Poverty,bridging between injecting drug users and the general population,and “interiorization” may explain the spread of HIV in southern Brazil |
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| Authors: | Mariana A Hacker Iuri Leite Samuel R Friedman Renata Gracie Carrijo Francisco I Bastos |
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| Institution: | 1. Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Zip code 21040-360 Rio de Janeiro, Brazil;2. National School of Public Health, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Zip code 21040-360 Rio de Janeiro, Brazil;3. National Development and Research Institutes, New York, NY 10010, USA;4. Institute of Scientific and Technological Information, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Zip code 21040-360 Rio de Janeiro, Brazil;1. Michigan Department of Community Health, Division of Immunization, 201 Townsend, PO Box 30195, Lansing, MI 48909, United States;2. Surveillance and Data Management Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE MS E-02, Atlanta, GA 30333, United States;3. Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE MS K-40, Atlanta, GA 30341, United States;4. Michigan Department of Community Health, Division for Vital Records and Health Statistics, 201 Townsend, PO Box 30195, Lansing, MI 48909, United States;2. New York University, New York, NY;1. Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA;2. Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill;3. Department of Epidemiology, Rollins School of Public Health at Emory University, Atlanta, GA;4. Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill;5. Department of Epidemiology, UNC Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill;6. Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health at Columbia University, New York, NY;7. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA;8. Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill;9. Department of Epidemiology and Biostatistics, Jackson State University, School of Public Health, Jackson, MS;10. ZevRoss Spatial Analysis, Ithaca, NY;11. Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL;1. Austin-Travis County Office of the Medical Director, 517 S. Pleasant Valley Road, Austin, TX 78741, United States;2. University of Texas – Austin, Emergency Medicine Residency Program, Clinical Education Center, Suite 2.230, 1400 North IH-35, Austin, TX 78701, United States;3. Mount Isa Centre for Rural and Remote Health, James Cook University, Townsville, QLD 4811, Australia |
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| Abstract: | The aim of this paper is to study how structural determinants and the role of injecting drug users (IDUs) as a bridging population to the general population affected the AIDS subepidemic in southern Brazil during 1986–2000. Data from 288 southernmost Brazilian municipalities were analyzed. Using hierarchical modeling and inputs from a Geographic Information System, a multilevel model was constructed. The dependent variable was the logged AIDS standardized incidence rate (among the heterosexual population aged 15–69-years-old); independent variables included indicators for education, water provision, sewage, and garbage collection, per capita income, Gini coefficient (on income), Human Development Index, indicators of accessibility, and AIDS rate among IDUs. Significant predictors included AIDS rate among IDUs, distance from/to highways/railways, the Human Development Index and the ratio of residents who have access to sanitary installations. Poverty (as measured by socioeconomic indicators) and bridging from IDUs contribute to the spread of HIV/AIDS in Brazilian southern municipalities. |
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