Bakgrund: Humant immunbristvirus, HIV, är ett virus som angriper kroppens immunsystem. Acquired immunodeficiency syndrome, AIDS, utvecklas från HIV efter lång tid utan behandling. I samhället råder det okunskap och rädsla kring sjukdomen vilket skapar stigmatisering och diskriminering som dagligen påverkar de som lever med HIV/AIDS. Attityden mot HIV-smittade personer är hos många negativ. Det finns sjuksköterskor som inte vill behandla HIV-smittade på grund av rädsla och okunskap. Att få diagnosen är livsomställande och att handskas med det är inte lätt. Syfte: Syftet var att beskriva hur det är att leva med HIV/AIDS i Norden. Metod: Litteraturöversikten baserades på sex kvantitativa och sju kvalitativa artiklar för att få en fördjupad kunskap och en överblick över kunskapsläget för hur det är att leva med HIV/AIDS i Norden. Resultat: I resultatet framkommer det tre kategorier som tillsammans ger en överblick om hur det är att leva med HIV/AIDS. Dessa kategorier är; anpassning till ett nytt liv, hålla hemligt eller komma ut och begränsad sexualitet. Stigmatisering påverkade personernas syn på sig själva och deras beslut kring avslöjandet av sjukdomen. Slutsats: Personer som lever med HIV bemöts ofta med okunskap, fördomar och avståndstagande, därför är bemötandet avgörande. Litteraturöversikten bidrar med information och kunskap som senare kan användas av vårdpersonal för att få en djupare förståelse för personer som lever med HIV. Sjuksköterskan bör ha kunskap om HIV/AIDS för att på bästa sätt kunna ge god omvårdnad, då okunnighet och fördomar i samhället ansågs vara värre än själva sjukdomen.Nyckelord: / Background: Human immunodeficiency virus, HIV, is a virus that attacks the immune system of the body. Acquired immunodeficiency syndrome, AIDS, develops from HIV if it is left untreated. There is a lack of knowledge and fear in the community, which creates stigmatization and discrimination towards the disease. This is affecting those who are living with it daily. The attitude towards HIV-infected individuals is negative. Some nurses are not willing to care for persons with HIV because of fear and lack of knowledge. The diagnosis alters the person’s previous life and to deal with the disease is not easy. Aim: The aim was to describe how it is to live with HIV/AIDS in the Nordic countries. Method: The literature review was based on six quantitative and seven qualitative articles chosen to get a deeper understanding and an overview of knowledge about how it is to live with HIV/AIDS in the Nordic countries. Result: The analysis resulted in three categories that together formed an overview of the life with HIV/AIDS. These categories are; adjusting to a new life, keep secret or come out and limited sexuality. Stigmatization affected the individuals’ view of themselves and their decisions concerning disclosure. Conclusion: People living with HIV are often countered with ignorance, prejudice and distance, therefore the encounter is important. The literature review contributes with information and knowledge that can be used by health professionals to receive a deeper understanding for people living with HIV. Nurses should have knowledge about HIV/AIDS to be able to provide good care. Lack of knowledge and prejudices in the community was considered worse than the disease itself.

