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Huang C, Ye L, Abdullah AS, Liang B, Jiang J, Ning C, Zang N, Zhang Y, Yang Y, Hu X, Yang Q, Luo C, Lao F, Liu H, Liang H, Huang J. No Increase in HIV Drug Resistance Mutations among Injecting Drug Users on Methadone Maintenance Therapy: A Prospective Cohort Study. Curr HIV Res 2020; 18:362-372. [PMID: 32652910 DOI: 10.2174/1570162x18666200712173630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Whether HIV-positive injecting drug users (IDUs) are at higher risk of developing drug resistance mutations (DRMs) after methadone maintenance therapy (MMT) than any other HIV-positive population is unclear. OBJECTIVE To compare the incidence of new DRMs in two population groups: antiretroviraltreatment (ART) HIV-positive IDUs and non-drug users. METHODS A prospective cohort of ART HIV-positive patients including IDUs who received MMT (MMT group) and non-drug users (N-MMT group) was established from April 2016 to December 2017 in Guangxi, China. RESULTS Of the 80 participants, 43 were in the MMT group and 37 were in the N-MMT group. Compared with the N-MMT group, the HRs of PIs, NRTIs and NNRTIs for new DRMs in the MMT group was 1.55 (95%CI: 0.28-8.64; P = 0.616), 1.51 (95%CI: 0.44-5.20; P = 0.512) and 0.45 (95%CI: 0.15-1.35; P = 0.155), respectively. There was no dose-response relationship between MMT and new DRMs for PIs, NRTIs and NNRTIs (P > 0.05). The new DRM incidence for NRTIs (138.23 per 104 person-months) was higher than for PIs (94.16 per 104 person-months) and NNRTIs (95.41per 104 person-months) in the MMT group, while the new DRM incidence for NNRTIs (208.24 per 104 person-months) was higher than for PIs (44.13 per 104 person-months) and NRTIs (91.78 per 104 person-months) in the N-MMT group. CONCLUSION Among ART HIV-positive patients, there is no significant difference in the incidence of new DRMs between IDUs receiving MMT and non-drug users. MMT has little impact on the development of DRMs among IDUs.
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Affiliation(s)
- Chunyuan Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Abu S Abdullah
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Chuanyi Ning
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University,
Nanning 530021, Guangxi, China
| | - Ning Zang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University,
Nanning 530021, Guangxi, China
| | - Yu Zhang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Yuan Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Xi Hu
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Quanlue Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Chaolian Luo
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University,
Nanning 530021, Guangxi, China
| | - Feixiang Lao
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
| | - Huifang Liu
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University,
Nanning 530021, Guangxi, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University,
Nanning 530021, Guangxi, China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Universities Key Laboratory of Prevention and
Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China
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Mehmood A, Abduljabbar T, Al-Hamoudi N, Gholamiazizi E, Kellesarian SV, Vohra F, Javed F. Self-perceived oral symptoms and periodontal status among young intravenous heroin addicts: A cross-sectional case-control study. J Periodontol 2019. [PMID: 29520791 DOI: 10.1002/jper.17-0495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND It is hypothesized that (a) self-perceived oral symptoms (OSs) are worse in intravenous heroin addicts (IHA) than controls; and (b) clinical periodontal inflammatory parameters (plaque index [PI], bleeding on probing [BOP], PD and clinical attachment loss [AL]), number of missing teeth (MT), and radiographic marginal bone loss (MBL) are higher in IHA compared with controls. The aim was to compare the self-perceived OSs and periodontal parameters among young IHA and controls. METHODS Sociodemographic data, self-perceived OSs and duration and daily frequency of intravenous heroin use was gathered using a structured questionnaire. Full-mouth PI, BOP, PD, and clinical AL were measured, and number of MT were recorded. Mesial and distal MBL on all teeth was measured on digital radiographs. Odds ratios (OR) with 95% confidence intervals (CI) were computed for self-perceived OSs and periodontal parameters were assessed using the Mann Whitney U-test and logistic regression analysis. Sample-size was estimated, and level of significance was set at P < 0.05. RESULTS OR (95% CI) for self-perceived loose teeth (P < 0.001), pain in teeth (P < 0.001), dry mouth (P < 0.001), burning sensation in mouth (P < 0.001), bleeding gums (P < 0.001) and pain during chewing (P < 0.001) were significantly higher in the test than control group. Number of MT (P < 0.05), PI (P < 0.05), clinical AL (P < 0.05), and mesial (P < 0.05) and distal (P < 0.05) MBL were statistically significantly higher among individuals in the test group compared with the control group. CONCLUSION Self-perceived OSs and periodontal inflammatory parameters were worse in IHA than controls.
