Abstract Background Reliable devices that quantitatively monitor the level of neuromuscular blockade after neuromuscular blocking agents’ administration are crucial. Electromyography and acceleromyography are two monitoring modalities commonly used in clinical practice. The primary outcome of this study is to compare the onset of neuromuscular blockade, defined as a Train-Of-Four Count (TOFC) equal to 0, as measured by an electromyography-based device (TetraGraph) and an acceleromyography-based device (TOFscan). The secondary outcome was to compare intubating conditions when one of these two devices reached a TOFC equal to 0. Methods One hundred adult patients scheduled for elective surgery requiring neuromuscular blockade were enrolled. Prior to induction of anesthesia, TetraGraph electrodes were placed over the forearm of patients’ dominant/non-dominant hand based on randomization and TOFscan electrodes placed on the contralateral forearm. Intraoperative neuromuscular blocking agent dose was standardized to 0.5 mg.kg−1 of rocuronium. After baseline values were obtained, objective measurements were recorded every 20 seconds and intubation was performed using video laryngoscopy once either device displayed a TOFC = 0. The anesthesia provider was then surveyed about intubating conditions. Results Baseline TetraGraph train-of-four ratios were higher than those obtained with TOFscan (Median: 1.02 [0.88, 1.20] vs. 1.00 [0.64, 1.01], respectively, p < 0.001). The time to reach a TOFC = 0 was significantly longer when measured with TetraGraph compared to TOFscan (Median: 160 [40, 900] vs. 120 [60, 300] seconds, respectively, p < 0.001). There was no significant difference in intubating conditions when either device was used to determine the timing of endotracheal intubation. Conclusions The onset of neuromuscular blockade was longer when measured with TetraGraph than TOFscan, and a train-of-four count of zero in either device was a useful indicator for adequate intubating conditions. Clinical trial number and registry URL NCT05120999, https://clinicaltrials.gov/ct2/show/NCT05120999. agents crucial practice TrainOfFour Train Of Four (TOFC electromyographybased electromyography (TetraGraph acceleromyographybased TOFscan. . (TOFscan) enrolled dominant/nondominant dominantnondominant dominant/non dominant non 05 5 mgkg1 mgkg mg kg 1 mg.kg− rocuronium 2 trainoffour train four Median (Median 102 02 1.0 0.88, 088 88 [0.88 1.20 vs 100 00 0.64, 064 64 [0.64 1.01, 101 1.01 , 01 1.01] respectively 0.001. 0001 0.001 001 0.001) 16 40, 40 [40 900 12 60, 60 [60 300 NCT05120999 NCT https//clinicaltrials.gov/ct2/show/NCT05120999. httpsclinicaltrialsgovct2showNCT05120999 httpsclinicaltrialsgovctshowNCT https //clinicaltrials.gov/ct2/show/NCT05120999. clinicaltrials gov ct2 show ct https://clinicaltrials.gov/ct2/show/NCT05120999 (TOFscan nondominant dominantnon mg.kg 10 1. 0.88 08 8 [0.8 1.2 0.64 06 6 [0.6 000 0.00 4 [4 90 [6 30 NCT0512099 https//clinicaltrials.gov/ct2/show/NCT05120999 httpsclinicaltrialsgovct showNCT httpsclinicaltrialsgovct2showNCT0512099 clinicaltrialsgovct2showNCT05120999 clinicaltrialsgovctshowNCT //clinicaltrials.gov/ct2/show/NCT05120999 https://clinicaltrials.gov/ct2/show/NCT0512099 0.8 [0. 0.6 0.0 [ 9 3 NCT051209 https//clinicaltrials.gov/ct2/show/NCT0512099 httpsclinicaltrialsgovct2showNCT051209 clinicaltrialsgovct clinicaltrialsgovct2showNCT0512099 //clinicaltrials.gov/ct2/show/NCT0512099 https://clinicaltrials.gov/ct2/show/NCT051209 [0 NCT05120 https//clinicaltrials.gov/ct2/show/NCT051209 httpsclinicaltrialsgovct2showNCT05120 clinicaltrialsgovct2showNCT051209 //clinicaltrials.gov/ct2/show/NCT051209 https://clinicaltrials.gov/ct2/show/NCT05120 NCT0512 https//clinicaltrials.gov/ct2/show/NCT05120 httpsclinicaltrialsgovct2showNCT0512 clinicaltrialsgovct2showNCT05120 //clinicaltrials.gov/ct2/show/NCT05120 https://clinicaltrials.gov/ct2/show/NCT0512 NCT051 https//clinicaltrials.gov/ct2/show/NCT0512 httpsclinicaltrialsgovct2showNCT051 clinicaltrialsgovct2showNCT0512 //clinicaltrials.gov/ct2/show/NCT0512 https://clinicaltrials.gov/ct2/show/NCT051 NCT05 https//clinicaltrials.gov/ct2/show/NCT051 httpsclinicaltrialsgovct2showNCT05 clinicaltrialsgovct2showNCT051 //clinicaltrials.gov/ct2/show/NCT051 https://clinicaltrials.gov/ct2/show/NCT05 NCT0 https//clinicaltrials.gov/ct2/show/NCT05 httpsclinicaltrialsgovct2showNCT0 clinicaltrialsgovct2showNCT05 //clinicaltrials.gov/ct2/show/NCT05 https://clinicaltrials.gov/ct2/show/NCT0 https//clinicaltrials.gov/ct2/show/NCT0 httpsclinicaltrialsgovct2showNCT clinicaltrialsgovct2showNCT0 //clinicaltrials.gov/ct2/show/NCT0 https://clinicaltrials.gov/ct2/show/NCT https//clinicaltrials.gov/ct2/show/NCT clinicaltrialsgovct2showNCT //clinicaltrials.gov/ct2/show/NCT

