A integralidade no cuidado das pessoas vivendo com HIV e AIDS: a experiência do Centro de Referência e Treinamento em DST/AIDS da SES-SP

Ao assumir o compromisso com a prevenção e tratamento, baseada no princípio da integralidade, a estratégia brasileira, fez a diferença na resposta nacional à aids nas décadas de 1980/90 e criou um novo paradigma que mostrou-se avançado do ponto de vista técnico, ético e político, contribuindo para a mudança nas recomendações das agências internacionais (OMS\\Banco Mundial) - do \"não tratar e só prevenir\" do início dos anos 1990, para o \"Tratamento como Prevenção\", base da atual proposta dos 90/90/90. Essa estratégia de controle da epidemia concentra responsabilidade na Rede de Serviços, em um período de discussão sobre mudanças no modelo de atenção a ser priorizado no país. Características relevantes dos contextos político e programáticos permitiram uma maior efetivação do cuidado às PVHA no Estado de São Paulo. O objetivo do presente estudo é recuperar a história do Centro de Referência e Treinamento em DST/Aids (CRT) na gestão e organização programática do cuidado em HIV/Aids no Estado de São Paulo, no período de 1988 a 2015, interpretando-a sob a perspectiva dos aspectos facilitadores e limitadores da incorporação prática do princípio da integralidade às ações de saúde. Realizou-se, nesse sentido, uma revisão narrativa da literatura sobre o tema da integralidade no campo da Saúde Coletiva Brasileira nas últimas cinco décadas. Tomando por base o cotejamento com esse desenvolvimento conceitual, a trajetória do CRT foi analisada por meio de entrevistas com atores-chaves no processo da gestão e organização programática do cuidado das PVHA no Estado de São Paulo, e análise dos documentos produzidos no processo. Esta análise foi organizada em torno de dois grandes eixos temáticos: (1) a criação e estruturação do CRT, e (2) as relações entre o CRT, os Programas Municipais de DST/aids e a rede de serviços assistenciais no Estado de São Paulo. Entre os resultados do estudo, destacam-se o resgate e reflexão crítica sobre o desenvolvimento dos discursos tecnocientíficos sobre integralidade no contexto das propostas de reforma da saúde no Brasil; a incorporação desses construtos às propostas desenvolvidas pelo CRT, especialmente em torno aos conceitos de vulnerabilidade, cuidado, clínica ampliada e direitos humanos em saúde; e a identificação de arranjos institucionais, estratégias técnicas e configurações políticas que permitiram ao CRT o exercício articulado de três níveis de gestão do cuidado (das PVHA, dos serviços e da Rede) numa mesma plataforma. Conclui-se apontando alcances e limites na efetivação da integralidade, que se mostraram desiguais nos três níveis de gestão do cuidado. Aponta-se maiores avanços na dimensão gerencial da rede e as maiores dificuldades na efetivação da integralidade no cuidado das PVHA e na gestão dos serviços de saúde

HIV/AIDS: um perfil epidemiológico do vírus e uma análise das práticas seguras, conhecimento e percepção de mulheres

In recent decades, the debate surrounding the consequences of the HIV has passed by great changes. Earlier, prevention campaigns focused risk groups then risk behaviors and ultimately vulnerability. Furthermore, over the years, the dimensions of HIV that emerged in the social environment are these: internalization, heterosexualization, impoverishment and feminization. Based on these contexts, the composition of this study comprises two papers: the former has the overall objective to analyze the epidemiology and incidence of HIV in Brazilian regions in the period from 1980 to 2012; the latter, it aims to find out whether there is the relationship among safe practices, knowledge and perception of women residents in Manaus and Boa Vista cities on the infection by HIV. In paper 1, it was used information from the Health Ministry, as a data source. Besides, it was developed an exploratory and spatial analysis of incidence rates and relative proportion of notified cases. In paper 2, was used as a source of data, the research "Evaluating the process of spatial and epidemic diffusion of HIV in the federal units of Brazil-Northern Region" in 2008. Furthermore, Statistical Techniques of Cluster Analysis, Analysis of Variance, Chi-Square and Logistic Regression were applied. In this paper, it was found that, in Brazilian Regions, the prevalence of reported cases occurred among heterosexuals in men 20-40 year age group and residing in metropolitan areas. It was observed a significant spatial correlation of the incidence rate of reported cases of HIV. It was also noted by the results that have good knowledge and awareness about HIV does not imply, essentially, in a safe sexual intercourse. These results have shown the need public policies geared to the guiding of society, based in educational strategies aiming both information about the virus and its prevention, as well as public awareness for safe sex practices or in stable or not intercourses

Estratégias de enfrentamento de pessoas vivendo com AIDS frente à situação da doença

The Acquired Immune Deficiency Syndrome (AIDS), considered today one chronic nature of the disease due to the advent of antiretroviral therapy (TARV), brings to individuals living with this disease, difficulties related to social interaction and adaptation to new physical condition and the routines imposed by the treatment. This reality has a strong impact on the lives of these people in order of overcoming them use coping strategies, Coping. In this context, the aim of this study was to characterize the epidemiological, clinical and life habits of people living with AIDS and analyze the coping strategies used with the situation of the disease, according to sociodemographic, clinical and life habits. This is a cross-sectional study with a quantitative approach. The sample consisted of 331 people registered at the clinic of the Hospital Giselda Trigueiro (HGT), located in Natal / RN, who had scheduling for outpatient medical consultation from January to August 2014. The study was approved by the Ethics Committee the Federal University of Rio Grande do Norte with the Presentation of Certificate for Ethics Assessment (CAAE), paragraph 16578613.0.0000.5537. The data of social characterization showed predominance of men (52%), young people (42%) coming from the capital (58%), mulatto (53%), single (56%), heterosexual (79%), poor (68 %). With regard to clinical aspects it has been found that most held the first HIV testing for less than five years (60%) had signs and symptoms of AIDS before the examination (90%) were hospitalized (90%) started ART for less than five years (60%) believe they have good knowledge of the disease (75%) and believe that their health has improved (92%). For lifestyle, it became clear that most do not consume alcohol (71%), do not smoke (88%) and do not use illicit drugs (92%) and never used condoms before diagnosis (62%) and only 192 (58%) use the currently codon. With regard to the reference was higher coping focused modes of emotion, although the problem solving has been the second most common. The mean scores of women, workers, religious and never abandoned the treatment were higher for all factors. Having a partner, living with family members and support in the treatment had higher average scores for various factors, coinciding in the confrontation, withdrawal and social support. As for the leisure and physical exercise also dominated the modes focused on emotion as was seen in the correlation between the time of treatment, education and family income and IEEFL factors, although with low intensity. The profile of the study population confers with national characteristics, suggesting feminization, internalization, pauperization, heterosexual, increased CD4 cell count and viral load reduction during treatment and maintaining healthy lifestyle habits. Coping strategies used were more focused on emotion. In this context, it is understood that the identification of these strategies can facilitate care planning, encouraging such persons to adapt to stressors with the situation of the disease