HPV vaccination in Latin America: Coverage status, implementation challenges and strategies to overcome it.

Cervical cancer remains a leading cause of morbidity and mortality amongst females in Latin America (LATAM). Cervical cancer is a preventable disease and HPV vaccination is a main key strategy towards its elimination. This study analyzes HPV vaccine implementation current status and the main barriers to achieve adequate coverage in the region. Data from the nineteen sovereign states of LATAM (comprised of all Portuguese and Spanish-speaking nations located south of the United States) were collected, including year of HPV vaccine implementation, gender and age targets, the number of doses included in the public program and coverage by dose. Sixteen out of the 19 evaluated countries have already implemented HPV vaccination programs. However, despite its proven efficacy and safety, HPV vaccine uptake in LATAM has been lower than expected. There is an evident decline in adhesion, mainly regarding the second dose. Several reasons are probably involved, of note: limited knowledge of HPV and HPV vaccine, misguided safety concerns, high cost, cultural barriers, and the Covid19 pandemic. Proper strategies to overcome these barriers are needed to ensure successful uptake. Effective policies are: adopting the one dose schedule, delivering the vaccine on both health center and schools, and advising health professionals to recommend the vaccine. Further research regarding HPV vaccine hesitancy in Latin America is needed.

COVID-19 vulnerability among Brazilian sexual and gender minorities: a cross-sectional study.

Minority groups are more prone to worsen their personal and social vulnerabilities during the COVID-19 pandemic. This study aimed to identify factors associated with the highest COVID-19 vulnerability in the Brazilian sexual and gender minorities. This is a cross-sectional study based on 826 respondents of the Brazilian LGBT+ Health Survey, conducted online from August to November 2020. The COVID-19 vulnerability was based on a previous vulnerability index created by an LGBT+ institution, which comprises three dimensions (income, COVID-19 exposure, and health). The outcome was the highest score quartile. Statistical analysis was based on logistic regression models. The COVID-19 vulnerability was higher in heterosexual and other scarce sexual orientations (OR = 2.34; 95%CI: 1.01-9.20, vs. homosexual), cisgender men (OR = 3.52; 95%CI: 1.35-4.44, vs. cisgender women), and those aged ≥ 50 years (OR = 3.74; 95%CI: 1.24-11.25, vs. 18-29 years old). A negative association was found with complete graduate education (OR = 0.06; 95%CI: 0.02-0.22, vs. complete high school), being white (OR = 0.44; 95%CI: 0.23-0.83), and proper facemask use (OR = 0.31; 95%CI: 0.13-0.76). Except for proper facemask use, factors associated with higher COVID-19 vulnerability are structural determinate and suggest overlapping vulnerabilities, as described by the syndemic model. It guides strategies to deal with the pandemic, which includes a joint approach to the common epidemic that affects sexual and gender minorities, broadening the intersectoral approach to decrease inequalities.

COVID-19 vulnerability among Brazilian sexual and gender minorities: a cross-sectional study / Vulnerabilidade à COVID-19 entre as minorias sexuais e de gênero no Brasil: um estudo transversal / Vulnerabilidad al COVID-19 entre minorías sexuales y de género en Brasil: un estudio transversal

Minority groups are more prone to worsen their personal and social vulnerabilities during the COVID-19 pandemic. This study aimed to identify factors associated with the highest COVID-19 vulnerability in the Brazilian sexual and gender minorities. This is a cross-sectional study based on 826 respondents of the Brazilian LGBT+ Health Survey, conducted online from August to November 2020. The COVID-19 vulnerability was based on a previous vulnerability index created by an LGBT+ institution, which comprises three dimensions (income, COVID-19 exposure, and health). The outcome was the highest score quartile. Statistical analysis was based on logistic regression models. The COVID-19 vulnerability was higher in heterosexual and other scarce sexual orientations (OR = 2.34; 95%CI: 1.01-9.20, vs. homosexual), cisgender men (OR = 3.52; 95%CI: 1.35-4.44, vs. cisgender women), and those aged ≥ 50 years (OR = 3.74; 95%CI: 1.24-11.25, vs. 18-29 years old). A negative association was found with complete graduate education (OR = 0.06; 95%CI: 0.02-0.22, vs. complete high school), being white (OR = 0.44; 95%CI: 0.23-0.83), and proper facemask use (OR = 0.31; 95%CI: 0.13-0.76). Except for proper facemask use, factors associated with higher COVID-19 vulnerability are structural determinate and suggest overlapping vulnerabilities, as described by the syndemic model. It guides strategies to deal with the pandemic, which includes a joint approach to the common epidemic that affects sexual and gender minorities, broadening the intersectoral approach to decrease inequalities.

