Neilane Bertoni

Consumo de álcool e drogas: principais achados de pesquisa de âmbito nacional, Brasil 2005

OBJETIVO: Analisar os padroes de consumo de alcool e drogas de uma amostra representativa da populacao urbana brasileira na sua inter-relacao com a saude sexual e reprodutiva. METODOS: Dados de inquerito de base populacional, de abrangencia nacional, com plano amostral complexo, realizado em 2005. Foram entrevistados 5.040 individuos de ambos os sexos, na faixa etaria de 16 a 65 anos. Analisaram-se questoes relativas consumo de alcool e drogas e comportamento sexual. Utilizou-se analise bivariada e multivariada. RESULTADOS: O alcool foi a substância mais frequentemente utilizada, com relato de uso regular, na vida, por 18% dos entrevistados. O consumo de drogas ilicitas foi referido por 9% dos entrevistados, especialmente, maconha e cocaina aspirada, com uso de drogas injetaveis infrequente. Observou-se declinio do consumo de cocaina aspirada e incremento do uso de maconha (nos ultimos 12 meses), comparados a resultados de pesquisa similar realizada em 1998. Historico de abuso sexual constituiu fator de risco do consumo de drogas e uso regular de alcool. A referencia por parte do entrevistado ao papel da religiao na sua formacao, ser branco e do sexo feminino se mostraram protetores frente ao consumo regular de alcool, particularmente prevalente entre homens mais velhos. As opcoes de lazer e a ausencia de praticas religiosas atuais se mostraram associadas ao consumo de drogas. CONCLUSOES: O consumo de alcool, regular ou nao, e prevalente na populacao urbana brasileira, enquanto o uso de drogas injetaveis se mostrou raro. Ao longo da ultima decada observou-se declinio no consumo de cocaina. Historico de abuso sexual se mostrou central ao consumo posterior de drogas e alcool.

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.

Putting respondent-driven sampling on the map: insights from Rio de Janeiro Brazil.

Background:Hard-to-reach populations with high background infection rates for HIV are particularly relevant in countries with restricted HIV epidemics, such as Brazil, where the very dynamics of the epidemic depends on the bridges between those populations and the general population. Respondent-driven sampling (RDS) has been one of the key strategies to assess such populations and inform policy making. Objectives:To geocode and visualize an RDS-based study on 605 heavy drug users, conducted in Rio de Janeiro, in 2009. Methods:The location and characteristics of the residence of interviewees were collected by an Audio Computer-Assisted Self Interview (ACASI) survey, supplemented by additional information. Place of residence was geocoded and depicted as network graphs and thematic maps. Results:The geographic distribution of the interviewees was found to be very heterogeneous. The recruiting chains progressed slowly during the successive waves toward neighborhoods far from the initial geographic axis. Despite the undeniable progress toward a broader geographic scope as the study proceeded through 11 successive waves, some key geographic areas were excluded. Conclusions:In the context of a large and complex urban area, plagued by structural violence and with a lively drug scene, the study made evident network bottlenecks. Either secondary to its relatively small sample size, structural constraints, or a combination of both, such bottlenecks represent a formidable challenge for RDS or other network-based methods as applied to urban settings with characteristics similar to Rio de Janeiro.

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.

Exploring sex differences in drug use, health and service use characteristics among young urban crack users in Brazil

IntroductionStudies have shown important gender differences among drug (including crack) users related to: drug use patterns; health risks and consequences; criminal involvement; and service needs/use. Crack use is prevalent in Brazil; however, few comparative data by sex exist. We examined and compared by sex key drug use, health, socio-economic indicators and service use in a bi-city sample of young (18–24 years), regular and marginalized crack users in Brazil.MethodsStudy participants (total n = 159; n = 124 males and n = 35 females) were recruited by community-based methods from impoverished neighborhoods in Rio de Janeiro and Salvador. Assessments occurred by an anonymous interviewer-administered questionnaire and serum collection for blood-borne virus testing between November 2010 and June 2011. Descriptive statistics and differences for key variables by sex were computed; in addition, a ‘chi-squared automatic interaction detector’ (‘CHAID’) analysis explored potential primary factors differentiating male and female participants.ResultsMost participants were non-white, and had low education and multiple income sources. More women had unstable housing and income from sex work and/or panhandling/begging, whereas more men were employed. Both groups indicated multi-year histories of and frequent daily crack use, but virtually no drug injection histories. Men reported more co-use of other drugs. More women were: involved in sex-for-drug exchanges; Blood-Borne Virus (BBV) tested and HIV+. Both groups reported similar physical and mental health patterns; however women more commonly utilized social or health services. The CHAID analysis identified sex work; paid work; begging/panhandling; as well as physical and mental health status (all at p < 0.05) as primary differentiating factors by sex.ConclusionsCrack users in our study showed notable differences by sex, including socio-economic indicators, drug co-use patterns, sex risks/work, BBV testing and status, and service utilization. Results emphasize the need for targeted special interventions and services for males and female crack users in Brazil.

