MEMORIA DEL ORGANISMO ANDINO DE SALUD CONVENIO HIPÓLITO UNANUE 1971­2021: ORAS-CONHU 2022 / 5 0 a ñ o s t r a b a ja n d o p o r la s a lu d, e l b ie n e s t a r y la in t e g r a c ió n a n d in a / ANNUAL REPORT OF THE ANDEAN HEALTH AGENCY HIPÓLITO UNANUE AGREEMENT 1971 ­ 2021 ORAS-CONHU; 2022

La presente publicación da cuenta de los principales hitos y logros obtenidos a través de las diferentes gestiones institucionales en los últimos cincuenta años. Estos sintetizan las apuestas y retos en la búsqueda de salud para todos, con sistemas nacionales de salud más accesibles y con el fortalecimiento de la ciudadanía en este terreno, coadyuvando a superar las brechas para alcanzar mayores niveles de equidad y bienestar para cada una de las personas. Ello permitirá enfrentar la actual pandemia con mayor eficacia, en estos tiempos, marcados por la emergencia, la experiencia y el compromiso de servicio, el ORAS-CONHU seguirá contribuyendo en responder los nuevos retos de los países andinos

"Dating is pure suffering": violence within affective-sexual relationships between adolescents in a school in the Costa Verde, Rio de Janeiro, Brazil. / "Namorar é só sofrência": violências na relação afetivo-sexual de adolescentes de uma escola na região Costa Verde, Rio de Janeiro, Brasil.

This work is the result of a master's thesis that aimed to understand students' perceptions of violence within affective-sexual relationships between adolescents in a public school in the Costa Verde, Rio de Janeiro. The study corpus was derived from participant observation in the school and in-depth interviews with three girls and three boys aged between 18 and 24 years. The core areas of analysis were affective-sexual trajectories, experiences involving violence within relationships, and agency in the face of conflict. The findings reveal that violence is part of the everyday lives of adolescents and reinforce the victim/aggressor dichotomy. The adolescents' interpretations of violence were divided into two categories: "suffering" and "serious acts of violence". These understandings influence the recognition of violence and agency. The reproduction of gender norms contributes to sustaining gender hierarchy and inequalities, which affect girls and boys differently. Silence on this issue contributes to the invisibility of violence within relationships and the consequent failure to seek support from relevant organizations and services. Further research is needed to gain a deeper understanding of violence within affective-sexual relationships between adolescents.

O presente trabalho é resultado de uma pesquisa de mestrado que objetivou compreender como as violências nas relações afetivo-sexuais na adolescência são significadas por estudantes de uma escola estadual da região Costa Verde do Rio de Janeiro. O corpus da pesquisa deriva da observação participante no espaço escolar e de entrevistas em profundidade com 3 moças e 3 rapazes entre 18 e 24 anos. Os eixos de análise foram: as trajetórias afetivo-sexuais, as experiências que envolvem algum tipo de ação violenta no relacionamento e as agências diante dos conflitos. Os resultados revelam que as violências fazem parte do cotidiano e reforçam a dicotomia vítima e agressor. As interpretações da violência são divididas em dois sistemas, a "sofrência" e "ações violentas graves", essas compreensões interferem no reconhecimento da violência e em suas agências. A reprodução de padrões sociais de gênero contribui para a manutenção de hierarquias e desigualdades que atingem a moças e rapazes de diferentes formas. O silenciamento a respeito do tema contribui para a invisibilidade da violência no relacionamento e consequentemente a não procura de cuidado junto aos serviços de saúde. É posto como desafio a expansão de estudos que possibilitem compreender melhor a violência nas relações afetivo-sexuais de adolescentes.

"Namorar é só sofrência": violências na relação afetivo-sexual de adolescentes de uma escola na região Costa Verde, Rio de Janeiro, Brasil / "Dating is pure suffering": violence within affective-sexual relationships between adolescents in a school in the Costa Verde, Rio de Janeiro, Brazil

Resumo O presente trabalho é resultado de uma pesquisa de mestrado que objetivou compreender como as violências nas relações afetivo-sexuais na adolescência são significadas por estudantes de uma escola estadual da região Costa Verde do Rio de Janeiro. O corpus da pesquisa deriva da observação participante no espaço escolar e de entrevistas em profundidade com 3 moças e 3 rapazes entre 18 e 24 anos. Os eixos de análise foram: as trajetórias afetivo-sexuais, as experiências que envolvem algum tipo de ação violenta no relacionamento e as agências diante dos conflitos. Os resultados revelam que as violências fazem parte do cotidiano e reforçam a dicotomia vítima e agressor. As interpretações da violência são divididas em dois sistemas, a "sofrência" e "ações violentas graves", essas compreensões interferem no reconhecimento da violência e em suas agências. A reprodução de padrões sociais de gênero contribui para a manutenção de hierarquias e desigualdades que atingem a moças e rapazes de diferentes formas. O silenciamento a respeito do tema contribui para a invisibilidade da violência no relacionamento e consequentemente a não procura de cuidado junto aos serviços de saúde. É posto como desafio a expansão de estudos que possibilitem compreender melhor a violência nas relações afetivo-sexuais de adolescentes.

Abstract This work is the result of a master's thesis that aimed to understand students' perceptions of violence within affective-sexual relationships between adolescents in a public school in the Costa Verde, Rio de Janeiro. The study corpus was derived from participant observation in the school and in-depth interviews with three girls and three boys aged between 18 and 24 years. The core areas of analysis were affective-sexual trajectories, experiences involving violence within relationships, and agency in the face of conflict. The findings reveal that violence is part of the everyday lives of adolescents and reinforce the victim/aggressor dichotomy. The adolescents' interpretations of violence were divided into two categories: "suffering" and "serious acts of violence". These understandings influence the recognition of violence and agency. The reproduction of gender norms contributes to sustaining gender hierarchy and inequalities, which affect girls and boys differently. Silence on this issue contributes to the invisibility of violence within relationships and the consequent failure to seek support from relevant organizations and services. Further research is needed to gain a deeper understanding of violence within affective-sexual relationships between adolescents.

Membrane hyperpolarization abolishes calcium oscillations that prevent induced acrosomal exocytosis in human sperm.

Sperm capacitation is essential to gain fertilizing capacity. During this process, a series of biochemical and physiological modifications occur that allow sperm to undergo acrosomal exocytosis (AE). At the molecular level, hyperpolarization of the sperm membrane potential (Em) takes place during capacitation. This study shows that human sperm incubated under conditions that do not support capacitation (NC) can become ready for an agonist stimulated AE by pharmacologically inducing Em hyperpolarization with Valinomycin or Amiloride. To investigate how Em hyperpolarization promotes human sperm's ability to undergo AE, live single-cell imaging experiments were performed to simultaneously monitor changes in [Ca2+ ]i and the occurrence of AE. Em hyperpolarization turned [Ca2+ ]i dynamics in NC sperm from spontaneously oscillating into a sustained slow [Ca2+ ]i increase. The addition of progesterone (P4) or K+ to Valinomycin-treated sperm promoted that a significant number of cells displayed a transitory rise in [Ca2+ ]i which then underwent AE. Altogether, our results demonstrate that Em hyperpolarization is necessary and sufficient to prepare human sperm for the AE. Furthermore, this Em change decreased Ca2+ oscillations that block the occurrence of AE, providing strong experimental evidence of the molecular mechanism that drives the acquisition of acrosomal responsiveness.

Impact of the COVID-19 Lockdown on Air Quality and Resulting Public Health Benefits in the Mexico City Metropolitan Area.

