From the early 1990s, rates of HIV infection increased dramatically in South Africa and by the early 2000s, AIDS emerged as the main cause of death for adult South Africans. During the first half of the 2000s, the South African government’s response to this crisis was inadequate, marked by denial and delays in implementing prevention and treatment, resulting in thousands of preventable deaths. Yet, apart from the challenges posed by the predominantly urban-based Treatment Action Campaign (TAC), the absence of a social response to this crisis is notable, especially in rural settings. This scenario forms the broad backdrop to this ethnographic study that draws on participant observation and interviews undertaken over a three-year period (2002-2005) in KwaBomba village previously in the Gazankulu Homeland, now located in the Bushbuckridge municipality of the South African lowveld. An ethnographic perspective provides an intimate vantage point from which to view peoples’ experiences of the AIDS epidemic and their responses in context. This perspective draws attention to gaps in public health and biomedical understandings of the epidemic and suggests alternatives to these understandings. In Bushbuckridge, mortality and morbidity due to AIDS became visible in the late 1990s and early 2000s. Households were incapable of dealing with the burden of illness and death while the health services were often unwilling and ill-prepared. HIV prevention campaigns based on individual behaviour change were not well suited to a context in which HIV spread through sexual networks. Despite widespread awareness of the threat of AIDS, the disease was subjected to public censorship and AIDS suffering was concealed. Public discourses of AIDS were hidden within gossip and rumour and articulated as witchcraft suspicions and accusations. Although these discourses appear to deny and suppress the reality of AIDS, I suggest that they are active attempts to deal with the AIDS crisis: gossip and rumour allocate blame and construct a local epidemiology through which the epidemic can be surveilled; interpreting AIDS as witchcraft creates the possibility of avenging untimely death. These discursive forms are critical in informing individual and social responses to the AIDS epidemic. While the absence of public acknowledgement of AIDS as a cause of illness and death suggests denial and fatalism and appears to limit public action, subaltern discourses create shared secrets to manage the AIDS epidemic at the local level. Furthermore, these discourses may constitute a form of resistance against biomedical models of causality. Ethnographic enquiry at the local level offers a nuanced understanding of social responses to the AIDS epidemic. By examining forms of expression that lie outside the domain of public health, the thesis reveals how these constitute significant forms of social action in response to the epidemic. / Thesis (PhD)--University of Pretoria, 2012. / Anthropology and Archaeology / unrestricted

Primate lentiviruses encode four “accessory proteins” including Vif, Vpu, Nef, and Vpr/ Vpx. Vif and Vpu counteract the antiviral effects of cellular restrictions to early and late steps in the viral replication cycle. The functions of Vpx/ Vpr are not well understood. This study presents evidence that the Vpx proteins of HIV-2/ SIVSMpromote HIV-1 infection by antagonizing an antiviral restriction in myeloid cells. Fusion of macrophages in which Vpx was essential for virus infection, with COS cells in which Vpx was dispensable for virus infection, generated heterokaryons that supported infection by wild-type SIV but not Vpx-deleted SIV. The restriction potently antagonized infection of macrophages by HIV-1, and expression of Vpx in macrophages in transovercame the restriction to HIV-1 and SIV infection. Similarly, the cellular restriction is the obstacle to transduction of macrophages by MLV. Neutralization of the restriction by Vpx rendered macrophages permissive to MLV infection. Vpx was ubiquitylated and both ubiquitylation and the proteasome regulated the activity of Vpx. The ability of Vpx to counteract the restriction to HIV-1 and SIV infection was dependent upon the HIV-1 Vpr interacting protein, damaged DNA binding protein 1 (DDB1), and DDB1 partially substituted for Vpx when fused to Vpr. This study further demonstrates that this restriction prevents transduction of quiescent monocytes by HIV-1. Although terminally differentiated macrophages are partially permissive to HIV-1, quiescent monocytes, which are macrophage precursors, are highly refractory to lentiviral infection. Monocyte-HeLa heterokaryons were resistant to HIV-1 infection, while heterokaryons formed between monocytes and HeLa cells expressing Vpx were permissive to HIV-1 infection, suggesting the resistance of quiescent monocytes to HIV-1 transduction is governed by a restriction factor. Encapsidation of Vpx within HIV-1 virions conferred the ability to infect quiescent monocytes. Introduction of Vpx into monocytes by pre-infection also rendered quiescent monocytes permissive to HIV-1 infection. Infection of monocytes by HIV-1 either with or without Vpx did not have an effect on temporal expression of CD71. In addition, Vpx increased permissivity of CD71– and CD71+cells to HIV-1 infection with no apparent bias. These results confirm that Vpx directly renders undifferentiated monocytes permissive to HIV-1 transduction without inducing their differentiation. The introduction of Vpx did not significantly alter APOBEC3G complex distribution, suggesting a restriction other than APOBEC3G was responsible for the resistance of monocytes to HIV-1. Collectively our results indicate that macrophages and monocytes harbor a potent antiviral restriction that is counteracted by the Vpx protein. The relative ability of primate lentiviruses and gammaretroviruses to transduce non-dividing myeloid-cells is dependent upon their ability to neutralize this restriction.

Philosophiae Doctor - PhD / In the decade since first identified, the Acquired Immunodeficiency syndrome (AIDS) has become a serious global disease. The nature of the Human Immunodeficiency Virus (HIV) that causes AIDS, whereby a carrier may be asymptomatic yet remain infectious, has enabled its dramatic spread. The number of AIDS cases is increasing exponentially, averaging a doubling time of between 8-15 months in different countries. Of the millions of HIV carriers, it is now estimated that all will eventually go on to develop full-blown AIDS and probably die within 15 years. Unlike other infectiqus diseases, there is currently no known vaccine or cure. Further, HIV is now virtually completely dependent on volitional sexual behaviours for transmission to occur. It is therefore an entirely preventable disease. However, since the behaviours that contribute to HIV-transmission are influenced by biological, psychological, and social factors, their alteration in line with safer sexual practices has been shown to be considerably complex and difficult. Intervention strategies that have relied on imparting knowledge about the disease have achieved limited success in influencing behaviour change. Unsafe sexual practices, and the risk of HIV-infection, often continue even when knowledge regarding prevention is adequate. It has therefore become apparent that other variables intrude which may mediate between knowledge acquisition, attitude formation, and consequent sexual behaviours. There appear to be no models which adequately explain the complexities in this area, and which enable adequate intervention strategies to be developed. The present study was undertaken to redress this problem, and to explore those variables that mediate in the area. Various psychological and social factors appear to be implicated in influencing sexual attitudes and behaviours. In order to adequately test the impact of psychosocial variables that were found to have significant associations in an exploratory study, a measuring instrument was developed. The AIDS Psychosocial Scale was statistically validated using content, frequency, factor, and reliability analyses and included psychological factors of self concept, defenses of denial, repression, and rationalisation, perceived empowerment in the form of locus of control and selfefficacy, and the social factor of peer pressure susceptibility. The impact of these psychosocial variables on indices of knowledge, condom attitude, and sexual practices, and on other epidemiological variables was tested using a sample of students at the University of the Western Cape (n=308). Results indicated a number of correlational and causal links between variables, confirming the mediational role psychosocial factors have in influencing knowledge acquisition, attitude formation, and behaviour outcome. A profile of lower self concept, higher defenses, lower self-efficacy, more external locus of control, and higher peer pressure susceptibility emerged which was associated with poorer knowledge, more negative attitudes, and higher unsafe sex. Based on this study, a model of psychosocial mediation is developed and its implications for intervention strategies discussed.

No description available.

Human Immunodeficiency Virus (HIV) is a virus that is transmitted through certain bodily fluids and compromises the immune system of its host. Despite the emergence of antiretroviral therapy (ART) converting human immunodeficiency virus type 1 (HIV-1) infection from a fatal disease to a chronic condition, there is still no cure. ART frequently reestablishes peripheral CD4+ T cell counts, but persistent immune dysfunction and inflammation strongly correlate with increased risks of attaining non-AIDS morbidity and mortality. Elimination of this reservoir may occur by the proposed mechanism of combining latency-reversing agents (LRAs) with immune effectors, such as CD8+ T cells (Meås et al., 2020). Here, our study investigates Toll-like receptor 7/8 (TLR 7/8) superagonists that may act as potent, effective latency reversal agents (LRAs). Whether this will prove to be the case needs to be further studied, and potential adverse toxicities must be identified. Whether comparable results will be observed in peripheral blood mononuclear cells (PBMCs) infected with HIV-1 as in our study using PBMCs infected with simian immunodeficiency virus (SIV) remains to be tested. Our results provide further hope for a potential cure for HIV-infected individuals.

Bakgrund: Hiv är ett kroniskt virus som angriper immunförsvaret. Det råder stor okunskap kring hiv samt en hel del fördomar och stigmatisering i samhället gällande de som är hiv-positiva. En diagnos medför en stor livsomställning och en transition genomgås. Det ligger i sjuksköterskans profession att bemöta varje person och hjälpa dem i den övergång som sker samt ge information angående hälso- och smittorisker. Syfte: Syftet var att beskriva upplevelsen av att få ett positivt hiv-besked och hur diagnosen hanteras. Metod: Innehållsanalys av biografier används för att belysa personernas subjektiva upplevelser. Resultat: I resultatet framkommer tre teman.  Att få döden som följeslagare; där det framkommer att beskedet är sammankopplat med olika känslor och är unikt för varje person, döden står i centrum.  Att stänga dörren eller komma ut; valet att leva öppet med sin sjukdom eller hålla den hemlig är kopplat till stigmatisering.  Slutet på livet eller början på något nytt; hur personerna hanterar och accepterar situationen så en transition kan genomgås. Slutsats: Med arbetet kan en ökad förståelse för hiv-smittade personer uppnås. Genom att öka kunskapen kring hiv bland vårdpersonal kan en mer individuell vård ges till dessa personer. / Background: Hiv is a chronic illness which attacks the immune system. There is an ignorance around hiv and prejudices and stigmatisation in the community regarding the hiv-positives. A diagnosis brings a life adjustment and the person goes through a transition. The nursing profession contains the meeting with individuals and helps them through the transition and give information about risks of health and infection. Aim: Describe the experience of knowledge about a positive hiv-diagnosis and the management of the diagnosis. Method: A content analysis of biographies uses to illustrate the individuals subjective experiences. Results: Three themes arrives in the result. Death as follower; it reveals that the announcement of the hiv-diagnosis is linked to different feelings and it’s unique for each person, death is crucial. Close the door or come out; the choice to live openly with the disease or keep it as a secret is connected to stigmatization. The end of life or the beginning of something new; how to deal with and accept the situation so a transition can lives through. Conclusion: This study can contribute to an increased comprehension forpeople who lives with hiv.  The knowledge about the diagnosis could contribute to a more individual medical care.

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>

Bakgrund: HIV/AIDS är idag en sjukdom som varit känd för oss i snart tre decennier. Synen på människor som har HIV har förvisso ändrats. Trots förändringar upplever personer med HIV fortfarande negativa attityder, diskriminering och socialt utanförskap både ute i samhället och inom sjukvården. Vid en närmare granskning av litteraturen visar det sig att attityder och rädslor finns kvar mot personer med HIV även hos sjukvårdspersonal. Syfte: Att undersöka sjuksköterskestudenters attityder till personer med HIV. Med frågeställningarna: Hur ser sjuksköterskestudenternas avståndstagande attityder till personer med HIV ut? Hur ser sjuksköterskestudenternas empatiska attityder till personer med HIV ut? Och finns det en önskan att kunna avstå från att vårda personer med HIV. Metod: Studien är deskriptiv kvantitativ med ett frågeformulär baserat på Aids Attitude Scale AAS, ett instrument som mäter avståndstagande och empatiska attityder till personer med HIV. Respondenterna grupperades utifrån ålder, vårderfarenhet och erfarenhet av att vårda patienter med HIV och jämfördes med varandra. Kvalitativa inslag finns i mätinstrumentet i form av möjligheter för respondenten att lämna kommentarer till det sista påståendet om jag gavs valmöjlighet skulle jag avstå från att vårda patienter med HIV. Resultat: Resultatet visar att respondenterna överlag har positiva attityder till personer med HIV. Resultatet visar att respondenterna i de äldre åldersgrupperna, 26- 30 år och 31- 45 år och de som hade tidigare vårderfarenhet, samt de som hade tidigare erfarenhet av vård av personer med HIV uppvisade mindre avståndstagande attityder men också mindre empatiska attityder. Andelen respondenter som ställde sig bakom påståendet om jag gavs valmöjlighet skulle jag avstå från att vårda patienter med HIV, var högre i grupperna där åldern var lägre, gruppen 20- 25 år och hos de som inte hade vårderfarenhet eller erfarenhet av att vårda patienter med HIV. Kunskap och utbildning kan vara av betydelse för att attityderna mot personer med HIV ska kunna ändras. Konklusion: Erfarenhet av att vårda sjuka människor i allmänhet och att vårda sjuka människor med HIV i synnerhet kan leda till lägre avståndstagande attityder mot personer med HIV.

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.