RESUMO
RESUMO Objetivou-se identificar o conhecimento e as situações de vulnerabilidade de homens jovens usuários de crack perante o HIV. Trata-se de pesquisa exploratória, descritiva e qualitativa, realizada em uma comunidade terapêutica do município de Fortaleza-CE, entre janeiro e março de 2012. Participaram do estudo 10 jovens, com idades entre 18 e 24 anos. As informações foram coletadas por meio de anotações em diário de campo e de entrevista semiestruturada, e os dados obtidos foram analisados pela técnica de análise de conteúdo. Os resultados indicaram quatro categorias temáticas: quem são os usuários de crack?; o conhecimento acerca do HIV; prevenção; e situações de vulnerabilidade ao HIV. Os jovens demonstraram pouco conhecimento sobre a AIDS, com predominância de mitos, e se consideravam vulneráveis ao HIV, visto que o compartilhamento de cachimbos para o uso do crack e a perda da consciência favoreciam o não uso do preservativo durante as relações sexuais e a multiplicidade de parceiros. A pesquisa traz subsídios para que o profissional de saúde se aproprie das necessidades relatadas pelos jovens e planeje estratégias educativas que possam permitir uma reflexão sobre a temática das drogas e sua relação complexa com os vários fatores que cercam essa questão, inclusive o HIV.
RESUMEN El objetivo fue identificar el conocimiento y las situaciones de vulnerabilidad de hombres jóvenes usuarios de crack ante el VIH. Se trata una investigación exploratoria-descriptiva, cualitativa, realizada en una comunidad terapéutica del municipio de Fortaleza-CE, entre enero y marzo de 2012. Participaron del estudio 10 jóvenes, con edades entre 18 y 24 años. Las informaciones fueron recolectadas por medio de apuntes en diario de campo y de entrevista semi estructurada, y los datos obtenidos fueron analizados por la técnica de análisis de contenido. Los resultados indicaron cuatro categorías temáticas: ¿quiénes son los usuarios de crack?; el conocimiento acerca del VIH; prevención; y situaciones de vulnerabilidad al VIH. Los jóvenes demostraron poco conocimiento sobre el SIDA, con predominancia de mitos, y se consideraban vulnerables al VIH, visto que el intercambio de pipas para el uso del crack yla pérdida de la conciencia favorecíanal no uso del preservativo durante las relaciones sexuales y la multiplicidad de compañeros. La investigación trae contribuciones para que el profesional de salud se apropie de las necesidades relatadas por los jóvenes y planee estrategias educativas que puedan permitir una reflexión sobre la temática de las drogas y su relación compleja con los varios factores que cercan esta cuestión, incluso, el VIH.
ABSTRACT This study aimed to identify the knowledge that young people who are crack users have on HIV and their situations of vulnerability. This is an exploratory, descriptive and qualitative research conducted in a therapeutic community in the city of Fortaleza, between January and March 2012. The study included 10 young men aged between 18 and 24 years. Information was collected through notes in a field diary and semi-structured interviews and data were analyzed using content analysis. The results indicated four thematic categories: who are the users of crack?; knowledge about HIV; prevention; and situations of vulnerability to HIV. The young men showed to have little knowledge about AIDS, especially believing in myths, and they are considered vulnerable to HIV, since they share pipes for the use of crack and lose consciousness favoring the practice of sex with multiple partners and without condoms. The research brings important information for the use healthcare professionals regarding the needs reported by young men and for them to plan educational strategies that might allow a reflection on the theme of drugs and its complex relationship with the various factors surrounding this issue, including HIV.
