[Self-assessment of STD/AIDS vulnerability among women, Brazil]

The Global Distribution and Epidemiology of Psychoactive Substance Use and Injection Drug Use Among Street-Involved Children and Youth: A Meta-Analysis

Background: Globally, street-involved children and youth (SICY) who work and live on/of the streets are at higher risk of increased psychoactive substances and injecting drug use. Objectives: The present study aimed to identify the prevalence, distribution, sociodemographic factors, and risk-taking behaviors associated with psychoactive substances and injecting drug use among SICY. Methods: Studies in English published from December 1 1985 to July 1 2022, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on psychoactive substances and injecting drug use among SICY. The pooled-prevalence estimates were obtained using a robust fixed-effects model. Results: The most commonly reported life-time and current psychoactive substance was tobacco followed by cannabis, LSD/ecstasy, cocaine, methamphetamine, heroin and injection drug use. The results showed that life-time and current prevalence of methamphetamine and cannabis use, as well as life-time prevalence of cocaine, LSD/ecstasy, heroin, tobacco, and injecting drug use increased as age rose while current prevalence of cocaine and tobacco use decreased as age rose. SICY who were male, homeless, had parents who had died, had history of substance use among family members or best friends, had experienced violence, had casual sex partners, had a history of working in the sex trade, and had unprotected sex were all related to psychoactive substance use and injecting drug use. Conclusions: Research examining this population suffers from lack of studies, therefore, improving the knowledge for interventions aimed at reducing risk behaviors, particularly those related to the transmission of sexually transmitted infections such as HIV is of great importance.

Testing the Effectiveness of Two Psychosocial Interventions on Socio-Cognitive Risk Factors for HIV/AIDS in Mozambican Women: A Randomized Controlled Trial

The objective of this study was to evaluate the efficacy of two psychosocial interventions (Didactic and ACCENT) on socio-cognitive risk factors, in vulnerable Mozambican women at risk for HIV/AIDS infection. The study design was a randomized controlled trial on Mozambican women at HIV/AIDS risk (n = 150). The participants were randomized into three groups: Didactic Intervention (experimental group), ACCENT intervention (experimental group), and control group. We used an adapted version of the Women's Health Questionnaire, which includes a series of scales and questionnaires assessing psychosocial relevant dimensions to female protection towards HIV/AIDS: HIV/AIDS knowledge, condom use negotiation self-efficacy, and perceived barriers against safer sex. Both interventions were equally effective in increasing HIV/AIDS knowledge. The ACCENT intervention was especially effective in promoting condom use negotiation self-efficacy and in decreasing perceived barriers against safer sex, essential variables for sexual protection. These results support the adaptation of Western interventions to the African context.

Socio-demographic, Marital, and Psychosocial Factors Associated with Condom Use Negotiation Self-Efficacy Among Mozambican Women at Risk for HIV Infection

PURPOSE

In Mozambique, women are the most affected by HIV/AIDS. Self-efficacy is one of the main predictors of effective use of a condom. Therefore, it is essential to identify the factors that influence condom-use negotiation self-efficacy in vulnerable women. The aim of this paper is to identify socio-demographic, marital, and psychosocial factors associated with condom-use negotiation self-efficacy among Mozambican women at risk for HIV infection.

METHODS

Participants were women (173) who were patients at the Gynecology Department of the Central Hospital of Beira, Mozambique, and at risk for HIV infection. Women completed measures of condom-use negotiation self-efficacy, HIV prevention knowledge, and perceived barriers against safer sex.

RESULTS

The results showed that demographic and marital variables are associated with condom-use negotiation self-efficacy, namely, those having more than 9 years of education, who are younger and not living with a partner, and who talk about AIDS with partners report higher condom-use negotiation self-efficacy. Regarding psychosocial factors, higher HIV prevention knowledge and fewer perceived barriers to safer sex predict higher condom-use negotiation self-efficacy.

