Student Number: 0501772G - MA research report - School of Social Sciences - Faculty of Humanities / Development Communication theories suggest that media plays a critical role in the transformation of societies (Melkote, 2003). In line with this thesis, this research discusses the extent to which news media can provide a platform for social change for women’s health issues for the development of South Africa, in the context of the prevention of mother-to-child transmission of HIV (PMTCT). With approximately 29.5% of women attending antenatal clinics throughout the country being HIV-positive, PMTCT is one issue that demonstrates the socio-economic and political complexities of women’s health in the context of development. The qualitative methodological approach involves a thematic content analysis of the news media’s coverage around issues of PMTCT between July 1, 2004 and July 1, 2-005 in two South African newspapers The Star and The Mail and Guardian. The methods also involve a thematisation of interview responses from various stakeholders within news media and the case of PMTCT in South Africa. Empirical studies associate women’s access to media with better health and fertility outcomes, irrespective of various income and education levels (“Ch. 10: The Media”, 2002). This research report explores the extent to which a commercially driven news media can be for development; particularly for HIV-positive pregnant women can voice their perspectives and make empowered decisions for their health.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-04-27T16:06:36Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação completa NOVO.pdf: 1536561 bytes, checksum: 66148935591022f06fd7a82dc088abee (MD5) / Made available in DSpace on 2017-04-27T16:06:36Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação completa NOVO.pdf: 1536561 bytes, checksum: 66148935591022f06fd7a82dc088abee (MD5) Previous issue date: 2016-05-31 / As políticas sociais para enfrentamento da crescente epidemia de Aids desde o início da década de 1980 foram centradas no controle epidemiológico e na prevenção. No entanto, uma série de contradições na implementação e eficácia dessas políticas vêm sendo observadas por diversos pesquisadores e especialistas. Tem sido notório o crescimento da epidemia entre as mulheres. Tal problemática tem evidenciado uma série de questões relacionadas à saúde da mulher vivendo com HIV/Aids, dentre elas as relativas à sexualidade e reprodução. O objetivo principal desta dissertação foi analisar a lógica das estratégias, seu significado e práticas em saúde relacionadas ao acesso de mulheres soropositivas aos direitos reprodutivos e direitos sexuais em paralelo faz-se necessário também analisar as possíveis formas abertas e veladas de negação dos direitos sexuais e reprodutivos das mulheres vivendo com HIV/Aids e quais as estratégias adotadas pelo serviço de referência para que elas exerçam o direito de escolha da maternidade de maneira saudável, sem riscos de reinfecção, infecção do parceiro ou do feto. Esta pesquisa possibilitou aprofundar e apreender o debate acerca das contradições e conflitos presentes em nosso problema de pesquisa e está fundamentada na Teoria Social Crítica. Como procedimentos metodológicos fizemos uso de: análise documental; revisão bibliográfica; entrevista semi estruturada e grupo focal. Consideramos que mesmo com os avanços obtidos com a elaboração da Política Nacional de DST/Aids, no que se refere à saúde das mulheres, percebe-se objetivamente uma série de contradições na sua efetivação, pois o tratamento antirretroviral por si só não resolve a gama de problemas oriundos da infecção. Além da garantia de antirretroviral, se faz necessário o acesso a medicamentos para doenças oportunistas, a ampliação do acesso a especialistas. Nas entrevistas com os profissionais do serviço de referência identificamos por parte da maioria o desconhecimento em relação aos direitos reprodutivos e sexuais, falta de articulação e planejamento sobre esses direitos, e que atuação sobre essa temática é caracterizada por práticas individualizadas, embora ocorra a preocupação em orientar as mulheres sobre métodos contraceptivos e de reprodução. Uma dificuldade importante apontada por esses profissionais foi a alta demanda de atendimentos em relação ao número de profissionais; reflexo da atual situação r o uso de preservativo com seus parceiros. Acreditamos que ignorar/negar os direitos reprodutivos e direitos sexuais de mulheres vivendo com HIV/Aids não faz com que eles desapareçam, pelo contrário, não possibilita a sua reflexão, desfavorecendo o debate sobre o assunto e dificultando o poder de negociação das mulheres no uso de preservativo. / Social policies to confront the growing AIDS epidemic since the 1980s were centered on epidemic control and prevention. However, a number of contradictions