Cotidiano de pessoas que vivem com VIH em Bissau, Guiné-Bissau: perspectivas, desafios e vulnerabilidades / Vida diaria de las personas que viven con VIH en Bissau, Guinea-Bissau: perspectivas, desafíos y vulnerabilidades / The daily life of people living with HIV in Bissau, Guinea-Bissau: perspectives, challenges and vulnerabilities

RESUMO Objetivo compreender as perspectivas e desafios no cotidiano de pessoas após a descoberta do viver com VIH em Bissau, Guiné-Bissau, tendo em vista diferentes contextos de vulnerabilidade. Método estudo exploratório-descritivo, que utilizou entrevista semiestruturada com 16 pessoas vivendo com VIH, acompanhadas em um hospital de Bissau. Empregou-se técnica de análise de conteúdo temática. Os relatos dos participantes foram analisados a partir de duas categorias empíricas: A descoberta, os impactos e os desafios de viver com VIH; e Experiência com o antirretroviral: recomeço e perspectivas. Resultados sinalizaram que os desafios iniciam com a revelação do diagnóstico que, geralmente, desperta uma diversidade de sentimentos e comportamentos. O estigma e a discriminação estimulam a adoção do sigilo sobre o status sorológico, resultando na fragilidade de suporte emocional no enfrentamento à soropositividade. A terapia antirretroviral foi vislumbrada como esperança para o enfrentamento da doença. A vulnerabilidade social foi a dimensão que mais se destacou, e violações dos direitos humanos foram constatadas. Conclusão e implicações para a prática o estudo permite compreender as perspectivas, desafios e vulnerabilidades de pessoas que vivem com VIH. O viver com VIH merece atenção especial por parte dos profissionais de saúde que atuam no cuidado dessas pessoas, destacando-se como contribuição a relevância de um cuidado de saúde integral, em que a ética e a subjetividade estejam presentes.

RESUMEN Objetivo este estudio cualitativo tuvo como objetivo comprender perspectivas y desafíos en la vida cotidiana de las personas que viven con VIH en Bissau, Guinea-Bissau, considerando diferentes contextos de vulnerabilidad. Método estudio exploratorio-descriptivo, que utilizó una entrevista semiestructurada con 16 personas que viven con el VIH, seguido en un hospital de Bissau. Se utilizó la técnica de análisis de contenido temático. Los informes de los participantes se analizaron a partir de dos categorías empíricas: El descubrimiento, los impactos y los desafíos de vivir con el VIH; y La experiencia antirretroviral: un nuevo comienzo y perspectivas. Resultados los resultados indicaron que los desafíos comienzan con la divulgación del diagnóstico, que generalmente suscita una diversidad de sentimientos y conductas. El estigma y la discriminación fomentan la adopción del secreto sobre el estado serológico, lo que resulta en un apoyo emocional débil para hacer frente a la seropositividad. La terapia antirretroviral es una esperanza para hacer frente a la enfermedad. La vulnerabilidad social fue la dimensión que más se destacó y se encontraron violaciones a sus derechos humanos. Conclusión e implicaciones para la práctica el estudio permite comprender las perspectivas, los desafíos y las vulnerabilidades de las personas que viven con el VIH. Vivir con VIH merece especial atención por parte de los profesionales de la salud que actúan en el cuidado de estas personas, destacando como aporte la relevancia de la atención integral en salud, en la que la ética y la subjetividad están presentes.

ABSTRACT Objective to understand perspectives and challenges in the daily lives of people after the discovery of living with HIV in Bissau, Guinea-Bissau, considering different contexts of vulnerability. Method an exploratory-descriptive study conducted through semi-structured interviews with sixteen people living with HIV attending a hospital in the city of Bissau. We used the thematic content analysis technique. Participants' reports were analyzed following two empirical categories: Discovery, impacts and challenges of living with HIV; and Experience with antiretroviral therapy: new beginning and perspectives. Results the results indicate that the challenges start with the disclosure of diagnosis, which arouses a diversity of feelings and behaviors. Stigma and discrimination encourage the adoption of confidentiality about serological status, which increases the fragility of emotional support in coping with seropositivity. Antiretroviral therapy was seen as a hope for coping with the disease. Social vulnerability was the dimension that stood out the most, and human rights violations involving people living with HIV were verified. Conclusion and implications for practice the study makes it possible to understand the perspectives, challenges and vulnerabilities of people living with HIV. Living with HIV deserves special attention from health professionals who work in the care of these people, highlighting as a contribution the relevance of comprehensive health care, in which ethics and subjectivity are present.

