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O presente trabalho discute as práticas de saúde desenvolvidas para o enfrentamento da epidemia com vistas à prevenção, promoção da saúde e adesão ao tratamento, tendo por cenário a experiência de Juiz de Fora/MG, considerado segundo município de Minas Gerais com o maior número de casos. Discute-se as práticas desenvolvidas, em especial as de cunho educativo, uma vez que, a aids no Brasil e no mundo configura-se numa epidemia que necessita de práticas de saúde de longo alcance, que visem não apenas o aspecto biológico da doença – a infecção pelo vírus HIV – mas também incorpore a influência de aspectos sociais, culturais e econômicos presentes na vida dos indivíduos que carregam o vírus ou estão sujeitos a ele. O estudo aponta que, para controle da aids, o governo brasileiro disponibiliza ações e serviços de saúde visando abarcar a sociedade como um todo. Assim, o estudo em questão torna-se relevante, na medida em que descortina como se materializam as práticas de saúde para enfrentamento da epidemia e no que elas contribuem para contenção do avanço da doença. This article discusses the health practices designed to combat the epidemic with a view to prevention, health promotion and treatment adherence, with the background of experience in Juiz de Fora / MG, considered second city of Minas Gerais with the largest number of cases. It discusses the practices developed, especially with an educational, as, AIDS in Brazil and the world presents itself in an epidemic that requires health practices long-range, aiming not only the biological aspect of the disease - the HIV virus - but also incorporates the influence of social, cultural and economic life of the present in individuals who carry the virus or are subject to it. The study shows that to control AIDS, the Brazilian government provides health services and actions aimed at encompassing society as a whole. Thus, the study in question becomes relevant in that it reveals how they materialize health practices to combat the epidemic and what they contribute to containment of disease progression.

El síndrome de inmunodeficiencia adquirida enfermedad infectocontagiosa, caracterizada por un defecto de la inmunidad celular, asociada a series infecciones y determinadas neoplasias, causado por el virus de la Inmunodeficiencia Adquirida. Calidad de vida es una sensación subjetiva de bienestar físico, psicológico y social. La función de la enfermera consiste en aquellos actos de ayuda, a otro individuo sano o enfermo en la realización de actividades que contribuyan a su salud, recuperación, o a una muerte tranquila Esta investigación es de tipo cuantitativa, descriptiva, observacional de corte transversal, se llevó a cabo en 50 pacientes con VIH/SIDA internados en el Instituto de Medicina Tropical, Asunción, Paraguay, en los meses de mayo a agosto de 2008. El propósito es conocer los datos sociodemográficos, identificar las manifestaciones clínicas, determinar la calidad de vida y caracterizar los cuidados de enfermería. Para la recolección de los datos fue eleborado un cuestionario, además del MOSSF36. Entre los hallazgos más importantes se destaca al sexo masculino, procedencia Asunción, edad de 20-30 años, bajo nivel socio económico y cultural. Los Signos y síntomas fueron: náuseas y vómitos, diarrea, disfagia y odinofagia, convulsiones, agotamiento físico, lesiones cutáneas; en las enfermedades oportunistas se destacan: el Síndrome de Wasting, anemia, meningitis por Cryptococcus neoformans, diarrea y deshidratación. La calidad de vida: dimensión energía, fatiga y salud mental; dimensión emocional función cognitiva y calidad de interacción social alcanzaron una medición muy baja. Se evidenció una valoración favorable respecto a las necesidades psicoafectivas, estigma y discriminación. Los pacientes califican de muy bueno a excelente los cuidados de enfermería y de los médicos Acquired immunodeficiency syndrome infectious disease characterized by a defect of cellular immunity, associated with serious infections and certain cancers, caused by the Acquired Immunodeficiency Virus. Quality of life is a subjective feeling of physical, psychological and social. The role of the nurse is those acts of assistance to another individual healthy or sick in activities that contribute to their health, recovery, or a peaceful death. This research is quantitative, descriptive, observational, transversal cutting Was carried out in 50 patients with HIV / AIDS hospitalized at the Instituto de Medicina Tropical, Asunción, Paraguay, in the months from May to August 2008. The purpose is to determine the demographic, clinical identify, determine the quality characterize life and nursing care. For the data collection was a questionnaire prepared, personalized, in addition to the MOS-SF36. Among the key findings highlighted the male sex, origin Asunción, age 20-30 years, low socioeconomic economic and cultural. The signs and symptoms were nausea and vomiting, diarrhea, dysphagia and odynophagia, seizures, physical exhaustion, skin lesions, in opportunistic infections are: Wasting syndrome, anemia, Cryptococcus neoformans meningitis, diarrhea and dehydration. The quality of life scale energy, fatigue and mental health, cognitive function and emotional dimension of social interaction as a measurement reached very low. It showed a favorable rating compared to psycho needs, stigma and discrimination. Patients described as very good to excellent nursing care and medicals.

