Thirty years of confronting the Aids epidemic in Brazil, 1985-2015

Temporal and Spatial Analysis Techniques as Potential Tools for Combating the HIV Epidemic among Young Brazilian Amazonian People: An Ecological Study

Background: The main goal of this study was to analyze the HIV epidemic temporally and spatially among young people living in Pará, Brazil, from 2007 to 2018. Methods: For the temporal analysis, we employed an integrated autoregression of moving averages model associated with the seasonal trend using the LOESS decomposition method, which allowed for predictions to be made. In the spatial analysis, the techniques of autocorrelation, spatial and spatio-temporal risk analysis, and geographically weighted regression were used. Results: During the study period, there were 8143 notifications of HIV/AIDS cases. The temporal prediction indicated a trend of growth in the incidence rate in the 20–24-year-old group from January 2019 to December 2022 and a trend of stability in the 15- to 19-year-old and 25- to 29-year-old groups. There was a territorial expansion of the HIV epidemic in Pará. Novo Progresso and the Metropolitan Region of Belém (RMB) were the zones with the highest spatial and spatio-temporal risk for HIV. Social determinants including the Basic Education Development Index, the number of physicians per 10,000 inhabitants, and the municipal high school abandonment rate in the municipalities were associated with the risk of HIV/AIDS among young people in Pará. Conclusions: To eliminate HIV among young people in Pará, the access to treatment, diagnosis, and preventive healthcare services should be expanded. Sexual and reproductive health education should be reinforced in schools and communities. Furthermore, it is necessary to promote social equity and fight HIV stigma.

Multilevel Analysis of Individual and Neighborhood Characteristics Associated with Viral Suppression Among Adults with HIV in Rio de Janeiro, Brazil

Understanding the impact of neighborhood context on viral suppression outcomes may help explain health disparities and identify future interventions. We assessed the relationship between individual characteristics, neighborhood socioeconomic context, and viral suppression using multilevel logistic regression models. Adults with HIV initiating antiretroviral therapy (ART) between 2000 and 2017, who resided in Rio de Janeiro and had an HIV-1 RNA level (viral load) measured 90-270 days after ART initiation were included. Overall, 83.9% achieved viral suppression. Participants who were older, had a higher level of education, and identified as heterosexual cisgender men and cisgender men-who-have-sex-with-men had increased odds of viral suppression. Later calendar year of ART initiation carried the strongest association with viral suppression, reflecting the increased effectiveness and tolerability of ART over time. Neighborhood socioeconomic indicators did not predict viral suppression in unadjusted or adjusted analyses, which may result from the integrated care provided in our health care facility together with Brazil's universal treatment.

Spatial and spatio-temporal distribution of women living with HIV mortality in Porto Alegre, Brazil, from 2007 to 2017

OBJETIVE:

To present some factors related to the mortality rates of WLHIV in the city of Porto Alegre-RS.

METHODS:

This is a spatial and spatio-temporal analysis of ecological data about all women monitored by the health care services for the vertical transmission (VT) of HIV, between 2007 and 2017, residing in the city that died during the period. The units of analysis were the 17 sanitary districts of the city. The dependent variable was the mortality rate. The independent territorial variables were the indicators of vulnerability to poverty, women householder proportion, lack of infrastructure, HDI, and GINI index. Still, the individual data collected were: age, race/color, level of education, and period since the HIV diagnosis. The analyses used SPSS 20.0, and QGIS 218.15.

RESULTS:

Regions with higher vulnerability to poverty and precarious local infrastructure registered higher WLHIV mortality rates, especially black/”pardo” women in fertile age with low education. The regions with most women householders presented a risk of mortality seven times higher. The population with vulnerability to poverty presented the same result.

CONCLUSIONS:

Regions with critical indicators of vulnerability presented higher mortality rates of WLHIV, which demonstrates social inequalities’ impact for these women.

