Agricultural areas represent around 40% of the earth surface and provide a variety of products and services essential to human societies. However, with policy reforms, market liberalisation and climate change issues, continuous land use and cover change (LUCC) brings uncertainty in the quantity and quality of ecosystem services supplied for the future generations. The processes of LUCC have been explored using top-down approaches at global and regional level but more recent methods have focused on agents’ interactions at smaller scale. This approach is better suited to understanding and modelling complex socio-ecological systems, which emerge from individual actions, and therefore for developing tools which improve policy effectiveness. In recent years, there has also been increasing interest in gaining more detailed understanding of the impacts of LUCC on the range of ecosystem services associated with different landscapes and farming practices. The objectives of this thesis are: 1/ to understand and model the internal processes of LUCC at local scale, i.e. farmer behaviour, 2/ to explore heterogeneous farmer decision making and the impacts it has on LUCC and on ecosystem services and 3/ to inform policy makers for improving the effectiveness of land-related policies. This thesis presents an agent-based modelling framework which integrates psycho-social models of heterogeneous farmer decisions and an ecological model of skylark breeding population. The model is applied to the Lunan, a small Scottish arable catchment, and is empirically-grounded using social surveys, i.e. phone interviews and choice-based conjoint experiments. Based on ecological attitudes and farming goals, three main types of farmer agents were generated: profit-oriented, multifunctionalist, traditionalist. The proportion of farmer types found within the survey was used to scale-up respondent results to the agent population, spatially distributed within a GIS-based representation of the catchment. Under three socio-economic scenarios, based on the IPCC-SRES framework, the three types of farmers maximise an utility function, which is disaggregated into economic, environmental and social preferences, and apply the farm strategy (i.e. land uses, management style, agri-environmental measures) that best satisfies them. Each type of agents demonstrates different reactions to market and policy pressures though farmers seem to be constrained by lack of financial opportunities and are therefore unable to fully comply with environmental and social goals. At the landscape level, the impacts on ecosystem services, in particular the skylark local population, depend strongly on policy objectives, which can be antagonist and create trade-offs in the provision of different services, and on farmer socio-environmental values. A set of policy recommendations is offered that encompasses the heterogeneity of farmer decision-making with the aim of meeting sustainable targets. Finally, further improvements of the conceptual and methodological framework are discussed.

This study makes a contribution to the Australian urban water supply industry because it highlights some of the critical issues the industry faces in the future. Through the scenarios it illuminates an alternative method to develop strategies for the future. Ultimately the end result of scenario planning is not a more accurate picture of the future, but better decision making for the future. This is a significant piece of research because it demonstrates the advantages of the scenario planning process as a method to illuminate the potential future dangers and opportunities in the water industry's business environment. The scenarios can be used as a launching pad for strategic planning and to prepare the water industry for the uncertainties it faces. Water is precious and essential to life. Water supply is arguably the ultimate essential service. Australia uses about 22,000 gigalitres of water [l gigalitre (GL) = 1,000,000,000 litres, approximately 444 Olympic swimming pools (ABS 2004)] per annum across all sectors, irrigation, industry and domestic. The aim of this study was to determine the critical issues for the future of the Australian urban water supply industry. The study achieved this with the aid of scenarios that tell stories about urban water supply to the year 2025. A key to this study is the concept of organisations as living organisms, which are capable of learning and adapting to changes in their business environment. Today's business environment is constantly changing through globalisation, technological innovation and society's values. To survive, organisations must be able to anticipate and adapt to this often uncertain environment. / Traditional methods, from a mechanistic perspective, of developing strategic plans for the future have a poor track record because they invariably rely on forecasting and predicting the future from historical information that, in an increasingly uncertain and fast changing