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The paper presents the effects of the storm‐time prompt penetration electric fields (PPEF) and traveling atmospheric disturbances (TADs) on the total electron content (TEC), foF2 and hmF2 in the American sector (north and south) during the geomagnetic storm on 23–24 April 2023. The data show a poleward shift of the Equatorial Ionization Anomaly (EIA) crests to 18°N and 20°S in the evening of 23 April (attributed to eastward PPEF) and the EIA crests remaining almost in the same latitudes after the PPEF reversed westward. The thermospheric neutral wind velocity, foF2, hmF2, and TEC variations show that TADs from the northern and southern high latitudes propagating equatorward and crossing the equator after midnight on 23 April. The meridional keograms of ΔTEC show the TAD structures in the north/south propagated with phase velocity 470/485 m/s, wave length 4,095/4,016 km and period 2.42/2.30 hr, respectively. The interactions of the TADs also appear to modify the wind velocities in low latitudes. The eastward PPEF and equatorward TADs also favored the development of a clear/not so clear F3 layer in northern/southern regions of the equator. Plain Language Summary: The thermosphere‐ionosphere‐magnetosphere system is largely affected during events of geomagnetic storms. Its dynamics, mainly in the ionized environment, may impact modern lives by degradations in the satellite signals affecting, for example, all applications involving Global Navigation Satellite System. The thermosphere and ionosphere responses to the large geomagnetic storm of 23–24 April 2023 are analyzed here and the main discoveries are the unexpected spatial plasma density distribution over Boa Vista (MLat ≈ 8°N) due to resulting effects of a disturbed eastward electric field and traveling atmospheric disturbance (TAD). The interactions/interferences of TADs were able to explain the unexpected moment of the peak in thermospheric neutral wind speed measurements over the equatorial station, as well as all variations in ionospheric parameters (foF2, hmF2, and total electron content) recorded in pairs by seven Digisondes and GNSS receivers spread across Brazil. Key Points: Interactions of traveling atmospheric disturbances (TADs) cause unexpected thermospheric neutral wind speeds in the American equatorial and low‐latitude sectorsThe effects resulting from a disturbed electric field and TADs were able to produce anomalous electron density distribution at low latitudesThe variations in the ionospheric observational measurements recorded around 4 UT in Brazil on 24 April 2023 were explained by the passages of TADs [ABSTRACT FROM AUTHOR]

Women in prison have high risk for non-communicable diseases both in relation to men in prison and in relation to women in the general population. This study documented the health disparities related to diseases among women in prison and in the general female population in Brazil. Women in prisons (WP) < 30 years old had a prevalence of hypertension (PR = 4.5; 95% CI 3.4–6.1), cardiovascular disease (PR = 4.4; 95% CI 2.4–7.9) and asthma (PR = 3.0; 95% CI 2.3–3.8) higher than general female population in Brazil in the same age group. Women in prison > 50 years old also presented asthma prevalence (PR = 4.3; 95% CI 2.9–6.3) higher than the general female population in Brazil in the same age group. These women in prison, overwhelmingly young, could be mistaken for an elderly population in Brazil. Actively responding to early disease in these women can reduce overall health costs and improve health care for this population that may have limited access to health care outside of prison. [ABSTRACT FROM AUTHOR]

Background: Despite the preventive policies adopted, reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) has been limited. The risk of hepatitis C virus (HCV) infection has increased among the most vulnerable population groups, including MSM. The aim of this study was to estimate the prevalence of HCV infection and to assess risky practices among MSM from 12 Brazilian cities. Methods: This study was carried out from June to December 2016 using respondent driven sampling (RDS). Participants completed a self-administered questionnaire to collect behavioral, socioeconomic, and demographic variables. In addition, the rapid diagnostic test (RDT) for HCV was offered. Positive results were sent to Instituto Adolfo Lutz for confirmation. Results: A total of 4,176 participants were recruited and 23 samples were sent for confirmation. Of these, 16 were confirmed, resulting in a prevalence of 0.7% (95% CI: 0.3%—1.7%). The Southeast region showed a prevalence of 0.9% (95% CI: 0.3—2.6), followed by the South region, with 0.6% (95% CI: 0.2—2.1). The Northeast region had a prevalence of 0.3% (95% CI: 0.1—1.0) and the Midwest 0.1% (95% CI: 0.0—0.7). No positive cases were found in the North. Single men aged 40 years or older were the majority of participants exposed to HCV. High levels of alcohol consumption, illicit drug use, irregular condom use, in addition to infection with other STIs, were associated with exposure to HCV. Conclusions: STIs continue to be important health problems in Brazil and globally. Many STIs are inapparent for many years until they bring more serious consequences. Extra investment in HCV is also warranted, given that it can be eliminated. Relying solely on clinical data to provide information about inapparent infection, especially in stigmatized populations, will make that goal more difficult to achieve. Surveillance studies, such as the one reported here need to be repeated over time to demonstrate trends and to provide information for evaluation, program and policies. Investments in the most vulnerable populations are critical to achieve the World Health Organization global health goals including the elimination of viral hepatitis by 2030. [ABSTRACT FROM AUTHOR]

The state of Ceará, in the Northeast Region of Brazil, presents the simultaneous circulation of Zika (ZIKV), dengue (DENV) and chikungunya (CHIKV) viruses. In 2017 there were a high number of cases of these three arboviruses, especially CHIKV. Here, we detected the presence of arboviruses ZIKV, DENV and CHIKV and their coinfections in women in endemic regions of the city of Fortaleza, Ceará in a post-Zika epidemic year. Sociodemographic and environmental characteristics associated with arbovirus positivity were also analyzed. Women (n = 1289) between 15 and 39 years old were included. RT-qPCR was performed for virus detection and IgM antibody positivity was also analyzed. One hundred and six (8.3%) participants were positive for one or more arboviruses. Monoinfections (76; 5.9%) were distributed between 22 (1.7%) for ZIKV, 39 (3.1%) for DENV and 15 (1.2%) for CHIKV. Co-infections were detected in 30 (2.3%) of the positive participants and one case with triple infection was found. IgM positivity was found in 2.4% of ZIKV RT-qPCR, 9.6% of DENV and 16.3% of CHIKV. RT-qPCR positivity for arboviruses was associated with low socioeconomic class and presence of a water box sealing in the household. A higher positivity to the three viruses occurred in the month with the lowest wind velocity, which was also preceded by the highest peak of rain and humidity. We identified the simultaneous circulation and co-infection of ZIKV, DENV and CHIKV in Fortaleza in a post-Zika epidemic year. We also highlight the need for continuous epidemiological surveillance combined with molecular diagnostic tools. [ABSTRACT FROM AUTHOR]

This study aimed to identify the prevalence of women in prisons who have already had an HIV test inside prison and the factors associated with this test. A cross-sectional study was carried out with 1327 women in 15 prisons in 9 states in Brazil. Almost 60% (95% CI: 57.8–63.7) of women have already been tested for HIV in prison. The factors associated with this HIV test were age ≥41 years (OR = 1.9; 95% CI = 1.2–2.9), highest level of education (OR = 1.9; 95% CI = 1.3–2.8), having been arrested 3 or more times (OR = 1.9; 95% CI = 1.3–2.8), having received information about HIV/STI in the lifetime (OR = 1.4; 95% CI = 1.1–1.9) and perceived themselves to be at no risk for HIV infection (OR = 1.7; 95% CI = 1.2–2.5), black or mixed race (OR = 0.7; 95% CI = 0.5–0.9) and having a male sexual partner (OR = 0.6; 95% CI = 0.5–0.9). The routine HIV testing in prisons needs to be expanded to promote HIV prevention for a population with limited access to these services outside of prison. [ABSTRACT FROM AUTHOR]

Far-right politicians in Brazil are attacking and censoring cultural heritage and enacting policies that go far beyond cultural heritage. These politicians are also dismantling the structural frameworks that protect, secure, encourage and enable cultural heritage at a time when it is experiencing serious and systematic crime threats. This is despite legal obligations in the Brazilian Constitution to protect it. In addition, these politicians are missing opportunities in the sector from which they could benefit hugely, as could the Brazilian population and the cultural heritage. Instead of waging 'culture wars', politicising security, and failing to adequately protect cultural heritage, a viable alternative is to govern the cultural economy. [ABSTRACT FROM AUTHOR]

Objective: In this study, we compared the frequency and intensity of childhood traumas in alcohol- or other drug-dependent patients, in patients with depression, and in a control group without psychiatric diagnoses. Methods: The study had a retrospective design of a clinical sample of men and women from the groups listed above. They were evaluated by the same standardized instrument: the "Childhood Trauma Questionnaire." Results: A higher frequency and intensity of emotional, physical, and sexual abuse were found in alcohol- and other drug-dependent patients than in patients with depression, who, in turn, presented significantly higher proportions than the control group. In all of the cases, the frequency was higher among women than men. Conclusion: Because of the high frequency and intensity of childhood traumas among alcohol- or other drug-dependent patients and depressed patients, the assessment of problems due to childhood traumas among these patients is essential to a better understanding of the etiology of those disorders and to their treatment. (Contains 3 tables and 1 figure.)

Background: The COVID-19 pandemic had a major impact on the mental health of healthcare workers (HCWs), especially in low and middle-income countries, which had to face additional political, social, and economic challenges. We thus aimed to assess the prevalence of mental health outcomes and the associated factors in HCWs treating COVID-19 patients in one of the most affected regions in Brazil. Methods: We used the Respondent-Driven Sampling method to assess the risks of COVID-19 infection and symptoms of mental disorders in nurses, nursing technicians, and physicians who worked on the frontline in the metropolitan region of Recife. 865 healthcare workers completed a survey regarding sociodemographic data, work-related risks, and symptoms of mental disorders - SRQ-20 for common mental disorders (CMD); AUDIT-C for problematic alcohol use; GAD-7 for anxiety; PHQ-9 for depression; PCL-5 for post-traumatic stress disorder (PTSD). Gile's successive sampling estimator was used to produce the weighted estimates by professional category. A Poisson regression model with robust variance was used to analyze factors associated with a positive screening for CMD. We will present the results of a cross-sectional analysis of the mental health outcomes after the first peak of COVID-19 – from August 2020 to February 2021. Results: The prevalence ratios for a positive screening for CMD were 34.9% (95% CI: 27.8–41.9) in nurses, 28.6% (95% CI: 21.3–36.0) in physicians, and 26.6% (95% CI: 16.8–36.5) in nursing technicians. Nurses presented a higher prevalence of depressive symptoms (23%). Positive screening for problematic alcohol use (10.5 to14.0%), anxiety (10.4 to 13.3%), and PTSD (3.3 to 4.4%) were similar between the professional categories. The main factors associated with CMD in nurses and physicians were related to an intrinsic susceptibility to mental illness, such as previous or family history of psychiatric disorder, and female sex. Among nurse technicians, work-related factors, such as accidents with biological material, presented the strongest association with CMD. Conclusion: The mental health of HCWs fighting COVID-19 in Recife was severely affected. It is crucial that healthcare services provide adequate working conditions and psychological support, investing in programs to promote and protect HCWs mental health. [ABSTRACT FROM AUTHOR]

Men who have sex with men who suffer stigmatization and discrimination become more fragile in facing life's problems, such as the search for treatment in health services. In the present study, the social aspects related to discrimination and violence among men who have sex with men in Belém, Pará, are evaluated. Data were obtained by applying the respondent-driven sampling method to recruit 349 participants aged 18 years or older and who reported having had at least one sexual relationship with a man in the last 12 months. Data were collected from June to December 2016 in a semi-structured interview. Five seeds were initially recruited who applied RDS. The vast majority were between 18 and 35 years old, had completed elementary school but not high school, and were of mixed race. Almost a third lived in peripheral neighborhoods and were employed/self-employed. Additionally, most participants reported having suffered aggression/discrimination, more often in religious contexts, with family or in health services. The findings reported here may contribute to the development of public policies aimed at this population and indicate the need for new strategies to combat sexually transmitted infections, stigma, and discrimination suffered by this population. [ABSTRACT FROM AUTHOR]

