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Cesar GA, do Lago BV, Ortiz Tanaka TS, Zanini PB, Bandeira LM, Puga MAM, Pires Fernandes FR, Pinto CS, Castro LS, Bertolacci-Rocha LG, dos Santos Fernandes CE, de Rezende GR, Motta-Castro ARC. Differences in risky sexual behaviors and HIV prevalence between men who have sex with men and transgender women in the Midwest Brazil. PLOS Glob Public Health 2024; 4:e0003061. [PMID: 38709753 PMCID: PMC11073717 DOI: 10.1371/journal.pgph.0003061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/05/2024] [Indexed: 05/08/2024]
Abstract
Men who have sex with men (MSM) and transgender women (TW) are disproportionally affected by HIV infection. This cross-sectional study evaluated the HIV-1/2 prevalence, risk factors and HIV molecular features of MSM and TW from Midwest Brazil. Four hundred and thirty participants (278 MSM and 152 TW) from Mato Grosso do Sul, Brazil, were interviewed and tested for HIV-1/2 infection between November 2011 and September 2013. Participants who were assigned male at birth, older than 18 years old and self-declared as MSM or TW were recruited from LGBT+ associations, as well as public (parks, square, streets, etc) and private [nightclubs, saunas, brothels, etc] places. The prevalence of HIV-1 was 14.4% (9.0% among MSM and 24% among TW; p<0.001). The factor independently associated with HIV-1 infection among MSM was being 30 years-old or older. Among TW, having suffered sexual coercion, lifetime syphilis infection and hepatitis C virus exposure were associated with HIV-1 infection. Phylogenetic analyses classified 65% sequences as subtype B and 35% as possible recombinants. All but one recombinant sample were from TW individuals. High HIV-1 prevalences were observed in both groups, highlighting the urgent need to devise specific HIV interventions targeting these key populations. Notably, TWs are more vulnerable to HIV infection, which was associated with sexual violence and co-infection with other STIs. With regard to MSM, being 30 years old or older was significanty associated to HIV, reinforcing the idea that MSM are less exposed [or exposed later] to STIs than TWs, although MSM are clearly more vulnerable than the general population.
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Affiliation(s)
- Gabriela Alves Cesar
- Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Bárbara Vieira do Lago
- Laboratory of Viral Hepatitis, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Institute of Immunobiological Technology (Bio-Manguinhos), Fiocruz, Rio de Janeiro, Brazil
| | - Tayana Serpa Ortiz Tanaka
- Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Priscila Brunini Zanini
- Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Larissa Melo Bandeira
- Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Clarice Souza Pinto
- Secretary of Health of the State of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | | | | | - Ana Rita Coimbra Motta-Castro
- Laboratory of Clinical Immunology, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
- Laboratory of Molecular Virology, Oswaldo Cruz Foundation, Mato Grosso do Sul, Campo Grande, MS, Brazil
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Calazans G, Facchini R. "But the category of exposure also has to respect identity": MSM, classifications and disputes in AIDS policy. Cien Saude Colet 2022; 27:3913-3922. [PMID: 36134797 DOI: 10.1590/1413-812320222710.08142022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/22/2022] Open
Abstract
This essay explores the relationship between diversity and public health by addressing tensions related to classifications and recognition in the field of HIV and AIDS policy. The objective is to reflect on how classificatory and operative categories are articulated within the scope of programmatic responses towards the social production of differences and inequalities. To do so it draws from the theoretical framework of studies on vulnerability and recognition and from a methodology that includes a critical review of the literature on the category men who have sex with men (MSM) and ethnographic material, derived from the authors' research and a literature review related to social movements, and research and policies focused on lesbians, gays, bisexuals, transvestites and transsexuals (LGBT). It reviews how the MSM category was constructed in the field of HIV and AIDS prevention policies at an international level, situating political actors and tensions. It problematizes these tensions by analyzing processes of production of political subjects as well as changes in socio-state relations that involve LGBT. It emphasizes the importance of considering how differences and inequalities emerge in socio-political processes and of dedicating studies to improve policies, ensuring an effectively more respectful care.
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Affiliation(s)
- Gabriela Calazans
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Av. Dr. Enéas Carvalho de Aguiar 255, Cerqueira César. 05403-000 São Paulo SP Brasil.
| | - Regina Facchini
- Núcleo de Estudos de Gênero Pagu, Programa de Pós-Graduação em Antropologia Social, Programa de Pós-Graduação em Ciências Sociais, Universidade Estadual de Campinas. Campinas SP Brasil
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3
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Calazans G, Facchini R. “But the category of exposure also has to respect identity”: MSM, classifications and disputes in AIDS policy. Ciênc saúde coletiva 2022. [DOI: 10.1590/1413-812320222710.08142022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This essay explores the relationship between diversity and public health by addressing tensions related to classifications and recognition in the field of HIV and AIDS policy. The objective is to reflect on how classificatory and operative categories are articulated within the scope of programmatic responses towards the social production of differences and inequalities. To do so it draws from the theoretical framework of studies on vulnerability and recognition and from a methodology that includes a critical review of the literature on the category men who have sex with men (MSM) and ethnographic material, derived from the authors’ research and a literature review related to social movements, and research and policies focused on lesbians, gays, bisexuals, transvestites and transsexuals (LGBT). It reviews how the MSM category was constructed in the field of HIV and AIDS prevention policies at an international level, situating political actors and tensions. It problematizes these tensions by analyzing processes of production of political subjects as well as changes in socio-state relations that involve LGBT. It emphasizes the importance of considering how differences and inequalities emerge in socio-political processes and of dedicating studies to improve policies, ensuring an effectively more respectful care.
