Migração e ruralização da Aids: relatos de vulnerabilidade de comunidades indígenas no México

OBJETIVO: Analizar la vulnerabilidad para ITS/VIH entre mujeres Purépechas y Zapotecas unidas en concubinato con varones que practican sexo sin protección. MÉTODOS: Estudio etnográfico realizado en febrero del 2004 y en diciembre del 2005 en localidades indígenas de Michoacán y Oaxaca, Mexico. Estos son entidades con niveles altos de expulsión migratoria, rezago comunitario y casos registrados de VIH/SIDA. Se entrevistaron en profundidad a 91 personas: migrantes temporales (24), mujeres indígenas (33), autoridades locales (20) y personal de salud (14). RESULTADOS: La ruralización del ITS/VIH puede relacionarse con las prácticas de iniciación sexual femeninas pero sobre todo con el miedo del migrante a que su concubina tenga relaciones extra-conyugales en su ausencia. El embarazo y la crianza son recursos masculinos de control de las esposas. CONCLUSIONES: La migración de retorno implica formas de vulnerabilidad para las mujeres indígenas en las localidades estudiadas, cuya sexualidad tiene un remarcado carácter reproductivo. Es necesario implementar políticas de prevención para ITS/VIH dirigidas a fortalecer derechos sexuales y reproductivos de las mujeres y que tomen en cuenta aspectos de identidad sexual masculina.OBJETIVO: Analisar a vulnerabilidade ao IST/HIV entre mulheres indígenas mexicanas unidas em concubinato com homens que praticam sexo sem proteção. MÉTODOS: Estudo etnográfico realizado nos meses de fevereiro de 2004 e dezembro de 2005 nas localidades rurais de Michoacán e de Oaxaca, México. Essas localidades possuem altos níveis de emigração, pobreza e casos de HIV/Aids. Foram realizadas entrevistas em profundidade com 91 pessoas: migrantes sazonais (24), mulheres indígenas (33), autoridades locais (20) e profissionais de saúde (14). RESULTADOS: A ruralização do HIV pode ser relacionada às práticas de iniciação sexual femininas e sobretudo ao medo do migrante de que sua esposa tenha relações extra-conjugais em sua ausência. A gravidez e a criança são recursos masculinos para controlar suas esposas. CONCLUSÕES: A migração de retorno implica formas de vulnerabilidade para as mulheres indígenas nas localidades estudadas, cuja sexualidade tem caráter marcadamente reprodutivo. É necessário desenvolver políticas de prevenção a IST/HIV dirigidas ao fortalecimento dos direitos sexuais reprodutivos das mulheres e que considerem aspectos da identidade masculina.OBJECTIVE: To evaluate the vulnerability for STI/HIV among Mexican indigenous women in common law marriage with men who practice sex without condom. METHODS: Ethnography study undertaken in indigenous villages of Michoacán and Oaxaca, Mexico, in February 2004 and December 2005. These rural communities are characterized by high migration rates, extreme poverty and HIV/AIDS cases. An in-depth interview was applied to transient migrants (24), indigenous women (33), local authorities (20) and health providers (14). RESULTS: Rural propagation of STI/HIV is associated to sexual female initiation and mostly to migrants' fear their concubines will have extramarital sex during their absence. Impregnating their wives and the resulting childcare is one of the men's resources for controlling their concubines. CONCLUSIONS: Return migration implies vulnerability for indigenous women in the rural communities studied whose sexuality has a strong reproductive profile. It is necessary to develop prevention campaigns against STI/HIV taking into account male sexual identities to improve women rights to sexual and reproductive health

Clinical and genetic characteristics of late-onset Huntington's disease

Background: The frequency of late-onset Huntington's disease (>59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. Objective: Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. Methods: Participants with late- and common-onset (30–50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. Results: Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P <.001). Overall motor and cognitive performance (P <.001) were worse, however only disease motor progression was slower (coefficient, −0.58; SE 0.16; P <.001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P <.001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P <.001). Conclusions: Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients