Fatores associados à troca de sexo por dinheiro em homens que fazem sexo com homens no Brasil / Factors associated with exchanging sex for money in men who have sex with men in Brazil

Resumo Objetivou-se analisar a associação entre fatores sociodemográficos, programáticos e contextuais e ter recebido dinheiro em troca de sexo entre homens que fazem sexo com homens (HSH). Estudo multicêntrico, transversal, realizado em 10 cidades brasileiras, entre 2008 e 2009. Foram entrevistados 3.749 HSH selecionados pela técnica amostral "Respondent Driven-Sampling" (RDS). "Odds Ratio" ponderado (ORp) foi obtido por meio de regressão logística, permanecendo no modelo final as variáveis associadas ao evento (p < 0,05). Da amostra total, 33,3% relataram ter recebido dinheiro em troca de sexo nos últimos 12 meses anteriores à entrevista. As variáveis associadas com o evento foram ter idade ≤ 25 anos, menor nível de escolaridade, classes sociais mais baixas, história prévia de infecção por sífilis, utilizar locais de encontros para ter parceiros sexuais, ter comportamento de risco para HIV muito alto e usar drogas ilícitas, se autoidentificarem como heterossexual ou bissexual, ter sofrido violência física devido à orientação sexual e apresentar ideação suicida sempre ou na maioria das vezes. Observa-se que os HSH que receberam dinheiro em troca de sexo apresentaram maior vulnerabilidade socioeconômica, programática e contextual, potencialmente aumentando o risco de infecção pelo HIV em relação aos demais HSH.

Abstract This study aimed to analyze the association between sociodemographic, programmatic and contextual factors and the receipt of money in exchange for sex among men who have sex with men (MSM). This is a multicenter, cross-sectional study conducted in ten Brazilian cities between 2008 and 2009. Adult MSM recruited through the Respondent Driven Sampling (RDS) were interviewed. Weighted Odds Ratio (ORw) was obtained through logistic regression, retaining the variables associated with the event (p < 0.05) in the final model. Of the total sample, 33.3% reported receiving money in exchange for sex in the last 12 months before the interview. The variables that were independently associated with the event were age less than or equal to 25 years, lower education, lower social classes, previous history of syphilis, using sites or services to find sexual partners in the previous month, very high risk behavior, using illicit drugs in the previous six months, self-identifying as heterosexual or bisexual, having suffered physical violence due to sexual orientation and having suicidal thoughts always or most of the time. It was observed that MSM who received money in exchange for sex had greater socioeconomic, programmatic and contextual vulnerability, potentially increasing the risk of HIV infection than the other MSM in the sample.

Adherence to antiretroviral therapy among people living with HIV/AIDS in northeastern Brazil: a cross-sectional study

ABSTRACT BACKGROUND: Nonadherence to antiretroviral therapy (ART) may lead to viral replication and development of antiretroviral resistance. OBJECTIVE: To identify the factors associated with nonadherence to ART among people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). DESIGN AND SETTING: Cross-sectional study in a tertiary-level hospital in northeastern Brazil. METHODS: Intake of less than 90% of the antiretroviral drugs prescribed in the last week prior to the interview was defined as nonadherence. Intake was evaluated using a questionnaire. Descriptive and multivariate analyses were conducted on the study population, with estimation of the respective odds ratios and 95% confidence intervals. RESULTS: The prevalence of nonadherence was 28.4%. Significant associations were found regarding the following variables: age less than 35 years, smoking, sedentary lifestyle, lack of medication and lack of knowledge regarding the patient's HIV status, on the part of the patient's partner or family. CONCLUSIONS: Encouragement of adherence to antiretroviral therapy is one of the fundamental pillars of treatment for HIV-infected patients. The high proportion of nonadherence (28.4%) and the predictive factors related to this indicate that it is necessary to improve patients' adherence to antiretroviral therapy.

Discrimination based on sexual orientation against MSM in Brazil: a latent class analysis / Discriminação por orientação sexual entre HSH no Brasil: uma análise de classes latentes

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.

