The objective of this study was to investigate the prevalence and factors associated with syphilis in homeless men in Central Brazil. It is a cross-sectional study conducted with 481 individuals attending four therapeutic communities between October and December 2015. A structured interview was conducted to collect sociodemographic data and risk factors for syphilis. Rapid/point-of-care and VDRL tests were performed to determine exposure to syphilis and the presence of active syphilis, respectively. Poisson regression analysis was used to verify the risk factors associated with the outcomes investigated. Of the study participants, 10.2% were reactive to the rapid test, and 5.4% had active syphilis. At the multiple regression analysis, schooling (adjusted prevalence ratio - APR: 0.89; p = 0.005), history of genital ulcer (APR: 2.59; p = 0.002), STI history (APR: 1.97; p = 0.042), and sexual intercourse under drug effects (APR: 1.60; p = 0.022) were independent factors associated with lifetime syphilis. Also, history of genital ulcer (APR: 2.19; p = 0.019), STI history (APR: 1.74; p = 0.033) and number of sexual partners in the last year (APR: 1.02; p = 0.044) were associated with active syphilis. The prevalence of syphilis among homeless men was rather high, confirming the vulnerability of this group to this infection. These results emphasize the need for educational intervention, improvement of risk reduction programs, availability of diagnostic tests, especially the rapid test, and treatment.

BackgroundHomeless men are highly vulnerable to acquisition of the hepatitis C virus (HCV) compared to the general population. In Brazil, a country of continental dimensions, the extent of HCV infection in this population remains unknown. The objective of this study is to investigate the epidemiological profile of exposure to HCV in homeless men in Central Brazil.MethodsA Cross-sectional study was conducted in 481 men aged over 18 years attending therapeutic communities specialized in the recovery and reintegration of homeless people. Participants were tested for anti-HCV markers using rapid tests. Poisson regression analysis was used to verify the risk factors associated with exposure to HCV.ResultsThe prevalence of HCV exposure was 2.5% (95.0% CI: 1.4 to 4.3%) and was associated with age, absence of family life, injection drug use, number of sexual partners, and history of sexually transmitted infections (STI). Participants reported multiple risk behaviors, such as alcohol (78.9%), cocaine (37.1%) and/or crack use (53.1%), and inconsistent condom use (82.6%). Injection drug use was reported by 8.7% of participants.ConclusionsThe prevalence of HCV infection among homeless men was relatively high. Several risk behaviors were commonly reported, which shows the high vulnerability of this population. These findings emphasize the need for the development of specific strategies to reduce the risk of HCV among homeless men.

Background People living in poverty (PLP) are highly vulnerable to hepatitis B virus (HBV) infection. This study aimed to investigate the epidemiology of HBV infection in PLP in the metropolitan region of Goiânia, Goiás State, in the Central-West Region of Brazil. Methods A cross-sectional study was conducted from August to December 2016 in adults aged ≥12 years living in poverty. The following serological markers for HBV were investigated: hepatitis B surface antigen (HBsAg), antibody to HBV core antigen (total anti-HBc), IgM anti-HBc, and hepatitis B surface antibody (anti-HBs), which were detected by enzyme-linked immunosorbent assay (ELISA). Poisson regression analysis with robust variance was performed to verify the factors associated with HBV exposure. Results The study included 378 participants. The overall prevalence rate of HBV (any viral marker) was 9.8% (95% confidence interval [CI], 7.2–13.2). The prevalence rate of HBsAg in combination with total anti-HBc was 0.8% (95% CI, 0.3–2.4), total anti-HBc in combination with anti-HBs was 7.7% (95% CI, 5.4–10.9), and total anti-HBc alone was 1.3% (95% CI, 0.5–3.0) in the population. Furthermore, isolated positivity for anti-HBs was identified in only 25.4% (95% CI, 21.3–30.0) of the participants. Multiple regression analysis revealed that age (adjusted prevalence ratio [APR], 1.04; 95% CI, 1.01–1.07), female sex (APR, 2.18; 95% CI, 1.01–4.73), sexual intercourse under the influence of alcohol (APR, 2.49; 95% CI, 1.36–7.06), and exposure to Treponema pallidum (APR, 3.10; 95% CI, 1.36–7.06) were associated with HBV exposure. Conclusion There was a high prevalence of HBV exposure in PLP in the Central-West Region of Brazil, indicating significant viral spread of the infection. Additionally, there was low serological evidence of immunisation against hepatitis B, indicating that a large proportion of the participants in this study are susceptible to the infection. The results support the need for public health policies that facilitate access to the existing healthcare services in hard-to-reach groups with special regard to immunisation programmes against hepatitis B.

INTRODUÇÃOO câncer do colo do útero (CCU) é o segundo tipo de câncer mais frequente entre as mulheres, com aproximadamente 500 mil casos novos por ano no mundo, sendo responsável anualmente pelo óbito de, aproximadamente, 230 mil mulheres 1 . Altas taxas de incidência do CCU são comumente observadas em países pouco desenvolvidos porque este tipo de neoplasia está associado a condições de vida precária, ausência ou fragilidade das estratégias de educação comunitária e à dificuldade de acesso a serviços públicos de saúde que realizem diagnóstico precoce e tratamento das lesões precursoras 2,3 . No Brasil, sem considerar os tumores de pele não melanoma, o CCU é o mais incidente na Região Norte. Nas regiões Centro-Oeste e Nordeste é o segundo mais frequente e nas regiões Sul e Sudeste ocupa a terceira posição 1 . O câncer cervical tem em sua etiologia a presença de infecção por tipos oncogênicos do papilomavírus humano (HPV) 4 , além de fatores coexistentes, que favorecem a persistência da infecção, entre os quais: tabagismo, uso de contraceptivos orais, múltiplos parceiros sexuais, multiparidade, início precoce das relações sexuais, déficit nutricional e imunológico, além de fatores genéticos .Dentre todos os tipos de câncer, o CCU é o que apresenta um dos mais altos índices de cura quando o diagnóstico é feito precocemente 1,6 . O exame citopatológico (Papanicolaou) é um método barato, factível, podendo ser utilizado no rastreamento de CCU em grandes grupos populacionais, em especial nos países em desenvolvimento 7 . No Brasil, o protocolo do Ministério da Saúde para prevenção de CCU em mulheres com vida sexual ativa e/ou idade ≤ 60 anos indica a realização de uma colpocitologia anual, sendo que após dois exames consecutivos negativos, essa triagem pode ser feita a cada três anos 2 . As mulheres são consideradas uma população particularmente vulnerável às infecções, especialmente às doenças sexualmente transmissíveis (DST) 8 . Mulheres que cumprem pena judicial em presídios, ou que aguardam a sentença jurídica em casa de detenção provisória, têm aumentada essa vulnerabilidade, uma vez que o cárcere lhes adiciona fatores que propiciam a aquisição e/ou transmissão dessas infecções, tais como a prática sexual desprotegida durante as visitas íntimas e a superlotação dos presídios associada ao histórico de violência social dentro do cárcere. Acrescenta-se a esses fatores, o perfil social e os comportamentos anteriores à carceragem, como baixo nível socioeconômico e de escolaridade; uso de drogas ilícitas; história de abuso sexual; prática sexual desprotegida associada à multiplicidade de parceiros e acesso precário aos serviços de saúde [8][9][10] .