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En 1987, la Tunisie a cree le Programme national de lutte contre les infections sexuellement transmissibles et le sida (PNLS). Les efforts ont ete centres sur la transmission des connaissances et la promotion d’une culture de prevention en matiere de VIH/sida par l’intermediaire de differents moyens de communication, dont la television. L’objectif des auteurs est d’etudier la production de discours a partir de 25 messages diffuses par la television, entre 1987 et 2010, ayant pour vocation la prevention du VIH/sida.

Community Learning Center (CLC) is a strategic place for various community learning activities thatfocus on potency empowerment to mobilize development in education, social, economy, and cultureincluding HIV AIDS prevention. Unfortunately, a few CLCs carry out the prevention education of HIVAIDS. This article provides a guide for educational and non-educational personnels in CLC/PKBM to carry out the integration of HIV AIDS prevention education either into CLC’s activities or subjectmatters within courses and youth programs. They are expected to be able to improve their skills inintegrating HIV AIDS education prevention and taking a part to combat stigma and discrimination.

International audience; For men who have sex with men (MSM), the Internet has imposed itself in the past decade as the place to be to meet other men with similar interests for sex or just to surf in search of excitement. This is a biennial study on the MSM in France. Between December 2005 and February 2006, 15,085 MSM completed an online questionnaire on their social and sexual uses of the Internet. Participants in the “The Gay Net Barometer 2006” study responded to questions related to their sexual and sexual risk behaviours. One third of respondents reported at least one event of unprotected anal intercourse while 11.1% reported frequent or systematic unprotected anal intercourse. These sexual risk behaviours were associated with various sociodemographic and sexual variables in addition to the recruitment website. The study suggests Internet users are not a homogeneous group and intervention targeting of them should be based on an in-depth understanding of the sexual cultures operating within websites.

Background Prior research suggests that a high prevalence of depression, with a detrimental impact on treatment outcomes exists among HIV-infected youth. Data on potential risk factors of depression among HIV-infected youth in sub-Saharan Africa are scarce. This cross-sectional study aimed to identify contributory/protective factors associated with depression in Malawian adolescents 12–18 years old living with HIV. Methods Depression was measured by a validated Chichewa version of the Beck Depression Inventory version-II (BDI-II) and the Children’s Depression Rating Scale-Revised (CDRS-R). Data on variables thought to potentially be contributory/protective were collected and included: socio-demographics, past traumatic events/stressors, behavioural factors/social support, and bio-clinical parameters. Chi-square test or two-sample t-test was used to explore associations between factors and depression. Additional testing via linear/logistic regression, adjusting for age and sex, identified candidate variables (p

The HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programs match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs) - a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programs.

Introduction : This article analyses the composition of healthcare costs for HIV/AIDS infected patients in a country with limited resources and attempts to identify the factors that influence these costs. The aims are to calculate medical care costs, analysing how they vary depending on patients' income, and to evaluate the factors explaining healthcare consumption. Methods: This is a prospective cohort study focusing on patients who were admitted to hospital for a short stay between January 2010 and June 2011, before their integration into a specialised program. The patients were selected randomly. Free consent was obtained from all participants. Data were analysed using the SPSS 19.0 software. The significance threshold was set at 5% and the CI (Confidence Interval) at 95%. We used Kruskal-Wallis tests, Fisher's exact test and multiple linear regression. Results: We monitored 209 patients. Their average age was 36.37 years (SD: 8.72). The sex ratio was 0.58 and the women patients were generally younger than the male ones (p=0.011). The overall cost of healthcare amounted to $US 41,922. The cost of Antiretroviral Therapy represented 21.6% ($US 9,045). The price of para-clinical examinations represented 46% ($US 19,136) of the overall cost. The patient's average monthly income was $US 157.40 whereas the average direct cost per patient was$US 201.45. Both monthly income (t=4.385; p=0.0000) and education level (t=3.703 p=0.0003) were statistically significant predictive factors for healthcare consumption. The medical care costs for patients with opportunistic infections were nine times higher than those for patients who presented none. The presence of opportunistic infections increased healthcare consumption by approximately 31$ US (CI 95%: 15-46.9). Conclusion: The average direct cost for patients on each short-term stay was higher than the average monthly income. To be able to access the necessary services, the patients need additional resources, which are derived from various sources. Monthly income and the level of education were both statistically significant predictors for healthcare consumption. The analysis allows us to extend the study by using different analytical accounting approaches such as by case and by pathology. Key words : Healthcare costs, HIV AIDS, Predictive factors for healthcare consumption.

