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1.
J Occup Health ; 62(1): e12163, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32914534

RESUMEN

OBJECTIVES: To estimate hypertension prevalence and associated factors among female correctional officers (FCO) in female Brazilian prisons. METHODS: Cross-sectional, analytical study conducted in 15 female prisons in all five Brazilian regions between January 2014 and December 2015. The study population consisted of correctional officers with at least 6 months in the position. The sampling included 40% of FCO present in the prison during data collection, yielding 295 FCOs. Data were collected via Audio Computer-Assisted Self-Interview. A physical examination of participants was conducted including blood pressure, weight, and waist and hip circumference. The Odds Ratio and confidence intervals for independent factors were estimated. RESULTS: Hypertension prevalence in correctional officers was 37.9%, (95% CI 32.1-44.0). Hypertension was associated with obesity (95% CI = 1.884-9.947), cardiovascular disease (95% CI = 3.348-16.724), and participation in the specific training course for the relevant position (95% CI = 1.413-9.564). CONCLUSIONS: While findings, except for the last factor, are not novel, this is the first such study conducted in Brazil. Hypertension prevalence among this pool of all female correctional officers is higher than in the average population, and FCOs associate this with the prison environment. Current training does not appear to address this problem. Especially since prison populations are growing in Brazil, this problem needs to be addressed for the health of the FCOs and the prisoners in their care.

2.
Artículo en Inglés | MEDLINE | ID: mdl-32889965

RESUMEN

Brazil has the third largest prison population in the world and is also experiencing a high and rising rate of syphilis infection. To establish the gaps in syphilis testing, we examined data from a nationally representative sample of incarcerated women in Brazil. Data originated from a cross-sectional survey designed to represent all regions of Brazil (N = 1,327). Data were collected by Audio Computer-Assisted Self-Interview, including variables in several blocks or domains. 49.2% had a lifetime history of being tested for syphilis. Increased likelihood of syphilis testing was significantly associated with completed elementary education (odds ratio ajustado [AOR] 1.75, 95% confidence interval [CI] 1.28-2.40), completed high school or more (AOR 2.04, 95% CI 1.36-3.06), income below minimum wage (AOR 1.46, 95% CI 1.10-1.94), homelessness (AOR 1.83, 95% CI 1.21-2.76), having heard of the female condom (AOR 1.92, 95% CI 1.25-2.95), received a condom in prison (AOR 1.56, 95% CI 1.11-2.21) or in public health services (AOR 1.50, 95% CI 1.13-1.98), lifetime history of pregnancy (AOR 2.55, 95% CI 1.67-3.89), had a gynecological examination (AOR 1.73, 95% CI 1.05-2.83), and perceived they had some chance (AOR 1.61, 95% CI 1.17-2.20) or a big chance (AOR 1.89, 95% CI 1.31-2.73) that they were likely to have been infected with HIV before entering prison.

3.
Ciênc. Saúde Colet ; 25(2): 623-632, Feb. 2020. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1055832

RESUMEN

Abstract The present study aims to identify the prevalence of physical violence against female prisoners in Brazil, as well as related factors. This is a cross-sectional national survey conducted in 15 female prisons in five regions of Brazil selected in multiple stages. The following types of analysis were performed: univariate analysis; stratified analysis relating the outcome (suffer physical violence inside prison) to predictor variables, using the Pearson chi-square test; calculation of the Odds Ratio (O.R.); and multiple logistic regression. The Hosmer-Lemeshow test was used for analysis of goodness of fit and adequacy of the model. The prevalence of physical violence inside female prisons was 37.4%. There was a correlation between physical violence victimization in prison and the following variables: physical victimization prior to arrest (p = 0.013), solitary confinement (p = 0.000), mental suffering (p = 0.003), current or previous abusive intake of alcohol (p = 0.011), current or previous injection of cocaine (p = 0.002) and not performing prison labor (p = 0.003). Physical violence has become inherent in the Brazilian female prison system. Continued studies are needed to monitor the situation and to develop interventions to prevent physical violence inside the facilities.


