HIV infection, high-risk behaviors and substance use in homeless men sheltered in therapeutic communities in Central Brazil

Brunini, Sandra; Barros, Cleiciane Vieira de Lima; Guimarães, Rafael Alves; Júnior, Hélio Galdino; Rezza, Giovanni; Santos, Jordana R.S.; Cunha, Vanessa Elias da; Sousa, Johnatan Martins; Ferreira, Priscilla Martins; Barros, David

doi:10.1177/0956462418767188

Cited by 9 publications

(16 citation statements)

References 16 publications

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“…Despite frequent alcohol and drug use of homeless persons have been already observed in Brazil and worldwide [20,26,82,83] and with higher infection risk to HIV and T. gondii in general population studies [41,84,85], there was no statistical association observed in the present study. Although one HIV-positive homeless person herein with multiple infections also declared himself as alcohol, marijuana, and skunk cannabis user, the other HIV-positive homeless persons denied alcohol and drug use.…”

Section: Discussioncontrasting

confidence: 71%

“…In Brazil, out of 247,795 reported HIV cases between 2007 and 2018, 117,415 (47.4%) persons were from the southeastern region, where Sao Paulo is located [24]. Studies in Brazilian general homeless population have shown HIV positivity in 6/330 (1.8%) and 69/1,405 (4.9%) individuals of Sao Paulo city, and 6/481 (1.2%) in another city of central-western Brazil [20,25,26]. In two studies of homeless populations co-infected with HIV and tuberculosis, prevalence varied from 4.4% in Minas Gerais to 17.3% in São Paulo, both southeastern Brazilian states [20,27,28].…”

Section: Introductionmentioning

confidence: 99%

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Serosurvey of anti-Toxoplasma gondii and anti-HIV antibodies in homeless persons of southeastern Brazil

Lg¹,

Pi²,

FFVd³

et al. 2020

Preprint

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Background: Homeless persons have been described as one of the most vulnerable populations worldwide, with higher morbidity and mortality of diseases associated with HIV occurrence. Seroprevalence of Toxoplasma gondii and HIV has been extensively studied in other vulnerable populations, however, no study to date have focused on their concomitant seroprevalence in homeless persons. Accordingly, the present study aimed to assess the concomitant seroprevalence of anti-T. gondii and anti-HIV antibodies and associated risk factors in homeless persons in a daytime homeless shelter of São Paulo, southeastern Brazil. Methods: Anti-T. gondii antibodies were detected by indirect fluorescent antibody test and anti-HIV levels by chemiluminescence enzyme immunoassay, with positive samples confirmed by rapid immunoblot assay. Results: Overall, IgG anti-T. gondii seropositivity was found in 43/120 (35.8%) homeless persons, with endpoint titers varying from 16 to 1,024. The only two pregnant women tested were negative for IgM by chemiluminescence enzyme immunoassay, with normal parturition and clinically healthy newborns in both cases. There were no statistical differences in the risk factors for anti-T. gondii serology (p>0.05). Anti- HIV seropositivity was found in 2/120 (1.7%) homeless persons, confirmed as HIV-1. One HIV seropositive individual was also sero-reactive to IgG anti-T. gondii, and both were negative to IgM anti-T. gondii. One HIV positive person was also diagnosed with syphilis, tuberculosis and body lice presence, while the other never returned for assistance. No evaluation of anti- HIV risk factors has been made due to the low seropositive rate. Conclusions: The anti-T. gondii prevalence herein was lower than other Brazilian populations, likely related to predominant intake of processed food such as ready-to-eat and fast-food meals, and thus, low ingestion of fresh salad and raw meat. On the other hand, the anti- HIV seropositivity was higher than the average of the general Brazilian population, with 0.4%. Despite the low prevalence of anti-T. gondii in homeless persons, clinical manifestations may be aggravated in HIV positive individuals. To the author's knowledge, this is the first study of anti-T. gondii serosurvey in homeless persons concomitantly assessed with anti-HIV seropositivity.

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Section: Discussioncontrasting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Serosurvey of anti-Toxoplasma gondii and anti-HIV antibodies in homeless persons of southeastern Brazil

Lg¹,

Pi²,

FFVd³

et al. 2020

Preprint

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“…Still, Brazilian regions in 2018, presented variable rates of HIV infection with 5,084 (11.6%) in the North region, 10,808 (24.6%) cases in the Northeast region, 16,586 (37.7%) in the region Southeast, 7,838 (17.8%) in the South and 3,625 (8.2%) in the Midwest 7 . In the central-western region of Brazil, an HIV prevalence of 1.24% was detected, with a signi cant association in relation to previous HIV tests and years of schooling 3 . In the southeastern region, in a similar population, the prevalence was 4.9%, with the majority being male (85.6%), non-white (71.5%), with a mean age of 40.9 years and low education (72.0%) 8 .…”

Section: Introductionmentioning

confidence: 95%

“…Given the magnitude of the problem, homeless people are more vulnerable to HIV infection, considering sexual risk behaviors and substance use 3 . Worldwide, the prevalence of HIV is different in relation to the population and risk behavior.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Factors Associated With HIV in Homeless People