Bakgrund: HIV (Human Immunodeficiency Virus) är en sjukdom som påverkar människors immunförsvar. Ca 30–35 miljoner människor lever med HIV i världen. HIV är en sjukdom som påverkar de drabbade både psykiskt och fysiskt. Syfte: Att beskriva vuxna patienters upplevelser av att leva med HIV med fokus på psykiska och fysiska aspekter samt beskriva hur undersökningsgruppen ser ut i de valda artiklarna. Metod: En beskrivande litteraturstudie baserat på 10 vetenskapliga artiklar med kvalitativ ansats. Databasen Cinahl användes till litteratursökningen. Huvudresultat: Resultatet i denna litteraturstudie visade att människor som lever med HIV känner rädsla, depression, oro och stress över att leva med sjukdomen. Känslorna kopplas till upplevelser av stigmatisering och diskriminering från vården och samhället. Människorna som lever med HIV är ofta rädda för hur de blir bemötta av allmänheten. Fysiska symtom som till exempel trötthet påverkar människor som lever med HIV negativt, och förmågan att leva ett normalt liv blir förhindrat. I litteraturstudien presenteras undersökningsgruppen tydligt utifrån vad författarna till de granskade studierna beskrivit. Slutsats: HIV-positiva personer kan mötas i alla vårdinsatser. Känslor av bland annat skuld och skam förekommer ofta hos personer med HIV. Som sjuksköterska är bemötandet av människor med HIV väldigt viktigt. / Background: HIV (Human Immunodeficiency Virus) is a disease that affect the human immune system. Around 30–35 million people are living with HIV in the world. HIV affects people, both mentally and physically. Aim: To describe adults/adult patients experiences of living with HIV, focusing on mental and physical aspects, and to describe how the study group looks in the selected studies. Method: A descriptive literature study, based on 10 scientific articles with qualitative approach. The database that was used to find the articles was Cinahl. Main Results: The result of this literature study shows that people living with HIV daily feel emotions of fear, depression, anxiety and stress due to living with the disease. The emotions connect directly to experiences of stigmatization and discrimination within the healthcare and community. People living with HIV are often afraid how other people will react their disease. Physical symptoms like fatigue affect their everyday life negative, and the ability to live a normal life is prevented. The study group is clearly presented based on what the authors of the audited studies describes. Conclusion: HIV-positive people can be found in all healthcare facilities. Emotions of guilt and shame often occure with people who are living with HIV. As a nurse, the attitude towards people with HIV is very important.

Magister Public Health - MPH / Background: Antiretroviral therapy (ART) was rolled out in South Africa in the public sector in 2004 and the treatment coverage has increased over the years to 56% in 2016. The increased treatment coverage has the potential to increase the level of HIV drug resistance. Drug resistance presents a major challenge to the management of HIV infection through antiretroviral therapy at the population level. The aim of this study was to determine the impact of the public sector antiretroviral therapy rollout on the prevalence of HIV drug resistance in South Africa and the factors associated with drug resistance. Methodology: A cross-sectional analytical study was used to determine the prevalence of drug resistance before and after ART rollout. The study population was HIV infected South Africans (infected between 1996 and 2011) who were not on antiretroviral therapy. The study sample was therapy naïve HIV infected South Africans who participated in published studies conducted between 1996 and 2011. HIV DNA sequences and associated data (participants’ age, gender, geographic location and estimated year of HIV infection) were accessed through the Los Alamos HIV Database. The database contains all HIV DNA sequences and associated data from all published studies and the data was freely accessible. A descriptive analysis was carried out on the data to determine characteristics of the study sample. Drug resistance mutations were detected using Calibrated Population Resistance Program on the Stanford University HIV Drug Resistance database. The output from the Calibrated Population Resistance Program analysis were used to determine the prevalence of drug resistance mutations. Results: There were 1701 DNA sequences obtained from the Los Alamos HIV Database for the three gene regions targeted by ART (reverse transcriptase, protease and integrase). Of these, 604 (35,5%) were for reverse transcriptase, 794 (46,7%) were for protease and 303 (17,8%) were for integrase. There was overrepresentation of DNA sequences from female participants (91%). There was no significant difference in the prevalence of drug resistance mutations between 1996-2004 (before ART rollout) and 2005-2011 (after ART rollout) in all the drug classes. There was also no association between drug resistance and age as well as gender. Conclusion: The data from this study suggest that the public sector rollout of ART did not result in an increase in the prevalence of drug resistance mutations in therapy naïve HIVinfected South Africans. There is need for further studies, which have a wider coverage of the South African population.

