Gabriela Calazans

Idade e uso de preservativo na iniciação sexual de adolescentes brasileiros

OBJETIVO: Analisar a idade e o uso do preservativo na iniciacao sexual de adolescentes brasileiros em dois periodos: 1998 e 2005. METODOS: Amostras representativas da populacao urbana brasileira foram entrevistadas em inquerito domiciliar por duas pesquisas, realizadas em 1998 e 2005. Dentre os entrevistados, 670 jovens (16 a 19 anos) sexualmente ativos foram selecionados para o estudo, 312 de 1998 e 358 de 2005. Para analise dos dados ponderados foram utilizados o teste qui-quadrado de Pearson e o teste exato de Fisher (±<5%). RESULTADOS: Em 2005, 61,6% dos jovens entrevistados tinham iniciado-se sexualmente, cuja idade media foi 14,9 anos, sem diferencas significativas para os jovens entrevistados em 1998. O uso de preservativo na primeira relacao sexual aumentou significativamente em relacoes estaveis (48,5% em 1998 vs. 67,7% em 2005) e casuais (47,2% em 1998 vs. 62,6% em 2005) em quase todos os segmentos. Persistiram as diferencas relacionadas a iniciacao sexual e ao uso de preservativos segundo genero, cor da pele e escolaridade, tal como observado em 1998. A diminuicao no uso de preservativo entre os jovens que se iniciaram sexualmente antes dos 14 anos, em todos os contextos de parceria, foi expressiva na regiao Sudeste e entre os mais escolarizados. CONCLUSOES: Como em outros paises, observou-se tendencia a estabilizacao da idade da iniciacao sexual entre jovens de 15 a 19 anos. O adiamento do inicio da vida sexual, mais frequente entre os jovens mais escolarizados, deve ser tema discutido no planejamento da educacao dos adolescentes para a sexualidade e prevencao das IST. Quanto a diminuicao da vulnerabilidade ao HIV, e relevante e significativo o incremento no uso de preservativo na iniciacao sexual.

Mudanças no âmbito da testagem anti-HIV no Brasil entre 1998 e 2005

OBJECTIVE To analyze changes in HIV testing, reasons reported by those who were tested or not and received counseling. METHODS Cross-sectional studies conducted in both men and women aged 16 to 65 years based on representative samples of urban Brazil in 1998 (n=3,600) and 2005 (n=5,040). Sociodemographic, sexual, reproductive characteristics, life experiences and health data were collected and analyzed. Potential differences in the distribution of variables was analyzed using Pearsons chi-square and design-based F test (+/- <5%). RESULTS In 1998 and 2005, 20.2% and 33.6% of interviewees had been tested, respectively. A total of 60% women aged 25-34 years were tested, but those who reported sexual initiation before the age of 16 and four or more sexual partners in the fi ve years prior to the interview were less tested. There was no significant increase in testing among men, except among those aged 55-65 years, per capita income between 1-3 and 5-10 monthly minimum wages, retired, historical Protestant and followers of African-Brazilian religions, living in the North/Northeast region and who reported homosexual/bisexual partners or no sexual relationship in the five years prior to the interview. Testing rates did not increase in those who self-reported as high risk for HIV. Among women, prenatal testing rate increased while work-related testing decreased among men. In 2005, half of those who were tested did not receive any advice before or after testing. CONCLUSIONS HIV testing scaling up was unequal and was mostly seen among women at childbearing age, adults and those better off. There seems to be an increase in testing rates in Brazil but without regard for peoples right to free choice and without offering more widely and better quality counseling.

Factors associated with condom use among youth aged 15-24 years in Brazil in 2003.

Objective:To analyse factors associated with the lack of condom use among young people at last sexual intercourse with a steady or casual partner. Design:A cross-sectional study involving 1170 household interviews and designed to build a representative sample of the population of young Brazilian residents aged 15–24 years (2003). Methods:In the multivariate analysis of data, non-conditional logistic regression modelling was applied to assess the determinants of condom use at last sexual intercourse among young people with steady or casual partners. Results:The overall level of condom use at last sexual intercourse was high (60%), although it was significantly more common in casual sexual partnership. Cohabitation was associated with a lack of condom use in both casual and steady partner encounters. In addition, being female, having less schooling, having no work history, and per capita family income above the minimum wage were factors related to not using condoms in the group of young people who had their last sexual encounter with steady partners. Among young people with casual partners, such factors included a positive history of alcohol use, first sex at 9–16 years of age, inadequate knowledge of AIDS treatability and bereavement related to violence. Conclusion:This study confirmed that the determinants of condom use among youth during last sexual intercourse vary according to whether the partner was casual or steady. Prevention campaigns should develop specific messages for each of these contexts.