HIV/AIDS knowledge among MSM in Brazil: a challenge for public policies / Conhecimento sobre HIV/aids entre HSH no Brasil: um desafio para as políticas públicas

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.

Histórico de violência entre mulheres que fazem uso de crack no estado de Pernambuco, Brasil / History of violence among women who use crack in the state of Pernambuco, Brazil

RESUMO Neste artigo, abordou-se o histórico de violência contra mulheres em contexto de uso abusivo de crack. Trata-se de um estudo transversal, envolvendo 243 usuárias de crack atendidas pelo Programa Atitude, em Pernambuco, entre 2014 e 2015. Observou-se que a maioria era jovem, negra, com baixa escolaridade e renda, início precoce da vida sexual, em uso compulsivo de crack, morando na rua e comercializando o corpo como a principal fonte de renda. A maioria (96,2%) relatou histórico de violência: psicológica (83,5%), física (87,7%) e sexual (55,1%), praticadas por parentes/amigos. Fatores como desigualdades sociais e de gênero foram relevantes nas situações de violência observadas.

ABSTRACT In this article, it was discussed the history of violence against women in the context of abusive use of crack. It is a cross-sectional study, involving 243 crack users attended by the Atitude Program, in Pernambuco, between 2014 and 2015. It was observed that they were mostly young, black, with low schooling and low-income, early start of sexual life, in compulsive use of crack, living on the street and commercializing the body as the main source of income. The majority (96.2%) reported a violence history: psychological (83.5%), physical (87.7%) and sexual (55.1%), practiced by relatives/friends. Factors such as social and gender inequalities were relevant in the situations of violence observed.

Incentives and barriers to HIV testing among female sex workers in Ceará / Incentivos e barreiras ao teste de HIV entre mulheres profissionais do sexo no Ceará

ABSTRACT 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.

RESUMO OBJETIVO Estimar a prevalência do HIV e descrever os incentivos e barreiras à realização do teste para o HIV entre mulheres profissionais do sexo. MÉTODOS Este estudo transversal recrutou 402 mulheres de 18 anos ou mais, residentes em Fortaleza, CE, que informaram ter tido relação sexual em troca de dinheiro nos últimos quatro meses. A amostra foi recrutada por meio da técnica Respondent Driven Sampling, entre agosto e novembro de 2010. RESULTADOS A adesão ao teste de HIV foi de 84,1% e a prevalência estimada da infecção pelo HIV foi de 3,8%. A amostra era jovem (25 a 39 anos), solteira (80,0%), com um a três filhos (83,6 %), tinham oito anos ou mais de estudo (65,7%) e pertencia às classes sociais D/E (53,1%). A maioria exercia a profissão em locais fechados (bares, motéis, hotéis, sauna - 88,9%), e a prostituição era a única fonte de renda (54,1%). Cerca de 25% da amostra desconhecia onde o teste de HIV era realizado na rede pública e 51,8% nunca fez o teste ou se testou há um ano ou mais. As principais barreiras ao teste foram acreditar que não corre risco de se infectar (24,1%) e o medo da discriminação caso o teste fosse reagente (20,5%). Os incentivos foram relacionados à maior oferta de locais para o teste (57,0%) e de unidades de saúde com horários alternativos (44,2%). CONCLUSÕES A prevalência foi semelhante à encontrada em outras cidades brasileiras de diferentes regiões do país, apesar de superiores a de mulheres não profissionais do sexo. A disponibilidade do teste em locais não relacionados à saúde e a oferta nas unidades básicas em horário não comercial são fatores que incentivam a realização do teste. Não se considerar sob-risco, medo de ser discriminada e desconhecimento dos locais onde o teste é realizado podem ser uma barreira para a realização do exame.