Os pacientes infectados pelo vírus da imunodeficiência humana (HIV) freqüentemente apresentam alterações digestivas, sendo o esôfago um alvo comum de lesões estruturais. A etiologia infecciosa é a mais freqüente neste grupo de pacientes. Múltiplos agentes já foram implicados como causadores de lesões esofágicas. As infecções virais são uma das principais causas de tais lesões, sendo os vírus mais implicados o citomegalovirus (CMV) e o vírus herpes simples (HSV). Muitas lesões ulceradas permanecem sem diagnóstico etiológico, mesmo após exaustiva investigação, sendo denominadas úlceras idiopáticas ou aftosas. Os métodos de diagnóstico usuais são demorados e pouco sensíveis. Assim, nosso estudo tem como principal objetivo estudar o papel do método da reação em cadeia da polimerase (PCR) no diagnóstico destas lesões. Durante o período de outubro de 1996 a outubro de 1997, foram estudados 79 pacientes HIV-positivos, que foram submetidos ao exame de endoscopia digestiva alta por indicação clínica. Estes foram submetidos a 89 exames endoscópicos, sendo colhidas 96 biópsias, as quais foram armazenadas em nitrogênio líquido (50) ou em freezer a –70oC (46). O DNA foi extraído usando método baseado na lise hipotônica, digestão com proteinase K, extração com fenol-clorofórmio e precipitação em etanol. Uma quantidade fixa foi usada para amplificação em ciclador térmico, utilizando primers específicos para CMV, Herpesvirus, HPV, HIV, Haemophilus ducreyi, Treponema pallidum e as micobactérias M. tuberculosis, M. avium e M. intracellulare. O produto final foi submetido a uma eletroforese em gel de agarose e corado com brometo de etídeo. A endoscopia não revelou alterações esofágicas em 26 exames (29,2%). As alterações observadas foram monilíase esofágica em 33 exames (37,1%), úlceras em 22 (24,7%); esofagite em 10 (11,2%) e áreas lugol-negativas em 9 (10,1%). A PCR resultou positiva para o CMV em 19 amostras (19,8%), para o Herpes em 4 (4,2%), para o HPV em 17 (17,7%), para o HIV em 37 (38,5%) e para o H. ducreyi em 3 (3,1%). Nenhuma amostra foi positiva para o T. pallidum e para micobactérias. No estudo de 29 amostras de 22 úlceras esofágicas a PCR detectou o CMV em 9 amostras (31%), o Herpes em 3 (10,3%), o HPV em 6 (20,7%), o HIV em 19 (65,5%) e o H. ducreyi em 2 (6,9%) e em 8 (36,4%) não foi detectado nenhum agente. O CMV foi detectado com freqüência nas úlceras esofágicas, sendo difícil diferenciar se havia infecção ativa ou latente. O HIV teve uma incidência elevada nas biópsias de úlceras, o que pode sugerir um possível papel etiológico deste agente em tais lesões. O HPV foi o terceiro agente mais freqüente, mas não foi possível caracterizá-lo como causador de lesões esofágica ulceradas. A PCR apresentou potencial para tornar-se um método útil na investigação das lesões esofágicas em pacientes infectados pelo HIV. / Patients infected by Human Immunodeficiency Virus (HIV) usually present digestive abnormalities and the esophagus is a common target of structural lesions. Infections are the most frequent cause of esophageal lesions in these patients. Several agents were already implied in this process. Viral infections are one of the main causes of such lesions and cytomegalovirus (CMV) and herpes simplex virus (HSV) were the most involved agents. Many ulcerated lesions persist without etiologic diagnosis even after exhaustive investigation, being denominated idiopathic or aphthous ulcers. The usual diagnostic methods are difficult and have low sensitivity. Thus, the main objective of our study was to evaluate the role of the polimerase chain reaction (PCR) method in the diagnosis of these lesions. During the period of October of 1996 to October of 1997, 79 HIV-positive patients were studied. They were submitted to upper digestive endoscopies, which were indicated on clinical basis. These patients were submitted to 89 upper digestive endoscopies, being obtained 96 biopsies, which were stored in liquid nitrogen or in a 70oC freezer. DNA was extracted using a method based on hypotonic lyses, proteinase K digestion, extraction with phenol-chloroform and precipitation in ethanol. A fixed amount was used for amplification in thermal cycler, using specific primers for CMV, herpesvirus, human papillomavirus (HPV), HIV, Haemophilus ducreyi, Treponema pallidum, Mycobacterium tuberculosis, Mycobacterium avium and Mycobacterium intracellulare. The final products were submitted to an electrophoresis in agarose gel and stained with ethidium bromide. The endoscopies did not reveal esophageal alterations in 26 exams(29,2%). The abnormalities observed were esophageal candidiasis in 33 exams (37,1%), ulcers in 22 (24,7%); esophagitis in 10 (11,2%) and