Desempenho dos serviços de saúde do SUS de uma macrorregião do estado de Pernambuco, Brasil

RESUMO O objetivo deste estudo foi avaliar o desempenho dos serviços de saúde de uma macrorregião do estado de Pernambuco. A pesquisa foi realizada utilizando dados do Projeto de Avaliação do Desempenho do Sistema de Saúde nas dimensões efetividade, acesso, adequação e aceitabilidade. O período de análise foi de 2008 a 2017. O julgamento foi realizado a partir da tendência esperada dos indicadores. Classificou-se o desempenho em: excelente (=75%), satisfatório (50%-74,9%), insatisfatório (49%-25%) e crítico (<25%). O desempenho foi insatisfatório nas dimensões efetividade (41,7%) e acesso (46%), e excelente nas dimensões adequação (76,2%) e aceitabilidade (100%). Entre os indicadores que contribuíram para o baixo desempenho nas primeiras dimensões, destacam-se: internações por pneumonia, incidência da síndrome da imunodeficiência adquirida, sífilis congênita, vacinação em crianças menores de um ano com tetravalente/pentavalente e procedimentos de alta complexidade. A classificação final revelou resultado satisfatório (52,4%) na Macrorregião de Saúde. Diante dos resultados, torna-se necessária a observação individual dos indicadores, visando ao planejamento de ações que promovam uma melhora nesse panorama. Esta pesquisa contribuiu para uma ampliação da avaliação de desempenho, divulgando a potencialidade do Projeto de Avaliação do Desempenho do Sistema de Saúde para o monitoramento e a análise do sistema de saúde.

Survival time and distance to access specialized treatment among people living with HIV/Aids in the state of Alagoas, Brazil

OBJECTIVE

To evaluate the effect of the distance between the place of residence and the specialized treatment service on the survival time of people living with HIV/Aids in Alagoas, Northeast Brazil.

METHODS

Data from the notification and mortality systems related to individuals aged 13 years or older diagnosed with the infection between 2007 and 2013 were used. The cases were observed for a period of follow-up until December 2017. For the analyses, the Pearson's χ2 test, Kaplan-Meier method, and Cox regression were adopted according to the outcome of the case, place of residence, distance to the health unit, population size of the municipality of residence, sex, skin color/ethnicity, and age.

RESULTS

Of the 2,732 analyzed cases, 760 individuals died of Aids-related causes. The average estimate of survival time for individuals residing in the capital was 98.6 months (95%CI 96.1-101). Among residents of inland cities, the estimate was 92.7 months (95%CI 89.3-96.1). There was a significant difference in curves throughout the period. The group residing in inland municipalities and those traveling a distance of >70 km had a higher average relative risk of death (RR=1.21, 95%CI 1.05-1.4 and RR=1.18, 95%CI 1.01-1.39, respectively).

CONCLUSION

Living in or near the capital decreases the average relative risk of death. In order to increase the survival time of HIV/Aids patients in Alagoas, it is suggested to decentralize specialized health care, that is, to create regional centers to care for these people.

Moral barriers to HIV prevention and care for gay and bisexual men: Challenges in times of conservatism in Brazil

This article examines narratives about promiscuity that are emphasized by some gay and bisexual men who are themselves living with HIV. We used semi-structured interviews to assess the processes, outcomes, and meanings of HIV diagnosis among 10 young gay and bisexual men aged between 18 and 30 years old. Interviews were conducted in health service settings for the diagnosis and treatment of HIV and AIDS in Salvador, Brazil. Based on a socioculturally oriented approach, the narratives suggest that discourse about promiscuity seems to persist, or is even strengthened, in order to explain HIV infection among young gays/bisexual men and to emphasize a more restrained sexual life following HIV diagnosis. Despite the biotechnologies and biomedical advances, some difficulties and tensions also persist in the daily life of young people living with HIV. Difficulties in starting new relationships, dilemmas around responsibility for infection/transmission, fear and guilt are elements that stand out in these narratives, demonstrating that HIV discourses and practices may produce greater stigma and discrimination in current times, individualizing and blaming certain people for the infection/transmission of the virus, and marginalizing practices that do not conform to hegemonic heteronormativity.