Background: Health providers are under unprecedented pressures to perform in the COVID-19 health crisis and under unprecedented risks. We initiated a large mixed-method survey of health professionals in five large metropolitan areas in Brazil to document the risks and needs of health professionals. To initiate the study, we conducted formative research. Methods: We conducted 77 open-ended semi-structured interviews online in a convenience sample of physicians, nurses, nurse technicians, and physiotherapists in Belem, Fortaleza, Porto Alegre, Recife, and São Paulo, Brazil. Design, data collection, and analysis were informed by Rapid Ethnographic Analysis (REA). Results: Responses are organized into three themes that emerged in the interviews: the lack of preparation – both locally and nationally—for the pandemic and its effects on staffing and training; the overlap of personal, family, and professional risk and consequences; and inadequately addressed anxiety and suffering among health staff. Conclusions: Our respondents were unprepared for the epidemic, especially the institutional sequelae and psychological cost. These consequences were exacerbated by both lack of leadership and sweeping changes undercutting the Brazilian health system noted by almost all participants. [ABSTRACT FROM AUTHOR]

Brazil has been severely affected by the COVID‐19 pandemic. Temperature and humidity have been purported as drivers of SARS‐CoV‐2 transmission, but no consensus has been reached in the literature regarding the relative roles of meteorology, governmental policy, and mobility on transmission in Brazil. We compiled data on meteorology, governmental policy, and mobility in Brazil's 26 states and one federal district from June 2020 to August 2021. Associations between these variables and the time‐varying reproductive number (Rt) of SARS‐CoV‐2 were examined using generalized additive models fit to data from the entire 15‐month period and several shorter, 3‐month periods. Accumulated local effects and variable importance metrics were calculated to analyze the relationship between input variables and Rt. We found that transmission is strongly influenced by unmeasured sources of between‐state heterogeneity and the near‐recent trajectory of the pandemic. Increased temperature generally was associated with decreased transmission and increased specific humidity with increased transmission. However, the impacts of meteorology, policy, and mobility on Rt varied in direction, magnitude, and significance across our study period. This time variance could explain inconsistencies in the published literature to date. While meteorology weakly modulates SARS‐CoV‐2 transmission, daily or seasonal weather variations alone will not stave off future surges in COVID‐19 cases in Brazil. Investigating how the roles of environmental factors and disease control interventions may vary with time should be a deliberate consideration of future research on the drivers of SARS‐CoV‐2 transmission. Plain Language Summary: Environmental factors such as outdoor temperature and humidity can affect the spread of the flu and other respiratory viruses. For this reason, early studies on the COVID‐19 pandemic hypothesized that temperature, humidity, and other environmental factors might create favorable or less favorable conditions to facilitate the spread of COVID‐19. At times, politicians and the media have disseminated these hypotheses without proper vetting. COVID‐19 has caused major impacts in Brazil, and in this study we use a statistical model that allows us to investigate how environmental factors, governmental policies, and human mobility are related to COVID‐19 transmission in Brazil from June 2020 to August 2021. We found that temperature and humidity were not very important in explaining COVID‐19 transmission. Governmental policies and human mobility played a larger role in explaining transmission, but whether changes in policies or human mobility led to increased versus decreased transmission varied throughout our study period. These changes with time may explain why the conclusions of other studies on what drives the spread of COVID‐19 may appear at odds with each other. Continuing to rely on proven mitigation measures such as mass vaccinations should be the key priority in the fight against COVID‐19 in Brazil. Key Points: Unmeasured sources of between‐state heterogeneity and recent waves of cases are the dominant drivers of SARS‐CoV‐2 transmission in BrazilThe impacts of policy, meteorology, and mobility on transmission vary in direction and magnitude within subperiods of our studyRelying on proven mitigation measures such as mass vaccinations should be the key priority in the continued fight against COVID‐19 [ABSTRACT FROM AUTHOR]

The HIV epidemic affects men who have sex with men (MSM) disproportionally in Brazil, and pre-exposure prophylaxis (PrEP) is effective for preventing HIV in this population. However, low perceived risk of HIV may influence the acceptability and decision to use PrEP. This study estimated the association between self-perception of HIV risk and acceptability of daily oral PrEP among Brazilian MSM. Respondent-driven sampling (RDS) was used for behavioral and biological surveillance to recruit 4,176 MSM 18 years or over in 12 Brazilian cities in 2016. Results were weighted using Gile's estimator in RDS Analyst software. Adjusted odds rations (OR) with 95% confidence intervals were calculated using multivariate logistic regression. Acceptability of daily oral PrEP was high (69.7%) among the 3,544 MSM available for analysis. Most participants self-reported low or moderate risk of HIV infection (67.2%) and a small proportion (9.3%) reported high risk. A dose–response relationship was observed between acceptability of PrEP and self-reported risk: PrEP acceptability was 1.88 times higher (OR 1.8; 95% CI: 1.24–2.85) among MSM whose perceived risk of HIV infection was low or moderate, and 5 times higher (OR 5.68; 95% CI: 2.54–12.73) among those who self-reported high risk compared to MSM reporting no HIV risk. MSM with the highest risk perception of HIV reported higher rates of PrEP acceptability. Given the availability of daily oral PrEP in the public health care system in Brazil, we suggest emphasizing counseling about self-perception of HIV risk as part of routine HIV prevention services. [ABSTRACT FROM AUTHOR]

The majority of the women in prisons comes from the poorest strata of society with limited access to education, income and health services. This contributes to the fact that female prisoners have a higher burden of adverse health events than both male prisoners and women in general population We objectived to estimate the prevalence of different morbidities and risk factors among female prisoners in Brazil. A total of 1,327 women were recruited in this cross-sectional study. Data were collected using a using audio computer-assisted self-interviewing questionnaire, rapid antibody tests and physical examination. The higher prevalences was of syphilis, infection sexually disease, arterial hypertense, asthma, common mental disorders and severe physical violence. Regarding risk factors, 36.3% have good knowledge about HIV, 55.8% were smokers, 72.3% had ever used any illicit drug, 92.1% are sedentary and 92.1% maintained an unhealthy diet. Female prisoners are disproportionately affected by various adverse health conditions. There is a need for an effective surveillance system inside prisons for early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva 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.)

To compare the prevalence and characteristics of hypertension in women experiencing incarceration (WEI) to the general population in Brazil: (1) a prison survey conducted from January 2014 to December 2015 in 15 states, with 1,327 WEI; and (2) a household survey in the 26 states and the Federal District of Brazil administered to women in the general population (WGP). Data analysis used SPSS® version 20.0. The point estimates and the prevalence ratio with their respective confidence intervals were calculated using Poisson regression. Ages in the two populations differed, 27.9% of WGP were over 50, while 7.3% of WEI were. The overall prevalence of arterial hypertension was 31.3% (95% CI: 28.6–34.0) in the WEI and 38.9% (95% CI: 37.8–39.9) for WGP. For individuals under 30, hypertension was found in 22.4% of WEI and 13.4% of WGP. WEI have a higher prevalence of hypertension at an earlier age than the GP. Less education, obesity, using illegal drugs, previous pregnancy, and not using contraceptives were more frequent in this group, revealing the need to implement policies aimed at treating both their hypertension and other health issues in prison. [ABSTRACT FROM AUTHOR]

The western Tropical Atlantic Ocean is a biogeochemically complex region due to the structure of the surface current system and the large freshwater input from the Amazon River coupled with the dynamics of precipitation. Such features make it difficult to understand the dynamics of the carbon cycle, leading to contrasting estimates in sea‐air CO2 exchanges in this region. Here, we demonstrate that these contrasting estimates occur because the western Tropical Atlantic Ocean can be split into three distinct sub‐regions in terms of the sea‐air CO2 exchanges. The sub‐region under the North Brazil Current domain acts as a weak annual CO2 source to the atmosphere, with low interannual variability. The sub‐region under the North Equatorial Current influence acts as an annual CO2 sink, with great temporal variability. The third sub‐region under the Amazon River plume influence shows greater interannual variability of CO2 exchanges, but it always acts as a net oceanic sink for CO2. Despite this large spatial variability, the entire region acts as a net annual CO2 sink of −1.6 ± 1.0 mmol m−2 day−1. Importantly, the Amazon River plume waters drive 87% of the CO2 uptake in the western Tropical Atlantic Ocean. In addition, we found a significant increasing trend in sea surface CO2 partial pressure in the North Brazil Current and North Equatorial Current waters. Such trends are more pronounced than the increase in atmospheric CO2 partial pressure, revealing the sensitivity of carbon dynamics in these sub‐regions to global climate change. Key Points: Sea‐air CO2 release (uptake) shown in the North Brazil Current (North Equatorial Current) domainStrong CO2 uptake under the Amazon River plume influence, which accounts for 87% of the CO2 uptake by the western Tropical Atlantic OceanIncreasing trend of sea surface CO2 partial pressure in the North Brazil Current and the North Equatorial Current waters [ABSTRACT FROM AUTHOR]

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Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva 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.)

Background Mycobacterium leprae was the first microorganism directly associated with a disease, however, there are still important gaps in our understanding of transmission. Although household contacts are prioritized, there is evidence of the importance of extrahousehold contacts. The goal of this article is to contribute to our understanding of the transmission of leprosy ex-household. Methods We compare co-location data of 397 leprosy cases and 211 controls drawn from the Centro de Dermatologia Sanitária D. Libânia in Fortaleza, Brazil. We collected lifetime geolocation data related to residence, school attendance and workplace and developed novel methods to establish a critical distance (Rc) for exposure and evaluated the potential for transmission for residence, school and workplace. Results Our methods provide different threshold values of distance for residence, school and workplace. Residence networks demonstrate an Rc of about 500 m. Cases cluster in workplaces as well. Schools do not cluster cases. Conclusions Our novel network approach offers a promising opportunity to explore leprosy transmission. Our networks confirm the importance of coresidence, provide a boundary and suggest a role for transmission in workplaces. Schools, on the other hand, do not demonstrate a clustering of cases. Our findings may have programmatic relevance. [ABSTRACT FROM AUTHOR]

Background Outbreaks of Chikungunya virus (CHIKV) occurred in Brazil during 2015–2017. Fortaleza was the city that reported the most cases. Methods The first round of a cohort study was conducted among women aged 15–39 y in Fortaleza, Brazil, in 2018 (Zika in Fortaleza). We collected sera to detect CHIKV IgG and IgM antibodies. Factors for CHIKV infection were identified using a Poisson regression model. Results We evaluated 1466 serum samples and 13.8% and 37.2% of women were found positive for CHIKV IgM and IgG antibodies, respectively. Living with more than four others in the same house and having an abandoned house nearby were associated with CHIKV infection. Being currently pregnant was associated with a decreased probability of CHIKV infection, which was also associated with pregnant women reporting using more repellent, both inside and outside the house, than non-pregnant women. Conclusions Crowding in households and abandoned houses nearby can increase potential transmission. Policies providing better living conditions and regulation of abandoned sites and buildings are necessary to control the mosquito population. Programmes providing repellant at low or no cost to pregnant women should be implemented in the neighbourhoods where arbovirus infections are endemic. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva 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.)

Copyright of Enfermagem em Foco is the property of Conselho Federal de Enfermagem 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.)

Background: The National Immunization Program Information System (SIPNI - Sistema de Informação do Programa Nacional de Imunização) in Brazil is a technological innovation management tool that enhances the performance of managers and health professionals in the evaluation and monitoring of immunization activities. In the country, the decentralization of the System is at an advanced stage, but it still faces challenges regarding its operation and use, impacting on its results. This study aims to evaluate the deployment of SIPNI in the state of Minas Gerais, in 2017.Method: Cross-section study performed in Primary Healthcare vaccination rooms in 54 municipalities in the Brazilian state of Minas Gerais, in 2017. A multidimensional questionnaire was used with nursing professionals who work in vaccination rooms, containing questions about the structure (presence of an internet-connected computer, instruction manual, software version, IT professional for technical support, trained healthcare professional, use of communication channels to obtain system information) and the process (activities performed by the staff to operate the immunization information system) of their work. Those questions refer to the components of the information system: system management, immunized-patient records, and Movement of Immunobiological. Implementation Degree (ID) was defined by a score system with different weights for each criterion, according to the importance level observed in it, with a rating of: adequate, partially adequate, inadequate and critically inadequate. For data analysis, median was used as the summary measure, and Pearson's Chi-Squared Test was used for proportion comparison.Results: Municipal SIPNI is not adequately implemented and that results mainly from the actions performed in health service units, indicating problems in the use of technology by professionals working in vaccination rooms. The structure was better evaluated than the process, presenting IDs of 70.9 and 59.5%, respectively. Insufficient internet access, inadequate use of communication channels, and lack of professional qualification were some of the identified structural issues. "Movement of Immunobiological" was the best-ranked component (ID = 68.5%), followed by "immunized patient records" (ID = 59.3%) and "SIPNI management" (ID = 50.7%). Partial performance of SIPNI is independent of population size in the municipality and of FSH coverage.Conclusions: SIPNI is still an underutilized technological innovation. There are challenges that must be overcome, such as implementation of the final web version, internet connectivity, and capabilities aimed at the use of information generated by technology. Nevertheless, perspectives regarding SIPNI are positive, with functionalities to optimize activities in vaccination rooms. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature 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.)

Objectives: To estimate hypertension prevalence and associated factors among female correctional officers (FCO) in female Brazilian prisons. Methods: Cross‐sectional, analytical study conducted in 15 female prisons in all five Brazilian regions between January 2014 and December 2015. The study population consisted of correctional officers with at least 6 months in the position. The sampling included 40% of FCO present in the prison during data collection, yielding 295 FCOs. Data were collected via Audio Computer‐Assisted Self‐Interview. A physical examination of participants was conducted including blood pressure, weight, and waist and hip circumference. The Odds Ratio and confidence intervals for independent factors were estimated. Results: Hypertension prevalence in correctional officers was 37.9%, (95% CI 32.1‐44.0). Hypertension was associated with obesity (95% CI = 1.884‐9.947), cardiovascular disease (95% CI = 3.348‐16.724), and participation in the specific training course for the relevant position (95% CI = 1.413‐9.564). Conclusions: While findings, except for the last factor, are not novel, this is the first such study conducted in Brazil. Hypertension prevalence among this pool of all female correctional officers is higher than in the average population, and FCOs associate this with the prison environment. Current training does not appear to address this problem. Especially since prison populations are growing in Brazil, this problem needs to be addressed for the health of the FCOs and the prisoners in their care. [ABSTRACT FROM AUTHOR]

Introduction: Leukemia is the most common cancer in children and has the highest rates of incidence in industrialized countries, followed by developing countries. This epidemiologic profile can mainly be attributed to the availability of diagnostic resources. In Brazil, leukemia diagnosis is a challenge due to financial viability, lack of hemovigilance services in isolated regions and the vast size of the territory. Its incidence in the state of Amazonas has been increasing since 2010. Therefore, this study aims to describe the epidemiological pattern and spatial distribution of patients with acute lymphoid leukemia and acute myeloid leukemia in Amazonas and identify the predictors of comorbidity and death. Materials and methods: A retrospective cross-sectional study was carried out based on patients’ data which was obtained from the database of a referral center for the period of 2005 to 2015. Variables included age, gender, ethnicity, civil status, schooling, income, location of residence, subtype of leukemia, comorbidities, and date of death. The spatial distribution was performed using QGIS v.2.18. Stata software was used for univariable and multivariable logistic regression to evaluate the association between both comorbidities and death for all characteristic groups of ALL and AML. Results: The group that was studied was composed of 577 ALL and 266 AML patients. For both, most patients were male, with a schooling period of 1–4 years, received<1 minimum wage, and lived mostly in Manaus, followed by the municipality of Tefé. There was no association between the development of comorbidities and analyzed variables in patients with ALL. AML patients that were >60 years old and with family history of the disease had the highest risk of developing comorbidities (OR = 5.06, p = 0.038; OR = 2.44, p = 0.041, respectively). Furthermore, patients with ALL and in the 41-50-year age group had a higher risk of death (OR = 31.12; p = 0.001). No association between death and explanatory variables were found in patients with AML. In addition, significant difference was observed in time to death (chi2 = 4,098.32, p = 0.000), with 50% of patients with AML dying within two years after diagnosis, whereas in ALL, this percentual of death only is reached in approximately 5 years. Conclusion: Our study describes the data of patients with acute leukemia in Amazonas, a remote region in the north of Brazil. In addition, it highlights the importance of hemovigilance in an Amazon region state, while focusing on peripheral areas which don't have prevention, diagnosis and treatment tools for this disease. [ABSTRACT FROM AUTHOR]

Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants' knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants' opinions about PrEP's contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil's civil society movement, may enhance the public health effort to expand access to PrEP in Brazil. [ABSTRACT FROM AUTHOR]

Open Government Data (OGD) is the term used since 2007 to refer to open government data, that is, public data produced or commissioned by the public sector, available on the internet for free use. The availability of OGD was encouraged by initiatives for disclosure of data carried out in 2009 by the United States of America and these initiatives were developed in several countries. However, with the amount of public information disclosed by governments, the idea of open content has been increasingly associated to access to information. In Brazil, plans that regard information policies do not establish a standard with guidelines or models for OGD publication. Thus, in the absence of metrics to evaluate the initiatives of data openness by the Brazilian government and its reuse, this article presents the Brazilian metric DGABr, one of the results of a doctoral research. DGABr is a proposed model to evaluate the OGD in the Federal Public Administration of Brazil, based on metrics and international indicators. The experience from other countries regarding OGD evaluation directed the creation of the DGABr; however, Brazil's legislation and information policies had a direct influence on OGD measurements. DGABr is an initial proposal to evaluate Brazil's OGD and their reuse and should evolve with the country's information policy. The proof of concept performed with the metric identified a positive result for the OGD evaluation, allowing validation of the perspectives and dimensions proposed in the metric and its potential reuse indicator. [ABSTRACT FROM AUTHOR]