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Affiliation(s)
- Abid Mehmood
- Department of Dentistry, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Tariq Abduljabbar
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Eng. Abdullah Bugshan research chair for Dental and Oral Rehabilitation, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nawwaf Al-Hamoudi
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Fahim Vohra
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Eng. Abdullah Bugshan research chair for Dental and Oral Rehabilitation, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Fawad Javed
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, NY
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Khademi N, Reshadat S, Zanganeh A, Saeidi S, Ghasemi S, Zakiei A. Identifying HIV distribution pattern based on clustering test using GIS software, Kermanshah, Iran. HIV & AIDS REVIEW 2016. [DOI: 10.1016/j.hivar.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Reyes-Urueña J, Brugal MT, Majo X, Domingo-Salvany A, Caylà JA. Cross sectional study of factors associated to self-reported blood-borne infections among drug users. BMC Public Health 2015; 15:1122. [PMID: 26566634 PMCID: PMC4644320 DOI: 10.1186/s12889-015-2442-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/22/2015] [Indexed: 11/16/2022] Open
Abstract
Background The study’s aim was to estimate the self-reported prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV), and to describe their associated risk factors in a population of users of illicit drugs recruited in Catalonia- Spain, during 2012. Methods Cross-sectional study. People with illicit drugs use were selected in three different types of healthcare centres. The questionnaire was a piloted, structured ad hoc instrument. An analysis was made to identify factors associated to self-reported HCV, HIV and co-infection. Correlates of reported infections were determined using univariate and multivariate Poisson regression (with robust variance). Results Among 512 participants, 39.65 % self-reported positive serostatus for HCV and 14.84 % for HIV, co-infection was reported by 13.48 %. Among the 224 injecting drug users (IDUs), 187 (83.48 %), 68 (30.36 %) and 66 (29.46 %) reported being positive for HCV, HIV and co-infection, respectively. A higher proportion of HIV-infected cases was observed among women, (18.33 % vs. 13.78 % in men). Prevalence of HCV, HIV and co-infection were higher among participants with early onset of drug consumption, long periods of drug injection or who were unemployed. A positive serostatus was self-reported by 21(7.34 %) participants who did not report any injection; among them 16 and eight, reported being positive for HCV and HIV, respectively; three reported co-infection. Only two people declared exchanging sex for money. For those that reported a negative test, the median time since the last HIV test was 11.41 months (inter-quartile range (IQR) 4–12) and for the HCV test was 4.5 months (IQR 2–7). Conclusions Among drug users in Catalonia, HIV, HCV and co-infection prevalence are still a big issue especially among IDUs. Women and drug users who have never injected drugs are groups with a significant risk of infection; this might be related to their high-risk behaviours and to being unaware of their serological status.
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Affiliation(s)
- Juliana Reyes-Urueña
- Department of Paediatrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain. .,Drug Use Epidemiology Research Group, IMIM-Hospital del Mar Medical Research Institute, Dr Aiguader 88, 08003, Barcelona, Spain. .,Teaching Unit of Preventive Medicine and Public Health, PSMAR-UPF-ASPB, Barcelona, Spain. .,Public Health Agency of Barcelona, Barcelona, Spain.
| | - M Teresa Brugal
- Public Health Agency of Barcelona, Barcelona, Spain. .,Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Xavier Majo
- Department of Health Government of Catalonia, Barcelona, Spain.
| | - Antonia Domingo-Salvany
- Drug Use Epidemiology Research Group, IMIM-Hospital del Mar Medical Research Institute, Dr Aiguader 88, 08003, Barcelona, Spain.
