"Sexuality? A Million Things Come to Mind": Reflections on Gender & Sexuality by Chilean Adolescents

Although Chile is a traditionally conservative country, considerable legal advances in sexual and reproductive rights over the past decade have brought discourses on sexuality into mainstream political, social and media agendas. In light of these changes it is important to explore how adolescents conceptualize sexuality, which in turn influences their understanding of sexual rights. 

This study is based on four focus group discussions and 20 semi-structured interviews with adolescents, and seven interviews with key informants in Santiago, Chile. Findings indicate that adolescent conceptualizations of sexuality are diverse, often expressed as attitudes or observations of their social context, and primarily shaped by peers, parents and teachers. Attitudes towards individuals with non-heterosexual orientations ranged from support to rejection, and conceptualizations of sexual diversity were also influenced by media, medicalization and biological explanations. Gender differences in sexual expression were described through gendered language and behaviour, in particular observations of gender stereotypes, censored female sexuality and discourses highlighting female risk. Many adolescents described social change towards greater equality regarding gender and sexuality. 

To optimize this change and help bridge the gap between legal and social recognition of sexual rights, adolescents should be encouraged to reflect critically on issues of gender equality and sexual diversity in Chile.

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By:   Macintyre AK1, Montero Vega AR2, Sagbakken M3.

• 1Researcher, Department of Community Medicine, Institute of Health and Society, University of Oslo, Norway. Electronic address: annakjmacintyre@gmail.com.
• 2Associate Professor and Director of the Centre for Reproductive Medicine and Integral Adolescent Development (CEMERA), Faculty of Medicine, Universidad de Chile, Santiago, Chile.
• 3Associate Professor, Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College, Oslo, Norway; Researcher, National Centre for Minority Health Research (NAKMI), Oslo, Norway.
• Reprod Health Matters. 2015 Nov;23(46):85-95. doi: 10.1016/j.rhm.2015.11.003. Epub 2015 Dec 9. 

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Tuberculosis in Prisoners & Their Contacts in Chile: Estimating Incidence & Latent Infection

SETTING:

Contact investigation of tuberculosis (TB) patients in Chilean prisons.

OBJECTIVE:

To estimate TB incidence and the prevalence of latent tuberculous infection (LTBI) among prisoners and their contacts; and 2) to determine factors associated with disease transmission.

DESIGN:

Cross-sectional study conducted in 46 prisons (51% of the total prison population) to assess the prevalence of and risk factors for LTBI among contacts of prisoners newly diagnosed with pulmonary TB. We used in vitro interferon-gamma release assays to establish LTBI and a questionnaire to address risk factors.

RESULTS:

During the 1-year follow-up, we studied 418 contacts of 33 active TB cases. We found high TB incidence (123.9 per 100 000 prisoners) and high LTBI prevalence (29.4%) among contacts. LTBI rates are significantly higher in prison inmates than in non-prisoners (33.2% vs. 15.6%). Male sex, illicit drugs, malnutrition, corticosteroid use, low educational level and sharing a cell with a case increase the risk of LTBI. Multivariate analyses showed that corticosteroid use, duration of incarceration and overcrowding are the most relevant determinants for LTBI among all contacts.

CONCLUSIONS:

Our results confirm that incarceration increases the risk of tuberculous infection and TB disease, and that it was associated not only with origin from vulnerable groups, but also with the prison environment. Reinforcing TB control is essential to prevent TB transmission in prisons.

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By:   Aguilera XP1, González C1, Nájera-De Ferrari M1, Hirmas M1, Delgado I1, Olea A1, Lezaeta L2, Montaña A3, González P3, Hormazábal JC4, Fernández J4,García C5, Herrera T5.

• 1Centro de Epidemiología y Políticas de Salud, Facultad de Medicina, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile.
• 2Departamento de Salud Gendarmería de Chile, Santiago, Chile.
• 3Clínica Alemana de Santiago, Santiago, Chile.
• 4Instituto de Salud Pública de Chile, Santiago, Chile.
• 5Ministerio de Salud de Chile, Santiago, Chile. 

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Homicide in Chile: Trends 2000 – 2012

Background

Homicide, an external cause of morbidity and mortality, caused 473,000 deaths worldwide in 2012, a rate of 6.2 per 100,000 inhabitants. The aim of this study was to describe homicide mortality trends in Chile between 2000 and 2012 by year, gender, age group, geographic distribution (by zone and by region) and type of homicide.

