[Sociodemographic profile of homeless people notified with tuberculosis in the municipality of Rio de Janeiro, Brazil, from 2015 to 2019]. / Perfil sociodemográfico das pessoas em situação de rua notificadas com tuberculose no Município do Rio de Janeiro, Brasil, nos anos de 2015 a 2019.

Brazil is one of the 30 countries with the highest incidence of tuberculosis (TB) and homeless people (HP) have 56 times more risk for illness than the general population, due to lower income and access to health. This study aimed to present the sociodemographic and epidemiological profile of HP notified for TB from 2015 to 2019 in the municipality of Rio de Janeiro and to analyze relationships between the variables studied and TB outcomes. This is a cross-sectional study with secondary data on TB notifications in HP in the period and place of the study. Descriptive analysis was performed, followed by analysis of the association between selected variables and TB outcomes with chi-square test and multinomial logistic regression to obtain the odds ratio (OR). The profile of HP with TB is men (74.9%), blacks (76.2%), with a mean age of 43.3 years (SD = 12.0), aged from 30 to 59 years (78.5%). The most frequent outcome was treatment withdrawal (43.3%), followed by cure (29.9%), and death (3.6%). The analyses showed that black individuals (OR = 1.4; 95%CI: 1.1-1.9), drug (OR = 1.7; 95%CI: 1.3-2.3) and alcohol use (OR = 1.3; 95%CI: 1.0-1.7) were risk factors for treatment withdrawal and that age groups older than 30 years or older (OR = 0.7; 95%CI: 0.5-0.9) and the extrapulmonary form (OR = 0.2; 95%CI: 0.1-0.6) were protective factors. The vulnerability of the HP is particularized in racial and gender profiles, as well as TB, thus reinforcing effective prevention and treatment actions is necessary to increase access to health services and the fight against TB in this context. And pay attention to the high proportion of incomplete data that limit the analyses for this problem.

O Brasil é um dos 30 países com maior incidência de tuberculose (TB). Pessoas em situação de rua (PSR) têm 56 vezes mais riscos para o adoecimento do que a população geral por terem menor renda e acesso à saúde. Os objetivos do estudo foram apresentar o perfil sociodemográfico e epidemiológico de PSR notificadas para TB entre 2015 e 2019 na cidade do Rio de Janeiro e analisar relações entre as variáveis estudadas e desfechos da TB. Trata-se de estudo transversal com dados secundários das notificações de TB em PSR no período e local do estudo. Foi realizada análise descritiva, seguida da verificação de associação entre variáveis selecionadas e desfechos para TB, com teste qui-quadrado e regressão logística multinomial, para obtenção da razão de chances (OR). O perfil predominante das PSR com TB é de homens (74,9%), negros (76,2%), com idade média de 43,3 anos (DP = 12,0) e faixa etária entre 30 e 59 anos (78,5%). O desfecho mais frequente foi abandono do tratamento (43,3%), seguido por cura (29,9%) e óbito (3,6%). As análises mostraram que raça negra (OR = 1,4; IC95%: 1,1-1,9) e uso de drogas (OR = 1,7; IC95%: 1,3-2,3) e álcool (OR = 1,3; IC95%: 1,0-1,7) foram fatores de risco para abandono do tratamento, enquanto faixas etárias a partir de 30 anos (OR = 0,7; IC95%: 0,5-0,9) e forma extrapulmonar (OR = 0,2; IC95%: 0,1-0,6) foram aspectos de proteção. A vulnerabilidade das PSR se particulariza em perfis de raça e gênero, tal qual a TB, portanto, é necessário reforçar ações de prevenção e tratamento efetivas para aumentar o acesso aos serviços de saúde e o enfrentamento da TB nesse contexto, além de atentar para a alta proporção de dados incompletos que limitam as análises desse agravo.

Brasil es uno de los treinta países con mayor incidencia de tuberculosis (TB), y las personas en situación de calle (PSC) tienen 56 veces más riesgo de contraer la enfermedad que la población en general debido a menores ingresos y acceso a la salud. El objetivo de este estudio fue presentar el perfil sociodemográfico y epidemiológico de las PSC diagnosticas con TB entre 2015 y 2019 en la ciudad de Río de Janeiro, así como analizar las relaciones entre las variables estudiadas y los resultados de la TB. Se trata de un estudio transversal, con datos secundarios de los casos de TB en las PSC para el período y el lugar del estudio. Se realizó el análisis descriptivo, seguido del análisis de la asociación entre las variables seleccionadas y los resultados para TB con la aplicación de la prueba de chi-cuadrado y de regresión logística multinomial para obtener el odds ratio (OR). En el perfil de las PSC con TB se encuentran hombres (74,9%) negros (76,2%), de edad promedio de 43,3 años (DE = 12,0), en el grupo de edad de entre 30 y 59 años (78,5%). El resultado más frecuente fue el abandono del tratamiento (43,3%), seguido de la cura (29,9%) y la muerte (3,6%). Los análisis mostraron que la raza negra (OR = 1,4; IC95%: 1,1-1,9), el consumo de drogas (OR = 1,7; IC95%: 1,3-2,3) y el alcohol (OR = 1,3; IC95%: 1,0-1,7) fueron los factores de riesgo para el abandono del tratamiento, y que los grupos de edad de más de 30 años (OR = 0,7; IC95%: 0,5-0,9) y la forma extrapulmonar (OR = 0,2; IC95%: 0,1-0,6) fueron los factores protectores. La vulnerabilidad de las PSC se agudiza en los perfiles de raza y de género tal como la TB, por lo que es necesario fortalecer las acciones efectivas de prevención y tratamiento para aumentarles el acceso a los servicios de salud y el combate de la TB en este contexto. Y, además, prestar atención a la alta proporción de datos incompletos que limitan los análisis para esta condición.

A Study on the Health and Wellness of Undergraduate Students (SABES-Grad): methodological aspects of a nationwide multicenter and multilevel study overlapping with the Covid-19 pandemic.

INTRODUCTION: The academic environment can negatively impact the mental health of undergraduate students, particularly in the context of the coronavirus disease 2019 (Covid-19) pandemic. This study aimed to describe the methodological and operational aspects of a study of the health and well-being of undergraduate students: the Study on the Health and Wellness of Undergraduate Students (SABES-Grad) project. METHOD: This was a nationwide cross-sectional study divided across two data collection strategies: a single-center, on-site data collection carried out in 2019 at the Universidade Federal do Rio Grande (FURG) and a multicenter, multilevel, online data collection carried out in 2020/2021 at FURG, the Universidade Federal Fluminense (UFF), the Universidade Federal do Mato Grosso (UFMT), the Universidade do Estado do Amazonas (UEA), and the Universidade Federal Rural de Pernambuco (UFRPE). The main outcomes of interest were depressive symptoms, generalized anxiety, and suicide risk. RESULTS: A total of 996 students participated in the 2019 data collection (63.8% female; median age of 22 years; response rate of 85.2%) and 5,720 students participated in the 2020/2021 collection (66.7% female; median age of 22 years; response rate of 84.3%). Significant variations in socioeconomic and demographic profiles were observed between the different universities. Approximately one-third of the sample had been tested for Covid-19 in 2020/2021, 7.8% of whom had tested positive. CONCLUSION: The SABES-Grad project was the result of collaborative work between several actors from public universities in Brazil. Several aspects of the preparation and execution of this research are discussed in terms of its originality and relevance. Barriers and limitations and strategies adopted to overcome them are also presented.