Meteorology and long-term trends in air pollutant concentrations may obscure the results from short-term policies implemented to improve air quality. This study presents changes in CO, NO2, O3, SO2, PM10, and PM2.5 based on their anomalies during the COVID-19 partial (Phase 2) and total (Phase 3) lockdowns in Mexico City (MCMA). To minimise the impact of the air pollutant long-term trends, pollutant anomalies were calculated using as baseline truncated Fourier series, fitted with data from 2016 to 2019, and then compared with those from the lockdown. Additionally, days with stagnant conditions and heavy rain were excluded to reduce the impact of extreme weather changes. Satellite observations for NO2 and CO were used to contrast the ground-based derived results. During the lockdown Phase 2, only NO2 exhibited significant decreases (p < 0.05) of between 10 and 23% due to reductions in motor vehicle emissions. By contrast, O3 increased (p < 0.05) between 16 and 40% at the same sites where NO2 decreased. During Phase 3, significant decreases (p < 0.05) were observed for NO2 (43%), PM10 (20%), and PM2.5 (32%) in response to the total lockdown. Although O3 concentrations were lower in Phase 3 than during Phase 2, those did not decrease (p < 0.05) from the baseline at any site despite the total lockdown. SO2 decreased only during Phase 3 in a near-road environment. Satellite observations confirmed that NO2 decreased and CO stabilised during the total lockdown. Air pollutant changes during the lockdown could be overestimated between 2 and 10-fold without accounting for the influences of meteorology and long-term trends in pollutant concentrations. Air quality improved significantly during the lockdown driven by reduced NO2 and PM2.5 emissions despite increases in O3, resulting in health benefits for the MCMA population. A health assessment conducted suggested that around 588 deaths related to air pollution exposure were averted during the lockdown. Our results show that to reduce O3 within the MCMA, policies must focus on reducing VOCs emissions from non-mobile sources. The measures implemented during the COVID-19 lockdowns provide valuable information to reduce air pollution through a range of abatement strategies for emissions other than from motor vehicles.

Seeing is believing: Current methods to observe sperm acrosomal exocytosis in real time.

Acrosomal exocytosis (AR) is a critical process that sperm need to undergo to fertilize an egg. The evaluation of the presence or absence of the acrosome is usually performed by using lectins or dyes in fixed cells. With this approach, it is neither possible to monitor the dynamic process of exocytosis and related molecular events while discriminating between live and dead cells, nor to evaluate the acrosomal status while sperm reside in the female reproductive tract. However, over the last two decades, several new methodologies have been used to assess the occurrence of AR in living cells allowing different groups to obtain information that was not possible in the past. These techniques have revolutionized the whole study of this process. This review summarizes current methods available to analyze AR in living cells as well as the important information that emerged from studies using these approaches.

Super-resolution imaging of live sperm reveals dynamic changes of the actin cytoskeleton during acrosomal exocytosis.

Filamentous actin (F-actin) is a key factor in exocytosis in many cell types. In mammalian sperm, acrosomal exocytosis (denoted the acrosome reaction or AR), a special type of controlled secretion, is regulated by multiple signaling pathways and the actin cytoskeleton. However, the dynamic changes of the actin cytoskeleton in live sperm are largely not understood. Here, we used the powerful properties of SiR-actin to examine actin dynamics in live mouse sperm at the onset of the AR. By using a combination of super-resolution microscopy techniques to image sperm loaded with SiR-actin or sperm from transgenic mice containing Lifeact-EGFP, six regions containing F-actin within the sperm head were revealed. The proportion of sperm possessing these structures changed upon capacitation. By performing live-cell imaging experiments, we report that dynamic changes of F-actin during the AR occur in specific regions of the sperm head. While certain F-actin regions undergo depolymerization prior to the initiation of the AR, others remain unaltered or are lost after exocytosis occurs. Our work emphasizes the utility of live-cell nanoscopy, which will undoubtedly impact the search for mechanisms that underlie basic sperm functions.This article has an associated First Person interview with the first author of the paper.