Factors associated with self-reported discrimination against men who have sex with men in Brazil

ABSTRACT OBJECTIVE To estimate self-reported discrimination due to sexual orientation among men who have sex with men (MSM) in Brazil and to analyze associated factors. METHODS A cross-sectional study of 3,859 MSM recruited in 2008-2009 with respondent driven sampling. Data collection conducted in health centers in 10 Brazilian cities. A face-to-face questionnaire was used and rapid HIV and syphilis tests conducted. Aggregated data were weighted and adjusted odds ratio estimated to measure the association between selected factors and self-reported discrimination due to sexual orientation. RESULTS The sample was predominantly young, eight plus years of schooling, pardo (brown), single, low-income, and identified themselves as gay or homosexual. The prevalence of self-reported discrimination due to sexual orientation was 27.7% (95%CI 26.2-29.1). Discrimination was independently associated with: age < 30 years, more years of schooling, community involvement and support, history of sexual and physical violence, suicidal thoughts, and unprotected receptive anal intercourse. CONCLUSIONS The prevalence of self-reported discrimination among MSM in Brazil is high. These results challenge the assumptions that MSM-specific prevention and support programs are not required or that health professionals do not need special training to address MSM needs.

Incentives and barriers to HIV testing in men who have sex with men in a metropolitan area in Brazil / Incentivos e barreiras para testagem do HIV em homens que fazem sexo com homens em região metropolitana do Brasil / Incentivos y barreras para el test del VIH en hombres que practican sexo con hombres en una región metropolitana de Brasil

Abstract: This study aimed to identify incentives and barriers to HIV testing in men who have sex with men (MSM). This was a cross-sectional study of MSM who had lived at least three months in greater metropolitan Fortaleza, Ceará State, Brazil, 2010. The study recruited 391 men ≥ 18 years of age who reported sexual relations with men in the previous six months, using Respondent Driven Sampling. Personal network and socio-demographic data were collected and HIV testing was offered, analyzed with RDSAT 6.0 and Stata 11.0. The majority were young (40.3%), had 5 to 11 years of schooling (57.3%), were single (85.1%), had low income (37.6%), and 58.1% had tested for HIV some time in life. Incentive to test: certainty of not being infected (34.1%) and the exposure to national campaign Fique Sabendo [Know your Status] (34%). Barriers: trust in partner(s) (21%) and fear of discrimination if tested positive (20.3%). Policies should be developed to ensure test confidentiality and communication campaigns focusing on information gaps and encouragement for testing.

Resumo: Identificar os incentivos e as barreiras aos testes de HIV entre homens que fazem sexo com homens (HSH). Estudo transversal entre HSH que residiram pelo menos três meses na região metropolitana de Fortaleza, Ceará, Brasil, em 2010. Foram recrutados 391 homens, ≥ 18 anos, que relataram sexo com homens nos últimos seis meses, utilizando Respondent Driven Sampling. Coletados os dados: rede social, sociodemográficos e oferecido o teste de HIV e analisados pelo RDSAT 6.0 e Stata 11.0. A maioria era jovem (40,3%), de 5 a 11 anos de escolaridade (57,3%), solteira (85,1%), baixa renda (37,6%), 58,1% testaram para o HIV alguma vez na vida. Incentivos ao teste: certeza de não estar infectado (34,1%) e campanha nacional Fique Sabendo (34%). Barreiras: confiar no(s) parceiro(s) (21%) e medo de discriminação se o resultado for positivo (20,3%). Políticas que assegurem a confidencialidade dos testes e campanhas de comunicação voltadas às lacunas de informação e incentivo ao teste devem ser desenvolvidas.

Resumen: Identificar los incentivos y las barreras a los test de VIH entre hombres que practican sexo con hombres (HSH). Estudio transversal entre HSH que residieron por lo menos tres meses en la región metropolitana de Fortaleza, Ceará, Brasil, en 2010. Fueron reclutados 391 hombres, ≥ 18 años, que relataron sexo con hombres en los últimos seis meses, utilizando Respondent Driven Sampling. Datos recogidos: red social, sociodemográficos y ofrecido el test de VIH y analizados por el RDSAT 6.0 y Stata 11.0. La mayoría era joven (40,3%), de 5 a 11 años de escolaridad (57,3%), soltero (85,1%), baja renta (37,6%), 58,1% se hicieron pruebas del VIH alguna vez en la vida. Incentivos al test: certeza de no estar infectado (34,1%) y campaña nacional Fique Sabendo (34%). Barreras: confiar en el compañero (s) (21%) y miedo a la discriminación si el resultado fuera positivo (20,3%). Se deben desarrollar políticas que aseguren la confidencialidad de los test, así como campañas de comunicación, dirigidas a las lagunas de información sobre este asunto, además de incentivos a la realización del test.

