Doubts Remain, Risks Persist: HIV Prevention Knowledge and HIV Testing Among Drug Users in Rio de Janeiro, Brazil

Abstract

Brazil has been recognized for being the first developing country to provide universal AIDS treatment. Brazil also implemented a comprehensive prevention initiative. These efforts have been successful, with about half the number of HIV/AIDS cases forecast in 1992 developing by 2000. However, HIV/AIDS continues to spread, including among not-in-treatment drug users. Questions have been raised about gaps in existing prevention efforts. Based on qualitative research in 2006-2008 with street drug users in Rio de Janeiro (focus groups, N=24; a pile sort, N=108; open-ended interviews, N=34), this paper examines enduring gaps in HIV knowledge and prevailing risk patterns and proposes strategies for strengthening prevention.

Knowledge of AIDS and HIV transmission among drug users in Rio de Janeiro, Brazil

“…Ferreira et al [12] clearly documented the poor knowledge on HIV/AIDS among people with lower educational levels compared to those with a college degree in a representative sample of Brazil urban population. Notwithstanding the impossibility to disentangle the specific role of social and behavioral variables, the synergistic influence of them on less than optimal knowledge on HIV/AIDS among impoverished drug users speak in favor of comprehensive preventative initiatives tailored to the specific needs of underserved people, and among them, among those people who are misuse substances [18]. One should remember here that over 40% of participants believed HIV could pass through the pores of a condom.…”

“…Data analyzed in this study refer to the baseline survey of the project "Assessing HIV Oral Testing of Brazilian Drug Users" performed by the Oswaldo Cruz Foundation in partnership with Iowa State University and the Hispanic Health Council, funded by the National Institute on Drug Abuse (NIDA [details in [18]]. Baseline data collection was conducted between May 2006 and April 2007 with a non-probabilistic sample of 295 drug users recruited in two heath services located in the municipality of Rio de Janeiro downtown and easily accessible by public transportation.…”

“…This is a relatively high proportion compared to other low and middle-income countries, although less than optimal according to the standards defined by the Brazilian Ministry of Health vis-à-vis the key UNGASS indicators [16]. Among drug users, testing may be even more infrequent, as Brazilian populations with lower income and education level - common characteristics of street drug users - have lower rates for HIV testing [15], as well as other risk-enhancing behavioral, attitudinal and social features discussed in previous publications of our research group [17,18]. …”

Pile sorting innovations: Exploring gender norms, power and equity in sub-Saharan Africa

“…Commonly used in the social sciences (Trotter andPotter 1993, Ryan andBernard 2000) and various health disciplines (Morse and Field 1995), the technique engages participants in sorting cards with words or pictures into piles that represent how they think about and categorise elements of interest. Applications of pile sorting in public health literature have included capturing local definitions of disease (Brieger 1994, Bolton 2001, Peltzer et al 2006, relationships between symptoms and disease severity (Binh et al 2002) and perceptions of behaviour-risk association (Caballero-Hoyos and Villasenor-Sierra 1996, Carlson et al 2004, Singer et al 2011; comparing local and biomedical treatment models (Calvet-Mir 996 C. Bourey et al et al 2008); and investigating the acceptability of interventions (Chang et al 2005, Dongre et al 2009). Applications specific to the role of gender relations in shaping sexual and reproductive health have included evaluating spousal communication and sexual decision-making in a low-income community in Mumbai (Maitra and Schensul 2002) and exploring sexual behaviours and partner communications among minority communities in Hartford, Connecticut and Philadelphia, Pennsylvania (Hock-Long et al 2005).…”

“…Studies have noted innovative benefits of pile sorting, including that it may evoke emotional content, serving as a catalyst for participants to reflect on their feelings (Neufeld et al 2004) and may provide a platform for education (e.g., educating participants on low and high-risk behaviours for HIV transmission that were sorted incorrectly) (Quintiliani et al 2008, Singer et al 2011. However, the authors are not familiar with studies that consider how pile sorting can deliberately facilitate reflection and generalisation by helping participants visualise and interact with the relationships they depict.…”