Predictors of survival among HIV-positive children on ART in Swaziland

The objective of the study was to determine predictors of survival among HIV-positive children (<15 years) in Swaziland. A retrospective cohort analysis of medical records for 4 167 children living with HIV who were initiated on antiretroviral therapy (ART) between 2004 and 2008, and followed up until 2014 was conducted in clinical settings at 36 health facilities. The Kaplan Meier Estimator, signed-ranks test, and the Cox proportional hazards regression model were applied to determine survival probabilities, significant difference among stratified survival functions and adjusted hazard ratios respectively. The results reveal that the median survival time for children was 78 months (95% CI: 77­79). Children who were initiated early on ART had higher survival probability over time (HR: 0.35 [95% CI: 0.21­0.57], p < 0.001) compared to those whose ART initiation was delayed. Children within the age group of <1 years had higher hazard (HR = 1.55 [95% CI: 1.16­2.08], p < 0.001) of death than children within the age group of 1­14 years. Children who were nourished had 88% lower hazard of death (HR: 0.12 [95% CI: 0.07­0.19], p < 0.001) than severely malnourished children. The study demonstrates that ART paediatric services are effective in increasing survival among HIV infected children and early initiated children have high survival probability. Active tuberculosis (TB), malnutrition, and delayed ART initiation remain predictors of poor survival among children living with HIV

Factors affecting virological non-suppression amongst HIV-positive patients on antiretroviral therapy: Uganda, August 2014 - July 2015

Introduction: virological suppression is a critical indicator for HIV treatment success and reduction in HIV transmission risk. However, despite the increasing number of people on antiretroviral therapy (ART), there is limited information about non-suppression and its determinants among HIV-positive (HIV+) individuals enrolled in care in many resource-limited settings. This study estimated the virological non-suppression rates amongst HIV+ patients who had been on ART for at least 6 months and the factors associated with non-suppression. Methods: a descriptive cross-sectional study was conducted using routinely collected data from viral load testing samples from 100,678 HIV+ patients enrolled in HIV care across the country between August 2014 and July 2015. Viral load testing was conducted at the Central Public Health Laboratories in Kampala, Uganda. We extracted data on socio-demographic, clinical and viral load testing results. We defined virological non-suppression as having ≥ 1000 copies of viral RNA/ml of blood for plasma or ≥ 5000 copies of viral RNA/ml of blood for dry blood spots. We used logistic regression to identify factors associated with virological non-suppression. Results: majority of the patients (68%) were females. The overall non-suppression rate was 11%. Second-time testers had a higher non-suppression rate than first-time testers (50% vs. 10%, OR = 7.0, 95%CI = 6.2-7.9); and children aged < 5 years (29%, OR = 5.3, 95%CI = 4.8-6.0) and adolescents aged 15-19 (27%, OR = 4.1, 95%CI = 3.7-4.5) had higher non-suppression rates than persons of other age groups. Non-suppression rates were also higher among suspected treatment failures (29%, OR = 4.0, 95%CI = 3.7-4.4), patients with reported adherence levels < 85% (35%, OR = 3.4, 95%CI = 3.0-3.9), and patients with active TB (20%, OR = 2.0, 95%CI = 1.5-2.3) than those without these conditions. Breastfeeding (6%, OR = 0.61, 95%CI = 0.54-0.69) and pregnant women (8%, OR = 0.77, 95%CI = 0.65-0.91) had lower non-suppression rates than non-breastfeeding and non-pregnant women (10%). Conclusion: virological non-suppression was associated with second time testers, young age, poor adherence, and TB co-infection. To maximize the benefits of the expanded ART, we recommend close follow-up and intensified targeted adherence support for second time testers, children and adolescents. Adherence to standard guidelines for managing TB/HIV co-infections should be emphasized by all ART clinics