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Figueiredo Catelan R, Azevedo FMD, Sbicigo JB, Vilanova F, da Silva LP, Zanella GI, Ramos ML, Costa AB, Nardi HC. Anticipated HIV stigma and delays in HIV testing among Brazilian heterosexual male soldiers. Psychology & Sexuality 2022. [DOI: 10.1080/19419899.2020.1773909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ramiro Figueiredo Catelan
- Psychology Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Social Psychology Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Juliana Burges Sbicigo
- Psychology Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Vilanova
- Psychology Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leticia Pessoa da Silva
- Psychology Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Mariana Leonhardt Ramos
- Psychology Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angelo Brandelli Costa
- Psychology Graduate Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Henrique Caetano Nardi
- Social Psychology Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Coelho LE, Torres TS, Veloso VG, Grinsztejn B, Jalil EM, Wilson EC, McFarland W. The Prevalence of HIV Among Men Who Have Sex With Men (MSM) and Young MSM in Latin America and the Caribbean: A Systematic Review. AIDS Behav 2021; 25:3223-37. [PMID: 33587242 DOI: 10.1007/s10461-021-03180-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 12/11/2022]
Abstract
Young men who have sex with men (YMSM) under 25 years old are among the few populations with increasing numbers of new HIV infections in parts of the world where HIV incidence is declining overall. In this systematic review, we synthesize the literature on HIV prevalence among MSM in Latin America and the Caribbean focusing on YMSM. Results were stratified according to study population sampling method used (probability and non-probability based). Forty-seven studies from 17 countries were published in the last 10 years. Among studies using probability-based sampling method (N = 21), HIV prevalence among MSM ranged from 1.2 to 32.6%. HIV prevalence tended to increase over time in studies sampling at different time points. HIV prevalence among YMSM exceeded 5.0% in more than a half of studies (51%; N = 22/43). Our review corroborates the high and potentially rising incidence of HIV among YMSM and characterizes the region's greatest challenge to ending the epidemic.
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Villela LM, Veloso VG, Hoagland B, Fernandes NM, Kallas EG, Madruga JV, Moreira RI, Grinsztejn B, De Boni RB. Possible risk compensation, attitudes, and beliefs among Brazilian individuals potentially eligible for pre-exposure prophylaxis. Int J STD AIDS 2021; 32:806-815. [PMID: 33615909 DOI: 10.1177/0956462421992157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pre-exposure prophylaxis (PrEP) prevents HIV infection among men who have sex with men (MSM) and transgender women (TGW) who are the groups that presents the high incidence risk in Brazil. This cross-sectional secondary analysis describes possible risk compensation, attitudes, and beliefs regarding the use of PrEP among 723 MSM and TGW evaluated in the PrEP Brazil study pre-screening phase. Possible risk compensation was reported by 31.6% individuals. In the multivariate model, factors that increased the likelihood of possible risk compensation were: self-referring as white vs. Black (AOR 2.05; CI 1.09, 3.85), perceiving high likelihood of getting HIV in next 12 months (AOR 1.78; CI 1.23, 2.56), being less afraid of HIV infection if using PrEP (AOR 1.93; CI 1.19, 3.14), feeling liberated to have more partners if using PrEP (AOR 2.93; CI 1.92, 4.49), and believing closest friends would use PrEP (AOR 2.51; CI 1.1, 5.71). We found that possible risk compensation was more common among individuals who presented high-risk perception for HIV infection, probably reflecting they feel at risk and could benefit from PrEP use.
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Affiliation(s)
- Larissa M Villela
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Valdiléa G Veloso
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Brenda Hoagland
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Nilo M Fernandes
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Esper G Kallas
- Centro de Referência e Treinamento em DST/AIDS, São Paulo, Brazil
| | | | - Ronaldo I Moreira
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
| | - Raquel B De Boni
- 37903Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Rio de Janeiro, Brazil
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Pellini ACG, Chiaravalloti-Neto F, Zanetta DMT. AIDS in men in the city of São Paulo, 1980-2012: spatial and space-time analysis. Rev Saude Publica 2020; 54:96. [PMID: 33175030 PMCID: PMC7647470 DOI: 10.11606/s1518-8787.2020054001815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 11/25/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify spatial and space-time clusters with high incidence rates of AIDS in men living in the city of São Paulo since the first case of the disease in 1980. METHODS HIV/AIDS notifications were obtained from the Notifiable Diseases Information System (57,440 men) between January 1980 and June 2012. The cases were geocoded by residence address; then analyses of purely spatial, space-time and spatial variation in temporal trends were performed for three sets of data: total cases of AIDS in men aged 13 years or older, men aged 50 years or older, and deaths from AIDS. RESULTS It was possible to geocode a significant proportion of AIDS cases (93.7%). In the purely spatial scanning analysis, considering the entire period evaluated, the AIDS epidemic in men presented an important spatial concentration in the Center and in contiguous areas of the North, Southeast and West regions of the municipality, regardless of age group and evolution to death (relative risks between 1.22 and 5.90). Considering space and time simultaneously, several clusters were found, spread throughout all regions of the municipality (relative risks between 1.44 and 8.61). In the analysis of spatial variation in temporal trends, the clusters in the most peripheral regions presented a higher annual percentage increase in disease rates (up to 7.58%), denoting the tendency of "peripherization" of the epidemic in men in the city of São Paulo. CONCLUSIONS This study allowed the detection of geographic clusters of high risk for AIDS in men, pointing to priority areas in the municipality, both for programmatic actions and to guide other studies.
