Drivers of Sexual Inactivity Among Women Living with HIV and AIDS: Findings of the GENIH Study in São Paulo, Brazil.

The advances on HIV/AIDS diagnosis and treatment have enabled people living with HIV/AIDS (PLHA) better quality of life. However, the persistence of HIV-related stigma and discrimination, and the risks triggered by HIV disclosure, may be a barrier to the sexual exercise of PLHA. We investigated the prevalence of sexual inactivity and the reasons given for it among a representative sample of women of reproductive age living with HIV/AIDS (WLWHA) in the municipality of São Paulo, Brazil. We surveyed 918 WLWHA with probability proportional to average number of visits in each of the 18 referral HIV/AIDS services. Sexual inactivity was defined as not having had vaginal sexual intercourse in the year prior to research. Statistical modeling of the factors associated with sexual inactivity was carried out by way of bivariate and multivariate analysis. In all, 22.2% (n = 200) of the women did not have sexual relations in the year prior to the interview. The majority reported a reduction in desire (64.5%) and sexual activity (68%). Among the women not in a relationship, the predictors of sexual inactivity were: being older (35-49) (ORa = 2.25); not being Catholic (ORa = 2.91); having kept the diagnosis secret from their partner (ORa = 2.45); having had up to five sexual partners throughout life (ORa = 3.81). The diagnosis of HIV seems to have more of an effect on the desire for and frequency of sexual activity than on its interruption. Sexual inactivity was influenced by the stigma of HIV/AIDS, by age, and by moral-religious values.

Preventing syndemic Zika virus, HIV/STIs and unintended pregnancy: dual method use and consistent condom use among Brazilian women in marital and civil unions.

Syndemic Zika virus, HIV and unintended pregnancy call for an urgent understanding of dual method (condoms with another modern non-barrier contraceptive) and consistent condom use. Multinomial and logistic regression analysis using data from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS), a nationally representative household survey of reproductive-aged women in Brazil, identified the socio-demographic, fertility and relationship context correlates of exclusive non-barrier contraception, dual method use and condom use consistency. Among women in marital and civil unions, half reported dual protection (30% condoms, 20% dual methods). In adjusted models, condom use was associated with older age and living in the northern region of Brazil or in urban areas, whereas dual method use (versus condom use) was associated with younger age, living in the southern region of Brazil, living in non-urban areas and relationship age homogamy. Among condom users, consistent condom use was associated with reporting Afro-religion or other religion, not wanting (more) children and using condoms only (versus dual methods). Findings highlight that integrated STI prevention and family planning services should target young married/in union women, couples not wanting (more) children and heterogamous relationships to increase dual method use and consistent condom use.

The emergency contraceptive pill in Brazil: High usage rates but schooling differences persist.

OBJECTIVES: This paper aims to analyze usage rates for the emergency contraceptive pill (ECP) among women living in the city of São Paulo and their associated factors. STUDY DESIGN: A population based cross-sectional survey was conducted in 2015 with a probabilistic sample of 4,000 women aged 15 to 44 living in São Paulo, Brazil. Response rate for households was 75% and 77% for eligible women. Binary logistic regression models were used to describe the association between each outcome and selected variables. RESULTS: A total of 51.4% of women living in the city of São Paulo had used ECP at least once in their lifetime. Women under 35 were more likely to use ECP, as were those with more than 9 years of schooling, having at least one live birth, not cohabiting with a partner, with more than two lifetime sexual partners and as length of sexual life decreased. Among ECP users, 32.6% used it only once, 47.5% used it 2 to 4 times, and 19.9% used it 5 or more times. CONCLUSIONS: Our findings suggest that ECPs have been incorporated into the contraceptive method mix for many women as a fundamental strategy for regulating fertility. Particularly young women, unmarried women and those who have had more partners seem to take greater advantage of ECP to prevent pregnancy. IMPLICATIONS: Despite the high use rate, lower levels of schooling are associated with lower levels of ECP use. There is a need for both policies to reduce schooling inequities and strategies to improve women's knowledge of reproduction and contraception.

The contribution of Journal Ciência & Saúde Coletiva to gender and health studies. / A contribuição da Revista Ciência & Saúde Coletiva para os estudos sobre e gênero e saúde.

This paper aims to explore Journal Ciência & Saúde Coletiva's contributions to gender and health studies. Therefore, mapping was carried out through the SciELO platform, using the terms gender, man/men, woman/women, youth/youths, adolescent/adolescents. A total of 164 papers were selected, categorized by year of publication, type of study, population, topics addressed, and method. The analysis of the material shows the journal's contribution to proposing themes that favor analyses from the gender perspective. Some productions reflect the most current discussions. However, the paucity of works on gender in life cycles and the intersectional approach suggests that the journal's proactive posture should be maintained to encourage gender analysis in other topics than sexual and reproductive health, masculinities, and gender violence against women.

Este artigo tem como finalidade explorar as contribuições da C&SC para os estudos sobre gênero e saúde. Para tanto, foi realizado um mapeamento por meio da plataforma da revista no SciELO, utilizando os unitermos gênero, homem/homens, mulher/mulheres, jovem/jovens, adolescente/adolescentes. Foram selecionados 164 artigos, categorizados em função do ano de publicação, tipo de estudo, população estudada, temas abordados e método. A análise do material aponta a contribuição da revista ao propor temas que favorecem análises na perspectiva de gênero. Algumas produções traduzem discussões atuais. Entretanto, o pequeno número de artigos sobre gênero nos ciclos de vida e desde uma abordagem interseccional sugere que a postura proativa da revista deve ser mantida para estimular análises de gênero em outros temas que não a saúde sexual e reprodutiva, as masculinidades e a violência de gênero contra mulheres.

[Differences in contraceptive practice in the city of São Paulo, Brazil: results of the Ouvindo Mulheres population survey]. / Diferenciais da prática contraceptiva no Município de São Paulo, Brasil: resultados do inquérito populacional Ouvindo Mulheres.

Contraception is essential for women to be able to regulate their fertility, exercising a key dimension of reproductive rights. However, little is known about how women deal with this challenge in Brazil's largest city, São Paulo. To fill this gap, the population survey Ouvindo Mulheres: Contracepção no Município de São Paulo was conducted with a probabilistic sample of 4,000 women 15 to 44 years of age living in this city in 2015. This article presents the prevalence of contraceptive practice and analyzes factors associated with lack of contraception use and with types of contraceptives. Prevalence of contraception was estimated for women with at least one heterosexual relation in the 12 months prior to the interview and who were not pregnant. Logistic regression was used to verify factors associated with lack of contraception use, and the CHAID model was used to identify associations with the types of contraceptives used. Prevalence of contraception was 84.8% (95%CI: 83.2-86.3). The most prevalent contraceptives were the pill and condoms. Factors associated with lack of contraceptive use were religion (Pentecostal), number of children (fewer than 3), not having used contraceptives in the first sexual relation, not having a partner, and not having had sex in the previous month. Number of children and woman's age were the first two levels of discrimination of the types of contraceptives used. Prevalence of contraception was high, but maintaining a concentration in two methods: historically, female sterilization and the pill prevailed, nowadays, the pill and condoms do. New hormonal contraceptives should be incorporated by the Brazilian Unified National Health System (SUS), besides promoting the use of long-acting methods such as IUDs.

A contracepção é fundamental para que as mulheres possam regular sua fecundidade, exercendo uma das dimensões dos direitos reprodutivos. No entanto, desconhecemos como elas enfrentam esse desafio na maior cidade do Brasil, São Paulo. Para preencher essa lacuna, o inquérito populacional Ouvindo Mulheres: Contracepção no Município de São Paulo foi realizado junto a uma amostra probabilística de 4 mil mulheres com 15 a 44 anos de idade, residentes nessa cidade, em 2015. Neste artigo, apresenta-se a prevalência da prática contraceptiva, analisam-se os fatores associados ao não uso de contracepção e aos tipos de contraceptivos em uso. A prevalência da anticoncepção foi estimada para mulheres com, pelo menos, uma relação heterossexual nos 12 meses anteriores à entrevista e que não estavam grávidas. Regressão logística foi utilizada para verificar fatores associados ao não uso de contracepção, e o modelo CHAID, para identificar associações aos tipos de contraceptivo em uso. A prevalência da anticoncepção foi 84,8% (IC95%: 83,2-86,3). Os contraceptivos mais prevalentes foram pílula e preservativo masculino. Associaram-se ao não uso de anticoncepção, religião (Pentecostal), número de filhos (menos do que 3), não ter usado contraceptivo na primeira relação sexual, não ter parceiro e não ter tido relação sexual no mês anterior. O número de filhos tidos e a idade da mulher foram os dois primeiros níveis de discriminação dos tipos de contraceptivo utilizados. A prevalência da anticoncepção é alta, mas mantém-se a concentração em dois métodos: anteriormente, laqueadura e pílula, agora, pílula e preservativo masculino. É necessário incorporar novos contraceptivos hormonais no Sistema Único de Saúde (SUS) e promover o uso de métodos de longa duração como o DIU.

