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de Sousa Mascena Veras MA, Menezes NP, Mocello AR, Leddy AM, Saggese GSR, Bassichetto KC, Gilmore HJ, de Carvalho PGC, Maschião LF, Neilands TB, Sevelius J, Lippman SA. Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil. BMC Public Health 2024; 24:791. [PMID: 38481195 PMCID: PMC10938823 DOI: 10.1186/s12889-024-18224-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03525340.
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Affiliation(s)
| | - Neia Prata Menezes
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Adrienne Rain Mocello
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Gustavo Santa Roza Saggese
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Luca Fasciolo Maschião
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jae Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
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Cohen M, Cruz LN, Cardoso RB, Albuquerque MDFPMD, Montarroyos UR, de Souza WV, Ludermir AB, de Carvalho MR, da Silva Vicente JD, Viegas Filho MP, Cortes FJM, de Siqueira Silva MT, Almeida CMC, Lima LNGC, Veras MADSM, Kendall C, Kerr LRFS, Martelli CMT, Camey SA. Impact of the COVID-19 pandemic on the mental health of frontline healthcare workers in a highly affected region in Brazil. BMC Psychiatry 2023; 23:255. [PMID: 37069533 PMCID: PMC10107551 DOI: 10.1186/s12888-023-04702-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023] Open
Abstract
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.
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Affiliation(s)
- Mírian Cohen
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos St, 2400, 2nd fl, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil.
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Luciane Nascimento Cruz
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil
- Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Bertoglio Cardoso
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Ramiro Barcelos St, 2400, 2nd fl, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | | | - Fanny Julia Mireille Cortes
- National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | - Carl Kendall
- Department of Community Health, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | | | - Suzi Alves Camey
- Statistics Department, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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Silva JDRPD, Knauth DR, Leal AF, Magno L, Dourado I, Veras MADSM, Kerr LRS. [Factors associated with inconsistent condom use among men who have sex with men in Brazil and their commercial sexual partners]. CAD SAUDE PUBLICA 2023; 38:e00099822. [PMID: 36921187 DOI: 10.1590/0102-311xpt099822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/20/2022] [Indexed: 01/31/2023] Open
Abstract
We aimed to analyze the factors associated with inconsistent condom use among men who have sex with men (MSM) and their commercial sexual partners in Brazil. This is a cross-sectional study with adult MSM who were recruited via respondent-driven sampling (RDS) in 12 Brazilian capitals in 2016. MSM answered a sociobehavioral questionnaire which included questions on their sexual behavior. The inconsistent use of condoms with their clientele was measured via insertive and receptive anal sex in the six months prior to our research and in their last sexual intercourse. The association between independent variables and the inconsistent use of condoms was measured via a Poisson regression model with robust variance and estimation of adjusted prevalence ratios (aPR). Data from 461 MSM were analyzed. We found a 26% prevalence of inconsistent condom use with their clientele (95%CI: 19.0-34.3, n = 123). Belonging to the lowest economic classes (D/E), having medium or low knowledge about HIV, having practiced insertive and receptive anal sex, and having never tested for HIV throughout their lives were associated with inconsistent use of condoms with their clientele. The variables associated with inconsistent use indicated that commercial sex is practiced in a context of greater vulnerability to HIV infection, referring to the need for biomedical and behavioral interventions which focus on access to and use of prevention strategies together with public policies to reduce socioeconomic inequalities among MSM who practice commercial sexual.