world, may no longer be appropriate. Scenarios are stories about the future. They combine uncertainty and trends with creativity, insight and intuition to enable an organisation to learn and develop strategies for the future from an organic perspective. Scenarios are not predictions, but they are plausible stories about the future. The stories do allow an organisation to re-perceive a different world by questioning prevailing paradigms and assumptions. The underlying philosophical basis for scenario planning is constructivist which is consistent with the ontological position taken for this study. This study was undertaken under a qualitative research paradigm. The ontological position taken to answer the research question was constructivist with a critical perspective where realities are intangible mental constructs based on the culture and experience of individuals or groups. Constructs are more or less informed and changeable. From an epistemological perspective the constructivist position assumes that the enquirer and subject of the research are interactively linked so that findings are created. Research under a constructivist paradigm requires a hermeneutical and dialectical methodology leading to interpretation. / The methodology adopted for this study was grounded research, being a modification of grounded theory and applicable to the business environment. Data were initially gathered by semi-structured interview, the objective being two fold. 1. The data were used to elicit critical issues for the future of the Australian urban water supply industry. 2. The data were used to develop 'plausible' futures for the urban water supply industry in the form of scenarios. The data were analysed using grounded research principles and organised using NVivo (Richards 1999; NVivo 2002). After two stages of analysis, 16 major categories, focusing on the future emerged from the data. In order to write the scenarios two key uncertainties critical to the future of the urban water supply industry were required for the scenario matrix. The two selected were 'Water availability' and 'Technological change' from the water industry's contextual environment. These two key uncertainties were considered to be the most uncertain and have the greatest impact on the future of the water industry. These two key uncertainties formed the context for the scenarios into which over 200 other issues were de-dimentionalised, as in the scenario planning method, and crafted into four scenarios. A time horizon of 2025 was selected for the scenarios to reflect the water industry's long term planning horizon. / The scenarios were called 'Decadent water use', which depicts a future where there is plenty of water and technology addresses the cost of service delivery; 'Smart water world', which depicts a future where water is scarce but is addressed by technology providing alternative sources of water; 'Muddy waters', which depicts a future where there is plenty of water but technology does not address the cost of delivery and issues of infrastructure deterioration and 'Mad Max water world', which depicts a future where water is scarce and technology does not address the scarcity, the situation becomes a crisis. From the scenarios and using concepts from complex adaptive systems theory a number of critical issues emerged from the data. Some were at a philosophical level such as whether water, as a common good, fits with society's philosophy about water. Others were at a practical level for example expressing the criticality for the water industry to build community trust and support. The research notes the potential for further qualitative research in the fields of community attitudes and behaviours towards water, water services, recycling wastewater and the preparedness to pay for water services. In addition there is potential to further develop scenarios presented in this study; 'Decadent water use', 'Smart water world', 'Muddy waters' and 'Mad Max water world'; for the Australian urban water supply industry using the data from this research as a basis for group consultation.

L'inici del programa de detecció precoç del càncer de mama en els districtes de Ciutat Vella i Sant Martí de la ciutat de Barcelona, va motivar la realització del primer estudi en el barri de la Barceloneta, amb l'objectiu d'analitzar diferents factors associats a la participació. La resposta després de la primera citació ha estat del 65%. S'ha relacionat amb l'historial clínic previ augmentant en quasi 4 vegades l'ods de resposta, i amb el receptor de la carta de citació, variant del 75% quan és la mateixa interessada fins el 47% quan la carta és dipositada a la bústia, i el 32% quan l'adreça és insegura. La resposta després de les citacions successives ha estat del 26%. S'ha relacionat amb l'historial clínic previ augmentant en quasi 8 vegades l'ods de resposta, i amb la raó de no haver vingut després de la primera citació, passant del 50% quan és circumstancial fins el 11% quan s'atribueix a manca d'interès. La taxa de cobertura (79%) disminueix amb l'edat, i augmenta amb el nivell educatiu.El segon estudi permet apreciar com prèviament al programa les mamografies no s'adequaven a les directrius europees. Un 59% de les dones entrevistades dels barris El Clot, Camp de l'Arpa i La Verneda, s'han fet una mamografia de cribratge en els últims quatre anys. Existeix una major utilització en dones més joves, de major nivell educatiu i que tenen historial clínic. La periodicitat era anyal en un 35%, biennal en un 38% i cada 2-4 anys en el 27% restant. El 58% de les mamografies s'han realitzat en la sanitat pública, que mostra el major percentatge (42%) de periodicitat biennal. En les dones participants, la visita al ginecòleg i la pràctica de citologia uterina han presentat la major associació (probabilitats 4 vegades superiors) amb la mamografia prèvia de cribratge. També s'han associat a una major utilització els antecedents personals de patologia mamària i familiars de càncer de mama, l'autoexploració mamària i la visita mèdica recent, mentre que l'autopercepció de salut ha presentat una relació inversa.Finalment, el tercer estudi és un assaig controlat aleatoritzat on s'han comparat tres diferents estratègies utilitzades per a invitar dones d'entre 50 a 64 anys a participar en el programa. L'estratègia del contacte directe incrementa de forma significativa fins un 22% la probabilitat de resposta després de la primera citació en les dones del barri de Raval Nord invitades. En el grup de contacte directe aquesta resposta era del 63%, comparat amb un 55% quan la carta era enviada pels professionals sanitaris del CAP, i un 52% quan era remesa pels responsables del programa. Aquest increment en el grup de contacte directe s'observa encara que sols s'ha aconseguit contactar en un 45% dels casos directament amb la mateixa dona. Quan aquest fet s'assoleix la resposta és del 72%. La utilització de professionals no sanitaris per a aconsellar les dones sembla ser una estratègia efectiva, particularment entre les dones de baix nivell educatiu. / The beginning of the breast cancer screening program in the Ciutat Vella and Sant Martí districts of Barcelona was the origin of the first study in the Barceloneta quarter, with the aim of analyzing different factors related to participation. The response after the first citation was 65%. Having a previous clinical history, increased in nearly 4 times the response odds. Response after the first citation was influenced by who the recipient of the citation letter was, ranging from 75% when this was the same person concerned to 47% when the letter was left in the letter-box, and to 32% when the address was uncertain. The response after subsequent citations was 26%. Having previous clinical history increased the response odds in almost 8 times. The response after successive citations, ranged from 50% when it was for circumstantial reasons, to 11 % when it was due to lack of interest. Coverage rate (79%) decreased with age, and increased with education level.The second study shows that, previously to the program, mammography screening did not comply with European guidelines. A screening mammography had been performed on 59 % of women interviewed in the El Clot, Camp de l'Arpa and La Verneda quarters. The utilization of mammography was higher among younger women, women with a higher education level, or who had previous visits to a physician. Periodicity was once a year in 35% of cases, once every two years in 38%, and every 2-4 years in the remaining 27 %. Mammographies were performed at the Public Heath Service in 58 % of cases. The Public Health Service shows the highest percentage (42 %) of biennial periodicity. The variables more strongly associated with the use of screening mammography (probabilities 4 times higher) were: visit to a gynecologist and performance of a pap smear. Also related to the utilization of screening mammography were: personal history of breast pathology, family history of breast cancer, breast self-examination, and recent visit to a general practitioner. Self-perceived health presented an inverse relation with screening mammography use.Finally, the third study is a randomized controlled trial where three different strategies of inviting 50 to 64 years old women to participate in the program were compared. The strategy of direct contact increased in a significant way, up to 22%, the possibility of response after the first citation among women invited in the Raval Nord quarter. The response rate in the direct contact group was 62%, compared to 55% when the letter was sent by Primary Health Care Team, and 52% when it was sent by those responsible of the program. This increase in the direct contact group is noticeable even though only in 45 % of cases it was possible to contact the subject herself. When this was achieved, response raised to 72%. Use of non-health professionals to advise women seems to be an effective strategy, especially among women with a lower educational level.

