1
|
Medeiros DSD, Magno L, Crosland Guimarães MD, Grangeiro A, Filho ME, Soares F, Greco D, Westin M, Ferraz D, Zucchi EM, Dourado I. Violence, Discrimination, and High Levels of Symptoms of Depression Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil. J Adolesc Health 2023; 73:S19-S25. [PMID: 37953004 DOI: 10.1016/j.jadohealth.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE This study aimed at describing the prevalence of symptoms of depression among 15-19 year old adolescent men who have sex with men (aMSM) and transgender women (aTGW), who were recruited in an HIV pre-exposure prophylaxis cohort study in three Brazilian capital cities. The study also examined potential associations, including violence and discrimination, with severe symptoms of depression among aMSM. METHODS This is a cross-sectional study of baseline data among 730 aMSM and 56 aTGW recruited between February 2019 and February 2021. Sociodemographic and behavioral data were collected. The 20-item Center for Epidemiologic Studies Depression scale was used to screen for symptoms of depression. Scores of ≥22 points indicate the presence of severe symptoms associated with major depression. Logistic regression was used to assess independent associations among aMSM, adjusting for sociodemographic variables. RESULTS Our findings indicate a high prevalence of symptoms of depression (overall prevalence = 58.5% and 69.6%; 21.2% and 25.0% for mild/moderate, and 37.3% and 44.6% for severe) among these aMSM and aTGW, respectively. Psychological violence (aOR = 1.74; 95% CI = 1.12-2.70), sexual violence (aOR = 1.79; 95% CI = 1.07-2.98), and discrimination due to sexual orientation (aOR = 1.71; 95% CI = 1.23-2.38) were independently associated with severe symptoms of depression in aMSM. DISCUSSION The high prevalence of severe symptoms of depression and its association with psychological and sexual violence and discrimination creates cycles of vulnerability and carries important public health implications. Thus, our findings indicate public policies should consider assessing depression, psychological and sexual violence, as well as discrimination, especially in populations that will be targeted by interventions, such as the use of pre-exposure prophylaxis.
Collapse
Affiliation(s)
- Danielle Souto de Medeiros
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia, Brazil.
| | - Laio Magno
- Departmento de Ciências da Saúde, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | | | - Alexandre Grangeiro
- Departmento de Medicina Preventiva, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcos Eustorgio Filho
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Dirceu Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mateus Westin
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Dulce Ferraz
- Fundação Oswaldo Cruz (Fiocruz), Diretoria Regional de Brasília, Brasília, Brazil; gUMR Inserm 1296 - Radiations: Défense Santé Environnement, Université Lumière Lyon 2, Lyon, France
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, São Paulo, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| |
Collapse
|
2
|
Rocha GM, Cândido RCF, de Carvalho NP, Carvalho EGA, Costa AAM, Machado IV, da Cruz Pimenta MP, de Paula Júnior JA, Guimarães MDC, de Pádua CAM. Strategies to increase HIV testing among men who have sex with men and transgender women: an integrative review. BMC Infect Dis 2023; 23:240. [PMID: 37072705 PMCID: PMC10111644 DOI: 10.1186/s12879-023-08124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/28/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women (TGW) are disproportionately affected by HIV, with much higher incidence and prevalence rates than in the general population in different countries. There are several barriers to testing among MSM and TGW, such as low risk perception, anticipation of HIV-related stigma, discrimination of sexual orientation, in addition to difficulties related to care and access to health services. Therefore, analyzing the available evidence of the effectiveness of strategies for scaling up HIV testing among key populations is essential to point out potential knowledge gaps which may need to be addressed and develop public health policies to promote testing and early diagnosis of HIV infection. METHODS An integrative review was carried out to evaluate strategies for scaling up HIV testing in these populations. Search strategy was performed on eight electronic databases, without language restriction. We included clinical trials, quasi-experimental studies, and non-randomized studies. Study selection and data extraction were both performed independently by pairs and disagreements were solved by a third revisor. The screening of the studies was carried out through the selection of titles/abstracts and the reading of the full texts of the pre-selected studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data extraction was performed using a structured form. RESULTS Thirty-seven publications referring to 35 studies were included, mostly being carried out in the United States of America and Australia. No studies were found evaluating disaggregated data on TGW. The studies were grouped into four types of intervention strategies: self-test distribution system (n = 10), organization of health services (n = 9), peer education (n = 6), and social marketing campaign (n = 10). Strategies that focused on the first three groups, combined or not, were more effective in increasing HIV testing among MSM. CONCLUSIONS Considering the diversity of interventions and the methodological heterogeneity of the included studies, strategies especially involving self-test distribution systems, associated with new information and communication technologies, should be evaluated in different communities and social contexts. Research evaluating specific studies on TGW population is still needed.
Collapse
|
3
|
Soares F, Magno L, da Silva LAV, Guimarães MDC, Leal AF, Knauth D, Veras MA, de Brito AM, Kendall C, Kerr LRFS, Dourado I. Perceived Risk of HIV Infection and Acceptability of PrEP among Men Who Have Sex with Men in Brazil. Arch Sex Behav 2023; 52:773-782. [PMID: 36169773 PMCID: PMC9517975 DOI: 10.1007/s10508-022-02342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 06/16/2023]
Abstract
The HIV epidemic affects men who have sex with men (MSM) disproportionally in Brazil, and pre-exposure prophylaxis (PrEP) is effective for preventing HIV in this population. However, low perceived risk of HIV may influence the acceptability and decision to use PrEP. This study estimated the association between self-perception of HIV risk and acceptability of daily oral PrEP among Brazilian MSM. Respondent-driven sampling (RDS) was used for behavioral and biological surveillance to recruit 4,176 MSM 18 years or over in 12 Brazilian cities in 2016. Results were weighted using Gile's estimator in RDS Analyst software. Adjusted odds rations (OR) with 95% confidence intervals were calculated using multivariate logistic regression. Acceptability of daily oral PrEP was high (69.7%) among the 3,544 MSM available for analysis. Most participants self-reported low or moderate risk of HIV infection (67.2%) and a small proportion (9.3%) reported high risk. A dose-response relationship was observed between acceptability of PrEP and self-reported risk: PrEP acceptability was 1.88 times higher (OR 1.8; 95% CI: 1.24-2.85) among MSM whose perceived risk of HIV infection was low or moderate, and 5 times higher (OR 5.68; 95% CI: 2.54-12.73) among those who self-reported high risk compared to MSM reporting no HIV risk. MSM with the highest risk perception of HIV reported higher rates of PrEP acceptability. Given the availability of daily oral PrEP in the public health care system in Brazil, we suggest emphasizing counseling about self-perception of HIV risk as part of routine HIV prevention services.
Collapse
Affiliation(s)
- Fabiane Soares
- Institute of Collective Health, Federal University of Bahia, Basílio da Gama, s/n, Campos Universitário Do Canela, Salvador, Bahia, CEP: 4.0110-040, Brazil.
| | - Laio Magno
- Department of Life Sciences, State University of Bahia, Salvador, Bahia, Brazil
| | | | | | - Andrea Fachel Leal
- Sociology Department, Institute of Philosophy and Human Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniela Knauth
- Department of Social Medicine, Faculty of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Amélia Veras
- School of Medical Sciences, Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Carl Kendall
- Department of Community Health, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Basílio da Gama, s/n, Campos Universitário Do Canela, Salvador, Bahia, CEP: 4.0110-040, Brazil
| |
Collapse
|
4
|
Ferreira DG, Veras MA, Saggese GSR, Guimarães MDC, Magno L, Dourado I, Maia Macena RH, Leal AF, Kendall C, Mércham-Hamann E, Bermúdez XPD, Knauth D, Sansigolo Kerr LR. Prevalence, Characteristics, and Factors Associated With Sexual Violence in Adulthood Among Brazilian MSM. Am J Mens Health 2022; 16:15579883221142173. [PMID: 36527370 PMCID: PMC9768831 DOI: 10.1177/15579883221142173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Most studies of sexual violence are with women, and although men who have sex with men (MSM) is the group of the men that has been most investigated for sexual violence, there are still several questions to be answered about sexual violence and sexual revictimization among MSM. This study aimed to estimate the prevalence of sexual violence in different stages of life and identify factors associated with sexual violence in adulthood among Brazilian MSM. We conducted an analysis with data from the study conducted in 2016 with 4,176 MSM from 12 Brazilian cities recruited through respondent-driven sampling (RDS), who answered a survey to a set of questions, among which some specific about sexual violence. Most participants were under 25 years old (56.5%), with more than 12 years of schooling (71.2%), mixed race (40.8%), single (86.2%), and belonging to some religion (50.9%). The lifetime prevalence of sexual violence was 20.3%. In our analyses, having experienced sexual violence in childhood and adolescence increased the odds of experiencing sexual violence in adulthood (prevalence ratio ratios [PRR] 4.93 (95% CI [1.99, 12.21]), as did experiencing physical violence (PRR 1.99; 95% CI [1.07, 3.71]) and receiving money for sex (PRR 2.26; 95% CI [1.17, 4.36]). In addition to violence in childhood and adolescence being risk factors for sexual violence in adulthood, we also observed that half of the sample experienced sexual violence repeatedly, characterizing sexual revictimization. It is important that health services are prepared to receive boys and men victims in order to reduce the chances of revictimization and other outcomes.
Collapse
Affiliation(s)
- Denis Gonçalves Ferreira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil,Denis Gonçalves Ferreira, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Motta Jr., 61—São Paulo 01221-020, Brazil.
| | - Maria Amelia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | | | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil
| | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Andréa Fachel Leal
- Instituto de Filosofia e Ciências Humanas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Carl Kendall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Edgar Mércham-Hamann
- Programa de Pós Graduação em Saúde Coletiva, Universidade de Brasília, Brasilia, Brasil
| | | | - Daniela Knauth
- Department of Social Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | |
Collapse
|
5
|
Braga LP, Szwarcwald CL, Damacena GN, de Souza-Júnior PRB, Dourado I, de Brito AM, Grangeiro A, Crosland Guimarães MD. Health vulnerabilities in female sex workers in Brazil, 2016. Medicine (Baltimore) 2022; 101:e30185. [PMID: 36107499 PMCID: PMC9439778 DOI: 10.1097/md.0000000000030185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Female sex workers (FSW) suffer stigma and discrimination that negatively impact their physical and mental health and affect access to health care services. This paper aims to describe selected health indicators among FSW in 12 Brazilian cities in 2016. Brazilian cross-sectional Biological Behavioral Surveillance Survey was conducted in 2016 among 4328 FSW recruited by respondent-driven sampling. The sample weighing was inversely proportional to participant's network sizes and the seeds were excluded from the analysis. Health indicators were estimated with 95% confidence interval and included indicators of health status, symptoms of depression, antenatal care, pap smear coverage, signs and symptoms of sexually transmitted infection, contraception and regular condom use, number of births and children alive per women, human immunodeficiency virus and syphilis testing, usual source of care, and perception of discrimination. Most participants self-rated their health as very good/good (65.8%) and 27.7% were positively screened for major depressive disorder episode on Patient Health Questionnaire-2. Antenatal coverage was 85.8% and 62.3% of FSW had access to pap smear exam in the past 3 years. A total of 67.0% of FSW were using some contraceptive method at the time of the study. Male condom was the most common method (37.1%), followed by oral pill (28.9%). A total of 22.5% FSW had never been tested for HIV and the main reasons were "not feeling at risk" (40.4%) and "being afraid or ashamed" (34.0%). The vast majority of FSW used Brazilian National Health System as their usual source of health care (90.2%). Approximately one-fifth of the participants felt discriminated against or were treated worse for being FSW (21.4%) and only 24.3% disclose their sex work status in health services. The vulnerability of FSW is expressed in all health indicators. Indicators of health status, antenatal care, pap smear coverage, and contraception were worse than in the Brazilian population, and point out to the importance of increase FSW's access to health care services. Also, stigma and discrimination emerged as an important barrier to FSW's health care in all dimensions and need to be struggled.
