Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV : a study with respondent-driven sampling in Brazil

Background: Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result. Methods: Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). Results: For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBTNGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. Conclusions: The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM

Experience of taking care of children exposed to HIV: a trajectory of expectations

OBJETIVO: conhecer a experiência do cuidador/mãe em relação ao cuidado para com a criança exposta ao vírus da imunodeficiência humana por transmissão vertical, na trajetória pós-natal. MÉTODO: pesquisa qualitativa, que utilizou o Interacionismo Simbólico como referencial teórico. Foram realizadas entrevistas com 39 cuidadores de crianças expostas ao vírus da imunodeficiência humana e em seguimento em um serviço especializado. Os dados foram analisados pela análise de conteúdo indutiva. RESULTADOS: apreenderam-se quatro categorias que reportam à experiência solitária de manuseio da terapia antirretroviral da criança, no que se refere principalmente à ausência ou incompletude de informações recebidas; estar atento aos cuidados, que incluem o uso da profilaxia para pneumonia, vacinas e outros restritos à interação mãe/criança; querer omitir a presença do vírus da imunodeficiência humana pelo medo do preconceito e olhar o futuro e temer a doença. CONCLUSÃO: a presença do vírus da imunodeficiência humana e a ameaça dessa infecção na criança são capazes de gerar apreensão e tantos outros sentimentos como medo, culpa e ansiedade no cuidador. Os profissionais de saúde precisam trabalhar conjuntamente com a mãe para o enfrentamento das demandas e sofrimentos. Assim, o tratamento para evitar a transmissão vertical será eficiente e a mãe, juntamente à criança, viverá essa trajetória com apoio, apesar da apreensão pelo resultado.OBJETIVO: conocer la experiencia del cuidador/madre en relación al cuidado de niño expuesto al VIH por transmisión vertical en la trayectoria posnatal. MÉTODO: investigación cualitativa, que utilizó el Interaccionismo Simbólico como referencial teórico. Fueron realizadas entrevistas con 39 cuidadores de niños expuestos al VIH y que eran acompañados en un servicio especializado. Los datos fueron analizados por el análisis de contenido inductivo. RESULTADOS: se encontraron cuatro categorías que informan sobre la experiencia solitaria de la administración de la terapia antirretroviral del niño, en lo que se refiere principalmente a: la ausencia o a informaciones incompletas recibidas; al estar atento a los cuidados, que incluyen el uso de la profilaxis para neumonía, vacunas y otros restringidos a la interacción madre-niño; al querer omitir la presencia del VIH por miedo al prejuicio; y al mirar al futuro y temer a la enfermedad. CONCLUSIÓN: la presencia del VIH y la amenaza de infectar al niño son capaces de generar preocupación y varios otros sentimientos en el cuidador, como miedo, culpa y ansiedad. Los profesionales de la salud precisan trabajar conjuntamente con la madre para el enfrentamiento de las demandas y sufrimientos. Así, el tratamiento para evitar la transmisión vertical será eficiente y la madre con el niño vivirán esa trayectoria con apoyo, a pesar de la preocupación por el resultado.'OBJECTIVE: to learn about the experience of caregivers/mothers providing care to infants exposed to HIV through vertical transmission. METHODS: this qualitative study used Symbolic Interactionism as the theoretical framework. A total of 39 caregivers of children exposed to HIV in follow-up at a specialized service were interviewed. Data were analyzed through inductive content analysis. RESULTS: four categories were identified that report on the lonely experience of handling the child's antiretroviral therapy, mainly due to a lack of information or incomplete information; being attentive to required care, such as the use of prophylaxis for pneumonia, vaccines, and other practices restricted to the mother-child interaction; the desire to omit the HIV out of fear of prejudice and fear of the disease, considering future prospects. CONCLUSION: the HIV and the threat this infection may affect the child cause apprehension and feelings such as fear, guilt and anxiety in the caregivers. Healthcare workers need to work together with mothers so they are able to cope with demands and distress. Only then will the treatment to avoid vertical transmission be efficient and will mother and child be supported during the process, despite apprehension with the outcome

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

A percepção de profissionais da saúde de um hospital sobre a violência contra as mulheres La percepción de profesionales de salud de un hospital sobre la violencia contra la mujer The perceptions of the health professionals at a hospital about the violence against women

Estudo qualitativo que objetivou conhecer percepções de profissionais de saúde acerca da assistência às mulheres em situação de violência. O cenário foi um hospital de ensino no sul do Brasil. Os sujeitos da pesquisa foram 12 profissionais de saúde do Centro Obstétrico e Pronto Socorro. A coleta dos dados realizou-se em abril/maio de 2008, a partir de vinheta e entrevista semi-estruturada. As informações foram organizadas e estruturadas por meio da análise temática. Dos resultados emergiram duas categorias: o diálogo como instrumento facilitador para a identificação da violência e seus encaminhamentos, e a complexidade do fenômeno e suas implicações na assistência. Aponta-se a necessidade de criação de espaços de responsabilização dos órgãos formadores e serviços de saúde na formação de equipe multiprofissional que discuta e implemente a política de atendimento às mulheres em situação de violência.<br>Estudio cualitativo que tuvo por objetivo conocer las percepciones de profesionales de salud acerca de la asistencia a las mujeres en situaciones de violencia. El escenario fue un hospital de enseñanza en el sur de Brasil. Los sujetos de la investigación fueron 12 profesionales de salud del Centro Obstétrico y Hospital de urgencias. La recolección de los datos se realizó en abril/mayo de 2008, a partir de viñeta y entrevista semiestructurada. Las informaciones fueron organizadas y estructuradas por medio del análisis temático. Los resultados emergieron dos categorías: el diálogo como instrumento facilitador para la identificación de la violencia y sus encaminamientos las mujeres y la complexidad del fenómeno y sus implicaciones en la asistencia. Se evidencia la necesidad de creación de espacios de responsabilización de los órganos formadores y servicios de salud en la formación del equipo multiprofesional que discuta e implemente la política de atención a las mujeres en situación de violencia.<br>This qualitative study aimed to know the perceptions of health professionals about the assistance to women living in a violent situation. The scenery was a teaching hospital of southern Brazil. The participants were 12 health professionals from the obstetric and emergency units. The data were collected by semistructured interviews started by a short story in April to May of 2008. The information was organized and categorized and subject to thematic analysis. The results showed two categories: the dialogue as a facilitator instrument to identify the violence and their referrals and the complexity of the phenomena and their implications to the assistance. We pointed out the necessity of to create spaces of the responsibility of agencies devoted to training human resources in health and health services. It is in order to form multiprofessional team that discuss and implements the policy care to women living in a violent situation

Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV : a study with respondent-driven sampling in Brazil

Background: Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result. Methods: Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). Results: For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBTNGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. Conclusions: The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM