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OBJECTIVE: The objective of the present study is to describe the sociodemographic and behavioral characteristics of a group of transgender women and travestis (TGW) with a history of incarceration and the institutional and social context of this experience in Brazil. METHODS: The analyzed data were derived from the TransOdara Study, a cross-sectional study conducted in five Brazilian capitals from December 2019 to July 2021. Participants were recruited using the Respondent-Driven Sampling (RDS) technique, in which, after an initial formative and exploratory stage, the first participants were identified; in turn, these participants recruited up to six other transgender women and travestis for the research. The study's outcome was the experience of incarceration throughout life, captured through the question: "Have you ever been arrested in your life?" RESULTS: A total of 1,245 TGW were interviewed, of which 20.3% (n=253) experienced incarceration. Incarceration was more frequent among those aged 33 to 42 years (35.6%), with lower level of education (45.5%, p<0.001), engaged in informal work (30.3%), without a partner (67.2%), and among those who reported illicit drug use (66.4%). The majority (60.9%) of TGW were incarcerated with cisgender men, and the most common reasons for imprisonment were drug trafficking (30.4%) followed by robbery (29.2%). Over a quarter of the interviewees (26.3%) experienced assault, and 13.8% reported experiencing sexual violence during incarceration. CONCLUSION: The results emphasize the high prevalence of incarceration among TGW. This incarceration takes place in male wards and in a context of high rates of physical and sexual violence.

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OBJECTIVE: To describe the prevalence, characteristics, and factors associated with sexual violence in transgender women and travestis (TGW) in Brazil. METHODS: This cross-sectional study was conducted in five Brazilian cities (Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo) between 2019 and 2021. Participants were recruited using the respondent-driven sampling (RDS) technique. The outcome of interest is the self-reported experience of sexual violence throughout the respondents' lifetime. We evaluated the actions taken by victims of sexual violence and how they dealt with the experience. Logistic regression analysis was employed to examine the associations between sociodemographic and behavioral factors (such as race, income, drug use, sex work, and access to healthcare) and the outcome. RESULTS: A total of 1,317 TGW were interviewed. Among them, 53% (n=698) reported experiencing sexual violence. For 64.4% (n=419) of the respondents, sexual violence occurred on more than one occasion. The majority of TGW did not seek health services (93.2%, n=648), disclose the violence (93.9%, n=653), nor seek support from family or friends (86.5%, n=601). A higher prevalence of sexual violence was associated with homelessness (adjusted prevalence ratio - aPR=1.69, 95% confidence interval - 95%CI 1.01-2.84), a history of engaging in sex work (aPR=2.04, 95%CI 1.46-2.85), self-reporting regular, bad, or very bad emotional health (aPR=1.67, 95%CI 1.28-2.19), and experiencing difficulties accessing health services in the previous year (aPR=2.78, 95%CI 1.74-4.43). CONCLUSION: The high prevalence of sexual violence, analyzed together with the actions of the victims, indicates a context of high vulnerability and low institutional support. In this scenario, violence can be exacerbated, resulting in severe health consequences.

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RESUMO: O estudo aqui apresentado teve por objetivo avaliar a percepção da qualidade do processo de aprendizagem no ambiente virtual dos estudantes do Programa Saúde com Agente. Tratou-se de um estudo transversal, realizado em 2022, com 9.145 estudantes dos cursos de Técnico em Agente Comunitário de Saúde e Técnico em Vigilância em Saúde com Ênfase no Combate às Endemias. Informações sobre a qualidade do processo de aprendizagem foram obtidas por meio do questionário Constructivist On-Line Learning Environment Survey, que consiste em 24 questões agrupadas em seis dimensões: relevância, reflexão crítica, interação, apoio dos tutores, apoio dos colegas e compreensão. Avaliaram-se o perfil sociodemográfico dos participantes e as principais formas de acesso ao curso e acompanhamento. Realizou-se análise descritiva; para análise de associação, utilizou-se o teste qui-quadrado ou exato de Fisher. A maioria dos participantes é do sexo feminino, faixa etária de 40 a 49 anos, da região Nordeste; realiza as atividades em casa e usa o celular/smartphone. Ao se considerarem as seis dimensões avaliadas, relevância, interação e apoio dos colegas obtiveram diferenças estatisticamente significativas entre os estudantes dos cursos de Técnico em Agente Comunitário de Saúde e Técnico em Vigilância em Saúde com Ênfase no Combate às Endemias.

ABSTRACT: The study presented here aimed to evaluate the perception of the quality of the learning process in the virtual environment of the students of the Health Program with Agent. It was a cross-sectional study conducted in 2022 with 9,145 students from the Community Health Agent Technician and Health Surveillance Technician courses with an Emphasis on Combating Endemic Diseases. Information on the quality of the learning process was obtained through the Constructivist On-Line Learning Environment Survey, which consists of 24 questions grouped into six dimensions: relevance, critical reflection, interaction, tutor support, peer support, and understanding. The sociodemographic profile of the participants and the primary forms of access to the course and monitoring were evaluated. Descriptive analysis was performed; for association analysis, the chi-square or Fisher's exact test was used. Most participants are females aged 40 to 49 from the Northeast region; they perform activities at home and use their cell phones/smartphones. When considering the six dimensions evaluated, relevance, interaction, and support of colleagues obtained statistically significant differences between the students of the courses of Community Health Agent Technician and Health Surveillance Technician with Emphasis on Combating Endemic Diseases.

RESUMEN: El objetivo del estudio presentado fue evaluar la percepción de la calidad del proceso de aprendizaje en el entorno virtual de los alumnos del Programa Salud con Agentes. Se trató de un estudio transversal realizado en 2022 con 9.145 alumnos de los cursos de Técnico en Agente Comunitario de Salud y Técnico en Vigilancia Sanitaria con énfasis en la lucha contra las enfermedades endémicas. La información sobre la calidad del proceso de aprendizaje se obtuvo a través de la Encuesta Constructivist On-Line Learning Environment Survey, que consta de 24 preguntas agrupadas en seis dimensiones: relevancia, reflexión crítica, interacción, apoyo de los tutores, apoyo de los alumnos y comprensión. Se evaluó el perfil sociodemográfico de los participantes y las principales vías de acceso al curso y seguimiento. Se realizó un análisis descriptivo y se utilizó la prueba de chi-cuadrado o la prueba exacta de Fisher para analizar las asociaciones. Los participantes eran en su mayoría mujeres, en la franja de edad 40 a 49 años, de la región Nordeste; realizaban las actividades en casa y utilizaban teléfonos móviles/smartphones. Al considerar las seis dimensiones evaluadas, la relevancia, la interacción y el apoyo de los compañeros mostraron diferencias estadísticamente significativas entre los alumnos de los cursos de Técnico en Agente Comunitario de Salud y Técnico en Vigilancia Sanitaria con Énfasis en la Lucha contra las Enfermedades Endémicas.

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ABSTRACT Objective To describe the prevalence, characteristics, and factors associated with sexual violence in transgender women and travestis (TGW) in Brazil. Methods This cross-sectional study was conducted in five Brazilian cities (Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo) between 2019 and 2021. Participants were recruited using the respondent-driven sampling (RDS) technique. The outcome of interest is the self-reported experience of sexual violence throughout the respondents' lifetime. We evaluated the actions taken by victims of sexual violence and how they dealt with the experience. Logistic regression analysis was employed to examine the associations between sociodemographic and behavioral factors (such as race, income, drug use, sex work, and access to healthcare) and the outcome. Results A total of 1,317 TGW were interviewed. Among them, 53% (n=698) reported experiencing sexual violence. For 64.4% (n=419) of the respondents, sexual violence occurred on more than one occasion. The majority of TGW did not seek health services (93.2%, n=648), disclose the violence (93.9%, n=653), nor seek support from family or friends (86.5%, n=601). A higher prevalence of sexual violence was associated with homelessness (adjusted prevalence ratio — aPR=1.69, 95% confidence interval — 95%CI 1.01-2.84), a history of engaging in sex work (aPR=2.04, 95%CI 1.46-2.85), self-reporting regular, bad, or very bad emotional health (aPR=1.67, 95%CI 1.28-2.19), and experiencing difficulties accessing health services in the previous year (aPR=2.78, 95%CI 1.74-4.43). Conclusion The high prevalence of sexual violence, analyzed together with the actions of the victims, indicates a context of high vulnerability and low institutional support. In this scenario, violence can be exacerbated, resulting in severe health consequences.

RESUMO Objetivo Descrever a prevalência, características e fatores associados à violência sexual em mulheres trans e travestis (MTT) no Brasil. Métodos Estudo transversal conduzido em cinco cidades brasileiras (Campo Grande, Manaus, Porto Alegre, Salvador e São Paulo) entre 2019 e 2021. As participantes foram recrutadas usando a técnica respondent-driven sampling (RDS). O desfecho é a experiência de violência sexual ao longo da vida. As ações tomadas pelas vítimas e como elas lidaram com a experiência foram avaliadas. Análise de regressão logística foi empregada para examinar as associações entre fatores sociodemográficos e comportamentais (como raça, renda, trabalho sexual e acesso aos serviços de saúde) e o desfecho. Resultados Um total de 1.317 MTT foram entrevistadas. Entre elas, 53% (n=698) relataram violência sexual. Para 64,4% (n=419) destas, a violência sexual ocorreu em mais de uma ocasião. A maioria das MTT não procurou serviços de saúde (93,2%, n=648), não denunciou (93,9%, n=653) nem buscou apoio de familiares ou amigos (86,5%, n=601). A maior prevalência de violência sexual foi associada à falta de moradia (razão de prevalência ajustada — RPa=1,69, IC 95% 1,01-2,84), histórico de envolvimento em trabalho sexual (RPa=2,04, IC 95% 1,46-2,85), relato de saúde emocional regular, ruim ou muito ruim (RPa=1,67, IC 95% 1,28-2,19) e experiência de dificuldades de acesso aos serviços de saúde (RPa=2,78, IC 95% 1,74-4,43). Conclusão A alta prevalência de violência sexual, analisada em conjunto com as ações das vítimas, indica um contexto de alta vulnerabilidade e baixo suporte institucional. Nesse cenário, a violência pode ser exacerbada, resultando em graves consequências para a saúde.

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ABSTRACT Objective: The objective of the present study is to describe the sociodemographic and behavioral characteristics of a group of transgender women and travestis (TGW) with a history of incarceration and the institutional and social context of this experience in Brazil. Methods: The analyzed data were derived from the TransOdara Study, a cross-sectional study conducted in five Brazilian capitals from December 2019 to July 2021. Participants were recruited using the Respondent-Driven Sampling (RDS) technique, in which, after an initial formative and exploratory stage, the first participants were identified; in turn, these participants recruited up to six other transgender women and travestis for the research. The study's outcome was the experience of incarceration throughout life, captured through the question: "Have you ever been arrested in your life?" Results: A total of 1,245 TGW were interviewed, of which 20.3% (n=253) experienced incarceration. Incarceration was more frequent among those aged 33 to 42 years (35.6%), with lower level of education (45.5%, p<0.001), engaged in informal work (30.3%), without a partner (67.2%), and among those who reported illicit drug use (66.4%). The majority (60.9%) of TGW were incarcerated with cisgender men, and the most common reasons for imprisonment were drug trafficking (30.4%) followed by robbery (29.2%). Over a quarter of the interviewees (26.3%) experienced assault, and 13.8% reported experiencing sexual violence during incarceration. Conclusion: The results emphasize the high prevalence of incarceration among TGW. This incarceration takes place in male wards and in a context of high rates of physical and sexual violence.