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-06T14:31:53Z No. of bitstreams: 1 ARQUIVO CORRIGIDO 01-02.pdf: 1068160 bytes, checksum: 38b0e56f132288ed14f83e4e0fbc1e42 (MD5) Made available in DSpace on 2021-01-06T14:31:53Z (GMT). No. of bitstreams: 1 ARQUIVO CORRIGIDO 01-02.pdf: 1068160 bytes, checksum: 38b0e56f132288ed14f83e4e0fbc1e42 (MD5) Previous issue date: 2010-03-09 This was an exploratory descriptive study with a quantitative approach on the vulnerability of women over 60 years in relation to HIV / AIDS, the problem was to find out what the process of self vulnerability reported by women aged 60 years and the relation to HIV AIDS from their sexual attitudes. The objectives were to describe the process of self vulnerability reported by women aged 60 and relation to HIV / AIDS from their sexual attitudes. Identify sexual attitudes among women over 60 years and more. Describe the knowledge about HIV / AIDS in women over 60 years .Describe the process of self vulnerability reported by women over 60 years in relation to HIV / AIDS. The study was conducted with women over 60 years who attended the activities Project called Longevidade da Secretaria Especial de Envelhecimento Saudável e Qualidade de Vida do Rio de Janeiro. The place were public spaces where he carried out the Project activities. The data were taken closed place during the months of September to October from 2009. In compliance with that recommended by Resolution 196/96, all subjects to an informed consent. The study was submitted to the Ethics Committee from the Prefeitura of Rio de Janeiro city in order to obtain authorization to disclose the name of the institution where the research was performed under the process number 84 A-2009. The study included 256 women. The questionnaire was created from the four dimensions established. The socio economic and demographic dimensions, process of self vulnerability, the knowledge about HIV/ AIDS and sexual practices. The collected data were organized in databases, created by the researcher through a Manager Database Microsoft Excel version 2003. We used descriptive statistics such as absolute frequency and relative frequency to attend the objectives of the study. We concluded that in the search, older women put themselves at risk when to have sexually actives do not use condoms. Make a well informed about the methods of prevention, but condom use is related to much more than information, but an object of confidence at the relations. We were understood that the prevention of HIV / AIDS in women over 60 years should include, in addition to strategies to pass the propagation of information, individual empowerment strategy, building self esteem, encouraging autonomy in general. Tratou-se de um estudo descritivo exploratório com abordagem quantitativa acerca da vulnerabilidade de mulheres com mais de 60 anos em relação ao HIV/AIDS, cujo problema foi descobrir qual o processo de vulnerabilidade auto referido por mulheres de 60 anos e mais em relação ao HIV/AIDS a partir de suas atitudes sexuais.Os objetivos foram: Descrever o processo de vulnerabilidade auto referido por mulheres com 60 anos e mais em relação ao HIV/AIDS a partir de suas atitudes sexuais. Identificar atitudes sexuais entre mulheres com mais de 60 anos e mais. Descrever o conhecimento sobre HIV/AIDS das mulheres com mais de 60 anos.Descrever o processo de vulnerabilidade auto referido por mulheres com mais de 60 anos em relação ao HIV/AIDS.O estudo foi realizado com mulheres com mais de 60 anos freqüentadoras das atividades do Projeto Longegividade da Secretária Especial de Envelhecimento Saudável e Qualidade de vida do Rio de Janeiro. O local escolhido foram espaços públicos aonde se realizavam as atividades do Projeto. A coleta de dados aconteceu no período dos meses de setembro e outubro de 2009. Em atendimento ao preconizado pela resolução 196/96, todos os sujeitos assinaram o termo