Transwomen are a high-risk population for HIV/AIDS worldwide. However, many transwomen do not test for HIV. This study aimed to identify factors associated with resistance to HIV testing among transwomen in Fortaleza/CE. A cross-sectional study was conducted between August and December 2008 with a sample of 304 transwomen recruited through respondent-driven sampling. Data analysis utilized Respondent-Driven Sampling Analysis Tool and SPSS 11.0. Univariate, bivariate, and multivariate analyses examined risk factors associated with resistance to HIV testing. Less than 18 years of age (OR = 4.221; CI = 2.419–7.364), sexual debut before 10 years of age (OR = 6.760; CI = 2.996–15.256), using illegal drugs during sex (OR = 2.384; CI = 1.310–4.339), experience of discrimination (OR = 3.962; CI = 1.540–10.195) and a belief that the test results were not confidential (OR = 3.763; CI = 2.118–6.688) are independently associated with resistance to testing. Intersectoral and targeted strategies aimed at encouraging the adoption of safer sexual behaviors and testing for HIV among transwomen are required. [ABSTRACT FROM AUTHOR]

Temporomandibular disorder (TMD) is a musculoskeletal condition characterized by pain and reduced function in the temporomandibular joint and/or associated masticatory musculature. Prevalence in the United States is 5% and twice as high among women as men. We conducted a discovery genome-wide association study (GWAS) of TMD in 10,153 participants (769 cases, 9,384 controls) of the US Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The most promising single-nucleotide polymorphisms (SNPs) were tested in meta-analysis of 4 independent cohorts. One replication cohort was from the United States, and the others were from Germany, Finland, and Brazil, totaling 1,911 TMD cases and 6,903 controls. A locus near the sarcoglycan alpha ( SGCA), rs4794106, was suggestive in the discovery analysis ( P = 2.6 × 106) and replicated (i.e., 1-tailed P = 0.016) in the Brazilian cohort. In the discovery cohort, sex-stratified analysis identified 2 additional genome-wide significant loci in females. One lying upstream of the relaxin/insulin-like family peptide receptor 2 ( RXP2) (chromosome 13, rs60249166, odds ratio [OR] = 0.65, P = 3.6 × 10-8) was replicated among females in the meta-analysis (1-tailed P = 0.052). The other (chromosome 17, rs1531554, OR = 0.68, P = 2.9 × 10-8) was replicated among females (1-tailed P = 0.002), as well as replicated in meta-analysis of both sexes (1-tailed P = 0.021). A novel locus at genome-wide level of significance (rs73460075, OR = 0.56, P = 3.8 × 10-8) in the intron of the dystrophin gene DMD (X chromosome), and a suggestive locus on chromosome 7 (rs73271865, P = 2.9 × 10-7) upstream of the Sp4 Transcription Factor ( SP4) gene were identified in the discovery cohort, but neither of these was replicated. The SGCA gene encodes SGCA, which is involved in the cellular structure of muscle fibers and, along with DMD, forms part of the dystrophin-glycoprotein complex. Functional annotation suggested that several of these variants reside in loci that regulate processes relevant to TMD pathobiologic processes. [ABSTRACT FROM AUTHOR]

Background: The predictive value of the serology to detection of IgM against the Mycobacterium leprae-derived phenolic glycolipid-I/PGL-I to identify leprosy patients who are at higher risk of developing reactions remains controversial. Whether baseline results of the ML Flow test can predict leprosy reactions was investigated among a cohort of patients enrolled in The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil (U-MDT/CT-BR). Methods: This was a descriptive study focusing on the main clinical manifestations of leprosy patients enrolled in the U-MDT/CT-BR from March 2007 to February 2012 at two Brazilian leprosy reference centers. For research purposes, 753 leprosy patients were categorized according to a modified Ridley-Jopling (R&J) classification and according to the development of leprosy reactions (reversal reaction/RR and erythema nodosum leprosum/ENL), and whether they had a positive or negative bacillary index/BI. Results: More than half of the patients (55.5%) reported leprosy reaction: 18.3% (138/753) had a RR and 5.4% (41/753) had ENL. Leprosy reactions were more frequent in the first year following diagnosis, as seen in 27% (205/753) of patients, while 19% (142/753) developed reactions during subsequent follow-up. Similar frequencies of leprosy reactions and other clinical manifestations were observed in paucibacillary (PB) and multibacillary (MB) leprosy patients treated with U-MDT and regular MDT (R-MDT) (P = 0.43 and P = 0.61, respectively). Compared with PB patients, leprosy reactions were significantly more frequent in MB patients with a high BI, and more patients developed RR than ENL. However, RR and neuritis were also reported in patients with a negative BI. At baseline, the highest rate of ML Flow positivity was observed in patients with a positive BI, especially those who developed ENL, followed by patients who had neuritis and RR. Among reaction-free patients, 81.9% were ML Flow positive, however, the differences were not statistically significant compared to reactional patients (P = 0.45). Conclusions: MB and PB patients treated with R-MDT and U-MDT showed similar frequencies of RR and other clinical manifestations. Positive ML Flow tests were associated with MB leprosy and BI positivity. However, ML Flow test results at baseline showed limited sensitivity and specificity for predicting the development of leprosy reactions. [ABSTRACT FROM AUTHOR]

The article presents the discussion on vaccination strategy for children and young people. Topics include vaccines responsible for substantial reductions in child mortality and are among the most cost-effective interventions in the health area; and considering the largest continuous reduction in childhood immunizations in a generation.

Despite global needs regarding the mitigation of the climatic and biodiversity crisis, Brazilian federal government signalized the bidding of 92 blocks of oil and gas exploitation. The potential production in these marine areas will add to the pre-salt reserves already contracted, multiplying by eight the Brazilian annual fossil fuel emissions by 2030. These potential emissions can reach the double of that currently produced by land uses and other sources. The ongoing governmental actions and omissions regarding deforestation, fostering of thermoelectric generation, and fragilization of the national environmental surveillance system, highlight the need for deeper international and multilateral discussion considering the achievement of global targets, explicit as necessaries in the last IPCC report. Considering the emergency context, the UN should present barriers to exploitation of remaining fossil fuel reserves, and a global orchestration to enable immediate and drastic reductions in our emissions, to avoid further negative impacts on the already fragile sociobiodiversity. [ABSTRACT FROM AUTHOR]