Las neurociencias como herramienta de comunicación y desarrollo de los procesos de globalización / The neurosciences as a communication and development tool of the globalization processes

Este artículo pretende elucidar las funciones que han cumplido las neurociencias como herramienta de comunicación en los procesos de diseminación de la aldea global. La globalización ha facilitado la masificación del uso de las nuevas Tecnologías de la Información y la Comunicación (TIC), del comercio y de la interconexión humana por medio de redes sociales. En éste proceso, el papel de las neurociencias ha sido decisivo, puesto que han permitido a las multinacionales y gobiernos de países desarrollados, contar con evidencias clínicas, experimentales y multicéntricas sobre la forma en que el cerebro selecciona un objeto por sobre los demás, siendo determinante en todos los movimientos financieros y bursátiles de la economía mundial. Los resultados indican que las neurociencias han llegado a todos los niveles de la sociedad a escala global; permitiendo que sus avances y desarrollos modifiquen la forma en que las multinacionales y los estados ofrecen sus productos y servicios a la humanidad de forma atractiva, eficaz y sugestiva.

This paper aims to elucidate the functions that neurosciences have fulfilled as a communication tool in the dissemination processes of the global village. Globalization has facilitated the massification of the use of new Information and Communication Technologies (ICT), commerce and human interconnection through social networks. In this process, the role of neuroscience has been decisive, since it has allowed multinational and developed country governments to have clinical, experimental and multicentric evidence on how the brain selects one object over others, being determinant in all financial and stock market movements of the world economy. The results indicate that neurosciences have reached all levels of society on a global scale; allowing their advances and developments to modify the way in which multinationals and states offer their products and services to humanity in an attractive, effective and suggestive way.

Role of Ion Channels in the Sperm Acrosome Reaction.

The acrosome reaction (AR) is a unique exocytotic process where the acrosome, a single membrane-delimited specialized organelle, overlying the nucleus in the sperm head of many species, fuses with the overlying plasma membrane. This reaction, triggered by physiological inducers from the female gamete, its vicinity, or other stimuli, discharges the acrosomal content modifying the plasma membrane, incorporating the inner acrosomal membrane, and exposing it to the extracellular medium. The AR is essential for sperm-egg coat penetration, fusion with the eggs' plasma membrane, and fertilization. As in most exocytotic processes Ca(2+) is crucial for the AR, as well as intracellular pH and membrane potential changes. Thus, among the required processes needed for this reaction, ion permeability changes involving channels are pivotal. In spite of the key role ion channels play in the AR, their identity and regulation is not fully understood. Though molecular and pharmacological evidence indicates that various ionic channels participate during the AR, such as store-operated Ca(2+) channels and voltage-dependent Ca(2+) channels, whole cell patch clamp recordings have failed to detect some of them until now. Since sperm display a very high resistance and a minute cytoplasmic volume, very few channels are needed to achieve large membrane potential and concentration changes. Functional detection of few channels in the morphologically complex and tiny sperm poses technical problems, especially when their conductance is very small, as in the case of SOCs. Single channel recordings and novel fluorescence microscopy strategies will help to define the participation of ionic channels in the intertwined signaling network that orchestrates the AR.

Grado de control metabólico en niños y adolescentes con diabetes mellitus tipo 1 / Metabolic control in children and adolescents with type 1 diabetes

Introducción: La diabetes mellitus tipo 1 (DM1) es una importante enfermedad en la población infanto-juvenil, que asociada a otros factores de riesgo cardiovascular, origina morbimortalidad a más temprana edad. Objetivo: Conocer el grado de control metabólico y determinar la prevalencia de factores de riesgo cardiovascular en pacientes con DM1. Pacientes y método: Estudio retrospectivo realizado entre abril y junio de 2011, en el cual se estudiaron menores de 19 años con DM1, controlados en el Hospital San Juan de Dios, en Santiago de Chile. Resultados: Se evaluaron 94 pacientes (edad promedio al diagnóstico: 7,3 años y edad actual: 11,9 años; tiempo de evolución: 4,5 años). El 79,8% presentó niveles de hemoglobina glucosilada (HbA1c) superiores a lo recomendado, con un promedio de 8,9%. El grupo entre 13 y 19 años fue el de peor control metabólico (86% con niveles de HbA1c anormal). El 26,6% presentó sobrepeso u obesidad. En el 20,3% se constató dislipidemia (colesterol LDL > 100 mg/dl) y en el 4,2% hipertensión arterial. Conclusiones: Solo el 20% de los pacientes presentan un control metabólico adecuado medido por HbA1c, aunque un perfil de riesgo cardiovascular aceptable. Es necesario incrementar los esfuerzos terapéuticos, especialmente en los adolescentes, enfatizando la importancia de un adecuado control nutricional como principal método de tratamiento de esta entidad.

