Transitioning Through AIDS Epidemics - Gender & Temporality

To understand the evolution of AIDS over time in Mato Grosso do Sul, Brazil, using incidence, lethality, and mortality coefficients.

A descriptive epidemiological study based on time series analysis of secondary data from the Notifiable Diseases Information System reported between 1985 and 2012.

The prevalence of AIDS was higher among men, with evidence of feminization during the first 14 years of the epidemic. There was no statistically significant sex difference in AIDS lethality. Women were 1.3 times more likely to survive than men.

Gender differences must be considered when designing new HIV/AIDS prevention strategies...

The AIDS incidence rate in the state of Mato Grosso do Sul during the 28-year epidemic increased 21 times among women and 6.3 times among men. It was higher than the national incidence during the same period (13.4 among women and 3.6 times among men).² The trend toward stabilization and decline in AIDS incidence in Brazil^{4, 5 and 6} was not seen in the state of Mato Grosso do Sul. The data for this state showed an increasing incidence in both men and women, with no evidence of decline among women.^{5, 6 and 7}The extensive border of Mato Grosso do Sul with Paraguay and Bolivia might have influenced the epidemiologic situation and AIDS incidence in this region as patients from those countries may have received treatment in health centers of the state.

The sex ratio observed across the four periods analyzed indicated a decline in the male-to-female (M:F) ratio of AIDS cases, confirming the observed tendency toward feminization of the epidemic, especially in the first 14 years, reflecting a trend similar to national data.² The higher vulnerability observed in women, unknown at the beginning of the epidemic, the rise in heterosexual transmission of HIV, and the unequal gender relations may explain this process.⁵

The AIDS lethality rate of 41.4% observed during the study period of 1985–2012 in Mato Grosso do Sul was approximately three percentage points above that of Brazil (38.65%) in the same period.² The gender-specific lethality rate was higher among men in all periods, a trend similar to national data.^2 and 8 Free and universal access to antiretroviral treatment and early diagnosis may have been predominant factors contributing to the decline in lethality observed throughout the study period. The scarcity of studies examining these indicators hinders the comparability across studies.

Mortality due to AIDS among both men and women increased during the first two periods of the epidemic and declined in the 3rd and 4th periods, with a more significant decline observed among men. Again, both the accessibility to treatment and the switch from monotherapy to combination therapy in 1996 are believed to have had an impact on the reduction in AIDS-related mortality.

Throughout the 28-year AIDS epidemic in Mato Grosso do Sul, the incidence of AIDS increased greatly among women, especially during the first 14 years. In the last periods, a relatively stable growth rate was observed in AIDS incidence among women. Despite the tendency toward feminization of the AIDS epidemic in Mato Grosso do Sul, the incidence of AIDS among men is still relevant in this region, mainly observed in homosexuals, bisexuals and heterosexuals who use drugs, and heterosexuals with sexual partners at high-HIV-risk.

The AIDS lethality rate was higher among men throughout the four periods; however, the differences in lethality between genders decreased in the last 14 years. Considering all deaths, survival among women was 1.3 times higher, and the analysis of AIDS mortality in relation to gender showed that men had a higher risk of death in all analyzed periods.

The time distribution of AIDS incidence, lethality, and mortality according to gender throughout the 28-year epidemic in Mato Grosso do Sul can contribute to public health policies and plans of action against the spread of the AIDS epidemic through better understanding of gender differences, with respect to both preventative and therapeutic approaches...

Below:  Incidence, lethality and mortality of AIDS in Mato Grosso do Sul state during the period of 1985–2012

Full article at: http://goo.gl/fHR9i6

By: Pinto CS1, Dos Santos Fernandes CE2, de Oliveira RD3, de Matos VT4, de Castro AR5.

• 1Health Department of the State of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil. Electronic address: claricepm@gmail.com.
• 2Biological and Health Science Center, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil.
• 3State University of Dourados, Dourados, Mato Grosso do Sul, Brazil.
• 4Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Grosso do Sul, Brazil.
• 5Biological and Health Science Center, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil; Oswaldo Cruz Foundation, Campo Grande, Mato Grosso do Sul, Brazil.  

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