Entre idas e vindas: histórias de homens sobre seus itinerários ao serviço de saúde para diagnóstico e tratamento de HIV/Aids / Between comings and goings: stories of men's itineraries to HIV/Aids health services

ResumoA partir de um estudo epidemiológico sobre apresentação tardia ao serviço de saúde para diagnóstico e tratamento de HIV/Aids, este artigo busca aprofundar a discussão sobre alguns aspectos envolvidos nesse processo. Buscou-se registrar narrativas de homens sobre suas trajetórias ou itinerários no processo de diagnóstico e tratamento de HIV/Aids, descrevendo os acontecimentos e atores presentes nas práticas cotidianas em que ocorrem os deslocamentos até o serviço de saúde. Foram realizadas 25 entrevistas semiestruturadas com homens com sorologia positiva para HIV, em um centro de referência para diagnóstico e tratamento em HIV/Aids, na cidade de Salvador, Bahia. Algumas dessas histórias estão presentes no decorrer deste artigo. Para além de um momento específico de apresentação tardia ao serviço de saúde, destaca-se a existência de uma série de ações/acontecimentos que se estende no tempo, ora dificultando, ora facilitando a continuidade do tratamento. Nessa direção, reconhecemos também a existência de barreiras, conflitos e tensões que ocorrem no interior das práticas do cuidado à saúde. Entretanto, essas mesmas tensões podem mobilizar formas e estratégias diversas de ação para que ocorra um acolhimento melhor e um cuidado à saúde de forma contínua e mais integral.

AbstractAs part of an epidemiologic study on late presentation (LP) to HIV/Aids health services, this study intends to analyze men´s narratives on trajectories or itineraries in seeking for HIV/Aids services and further describe the events and actors present on daily practices in which occurs the displacement of the patients to the health service. The study was conducted at the only State Reference Center for HIV/Aids in Salvador, Bahia. Twenty five semi-structured interviews with men - with positive HIV serology - were realized at the reference center. Some of those narratives are presented throughout this article. This article considers LP to health services not as an specific moment. Beyond that, it analyses the existence of a network of actions/events which prolongs the LP on time, sometimes hindering and sometimes facilitating the ongoing treatment. In this direction we also recognize the existence of barriers, conflicts and tensions in which occurs the practices of health care. Nonetheless, these same conflicts enable the creation of several actions and strategies to a better reception and a more continuous and fulfilled way of health care.

Sudarshan Kriya yoga improves quality of life in healthy people living with HIV (PLHIV): results from an open label randomized clinical trial.

background & objectives: Improving quality of life (QOL) of healthy people living with HIV (PLHIV) is critical needing home-based, long-term strategy. Sudarshan Kriya yoga (SKY) intervention is acknowledged for its positive impact on health. It is hypothesised that SKY would improve PLHIV’s QOL, justifying an evaluation. Methods: In this open label randomized controlled pilot trial, 61 adult PLHIV with CD4 count more than 400 cells/μl and Karnofsky scale score above 70 were enrolled. Those with cardiac disease, jaundice, tuberculosis, or on antiretroviral therapy/yoga intervention were excluded. All were given standard care, randomized to SKY intervention (31: I-SKY) and only standard of care in control (30: O-SOC) arms. The I-SKY participants were trained for six days to prepare for daily practice of SKY at home for 30 min. A validated 31-item WHOQOL-HIVBREF questionnaire was used to document effect in both arms from baseline to three visits at 4 wk interval. Results: Baseline QOL scores, hypertension and CD4 count were similar in both arms. An overall 6 per cent improvement of QOL scores was observed in I-SKY group as compared to O-SOC group, after controlling for baseline variables like age, gender, education and occupation (p=0.016); 12 per cent for physical (p=0.004), 11 per cent psychological (p=0.023) and 9 per cent level of independence (p=0.001) domains. Improvement in I-SKY observed at post-training and in the SKY adherence group showed increase in these two domains. Conclusions: A significant improvement in QOL scores was observed for the three health related QOL domains in SKY intervention arm. This low cost strategy improved physical and psychological state of PLHIV calling for upscaling with effective monitoring for sustainability of quality of life.

