Effectiveness of services for Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) depends on viable and efficient health systems, adherence to and utilization of services. Despite strategies to provide access to PMTCT of HIV services, utilization of these services remain low in Nigeria thereby increasing child morbidity and mortality from HIV-related causes. Adherence to comprehensive HIV/AIDS care, for both the mother and baby, remain a challenge for HIV positive women. Utilizing the Health Belief Model and Social Support Theory, this qualitative study explores factors influencing utilization and adherence to PMTCT services by mothers living with HIV/AIDS in Rivers State, Nigeria. Purposive sampling procedures were used to select 40 study participants including 20 HIV positive mothers and 20 health care workers as key informants. Findings indicate that high self-perceived susceptibility to HIV influences utilization and adherence to PMTCT services among mothers living with HIV and AIDS in Rivers State. Although utilization and adherence to PMTCT were reported very high among this population, there were however challenges and barriers to optimal utilization of PMTCT. These include unavailability of test kits, antiretroviral medication stock-outs, and inadequate human resources for health. High transport, PMTCT and antenatal care costs were identified as the major socio-economic barriers to PMTCT administration as well as the high financial burden of formula feeding for women that preferred exclusive formula feeding. In addition to increased numbers of health care workers trained in PMTCT service delivery, recommendations for a public health approach to service delivery and a streamlined primary care strategy are proposed. These include social and community activities to address HIV/AIDS stigma, improving awareness of PMTCT facts, addressing gender relations and encouraging male participation. Inter-ministerial collaborations and targeted partnerships are also recommended for expanding coverage and ensuring optimal utilization of PMTCT services.

Over 60% of those living with HIV/AIDS are women, the majority of them in their sexual and reproductive years (UNAIDS, 2006). With antiretroviral (ARV) drugs, most of them are living longer and healthier to engage in sexual and reproductive activities (WHO, 2006). This study explored the sexual and reproductive decisions and experiences of women living with HIV/AIDS (WLWHA) in Abuja, Nigeria. Only those who became pregnant and had a child after being diagnosed with HIV participated in the study. The study was an interview based qualitative research. The design of the interview guide was informed by the PEN-3 Model (Airhihenbuwa, 1995). A combination of purposive and snowball sampling technique was used to select 17 WLWHA aged between 26 and 41. Most of them had limited education, only the 3 of them with post secondary education had professional jobs; the rest are either housewives or petty traders. Most of the women had reduced sexual desire but felt compelled to acquiesce to their husband’s sexual demands out of cultural and religious sense of duty, fear that he would have sex outside marriage and/or beat them. While a few used condoms, most either did not use condom or used it inconsistently. Condoms were used mainly to prevent re-infection with another strain of HIV or to prevent infecting a negative partner. Reason for non use of condom includes reduced sexual pleasure with condoms, belief that condoms are used not for wives and that being on ARV precludes the need to use condom. Often, condom negotiation leads to violence. Most of the women still wanted more children and did not use contraceptives. Among the few who used contraceptives, condoms, hormone injections, intrauterine device (IUD) and tubal ligation are their methods of choice. The women chose to have babies to secure their marriage, fulfill maternal instinct and to “leave something behind”. Their decisions were informed by the belief that ARV would keep them alive, while Prevention of Mother to Child Transmission (PMCTC) programs would prevent infection to their babies. To conceive, they had unprotected sex during ovulation. Two serodiscordant couples used syringes to inseminate. Most of them had experienced obstetric challenges including infertility, miscarriages, preterm births, and infant deaths. Most of the women bottle-fed to prevent infecting their babies, however they were under tremendous pressure to breastfeed due to the cultural value attached to breastfeeding. Women living with HIV/AIDS in Abuja Nigeria, had unmet sexual and reproductive health needs. Their sexual and reproductive decisions were influenced by their individual circumstances, including their level of education, poverty, cultural and family influences, partner’s HIV status, stigma and discrimination, and access to PMTCT and ARV programs. To meet the sexual and reproductive health needs of WLWHA, program planners and policy makers should take these factors into consideration and ensure that programs are comprehensive and integrated.

