Social geography of AIDS in Brazil: identifying patterns of regional inequalities

Abstract

The trend towards decline and stabilization of the AIDS epidemic in Brazil should be analyzed carefully, since aggregate data can mask regional or local inequalities in such a large and diverse country. The current study reevaluates the epidemic’s spatial dissemination and the AIDS-related mortality pattern in Brazil. The study considered all AIDS cases diagnosed in individuals over 18 years of age and living in Brazil, as well as AIDS deaths recorded in 1998-2008. Three-year moving average rates were estimated, and a spatial analysis was conducted using a local empirical Bayesian method. The epidemic was only found to be expanding in the North and Northeast regions, while declining in the rest of the country, especially in the Southeast. According to the findings, the apparent stabilization of AIDS mortality tends to mask regional disparities. Social determinants of health and regional disparities should be taken into account in program development and policymaking.

Bayesian joint modeling of longitudinal and spatial survival AIDS data

“…Apart from the last, the first five states have moderate population density and economic growth and, even expecting to have better Public Health conditions, they still have some latent risk factors for HIV/AIDS issue. As reported by Teixeira et al [44], AIDS epidemic in Brazil was only found to be expanding in the North and Northeast regions, while declining in the rest of the country, especially in the Southeast. Similar maps for models XXIV and XIV can be found on SuppMat Figure 3 and Figure 4, respectively.…”

Mortality related to tuberculosis-HIV/AIDS co-infection in Brazil, 2000-2011: epidemiological patterns and time trends

“…The presence of variables consid- Table 3 Joinpoint regression analysis of mortality rates related to TB-HIV/AIDS co-infection by region, sex and age group. ered indicators for poverty in Brazil and a higher risk among those with a low education and the black population, confirms the increased mortality in these regions 6,9,10,15,16,26,27 . Similar to other infectious diseases, poverty may have increased the vulnerability for TB and HIV/AIDS cases.…”

“…Similar to other infectious diseases, poverty may have increased the vulnerability for TB and HIV/AIDS cases. There is a clear link between TB, poverty and social exclusion, hampering control efforts in many Brazilian regions 10,27,28 . Those who are mostly affected live in poor, urban neighborhoods, with a trend to more and more rural areas 9 .…”

“…Those who are mostly affected live in poor, urban neighborhoods, with a trend to more and more rural areas 9 . HIV/AIDS is being spread within the poorest populations in the country, with negative impacts on clinical and epidemiological aspects 22,27 . In cases with TB-HIV/AIDS co-infection, poverty has previously been shown to be related to higher mortality rates 10,26,29 .…”

Trends in AIDS-related mortality among people aged 60 years and older in Brazil: a nationwide population-based study

“…Thus, in addition to new infections in adults over 60 years, it can be inferred that a part of the AIDS cases and deaths in this age group may result from individuals being infected when they were aged 50-60 years, since the evolution time between HIV infection and AIDS diagnosis can be 5-10 years (Affeldt et al, 2015;Oliveira, Paz, & Melo, 2013). In this study, the highest AIDS-related mortality rates in people aged 60 years and older were observed in the most socioeconomically developed regions of the country, such as the South and Southeast (Girondi et al, 2012;Teixeira, Gracie, Malta, & Bastos, 2014). This is due to the fact that these regions recorded the most AIDS cases and present the highest incidence rates of the disease in the country (Brazilian Ministry of Health, 2015; Girondi et al, 2012).…”