Sexual and reproductive health among young people, Rio de Janeiro, Brazil. / Saúde sexual e reprodutiva para a população adolescente, Rio de Janeiro, Brasil.

We aimed to analyze the geographic distribution, the structure of healthcare services and the human resources of all units of the Sistema Único de Saúde (SUS - the Unified Health System) that provide sexual and reproductive health (SRH) services to the adolescent population in the second largest city in Brazil. We conducted a cross-sectional study with geographical mapping and data collection through a questionnaire applied in person with coordinators of the units or their representatives in 147 outpatient clinics in Rio de Janeiro that have SSR services. We found that in over 90% of the units, adolescents are treated together with the adult population, without particular shifts or rooms for this age group. In more than 10% of services, treatment is only provided with the presence of the guardian. In cases of sexual violence, this proportion is 34%. Specific educational activities for this age group are only carried out in 12.9% of units and less than one third of doctors had received some kind of training to deal with adolescent health. In conclusion, despite the wide geographic distribution of health facilities, the structure of care and the human resources do not meet the specific needs of adolescents.

Saúde sexual e reprodutiva para a população adolescente, Rio de Janeiro, Brasil / Sexual and reproductive health among young people, Rio de Janeiro, Brazil

Resumo Objetivamos analisar a distribuição geográfica, a estrutura de atendimento e os recursos humanos das unidades do Sistema Único de Saúde (SUS) que prestam serviços em saúde sexual e reprodutiva (SSR) à população adolescente, na segunda maior cidade do Brasil. Realizamos estudo transversal com mapeamento geográfico e coleta de dados por meio de questionário aplicado aos coordenadores, em todas as 147 unidades ambulatoriais do Rio de Janeiro, dispostas ao atendimento em SSR. Verificamos que todas as Regiões Administrativas (RA) desse município dispõem de unidades de atendimento para adolescentes, entretanto, em mais de 90% delas, eles são atendidos juntamente com a população adulta, sem turnos ou salas específicas. Em mais de 10% dos serviços, a assistência só é dada na presença do responsável. Em casos de violência sexual a proporção mostrou-se ainda maior, chegando a atingir 34% dos casos. Em apenas 12,9% das unidades são realizadas atividades educativas direcionadas a adolescentes e constatou-se que menos de 1/3 dos médicos estava capacitado para lidar com a saúde do adolescente. Em conclusão, apesar da larga distribuição geográfica das unidades de saúde, a estrutura do atendimento e os recursos humanos não atendem a contento as especificidades do público adolescente.

Abstract We aimed to analyze the geographic distribution, the structure of healthcare services and the human resources of all units of the Sistema Único de Saúde (SUS - the Unified Health System) that provide sexual and reproductive health (SRH) services to the adolescent population in the second largest city in Brazil. We conducted a cross-sectional study with geographical mapping and data collection through a questionnaire applied in person with coordinators of the units or their representatives in 147 outpatient clinics in Rio de Janeiro that have SSR services. We found that in over 90% of the units, adolescents are treated together with the adult population, without particular shifts or rooms for this age group. In more than 10% of services, treatment is only provided with the presence of the guardian. In cases of sexual violence, this proportion is 34%. Specific educational activities for this age group are only carried out in 12.9% of units and less than one third of doctors had received some kind of training to deal with adolescent health. In conclusion, despite the wide geographic distribution of health facilities, the structure of care and the human resources do not meet the specific needs of adolescents.

Perception of pre- and post-HIV test counseling among patients diagnosed with aids in adolescence HIV test counseling for adolescents. / Percepção de pacientes com AIDS diagnosticada na adolescência sobre o aconselhamento pré e pós-teste HIV realizado.

Pre- and post-HIV test counseling has singular importance in adolescence, since it is a phase of great changes, and AIDS is an incurable chronic disease. In order to comprehend the perception of young people with AIDS diagnosed in adolescence regarding the counseling received upon testing, we conducted 39 in-depth interviews, with 23 in female patients and 16 male patients, and then analyzed the data with extensive reading, categorization and interpretation on a comprehensive basis. The results revealed that less than one third received pre-test counseling (30.8%), which often was limited to the explanation of the reason of the test, and 51.2% were counseled post-test. We found that most patients were unaccompanied when receiving the communication of their seropositivity, some of which were later informed by the adolescent's guardian. Some patients felt secure after counseling, realizing that the disease is something that would not change their lives, if they properly followed the guidelines. On the other hand, the feelings of desperation and suicide expressed by some of the patients may have been influenced by the lack of adequate counseling. We have concluded that, for the improved management of the epidemic, there is a need to enhance the communications of health professionals, especially those that are in primary care, pre-natal services, gynecology and family health strategy.

Percepção de pacientes com AIDS diagnosticada na adolescência sobre o aconselhamento pré e pós-teste HIV realizado / Perception of pre- and post-HIV test counseling among patients diagnosed with aids in adolescence HIV test counseling for adolescents

Resumo O aconselhamento pré e pós-teste HIV tem importância singular na adolescência. Objetivamos conhecer a percepção de jovens com Aids diagnosticada na adolescência, sobre o aconselhamento recebido na ocasião do teste. Realizamos 39 entrevistas em profundidade, 23 em pacientes do sexo feminino e 16 do masculino e analisamos os dados com leitura exaustiva, categorização e interpretação de base compreensiva. Os resultados revelaram que menos de um terço recebeu aconselhamento pré-teste (30,8%) que amiúde se resumiu na explicação do motivo do exame e 51,2% foi aconselhado no pós-teste. Verificamos que a maioria estava desacompanhada na comunicação da soropositividade e parte deles tomou ciência pelo responsável posteriormente. Alguns interlocutores sentiram-se seguros após o aconselhamento, percebendo a doença como algo que não mudaria suas vidas, desde que seguissem adequadamente as orientações. Por outro lado, atitudes de desespero e desejo de morte manifestadas por alguns podem ter sido infuenciadas pela falta de aconselhamento satisfatório. Concluímos que há necessidade de aperfeiçoamento comunicacional dos profissionais de saúde, principalmente os que atuam na atenção primária, nos serviços de pré-natal, ginecologistas e estratégia de saúde da família.

Abstract Pre- and post-HIV test counseling has singular importance in adolescence, since it is a phase of great changes, and AIDS is an incurable chronic disease. In order to comprehend the perception of young people with AIDS diagnosed in adolescence regarding the counseling received upon testing, we conducted 39 in-depth interviews, with 23 in female patients and 16 male patients, and then analyzed the data with extensive reading, categorization and interpretation on a comprehensive basis. The results revealed that less than one third received pre-test counseling (30.8%), which often was limited to the explanation of the reason of the test, and 51.2% were counseled post-test. We found that most patients were unaccompanied when receiving the communication of their seropositivity, some of which were later informed by the adolescent's guardian. Some patients felt secure after counseling, realizing that the disease is something that would not change their lives, if they properly followed the guidelines. On the other hand, the feelings of desperation and suicide expressed by some of the patients may have been influenced by the lack of adequate counseling. We have concluded that, for the improved management of the epidemic, there is a need to enhance the communications of health professionals, especially those that are in primary care, pre-natal services, gynecology and family health strategy.

Experiências homossexuais de adolescentes: considerações para o atendimento em saúde / Experiencias homosexuales de adolescentes: consideraciones para la atención en salud / Homosexual experiences of adolescents: considerations for healthcare

Objetivamos conhecer significados das práticas homoafetivas de adolescentes, tendo em vista contextos de vulnerabilidade que envolvem o exercício da sexualidade numa sociedade homofóbica. Realizamos entrevistas com nove rapazes e quatro moças que procuraram atendimento em saúde e relataram experiência homossexual. Para alguns rapazes, a experiência homossexual ocorreu de forma circunstancial, por curiosidade e experimentação; para outros, esteve associada à prostituição, e, para a maioria, relacionou-se à identidade homossexual autodeclarada. Nas moças, dois significados sobressaíram: a atividade homossexual associada ao amor e como possível reação à violência sexual sofrida antes do início da experiência homossexual. Todos os entrevistados revelaram nunca terem sido perguntados ou orientados acerca de homossexualidade nos serviços de saúde. O estudo evidencia a necessidade de uma política de atenção integral à saúde deste público, cuja sexualidade é diversa do padrão hegemônico da sociedade...