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Affiliation(s)
- Alessandra Cristina Guedes Pellini
- Universidade Nove de JulhoFaculdade de MedicinaSão PauloSPBrasilUniversidade Nove de Julho. Faculdade de Medicina. Diretoria de Ciências Médicas. São Paulo, SP, Brasil
| | - Francisco Chiaravalloti-Neto
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de EpidemiologiaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brasil
| | - Dirce Maria Trevisan Zanetta
- Universidade de São PauloFaculdade de Saúde PúblicaDepartamento de EpidemiologiaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brasil
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Kendall C, Kerr L, Mota RS, Guimarães MDC, Leal AF, Merchan-Hamann E, Dourado IC, Veras MA, Brito AMD, Pontes AK, Castro ARCM, Macena RHM, Knauth D, Linda LC, Oliveira LC, Cavalcante S, Camillo AC, Bermudez XPD, Moreira RC, Benzaken AS, Pereira G, Pascom ARP, Pimenta C, Grazina Johnston L. The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics. Rev Bras Epidemiol 2019; 22:e190004. [PMID: 30892467 DOI: 10.1590/1980-549720190004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. METHODS Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. RESULTS Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). CONCLUSION The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.
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Affiliation(s)
- Carl Kendall
- Tulane University, Global Community Health and Behavioral Sciences - New Orleans (LA), United States.,Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Ligia Kerr
- Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Rosa Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | | | - Andrea Fachel Leal
- Departamento de Sociologia, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Edgar Merchan-Hamann
- Faculdade de Ciências da Saúde, Saúde Coletiva, Universidade de Brasília - Brasília (DF), Brazil
| | - Inês Costa Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia - Salvador (BA), Brazil
| | - Maria Amélia Veras
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo - São Paulo (SP), Brazil
| | - Ana Maria de Brito
- Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães - Recife, PE, Brazil
| | - Alexandre Kerr Pontes
- Instituto de Psicologia, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | | | | | - Daniela Knauth
- Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | | | | | | | | | - Adele Schwartz Benzaken
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Gerson Pereira
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Ana Roberta Pati Pascom
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Cristina Pimenta
- Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais, Ministério da Saúde - Brasília (DF), Brazil
| | - Lisa Grazina Johnston
- Tulane University, Global Community Health and Behavioral Sciences - New Orleans (LA), United States
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Abstract
We sought to leverage the strengths of time location sampling (TLS) and respondent-driven sampling (RDS) for surveys of hidden populations by combing elements of both methods in a new approach we call "starfish sampling." Starfish sampling entails random selection of venue-day-time units from a mapping of the locations where the population can be found, combined with short chains of peer referrals from their social networks at the venue or presenting to the study site later. Using the population of transmen in San Francisco as a case example, we recruited 122 eligible participants using starfish sampling: 79 at randomly selected venues, 11 on dating applications, and 32 by referral. Starfish sampling produced one of the largest community-recruited samples specifically for transmen to date. Starfish sampling is a flexibility method to recruit and sample hidden populations for whom conventional TLS and RDS may not work in theory or practice.
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Affiliation(s)
- H Fisher Raymond
- School of Public Health, Rutgers University, Piscataway, NJ, USA
- University of California, San Francisco, CA, USA
| | - Yea-Hung Chen
- University of California, San Francisco, CA, USA
- San Francisco Department of Public Health, 25 Van Ness, Suite 700, San Francisco, CA, 94102, USA
| | - Willi McFarland
- University of California, San Francisco, CA, USA.
- San Francisco Department of Public Health, 25 Van Ness, Suite 700, San Francisco, CA, 94102, USA.
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Li WY, Chen M, Huang SW, Jen IA, Wang SF, Yang JY, Chen YH, Chen YMA. Molecular epidemiology of HIV-1 infection among men who have sex with men in Taiwan from 2013 to 2015. PLoS One 2018; 13:e0202622. [PMID: 30521534 PMCID: PMC6283607 DOI: 10.1371/journal.pone.0202622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/07/2018] [Indexed: 11/24/2022] Open
Abstract
Men who have sex with men (MSM) is the major risk population of HIV-1 infection in Taiwan, and its surveillance has become critical in HIV-1 prevention. We recruited MSM subjects from 17 high-risk venues and 4 community centers in northern and southern Taiwan for anonymous HIV-1 screening during 2013–2015. Blood samples were obtained for genotyping and phylogenetic analysis, and a questionnaire survey covering demographic variables and social behavior was conducted. In total, 4,675 subjects were enrolled, yielding a HIV-1 prevalence rate of 4.3% (201/4675). Eight risk factors including subjects who did not always use condoms (OR = 1.509, p = 0.0123), those who used oil-based lubricants (OR = 1.413, p = 0.0409), and those who used recreational drugs (OR = 2.182, p = < .0001) had a higher risk of HIV-1 infection. The annual prevalence and incidence of HIV-1 showed a downward trend from 2013 to 2015 (6.56%, 5.97 per 100 person-years in 2013; 4.53%, 3.97 per 100 person-years in 2014; 1.84%, 2.08 per 100 person-years in 2015). Factors such as always using condoms, water-based lubricant use, correct knowledge of lubricating substitutes, and recreational drug use were significantly associated with the trend of incidence. Phylogenetic tree analysis showed that the cross-regional and international interaction of the local MSM population may have facilitated transmission of HIV. This survey of high-risk venues showed decreased prevalence and incidence of HIV-1 infection in Taiwan from 2013 to 2015, and this may be related to changes in behavioral patterns. Moreover, cross-regional interaction and recreational drug use need to be considered in future surveillance.