RESUMO Objetivo: O objetivo do presente estudo é descrever as características sociodemográficas e comportamentais de um grupo de mulheres trans e travestis (MTT) com histórico de encarceramento e o contexto institucional e social desta experiência no Brasil. Métodos: Os dados são provenientes do Estudo TransOdara, de delineamento transversal, realizado em 5 capitais brasileiras no período de dezembro de 2019 a julho de 2021. As participantes foram recrutadas pela técnica Respondent-Driven Sampling (RDS), onde, após uma etapa inicial formativa e exploratória, as primeiras participantes foram identificadas; elas, por sua vez, recrutavam até outras seis mulheres trans e travestis para a pesquisa. O desfecho do estudo foi a experiência de encarceramento durante a vida apreendido através da pergunta: "Você alguma vez na vida já foi presa?". Resultados: Um total de 1.245 MTT foram entrevistadas. Destas, 20,3% (n=253) experienciaram o cárcere. O encarceramento foi mais frequente entre as entrevistadas de 33 a 42 anos (35,6%), com menor escolaridade (45,5%), em situação de trabalho informal (30,3%) e entre aquelas que reportaram uso de drogas ilícitas (66,4%). A maioria (60,9%) das MTT ficou presa com homens cisgênero, e o motivo da prisão mais frequente foi o tráfico de drogas (30,4%), seguido de roubo (29,2%). Mais de um quarto das entrevistadas (26,3%) sofreu agressão, e 13,8% relataram ter sofrido violência sexual durante o encarceramento. Conclusão: Os resultados destacam a elevada prevalência de encarceramento entre MTT. Este encarceramento se dá em alas masculinas e em um contexto de altas taxas de violência física e sexual.

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Objetivo: Analisar as habilidades do agente comunitário de saúde (ACS) durante o curso técnico do Programa Saúde com Agente. Método: Estudo transversal, com questionário estruturado online, incluindo dados sociodemográficos e habilidades dos estudantes, organizado em domínios e dimensões. Resultados: Foram encontrados altos percentuais de "saber fazer" para planejamento de ações educativas, de promoção à saúde e de prevenção de acidentes (59,3%), visitas domiciliares (74,4%), identificação de usuários que não fazem uso correto dos medicamentos (52,5%) ou que apresentam fatores de risco para doenças transmissíveis (58,0%) e encaminhamento de usuários com infecções sexualmente transmissíveis (56,9%). Com relação às medidas de pressão arterial (27,7%) e glicemia (27,4%), os percentuais foram baixos. Por sua vez, a opção "não saber fazer" foi encontrada em altos percentuais para realizar manobras de reanimação cardiorrespiratória (40,4%) e realizar técnicas de imobilização em pessoas vítimas de trauma (43,2%). Conclusão: Os ACS percebem que têm habilidades para realizar ações educativas e visitas domiciliares. As lacunas apareceram no âmbito das doenças crônicas e dos primeiros socorros, atribuições mais recentes, reforçando a importância de uma formação de nível técnico que contemple o seu trabalho. O curso técnico do Programa Saúde com Agente vai ao encontro das necessidades de formação desses trabalhadores, potencializando seu trabalho na Atenção Primária, na busca de melhores indicadores de saúde para o país.

Objective: To analyze the skills of community health workers (CHWs) during the technical course of the Health with Worker Program, implemented by the Brazilian Ministry of Health. Method: cross-sectional study, using a structured online questionnaire organized into domains and dimensions, collecting data on students' skills and their sociodemographic profiles. Results: High percentages of "I know how to do it" were found for planning educational, health promotion and accident prevention measures (59.3%), paying home visits (74.4%), identifying users who do not take medications correctly (52.5%) or who present risk factors for communicable diseases (58.0%), and referring users with sexually transmitted infections (56.9%). As for measuring blood pressure (27.7%) and blood glucose (27.4%), the percentages were low. On the other hand, the option "I do not know how to do it" was found in high percentages for performing cardiopulmonary resuscitation maneuvers (40.4%) and performing immobilization techniques on trauma victims (43.2%). Conclusion: CHWs realize that they have the skills to carry out educational activities and pay home visits. The gaps appeared in the areas of chronic diseases and first aid, more recent assignments, reinforcing the importance of technical-level training that covers these topics. The technical course of the Health with Worker Program meets the training needs of these workers, enhancing their performance in Primary Care, in search of better health indicators for Brazil.

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OBJECTIVE: This study aimed to evaluate factors associated with inconsistent condom use with casual partners in a population of men who have sex with men (MSM) in Brazil. METHODS: In 2016, 4,176 MSM >18 years were enrolled in 12 capitals of Brazil using a Respondent Driven Sampling (RDS) method. For the construction of the outcome, we evaluated questions about condom use in all anal intercourse (receptive and insertive) in the previous six months and the last sexual intercourse. Estimates were calculated using a weighted complex sample design. We performed a logistic regression analysis to determine the associations between sociodemographic and behavioral factors and inconsistent condom use in sexual relationships with casual male partners. RESULTS: More than half of our sample (50.8%) had not used condoms consistently with casual partners in the previous six months. Inconsistent condom use was significantly associated with: low education (weighted odds ratio - wOR: 1.55; 95% confidence interval - CI 0.99-2.40), lack of counseling on sexually transmitted infections STI (wOR: 1.51; 95%CI 1.05-2.17), non-use of condoms at sexual debut (wOR: 3.05; 95%CI 2.12-4.40) and moderate and high perceived risk for HIV (wOR: 1.51; 95%CI 1.07-2.14). Higher age was negatively associated with inconsistent condom use (wOR=0.97, 95%CI 0.89-0.99). CONCLUSION: Despite being an individual behavior, condom use is related to factors beyond the individual scope. HIV/Aids prevention policies should focus on younger MSM, providing qualified information about condom use, preferably before the beginning of their sexual life.

