HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: a systematic review and meta-analysis.
HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: a systematic review and meta-analysis.
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DOI：
10.1186/1471-2458-10-317
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发表时间：
2010-06-07
影响因子：
4.5
通讯作者：
Bastos FI
中科院分区：
文献类型：
--
作者：
Malta M;Magnanini MM;Mello MB;Pascom AR;Linhares Y;Bastos FI
巴西对艾滋病疫情的应对是众所周知的，但缺乏对弱势群体──男男性行为者（MSM）、女性性工作者（FSW）和吸毒者（DU）──的系统审查，仍然是现有文献中的一个主要空白。我们的目标是对评估MSM、FSW和DU中HIV患病率的研究进行系统回顾和荟萃分析，计算合并的合并患病率并总结与每组合并患病率相关的因素。检索了1999年至2009年间以英文、法文、西班牙文或葡萄牙文发表的同行评议论文，检索了9个电子数据库（MEDLINE via PubMed、EMBASE、Cochrane CENTRAL、AIDSLINE、AMED、CINAHL、TOXNET、SciELO和ISI-Web of Science）。要纳入审查，研究必须测量艾滋病毒流行率和/或发病率，作为分析中至少一个特定人群的主要结果。针对这三个人群的研究主要分析了年龄在30岁或以下的年轻人。在FSW中，选择了8项研究（3,625名参与者），一致确定性客户比偶尔和稳定的伴侣使用更多的避孕套。FSW的HIV综合流行率为6.2 （95% CI: 4.4-8.3）。确定了10项针对MSM的研究（6,475名参与者）。在这些研究中，无保护的肛交通常被报道，但根据关系的性质——稳定的性伴侣还是偶尔的性伴侣——和性行为——接受性肛交还是插入性肛交，有很大的差异。男男性接触者的艾滋病毒总流行率为13.6 （95% CI: 8.2-20.2）。确定了29项针对DU的研究（13063名参与者）。这些研究一致认为，注射药物使用和共用注射器/针头是艾滋病毒感染的关键预测因素，以及从事性工作和男性之间的性行为。针对DU的研究中HIV的总流行率为23.1 （95% CI: 16.7-30.2）。与一般人群相比，巴西的FSW、MSM和DU感染艾滋病毒的风险较高，其中艾滋病毒感染率相对较低（约0.6%）。重点预防战略应针对这些弱势群体，提供准确的信息、咨询和检测，以及促进行为改变的具体手段（例如，获得避孕套、药物滥用治疗，以及针对活跃注射吸毒者的清洁注射器），并根据性别和文化的具体需要量身定制。提供这些服务的方案需要在全国的公共卫生服务中实施，以减少这些人群感染艾滋病毒的脆弱性。
The Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations ─ men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group. Nine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE, AMED, CINAHL, TOXNET, SciELO, and ISI-Web of Science) were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1999 to 2009. To be included in the review, studies had to measure HIV prevalence and/or incidence as the primary outcome among at least one specific population under analysis. The studies targeting the three populations analyzed mostly young participants aged 30 years or less. Among FSW, eight studies were selected (3,625 participants), consistently identifying higher condom use with sexual clients than with occasional and stable partners. The combined HIV prevalence for FSW was 6.2 (95% CI: 4.4-8.3). Ten studies targeting MSM were identified (6,475 participants). Unprotected anal intercourse was commonly reported on those studies, but with great variability according to the nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex. Pooled HIV prevalence for MSM was 13.6 (95% CI: 8.2-20.2). Twenty nine studies targeting DU were identified (13,063 participants). Those studies consistently identified injection drug use and syringe/needle sharing as key predictors of HIV-infection, as well as engagement in sex work and male-to-male sex. The combined HIV prevalence across studies targeting DU was 23.1 (95% CI: 16.7-30.2). FSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (~0.6%). Those vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e.g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs. Programs that provide these services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.