Nuestro objetivo fue conocer los significados de las prácticas homoafectivas de adolescentes, llevando en consideración contextos de vulnerabilidad que envuelven el ejercicio de la sexualidad en una sociedad homofóbica. Realizamos entrevistas con nueve muchachos y cuatro muchachas que buscaron atención de salud y relataron la experiencia homosexual. Para algunos muchachos, la experiencia homosexual se realizó de forma circunstancial, por curiosidad y como experiencia; para otros, estuvo vinculada a la prostitución y para la mayoría se relacionó con la identidad homosexual auto-declarada. En las muchachas se destacaron dos significados: la actividad homosexual asociada al amor y como posible reacción a la violencia sexual sufrida antes del inicio de la experiencia homosexual. Todos los entrevistados revelaron que nunca nadie les había preguntado u orientado sobre la homosexualidad en los servicios de salud. El estudio muestra la necesidad de una política de atención total a la salud de este público, cuya sexualidad es diferente del estándar hegemónico de la sociedad...

We aimed to ascertain the meanings of homosexual relationships among adolescents, in view of contexts of vulnerability that involve exercising sexuality in a homophobic society. We conducted interviews with nine male and four female adolescents who sought healthcare attendance and reported having homosexual experiences. For some of the boys, the homosexual experience occurred circumstantially, due to curiosity and experimentation; for others, it was associated with prostitution. For most of them, it was related to self-reported homosexual identity. Among the girls, two meanings stood out: homosexual activity associated with love and as a possible reaction to sexual violence suffered before the start of the homosexual experience. All the interviewees said that they had never been asked or guided about homosexuality at healthcare services. This study shows that there is a need for a comprehensive healthcare policy for this population, whose sexuality is different from the hegemonic pattern of society...

HIV infection in male adolescents: a qualitative study.

`The gradual reduction in the incidence of AIDS among men who have sex with men has not occurred in the youngest age group; on the contrary, it is growing. This paper examines the vulnerabilities of adolescent males at risk of HIV infection. This is a qualitative study conducted through interviews with HIV positive young men undergoing treatment, whose diagnosis was made during adolescence. The interviews were recorded and transcribed in full. They were analyzed by intensive reading, classified by issues, and interpreted from a hermeneutic-dialectic perspective in dialogue with the literature. We interviewed 16 young men whose diagnosis occurred between the ages of 11 and 19 and for all of them the method of HIV transmission was sexual; 12 of the men were homosexual and 4 were heterosexual. It was evident that vulnerable situations included disbelief in the possibility of contamination, subjection to sex, homophobia and commercial sexual exploitation. This study demonstrates the importance of the formulation of public policies on sexual and reproductive health, which include adolescents and young men. These policies should embody the perspective of masculinity in all its widest aspects, as well as actions in favor of sexual diversity.

[HIV infection in female adolescents: a qualitative study]. / Infecção pelo HIV em adolescentes do sexo feminino: um estudo qualitativo.

OBJECTIVE: To investigate the vulnerabilities that favor HIV infection by female adolescents and young adults and to determine the difficulties faced by this population following diagnosis. METHODS: For this qualitative study we interviewed HIV-seropositive young or adolescent women diagnosed as adolescents and receiving treatment at the time of the interviews. The interviews were audio recorded and entirely transcribed. The data obtained were analyzed through intensive reading, classification of themes, and hermeneutic dialectic analysis in dialogue with the literature. RESULTS: Twenty-three women diagnosed between 11 and 19 years of age were interviewed. Twenty-one participants had acquired Aids via sexual transmission and one from blood. Transmission mode was unknown in one case. The interviews revealed the following vulnerability situations: disbelief in the possibility of contamination, young age at sexual initiation (below the Brazilian national average), not using a condom, having promiscuous partners or partners who used injectable drugs, and submitting to violence. The main problems faced after the diagnosis were prejudice, discrimination, need to take medication daily, and concerns associated with the desire of becoming a mother. CONCLUSIONS: Reducing the feminization of Aids entails enhancing the debate regarding sexuality and the dilemmas faced by adolescents to establish an open and unprejudiced dialogue that is not biased by norms, in addition to providing guidance about sexually transmitted diseases, with free and uncomplicated distribution of condoms.