Fatores associados à não adesão aos antirretrovirais em adultos com AIDS nos seis primeiros meses da terapia em Salvador, Bahia, Brasil / Factors associated with non-adherence to antiretroviral therapy in adults with AIDS in the first six months of treatment in Salvador, Bahia State, Brazil / Factors associated with non-adherence to antiretroviral therapy in adults with AIDS in the first six months of treatment in Salvador, Bahia State, Brazil / Factores asociados a la no adherencia a la terapia antirretroviral en adultos con SIDA en los primeros seis meses de tratamiento en Salvador, Bahia, Brasil

O controle da replicação viral é essencial na terapia antirretroviral altamente potente (TARV) e a adesão ao tratamento é o fundamento para esse controle. Fatores individuais e externos influenciam a adesão aos antirretrovirais (ARV). Estudo transversal para investigar fatores associados à não adesão à TARV, em indivíduos com AIDS em Salvador, Bahia, Brasil, com idade ≥ 13 anos e primeira prescrição em 2009. Dados coletados em prontuários e registros da farmácia. Dos 216 pacientes, 65,3% eram homens; idade média 37,8 ± 9,5 anos, solteiros 67,9%; heterossexuais 64%; > 8 anos de estudo 65,3%, etilistas 61,5% e não relatou tabagismo 75,1% ou uso de drogas 93,7%. Iniciaram a TARV com TCD4+ < 350 células/mm3 94%, 61,8% sintomáticos e 68,4% apresentaram reação adversa ao medicamento. Prevalência de não adesão 25%. Variáveis associadas: maior tempo entre o diagnóstico de infecção pelo HIV e a AIDS (aOR = 3,9), reação adversa ao medicamento (aOR = 2,4), idade menor que 34 anos (aOR = 2,2), menos que 8 anos de estudo (aOR = 2,2) e uso de drogas (aOR = 2,6). A alta taxa de não adesão é um problema importante nos seis primeiros meses da TARV.

El objetivo de este estudio fue investigar factores asociados a la no adherencia a terapia antirretroviral altamente potente (TARV) en los primeros seis meses de tratamiento. Estudio transversal en individuos con SIDA de Salvador, Bahia, Brasil, de edad ≥ 13 anos, cuya primera prescripción a antirretroviral (ARV) fue en 2009. Se utilizaron historias clínicas y registros de farmacia. De 216 pacientes, 65,3% fueron hombres de 37,8 ± 9,5 años en promedio. La mayoría informó ser soltero 67,9%, heterosexual 64%, 8 años de estudio o más 65,3%, consumir alcohol 61,5%, y negó tabaquismo 75,1% y uso de drogas ilícitas 93.7%. El 94% inició TARV con TCD4+ < 350 células/mm3; 61,8% estaba sintomático, 68,4% presentó reacciones adversas a ARV. La prevalencia de no adherencia fue 25%. Variables asociadas fueron: mayor tiempo entre infección por HIV y SIDA (aOR = 3,9), reacción adversa al medicamento (aOR = 2,4), edad menor a 34 años (aOR = 2,2), escolaridad menor a 8 años (aOR = 2,2) y uso de drogas ilícitas (aOR = 2,6). La alta tasa de no adherencia es un problema importante en los primeros seis meses de tratamiento antirretroviral.