La contracepción es fundamental para que las mujeres puedan regular su fecundidad, ejerciendo una de las dimensiones de sus derechos reproductivos. No obstante, desconocemos cómo enfrentan este desafío en la mayor ciudad de Brasil, São Paulo. Para resolver esta cuestión, se realizó la encuesta poblacional Ouvindo Mulheres: Contracepção no Município de São Paulo, mediante una muestra probabilística de 4 mil mujeres de 15 a 44 años de edad, residentes en esa ciudad en 2015. En este artículo se presenta la prevalencia de la práctica contraceptiva, se analizan los factores asociados con el no uso de métodos anticonceptivos, así como los tipos de contraceptivos en uso. La prevalencia de la anticoncepción se estimó en mujeres con por lo menos una relación heterosexual, en los 12 meses anteriores a la entrevista, y que no estaban embarazadas. Se utilizó la regresión logística para verificar factores asociados al no uso de contracepción y el modelo CHAID para identificar asociaciones respecto a los tipos de contraceptivo en uso. La prevalencia de la anticoncepción fue 84,8% (IC95%: 83,2-86,3). Los contraceptivos más prevalentes fueron la píldora y el condón. Se asociaron al no uso de anticonceptivos: religión (Pentecostal), número de hijos (menos de 3), no haber usado contraceptivo en la primera relación sexual, no tener pareja y no haber tenido relaciones sexuales durante el mes anterior. El número de hijos y la edad de la mujer fueron los dos primeros niveles de discriminación de los tipos de contraceptivo utilizados. La prevalencia de la anticoncepción es alta, pero se mantiene la concentración en dos métodos: anteriormente, ligadura y píldora, ahora, píldora y condón. Es necesario incorporar nuevos contraceptivos hormonales en el Sistema Único de Salud (SUS), así como promover el uso de métodos de larga duración como el DIU.

Typologies of violence against women in Brazil: A latent class analysis of how violence and HIV intersect.

We address the limited understanding around the overlap between violence and HIV in Brazil. Data was from two clinic-based samples of HIV-positive (n = 1534) and HIV-negative women (n = 1589) in São Paulo and Porto Alegre. We conducted latent class analysis and identified violence typologies by type of violence, life course timing, frequency, and perpetrator, stratified by city and HIV-status. Overall, HIV-positive women experienced more lifetime physical and sexual violence than HIV-negative women. Twelve unique violence latent classes were identified. In São Paulo, HIV-positive women were likely to have endured physical violence several times (Conditional Probability [CP]: 0.80) by an intimate partner (CP: 0.85), and sexual violence several times (CP: 0.46) by an intimate partner (CP: 0.62). In Porto Alegre, HIV-positive women endured physical violence several times (CP: 0.80) by an intimate partner (CP: 0.70) during childhood/adolescence (CP: 0.48), and sexual violence several times (CP: 0.54) by an intimate partner (CP: 0.60). Findings inform interventions to educate around gender equity, violence, and the health effects of violence including HIV, integrate HIV and violence services, and improve the provision of bio-medical HIV prevention among HIV-negative women who experience violence.

[Sexual behavior and practices among men and women, Brazil 1998 and 2005]. / Comportamento e práticas sexuais de homens e mulheres, Brasil 1998 e 2005.

OBJECTIVE: To compare basic findings from two studies on sexual behavior and practices among women and men and their associations with sociodemographic characteristics of this population. METHODS: Data analyzed were obtained by a questionnaire applied to a probabilistic sample comprised of 3,423 people in 1998, and 5,040 people in 2005, all aged between 16 and 65 years, and living in urban areas of Brazil. Comparative analyses were performed by sex and year of research, and according to sociodemographic variables, using Pearson's chi-square test. RESULTS: The number of sexual partners in the year that preceded the interview decreased from 29.5% to 23.1% among men. Variability in sexual behavior and practices according to age, level of education, marital status, religion and place of residence, in addition to specific characteristics based on sex, was observed. There was also an increase in the proportion of women who began their sexual life in the 16-to-19-year age group and had completed up to elementary school, or lived in Southern Brazil. Moreover, it was observed an increase of sexual activity reported by women in the last year, and a decrease among men over 55 years of age, Protestant/Pentecostal, or separated/widowed. The proportion of men with more than one sexual partner in the last year decreased among those aged between 25 and 44 years or who have completed up to high-school. There was an increase in oral sex practice reported by women who are over 35 years of age or live in Northern/Northeastern Brazil. CONCLUSIONS: Comparative analysis from 1998 to 2005 suggested a tendency towards differences between women and men decreasing. This probably results from a pattern of change characterized by an increase in the frequency of female behavior investigated and a decrease in the frequency of male behavior.

[Trends in condom use: Brazil 1998 and 2005]. / Uso do preservativo: tendências entre 1998 e 2005 na população brasileira.

