ABSTRACT
O Centro de Referência e Treinamento DST/Aids-SP da Secretaria de Estado da Saúde de São Paulo, inaugurou, em junho de 2009, em suas dependências, o primeiro ambulatório voltado exclusivamente à saúde integral de travestis e transexuais do país, com ênfase no processo transexualizador do Sistema Único de Saúde (SUS) e nas necessidades dessa população. Este artigo tem por objetivo apresentar as modalidades assistenciais ofertadas no serviço, as demandas da população atendida no ambulatório, suas vulnerabilidades, fatores de risco e resiliência a que está submetida, assim como as considerações e os desafios no campo da política pública voltada à população trans para promover seu acesso à atenção em saúde de forma acolhedora, livre de preconceito, julgamentos morais e práticas discriminatórias.
ABSTRACT
Resumo O objetivo deste trabalho é discutir os fatores determinantes da vulnerabilidade das mulheres negras a HIV/aids. Pela descrição e análise de dados socioeconômicos, de incidência e mortalidade de aids e da mortalidade de outras patologias, desenha-se o quadro epidemiológico que ressalta as iniquidades em saúde da população negra e, em particular, das mulheres desse segmento populacional. Quando comparadas às mulheres brancas, as negras apresentam, repetidamente, maior risco de adoecimento e morte. A discussão sobre violência sexual e doméstica reitera as disparidades e a maior vulnerabilidade social da mulher negra. As desigualdades socioeconômicas e o racismo institucional são as hipóteses explicativas para a alta vulnerabilidade às DST/aids das mulheres negras. Apenas com uma ampla gama de ações multissetoriais, incisivo enfrentamento do racismo institucional pelo Estado e fortalecimento do movimento social será possível iniciar a longa jornada para se alcançar o propalado princípio de equidade na saúde.
Abstract The aim of this paper is to discuss the determinants of the vulnerability of black women to HIV/AIDS. By describing and analyzing socioeconomic data, incidence and mortality by AIDS and other diseases, we have drawn an epidemiological framework that emphasizes health inequities of black people, particularly black women. When compared to white women, black women have repeatedly increased risk of illness and death. The discussion of sexual and domestic violence reiterates disparities and social vulnerability of the black women. Socioeconomic inequalities and institutional racism are explanatory hypotheses for the high vulnerability of black women to STD/AIDS. Only a wide range of multisectoral actions, incisive facing of institutional racism by the governments and strengthening of the social movement will allow the beginning of a long journey to reach the principle of equity in health.
Subject(s)
Humans , Female , Women's Health , Acquired Immunodeficiency Syndrome , HIV , Black People , Violence Against Women , Sexual Health , Socioeconomic Factors , Risk Groups , Mortality , Health Equity , Social Vulnerability , Racism , Human RightsABSTRACT
The impact of HIV on the decision to interrupt pregnancy remains an understudied topic in Brazil and the world. The technical means to implement HIV prevention and treatment interventions are widely available in Brazil. Although Brazil has restrictive abortion laws, induced abortion occurs frequently. This qualitative study investigates the extent to which Brazilian women are motivated to seek abortion as a consequence of having HIV disease, and the extent to which the decision is part of a larger reproductive decision-making context. Researchers interviewed 30 women who were living with HIV and had terminated pregnancies or attempted to do so. Many women identified their HIV status as an important aspect of their decision-making regarding abortion. Women also took into account issues such as the stage of life when the pregnancy occurred and the absence of support from partners and families. Contraceptive practices, pregnancy and abortion in this population are influenced by multiple factors that act on the structural, social, interpersonal and individual levels. We hypothesize that HIV infection and abortion are sometimes associated with similar contexts of vulnerability. Health services therefore should address HIV and reproductive issues together, with reproductive and sexual rights serving as the fundamental basis of health care.
