Raquel De Boni

Association between psychiatric symptoms and severity of alcohol dependence in a sample of brazilian men.

The objective of this study was to verify the association between psychiatric symptoms and severity of alcohol dependence in male patients who sought treatment in two Brazilian treatment sites. A cross-sectional study was designed with 36 cases stratified into two groups according to the severity of alcohol dependence ascertained by the Short Form Alcohol Dependence Data scale; participants also answered the Mini-Mental State Examination, the Mini International Neuropsychiatric Interview, and the Symptom Check List 90. The mean age of the sample was 46 years, and 63.9% fulfilled criteria for severe alcohol dependence. Obsessive-compulsive, depressive, and paranoid symptoms were the most common clinical findings in the sample. Patients with severe dependence showed higher scores of psychiatric symptoms compared with patients with mild/moderate dependence across all analyses (p < .05). These data suggest an association between severity of alcohol dependence and psychiatric symptoms, pointing at the relevance of early detection of this clinical situation.

Awareness and Willingness to Use Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men and Transgender Women in Brazil

Antiretroviral pre-exposure prophylaxis (PrEP) is recommended to prevent HIV infection among high-risk men who have sex with men (MSM) though not available in Brazil where the HIV epidemic persists unabated in this group. This cross-sectional study describes PrEP awareness and willingness and associated factors among MSM and transvestite/transgender women (trans women) pre-screened for the PrEP Brasil study. Awareness was reported by 61.3xa0% of the participants and was associated with age, education, site, study period and prior HIV testing. Most participants (82.1xa0%) were willing to use PrEP, which was associated with site, study period, number of male condomless anal sexual partners and anal sex with HIV positive/unknown partners. PrEP information is need among young and less educated individuals. Willingness to use PrEP was high and future studies should be conducted to confirm PrEP acceptability and the characteristics of the population who chose to adopt this intervention.

Chlamydia trachomatis, Neisseria gonorrhoeae and syphilis among men who have sex with men in Brazil

BackgroundSexually transmitted diseases (STD) are frequently asymptomatic and increase the likelihood of transmitting and acquiring HIV. In Brazil, the guidelines for STDs diagnosis and treatment are based on the syndromic approach. Nucleic acid amplification tests (NAAT) has been recommended as routine STDs screening in some countries, especially for men who have sex with men (MSM). Limited data are available about how to best define target groups for routine screening by NAATs within this population. We aimed to assess the prevalence of rectal and urethral Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections and syphilis, and the factors associated with having at least one STD among HIV-infected and uninfected MSM in Rio de Janeiro, Brazil.MethodsFrom August 2010 to June 2012, 391 MSM were enrolled into the Evandro Chagas National Institute of Infectious Diseases-INI-Fiocruz cohort, and 292 MSM (HIV-infected:211 and HIV-uninfected:81) were included in this study. NAATs were performed on the rectal swabs and urine for CT and NG. The rapid plasma reagin test and microhemagglutination assay for Treponema pallidum were performed for syphilis diagnosis.ResultsThe overall prevalence of STD was 20.0xa0% (95%CI:15.7-25.1): 10xa0% anorectal chlamydia; syphilis 9.9xa0%; anorectal gonorrheae 2.5xa0%; and urethral chlamydia 2.2xa0%; no case of urethral gonorrheae was detected. The proportion of HIV-positive MSM who had at least one STD was nearly two times that of HIV-negative MSM (22.6xa0% vs 13.2xa0%; Pu2009=u20090.09). The frequency of each STD, except for anorectal NG (1.5xa0% vs.5.2xa0%), was higher among HIV-positive than HIV-negative individuals. Among the 211 asymptomatic participants, 17.5xa0% (nu2009=u200937) were identified as having at least one STD; 10.4xa0% (nu2009=u200922/211) tested positive for anorectal chlamydia. Sixty five percent of HIV-positive MSM were asymptomatic at the time of the STD diagnosis, while 100.0xa0% of the HIV-negative MSM. Age (APRu2009=u20090.78; 95%CI:0.60-1.00 for each additional ten years) and a positive-HIV serostatus (APRu2009=u20092.05; 95%CI:1.03-4.08) were significantly associated with STD diagnosis.ConclusionAn overall high STD-prevalence rate was observed, especially among HIV-infected and in younger individuals, and the majority of STDs were asymptomatic. STD screening using NAATs among asymptomatic MSM is a potentially cost-effective intervention for the prevention of HIV infection among MSM.

High rates of injured motorcycle drivers in emergency rooms and the association with substance use in Porto Alegre, Brazil

Background Although the fleet of motorcycles and the number of traffic accidents (TA) is increasing in the world, few studies have evaluated intoxication by alcohol and/or drugs in this group of drivers. This study aims to evaluate the prevalence of motorcycle riders among drivers who are victims of TA, and ascertain factors associated with drug and alcohol use. Methods All TA victims admitted on a 24/7 routine between October and November 2008 to two trauma hospitals of Porto Alegre, Brazil were invited to participate, then submitted to an interview, breathalysed and had their saliva collected for drugs. Results Among the overall sample of drivers, 78.4% were motorcycle riders. Toxicological analysis yielded a 15.3% prevalence of marijuana use, 9.2% of cocaine use, 3.2% benzodiazepine use and 7% of alcohol use. Factors associated with alcohol or drug intoxication were the diagnosis of alcohol abuse or dependence and history of previous TA. Conclusions The prevalence of motorcycle riders among drivers who are victims of TA was alarming. The association of alcohol abuse or dependency and intoxication justify the need for therapeutic interventions specifically targeted to the treatment of drug dependency, as well as public policies directed to prevention of injuries–particularly among recidivist motorcycle riders.

Age and gender as risk factors for the transmission of HIV in a sample of drug users of Porto Alegre, Brazil

Objective: To verify the association between age and gender regarding HIV seropositivity in drug users who seek public health centers in Porto Alegre, Brazil. Methods: The authors designed a cross-sectional study with a convenience sampling of 695 men and women aged above 15, who reported recent drug use and risk behaviors to HIV exposure. We used a standard questionnaire (CRA, Brazilian version of the RAB, Risk Assessment Battery) to assess risk behaviors and we collected blood for HIV testing. Results: Most individuals were males (75,8%), with a mean age of 29.4 years, less than seven years of schooling (42,4%), and family income equal or superior to four minimum wages (46%). There was no significant association between gender and seropositivity. Multivariate analyses showed that individuals aged above 30 had a three-fold increased odds of being seropositive over subjects aged 20 or less. Intravenous drug users who had been using drugs since 1980 had five-fold odds of seropositivity and those who had been using them in the month prior to the interview had four-fold odds. Discussion: Subjects aged more than 30 showed higher odds of seropositivity than the younger group. This is possibly due to a higher use of intravenous cocaine and to having more risk behaviors along their lifetime. There was no difference in seropositivity between genders, what differs from current data of other studies, if we take into consideration that rates of populational seropositivity among women have increased, mostly among drug users, who are, therefore, at double risk. The development of further studies is mandatory in order to assess gender and age as risk factors for seropositivity, whether to confirm or to deny these findings, and to plan specific strategies for high-risk groups.

Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America.

This cross-sectional study describes substance use prevalence and its association with combination antiretroviral therapy (cART) adherence among 3343 individuals receiving care at HIV clinics in Argentina, Brazil, Chile, Honduras, Mexico, and Peru. A rapid screening tool evaluated self-reported 7-day recall of alcohol, marijuana, cocaine, heroin, and methamphetamine use, and missed cART doses. Overall, 29.3xa0% individuals reported having ≥1 alcoholic drinks, 5.0xa0% reported any illicit drug use and 17.0xa0% reported missed cART doses. In the logistic regression model, compared to no substance use, alcohol use [adjusted odds ratio (AOR)xa0=xa02.46, 95xa0% confidence interval (CI): 1.99–3.05], illicit drug use (AORxa0=xa03.57, 95xa0% CI: 2.02–6.30), and using both alcohol and illicit drugs (AORxa0=xa04.98, 95xa0% CI: 3.19–7.79) were associated with missed cART doses. The associations between substance use and likelihood of missing cART doses point to the need of targeting alcohol and illicit drug use to improve adherence among people living with HIV in Latin America.ResumenEste estudio transversal describe la prevalencia del uso de sustancias y su asociación con la adherencia a TARVc en 3433 individuos atendidos en centros clínicos de VIH en Argentina, Brasil, Chile, Honduras, México y Perú. Se aplicó una herramienta de escrutinio rápido para el uso de alcohol, marihuana, cocaína, heroína y metanfetaminas, así como para el reporte de dosis perdidas de TARV en los siete días anteriores. En general, 29.3 % participantes reportaron haber consumido una o más bebidas alcohólicas, 5% reportaron haber usado alguna droga ilícita y 17 % reportaron haber perdido al menos una dosis del TARVc. Usando un modelo de regresión logística, se observó que en comparación al grupo que no consumió ninguna sustancia, el uso de alcohol (odds ratio ajustada (AOR)=2.46, intervalo de confianza del 95 % (IC95 %): 1.99–3.05), el uso de cualquier sustancia ilícita (AOR=3.57, IC95%: 2.02–6.30), y el uso de ambos (AOR = 4.98, 95 % CI: 3.19–7.79) se asociaron a pierda de alguna dosis de TARVc. La relación entre el uso de sustancias y el incremento en la mala adherencia a la TARVc señala la necesidad de atender el uso de alcohol y drogas ilícitas para así mejorar la adherencia en personas que viven con VIH en América Latina.

Factors Associated with Tobacco Smoking and Cessation among HIV-Infected Individuals under Care in Rio de Janeiro, Brazil

Worldwide the prevalence of smoking among people living with HIV/AIDS is elevated compared to the general population. This probably reflects the cluster of individual characteristics that have shared risk factors for HIV infection and smoking. A cross-sectional study, enrolling a convenience sample from a Brazilian HIV clinical cohort was conducted to evaluate the prevalence of tobacco smoking and the factors associated with current smoking and abstinence. A total of 2,775 HIV-infected individuals were interviewed: 46.2% have never smoked, 29.9% were current smokers and 23.9% were former smokers. Current smokers had a higher prevalence of alcohol and illicit drug use when compared to the other two groups. A higher proportion of heterosexual individuals were former smokers or never smokers while among men who have sex with men (MSM) a higher proportion were current smokers. Former smokers had been more frequently diagnosed with high blood pressure, diabetes mellitus, cardiovascular diseases and depression, while for current smokers lung diseases were more frequent. Former smokers and current smokers were more likely to have had any hospital admission (42.0% and 41.2%, respectively) than participants who never smoked (33.5%) (p<0.001). Multivariate model results showed that current smokers (versus never smokers) were more likely to be less educated, to report the use of alcohol, crack and cocaine and to present clinical comorbidities. Former smokers (versus current smokers) were more likely to be older, to have smoked for a shorter amount of time and to have smoked >31 cigarettes/day. MSM (compared to heterosexuals) and cocaine users (versus non-users) had lower odds of being former smokers. Considering our results, smoking cessation interventions should be tailored to younger individuals, MSM and substance users.

Differences between attendance in emergency care of male and female victims of traffic accidents in Porto Alegre, Rio Grande do Sul State, Brazil

Driving under the influence of alcohol/ drugs (DUI) is a well-established risk factor for traffic accidents, and men and women have different consumption patterns. The scope of this paper is to analyze differences in alcohol and drug consumption, as well as on behavior associated with traffic accidents among men and women. A cross-sectional study was conducted with 609 sequential traffic accident victims attended in emergency care from Porto Alegre. Subjects gave a structured interview, were breathalyzed and had a saliva test for alcohol/drug screening. Results showed that women were mainly passengers or pedestrians (p < 0.001). There was no significant difference in positive blood alcohol concentration. However, men reported more binge drinking and THC use, while women had more benzodiazepine in their saliva (p<0.05). This is the first Brazilian study to compare alcohol and drug use among men and women who were the victims of traffic accidents. Results point to differences in the pattern of substance abuse, as well on risk behavior. Data may be useful for specific prevention strategies that take gender differences into consideration.