Integralidade do cuidado na testagem anti-HIV: o olhar das mulheres / Care integrality in HIV testing: the look of women / Atención integral en las pruebas del VIH: la mirada de las mujeres

A detecção da positividade para o HIV, durante o trabalho de parto, por meio dos testes rápidos, fragiliza as mulheres e gera demandas específicas de cuidados. Este estudo objetivou analisar o cuidado profissional a mulheres com teste rápido positivo para HIV a partir do olhar de mulheres que tomaram conhecimento da positividade durante o trabalho de parto ou puerpério. Trata-se de estudo do tipo exploratório, com abordagem qualitativa. Os dados foram coletados por meio de entrevista semiestruturada e analisados por meio da técnica de análise de discurso. Observou-se que as relações de cuidado às mulheres com teste rápido positivo para HIV se distanciam da integralidade, uma vez que se mantêm distantes e superficiais, sendo norteadas pelo modelo biomédico. A incorporação da perspectiva da integralidade nas ações de saúde exige reflexão por parte do(a)s profissionais, do(a)s gestore(a)s do sistema público de saúde, bem como a capacitação desse(a)s profissionais.

The positive detection during partum labor makes women weak and generates specific care demands. The aim of this research was to analyze professional care to women with positive result from fast HIV test based on the point of view of women who knew the positive result during partum labor or postpartum. This is an exploratory study with a qualitative approach. Data were collected through semi-structured interviews and analyzed using the discourse analysis technique. It was observed that the relations of care for women with positive rapid HIV test are far away from integrality, since they remain distant and superficial, being guided by the biomedical model. The mainstreaming of integrality in health care requires consideration by the professional, public health system managers, as well as training of those professionals.

La detección de seropositividad durante el trabajo de parto debilita las mujeres y genera demandas específicas de atención. El estudio objetivó analizar la atención profesional a las mujeres con resultado positivo para el VIH, desde la mirada de las mujeres que se enteraron de la seropositividad durante el trabajo de parto o el puerperio. El estudio es de carácter exploratorio con un abordaje cualitativo. Los datos fueron recolectados a través de entrevistas semi-estructuradas y analizadas con la técnica del análisis del discurso. Fue observado que las relaciones de atención a las mujeres seropositivas para el VIH se distancian de la integralidad, ya que se mantienen alejadas y superficiales, siendo guiado por el modelo biomédico. La incorporación de la perspectiva de la integralidad en las acciones de salud requiere una reflexión por parte de los profesionales, de los administradores del sistema de salud pública, además de la capacitación de estos profesionales.

Les determinants du desir de grossesse chez les femmes seropositives sous traitement antiretroviral dans le District de Rwamagana

L'etude vise a analyser les determinants du desir de grossesse chez les femmes seropositives sous traitement anti-retroviral; afin de contribuer a la reduction de la transmission du virus de la mere a l'enfant. Elle a pour objectifs specifiques de determiner la proportion des grossesses chez les femmes a serologie VIH positive; d'evaluer l'attitude du personnel de sante a l'egard des messages a donner aux femmes seropositives sous ARVs en ce qui concerne le desir de la grossesse; et relever les facteurs determinant le desir d'avoir des enfants apres la mise ne route d'un traitement par antiretroviraux . Il s'agit d'une etude descriptive transversale. Elle a ete conduite aupres de 260 femmes infectees par le VIH sous ARVs et suivies dans les FOSA; ayant les services de VCT/PMTCT et des ARVs. L'etude montre que 26;9 des femmes ont ete enceintes apres avoir ete informees de leur statut serologique positif pour le VIH et que 38;5 des femmes seropositives sous traitement anti-retroviral desirent avoir des enfants dans le futur. La majorite des femmes (82;7) reconnaissent l'importance de l'utilisation des contraceptifs alors que le pourcentage des femmes qui connaissent l'importance d'utiliser les ARVs pendant la grossesse et l'accouchement pour reduire le risque de transmission de la mere a l'enfant est de 76;9. Les facteurs determinant le desir de la grossesse parmi les femmes seropositives sont : La confiance attribuee aux anti-retroviraux; la parite c'est-a-dire les femmes qui n'ont pas eu d'enfant ont un desir de maternite deux fois superieur que les femmes qui ont eu au moins un enfant; et la non utilisation des methodes contraceptives chez les femmes a serologie VIH positives pour reduire le risque de transmission de la mere a l'enfant. Nous recommandons de renforcer l'integration des activites de sante de la reproduction et de Planning familial dans les services de lutte contre le VIH/SIDA;a savoir le PTME; Conseils et depistage volontaire du VIH; ainsi que la prise en charge des patients seropositifs