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ABSTRACT Objective: This study aimed to evaluate factors associated with inconsistent condom use with casual partners in a population of men who have sex with men (MSM) in Brazil. Methods: In 2016, 4,176 MSM >18 years were enrolled in 12 capitals of Brazil using a Respondent Driven Sampling (RDS) method. For the construction of the outcome, we evaluated questions about condom use in all anal intercourse (receptive and insertive) in the previous six months and the last sexual intercourse. Estimates were calculated using a weighted complex sample design. We performed a logistic regression analysis to determine the associations between sociodemographic and behavioral factors and inconsistent condom use in sexual relationships with casual male partners. Results: More than half of our sample (50.8%) had not used condoms consistently with casual partners in the previous six months. Inconsistent condom use was significantly associated with: low education (weighted odds ratio — wOR: 1.55; 95% confidence interval — CI 0.99-2.40), lack of counseling on sexually transmitted infections STI (wOR: 1.51; 95%CI 1.05-2.17), non-use of condoms at sexual debut (wOR: 3.05; 95%CI 2.12-4.40) and moderate and high perceived risk for HIV (wOR: 1.51; 95%CI 1.07-2.14). Higher age was negatively associated with inconsistent condom use (wOR=0.97, 95%CI 0.89-0.99). Conclusion: Despite being an individual behavior, condom use is related to factors beyond the individual scope. HIV/Aids prevention policies should focus on younger MSM, providing qualified information about condom use, preferably before the beginning of their sexual life.

RESUMO Objetivo: Este estudo tem como objetivo avaliar os fatores associados ao uso inconsistente do preservativo com parceiros casuais em uma população de homens que fazem sexo com homens (HSH) no Brasil. Métodos: Trata-se de um estudo transversal, com método de amostragem Respondent Driven Sampling (RDS), desenvolvido em 12 capitais do Brasil, com 4.176 HSH. Para a construção do desfecho, foram avaliadas questões sobre o uso do preservativo em todas as relações anais (receptivas e insertivas) nos últimos seis meses e a última relação sexual. As estimativas foram calculadas usando um desenho amostral complexo ponderado. Realizamos uma análise de regressão logística para determinar as associações entre fatores sociodemográficos e comportamentais e o uso inconsistente do preservativo. Resultados: Mais da metade da nossa amostra (50,8%) não usou preservativo de forma consistente com parceiros casuais nos últimos seis meses. O uso inconsistente do preservativo foi significativamente associado a: falta de aconselhamento sobre infecções sexualmente transmissíveis (weighted odds ratio — wOR: 1,51; intervalo de confiança — IC95% 1,05-2,17), não uso de preservativo na primeira relação sexual (wOR: 3,05; IC95% 2,12-4,40) e autopercepção de risco para o HIV como moderado e alto (wOR: 1,51; IC95% 1,07-2,14). Maior idade foi negativamente associada ao uso inconsistente do preservativo (wOR=0,97, IC95% 0,89-0,99). Conclusão: Apesar de ser um comportamento individual, o uso do preservativo está relacionado a fatores além do âmbito privado. As políticas de prevenção ao HIV/AIDS devem focar nos HSH mais jovens, fornecendo informações qualificadas sobre o uso do preservativo, preferencialmente antes do início da vida sexual.

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BACKGROUND: There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up. METHODS: This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. RESULTS: Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09-1.43), the mother's self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03-1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26-1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02-1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12-1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24-1.52). CONCLUSION: Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.

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Resumo Devido ao estigma associado aos estereótipos negativos e à transfobia, os direitos humanos das pessoas trans são violados diariamente, fazendo com que sejam marginalizadas e excluídas dos serviços de saúde. O campo de estudo foi o Ambulatório Trans (Ambulatório T) da Atenção Primária à Saúde (APS) de Porto Alegre, que trabalha na lógica do reconhecimento das identidades trans, das demandas de saúde e da autonomia dos sujeitos. Neste artigo apresentamos os resultados parciais de um estudo que avalia a implantação do Ambulatório T. Fazem parte do estudo 269 pessoas trans na primeira etapa e 116 na segunda etapa. O Ambulatório T mostra que o acompanhamento de saúde, caracterizado pela não patologização das identidades trans, é fundamental para o Sistema Único de Saúde, no qual as barreiras de acesso podem ser minimizadas ou removidas para que seja possível cuidar da saúde de pessoas trans de forma integral na APS.

Abstract Due to the stigma associated with negative stereotypes and transphobia, the human rights of trans people are violated daily, causing them to be marginalized and excluded from health services. The field of study was the Trans Ambulatory (T Ambulatory) of Primary Health Care in Porto Alegre, which works in the logic of recognizing trans identities, health demands, and the autonomy of subjects. In this article, we will present the partial results of a study that evaluates the implementation of the T Ambulatory. The study includes 269 transgender people in the first stage and 116 in the second stage. The T Ambulatory shows that health monitoring, characterized by the non-pathologization of trans identities, is essential for the Unified Health System. The access barriers can be minimized or removed. And so that it is possible to take care of trans people's health integrally in primary health care.

Resumen Debido al estigma asociado a los estereotipos negativos y la transfobia, los derechos humanos de las personas trans son violados a diario, lo que las margina y excluye de los servicios de salud. El campo de estudio fue el Ambulatorio Trans (Ambulatorio T) de la Atención Primaria de Salud (APS) de Porto Alegre, que trabaja en la lógica del reconocimiento de las identidades trans, las demandas de salud y la autonomía de los sujetos. En este artículo presentaremos los resultados parciales de un estudio que evalúa la implementación del Ambulatorio T. El estudio incluye a 269 personas trans en la primera etapa y 116 en la segunda etapa. El Ambulatorio T muestra que la vigilancia de la salud, caracterizada por la no patologización de las identidades trans, es fundamental para el Sistema Único de Salud, en el que se pueden minimizar o eliminar las barreras de acceso, y para que sea posible cuidar la salud de las personas trans integralmente en Atención Primaria de Salud.

