Risco frente ao HIV/Aids entre mulheres trabalhadoras do sexo que usam crack no sul do Brasil

OBJECTIVE: To understand the social context of female sex workers who use crack and its impact on HIV/AIDS risk behaviors. METHODODOLOGICAL PROCEDURES: Qualitative study carried out in Foz do Iguaçu, Southern Brazil, in 2003. Twenty-six in-depth interviews and two focus groups were carried out with female commercial sex workers who frequently use crack. In-depth interviews with health providers, community leaders and public policy managers, as well as field observations were also conducted. Transcript data was entered into Atlas.ti software and grounded theory methodology was used to analyze the data and develop a conceptual model as a result of this study. ANALYSIS OF RESULTS: Female sex workers who use crack had low self-perceived HIV risk in spite of being engaged in risky behaviors (e.g. unprotected sex with multiple partners). Physical and sexual violence among clients, occasional and stable partners was widespread jeopardizing negotiation and consistent condom use. According to health providers, community leaders and public policy managers, several female sex workers who use crack are homeless or live in slums, and rarely have access to health services, voluntary counseling and testing, social support, pre-natal and reproductive care. CONCLUSIONS: Female sex workers who use crack experience a plethora of health and social problems, which apparently affect their risks for HIV infection. Low-threshold, user-friendly and gender-tailored interventions should be implemented, in order to increase the access to health and social-support services among this population. Those initiatives might also increase their access to reproductive health in general, and to preventive strategies focusing on HIV/AIDS and other sexually transmitted infections.OBJETIVO: Comprender el contexto social en el cual están insertadas trabajadoras del sexo que usan crack y su impacto en la adopción de comportamientos de riesgo frente al HIV/Sida. MÉTODOS: Se realizó estudio cualitativo en Foz de Iguacu (Sur de Brasil), en 2003. Se realizaron 26 encuestas con profundidad y dos grupos focales con trabajadoras del sexo que utilizan crack frecuentemente. También se realizaron encuestas con profundidad con profesionales de la salud, líderes comunitarios y gerentes de políticas públicas, además de observaciones de campo. Los datos transcritos fueron codificados con ayuda del software Atlas.ti y el método grounded theory (teoría fundamentada en datos) fue utilizada para analizar los datos y desarrollar un modelo conceptual como resultado de estudio. ANÁLISIS DE LOS RESULTADOS: Las trabajadoras del sexo que utilizan crack presentaron baja autopercepción del riesgo frente al HIV, a pesar de estar relacionadas con comportamientos de riesgo, como sexo desprotegido con múltiples parejas. Experiencias de violencia física y sexual con clientes, parejas ocasionales y estables fueron bastante frecuentes entre estas mujeres, perjudicando la negociación y el uso consistente de preservativos. Según los profesionales de la salud, los líderes comunitarios y los gerentes de políticas públicas, diversas trabajadoras del sexo usuarias de crack, viven en las calles o en barrios, raramente tienen acceso a los servicios de salud, de consejos y exámenes anónimos, de apoyo social y de salud reproductiva y pre-natal. CONCLUSIONES: Las profesionales del sexo que utilizan crack experimentaron varios problemas sociales y de salud que parecen influenciar sobre el riesgo a la infección por el HIV. Intervenciones de bajo umbral, amigables y dirigidas para cuestiones de género deben ser implementadas buscando facilitar el acceso a servicios de salud y de apoyo social en esa población. Tales iniciativas podrán también facilitar el acceso de ese grupo a servicios dirigidos a la salud reproductiva en general y estrategias específicamente dirigidas a la prevención del HIV/Sida y otras infecciones sexualmente transmisibles.OBJETIVO: Compreender o contexto social no qual estão inseridas trabalhadoras do sexo que usam crack e seu impacto na adoção de comportamentos de risco frente ao HIV/Aids. PROCEDIMENTOS METODOLÓGICOS: Estudo qualitativo realizado em Foz do Iguaçu (PR), em 2003. Foram realizadas 26 entrevistas em profundidade e dois grupos focais com trabalhadoras do sexo que utilizam crack freqüentemente. Também foram realizadas entrevistas em profundidade com profissionais de saúde, líderes comunitários e gerentes de políticas públicas, além de observações de campo. Os dados transcritos foram codificados com auxílio do software Atlas.ti e a metodologia grounded theory (teoria fundamentada em dados) foi utilizada para analisar os dados e desenvolver um modelo conceitual como resultado do estudo. ANÁLISE DOS RESULTADOS: As trabalhadoras do sexo que utilizam crack apresentaram baixa autopercepção de risco frente ao HIV, apesar de estarem envolvidas em comportamentos de risco, como sexo desprotegido com múltiplos parceiros. Experiências de violência física e sexual com clientes, parceiros ocasionais e estáveis foram bastante freqüentes entre estas mulheres, prejudicando a negociação e o uso consistente de preservativos. Segundo profissionais de saúde, líderes comunitários e gerentes de políticas públicas, diversas trabalhadoras do sexo usuárias de crack, são moradoras de rua ou favelas, raramente acessam serviços de saúde, de aconselhamento e testagem anônimos, de apoio social e de saúde reprodutiva e pré-natal. CONCLUSÕES: As profissionais do sexo que utilizam crack vivenciam vários problemas sociais e de saúde que parecem influenciar o risco à infecção pelo HIV. Intervenções de limiar baixo, amigáveis e voltadas para questões de gênero devem ser implementadas objetivando facilitar o acesso a serviços de saúde e de apoio social nessa população. Tais iniciativas poderão também facilitar o acesso deste grupo a serviços voltados para saúde reprodutiva em geral e estratégias especificamente voltadas para prevenção do HIV/Aids e demais infecções sexualmente transmissíveis

