{"id":67306,"date":"2012-10-19T18:00:29","date_gmt":"2012-10-19T21:00:29","guid":{"rendered":"http:\/\/revistapesquisa.fapesp.br\/?p=67306"},"modified":"2017-03-03T16:22:57","modified_gmt":"2017-03-03T19:22:57","slug":"aids-still-far-from-under-control","status":"publish","type":"post","link":"https:\/\/revistapesquisa.fapesp.br\/en\/aids-still-far-from-under-control\/","title":{"rendered":"AIDS still far from under control"},"content":{"rendered":"
\"\"

Leonilson\/Photograph Edouard Fraipont<\/span>Jogos perigosos (Dangerous games) (left), c. 1990, acrylic on canvas, 50 x 60 cm – text loosely translated: These dangerous games are not war, nor are they in the sea or in space, but behind a pair of glasses and jeansLeonilson\/Photograph Edouard Fraipont<\/span><\/p><\/div>\n

Healthcare professionals are worried about the silent march of AIDS. The most recent cause for concern are the results of a survey interviewing 1,217 patrons at bars, movie theaters, and nightclubs in Rep\u00fablica and Consola\u00e7\u00e3o, two neighborhoods in downtown S\u00e3o Paulo. The study found high rates of infection with the HIV virus, which causes AIDS, especially among young gays. It also revealed situations that leave these individuals very vulnerable to infections and detected gaps in prevention strategies for a disease that remains a public health challenge, with 37,000 new cases appearing in Brazil every year, 7,000 in the state of S\u00e3o Paulo alone.<\/p>\n

Of interviewees between the ages of 18 and 24, 6.4% were infected with the HIV virus \u2013 a rate about 50 times greater than the national average for this age bracket. Among interviewees in the 18- to 19-year-old range, the infection rate was 5%, suggesting that these individuals were infected during their first two years of sexual activity. Looking at all age brackets, the overall infection rate was 15% for HIV and 18% for syphilis, another sexually transmitted disease (STD).<\/p>\n\n\n\n
Leonilson<\/strong>
\nThe artist Jos\u00e9 Leonilson Bezerra Dias was born in Fortaleza, Cear\u00e1, in 1957. The overriding theme of his work became AIDS in 1991, when he discovered he had HIV\/AIDS. Leonilson died in 1993.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u201cThese are unacceptably high numbers,\u201d states Maria Am\u00e9lia Veras, professor at the School of Medical Sciences at S\u00e3o Paulo\u2019s Santa Casa Hospital and one of the research project coordinators. Known as SampaCentro, the study has brought together researchers from Santa Casa\u2019s School of Medical Sciences, the S\u00e3o Paulo State Department of Health, the State University of Campinas (Unicamp), the University of S\u00e3o Paulo (USP), the Adolfo Lutz Institute, the Oswaldo Cruz Foundation (Fiocruz), and nongovernmental organizations (NGOs). \u201cWhat we saw reflects what is also happening in other regions of the city and in other cities,\u201d says Gabriela Calazans, professor at Santa Casa, researcher at the S\u00e3o Paulo State Department of Health\u2019s Reference and Training Center on Sexually Transmitted Diseases and AIDS, and another coordinator on the project.<\/p>\n

The Ministry of Health has recorded an increase in the infection among gays between the ages of 17 and 22 \u2013 from 0.56% in 2002 to 1.2% of the total number of infected individuals in 2007 \u2013 but, according to the research coordinators, the social and sexual habits of gays and bisexuals have not been examined in depth in S\u00e3o Paulo since the Bela Vista Project, about ten years ago.<\/p>\n

The locations surveyed in the study are patronized mainly by gays (80% of those interviewed). These areas are also frequented by men who have sex with other men but do not consider themselves homosexuals, as well as men who have relations with women. This highlights the need for specific preventive initiatives among all groups. Statistical records indicate 608,230 cases of AIDS in Brazil from 1980 to June 2011, with a growing incidence among women, who are primarily infected through heterosexual contact. According to the Ministry of Health, there was one case of AIDS among women for every 26 among men in 1985; by 2010, the proportion had shifted to one case among women for every 1.7 among men.<\/p>\n

Fear and discrimination <\/strong>
\nThirty years after S\u00e3o Paulo and other states registered their first cases, AIDS is now less visible, as it is no longer an incurable disease with a high mortality rate. In many ways, however, little seems to have changed. While there is no more talk of \u201crisk groups\u201d \u2013 a public health concept that in the early days of the epidemic incited discrimination even among those who were not infected \u2013 the groups now referred to as \u201cmore vulnerable\u201d are still victims of discrimination at school, at work, within their families, and among their circles of friends, as this study bears out. There is continued concern over the risks of HIV infection but prevention does not always seem possible. People who might have the infection tend to put off being tested for the virus out of fear of suffering the consequences of a disease whose treatment remains an arduous ordeal. Condom use is still the safest and cheapest way of avoiding infection, but it isn\u2019t always promoted and therefore isn\u2019t always adopted by young people and other segments who are more exposed to the infection.<\/p>\n

\"062-067_AIDS_200-1A_novo\"<\/a>Almost half (43%) of those interviewed said they had at least a college education, indicating that they did not catch the virus or run the risk of doing so because they lacked access to information. Almost all interviewees recognized that there is a high (69%) or moderate (28%) risk of contracting HIV during gay sex, but awareness of this risk did not always translate into actions that could avoid infection: almost one-third (29%) of those interviewed reported that it was difficult to use a condom when they were in love, and 13% find it hard to tell their partner that they want to use a condom.<\/p>\n

\u201cIn the context of life and relationships, there isn\u2019t always room to adopt the prevention measures that can keep the virus from being transmitted to other people,\u201d says Calazans. She draws a parallel with the prevention of diseases like high blood pressure, diabetes, or obesity: \u201cEven though we know we should change our diets and engage in physical activities, it\u2019s not always easy to incorporate these changes into our lives.\u201d<\/p>\n

In most of the 73 places visited, interviewers found no posters or materials on methods for preventing infection or recommending screening tests for HIV or other STDs. \u201cSeveral managers said that the public needs to know more about AIDS prevention measures,\u201d Calazans pointed out. \u201cA few said our work would bother their business and they wouldn\u2019t let the interviewers in, arguing that their customers were there to have fun and didn\u2019t want to hear about sickness. Barriers like this were more common in places catering to higher socioeconomic classes.\u201d<\/p>\n

From November 2011 to January 2012, 34 interviewers usually worked from about 10 pm to 2 am to get to know the habits and fears of gays, heterosexuals, and bisexuals. When they approached someone, they would ask a simple question \u2013\u00a0 \u201cCan you take part in a survey?\u201d \u2013 followed immediately by an incisive one: \u201cHave you ever had anal or oral sex with a gay or transvestite?\u201d<\/p>\n

\"062-067_AIDS_200-1B_novo\"<\/a>After the interview, which averaged 45 minutes, the interviewers invited the interviewees to give a finger-stick blood sample to check for HIV. Of the 1,217 interviewees, 778 took the test but only 282 picked up the results at the Department of Health\u2019s Reference and Training Center on STDs and AIDS, in Vila Mariana. Of the 235 who took the syphilis and hepatitis B and C tests, 172 went to get their results. \u201cMany of the participants agreed to have the test as a way of contributing to the production of knowledge that might redirect the development of public health policies for the group, but they said up front that they weren\u2019t interested in picking up the results, in many cases because they already knew what they\u2019d be, but also because they were afraid,\u201d Calazans says.<\/p>\n

\u201cMainly among men who have sex with men, the fear of knowing that you\u2019re positive appears as the biggest reason for not having the test or not wanting to know the result,\u201d stated Veras when she presented the study\u2019s findings on the morning of August 30 at a congress on AIDS prevention in S\u00e3o Paulo. \u201cIf the test result is positive, it can augment discrimination and social isolation.\u201d<\/p>\n

Questionable stabilization<\/strong>
\n\u201cToday\u2019s young people hadn\u2019t seen the face of AIDS when we started prevention work at schools,\u201d says Vera Paiva, coordinator of the Nucleus for AIDS Prevention Studies (NEPAIDS) and professor at USP\u2019s Institute of Psychology.\u00a0 Anyone born post-1990 has probably only heard tell of the terror of the early days of AIDS, in the 1980s, when neither doctors nor patients knew what the disease was or what caused it. There was no medicine for it until the mid-1990s, and so when people with AIDS got to the hospital, they knew they\u2019d be placed in an isolation wing and would die within a few weeks or, at most, months.<\/p>\n

\u201cAt the onset of the epidemic, in the midst of the panic, as women teachers, parents, and members of the clergy grew convinced of the need for psycho-educational work that fostered prevention, it was easier to work with schools,\u201d says Paiva. \u201cBut many administrators today restrict prevention efforts at schools, even though 97% of Brazilians, from all social groups, have expressed support for educating adolescents in school about the use of condoms. It was also the work at schools that achieved the celebrated stabilization of epidemic growth.\u201d<\/p>\n

\"062-067_AIDS_200-3\"<\/a>For Paiva, the notion promoted by the Ministry of Health that the epidemic has been stabilized \u201cshouldn\u2019t be commemorated, especially not to the extent that it is.\u201d \u201cWe wanted to get rid of inflation, not control it,\u201d she offers as way of comparison. \u201cWe can\u2019t be content seeing infection rates at high levels. The misguided celebration of stabilization, today\u2019s homophobia, and the intensification of religious discourse can undo decades-long mobilization and prevention work.\u201d Activists, people with AIDS and their friends and family, researchers, and physicians relentlessly and successfully worked together to stem the epidemic\u2019s advance through prevention methods until the late 1990s, when the first AIDS medications began to be distributed.<\/p>\n

At the same time, numerous teams worked steadfastly at research institutes and universities to help fight the epidemic. One of the milestones in this endeavor was identification of the HIV virus in Brazil in 1987, as a result of work by immunologist Bernardo Galv\u00e3o, a native of the state of Bahia, and his team at the Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro (see<\/em> Pesquisa FAPESP\u00a0n\u00ba\u00a0118<\/em><\/a>). In the years that followed, other groups started identifying the most common HIV subtypes in the country, thus contributing to the enhancement of medical treatment.<\/p>\n

\u201cResignation\u201d<\/strong>
\nOn August 21, the manifesto \u201cAIDS no Brasil hoje \u2013 o que nos tira o sono<\/em>\u201d (AIDS in Brazil today: what keeps us awake) began circulating on the Internet and was later debated at the congress held in S\u00e3o Paulo. The title was an allusion to a comment made by Dirceu Greco, director of the Ministry of Health\u2019s Department of STDs, AIDS, and Hepatitis. At the international AIDS conference held in Washington DC, he remarked that he wasn\u2019t losing any sleep over the disease in Brazil.<\/p>\n

The document \u2013 which in just a few days had nearly 370 signatures, headed by that of Vera Paiva, of NEPAIDS \u2013 declared: \u201cThe affirmation that the AIDS epidemic is under control in Brazil is not only fallacious, it has compromised our national response, depoliticizing the discussion and discouraging international investments. If in the past affirming that we had the world\u2019s best AIDS program legitimized audacious decisions that were previously a mark of the Brazilian program and yielded so many benefits for the public, what we have today is, inversely, an outdated program, whose components are not enough to address the epidemic\u2019s national profile.\u201d The document showed a 10% rise in the number of AIDS deaths (from 11,100 in 2005 to 12,073 in 2010) and of 12% in the number of cases (from 33,166 in 2005 to 37,219 in 2010).<\/p>\n

\"El

LEONILSON; FOTO EDOUARD FRAIPONT<\/span>El Puerto<\/em> (The door), c. 1992, embroidery on cotton cloth and mirrored frame, 23 x 16 cmLEONILSON; FOTO EDOUARD FRAIPONT<\/span><\/p><\/div>\n

\u201cIt seems like different actors grew resigned in their responses to the epidemic,\u201d observed Ivo Brito, coordinator of the prevention unit of the Health Ministry\u2019s national STD and AIDS program, at one of the congress debates. \u201cWe were looking at general trends, not at specificities or micro-areas, which very often revealed quite different data. AIDS is not a single epidemic; it\u2019s a set of epidemics, a mosaic, displaying unique features.\u201d<\/p>\n

And now what do we do?<\/strong>
\n\u201cYou can\u2019t tackle the prevention of sexually transmitted diseases without recognizing that there is a broad diversity of behaviors, sexual orientations, and ways that people satisfy their desires,\u201d Veras emphasizes. She reports that her team has been meeting with representatives of the government and NGOs to ensure that their analyses help to guide initiatives that are able to curb AIDS and other STDs. \u201cWe have to be creative and expand prevention actions,\u201d she says. Veriano Terto Junior, general coordinator of the Brazilian Interdisciplinary AIDS Association (ABIA), one of the area\u2019s oldest NGOs, agrees: \u201cA single prevention strategy \u2013 recommending condom use \u2013 has not been enough.\u201d<\/p>\n

Experts recognize the urgent need to broaden access to condoms, testing, and healthcare services and reinforce counseling efforts on how to prevent infection and expand prevention strategies. One of the latest ideas, heavily debated in recent months, is the use of antivirals that could be taken before or shortly after exposure to situations where there is a risk of infection. Experts stress, however, that this potential new preventive treatment is still under evaluation and it is not clear what groups might best be served by it or how it would effectively work.<\/p>\n

Working more intensely with groups that are more vulnerable to HIV infection seems to be a priority once again. Paulo Roberto Teixeira, advisor to the state STD-AIDS program in S\u00e3o Paulo, had made this recommendation right at the outset of the epidemic, as noted in the book AIDS \u2013 A epidemia<\/em> (AIDS \u2013 The epidemic), published in 1987. On the last day of the AIDS congress in S\u00e3o Paulo, he stated: \u201cWe\u2019re all dissatisfied with what we\u2019ve managed to accomplish so far.\u201d<\/p>\n

Over the past ten years, according to Teixeira, there has been no change in prevalence, which remains high among gays, men who have sex with men, and prostitutes. \u201cIn the last ten years, since the epidemic acquired its current profile of pauperization, interiorization, and heterosexualization, have preventive measures suffered? Has the effort to de-characterize risk groups and say that AIDS belongs to all of us reduced intervention among more vulnerable groups? We have to re-assess.\u201d<\/p>\n

Another substantial challenge is how to identify and treat women with HIV\/AIDS. Marli Cassamassimo Duarte studied the prevalence of STDs in 184 women with HIV between the ages of 18 and 67 seen at the infectology clinic at the Botucatu School of Medicine of S\u00e3o Paulo State University (Unesp). Of the total, 84% had been infected by their current or previous partner; 83% presented the human papillomavirus (HPV), which causes cervical cancer; and 24.6% had chlamydia, a bacterial STD. \u201cThe high rate of STDs is indicative of unprotected sex and promotion of the transmission chain,\u201d concluded Duarte. As these microorganisms increase the risk of HIV infection, she suggests: \u201cScreening for sexually transmitted diseases should be reinforced at basic healthcare units.\u201d<\/p>\n

Project<\/strong>
\n<\/em>Sexual behaviors and practices, access to prevention, and the prevalence of HIV and other sexually transmitted infections among gays, transvestites, and men who have sex with men (MSM) in the central region of S\u00e3o Paulo\u00a0<\/em>(n\u00ba 09\/53082-9<\/a>);\u00a0Grant mechanism\u00a0<\/strong>Public Policy Research for the National Healthcare System (SUS);\u00a0Coordinator<\/strong>\u00a0Maria Am\u00e9lia de Sousa Mascena Veras \u2013 School of Medical Sciences of Santa Casa Hospital in S\u00e3o Paulo;\u00a0Investment<\/strong>\u00a0R$359,124.00 (FAPESP).<\/p>\n","protected":false},"excerpt":{"rendered":"High infection rates reveals weak spots in prevention strategies ","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[159],"tags":[229,260],"coauthors":[5968],"class_list":["post-67306","post","type-post","status-publish","format-standard","hentry","category-science","tag-epidemiology","tag-public-health"],"acf":[],"_links":{"self":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/67306","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/comments?post=67306"}],"version-history":[{"count":0,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/67306\/revisions"}],"wp:attachment":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/media?parent=67306"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/categories?post=67306"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/tags?post=67306"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/coauthors?post=67306"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}