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No. of bitstreams: 1 renatacristinajustodearaujo.pdf: 661309 bytes, checksum: 6b4552261e526a4ac2b47d6e88621eb4 (MD5) Previous issue date: 2015-08-19 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Resumo da Dissertação de Mestrado ao Programa de Pós-Graduação em Enfermagem da Universidade Federal de Juiz de Fora como parte dos requisitos necessários à obtenção do título de Mestre em Enfermagem. O objeto desta investigação foi o ser mulher jovem gestante convivendo com o HIV. O objetivo foi desvelar os sentidos advindos desta condição durante a gestação de mulheres jovens que convivem com o HIV. Elegeu-se a fenomenologia, fundada no referencial teórico filosófico de Martin Heidegger como método de investigação. Estudo desenvolvido no Serviço de Assistência Especializada em um município da Zona da Mata Mineira com seis jovens gestantes portadoras do HIV. Utilizou-se a entrevista fenomenológica, através da técnica da entrevista aberta e um questionário. A compreensão vaga e mediana permitiu elaborar o fio condutor num movimento da compreensão do vivido da gestação sendo soropositiva e a interpretação do sentido do que é ser mulher jovem convivendo com o HIV.A vivência da gestação sendo soropositiva se inicia com a lembrança da notícia da gestação como sendo um momento marcante, para algumas, de não aceitação, porém, às vezes, desejada e até mesmo planejada; convivem com a possibilidade de transmitir o vírus para os filhos, o que causa medo e insegurança, porém sabem que o uso correto do medicamento e a crença em Deus fortalecem a esperança da criança nascer saudável e até mesmo da cura. Na compreensão interpretativa desvelou-se o sentido do ser-aí no mundo em sua existencialidade, mostrando seu movimento no cotidiano, com experiências e sentimentos diversificados do seu ser no mundo com os outros, assumindo o lugar de protagonista de suas vivências, mostrando-se na dupla facticidade: ser jovem gestante e portadora do vírus. Demonstra que, às vezes, não queria estar grávida, mas aceita bem essa atual situação vivenciando alternância de sentimentos. No movimento de existir-sendo, vivenciam seu passado e sabem que não tem outro caminho a não ser, seguir ir em frente, se relacionam com seus pares, sua família, escola e comunidade, assumem a identidade impessoal, mostram-se como todas as gestantes e não divulga que tem o vírus. Vivem com-os-outros, o temor de ser rejeitada por ser soropositiva, mantendo o anonimato de sua sorologia. Projeta seu futuro, mostrando-se aberta às possibilidades da vida, como de qualquer outra jovem não soropositiva, porém com particularidades que a soropositividade lhe traz. Tem conhecimento sobre a doença e sabe dos benefícios do tratamento, não se sentem doentes, apesar de relatar os efeitos desagradáveis dos antiretrovirais. / Abstract from the Dissertation to the Graduate Program in Nursing at the Juiz de Fora Federal University as part of the requirements for obtaining the title of Master in Nursing. The purpose of this investigation was to being young pregnant women living with HIV. The objective was to reveal the aspects coming from this condition during pregnancy of young women living with HIV. It was elected the phenomenology, based on philosophical theoretical reference by Martin Heidegger as a research method. The study was developed in the Specialized Assistance Service- Serviço de Assistência Especializada- in a city in Zona da Mata Mineira with six young pregnant women with HIV. It was used the phenomenological interview, using the technique of open interview and a questionnaire. The vague understanding enabled to prepare the progressive movement to understanding the lives of pregnant women being HIV positive and the interpretation of the meaning of being a young woman living with HIV.The experience of being HIV positive pregnancy begins with the memory of the pregnancy news to be a defining moment for some women, not acceptance but sometimes desired and even planned; They live with the possibility of transmitting the virus to their children, which causes fear and insecurity, but they know that the correct use of medication and their faith and belief in God strengthen the hope that child will born healthy and even healed. The interpretive understanding unveiled the sense of being present in the world in its existentiality, showing their movement in daily life, experiences and diverse feelings of being in the world with others, taking over from protagonist role of their lives, showing up the double factuality: being young and pregnant women carrying the HIV virus. It shows that sometimes did not want to be pregnant but well accept this current situation experiencing alternating feelings. In the movement their existance, they experience their past and they know no other way go, so they go ahead, relating to their partners, family, school and community, taking the impersonal identity, it shows how all pregnant and they do not reveal they have the virus. Living with-others, the fear of being rejected for being HIV positive, maintaining the anonymity of their HIV status. Design your future, that it was open to the possibilities of life like any other young woman did not have HIV positive, but with peculiarities that having HIV brings. Once having knowledge about the disease and knowig the benefits of treatment, do not feel sick, despite reporting the unpleasant effects of antiretrovirals.

The HIV and AIDS pandemic is arguably the greatest threat facing the world today. The pandemic has a far-reaching impact on society, including the workplace. The effect in the workplace is observed in various areas including a reduction in certain skills levels, mortality and declining job performance of employees living with HIV or AIDS. In addition, the fear of discrimination and stigmatisation prevents infected employees from disclosing their HIV status, thus driving the pandemic underground. Despite the potential negative impact that is looming, many employers still do not have any workplace support programmes in place to manage HIV and AIDS in their organisations. However, some employers have implemented workplace support programmes. This research thus explored the influence of workplace support programmes on the job performance of employees that were living with HIV or AIDS. The findings suggest that job performance is positively influenced where workplace support programmes have been implemented. / Industrial and Organisational Psychology / M.Comm. (Industrial and Organisational Psychology)

<p>The devastation caused by the Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS) is having a major impact on both the social and economic environment in South Africa. HIV/AIDS hits at the core of the businesses structure - the bottom line. In the absence of a cure for the disease or an effective vaccine, the challenge for all the stakeholders is how to successfully contain and limit the impact of the disease. Intervention programmes such as awareness, knowledge sharing and sero-prevailance testing have the potential to limit HIV/AIDS infections and reduce high-risk behaviours. Whilst education and awareness programmes have been relatively successful in highlighting the dangers of HIV infection, perception, attitudes and behaviours of employees towards HIV/AIDS have dampened voluntary HIV screening initiatives. Many South African organisations have commendable HIV/AIDS education and awareness programmes, however, a concerning fact is that employees are reluctant to avail themselves to voluntary HIV/AIDS testing. Stigmatising attitudes toward persons living with HIV/AIDS may reduce people&rsquo / s willingness to have themselves tested for the Human Immunodeficiency Virus (HIV). This may increase the risk of transmission. It may also lead to increased absenteeism in the workplace, and workdays lost resulting from excessive sick.<br /> <br /> The aim of the study was to establish what the perceptions and attitudes are of employees at different levels of the organisation with regard to HIV/AIDS testing. A further aim was to identify possible reasons for the poor employee response to voluntary HIV/AIDS testing. It was thus important for this research to gauge employee knowledge, attitude and behaviour toward HIV/AIDS in order for organisations to develop strategies for effective HIV/AIDS counselling and testing programmes.<br /> <br /> The data for this study was collected by means of a self report questionnaire. The questionnaire was administered to a sample of employees across all levels of the organisation using the convenient sample approach to identify the respondents. Two hundred and forty six (246) out of a total of 600 questionnaires distributed were returned, making the response rate a credible 41%.<br /> The Statistical Package for Social Science (SPSS) was used to analyse the data obtained from the questionnaire. Both inferential and descriptive statistical approaches were used to analyse the data. The Analyses Of Variance (ANOVA) was used to determine whether differences exist in the perceptions and attitudes of employees at different levels and groupings in the organisation. Additionally post hoc tests (i.e. the Scheffe test) were applied to all comparisons of means after the analysis of variance.<br /> <br /> The findings of this research are important for the role of HIV/AIDS testing and awareness/preventions strategies implemented in South Africa. It provides more insight as to why employees resist HIV/AIDS testing. It can furthermore assist organisations in developing strategies for implementing effective HIV/AIDS awareness and/or prevention programmes. More specifically, the findings identified ways in which organisations can redesign their intervention programmes so as to encourage a greater number of employees to submit to voluntary HIV/AIDS testing.</p>

