Leveraging early HIV diagnosis and treatment in Thailand to conduct HIV cure research.

Thailand has the highest prevalence of HIV among countries in Asia but has also been a pioneer in HIV prevention and treatment efforts in the region, reducing the incidence of new infections significantly over the last two decades. Building upon this remarkable history, Thailand has set an ambitious goal to stop the AIDS epidemic in the country by 2030. A key component of the strategy to achieve this goal includes scale-up of HIV screening programs to facilitate early HIV diagnosis and investment in mechanisms to support immediate initiation of antiretroviral therapy (ART). Initiation of ART during early or acute HIV infection not only reduces viremia, thereby halting onward transmission of HIV, but also may facilitate HIV remission by reducing the size of the latent HIV reservoir and preserving immune function. In Thailand, many efforts have been made to reduce the time from HIV infection to diagnosis and from diagnosis to treatment, especially among men who have sex with men and transgender women. Successfully identifying and initiating ART in individuals with acute HIV infection has been leveraged to conduct groundbreaking studies of novel strategies to achieve HIV remission, including studies of broadly-neutralizing HIV-specific monoclonal antibodies and candidate therapeutic vaccines. These efforts have mostly been deployed in Bangkok and future efforts should include other urban and more rural areas. Continued progress in HIV prevention, screening, and treatment will position Thailand to substantially limit new infections and may pave the way for an HIV cure.

HIV testing among clients in high HIV prevalence venues: disparities between older and younger adults.

The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus (HIV) testing of every client presenting for services in venues where HIV prevalence is high. Because older adults (aged ≥50 years) have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent (past 12 months) and ever HIV testing in a probability sample of at-risk adults (N = 1238) seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category (<50 years vs. ≥50 years) and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.40-0.90) or ever (OR = 0.6; 95% CI = 0.40-0.90). Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis.

Evaluation of Chiapas' HIV/AIDS information system of epidemiological surveillance / Evaluación del Sistema de Información de Vigilancia Epidemiológica de VIH/SIDA en Chiapas

Background: The functionality and performance of a health information system should be evaluated from the perspective of those who develop its processes. Considering the above, this study evaluated the performance of the HIV/AIDS Epidemiological Surveillance System (SIVE VIH/SIDA, according to its initials in Spanish) in Chiapas, Mexico. Methods: Qualitative study on the performance, structure and dynamics of SIVE VIH/SIDA, based on interviews with the personnel participating in this surveillance system, using the Updated Guidelines for the Evaluation of Public Health Surveillance Systems. The analysis was performed through the cyclic interactive method of content analysis, from which the evaluation indices were constructed. Results: A total of 32 interviews were conducted. The structure was described as well defined, at the expense of organizational dimensions, procedures and material resources. The dynamics of information, from the perspective of the collection, processing and use of information, was rated as regular. The performance of the SIVE HIV/AIDS in Chiapas was regular at the expense of these attributes of the information system: simplicity, flexibility, quality of data, acceptability, sensitivity, representativeness, timeliness and stability. Conclusions: In order to improve the performance of SIVE VIH/SIDA, it is necessary to strengthen the human resources and use of information dimensions, so that it can be an instrument for action.

Introducción: la funcionalidad y el desempeño de un sistema de información en salud deben evaluarse desde la perspectiva de quienes desarrollan sus procesos. Considerando lo anterior, este estudio evaluó el desempeño del Sistema de Vigilancia Epidemiológica del Virus de Inmunodeficiencia Humana/Síndrome de Inmunodeficiencia Adquirida (SIVE VIH/SIDA) en Chiapas, México. Métodos: estudio cualitativo sobre el desempeño, la estructura y la dinámica del SIVE VIH/SIDA, el cual se llevó a cabo con base en entrevistas al personal que participa en él, de acuerdo con las Guías Actualizadas para la Evaluación de Sistemas de Vigilancia en Salud Pública de los Centros para el Control y la Prevención de Enfermedades. El análisis se hizo con el método interactivo cíclico del análisis de contenido, a partir de lo cual se construyeron los índices de evaluación. Resultados: se hicieron un total de 32 entrevistas. La estructura fue calificada como bien definida, a expensas de las dimensiones organización, procedimientos y recursos materiales. La dinámica de información, desde la perspectiva de la recolección, el procesamiento y el uso de la información, fue calificada como regular. El desempeño del SIVE VIH/SIDA en Chiapas fue regular a expensas de los atributos simplicidad, flexibilidad, calidad de los datos, aceptabilidad, sensibilidad, representatividad, oportunidad y estabilidad. Conclusiones: para mejorar el desempeño del SIVE VIH/SIDA se requiere fortalecer las dimensiones de recursos humanos y el uso de la información, para que así se constituya en un instrumento para la acción.

Psychosocial outcomes in a cohort of perinatally HIV-infected adolescents in Western Jamaica.

BACKGROUND: Psychosocial factors interact with adolescent development and affect the ability of HIV-infected adolescents to cope with and adhere to treatment. AIM: To evaluate psychosocial outcomes in perinatally HIV-infected adolescents (PHIVAs) in Western Jamaica after psychosocial intervention. METHODS: The Bright Futures Paediatric Symptom Checklist (BF-PSC) was used for psychological screening of PHIVAs in Western Jamaica. Referred patients were evaluated using the Youth version of the Columbia Impairment Scale (CIS). Demographic, laboratory and clinical data obtained between July 2014 and June 2016 were evaluated retrospectively and outcomes were reviewed before and after psychosocial intervention. RESULTS: Sixty PHIVAs were enrolled and 36 (60%) had a positive BF-PSC score that necessitated referral. The BF-PSC correctly identified 89% of patients with impaired psychosocial assessment by CIS scores. Referred patients were less likely to adhere to treatment, to be virologically suppressed or to have a CD4+ count of >500 cells/µl, and were more likely to be in the late teenage group or to be of orphan status. After intervention, the prevalence of viral suppression increased and median viral load decreased. A difference in mean CD4+ cell count was detected before but not after intervention in teenage and orphan groups. CONCLUSIONS: The BF-PSC identified at-risk PHIVAs with impaired psychosocial functioning. Increased vulnerability was noted in orphans and older teenagers. Psychosocial interventions (including family therapy) reduced psychosocial impairment and improved virological suppression. Mental health intervention should be instituted to facilitate improved clinical outcomes, autonomy of care and transition to adult care.

