Made available in DSpace on 2014-06-11T19:27:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-27Bitstream added on 2014-06-13T18:56:28Z : No. of bitstreams: 1 000739643.pdf: 2791734 bytes, checksum: aae95ccda629ae14f8244d4bcc04e29a (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O conhecimento dos fatores que influenciam a qualidade de vida e condição de saúde bucal das pessoas que vivem com HIV/AIDS é importante para o planejamento das ações nos serviços de saúde. O presente estudo teve como objetivo verificar os fatores que influenciam na qualidade de vida e na condição de saúde bucal das pessoas que vivem com HIV/AIDS. Foi realizado um estudo transversal com abordagem quantitativa, desenvolvido em 2012, com uma amostra de 177 HIV+ que fazem acompanhamento no Centro de referência DST/AIDS, de Vitória, Espírito Santo. Utilizou-se um questionário estruturado para avaliar as condições sociodemográficas, aspectos relacionados ao HIV, hábitos, utilização e satisfação com serviço de saúde. A qualidade de vida foi analisada por meio do instrumento HAT-QoL, com 42 itens divididos em nove domínios: Atividade Geral, Atividade Sexual, Preocupações com sigilo, Preocupação com a Saúde, Preocupação Financeira, Conscientização sobre o HIV, Satisfação com a Vida, Questões relativas à medicação e Confiança no médico. Os dados de saúde bucal foram coletados por meio do índice de CPO-D, uso e necessidade de prótese e Índice Periodontal Comunitário, de acordo com os critérios propostos pela Organização Mundial de Saúde, por um pesquisador calibrado (kappa>0,81). Foram realizadas análises descritivas, bivariadas, regressão linear e logística múltipla, considerando nível de significância de 0,05 e intervalo de confiança de 95%. Os dados foram avaliados no programa SPSS, versão 17.0. Na análise da qualidade de vida o domínio do HAT-QoL com menor média foi Preocupação financeira (39,4), seguido de Preocupação com sigilo (43,2), Atividades sexuais (55,2) e Preocupação com a saúde (62,88). Houve associação... / The importance to know the factors that influence the quality of life and oral health of individuals with HIV/AIDS is focused on the planning of actions on health services. The present study had the aim to verify the factors that influence the quality of life and oral health of individuals with HIV/AIDS. It was realized a cross-sectional study with quantitative approaching, developed in 2012 with 177 HIV+ that were attended on the AIDS Reference Public Centre, in Vitória, Espírito Santo State, Brazil. It was used a structured questionnaire to evaluate social and demographic status, aspects related to HIV, habits, the use and satisfaction with health service. The quality of life was analyzed using the HAT-QoL instrument with 43 items divided in 9 domains: General Activity, Sexual Life, Worries with Secrecy, Worries with Health, Financial Worries, Awareness about HIV, Life Satisfaction, Questions related to medicine and trust in the doctor. The oral health data were collected using the DMF-T Index, the use and necessity of prosthesis and Periodontal Index, according to World Health Organization’s criteria, performed by a trained researcher (Kappa>0.081). Descriptive and bivariate analysis, linear and multiple logistic regression models were applied, adopting 0.05 of significance level. Data were evaluated by SPSS software, version 17.0. About quality of life, the domain of HAT-QoL questionnaire that showed the lowest average was financial worries (39.4), followed by worries with secrecy (43.2), sexual life (55.2) and worries with health (62.88). There was association between the worst score o quality of life and the follow variables: have no registered work (p<0.001), to be black or mixed (p=0.045), to consume alcoholic drinks (p=0.041), not to use antiretroviral therapy...

Orientador: Flávia Heloísa dos Santos / Resumo: A estimativa de pessoas vivendo com HIV/AIDS é de 734mil, a maior concentração de casos é na população com idade entre 25 e 39 anos desde 1980 até junho de 2014. Devido à supressão do sistema imune e queda do número de células de defesa CD4, o paciente pode ser acometido por alterações no funcionamento fisiológico e por doenças oportunistas, incluindo as manifestações neurológicas, como os transtornos neurocognitivos associados ao HIV (HAND; HIV-associated neurocognitive disorders). Pessoas com HAND geralmente apresentam comprometimento da aprendizagem e das habilidades motoras, alterações de humor e déficits nos domínios cognitivos, os quais são classificados conforme a gravidade como leve, moderada ou grave e podem comprometer a adesão ao tratamento com antirretrovirais e à qualidade de vida. Contudo, a relação entre estas variáveis, cruciais para a sobrevivência do paciente, não se encontra estabelecida, sendo o envelhecimento uma das variáveis a esclarecer. Objetivou-se traduzir e adaptar o instrumento Simplified Medication Adherence Questionnaire (SMAQ); avaliar e comparar diferenças do desempenho cognitivo entre dois grupos em função da idade e identificar relações entre Qualidade de Vida e adesão à Terapia Antirretroviral combinada. Foram avaliados 50 voluntários com idades entre 21 e 58 anos e divididos em dois grupos (jovens e maduros) que participaram do protocolo completo, composto por testes cognitivos (domínios cognitivos: atenção, memória, linguagem e inteligênc... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In Brazil, 734,000 people are currently estimated to live with HIV/AIDS, and most cases concentrate in the 25 to 39 year-old population bron from 1980 to June 2014. Due to supression of immune system and fall in the number of CID4 T immune cells, a patient may be affected by changes in physiologic functioning and opportunistic diseases, including neurological manifestations such as HIV-associated neurocognitive disorders (HAND). People with HAND usually present learning and motor skills impairments, mood changes, and deficits in cognitive domains, which area classified according to gravity as mild, moderate or servere and may compromise adherence to antiretroviral therapy and quality of life. However, the relation between those variables, which are critical to a patien'ts survival, has not been established yet, and aging is a variable to be clarified. The objective of this study was to translate and to adapt the Simplified Medication Adherence Questionnaire (SMAQ) to Brazilian Portuguese; to evaluate and to compare differences in cognitive performance between two groups accoording to age; and to identify and to compare relations between quality of life and adherence to cArt (Combination Antiretroviral Therapy). In this study, 50 volunteers, aged from 21 to 58 years old, were assessed and divided into two groups (young adults and mature). Both groups took part of the full protocoll, composed by cognitive tests (cognitive domains: attention, memory, language, and intelligence) and screening scales for depression, anxiety, use of psychoactive drugs, treatment adherence and quality of life, and socioeconomic status. As a result, significant differences between the groups were found in the following cognitive domains: episodic memory, working memory, language, visuopatial processing and sensory-motor function, which made it possible to observe age influence on the cognitive impairment of people living with HIV / Mestre

Made available in DSpace on 2014-08-20T14:31:28Z (GMT). No. of bitstreams: 1 dissertacao_laura_maria_jorge_santos.pdf: 1428533 bytes, checksum: e3c51067725ef21be5a8179e067d8e11 (MD5) Previous issue date: 2012-02-10 / Toxoplasmosis is a common zoonosis worldwide caused by Toxoplasma gondii, and high infection prevalence in humans and animals. It is usually asymptomatic, however in immunocompromised individuals and in fetuses it may cause severe injury. Wild and domestic felids are the definitive hosts for the parasite, and they shed oocysts in their faeces. Carnivorism, fecal-oral and congenital is the main route of toxoplasmosis transmission. Further studies are needed to investigate the sanity of buffaloes in relation to T. gondii infection, because of the growing demand for buffalo meat and meat products. This work aims to know the prevalence of T. gondii infection in buffaloes and cattle that share the same area in southern Rio Grande do Sul state, and correlate data obtained, including age factor, to identify possible sources of infection. Blood samples were collected by means of jugular venipuncture in 169 buffaloes and 121 beef cattle of different ages, living in a farm in southern Brazil. T. gondii were performed by the indirect fluorescent-antibody (IFA) technique, according to Camargo (1964), using a WAMA Diagnostic® kit. Positive and negative control serum to T. gondii and conjugated Anti-bovine IgG (whole molecule) FITC produced in rabbits, Sigma/F7887 were used. The animals were considered positive from a dilution of 1:64. Significant levels of antibodies to T. gondii were detected in 27.2% of buffaloes and 17.4% of cattle. Statistical difference p≤ 0.05 The presence of cats may also indicate the likelihood of a contaminated environment. Age of animals was significantly associated with seropositivity for toxoplasmosis detected in older buffaloes, due to longer exposure. Buffaloes and cattle are strict herbivores, and high prevalence of T. gondii suggests contamination of the environment by oocysts, featuring horizontal transmission. / A toxoplasmose é uma zoonose causada pelo protozoário Toxoplasma gondii, de ocorrência mundial, com alta prevalência da infecção em seres humanos e animais, geralmente na forma assintomática, entretanto, em indivíduos imunodeprimidos e fetos podem ocorrer lesões severas. Os Felídeos são os hospedeiros definitivos do parasito e eliminam oocistos em suas fezes. A principal via de transmissão da toxoplasmose é carnivorismo, fecal-oral e congênita. Devido à crescente procura pela carne de bubalinos e seus derivados e a já existente pecuária bovina no Rio Grande do Sul, são necessários estudos mais aprofundados para investigar a sanidade destas espécies com relação à infecção por T. gondii. Este trabalho teve como objetivos conhecer a prevalência da infecção por Toxoplasma gondii em bubalinos e bovinos que compartilham a mesma área no sul do Rio Grande do Sul e correlacionar os dados obtidos entre ambas as espécies, incluindo o fator idade, visando identificar possíveis fontes de infecção. Foram coletadas amostras de sangue por punção venosa da jugular em 169 búfalos e 121 bovinos de corte de diferentes idades que convivem em uma propriedade no sul do Brasil. Foram realizados exames sorológicos para T. gondii através da técnica da Reação de Imunofluorecência Indireta (RIFI) segundo Camargo (1964) utilizando o ―kit‖ WAMA Diagnóstica®. Utilizou-se soros controle positivo e negativo para T. gondii previamente conhecidos, assim como conjugado anti-IgG bovina (molécula inteira com FITC, produzido em coelhos, Sigma/F-7887). Os animais foram considerados positivos a partir da diluição 1:64. Níveis significativos de anticorpos para T. gondii foram detectados em 27,2% dos bubalinos e 17,4% dos bovinos. Foi considerada diferença estatística p ≤0,05. A presença dos felídeos pode indicar a possibilidade de um ambiente contaminado. A idade dos bubalinos foi significativamente associada à soropositividade detectada para toxoplasmose devido possivelmente ao maior tempo de exposição, o que não foi constatado nos bovinos. Bubalinos e bovinos são estritamente herbívoros e, a alta prevalência de T. gondii sugere contaminação do meio ambiente com, oocistos caracterizando a transmissão horizontal.

