Estudo de comportamento associado à infecção pelo HIV e HCV em detentas de um presídio de São Paulo, Brasil

Detection of sexually transmitted infections among transvestites and transsexual women in prison in the metropolitan region of Rio de Janeiro, Brazil

OBJECTIVE

To evaluate the seropositivity rate of rapid tests for HIV, syphilis and hepatitis B and C among transvestites and transgender women (transfeminine persons) inmates in the metropolitan region of Rio de Janeiro, analyzing the results based on sociodemographic, prison profile and access to health technologies to prevent sexually transmitted infections (STIs).

METHODS

Cross-sectional census-type study carried out with transfeminine in eleven male prisons in Rio de Janeiro, between the months of April and June 2021.

RESULTS

The detection rates found were 34.4% for HIV, and 48.9% for syphilis, and 0.8% for type B and C hepatitis. Seropositivity for more than one infection was verified in 25.4% of participants, and HIV/syphilis was the most prevalent. An increase in the level of education (p=0.037) and having a steady partner in prison (p=0.041) were considered protective factors for STIs in this population. Difficulties were identified in accessing STI prevention technologies, such as male condoms, lubricating gel, rapid tests, and prophylactic antiretroviral therapies for HIV.

CONCLUSION

HIV and syphilis seropositivity rates were high, but within the profile found in this population in other studies inside or outside prisons. The data found indicates the need to incorporate effective strategies for access to health technologies for the prevention of STIs. The scarcity of scientific publications containing epidemiological data on STIs in the transfeminine prison population limited deeper comparisons of the results obtained in this study.

Effect of a board game about sexually transmitted infections on imprisoned women's knowledge: protocol for a quasi-experimental study

INTRODUCTION

The prevalence of sexually transmitted infections in imprisoned women is high. In the prison school context, education in health is one of the best strategies to achieve positive indicators in terms of health promotion and disease prevention. The use of educational technologies, such as board games, can aid in the process of knowledge acquisition on a given subject matter. This article describes the protocol of a health educational intervention that addresses content about sexually transmitted infections directed to imprisoned women in a prison school.

METHODS AND ANALYSIS

A quasi-experimental study to test the effect of a board game on 64 imprisoned women's level of knowledge about sexually transmitted infections. The Previna board game was specifically created and validated for these women. The primary outcome will be the level of knowledge on sexually transmitted infections, measured using a score obtained after the assessment conducted during the initial interview, immediately after the intervention and after 15 days.

ETHICS AND DISCLOSURE

This study was approved by the Research Ethics Committee of the Federal University of Pernambuco (Opinion No. 3 986 050 and CAAE: 30035520.7.0000.5208). The results will be presented to the school and to the Federal University of Pernambuco, as part of the activities of a PhD Thesis in Nursing, and will be disclosed in peer-reviewed journals and scientific events.

TRIAL REGISTRATION NUMBER

RBR-2JWS7DV.

HIV testing inside Brazilian female prisons: results of a national survey

This study aimed to identify the prevalence of women in prisons who have already had an HIV test inside prison and the factors associated with this test. A cross-sectional study was carried out with 1327 women in 15 prisons in 9 states in Brazil. Almost 60% (95% CI: 57.8-63.7) of women have already been tested for HIV in prison. The factors associated with this HIV test were age ≥41 years (OR = 1.9; 95% CI = 1.2-2.9), highest level of education (OR = 1.9; 95% CI = 1.3-2.8), having been arrested 3 or more times (OR = 1.9; 95% CI = 1.3-2.8), having received information about HIV/STI in the lifetime (OR = 1.4; 95% CI = 1.1-1.9) and perceived themselves to be at no risk for HIV infection (OR = 1.7; 95% CI = 1.2-2.5), black or mixed race (OR = 0.7; 95% CI = 0.5-0.9) and having a male sexual partner (OR = 0.6; 95% CI = 0.5-0.9). The routine HIV testing in prisons needs to be expanded to promote HIV prevention for a population with limited access to these services outside of prison.

