Revisiting the Use of Condoms in Brazil

ABSTRACT

Introduction:It is known that a single prevention strategy is not enough to control multiple HIV epidemics around the world and in Brazil. However, it is not only necessary to recognize the importance of condoms as part of the policy of HIV/AIDS prevention but also discuss its limits. In this article, we aim to investigate the use of condoms in Brazil, draw critical reflections, and understand how they can once again be highlighted in Brazil's prevention strategy going forward.

METHODS:

A narrative review of literature was conducted using keywords in PubMed. Reports from national surveys that guide the epidemiological and behavioral surveillance of the Brazilian Ministry of Health were also included.

RESULTS:

A total of 40 articles and 3 reports were included in the review and 11 intervention studies to promote the condom use; the main findings were as follows: 1) Despite the increase in national studies on sexual behavior, little attention is given to the role of condom use; 2) There are few studies examining the factors associated with condom use among key populations such as men who have sex with men (MSM), female sex workers (FSW), drug users (DU), and transvestites and transexuals (TT), while substantial studies focus on adolescents and women; 3) Evidence suggests that a combination of interventions is more effective.

DISCUSSION:

new prevention technologies must not lose sight of the critical importance of condoms, and efforts to reintroduce them should focus on the role of pleasure in addition to their potential to minimize the risk of HIV.

Table 2 Factors associated with condom use by different population groups. 

Fatores	General Population	MSM	Sex workers	Drug users	Teens	Women	Indians	Seniors	Conscripts
Associated with increased condom use
Male	X	X
Younger ages	X	X	X
Higher education	X
Multiple partners in the recent past	X	X	X	X
Single	X	X
With casual partners (vs. fixed or regular partners)	X
Mother's education > 8 years	X
Having or buying condoms	X	X
Already took condoms for free	X
Associated with decreased condom use
Married or in a stable relationship	X	X
Initiation of sexual activity before 14 years	X	X
Not informed about HIV/AIDS	X
Negative attitudes toward condom	X
Not knowing someone with AIDS and not engaging in gay NGOs	X
Being MSM	X
Contradictory results
Years of schooling	X
Religion	X
Socioeconomic status	X
Other factors relevant to the groups, but no quantification of the effect on condom use
Incorrect beliefs about the use of condoms and STDs	X	X
Condom use as contraceptive	X
Gender relations	X	X
Situations of violence	X

X: indicates association with the specific category; MSM: men who have sex with men.

Purchase full article at:  http://goo.gl/e7BHSo  [Article in English, Portuguese]

By:  Dourado I1, MacCarthy S2, Reddy M2, Calazans G3, Gruskin S2.

• 1Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil.
• 2Program on Global Health and Human Rights, University of Southern California, Los Angeles, CA, USA.
• 3School of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil. 

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The Peer & Non-Peer: The Potential of Risk Management for HIV Prevention in Contexts of Prostitution

Sex workers have been the protagonists and focus of HIV prevention campaigns and research since the late 1980s in Brazil. Through a review of national and international literature, combined with a history of sex workers' involvement in the construction of the Brazilian response, this article explores the overlaps and disconnects between research and practice in contexts of prostitution over the past three decades. 

We review the scientific literature on the epidemiology of HIV among sex workers and prevention methodologies. We conclude that although research focus and designs often reinforce the idea that sex workers' vulnerability is due to their sexual relationships with clients, their greatest vulnerability has been found to be with their nonpaying intimate partners. 

Few studies explore their work contexts and structural factors that influence safe sex practices with both types of partners. The negative effects of criminalization, stigma, and exclusively biomedical and peer education-based approaches are well documented in the scientific literature and experiences of sex worker activists, as is the importance of prevention programs that combine empowerment and human rightsbased approach to reduce HIV infection rates. 

We conclude that there is a need for actions, policies, and research that encompass the environment and context of sex workers' lives and reincorporate the human rights and citizenship frame that dominated the Brazilian response until the end of the 2000s. As part of HIV prevention efforts, female sex workers need to be considered above all as women, equal to all others.

Full article at:  http://goo.gl/IFI6Jv

By:  Leite GS1, Murray L2, Lenz F3.

• 1Davida - Prostitution, Civil Rights and Health, Rio de Janeiro, RJ, Brasil.
• 2Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
• 3Graduate Program in Communication, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. 

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Risk Behaviors for Sexually Transmitted Diseases among Crack Users

To investigate the prevalence and risk behaviors by means of reporting of sexually transmitted diseases among crack users.

Cross-sectional study carried out with 588 crack users in a referral care unit for the treatment of chemical dependency. Data were collected by means of face-to-face interview and analyzed using Stata statistical software, version 8.0.

Of the total participants, 154 reported antecedents of sexually transmitted diseases. Ages between 25 and 30 years and over 30 years, alcohol consumption, antecedents of prostitution and sexual intercourse with person living with human immunodeficiency virus/AIDS were independently associated with reporting of sexually transmitted diseases.

The results of this study suggest high risk and vulnerability of crack users for sexually transmitted diseases.

Table 2 Analysis of factors associated with reporting of sexually transmitted diseases in 588 institutionalized crack users. Goiânia, GO, Brazil, 2012-2013 

*Sexually Transmitted Disease

†Denominator reflects the number of valid responses

‡Prevalence Ratio

§Confidence interval of 95%

||Ajusted by age, marital status, time of crack use, alcohol consumption, prison record, condom use with casual partner, antecedents of prostitution and sexual intercourse with a person living with HIV/AIDS

¶Last six months

**Last year

Full article at: http://goo.gl/f0UjmL

By: Guimarães RA1, Silva LN2, França DD3, Del-Rios NH4, Carneiro MA4, Teles SA1.

• 1Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia, GO, BR.
• 2Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO, BR.
• 3Universidade Federal de Goiás, Goiânia, GO, BR.
• 4Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, BR.  

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HIV-Testing among Female Sex Workers on the Border Between Brazil & French Guiana: The Need for Targeted Interventions

The border between Brazil and French Guiana is a place of economic, cultural, social and sexual exchange. Female sex workers represent a high risk population for HIV in this area where sexual tourism is particularly developed. HIV testing seems to be an important element in the fight against the epidemic. Indeed, early HIV testing gives access to treatments and prevention. 

An HIV/AIDS knowledge, attitudes, behaviors and practices survey was conducted in 2011 among sex workers along the border between Brazil and French Guiana. A total of 213 female sex workers were interviewed. 

One third (31.5%) of the interviewed had never tested for HIV. 

• Factors associated with non HIV-testing were the lack of knowledge of places where to do an HIV test, 
• to be 30 or older, 
• feeling at risk of HIV, 
• not evaluating one's own risk towards HIV, 
• and living in Oiapoque. 

These results clearly suggest that targeted interventions are needed to encourage and assist female sex workers to get tested regularly.

Table 2 Predictive factors of having performed a free voluntary HIV test on the border between French Guiana and Brazilian (n = 194): bivariate and multivariate analyses. 

	Has already been tested for HIV n/total (%)	Crude OR (95%CI)	Adjusted OR (95%CI)	Adjusted p-value
Knowledge of where to test
Yes	111/143 (77.6)	1.00	1.00
No	20/51 (39.2)	0.12 (0.07-0.20)	0.23 (0.10-0.52)	0.000
Perceived risk of HIV
Feels at risk	28/43 (65.1)	0.93 (0.46-1.90)	0.26 (0.07-0.93)	0.039
Does not feel at risk	29/35 (82.8)	1.00	1.00
Does not know	35/77 (45.4)	0.21 (0.11-0.40)	0.33 (0.11-0.99)	0.049
No response	40/44 (90.9)	6.85 (2.33-20.10)	3.46 (0.79-15.08)	0.099
Median age
Less than 30	94/129 (72.9)	1.00	1.00
30 or more	38/70 (54.3)	1.40 (0.91-2.15)	0.28 (0.12-0.63)	0.002
Lives in Oiapoque
Yes	104/169 (61.5)	0.11 (0.03-0.49)	0.05 (0.01-0.28)	0.001
No	28/30 (93.3)	1.00	1.00

95%CI: 95% confidence interval; OR: odds ratio.

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By:  Parriault MC1, van Melle A1, Basurko C1, Gaubert-Marechal E2, Macena RH3, Rogier S1, Kerr LR3, Nacher M1.

• 1Centre d'Investigation Clinique Antilles Guyane, Cayenne General Hospital, Cayenne, GF.
• 2COREVIH Guyane, Cayenne General Hospital, Cayenne, GF.
• 3Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, BR.
• 
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Risk Factors for Sexually Transmitted Diseases among Sex Workers in the Interior of Piaui, Brazil

OBJECTIVE:

To identify the risk factors for STD among female sex workers and the characteristics of this population, and to verify the association between condom use by their male partners and clients.

METHOD:

Cross-sectional and correlational study conducted with 73 sex workers registered at the Sex Workers´ Association of the municipality of Picos -PI, Brazil. Data were collected in September and October 2010 using a questionnaire to obtain sociodemographic information and the participants´ background in the sex industry. Ethical aspects were observed.

RESULTS:

There was no significant association between most of the sociodemographic variables and background in the sex industry and condom use by male partners or clients. However, there was a significant association with years in the sex industry (p = 0.029). Sex workers who had been in the industry for the longest used condoms for protection against sexually transmitted diseases.

CONCLUSION:

It is essential to create health promotion strategies that observe the real-life experiences of sex workers.

Read more at:: http://ht.ly/RRGuc 

By: Penha JC1, Aquino CB2, Neri Éde A3, Reis TG4, Aquino Pde S2, Pinheiro AK2.

• 1Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil.
• 2UFC, Fortaleza, Ceará, Brazil.
• 3Faculdades Integradas de Jacarepaguá, Teresina, Piauí, Brazil.
• 4Unidades Integradas de Pós-Graduação Pesquisa e Extensão, Teresina, Piauí, Brazil.