BACKGROUND: Stellenbosch University's (SU) Faculty of Medicine and Health Sciences (FMHS), developed a sexual health course to be integrated throughout the revised medical curriculum. AIM: To use the Sexual Health Education for Professionals Scale (SHEPS) to gather baseline and future follow-up data to inform curriculum development and evaluation. SETTING: The first-year medical students (N = 289) of the FMHS SU. METHODS: The SHEPS was answered before the start of the sexual health course. The knowledge, communication and attitude sections were answered with a Likert-type scale. Students had to describe their perceived confidence in their knowledge and communication skills to care for patients within specific sexuality-related clinical scenarios. The attitude section measured the students' level of agreement or disagreement on sexuality-related opinion statements. RESULTS: The response rate was 97%. Most students were female, and 55% of the class were first taught about sexuality in the age group 13-18 years. The students had more confidence in their communication skills than knowledge before any tertiary training. The attitude section revealed a binomial distribution, ranging from acceptance to a more restrictive attitude towards sexual behaviour. CONCLUSION: It is the first time the SHEPS has been used in a South African context. The results provide novel information about the range of perceived sexual health knowledge, skills and attitudes of first-year medical students before they start tertiary training CONTRIBUTION: Findings from this study will guide content development and evaluation of the sexual health course at the institution where the study was conducted, as well as allow for culture sensitive education.