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Affiliation(s)
- Wei-You Li
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Marcelo Chen
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Szu-Wei Huang
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-An Jen
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Fan Wang
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jyh-Yuan Yang
- Research and Diagnostic Center, Taipei, Centers for Disease Control, Department of Health, Taipei, Taiwan
| | - Yen-Hsu Chen
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ming Arthur Chen
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- * E-mail:
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Gomes R, Murta D, Facchini R, Meneghel SN. Gender and sexual rights: their implications on health and healthcare. Cien Saude Colet 2018; 23:1997-2006. [PMID: 29972506 DOI: 10.1590/1413-81232018236.04872018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/26/2018] [Indexed: 11/22/2022] Open
Abstract
This article is an objective examination of aspects of gender and sexual rights, and their implications in the field of health field, using the methodology of an essay. The first part discusses femicide, highlighting that there are deaths of women due to the fact of being women, which constitute what could be described as the crimes of lèse-humanité or 'femi-genocide'. The second part discusses sexual and gender diversity, with an emphasis on the fragility of the 'right to have rights' expressed in the deterioration in health conditions of the population that is LGBTI (Lesbians, Gays, Bisexuals, Transvestites, Transsexuals and Intersex). Finally, the essay discusses recognition of gender plurality, and the limitations imposed on the rights of non-usual normativebodies bodies; criticism is directed at reiteration of the binary and cisgender normative ethos, which can exacerbate the health vulnerability of people with trans and other non-normative bodies and identities. It is concluded that, in the 30 years' existence of Brazil's Unified Health System (SUS), there have been advances in the political sphere, many of them created by or as a result of social movements, and initiatives that seek to confront femicide and the inadequate assistance available to LGBTI people. In the context of these challenges, it is reiterated that there is a necessary relationship between promotion of health and protection of human rights related to gender and sexuality.
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Affiliation(s)
- Romeu Gomes
- Instituto Nacional de Saúde da Criança, da Mulher e do Adolescente Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Daniela Murta
- Superintendência de Promoção da Saúde, Secretaria Municipal de Saúde. Rio de Janeiro RJ Brasil
| | - Regina Facchini
- Núcleo de Estudos de Gênero Pagu, Programa de Pós-Graduação em Ciências Sociais. Campinas SP Brasil
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Ferreira JP, Miskolci R. Homosexual desire after AIDS: an analysis of the criteria adopted by men in the search for same sex partners. Cien Saude Colet 2018; 25:999-1010. [PMID: 32159669 DOI: 10.1590/1413-81232020253.17202018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/23/2018] [Indexed: 11/22/2022] Open
Abstract
This article analyzes changes and continuities in partner search criteria by homosexual men considering the impact of the HIV-AIDS epidemic in the city of São Paulo, Brazil. Thus, it compares two different historical moments: between 1979 and 1981 (pre-epidemic) and 2015 to 2017 (post-epidemic). In the first period, the source incorporated 120 classified ads collected from the Lampião da Esquina newspaper and in the second period, the preferences and criteria used to search for partners were analyzed using geolocalized applications, based on 120 online profiles. The data show that that between 1979-1981 the search for "discreet" partners took place, while the sexual panic created in the deadliest period of the AIDS epidemic boosted the use of the Internet in search of partners less likely to be infected with HIV, the "out of the (gay) scene". Since then, the search for "discreet and out of the (gay) scene" has consolidated itself by shaping the body's ideals and conduct that shape the current São Paulo online sex market in which part of the homosexuals take part.
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Affiliation(s)
- João Paulo Ferreira
- Departamento de Sociologia, Universidade Federal de São Carlos. Rod. Washington Luiz s/n. 13565-905, São Carlos, SP, Brasil.
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13
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Abstract
OBJECTIVE An ecological study describring the spatial characteristics of AIDS in São Paulo city between 2001 and 2010 according to the place of residence of reported cases in adults. METHODS The AIDS reported cases (28,146), grouped by sex, were geocodified (25,969) and linked with a census tract database (18,953). Case and population at risk data supplied spatial cluster identification and relative risk estimate by the scan method, using the discrete Poisson model. Incidence rate and proportional distribution allowed comparing people living in the high-risk clusters areas to other locations by age, race/ethnicity, schooling and transmission category. RESULTS The AIDS incidence rate decreased in both sexes except among young men and older people. The identification of spatial high-risk clusters showed that the decrease of AIDS did not occur in the same way in the city. Clusters located in the central area presented the highest AIDS incidence rates (245.7/100,000 men), especially among black women (RR = 7.9), men who have sex with men (66.2%) and injection drug users (10.7%) participation. In peripheral clusters, identified only in the female population, the epidemic can be related to the poverty of these women (22.5% low education level). Residents in the north and central-south areas of the city are generally black, with little schooling, and predominantly heterosexually infected. CONCLUSIONS The study of spatial clusters using a census tract helps to determine epidemiological patterns inside the city and in specific populations. Spatial stratification and key population epidemiological patterns were identified in four regions in São Paulo city.