Human papillomaviruses (HPV) are double-stranded, DNA, epitheliotropic viruses that infect skin and mucosal membranes. Over 200 types of HPV have been identified and classified into alpha (α), beta (β), gamma (γ), mu (µ), and nu (ν) genera. HPV in the genus α mainly infect mucosal membranes, cause the majority of the ano-genital cancers, and are widely studied. However, epidemiology of HPV in the other genera, which mainly infect skin, is poorly understood. Few studies have reported the seroprevalence of cutaneous HPV among healthy individuals, and to date, no study has prospectively examined the association between cutaneous HPV seropositivity and development of external genital lesions (EGLs) in men. The objectives of this study were to estimate the seroprevalence of cutaneous HPV types and investigate factors associated with the seropositivity, and evaluate the association between seropositivity to cutaneous HPV types and the risk of development of EGLs. Several studies have reported the seroprevalence of mucosal HPV types (6, 11, 16 and 18) in the 4-valent HPV vaccine among men. However, few studies have reported the seroprevalence of the five additional HPV types (31, 33, 45, 52 and 58) in the recently approved 9-valent HPV (9vHPV) vaccine specifically among men across a broad age range. Baseline data on seroprevalence prior to vaccine introduction and dissemination are needed to establish the effectiveness of vaccines over time. Also, this study estimated the seroprevalence of 9vHPV vaccine types and investigated factors associated with the seropositivity among men residing in Brazil, Mexico, and the United States (U.S.). To estimate the seroprevalence of cutaneous HPV types and 9vHPV vaccine types, 600 men were randomly selected from the HPV Infection in Men (HIM) Study. To examine the association between seropositivity to cutaneous HPV types and development of EGLs, a case-control study of 163 incident EGL cases and 352 EGL-free controls nested in the HIM cohort was conducted. Cases were ascertained through visual inspection at each of up to 10 biannual clinical visits, confirmed through biopsy, and categorized into condyloma, suggestive of condyloma, penile intraepithelial neoplasia (PeIN) and other EGLs. Archived serum specimens were tested for antibodies against 14 cutaneous HPV types, β types (5, 8, 12, 14, 17, 22, 23, 24, 38 and 47), α type 27, γ type 4, µ type1 and ν type 41, and 9vHP types (6, 11, 16, 18, 31, 33, 45, 52 and 58) using a glutathione S-transferase (GST) L1-based multiplex serology assay. Socio-demographic and sexual behavior data were collected through a questionnaire. Binomial proportions were used to estimate seroprevalence, and logistic regression was used to examine factors associated with seropositivity. Overall, seroprevalence of ≥1 cutaneous HPV types was 65.4%, 1≥ β-HPV types was 39.0%, α-HPV 27 was 8.9%, γ-HPV 4 was 30.9%, µ-HPV 1 was 28.6%, and ν-HPV 41was 9.4%. Higher educational attainment was significantly associated with seropositivity to ≥1 cutaneous HPV types (adjusted odds ratio [AOR] 1.75 for ≥16 years of education vs. ≤12 years of education, 95% confidence interval [CI] 1.08-2.83), and seropositivity of ≥1 β-HPV types was significantly associated with increasing age (AOR 1.72 for men aged 31-44 years vs. men aged 18-30 years, 95% CI: 1.12–2.63,). Country of residence, circumcision status, and lifetime number of male anal sex partners were other factors significantly associated with various type-specific cutaneous HPV seropositivity. No statistically significant association was observed between grouped or individual cutaneous HPV seropositivity and the risk of development of EGLs across all pathological diagnoses. The seroprevalence of grouped and individual cutaneous HPV types was similar across different EGL categories and controls, with the most frequent types being ɤ-HPV 4, µ-HPV 1, and β-HPV 8. The seroprevalence of ≥1 9vHPV vaccine types was 28.3%, ≥1 high-risk types was 14.0%, five additional high-risk types was 11.2%, and low-risk types (6/11) was 17.4%. Compared to men with no male anal sex partners, men with ≥2 partners were two times more likely to be seropositive for grouped 9vHPV vaccine types, ≥1 high-risk types and ≥1 low-risk types, in addition to individual HPV types 6, 16, 33, and 58, with AORs ranging from 2.19 to 7.36. Older age, current smoking, and being single were other factors significantly positively associated with different grouped and type-specific seropositivity. In conclusion, our data show that exposure to cutaneous HPV was common in men although different risk factors were independently associated with grouped and type-specific cutaneous HPV seropositivity. It appears that exposure to cutaneous HPV is not likely to increase the risk of EGLs among men. Similarly, exposure to 9vHPV vaccine types was also common in men and seropositivity to 9vHPV vaccine types was positively associated with older age and lifetime number male anal sex partners.