A sexualidade de adolescentes vivendo com HIV: direitos e desafios para o cuidado / The sexuality of HIV-positive adolescents: rights and challenges for healthcare

Sexualidade e saúde reprodutiva configuram questões relevantes para o cuidado integral à saúde de pessoas vivendo com HIV. Políticas públicas e serviços de saúde, entretanto, têm dedicado insuficiente atenção ao assunto. O objetivo deste trabalho é compreender como adolescentes e jovens soropositivos lidam com suas experiências sexuais e projetos de namoro, desejo de constituir família e de ter filhos. O estudo qualitativo entrevistou em profundidade 21 adolescentes vivendo com HIV (por transmissão vertical, sexual ou sanguínea) e 13 cuidadores de crianças e jovens, vivendo em São Paulo e em Santos, Brasil. As narrativas descrevem como aprenderam a lidar com a sexualidade e a ansiedade da revelação do diagnóstico nesse contexto. Destacam-se nas narrativas o despreparo, a desinformação sobre prevenção e a falta de apoio para lidar com a situação, assim como o estigma e a discriminação que atravessa grande parte das dificuldades relatadas. O artigo discute criticamente alguns dos desafios postos para uma adequada atenção à questão no Brasil, especialmente a consideração de jovens soropositivos como sujeitos de direitos sexuais, sugerindo diretrizes para a incorporação desta temática a um cuidado integral e humanizado de crianças e jovens vivendo com HIV.

Sexuality and reproductive healthcare represent relevant issues for comprehensive care of HIV-positive adolescents. However, public policies and health services give this issue insufficient attention. The scope of this article is to assess how HIV-positive young people and teenagers cope with their sexuality, dating and the urge to have children and start a family. In a qualitative study, in-depth interviews were staged with 21 HIV-positive (contracted by vertical, sexual or intravenous transmission) teenagers and 13 caregivers of children and youths living in Sao Paulo and Santos. The interviews revealed the different ways teenagers cope with their sexuality and with the anxiety of HIV disclosure in this context. Lack of information about HIV prevention, lack of support and skills to cope with their sexuality were revealed in the reports. Furthermore, stigma and discrimination were the most frequently reported difficulties. The main challenges to be faced in Brazil in regard to this issue are discussed, especially the need to consider HIV-positive youth as entitled to sexual rights. Recommendations are also made for incorporating the issue into a humanized and comprehensive care approach for HIV-positive children and young people.

Evolución de los embarazos de mujeres infectadas por el virus de la inmunodeficiencia humana / Pregnancy outcome in HIV-infected women

Objetivo. Identificar las complicaciones médicas de las embarazadas infectadas por el virus de la inmunodeficiencia humana (VIH) y asintomáticas, y determinar el riesgo que el virus representa para el desarrollo de las mismas. Material y métodos. Se comparó la evolución del embarazo y el resultado perinatal de 44 embarazadas seropositivas al VIH, asintomáticas y que presentaron más de 200 linfocitos CD4/mm al cubo, con embarazadas control no infectadas; las pacientes se parearon por edad y nivel socioeconómico. Resultados. En 42 (95.4 por ciento) pacientes la vía de contagio fue sexual; 35 (79.5 por ciento) tenían menos de un año de saber que estaban infectadas y 15 (34 por ciento) recibieron tratamiento antiviral durante la gestación. Las mujeres infectadas por el VIH presentaron un riesgo mayor de complicaciones infecciosas (RR3.1, IC95 por ciento 1.9-52), cervicovaginitis (RR2.2, IC95 por ciento 1-48) y enfermedades de transmisión sexual (RR18,IC95 por ciento 2.3-137). El promedio de peso y talla de los recién nacidos y el número de complicaciones neonatales fueron similares entre los grupos comparados. El análisis estratificado mostró que la ausencia de tratamiento antirretroviral y el antecedente de tres o más parejas sexuales incrementaron el riesgo de complicaciones infecciosas. Conclusiones. Las embarazadas seropositivas al VIH y asintomáticas no tuvieron un riesgo mayor de complicaciones médicas del embarazo, con excepción de problemas infecciosos