Resumo O presente artigo objetiva identificar a prevalência de violência física no interior das prisões femininas brasileiras, bem como fatores associados. Estudo transversal de abrangência nacional, realizado em 15 unidades prisionais femininas nas cinco regiões do Brasil em amostra selecionada por múltiplos estágios. Realizou-se análise univariada; análise estratificada em relação ao desfecho (sofrer violência física dentro da prisão) e as variáveis preditoras através do teste de Chi-quadrado de Pearson; cálculo da Odds Ratio; e regressão logística múltipla. Utilizou-se o teste Hosmer-Lemeshow para análise de qualidade de ajuste e adequação do modelo. A prevalência de violência física dentro das prisões femininas brasileiras foi de 37.4%. Houve correlação entre a vitimização da violência física na prisão e as seguintes variáveis: vitimização física prévia (p = 0.013), isolamento (p = 0.000), sofrimento mental (p = 0.003), ingestão abusiva e/ou dependência alcoólica (p = 0.011), uso atual ou prévio de cocaína injetável (p = 0.002) e ócio prisional (p = 0.003). A violência física tornou-se inerente ao sistema prisional feminino brasileiro. Estudos futuros são necessários no intuito de fornecer propostas para intervenções efetivas de modo a prevenir a violência física dentro das instalações prisionais.

4.
Cien Saude Colet ; 25(2): 623-632, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32022202

RESUMEN

The present study aims to identify the prevalence of physical violence against female prisoners in Brazil, as well as related factors. This is a cross-sectional national survey conducted in 15 female prisons in five regions of Brazil selected in multiple stages. The following types of analysis were performed: univariate analysis; stratified analysis relating the outcome (suffer physical violence inside prison) to predictor variables, using the Pearson chi-square test; calculation of the Odds Ratio (O.R.); and multiple logistic regression. The Hosmer-Lemeshow test was used for analysis of goodness of fit and adequacy of the model. The prevalence of physical violence inside female prisons was 37.4%. There was a correlation between physical violence victimization in prison and the following variables: physical victimization prior to arrest (p = 0.013), solitary confinement (p = 0.000), mental suffering (p = 0.003), current or previous abusive intake of alcohol (p = 0.011), current or previous injection of cocaine (p = 0.002) and not performing prison labor (p = 0.003). Physical violence has become inherent in the Brazilian female prison system. Continued studies are needed to monitor the situation and to develop  interventions to prevent physical violence inside the facilities.

5.
Sci Rep ; 10(1): 2646, 2020 02 14.
Artículo en Inglés | MEDLINE | ID: mdl-32060389

RESUMEN

Respondent Driven Sampling study (RDS) is a population sampling method developed to study hard-to-reach populations. A sample is obtained by chain-referral recruitment in a network of contacts within the population of interest. Such self-selected samples are not representative of the target population and require weighing observations to reduce estimation bias. Recently, the Network Model-Assisted (NMA) method was described to compute the required weights. The NMA method relies on modeling the underlying contact network in the population where the RDS was conducted, in agreement with directly observable characteristics of the sample such as the number of contacts, but also with more difficult-to-measure characteristics such as homophily or differential characteristics according to the response variable. Here we investigated the use of the NMA method to estimate HIV prevalence from RDS data when information on homophily is limited. We show that an iterative procedure based on the NMA approach allows unbiased estimations even in the case of strong population homophily and differential activity and limits bias in case of preferential recruitment. We applied the methods to determine HIV prevalence in men having sex with men in Brazilian cities and confirmed a high prevalence of HIV in these populations from 3.8% to 22.1%.

