Over 60% of those living with HIV/AIDS are women, the majority of them in their sexual and reproductive years (UNAIDS, 2006). With antiretroviral (ARV) drugs, most of them are living longer and healthier to engage in sexual and reproductive activities (WHO, 2006). This study explored the sexual and reproductive decisions and experiences of women living with HIV/AIDS (WLWHA) in Abuja, Nigeria. Only those who became pregnant and had a child after being diagnosed with HIV participated in the study. The study was an interview based qualitative research. The design of the interview guide was informed by the PEN-3 Model (Airhihenbuwa, 1995). A combination of purposive and snowball sampling technique was used to select 17 WLWHA aged between 26 and 41. Most of them had limited education, only the 3 of them with post secondary education had professional jobs; the rest are either housewives or petty traders. Most of the women had reduced sexual desire but felt compelled to acquiesce to their husband’s sexual demands out of cultural and religious sense of duty, fear that he would have sex outside marriage and/or beat them. While a few used condoms, most either did not use condom or used it inconsistently. Condoms were used mainly to prevent re-infection with another strain of HIV or to prevent infecting a negative partner. Reason for non use of condom includes reduced sexual pleasure with condoms, belief that condoms are used not for wives and that being on ARV precludes the need to use condom. Often, condom negotiation leads to violence. Most of the women still wanted more children and did not use contraceptives. Among the few who used contraceptives, condoms, hormone injections, intrauterine device (IUD) and tubal ligation are their methods of choice. The women chose to have babies to secure their marriage, fulfill maternal instinct and to “leave something behind”. Their decisions were informed by the belief that ARV would keep them alive, while Prevention of Mother to Child Transmission (PMCTC) programs would prevent infection to their babies. To conceive, they had unprotected sex during ovulation. Two serodiscordant couples used syringes to inseminate. Most of them had experienced obstetric challenges including infertility, miscarriages, preterm births, and infant deaths. Most of the women bottle-fed to prevent infecting their babies, however they were under tremendous pressure to breastfeed due to the cultural value attached to breastfeeding. Women living with HIV/AIDS in Abuja Nigeria, had unmet sexual and reproductive health needs. Their sexual and reproductive decisions were influenced by their individual circumstances, including their level of education, poverty, cultural and family influences, partner’s HIV status, stigma and discrimination, and access to PMTCT and ARV programs. To meet the sexual and reproductive health needs of WLWHA, program planners and policy makers should take these factors into consideration and ensure that programs are comprehensive and integrated.

Stigma and discrimination (SAD) attached to Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been recognised as a major obstacle to HIV prevention, treatment, care and support throughout the world. SAD is more devastating when it occurs in health care settings where it is least expected. Health care providers (HCPs) are supposed to provide physical, social and psychological support to people living with HIV (PLWHA) but HIV and AIDS-related SAD has been extensively documented among the HCPs. Different studies have pointed out that there are three major actionable causes of HIV-related SAD in health care settings. These are lack of awareness among HCPs, fear of casual contacts and associating the SAD to immoral behaviour. The main objective of the current study is to determine the magnitude of HIV and AIDS-related SAD and its associated factors in hospitals and then to propose appropriate SAD reduction-intervention strategy in the health care settings. The study employed pre-test-post-test design with non-equivalent control group. Two paradigms were used in this study including quantitative and qualitative approaches. The sampling method for the quantitative part of the study was probability sampling in which the respondents were randomly selected using stratified sampling technique. The study was able to determine the magnitude of HIV and AIDS-related SAD among the HCPs. Moreover, the study has identified the factors that are attributed to the prevalence of SAD in the hospitals. The major factors identified for causing the SAD in the hospitals were sex, age, work experience, low level of knowledge, negative attitudes and percieved risk of HIV infection of some HCPs toward the PLWHA. The intervention made on the respondents in the treatment group was able to reduce the overall prevalence of the SAD among the HCPs. The study suggests that to reduce the SAD, HIV and AIDS-related trainings before and after graduation is critical to improve the knowledge, attitudes and practices of the HCPs. Besides, ensuring the availability of the protective supplies in hospitals is crucial in reducing the fear of HIV infection among the HCPs while providing care for HIV positive patients. Effective implementation of the hospital policies, strategies, guidelines and protocols along with good institutional support is also vital in creating safe and user-friendly hospitals for PLWHA. / Health Studies

