Simone Monteiro

HIV/AIDS risk among female sex workers who use crack in Southern Brazil

OBJECTIVEnTo understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study.nnnANALYSIS OF RESULTSnFemale sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care.nnnCONCLUSIONSnFemale sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.OBJETIVO: Comprender el contexto social en el cual estan insertadas trabajadoras del sexo que usan crack y su impacto en la adopcion de comportamientos de riesgo frente al HIV/Sida. METODOS: Se realizo estudio cualitativo en Foz de Iguacu (Sur de Brasil), en 2003. Se realizaron 26 encuestas con profundidad y dos grupos focales con trabajadoras del sexo que utilizan crack frecuentemente. Tambien se realizaron encuestas con profundidad con profesionales de la salud, lideres comunitarios y gerentes de politicas publicas, ademas de observaciones de campo. Los datos transcritos fueron codificados con ayuda del software Atlas.ti y el metodo grounded theory (teoria fundamentada en datos) fue utilizada para analizar los datos y desarrollar un modelo conceptual como resultado de estudio. ANALISIS DE LOS RESULTADOS: Las trabajadoras del sexo que utilizan crack presentaron baja autopercepcion del riesgo frente al HIV, a pesar de estar relacionadas con comportamientos de riesgo, como sexo desprotegido con multiples parejas. Experiencias de violencia fisica y sexual con clientes, parejas ocasionales y estables fueron bastante frecuentes entre estas mujeres, perjudicando la negociacion y el uso consistente de preservativos. Segun los profesionales de la salud, los lideres comunitarios y los gerentes de politicas publicas, diversas trabajadoras del sexo usuarias de crack, viven en las calles o en barrios, raramente tienen acceso a los servicios de salud, de consejos y examenes anonimos, de apoyo social y de salud reproductiva y pre-natal. CONCLUSIONES: Las profesionales del sexo que utilizan crack experimentaron varios problemas sociales y de salud que parecen influenciar sobre el riesgo a la infeccion por el HIV. Intervenciones de bajo umbral, amigables y dirigidas para cuestiones de genero deben ser implementadas buscando facilitar el acceso a servicios de salud y de apoyo social en esa poblacion. Tales iniciativas podran tambien facilitar el acceso de ese grupo a servicios dirigidos a la salud reproductiva en general y estrategias especificamente dirigidas a la prevencion del HIV/Sida y otras infecciones sexualmente transmisibles.

Viral suppression and adherence among HIV-infected children and adolescents on antiretroviral therapy: Results of a multicenter study.

OBJECTIVEnTo evaluate treatment adherence among perinatally-infected pediatric human immunodeficiency virus (HIV) patients followed in pediatric centers in Brazil.nnnMETHODSnThis was a cross-sectional multicenter study. Medical records were reviewed and adherence scale, assessment of caregivers quality of life (WHOQOL-BREF), anxiety, depression, and alcohol/substances use/abuse were assessed. Outcomes included self-reported 100% adherence in the last three days and HIV viral load (VL)<50 copies/mL. Statistical analyses included contingency tables and respective statistics, and multivariable logistic regression.nnnRESULTSn260 subjects were enrolled: 78% children and 22% adolescents; 93% of caregivers for the children and 77% of adolescents reported 100% adherence; 57% of children and 49% of adolescents had VL<50 copies/mL. In the univariate analyses, HIV diagnosis for screening due to maternal infection, lower caregiver scores for anxiety, and higher scores in physical and psychological domains of WHOQOL-BREF were associated with 100% adherence. Shorter intervals between pharmacy visits were associated with VL<50 copies/mL (p ≤ 0.01). Multivariable regression demonstrated that caregivers who did not abuse alcohol/other drugs (OR=0.49; 95% CI: 0.27-0.89) and median interval between pharmacy visits<33 days (OR=0.97; 95% CI: 0.95-0.98) were independently associated with VL<50 copies/mL; whereas lower caregiver scores for anxiety (OR=2.57; 95% CI: 1.27-5.19) and childrens HIV diagnosis for screening due to maternal infection (OR=2.25; 95% CI: 1.12-4.50) were found to be independently associated with 100% adherence.nnnCONCLUSIONSnPediatric HIV programs should perform routine assessment of caregivers quality of life, and anxiety and depression symptoms. In this setting, pharmacy records are essential to help identify less-than-optimal adherence.

Evaluation of the ZIG-ZAIDS game: an entertaining educational tool for HIV/Aids prevention

This article presents the evaluation process for the ZIG-ZAIDS game, investigating the materials applicability in formal and informal educational contexts, i.e., how the game has been used by health professionals, parents, and the target population (pre-adolescents, or children over 9 years old). The study involved evaluation questionnaires sent to a list of schools and institutions using the game, plus interviews and visits to places where the game was used as well as tested with groups of students. It also includes an analysis of evaluation previously sent by the authors to people who had requested the game. The results showed that the populations level of information is more relevant than age in relation to the games impact. Another important aspect relates to ZIG-ZAIDS applicability to different situations: training of health and teaching professionals; activities with street children; municipal institutions and events, schools, companies, communities, and health care centers. In summary, ZIG-ZAIDS was found to be an entertaining, creative, and innovative alternative for providing information on AIDS and sexuality.