Há uma tendência mundial de mudanças qualitativas na abordagem clínico-laboratorial do paciente em tratamento para o HIV/aids. A terapia anti-retroviral (TARV) no Brasil, como aconteceu em países industrializados do Hemisfério Norte que adotaram o acesso universal a esse tratamento, trouxe benefícios na sobrevida e redução da morbidade e mortalidade relacionada à doença. O presente artigo teve como objetivo apresentar uma revisão de literatura sobre o tema da adesão à TARV. Encontraram-se 56 artigos com as seguintes variáveis de classificação: fatores sociodemográficos; vulnerabilidade ao HIV; uso dos serviços de saúde; e TARV. A proposição principal extraída dos estudos é a necessidade de monitoramento contínuo dos pacientes. A fase inicial da terapia é crítica e, para criar vínculo com o paciente, é necessário acompanhamento individual, suporte social e informação sobre aids. Os serviços de referências para HIV/aids devem monitorar o início do tratamento no sentido de superar prováveis obstáculos, otimizar as boas experiências e incrementar a adesão aos anti-retrovirais.

Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho original seja corretamente citado.

Introduction: High level of HIV/AIDS knowledge is required for an effective adoption of preventive strategies. Objective: To assess HIV/AIDS knowledge among men who have sex with men (MSM) in 12 Brazilian cities. Methods: Respondent-Driven Sampling method was used for recruitment. HIV/AIDS knowledge was assessed by Item Response Theory. Difficulty and discrimination parameters were estimated, and the knowledge score was categorized in three levels: high, medium, and low. Logistic regression was used for analysis. Results: Among 4,176 MSM, the proportion of high level of knowledge was 23.7%. The following variables were positively associated with high knowledge (p < 0.05): age 25+ years old, 12+ years of schooling, white skin color, having health insurance, having suffered discrimination due to sexual orientation, having had a syphilis test, and having received educational material in the previous 12 months. Exchanging sex for money was negatively associated. Conclusions: The proportion of only 23.7% of high HIV/AIDS knowledge was low. We should note that the only potential source of knowledge acquisition associated with high level of knowledge was receiving educational materials. Our study indicates the need for expansion of public prevention policies focused on MSM and with more effective communication strategies, including the development of knowledge that involves motivation and abilities for a safer behavior.

The objectives of this study were to evaluate anti-retroviral (ARV) prescription pickups during twelve months following the first prescription and to identify factors associated with irregular pickups or permanent dropout in two public HIV/AIDS referral centers in Belo Horizonte, Minas Gerais State, Brazil. Participants (n = 323) were antiretroviral naïve and were recruited from May 2001 to May 2002. A total of 98 (30.3%) patients abandoned treatment, and 187 (57.9%) had at least one irregular pickup. Patients with irregular pickups and dropouts were compared to those with regular pickups. Multinomial multivariate analysis showed that living outside Belo Horizonte, CD4+ T-lymphocyte count greater than 200/mm(3), and antiretroviral regimen without protease inhibitors were associated with irregular pickups. In addition to these variables, not being on other medications, and any non-adherence recorded on patient charts were associated with treatment dropout. Pharmacy records are important potential indicators of non-adherence and should be incorporated as such in clinical practice. Strategies should be prioritized to reach out to dropouts or patients with irregular ARV pickups.

OBJECTIVETo evaluate the level of HIV/AIDS knowledge among men who have sex with men in Brazil using the latent trait model estimated by Item Response Theory.METHODSMulticenter, cross-sectional study, carried out in ten Brazilian cities between 2008 and 2009. Adult men who have sex with men were recruited (n = 3,746) through Respondent Driven Sampling. HIV/AIDS knowledge was ascertained through ten statements by face-to-face interview and latent scores were obtained through two-parameter logistic modeling (difficulty and discrimination) using Item Response Theory. Differential item functioning was used to examine each item characteristic curve by age and schooling.RESULTSOverall, the HIV/AIDS knowledge scores using Item Response Theory did not exceed 6.0 (scale 0-10), with mean and median values of 5.0 (SD = 0.9) and 5.3, respectively, with 40.7% of the sample with knowledge levels below the average. Some beliefs still exist in this population regarding the transmission of the virus by insect bites, by using public restrooms, and by sharing utensils during meals. With regard to the difficulty and discrimination parameters, eight items were located below the mean of the scale and were considered very easy, and four items presented very low discrimination parameter (< 0.34). The absence of difficult items contributed to the inaccuracy of the measurement of knowledge among those with median level and above.CONCLUSIONSItem Response Theory analysis, which focuses on the individual properties of each item, allows measures to be obtained that do not vary or depend on the questionnaire, which provides better ascertainment and accuracy of knowledge scores. Valid and reliable scales are essential for monitoring HIV/AIDS knowledge among the men who have sex with men population over time and in different geographic regions, and this psychometric model brings this advantage.

Introduction: The HIV epidemic in Brazil is characterized as concentrated on key populations, incluiding men Who have sex with men (MSM). However, monitoring and evaluation indicators are not well known at Municipal or State levels. Objective: To describe risk behaviors and HIV and syphilis prevalences among MSM in Belo Horizonte, MG. Methods: Cross-sectional study part of a national multicenter study among adult MSM in Brazil. The sample was recruited using Respondent Driven Sampling (RDS) technique. Semistructure interviews and serological exams for HIV and syphilis were conducted. Resultads: A total of 274 MSM were recruited in Belo Horizonte. Participants were mostly young, with high education, social classes A/B, self-reported as gay or homosexual and with high proportion of irregular use of condoms. Weighted prevalence of HIV infection and syphilis were, respectively, 10.3% and 13.9%. Age, color, sharing with their mother or father their sexual orientation, prior HIV and syphilis testing, and previous diagnosis of syphilis or other STDs were statistically associated with both infections (p<0.05). Marital status, family disapproval or indifference of their sexual orientation, better HIV/Aids knowledge, not knowing their chances of acquiring HIV were statistically associated only with HIV and social class only with syphilis. Conclusion: These results indicate the severity of the HIV epidemic amongthe MSM population in Belo Horizonte. Public policies at the municipal and state levels must be implemented and/or revised urgently. RESUMO Introdução: a epidemia do HIV no Brasil caracteriza-se como concentrada em populações-chave, incluindo homens que fazem sexo com homens (HSH). No entanto, são pouco conhecidos os indicadores de monitoramento e avaliação da epidemia em nível estadual ou municipal destas populações. Objetivo: descrever comportamentos de risco e prevalências de HIV e sífilis em população de HSH em Belo Horizonte, MG. Métodos: estudo de corte transversal parte de estudo multicêntrico nacional entre HSH adultos. A amostra foi recrutada pela técnica Respondent Driven Sampling (RDS). Foram realizadas entrevistas semiestruturadas e exames para HIV e sífilis. Resultados: foram recrutados 274 HSH em Belo Horizonte. Os participantes eram principalmente indivíduos jovens, com alta escolaridade, de classes sociais A/B, que se autorreferiram gay ou homossexual e tinham alta proporção do uso irregular de preservativos. As prevalências ponderadas da infecção pelo HIV e de sífilis foram, respectivamente, 10,3 e 13,9%. Idade, cor, contar para a mãe ou pai sobre a orientação sexual, testagem prévia para o HIV ou sífilis, diagnóstico prévio de sífilis ou de outras DSTs foram estatisticamente associados a ambas as infecções (p<0,05). Estado civil, família ser indiferente ou desaprovar a opção sexual, Vulnerabilidade e fatores associados a HIV e sífilis em homens que fazem sexo com homens, Belo Horizonte, MG Vulnerability and factors associated with HIV and syphilis among men who have sex with men, Belo Horizonte, MG

Introduction:The Brazilian HIV epidemic is considered concentrated among vulnerable populations, particularly men who have sex with men (MSM). Objective: This paper analyzes the characteristics of sexual behavior and its associated factors among MSM in the city of Belo Horizonte, MG. Methods: Cross-sectional study conducted in 2008-2009, among 274 MSM recruited by Respondent Driven Sampling (RDS). Odds Ratios were estimated by logistic regression. Results: Among 274 subjects, 35.7% reported inconsistent condom use in receptive anal intercourse in the 6 months preceding the interview, with a high proportion of multiple sexual partnerships (average of 4.3 partners). Final logistic regression model showed that being married or living in a stable relationship, selfreported sexual identity as 'gay', feeling tense or worried some or many times in the past 12 months, history of sexual intercourse under influence of alcohol in the last six months, low knowledge about HIV transmission and history of previous testing for syphilis were factors independently associated with inconsistent use of condoms during receptive anal intercourse in the sample. Conclusions: The proportion of inconsistent condom use in this MSM population was high. Specific intervention strategies for should be developed with special attention to the use of alcohol and drugs, fighting stigma and prejudice, as well as expanding testing and comprehensive health assistance. The indicator inconsistent condom use in receptive anal sex should be incorporated in the monitoring and evaluation of the Aids epidemic at the municipal level in this key population of MSM. RESUMO Introdução: a epidemia do HIV no Brasil é considerada concentrada em populações vulneráveis, principalmente em homens que fazem sexo com outros homens (HSH). Objetivo: este trabalho objetiva descrever as características do comportamento sexual de risco e analisar as características associadas ao uso inconsistente de preservativos nas relações sexuais anais receptivas entre homens que fazem sexo com homens (HSH) em Belo Horizonte, MG.Métodos: estudo de corte transversal, conduzido em 2008. Odds Ratios foram estimadas por regressão logística. Resultados: entre 274 indivíduos, 35,7% informaram uso inconsistente de preservativo nas relações anais receptivas nos seis meses anteriores à entrevista, com elevada proporção de parcerias sexuais múltiplas (média de 4,3 parceiros). Ser casado ou estar em união estável, identidade sexual autorreferida como gay, sentir-se tenso ou preocupado algumas ou muitas vezes nos últimos 12 meses, história de relação sexual sob efeito de álcool nos últimos seis meses, baixo conhecimento sobre transmissão do HIV e história de testagem prévia para sífilis foram fatores independentemente associados ao uso incon-Sexo anal receptivo desprotegido entre homens que fazem sexo com homens, Belo Horizonte, MG Unprotected receptive anal sex among men who have sex with men, Belo Horizonte, MG

ABStRACt. PedexPert is a Windows-based Bayesian network software, especially constructed to solve problems in parentage testing that are complex because of missing genetic information on the alleged father and/or because they involve genetic mutations. PedexPert automates the creation and manipulation of Bayesian networks, implementing algorithms that convert pedigrees and sets of indispensable information (genotypes, allele frequencies, mutation rates) into Bayesian networks. This program has a novel feature that can incorporate information about gene mutations into tables of conditional probabilities of transmission of alleles from the alleged father to the child, without adding new nodes to the network. This permits using the same Bayesian network in different modes, for analysis of cases that include mutations or not. PedexPert is user-friendly and greatly reduces the time of analysis for complex cases of paternity testing, eliminating most sources of logical and operational error.