The control of viral replication is essential in the highly active antiretroviral therapy (HAART), and adherence to therapy is instrumental for such control. Individual and external factors influence adhesion to the use of antiretroviral (ARV) drugs. This is a cross-sectional study to investigate factors associated with non-adherence to HAART in AIDS patients in Salvador, Bahia State, Brazil, with age ≥ 13 years and first prescription in 2009. Data was collected from patient charts and pharmacy records. From a total of 216 patients, 65.3% were males; mean age 37.8 ± 9.5 years; single, 67.9%; heterosexual, 64%; more than 8 years of school education, 65.3%; alcohol users, 61.5%; non-smokers, 75,1% or non-illicit drug users, 93.7%. A proportion of 94% started ARV therapy with TCD4+ < 350 cells/mm3; 61.8% were symptomatic; and 68.4% had an adverse drug reaction. The prevalence of non-adherence was 25%. The variables associated were: longer time between HIV infection and AIDS (aOR = 3.9), adverse drug reaction (aOR = 2.4), under 34 years of age (aOR = 2.2), less than 8 years of school education (aOR = 2.2) and illicit drugs use (aOR = 2.6). A high-non-adherence rate is an important problem within the first six months of HAART.

Caracterização dos casos de violência física, psicológica, sexual e negligências notificados em Recife, Pernambuco, 2012 / Characterization of cases of physical, psychological and sexual violence and negligence reported in Recife, Pernambuco, 2012

Objetivo: descrever o perfil dos casos de violência notificados na cidade de Recife, Estado de Pernambuco, Brasil. Métodos: estudo descritivo que incluiu todos os casos de violência doméstica, sexual e outras violências registrados no Sistema de Informação de Agravos de Notificação (Sinan) de Recife-PE, em 2012. Resultados: foram notificados 3.119 casos de violência no ano estudado, sendo 67,3 por cento mulheres, 33,6 por cento na faixa etária de 0 a 9 anos e 51,6 por cento de cor da pele parda; a violência física foi a mais notificada (49,5 por cento); na violência sexual, o principal agressor era um desconhecido (30,7 por cento), sendo um familiar nos demais tipos de violência; metade dos casos foi encaminhada para outros serviços de saúde (50,2 por cento). Conclusão: entre os casos de violência notificados, as principais vítimas foram mulheres, crianças e indivíduos de cor da pele parda; as estratégias intersetoriais de apoio às vítimas de violência e seus familiares devem ser focadas nos grupos de maior vulnerabilidade.

Objective: to describe the profile of interpersonal violence cases reported in Recife – Pernambuco - Brazil. Methods: this is a cross-sectional study of cases of domestic, sexual and other violence registered on the Recife Notifiable Diseases Information System in 2012. Results: 3,119 cases of violence were reported. 67.3 per cent were female, 33.6 per cent aged 0 to 9 and 51.6 per cent dark-skinned. Physical violence was the main form of aggression reported (49.5 per cent). Concerning sexual violence, the main aggressor was unknown (30.7 per cent). In other types of violence most frequently the aggressor was a family member. Half of the cases were referred to other health services (50.2 per cent). Conclusion: in the above reported cases, highest prevalence of violence was detected in females, children and dark-skinned people. Intersectoral strategies to support victims and their families should focus on the most vulnerable groups identified in this study.

Primary resistance of HIV to antiretrovirals among individuals recently diagnosed at voluntary counselling and testing centres in the metropolitan region of Recife, Pernambuco