Comparing key characteristics of young adult crack users in and out-of-treatment in Rio de Janeiro, Brazil

BackgroundCrack use is prevalent among street drug users in Brazilian cities, yet despite recent help system reforms and investments, treatment utilization is low. Other studies have identified a variety of – often inconsistent – factors associated with treatment status among crack or other drug users. This study compared socio-economic, drug use, health and service use characteristics between samples of young adult crack users in- and out-of-treatment in Rio de Janeiro, Brazil.FindingsStreet-involved crack users (n = 81) were recruited by community-based methods, and privately assessed by way of an anonymous interviewer-administered questionnaire as well as biological methods, following informed consent. In-treatment users (n = 30) were recruited from a public service in-patient treatment facility and assessed based on the same protocol. Key indicators of interest were statistically cross-compared. Not-in-treatment users were less likely to: be white, educated, stably housed, to be involved in drug dealing, to report lifetime marijuana and current alcohol use, to report low mental health status and general health or addiction/mental health care; they were more likely to: be involved in begging and utilize social services, compared to the in-treatment sample (statistical significance for differences set at p < .05).ConclusionsIn-treatment and not-in-treatment crack users differed on several key characteristics. Overall, in-treatment users appeared to be more socio-economically integrated and connected to the health system, yet not acutely needier in terms of health or drug problems. Given overall low treatment utilization but high need, efforts are required to facilitate improved treatment access and use for marginalized crack users in Brazil.

Syringe exchange programs in Brazil: preliminary assessment of 45 programs

The present study aims to evaluate the current operation of Brazilian syringe exchange programs (SEP). After consulting national and regional networks of people working in projects/programs aiming to reduce drug-related harm, we identified 134 potential participant programs. Unfortunately, only 45 SEPs answered a survey, even after repeated attempts. The survey addressed: coverage, funding, procurement of basic supplies, managerial capacity, and the local political environment. Findings were triangulated with in-depth interviews with key informants. The main findings included: satisfactory adherence to the initiatives and adequate documentation, but deficiencies in terms of coverage and monitoring, and uneven procurement of resources. Program personnel work mostly on a provisional basis, despite the efforts of local coordinators. Most programs are funded by the National STDs/AIDS Program. A comprehensive agenda aiming to improve current operations should include: concerted efforts to improve local and regional databanks, incentives/sanctions toward full accountability of initiatives carried by the programs, and a genuine culture of monitoring and evaluation.

Individual and contextual factors of influence on adherence to antiretrovirals among people attending public clinics in Rio de Janeiro, Brazil

BackgroundThere are inconsistencies in the determinants of adherence to antiretrovirals (ARVs) across settings as well as a lack of studies that take into consideration factors beyond the individual level. This makes it necessary to examine factors holistically in multiple settings and populations while taking into consideration the particularities of each context, in order to understand the patterns of ARV adherence. This research explored ARV adherence and individual, relational and environmental-structural factors.MethodsA cross-sectional survey was conducted from August 2008 through July 2009 among participants currently on ARVs recruited from 6 public health clinics, selected to maximize diversity in terms of caseload and location, representing the range of clinics within Rio de Janeiro city, Brazil. Multivariate logistic regression analysis was used to assess the association between our multilevel factors with ARV adherence among participants with complete cases (n = 632).ResultsEighty-four percent of respondents reported adherence to all of their ARV doses in the last 4 days. Of the socio-demographic variables, those who had one child were positively associated with adherence (AOR 2.29 CI [1.33-3.94]). On the relational level, those with high social support (AOR 2.85 CI [1.50-5.41]) were positively associated with adherence to ARVs. On the environmental-structural level, we found gender was significant with women negatively associated with adherence to ARVs (AOR 0.58 CI [0.38-0.88]) while those with a high asset index (AOR 2.47 CI [1.79-3.40]) were positively associated with adherence to ARVs.ConclusionsThis research highlights the importance of examining the multiple levels of influence on ARV adherence. Intervention research in lower and middle-income settings should address and evaluate the impact of attending to both gender and economic inequalities to improve ARV adherence, as well as relational areas such as the provision of social support.