Suicide risk among undergraduate students in Brazil in the periods before and during the COVID-19 pandemic: results of the SABES-Grad national survey.

BACKGROUND: Undergraduate students present high rates of psychological distress, including suicide risk. Due to the coronavirus disease 2019 (COVID-19) pandemic, this scenario may have been aggravated. Thus, the objective of the current study was to evaluate changes in the suicide risk rate from the period before to during the COVID-19 pandemic, as well as the factors associated with this outcome among Brazilian undergraduate students. METHODS: This was a nationwide survey carried out in Brazil with a cross-sectional design, including two data collection periods: a single-center in-person collection in 2019 and another multicenter online collection in 2020/2021. Data were collected using self-administered instruments. The outcome was a high risk of suicide, measured through the Mini International Neuropsychiatric Interview. Analyses were carried out on data from two periods, i.e. before and during the pandemic (bivariate analysis and interaction tests), and a model of associated factors (multivariate analysis using Poisson regression) was developed including all participating universities distributed in the five regions of Brazil. RESULTS: In total, 6716 Brazilian undergraduate students participated (996 in 2019 and 5720 in 2020/2021). The prevalence of a high suicide risk rose from 11.3% to 17.0%, especially among women and poorer individuals. The prevalence of a high risk of suicide among Brazilian undergraduates was 19.6% and was associated with several socioeconomic, academic, pandemic, and mental health factors. CONCLUSIONS: The prevalence of a high suicide risk increased from prepandemic to during the pandemic, appearing to be largely influenced by social determinants, in conjunction with the implications of the COVID-19 pandemic.

A Study on the Health and Wellness of Undergraduate Students (SABES-Grad): methodological aspects of a nationwide multicenter and multilevel study overlapping with the Covid-19 pandemic

Abstract Introduction The academic environment can negatively impact the mental health of undergraduate students, particularly in the context of the coronavirus disease 2019 (Covid-19) pandemic. This study aimed to describe the methodological and operational aspects of a study of the health and well-being of undergraduate students: the Study on the Health and Wellness of Undergraduate Students (SABES-Grad) project. Method This was a nationwide cross-sectional study divided across two data collection strategies: a single-center, on-site data collection carried out in 2019 at the Universidade Federal do Rio Grande (FURG) and a multicenter, multilevel, online data collection carried out in 2020/2021 at FURG, the Universidade Federal Fluminense (UFF), the Universidade Federal do Mato Grosso (UFMT), the Universidade do Estado do Amazonas (UEA), and the Universidade Federal Rural de Pernambuco (UFRPE). The main outcomes of interest were depressive symptoms, generalized anxiety, and suicide risk. Results A total of 996 students participated in the 2019 data collection (63.8% female; median age of 22 years; response rate of 85.2%) and 5,720 students participated in the 2020/2021 collection (66.7% female; median age of 22 years; response rate of 84.3%). Significant variations in socioeconomic and demographic profiles were observed between the different universities. Approximately one-third of the sample had been tested for Covid-19 in 2020/2021, 7.8% of whom had tested positive. Conclusion The SABES-Grad project was the result of collaborative work between several actors from public universities in Brazil. Several aspects of the preparation and execution of this research are discussed in terms of its originality and relevance. Barriers and limitations and strategies adopted to overcome them are also presented.

Perfil sociodemográfico das pessoas em situação de rua notificadas com tuberculose no Município do Rio de Janeiro, Brasil, nos anos de 2015 a 2019 / Sociodemographic profile of homeless people notified with tuberculosis in the municipality of Rio de Janeiro, Brazil, from 2015 to 2019 / Perfil sociodemográfico de personas en situación de calle diagnosticadas con tuberculosis en el municipio de Río de Janeiro, Brasil, en los años de 2015 a 2019

Resumo: O Brasil é um dos 30 países com maior incidência de tuberculose (TB). Pessoas em situação de rua (PSR) têm 56 vezes mais riscos para o adoecimento do que a população geral por terem menor renda e acesso à saúde. Os objetivos do estudo foram apresentar o perfil sociodemográfico e epidemiológico de PSR notificadas para TB entre 2015 e 2019 na cidade do Rio de Janeiro e analisar relações entre as variáveis estudadas e desfechos da TB. Trata-se de estudo transversal com dados secundários das notificações de TB em PSR no período e local do estudo. Foi realizada análise descritiva, seguida da verificação de associação entre variáveis selecionadas e desfechos para TB, com teste qui-quadrado e regressão logística multinomial, para obtenção da razão de chances (OR). O perfil predominante das PSR com TB é de homens (74,9%), negros (76,2%), com idade média de 43,3 anos (DP = 12,0) e faixa etária entre 30 e 59 anos (78,5%). O desfecho mais frequente foi abandono do tratamento (43,3%), seguido por cura (29,9%) e óbito (3,6%). As análises mostraram que raça negra (OR = 1,4; IC95%: 1,1-1,9) e uso de drogas (OR = 1,7; IC95%: 1,3-2,3) e álcool (OR = 1,3; IC95%: 1,0-1,7) foram fatores de risco para abandono do tratamento, enquanto faixas etárias a partir de 30 anos (OR = 0,7; IC95%: 0,5-0,9) e forma extrapulmonar (OR = 0,2; IC95%: 0,1-0,6) foram aspectos de proteção. A vulnerabilidade das PSR se particulariza em perfis de raça e gênero, tal qual a TB, portanto, é necessário reforçar ações de prevenção e tratamento efetivas para aumentar o acesso aos serviços de saúde e o enfrentamento da TB nesse contexto, além de atentar para a alta proporção de dados incompletos que limitam as análises desse agravo.