Resumo Objetivo Existem poucos estudos multinacionais sobre os resultados do tratamento da neoplasia trofoblástica gestacional (NTG) na América do Sul. O objetivo deste estudo foi avaliar a apresentação clínica, os resultados do tratamento e os fatores associados a casos de quimiorresistência em NTG pós-molar de baixo risco tratados com quimioterapia de agente único de primeira linha em três centros sul-americanos. Métodos Estudo multicêntrico de coorte histórica incluindo mulheres com NTG pós-molar de baixo risco com estadiamento International Federation of Gynecology and Obstetrics (FIGO) em centros de atendimento na Argentina, Brasil e Colômbia entre 1990 e 2014. Foram obtidos dados sobre as características do paciente, apresentação da doença e resposta ao tratamento. A regressão logística foi usada para avaliar a relação entre fatores clínicos e resistência ao tratamento de primeira linha com agente único. Foi realizada uma análise multivariada dos fatores clínicos significativos na análise univariada. Resultados Cento e sessenta e três mulheres com NTG de baixo risco foram incluídas na análise. A taxa global de resposta completa à quimioterapia de primeira linha foi de 80% (130/163). As taxas de resposta completa ao metotrexato ou actinomicina-D como tratamento de primeira linha e actinomicina-D como tratamento de segunda linha após falha do metotrexato foram 79% (125/157), 83% (⅚) e 70% (23/33), respectivamente. A mudança para o tratamento de segunda linha por quimiorresistência ocorreu em 20,2% dos casos (33/163). A análise multivariada demonstrou que pacientes com pontuação de risco FIGO de 5 a 6 foram 4,2 vezes mais propensos a desenvolver resistência ao tratamento com agente único de primeira linha (p= 0,019). Conclusão 1) Na apresentação, a maioria das mulheres demonstrou características clínicas favoráveis a um bom resultado, 2) a taxa geral de remissão completa sustentada após o tratamento de primeira linha com agente único foi comparável à de países desenvolvidos, 3) um escore de risco FIGO de 5 ou 6 está associado ao desenvolvimento de resistência à quimioterapia de agente único de primeira linha.

Abstract Objective There are few multinational studies on gestational trophoblastic neoplasia (GTN) treatment outcomes in South America. The purpose of this study was to assess the clinical presentation, treatment outcomes, and factors associated with chemoresistance in low-risk postmolar GTN treated with first-line single-agent chemotherapy in three South American centers. Methods Multicentric, historical cohort study including women with International Federation of Gynecology and Obstetrics (FIGO)-staged low-risk postmolar GTN attending centers in Argentina, Brazil, and Colombia between 1990 and 2014. Data were obtained on patient characteristics, disease presentation, and treatment response. Logistic regression was used to assess the relationship between clinical factors and resistance to first-line single-agent treatment. A multivariate analysis of the clinical factors significant in univariate analysis was performed. Results A total of 163 women with low-risk GTN were included in the analysis. The overall rate of complete response to first-line chemotherapy was 80% (130/163). The rates of complete response to methotrexate or actinomycin-D as first-line treatment, and actinomycin-D as second-line treatment postmethotrexate failure were 79% (125/157), 83% (⅚), and 70% (23/33), respectively. Switching to second-line treatment due to chemoresistance occurred in 20.2% of cases (33/163). The multivariate analysis demonstrated that patients with a 5 to 6 FIGO risk score were 4.2-fold more likely to develop resistance to first-line single-agent treatment (p= 0.019). Conclusion 1) At presentation, most women showed clinical characteristics favorable to a good outcome, 2) the overall rate of sustained complete remission after first-line single-agent treatment was comparable to that observed in developed countries, 3) a FIGO risk score of 5 or 6 is associated with development of resistance to first-line single-agent chemotherapy.

BACKGROUND: Tanzania is a country experiencing multiple sexual health challenges, but providers receive no formal training in sexual health AIM: This study aimed to assess (1) what sexual health challenges are commonly seen in clinics in Tanzania, (2) which are raised by patients, (3) which are not addressed and (4) which topics to prioritise for a sexual health curriculum SETTING: Healthcare settings in Tanzania METHODS: Participants were 60 experienced and 61 student doctors, nurses and midwives working in Dar es Salaam. The authors conducted 18 focus groups stratified by profession (midwifery, nursing or medicine) and experience (practitioners vs. students RESULTS: Providers identified six common sexual health concerns: (1) Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and sexually transmissible infection (STI) (especially syphilis and gonorrhoea), (2) sexual violence (including intimate partner violence and female genital mutilation), (3) early and unwanted pregnancy (including early sexual debut and complications from abortion), (4) sexual dysfunctions, (5) key population concerns (e.g. lesbian, gay, bisexual, transgender (LGBT); sex work) and (6) non-procreative sexual behaviour (including pornography and masturbation in males and oral and anal sex practices in heterosexual couples). Across professions, few differences were observed. Homosexuality, sex work, masturbation and pornography were identified as taboo topics rarely discussed. Most participants (81%) wanted one comprehensive sexual health curriculum delivered across disciplines CONCLUSION: A sexual health curriculum for health students in Tanzania needs to address the most common sexual health concerns of patients. In addition to teaching sexual science and clinical care, skills training in how to address taboo topics is recommended. Students endorsed almost all sexual health topics, which suggests that a comprehensive curriculum is appropriate