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Affiliation(s)
| | - Daniela Riva Knauth
- Instituto de Filosofia e Ciências Humanas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Andréa Fachel Leal
- Instituto de Filosofia e Ciências Humanas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil
| | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Bassichetto KC, Saggese GSR, Maschião LF, Carvalho PGCD, Gilmore H, Sevelius J, Lippman SA, Veras MADSM. Factors associated with the retention of travestis and transgender women living with HIV in a peer navigation intervention in São Paulo, Brazil. CAD SAUDE PUBLICA 2023; 39:e00147522. [PMID: 37132720 DOI: 10.1590/0102-311xpt147522] [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: 08/08/2022] [Accepted: 02/27/2023] [Indexed: 05/04/2023] Open
Abstract
Travestis and transgender women (TrTGW) constitute the groups with the highest HIV prevalence in the world, with higher probability of infection compared with the general population and lower adherence to prevention and treatment strategies than other vulnerable groups. Considering these challenges, this study describes the factors associated with the retention of TrTGW with HIV to the TransAmigas project. Participants were recruited from April 2018 to September 2019 in a public health service in São Paulo, Brazil. A total of 113 TrTGW were randomly assigned to either a peer navigation intervention (75) or a control group (38) and followed up for nine months. To analyze the association between the selected variables and the outcome ("retention at nine months", regardless of contact at three months, defined by the "full completion of the final questionnaire"), bivariate and multivariate logistic regression models were used. Peer contact forms were qualitatively assessed to validate and complement the previous selection of quantitative component variables. Of the 113 participants, 79 (69.9%) participated in the interview after nine months, of which 54 (72%) were from the intervention group and 25 (66%) from the control group. In the final multivariate model, contact at three months (adjusted odds ratio - aOR = 6.15; 95% confidence interval - 95%CI: 2.16-17.51) and higher schooling level (≥ 12 years) (aOR = 3.26; 95%CI: 1.02-10.42) remained associated with the outcome, adjusted by race/skin color, age ≤ 35 years, and HIV serostatus disclosure. Future studies with TrTGW should include contact at regular intervals, with additional efforts aimed at participants with lower schooling level.
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Barberia LG, de P Moreira N, Kemp B, de Sousa Mascena Veras MA, Zamudio M, Rosa ISC, de J Carvalho R, Sousa TCM. Evaluation of the effectiveness of surveillance policies to control the COVID-19 pandemic in São Paulo, Brazil. Glob Health Res Policy 2022; 7:27. [PMID: 35974420 PMCID: PMC9381395 DOI: 10.1186/s41256-022-00260-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 08/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surveillance efforts are essential to pandemic control, especially where the state is the primary health provider, such as Brazil. When public health testing guidelines limit molecular tests, there are reductions in detection efforts aimed at early recognition, isolation, and treatment of those infected with the virus. This study evaluates the effectiveness of surveillance policies to control the COVID-19 pandemic in São Paulo. METHODS We conducted an interrupted time series analysis with a segmented regression model to analyze if changes in the state's guidelines improved RT-PCR testing outcomes in Brazil's most affluent and largest state, São Paulo. Anonymized daily data on the RT-PCR tests conducted in public laboratories belonging to the state-wide network from March 1, 2020 to June 5, 2021 were extracted from the Sao Paulo State open-source database, while the data on the genomic sequences were obtained from GISAID. We then aggregated these data for the 17 regional health departments in the state to evaluate regional-level outcomes. RESULTS The public health system restricted RT-PCR testing to hospitalized cases in the first months. Testing was expanded to permit symptomatic testing of non-hospitalized persons only in July 2020, but a statistically significant increase in surveillance efforts was not observed. Case definition was expanded to allow case confirmation based on clinical, laboratory and image data criteria other than an RT-PCR test without increasing the testing effort for asymptomatic suspicious cases in September 2020. There was an increase in the mean volume of testing in each RHD, but the test positivity rate increased due to insufficient testing expansion. Results also show an uneven improvement in testing outcomes following these changes across the state's regional health departments. CONCLUSIONS Evidence suggests that lower RT-PCR testing and genomic surveillance efforts are associated with areas characterized by a higher population concentration and a greater population reliance on the public health system. Our results highlight the need to structure health surveillance and information systems for disease control and prevention in emergency settings considering local demographics and vulnerabilities. In high prevalence settings, efforts at identifying and including vulnerable populations in routine and enhanced surveillance programs during COVID-19 must be significantly improved.
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Affiliation(s)
- Lorena G Barberia
- Department of Political Science, University of São Paulo, Avenida Professor Luciano Gualberto, 315 - Sala 2067 - Cidade Universitária, São Paulo, SP, 05508-900, Brazil.
| | - Natália de P Moreira
- Department of Political Science, University of São Paulo, Avenida Professor Luciano Gualberto, 315 - Sala 2067 - Cidade Universitária, São Paulo, SP, 05508-900, Brazil
| | - Brigina Kemp
- Conselho de Secretários Municipais de Saúde - SP, Avenida Angélica, 2466, - 17° floor - Consolação, São Paulo, SP, 01228200, Brazil
| | - Maria Amelia de Sousa Mascena Veras
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Dr Cesario Mota Jr St. 61, São Paulo, SP, 01221-020, Brazil
| | - Marcela Zamudio
- Department of Political Science, University of São Paulo, Avenida Professor Luciano Gualberto, 315 - Sala 2067 - Cidade Universitária, São Paulo, SP, 05508-900, Brazil
| | - Isabel Seelaender Costa Rosa
- Department of Political Science, University of São Paulo, Avenida Professor Luciano Gualberto, 315 - Sala 2067 - Cidade Universitária, São Paulo, SP, 05508-900, Brazil
| | - Rebeca de J Carvalho
- Department of Public Administration and Government, FGV EAESP Business Administration School of São Paulo, Avenida 9 de julho, 2029, Bela Vista, São Paulo, SP, 01313-902, Brazil
| | - Tatiane C M Sousa
- Department of Political Science, University of São Paulo, Avenida Professor Luciano Gualberto, 315 - Sala 2067 - Cidade Universitária, São Paulo, SP, 05508-900, Brazil.,Fundação Oswaldo Cruz, ENSP, Rio de Janeiro, RJ, Brazil
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Lippman SA, Sevelius JM, Saggese GSR, Gilmore H, Bassichetto KC, de Barros DD, de Oliveira RB, Maschião LF, Chen D, de Sousa Mascena Veras MA. Peer Navigation to Support Transgender Women's Engagement in HIV Care: Findings from the Trans Amigas Pilot Trial in São Paulo, Brazil. AIDS Behav 2022; 26:2588-2599. [PMID: 35119537 PMCID: PMC9252974 DOI: 10.1007/s10461-022-03595-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/26/2022]
Abstract
Trans women living with HIV (TWH) have suboptimal HIV care engagement. We pilot tested Trans Amigas, a theory-based, trans-specific peer navigation (PN) intervention to address barriers to care in São Paulo, Brazil. TWH were randomized to the PN intervention (n = 75) or control (n = 38) condition. Control participants were referred to trans-friendly HIV care. Intervention participants were assigned a navigator who conducted nine in-person one-on-one sessions and bi-weekly phone or text check-ins to help participants overcome barriers to care and work towards gender affirmation and healthcare goals. We followed participants for 9 months to determine intervention feasibility, acceptability, and preliminary efficacy in improving retention in care. Analyses were intention to treat (ITT). Intervention acceptability was high: at end line, 85.2% of PN participants said they would continue receiving services and 94.4% would recommend peer navigation to a friend. A priori feasibility criteria were met: 92% of eligible participants enrolled and 70% were retained at 9 months; however, only 47% achieved moderate or better adherence to both in-person and phone/text program components. Though the pilot was not powered for efficacy, ITT findings trended toward significance, with intervention participants 40% more likely to be retained in care at the end of the study. Population-specific peer programming to support care engagement is acceptable, feasible, and can improve HIV outcomes for Trans women living with HIV.