de consentimento livre e esclarecido. O estudo foi submetido à apreciação do Comitê de Ética da Prefeitura do Rio de Janeiro a fim obter a autorização para a divulgação do nome da Instituição aonde foi realizada a pesquisa, sob o parecer de número 84 A-2009. Participaram do estudo 256 mulheres. O questionário foi criado à partir de quatro dimensões estabelecidas. Dimensão sócio econômico e demográfica, processo de vulnerabilidade auto referido, conhecimento sobre HIV/AIDS e práticas sexuais. Os dados coletados foram organizados em bancos de dados, criados pelo pesquisador através de um sistema Gerenciador de Banco de Dados Microsoft Excel versão 2003. Foram utilizadas medidas estatísticas descritivas como freqüência absoluta e a freqüência relativa para atender aos objetivos do estudo. Concluiu-se que em nossa amostra as mulheres idosas se colocam em situação de risco, quando ao possuir vida sexual ativa não usam preservativos. Compõem um grupo bem informado acerca dos métodos de prevenção, porém a utilização do preservativo esta relacionada, a muito mais do que informação e sim a um objeto de confiança nas relações. Entendeu-se que a prevenção ao HIV/AIDS em mulheres com mais de 60 anos deveria incluir, além de estratégias de repasse de repasse de informação, estratégia de fortalecimento individual, reforço na auto estima e estimulo a autonomia de uma forma geral.

Los inmigrantes suponen actualmente el 11,4% de la población española y en ellos se diagnosticó el 37% de las nuevas infecciones de VIH en 2008. Debido a las elevadas tasas de infección de la población inmigrante y al riesgo existente entre los adolescentes, el objetivo de este estudio descriptivo mediante encuenta es analizar las características fundamentales de la conducta sexual en general y de riesgo para ITS/ VIH, en particular, de los adolescentes en España, comparando entre adolescentes autóctonos y latinoamericanos, con el fin de evaluar si existen diferencias debidas a factores culturales. La muestra estuvo compuesta por 2.962 adolescentes residentes en España, de los que el 71% era de origen autóctono y el 29% de origen latinoamericano; el 49,9% eran hombres y el 50,1% mujeres. En los resultados se observa que los adolescentes latinoamericanos utilizan menos el preservativo que los autóctonos, tienen un mayor número de parejas sexuales y presentan un mayor consumo de drogas en las relaciones sexuales, con lo que emiten un mayor número de conductas de riesgo para las ITS y el VIH. En la discusión se comentan estos resultados y se plantea la necesidad de programas de prevención adaptados a los adolescentes de minorías étnicas residentes en España., Immigrants are the 11.4% of the Spanish population now and the 37% of the new HIV infection cases diagnosed in 2008 were in them. Due to the high rates of infection in immigrants and the existing risk among adolescents, the main aim of this study is to analyze the basic characteristics of sexual behaviour in Spanish adolescents, comparing between two groups: Spanish native adolescents and Latin American immigrant adolescents. The sample was composed by 2,962 adolescents (71% were native and 29% were Latin American). Of them, 49.9% were males and 51.1% were females. Participants provided information about several sociodemographic characteristics and their sexual life history. Results showed that Latin American adolescents used less condoms compared to native adolescents and had a higher drugs use during sexual intercourses which means that Latin American adolescents are more envolved in sexual risk behaviours. In the discussion section, these results are mentioned as well as the need of prevention programs tailored to ethnic minorities living in Spain., Esta investigación ha sido realizada gracias a la beca de Formación de Profesorado Universitario (FPU) (referencia AP-2005-1256) concedida al segundo autor por el Ministerio de Educación y Ciencia.