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The purpose of this study was to identify factors associated with HIV and vulnerability contexts for women in Porto Alegre, Brazil. The participants were 1326 women recruited by complex sampling design, divided into two groups: 640 women with HIV (WLH) and 686 women who did not have HIV (WNLH). Gross and weighted statistical analyses were performed. Logistic regression models were used to estimate the odds ratio (OR) for 12 variables. The main results demonstrated that WLH had lower income (p < .001) and poorer education (p = .038), and few used condoms during their first sexual intercourse (p < .001). The occurrence of HIV was higher among the black population (p < .001). Sex in exchange for money (p < .001) and sexually transmitted infections (p < .001) were more frequent among WLH than among WNLH. The age of sexual debut and age difference from the partner at first sexual intercourse (FSI) were not associated with the outcome. The high percentage of non-use of condoms during the FSI shows how vulnerable individuals are right at the beginning of their sexual lives. More effective prevention strategies can be developed by nurses in view of the contexts of vulnerability surrounding women.

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BACKGROUND: Tuberculosis is a curable disease, which remains the leading cause of death among infectious diseases worldwide, and it is the leading cause of death in people living with HIV. The purpose is to examine survival and predictors of death in Tuberculosis/HIV coinfection cases from 2009 to 2013. METHODS: We estimated the survival of 2,417 TB/HIV coinfection cases in Porto Alegre, from diagnosis up to 85 months of follow-up. We estimated hazard ratios and survival curves. RESULTS: The adjusted risk ratio (aRR) for death, by age, hospitalization, and Directly Observed Treatment was 4.58 for new cases (95% CI: 1.14-18.4), 4.51 for recurrence (95% CI: 1.11-18.4) and 4.53 for return after abandonment (95% CI: 1.12-18.4). The average survival time was 72.56 ± 1.57 months for those who underwent Directly Observed Treatment and 62.61 ± 0.77 for those who did not. CONCLUSIONS: Case classification, age, and hospitalization are predictors of death. The occurrence of Directly Observed Treatment was a protective factor that increased the probability of survival. Policies aimed at reducing the mortality of patients with TB/HIV coinfection are needed.

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The scope of this study was to identify the levels of satisfaction of the elderly regarding the organization of services in primary health care services. It involved a cross-sectional survey of 18,671 users of the Unified Health System. Information on satisfaction with care was collected, categorized as satisfied (very good, good and average perception) and dissatisfied (poor and very poor). The aspects researched included: characteristics of the organization of care and the secondary data from the 1st cycle of the Brazilian Program for Improving Access and Quality in Primary Health Care (PMAQ-AB). Logistic regression was used to obtain the odds ratio (OR) and confidence interval (CI95%), adjusted for sociodemographic factors. The prevalence of satisfaction was 87%. The aspects associated with satisfaction (p<0.05), after analysis of factors that could distort the results, were access to the health unit, home visit and availability of medication - related to the organization of services; and, performing an active search, solving the problem in the unit, as well as the physical examination and consultation time - related to the organization of care. The analyses describe multiple aspects of the organization of care and services associated with the satisfaction of the elderly with basic health care services.

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Men are the main group affected by HIV infection in Brazil, with an upward trend in the last 10 years. According to official data, heterosexual men represent 49% of cases, followed by homosexuals with 38% and bisexuals with 9.1%. Heterosexual men have been subsumed in the category "overall population" and have failed to receive specific attention in preventive policies or activities. The article proposes to analyze the circumstances and strategies by which heterosexual men learn of their HIV diagnosis. The study thus seeks to understand the paths and social actors involved in their HIV/AIDS diagnosis. The data are from a qualitative study interviewing 36 men living with HIV/AIDS that did not self-identify as homosexuals and/or bisexuals. The men were contacted in three specialized AIDS services in Porto Alegre, Rio Grande do Sul State, Brazil. The results indicate that men consider themselves immune to HIV, and that the diagnosis is an unexpected event. Women (affective-sexual partners and/or former partners) are fundamental components in the men's diagnosis, since they reveal the presence of HIV through either prenatal care or their own illness. An important share of these men discover that they are HIV-positive through some illness such as tuberculosis or after several visits to health services. Spontaneous search for HIV testing only occurs through situations and signs associated with possible infection. Heterosexual men have few opportunities for HIV diagnosis, and beyond gender issues, they are subject to programmatic vulnerability.

Os homens são o principal grupo afetado pela infecção do HIV no Brasil, com tendência de crescimento nos últimos dez anos. Nos dados oficiais, os homens heterossexuais representam 49% dos casos, os homossexuais 38% e os bissexuais 9,1%. Os homens heterossexuais ficaram subsumidos na categoria de "população geral", não recebendo destaque em políticas ou ações de prevenção. O presente artigo se propõe a analisar as circunstâncias e estratégias por meio das quais os homens heterossexuais descobrem o diagnóstico do HIV. Busca-se, assim, compreender os caminhos percorridos, bem como os atores sociais envolvidos no diagnóstico de HIV/aids. Os dados analisados resultam de uma pesquisa qualitativa na qual foram entrevistados 36 homens vivendo com HIV/aids que não se identificam como homossexuais e/ou bissexuais. Esses homens foram contatados em três serviços especializados em aids de Porto Alegre, Rio Grande do Sul, Brasil. Os resultados indicam que eles se consideram imunes ao HIV, sendo o diagnóstico um evento inesperado. As mulheres (parceiras afetivo-sexuais e/ou ex-parceiras) são peças fundamentais para o diagnóstico masculino, pois revelam, seja pelo pré-natal, seja pelo adoecimento, a presença do HIV. Uma parcela importante dos homens se descobre soropositivo por ocasião de alguma doença, como a tuberculose, ou após várias idas e vindas dos serviços de saúde. A busca pela testagem de forma espontânea só acontece mediante a identificação de situações e sinais associados a uma possível contaminação. Os homens heterossexuais possuem poucas oportunidades de diagnóstico do HIV e, para além do gênero, são sujeitos à vulnerabilidade programática.

