Effects of Exercise Interventions on Aerobic Capacity and Health-Related Quality of Life in People Living With HIV/AIDS: Systematic Review and Network Meta-Analysis.

OBJECTIVE: Exercise is a recommended component of care for people living with HIV/AIDS; however, it is unclear which type of exercise is most effective. The purpose of this study was to investigate the relative effects of different types of exercise interventions on aerobic capacity measured by peak oxygen consumption (peak VO2) and health-related quality of life (HRQoL) in this population. METHODS: For this systematic review and indirect-comparisons meta-analysis (network meta-analysis), different electronic databases were searched up to February 2020 for randomized controlled trials that evaluated the effects of different types of exercise interventions on peak VO2 and HRQoL of people living with HIV/AIDS. Mean differences, standardized mean difference (SMD), and 95% CI were calculated. Fixed- and random-effects Bayesian network meta-analysis were used to compare the relative effectiveness of the different exercise interventions. RESULTS: Forty studies met the study criteria, reporting on a total of 1518 patients. When comparing the exercise interventions with usual care (control group) for the peak VO2 outcome, combined aerobic and resistance exercise was the highest ranked exercise intervention with an SMD of 4.2 (95% CI = 2.5 to 5.9), followed by aerobic exercise (SMD = 3.1; 95% CI = 1.4 to 5.1). Compared with aerobic exercise, resistance training, and yoga, combined aerobic and resistance exercise was the best exercise intervention to promote improvement on physical function, general health, mental health, and energy/vitality domains HRQoL. CONCLUSION: The combined aerobic and resistance exercise was the highest ranked exercise intervention to improve peak VO2 and HRQoL. Combined aerobic and resistance exercise should be considered as a component of care for people living with HIV/AIDS.

The Role of Faith-Based Organizations in the Education, Support, and Services for Persons Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome.

Faith-based organizations are in a unique position to provide resilience-enhancing efforts for persons living with human immunodeficiency virus/AIDS. Many persons living with human immunodeficiency virus/AIDS report having a strong faith or religious affiliation, with a large percentage attending church services on a regular basis. Faith-based organizations can use these factors to reach out to these individuals and effectively promote health, well-being, education, and support. Faith-based organizations can contribute to the reduction of stigma and isolation for persons living with human immunodeficiency virus/AIDS.

Mindful Living with Human Immunodeficiency Virus and AIDS: Behavioral Medicine for Patient Resilience and Improved Screening Practices.

Complementary techniques are useful in treating adverse symptoms of human immunodeficiency virus (HIV) and AIDS, and in preventing disease spread by encouraging screening. This study indicates that HIV diagnosis rates are higher in states where behavioral medicine is practiced; participation in such activities may influence the extent to which someone might closely monitor personal health. A strong evidence-base exists for the recommendation of mindfulness practices that improve rates of primary preventive practices and self-reported quality of life for participants living with chronic conditions such as HIV and AIDS. Access to such programs is an area for future research and practice.

Síndrome de reconstitución inmune en un paciente de sida con una tuberculosis diseminada / Immune reconstitution syndrome in an AIDS patient with disseminated tuberculosis

La tuberculosis es un factor de riesgo en los pacientes con sida, ya que una vez iniciado el tratamiento antirretroviral pueden de desarrollar un síndrome de reconstitución inmune, lo que favorecería el deterioro del su estado clínico. Se presenta el caso de un paciente masculino, de 24 años de edad, diagnosticado de sida hace 4 años, y tratamiento irregular con antirretrovirales. Acudió al Hospital Universitario Clínico Quirúrgico "Comandante Faustino Pérez Hernández" con fiebre elevada, acompañado de cuadro general, manifestaciones respiratorias y dolor inguinal derecho. En el examen físico se constató un cuadro adénico generalizado, fue hospitalizado para estudio y tratamiento. Se diagnosticó un síndrome de reconstitución inmune en un paciente de sida con una tuberculosis diseminada, el cual fallece a pesar de la terapéutica impuesta. Este síndrome se caracteriza por una restauración gradual de la inmunidad patógeno-específica, donde el sistema inmune es capaz de reconocer patógenos presentes pero clínicamente ocultos. Se asocia a otros factores de riesgo y puede ser letal; de ahí que el reconocimiento oportuno de los pacientes con alto riesgo de contraerlo, así como un adecuado manejo sobre cuándo iniciar la terapia antirretroviral en cada caso específico, es quizá la única forma de prevenir su desarrollo (AU).

