A traveling SARS-CoV-2 laboratory as part of a pandemic response among vulnerable Brazilian populations.

BACKGROUND: Brazil has been dramatically hit by the SARS-CoV-2 pandemic and is a world leader in COVID-19 morbidity and mortality. Additionally, the largest country of Latin America has been a continuous source of SARS-CoV-2 variants and shows extraordinary variability of the pandemic strains probably related to the country´s outstanding position as a Latin American economical and transportation hub. Not all regions of the country show sufficient infrastructure for SARS-CoV-2 diagnosis and genotyping which can negatively impact the pandemic response. METHODS: Due to this reason and to disburden the diagnostic system of the inner São Paulo State, the Butantan Institute established the Mobile Laboratory (in Portuguese: LabMovel) for SARS-CoV-2 testing which started a trip of the most important "hotspots" of the most populous Brazilian region. The LabMovel initiated in two important cities of the State: Aparecida do Norte (an important religious center) and the Baixada Santista region which incorporates the port of Santos, the busiest in Latin America. The LabMovel was fully equipped with an automatized system for SARS-CoV-2 diagnosis and sequencing/genotyping. It also integrated the laboratory systems for patient records and results divulgation including in the Federal Brazilian Healthcare System. RESULTS: Currently,16,678 samples were tested, among them 1,217 from Aparecida and 4,564 from Baixada Santista. We tracked the delta introductio in the tested regions with its high diversification. The established mobile SARS-CoV-2 laboratory had a major impact on the Public Health System of the included cities including timely delivery of the results to the healthcare agents and the Federal Healthcare system, evaluation of the vaccination status of the positive individuals in the background of exponential vaccination process in Brazil and scientific and technological divulgation of the fieldwork to the most vulnerable populations. CONCLUSIONS: The SARS-CoV-2 pandemic has demonstrated worldwide the importance of science to fight against this viral agent and the LabMovel shows that it is possible to integrate researchers, clinicians, healthcare workers and patients to take rapid actions that can in fact mitigate this and other epidemiological situations.

SARS-COV-2 genomic monitoring in the state of São Paulo unveils two emerging AY.43 sublineages.

Delta VOC is highly diverse with more than 120 sublineages already described as of November 30, 2021. In this study, through active monitoring of circulating severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants in the state of São Paulo, southeast Brazil, we identified two emerging sublineages from the ancestral AY.43 strain which were classified as AY.43.1 and AY.43.2. These sublineages were defined by the following characteristic nonsynonymous mutations ORF1ab:A4133V and ORF3a:T14I for the AY.43.1 and ORF1ab:G1155C for the AY.43.2 and our analysis reveals that they might have a likely-Brazilian origin. Much is still unknown regarding their dissemination in the state of São Paulo and Brazil as well as their potential impact on the ongoing vaccination process. However, the results obtained in this study reinforce the importance of genomic surveillance activity for timely identification of emerging SARS-CoV-2 variants which can impact the ongoing SARS-CoV-2 vaccination and public health policies.

Dynamic clade transitions and the influence of vaccination on the spatiotemporal circulation of SARS-CoV-2 variants.

Since 2021, the emergence of variants of concern (VOC) has led Brazil to experience record numbers of in COVID-19 cases and deaths. The expanded spread of the SARS-CoV-2 combined with a low vaccination rate has contributed to the emergence of new mutations that may enhance viral fitness, leading to the persistence of the disease. Due to limitations in the real-time genomic monitoring of new variants in some Brazilian states, we aimed to investigate whether genomic surveillance, coupled with epidemiological data and SARS-CoV-2 variants spatiotemporal spread in a smaller region, can reflect the pandemic progression at a national level. Our findings revealed three SARS-CoV-2 variant replacements from 2021 to early 2022, corresponding to the introduction and increase in the frequency of Gamma, Delta, and Omicron variants, as indicated by peaks of the Effective Reproductive Number (Reff). These distinct clade replacements triggered two waves of COVID-19 cases, influenced by the increasing vaccine uptake over time. Our results indicated that the effectiveness of vaccination in preventing new cases during the Delta and Omicron circulations was six and eleven times higher, respectively, than during the period when Gamma was predominant, and it was highly efficient in reducing the number of deaths. Furthermore, we demonstrated that genomic monitoring at a local level can reflect the national trends in the spread and evolution of SARS-CoV-2.

The Divergent Pattern of SARS-CoV-2 Variant Predominance and Transmission Dynamics in the Brazilian Island of Ilhabela.

Our effort in SARS-CoV-2 genomic surveillance in Brazil has detected the Alpha Variant of Concern with a predominance higher than 75% in the population of Ilhabela island (São Paulo State) at a time when the Gamma VOC was already predominating the mainland raised concerns for closer surveillance on this island. Therefore, we intensified the surveillance for 24 weeks by generating data from 34% of local positive cases. Our data show that the patterns of VOC predominance dynamics and infection rates were in general distinct from the mainland. We report here the first known case of Alpha predominance in a Brazilian population, a delay greater than 3 months for the Gamma to dominate the previous variants compared to the mainland, and a faster dispersion rate of Gamma and Delta VOCs compared to the mainland. Phylogenetic analysis revealed the SARS-CoV-2 transmission dynamics in Ilhabela were characterized by multiple independent introduction events of Gamma and Delta, with a few events of Alpha introduction, two of them followed by community transmission. This study evidenced the peculiar behavior of SARS-CoV-2 variants in an isolated population and brought to light the importance of specific programs for SARS-CoV-2 genomic surveillance in isolated populations.