Submitted by Lívia Bertazzo Sacilotto (livia.bsacilotto@gmail.com) on 2017-03-08T06:52:01Z No. of bitstreams: 1 sacilotto_lb_me_bt.pdf: 2686215 bytes, checksum: b3f919111b6e0a1f81fe1d0c5ae28c47 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2017-03-13T14:03:44Z (GMT) No. of bitstreams: 1 sacilotto_lb_me_bt.pdf: 2686215 bytes, checksum: b3f919111b6e0a1f81fe1d0c5ae28c47 (MD5) / Made available in DSpace on 2017-03-13T14:03:44Z (GMT). No. of bitstreams: 1 sacilotto_lb_me_bt.pdf: 2686215 bytes, checksum: b3f919111b6e0a1f81fe1d0c5ae28c47 (MD5) Previous issue date: 2017-02-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A lipodistrofia associada ao HIV (LAHIV) é caracterizada pela redistribuição de gordura corporal, sendo uma das consequências da introdução da terapia antirretroviral (TARV) e relacionada ao aumento do risco para o desenvolvimento de doenças cardiovasculares. Seu diagnóstico é subjetivo e classificado em três tipos, de acordo com a região corporal em que há perda e/ou acúmulo de gordura, a saber, lipoatrofia, lipohipertrofia e lipodistrofia mista, acompanhada ou não de alterações metabólicas. O objetivo do presente trabalho foi verificar a associação dos diferentes subtipos de LAHIV em pessoas vivendo com HIV/aids com os componentes da síndrome metabólica e composição corporal. Foram avaliados dados clínicos, imunológicos, metabólicos, antropométricos e composição corporal de 40 pessoas vivendo com HIV/aids em acompanhamento ambulatorial e uso regular de TARV, de ambos os sexos, com diagnóstico clínico de LAHIV. Os principais achados do estudo foram maiores alterações de perfil lipídico entre as mulheres. Não houve diferença estatística entre os subtipos para o perfil metabólico. As principais alterações foram identificadas no grupo lipohipertrofia, que tiveram maiores valores de porcentual de gordura corporal total, área de gordura visceral (AGV), índice de massa corpórea (IMC) e circunferências abdominal e do pescoço em relação aos outros dois grupos. A massa magra foi superior apenas em relação ao grupo lipodistrofia mista e a massa de gordura em relação ao grupo lipoatrofia. O IMC mostrou forte correlação com a AGV. Em conclusão, o presente estudo mostrou que apesar destes indivíduos apresentarem alterações de indicadores antropométricos importantes relacionadas ao diagnóstico de LAHIV, não são acompanhadas de alterações metabólicas. Estratégias como mudança comportamental, identificação, prevenção e tratamento de doenças crônicas são importantes para reduzir os riscos para o desenvolvimento de doenças cardiovasculares. / HIV-associated lipodystrophy syndrome (HALS) is characterized by body fat redistribution as a consequence of the antiretroviral therapy (ART) introduction, associated to an increased risk of cardiovascular disease development. Subjective diagnoses, classified between tree subtypes according to the body region on which fat is lost and/or accumulated, named lipoatrophy, lipohypertrophy and mixed lipodystrophy, are possibly accompanied of metabolic alterations. The objetive of the present study was to verify the association between HALS different subtypes, in people living with HIV/aids, and the components of metabolic syndrome and body composition. Forty PLHA, with clinical diagnosis of HALS and from both genders, were assessed. They performed ambulatorial follow up and used ART regularly. The main findings were greater lipid profile alterations among women, while no metabolic profile differences were found between the HALS subtypes. The lipohypertrophy group showed major alterations, with higher values for total body fat percent, visceral fat area (VFA), body mass index (BMI), abdominal and neck circumferences when compared to the other groups. Lean body mass was superior only compared to the mixed lipodystrophy group, and fat mass only compared to the lipoatrophy group. BMI showed strong correlation to the VFA. In conclusion, despite anthropometric alterations related to HALS these individuals present, those are not accompanied by metabolic alterations. Strategies, as behavioral changes and disorders prevention are important to decrease the risk of cardiovascular disease development.