Burden of HIV, Syphilis, and Hepatitis B and C Among Inmates in a Prison State System in Mexico

We studied the prevalence of HIV, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV) infection and associated risk behaviors in the prison state system of Guanajuato, Mexico between September 2011 and February 2012. Blood samples were drawn from adult inmates in all State prisons who agreed to participate in this cross-sectional study. Data on risk behaviors were collected by using self-administered questionnaires. The prevalence of HIV, syphilis, HBV, and HCV infection was 0.6% [95% confidence interval (CI) = 0.2-1.1], 0.7% (95% CI = 0.4-1.0), 0.4 (95% CI = 0.04-0.74), and 4.8 (95% CI = 3.6-5.9), respectively. Female inmates had a higher prevalence of HIV (1.5% vs. 0.6%, p = .05), whereas male inmates had a higher prevalence of HCV (1% vs. 5%, p = .008). Twenty percent (n = 443, 95% CI = 15-26) of the participants were tattooed during incarceration, and most of them were tattooed with recycled materials. Around 60% (57%, 95% CI = 49-65) used drugs before incarceration, and 9.2% (n = 205) used injected drugs. During incarceration, 30% (95% CI = 23-39) used drugs and 43 continued injecting (20% of users). Consistent condom use was low among men before incarcerations but decreased by half during incarceration. The highest consistent condom use before incarceration was among men who have sex with men (MSM) (17.7%, 95% CI = 14-22), but it decreased (9%, 95% CI = 3-14) during incarceration. The prevalence of HIV, HBV, HCV, and syphilis in these inmates is higher than that of the local adult population. Most inmates had sex in prison, but few used condoms consistently. Access to condoms is apparently harder for MSM. Interventions to increase condom use, reduce use of shared or recycled materials for tattooing and injecting drugs, and treatment for drug abuse are needed.

Estimating the Size of the HCV Infection Prevalence: A Modeling Approach Using the Incidence of Cases Reported to an Official Notification System

In this paper we propose two methods to give a first rough estimate of the actual number of hepatitis C virus (HCV)-infected individuals (prevalence) taking into account the notification rate of newly diagnosed infections (incidence of notification) and the size of the liver transplantation waiting list (LTWL) of patients with liver failure due to chronic HCV infection. Both approaches, when applied to the Brazilian HCV situation converge to the same results, that is, the methods proposed reproduce both the prevalence of reported cases and the LTWL with reasonable accuracy. We use two methods to calculate the prevalence of HCV that, as a first, and very crude approximation, assumes that the actual prevalence of HCV in Brazil is proportional to the reported incidence to the official notification system with a constant denoted [Formula: see text]. In the paper we discuss the limitations and advantages of this assumption. With the two methods we calculated [Formula: see text], which reproduces both the reported incidence and the size of the LTWL. With the value of [Formula: see text] we calculated the prevalence I(a) (the integral of which resulted in 1.6 million people living with the infection in Brazil, most of whom unidentified). Other variables related to HCV infection (e.g., the distribution of the proportion of people aged a who got infected n years ago) can be easily calculated from this model. These new variables can then be measured and the model can be recursively updated, improving its accuracy.

[Seroprevalence and factors associated with human immunodeficiency virus (HIV) and syphilis in inmates in the state of Pernambuco, Brazil]

Prison inmates are more vulnerable to HIV and other Sexually Transmitted Infections (STIs) due to risk factors such as needle sharing and unprotected sex with homosexuals. The aim of this work was to determine the seroprevalence and risk factors associated with the human immunodeficiency virus (HIV-1/2) and syphilis among male inmates in Caruaru, State of Pernambuco, Brazil. A cross-sectional study was performed between May and July 2011, when 1,097 inmates at a prison in Caruaru were assessed by means of interviews and blood sample collection for performing the respective tests. The prevalence was 1.19% for HIV infection and 3.92% for syphilis. HIV infection showed a statistically significant association (p <0.05), with injected drug use, homosexuality and blood transfusions. With respect to HIV status and syphilis, factors related to sex life were statistically significant (p <0.05). The prison population is a high risk group for the diseases investigated. The prevalence rates identified indicate the need to implement prevention programs, helping to contain such diseases in this particular population group.

Prevalence of hepatitis C virus in Brazil's inmate population: a systematic review

OBJECTIVE

To estimate the prevalence of hepatitis C virus infection in Brazil’s inmate population.