Submitted by Lívia Bertazzo Sacilotto (livia.bsacilotto@gmail.com) on 2017-03-08T06:52:01Z No. of bitstreams: 1 sacilotto_lb_me_bt.pdf: 2686215 bytes, checksum: b3f919111b6e0a1f81fe1d0c5ae28c47 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2017-03-13T14:03:44Z (GMT) No. of bitstreams: 1 sacilotto_lb_me_bt.pdf: 2686215 bytes, checksum: b3f919111b6e0a1f81fe1d0c5ae28c47 (MD5) / Made available in DSpace on 2017-03-13T14:03:44Z (GMT). No. of bitstreams: 1 sacilotto_lb_me_bt.pdf: 2686215 bytes, checksum: b3f919111b6e0a1f81fe1d0c5ae28c47 (MD5) Previous issue date: 2017-02-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A lipodistrofia associada ao HIV (LAHIV) é caracterizada pela redistribuição de gordura corporal, sendo uma das consequências da introdução da terapia antirretroviral (TARV) e relacionada ao aumento do risco para o desenvolvimento de doenças cardiovasculares. Seu diagnóstico é subjetivo e classificado em três tipos, de acordo com a região corporal em que há perda e/ou acúmulo de gordura, a saber, lipoatrofia, lipohipertrofia e lipodistrofia mista, acompanhada ou não de alterações metabólicas. O objetivo do presente trabalho foi verificar a associação dos diferentes subtipos de LAHIV em pessoas vivendo com HIV/aids com os componentes da síndrome metabólica e composição corporal. Foram avaliados dados clínicos, imunológicos, metabólicos, antropométricos e composição corporal de 40 pessoas vivendo com HIV/aids em acompanhamento ambulatorial e uso regular de TARV, de ambos os sexos, com diagnóstico clínico de LAHIV. Os principais achados do estudo foram maiores alterações de perfil lipídico entre as mulheres. Não houve diferença estatística entre os subtipos para o perfil metabólico. As principais alterações foram identificadas no grupo lipohipertrofia, que tiveram maiores valores de porcentual de gordura corporal total, área de gordura visceral (AGV), índice de massa corpórea (IMC) e circunferências abdominal e do pescoço em relação aos outros dois grupos. A massa magra foi superior apenas em relação ao grupo lipodistrofia mista e a massa de gordura em relação ao grupo lipoatrofia. O IMC mostrou forte correlação com a AGV. Em conclusão, o presente estudo mostrou que apesar destes indivíduos apresentarem alterações de indicadores antropométricos importantes relacionadas ao diagnóstico de LAHIV, não são acompanhadas de alterações metabólicas. Estratégias como mudança comportamental, identificação, prevenção e tratamento de doenças crônicas são importantes para reduzir os riscos para o desenvolvimento de doenças cardiovasculares. / HIV-associated lipodystrophy syndrome (HALS) is characterized by body fat redistribution as a consequence of the antiretroviral therapy (ART) introduction, associated to an increased risk of cardiovascular disease development. Subjective diagnoses, classified between tree subtypes according to the body region on which fat is lost and/or accumulated, named lipoatrophy, lipohypertrophy and mixed lipodystrophy, are possibly accompanied of metabolic alterations. The objetive of the present study was to verify the association between HALS different subtypes, in people living with HIV/aids, and the components of metabolic syndrome and body composition. Forty PLHA, with clinical diagnosis of HALS and from both genders, were assessed. They performed ambulatorial follow up and used ART regularly. The main findings were greater lipid profile alterations among women, while no metabolic profile differences were found between the HALS subtypes. The lipohypertrophy group showed major alterations, with higher values for total body fat percent, visceral fat area (VFA), body mass index (BMI), abdominal and neck circumferences when compared to the other groups. Lean body mass was superior only compared to the mixed lipodystrophy group, and fat mass only compared to the lipoatrophy group. BMI showed strong correlation to the VFA. In conclusion, despite anthropometric alterations related to HALS these individuals present, those are not accompanied by metabolic alterations. Strategies, as behavioral changes and disorders prevention are important to decrease the risk of cardiovascular disease development.

<p>Peripheral neuropathy (PN) is a common neurological complication occurring in the asymptomatic and symptomatic stages of human immune deficiency virus (HIV) infection. The pain and other symptoms caused by PN can impair functional ability and limit physical activity that could affect quality of life (QoL). Additionally, studies done on quality of life of people living with HIV/AIDS have shown that, HIV-related neurological syndromes, including PN, significantly reduce QoL. The aim of this study was to determine the prevalence of peripheral neuropathy amongst and the quality of life of adults living with HIV/AIDS attending the out-patient clinic at Rutongo Hospital in Rulindo District in Rwanda.</p>

<p>This was a descriptive qualitative study. Eight people living with HIV, four of which had disclosed their status, were individually interviewed. Two focus group discussions (each comprising 6 participants) were also conducted with health workers. The study was based at an urban TB hospital which is currently providing a range of HIV-related services including HIV Voluntary Counselling and Testing, case management and treatment.</p>

<p>Peripheral neuropathy (PN) is a common neurological complication occurring in the asymptomatic and symptomatic stages of human immune deficiency virus (HIV) infection. The pain and other symptoms caused by PN can impair functional ability and limit physical activity that could affect quality of life (QoL). Additionally, studies done on quality of life of people living with HIV/AIDS have shown that, HIV-related neurological syndromes, including PN, significantly reduce QoL. The aim of this study was to determine the prevalence of peripheral neuropathy amongst and the quality of life of adults living with HIV/AIDS attending the out-patient clinic at Rutongo Hospital in Rulindo District in Rwanda.</p>