This article aimed to describe the profile of Brazilian Society with respect to its acquired knowledge about HIV/AIDS. This way, it identified how socioeconomic, demographic, behavioral, and location factors affect the level of knowledge of people about the ways of transmission of the HIV, following the information extracted from the survey: “Sexual Behavior of the Brazilian Population and Perceptions of HIV/AIDS”. The identification of groups exposed to the lack of knowledge is an important factor to identify potential risk groups, which could be targeted in more effective prevention campaigns. Ordered Logit Models were used in the empirical analysis given that the index of knowledge provided by the survey was ordered in an asymmetric way. It was verified that the “poverting” process of AIDS could be affected by the different levels of knowledge among groups, favoring those with better education and social level. Moreover, the Northeast region presented the lowest level of knowledge, what transcribe regionally the process mentioned above. Finally, a better knowledge about AIDS is found among heterosexual women than among either heterosexual men or homosexual/bi. A possible mismatch between quality information and potential risk groups raises doubts about the effectiveness of generalized prevention campaigns. Although the media effect was statistically significant, especially through radio and TV, it was of reduced magnitude. Este artigo procurou traçar um perfil da sociedade brasileira em idade sexualmente ativa com respeito ao conhecimento adquirido sobre HIV/AIDS. Neste sentido procurou-se identificar como fatores socioeconômicos, demográficos, comportamentais e de localização, influenciam no nível de conhecimento das pessoas sobre as formas de transmissão do HIV,a partir das informações geradas pela pesquisa: “Comportamento Sexual da População Brasileira e Percepções do HIV/AIDS”. A identificação de grupos mais expostos a falta de conhecimento é um fator importante para identificar potenciais grupos de risco que possam ser alvo de campanhas de prevenção mais eficazes. Para desenvolver a análise empírica foram utilizados Modelos Logit Ordenados, dado que a variável identificadora do nível de conhecimento desta pesquisa segue um ordenamento crescente com escalas assimétricas. A partir desta análise, verificou-se que o processo de “pauperização” da AIDS no Brasil pode ter sido influenciado por um desnível significativo no nível de conhecimento sobre HIV/AIDS, desfavorecendo aqueles com piores condições de educação e nível social. Também se verificou que a região Nordeste apresentou o menor nível de conhecimento o que conjuga em escala regional o processo acima descrito. Ainda observou-se que o conh ecimento é mais perceptível em mulheres heterossexuais do que em homens heterossexuais ou homossexuais/bi. Um possível desencontro entre informações de qualidade e grupos potenciais de risco leva ao questionamento da eficácia de campanhas de prevenção generalistas. Embora o efeito da mídia no conhecimento tenha sido estatisticamente significante, principalmente para rádio e televisão, ele foi de magnitude reduzida.