Tuberculosis is a risk factor in patients with AIDS, because once the retroviral treatment begins they can develop an immune reconstitution syndrome that would favor the deterioration of their clinical status. The case of a male patient, aged 24 years is presented. He was diagnosed with AIDS four years ago, and was irregularly treated with antiretroviral. The patient assisted the Clinic-surgical University Hospital "Comandante Faustino Pérez Hernández" with high fever accompanied by general characteristics, respiratory manifestations and right inguinal pain. At the physical examination, generalized adenic characteristics were found. A syndrome of immune reconstitution was diagnosed in an AIDS patient with disseminated tuberculosis; the patient died in spite of the imposed therapy. This syndrome is characterized by the gradual restoration of the pathogen-specific immunity, where the immune system is able of recognizing the pathogens that are present but clinically hidden. It is associated to other risk facts and may be lethal; therefore the timely recognition of the patients at high risk of suffering it, and also an adequate management about when to begin the anti-retroviral therapy in each specific case, is the unique way of preventing its development (AU).

Quality of life, socioeconomic and clinical factors, and physical exercise in persons living with HIV/AIDS.

OBJECTIVE: To analyze whether socioeconomic and clinical aspects and the aspects of healthy life habits are associated with the quality of life of persons living with HIV/AIDS. METHODS: This is a cross-sectional exploratory quantitative research, with 227 persons living with HIV/AIDS, treated at two hospitals of reference between April 2012 and June 2014. We used structured questionnaires to assess socioeconomic aspects (gender, age, education level, marital status, race, socioeconomic status, dependents on family income, employment relationship), clinical parameters (time of disease diagnosis, use and time of medication, CD4 T-cell count, and viral load), and practice of physical exercise. To assess quality of life, we used the Quality of Life questionnaire (HAT-QoL). For characterization of the socioeconomic and clinical data and domains of quality of life, we conducted a descriptive analysis (simple frequency, averages, and standard deviations). We applied linear regression, following a hierarchical model for each domain of quality of life. RESULTS: The domains that presented lower averages for quality of life were financial concern, concern with confidentiality, general function, and satisfaction with life. We found associations with the variables of socioeconomic status and physical exercise, therapy, and physical exercise for the last two domains, consecutively. CONCLUSIONS: The quality of life of persons living with HIV/AIDS shows losses, especially in the financial and confidentiality areas, followed by general function of the body and satisfaction with life, in which socioeconomic and clinical aspects and healthy living habits, such as the practice of physical exercise, are determining factors for this reality. OBJETIVO: Analisar se aspectos socioeconômicos, clínicos e de hábitos de vida saudável estão associados à qualidade de vida em pessoas vivendo com HIV/aids. MÉTODOS: Pesquisa quantitativa exploratória de corte transversal, com 227 pessoas vivendo com HIV/aids, atendidos em dois hospitais de referência entre os períodos de abril 2012 a junho de 2014. Foram utilizados questionários estruturados para avaliar aspectos socioeconômicos (sexo, idade, escolaridade, estado civil, cor de pele, status socioeconômico, dependentes da renda familiar, vínculo empregatício), parâmetros clínicos (tempo de diagnóstico da doença, uso e tempo de medicação, contagem de células TCD4 e carga viral) e prática de exercício físico. Para avaliar qualidade de vida, utilizou-se o questionário Quality of Life (HAT-QoL). Para caracterização dos dados socioeconômicos, clínicos e domínios da qualidade de vida, conduzimos análise descritiva (frequência simples, médias e desvios-padrão). Aplicamos regressão linear, seguindo um modelo hierárquico para cada domínio da qualidade de vida. RESULTADOS: Os domínios que apresentaram menores médias para a qualidade de vida foram preocupação financeira, preocupação com sigilo, função geral e satisfação com a vida. Foram encontradas associações com as variáveis status socioeconômico e exercício físico; terapia; e exercício físico para os dois últimos domínios, consecutivamente. CONCLUSÕES: A qualidade de vida de pessoas vivendo com HIV/aids apresentam prejuízos, principalmente nas questões financeiras e de sigilo, seguidos da função geral do corpo e satisfações com a vida, em que os aspectos socioeconômicos, clínicos e hábitos de vida saudável, como a prática de exercício físico, são fatores determinantes para essa realidade.

