INTRODUCTION: Sex workers (SW) clients represent a bridge population for HIV transmission from high risk to low risk general population. MATERIALS AND METHODS: A cross-sectional anonymous telephone survey was carried out at the AIDS and Sexually Transmitted Infections Helpline of National Institute of Health in Italy. The questionnaire was proposed on a voluntary basis to a sample of 119 subjects from helpline users. RESULTS: The 119 participants were all males, aged between 19 and 59 years and mostly accessed female prostitutes. Vaginal intercourses with SW were more frequently reported, followed by passive oral, active oral sex and active anal intercourses. Cumulatively, 86.6% and 84.6% of vaginal and anal intercourses were respectively reported as regularly protected by condom. DISCUSSION: The telephone interview allowed an eased access, a high response rate and a standardised evaluation of questions CONCLUSIONS: It is necessary a constant monitoring of the characteristics, behaviour, risk perception and testing of SW clients in Italian and other populations.

O objetivo deste estudo foi analisar os óbitos de menores de cinco anos por doenças evitáveis ocorridos em 2008 no município de Maringá, PR. Estudo quantitativo, descritivo, com 41 óbitos. Como instrumento norteador de coleta de dados, utilizou-se o formulário de investigação do Comitê de Prevenção do Óbito Infantil e Fetal. Dos 41 casos encontrados, 65,9% representaram óbitos neonatais, 24,4% pós-neonatais e 9,7%, de criança com mais de um ano; destes, 90,2% óbitos foram considerados evitáveis, sendo 64,9% neonatais, 27,0% pós-neonatais e 8,1% na idade acima de um ano. Quanto às medidas de evitabilidade, percebeu-se que as atividades de prevenção foram as mais encontradas entre as possibilidades de redução do óbito, com 59,5%, seguidas de ações de diagnóstico e tratamento precisos, com 35,1%. Conclui-se que a maioria dos óbitos evitáveis tem relação direta com a assistência à gestante no pré-natal e no parto, demonstrando a necessidade de instituir uma prática efetiva e de qualidade.

Analyze the deaths in children under five years old, from preventable diseases have occurred in 2008 in Maringá, PR. Quantitative and descriptive study, with 41 deaths. As a guiding instrument for data collection, we used the form of research of the Committee on the Prevention of Infant and Fetal Death. From the 41 cases found, neonatal deaths accounted for 65.9%, 24.4% post-neonatal deaths and 9.7% above a year, 90.2% of these deaths were considered preventable, being 64.9% neonatal, 27.0 % post-neonatal and 8.1% newborn after one year old. For measures of preventability, it was realized that prevention activities were found more often among the possibilities for reducing death, with 59.5%, followed by actions of accurate diagnosis and treatment with 35.1%. It was concluded that the majority of preventable deaths has direct relationship with the care of pregnant women in prenatal and childbirth, demonstrating the need to establish an effective practice and quality.

Analizar las muertes de niños menores de cinco años por enfermedades evitables ocurridas en 2008 en Maringá, PR. Investigación cuantitativa, descriptiva, con 41 óbitos. Como instrumento de orientación para la recolección de datos, se utilizó el formulario de investigación de la Comisión de la Prevención de la Mortalidad Infantil y Fetal. De los 41 casos encontrados, un 65,9% representaron óbitos neonatales, 24,4% post-neonatales y 9,7% por encima de un año; de estos 90,2% de las muertes fueron consideradas evitables, siendo un 64,9% neonatales, 27,0% post-neonatales y 8,1% en la edad por encima de un año. Cuanto a las medidas de prevención, se observó que las actividades de prevención se han encontrado con mayor frecuencia entre las posibilidades de reducción de la muerte, dejando a un 59,5%, seguido por las acciones de diagnóstico y tratamiento, con un 35,1%. Conclusión: la mayoría de las muertes evitables tiene relación directa con el cuidado de las mujeres embarazadas en control prenatal y el momento del parto, lo que demuestra necesidad de establecer una práctica efectiva y de calidad.

Analyze the deaths in children under five years old, from preventable diseases have occurred in 2008 in Maringá, PR. Quantitative and descriptive study, with 41 deaths. As a guiding instrument for data collection, we used the form of research of the Committee on the Prevention of Infant and Fetal Death. From the 41 cases found, neonatal deaths accounted for 65.9%, 24.4% post-neonatal deaths and 9.7% above a year, 90.2% of these deaths were considered preventable, being 64.9% neonatal, 27.0 % post-neonatal and 8.1% newborn after one year old. For measures of preventability, it was realized that prevention activities were found more often among the possibilities for reducing death, with 59.5%, followed by actions of accurate diagnosis and treatment with 35.1%. It was concluded that the majority of preventable deaths has direct relationship with the care of pregnant women in prenatal and childbirth, demonstrating the need to establish an effective practice and quality.

