Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 2 - Apr/Jun - 2019

Original Article Imprimir 

Páginas 72 a 81


Profile of adolescents and young adults with HIV/AIDS in the Brazilian northeast region between the years 2004 and 2016

Perfil de adolescentes y adultos jóvenes con VIH/SIDA en la región noreste de Brasil entre 2004 y 2016

Perfil de adolescentes e jovens adultos portadores de HIV/AIDS na regiao nordeste brasileira entre os anos de 2004 e 2016

Autores: David de Alencar Correia Maia1; Izolda Souza Costa2; Hatus da Silva Almeida3; Deyvison de Lacerda Lopes4; Sueli de Souza Costa5

1. Doctorate in Dentistry Sciences by the Sao Leopoldo Mandic College (SLMANDIC). Master in Psychology by the Fortaleza University (UNIFOR). Teacher by the Universitary Center of Fametro (UNIFAMETRO). Fortaleza, CE, Brazil
2. Mastering in Health and Environment by the Federal University of Maranhao (UFMA). Sao Luís, MA, Brazil
3. Graduating in Medicine by the Federal University of Maranhao (UFMA). Sao Luís, MA, Brazil
4. Graduating in Medicine by the Federal University of Maranhao (UFMA). Sao Luís, MA, Brazil
5. Doctorate in Dentistry Sciences by the Sao Leopoldo Mandic College (SLMANDIC). Master in Dentistry by the Cruzeiro do Sul University (UNICSUL). Pinheiro, MA, Brazil

Correspondência:
David de Alencar Correia Maia
Complexo Odontológico FAMETRO
Av. Filomeno Gomes, nº184 - Jacarecanga
Fortaleza, CE, Brasil. CEP: 60010-281
(davidmaia42@gmail.com)

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Keywords: HIV infections; HIV Seroprevalence; Adolescent; Young Adult; Health Vulnerability.
Palabra Clave: Infecciones por HIV; Seroprevalencia de HIV; Adolescente; Adulto Joven; Vulnerabilidad en Salud.
Descritores: Infecçoes por HIV; Soroprevalência de HIV; Adolescente; Adulto Jovem; Vulnerabilidade em Saúde.

Abstract:
OBJECTIVE: Describe the characteristics of HIV/AIDS among adolescents and young adults between the years 2004 and 2016 in the nine states of the Brazilian Northeast Region.
METHODS: This is a time-series study with data available in the SINAN Information System between January 2004 and July 2016.
RESULTS: A total of 6981 new cases were reported in the Region. Most of them have these characteristics: age between 21 and 24 years (70.90%); male gender (60.74%); brown skin color (65.17%); heterosexual behavior (53.56%); with the highest concentration of cases in the State of Pernambuco (23.53%). From 2004 to 2008, there was a growth in the total number of cases, falling in 2009, growing again from 2010, reaching its peak in 2013 (945 new cases), reducing again from 2014. The highest coefficients were observed in the groups with lower school leveals.
CONCLUSION: AIDS among adolescents showed a trend to grow in the last decade, with a higher incidence among heterosexual men, between the ages of 21 and 24, justifying the creation of specific prevention campaigns for adolescents and young adults, aimed at coping with the disease.

Resumen:
OBJETIVO: Describir las características del HIV/SIDA en adolescentes y jóvenes adultos entre los años 2004 y 2016 en los nueve Estados de la Región Noreste brasileña.
MÉTODOS: Se trata de un estudio de serie temporal, con datos disponibles en el Sistema de Información de Agravios de Notificación (SINAN) entre enero de 2004 y julio de 2016.
RESULTADOS: En el periodo, fueron notificados un total de 6981 nuevos casos en la Región. La mayoría tiene como características: edad entre 21 y 24 años (70,90%); género masculino (60,74%); raza parda (65,17%); comportamiento heterosexual (53,56%); con mayor concentración de casos en el Estado de Pernambuco (23,53%). De 2004 a 2008, se observa un crecimiento del número total de casos, cayendo en 2009, volviendo a crecer a partir de 2010, llegando a su tope en 2013 (945 nuevos casos), reduciendo nuevamente a partir de 2014. Los mayores coeficientes de incidencia fueron observados en los grupos con menor escolaridad.
CONCLUSION: El SIDA en adolescentes presentó tendencia de crecimiento en la última década, habiendo mayor incidencia entre los hombres en la franja etaria entre 21 y 24 años, heterosexuales, lo que justifica la creación de campañas de prevención específicas para la población adolescente y adulta joven, con miras al enfrentamiento de la enfermedad.

