Background: Nurses work closely with patients to improve care and alleviate suffering among PLHIV. However, the segregation of MSM in society and the criminalization of same-sex behaviours have caused great havoc causing deaths and suffering in developing countries for more than three decades since the scourge of HIV/AIDS emerged. Aim: The study aimed to illuminate the caring encounters in nursing management of HIV/AIDS among MSM living in Nairobi, Kenya. Method: Five semi-structured interviews were conducted to nurses and data analysed through thematic analysis. Results: Four themes were constructed; the importance of holistic care approach, operanalization of empowerment, the need for sensitization, and living in segregation. Eight sub-themes were formulated: achieving positive patient ́s wellbeing, effective nurse-patient relationship, improving health awareness, provision of social support, conflicts of values, judgmental nurses, rejection of MSM in the society, and rampant discrimination of MSM. Conclusion: Sensitized nurses on MSM sexual behaviours provide holistic care and empower MSM in the management of HIV/AIDS, unlike the ones who still hold onto homophobic prejudice based on religious, cultural and personal beliefs. The study recommends the training of nurses to be aware of the harmful societal attitudes, beliefs, rejection, and discrimination that hinders the effective management of HIV/AIDS. / Bakgrund: Sjuksköterskor arbetar nära medpatienterna för att förbättra omvårdnad och lindra lidandet bland de som lever med HIV/AIDS. Dock orsakar segregeringen av MSM i samhället och kriminaliseringen av samkönat sexbeteende avsevärt kaos vilket orsakar död och lidande i utvecklingsländer i mer än tre decennier sedan plågan av HIV/AIDS börjande. Syfte: Studien syftar till att belysa bemötande vid omvårdnaden vid hanteringen av HIV/AIDS bland MSM som bor i Nairobi, Kenya. Metod: Fem semistrukturerade intervjuer utfördes med sjuksköterskor och data analyserades medelst tematisk analys. Resultat: Fyra teman identifierades: vikten av holistiskt tillvägagångssätt vid omvårdnad, operalisering av bemyndigande, behovet av sensibilisering, och att leva i segregering. Åtta underteman formulerades: att uppnå positivt välbefinnande hos patienter, effektiva sjuksköterska-patient-förhållanden, förbättra hälsomedvetenhet, tillhandahållande av socialt stöd, värdekonflikter, fördömande sjuksköterskor, förkastande av MSM i samhället, och utbredd diskriminering av MSM. Slutsats: Sensibiliserade sjuksköterskor avseende sexuella beteenden hos MSM tillhandahåller holistisk omvårdnad och bemyndigar MSM i hanterandet av HIV/AIDS, till skillnad från de som håller fast vid homofobiska fördomar baserade på religiösa, kulturella och personliga övertygelser. Studien rekommenderar att utbildningen av sjuksköterskor uppmärksammar skadliga sociala attityder, övertygelse, förkastelse, och diskriminering som hindrar effektiv hantering av HIV/AIDS.

This study sought to increase knowledge as it relates to HIV-prevention for older adults, especially for MSM who are HIV-negative. In participating in this study, participants shared their experiences, stories and feelings related to their exposure to HIV and HIV-prevention initiatives. Using a Traditional Grounded Theory method, 22 interviews with older MSM were conducted with the aim of producing a theory that explained how these men lived prior to HIV, the different ways they responded to the onset of the virus, how they have lived their lives over the last three decades, and the extent to which the virus continues to impact their lives.

Introdução No contexto da valorização crescente do teste anti-HIV como estratégia de prevenção programática, a promoção do teste anti-HIV como estratégia de prevenção entre homens que fazem sexo com homens (HSH) é fundamental. Objetivo - Analisar os fatores associados tanto ao uso rotineiro como episódico do teste anti-HIV. Métodos - Os participantes foram 946 HSH entrevistados pelo Projeto SampaCentro em locais de sociabilidade HSH da região central de São Paulo entre novembro de 2011 e janeiro de 2012, nunca testados ou que procuraram o teste espontaneamente. A metodologia de amostragem foi a time-space-sampling e foram utilizados protocolos do Stata 12.0 para análise de amostras complexas. Os homens que se testaram por rotina ou episodicamente foram comparados aos nunca testados. As variáveis analisadas nos dois modelos de regressão de Poisson foram divididas em três níveis: características sociodemográficas (primeiro nível); socialização na comunidade gay e exposição da orientação sexual, discriminação e opiniões e atitudes em relação ao HIV/Aids e ao teste (segundo nível); percepção de risco, estratégias de prevenção e práticas e parcerias sexuais (terceiro nível). Resultados Os homens que se testaram rotineiramente eram mais velhos e moradores no Centro de SP. Além disso, tinham exposto a orientação sexual para profissional de saúde, sido discriminados em serviços de saúde mas não por amigos e/ou vizinhos (em razão da sexualidade) e não mencionaram medo do resultado do teste como motivo para HSH não se testarem. Também tinham maior probabilidade de conhecer pessoa soropositiva e de ter parcerias estáveis sem sexo anal desprotegido nas casuais (comparado a ter apenas parcerias casuais protegidas). Os homens que se testaram episodicamente eram mais velhos, residentes do Centro de SP, não moravam com parentes, expuseram sua orientação sexual para profissional de saúde, não reportaram medo do resultado do teste como barreira, conheciam pessoa soropositiva e mencionaram parceria estável sem sexo desprotegido com parceiro casual ou então sexo desprotegido em parcerias casuais (comparado a ter apenas parcerias casuais protegidas). Conclusões Os mais jovens, os que moram fora do centro de São Paulo, e os que expões menos sua orientação sexual são os segmentos que menos se testam rotineira ou episodicamente. Assim, dependem de ações para que seu direito seja protegido e assegurado. A estigmatização e a discriminação da homossexualidade deve ser combatida para que não impeça o acesso ao teste e a outros serviços de saúde. Disseminar informações e socializar os mais jovens para o diálogo sobre as estratégias de prevenção biomédicas e estratégias comunitárias de prevenção é necessário. Para ampliar o acesso e qualidade da testagem como recurso fundamental de programas de prevenção permanece o desafio de sustentar o debate sobre sexualidade e prevenção a cada geração, assim como nos programas de formação de educadores e de profissionais de saúde de todas as áreas. / Introduction The relevance of HIV testing is growing in programmatic policies. Promoting HIV testing among men who have sex with men (MSM) is of utter importance. Objective Analyze factors associated with routine and episodic use of HIV testing. Methods Our participants were selected from the database of Projeto SampaCentro, a time-location sampling serobehavioral surveillance survey of MSM in São Paulo, Brazil, that took place between November 2011 and January 2012. Our participants were 946 MSM not HIV positive who were never tested or whose last testing was client-initiated. All analysis were performed using complex samples protocols in Stata 12.0. Men were divided in routine testers, episodic testers and men who had never tested. Routine testers and episodic testers were compared to those who had never tested using two Poisson regression models. Variables were divided in three levels of analysis: sociodemographic (first level); socialization in gay community and disclosure of sexual orientation, discrimination, attitudes and opinions on HIV/AIDS and testing (second level); risk perception, prevention strategies and sexual practices and partnerships (third level). Results Routine testers were older and lived in Central São Paulo, had more frequently disclosed their sexual orientation to a health professional and been discriminated against in health service settings, were less likely to having suffered discrimination from friends and/or neighbors and to point fear as a barrier to testing, were more likely to know someone infected with HIV and to mention steady partners without unprotected anal intercourse (UAI) with casual partners (compared to having only casual partners with no UAI). Episodic testers were also older and more likely to live in Central São Paulo, less likely to live with relatives, more likely to have disclosed their sexual orientation to a health professional, less likely to point fear as a barrier to testing, more likely to know someone infected with HIV. This group more frequently mentioned steady partners without UAI with casual partners and UAI with casual partners, regardless of mentioning steady partners (compared to having only casual partners with no events of UAI). Conclusion Young MSM, those who live outside Central São Paulo and those less ready to disclose their sexual orientation are the MSM segments that are less likely to test, routinely or episodically. Therefore, programmatic actions are needed to ensure their rights are protected. Stigmatization and discrimination of homosexuality must be mitigated so that it wont be a barrier to information about prevention and testing services. Additionally, information on biomedical and communitarian prevention technologies must be shared and presented to those not yet familiar with these strategies. In order to improve access and quality of testing, the challenge of sustaining the debate about sex, sexuality and prevention remains, as new generations of MSM will need to be introduced to this debate. The same is true for the course curriculum of health professionals and educators.