| | - Joan A Caylà
- Department of Paediatrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain. .,Public Health Agency of Barcelona, Barcelona, Spain. .,Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain. .,CIBER in Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Budambula V, Musumba FO, Webale MK, Kahiga TM, Ongecha-Owuor F, Kiarie JN, Sowayi GA, Ahmed AA, Ouma C, Were T. HIV-1 protease inhibitor drug resistance in Kenyan antiretroviral treatment-naive and -experienced injection drug users and non-drug users. AIDS Res Ther 2015; 12:27. [PMID: 26279669 PMCID: PMC4537595 DOI: 10.1186/s12981-015-0070-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/07/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although injection drug use drives antiretroviral drug resistance, the prevalence of protease inhibitor (PI) resistance among Kenyan IDUs remains undetermined. We, therefore, explored PI resistance mutations and their association with viral load and CD4+ T cell counts in HIV-1 infected IDUs (ART-naive, n = 32; and -experienced, n = 47) and non-drug users (ART-naive, n = 21; and -experienced, n = 32) naive for PI treatment from coastal Kenya. RESULTS Only IDUs harboured major PI resistance mutations consisting of L90M, M46I and D30 N among 3 (6.4 %) ART-experienced and 1 (3.1 %) -naive individuals. Minor PI mutations including A71T, G48E, G48R, I13V, K20I, K20R, L10I, L10V, L33F, L63P, T74S, V11I, and V32L were detected among the ART-experienced (36.2 vs. 46.9 %) and -naive (43.8 vs. 66.7 %) IDUs and non-drug users, respectively. All the four IDUs possessing major mutations had high viral load while three presented with CD4+ T cell counts of <500 cells/ml. Among the ART-naive non-drug users, CD4+ T cell counts were significantly lower in carriers of minor mutations compared to non-carriers (P < 0.05). CONCLUSION Transmitted drug resistance may occur in IDUs underscoring the need for genotyping resistance before initiating PI treatment.
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Affiliation(s)
- Valentine Budambula
- />Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Francis O. Musumba
- />Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya
- />Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mark K. Webale
- />Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya
| | - Titus M. Kahiga
- />Department of Pharmacy and Complementary Medicine, Kenyatta University, Nairobi, Kenya
| | - Francisca Ongecha-Owuor
- />Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| | - James N. Kiarie
- />Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - George A. Sowayi
- />Department of Medical Laboratory Sciences, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | | | - Collins Ouma
- />Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya
- />Health Challenges and Systems Program, African Population and Health Research Centre, Nairobi, Kenya
| | - Tom Were
- />Department of Medical Laboratory Sciences, Masinde Muliro University of Science and Technology, P. O. Box 190, Kakamega, 50100 Kenya
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Fagundes LJ, Vieira EE, Moysés ACMC, Lima FDD, Morais FRBD, Vizinho NL. Sexually transmitted diseases in a specialized STD healthcare center: epidemiology and demographic profile from January 1999 to December 2009. An Bras Dermatol 2014; 88:523-9. [PMID: 24068122 PMCID: PMC3760926 DOI: 10.1590/abd1806-4841.20132149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 10/16/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sexually Transmitted Diseases are still considered a serious public health problem in Brazil and worldwide. OBJECTIVE To examine Sexually Transmitted Diseases prevalence and the sickness impact profile of STDs in a reference health center specializing in the treatment of Sexually Transmitted Diseases. METHOD We collected epidemiological, demographic, clinical and laboratory data from the medical records and interviews of 4,128 patients who had attended the center from January 1999 to December 2009. RESULTS Male patients outnumbered (76%) females (24%), Caucasians outnumbered (74.3%) those of mixed race (14.8%), blacks (10.8%) and Asians (0.1%). STD occurrence was higher in the 20-29 age group (46.2%) This population included 34.7% high school graduates, 8.7% college graduates and 0.8% illiterates. As for affective-sexual orientation, 86.5% were heterosexual, 7.8% homosexual and 5.5% bisexual. Regarding patients' sexual practices over the previous 30 days, 67.7% reported sexual intercourse with one person, 8.6% had had sex with two persons and 3.9%, with three or more people. The highest incidence of STD was condyloma acuminata, affecting 29.4% of all the patients, genital candidiasis 14.2%, and genital herpes 10.6%. Of the 44.3% who submitted to serologic testing for HIV detection 5% were positive, with a ratio of 6.8 males to 1 female. CONCLUSIONS STD prevalence remains high in Brazil and it is necessary to invest in early detection, prevention and treatment.
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Affiliation(s)
- Luiz Jorge Fagundes
- Escola Geraldo de Paula Souza Health Center, Faculty of Public Health, University of São Paulo, São PauloSP, Brazil
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Friedman SR, West BS, Tempalski B, Morton CM, Cleland CM, Des Jarlais DC, Hall HI, Cooper HLF. Do metropolitan HIV epidemic histories and programs for people who inject drugs and men who have sex with men predict AIDS incidence and mortality among heterosexuals? Ann Epidemiol 2014; 24:304-11. [PMID: 24529517 DOI: 10.1016/j.annepidem.2014.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/09/2014] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE We focus on a little-researched issue-how human immunodeficiency virus (HIV) epidemics and programs in key populations in metropolitan areas affect epidemics in other key populations. We consider (1) How are earlier epidemics among people who inject drugs (PWID) and men who have sex with men (MSM) related to later AIDS incidence and mortality among heterosexuals?; (2) Were prevention programs targeting PWID or MSM associated with lower AIDS incidence and mortality among heterosexuals?; and (3) Was the size of the potential bridge population of noninjecting drug users (NIDUs) in a metropolitan area associated with later AIDS incidence and mortality among heterosexuals? METHODS Using data for 96 large U.S. metropolitan areas, Poisson regression assessed associations of population prevalences of HIV-infected PWID and MSM (1992); NIDU population prevalence (1992-1994); drug use treatment coverage for PWID (1993); HIV counseling and testing coverage for MSM and for PWID (1992); and syringe exchange presence (2000) with CDC data on AIDS incidence and mortality among heterosexuals in 2006-2008, with appropriate socioeconomic controls. RESULTS Population density of HIV+ PWID and of NIDUs were positively related, and prevention programs for PWID negatively related to later AIDS incidence among heterosexuals and later mortality among heterosexuals living with AIDS. HIV+ MSM population density and prevention programs for MSM were not associated with these outcomes. CONCLUSIONS Efforts to reduce HIV transmission among PWID and NIDUs may reduce AIDS and AIDS-related mortality among heterosexuals. More research is needed at metropolitan area, network, and individual levels into HIV bridging across key populations and how interventions in one key population affect HIV epidemics in other key populations.
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Affiliation(s)
- Samuel R Friedman
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Brooke S West
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY
| | - Barbara Tempalski
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY
| | - Cory M Morton
- Institute of Infectious Disease Research, National Development and Research Institutes, Inc., New York, NY
| | | | | | - H Irene Hall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hannah L F Cooper
- Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
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The Brazilian Drug Policy Situation: The Public Health Approach Based on Research Undertaken in a Developing Country. Public Health Rev 2013. [DOI: 10.1007/bf03391706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Economic and political instability and related "big events" are widespread throughout the globe. Although they sometimes lead to epidemic HIV outbreaks, sometimes they do not-and we do not understand why. Current behavioural theories do not adequately address these processes, and thus cannot provide optimal guidance for effective intervention. Based in part on a critique of our prior "pathways" model of big events, we suggest that cultural-historical activity theory (CHAT) may provide a useful framework for HIV research in this area. Using CHAT concepts, we also suggest a number of areas in which new measures should be developed to make such research possible.
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Bastos FI. Structural violence in the context of drug policy and initiatives aiming to reduce drug-related harm in contemporary Brazil: a review. Subst Use Misuse 2012. [PMID: 23186486 DOI: 10.3109/10826084.2012.705678] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Brazil, the 6th largest world economy, has experienced rapid economic, demographic, and social structural changes during the last decade. Notwithstanding, Brazil being one of the most unequal societies worldwide, 40 million of 200 million Brazilians have moved from poverty to middle-class standards during this period. This review analyzes the success of different Brazilian initiatives aiming to reduce drug consumption-related harms, as well as the failed attempts to curb structural violence, despite some very recent initiatives have yet to be fully implemented and evaluated.
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Elias LDA, Bastos FI. Saúde pública, redução de danos e a prevenção das infecções de transmissão sexual e sanguínea: revisão dos principais conceitos e sua implementação no Brasil. CIENCIA & SAUDE COLETIVA 2011; 16:4721-30. [DOI: 10.1590/s1413-81232011001300021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 01/23/2010] [Indexed: 11/22/2022] Open
Abstract
Este artigo aborda o contexto histórico e o marco conceitual da implantação dos programas de redução de danos no campo da saúde pública, com ênfase nos programas brasileiros. A presente revisão teve como objetivo principal investigar a pertinência atual de tais programas no enfrentamento das infecções de transmissão sexual e sanguínea, em especial, a AIDS e a hepatite C. Os resultados sistematizados pela literatura nacional e internacional indicam que as ações práticas de redução de danos são mais efetivas quando integradas a outras medidas de saúde pública, guiadas por princípios em comum. Iniciativas de redução de danos afinadas com princípios de saúde pública não se prendem a modelos, nem se esgotam em cuidados de saúde propriamente ditos. Abrangem diversas modalidades de ações pragmáticas, com base em políticas públicas, devem estar em sintonia com a comunidade desde seu planejamento, e serem executadas em parceria com esta.