Determining the prevalence and type of antiretroviral (ARV) resistance among ARV-naïve individuals is important to assess the potential responses of these individuals to first-line regimens. The prevalence of primary resistance and the occurrence of recent infections among individuals with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) were identified among recently diagnosed patients at five sexually transmitted disease/AIDS testing and counselling centres in the metropolitan region of Recife (RMR), Pernambuco, Brazil, between 2007-2009. One-hundred and eight samples were analysed using the Calypte® BED assay. Males predominated (56%), as did patients aged 31-50 years. Twenty-three percent presented evidence of a recent HIV infection. The median CD4+ T lymphocyte count was 408 cells/mm³ and the median viral load was 3.683 copies/mL. The prevalence of primary resistance was 4.6% (confidence interval 95% = 1-8.2%) based on criteria that excluded common polymorphisms in accordance with the surveillance drug resistance mutation criteria. The prevalence of resistance to non-nucleoside reverse transcriptase, nucleoside/nucleotide reverse transcriptase and protease inhibitors were 3.8%, 1.5% and 0.8%, respectively. Fifty-seven percent of strains were from clade B, 37.7% were clade F and 3.1% were clade C; there were no statistically significant differences with respect to resistance between clades. Recent infection tended to be more common in men (p = 0.06) and in municipalities in the south of the RMR (Jaboatão dos Guararapes and Cabo de Santo Agostinho) (p = 0.046). The high prevalence of recent infection and the high prevalence of non-B strains in this poor Brazilian region merit further attention.

Recent HIV infection rates among HIV positive patients seeking voluntary counseling and testing centers in the metropolitan region of Recife - Pe, Brazil

The BED capture enzyme immunoassay test makes it possible to determine whether individuals were recently infected with HIV. OBJECTIVE: In this study, the overall HIV and recent infections prevalences were determined at five Voluntary Counseling and Testing (VCT) centers, in the Metropolitan Region of Recife, Northeastern of Brazil. MATERIAL AND METHODS: A cross-sectional study was conducted among users of five VCTs in the metropolitan region of Recife between July 2007 and April 2009. Out of the individuals who tested positive for HIV, 169 were analyzed to assess the prevalence of recent infection by means of the BED-CEIA (BED-Calypte®). RESULTS: Out of 46,696 individuals tested 916 (1.96%) turned out positive for HIV infection The highest prevalence was in Recife (3.9%). The prevalence was higher among males (3.93%), and men who have sex with men (MSM) (12.4%). The frequency of recent infections among the 169 subjects evaluated was 23.7%. Recent infections were more common among individuals under 25 years of age. There was slight predominance of men and higher frequency of heterosexuals in both groups, but still a significant portion of MSM (33%). Subtype B predominated, followed by a high proportion of subtype F. CONCLUSIONS: Recent infection occurs mainly among young individuals and heterosexuals, despite a significant proportion of recent infection among MSM. These results suggest that preventive actions aimed at the MSM community remains a challenge and efforts focusing this group should continue to be a priority.

Anemia no binômio mãe-filho no Estado de Pernambuco, Brasil / Mother-child anemia in the State of Pernambuco, Brazil

Analisaram-se prevalência e fatores associados à anemia em mães (n = 1.022) e seus filhos (n = 1.242) menores de 5 anos em Pernambuco, Brasil, 2006. Estudo transversal, populacional, com amostra probabilística representativa do meio urbano e rural. Diagnóstico de anemia determinado pelo nível de hemoglobina < 11g/dL (crianças) e < 12g/dL (mulheres), dosagem feita pelo HemoCue. Análises uni e multivariadas realizadas por regressão de Poisson com ajuste robusto do erro padrão, adotando-se para crianças modelo hierárquico de determinação do desfecho. Este procedimento não foi aplicado às mães, pelo pequeno número de fatores associados nas análises univariadas. Prevalência de anemia foi 16,4 por cento e 34,4 por cento, em mães e filhos, respectivamente. Mães anêmicas comparadas às mães com níveis normais de hemoglobina apresentaram RP = 1,44 (IC95 por cento: 1,21-1,72) em relação ao risco de anemia em seus filhos, praticamente se mantendo no modelo ajustado (RP = 1,39; IC95 por cento: 1,16-1,66). A prevalência de anemia nos filhos foi o dobro da registrada nas mães, encontrando-se, no modelo final, apenas um único fator comum para ambos: renda per capita familiar.