Itinerário terapêutico de idosos vivendo com HIV/Aids: perspectivas da história oral / Therapeutic Itinerary of Elderly Living with HIV/Aids: Oral History Perspectives

Resumo Objetivo: Analisar o itinerário terapêutico de idosos vivendo com HIV em assistência num município do Oeste Catarinense. Metodologia: Estudo qualitativo com método história oral temática. A população foi composta por idosos que vivem há mais de cinco anos com HIV/Aids, assistidos em um Serviço de Atendimento Especializado. Foram realizados dois encontros para aproximação e três momentos de entrevistas em profundidade abordando questões relacionadas as trajetórias assistenciais dos sujeitos e sua relação com a doença. A análise de dados foi realizada por meio da análise temática de conteúdo. Resultados e Discussão: Os idosos tiveram seu diagnóstico em fase tardia o que mostra a dificuldade dos serviços de saúde em identificar precocemente o HIV na pessoa idosa. O tratamento foi centralizado na medicação com antirretrovirais, de maneira setorializada em serviço especializado e com equipe constituída por profissional médico, enfermeiro e farmacêutico. Também foi evidenciado baixo acesso a recursos não farmacológicos, como assistência psicoterapêutica. Considerações finais: A trajetória assistencial precisa ser qualificada na direção de garantir maior acesso as redes de saúde e as equipes interprofissionais para uma atenção à saúde integral que realize o diagnóstico precoce com vistas a reduzir os riscos de complicações e ofereça um cuidado integral e humanizado, que extrapole o uso de medicamentos.

Abstract Objective: To analyze the therapeutic itinerary of elderly people living with HIV assisted in a municipality in Western Santa Catarina. Methodology: Qualitative study with thematic oral history method. The population was consisted of elderly people who have been living with HIV/Aids for more than five years, assisted in a Specialized Care Service. Two meetings were held for approximation and three moments of in-depth interviews. Data analysis was performed through thematic content analysis. Results and Discussion: The elderly had their diagnosis at a late stage, use antiretrovirals in their therapeutic journey, they have the specialized service as the central treatment space and greater contact with the medical professional, nurse and pharmacist. Final considerations: The therapeutic itineraries were built in a way that diagnoses happen late, with treatment focused on medication, in a sectorized way and without a diverse interprofessional team.

Repercussões físicas, emocionais e sociais produzidas pelo HIV/AIDS na vida dos idosos / Physical, emotional and social repercussions caused by HIV/AIDS in the lives of the elderly: thematic oral history perspectives

Introdução: os dados epidemiológicos mostram um aumento da população idosa vivendo com HIV/AIDS no Brasil. Esta doença impacta de diferentes formas a vida da pessoa constituindo um desafio para os serviços de saúde. Objetivo: verificar as alterações físicas, emocionais e sociais produzidas pelo HIV/AIDS na vida de idosos. Metodologia: estudo qualitativo com método história oral temática. Realizado no Serviço de Atendimento Especializado (SAE) em HIV/AIDS de uma cidade do Oeste Catarinense com a inclusão de três idosos, duas mulheres e um homem, com média de idade de 66 anos e diagnóstico do HIV/AIDS há mais de cinco anos. Foram realizados cinco encontros, dois de observação no domicílio e três para realização da entrevista em profundidade com validação de todas as etapas. A análise dos dados foi realizada por meio da análise de conteúdo temática. A pesquisa foi aprovada no comitê de ética. Resultados e discussão: os idosos apresentaram sintomas físicos decorrentes da imunossupressão sendo o principal deles o emagrecimento, que se constituiu como um sinal de alerta para o diagnóstico do HIV/AIDS. As repercussões emocionais foram o medo e a angústia, mais presentes no momento do diagnóstico e início dos tratamentos. As repercussões sociais estiveram atreladas ao isolamento social, saída de grupos e perda do papel no trabalho. Considerações finais: o HIV/AIDS repercute na vida dos idosos e produz diferentes alterações, quer sejam físicas, emocionais e/ou sociais. Nessa direção, incluir essas demandas no planejamento de ações para esse grupo populacional tornará a assistência à saúde mais resolutiva.(AU)

Introduction: epidemiological data show an increase in the elderly population living with HIV/AIDS in Brazil. This disease affects people's lives in different ways and constitutes a challenge for health services. Objective: To verify the physical, emotional, and social repercussions caused by HIV/AIDS in the lives of the elderly. Methodology: a qualitative study which used thematic oral history as a method. The research was carried out at the Specialized Care Service (SAE) on HIV/AIDS in a city in western Santa Catarina, which included three elderly diagnosed with HIV/AIDS for more than five years. Two meet-ings were held for approximation and three moments of in-depth interviews with validation in all stages. Data analysis had performed through thematic content analysis, according to Minayo (2014). Results and discussion: The elderly presented physical symptoms resulting from immunosuppression, the main one being weight loss, which constitutes a warning sign for the diagnosis of HIV/AIDS. The emotional repercussions were the fear and anguish most present at the time of diagnosis and the beginning of treatments. The social repercussions were linked to social isolation, leaving groups, and losing the social role of work, being partially reintroduced. Final considerations: HIV/AIDS affects the lives of the elderly, producing different changes, whether physical, emotional, and social, and health services and an interprofessional team need to ensure a broader view of this whole context to qualify assistance.(AU)

Early diagnosis of HIV/aids infection: concept analysis / Diagnóstico precoz de la infección por VIH/SIDA: análisis de concepto / Diagnóstico precoce da infecção por HIV/Aids: análise de conceito

ABSTRACT Objectives: to analyze the concept of "early diagnosis of HIV/Aids infection" in light of Walker and Avant's conceptual analysis model. Methods: concept analysis study based on the framework proposed by Walker and Avant, instrumented by a scoping review conducted in April 2022, following the recommendations of the Joanna Briggs Institute and checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The search was made in eight data sources, obtaining sixteen articles. Results: the study found homosexual intercourses, early examination, anti-HIV antibodies, CD4 count, and sexually transmitted infection as the main attributes of the concept. As antecedents: information, risky behavior, unprotected sexual relations, prevention, and access to the service. As main consequences: antiretroviral treatment, seroconversion, transmission, and consultations. Final Considerations: the study approached the circumstantial situations of the theme, its attributes, antecedents, and consequences, qualifying the work process based on knowledge of nursing practice.