Methods

This was a population-based study. Data for homicide mortality in Chile between 2000 and 2012 were used and they were provided by the Chilean Ministry of Health’s Department of Statistics and Health Information (DEIS) and PAHO/WHO. The homicide mortality rates were calculated per 100,000 inhabitants. The study variables were year, geographic distribution, gender, age group and type of homicide. The annual percentage change (APC) of the rates was analyzed, and a logarithm of the rates by year and region was fitted by applying linear regression models. In addition, relative risks (RR) were calculated. 95 % confidence intervals were considered in all the analyses.

Results

The average yearly rate of homicide (HMR) in Chile (2000–2012) was 4.9. The rates were higher in men (8.7) than in women (1.1), with a RR of 8.2. The rates were higher in the country’s central zone (5.0), increasing in recent years in the southern zone, with a significant positive APC of 1.1 %. The Aisén Region had the highest rate (7.6), although Antofagasta was the region with the most significant APC (3.1 %). The highest rate (9.2) was verified in the 25 to 39 age group. The highest rate (5.5) was recorded in 2005. The most frequent type of homicide was assault with an object (44.8 %).

Conclusions

Although the homicide rates are higher in the southern zone of the country, the northern zone is showing a tendency to increase, becoming an even more serious problem, which not only affects those directly involved, but society as a whole.

Below:  Homicide mortality rate per 100,000 population by zone

Full article at: http://goo.gl/IY9VoZ

By:   Tamara Otzen^1234*, Antonio Sanhueza⁵⁶, Carlos Manterola¹⁷, Tamara Melnik⁴ and Monica Hetz⁸

¹Doctorado en Ciencias Médicas, Universidad de La Frontera, Avenida Alemania 0458, Temuco, Chile

²Escuela de Psicología, Universidad Autónoma de Chile, Temuco, Chile

³Universidad Científica del Sur, Lima, Peru

⁴Programa de Pós-graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo, São Paulo, Brazil

⁵Departamento de Matemática y Estadísticas, Universidad de La Frontera, Temuco, Chile

⁶Pan American Health Organization/Regional Office of the World Health Organization, Washington, USA

⁷Departamento de Cirugía, Universidad de La Frontera, Temuco, Chile

⁸Psychology, Catholic University of Temuco, Temuco, Chile

 

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Aggressive and Prosocial? Examining Latent Profiles of Behavior, Social Status, Machiavellianism, and Empathy

The present study tests whether aggression and prosocial behavior can coexist as part of a socially functional and adaptive profile among early adolescents. Using a person-centered approach, the study examined early adolescents' likelihood of being classified into profiles involving aggressive and prosocial behavior, social status (popular, liked, cool), machiavellianism, and both affective and cognitive components of empathy (empathic concern and perspective taking, respectively). 

Participants were 1170 early adolescents (10-12 years of age; 52 % male) from four schools in metropolitan Santiago, Chile. Through latent profile analysis, three profiles emerged (normative-low aggressive, high prosocial-low aggressive, and high aggressive-high popular status). Both empathic concern and perspective taking were higher in the high prosocial-low aggressive profile, whereas the high aggressive-high popular status profile had the lowest scores on both empathy components as well as machiavellianism. No profile emerged where aggressive and prosocial behaviors were found to co-exist, or to be significantly above the mean. 

The results underscore that aggressive behavior is highly contextual and likely culturally specific, and that the study of behavioral profiles should consider social status as well as socio-emotional adjustment indicators. These complex associations should be taken into consideration when planning prevention and intervention efforts to reduce aggression or school bullying and to promote positive peer relationships.

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By:  Berger C1, Batanova M2, Cance JD3.

• 1Escuela de Psicologia, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul, 7820436, Santiago, Chile. cberger@uc.cl.
• 2Tufts University, Medford, MA, USA. milena.batanova@tufts.edu.
• 3The University of Texas at Austin, Austin, TX, USA. jdcance@austin.utexas.edu. 