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Affiliation(s)
- Breno Souza de Aguiar
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Cassia Maria Buchalla
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
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14
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Abstract
BACKGROUND Brazil's response to the HIV epidemic now includes free access to preexposure prophylaxis (PrEP) to populations at substantial risk for HIV infection including men who have sex with men (MSM). We used nationally representative demographic, epidemiologic, and surveillance data to offer estimates for the number of MSM at substantial risk for HIV infection who might be eligible and willing to use PrEP in Brazil. METHODS Starting from the age/sex-stratified population, we calculated the number of men aged 15 to 64 years, in 5-year age groups, and the proportion of those who report sex with other men during their lifetime. We focused on 11 cities (representing all regions) that are responsible for a significant fraction of the HIV burden of the country and used city-specific HIV prevalence estimates to infer the fraction of MSM who are HIV-negative. We then derived the proportion of HIV-negative MSM under substantial risk for HIV infection defined as having unprotected receptive anal intercourse in the 6 months before study participation. Finally, PrEP uptake among the eligible was inferred from the PrEP Brazil study. RESULTS Our results show that PrEP demand in these 11 cities is of 66,120 men aged 15 to 64 years. When we consider the lower and upper bounds for the available parameters, we find that PrEP demand in these 11 cities might vary from 33,378 to 97,962 men. If PrEP is restricted to those aged 15 to 49 years, demand drops by 20%. PrEP demand varies considerably by city, mostly because of the differences in population size and city-specific HIV prevalence. DISCUSSION We have shed light on the probable size of PrEP demand in Brazil certain that the incorporation of PrEP as part of Brazil's combination prevention for populations at substantial risk for HIV infection is a necessary challenge. PrEP will not only prevent HIV infections, it will also expand testing among the most vulnerable with the added benefit of offering combination prevention for the uninfected and immediate treatment for those already infected. As such, expected added benefits of PrEP will be earlier linkage to care, prompt treatment initiation leading to health benefits and decreased transmission.
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Affiliation(s)
- Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro
| | - Adele Benzaken
- Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Tatianna M. de Alencar
- Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Cristina Pimenta
- Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro
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15
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Chow JY, Konda KA, Calvo GM, Klausner JD, Cáceres CF. Demographics, Behaviors, and Sexual Health Characteristics of High Risk Men Who Have Sex With Men and Transgender Women Who Use Social Media to Meet Sex Partners in Lima, Peru. Sex Transm Dis 2017; 44:143-8. [PMID: 28178111 DOI: 10.1097/OLQ.0000000000000566] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women (TW) in Peru bear a disproportionate burden of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). In a context of quickly expanding communication technology, increasing numbers of MSM and TW are using social media applications to seek sex partners. Understanding social media users and their sex partnering practices is needed to update HIV and STI prevention programming. METHODS In Lima, Peru, 312 MSM and 89 TW from 2 STI clinics underwent HIV and STI testing and participated in a survey of demographics, behaviors, sexual health, and social media practices. χ, t tests, and Wilcoxon Mann-Whitney tests were used to compare those with and without recent social media sex partners. RESULTS Men who have sex with men with social media sex partners were younger, more educated, and more likely to identify as gay. They were significantly more likely to report greater numbers of sex partners, including anonymous sex partners; sex in higher-risk venues, orgies, and have rectal Neisseria gonorrhoeae or Chlamydia trachomatis infection. Transgender women with social media sex partners were also younger, more likely to participate in sex work, and have a lower rate of rapid plasma reagin positivity or history of syphilis. Participants reported using several social media sites including sexual hook-up applications, websites for gay men, pornographic websites, and chat sites, but the most common was Facebook. CONCLUSIONS Prevention strategies targeting Peruvian MSM and TW who use social media are needed to address higher-risk sexual behavior and the high burden of STIs.
