Safe sexual behaviour among female partners of HIV-infected men in Rio de Janeiro, Brazil.

A cross-sectional study was designed to assess safe sexual behaviour among heterosexual couples after the woman learned of her partner's infection with HIV. Female partners who had known their partners' serostatus for at least 4 weeks were eligible for participation. Couples were interviewed separately and independent predictors of safe sexual behaviour were identified using multiple logistic regression. Safe sexual behaviour was defined as no unprotected vaginal, oral, or anal intercourse. Of 328 women, 197 (60%) reported safe sexual behaviour since learning of their partners' infection. Significant independent predictors of safe sexual behaviour included older women (>30 years old) (odds ratio [OR]=1.89; 95% confidence intervals [CI]=1.01-3.51), current negative HIV serostatus (OR=2.72; 95% CI=1.50-4.94), advanced clinical stage of the index case (OR=1.96; 95% CI=1.07-3.59), longer duration of relationship (10+ years) (OR= 2.35; 95% CI=1.15-4.82), fewer sex contacts (<100) (OR=2.01; 95% CI=1.14-3.56), only one lifetime partner (OR=2.29; 95% CI=1.26-4.17), non-smoking (OR=2.67; 95% CI=1.43-4.99), not practising oral sex (OR=3.35; 95% CI=1.82-6.19) and previous HIV testing (OR=2.11; 95% CI=1.09-4.07). In addition, women who had known their partner's infection for longer were less likely to report safe sexual behaviour (P < 0.001). Our results indicate that among female partners of HIV-positive Brazilian men, learning of their partner's infection does not uniformly result in safe sexual behaviour. Counselling must emphasize disclosure of serostatus to female partners and target couples with short-term relationships, as well as those where the woman has known about her male partner's infection for a long time, because these are the least likely to maintain safe sexual behaviour.

A follow-up study of morbidity and mortality associated with hepatitis C virus infection and its interaction with human T lymphotropic virus type I in Miyazaki, Japan.

A follow-up study was performed to analyze the effects of hepatitis C virus (HCV) infection on morbidity and mortality in the adult population from a village in Japan found to have endemic levels of both HCV and human T lymphotropic virus type I (HTLV-I). By use of the Cox proportional hazards model, rate ratios (RRs) and 95% confidence intervals (CIs) were estimated. Strong, significant effects of seropositivity for antibodies to HCV on self-reported incident liver disease (RR, 3.5; 95% CI, 1.9-6.4) and on death due to liver cancer (RR, 8.2; 95% CI, 1.6-41.4) were observed. Dual infection with HCV and HTLV-I seemed to have a synergistic effect on incident liver disease (RR, 5.9) as well as on death from liver cancer (RR, 21.9). HCV infection also was positively, although not significantly, associated with reported incident diabetes. Our findings suggest that coinfection with HTLV-I may affect the course of HCV-associated disease.

Infection with hepatitis B and C viruses, social class and cancer.

The hepatitis B and C viruses (HBV and HCV) are major etiological factors in the occurrence of hepatocellular carcinoma (HCC) worldwide, but most especially in developing countries where the majority of liver cancer cases can be found. In parallel with the geographic distribution of HCC, high levels of HBV endemicity are concentrated in the developing world. The association between chronic infection with HBV and low social class is quite strong; socioeconomic factors such as low educational attainment, lower social stratum, and crowded urban residence have been reported to predict higher HBV chronic carrier prevalence in both developed and developing countries. More importantly, the effect of poverty on HBV endemicity is clearly evident among younger age groups, and earlier chronic HBV infection seems to increase the risk of development of HCC. As assays for detecting HCV antibodies have only recently become available, the data on the relationship between HCV infection and socioeconomic status are much fewer. However, the limited number of studies that have investigated the seroepidemiology of HCV report an association between higher prevalence of antibodies to HCV and indicators of low social class. It would appear that the striking correlation between HCC and low socioeconomic status is largely related to the impact of poverty on the spread of HBV and probably HCV.

HIV infection among female partners of seropositive men in Brazil. Rio de Janeiro Heterosexual Study Group.

A heterosexual partner study was carried out in Rio de Janeiro, Brazil, from August 1990 to December 1991. The main objectives were to determine the rate of male-to-female transmission of human immunodeficiency virus (HIV) and to determine risk factors. Male index cases were recruited according to the following criteria: 1) confirmed HIV positivity, 2) 18 years old or older; 3) heterosexual contact within the past year. Only female partners who reported not to have other risk factors but to have had sexual contact with the index case were invited to participate. Couples were interviewed for risk factors and had blood collected for laboratory studies. The overall prevalence of HIV infection was 45 percent among 204 female partners in the study. Using logistic regression, the authors found the following factors to be independently (p < 0.05) associated with HIV infection: 1) anal sex (odds ratio (OR) = 3.74, 95% confidence interval (CI) 1.87-7.45); 2) condom use during vaginal sex sometimes (OR = 1.45, 95% CI 1.07-1.96), rarely (OR = 2.10, 95% CI 1.15-3.83), or never (OR = 3.04, 95% CI 1.23-7.50) as compared with always; 3) frequency of sexual contacts in the year prior to interview (100+) (OR = 2.00, 95% CI 1.03-3.91); and 4) oral contraceptive use (OR = 2.04, 95% CI 0.97-4.29). In addition to a borderline significance of oral contraceptive use, there was a strong suggestion of an interaction with history of sexually transmitted diseases.

[The hidden face of AIDS in Brazil]. / O Não-dito da AIDS.

The authors report on the evolution of the AIDS epidemic in Brazil from the point of view of the construction of social representations about "risk groups" involved in the spread of the disease. They emphasize the need to demystify the immediate correlation between AIDS and homosexual transmission. They highlight the role of intravenous drug users and of heterosexual transmission in new AIDS cases in Brazil - groups and behaviours that are not included in the priorities of local health authorities.