Magalhães¹,

Brito²,

Carvalho³

et al. 2021

Preprint

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BackgroundInfection with the human immunodeficiency virus (HIV) compromises the immune system of infected people. Homeless people are more vulnerable to HIV infection due to behavioral and sexual factors. The main objective of this study was to estimate the prevalence of infection by the Human Immunodeficiency Virus (HIV) in homeless people in a capital of Northeastern Brazil. MethodsCross-sectional study carried out at the Reference Center for the homeless population (Centro Pop), in a capital of Northeastern Brazil, from September/2017 to September/2018. Data collected through a semi-structured form including socio-demographic data, risk and sexual behaviors and anti-HIV serology. Data were analyzed using Person's Chi-square test. The study was approved by the Research Ethics Committee (CEP) of the Federal University of Piauí. ResultsA prevalence of 3.9% was detected among the 204 homeless people investigated,, that is, 8-204 of anti-HIV reagent, with statistical significance in relation to sexual practice with people of the same sex p ≤ 0.012 and previous sexually transmitted infection (STI) p ≤ 0.002. There was a predominance of males 87.3%, 66.0% were over thirty years of age, 58.3% had less than 12 years of schooling, 84.8% declared they were non-white, 57.3% had no fixed income, 67.0% professed religion, 89.7% declared to be heterosexual, 71.5% did not use a condom during the first sexual intercourse, 28.4% had had sexual intercourse with people of the same sex, and 41.0% had a history of STI. ConclusionsHIV prevalence was higher than in people in the general population. Results show an association between history of any STI and more time on the streets. And also risk behaviors such as high consumption of alcohol and other drugs, low frequency of condom use, increased number of sexual partners.

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“…As human immunodeficiency virus (HIV) disproportionately impacts populations that suffer from health disparities, these marginalized people often face an increased risk of HIV infection compared to that of the general population. Findings [6–11] suggest that the overall prevalence rates of HIV infection among homeless people (1.24 to 1.7%), sex workers (8 to 17.3%) and drug users (17.7 to 34%) are relatively high. The estimated HIV prevalence in adults aged 15–49 years worldwide at the end of 2017 was 0.8% [12].…”

Section: Introductionmentioning

confidence: 99%

How does hard-to-reach status affect antiretroviral therapy adherence in the HIV-infected population? Results from a meta-analysis of observational studies

Lin¹,

Zhang²,

He³

et al. 2019

BMC Public Health

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Background Socially disadvantaged groups, such as drug users, sex workers and homeless individuals, are labelled as “hard-to-reach” (HTR) in public health and medical research. HIV disproportionately impacts these populations, but data on how the HTR status could affect antiretroviral therapy (ART) adherence among HIV-positive people are limited and have not been previously synthesized in a systematic manner. We performed a meta-analysis to explore the association between HTR status and optimal antiretroviral therapy adherence in the HIV-infected population to provide evidence and recommendations regarding ART adherence improvement and HIV infection control and prevention among HTR people. Methods The PubMed, EMBASE, and Cochrance Library databases and the bibliographies of relevant studies were systematically searched up to December 2018. Full-text studies published in English were included, and no geographic or race restrictions were applied. Studies that quantitatively assessed the association between HTR status and optimal ART adherence among HIV-infected populations with a status of homelessness, sex work, or drug use were eligible for inclusion. We estimated the pooled odds ratios (ORs) of HTR characteristics related to ART adherence from each eligible study using a random effects model. The sensitivity, heterogeneity and publication bias were assessed. Results Our search identified 593 articles, of which 29 studies were eligible and included in this meta-analysis. The studies were carried out between 1993 and 2017 and reported between 1999 and 2018. The results showed that HTR status resulted in a 45% reduction in the odds of achieving optimal ART adherence compared to odds in the general population (OR = 0.55, 95% confidential intervals (CIs) 0.49–0.62), and this significant inverse association was consistently found regardless of study design, exposure measurement, adherence cut-off points, etc. Subgroup analyses revealed that the HTRs tend to be suboptimal adhering during a longer observational period. Conclusions HIV treatment adherence is extremely negatively affected by HTR status. It is crucial to develop appropriate interventions to improve ART adherence and health outcomes among HTR people who are HIV-infected. Electronic supplementary material The online version of this article (10.1186/s12889-019-7135-0) contains supplementary material, which is available to authorized users.

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HIV infection, high-risk behaviors and substance use in homeless men sheltered in therapeutic communities in Central Brazil

Cited by 9 publications

References 16 publications

Serosurvey of anti-Toxoplasma gondii and anti-HIV antibodies in homeless persons of southeastern Brazil

Serosurvey of anti-Toxoplasma gondii and anti-HIV antibodies in homeless persons of southeastern Brazil

Prevalence and Factors Associated With HIV in Homeless People

How does hard-to-reach status affect antiretroviral therapy adherence in the HIV-infected population? Results from a meta-analysis of observational studies

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HIV infection, high-risk behaviors and substance use in homeless men sheltered in therapeutic communities in Central Brazil

Cited by 9 publications

References 16 publications

Serosurvey of anti-Toxoplasma gondii and anti-HIV antibodies in homeless persons of southeastern Brazil

Serosurvey of anti-Toxoplasma gondii and anti-HIV antibodies in homeless persons of southeastern Brazil

Prevalence and Factors Associated With HIV&nbsp;in Homeless People

How does hard-to-reach status affect antiretroviral therapy adherence in the HIV-infected population? Results from a meta-analysis of observational studies

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Prevalence and Factors Associated With HIV in Homeless People