Grupos minoritários são mais propensos a fortalecer suas vulnerabilidades pessoais e sociais, aumentando a vulnerabilidade à COVID-19 durante a pandemia. Este estudo objetivou identificar fatores associados à maior vulnerabilidade à COVID-19 entre as minorias sexuais e de gênero no Brasil. Trata-se de um estudo transversal realizado com 826 entrevistados do Inquérito Nacional de Saúde LGBT+, realizado online de agosto a novembro de 2020. A vulnerabilidade à COVID-19 pautou-se em um índice de vulnerabilidade anterior criado por uma instituição LGBT+, compreendendo três dimensões (renda, exposição à COVID-19, e saúde). O resultado foi o quartil de maior pontuação. A análise estatística foi baseada em modelos de regressão logística. Vulnerabilidade à COVID-19 foi maior em heterossexuais e outras sexualidades menores (OR = 2,34; IC95%: 1,01-9,20, vs. homossexual), homens cisgênero (OR = 3,52; IC95%: 1,35-4,44, vs. mulheres cisgênero), e aqueles com 50 anos ou mais (OR = 3,74; IC95%: 1,24-11,25, vs. 18-29 anos). Verificou-se associação negativa entre ter pós-graduação (OR = 0,06; IC95%: 0,02-0,22, vs. até o Ensino Médio), ter cor de pele branca (OR = 0,44; IC95%: 0,23-0,83) e usar máscara adequada (OR = 0,31; IC95%: 0,13-0,76). Exceto pelo uso adequado da máscara, fatores associados à maior vulnerabilidade à COVID-19 são determinantes estruturais e sugerem vulnerabilidades que se sobrepõem, como descrito pelo modelo sindêmico. Ele orienta estratégias para lidar com a pandemia, que engloba uma abordagem conjunta da epidemia comum que afeta as minorias sexuais e de gênero, ampliando a abordagem intersetorial para diminuir as desigualdades.

Los grupos minoritarios son los más propensos a intensificar sus vulnerabilidades individuales y sociales, lo que aumenta la vulnerabilidad al COVID-19 durante la pandemia. Este estudio tuvo como objetivo identificar los factores asociados con mayor vulnerabilidad al COVID-19 entre las minorías sexuales y de género en Brasil. Se trata de un estudio transversal, realizado con 826 personas que respondieron la Encuesta Brasileña sobre la Salud LGBT+, aplicada en línea entre agosto y noviembre de 2020. La vulnerabilidad al COVID-19 se basó en un índice de vulnerabilidad anterior creado por una institución LGBT+, el cual comprende tres dimensiones (renta, exposición al COVID-19 y salud). El resultado fue el cuartil de mayor puntuación. El análisis estadístico se basó en modelos de regresión logística. La vulnerabilidad al COVID-19 fue mayor en heterosexuales y otras sexualidades menores (OR = 2,34; IC95%: 1,01-9,20, vs. homosexual), hombres cisgénero (OR = 3,52; IC95%: 1,35-4,44, vs. mujeres cisgénero), y los de 50 años o más (OR = 3,74; IC95%: 1,24-11,25, vs. 18-29 años). Hubo una asociación negativa entre tener un título de posgrado (OR = 0,06; IC95%: 0,02-0,22, vs. hasta la secundaria), tener color de piel blanca (OR = 0,44; IC95%: 0,23-0,83) y usar mascarilla adecuadamente (OR = 0,31; IC95%: 0,13-0,76). Excepto por el uso adecuado de mascarilla, los factores asociados con una mayor vulnerabilidad al COVID-19 son determinantes estructurales y apuntan vulnerabilidades superpuestas, tal como lo describe el modelo sindémico. Este orienta estrategias para enfrentar la pandemia, que constan de un enfoque conjunto de la epidemia común que afecta a las minorías sexuales y de género, ampliando el enfoque intersectorial para reducir las desigualdades.