CONCLUSION

These results can contribute to sexual health promotion and HIV/AIDS prevention in Mozambican women because they identify at-risk groups and marital and psychosocial malleable factors that can be targeted in AIDS prevention among at-risk Mozambican women.

Is there a relationship between students' knowledge of HIV/AIDS ways of transmission and their responses regarding their proximity to people living with HIV/AIDS?

This paper aims to identify college students' knowledge of HIV ways of transmission and correlate it with their answers concerning the proximity to people living with HIV/AIDS. We applied a questionnaire from the Brazilian Ministry of Health to 591 health undergraduate students. We analyzed the 10 questions about the virus ways of transmission, evaluating the number of correct answers and verifying the association between the number of correct answers and questions related to the proximity to people living with HIV/AIDS. Most students (96%) answered correctly 7 to 10 questions related to HIV ways of transmission (Group A) and 4% answered correctly 3 to 6 questions (Group B). Correlating these two subgroups and the answers about the non-acceptance of proximity to people living with HIV/AIDS, we found significant association between Group B and the agreement that the employer should fire an employee living with HIV and the statement that they would feel uncomfortable if a child living with HIV/AIDS studied at the same school as their own children. Negative opinions concerning the proximity to people living with HIV/AIDS were less prevalent, but were correlated to the lower knowledge of HIV ways of transmission.

[Voluntary versus health professional-initiated HIV testing: a population-based study in women in a city in Southern Brazil]

This was a cross-sectional population-based study that aimed to describe the prevalence of HIV testing and associated factors in women in Pelotas, Rio Grande do Sul State, Brazil. A total of 1,222 women were interviewed. We estimated the overall testing prevalence (yes/no) and prevalence disaggregated by testing ordered by a health professional versus voluntary testing. Test prevalence was 66.1% (95%CI: 63.4-68.8): 52.4% for testing ordered by a health professional (95%CI: 49.6-55.2) and 13.6% for spontaneous testing (95%CI: 11.6-15.5). The principal reason for testing was prenatal screening (52%). Age, age at sexual initiation, and having children were associated statistically with both voluntary and health professional-initiated testing. Sexual risk score, conjugal status, and condom use were only associated statistically with testing ordered by a health professional, while history of anal sex was only associated with spontaneous testing. The results indicate that HIV testing is closely related to prenatal care and that risk perception by the attending health professional appears to be more accurate than the patient's own perception.

Aspectos de gênero e vulnerabilidade ao HIV/aids entre usuários de dois dos Serviços de Atendimento Especializado em DST/aids de São Luís, Maranhão

Resumo Foram pesquisados os fatores que contribuem para a vulnerabilidade de homens e mulheres que vivem com HIV/aids, usuários dos Serviços de Atendimento Especializado (SAE) em DST/aids, se examinando as diferenças sociodemográficas e epidemiológicas, além de seu acolhimento e acesso ao diagnóstico e tratamento. Realizou-se um estudo observacional, descritivo e de corte transversal, em que foram entrevistados 248 indivíduos, entre outubro e dezembro de 2007. Para análise, empregou-se o teste do qui-quadrado de Pearson e a análise multivariada através da técnica CHAID (nível de significância de 5%), observando-se as variações por sexo. Percebeu-se que alguns elementos de ordem individual, social e programática, incluindo questões de gênero, contribuíram de maneira significativa para a vulnerabilidade dos entrevistados. Observaram-se importantes diferenças entre homens e mulheres, considerando: emprego e renda, total de parcerias e uso de preservativo. A forma de acolhimento e acesso ao diagnóstico e tratamento nos SAE se apresentou como um elemento de incremento de vulnerabilidade, por não promover um atendimento integral aos usuários. Identificaram-se, ainda, aspectos de vulnerabilidade diferencial no grupo das mulheres em relação ao "uso do preservativo após o diagnóstico", associado ao tipo de parceria (fixa ou não) e ao "entendimento do que lhe diz o infectologista durante as consultas", o qual esteve relacionado diretamente ao tempo de atendimento no SAE. Nesse sentido, um caminho para a diminuição da vulnerabilidade perpassa pela busca da equidade de gênero e de etnia, com vista à melhoria da qualidade de vida das pessoas.

