Maeve Brito de Mello

HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A Systematic Review and Meta-analysis

BackgroundThe Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations ─ men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group.MethodsNine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE, AMED, CINAHL, TOXNET, SciELO, and ISI-Web of Science) were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1999 to 2009. To be included in the review, studies had to measure HIV prevalence and/or incidence as the primary outcome among at least one specific population under analysis.ResultsThe studies targeting the three populations analyzed mostly young participants aged 30 years or less. Among FSW, eight studies were selected (3,625 participants), consistently identifying higher condom use with sexual clients than with occasional and stable partners. The combined HIV prevalence for FSW was 6.2 (95% CI: 4.4-8.3). Ten studies targeting MSM were identified (6,475 participants). Unprotected anal intercourse was commonly reported on those studies, but with great variability according to the nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex. Pooled HIV prevalence for MSM was 13.6 (95% CI: 8.2-20.2). Twenty nine studies targeting DU were identified (13,063 participants). Those studies consistently identified injection drug use and syringe/needle sharing as key predictors of HIV-infection, as well as engagement in sex work and male-to-male sex. The combined HIV prevalence across studies targeting DU was 23.1 (95% CI: 16.7-30.2).ConclusionsFSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (~0.6%). Those vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e.g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs. Programs that provide these services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.

Assessing Network Scale-up Estimates for Groups Most at Risk of HIV/AIDS: Evidence From a Multiple-Method Study of Heavy Drug Users in Curitiba, Brazil

One of the many challenges hindering the global response to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic is the difficulty of collecting reliable information about the populations most at risk for the disease. Thus, the authors empirically assessed a promising new method for estimating the sizes of most at-risk populations: the network scale-up method. Using 4 different data sources, 2 of which were from other researchers, the authors produced 5 estimates of the number of heavy drug users in Curitiba, Brazil. The authors found that the network scale-up and generalized network scale-up estimators produced estimates 5–10 times higher than estimates made using standard methods (the multiplier method and the direct estimation method using data from 2004 and 2010). Given that equally plausible methods produced such a wide range of results, the authors recommend that additional studies be undertaken to compare estimates based on the scale-up method with those made using other methods. If scale-up-based methods routinely produce higher estimates, this would suggest that scale-up-based methods are inappropriate for populations most at risk of HIV/AIDS or that standard methods may tend to underestimate the sizes of these populations.

The Game of Contacts: Estimating the Social Visibility of Groups

Estimating the sizes of hard-to-count populations is a challenging and important problem that occurs frequently in social science, public health, and public policy. This problem is particularly pressing in HIV/AIDS research because estimates of the sizes of the most at-risk populations-illicit drug users, men who have sex with men, and sex workers-are needed for designing, evaluating, and funding programs to curb the spread of the disease. A promising new approach in this area is the network scale-up method, which uses information about the personal networks of respondents to make population size estimates. However, if the target population has low social visibility, as is likely to be the case in HIV/AIDS research, scale-up estimates will be too low. In this paper we develop a game-like activity that we call the game of contacts in order to estimate the social visibility of groups, and report results from a study of heavy drug users in Curitiba, Brazil (n = 294). The game produced estimates of social visibility that were consistent with qualitative expectations but of surprising magnitude. Further, a number of checks suggest that the data are high-quality. While motivated by the specific problem of population size estimation, our method could be used by researchers more broadly and adds to long-standing efforts to combine the richness of social network analysis with the power and scale of sample surveys.

Uso de álcool e drogas e sua influência sobre as práticas sexuais de adolescentes de Minas Gerais, Brasil

This article summarizes the findings of a survey including 5,981 students from public schools in Minas Gerais State, Brazil. The analysis assessed the influence of drug use on sexual practices. Among the boys engaged in relationships with casual partners who stated having used illicit drugs, 55.7% reported consistent condom use, as compared to 65.4% among those not reporting such habits. Among boys engaged in relationships with stable partners who reported illicit drug use, consistent condom use was reported by 42.7%, versus 64.1% among those not reporting such habits. In the subgroup of boys engaged in stable relationships who did not report illicit drug use, consistent condom use was less frequent among those that used alcohol/cigarettes, compared to those who did not drink or smoke (60.7% vs. 71.1%). Girls were less likely than boys to use condoms consistently, regardless of the nature of their relationships, without a noticeable influence of drug use. Policies to prevent drug abuse, sexually transmitted diseases, and unplanned pregnancy should be fully integrated.

