O objetivo do estudo foi avaliar a influência da implantação do projeto Pré-natal do parceiro (PNP) no município de Ribeirão Preto sobre: 1) as taxas das infecções pelo vírus da imunodeficiência humana (HIV), vírus das hepatites B e C (VHB, VHC) e pelo Treponema pallidum (TP) entre gestantes; 2) as taxas de transmissão vertical (TV) dos VHB, VHC, do HIV e do TP; 3) os indicadores de qualidade do pré-natal (número de consultas; idade gestacional (IG) na primeira consulta; desfecho gestacional); 4) os indicadores perinatais (peso ao nascer; prematuridade; índice de Apgar no 1º e 5º minutos) e 5) as taxas das infecções pelos VHB, VHC, do HIV e do TP nos parceiros que aderiram ao projeto. Estudo transversal do grupo de gestantes (G) e nascidos vivos (NV) que tiveram seus parceiros participantes do projeto PNP (denominados G1 e NV1) e do grupo de gestantes e NV que não tiveram seus parceiros participantes do projeto PNP (denominados G2 e NV2). Os grupos de gestantes e parceiros foram incluídos no estudo no período de 1º de Julho de 2013 a 30 de Junho de 2014 e os grupos de NV, entre 1º de Julho de 2013 a 31 de Dezembro de 2014. Foram selecionadas 5391 gestantes (1781 do G1 e 3610 do G2), 1781 parceiros e 4044 NV (1376 do NV1 e 2668 do NV2). Utilizado o teste Quiquadrado de Pearson com um nível de significância de 5%. Os resultados demonstraram prognósticos estatisticamente mais favoráveis no grupo onde houve a participação do parceiro no pré-natal (G1 e NV1). Encontraram-se menores taxas de TV (0,7% no NV1 e 1,5% no NV2 com p= 0,04); início mais precoce do PN (com até 120 dias de gestação 88,3% no G1 e 84,5% no G2 com p< 0,01); mais de sete consultas no PN (80,8% no G1 e 74,3% no G2 com p< 0,01); desfecho gestacional favorável (95,9% no G1 e 94,2% no G2 com p= 0,01); menores taxas de prematuridade (10,3% no NV1 e 12,9% no NV2 com p= 0,01), menor ocorrência de baixo peso ao nascer (8,7% no NV1 e 11,4% no NV2 com p< 0,01) e melhores índices de Apgar no 5º minuto (2,5% de Apgar <= 7 no NV1 e 3,8% no NV2 com p= 0,03). Frente a estes dados foi possível concluir que a estratégia de inclusão do parceiro no PN foi importante na identificação e tratamento da sífilis reduzindo significativamente a taxa de TV do TP. A adesão do parceiro ao PNP foi fundamental para a adesão da gestante ao PN associando-se também à melhora significativa dos indicadores de saúde perinatal / The goal of these study was to evaluate of the influence of the implementation of the project \"Male Partner in the Prenatal Care (MPPC)\" in Ribeirao Preto city on: 1) the rates of infection by the human immunodeficiency virus (HIV), hepatitis virus B and C (HBV, HCV), and Treponema pallidum (TP) among pregnant women; 2) the vertical transmission (VT) rates of HBV, HCV, HIV and TP; 3) the prenatal care quality indicators (number of visits, gestational age (GA) at the first visit, gestational outcome); 4) the perinatal indicators (birth weight, prematurity, Apgar score at 1 and 5 minutes) and 5) the rates of infection with HIV, HBV, HCV and TP in partners that have joined the project. It is a cross-sectional study of group of the pregnant women (G) and born alive (BA) who had their partners participating MPPC project (called G1 and NV1) and the group of pregnant women and BA who have not had their partners participants (called G2 and NV2). The pregnant women groups and the male partners group were surveyed in the period from July 1, 2013 to June 30, 2014 and the BA groups, between July 1, 2013 to December 31, 2014. Were selected 5391 pregnant women (1781 of the G1 and 3610 of the G2), 1781 partners and 4044 BA (1376 of the NV1 and 2668 of the NV2). Used the Chi-square test of Pearson with a 5% significance level. The results showed statistically more favorable prognosis in the group where there was the partner\'s participation in prenatal care (G1 and NV1). The lower VT rate was found (0.7% in NV 1 and 1.5% in NV2 p= 0.04); earlier initiation of PN (up to 120 days of gestation 88.3% in G1 and 74.3% in G2 with p< 0.01); more than seven consultations in PNC (80.8% in G1 and 74.3% in G2 with p< 0.01); favorable pregnancy outcome (95.9% in G1 and 94.2% in G2 with p= 0.01); lower prematurity rates (10.3% in the NV1 and 12.9% in the NV2 with p= 0.01); lower incidence of low birth weight (8.7% in NV1 and 11.4% in NV2 with p< 0.01) and better Apgar scores at five minutes (2.5% Apgar <= 7 in NV1 and 3.8% in NV2 with p= 0.03). Considering these data it was concluded that the male partner\'s inclusion strategy in prenatal care was important in the identification and treatment of syphilis reducing significantly the VT rate of the TP. The partner\'s adherence to MPPC project was essential to the mother\'s adherence to PNC and it was also associated with significant improvement in perinatal health indicators.

HIV, syphilis, malaria, and anaemia are major causes of adverse pregnancy outcomes in sub-Saharan Africa (SSA). Despite global and national policies advocating for screening of these conditions, only HIV testing has achieved good coverage, precluding early detection and appropriate management in pregnancy. Rapid pointof-care tests (POCTs) provide an opportunity to integrate diagnosis and provide timely treatment of these conditions in rural antenatal care (ANC) settings. After an introductory chapter, a review of the literature on these four conditions in pregnancy is presented with a focus on SSA. The thesis then shifts attention to Kenya, a country that embodies many of the disease challenges and health system characteristics of the region. Kenyan ANC policy recommends testing for HIV, syphilis and anaemia and preventive strategies for malaria. The following chapters are comprised of three linked studies conducted in western Kenya, that use different methods to progressively investigate the implementation success of integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at seven peripheral dispensaries. Baseline data confirmed that testing requirements for syphilis, malaria and anaemia are not currently met at dispensary level. We implemented an intervention where test kits were supplied and training plus supervision were provided to enable healthcare workers to conduct integrated POCT for pregnant women. Adoption and fidelity were measured quantitatively using exit interviews, antenatal registers and proficiency scores (Study 1: Integrating point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia in antenatal care at dispensary level in western Kenya: an implementation study) while acceptability, appropriateness and feasibility were assessed qualitatively (Study 2: Exploring healthcare workers and pregnant women’s perspectives on appropriateness, acceptability and feasibility of integrating point-of care testing: A qualitative study). Our findings show that the innovation was highly adopted, meaning almost all pregnant women received the essential tests. This was supported by the qualitative findings where healthcare workers and pregnant women found the innovation acceptable and appropriate. However, fidelity to clinical management guidelines can still be improved. Our qualitative findings provide some explanation for these gaps. One common sentiment among interviews with healthcare workers was that workload was perceived to be a barrier to providing quality care. We explored this further with discrete-event simulation modelling (Study 3: Investigating the operational impact of integrating HIV, syphilis, malaria and anaemia point-of-care testing in antenatal care clinics in western Kenya: a discrete event simulation model) and found the healthcare workers were actually under-utilized. This suggests that nurses should, in theory, have sufficient time to deliver essential ANC services. While integrating POCT addresses one gap, additional interventions to support and supervise healthcare workers are needed to ensure appropriate and high quality of care. An integrated approach to health systems strengthening and more investment in implementation and translation research using multi-methods are needed.