RESUMEN Objetivos: analizar concepto "diagnóstico precoz de la infección por VIH/SIDA" fundado en modelo de análisis conceptual de Walker y Avant. Métodos: estudio de análisis de concepto basado en referencial propuesto por Walker y Avant, instrumentalizado por revisión de ámbito realizada en abril de 2022, siguiendo las recomendaciones de Joanna Briggs Institute y checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Búsqueda hecha en ocho fuentes de datos, obteniendo 16 artículos. Resultados: verificado como principales atributos del concepto: Relaciones sexuales homosexuales, Examen precoz, Anticuerpos Anti-VIH, Recuento de CD4 e Infección sexualmente transmisible. Como antecedentes: Información, Conducta de riesgo, Relaciones sexuales sin protección, Prevención y Acceso al servicio. Como principales consecuentes: Tratamiento antirretroviral, Seroconversión, Transmisión y Consultas. Consideraciones Finales: el estudio acercó las situaciones circunstanciales de la temática, sus atributos, antecedentes y consecuentes, calificando el proceso de trabajo fundamentado en el conocimiento de la práctica de enfermería.

RESUMO Objetivos: analisar o conceito "diagnóstico precoce da infecção por HIV/aids" à luz do modelo de análise conceitual de Walker e Avant. Métodos: estudo de análise de conceito baseado no referencial proposto por Walker e Avant, instrumentalizado por uma revisão de escopo realizada em abril de 2022, seguindo as recomendações do Joanna Briggs Institute e checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A busca foi feita em oito fontes de dados, obtendo-se 16 artigos. Resultados: verificou-se como principais atributos do conceito: Relações sexuais homossexuais, Exame precoce, Anticorpos anti-HIV, Contagem de CD4 e Infecção sexualmente transmissível. Como antecedentes: Informação, Comportamento de risco, Relações sexuais desprotegidas, Prevenção e Acesso ao serviço. Como principais consequentes: Tratamento antirretroviral, Soroconversão, Transmissão e Consultas. Considerações Finais: o estudo aproximou as situações circunstanciais da temática, seus atributos, antecedentes e consequentes, qualificando o processo de trabalho fundamentado no conhecimento da prática de enfermagem.

[Men who have sex with men and human immunodeficiency virus testing in dental practice]. / Hombres que tienen sexo con hombres y detección del virus de la inmunodeficiencia humana en odontología.

OBJECTIVE: To explore the attitudes of men who have sex with men (MSM) towards the implementation of rapid HIV-1/2 testing in the dental practice, and to evaluate MSM's perceptions of stigma and discrimination related to sexual orientation by dental care professionals. METHODS: Cross-sectional study using a self-administered, anonymous, structured analytical questionnaire answered by 185 MSM in Mexico. The survey included sociodemographic variables, MSM's perceptions towards public and private dental providers, and dental services, as well as their perception towards rapid HIV-1/2 testing in the dental practice. In addition, the perception of stigma and discrimination associated with their sexual orientation was explored by designing a psychometric Likert-type scale. The statistical analysis included factor analysis and non-hierarchical cluster analysis. RESULTS: 86.5% of the respondents expressed their willingness to take a rapid HIV-1/2 screening test during their dental visit. Nevertheless, 91.9% of them considered it important that dental professionals must be well-trained before administering any rapid HIV-1/2 tests. Factor analysis revealed two factors: experiences of sexual orientation stigma and discrimination in dental settings, and feelings of concern about the attitude of the dentist and dental staff towards their sexual orientation. Based on these factors and cluster analysis, three user profiles were identified: users who have not experienced stigma and discrimination (90.3%); users who have not experienced stigma and discrimination, but feel a slight concern (8.1%), and users who have experienced some form of discrimination and feel concern (1.6%). CONCLUSION: The dental practice may represent a potential location for rapid HIV-1/2 testing contributing to early HIV infection diagnosis.

Electrolyte imbalance and sleep problems during anti-retroviral therapy: an under-recognized problem.

Human immunodeficiency virus (HIV) infection, and the anti-retroviral therapy (ART) associated complications necessitate that the medical care system keeps evolving for proper management of this group of patients. Electrolyte imbalance and sleep problems are common in patients on ART. Both of these conditions are associated with increased morbidity (such as acute kidney injury, chronic kidney disease, low CD4 count, non-adherence and depression) and mortality. Therefore, screening for both sleep problems and electrolytes imbalance may help to decrease the risk of complications in patients on ART.

Cuidado enfermero en paciente portador de VIH con bronconeumonía / Nursing care in HIV-positive patients with bronchopneumonia

Objetivo: Analizar los cuidados de enfermería en pacientes portadores de VIH con diagnóstico de Bronco Neumonía. Método: Se realizó una revisión bibliográfica de documentos científicos basados en los cuidados de enfermería en pacientes portadores de VIH con diagnóstico de Bronco Neumonía. Resultados: Se seleccionaron 15 artículos científicos que van en el rango de publicación del 2020 - 2021 con aportaciones relevantes. Conclusión: La función del profesional de enfermería es atender tanto a la persona sana como enferma, en todo tipo de actividades que contribuyen a su salud o a recuperarla, se estima que del 5 al 20% son afectados, de esta manera es la etiología más frecuente en la población infectada por el Virus de Inmunodeficiencia Humana con mayor incidencia en la población masculina joven.

Objective: To analyze nursing care in HIV patients with a diagnosis of Bronchopneumonia. Methods: A literature review of scientific papers based on nursing care in HIV patients with a diagnosis of Bronchopneumonia was carried out. Results: 15 scientific articles with relevant contributions were selected within the publication range of 2020 - 2021. Conclusion: The role of the nursing professional is to care for both the healthy and sick person, in all types of activities that contribute to their health or to recover it, it is estimated that 5 to 20% are affected, in this way it is the most frequent etiology in the population infected by the Human Immunodeficiency Virus with higher incidence in the young male population.