Yes / The resilience of systems derives from many inputs, relating both to design and to operational planning. In the latter context the role and effective functioning of the ‘blue light’ emergency services is often critical. The judgements and decisions that have to be made are complex and time-constrained, often undertaken before all the critical information that might be wanted is available. Recent developments in decision research, notably the on-going dual process debate, suggest that the process of decision making adopted is often more complex than had previously been appreciated and strongly linked to both context and individual factors, notably expertise. In the light of such developments, this paper presents an empirical study of emergency responders working in realistic, non-laboratory conditions. It argues that recent moves to recognise the need to support, through the way in which information is provided, more intuitive as well as analytic modes of thinking in decision support are timely and that an important research agenda exists linking decision support design with a fuller understanding of exactly how individuals make their decisions in emergency conditions. / This research was funded by ESRC and 1Spatial, a Cambridge-based software company specialising in high volume, business critical data.

Made available in DSpace on 2014-06-11T19:29:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-26Bitstream added on 2014-06-13T19:38:43Z : No. of bitstreams: 1 baptista_ccwd_me_botfm.pdf: 436274 bytes, checksum: 9718ab06761a44f8ce86a377e88d3850 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Estudos sobre a utilização de serviços de saúde podem contribuir com a racionalização dos gastos, o planejamento, a reorganização das ações e programas buscando melhorar a qualidade dos serviços prestados. Os inquéritos de saúde de base populacional coletam simultaneamente informações sobre a situação de saúde, as condições de vida, a utilização dos serviços, incorporando informações sobre a população atendida e não atendida, caracterizando a demanda segundo variáveis biológicas, socioeconômicas e geográficas. O estudo da utilização dos serviços de saúde permite conhecer sua acessibilidade para os diversos grupos sócio-econômicos e avaliar a equidade do sistema de saúde. Conhecer o perfil de utilização dos serviços de saúde de Botucatu-SP, em relação à morbidade referida de 15 dias e outros motivos de utilização, segundo características dos usuários e dos serviços procurados. Foram analisados dados, coletados em inquérito de base populacional, relativos à procura de serviços de saúde em amostra populacional urbana de Botucatu, a partir das morbidades referidas e outros motivos, não mórbidos, de procura de serviços de saúde nos últimos 15 dias anteriores a data da entrevista. Os problemas de saúde foram classificados segundo os capítulos da CID 10, sua freqüência e prevalência foram analisadas segundo as variáveis de idade e sexo. Foram estudados a procura de serviços e os motivos da não-procura, o grau de satisfação com o atendimento recebido e a resolubilidade dos problemas de saúde entre os que procuraram e não procuraram os serviços de saúde. Foram caracterizados os serviços procurados, se públicos ou privados, as formas e fontes de pagamento dos atendimentos, de exames solicitados e de medicamentos prescritos. Foram estudadas as variáveis sexo e idade, grau de instrução... / Studies on the use of health services may contribute to reasonable spending, planning, reorganization of actions and programs aiming to improve the quality of delivered services. Populational-based health surveys simultaneously collect information about health condition, life conditions, and the use of services, incorporating information about serviced and non-serviced population, characterizing the demand according to biological, social, economic and geographical variables. The study of the use of health services allows knowing its accessibility to various social and economical groups and evaluating health system equity. To know the profile of the use of health service in Botucatu-SP, related to 15 days referred morbidity and other reasons of use, according to characteristics of users and pursued services. Collected data from a populational-based survey were analyzed and they were related to the pursuit of health services in an urban population sample in Botucatu, from the referred morbidity and other non-morbid reasons of pursuing health services on the last 15 days prior to the day of interview. Health problems were classified according to the chapters of CID 10, its frequency and prevalence were analyzed according to age and sex. The pursued and non-pursued of services, the degree of satisfaction of delivered service and the solution of problems among those who pursued and the ones who did not pursue the services were studied. Pursued services were characterized according to public or private, the ways and sources of service payment, asked examinations and prescribed medications. Variables like sex and age, education degree of the head of the family, and per capita income related to the use of the service were studied. Results: From 1558 interviewed people, 413 (26, 0%) referred one or more health problems... (Complete abstract click electronic access below)