Changes in sexual behavior following a sex education program in Brazilian public schools

Este artigo descreve a avaliacao de possiveis mudancas no comportamento sexual de adolescentes que participaram de um programa de educacao sexual implementado em escolas publicas selecionadas em quatro municipios de Minas Gerais, Brasil. O programa esta inserido no contexto dos direitos reprodutivos, discute os riscos de praticas sexuais inseguras e enfoca os aspectos positivos da sexualidade. Utilizou-se um desenho quase-experimental com pre e pos-teste e grupo controle nao-equivalente. Foram incluidos 4.795 questionarios na analise dos resultados. O programa conseguiu dobrar o uso consistente do preservativo com parceiro casual e aumentar em 68% o uso de metodos anticoncepcionais modernos na ultima relacao sexual. A intervencao nao teve efeito sobre a idade da primeira relacao sexual ou na pratica de atividades sexuais. Concluindo, o programa foi eficaz em gerar mudancas positivas no comportamento sexual de adolescentes sem antecipar ou estimular a pratica sexual.

Fatores associados ao acesso anterior à gestação a serviços de saúde por adolescentes gestantes

OBJETIVO: Analisar os fatores determinantes do acesso de adolescentes gestantes a servicos de atencao primaria a saude, anterior a ocorrencia da gestacao. METODOS: Estudo transversal baseado em referencial teorico. O acesso a servicos foi analisado em cinco dimensoes: geografico, economico, administrativo, psicossocial e de informacao. Participaram 200 adolescentes primigestas (10 a 19 anos) atendidas em uma unidade basica de saude do municipio de Indaiatuba (SP), em 2003. Um questionario com perguntas abertas e fechadas referentes ao acesso ao ultimo servico de saude utilizado, anterior a gestacao, foi aplicado as participantes no momento de sua primeira consulta de pre-natal. Os dados foram analisados por meio do teste de qui-quadrado de Pearson ou exato de Fisher e por regressao logistica multipla, considerando as cinco dimensoes de acesso. RESULTADOS: Mais da metade (63,7%) das adolescentes utilizou algum servico de saude para consulta ginecologica. Entre as que nunca consultaram um ginecologista, as justificativas dadas foram falta de informacao (43,8%) ou sentimento de medo ou vergonha (37,0%). A principal dificuldade de acesso ao servico esteve relacionada a barreiras psicossociais, identificadas por 77,0% das adolescentes. CONCLUSOES: Entre as barreiras de acesso ao servico de saude, foram significativas apenas as psicossociais. Sao necessarias novas estrategias para facilitar o acesso ao servico de saude as adolescentes, incluindo acoes que diminuam as barreiras de genero e que se considerem suas caracteristicas sociodemograficas e o vinculo com seus parceiros.OBJECTIVE To assess determinants of access to primary care services prior to pregnancy by pregnant adolescents. METHODS Theory-based cross-sectional study conducted to examine access to heath services at five dimensions: geographic, economic, administrative, psychosocial and information. There were included in the study 200 first-time pregnant adolescents (aged 10 to 19 years) who attended a primary care unit in the municipality of Indaiatuba, Southeastern Brazil, in 2003. Data was collected using a semi-structured questionnaire applied in face-to-face interviews conducted just before their first pre-natal care visit. Data analyses were performed through Persons chi-square or Fishers exact test, and by a multivariate logistic regression model including all five dimensions of access. RESULTS More than half (63.7%) of the adolescents utilized some gynecological care service. Information (43.8%) or psychosocial feelings of embarrassment or fear (37.0%) barriers were the most frequent reasons given for not having sought care before. The main barrier to health service access was related to the psychosocial dimension, reported by 77.0% of the adolescents studied. CONCLUSIONS Among all barriers to health service access, the most important were those related to the psychosocial dimension. There is a need for new strategies to facilitate access to health services by adolescents, including actions to reduce gender-based barriers taking into consideration sociodemographic characteristics of this population and the relationship they have with their partners.

Factors associated with access to health services prior to pregnancy by pregnant adolescents