Recent HIV infections: evaluation of a simple identification score for newly diagnosed patients

ABSTRACT OBJECTIVE Recognize incident infection to better characterize the groups that fuel HIV epidemic. We propose a simple score to identify recent infections among newly diagnosed patients as a HIV surveillance tool. METHODS Newly diagnosed patients were defined as recent infections when a negative serological test in the previous year was available. Laboratory tests, such as the avidity index (Bio-Rad, according to the CEPHIA protocol), chemiluminescent intensity (CMIA, architect, Abbott), and the nucleotide ambiguity index of partial pol sequences were used as proxies of recency. A simple score based on clinical symptoms of acute retroviral syndrome during the previous year, CD4+ T cell count, and viral load at admission was tested to assess the predictive power, using receiver operating characteristic (ROC) curves, to identify recent cases of infection. RESULTS We evaluated 204 recently diagnosed patients who were admitted to the Ambulatório de Referência em Moléstias Infecciosas de Santo André (Santo André Reference Infectious Diseases Outpatient Clinic), in the metropolitan region of São Paulo, Brazil, recruited between 2011 and 2018. An HIV-negative test in the year prior to enrollment was documented in 37% of participants. The proportion of cases classified as recent infections (less than one year), according to the laboratory proxies were: 37% (67/181) for an avidity index < 40%, 22% (30/137) for a CMIA < 200, and 68% (124/181) for an ambiguity index < 0.5%. Using different combinations of recency definitions, our score showed an area under the ROC curve from 0.66 to 0.87 to predict recency. CONCLUSIONS Using data from patients' interviews and routine laboratory tests at admission, a simple score may provide information on HIV recency and thus, a proxy for HIV incidence to guide public policies. This simple for the Brazilian public health system and other low- and middle-income countries.

Pessoas vivendo com o vírus da imunodeficiência humana: percepção sobre atendimento odontológico / People living with the human immunodeficiency virus: perception of dental care / Personas que viven con el virus de la inmunodeficiencia humana: percepción de la atención odontológica

Objetivo: Avaliar a percepção da pessoa vivendo com o vírus da imunodeficiência humana sobre a ocorrência de atitudes discriminatórias em atendimento odontológico. Métodos: Trata-se de um estudo qualitativo, realizado com pessoas vivendo com o vírus da imunodeficiência humana e em tratamento em um centro de referência, na cidade de Governador Valadares, Minas Gerais, Brasil, no período de janeiro a julho de 2019. Foram incluídos 25 participantes no estudo, tendo sido realizadas entrevistas semiestruturadas. Os dados coletados foram submetidos à análise de conteúdo temática e, a partir daí, as categorias que emergiram incluíram o receio da informação do diagnóstico ao profissional de saúde e a recusa de atendimento por profissionais da saúde. Resultados: Entre os entrevistados, houve percepção de confiança para informação de sua condição sorológica ao profissional, embora também tenha ocorrido omissão dela. Foi percebida certa insegurança relacionada ao cirurgião-dentista na realização do tratamento odontológico, incluindo atitudes discriminatórias no consultório e até recusa de atendimento. Conclusão: Entre as pessoas vivendo com o vírus da imunodeficiência humana investigadas no presente estudo, houve percepção de condutas discriminatórias e dificuldades para conseguirem atendimento odontológico, além do receio de informar seu diagnóstico ao cirurgião-dentista, omitindo-o.

Objective: To assess the perception people living with the human immunodeficiency virus have in relation to the occurrence of discriminatory attitudes during dental care. Methods: This is a qualitative study conducted with people living with the human immunodeficiency virus undergoing treatment in a reference center in the city of Governador Valadares, Minas Gerais, Brazil, from January to July 2019. The study included 25 participants, and semi-structured interviews were carried out. The collected data were subjected to Thematic Content Analysis and the categories that emerged included fear of disclosing the diagnosis to the health care professional and health care professionals' refusal to provide care. Results: Among the interviewees, there was a perception of trust in disclosing serological status to the professional, but there were also some who hid it. Certain insecurity was noted in dentists while delivering dental treatment, and there were some discriminatory attitudes in the office and even refusal to deliver care. Conclusion: There was a perception of discriminatory behavior and difficulties in obtaining dental care among the people living with the human immunodeficiency virus analyzed in the present study. In addition, there was fear of disclosing the diagnosis to the dentist, and some hid it.

Objetivo: Evaluar la percepción de la persona que vive con el virus de la inmunodeficiencia humana sobre la ocurrencia de actitudes de discriminación durante la atención odontológica. Métodos: Se trata de un estudio cualitativo realizado con personas que viven con el virus de la inmunodeficiencia humana y en tratamiento en un centro de referencia de la ciudad de Governador Valadares, Minas Gerais, Brasil, en el periodo entre enero y julio de 2019. Se ha incluido 25 participantes en el estudio utilizándose de entrevistas semiestructuradas. Se ha realizado el análisis de contenido temático de los datos recogidos de los cuales emergieron las categorías que han incluido el miedo de la información del diagnóstico para el profesional sanitario y el rechazo de la atención de parte de los profesionales sanitarios. Resultados: Entre los entrevistados, hubo la percepción de confianza para dar la información de su condición serológica al profesional aunque también haya ocurrido la omisión de información. Se ha percibido cierta inseguridad relacionada al cirujano-odontólogo para la realización del tratamiento lo que incluye las actitudes de discriminación en el consultorio hasta el rechazo de la atención. Conclusión: Entre las personas que viven con el virus de la inmunodeficiencia humana investigadas en el estudio, hubo la percepción de conductas de discriminación y dificultades para conseguir la atención odontológica además del miedo para informar su diagnóstico al cirujano-odontólogo, omitiéndolo.

Movilidad y turismo sexual en la ciudad de Taxco, México / Mobility and sex tourism in the city of Taxco, México

RESUMEN Objetivo a) estudiar la movilidad y el turismo sexual que realizan trabajadores de taxis de la ciudad de Taxco, Guerrero, México y b) analizar los datos de casos confirmados del Virus de la Inmunodeficiencia Humana (VIH) y Síndrome de Inmunodeficiencia Adquirida (SIDA) en el municipio de Taxco, del año 2006 al 2016. Materiales y Métodos El estudio fue de tipo cualitativo no probabilístico. Se diseñó un cuestionario de entrevista de preguntas abiertas, y se aplicó a 30 trabajadores de taxis en la ciudad de Taxco, Guerrero, México. También se entrevistó a cinco médicos especialistas (informantes clave anónimos). Resultados El 60% (18 casos) del grupo entrevistado manifestó haber contratado sexo-servidoras. Las ciudades a donde se acudió en mayor medida para dicha actividad fueron Jojutla (Estado de Morelos), Iguala y Taxco (Estado de Guerrero) y Ciudad de México. Se registró un total de 72 casos confirmados de VIH y sida en los 10 años considerados. Conclusiones La ciudad de Jojutla fue el lugar más visitado en cuestión de movilidad con motivo de contratar dicho sexoservicio. En lo anterior influyeron determinantemente tanto los bajos precios, como la corta edad de sexoservidoras que lo frecuentaban. Finalmente, las afirmaciones de especialistas en salud entrevistados confrontan los datos estadísticos oficiales sobre casos de VIH/sida.

ABSTRACT Objective (a) To study the mobility and sex tourism carried out by taxi workers in the city of Taxco, Guerrero, México. (b) To analyze the data of confirmed cases of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the municipality of Taxco, from 2006 to 2016. Material and Methods The study was qualitative, non-probabilistic. An open-ended interview questionnaire was designed and applied to 30 taxi workers in the city. Five specialist physicians (anonymous key informants) were interviewed. Results The findings show how 60% (18 cases) of the interviewed group stated that they had hired sex workers. The cities that were most attended for such activity were Jojutla (State of Morelos), Iguala and Taxco (State of Guerrero), and México City. A total of 72 confirmed cases of HIV and AIDS were registered in the 10 years considered. Conclusions The city of Jojutla was the most visited place in terms of mobility for the purpose of hiring this sex service. Both the low prices, to the young age of the sex workers who frequented it had a decisive influence on the above. Finally, the statements of health specialists interviewed confront the official statistical data on HIV/AIDS cases.

Positividade ao hiv e fatores associados em um centro de testagem e aconselhamento / Positividad al vih y factores asociados en un centro de consejería y pruebas / Hiv positivity and associated factors in a counseling and testing center

RESUMO Objetivo: Analisar os fatores sociodemográficos e comportamentais associados à positividade ao Vírus da Imunodeficiência Humana (HIV) em usuários de um Centro de Testagem e Aconselhamento (CTA). Método: Estudo transversal com 5.229 usuários que realizaram o teste rápido para HIV, registrados no Sistema de Informação do CTA. As análises bivariadas e multivariadas foram realizadas utilizando-se a regressão logística binária, com apresentação do OddsRatio, intervalo de confiança de 95% e p-valor <0,05. Resultados: A prevalência de infecção pelo HIV foi de 5,0% (259), com maior acometimento da população mais jovem (p=0,010). Observou-se maior positividade entre as pessoas vivendo com HIV/Aids (91,3%; p<0,001) e homens que fazem sexo com homens (HSH) (20%; p<0,001). Nas análises multivariadas verificou-se maior associação à infecção pelo HIV no modelo 2 que inclui, as variáveis sociodemográficas e comportamentais, como: o recorte populacional de HSH, o compartilhamento de seringas, a orientação sexual HSH, ter infecções sexualmente transmissíveis (IST) nos últimos 12 meses, parceiro soropositivo para HIV e uso irregular ou não uso do preservativo nos últimos 12 meses com parceiro fixo. Conclusão: A vulnerabilidade ao HIV foi mais associada aos fatores relacionados ao compartilhamento de seringas e ao comportamento sexual, especialmente os HSH e as parcerias fixas.

resumen Objetivo: analizar los factores sociodemográficos y comportamentales asociados a la positividad al Virus de la Inmunodeficiencia Humana (VIH) en usuarios de un Centro de Consejería y Pruebas. Método: estudio transversal con 5.229 usuarios que realizaron la prueba rápida para VIH, registrados en el Sistema de Información del Centro. Los análisis bivariados y multivariados fueron realizados utilizando la regresión logística binaria, con presentación del OddsRatio, intervalo de confianza de 95% y p-valor <0,05. Resultados: la prevalencia de infección por el VIH fue de 5,0% (259), con mayor acometimiento de la población más joven (p=0,010). Se observó mayor positividad entre las personas viviendo con VIH/sida (91,3%; p<0,001) y hombres que hacen sexo con hombres (HSH) (20%; p<0,001). En los análisis multivariados se verificó mayor asociacióna la infección por el VIH en el modelo 2 que incluye las variables sociodemográficas y comportamentales como: el recorte poblacional de HSH, el compartir jeringas, la orientación sexual HSH, tener enfermedades de transmisión sexual (ETS) en los últimos 12 meses, compañero seropositivo para VIHy uso irregular o la falta del uso de preservativo en los últimos 12 meses con compañero fijo. Conclusión: la vulnerabilidad al VIH fue más asociada a los factores relacionados al compartir jeringas y al comportamiento sexual, especialmente los HSH y los compañeros fijos.

ABSTRACT Objective: To analyze the sociodemographic and behavioral factors associated with Human Immunodeficiency Virus (HIV) positivity in users of a Counseling and Testing Center (CTC). Method: Across-sectional study with 5,229 users who performed the rapid HIV test, registered in the CTC's Information System. Bivariate and multivariate analyzes were performed using binary logistic regression, presenting OddsRatio, 95% confidence interval and p-value <0.05. Results: The prevalence of HIV infection was 5.0% (259), with greater involvement of the younger population (p=0.010). Greater positivity was observed among people living with HIV/AIDS(91.3%; p <0.001) and men who have sex with men (MSM) (20%; p<0.001). In multivariate analyzes, there was a greater association with HIV infection in model 2, which includes sociodemographic and behavioral variables, such as: the populational cut of MSM, needle sharing, MSM sexual orientation, having sexually transmitted infections (STIs) in the last 12 months, HIV-positive partner and irregular or no condom use in the last 12 months with a steady partner. Results: Conclusion: Vulnerability to HIV was more associated with factors related to needle sharing and sexual behavior, especially MSM and steady partnerships.

