Divânia Dias da Silva França

Risk behaviors for sexually transmitted diseases among crack users

Objetivos:investigar la prevalencia y las conductas de riesgo a traves del informe de las enfermedades de transmision sexual entre los usuarios de crack.Metodo:estudio transversal con 588 usuarios de crack, de una unidad de referencia para el tratamiento de la dependencia quimica. Los datos fueron obtenidos a traves de entrevista cara a cara y se analizaron utilizando el programa estadistico Stata, version 8.0.Resultados:del total de participantes, 154 (26,2%; IC 95%: 22,8-29,9) informaron antecedentes de enfermedades de transmision sexual. Edad entre 25 y 30 anos (RP: 2,1; IC9 5%: 1,0-4,0) y superior a 30 anos (RP: 3,8; IC 95%: 2,1-6,8), consumo de alcohol (OR: 1,9; IC 95%: 1,1-3,3), antecedentes de prostitucion (RP: 1,9; IC 95%: 1,3-2,9) y relaciones sexuales con persona viviendo con el virus de inmunodeficiencia humana/ SIDA (RP: 2,7; IC 95%: 1,8-4,2) se asociaron de forma independiente con la notificacion de las enfermedades de transmision sexual.Conclusion:los resultados de este estudio sugieren alto riesgo y la vulnerabilidad de los usuarios de crackpara las enfermedades de transmision sexual.Abstract Objectives: to investigate the prevalence and risk behaviors by means of reporting of sexually transmitted diseases among crack users. Method: cross-sectional study carried out with 588 crack users in a referral care unit for the treatment of chemical dependency. Data were collected by means of face-to-face interview and analyzed using Stata statistical software, version 8.0. Results: of the total participants, 154 (26.2%; 95% CI: 22.8-29.9) reported antecedents of sexually transmitted diseases. Ages between 25 and 30 years (RP: 2.1; 95% CI: 1.0-4.0) and over 30 years (RP: 3.8; 95% CI: 2.1-6.8), alcohol consumption (RP: 1.9; 95% CI: 1.1-3.3), antecedents of prostitution (RP: 1.9; 95% CI: 1.3-2.9) and sexual intercourse with person living with human immunodeficiency virus/AIDS (RP: 2.7; 95% CI: 1.8-4.2) were independently associated with reporting of sexually transmitted diseases. Conclusion: the results of this study suggest high risk and vulnerability of crack users for sexually transmitted diseases.Objetivos: investigar la prevalencia y las conductas de riesgo a traves del informe de las enfermedades de transmision sexual entre los usuarios de crack. Metodo: estudio transversal con 588 usuarios de crack, de una unidad de referencia para el tratamiento de la dependencia quimica. Los datos fueron obtenidos a traves de entrevista cara a cara y se analizaron utilizando el programa estadistico Stata, version 8.0. Resultados: del total de participantes, 154 (26,2%; IC 95%: 22,8-29,9) informaron antecedentes de enfermedades de transmision sexual. Edad entre 25 y 30 anos (RP: 2,1; IC9 5%: 1,0-4,0) y superior a 30 anos (RP: 3,8; IC 95%: 2,1-6,8), consumo de alcohol (OR: 1,9; IC 95%: 1,1-3,3), antecedentes de prostitucion (RP: 1,9; IC 95%: 1,3-2,9) y relaciones sexuales con persona viviendo con el virus de inmunodeficiencia humana/ SIDA (RP: 2,7; IC 95%: 1,8-4,2) se asociaron de forma independiente con la notificacion de las enfermedades de transmision sexual. Conclusion: los resultados de este estudio sugieren alto riesgo y la vulnerabilidad de los usuarios de crack para las enfermedades de transmision sexual

Outreach hepatitis B vaccination of female sex workers in central-west Brazil: immunization status, compliance, and immune response.

