RESUMO
Background: Club drug users are high risk and vulnerable population for adverse drug-related consequences and sexual risk behaviors. Few investigations have addressed the possible interrelationship between early trauma and PTSD among young club drug using populations. Objective: Exposure to traumatic experiences - especially in childhood, has been linked to risk behaviors exposure and substance use disorder. This study aimed to assess and compare drug use patterns and the presence of childhood sexual abuse (CSA) experiences among ecstasy and LSD users with and without Posttraumatic Stress Disorder (PTSD). Method: This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals. The Global Appraisal of Individual Needs questionnaire was used as the primary assessment instrument. Participants were from 18 to 39 years of age, had used ecstasy and/or LSD in the 90 days prior to the interview, and were not in treatment for alcohol and other drug problems. Results: Out of the 240 participants, 123 (51.2%) presented PTSD symptoms. Those presenting PTSD were younger, less educated, with lower income, and presented higher drug use severity than those without PTSD symptoms. Moreover, a higher prevalence of sexual risk behavior was verified among those with PTSD. There was an association between PTSD symptoms and CSA history, where 64.2% of individuals with PTSD also presented CSA, compared to 47% among those without PTSD (p = .028). Individuals with co-occurring history of CSA and PTSD symptoms reported earlier use of ecstasy, LSD, and cocaine compared to individuals with a history of CSA but without PTSD. Conclusions: In the present study, participants with a history of PTSD demonstrate a history of CSA, as well as pronounced severity in several areas - precocity of use, severity of addiction, and greater exposure to situations of sexual risk. Thus, a cycle of traumatization may be established through early potential trauma, which can remain unprocessed and contribute to earlier and more severe substance use and sexual risk behaviors. Identification of PTSD symptoms and risk for HIV and other STIs among young club drug users is critical to address focused treatment approaches for this vulnerable population.
Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Usuários de Drogas/psicologia , Drogas Ilícitas , Assunção de Riscos , Comportamento Sexual/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto JovemRESUMO
Abstract Background This study examined drug use patterns and psychiatric symptoms of anxiety and depression among young Brazilian sexual minority ecstasy and LSD users and compared findings with those reported for their heterosexual peers. Method This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not on treatment for alcohol and drug abuse. Results Of the 240 subjects enrolled (mean age: 22.9±4.5 years), 28.7% were gay or bisexuals. Multivariate regression analysis showed that the prevalence of depression symptoms in the past 12 months in the sexual minority group was 37% higher than among heterosexuals (prevalence ratio [PR]=1.79; 95% confidence interval [95%CI] 1.03-3.11; p=0.037). Conclusion Strategies should be developed to assess and address individual needs and treatment approaches should be tailored to address depressive symptoms in young, sexual minority club drug users.
Resumo Introdução Este estudo examinou os padrões de uso de drogas e os sintomas psiquiátricos de ansiedade e depressão entre brasileiros não heterossexuais usuários de ecstasy e/ou LSD e comparou os achados com aqueles relatados por seus pares heterossexuais. Método Este estudo transversal empregou amostragens direcionadas e abordagens de mapeamento etnográfico através de entrevistas presenciais realizadas em bares e festivais de música eletrônica usando uma versão adaptada e semiestruturada do questionário de Avaliação Global de Necessidades Individuais. A amostra incluiu 240 adultos jovens do sexo masculino e feminino que haviam usado ecstasy e/ou LSD nos 90 dias anteriores à entrevista e que não estavam em tratamento para abuso de álcool e drogas. Resultados Dos 240 sujeitos incluídos (idade média: 22,9±4,5 anos), 28,7% eram homossexuais ou bissexuais. A análise de regressão multivariada mostrou que a prevalência de sintomas de depressão nos últimos 12 meses no grupo não heterossexual foi 37% superior à dos heterossexuais [razão de prevalência (RP) = 1,79; intervalo de confiança de 95% (IC95%) 1.03-3.11; p=0,037]. Conclusão Estratégias devem ser desenvolvidas para avaliar e abordar as necessidades individuais, e as abordagens de tratamento devem ser adaptadas para sintomas depressivos em usuários de drogas jovens e não heterossexuais.