BACKGROUND: Few data are available on the presence and characteristics of transgender populations in sub-Saharan Africa (SSA), which makes the provision of health services for key populations difficult. AIM: This study aimed to ascertain the presence and characteristics of trans women in seven cities in Tanzania, East Africa. SETTING: Tanzania, East Africa. METHODS: Outreach to men who have sex with men (MSM) in seven large cities in Tanzania was carried out by non-governmental organisation (NGO) staff familiar with this community. Survey questions administered via interviews were used to identify participants who self-identify as trans. From the self-identification data, an estimate of the relative size of the trans women population in this sample was calculated. RESULTS: In the sample of 300 participants, 17.0% of participants were identified as 'transsexual or transgender' (survey wording); 70.1% of these trans participants indicated that they identify themselves as a woman. Of those identifying themselves as transsexual or transgender, 43.1% reported living part- or full-time as a woman and eight (15.0%) reported hormone use. The highest percentage of hormone use (40.0%) was found in those living as a woman full-time. Notably, there was significant ignorance amongst the sample of the terms 'transsexual and transgender' or their explanation in Swahili, reported by interviewers. CONCLUSION: In this study, it is clear that trans women populations exist in Tanzania, with high levels of stigmatisation and threats to their lives. They should be included in health outreach and services to key populations. One in six self-identified as trans women, although the lack of knowledge of this concept in Swahili or English may have inaccurately represented numbers.

RESUMO Objetivo: examinar as experiências vivenciadas por parte de pessoas auto-identificadas como trans para acessar aos cuidados de saúde mental e, em particular, sua percepção de barreiras de acesso. Métodos: estudo qualitativo que utilizou a análise fenomenológica interpretativa (IPA) e a teoria Tanatopolítica de Giorgio Agamben como referencial teórico. Foram realizadas 11 entrevistas individuais e semi-estruturadas entre dezembro de 2009 e janeiro de 2010. Resultados: em nossa análise, identificamos as seguintes principais barreiras em relação ao acesso aos sistemas de saúde: desempenho dos profissionais de saúde e; as politicas de invisibilização e apagamento. Através das experiências analisadas, identificamos a existência de um despotismo panóptico (psiquiátrico) liderado por instituições de saúde, prestadores de cuidados de saúde e políticas públicas. A psiquiatria tanatopolítica e outras estratégias de apagamento passivo têm um impacto cumulativo porque os trans-corpos não são contados nem reconhecidos como indivíduos saudáveis com condições de saúde específicas. Conclusão: os achados demostram que, embora tenha havido algum progresso com relação ao acesso aos serviços de saúde canadense, ainda existem inúmeros desafios para superar as barreiras de acesso.

ABSTRACT Objective: to examine the lived experiences of trans-identified individuals accessing mental health care, and in particular, their perceptions of barriers to access. Method: this qualitative study was conducted using interpretative phenomenological analysis and supported by Agamben’s theory of Thanatopolitics. Eleven one-to-one, semi-structured interviews were conducted between December 2009 and January 2010. Results: in our analysis, we identified the following main barriers regarding access to the healthcare system: healthcare providers’ performance; and thanatopolitics of erasure. Through the analyzed experiences, we identified the existence of a (psychiatric) panoptical despotism lead by healthcare institutions, healthcare providers and public policies. Thanatopolitical psychiatrization and other passive erasure strategies have a cumulative impact because trans-bodies are not counted or not recognized fully as healthy individuals with specific health conditions. Conclusion: the findings show that although there has been some progress, numerous challenges still remain in order to overcome the barriers to accessing healthcare services.