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Saffier IP, Kawa H, Harling G. A scoping review of prevalence, incidence and risk factors for HIV infection amongst young people in Brazil. BMC Infect Dis 2017; 17:675. [PMID: 29020929 PMCID: PMC5637257 DOI: 10.1186/s12879-017-2795-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/04/2017] [Indexed: 11/12/2022] Open
Abstract
Background Despite young people being a key population for HIV prevention, the HIV epidemic amongst young Brazilians is perceived to be growing. We therefore reviewed all published literature on HIV prevalence and risk factors for HIV infection amongst 10-25 year olds in Brazil. Methods We searched Embase, LILACS, Proquest, PsycINFO, PubMed, Scopus and Web of Science for studies published up to March 2017 and analyzed reference lists of relevant studies. We included published studies from any time in the HIV epidemic which provided estimates specific to ages 10-25 (or some subset of this age range) for Brazilians on either: (a) HIV prevalence or incidence; or (b) the association between HIV and socio-demographic or behavioral risk factors. Results Forty eight publications met the inclusion criteria: 44 cross-sectional, two case-control, two cohort. Four studies analysed national data. Forty seven studies provided HIV prevalence estimates, largely for six population subgroups: Counselling and Testing Center attendees; blood donors; pregnant women; institutional individuals; men-who-have-sex-with-men (MSM) and female sex workers (FSW); four provided HIV incidence estimates. Twelve studies showed HIV status to be associated with a wide range of risk factors, including age, sexual and reproductive history, infection history, substance use, geography, marital status, mental health and socioeconomic status. Conclusions Few published studies have examined HIV amongst young people in Brazil, and those published have been largely cross-sectional and focused on traditional risk groups and the south of the country. Despite these limitations, the literature shows raised HIV prevalence amongst MSM and FSW, as well as amongst those using drugs. Time trends are harder to identify, although rates appear to be falling for pregnant women, possibly reversing an earlier de-masculinization of the epidemic. Improved surveillance of HIV incidence, prevalence and risk factors is a key component of efforts to eliminate HIV in Brazil.
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Affiliation(s)
| | - Hélia Kawa
- Department of Epidemiology, Fluminense Federal University, Niterói, Brazil
| | - Guy Harling
- Institute for Global Health, University College London, Mortimer Market Centre, London, WC1E 6JB, UK. .,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
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17
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Redoschi BRL, Zucchi EM, Barros CRDS, Paiva VSF. Routine HIV testing in men who have sex with men: from risk to prevention. CAD SAUDE PUBLICA 2017; 33:e00014716. [PMID: 28538786 DOI: 10.1590/0102-311x00014716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/01/2017] [Indexed: 11/22/2022] Open
Abstract
We conducted a critical review of the literature on recurrent use of HIV testing in men who have sex with men (MSM). We performed a narrative review of the literature in which we analyzed the various conceptions on frequent testing over time, the implications for health programs, and the main social markers that influence the incorporation of HIV testing as routine care. Although it has existed since the 1990s, recurrent testing among MSM was frequently interpreted as increased exposure to HIV due to lack of condom use, and therefore as "unnecessary" testing. Beginning in the 2000s, periodic testing has become a programmatic recommendation and has been interpreted as a goal. Individuals' perception of their use of the test has rarely been considered in order to characterize such use as routine care. On the social and cultural level, individual aspects associated with recent or routine testing were included in contexts of favorable norms for testing and less AIDS stigma. Differences in generation, schooling, and types of affective-sexual partnerships play an important part in testing. Such differences highlight that the epidemiological category "men who have sex with men" encompasses diverse relations, identities, and practices that result in specific uses of the test as a prevention strategy. Thus, dialogue between programs, health professionals, and the persons most affected by the epidemic is crucial for building responses with real potential to confront the HIV epidemic, based on respect for human rights.
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Affiliation(s)
| | - Eliana Miura Zucchi
- Programa de Pós-graduação Stricto Sensu em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
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Hoagland B, De Boni RB, Moreira RI, Madruga JV, Kallas EG, Goulart SP, Cerqueira N, Torres TS, Luz PM, Fernandes NM, Liu AY, Grinsztejn B, Veloso VG. Awareness and Willingness to Use Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men and Transgender Women in Brazil. AIDS Behav 2017; 21:1278-1287. [PMID: 27531461 DOI: 10.1007/s10461-016-1516-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Antiretroviral pre-exposure prophylaxis (PrEP) is recommended to prevent HIV infection among high-risk men who have sex with men (MSM) though not available in Brazil where the HIV epidemic persists unabated in this group. This cross-sectional study describes PrEP awareness and willingness and associated factors among MSM and transvestite/transgender women (trans women) pre-screened for the PrEP Brasil study. Awareness was reported by 61.3 % of the participants and was associated with age, education, site, study period and prior HIV testing. Most participants (82.1 %) were willing to use PrEP, which was associated with site, study period, number of male condomless anal sexual partners and anal sex with HIV positive/unknown partners. PrEP information is need among young and less educated individuals. Willingness to use PrEP was high and future studies should be conducted to confirm PrEP acceptability and the characteristics of the population who chose to adopt this intervention.
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Affiliation(s)
- Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil.
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | | | | | | | | | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Nilo Martinez Fernandes
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI/FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
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Ravasi G, Grinsztejn B, Baruch R, Guanira JV, Luque R, Cáceres CF, Ghidinelli M. Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America. J Int AIDS Soc 2016; 19:21113. [PMID: 27760687 DOI: 10.7448/IAS.19.7.21113] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/12/2016] [Indexed: 01/01/2023] Open
Abstract
Introduction Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America. Discussion Although demonstration projects are ongoing or being planned in a number of countries, to date no Latin American country has implemented a public PrEP programme. The knowledge of policymakers about PrEP implementation needs to be strengthened, and programmatic guidance and cost estimate tools need to be developed to support adequate planning. Despite high levels of awareness among health providers, especially if engaged in HIV or key population care, willingness to prescribe PrEP is still low due to the lack of national policies and guidelines. Key populations, especially men who have sex with men, transgender women and sex workers, have been engaged in demonstration projects, and qualitative research shows high awareness and willingness to use PrEP, especially if accessible in the public sector for free or at affordable price. Concerns of safety, adherence, effectiveness and risk compensation need to be addressed through targeted social communication strategies to improve PrEP knowledge and stimulate demand. Alliance among policymakers, civil society and representatives from key populations, healthcare providers and researchers will be critical for the design and successful implementation of PrEP demonstration projects of locally adapted delivery models. The use of mechanisms of joint negotiation and procurement of antiretrovirals could reduce costs and significantly increase the cost-effectiveness of PrEP. Conclusions PrEP is an additional prevention tool and should be implemented in combination and synergy with other prevention interventions. PrEP programmes should target high-risk individuals from key populations for higher cost-effectiveness. Demonstration projects may generate strategic information for and lead to the implementation of full-scale PrEP programmes.