Collapse
Affiliation(s)
- Letícia Penna Braga
- Postgraduate Program in Epidemiology in Public Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- *Correspondence: Letícia Penna Braga, Postgraduate Program in Epidemiology in Public Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (e-mail: )
| | - Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paulo Roberto Borges de Souza-Júnior
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Ana Maria de Brito
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation IAM/Fiocruz, Recife, Pernambuco, Brazil
| | | | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
6
|
de Almeida MM, da Silva LAV, Bastos FI, Guimarães MDC, Coutinho C, de Brito AM, Cavalcante S, Dourado I. Factors associated with symptoms of major depression disorder among transgender women in Northeast Brazil. PLoS One 2022; 17:e0267795. [PMID: 36048808 PMCID: PMC9436078 DOI: 10.1371/journal.pone.0267795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 04/17/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Transgender women (TGW) are one of the most vulnerable groups, including higher prevalence of HIV and mental health disorders, such as anxiety and depression than in the general population. Major Depression Disorder (MDD) is one of the most important mental health conditions due to an increasing trend in prevalence in the general population. This study aims at describing the prevalence of symptoms of MDD (SMDD) and associated factors among TGW in capitals of three States in Northeast Brazil. METHODS TGW n = (864) were selected from the cities of Salvador (n = 166), Recife (n = 350), and Fortaleza (n = 348) using Respondent Driven Sampling methodology. Symptoms of MDD were defined according to the Patient Health Questionnaire-9 scale. Multinomial logistic regression was used to compare those with mild/moderate or moderately severe/severe symptoms of depression with those with no depression, respectively, using complex sample design. Weighted Odds Ratio with 95% confidence interval were estimated. RESULTS 51.1% of the sample was classified as mild/moderate and 18.9% as moderately severe/severe SMDD. Mild/moderate SMDD was associated with a history of sexual violence (OR = 2.06, 95%CI: 1.15-3.68), history of physical violence (OR = 2.09, 95%CI: 1.20-3.67),) and poor self-rated quality of life (OR = 2.14, 95%CI: 1.31-3.49).). Moderately severe/severe SMDD was associated with history of sexual violence (OR = 3.02, 95%CI: 1.17-7.77), history of physical violence (OR = 4.34, 95% CI:1.88-6.96), poor self-rated quality of life (OR = 3.32, 95%CI:1.804-6.12), lack of current social support (OR = 2.53, 95%IC: 1.31-4.88) and lack of family support in childhood (OR = 2.17, 95%IC 1.16-4.05)). CONCLUSIONS Our findings strengthens the evidence of a higher prevalence of SMDD among TGW as compared to the general population. Public health policies and actions that target social determinants of risk and protection for MDD among TGW must be urgently implemented.
Collapse
Affiliation(s)
| | - Luís Augusto Vasconcelos da Silva
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Institute of Arts, Sciences and Humanities, Federal University of Bahia, Salvador, Brazil
| | | | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Ana Maria de Brito
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil
| | - Socorro Cavalcante
- Health Department of the State of Ceará and Municipality of Fortaleza, Fortaleza, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
7
|
Mendicin CCP, Moreira Costa AA, da Silva GJ, Braga LP, Rocha GM, Carmo RA, Guimarães MDC, de Pádua CAM. Metabolic comorbidities and systemic arterial hypertension: the challenge faced by HIV patientson long-term use of antiretroviral therapy. Hosp Pract (1995) 2022; 50:75-81. [PMID: 35040377 DOI: 10.1080/21548331.2022.2030564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Our objective was to estimate the frequency of comorbidities and assess its relationship with exposure factors after a long-term of ART use. METHODS : A cross-sectional study with PLHIV (≥18 years-old), who initiated ART between 2001-2005 and attended an HIV/AIDS public-referral center (Belo Horizonte/Brazil) was performed. Demographic, clinical, therapeutic and lifestyle data were obtained through interviews, medical charts, public database, routine laboratory exams and bone densitometry. The outcome was the number of comorbidities: hyperglycemia, dyslipidemia, systemic arterial-hypertension (SAH) and low bone mineral density (BMD). Absolute/relative frequencies were calculated. Factors associated with the outcome were assessed by quasi-Poisson regression. RESULTS: Of the 98 participants, 53% were male, 79% over 43 years-old. Moderate physical-activity was observed in 82%, overweight/obesity in 50% and 58% used ART based on two nucleoside reverse transcriptase inhibitors (NRTI) plus one non-nucleoside reverse transcriptase inhibitor (NNRTI). After a mean of 15.6 years of ART exposure, 207 comorbidities were identified and 93% participants presented at least one comorbidity (mean=2.1/participant). The most frequent overlapping was composed by two co-occurrences: dyslipidemia+hyperglycemia or dyslipidemia+SAH, n=36 in each co-occurrence. The quasi-Poisson regression showed an increase of 3% in the number of comorbidities per year of age (OR=1.03;95%CI=1.02-1.04) and 84% among PLHIV on moderate physical-activity (ref=heavy physical-activity) (OR=1.84;95%CI=1.08-3.13). CONCLUSIONS Our study shows that the aging slightly contributed to comorbidities. However, the practice of physical-activities is crucial to prevent chronic-diseases. Treatment and preventive measures should be encouraged to diminish the burden of disease and improve quality of life among PLHIV.
Collapse
Affiliation(s)
- Cássia Cristina Pinto Mendicin
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
| | | | - Gabriella Jomara da Silva
- Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
| | | | - Gustavo Machado Rocha
- Federal University of São João del-Rei (UFSJ), Divinópolis city, Minas Gerais state, Brazil
| | - Ricardo Andrade Carmo
- Infectious Diseases Reference Center, CTR/DIP Orestes Diniz, Municipal Health Division/ Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
| | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
| | - Cristiane A Menezes de Pádua
- Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte city, Minas Gerais state, Brazil
| |
Collapse
|
8
|
Magno L, Guimarães MDC, Leal AF, Dourado I, Knauth DR, Bermúdez XPD, Rocha GM, Veras MADSM, Kendall C, Brito AMD, Kerr LRS. Perception of discrimination due to sexual orientation and associated factors among men who have sex with men in 12 Brazilian cities. CAD SAUDE PUBLICA 2022; 38:EN199121. [DOI: 10.1590/0102-311xen199121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022] Open
Abstract
Discrimination due to sexual orientation (DDSO) has an important association with health outcomes among men who have sex with men (MSM). This study aimed to analyze factors associated with DDSO among MSM in 12 Brazilian cities. This is a cross-sectional study with 4,176 MSM participants recruited in 2016 which used a respondent-driven sampling method in 12 Brazilian cities. DDSO levels were previously identified by a latent class analysis based on 13 variables from the discrimination section. An ordinal logistic regression was used to assess associations with these DDSO levels, and weighted ordinal odds ratios (OR) and their respective 95% confidence intervals (95%CI) were estimated using Gile’s estimator. Most participants were young (< 25 years old) black or of mixed-race (pardo), single individuals who had a religious affiliation, primary or incomplete secondary education, and a high and average socioeconomic status. More than half (65%) reported DDSO in the 12 months prior to this study. We observed an independent association among the four latent DDSO classes and the following variables: age < 25 years old (OR = 1.66; 95%CI: 1.21-2.27), white skin color (OR = 1.43; 95%CI: 1.02-2.01), history of sexual (OR = 2.33; 95%CI: 1.58-3.43) and physical violence (OR = 3.08; 95%CI: 2.11-4.49), disclosure of their sexual orientation as MSM to their fathers (OR = 2.00; 95%CI: 1.47-2.72), experienced suicidal ideation in the two weeks prior to this study (OR = 2.09; 95%CI: 1.46-2.98), and use of any illicit drugs in the last six months (OR = 1.61; 95%CI: 1.19-2.18). Our results indicate that contextual factors may contribute to high DDSO levels among MSM in Brazil. Public health policies toward human rights surveillance and protection among MSM must be urgently addressed.
Collapse
Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia, Brazil; Universidade Federal da Bahia, Brazil
| | | | | | | | | | | | | | | | - Carl Kendall
- Tulane University School of Public Health and Tropical Medicine, U.S.A
| | | | | |
Collapse
|
9
|
Braga LP, Damacena GN, Szwarcwald CL, Guimarães MDC. Sexual, reproductive health and health status of female sex workers in 12 Brazilian cities, 2016. Rev Bras Epidemiol 2021; 24:e210057. [PMID: 34730712 DOI: 10.1590/1980-549720210057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate differences in sexual, reproductive health and health status indicators of female sex workers in 12 Brazilian cities. METHODS Cross-sectional study of biological and behavioral surveillance survey with a minimum sample of 350 female sex workers per city, recruited by respondent driven sampling, in 2016. Complex sample design was considered in the data analysis. Indicators and 95% confidence intervals related to sexual and reproductive health, and health status were described separately by city and for the total sample. RESULTS The total sample consisted of 4,328 female sex workers. The coverage of Pap smear exam, human immunodeficiency virus and syphilis tests and antenatal care indicators varied by 20 percentages points or more. Pap smear exam coverage ranged from 53.4% in Recife to 73.0% in Porto Alegre. The highest percentage of female sex workers who had never been tested for human immunodeficiency virus and syphilis was in Fortaleza (36.8 and 63.8%, respectively). Antenatal coverage ranged from 61.1% in Salvador to 99.0% in Curitiba. In five cities, the proportion of female sex workers who disclosed their sex work status in health services was over 20.0%. CONCLUSION The differences between the indicators in the 12 cities followed the Brazilian population profile, with more vulnerable sex workers in the North and Northeast regions. The results show that it is essential to consider the barriers to accessing health, such as stigma and discrimination, which restrict the addressing of female sex workers specific needs.
Collapse
Affiliation(s)
- Letícia Penna Braga
- Post-graduate program in Public Health Epidemiology, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Giseli Nogueira Damacena
- Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Célia Landmann Szwarcwald
- Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais - Minas Gerais (MG), Brazil
| |
Collapse
|
10
|
Mendicino CCP, Moodie EEM, Guimarães MDC, Pádua CAMD. Immune recovery after antiretroviral therapy initiation: a challenge for people living with HIV in Brazil. CAD SAUDE PUBLICA 2021; 37:e00143520. [PMID: 34669770 DOI: 10.1590/0102-311x00143520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
Immune recovery reflects health conditions. Our goal was to estimate the time it takes to achieve immune recovery and its associated factors, in people living with HIV (PLHIV), after antiretroviral therapy (ART) initiation. A historical cohort study was performed among PLHIV (> 18 years-old) in Minas Gerais State, Brazil, using data from healthcare databases. Patients initiating ART between 2009-2018, with T-CD4+ lymphocytes and viral load recorded before and after antiretroviral therapy were included. The outcome is achievement of immune recovery, defined as the first T-CD4+ > 500 cells/µL after ART initiation. Explanatory variables were age, gender, place of residence, year of ART initiation, baseline viral load and T-CD4+, viral load status, and adherence to ART at follow-up. Descriptive analysis, cumulative, and person-time incidences of immune recovery were estimated. Median-time to immune recovery was estimated using Kaplan-Meier method. Factors associated with immune recovery were assessed by Cox regression. Among 26,430 PLHIV, 8,014 (30%) were eligible. Most were male (67%), mean age 38.7 years, resided in non-central region, median-baseline T-CD4+ = 228 cells/µL (< 200 cells/µL = 43%) and viral load median-baseline = 4.7 log10 copies/mL (detectable viral load = 99%). Follow-up time = 15,872 person-years. Cumulative and incidence rate were 58% (95%CI: 57-58) (n = 4,678) and 29.47 cases/100 person-years, respectively. Median-time to immune recovery was of 22.8 months (95%CI: 21.9-24.0). Women living with HIV, younger than 38 years of age, with T-CD4+ baseline > 200 cells/µL, detectable viral load (baseline), antiretroviral therapy-adherence and undetectable viral load (follow-up) were independently associated with immune recovery. Time to immune recovery remains long and depends on early treatment and antiretroviral therapy-adherence.
