All the contents of this chapter, except where otherwise noted, is licensed under a Creative Commons Attribution-Non Commercial-ShareAlike 3.0 Unported.Todo o conteúdo deste capítulo, exceto quando houver ressalva, é publicado sob a licença Creative Commons Atribuição -Uso Não Comercial -Partilha nos Mesmos Termos 3.0 Não adaptada.Todo el contenido de este capítulo, excepto donde se indique lo contrario, está bajo licencia de la licencia Creative Commons Reconocimento-NoComercial-CompartirIgual 3.0 Unported. Caminhos da saúde pública no BrasilJacobo Finkelman (Org.

This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS).Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy.A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities.A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7–20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4–21.7) were seropositive.HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0–14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.

Objective-Brazil accounts for ∼70% of injection drug users (IDU) receiving HAART in low/ middle income countries. We evaluated the impact of HAART availability/access on AIDS-related mortality among IDU versus men who have sex with men (MSM). Design-Nationwide analysis on Brazilian IDU and MSM diagnosed with AIDS in 2000-2006.Methods-Four national information systems were linked and Cox regression was used to assess impact of HAART availability/access on differential AIDS-related mortality.Results-Among 28,426 patients, 6,777 died during 87,792 person-years of follow-up. Compared to MSM, IDU were significantly less likely to be receiving HAART, to have ever had determinations for CD4 or viral load. After controlling for confounders, IDU had a significantly higher risk of death (AHR: 1.94; 95% CI: 1.84-2.05). Among the subset that had at least one CD4 and viral load determination, higher risk of death among IDU persisted (HR: 1.82; 95% CI: 1.58-2.11). Non-white ethnicity significantly increased this risk, while prompt HAART uptake after AIDS diagnosis reduced the risk of death. After controlling for spatially-correlated survival data, AIDS-related mortality remained higher in IDU than in MSM.

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BackgroundIn addition to screening by Pap smears, vaccination against human papillomavirus (HPV) can dramatically reduce cervical cancers caused by the virus. The acceptance of HPV vaccination is directly related to HPV knowledge. This research aimed to evaluate knowledge about HPV and vaccination among men and women aged 16–25 years who use the public health system in Brazil.MethodsThis was a cross-sectional, multicenter study of sexually active young adults recruited from 119 primary care units between 2016 and 2017. All participants answered a face-to-face standardized questionnaire.ResultsOf 8581 participants, the mean percentage of correct answers about HPV and vaccination was 51.79% (95% CI 50.90-52.67), but 75.91% (95% CI 74.13-77.69) had awareness of the HPV vaccination. Women answered a higher proportion of questions correctly than men did (p = 0.0003). Lower education level was the variable that most interfered with knowledge. The best information sources for knowledge were both health professionals and the media (1.33%, 95% CI 1.03-1.70).ConclusionsThe results emphasize the importance of educational programs about HPV and vaccination among young adults, especially in socially disadvantaged populations. These findings can help to increase the vaccination rate in the country and to stimulate public health policies.

To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.

Behavioral surveillance surveys have been carried among military conscripts, in Brazil, since 1996. This paper presents the results of the 2007 survey and compares actual findings with those obtained in previous studies carried out in the period 1999-2002. The conscripts were selected with a two stage sampling stratified by geographical region. The study included a self-reported questionnaire and blood collection for HIV and syphilis testing. Data from 35,432 conscripts aged 17-20 years old were analyzed. The findings show a reduction in regular condom use, with fixed and casual partners, mainly among those with poor educational level. The proportion of conscripts that have sex with other men was maintained (3.2%), but the index of risky sexual behavioral showed worsening results in this group. Also, the HIV prevalence rate increased from 9 to 11.3 per 10,000 in 2007, though the increase was not statistically significant. In conclusion, the evidences found in this paper indicate the need of reformulate policy among young adults.

Since 1996, the Brazilian Department of Sexually Transmitted Infections (STI), AIDS and Viral Hepatitis (Departamento de Vigilância, Prevenção e Controle das IST, do HIV, AIDS e Hepatites Virais, Secretaria de Vigilância em Saúde, Ministério da Saúde) in collaboration with the Brazilian Ministry of Defense has conducted periodic and anonymous probability sample surveys to determine the human immunodeficiency virus (HIV) prevalence, the sexual and risk behaviors among conscripts of the Brazilian army. This study aimed to estimate the HIV seroprevalence of conscripts in Brazil by geographic region and to describe behavior in relation to the risk of HIV transmission by analyzing data from the Brazilian Conscripts Survey 8th edition performed in 2016.Conscripts were selected with a 2-stage sampling method stratified by geographical region. The study included a self-reported questionnaire and blood collection for HIV, hepatitis, and syphilis testing. Data from 37,282 conscripts between 17 and 22 years of age were analyzed. Of these conscripts, 73.7% stated that they were sexually active. The overall country-wide prevalence of HIV was 0.12%. The geographic prevalence rates were as follows: north (0.24%), northeast (0.15%), central-west (0.13%), southeast (0.07%), and south (0.10%). The proportion of conscripts who reported having sex with other men was 4.4%, and the estimated HIV prevalence in this group was 1.32%. Regarding prophylaxis use, 45.6% of the participants reported consistent condom use with casual partners within the last year, and 34.5% reported condom use with steady partners within the last year. The independent factors associated with HIV infection were: MSM status (odds ratio [OR] = 14.62; P = .000) and having more than 10 partners over their lifetime (OR = 3.32; P = .028).Our data suggest that the HIV prevalence among young men in Brazil remains stable except for the north region, and MSM continue to be associated with a high risk for HIV infection at a rate that is approximately 13-fold higher than the rate among men without a history of sex with another man. Our findings confirm the need to scale up combination HIV prevention for young men, including MSM, in Brazil.