Dynamics of SARS-CoV-2 Variants of Concern in Vaccination Model City in the State of Sao Paulo, Brazil.

From a country with one of the highest SARS-CoV-2 morbidity and mortality rates, Brazil has implemented one of the most successful vaccination programs. Brazil's first model city vaccination program was performed by the CoronaVac vaccine (Sinovac Biotech) in the town of Serrana, São Paulo State. To evaluate the vaccination effect on the SARS-CoV-2 molecular dynamics and clinical outcomes, we performed SARS-CoV-2 molecular surveillance on 4375 complete genomes obtained between June 2020 and April 2022 in this location. This study included the period between the initial SARS-CoV-2 introduction and during the vaccination process. We observed that the SARS-CoV-2 substitution dynamics in Serrana followed the viral molecular epidemiology in Brazil, including the initial identification of the ancestral lineages (B.1.1.28 and B.1.1.33) and epidemic waves of variants of concern (VOC) including the Gamma, Delta, and, more recently, Omicron. Most probably, as a result of the immunization campaign, the mortality during the Gamma and Delta VOC was significantly reduced compared to the rest of Brazil, which was also related to lower morbidity. Our phylogenetic analysis revealed the evolutionary history of the SARS-CoV-2 in this location and showed that multiple introduction events have occurred over time. The evaluation of the COVID-19 clinical outcome revealed that most cases were mild (88.9%, 98.1%, 99.1% to Gamma, Delta, and Omicron, respectively) regardless of the infecting VOC. In conclusion, we observed that vaccination was responsible for reducing the death toll rate and related COVID-19 morbidity, especially during the gamma and Delta VOC; however, it does not prevent the rapid substitution rate and morbidity of the Omicron VOC.

Medicines' private costs among elderly and the impairment of family income in a medium-sized municipality in the state of São Paulo. / Gasto privado com medicamentos entre idosos e o comprometimento da renda familiar em município de médio porte no estado de São Paulo.

INTRODUCTION: The acquisition of medicines accounts for a significant proportion of private health expenditures. The objective of this study was to analyse the private spending with the purchase of medicines and the commitment of the family income, by the elderly. METHODS: Population survey conducted in Praia Grande, São Paulo, Brazil. The monthly expenditure and the per capita family income commitment with the purchase of medicines were calculated from the information obtained in the interviews. The variables were described in absolute and relative frequencies and the hypothesis test was Pearson's χ2, Student's t and Anova, with a significance level of 5%. RESULTS: The prevalence of drug use was 61.2%. The average monthly expenditure per capita was R$ 34.59, with significantly higher income impairment for individuals with higher levels of education, without chronic diseases and health plan beneficiaries. CONCLUSION: The prevalence of drug use was low. The cost generated by the purchase of medicines is one of the ways in which inequality can manifest in society. The expansion of free drug provision would be necessary to expand access and avoid spending, especially those who have private health plans but cannot afford drug treatment.

Correlated factors of depression among male and female inmates. / Fatores associados à depressão em homens e mulheres presos.

INTRODUCTION: The prevalence of depression is high in the prison system, and the differences between sex regarding associated risk factors are still not clear. We analyzed the correlated factors of depression among incarcerated men and women in the state of São Paulo, Brazil. METHODOLOGY: A cross-sectional study with stratified and multi-stage probabilistic sample was performed. Composite International Diagnostic Interview (CIDI) was applied for psychiatric diagnostic classification, as well as a questionnaire on criminal history with 1,192 men and 617 women. Lifetime prevalence of mental disorder was calculated, and association analysis performed by multinomial logistic regression stratified by sex. A dependent variable was categorized into depression, any other mental disorder and no mental disorder (reference). RESULTS: The prevalence of depression was of 33.3% -(30.3 - 36.5) in women and 12.9% (11.1 - 15.0) in men. Depression was associated with disciplinary penalty, being in a stable relationship, physical health problems and history of infringement in adolescence in men. Regarding other mental illnesses, the correlated factors were historical transgression during adolescence and re-offense. Among women, depression was associated with physical health problems, drug crimes, violent crimes and being imprisoned. DISCUSSION: Results confirmed the differences between associated factors with depression regarding sex. CONCLUSION: Differences in the profile between men and women require effective specialized programs, considering the need for coping strategies for incarcerated men and health-related rehabilitation for women with depression.