Collapse
Affiliation(s)
- Cássia C P Mendicino
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | | |
Collapse
|
11
|
Almeida LFD, Guimarães MDC, Dourado I, Veras MADSM, Magno L, Leal AF, Kerr LRS, Kendall C, Pontes AK, Rocha GM. Envolvimento em organizações não governamentais e a participação em ações de prevenção ao HIV/aids por homens que fazem sexo com homens no Brasil. CAD SAUDE PUBLICA 2021. [DOI: 10.1590/0102-311x00150520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A epidemia do HIV no Brasil é concentrada em populações-chave. Organizações não governamentais (ONGs) que atuam em defesa dos direitos da população LGBT e de pessoas vivendo com HIV/aids podem contribuir para o desenvolvimento de políticas de prevenção. O objetivo deste estudo é avaliar o envolvimento em ONGs e analisar sua associação com a participação individual em ações de educação em saúde, testagem e prevenção às infecções sexualmente transmissíveis (IST) e ao HIV, como parte de um estudo nacional de vigilância biológica e comportamental entre homens que fazem sexo com homens (HSH). Trata-se de estudo transversal utilizando respondent driven sampling (RDS) em 12 cidades brasileiras. A magnitude da associação do envolvimento em ONGs com cada ação foi avaliada pela estimativa de odds ratio por meio de regressão logística por amostragem complexa, considerando cada cidade como um estrato e ponderando pelo estimador de Gile. Foi estimada a proporção relativa atribuída ao envolvimento em ONGs para cada evento avaliado. Dentre 4.176 participantes, a maioria tinha menos de 25 anos (56,5%) e baixo nível econômico (56,7%). Um quarto dos HSH referiu se envolver em ONGs, que foi significativamente associado com as ações avaliadas: receber preservativo e gel lubrificante, participar de palestra, receber material educativo e aconselhamento em IST, conhecimento de profilaxia pós-exposição (PEP) e profilaxia pré-exposição (PrEP), testagem para sífilis e HIV, ter aceitação do autoteste e saber onde realizar teste para HIV. ONGs têm um papel histórico na resposta à epidemia de HIV no Brasil e, apesar de terem sofrido significativa redução de recursos nos últimos anos, mantêm relevante atuação nas ações de saúde pública.
Collapse
Affiliation(s)
| | | | | | | | - Laio Magno
- Universidade Federal da Bahia, Brazil; Universidade do Estado da Bahia, Brazil
| | | | | | | | | | | |
Collapse
|
12
|
Mendicino CCP, da Silva GJ, Braga LP, Colosimo EA, Guimarães MDC, de Pádua CAM. Monitoring HIV infection in Minas Gerais state: 15-year assessment of adults living with HIV initiating Antiretroviral Therapy. Rev Soc Bras Med Trop 2020; 53:e20200360. [PMID: 33331608 PMCID: PMC7747810 DOI: 10.1590/0037-8682-0360-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The first Brazilian HIV treatment recommendation was put forward in 1996, resulting in 12 subsequent guidelines. Several changes were made regarding "when" and "how" to begin treatment. The latest guideline recommends immediate initiation of antiretroviral therapy (ART). This study aimed to describe the evolution of HIV treatment among people living with HIV (PLHIV) who initiated ART between 2004 and 2018 based on the national guideline recommendations concerning T-CD4+ and VL measurements. METHODS A cross-sectional analysis of data of PLHIV aged >18 years, in Minas Gerais who received ART between 2004 and 2018 was conducted. Clinical, therapeutic, and demographic information were obtained from national healthcare databases. The study was divided into four periods: 2004-2007, 2008-2012, 2013-2016, and 2017-2018. Descriptive analyses were performed. RESULTS A total of 60,618 PLHIV initiated ART (67% male and 48% aged 25-39 years), 36% of whom had CD4 counts at ART initiation and 51% documented VL after ART initiation. The median CD4 count ranged from 288 to 373 cells/µL. The median time to ART initiation decreased from 604 to 28 days and was lower among males (p <0.01). The median time from ART initiation to the first VL result decreased from 101 to 62 days over the study period, while the median VL after ART initiation ranged from 2.3 to 1.7 log10 copies/ml. CONCLUSIONS Although our results demonstrated that most recommendations were followed, there seemed to be little impact on CD4 counts and VL testing. This may result in an inadequate evaluation of ART effectiveness.
Collapse
Affiliation(s)
- Cássia Cristina Pinto Mendicino
- Universidade Federal de Minas Gerais, Faculdade de Farmácia, Programa de Pós-Graduação Stricto Sensu em Medicamentos e Assistência Farmacêutica, Belo Horizonte, MG, Brasil
| | - Gabriella Jomara da Silva
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação Stricto Sensu em Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil
| | - Letícia Penna Braga
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública, Programa Stricto Sensu de Pós-graduação em Epidemiologia em Saúde Pública, Rio de Janeiro, RJ, Brasil
| | - Enrico Antônio Colosimo
- Universidade Federal de Minas Gerais, Instituto de Ciências Exatas, Departamento de Estatística, Belo Horizonte, MG, Brasil
| | | | - Cristiane Aparecida Menezes de Pádua
- Universidade Federal de Minas Gerais, Faculdade de Farmácia, Programa de Pós-Graduação Stricto Sensu em Medicamentos e Assistência Farmacêutica, Belo Horizonte, MG, Brasil
| |
Collapse
|
13
|
Magno L, Leal AF, Knauth D, Dourado I, Guimarães MDC, Santana EP, Jordão T, Rocha GM, Veras MA, Kendall C, Pontes AK, de Brito AM, Kerr L. Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil. BMC Infect Dis 2020; 20:865. [PMID: 33213389 PMCID: PMC7678175 DOI: 10.1186/s12879-020-05589-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result. METHODS Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile's estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). RESULTS For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. CONCLUSIONS The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.
Collapse
Affiliation(s)
- Laio Magno
- Department of Life Sciences, Bahia State University, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Bahia, Brazil.
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil.
| | - Andrea Fachel Leal
- Sociology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela Knauth
- Department of Social Medicine, Universidade Federal do Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | | | - Elis Passos Santana
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Tiago Jordão
- Department of Life Sciences, Bahia State University, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Bahia, Brazil
| | | | | | - Carl Kendall
- Tulane School of Public Health and Tropical Medicine, New Orleans, USA
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Ligia Kerr
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| |
Collapse
|
14
|
Alecrim DJD, Ceccato MDGB, Dourado I, Kerr L, Brito AMD, Guimarães MDC. Factors associated with exchanging sex for money in men who have sex with men in Brazil. Cien Saude Colet 2020; 25:1025-1039. [PMID: 32159671 DOI: 10.1590/1413-81232020253.18052018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/14/2018] [Indexed: 11/21/2022] Open
Abstract
This study aimed to analyze the association between sociodemographic, programmatic and contextual factors and the receipt of money in exchange for sex among men who have sex with men (MSM). This is a multicenter, cross-sectional study conducted in ten Brazilian cities between 2008 and 2009. Adult MSM recruited through the Respondent Driven Sampling (RDS) were interviewed. Weighted Odds Ratio (ORw) was obtained through logistic regression, retaining the variables associated with the event (p < 0.05) in the final model. Of the total sample, 33.3% reported receiving money in exchange for sex in the last 12 months before the interview. The variables that were independently associated with the event were age less than or equal to 25 years, lower education, lower social classes, previous history of syphilis, using sites or services to find sexual partners in the previous month, very high risk behavior, using illicit drugs in the previous six months, self-identifying as heterosexual or bisexual, having suffered physical violence due to sexual orientation and having suicidal thoughts always or most of the time. It was observed that MSM who received money in exchange for sex had greater socioeconomic, programmatic and contextual vulnerability, potentially increasing the risk of HIV infection than the other MSM in the sample.
Collapse
Affiliation(s)
- Denyr Jeferson Dutra Alecrim
- Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antonio Carlos 6627, Pampulha. 31270-010, Belo Horizonte, MG, Brasil.
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antonio Carlos 6627, Pampulha. 31270-010, Belo Horizonte, MG, Brasil.
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador, BA, Brasil
| | - Ligia Kerr
- Universidade Federal do Ceará. Departamento de Saúde Comunitária. Fortaleza, CE, Brasil
| | | | | |
Collapse
|
15
|
Rocha GM, Guimarães MDC, de Brito AM, Dourado I, Veras MA, Magno L, Kendall C, Kerr LRFS. High Rates of Unprotected Receptive Anal Intercourse and Their Correlates Among Young and Older MSM in Brazil. AIDS Behav 2020; 24:938-950. [PMID: 30879210 DOI: 10.1007/s10461-019-02459-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to estimate the prevalence and factors associated with unprotected receptive anal intercourse (URAI), stratified by age (18-24 or 25 + years old), in a sample of 4,129 MSM recruited by respondent driven sampling in 12 Brazilian cities in 2016. The prevalence of URAI was higher among younger MSM (41.9% vs 29.7%) (p < 0.01). Multivariate analysis indicated that perception of risk, sexual identity, self-rated health status, and having commercial sex were associated with URAI among younger MSM. History of sexual violence, sex with younger partners, having 6 + partners and unprotected sexual debut were associated with URAI among older MSM. Marital status, having stable partner, and reporting sex with men only were associated with URAI in both groups. Despite access to condoms and lubricants, preventive efforts may not be reaching MSM effectively. Age specific intervention approaches, including stigma, discrimination, and perception of risk must be considered.
Collapse
Affiliation(s)
- Gustavo Machado Rocha
- Federal University of São João del-Rei, Rua Sebastião Gonçalves Coelho, 400, CEP 35502-296, Divinópolis, MG, Brazil.
| | | | | | - Ines Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Maria Amélia Veras
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia, Salvador, Brazil
| | - Carl Kendall
- Center for Global Health Equity, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | | |
Collapse
|
16
|
Teixeira RA, Naghavi M, Guimarães MDC, Ishitani LH, França EB. Quality of cause-of-death data in Brazil: Garbage codes among registered deaths in 2000 and 2015. Rev Bras Epidemiol 2019; 22Suppl 3:e19002.supl.3. [PMID: 31800854 DOI: 10.1590/1980-549720190002.supl.3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/07/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION reliability of mortality data is essential for health assessment and planning. In Brazil, a high proportion of deaths is attributed to causes that should not be considered as underlying causes of deaths, named garbage codes (GC). To tackle this issue, in 2005, the Brazilian Ministry of Health (MoH) implements the investigation of GC-R codes (codes from chapter 18 "Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified, ICD-10") to improve the quality of cause-of-death data. This study analyzes the GC cause of death, considered as the indicator of data quality, in Brazil, regions, states and municipalities in 2000 and 2015. METHODS death records from the Brazilian Mortality Information System (SIM) were used. Analysis was performed for two GC groups: R codes and non-R codes, such as J18.0-J18.9 (Pneumonia unspecified). Crude and age-standardized rates, number of deaths and proportions were considered. RESULTS an overall improvement in the quality of mortality data in 2015 was detected, with variations among regions, age groups and size of municipalities. The improvement in the quality of mortality data in the Northeastern and Northern regions for GC-R codes is emphasized. Higher GC rates were observed among the older adults (60+ years old). The differences among the areas observed in 2015 were smaller. CONCLUSION the efforts of the MoH in implementing the investigation of GC-R codes have contributed to the progress of data quality. Investment is still necessary to improve the quality of cause-of-death statistics.