OBJECTIVE: To analyze the levels, tendencies and sociodemographic differentials of condom use among the Brazilian urban population. METHODS: The data analyzed was collected in 1998 and 2005, in the study, "Sexual Behavior and Perceptions of the Brazilian Population concerning HIV/Aids". The probabilistic samples, in multiple stages, included men and women aged 16 to 65 years old, living in urban areas. Interviews with individuals that had been sexually active during the 12 months preceding the interview were included in the analysis. The univariate models were based on chi-square tests, corrected by sample planning, and odds ratio calculations; multivariate analysis involved adjustment of logistic regression models, controlling all other interest variables. RESULTS: There was a significant increase in the use of condoms in the 12 months preceding the interview and at the last sexual intercourse. Young people from 16 to 24 years of age protected themselves more in sexual intercourse, particularly with eventual partners. Men used condoms more frequently only when they had an eventual partner. The use of condoms was more frequent among single people. There were no regional differences with respect to the consistent use of the condom. In stable relationships Pentecostals reveal the least amount of protection in sexual intercourse. People who have no religious affiliation or adepts of other religions have higher rates of protection. Level of education, an important differential with respect to the use of condoms in 1998, maintained its prominence in 2005. CONCLUSIONS: The results indicate the need for greater in depth discussion concerning actions that are geared towards increasing the consistent use of condoms, particularly among populations with lower educational levels and those that are more vulnerable, such as young women or women in stable relationships.

Notes on the female condom: experiences in Brazil.

A nationwide effort to introduce the female condom (FC) into public health services was undertaken in Brazil in 1998-99. To this end, the Ministry of Health sponsored a national research group of public health professionals, aided by local field workers and supervisors, to conduct a preparatory study at 20 sites in six cities. Clinic health workers were trained to conduct the study. Following an educational session, 2382 women volunteered to use the FC and to report their experiences at follow-up. Among those seen at 15 days, 1782 had used the FC at least once; among those seen at the 90-day follow-up, 1453 women had used it at least once, while 1296 of them liked it and wished to continue its use. Among these 1296 women, barrier use at last intercourse (either with a male or a female condom) was more than double at 90 days what it had been at baseline: 70% compared with 33%. Clinics providing active health-education activities achieved higher rates of follow-up and of FC acceptability. These findings suggest that in Brazil, the introduction of the FC at public health centres could lead to high initial adoption rates and that continued use would be effective in encouraging safer sex. The level of health education and type of clinic are likely to influence the effectiveness of a future programme.

[Trajectories of women living with HIV/AIDS in Brazil. Progress and permanence of the response to the epidemic]. / Trajetórias de mulheres vivendo com HIV/aids no Brasil. Avanços e permanências da resposta à epidemia.

This article analyzes the trajectories of 85 women living with HIV/AIDS in six Brazilian cities: Belém, São Paulo, Ribeirão Preto, Goiânia, Recife and Pelotas, to understand some specific aspects of their experiences before and after diagnosis. It is based on in-depth interviews conducted in 2009 addressing women diagnosed with HIV between 1 and 20 years previously. The results show a profile characterized by limited access to school, health services and labor and a marked presence of violence. The reasons for applying HIV tests vary over time and there is an increase in prenatal testing, although no modifications in the context of the infection are apparent. For some women, the diagnosis determines changes in lifestyle. However, for the majority, social and labor experiences and the decisions about love, sexuality and reproduction seem to respond to their immediate demands and opportunities. The management of the diagnosis and the support received influence living with HIV/AIDS. These results show the need for actions for prevention and testing not restricted to pregnant women, even in the context of a concentrated epidemic. Studies adopting a biographical perspective can contribute to prevent or improve living with HIV/AIDS appropriate to the different moments of the womens' trajectories.

Differences and similarities in women living and not living with HIV: contributions by the GENIH study to sexual and reproductive healthcare. / Diferenças e similaridades entre mulheres que vivem e não vivem com HIV: aportes do estudo GENIH para a atenção à saúde sexual e reprodutiva.

This quantitative study in the city of São Paulo, Brazil, compared contexts of social vulnerability and sexual and reproductive behavior in a sample of 975 women living with HIV/AIDS (WLHIV) and 1,003 women not living with HIV, the latter recruited among users of the primary healthcare system. WLHIV experienced situations of greater vulnerability that potentially increased their risk of HIV infection and unplanned pregnancy and abortion. Compared to women users of the primary healthcare system, WLHIV reported higher rates of drug use, sex for money, exposure to intimate partner violence, difficulties in access to services for prevention and early diagnosis, unplanned pregnancies, induced abortion, and teenage pregnancy. A considerable number of the women users of the primary healthcare system shared these same experiences, but at lower rates. The identification of contexts of vulnerability and the integration of HIV testing services with sexual and reproductive health services should constitute lines of care for these women, both in specialized and primary care services.