INTRODUÇÃO: As prevalências de depressão em presídios são altas, porém não há clareza sobre os fatores de risco entre os sexos. Analisamos os fatores associados à depressão entre homens e mulheres presos no estado de São Paulo. METODOLOGIA: Estudo transversal, de 2006 a 2007, com amostra probabilística estratificada e em múltiplos estágios. Aplicaram-se o Composite International Diagnostic Interview (CIDI) para diagnóstico psiquiátrico e questionário sobre histórico criminal em 1.192 homens e 617 mulheres. As prevalências foram calculadas para vida e fatores associados, para cada sexo, analisadas por meio da regressão logística multinomial. A variável dependente foi categorizada em: depressão, outro transtorno e sem transtorno mental. RESULTADOS: A prevalência de depressão em mulheres foi de 33,3% (30,3 - 36,5) e em homens de 12,9% (11,1 - 15,0). Entre homens, foram associados à depressão falta disciplinar no presídio, histórico infracional na adolescência, ter companheira e problemas de saúde. Associados a outros transtornos: histórico infracional na adolescência e reincidência. Entre mulheres, as associações com depressão foram: problemas de saúde, crime de drogas e violência, estar presa em penitenciária e reincidência. Outros transtornos foram com problemas de saúde, reincidência, histórico infracional e crime violento. DISCUSSÃO: Resultados confirmam estudos sobre diferenças entre os sexos para fatores associados à depressão. CONCLUSÃO: Há diferenças no perfil de homens e mulheres, que demandam distintas estratégias de enfrentamento, como coping e reabilitação em saúde para as mulheres com depressão.

[Psychological well-being among transvestites and trans women in the state of São Paulo, Brazil]. / Bem-estar psicológico entre travestis e mulheres transexuais no Estado de São Paulo, Brasil.

This article sought to estimate factors associated with the psychological well-being of transvestites and trans women. It is a cross-sectional study with 602 transvestites and trans individuals in seven cities in the state of São Paulo, Brazil from 2014 to 2015. We carried out a sample selection through a consecutive approach and using the snowball technique. The dependent variable was psychological well-being (WHOQOL-BREF) and the independent variables were: sociodemographic characteristics, body modifications, health conditions, violence and incarceration. We used a multiple variance analysis to identify associated factors. Most were black or brown and were aged between 25 and 39 years, had up to complete secondary education, individual income of up to two times the minimum wage and worked, and 42.3% were sex workers. Around one-quarter had been incarcerated. Around one-quarter were in treatment for HIV. Mean psychological well-being score was 63.2 (95%CI: 61.8-64.6). In the multiple analysis, the factors associated with lower psychological well-being were: not having a fixed address, having lower educational levels, being dissatisfied with personal relationships, friend support or the gender-affirming procedures they had undergone and having suffered verbal or sexual violence. While worse living conditions and exposure to violence harm the psychological well-being of transvestites and trans women, the possibility of undergoing desired body transformations and having their social name respected interfere positively in their evaluations of their lives.

O objetivo do trabalho foi estimar fatores associados ao bem-estar psicológico de travestis e mulheres transexuais. Estudo transversal com 602 travestis e pessoas transexuais em sete municípios do Estado de São Paulo, Brasil entre 2014 e 2015. Foi realizada seleção amostral com abordagem consecutiva e técnica bola de neve. A variável dependente foi bem-estar psicológico (WHOQOL-BREF) e as independentes foram: características sociodemográficas, modificações corporais, condições de saúde, violência e encarceramento. A análise de variância múltipla foi usada para identificar os fatores associados. A maioria tinha cor da pele preta ou parda e entre 25 e 39 anos de idade, até o Ensino Médio completo, renda individual de até dois salários mínimos e trabalhava, sendo 42,3% profissionais do sexo. Cerca de um quarto já foi presa. Em torno de um quarto fazia tratamento para HIV. O escore médio observado foi de 63,2 (IC95%: 61,8-64,6). Na análise múltipla, estiveram associados ao menor bem-estar psicológico: não ter endereço fixo, ter menor escolaridade, estar insatisfeita com as relações pessoais, suporte de amigos ou procedimentos transexualizadores realizados e ter sofrido violência verbal ou sexual. Enquanto piores condições de vida e de exposição à violência prejudicam o bem-estar psicológico de travestis e mulheres transexuais, a possibilidade de realizar transformações corporais desejadas e o respeito ao nome social interferem positivamente na avaliação que fazem de suas vidas.

El objetivo fue estimar factores asociados al bienestar psicológico de travestis y mujeres transexuales. Se trata de un estudio transversal con 602 travestis y personas transexuales en siete municipios del estado de São Paulo, Brasil, entre 2014 y 2015. Se realizó una selección de muestras con un enfoque consecutivo y técnica bola de nieve. La variable dependiente fue bienestar sicológico (WHOQOL-BREF) y las independientes fueron: características sociodemográficas, modificaciones corporales, condiciones de salud, violencia y encarcelamiento. Se usó un análisis multivariante de variancia para identificar los factores asociados. La mayoría tenía el color de piel negro o eran mulatos, y entre 25 y 39 años de edad, con hasta la enseñanza media completa, renta individual de hasta dos salarios mínimos y trabajaba, siendo un 42,3% profesionales del sexo. Cerca de un cuarto ya estuvo presa. También cerca de un cuarto estaba con tratamiento para el VIH. Las puntuaciones medias de bienestar sicológico fue 63,2 (IC95%: 61,8-64,6). En el análisis múltiple, estuvieron asociados a un menor bienestar sicológico: no tener dirección fija, tener menor escolaridad, estar insatisfecha con las relaciones personales, apoyo de amigos o procedimientos transexualizadores realizados, y haber sufrido violencia verbal o sexual. Mientras que unas peores condiciones de vida y de exposición a la violencia perjudican el bienestar sicológico de travestis y mujeres transexuales, la posibilidad de realizar las transformaciones corporales deseadas y el respeto al nombre social interfieren positivamente en la evaluación que hacen de sus vidas.

Factors associated with condom use inyoung people-A population-based survey. / Fatores associados ao uso de preservativoem jovens - inquérito de base populacional.

INTRODUCTION: This study aimed to identify the factors associated with condom use in the last sexual intercourse. METHODS: A population-based survey with young people aged 15-24, in the city of São Paulo, which collected sociodemographic data referring to knowledge about sex and sexual behavior. RESULTS: Among 821 sexually active young people interviewed in the last year, condom use in their last sexual intercourse was positively associated with: 1) not being married; 2) use of condom at sexual onset; and 3) receiving free condoms; additionally, among men: 4) casual partners in the previous year; and 5) partner of the same sex; and, amongwomen: 6) sexual onset after the age of 15. Having been tested for HIV was a negative association among women. Condoms are widely acknowledged, and there is a pattern of use for the first and last sexual intercourse. Access to free condoms is an important factor for use, and people use condoms according to standards that configure risk management. CONCLUSIONS: The strategy of primary prevention with the use of condoms is not yet exhausted. Based on this study, the city of São Paulo takes prevention as a public policy and allocates large condoms dispensers in 26 urban bus terminals, where 6million people circulate daily. In 2016, 75,546,720 free condoms were distributed, 30% in bus terminals alone.

INTRODUÇÃO: O objetivo do estudo foi identificar os fatores associados ao uso de preservativo na última relação sexual. MÉTODOS: Inquérito de base populacional com jovens de 15 a 24 anos, residentes no município de São Paulo (MSP), que obteve informações sociodemográficas sobre conhecimentos e comportamentos sexuais por meio de questionário. RESULTADOS: Entre os 821 jovens sexualmente ativos no último ano, o uso do preservativo na última relação foi positivamente associado a: 1) não ter sido casado; 2) uso de preservativo na primeira relação sexual; e 3) receber preservativos gratuitos; adicionalmente, em homens: 4) parceiro casual no último ano; e 5) parceiro do mesmo sexo; e em mulheres: 6) debut sexual após os 15 anos. Ter realizado teste anti-HIV mostrou associação negativa entre as mulheres. O preservativo é amplamente reconhecido; há um padrão de uso na primeira e na última relação sexual; o acesso ao preservativo gratuito é um importante fator para o seu uso pelos jovens; e as pessoas usam preservativo de acordo com padrões que configuram gestão de risco. CONCLUSÕES: A estratégia de prevenção primária com preservativos não está esgotada. A partir deste estudo, a cidade de São Paulo adotou a prevenção como política pública e alocou grandes dispensadores de preservativos nos 26 terminais de ônibus urbanos, por onde circulam 6milhões de pessoas diariamente. Em2016 foram distribuídos 75.546.720 preservativos gratuitos, entre os quais 30% apenas nos terminais de ônibus.

Factors associated with sexually transmitted infections: a population based survey in the city of São Paulo, Brazil. / Fatores associados às infecções sexualmente transmissíveis: inquérito populacional no município de São Paulo, Brasil.

We determined the prevalence of sexually transmitted infections (STIs), the factors associated with infection and types of counseling received by men and women from health professionals in the City of São Paulo. The investigation consisted of a cross-sectional study conducted with men and women aged between 15 and 64 years living in the City of São Paulo. Of 4,057 individuals who had engaged in sexual activity, 6.3% reported previous history of a STI: 4.3% of women and 8.2% of men. The factors associated with STI were being aged over 34 years and not using a condom during first sexual intercourse, among men, and being aged over 25 years among women. Protective factors included not having had sexual intercourse with someone from the same sex, among men, and having initiated sexual activity after the age of 15 years and not having a casual sex partner over the last 12 months, among women. Counseling about the importance of HIV and syphilis testing was received by 72.1% and 64.7% of women, respectively, while fewer than half of the men received this type of counseling (40.2% and 38.6 %, respectively). The prevalence of previous history of a STI was high among the population of the City of São Paulo. The findings of this study informed the development, implementation, and evaluation of STI policies, including those directed at HIV, leading to a reduction in the barriers that hinder access to and use of condoms and the creation of STI prevention app.

Descrevemos a frequência de infecções sexualmente transmissíveis (IST), os fatores associados e as orientações recebidas dos profissionais de saúde entre homens e mulheres no município de São Paulo. Estudo de corte transversal, com inquérito populacional, com indivíduos de 15 a 64 anos residentes em São Paulo. De 4057 indivíduos que iniciaram a vida sexual, 6,3% relataram IST durante a vida, 4,3% das mulheres e 8,2% dos homens. As IST mostraram associação, entre os homens, com: idade > 34 anos, não uso de preservativo na primeira relação sexual; e entre as mulheres idade > 25 anos. Mostraram-se fatores de proteção, entre os homens: não ter tido relações sexuais com pessoa do mesmo sexo; e entre as mulheres: início sexual > 15 anos de idade e não ter tido parceria casual no último ano. Quanto às orientações, 72,1% e 64,7% das mulheres as receberam sobre a importância de realizar testes para HIV e sífilis, respectivamente, enquanto foram ofertadas para menos da metade dos homens (40,2% e 38,6%). A elevada proporção de antecedentes de IST entre a população do município e os resultados deste estudo possibilitaram a construção, implementação e avaliação de políticas públicas de saúde para o enfrentamento das IST incluindo o HIV, com diminuição de barreiras de acesso aos preservativos e criação de um app para prevenção.

Intimate partner violence reported by female and male users of healthcare units.

OBJECTIVE: To analyze nonfatal violence suffered and committed by adult men and women, in an intimate relationship. METHODS: The participants in the research were women aged between 15 and 49 years and men between 18 and 60 years, interviewed by face-to-face questionnaire application. The sample selection was of consecutive type, according to the order of arrival of the users. We conducted temporarily independent investigations and covered different health services to avoid couples and relationships in which the retaliation could be overvalued. To improve the comparison, we also examined reports of men and women from the same service, i.e., a service that was common to both investigations. We compared the situations suffered by women according to their reports and cross-linked the information to what men, according to their own reports, do against intimate partners or ex-partners. We also examined the cross-linked situation in reverse: the violence committed by women against their partners, according to their reports, in comparison with the violence suffered by men, also according to their reports, even if, in this case, the exam refers only to physical violence. The variables were described using mean, standard deviation, frequencies and proportions, and the hypothesis testing used was: Fisher's exact and Pearson's Chi-square tests, adopting a significance level of 5%. RESULTS: Victimization was greater among women, regardless of the type of violence, when perpetrated by intimate partner. The perception of violence was low in both genders; however, women reported more episodes of multiple recurrences of any violence and sexual abuse suffered than men acknowledged to have perpetrated. CONCLUSIONS: The study in its entirety shows significant gender differences, whether about the prevalence of violence, whether about the perception of these situations. OBJETIVO: Analisar as violências não fatais sofridas e praticadas por homens e mulheres adultos, em situação de parceria íntima. MÉTODOS: Os sujeitos da pesquisa foram mulheres entre 15 a 49 anos e homens entre 18 a 60 anos, entrevistados por aplicação de questionário face a face. A seleção amostral foi do tipo consecutivo, captando-se os participantes por ordem de chegada ao serviço. Foram conduzidos como investigações temporalmente independentes e abrangendo diferentes serviços, para evitar o estudo em casais, nos quais o revide poderia estar supervalorizado. Para adensar um pouco mais a comparação, também examinamos relatos de homens e mulheres pertencentes a um mesmo serviço, ou seja, um serviço que foi participante comum às duas investigações. Comparamos as situações sofridas pelas mulheres segundo seus relatos e, de modo entrecruzado, as situações que os homens, segundo seus relatos, praticam contra as mulheres, suas parceiras íntimas ou ex-parceiras. Também examinamos a situação entrecruzada reversa: a violência praticada pelas mulheres contra seus parceiros, segundo seus próprios relatos, comparativamente à violência sofrida pelos homens, segundo seus relatos, ainda que, neste caso, o exame se refere apenas à violência física. As variáveis foram descritas por meio de média, desvio padrão, frequências e proporções e os testes de hipóteses utilizados foram: Exato de Fisher e Qui-quadrado de Pearson, adotando-se nível de significância de 5%. RESULTADOS: A vitimização foi maior entre as mulheres, independentemente do tipo de violência, quando perpetrada por parceiro íntimo. A percepção da violência foi baixa em ambos os sexos; entretanto, mulheres relataram mais episódios de múltiplas recorrências de quaisquer violências e de violência sexual sofrida do que os homens reconheceram que perpetraram. CONCLUSÕES: O estudo em seu todo mostra importantes diferenças de gênero, quer quanto às prevalências das violências, quer quanto à percepção dessas situações.

Individual- and contextual-level factors associated with client-initiated HIV testing.

BACKGROUND: Knowing the reasons for seeking HIV testing is central for HIV prevention. Despite the availability of free HIV counseling and testing in Brazil, coverage remains lacking. METHODS: Survey of 4,760 respondents from urban areas was analyzed. Individual-level variables included sociodemographic characteristics; sexual and reproductive health; HIV/AIDS treatment knowledge and beliefs; being personally acquainted with a person with HIV/AIDS; and holding discriminatory ideas about people living with HIV. Contextual-level variables included the Human Development Index (HDI) of the municipality; prevalence of HIV/AIDS; and availability of local HIV counseling and testing (CT) services. The dependent variable was client-initiated testing. Multilevel Poisson regression models with random intercepts were used to assess associated factors. RESULTS: Common individual-level variables among men and women included being personally acquainted with a person with HIV/AIDS and age; whereas discordant variables included those related to sexual and reproductive health and experiencing sexual violence. Among contextual-level factors, availability of CT services was variable associated with client-initiated testing among women only. The contextual-level variable "HDI of the municipality" was associated with client-initiated testing among women. CONCLUSION: Thus, marked gender differences in HIV testing were found, with a lack of HIV testing among married women and heterosexual men, groups that do not spontaneously seek testing.

Adolescent pregnancy and transition to adulthood in young users of the SUS.

OBJECTIVE: The objective of this study is to contextualize adolescent pregnancy from milestones associated with the process of transition from youth to adulthood. METHODS: This is a cross-sectional study conducted with 200 adolescents, users of the Brazilian Unified Health System. The sample size for the estimation of proportions has been calculated assuming a population ratio of 0.50 and 95% confidence level. The dependent variables - planned pregnancy, living with a partner, and having left the parents' house - have been considered as markers of transition from dependence to independence, from youth to adulthood. In the analysis of the associated factors, we have used the Poisson model with robust variance. RESULTS: Average age was 17.3 years, and most adolescents lived with a partner; approximately half of the adolescents got pregnant from their first partner and the average age of first sexual intercourse was 14.6 years. Only 19% of the adolescents were studying and most dropped out of school before the beginning of the pregnancy. In the bivariate and multiple analysis, we could see that the relationship with a partner for more than two years was associated with the three dependent variables. CONCLUSIONS: The path of transition to adulthood has been the establishment of a link with a partner and consequent pregnancy, suggesting a clear pattern of male guardianship. The changing role of women in society observed in recent decades, which means choosing a professional career, defining the number of children, and choosing their partner(s), has not reached these young persons. OBJETIVO: Contextualizar a gestação em adolescentes a partir de marcos associados ao processo de transição da juventude para a vida adulta. MÉTODOS: Estudo transversal realizado com 200 adolescentes usuárias do Sistema Único de Saúde. O tamanho da amostra para a estimação de proporções foi calculado considerando uma proporção populacional de 0,50, e nível de confiança de 95%. As variáveis dependentes - gestação planejada, morar com o parceiro e ter saído da casa dos pais - foram consideradas marcadores da transição da dependência para a independência, da juventude para a vida adulta. Na análise dos fatores associados, utilizou-se o modelo de Poisson com variância robusta. RESULTADOS: A idade média foi 17,3 anos, a maioria coabitava com o companheiro; aproximadamente metade engravidou do primeiro parceiro e a idade média da primeira relação sexual foi 14,6 anos. Apenas 19% das jovens estudavam e o abandono escolar foi, na maior parte, anterior ao início da gestação. Nas análises bivariadas e na análise múltipla, observou-se que relacionar-se com o parceiro há mais de dois anos se associou às três variáveis dependentes. CONCLUSÕES: O caminho de transição para a vida adulta foi o estabelecimento de um vínculo com um parceiro e consequente maternidade, sugerindo padrão claro de tutela masculina. A mudança do papel da mulher na sociedade observada nos últimas décadas, que implica optar por uma carreira profissional, definir número de filhos e escolher o(s) parceiro(s),não chegou a parcela dessas jovens.

Routine HIV testing in men who have sex with men: from risk to prevention. / Uso rotineiro do teste anti-HIV entre homens que fazem sexo com homens: do risco à prevenção.

We conducted a critical review of the literature on recurrent use of HIV testing in men who have sex with men (MSM). We performed a narrative review of the literature in which we analyzed the various conceptions on frequent testing over time, the implications for health programs, and the main social markers that influence the incorporation of HIV testing as routine care. Although it has existed since the 1990s, recurrent testing among MSM was frequently interpreted as increased exposure to HIV due to lack of condom use, and therefore as "unnecessary" testing. Beginning in the 2000s, periodic testing has become a programmatic recommendation and has been interpreted as a goal. Individuals' perception of their use of the test has rarely been considered in order to characterize such use as routine care. On the social and cultural level, individual aspects associated with recent or routine testing were included in contexts of favorable norms for testing and less AIDS stigma. Differences in generation, schooling, and types of affective-sexual partnerships play an important part in testing. Such differences highlight that the epidemiological category "men who have sex with men" encompasses diverse relations, identities, and practices that result in specific uses of the test as a prevention strategy. Thus, dialogue between programs, health professionals, and the persons most affected by the epidemic is crucial for building responses with real potential to confront the HIV epidemic, based on respect for human rights.

[Use of industrial liquid silicone to transform the body: prevalence and factors associated with its use among transvestites and transsexual women in São Paulo, Brazil]. / Silicone líquido industrial para transformar o corpo: prevalência e fatores associados ao seu uso entre travestis e mulheres transexuais em São Paulo, Brasil.

This study aimed to estimate the prevalence of use of industrial liquid silicone (ILS) among transvestite persons and transsexual women and identify associated factors. This was a cross-sectional study in seven municipalities in São Paulo State, Brazil, with data collected in 2014 and 2015 in a sample of 576 individuals. Analysis of the associated factors used a Poisson model with robust variance to estimate the crude and adjusted prevalence ratios. Prevalence of use of ILS was 49%, mean age at first injection of ILS was 22 (± 5.3) years, and 43% reported health problems resulting from its use. Having less than a university education, age 20 years and older, self-identification as transvestite, and sex work were positively associated with use of ILS according to the multivariate model. There was a high prevalence of ILS use and resulting health problems, indicating the need to prevent its use and reduce the resulting health problems. It is thus essential to ensure access to the necessary resources for body changes during transition through comprehensive care for transvestites and transsexual persons in the Brazilian Unified National Health System (SUS). Finally, health policies should include demands for body changes as part of gender identity construction, respecting each person's unique needs in this transition process.