Abstract: Brazil is one of the 30 countries with the highest incidence of tuberculosis (TB) and homeless people (HP) have 56 times more risk for illness than the general population, due to lower income and access to health. This study aimed to present the sociodemographic and epidemiological profile of HP notified for TB from 2015 to 2019 in the municipality of Rio de Janeiro and to analyze relationships between the variables studied and TB outcomes. This is a cross-sectional study with secondary data on TB notifications in HP in the period and place of the study. Descriptive analysis was performed, followed by analysis of the association between selected variables and TB outcomes with chi-square test and multinomial logistic regression to obtain the odds ratio (OR). The profile of HP with TB is men (74.9%), blacks (76.2%), with a mean age of 43.3 years (SD = 12.0), aged from 30 to 59 years (78.5%). The most frequent outcome was treatment withdrawal (43.3%), followed by cure (29.9%), and death (3.6%). The analyses showed that black individuals (OR = 1.4; 95%CI: 1.1-1.9), drug (OR = 1.7; 95%CI: 1.3-2.3) and alcohol use (OR = 1.3; 95%CI: 1.0-1.7) were risk factors for treatment withdrawal and that age groups older than 30 years or older (OR = 0.7; 95%CI: 0.5-0.9) and the extrapulmonary form (OR = 0.2; 95%CI: 0.1-0.6) were protective factors. The vulnerability of the HP is particularized in racial and gender profiles, as well as TB, thus reinforcing effective prevention and treatment actions is necessary to increase access to health services and the fight against TB in this context. And pay attention to the high proportion of incomplete data that limit the analyses for this problem.

Resumen: Brasil es uno de los treinta países con mayor incidencia de tuberculosis (TB), y las personas en situación de calle (PSC) tienen 56 veces más riesgo de contraer la enfermedad que la población en general debido a menores ingresos y acceso a la salud. El objetivo de este estudio fue presentar el perfil sociodemográfico y epidemiológico de las PSC diagnosticas con TB entre 2015 y 2019 en la ciudad de Río de Janeiro, así como analizar las relaciones entre las variables estudiadas y los resultados de la TB. Se trata de un estudio transversal, con datos secundarios de los casos de TB en las PSC para el período y el lugar del estudio. Se realizó el análisis descriptivo, seguido del análisis de la asociación entre las variables seleccionadas y los resultados para TB con la aplicación de la prueba de chi-cuadrado y de regresión logística multinomial para obtener el odds ratio (OR). En el perfil de las PSC con TB se encuentran hombres (74,9%) negros (76,2%), de edad promedio de 43,3 años (DE = 12,0), en el grupo de edad de entre 30 y 59 años (78,5%). El resultado más frecuente fue el abandono del tratamiento (43,3%), seguido de la cura (29,9%) y la muerte (3,6%). Los análisis mostraron que la raza negra (OR = 1,4; IC95%: 1,1-1,9), el consumo de drogas (OR = 1,7; IC95%: 1,3-2,3) y el alcohol (OR = 1,3; IC95%: 1,0-1,7) fueron los factores de riesgo para el abandono del tratamiento, y que los grupos de edad de más de 30 años (OR = 0,7; IC95%: 0,5-0,9) y la forma extrapulmonar (OR = 0,2; IC95%: 0,1-0,6) fueron los factores protectores. La vulnerabilidad de las PSC se agudiza en los perfiles de raza y de género tal como la TB, por lo que es necesario fortalecer las acciones efectivas de prevención y tratamiento para aumentarles el acceso a los servicios de salud y el combate de la TB en este contexto. Y, además, prestar atención a la alta proporción de datos incompletos que limitan los análisis para esta condición.

Chemsex practice among men who have sex with men (MSM) during social isolation from COVID-19: multicentric online survey. / Prática de chemsex entre homens que fazem sexo com homens (HSH) durante período de isolamento social por COVID-19: pesquisa online multicêntrica.

The aim of this study was to investigate factors associated with sex practice under the effect of drugs (chemsex) among men who have sex with men (MSM) during the period of social isolation in the context of the COVID-19 pandemic. A multicenter online survey was applied to Brazil and Portugal in April 2020 when the two countries were under restrictive health measures due to the pandemic. Participants were recruited with an adaptation of the respondent driven sampling (RDS) method in the online environment. Data were collected using social networks and dating apps for MSM. We used bivariate and multivariate logistic regression to produce crude (OR) and adjusted odds ratios (aOR). In a universe of 2,361 subjects, 920 (38.9%) reported engaging in chemsex practice, which involved casual partners in 95% of the cases. Higher OR of engaging in chemsex were associated with Brazil (aOR = 15.4; 95%CI: 10.7-22.1), not being in social isolation (aOR = 4.9; 95%CI: 2.2-10.9), engaging in casual sex during social distancing (aOR = 52.4; 95%CI: 33.8-81.4), group sex (aOR = 2.9; 95%CI: 2.0-4.4), not presenting any symptom of COVID-19 (aOR = 1.3; 95%CI: 1.1-1.8), not living with the sex partner (aOR = 1.8; 95%CI: 1.2-2.6), and using pre-exposure prophylaxis (aOR = 2.6; 95%CI: 1.8-3.7). The occurrence of chemsex was high, especially in Brazil, where the proposed social distancing did not gain adherence by MSM.

Investigar os fatores associados à prática do sexo sob o efeito de drogas (chemsex) entre homens que fazem sexo com homens (HSH) durante período de isolamento social, no contexto da pandemia da COVID-19. Inquérito multicêntrico online, aplicado aos territórios de Brasil e Portugal em abril de 2020, enquanto os dois países vivenciavam medidas sanitárias restritivas para a doença. Os participantes foram recrutados valendo-se de uma adaptação do método respondent driven sampling (RDS) ao ambiente virtual. Os dados foram coletados usando redes sociais e aplicativos de encontro voltados a HSH. Utilizamos regressão logística bivariada e multivariada para a produção das odds bruto (OR) e ajustado (ORa). Em um universo de 2.361 sujeitos, 920 (38,9%) realizaram a prática do chemsex, que, em 95% dos casos, foi realizada com parceiro casual. Aumentaram as chances de se envolver em chemsex: morar no Brasil (ORa = 15,4; IC95%: 10,7-22,1); não estar em isolamento social (ORa = 4,9; IC95%: 2,2-10,9); fazer sexo casual durante o distanciamento social (ORa = 52,4; IC95%: 33,8-81,4); fazer sexo grupal (ORa = 2,9; IC95%: 2,0-4,4); não apresentar nenhum tipo de sintoma para a COVID-19 (ORa = 1,3; IC95%: 1,1-1,8); não residir com o parceiro (ORa = 1,8; IC95%: 1,2-2,6) e estar em uso da profilaxia pré-exposição (ORa = 2,6; IC95%: 1,8-3,7). A ocorrência de chemsex foi elevada, sobretudo no Brasil, onde o isolamento social proposto não sensibilizou os HSH à adesão.