OBJECTIVES To evaluate the hepatitis B immunization status of female sex workers (FSWs) in Central-West Brazil and to evaluate their compliance with and immune response to hepatitis B vaccination delivered using outreach strategies. METHODS A total of 721 FSWs recruited in 2 large cities in Central-West Brazil were interviewed and screened for the presence of hepatitis B virus (HBV) markers. Hepatitis B vaccine was offered to all women susceptible to HBV, using outreach strategies. The immune response of FSWs who received a full course of vaccine was assessed following the final vaccine dose. RESULTS We found that 27.6% of FSWs, the majority of whom were aged 18 to 25 years, had serological evidence of previous hepatitis B vaccination. A total of 434 FSWs were eligible for vaccination, 389 (89.6%) of whom accepted the first hepatitis B vaccine dose. Of those, 64% received a second dose and 37.5% received all three doses. Through the outreach strategy, there was a 52.2% increase in the number of women who received the second dose and a 67% increase in the number who received the third dose. Of the 146 women who received a full course of vaccine, 105 accepted testing for quantitative anti-HBs (hepatitis B surface antibody) following the final vaccine dose, and 92.4% of those tested had developed protective levels of anti-HBs. Lower education level, workplace, and length of prostitution were predictors of full-vaccine acceptance. CONCLUSIONS The present findings illustrate the benefits of using outreach strategies to overcome the difficulties of vaccinating hard-to-reach populations such as FSWs.

High frequency of mayaro virus IgM among febrile patients, central Brazil

Mayaro virus (MAYV), an Aedes mosquito–borne alphavirus, is endemic to Brazil and other South America countries. We investigated dengue- and chikungunya-negative febrile patients visiting rural areas near Goiânia, Goiás, and found a high proportion (55%) of MAYV IgM. Our findings suggest the presence of highly endemic foci of MAYV in central Brazil.

Vulnerability to Sexually Transmitted Infections in women who sell sex on the route of prostitution and sex tourism in Central Brazil

OBJECTIVE: to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs). METHODS: a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews. RESULTS: most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment. CONCLUSION: the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.OBJECTIVE to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs). METHODS a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews. RESULTS most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment. CONCLUSION the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.

Low prevalence, low immunization and low adherence to full hepatitis B vaccine scheme and high-risk behaviors among crack cocaine users in central Brazil

Crack cocaine users represent a target group for hepatitis B vaccination. We evaluate the HBV epidemiology, immunization status and compliance with a super-accelerated vaccination schedule among in-treatment crack cocaine users in central Brazil. Six hundred in-treatment crack cocaine users were interviewed, and serum samples were tested for HBV markers. A super-accelerated vaccination schedule of HBV vaccine was offered to all susceptible crack cocaine users. In total, 7.0% of those tested had at least one positive marker of HBV exposure. Age, use of crack cocaine through improvised pipe, exchange of sex for money/drugs and previous sexually transmitted infections (STIs) were predictors of HBV exposure. One hundred six (17.7%) individuals showed a serological profile of hepatitis B vaccination. Of these, 54.7% were less than 25 years old, and only 13% of individuals were more than 35 years old. Although 91.8% of crack users accepted the first vaccine dose, only 21.7% received all three doses. Of the 23 crack cocaine users who agreed to have their vaccine response evaluated, 78.3% developed protective anti-HBs titers. Premature termination of treatment was the most common reason for not receiving the full vaccine series. Despite the low prevalence of HBV exposure among in-treatment crack cocaine users in central Brazil, the low rate of immunization and the high frequency of high-risk behaviors highlight the potential for crack users to acquire and disseminate this infection and therefore maintain the viral reservoir. Health practitioners need to keep this in mind, taking advantage of all opportunities to access this population and vaccinate against HBV.

Comportamentos de risco para doenças sexualmente transmissíveis em usuários de crack