METHODS

Systematic review on hepatitis C virus infection in the inmate population. Brazilian studies published from January 1, 1989 to February 20, 2014 were evaluated. The methodological quality of the studies was assessed using a scale of 0 to 8 points.

RESULTS

Eleven eligible studies were analyzed and provided data on hepatitis C virus infection among 4,375 inmates from seven states of Brazil, with a mean quality classification of 7.4. The overall hepatitis C virus prevalence among Brazilian inmates was 13.6% (ranging from 1.0% to 41.0%, depending on the study). The chances of inmates being seropositive for hepatitis C virus in the states of Minas Gerais (MG), Sergipe (SE), Mato Grosso do Sul (MS), Rio Grande do Sul (RS), Goiás (GO) and Espirito Santo (ES) were 84.0% (95%CI 0.06;0.45), 92.0% (95%CI 0.04;0.13), 88.0% (95%CI 0.09;0.18), 74.0% (95%CI 0.16;0.42), 84.0% (95%CI 0.08;0.31) and 89.0% (95%CI 0.01;0.05) respectively, lower than that observed in the Sao Paulo state (seroprevalence of 29.3%). The four studies conducted in the city of Sao Paulo revealed a lower prevalence in more recent studies compared to older ones.

CONCLUSIONS

The highest prevalence of hepatitis C virus infection in Brazil’s inmate population was found in Sao Paulo, which may reflect the urban diversity of the country. Despite Brazilian studies having good methodological quality to evaluate the prevalence of the hepatitis C virus, they are scarce and lack data on risk factors associated with this infection, which could support decisions on prevention and implementation of public health policies for Brazilian prisons.

[Risk factors for cancer of the cervix in women prisoners]

The study aimed to identify risk factors for the development of cervical cancer in women prisoners. Cross sectional study with a quantitative approach carried out in a female penal institute on the state of Ceará, Brazil. The selection of the sample occurred according to the availability of female prisoners at the time of collection, with a total of 36 women prisoners. Regard to the risks for cervical cancer, 16 (44,5%) women were smokers, 24 (70.5%) have made use of the oral contraceptive for a median of 46 months, 24 (66,6%) began their sexual lives with less than 15 years, and 26 (72,2%) reported use of condoms, but 10 (38,4%) of them used it rarely. These findings demonstrate that the prisoner female population is more vulnerable to the cervical cancer, requiring the health promotion in the correctional institution environment, since that time is configured as a unique opportunity.

Prevalence of hepatitis C in adult users of the public health service of São José dos Pinhais--Paraná

OBJECTIVES

We aimed to investigate the prevalence of Hepatitis C in adult users of the Public Health Services of São José dos Pinhais - Paraná.

METHODS

We performed an epidemiological survey with a probabilistic sample of 5,017 volunteers who answered a questionnaire and were submitted to an anti-HCV quick test. Data were organized using Epi-info 3.5.1. The association between the presence of the disease and the factors of interest in the study were evaluated by the Chi-square test. We used a Logistic Regression Adjusted Model for risk factor analysis and the Wald test for decision making on the importance of the risk factors.

RESULTS

The absolute frequency of positive anti-HCV was 13, with a prevalence of 0.30%, (IC = 0.12% - 0.40%). A higher probability of the disease was reported in males (p = 0.008) and in single, separated and widowed subjects (p = 0.045); in subjects with prior HCV symptoms (p < 0.001) and a previous blood transfusion (p < 0.001); and with the presence of a tattoo (p = 0.033). Drug abuse, blood transfusion and age > 40 years increased the risk for disease, regardless of sex, age and marital status.

CONCLUSION

We found a low prevalence of Hepatitis C, albeit expected for Southern Brazil. Our results did not differ from other studies as to contamination risks. The study may contribute to highlight the importance of Hepatitis C, the need to implement strategies to cope with it, and stimulate better understanding of Hepatitis C.

Hepatitis C, hepatitis B and HIV infection among Egyptian prisoners: seroprevalence, risk factors and related chronic liver diseases

BACKGROUND AND AIM

Prisons in Egypt do not currently screen for blood-borne viruses, and there are no statistics concerning the prevalence of hepatitis C virus, hepatitis B virus or human immunodeficiency virus among prisoners. This study was performed to detect the prevalence of antibodies against hepatitis C, hepatitis B core and human immunodeficiency virus among Egyptian prisoners.