Quality of life, socioeconomic and clinical factors, and physical exercise in persons living with HIV/AIDS / Qualidade de vida, fatores socioeconômicos e clínicos e prática de exercício físico em pessoas vivendo com HIV/aids

ABSTRACT OBJECTIVE To analyze whether socioeconomic and clinical aspects and the aspects of healthy life habits are associated with the quality of life of persons living with HIV/AIDS. METHODS This is a cross-sectional exploratory quantitative research, with 227 persons living with HIV/AIDS, treated at two hospitals of reference between April 2012 and June 2014. We used structured questionnaires to assess socioeconomic aspects (gender, age, education level, marital status, race, socioeconomic status, dependents on family income, employment relationship), clinical parameters (time of disease diagnosis, use and time of medication, CD4 T-cell count, and viral load), and practice of physical exercise. To assess quality of life, we used the Quality of Life questionnaire (HAT-QoL). For characterization of the socioeconomic and clinical data and domains of quality of life, we conducted a descriptive analysis (simple frequency, averages, and standard deviations). We applied linear regression, following a hierarchical model for each domain of quality of life. RESULTS The domains that presented lower averages for quality of life were financial concern, concern with confidentiality, general function, and satisfaction with life. We found associations with the variables of socioeconomic status and physical exercise, therapy, and physical exercise for the last two domains, consecutively. CONCLUSIONS The quality of life of persons living with HIV/AIDS shows losses, especially in the financial and confidentiality areas, followed by general function of the body and satisfaction with life, in which socioeconomic and clinical aspects and healthy living habits, such as the practice of physical exercise, are determining factors for this reality.

RESUMO OBJETIVO Analisar se aspectos socioeconômicos, clínicos e de hábitos de vida saudável estão associados à qualidade de vida em pessoas vivendo com HIV/aids. MÉTODOS Pesquisa quantitativa exploratória de corte transversal, com 227 pessoas vivendo com HIV/aids, atendidos em dois hospitais de referência entre os períodos de abril 2012 a junho de 2014. Foram utilizados questionários estruturados para avaliar aspectos socioeconômicos (sexo, idade, escolaridade, estado civil, cor de pele, status socioeconômico, dependentes da renda familiar, vínculo empregatício), parâmetros clínicos (tempo de diagnóstico da doença, uso e tempo de medicação, contagem de células TCD4 e carga viral) e prática de exercício físico. Para avaliar qualidade de vida, utilizou-se o questionário Quality of Life (HAT-QoL). Para caracterização dos dados socioeconômicos, clínicos e domínios da qualidade de vida, conduzimos análise descritiva (frequência simples, médias e desvios-padrão). Aplicamos regressão linear, seguindo um modelo hierárquico para cada domínio da qualidade de vida. RESULTADOS Os domínios que apresentaram menores médias para a qualidade de vida foram preocupação financeira, preocupação com sigilo, função geral e satisfação com a vida. Foram encontradas associações com as variáveis status socioeconômico e exercício físico; terapia; e exercício físico para os dois últimos domínios, consecutivamente. CONCLUSÕES A qualidade de vida de pessoas vivendo com HIV/aids apresentam prejuízos, principalmente nas questões financeiras e de sigilo, seguidos da função geral do corpo e satisfações com a vida, em que os aspectos socioeconômicos, clínicos e hábitos de vida saudável, como a prática de exercício físico, são fatores determinantes para essa realidade.

[Development of valorization of physical activity: the role of HIV associations]. / La construction de la valorisation de l'activité physique : le rôle des associations VIH.

With the arrival of triple combination therapy in 1996-1997, HIV infection, considered up until then to be a life-threatening condition, changed statuses within the realm of public health actions Progressively likened to a "chronic illness", the discourse on HIV prevention targeting people living with HIV (PLHIV) began to evolve. A review of the scientific literature and the journals of four national HIV associations published between 1990 and 2010 shows that physical activities, previously discouraged because considered to be dangerous, have become increasingly presented as a means of improving quality of life and are increasingly recommended for PLHIV. This article studies this reconfiguration of the discourse on HIV prevention, as well as its effects on the discourse conveyed by HIV associations. The article shows how the new classification of HIV as a "chronic illness", on the basis of scientific expertise, has led to a modified discourse on prevention, including the recommendation of regular and controlled physical activity. This new orientation has contributed to the restructuring of HIV associations which relay this discourse and modify their organization and services, increasingly offering access to physical activities. However, this raises the question of the effects of this new representation of physical activities, as there has been little conside-ration of the difficulties encountered by PLHIV to respond to these repeated encouragements to modify their lifestyles in order to be "good" chronically ill patients. .