Objetivos:investigar la prevalencia y las conductas de riesgo a traves del informe de las enfermedades de transmision sexual entre los usuarios de crack.Metodo:estudio transversal con 588 usuarios de crack, de una unidad de referencia para el tratamiento de la dependencia quimica. Los datos fueron obtenidos a traves de entrevista cara a cara y se analizaron utilizando el programa estadistico Stata, version 8.0.Resultados:del total de participantes, 154 (26,2%; IC 95%: 22,8-29,9) informaron antecedentes de enfermedades de transmision sexual. Edad entre 25 y 30 anos (RP: 2,1; IC9 5%: 1,0-4,0) y superior a 30 anos (RP: 3,8; IC 95%: 2,1-6,8), consumo de alcohol (OR: 1,9; IC 95%: 1,1-3,3), antecedentes de prostitucion (RP: 1,9; IC 95%: 1,3-2,9) y relaciones sexuales con persona viviendo con el virus de inmunodeficiencia humana/ SIDA (RP: 2,7; IC 95%: 1,8-4,2) se asociaron de forma independiente con la notificacion de las enfermedades de transmision sexual.Conclusion:los resultados de este estudio sugieren alto riesgo y la vulnerabilidad de los usuarios de crackpara las enfermedades de transmision sexual.Abstract Objectives: to investigate the prevalence and risk behaviors by means of reporting of sexually transmitted diseases among crack users. Method: cross-sectional study carried out with 588 crack users in a referral care unit for the treatment of chemical dependency. Data were collected by means of face-to-face interview and analyzed using Stata statistical software, version 8.0. Results: of the total participants, 154 (26.2%; 95% CI: 22.8-29.9) reported antecedents of sexually transmitted diseases. Ages between 25 and 30 years (RP: 2.1; 95% CI: 1.0-4.0) and over 30 years (RP: 3.8; 95% CI: 2.1-6.8), alcohol consumption (RP: 1.9; 95% CI: 1.1-3.3), antecedents of prostitution (RP: 1.9; 95% CI: 1.3-2.9) and sexual intercourse with person living with human immunodeficiency virus/AIDS (RP: 2.7; 95% CI: 1.8-4.2) were independently associated with reporting of sexually transmitted diseases. Conclusion: the results of this study suggest high risk and vulnerability of crack users for sexually transmitted diseases.Objetivos: investigar la prevalencia y las conductas de riesgo a traves del informe de las enfermedades de transmision sexual entre los usuarios de crack. Metodo: estudio transversal con 588 usuarios de crack, de una unidad de referencia para el tratamiento de la dependencia quimica. Los datos fueron obtenidos a traves de entrevista cara a cara y se analizaron utilizando el programa estadistico Stata, version 8.0. Resultados: del total de participantes, 154 (26,2%; IC 95%: 22,8-29,9) informaron antecedentes de enfermedades de transmision sexual. Edad entre 25 y 30 anos (RP: 2,1; IC9 5%: 1,0-4,0) y superior a 30 anos (RP: 3,8; IC 95%: 2,1-6,8), consumo de alcohol (OR: 1,9; IC 95%: 1,1-3,3), antecedentes de prostitucion (RP: 1,9; IC 95%: 1,3-2,9) y relaciones sexuales con persona viviendo con el virus de inmunodeficiencia humana/ SIDA (RP: 2,7; IC 95%: 1,8-4,2) se asociaron de forma independiente con la notificacion de las enfermedades de transmision sexual. Conclusion: los resultados de este estudio sugieren alto riesgo y la vulnerabilidad de los usuarios de crack para las enfermedades de transmision sexual

La vulnerabilidad a las enfermedades de transmisión sexual en mujeres que venden sexo en ruta de prostitución y turismo sexual en Brasil Central

OBJECTIVE: to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs). METHODS: a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews. RESULTS: most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment. CONCLUSION: the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.OBJECTIVE to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs). METHODS a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews. RESULTS most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment. CONCLUSION the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.

HIV-1 infection among crack cocaine users in a region far from the epicenter of the HIV epidemic in Brazil: Prevalence and molecular characteristics

Brazil has the largest cocaine market in South America, and crack cocaine use is closely associated with HIV-1 infection. This study investigated the prevalence, risk factors, and HIV-1 subtypes, including recombinant forms and mutations associated with drug resistance, among crack cocaine users in Central-West Brazil. We recruited 600 crack cocaine users admitted to a referral hospital in Goiânia for psychiatric disorders. The participants were interviewed; blood samples were collected for anti-HIV-1/2 serological screening. HIV-1 pol gene sequences (entire protease [PR] and partial reverse transcriptase [RT]) were obtained from plasma RNA. HIV-1 subtypes, recombinant viruses, transmitted drug resistance (TDR), and secondary drug resistance mutations were investigated. The median participant age was 30 years (range, 18–68 years); most were male, single, unemployed, and of mixed races. Among them, 2.8% (17/600) were HIV-1 positive: 2.2% of men (11/507) and 6.5% of women (6/93). The main predictors of HIV-1 seropositivity were a sexual partner with HIV infection, irregular condom use, and previous homelessness. HIV-1 pol sequences (12/17) indicated the predominance of subtype B (n = 7), followed by recombinant forms FPR/BRT (n = 1) and BPR/FRT (n = 2) and subtypes F1 (n = 1) and C (n = 1). TDR prevalence was 58.3% (7/12). Isolates from two participants showed mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) only (M41L, T125C, T125F, M184V), while an isolate from one patient who had received antiretroviral therapy (ART) since 2008 had a mutation associated with resistance to non-NRTI (G190S). Five isolates had secondary mutations to protease inhibitors (K20M, L10V, L33I, A71T, A71V). In conclusion, the findings of HIV-1 circulation, TDR to NRTI, and secondary mutations to protease inhibitors in ART-naïve crack cocaine users support the importance of monitoring this population in regions far from the epicenter of the HIV epidemic.