Subject(s)
Abortion, Induced/psychology , Decision Making , HIV Infections/psychology , Motivation , Adolescent , Adult , Brazil/epidemiology , Contraception , Female , Health Personnel , Humans , Middle Aged , Qualitative Research , Reproductive Health Services/organization & administration , Young AdultSubject(s)
Coitus , Men , Homosexuality, Male , Public Policy , Disease Prevention , Sex , Acquired Immunodeficiency SyndromeABSTRACT
BACKGROUND: HIV infection in children is an important public health problem in the world, mainly in poorer countries. If all recommendations are followed, the elimination of HIV vertical transmission is a concrete possibility. This study aims to estimate vertical transmission rates of HIV in São Paulo State, Brazil, based on pregnant women diagnosed and reported in 2006, identifying potentially associated factors. METHODS: This study involves a retrospective cross-sectional analysis of information systems and records of infected pregnant women and children exposed to HIV. The rate of vertical transmission was estimated and variables associated with the antenatal, delivery, and postnatal periods were analyzed by the chi-square test, and Fisher exact test was used for variables with an expected frequency <5. The relative risks were calculated with 95% confidence intervals. RESULTS: The rate of vertical transmission in São Paulo state was 2.7% (95% confidence interval: 1.86 to 3.94) in 2006, decreasing 83.1% in comparison with 1988-1993. The main associated variables were lack of prenatal visits or <6 visits, no antiretroviral prophylaxis during labor or neonatal use for <6 weeks, and maternal breastfeeding. CONCLUSIONS: There is a decreasing trend of HIV vertical transmission in São Paulo with levels approaching elimination, which seems to be associated with antiretroviral policy and interruption of breastfeeding. Although there are serious operational issues, conditions exist to respond effectively. São Paulo state demonstrates that it is possible to achieve advanced levels of control for this mode of HIV transmission.
Subject(s)
HIV Infections/prevention & control , HIV Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Adolescent , Adult , Anti-HIV Agents/therapeutic use , Brazil , Breast Feeding , Cross-Sectional Studies , Female , Guideline Adherence , Humans , Incidence , Infant , Infant, Newborn , Middle Aged , Pregnancy , Retrospective Studies , Young AdultSubject(s)
Humans , HIV , Acquired Immunodeficiency Syndrome/prevention & control , Condoms , Hepatitis, Viral, Human , MarriageSubject(s)
Humans , Condoms , Hepatitis, Viral, Human , HIV , Marriage , Acquired Immunodeficiency Syndrome/prevention & controlABSTRACT
This study aimed to identify and compare the characteristics of women living (WLHA) and not living with HIV/AIDS (WNLHA) regarding the report of lifetime induced abortion. Data from 1,777 MVHA and 2,045 MNVHA were collected between November 2003 and December 2004 during a cross-sectional study carried out in 13 municipalities of Brazil. After adjustment for confounding variables, 13.3% of MVHA versus 11.0% of MNVHA reported induced abortion in their lifetime (p>0.05). In multivariate analysis, independent correlates of lifetime induced abortion for both groups were: age, with older women reporting greater proportions of reporting induced abortion, living in the North region of Brazil, age at sexual debut (up to 17 years old), having three or more lifetime sexual partners, having ever used drugs and self-reporting occurrence of sexually transmitted diseases. The results suggest that, in general, the characteristics of women who reported induced abortion in both groups were similar, and that the contexts associated to HIV infection and to reproductive practices and decisions among women might share similarities.
Subject(s)
Abortion, Induced/statistics & numerical data , HIV Infections , Acquired Immunodeficiency Syndrome , Adolescent , Adult , Brazil , Female , Humans , Middle Aged , Young AdultABSTRACT
This article aims to identify contexts of vulnerability related to HIV among Brazilian women. From November 2003 to December 2004, a cross-sectional study was conducted in 13 municipalities in the five Brazilian regions. The study included 1,777 women with a positive HIV diagnosis and 2,045 women attending public health care services. There were no significant differences between the two groups concerning number of sexual partners. However, HIV-positive women had a history of earlier sexual initiation and lower frequency of condom use. Higher proportions of HIV-positive women had used drugs, had a history of previous STDs, and had been victims of sexual violence some time in their life. The findings suggest the importance of considering strategies for HIV prevention focused on women's empowerment as a whole, and not focused only on their individual behaviors.