6.
AIDS Behav ; 24(3): 938-950, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30879210

RESUMEN

The aim of this study was to estimate the prevalence and factors associated with unprotected receptive anal intercourse (URAI), stratified by age (18-24 or 25 + years old), in a sample of 4,129 MSM recruited by respondent driven sampling in 12 Brazilian cities in 2016. The prevalence of URAI was higher among younger MSM (41.9% vs 29.7%) (p < 0.01). Multivariate analysis indicated that perception of risk, sexual identity, self-rated health status, and having commercial sex were associated with URAI among younger MSM. History of sexual violence, sex with younger partners, having 6 + partners and unprotected sexual debut were associated with URAI among older MSM. Marital status, having stable partner, and reporting sex with men only were associated with URAI in both groups. Despite access to condoms and lubricants, preventive efforts may not be reaching MSM effectively. Age specific intervention approaches, including stigma, discrimination, and perception of risk must be considered.

7.
Sex Transm Dis ; 47(2): 105-110, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31851039

RESUMEN

BACKGROUND: In 2016, approximately 42,000 women were incarcerated in Brazil. The objectives of this study were to measure the lifetime prevalence of syphilis and sociodemographic and behavior correlates of antibody positivity among female prisoners in Brazil. METHODS: We conducted a cross-sectional survey of 1327 incarcerated women in 2014 to 2015 sampled through a multistage cluster design to represent the penitentiary system throughout Brazil. A rapid treponemal antibody test approved by the Ministry of Health (Rapid Test DPP Sífilis Bio-Manguinhos) was used to detect lifetime history of infection. Analyses were adjusted using weights based on the inverse of the product of the probabilities of the sampling units at each stage of the design. Variables significantly associated with syphilis infection at P < 0.05 in multivariate analyses were retained in the final model. RESULTS: Prevalence of syphilis antibody among female prisoners in Brazil was 11.6% (95% confidence interval [CI], 9.8%-13.8%). Higher syphilis prevalence was associated with black/Afro-Brazilian or mixed race/ethnicity (adjusted odds ratio [AOR], 1.78; 95% CI, 1.10-2.87), homelessness (AOR, 4.58; 95% CI, 2.78-7.56), abortion (AOR, 1.56; 95% CI, 1.02-2.38), and sexual violence (AOR, 1.59; 95% CI, 1.01-2.49). Syphilis prevalence was lower among women who had received condoms in school (AOR, 0.28; 95% CI, 0.08-1.00) as a marker for reproductive health education. CONCLUSIONS: Women within the vast Brazilian prison system demonstrate a high lifetime cumulative incidence of syphilis. Our data advocate for increased screening and treatment of syphilis of incarcerated women and help identify women at higher risk within the prison system and within their communities of origin.

8.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190003, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576979

RESUMEN

INTRODUCTION: Discrimination based on sexual orientation can influence vulnerability to HIV, increasing exposure to risky sexual behavior among men who have sex with men (MSM). OBJECTIVES: To analyze data using latent class analysis (LCA) to identify groups of individuals with specific patterns of discrimination based on sexual orientation (DSO). METHODS: Cross-sectional study using respondent-driven sampling in 12 Brazilian cities in 2016. LCA was used to characterize discrimination among MSM based on 13 variables in the survey questionnaire. The proportions of men reporting DSO and other variables of interest were estimated using Gile's Successive Sampling estimator. RESULTS: Most MSM were young, single, had a religion, had a high school or college degree, black or brown skin color, and socioeconomic status classified as average. More than half of the participants reported that they had been discriminated against during the last 12 months due to their sexual orientation (65%), more than a third said they had felt afraid of walking in public places during the past 12 months, and about one-fifth of participants reported having been victims of physical or sexual assault due to DSO. DSO was classified into four latent classes: "very high", "high", "moderate" and "low", with estimates of 2.2%, 16.4%, 35.1%, and 46.19%, respectively. CONCLUSION: We observed a high proportion of discrimination against MSM in this study. The use of LCA differentiated parsimoniously classes of discrimination.