Evolução da infecção pelo HIV entre os povos indígenas do Brasil Central / Evolution of HIV infection in indigenous peoples in Central Brazil / Evolución de la infección por VIH entre los pueblos indígenas de Brasil Central

A distribuição da epidemia de aids no Brasil está associada a uma ampla gama de fatores que definem maior ou menor vulnerabilidade de grupos populacionais. O estudo teve como objetivo analisar as características clínicas e laboratoriais dos casos de infecção pelo HIV/aids em indivíduos com 13 anos de idade ou mais, e sua evolução para o óbito na população indígena assistida pelo Distrito Sanitário Especial Indígena de Mato Grosso do Sul. Realizou-se um estudo descritivo e retrospectivo sobre a condição clínica e evolução da doença entre 2001 e 2014, a partir de três bases de dados secundários. Foram avaliados o tempo de evolução para a aids, o tempo de evolução ao óbito, a carga viral, a contagem de linfócitos T-CD4+ e o tempo de sobrevida. Foram identificados 103 casos de infecção pelo HIV, dos quais 48,5% evoluíram para aids, sendo 60% em menos de um ano desde o diagnóstico. Foram registrados 40 óbitos, sendo 77,5% em decorrência da infecção pelo HIV. Desses que morreram, apenas 30% tiveram sobrevida maior do que um ano. Este estudo sugere que o diagnóstico da infecção pelo HIV se deu nas fases avançadas da doença, revelando-se tardio e apontando uma cobertura diagnóstica deficiente. A rápida evolução ao óbito e curto período de sobrevida também podem indicar fragilidade no acesso aos serviços de saúde de referência, assim como desarticulação e pactuações insuficientes entre Distrito, municípios e estado.

Distribution of the AIDS epidemic in Brazil is associated with a wide range of factors that determine different population groups' greater or lesser vulnerability. The study's objective was to analyze clinical and laboratory characteristics of HIV/AIDS in individuals 13 years or older and the evolution to death in the indigenous population assisted by the Special Indigenous Health District of the State of Mato Grosso do Sul, Brazil. A descriptive and retrospective study was performed on the clinical conditions and evolution of the disease from 2001 to 2014, based on three secondary databases. The study assessed time in progression to AIDS, time in progression to death, viral load, CD4+ T-lymphocyte count, and survival time. A total of 103 cases of HIV infection were identified, of which 48.5% progressed to AIDS, 60% in less than a year since diagnosis. Forty deaths were recorded, 77.5% of which due to HIV infection. Of those who died, only 30% had survived for more than a year. The study suggests that diagnosis of HIV infection occurred in advanced stages of the disease (i.e., late), and points to deficient diagnostic coverage. Rapid progression to death and short survival time are indicative of insufficient access to specialized health services, as well as disconnection and deficient collaboration between the Indigenous Health District, municipalities, and the state.

La distribución de la epidemia de sida en Brasil está asociada a una amplia gama de factores que definen mayor o menor vulnerabilidad de grupos poblacionales. El objetivo del estudio fue analizar las características clínicas y de laboratorio de los casos de infección por el VIH/sida en individuos con 13 años de edad o más, y su evolución hacia el óbito en la población indígena, asistida por el Distrito Sanitario Especial Indígena de Mato Grosso do Sul. Se realizó un estudio descriptivo y retrospectivo sobre la condición clínica y la evolución de la enfermedad entre 2001 y 2014, a partir de tres bases de datos secundarios. Se evaluó el tiempo de evolución para el sida, el tiempo de evolución para el óbito, la carga viral, el cálculo de linfocitos T-CD4+ y el tiempo de supervivencia. Se identificaron 103 casos de infección por VIH, de los cuales un 48,5% evolucionaron hacia sida, siendo 60% en menos de un año desde el diagnóstico. Se registraron 40 óbitos, siendo un 77,5% derivados de la infección por VIH. De esos que murieron, solamente un 30% tuvieron una supervivencia mayor que un año. Este estudio sugiere que el diagnóstico de la infección por VIH se produjo en fases avanzadas de la enfermedad, revelándose tardío y apuntando una cobertura diagnóstica deficiente. La rápida evolución al óbito y corto período de supervivencia, también pueden indicar fragilidad en el acceso a los servicios de salud de referencia, así como la descoordinación y acuerdos insuficientes entre distrito, municipios y estado.

HIV testing in the maternity ward and the start of breastfeeding: a survival analysis.

OBJECTIVE: The purpose of this study was to analyze the factors that influence of the time between birth and the beginning of breastfeeding, especially at the moment of the rapid HIV test results at hospital admission for delivery. METHODS: Cohort study of 932 pregnant women who underwent rapid HIV test admitted in the hospital for delivery in Baby-Friendly Hospitals. The survival curves of time from birth to the first feeding were estimated by the Kaplan-Meier method and the joint effect of independent variables by the Cox model with a hierarchical analysis. As the survival curves were not homogeneous among the five hospitals, hindering the principle of proportionality of risks, the data were divided into two groups according to the median time of onset of breastfeeding at birth in women undergoing rapid HIV testing. RESULTS: Hospitals with median time to breastfeeding onset at birth of up to 60 min were considered as early breastfeeding onset and those with higher medians were considered as late breastfeeding onset at birth. Risk factors common to hospitals considered to be with early and late breastfeeding onset at birth were: cesarean section (RR=1.75 [95% CI: 1.38-2.22]; RR=3.83 [95% CI: 3.03-4.85]) and rapid test result after birth (RR=1.45 [95% CI: 1.12-1.89]; RR=1.65 [95% CI: 1.35-2.02]), respectively; and hospitals with late onset: starting prenatal care in the third trimester (RR=1.86 [95% CI: 1.16-2.97]). CONCLUSIONS: The onset of breastfeeding is postponed, even in Baby-Friendly Hospitals, when the results of the rapid HIV test requested in the maternity are not available at the time of delivery.