OBJETIVO: Analisar os fatores determinantes do acesso de adolescentes gestantes a servicos de atencao primaria a saude, anterior a ocorrencia da gestacao. METODOS: Estudo transversal baseado em referencial teorico. O acesso a servicos foi analisado em cinco dimensoes: geografico, economico, administrativo, psicossocial e de informacao. Participaram 200 adolescentes primigestas (10 a 19 anos) atendidas em uma unidade basica de saude do municipio de Indaiatuba (SP), em 2003. Um questionario com perguntas abertas e fechadas referentes ao acesso ao ultimo servico de saude utilizado, anterior a gestacao, foi aplicado as participantes no momento de sua primeira consulta de pre-natal. Os dados foram analisados por meio do teste de qui-quadrado de Pearson ou exato de Fisher e por regressao logistica multipla, considerando as cinco dimensoes de acesso. RESULTADOS: Mais da metade (63,7%) das adolescentes utilizou algum servico de saude para consulta ginecologica. Entre as que nunca consultaram um ginecologista, as justificativas dadas foram falta de informacao (43,8%) ou sentimento de medo ou vergonha (37,0%). A principal dificuldade de acesso ao servico esteve relacionada a barreiras psicossociais, identificadas por 77,0% das adolescentes. CONCLUSOES: Entre as barreiras de acesso ao servico de saude, foram significativas apenas as psicossociais. Sao necessarias novas estrategias para facilitar o acesso ao servico de saude as adolescentes, incluindo acoes que diminuam as barreiras de genero e que se considerem suas caracteristicas sociodemograficas e o vinculo com seus parceiros.OBJECTIVE To assess determinants of access to primary care services prior to pregnancy by pregnant adolescents. METHODS Theory-based cross-sectional study conducted to examine access to heath services at five dimensions: geographic, economic, administrative, psychosocial and information. There were included in the study 200 first-time pregnant adolescents (aged 10 to 19 years) who attended a primary care unit in the municipality of Indaiatuba, Southeastern Brazil, in 2003. Data was collected using a semi-structured questionnaire applied in face-to-face interviews conducted just before their first pre-natal care visit. Data analyses were performed through Persons chi-square or Fishers exact test, and by a multivariate logistic regression model including all five dimensions of access. RESULTS More than half (63.7%) of the adolescents utilized some gynecological care service. Information (43.8%) or psychosocial feelings of embarrassment or fear (37.0%) barriers were the most frequent reasons given for not having sought care before. The main barrier to health service access was related to the psychosocial dimension, reported by 77.0% of the adolescents studied. CONCLUSIONS Among all barriers to health service access, the most important were those related to the psychosocial dimension. There is a need for new strategies to facilitate access to health services by adolescents, including actions to reduce gender-based barriers taking into consideration sociodemographic characteristics of this population and the relationship they have with their partners.

Factores asociados con el acceso anterior a la gestación a los servicios de salud por adolescentes gestantes

OBJETIVO: Analisar os fatores determinantes do acesso de adolescentes gestantes a servicos de atencao primaria a saude, anterior a ocorrencia da gestacao. METODOS: Estudo transversal baseado em referencial teorico. O acesso a servicos foi analisado em cinco dimensoes: geografico, economico, administrativo, psicossocial e de informacao. Participaram 200 adolescentes primigestas (10 a 19 anos) atendidas em uma unidade basica de saude do municipio de Indaiatuba (SP), em 2003. Um questionario com perguntas abertas e fechadas referentes ao acesso ao ultimo servico de saude utilizado, anterior a gestacao, foi aplicado as participantes no momento de sua primeira consulta de pre-natal. Os dados foram analisados por meio do teste de qui-quadrado de Pearson ou exato de Fisher e por regressao logistica multipla, considerando as cinco dimensoes de acesso. RESULTADOS: Mais da metade (63,7%) das adolescentes utilizou algum servico de saude para consulta ginecologica. Entre as que nunca consultaram um ginecologista, as justificativas dadas foram falta de informacao (43,8%) ou sentimento de medo ou vergonha (37,0%). A principal dificuldade de acesso ao servico esteve relacionada a barreiras psicossociais, identificadas por 77,0% das adolescentes. CONCLUSOES: Entre as barreiras de acesso ao servico de saude, foram significativas apenas as psicossociais. Sao necessarias novas estrategias para facilitar o acesso ao servico de saude as adolescentes, incluindo acoes que diminuam as barreiras de genero e que se considerem suas caracteristicas sociodemograficas e o vinculo com seus parceiros.OBJECTIVE To assess determinants of access to primary care services prior to pregnancy by pregnant adolescents. METHODS Theory-based cross-sectional study conducted to examine access to heath services at five dimensions: geographic, economic, administrative, psychosocial and information. There were included in the study 200 first-time pregnant adolescents (aged 10 to 19 years) who attended a primary care unit in the municipality of Indaiatuba, Southeastern Brazil, in 2003. Data was collected using a semi-structured questionnaire applied in face-to-face interviews conducted just before their first pre-natal care visit. Data analyses were performed through Persons chi-square or Fishers exact test, and by a multivariate logistic regression model including all five dimensions of access. RESULTS More than half (63.7%) of the adolescents utilized some gynecological care service. Information (43.8%) or psychosocial feelings of embarrassment or fear (37.0%) barriers were the most frequent reasons given for not having sought care before. The main barrier to health service access was related to the psychosocial dimension, reported by 77.0% of the adolescents studied. CONCLUSIONS Among all barriers to health service access, the most important were those related to the psychosocial dimension. There is a need for new strategies to facilitate access to health services by adolescents, including actions to reduce gender-based barriers taking into consideration sociodemographic characteristics of this population and the relationship they have with their partners.