Asunto(s)
Homosexualidad Masculina/estadística & datos numéricos , Sexismo/estadística & datos numéricos , Adulto , Brasil/epidemiología , Estudios Transversales , Discriminación en Psicología , Homosexualidad Masculina/etnología , Humanos , Análisis de Clases Latentes , Masculino , Autoinforme , Sexismo/etnología , Factores Socioeconómicos
9.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190005, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31576981

RESUMEN

INTRODUCTION: High level of HIV/AIDS knowledge is required for an effective adoption of preventive strategies. OBJECTIVE: To assess HIV/AIDS knowledge among men who have sex with men (MSM) in 12 Brazilian cities. METHODS: Respondent-Driven Sampling method was used for recruitment. HIV/AIDS knowledge was assessed by Item Response Theory. Difficulty and discrimination parameters were estimated, and the knowledge score was categorized in three levels: high, medium, and low. Logistic regression was used for analysis. RESULTS: Among 4,176 MSM, the proportion of high level of knowledge was 23.7%. The following variables were positively associated with high knowledge (p < 0.05): age 25+ years old, 12+ years of schooling, white skin color, having health insurance, having suffered discrimination due to sexual orientation, having had a syphilis test, and having received educational material in the previous 12 months. Exchanging sex for money was negatively associated. CONCLUSIONS: The proportion of only 23.7% of high HIV/AIDS knowledge was low. We should note that the only potential source of knowledge acquisition associated with high level of knowledge was receiving educational materials. Our study indicates the need for expansion of public prevention policies focused on MSM and with more effective communication strategies, including the development of knowledge that involves motivation and abilities for a safer behavior.


Asunto(s)
Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Brasil , Estudios Transversales , Infecciones por VIH/prevención & control , Conductas de Riesgo para la Salud , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Factores Socioeconómicos , Encuestas y Cuestionarios
10.
Rev Bras Epidemiol ; 22: e190004, 2019 03 14.
Artículo en Inglés | MEDLINE | ID: mdl-30892467

RESUMEN

INTRODUCTION: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. METHODS: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. RESULTS: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). CONCLUSION: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.


Asunto(s)
Infecciones por VIH/diagnóstico , Hepatitis B/diagnóstico , Hepatitis C/diagnóstico , Homosexualidad Masculina/estadística & datos numéricos , Sífilis/diagnóstico , Adulto , Brasil/epidemiología , Infecciones por VIH/epidemiología , Encuestas Epidemiológicas/métodos , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Humanos , Masculino , Vigilancia de la Población , Prevalencia , Autoinforme , Encuestas y Cuestionarios , Sífilis/epidemiología
11.
J Interpers Violence ; 34(21-22): 4404-4420, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-29294619

RESUMEN

Although teen dating violence victims' reticence in seeking help from adults is well documented, little is known about youths' comparative perceptions of the types of help offered by and effectiveness of various sources. This qualitative study solicited teens' perceptions of sources of help for victims using in-depth interviews with African American youth (ages 13-18) in two public high schools in New Orleans (N = 38). Participants were recruited purposively by researchers during lunchtime and via referral by school personnel. Interviews were transcribed verbatim and coded independently by two study team members. Thematic content analyses were conducted. Teens reported that victims were most likely to seek help from friends, who were largely expected to provide advice and comfort. Nearly half reported that teens would be likely to seek help from family, who would provide more active responses to dating violence (i.e., reporting to authorities, confronting the abuser). Fewer respondents believed teens would seek help from other adults, such as school personnel, who were also perceived as likely to enlist outside authorities. Fears about lack of confidentiality and over-reaction were the main perceived barriers to accessing help from adults. Furthermore, although respondents believed teens would be less likely to seek help from adults, adults were perceived as more effective at stopping abuse compared with peers. Interventions that train peer helpers, explain confidentiality to teens, increase school personnel's ability to provide confidential counseling, and promote use of health services may improve access to help for teen dating violence victims.

12.
Rev. bras. epidemiol ; 22: e190004, 2019. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-990748

RESUMEN

ABSTRACT: Introduction: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. Methods: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. Results: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). Conclusion: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.


