HIV pre-exposure prophylaxis and incidence of sexually transmitted infections in Brazil, 2018 to 2022: An ecological study of PrEP administration, syphilis, and socioeconomic indicators.

BACKGROUND: Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is one of the pillars of a combination prevention strategy for reducing the risk of new infections caused by HIV. The daily use of antiretroviral drugs by individuals who are not infected with HIV is required to prevent infection. Although its efficacy has been well established in the literature, in recent years, the decreased supply of antiretroviral drugs has been associated with an increase in the incidence of sexually transmitted infections (STI) and changes in the social determinants of health. An ecological study was conducted covering a five-year period (2018-2022), starting from the year of initiation of PrEP administration in Brazilian state capitals. PRINCIPAL FINDINGS: Descriptive analysis was performed, and the spatial distribution of study data was taken into account. Correlation analysis was used to assess the association between PrEP administration, the incidence and detection rate of STI, and socioeconomic data. The southern region showed the highest incidence rates of STI, but the northern and northeastern regions demonstrated the worst socioeconomic indicators, especially those related to illiteracy and basic sanitation. PrEP administration was significantly correlated with illiteracy (ρ = -0.658), per capita income (ρ = 0.622), public garbage collection (ρ = 0.612), syphilis (ρ = 0.628) and viral hepatitis (ρ = 0.419) incidences. Further, all STI were significantly associated with illiteracy and per capita income. SIGNIFICANCE: Our findings highlight the need to continue exploring PrEP use and rising syphilis rates. In terms of policy, PrEP administration appears to be inversely associated with regions of greater social vulnerability. Further efforts should focus on the social determinants and health needs of this population to improve access to PrEP and reduce social disparities.

O papel da família no exercício dos direitos do portador de transtorno mental: revisão bibliográfica / The role of familly in the exercise of the rights of mental illness patients: a bibliographical review

A família é um grupo formado por pessoas que compartilham significados de suas vivências existenciais. Devido à grande influência da família na vida de seus membros, não se pode desvinculá-la do contexto de saúde mental, sendo importante conhecer a dinâmica familiar, bem como a representação da doença para ela. O objetivo é identificar os fatores de risco e de proteção no contexto familiar que influenciam no exercício dos direitos dos portadores de transtornos mentais. Trata-se de uma revisão da literatura em documentos publicados entre 2003 a 2013. Para a família, o transtorno mental é tido como fator desencadeante de sobrecarga, seja ela socioeconômica, nas dificuldades em lidar com os sintomas do transtorno mental e suas imprevisibilidades, desgaste emocional e até mesmo culpabilidade pela doença, buscando muitas vezes a união e o zelo de seu familiar vulnerável como métodos de enfrentamento. Contudo, há predominância dos fatores de risco aos de proteção na maioria dos casos. As estratégias que podem ser tomadas pela equipe de saúde são: valorizar a força da família, lhe atender quando buscar ajuda, possibilitar a aproximação das relações afetivas e trabalhar em parceria com a família, compartilhando saberes, sendo fundamental despir-se de valores próprios, atuando de forma flexível e planejada, pois cada família tem sua peculiaridade. Para garantir os direitos do portador de transtorno mental faz-se necessária uma mudança nos paradigmas de atendimento psicossocial, de modo a inserir a família no atual contexto de assistência, encarando-a como forma de intervenção, educando os profissionais que atuarão no campo da saúde mental. Dentre os profissionais atuantes nesta área, o enfermeiro desempenha papel fundamental como agente de mudanças, utilizando-se de seus saberes e práticas como meio de resgatar a condição de cidadão dos indivíduos em sofrimento mental, pautado nos princípios da reforma psiquiátrica.

Family consists in a group of people that share the meanings of their existential experiences. Due to the great influence of the family in the life of its members, one cannot disassociate it from the mental health context; hence, it is important to know the family dynamics, as well as what the illness represents to it. The main goal is to identify the risk and protection factors in the family context that have influence in the exercise of the rights of people with mental disorders. This is a bibliographical review based on documents published between 2003 and 2013. For the family, the mental disorder is seen as a trigger factor produced by an overload, whether it is of a socio-economic character, based on the difficulties of dealing with the symptoms of the mental illness and its unpredictability, emotional distress or even a feeling of guilty for the disease, leading many times to the union and care of the vulnerable family member as a coping method. However, there is the prevalence of risk factors over protection factors in most of the cases. The strategies that can be taken by the medical health team are: value the family strength, attending them when they look for help in order to enable the approach of affective relationships and work jointly with the family, sharing knowledge. Here it is fundamental to be free from their own values, acting in a flexible and planned way, since each family has its own peculiarities. In order to guarantee the rights of the mental illness patient, a shift in the psychosocial care paradigm is needed in order to insert the family in the current context of assistance, looking at it as an intervention, collaborating to educate the professionals who will work in the mental health . Among the professionals that work in this area, nurses plays a fundamental role as an agent of change, using his/her knowledge and practices as an instrument for the rescue of the citizen condition of the individuals with mental disorder, based on the principles of psychiatric reform.