A presente pesquisa tem por finalidade apresentar uma análise acerca dos pressupostos filosóficos, educacionais, psicológicos e históricos contidos no projeto \"Viver nas aldeias com saúde: conhecer e prevenir Doenças Sexualmente Transmissíveis (DST) e Aids\". Essa iniciativa foi realizada com os discentes do Curso de Formação de Professores Kadiwéu e Kinikinau de Mato Grosso do Sul, no período de novembro de 2003 a fevereiro de 2004, na Reserva Indígena Kadiwéu oferecido pela Escola Municipal Indígena \"Ejiwajegi\" Pólo e Extensões, vinculada à Prefeitura Municipal de Porto Murtinho. A participação nesse projeto, bem como as reflexões dele decorrentes, possibilitou-me conhecer as concepções dessas sociedades indígenas a respeito de corpo e sexualidade; saúde e doença; prevenção, tratamento e comunidade; contribuindo, dessa forma, para o aprimoramento das políticas públicas destinadas a essa população. Para aprofundar as bases do projeto mencionado, tive de retornar ao início do século XX, pois foi a partir da criação do Serviço de Proteção aos Índios e Localização de Trabalhadores Nacionais (SPILTN, posteriormente Serviço de Proteção aos Índios SPI), em 1910, que se iniciaram as experiências sistemáticas de escolarização dos grupos indígenas do país. Nesse exercício de sistematização, apresentarei a produção acadêmica a respeito do tema, problematizando-a, a partir de obras que considero significativas no contexto científico. Os Estados de Mato Grosso e Mato Grosso do Sul foram escolhidos para análise, pois neles se concentram os grupos indígenas com experiências em práticas educativas. A pesquisa foi desenvolvida por meio de fontes diversificadas escritas, iconográficas e orais além da análise de documentos provenientes, sobretudo, de missões religiosas e do órgão indigenista oficial (primeiramente SPI e posteriormente Funai Fundação Nacional do Índio). Os dados coletados no conjunto das Oficinas de Prevenção das Doenças Sexualmente Transmissíveis (DST) e da Aids foram analisados a partir de referenciais teóricos provenientes da antropologia, assim como das teorias que se debruçam sobre as representações sociais da doença, a partir de estudos da história indígena, da educação e da psicologia social. O eixo central da prevenção das DST/Aids está na sexualidade e na intimidade de homens e mulheres. Isso implica desvelar todo o núcleo cultural das etnias estudadas. O aprender a proteger-se passa pela linguagem e pela estruturação do discurso da temática preventiva. A escola é uma mediadora em potencial; afinal, trata-se de um espaço universal de produção de saberes e conhecer as formas de disseminação do HIV é também uma das maneiras de aprender a se proteger, não só do Outro, mas, sobretudo de si e do seu próprio desejo. / The aim of this research is to analyze the philosophical, educational, psychological and historical presuppositions of the project \"Viver nas aldeias com saúde: conhecer e prevenir Doenças Sexualmente Transmissíveis (DST) e Aids\". This initiative was taken with the teachers of the Kadiwéu and Kinikinau Teacher Formation Course of Mato Grosso do Sul, from November 2003 to February 2004, in Reserva Indígena Kadiwéu , offered by Escola Municipal Indígena \"Ejiwajegi\" Pólo e Extensões, linked to the Prefeitura Municipal of Porto Murtinho. The participation in this project, as well as the reflections it arose, allowed me to know the conceptions of this indigenous societies about body and sexuality; health and disease; prevention, treatment and community; contribut ing, thus, to the improvement of public policies towards this population. In order to deepen the projects basis, I had to come back to the beginning of the 20th century , as it was from the creation of the Serviço de Proteção aos Índios e Localização de Trabalhadores Nacionais (SPILTN, later called Serviço de Proteção aos Índios SPI), in 1910, that the systematic experiences of schooling of indigenous groups in the country started. In this attempt at systematizing, I present an academic production about the theme, focusing it from works I have regarded as significant in the scientific context. The States of Mato Grosso and Mato Grosso do Sul have been chosen for analysis, as they concentrate the indigenous groups with experience in educational practice. The research has been developed with the help of diversified sources written, iconographic and oral in addition to the analysis of documents coming especially from religious missions and from the official indigenous organization (formerly SPI and then Funai Fundação Nacional do Índio). The data collected in the Workshops of Prevention of Sexually Transmitted Diseases (STD) and Aids have been analyzed from theoretical references based on anthropology, as well as on theories which lean towards the social representations of the disease, and also from studies of indigenous history, education and social psychology. The central axis of STD/Aids prevention lies on sexuality and on intimacy between men and women. This implies unveiling the whole cultural nucleus of the ethnic groups studied. Learning to protect oneself passes through language and through the structure of the preventive thematic discourse. The school is a potential mediator; after all, it is a universal space of knowledge production and knowing the forms of HIV spread is also one of the ways to learn to protect, not only from the Other, but specially from oneself an from ones own wish.

