Narrative review of studies on HIV pre-exposure prophylaxis in Brazil and its implementation in the public health network.

OBJECTIVES: To discuss studies conducted in Brazil relating to PrEP, from 2012 to 2022, based on a narrative review. METHODOLOGY: The databases of the Virtual Health Library/PAHO, portals from Scielo, Scopus, and PubMed, and the descriptors in English and Portuguese 'Pre-exposure to HIV' and 'Brazil' were used, as well as a list of planned/in-progress demonstrative studies. Inclusion criteria consists of articles with fieldwork in Brazil coupled with PrEP in the Brazilian scenario; and articles in English or Portuguese. Articles in which PrEP was not the central theme and the participating Brazilian population did not reside in Brazil were excluded. RESULTS: 107 papers have been reviewed, 80 articles met the inclusion criteria. The majority participating population was men who have sex with men. 61 studies preceded the implementation of PrEP in Brazil. Studies carried out after implementation (n = 19) deal primarily with the impact of the COVID-19 pandemic. CONCLUSIONS: There was an incipient number of studies on the injectable form of PrEP. Fewer studies included segments with greater difficulties in access, use, and adherence. Despite the issues that circumscribe this prevention technology, literature is consensual on the importance of Brazilian leadership for implementing PrEP.

Factors Associated with Low Levels of HIV Testing among Men Who Have Sex with Men (MSM) in Brazil.

The aim of this study was to assess risk factors associated with low levels of HIV testing among MSM recruited through respondent driven sampling (RDS) in Brazil. Of 3,617 participants, 48.4% had never tested previously for HIV. A logistic model indicated that younger age, lower socioeconomic class, education, poor HIV/AIDS knowledge, no history of cruising, and having been tested during the study were characteristics independently associated with low levels of previous HIV testing. The HIV testing rate among MSM in Brazil is still low in spite of the availability of a large number services providing universal and free access to HIV/AIDS diagnosis and treatment. To respond to low utilization, the authors propose a higher priority for testing for key populations such as MSM, expanded education, expanding testing sites and a welcoming and nonjudgmental environment in health services.

HIV-1, HBV, HCV, HTLV, HPV-16/18, and Treponema pallidum infections in a sample of Brazilian men who have sex with men.

BACKGROUND: Men who have sex with men (MSM) are more vulnerable to blood-borne infections and/or sexually-transmitted infections (STI). This study was conducted to estimate the prevalences of mono and co-infections of HIV-1 and other blood-borne/STIs in a sample of MSM in Campinas, Brazil. METHODS: Responding Driven Sampling (RDS) was used for recruitment of MSM. Serum samples collected from 558 MSM were analyzed for the presence of serological markers for HIV-1, HBV, HCV, HTLV, HPV-16/18, and T. pallidum infections. RESULTS: The highest prevalences of infection in serum samples were found for HPV-16 and 18 (31.9% and 20.3%, respectively). Approximately 8% of the study population showed infection with HIV-1, and within that group, 27.5% had recently become infected with HIV-1. HBV infection and syphilis were detected in 11.4% and 10% of the study population, respectively, and the rates of HTLV and HCV infection were 1.5% and 1%, respectively. With the exception of HTLV, all other studied infections were usually found as co-infections rather then mono-infections. The rates of co-infection for HCV, HPV-18, and HIV-1 were the highest among the studied infections (100%, 83%, and 85%, respectively). Interestingly, HTLV infection was usually found as a mono-infection in the study group, whereas HCV was found only as a co-infection. CONCLUSIONS: The present findings highlight the need to educate the MSM population concerning their risk for STIs infections and methods of prevention. Campaigns to encourage vaccination against HBV and HPV could decrease the rates of these infections in MSM.

Exploring the relationship between induced abortion and HIV infection in Brazil.

The impact of HIV on the decision to interrupt pregnancy remains an understudied topic in Brazil and the world. The technical means to implement HIV prevention and treatment interventions are widely available in Brazil. Although Brazil has restrictive abortion laws, induced abortion occurs frequently. This qualitative study investigates the extent to which Brazilian women are motivated to seek abortion as a consequence of having HIV disease, and the extent to which the decision is part of a larger reproductive decision-making context. Researchers interviewed 30 women who were living with HIV and had terminated pregnancies or attempted to do so. Many women identified their HIV status as an important aspect of their decision-making regarding abortion. Women also took into account issues such as the stage of life when the pregnancy occurred and the absence of support from partners and families. Contraceptive practices, pregnancy and abortion in this population are influenced by multiple factors that act on the structural, social, interpersonal and individual levels. We hypothesize that HIV infection and abortion are sometimes associated with similar contexts of vulnerability. Health services therefore should address HIV and reproductive issues together, with reproductive and sexual rights serving as the fundamental basis of health care.

[Early diagnosis and correlations of sexually transmitted infections among women in primary care health services]. / Diagnóstico precoce e os fatores associados às infecções sexualmente transmissíveis em mulheres atendidas na atenção primária.

INTRODUCTION: Sexually Transmitted Infections (STIs) in women remain a public health challenge due to high prevalence, difficulties to implement early diagnosis strategies and high rates of complications. OBJECTIVE: Identify the prevalence of STIs among users of a primary health care clinic in São Paulo. METHODS: Women, 18 to 40 years of age, were invited to self-collect vaginal specimens to be tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by Polymerase Chain Reaction (PCR). Women were also invited to answer a demographic and sexual history questionnaire, either on the computer or face-to-face. RESULTS: The prevalence of STIs obtained from the 781 women included in the study was: Chlamydia trachomatis: 8.4%, Neisseria gonorrhoeae: 1.9%, and Trichomonas vaginalis: 3.2%. Thirteen percent tested positive for at least one out of the three STIs. The variables associated independently with a higher risk of STIs were: age under 20-years-old, more than two lifetime sexual partners, and self-perception of STI risk. The use of condoms as a contraceptive method proved to be a protective factor. CONCLUSION: The high prevalence found among these women indicates the need for the implementation of STI screening strategies in primary care settings in Brazil.

Prevalence and factors associated with HSV-2 and hepatitis B infections among truck drivers crossing the southern Brazilian border.

OBJECTIVES: The authors estimate the prevalence of HIV, syphilis, hepatitis B virus (HBV) and herpes simplex virus type-2 (HSV-2) infection and correlates of HBV and HSV-2 infection among truck drivers crossing the southern Brazilian border at Foz do Iguaçu. METHODS: Between October 2003 and March 2005, 1945 truck drivers were sampled while accessing voluntary counselling and testing services; 1833 (94.2%) were tested for HIV (ELISA and confirmatory immunofluorescence assay) and syphilis (non-treponemal (VDRL) and treponemal tests (FTA-ABS)). From these, 799 stored sera were tested for HSV-2 (type-specific ELISA test for detection of IgG) and HBV (core antibodies (anti-HBc) with positives tested for surface antigen (HBsAg)). The authors estimate HIV, syphilis, HSV-2 and HBV prevalence and determine socio-demographic and behavioural correlates of HSV-2 infection and HBV exposure. RESULTS: HIV prevalence was 0.3% (95% CI 0.1 to 0.6) and syphilis 4.5% (95% CI 3.6 to 5.4). Among those tested for HBV and HSV-2, 32.3% (95% CI 28.9 to 35.6) had serological evidence of exposure to HBV and 26.6% (95% CI 23.5 to 29.7) tested positive for HSV-2. Factors independently associated with HBV exposure included increasing age, Brazilian nationality and unprotected anal sex. Increasing age and reporting an unknown number of lifetime partners were associated with HSV-2 infection. CONCLUSIONS: In this sample of truck drivers in southern Brazil, HIV prevalence was lower than national population estimates; exposure to HBV was higher than population estimates, while per cent positive for HSV-2 was similar to population estimates. The low prevalence of HIV in truck drivers indicates prevention successes; however, future HIV prevention programming should incorporate HBV vaccination and sexually transmitted infection prevention.

