HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon

Abstract

BackgroundContextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis. We estimated the prevalence of both infections among indigenous people in nine indigenous health districts of the Brazilian Amazon and examined the context of community vulnerability to acquiring these infections.MethodsWe trained 509 health care workers to screen sexually active populations in the community for syphilis and HIV using rapid testing (RT). We then assessed the prevalence of HIV and syphilis using RT. A multivariable analysis was used to identify factors associated with syphilis infection (sociodemographic, condom use, intrusion, population mobility, and violence).ResultsOf the 45,967 indigenous people tested, the mean age was 22.5 years (standard deviation: 9.2), and 56.5% were female. Overall, for HIV, the prevalence was 0.13% (57/43,221), and for syphilis, the prevalence was 1.82% (745/40,934). The prevalence in men, women, and pregnant women for HIV was 0.16%, 0.11%, and 0.07%, respectively, and for syphilis, it was 2.23%, 1.51%, and 1.52%, respectively. The district Vale do Javari had the highest prevalence of both infections (HIV: 3.38%, syphilis: 1.39%). This district also had the highest population mobility and intrusion and the lowest availability of prenatal services. Syphilis infection was independently associated with age (odds ratio [OR] 1.04, 95% confidence interval [CI]: 1.03–1.05), male sex (OR 1.32, 95% CI: 1.14–1.52), and mobility (moderate: OR: 7.46, 95% CI: 2.69–20.67; high: OR 7.09, 95% CI: 3.79–13.26).ConclusionsThe large-scale integration of RT in remote areas increased case detection among pregnant women, especially for syphilis, in districts with higher vulnerability. Mobility is an important risk factor, especially in districts with higher vulnerability. Contextually appropriate approaches that address this factor could contribute to the long-term success of HIV and syphilis control programs.

Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals

“…In accordance with the Stork Network, 79.3% of women start prenatal care by the 12th week. The median maternal age was 27 years old (interquartile range: [22][23][24][25][26][27][28][29][30][31][32][33]. Regarding the adequacy of prenatal care (adequate and intensive), the mean value for the 27 cities was 79.7% (SD = 7.3), varying from Curitiba (92.1%) to Macapá (59.7%).…”

“…The vulnerability of women receiving inadequate prenatal care and, even worse, when infected with syphilis, shows the need of a closer approach on this population, in order to compensate its vulnerability. Other factors associated with vulnerability, such as poverty, violence, and inequality may be present in different degrees among Brazilian cities, prompting the need of strategies designed to reach those women 23,24 . The FHS could play a positive role in this situation, as long as health teams are inside the poorer communities.…”

High rate of seromarkers for HIV, HBV and syphilis among blood donors using confidential unit exclusion, before and after HIV‐NAT implementation at a major public blood bank in the Brazilian Amazon

“…Compared to the national rates, the Brazilian Amazon registered higher levels of active syphilis, HBV/HBsAg, and HIV in vulnerable population from the triple Brazil‐Colombia‐Venezuela border . A recent rapid test screening of indigenous populations in remote Brazilian Amazon areas showed an overall prevalence of 0.13% for HIV and 1.82% for syphilis …”

Prevalencia de sífilis y características del comportamiento de los jóvenes indígenas del Paraguay, 2016

“…Las publicaciones en esta área son escasas (11) , por lo que la comparación de los grupo resulta difícil, sin embargo, en comparación con los resultados de Benzaken et al, 2017 (3) , Orellana ER et al, 2013 (12) y Bartlett E et al, 2008 (13) la prevalencia ha sido mayor en este estudio, asimismo respecto al sexo, al igual que los estudios anteriores se pudo apreciar que la mayor prevalencia se ha encontrado en el sexo masculino (3,12,13) . En comparación con la población no indígena se encuentra 2 veces más elevada con relación a los datos manejados por la OPS, (14) , el estudio de Newman L et al,2015 (1) y el estudio de Diaz J, 2013 (5) .…”

“…En Brasil a partir de un estudio en 36.173 parturientas en el 2011 se estimó la prevalencia global de sífilis para el país en 0,89% mientras que en las regiones Norte, Nordeste, Sudeste, Sur y Centro oeste fue de 1,05%, 1,14%, 0,73%, 0,48% y 1,20%, respectivamente. Los datos actualizados del 2016 revelan que fueron notificados en el Brasil 87.593 casos de sífilis adquirida, 37.436 casos de sífilis en embarazadas y 20.474 casos de sífilis congénita, entre ellos 185 óbitos (3) .…”