Infecção pelo HIV em adolescentes do sexo masculino: um estudo qualitativo / HIV infection in male adolescents: a qualitative study

Resumo A redução gradativa da incidência de Aids entre homens que fazem sexo com homens não tem acontecido na faixa etária mais jovem que, ao contrário, está aumentando. Objetivamos conhecer as vulnerabilidades de adolescentes do sexo masculino que favoreceram a contaminação pelo HIV. Realizamos estudo qualitativo por meio de entrevistas com homens jovens soropositivos em tratamento, cujo diagnóstico foi feito na adolescência. Gravamos e transcrevemos as entrevistas na íntegra e as analisamos através de leitura intensiva, classificação por temas, e interpretação na perspectiva hermenêutica-dialética em diálogo com a literatura. Entrevistamos 16 homens jovens, cujo diagnóstico ocorreu entre 11 e 19 anos e em todos eles a via de transmissão do HIV foi sexual, sendo 12 homo e 4 heterossexuais. Evidenciou-se como situações de vulnerabilidade a descrença na possibilidade de contaminação, a sujeição sexual, a homofobia e a exploração sexual comercial. Este estudo demonstra a grande importância da formulação de políticas públicas em saúde sexual e reprodutiva que contemple adolescentes e jovens do sexo masculino com a perspectiva de masculinidade em toda sua amplitude e ações para diversidade sexual.

Abstract The gradual reduction in the incidence of AIDS among men who have sex with men has not occurred in the youngest age group; on the contrary, it is growing. This paper examines the vulnerabilities of adolescent males at risk of HIV infection. This is a qualitative study conducted through interviews with HIV positive young men undergoing treatment, whose diagnosis was made during adolescence. The interviews were recorded and transcribed in full. They were analyzed by intensive reading, classified by issues, and interpreted from a hermeneutic-dialectic perspective in dialogue with the literature. We interviewed 16 young men whose diagnosis occurred between the ages of 11 and 19 and for all of them the method of HIV transmission was sexual; 12 of the men were homosexual and 4 were heterosexual. It was evident that vulnerable situations included disbelief in the possibility of contamination, subjection to sex, homophobia and commercial sexual exploitation. This study demonstrates the importance of the formulation of public policies on sexual and reproductive health, which include adolescents and young men. These policies should embody the perspective of masculinity in all its widest aspects, as well as actions in favor of sexual diversity.

The perceptions of medical researchers on qualitative methodologies.

We aimed to verify doctor's perception of the qualitative research method, via a qualitative study of interviews with questions on the academic profile of doctors and on the methodology. We interviewed 42 professionals, of which 18 had experience with the qualitative method and 24 with the quantitative method. The results showed that knowledge on the qualitative method was virtually nil among "quantitative researchers", who did not value qualitative research, although some of those realized that it would be important to be more accepting in clinical practice. Others only considered the method as subsidiary to quantitative. The majority considered qualitative methods as lacking academic structure, taking too long to conduct empirical studies, and being difficult to publish. All of them criticized the misuse of the method, and the "quantitatives" pointed out the problem of being unable to reproduce. We concluded that widening the use of the qualitative method by doctors requires investment from the beginning of the academic career and participation in qualitative research projects.

Infecção pelo HIV em adolescentes do sexo feminino: um estudo qualitativo / HIV infection in female adolescents: a qualitative study

OBJETIVO: Conhecer as vulnerabilidades que favoreceram a infecção pelo HIV em adolescentes e jovens do sexo feminino e verificar as dificuldades enfrentadas por essa população após o diagnóstico. MÉTODOS: Estudo qualitativo realizado por meio de entrevistas com mulheres adolescentes e jovens soropositivas em tratamento, com diagnóstico feito na adolescência. As entrevistas foram gravadas e transcritas na íntegra e os dados obtidos foram analisados através de leitura intensiva, classificação por temas e interpretação na perspectiva hermenêutica-dialética em diálogo com a literatura. RESULTADOS: Foram entrevistadas 23 mulheres cujo diagnóstico ocorreu entre 11 e 19 anos e que, em sua maioria, foram infectadas através do contato sexual, exceto em dois casos (um com via de transmissão sanguínea e outro desconhecida). Evidenciaram-se como situações de vulnerabilidade a descrença na possibilidade de contaminação, a baixa idade da iniciação sexual (menor que a média brasileira), o não uso de preservativo, parceiros promíscuos ou usuários de drogas injetáveis e submissão a situações de violência. Os principais problemas enfrentados após o diagnóstico foram o preconceito, a discriminação, a necessidade de tomar medicamentos diariamente e as preocupações relacionadas ao desejo de ser mãe. CONCLUSÕES: Reduzir a feminização da Aids implica em ampliar e aprofundar o debate em torno da sexualidade e dos dilemas vivenciados por adolescentes a respeito desse assunto, de forma aberta, não preconceituosa e não normatizadora, nas escolas e cenários de convivência de jovens, além de fornecer orientação sobre doenças sexualmente transmissíveis, com distribuição gratuita e desburocratizada de preservativos.

OBJECTIVE:To investigate the vulnerabilities that favor HIV infection by female adolescents and young adults and to determine the difficulties faced by this population following diagnosis. METHODS: For this qualitative study we interviewed HIV-seropositive young or adolescent women diagnosed as adolescents and receiving treatment at the time of the interviews. The interviews were audio recorded and entirely transcribed. The data obtained were analyzed through intensive reading, classification of themes, and hermeneutic dialectic analysis in dialogue with the literature. RESULTS: Twenty-three women diagnosed between 11 and 19 years of age were interviewed. Twenty-one participants had acquired Aids via sexual transmission and one from blood. Transmission mode was unknown in one case. The interviews revealed the following vulnerability situations: disbelief in the possibility of contamination, young age at sexual initiation (below the Brazilian national average), not using a condom, having promiscuous partners or partners who used injectable drugs, and submitting to violence. The main problems faced after the diagnosis were prejudice, discrimination, need to take medication daily, and concerns associated with the desire of becoming a mother. CONCLUSIONS: Reducing the feminization of Aids entails enhancing the debate regarding sexuality and the dilemmas faced by adolescents to establish an open and unprejudiced dialogue that is not biased by norms, in addition to providing guidance about sexually transmitted diseases, with free and uncomplicated distribution of condoms.

The perceptions of medical researchers on qualitative methodologies / Percepción de los investigadores médicos en metodologías cualitativas / Percepção de pesquisadores médicos sobre metodologias qualitativas

We aimed to verify doctor's perception of the qualitative research method, via a qualitative study of interviews with questions on the academic profile of doctors and on the methodology. We interviewed 42 professionals, of which 18 had experience with the qualitative method and 24 with the quantitative method. The results showed that knowledge on the qualitative method was virtually nil among "quantitative researchers", who did not value qualitative research, although some of those realized that it would be important to be more accepting in clinical practice. Others only considered the method as subsidiary to quantitative. The majority considered qualitative methods as lacking academic structure, taking too long to conduct empirical studies, and being difficult to publish. All of them criticized the misuse of the method, and the "quantitatives" pointed out the problem of being unable to reproduce. We concluded that widening the use of the qualitative method by doctors requires investment from the beginning of the academic career and participation in qualitative research projects.

El objetivo es verificar la percepción de médicos sobre el método de investigación cualitativa. Se trata de un estudio cualitativo por medio de entrevistas con preguntas sobre el perfil de los médicos y sobre el método. Entrevistamos a 42 profesionales, 18 con experiencia en el método cualitativo y 24 con el cuantitativo. Los resultados mostraron que el conocimiento sobre lo cualitativo es casi nulo entre los "cuantitativistas", que no valoran la investigación cualitativa, aunque algunos se dan cuenta de que sería importante tener un enfoque más amplio en la práctica clínica. Otros la ven como subsidiaria a lo cuantitativo. Sus dificultades para utilizar ese abordaje son: falta de formación, cantidad de tiempo que exigen y problemas de publicación. Todos han criticado el mal uso del método. Los "cuantitativistas" han destacado como fragilidad, la no reproductibilidad. Llegamos a la conclusión de que para ampliar el uso de los abordajes cualitativos entre los médicos es importante invertir en su formación desde el inicio del curso y la participación en proyectos de investigación cualitativa.

Objetivamos verificar a percepção de médicos sobre o método qualitativo de pesquisa. Estudo qualitativo por meio de entrevistas com questões sobre o perfil acadêmico do médico e perguntas abertas a respeito do método. Entrevistamos 42 profissionais, sendo 18 com experiência no método qualitativo e 24 com o quantitativo. Os resultados evidenciaram que o conhecimento sobre o qualitativo é quase nulo entre os pesquisadores "quantitativistas", os quais não valorizam a pesquisa qualitativa, embora alguns percebam que seria importante ter uma postura mais compreensiva na prática clínica. Outros só a veem como subsidiária ao quantitativo. As principais dificuldades da maioria são: falta de formação, tempo longo despendido nos estudos empíricos e dificuldade de publicação. Todos os entrevistados criticaram o mau uso do método, e os "quantitativistas" ressaltaram, como problema, sua não reprodutibilidade. Concluímos que ampliar o uso do método qualitativo por médicos exige investimento na formação desde o início da graduação e participação em projetos de pesquisa qualitativa.