Introduction: Type 1 diabetes mellitus (T1D) is an important disease in children and adolescent being a major risk factor for early morbidity and mortality. Objective: To know the degree of metabolic control and prevalence of cardiovascular risk factors in T1D patients. Patients and method: Retrospective study including patients under 19 years of age with T1D controlled at a Chilean hospital in 2011. Results: 94 patients were evaluated (average age at diagnosis: 7,3 years; current age: 11,9 years; evolution time: 4,5 years). Seventy-nine percent (79,8%) of patients presented glycated hemoglobin (HbA1c) over the recommended level with an average of 8,9%. The group between 13 and 19 years of age exhibited the worst metabolic control (86% with HbA1c abnormal levels). Overweight or obesity occurred in 26,6% of patients, 20,3% had LDL >100 mg/dl and 4,2% had hypertension. Conclusions: Only about twenty percent of patients had adequate metabolic control as measured by HbA1c, although cardiovascular risk profile was acceptable. Therapeutic and educational efforts must be reinforced mainly in adolescents, emphasizing the importance of adequate nutritional management as a primary method to treat this entity.

A Specific Transitory Increase in Intracellular Calcium Induced by Progesterone Promotes Acrosomal Exocytosis in Mouse Sperm.

During capacitation, sperm acquire the ability to undergo the acrosome reaction (AR), an essential step in fertilization. Progesterone produced by cumulus cells has been associated with various physiological processes in sperm, including stimulation of AR. An increase in intracellular Ca(2+) ([Ca(2+)]i) is necessary for AR to occur. In this study, we investigated the spatiotemporal correlation between the changes in [Ca(2+)]i and AR in single mouse spermatozoa in response to progesterone. We found that progesterone stimulates an [Ca(2+)]i increase in five different patterns: gradual increase, oscillatory, late transitory, immediate transitory, and sustained. We also observed that the [Ca(2+)]i increase promoted by progesterone starts at either the flagellum or the head. We validated the use of FM4-64 as an indicator for the occurrence of the AR by simultaneously detecting its fluorescence increase and the loss of EGFP in transgenic EGFPAcr sperm. For the first time, we have simultaneously visualized the rise in [Ca(2+)]i and the process of exocytosis in response to progesterone and found that only a specific transitory increase in [Ca(2+)]i originating in the sperm head promotes the initiation of AR.

[Metabolic control in children and adolescents with type 1 diabetes]. / Grado de control metabólico en niños y adolescentes con diabetes mellitus tipo 1.

INTRODUCTION: Type 1 diabetes mellitus (T1D) is an important disease in children and adolescent being a major risk factor for early morbidity and mortality. OBJECTIVE: To know the degree of metabolic control and prevalence of cardiovascular risk factors in T1D patients. PATIENTS AND METHOD: Retrospective study including patients under 19 years of age with T1D controlled at a Chilean hospital in 2011. RESULTS: 94 patients were evaluated (average age at diagnosis: 7.3 years; current age: 11,9 years; evolution time: 4.5 years). Seventy-nine percent (79.8%) of patients presented glycated hemoglobin (HbA1c) over the recommended level with an average of 8.9%. The group between 13 and 19 years of age exhibited the worst metabolic control (86% with HbA1c abnormal levels). Overweight or obesity occurred in 26.6% of patients, 20.3% had LDL >100mg/dl and 4.2% had hypertension. CONCLUSIONS: Only about twenty percent of patients had adequate metabolic control as measured by HbA1c, although cardiovascular risk profile was acceptable. Therapeutic and educational efforts must be reinforced mainly in adolescents, emphasizing the importance of adequate nutritional management as a primary method to treat this entity.