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Affiliation(s)
- Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Jae M Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Gustavo Santa Roza Saggese
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
- Faculty of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Hailey Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | | | | | | | | | - Dorothy Chen
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
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Magno L, Guimarães MDC, Leal AF, Dourado I, Knauth DR, Bermúdez XPD, Rocha GM, Veras MADSM, Kendall C, Brito AMD, Kerr LRS. Perception of discrimination due to sexual orientation and associated factors among men who have sex with men in 12 Brazilian cities. CAD SAUDE PUBLICA 2022; 38:EN199121. [DOI: 10.1590/0102-311xen199121] [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: 08/10/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022] Open
Abstract
Discrimination due to sexual orientation (DDSO) has an important association with health outcomes among men who have sex with men (MSM). This study aimed to analyze factors associated with DDSO among MSM in 12 Brazilian cities. This is a cross-sectional study with 4,176 MSM participants recruited in 2016 which used a respondent-driven sampling method in 12 Brazilian cities. DDSO levels were previously identified by a latent class analysis based on 13 variables from the discrimination section. An ordinal logistic regression was used to assess associations with these DDSO levels, and weighted ordinal odds ratios (OR) and their respective 95% confidence intervals (95%CI) were estimated using Gile’s estimator. Most participants were young (< 25 years old) black or of mixed-race (pardo), single individuals who had a religious affiliation, primary or incomplete secondary education, and a high and average socioeconomic status. More than half (65%) reported DDSO in the 12 months prior to this study. We observed an independent association among the four latent DDSO classes and the following variables: age < 25 years old (OR = 1.66; 95%CI: 1.21-2.27), white skin color (OR = 1.43; 95%CI: 1.02-2.01), history of sexual (OR = 2.33; 95%CI: 1.58-3.43) and physical violence (OR = 3.08; 95%CI: 2.11-4.49), disclosure of their sexual orientation as MSM to their fathers (OR = 2.00; 95%CI: 1.47-2.72), experienced suicidal ideation in the two weeks prior to this study (OR = 2.09; 95%CI: 1.46-2.98), and use of any illicit drugs in the last six months (OR = 1.61; 95%CI: 1.19-2.18). Our results indicate that contextual factors may contribute to high DDSO levels among MSM in Brazil. Public health policies toward human rights surveillance and protection among MSM must be urgently addressed.
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Affiliation(s)
- Laio Magno
- Universidade do Estado da Bahia, Brazil; Universidade Federal da Bahia, Brazil
| | | | | | | | | | | | | | | | - Carl Kendall
- Tulane University School of Public Health and Tropical Medicine, U.S.A
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de Sousa Mascena Veras MA, Saggese GSR, Gomez JL, Silveira P, Paiatto B, Ferreira D, de Souza PA, Calado R, Castejon MJ, Yamashiro R, de Macedo Brígido LF, Turner C, Lin J, Wilson EC, McFarland W. Brief Report: Young Age and Sex Work Are Associated With HIV Seroconversion Among Transgender Women in São Paulo, Brazil. J Acquir Immune Defic Syndr 2021; 88:e1-e4. [PMID: 34050104 PMCID: PMC8373663 DOI: 10.1097/qai.0000000000002737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transgender women worldwide have the highest prevalence of HIV and the lowest access to prevention among groups at risk of HIV. However, few longitudinal studies have directly measured HIV incidence and identified predictors of HIV acquisition among transgender women. SETTING São Paulo, Latin America's largest city. METHODS We conducted a longitudinal study among transgender women in São Paulo. Participants were recruited by a long-chain peer referral process from May 2017 to July 2019. Those aged 18 years and older and who were HIV-negative at baseline were retested every 6 months up to 18 months. HIV incidence was calculated by dividing the number of seroconversions by the person-years (PYs) of follow-up; 95% confidence intervals (CIs) were constructed assuming a Poisson distribution. Conditional maximum likelihood ratios assessed differences in HIV incidence by risk factors. RESULTS A racially/ethnically diverse sample of 545 HIV-negative transgender women was enrolled. In 485.5 PYs of follow-up, 13 seroconversions were observed, yielding an incidence of 2.68 per 100 PYs (95% CI: 1.43 to 4.58). HIV incidence was significantly higher among transgender women aged 18-24 years (rate ratio 3.85, 95% CI: 1.24 to 12.93) and among those who engaged in sex work in the preceding month (rate ratio 5.90, 95% CI: 1.71 to 26.62). CONCLUSIONS HIV transmission continues at a high rate among transgender women in Brazil. Factors such as young age, lower level of education, and limited employment opportunities may lead to dependence on sex work that in turn increases HIV risk. Transgender-friendly prevention services, particularly programs delivering pre-exposure prophylaxis, are urgently needed.
