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      Diferenças entre fatores de risco para infecção pelo HIV em usuários de drogas injetáveis do Rio de Janeiro e Porto Alegre Translated title: Risks differences of HIV infection between injection drug users in Rio de Janeiro and Porto Alegre

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          Abstract

          INTRODUÇÃO: No Brasil, aproximadamente 19 mil pessoas adquiriram o vírus HIV por meio do uso de drogas injetáveis desde o início da epidemia, com a soroprevalência em amostras destes usuários variando entre 25% e 65%. O objetivo deste estudo é comparar os comportamentos de risco para infecção por HIV entre amostras de usuários de cocaína injetável do Rio de Janeiro e de Porto Alegre. MÉTODOS: Comparação entre dados de estudos transversais conduzidos em Porto Alegre e no Rio de Janeiro. Um grupo de 250 indivíduos que haviam utilizado cocaína injetável nos seis meses prévios à coleta respondeu ao RBA (Risk Behaviour Assessement) e realizou testagem anti-HIV em ambos os centros. RESULTADOS: Não houve diferença estatisticamente significativa entre os dados demográficos, exceto entre as médias de idade (31 anos no Rio de Janeiro e 28 anos em Porto Alegre). Em Porto Alegre, houve maior uso de cocaína injetável e maior número de comportamentos de risco relacionados a este uso. No Rio de Janeiro, houve mais comportamentos sexuais de risco e uso mais freqüente de cocaína aspirada e álcool. DISCUSSÃO: Os usuários de cocaína injetável das duas regiões estudadas apresentavam freqüências diferentes nos comportamentos de risco para HIV, e estes comportamentos parecem estar relacionados com o tipo, a via e a freqüência das drogas utilizadas. Os dados foram coletados entre 1994 e 1997, quando o uso de crack era menor nestas cidades, o que pode ter alterado o padrão atual de comportamentos de risco para HIV em usuários de cocaína.

          Translated abstract

          INTRODUCTION: In Brazil, about 19.000 of HIV cases have been attributed to injection drug use, with the seroprevalence among such samples ranging from 25% to 65%. The aim of this study is to compare drug using and HIV risk behaviors among injection cocaine users in Rio de Janeiro and Porto Alegre. METHODS: Comparative analysis of cross-sectional data from two studies conducted in Porto Alegre and Rio de Janeiro. 250 respondents who reported using cocaine by injection in the six months prior to interview were interviewed using NIDA´s RBA (Risk Behavior Assessment) and participated in voluntary HIV testing. RESULTS: There were no statistically significant differences between the two samples in terms of demographic characteristics, with the exception of mean age (31 years in Rio de Janeiro and 28 years in Porto Alegre). The Porto Alegre sample reported more frequent cocaine injection and more injecting risk behaviors. The Rio de Janeiro sample displayed more sexual risk behaviors and more frequent use of both alcohol and snorted cocaine. DISCUSSION: Cocaine injectors in the two regions studied displayed different levels of HIV risk behaviors, and these behaviors appear to be related to the type, method and frequency of drug use. These data were collected between 1994 and 1997 when the use of crack was less common in these cities, which may have changed the current level of risk behaviors for HIV among cocaine users.

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          Intersecting epidemics--crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team.

          The smoking of "crack" cocaine is thought to be associated with high-risk sexual practices that accelerate the spread of infection with the human immunodeficiency virus (HIV). We studied 2323 young adults, 18 to 29 years of age, who smoked crack regularly or who had never smoked crack. The study participants, recruited from the streets of inner-city neighborhoods in New York, Miami, and San Francisco, were interviewed and tested for HIV. This report presents the findings for the 1967 participants (85 percent) who had never injected drugs. Of the 1137 crack smokers, 15.7 percent were positive for HIV antibody, as compared with 5.2 percent of the 830 nonsmokers (prevalence ratio adjusted for the city, 2.4; 99 percent confidence interval, 1.7 to 3.6). The prevalence of HIV was highest among the crack-smoking women in New York (29.6 percent) and Miami (23.0 percent). Of the 283 women who had sex in exchange for money or drugs, 30.4 percent were infected with HIV as compared with 9.1 percent of the 286 other women (prevalence ratio, 3.1; 99 percent confidence interval, 1.9 to 5.1); of the 91 men who had anal sex with other men, 42.9 percent were infected with HIV as compared with 9.3 percent of the 582 men who did not have anal sex with other men (prevalence ratio, 4.7; 99 percent confidence interval, 3.0 to 7.4). In multivariable analyses, these high-risk sexual practices accounted for the higher prevalence of HIV infection among the crack smokers, as compared with those who did not smoke crack. Women who had recently had unprotected sex in exchange for money or drugs were as likely to be infected as men who had had sex with men (40.9 percent vs. 42.9 percent). In poor, inner-city communities young smokers of crack cocaine, particularly women who have sex in exchange for money or drugs, are at high risk for HIV infection. Crack use promotes the heterosexual transmission of HIV.
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            Cocaine use and HIV infection in intravenous drug users in San Francisco.

            We assessed risk factors for human immunodeficiency virus (HIV) infection in 633 heterosexual intravenous drug users. The HIV seroprevalence was 26% in blacks, 10% in Hispanics, and 6% in whites. Intravenous cocaine use significantly increased the risk of HIV infection, with a seroprevalence of 35% in daily cocaine users (odds ratio, 6.4; 95% confidence interval, 3.0 to 13.3). Black subjects were more likely to use cocaine regularly. Drug use in shooting galleries and sharing of drug injection equipment were also associated with HIV infection and were more common in cocaine users. By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection. Methadone therapy was associated with substantial reductions in heroin use and some reduction in cocaine use, but 24% of cocaine users receiving methadone began or increased cocaine injection after entry into treatment.
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              Boletim epidemiológico AIDS

              PRJ Marins (2002)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rpc
                Archives of Clinical Psychiatry (São Paulo)
                Arch. Clin. Psychiatry (São Paulo)
                Faculdade de Medicina da Universidade de São Paulo (São Paulo )
                1806-938X
                2005
                : 32
                : 1
                : 5-9
                Affiliations
                [1 ] Universidade Federal do Rio Grande do Sul Brazil
                [2 ] University of Delaware EUA
                Article
                S0101-60832005000100001
                10.1590/S0101-60832005000100001
                4dfffaf9-f552-4891-95b0-758a87e929ae

                http://creativecommons.org/licenses/by/4.0/

                History
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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0101-6083&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL
                PSYCHIATRY

                Internal medicine,Clinical Psychology & Psychiatry
                HIV,AIDS,cocaine,injection drugs,cocaína,drogas injetáveis

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