HIV and syphilis infections and associated factors among patients in treatment at a Specialist Alcohol, Tobacco, and Drugs Center in São Paulo’s “Cracolândia”

Abstract Introduction This study describes the epidemiological scenario of human immunodeficiency virus (HIV) and syphilis at the biggest specialist drug addiction center in Brazil. The great challenge is to find strategies to reduce the impact of inequality and discrimination and develop policies to protect individuals living with – or at risk of – infections. Methods During the period from January 1 to May 31, 2016, a cross-sectional study was conducted on which all patients (N = 806) seeking inpatient treatment were enrolled. A structured diagnostic interview and rapid tests were conducted initially, and diagnoses were confirmed by tests conducted at a venereal disease research laboratory (VDRL). Results HIV and syphilis rates were 5.86% and 21.9%, respectively. Women were nearly 2.5 times more likely to have syphilis. HIV infection was associated with unprotected sex (odds ratio [OR]: 3.27, p = 0.003, 95% confidence interval [95%CI]: 1.51-7.11), and suicidal ideation (OR: 6.63, p = 0.001, 95%CI: 3.37-14.0). Although only 1.86% reported injecting drugs at any point during their lifetimes, this variable was associated with both HIV and syphilis. Elevated rates of HIV and syphilis were observed in the context of this severe social vulnerability scenario. Conclusion The risk factors identified as associated with HIV and syphilis should be taken into consideration for implementation of specific prevention strategies including early diagnosis and treatment of sexually transmitted infections (STI) to tackle the rapid spread of STIs in this population.

摘要 本研究针对巴西最大的专科戒毒中心的人类免疫缺陷病毒（HIV）与梅毒（syphilis）流行现状展开描述。当前面临的重大挑战在于，需探寻可降低不平等与歧视影响的策略，并制定政策以保护已感染或面临感染风险的人群。
方法 本研究于2016年1月1日至5月31日期间开展一项横断面研究，纳入所有寻求住院治疗的患者（N=806）。研究初期采用结构化诊断访谈与快速检测手段，并通过性病研究实验室（VDRL）检测结果确认诊断。
结果 HIV与梅毒的感染率分别为5.86%与21.9%。女性感染梅毒的风险约为男性的2.5倍。HIV感染与无保护性行为（比值比[OR]=3.27，p=0.003，95%置信区间[95%CI]=1.51~7.11）及自杀意念（比值比[OR]=6.63，p=0.001，95%置信区间[95%CI]=3.37~14.0）显著相关。尽管仅有1.86%的受访者报告曾在人生中注射过毒品，但该因素与HIV及梅毒感染均存在关联。在本次研究涉及的严重社会脆弱性场景中，HIV与梅毒的感染率处于较高水平。
结论 本研究识别出的与HIV及梅毒感染相关的风险因素，应被纳入针对性预防策略的制定考量，包括及早诊断与治疗性传播感染（STI），以遏制该人群中性传播感染的快速蔓延。