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Ansiedade/etnologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Depressão/etnologia , Minorias Sexuais e de Gênero/psicologia , Psicotrópicos/administração & dosagem , Brasil , Estudos Transversais , Análise Multivariada , Inquéritos e Questionários , N-Metil-3,4-Metilenodioxianfetamina/administração & dosagem , Heterossexualidade/psicologia , Dietilamida do Ácido Lisérgico/administração & dosagemRESUMO
BACKGROUND: This study examined drug use patterns and psychiatric symptoms of anxiety and depression among young Brazilian sexual minority ecstasy and LSD users and compared findings with those reported for their heterosexual peers. METHOD: This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not on treatment for alcohol and drug abuse. RESULTS: Of the 240 subjects enrolled (mean age: 22.9±4.5 years), 28.7% were gay or bisexuals. Multivariate regression analysis showed that the prevalence of depression symptoms in the past 12 months in the sexual minority group was 37% higher than among heterosexuals (prevalence ratio [PR]=1.79; 95% confidence interval [95%CI] 1.03-3.11; p=0.037). CONCLUSION: Strategies should be developed to assess and address individual needs and treatment approaches should be tailored to address depressive symptoms in young, sexual minority club drug users.
Assuntos
Ansiedade/etnologia , Depressão/etnologia , Minorias Sexuais e de Gênero/psicologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Brasil/epidemiologia , Estudos Transversais , Feminino , Heterossexualidade/psicologia , Humanos , Dietilamida do Ácido Lisérgico/administração & dosagem , Masculino , Análise Multivariada , N-Metil-3,4-Metilenodioxianfetamina/administração & dosagem , Psicotrópicos/administração & dosagem , Inquéritos e Questionários , Adulto JovemRESUMO
This article describes data on the motivations for selling ecstasy among young adults in the electronic dance music (EDM) club culture in Brazil. Individual interviews were conducted with 20 individuals recruited for their involvement in the EDM club scene. Eligible participants were aged 18-39 and reported ecstasy and/or LSD use one or more times in the past 90 days. Exclusion criteria included current treatment for drug/alcohol problems and cognitive impairment or clinically evident psychiatric disorder. Mean age was 22.92 (SD 2.77), 60% were male, 45% reported 12 or more years of education, 50% did not have a primary partner, 50% were living alone, and all had friends who also used ecstasy. Three main themes emerged: (1) "easy" transition from ecstasy user to seller; (2) desire to achieve popularity and fame; and (3) need to sell ecstasy to maintain the high cost of EDM club scene participation. This is one of the first studies of ecstasy sellers in Brazil. The results demonstrate the ease with which the participants transition from ecstasy user to seller. Given the potential health and social dangers associated with ecstasy use, public health campaigns to prevent ecstasy use and policy initiatives to limit the ecstasy supply are warranted.
Assuntos
Comportamento do Adolescente , Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Comércio , Dança , Tráfico de Drogas/psicologia , Usuários de Drogas/psicologia , Alucinógenos/provisão & distribuição , Motivação , Música , N-Metil-3,4-Metilenodioxianfetamina/provisão & distribuição , Adolescente , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/economia , Brasil , Comércio/economia , Feminino , Alucinógenos/economia , Humanos , Entrevistas como Assunto , Estilo de Vida , Masculino , N-Metil-3,4-Metilenodioxianfetamina/economia , Pesquisa Qualitativa , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVES: To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview. METHODS: This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse. RESULTS: Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PRâ=â1.26; 95% confidence interval (CI): 1.044-1.543; pâ=â0.017) and the use of alcohol/drugs to make sex last longer (PRâ=â1.430; 95% CI: 1.181-1.732; p<0.001) are associated with unprotected sex. CONCLUSIONS: The implementation of intervention strategies aimed at reducing sexually risky behaviors should take into consideration the specific characteristics of drug users and should include the development of safer sex negotiation skills.