lugol-negative areas in 9 (10,1%). The PCR was positive to CMV in 19 samples (19,8%), for Herpes in 4 (4,2%), for HPV in 17 (17,7%), for HIV in 37 (38,5%) and for the H. ducreyi in 3 (3,1%). No sample was positive for T. pallidum or micobacterium. In the study of the esophageal ulcers by PCR, CMV was detected in 9 samples (31%), Herpes in 3 (10,3%), HPV in 6 (20,7%), HIV in 19 (65,5%), H. ducreyi in 2 (6,9%) and any agent was detected in 8 samples (36,4%). CMV was frequently detected in esophageal ulcers, being difficult to differentiate between active and latent infections. The HIV had an elevated incidence in ulcer biopsies, which may suggest a possible etiologic role of this virus in such lesions. HPV was the third more frequent agent, but it was not possible to attribute the esophageal lesions to that virus. In conclusion, this study suggests that the PCR can be an useful method in the investigation of esophageal lesions in HIV infected patients.

Abstract Background: 36,9 millions of people are today living with the Human immunodeficiency virus (HIV). Every year 400-500 new cases of HIV occur and today approximately 6,500 people live with the disease in Sweden. Getting a chronic disease can mean a changed life situation for the affected person and the society tends to stigmatize people living with HIV. Purpose: To describe people's experiences of living with HIV. Method: A literature study with descriptive design was produced and 12 scientific qualitative articles from the database CINAHL were included in the content of the study. Findings: Four main themes were identified for the study's findings: Getting the diagnosis of HIV, Relationships, Difficulties and Negative Emotions, and Changed Perspectives and Positive Emotions. Some participants in the study experienced difficulties living with HIV. In connection with newly discovered HIV diagnosis, many feelings and reactions could arise. Lost hopes, guilt and shame were common experiences of people living with HIV. Fear existed over how family, friends and society would look at them differently. Some people experienced a negative response from healthcare professionals, while some found healthcare professionals as an important support. Some people initially felt feelings of hopelessness and looked at their illness as a death sentence, but over time they got a changed perspective with increased understanding and could instead see bright on the future. Conclusion: Different experiences emerged from living with HIV. Getting the diagnosis of HIV could create devastating feelings for the affected person, but through different kinds of support and strategies, people could have a more positive view of life. Experiences of being treated differently in health care and from their environment could be a great strain in their daily life. In the nurse's work it is therefore important to provide people with HIV as well as relatives with adequate information about the disease and work for person-centered care.

Human immunodeficiency virus type 1 (HIV-1) establishes a persistent infection that leads to acquired immunodeficiency syndrome (AIDS). Approximately 36 million people worldwide are living with HIV-1, which is commonly acquired through sexual contact. Antiviral therapies control disease progression, but do not eliminate this virus from the host. Thus, global efforts are focused on developing vaccines that prevent HIV-1 transmission. Such vaccines are based on eliciting the production of protective antibodies that target the envelope glycoproteins (Envs) of this virus. Unfortunately, HIV-1 immunization trials have shown limited efficacy. A better understanding of the antibody-mediated inactivation process is needed to improve vaccine strategies. In this work we describe two novel factors that contribute to HIV-1 inactivation. First, we show that structural stability of the Env protein determines its sensitivity to vaccine-elicited antibodies. Different interactions within Env contribute to its stability. Perturbation of the Env-stabilizing interactions by physical and chemical treatments enhances sensitivity of HIV-1 to antibodies. Second, we found that the chemical composition of the transmission medium affects Env inhibition by antibodies and other inhibitory agents. Semen is the most common vehicle for HIV-1 transmission. This medium contains high concentrations of the sugar fructose. We found that semen fructose competitively blocks binding of antiviral agents that target sugar residues on Env. Together, this work advances our understanding of the mechanism that underlies HIV-1 inactivation by vaccine-elicited antibodies and provides novel strategies to enhance their potency.

