Introdução: O cenário da epidemia da AIDS vem se modificando no Brasil e no mundo e o perfil epidemiológico das pessoas vivendo com HIV/AIDS vem sofrendo sucessivas alterações desde a década de 80. Embora os homens representem em números absolutos, o maior número de notificações do total de casos de AIDS, a velocidade de crescimento da epidemia é maior entre as mulheres. O Brasil tem uma resposta à epidemia de DST/AIDS reconhecida internacionalmente, baseada nos princípios do SUS à universalidade, à equidade e à integralidade na assistência. Um dos capítulos desta resposta é a prevenção da transmissão vertical do HIV. O tema que vem ganhando importância na medida em que a AIDS recebe status de doença crônica e as mulheres soropositivas podem fazer as suas escolhas reprodutivas. A prevenção da transmissão vertical do HIV contempla testagem para diagnóstico precoce, terapia antirretroviral durante a gravidez e o parto, terapia antirretroviral para o recém-nascido e a não amamentação. Objetivo- Conhecer como as ações de prevenção e controle da transmissão vertical do Vírus da Imunodeficiência Humana são percebidas pelas gestantes e puérperas atendidas pelo Programa Estadual de DST/AIDS, e sua satisfação, ou insatisfação, em relação à assistência recebida. Método- Nossa amostra foi composta por 14 mulheres, sendo 13 soropositivas para o HIV que engravidaram e tiveram pelo menos um filho no contexto da soropositividade e uma, soronegativa para o HIV e mãe adotiva de uma criança soropositiva. Para a coleta de dados foi utilizada a metodologia qualitativa, com base em entrevistas individuais, semiestruturadas, realizadas em 2010. Resultados - Não houve aconselhamento para a testagem de nenhuma mulher da amostra. As mulheres apresentaram, no geral, uma falta de identificação com o perfil de pessoas que podem se infectar com o HIV, sendo surpreendidas com o diagnóstico. Oito pais apresentaram status sorológico desconhecido, sendo que três negaram-se à testagem. Há dificuldades por parte das mulheres, para promoverem relações sexuais protegidas com o uso do preservativo masculino. Os efeitos adversos dos antirretrovirais são descritos como obstáculo importante à adesão ao tratamento. O alojamento conjunto foi o cenário das piores vivências dentre toda a assistência recebida, destaque dado ao tema aleitamento materno. Há uma lacuna entre as demandas das mulheres em produzir e relatar as suas narrativas e a inexistência de espaços de escuta, seja individualmente na relação com o profissional médico, seja em grupos. Conclusões - A ausência do aconselhamento como espaço de abordagem e esclarecimentos, informações e escolhas, dificulta uma ação mais oportuna para a redução da transmissão vertical do HIV. As mulheres comuns não são atingidas pelas informações sobre HIV/AIDS oferecidas pelas campanhas para prevenção da infecção. O uso do preservativo para evitar a infecção ainda é uma decisão masculina. As mulheres raramente encontram interlocução entre os profissionais, para tirarem suas dúvidas e planejarem sua vida reprodutiva de forma mais segura. Apesar da falta de discussão sobre o planejamento terapêutico, a via de parto e os cuidados com o bebê, as mulheres seguem a prescrição e seguem com seus medos e suas dúvidas / Introduction: The scenario of the AIDS epidemic has been changing in Brazil and worldwide, and epidemiological profile of people living with HIV / AIDS has undergone successive changes since the 80\'s. Although men represent in absolute numbers, the highest number of notifications of all cases of AIDS, the epidemic growth rate is higher among women. Brazil has a response to the epidemic of STD / AIDS internationally recognized principles of the SUS: universality, equity and integrity in service. One of the elements of this response is the prevention of vertical transmission of HIV. The theme that is gaining importance, as AIDS gets the status of chronic disease and HIV positive women can make their own reproductive choices. The prevention of vertical transmission of HIV includes testing for early diagnosis, antiretroviral therapy during pregnancy and delivery, antiretroviral therapy for the newborn and not breastfeeding. Objective -To study how the prevention and control of vertical transmission of human immunodeficiency virus are perceived by pregnant women and new mothers assisted by the State Program of STD / AIDS, and their satisfaction or dissatisfaction in relation to care received. Methods -Our sample consisted of 14 women, 13 HIV-positive pregnant and who had at least one child in the context of being HIV positive and one was seronegative for HIV and an adoptive mother of an HIV positive child. To collect data we used the qualitative methodology, based on individual interviews, semi-structured, conducted in 2010. Results - There was no counseling for the testing of any women in the sample. Women had, overall, a lack of identification with the profile of people who can become infected with HIV, being surprised by the diagnosis. Eight male partners had unknown HIV status, and three refused to be tested. There are difficulties, for women, to promote safe sex with condom use. Adverse effects of antiretroviral drugs are described as barrier to treatment adherence. Rooming-in was the scene of the worst experiences among all the care received, highlighting the theme of breastfeeding. There is a gap between women\'s demands to produce and report their stories and the lack of opportunities to listen, either individually in relation to the medical professional, either in groups. Conclusions - The lack of counseling as a space for dialogue and explanations, information and choices, hampers a more timely action to reduce vertical transmission of HIV. The \"ordinary\" women are not affected by information about HIV / AIDS provided by the campaigns to prevent infection. The use of condoms to prevent infection is still a male decision. Women are rarely have the opportunity to with professionals, to expose their questions and plan their reproductive lives more safely. In this setting of lack ofparticipation on treatment planning, delivery or baby care, women follow the \"prescription\" and move on with their fears and doubts

Introdução: O cenário da epidemia da AIDS vem se modificando no Brasil e no mundo e o perfil epidemiológico das pessoas vivendo com HIV/AIDS vem sofrendo sucessivas alterações desde a década de 80. Embora os homens representem em números absolutos, o maior número de notificações do total de casos de AIDS, a velocidade de crescimento da epidemia é maior entre as mulheres. O Brasil tem uma resposta à epidemia de DST/AIDS reconhecida internacionalmente, baseada nos princípios do SUS à universalidade, à equidade e à integralidade na assistência. Um dos capítulos desta resposta é a prevenção da transmissão vertical do HIV. O tema que vem ganhando importância na medida em que a AIDS recebe status de doença crônica e as mulheres soropositivas podem fazer as suas escolhas reprodutivas. A prevenção da transmissão vertical do HIV contempla testagem para diagnóstico precoce, terapia antirretroviral durante a gravidez e o parto, terapia antirretroviral para o recém-nascido e a não amamentação. Objetivo- Conhecer como as ações de prevenção e controle da transmissão vertical do Vírus da Imunodeficiência Humana são percebidas pelas gestantes e puérperas atendidas pelo Programa Estadual de DST/AIDS, e sua satisfação, ou insatisfação, em relação à assistência recebida. Método- Nossa amostra foi composta por 14 mulheres, sendo 13 soropositivas para o HIV que engravidaram e tiveram pelo menos um filho no contexto da soropositividade e uma, soronegativa para o HIV e mãe adotiva de uma criança soropositiva. Para a coleta de dados foi utilizada a metodologia qualitativa, com base em entrevistas individuais, semiestruturadas, realizadas em 2010. Resultados - Não houve aconselhamento para a testagem de nenhuma mulher da amostra. As mulheres apresentaram, no geral, uma falta de identificação com o perfil de pessoas que podem se infectar com o HIV, sendo surpreendidas com o diagnóstico. Oito pais apresentaram status sorológico desconhecido, sendo que três negaram-se à testagem. Há dificuldades por parte das mulheres, para promoverem relações sexuais protegidas com o uso do preservativo masculino. Os efeitos adversos dos antirretrovirais são descritos como obstáculo importante à adesão ao tratamento. O alojamento conjunto foi o cenário das piores vivências dentre toda a assistência recebida, destaque dado ao tema aleitamento materno. Há uma lacuna entre as demandas das mulheres em produzir e relatar as suas narrativas e a inexistência de espaços de escuta, seja individualmente na relação com o profissional médico, seja em grupos. Conclusões - A ausência do aconselhamento como espaço de abordagem e esclarecimentos, informações e escolhas, dificulta uma ação mais oportuna para a redução da transmissão vertical do HIV. As mulheres comuns não são atingidas pelas informações sobre HIV/AIDS oferecidas pelas campanhas para prevenção da infecção. O uso do preservativo para evitar a infecção ainda é uma decisão masculina. As mulheres raramente encontram interlocução entre os profissionais, para tirarem suas dúvidas e planejarem sua vida reprodutiva de forma mais segura. Apesar da falta de discussão sobre o planejamento terapêutico, a via de parto e os cuidados com o bebê, as mulheres seguem a prescrição e seguem com seus medos e suas dúvidas / Introduction: The scenario of the AIDS epidemic has been changing in Brazil and worldwide, and epidemiological profile of people living with HIV / AIDS has undergone successive changes since the 80\'s. Although men represent in absolute numbers, the highest number of notifications of all cases of AIDS, the epidemic growth rate is higher among women. Brazil has a response to the epidemic of STD / AIDS internationally recognized principles of the SUS: universality, equity and integrity in service. One of the elements of this response is the prevention of vertical transmission of HIV. The theme that is gaining importance, as AIDS gets the status of chronic disease and HIV positive women can make their own reproductive choices. The prevention of vertical transmission of HIV includes testing for early diagnosis, antiretroviral therapy during pregnancy and delivery, antiretroviral therapy for the newborn and not breastfeeding. Objective -To study how the prevention and control of vertical transmission of human immunodeficiency virus are perceived by pregnant women and new mothers assisted by the State Program of STD / AIDS, and their satisfaction or dissatisfaction in relation to care received. Methods -Our sample consisted of 14 women, 13 HIV-positive pregnant and who had at least one child in the context of being HIV positive and one was seronegative for HIV and an adoptive mother of an HIV positive child. To collect data we used the qualitative methodology, based on individual interviews, semi-structured, conducted in 2010. Results - There was no counseling for the testing of any women in the sample. Women had, overall, a lack of identification with the profile of people who can become infected with HIV, being surprised by the diagnosis. Eight male partners had unknown HIV status, and three refused to be tested. There are difficulties, for women, to promote safe sex with condom use. Adverse effects of antiretroviral drugs are described as barrier to treatment adherence. Rooming-in was the scene of the worst experiences among all the care received, highlighting the theme of breastfeeding. There is a gap between women\'s demands to produce and report their stories and the lack of opportunities to listen, either individually in relation to the medical professional, either in groups. Conclusions - The lack of counseling as a space for dialogue and explanations, information and choices, hampers a more timely action to reduce vertical transmission of HIV. The \"ordinary\" women are not affected by information about HIV / AIDS provided by the campaigns to prevent infection. The use of condoms to prevent infection is still a male decision. Women are rarely have the opportunity to with professionals, to expose their questions and plan their reproductive lives more safely. In this setting of lack ofparticipation on treatment planning, delivery or baby care, women follow the \"prescription\" and move on with their fears and doubts

This qualitative study aimed to explore and describe the experiences of women living with HIV and Aids in Centurion, Gauteng Province. The study was conducted at Lyttleton clinic and 12 women living with HIV and Aids were selected for the study using a non-probability, purposive sampling technique. In-depth, individual semi-structured interviews were used during data collection. A thematic content approach in data analysis yielded the following main themes: experience of being diagnosed HIV positive, disclosure of an HIV positive status, physical signs and symptoms of HIV and Aids, stigma/ emotional stress well experiences in services rendered. The study highlighted the need for a well-established health system, assisting women living with HIV and Aids on how to cope and to raise awareness on HIV and Aids. / Health Studies / M. A. (Public Health)

A qualitative study was undertaken in Pietermaritzburg to unveil the experiences and challenges of WLWHIV as perceived by social workers as well as to explore and describe the experiences of social workers in rendering services to these women. Explorative, descriptive and contextual research designs were employed for the research process. Purposive and snowball sampling techniques were utilised to recruit participants who met the set criteria. Face-to-face semi-structured interviews were conducted with thirteen participants. Data obtained were transcribed and analysed applying Tesch‘s eight steps (Creswell, 2009). Data verification was guided by Guba‘s model (Krefting, 1991). The findings revealed the existence of strained relationships between WLWHIV and their partners and ineffective delivery of social work services to WLWHIV. Based on the findings, it is recommended that specialised training for social workers on issues related to death and dying and services for children of WLWHIV be incorporated in the guidelines for social work practice / Social Work / M.A. (social Work)