RESUMO: Introdução: Este artigo detalha os métodos utilizados na segunda Pesquisa Nacional de Vigilância Biológica e Comportamental (BBSS) do HIV, sífilis e hepatite B e C entre os homens que fazem sexo com homens no Brasil. Métodos: O método Respondent-driven Sampling (RDS) foi utilizado em 12 cidades em 2016. A amostra foi iniciada com cinco a seis sementes em cada cidade. Testes rápidos para o HIV, sífilis e Hepatite B e C foram oferecidos aos participantes. O software RDS Analyst com o estimador de amostragem sucessiva (SS) de Gile foi utilizado para ajustar os resultados como recomendado, gerando um peso para cada indivíduo para análises. Osdados das 12cidades foram unidos em um único banco e analisados usando as ferramentas de dados complexos do Stata 14.0, com cada cidade sendo tratada como seu próprio estrato. Resultados: A duração da coleta de dados variou de 5,9 a 17,6 semanas e 4.176 homens foram recrutados nas 12 cidades. Dois sites não alcançaram o tamanho da amostra alvo devido a uma demora de seis meses na aprovação local do Comitê de Ética. Todas as cidades atingiram a convergência na principal variável estudada (HIV). Conclusão: O BBSS foi representativo e concluído conforme planejado e dentro do orçamento. A descrição dos métodos aqui é mais detalhada do que o habitual, devido às novas ferramentas e requisitos de diagnóstico das novas diretrizes do STROBE-RDS.

13.
Rev. bras. epidemiol ; 22(supl.1): e190005, 2019. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1042211

RESUMEN

ABSTRACT Introduction: High level of HIV/AIDS knowledge is required for an effective adoption of preventive strategies. Objective: To assess HIV/AIDS knowledge among men who have sex with men (MSM) in 12 Brazilian cities. Methods: Respondent-Driven Sampling method was used for recruitment. HIV/AIDS knowledge was assessed by Item Response Theory. Difficulty and discrimination parameters were estimated, and the knowledge score was categorized in three levels: high, medium, and low. Logistic regression was used for analysis. Results: Among 4,176 MSM, the proportion of high level of knowledge was 23.7%. The following variables were positively associated with high knowledge (p < 0.05): age 25+ years old, 12+ years of schooling, white skin color, having health insurance, having suffered discrimination due to sexual orientation, having had a syphilis test, and having received educational material in the previous 12 months. Exchanging sex for money was negatively associated. Conclusions: The proportion of only 23.7% of high HIV/AIDS knowledge was low. We should note that the only potential source of knowledge acquisition associated with high level of knowledge was receiving educational materials. Our study indicates the need for expansion of public prevention policies focused on MSM and with more effective communication strategies, including the development of knowledge that involves motivation and abilities for a safer behavior.


RESUMO Introdução: Alto nível de conhecimento sobre HIV/aids é necessário para uma efetiva adoção de estratégias preventivas. Objetivo: Avaliar o nível de conhecimento sobre HIV/aids entre homens que fazem sexo com homens (HSH) de 12 cidades brasileiras. Metodologia: O método Respondent-Driven Sampling foi utilizado para recrutamento. O conhecimento sobre HIV/aids foi avaliado por meio de 12 perguntas e analisados pela Teoria de Resposta ao Item. Foram estimados os parâmetros de dificuldade e discriminação e o escore de conhecimento categorizado em três níveis: alto, médio e baixo. Regressão logística foi utilizada para a análise. Resultados: Do total de 4.176 HSH, a proporção de alto nível de conhecimento foi de 23,7%. Estiveram associados positivamente (p < 0,05) com o alto conhecimento: idade 25+ anos, escolaridade 12+ anos, cor da pele branca, ter plano de saúde, ter sofrido discriminação devido à orientação sexual, ter realizado teste para sífilis e recebido material educativo nos últimos 12 meses. Ter recebido dinheiro por sexo esteve negativamente associado. Conclusões: A proporção de apenas 23,7% de alto nível de conhecimento sobre HIV/aids foi baixa. Destaca-se que a única potencial fonte formal de aquisição de conhecimento associada com alto nível de conhecimento foi receber material educativo. Este estudo aponta a necessidade de expandir as políticas públicas de prevenção focadas no segmento HSH e com estratégias de comunicação mais eficazes, incluindo o desenvolvimento de conhecimento que envolva motivação e habilidade para um comportamento mais seguro.