Background: The Division of Global HIV/AIDS at the Centers for Disease Control and Prevention (CDC) is working on a public health evaluation (PHE) in the eastern districts of Botswana. This PHE aims to evaluate the effectiveness of Project AIM, a group-level intervention designed to reduce HIV risk behaviors in youth ages 11 to 14, when combined with the regular Botswana Skills for Life Curriculum, a standard HIV prevention education curriculum in Botswana schools. In order to evaluate Project AIM, a self-report survey and a biological testing for herpes simplex virus type 2 (HSV-2) will be conducted. Methodology: Based on studies done on the psychosocial impact of HSV-2 diagnosis on asymptomatic individuals in the USA, the literature recommends providing pre and post counseling and education to individuals testing for genital herpes to help cope and diminish the psychosocial impact of the diagnosis. In order to prepare Botswana’s clinics and schools participating in the PHE to provide the support for newly diagnosed adolescents with HSV-2, guidance materials were developed for health care practitioners and school guidance teachers. Materials were created using Information Mapping technique to analyze, organize, and present the information, and the Microsoft Office Flesch Kinkade Grade Level (FK) tool to assess the readability levels of the materials. Results: Guidance materials were prepared using the 7±2 theoretical limit of human short-term memory information mapping rule, and the FK grade levels of 6.0 to 8.0 recommended readability scores. Guidance materials included information regarding HSV-2 symptoms, treatment, and prevention. They also included information on the PHE study, youth friendly health services, counseling and education, clinic referrals and contact information. Conclusions: The development of guidance materials for schools and clinic participants of the CDC PHE in Botswana will provide health practitioners and school guidance teachers with accurate HSV-2 information to counsel and educate student participants in this research study. The guidance materials should help students cope with potential psychosocial disorders associated with pre and post diagnosis of HSV-2.

Co-infection with a sexually transmitted infection (STI) is both an indicator of behavioural risk, as well as an indicator of increased risk for infection with HIV. This is a cross-sectional, descriptive study. The overall aim of the study is to profile the demographic data, health seeking behaviour, sexual risk behaviour and HIV awareness and willingness to test in a sample of STI clinic attendees in order to inform intervention programmes aimed at reducing the burden of disease in this group, thereby reducing HIV risk. It is hypothesised that those individuals who are poorly informed about key prevention information (particularly regarding the biological susceptibility to HIV infection when co-infected with an STI), who are poorly motivated due to poor attitudes towards or lack of social norms in favour of prevention behaviour, and who lack some key behaviour skills (like skills for identifying STIs early, or negotiating safer sexual practises) will be less likely to be able to initiate and maintain specific prevention behaviours. Data are collected using a structured questionnaire and analysed in relation to the Information-Motivation Behavioural Skills (IMB) model of HIV prevention behaviour. This model was specifically developed to provide a conceptual framework for the design, implementation and assessment of targeted and empirically focussed interventions to change sexual risk behaviour in HIV. Components of the IMB model that are identified as important in contributing to risk of infection in this group are identified. Finally, recommendations regarding the form and content of an intervention in this group are made. The study concludes that STI clinics may be excellent environments within which to implement HIV risk reduction pehavioural interventions which currently may be missed opportunities. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

<p>The effect of industrialisation has thrust the pharmaceutical profession into a clinical paradigm where the approcah to pharmaceutical decisions is more disease and patient orientated. Consequently, South African community pharmacies are inundated with requests from the public for advice and treatment on a wide range of medical conditions, including sexually transmitted infections (STI's). Although community pharmacies are often the first port of call for undiagnosed STI, limited diagnostic skills and legally-imposed prescribing restrictions preclude pharmacists from providing the necessary clinical management. The overarching goal of this dissertation was to present objective arguments and evidences (new and existing) around an expanded role for pharmacists in STI partner management.</p>

Throughout the history of mankind, many infectious diseases have been treated with plant extracts. Venereal infections are one such group and are regarded as conditions that are highly responsive to traditional treatment. Aqueous, ethanol and ethyl acetate extracts of 13 plants used in South Africa for the treatment of venereal diseases were screened for in vitro antibacterial, antifungal, mutagenic and antimutagenic activities. Antibacterial activity was evaluated using the disc-diffusion and microdilution assays to determine the minimal inhibitory concentration (MIC) values of the extracts. The extracts were tested against the Gram-positive bacteria Bacillus subtilis and Staphylococcus aureus, and the Gram-negative bacteria Escherichia coli and Klebsiella pneumoniae. Among the plants tested, Gunnera perpensa, Harpephyllum caffrum, Hypoxis latifolia and Ledebouria ovatifolia showed the best antibacterial activity. The aqueous rhizome extract of Gunnera perpensa displayed good activity against Gram-negative bacteria with an MIC value of 0.78 mg/ml, and against S. aureus (0.78 mg/ml). Aqueous and ethanol extracts of H. caffrum bark were active against both Gram-positive and Gram-negative bacteria. Hypoxis latifolia aqueous corm extracts exhibited very good MIC values against K. pneumoniae (0.78 mg/ml), E. coli and S. aureus (1.56 mg/ml). Ethanol and ethyl acetate bulb extracts of Ledebouria ovatifolia displayed good activity against Bacillus subtilis bacteria with MIC values of 0.78 mg/ml and 0.39 mg/ml respectively. Antifungal activity was evaluated using the microdilution bioassay. Good activity was shown by the ethanolic bark extracts of Bersama lucens and Harpephyllum caffrum against Candida albicans. Only in the case of Harpephyllum caffrum did aqueous extracts have activity against Candida albicans. In the Ames test, all plant extracts showed a negative genotoxic response except for ethanol and ethyl acetate bulb extracts of Cyrtanthus obliquus which induced mutations in TA98. Moderate antimutagenic activity was observed with the ethyl acetate extract of G. perpensa and the ethanolic extract of H. latifolia. High antibacterial and antifungal activity detected with Harpephyllum caffrum bark extracts resulted in an investigation on seasonal and geographical variation of this inhibitory activity. Seasonal variation in antibacterial and antifungal activities was investigated in order to determine the best collection time to ensure potential high medicinal activity in plant preparations. The highest inhibitory activity was detected with plant material collected in June and December 2003, with a decline in activity when collections were made in September 2004. The chemical profiles of TLC chromatograms were compared and little variation was found, particularly in the case of plant material obtained from the Botanic Garden of the University of KwaZulu-Natal and a 'Muthi' Shop in Pietermaritzburg. Identification of active compounds from G. perpensa and H. caffrum was not successful due to insufficient amounts of isolated fractions. / Thesis (Ph.D.)-University of KwaZulu-Natal, 2006.

