Rafael Alves Guimarães

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

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.

Transactional Sex among Noninjecting Illicit Drug Users: Implications for HIV Transmission

Noninjecting illicit drug users (NIDUs) present high risk for HIV infection, due especially to transactional sex. This study aimed to estimate the prevalence and risk factors for transactional sex among NIDUs in the Southwest region of Goiás State, Central Brazil. The prevalence of self-reported transactional sex was 22.8%. Prevalence in women and men was 52.7% and 16.8%, respectively, a significant difference (p < 0.001). Crack use and history of sexually transmitted infections (STI) were risk factors for transactional sex in men. Homelessness, crack use, sex under the influence of drugs, and history of sexual violence were risk factors for transactional sex in women. A high prevalence of transactional sex was observed among NIDUs. This risk behavior may contribute to the high rates of HIV among this population and their social networks and in the general population.

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

HIV testing in Non-Injection Drug Users: prevalence and associated factors

The objective of this study was to estimate the prevalence of and identify factors associated with lifetime testing for the human immunodeficiency virus (HIV) in non-injection drug users (NIDU). A cross-sectional study was conducted with 323 individuals in clinics for chemical dependency in the state of Goiás in the Central-West region of Brazil. Logistic regression analysis was used to identify factors associated with lifetime HIV testing. Testing for HIV was associated with age, female gender, crack use, history of sexually transmitted infections, acquaintance with people living with HIV/AIDS and/or who had died from AIDS, and history of having received some instruction on HIV/AIDS prevention methods. It was found that only 26.6% reported having access to the HIV rapid test. We concluded determinants for HIV testing must be taken into account when planning prevention and programming strategies. These include the widening of testing coverage among NIDU, educational health actions, establishment of links between sexually transmitted infection prevention services and addiction treatment services, and the use of rapid tests to help people who are in contact with the virus learn about their HIV status, enter treatment, and improve their quality of life.

Exposure to hepatitis C virus in homeless men in Central Brazil: a cross-sectional study

BackgroundHomeless men are highly vulnerable to acquisition of the hepatitis C virus (HCV) compared to the general population. In Brazil, a country of continental dimensions, the extent of HCV infection in this population remains unknown. The objective of this study is to investigate the epidemiological profile of exposure to HCV in homeless men in Central Brazil.MethodsA Cross-sectional study was conducted in 481 men aged over 18 years attending therapeutic communities specialized in the recovery and reintegration of homeless people. Participants were tested for anti-HCV markers using rapid tests. Poisson regression analysis was used to verify the risk factors associated with exposure to HCV.ResultsThe prevalence of HCV exposure was 2.5% (95.0% CI: 1.4 to 4.3%) and was associated with age, absence of family life, injection drug use, number of sexual partners, and history of sexually transmitted infections (STI). Participants reported multiple risk behaviors, such as alcohol (78.9%), cocaine (37.1%) and/or crack use (53.1%), and inconsistent condom use (82.6%). Injection drug use was reported by 8.7% of participants.ConclusionsThe prevalence of HCV infection among homeless men was relatively high. Several risk behaviors were commonly reported, which shows the high vulnerability of this population. These findings emphasize the need for the development of specific strategies to reduce the risk of HCV among homeless men.

Inconsistent use of condoms in non-injecting illicit drug users.

Non-injecting illicit drug users (NIDU) are a highly vulnerable group for the acquisition of the human immunodeficiency virus (HIV). The majority of these individuals present multiple risk behaviors, such as multiple sexual partners, exchange of sex for money or drugs, and inconsistent use of condoms.1 In addition, this group consists of individuals with low levels of income and education, which enhances the risk of viral acquisition. Studies have shown high rates of inconsistent use of condoms in NIDU, which increases the risk in this population for the acquisition and transmission of HIV.2,3 In this context, the objectives of this study were to estimate the prevalence of inconsistent condom use in NIDU and to identify the factors associated with unprotected sex with casual partners. A cross-sectional study was conducted with 323 NIDU hospitalized in two chemical dependency treatment clinics located in the southwest of Goiás, central west region of Brazil. The study included individuals aged 18 years or over who had used non-injection drugs in the month before the admission date (marijuana, intranasal cocaine, crack, intranasal heroin, inhalants, LSD, and ecstasy). Data collection was carried out between December 2014 and June 2015, through face to face interviews, covering sociodemographic characteristics, drug use pattern, and condom use with casual partners in the previous year. Inconsistent condom use was defined as irregular use (occasionally or never) by type of sexual intercourse (oral, anal, or vaginal).2 Univariate analysis was performed to verify the association between the variables and inconsistent use of condoms by sexual practice, using the STATA, version 12.0 program. The study was approved by the Research Ethics Committee of the Federal University of Goiás, authorization No. 926.819/2014. Informed consent was obtained from all participants. The mean age of the participants was 32.4 years (standard deviation: 11.3) and the majority were male (83.0%). Inconsistent use of condoms in oral, vaginal, and anal sex was reported by 72.2% (95% CI: 66.7–76.7%), 83.5% (95% CI: 79.3–87.4%) and 37.5% (95% CI: 32.3–43.1%) of the participants, respectively. A higher prevalence of inconsistent condom use during vaginal and anal sex was verified in females (Prevalence Ratio: 1.40; 95% CI: 1.16–1.69) and in those with a diagnosis of cannabis dependence (Prevalence Ratio: 1.24; 95% CI: 1.01–1.53). A high frequency of inconsistent condom use was observed in this study, confirming the vulnerability of NIDU for the acquisition of HIV. In this context, it is necessary to expand health promotion and prevention of sexually transmitted infections in these individuals, with the availability of condoms, encouraging safe sex practices, and health education of this population.

Prevalência de sinais e sintomas e conhecimento sobre doenças sexualmente transmissíveis

Objective To estimate the prevalence of signs and symptoms of sexually transmitted diseases and to verify the knowledge of adolescents and young people of an urban settlement about these infections. Methods This was a cross-sectional study conducted among 105 settlers aged 12-24 years old. Data were collected through interviews and analyzed using the Statistical Package for the Social Sciences, version 17.0. Results Of the participants who responded regarding sexually transmitted diseases, 20.6% reported signs and/or symptoms, with a higher proportion in females, those who had a piercing and/or tattoo, and who consumed alcohol before or during sexual intercourse (p <0.05). Also, many participants showed ignorance about the signs and symptoms of sexually transmitted diseases. Conclusion The presence of signs and/or symptoms of sexually transmitted diseases were associated with factors related to individual vulnerability of adolescents and young people of the settlement.

Use of illicit drugs by adolescents and young adults of an urban settlement in Brazil

OBJECTIVE To estimate the prevalence and factors associated with illicit drug use by adolescents and young adults of a formal urban settlement. METHOD Cross-sectional study including adolescents and young adults 12-24 years of an urban settlement in the Midwest Region of Brazil. Data were collected using a structured questionnaire and analyzed using Stata, version 12.0. We used Poisson regression model to estimate the factors associated with illicit drug use. RESULTS Of the total participants (n=105), 27.6% (95CI 20.0-36.9%) had used illicit drugs such as marijuana, cocaine, crack, LSD and inhalants. The consumption of these substances was associated with male gender, use of body piercing and/or tattoos, licit drug use and self-report of signs and/or symptoms of sexually transmitted infections. CONCLUSION High prevalence of illicit drug use was found in the individuals investigated, ratifying the presence of risk factors to the vulnerability of the settlers to use these substances in the urban settlement population.

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.