Assuntos
Usuários de Drogas/estatística & dados numéricos , Assunção de Riscos , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Adulto , Brasil , Estudos Transversais , Usuários de Drogas/psicologia , Feminino , Humanos , Masculino , Análise Multivariada , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Sexo sem Proteção/psicologia , Adulto JovemRESUMO
OBJECTIVES: To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview. METHODS: This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse. RESULTS: Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PR = 1.26; 95% confidence interval (CI): 1.044-1.543; p = 0.017) and the use of alcohol/drugs to make sex last longer (PR = 1.430; 95% CI: 1.181-1.732; p<0.001) are associated with unprotected sex. CONCLUSIONS: The implementation of intervention strategies aimed at reducing sexually risky behaviors should take into consideration the specific characteristics of drug users and should include the development of safer sex negotiation skills. .
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Usuários de Drogas/estatística & dados numéricos , Assunção de Riscos , Sexo sem Proteção/estatística & dados numéricos , Brasil , Estudos Transversais , Usuários de Drogas/psicologia , Análise Multivariada , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Sexo sem Proteção/psicologiaRESUMO
Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on their use among young, middle-class, club goers in Brazil. We conducted standardized face-to-face interviews with 200 male and female ecstasy and/or LSD users, focusing on drug use and sexual history, current risk behaviors, and psychiatric symptomatology. Participants with early sexual debut (before 14) were more likely to report lifetime use of marijuana and powder and crack cocaine than those with later sexual initiation. Early sexual debut was associated with past year sexual risk behaviors, including having sex while high (Prevalence Ratio (PR)=1.3), having two or more sex partners (PR=1.3), as well as history of sexual abuse (PR=13.6). Depression and anxiety scores were similar by age of sexual initiation. The implications of these findings are discussed.
RESUMO
OBJECTIVES: To compare changes in AIDS knowledge and risk behaviors among Brazilian cocaine users in an intervention trial. METHOD: 119 participants were randomly assigned to either a standard or a standard plus "thought mapping" intervention, and re-interviewed 2 and 8 weeks after intake using standardized data collection instruments. Intervention effects were examined using generalized estimated equation model. RESULTS: Significant increases in AIDS knowledge and condom use were observed in the experimental group, as well as significant changes in the subscores for sexual and drug risks. The experimental intervention was less successful in decreasing mean days of cocaine use when compared to the standard. CONCLUSION: Although not robust, the findings nevertheless suggest that components of the experimental thought-mapping model might be useful in combination with other approaches.
OBJETIVOS: Comparar as mudanças em conhecimento sobre AIDS e comportamentos de risco em usuários de cocaína brasileiros submetidos a uma intervenção experimental. MÉTODO: 119 sujeitos foram aleatoriamente designados para uma intervenção padrão ou uma intervenção padrão adicionada a um "mapa cognitivo", e re-entrevistados duas e oito semanas após admissão no estudo, utilizando-se instrumentos de coleta padronizados. Os efeitos da intervenção foram examinados utilizando modelo de equações de estimação generalizadas. RESULTADOS: Foram observados aumentos significativos no conhecimento sobre AIDS e uso de preservativos no grupo experimental, bem como modificações significativas nos subescores para risco sexual e uso de drogas. A intervenção experimental teve menos sucesso em diminuir dias de uso de cocaína quando comparada com a intervenção padrão. CONCLUSÃO: Apesar de não serem robustos, os achados sugerem que os componentes do modelo de mapa cognitivo experimentados poderiam ser úteis em combinação com outras abordagens.