Factor analyses of a social support scale using two methods.

PURPOSE: Evaluation and comparison of the factor structure of the Medical Outcomes Study Social Support Survey (MOS-SSS) using both confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) with two samples of people living with HIV/AIDS in China. METHODS: Secondary analyses were conducted with data from two comparable samples of 320 people living with HIV/AIDS from the same hospital using the same inclusion criteria. The first sample of 120 was collected in 2006, and the second sample of 200 was collected in 2012. For each sample, CFA was first performed on the original four-factor structure to check model fit, followed by EFA to explore other factor structures and a subsequent CFA for model fit statistics to be compared to the original four-factor CFA. RESULTS: In both samples, CFA on the originally hypothesized four-factor structure yielded an acceptable model fit. The EFA yielded a two-factor solution in both samples, with different items included in each factor for the two samples. Comparison of CFA on the a priori four-factor structure and the new two-factor structure in both samples indicated that both factor structures were of acceptable model fit, with the four-factor model performing slightly better than the two-factor model. CONCLUSION: Factor structure of the MOS-SSS is method-dependent, with CFA supporting a four-factor structure, while EFA yielded a two-factor structure in two separate samples. We need to be careful in selecting the analytic method when applying the MOS-SSS to various samples and choose the factor structure that best fits the theoretical model.

"Not easy at all but I am trying": barriers and facilitators to physical activity in a South African cohort of people living with HIV participating in a home-based pedometer walking programme.

The promotion of physical activity is encouraged in people living with HIV and AIDS (PLWHA) as a means of promoting wellness and health. Adherence to programmes that promote exercise is often reduced, and home-based programmes are suggested to improve adherence. This study investigated the personal and environmental factors that cause barriers and facilitators of physical activity in a home-based pedometer walking programme as a means of highlighting adherence challenges. An observational study nested in a randomised controlled trial was conducted in a cohort of South African PLWHA on antiretroviral therapy over a six-month period. Descriptive analysis and qualitative content analysis of 42 participants who underwent physical activity modification assisted with data review. The mean age of the sample was 38.7 (±8.9) years, consisted mostly of women (n = 35; 83.3%) who were employed (n = 19; 45.2%) but earning very little (less than R500 per month) and often single or widowed (n = 23; 54.8%). Barriers to physical activity identified included physical complaints, e.g., low-energy levels; psychological complaints, e.g., stress levels; family responsibility, e.g., being primary caregivers; the physical environment, e.g., adverse weather conditions; social environment, e.g., domestic abuse and crime; and workplace, e.g., being in a sedentary job. Facilitators of physical activity included support and encouragement from friends and family, religious practices during worship and community environment, e.g., having access to parks and sport fields. The study is of benefit as it highlights personal and environmental factors that need to be considered when developing or implementing a home-based walking programme in PLWHA.

Examining the role of vocational rehabilitation on access to care and public health outcomes for people living with HIV/AIDS.

PURPOSE: The purpose of this study is to examine the role of vocational rehabilitation services in contributing to the goals of the National HIV/AIDS strategy. Three key research questions are addressed: (a) What is the relationship among factors associated with the use of vocational rehabilitation services for people living with HIV/AIDS? (b) Are the factors associated with use of vocational rehabilitation also associated with access to health care, supplemental employment services and reduced risk of HIV transmission? and (c) What unique role does use of vocational rehabilitation services play in access to health care and HIV prevention? METHOD: Survey research methods were used to collect data from a broad sample of volunteer respondents who represented diverse racial (37% Black, 37% White, 18% Latino, 7% other), gender (65% male, 34% female, 1% transgender) and sexual orientation (48% heterosexual, 44% gay, 8% bisexual) backgrounds. RESULTS: The fit of the final structural equation model was good (root mean square error of approximation = 0.055), with 90% upper bound of 0.058, Comparative Fit Index = 0.953, TLI = 0.945). Standardized effects with bootstrap confidence intervals are reported. CONCLUSIONS: Overall, the findings support the hypothesis that vocational rehabilitation services can play an important role in health and prevention strategies outlined in the National HIV/AIDS strategy.