Representações sociais da AIDS para estudantes de Psicologia

Resumo A Síndrome da Imunodeficiência Adquirida (Aids) configura-se como fenômeno social que ultrapassa o conceito de doença, constituindo-se em estigma para aquele que tem o diagnóstico. É um problema de saúde pública que afeta faixas etárias, classes socioeconômicas e sociedades indistintamente, a Aids constitui temática de estudo e investigação inesgotável. Esta pesquisa apoia-se na teoria das Representações Sociais e tem como objetivo analisar as representações da Aids, de saúde e de doença para 20 estudantes de Psicologia. A análise dos dados se deu por meio da análise de conteúdo, e os resultados apontaram que o conhecimento sobre a Aids nem sempre resulta em comportamentos mais seguros; as representações revelaram preconceito e estereotipias, identificando a Aids como a doença do outro e se fazendo presentes no imaginário social, dificultando a convivência social com as pessoas com HIV/ Aids. Estes resultados sugerem uma reflexão sobre as campanhas educativas e preventivas.

Assessment of sexual risk behaviors and perception of vulnerability to sexually transmitted diseases/acquired immunodeficiency syndrome in women, 1999-2012: a population based survey in a medium-sized Brazilian city

Sexual behavior is a key factor for susceptibility to sexually transmitted diseases. An evaluation of the sexual behavior of women at reproductive age was conducted in 1999. A replication of this study aims to evaluate the current situation and identify changes in sexual behavior, 13 years later. This is a population-based cross-sectional study, conducted with 1071 women in Pelotas, Brazil. Compared to the 1999 study, a 14% increase in early sexual debut and an 8% decrease in the non-use of condoms were observed in 2012. The proportion of women who reported anal sex doubled between these periods. There was no trend of increase or decrease in the prevalence of behaviors with distinct patterns being observed for each of them. Reduction of non-use of condoms may be an indicator of the effectiveness of campaigns to promote safe sex. However, the increased prevalence of early sexual debut and anal sex indicates the need for campaigns to continue and to expand their focus, especially among vulnerable groups.

Diagnóstico de HPV: o processo de interação da mulher com seu parceiro

Pesquisa descritiva, com abordagem qualitativa, que objetivou analisar o processo de interação da mulher com seu parceiro a partir do diagnóstico de infecção pelo papilomavírus humano (HPV). Foi realizada em treze comunidades dos municípios de Duque de Caxias e Nova Iguaçu, Estado do Rio de Janeiro, de outubro/2006 a setembro/2008. Foram entrevistadas 20 mulheres com diagnóstico de infecção pelo HPV de alto risco oncogênico. Os pressupostos do Interacionismo Simbólico e da Grounded Theory nortearam a coleta e análise dos dados. Os resultados revelaram que o diagnóstico do HPV significa sérios desafios no relacionamento das mulheres com seu parceiro principalmente no que se refere à adoção de medidas preventivas. Conclui-se que estas questões indicam a necessidade de um atendimento humanizado que favoreça o empoderamento das mulheres.

Quantification of mast cells in the uterine cervix of women infected with human immunodeficiency virus

The objective of the study was to identify mastocytosis in the chorionic epithelium of the uterine cervix in HIV-infected and non-HIV-infected women in autopsy specimens using histochemistry and immunohistochemistry techniques. Sixteen cervical tissue specimens were collected, of which 10 (62.50%) were from HIV-infected women. Histochemical and immunohistochemical techniques were used to evaluate mast cell density using Giemsa stain and anti-mast cell tryptase and anti-mast cell chymase antibodies, respectively. The study of the sheets and counting of mast cells with blue (Giemsa) or brown staining (anti-mast cell tryptase or chymase antibodies) were performed by 3 examiners, and 10 consecutive fields were examined under a light microscope at 400× magnification. A significant difference was found in mast cell density in the chorionic epithelium of the cervix in HIV-infected compared with non-HIV-infected women. The present study may contribute to the characterization of genital mucosa abnormalities and help better understand the potential role of mast cells in HIV-infected women.