[The AIDS epidemic in adolescents between the ages of 13 and 19 in the City of Rio de Janeiro, Brazil: space-time description]. / A epidemia de AIDS em adolescentes de 13 a 19 anos, no município do Rio de Janeiro: descrição espaço-temporal.

INTRODUCTION: The purpose of this study was to analyze the dynamics of the AIDS epidemic affecting adolescents in Rio de Janeiro to establish healthy prevention strategies. The incidence of AIDS in Brazil is declining among men who have sex with men (MSM) except in individuals between 13 and 19 years of age, and the feminization phenomenon is more pronounced among adolescents. METHODS: We evaluated data from Sistema de Informações de Agravos de Notificação (SINAN) regarding cases of AIDS in patients aged between 13 and 19 years through November 2009. RESULTS: This study includes 656 cases. The incidence of AIDS increased until 1998, and, since 1996, more cases have been diagnosed in girls than in boys. The homo/bisexual exposure category predominantly consisted of boys (50.8%), and the heterosexual category predominantly consisted of girls (88.9%). The geographic distribution of the cases by year of diagnosis revealed that the increase was proportionally larger in the poorest area and that there was a large decrease in the wealthiest area. A decreasing linear tendency was observed in the relationship between the year of diagnosis and the human development index (HDI). CONCLUSIONS: This study demonstrates the need for greater investment in sexual health and reproductive services in the poorest areas of the city and in the promotion of healthy sexual practices directed to MSM and female adolescents.

A epidemia de AIDS em adolescentes de 13 a 19 anos, no município do Rio de Janeiro: descrição espaço-temporal / The AIDS epidemic in adolescents between the ages of 13 and 19 in the City of Rio de Janeiro, Brazil: space-time description

INTRODUÇÃO: o objetivo do estudo foi analisar a epidemia de AIDS em adolescentes no município do Rio de Janeiro para subsidiar políticas públicas de prevenção. A incidência de AIDS no Brasil está diminuindo entre homens que fazem sexo com homens (HSH), exceto entre 13 e 19 anos e a feminização é mais intensa entre adolescentes. MÉTODOS: Estudo de dados do Sistema de Informações de Agravos de Notificação (SINAN) de casos diagnosticados, entre 13 e 19 anos até novembro de 2009. RESULTADOS: Foram analisados 656 casos, com incidência crescente até 1998 e verificou-se que, desde 1996, ocorrem mais casos no sexo feminino do que no masculino. A categoria de exposição homo/bissexual é predominante nos rapazes (50,8%) e a heterossexual nas moças (88,9%). A distribuição geográfica dos casos no município por ano de diagnóstico revelou que houve proporcionalmente grande aumento da incidência na Área de Planejamento mais pobre da cidade e redução acentuada na mais rica. Observou-se uma tendência linear decrescente entre o ano de diagnóstico e o índice de desenvolvimento humano (IDH). CONCLUSÕES: O estudo aponta a necessidade de investimento em serviços de saúde sexual e reprodutiva nas áreas mais pobres da cidade e ações de promoção de saúde direcionadas aos rapazes HSH e às adolescentes.

INTRODUCTION: The purpose of this study was to analyze the dynamics of the AIDS epidemic affecting adolescents in Rio de Janeiro to establish healthy prevention strategies. The incidence of AIDS in Brazil is declining among men who have sex with men (MSM) except in individuals between 13 and 19 years of age, and the feminization phenomenon is more pronounced among adolescents. METHODS: We evaluated data from Sistema de Informações de Agravos de Notificação (SINAN) regarding cases of AIDS in patients aged between 13 and 19 years through November 2009. RESULTS: This study includes 656 cases. The incidence of AIDS increased until 1998, and, since 1996, more cases have been diagnosed in girls than in boys. The homo/bisexual exposure category predominantly consisted of boys (50.8%), and the heterosexual category predominantly consisted of girls (88.9%). The geographic distribution of the cases by year of diagnosis revealed that the increase was proportionally larger in the poorest area and that there was a large decrease in the wealthiest area. A decreasing linear tendency was observed in the relationship between the year of diagnosis and the human development index (HDI). CONCLUSIONS: This study demonstrates the need for greater investment in sexual health and reproductive services in the poorest areas of the city and in the promotion of healthy sexual practices directed to MSM and female adolescents.