Collapse
Affiliation(s)
- Renato Azeredo Teixeira
- Public Health Graduate Program, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation - Seattle (WA), United States
| | - Mark Drew Crosland Guimarães
- Public Health Graduate Program, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Lenice Harumi Ishitani
- Epidemiology and Health Assessment Research Group, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Elizabeth Barboza França
- Public Health Graduate Program, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| |
Collapse
|
17
|
Guimarães MDC, Magno L, Ceccato MDGB, Gomes RRDFM, Leal AF, Knauth DR, Veras MADSM, Dourado I, Brito AMD, Kendall C, Kerr LRFS. HIV/AIDS knowledge among MSM in Brazil: a challenge for public policies. Rev Bras Epidemiol 2019; 22Suppl 1:e190005. [PMID: 31576981 DOI: 10.1590/1980-549720190005.supl.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION High level of HIV/AIDS knowledge is required for an effective adoption of preventive strategies. OBJECTIVE To assess HIV/AIDS knowledge among men who have sex with men (MSM) in 12 Brazilian cities. METHODS Respondent-Driven Sampling method was used for recruitment. HIV/AIDS knowledge was assessed by Item Response Theory. Difficulty and discrimination parameters were estimated, and the knowledge score was categorized in three levels: high, medium, and low. Logistic regression was used for analysis. RESULTS Among 4,176 MSM, the proportion of high level of knowledge was 23.7%. The following variables were positively associated with high knowledge (p < 0.05): age 25+ years old, 12+ years of schooling, white skin color, having health insurance, having suffered discrimination due to sexual orientation, having had a syphilis test, and having received educational material in the previous 12 months. Exchanging sex for money was negatively associated. CONCLUSIONS The proportion of only 23.7% of high HIV/AIDS knowledge was low. We should note that the only potential source of knowledge acquisition associated with high level of knowledge was receiving educational materials. Our study indicates the need for expansion of public prevention policies focused on MSM and with more effective communication strategies, including the development of knowledge that involves motivation and abilities for a safer behavior.
Collapse
Affiliation(s)
| | - Laio Magno
- Department of Life Sciences, Universidade do Estado da Bahia - Salvador (BA), Brazil.,Institute of Collective Health, Universidade Federal da Bahia - Salvador (BA), Brazil
| | | | | | - Andrea Fachel Leal
- Department of Sociology, Institute of Philosophy and Humanities. Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Daniela Riva Knauth
- Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul - Rio Grande (RS), Brazil
| | | | - Inês Dourado
- Institute of Collective Health, Universidade Federal da Bahia - Salvador (BA), Brazil
| | - Ana Maria de Brito
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation - Recife (PE), Brazil
| | - Carl Kendall
- Tulane School of Public Health and Tropical Medicine - New Orleans (LA), United States of America.,Department of Community Health, Federal University of Ceará - Fortaleza (CE), Brazil
| | | | | |
Collapse
|
18
|
Kendall C, Kerr L, Mota RS, Guimarães MDC, Leal AF, Merchan-Hamann E, Dourado IC, Veras MA, Brito AMD, Pontes AK, Castro ARCM, Macena RHM, Knauth D, Linda LC, Oliveira LC, Cavalcante S, Camillo AC, Bermudez XPD, Moreira RC, Benzaken AS, Pereira G, Pascom ARP, Pimenta C, Grazina Johnston L. The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics. Rev Bras Epidemiol 2019; 22:e190004. [PMID: 30892467 DOI: 10.1590/1980-549720190004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. METHODS Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. RESULTS Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). CONCLUSION The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.
Collapse
Affiliation(s)
- Carl Kendall
- Tulane University, Global Community Health and Behavioral Sciences - New Orleans (LA), United States.,Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Ligia Kerr
- Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Rosa Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | | | - Andrea Fachel Leal
- Departamento de Sociologia, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Edgar Merchan-Hamann
- Faculdade de Ciências da Saúde, Saúde Coletiva, Universidade de Brasília - Brasília (DF), Brazil
| | - Inês Costa Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia - Salvador (BA), Brazil
| | - Maria Amélia Veras
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo - São Paulo (SP), Brazil
| | - Ana Maria de Brito
- Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães - Recife, PE, Brazil
| | - Alexandre Kerr Pontes
- Instituto de Psicologia, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | | | | | - Daniela Knauth
- Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | | | | | | | | | - Adele Schwartz Benzaken
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Gerson Pereira
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Ana Roberta Pati Pascom
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Cristina Pimenta
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Lisa Grazina Johnston
- Tulane University, Global Community Health and Behavioral Sciences - New Orleans (LA), United States
| |
Collapse
|
19
|
Dourado I, Guimarães MDC, Damacena GN, Magno L, de Souza Júnior PRB, Szwarcwald CL. Sex work stigma and non-disclosure to health care providers: data from a large RDS study among FSW in Brazil. BMC Int Health Hum Rights 2019; 19:8. [PMID: 30832659 PMCID: PMC6399834 DOI: 10.1186/s12914-019-0193-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/25/2019] [Indexed: 11/20/2022]
Abstract
Background Stigma in health services may be detrimental to health seeking attitudes and practices. This study investigates non-disclosure of sex work to health care providers among female sex workers (FSW) in Brazil and its association with the utilization of health care services. Methods This study used cross-sectional respondent-driven sampling, carried out in 12 Brazilian cities to identify HIV risk behaviors among FSW. We first assessed statistical associations of sociodemographic, human right violations, health service access and utilization, and discrimination variables with non-disclosure of FSW status to health care providers as outcome. Secondly, we investigated the association of non-disclosure of FSW status with selected preventive health care outcomes: HIV testing, PAP smear exam, and post-exposure prophylaxis (PEP). Adjusted odds ratio with 95% confidence intervals were calculated by multivariable logistic regressions. Results Among 4245 recruited FSW, a high percentage received free condoms (82%) but only 24.4% were counseled on STI. Most FSW used non-specialized public healthcare routinely (62.6%), but only 51.5% had a Pap smear exam in the last two years and less than 40% were tested for HIV in the last 12 months. Among FSW who engaged in risky behavior (49.6%), only 8.3% used PEP. Regarding human rights violations, approximately 15% were required to give part of their earnings to owners of workplace establishments, 38% started sex work under 18 years old and 6% were required to periodically present their HIV test results. 21.3% reported having faced discrimination in health services, and 24.3% always disclosed their FSW status. Multivariable logistic models indicated significant associations of non-disclosure on the four healthcare outcomes, with lower odds of using preventive health services among women who did not disclose their sex work status, even after controlling for age, educational level, NGO affiliation, and type of health care routinely used. Conclusions Our results indicate that sex work stigmatization within health services may be one of the main barriers to STI control and HIV response among FSW. It is essential to combat stigmatization and discrimination against FSW in health services to guarantee the appropriate uptake of preventive services available in the public health system in Brazil.
Collapse
Affiliation(s)
- Inês Dourado
- Collective Health Institute, Federal University of Bahia, Av. Basílio da Gama, s/n, Campus Universitário do Canela, Salvador, Bahia, 40110-040, Brazil.
| | | | - Giseli Nogueira Damacena
- Institute of Scientific Communication and Information on Public Health of Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laio Magno
- Department of Life Sciences, Bahia State University, Campus 1, Salvador, Bahia, Brazil
| | | | - Celia Landmann Szwarcwald
- Institute of Scientific Communication and Information on Public Health of Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | |
Collapse
|
20
|
Magno L, Silva LAVD, Guimarães MDC, Veras MADSM, Deus LFAD, Leal AF, Knauth DR, Brito AMD, Rocha GM, Lima LNGC, Kendall C, Motta-Castro ARC, Kerr LRFS, Mota RMS, Merchan-Hamann E, Dourado IC. Discrimination based on sexual orientation against MSM in Brazil: a latent class analysis. Rev bras epidemiol 2019; 22Suppl 1:e190003. [DOI: 10.1590/1980-549720190003.supl.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/12/2019] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: Discrimination based on sexual orientation can influence vulnerability to HIV, increasing exposure to risky sexual behavior among men who have sex with men (MSM). Objectives: To analyze data using latent class analysis (LCA) to identify groups of individuals with specific patterns of discrimination based on sexual orientation (DSO). Methods: Cross-sectional study using respondent-driven sampling in 12 Brazilian cities in 2016. LCA was used to characterize discrimination among MSM based on 13 variables in the survey questionnaire. The proportions of men reporting DSO and other variables of interest were estimated using Gile’s Successive Sampling estimator. Results: Most MSM were young, single, had a religion, had a high school or college degree, black or brown skin color, and socioeconomic status classified as average. More than half of the participants reported that they had been discriminated against during the last 12 months due to their sexual orientation (65%), more than a third said they had felt afraid of walking in public places during the past 12 months, and about one-fifth of participants reported having been victims of physical or sexual assault due to DSO. DSO was classified into four latent classes: “very high”, “high”, “moderate” and “low”, with estimates of 2.2%, 16.4%, 35.1%, and 46.19%, respectively. Conclusion: We observed a high proportion of discrimination against MSM in this study. The use of LCA differentiated parsimoniously classes of discrimination.
Collapse
Affiliation(s)
- Laio Magno
- State University of Bahia, Brazil; Federal University of Bahia, Brazil
| | | | | | | | | | | | | | | | | | | | - Carl Kendall
- Tulane School of Public Health and Tropical Medicine, United States
| | | | | | | | | | | |
Collapse
|
21
|
Pereira GFM, Pimenta MC, Giozza SP, Caruso AR, Bastos FI, Guimarães MDC. HIV/AIDS, STIs and viral hepatitis in Brazil: epidemiological trends. Rev bras epidemiol 2019; 22Suppl 1:e190001. [DOI: 10.1590/1980-549720190001.supl.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
22
|
Guimarães MDC, Carneiro M, Abreu DMXD, França EB. Resposta ao comentário do artigo “Mortalidade por HIV/Aids no Brasil, 2000-2015: Motivos para preocupação?”. Rev bras epidemiol 2018; 21:e180023. [DOI: 10.1590/1980-549720180023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
23
|
Melo APS, Lima EDP, Barros FCRD, Camelo LDV, Guimarães MDC. Homelessness and incarceration among psychiatric patients in Brazil. Cien Saude Colet 2018; 23:3719-3733. [PMID: 30427444 DOI: 10.1590/1413-812320182311.12522016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/23/2016] [Indexed: 11/21/2022] Open
Abstract
Psychiatric patients are at increased risk of adverse life events, such as being incarcerated and homelessness in their life course. Using data from a cross-sectional multicenter study of 2,475 patients selected from 26 mental health services in Brazil, we examined the association of sociodemographic, clinical, behavioral, and adverse life characteristics with history of homelessness, incarceration or their co-occurrence during lifetime. Odds ratios were obtained by multinomial logistic regression models. The prevalence of homelessness, incarceration and co-occurrence of these two conditions were 8.6%, 16.4%, and 9.4%, respectively. Lower income, living in unstable condition, intellectual disability, and cigarette smoking were associated with homelessness. Being male, lower schooling, sex under effect of alcohol or drugs, and multiple sex partners were associated with incarceration. Psychiatric hospitalizations, substance use, and history of sexually transmitted diseases, and sexual, physical, or verbal violence were associated with co-occurrence of both conditions. Our findings suggest that incarceration and homelessness are very prevalent and correlated in psychiatric patients in Brazil. Many of the associated factors are potentially modifiable, and may act synergistically requiring integrated care.
Collapse
Affiliation(s)
- Ana Paula Souto Melo
- Faculdade de Medicina, Universidade Federal de São João Del-Rei. Av. Sebastião Gonçalves Coelho 400/209A, Bairro Chanadour. 35501-296 Divinópolis MG Brasil.
| | - Eduardo de Paula Lima
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | | | - Lidyane do Valle Camelo
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Mark Drew Crosland Guimarães
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| |
Collapse
|
24
|
Silva MR, Rocha ADS, Araújo FR, Fonseca-Júnior AA, Alencar APD, Suffys PN, Costa RRD, Moreira MAS, Guimarães MDC. Risk factors for human Mycobacterium bovis infections in an urban area of Brazil. Mem Inst Oswaldo Cruz 2018; 113:e170445. [PMID: 29898014 PMCID: PMC5989489 DOI: 10.1590/0074-02760170445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/08/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has classified human zoonotic tuberculosis (TB) due to Mycobacterium bovis as a neglected issue in the developing world. In a recent cross-sectional study in Brazil, three of 189 TB patients presented with a coinfection of M. bovis and M. tuberculosis and were selected as cases for this study. OBJECTIVE The aim was to evaluate risk factors (RF) for zoonotic TB in an urban area of Brazil in order to guide preventive programmes. METHODS A matched case-control study was carried out nested within a cross-sectional study. For each of the three cases, 14 age- and sex-matched controls (TB due to M. tuberculosis) were selected. FINDINGS Zoonotic potential exposures (ZE) and extrapulmonary TB (EPTB) were independently associated with zoonotic TB in multivariate analyses. CONCLUSIONS ZE by occupation and consumption of raw milk and derivative products that place individuals in direct and indirect contact with animals and their excretions/secretions increase the risk for zoonotic TB in Brazil, especially among those with EPTB. Therefore, measures such as efficient control of bovine TB, distribution of pasteurised milk and its derivative products, and the diagnosis and monitoring of zoonotic TB in humans are essential steps, especially in developing countries where bovine TB is enzootic, and further studies are necessary.