Mulheres Negras e HIV: determinantes de vulnerabilidade na região serrana do estado do Rio de Janeiro

Trata-se de estudo de base quantitativa que teve como objetivo central analisar componentes socioculturais e comportamentais relacionados ao processo de vulnerabilização ao HIV/aids a partir da percepção de mulheres negras na região serrana do estado do Rio de Janeiro. Para tal, foram entrevistadas 1.464 mulheres negras dos diferentes municípios que compõem essa região. Os principais determinantes que marcaram com maior intensidade a vulnerabilidade dessas mulheres associaram-se aos seguintes fatores: baixa escolaridade, renda e, consequentemente, acesso a bens e serviços, baixo índice de uso sistemático do preservativo e percepções de gênero, que reforçam a menor autonomia feminina na tomada de decisões protetoras.

A vulnerabilidade da mulher idosa em relação à AIDS

Trata-se de revisão sistemática da literatura que abrange o período de 1994 a 2009, cujo objetivo foi discutir a vulnerabilidade da mulher idosa em relação às Doenças Sexualmente Transmissíveis e Síndrome da Imunodeficiência Adquirida (Aids). Foi realizada a busca nas bases: Biblioteca Virtual em Saúde, Scientific Eletronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE), usando-se como descritores vulnerabilidade, mulher e Aids. Foram analisados 18 textos incluindo artigos em periódicos, teses e dissertações. Concluiu-se que mulheres idosas e vulnerabilidade à Aids estão diretamente relacionadas, através de características de gênero que perpassam pela submissão, construídas histórica e socialmente. É fundamental o desenvolvimento de estudos que gerem publicações acessíveis às mulheres, de modo a possibilitar que estas possam ver a si mesmas como sujeitos em risco de contrair Aids pelo simples fato de serem mulheres.

[Knowledge and risk perception on HIV/AIDS by Brazilian population, 1998 and 2005]

OBJECTIVE

To describe the level of knowledge and risk perception on HIV/AIDS of the Brazilian Population.

METHODS

Data base from a national survey on sexual behavior and HIV/AIDS risk perception in the Brazilian population, in 1998 and 2005, were used. A synthetic indicator was used, composed by nine questions on the level of knowledge and risk perception on the forms of transmission of the virus and risk situations, according to population subgroups.

RESULTS

Men increased their level of knowledge in the period, reaching the same information level of women. Among youngsters, there was no significant increase in knowledge, and the difference between sexes was absent in this dimension. Regarding risk perception, there was an increase in the proportion of those that declared they were not under risk of HIV/AIDS contamination.

CONCLUSIONS

Despite the increase in the level of general knowledge, the study's results indicate the need for actions and programs of HIV/AIDS prevention in the general population and, especially, with youngsters.

Aspectos históricos do feminino e do maternal e a infecção pelo HIV em mulheres

O presente artigo teve por objetivo examinar aspectos históricos ligados ao feminino e ao maternal, buscando ampliar a compreensão sobre a maternidade no contexto da infecção pelo HIV/aids. Apresenta-se uma revisão do papel da mulher ao longo da história, demonstrando a dissociação histórica do feminino dividido entre a mãe, digna de respeito e consideração, e a prostituta, marginalizada e desrespeitada. Nesse contexto, discutem-se as doenças sexualmente transmissíveis e as reações sociais diante destas infecções em mulheres e, em especial, a questão da maternidade no contexto de HIV/aids. Destaca-se a presença de crenças sociais historicamente construídas a respeito dos comportamentos femininos como fatores que dificultam a efetiva prevenção de DST/HIV/aids em mulheres, o que indica a necessidade de reflexão quanto às estratégias de prevenção e assistência.

