Tuberculosis/HIV/AIDS coinfection in Porto Alegre, RS/Brazil - invisibility and silencing of the most affected groups

OBJECTIVE: To analyze how belonging to certain social groups contributes to constituting the vulnerabilities associated with illnesses due to tuberculosis/HIV/AIDS coinfection. METHODOLOGYThis is a qualitative study carried out in the city of Porto Alegre, state of Rio Grande do Sul, in regions of high social vulnerability. Twenty coinfected people were interviewed in specialized health services between August and December 2016. The analysis was based on the frameworks The Sound of Silence and Vulnerability and Human Rights. RESULTS: Socioeconomic conditions were decisive for the constitution of the vulnerability conditions. Processes of people invisibilization, and the silencing of their voices, in a scenario marked by economic, racial and gender inequalities, contributed for their health needs not to be understood and effectively taken into account in the services actions. FINAL CONSIDERATIONS: The more effective strategies are to legitimize voices and to understand the needs of those affected by coinfection, the greater the chances that programmatic responses to the problem will be successful

Floquet theory for seasonal environmental forcing of spatially explicit waterborne epidemics

The transmission of waterborne pathogens is a complex process that is heavily linked to the spatial characteristics of the underlying environmental matrix as well as to the temporal variability of the relevant hydroclimatological drivers. In this work, we propose a time-varying, spatially explicit network model for the dynamics of waterborne diseases. Applying Floquet theory, which allows to extend results of local stability analysis to periodic dynamical systems, we find conditions for pathogen invasion and establishment in systems characterized by fluctuating environmental forcing, thus extending to time-varying contexts the generalized reproduction numbers recently obtained for spatially explicit epidemiology of waterborne disease. We show that temporal variability may have multifaceted effects on the invasion threshold, as it can either favor pathogen invasion or make it less likely. Moreover, environmental fluctuations characterized by distinctive geographical signatures can produce diversified, highly nontrivial effects on pathogen invasion. Our study is complemented by numerical simulations, which show that pathogen establishment is neither necessary nor sufficient for large epidemic outbreaks to occur in time-varying environments. Finally, we show that our framework can be used to reliably characterize the early geography of epidemic outbreaks triggered by fluctuating environmental conditions