Prevención de transmisión vertical VIH: antirretrovirales y otros factores protectores / Prevention of vertical transmission HIV: antiretroviral and other protective factors

Estudiar los factores asociados a la prevención de la transmisión vertical VIH y su relación con la tasa de infección en niños. Estudio retrospectivo, analítico, observacional de la consulta de seguimiento VIH/Sida del Hospital Universitario de Caracas, período 2005-2010. Revisión de historias y fichas médicas de exposición perinatal VIH. Análisis estadístico descriptivo, cálculo de OR con intervalos de confianza de 95%. 321 niños incluidos. El diagnóstico de las madres VIH fue: 41,7% período preconcepcional, 41,7% gestación, 10,3% puerperio y 6,2% posnatal. 83,9% de las madres que recibieron tratamiento antrirretroviral durante gestación. 83,5% inició antes de las 34 semanas. 60,7% (n=195) de los neonatos fueron obtenidos por cesárea. 49,1% (n=158) de las madres recibieron zidovudina intraparto. 72,6% (n=238) de los neonatos inició adecuadamente zidovudina. 9% (n=28) recibió lactancia materna. Tasa general de transmisión VIH 5,6% (n=18), con ascenso en la tasa desde 1,4% (IC:0,18-5,20) en las diagnosticadas durante período preconcepcional, hasta 50,0% (IC:25,58-74,41) en posnatal. El acumulado de factores de protección resulta en menor tasa de infección con el cumplimiento de al menos 2 de ellos (P<0,05). El cumplimiento del tratamiento gestacional materno, zidovudina periparto, cesárea electiva, zidovudina neonatal y omisión de leche materna fueron factores protectores estadísticamente significativos para la prevención de la transmisión vertical VIH. El control prenatal y el cumplimiento del tratamiento antirretroviral gestacional materno, zidovudinaperiparto, cesárea electiva, zidovudina neonatal y omisión de leche materna son factores protectores efectivos para disminuir la transmisión vertical. El programa nacional de tratamiento antirretroviral para infección VIH debe continuar y optimizar su funcionamiento

Study the factors associated with the prevention of HIV vertical transmission and the relation with the rate of infection in children. Retrospective, analytic and observational study of the Infectious Pediatrics Consultation at the Hospital Universitario de Caracas, during 2005 to 2010. Medical histories and data from the format of perinatal HIV exposition were revised. Descriptive analysis, OR calculation with confidence intervals of 95%. 321 children were included. The HIV diagnosis of mothers were: 41,7% in the preconceptional period, 41,7% in the gestational period, 10,3% in the puerperal period and 6,2% in the posnatal period. 83,9% of mothers who received antiretroviral treatment before birth. 72,6% (n=238) of the newborns used AZT, 9% received breastfeeding. Rate of HIV transmission was 5,6% (n=18). If diagnosis had been preconceptional, the rate was 1,4% (IC:0,18-5,20) and it increased to 50,0% (IC:25,58-74,41), in case of the posnatal diagnosis. The accomplishment of at least two protective factors resulted in a lower rate of infection (P<0,05). The gestational treatment, the AZT before birth, the elective cesarean, the AZT neonatal and the omission of breastfeeding were protective factors with statistical significance to prevent vertical transmission of HIV. The gestational treatment, the AZT before birth, the elective cesarean, the AZT neonatal and the omission of breastfeeding are protective factors effective to prevent HIV vertical transmission. The national program of antiretroviral treatment must be maintained and optimized

[Expansion of HIV counseling and testing strategies: technical challenges and ethical-political tensions]. / Ampliación de las estrategias de consejería y prueba del VIH: desafíos técnicos y tensiones ético-políticas.

