Abstract
BackgroundContextual 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.MethodsWe 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).ResultsOf 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).ConclusionsThe 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.
Highlights
Contextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis
Brazil has reported a syphilis prevalence of 0.85% [1] and a human immunodeficiency virus (HIV) prevalence of 0.4% [2]; information is scarce on the epidemiology of these infections among indigenous people and regarding which areas or groups should be targeted by prevention efforts [2]
A total of 45,967 indigenous people were tested for HIV and syphilis, accounting for 54.7% of the presumably sexually active population (n = 84,038) (Table 1)
Summary
Contextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis. HIV prevalence in the northern region of the country, where most of the 250 different Brazilian indigenous groups live [6], show increasing trends in the last decade [7] This increasing HIV prevalence may be due to a wide range of factors, including an adverse socioeconomic context, internal migration flows, inner forms of colonization and expropriation [8], the intensification of large-scale development projects [9], and the opening of new agricultural frontiers in traditional indigenous territories of the Amazon region. All of these factors can be sample characteristics for constructing a vulnerability index [10, 11]. Indigenous women face multiple discriminations on the basis of sex, race/ethnicity, language, culture, religion and class
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