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AIDS morbidity and mortality in Brazilian children before and after highly active antiretroviral treatment implementation: an assessment of regional trends. Pediatr Infect Dis J 2011; 30:773-7. [PMID: 21502903 DOI: 10.1097/inf.0b013e31821b11ab] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this study was to analyze regional trends over time of acquired immunodeficiency syndrome (AIDS) cases and deaths in Brazilian children, before and after implementation of free access to highly active antiretroviral treatment (HAART). METHODS We performed a nation-wide study with an ecologic design and a time-series analysis of AIDS incidence and mortality rates in children (0-12 years of age), using polynomial regression models. Data were obtained from official national databases on age group, residence region, and year of AIDS diagnosis and death (1984-2008). RESULTS Between 1984 and 2008, 14,314 (2.7%) AIDS cases and 5041 deaths (2.3% of all AIDS-related deaths) were reported in Brazilian children. Incidence after 1996 was reduced by 23%, as compared with the pre-HAART era. The mortality rate observed in the HAART era was reduced by 63.6%. There was a significant reduction in the incidence in the Southeast and Central-West regions (P < 0.001), but the less industrialized North region showed an increase in the pre-HAART era (P < 0.001), and the Northeast region showed a stabilization trend (P < 0.001). In the South region, the incidence of AIDS increased in the 0 to 4 years subgroup. A reduction of AIDS mortality in the Southeast (P < 0.001), South, and Central-West regions (P < 0.001) was seen, but the Northeast and North regions maintained an increasing mortality trend (P < 0.001). CONCLUSIONS Despite the overall reduction in AIDS-related cases and deaths among children in Brazil since HAART, marked regional differences continue to exist. These reflect structural factors, different transmission dynamics, and operational issues. There is a need for improving the health service network with special emphasis on the less developed regions.
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Cremonese C, Backes V, Olinto MTA, Dias-da-Costa JS, Pattussi MP. Neighborhood sociodemographic and environmental contexts and self-rated health among Brazilian adults: a multilevel study. CAD SAUDE PUBLICA 2011; 26:2368-78. [PMID: 21243231 DOI: 10.1590/s0102-311x2010001200015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 08/02/2010] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the association between sociodemographic and environmental contexts on self-rated health. A population-based cross-sectional study with a random sample of 38 neighborhoods (census tracts) and 1,100 adults was carried out. Data analysis used multilevel logistic regression. Data from the Brazilian Census of 2000, mean income, years of study of the head of household and mean number of residents per tract were R$955 (SD = 586), 8 years (SD = 3), and 746 residents (SD = 358) respectively. Higher prevalences of fair/poor self-rated health were found in neighborhoods with greater populations and lower income/schooling levels. After control for individual variables, the odds for fair/poor self-rated health was twice as high in more populous (OR = 2.04; 95%CI: 1.15-3.61) and lower-income neighborhoods (OR = 2.29; 95%CI: 1.16-4.50) compared to less populous, higher-income ones. Self-rated health depends on individual characteristics and the sociodemographic context of neighborhoods.
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Affiliation(s)
- Cleber Cremonese
- Programa de Pós-graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brasil
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Barreto ML, Teixeira MG, Bastos FI, Ximenes RAA, Barata RB, Rodrigues LC. Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs. Lancet 2011; 377:1877-89. [PMID: 21561657 DOI: 10.1016/s0140-6736(11)60202-x] [Citation(s) in RCA: 183] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite pronounced reductions in the number of deaths due to infectious diseases over the past six decades, infectious diseases are still a public health problem in Brazil. In this report, we discuss the major successes and failures in the control of infectious diseases in Brazil, and identify research needs and policies to further improve control or interrupt transmission. Control of diseases such as cholera, Chagas disease, and those preventable by vaccination has been successful through efficient public policies and concerted efforts from different levels of government and civil society. For these diseases, policies dealt with key determinants (eg, the quality of water and basic sanitation, vector control), provided access to preventive resources (such as vaccines), and successfully integrated health policies with broader social policies. Diseases for which control has failed (such as dengue fever and visceral leishmaniasis) are vector-borne diseases with changing epidemiological profiles and major difficulties in treatment (in the case of dengue fever, no treatment is available). Diseases for which control has been partly successful have complex transmission patterns related to adverse environmental, social, economic, or unknown determinants; are sometimes transmitted by insect vectors that are difficult to control; and are mostly chronic diseases with long infectious periods that require lengthy periods of treatment.