Incentives to provide universal access to antiretroviral therapy in order to control the HIV/AIDS epidemic also encouraged the diversification of HIV testing strategies, as demonstrated by the simultaneous existence of Voluntary Counseling and Testing (VCT) and Provider-Initiated HIV Testing and Counseling (PITC). This paper analyzes the concepts, principles and implementation of the VCT and PITC models regarding counseling, confidentiality and informed consent in Brazil and other countries, based on a literature review of works in the Lilacs, Medline, Sociological Abstracts and Cochrane databases published between 2000 and 2013. According to the literature, PITC increases rates of testing in comparison with VCT, but reduces sexual and reproductive rights and the autonomy of users. These findings suggest technical challenges and ethical tensions between the paradigm of exceptionalism and the normalization of HIV testing. The necessity to reconcile increased access to HIV tests with the local capacity to offer comprehensive care for people living with HIV/AIDS is highlighted. It is recommended that interdisciplinary studies about the social effects of VCT and PITC be amplified.

Ampliación de las estrategias de consejería y prueba del VIH: desafíos técnicos y tensiones ético-políticas / Expansion of HIV counseling and testing strategies: technical challenges and ethical-political tensions

Los incentivos en el acceso universal a la terapia antirretroviral para el control del VIH-sida, estimularon la diversificación de los modelos de testeo del VIH, que se expresa en la coexistencia del Voluntary Counseling and Testing (VCT) y Provider-Initiated HIV Testing and Counseling (PITC). Este artículo analiza los conceptos, los fundamentos y la aplicación de los modelos VCT y PITC con respecto a la consejería, la confidencialidad y el consentimiento informado en Brasil y en otros países, a partir de una revisión de la bibliografía en las bases Lilacs, Medline, Sociological Abstracts y Cochrane, publicada entre 2000 y 2013. Según los estudios, el PITC aumenta las tasas de testeo en relación con el VCT, pero reduce los derechos sexuales y reproductivos y la autonomía de los usuarios. Estos resultados señalan los desafíos técnicos y las tensiones éticas entre el paradigma de la excepcionalidad y la normalización del test. Se destaca la necesidad de conciliar el aumento en el acceso al examen con la capacidad local de cuidado integral a las personas que viven con VIH-sida y se recomienda ampliar los estudios interdisciplinares sobre los efectos sociales del VCT y PITC.(AU)

Incentives to provide universal access to antiretroviral therapy in order to control the HIV/AIDS epidemic also encouraged the diversification of HIV testing strategies, as demonstrated by the simultaneous existence of Voluntary Counseling and Testing (VCT) and Provider-Initiated HIV Testing and Counseling (PITC). This paper analyzes the concepts, principles and implementation of the VCT and PITC models regarding counseling, confidentiality and informed consent in Brazil and other countries, based on a literature review of works in the Lilacs, Medline, Sociological Abstracts and Cochrane databases published between 2000 and 2013. According to the literature, PITC increases rates of testing in comparison with VCT, but reduces sexual and reproductive rights and the autonomy of users. These findings suggest technical challenges and ethical tensions between the paradigm of exceptionalism and the normalization of HIV testing. The necessity to reconcile increased access to HIV tests with the local capacity to offer comprehensive care for people living with HIV/AIDS is highlighted. It is recommended that interdisciplinary studies about the social effects of VCT and PITC be amplified.(AU)

Ampliación de las estrategias de consejería y prueba del VIH: desafíos técnicos y tensiones ético-políticas / Expansion of HIV counseling and testing strategies: technical challenges and ethical-political tensions