14.
Rev. bras. epidemiol ; 22(supl.1): e190003, 2019. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1042212

RESUMEN

ABSTRACT Introduction: Discrimination based on sexual orientation can influence vulnerability to HIV, increasing exposure to risky sexual behavior among men who have sex with men (MSM). Objectives: To analyze data using latent class analysis (LCA) to identify groups of individuals with specific patterns of discrimination based on sexual orientation (DSO). Methods: Cross-sectional study using respondent-driven sampling in 12 Brazilian cities in 2016. LCA was used to characterize discrimination among MSM based on 13 variables in the survey questionnaire. The proportions of men reporting DSO and other variables of interest were estimated using Gile's Successive Sampling estimator. Results: Most MSM were young, single, had a religion, had a high school or college degree, black or brown skin color, and socioeconomic status classified as average. More than half of the participants reported that they had been discriminated against during the last 12 months due to their sexual orientation (65%), more than a third said they had felt afraid of walking in public places during the past 12 months, and about one-fifth of participants reported having been victims of physical or sexual assault due to DSO. DSO was classified into four latent classes: "very high", "high", "moderate" and "low", with estimates of 2.2%, 16.4%, 35.1%, and 46.19%, respectively. Conclusion: We observed a high proportion of discrimination against MSM in this study. The use of LCA differentiated parsimoniously classes of discrimination.


RESUMO Introdução: A discriminação por orientação sexual (DPOS) pode influenciar a vulnerabilidade ao HIV aumentando a exposição a comportamentos sexuais de risco entre homens que fazem sexo com homens (HSH). Objetivos: Examinar dados utilizando a análise de classes latentes (ACL) para identificar grupos de indivíduos com padrões específicos de DPOS. Métodos: Estudo transversal com entrevistados recrutados pelo processo amostral respondent driven sampling em 12 cidades brasileiras em 2016. A ACL foi usada para caracterizar o DPOS entre HSH com base em 13 variáveis do bloco de discriminação do questionário da pesquisa. As proporções de DPOS e das variáveis de interesse, bem como seus intervalos de confiança (95%) foram ponderados usando o estimador de Gile. Resultados: A maioria era de jovens, solteiros, com alguma religião, escolaridade média ou superior, cor da pele preta ou parda e com nível socioeconômico médio. Mais da metade referiu ter sido discriminado nos últimos 12 meses por sua orientação sexual (65%), mais de um terço referiu ter tido medo de andar em lugares públicos nos últimos 12 meses e em torno de um quinto dos participantes reportaram ter sofrido agressão física ou sexual na vida. A DPOS foi classificada em 4 classes latentes, "muito alta", "alta", "média" e "baixa", com estimativas de 2,2%, 16,4%, 35,1% e 46,19%, respectivamente. Conclusão: Observou-se alta proporção de discriminação entre os HSH participantes deste estudo. A utilização da ACL discriminou de maneira parcimoniosa as classes de DPOS.

15.
Transgend Health ; 3(1): 118-126, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30014040

RESUMEN

Purpose: Gender Minority (GM) individuals experience healthcare access barriers, including financial concerns and discrimination, which influence their health seeking behaviors. This study explores the alternative navigation strategies used by GM individuals to cope with these barriers and access care, both biomedical and complementary and alternative medicine (CAM). Methods: In-depth interviews were conducted with GM individuals (n=18) and healthcare providers (n=5) identified through purposive sampling. Semistructured guides were used to elicit information about healthcare seeking strategies and experiences. Transcribed interview data were coded, sorted, and analyzed for key themes. Results: Commonly discussed healthcare access barriers included the following: identifying a competent provider, costs and insurance obstacles, and anticipated discrimination. Respondents expressed a need for gender-affirming care within the biomedical system, and alternative navigation strategies to overcome access barriers, including travelling abroad for surgical procedures, ordering hormones online, and sharing with friends. Respondents discussed CAM principally related to emotional health, preferring CAM to biomedical offerings. Utilizing social networks to access all care modalities was common. Conclusions: The healthcare-seeking behavior of GM individuals demonstrates great resilience. This population is committed to accessing gender-affirming care regardless of the associated risks of care outside of provider supervision. The healthcare community needs to eliminate access barriers and support harm reduction strategies. CAM for emotional health support and the role of social networks in accessing care resources should be better integrated into care for this population.