Assuntos
Adulto , Humanos , Masculino , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/epidemiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Transtornos Relacionados ao Uso de Cocaína/psicologia , Transtornos Relacionados ao Uso de Cocaína/terapia , Redes Comunitárias , Preservativos , Infecções por HIV/transmissão , Educação Sexual , Parceiros Sexuais , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/terapiaRESUMO
OBJECTIVES: To compare changes in AIDS knowledge and risk behaviors among Brazilian cocaine users in an intervention trial. METHOD: 119 participants were randomly assigned to either a standard or a standard plus "thought mapping" intervention, and re-interviewed 2 and 8 weeks after intake using standardized data collection instruments. Intervention effects were examined using generalized estimated equation model. RESULTS: Significant increases in AIDS knowledge and condom use were observed in the experimental group, as well as significant changes in the subscores for sexual and drug risks. The experimental intervention was less successful in decreasing mean days of cocaine use when compared to the standard. CONCLUSION: Although not robust, the findings nevertheless suggest that components of the experimental thought-mapping model might be useful in combination with other approaches.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Transtornos Relacionados ao Uso de Cocaína/psicologia , Transtornos Relacionados ao Uso de Cocaína/terapia , Redes Comunitárias , Preservativos/estatística & dados numéricos , Infecções por HIV/transmissão , Humanos , Masculino , Educação Sexual , Parceiros Sexuais , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/terapiaRESUMO
OBJECTIVE: There is no information in the literature on the impact of crack smoking using crushed aluminum cans as makeshift pipes, a common form of crack use in Brazil. Since aluminum intake is associated with neurological damage, we measured serum aluminum levels in crack smokers. The objective of this study was to ascertain the levels of aluminum in crack users who smoke on makeshift aluminum pipes. METHOD: 71 female crack smokers, their mean age being 28.0 (+/- 7.7), provided information about their drug use, and had blood samples tested for serum aluminum level. RESULTS: 56 (79%) subjects smoked crack from crushed can pipes, while 15 (21%) smoked from other containers. Fifty-two (73.2%) out of the 71 subjects presented a serum aluminum level of 2 microg/l and 13 (18.3%) had a serum aluminum level of 6 microg/l cut-off point, which is above the reference value. When compared to non-drug users matched by their mean age and gender, they had similar median values and interquartile ranges for serum aluminum level [3 (2-4.6) for crack smokers; 2.9 (1.6-4.1) for controls], but with different means and standard deviations (4.7 +/- 4.9 and 2.9 +/- 1.7, respectively). DISCUSSION: Crack smokers have high serum aluminum level, but we are unsure of its complete association with aluminum cans. Further studies are needed. If such association is proven true in future research, further issues will be raised in dealing with this important disorder, including proper planning and evaluation of public health policies in this area.
Assuntos
Alumínio/sangue , Transtornos Relacionados ao Uso de Cocaína/sangue , Cocaína Crack , Adolescente , Adulto , Doença de Alzheimer/induzido quimicamente , Disponibilidade Biológica , Brasil , Feminino , Humanos , Estatísticas não ParamétricasRESUMO
OBJECTIVE: There is no information in the literature on the impact of crack smoking using crushed aluminum cans as makeshift pipes, a common form of crack use in Brazil. Since aluminum intake is associated with neurological damage, we measured serum aluminum levels in crack smokers. The objective of this study was to ascertain the levels of aluminum in crack users who smoke on makeshift aluminum pipes. METHOD: 71 female crack smokers, their mean age being 28.0 (± 7.7), provided information about their drug use, and had blood samples tested for serum aluminum level. RESULTS: 56 (79 percent) subjects smoked crack from crushed can pipes, while 15 (21 percent) smoked from other containers. Fifty-two (73.2 percent) out of the 71 subjects presented a serum aluminum level of 2 æg/l and 13 (18.3 percent) had a serum aluminum level of 6 æg/l cut-off point, which is above the reference value. When compared to non-drug users matched by their mean age and gender, they had similar median values and interquartile ranges for serum aluminum level [3 (2-4.6) for crack smokers; 2.9 (1.6-4.1) for controls], but with different means and standard deviations (4.7 ± 4.9 and 2.9 ± 1.7, respectively). DISCUSSION: Crack smokers have high serum aluminum level, but we are unsure of its complete association with aluminum cans. Further studies are needed. If such association is proven true in future research, further issues will be raised in dealing with this important disorder, including proper planning and evaluation of public health policies in this area.