Diagnóstico precoce e os fatores associados às infecções sexualmente transmissíveis em mulheres atendidas na atenção primária / Early diagnosis and correlations of sexually transmitted infections among women in primary care health services

INTRODUÇÃO: Infecções Sexualmente Transmissíveis (IST) em mulheres permanecem um desafio para a Saúde Pública: elevada prevalência, dificuldade para implantação de estratégias de diagnóstico precoce e elevada ocorrência de sequelas. OBJETIVO: Identificar a prevalência de IST em usuárias de um serviço de atenção primária à saúde em São Paulo. MÉTODOS: Mulheres de 18 a 40 anos foram convidadas para realizar autocoleta de secreção vaginal para a detecção de Chlamydia trachomatis, Neisseria gonorrhoeae e Trichomonas vaginalis por meio de Reacão em Cadeia da Polimerase (PCR). As mulheres também responderam a um questionário com questões demográficas e relativas à história sexual face a face ou autoaplicado por meio de um computador. RESULTADOS: Das 781 mulheres incluídas no estudo, as prevalências obtidas foram: Chlamydia trachomatis (8,4 por cento), Neisseria gonorrhoeae (1,9 por cento) e Trichomonas vaginalis (3,2 por cento). A positividade para pelo menos uma das três IST foi de 13 por cento. As variáveis associadas independentemente com maior risco de IST foram: idade menor que 20 anos, mais de dois parceiros sexuais na vida e percepção de risco para IST; o uso de preservativo como método contraceptivo foi um fator protetor. CONCLUSÃO: A prevalência encontrada em usuárias indica a necessidade da implantação de estratégias de rastreamento de IST em serviços de atenção primária.

INTRODUCTION: Sexually Transmitted Infections (STIs) in women remain a public health challenge due to high prevalence, difficulties to implement early diagnosis strategies and high rates of complications. OBJECTIVE: Identify the prevalence of STIs among users of a primary health care clinic in São Paulo. METHODS: Women, 18 to 40 years of age, were invited to self-collect vaginal specimens to be tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by Polymerase Chain Reaction (PCR). Women were also invited to answer a demographic and sexual history questionnaire, either on the computer or face-to-face. RESULTS: The prevalence of STIs obtained from the 781 women included in the study was: Chlamydia trachomatis: 8.4 percent, Neisseria gonorrhoeae: 1.9 percent, and Trichomonas vaginalis: 3.2 percent. Thirteen percent tested positive for at least one out of the three STIs. The variables associated independently with a higher risk of STIs were: age under 20-years-old, more than two lifetime sexual partners, and self-perception of STI risk. The use of condoms as a contraceptive method proved to be a protective factor. CONCLUSION: The high prevalence found among these women indicates the need for the implementation of STI screening strategies in primary care settings in Brazil.

[Contexts of HIV vulnerability among Brazilian women]. / Contextos de vulnerabilidade para o HIV entre mulheres brasileiras.

This article aims to identify contexts of vulnerability related to HIV among Brazilian women. From November 2003 to December 2004, a cross-sectional study was conducted in 13 municipalities in the five Brazilian regions. The study included 1,777 women with a positive HIV diagnosis and 2,045 women attending public health care services. There were no significant differences between the two groups concerning number of sexual partners. However, HIV-positive women had a history of earlier sexual initiation and lower frequency of condom use. Higher proportions of HIV-positive women had used drugs, had a history of previous STDs, and had been victims of sexual violence some time in their life. The findings suggest the importance of considering strategies for HIV prevention focused on women's empowerment as a whole, and not focused only on their individual behaviors.

Contextos de vulnerabilidade para o HIV entre mulheres brasileiras / Contexts of HIV vulnerability among Brazilian women

Este artigo tem como objetivo identificar os contextos de vulnerabilidade para o HIV entre mulheres brasileiras. Entre novembro de 2003 a dezembro de 2004 foi realizado um estudo de corte transversal em 13 municípios distribuídos nas cinco regiões do país, incluindo, respectivamente, 1.777 mulheres com diagnóstico positivo para HIV e 2.045 mulheres usuárias de serviços públicos de atenção à saúde da mulher sem diagnóstico conhecido de soropositividade para o HIV. A comparação entre os dois grupos mostrou que as mulheres com diagnóstico de HIV/AIDS não apresentaram um número de parceiros significativamente diferente com relação às mulheres sem diagnóstico de HIV/AIDS. No entanto, as mulheres vivendo com HIV/AIDS apresentaram início da vida sexual mais precoce, menor aderência ao uso de preservativos, e uma maior proporção dessas mulheres relatou uso de drogas, ocorrência de DST e de violência sexual na vida. Tais resultados sugerem a importância de pensar em estratégias de prevenção voltadas para o fortalecimento das mulheres e não apenas focadas em seus comportamentos individuais.

