AIDS in Brazil: The Challenge and the Response

Bastos, Francisco I.; Nunn, Amy; Hacker, Mariana A.; Malta, Mônica; Szwarcwald, Célia Landman

doi:10.1007/978-0-387-72711-0_29

Cited by 17 publications

(22 citation statements)

References 69 publications

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“…This result demonstrates a protection in relation to the adnexal factors, since these are among those that potentially increase the transmission of HIV. (16,17,23) In this study, 79.4% of pregnant women (Table 3) received intravenous AZT during labor and delivery, which accounted for 93.1% of the births of those women that occurred in Maceió, and not in the interior of the State.…”

Section: Discussionmentioning

confidence: 75%

“…In Brazil, the majority of AIDS cases in women occur in those who are poorly educated and have less skilled occupations. (4,(14)(15)(16)(17) The conditions of poverty and social exclusion directly affect the lives of these women and their descendants. The lack of bargaining power in sexual relationships characterize an aggravating factor for HIV infection.…”

Section: Discussionmentioning

confidence: 99%

“…However, 28.4% initiated prenatal care during the second trimester, and 30.4% during the third trimester, showing that the majority lost opportunities for both early diagnosis and for the initiation of antiretroviral prophylaxis. (15,16,20,21) The prevalence of the drop in viral load is a result of interventions in the prenatal period, resulting in the reduction of vertical transmission. (4,5,9,10,(16)(17)(18)(19)(20)(21) Different authors, in Brazil and in other regions of the world, have demonstrated that the period of major risk of transmission of the vírus is concentrated in the third trimester of pregnancy, and principally at the time of birth.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that, when the viral load is lowered for the mother, there is a lower possibility of vertical transmission. (4,7,8,10,16,(20)(21)(22)(23) The use of antiretroviral treatment in the second and third trimesters of pregnancy (29.4% and 26.5%, respectively), showing a low adherence to prophylaxis. Even worse are the numbers (18.6%) of those pregnant women who did not prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

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Transmissão vertical do HIV em população atendida no serviço de referência

2013

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Objective: To identify the rate of vertical transmission of HIV and assess the factors involved in maternal and fetal share. Methods: Cross-sectional study conducted in the Specialized Care Service. We investigated 102 clinical records of HIV positive women who had given birth to live newborns. The primary variable was the occurrence of vertical transmission of HIV and the secondary variables were the factors associated with vertical transmission of HIV. Results: Prevalence of 6.6% of vertical transmission. Among the infected children: 40.0% of mothers with out prenatal care and 75% without prophylaxis with antiretroviral drugs during the prenatal, 50.0% without AZT prophylaxis with oral and breast-fed. Among the uninfected children: 91.5% were started on prophylaxis with oral AZT at birth and 84.1% of mothers received ARV delivery. Conclusion: The occurrence of vertical transmission of HIV in the reference service corresponded to 6.6%, indicating a high prevalence. ResumoObjetivo: Identificar a taxa de transmissão vertical do HIV e avaliar os fatores envolvidos em partes materna fetal. Métodos: Estudo transversal realizado no Serviço de Atendimento Especializado. Foram investigados 102 prontuários de mulheres com HIV que deram à luz a recém-nascidos vivos. Resultados: A prevalência de 6,6% de transmissão vertical. Entre as crianças infectadas: 40,0% de mães sem pré-natal e 75% sem a profilaxia com anti-retrovirais durante o pré-natal, 50,0% sem profilaxia com AZT com oral e amamentado. Entre as crianças não infectadas: 91,5% iniciaram a profilaxia com AZT oral ao nascimento e 84,1% das mães receberam ARV. Conclusão: A ocorrência de transmissão vertical do HIV no serviço de referência correspondeu a 6,6%, o que indica uma alta prevalência.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transmissão vertical do HIV em população atendida no serviço de referência

2013

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“…3 Poverty is a critical health determinant in individuals and populations as it increases their vulnerability to different diseases and is a major barrier to equitable access to health care services, information and preventive measures. 9 Previous studies of HIV-positive pregnant women in Porto Alegre documented clustering of areas with high prevalence rates and a substantial proportion of people living in shantytowns (favelas) along the city fringes.…”

mentioning

confidence: 99%

Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators

et al. 2009

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OBJECTIVE:To identify clustering areas of infants exposed to HIV during pregnancy and their association with indicators of primary care coverage and socioeconomic condition. METHODS:Ecological study where the unit of analysis was primary care coverage areas in the city of Porto Alegre, Southern Brazil, in 2003. Geographical Information System and spatial analysis tools were used to describe indicators of primary care coverage areas and socioeconomic condition, and estimate the prevalence of liveborn infants exposed to HIV during pregnancy and delivery. Data was obtained from Brazilian national databases. The association between different indicators was assessed using Spearman's nonparametric test. RESULTS:There was found an association between HIV infection and high birth rates (r=0.22, p<0.01) and lack of prenatal care (r=0.15, p<0.05). The highest HIV infection rates were seen in areas with poor socioeconomic conditions and diffi cult access to health services (r=0.28, p<0.01). The association found between higher rate of prenatal care among HIV-infected women and adequate immunization coverage (r=0.35, p<0.01) indicates that early detection of HIV infection is effective in those areas with better primary care services. CONCLUSIONS:Urban poverty is a strong determinant of mother-to-child HIV transmission but this trend can be fought with health surveillance at the primary care level.

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Evolution of HIV/AIDS response in Brazil: Policy innovations and challenges in the fourth decade of the epidemic

Fonseca

Bastos

2017

Health Planning & Management

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Brazil was the first low- and middle-income country to provide universal treatment access to people living with the acquired immunodeficiency syndrome (AIDS), becoming a widely acclaimed model for best practice to managing this epidemic. However, we know little about important challenges to the key pillars of Brazil's response. This article discusses how the evolution of the country's health system institutions and international advancements in AIDS treatment and prevention affected the national response. Decentralization of health system resources and policy making brought fresh challenges to the centralized governance of the national AIDS program and to civil society, weakening their coordination and advocacy capacity. Regardless, AIDS treatment and prevention strategies in Brazil remain aligned with the current international protocols, but unfortunately have been restricted in some geographic areas and/or populations.

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AIDS in Brazil: The Challenge and the Response

Cited by 17 publications

References 69 publications

Transmissão vertical do HIV em população atendida no serviço de referência

Transmissão vertical do HIV em população atendida no serviço de referência

Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators

Evolution of HIV/AIDS response in Brazil: Policy innovations and challenges in the fourth decade of the epidemic

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