OBJETIVO: Não há informação na literatura sobre o impacto do uso de crack fumado em latas de alumínio utilizadas como cachimbos improvisados, uma forma comum de uso de crack no Brasil. Uma vez que a ingestão de alumínio está associada a dano neurológico, nós medimos alumínio sérico em usuários de crack. O objetivo deste estudo foi avaliar os níveis de alumínio em usuários de crack que fumam em cachimbos improvisados de lata de alumínio. MÉTODO: Setententa e uma usuárias de crack, com média de idade de 28,0 anos (± 7,7), forneceram informação sobre seu uso de drogas e tiveram amostras de seu sangue testadas para níveis séricos de alumínio. RESULTADOS: Cinqüenta e seis (79 por cento) sujeitos fumaram crack usando cachimbos de lata e 15 (21 por cento) fumaram em outros formatos. Cinqüenta e dois (73,2 por cento) dos 71 sujeitos apresentaram níveis de alumínio sérico de 2 æg/l e 13 (18,3 por cento) tinham níveis no ponto de corte 6 æg/l, o que está acima dos valores de referência. Quando comparados com não-usuários pareados por média de idade e do mesmo gênero, os sujeitos tiveram valores medianos e intervalos inter-quartil para níveis séricos similares [3 (2-4,6) para usuários de crack; 2,9 (1,6-4,1) para os controles], porém com médias e desvios-padrão diferentes (4,7 ± 4,9 e 2,9 ± 1,7, respectivamente). DISCUSSÃO: Usuários de crack apresentam altos níveis de alumínio sérico, mas não temos certeza disto estar associado completamente com as latas de alumínio. Mais estudos são necessários. Se tal associação se mostrar verdadeira em pesquisa no futuro, questões terão que ser debatidas a respeito deste problema, incluindo planejamento apropriado e avaliação das políticas públicas nesta área.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Alumínio/sangue , Transtornos Relacionados ao Uso de Cocaína/sangue , Cocaína Crack , Doença de Alzheimer/induzido quimicamente , Disponibilidade Biológica , Brasil , Estatísticas não ParamétricasRESUMO
For well over a decade, researchers in Porto Alegre, Brazil, have been documenting the extent of the AIDS epidemic in the region, with a specific focus on the linkages between drug use and HIV seropositivity. Virtually all of the studies conducted during those years found injection drug use (IDU) to be the major vector for HIV seropositivity in this population. However, recent research found that the number of IDUs had declined significantly. Qualitative interviews and focus groups suggested many reasons for this decline: (1) many had died, because they had never heard of AIDS or HIV, and were unaware of how HIV is transmitted. As a result, they had become infected through the sharing of injection paraphernalia. (2) The quality of street cocaine had declined, making injection difficult. (3) Because of a fear of AIDS, some shifted to the smoking of crack, which had become a newly availability commodity in the street culture. Within this context, this article describes the qualitative data describing the decline of cocaine injecting and the corresponding emergence of crack use in Porto Alegre, Brazil, and related HIV risks.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/psicologia , Infecções por HIV/psicologia , Assunção de Riscos , Brasil/epidemiologia , Cocaína/análise , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack/análise , Coleta de Dados , Grupos Focais , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Entrevistas como Assunto , Uso Comum de Agulhas e Seringas , Programas de Troca de Agulhas , Trabalho Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologiaRESUMO
Data from five studies were pooled to describe associations between drug use and HIV. The Risk Assessment. Battery in Porto Alegre, Brazil, was used to collect data from 1449 subjects in 5 separate studies conducted between 1995 and 2004. The subjects were divided into categories based on their pattern of drug use: (1) injection drug users (IDUs), (2) crack smokers, (3) frequent drug users, and (4) infrequent cocaine/alcohol/marijuana users. The sample consisted primarily of young males with low education and income levels. Half of the subjects reported frequent condom use, and exchanges involving drugs, sex, and money were infrequent (although more common in groups 1 and 2). The overall seroprevalence was 20.6%, and the prevalence was different across the four groups, showing a linear decrease from group 1 (57.1%) to group 4 (11.7%). The IDU and crack-smoking groups showed similarities in their risk levels when compared with the other two groups, and individuals in group 1, 2, and 3 were more likely to report having had four or more sex partners. After controlling for all other risk factors, IDU, males having sex with males, and crack use were highly associated with HIV (OR 7.30, 95% CI: 5.10.10.40; OR 3.04, 95%CI: 1.89,4.80; OR 2.03, 95%CI: 1.40, 2.92, respectively). The findings confirm that poverty, low education, and IDU remain risk factors for HIV in Porto Alegre, Brazil, and the study identities crack smoking as a new risk factor.
Assuntos
Soropositividade para HIV/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Fatores Etários , Brasil/epidemiologia , Área Programática de Saúde , Feminino , Redução do Dano , Humanos , Estudos Longitudinais , Masculino , Prevalência , Medição de Risco , Assunção de Riscos , Estudos Soroepidemiológicos , Fatores Sexuais , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
OBJECTIVE: To describe substance use, HIV seroprevalence, and risk of exposure to HIV infection in individuals seeking HIV testing in two screening centers (a municipal one and a state one) in the city of Porto Alegre, Rio Grande do Sul, Brazil. METHODS: Using a cross-sectional design, we enrolled a convenience sample of 1 026 men and women between 15 and 60 years of age. We included all the subjects who, after an initial triage, reported any drug use or any behavior or situation with risk of HIV transmission. A Brazilian-Portuguese version of the Risk Assessment Battery was used to assess exposure to risk situations. Blood samples were tested for anti-HIV antibodies, using enzyme-linked immunosorbent assay. Before the blood test, individuals participated in a group counseling session (with a maximum of 20 participants) on HIV and AIDS, in line with the criteria of the Ministry of Health of Brazil. RESULTS: Among the sample, a high overall HIV seroprevalence was found, 15.1%. Drug use did not explain all of the risk exposure. In comparison to those who reported no injecting drug use, the odds ratio (OR) for being HIV-positive for those who reported injecting drug use at some point in their life was 7.6 (95% confidence interval (CI) = 4.4 to 13.0). However, only 10.3% of the sample reported any injecting drug use. The variables that were associated with HIV seropositivity were: male gender (OR = 1.8; 95% CI = 1.1 to 2.8), monthly family income below three times the minimum-salary amount (OR = 2.1; 95% CI = 1.3 to 3.5), age over 25 (OR = 1.7; 95% CI = 1.1 to 2.7), and having had sexual relations with a partner who was possibly HIV-positive (OR = 1.8; 95% CI = 1.1 to 3.2). CONCLUSIONS: Even irregular or occasional drug use increases the odds of seropositivity, particularly if intravenous drugs are used. Sexual transmission played an important role in seropositivity in this sample, indicating that drug use can affect the judgment of risk and thus contribute to HIV transmission.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Soroprevalência de HIV , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
OBJETIVO: Descrever o uso de substâncias, a soroprevalência e a presença de situações de risco para infecção por HIV em indivíduos que buscaram testagem sorológica em um centro municipal e em um centro estadual de testagem e aconselhamento na Cidade de Porto Alegre (RS), Brasil. MÉTODO: Através de um delineamento transversal, foi obtida uma amostra de conveniência de 1 026 homens e mulheres com idade entre 15 e 60 anos. Foram incluídos todos os indivíduos que, após uma triagem inicial, descreviam qualquer uso de droga ou qualquer comportamento ou situação de risco para a transmissão do HIV. Para avaliar a exposição a situações de risco, utilizou-se o questionário de comportamento de risco para AIDS, uma versão do risk assessment battery (RAB) traduzida para o português brasileiro. As amostras de sangue foram testadas para anticorpos anti-HIV usando o método imunoenzimático (ELISA). Antes do exame, cada indivíduo participava de uma sessão de aconselhamento em grupo (máximo de 20 participantes) sobre HIV e AIDS, de acordo com os critérios do Ministério da Saúde do Brasil. RESULTADOS: A taxa de soropositividade para a amostra em geral foi alta, de 15,1 por cento. O uso de substâncias não explicou toda a exposição ao risco; o uso de drogas injetáveis ao longo da vida, apesar de apresentar uma razão de chances (OR) de 7,6 (IC95 por cento = 4,4 a 13,0) para soropositividade, esteve presente em apenas 10,3 por cento das respostas. Gênero masculino (OR = 1,8; IC95 por cento = 1,1 a 2,8), renda