<p>Peripheral neuropathy (PN) is a common neurological complication occurring in the asymptomatic and symptomatic stages of human immune deficiency virus (HIV) infection. The pain and other symptoms caused by PN can impair functional ability and limit physical activity that could affect quality of life (QoL). Additionally, studies done on quality of life of people living with HIV/AIDS have shown that, HIV-related neurological syndromes, including PN, significantly reduce QoL. The aim of this study was to determine the prevalence of peripheral neuropathy amongst and the quality of life of adults living with HIV/AIDS attending the out-patient clinic at Rutongo Hospital in Rulindo District in Rwanda.</p>

<p>Peripheral neuropathy (PN) is a common neurological complication occurring in the asymptomatic and symptomatic stages of human immune deficiency virus (HIV) infection. The pain and other symptoms caused by PN can impair functional ability and limit physical activity that could affect quality of life (QoL). Additionally, studies done on quality of life of people living with HIV/AIDS have shown that, HIV-related neurological syndromes, including PN, significantly reduce QoL. The aim of this study was to determine the prevalence of peripheral neuropathy amongst and the quality of life of adults living with HIV/AIDS attending the out-patient clinic at Rutongo Hospital in Rulindo District in Rwanda.</p>

Pour les personnes vivant avec le VIH (PVVIH), leur maladie constitue une expérience subjective susceptible d’influer sur leur qualité de vie (QV). Cette thèse explore l’influence de la perception que les PVVIH ont de leur maladie, ainsi que des stratégies de coping, l’auto-efficacité, les stratégies de contrôle en matière de santé, le soutien social et l’ajustement des buts sur la QV et troubles anxio-dépressifs. Une approche comparative entre des personnes françaises avec et sans VIH d’une part et avec des PVVIH françaises et brésiliennes d’autre part a été entreprise. Les participants (France : PVVIH n=206 et sans VIH n=220 ; Brésil : PVVIH n=128) ont répondu à un ensemble de questionnaires évaluant chacune de ces variables. Tout d’abord les résultats ont conforté la plus faible QV et des troubles anxio-dépressifs plus élevés chez les PVVIH comparativement aux personnes sans VIH, mesurés ici à l’aide d’odds ratio. Par ailleurs, les modèles d’équations structurelles ont permis de vérifier l’influence de la perception de la maladie, de l’auto-efficacité et de l’ajustement aux buts des PVVIH françaises sur la QV. Enfin, les régressions hiérarchiques ont montré que la perception de la maladie, l’auto-efficacité et le soutien social étaient des variables prédictives de la QV tant en France qu’au Brésil. La discussion souligne la nécessité de prendre en considération la perception de la maladie dans la compréhension de l’ajustement des PVVIH / For people living with HIV/AIDS (PLWHA), their illness is a subjective experience that may affect their quality of life (QOL). This thesis explores the influence of the perception that PLWHA have of their illness, as well as coping strategies, self-efficacy, health engagement control strategies, social support and goal adjustment on QV and anxiety/depression. A comparative approach between French with/without HIV and PLWHA in France and Brazil was undertaken. Participants (France: PLWHA n=206, without HIV n=220; Brazil: PLWHA n=128) completed questionnaires assessing each of these variables. The results confirm, with the use of odds ratios, that PLWHA have a lower QOL and more anxiety/depression when compared to people without HIV. Moreover, structural equation models were used to verify the influence of illness perception, self-efficacy and goal adjustment on QOL of French PLWHA. Finally, hierarchical regressions showed that illness perception, self-efficacy and social support were predictive of QOL both in France and Brazil. The discussion highlights the need to take into account illness perception to understand the adjustment of PLWHA

Orientador: Paulo Câmara Marques Pereira / Resumo: A lipodistrofia associada ao HIV (LAHIV) é caracterizada pela redistribuição de gordura corporal, sendo uma das consequências da introdução da terapia antirretroviral (TARV) e relacionada ao aumento do risco para o desenvolvimento de doenças cardiovasculares. Seu diagnóstico é subjetivo e classificado em três tipos, de acordo com a região corporal em que há perda e/ou acúmulo de gordura, a saber, lipoatrofia, lipohipertrofia e lipodistrofia mista, acompanhada ou não de alterações metabólicas. O objetivo do presente trabalho foi verificar a associação dos diferentes subtipos de LAHIV em pessoas vivendo com HIV/aids com os componentes da síndrome metabólica e composição corporal. Foram avaliados dados clínicos, imunológicos, metabólicos, antropométricos e composição corporal de 40 pessoas vivendo com HIV/aids em acompanhamento ambulatorial e uso regular de TARV, de ambos os sexos, com diagnóstico clínico de LAHIV. Os principais achados do estudo foram maiores alterações de perfil lipídico entre as mulheres. Não houve diferença estatística entre os subtipos para o perfil metabólico. As principais alterações foram identificadas no grupo lipohipertrofia, que tiveram maiores valores de porcentual de gordura corporal total, área de gordura visceral (AGV), índice de massa corpórea (IMC) e circunferências abdominal e do pescoço em relação aos outros dois grupos. A massa magra foi superior apenas em relação ao grupo lipodistrofia mista e a massa de gordura em relação ao grupo lipoatrof... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Magister Scientiae (Physiotherapy) - MSc(Physio) / Peripheral neuropathy (PN) is a common neurological complication occurring in the asymptomatic and symptomatic stages of human immune deficiency virus (HIV) infection. The pain and other symptoms caused by PN can impair functional ability and limit physical activity that could affect quality of life (QoL). Additionally, studies done on quality of life of people living with HIV/AIDS have shown that, HIV-related neurological syndromes, including PN, significantly reduce QoL. The aim of this study was to determine the prevalence of peripheral neuropathy amongst and the quality of life of adults living with HIV/AIDS attending the out-patient clinic at Rutongo Hospital in Rulindo District in Rwanda. / South Africa

