Drug Use and Risks for HIV/AIDS Among Indigent Women in Rio de Janeiro, Brazil

SUMMARY

The PROVIVA project (Projeto Venha Informar-sesobre o Virus da AIDS), funded by the National Institute on Drug Abuse and administered by the University of Miami School of Medicine, was established in 1993 for the purpose of developing and implementing a community-wide HIV/AIDS prevention effort in Rio de Janeiro, Brazil. Recruitment began in mid-1994 and the specific target groups included cocaine-using women and men in Rio's favelas (shantytowns) and “red light” districts. Study participants were obtained through standard chain referral and targeted sampling techniques, and through May 31, 1997 over 1,500 were enrolled in the project. This analysis focuses on the first 339 women recruited.

The women ranged in age from 18 to 62, with a median of 29 years. The majority were either black or multi-racial (morena, parda, mulata, café com leite, and other multi-racial designations), and almost all were of low socio-economic status. The HIV risk behaviors engaged in by these women during the 30-day period prior to interview included sex with multiple partners (17%), sex with an injection drug user (3.8%), injection drug use (4.1%), and anal sex (12.7%). In addition, also during the past 30 days, 70.8% had used cocaine either daily or several times a week and 81% reported no use of condoms. Finally, 95.6% of the women had never been in drug treatment, 28.9% reported exchanging sex for money, 10.3% reported exchanging sex for drugs, and 15.5% reported histories of one or more sexually transmitted diseases.

A total of 8.5% of the women tested positive for antibody to HIV-1. The HIV test results and risk behaviors, combined with the apparent lack of drug abuse treatment services suggest that cocaine-using women in Rio's favelas and red light districts are in need of concentrated services in the areas of HIV and other STD prevention/intervention, substance abuse treatment, and other risk reduction initiatives.