Assuntos
Humanos , Masculino , Adulto Jovem , Síndrome da Imunodeficiência Adquirida/prevenção & controle , HIV/imunologia , Cocaína Crack/efeitos adversos , Análise de Vulnerabilidade/análise , Necessidades e Demandas de Serviços de Saúde/normas , Parceiros Sexuais/classificação , Preparações Farmacêuticas/análise , Preservativos/normas , Vulnerabilidade a Desastres/prevenção & controleRESUMO
BACKGROUND: Despite over a decade of research and programming, little evidence is available on effective strategies to reduce HIV risks among Central American men who have sex with men (MSM). The Pan-American Social Marketing Organization (PASMO) and partners are implementing a HIV Combination Prevention Program to provide key populations with an essential package of prevention interventions and services: 1) behavioral, including interpersonal communications, and online outreach; 2) biomedical services including HIV testing and counseling and screening for STIs; and 3) complementary support, including legal support and treatment for substance abuse. Two years into implementation, we evaluated this program's effectiveness for MSM by testing whether exposure to any or a combination of program components could reduce HIV risks. METHODS: PASMO surveyed MSM in 10 cities across Guatemala, El Salvador, Nicaragua, Costa Rica, and Panama in 2012 using respondent-driven sampling. We used coarsened exact matching to create statistically equivalent groups of men exposed and non-exposed to the program, matching on education, measures of social interaction, and exposure to other HIV prevention programs. We estimated average treatment effects of each component and all combined to assess HIV testing and condom use outcomes, using multivariable logistic regression. We also linked survey data to routine service data to assess program coverage. RESULTS: Exposure to any program component was 32% in the study area (n = 3531). Only 2.8% of men received all components. Men exposed to both behavioral and biomedical components were more likely to use condoms and lubricant at last sex (AOR 3.05, 95% CI 1.08, 8.64), and those exposed to behavioral interventions were more likely to have tested for HIV in the past year (AOR 1.76, 95% CI 1.01, 3.10). CONCLUSIONS: PASMO's strategies to reach MSM with HIV prevention programming are still achieving low levels of population coverage, and few men are receiving the complete essential package. However, those reached are able to practice HIV prevention. Combination prevention is a promising approach in Central America, requiring expansion in coverage and intensity.
Assuntos
Infecções por HIV/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Prevenção Primária/organização & administração , Sexo Seguro/estatística & dados numéricos , Adolescente , Adulto , América Central/epidemiologia , Preservativos/estatística & dados numéricos , Costa Rica/epidemiologia , El Salvador/epidemiologia , Guatemala/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Nicarágua/epidemiologia , Avaliação de Programas e Projetos de Saúde , Comportamento de Redução do Risco , Parceiros Sexuais/classificação , Inquéritos e QuestionáriosRESUMO
Condom use during last sexual contact is a survey measure that may be used to inform monitoring and evaluation indicators of recent condom use in populations at risk for HIV infection and other sexually transmitted infections, such as the uniformed services. The authors tested for differences in condom use measures that were fielded within separate Biological and Behavioral Surveillance Surveys conducted in the armed forces of two separate nations: the Dominican Republic and Belize. Both surveys included measures of condom use during last sexual contact with specified partners and both surveys included the Risk Behavior Assessment (RBA), which measures specific sexual acts and condom use frequency during a specified time period. In both samples, more than 40% of respondents who reported condom use during last sexual contact with a regular partner also reported engaging in unprotected sex when screened with the RBA. Furthermore, more than 60% of respondents who reported condom use during last sexual encounter with a commercial sex worker also reported engaging in unprotected sex when screened with the RBA. The results carry implications for monitoring and evaluation indicators of large-scale HIV prevention programs. The authors recommend that, when feasible, more in-depth instruments such as the RBA be considered to measure recent condom use in populations of uniformed services personnel.
Assuntos
Preservativos/estatística & dados numéricos , Militares/estatística & dados numéricos , Assunção de Riscos , Trabalho Sexual/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais/classificação , Adulto , Atitude Frente a Saúde , Belize , República Dominicana , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Medicina Militar , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: We investigated the hypothesis that partner-specific characteristics are important to improve an individual's risk characterization. DESIGN: It has been shown that the egocentric network structure is important to establish a person's risk for infection. METHODS: The study was cross-sectional in its design and enrolled 1231 volunteers at one HIV testing site in Rio de Janeiro, Brazil, and applied an adapted ego-network questionnaire. Each individual was interviewed about their own risk factors and those related to up to 10 sex partners. We used the dyadic data analysis method in which each relationship forms a record. Two receiver operator characteristic curves were generated, and the ability to correctly predict volunteers' HIV serostatus based on a model with characteristics of volunteers and sex partners and another with only volunteers' characteristics was evaluated. RESULTS: Partner-related variables were associated with HIV serostatus both for men and women. The model with volunteer/sex partners' characteristics performed better in discriminating between HIV-positive and negative volunteers only for men but not for women. The c statistic for men volunteers was 0.82 [95% confidence interval (CI) 0.77-0.87] for the volunteer alone model and 0.88 (95% CI 0.86-0.91) for the combined model (P = 0.03). The values for women were 0.75 (95% CI 0.65-0.86) and 0.78 (95% CI 0.71-0.85), respectively (P = 0.71). CONCLUSION: Ego-network theory-based approaches provide additional information for characterizing risk for HIV infection among men.