Magister Artium - MA / Due to tremendous stigma attached to HIV/AIDS, revelation of HIV positive sero-status of an individual has become a significant risk in communities of South Africa (Kalichman el al., 2003;Deacon et al., 2004; Kalichman et al., 2005, Simbayi et al., 2007). Several researchers have argued that HIV/AIDS stigma poses severe problems which include that it delays HIV testing;stops people living with HIV and AIDS (PLWHA) from seeking care; inhibits incorporation of prevention behaviours; increases violence against HIV-positive people; and extends beyond PLWHA to families, providers and volunteers. HIV/AIDS stigma is widespread, and it is widely accepted that it does not only reflect but also is exacerbated by co-existing stigmas related to poverty, race, gender, substance use, and sexual behaviour (Parker et al., 2002; Parker & Aggleton, 2003; Holloway, Seaton, Taylor, 2004).This study aimed to understand whether HIV/AIDS as a social construct and those living with HIV/AIDS are understood and responded to differently by males and females and those previously classified by the apartheid divisive policy as African and Coloured participants in the context of their daily encounters. Hence, the study investigated whether there is a relationship between race, gender and HIV/AIDS stigma among participants and whether this relationship is mediated by age, educational level, and participants’ household situation. In addition, the study explored whether gendered stigmatization is subscribed to by participants, while it further sought to assess the extent to which participants were exposed to HIV and AIDS; and whether there were gender and racial differences with respect to participants’ perceptions about PLWHA.Finally, the study scrutinized participants’ perceived levels where they believe interventions to eliminate stigma could be prioritized. This study utilized a survey questionnaire drawn up on the basis of qualitative findings in earlier studies on stigma and HIV/AIDS in both ‘African’ and ‘coloured’ communities. Two hundred participants were recruited through a convenience sampling method in the Mitchell’s Plain area of Cape Town, South Africa. The sample was stratified by ‘race’ and gender with the majority between the age of 35 and 49 years; 50.3 % of the respondents in the sample were males, while 49.7 % were females. The majority of the respondents were Africans of Xhosa speaking descent(49.2 %) and coloureds (48.2 %) with a small proportion of whites (2.5 %). All standard ethical procedures for research with human participants were adhered to and the project was registered with the UWC Research & Ethics Committee. All participants responded on the basis of informed consent and consent forms were signed to confirm ethical assurances. Confidentiality of the data was observed and the data was kept in a locked up and secure place for a period of five years after the study. Completed survey questionnaires were coded, and analyzed quantitatively using the Statistical Package for Social Sciences version 17.0 (SPSS) and SAS.Inferential statistics showed highly significant gender differences in participants’ personal stigmatization. More so, personal stigma attitudes were more likely to be found among older males and with means to support their households. Descriptive results showed these older males were less likely to know someone with HIV. The study acknowledged that HIV and AIDS as well as PLWHA are socially constructed and intersected with existing social inequalities on difference and hence, recommends that interventions to address HIV/AIDS stigma need to take cognizance of the contexts in which it occurs. It seems important to address de-stigmatization efforts at coloured families since descriptive results reflect some denial that HIV is a challenge and/or that PLWHA are stigmatized in families and community at large. Gendered constructions of stigma, while impacting on both men and women (since both appear to be stigmatized differently), are clearly still salient and it is recommended that efforts be continually made to raise the way in which gender, class, racialised and other differences of power are being played in community responses to HIV and those living with HIV/AIDS.

No description available.