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.

Objective(s): The purpose of this study was to describe the impact of fatigue on quality of life (QOL), physical function, and participation in social, recreational, and daily living activities (ADLs) in women living with HIV. Methods: HIV-infected women (n=15; age 44±8 years) were recruited from the Clinical Immunological Outpatient Clinic (CIOC) and the HIV/AIDS Regional Services (HARS) in Kingston. Four questionnaires were completed to obtain information on demographics, fatigue (HIV-Related Fatigue Scale, HRFS), QOL (Medical Outcomes Survey HIV Healthy Survey (MOS-HIV), and valued social, recreational and daily living activities. Participants then performed the 6-minute walk test (6MWT) to assess their physical function. Assessments were conducted in the CIOC or in a gymnasium at another location. Results: Mean length of HIV infection was 12±5 years and 14 of the 15 women were on anti-retroviral therapy. Seven of the 15 women did not have significant issues with fatigue on the HRFS. The other 8 reported that fatigue severely interfered with ADLs, socialization and mental functioning. QOL scores were significantly lower in the fatigued group compared with the non-fatigued group in 8 of 11 sub-scales of the MOS-HIV; the values being approximately 50% of those in the non-fatigued group. Socializing with friends, walking, grocery shopping and cleaning were listed as activities in which participants experienced limitations. No significant differences were found between the fatigued and non-fatigued groups for the distance walked in the 6MWT or for the percent of predicted distance walked. Conclusions: Half of the women with HIV in this study reported that fatigue interfered with daily functioning and participation in day to day activities, impacting their QOL. These findings suggest that fatigue can be a major issue impacting QOL in this population; therefore, fatigue reduction should be one of the priorities of HIV-related medical management. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-08-29 13:51:52.993

Human immunodeficiency virus (HIV) can result in posttraumatic stress disorder (PTSD) as events related to illness act as traumatic stressors. This study tested some basic hypotheses of Sewell and Cromwell's personal construct model of PTSD in HIV+ women both with and without diagnoses of PTSD. Trauma-related constructs of HIV+ women with PTSD with HIV+ non-PTSD controls at varying stages of illness were compared. The elaboration, rankings, and valence of trauma-related constructs were examined using the Life Events Repertory Grid (LERG) procedure. Findings provided evidence that a clinical diagnosis of PTSD in women was not associated with the degree of construct elaboration. These findings may imply a qualitative difference in cognitive processing of social stressors and violent stressors.

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

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

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