El objetivo fue investigar los factores asociados a la práctica del sexo bajo el efecto de drogas (chemsex), entre hombres que practican sexo con hombres (HSH) durante el período de aislamiento social en el contexto de la pandemia de la COVID-19. Se realizó una encuesta multicéntrica en línea, aplicada al territorio de Brasil y Portugal en abril de 2020, mientras los dos países vivían medidas sanitarias restrictivas por la COVID-19. Los participantes se reclutaron mediante una adaptación del método respondent driven sampling (RDS) al ambiente virtual. Los datos fueron recabados usando redes sociales y aplicaciones de encuentros dirigidos a HSH. Utilizamos la regresión logística bivariada y multivariada para la producción de las odds ratio brutas (OR) y ajustadas (ORa). En un universo de 2.361 sujetos, 920 (38,9%) realizaron la práctica del chemsex, que en el 95% de los casos se realizó con una pareja casual. Aumentaron las oportunidades de implicarse en chemsex: vivir en Brasil (ORa = 15,4; IC95%: 10,7-22,1); no estar en aislamiento social (ORa: = 4,9; IC95%: 2,2-10,9); practicar sexo casual durante el distanciamiento social (ORa = 52,4; IC95%: 33,8-81,4); practicar sexo grupal (ORa = 2,9; IC95%: 2,0-4,4); no presentar ningún tipo de síntoma de COVID-19 (ORa = 1,3; IC95%: 1.1-1.8); no residir con la pareja (ORa = 1,8; IC95%: 1,2-2,6) y estar usando la profilaxis previa a la exposición (ORa = 2,6; IC95%: 1,8-3,7). La ocurrencia de chemsex fue elevada, sobre todo en Brasil, donde el aislamiento social propuesto no sensibilizó a los HSH a la adhesión.

[Inequalities in congenital syphilis trends in the city of Niterói, Brazil, 2007-2016Desigualdades en la tendencia de sífilis congénita en la ciudad de Niterói, Brasil, 2007-2016]. / Desigualdades na tendência da sífilis congênita no município de Niterói, Brasil, 2007 a 2016.

OBJECTIVE: To describe the temporal distribution and epidemiologic characteristics of congenital syphilis (CS) cases in the city of Niterói, southeastern Brazil, from 2007 to 2016. METHOD: This descriptive time series analysis of the incidence of CS used data from the Notifiable Diseases Information System (SINAN) and the Live Birth Information System (SINASC). The sample included all notified cases. A probabilistic matching was performed between SINAN and SINASC data to recover ignored information. The time series was estimated using logarithmic regression according to sociodemographic and prenatal care variables. RESULTS: There were 754 identified cases of CS in the study period (mean incidence: 11.9 cases/1 000 live births). The incidence was higher in younger women (10 to 19; 20 to 24 years) and in those with black skin, low schooling, and without prenatal care. Of the overall group, only 57.6% received a diagnosis of syphilis during prenatal care. Treatment was not adequate in 87,7%, and only 12.2% of partners were treated. SC incidence presented a growing trend of 16%/year, reaching 23.2 cases/1 000 living births in 2016. This growth was especially marked in female adolescents (25.2%/year), brown race/skin color (16.8%/year), women with low schooling (57.1%/year) and women who received prenatal care (17.3%/year); and, from 2012 to 2016, in women without information on skin color. CONCLUSIONS: Social inequalities were linked to CS in the present sample. Also, increasing CS incidence was detected in youth. Health care professionals must be trained to manage gestational syphilis, and public policies must effectively address the social determinants of this condition.

OBJETIVO: Describir la distribución temporal y las características epidemiológicas de la sífilis congénita en Niterói, sureste de Brasil, de 2007 a 2016. MÉTODOS: Estudio descriptivo de series temporales sobre la incidencia de la sífilis congénita; se utilizaron datos del Sistema de Información de Enfermedades Notificables (SINAN) y del Sistema de Información de Nacimientos Vivos (SINASC). La muestra incluyó todos los casos reportados. Se realizó además una relación probabilística entre el SINAN y el SINASC para recuperar información ignorada. La serie temporal se estimó mediante regresión logarítmica, según variables sociodemográficas y prenatales. RESULTADOS: En el período estudiado se identificaron 754 casos de sífilis congénita (incidencia media de 11,9 casos/1 000 nacidos vivos). La incidencia fue mayor en las mujeres jóvenes (10-19, 20-24 años), mujeres de raza negra, con baja escolaridad y sin atención prenatal. Del total de mujeres, sólo se realizó el diagnóstico de sífilis durante la atención prenatal en 57,6%. El tratamiento fue inadecuado en 87,7% de las mujeres, solo el 12,2% de las parejas fueron tratadas. La enfermedad presentó una tendencia creciente (16%/año), y alcanzó 23,2 casos/1 000 nacidos vivos en 2016. El aumento fue más pronunciado en las adolescentes (25,2%/año), raza/color de piel morena (16.8%/año), mujeres con baja educación (57,1%/año), mujeres que recibieron atención prenatal (17,3%/año) y, de 2012 a 2016, en mujeres sin información sobre el color de la piel. CONCLUSIONES: En esta muestra se destacaron las desigualdades sociales en la aparición de sífilis congénita, con una incidencia creciente en las jóvenes. Se requiere capacitación de los profesionales de la salud en el manejo de la sífilis gestacional y la acción efectiva de políticas públicas sobre los determinantes sociales de la sífilis.

Desigualdades na tendência da sífilis congênita no município de Niterói, Brasil, 2007 a 2016

[RESUMO]. Objetivo. Descrever a distribuição temporal e as características epidemiológicas da sífilis congênita (SC) em Niterói, Sudeste do Brasil, de 2007 a 2016. Métodos. Este estudo descritivo de série temporal da incidência de SC utilizou os dados do Sistema de Informação de Agravos de Notificação (SINAN) e do Sistema de Informações sobre Nascidos Vivos (SINASC). A amostra incluiu todos os casos notificados. Além disso, foi realizado um relacionamento probabilístico entre SINAN e SINASC para recuperar informações ignoradas. A série temporal foi estimada por regressão logarítmica, de acordo com variáveis sociodemográficas e de pré-natal. Resultados. Identificaram-se 754 casos de SC no período estudado (incidência média de 11,9 casos/1 000 nascidos vivos). A incidência foi mais elevada em jovens (10 a 19 anos; 20 a 24 anos), participantes de cor preta e naquelas com baixa escolaridade e sem pré-natal. Do total de mulheres, apenas 57,6% obtiveram o diagnóstico de sífilis durante o pré-natal. O tratamento foi inadequado em 87,7% das mulheres. Apenas 12,2% dos parceiros foram tratados. Houve tendência crescente do agravo (16%/ano), que atingiu 23,2 casos/1 000 nascidos vivos em 2016. O crescimento foi mais acentuado em adolescentes do sexo feminino (25,2%/ano), raça/cor parda (16,8%/ano), indivíduos com baixa escolaridade (57,1%/ano) e mulheres que realizaram pré-natal (17,3%/ano); e, no período de 2012 a 2016, em mulheres com informação ignorada para a cor da pele. Conclusões. As iniquidades sociais se destacaram na ocorrência de SC, com incidência crescente em jovens. É necessária a capacitação dos profissionais de saúde para o manejo da sífilis gestacional e uma atuação efetiva das políticas públicas sobre os determinantes sociais da sífilis.