familiar inferior a 3 salários mínimos por mês (OR = 2,1; IC95 por cento = 1,3 a 3,5), idade acima de 25 anos (OR = 1,7; IC95 por cento = 1,1 a 2,7) e ter tido relação sexual com possível indivíduo soropositivo (OR = 1,8; IC95 por cento = 1,1 a 3,2) estiveram associados com soropositividade. CONCLUSÕES: Mesmo o uso não regular ou sistemático de substâncias, em especial sob forma endovenosa, aumenta as chances de soropositividade. A transmissão sexual teve um papel importante na soropositividade nesta amostra, indicando que a diminuição do senso crítico pelo uso de drogas pode comprometer a avaliação de situações de risco e contribuir para a transmissão do HIV
Objective. To describe substance use, HIV seroprevalence, and risk of exposure to HIV infection in individuals seeking HIV testing in two screening centers (a municipal one and a state one) in the city of Porto Alegre, Rio Grande do Sul, Brazil. Methods. Using a cross-sectional design, we enrolled a convenience sample of 1 026 men and women between 15 and 60 years of age. We included all the subjects who, after an initial triage, reported any drug use or any behavior or situation with risk of HIV transmission. A Brazilian-Portuguese version of the Risk Assessment Battery was used to assess exposure to risk situations. Blood samples were tested for anti-HIV antibodies, using enzyme-linked immunosorbent assay. Before the blood test, individuals participated in a group counseling session (with a maximum of 20 participants) on HIV and AIDS, in line with the criteria of the Ministry of Health of Brazil. Results. Among the sample, a high overall HIV seroprevalence was found, 15.1%. Drug use did not explain all of the risk exposure. In comparison to those who reported no injecting drug use, the odds ratio (OR) for being HIV-positive for those who reported injecting drug use at some point in their life was 7.6 (95% confidence interval (CI) = 4.4 to 13.0). However, only 10.3% of the sample reported any injecting drug use. The variables that were associated with HIV seropositivity were: male gender (OR = 1.8; 95% CI = 1.1 to 2.8), monthly family income below three times the minimum-salary amount (OR = 2.1; 95% CI = 1.3 to 3.5), age over 25 (OR = 1.7; 95% CI = 1.1 to 2.7), and having had sexual relations with a partner who was possibly HIV-positive (OR = 1.8; 95% CI = 1.1 to 3.2). Conclusions. Even irregular or occasional drug use increases the odds of seropositivity, particularly if intravenous drugs are used. Sexual transmission played an important role in seropositivity in this sample, indicating that drug use can affect the judgment of risk and thus contribute to HIV transmission.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Sorodiagnóstico da AIDS , Soroprevalência de HIV , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Inquéritos e Questionários , Fatores de RiscoRESUMO
As the HIV/AIDS epidemic continues to expand and penetrate new communities around the globe, risk reduction intervention initiatives must continue to evolve and adapt to new challenges and populations. This is especially true in the Caribbean Basin, where the feminization of the HIV epidemic is tied to a cultural milieu characterized by pervasive gender inequality. HIV intervention programs in the Caribbean must treat women's risks as a function of the social context, standards, and meanings of sexual behaviors and practices in the local community. As such, this article describes an initiative to develop an HIV prevention-intervention protocol for the cultural context of substance abusing women in the US Virgin Islands. Through street-based survey research combined with focus groups and in-depth interviews with such "cultural insiders" as members of the substance-abusing target population, members of the local public health and social services system, and community leaders, a culturally sensitive HIV/AIDS protocol was developed which addresses the supports and barriers to risk reduction faced by substance abusing women in the Virgin Islands.
