Variability in life expectancy among people with HIV in Brazil by gender and sexual orientation

Abstract Introduction In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. Methods Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. Results With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. Conclusions In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities.

Quando corpos dissidentes proclamam seus lugares como corpos diz-sonantes / When dissident bodies proclaim their places as dissonant bodies

Resumo O objetivo deste ensaio é apresentar o conceito de corpos diz-sonantes e dar visibilidade a esses corpos no campo da saúde coletiva, a partir de perspectivas anti-coloniais e queers. São corpos muitas vezes considerados dissidentes, cujas existências consideradas abjetas, descartáveis e marginalizadas, pela sociedade neoliberal e necropolítica são apresentadas como outras possibilidades frente às lógicas e estratégias políticas de reprodução hegemônica da vida-capital e nas políticas de saúde. Debate tensionamentos de novas possibilidades e alternativas de modos outros de existências e de mundos inclusivos, em que todas as vidas sejam consideradas, em suas singularidades e diferenças, radicalmente iguais na validação dos seus modos de viver.

Abstract This essay aims to present the concept of dissonant bodies and give visibility to these bodies in the field of public health from anti-colonial and queer perspectives. These bodies are often considered dissidents. Their existence is considered abject, disposable, and marginalized by neoliberal and necropolitical society. It is presented as another possibility in the face of the logic and political strategies of hegemonic reproduction of capital-life and health policies. It debates tensions of new possibilities and alternatives of other modes of existence and inclusive worlds, in which all lives are considered, in their singularities and differences, radically equal in the validation of their ways of living.

Recorte raça/cor dos indicadores materno-infantis em uma regional de saúde do estado de Goiás / Race/color breakdown of maternal and child indicators in a regional health in the state of Goiás

Embora o Sistema Único de Saúde tenha os princípios de universalidade e equidade, parcelas da sociedade possuem acesso deficiente aos serviços prestados, dentre elas, pessoas de grupos étnico-raciais com ancestralidade negra. Estudos anteriores mostraram prejuízos na assistência materna e infantil, com pior cuidado oferecido às mães pardas e pretas no Brasil. Objetivos: Avaliar indicadores materno-infantis da Regional Nordeste I de Goiás entre 2011 e 2021, com recorte raça/cor. Métodos: Trata-se de um estudo ecológico, com dados coletados do Departamento de Informática do Sistema Único de Saúde (DATASUS). Foram realizadas estatísticas descritiva e analítica dos indicadores materno-infantis da regional, com comparação entre os grupos de raça/cor. Resultados: Observou-se piora dos indicadores materno-infantis nas mulheres pretas e indígenas, com maiores porcentagens de partos pós-termo e filhos com baixo peso ao nascer, quando comparadas às mulheres brancas e pardas. Apenas 54,56% das gestantes realizaram 6 ou mais consultas de pré-natal, o que provavelmente foi a causa de uma alta prevalência de sífilis congênita local. Mantém-se baixa adesão em consultas de puerpério e puericultura. Observou-se grande incompletude dos dados sobre raça/cor no DATASUS. Conclusões: A falta de adesão das gestantes e mães às consultas de pré-natal, puerpério e puericultura foi a principal falha observada na regional. A falta de vínculo entre equipes de saúde e usuárias do SUS, alta prevalência de famílias carentes e de residentes de zonas rurais na região dificultam o acesso aos serviços de saúde e a continuidade do cuidado

Although Brazil's universal health system has the principles of universality and equity, parts of society have poor access to the services provided, including people from ethnic-racial groups with black ancestry. Previous studies have shown losses in maternal and child care, with worse care offered to brown and black mothers in Brazil. Objectives: To evaluate maternal and child indicators in the Northeast I region of Goiás between 2011 and 2021, with a race/color breakdown. Methods: This is an ecological study, with data collected from the Department of Informatics of the Unified Health System (DATASUS). Descriptive and analytical statistics were carried out on the region's maternal and child indicators, with a comparison between race/color groups. Results: A worsening of maternal and child indicators was observed in black and indigenous women, with higher percentages of post-term deliveries and children with low birth weight, when compared to white and brown women. Only 54.56% of pregnant women had 6 or more prenatal consultations, which is probably the reason for the high prevalence of congenital syphilis locally. Adherence to puerperium and childcare appointments remains low. The data on race/color in DATASUS was very incomplete. Conclusions: Lack of adherence by pregnant women and mothers to prenatal, puerperium and childcare appointments was the main shortcoming observed in the region. The lack of links between health teams and SUS users, the high prevalence of poor families and rural residents in the region make access to health services and continuity of care difficult

Impact of COVID-19 public health responses on income, food security and health services among key and vulnerable women in South Africa

Globally, COVID-19 has impacted lives and livelihoods. Women living with HIV and/or at high risk of acquiring HIV are socially and economically vulnerable. Less is known of the impact of COVID-19 public health responses on women from key and vulnerable populations. The purpose of this cross-sectional survey conducted in four South African provinces with a high burden of HIV and COVID-19 from September to November 2021 was to advance understanding of the socio-economic and health care access impact of COVID-19 on women living with HIV or at high risk of acquiring HIV. A total of 2 812 women >15 years old completed the survey. Approximately 31% reported a decrease in income since the start of the pandemic, and 43% an increase in food insecurity. Among those accessing health services, 37% and 36% reported that COVID-19 had impacted their access to HIV and family planning services respectively. Economic and service disruptions were enhanced by living in informal housing, urbanisation and being in the Western Cape. Food insecurity was increased by being a migrant, having fewer people contributing to the household, having children and experience of gender-based violence. Family planning service disruptions were greater for sex workers and having fewer people contributing to the household. These differentiated impacts on income, food security, access to HIV and family planning services were mediated by age, housing, social cohesion, employment and household income, highlighting the need for improved structural and systemic interventions to reduce the vulnerability of women living with HIV or at high risk of acquiring HIV.