Made available in DSpace on 2014-06-11T19:24:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-20Bitstream added on 2014-06-13T19:30:56Z : No. of bitstreams: 1 rodrigues_apap_me_botfm.pdf: 307654 bytes, checksum: d1225cf105baf9e5637e31cc16c9d21b (MD5) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Universidade Estadual Paulista (UNESP) As repercussões clínicas da subnutrição tornam os indivíduos infectados pelo HIV mais suscetíveis a infecções oportunistas e redução da eficácia e tolerância aos medicamentos, fatos que justificam a avaliação nutricional de todos os indivíduos infectados pelo HIV, particularmente na atenção hospitalar. Os objetivos da pesquisa foram traçar o perfil nutricional dos infectados pelo HIV e hospitalizados num município de médio porte do interior do estado de São Paulo. Comparar o desempenho de diferentes métodos de avaliação do estado nutricional, com vistas a subsidiar a adoção de protocolo de avaliação nutricional adequado. Os métodos de avaliação nutricional empregados foram a Avaliação Nutricional Subjetiva Global (ANSG), o Índice de Massa Corporal (IMC), a classificação Papini-Berto (PB), a análise dos componentes primários da impedância bioelétrica e dados laboratoriais – linfócitos totais e albumina. Foram descritos e comparados os dados dos indivíduos estratificados em grupos segundo contagem de linfócito T CD4+ (>200cell/mm³, ≤200cell/mm³ e ausência deste exame) e em relação ao tipo de tratamento (uso da TARV, sem TARV prescrita e não adesão à TARV). Além das categorias originais de cada método, os indivíduos foram classificados também de forma dicotômica em subnutridos e não subnutridos, para a análise de concordância entre ANSG, PB e IMC. Foram calculados: sensibilidade, especificidade, valor preditivo positivo e negativo, adotando-se o IMC como “padrão ouro” em relação à ANSG e Papini-Berto e a ANSG como “padrão ouro” em relação à Papini-Berto. Para a comparação entre o perfil nutricional dos indivíduos segundo grupos foram utilizados os testes estatísticos de ANOVA, Kruskal Will Test e Test Tukey. Em todas as análises estatísticas adotou-se nível de significância de 5%. Foram avaliados... The clinical effects of malnutrition make the HIV infected patient more susceptible to opportunistic infections and reduce the effectiveness and tolerance to drugs, justifying the nutritional assessment of all individuals infected by HIV, particularly in hospital care. The purpose of this study was to analyze the nutritional profile of HIV infected individuals hospitalized in a medium-sized city in São Paulo state and compare the performance of different methods used to evaluate nutritional status, in order to support the adoption of an adequate protocol for nutritional evaluation. The nutritional evaluation methods used were the Subjective Global Nutritional Assessment (ANSG), the Body Mass Index (BMI), the Papini-Berto classification (PB), analysis of the primary components of bioelectric impedance and laboratory tests - albumin and total lymphocyte. The data of the individuals were described and compared in groups stratified according to count of T CD4+ lymphocyte (>200cell/mm³, ≤ 200cell/mm³ and absence of this test) and also to the type of treatment (using ART, without ART prescribed and without adherence to ART therapy). In addition to the original categories of each method, patients were also classified, in a dichotomic way, in malnourished and not malnourished, for the analysis of the correlation between ANSG, PB and BMI. Sensitivity, specificity, positive and negative predictive value were calculated adopting the BMI as gold standard in relation to ANSG and Papini-Berto and ANSG as gold standard in relation to Papini-Berto. For comparison between the nutritional profile of individuals according to groups were used statistical tests ANOVA, Kruskal Will Test and Testd Tukey. In all statistical analysis was adopted significance level of 5%. 101 individuals were evaluated, 60.4% male and 39.6% female, mean age 39.75 ± 9.74 years and hospitalization... (Complete abstract click electronic access below)

Objetivo: El estudio tuvo como objetivo construir y establecer las propiedades psicométricas del Cuestionario de adherencia al tratamiento para mujeres con VIH/sida (CAT-M VIH), con el fin de contribuir a lo que actualmente es una necesidad yuna prioridad a nivel mundial, tantopara el control de la infección como para el mejoramiento de la calidad de vida de las enfermas. Las medidas de evaluación actuales son limitadas y deficientes, siendo importante el desarrollo de nuevos instrumentos que consideren las diferencias según el género. Método: Elestudio fuede tipo instrumental (psicométrico). La muestra se seleccionó intencionalmente y estuvo compuesta por 121 mujeres con VIH/sida, atendidas en 8 instituciones de salud de la ciudad de Cali y que recibían tratamiento antirretroviral. Las propiedades psicométricas analizadas fueron la validez de contenido, la capacidad de discriminación de los ítems, la estructura factorial como indicador de validez de constructo y la fiabilidad del CAT-M VIH. Resultados: El cuestionario quedó conformado por 17 ítems que se refieren a comportamientos de adherencia a aspectos farmacológicos,a aspectos no farmacológicos yde autocuidado, a medidas para prevenir las infecciones de transmisiónsexual (ITS) y a disminuir el consumo de drogas. Cuenta con unas propiedades psicométricas preliminares aceptables, entre ellas, una adecuada fiabilidad (α=0.634) y una buena estructura interna. Los ítems que lo componen presentan adecuados índices de discriminación y pertinencia a nivel clínico. Conclusiones: El CAT-M VIH constituye una propuesta de mejoría de las limitaciones teóricas y metodológicas en la evaluación de la adherencia al tratamiento en mujeres; responde a una concepción integral que trasciende la toma de medicamentos antirretrovirales y con una gran utilidad a nivel clínico e investigativo que se discute en este artículo., Purpose: The purpose of the study was to construct and establish the psychometric properties of the questionnaire of adherence to treatment for HIV-infected women (CAT-M VIH), contributing to the current global need of controlling HIV infection and improving the qualityof life for HIV patients. The existingassessment measures are limited and deficient; hence, the development of new tools considering gender differences is important. Method: The study was instrumental (psychometric). The sample was composed of 121 women with HIV/aids attending 8 health-service facilities in the city of Cali and taking antiretroviral medication. The psychometric properties assessed were the content validity, the items discrimination ability, the factorial structure as an index to construct validity, and the reliability of the CAT-M VIH. Results: The questionnaire was finally composed of 17 items, which reflect adherence behavior to pharmacological treatment, to nonpharmacological and self-care aspects, to the prevention of sexually transmitted diseases advice, and to drug use restrictions. The preliminary psychometric properties are acceptable, having good reliability (a=0.634) and good internal structure. The items have adequate discrimination indexes and clinical relevance. Conclusions: The CAT-MVIHcould aid in improving the theoretical and methodological limitations in assessing adherence to treatment of women, responding to an integral concept of such that includes more than the antiretroviral medication taken and havingsubstantial clinical and research utility, which is discussed in this article., Investigación financiada por la Pontificia Universidad Javeriana, Cali, Colombia.

Voluntary counselling and testing (VCT) is an important tool in HIV prevention efforts and in the identification of HIV-infected individuals for care and treatment services. But despite the central role of VCT in the response to HIV/AIDS, less than 20% of South Africans have been tested for HIV. Although there are substantial barriers to seeking VCT, including quality of services and AIDS-related stigma, improving VCT rates remains a critical part of the response to the HIV/AIDS epidemic. Recently there has been particular interest in the potential influence of access to antiretroviral therapy (ART) on demand for HIV testing services. It has been suggested that the availability of effective treatment for HIV/AIDS may help motivate individuals to find out their HIV status. However, this possibility remains largely hypothetical and there have been few studies investigating this question. In light of the importance of VCT as an entry point to HIV prevention interventions and treatment services, the possible impact of ART availability on VCT uptake has major implications for the public health response to HIV/AIDS in South Africa. We investigated whether the availability of ART was associated with HIV testing among individuals attending the site B day hospital in Khayelitsha near Cape Town, the setting for a well-publicised antiretroviral pilot.