P3.203 Epidemiology of hiv among crack users in goiás, brazilian midwestern region

Introduction Midwestern Brazil is a significant route and market for cocaine in South America. The consumption of illicit drugs has contributed to HIV dissemination worldwide. Despite this scenario there is little information on the epidemiology of HIV among crack cocaine users in this region. The aims of this study were to estimate the prevalence, risk factors and HIV-1 subtypes among crack users in Goiania, a city in Midwestern Brazil. Methods A total of 600 crack users were interviewed and blood samples were collected for detection of anti-HIV-1. HIV-RNA was detected in positive samples, the HIV-1 protease (PR) and reverse transcriptase (RT) regions were sequenced; subtypes were assigned by REGA/phylogenetic analysis. HIV-subtypes were assigned by REGA. Univariate and multivariate analysis were carried out to identify predictors of HIV infection. This study was analysed and approved by the Committee on Ethics in Human Research of Hospital das Clínicas, Universidade Federal de Goiás. Results The median age of participants was 30 years old, and the majority were male, mixed race, single, and unemployed. Of the total, 2.8% were HIV-positive. Having sex with an HIV carrier, irregular condom use during sexual intercourse, and experience of living on the streets were predictors of HIV positivity (p<0.05). In 12 out of 17 crack users RNA HIV-1 were amplified and sequenced. Seven isolates were subtype B, one subtype F1 and one subtype C. Conclusion A high HIV prevalence was observed among crack users in Midwestern Brazil, a region far from the epicentre of HIV epidemiology. The predictors of HIV infection identified are concerning, and necessitate preventive strategies for HIV infection specifically directed toward this population. HIV-1 subtype C seems to have emerged over the last few years in this population at the centre of the country. Support: This work was supported by Conselho Nacional de Desenvolvimento Cientifico e Tecnologico – CNPq, and Fundação de Amparo a Pesquisa do Estado de Goiás – FAPEG

P3.204 Prevalence and risk factors for syphilis in crack users in goiânia city, brazil central

Introduction Crack users are at high risk for syphilis, due to multiple risk behaviours, such as inconsistent condom use, exchanging sex for money and/or drugs and multiple sexual partners. However, there is a gap in the literature on the epidemiology of this infection in crack users in developing countries, including Brazil. The aim of this study was to investigate the prevalence and risk factors of syphilis in crack users in Goiânia, Brazil Central. Methods A cross-sectional study was conducted with 600 users of a reference unit for chemical dependency treatment of Goiás, between 2012 to 2013. All participants were interviewed regarding socio-demographic characteristics and risk behaviours and blood samples were then collected for the detection of anti-Treponema pallidum antibodies using enzyme-linked immunosorbent assay (ELISA). Positive samples were tested by the Venereal Disease Research Laboratory (VDRL). Active syphilis was considered when there was a positive ELISA result and VDRL titers≥1:8. Poisson regression analysis was used to analyse the factors associated with active syphilis. Results Of the total participants, 13.8% (95.0% CI: 11.3% to 16.8%) were positive in ELISA. The prevalence of active syphilis was 4.5% (95.0% CI: 3.1% to 6.5%). The prevalence of exposure to Treponema pallidum and active syphilis was statistically higher in women than in men (p<0.001). In multivariable model, female sex (adjusted prevalence ratio [APR]: 3.73; p<0.001), schooling (APR: 0.88; p=0.030), exchange sex for money and/or drugs (APR: 3.22; p=0.040) and a history of genital ulcers in previous six months (APR: 4.12; p=0.010) were associated with active syphilis. Conclusion The results of this research show high prevalence of syphilis in crack users in Goiânia city. Comprehensive care for this population should be offered, including strategies such as health education, condom provision, and regular infection testing. Support: Fundação de Amparo a Pesquisa do Estado de Goiás – FAPEG; Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq