RESUMO
Worldwide, policies to combat human immunodeficiency virus (HIV) have led to a small decrease in the acquired immunodeficiency syndrome (AIDS) mortality rate among young people. For greater policy efficacy, it is necessary to determine the influence of social determinants of health (SDHs) in each territory. The objective of this study was to spatially analyse the AIDS mortality rate among young people in a province of the Brazilian Amazon and the spatial variability of the rate promoted by SDHs. All reports of AIDS deaths between 2007 and 2018 among young people living in the state of Pará were included in the study. The mortality rate was analysed using spatial distribution and autocorrelation, spatial scanning, and geographically weighted regression (GWR). During the study period, there were 1,372 deaths from AIDS among young people with a territorial expansion. The spatial autocorrelation showed two high-high clusters in the period from 2007 to 2010, one formed by municipalities in south-eastern Pará and one in the metropolitan region of Belém, with only the latter remaining between 2011 and 2018. This region showed a higher spatial risk for AIDS mortality and was the only cluster with spatiotemporal risk in the 2013-2018 period. Spatial variability was promoted by the i) the youth homicide rate, ii) the elementary school dropout rate and iii) the number of families registered in the Unified Registry for Social Programs (CadÚnico). This study provides support for the implementation of effective focal policies to combat HIV and reduce the mortality rate among young people in Pará.
Assuntos
Síndrome da Imunodeficiência Adquirida , Adolescente , Humanos , Brasil/epidemiologia , Análise Espacial , Pesquisa , Regressão EspacialRESUMO
BACKGROUND: Although considerable progress has been made over the last decades, human immunodeficiency virus (HIV) incidence and acquired immunodeficiency syndrome (AIDS) mortality rates have remarkably increased in the Brazilian Amazon region. Here, we employed temporal analysis to determine the impact of public policies on the HIV epidemic in the state of Pará, Brazil, which has the second highest HIV incidence rate in the Amazon region. DESIGN AND METHODS: This is an ecological study conducted in the state of Pará, employing secondary data of HIV/AIDS cases notified to the Information System for Notifiable Diseases, 2007-2018. The following epidemiological variables were collected: year of notification, municipality of residence, age, sex, education, exposure category, and HIV/AIDS diagnostic criteria. The study population was composed of 21,504 HIV/AIDS cases. The HIV/AIDS incidence rates were analyzed employing the temporal trend analysis (TTA) followed by the chi-square test and residue analysis to determine the association between the epidemiological variables and time series periods. RESULTS: A total of 50% of the notifications were composed of AIDS cases. TTA identified two periods in HIV/AIDS incidence, with stabilization of cases in the first period (G1, 2007-2012) and an upward trend in the second period (G2, 2012-2018). The most prevalent epidemiological characteristics in G2 (versus G1) were as follows: young people, brown skin color, higher schooling, and homosexuals. CONCLUSIONS: Public policy to control HIV infection in the Brazilian Amazon region has been partially effective. HIV screening tests and treatment should be made widely available to eradicate HIV infection in the Amazon region by 2030.