Resumo:
OBJETIVO: Descrever as características do HIV/AIDS em adolescentes e jovens adultos entre os anos de 2004 e 2016 nos nove Estados da Regiao Nordeste brasileiro.
MÉTODOS: Trata-se de um estudo de série temporal, com dados disponíveis no Sistema de Informaçao de Agravos de Notificaçao (SINAN) entre janeiro de 2004 e julho de 2016.
RESULTADOS: No período, foram notificados um total de 6981 novos casos na Regiao. A maioria tem como características: idade entre 21 e 24 anos (70,90%); gênero masculino (60,74%); raça parda (65,17%); comportamento heterossexual (53,56%); com maior concentraçao de casos no Estado de Pernambuco (23,53%). De 2004 a 2008, observa-se um crescimento do número total de casos, caindo em 2009, voltando a crescer a partir de 2010, chegando ao seu pico em 2013 (945 novos casos), reduzindo novamente a partir de 2014. Os maiores coeficientes de incidência foram observados nos grupos com menor escolaridade.
CONCLUSAO: A AIDS em adolescentes apresentou tendência de crescimento na última década, havendo maior incidência entre os homens, na faixa etária entre 21 e 24 anos, heterossexuais, o que justifica a criaçao de campanhas de prevençao específicas para a populaçao adolescente e adulta jovem, visando o enfrentamento da doença.

INTRODUCTION

In the 80's there was the emergence of a new disease that was initially identified as a syndrome and later recognized as a clinical entity of viral etiology, called Acquired Immunodeficiency Syndrome (AIDS). Between 1980 and 1985 the first cases of the disease appeared in the USA, Haiti and Central Africa, and in Brazil the first case was discovered in 1980. That same year the knowledge of the possible factor of transmission through sexual contact, drug use was reinforced. or exposure to blood and derivatives. The first reported cases of AIDS in Brazil arose in so-called risk groups, which included male homosexuals, injecting drug users and prostitutes1.

However, the evolution of the epidemic has revealed the ability to reach all people who adopt risky behaviors, such as having unprotected sex or sharing syringes2. This syndrome has been responsible for significant changes in the health field and in other areas by involving health and behavioral aspects. And, despite having brought challenges to the scientific area and giving greater visibility to issues related to sexuality, prevention through campaigns and alertness to health problems has been a measure of importance for Public Health, ensuring the quality of life of women. population3.

Epidemiological developments have allowed the disease to be directed not only to isolated groups (homosexuals, prostitutes, and injecting drug users), but to society as a whole. This targeting showed the growth of Human Immunodeficiency Virus (HIV) infection in women of childbearing age. Even so, there was no change in stigma in relation to the disease2. The concept of risk or risk behavior has been disused and is now replaced by social vulnerability, where structural factors led to the advance of the epidemic, such as material conditions of existence, sexuality, citizenship, race/color, among others, requiring policies and/or actions to combat HIV/AIDS from a social and not merely sanitary perspective2,4. In addition, the naturalization of HIV/AIDS infection as a drug-controllable disease, belief in the impossibility of HIV transmission related to undetectable viral load, feeling of invincibility that arises with the time of living between the couple, and its influence on maintaining Safe sex are factors of vulnerability that contribute to the increase in the number of cases5-6.

Today HIV/AIDS affects several groups, regardless of gender, gender or sexual option and in recent years has increased the number among adolescents and young adults6. The Health Sciences Descriptors (DECs)7 classify as adolescents the individual who is between 13 and 18 years old, and a young adult would be between 19-24 years old. However, the World Health Organization8 (WHO) considers adolescence the period from 10 to 19 years, distinguishing between the initial adolescence of 10 to 14 years and the final adolescence between 15 to 25 years. The concern about the final adolescent age group described by the WHO8 arises from the fact that vulnerability is greater because it is a stage in life where social, psychological and physical conflicts are common, and where there is a discovery of pleasure9. Therefore, health education actions are needed to guide the risks of contamination of sexually transmitted diseases (STD) in general and of AIDS6,10. This phase has many biological, cognitive, emotional and social changes, being the moment when "new practices and behaviors, gain of autonomy, exposure to various situations and risks that can lead them to be contaminated" are adopted10.