Vulnerabilidad al VIH en mujeres en riesgo social

OBJETIVO: Evaluar la vulnerabilidad por factores de riesgo al VIH/SIDA en mujeres en riesgo social. MÉTODOS: Estudio llevado a cabo con 178 mujeres dueñas de casa (n=101) y trabajadoras del sector salud (n=77) de Antofagasta, Chile, en 2006-2007. Las dueñas de casa fueron consideradas en riesgo social. La vulnerabilidad al VIH fue calculada por medio de una escala que agrupó 21 reactivos en tres dimensiones: roles de género, comunicación con la pareja y actitud ante al uso del preservativo. Para determinar el peso relativo de cada una de las dimensiones en la vulnerabilidad total se realizó un análisis de regresión múltiple utilizando el puntaje total de la escala como variable dependiente y cada una de las tres dimensiones como variable independiente. RESULTADOS: En el grupo general, la dimensión con peso relativo mayor fue la dimensión actitud frente al uso del preservativo (0.542), seguida de relación de pareja (0.453) y roles de género (0.379). Para mujeres dueñas de casa, se observó una variación: relación de pareja (0.597), actitud frente al uso del preservativo (0.508) y roles de género (0.403). Para trabajadoras de la salud, el peso de las dimensiones fue: actitud frente al uso del preservativo (0.638), relación de pareja (0.397), y roles de género (0.307). CONCLUSIONES: Los resultados permiten inferir diferencias en los factores que condicionan la vulnerabilidad al VIH en los grupos de mujeres, siendo para aquellas que están en riesgo social el rol de género el factor con mayor capacidad predictiva de riesgo.

Características reprodutivas e utilização de serviços preventivos em saúde por mulheres em idade fértil: resultados de dois estudos transversais de base populacional no extremo Sul do Brasil

Em 1995 e 2004 foram realizados dois estudos transversais representativos com mulheres de 15 a 49 anos em Rio Grande, Rio Grande do Sul, Brasil, visando avaliar alguns indicadores básicos de saúde. A amostra incluiu 1.339 mulheres em 1995 e 1.311 em 2004. Aplicou-se questionário padronizado no domicílio investigando sobre características demográficas, sócio-econômicas, reprodutivas e utilização de serviços preventivos de saúde. A análise consistiu em comparar estes indicadores nos dois estudos pelo teste do qui-quadrado. Observou-se melhoria nas condições de habitação, saneamento, escolaridade, mas piora da renda familiar. A idade média de início das atividades sexuais diminuiu, a taxa de gravidez na adolescência aumentou em 33% assim como aumentou a realização de exame citopatológico de colo uterino em 48% e mama em 30%. A utilização de métodos contraceptivos diminuiu 3%, enquanto o uso de preservativos masculinos passou de 8% para 21%. Esforços deveriam ser feitos não somente visando incentivar a realização de exames de mama e citopatológico de colo uterino como também de retardar o início das atividades sexuais e de promover o uso de métodos contraceptivos, especialmente de preservativos.

Behavior, knowledge and perception of risks about sexually transmitted diseases in a group of people over 50 years old

The goal was to analyze the behavior, knowledge and risk perception about sexually transmitted diseases / AIDS (STD/AIDS) in people over 50 years old. 165 public servants at a State Secretary in Mato Grosso, Brazil were interviewed. The chi-square test and logistic regression tests were used for the analysis of risk perception and the behavior and knowledge variables about STD/AIDS. Most of the respondents were female (60.6%), 63.2 had a fixed partner, 72.4% had sexual relations in the past six months, and only 13.3% always wore condoms, with 21.5% being male and 8% female. Perception of risk was associated with non-use of condoms in their last sexual relation (p<0.001) and answering that anyone may acquire a STD/AIDS (p=0.039). The challenge of public policies is to increase actions, directing them to promote the health of the adult and elderly populations, especially regarding sexuality and vulnerability to STD/AIDS.

