Desire for a child among women living with HIV/AIDS in northeast Brazil.

In Brazil, an increasing proportion of new HIV infections and AIDS cases involve women of reproductive age. To describe the reproductive desire of women with HIV/AIDS and to identify factors associated with the desire for motherhood, a cross-sectional study was carried out in the referral hospital for infectious diseases in Ceará State, northeast Brazil. In total, 229 women were included in data analysis. Median age was 32 years (interquartile range, 26-37), and 63% had a monthly family income of less than 210 USD. Forty-nine percent were using a contraceptive method, and 37% wished to undergo tubal ligation. Sixty-four percent of the latter women were motivated by the fear of having an HIV-positive child. Forty percent of the participants wanted to have a child. In the multivariate regression analysis, variables independently associated with women's desire to have a child were: younger age (in years, odds ration [OR] = 0.94; 95% confidence interval [CI]: 0.90-0.98), number of children (OR = 0.73; 95% CI: 0.57-0.96), and partner's desire for a child (OR = 3.35; 95%CI: 1.75-6.39). Having a partner who did not know about the woman's positive serostatus was negatively associated with the woman's desire for a child (OR = 0.17; 95% CI: 0.04-0.69). No variable related to clinical status was significantly associated with the outcome variable. Our data showed that many unsterilized HIV-positive women in northeast Brazil, at whatever stage of illness, have a desire for children. We recommend that nondirective counseling, consisting of helping women evaluate their own feelings, goals and needs with respect to reproductive options be provided.

Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case-control study.

BACKGROUND: Brazil reports almost 80% of all leprosy cases in the Americas. This study aimed to identify socioeconomic, environmental, and behavioural factors associated with risk of leprosy occurrence in the endemic North-eastern region. METHODS: A case-control study in four municipalities. CASES: cases of leprosy diagnosed in the previous 2 years, with no other known, current, or past case of leprosy in the household or in the neighbourhood. CONTROLS: individuals presenting for reasons other than skin problems to the health unit where the case was diagnosed and who lived in the same municipality as the case with whom it was matched. For each case four controls were selected. A semi-structured questionnaire was used to collect demographic, socioeconomic, environmental, and behavioural data. A multivariate hierarchical analysis was performed according to a previously defined framework. RESULTS: 226 cases and 857 controls were examined. Low education level, ever having experienced food shortage, bathing weekly in open water bodies (creek, river and/or lake) 10 years previously, and a low frequency of changing bed linen or hammock (>or=biweekly) currently were all significantly associated with leprosy. Having a BCG vaccination scar was found to be a highly significant protective factor. CONCLUSIONS: Except for BCG vaccination, variables that remained significant in the hierarchical analysis are cultural or linked to poverty. They may act on different levels of the transmission of Mycobacterium leprae and/or the progress from infection to disease. These findings give credit to the hypothesis that person-to-person is not the only form of M. leprae transmission, and that indirect transmission might occur, and other reservoirs should exist outside the human body.

Survival of adult AIDS patients in a reference hospital of a metropolitan area in Brazil.

OBJECTIVE: To evaluate the influence of sociodemographic, clinical, and epidemiological factors in AIDS patients survival in a reference hospital. METHODS: A sample of 502 adult AIDS patients out of 1,494 AIDS cases registered in a hospital in Fortaleza, Brazil, was investigated between 1986 and 1998. Sixteen cases were excluded due to death at the moment of the AIDS diagnosis and 486 were analyzed in the study. Socioeconomic and clinical epidemiological were the variables studied. Statistical analysis was conducted using the Kaplan-Meier survival analysis and the Cox proportional hazards model. RESULTS: Three hundred and sixty two out of the 486 patients studied took at least one antiretroviral drug and their survival was ten times longer than those who did not take any drug (746 and 79 days, respectively, p <0.001). Patients who took two nucleoside reverse transcriptase inhibitors (NRTI) plus protease inhibitor were found to have higher survival rates (p <0.001). The risk of dying in the first year was significantly lower for patients who took NRTI and a protease inhibitor compared to those who took only NRTI. In addition, this risk was much lower from the second year on (0.10; 95%CI: 0.42-0.23). The risk of dying in the first year was significantly higher for less educated patients (15.58; 95%CI: 6.64-36.58) and those who had two or more systemic diseases (3.03; 95%CI: 1.74-5.25). After the first year post-diagnosis, there was no risk difference for these factors. CONCLUSIONS: Higher education revealed to exert a significant influence in the first-year survival. Antiretroviral drugs had a greater impact in the survival from the second year on. A more aggressive antiretroviral therapy started earlier could benefit those patients.

