Hepatitis B Prevalence among Men Who Have Sex with Men in Brazil.

Hepatitis B virus (HBV) is a global public health problem and requires specific prevention actions, particularly focusing on the key populations, such as men who have sex with men (MSM). We aimed at assessing the prevalence of HBV infection, among MSM, in a multicity study in Brazil. In 2016, we conducted a survey using a respondent-driven sampling methodology in 12 Brazilian cities. Rapid tests (RT) were performed on 3178 samples from those MSM. Positive results were tested for HBV DNA and sequenced. If negative for HBV DNA, samples were tested for serological markers. The prevalence rate of HBV exposure and clearance was 10.1% (95% CI: 8.1-12.6), and 1.1% (95%; CI: 0.6-2.1) were confirmed to be HBsAg-positive. Of those samples tested for anti-HBs (n = 1033), only 74.4% presented a serological profile analogous to that elicited by hepatitis B vaccination. Among HBsAg-positive samples (n = 29), 72.4% were HBV DNA-positive, and from these, 18 were sequenced. HBV genotypes A, F, and G were found in 55.5%, 38.9%, and 5.6%, respectively. This study indicates high prevalence rates of MSM HBV exposure and a low positivity index for the serological marker of HBV vaccine immunity. These findings may contribute to the discussion of strategies to prevent hepatitis B and reinforce the importance of promoting HBV vaccination in this key population.

Envolvimento em organizações não governamentais e a participação em ações de prevenção ao HIV/aids por homens que fazem sexo com homens no Brasil / Involvement in nongovernmental organizations and participation in HIV/AIDS prevention by men who have sex with men in Brazil / Implicación en organizaciones no gubernamenntales y participación en acciones de prevención contra el VIH/sida de hombres que practican sexo con hombres en Brasil

A epidemia do HIV no Brasil é concentrada em populações-chave. Organizações não governamentais (ONGs) que atuam em defesa dos direitos da população LGBT e de pessoas vivendo com HIV/aids podem contribuir para o desenvolvimento de políticas de prevenção. O objetivo deste estudo é avaliar o envolvimento em ONGs e analisar sua associação com a participação individual em ações de educação em saúde, testagem e prevenção às infecções sexualmente transmissíveis (IST) e ao HIV, como parte de um estudo nacional de vigilância biológica e comportamental entre homens que fazem sexo com homens (HSH). Trata-se de estudo transversal utilizando respondent driven sampling (RDS) em 12 cidades brasileiras. A magnitude da associação do envolvimento em ONGs com cada ação foi avaliada pela estimativa de odds ratio por meio de regressão logística por amostragem complexa, considerando cada cidade como um estrato e ponderando pelo estimador de Gile. Foi estimada a proporção relativa atribuída ao envolvimento em ONGs para cada evento avaliado. Dentre 4.176 participantes, a maioria tinha menos de 25 anos (56,5%) e baixo nível econômico (56,7%). Um quarto dos HSH referiu se envolver em ONGs, que foi significativamente associado com as ações avaliadas: receber preservativo e gel lubrificante, participar de palestra, receber material educativo e aconselhamento em IST, conhecimento de profilaxia pós-exposição (PEP) e profilaxia pré-exposição (PrEP), testagem para sífilis e HIV, ter aceitação do autoteste e saber onde realizar teste para HIV. ONGs têm um papel histórico na resposta à epidemia de HIV no Brasil e, apesar de terem sofrido significativa redução de recursos nos últimos anos, mantêm relevante atuação nas ações de saúde pública.