Background: Men who have sex with men (MSM) are at increased risk of exposure to hepatitis B virus (HBV) compared with the general population. This study aims to assess the epidemiological and virological characteristics of HBV infection in a sample of MSM in Brazil, where data are scarce. Methods: A cross-sectional study was conducted among MSM in the City of Goiânia, Central Brazil, from March to November 2014, using Respondent-Driven Sampling (RDS). After signing the consent form, participants were interviewed and a blood sample collected. All samples were tested for HBV serological markers and HBV DNA. HBV nucleotide sequence analysis was also performed. Results: A total of 522 MSM were recruited in the study. The prevalence of HBV infection (current or past [presence of anti-HBc marker]) was 15.4% (95% CI: 8.7–25.8) and the rate of HBsAg carriers was 0.6% (95% CI: 0.2–1.6). About 40% (95% CI: 32.3–48.8) of the participants had serological evidence of previous HBV vaccination (reactive for isolated anti-HBs). In addition, 44.3% (95% CI: 36.1–52.9) were seronegative for all HBV markers. Age over 25 years old, receptive anal intercourse, previous sex with women, and history of sexually transmitted infections (STIs) were factors associated with HBV infection. HBV DNA was detected only in HBsAg-positive individuals. HBV isolates were classified into genotype A (subgenotypes A1 and A2), and some mutations were identified throughout the genome. Therefore, occult HBV infection was not observed in the study population. Conclusions: Public health strategies should be improved for the MSM population in order to prevent HBV and other STIs, as well as to provide appropriate management of patients with active infections. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Kineanthropometry & Human Performance is the property of Brazilian Journal of Kineanthropometry & Human Performance 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.)

An international multi-disciplinary group of 24 researchers met to discuss ocean acidification (OA) during the Brazilian OA Network/Surface Ocean-Lower Atmosphere Study (BrOA/SOLAS) Workshop. Fifteen members of the BrOA Network () authored this review. The group concluded that identifying and evaluating the regional effects of OA is impossible without understanding the natural variability of seawater carbonate systems in marine ecosystems through a series of long-term observations. Here, we show that the western South Atlantic Ocean (WSAO) lacks appropriate observations for determining regional OA effects, including the effects of OA on key sensitive Brazilian ecosystems in this area. The impacts of OA likely affect marine life in coastal and oceanic ecosystems, with further social and economic consequences for Brazil and neighboring countries. Thus, we present (i) the diversity of coastal and open ocean ecosystems in the WSAO and emphasize their roles in the marine carbon cycle and biodiversity and their vulnerabilities to OA effects; (ii) ongoing observational, experimental, and modeling efforts that investigate OA in the WSAO; and (iii) highlights of the knowledge gaps, infrastructure deficiencies, and OA-related issues in the WSAO. Finally, this review outlines long-term actions that should be taken to manage marine ecosystems in this vast and unexplored ocean region. [ABSTRACT FROM AUTHOR]

Several factors suggest that armadillos present an important risk for human leprosy infection. This study uses semi-structured interviews to better illustrate how human interaction with armadillos may increase the risk of leprosy transmission. The participants were all residents of the state of Ceará, in northeastern Brazil, all acknowledged contact with armadillos either through hunting, through cooking, or through consumption of its meat. This study raises important issues about contact between human beings and armadillos. The interviews provide evidence of numerous situations in which leprosy transmission via the armadillo is possible. At a minimum, people who hunt armadillos need to be made aware of the risk of infection. [ABSTRACT FROM AUTHOR]

To increase the effectiveness of ongoing anti-dengue control measures, we conducted a case-control study in a favela in Fortaleza (north-east Brazil) during an outbreak of dengue fever. Cases were defined according to the national guidelines for dengue control as well as based on the detection of IgM-dengue antibodies, and 34 cases and 34 controls were investigated. Significant risk factors were: living in a street perpendicular to the beach on which the favela is situated (P < 0.0001), an interval > 30 days since the last visit of the vector control agent (P=0.001), receptacles in the garden or courtyard (P=0.001), plants with temporary water pools on the property, gutter to collect rainwater, uncovered water storage container (all P=0.02), and no waste collection (P=0.03). Socio-economic variables were not associated with dengue fever. The probable starting point of the epidemic was an uncovered water tank on the roof of the house adjacent to the index case. From there, the outbreak spread uphill parallel to the prevailing direction of the wind. Thus, the chronological and spatial evolution of the epidemic could have been forecast after the first cases had occurred. This example of investigative epidemiology in an operational setting shows that targeted intervention leading to increased effectiveness of control measures is possible. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature 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.)

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

Despite the known benefits of early treatment initiation for individual morbidity and mortality, as well as for reducing the risk of transmission, late presentation (LP) to HIV/AIDS services remains a major concern in many countries. There is little information on LP from middle- and low-income countries and studies that do evaluate LP commonly disaggregate data by sex. It is rare, however, for researchers to further disaggregate the data by pregnancy status so it remains unclear if pregnancy status modifies the effects associated with sex. The study was conducted at the only State Reference Center for HIV/AIDS in Salvador, Brazil's third largest city. LP was defined as a patient accessing services with a CD4 < 350 cells/mm3. Data were abstracted from the electronic medical records of 1421 patients presenting between 2007 and 2009. CD4 counts and viral load (VL) information was validated with data from the National CD4/VL Database. Descriptive and bivariate statistics were conducted to inform the multivariate analysis. Adjusted prevalence ratios (APR) were estimated using generalized linear models due to the high frequency of the outcome. Half of the sample (52.5%;n= 621) was classified as LP. Compared to the prevalence among pregnant women (21.1%), the prevalence of LP was more than twice as high among non-pregnant women (56.0%) and among men (55.4%). The multivariate analysis demonstrated no statistical difference between men and nonpregnant women (APR 1.04; 95%CI 0.92–1.19), but the APR of LP for nonpregnant women was 53% less than men (APR 0.47; 95%CI 0.33–0.68). These results highlight the importance of analyzing data disaggregated not only by sex but also by pregnancy status to accurately identify the risk factors associated with LP so that programs and policies can effectively and efficiently address LP in Brazil and beyond. [ABSTRACT FROM PUBLISHER]