[Use of condoms during sexual intercourse: a population-based study]

OBJECTIVE

To describe characteristics associated with failure to use condoms during sexual intercourse by women.

METHODS

We conducted a cross-sectional population-based study including 1,026 women aged 20-60 years living in the urban area of a city in Southern Brazil, in 2003. Cluster sampling was carried out by randomly selecting 40 of the city's 270 census sectors. We performed logistic regression analysis of failure to use condoms in relation to socioeconomic, demographic, obstetric, and health care usage variables.

RESULTS

Among studied women, 867 (84.5%) reported being sexually active; of these, 252 (29.1%) wore condoms during sexual intercourse. Logistic regression showed that the most vulnerable groups were women who were married or in stable partnerships, and women aged more than 40 years. We found no associations with the other variables explored.

CONCLUSIONS

Prevalence of condom use was low; we were able to identify a group of women that needs to be targeted by health policies and services in order to improve perception of the risk of acquiring sexually transmitted diseases.

Sexual and drug use risk behaviors among children and youth in street circumstances in Porto Alegre, Brazil

We conducted a cross-sectional study to assess sexual and drug use risk in 161 children and youth in street circumstances in Porto Alegre, Brazil. Median age was 14 and 79% were male. Overall, 59% reported ever having had sex; a significantly higher proportion of males (66%) compared to females (30%). Overall, 39% reported illicit drug use in the last year, and only 1.2% reported injection drug use. In multivariate analyses, correlates of unsafe sex included younger age of sexual debut, and having a steady sex partner. Independent correlates of illicit drug use included lack of family contact, increased hours in the street daily, having had an HIV test, and older age. A high proportion of children and youth in street circumstances reported high risk sex and drug exposures, confirming their vulnerability to HIV/STD. Services Centers, such as where this research was carried out, offer an opportunity for interventions.

[Screening of sexually transmitted diseases in clinical and non-clinical settings in Salvador, Bahia, Brazil]

The objectives were to study: (1) acceptance of STD screening in non-clinical settings for asymptomatic individuals; (2) risk factors and STD prevalence among individuals in non-clinical and clinical settings; and (3) non-clinical screening of asymptomatic populations as a feasible method for STD control. We recruited 139 males and 486 females between 18 and 30 years of age from a family planning clinic, schools, and community centers in low-income neighborhoods. We asked about STD symptoms and STD/HIV risk behaviors and tested the individuals for gonorrhea, Chlamydia, syphilis, and HIV. Except for HIV, women recruited directly from the community had higher STD rates than those who came in for care at the clinic. Screening in non-clinical settings in Brazil is feasible and has a high yield among young adults in low-income communities. Infected participants would likely never have otherwise sought care or been tested or treated. STD control efforts could be implemented in any site that can reach populations at risk and become a routine procedure in health care settings where people report for problems unrelated to STDs.

Factors associated with condom use in women from an urban area in southern Brazil

This study investigated the prevalence of factors associated with condom use during last sexual intercourse in 15-49-year-old women in a probabilistic sample from the urban area of Pelotas, southern Brazil. A questionnaire administered by an interviewer, investigating socioeconomic characteristics and habits, and another (self-administered) questionnaire on sexual behavior-related variables were used. Poisson regression, following a hierarchical model, was used for data analysis. 1,543 women were included, and losses and refusals amounted to 3.5%. Prevalence of condom use in last sexual intercourse was 28.0%. Condom use was positively associated with younger age, greater schooling, non-white color, single marital status, and greater number of sex partners in the previous three months. This suggests that the group most vulnerable to STDs/AIDS due to lack of condom use is white, adult women, in stable unions, with fewer sexual partners.