Los hombres son el principal grupo afectado por la infección del VIH en Brasil, con una tendencia de crecimiento en los últimos 10 años. En los datos oficiales, los hombres heterosexuales representan un 49% de los casos, los homosexuales un 38% y los bisexuales un 9,1%. Los hombres heterosexuales quedaron encajados en la categoría de "población general", no siendo relevantes en políticas o acciones de prevención. Este artículo se propone analizar las circunstancias y estrategias a través de las cuales los hombres heterosexuales descubren el diagnóstico del VIH. Se busca, de esta forma, comprender los caminos recorridos, así como los actores sociales implicados en el diagnóstico del VIH/SIDA. Los datos analizados son resultado de una investigación cualitativa en la que se entrevistaron a 36 hombres, viviendo con VIH/SIDA, que no se identifican como homosexuales y/o bisexuales. Se contactó con estos hombres a través de tres servicios especializados en sida de Porto Alegre, Rio Grande do Sul, Brasil. Los resultados indican que los hombres se consideran inmunes al VIH, siendo el diagnóstico un evento inesperado. Las mujeres (parejas afectivo-sexuales y/o ex-parejas) son piezas fundamentales para el diagnóstico masculino, puesto que revelan, sea a través del cuidado prenatal, sea a través de la enfermedad, la presencia del VIH. Una parte importante de los hombres se descubre seropositiva, debido a alguna enfermedad, como la tuberculosis, o tras varias idas y venidas a los servicios de salud. La búsqueda de un test espontáneo solamente se produce mediante la identificación de situaciones y señales asociadas a una posible infección. Los hombres heterosexuales poseen pocas oportunidades de diagnóstico del VIH y, más allá del género, están sujetos a vulnerabilidad programática.

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Resumo: Os homens são o principal grupo afetado pela infecção do HIV no Brasil, com tendência de crescimento nos últimos dez anos. Nos dados oficiais, os homens heterossexuais representam 49% dos casos, os homossexuais 38% e os bissexuais 9,1%. Os homens heterossexuais ficaram subsumidos na categoria de "população geral", não recebendo destaque em políticas ou ações de prevenção. O presente artigo se propõe a analisar as circunstâncias e estratégias por meio das quais os homens heterossexuais descobrem o diagnóstico do HIV. Busca-se, assim, compreender os caminhos percorridos, bem como os atores sociais envolvidos no diagnóstico de HIV/aids. Os dados analisados resultam de uma pesquisa qualitativa na qual foram entrevistados 36 homens vivendo com HIV/aids que não se identificam como homossexuais e/ou bissexuais. Esses homens foram contatados em três serviços especializados em aids de Porto Alegre, Rio Grande do Sul, Brasil. Os resultados indicam que eles se consideram imunes ao HIV, sendo o diagnóstico um evento inesperado. As mulheres (parceiras afetivo-sexuais e/ou ex-parceiras) são peças fundamentais para o diagnóstico masculino, pois revelam, seja pelo pré-natal, seja pelo adoecimento, a presença do HIV. Uma parcela importante dos homens se descobre soropositivo por ocasião de alguma doença, como a tuberculose, ou após várias idas e vindas dos serviços de saúde. A busca pela testagem de forma espontânea só acontece mediante a identificação de situações e sinais associados a uma possível contaminação. Os homens heterossexuais possuem poucas oportunidades de diagnóstico do HIV e, para além do gênero, são sujeitos à vulnerabilidade programática.

Abstract: Men are the main group affected by HIV infection in Brazil, with an upward trend in the last 10 years. According to official data, heterosexual men represent 49% of cases, followed by homosexuals with 38% and bisexuals with 9.1%. Heterosexual men have been subsumed in the category "overall population" and have failed to receive specific attention in preventive policies or activities. The article proposes to analyze the circumstances and strategies by which heterosexual men learn of their HIV diagnosis. The study thus seeks to understand the paths and social actors involved in their HIV/AIDS diagnosis. The data are from a qualitative study interviewing 36 men living with HIV/AIDS that did not self-identify as homosexuals and/or bisexuals. The men were contacted in three specialized AIDS services in Porto Alegre, Rio Grande do Sul State, Brazil. The results indicate that men consider themselves immune to HIV, and that the diagnosis is an unexpected event. Women (affective-sexual partners and/or former partners) are fundamental components in the men's diagnosis, since they reveal the presence of HIV through either prenatal care or their own illness. An important share of these men discover that they are HIV-positive through some illness such as tuberculosis or after several visits to health services. Spontaneous search for HIV testing only occurs through situations and signs associated with possible infection. Heterosexual men have few opportunities for HIV diagnosis, and beyond gender issues, they are subject to programmatic vulnerability.

Resumen: Los hombres son el principal grupo afectado por la infección del VIH en Brasil, con una tendencia de crecimiento en los últimos 10 años. En los datos oficiales, los hombres heterosexuales representan un 49% de los casos, los homosexuales un 38% y los bisexuales un 9,1%. Los hombres heterosexuales quedaron encajados en la categoría de "población general", no siendo relevantes en políticas o acciones de prevención. Este artículo se propone analizar las circunstancias y estrategias a través de las cuales los hombres heterosexuales descubren el diagnóstico del VIH. Se busca, de esta forma, comprender los caminos recorridos, así como los actores sociales implicados en el diagnóstico del VIH/SIDA. Los datos analizados son resultado de una investigación cualitativa en la que se entrevistaron a 36 hombres, viviendo con VIH/SIDA, que no se identifican como homosexuales y/o bisexuales. Se contactó con estos hombres a través de tres servicios especializados en sida de Porto Alegre, Rio Grande do Sul, Brasil. Los resultados indican que los hombres se consideran inmunes al VIH, siendo el diagnóstico un evento inesperado. Las mujeres (parejas afectivo-sexuales y/o ex-parejas) son piezas fundamentales para el diagnóstico masculino, puesto que revelan, sea a través del cuidado prenatal, sea a través de la enfermedad, la presencia del VIH. Una parte importante de los hombres se descubre seropositiva, debido a alguna enfermedad, como la tuberculosis, o tras varias idas y venidas a los servicios de salud. La búsqueda de un test espontáneo solamente se produce mediante la identificación de situaciones y señales asociadas a una posible infección. Los hombres heterosexuales poseen pocas oportunidades de diagnóstico del VIH y, más allá del género, están sujetos a vulnerabilidad programática.