[ABSTRACT]. Objective. To describe the temporal distribution and epidemiologic characteristics of congenital syphilis (CS) cases in the city of Niterói, southeastern Brazil, from 2007 to 2016. Method. This descriptive time series analysis of the incidence of CS used data from the Notifiable Diseases Information System (SINAN) and the Live Birth Information System (SINASC). The sample included all notified cases. A probabilistic matching was performed between SINAN and SINASC data to recover ignored information. The time series was estimated using logarithmic regression according to sociodemographic and prenatal care variables. Results. There were 754 identified cases of CS in the study period (mean incidence: 11.9 cases/1 000 live births). The incidence was higher in younger women (10 to 19; 20 to 24 years) and in those with black skin, low schooling, and without prenatal care. Of the overall group, only 57.6% received a diagnosis of syphilis during prenatal care. Treatment was not adequate in 87,7%, and only 12.2% of partners were treated. SC incidence presented a growing trend of 16%/year, reaching 23.2 cases/1 000 living births in 2016. This growth was especially marked in female adolescents (25.2%/year), brown race/skin color (16.8%/year), women with low schooling (57.1%/year) and women who received prenatal care (17.3%/year); and, from 2012 to 2016, in women without information on skin color. Conclusions. Social inequalities were linked to CS in the present sample. Also, increasing CS incidence was detected in youth. Health care professionals must be trained to manage gestational syphilis, and public policies must effectively address the social determinants of this condition.

[RESUMEN]. Objetivo. Describir la distribución temporal y las características epidemiológicas de la sífilis congénita en Niterói, sureste de Brasil, de 2007 a 2016. Métodos. Estudio descriptivo de series temporales sobre la incidencia de la sífilis congénita; se utilizaron datos del Sistema de Información de Enfermedades Notificables (SINAN) y del Sistema de Información de Nacimientos Vivos (SINASC). La muestra incluyó todos los casos reportados. Se realizó además una relación probabilística entre el SINAN y el SINASC para recuperar información ignorada. La serie temporal se estimó mediante regresión logarítmica, según variables sociodemográficas y prenatales. Resultados. En el período estudiado se identificaron 754 casos de sífilis congénita (incidencia media de 11,9 casos/1 000 nacidos vivos). La incidencia fue mayor en las mujeres jóvenes (10-19, 20-24 años), mujeres de raza negra, con baja escolaridad y sin atención prenatal. Del total de mujeres, sólo se realizó el diagnóstico de sífilis durante la atención prenatal en 57,6%. El tratamiento fue inadecuado en 87,7% de las mujeres, solo el 12,2% de las parejas fueron tratadas. La enfermedad presentó una tendencia creciente (16%/año), y alcanzó 23,2 casos/1 000 nacidos vivos en 2016. El aumento fue más pronunciado en las adolescentes (25,2%/año), raza/color de piel morena (16.8%/año), mujeres con baja educación (57,1%/año), mujeres que recibieron atención prenatal (17,3%/año) y, de 2012 a 2016, en mujeres sin información sobre el color de la piel. Conclusiones. En esta muestra se destacaron las desigualdades sociales en la aparición de sífilis congénita, con una incidencia creciente en las jóvenes. Se requiere capacitación de los profesionales de la salud en el manejo de la sífilis gestacional y la acción efectiva de políticas públicas sobre los determinantes sociales de la sífilis.

Desigualdades na tendência da sífilis congênita no município de Niterói, Brasil, 2007 a 2016 / Inequalities in congenital syphilis trends in the city of Niterói, Brazil, 2007-2016 / Desigualdades en la tendencia de sífilis congénita en la ciudad de Niterói, Brasil, 2007-2016

RESUMO Objetivo. Descrever a distribuição temporal e as características epidemiológicas da sífilis congênita (SC) em Niterói, Sudeste do Brasil, de 2007 a 2016. Métodos. Este estudo descritivo de série temporal da incidência de SC utilizou os dados do Sistema de Informação de Agravos de Notificação (SINAN) e do Sistema de Informações sobre Nascidos Vivos (SINASC). A amostra incluiu todos os casos notificados. Além disso, foi realizado um relacionamento probabilístico entre SINAN e SINASC para recuperar informações ignoradas. A série temporal foi estimada por regressão logarítmica, de acordo com variáveis sociodemográficas e de pré-natal. Resultados. Identificaram-se 754 casos de SC no período estudado (incidência média de 11,9 casos/1 000 nascidos vivos). A incidência foi mais elevada em jovens (10 a 19 anos; 20 a 24 anos), participantes de cor preta e naquelas com baixa escolaridade e sem pré-natal. Do total de mulheres, apenas 57,6% obtiveram o diagnóstico de sífilis durante o pré-natal. O tratamento foi inadequado em 87,7% das mulheres. Apenas 12,2% dos parceiros foram tratados. Houve tendência crescente do agravo (16%/ano), que atingiu 23,2 casos/1 000 nascidos vivos em 2016. O crescimento foi mais acentuado em adolescentes do sexo feminino (25,2%/ano), raça/cor parda (16,8%/ano), indivíduos com baixa escolaridade (57,1%/ano) e mulheres que realizaram pré-natal (17,3%/ano); e, no período de 2012 a 2016, em mulheres com informação ignorada para a cor da pele. Conclusões. As iniquidades sociais se destacaram na ocorrência de SC, com incidência crescente em jovens. É necessária a capacitação dos profissionais de saúde para o manejo da sífilis gestacional e uma atuação efetiva das políticas públicas sobre os determinantes sociais da sífilis.(AU)

ABSTRACT Objective. To describe the temporal distribution and epidemiologic characteristics of congenital syphilis (CS) cases in the city of Niterói, southeastern Brazil, from 2007 to 2016. Method. This descriptive time series analysis of the incidence of CS used data from the Notifiable Diseases Information System (SINAN) and the Live Birth Information System (SINASC). The sample included all notified cases. A probabilistic matching was performed between SINAN and SINASC data to recover ignored information. The time series was estimated using logarithmic regression according to sociodemographic and prenatal care variables. Results. There were 754 identified cases of CS in the study period (mean incidence: 11.9 cases/1 000 live births). The incidence was higher in younger women (10 to 19; 20 to 24 years) and in those with black skin, low schooling, and without prenatal care. Of the overall group, only 57.6% received a diagnosis of syphilis during prenatal care. Treatment was not adequate in 87,7%, and only 12.2% of partners were treated. SC incidence presented a growing trend of 16%/year, reaching 23.2 cases/1 000 living births in 2016. This growth was especially marked in female adolescents (25.2%/year), brown race/skin color (16.8%/year), women with low schooling (57.1%/year) and women who received prenatal care (17.3%/year); and, from 2012 to 2016, in women without information on skin color. Conclusions. Social inequalities were linked to CS in the present sample. Also, increasing CS incidence was detected in youth. Health care professionals must be trained to manage gestational syphilis, and public policies must effectively address the social determinants of this condition.(AU)