Background. This paper describes the first national burden of disease study for South Africa. The main focus is the burden due to premature mortality, i.e. years of life lost (YLLs). In addition, estimates of the burden contributed by morbidity, i.e. the years lived with disability (YLDs), are obtained to calculate disability-adjusted life years (DALYs); and the impact of AIDS on premature mortality in the year 2010 is assessed.Method. Owing to the rapid mortality transition and the lack of timely data, a modelling approach has been adopted. The total mortality for the year 2000 is estimated using a demographic and AIDS model. The non-AIDS cause-of-death profile is estimated using three sources of data: Statistics South Africa, the National Department of Home Affairs, and the National Injury Mortality Surveillance System. A ratio method is used to estimate the YLDs from the YLL estimates.Results. The top single cause of mortality burden was HIV / AIDS followed by homicide, tuberculosis, road traffic accidents and diarrhoea. HIV / AIDS accounted for 38% of total YLLs, which is proportionately higher for females (47%) than for males (33%). Pre-transitional diseases, usually associated with poverty and underdevelopment, accounted for 25%, non-communicable diseases 21% and injuries 16% of YLLs. The DALY estimates highlight the fact that mortality alone underestimates the burden of disease, especially with regard to unintentional injuries, respiratory disease, and nervous system, mental and sense organ disorders. The impact of HIV / AIDS is expected to more than double the burden of premature mortality by the year 2010.Conclusion. This study has drawn together data from a range of sources to develop coherent estimates of premature mortality by cause. South Africa is experiencing a quadruple burden of disease comprising the pre-transitional diseases, the emerging chronic diseases, injuries, and HIV / AIDS. Unless interventions that reduce morbidity and delay morbidity become widely available, the burden due to HIV / AIDS can be expected to grow very rapidly in the next few years. An improved base of information is needed to assess the morbidity impact more accurately.

This thesis examines aspects of the prevention of sexually transmitted diseases (STDs) in the Australian community, with a particular emphasis on HIV/AIDS in the context of general practice (or primary care settings). The work has four broad aims: i) To describe the primary prevention of sexually transmitted diseases, following from the arrival of the HIV/AIDS pandemic in Australia ii) To describe HIV/STD risk behaviour iii) To summarise previously known evidence of interventions to reduce risk and to raise awareness of HIV and other sexually transmitted diseases iv) To contribute new evidence addressing the potential of the general practitioners' role in HIV/STD prevention The first chapter gives a brief review of the history of HIV/AIDS from its discovery in the United States of America to its appearance in Australia and New Zealand, and discusses the Australian response strategies, both initial and continuing, to confine the epidemic. Specifically, the arrival of HIV/AIDS gave rise to increasing awareness of sexually transmitted diseases, which hitherto, although sometimes chronic, were rarely fatal. The public health risk of HIV necessitated swift government action and led to wider acceptance of publicity about sexual behaviour. Although the thesis does not concentrate solely on HIV, this is still an emphasis. This chapter provides useful background to ensuing chapters. Chapter Two provides an overview of behavioural risk in sexually transmitted diseases. It gives a review of risk factor prevalence studies, and introduces risk behaviour and cognitive models of behaviour change, as applied to STD risk. Sexual behaviour is a complex social interaction, usually involving more than one person, and relying on the personality and behaviour patterns intrinsic to the individuals taking part. It is therefore perhaps more challenging to alter than behaviour which is undertaken alone, being dependent on the behaviour and intentions of both parties. Moreover, comprehensive assessment of sexual risk behaviour requires very detailed information about each incident. Its private nature makes accurate data difficult to obtain, and sexual risk behaviour is, correspondingly, difficult to measure. Chapter Three reviews the effectiveness of interventions tested in primary health care settings to reduce sexual risk behaviour. The candidate uses a replicable method to retrieve and critique studies, comparable with standards now required by the Cochrane Collaboration. From 22 studies discussed, nine health interventions were short, 'one-shot', efforts owing to limited time, resources and other practical constraints. This review demonstrates the scarcity of interventions with people who may be perceived as 'low-risk'. Only four interventions were carried out in community health centres and two in university health clinics. One of the university interventions showed no change in sexual behaviour in any of three arms of the intervention (Wenger, Greenberg et al 1992) while the other showed an increase in condom use in both groups, although the intervention group's self-efficacy and assertiveness also improved (Sikkema, Winett & Lombard 1995). The rationale for the intervention, where given, is described. Chapter Four analyses the content, format