Estudo quantitativo foi conduzido no Município de São Paulo, Brasil, comparando contextos de vulnerabilidade social e o comportamento sexual e reprodutivo de uma amostra de 975 mulheres vivendo com HIV/aids (MVHA) e de 1.003 mulheres usuárias da rede de atenção básica à saúde. As MVHA são marcadas por situações de maior vulnerabilidade que, potencialmente, aumentaram o seu risco para a infecção pelo HIV e para eventos no campo reprodutivo. Comparando com mulheres usuárias da rede de atenção básica à saúde, as MVHA relataram em maiores proporções: uso de drogas, sexo em troca de dinheiro, exposição a parceiros íntimos violentos, dificuldades no acesso a serviços de prevenção e diagnóstico precoce, ocorrência de gestações não planejadas, aborto provocado e gravidez na adolescência. Parcela considerável das mulheres usuárias da rede de atenção básica à saúde compartilha as mesmas experiências, porém em menor magnitude. A identificação de contextos de vulnerabilidade e a integração de serviços de testagem anti-HIV e de saúde sexual e reprodutiva devem compor as linhas de cuidado às mulheres, tanto nos serviços especializados quanto nos de atenção básica.

El estudio cuantitativo se realizó en el Municipio de São Paulo, Brasil, comparando contextos de vulnerabilidad social y el comportamiento sexual y reproductivo de una muestra de 975 mujeres, viviendo con VIH/SIDA (MVHA) y de 1.003 mujeres usuarias de la red de atención básica a la salud. Las MVHA se marcan por situaciones de mayor vulnerabilidad que, potencialmente, aumentaron su riesgo para la infección por el VIH y para eventos en el campo reproductivo. Comparando con mujeres usuarias de la red de atención básica a la salud, las MVHA informaron en mayor proporción de: consumo de drogas, sexo a cambio de dinero, exposición a parejas sentimentales violentas, dificultades en el acceso a servicios de prevención y diagnóstico precoz, ocurrencia de gestaciones no planeadas, aborto provocado y embarazo en la adolescencia. Una proporción considerable de las mujeres usuarias de la red de atención básica a la salud comparte las mismas experiencias, aunque en menor magnitud. La identificación de contextos de vulnerabilidad y la integración de servicios de test anti-VIH y de salud sexual y reproductiva deben formar parte de las líneas de cuidado a las mujeres, tanto en los servicios especializados, como en los de atención básica.

[Women who have sex with women: estimates for Brazil]. / Mulheres que fazem sexo com mulheres: algumas estimativas para o Brasil.

This paper analyzes the proportion of Brazilian women who have sex with women, considering three time periods. The data are from a national population-based survey from 1998. The proportion of the female population who reported having any same-sex relations during their lifetime decreased from 3% to 1.7% in the previous five years and remained at 1.7% in the last year. Comparing the data by gender, the results suggest that women and men have different patterns of homosexual and heterosexual experiences over the course of their lives.

Dual protection to address the global syndemic of HIV and unintended pregnancy in Brazil.

BACKGROUND: Syndemic HIV and unintended pregnancy is prevalent in Brazil, where 79% of female HIV cases occur in women of reproductive age and 55% of all pregnancies are unintended. Although increasing condom use to prevent HIV may decrease non-barrier contraception and increase unintended pregnancy, few studies focus on dual protection or dual methods (condoms with another modern contraceptive). AIM: To describe the correlates of dual method use and consistent condom use in women of reproductive age in Brazil. METHOD: Data are from the 2006 Pesquisa Nacional de Demografia e Saúde da Mulher e da Criança, a decennial nationally representative household survey of women of reproductive age in Brazil. Multivariate logistic regression models identify the socio-demographic, sexual debut, fertility and relationship factors associated with dual method use and consistent condom use. RESULTS: Two-thirds of contracepting women in Brazil used dual protection (40% exclusive condoms, 27% dual methods). Consistent condom use in the past year occurred among 61% of exclusive condom users and 27% of dual method users. Dual methods (vs exclusive condoms) was associated with some high school education [relative risk ratio (RRR)=1.69, p<0.05], living in the Southern region (RRR=1.59, p<0.01), and number of children (RRR=1.22, p<0.01), net of other factors. Consistent condom use was associated with condom use at sexual debut [adjusted odds ratio (AOR)=1.84, p<0.001], wants no (more) children (AOR=1.86, p<0.001), single/separated relationship status (AOR=2.77/2.45, p<0.001) and using exclusive condoms (vs dual methods: AOR=0.19, p<0.001). CONCLUSIONS: Findings highlight that targeting and delivering integrated HIV and family planning services should focus on completed/large families. single/separated individuals, and promoting dual protection at sexual debut.