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Cáceres CF, Bekker L, Godfrey-faussett P. Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016; 19:21479. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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21
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Bruhn R, Moreno E, Sabino EC, Ferreira NAF, Carneiro-Proietti ABF, Lopes MED, Sampaio D, Loureiro P, Custer B, Goncalez TT. Self-reported historic human immunodeficiency virus (HIV) testing in a Brazilian blood donor HIV case-control study. Transfusion 2016; 56:2857-2867. [PMID: 27716930 DOI: 10.1111/trf.13792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/06/2016] [Accepted: 06/28/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND There has been increased worldwide emphasis on the many benefits of human immunodeficiency virus (HIV) serostatus awareness for both infection prevention and improved treatment outcomes. Previous studies indicate that donors may use blood donation to be tested; the objectives of this analysis were to assess, among donors with previously undisclosed risk behavior in the 12 months before donation, the frequency of those who have previously been tested for HIV and the demographic and behavioral factors associated with such testing. STUDY DESIGN AND METHODS In this secondary analysis from an HIV case-control study of blood donors in Brazil, we analyzed the response to the question, "Other than blood donation, have you ever been tested for HIV?" Demographic and disclosed risk behaviors associated with previous testing were determined. RESULTS The study included 341 HIV-positive cases and 791 HIV-negative controls (1:2 case/control ratio). Overall, 31% of blood donors (40% of cases and 26% of controls) reported having been tested for HIV outside of blood donation. History of HIV testing varied according to sex, HIV status, and reported sexual risk behavior. CONCLUSION Although it is encouraging that previous testing was more frequent in donors with acknowledged sexual risk behavior in Brazil, 60% still had not been tested for HIV outside of the blood donation setting. Educating donors on the importance of not using blood centers as a means to get tested for HIV in Brazil, especially if they engage in higher risk behaviors, and seeking alternate testing venues instead could improve the safety of donated blood.
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Affiliation(s)
- Roberta Bruhn
- Blood Systems Research Institute, Epidemiology, San Francisco, California
| | - Elizabeth Moreno
- Fundação Hemominas/Hemocentro de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ester C Sabino
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, Brazil.,Department of Infectious Disease, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Divaldo Sampaio
- Fundação Hemope/Hemocentro de Pernambuco, Recife, Pernambuco, Brazil
| | - Paula Loureiro
- Fundação Hemope/Hemocentro de Pernambuco, Recife, Pernambuco, Brazil.,University of Pernambuco, FCM, Fundação Hemope, Recife, Pernambuco, Brazil
| | - Brian Custer
- Blood Systems Research Institute, Epidemiology, San Francisco, California
| | - Thelma T Goncalez
- Blood Systems Research Institute, Epidemiology, San Francisco, California
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Castro R, Ribeiro-Alves M, Corrêa RG, Derrico M, Lemos K, Grangeiro JR, de Jesus B, Pires D, Veloso VG, Grinsztejn B. The Men Who Have Sex with Men HIV Care Cascade in Rio de Janeiro, Brazil. PLoS One 2016; 11:e0157309. [PMID: 27299524 PMCID: PMC4907447 DOI: 10.1371/journal.pone.0157309] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/29/2016] [Indexed: 11/25/2022] Open
Abstract
Brazil has a concentrated HIV epidemic and men who have sex with men (MSM) are disproportionately affected. Yet, no data is available on the HIV care cascade for this population. This study aimed to assess the HIV care cascade among MSM newly diagnosed through innovative testing strategies in Rio de Janeiro. Data from 793 MSM and travestites/transgender women (transwomen) tested for HIV at a non-governmental LGBT organization and a mobile testing unit located at a gay friendly venue were analyzed. A 12-month-after-HIV-diagnosis-censored cohort was established using CD4, viral load and combination antiretroviral therapy (cART) longitudinal data from those diagnosed with HIV. A cross-sectional HIV care cascade was built using this data. The relative risks of achieving each cascade-stage were estimated using generalized linear models according to age, self-declared skin-color, education, history of sexually transmitted diseases (STD), drug use and prior HIV testing. From Jan-2013 to Jan-2014, 793 MSM and transwomen were tested, 131 (16.5%) were HIV-infected. As of January 2015, 95 (72.5%) were linked to HIV care, 90 (68.7%) were retained in HIV care, 80 (61.1%) were on cART, and 50 (38.2%) were virally suppressed one year after HIV diagnosis. Being non-white (Relative risk [lower bound; upper bound of 95% confidence interval] = 1.709 [1.145; 2.549]) and having a prior HIV-test (1.954 [1.278; 2.986]) were associated with an HIV-positive diagnosis. A higher linkage (2.603 [1.091; 6.211]) and retention in care (4.510 [1.880; 10.822]) were observed among those who were older than 30 years of age. Using community-based testing strategies, we were able to access a high-risk MSM population and a small sample of transwomen. Despite universal care coverage and the test-and-treat policy adopted in Brazil, the MSM cascade of care indicates that strategies to increase linkage to care and prompt cART initiation targeted to these populations are critically needed. Interventions targeting non-white and young MSM should be prioritized.