Revisiting the use of condoms in Brazil

INTRODUCTION It is known that a single prevention strategy is not enough to control multiple HIV epidemics around the world and in Brazil. However, it is not only necessary to recognize the importance of condoms as part of the policy of HIV/AIDS prevention but also discuss its limits. In this article, we aim to investigate the use of condoms in Brazil, draw critical reflections, and understand how they can once again be highlighted in Brazils prevention strategy going forward. METHODS A narrative review of literature was conducted using keywords in PubMed. Reports from national surveys that guide the epidemiological and behavioral surveillance of the Brazilian Ministry of Health were also included. RESULTS A total of 40 articles and 3 reports were included in the review and 11 intervention studies to promote the condom use; the main findings were as follows: 1) Despite the increase in national studies on sexual behavior, little attention is given to the role of condom use; 2) There are few studies examining the factors associated with condom use among key populations such as men who have sex with men (MSM), female sex workers (FSW), drug users (DU), and transvestites and transexuals (TT), while substantial studies focus on adolescents and women; 3) Evidence suggests that a combination of interventions is more effective. DISCUSSION new prevention technologies must not lose sight of the critical importance of condoms, and efforts to reintroduce them should focus on the role of pleasure in addition to their potential to minimize the risk of HIV.

The effect of prevention methods on reducing sexual risk for HIV and their potential impact on a large-scale: a literature review

A spectrum of diverse prevention methods that offer high protection against HIV has posed the following challenge: how can national AIDS policies with high coverage for prevention and treatment make the best use of new methods so as to reverse the current high, and even rising, incidence rates among specific social groups? We conducted a narrative review of the literature to examine the prevention methods and the structural interventions that can have a higher impact on incidence rates in the context of socially and geographically concentrated epidemics. Evidence on the protective effect of the methods against sexual exposure to HIV, as well as their limits and potential, is discussed. The availability and effectiveness of prevention methods have been hindered by structural and psychosocial barriers such as obstacles to adherence, inconsistent use over time, or only when individuals perceive themselves at higher risk. The most affected individuals and social groups have presented limited or absence of use of methods as this is moderated by values, prevention needs, and life circumstances. As a result, a substantial impact on the epidemic cannot be achieved by one method alone. Programs based on the complementarity of methods, the psychosocial aspects affecting their use and the mitigation of structural barriers may have the highest impact on incidence rates, especially if participation and community mobilization are part of their planning and implementation.

Uso de Camisinha no Brasil: um olhar sobre a produção acadêmica acerca da prevenção de HIV/Aids (2007-2011)

Since the beginning of the AIDS epidemic, condoms have been the main preventive strategy of the Brazilian policies. This study presents a refl ective essay on the academic production on condom use as a method for HIV/AIDS prevention in Brazil, based on papers published in scientifi c journals between 2007 and 2011 and indexed in the Virtual Health Library. It outlines an overview of these studies and their results and conclusions. Despite the diversity of the production analyzed, it was found that the studies concentrated on young people, with great attention given to gender issues. From combined analysis on the goals and the theoretical and methodological frameworks of the articles, six areas of

Condom Use in Brazil: An Overview of the Academic Production on HIV/AIDS Prevention (2007-2011)

Since the beginning of the AIDS epidemic, condoms have been the main preventive strategy of the Brazilian policies. This study presents a refl ective essay on the academic production on condom use as a method for HIV/AIDS prevention in Brazil, based on papers published in scientifi c journals between 2007 and 2011 and indexed in the Virtual Health Librar y. It outlines an overview of these studies and their results and conclusions. Despite the diversity of the production analyzed, it was found that the studies concentrated on young people, with great attention given to gender issues. From combined analysis on the goals and the theoretical and methodological frameworks of the articles, six areas of production of knowledge on the subject were identifi ed: epidemiological studies; studies on knowledge and behavior; studies on specifi c contexts; studies on senses and meanings; studies on activities; and review studies. The literature analyzed is presented in a diffuse manner so as it interlocks approaches and directions, which requires an epistemological and methodological maturity of the frameworks used.

Uso de Preservativo en Brasil: Una Mirada a la Producción Académica sobre la Prevención de VIH/SIDA (2007-2011)

Since the beginning of the AIDS epidemic, condoms have been the main preventive strategy of the Brazilian policies. This study presents a refl ective essay on the academic production on condom use as a method for HIV/AIDS prevention in Brazil, based on papers published in scientifi c journals between 2007 and 2011 and indexed in the Virtual Health Library. It outlines an overview of these studies and their results and conclusions. Despite the diversity of the production analyzed, it was found that the studies concentrated on young people, with great attention given to gender issues. From combined analysis on the goals and the theoretical and methodological frameworks of the articles, six areas of production of knowledge on the subject were identifi ed: epidemiological studies; studies on knowledge and behavior; studies on specifi c contexts; studies on senses and meanings; studies on activities; and review studies. The literature analyzed is presented in a diffuse manner so as it interlocks approaches and directions, which requires an epistemological and methodological maturity of the frameworks used.