This article aims to identify contexts of vulnerability related to HIV among Brazilian women. From November 2003 to December 2004, a cross-sectional study was conducted in 13 municipalities in the five Brazilian regions. The study included 1,777 women with a positive HIV diagnosis and 2,045 women attending public health care services. There were no significant differences between the two groups concerning number of sexual partners. However, HIV-positive women had a history of earlier sexual initiation and lower frequency of condom use. Higher proportions of HIV-positive women had used drugs, had a history of previous STDs, and had been victims of sexual violence some time in their life. The findings suggest the importance of considering strategies for HIV prevention focused on women's empowerment as a whole, and not focused only on their individual behaviors.

Contextos de vulnerabilidade para o HIV entre mulheres brasileiras / Contexts of HIV vulnerability among Brazilian women

Este artigo tem como objetivo identificar os contextos de vulnerabilidade para o HIV entre mulheres brasileiras. Entre novembro de 2003 a dezembro de 2004 foi realizado um estudo de corte transversal em 13 municípios distribuídos nas cinco regiões do país, incluindo, respectivamente, 1.777 mulheres com diagnóstico positivo para HIV e 2.045 mulheres usuárias de serviços públicos de atenção à saúde da mulher sem diagnóstico conhecido de soropositividade para o HIV. A comparação entre os dois grupos mostrou que as mulheres com diagnóstico de HIV/AIDS não apresentaram um número de parceiros significativamente diferente com relação às mulheres sem diagnóstico de HIV/AIDS. No entanto, as mulheres vivendo com HIV/AIDS apresentaram início da vida sexual mais precoce, menor aderência ao uso de preservativos, e uma maior proporção dessas mulheres relatou uso de drogas, ocorrência de DST e de violência sexual na vida. Tais resultados sugerem a importância de pensar em estratégias de prevenção voltadas para o fortalecimento das mulheres e não apenas focadas em seus comportamentos individuais.(AU)

This article aims to identify contexts of vulnerability related to HIV among Brazilian women. From November 2003 to December 2004, a cross-sectional study was conducted in 13 municipalities in the five Brazilian regions. The study included 1,777 women with a positive HIV diagnosis and 2,045 women attending public health care services. There were no significant differences between the two groups concerning number of sexual partners. However, HIV-positive women had a history of earlier sexual initiation and lower frequency of condom use. Higher proportions of HIV-positive women had used drugs, had a history of previous STDs, and had been victims of sexual violence some time in their life. The findings suggest the importance of considering strategies for HIV prevention focused on women's empowerment as a whole, and not focused only on their individual behaviors.(AU)

Consistency in women's reports of sensitive behavior in an interview mode experiment, São Paulo, Brazil.

CONTEXT: Inaccurate reporting of sexual behavior creates a misleading picture of individuals' risk for STI infection. Despite a substantial body of U.S. research on the consistency of self-reports of sensitive behavior, only a few such studies have been conducted in developing countries. METHODS: Consistency in the reporting of sexual activity and other sensitive behaviors was assessed among 818 women aged 18-40 who enrolled in 2004 in a study examining STI screening and diagnosis in São Paulo, Brazil. Participants were randomized into face-to-face interview and audio computer-assisted self-interview (audio-CASI) groups, and a six-week follow-up interview was conducted using audio-CASI for all participants. Differences between groups were assessed using t tests, and logistic regression analyses were used to estimate the likelihood of inconsistency within the enrollment interview and between the enrollment and follow-up interviews. RESULTS: Consistency in reporting at the enrollment interview was higher in the face-to-face group than in the audio-CASI group, likely because interviewers prompted women to reconcile discrepant responses, whereas the audio-CASI program did not enforce logical consistency. However, consistency between enrollment and follow-up was significantly lower in the face-to-face group for abortion, marijuana use, transactional sex, coerced sex and number of lifetime sexual partners, because of increased reporting at follow-up using audio-CASI. CONCLUSION: Although the analysis of internal consistency at enrollment suggests that computerized interviewing may increase random measurement error, it appears to reduce social desirability bias and encourage higher reporting of sensitive behaviors.