A infecção pelo HIV/aids no mundo atinge, desproporcionalmente, determinados grupos sociais, dentre eles a população privada de liberdade. Mediante o impacto da epidemia no âmbito carcerário, organismos internacionais orientam a adoção de estratégias de cuidado, pautadas em evidências científicas, o que determina o impacto positivo no controle do agravo nas prisões. Este estudo objetivou identificar e analisar as evidências científicas disponíveis na literatura sobre a assistência prestada às pessoas que vivem com HIV/aids (PVHA) no âmbito prisional. Trata-se de uma Revisão Integrativa da Literatura, tendo a prática baseada em evidências (PBE) como referencial teórico. No que se refere às etapas de desenvolvimento da revisão integrativa, procedeu-se à seleção dos estudos, por meio da utilização de descritores controlados e palavras-chaves junto às bases de dados LILACS, PUBMED, CINAHL e Web of Science. Dos 894 estudos recuperados, após leitura de forma independente por duas pesquisadoras, derivou-se uma amostra final de 15 estudos. Houve predomínio de pesquisas realizadas nos Estados Unidos, com população masculina, indivíduos afrodescendentes e com história pregressa de mais de um encarceramento ao longo da vida. A população abordada se encontrava em situação de privação de liberdade, contudo, em processo de transição para a comunidade. De modo geral, as estratégias de cuidado prestadas às PVHA em situação de encarceramento, enfocaram a coordenação e a transição para a comunidade, mediante estratégias de gestão de caso com referência e vínculo para serviços de saúde e sociais, planejamento de alta, tratamento de substituição com a utilização de metadona para dependentes químicos e a Terapia Antirretroviral Diretamente Administrada (DAART) para grupos com baixa adesão ao tratamento, em especial os usuários de drogas. Há que se ressaltarem as investiduras na identificação, sensibilização e engajamento de outros atores-chave, com destaque para egressos do sistema prisional visando a implementação de estratégias educativas, assistenciais e de suporte por pares, bem como a identificação, tentativa de reestabelecimento e fortalecimento de vinculo com a rede de suporte social dos indivíduos privados de liberdade em transição para a comunidade. Destaca-se o papel da enfermagem na viabilização das estratégias de gestão do caso, planejamento de alta, sensibilização e capacitação de atores-chave com potencial de engajamento nas atividades envolvendo o cuidado por pares. Concluiu-se que a assistência no âmbito prisional pautou-se no cuidado ampliado, transcendendo a dimensão clínica do manejo do HIV/aids em si, uma vez que incorporou no bojo das ações desenvolvidas, a identificação e integração de ações e serviços sociais e de saúde, valorizando, deste modo, um processo de cuidar pautado na reinserção social dos sujeitos no período que corresponde ao pré e pós-livramento prisional / The HIV infection affects certain social groups disproportionately, among them the prisoners. By the impact of the epidemic in prisonal ambit, international organizations guide to care strategies, conducted by scientific evidence, which determines the positive impact in controlling the disease in prisons. This study aimed to identify and analyze the scientific evidence available in the literature on assistance provided to people living with HIV/AIDS (PLWHA) in the prison context. This is an integrative review of the literature, and evidence-based practice (EBP) as the theoretical reference. With regard to development stages of the integrative review, we proceeded to the selection of studies, using controlled descriptors and keywords together to databases LILACS, PUBMED, CINAHL and Web of Science. Independently, two investigators read 894 recovered studies and derived a final sample of 15 studies. There was a predominance of researches done in the United States, with male population, Afro-descendant and individuals with a history of more than one life-long imprisonment. The covered population was in a situation of deprivation of liberty. However, they were in transition process to the community again. Generally, the care strategies provided to PLWHA in incarceration situation, focused on the coordination and the transition to the community, through case management strategies with reference and link to health and social services, discharge planning, substitution treatment with the use of methadone for drug addicts and the Directly Administered Antiretroviral Therapy (DAART) for groups with low adherence to treatment, particularly drug users. We have to highlight the investitures in identification, awareness and engagement of other key actors, especially former convicts, aiming the educational strategies implementation, care