Sanctuary or double-edged sword? Challenges confronting adolescents living at Nkosi's Haven in Johannesburg, South Africa.

Living in an institution associated with HIV and AIDS is likely to exacerbate difficulties experienced by teenagers who have to cope with the normal stresses of adolescence. The aim of the study was to explore the challenges that adolescents living at Nkosi's Haven encounter and whether they experience any problems when interacting with their peers and other members of the community. The study was located within a qualitative research paradigm and utilised a purposive, non-probability sample of 15 participants recruited from two Nkosi's Havens. A semi-structured interview schedule was employed as the research tool, with in-depth one-on-one interviews adopted as the method of data collection. Thematic content analysis was used to analyse the data collected during the interviews. The main finding that emanated from the study was that Nkosi's Haven is indeed a place of care and nurturing as adolescents are afforded the opportunity to continue with their educational needs while basic and psychosocial needs are also addressed. However, it also emerged that rejection, discrimination, social exclusion and stigmatisation associated with the setting make it difficult for resident adolescents to integrate freely with their peers at school and in the community. The conclusion drawn is that Nkosi's Haven can be regarded as a double-edged sword as it presents both positive and negative factors that impact on its resident adolescents. Results are discussed in terms of their implications for community awareness programmes, policies and practice changes regarding employment and training of staff, and visiting of parents as well as future research.

Helping people with HIV/AIDS return to work: a randomized clinical trial.

OBJECTIVE: New treatments introduced in the mid-1990s led many people with HIV/AIDS who previously had been disabled by their disease to contemplate workforce reentry; many remain unemployed, and little is known concerning interventions that might help them return to work. We report the results of a randomized clinical trial of an intervention designed to help people with HIV/AIDS reenter the workforce. DESIGN: We tested a mixed (group-individual) modality intervention that incorporated elements of Motivational Interviewing (Miller & Rollnick, 2002), skills building from Dialectical Behavior Therapy (Linehan, 1993), and job-related skills (Price & Vinokur, 1995). A total of 174 individuals participated in either the intervention or in standard of care and were followed for 24 months. RESULTS: Compared with individuals referred for standard of care, participants in the intervention engaged in more workforce-reentry activities over time and, once employed, were more likely to remain employed. Dose-response analyses revealed that among intervention participants, participants who attended more than 1 individual session engaged in more workforce-reentry activities than individuals who attended 1 or fewer individual sessions, whereas frequency of group session participation did not effect a difference between participants who attended more than 6 group sessions and participants who attended 6 or fewer group sessions. CONCLUSION: Theoretically based workforce-reentry assistance programs can assist disabled people with HIV/AIDS in their return-to-work efforts.

Addressing intersections in HIV/AIDS and mental health: the role of organizations for d/Deaf and hard of hearing individuals in South Africa.

Like south africans generally, d/Deaf and hard of hearing South Africans are at risk of HIV/AIDS and mental disorders resulting from barriers to communication and care. In interviews and a focus group, members of South African organizations for d/Deaf and hard of hearing individuals all gave priority to HIV/AIDS education and prevention, citing risks resulting from language and communication barriers, inadequate schooling, and insufficient information in South African Sign Language. Participants gave varied descriptions of HIV/AIDS programs in schools for d/Deaf and hard of hearing students and described school initiatives they had directed. Some participants gave mental health problems lesser priority; others said susceptibility to mental disorders may result from communication difficulties and therefore warrants specialized services. Others, seeing a need to address mental health in HIV/AIDS prevention, had designed programs accordingly. Such prevention efforts merit support, as do activities to reduce communication barriers.