16.
Rev Saude Publica ; 52: 64, 2018 Jun 28.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-29972431

RESUMEN

OBJECTIVE: Estimating HIV prevalence and describing the incentives and barriers for HIV testing among female sex workers. METHODS: This cross-sectional study recruited 402 women aged 18 years or older, residing in Fortaleza, state of Ceará, Brazil, who reported having had sexual intercourse in exchange for money in last four months. The sample was recruited using Respondent Driven Sampling, between August and November 2010. RESULTS: The 84.1% of the sample tested and the estimated prevalence of HIV infection was 3.8%. The sample was young (25 to 39 years ), single (80.0%), with one to three children (83.6%), had eight or more years of schooling (65.7%), and belonged to social classes D/E (53.1%). The majority worked in fixed locations (bars, motels, hotels, sauna - 88.9%), and prostitution was their only source of income (54.1%). About 25% of the sample did not know where to test in the public health sector and 51.8% either never tested or hadn't tested for over a year or more. The main reported barriers to testing were the perceptions that there was no risk of becoming infected (24.1%), and, alternatively, fear of discrimination if the test was positive (20.5%). Incentives for testing were the greater availability of testing sites (57.0%) and health facilities with alternative schedules (44.2%). CONCLUSIONS: Prevalence for HIV was similar to that found in other Brazilian cities in different regions of the country, although higher than the general female population. Non-traditional venues not associated with the health system and availability of testing in health units during non-commercial hours are factors that encourage testing. Not considering oneself to be at risk, fear of being discriminated against and not knowing testing locations are barriers.


Asunto(s)
Infecciones por VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Trabajadores Sexuales/estadística & datos numéricos , Adolescente , Adulto , Anciano , Brasil/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Accesibilidad a los Servicios de Salud , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Prevalencia , Trabajadores Sexuales/psicología , Factores Socioeconómicos , Adulto Joven
17.
Medicine (Baltimore) ; 97(1S Suppl 1): S62-S68, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29912816

RESUMEN

INTRODUCTION: Periodic monitoring of sociobehavior characteristics at a national level is an essential component of understanding the dynamics the human immunodeficiency virus (HIV) epidemic worldwide, including Brazil. METHODS: This paper compares descriptive sociobehavior characteristics in 2 national cross-sectional HIV biological behavioral surveillance surveys (BBSS) conducted in 2009 and 2016 among men who have sex with men (MSM) in Brazil. Respondent driven sampling (RDS) was used for recruitment in both years. Overall proportions were weighted according to Gile's estimator using RDS Analyst Software and 95% confidence intervals were calculated for comparisons between the 2 periods. Further comparisons were stratified by age groups (<25 and 25+ years old). RESULTS: Overall, 3749 and 4176 MSM were recruited in 2009 and 2016, respectively. In 2016, participants were younger than 25 years old (58.3%), with 12 or more years of education (70.4%), with higher socioeconomic status (40.7%), and had a higher proportion of whites (31.8%), as compared to 2009. Also, participants in 2016 reported less alcohol use and binge drinking, but used illicit drugs more frequently. There was an increase among MSM who self-reported their HIV risk as low and had low HIV knowledge while the proportion of those who were never tested for HIV dropped from 49.8% in 2009 to 33.8% in 2016. Although more than three-quarters received free condoms in both years, STD counseling remained low (32% and 38% for 2009 and 2016, respectively). Sexual risk behavior remained at high levels, especially unprotected anal receptive sex and sex with multiple partners. Younger MSM (<25 years old) showed riskier sexual practices than those 25+ years old, when comparing 2016 to 2009. CONCLUSIONS: Our results indicate a worrisome risk behavior trend among Brazilian MSM, especially among younger ones. These results can contribute for a better understanding of the HIV epidemics in Brazil, with timely shift in strategies so improved effectiveness in public health prevention efforts can be achieved.


Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Asunción de Riesgos , Conducta Sexual/psicología , Adolescente , Adulto , Brasil/epidemiología , Condones/provisión & distribución , Estudios Transversales , VIH/aislamiento & purificación , VIH/patogenicidad , Infecciones por VIH/mortalidad , Homosexualidad Masculina/psicología , Humanos , Drogas Ilícitas/efectos adversos , Masculino , Prevalencia , Muestreo , Autoinforme , Conducta Sexual/estadística & datos numéricos , Clase Social , Sexo Inseguro/estadística & datos numéricos , Adulto Joven
18.
Medicine (Baltimore) ; 97(1S Suppl 1): S9-S15, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29794604

RESUMEN

This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS).Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy.A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities.A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7-20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4-21.7) were seropositive.HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0-14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.


Asunto(s)
Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Brasil/epidemiología , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
19.
Cult Health Sex ; 20(12): 1362-1377, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29533145

RESUMEN

Gender-minority health disparity research is limited by binary gender measurement practices. This study seeks to broaden current discourse on gender identity measurement in the USA, including measurement adoption challenges and mitigation strategies, thereby allowing for better data collection to understand and address health disparities for people of all genders. Three data sources were used to triangulate findings: expert interviews with gender and sexuality research leaders; key-informant interviews with gender minorities in New Orleans, LA; and document analysis of relevant surveys, guides and commentaries. Ten key dilemmas were identified: 1) moving beyond binary gender construction; 2) conflation of gender, sex and sexual orientation; 3) emerging nature of gender-related language; 4) concerns about item sensitivity; 5) research fatigue among gender minorities; 6) design and analytical limitations; 7) categorical and procedural consistency; 8) pre-populated vs. open-field survey items; 9) potential misclassification; and 10) competing data collection needs. Researchers must continue working toward consensus concerning better practices is gender measurement and be explicit about their methodological choices. The existence of these dilemmas must not impede research on important health issues affecting gender minorities.


Asunto(s)
Identidad de Género , Minorías Sexuales y de Género , Femenino , Accesibilidad a los Servicios de Salud , Disparidades en el Estado de Salud , Humanos , Entrevistas como Asunto , Masculino , Investigación Cualitativa , Investigación , Encuestas y Cuestionarios , Estados Unidos
20.
Braz J Infect Dis ; 22(2): 113-122, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29551334

RESUMEN

HIV/AIDS epidemic is not well controlled, and multiple sexual behavior factors help explain high rates of HIV infection among men who have sex with men (MSM). This article proposes to exam the use of a potential risk behavior score for HIV infection, based on the type and number of sexual partners, and condom use, and their associated factors in a sample of MSM in Brazil. A cross sectional RDS (Respondent Driven Sampling) study was performed among 3738 MSM aged 18+ years old from ten Brazilian cities. The risk behavior score was composed by the number of male partners and anal condom use in the last year with steady, casual, and commercial partners. Most participants were 25+ years old (58.1%), non-white (83.1%), and single (84.9%). Final weighted ordinal logistic model showed that age≤25 years old (p=0.037), homosexual or bisexual identity (p<0.001), sexual initiation before 15-year-old (p<0.001), having sex with men only in the last 12 months (p<0.001), frequent alcohol and illicit drug use (p<0.001), and use of local sites to meet sexual partners in the last month were independently associated with higher scores of risky behavior. Specific strategies should be developed aimed at the MSM population. Additionally, pre-exposed prophylaxis (Prep) should be considered for those at higher score as a strategy for reducing risk for HIV infection in this population.


Asunto(s)
Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Asunción de Riesgos , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Adolescente , Adulto , Brasil/epidemiología , Condones/estadística & datos numéricos , Estudios Transversales , Escolaridad , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Masculino , Medición de Riesgo , Factores de Riesgo , Parejas Sexuales , Clase Social , Sífilis/sangre , Sífilis/transmisión , Adulto Joven
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