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BACKGROUND: TB/HIV coinfection is a serious public health issue in Brazil, and patients with coinfection have difficulty adhering to treatments. Directly observed treatment (DOT) has been recommended by the World Health Organization, considering the vulnerability of those affected. The purpose is to investigate the occurrence of DOT and associated factors compared to conventional treatment in Porto Alegre, Brazil. METHODS: A retrospective cohort study was carried out with all patients with coinfection from 2009 to 2013 in the city of Porto Alegre, Brazil, the state capital with the highest rate of coinfection in Brazil. The data came from national health information systems. The dependent variable was the performance of DOT. Bivariate and multivariable models were used to determine factors associated with DOT. The percentage of cure and death was verified in a period of two years, comparing patients who received and did not receive DOT. RESULTS: 2,400 cases of coinfection were reported, with 1,574 males and 826 females and a mean age of 38 years ± 9.91 years. The occurrence of DOT was 16.9%. In the multivariable analysis, factors independently associated to DOT were the year (with greater chances of being received in 2012 and 2013), place of origin, non-white race (OR = 1.29, 95% CI = 1.08-1.54), cases of relapse (OR = 1.33; 95% CI = 1.03-1.73), readmission after abandonment (OR = 1.48, 95% CI = 1.20-1.83), transfer (OR = 2.04; 95% CI = 1.40-2.98), acid-fast bacilli (AFB) test with positive result in first sample (OR = 1.73, 95% CI = 1.24-2.42), alcohol abuse (OR = 1.39; 95% CI = 1.16-1.67), and mental disorders (OR = 1.83; 95% CI = 1.38-2.44.) Of the 532 cases of death, occurring in two years, 10.2% were in patients who underwent DOT and 89.8% in patients who did not undergo DOT (p<0.001). O percentual de óbitos em pessoas que receberam DOT foi de 13% e o percentual de óbitos para pessoas que receberam tratamento convencional foi de 24%. CONCLUSIONS: There was an increase in the percentage of DOT over the years in the scenario studied, and the predictors for DOT were related to social vulnerability. In relation to death within two years, a lower proportion was found in patients who underwent DOT, suggesting a protective effect of the strategy.

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ABSTRACT Objective: To describe and compare the epidemiological profile of cases of tuberculosis and HIV coinfection of the District Administration Health Units of Porto Alegre, Brazil, from 2009 to 2013. Method: Retrospective cohort with data from national health information systems. Sociodemographic, clinical and follow-up variables were investigated through association tests. Results: 2,419 cases of tuberculosis and HIV coinfection were reported, with a mean age of 38 ± 9.91 years, predominantly white and with up to 7 years of study. The comparison between the District Administration Health Units was significant in terms of race/color (p<0.001), gender (p<0.001), schooling (p<0.004), age (p<0.003), place of origin (p<0.001), (p<0.001), alcoholism (p<0.001), indication and performance of Directly Observed Therapy (p<0.001), closure (p<0.001). Conclusion: Socioeconomic and treatment variables influence the occurrence of coinfection in different areas of Porto Alegre, reinforcing that the sum of different factors explains the indicators of the disease.

RESUMEN Objetivo: Describir y comparar el perfil epidemiológico de los casos de coinfección por Tuberculosis y VIH, por la Gerencia Distrital de Porto Alegre, en el período de 2009 a 2013. Método: Cohorte, retrospectiva, con datos de sistemas nacionales de información en salud. Se investigaron variables sociodemográficas, clínicas y de seguimiento, por medio de pruebas de asociación. Resultados: Se notificaron 2.419 casos de coinfección Tuberculosis y VIH, con una media de edad de 38 ± 9,91 años, predominantemente blancos y con hasta 7 años de estudio. La comparación entre las Gerencias Distritales fue significativa como raza/color (p <0,001), sexo (p <0,001), escolaridad (p <0,004), edad (p <0,003), lugar de origen (p <0,001), situación de origen (p <0,001), alcoholismo (p <0,001), indicación y realización de tratamiento directamente observado (p <0,001), situación de cierre (p <0,001). Conclusión: Las variables socioeconómicas y de realización del tratamiento influencian la ocurrencia de la coinfección en diferentes áreas de Porto Alegre, reforzando que la suma de diferentes factores explica los indicadores de la enfermedad.

RESUMO Objetivo: Descrever e comparar o perfil epidemiológico dos casos de coinfecção por Tuberculose e HIV, pela Gerência Distrital de Porto Alegre, no período de 2009 a 2013. Método: Coorte retrospectivo, com dados de sistemas nacionais de informação em saúde. Foram investigadas variáveis sociodemográficas, clínicas e de acompanhamento, por meio de testes de associação. Resultados: Foram notificados 2.419 casos de coinfecção Tuberculose e HIV, com média de idade de 38 ±9,91 anos, predominantemente brancos e com até 7 anos de estudo. A comparação entre as Gerências Distritais foi significativa quanto raça/cor (p<0,001), sexo (p<0,001), escolaridade (p<0,004), idade (p<0,003), local de origem (p<0,001), situação de entrada (p<0,001), alcoolismo (p<0,001), indicação e realização de Tratamento Diretamente Observado (p<0,001), situação de encerramento (p<0,001). Conclusão: Variáveis socioeconômicas e de realização do tratamento influenciam a ocorrência da coinfecção em diferentes áreas de Porto Alegre, reforçando que a soma de diferentes fatores explica os indicadores da doença.