Thesis advisor: Kevin J. Mahoney / Recent empirical epidemiological and behavioral research has indicated that some secondary intervention preventions (e.g., condom use, HIV-disclosure, serosorting, etc.) might not be suitable for all HIV-infected gay and bisexual men, particularly for those who engage in multiple episodes of unprotected anal intercourse (UAI). The purpose of this dissertation was to answer the primary research question: What are the psychological, behavioral and contextual factors associated with HIV-infected men who have sex with men (MSM) who engage in risky sexual behavior? A qualitative descriptive approach was used to conduct a content analysis of 14 in-depth, semi-structured interviews and to provide a description of the lives of MSM who do not consistently use traditional secondary risk behavior strategies (e.g., safer-sex negotiation, condom use, etc.) to reduce HIV transmission among sexual partners, particularly those partners who are HIV-uninfected or whose HIV status is unknown. Risky sexual behavior was defined by HIV-infected MSM who had engaged in multiple episodes of UAI in the past three months. These interviews gathered preliminary data on the feasibility and acceptability of secondary HIV behavioral prevention strategies for MSM who engage in very risky sexual behavior. In addition, these data have identified descriptive themes that could be used to augment traditional secondary HIV invention preventions, creating new and specific risk-reduction strategies for this very high-risk group. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Introdução No contexto da valorização crescente do teste anti-HIV como estratégia de prevenção programática, a promoção do teste anti-HIV como estratégia de prevenção entre homens que fazem sexo com homens (HSH) é fundamental. Objetivo - Analisar os fatores associados tanto ao uso rotineiro como episódico do teste anti-HIV. Métodos - Os participantes foram 946 HSH entrevistados pelo Projeto SampaCentro em locais de sociabilidade HSH da região central de São Paulo entre novembro de 2011 e janeiro de 2012, nunca testados ou que procuraram o teste espontaneamente. A metodologia de amostragem foi a time-space-sampling e foram utilizados protocolos do Stata 12.0 para análise de amostras complexas. Os homens que se testaram por rotina ou episodicamente foram comparados aos nunca testados. As variáveis analisadas nos dois modelos de regressão de Poisson foram divididas em três níveis: características sociodemográficas (primeiro nível); socialização na comunidade gay e exposição da orientação sexual, discriminação e opiniões e atitudes em relação ao HIV/Aids e ao teste (segundo nível); percepção de risco, estratégias de prevenção e práticas e parcerias sexuais (terceiro nível). Resultados Os homens que se testaram rotineiramente eram mais velhos e moradores no Centro de SP. Além disso, tinham exposto a orientação sexual para profissional de saúde, sido discriminados em serviços de saúde mas não por amigos e/ou vizinhos (em razão da sexualidade) e não mencionaram medo do resultado do teste como motivo para HSH não se testarem. Também tinham maior probabilidade de conhecer pessoa soropositiva e de ter parcerias estáveis sem sexo anal desprotegido nas casuais (comparado a ter apenas parcerias casuais protegidas). Os homens que se testaram episodicamente eram mais velhos, residentes do Centro de SP, não moravam com parentes, expuseram sua orientação sexual para profissional de saúde, não reportaram medo do resultado do teste como barreira, conheciam pessoa soropositiva e mencionaram parceria estável sem sexo desprotegido com parceiro casual ou então sexo desprotegido em parcerias casuais (comparado a ter apenas parcerias casuais protegidas). Conclusões Os mais jovens, os que moram fora do centro de São Paulo, e os que expões menos sua orientação sexual são os segmentos que menos se testam rotineira ou episodicamente. Assim, dependem de ações para que seu direito seja protegido e assegurado. A estigmatização e a discriminação da homossexualidade deve ser combatida para que não impeça o acesso ao teste e a outros serviços de saúde. Disseminar informações e socializar os mais jovens para o diálogo sobre as estratégias de prevenção biomédicas e estratégias comunitárias de prevenção é necessário. Para ampliar o acesso e qualidade da testagem como recurso fundamental de programas de prevenção permanece o desafio de sustentar o debate sobre sexualidade e prevenção a cada geração, assim como nos programas de formação de educadores e de profissionais de saúde de todas as áreas. / Introduction The relevance of HIV testing is growing in programmatic policies. Promoting HIV testing among men who have sex with men (MSM) is of utter importance. Objective Analyze factors associated with routine and episodic use of HIV testing. Methods Our participants were selected from the database of Projeto SampaCentro, a time-location sampling serobehavioral surveillance survey of MSM in São Paulo, Brazil, that took place between November 2011 and January 2012. Our participants were 946 MSM not HIV positive who were never tested or whose last testing was client-initiated. All analysis were performed using complex samples protocols in Stata 12.0. Men were divided in routine testers, episodic testers and men who had never tested. Routine testers and episodic testers were compared to those who had never tested using two Poisson regression models. Variables were divided in three levels of analysis: sociodemographic (first level); socialization in gay community and disclosure of sexual orientation, discrimination, attitudes and opinions on HIV/AIDS and testing (second level); risk perception, prevention strategies and sexual practices and partnerships (third level). Results Routine testers were older and lived in Central São Paulo, had more frequently disclosed their sexual orientation to a health professional and been discriminated against in health service settings, were less likely to having suffered discrimination from friends and/or neighbors and to point fear as a barrier to testing, were more likely to know someone infected with HIV and to mention steady partners without unprotected anal intercourse (UAI) with casual partners (compared to having only casual partners with no UAI). Episodic testers were also older and more likely to live in Central São Paulo, less likely to live with relatives, more likely to have disclosed their sexual orientation to a health professional, less likely to point fear as a barrier to testing, more likely to know someone infected with HIV. This group more frequently mentioned steady partners without UAI with casual partners and UAI with casual partners, regardless of mentioning steady partners (compared to having only casual partners with no events of UAI). Conclusion Young MSM, those who live outside Central São Paulo and those less ready to disclose their sexual orientation are the MSM segments that are less likely to test, routinely or episodically. Therefore, programmatic actions are needed to ensure their rights are protected. Stigmatization and discrimination of homosexuality must be mitigated so that it wont be a barrier to information about prevention and testing services. Additionally, information on biomedical and communitarian prevention technologies must be shared and presented to those not yet familiar with these strategies. In order to improve access and quality of testing, the challenge of sustaining the debate about sex, sexuality and prevention remains, as new generations of MSM will need to be introduced to this debate. The same is true for the course curriculum of health professionals and educators.

This study examined the relation between stigma and reporting of intimate partner violence (IPV) in a sample of men who have sex with men (MSM). It was hypothesized that enacted stigma would result in lower reporting of IPV and that the type of IPV would moderate the relationship between enacted stigma and reporting. Using an online survey, we measured IPV (physical, psychological, and sexual violence) and stigma (perceived, enacted, and internalized). Participants (N = 46) were asked if they had ever experienced any of those forms of violence, as well as if they had ever reported the violence through an online survey. They were then asked how likely they would be to report the violence if it happened again in the future. Responses were analyzed using logistical regression with moderation to determine if a) enacted stigma was associated with lower reporting of intimate partner violence and if b) type of violence moderated stigma and reporting, such that physical violence would have the strongest relation between stigma and reporting of IPV. Results showed that enacted stigma was associated with more IPV reporting across all types of violence: physical (coefficient: 1.539, p<.0005), sexual (coefficient: .999, p<.05), and psychological (coefficient: 1.203, p<.005). Results of testing the moderating role of violence type on the relationship between enacted stigma and IPV were non-significant for all types of violence. In conclusion, the more enacted stigma that was experienced, the more reporting occurred. In addition, type of violence did not moderate the relation between enacted stigma and reporting of intimate partner violence.

Despite significant research and inroads with the human immunodeficiency virus (HIV), disparities in HIV infection continue to widen for African American (AA) men who have sex with men (MSM). In recent times, cultural competence has been receiving increased attention as a possible factor to enhance the quality of health messaging and lessening HIV disparities. However, there is a dearth of research specifically dedicated to AA MSM and culturally competent HIV health messages. To address this gap, this qualitative research was designed to investigate the self-perceived cultural competency among HIV counselors. The theoretical framework for the project was the PEN-3 cultural model. The interview participants for the study were 10 HIV interventionists employed with health institutions that partially or entirely specialize in HIV prevention in the Richmond, Virginia, area. The analysis of the data was aided by a phenomenology analytical approach. The results revealed that cultural competence training can be one effective means to enhance the quality of health messages targeting AA MSM. This investigation has social change implications, especially in the context of developing sustainable HIV prevention interventions focused on integrating culture, thereby reducing HIV disparities in the Richmond metropolitan area. The findings may also lend insight into the various ways that health establishments can engage in culturally relevant prevention and position themselves to be leaders in informing the development of culturally competent HIV prevention messages that will aid in the acceleration of changing longstanding, ineffective prevention approaches targeting AA MSM.