Differences in the Access to Sterilization between Women Living and Not Living with HIV: Results from the GENIH Study, Brazil.

BACKGROUND: In many countries, young women of reproductive age have been especially affected by the HIV epidemic, which have fostered research to better understand how HIV infection influences and shapes women´s fertility and reproductive and sexual decisions. In Brazil, few studies have focused on the impact of the HIV epidemic on contraceptive choices among women living with HIV (WLHIV). OBJECTIVE: This study evaluates the impact HIV infection may have in the access to female sterilization in Brazil, using a time-to-event analysis. METHODS: A cross-sectional quantitative study (GENIH study) was conducted between February 2013 and April 2014 in the city of São Paulo, comparing two probabilistic samples of 975 WLHIV and 1,003 women not living with HIV (WNLHIV) aged 18 to 49. Sexual and reproductive data was collected retrospectively in order to reconstruct women's reproductive trajectories. Given the objectives of this study, the analysis was restricted to women with parity one or more and, in case of WLHIV, to those sterilized after HIV diagnosis and not infected through vertical transmission. The final sample analysis included 683 WNLHIV and 690 WLHIV. A series of multivariable-adjusted Cox models estimated the probability of being sterilized after HIV diagnosis, compared with WNLHIV. Models were adjusted for schooling, race/color, and stratified by parity at last delivery (1-2, 3+). Hazard ratios were calculated for female sterilization, and separately for interval and postpartum procedures (performed in conjunction with caesarean section or immediately after vaginal delivery). Additionally, information regarding unmet demand for female sterilization was also explored. FINDINGS: No statistical difference in the overall risk of sterilization between WLHIV and WNLHIV in the two parity-related groups is observed: HR = 0.88 (0.54-1.43) and 0.94 (0.69-1.29), respectively, among women with 1-2 children and those with three and more. However, significant differences regarding the impact of HIV infection at sterilization are observed depending on the timing and the type of sterilization procedure. The probability of obtaining an interval sterilization is significantly lower for WLHIV compared to those not living with HIV. The reverse occurs regarding postpartum sterilization. Although sterilization is mainly performed in conjunction with caesarean section in Brazil, it is evident that caesarean sections are not the sole factor increasing the risk of sterilization among WLHIV. CONCLUSION: The results indicate barriers in the access to services offering interval sterilization for WLHIV and certain facilitation in obtaining the procedure in conjunction with caesarean section. Health policy makers at local and national levels should promote institutional changes in order to facilitate access to interval sterilization and to confront the sensitive discussion of WLHIV's eligibility for postpartum sterilization. It is also urgent to increase access to a wider range of contraceptive methods for WLHIV and promote dual method protection strategies. Moreover, since condom use may decrease in the future in the context of the preventive effect of antiretroviral therapy, promoting dual methods will expand the choices regarding the reproductive rights of women living with HIV.

Prevention of the heterosexual HIV infection among women: Is it possible to think about strategies without considering their reproductive demands?

This article aims to discuss the prevention of the heterosexual HIV infection among women, considering and relationship between this practice and their reproductive demands, based on a critical analysis of the recent literature on the issue. It is assumed the relative exhaustion in the discourse about male condom use in all sexual relations, and the need to recognize that for many women in childbearing age, HIV prevention cannot be dissociated of the contraception practices, although the symbolic and technologically distinction between them. Furthermore, not always the contexts in which the sex occurs allows preventive practices. Women are different, and also their risks, vulnerabilities and needs, and this differences must be identified. The adequacy of preventive strategies to their particularities and situations experienced by each requires an effort of incorporation of available scientific knowledge to the actions taken by the health services, as well as conducting research on specific points relating to heterosexual practices.

A contribuição da Revista Ciência & Saúde Coletiva para os estudos sobre e gênero e saúde / The contribution of Journal Ciência & Saúde Coletiva to gender and health studies

Resumo Este artigo tem como finalidade explorar as contribuições da C&SC para os estudos sobre gênero e saúde. Para tanto, foi realizado um mapeamento por meio da plataforma da revista no SciELO, utilizando os unitermos gênero, homem/homens, mulher/mulheres, jovem/jovens, adolescente/adolescentes. Foram selecionados 164 artigos, categorizados em função do ano de publicação, tipo de estudo, população estudada, temas abordados e método. A análise do material aponta a contribuição da revista ao propor temas que favorecem análises na perspectiva de gênero. Algumas produções traduzem discussões atuais. Entretanto, o pequeno número de artigos sobre gênero nos ciclos de vida e desde uma abordagem interseccional sugere que a postura proativa da revista deve ser mantida para estimular análises de gênero em outros temas que não a saúde sexual e reprodutiva, as masculinidades e a violência de gênero contra mulheres.