and quality of sexual health information brochures available in New South Wales at the time of the candidate's own planning for an interventional study. One of the most effective ways to disseminate information widely is by the use of educational literature, especially when the subject material is potentially sensitive or embarrassing to discuss in person. In this chapter, the candidate reviews the literature available at the time of designing the intervention used in Chapter Five. Readability, attractiveness, clarity and the accurate presentation of facts about sexually transmitted disease risk are examined for each pamphlet. Forty-seven pamphlets were scored according to the Flesch formula, and twenty-four of these scored in the 'fairly' to 'very difficult' range. There was, therefore, a paucity of easy-to-read material on these subjects. Chapter Five evaluates a general practitioner-based counselling intervention to raise awareness of sexually transmitted diseases and to modify HIV/STD risk behaviour. While adults aged 18-25 are less likely than older cohorts to have a regular general practitioner or to visit often, most people visit a general practitioner at least once a year. This could provide an opportunity for the general practitioner to raise preventive health issues, especially with infrequent attendees. As the effectiveness of an opportunistic intervention about sexual risk behaviour was yet to be tested, the candidate designed an innovative randomised controlled trial to raise awareness of risk and increase preventive behaviour. The participation rate was 90% and 76% consented to followup; however the attrition rate meant that overall only 52% of the original participants completed the follow-up questionnaire. The intervention proved easy and acceptable both to GPs and to patients, and risk perception had increased at three months' follow-up; however this occurred in both the control (odds ratio 2.6) and the intervention group, whose risk perception at baseline was higher (odds ratio 1.3). In order to establish some markers of risk in the general population, Chapter Six analyses data resulting from questions on sexual behaviour asked in the Central Sydney section of the NSW Health Survey. The candidate advocated for inclusion of relevant questions to determine some benchmarks of sexual risk behaviour and to provide an indication of condom use among heterosexuals. Although limited in scope as a result of competing priorities for questions in the survey, results demonstrate that, while a small percentage of people were at risk, those with higher levels of partner change or of alcohol use were the most likely to always use condoms. Specifically, 100% of those with more than four new partners in the last 12 months had used condoms with every new partner. In addition, 'heavy' alcohol users were more likely to report condom use every time with new partners (odds ratio 0.34). To furnish data to inform future planning of educational activities for general practitioners, Chapter Seven presents the results of a survey of Central Sydney general practitioners' opinions and current practices in HIV risk reduction with in the broader context of sexually transmitted disease prevention. The general practitioner is in an ideal position to provide information and advice, especially if future research affirms the impact of such advice on STD risk behaviour. General practitioners in this study said they would be slightly more likely to discuss sexual health matters with young patients than with older ones (p=0.091), but this was not significant. The most cited barrier to discussing sexual health was inadequate remuneration for taking time to do so (over 50% gave this reason). The next most cited obstacle was difficulty in raising the subject of STDs or HIV in routine consultations, but this reason was given by less than half the sample. Forty-six percent had participated in continuing medical education programs in STDs, HIV/AIDS, or hepatitis diagnosis or management; 32% of GPs had patients with HIV, and 55% of all GPs indicated they would like more training in management and continuity of care of HIV patients. Approximately half (51%) wanted more training in sexuality issues, including sexual dysfunction. Chapter Eight reviews the whole thesis and discusses future directions for the research agenda.

International audience; A short story in a Brummie dialect that is read forwards and then backwards. A woman shoots a man who infected her with HIV.

O presente texto sistematiza alguns insigths acerca da prostituição feminina e do impacto das políticas públicas da área de HIV/Aids sobre esta população, assim como sobre a atuação de ONGs locais e transnacionais num campo em que as associações de prostitutas emergem como novos movimentos sociais. De um lado, uma abordagem etnográfica permite deslocar o eixo de análise dos preconceitos que cercam a prostituição, para as categorias com as quais estas mulheres estruturam sua vida cotidiana (e são estruturadas). De outro lado, o estudo centra-se nas ONGs enquanto executoras de parte das referidas políticas – promoção e prevenção, fundamentalmente – o que permite refletir sobre o impacto das diretrizes da cooperação internacional sobre este tipo de organização; suas contradições e articulações com o surgimento de um novo ator social – as organizações de prostitutas – que se constrói em torno de reivindicações que transcendem a área de saúde.