Assessing antiretroviral therapy success in HIV/AIDS morbidity and mortality trends in Brazil, 1990-2017: an interrupted time series study

To describe the trends of HIV/AIDS metrics related to the burden of disease for Brazil between 1990 and 2017 we conducted a timeseries analysis for HIV/AIDS indicators by extracting data from the Global Burden of Disease study. We calculated traditional prevalence, incidence and mortality rates, the number of years lost by HIV-related deaths (YLL) and disability (YLD), and disability-adjusted life years (DALY). We estimated time series models and assessed the impact of highly active antiretroviral therapy (HAART) on the same indicators. In the set of disability-adjusted life years (DALY), the highest weight of its magnitude was due to YLL. There was a decline, especially after 1996, of DALY, mortality and YLL for HIV/AIDS. However, YLD, incidence, and prevalence increased over the same period. Also, the analysis of interrupted time series showed that the introduction of HAART into health policy had a significant impact on indicators, especially for DALY and YLL. We need to assess the quality of life of people living with HIV, especially among older adults. In addition, we need to focus on primary prevention, emphasizing methods to avoid infection and public policies should reflect this.

HIV-1 mother-to-child transmission in Brazil (1994-2016): a time series modeling

HIV-1 mother-to-child transmission (HIV-1 MTCT), is an important cause of children mortality worldwide. Brazil has been traditionally praised by its HIV/Aids program, which provides free-of-charge care for people living with HIV-1. Using public epidemiology and demographic databases, we aimed at modeling HIV-1 MTCT prevalence in Brazil through the years (1994-2016) and elaborate a statistical model for forecasting, contributing to HIV-1 epidemiologic surveillance and healthcare decision-making. We downloaded sets of live births and mothers' data alongside HIV-1 cases notification in children one year old or less. Through time series modeling, we estimated prevalence along the years in Brazil, and observed a remarkable decrease of HIV-1 MTCT between 1994 (10 cases per 100,000 live births) and 2016 (five cases per 100,000 live births), a reduction of 50%. Using our model, we elaborated a prognosis for each Brazilian state to help HIV-1 surveillance decision making, indicating which states are in theory in risk of experiencing a rise in HIV-1 MTCT prevalence. Ten states had good (37%), nine had mild (33%), and eight had poor prognostics (30%). Stratifying the prognostics by Brazilian region, we observed that the Northeast region had more states with poor prognosis, followed by North and Midwest, Southeast and South with one state of poor prognosis each. Brazil undoubtedly advanced in the fight against HIV-1 MTCT in the past two decades. We hope our model will help indicating where HIV-1 MTCT prevalence may rise in the future and support government decision makers regarding HIV-1 surveillance and prevention.

Assessment of pain and associated factors in people living with HIV/AIDS

OBJECTIVE

to evaluate pain in people living with human immunodeficiency virus/acquired immunodeficiency syndrome and to relate it to sociodemographic and clinical factors, depressive symptoms and health-related quality of life.

METHOD

descriptive, analytical, observational, cross-sectional and quantitative study. Three hundred and two (302) people assisted at a specialized care service participated in the study. Instruments were used to evaluate sociodemographic and clinical data, depressive symptoms, and health-related quality of life. Descriptive, bivariate analysis and multiple logistic regression were used.

RESULTS

the incidence of pain of mild intensity was 59.27%, recurrent in the head, with interference in mood, mostly affecting females and individuals with no schooling/low schooling. Women were more likely to have moderate or severe pain. People aged 49 to 59 years had greater pain intensity than people aged 18 to 29 years. The variables depressive symptoms and pain were directly proportional. The higher the health-related quality of life and schooling, the lower was the possibility of presence of pain.