Analizar las muertes de niños menores de cinco años por enfermedades evitables ocurridas en 2008 en Maringá, PR. Investigación cuantitativa, descriptiva, con 41 óbitos. Como instrumento de orientación para la recolección de datos, se utilizó el formulario de investigación de la Comisión de la Prevención de la Mortalidad Infantil y Fetal. De los 41 casos encontrados, un 65,9% representaron óbitos neonatales, 24,4% post-neonatales y 9,7% por encima de un año; de estos 90,2% de las muertes fueron consideradas evitables, siendo un 64,9% neonatales, 27,0% post-neonatales y 8,1% en la edad por encima de un año. Cuanto a las medidas de prevención, se observó que las actividades de prevención se han encontrado con mayor frecuencia entre las posibilidades de reducción de la muerte, dejando a un 59,5%, seguido por las acciones de diagnóstico y tratamiento, con un 35,1%. Conclusión: la mayoría de las muertes evitables tiene relación directa con el cuidado de las mujeres embarazadas en control prenatal y el momento del parto, lo que demuestra necesidad de establecer una práctica efectiva y de calidad.

O objetivo deste estudo foi analisar os óbitos de menores de cinco anos por doenças evitáveis ocorridos em 2008 no município de Maringá, PR. Estudo quantitativo, descritivo, com 41 óbitos. Como instrumento norteador de coleta de dados, utilizou-se o formulário de investigação do Comitê de Prevenção do Óbito Infantil e Fetal. Dos 41 casos encontrados, 65,9% representaram óbitos neonatais, 24,4% pós-neonatais e 9,7%, de criança com mais de um ano; destes, 90,2% óbitos foram considerados evitáveis, sendo 64,9% neonatais, 27,0% pós-neonatais e 8,1% na idade acima de um ano. Quanto às medidas de evitabilidade, percebeu-se que as atividades de prevenção foram as mais encontradas entre as possibilidades de redução do óbito, com 59,5%, seguidas de ações de diagnóstico e tratamento precisos, com 35,1%. Conclui-se que a maioria dos óbitos evitáveis tem relação direta com a assistência à gestante no pré-natal e no parto, demonstrando a necessidade de instituir uma prática efetiva e de qualidade.

BACKGROUND: Clients of sex workers represent a relevant target for interventions aimed at the prevention of HIV and sexually transmitted infections (STIs). Within prevention strategies, the AIDS and sexually transmitted infections helpline (Telefono Verde AIDS/ IST, TVA-IST) of National Institute of Health in Italy has provided, since 1987, specific information and counselling interventions. AIM: The present study reports data on anagraphical characteristics and behaviours of clients of sex workers, anonymously reported at TVA-IST in the period 1987-2010. DISCUSSION: Among 95 149 phone calls (14% of the total) considered 99.5% came from males, over 80% aged under 37 years and prevalently from Northern Italy. Among sexual behaviours, unprotected sexual intercourses were reported in the 26% of the calls. Subjects under 27 years reported a higher frequency of unprotected anal intercourse, while they used protection with oral and vaginal intercourses in a greater extent than older ones. Due to differential behaviours within clients of sex workers, specific informative strategies for this targeted population should adequately consider age-related differences.

INTRODUCTION: In the last 10 years migration processes have progressively increased worldwide and in Italy about 5 millions of residing migrants are estimated. To meet health needs of these new residents, effective relational and communication tools, which allow a reciprocal intercultural interaction within health care structures, are therefore necessary. AIM: This article faces the main features of the relational-communication processes associated with health promotion and care in the migrant population in Italy to the aim of identifying the key and critical points within the interaction between different cultures, focusing on the role of specific professional figures, including cultural mediators and health educators. RESULTS: Within the activity of HIV phone counselling operated by Psyco-socio-behavioural, Communication and Training Operating Unit of National Institute of Health in Italy, an intercultural approach was successfully experienced in a project targeted to migrants (2007-2008). Specifically, the presence of cultural mediators answering in the languages of main migrants' groups allowed the increase of calls from migrant people and of the information provided.

In 2006 we conducted a cross-sectional study involving hospital clinical centres in five Italian cities to compare the sexual behaviour of HIV-positive MSM (men who have sex with men) before and after the diagnosis of HIV infection. Each centre was asked to enrol 30 HIV-positive persons aged > 18 years. The questionnaire was administered to 143 MSM on average 9 years after HIV diagnosis. After diagnosis there was a decrease in the number of sexual partners: the percentage of persons who reported having had more than 2 partners decreased from 95.8% before diagnosis to 76.2% after diagnosis. After diagnosis, there was a significant decrease in the percentage of persons who had never (or not always) used a condom with their stable partner for anal sex from 69.2% before diagnosis to 26.6% after diagnosis and for oral-genital sex from 74.8% before diagnosis to 51.7% after diagnosis. Though at-risk behaviour seems to decrease after diagnosis, seropositive MSM continue to engage in at-risk practices: one fourth of them did not use a condom during sexually transmitted infections (STI) episodes, 12.5% of the participants had had sex for money, and 8.4% had paid for sex. The study shows that our sample of Italian HIV-positive MSM, though aware of being infected, engage in sexual behaviours that could sustain transmission of HIV and other STIs. The results could constitute the first step in implementing national prevention programs for persons living with HIV.