Resumo: Estudos sobre a utilização de serviços de saúde podem contribuir com a racionalização dos gastos, o planejamento, a reorganização das ações e programas buscando melhorar a qualidade dos serviços prestados. Os inquéritos de saúde de base populacional coletam simultaneamente informações sobre a situação de saúde, as condições de vida, a utilização dos serviços, incorporando informações sobre a população atendida e não atendida, caracterizando a demanda segundo variáveis biológicas, socioeconômicas e geográficas. O estudo da utilização dos serviços de saúde permite conhecer sua acessibilidade para os diversos grupos sócio-econômicos e avaliar a equidade do sistema de saúde. Conhecer o perfil de utilização dos serviços de saúde de Botucatu-SP, em relação à morbidade referida de 15 dias e outros motivos de utilização, segundo características dos usuários e dos serviços procurados. Foram analisados dados, coletados em inquérito de base populacional, relativos à procura de serviços de saúde em amostra populacional urbana de Botucatu, a partir das morbidades referidas e outros motivos, não mórbidos, de procura de serviços de saúde nos últimos 15 dias anteriores a data da entrevista. Os problemas de saúde foram classificados segundo os capítulos da CID 10, sua freqüência e prevalência foram analisadas segundo as variáveis de idade e sexo. Foram estudados a procura de serviços e os motivos da não-procura, o grau de satisfação com o atendimento recebido e a resolubilidade dos problemas de saúde entre os que procuraram e não procuraram os serviços de saúde. Foram caracterizados os serviços procurados, se públicos ou privados, as formas e fontes de pagamento dos atendimentos, de exames solicitados e de medicamentos prescritos. Foram estudadas as variáveis sexo e idade, grau de instrução... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Studies on the use of health services may contribute to reasonable spending, planning, reorganization of actions and programs aiming to improve the quality of delivered services. Populational-based health surveys simultaneously collect information about health condition, life conditions, and the use of services, incorporating information about serviced and non-serviced population, characterizing the demand according to biological, social, economic and geographical variables. The study of the use of health services allows knowing its accessibility to various social and economical groups and evaluating health system equity. To know the profile of the use of health service in Botucatu-SP, related to 15 days referred morbidity and other reasons of use, according to characteristics of users and pursued services. Collected data from a populational-based survey were analyzed and they were related to the pursuit of health services in an urban population sample in Botucatu, from the referred morbidity and other non-morbid reasons of pursuing health services on the last 15 days prior to the day of interview. Health problems were classified according to the chapters of CID 10, its frequency and prevalence were analyzed according to age and sex. The pursued and non-pursued of services, the degree of satisfaction of delivered service and the solution of problems among those who pursued and the ones who did not pursue the services were studied. Pursued services were characterized according to public or private, the ways and sources of service payment, asked examinations and prescribed medications. Variables like sex and age, education degree of the head of the family, and per capita income related to the use of the service were studied. Results: From 1558 interviewed people, 413 (26, 0%) referred one or more health problems... (Complete abstract click electronic access below) / Orientador: Luana Carandina / Coorientador: Antonio Luiz Caldas Junior / Banca: Marilisa Berti de Azevedo Barros / Banca: Carmen Maria C. Monti Julian / Mestre

The purpose of this research was to provide an understanding of past efforts to predict recreation choice behavior. Additionally, from this past research in recreation and in the fields of psychology and consumer behavior, a lexicographic semi-order model was selected and tested for applicability in approximating recreation site choices. Testinq this model required initial work in deciding upon physical, social, and managerial attributes of a recreation site which may be relevant to a choice decision. A framework was developed to analyze the multitude of studies dealing with recreation site attributes. Using a microcomputer based data collection instrument in a laboratory situation, the lexicographic semi-order choice model was found to be successful in predicting the elimination of alternatives from a choice set. There was a negative relationship between the level of experience an individual had in backcountry use in the Southern Appalachians and the specificity with which they perceived attributes of the resource. The lexicographic semi-order choice model appears to be a feasible format for developing microcomputer-based decision aids for backcountry recreation site selection. / Ph. D.