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Affiliation(s)
- Mauricio L Barreto
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
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Ramos AN, Matida LH, Hearst N, Heukelbach J. AIDS in Brazilian children: history, surveillance, antiretroviral therapy, and epidemiologic transition, 1984-2008. AIDS Patient Care STDS 2011; 25:245-55. [PMID: 21413856 DOI: 10.1089/apc.2010.0378] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We present a systematic review of historical, political, and epidemiologic aspects of AIDS in Brazilian children. Over 25 years, Brazil has developed different strategies to control AIDS in children. Three revisions of criteria for defining AIDS cases in children and nine national guidelines on antiretroviral therapy administration for management of HIV infection were published. These guidelines represent important progress, including aspects of HIV/AIDS surveillance, antiretroviral treatment, opportunistic conditions, prophylaxis, and laboratory testing. Brazil has significantly expanded access to free therapy with different classes of antiretroviral drugs. Initially focusing on treatment for HIV and opportunistic conditions, the scope of treatment guidelines gradually expanded to comprehensive health care for children and adolescents. From 1996 to 2008, the number of AIDS cases and deaths in children has been reduced by 67% and 65%, respectively, as a result of different strategies to prevent mother-to-child transmission of HIV and highly active antiretroviral therapy administration to infected children. Improved morbidity, mortality, and survival of Brazilian children with AIDS demonstrate clear benefits of adopting a policy of free and universal access to antiretroviral drugs associated with comprehensive care. However, important issues remain to be resolved, mainly concerning social, operational, and regional inequalities in coverage and quality of care, and epidemiological surveillance in different regions of the country. This broad review shows that the overall situation of pediatric AIDS in Brazil represents an incomplete process of epidemiologic and demographic transition, with the coexistence of old and new clinical and epidemiologic challenges.
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Affiliation(s)
- Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | | | - Norman Hearst
- University of California, San Francisco, San Francisco, California
| | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Bertoni N, Singer M, Silva CM, Clair S, Malta M, Bastos FI. Knowledge of AIDS and HIV transmission among drug users in Rio de Janeiro, Brazil. Harm Reduct J 2011; 8:5. [PMID: 21324119 PMCID: PMC3049124 DOI: 10.1186/1477-7517-8-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 02/15/2011] [Indexed: 12/04/2022] Open
Abstract
Background Proper knowledge of HIV transmission is not enough for people to adopt protective behaviors, but deficits in this information may increase HIV/AIDS vulnerability. Objective To assess drug users' knowledge of HIV/AIDS and the possible association between knowledge and HIV testing. Methods A Cross-sectional study conducted in 2006/7 with a convenience sample of 295 illicit drug users in Rio de Janeiro, assessing knowledge on AIDS/HIV transmission and its relationship with HIV testing. Information from 108 randomly selected drug users who received an educational intervention using cards illustrating situations potentially associated with HIV transmission were assessed using Multidimensional Scaling (MDS). Results Almost 40% of drug users reported having never used condoms and more than 60% reported not using condoms under the influence of substances. Most drug users (80.6%) correctly answered that condoms make sex safer, but incorrect beliefs are still common (e.g. nearly 44% believed HIV can be transmitted through saliva and 55% reported that HIV infection can be transmitted by sharing toothbrushes), with significant differences between drug users who had and who had not been tested for HIV. MDS showed queries on vaginal/anal sex and sharing syringes/needles were classified in the same set as effective modes of HIV transmission. The event that was further away from this core of properly perceived risks referred to blood donation, perceived as risky. Other items were found to be dispersed, suggesting inchoate beliefs on transmission modes. Conclusions Drug users have an increased HIV infection vulnerability compared to the general population, this specific population expressed relevant doubts about HIV transmission, as well as high levels of risky behavior. Moreover, the findings suggest that possessing inaccurate HIV/AIDS knowledge may be a barrier to timely HIV testing. Interventions should be tailored to such specific characteristics.