<p>This was a descriptive qualitative study. Eight people living with HIV, four of which had disclosed their status, were individually interviewed. Two focus group discussions (each comprising 6 participants) were also conducted with health workers. The study was based at an urban TB hospital which is currently providing a range of HIV-related services including HIV Voluntary Counselling and Testing, case management and treatment.</p>

Pour les personnes vivant avec le VIH (PVVIH), leur maladie constitue une expérience subjective susceptible d’influer sur leur qualité de vie (QV). Cette thèse explore l’influence de la perception que les PVVIH ont de leur maladie, ainsi que des stratégies de coping, l’auto-efficacité, les stratégies de contrôle en matière de santé, le soutien social et l’ajustement des buts sur la QV et troubles anxio-dépressifs. Une approche comparative entre des personnes françaises avec et sans VIH d’une part et avec des PVVIH françaises et brésiliennes d’autre part a été entreprise. Les participants (France : PVVIH n=206 et sans VIH n=220 ; Brésil : PVVIH n=128) ont répondu à un ensemble de questionnaires évaluant chacune de ces variables. Tout d’abord les résultats ont conforté la plus faible QV et des troubles anxio-dépressifs plus élevés chez les PVVIH comparativement aux personnes sans VIH, mesurés ici à l’aide d’odds ratio. Par ailleurs, les modèles d’équations structurelles ont permis de vérifier l’influence de la perception de la maladie, de l’auto-efficacité et de l’ajustement aux buts des PVVIH françaises sur la QV. Enfin, les régressions hiérarchiques ont montré que la perception de la maladie, l’auto-efficacité et le soutien social étaient des variables prédictives de la QV tant en France qu’au Brésil. La discussion souligne la nécessité de prendre en considération la perception de la maladie dans la compréhension de l’ajustement des PVVIH / For people living with HIV/AIDS (PLWHA), their illness is a subjective experience that may affect their quality of life (QOL). This thesis explores the influence of the perception that PLWHA have of their illness, as well as coping strategies, self-efficacy, health engagement control strategies, social support and goal adjustment on QV and anxiety/depression. A comparative approach between French with/without HIV and PLWHA in France and Brazil was undertaken. Participants (France: PLWHA n=206, without HIV n=220; Brazil: PLWHA n=128) completed questionnaires assessing each of these variables. The results confirm, with the use of odds ratios, that PLWHA have a lower QOL and more anxiety/depression when compared to people without HIV. Moreover, structural equation models were used to verify the influence of illness perception, self-efficacy and goal adjustment on QOL of French PLWHA. Finally, hierarchical regressions showed that illness perception, self-efficacy and social support were predictive of QOL both in France and Brazil. The discussion highlights the need to take into account illness perception to understand the adjustment of PLWHA

Orientador: Paulo Câmara Marques Pereira / Resumo: A lipodistrofia associada ao HIV (LAHIV) é caracterizada pela redistribuição de gordura corporal, sendo uma das consequências da introdução da terapia antirretroviral (TARV) e relacionada ao aumento do risco para o desenvolvimento de doenças cardiovasculares. Seu diagnóstico é subjetivo e classificado em três tipos, de acordo com a região corporal em que há perda e/ou acúmulo de gordura, a saber, lipoatrofia, lipohipertrofia e lipodistrofia mista, acompanhada ou não de alterações metabólicas. O objetivo do presente trabalho foi verificar a associação dos diferentes subtipos de LAHIV em pessoas vivendo com HIV/aids com os componentes da síndrome metabólica e composição corporal. Foram avaliados dados clínicos, imunológicos, metabólicos, antropométricos e composição corporal de 40 pessoas vivendo com HIV/aids em acompanhamento ambulatorial e uso regular de TARV, de ambos os sexos, com diagnóstico clínico de LAHIV. Os principais achados do estudo foram maiores alterações de perfil lipídico entre as mulheres. Não houve diferença estatística entre os subtipos para o perfil metabólico. As principais alterações foram identificadas no grupo lipohipertrofia, que tiveram maiores valores de porcentual de gordura corporal total, área de gordura visceral (AGV), índice de massa corpórea (IMC) e circunferências abdominal e do pescoço em relação aos outros dois grupos. A massa magra foi superior apenas em relação ao grupo lipodistrofia mista e a massa de gordura em relação ao grupo lipoatrof... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Magister Scientiae (Physiotherapy) - MSc(Physio) / Peripheral neuropathy (PN) is a common neurological complication occurring in the asymptomatic and symptomatic stages of human immune deficiency virus (HIV) infection. The pain and other symptoms caused by PN can impair functional ability and limit physical activity that could affect quality of life (QoL). Additionally, studies done on quality of life of people living with HIV/AIDS have shown that, HIV-related neurological syndromes, including PN, significantly reduce QoL. The aim of this study was to determine the prevalence of peripheral neuropathy amongst and the quality of life of adults living with HIV/AIDS attending the out-patient clinic at Rutongo Hospital in Rulindo District in Rwanda. / South Africa