Orientador: Artênio José Isper Garbin / Banca: Rogério Nogueira de Oliveira / Banca: Eliel Soares Orenha / Resumo: Objetivou-se verificar e analisar a ocorrência de atitudes discriminatórias de profissionais de saúde na assistência à saúde de pessoas com HIV/AIDS. Trata-se de uma pesquisa quantiqualitativa com a participação de 68 pessoas com HIV/AIDS provenientes de quatro ONGs/AIDS dos seguintes municípios: Araçatuba-SP, Birigui-SP, Dourados-MS e Uberlândia- MG. Os participantes da pesquisa, após consentimento livre e esclarecido, responderam a questionários auto-administrados contendo perguntas abertas e fechadas abrangendo o tema proposto. Posteriormente, realizaram-se entrevistas semi-estruturadas individuais com 19 indivíduos que haviam vivenciado situações discriminatórias praticadas por profissionais de saúde. Para a análise dos resultados, utilizou-se o programa Epi-info, versão 6.04 (dados quantitativos) e a análise de conteúdo (dados qualitativos). Dentre os 68 participantes da pesquisa, 41,2% afirmaram terem sido discriminados por profissionais de saúde, dos quais 78,6% foram discriminados no serviço público de saúde. Dentre as situações discriminatórias vivenciadas pelos portadores do HIV, em 34,2% estavam envolvidos os profissionais de enfermagem, em 34,2% os cirurgiões-dentistas e em 31,6% os médicos. Por meio dos relatos foi possível observar que as atitudes discriminatórias ocorreram através do atendimento diferenciado, recusa de tratamento ou utilização de medidas extras de biossegurança, tendo ocorrido inclusive em instituições de ensino superior na área da saúde. É necessária a adoção de estratégias para combater a ocorrência de tais atos visando-se a humanização na assistência a saúde de pessoas com HIV/AIDS e a melhoria na qualidade de vida desses pacientes. / Abstract: This study aimed to verify and to analyze the occurrence of discriminatory attitudes of health care workers in the assistance to the health of people living with HIV/AIDS. A quantitativequalitative research was carried out with the participation of 68 HIV-positive people proceeding from four Not Governmental Organizations for AIDS from four brazilian cities. The participants of the research answered the auto-administrate questionnaires that contained open and closed questions including the considered subject. Later, it was carried out face to face semistructuralized interviews with 19 individuals who had been discriminated by health care workers. For the analysis of the data we used the Epi-info, version 6.04 program and the content analysis. Among the sixty-eight participants, 41.2% stated to have been discriminated by health care workers and among these people, 78.6% had been discriminated in the health public service. The discriminatory situations were practiced by nursing professionals (34.2%), dentists (34.2%) and physicians (31.6%). Through the stories it was possible to observe that the discriminatory attitudes occurred by the differentiated attendance, refusal of treatment or by the adoption of extra precautions measures, having also occurred in colleges with courses in health area. The adoption of strategies to fight against the occurrence of such acts is necessary aiming at human assistance to the health of HIV-positive individuals and the improvement in the life quality of these patients. / Mestre

Made available in DSpace on 2014-06-11T19:27:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-12-08Bitstream added on 2014-06-13T19:56:31Z : No. of bitstreams: 1 lelis_rt_me_araca.pdf: 428739 bytes, checksum: f49d55269c9f31b739ebda524307b889 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivou-se verificar e analisar a ocorrência de atitudes discriminatórias de profissionais de saúde na assistência à saúde de pessoas com HIV/AIDS. Trata-se de uma pesquisa quantiqualitativa com a participação de 68 pessoas com HIV/AIDS provenientes de quatro ONGs/AIDS dos seguintes municípios: Araçatuba-SP, Birigui-SP, Dourados-MS e Uberlândia- MG. Os participantes da pesquisa, após consentimento livre e esclarecido, responderam a questionários auto-administrados contendo perguntas abertas e fechadas abrangendo o tema proposto. Posteriormente, realizaram-se entrevistas semi-estruturadas individuais com 19 indivíduos que haviam vivenciado situações discriminatórias praticadas por profissionais de saúde. Para a análise dos resultados, utilizou-se o programa Epi-info, versão 6.04 (dados quantitativos) e a análise de conteúdo (dados qualitativos). Dentre os 68 participantes da pesquisa, 41,2% afirmaram terem sido discriminados por profissionais de saúde, dos quais 78,6% foram discriminados no serviço público de saúde. Dentre as situações discriminatórias vivenciadas pelos portadores do HIV, em 34,2% estavam envolvidos os profissionais de enfermagem, em 34,2% os cirurgiões-dentistas e em 31,6% os médicos. Por meio dos relatos foi possível observar que as atitudes discriminatórias ocorreram através do atendimento diferenciado, recusa de tratamento ou utilização de medidas extras de biossegurança, tendo ocorrido inclusive em instituições de ensino superior na área da saúde. É necessária a adoção de estratégias para combater a ocorrência de tais atos visando-se a humanização na assistência a saúde de pessoas com HIV/AIDS e a melhoria na qualidade de vida desses pacientes. / This study aimed to verify and to analyze the occurrence of discriminatory attitudes of health care workers in the assistance to the health of people living with HIV/AIDS. A quantitativequalitative research was carried out with the participation of 68 HIV-positive people proceeding from four Not Governmental Organizations for AIDS from four brazilian cities. The participants of the research answered the auto-administrate questionnaires that contained open and closed questions including the considered subject. Later, it was carried out face to face semistructuralized interviews with 19 individuals who had been discriminated by health care workers. For the analysis of the data we used the Epi-info, version 6.04 program and the content analysis. Among the sixty-eight participants, 41.2% stated to have been discriminated by health care workers and among these people, 78.6% had been discriminated in the health public service. The discriminatory situations were practiced by nursing professionals (34.2%), dentists (34.2%) and physicians (31.6%). Through the stories it was possible to observe that the discriminatory attitudes occurred by the differentiated attendance, refusal of treatment or by the adoption of extra precautions measures, having also occurred in colleges with courses in health area. The adoption of strategies to fight against the occurrence of such acts is necessary aiming at human assistance to the health of HIV-positive individuals and the improvement in the life quality of these patients.