Gasto privado com medicamentos entre idosos e o comprometimento da renda familiar em município de médio porte no estado de São Paulo / Medicines' private costs among elderly and the impairment of family income in a medium-sized municipality in the state of São Paulo

RESUMO: Introdução: A aquisição de medicamentos responde por proporção importante dos gastos privados em saúde. O objetivo deste trabalho foi analisar o gasto privado com a compra de medicamentos e o comprometimento da renda familiar por idosos. Métodos: Inquérito populacional realizado em Praia Grande, São Paulo, 2013. O gasto mensal e o comprometimento da renda familiar per capita com a compra de medicamentos foram calculados com base nas informações obtidas nas entrevistas. As variáveis foram descritas em frequências absolutas e relativas, e os testes de hipótese utilizados foram o χ2 de Pearson, o t de Student e a análise de variância (Anova), com nível de significância de 5%. Resultados: A prevalência de utilização de medicamentos foi de 61,2%, e o gasto médio mensal per capita, de R$ 34,59, sendo significativamente maior o comprometimento da renda para os indivíduos com maior escolaridade, sem doenças crônicas e beneficiários de planos de saúde. Conclusão: A prevalência de utilização de medicamentos foi baixa. O custo gerado pela aquisição de medicamentos é uma das formas pelas quais pode se manifestar a desigualdade na sociedade. A ampliação da provisão gratuita de medicamentos seria necessária para expandir o acesso e evitar gastos, sobretudo àqueles que possuem planos de saúde privados, mas que não conseguem arcar com as despesas de tratamento medicamentoso.

ABSTRACT: Introduction: The acquisition of medicines accounts for a significant proportion of private health expenditures. The objective of this study was to analyse the private spending with the purchase of medicines and the commitment of the family income, by the elderly. Methods: Population survey conducted in Praia Grande, São Paulo, Brazil. The monthly expenditure and the per capita family income commitment with the purchase of medicines were calculated from the information obtained in the interviews. The variables were described in absolute and relative frequencies and the hypothesis test was Pearson's χ2, Student's t and Anova, with a significance level of 5%. Results: The prevalence of drug use was 61.2%. The average monthly expenditure per capita was R$ 34.59, with significantly higher income impairment for individuals with higher levels of education, without chronic diseases and health plan beneficiaries. Conclusion: The prevalence of drug use was low. The cost generated by the purchase of medicines is one of the ways in which inequality can manifest in society. The expansion of free drug provision would be necessary to expand access and avoid spending, especially those who have private health plans but cannot afford drug treatment.

Covid-19 em uma Região Metropolitana: vulnerabilidade social e políticas públicas em contextos de desigualdades / Covid-19 in a Metropolitan Region: public polices and social vulnerability within a context of inequality

RESUMO A Covid-19 chegou rapidamente à periferia das grandes cidades brasileiras, a qual é socialmente mais vulnerável. A baixa capacidade de testagem resulta na adoção de medidas sem informações consistentes sobre o comportamento da doença e interfere na adoção de ações de controle. Objetivou-se estimar a prevalência de infecção por SARS-CoV-2 na população da Região Metropolitana da Baixada Santista (RMBS) e analisar impactos da vulnerabilidade social e de políticas públicas implementadas em contextos de desigualdades. Estudo de caráter quantitativo, transversal, mediante inquérito sorológico seriado e aplicação de questionário em amostragem populacional estratificada e coleta domiciliar, nos nove municípios da RMBS. Conclui-se que a soroprevalência medida foi de 1,4% na primeira fase, e de 2,2% na segunda; permitindo estimar 15 pessoas infectadas para cada caso notificado na primeira fase, e 10 na seguinte. A letalidade foi recalculada para 0,40% e 0,48% em cada fase, aproximando-se da casuística internacional. Pessoas mais vulneráveis são as mais atingidas pela pandemia, devendo ser consideradas: informalidade no trabalho, baixa renda, cor da pele autorreferida como preta ou parda e informações ambivalentes quanto à prevenção. Os resultados reforçam a importância do isolamento social e da adoção de medidas econômicas e sociais protetivas destinadas às populações vulneráveis.

ABSTRACT Covid-19 dramatically impacted socially vulnerable regions at the outskirts of large Brazilian cities. Besides, low testing capacity resulted in the lack of proper control measures due to inconsistent information on the disease's behavior. This study aimed to estimate prevalence of SARS-CoV-2 antibodies among the Baixada Santista Metropolitan Region (RMBS) population and the impacts of social vulnerability and public policies implemented within an environment of inequality. A quantitative, cross-sectional study, through a serial serological survey and the application of a questionnaire in stratified population sampling and home drew, in nine municipalities of RMBS. Seroprevalence was 1.4% in the first and 2.2% in the second phase, allowing to estimate 15 infected people for each case notified in the first phase, and 10 in the following. Lethality was recalculated to 0.40% and 0.48% in each phase, approaching the international rates. Socially vulnerable people were the most affected by the pandemic. Informal work, low income, self-reported skin color as black or brown, and ambivalent information regarding prevention should be considered as risk factors. Our results reinforce the relevance of social isolation and the adoption of protective economic and social measures, especially for socially vulnerable populations.

Fatores associados à depressão em homens e mulheres presos / Correlated factors of depression among male and female inmates

RESUMO: Introdução: As prevalências de depressão em presídios são altas, porém não há clareza sobre os fatores de risco entre os sexos. Analisamos os fatores associados à depressão entre homens e mulheres presos no estado de São Paulo. Metodologia: Estudo transversal, de 2006 a 2007, com amostra probabilística estratificada e em múltiplos estágios. Aplicaram-se o Composite International Diagnostic Interview (CIDI) para diagnóstico psiquiátrico e questionário sobre histórico criminal em 1.192 homens e 617 mulheres. As prevalências foram calculadas para vida e fatores associados, para cada sexo, analisadas por meio da regressão logística multinomial. A variável dependente foi categorizada em: depressão, outro transtorno e sem transtorno mental. Resultados: A prevalência de depressão em mulheres foi de 33,3% (30,3 - 36,5) e em homens de 12,9% (11,1 - 15,0). Entre homens, foram associados à depressão falta disciplinar no presídio, histórico infracional na adolescência, ter companheira e problemas de saúde. Associados a outros transtornos: histórico infracional na adolescência e reincidência. Entre mulheres, as associações com depressão foram: problemas de saúde, crime de drogas e violência, estar presa em penitenciária e reincidência. Outros transtornos foram com problemas de saúde, reincidência, histórico infracional e crime violento. Discussão: Resultados confirmam estudos sobre diferenças entre os sexos para fatores associados à depressão. Conclusão: Há diferenças no perfil de homens e mulheres, que demandam distintas estratégias de enfrentamento, como coping e reabilitação em saúde para as mulheres com depressão.

ABSTRACT: Introduction: The prevalence of depression is high in the prison system, and the differences between sex regarding associated risk factors are still not clear. We analyzed the correlated factors of depression among incarcerated men and women in the state of São Paulo, Brazil. Methodology: A cross-sectional study with stratified and multi-stage probabilistic sample was performed. Composite International Diagnostic Interview (CIDI) was applied for psychiatric diagnostic classification, as well as a questionnaire on criminal history with 1,192 men and 617 women. Lifetime prevalence of mental disorder was calculated, and association analysis performed by multinomial logistic regression stratified by sex. A dependent variable was categorized into depression, any other mental disorder and no mental disorder (reference). Results: The prevalence of depression was of 33.3% ­(30.3 - 36.5) in women and 12.9% (11.1 - 15.0) in men. Depression was associated with disciplinary penalty, being in a stable relationship, physical health problems and history of infringement in adolescence in men. Regarding other mental illnesses, the correlated factors were historical transgression during adolescence and re-offense. Among women, depression was associated with physical health problems, drug crimes, violent crimes and being imprisoned. Discussion: Results confirmed the differences between associated factors with depression regarding sex. Conclusion: Differences in the profile between men and women require effective specialized programs, considering the need for coping strategies for incarcerated men and health-related rehabilitation for women with depression.

Fatores associados ao uso de preservativoem jovens - inquérito de base populacional / Factors associated with condom use inyoung people-A population-based survey

RESUMO: Introdução: O objetivo do estudo foi identificar os fatores associados ao uso de preservativo na última relação sexual. Métodos: Inquérito de base populacional com jovens de 15 a 24 anos, residentes no município de São Paulo (MSP), que obteve informações sociodemográficas sobre conhecimentos e comportamentos sexuais por meio de questionário. Resultados: Entre os 821 jovens sexualmente ativos no último ano, o uso do preservativo na última relação foi positivamente associado a: 1) não ter sido casado; 2) uso de preservativo na primeira relação sexual; e 3) receber preservativos gratuitos; adicionalmente, em homens: 4) parceiro casual no último ano; e 5) parceiro do mesmo sexo; e em mulheres: 6) debut sexual após os 15 anos. Ter realizado teste anti-HIV mostrou associação negativa entre as mulheres. O preservativo é amplamente reconhecido; há um padrão de uso na primeira e na última relação sexual; o acesso ao preservativo gratuito é um importante fator para o seu uso pelos jovens; e as pessoas usam preservativo de acordo com padrões que configuram gestão de risco. Conclusões: A estratégia de prevenção primária com preservativos não está esgotada. A partir deste estudo, a cidade de São Paulo adotou a prevenção como política pública e alocou grandes dispensadores de preservativos nos 26 terminais de ônibus urbanos, por onde circulam 6milhões de pessoas diariamente. Em2016 foram distribuídos 75.546.720 preservativos gratuitos, entre os quais 30% apenas nos terminais de ônibus.

ABSTRACT: Introduction: This study aimed to identify the factors associated with condom use in the last sexual intercourse. Methods: A population-based survey with young people aged 15-24, in the city of São Paulo, which collected sociodemographic data referring to knowledge about sex and sexual behavior. Results: Among 821 sexually active young people interviewed in the last year, condom use in their last sexual intercourse was positively associated with: 1) not being married; 2) use of condom at sexual onset; and 3) receiving free condoms; additionally, among men: 4) casual partners in the previous year; and 5) partner of the same sex; and, amongwomen: 6) sexual onset after the age of 15. Having been tested for HIV was a negative association among women. Condoms are widely acknowledged, and there is a pattern of use for the first and last sexual intercourse. Access to free condoms is an important factor for use, and people use condoms according to standards that configure risk management. Conclusions: The strategy of primary prevention with the use of condoms is not yet exhausted. Based on this study, the city of São Paulo takes prevention as a public policy and allocates large condoms dispensers in 26 urban bus terminals, where 6million people circulate daily. In 2016, 75,546,720 free condoms were distributed, 30% in bus terminals alone.