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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon

Authors: Adele Schwartz Benzaken, Meritxell Sabidó, Ivo Brito, Ximena Pamela Díaz Bermúdez, Nina Schwartz Benzaken, Enrique Galbán, Rosanna W Peeling, David Mabey

Published in: International Journal for Equity in Health | Issue 1/2017

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Abstract

Background

Contextual 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.

Methods

We 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).

Results

Of 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).

Conclusions

The 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.
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Metadata
Title
HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon
Authors
Adele Schwartz Benzaken
Meritxell Sabidó
Ivo Brito
Ximena Pamela Díaz Bermúdez
Nina Schwartz Benzaken
Enrique Galbán
Rosanna W Peeling
David Mabey
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0589-8

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