and support by peers, as well as the identification, attempt to re-establishment and strengthening of bonds with the social support network of private individuals of freedom in transition to the community. Besides, it is important to point the nursing role in the feasibility of case management strategies, discharge planning, sensitization and training of key actors with potential engagement in activities involving peer care. In conclusion, the assistance in the prison context was characterized in the extended care, transcending the clinical dimension of the management of HIV/AIDS itself. It is explained once it had incorporated in the core of the actions taken, the identification and integration of actions and social services and health, valuing, thus, a process of care founded on the social reintegration of the subjects in the period corresponding to the pre and post-prison

A magnitude da epidemia da aids e os desafios em garantir uma rede de atenção que atenda às necessidades das pessoas que vivem com HIV/AIDS justificam a realização do presente estudo, que tem por objetivos: contextualizar a trajetória em busca por cuidados de uma mulher que vive com HIV/AIDS e discutir os nós críticos da integralidade neste percurso. Trata-se de um estudo de caso, qualitativo, exploratório, na perspectiva teórico-conceitual da Integralidade. Utilizou-se a História de Vida Focal e o Itinerário Terapêutico. Para análise dos resultados, utilizou-se análise de discurso proposta por Fiorin. Identificou-se neste percurso que os desafios de conviver com o HIV consistiram em: lidar com o risco da transmissão vertical; conviver com o medo de ter o diagnóstico revelado; e conciliar a rotina de vida com a manutenção da terapia antirretroviral. As fragilidades da integralidade neste percurso consistiram em: predominante visão biológica do adoecimento na Atenção Básica; falta de articulação entre UBS, SAE-DST/AIDS e maternidade; falta de fluxos estruturados para a assistência da mulher com HIV na maternidade; e a invisibilidade do trabalho da enfermeira. Como potencialidades da integralidade: as Redes de Sustentação (família e amiga) e Apoio (trabalho, estudo, igreja e alguns profissionais de saúde); e a organização dos serviços ao favorecer acessibilidade à usuária no sistema de serviços de saúde. Concluiu-se que a articulação dos serviços ainda se encontra fragilizada e que está no usuário a centralidade da busca por cuidados, sendo ele e sua família, elos integradores entre os diferentes serviços assistenciais de saúde. Apontou-se a necessária implementação de Linhas de Cuidado na Atenção em HIV/AIDS, a fim de buscar integralidade na organização dos fluxos assistenciais. / The magnitude of the AIDS epidemic and the need for a network of comprehensive care to people living with HIV/AIDS justify the conduct of this study. The study aims were: to contextualize the trajectory in search for care of a woman living with HIV/AIDS and to discuss the critical points of the Comprehensiveness in this trajectory. This was a case-study, qualitative, exploratory, with the theoretical-conceptual of the Comprehensiveness. The method used was the Focused Life History and the Therapeutic Itinerary. The data were analyzed using the Fiorins Technical Discourse. The study identified that there are challenges of living with HIV: afraid of the risk of vertical transmission during pregnancy; to omit the diagnosis of HIV for afraid of prejudice and social isolation; and to reconcile the routine of study, work, care for her daughter and her mother, with the need to remain adhered to antiretroviral therapy. The problems of the Comprehensiveness in this trajectory were: predominantly biological view of illness in Primary Health Care; lack of articulation between Basic Health Units, Reference Units on HIV/AIDS and maternity hospital; lack of structured flows for the assistance of women with HIV in maternity hospital; and invisibility of the nurses work. As potentials Comprehensiveness: networks of support (family, friend, some health workers, church, work and study) and the organization of services to facilitate user access to the system of health services. It was concluded that the articulation of the services is still fragile and that the search for care has centrality in the user of health services. Furthermore, the study concluded that is the user of health services and her family that make link in the network of health services. The study indicated the necessary implementation of Lines of Care in HIV/AIDS Attention, to get Comprehensiveness in the organization of care flows.

Made available in DSpace on 2016-04-28T18:22:38Z (GMT). No. of bitstreams: 1 Vanessa Medina.pdf: 2412967 bytes, checksum: fd442f9d22e56808ca1548cfb5d76964 (MD5) Previous issue date: 2013-02-22 / some authors suggest that patients with acquired immune deficiency syndrome (AIDS) show vocal production disturbances, but there are few reports concerned on voice quality description. Objective: to evaluate the voice quality of subjects with AIDS from a phonetic perspective. Methodology: this study took place at the Institute of Infectology Emílio Ribas and has been properly approved by its ethical committee. 29 subjects were divided into two groups (group 1: research, group 2: reference). Group 1 was composed by 20 subjects with AIDS, 10 male and 10 female, all of them with metabolic alterations (Dyslipidemia) and under antiretroviral therapy. Group 2 was composed of 9 subjects, 5 female and 4 male, all of them with metabolic alterations (Dyslipidemia), without AIDS. The audio samples were recorded and submitted to auditory (Vocal Profile Analysis Scheme for Brazilian Portuguese) and acoustic analysis (ExpressionEvaluator Script running in PRAAT v.10 software). The auditory and acoustic data underwent multivariate statistic analysis (software XLStat). Results: Group 1 (AIDS) revealed predominance of the vocal tract (retracted tongue body, lowered tongue body and pharyngeal constriction), muscular tension (vocal tract hyperfunction) and phonatory settings (creaky voice, harsh voice associated to whisper), differing by gender. From the acoustic point of view, the discriminator power of the acoustic measures was decreased when compared to perceptual descriptions. From the perceptual point of view the period of antiretroviral treatment revealed a relation with voice quality settings. Conclusion: the phonetic approach of voice quality in a group of subjects with AIDS revealed voice quality settings related to pharyngeal constriction and retracted tongue body. From an acoustic perspective, the acoustic measures revealed relevance for the description of the male population with AIDS. The integrated analysis of perceptual and acoustic data revealed correlation between vocal tract, tension and phonatory settings and LTAS long term spectrogram, spectral slope and fundamental frequency (f0) measures. The descriptions of voice quality settings, from the perceptual perspective, were relevant to characterize the voice quality of the studied group, as well as for revealing the association with the duration of antiretroviral therapy / apesar de alguns estudos sugerirem que pacientes com a Síndrome da Imunodeficiência Adquirida (SIDA) apresentam alterações nas estruturas envolvidas na produção vocal, não há relatos de descrições de qualidade vocal neste grupo. Objetivo: avaliar, do ponto de vista fonético, a qualidade vocal de indivíduos portadores da Síndrome da Imunodeficiência Adquirida (AIDS), por meio da descrição de correlatos acústicos e perceptivos. Metodologia: o estudo foi realizado no instituto de infectologia Emílio Ribas, com aprovação do comitê de ética. O grupo estudado constou de 29 indivíduos, sendo divididos em dois grupos (grupo pesquisa e grupo referência). O grupo de pesquisa foi constituído por 20 indivíduos portadores de SIDA, 10 homens e 10 mulheres com presença de alterações metabólicas (dislipidemia) e uso de medicamento antirretroviral. O grupo controle foi composto por nove indivíduos, cinco mulheres e quatro homens que apresentaram alteração metabólica: dislipidemia sem a presença de SIDA. As amostras de áudio foram coletadas e submetidas a análise perceptivo-auditiva (roteiro VPAS - PB) e acústica (script ExpressionEvaluator aplicável ao software Praat v.10). Os dados perceptivo-auditivos e acústicos foram analisados por meio de análise estatística de natureza multivariada (software XLStat). Resultados: o grupo estudado (SIDA) revelou o predomínio de ajustes do trato vocal (corpo de língua recuado, corpo de língua abaixado e constrição faríngea), ajustes de tensão muscular (hiperfunção de trato vocal) e ajustes fonatórios (voz crepitante, escape de ar associado a voz áspera), diferenciados por gêneros. Do ponto de vista acústico, o valor segregatório das medidas acústicas foi inferior às descrições perceptivas. O tempo de medicação revelou relação com as manifestações de qualidade vocal do ponto de vista perceptivo. Conclusão: do ponto de vista fonético, foram destacados na população com SIDA os ajustes de qualidade vocal de constrição faríngea e de corpo de língua recuado. Do ponto de vista acústico, as informações de medidas acústicas revelaram relevância para descrição da população SIDA do gênero masculino. A análise integrada de dados perceptivos e acústicos revelou a maior correlação de ajustes de trato vocal, de tensão e fonatórios a medidas acústicas de LTAS- espectro de longo termo, declínio espectral e frequência fundamental- f0. As descrições de ajustes de qualidade vocal por meio perceptivo foram relevantes para caracterizar a qualidade vocal do grupo estudado, bem como revelaram associação com o tempo de medicação

Magister Psychologiae - MPsych / Globally, and especially in Sub-Saharan Africa the advent of HIV and AIDS has created new inequalities within already challenged health care systems. Chronic illnesses have often been associated with increased prevalence of psychological symptoms. Both national and international studies have found a strong association between psychiatric morbidity and HIV and AIDS. Furthermore, studies have found that social support contributes to positive adjustment of individuals infected with HIV and provides a buffer against the effects of anxiety. The aim of this study was therefore to examine anxiety and social support in adults diagnosed with HIV or AIDS at a public health clinic in the Western Cape. The objectives in relation to the aim were: (1) To determine the prevalence of anxiety in adults diagnosed with HIV or AIDS. (2) To determine the degree of social support, as a component of quality of life,in adults diagnosed with HIV or AIDS. (3) To examine the relationship between anxiety and social support in adults diagnosed with HIV or AIDS. The broad theoretical framework that guides this study is the bio-psycho-social model. A cross-sectional design was used in which 70 participants were recruited using a purposive sampling method. Participants were assessed using well-validated self-administered questionnaires: Hospital Anxiety and Depression Scale(HADS) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 17.1. Correlational and inferential statistics were conducted. The findings of this study indicated that participants in this study had higher levels of anxiety (28%) when compared to the general population (15.8%). Participants in this study, indicated a 59% enjoyment and satisfaction with social support, which indicates satisfaction with social support some of the time. There was however no significant relationship between anxiety and social support in this study. HIV intervention efforts should include screening HIV positive individuals for the presence of psychiatric symptoms. Interventions should also include encouraging HIV positive individuals to maintain and expand their social networks.