CONCLUSION

presence of pain is of concern and has association with female sex, lack of schooling/low schooling, worse level of health-related quality of life and presence of depressive symptoms.

Spatial analysis of AIDS and the social determinants of health

INTRODUCTION

The social determinants of health (SDH) are factors that can influence the distribution of rates for acquired immunodeficiency syndrome (AIDS) in a given region. The objective of this study was to analyze SDHs related to AIDS.

METHOD

Ecological study, using spatial analyses techniques. 7,896 disease case reports were analyzed over a period of 11 years. Subjects were 13 years or older and residents of the state of Ceará, in the northeast of Brazil. The area of analysis was the municipality, calculating both the average rate of AIDS and the Freeman-Tukey transformed average rate for measuring softening. We used the Simple Linear Regression Model to make the spatial correlation between AIDS detection rates and SDH. A Geographic Information Systems (GIS) was used to manipulate georeferenced data.

RESULTS

High rates of AIDS could be found in cities with better living conditions. Additionally, there was a significant relationship between primary health care coverage and lower rates of the disease in Ceará.

CONCLUSION

Socioeconomic indicators with statistically significant correlation to the distribution of AIDS should be targeted by strategies policies in the fight against the disease.

The National Reproductive Health Programme in Cape Verde: scope, limits and challenges

Cape Verde is an archipelago on the African coast, with 538,535 inhabitants living on nine islands. Since it gained independence in 1975, the country has experienced rapid economic and social growth, with significant gains in education as well as a reduction in maternal and infant mortality deaths. In 2001, following the guidelines of the International Conference on Population and Development (ICPD, Cairo, 1994), the National Reproductive Health Program (PNSR) was launched aiming to provide sexual and reproductive health (SRH) services to adolescents, young people and adult men, in partnership with the education sector and youth centers. However, the continuance of unplanned pregnancies, illegal abortions and HIV infections has indicated that there are gaps in the program`s implementation. Studies conducted in the country point to socio-cultural aspects as well as aspects covering organizations and the services on offer, as some of the reasons for the identified problems. This paper aims to reflect on the scope and limits of the PNSR in Cape Verde with consideration being given to the challenges of implementing health policies that affect cultural practices related to gender and sexuality. Consideration is also given to the specifics of Cape Verde`s demographics, economic and cultural aspects as well as the importance of the SRH services to its development.

Social welfare related to AIDS in Brazil: factors associated with social assistance and social security, 2004 - 2016

OBJECTIVE

To describe the occurrence of social welfare benefits related to AIDS in Brazil and to compare the characteristics of the beneficiaries of social assistance and social security in 2004 - 2016.

METHODS

This was an observational, analytical study based on secondary data obtained from the Ministry of Social Security of Brazil. Sociodemographic and epidemiologic characteristics of the beneficiaries of AIDS-related social assistance and social security were analyzed.

RESULTS

From 2004 - 2016, a total of 99 369 benefits were granted, the majority of which were sick pay (64%), followed by social assistance benefits (26.5%) and disability retirement (8.1%). At the time that benefits were initiated, 51% of the individuals were unemployed. Those living in urban areas, females, the young, the elderly, and residents of the North and Northeast received more social assistance benefits. Duration of social assistance benefits (average 4 589 days) was greater than that of social security benefits (302 days). Survival among women (578 months) was greater than among men (311 months).

CONCLUSIONS

In Brazil, the profile of social welfare beneficiaries living with AIDS reveals their social vulnerability. Controlling AIDS should be a priority on public agendas, aiming to minimize the disease's social and economic impact, especially on public health, social security, and social assistance.

Cooperação internacional: doações de medicamentos realizadas pelo governo brasileiro de 2005 a 2016

Objetivo.

Fazer um levantamento acerca das doações internacionais de medicamentos pelo governo brasileiro de 2005 a 2016, identificando o número de unidades de medicamentos doadas e o montante financeiro que esse volume representa.

Métodos.