Le dévoilement de sa séropositivité représente une préoccupation quotidienne des femmes vivant avec le VIH, complexifié par la stigmatisation. L'état des connaissances demeure très fragmenté : les études révèlent des patterns (à qui les femmes dévoilent et à quelle fréquence), les raisons pour dévoiler ou non, les conséquences positives et négatives ainsi que les facteurs liés au dévoilement, limitant une compréhension globale du phénomène. Inspirée de la toile de fond de Parse (1998, 2003), cette présente étude visait à décrire et à mieux comprendre l'expérience du dévoilement, telle que perçue par des femmes vivant avec le VIH nées au Québec. La méthode phénoménologique a été privilégiée afin de recueillir des données auprès de sept participantes, par la tenue d’une entrevue semi structurée. L’analyse des données a reposé sur deux activités de recherche proposées par van Manen (1997), soit la réflexion et l’écriture, permettant d’identifier les sept thèmes suivants : 1) Se respecter tout en considérant les confidents ; 2) Ressentir l’appréhension; 3) Exercer un contrôle pour assurer une protection; 4) S’engager délibérément dans une démarche de révélation-dissimulation; 5) S’exposer au contexte social stigmatisant empreint d’exclusion; 6) Souffrir intérieurement; 7) Bénéficier des retombées positives de sa décision. Ces thèmes ont contribué à la formulation de l’essence du phénomène étudié soit : vivre l’ambivalence d’une démarche paradoxale de révélation-dissimulation, au cœur d’une souffrance profonde intensifiée par la stigmatisation, tout en s’enrichissant des bienfaits recueillis. Il est permis de croire que ces résultats puissent avoir des retombées positives pour guider la pratique infirmière autour du soutien aux femmes dans leur expérience de dévoilement. / Disclosure of seropositivity is a constant concern in women living with HIV; a situation further complicated by social stigma. Knowledge on this topic remains fragmented. Studies show certain patterns –such as to whom and how often women disclose this information–, the reasons for disclosure, the positive and negative consequences as well as the predisposing factors of disclosure, all of which limit the global understanding of this phenomenon. Inspired by Parse’s nursing theory (1998, 2003), the purpose of this study is to describe and gain a better understanding of the experience of disclosing the information of being seropositive as perceived by Quebec-born women living with HIV. The phenomenological method was chosen for data collection from seven participants through a semi-structured interview. Data analysis rested on two research activities suggested by van Manen (1997): reflection and writing, which allowed identification of the following seven themes: 1) Having self-respect while choosing confidants; 2) Feeling apprehension; 3) Exercising control to ensure protection; 4) Deliberately engaging in a process of revealing-concealing; 5) Exposing oneself to stigma and social exclusion; 6) Internal suffering; 7) Benefiting from the positive effects of such a decision. These themes contributed to the formulation of the essence of the phenomenon which can be read as such: Living the ambivalence of a paradoxical process of revealing-concealing, within a profound suffering intensified by stigma, while being enriched by the benefits attained. We believe that these results could have positive effects to guide nursing practice in supporting women during their experience of disclosure.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / RESUMO O surgimento do HIV/aids e o delineamento da epidemia demandaram mudanÃas para a saÃde sexual e reprodutiva de homens e mulheres que (con) vivem com o vÃrus. A sobrevida e a qualidade de vida melhoradas com o aparecimento da terapia antiretroviral combinada colocou em destaque o aspecto de cronicidade da infecÃÃo pelo HIV, delineando possibilidades de relaÃÃes afetivo-sexuais e reprodutivas, mediante esta nova realidade, num panorama complexo que envolve casais soroconcordantes e sorodiscordantes em contextos de vida similares aos nÃo-infectados, num processo de re-significaÃÃo do HIV/aids e de busca pelo controle dessa pandemia. Este estudo teve como objetivo compreender vivÃncias sexuais e reprodutivas de pessoas que (con) vivem com HIV. A Teoria HumanÃstica de Enfermagem de Paterson e Zderad foi utilizada como referencial teÃrico-metodolÃgico. Trata-se de uma pesquisa descritiva com delineamento qualitativo, realizada no ambulatÃrio de infectologia do Hospital-Escola Santo InÃcio, em Juazeiro do Norte-CE. Os sujeitos do estudo foram 16 pessoas que (con) vivem com HIV/aids, 7 homens e 9 mulheres. Os dados foram coletados nos meses de julho a novembro de 2007, por meio de observaÃÃo livre, consulta aos prontuÃrios e entrevista semi-estruturada. Para anÃlise dos depoimentos foi adotada a tÃcnica de anÃlise de conteÃdo, de onde emergiram trÃs temÃticas: 1. VivÃncia Sexual; 2. VivÃncia Reprodutiva; e 3. VivÃncia da Conjugalidade. Nestas temÃticas, foram identificadas onze sub-temÃticas: 1. O preservativo nas relaÃÃes sexuais; 2. AlteraÃÃes no desejo apÃs a descoberta da soropositividade ao HIV; 3. AlteraÃÃes na prÃtica sexual apÃs a descoberta da soropositividade ao HIV; 4. MÃtodos contraceptivos usados antes da vivÃncia e convivÃncia com o HIV/aids; 5. O preservativo como referÃncia contraceptiva e de proteÃÃo nas relaÃÃes sexuais; 6. Desconhecimento do uso de outros mÃtodos contraceptivos na infecÃÃo pelo HIV; 7. Desejo de ter filhos; 8. Medo da transmissÃo vertical do HIV; 9. (Des)conhecimento das medidas profilÃticas na reduÃÃo da transmissÃo vertical do HIV; 10. ModificaÃÃo na relaÃÃo conjugal frente ao cuidado consigo e com o outro; 11. A quebra da confianÃa depositada no outro frente ao HIV. Das pessoas que vivem e convivem com HIV/aids foram apreendidas diferentes experiÃncias e significados para as vivÃncias sexuais e reprodutivas, em cenÃrios de vida complexos, ainda permeados pelos estigmas decorrentes da aids. Os sujeitos deste estudo viviam em uniÃo conjugal variando de oito meses hà mais de quinze anos, dos quais onze viviam em relaÃÃo conjugal soroconcordante ao HIV e cinco em relaÃÃo sorodiscordante. NÃo percebemos divergÃncia de dados pela variÃvel tempo de uniÃo. Verificamos situaÃÃo sÃcio-econÃmica precÃria e presenÃa de filhos, dos quais cinco concebidos apÃs o conhecimento do status sorolÃgico, e mais duas mulheres no perÃodo gestacional. O tempo de convivÃncia com a infecÃÃo foi variÃvel, de menos de um ano a mais de onze anos. Em metade dos casos o contexto de descoberta da infecÃÃo pelo HIV envolveu o perÃodo gestacional, sendo os outros apÃs doenÃa oportunista ou por convocaÃÃo de parceiro, revelando-se como um momento difÃcil pela infidelidade conjugal comprovada. Os resultados indicaram que o preservativo nÃo fazia parte da rotina sexual atà o conhecimento do status sorolÃgico, sendo essa condiÃÃo determinante para a adesÃo ao preservativo masculino. A estabilidade da relaÃÃo conjugal atuava, na fase prÃ-infecÃÃo, como um dos fatores que contribuÃa para a determinaÃÃo do nÃo uso de preservativo, oferecendo contextos de maior vulnerabilidade, onde o gÃnero aparece como principal fator. O uso do preservativo masculino, apÃs a soroconversÃo, evidenciou as dificuldades nessa adesÃo, principalmente entre os que nunca haviam experienciado esse mÃtodo de proteÃÃo, revelando possÃvel consciÃncia para a necessidade de adaptaÃÃo ao dispositivo na relaÃÃo sexual, que se mostra re-significada para essas pessoas. Contudo, hà um enfrentamento maior para a manutenÃÃo da prÃtica de prevenÃÃo pelo uso do preservativo masculino em casais sorodiscordantes. A descoberta da soropositividade ao HIV demandou modificaÃÃes na rotina sexual, evidenciando a diminuiÃÃo do desejo sexual e alteraÃÃo nas prÃticas sexuais, com distintos aspectos entre homens e mulheres pesquisados. Foram expressas mudanÃas no uso rotineiro dos mÃtodos contraceptivos anterior à soroconversÃo, com a utilizaÃÃo de novos mÃtodos, notadamente o preservativo masculino, frente à presenÃa do HIV. Evidenciamos o desconhecimento de alternativas anticonceptivas diante da infecÃÃo pelo HIV e da aids. O desejo de ter filhos foi observado em homens e mulheres, onde o medo da transmissÃo vertical aparece como forte determinante em abolir essa escolha, com o desconhecimento de medidas profilÃticas na reduÃÃo da transmissÃo vertical. As dificuldades no enfrentamento do HIV/aids impÃem mudanÃas no cotidiano da conjugalidade, destacando um comportamento conjugal bilateral de cuidado com o outro em uma relaÃÃo ambÃgua frente à confianÃa quebrada exposta com o conhecimento do status sorolÃgico. Este estudo nos permitiu perceber que à preciso abrir canais de diÃlogo sobre experiÃncias sexuais e reprodutivas, salientando a importante dimensÃo que à conferida Ãs relaÃÃes entre profissionais e pacientes, como partÃcipes na busca da promoÃÃo da saÃde numa realidade em construÃÃo, de re-significaÃÃo de vida, relaÃÃes e saÃde. Evidencia-se o perÃodo gestacional como um importante momento para o diagnÃstico da infecÃÃo pelo HIV, para aconselhamento das recomendaÃÃes para reduÃÃo da transmissÃo vertical, com inicio precoce da profilaxia da transmissÃo vertical, num atendimento humanizado, livre de julgamentos e preconceitos. A assistÃncia em saÃde sexual e reprodutiva Ãs pessoas vivendo com HIV demanda inÃmeras questÃes e desafios, mas, sobretudo, aponta para a necessidade da assistÃncia integral, nÃo-dicotÃmica, onde prevenÃÃo e tratamento se conjugam, reconhecendo limites, possibilidades, finalidades e prioridades, na individualizaÃÃo do cuidado humano. / ABSTRACT The arise of HIV/AIDS and the design of the epidemy demanded changes in the sexual and reproductive health of men and women who live with the virus. The fact that survival and life quality improved with the advent of antiretroviral therapy highlighted the aspect of chronicity of HIV infection, outlining possibilities for affective-sexual and reproductive relationships in this new reality, in a complex scenery that involves concordant and discordant couples in contexts of life similar to non-infected people, in a process of re-signification of HIV/AIDS and of search for control of this pandemy. This study aimed to understand sexual and reproductive experience of people who live with HIV. The Humanistic Nursing Theory by Paterson and Zderad was used as a theoretical and methodological reference. This is a descriptive research with qualitative design, held at the infectology clinic of the School Hospital Santo InÃcio, in Juazeiro do Norte-CE. The subjects of the study were 16 people who live with HIV/AIDS, 7 men and 9 women. Data were collected from July through November, 2007, through free observation, analysis of medical records and semi-structured interview. For the testimoniesâ analysis the technique of content analysis was adopted, from which emerged three themes: 1. Sexual experience; 2. Reproductive experience, and 3. Marriage Experience. In these themes one identified eleven sub-themes: 1. The condom in sexual intercourses; 2. Changes in desire after the discovery of HIV seropositivity, 3. Changes in sexual practice after the discovery of HIV seropositivity, 4. Contraceptive methods used before the experience and living with HIV/AIDS; 5. The condom as a contraceptive reference and protection in sexual intercourses; 6. Ignorance about the use of other contraceptive methods in HIV infection; 7. Desire to have children; 8. Fear of vertical transmission of HIV; 9. (Lack of) knowledge about prophylactic measures to reduce the vertical transmission of HIV; 10. Modification in marital relationship due to self-care and care with the other; 11. The distrust in the partner because of HIV. Out of the people who experience and live with HIV/AIDS one got different experiences and meanings for sexual and reproductive experiences in complex life sceneries, still permeated by the stigma resulting from AIDS. The subjects of this study lived in marital union ranging from eight months through over fifteen years, eleven of whom lived in conjugal concordant relationship to HIV and five in discordant relationship. We did not notice divergence of data by the variable time of union. We noticed difficult socioeconomic situation and presence of children, including five conceived after the knowledge of HIV, and two women during pregnancy. The time spent living with the infection varied from less than a year to more than eleven years. In half the cases the context of discovery of HIV infection involved the gestational period, the others after