Abstract This paper aims to explore Journal Ciência & Saúde Coletiva's contributions to gender and health studies. Therefore, mapping was carried out through the SciELO platform, using the terms gender, man/men, woman/women, youth/youths, adolescent/adolescents. A total of 164 papers were selected, categorized by year of publication, type of study, population, topics addressed, and method. The analysis of the material shows the journal's contribution to proposing themes that favor analyses from the gender perspective. Some productions reflect the most current discussions. However, the paucity of works on gender in life cycles and the intersectional approach suggests that the journal's proactive posture should be maintained to encourage gender analysis in other topics than sexual and reproductive health, masculinities, and gender violence against women.

A contribuição da Revista Ciência & Saúde Coletiva para os estudos sobre e gênero e saúde / The contribution of Journal Ciência & Saúde Coletiva to gender and health studies

Este artigo tem como finalidade explorar as contribuições da C&SC para os estudos sobre gênero e saúde. Para tanto, foi realizado um mapeamento por meio da plataforma da revista no SciELO, utilizando os unitermos gênero, homem/homens, mulher/mulheres, jovem/jovens, adolescente/adolescentes. Foram selecionados 164 artigos, categorizados em função do ano de publicação, tipo de estudo, população estudada, temas abordados e método. A análise do material aponta a contribuição da revista ao propor temas que favorecem análises na perspectiva de gênero. Algumas produções traduzem discussões atuais. Entretanto, o pequeno número de artigos sobre gênero nos ciclos de vida e desde uma abordagem interseccional sugere que a postura proativa da revista deve ser mantida para estimular análises de gênero em outros temas que não a saúde sexual e reprodutiva, as masculinidades e a violência de gênero contra mulheres.

Diferenciais da prática contraceptiva no Município de São Paulo, Brasil: resultados do inquérito populacional Ouvindo Mulheres / Differences in contraceptive practice in the city of São Paulo, Brazil: results of the Ouvindo Mulheres population survey

A contracepção é fundamental para que as mulheres possam regular sua fecundidade, exercendo uma das dimensões dos direitos reprodutivos. No entanto, desconhecemos como elas enfrentam esse desafio na maior cidade do Brasil, São Paulo. Para preencher essa lacuna, o inquérito populacional Ouvindo Mulheres: Contracepção no Município de São Paulo foi realizado junto a uma amostra probabilística de 4 mil mulheres com 15 a 44 anos de idade, residentes nessa cidade, em 2015. Neste artigo, apresenta-se a prevalência da prática contraceptiva, analisam-se os fatores associados ao não uso de contracepção e aos tipos de contraceptivos em uso. A prevalência da anticoncepção foi estimada para mulheres com, pelo menos, uma relação heterossexual nos 12 meses anteriores à entrevista e que não estavam grávidas. Regressão logística foi utilizada para verificar fatores associados ao não uso de contracepção, e o modelo CHAID, para identificar associações aos tipos de contraceptivo em uso. A prevalência da anticoncepção foi 84,8% (IC95%: 83,2-86,3). Os contraceptivos mais prevalentes foram pílula e preservativo masculino. Associaram- -se ao não uso de anticoncepção, religião (Pentecostal), número de filhos (menos do que 3), não ter usado contraceptivo na primeira relação sexual, não ter parceiro e não ter tido relação sexual no mês anterior. O número de filhos tidos e a idade da mulher foram os dois primeiros níveis de discriminação dos tipos de contraceptivo utilizados. A prevalência da anticoncepção é alta, mas mantém-se a concentração em dois métodos: anteriormente, laqueadura e pílula, agora, pílula e preservativo masculino. É necessário incorporar novos contraceptivos hormonais no Sistema Único de Saúde (SUS) e promover o uso de métodos de longa duração como o DIU.

Diferenciais da prática contraceptiva no Município de São Paulo, Brasil: resultados do inquérito populacional Ouvindo Mulheres / Differences in contraceptive practice in the city of São Paulo, Brazil: results of the Ouvindo Mulheres population survey / Diferenciales de la práctica contraceptiva en el Municipio de São Paulo, Brasil: resultados de la encuesta poblacional Ouvindo Mulheres