In addition, there has been an annual increase in the number of young people infected with HIV/AIDS, which is due to the vulnerability of adolescents who become sexually active before 15 years of age11. A survey conducted by the Ministry of Health on the population's sexual behavior in 2008 confirms this information, where data show that among Brazilians aged 16-24 years, 36.9% had sex before the age of 15 and between females, the percentage was 17%12.

The onset of early sexual life is associated with a high incidence of sexually transmitted diseases (STD), considered as one of the most frequent health problems6,13-14. In Brazil, every year, a contingent of 4 million young people become sexually active, where the median age of first sexual intercourse is 14 years for men, and 15 years for women, and early onset of sexual life. It can be considered an aggravating factor for risky behavior in the face of HIV/AIDS, and unprotected sex is also an aggravating factor for teenage pregnancy6,10,14.

The factors that have contributed to increase the incidence of sexual intercourse among adolescents are multiple and complex and it is difficult to assess the importance of each one14. But consequences of the low age of the female menarche can be observed in the rejuvenation of the reproductive process in Brazil, whose fertility rate among young women has increased from 17% to 23% in the last 10 years15 and in the feminization of AIDS, most intense between 13 and 19 years, where there has already been a reversal of the proportion of cases between males and females16.

This vulnerability of the group included in the final adolescence makes this study relevant in describing the incidence of HIV/AIDS in these age groups, alerting for greater care and attention of education and specific health programs for these groups.

More than half of the new HIV infections that occur today affect the population aged 15-24. However, the needs of millions of young people around the world remain systematically unmet when developing HIV/AIDS strategies or policies. It is estimated that 11.8 million 15- to 24-year-olds now live with HIV/AIDS worldwide. Each day, about 6,000 young people in this age group become infected with HIV11. Of the 4,500 new HIV infections in 2016, 35% occurred among 15- to 24-year-olds, and one in ten sexually active people annually get one STD17.

The total number of AIDS cases in young people aged 15 to 24, from 1982 to June 2011, corresponds to 66,698. In 2010, the region with the highest incidence rate was the South (14.3 cases per 100,000 inhabitants), followed by the North (12.8), Southeast (9.2), Midwest (7, 9) and Northeast (6.9). The sex ratio in young people aged 15-24, currently at 1.4, that is, for every 14 men with HIV/AIDS, there are 10 women in the same situation18.

Considering the official data on the clinical and epidemiological characteristics of adolescents between 15 and 24 years old with HIV/AIDS in the Northeast Region, between 2004 and June 2016, it is important to analyze this context in order to describe the profile of the contaminated population in this age group. Thus, it is possible to suggest the creation of public policies for prevention and treatment in order to guide new research and guide health professionals interested in the subject.


OBJECTIVE

Describe the profile of the adolescent population with HIV/AIDS in the Northeast, between 2004 and 2016.


METHODS

To characterize the profile of adolescents aged 15 to 24 years with AIDS/HIV in Northeast Brazil, the cross-sectional, analytical, descriptive and exploratory method was used.

Data collection was performed at the SINAN (Notification Disease Information System), SISCEL (Laboratory Test Control System of the National CD4+/CD8 and Viral Load Lymphocyte Count Network) and SIM (Mortality Information System), made available by the Department of Informatics of the Unified Health System (DATASUS), at the electronic address (http://www.datasus.gov.br), considering the period from 01/01/2004 to 06/30/2016. This database is open to the public.

We considered and studied the cases of HIV/AIDS reported in the system, by year of diagnosis, from January 1, 2004 to June 30, 2016 (last available period).

The population chosen for the present study consisted of adolescents aged 15 to 24 years with HIV/AIDS, notified by the SINAN, SIM, SISCEL systems. All 6,981 cases notified by the system in the period were studied, this number corresponded to 100%, in this age group in the Brazilian Northeast.

The variables addressed in this study were as follows: age, gender, education (years of schooling), sexual choice and race. The data of these variables were collected by state and always crossed with the age group divided into: from 15 to 20 years old and from 21 to 24 years old.

A connection has been established between the SINAN, SISCEL and SIM databases. Data were presented in tables and graphs. Data were entered in an Excel spreadsheet where the initial compilation was performed. Results were analyzed using frequency distribution tables and graphs in Excel 2007. Analyzes were performed using the SAS program (SAS Institute Inc., Cary, NC, USA, Release 9.2, 2010.). The process adopted in the data analysis involved measures based on the incidence coefficient according to gender, age, education, race and sexual choice. The incidence coefficients were measured by excellence of risk and disease aggravation in these groups.

This study is in accordance with the norms of Resolution 466/12 of the National Health Council, and does not require the opinion of the Research Ethics Committee, as it uses a database open to the public.


RESULTS

Most of the adolescents notified with HIV/AIDS in the Northeast region in the period analyzed are between 21 and 24 years old (70.90%), are male (60.74%) and mixed race (65.17%). A high number of people (23.32%) did not report their level of education, but most of those who reported (32.95%) had not completed elementary education, and the minority were at the extremes (illiterate, 2.25%; or higher complete, 2.87%).

Regarding the year of notification, there is a higher number of cases in males throughout the surveyed period (Figure 1). Among these, the 21-24 age group prevails, with a higher incidence in the brown race and with incomplete primary education (Figure 2).


Figure 1. Number of reported cases of HIV/AIDS in the Northeast of Brazil in adolescents aged 15-24 years, according to year and gender.


Figure 2. Number of reported cases of HIV/AIDS in the Northeast of Brazil in adolescents aged 15 to 24, according to year and level of education.



Due to the Hierarchical Exposure Category, 16.28% of the cases surveyed do not contain information on the exposure category to HIV/AIDS, representing a total of 1,137 notifications (Table 1). Among those with information, there is a higher incidence in heterosexual individuals, according to reports every year.




Concerning the Brazilian state of the Northeast, Pernambuco presented the highest number of reported cases in the analyzed period (23.53%), followed by Bahia (18.94%), Ceará (17.64%) and Maranhao (11.58%), with the lowest number occurring in Sergipe (4.55%) (Table 2). When analyzing by gender, the same states rank in the same position in the ranking of notifications, and eight of the nine northeastern states presented the predominance of males, except for Bahia (Figure 3).




Figure 3. Number of reported cases of HIV/AIDS in the Northeast of Brazil in adolescents aged 15 to 24, according to the notified State, from January 2004 to June 2016.



DISCUSSION

The results obtained in the research show that the incidence of HIV in adolescents aged 15 to 24 years in the studied period has reduced. In Brazil, according to data from UNAIDS17, "from 2006 to 2015, the detection rate of AIDS cases among young men aged 15-19 almost tripled (from 2.4 to 6.9 cases per 100.000 inhabitants) and among young people aged 20-24, the rate has more than doubled (from 15.9 to 33.1 cases per 100,000 inhabitants)"17. The survey showed 95.02 cases per 100,000 inhabitants in this geographical region, whose population of young people between 15 and 24 years old is 7,346,838 inhabitants, according to the IBGE19.

The Ministry of Health20 provides epidemic data by geographic region and the latest publication in 2016 shows that from 2001 to 2011, the incidence rate fell in the Southeast from 23 to 21 cases per 100,000 inhabitants. In other regions, this incidence rate increased: 27 to 31 in the South; 9 to 20 in the North; 14 to 17 in the Midwest; and 7 to 14 in the Northeast20. However, when analyzing the data observed in the present research, it is noted that the cases in the Northeast decreased, and that, when analyzed year by year, there is an oscillation: there was a small increase in the number of cases between 2004 and 2005; in 2006 it decreased and increased again year by year until 2013; but in 2014 there was a significant drop from 945 cases in 2013 to 416 in 2014.