A história infantil como recurso para a compreensão do processo saúde-doença pela criança com HIV / The children's story as a resource for understanding the health-disease process for children with HIV

O viver das crianças portadoras do vírus do HIV é marcado por especificidades que dizem respeito ao estigma, preconceito e silêncio sobre a condição de saúde, os quais interferem na sua participação no processo terapêutico. A partir desta questão, criou-se uma história infantil cuja temática envolve o processo saúde-doença relacionado ao HIV/ aids na infância. O estudo em pauta, de cunho qualitativo, tem o objetivo de analisar de como a história infantil que aborde questões relacionadas ao HIV/aids (uso contínuo de medicação, sigilo, segredo, efeitos colaterais, exames, internações, entre outros) contribui para a compreensão do processo saúde-doença para a criança com HIV. Realizado no ambulatório de pediatria do Hospital Conceição em Porto Alegre/RS, no período entre maio e dezembro de 2011, o estudo contou com cinco crianças participantes, com idades entre sete e 10 anos, e seus cuidadores. Para a coleta de dados utilizou-se a técnica de grupo focal e entrevista. Os dados foram analisados mediante análise temática de conteúdo em que emergiram duas categorias: 1) Identificação com a história e a relação com o processo saúde-doença das quais derivaram as subcategorias: situações do cotidiano, vivências e perspectivas; 2) Compreensão da história e do processo saúde-doença, com suas subcategorias: conhecimentos prévios, apreensão e somando conhecimentos. Os resultados demonstraram que mediante a contação de histórias é possível conversar com as crianças sobre o processo saúde-doença sem revelar o diagnóstico, levando-as a compreenderem esse processo e a importância do tratamento. A interação com a história, por meio de catarse, permitiu a identificação de suas vidas com as das personagens e com seus projetos de vida. Percebeu-se que a história infantil pode ser um dos recursos para auxiliar pais, demais cuidadores, e profissionais da saúde envolvidos com a aids infantil a iniciar ou desencadear o processo de revelação do diagnóstico para a criança.

Rehabilitación fisioterapéutica de personas viviendo con el virus de inmunodeficiencia humana y sida / Physiotherapeutic rehabilitation of people with HIV/AIDS

La rehabilitación fisioterapéutica de personas viviendo con el virus de inmunodeficiencia humana y sida, compensa índices de discapacidad y aumenta la calidad de vida, con independencia de su duración; pero debe ser permanente -- acorde con las necesidades --, individualizada, flexible, adaptada y estrechamente vinculada con cuidados médicos. Se concluye que las repercusiones de las deficiencias, discapacidades y minusvalías (transitorias o permanentes) provocadas por esa infección, al no producirse exclusivamente en el plano físico, deben ser evaluadas y cuidadosamente atendidas por un equipo de salud multidisciplinario.

Physiotherapeutic rehabilitation of people with HIV/AIDS compensates handicap indexes and increases life quality, independently of its length period. However, it has to be permanent -- according to the needs of these people --, individualized, flexible, adaptive, and closely related to medical care. Thus, it is concluded that repercussions of deficiencies, handicaps, and disabilities (temporal or permanent) due to this infection must be assessed and carefully treated by a multidisciplinary medical staff when they are not produced exclusively in the physical level.

Tratamento da lipoatrofia facial em pessoas vivendo com HIV/AIDS: afastando o preconceito e melhorando a qualidade de vida / Tratamiento de la lipoatrofia facial en la gente infectada por HIV/AIDS: apartándose del prejuicio y mejorando la calidad de vida / Treatment of facial lipoatrophy in people infected by HIV/AIDS: moving away from prejudice and improving quality of life

Nos dias atuais observamos um maior controle da AIDS, com o advento da terapêutica anti-retroviral, mas os portadores do vírus HIV continuam suscetíveis a uma série de conseqüências físicas, psicológicas e sociais. Uma delas é a lipoatrofia facial, causada pala terapêutica antiretroviral, que causa modificações intensas no rosto. Um tratamento proposto e disponibilizado pelo SUS, neste caso, é o polimetilmetacrilato para o preenchimento cutâneo. Este artigo é o resultado de uma pesquisa que objetivou conhecer o sentimento do portador de HIV/AIDS em relaçãoa lipoatrofia facial e o significado de ter realizado o preenchimento facial. O estudo foi desenvolvido através de metodologia qualitativa, com uma amostra intencional de oito indivíduos que se submeteram à terapêutica de preenchimento cutâneo. O tratamento dos dados foi realizado através do Discurso do Sujeito Coletivo e pudemos encontrar como resultados dois momentos importantes. O primeiro relacionado à presença da lipoatrofia facial, onde as ideias centrais demonstram a redução da autoestima, insatisfação com a autoimagem, além de medos e inseguranças gerados pelos estigmas e discriminação contra HIV/AIDS. Em contrapartida a esse sentimento negativo, o preenchimento facial, se torna um marco importante e positivo, com o retorno da autoestima e melhora da autoimagem e melhora da adesão medicamentosa. Pudemos concluir que o oferecimento gratuito desse tratamento da lipoatrofia facial, aumentou a qualidade de vida desses portadores de HIV/AIDS, pois melhorou a aparência “distorcida”, ajudando-os a recuperar sua identidade e dignidade, preservando-os da discriminação e preconceito.

Nowadays we observe a higher control of AIDS, with the advent of anti-retroviral therapies, although people infected by HIV continue susceptible to a series of physical, psychological and social consequences. One of them is face lipoatrophy, caused by anti-retroviral treatments, which cause intense modifications in the face. A treatment considered and made available by SUS (Brazil’s Unified Health System), polymetilmetacrilate for skin filling. This article is the result of a research aiming at knowing how people infected by HIV/AIDS feel regarding facial lipoatrophy and the meaning of having skin filling. The study was developed through a qualitative methodology, with an intentional sample of eight individuals submitted to the skin filling treatment. Data treatment was carried through the Collective Subject Discourse and results had two important moments. The first is related to the presence of facial lipoatrophy, where central ideas demonstrate the reduction of self-esteem, non satisfaction with self-image, and fears and problems generated by stigmata and discrimination against HIV/AIDS. On the other hand this negative feeling about skin filling becomes an important and positive landmark with the return of self-esteem and improvements of self-imageand adhesion to treatment. We could conclude that free treatment of facial lipoatrophy increased the quality of life of subjects, improving their “distorted” appearance, helping them to rescue their identity and dignity, preserving them from discrimination and prejudice.

Observamos hoy en día un control más alto del SIDA, con el advenimiento de terapias antiretrovirales aunque la gente infectada por la SIDA continúe susceptible a una serie de consecuencias de la físicas, psicológicas y sociales. Una de ellas es la lipoatrofia de la cara, causada por los tratamientos antiretrovirales, que causan modificaciones intensas en la cara. Un tratamiento considerado e disponible por SUS (sistema unificado de la salud del Brasil) es el polimetilmetacrilato para el relleno de la piel. Este artículo es el resultado de una investigación que tiene como objetivo saber como la gente infectada por el SIDA siente acerca de la lipoatrofia facial y al significado de tener relleno de la piel. El estudio fue desarrollado con una metodología cualitativa, con una muestra intencional de ocho individuos sometidos al tratamiento de relleno de la piel. El tratamiento de los datos se hizo con el discurso del sujeto colectivo y los resultados tuvieran dos momentos importantes. El primer se relaciona con la presencia de lipoatrofia facial, donde las ideas centrales demuestran la reducción del amor propio, la no satisfacción con la auto-imagen, y miedos y problemas generados por los estigmas y la discriminación contra la SIDA. Esta sensación negativa sobre el relleno de la piel se convierte en una señal importante y positiva con la vuelta del amor propio y las mejoras de la auto-imagen y de la adherencia al tratamiento. Podríamos concluir que el tratamiento gratuito de la lipoatrofia facial aumentó la calidad de vida de los sujetos, mejorando su aspecto “torcido”, ayudándoles a rescatar su identidad y dignidad, preservándolas de la discriminación y del prejuicio.

[The usefulness of a genogram as a tool in therapeutic patient education: an exploratory study of parents of children living with HIV/AIDS in Benin]. / Utilité du génogramme dans l'éducation thérapeutique : une étude exploratoire auprès de parents d'enfants vivant avec le VIH/sida au Bénin.

Understanding family dynamics and relationship is an important facet of care, therapeutic education and psychosocial support. As part of a therapeutic education program organized within a pediatric service in Cotonou, Benin, we have experimented with the genogram at the time of diagnosis and tested it as an educational tool. This study evaluates the usefulness of the genogram for therapeutic patient education, and its capacity to serve as an aid to better understand family structure and dynamics. The study was conducted in 2007 with 29 parents of children living with HIV / AIDS. Six professionals observed the conditions for the development and application of the genograms their effects on the production of information of an educational nature. The results indicate that it can provide families and caregivers benchmarks essential for understanding the role of the family and community in which the child-patient is situated and how they function. It facilitates the identification of key resource persons for the child and selfcare to be mobilized and fostered within the family.