Survival and quality of life in HIV-positive patients treated with a polyantigenic immunomodulator

A polyantigenic immunomodulator (PAI), previously known as polyantigenic vaccine, which consists of a mixture of antigens of inactivated bacteria with antigens of influenza virus in a peanut-oil-arlacel-A-aluminium monoesterate emulsion, increased tumor resistance and induced tumor regression in tumor bearing mice. This report presents clinical and laboratory data that demonstrate the effect of PAI in long term prolongation of disease free state in HIV positive patients. A total of 40 patients, 35 males and 5 females, with a mean age of 41.1 +/- 10.5 years, ranging from 28 to 68 years, HIV positive by (ELISA and Western Blot), with no restriction on the CD4 + T lymphocytes counts, were included in this open study. The PAI regimen was one subcutaneous injection per week for patients with < 400 CD4 + lymphocytes and one monthly injection for patients with CD4 + count > 400. All patients were monitored at different intervals for lymphocyte counts, clinical condition and treatment toxicity. After a follow up of eight years 81 percent of the patients were alive and 47 percent were free of disease. In patients without AIDS, the weight was 153.9 +/- 28 pounds pre-PAI and 164.6 +/- 27 (P = 1.2 x 10(-4); the CD4 + lymphocyte count was 795 +/- 421 pre-PAI and 585 +/- 279 post PAI (P = 0.08). In patients alive with AIDS, the weight was 159.5 +/- 32 pre-PAI and 163.9 +/- 32 pounds post-PAI (P = 0.8); the CD4 + lymphocyte counts was 491 +/- 255 pre-PAI and 298 +/- 142 post-PAI (P = 0.08); and five AIDS-related infections occurred in five patients. In patients who died the weight was 157.7 +/- 23 pre and 146.8 +/- 30 post (P = 0.10); and the CD4 count was 340.7 +/- 149 pre and 103.4 +/- 88 post (P = 0.0057). All died with infection. No toxicity with the use of PAI was reported. PAI improves disease free survival and quality of life in HIV + patients

Infección por VIH: recomendaciones para el manejo del adulto asintomático y de algunos síndromes clínicos / Infection by HIV: recommendations for the management of asymtomatic adults and some clinical syndromes

This paper presents recommendations on the care of HIV infected adults based upon the author's personal experience with close to 700 patients in a multiprofessional pilot center. This medical care has 5 main objectives: 1)Promotion of good health (through standard recommendation of hygiene, health habits and regular checkup) 2)Prevention of infectious complications (through detection of latent pathogens, chemoprophylaxis, vaccination and avoidance of risk exposures). 3)Treatment of complications (mainly infectious, through early diagnosis and proper treatment); 4)Delay of HIV disease progression (through timely and properly chosen antiretroviral therapy) 5)Reduction of HIV disease progression spread from index case of others (through promotion of responsible behavior and avoidance of pregnancy and HIV exposure to others). Studies for evaluating global health and immunologic status and carriage of potential pathogens are discissed as well as the criteria and timing for chemoprofilaxis for tuberculosis and P carinii pneumonia (PCP). Algorithms for the management of major clinical syndromes and presented: diarrhea (afebrile, mostly parasitic, versus febrile, frequently bacterial); pneumonia (lobar mostly bacterial versus interstitial, frequently PCP specially if lymphopenic and not receiving PCP prophylaxis); brain mass lesion (most commonly toxoplasmosis). Finally, the evaluation and diagnostic possibilities of febrile patients is presented, based upon the immunologic status and associated symptoms

Construyendo una vida positiva: un manual informativo y de orientación para personas con VIH/SIDA y sus familiares y amigos / Building a positive life

Brinda información sobre el VIH: su transmisión; evolución natural; infecciones asociadas; síntomas; cuidado y control médico que debe tener una persona seropositiva; cambios que debería adoptar para mejorar sus condiciones físicas; aspecto psicológico y cambio de conducta; relación enfermo-sociedad