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Affiliation(s)
| | | | - José Luis Gomez
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Paula Silveira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
- Faculdade de Saúde Pública, Universidade de São Paulo, Brazil
| | - Beatriz Paiatto
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Denis Ferreira
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Paola Alves de Souza
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
- Faculdade de Psicologia Social, Universidade de São Paulo, Brazil
| | - Rodrigo Calado
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Márcia Jorge Castejon
- Instituto Adolfo Lutz, Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, Brazil
| | - Rosemeire Yamashiro
- Instituto Adolfo Lutz, Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, Brazil
| | | | - Caitlin Turner
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Jess Lin
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
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Almeida LFD, Guimarães MDC, Dourado I, Veras MADSM, Magno L, Leal AF, Kerr LRS, Kendall C, Pontes AK, Rocha GM. Envolvimento em organizações não governamentais e a participação em ações de prevenção ao HIV/aids por homens que fazem sexo com homens no Brasil. CAD SAUDE PUBLICA 2021. [DOI: 10.1590/0102-311x00150520] [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: 11/21/2022] Open
Abstract
A epidemia do HIV no Brasil é concentrada em populações-chave. Organizações não governamentais (ONGs) que atuam em defesa dos direitos da população LGBT e de pessoas vivendo com HIV/aids podem contribuir para o desenvolvimento de políticas de prevenção. O objetivo deste estudo é avaliar o envolvimento em ONGs e analisar sua associação com a participação individual em ações de educação em saúde, testagem e prevenção às infecções sexualmente transmissíveis (IST) e ao HIV, como parte de um estudo nacional de vigilância biológica e comportamental entre homens que fazem sexo com homens (HSH). Trata-se de estudo transversal utilizando respondent driven sampling (RDS) em 12 cidades brasileiras. A magnitude da associação do envolvimento em ONGs com cada ação foi avaliada pela estimativa de odds ratio por meio de regressão logística por amostragem complexa, considerando cada cidade como um estrato e ponderando pelo estimador de Gile. Foi estimada a proporção relativa atribuída ao envolvimento em ONGs para cada evento avaliado. Dentre 4.176 participantes, a maioria tinha menos de 25 anos (56,5%) e baixo nível econômico (56,7%). Um quarto dos HSH referiu se envolver em ONGs, que foi significativamente associado com as ações avaliadas: receber preservativo e gel lubrificante, participar de palestra, receber material educativo e aconselhamento em IST, conhecimento de profilaxia pós-exposição (PEP) e profilaxia pré-exposição (PrEP), testagem para sífilis e HIV, ter aceitação do autoteste e saber onde realizar teste para HIV. ONGs têm um papel histórico na resposta à epidemia de HIV no Brasil e, apesar de terem sofrido significativa redução de recursos nos últimos anos, mantêm relevante atuação nas ações de saúde pública.