This study investigates male sexual behaviour and protective practices in the context of a generalized HIV/AIDS epidemic in Mozambique. It focus on how gender norms, particularly notions of masculinity influence sexual behaviour and the ability of men (and women) to protect themselves against HIV infection. A combination of qualitative and quantitative methods is used in this study. The qualitative data comes from 16 focus group discussions and 20 in-depth interviews and the quantitative data comes from a survey conducted with 209 men and 217 women. This methodological approach has proven useful in exploring complex and sensitive matters such as sexual behaviour. In this study, where it was possible, the findings from the survey were supported by quotes from focus groups discussions and in-depth interviews. The findings of this study reveal that traditional gender norms, particularly rigid notions of masculinity are still prevalent in the study settings. The existing notions of manhood are mostly associated with traditional views of men as providers and main breadwinners. In contrast, women are seen as the family caregivers. Practices which bring social prestige both in the community and in the society at large are highly valued for men. Meanwhile, traditional notions of masculinity face enormous challenges in the existing socio-economic context which is characterized by a lack of employment and widespread poverty. This has negative consequences for male self-esteem including their sense of manhood. The study shows that some men believe that having multiple sexual partners is part of male identity and is supported by culture. Similarly, some women also believe that a man cannot be satisfied with one partner or stay long without having sex. These beliefs have important implications in a country with a high prevalence of HIV/AIDS. The study found that traditional notions of manhood prevent men from accessing correct health information thereby perpetuating the cycle of harmful practices for themselves and their females partners. The findings of this study suggest that despite a universal awareness of HIV infection and protective strategies, multiple sexual partnerships and unprotected sex among heterosexual men and women are the driving force sustaining the HIV/AIDS pandemic in the study settings. This is worsened by the widespread negative meanings attached to condoms. The study shows that the level of condom use (31 percent among men and 20 percent among women) is encouraging but not sufficient to curb the level of HIV infections. Consistent condom use remains a major challenge as much fewer men and women report using condoms in all their sexual encounters. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

No abstract available. / Thesis (M.Dev.Studies)-University of Natal, Durban, 2002.

In light of the current HIV/ AIDS epidemic. the sexual risk taking and health seeking behaviour of South African adolescents is of extreme interest to rescearchers and programme implementers. Using a database of adolescents between the ages of 14 and 22 from Durban Metro and Mtunzini Magisterial District in KwaZulu-Natal Province. This paper seeks to investigate which antecedents impact most on adolescent sexual behaviour. Risk taking behaviour of interest is whether or not a condom was worn at last intercourse. The analysis also seeks to test the impact of Life Skills education in school on this behavioural outcome. Although much of the literature has pointed to more distal factors having greater influence on adolescent health seeking and risk taking behaviour. This analysis has showed that issues relating more closely to levels of communication within a relationship, attitudes towards the use of condoms. and previous health seeking behaviour. have the greatest impact on condom use. Those adolescents who wore a condom the first time they had sex. who felt they could confidently convince their partner to use a condom and who maintain high levels of communication with their partner. were found most likely to have used a condom the last time they had intercourse. / Thesis (M.Dev.Studies)-University of Natal, Durban, 2000.