M. S.

Rural water systems (RWS) are commonly used to provide water to households for domestic uses (drinking, cleaning, washing, and sanitation) in developing countries. Water supply practitioners often classify these systems as single-use water systems (SUS) or multiple-use water systems (MUS). Smallholder farming communities in rural western hills of Nepal typically use such systems for both domestic and income-generating productive activities (e.g., agriculture, livestock, dairy, bio-gas, Rakshi), regardless of whether they were designed for single or multiple water uses. Therefore, this research frames both systems as providing multiple-use water services that enhance the productive activity and livelihoods of small- holders. Little is known on the factors that influence the productive activity of households in the western middle hills of Nepal and the impact these activities have on the technical performance of water systems (measured by duration of system breakdowns). This research identifies the extent of water-related productive activities in rural Nepali households supported by single-use water systems (SUS) vs. multiple-use water systems (MUS), and explores the factors that enables households to engage in high-levels of productive activity. The vast majority of households were found to engage in small-scale productive activities no matter what the rural water systems were designed to support, and more than half of them earned an income from water-based activities. Households engaged in high-levels of productive activity farm as a primary occupation, use productive technologies, are motivated to pursue productive activities, have received water-related productive activity training, and have received external support related to productive activities. A multinomial regression was used to predict the factors associated with high levels of productive activities undertaken by small farms. A hierarchical regression model was then used to examine both household- and system-level variables that contribute to the breakdown of rural water systems, focusing on the duration of breakdowns. The predictors of water system breakdowns include social factors (household involvement in decision-making during water system planning and construction and a household's sense of ownership toward the water system), technical factors (the management capacity of the water user committee and activity level of the system operator), economic factors (income earned from water-based productive activities), and geographic factors (the distance from the village to the water source). Finally, a conceptual model was developed to help identify strategies for implementing and scaling-up MUS. Scaling-up strategies for MUS begin with community participation in lo- cal government planning and budgeting. Under a new Constitution that went into effect in January 2017, newly formed local governments are to be provided with the funding and budget authority to determine local service priorities and how these services will be funded, designed, and implemented. The scaling-up of MUS would require local government officials, water system users, and private actors to develop the technical and institutional capacity needed to build and manage MUS, including the many support services needed by small- holder growers to realize its benefits. This research also examines the potential approaches that could enable subsistence farmers to become viable commercial producers. While growers are typically risk-adverse producers, this research identifies the mediating factors that could expand the long-term engagement of these producers in commercial agricultural production. These factors include adequate access to year-round irrigation, the use of improved production technologies and practices, improved access to rural markets, and improved production skills. The findings of this research will also be of value to Governmental, Non-Governmental Organizations (NGOs) and private sector actors who are looking to effectively mobilize their resources and expertise in support of smallholder farming in the hills of Nepal. / Doctor of Philosophy / A vast majority of farmers in the western middle hills of Nepal are smallholders who often use family labor and follow traditional agricultural and water use practices. They have been traditionally using rural water systems to meet their multiple water needs alongside domes- tic uses (drinking, cleaning, washing, and sanitation). There is growing interest for these systems to also be used for small-scale productive activities such as growing vegetables and livestock production. Evidence shows that these activities are an important source of income for farming families. However, little is known on the conditions that are needed to expand these activities and improve livelihoods. This research identifies the conditions under which rural water systems can become productive and technically sound, and outlines the strategies that can be deployed to scale-up productive activities. The research examines a broad range of perspectives (from rural farmers to development experts) on the limited commercialization of rural agriculture in the rural middle hills of Nepal and the potential approaches to promoting agricultural growth and commercialization among small landholders. The substance farmers were found to require both the means and motivation (i.e., extensive support services such as access to markets, input suppliers, irrigation and agricultural technologies, and production training) to become commercial farmers. Second, more than 90% of households were engaged in small-scale water-based production activities and more than half of them earned an income from these activities. The research revealed the conditions that enabled these households to engage in high levels of productive activities. Further, the factors that affect water system breakdowns were investigated. Since farmers are engaged in small-scale production, the interlinkages between productive income and system performance were examined. Finally, the research explores how multiple-use water services have the potential to be scaled-up in the middle hills of Nepal and beyond. Successful scaling-up strategies begin with community participation in local government planning and budgeting. This activity needs to be supported by substantial capacity building among government officials, water system users, and private actors on the factors needed to expand the productive use of water. Broad implementation of multiple-use water systems also requires careful documentation and dissemination of their benefits to key state and non-state actors. The results from this research can be used to identify appropriate households, communities, and water systems for programs focused on expanding water and agricultural productivity. Therefore, this research will have important implications for the Nepali government with regards to what policy, capacity development, and institutional arrangements need to be addressed to implement productive and sustainable rural water systems. This research can also be of special interest to Non-Governmental Organisations (NGOs) and private sector actors looking to effectively mobilize their resources and expertise relating to a smallholder farming in Nepal.