The results of this research pointed to the prevalence of HIV/AIDS in males, aged 15 to 24 years. However, for the Ministry of Health20, this difference has been decreasing over the years in the Brazilian context. However, in the Northeast region, this research shows a small difference in the number of cases by gender between the years 2004 to 2009. But, from 2010 to 2014, the ratio between the number of cases in males and females increased: 2004, the ratio was 1.01 cases from the first to the second; in 2016 it reached 1.54 cases in males for every 1 in females. Despite this, the case ratio between the male and female population remains stable, following national data20.

Regarding the age group affected by HIV/AIDS, every 14 seconds, a young person between 15 and 24 years old is infected with HIV/AIDS. And of all new infections, about half occur in this age group10-14. Worldwide, more than 7,000 young people are infected with HIV/AIDS daily, totaling 2.6 million per year17. In Brazil, data from the Ministry of Health20 indicate that there were 12,046 cases of HIV/AIDS among young people aged 10-19 years since the epidemic began in the 1980s until 2012, representing 1.8% of the cases reported in the country. In our research, there was a higher incidence in young people aged 21 to 24 years (70.90%). This result is relative to the notifications that occur in an older age group, but the contamination occurs in an earlier period, with a significant increase of cases in the 10 to 14 and 15 to 19 years old groups. It should be considered that the infections that motivated the reported cases in early adulthood (between 20 and 24 years) most likely occurred during adolescence10,12.

One of the reasons for HIV/AIDS infection is the lack of access to information, and the lower the level of education, the lower the percentage of knowledge of ways to prevent and transmit HIV4,6,10,12,15. In the data collected in the present research, there is an increase in the proportion of disease in the less educated population and a decrease in the more educated levels of education. This fact leads to a reflection on prevention strategies and educational campaigns, which should be clear and adapted to the level of understanding of people with less formal education, and understanding about the vulnerabilities of young Brazilians and their social determinants is fundamental. for strengthening public programs and policies6.

Regarding the form of transmission, the Ministry of Health20 recorded, in 2012, a percentage of 86.8% of cases (all age groups) due to heterosexual relationships. Our research corroborates the national data where the majority who reported the sexual option declared heterosexual (3,739 individuals or 53.56%) in all analyzed years, and in 2012 336 cases were reported in adolescents aged 15 to 24 years. , which is equivalent to 37% of the cases reported that year in this age group.

The predominance of heterosexual cases found in this study can be attributed to several factors, such as difficulty in negotiating between partners for the adoption of preventive measures; doubts about condom effectiveness and use; lack of knowledge about transmission routes; full trust in the partner; taboo on immunity, in addition to the absence of strategies to prevent the risk of infection with HIV/AIDS2,10,12,14,15.

When analyzing by State (Figure 3), Pernambuco presents the highest number of reported cases among the population and period surveyed, which corroborates with other data indicating that the highest incidence of HIV/AIDS in the Northeast is in coastal cities, due to greater tourism and sexual exploitation in this region18.


CONCLUSION

The incidence of HIV/AIDS among adolescents aged 15 to 24 years in the Northeast of Brazil from 2004 to 2016 has increased until 2013, with divergent behavior between sexes from that year, having declined in females and growing slightly total by 2015.

More than three decades after the onset of the HIV/AIDS epidemic, it is possible to observe a significant change in the epidemiological characteristics of the disease and the affected populations, denoting the fall of the precepts that called specific groups as the most predisposing to HIV infection and AIDS development. According to the research, it is possible to observe more directly this change in adolescents, where heterosexualization is a striking feature.

With the onset of increasingly early sexual activity, the chances of contracting HIV/AIDS increase. Thus, it is necessary to plan and execute actions aimed at reducing the new contagions, as well as measures that seek to improve the rates of early detection of cases, since the adolescent population does not recognize themselves as vulnerable, even after unprotected sex. In addition, the data collected in this research emphasize the importance of establishing HIV/AIDS prevention and care programs for young people in the Northeast.

It is necessary to understand the importance of raising and consolidating indicators in order to support effective policies and practices for prevention and control of the main exposure factors, thus contributing to a change in the epidemiological picture of HIV/AIDS in adolescence.


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