Percepção dos profissionais de saúde e dos usuários sobre o aconselhamento no teste rápido para HIV / Percepción de los profesionales de salud y usuarios acerca del conseñado en el contexto de la prueba rápida para VIH / Perception of health professionals and users about counseling in the context of rapid HIV testing

RESUMO Objetivo Analisar a percepção acerca do aconselhamento no contexto do teste rápido para o HIV. Método Pesquisa com abordagem qualitativa realizada no Centro de Testagem e Aconselhamento com profissionais de saúde e com usuários do Centro de Testagem e Aconselhamento. A análise seguiu os passos propostos na fenomenologia empírica de Giorgi articulando-a com a literatura. Resultados Identificaram-se cinco categorias: a experiência anterior à realização do Teste Rápido; Intencionalidade de sentimentos; Percepção do aconselhamento pelo usuário; Percepção do aconselhamento individual no pós-teste e; Percepção de profissionais sobre o aconselhamento. O aconselhamento coletivo é percebido pelos usuários como palestra sobre HIV/Aids com ênfase em consequências negativas; e o aconselhamento individual, como mais confortável e como possibilidade para exposição de dúvidas. Discussão Considera-se que, mesmo sabendo da importância do aconselhamento, este é realizado de forma empírica, reduzindo o ato ao repasse de informações com teor educativo, visando apenas à aprendizagem cognitiva como meio de disseminar o conhecimento, tentando, assim, reduzir a cadeia de transmissão da HIV/Aids.

RESUMEN Objetivo Analizar la percepción acerca del asesoramiento en el contexto de la prueba rápida para el VIH. Método Investigación con enfoque cualitativo realizada en el Centro de Pruebas y Asesoramiento con profesionales de salud y de los usuarios del Centro de Pruebas y Asesoramiento. El análisis siguió los pasos propuestos en la fenomenología empírica de Giorgi, articulando con la literatura. Resultados Se identificaron cinco categorías: la experiencia anterior a la realización de la prueba rápida; Intencionalidad de sentimientos; Percepción del asesoramiento por el usuario; Percepción del asesoramiento individual en el post-test y; Percepción de profesionales sobre el asesoramiento. El asesoramiento colectivo es percibido por los usuarios como conferencia sobre HIV / SIDA con énfasis en consecuencias negativas y el asesoramiento individual como más cómodo y posibilidad para la exposición de dudas. Discusión: Se considera que, aunque se sabe de la importancia del asesoramiento, éste se realiza de forma empírica, reduciendo el acto al traspaso de informaciones con contenido educativo, visando que el sólo el aprendizaje cognoscitivo y como medio de diseminar el conocimiento, intentando así reducir la cadena de transmisión de la HIV / SIDA.

ABSTRACT Objective To recognize the perception of counseling by professionals and users of the Testing and Counseling Center to perform the Rapid Test for the diagnosis of HIV. Method Qualitative research conducted at the Testing and Counseling Center. We interviewed users and professionals who performed the rapid test. The analysis followed the steps proposed in the empirical phenomenology of Giorgi, articulating with the literature. Results Five categories were identified: Prepredicative experience when performing The rapid test; Intent of feelings; Perception of user advice; Perception of individual counseling in the post-test and; Perception of professionals about counseling. Collective counseling is perceived by the users as a talk about STI / Aids with an emphasis on negative consequences and individual counseling as more comfortable and possibility for exposing doubts. Discussion It is considered that even knowing the importance of counseling, this is done in an empirical way, reducing the act to the transfer of information with educational content, aiming at only cognitive learning and as a means of disseminating knowledge, thus trying to reduce the HIV/ Aids transmission chain.

Tendencias de mortalidad por VIH/SIDA en la ciudad de Pereira, Colombia (2002-2014): estudio ecológico / Trends in HIV / AIDS mortality in the city of Pereira, Colombia (2002-2014): ecological study

RESUMEN Objetivo: evaluar las tendencias de la mortalidad por VIH y sus factores asociados en el periodo 2002-2014 del municipio de Pereira. Materiales y métodos: estudio ecológico de serie temporal. Utiliza como fuente de información las bases de datos de certificados de defunción codificados por el Departamento Administrativo Nacional de Estadísticas. Las tendencias de la mortalidad se estimaron de acuerdo con las siguientes variables: edad, sexo, área de residencia y causa de muerte. Se realizó un análisis exploratorio con los datos en bruto, aplicando estadística descriptiva para el cálculo de porcentajes, medidas de tendencia central y variabilidad. Se aplicó regresión joinpoint para identificar tendencias en tasas ajustadas. Resultados: la mortalidad de los pacientes con infección por VIH en el periodo 2002-2014 fue en promedio de 11,9 por 100.000 habitantes. La mortalidad se mantuvo estable sin presentar variaciones estadísticamente significativas en el periodo evaluado (VPAP: 2,6; IC 95 %: -2,7 -8,1; p = 0,6), con una tendencia al aumento de 14,3 % por año, del año 2002 al año 2005, otra tendencia a la disminución de -1,1 % por año en el periodo 2005-2014. La mortalidad fue mayor en el sexo masculino, los pacientes de edad avanzada, aquellos con causas no infecciosas y que residen en la zona urbana. Conclusión: se presentó una alta mortalidad de los pacientes con infección por VIH y una tendencia sin variaciones significativas en el periodo 2002-2014 en la ciudad de Pereira, Colombia.

SUMMARY Objective: To evaluate trends in HIV mortality and its associated factors in the period 2002-2014 for the municipality of Pereira. Materials and methods: Ecological study, using as a source of information the databases of death certificates codified by the National Administrative Department of Statistics. The variables selected to estimate the trends were: age, sex, area of residence and cause of death. An exploratory analysis was carried out applying descriptive statistics for the calculation of percentages, measures of central tendency and variability. Joinpoint regression was applied to identify trends in adjusted rates. Results: The average mortality of patients with HIV infection in the period 2002-2014 was 11.9 per 100,000 people. Mortality remained stable without presenting statistically significant variations in the evaluated period (VPAP: 2.6, 95% CI: -2.7 -8.1, p = 0.6), with an increase of 14.3% per year from 2002 to the year 2005 and another tendency to decrease by -1.1% per year in the period 2005-2014. Mortality was greater in males, elderly patients, those with non-infectious diseases and residing in urban areas. Conclusion: There was a high mortality of patients with HIV infection and a trend without significant variations in the period of the years 2002-2014 in the city of Pereira, Colombia.