Assuntos
Infecções por HIV/prevenção & controle , Pobreza , Desenvolvimento de Programas , Transtornos Relacionados ao Uso de Substâncias , Cultura , Coleta de Dados , Feminino , Grupos Focais , Humanos , Pesquisa Qualitativa , Assunção de Riscos , Estados Unidos , Ilhas Virgens Americanas , Populações VulneráveisRESUMO
INTRODUÇAO: No Brasil, aproximadamente 19 mil pessoas adquiriram o vírus HIV por meio do uso de drogas injetáveis desde o início da epidemia, com a soroprevalência em amostras destes usuários variando entre 25 por cento e 65 por cento. O objetivo deste estudo é comparar os comportamentos de risco para infecção por HIV entre amostras de usuários de cocaína injetável do Rio de Janeiro e de Porto Alegre. MÉTODOS: Comparação entre dados de estudos transversais conduzidos em Porto Alegre e no Rio de Janeiro. Um grupo de 250 indivíduos que haviam utilizado cocaína injetável nos seis meses prévios à coleta respondeu ao RBA (Risk Behaviour Assessement) e realizou testagem anti-HIV em ambos os centros. RESULTADOS: Não houve diferença estatisticamente significativa entre os dados demográficos, exceto entre as médias de idade (31 anos no Rio de Janeiro e 28 anos em Porto Alegre). Em Porto Alegre, houve maior uso de cocaína injetável e maior número de comportamentos de risco relacionados a este uso. No Rio de Janeiro, houve mais comportamentos sexuais de risco e uso mais freqüente de cocaína aspirada e álcool. DISCUSSAO: Os usuários de cocaína injetável das duas regiões estudadas apresentavam freqüências diferentes nos comportamentos de risco para HIV, e estes comportamentos parecem estar relacionados com o tipo, a via e a freqüência das drogas utilizadas. Os dados foram coletados entre 1994 e 1997, quando o uso de crack era menor nestas cidades, o que pode ter alterado o padrão atual de comportamentos de risco para HIV em usuários de cocaína.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Infecções por HIV/diagnóstico , Transtornos Relacionados ao Uso de Cocaína/complicações , Fatores de RiscoRESUMO
A cross-sectional study with a sample of 420 drug users from Porto Alegre, Rio Grande do Sul State, Brazil, was utilized to assess demographic variables, drug use, and risk behaviors for HIV infection. We used the Brazilian version of the Risk Assessment Battery. Overall HIV seropositivity was 22.6%; 39.3% of the subjects infected were at least 30 years old, and 69.5% were males. In the month prior to the interview, 56.8% of the sample had used marijuana, 43.6% had sniffed cocaine, 17.6% had injected cocaine, and 42.4% had used alcohol on a frequent basis. The variables that continued to be associated with HIV infection after logistic regression were age (30 or older) (OR: 2.89; 95%CI: 1.17-7.12), having less than seven years of schooling (OR: 2.10; 95%CI: 1.02-4.36), having a monthly family income of less than one minimum wage, or approximately U$90 (OR: 2.89; 95%CI: 1.32-6.32), and having injected drugs (OR: 5.18; 95%CI: 1.32-6.32). Seroprevalence in this sample is considered high, particularly since 70.0% of the sample reported no prior drug injection. Variables associated with HIV infection are similar to the national and international literature and agree with the theoretical model of risk behavior proposed by the first author.
Assuntos
Infecções por HIV/transmissão , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Brasil , Estudos Transversais , Comportamento Perigoso , Feminino , Soropositividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Assunção de Riscos , Fatores SocioeconômicosRESUMO
Em um estudo transversal com uma amostra de 420 usuários de drogas de Porto Alegre, Rio Grande do Sul, Brasil, foram avaliados demografia, uso de drogas e situações de risco para contaminação pelo HIV por meio da versão brasileira do questionário Comportamentos de Risco para AIDS. A prevalência de HIV positivos foi de 22,6 por cento; 39,3 por cento tinham 30 anos ou mais e 69,5 por cento eram homens. Nos trinta dias prévios à coleta, 56,8 por cento tinham usado maconha, 43,6 por cento cocaína inalada, 17,6 por cento cocaína injetada e 42,4 por cento álcool freqüentemente. As variáveis que se mantiveram associadas com infecção por HIV após regressão logística foram idade superior a trinta anos (RC: 2,89; IC95 por cento: 1,17-7,12), ter menos de sete anos de estudo (RC: 2,10; IC95 por cento: 1,02-4,36), renda de menos de um salário mínimo (RC: 2,89; IC95 por cento: 1,32-6,32) e ter usado droga injetável (DI) (RC: 5,18; IC95 por cento: 2,89-9,28). A taxa de infecção pelo HIV encontrada foi alta, considerando que 70,0 por cento nunca haviam usado DI. As variáveis associadas com contaminação por HIV estão de acordo com as literaturas nacional e internacional e com o modelo teórico de exposição a risco proposto pelo primeiro autor.