Thesis (doctoral)--Ludwig-Maximilians-Universität, 1996.

Thesis (M.N.)--Memorial University of Newfoundland, 1996. / Typescript. Bibliography: leaves 94-104. Also available online.

Thesis (Ph. D.)--Université Laval, 2005. / Title from PDF title page (viewed on Oct. 5, 2006). Includes bibliographical references (p. [299]-320).

This ethnography of intravenous (IV) drug users challenges popular representations of a "junkie" subculture and stereotypes of users as rejecting the dominant cultural values of mainstream society. Users attempts to construct and maintain a moral identity are examined. Beyond "war stories" ennobling street life and survival, life narratives were constructed through a juxtaposition of voices and images establishing moral worth in opposition to others. Moral identity is a central concern for IV drug users, one influencing their response to risk. Social relations, responsibility, and an ethic of care were found to underlay the moral codes developed by users, codes socially-embedded and to some degree gender specific. Men tended to adopt a "tough guy," "independence" voice in which responsibility was largely framed around status and image as a role model. Women tended to see responsibility and morality within a web of interdependence and care. Social responsibility was a measure of moral goodness. The desire to be defined by mainstream values was strongly evident among women users who were mothers. Motherhood was a core symbol representing inherent goodness, a marker of moral identity, and a means toward achieving a socially acceptable identity. The identities of "junkie" and "mother" placed women in a state of perpetual tension and conflict as manifested in issues of child custody and welfare. Maintaining relationship with their children was central to the women's moral identity, be it based in daily interaction or visitations inspiring hopes for a future. This ethnography suggests that IV drug users, while chemically dependent, maintain a sense of agency. Contrary to stereotypes of irresponsibility, users are reflexive about their habit's control and their use of drugs to block suffering, social responsibility, and the pain they cause others. Displays of agency and exercises of control proved critical in identity construction, particularly for women users diagnosed HIV positive. Documented was the process whereby they redefined their "health" and moral identity in the company of others who assisted in constructing identities in contrast to the negative stereotypes of AIDS. Through discourse within these "life narrative groups" a positive diagnosis was transposed into a positive identity.

<p>Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual&nbsp / TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death&nbsp / amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload&nbsp / due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may&nbsp / not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy.&nbsp / Clinicbased training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored. </p>

there is a growing body of research on men who have sex with men (MSM) and risk factors for HIV in South Africa. However, in order to develop more appropriate and relevant interventions to reduce the transmission of HIV amongst MSM and MSMW, there was a need to deepen our understanding of sexual risk behaviour and protective practices. The aim of the study was to explore the sexual risk and protective behaviour of men who have sex with men and women in Soweto, South Africa.

Introduction Voluntary Counselling and Testing (VCT) play a crucial role in the control and management of the HIV/AIDS epidemic. It is essential to understand the factors that influence the utilisation of VCT to improve implementation of measures that encourage VCT uptake. The purpose of this study was to determine factors affecting the utilisation of Voluntary Counselling and Testing (VCT) services for HIV/AIDS in Sowa, Botswana. Methodology A cross-sectional study was carried out by collecting data from 71 randomly selected participants residing in the community of Sowa, Botswana. Open and close ended questions were used. Relevant demographic data were collected from each respondent. Univariate and multivariate analysis was done using chi square test and logistic regression models through STATA11 statistical software. Results About half of the respondents were willing to utilise the VCT services. Willingness to utilise VCT was significantly associated with the respondents' choice of VCT centres, worry about confidentiality at VCT centres, and concern about their partners' being aware of their use of VCT. The expected reactions of their partner, family and community to the use of VCT by the respondents, in addition to the willingness of respondents to inform their partners the result of their HIV test, were other factors associated with the use of VCT. Multivariate regression showed that being "not worried" (AOR 33.48; 95CI 5.63 - 199.15) about confidentiality at VCT centres predicted the willingness to use VCT. In addition, not worried that their partners were aware they had utilised VCT (AOR 7.25; 95CI 1.69- 31.14), and readiness to inform their partners about the result of their HIV test (AOR 14.96; 95CI 3.74- 59.85), predicted the willingness of respondents to utilise VCT. Similarly, the expectation of a happy reaction from partner (AOR 47.02; 95CI 3.83- 577.11) and family (AOR 45.13 95CI 3.28-620.72) on being aware the respondent had used VCT, also predicted willingness to use VCT. Conclusion This study confirmed that stigma related to VCT use and confidentiality at VCT centres influence the utilisation of VCT services. Also, concern about partner's awareness that a respondent had used VCT and the expected response of partner, family, and community, were all important influencing factors to the utilisation of voluntary counseling and HIV testing services. These issues need to be addressed in order to increase VCT uptake among individuals and the community.

A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine (Pharmacotherapy) / Background: The decision of when to start treatment in an HIV-infected individual has always been problematic as far as CD4 count is concerned. Aims: To determine the clinical outcome of patients who commence HAART at different CD4 cell count levels. Method: Retrospective analysis of records of a cohort of patients who are received ART at workplace wellness clinics in three mines in Limpopo province from January 2003 to December 2009. Patients were divided into three groups based on their baseline, group A (CD4 <100), group B (CD4 101-200) and group C (CD4 201-250) Each patient’s data was analyzed one year after his/her commencement. Results: The percentage of patients who died in group A (16%) differs significantly from the percentage of patients who died in group B (4%) (Fisher exact test p= 0.038) and also differ significantly from the percentage of patients who died in group C (0%) (Fisher exact test p= 0.011). The percentages of patients who developed TB in the three groups are 8%, 8% and 2.9% respectively. When compared statistically, these percentages do not differ significantly (Fisher exact test p=0.059).The percentages of patients with severe bacterial pneumonia in the three groups (2%, 2% and 0% respectively) do not differ significantly (Fisher exact test p=0,276).The percentage of hospital admissions for patients in group A (18%) differ significantly from the percentage in group B (6%) and the percentage in group C (6%) (Fisher exact test p= 0.05). The percentage of patients with weight loss of more than 10% of baseline value in group A (24%) differ significantly from the percentage in group B (4%) (Fisher exact test p= 0.003) and also differ significantly to from the percentage in group C (0%) (Fisher exact test p= 0.001). The percentage of patients with undetectable viral load in group B (89%) is significantly different from the percentage in group A (69%) (Fisher exact test p= 0.03) and is also significantly different from the percentage in group C (61%) (Fisher exact test p= 0.008).The change in mean CD4 cell count was found to be statistically significant within each group (paired t test, p<0.0001), but the mean changes between the three groups (132,141 and 172) respectively, do not differ significantly (ANOVA test). Conclusion: Patients with baseline CD4 cell count of less than 100 have a poor clinical outcome when compared to patients with baseline CD4 cell count of more than 100. Efforts must be made to identify patients early before CD4 cell count fall to below 100 and preferably initiate HAART when CD4 cell count is above 200.

OBJETIVOS: conhecer os perfis epidemiológico, clínico e laboratorial dos pacientes com infecção por Salmonella spp. e o perfil de sensibilidade antimicrobiana destas cepas de Salmonella spp., no Instituto de Infectologia Emílio Ribas, São Paulo (SP), no período de 1992 a 2002.MÉTODOS: revisão dos prontuários médicos dos pacientes e avaliação do perfil de sensibilidade das cepas de Salmonella ssp. pelo método de disco difusão das cepas aos antimicrobianos ciprofloxacina, ceftriaxone, cloranfenicol, ácido nalidíxico, ampicilina, sulfametoxazol-trimetropim (SMX-TMP), tetraciclina e estreptomicina. RESULTADOS: um total de 146 cepas de Salmonella spp. foram isoladas a partir de pacientes diferentes durante o período avaliado. Cento e onze (76,0%) pacientes eram do sexo masculino e 35 (24,0%), do feminino. A média de idade dos pacientes foi de 29,33 ± 12,76 anos (mínima de um ano e máxima de 70 anos). Cento e seis (72,6%) pacientes residiam na cidade de São Paulo. Em 128 (87,7%) casos, a fonte provável de contaminação por Salmonella spp. era desconhecida. A febre, diarréia, náuseas e/ou vômitos e sintomatologia respiratória estiveram presentes em, respectivamente, 111(76%), 92 (63%), 67 (45,9%) e 63 (43,2%) pacientes na admissão hospitalar. Em indivíduos HIV-positivos, os sintomas respiratórios foram mais os comuns. A maior parte das cepas foi obtida de sangue e fezes, respectivamente, 109 (74,4%) e 22 (15,1%) cepas. Trinta e cinco (24,0%) cepas eram do sorotipo Salmonella Typhi e 111 (76%), sorotipos não-Typhi, sendo os sorotipos mais comuns Enteritidis com 42 (37,8%) cepas; Typhimurium, 23 (20,7%); I,4,[5],12:i:-, 16 (14,4%) e Dublin, 16 (14,4%). Noventa e sete (66,4%) pacientes tinham sorologia para HIV positiva e seis (4,1%), negativa. Quarenta e três (29,5%) pacientes tinham sorologia anti-HIV desconhecida. Entre os 97 pacientes HIV-positivo, em 14 (14,4%), o episódio atual de salmonelose, com ou sem patologias oportunistas, foi a responsável pela descoberta da infecção pelo HIV ou desenvolvimento para a sida em indivíduos já sabidamente HIV-positivo. Os seguintes percentuais de sensibilidade foram encontrados nos antimicrobianos estudados: ciprofloxacina, 100% de sensibilidade; ceftriaxone, 99,3%; cloranfenicol, 96,6%; ácido nalidíxico, 95,2%; ampicilina, 92,5%; sulfametoxazoltrimetoprim, 91,8%; tetraciclina, 86,3% e estreptomicina, 65,8%. Trinta e oito (26,0%) pacientes evoluíram para o óbito, sendo todos HIV-positivo/AIDS (p< 0,0001) e em todos isoladas cepas de Salmonella não-Typhi (p = 0,0001). CONCLUSÕES: a ocorrência dos sorotipos Typhi e não-Typhi e a sintomatologia diferem segundo a condição sorológica para o HIV. A cultura do sangue e de fezes deve fazer parte da rotina do diagnóstico. Ciprofloxacina, ceftriaxone,cloranfenicol e ampicilina constituem opções terapêuticas adequadas para a infecção por Salmonella spp.. Foram fatores de risco para o óbito, sorologia anti-HIV positiva e o isolamento de Salmonella não-Typhi. / OBJECTIVES: knwon the epidemiological, clinical and laboratorial characteristics of the patients with infection due to Salmonella spp. and the pattern of susceptibility to antimicrobials of such isolates of Salmonella spp., from \"Instituto de Infectologia Emílio Ribas, São Paulo\" (SP), in the period of January 1992 to December 2002. METHODS: review of the patients charts and evaluation of the pattern of susceptibility from the isolates of Salmonella spp. performing the disk diffusion method to the antimicrobials ciprofloxacin, ceftriaxone, chloramphenicol, nalidixic acid, ampicillin, trimethoprim/sulfamethoxazole, tetracycline and streptomycin. RESULTS: a total of 146 isolates were obtained from different patients in the period evalueted. One-hundred and eleven (76.0%) patients were male and 35 (24.0%), female. The median age was 29.33 ± 12.76 years (range one year 70 years). One-hundred and six (72.6%) patients lived in the city of São Paulo. In 128 (87.7%) cases, the probable source of contamination with Salmonella spp. was unknwon. Fever, diarrhoea, nausea and/or vomiting and respiratory sintomatology were present, respectively, in 111(76%), 92 (63%), 67 (45.9%) and 63 (43.2%) patients at presentation. In HIV-seropositive patients, respiratory sintomatology was the most common. Most of the isolates were obtained from blood and stool, respectively, 109 (74.4%) and 22 (15.1%) isolates. Thirty-five (24.0%) isolates belonged to serotype Salmonella Typhi and 111 (76%) to non-Typhi serotypes, being the most common Enteritidis with 42 (37.8%) isolates; Typhimurium, 23 (20.7%); I,4,[5],12:i:-, 16 (14.4%) and Dublin, 16 (14.4%). Ninety-seven (66.4%) patients had HIVserology positive and six (4.1%) patients, negative. In 43(29.5%) patients, the HIV serology was unknown. Considering the 97 HIV-seropositive patients, in 14 (14,4%), the actual episode of salmonellosis, with or without oportunistic infections, was the responsible for the discovery of the HIV infection or to development to Acquired Immunodeficiency Syndrome in already known HIV-seropositive patients. The following percentages of susceptibility were found in the antimicrobials analysed: ciprofloxacin, susceptibility of 100%; ceftriaxone, 99.3%; chloramphenicol, 96.6%; nalidixic acid, 95.2%; ampicillin, 92.5%; trimethoprim/sulfamethoxazole, 91.8%; tetracycline, 86.3% and streptomycin, 65.8%. Thirtyeight (26.0%) evoluted to death, being all HIV-positive patients (p < 0.0001) with infection to non-typhoidal Salmonellae (p = 0.0001). CONCLUSIONS: the occurrence of serotypes Typhi and non-Typhi and the patients sintomatology depends on the HIV-serology. Culture of blood and stool should be part of the diagnosis. Ciprofloxacin, ceftriaxone, chloramphenicol and ampicillin are good therapeutic options for Salmonella spp. infection. HIV-serology positive and the isolation of non-Typhi Salmonella were risk factors to death.

Este estudo objetivou compreender os significados de viver com o vírus da imunodeficiência adquirida/síndrome da imunodeficiência adquirida (HIV/aids) sob a perspectiva de pessoas vivendo com HIV (PVH), acompanhadas no Serviço de Atendimento Especializado em doenças infectocontagiosas (SAE) de São José do Rio Preto, São Paulo. Estudo com abordagem qualitativa, edificado no referencial teórico-metodológico da Análise de Discurso de matriz francesa. A população de estudo foi constituída por 11 sujeitos, os quais foram admitidos no SAE no ano 2000 e estavam em seguimento clínico ambulatorial no referido serviço em 2015. A geração de dados foi realizada entre os meses de maio e agosto de 2015. Aplicou-se a técnica de entrevista semidirigida norteada por roteiro de entrevista e utilizou-se, ainda, formulário de coleta de dados que considerou dados secundários (prontuário individual) e os relatos dos sujeitos. As entrevistas foram áudio-gravadas, transcritas na íntegra e armazenadas no software Atlas ti 7.0. Os gestos interpretativos possibilitaram a elaboração de dois blocos discursivos (BD): Sentidos de incorporação e (re)produção do discurso biomédico; e Da normalização à resistência: processos de experienciar o HIV/aids em cronicidade. No primeiro BD, os sujeitos adoecidos incorporaram o discurso biomédico, pautando suas experiências no cientificismo e na patologia. Com efeito, reproduziram o discurso dominante reverberando sentidos de seguimento ininterrupto da terapêutica medicamentosa, bem como de práticas e de comportamentos legitimados como salutares (alimentação saudável, higiene pessoal). No segundo BD, foram analisados os sentidos de normalização discursiva do HIV/aids, de modo que os sujeitos relacionaram as experiências de adoecimento às atividades do cotidiano que, sobretudo, deveriam minimizar exposição a situações de risco à saúde. Observou-se, porém, que tais sentidos de normalização estão envoltos em contextos fragilizadores, tais como o preconceito, o estigma e a discriminação ante ao HIV. Aspectos que pareceram estar na base de um discurso de resistência dos sujeitos adoecidos que, por sua vez, pareceu justificar momentos/períodos de interrupção do tratamento medicamentoso. Concluiu-se que o cuidado às PVH em cronicidade requer, entre outros, a constituição de reflexões (outras) que favoreçam uma relação dialógica proximal entre os profissionais de saúde e os sujeitos adoecidos. De tal sorte que se compreenda a dinamicidade de uma condição de adoecimento em constante devir, balizada pelo modo de ser e de estar de cada sujeito em seu meio / The goal of this study was to understand the meanings of living with the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) by the perspective of people living with HIV (PLH), assisted by the Specialized Service of infectious diseases (SS), São José do Rio Preto, São Paulo. Study through a qualitative approach, based on the theoretical-methodological referential of french Discourse Analysis framework. The study population consisted of 11 subjects, who were admitted to the SS in the year 2000 and were in an outpatient clinical follow-up in the same medical facility in 2015. Data were generated between May and August 2015. The semi-guided interview technique was applied guided by interview script. In addition, data collection form was used which considered secondary data (individual records) and the subjects\' reports. The interviews were audio-recorded, transcribed in full and stored in the software Atlas ti 7.0. The interpretative gestures allowed the elaboration of two discursive blocks (DB): Sense of incorporation and (re)production of the biomedical discourse; and From normalization to resistance: processes of experiencing HIV/AIDS in chronicity. In the first DB, the sick individuals incorporated the biomedical discourse, guiding their experiences in scientism and pathology. In fact, they reproduced the dominant discourse reverberating meanings of uninterrupted follow-up of drug therapy, as well as practices and behaviors legitimized as healthy (healthy eating, personal hygiene). In the second DB, the meanings of discursive normalization of HIV/AIDS were analyzed, so that the subjects related the experiences of illness to daily activities that, above all, should minimize exposure to health risk situations. It has been observed, however, that such meanings of normalization are embedded in fragilizing contexts, such as prejudice, stigma and discrimination against HIV. Aspects that seemed to be the basis of the sick subjects\' resistance discourse, which, in turn, seemed to justify moments/periods of interruption of drug treatment. It was concluded that care for chronical PLH requires, among other things, the constitution of reflections (others) that favor a proximal dialogical relationship between health professionals and those who are ill. So that the dynamicity of a condition of illness in constant becoming can be understood, distinguished by the way of being and being of each subject in its environment