Clin Microbiol Infect 2012; 18 (Suppl. 7): 6877 Abstract Mucosal candidiasis is frequent in immunocompromised HIV-infected highly active antiretroviral (HAART) naive patients or those who have failed therapy. Mucosal candidiasis is a marker of progressive immune deficiency. Because of the frequently marked and prompt immune reconstitution induced by HAART, there is no recommendation for primary antifungal prophylaxis of mucosal candidiasis in the HIV setting in Europe, although it has been evidenced as effective in the pre-HAART era. Fluconazole remains the first line of therapy for both oropharyngeal candidiasis and oesophageal candidiasis and should be preferred to itraconazole oral solution (or capsules when not available) due to fewer side effects. For patients who still present with fluconazole-refractory mucosal candidiasis, oral treatment with any other azole should be preferred based on precise Candida species identification and susceptibility testing results in addition to the optimization of HAART when feasible. For vaginal candidiasis, topical therapy is preferred.

This study aimed to estimate the cost-effectiveness and return on investment of HIV programs implemented during 2003-2010 in Indonesia and to contribute to the allocative efficiency of the HIV prevention response in Indonesia through analyses to inform the prioritization of resources for the 2015-2019 national HIV budget in the context of reductions in international donor funding. The spending-outcome relationships and epidemiological model were used to compare observed conditions with counterfactual scenarios of reduced/no programs to calculate he cost-effectiveness and estimate healthcare costs saved and thus the return on investment. Model simulations of epidemic projections over many combinations of possible resource allocations were used to identify optimal allocations for reducing new infections over the next HIV budget period.

Il testo presenta le principali sfide che l'epidemia di HIV/AIDS pone alle comunità rurali dell'Africa australe (una delle aree a più alta incidenza della malattia). In particolare si presentano i problemi relativi allo sviluppo agricolo, all'accesso alla terra, alla formazione dei redditi per gli individui e per le comunità rurali della regione in rapporto al mutato contesto socioeconomico legato alla diffusione dell'epidemia.

This licentiate thesis presents the use of participatory approach to developing a data warehouse for data mining in health care. Uganda is one of the countries that faced the largest brunt of the HIV/AIDS epidemic at its inception in the early 1980s with reports of close to a million deaths. Government and nongovernmental interventions over the years saw massive reductions in HIV prevalence rates over the years. This reduction in HIV prevalence rates led to great praises by the international community and a call for other countries to model Uganda’s approach to battling the epidemic. In the last decade the reduction in HIV prevalence rates have stagnated and in some cases increased. This has lead to a call for reexamination of the HIV/AIDS fight with an emphasis on collective efforts of all approaches. One of these collective efforts is the introduction of antiretroviral therapy (ART) for those already infected with the virus. Antiretroviral therapy has numerous challenges in Uganda not least of which is the cost of the therapy especially on a developing country with limited resources. It is estimated that of the close to 1 million infected in Uganda only 300,000 are on antiretroviral therapy (UNAIDS, 2009). Additional challenges of the therapy includes following through a treatment regimen that is prescribed. Given the costs of the therapy and the limited number of people able to access the therapy it is imperative that this effort be as effective as possible. This research hinges on using data mining techniques with monitoring HIV patient’s therapy, most specifically their adherence to ART medication. This is crucial given that failure to adhere to therapy means treatment failure, virus mutation and huge losses in terms of costs incurred in administering the therapy to the patients. A system was developed to monitor patient adherence to therapy, by using a participatory approach of gathering system specification and testing to ensure acceptance of the system by the stakeholders. Due to the cost implications of over the shelf software the development of the system was implemented using open source software with limited license costs. These can be implemented in resource constrained settings in Uganda and elsewhere to assist in monitoring patients in HIV therapy. A algorithm that is used to analyze the patient data warehouses for information on and quickly assists therapists in identifying potential risks such as non-adherence and treatment failure. Open source dimensional modeling tools power architect and DB designer were used to model the data warehouse using open source MYSQL database. The thesis is organized in three parts with the first part presenting the background information, the problem, justification, objectives of the research and a justification for the use of participatory methodology. The second part presents the papers, on which this research is based and the final part contains the summary discussions, conclusions and areas for future research. The research is sponsored by SIDA under the collaboration between Makerere University and Blekinge Institute of Technology (BTH) in Sweden.

This paper summarizes the key findings of an 'After Action Review' (AAR) that reflects a decade of experience in designing and implementing ten HIV/AIDS projects in the Caribbean, financed by the World Bank. The objective is to identify what worked (and what didn't) in the project approach, design and implementation, distilling useful lessons for other projects in small states.