Homo/bissexualidade masculina: um estudo sobre práticas sexuais desprotegidas em Fortaleza / Male homo/bisexuality: a study about unprotected sexual intercourse in Fortaleza, Brazil

Estudo transversal realizado junto a 400 homens de prática homo/bissexual onde se buscou analisar fatores relacionados ao envolvimento em relaçöes sexuais desprotegidas, entre homo/bissexuais masculinos de Fortaleza (CE), no período de maio a agosto de 1995. Os dados foram coletados através de quetionário semi-estruturado, aplicado por 10 entrevistadores. Os entrevistados foram agrupados em 5 classes sociais e 4 faixas etárias. Foi realizada uma análise univariada entre a variável dependente (envolvimento com Relaçöes Sexuais Desprotegidas - RSD) e os fatores predisponentes a estas, através de teste exato de Fischer. Dentre estes fatores, aqueles que se mostraram significativos foram incluídos na análise multivariada, através de regressäo logística. Quarenta e sete por cento dos entrevistados se envolveram com relaçöes sexuais desprotegidas (RSD) e os fatores relacionados a este envolvimento foram: näo possuir informaçöes básicas sobre transmissäo do HIV/AIDS, ter tido uma freqüência de relaçäo sexual com outro homem maior ou igual a 1 vez no mês nos últimos 12 meses, ter tido 1 ou mais contatos sexuais com mulheres nos últimos 12 meses, sentir-se muito excitado com sexo desprotegido, mostrar atitudes negativas em relaçäo ao Sexo Mais Seguro, näo conhecer alguém com AIDS e a näo participaçäo em organizaçöes homossexuais. Um contingente ainda grande de homens com prática homo/bissexual se envolve em práticas de risco, necessitando de um aumento do nível de informaçäo, erotizaçäo de outras práticas de menor risco e o fortalecimento das relaçöes sociais visando efetivar os programas de prevençäo do HIV/AIDS junto a esta populaçäo

Tuberculose associada à AIDS: situaçäo da regiäo do Nordeste brasileiro / Tuberculosis associated with AIDS: the position in a Northeastern region of Brazil

Ingestigar os principais aspectos da co-infecçäo pelo HIV e o Mycobacterium tuberculsis nos pacientes adultos assistidos pelo hospital de referência para doenças infecciosas do Estado do Ceará, Brasil, responsável pela notificaçäo de 89,3 por cento dos casos registrados no Estado, entre 1986-92. Foram coletados dados de prontuários de pacientes maiores de 15 anos, com diagnóstico de AIDS, atendidos em hospital de referência estadual, regiäo Nordeste do Brasil. A análise dos dados segue o critério do Ministério da Saúde, para definiçäo dessa doença. A tuberculose apresentou-se em 30,6 por cento dos pacientes estudados (151/493) e foi diagnosticada até o primeiro ano após o diagnóstico da AIDS em 76,8 por cento dos casos. Observou-se uma tendência crescente na proporçäo de casos de tuberculose entre pacientes com AIDS conforme decresce o nível de escolaridade (<0,001). A forma extrapulmonar apresentou-se em 23,9 por cento dos casos e a forma miliar em 25 por cento destes casos, diferindo significativamente (p<0,001 para as duas proporçöes) dos casos com tuberculose sem infecçäo pelo HIV registrados no Estado, em 1992. O precoce desenvolvimento da tuberculose, a elevada presença de formas extrapulmonares e a alta letalidade indicam que as medidas de prevençäo e controle da AIDS e da tuberculose näo devem ser vistas separadamente.

Estudo epidemiológtico da febre purpúrica brasileira - epidemia em localidade do Estado de Säo Paulo (Brasil), 1986 / Epidemiological study of Brazilian purpuric fever. Epidemic in a locality of Säo Paulo state (Brazil), 1986

Estudou-se um surto de febre purpúrica brasileira ocorrido em Serrana, SP (Brasil) em 1986 e sua associaçäo com conjuntivite purulenta, aglomeraçäo e sintomas respiratórios. Foi adotado o modelo de estudo, caso-controle. Chamou-se caso confirmado o paciente que satisfizesse um conjunto de critérios tendo "score" maior ou igual a 12 pontos, e caso suspeito "score" entre 8 e 12 (o "score" foi efetuado usando-se o seguinte critério: ocorrência de febre, igual a 5 pontos; diarréia e/ou vômitos igual a 1; fenômenos hemorrágicos igual a 3; plaquetopenia e/ou leucopenia igual a 3; hemocultura e/ou líquor e/ou cultura de orofaringe positiva para Haemophylus aegyptius igual a 7; síndrome de Waterhouse Friedrichsen igual a 7). Tomou-se como controle crianças com "score" menor do que 5. O controle foi pareado com o caso segundo as variáveis idade, sexo e condiçäo sócio-econômica. Levantaram-se informaçöes sobre 14 casos confirmados, 38 suspeitos e 78 controles. Conclui-se que a febre purpúrica brasileira apresentou forte associaçäo com conjuntivite purulenta pregressa e/ou atual; parece haver associaçäo entre aglomeraçäo e febre purpúrica e que os sintomas respiratórios como tosse e/ou coriza näo estäo a ela associados, pelo menos na populaçäo estudada