The HIV epidemic in Brazil is concentrated in key populations. Nongovernmental organizations (NGOs) working in defense of LGBT rights and the rights of persons living with HIV/AIDS can contribute to the development of prevention policies. The current study's objectives are to assess involvement in NGOs and analyze the association with individual participation in health education, testing, and STI and HIV prevention activities as part of a national study on biological and behavioral surveillance in men who have sex with men (MSM). This is a cross-sectional study using respondent-driven sampling in 12 Brazilian cities. The magnitude of the association between involvement in NGOs and each activity was assessed with estimation of odds ratios via logistic regression with complex sampling, considering each city as a stratum and weighting by the Gile estimator. The relative proportion attributed to involvement in NGOs was estimated for each event. Among 4,176 participants, the majority were under 25 years of age (56.5%) and with low socioeconomic status (56.7%). One-fourth of MSM reported being involved in NGOs, which was associated significantly with the target activities: receiving free condoms and lubricant gel, participating in talks on STIs, receiving educational materials and counseling on STIs, prior knowledge of post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), testing for syphilis and HIV, acceptance of HIV self-testing, and knowing where to get an HIV test. NGOs play a historical role in the response to the HIV epidemic in Brazil, and despite a significant cutback in resources in recent years, they have maintained relevant work in public health activities.

La epidemia de VIH en Brasil se concentra en poblaciones clave. Organizaciones no gubernamentales (ONGs) que actúan en defensa de los derechos de la población LGBT, y de personas viviendo con VIH/sida, pueden contribuir al desarrollo de políticas de prevención. El objetivo de este estudio es evaluar la implicación en ONGs y analizar su asociación con la participación individual en acciones de educación en salud, pruebas y prevención frente a las IST y al VIH, como parte de un estudio nacional de vigilancia biológica y comportamental entre hombres que practican sexo con hombres (HSH). Se trata de un estudio transversal, utilizando respondent driven sampling en 12 ciudades brasileñas. Se evaluó la magnitud de la asociación de la implicación en ONGs con cada acción mediante la estimación de odds ratio, a través de una regresión logística por muestra compleja, considerando cada ciudad como un estrato, y ponderando por el estimador de Gile. Se estimó la proporción relativa atribuida a la implicación en ONGs para cada evento evaluado. De entre los 4176 participantes, la mayoría tenía menos de 25 años (56,5%) y bajo nivel económico (56,7%). Un cuarto de los HSH mencionó estar implicado en ONGs, lo que estuvo significativamente asociado con las acciones evaluadas: recibir preservativo y gel lubrificante, participar en ponencias, recibir material educativo y consejo en IST, conocimiento de profilaxia pos-exposición (PEP) y profilaxia pre-exposición (PrEP), pruebas de sífilis y VIH, haber aceptado el autotest y saber donde realizar el test para el VIH. Las ONGs tienen un papel histórico en la respuesta a la epidemia de VIH en Brasil y, a pesar de haber sufrido una significativa reducción de recursos en los últimos años, mantienen una relevante actuación en las acciones de salud pública.

Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil.

BACKGROUND: Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result. METHODS: Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile's estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). RESULTS: For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. CONCLUSIONS: The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.

The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics.

INTRODUCTION: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. METHODS: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. RESULTS: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). CONCLUSION: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.

The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics / Inquérito sobre o HIV entre HSH no Brasil em 2016 usando respondent-driven sampling (RDS): descrição dos métodos e dos diagnósticos do RDS

ABSTRACT: Introduction: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. Methods: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. Results: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). Conclusion: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.

RESUMO: Introdução: Este artigo detalha os métodos utilizados na segunda Pesquisa Nacional de Vigilância Biológica e Comportamental (BBSS) do HIV, sífilis e hepatite B e C entre os homens que fazem sexo com homens no Brasil. Métodos: O método Respondent-driven Sampling (RDS) foi utilizado em 12 cidades em 2016. A amostra foi iniciada com cinco a seis sementes em cada cidade. Testes rápidos para o HIV, sífilis e Hepatite B e C foram oferecidos aos participantes. O software RDS Analyst com o estimador de amostragem sucessiva (SS) de Gile foi utilizado para ajustar os resultados como recomendado, gerando um peso para cada indivíduo para análises. Osdados das 12cidades foram unidos em um único banco e analisados usando as ferramentas de dados complexos do Stata 14.0, com cada cidade sendo tratada como seu próprio estrato. Resultados: A duração da coleta de dados variou de 5,9 a 17,6 semanas e 4.176 homens foram recrutados nas 12 cidades. Dois sites não alcançaram o tamanho da amostra alvo devido a uma demora de seis meses na aprovação local do Comitê de Ética. Todas as cidades atingiram a convergência na principal variável estudada (HIV). Conclusão: O BBSS foi representativo e concluído conforme planejado e dentro do orçamento. A descrição dos métodos aqui é mais detalhada do que o habitual, devido às novas ferramentas e requisitos de diagnóstico das novas diretrizes do STROBE-RDS.

HIV prevalence among men who have sex with men in Brazil: results of the 2nd national survey using respondent-driven sampling.

This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS).Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy.A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities.A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7-20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4-21.7) were seropositive.HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0-14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.

Ciência e política das drogas: as controvérsias em torno das políticas públicas de internação compulsória / Science and drug policies: controversies in public policies of compulsory confinement / Ciencia y política de drogas: las controversias alrededor de las políticas públicas de internación compulsiva

Propõe-se, no âmbito deste trabalho, problematizar a discussão acerca das internações compulsórias, a partir de apontamentos para as controvérsias que têm habitado as propostas de políticas públicas contemporâneas, as quais emergem da temática das drogas no Brasil. Entende-se que tal debate converge para o plano da articulação entre ciência, sociedade e tecnologia,composição de forças heterogêneas que produzem o que se toma por realidade. Em meio a tais controvérsias, propomos, com base na Teoria Ator-Rede, traçar uma cartografia das redes que fazem circular e acabam por produzir aquilo que entendemos por internações compulsórias. As controvérsias rastreadas nos conduziram a uma relação indissociável entre a construção de verdades e a produção política. Os modos de conhecer – e a consequente produção de saberes – produzem mundos que compõem territórios existenciais na contemporaneidade: ontologias que se constituem a partir do caráter performativo das práticas sociais.

In this article we problematize the ongoing discussion around the publicpolicies of compulsory confinement for drug users that is happening in Brazil, as well as the controversies that emerge from the public debate on drugs and the implementation of these policies. We understand that the articulation between the heterogeneous forces of science, society and technology produce the social understanding of the issues around the thematic of drug use. In that sense, we assert that there is an inseparable relation between knowledge and politics: the act of producing truths - and the consequent production of knowledge - creates worlds that constitute contemporary existential territories: ontologies that are composed from the performative character of social practices. Amid such controversies, our proposal is, based on Actor Network Theory, to draw a map of networks that produce what we understand as compulsory confinement. These controversies led to a strong connection between the heterogeneous forces of science, society and technology produce the social understanding of the issues around the thematic of drug use. In that sense, we assert that there is an inseparable relation between knowledge and politics: the act of producing truths - and the consequent production of knowledge - createsworlds that constitute contemporary existential territories: ontologies that are composed from the performative character of social practices.

Se propone, en el marco de este trabajo, problematizar la discusión de la internación compulsiva a partir de las notas de las controversias que hanconformado las propuestas de políticas públicas contemporáneas que se desprenden del tema que involucra la cuestión de drogas en Brasil. Por lotanto, se entiende que tal debate converge hacia el plano de la articulación entre la ciencia, la sociedad y la tecnología, la composición de fuerzas heterogéneas que producen lo que se entiende por realidad. En medio de tales controversias, se propone, sobre la base de la teoría del actor-red,dibujar un mapa de las redes que circulan y terminan produciendo lo que entendemos por internación compulsiva. La controversia nos llevó a un vínculo indisoluble entre la construcción de verdades y producción política: los modos de conocer – y la consiguiente producción de saberes – producen mundos que componen territorios existenciales en la contemporaneidad: ontologías que se constituyen a partir del carácter performativo de las prácticas sociales.

Ciência e política das drogas: as controvérsias em torno das políticas públicas de internação compulsória / Science and drug policies: controversies in public policies of compulsory confinement / Ciencia y política de drogas: las controversias alrededor de las políticas públicas de internación compulsiva

