objective to analyze the epidemiological profile of the AIDS epidemic, in a space-time approach of the cases of HIV infection and AIDS deaths in São Paulo, from 1996 to 2007, this study uses an ecological design cross. The unit of analysis is the Administrative District. From this unit are calculated relative risks of becoming infected with HIV and of dying from AIDS within the defined period. The temporal analysis is done by the circumstances of the years 1996, 2000, 2004 and 2007 for each gender, which indicates the current situation and trends over time. The spatial statistical analysis helps districts find significantly higher risk and / or below average in the municipality. We used data on deaths from AIDS by Administrative District Residential in São Paulo for the period 1996 to 2007, by gender and age of the WHO (World Health Organization), obtained on SINAM Site PRO-AIM ( Improvement Program for Information Mortality). The data on population totals by district, year, genre and the same age groups were obtained at the site of SEADE. For 2000, data correspond to the IBGE Census and for others, the population estimation of the Foundation. It corresponded to the digital base map of IBGE - census tracts for the city of São Paulo, 2000. We calculated relative risks (RR) for the period and for each year in each administrative district to HIV infection and AIDS mortality by gender and total population. The RR was calculated using the program SaTScan. The addresses were geocoded using the Maptitude program, from the base to street addresses in the city of São Paulo, using the address (street and number) and zip code. The spatial clusters were mapped using the corocromática technique. The maps show high risk clusters in red and low risk, in blue. The epidemic has had major modifications before it was a disease that affects the upper class population, today the landscape of HIV / AIDS shows that the less favored population in terms of socioeconomic background is more affected due to the lack of information and preparation to deal with preventive measures. It can be argued that the spatial and temporal distribution of mortality from AIDS and HIV infection much like walking. In both, significant spatial clusters occur in the central site and lower than expected cases in south-central, southeast and south.

INTRODUÇÃO: Tem-se afirmado que os distúrbios do sono começam precocemente na doença do HIV. Avaliamos as características do sono e a Qualidade de Vida (QV) de mulheres portadoras de HIV/AIDS. MÉTODO: Realizado no Centro Corsini o grupo-estudo foi composto por 30 mulheres portadoras de HIV/AIDS, idade média 35,4 anos. O grupo-controle foi composto por 30 mulheres que desconheciam seu diagnóstico para HIV do Centro de Saúde 31 de Março. Instrumentos: Índice de Qualidade do Sono de Pittsburgh, Inventário de Depressão Beck, Inventário de Ansiedade Beck e HIV/AIDS-Target Quality of Life. RESULTADOS: Houve significativa diferença entre o grupo de doentes de AIDS e o grupo controle quanto à pontuação global do sono (p=0,003). Com relação a sintomas depressivos e de ansiedade, os resultados apontaram que o grupo de doentes de AIDS apresenta índices mais elevados de ansiedade e não houve diferença significativa nos sintomas de depressão. Em relação à QV não houve diferença significativa entre os grupos de mulheres sintomáticas e assintomáticas, mas as assintomáticas apresentaram mais prejuízos nos domínios de QV do que o grupo controle. CONCLUSÃO: Há prejuízo na qualidade do sono e QV das mulheres portadoras de HIV/AIDS, com presença de sintomas depressivos e de ansiedade / INTRODUCTION: Sleep disorders have allegedly been described early in the HIV infection. Both the characteristics of sleep and quality of life in women with HIV/AIDS were evaluated. METHOD: Conducted at the Corsini Center, the study group consisted of 30 women with HIV/AIDS, mean age 35.4 years, and 30 women who had no known HIV diagnoses as the control group. METHODS: The Pittsburgh Sleep Quality Index, the Beck Depression Inventory, the Beck Anxiety Assessment and HIV/AIDS - Target Quality of Life were applied. RESULTS: There was a significant difference between the AIDS and the control groups drawn from the Center of Health \'31 de Março\', for global sleep scores (p=0.003). Concerning depressive and anxiety symptoms, findings revealed that AIDS patients presented higher levels of anxiety, but there was no significant difference in the symptoms of depression for either group. In terms of quality of life there was significant difference between symptomatic and non-symptomatic groups of women. No significant difference in QoL was seen between symptomatic and assymptomatic groups, although assymptomatic women did present greater compromise in QoL domains than controls. CONCLUSION: Compromised sleep and quality of life was observed in women infected with HIV/AIDS suffering from both depressive and anxiety symptoms

A Profilaxia Pré-exposição ao HIV (PrEP) é uma nova estratégia de prevenção na qual os indivíduos consomem uma combinação de antirretrovirais diariamente para evitar a aquisição do vírus da AIDS. O objetivo deste estudo foi compreender, a partir da experiência dos usuários de PrEP, a produção do processo de individualização e saúde. Analisou-se o conteúdo de discussões de um grupo de usuários de PrEP, e de pessoas interessadas no assunto, numa rede social virtual com predominância de gays, bissexuais e outros homens que fazem sexo com homens. Os resultados e discussão foram distribuídos em três artigos científicos: o primeiro, discute os conflitos da experiência dos usuários no contexto da sociedade do risco e da individualização. O segundo explora a produção das dimensões do desejo e do prazer sexual - mediados pela PrEP - na vida dos indivíduos. O terceiro, aproxima e discute a experiência dos usuários de PrEP com processos identitários autoproduzidos na individualização contemporânea. As considerações finais, por fim, refletem sobre as implicações às repostas sociais e políticas à epidemia de HIV/AIDS no atual contexto de quimioprofilaxias. / HIV Pre-exposure Prophylaxis (PrEP) is a new prevention strategy in which individuals take a daily combination of antiretrovirals in order to prevent acquiring HIV. This study aimed to understand, grounded in PrEP users\' experiences, the production of the individualization process and health. We conducted a discussion-content-analysis of PrEP users, and of interested persons on the subject, in a digital social network. Gays, bisexuals and other Men who have sex with Men accounted for the majority of the group members. Results and discussion were presented in three scientific articles: the first discusses conflicts from the experience of PrEP users in the context of risk society and individualization. The second explores productions of sexual desire and sexual pleasure - mediated by PrEP - on individuals\' lives. The third approaches and discusses PrEP users experiences and self-produced identity processes in contemporary individualization. Final remarks reflects on the implications for social and political responses to the HIV / AIDS epidemic given the current context of chemoprophylaxis.