METHODS

The study was conducted in an Egyptian prison. The prisoners voluntarily completed a risk factor questionnaire and provided blood specimens for testing for antibodies against hepatitis C virus, hepatitis B virus core antigen and human immunodeficiency virus. Positive results were confirmed by the detecting HCV RNA via polymerase chain reaction. Multivariate regression analysis was performed to determine the factors that were independently associated with positive HCV serology.

RESULTS

Five hundred resident prisoners were screened. The prevalence of hepatitis C virus antibodies was 15.8% (79/500), and viremia was confirmed by PCR in 77.2% (61/79) of the antibody-positive prisoners. The prevalence of antibodies to hepatitis B core antigen was 9.8% (49/500), and 1.2% (6/500) of prisoners were dually infected with HBV and HCV. Antibodies to human immunodeficiency virus were not detected in any of the prisoners. The best predictor for hepatitis C and hepatitis B infection was a history of intravenous drug use (P<0.011 for HBV and P<0.001 for HCV), a period of >10 years spent in prison (P<0.052 for HBV and P<0.021 for HCV) and shared toiletries (P<0.059 for HBV and P<0.002 for HCV).

CONCLUSION

Hepatitis C and hepatitis B virus infections constitute an important public health problem in prisons. Public health strategies to prevent morbidity and mortality from these infections should include hepatitis B vaccination, HCV testing, counseling and medical management of infected prisoners.

[Knowledge, attitude and practices regarding condom use among women prisoners: the prevention of STD/HIV in the prison setting]

The objective of this study was to evaluate the knowledge, attitude and practices of women prisoners regarding the use of female and male condoms as a means of prevention against STD/HIV. This quantitative and evaluative Knowledge, Attitude and Practice (KAP) study included 155 female prisoners. Data collection was performed between January and March 2010 at the State of Ceará Women's Penitentiary. Although the women had heard of and/or knew about the purposes of the use of condoms, only 35 (22.6%) had appropriate knowledge regarding male condoms, and 11 (7.1%) in regards to the use of female condoms. Their attitudes were less favorable regarding oral sex. Appropriate practice was not significantly representative, particularly regarding the female condom. Homo/bisexuality, gender issues, lack of knowledge, and the difficult access to condoms are obstacles that must be considered in the promotion of sexual health in the studied group.

Condicionantes sociodemográficos e sexuais do conhecimento, atitude e prática de presidiárias quanto ao uso de preservativos

Objetivou-se avaliar o conhecimento, a atitude e a prática de presidiárias quanto ao uso do preservativo masculino e feminino, como medida preventiva às DSTs/HIV e suas relações com aspectos sociodemográficos e sexuais. Pesquisa quantitativa, avaliativa, do tipo Inquérito Conhecimento, Atitude e Prática, envolvendo 155 presidiárias. A coleta de dados realizou-se de janeiro a março de 2010 na penitenciária feminina do Estado do Ceará. Das mulheres investigadas, 35 (22,6%) tinham conhecimento adequado sobre o preservativo masculino e 11 (7,1%) sobre o feminino. As atitudes foram menos favoráveis quanto ao uso no sexo oral. A prática adequada apresentou baixa ocorrência, em especial do preservativo feminino. A atitude associou-se com a idade e a idade da coitarca, enquanto que a prática adequada associou-se com história de prostituição. Conclui-se que as estratégias de promoção da saúde sexual em ambiente prisional devem englobar a complexidade dos aspectos envolvidos no uso dos preservativos.

Para além das grades e punições: uma revisão sistemática sobre a saúde penitenciária

Procedeu-se a uma revisão sistemática acerca das produções científicas sobre Saúde Penitenciária, objetivando verificar como a temática vem sendo abordada, identificar qual o foco mais explorado e apontar possíveis lacunas. A busca foi realizada na Biblioteca Virtual de Saúde. Foram localizados 1160 artigos: 1104 na Medline; 19 na Lilacs e 37 na SciELO, publicados no período de 1993 a 2010. Como as bases de dados da Medline e da Lilacs não disponibilizam os artigos na integra, foram mapeados os locais, as datas e o idioma de publicação dos textos. O aprofundamento analítico delimitou-se aos trabalhos cujos textos estavam na íntegra e disponibilizados gratuitamente, hospedados na SciELO. Evidenciou-se que a produção científica está presente nos cinco continentes do mundo, apresentando predominância da abordagem quantitativa, com foco na identificação do perfil sociodemográfico e das condições de saúde dos encarcerados: incidência de tuberculose, de infecção pelo Vírus da Imunodeficiência Humana e pelo Vírus da Hepatite C. Há uma predominância de estudos realizados com detentos do sexo masculino, em comparação ao sexo feminino. Percebe-se que a saúde dos detentos é um problema de saúde pública emergente, que demanda pesquisas que possam vir a orientar políticas e estratégias de saúde.

Presence of high-grade intraepithelial lesions among women deprived of their liberty: a documental study

The aim of this study was to analyze the results of the Pap smears of women deprived of their liberty. It is a retrospective, documental study, with a quantitative approach, performed in a female prison of Ceará, Brazil, with a sample of 672 patient records. Regarding the microbiological findings, it was verified that the main cervical-vaginal colonization was by bacilli suggestive of Gardnerella/Mobiluncus (21.8%), followed by Trichomonas vaginalis (12%), and Candida sp (5.8%). The frequencies of samples with atypical cells presented rates of 4.1% for Atypical Cells of Undetermined Significance; 3.2% for Low-grade Intraepithelial Lesions; and 2.5% for High-grade Intraepithelial Lesions. The importance of screening for cervical cancer in female prisons was highlighted, as well as the inclusion of the nurse in this environment, ensuring individualized, quality care for women deprived of their liberty.

Prevalence, genotypes and factors associated with HCV infection among prisoners in Northeastern Brazil

AIM: To determine hepatitis C virus (HCV) seroprevalence and its genotypes, and to identify the factors associated with HCV infection.

METHODS: This cross-sectional study, conducted in two prisons (one male and one female) in the State of Sergipe, Brazil, comprised 422 subjects. All of the prisoners underwent a rapid test for the detection of HCV antibodies. Patients with a positive result were tested for anti-HCV by enzyme linked immunosorbent assay and for HCV RNA by qualitative polymerase chain reaction (PCR). The virus genotype was defined in every serum sample that presented positive for PCR-HCV. In order to determine the factors independently associated with positive serology for HCV, multivariate logistic regression was used.

RESULTS: HCV seroprevalence was 3.1%. Of the 13 subjects with positive anti-HCV, 11 had viremia confirmed by PCR. Of these, 90.9% had genotype 1. A total of 43 (10.2%) were injecting drug users, and HCV seroprevalence in this subgroup was 20.6%. The variable most strongly associated with positive serology for HCV was use of injecting drugs [odds ratio (OR), 23.3; 95% confidence interval (CI), 6.0-90.8]. Age over 30 years (OR, 5.5; 95%CI, 1.1-29.2), history of syphilis (OR, 9.8; 95%CI, 1.7-55.2) and history of household contact with HCV positive individual (OR, 14.1; 95%CI, 2.3-85.4) were also independently associated with HCV infection.

CONCLUSION: Most of the HCV transmissions result from parenteral exposure. However, there is evidence to suggest a role for sex and household contact with an infected subject in virus transmission.

HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: a systematic review and meta-analysis

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.

Cost-effectiveness analysis of a hypothetical hepatitis C vaccine compared to antiviral therapy

We propose a mathematical model to simulate the dynamics of hepatitis C virus (HCV) infection in the state of São Paulo, Brazil. We assumed that a hypothetical vaccine, which cost was taken to be the initial cost of the vaccine against hepatitis B exists and it is introduced in the model. We computed its cost-effectiveness compared with the anti-HCV therapy. The calculated basic reproduction number was 1.20. The model predicts that without intervention a steady state exists with an HCV prevalence of 3%, in agreement with the current epidemiological data. Starting from this steady state three interventions were simulated: indiscriminate vaccination, selective vaccination and anti-HCV therapy. Selective vaccination proved to be the strategy with the best cost-effectiveness ratio, followed by indiscriminate vaccination and anti-HCV therapy.