Objectif : Évaluer la « lourdeur » de la prise en charge clinique des personnes vivant avec le VIH/SIDA (PVVIH) afin d’ajuster l’allocation des ressources en GMF. Méthodologie : Analyse comparative entre le GMF de la Clinique médicale l’Actuel, les GMF montréalais et de l’ensemble du Québec, en identifiant les différences dans les profils de consommation de soins pour les années civiles 2006 à 2008 et les coûts d’utilisation des services pour l’année 2005. Résultats : En 2008, 78% de la clientèle inscrite au GMF de la Clinique médicale l’Actuel est vulnérable comparativement à 28% pour les autres GMF montréalais, une tendance observée pour l’ensemble du Québec. Le nombre moyen de visites par individu inscrit et vulnérable est de 7,57 au GMF l’Actuel alors que la moyenne montréalaise est de 3,37 et celle du Québec de 3,47. Enfin, le coût moyen des visites médicales au GMF l’Actuel en 2005 est de 203,93 $ comparativement à des coûts variant entre 132,14 et 149,53 $ pour les unités de comparaison. Conclusion : L’intensité de l’utilisation des ressources au GMF de la Clinique médicale l’Actuel (nombre d’individus vulnérables, nombre de visites et coûts) suggère que la prise en charge clinique des personnes vivant avec le VIH/SIDA est beaucoup plus lourde qu’un citoyen tout venant ou même de la majorité des autres catégories de vulnérabilité. Afin d’offrir un traitement juste et équitable aux GMF, l’inscription devrait être ajustée afin de tenir compte de la « lourdeur » de cette clientèle et valoriser la prise en charge des personnes qui présentent des tableaux cliniques complexes. / Objective: To evaluate the “burden” involved in the clinical management of people living with HIV/AIDS, in order to adjust the allocation of resources in terms of family medicine groups (FMG). Methodology: A comparative analysis of FMG Clinique médicale l’Actuel, FMGs in Montréal and throughout Québec, identifying differences in care consumption profiles for the years 2006 to 2008 and the costs of use of services for 2005. Results: In 2008, seventy eight percent (78%) of the clientele registered with the FMG at Clinique médicale l’Actuel was considered vulnerable, in comparison to twenty eight percent (28%) at other Montréal FMGs, a trend observed throughout Québec. The average number of visits per registered individuals was 7.57 at the Actuel FMG, while the average in Montréal was 3.37 and in Québec overall, 3.47. In 2005, the average cost of a visit at the Actuel FMG was $203.93 compared to costs that varied from $132.14 to $149.53 for comparative units. Conclusion: The intensity of use of FMG resources at the Clinique médicale l’Actuel (number of vulnerable individuals, number of visits and costs) suggests that the clinical management of people living with HIV/AIDS is a much heavier burden than that of an average citizen, or even from the majority of other categories of vulnerability. In order to ensure that all FMGs are treated fairly and equitably, registration should be adjusted to take into account the “burden” of this clientele and to place more value on the case management of people with complex clinical presentations.