opportunistic disease or by convincing of the partner, being a difficult moment due to proved marital infidelity. The results indicated that the condom was not part of their sexual routine until the knowledge of HIV, being the virus a determinant condition for joining the condom. The stability of the conjugal relationship served in the pre-infection phase as one of the factors that contributed to the non-use of condoms, causing larger contexts of vulnerability, where the genre appears as the main factor. The use of male condoms, after seroconversion, highlighted the difficulties in adhesion, especially among those who had never experienced this method of protection, revealing possible awareness of the need to adapt to the device in sexual intercourse, which is re-signified for these people. However, there is a bigger confrontation for the maintenance of the prevention practice by the use of condoms in discordant couples. The discovery of HIV seropositivity demanded changes in sexual routine, showing a decrease in sexual desire and change in sexual practices, with different aspects for men and women surveyed. There were changes in routine of contraceptive methods used before the seroconversion, using new methods, especially the male condom, in the presence of HIV. We highlighted the lack of knowledge of alternatives contraceptive methods face to HIV infection and AIDS. The desire to have children was observed in men and women, and the fear of vertical transmission appears as a strong determinant to deny that choice, with the lack of prophylactic measures to reduce vertical transmission. The difficulties in fighting against HIV/AIDS require changes in the daily life of the couple, highlighting a bilateral marital behavior of care for the other in an ambiguous relationship because of distrust with the knowledge of HIV infection. This study allowed us to realize that we must open channels of dialogue about sexual and reproductive experiences, stressing the important dimension that is given to the relationships between professionals and patients, as participants in the search of health promotion in a reality still in construction, of re-signification of life, of relationships and health. The gestational period is highlighted as an important moment for the diagnosis of HIV infection, to advise the recommendations and to reduce vertical transmission, beginning with early prevention of vertical transmission, through humanized care, free of judgments and prejudice. The assistance in sexual and reproductive health for people living with HIV demands several questions and challenges, but it points mainly to the need of integral and non-dichotomous assistance, where prevention and treatment work together, recognizing limits, possibilities, aims and priorities, in the individualization of human care.

Le dévoilement de sa séropositivité représente une préoccupation quotidienne des femmes vivant avec le VIH, complexifié par la stigmatisation. L'état des connaissances demeure très fragmenté : les études révèlent des patterns (à qui les femmes dévoilent et à quelle fréquence), les raisons pour dévoiler ou non, les conséquences positives et négatives ainsi que les facteurs liés au dévoilement, limitant une compréhension globale du phénomène. Inspirée de la toile de fond de Parse (1998, 2003), cette présente étude visait à décrire et à mieux comprendre l'expérience du dévoilement, telle que perçue par des femmes vivant avec le VIH nées au Québec. La méthode phénoménologique a été privilégiée afin de recueillir des données auprès de sept participantes, par la tenue d’une entrevue semi structurée. L’analyse des données a reposé sur deux activités de recherche proposées par van Manen (1997), soit la réflexion et l’écriture, permettant d’identifier les sept thèmes suivants : 1) Se respecter tout en considérant les confidents ; 2) Ressentir l’appréhension; 3) Exercer un contrôle pour assurer une protection; 4) S’engager délibérément dans une démarche de révélation-dissimulation; 5) S’exposer au contexte social stigmatisant empreint d’exclusion; 6) Souffrir intérieurement; 7) Bénéficier des retombées positives de sa décision. Ces thèmes ont contribué à la formulation de l’essence du phénomène étudié soit : vivre l’ambivalence d’une démarche paradoxale de révélation-dissimulation, au cœur d’une souffrance profonde intensifiée par la stigmatisation, tout en s’enrichissant des bienfaits recueillis. Il est permis de croire que ces résultats puissent avoir des retombées positives pour guider la pratique infirmière autour du soutien aux femmes dans leur expérience de dévoilement. / Disclosure of seropositivity is a constant concern in women living with HIV; a situation further complicated by social stigma. Knowledge on this topic remains fragmented. Studies show certain patterns –such as to whom and how often women disclose this information–, the reasons for disclosure, the positive and negative consequences as well as the predisposing factors of disclosure, all of which limit the global understanding of this phenomenon. Inspired by Parse’s nursing theory (1998, 2003), the purpose of this study is to describe and gain a better understanding of the experience of disclosing the information of being seropositive as perceived by Quebec-born women living with HIV. The phenomenological method was chosen for data collection from seven participants through a semi-structured interview. Data analysis rested on two research activities suggested by van Manen (1997): reflection and writing, which allowed identification of the following seven themes: 1) Having self-respect while choosing confidants; 2) Feeling apprehension; 3) Exercising control to ensure protection; 4) Deliberately engaging in a process of revealing-concealing; 5) Exposing oneself to stigma and social exclusion; 6) Internal suffering; 7) Benefiting from the positive effects of such a decision. These themes contributed to the formulation of the essence of the phenomenon which can be read as such: Living the ambivalence of a paradoxical process of revealing-concealing, within a profound suffering intensified by stigma, while being enriched by the benefits attained. We believe that these results could have positive effects to guide nursing practice in supporting women during their experience of disclosure.

La thèse propose une analyse sociologique des expériences de la séropositivité au VIH des homosexuels masculins, à l’heure de la mise en indétectabilité biologique du virus dans leurs corps. La conduite d’une enquête longitudinale durant les deux premières années suivant le diagnostic médical mêlant essentiellement des entretiens biographiques répétés avec ces hommes, et des observations multi-situées au sein des différents espaces qu’ils fréquentent et traversent – les Services des Maladies Infectieuses et Tropicales des hôpitaux ; des associations liées au VIH-sida et/ou communautaires Lesbiennes, Gay, Bi et Transexuelles ; des espaces de sociabilités homosexuelles ; la sphère privée : amicale, familiale et liée au couple –, permet de saisir les formes plurielles d’appropriation de la séropositivité. Aussi, la notion de carrière permet d’analyser la façon dont les histoires individuelles de ces hommes s’articulent à l’expérience de l’institution VIH et à ses dispositifs, à la fois dans et hors les murs de l’hôpital. De la culpabilisation au rachat, en passant par la responsabilisation, à partir d’un même itinéraire moral se dessinent différents devenirs séropositifs, en fonction des ressources et dispositions sociales et morales des enquêtés. La thèse montre les processus de transformations subjectives qui s’opèrent chez ces hommes, travaillés par des enjeux moraux mouvants et divergents liés essentiellement à la responsabilisation homosexuelle, pour se racheter et/ou changer. La séropositivité au VIH fait l’objet d’une socialisation spécifique, marquée par un processus de disqualification. L’expérience de cette disqualification sociale, à la fois biologique et morale, où le corps est désormais subordonné à la surveillance et au pouvoir biomédical, vient aussi troubler les dispositions genrées. Dans ce cadre, les devenirs séropositifs sont le produit de l’articulation des socialisations à la séropositivité et de celles antérieures, notamment en termes de morale et de genre. Ils sont également liés à la façon dont ces hommes ont construit leur engagement puis leur carrière homosexuelle, participant à une recomposition des masculinités lors du processus de socialisation à la séropositivité. La thèse conduit in fine à un éclairage du fonctionnement de l’institution VIH en France, des caractéristiques de ses dispositifs, et des tenants normatifs et/ou moralisateurs des biotechnologies et de l’usage de la biochimie se généralisant dans la discipline des corps et la surveillance en santé publique. / The thesis proposes a sociological analysis of gay men’s experiences of HIV, in the time of biological undetectability of the virus in their bodies. The conduct of a longitudinal survey during the first two years following the medical diagnosis, which essentially involves repeated biographical interviews with these men, and multi-site observations within the different spaces they use and cross - the Infectious Diseases and Tropical hospitals; HIV / AIDS and/or LGBT NGOs; spaces of gay sociability; private sphere: friends, family and couple, allows us to grasp the plural forms of appropriation of their HIV status. The concept of career helps us to analyze how the individual stories of these men articulate with the experience of the HIV institution and its devices, both within and outside the walls of the hospital. From guilt to empowerment, through accountability, from the same moral itinerary emerge different HIV-positive outcomes, depending on the resources and social and moral dispositions of the respondents.The thesis shows the processes of subjective transformations that take place among these men, facing changing and divergent moral issues linked essentially to homosexual responsibility, to redeem themselves and / or change. HIV positivity is the subject of a specific socialization, marked by a disqualification process. The experience of this social disqualification, both biological and moral, where the body is now subordinated to biomedical surveillance and power, also disturbs the gendered dispositions. In this context, HIV-positive outcomes are the result of HIV socializations articulated to previous ones, in particular in terms of morality and gender. They are also linked to how these men built their commitment and then their homosexual career, participating in a redefinition of masculinities during the process of HIV socialization. The thesis eventually highlights the HIV institution works in France, the characteristics of its devices, as well as the normative and / or moralistic impacts of biotechnologies and use of biochemistry that have generalized in the discipline of bodies and public health surveillance.