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Prevalence of Oral Candidiasis in HIV/AIDS Children in Highly Active Antiretroviral Therapy Era. A Literature Analysis

Highly active antiretroviral therapy has decreased the morbidity and mortality related to HIV infection, including oral opportunistic infections. This paper offers an analysis of the scientific literature on the epidemiological aspects of oral candidiasis in HIV-positive children in the combination antiretroviral therapy era. 

An electronic databases search was made covering the highly active antiretroviral therapy era (1998 onwards). The terms used were oral lesions, oral candidiasis and their combination with highly active antiretroviral therapy and HIV/AIDS children. The following data were collected from each paper: year and country in which the investigation was conducted, antiretroviral treatment, oral candidiasis prevalence and diagnostic parameters (clinical or microbiological). 

Prevalence of oral candidiasis varied from 2.9% in American HIV-positive children undergoing highly active antiretroviral therapy to 88% in Chilean HIV-positive children without antiretroviral therapy. With respect to geographical location and antiretroviral treatment, higher oral candidiasis prevalence in HIV-positive children on combination antiretroviral therapy/antiretroviral therapy was reported in African children (79.1%) followed by 45.9% reported in Hindu children. 

In HIV-positive Chilean children on no antiretroviral therapy, high oral candidiasis prevalence was reported (88%) followed by Nigerian children (80%). Oral candidiasis is still frequent in HIV-positive children in the highly active antiretroviral therapy era irrespective of geographical location, race and use of antiretroviral therapy.

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By: Gaitán-Cepeda LA1, Sánchez-Vargas O2, Castillo N3.

• 1Laboratory of Oral Pathology, Postgraduate and Research Division, Dental School, National Autonomous University of Mexico, Coyoacan, México lgaitan@unam.mx.
• 2Laboratory of Microbiology, Pathology and Biochemical, Faculty of Stomatology, Autonomous University of San Luis Potosi, San Luis Potosí, México.
• 3Microbiology area, Health Sciences Center, Autonomous University of Baja California, Valle de las Palmas, Tijuana, Baja California, México.  

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Monitoring of HIV treatment in Seven Countries in the WHO Region of the Americas

To determine the prevalence of adequate monitoring and the costs of measuring CD4+ T-lymphocytes (CD4+ cell) and human immunodeficiency virus (HIV) viral load in people receiving antiretroviral therapy (ART) in seven countries in the WHO Region of the Americas. Methods We obtained retrospective, longitudinal data for 14 476 adults who started a first ART regimen at seven HIV clinics in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru between 2000 and 2011. We estimated the proportion of 180-day periods with adequate monitoring, which we defined as at least one CD4+ cell count and one viral load measurement. Factors associated with adequate monitoring were analysed using regression methods. The costs of the tests were estimated.

The median follow-up time was 50.4 months; the proportion of 180-day periods with adequate CD4+ cell counts was 69% while the proportion with adequate monitoring was 62%. Adequate monitoring was more likely in participants who were older, who started ART more recently, whose first regimen included a non-nucleoside reverse transcriptase inhibitor or who had a CD4+ cell count less than 200 cells/µl at ART initiation. The cost of one CD4+ cell count ranged from 7.37 United States dollars (US$) in Argentina to US$ 64.09 in Chile; the cost of one viral load measurement ranged from US$ 20.34 in Brazil to US$ 186.28 in Haiti.

In HIV-infected participants receiving ART in the WHO Region of the Americas, CD4+ cell count and viral load monitoring was often carried out less frequently than regional guidelines recommend. The laboratory costs of monitoring varied greatly.

Table 1 Antiretroviral treatment programmes in seven countries in the WHO Region of the Americas, 2000-2011 

Characteristic			Site of adult HIV clinica
	Argentina	Brazil	Chile	Haiti	Honduras	Mexico	Peru
No. of participants in study	1285	2446	1080	5696	789	772	2408
Start of universal access to ART, year	2000	1991b	2003	2003	2003	2002	2004
Type of clinic	Private	Public	Public	NGO	Public	Public	Public
Guidelines used for monitoring ART efficacy	SADI, MOH	MOH	MOH	MOH, PAHO	MOH	MOH	MOH
Recommended periodicity of CD4+ cell count monitoring	3-4 months	3-6 months	3-4 monthsc	6 months	6 months	4-6 months	6 months
Cost of one CD4+ cell count, US$d	7.37	17.62	64.09	32.6	14.31 33.39	59.67	38.12e
Source of funding for CD4+ cell count monitoring	Refund from Argentine government, social insurance	Brazilian government	Chilean government	PEPFAR, GFATM	Honduran government, social insurance	Mexican government	Peruvian government
Cost of one HIV viral load measurement, US$d	55.26	20.34	119.14	186.28f	33.39g160.19h	119.27	86.32
Source of funding for HIV viral load monitoring	Refund from Argentine government, social insurance	Brazilian government	Chilean government	Researchfunded	Honduran government, social insurance	Mexican government	Peruvian government