In this study, a model of cognitive behavioural therapy (CBT) was developed, implemented and assessed. The aim of this model is to assist HIV-positive women in dealing with internalised and enacted stigma. Since much of the research about therapies developed to deal with HIV-related stigma so far has been done within a western frame of reference, in the current study a model was developed to suit the local South African situation. Women were specifically targeted as they are more vulnerable to HIV/AIDS and are disproportionately affected by the epidemic. Because of culturally determined gender roles, women are not always in a position to take control of their sexual health. Furthermore, because of the negative experiences of HIV diagnosis, the stigma has a negative impact on women’s behaviour. As a result, there is a need for a therapeutic model to assist HIV-positive women in changing the experience of internalised stigma and discrimination. A CBT approach was used in therapy to challenge the women’s dysfunctional beliefs, to change their automatic thoughts and to promote more realistic adaptive patterns of thinking. All of these aimed to assist them in dealing with stigma. Eight therapy sessions (one a week for eight weeks) were planned for each of the women. This research was conducted in two phases. In Phase 1, data was gathered about the experiences of HIV-positive women to gain an understanding of their experiences of HIV-related stigma and discrimination. Various sources of information were used to identify not only the relevant themes contributing to the individual’s experience of internalised stigma, but also possible ways to change them. These sources included a study of the available literature, the researcher's own experience and focus group discussions with other psychologists in practice, and interviews with five HIV-positive women (in the form of case studies). Five women living with HIV/AIDS, who were experiencing difficulties in dealing with stigma, were recruited at Witbank Hospital, where they were interviewed and asked to complete five psychometric instruments. The researcher scrutinised the data gained from the psychometric scales to assess the validity of the instruments to identifying the feelings of the participants the researcher observed in the interviews. Rubin and Rubin's (1995) method was used to analyse the data. The findings that emerged from Phase 1 were used to identify common themes to be addressed in the intervention, for example feelings of powerlessness, feelings of guilt, behavioural implications of stigma, the experience of the reaction of others and uncertainty about the future. These themes were used as guidelines and were adapted according to the specific needs of each of the women seen in therapy so as to address negative feelings and behaviour. Phase 2 focused on the implementation and evaluation of the cognitive behavioural model. A purposive sampling technique was used for this study. The model was tried out with ten HIV-positive women who served as the experimental group. A quasi-experimental design was used, involving a pre-and post-test and a control group consisting of ten other women identified at the same hospital. The scores that the experimental group and the control group obtained before the intervention were compared to verify that the two groups were comparable prior to the intervention. Post-test scores were compared to investigate differences between the groups after the intervention. The process notes of the therapy sessions were analysed by means of qualitative analysis to understand the reactions of the women in therapy. This contributed to the researcher’s understanding of the appropriateness and effectiveness of various therapeutic techniques used with the experimental group. Findings of this research indicate that, when compared to the control group, the experimental group not only experienced less depression, internalised stigma and negative coping, but also higher levels of self-esteem and positive coping after having participated in eight therapy sessions. The study further revealed that being HIV positive and trying to cope with stigma and discrimination involve diverse experiences for women, although there are common themes for all participants. It was recommended that the intervention be altered in future use in the following ways: Those techniques that were found to be more effective with the majority of women (positive cognitive reframing, teaching of coping strategies, homework assignments, decatastrophising and assertiveness training) could probably be used with success in similar conditions. Only the techniques that worked well should be used, and care should be taken not to use too many techniques. Each client should be given the time to question the evidence for her automatic thoughts and to draw her own conclusions about her situation, feelings or thoughts and to grasp the cognitive strategies, rather than to bombard her with many different techniques. The therapist should also relate more to the individual client and adapt the model to her context, rather than to implement the model rigorously. / Thesis (PhD)--University of Pretoria, 2009. / Psychology / unrestricted

