The social epidemiology of Zika: stigma, transmission, and prevention in Brazil

Abstract

Abstract Zika Virus continues to pose a threat to public health in Brazil. In the absence of an infrastructure-focused approach to eradication, it is crucial to understand points of intervention that may increase preventative action in the population. There has been a lack of studies on how socioeconomic and demographic factors relate to attitudes and behaviors surrounding Zika. The purpose of this study was to investigate factors influencing stigma, transmission knowledge, and prevention method use in Brazil. This study relied on nationally-representative data collected for the 2016/2017 AmericasBarometer survey. A multi-stage national probability sample design was used, yielding 1,532 participants. Items were selected representing three thematic categories: stigmatizing attitudes, accuracy of transmission knowledge, and the frequency of prevention method use. Multi-level modeling was used to assess the relationship between each item and gender, urban/rural living, income, and education, nested by region. Education level was the strongest and most common predictor overall in this study. Higher levels of education were associated with less stigma against those with Zika, t(677)= 3.41, p < 0.01, and more accurate transmission knowledge, t(1326)=5.31, p < 0.001. For prevention method use, female gender was the strongest predictor, t(1408)=4.85, p < 0.001. These relationships did not differ significantly by region. The governmental response to Zika thus far has focused primarily on vector control. This has had limited success and placed the burden of prevention primarily on women and girls. The results of this study suggest that, in the absence of structural change, targeted interventions may be necessary to increase the accuracy of Zika-related knowledge and prevention method use. In addition to community-level interventions, advocacy for equitable access to education and increased availability of comprehensive family planning are critical. Key messages There are multi-level barriers to Zika knowledge and prevention use that will require structural, community, and individual-level interventions. Severe weather events driven by climate change will further damage fragile water/sanitation infrastructures in Brazil. Multi-sector collaboration is needed for environmental and population health.