With the prevalence of the Human Immuno-deficiency Virus (HIV) being approx 18% in South Africa, it is highly likely that occupational therapists (OTs) and physiotherapists (PTs) working in hospitals will be in daily contact with patients who are HIV positive. It is therefore important that these therapists be knowledgeable about the condition, its causes, progress and the rehabilitative intervention if they are to make a difference in the lives of these patients. This study therefore aimed at evaluating the knowledge and perceptions that a sample of OTs and PTs had of HIV and AIDS as previous studies had found the knowledge and attitudes of health professionals towards these patients to be poor. It was therefore thought to be important to ascertain whether this had changed in more recent years. A purposive sample of 49 OTS and PTs, drawn from the list of therapists who were employed in the public hospitals of Limpopo Province where both OTs and PTs worked, were selected for the study. These therapists were required to answer a questionnaire which contained both open and closed questions covering knowledge and perceptions of HIV and the Acquired Immune-Deficiency Syndrome (AIDS). The questionnaire was given to the therapists at specially organised meetings at each of the hospitals selected. Thirty five therapists who attended these sessions, answered the questionnaire. The findings of this study confirmed that of other researchers, namely that there is a relatively poor knowledge base of HIV and AIDS, and therapists generally are uncomfortable being in contact with this type of patient. Thus indicating that, in spite of the increased number of patients who are HIV+ and who have AIDS and the consequent increase in contact between therapist and client, the knowledge base of OTs and PTs in this sample was no different from that found in previous studies. Thus pointing out that there is an urgent need to address these deficiencies through training and mentoring.

International audience; Among gay men, serious health risks (unsafe sex, compulsivity) are associated with seeking sex on the Internet. To better understand the repercussions of this activity from a user's perspective, qualitative interviews with 22 gay men reporting Internet use for sexual purposes were submitted to Interpretative Phenomenological Analysis. The repercussions perceived clustered around themes of sociability (making contact and meeting consequences), sexuality (discovering and deviating), identity (becoming and concealing), and dependency. Findings may help improve the relevance and appeal of online interventions with gay men and sensitize professionals to health issues not traditionally reported in the scientific and clinical literature on gay men and Internet use.

National audience

the 1-, 3-, and 5-year patient and graft survival rates were 84.6%, 84.6%, and 70.5% and 84.6%, 84.6%, and 84.6%, respectively, with a median follow-up of 35 months(range ¼ 2-73 months).

Mucosal candidiasis is frequent in immunocompromised HIV-infected highly active antiretroviral (HAART) naive patients or those who have failed therapy. Mucosal candidiasis is a marker of progressive immune deficiency. Because of the frequently marked and prompt immune reconstitution induced by HAART, there is no recommendation for primary antifungal prophylaxis of mucosal candidiasis in the HIV setting in Europe, although it has been evidenced as effective in the pre-HAART era. Fluconazole remains the first line of therapy for both oropharyngeal candidiasis and oesophageal candidiasis and should be preferred to itraconazole oral solution (or capsules when not available) due to fewer side effects. For patients who still present with fluconazole-refractory mucosal candidiasis, oral treatment with any other azole should be preferred based on precise Candida species identification and susceptibility testing results in addition to the optimization of HAART when feasible. For vaginal candidiasis, topical therapy is preferred.

Introducción: las enfermedades oportunistas, y dentro de ellas la meningitis criptocóccica en pacientes inmunodeprimidos, constituyen causa mayor de letalidad en países en vías de desarrollo. Objetivo: identificar factores de mal pronóstico como la acelularidad del líquido cefalorraquídeo (LCR) para individualizar medidas terapéuticas encaminadas al logro de una mayor supervivencia y calidad de vida de estos pacientes. Métodos: se estudió la celularidad de todos los LCR de los 170 casos de Bojanala, North West, ingresados en el Hospital Provincial de Rustenburg, South África por meningitis criptocóccica desde mayo de 2001 hasta abril de 2004. Se interrelacionó el número de células blancas del LCR con la letalidad intrahospitalaria, seropositividad al virus de inmunodeficiencia humana (VIH) y nivel de linfocitos T4. Resultados: se detectó una asociación altamente significativa entre acelularidad basal del LCR y riesgo a morir, y significativa con progresión lineal de mayor mortalidad en los casos con descenso evolutivo del número de células blancas en sucesivos LCR. Se constató un alto índice de letalidad (36,5 %) por meningitis criptocóccica. No hubo diferencias significativas entre acelularidad y letalidad en pruebas de comparación de grupos acorde al nivel de linfocitos T4 y a la confirmación o no de la seropositividad al VIH. Conclusiones: tanto la acelularidad basal como la progresión descendente evolutiva del número de células blancas del LCR constituyen herramientas útiles para la predicción del riesgo a morir por meningitis criptocóccica.

This study aimed to estimate the cost-effectiveness and returns on investments of HIV prevention programs implemented during 2006-2010 and to identify the optimal allocation of resources across combinations of programs for an effective HIV prevention response to inform the prioritization of funding and health resources in Vietnam. The spending-outcome relationships and an epidemiological model were used to compare observed conditions with counterfactual scenarios of reduced or no programs to calculate the cost-effectiveness and estimate healthcare costs saved and thus the return on investment. Model simulations of epidemic projections over many combinations of possible resource allocations were used to identify optimal allocations for reducing new infections over the next HIV budget period.