Magister Public Health - MPH / The reproductive health of women is hugely dependent on the involvement of their male partners. Men also serve as gatekeepers to women’s access to reproductive health services. Male involvement is an important recommendation for the Prevention of Mother-to-Child Transmission of HIV (PMTCT) program as their participation in antenatal care and HIV testing has been found to decrease infant HIV infection and increase HIV free survival. Male involvement is not just about promoting men to accompany their partners to antenatal clinic, but for men to provide supportive roles in their families, and also to bring men into HIV preventive and care services. Male involvement in PMTCT is defined as the fathers’ active involvement in attending antenatal care services and HIV testing during the antenatal period as well as the couple’s acceptance of PMTCT if the mother is found to be HIV positive. Men are traditionally not directly involved in their partner’s health in many sub-Saharan countries, although they most often make decisions about use of services. They may provide financial support but attending health services with their partner is not seen as part of the male’s role. There are therefore huge challenges in efforts to get men involved in reproductive health services and there is a need to better understand how to promote male involvement in different settings. Male involvement in PMTCT was adopted by the Zambian Government in 1999 but not much is known on how best to initiate and develop male involvement in their partner’s health.

Estudou-se a experiência de mulheres vivendo com HIV e aids também conviverem com situações de violência por parceiro íntimo, e as repercussões destes entrecruzamentos para o cuidado de sua saúde. Tomamos como referência o conceito de vulnerabilidade já formulado para a AIDS e retrabalhado especificamente para as questões de gênero, permitindo explorar o conceito nas situações de violência doméstica contra as mulheres. Partiu-se do pressuposto que os contextos do HIV/Aids podem gerar situações de violência de mulheres soropositivas e que as representações amorosas, o ideal de conjugalidade e de família podem influenciar no impacto do cuidado da saúde das mulheres. Foram realizadas 20 entrevistas em profundidade com mulheres em acompanhamento do HIV/Aids, inseridas nos Serviços de Saúde da Rede Especializada em DST/Aids da cidade de São Paulo, na modalidade história de vida. Encontraram-se diversos contextos da vulnerabilidade, denominada de gênero, nas narrativas produzidas, na infância, adolescência e fase adulta, reforçando padrões hegemônicos de gênero ao longo dos diferentes ciclos de vida dessas mulheres. O estudo aponta que as experiências do adoecimento na revelação do diagnóstico é o elemento disparador de medos e sofrimentos em decorrência da reação dos parceiros e a das preocupações com os filhos. O diagnóstico do HIV é o momento não só do contato com a doença, mas de desvelar ou reconhecer situações de violência. É a partir das concepções e contextos de vida que as mulheres identificam o modo de se situarem no enfrentamento do HIV e da violência. O cuidado da saúde foi abordado tanto como cuidado de si, quanto na relação com os serviços de saúde, o que mostrou a grande preocupação representada pelas dificuldades que, em função de suas condições de portadoras do HIV, essas mulheres viam para se manterem na condição tradicional de cuidadoras, dentro das referências do padrão social de gênero, quer em torno de seus adoecimentos e expectativas de vida futura, quer para com os filhos. Tais preocupações surgem como justificativas da manutenção da família diante de parceiros violentos. Embora presente, observou-se que o tema violência não é pauta na atenção à saúde da mulher vivendo com HIV e aids, nos serviços de saúde especializados. A vulnerabilidade de gênero destaca-se pela ênfase na condição materna, em que por ela e para ela as mulheres dão significados às suas vidas, ao adoecimento e ao cuidado. / This work studied the experience of women living with HIV and AIDS also live with situations of violence by their intimate partner and the implications of these intersections for their health care. We took as reference the concept of vulnerability already formulated to AIDS and adapted for gender issues, allowing explore it in situations of domestic violence against women. We started from the assumption that the contexts of HIV / AIDS can lead to situations of domestic violence involving HIV positive women and that the representations of love, the ideal of marital and family can influence on health care of these women. We made 20 in-depth interviews with women living with HIV / AIDS, followed on STD / AIDS reference centers of the Municipality of São Paulo, using living history method. We found in the narratives several contexts