Prevalence of anemia and associated factors were analyzed in mothers (n = 1,022) and their children under 5 years of age (n = 1,242) in Pernambuco State, Brazil, 2006. This was a cross-sectional population-based study with a probabilistic sample in an urban and rural area. Anemia was diagnosed by hemoglobin level (children < 11.0g/dL, women < 12.0g/dL) using HemoCue. Univariate and multivariate analyses used Poisson regression with robust adjustment of standard error, adopting a hierarchical model for determination in children with anemia as the outcome. This same procedure was not applied to mothers because of the small number of associated factors in the univariate analyses. Anemia prevalence was 16.4 percent in mothers and 34.4 percent in children. Anemic as compared to non-anemic mothers showed a prevalence ratio of 1.44 (95 percentCI: 1.21-1.72) for anemia in their children, maintaining similar values in the adjusted model (PR = 1.39: 95 percentCI: 1.16-1.66). Anemia prevalence in children was double that of mothers, with the final model showing only one common factor: per capita family income.

Fatores associados à interrupção de tratamento anti-retroviral em adultos com AIDS: Rio Grande do Norte, Brasil, 1999 - 2002 / Cofactors of antiretroviral treatment interruption in cases of adults with AIDS: Rio Grande do Norte, Brazil, 1999-2002

OBJETIVO: Com o intuito de analisar os fatores associados à interrupção do tratamento anti-retroviral em adultos com AIDS, no Rio Grande do Norte, Brasil, realizou-se estudo nas unidades locais de referência no atendimento à AIDS. MÉTODOS: Tomou-se como critério de não interrupção o comparecimento a pelo menos 80 por cento das visitas programadas à farmácia para o recebimento das drogas prescritas, por um período de seis meses consecutivos, após a data da prescrição. RESULTADOS: O estudo compreendeu 498 casos, dos quais 52,4 por cento já chegaram a um serviço especializado com alguma condição indicativa de imunodeficiência. O percentual total de não interrupção foi de 64,1 por cento. Não foi encontrada associação com as variáveis sexo, categoria de exposição e contagem de CD4+, nem com o tipo de esquema anti-retroviral. Os resultados da análise multivariada revelaram associações significativas entre interrupção e início do tratamento após internamento hospitalar, uso de drogas, tratamento psiquiátrico, baixo grau de escolaridade e idade de 25 a 34 anos. CONCLUSÃO: Os resultados sugerem que a interrupção do tratamento é um problema crítico nos seis primeiros meses seguintes ao início da terapia anti-retroviral em indivíduos virgens de tratamento, e, especialmente, entre os adultos jovens, com história prévia de tratamento psiquiátrico, que usam ou fizeram uso de drogas lícitas ou ilícitas até um ano antes de iniciar o tratamento com anti-retrovirais, que iniciam a terapia após internamento hospitalar e têm baixo nível de escolaridade.

Regional patterns of the temporal evolution of the AIDS epidemic in Brazil following the introduction of antiretroviral therapy

We examined the characteristics of the AIDS epidemic in the northeastern region of Brazil, comparing it to the epidemic in Brazil as a whole, and to the state of São Paulo, with respect to the temporal evolution of morbidity and mortality during the period 1990 to 1999, using information from communicable disease reports and mortality records. Since 1996, the incidence rate of AIDS in adults in Brazil as a whole and in São Paulo has been showing a trend towards stability, whereas in the Brazilian northeast the incidence rates of the disease continue to grow. In the northeast, sexual transmission is responsible for more than 80 percent of cases, injectable drug users (IDU) comprising only a small percentage of cases. There is a greater incidence of AIDS among groups with lower educational levels throughout the country. The comparative analysis of cases of AIDS and of deaths from AIDS shows growth, both in the number of cases and in the number of deaths; however, from 1996 onwards there has been a progressive reduction in the number of deaths in all regions analyzed. With respect to the incidence of cases of the disease acquired by vertical transmission, a significant growth trend can be seen in all regions for cases born in the period 1990-6, but in 1997 temporal analysis showed evidence of a reduction in this growth. In conclusion, temporal changes have occurred in the AIDS epidemic in Brazil, which has been showing a trend towards stability since 1996, when potent ARV therapy was introduced. However, this deceleration is not homogenous throughout all the regions.