Older adults with infectious and chronic diseases, such as cardiovascular disease and human immunodeficiency virus (HIV), are at high risk for associated chronic comorbidities, which are associated with increased medical expenditures to cover treatment costs. The purpose of this study was to investigate (a) whether adults 65 or older with either HIV or cardiovascular disease were predisposed to increased medical expenditures versus adults 64 and younger, and (b) the impact of race and type of health service used on total direct medical expenditures incurred among adults with HIV or cardiovascular disease. A quantitative, deductive, retrospective cross-sectional design was used, and the behavioral model of health services use and the socioecological model were chosen as the study’s theoretical foundations. Analyses were conducted using binary logistic regression. Controlling for confounding variables of education and region of residence, the key findings were that adults ≥ 65 years had higher odds of incurring higher expenditures overall. White patients had higher odds of incurring higher expenditures for medication (OR 1.251), office-based visits (OR 1.433), inpatient visits (OR 1.245), and outpatient visits (OR 1.451) when compared to other races. Older adults with HIV had higher expenditures for medication and home health (OR 1.850); and older adults with cardiovascular disease had higher outpatient (OR 1.235), inpatient (OR 2.142), and emergency room expenditures (OR 1.063). These findings might promote social change because assessing the influences of cost disparities on infectious and chronic diseases can help address variations in health care costs and can initiate the development of tailored evidence-based practice guidelines that can help older adults.

Thesis (M.Sc. (Pharmacology)) --University of Limpopo, 2014 / Consult the document

Stigma and discrimination are now recognised as major factors in the spread of Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS). To date, research has focused on how to change individual responses to stigma and discrimination without exploring the social and structural dimensions. Complex community and societal dimensions, such as culture, power and difference need to be explored if progress is to be made in coping with stigma and discrimination. India now has HIV/AIDS prevalence figures to rival sub Saharan Africa. The disease has spread from high-risk populations such as intravenous drug users and commercial sex workers into the general population. Married, monogamous, heterosexual women in slum communities are highly vulnerable. Factors such as caste, class, ethnic group, poverty and social expectations present formidable layers of stigma for these women. They have also faced discrimination since before their birth. HIV/AIDS imposes yet another layer of stigma and discrimination upon their shoulders. The aims of the study were firstly to investigate whether stigma and discrimination existed for these women by documenting and analysing literature on the individual, societal and cultural situation of Indian women living with HIV/AIDS (IWLWHAs). Secondly, the study aimed to identify, evaluate and explore the psychosocial needs and coping strategies of IWLWHAs, to determine the barriers to accessing health services, and describe community perceptions as they were experienced by the participants. / This qualitative research study examined the multiple layers of stigma and discrimination experienced by women infected and affected by HIV/AIDS in a low socio-economic area of Mumbai, India. This was achieved by interviewing women who were benefiting from a home-based service - Positive Living - An integrated home-based care programme for people living with HIV/AIDS under the auspices of the KJ Somaiya Hospital in Mumbai. This programme provides a nutrition and home-based service to the nearby community slums. The conceptual framework used for this study was developed to evaluate the effects of natural disasters such as tsunamis, floods and earthquakes. HIV/AIDS is no less of a tragedy for individuals, families and communities. Within this framework, human capacity or the ability of individuals to cope is linked to social ecology - the relationship between individuals and their community. This dimension overlaps with culture and values. Three other dimensions affect humans - economic status, the environment and living conditions, and physical health. I have developed this framework further to examine threats and strengths which arise from these dimensions, and which affect