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Affiliation(s)
- Rodolfo Castro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
- Instituto de Saúde Coletiva, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Marcelo Ribeiro-Alves
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Renato Girade Corrêa
- Departamento de DST, Aids e Hepatites Virais, Ministério da Saúde, Brasília, DF, Brazil
| | - Monica Derrico
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Katia Lemos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
- Gerência de DST, Aids, Sangue e Hemoderivados, Secretaria de Estado de Saúde, Rio de Janeiro, RJ, Brazil
| | - Jose Roberto Grangeiro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
- Grupo Arco-Íris, Rio de Janeiro, RJ, Brazil
| | - Beto de Jesus
- Associação Internacional de Lésbicas, Gays, Bissexuais, Transexuais e Intersexuais para a América Latina e o Caribe, Buenos Aires, CABA, Argentina
| | - Denise Pires
- Gerência de DST, Aids, Sangue e Hemoderivados, Secretaria de Estado de Saúde, Rio de Janeiro, RJ, Brazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Pascom ARP, Dutra de Barros CH, Lobo TDDM, Pasini EN, Comparini RA, Caldas de Mesquita F. Point-of-care HIV tests done by peers, Brazil. Bull World Health Organ 2016; 94:626-30. [PMID: 27516641 PMCID: PMC4969986 DOI: 10.2471/blt.15.162461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/25/2016] [Accepted: 03/10/2016] [Indexed: 01/30/2023] Open
Abstract
Problem Early diagnosis of infections with human immunodeficiency virus (HIV) is needed – especially among key populations such as sex workers, transgender people, men who have sex with men and people who use drugs. Approach The Brazilian Ministry of Health developed a strategy called Viva Melhor Sabendo (“live better knowing”) to increase HIV testing among key populations. In partnership with nongovernmental organizations (NGOs), a peer point-of-care testing intervention, using an oral fluid rapid test, was introduced at social venues for key populations at different times of the day. Local setting Key populations in Brazil can have 40 times higher HIV prevalence than the general population (14.8% versus 0.4%). Relevant changes Legislation was reinterpreted, so that oral fluid rapid tests could be administered by any person trained in rapid testing by the health ministry. Between January 2014 and March 2015, 29 723 oral fluid tests were administered; 791 (2.7%) were positive. Among the key populations, transgender people had the greatest proportion of positive results (10.7%; 172/1612), followed by men who declared themselves as commercial sex workers (8.7%; 165/1889) and men who have sex with men (4.8%; 292/6055). Lessons learnt The strategy improved access to HIV testing. Testing done by peers at times and locations suitable for key populations increased acceptance of testing. Working with relevant NGOs is a useful approach when reaching out to these key populations.
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Affiliation(s)
- Ana Roberta Pati Pascom
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Clarissa Habckost Dutra de Barros
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Tainah Dourado de Miranda Lobo
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Elisiane Nelcina Pasini
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Regina Aparecida Comparini
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
| | - Fábio Caldas de Mesquita
- STI, AIDS and Viral Hepatitis Department, Health Surveillance Secretariat, Ministry of Health, Setor Administrativo Federal Sul (SAFS) 02 - Bloco F - Ed. Premium Torre I, Sala 4, 70.070-600, Brasília, DF, Brazil
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Veloso VG, Mesquita F, Grinsztejn B. Pre-exposure prophylaxis for men and transgender women who have sex with men in Brazil: opportunities and challenges. J Int AIDS Soc 2015; 18:20010. [PMID: 26198347 DOI: 10.7448/IAS.18.4.20010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction The World Health Organization recently released guidelines on the use of pre-exposure prophylaxis (PrEP) for prevention of HIV infection among men and transgender women (TGW) who have sex with men based on results of randomized clinical trials. The aim of this commentary is to discuss the opportunities and challenges of incorporating PrEP into the Brazilian continuum of HIV care and prevention for men who have sex with men (MSM) and TGW. Discussion Key aspects of the AIDS epidemic among MSM and TGW in Brazil and the comprehensive Brazilian response to the epidemic are presented. The universal access to health care provided through the Brazilian Unified Health System (SUS) and the range of prevention and care services already available countrywide to HIV-positive individuals and at-risk MSM and TGW are identified as the main facilitators for the implementation of PrEP. Limited PrEP awareness among MSM, TGW and health care providers, low HIV testing frequency and low HIV risk perception among MSM and TGW represent the core challenges to be addressed. Data generated by demonstration projects in Brazil will provide an important contribution to PrEP rollout in Brazil. Conclusions The implementation of PrEP in Brazil is feasible. A synergistic rollout of treatment as prevention and PrEP will maximize public health and individual benefits of the country's comprehensive response to the AIDS epidemic.
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