HIV/AIDS-related stigma and discrimination (S&D), lack of social support, poverty, and gender inequalities have been identified as factors in the increased prevalence rate of HIV transmission in Enugu, Nigeria, especially among women ages 15 to 49 years. Despite the funding of reduction programs, HIV/AIDS-related S&D remain a major driving force in the increased rate of new HIV cases in Enugu. This study addressed a perceived need for behavioral change intervention approaches that span all societal factors to reduce the HIV infection rate in Enugu Nigeria. The study was guided by Goffman's (1963) social S&D theory. The sample was composed of 132 women living with HIV/AIDS WLWHA ages 21 to 54 years, purposefully sampled from the 4 HIV and AIDS comprehensive initiatives care centers in Enugu, Nigeria. Fifteen WLWHA were interviewed and 114 participated in an online survey. The descriptive statistics and a multiple linear regression analysis and comparison revealed a convergent significant relationship between the S&D determinants (social, political, psychological, environmental, and cultural) and HIV/AIDS-related S&D towards WLWHA in Enugu F (4,109) = 45.09, p

The purpose of this research study is to determine the factors influencing reproductive health choices of women living with HIV attending primary health care services. The need for this research study is evident in that most women attending health care services at primary health care clinics, and who are HIV positive report unintended pregnancy. The study sought to provide answers to factors influencing their reproductive choices. A quantitative, descriptive and cross-sectional research study was used in this study. The sample consisted of 83 females between the ages of 18 and 40. The findings of the research study provided the researcher with adequate evidence on the factors influencing reproductive health choices of women living with HIV attending primary health care services. The approach to reproductive health services was still acceptable but needs to be improved. Moreover, the identified factors therefore influenced one’s perceptions on reproductive health decisions among HIV-infected women. / Health Studies / M.A. (Public Health)

A needs assessment during 2000 guided the design of a buddy system in Botswana. Implementation of this care and support system for and by 39 HIV+ve female buddy-client pairs started in 2002. During April and November 2002, levels of disclosure, self-care, support and quality of life of buddy-client pairs and the controls (n = 38) were compared. Orem's self-care theory, Maslow's hierarchy of needs and Cohen and Syme's conceptualisation of social support formed the theoretical framework. By November 2002, clients' disclosure levels, self-care for TB, and antiretroviral therapy adherence had improved. Higher income, higher education and older age predicted higher levels of self-care for antiretroviral therapy. The social support survey reported satisfaction with types of support available in November 2002 (N = 112). Clients' scores for self-care for TB, antiretroviral therapy and social support improved more than those of controls over the study period. The personal resource questionnaire measured perceptions of support: buddies' scores increased more than those of clients. Women on antiretroviral therapy completed the adherence attitudes inventory in April and November 2002 and reported a downward trend in adherence. Findings of the quality of life (SF 36) instrument showed that during the six-month study period, physical and mental health component summary scores improved but remained low (N = 112). During 2003 Botswana's community-based buddy-support programme was adopted by four other countries in Southern Africa in an attempt to enhance the quality of life of HIV+ve women in these countries. / Health Studies / D. Litt. et Phil. (Health Studies)

A needs assessment during 2000 guided the design of a buddy system in Botswana. Implementation of this care and support system for and by 39 HIV+ve female buddy-client pairs started in 2002. During April and November 2002, levels of disclosure, self-care, support and quality of life of buddy-client pairs and the controls (n = 38) were compared. Orem's self-care theory, Maslow's hierarchy of needs and Cohen and Syme's conceptualisation of social support formed the theoretical framework. By November 2002, clients' disclosure levels, self-care for TB, and antiretroviral therapy adherence had improved. Higher income, higher education and older age predicted higher levels of self-care for antiretroviral therapy. The social support survey reported satisfaction with types of support available in November 2002 (N = 112). Clients' scores for self-care for TB, antiretroviral therapy and social support improved more than those of controls over the study period. The personal resource questionnaire measured perceptions of support: buddies' scores increased more than those of clients. Women on antiretroviral therapy completed the adherence attitudes inventory in April and November 2002 and reported a downward trend in adherence. Findings of the quality of life (SF 36) instrument showed that during the six-month study period, physical and mental health component summary scores improved but remained low (N = 112). During 2003 Botswana's community-based buddy-support programme was adopted by four other countries in Southern Africa in an attempt to enhance the quality of life of HIV+ve women in these countries. / Health Studies / D. Litt. et Phil. (Health Studies)