The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance : an AMR Insights global perspective

The COVID-19 pandemic presents a serious public health challenge in all countries. However, repercussions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on future global health are still being investigated, including the pandemic’s potential effect on the emergence and spread of global antimicrobial resistance (AMR). Critically ill COVID-19 patients may develop severe complications, which may predispose patients to infection with nosocomial bacterial and/or fungal pathogens, requiring the extensive use of antibiotics. However, antibiotics may also be inappropriately used in milder cases of COVID-19 infection. Further, concerns such as increased biocide use, antimicrobial stewardship/infection control, AMR awareness, the need for diagnostics (including rapid and point-of-care diagnostics) and the usefulness of vaccination could all be components shaping the influence of the COVID-19 pandemic. In this publication, the authors present a brief overview of the COVID-19 pandemic and associated issues that could influence the pandemic’s effect on global AMR.This study was supported by internal funding.https://academic.oup.com/jacamram2022School of Health Systems and Public Health (SHSPH

The coronavirus 2019-nCoV epidemic: Is hindsight 20/20?

Em decorrência da pandemia decretada pela OMS em 2020, o artigo encontra-se em acesso aberto.Submitted by Raphael Belchior ([email protected]) on 2020-03-12T17:04:53Z No. of bitstreams: 1 COVID-19 - PIIS258953702030033X.pdf: 262013 bytes, checksum: 488a65dfa24faa5a150a2daf7f041bf8 (MD5)Approved for entry into archive by Raphael Belchior ([email protected]) on 2020-03-12T18:06:40Z (GMT) No. of bitstreams: 1 COVID-19 - PIIS258953702030033X.pdf: 262013 bytes, checksum: 488a65dfa24faa5a150a2daf7f041bf8 (MD5)Made available in DSpace on 2020-03-12T18:06:40Z (GMT). No. of bitstreams: 1 COVID-19 - PIIS258953702030033X.pdf: 262013 bytes, checksum: 488a65dfa24faa5a150a2daf7f041bf8 (MD5) Previous issue date: 2020Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Departamento de Ciências Sociais. Rio de Janeiro, RJ, Brasil / Department of Psychiatry, Faculty of Medicine, University of Toronto. Toronto, ON, Canada / nstitute for Mental Health Policy Research, Centre for Addiction and Mental Health. Toronto, ON, Canada.Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California. Los Angeles, USA.Department of Medicine, University of California San Diego School of Medicine, La Jolla. CA, USA