Table 2 Characteristics of participants receiving ART in seven countries in the WHO Region of the Americas, 2000-2011 

Participants' characteristic				Site of adult HIV clinica
	Argentina	Brazil	Chile	Haiti	Honduras Mexico		Peru		Total (n = 14 476)
		(n= 2446) (n=1080) (n=5696)			(n = 789) (n = 772)			(n = 2408)
Age in years, median (IQR)	(33-46)	38 38 39	(32-45)	(32-46)	36 34 (30-43) (29-42)		(29-43)	35	37
									(31-45)
Male sex, no. (%)	925 (72)	1611 (66)	952 (88)	2480 (44) 422 (53) 673 (87)			1691 (70)		8754 (60)
Probable cause of infection, no. (%) Heterosexual sex	340 (26)	1136 (46)	285 (26)	0 (0) 471 (60) 219 (28)			1562 (65)		4013 (28)
Homosexual sex	181 (14)	833 (34)	785 (73)	0 (0) 49 (6) 514 (67)			831 (35)		3193 (22)
Other	55 (4)	81 (3)	9 (1)	0 (0) 3 (0) 17 (2)			13 (1)		178 (1)
Unknown	709 (55)	396 (16)	1 (0)	5696 (100) 266 (34) 22 (3)			2 (0)		7092 (49)
CD4+ cell count at ART initiation, no. (%) Data missing	306 (24)	426 (17)	302 (28)	772 (14) 151 (19) 132 (17)			326 (14)		2415 (17)
200-350 cells/µL < 200 cells/µL	306 (24)	771 (32)	373 (35)	3035 (53) 447 (57) 355 (45)			1222 (51)		6509 (45)
200-350 cells/µL	349 (27)	650 (27)	234 (22)	1537 (27) 146 (19) 184 (24)			526 (22)		3626 (25)
350 cells/µL	324 (25)	599 (24)	171 (16)	352 (6) 45 (6) 101 (13)			334 (14)		1926 (13)
Prior AIDS-defining eventb at ART initiation, no. (%)	54 (4)	172 (7)	292 (27)	1223 (21) 252 (32) 332 (43)			848 (35)		3173 (22)
Prior AIDS-defining event or CD4+ cell count < 200 cells/µL at ART initiation	335 (26)	871 (36)	541 (50)	3423 (60) 536 (68) 486 (63)			1515 (63)		7707 (53)
NNRTI-based ART regimen, no. (%)	869 (68)	1270 (52)	858 (79)	5279 (93) 745 (94) 607 (79)			2024 (84)		11 652 (80)

Full article at: http://goo.gl/QBS4Ey

By: 

Pablo F Belaunzarán-Zamudioa, Yanink N Caro-Vegaa, Bryan E Shepherdb, Brenda E Crabtree-Ramíreza, Paula M Luzc, Beatriz Grinsztejnc, Carina Cesard, Pedro Cahnd, Claudia Cortése, Marcelo Wolffe, Jean W Papef, Denis Padgettg, Eduardo Gotuzzoh, Catherine McGowani, Juan G Sierra-Maderoa

^a Clínica de Inmuno-Infectología, Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Calle Vasco de Quiroga 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, México Distrito Federal, CP 14080, Mexico.

^b Department of Biostatistics, Vanderbilt University, Nashville, United States of America (USA).

^c Instituto de Pesquisa Clínica Evandro Chagas, Fundacão Oswaldo Cruz, Rio de Janeiro, Brazil.

^d Fundación Huésped, Buenos Aires, Argentina.

^e Fundación Arriarán, Universidad de Chile, Santiago, Chile.

^f Le Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti.

^g Instituto Hondureño de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras.

^h Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru.

ⁱDepartment of Medicine, Vanderbilt University, Nashville, USA.

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