Retrospective analysis of risk factors and gaps in prevention strategies for mother-to-child HIV transmission in Rio de Janeiro, Brazil

Background Despite great progress made in methods to prevent mother-to-child transmission of HIV (MTCT), delivery and uptake of these measures remains a challenge in many countries. Although the Brazilian Ministry of Health aimed to eliminate MTCT by 2015, infection still occured in 15–24% of infants born to HIV-infected mothers. We sought to identify remaining factors that constrain MTCT elimination. Methods We conducted a retrospective, matched case-control study by reviewing hospital charts of infants born to HIV-infected mothers between 1997 and 2014 at three MTCT reference hospitals in the Rio de Janeiro metropolitan area. Cases were defined as HIV-exposed children with two positive HIV tests before 18 months of age; controls were defined as HIV-exposed children with two negative HIV tests before 18 months of age. We performed bivariate and MTCT cascade analyses to identify risk factors for MTCT and gaps in prevention services. Results We included 435 infants and their mothers (145 cases, 290 controls). Bivariate analyses of MTCT preventative care (PMTCT) indicated that cases were less likely to complete all individual measures in the antenatal, delivery, and postnatal period (p < 0.05). Assessing completion of the PMTCT cascade, the sequential steps of PMTCT interventions, we found inadequate retention in care among both cases and controls, and cases were significantly less likely than controls to continue receiving care throughout the cascade (p < 0.05). Motives for incompletion of PMTCT measures included infrastructural issues, such as HIV test results not being returned, but were most often due to lack of care-seeking. Over the course of the study period, PMTCT completion improved, although it remained below the 95% target for antenatal care, HIV testing, and antenatal ART set by the WHO. Adding concern, evaluation of co-infections indicated that case infants were also more likely to have congenital syphilis (OR: 4.29; 95% CI: 1.66 to 11.11). Conclusions While PMTCT coverage has improved over the years, completion of services remains insufficient. Along with interventions to promote care-seeking behaviour, increased infrastructural support for PMTCT services is needed to meet the HIV MTCT elimination goal in Brazil as well as address rising national rates of congenital syphilis

Favela ou Comunidade? How demarcating informal settlements from the top-down or the bottom-up can identify, address, and perpetuate health disparities

Place-based effects on health have been well-documented; however, narrow constructions of place, neighborhood and individual- as well as community-level identity hinder our ability to more fully understand the ways in which place affects health outcomes for diverse populations. Informal settlements in Rio de Janeiro (colloquially referred to as favelas) have been demarcated by local and federal government agencies with fixed boundaries for administrative purposes, including identifying areas for infrastructure improvements, renewal or removal. However, local and federal administrative boundaries often do not match each other, and the collective lived experience of residents of these favela communities tend not to be clearly bounded by those official designations. This dissertation sets out to address the following questions:1) How do administrative boundaries of informal settlements overlap, or not, with the terms and definitions used to describe these places by the people who live there? 2) How do residents of informal settlements in Rio de Janeiro operate to either reinforce or push back against these officially designated boundaries? 3) Do narrow constructions of place conceal demographic disparities in access to municipal infrastructure?In my dissertation I first examine how informal settlements in Rio de Janeiro are places constructed by top-down institutional forces, such as administrative processes employed by the State through the national census and local government efforts to push marginalized residents into these areas, as well as removing these parts of the city entirely. Further, I examine how residents contest and reshape the boundaries of their communities, both in pushing back and challenging the official categorizations of the State, as well as embarking on their own boundary-setting practices by mapping and documenting their communities for themselves with the goal of improving community health and well-being. Through these processes of contested place-making, residents help to identify community needs and provide resources for themselves that the State has been unwilling or unable to provide. Running throughout this work is an understanding that place and identity are socially constructed and socially contested, both dynamically responding to pressure exerted by the State from the top-down and community members from the bottom-u

Latinx Geographies : Opening Conversations

With increased interest in Latinx geographies there is a need for more in-depth exploration of how Latinx geographers are approaching this work in their own words. In this article, we open a discussion on Latinx geographies that is grounded in our multiple, different, embodied experiences as Latinx geographers who have gathered over the last several years to have conversations, create spaces and build relationships of care and accountability with each other. We reflect on how we each arrived to Latinx geographies, what it means to us, how we do Latinx geographies and what is on the horizon. We refuse singular or imposed definitions, and collectively imagine an expansive, nuanced, and relational Latinx geographies that critically engages with difference, conquest, power, and liberation across Turtle Island and Abya Yala