Department of STI, AIDS and Viral Hepatitis, Secretary for Health Surveillance, Ministry of Health Brazil, Brasília, DF, Brazil.
Tropical Medicine Foundation Doctor Heitor Vierira Dourado, Manaus, Brazil.
Int J Equity Health. 2017 Jun 5;16(1):92. doi: 10.1186/s12939-017-0589-8.
Contextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis. We estimated the prevalence of both infections among indigenous people in nine indigenous health districts of the Brazilian Amazon and examined the context of community vulnerability to acquiring these infections.
We trained 509 health care workers to screen sexually active populations in the community for syphilis and HIV using rapid testing (RT). We then assessed the prevalence of HIV and syphilis using RT. A multivariable analysis was used to identify factors associated with syphilis infection (sociodemographic, condom use, intrusion, population mobility, and violence).
Of the 45,967 indigenous people tested, the mean age was 22.5 years (standard deviation: 9.2), and 56.5% were female. Overall, for HIV, the prevalence was 0.13% (57/43,221), and for syphilis, the prevalence was 1.82% (745/40,934). The prevalence in men, women, and pregnant women for HIV was 0.16%, 0.11%, and 0.07%, respectively, and for syphilis, it was 2.23%, 1.51%, and 1.52%, respectively. The district Vale do Javari had the highest prevalence of both infections (HIV: 3.38%, syphilis: 1.39%). This district also had the highest population mobility and intrusion and the lowest availability of prenatal services. Syphilis infection was independently associated with age (odds ratio [OR] 1.04, 95% confidence interval [CI]: 1.03-1.05), male sex (OR 1.32, 95% CI: 1.14-1.52), and mobility (moderate: OR: 7.46, 95% CI: 2.69-20.67; high: OR 7.09, 95% CI: 3.79-13.26).
The large-scale integration of RT in remote areas increased case detection among pregnant women, especially for syphilis, in districts with higher vulnerability. Mobility is an important risk factor, especially in districts with higher vulnerability. Contextually appropriate approaches that address this factor could contribute to the long-term success of HIV and syphilis control programs.
背景因素影响人类免疫缺陷病毒（HIV）和梅毒的感染风险。本研究评估了巴西亚马逊地区 9 个土著卫生区土著人群中这两种感染的流行情况，并探讨了社区感染这些疾病的脆弱性背景。
我们培训了 509 名卫生保健工作者，使用快速检测（RT）在社区中对有性行为的人群进行梅毒和 HIV 筛查。然后，我们使用 RT 评估 HIV 和梅毒的流行率。采用多变量分析确定与梅毒感染相关的因素（社会人口学、避孕套使用、入侵、人口流动和暴力）。
在接受检测的 45967 名土著人中，平均年龄为 22.5 岁（标准差：9.2），56.5%为女性。总体而言，HIV 的流行率为 0.13%（57/43221），梅毒的流行率为 1.82%（745/40934）。男性、女性和孕妇的 HIV 流行率分别为 0.16%、0.11%和 0.07%，梅毒的流行率分别为 2.23%、1.51%和 1.52%。瓦尔德雅瓦里区（Vale do Javari）的两种感染流行率最高（HIV：3.38%，梅毒：1.39%）。该地区人口流动和入侵率最高，产前服务的提供率最低。梅毒感染与年龄（比值比[OR]1.04，95%置信区间[CI]：1.03-1.05）、男性（OR 1.32，95% CI：1.14-1.52）和流动（中度：OR：7.46，95% CI：2.69-20.67；高度：OR 7.09，95% CI：3.79-13.26）独立相关。
大规模整合 RT 可提高偏远地区孕妇的病例检出率，特别是在脆弱性更高的地区。流动是一个重要的危险因素，特别是在脆弱性更高的地区。针对这一因素的针对性方法可能有助于 HIV 和梅毒控制项目的长期成功。