in the implementation and efficacy of these policies have been observed by many investigators and experts. It has been noticeable growth of the epidemic among women. This issue has highlighted a number of questions related to women's health living with HIV / AIDS, among them those related to sexuality and reproduction. The main objective of this thesis was to analyze the logic of strategies, its meaning and health practices related to access of HIV-positive women to reproductive and sexual rights, in parallel it is necessary to also analyze the possible open and veiled forms of denial of sexual and reproductive rights of women living with HIV / AIDS and what are the strategies adopted by the referral service so that they exercise their right to choose the healthy way maternity, without the risk of reinfection, infection of the partner or of the fetus. This research allowed deepening and grasping the debate about the contradictions and conflicts present in our research problem from theoretical discussions. This study is based on elements of Critical Social Theory. As methodological procedures we use: analysis of documents; literature review; semi structured interviews and focus group. We consider that even with the progress made with the development of the National Policy of STD / AIDS in relation to women's health it’s perceived objectively a series of contradictions in its effectiveness because the antiretroviral treatment alone does not solve the range of problems arising from the infection. In addition to antiretroviral guarantee, it is necessary the access to drugs against opportunistic diseases and expanding access to specialists. In interviews with professionals of referral service we realize individual performance of each, although occur concern in guiding women on contraceptives and methods of breeding the best possible way. A major difficulty pointed out by these professionals was the high demand for care in relation to the number of professionals; reflection of the current situation of the Brazilian public health, precariousness, underfunding, privatization. In focus group we noticed the lack of knowledge of women on reproductive and sexual rights, reflected in unsafe practices to prevent and difficulty to negotiate condom use with their partners. We believe that ignore / deny the reproductive and sexual rights of women living with HIV / AIDS does not mak ver their lives and more consciously make sexual and reproductive choices; and the professionals who accompany them have the role of supporting the decisions adopted and the recognition of the risks and benefits assumed from certainties situations or uncertainties, advantages or disadvantages

The study reports on the perceptions of the midwives and pregnant women of the PMTCT of HIV programme at the antenatal care and maternity ward at the Johan Heyns Community Health Centre. A qualitative approach was adopted to conduct the study. Purposive sampling was used to select participants and was informed by social behavioural theories. Data was collected using interviews and analysed using thematic categorisation. The findings show that at the first PMTCT encounter participants had little to no knowledge of the PMTCT programme, generally displayed a lack of interest, experienced emotional distress, and fear at the thought of having to disclosing their HIV-positive status to their partners/family and had certain trepidations about participating in the PMTCT programme. The participants’ perception on their roles was that their roles were interlinked, midwife needs the recipients (pregnant woman) and pregnant woman needs the provider (midwife) therefore one cannot do PMTCT without the other. The study recommends that the capacity building of pregnant women be optimised, that PMTCT awareness campaigns for women of childbearing age should be a priority and PMTCT skills to be prerequisite for midwives deployed to ANC clinics and maternity ward units. / Health Studies / M. A. (Social Behaviour Studies in HIV/AIDS)

The study reports on the perceptions of the midwives and pregnant women of the PMTCT of HIV programme at the antenatal care and maternity ward at the Johan Heyns Community Health Centre. A qualitative approach was adopted to conduct the study. Purposive sampling was used to select participants and was informed by social behavioural theories. Data was collected using interviews and analysed using thematic categorisation. The findings show that at the first PMTCT encounter participants had little to no knowledge of the PMTCT programme, generally displayed a lack of interest, experienced emotional distress, and fear at the thought of having to disclosing their HIV-positive status to their partners/family and had certain trepidations about participating in the PMTCT programme. The participants’ perception on their roles was that their roles were interlinked, midwife needs the recipients (pregnant woman) and pregnant woman needs the provider (midwife) therefore one cannot do PMTCT without the other. The study recommends that the capacity building of pregnant women be optimised, that PMTCT awareness campaigns for women of childbearing age should be a priority and PMTCT skills to be prerequisite for midwives deployed to ANC clinics and maternity ward units. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-20T16:29:39Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) CIENCIAS MEDICAS GABRIELA AVILA.pdf: 1035117 bytes, checksum: 1e557cad3ea706ebe746a5080324d310 (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-20T16:29:50Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) CIENCIAS MEDICAS GABRIELA AVILA.pdf: 1035117 bytes, checksum: 1e557cad3ea706ebe746a5080324d310 (MD5) / Made available in DSpace on 2017-09-20T16:29:50Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) CIENCIAS MEDICAS GABRIELA AVILA.pdf: 1035117 bytes, checksum: 1e557cad3ea706ebe746a5080324d310 (MD5) Previous issue date: 2017 / Universidade Federal Fluminense / O padrão da epidemia da infecção pelo vírus da imunodeficiência humana (HIV) entre crianças modificou-se substancialmente nos últimos anos, com declínio no número de novas infecções na população pediátrica após a implementação, em 1994, do protocolo PACTG 076 (Pediatric Aids Clinical Trials Group 076). Posteriormente, o impacto da terapia antirretroviral combinada durante a gestação, primariamente para diminuir a morbidade na mãe, apresentou o benefício adicional da redução das taxas de TVHIV. Este estudo é uma série de casos, cujo objetivo é conhecer o perfil clínico-epidemiológico das gestantes infectadas pelo HIV atendidas no Serviço de Infectologia do Hospital Universitário Antônio Pedro no período de 1998 a 2013, o resultado de suas gestações ea taxa de transmissão vertical do HIV. Foram investigadas 115 gestantes, que resultaram em 152 gestações, através da seleção mediante consulta ao registro de atendimento no ambulatório de Serviço de Infectologia do HUAP. A média de idade das gestantes atendidas foi de 26 anos (desvio padrão - DP = 2,1) e 57,9% eram brancas. A idade gestacional média na primeira consulta foi de 22,8 semanas gestacionais (DP = 7,8). Embora a maioria já soubesse ser portadora do HIV, 46,4% foram diagnosticados em mulheres que não tinham conhecimento do seu estado sorológico. A percentagem de gestações consideradas em imunossupressão grave (CD4 + <200 células / mm3) caiu de 17,9% antes de iniciar a terapêutica anti-retroviral para 8,9% na consulta pré-parto. Houve também um aumento na proporção de mulheres grávidas que atingiram uma carga viral não detectada, de 10,4% para 37,9%. A taxa de transmissão vertical do HIV foi de 1,6%., corroborando para a importância do acompanhamento pré-natal adequado e do tratamento com antirretrovirais potentes, fundamentais para a saúde das gestantes e para prevenção da transmissão do HIV aos recém-nascidos. / The pattern of the human immunodeficiency virus (HIV) epidemic among children has changed substantially in recent years, with a decline in the number of new infections in the pediatric population following the implementation in 1994 of the PACTG 076 protocol (PEDIATRIC AIDS CLINICAL TRIALS GROUP 076). Subsequently, the impact of combination antiretroviral therapy during pregnancy, primarily to reduce maternal morbidity, had the additional benefit of reducing maternal-fetal transmission rates of the virus. This study is a series of cases, whose objective is to know the clinical-epidemiological profile of HIV-infected pregnant women attended the Infectious Disease Department of the Antônio Pedro University Hospital from 1998 to 2013, the outcome of their pregnancies and the vertical HIV transmission rate. 115 pregnant women, resulting in 152 pregnancies, were investigated through the selection by consulting medical records. The mean age of the pregnant women attended was 26 years (standart deviation - ST = 2.1), 57.9% of them were white. The mean gestational age at the first outpatient clinic was 22.8 gestational weeks (ST = 7.8). Although most of them already knew to be HIV carrier, 46.4% were diagnosed in women who were unaware of their serological status. The percentage of pregnancies considered in severe immunosuppression (CD4+ < 200 cells/mm3) fell from 17.9% before starting antiretroviral therapy to 8.9% in the prepartum consultation. There was also an increase in the proportion of pregnant women who achieved an undetected viral load, from 10.4% to 37.9%. The vertical HIV transmission rate was 1.6%, corroborating the importance of adequate prenatal care and treatment with potent antiretroviral drugs, which are essential for the health of pregnant women and for the prevention of HIV transmission to newborns.

Thesis (MScMedSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Hepatitis B virus (HBV) immunisation protocols in much of Africa are based on data from the pre-human immunodeficiency virus (pre-HIV) era that indicated that HBV transmission occurs predominantly horizontally between siblings and play-mates rather than vertically from mother to child. The immunosuppression associated with HIV infection however may release HBV from immune control resulting in higher HBV viral loads, which may increase the risk of perinatal mother to child transmission of HBV. The aim of this study was to determine the prevalence and characteristics of chronic HBV infection in HIV-infected pregnant women compared to HIV-uninfected pregnant women in the Western Cape province of South Africa. Ethical approval was obtained to conduct a retrospective, matched case-control, unlinked anonymous study using residual plasma samples from the 9355 pregnant women included in the Western Cape's 2008 National HIV and Syphilis Antenatal Survey. Samples were tested for HBsAg on the AxSYM (Abbott, Chicago, IL) and confirmed by neutralization. Confirmed HBsAg-positive samples were tested for HBeAg, anti-HBe and anti-HD (Diasorin, Saluggia, Italy) and had HBV viral load and genotyping done. In addition, HBsAg-negative samples were tested for anti-HBc. Samples from 1549 HIV-infected pregnant women were included and matched to the same number of samples from age- and race-matched HIV-uninfected women. Median age of 26 years, parity and education were similar in the two groups. The prevalence of HBsAg was 3.4% for the HIV-infected group and 2.9% for the HIV-uninfected group. HBV DNA loads of greater than 104 IU/ml were detected in 32.1% of HBsAg-positive, HIV/HBV co-infected women, and in 14.3% HBsAg positive, HBV mono-infected women. Among the HIV-infected group 18.9% of HBsAg-positive were HBeAg positive, with a median viral load of 7.93 log10 IU/ml; whilst 15.5% HIV-uninfected women were positive for HBeAg with a median viral load of 6.07 log10 IU/ml. Genotype A was seen in 92.6% of the isolates while 7.4% of the isolates were genotype D. Serum total anti-HBc antibodies that are a marker of past infection were detected in 42.2% of HIV-infected and in 24.1% of HIV-uninfected women that were negative for HBsAg. No positive sample for anti-HD was seen among all HBsAg-positive samples. This data indicates that there is increased exposure to HBV in HIV-infected pregnant women than in HIV-uninfected women and that a greater proportion of HIV-infected pregnant women compared to HBV mono-infected pregnant women may be at increased risk of transmitting HBV to their infants. Further studies are needed to determine the rate of vertical transmission of HBV in the HIV era. / AFRIKAANSE OPSOMMING: Hepatitis B virus (HBV) immunisasie protokolle vir meeste dele van Afrika is gebaseer op data versamel in die era voor MIV. Die data dui aan dat HBV oordrag hoofsaaklik deur horisontale transmissie tussen broers, susters en speelmaats eerder as vertikale transmissie van moeder na kind plaasvind. Die onderdrukking van die immuunstelsel as gevolg van MIV infeksie kan egter lei tot 'n verhoogde risiko van perinatale HBV oordrag van moeder na kind. Die doel van hierdie studie was om die voorkoms en karakter van chroniese HBV infeksie in MIV-positiewe swanger vroue te vergelyk met die van MIV-negatiewe swanger vroue. Etiese goedkeuring is verkry om 'n retrospektiewe, deursnee-, ongekoppelde anonieme studie uit te voer wat gebruik maak van oorblywende plasma monsters van 9355 swanger vroue wat ingesluit is in die Wes-Kaap 2008 Nasionale MIV en Sifilis Voorgeboortelike Opname. Die monsters was getoets vir HBsAg antiliggame (AxSYM, Abbott, Chicago, IL) en bevestig deur neutralisasie toetse. Positiewe monsters was getoets vir HBeAg en anti-HBe (Diasorin, Saluggia, Italië). HBV viruslading en genotipering was ook op HBsAg positiewe monsters gedoen. Die HBsAg negatiewe monsters was getoets vir die teenwoordigheid van anti-HBc. Monsters van 1549 MIV-positiewe swanger vroue was ingesluit in die studie. Dieselfde aantal monsters van MIV-negatiewe vroue, met ooreenstemende ouderdom en etnisiteit, was ingesluit as kontroles. Die gemiddelde ouderdom van albei groepe was 26 jaar. Pariteit en opvoeding was dieselfde in albei groepe. Die voorkomssyfer van HbsAg was 3.4% in die MIV-positiewe groep en 2.8% in die MIV-negatiewe groep. HBV DNS ladings van meer as 104 IU/ml was waargeneem in 32.1% van die MIV-mede-geinfekteerde vroue en in 14.3% van die MIV-negatiewe groep. In die MIV-positiewe groep was 18.9% vroue HBeAg positief, met 'n gemiddelde virale lading van 7.93 log10 IU/ml, terwyl 15.5% MIV-negatiewe vroue positief was vir HBeAg met 'n gemiddelde virale lading van 6.07 log10 IU/ml. In ons studie was 92.6% van die monsters genotipe A en 7.4% genotipe D. Toatale anti-HBc antiliggame, 'n merker van vorige infeksie, was gevind in 42.2% van MIV-mede-geïnfekteerde vroue en 24.1% van MIV-negatiewe vroue wat negatief was vir HBsAg antiliggame. Data van ons studie dui op 'n verhoogde risiko vir vertikale HBV transmissie van MIV-positiewe moeders na hul babas. Verdere studies word benodig om vas te stel of vertikale transmissie van HBV van MIV-positiewe vroue na hul babas plaasvind. / Wellcome Trust / Poliomyelitis Research Foundation