Collapse
|
25
|
Guimarães MDC, Carneiro M, Abreu DMXD, França EB. HIV/AIDS Mortality in Brazil, 2000-2015: Are there reasons for concern? Rev Bras Epidemiol 2018; 20Suppl 01:182-190. [PMID: 28658382 DOI: 10.1590/1980-5497201700050015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/10/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction and objective: Mortality studies are essential for the monitoring of the HIV/AIDS epidemic. Quality and completeness of data from the mortality information system (SIM) require complementary approaches. Methods: Two sources of data were used to assess mortality trends due to HIV/AIDS in Brazil from 2000 and 2014/15: a) data from the SIM published by the Department of STDs, AIDS, and viral hepatitis, and b) Global Burden of Disease 2015 (GBD 2015) studies. Descriptive analyses were carried out and trends in relative reduction of age-adjusted mortality rates per 100,000 inhabitants were compared according to the two methods. Results: Overall, the magnitude of the mortality rates estimated by the GBD method, for Brazil and its Federative Units (FU), was greater than those obtained from the SIM. The relative reduction was higher for SIM data and there were shifts in the ranking according to the FUs. Between 2000 and 2014/15 there was an increase in the mortality rates for most of the FUs (78 and 88% according to the SIM and GBD, respectively). Conclusion: Data regarding mortality due to HIV/AIDS in Brazil should be of concern, regardless of the method used. Differences in magnitude, relative reductions, and ranking can be attributed to methodological differences, but the GBD is broader, with a higher capacity to capture incorrectly classified data and causes of death not registered or not coded as being due to HIV/AIDS. Alternative and complementary data sources can provide important information for HIV/AIDS public policies in Brazil.
Collapse
Affiliation(s)
- Mark Drew Crosland Guimarães
- Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Mariângela Carneiro
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Daisy Maria Xavier de Abreu
- Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Elisabeth Barboza França
- Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| |
Collapse
|
26
|
Guimarães MDC, Kendall C, Magno L, Rocha GM, Knauth DR, Leal AF, Dourado I, Veras MA, de Brito AM, Kerr LRFS. Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016. Medicine (Baltimore) 2018; 97:S62-S68. [PMID: 29912816 PMCID: PMC5991533 DOI: 10.1097/md.0000000000009079] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Periodic monitoring of sociobehavior characteristics at a national level is an essential component of understanding the dynamics the human immunodeficiency virus (HIV) epidemic worldwide, including Brazil. METHODS This paper compares descriptive sociobehavior characteristics in 2 national cross-sectional HIV biological behavioral surveillance surveys (BBSS) conducted in 2009 and 2016 among men who have sex with men (MSM) in Brazil. Respondent driven sampling (RDS) was used for recruitment in both years. Overall proportions were weighted according to Gile's estimator using RDS Analyst Software and 95% confidence intervals were calculated for comparisons between the 2 periods. Further comparisons were stratified by age groups (<25 and 25+ years old). RESULTS Overall, 3749 and 4176 MSM were recruited in 2009 and 2016, respectively. In 2016, participants were younger than 25 years old (58.3%), with 12 or more years of education (70.4%), with higher socioeconomic status (40.7%), and had a higher proportion of whites (31.8%), as compared to 2009. Also, participants in 2016 reported less alcohol use and binge drinking, but used illicit drugs more frequently. There was an increase among MSM who self-reported their HIV risk as low and had low HIV knowledge while the proportion of those who were never tested for HIV dropped from 49.8% in 2009 to 33.8% in 2016. Although more than three-quarters received free condoms in both years, STD counseling remained low (32% and 38% for 2009 and 2016, respectively). Sexual risk behavior remained at high levels, especially unprotected anal receptive sex and sex with multiple partners. Younger MSM (<25 years old) showed riskier sexual practices than those 25+ years old, when comparing 2016 to 2009. CONCLUSIONS Our results indicate a worrisome risk behavior trend among Brazilian MSM, especially among younger ones. These results can contribute for a better understanding of the HIV epidemics in Brazil, with timely shift in strategies so improved effectiveness in public health prevention efforts can be achieved.
Collapse
Affiliation(s)
| | - Carl Kendall
- Center for Global Health Equity, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Laio Magno
- Department of Life Sciences, State University of Bahia, Salvador, Bahia
| | | | | | | | - Ines Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia
| | | | | | | |
Collapse
|
27
|
Santos MA, Guimarães MDC, Helena ETS, Basso CR, Vale FC, Carvalho WMDES, Alves AM, Rocha GM, Acurcio FDA, Ceccato MDGB, do Prado RR, Menezes PR, Nemes MIB. Monitoring self-reported adherence to antiretroviral therapy in public HIV care facilities in Brazil: A national cross-sectional study. Medicine (Baltimore) 2018; 97:S38-S45. [PMID: 29912815 PMCID: PMC5991539 DOI: 10.1097/md.0000000000009015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patient adherence to antiretroviral therapy (ART) is critical for HIV treatment success. Monitoring rates of adherence in public HIV outpatient care facilities can improve outcomes in Brazil where ART is universally available. METHODS We conducted a national cross-sectional survey of ART adherence in 2010. Participants were selected using a multistage probability sample. First, HIV outpatient care facilities were stratified according to 7 Organizational Quality Classification (OQC) groups and regions. Second, 1 or 2 facilities were selected per region for each OQC group. Finally, patients were randomly selected at each facility. In a first component, patients were invited to answer to a web-based questionnaire (WebAd-Q), a validated self-reported tool that includes 3 questions on adherence to ART in the past 7 days (time scheduling-timing, drug regimen-medication, and pill counts-dose), herein named indicators of potential nonadherence (IPN). In addition, a subsample of participants were interviewed in order to obtain further data on sociodemographic and clinical characteristics (second component). The proportion of each IPN was estimated using weighted data to account for the sampling design with 95% confidence interval (CI) and descriptive analysis was carried out. RESULTS Fifty-five facilities were chosen and 2424 patients completed the WebAd-Q in the first component of the study, while 598 patients were interviewed for the second component. The weighted proportions of the IPN were 50.9%, 31.8%, and 19.5%, for timing, medication, and dose, respectively, while11.7% had all 3 indicators, varying from 5.9% in the Southeast and 21.9% in the Northeast regions. Overall, 61.1% of the patients had at least 1 IPN (95% CI: 58.5-63.7%). Patients reporting depression symptoms, illicit drug use and those who missed medical appointments had worse nonadherence outcomes. CONCLUSIONS Overall, there was a high proportion of all indicators IPN and timing was the main component associated with low adherence. Although these indicators may not necessarily indicate individual nonadherence, they represent a worrisome scenario in the public Brazilian HIV care facilities. On a routine basis, these facilities can identify gaps in providing counseling and ART orientation to their clientele and develop innovative strategies to prevent nonadherence.
Collapse
Affiliation(s)
- Maria Altenfelder Santos
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | | | - Cáritas Relva Basso
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | - Felipe Campos Vale
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | - Ana Maroso Alves
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | | | | | | | - Paulo Rossi Menezes
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | |
Collapse
|
28
|
Ferreira-Júnior ODC, Guimarães MDC, Damacena GN, de Almeida WDS, de Souza-Júnior PRB, Szwarcwald CL. Prevalence estimates of HIV, syphilis, hepatitis B and C among female sex workers (FSW) in Brazil, 2016. Medicine (Baltimore) 2018; 97:S3-S8. [PMID: 29912817 PMCID: PMC5991541 DOI: 10.1097/md.0000000000009218] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Female sex workers (FSW) bear a high burden of sexually transmitted infections (STI). In this paper, we estimate the prevalence of human immunodeficiency virus (HIV), HBV = hepatitis B virus (HBV), HCV = hepatitis C virus (HCV), syphilis and co-infections in the second Biological and Behavioral Surveillance Survey among FSW in Brazil. METHOD The survey was conducted in 12 Brazilian cities from July to November 2016. We used respondent-driven sampling (RDS) to recruit 350 FSW in each city. Rapid tests were used for screening HIV, syphilis, HCV, and HBV. Confirmatory tests were performed on all samples with reactive rapid test result. All testing algorithms and interpretations were done according to the recommendations of the Department of STI/AIDS and viral hepatitis, Ministry of Health. The STI diagnoses were given by: confirmed HIV infection by a positive result on Western blot; active syphilis infection, defined by a RPR titer equal or greater than 1/8; viremia period of HBV and HCV infections, characterized by a detectable (or quantifiable) viral load. Prevalence estimates and standard errors were calculated using statistical procedures suitable for data collected by RDS. RESULTS Excluding the seeds, 4245 FSW were enrolled. Prevalence estimates were: HIV 5.3% (95% CI: 4.4%-6.2%); active syphilis 8.5% (95% CI: 7.3%-9.7%); HBV 0.4% (95% CI: 0.2%-0.7%); and, HCV 0.9% (95% CI: 0.6%-1.3%). Among the 4154 FSW tested for the 4 infections, 13.3%; (95% CI 12.0%-14.8%) were diagnosed with at least one of the infections, of which 87.6% (95% CI: 83.3%-90.9%) had single infections. The prevalence of HIV/syphilis co-infection was 1.09% (95% CI: 0.7%- 1.6%) and of HIV/HCV or HBV infections was 0.4% (95% CI: 0.2%-0.7%). CONCLUSIONS Our results reveal the need to conduct more studies to estimate the prevalence of STI and co-infections among FSW in Brazil. Longitudinal trends in the prevalence estimates of HIV and other STI provide information to monitor changes in this high-risk population. Additionally, the study highlights the importance of measuring the hepatitis burden among FSW living with HIV, and the need of including FSW in all aspects of STI prevention, care, and treatment programs.
Collapse
Affiliation(s)
| | | | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paulo Roberto Borges de Souza-Júnior
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
29
|
Szwarcwald CL, Damacena GN, de Souza-Júnior PRB, Guimarães MDC, de Almeida WDS, de Souza Ferreira AP, Ferreira-Júnior ODC, Dourado I. Factors associated with HIV infection among female sex workers in Brazil. Medicine (Baltimore) 2018; 97:S54-S61. [PMID: 29912814 PMCID: PMC5991538 DOI: 10.1097/md.0000000000009013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Female sex workers (FSWs) are one of the most-at-risk population groups for human immunodeficiency virus (HIV) infection. This paper aims at identifying the main predictors of HIV infection among FSW recruited in the 2nd Biological and Behavioral Surveillance Survey in 12 Brazilian cities in 2016. METHOD Data were collected on 4245 FSW recruited by respondent driven sampling (RDS). Weights were inversely proportional to participants' network sizes. To establish the correlates of HIV infection, we used logistic regression models taking into account the dependence of observations resultant from the recruitment chains. The analysis included socio-demographic sex work characteristics, sexual behavior, history of violence, alcohol and drug use, utilization of health services, and occurrence of other sexually transmitted infections (STIs). RESULTS HIV prevalence was estimated as 5.3% (4.4%-6.2%). The odds ratio (OR) of an HIV-positive recruiter choosing an HIV-positive participant was 3.9 times higher than that of an HIV-negative recruiter (P < .001). Regarding socio-demographic and sex work characteristics, low educational level, street as the main work venue, low price per sexual encounter, and longer exposure time as a sex worker were found to be associated with HIV infection, even after controlling for the homophily effect. The OR of being HIV infected among FSW who had been exposed to sexual violence at least once in a lifetime (OR = 1.5, P = .028) and the use of illicit drugs at least once a week were highly significant as well, particularly for frequent crack use (OR = 3.6, P < .001). Among the sexual behavior indicators, not using condoms in some circumstances were significantly associated with HIV infection (OR = 1.8, P = .016). Regarding the occurrence of other STI, the odds of being HIV infected was significantly higher among FSW with a reactive treponemal test for syphilis (OR = 4.6, P < .001). CONCLUSIONS The main factors associated with HIV infection identified in our study characterize a specific type of street-based sex work in Brazil and provided valuable information for developing interventions. However, there is a further need of addressing social and contextual factors, including illicit drug use, violence, exploitation, as well as stigma and discrimination, which can influence sexual behavior.
Collapse
Affiliation(s)
- Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Paulo Roberto Borges de Souza-Júnior
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | | | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | - Arthur Pate de Souza Ferreira
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro
| | | | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| |
Collapse
|
30
|
Kerr L, Kendall C, Guimarães MDC, Salani Mota R, Veras MA, Dourado I, Maria de Brito A, Merchan-Hamann E, Pontes AK, Leal AF, Knauth D, Castro ARCM, Macena RHM, Lima LNC, Oliveira LC, Cavalcantee MDS, Benzaken AS, Pereira G, Pimenta C, Pascom ARP, Bermudez XPD, Moreira RC, Brígido LFM, Camillo AC, McFarland W, Johnston LG. HIV prevalence among men who have sex with men in Brazil: results of the 2nd national survey using respondent-driven sampling. Medicine (Baltimore) 2018; 97:S9-S15. [PMID: 29794604 PMCID: PMC5991534 DOI: 10.1097/md.0000000000010573] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/05/2018] [Indexed: 12/11/2022] Open
Abstract
This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS).Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy.A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities.A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7-20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4-21.7) were seropositive.HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0-14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.
Collapse
Affiliation(s)
- Ligia Kerr
- Faculdade de Medicina, Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brasil
| | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, USA, Faculdade de Medicina da Universidade Federal do Ceará, Saúde Comunitária, Fortaleza, CE
| | | | - Rosa Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará, Fortaleza, CE
| | - Maria Amélia Veras
- Departamento de Saúde Coletiva, Faculdade de Ciências Medicas da Santa Casa de São Paulo, São Paulo, SP
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA
| | | | - Edgar Merchan-Hamann
- Centro de Ciências da Saúde – Departamento de Saúde Coletiva, Universidade de Brasília Faculdade de Ciências da Saúde, Brasília
| | | | | | - Daniela Knauth
- Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS
| | | | | | | | | | | | | | - Gerson Pereira
- Departamento de IST e HIV/AIDS e Hepatites Virais, Ministério da Saúde, Brasília
| | - Cristina Pimenta
- Departamento de IST e HIV/AIDS e Hepatites Virais, Ministério da Saúde, Brasília
| | | | | | | | | | | | - Willi McFarland
- Center for Global Health, University of California, San Francisco, CA
| | - Lisa G. Johnston
- Tulane School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, New Orleans, LA, USA
| |
Collapse
|
31
|
Szwarcwald CL, de Almeida WDS, Damacena GN, de Souza-Júnior PRB, Ferreira-Júnior ODC, Guimarães MDC. Changes in attitudes, risky practices, and HIV and syphilis prevalence among female sex workers in Brazil from 2009 to 2016. Medicine (Baltimore) 2018; 97:S46-S53. [PMID: 29893747 PMCID: PMC5991537 DOI: 10.1097/md.0000000000009227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The present study aims at investigating the progress made toward controlling the human immunodeficiency virus (HIV)/AIDS epidemic among female sex workers (FSW) from 2009 to 2016. METHODS The baseline of respondent-driven sampling (RDS) study among FSW was carried out in 2009, in 10 Brazilian municipalities. In 2016, information on FSW were collected in 12 municipalities. The analyses took into account the dependence among observations, resulting from the recruitment chains, and the unequal probabilities of selection, resulting from the different network sizes. We analyzed changes in attitudes and risky behavior practices as well as variations in HIV and syphilis prevalence based on the comparison of 95% confidence intervals for each estimate. RESULTS Information on 2523 (2009) and 4245 (2016) FSW were analyzed. Commercial sex debut shifted to younger ages: while in 2009 the proportion of women who started sex work under 18 years old was 28.3%, in 2016 this percentage rose to 38.3%. The proportion of FSW affiliated to a nongovernmental organization (NGO) in defense of their rights (14.0%), in 2009, decreased to 7.8%, in 2016, as well as the proportion of FSW who received counseling on sexually transmitted infections (STI) in the past 6 months, from 47.5% to 24.4%. Relevant improvements were found for HIV testing in the last 12 months (from 20.3% to 39.3%). The proportions of those who were never tested for syphilis dropped from 57.9% to 48.5%. However, an opposite decreasing trend was found for the Pap smear examination in the last 12 months, decreasing from 43.6% to 31.5%. Regular condom use with clients significantly increased in the period. Regarding HIV prevalence, the 5% level was sustained and no significant differences were found, but syphilis prevalence was found to be more than 3 times higher in 2016 (8.5%) than in 2009 (2.4%). DISCUSSION Many are the challenges to be faced in attempting to reverse the upward trend of syphilis among FSW in Brazil. Despite the progress in condom distribution free of charge, it is necessary to increase awareness campaigns, emphasize the use, reaffirm STI counseling, and reiterate the need of regular syphilis screening in this key population group.
Collapse
Affiliation(s)
- Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Wanessa da Silva de Almeida
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation
| | | | | | | | | |
Collapse
|
32
|
Rocha GM, Kerr LRFS, Kendall C, Guimarães MDC. Risk behavior score: a practical approach for assessing risk among men who have sex with men in Brazil. Braz J Infect Dis 2018; 22:113-122. [PMID: 29551334 PMCID: PMC9428223 DOI: 10.1016/j.bjid.2018.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 01/01/2023] Open
Abstract
HIV/AIDS epidemic is not well controlled, and multiple sexual behavior factors help explain high rates of HIV infection among men who have sex with men (MSM). This article proposes to exam the use of a potential risk behavior score for HIV infection, based on the type and number of sexual partners, and condom use, and their associated factors in a sample of MSM in Brazil. A cross sectional RDS (Respondent Driven Sampling) study was performed among 3738 MSM aged 18+ years old from ten Brazilian cities. The risk behavior score was composed by the number of male partners and anal condom use in the last year with steady, casual, and commercial partners. Most participants were 25+ years old (58.1%), non-white (83.1%), and single (84.9%). Final weighted ordinal logistic model showed that age ≤ 25 years old (p = 0.037), homosexual or bisexual identity (p < 0.001), sexual initiation before 15-year-old (p < 0.001), having sex with men only in the last 12 months (p < 0.001), frequent alcohol and illicit drug use (p < 0.001), and use of local sites to meet sexual partners in the last month were independently associated with higher scores of risky behavior. Specific strategies should be developed aimed at the MSM population. Additionally, pre-exposed prophylaxis (Prep) should be considered for those at higher score as a strategy for reducing risk for HIV infection in this population.
Collapse
Affiliation(s)
- Gustavo Machado Rocha
- Universidade Federal de São João Del-Rei, Campus Centro Oeste Dona Lindu, Divinópolis, Minas Gerais, Brasil.
| | | | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Mark Drew Crosland Guimarães
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| |
Collapse
|
33
|
Almeida-Brasil CC, Ceccato MDGB, Battistella Nemes MI, Crosland Guimarães MD, de Assis Acurcio F. Improving community mobilization in HIV treatment management: practical suggestions from patients in Brazil. Rev Panam Salud Publica 2017; 41:e119. [PMID: 31384256 PMCID: PMC6645207 DOI: 10.26633/rpsp.2017.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 01/15/2017] [Indexed: 11/24/2022]
Abstract
Objectives. To describe patients’ suggestions on improving the management of antiretroviral therapy (ART) and to identify the roles that key stakeholders should play in taking responsibility for those recommendations. Methods. This research was embedded within a national cross-sectional study on patient adherence to ART and the associated factors. A subsample of the study patients were asked to offer suggestions on how to improve daily management of ART, and their answers were analyzed using a content analysis approach. The recommendations were then interpreted in terms of who should be responsible for them, and the suggestions were organized into three levels: micro (patient), meso (health care team), and macro (researchers, policymakers, family, friends, and the general public). Results. Of the 552 participants from the subsample, 60% were male, their average age was 44.1 years, and 62% were nonadherent in at least at one of three dimensions (missing doses, improper timing, or improper dosing). The categories underlying the micro level were “believing in treatment efficacy,” “being motivated,” “accepting HIV status,” and “sharing experiences with other patients.” At the meso level the suggestion categories were “more information from health care providers” and “humanization of care.” The macro level categories were “social support and actions against stigma,” “research proposals,” and “improvement of health care services.” Conclusions. Patients are influenced by the health policies, care, and support offered by health care providers, organizations, policymakers, and communities. In turn, these stakeholders develop the policies and deliver their care and support based on the responses and actions of patients. All stakeholders should work together to engage, educate, and support patients in addressing ART management.
Collapse
Affiliation(s)
- Celline Cardoso Almeida-Brasil
- Universidade Federal de Minas Gerais, School of Medicine Department of Social and Preventive Medicine, Belo Horizonte Minas Gerais Brazil Universidade Federal de Minas Gerais, School of Medicine, Department of Social and Preventive Medicine, Belo Horizonte, Minas Gerais, Brazil
| | - Maria das Graças Braga Ceccato
- Universidade Federal de Minas Gerais, School of Medicine Department of Social and Preventive Medicine, Belo Horizonte Minas Gerais Brazil Universidade Federal de Minas Gerais, School of Medicine, Department of Social and Preventive Medicine, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Inês Battistella Nemes
- Universidade de São Paulo, School of Medicine Department of Preventive Medicine, São Paulo São Paulo Brazil Universidade de São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, São Paulo, Brazil
| | - Mark Drew Crosland Guimarães
- Universidade Federal de Minas Gerais, School of Medicine Department of Social and Preventive Medicine, Belo Horizonte Minas Gerais Brazil Universidade Federal de Minas Gerais, School of Medicine, Department of Social and Preventive Medicine, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco de Assis Acurcio
- Universidade Federal de Minas Gerais, School of Medicine Department of Social and Preventive Medicine, Belo Horizonte Minas Gerais Brazil Universidade Federal de Minas Gerais, School of Medicine, Department of Social and Preventive Medicine, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
34
|
Magno L, Dourado I, da Silva LAV, Brignol S, Brito AMD, Guimarães MDC, Benzaken A, Pinho ADA, Kendall C, Kerr LRFS. Factors associated with self-reported discrimination against men who have sex with men in Brazil. Rev Saude Publica 2017; 51:102. [PMID: 29166436 PMCID: PMC5697921 DOI: 10.11606/s1518-8787.2017051000016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To estimate self-reported discrimination due to sexual orientation among men who have sex with men (MSM) in Brazil and to analyze associated factors. METHODS A cross-sectional study of 3,859 MSM recruited in 2008–2009 with respondent driven sampling. Data collection conducted in health centers in 10 Brazilian cities. A face-to-face questionnaire was used and rapid HIV and syphilis tests conducted. Aggregated data were weighted and adjusted odds ratio estimated to measure the association between selected factors and self-reported discrimination due to sexual orientation. RESULTS The sample was predominantly young, eight plus years of schooling, pardo (brown), single, low-income, and identified themselves as gay or homosexual. The prevalence of self-reported discrimination due to sexual orientation was 27.7% (95%CI 26.2–29.1). Discrimination was independently associated with: age < 30 years, more years of schooling, community involvement and support, history of sexual and physical violence, suicidal thoughts, and unprotected receptive anal intercourse. CONCLUSIONS The prevalence of self-reported discrimination among MSM in Brazil is high. These results challenge the assumptions that MSM-specific prevention and support programs are not required or that health professionals do not need special training to address MSM needs.