Assuntos
Soronegatividade para HIV , Soropositividade para HIV/transmissão , Parceiros Sexuais/classificação , Inquéritos e Questionários , Adulto , Brasil/epidemiologia , Intervalos de Confiança , Estudos Transversais , Feminino , Soropositividade para HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Medição de Risco/classificação , Sexo Seguro/psicologia , Fatores Sexuais , Parceiros Sexuais/psicologiaRESUMO
OBJECTIVES: We compared Black West Indian immigrants' and US-born Blacks' sexual and drug-use risk behaviors and their beliefs related to using condoms and informing partners of sexually transmitted infections (STIs) to identify possible differences in risk. METHODS: We drew data from the baseline assessment of a clinic-based intervention designed to increase partner STI notification. RESULTS: Black West Indian men were less likely than were US-born Black men to report nonregular partners. There were no differences in condom use. US-born Black women were more likely than were Black West Indian women to be extremely confident that they could convince their regular partners to use condoms (odds ratio [OR] = 2.40; 95% confidence interval [CI] = 1.21, 4.76), whereas there were no differences between Black West Indian and US-born Black men on this measure (interaction P = .06). US-born Black women were more likely than were Black West Indian women to be extremely confident in their ability to discuss STI screening with their regular partners (OR = 1.89; 95% CI = 1.03, 3.47). CONCLUSIONS: Black West Indian women's lower levels of confidence that they can discuss STI screening with their regular partners and convince these partners to use condoms may increase their infection risk. Gender-sensitive interventions are warranted for Black West Indian immigrants, especially women.
Assuntos
Negro ou Afro-Americano/psicologia , Preservativos/estatística & dados numéricos , Emigrantes e Imigrantes/psicologia , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Comportamento Sexual/etnologia , Parceiros Sexuais/psicologia , Adolescente , Adulto , Negro ou Afro-Americano/classificação , Negro ou Afro-Americano/educação , Infecções por Chlamydia/etnologia , Infecções por Chlamydia/prevenção & controle , Centros Comunitários de Saúde , Busca de Comunicante , Emigrantes e Imigrantes/educação , Feminino , Gonorreia/etnologia , Gonorreia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Autoeficácia , Parceiros Sexuais/classificação , Transtornos Relacionados ao Uso de Substâncias/etnologia , Serviços Urbanos de Saúde , Índias Ocidentais/etnologiaRESUMO
A la serie de cambios que ocurren en el organismo, como producto de estímulos sexuales, se le conoce como respuesta sexual humana. La diversidad de respuestas frente a un estímulo significa que su efectividad está condicionada por situaciones tales como el estado de ánimo, experiencias previas, desconocimiento de las preferencias del compañero y antecedentes culturales, religiosos o morales. Para dar una idea de las reacciones fisiológicas, el ciclo de la respuesta sexual se, divide en cuatro fases: 1.- Fase de excitación. Se desarrolla a partir de estímulos orgánicos y psicológicos, la respuesta es reciproca a la intensidad. 2.- Fase de meseta. La tensión sexual se intensifica y se mantiene, su duración depende del estímulo empleado. 3.- Fase de orgasmo. Se limita a los escasos segundos durante los cuales la congestión y las contracciones musculares desarrolladas por el estímulo sexual se descargan en forma explosiva. Esta situación involuntaria se alcanza a un nivel que representa el máximo de tensión sexual para cada experiencia particular y 4.- Fase de resolución. Este período involuntario de pérdida de la tensión lleva al individuo a un estado de inexcitabilidad, mientras que la mujer puede volver a un estado de orgasmo en cualquier momento de esta fase. Se enumeran los cambios fisiológicos en cada una de las fases tanto en la mujer como en el hombre; así como en el embarazo, el puerperio y en el envejecimiento