Search

Copyright of Revista de Saúde Pública is the property of Faculdade de Educacao da Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To assess the prevalence and vulnerability of homeless people to HIV infection., Methods: Cross-sectional study conducted with a non-probabilistic sample of 1,405 homeless users of shelters in the city of São Paulo, southeastern Brazil, from 2006 to 2007. They were all tested for HIV and a structured questionnaire was applied. Their vulnerability to HIV was determined by the frequency of condom use: those who reported using condoms only occasionally or never were considered the most vulnerable. Multinomial and logistic regression models were used to estimate effect measures and 95% confidence intervals., Results: There was a predominance of males (85.6%), with a mean age of 40.9 years, 72.0% had complete elementary schooling, and 71.5% were non-white. Of all respondents, 15.7% reported being homosexual or bisexual and 62,0% reported having casual sex. The mean number of sexual partners in the last 12 months was 5.4. More than half (55.7%) of the respondents reported lifetime drug use, while 25.7% reported frequent use. Sexually-transmitted disease was reported by 39.6% of the homeless and 38.3% reported always using condoms. The prevalence of HIV infection was 4.9% (17.4% also tested positive for syphilis) and about half of the respondents (55.4%) had access to prevention programs. Higher HIV prevalence was associated with younger age (18-29 years, OR = 4.0 [95%CI 1.54;10.46]); past history of sexually-transmitted disease (OR = 3.3 [95%CI 1.87;5.73]); homosexual sex (OR = 3.0 [95%CI 1.28;6.92]); and syphilis (OR = 2.4 [95%CI 1.13;4.93]). Increased vulnerability to HIV infection was associated with being female; young; homosexual sex; having few partners or a steady partner; drug and alcohol use; not having access to prevention programs and social support., Conclusions: The HIV epidemic has a major impact on homeless people reflecting a cycle of exclusion, social vulnerability, and limited access to prevention.

Objective: To analyze different patterns of occurrence of AIDS in Brazilian cities between 2002 and 2006, associating trend and magnitude with socio-demographic indicators and local characteristics of the epidemic., Methods: This was an ecological study that categorized cities according to magnitude and trend of the epidemic and subsequently analyzed, considering social indicators, types of HIV transmission and year of first case reported. Data came from the Brazilian Epidemiological Surveillance System, the Brazilian Institute of Geography and Statistics and the United Nations Development Program for Brazil. Linear regression was used to estimate trend and chi-square statistics and ANOVA to analyze indicators., Results: A total of 4,190 cities (75.3%) reported AIDS cases between 2002 and 2006. Of these, 3,403 (81.2%) had an occurrence of "small magnitude" (mean=4.7 cases), 367 (8.8%) of "average magnitude" (mean=30.3 cases) and 420 (10.0%) of "great magnitude" (mean=378.7 cases). Cases of "small magnitude" were associated with lower incidence; beginning of the epidemic after 1991; presence of one or two types of transmission; especially heterosexual contact; with occurrences of cases in one or two years of the period; and lower human development index (HDI). Those of a "great magnitude" were associated with larger cities and higher HDI; presence of all types of transmission; beginning of the epidemic between 1980/1991; and trend towards reduction/stabilization, especially due to a decrease in transmission among injecting drug users. Growth of the epidemic was concentrated in "small magnitude" cities, although without significance to the point of changing proportional participation (8.7%) of these cities in the group of cases in Brazil., Conclusions: The AIDS epidemic remains concentrated in urban centers and the spread of cases to the countryside is characterized by irregular occurrence and small magnitude. Cities with low HDI and exclusive transmission through heterosexual contact showed low capacity of increase and the reduction of the epidemic is especially associated with the decrease in transmission among injecting drug users.

Objective: To characterize and analyze technological profiles of voluntary HIV counseling and testing centers in Brazil., Methods: A structured self-completion questionnaire with 78 questions was used. This questionnaire was answered by 320 (83.6%) of the 383 Brazilian centers, in 2006. Responses that characterized the services' technological profile were analyzed using K-means clustering technique. Associations between the profiles described and the municipal contexts were analyzed using the chi-square and residue analysis for proportions, and ANOVA and Bonferroni for means., Results: Centers showed significant deficiencies to guarantee adequate services. A total of four technological profiles were identified. The 'care' profile (21.6%) predominated among the services instituted before 1993, in areas with high AIDS incidence and in large cities. The 'prevention' profile (30.0%), prevalent between 1994 and 1998, was the type that best complies with the Ministry of Health's norms, with better readiness and productivity indicators. The 'care and prevention' profile (26.9%), included in the AIDS services, predominated between 1999 and 2002, and developed the most comprehensive set of activities, including STD treatment. The 'testing' profile (21.6%) was the most precarious, found where the epidemic is most recent and with a lower number of people tested., Conclusions: Counseling and testing centers constitute a set of heterogeneous services. In addition, service implementation guidelines have not been completely incorporated in Brazil, thus having and influence on low resolution and productivity indicators and also the inadequate development of prevention activities.