HIV, STDs, anal sex and AIDS prevention policy in a northeastern Brazilian city

Abstract

Data on HIV/AIDS, other STDs, and related sexual practices and AIDS prevention measures in São Luís, capital of Maranhão state, were collected in May-July 1995 using participant-observation fieldwork, including a number of face-to-face interviews in addition to archival research, and were updated by correspondence in 1996-1997 and a brief visit in February 1998. In contrast to the continuing severe AIDS epidemic in southern Brazil, public health statistics and public HIV testing recently instituted in São Luís suggest that HIV infection has remained largely concentrated among men who have sex with men, as well as a few, though growing number of cases of women evidently infected by such men. However, other STDs are endemic to the region, and could provide an increasing portal of entry for HIV infection. AIDS prevention education programmes have commenced in public schools and elsewhere in São Luís, but greater emphasis needs to also be placed on the prevention and treatment of other STDs. As in other regions of Brazil and Latin America, the reportedly common practice of anal sex among heterosexuals also represents a significant yet typically underemphasized risk factor for HIV.

PIP: Brazil has since the beginning of the AIDS pandemic consistently reported the second or third highest number of AIDS cases in the world. As of June 1996, most of the 82,852 officially reported AIDS cases were concentrated in the southeastern regions of the country, with the majority of Brazilian AIDS and HIV cases continuing to belong to the higher-risk groups of men who have sex with men, and IV drug users. By February 1995, 325 AIDS cases had been reported in Maranhao state. The incidence of AIDS cases in Maranhao state was 6.9/100,000 population, far lower than the 120.6/100,000 in the state of Sao Paulo. The majority of these cases were located in Sao Luis, the state capital. Data were collected in Sao Luis on HIV/AIDS, other sexually transmitted diseases (STDs), related sex practices, and AIDS prevention measures during May-July 1995 through participant-observation field work, face-to-face interviews, archival research, updated by correspondence in 1996-97, and a brief visit in February 1998. Public health statistics and findings from public HIV testing recently conducted in the city suggest that HIV infection has remained largely concentrated among men who have sex with men, with a few, but growing number of cases of women apparently infected by such men. The other STDs endemic to the region could facilitate the spread of HIV infection. Although AIDS prevention education programs have begun in public schools and elsewhere in the city, greater attention needs to be given to preventing and treating other STDs. As in other regions of Brazil and Latin America, the common practice of anal sex among heterosexuals is a significant risk factor for HIV transmission.