The Brazilian response to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic is being observed all over the world because of its success. Understanding the role of injection drug users (IDUs) in the epidemic and the political response thereto is a key factor in the control of the epidemic in Brazil. This paper summarizes some of the most important analyses of the Brazilian response to the HIV/AIDS epidemic among and from IDUs. Key elements of the response include the support of the Brazilian Universal Public Health System, the provision of universal access to highly active antiretroviral therapy, and the creation of harm reduction projects that are politically and financially supported by the federal government. The response among and from IDUs is a key element in overall control of the HIV/AIDS epidemic. The response to the epidemic among and from IDUs has been headed in the correct direction since its beginning and is now being intensively expanded.
This study estimated the number of street injecting drug user (IDU) clients of a syringe-exchange program (SEP) who were infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). A two-sample capture-recapture method was carried out. The first capture listed all interviewed IDUs outreached for syringe exchange from April 1 to May 1, 1998; the second capture involved those outreached from May 2 to June 6, 1998. Blood spots were collected for HIV and HCV serologies. Analysis used captured probability model varying with time. We interviewed 55 IDUs in the first capture and 99 in the second; 17 participated in both samples. An estimate of 317 IDUs attending the SEP was obtained (95% confidence interval [CI] 235-467). Based on the overall seroprevalence rates for HIV (47.7%) and HCV (53.1%), it was estimated that 151 IDUs were HIV infected (95% CI 112-223) and 168 (95% CI 125-248) were HCV infected. Enumeration of IDUs associated with estimates of the total number of HIV and HCV seropositives provide a powerful tool for SEPs to help monitor the number of IDUs, to plan for provisions, and to organize the new demands on existing health facilities for HIV and HCV care.
Changes in human immunodeficiency virus (HIV) infection among injection drug users (IDUs) are provoking a shift in the pattern of the HIV/AIDS epidemic in some regions of Brazil. IDUs living in 2 cities (Porto Alegre and Itajaí) in southern Brazil were contacted, interviewed, and tested for HIV. In 1998, 187 IDUs were surveyed and, in 2000, 352 IDUs. In Porto Alegre, HIV seroprevalence, age, and duration of injection history increased significantly over time. In contrast, a trend toward decline was observed in Itajaí. Homelessness, joblessness, and prison incarceration, as well as lifetime needle sharing, also increased over time in Porto Alegre. At the time of the study, at both sites, rates of needle sharing and condom use were similar, but use of syringe exchange programs, health and drug treatment, and HIV testing had increased over time. IDUs living in southern Brazil are at increased risk of HIV infection, indicating the continued need for permanent surveillance and preventive strategies.
O presente estudo objetivou analisar, em caráter exploratório e segundo uma abordagem qualitativa, a ótica dos usuários de drogas injetáveis (UDI) sobre: (a) riscos associados à prática injetável; (b) riscos frente ao HIV/AIDS; (c) prevenção diante do HIV/AIDS. O estudo foi feito em cinco cidades que possuíam o Projeto de Redução de Danos (Projeto AjUDE-Brasil). Foram realizadas quarenta entrevistas semi-estruturadas. O conceito de "risco" foi a categoria chave deste trabalho. Os UDI apontam que os principais riscos que correm são os de "pegar doenças", a "overdose" e a violência. Articulam estratégias para lidar com esses riscos ou minimizá-los. Revelam alto nível de informação geral sobre HIV/AIDS, mas pouco conhecimento sobre reinfecção e outras doenças transmitidas pelo sangue. Os UDI tentam seguir as recomendações das campanhas de saúde; porém, enfrentam as dificuldades impostas pelas práticas de adição. Sugerem estratégias alternativas e demonstram uma leitura particular do conceito de "compartilhamento".
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