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Affiliation(s)
- Neilane Bertoni
- Institute for Scientific and Technological Information and Communication in Health (LIS/ICICT), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Singer M, Clair S, Malta M, Bastos FI, Bertoni N, Santelices C. Doubts remain, risks persist: HIV prevention knowledge and HIV testing among drug users in Rio de Janeiro, Brazil. Subst Use Misuse 2011; 46:511-22. [PMID: 20392169 DOI: 10.3109/10826081003720881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Brazil has been recognized for being the first developing country to provide universal AIDS treatment. Brazil also implemented a comprehensive prevention initiative. These efforts have been successful, with about half the number of HIV/AIDS cases forecast in 1992 developing by 2000. However, HIV/AIDS continues to spread, including among not-in-treatment drug users. Questions have been raised about gaps in existing prevention efforts. Based on qualitative research in 2006-2008 with street drug users in Rio de Janeiro (focus groups, N=24; a pile sort, N=108; open-ended interviews, N=34), this paper examines enduring gaps in HIV knowledge and prevailing risk patterns and proposes strategies for strengthening prevention.
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Affiliation(s)
- Merrill Singer
- Department of Anthropology, University of Connecticut, Storrs, Connecticut 06269, USA.
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Strathdee SA, Stockman JK. Epidemiology of HIV among injecting and non-injecting drug users: current trends and implications for interventions. Curr HIV/AIDS Rep 2010; 7:99-106. [PMID: 20425564 PMCID: PMC2856849 DOI: 10.1007/s11904-010-0043-7] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Injecting drug use is a major driver of HIV infections in Eastern Europe, the Commonwealth of Independent States, North Africa, the Middle East, and many parts of Asia and North America. We provide a global overview of the epidemiology of HIV infection among drug users and present current drug use trends that may constitute important epidemic drivers. We describe trends in ethnic disparities among injecting drug using (IDU) populations in the United States, and comment upon how these trends may now be changing. We present examples where HIV infection among non-IDUs who use cocaine, crack, and methamphetamine by other routes of administration is similar to that among IDUs, and discuss potential mechanisms of HIV spread in this overlooked population. Finally, we comment upon the potential implications of these observations for HIV interventions among IDU and non-IDU populations, taking into account different strategies that are needed in settings where HIV and/or injecting drug use has been established, or threatens to emerge.
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Affiliation(s)
- Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0507, USA.
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Barcellos C, Feitosa P, Damacena GN, Andreazzi MA. Highways and outposts: economic development and health threats in the central Brazilian Amazon region. Int J Health Geogr 2010; 9:30. [PMID: 20553625 PMCID: PMC3161375 DOI: 10.1186/1476-072x-9-30] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 06/17/2010] [Indexed: 11/12/2022] Open
Abstract
Background Economic development is often evoked as a driving force that has the capacity to improve the social and health conditions of remote areas. However, development projects produce uneven impacts on local communities, according to their different positions within society. This study examines the spatial distribution of three major health threats in the Brazilian Amazon region that may undergo changes through highway construction. Homicide mortality, AIDS incidence and malaria prevalence rates were calculated for 70 municipalities located within the areas of influence of the Cuiabá-Santarém highway (BR-163), i.e. in the western part of the state of Pará state and the northern part of Mato Grosso. Results The municipalities were characterized using social and economic indicators such as gross domestic product (GDP), urban and indigenous populations, and recent migration. The municipalities' connections to the region's main transportation routes (BR-163 and Trans-Amazonian highways, along with the Amazon and Tapajós rivers) were identified by tagging the municipalities that have boundaries crossing these routes, using GIS overlay operations. Multiple regression was used to identify the major driving forces and constraints relating to the distribution of health threats. The main explanatory variables for higher malaria prevalence were: proximity to the Trans-Amazonian highway, high proportion of indigenous population and low proportion of migrants. High homicide rates were associated with high proportions of migrants, while connection to the Amazon River played a protective role. AIDS incidence was higher in municipalities with recent increases in GDP and high proportions of urban population. Conclusions Highways induce social and environmental changes and play different roles in spreading and maintaining diseases and health threats. The most remote areas are still protected against violence but are vulnerable to malaria. Rapid economic and demographic growth increases the risk of AIDS transmission and violence. Highways connect secluded localities and may threaten local populations. This region has been undergoing rapid localized development booms, thus creating outposts of rapid and temporary migration, which may introduce health risks to remote areas.