of the so called gender vulnerability occurred in childhood, adolescence and adulthood, reinforcing hegemonic gender patterns over the different life cycles of these women. The study shows that the fact of the diagnosis disclosure to be made during an illness is the element that triggers fear and suffering in relation to the reaction of the partners and worries with their children. The time of HIV diagnosis is not only the moment of contact with the disease, but also the time to uncover or recognize situations of violence. It is through conceptions and contexts of life that women identify how to locate themselves in the struggle against HIV and violence. Health care was addressed as much as caring for oneself as well in relation with the health services. This approach showed the great concern about the difficulties perceived by these women in order to keep the condition of traditional caregivers within the references of hegemonic social pattern of gender, either about their illnesses and future life expectations either about children. Such concerns arise as a justification for maintaining the family when there is coexistence with a violent partner. Although present, it was observed that violence is not an issue discussed in health care of women living with HIV and AIDS in specialized health services. The vulnerability of gender of these women is distinguished by an emphasis on maternal condition which gives meaning to their lives, illness and care.

Este estudo consiste em uma análise crítica sobre uma intervenção focada na melhoria da adesão de pessoas vivendo com aids ao tratamento antirretroviral, construída com base nas proposições da psicologia social construcionista, do referencial do Cuidado e do quadro da vulnerabilidade e dos direitos humanos. Essa intervenção foi testada pela primeira vez em um serviço de referência em DST/AIDS do estado de São Paulo, tendo sido conduzida por três profissionais de saúde previamente capacitadas, junto a pacientes em tratamento na instituição. Com o objetivo de descrever essa experiência e de compreender a viabilidade da condução da intervenção no contexto do SUS, por profissionais de diferentes especialidades, as três profissionais que integraram o estudo foram entrevistadas em profundidade, individualmente e em grupo. As entrevistas abordaram as reflexões das participantes sobre o processo de capacitação e a experiência prática na intervenção, incluindo seus relatos sobre os encontros que realizaram com os pacientes como parte da intervenção. Na discussão, enfocamos as principais facilidades e dificuldades encontradas pelas participantes ao longo do processo; as repercussões percebidas para sua atuação profissional e para o tratamento dos pacientes; e os desafios e sugestões levantados para uma futura implantação da intervenção em outros serviços. A proposta de intervenção mostrou-se factível do ponto de vista das profissionais que a conduziram e trouxe importantes reflexões para as práticas na área da assistência às pessoas vivendo com aids, contribuindo para o debate sobre as concepções teóricas e metodológicas que fundamentam as ações voltadas para a melhoria da adesão ao tratamento antirretroviral / This study presents a critical analysis of an intervention that sought to improve adherence of people living with aids to antiretroviral treatment based on the propositions of the social constructionist psychology, the Care reference and the vulnerability and human rights framework. This intervention was tested for the first time in an STD/AIDS reference service in the state of Sao Paulo. It was conducted by three previously trained health workers, along with patients undergoing treatment at the institution. Aiming to describe this experience and to understand the feasibility of the interventions conduction within SUS by workers from different areas, the three health workers who were part of the study were invited to answer to individual and group in-depth interviews. The interviews approached participants considerations regarding interventions training process and practical experience, including their reports about the meetings they held with patients as part of the intervention. In the discussion, we focused on the positive aspects and the main difficulties faced by participants throughout the process; the perceived results concerning their work practice and the patients treatment; and the challenges and suggestions proposed for a future implementation of the intervention in other services. The intervention was considered feasible from the health workers point of view and it brought important considerations about the practice developed to assist people living with aids, contributing to the debate concerning the theoretical and methodological conceptions that underlie the actions directed to improve the adherence to antiretroviral therapy