Unprotected sex among men who have sex with men living with HIV in Brazil: a cross-sectional study in Rio de Janeiro

BackgroundMany countries are facing concentrated HIV epidemics among vulnerable populations, including men who have sex with men (MSM). Unprotected anal intercourse (UAI) is the main HIV transmission route among them and its understanding in the different cultures and how it relates to HIV transmission, re-infection and development of HIV antiretroviral resistance has important public health implications. Data on UAI among Brazilian MSM are scarce. This study aims to evaluate the prevalence and associated factors of UAI among HIV-infected MSM who had sex with seronegative or male partners with an unknown serostatus.MethodA cross-sectional study nested in a cohort was conducted in Rio de Janeiro, Brazil. The one hundred and fifty five MSM included in the study answered an ACASI interview and provided biological samples. Generalized linear models were used to identify variables associated with UAI.ResultsOverall, UAI with an HIV-negative or unknown serostatus male partner was reported by 40.6% (63/155) of MSM. Lifetime sexual abuse or domestic violence was reported by 35.9%, being more frequent among MSM who reported UAI compared to those who did not (Pu2009=u20090.001). Use of stimulants before sex was reported by 20% of the MSM, being slightly higher among those who reported UAI (27.0% vs. 15.2%; Pu2009=u20090.072). Commercial sex was frequent among all MSM (48.4%). After multivariate modeling, the report of sexual abuse or domestic violence (ORu2009=u20092.70; 95% CI: 1.08-7.01), commercial sex (ORu2009=u20092.28; 95% CI: 1.04- 5.10), the number of male sexual partners (pu2009=u20090.039) and exclusively receptive anal intercourse (ORu2009=u20090.21; 95% CI: 0.06-0.75) remained associated with UAI. CD4 levels, HIV viral load and antiretroviral therapy were not associated with UAI.ConclusionThe UAI prevalence found with negative or unknown HIV status partners points out that other interventions are needed as additional prevention tools to vulnerable MSM. The main factors associated with UAI were a lifetime history of violence, commercial sex and the number of male sexual partners. This clustering of different behavioral, health and social problems in this population reinforce the need of a comprehensive approach on treating and preventing HIV among MSM.

Binge drinking is associated with differences in weekday and weekend adherence in HIV-infected individuals

BACKGROUNDnUnderstanding patterns of antiretroviral adherence and its predictors is important for designing tailored interventions. Alcohol use is associated with non-adherence. This study aimed to evaluate: (1) if there was a difference in weekday compared with weekend adherence in HIV-infected individuals from low and middle income countries (LMIC), and (2) whether binge drinking was associated with this difference.nnnMETHODSnData from a randomized trial conducted at 9 sites in 8 LMIC were analyzed. Microelectronic monitors were used to measure adherence. Differences between weekday and weekend adherence in each quarter (successive 12-week periods) were compared using Wilcoxon signed rank tests and predictors of adherence, including baseline binge drinking, were evaluated using Generalized Estimating Equations.nnnRESULTSnData from 255 participants were analyzed: 49.8% were male, median age was 37 years and 28.6% enrolled in Haiti. At study entry, only 2.7% reported illicit substance use, but 22.3% reported binge drinking at least once in the 30 days prior to enrollment. Adherence was higher on weekdays than weekends (median percent doses taken: 96.0% vs 94.4%; 93.7% vs 91.7%; 92.6% vs 89.7% and 93.7% vs 89.7% in quarters 1-4 respectively, all p<0.001). Binge drinking at baseline and time on study were both associated with greater differences between weekday and weekend adherence.nnnCONCLUSIONSnAdherence was worse on weekends compared to weekdays: difference was small at treatment initiation, increased over time and was associated with binge drinking. Screening and new interventions to address binge drinking, a potentially modifiable behavior, may improve adherence in HIV-infected individuals in LMIC.