Several studies indicate that mortality and morbidity can be well correlated to atmospheric aerosol concentrations with aerodynamic diameter less than 2.5 µm (PM2.5). In this work the PM2.5at Recife city was analyzed as part of a main research project (INAIRA) to evaluate the air pollution impact on human health in six Brazilian metropolitan areas. The average concentration, for 309 samples (24-hr), from June 2007 to July 2008, was 7.3 µg/m³, with an average of 1.1 µg/m³ of black carbon. The elemental concentrations of samples were obtained by x-ray fluorescence. The concentrations were then used for characterizing the aerosol, and also were employed for receptor modelling to identify the major local sources of PM2.5. Positive matrix factorization analysis indicated six main factors, with four being associated to soil dust, vehicles and sea spray, metallurgical activities, and biomass burning, while for a chlorine factor, and others related to S, Ca, Br, and Na, we could make no specific source association. Principal component analysis also indicated six dominant factors, with some specific characteristics. Four factors were associated to soil dust, vehicles, biomass burning, and sea spray, while for the two others, a chlorine- and copper-related factor and a nickel-related factor, it was not possible to do a specific source association. The association of the factors to the likely sources was possible thanks to meteorological analysis and sources information. Each model, although giving similar results, showed factors’ peculiarities, especially for source apportionment. The observed PM2.5concentration levels were acceptable, notwithstanding the high urbanization of the metropolitan area, probably due to favorable conditions for air pollution dispersion. More than a valuable historical register, these results should be very important for the next analysis, which will correlate health data, PM2.5levels, and sources contributions in the context of the six studied Brazilian metropolises.Implications: The analysis of fine particulate matter (PM2.5) in Recife city, Brazil, gave a significant picture of the local concentration and composition of this pollutant, which exhibits robust associations to adverse human health effects. Data from 1 year of sampling evaluated the seasonal variability and its connections with weather patterns. Source apportionment in this metropolitan area was obtained based in a combination of receptor models: principal component analysis (PCA)/chemical mass balance (CMB) and positive matrix factorization (PMF). These results give guidelines for local air pollution control actions, providing significant information for a health study in the context of establishing a new national air pollution protocol based on Brazilian cities data. [ABSTRACT FROM PUBLISHER]

This study explores the relationships between demographic, socioeconomic and health statuses of children whose parents were HIV positive in two cities in Northeast Brazil. We conducted a multisite exploratory study in HIV/AIDS referral services for HIV/AIDS in Fortaleza, the capital of Ceará State, and Salvador, the capital of Bahia State, between June 2008 and March 2009. The study population consisted of 562 HIV+ adults − or caretakers of children of HIV+ adults − who provided information about a single index child under 13 years of age of either sex in their household. A structured questionnaire was used for to the adult parent or caretaker. We used multiple correspondence analysis (MCA), as implemented in the software SPAD (Portable Système pour l'Analyse des données). This analysis enabled us to identify the relationships between a large number of variables simultaneously. Of the 562 children, 311 (55.3%) lived in Fortaleza and 251 (44.7%) lived in Salvador. The proportion of HIV-infected children in Fortaleza was 14.2%, and 61.4% (27/44) of these had progressed to AIDS. In Salvador 34.7% of children were seropositive and 95% (83/87) were diagnosed with AIDS. The most important factors that emerged from the study were city and serostatus of the children. These two active variables accounted for 75.3% of the variance. Results are grouped into four profiles that describe the complex of socioeconomic variables closely associated with these families, and the complex and multiple epidemics of HIV, discrimination and poverty associated with these AIDS-affected families. [ABSTRACT FROM PUBLISHER]

Travestisare highly vulnerable to HIV infection in Brazil. We conducted a survey among 304 travestis using Respondent-Driven Sampling from August to December 2008. Travestis are young (49% <24 years), poorly educated (55% just elementary school), low social class (62% Class C-E), reside with families (49%) or friends/madam (22%), are victims of homophobia (91%) and violence (61%). They report early sexual debut (75% <14), many sexual partners, drug use during sex (43%), and unprotected sex (male partner, 47%, both male and female partners, 50%). Sex work is common (82%, 59% >10 partners last six months) and relatively low cost (median=US$24). A majority report testing for HIV (69%), and report high prevalence (12% disclosed a positive result). Almost all the respondents refused to test in the study. Interventions, targeted to both travestis and to the general community about sexual discrimination, are necessary. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess factors associated with unprotected receptive anal intercourse (URAI) in a sample of MSM recruited by respondent driven sampling in Brazil. Among 3,449 participants, 36.5 % reported URAI. Final logistic model indicated that living with a male partner, illicit drug use, having stable partnership, having sex with men only, having few friends encouraging condom use, and high self-perceived risk for HIV infection were characteristics independently associated with URAI. Intervention strategies should focus on the role of anal sex practices on HIV transmission, address illicit drug use, stigma and expansion of HIV testing and care. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented wherein the authors report a study which was conducted to determine the prevalence and virologic profile of HIV infections among female sex workers in Brazil.

Background: Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result.Methods: Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile's estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times).Results: For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability.Conclusions: The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM. [ABSTRACT FROM AUTHOR]

Perinatal HIV prevention has been successful in developing countries but disparities in success between rich countries and poor countries have also been observed. Access to prevention of mother-to-child transmission (PMTCT) remains a challenge in many developing countries. In 2007, the Ministry of Health launched the Plan to Reduce the Vertical Transmission of HIV and Syphilis in Brazil to address this need. A cross-sectional study of children living in families affected by HIV was conducted in Ceara State, Northeast Brazil between June 2008 and January 2009 to explore socioeconomic effects of HIV status. Proportion of children with an HIV-positive test was calculated and stratified by age to estimate the impact of PMTCT programs. Chi-square test was employed to compare those proportions. Stata™10.0 software was used for the calculation. We interviewed 437 adults who were visiting the hospital for a consultation or to pickup medication who also had a child less than 13 years of age living with them. They also provided information about other household members (n=1789). Our study showed that children infected with HIV or who live in a household with one or both parents infected with HIV or dead from AIDS live in families of low social class and educational achievement. Seroprevalence is not lower in the cohort of those children 0-2 as compared to 3-4 and 5-12 years of age. Even in Brazil, with its successful PMTCT program overall, there are great disparities among sites. Data from the sites reported here are equivalent to many poor areas in sub-Saharan Africa. This argues that global concern for targeting areas most affected by the epidemic must consider areas within some of the most prosperous countries in the world. [ABSTRACT FROM AUTHOR]