Evaluating e ectiveness of syringe exchange programmes: current issues and future prospects

The authors gratefully acknowledge Dr. T. Valente who provided a critical review of the manuscript and Ms. T.O. Johnson who assisted in manuscript preparation. They thank also Drs. Nick Crofts (Australia)and Fernando Marques (Brazil) for the unpublished information they kindly provided. FIB is partially supported by a National Research Council (CNPq) salary grant (IIA) and is a recipient of an award scholarship from Rio de Janeiro Research Council (FAPERJ).Made available in DSpace on 2010-08-23T16:58:31Z (GMT). No. of bitstreams: 3 license.txt: 1841 bytes, checksum: 94fc60ed243e752c2053c81ada7b10be (MD5) Bastos_Evaluating Effectiveness os syringe_2000.pdf: 151776 bytes, checksum: 3afdc3927234a015949668b91d37e4e7 (MD5) Bastos_Evaluating Effectiveness os syringe_2000.pdf.txt: 64059 bytes, checksum: 659c485c14aa9ce7195c866d1592804e (MD5) Previous issue date: 2000Made available in DSpace on 2010-11-04T14:19:50Z (GMT). No. of bitstreams: 3 Bastos_Evaluating Effectiveness os syringe_2000.pdf.txt: 64059 bytes, checksum: 659c485c14aa9ce7195c866d1592804e (MD5) Bastos_Evaluating Effectiveness os syringe_2000.pdf: 151776 bytes, checksum: 3afdc3927234a015949668b91d37e4e7 (MD5) license.txt: 1841 bytes, checksum: 94fc60ed243e752c2053c81ada7b10be (MD5) Previous issue date: 2000Oswaldo Cruz Foundation. Center for Scientific and Technological Information. Department of Health Information. Rio de Janeiro, RJ, Brazil.Johns Hopkins University. School of Hygiene and Public Health. Department of Epidemiology. Baltimore, MD, USA.Although a large body of international literature has found syringe exchange programmes (SEPs) to be associated with reduced incidence of blood borne pathogens among injection drug users, recent studies have fuelled controversy surrounding SEP e ectiveness. Existing studies are observational in nature and have seldom considered ecologic aspects a ecting SEP functioning and evaluation. The authors apply concepts from infectious disease epidemiology to discuss the direct and indirect e ects of SEP upon the spread of blood borne pathogens in drug users, their social networks and the broader community. Further, the authors discuss social policies, particularly drug control policies, which have directly and/or indirectly limited SEP functioning at local and national levels. A critical review of the literature suggests that biases common to observational studies can account for higher HIV incidence among SEP attenders relative to non-attenders. Strong selection factors often lead high-risk drug users to be over-represented among SEP attenders. Failure to account for these factors and the indirect e ects of SEPs can bias interpretations of programme e ectiveness. Future SEP evaluations should consider behavioural data, the local ethnographic context, the prevalence of infectious disease in the groups under study and the structural components of SEP that are most and least e ective at reducing incidence of blood borne pathogens. Hierarchical models that take into account the ecological dimensions of SEP are recommended as an approach for future studies. Beyond methodologic concerns, the authors discuss social, legal and programmatic obstacles that must be overcome in order to maximise SEP e ectiveness

Monkeypox and Global Health Inequities: A Tale as Old as Time…

Infectious disease outbreaks can quickly become global in what has increasingly become a closely interconnected world, influenced by what is considered to be an unprecedented era of technological, demographic, and climatic change [...]