Resumo: A contracepção é fundamental para que as mulheres possam regular sua fecundidade, exercendo uma das dimensões dos direitos reprodutivos. No entanto, desconhecemos como elas enfrentam esse desafio na maior cidade do Brasil, São Paulo. Para preencher essa lacuna, o inquérito populacional Ouvindo Mulheres: Contracepção no Município de São Paulo foi realizado junto a uma amostra probabilística de 4 mil mulheres com 15 a 44 anos de idade, residentes nessa cidade, em 2015. Neste artigo, apresenta-se a prevalência da prática contraceptiva, analisam-se os fatores associados ao não uso de contracepção e aos tipos de contraceptivos em uso. A prevalência da anticoncepção foi estimada para mulheres com, pelo menos, uma relação heterossexual nos 12 meses anteriores à entrevista e que não estavam grávidas. Regressão logística foi utilizada para verificar fatores associados ao não uso de contracepção, e o modelo CHAID, para identificar associações aos tipos de contraceptivo em uso. A prevalência da anticoncepção foi 84,8% (IC95%: 83,2-86,3). Os contraceptivos mais prevalentes foram pílula e preservativo masculino. Associaram-se ao não uso de anticoncepção, religião (Pentecostal), número de filhos (menos do que 3), não ter usado contraceptivo na primeira relação sexual, não ter parceiro e não ter tido relação sexual no mês anterior. O número de filhos tidos e a idade da mulher foram os dois primeiros níveis de discriminação dos tipos de contraceptivo utilizados. A prevalência da anticoncepção é alta, mas mantém-se a concentração em dois métodos: anteriormente, laqueadura e pílula, agora, pílula e preservativo masculino. É necessário incorporar novos contraceptivos hormonais no Sistema Único de Saúde (SUS) e promover o uso de métodos de longa duração como o DIU.

Abstract: Contraception is essential for women to be able to regulate their fertility, exercising a key dimension of reproductive rights. However, little is known about how women deal with this challenge in Brazil's largest city, São Paulo. To fill this gap, the population survey Ouvindo Mulheres: Contracepção no Município de São Paulo was conducted with a probabilistic sample of 4,000 women 15 to 44 years of age living in this city in 2015. This article presents the prevalence of contraceptive practice and analyzes factors associated with lack of contraception use and with types of contraceptives. Prevalence of contraception was estimated for women with at least one heterosexual relation in the 12 months prior to the interview and who were not pregnant. Logistic regression was used to verify factors associated with lack of contraception use, and the CHAID model was used to identify associations with the types of contraceptives used. Prevalence of contraception was 84.8% (95%CI: 83.2-86.3). The most prevalent contraceptives were the pill and condoms. Factors associated with lack of contraceptive use were religion (Pentecostal), number of children (fewer than 3), not having used contraceptives in the first sexual relation, not having a partner, and not having had sex in the previous month. Number of children and woman's age were the first two levels of discrimination of the types of contraceptives used. Prevalence of contraception was high, but maintaining a concentration in two methods: historically, female sterilization and the pill prevailed, nowadays, the pill and condoms do. New hormonal contraceptives should be incorporated by the Brazilian Unified National Health System (SUS), besides promoting the use of long-acting methods such as IUDs.

Resumen: La contracepción es fundamental para que las mujeres puedan regular su fecundidad, ejerciendo una de las dimensiones de sus derechos reproductivos. No obstante, desconocemos cómo enfrentan este desafío en la mayor ciudad de Brasil, São Paulo. Para resolver esta cuestión, se realizó la encuesta poblacional Ouvindo Mulheres: Contracepção no Município de São Paulo, mediante una muestra probabilística de 4 mil mujeres de 15 a 44 años de edad, residentes en esa ciudad en 2015. En este artículo se presenta la prevalencia de la práctica contraceptiva, se analizan los factores asociados con el no uso de métodos anticonceptivos, así como los tipos de contraceptivos en uso. La prevalencia de la anticoncepción se estimó en mujeres con por lo menos una relación heterosexual, en los 12 meses anteriores a la entrevista, y que no estaban embarazadas. Se utilizó la regresión logística para verificar factores asociados al no uso de contracepción y el modelo CHAID para identificar asociaciones respecto a los tipos de contraceptivo en uso. La prevalencia de la anticoncepción fue 84,8% (IC95%: 83,2-86,3). Los contraceptivos más prevalentes fueron la píldora y el condón. Se asociaron al no uso de anticonceptivos: religión (Pentecostal), número de hijos (menos de 3), no haber usado contraceptivo en la primera relación sexual, no tener pareja y no haber tenido relaciones sexuales durante el mes anterior. El número de hijos y la edad de la mujer fueron los dos primeros niveles de discriminación de los tipos de contraceptivo utilizados. La prevalencia de la anticoncepción es alta, pero se mantiene la concentración en dos métodos: anteriormente, ligadura y píldora, ahora, píldora y condón. Es necesario incorporar nuevos contraceptivos hormonales en el Sistema Único de Salud (SUS), así como promover el uso de métodos de larga duración como el DIU.