Everton Ferreira Lemos

A Cross-Sectional Survey of HIV Testing and Prevalence in Twelve Brazilian Correctional Facilities

Background Prior studies have reported higher HIV prevalence among prisoners than the general population in Brazil, but data have been derived from single prisons. The aim of this study was to evaluate HIV testing practices, prevalence and linkage to care among inmates in a network of 12 prisons. Methods We administered a questionnaire to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV and syphilis testing from January to December 2013. We evaluated factors associated with HIV testing and infection using multivariable logistic regression models. Six months after HIV testing, we assessed whether each HIV-infected prisoner was engaged in clinical care and whether they had started antiretroviral therapy. Results We recruited 3,362 inmates, of whom 2,843 (85%) were men from 8 prisons, and 519 (15%) were women from 4 prisons. Forty-five percent of participants reported never having been tested for HIV previously. In multivariable analysis, the variables associated with previous HIV testing were lack of a stable partner (adjusted odds ratio [AOR]: 1.38; 95% CI: 1.18–1.60), completed more than four years of schooling (AOR 1.40; 95% CI: 1.20–1.64), history of previous incarceration (AOR: 1.68; 95% CI: 1.43–1.98), history of mental illness (AOR 1.52; 95% CI: 1.31–1.78) and previous surgery (AOR 1.31; 95% CI: 1.12–1.52). Fifty-four (1.6%) of all participants tested positive for HIV; this included 44 (1.54%) men and 10 (1.92%) women. Among male inmates, HIV infection was associated with homosexuality (AOR 6.20, 95% CI: 1.73–22.22), self-report of mental illness (AOR 2.18, 95% CI: 1.13–4.18), history of sexually transmitted infections (AOR 3.28, 95% CI: 1.64–6.56), and syphilis sero-positivity (AOR 2.54, 95% CI: 1.20–5.39). Among HIV-infected individuals, 34 (63%) were unaware of their HIV status; only 23 of these 34 (68%) newly diagnosed participants could be reached at six month follow-up, and 21 of 23 (91%) were engaged in HIV care. Conclusions HIV testing rates among prison inmates are low, and the majority of HIV-infected inmates were unaware of their HIV diagnosis. Incarceration can be an opportunity for diagnosis and treatment of HIV among vulnerable populations who have poor access to health services, but further work is needed on transitional HIV care for released inmates.

Maternal mortality according to race/skin color in Mato Grosso do Sul, Brazil, from 2010 to 2015

Objectives: to investigate the epidemiological profile, by race/skin color, of maternal deaths in the state of Mato Grosso do Sul, Brazil. Methods: the present epidemiological study of maternal death distribution by race/skin color was based on data extracted from Brazilian mortality and livebirth information systems from 2010 to 2015. The maternal mortality ratio and the specific maternal mortality ratio were calculated and analyzed according to obstetric variables. Results: the death risk for black (RR = 4.3, CI95%= 2.08-8.71) and indigenous women (RR = 3.7, CI95% 2.2-6.23) was approximately fourfold in comparison to the risk for white women. For direct causes of death, the state of Mato Grosso do Sul showed higher levels, 74.1%, as well as for most races/skin colors in the first triennium. The specific maternal mortality ratio was higher among black and indigenous women aged30 to 39 years old (416.7 and 651.8, respectively) per 100,000 live births (p<0.05). Conclusions: higher maternal mortality ratio for indigenous and black women and the predominance of deaths related to direct obstetric causes among race/skin color categories reflect inadequate health care during pregnancy and puerperium.

COZINHA TERENA: NOVAS PRÁTICAS ALIMENTARES EM TEMPOS DE MUDANÇA

Este estudo teve por objetivo identificar aspectos da cozinha terena, analisando a composicao da dieta, as praticas alimentares e recomendacoes gerais em situacoes especificas da vida, como o puerperio e presenca de doencas. O estudo foi de abordagem qualitativa com individuos terena, identificados como informantes-chave nas questoes da comida e cozinha e residentes na Terra Indigena Buriti, Mato Grosso do Sul, Brasil. Os relatos evidenciaram significativas mudancas nas praticas alimentares, com destaque para as mudancas ocorridas na obtencao e plantio dos proprios alimentos, a introducao de alimentos industrializados e as preocupacoes com os resultados oriundos dos novos habitos. A limitacao da area disponivel, a degradacao ambiental e a presenca de alimentos fornecidos na cesta basica foram indicadas como elementos que contribuem para alteracoes da dieta terena. A permanencia da cozinha de taquarussu, o fogao a lenha, a conservacao das carnes pela desidratacao, os alimentos disponiveis no fogao, o local das refeicoes, a familia reunida, os utensilios e as receitas transmitidas oralmente sao elementos repletos de valores simbolicos da cultura terena. Novos estudos sao necessarios para aprofundamento de elementos aqui identificados e abordados como pequenos fragmentos da realidade, necessitando de maior discussao teorica sobre a rica experiencia terena em contexto de mudanca.

Prevalence of syphilis diagnosed in female inmates of city Ponta Porã

Background Syphilis is a growing public health problem in several countries. The infection is systemic, usually involving mucocutaneous ulcers and rashes in the early phases, and a range of serious complications including cardiovascular and neurological disease in later phases [1,2]. Global control of syphilis is hampered by slow and insensitive diagnostic methods, particularly for risk population like prison inmates [3,4]. This study aimed to analyze the prevalence and socio-demographic, behavioral and institutional factors associated with Treponema pallidum infection in prison women in Ponta Porã city, Mato Grosso do Sul.