RESUMEN Objetivo: examinar las experiencias vividas por los individuos auto-identificados como trans al accesar a los servicios de salud mental y, en particular, sus percepciones sobre las barreras de acceso. Método: este estudio cualitativo se realizó mediante el análisis interpretativo fenomenológico (IPA) y apoyado en la teoría Tanatopolítica de Giorgio Agamben. Se realizaron 11 entrevistas semiestructuradas entre diciembre de 2009 y enero de 2010. Resultados: en nuestro análisis, identificamos las siguientes principales barreras de acceso al sistema de salud: desempeño de los proveedores de servicios de salud y, la tanatopolítica de la invisibilización. A través de las experiencias analizadas, identificamos la existencia de un despotismo (psiquiátrico) panóptico liderado por instituciones sanitarias, proveedores de atención médica y políticas públicas. La psiquiatrización tanatopolítica y otras estrategias de invisibilización pasiva tienen un impacto acumulativo porque los trans-cuerpos no se cuentan o no se reconocen plenamente como individuos sanos con condiciones de salud específicas. Conclusión: los hallazgos muestran que si bien se han producido algunos avances en la materia, todavía quedan muchos desafíos por superar con relación a las barreras al acceso a los servicios de salud.

ABSTRACT Objective: to examine the lived experiences of trans-identified individuals accessing mental health care, and in particular, their perceptions of barriers to access. Method: this qualitative study was conducted using interpretative phenomenological analysis and supported by Agamben’s theory of Thanatopolitics. Eleven one-to-one, semi-structured interviews were conducted between December 2009 and January 2010. Results: in our analysis, we identified the following main barriers regarding access to the healthcare system: healthcare providers’ performance; and thanatopolitics of erasure. Through the analyzed experiences, we identified the existence of a (psychiatric) panoptical despotism lead by healthcare institutions, healthcare providers and public policies. Thanatopolitical psychiatrization and other passive erasure strategies have a cumulative impact because trans-bodies are not counted or not recognized fully as healthy individuals with specific health conditions. Conclusion: the findings show that although there has been some progress, numerous challenges still remain in order to overcome the barriers to accessing healthcare services.

RESUMEN Objetivo: examinar las experiencias vividas por los individuos auto-identificados como trans al accesar a los servicios de salud mental y, en particular, sus percepciones sobre las barreras de acceso. Método: este estudio cualitativo se realizó mediante el análisis interpretativo fenomenológico (IPA) y apoyado en la teoría Tanatopolítica de Giorgio Agamben. Se realizaron 11 entrevistas semiestructuradas entre diciembre de 2009 y enero de 2010. Resultados: en nuestro análisis, identificamos las siguientes principales barreras de acceso al sistema de salud: desempeño de los proveedores de servicios de salud y, la tanatopolítica de la invisibilización. A través de las experiencias analizadas, identificamos la existencia de un despotismo (psiquiátrico) panóptico liderado por instituciones sanitarias, proveedores de atención médica y políticas públicas. La psiquiatrización tanatopolítica y otras estrategias de invisibilización pasiva tienen un impacto acumulativo porque los trans-cuerpos no se cuentan o no se reconocen plenamente como individuos sanos con condiciones de salud específicas. Conclusión: los hallazgos muestran que si bien se han producido algunos avances en la materia, todavía quedan muchos desafíos por superar con relación a las barreras al acceso a los servicios de salud.

RESUMO Objetivo: examinar as experiências vivenciadas por parte de pessoas auto-identificadas como trans para acessar aos cuidados de saúde mental e, em particular, sua percepção de barreiras de acesso. Métodos: estudo qualitativo que utilizou a análise fenomenológica interpretativa (IPA) e a teoria Tanatopolítica de Giorgio Agamben como referencial teórico. Foram realizadas 11 entrevistas individuais e semi-estruturadas entre dezembro de 2009 e janeiro de 2010. Resultados: em nossa análise, identificamos as seguintes principais barreiras em relação ao acesso aos sistemas de saúde: desempenho dos profissionais de saúde e; as politicas de invisibilização e apagamento. Através das experiências analisadas, identificamos a existência de um despotismo panóptico (psiquiátrico) liderado por instituições de saúde, prestadores de cuidados de saúde e políticas públicas. A psiquiatria tanatopolítica e outras estratégias de apagamento passivo têm um impacto cumulativo porque os trans-corpos não são contados nem reconhecidos como indivíduos saudáveis com condições de saúde específicas. Conclusão: os achados demostram que, embora tenha havido algum progresso com relação ao acesso aos serviços de saúde canadense, ainda existem inúmeros desafios para superar as barreiras de acesso.

Resumen Este estudio tuvo como objetivo analizar la mortalidad por VIH/sida en Cali, Colombia, en el periodo 1986-2012, y a partir de ahí, comprender, desde el punto de vista conceptual, los determinantes sociales relacionados. Se llevó a cabo un estudio observacional, longitudinal, retrospectivo, con un total de 14 192 casos. Se encontró una tendencia creciente de la tasa de mortalidad, en especial a partir del año 1996; en el 2011 se presentó la mayor tasa de todo el periodo. La medición de la desigualdad reveló que se han producido más muertes en estratos medios y bajos, en comparación con el estrato alto. Este estudio aporta evidencia sobre las desigualdades persistentes en la mortalidad por VIH/sida como expresión de inequidades de tipo estructural en la ciudad de Cali. En la perspectiva de Breilh, son procesos críticos de determinación económica y social que pudieron afectar la mortalidad, especialmente de los grupos con más vulnerados socialmente.

Abstract The purpose of this study was to analyze the mortality due to HIV/Aids in Cali, Colombia, in the 1986-2012 period, and, from there, understand from a conceptual point of view the related social determinants. We carried out a retrospective observational longitudinal study with a total of 14,192 cases. We found a growing tendency in the mortality rate, particularly starting in 1996. The higher rate for the whole period was seen in 2011. The inequality measure revealed a higher number of deaths in lower and middle social strata, when compared with the high strata. This study provides evidence on the persistent inequalities in the mortality due to HIV/Aids, as an expression of the structural inequalities present in Cali. In Breilh’s perspective, critical social and economic determination processes could have affected mortality, especially in the groups whose social rights have been violated the most.

Resumo Este estudo teve como objetivo analisar a mortalidade por VIH/sida em Cali, Colômbia, no período 19862012, e a partir daí, compreender desde o ponto de vista conceitual, as determinantes sociais relacionadas. Um estudo observacional, longitudinal, retrospectivo, com um total de 14 192 casos foi realizado. Encontrara-se uma tendência crescente da taxa de mortalidade, em especial a partir do ano 1996; no ano 2011 apresentou-se a maior taxa do período tudo. A medição da desigualdade revelou que foram produzidas mais mortes nas camadas sociais medias e baixas, em comparação com as altas. Este estudo fornece evidencia sobre as desigualdades persistentes na mortalidade por VIH/sida, como expressão de iniquidades de tipo estrutural na cidade de Cali. Na perspectiva de Breilh, são processos críticos de determinação económica e social que puderam afetar a mortalidade, especialmente dos grupos com mais vulnerados socialmente.

Los adolescentes latinos de Estados Unidos presentan tasas de natalidad más altas y mayores probabilidades de iniciación sexual temprana en comparación con adolescentes de otros grupos raciales-étnicos. Entender las razones de los jóvenes latinos para retrasar o iniciar el coito vaginal por primera vez es importante en el diseño de programas de promoción de salud culturalmente relevantes. En el presente estudio cualitativo se realizaron 21 entrevistas semiestructuradas con adolescentes latinos sobre las razones para iniciarse o abstenerse de practicar el coito vaginal por primera vez. Siete de los participantes habían debutado sexualmente y 14 se habían abstenido de hacerlo. Quienes se habían iniciado reconocieron haberlo hecho por curiosidad, deseo sexual y por placer, pero admitieron haberse iniciado sexualmente en el contexto de una relación romántica con su pareja. Quienes se habían abstenido reportaron razones personales (no sentirse preparados, esperar hasta el matrimonio, temor de adquirir una infección sexualmente transmisible o de quedar embarazada) y también citaron fuentes externas de prohibición (padres y religión). Ocho de los 14 adolescentes también atribuyeron el haberse abstenido al no haber establecido una relación romántica todavía. El análisis de los resultados sugiere que los adolescentes latinos de los Estados Unidos con características similares a la muestra estudiada tienen los conocimientos y están dispuestos a tomar decisiones razonadas sobre su iniciación sexual.

US Latino adolescents have higher teenage birthrates and higher probabilities for early sexual initiation, compared to other racial/ethnic groups. Understanding their reasons for delaying or initiating first-time vaginal intercourse is important in designing culturally relevant health promotion programs. Using qualitative methods, we analyzed 21 semi-structured interviews with US Latino adolescents regarding their sexual initiations. Seven had sexually debuted, acknowledging sexual feelings of desire, curiosity and pleasure for their romantic partner. The remaining 14 had not debuted citing reasons of self-interest and external prohibitive factors. Eight out of 14 also attributed their status to not being in a romantic relationship. Our findings suggest several areas for increased discussion including how romantic relationships and Latino cultural values influence sexual initiation and the use of contraception. These findings could improve health promotion programs by identifying critical elements that may resonate with US Latino adolescent socio-cultural values and sexual development.

OBJECTIVE: To assess and analyze the associations between adherence to treatment and social position in women living with HIV/AIDS. METHOD: A cross-sectional, descriptive, correlational study among 269 Colombian women was conducted. Participants completed three questionnaires: a socio-demographic and clinical characteristics survey, a treatment adherence scale, and a social position survey. RESULTS: Women of low social position had a significantly higher probability of low treatment adherence (OR = 5.651, P < 0.0001), and the majority of social position variables measured had a significant effect on adherence. A general model considering the variables "type of national health care plan" ("contributive," "subsidized," or, in the case of vinculadas or the uninsured, "none"); "having HIV-positive children"; and "level of viral load" was statistically reliable in predicting study participants' treatment adherence. Membership in the subsidized plan or being uninsured had a greater effect on the probability of low adherence than membership in the contributive plan (OR = 3.478, P < 0.0001). Univariate regression analyses confirmed that women with HIV-positive children and a viral load > 400 copies/ml were more likely to have low adherence than women without those characteristics (OR = 2.395, P = 0.0274 and OR = 2.178, P = 0.0050, respectively). CONCLUSIONS: Improving women's adherence to HIV/AIDS treatment in Colombia would require eliminating barriers to national health care system and comprehensive health care services and implementing programs that take into account women's role as maternal caregivers The findings underscore the need to integrate variables related to gender inequality and social position in treatment adherence analysis, as advocated in the social determinants of health approach.

OBJETIVO: Evaluar y analizar las asociaciones existentes entre la adhesión al tratamiento y la posición social de las mujeres con VIH/sida. MÉTODOS: Se realizó un estudio transversal, descriptivo y correlacional con 269 colombianas. Las participantes respondieron tres cuestionarios: uno sobre las características sociodemográficas y clínicas, uno sobre su posición social y una escala sobre la adhesión al tratamiento. RESULTADOS: Las mujeres de baja posición social tenían una mayor probabilidad de presentar baja adhesión al tratamiento (OR = 5,651; P < 0,0001); la mayoría de las variables de posición social influyeron significativamente sobre la adhesión. Un modelo general con las variables "tipo de plan nacional de salud" ("contributivo", "subsidiado" o, en las vinculadas y las no aseguradas, "ninguno"), "tener hijos positivos al VIH" y "nivel de carga viral" resultó estadísticamente fiable para predecir la adhesión al tratamiento. Ser miembro del plan subsidiado o no tener seguro influyeron más en la probabilidad de baja adhesión al tratamiento que ser miembro del plan contributivo (OR = 3,478; P < 0,0001). El análisis de regresión monofactorial confirmó que las mujeres con hijos positivos al VIH o carga viral > 400 copias/mL tenían mayor probabilidad de presentar baja adhesión que las mujeres sin esas características (OR = 2,395; P = 0,0274 y OR = 2,178; P = 0,005, respectivamente). CONCLUSIONES: Mejorar la adhesión de las mujeres al tratamiento para el VIH/sida en Colombia requiere eliminar barreras al sistema nacional de salud, brindar servicios integrales e implementar programas que tomen en cuenta el papel de las mujeres como madres cuidadoras de enfermos. Estos resultados subrayan la necesidad de integrar variables relacionadas con la inequidad de género y la posición social al análisis de la adhesión al tratamiento, como promueve el enfoque de determinantes sociales de la salud.

Os autores fazem uma revisão do papel das variáveis situacionais nos comportamentos de risco para a saúde, assim como, da literatura sobre os impactos do contexto e da situação na saúde pública. São apresentados três postulados para um modelo situacional: que a situação possa explicar a variância adicional nos comportamentos de risco; que o poder da situação seja recíproca em relação ao grau de autonomia individual e que a situação possa ser definida e mensurada. Uma metodologia situacional é apresentada para medir as situações na saúde pública a partir de dados preliminares sobre sua eficácia no contexto do comportamento sexual e uso de drogas injetáveis como fatores de risco para a transmissão do HIV. São discutidas intervenções que maximizam o uso da informação com base situacional. Conclui-se que as apresentações situacionais podem oferecer poder explanatório adicional na saúde pública, assim como, servir como meio para intervir ao nível situacional.

This paper reviews the role of situational variables in health risk behaviors and the literature on the impact of context and situation in public health. Three postulates for a situational model are presented: that the situation can account for additional variance in explanation of health risk behaviors; that the power of the situation is reciprocal to the degree of individual autonomy; and that the situation is definable and measurable. A situational presentation methodology is presented for measuring situations in public health with preliminary data on its efficacy in the context of sexual behavior and injecting drug use as HIV transmission risks. Interventions which maximize the use of situationally-based information are discussed. It is concluded that situational presentations may offer additional explanatory power in public health and a means for intervening at a situational level.

Os autores fazem uma revisão do papel das variáveis situacionais nos comportamentos de risco para a saúde, assim como, da literatura sobre os impactos do contexto e da situação na saúde pública. São apresentados três postulados para um modelo situacional: que a situação possa explicar a variância adicional nos comportamentos de risco; que o poder da situação seja recíproca em relação ao grau de autonomia individual e que a situação possa ser definida e mensurada. Uma metodologia situacional é apresentada para medir as situações na saúde pública a partir de dados preliminares sobre sua eficácia no contexto do comportamento sexual e uso de drogas injetáveis como fatores de risco para a transmissão do HIV. São discutidas intervenções que maximizam o uso da informação com base situacional. Conclui-se que as apresentações situacionais podem oferecer poder explanatório adicional na saúde pública, assim como, servir como meio para intervir ao nível situacional.

This paper reviews the role of situational variables in health risk behaviors and the literature on the impact of context and situation in public health. Three postulates for a situational model are presented: that the situation can account for additional variance in explanation of health risk behaviors; that the power of the situation is reciprocal to the degree of individual autonomy; and that the situation is definable and measurable. A situational presentation methodology is presented for measuring situations in public health with preliminary data on its efficacy in the context of sexual behavior and injecting drug use as HIV transmission risks. Interventions which maximize the use of situationally-based information are discussed. It is concluded that situational presentations may offer additional explanatory power in public health and a means for intervening at a situational level.