Nel 2006 abbiamo condotto uno studio trasversale in 5 centri clinici ospedalieri di cinque città italiane per confrontare negli uomini HIV positivi che avevano avuto rapporti sessuali con altri uomini, il comportamento sessuale prima e dopo la diagnosi di infezione da HIV. Ogni centro clinico ha reclutato 30 maschi omosessuali HIV positivi di età > 18 anni. Il questionario, appositamente preparato per questo studio, è stato somministrato a 143 uomini HIV positivi in media 9 anni dopo la diagnosi di HIV. Allo studio hanno partecipato143 uomini. Dopo la diagnosi di HIV è stata evidenziata una diminuzione del numero di partner sessuali: la percentuale di uomini che avevano più di 2 partner è passata dal 95,8% prima della diagnosi al 76,2% dopo la diagnosi. Dopo la diagnosi di HIV tra le persone con relazioni stabili è diminuita la percentuale di persone che non usavano il preservativo nei rapporti anali dal 69,2% prima della diagnosi al 26,6% dopo la diagnosi e nei rapporti oro-genitali dal 74,8% al 51,7%. Un quarto dei partecipanti ha dichiarato di non aver usato il condom con una infezione sessualmente trasmessa (IST) in atto, il 12,5% aveva avuto rapporti sessuali in cambio di soldi e l'8,4% aveva pagato per avere rapporti sessuali. Questo studio mostra che il nostro campione di omosessuali HIV-positivi, anche se consapevole di essere infetto, ancora pratica comportamenti sessuali a rischio che potrebbero trasmettere l'infezione da HIV e altre IST. I risultati di questo studio potrebbero costituire un primo passo nella realizzazione dei programmi nazionali di prevenzione per le persone affette da HIV.

This work aims to delineate the long journey of health communication, from the beginning to the present, stressing how the concept of health service and human health have been evolving together with the kind of political approach to the problem. First, the approach was mainly repressive and based on the surveillance of territory, so that jurisdiction in health matters was centralized and entrusted to the Ministry of Interior. Consequently, communication had little space and was directed to an elite group of insiders, who were able to cope with any public health emergencies, using a very technical and essential language, confusing for most people. In the course of the years, we understood that the reaching of the objective health could be realized with the involvement of citizens, organized groups, public and private institutions. Therefore, it is necessary to ensure citizens the right to receive a clear and correct information, enabling them to be self responsible and better manage their health, in a more and more personalized way, using an authoritative but confidential language and all the modern media.

Questo lavoro intende delineare il lungo cammino della comunicazione sulla sanità e sulla salute, dagli esordi ad oggi, sottolineando come il concetto di salute sia andato evolvendosi di pari passo con il tipo di approccio politico al problema. Dapprima, l'orientamento era soprattutto repressivo e di vigilanza, tanto che la materia sanitaria era affidata al Ministero dell'Interno. Di conseguenza, la comunicazione era ridotta al minimo e rivolta agli addetti che potevano fronteggiare eventuali emergenze sanitarie, utilizzando un linguaggio tecnico e scarno. Solo nel corso degli anni, si è compreso come il raggiungimento dell'obiettivo salute si realizzi con il coinvolgimento diretto dei cittadini e debba fondarsi sull'integrazione tra gruppi, persone, istituzioni pubbliche e private. Pertanto, è necessario assicurare alla popolazione una corretta e chiara informazione che consenta alla persona di migliorare la gestione della propria salute, in modo consapevole e responsabile, usando un linguaggio autorevole e confidenziale, utilizzando tutti i moderni mezzi di comunicazione sociale.

In the present work, we outline basic health counselling skills, specifically, those for performing pre-test and post-test counselling for HIV infection. The ultimate goal is to propose that counselling be performed in facilities that carry out screening for anti-HIV antibodies, following standardised (and thus replicable) criteria, with consistent focus on the quality of the relationship between the healthcare professional and the individual undergoing testing and on the individual's specific needs.

Il presente lavoro intende delineare gli aspetti peculiari dell'applicazione delle competenze di base del counselling in ambito sanitario, con particolare riferimento all' intervento effettuato nel pre e post test HIV La finalità principale è quella di proporre l'applicazione dell'intervento di counselling nei Servizi dove si effettua lo screening per la ricerca degli anticorpi anti-HIV, secondo criteri standardizzati e, pertanto, replicabili, mantenendo costantemente l'attenzione alla qualità della relazione e alle specifiche esigenze del singolo individuo.