Home-based self-sampling and self-testing for sexually transmitted infections: acceptable and feasible alternatives to provider-based screening in low-income women in São Paulo, Brazil.

OBJECTIVE: The objective of this study was to determine whether home-based screening for sexually transmitted infections (STIs) is acceptable, feasible, and increases the proportion of women screened among low-income women in São Paulo, Brazil. STUDY DESIGN: Eight hundred eighteen women were randomized to receive a clinic appointment or a kit for home-based STI self-collection and testing. All participants collected 2 vaginal swabs, one for polymerase chain reaction detection of chlamydia, gonorrhea, and trichomoniasis and another for a self-conducted rapid test for trichomoniasis. RESULTS: Slightly more women responded to the initiative within 2 weeks in the home group (80%) than in the clinic group (76%) with younger women showing improved response to home-based screening. Ninety-four percent of home group participants successfully completed self-collection and self-testing on their first attempt. CONCLUSIONS: Home-based self-collection and self-testing was acceptable, feasible, and resulted in a slightly higher response rate. Home sampling and testing provide promising alternatives to clinic-based STI screening across diverse contexts.

Partner-delivered medication for sexually transmitted infections: findings from Brazil.

BACKGROUND: Notifying and treating sexual partners of women or men diagnosed with a sexually transmitted infection (STI) is imperative to reducing STI transmission. METHODS: As part of a study to examine the introduction of home-based STI testing and rapid-point-of-care diagnostics in a low income population of women in São Paulo, Brazil, we offered 108 women diagnosed with an STI the opportunity to contact partner(s) herself have a clinician contact partner(s) or provide her with medication for partner(s). RESULTS: Offering partner-delivered medication to women with gonorrhea, chlamydia and/or trichomoniasis, in addition to the standard referral strategies, resulted in high rates of partner treatment, with 80 percent of reported male partners and 96 percent of notified male partners treated. Type of partnership strongly predicted whether the partner was successfully treated. More than half of women interviewed reported partner-delivered medication as their first choice for partner notification in the future. CONCLUSION: As diagnostic capability for STIs improves in Brazil and other Latin America countries, offering expanded options for partner notification will be an important tool to reduce infection rates. Partner-delivered therapy should be prioritized as it increases the number of partners treated. Introduction of this method will require discussions with providers to remove potential barriers to implementation.

[Violence against women: a study in a primary healthcare unit]. / Violência contra a mulher: estudo em uma unidade de atenção primária à saúde.

OBJECTIVES: There is scarce information on violence against women in the Brazilian society. This fact is rarely reported in medical records as part of the diagnosis and case management, despite evidence showing the significant impact of violence on the population's health. The study aim was to estimate the occurrence of violence against women, and to determine the nature and magnitude of the violent action and the relationship between women and her aggressors. METHODS: The study was conducted among women seen in a primary care unit of the city of São Paulo, Brazil, in a two-month period in 1998. The occurrence of violence cases was ascertained using standardized interviews to all women aged 15 to 49 years who sought health care during the study. Three-hundred and twenty-two women were interviewed. RESULTS: Of the participants, 143 (44.4%; IC95%=38.9-49.8%) reported at least one episode of physical violence in their adult life, 110 of those perpetrated by their partners or family members (34.1%; IC95%=28.9-39.3%). Thirty-seven women (11.5%; IC95%=8.0-14.9%) reported at least one episode of sexual violence in their adult life, 23 of those perpetrated by their partners or family members (7.1%; IC95%=4.3-9.9%). CONCLUSIONS: As reported in other countries, physical and sexual violence is highly frequent among women seen in primary care services. In most cases their partners and family members are the perpetrators and the episodes are mostly serious and recurrent.