RESUMEN Objetivo. Describir la distribución temporal y las características epidemiológicas de la sífilis congénita en Niterói, sureste de Brasil, de 2007 a 2016. Métodos. Estudio descriptivo de series temporales sobre la incidencia de la sífilis congénita; se utilizaron datos del Sistema de Información de Enfermedades Notificables (SINAN) y del Sistema de Información de Nacimientos Vivos (SINASC). La muestra incluyó todos los casos reportados. Se realizó además una relación probabilística entre el SINAN y el SINASC para recuperar información ignorada. La serie temporal se estimó mediante regresión logarítmica, según variables sociodemográficas y prenatales. Resultados. En el período estudiado se identificaron 754 casos de sífilis congénita (incidencia media de 11,9 casos/1 000 nacidos vivos). La incidencia fue mayor en las mujeres jóvenes (10-19, 20-24 años), mujeres de raza negra, con baja escolaridad y sin atención prenatal. Del total de mujeres, sólo se realizó el diagnóstico de sífilis durante la atención prenatal en 57,6%. El tratamiento fue inadecuado en 87,7% de las mujeres, solo el 12,2% de las parejas fueron tratadas. La enfermedad presentó una tendencia creciente (16%/año), y alcanzó 23,2 casos/1 000 nacidos vivos en 2016. El aumento fue más pronunciado en las adolescentes (25,2%/año), raza/color de piel morena (16.8%/año), mujeres con baja educación (57,1%/año), mujeres que recibieron atención prenatal (17,3%/año) y, de 2012 a 2016, en mujeres sin información sobre el color de la piel. Conclusiones. En esta muestra se destacaron las desigualdades sociales en la aparición de sífilis congénita, con una incidencia creciente en las jóvenes. Se requiere capacitación de los profesionales de la salud en el manejo de la sífilis gestacional y la acción efectiva de políticas públicas sobre los determinantes sociales de la sífilis.(AU)

Prática de chemsex entre homens que fazem sexo com homens (HSH) durante período de isolamento social por COVID-19: pesquisa online multicêntrica / Práctica de chemsex entre hombres que practican sexo con hombres (HSH) durante período de aislamiento social por la COVID-19: una encuesta multicéntrica en línea / Chemsex practice among men who have sex with men (MSM) during social isolation from COVID-19: multicentric online survey

Investigar os fatores associados à prática do sexo sob o efeito de drogas (chemsex) entre homens que fazem sexo com homens (HSH) durante período de isolamento social, no contexto da pandemia da COVID-19. Inquérito multicêntrico online, aplicado aos territórios de Brasil e Portugal em abril de 2020, enquanto os dois países vivenciavam medidas sanitárias restritivas para a doença. Os participantes foram recrutados valendo-se de uma adaptação do método respondent driven sampling (RDS) ao ambiente virtual. Os dados foram coletados usando redes sociais e aplicativos de encontro voltados a HSH. Utilizamos regressão logística bivariada e multivariada para a produção das odds bruto (OR) e ajustado (ORa). Em um universo de 2.361 sujeitos, 920 (38,9%) realizaram a prática do chemsex, que, em 95% dos casos, foi realizada com parceiro casual. Aumentaram as chances de se envolver em chemsex: morar no Brasil (ORa = 15,4; IC95%: 10,7-22,1); não estar em isolamento social (ORa = 4,9; IC95%: 2,2-10,9); fazer sexo casual durante o distanciamento social (ORa = 52,4; IC95%: 33,8-81,4); fazer sexo grupal (ORa = 2,9; IC95%: 2,0-4,4); não apresentar nenhum tipo de sintoma para a COVID-19 (ORa = 1,3; IC95%: 1,1-1,8); não residir com o parceiro (ORa = 1,8; IC95%: 1,2-2,6) e estar em uso da profilaxia pré-exposição (ORa = 2,6; IC95%: 1,8-3,7). A ocorrência de chemsex foi elevada, sobretudo no Brasil, onde o isolamento social proposto não sensibilizou os HSH à adesão.

El objetivo fue investigar los factores asociados a la práctica del sexo bajo el efecto de drogas (chemsex), entre hombres que practican sexo con hombres (HSH) durante el período de aislamiento social en el contexto de la pandemia de la COVID-19. Se realizó una encuesta multicéntrica en línea, aplicada al territorio de Brasil y Portugal en abril de 2020, mientras los dos países vivían medidas sanitarias restrictivas por la COVID-19. Los participantes se reclutaron mediante una adaptación del método respondent driven sampling (RDS) al ambiente virtual. Los datos fueron recabados usando redes sociales y aplicaciones de encuentros dirigidos a HSH. Utilizamos la regresión logística bivariada y multivariada para la producción de las odds ratio brutas (OR) y ajustadas (ORa). En un universo de 2.361 sujetos, 920 (38,9%) realizaron la práctica del chemsex, que en el 95% de los casos se realizó con una pareja casual. Aumentaron las oportunidades de implicarse en chemsex: vivir en Brasil (ORa = 15,4; IC95%: 10,7-22,1); no estar en aislamiento social (ORa: = 4,9; IC95%: 2,2-10,9); practicar sexo casual durante el distanciamiento social (ORa = 52,4; IC95%: 33,8-81,4); practicar sexo grupal (ORa = 2,9; IC95%: 2,0-4,4); no presentar ningún tipo de síntoma de COVID-19 (ORa = 1,3; IC95%: 1.1-1.8); no residir con la pareja (ORa = 1,8; IC95%: 1,2-2,6) y estar usando la profilaxis previa a la exposición (ORa = 2,6; IC95%: 1,8-3,7). La ocurrencia de chemsex fue elevada, sobre todo en Brasil, donde el aislamiento social propuesto no sensibilizó a los HSH a la adhesión.

The aim of this study was to investigate factors associated with sex practice under the effect of drugs (chemsex) among men who have sex with men (MSM) during the period of social isolation in the context of the COVID-19 pandemic. A multicenter online survey was applied to Brazil and Portugal in April 2020 when the two countries were under restrictive health measures due to the pandemic. Participants were recruited with an adaptation of the respondent driven sampling (RDS) method in the online environment. Data were collected using social networks and dating apps for MSM. We used bivariate and multivariate logistic regression to produce crude (OR) and adjusted odds ratios (aOR). In a universe of 2,361 subjects, 920 (38.9%) reported engaging in chemsex practice, which involved casual partners in 95% of the cases. Higher OR of engaging in chemsex were associated with Brazil (aOR = 15.4; 95%CI: 10.7-22.1), not being in social isolation (aOR = 4.9; 95%CI: 2.2-10.9), engaging in casual sex during social distancing (aOR = 52.4; 95%CI: 33.8-81.4), group sex (aOR = 2.9; 95%CI: 2.0-4.4), not presenting any symptom of COVID-19 (aOR = 1.3; 95%CI: 1.1-1.8), not living with the sex partner (aOR = 1.8; 95%CI: 1.2-2.6), and using pre-exposure prophylaxis (aOR = 2.6; 95%CI: 1.8-3.7). The occurrence of chemsex was high, especially in Brazil, where the proposed social distancing did not gain adherence by MSM.

