Doubts Remain, Risks Persist: HIV Prevention Knowledge and HIV Testing Among Drug Users in Rio de Janeiro, Brazil

Abstract

Brazil has been recognized for being the first developing country to provide universal AIDS treatment. Brazil also implemented a comprehensive prevention initiative. These efforts have been successful, with about half the number of HIV/AIDS cases forecast in 1992 developing by 2000. However, HIV/AIDS continues to spread, including among not-in-treatment drug users. Questions have been raised about gaps in existing prevention efforts. Based on qualitative research in 2006–2008 with street drug users in Rio de Janeiro (focus groups, N = 24; a pile sort, N = 108; open-ended interviews, N = 34), this paper examines enduring gaps in HIV knowledge and prevailing risk patterns and proposes strategies for strengthening prevention.

RÉSUMÉ

Brésil a été reconnu comme le premier pays en développement à mettre en œuvre un programme de traitement universel du SIDA. Le Brésil a également mis en œuvre des initiatives de prévention globale. Des efforts ont été couronnés de succès, ayant été enregistrée, environ la moitié du nombre de cas de VIH / SIDA qui, en 1992, il était prévu qu’ils seraient enregistrées en 2000. Toutefois, le VIH / SIDA continue à se répandre parmi les consommateurs de drogues hors de traitement. Des questions ont été soulevées au sujet d’éventuelles lacunes dans les efforts de prévention en cours. Basé sur une recherche qualitative menée en 2006–2008, avec les usagers de drogues à Rio de Janeiro (groupes de discussion, N = 24; choix des piles de lettres avec des illustrations N = 108; entretiens ouverts, N = 34), cette techniques on évalue les lacunes actuelles des connaissances sur le VIH et dans les modèles de risque plus fréquent, et propose des stratégies pour le renforcement de la prévention.

RESUMEN

Brasil ha sido reconocido como el primer país en desarrollo que ofrece un tratamiento universal contra el SIDA. Este país también ha implementado una iniciativa amplia de prevención en esta área. Estos esfuerzos han sido exitosos ya que en el año 2000 existía sólo la mitad de casos de VIH/SIDA que se habían anticipado en 1992. Sin embargo, el VIH/SIDA continúa expandiéndose, incluso entre la población drogodependiente que está fuera de tratamiento. Algunas preguntas han surgido sobre las lagunas existentes en los esfuerzos de prevención. Basándose en un estudio cualitativo realizado en 2006–2008 con drogodependientes callejeros en Río de Janeiro (grupos de discusión, N = 24; clasificación de grupo de conceptos, N = 108; entrevistas extensas, N = 34), este ensayo examina las lagunas que aún existen en relación al conocimiento que se tiene sobre el VIH y a los patrones de riesgo prevalecientes, a la vez que propone estrategias para fortalecer la prevención.

RESUMO

O Brasil tem sido reconhecido como o primeiro país em desenvolvimento a implementar um programa de tratamento universal da AIDS. O Brasil implementou também iniciativas abrangentes de prevenção. Os esforços têm sido bem sucedidos, tendo sido registrados, aproximadamente, metade do número de casos de HIV/AIDS que, em 1992, previu-se que viriam a ser registrados em 2000. No entanto, o HIV/AIDS continua se disseminando, inclusive entre os usuários de drogas que não estão em tratamento. Questões têm sido formuladas acerca de possíveis lacunas no âmbito dos esforços de prevenção em curso. Baseado em pesquisa qualitativa realizada em 2006–2008, com usuários de drogas, das ruas do Rio de Janeiro (grupos focais, N = 24; escolha de pilhas de cartas com ilustrações N = 108; entrevistas abertas, N = 34), este artigo avalia lacunas persistentes no conhecimento acerca do HIV e nos padrões de risco mais freqüentes, e propõe estratégias para o fortalecimento da prevenção.

Keywords :

• HIV/AIDS
• cocaine drug users
• Brazil
• HIV testing
• prevention
• qualitative methods

THE AUTHORS

Merrill Singer, Ph.D., a medical anthropologist, is a professor in the Department of Anthropology and a senior research scientist at Center for Health, Intervention and Prevention at the University of Connecticut. Additionally, he is affiliated with the Center for Interdisciplinary Research on AIDS at Yale University. His research and writing focus on the political ecology of health, HIV/AIDS, illicit drug use, and anthropogenic environmental health issues including global warming. He has published over 225 articles and book chapters and has authored or edited 24 books. He is a recipient of the Rudolph Virchow Prize, the George Foster Memorial Award for Practicing Anthropology, the AIDS and Anthropology Paper Prize, and the Prize for Distinguished Achievement in the Critical Study of North America.

Scott Clair received his Ph.D. in social psychology in 1996 from the University of Houston. Previous to coming to Iowa State University, he spent 5 years in a joint appointment with the Hispanic Health Council and the Yale University's Center for Interdisciplinary Research on AIDS. Dr. Clair has been actively involved in numerous research projects focusing on four main areas: (1) risky behavior, particularly the HIV risk behaviors of drug users; (2) the effects of oral HIV testing on HIV transmission beliefs; (3) the application of social network models to risk behavior; and (4) the dissemination of effective interventions.

Monica Malta, Ph.D., M.P.H., is an associate professor in the National School of Public Health of the Social Science Department at the Oswaldo Cruz Foundation (FIOCRUZ), Brazil. Much of her recent research and publications has focused on understanding and responding to the social context surrounding HIV prevention and care initiatives among disenfranchised groups from Brazil, in particular people living with HIV/AIDS and drug users.

Francisco I. Bastos, M.D., Ph.D., a senior researcher and chairman of the graduate studies program in epidemiology at the Oswaldo Cruz Foundation (FIOCRUZ), Brazil, is a physician who has extensive experience working on studies assessing populations at high risk of HIV infection in Brazil, an area in which he is well published. He has been involved in the planning and management of multicity projects such as the WHO Multi-City Project on HIV/AIDS and viral hepatitis among injection drug users and different protocols belonging to the cooperative HIV Prevention Trials Network sponsored by the National Institutes of Health. Dr. Bastos has also been involved in analyses aiming to assess the status and trends of the AIDS epidemic in Brazil.

Neilane Bertoni, a Ph.D. candidate in epidemiology at the Oswaldo Cruz Foundation (FIOCRUZ), Brazil, is a statistician, with experience in the area of public health, mainly HIV/AIDS and drug use.

Claudia Santelices, Ph.D., is an associate research scientist at the Institute on Urban Health Research, Northeastern University in Boston, and has worked as leading ethnographer on several ethno-epidemiological studies on substance abuse and HIV/AIDS risk among US national and foreign national underserved populations. She has also collaborated as consultant ethnographer in similar studies conducted in Mexico and Brazil. Prior to her current appointment at the Northeastern University's Institute on Urban Health Research, Dr. Santelices was an associate research scientist at the University of Connecticut's Center for Health, Intervention and Prevention.

Notes

1 The often-used nosology “drugs of abuse” is both unscientific and misleading in that (1) it mystifies and empowers selected active chemicals into a category whose underpinnings are neither theoretically anchored nor evidence informed and that is based upon “principles of faith” held and transmitted by a range of stakeholders representing a myriad of agendas and goals, and (2) active chemical substances of any types—“drugs”—are used or misused; living organisms can be and are all too often abused. Editor's note.