Concepção de mulheres sobre vivência com vírus da imunodeficiência humana e impossibilidade de amamentar / Concepción de mujeres sobre vivir con virus de la inmunodeficiencia humana e imposibilidad de amamantar / Womens conception about living with human immunodeficiency virus and impossibility of breastfeeding

Objetivos: discutir a concepção de mulheres sobre a vivência com o vírus da imunodeficiência humana e a impossibilidade de amamentar. Método: estudo descritivo, exploratório, com abordagem qualitativa, realizado com 12 mulheres em um hospital universitário no Rio de Janeiro, Brasil. A coleta de dados, por meio de entrevista individual e semiestruturada, ocorreu entre junho de 2017 e março de 2018. Os dados foram analisados mediante a utilização do referencial metodológico da análise de conteúdo. Resultados: a maioria das participantes foi diagnosticada no pré-natal e no parto. Elas reconheceram os benefícios da amamentação e seguiram a recomendação de não amamentar. Conclusão: as participantes reconheceram os benefícios da amamentação e, mesmo que tristes e frustradas diante da impossibilidade de amamentar, transcenderam esses sentimentos, por proteção ao filho, reafirmando o papel atribuído pela sociedade e pela cultura e as assimetrias de gênero relacionadas à reprodução e maternidade.

Objetivos: discutir la concepción de mujeres sobre vivir con el virus de la inmunodeficiencia humana y la imposibilidad de amamantar. Método: estudio exploratorio descriptivo, con enfoque cualitativo, con 12 mujeres en hospital universitario de Río de Janeiro, Brasil. Recopilación de datos a través de entrevistas individuales y semiestructuradas, entre junio de 2017 y marzo de 2018. Datos analizados por el marco metodológico del análisis de contenido. Resultados: la mayoría de los participantes fueron diagnosticados durante el prenatal y parto. Reconocieron los beneficios de la lactancia materna y siguieron la recomendación de no amamantar. Conclusión: los participantes reconocieron los beneficios de la lactancia materna y, aunque tristes y frustradas ante la imposibilidad de la lactancia materna, trascendieron estos sentimientos para proteger al niño, reafirmando el papel atribuido por la sociedad y la cultura y las asimetrías de género relacionadas con la reproducción y maternidad.

Objectives: to discuss women's conception about living with the human immunodeficiency virus and the impossibility of breastfeeding. Method: descriptive, exploratory study, with a qualitative approach, conducted with 12 women in a university hospital in Rio de Janeiro, Brazil. Data collection, through individual and semi-structured interviews, occurred between June 2017 and March 2018. The data were analyzed using the methodological framework of content analysis. Results: most participants were diagnosed during prenatal care and delivery. They recognized the benefits of breastfeeding and followed the recommendation not to breastfeed. Conclusion: the participants recognized the benefits of breastfeeding and, even if sad and frustrated at the impossibility of breastfeeding, transcended these feelings to protect their child, reaffirming the role attributed by society and culture and gender asymmetries related to reproduction and motherhood.

Reflexões humanísticas em serviço de atendimento especializado em HIV / Humanistic reflections on specialized HIV care service / Reflexiones humanísticas en un servicio de atención especializado en VIH

Resumo A postura do médico em relação a diagnóstico e esclarecimentos ao paciente infectado pelo vírus da imunodeficiência humana baseia-se principalmente na percepção pessoal e experiência humanística. O objetivo deste estudo foi relatar a experiência de estudantes de medicina do sexto período do Centro Universitário Metropolitano da Amazônia, em Belém/PA, durante as aulas do módulo de Habilidades Clínicas (Eixo Infectologia) no Centro de Atenção à Saúde em Doenças Infecciosas Adquiridas. Depois de prestarem atendimentos ambulatoriais e discutirem casos clínicos por cinco meses, os estudantes se deram conta da necessidade de humanização nessa área, considerando questões biopsicossociais. De modo geral, a experiência ampliou os conhecimentos adquiridos nas aulas e permitiu aplicar o cuidado integral ao paciente, além de estimular formação mais humanística e crítica desses profissionais de saúde.

Abstract The physicians's attitude towards diagnosis and clarifications to the patient infected by the human immunodeficiency virus is based mainly on personal perception and humanistic experience. The objective of this study was to report the experience of medical students from the sixth period of the Centro Universitário Metropolitano da Amazônia, in Belém, Pará, Brazil, during classes of the Clinical Skills module (Infectious Axis) at the Center for Attention on Acquired Infectious Diseases. After providing outpatient care and discussing clinical cases for five months and considering biopsychosocial issues, the students realized a need for humanization in this area. The experience expanded the knowledge acquired in class and allowed the delivery of comprehensive care to the patient, in addition to encouraging more humanistic and critical training of these health professionals.

Resumen La actitud del médico respecto al diagnóstico y la aclaración de la condición del paciente infectado por el VIH está relacionada con la percepción personal y la experiencia humanística. El presente estudio tuvo el objetivo de presentar la experiencia de estudiantes de medicina del sexto período del Centro Universitário Metropolitano da Amazônia, en Belém, Pará, Brasil, durante las clases del módulo Habilidades Clínicas (Eje Infectología) en el Centro de Atención de Enfermedades Infecciosas Adquiridas. Los estudiantes ofrecieron atención ambulatoria y tuvieron discusión de casos durante cinco meses y pudieron advertir la necesidad de humanización en esta área debido a problemas biopsicosociales. La experiencia brindó la oportunidad de ampliar los conocimientos adquiridos durante las clases y aplicar una atención integral al paciente, y estimular la capacitación de profesionales de la salud con un perfil humanístico y crítico.