HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: A Systematic Review and Meta-analysis

Abstract

BackgroundThe Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations ─ men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group.MethodsNine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE, AMED, CINAHL, TOXNET, SciELO, and ISI-Web of Science) were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1999 to 2009. To be included in the review, studies had to measure HIV prevalence and/or incidence as the primary outcome among at least one specific population under analysis.ResultsThe studies targeting the three populations analyzed mostly young participants aged 30 years or less. Among FSW, eight studies were selected (3,625 participants), consistently identifying higher condom use with sexual clients than with occasional and stable partners. The combined HIV prevalence for FSW was 6.2 (95% CI: 4.4-8.3). Ten studies targeting MSM were identified (6,475 participants). Unprotected anal intercourse was commonly reported on those studies, but with great variability according to the nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex. Pooled HIV prevalence for MSM was 13.6 (95% CI: 8.2-20.2). Twenty nine studies targeting DU were identified (13,063 participants). Those studies consistently identified injection drug use and syringe/needle sharing as key predictors of HIV-infection, as well as engagement in sex work and male-to-male sex. The combined HIV prevalence across studies targeting DU was 23.1 (95% CI: 16.7-30.2).ConclusionsFSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (~0.6%). Those vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e.g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs. Programs that provide these services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.

Prevalência e vulnerabilidade à infecção pelo HIV de moradores de rua em São Paulo, SP

“…13,e It can be affected by a relationship of affection, awareness of the risk, and trust in sexual partners, among others. Alcohol and drug use impairs an individual's ability to make a choice on condom use, especially when used before sex.…”

“…The AIDS epidemic in Brazil is characterized by major urban concentration of cases 8 in specifi c population groups including sex workers 23 (HIV prevalence rates of 4.8%), men who have sex with men (MSM) (13.6%) 13 and drug users (23.1%). 13 The greater impact of the HIV/AIDS epidemic in these groups is mainly associated with individual factors and social and institutional contexts especially unsafe sexual behavior and drug use; discrimination; social inequality; and poor access to care services.…”

“…13 The greater impact of the HIV/AIDS epidemic in these groups is mainly associated with individual factors and social and institutional contexts especially unsafe sexual behavior and drug use; discrimination; social inequality; and poor access to care services. All these factors strongly affect homeless people in Brazil, 3,a,b and in other countries.…”

New HIV prevention methods: recognizing boundaries between individual autonomy and public policies

“…In the metropolitan regions of South and North Regions, the epidemic takes alarming contours, as there may be a prevalence of more than 1% in the general population in some of the cities 5 . These rates are even higher than 5% in the most vulnerable populations to human immunodeficiency virus (HIV) infection, such as prostitutes, drug users, and homeless people in different urban centers of the country 6 .…”

Social geography of AIDS in Brazil: identifying patterns of regional inequalities

“…The epidemic's apparent homogeneity and stability mask a complex situation with localized epidemic processes affecting certain regions and/ or populations at greater risk 2 .…”