human resilience. An exploratory case study was considered the most suitable approach to explore these areas, as it permits more sensitivity and richer data, and enhances rigour. In-depth interviews of 45 women in three different age groups, home visits and observations, focus group discussion, key informants, narratives, vignettes and photographs were supported by documentary data collection in triangulation of the data. A reflective journal recorded observations and perceptions in the field during three months in India. / Results from the combined data indicated that IWLWHAs experienced discrimination in their families, communities and health care settings. Fear of future discrimination ensured secrecy which, in turn, prevented them accessing community services which would provide emotional and physical support. A range of reactions was demonstrated by the affected women, half of whom were also infected which added to their burden. Women who could not disclose their condition were extremely isolated, lacked family and community support, feared the future and felt hopeless. Despite their appalling living conditions of poverty, overcrowding, prevalence of disease and pollution, the women displayed a sense of pride, dignity and resilience. Culturally appropriate strategies are necessary to address the lack of education and awareness as only two of the 45 women had any knowledge of HIV/AIDS before their own diagnosis which often followed their husbands' positive status. In addition, the social and cultural dimensions which affect these women have to be explored and examined in order to strengthen the 'shock absorbers' of the family. The community health workers and co-ordinator of the home-based service were vital in providing emotional support and health information to the women. Finally, no change is possible unless men take responsibility for their sexual mores. Policy makers and programmes have to look further for strategies which would engage men in the process to change their attitudes and thus protect vulnerable women and children.

This thesis presents data on two separate areas relevant to the prevention of HIV and sexually transmitted infection (STI) transmission in homosexual men. These data arise from the community-based Health in Men (HIM) cohort of HIV-negative homosexual men in Sydney. First, the association of circumcision status with HIV and STIs was examined. Older age, ethnicity and country of birth were demographic factors independently associated with circumcision status. Self-report was a valid measure of circumcision status in this population. Overall, being circumcised was associated with a non-significant reduced risk of HIV seroconversion in the HIM cohort (HR 0.76, 95% CI 0.41-1.41, p=0.381). Among the one-third of participants predominantly practising the insertive role in anal intercourse (AI), being circumcised was associated with a significantly reduced risk of HIV infection (HR 0.15, 95% CI 0.03-0.80, p=0.026). Circumcised HIM participants also had a lower risk of incident syphilis (HR 0.35, 95% CI 0.15-0.84, p=0.019), however circumcision status had no significant effect on the remainder of prevalent and incident STIs examined. Second, risk factors for pharyngeal gonorrhoea and chlamydia were investigated. The BD ProbeTec nucleic acid amplification test (NAAT) had a positive predictive value (PPV) for pharyngeal gonorrhoea diagnosis of only 30.4% (95% CI 25.2-36.1%) when compared to a previously validated NAAT targeting the gonococcal porA pseudogene. Pharyngeal gonorrhoea was common in HIM, mostly occurred without concurrent anogenital infection and may frequently spontaneously resolve. Infection was independently associated with younger age (p-trend=0.001), higher number of male partners (p-trend=0.002), contact with gonorrhoea (p<0.001) and insertive oro-anal sex with casual partners (p-trend=0.044). Pharyngeal chlamydia was less common but a high prevalence/incidence ratio suggested that infection may persist in the pharynx for long periods. Pharyngeal chlamydia was independently associated with receptive penile-oral sex with casual partners (p-trend=0.009). In conclusion, circumcision may have a role as an HIV prevention intervention among the subgroup of homosexual men who predominantly practise insertive rather than receptive AI. Regular screening of the pharynx including a validated supplemental NAAT for gonorrhoea diagnosis may prevent much transmission to anogenital sites, whereas chlamydia occurs too infrequently in the pharynx to recommend routine screening in homosexual men.