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Affiliation(s)
- Christovam Barcellos
- Health Information Research Department, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Malta M, Magnanini MMF, Mello MB, Pascom ARP, Linhares Y, Bastos FI. HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: a systematic review and meta-analysis. BMC Public Health 2010; 10:317. [PMID: 20529289 PMCID: PMC2898825 DOI: 10.1186/1471-2458-10-317] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 06/07/2010] [Indexed: 11/06/2022] Open
Abstract
Background The Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations ─ men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group. Methods Nine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE, AMED, CINAHL, TOXNET, SciELO, and ISI-Web of Science) were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1999 to 2009. To be included in the review, studies had to measure HIV prevalence and/or incidence as the primary outcome among at least one specific population under analysis. Results The studies targeting the three populations analyzed mostly young participants aged 30 years or less. Among FSW, eight studies were selected (3,625 participants), consistently identifying higher condom use with sexual clients than with occasional and stable partners. The combined HIV prevalence for FSW was 6.2 (95% CI: 4.4-8.3). Ten studies targeting MSM were identified (6,475 participants). Unprotected anal intercourse was commonly reported on those studies, but with great variability according to the nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex. Pooled HIV prevalence for MSM was 13.6 (95% CI: 8.2-20.2). Twenty nine studies targeting DU were identified (13,063 participants). Those studies consistently identified injection drug use and syringe/needle sharing as key predictors of HIV-infection, as well as engagement in sex work and male-to-male sex. The combined HIV prevalence across studies targeting DU was 23.1 (95% CI: 16.7-30.2). Conclusions FSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (~0.6%). Those vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e.g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs. Programs that provide these services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.
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Affiliation(s)
- Monica Malta
- Social Science Department, Sergio Arouca School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Grangeiro A, Escuder MML, Castilho EA. Magnitude and trend of the AIDS epidemic in Brazilian cities, from 2002 to 2006. Rev Saude Publica 2010; 44:430-40. [PMID: 20464259 DOI: 10.1590/s0034-89102010005000013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 02/09/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze different patterns of occurrence of AIDS in Brazilian cities between 2002 and 2006, associating trend and magnitude with socio-demographic indicators and local characteristics of the epidemic. METHODS This was an ecological study that categorized cities according to magnitude and trend of the epidemic and subsequently analyzed, considering social indicators, types of HIV transmission and year of first case reported. Data came from the Brazilian Epidemiological Surveillance System, the Brazilian Institute of Geography and Statistics and the United Nations Development Program for Brazil. Linear regression was used to estimate trend and chi-square statistics and ANOVA to analyze indicators. RESULTS A total of 4,190 cities (75.3%) reported AIDS cases between 2002 and 2006. Of these, 3,403 (81.2%) had an occurrence of "small magnitude" (mean=4.7 cases), 367 (8.8%) of "average magnitude" (mean=30.3 cases) and 420 (10.0%) of "great magnitude" (mean=378.7 cases). Cases of "small magnitude" were associated with lower incidence; beginning of the epidemic after 1991; presence of one or two types of transmission; especially heterosexual contact; with occurrences of cases in one or two years of the period; and lower human development index (HDI). Those of a "great magnitude" were associated with larger cities and higher HDI; presence of all types of transmission; beginning of the epidemic between 1980/1991; and trend towards reduction/stabilization, especially due to a decrease in transmission among injecting drug users. Growth of the epidemic was concentrated in "small magnitude" cities, although without significance to the point of changing proportional participation (8.7%) of these cities in the group of cases in Brazil. CONCLUSIONS The AIDS epidemic remains concentrated in urban centers and the spread of cases to the countryside is characterized by irregular occurrence and small magnitude. Cities with low HDI and exclusive transmission through heterosexual contact showed low capacity of increase and the reduction of the epidemic is especially associated with the decrease in transmission among injecting drug users.
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Affiliation(s)
- Alexandre Grangeiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Jarlais DCD. Learning from HIV epidemics among injecting drug users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2009; 21:97-9. [PMID: 20018500 DOI: 10.1016/j.drugpo.2009.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/05/2009] [Accepted: 11/06/2009] [Indexed: 11/30/2022]
Abstract
HIV/AIDS was the defining issue for international harm reduction during its first twenty years. This issue was marked by strong contrasts: rapid HIV transmission in some populations of injecting drug users, and close to elimination of HIV in other populations; a formidable research base for designing effective HIV programmes and persistent political problems in implementing evidence-based programmes on a public health scale. Elevated rates of HIV infection among ethnic minority drug users have occurred in many different countries. We do not yet have systematic knowledge of how to reduce stigmatization of AIDS or people who use drugs. Nevertheless, international harm reduction for people who use drugs has moved beyond HIV/AIDS to a variety of other health and social problems, while retaining firm bases in science and human rights.
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Affiliation(s)
- Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 160 Water Street, Room 2462, 24th Floor, New York, NY 10038, USA
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