The Dynamics of the Human Immunodeficiency Virus Epidemics in the South of Brazil: Increasing Role of Injection Drug Users

Abstract

Changes in human immunodeficiency virus (HIV) infection among injection drug users (IDUs) are provoking a shift in the pattern of the HIV/AIDS epidemic in some regions of Brazil. IDUs living in 2 cities (Porto Alegre and Itajaí) in southern Brazil were contacted, interviewed, and tested for HIV. In 1998, 187 IDUs were surveyed and, in 2000, 352 IDUs. In Porto Alegre, HIV seroprevalence, age, and duration of injection history increased significantly over time. In contrast, a trend toward decline was observed in Itajaí. Homelessness, joblessness, and prison incarceration, as well as lifetime needle sharing, also increased over time in Porto Alegre. At the time of the study, at both sites, rates of needle sharing and condom use were similar, but use of syringe exchange programs, health and drug treatment, and HIV testing had increased over time. IDUs living in southern Brazil are at increased risk of HIV infection, indicating the continued need for permanent surveillance and preventive strategies.

Reconstructing the AIDS epidemic among injection drug users in Brazil

“…Our findings for AIDS incidence (which reflect epidemics of HIV transmission occurring several years earlier) are also supported and extended by individual-level studies, documenting persistently high HIV infection rates in southern municipalities 25,26 . The main difference between our findings (based on AIDS Table 1 Coefficient and confidence interval of variables in the final multilevel model.…”

“…Neperian logarithm of standardized rate versus standard distance to the State capital (km), 1986-2000. data) and those from studies reporting HIV infection rates in the late 1990s through 2000 relates to Porto Alegre, the capital of Rio Grande do Sul. In Porto Alegre, our analyses suggest a decline in incidence, in contrast to the disquieting increase among IDUs, recruited in local communities in 1998 and 2000 26 and a high HIV incidence among non-injecting heavy cocaine users from a cohort followed from 1996 to 1998 25 . However, both our findings and inferences are based on non-random samples of hard-to-reach populations and should thus be viewed with caution.…”

The contribution of two Brazilian multi-center studies to the assessment of HIV and HCV infection and prevention strategies among injecting drug users: the AjUDE-Brasil I and II Projects

“…Methods and procedures used in the two studies have been described in various publications 5,6,7,8,9,10,11,12 . They will be summarized to introduce the analyses conducted herein and the respective findings, as well as to provide an overview of the two studies, which provide the material for several articles in this same thematic issue.…”

AIDS incidence and mortality in injecting drug users: the AjUDE-Brasil II Project

“…In some cities or regions, especially in the South, injecting drug users (IDUs) constitute an important component of the epidemic. In the southernmost State capital city, Porto Alegre, HIV prevalence among IDUs has reached 65% 2,3 .…”