Estudo descritivo e exploratório utilizando análise de dados secundários disponíveis no Sistema de Gestão de Materiais do Ministério da Saúde (SISMAT). Foram levantadas informações sobre país solicitante, ano da doação, medicamento, número de unidades farmacêuticas doadas e valor correspondente (em reais).

Resultados.

No período estudado, 66 554 892 unidades de medicamentos foram doadas, correspondendo a 84 371 308,72 reais (25 505 235,70 dólares). Foram doados medicamentos para Angola, Benin, Bolívia, Burkina Faso, Cabo Verde, Colômbia, Costa do Marfim, Cuba, El Salvador, Equador, Guatemala, Guiana, Guiné Bissau, Haiti, Honduras, Líbia, Moçambique, Nicarágua, Paraguai, Peru, República Dominicana, São Tomé e Príncipe, Síria e Suriname, países do Mercado Comum e Comunidade do Caribe (CARICOM) e Organização Pan-Americana da Saúde (OPAS). Não foi detectado nenhum padrão de distribuição em termos quantitativos. Picos no número de medicamentos doados ocorreram em 2008, 2011 e 2012, com maior número de países contemplados em 2006 e 2012 (13 e 14 países, respectivamente). Foram doados medicamentos para HIV/Aids, malária, leishmaniose, diabetes, cólera, esquistossomose, tuberculose, gripe influenza, doenças oportunistas, imunizações, suporte nutricional e calamidade pública.

Conclusões.

Em grande medida, os medicamentos doados foram antimicrobianos utilizados para tratamento de doenças tropicais negligenciadas. Estudos adicionais são sugeridos para correlacionar intervenções de saúde pública com as doações de medicamentos, como forma de promover o desenvolvimento econômico sustentável dos países beneficiários.

Risk management in providing specialized care for people living with AIDS

OBJECTIVE

Analyzing the provision of actions related to managing clinical risk in managing specialized care for people living with AIDS.

METHOD

A cross-sectional study carried out in a reference outpatient clinic in Paraíba, with a sample of 150 adults with AIDS. Data were collected through primary and secondary sources using a structured questionnaire, analyzed using descriptive statistics, multiple correspondence analysis and logistic regression model to determine the association between "providing care" and "clinical risk."

RESULTS

Actions with satisfactory provision express a biological care focus; the dimensions that most contributed to a satisfactory assessment of care provision were "clinical and laboratory evaluations" and "prevention and self-care incentivization"; 45.3% of participants were categorized into high clinical risk, 34% into average clinical risk, and 20.7% into low clinical risk; a positive association between providing care and clinical risk was found.

CONCLUSION

The need to use risk classification technologies to direct the planning of local care provision became evident considering its requirements, and thus qualifying the care provided in these areas.

OBJETIVO

Analisar a oferta de ações relacionadas ao manejo de risco clínico na gestão do cuidado especializado a pessoas vivendo com aids.

MÉTODO

Estudo transversal realizado em ambulatório de referência na Paraíba, com amostra de 150 adultos com aids. Os dados foram coletados por meio de fontes primárias e secundárias utilizando-se de formulário estruturado, e analisados através de estatística descritiva, análise de correspondência múltipla e modelo de regressão logística para averiguar a associação entre "oferta" e "risco clínico".

RESULTADOS

As ações de oferta satisfatória expressam foco biologicista do cuidado; as dimensões que mais contribuíram para o julgamento satisfatório da oferta foram "avaliação clínica e laboratorial" e "prevenção e estímulo ao autocuidado"; 45,3% dos participantes foram categorizados em risco clínico alto, 34% em risco clínico médio, e 20,7% em risco clínico baixo; e verificou-se associação positiva entre oferta e risco clínico.

CONCLUSÃO

Ficou evidente a necessidade da utilização de tecnologias de classificação de risco para direcionar o planejamento da oferta local, considerando-se as necessidades, e assim qualificar o cuidado produzido nestes espaços.