Los incentivos en el acceso universal a la terapia antirretroviral para el control del VIH-sida, estimularon la diversificación de los modelos de testeo del VIH, que se expresa en la coexistencia del Voluntary Counseling and Testing (VCT) y Provider-Initiated HIV Testing and Counseling (PITC). Este artículo analiza los conceptos, los fundamentos y la aplicación de los modelos VCT y PITC con respecto a la consejería, la confidencialidad y el consentimiento informado en Brasil y en otros países, a partir de una revisión de la bibliografía en las bases Lilacs, Medline, Sociological Abstracts y Cochrane, publicada entre 2000 y 2013. Según los estudios, el PITC aumenta las tasas de testeo en relación con el VCT, pero reduce los derechos sexuales y reproductivos y la autonomía de los usuarios. Estos resultados señalan los desafíos técnicos y las tensiones éticas entre el paradigma de la excepcionalidad y la normalización del test. Se destaca la necesidad de conciliar el aumento en el acceso al examen con la capacidad local de cuidado integral a las personas que viven con VIH-sida y se recomienda ampliar los estudios interdisciplinares sobre los efectos sociales del VCT y PITC.

Incentives to provide universal access to antiretroviral therapy in order to control the HIV/AIDS epidemic also encouraged the diversification of HIV testing strategies, as demonstrated by the simultaneous existence of Voluntary Counseling and Testing (VCT) and Provider-Initiated HIV Testing and Counseling (PITC). This paper analyzes the concepts, principles and implementation of the VCT and PITC models regarding counseling, confidentiality and informed consent in Brazil and other countries, based on a literature review of works in the Lilacs, Medline, Sociological Abstracts and Cochrane databases published between 2000 and 2013. According to the literature, PITC increases rates of testing in comparison with VCT, but reduces sexual and reproductive rights and the autonomy of users. These findings suggest technical challenges and ethical tensions between the paradigm of exceptionalism and the normalization of HIV testing. The necessity to reconcile increased access to HIV tests with the local capacity to offer comprehensive care for people living with HIV/AIDS is highlighted. It is recommended that interdisciplinary studies about the social effects of VCT and PITC be amplified.

Aconselhamento no âmbito dos Centros de Testagem no estado do Rio de Janeiro: uma análise das práticas e saberes na prevenção das DST/Aids / Counseling under the Testing Centers in the state of Rio de Janeiro: a review of practices and knowledge in the prevention of STD / AIDS

Esta tese objetiva analisar os contornos da prática do aconselhamento em DST/Aids em sete Centros de Testagem e Aconselhamento (CTA) do estado do Rio de Janeiro, a partir de duas dimensões: o fazer cotidiano, levando em consideração as articulações entre o contexto da prática e os conhecimentos e competências dos aconselhadores e o saber fazer; constituído pelo roteiros de interação dos mesmos e a história de seu habitus profissional...

This thesis aims to analyze the characteristics of STI/HIV counseling in seven Voluntary Counseling and Testing (VCT) of Rio de Janeiro state. Two dimensions of the practices are analyzed...

Ampliación de las estrategias de consejería y prueba del VIH: desafíos técnicos y tensiones ético-políticas. / [Expansion of HIV counseling and testing strategies: technical challenges and ethical-political tensions].

Incentives to provide universal access to antiretroviral therapy in order to control the HIV/AIDS epidemic also encouraged the diversification of HIV testing strategies, as demonstrated by the simultaneous existence of Voluntary Counseling and Testing (VCT) and Provider-Initiated HIV Testing and Counseling (PITC). This paper analyzes the concepts, principles and implementation of the VCT and PITC models regarding counseling, confidentiality and informed consent in Brazil and other countries, based on a literature review of works in the Lilacs, Medline, Sociological Abstracts and Cochrane databases published between 2000 and 2013. According to the literature, PITC increases rates of testing in comparison with VCT, but reduces sexual and reproductive rights and the autonomy of users. These findings suggest technical challenges and ethical tensions between the paradigm of exceptionalism and the normalization of HIV testing. The necessity to reconcile increased access to HIV tests with the local capacity to offer comprehensive care for people living with HIV/AIDS is highlighted. It is recommended that interdisciplinary studies about the social effects of VCT and PITC be amplified.