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Affiliation(s)
| | | | | | | | - Laio Magno
- Universidade Federal da Bahia, Brazil; Universidade do Estado da Bahia, Brazil
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Teixeira MG, Kerr LRFS, Ximenes RADA, Almeida RLFD, Ichihara MY, Albuquerque MDFMD, Aquino EML, Werneck GL, Carmo EH, Medronho RA, Oliveira WKD, Henriques CMP, Kendall C, Silva AAMD, Almeida Filho NM, Souza WVD, Veras MADSM, Penna GO, Silva GAE, Brandão Filho SP, Barreto ML. Fortalecer as atividades de informação e vigilância epidemiológica é essencial e urgente para reduzir a força de transmissão do SARS-CoV-2. Rev bras epidemiol 2021. [DOI: 10.1590/1980-549720210049] [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: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Estela M L Aquino
- Universidade Federal da Bahia, Brasil; Fundação Oswaldo Cruz, Brasil
| | | | | | | | | | | | - Carl Kendall
- Universidade Federal do Ceará, Brasil; Tulane School of Public Health and Tropical Medicine, Estados Unidos da América
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11
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Garcia LP, Traebert J, Boing AC, Santos GFZ, Pedebôs LA, d'Orsi E, Prado PI, Veras MADSM, Boava G, Boing AF. The potential spread of Covid-19 and government decision-making: a retrospective analysis in Florianópolis, Brazil. Rev Bras Epidemiol 2020; 23:e200091. [PMID: 33027433 DOI: 10.1590/1980-549720200091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the association between the transmission potential of SARS-CoV-2 and the decisions made by the municipal government of Florianópolis (Brazil) regarding social distancing. METHODS We analyzed new cases of COVID-19 identified in Florianópolis residents between February 1 and July 14, 2020, using a nowcasting approach. Decrees related to COVID-19 published in the Official Gazette of the Municipality between February 1 and July 14, 2020 were also analyzed. Based on the actions proposed in the decrees, whether they loosened social distancing measures, or increased or maintained existing restrictions, was analyzed, thus creating a Social Distancing Index. Time-dependent reproduction numbers (Rt) for a period of 14 days prior to each decree were calculated. A matrix was constructed associating the classification of each decree and the Rt values, analyzing the consonance or dissonance between the potential dissemination of SARS-CoV-2 and the actions of the decrees. RESULTS A total of 5,374 cases of COVID-19 and 26 decrees were analyzed. Nine decrees increased social distancing measures, nine maintained them, and eight loosened them. Of the 26 actions, 9 were consonant and 17 dissonant with the tendency indicated by the Rt. Dissonance was observed in all of the decrees that maintained the distance measures or loosened them. The fastest expansion in the number of new cases and the greatest amount of dissonant decrees was found in the last two months analyzed. CONCLUSION There was an important divergence between municipal measures of social distancing with epidemiological indicators at the time of each political decision.
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Affiliation(s)
- Leandro Pereira Garcia
- Gerência de Inteligência e Informação, Secretaria Municipal de Saúde de Florianópolis - Florianópolis (SC), Brasil
| | - Jefferson Traebert
- Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina - Florianópolis (SC), Brasil
| | - Alexandra Crispim Boing
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil.,Observatório COVID-19 Brasil - São Paulo (SP), Brasil
| | - Grazielli Faria Zimmer Santos
- Grupo de Pesquisa em Coprodução do Bem Público: Accountability e Gestão, Universidade do Estado de Santa Catarina - Florianópolis (SC), Brasil
| | - Lucas Alexandre Pedebôs
- Gerência de Inteligência e Informação, Secretaria Municipal de Saúde de Florianópolis - Florianópolis (SC), Brasil
| | - Eleonora d'Orsi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Paulo Inacio Prado
- Observatório COVID-19 Brasil - São Paulo (SP), Brasil.,Instituto de Biologia, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Giuliano Boava
- Departamento de Matemática, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Antonio Fernando Boing
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil.,Observatório COVID-19 Brasil - São Paulo (SP), Brasil
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Veras MADSM, Boing AF. 10 th Brazilian Congress of Epidemiology: building our field with solidarity. CAD SAUDE PUBLICA 2017; 33:e00189517. [PMID: 29166491 DOI: 10.1590/0102-311x00189517] [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: 11/22/2022] Open
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Pinto TP, Teixeira FDB, Barros CRDS, Martins RB, Saggese GSR, Barros DDD, Veras MADSM. Silicone líquido industrial para transformar o corpo: prevalência e fatores associados ao seu uso entre travestis e mulheres transexuais em São Paulo, Brasil. CAD SAUDE PUBLICA 2017; 33:e00113316. [DOI: 10.1590/0102-311x00113316] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/08/2016] [Indexed: 05/29/2023] Open
Abstract
O objetivo deste trabalho foi estimar a prevalência do uso de silicone líquido industrial (SLI) entre pessoas travestis e mulheres transexuais e identificar os fatores relacionados a esta prática. Trata-se de estudo transversal realizado em sete municípios do Estado de São Paulo, Brasil, com dados coletados entre 2014 e 2015, em uma amostra de 576 pessoas. Na análise dos fatores associados, utilizamos o modelo de Poisson com variância robusta para estimar as razões de prevalências bruta e ajustada. A prevalência do uso de SLI foi de 49%, a média de idade para a primeira colocação de SLI foi de 22 (± 5,3) anos e aproximadamente 43% informaram a ocorrência de problemas de saúde decorrente do uso. No modelo múltiplo ter escolaridade menor que o nível superior, estar em faixa etária a partir dos 20 anos, identificar-se como travesti e exercer a prostituição foram associados positivamente com a utilização de SLI. Houve uma elevada prevalência do uso de SLI e de problemas decorrentes desta prática, indicando um desafio acerca da prevenção do uso e da redução dos danos à saúde provocados pelo SLI. Dessa forma, torna-se fundamental assegurar o acesso aos recursos necessários para a realização das modificações corporais ao longo do percurso de transição por meio de uma atenção integral à saúde das pessoas travestis e transexuais no Sistema Único de Saúde. Finalmente, incluir nas políticas de saúde as demandas por modificações corporais como parte da construção da identidade de gênero, respeitando as necessidades singulares de cada pessoa neste processo de transição.
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de Sousa Mascena Veras MA, Calazans GJ, de Almeida Ribeiro MCS, de Freitas Oliveira CA, Giovanetti MR, Facchini R, França IL, McFarland W. High HIV Prevalence among Men who have Sex with Men in a Time-Location Sampling Survey, São Paulo, Brazil. AIDS Behav 2015; 19:1589-98. [PMID: 25384906 DOI: 10.1007/s10461-014-0944-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We conducted a time-location sampling sero-behavioral surveillance survey of men who have sex with men (MSM) in São Paulo, Brazil, the largest city in Latin America and the Southern Hemisphere (N = 1,217 interviewed with serological results for 771). HIV prevalence was 15.4 % (95 % CI 11.6-20.1), with only 45.8 % previously aware of their infection. HIV prevalence achieved 6.4 % among youth 18-24 years and was higher among MSM with lower socio-economic status. In multivariate analysis, correlates of HIV were older age, gay identity, lower socio-economic status, social networks with HIV-positive MSM, receptive anal sex, and internet sex partners. Policy change towards increasing avenues for HIV testing coupled with antiretroviral treatment regardless of CD4 count or stage of disease stand to benefit the MSM community if scaled up fast enough.
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Veras MADSM, Ribeiro MCA, Jamal LF, McFarland W, Bastos FI, Ribeiro KB, Barata RB, Moraes JCD, Reingold AL. The "AMA-Brazil" cooperative project: a nation-wide assessment of the clinical and epidemiological profile of AIDS-related deaths in Brazil in the antiretroviral treatment era. CAD SAUDE PUBLICA 2011; 27 Suppl 1:S104-13. [DOI: 10.1590/s0102-311x2011001300011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 08/05/2010] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to assess the profile of AIDS-related deaths in the post antiretroviral therapy (ART) scale up period in Brazil. A case-control study was conducted including a nationally probabilistic sample of AIDS deaths and living controls. Data were abstracted from medical records and nation-wide databases of AIDS cases, mortality, ART care, and laboratory testing. Interrupted (adjusted odds ratio - AOR 4.35, 95%CI: 3.15-6.00) or no use of ART (AOR 2.39, 95%CI: 1.57-3.65) was the strongest predictor of death, followed by late diagnosis (AOR 3.95, 95%CI: 2.68-5.82). Criterion other than CD4 < 350 had a higher likelihood of death (AOR 1.65, 95%CI: 1.14-2.40). Not receiving recommended vaccines (AOR, 1.76, 95%CI: 1.21-2.56), presenting AIDS-related diseases (AOR 2.19, 95%CI: 1.22-3.93) and tuberculosis (AOR 1.50, 95%CI: 1.14-1.97) had higher odds of death. Being an injecting drug user (IDU) had a borderline association with higher odds of death, while homo/bisexual exposure showed a protective effect. Despite remarkable successes, Brazilians continue to die of AIDS in the post-ART scale up period. Many factors contributing to continued mortality are preventable
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