Most frequent errors in inhalation technique of patients with asthma treated at a tertiary care hospital.

OBJECTIVE: To demonstrate the most frequent errors in inhalation technique in patients with asthma undergoing treatment at a tertiary care hospital. METHODS: A cross-sectional study with a convenience sample of asthma patients aged 18 years or over, treated at a pulmonology outpatient clinic of a tertiary care hospital. The assessment of inhalation technique of users of the dry powder inhalers Aerolizer®, Aerocaps and Diskus®, or metered-dose inhalers was based on the manufacturer's instructions for use of each inhaler device. Patients demonstrated the inhalation technique with empty inhaler devices, and it was considered correct when all stages were performed properly, or when errors probably did not interfere with the treatment outcome. RESULTS: Among 71 participants, 43 (60.5%) performed inhalation technique incorrectly. Among metered-dose inhalers and dry powder inhalers users, inhalation technique errors were found in 84.2% and 51.9%, respectively (p=0.013). Errors were more frequent at the exhalation stage (67.4%), followed by breathing in (58.1%) and apnea (51.2%). In the group using dry powder inhalers, the most common errors occurred during exhalation and, for those using metered-dose inhalers, the most compromised stage was aspiration. CONCLUSION: Errors were more frequent among those using metered-dose inhalers compared with dry powder inhalers. Misconceptions are more common at the expiration stage among users of dry powder inhalers and in aspiration among those on metered-dose inhalers.

Most frequent errors in inhalation technique of patients with asthma treated at a tertiary care hospital / Erros mais frequentes na técnica inalatória de pacientes com asma brônquica em tratamento em hospital terciário

ABSTRACT Objective: To demonstrate the most frequent errors in inhalation technique in patients with asthma undergoing treatment at a tertiary care hospital. Methods: A cross-sectional study with a convenience sample of asthma patients aged 18 years or over, treated at a pulmonology outpatient clinic of a tertiary care hospital. The assessment of inhalation technique of users of the dry powder inhalers Aerolizer®, Aerocaps and Diskus®, or metered-dose inhalers was based on the manufacturer's instructions for use of each inhaler device. Patients demonstrated the inhalation technique with empty inhaler devices, and it was considered correct when all stages were performed properly, or when errors probably did not interfere with the treatment outcome. Results: Among 71 participants, 43 (60.5%) performed inhalation technique incorrectly. Among metered-dose inhalers and dry powder inhalers users, inhalation technique errors were found in 84.2% and 51.9%, respectively (p=0.013). Errors were more frequent at the exhalation stage (67.4%), followed by breathing in (58.1%) and apnea (51.2%). In the group using dry powder inhalers, the most common errors occurred during exhalation and, for those using metered-dose inhalers, the most compromised stage was aspiration. Conclusion: Errors were more frequent among those using metered-dose inhalers compared with dry powder inhalers. Misconceptions are more common at the expiration stage among users of dry powder inhalers and in aspiration among those on metered-dose inhalers.

RESUMO Objetivo: Demonstrar os erros mais frequentes na técnica inalatória de pacientes com asma brônquica em tratamento em hospital terciário. Métodos: Estudo transversal, com amostra de conveniência de pacientes com asma, com 18 anos ou mais, em tratamento em ambulatório de pneumologia de um hospital terciário. A avaliação da técnica inalatória dos usuários dos dispositivos de pó seco Aerolizer ®, Aerocaps® ou Diskus®, ou de aerossóis dosimetrados teve como base as orientações da bula do fabricante de cada dispositivo inalatório. Os pacientes demonstraram a técnica inalatória com dispositivos inalatórios vazios, e ela foi considerada correta quando todas as etapas foram realizadas de forma apropriada, ou quando os equívocos provavelmente não interferiam no resultado do tratamento. Resultados: Entre os 71 participantes, 43 (60,5%) realizaram a técnica inalatória de forma incorreta. Dentre os usuários de aerossóis dosimetrados e dispositivos de pó seco, ocorreram erros de técnica inalatória em 84,2% e 51,9%, respectivamente (p=0,013). Os erros foram mais frequentes na etapa da expiração (67,4%), seguidos da aspiração (58,1%) e da apneia (51,2%). No grupo que usava dispositivos de pó seco, os erros mais comuns aconteceram na expiração e, nos que utilizavam aerossóis dosimetrados, a etapa mais comprometida foi a aspiração. Conclusão: Os erros foram mais frequentes entre os que usavam aerossóis dosimetrados em comparação com dispositivos de pó seco. Os equívocos foram mais comuns na etapa da expiração entre os usuários de dispositivos de pó seco e na aspiração entre os que usavam aerossóis dosimetrados.

Incorrect use of inhalation devices among patients with bronchial asthma. A hospital-based cross-sectional study in Rio de Janeiro, Brazil.

CONTEXT AND OBJECTIVE: Treatment of asthma implies inhalation of specific drugs to reach high concentrations in the respiratory tree and ensure low drug bioavailability and few adverse effects. This study aimed to evaluate the effectiveness of the inhalation technique among outpatients with asthma. DESIGN AND SETTING: Tertiary-care hospital-based cross-sectional study in Rio de Janeiro. METHODS: We evaluated inhalation practices in a convenience sample. A questionnaire was used to investigate sociodemographic data and assess disease control level, duration of use of the inhalation device, length of treatment and previous instructions provided by the prescribing physician. Patients demonstrated their inhalation technique using empty devices, and their technique was considered correct when all steps were appropriately performed or when errors did not interfere with the treatment outcome. RESULTS: Among the 71 participants, 53 (74.7%) had been using the same inhaler device for at least two years and 41 (57.8%) had been under treatment for two years or more. Twelve (17.1%) said that they had been taught once and 57 (81.4%) at least twice, while one (1.4%) reported not having received any guidance regarding use of inhaler devices. Eighteen patients (25.3%) presented controlled asthma and 28 (39.5%) performed the inhalation technique correctly. Incorrect technique was associated with fewer evaluations of the inhalation technique (P =0.04) and uncontrolled asthma (P = 0.01). CONCLUSIONS: Less than half of the sample performed the inhalation technique correctly. Incorrect inhalation technique was related to lower number of evaluations of the use of the inhalation device and uncontrolled asthma.

Social networks of men who have sex with men: a study of recruitment chains using Respondent Driven Sampling in Salvador, Bahia State, Brazil.

Social and sexual contact networks between men who have sex with men (MSM) play an important role in understanding the transmission of HIV and other sexually transmitted infections (STIs). In Salvador (Bahia State, Brazil), one of the cities in the survey Behavior, Attitudes, Practices, and Prevalence of HIV and Syphilis among Men Who Have Sex with Men in 10 Brazilian Cities, data were collected in 2008/2009 from a sample of 383 MSM using Respondent Driven Sampling (RDS). Network analysis was used to study friendship networks and sexual partner networks. The study also focused on the association between the number of links (degree) and the number of sexual partners, in addition to socio-demographic characteristics. The networks' structure potentially facilitates HIV transmission. However, the same networks can also be used to spread messages on STI/HIV prevention, since the proximity and similarity of MSM in these networks can encourage behavior change and positive attitudes towards prevention.

Social networks of men who have sex with men: a study of recruitment chains using Respondent Driven Sampling in Salvador, Bahia State, Brazil / Las redes sociales de hombres que mantienen sexo con hombres: estudio de muestreo en cadena con Respondent Driven Sampling en Salvador, Bahía, Brasil / Redes sociais de homens que fazem sexo com homens: estudo das cadeias de recrutamento com Respondent Driven Sampling em Salvador, Bahia, Brasil

Abstract Social and sexual contact networks between men who have sex with men (MSM) play an important role in understanding the transmission of HIV and other sexually transmitted infections (STIs). In Salvador (Bahia State, Brazil), one of the cities in the survey Behavior, Attitudes, Practices, and Prevalence of HIV and Syphilis among Men Who Have Sex with Men in 10 Brazilian Cities, data were collected in 2008/2009 from a sample of 383 MSM using Respondent Driven Sampling (RDS). Network analysis was used to study friendship networks and sexual partner networks. The study also focused on the association between the number of links (degree) and the number of sexual partners, in addition to socio-demographic characteristics. The networks’ structure potentially facilitates HIV transmission. However, the same networks can also be used to spread messages on STI/HIV prevention, since the proximity and similarity of MSM in these networks can encourage behavior change and positive attitudes towards prevention.

Resumen Redes sociales y de contacto sexual entre hombres que practican sexo con hombres (HSH) tienen un papel importante en la comprensión de la aparición de las enfermedades de transmisión sexual (ETS) y el VIH, debido a la posibilidad de circulación de los agentes infecciosos en estas estructuras. Los datos de Salvador, Bahía, Brasil, que se recabaron de la encuesta Comportamiento, Actitudes, Prácticas y Prevalencia de VIH y Sífilis entre Hombres que Practican Sexo con Hombres en 10 Ciudades Brasileñas, fueron recogidos en 2008/2009 en una muestra de 383 HSH, usando Respondent Driven Sampling. Se utilizó el análisis de redes sociales para investigar las redes de amigos y parejas sexuales. También se analizó la relación entre el número de conexiones (grado) y el número de parejas sexuales, y las características socio-demográficas. Las redes presentan estructuras que facilitan la transmisión del VIH. Sin embargo, se puede aprovechar para difundir información para prevención del VIH y las ETS, así como que la proximidad y la similitud de los HSH en estas redes pueden influir en el comportamiento y las actitudes positivas para la prevención de las mismas.

Resumo As redes sociais e de contato sexual entre homens que fazem sexo com homens (HSH) têm um papel importante na compreensão da ocorrência de doenças sexualmente transmissíveis (DST) e HIV, devido ao potencial de circulação de agentes infecciosos nestas estruturas. Dados da cidade de Salvador, Bahia, Brasil, que integraram a pesquisa Comportamento, Atitudes, Práticas e Prevalência de HIV e Sífilis entre Homens que Fazem Sexo com Homens em 10 Cidades Brasileiras foram coletados em 2008/2009 numa amostra de 383 HSH por meio da técnica Respondent Driven Sampling (RDS). Análise de redes sociais foi utilizada para investigar as redes de amigos e parceiros sexuais. Também foi avaliada a relação entre o número de conexões (grau), o número de parceiros sexuais e as características sociodemográficas. As redes apresentaram estruturas que facilitam a transmissão do HIV. Porém, estas redes podem ser exploradas para a disseminação de informações sobre a prevenção do HIV e DST, visto que a proximidade e similaridade dos HSH nessas redes podem influenciar comportamentos e atitudes positivas para a prevenção.

Sociodemographic factors and health in a population of children living in families infected with HIV in Fortaleza and Salvador, Brazil.

This study explores the relationships between demographic, socioeconomic and health statuses of children whose parents were HIV positive in two cities in Northeast Brazil. We conducted a multisite exploratory study in HIV/AIDS referral services for HIV/AIDS in Fortaleza, the capital of Ceará State, and Salvador, the capital of Bahia State, between June 2008 and March 2009. The study population consisted of 562 HIV+ adults - or caretakers of children of HIV+ adults - who provided information about a single index child under 13 years of age of either sex in their household. A structured questionnaire was used for to the adult parent or caretaker. We used multiple correspondence analysis (MCA), as implemented in the software SPAD (Portable Système pour l'Analyse des données). This analysis enabled us to identify the relationships between a large number of variables simultaneously. Of the 562 children, 311 (55.3%) lived in Fortaleza and 251 (44.7%) lived in Salvador. The proportion of HIV-infected children in Fortaleza was 14.2%, and 61.4% (27/44) of these had progressed to AIDS. In Salvador 34.7% of children were seropositive and 95% (83/87) were diagnosed with AIDS. The most important factors that emerged from the study were city and serostatus of the children. These two active variables accounted for 75.3% of the variance. Results are grouped into four profiles that describe the complex of socioeconomic variables closely associated with these families, and the complex and multiple epidemics of HIV, discrimination and poverty associated with these AIDS-affected families.

Estudo epidemiológico das práticas sexuais desprotegidas em uma população de homens e travestis / Epidemiological study of the unprotected sexual practices in a population by men and transvestites

A prática do sexo oral e anal sem o uso do preservativo masculino é um importante fator para a infecção pelo HIV e outras DST na população dos homens que fazem sexo com homens (HSH) e das travestis. As relações entre características sociais, individuais, institucionais e as práticas sexuais desprotegidas são informações que podem ser utilizadas para estruturar ações de prevenção. Investigar as associações entre fatores de vulnerabilidade e as práticas sexuais desprotegidas além de descrever características dos HSH e travestis faz parte dos objetivos deste trabalho. O presente estudo é um recorte do Projeto Convida, inquérito sobre conhecimentos, atitudes, comportamentos e práticas de risco para a infecção pelo HIV entre HSH na cidade de Salvador na Bahia, em 2003. A população do estudo foi de HSH e travestis residentes na cidade de Salvador e região metropolitana que responderam ao questionário e que freqüentaram a “cena gay” desta cidade. A parte exploratória do estudo foi realizada com a análise de correspondência...