Par leur fréquence d'horloge pouvant atteindre plusieurs dizaines de GHz et leur très faible dissipation, les circuits numériques supraconducteurs, fondés sur la logique à quantum de flux (RSFQ: Rapid Single-Flux Quantum), sont envisagés pour diverses applications spécifiques du fait de leurs performances exceptionnelles, très au delà de celles des filières électroniques classiques. Ces circuits RSFQ traitent l'information numérique sous forme d'impulsions de tension picoseconde avec une aire quantifiée de 2,07mV.ps, correspondant à un quantum de flux h/2e. L'électronique numérique supraconductrice ouvre ainsi la voie de l'électronique ultra-rapide en associant une large bande passante à une très faible dissipation.<br /><br />L'objectif de ce travail est d'étudier les interfaces optoélectroniques permettant de détecter et échantillonner les impulsions quantifiées résultant de la commutation des jonctions Josephson shuntées qui composent les circuits RSFQ. Nous avons développé une approche théorique et expérimentale de la sensibilité des photocommutateurs destinés à la détection d'impulsions RSFQ. Nous avons utilisé des photocommutateurs MSM (Métal-Semiconducteur-Métal) rapides de structure planaire à base d'Arséniure de Gallium épitaxié à basse température (AsGa-BT). Les caractéristiques physiques du matériau semi-conducteur telles que la résistance d'obscurité, la mobilité des porteurs libres et la durée de vie sont les paramètres clé pour obtenir des impulsions ultracourtes. La bonne résolution temporelle est donc assurée par les propriétés physiques du matériau. Un modèle basé sur un circuit hyperfréquence équivalent, a permis de prédire le comportement hyperfréquence du photocommutateur, éclairé ou non éclairé, lors du passage d'une impulsion RSFQ. De plus, ce modèle permet d'étudier l'influence des paramètres géométriques du photocommutateur sur la sensibilité de ce dernier. Nous avons déduit que le photocommutateur à gap à base d'AsGa-BT est bien adapté pour la détection des signaux subpicosecondes de faible amplitude.

<p>Studien bygger på en analys av RFSL:s informationsmaterial riktat till män som har sex med män (MSM), om hur de ska skydda sig mot hiv. Oftast vid hiv- och aidskampanjer ligger fokus på att avskräcka folk från att ha sex medan materialet i denna studie uppmanar individen till att ha sex. Det beror på att RFSL är medvetna om att det inte går att använda sig av olika skrämseltekniker för att avskräcka folk från att ha sex. Istället är deras budskap att ha säkrare sex och testa sig regelbundet så att individen är medveten om sin status.</p><p>De metoder som har använts för att analysera materialet är innehållsanalys samt semiotik. De teorietiska perspektiven som är utgångspunkterna i denna studie är; heteronormativitet, hegemonisk maskulinitet och intersektionalitet. Alla tre teorier beskriver och granskar de strukturer som finns i samhället samt i dess institutioner. Dessa perspektiv har valts därför att de kompletterar varandra på ett bra sätt och är relevanta för studiens syfte.</p><p> </p>

Studien bygger på en analys av RFSL:s informationsmaterial riktat till män som har sex med män (MSM), om hur de ska skydda sig mot hiv. Oftast vid hiv- och aidskampanjer ligger fokus på att avskräcka folk från att ha sex medan materialet i denna studie uppmanar individen till att ha sex. Det beror på att RFSL är medvetna om att det inte går att använda sig av olika skrämseltekniker för att avskräcka folk från att ha sex. Istället är deras budskap att ha säkrare sex och testa sig regelbundet så att individen är medveten om sin status. De metoder som har använts för att analysera materialet är innehållsanalys samt semiotik. De teorietiska perspektiven som är utgångspunkterna i denna studie är; heteronormativitet, hegemonisk maskulinitet och intersektionalitet. Alla tre teorier beskriver och granskar de strukturer som finns i samhället samt i dess institutioner. Dessa perspektiv har valts därför att de kompletterar varandra på ett bra sätt och är relevanta för studiens syfte.