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OBJECTIVE: To describe and compare the epidemiological profile of cases of tuberculosis and HIV coinfection of the District Administration Health Units of Porto Alegre, Brazil, from 2009 to 2013. METHOD: Retrospective cohort with data from national health information systems. Sociodemographic, clinical and follow-up variables were investigated through association tests. RESULTS: 2,419 cases of tuberculosis and HIV coinfection were reported, with a mean age of 38 ± 9.91 years, predominantly white and with up to 7 years of study. The comparison between the District Administration Health Units was significant in terms of race/color (p<0.001), gender (p<0.001), schooling (p<0.004), age (p<0.003), place of origin (p<0.001), (p<0.001), alcoholism (p<0.001), indication and performance of Directly Observed Therapy (p<0.001), closure (p<0.001). CONCLUSION: Socioeconomic and treatment variables influence the occurrence of coinfection in different areas of Porto Alegre, reinforcing that the sum of different factors explains the indicators of the disease.

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Este artigo discute tematizações sobre o preconceito no discurso de trabalhadores da saúde que cursaram o Projeto Caminhos do Cuidado, identificando efeitos que colaboraram para a superação dessas relações quanto a usuários de álcool e outras drogas. Utilizamos metodologia qualitativa, com análise de conteúdo. A análise se baseou em dados provenientes de 78 rodas de conversa e 39 registros etnográficos, ocorridas nas 27 Unidades Federativas do Brasil. Os dados descrevem movimentos reflexivos dos trabalhadores que possibilitaram o enquadramento de relações identitárias para além de crivos morais e da essencialização dos sujeitos. Nossos resultados apontam a importância da experiência para a desconstrução de estereótipos e preconceitos, por produzir processos de desidentificação necessários para a superação de preconceitos. Destaca-se a importância do agente comunitário de saúde como o profissional estratégico para o trabalho com a temática do preconceito nos territórios.

This article discusses thematizations about prejudice in health workers’ discourses, who attended the project "Caminhos do Cuidado" (The Ways of Care), identifying effects that contributed to overcoming these relationships in relation to users of alcohol and other drugs. We applied qualitative methodology with content analysis. The analysis was based on data from 78 conversation meetings and 39 ethnographic records, which occurred in all 27 States of Brazil. The data describe the workers’ reflexive movements that allowed the framing of identity relations beyond moral screens and the essentialization of the subjects. Our results point to the importance of experience for the deconstruction of stereotypes and prejudices, as it produces the de-identification processes necessary to overcome prejudices. We highlighted the importance of the community health agent, as the strategic professional to work with the theme of prejudice in the approached places.

Este artículo analiza las tematizaciones sobre los prejuicios en el discurso de los trabajadores de salud que asistieron al proyecto "Caminhos do Cuidado", identificando los efectos que contribuyeron a superar estas relaciones con los usuarios de alcohol y otras drogas. Utilizamos metodología cualitativa con análisis de contenido. El análisis se basó en datos de 78 círculos de conversación y 39 registros etnográficos, que ocurrieron en todas las regiones de Brasil. Los datos describen los movimientos reflexivos de los trabajadores que permitieron enmarcar las relaciones de identidad más allá de las pantallas morales y la esencialización de los sujetos. Nuestros resultados apuntan a la importancia de la experiencia para la deconstrucción de estereotipos y prejuicios, ya que produce los procesos de desidentificación necesarios para superar los prejuicios. Destacamos la importancia del agente comunitario de salud, como el profesional estratégico para trabajar con el tema del prejuicio en los territorios.

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In locations with a high rate of tuberculosis (TB) and HIV infection, there are a number of strategies to prevent negative outcomes such as opportunistic infections, hospitalizations and death, and this article investigates risk factors for the occurrence of hospitalization and death in cases of TB/HIV co-infection in the south of Brazil. The data are taken from a population-based retrospective cohort study on cases of TB/HIV co-infection from 2009 to 2013 in Porto Alegre, Brazil. Sociodemographic, epidemiological and clinical variables were analyzed. Relative risk (RR) estimates for hospitalization and death were determined by regression models. There were 2,419 co-infection cases, of which 1,527 (63.1%) corresponded to hospitalizations, and 662 (27.4%) to death. The occurrence of hospitalization was associated with ≤ 7 years of schooling (RR = 3.47, 95%CI: 1.97-6.29), 8-11 years of schooling (RR = 2.56, 95%CI: 1.44-4.69), place of origin-district health authorities Northwest/Humaitá/Navegantes/Ilhas (RR = 2.01, 95%CI: 1.44-2.82), type of entry into the surveillance system as in cases of reentry after withdrawal (RR = 1,35, 95%CI: 1.07-1.70), closure in surveillance as in withdrawal of treatment (RR = 1.47, 95%CI: 1.18-1.83) and multidrug-resistant tuberculosis (RR = 3.94, 95%CI: 1.97-8.81). The occurrence of death was associated with age (RR = 1.07, 95%CI: 1,01-1,14), ≤ 7 years of schooling (RR = 3.94, 95%CI: 2.26-7.09), 8-11 years of schooling (RR = 2.84, 95%CI: 1.61-5.16), place of origin-district health authorities Baltazar (RR = 2.05, 95%CI: 1.48-2.86), type of entry in the surveillance system as cases of re-entry after withdrawal (RR = 1.53, 95%CI: 1.22-1.91), relapse (RR = 1.33, 95%CI: 1.03-1.73). The occurrence of hospitalizations and deaths is high among co-infected patients. Our estimation approach is important in order to identify, from the surveillance data, the risk factors for hospitalization and death in co-infected patients, so that they may receive more attention from the Brazilian national healthcare system.

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