Collapse
Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia. Departamento de Ciências da Vida. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Inês Dourado
- Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Luís Augusto V da Silva
- Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Humanidades, Artes & Ciências Professor Milton Santos. Salvador, BA, Brasil
| | - Sandra Brignol
- Universidade Federal Fluminense. Instituto de Saúde Coletiva. Niterói, RJ, Brasil
| | | | - Mark Drew Crosland Guimarães
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil
| | - Adele Benzaken
- Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de IST, Aids e Hepatites Virais. Brasília, DF, Brasil
| | - Adriana de A Pinho
- Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Carl Kendall
- Center for Global Health Equit. Tulane School of Public Health and Tropical Medicine. New Orleans, Louisiana, USA
| | | |
Collapse
|
35
|
Gomes RRDFM, Ceccato MDGB, Kerr LRFS, Guimarães MDC. [Factors associated with low knowledge on HIV/AIDS among men who have sex with men in Brazil]. CAD SAUDE PUBLICA 2017; 33:e00125515. [PMID: 29091176 DOI: 10.1590/0102-311x00125515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/13/2016] [Indexed: 11/22/2022] Open
Abstract
This cross-sectional study analyzed social vulnerability, individual, and programmatic factors associated with low knowledge on HIV/AIDS among men who have sex with men (MSM). Respondent Driven Sampling (RDS) was used in 10 Brazilian cities. Knowledge scores on HIV/AIDS were estimated by Item Response Theory and categorized in three levels: high, medium, and low knowledge. Ordinal logistic regression was used for the analysis. Of the 3,746 MSM, 36.6%, 37.4%, and 26% showed high, medium, and low knowledge, respectively. The following were associated with low knowledge in the final model: schooling ≤ 8 years, non-white skin color, economic classes C and D-E, age < 25 years, having only one sex partner, and no previous HIV test. It is essential to improve knowledge on HIV/AIDS among young MSM with low socioeconomic status. Interventions focused on programmatic vulnerability factors can help reduce individual and social risk.
Collapse
|
36
|
Nahas MA, Melo APS, Cournos F, Mckinnon K, Wainberg M, Guimarães MDC. Recent illicit drug use among psychiatric patients in Brazil: a national representative study. Rev Saude Publica 2017; 51:74. [PMID: 28832753 PMCID: PMC5559216 DOI: 10.11606/s1518-8787.2017051006543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/11/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate factors associated to illicit drug use among patients with mental illness in Brazil according to gender. METHODS A cross-sectional representative sample of psychiatric patients (2,475 individuals) was randomly selected from 11 hospitals and 15 public mental health outpatient clinics. Data on self-reported illicit drug use and sociodemographic, clinical and behavioral characteristics were obtained from face-to-face interviews. Logistic regression was used to estimate associations with recent illicit drug use. RESULTS The prevalence of any recent illicit drug use was 11.4%. Men had higher prevalence than women for all substances (17.5% and 5.6%, respectively). Lower education, history of physical violence, and history of homelessness were associated with drug use among men only; not professing a religion was associated with drug use in women only. For both men and women, younger age, current hospitalization, alcohol and tobacco use, history of incarceration, younger age at sexual debut, and more than one sexual partner were statistically associated with illicit drug use. CONCLUSIONS Recent illicit drug use among psychiatric patients is higher than among the general Brazilian population and it is associated with multiple factors including markers of psychiatric severity. Our data indicate the need for the development of gender-based drug-use interventions among psychiatric patients in Brazil. Integration of substance use treatment strategies with mental health treatment should be a priority.
Collapse
Affiliation(s)
- Miriam Almeida Nahas
- Programa de Pós-Graduação em Saúde Pública. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte MG, Brasil
| | - Ana Paula Souto Melo
- Faculdade de Medicina. Universidade Federal de São João del-Rei. Divinópolis, MG, Brasil
| | - Francine Cournos
- Mailman School of Public Health. Columbia University. New York, USA
| | - Karen Mckinnon
- New York State Psychiatric Institute. Columbia University. New York, USA
| | - Milton Wainberg
- New York State Psychiatric Institute. Columbia University. New York, USA
| | - Mark Drew Crosland Guimarães
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| |
Collapse
|
37
|
Costa JDO, Ceccato MDGB, Melo APS, Acurcio FDA, Guimarães MDC. Gender differences and psychotropic polypharmacy in psychiatric patients in Brazil: a cross-sectional analysis of the PESSOAS Project. CAD SAUDE PUBLICA 2017; 33:e00168915. [PMID: 28538794 DOI: 10.1590/0102-311x00168915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 08/19/2016] [Indexed: 12/13/2022] Open
Abstract
We aimed to estimate the prevalence and correlates of psychotropic polypharmacy in Brazilian psychiatric patients by gender. Sociodemographic, behavioral and clinical data were obtained through face-to-face interviews and medical charts of 2,475 patients. Psychotropic polypharmacy was defined as the use of two or more psychotropic drugs and occurred in 85.7% of men (95%CI: 83.6%-87.6%) and 84.9% of women (95%CI: 82.8%-86.8%; p > 0.05). The mean number of psychotropic drugs/patient was 2.98 ± 1.23 and most common combinations included antipsychotics. Multivariate analysis showed that for both genders, previous hospitalization, severe mental illness, multiple psychiatric diagnoses and an insufficient number of professionals in the health care unit was associated with psychotropic polypharmacy. However, other correlates such as inpatient care, use of non-psychotropic drugs, living in unstable conditions and current smoking vary among them. Psychotropic polypharmacy was a common practice in this national sample. The results highlighted the need for national guidelines to manage patients with mental illness, considering the difference among genders and disease severity, to reduce the burden of polyphamacy in this population.
Collapse
Affiliation(s)
| | | | - Ana Paula Souto Melo
- Faculdade de Medicina, Universidade Federal de São João del-Rei, Divinópolis, Brasil
| | | | | |
Collapse
|
38
|
Soares PDA, Duarte HHP, Oliveira JVD, Faúla LL, Torres RSLDA, Penkal ML, Guimarães MDC. [Outbreak of nephritis by Streptococcus equi subspecies zooepidemicus: case-control study in the municipality of Monte Santo de Minas, Minas Gerais, Brazil, 2013]. Epidemiol Serv Saude 2017; 26:405-412. [PMID: 28492782 DOI: 10.5123/s1679-49742017000200018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/15/2016] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE to investigate an outbreak of nephritis by Streptococcus zooepidemicus in Monte Santo de Minas, Minas Gerais State, Brazil. METHODS a case-control study and attempt to isolate the bacterial agent were carried out from January to April 2013, using clinical and laboratory data, interviews and inspections. RESULTS 417 suspected cases were reported, of which 175 (42.0%) were confirmed; 90.9% lived in that municipality, of which 67.4% were female, with median age of 36 years; 24% of cases were hospitalized; three ice cream shops in the municipality used type A milk; there was significant association between the illness and the consumption of type A milk (odds ratio [OR]=4.16/95%CI: 1.55;11.18), one of the ice cream made with this milk (OR=3.09/95%CI: 1.39;6.86) and milk shake of non-processed milk (OR=3.25/95%CI: 1.13;9.36); the bacterium was not detected in rural properties. CONCLUSION the outbreak of nephritis by Streptococcus zooepidemicus was associated with the consumption of milk and dairy products.
Collapse
Affiliation(s)
- Patricia de Almeida Soares
- Secretaria de Estado de Saúde de Minas Gerais, Superintendência de Vigilância Epidemiológica, Ambiental e Saúde do Trabalhador, Belo Horizonte-MG, Brasil
| | - Heloísa Helena Pelluci Duarte
- Secretaria de Estado de Saúde de Minas Gerais, Superintendência de Vigilância Epidemiológica, Ambiental e Saúde do Trabalhador, Belo Horizonte-MG, Brasil
| | | | - Leandro Leão Faúla
- Fundação Ezequiel Dias, Serviço de Microbiologia de Produtos, Belo Horizonte-MG, Brasil
| | | | - Margareth Leonor Penkal
- Laboratório Central do Estado do Paraná, Laboratório de Pesquisa e Identificação de Estreptococos, Curitiba-PR, Brasil
| | | |
Collapse
|
39
|
Mendicino CCP, Braga LP, Pádua CAMD, Guimarães MDC. High incidence of hypertriglyceridemia in a Brazilian cohort of people living with HIV/AIDS undergoing antiretroviral treatment in Belo Horizonte, 2001-2010. Rev Soc Bras Med Trop 2017; 49:758-762. [PMID: 28001224 DOI: 10.1590/0037-8682-0078-2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/30/2016] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Hypertriglyceridemia incidence should be estimated in HIV-infected patients after antiretroviral therapy (ART) initiation. METHODS: We retrospectively analyzed clinical data of HIV-infected adults at 3 public referral centers. Cumulative and person-time incidences were estimated for patients without hypertriglyceridemia. Survival time and hazard ratio (HR) were estimated by Kaplan-Meier analysis and Cox proportional regression, respectively. RESULTS: Cumulative and person-time incidences were 40.4% and 1.4 cases/100 person-months, respectively. The median period for hypertriglyceridemia occurrence was 47 months. Men and patients with switched ART regimens had increased hypertriglyceridemia risk (HR=3.05 and 3.34, respectively). CONCLUSIONS: Hypertriglyceridemia incidence is high in HIV-infected patients undergoing ART.
Collapse
Affiliation(s)
- Cássia Cristina Pinto Mendicino
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Letícia Pena Braga
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cristiane Aparecida Menezes de Pádua
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mark Drew Crosland Guimarães
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
40
|
Assunção AÁ, Lima EDP, Guimarães MDC. [Mental disorders and participation in the labor market: a multicenter national study in Brazil]. CAD SAUDE PUBLICA 2017; 33:e00166815. [PMID: 28380147 DOI: 10.1590/0102-311x00166815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 05/12/2016] [Indexed: 11/22/2022] Open
Abstract
The objective was to explore the relationship between labor market participation and patient characteristics in a representative sample of 2,475 adults admitted to 26 Brazilian mental health institutions (15 Centers for Psychosocial Care and 11 hospitals). Socio-demographic, clinical, and behavioral characteristics were obtained with structured interviews. Multinomial regression was used. Increased likelihood of temporary absence from the work market was associated with female gender, single, divorced, or widowed conjugal status, lack of stable housing, and history of first admission or treatment before the age of 18. Increased likelihood of permanent absence from the labor market was associated with older age. Temporary or permanent leave from work was directly associated with low schooling, lifetime hospitalizations, and diagnosis of severe mental disorder and inversely associated with alcohol and drug use. The occupational vulnerabilities identified in the study raise the debate on specific policies for the mental health sector.
Collapse
Affiliation(s)
- Ada Ávila Assunção
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | |
Collapse
|
41
|
Freitas MIDF, Bonolo PDF, Miranda WDD, Guimarães MDC. INTERACTIONS AND THE ANTIRETROVIRAL THERAPY ADHERENCE AMONG PEOPLE LIVING WITH HIV/AIDS. REME: Revista Mineira de Enfermagem 2017. [DOI: 10.5935/1415-2762.20170011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
42
|
De Abreu DMX, Guimarães MDC, Franco GDC, Lana GDC, Ishitani LH, França EB. O Impacto da Correção dos Dados na Mortalidade Prematura por Câncer de Próstata, Brasil, 1996-2011. Rev Brasileira De Cancerologia 2016. [DOI: 10.32635/2176-9745.rbc.2016v62n2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Introdução: Nas análises de mortalidade, devem ser observados o grau de cobertura e a qualidade das informações para reduzir o risco de apresentar estimativas de mortalidade com viés de sub-registro e/ou registro incorreto da causa de morte. Objetivo: Analisar a mortalidade por câncer de próstata na população masculina entre 30 e 69 anos de idade, no Brasil e regiões, de 1996 a 2011, corrigindo pelo sub-registro de óbitos e redistribuição de causas maldefinidas e inespecíficas. Método: Foram redistribuídos óbitos: de sexo e idade ignorados; causas mal definidas e causas inespecíficas; e corrigido o sub-registro no Sistema de Informações sobre Mortalidade. Para análise das séries de cada região e Brasil, aplicou-se um modelo de regressão linear com erros autorregressivos e o modelo de espaços de estados. Resultados: Após correção do sub-registro, as taxas de mortalidade por câncer de próstata aumentaram em 22,2% (1996) e 6,2% (2011). A redistribuição de causas mal definidas contribuiu em 21,4%, especialmente em 1996. Os códigos inespecíficos apresentaram um impacto muito reduzido no total de óbitos corrigidos. Após a correção, a região Nordeste passou a apresentar a maior taxa de morte por câncer de próstata e a região Sudeste a menor, em 1996 e 2011. Observou-se tendência de redução nos níveis de mortalidade no período analisado e também uma diminuição entre os diferenciais regionais em 2011. Conclusão: A correção dos dados permitiu obter um quadro mais específico da mortalidade por câncer de próstata, de modo a auxiliar no adequado planejamento das ações de saúde pública.
Collapse
|
43
|
Bezerra VM, Medeiros DSD, Gomes KDO, Souzas R, Giatti L, Steffens AP, Kochergin CN, Souza CL, Moura CSD, Soares DA, Santos LRCS, Cardoso LGV, Oliveira MVD, Martins PC, Neves OSC, Guimarães MDC. [Health survey in Quilombola communities (descendants of Afro-Brazilian slaves who escaped from slave plantations that existed in Brazil until abolition in 1888) in Vitória da Conquista in the state of Bahia (COMQUISTA Project), Brazil: methodological aspects and descriptive analysis]. Cien Saude Colet 2016; 19:1835-47. [PMID: 24897483 DOI: 10.1590/1413-81232014196.01992013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/24/2013] [Indexed: 11/21/2022] Open
Abstract
The scope of this article was to present the methodology, preliminary descriptive results and the reliability of the instruments used in the COMQUISTA Project. It involved a cross-sectional study with adults (>18 years) and children (up to 5 years old) of Quilombola communities in Vitória da Conquista, Bahia. Data collection consisted of individual and household interviews, anthropometric and blood pressure measurements. A semi-structured questionnaire adapted from the Brazilian National Health Survey (PNS) was used and the interviews were conducted using handheld computers. 397 housing units were visited and 797 adults and 130 children were interviewed. The demographic profile of the Quilombolas was similar to the Brazilian population with respect to sex and age, however, they had precarious access to basic sanitation and a low socioeconomic status. The analysis of reliability revealed the adequacy of strategies adopted for quality assurance and control in the study. The methodology used was considered adequate to achieve the objectives and can be used in other populations. The results indicate the need for implementing strategies to improve the quality of life and reduce the degree of vulnerability of the Quilombolas.
Collapse
|
44
|
Ceccato Junior BPV, Guimarães MDC, Lopes APC, Nascimento LF, Novaes LM, Del Castillo DM, Melo VH. Incidence of Cervical Human Papillomavirus and Cervical Intraepithelial Neoplasia in Women with Positive and Negative HIV Status. Rev Bras Ginecol Obstet 2016; 38:231-8. [PMID: 27123772 PMCID: PMC10309363 DOI: 10.1055/s-0036-1583294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objectives To evaluate the incidence and factors associated with cervical intraepithelial neoplasia (CIN) and cervical infection by human papillomavirus (HPV) among HIV-positive and HIV-negative women. Methods A cohort of 103 HIV positive and 113 HIV negative women were monitored between October 2008 and February 2012, for at least one year. Procedures included cervical cytology, DNA/HPV detection by polymerase chain reaction, colposcopy with biopsy if necessary, followed by an interview for exposure characteristics data. CIN was based on the histopathological results. Results The incidence of CIN was of 8.8 and 4.6 cases/100 women-years in HIV-positive and HIV-negative women, respectively. HIV-positive women presented a hazard ratio (HR) of 2.8 for CIN and developed lesions earlier (0.86 year) than HIV-negative women (2 years) (p = 0.01). The risk of developing CIN decreased with age (HR = 0.9) and marital status (HR = 0.4). HPV patients presented a higher incidence of CIN when compared HIV-positive and HIV-negative women (p = 0.01). The incidence of HPV cervical infection was 18.1 and 11.4 cases/100 women-years in HIV-positive and HIV-negative women, respectively. Those HIV-positive presented earlier HPV infection(p = 0.002). The risk of developing HPV infection decreased with age and was higher among HIV-positive women. HPV 16 was the most common type in HIV-positive women, and also the type most closely associated with CIN in HIV-negative women. Conclusions HIV-positive women had a greater incidence of HPV and CIN, and in a shorter time interval. More rigorous and timely clinical control is required for this group.
Collapse
Affiliation(s)
- Benito Pio Vitorio Ceccato Junior
- Department of Gynecology and Obstetrics, Faculdade de Ciencias Médicas de Minas Gerais - FCCMG, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | - Dora Méndez Del Castillo
- Center for Action and Research in Support Diagnostics, UFMG, Belo Horizonte, Minas Gerais, Brazil
| | - Victor Hugo Melo
- Department of Gynecology and Obstetrics, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
45
|
Nonato SM, Melo APS, Guimarães MDC. Sífilis na gestação e fatores associados à sífilis congênita em Belo Horizonte-MG, 2010-2013. Epidemiol Serv Saúde 2015. [DOI: 10.5123/s1679-49742015000400010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
46
|
Barroso SM, Melo AP, Guimarães MDC. Factors associated with depression: sex differences between residents of Quilombo communities. Rev bras epidemiol 2015; 18:503-14. [DOI: 10.1590/1980-5497201500020017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/30/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: The Quilombola population is subject to numerous sources of social vulnerability, but few studies investigate their physical or mental health conditions. OBJECTIVES: To investigate the factors associated with depression in men and women, separately. METHODOLOGY: Cross-sectional population-based study with 764 randomly selected participants from five quilombo communities in Vitória da Conquista, Bahia, Brazil. The cutoff point for depression was ≥ 10 points, assessed by the Patient Health Questionnaire score (PHQ-9), and the presence of five or more symptoms. We estimated the prevalence ratio with 95% confidence intervals using Poisson regression models with robust estimators stratified by gender. RESULTS: Among men, factors associated with depression were previous diagnosis of chronic illnesses, poor/very poor health self-assessment, and poor access to health services. Among women, the associated factors were previous diagnosis of psychiatric disorders, poor/very poor health self-perception, history of tobacco smoking, and self-declaration of race as not black. CONCLUSION: Factors associated with depression differ between men and women and must be considered in interventions to fight depression within this population.
Collapse
|
47
|
Peixoto ERDM, Barros FCRD, Guimarães MDC. Factors associated with unprotected sexual practice among men and women with mental illnesses in Brazil. CAD SAUDE PUBLICA 2015; 30:1475-86. [PMID: 25166944 DOI: 10.1590/0102-311x00029313] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 11/25/2013] [Indexed: 11/22/2022] Open
Abstract
This study estimated the rate and correlates of recent unprotected sex among sexually active psychiatric patients in Brazil, stratified by gender. The prevalence of unprotected sex among women and men were 89% and 77%, respectively. Significant correlates with unprotected sex were: being married/in union, living with children/partner, and cigarette smoking in both genders; lower income, depression and anxiety diagnoses among men only; older age, no previous HIV testing, sex under the influence of alcohol/drugs, and verbal violence among women only. Interventions to reduce risk behavior among psychiatric patients in Brazil are urgent and should take into account gender differences.
Collapse
|
48
|
Pereira JDC, Silva MR, da Costa RR, Guimarães MDC, Leite ICG. Profile and follow-up of patients with tuberculosis in a priority city in Brazil. Rev Saude Publica 2015; 49:6. [PMID: 25741659 PMCID: PMC4386562 DOI: 10.1590/s0034-8910.2015049005304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 08/02/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the cases of tuberculosis and the impact of direct follow-up on the assessment of treatment outcomes. METHODS This open prospective cohort study evaluated 504 cases of tuberculosis reported in the Sistema de Informação de Agravos de Notificação (SINAN - Notifiable Diseases Information System) in Juiz de Fora, MG, Southeastern Brazil, between 2008 and 2009. The incidence of treatment outcomes was compared between a group of patients diagnosed with tuberculosis and directly followed up by monthly consultations during return visits (287) and a patient group for which the information was indirectly collected (217) through the city's surveillance system. The Chi-square test was used to compare the percentages, with a significance level of 0.05. The relative risk (RR) was used to evaluate the differences in the incidence rate of each type of treatment outcome between the two groups. RESULTS Of the outcomes directly and indirectly evaluated, 18.5% and 3.2% corresponded to treatment default and 3.8% and 0.5% corresponded to treatment failure, respectively. The incidence of treatment default and failure was higher in the group with direct follow-up (p < 0.05) (RR = 5.72, 95%CI 2.65;12.34, and RR = 8.31, 95%CI 1.08;63.92, respectively). CONCLUSIONS A higher incidence of treatment default and failure was observed in the directly followed up group, and most of these cases were neglected by the disease reporting system. Therefore, effective measures are needed to improve the control of tuberculosis and data quality.
Collapse
Affiliation(s)
- Jisleny da Cruz Pereira
- Programa de Pós-Graduação em Saúde. Universidade Federal de Juiz de Fora. Juiz de Fora, MG, Brasil
| | | | | | | | | |
Collapse
|
49
|
Barros FCRD, Melo APS, Cournos F, Cherchiglia ML, Peixoto ERDM, Guimarães MDC. Cigarette smoking among psychiatric patients in Brazil. CAD SAUDE PUBLICA 2015; 30:1195-206. [PMID: 25099043 DOI: 10.1590/0102-311x00027113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 11/25/2013] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to estimate tobacco smoking prevalence among psychiatric patients attended in care facilities in Brazil and assess associated factors. A cross-sectional multicenter study was conducted of psychiatric patients (N = 2,475) selected from 26 care facilities. Current and ex-smokers were compared to those who had never smoked. Odds ratios were estimated using logistic regression. The current and past smoking prevalence rates were 52.7% and 18.9%, respectively. Being male, aged 40 years or over, drug and alcohol use, unprotected sex and a history of physical violence were factors associated with both current and past smoking, while a low education level (≤ 8 years of schooling), history of homelessness, not practicing a religion, current or previous psychiatric hospitalization, and main psychiatric diagnosis substance use disorders, were factors only associated with current smoking. Tobacco smoking prevalence among this population was high and was higher than the rate in the general population. Appropriate interventions and smoking prevention policies should be incorporated into mental health services.
Collapse
Affiliation(s)
| | - Ana Paula Souto Melo
- Faculdade de Medicina, Universidade Federal de São João Del-Rei, Divinópolis, Brasil
| | - Francine Cournos
- Mailman School of Public Health, Columbia University, New York, U.S.A
| | | | | | | |
Collapse
|
50
|
Gomes RRDFM, Batista JR, Ceccato MDGB, Kerr LRFS, Guimarães MDC. HIV/AIDS knowledge among men who have sex with men: applying the item response theory. Rev Saude Publica 2015; 48:206-15. [PMID: 24897041 PMCID: PMC4206150 DOI: 10.1590/s0034-8910.2014048004911] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 11/12/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the level of HIV/AIDS knowledge among men who have sex with men in Brazil using the latent trait model estimated by Item Response Theory. METHODS Multicenter, cross-sectional study, carried out in ten Brazilian cities between 2008 and 2009. Adult men who have sex with men were recruited (n = 3,746) through Respondent Driven Sampling. HIV/AIDS knowledge was ascertained through ten statements by face-to-face interview and latent scores were obtained through two-parameter logistic modeling (difficulty and discrimination) using Item Response Theory. Differential item functioning was used to examine each item characteristic curve by age and schooling. RESULTS Overall, the HIV/AIDS knowledge scores using Item Response Theory did not exceed 6.0 (scale 0-10), with mean and median values of 5.0 (SD = 0.9) and 5.3, respectively, with 40.7% of the sample with knowledge levels below the average. Some beliefs still exist in this population regarding the transmission of the virus by insect bites, by using public restrooms, and by sharing utensils during meals. With regard to the difficulty and discrimination parameters, eight items were located below the mean of the scale and were considered very easy, and four items presented very low discrimination parameter (< 0.34). The absence of difficult items contributed to the inaccuracy of the measurement of knowledge among those with median level and above. CONCLUSIONS Item Response Theory analysis, which focuses on the individual properties of each item, allows measures to be obtained that do not vary or depend on the questionnaire, which provides better ascertainment and accuracy of knowledge scores. Valid and reliable scales are essential for monitoring HIV/AIDS knowledge among the men who have sex with men population over time and in different geographic regions, and this psychometric model brings this advantage.
Collapse
|