Propõe-se, no âmbito deste trabalho, problematizar a discussão acerca dasinternações compulsórias, a partir de apontamentos para as controvérsiasque têm habitado as propostas de políticas públicas contemporâneas, asquais emergem da temática das drogas no Brasil. Entende-se que tal debateconverge para o plano da articulação entre ciência, sociedade e tecnologia,composição de forças heterogêneas que produzem o que se toma por realidade. Em meio a tais controvérsias, propomos, com base na Teoria Ator-Rede, traçar uma cartografia das redes que fazem circular e acabam por produzir aquilo que entendemos por internações compulsórias. As controvérsias rastreadas nos conduziram a uma relação indissociável entre a construção de verdades e a produção política. Os modos de conhecer – e a consequente produção de saberes – produzem mundos que compõem territórios existenciais na contemporaneidade: ontologias que se constituem a partir do caráter performativo das práticas sociais. (AU)

In this article we problematize the ongoing discussion around the publicpolicies of compulsory confinement for drug users that is happening in Brazil, as well as the controversies that emerge from the public debate on drugs and the implementation of these policies. We understand that the articulation between the heterogeneous forces of science, society and technology produce the social understanding of the issues around the thematic of drug use. In that sense, we assert that there is an inseparable relation between knowledge and politics: the act of producing truths - and the consequent production of knowledge - creates worlds that constitute contemporary existential territories: ontologies that are composed from the performative character of social practices. Amid such controversies, our proposal is, based on Actor Network Theory, to draw a map of networks that produce what we understand as compulsory confinement. These controversies led to a strong connection between the heterogeneous forces of science, society and technology produce the social understanding of the issues around the thematic of drug use. In that sense, we assert that there is an inseparable relation between knowledge and politics: the act of producing truths - and the consequent production of knowledge - createsworlds that constitute contemporary existential territories: ontologies that are composed from the performative character of social practices. (AU)

Se propone, en el marco de este trabajo, problematizar la discusión de la internación compulsiva a partir de las notas de las controversias que hanconformado las propuestas de políticas públicas contemporáneas que se desprenden del tema que involucra la cuestión de drogas en Brasil. Por lotanto, se entiende que tal debate converge hacia el plano de la articulación entre la ciencia, la sociedad y la tecnología, la composición de fuerzas heterogéneas que producen lo que se entiende por realidad. En medio de tales controversias, se propone, sobre la base de la teoría del actor-red,dibujar un mapa de las redes que circulan y terminan produciendo lo queentendemos por internación compulsiva. La controversia nos llevó a un vínculo indisoluble entre la construcción de verdades y producción política: los modos de conocer – y la consiguiente producción de saberes – producen mundos que componen territorios existenciales en la contemporaneidad: ontologías que se constituyen a partir del carácter performativo de las prácticas sociales. (AU)

Função escolar x evasão: a falência da educação para o trabalho / School Function and pupils' drop-out: The failure of education for work

O artigo apresenta a discussão de uma pesquisa realizada numa escola da rede pública de Fortaleza-CE, como parte de uma disciplina de Psicologia Escolar. A pesquisa investigou as relações entre a função da escola e evasão escolar, pelo ponto de vista de educadores e alunos. Foi utilizado o referencial teórico foucaultiano para a análise dos dados. Como resultados, podemos apontar que há um desencontro entre a função que a escola deveria assumir na ótica dos alunos e a função que os educadores a fazem assumir ao se comprometerem com determinadas obrigações institucionais, resultando disso a massiva evasão encontrada no estabelecimento em questão. Compreendemos que o fato de a escola pública não assegurar uma vaga no mercado de trabalho especializado para seus alunos, via vestibular ou ensino técnico, contrapõe-se à função escolar de educação para o trabalho. Estando enfraquecida nessa função, a escola não consegue manter seus alunos, mesmo apelando para os mais diversos mecanismos de controle disciplinares.

The article discusses the results of a research done in a public school in Fortaleza (Brazil) as part of a School Psychology course. The research investigated the relationship between the function of school and pupils' drop-out based upon the opinions of the pupils and teachers. It was used a Foucauldian theoretical reference in order to analyze the collected data. It could be found that there is a difference between the school function perceived by the pupils and the function that teachers try to develop through institutional rules, resulting on the massive student drop-out reported in the researched school. When public schools fail to assure a better place for its pupils in the job market, through university access or technical formation, the idea of school as 'education for work' becomes contradictory. When this function is undermined, the school cannot avoid student drop-out despite the use of different disciplinary control mechanisms.