Resumo OBJETIVO: analisar a circulação dos vírus respiratórios em residentes na região metropolitana de Belo Horizonte, Brasil, hospitalizados em Belo Horizonte, de 2011 a 2013. MÉTODOS: estudo descritivo de 5.158 indivíduos com síndrome respiratória aguda grave; foram comparadas as características dos casos confirmados com casos descartados ou sem coleta de swab. RESULTADOS: metade dos vírus isolados foi da influenza A, especialmente os subtipos A(H1N1)pdm09 em pessoas de 20-59 anos e A(H3N2) naquelas com 60 anos ou mais; crianças menores de cinco anos tiveram identificado, com maior frequência, o vírus sincicial respiratório (65,6%), seguido pelo vírus da influenza A (21,2%); o vírus da influenza circulou em todas as estações do ano, e seus períodos de maior incidência intercalaram-se com os de maior atividade do vírus sincicial respiratório. CONCLUSÃO: o monitoramento dos vírus respiratórios contribui para o conhecimento dos períodos de circulação viral e a adoção de medidas de controle específicas.

Abstract OBJECTIVE: to analyze the circulation of respiratory viruses in people living in the metropolitan area of Belo Horizonte, Brazil, and hospitalized in Belo Horizonte from 2011 to 2013. METHODS: this is a descriptive study of 5,158 patients with Severe Acute Respiratory Syndrome; a comparison was made between the characteristics of confirmed cases and those of discarded cases or cases without swab samples. RESULTS: Influenza A virus accounted for half the isolated viruses, especially subtype A(H1N1)pdm09 among patients aged 20-59 years old, and subtype A(H3N2) in those aged 60 or over; the most frequently identified respiratory virus among children under five years old was respiratory syncytial virus (65.6%), followed by influenza A virus (21.2%); influenza virus circulated in all seasons of the year and its periods of greatest incidence were interspersed with those of higher Respiratory Syncytial Virus activity. CONCLUSION: monitoring respiratory viruses contributes to knowledge about periods of virus circulation and the adoption of specific control measures.

Resumen OBJETIVOS: analizar la circulación de virus respiratorios en residentes de la región metropolitana de Belo Horizonte, Brasil, hospitalizados entre 2011 y 2013. MÉTODOS: estudio descriptivo de 5.158 individuos con infección respiratoria aguda grave; fueron comparadas las características de los casos confirmados con los descartados o sin colecta de swab. RESULTADOS: la mitad de los virus aislados fueron influenza A, especialmente subtipos A(H1N1)pdm09 en personas entre 20-59 años, y A(H3N2) en personas de 60 años o más; los niños menores de cinco años presentaron, con mayor frecuencia, el virus sincicial respiratorio (65,6%), seguido por influenza tipo A (21,2%); el virus de la Influenza circuló en todas las estaciones y los periodos de mayor incidencia se intercalaron con los de mayor actividad del virus sincicial. CONCLUSIÓN: el monitoriamente del virus respiratorio contribuyo para el conocimiento de los periodos de circulación viral y la adopción de medidas de control específicas.

Resumo OBJETIVO: analisar a circulação dos vírus respiratórios em residentes na região metropolitana de Belo Horizonte, Brasil, hospitalizados em Belo Horizonte, de 2011 a 2013. MÉTODOS: estudo descritivo de 5.158 indivíduos com síndrome respiratória aguda grave; foram comparadas as características dos casos confirmados com casos descartados ou sem coleta de swab. RESULTADOS: metade dos vírus isolados foi da influenza A, especialmente os subtipos A(H1N1)pdm09 em pessoas de 20-59 anos e A(H3N2) naquelas com 60 anos ou mais; crianças menores de cinco anos tiveram identificado, com maior frequência, o vírus sincicial respiratório (65,6%), seguido pelo vírus da influenza A (21,2%); o vírus da influenza circulou em todas as estações do ano, e seus períodos de maior incidência intercalaram-se com os de maior atividade do vírus sincicial respiratório. CONCLUSÃO: o monitoramento dos vírus respiratórios contribui para o conhecimento dos períodos de circulação viral e a adoção de medidas de controle específicas.

Abstract OBJECTIVE: to analyze the circulation of respiratory viruses in people living in the metropolitan area of Belo Horizonte, Brazil, and hospitalized in Belo Horizonte from 2011 to 2013. METHODS: this is a descriptive study of 5,158 patients with Severe Acute Respiratory Syndrome; a comparison was made between the characteristics of confirmed cases and those of discarded cases or cases without swab samples. RESULTS: Influenza A virus accounted for half the isolated viruses, especially subtype A(H1N1)pdm09 among patients aged 20-59 years old, and subtype A(H3N2) in those aged 60 or over; the most frequently identified respiratory virus among children under five years old was respiratory syncytial virus (65.6%), followed by influenza A virus (21.2%); influenza virus circulated in all seasons of the year and its periods of greatest incidence were interspersed with those of higher Respiratory Syncytial Virus activity. CONCLUSION: monitoring respiratory viruses contributes to knowledge about periods of virus circulation and the adoption of specific control measures.

Resumen OBJETIVOS: analizar la circulación de virus respiratorios en residentes de la región metropolitana de Belo Horizonte, Brasil, hospitalizados entre 2011 y 2013. MÉTODOS: estudio descriptivo de 5.158 individuos con infección respiratoria aguda grave; fueron comparadas las características de los casos confirmados con los descartados o sin colecta de swab. RESULTADOS: la mitad de los virus aislados fueron influenza A, especialmente subtipos A(H1N1)pdm09 en personas entre 20-59 años, y A(H3N2) en personas de 60 años o más; los niños menores de cinco años presentaron, con mayor frecuencia, el virus sincicial respiratorio (65,6%), seguido por influenza tipo A (21,2%); el virus de la Influenza circuló en todas las estaciones y los periodos de mayor incidencia se intercalaron con los de mayor actividad del virus sincicial. CONCLUSIÓN: el monitoriamente del virus respiratorio contribuyo para el conocimiento de los periodos de circulación viral y la adopción de medidas de control específicas.

Sexually transmitted diseases are still highly prevalent worldwide and represent an important public health problem. Psychiatric patients are at increased risk of sexually transmitted diseases but there are scarce published studies with representative data of this population. We sought to estimate the prevalence and correlates of self-reported sexually transmitted diseases among patients with mental illnesses under care in a national representative sample in Brazil (n = 2145). More than one quarter of the sample (25.8%) reported a lifetime history of sexually transmitted disease. Multivariate analyses showed that patients with a lifetime sexually transmitted disease history were older, had history of homelessness, used more alcohol and illicit drugs, suffered violence, perceived themselves to be at greater risk for HIV and had high risk sexual behavioral: practised unprotected sex, started sexual life earlier, had more than ten sexual partners, exchanged money and/or drugs for sex and had a partner that refused to use condom. Our findings indicate a high prevalence of self-reported sexually transmitted diseases among psychiatric patients in Brazil, and emphasize the need for implementing sexually transmitted diseases prevention programs in psychiatric settings, including screening, treatment, and behavioral modification interventions.

OBJECTIVE: We conducted a study to identify gender differences in factors associated with the first episode of non-adherence in the 12 months following the first antiretroviral prescription. METHODS: A concurrent prospective study of patients initiating antiretroviral therapy in Brazil was conducted from 2001-2002. The self-reported measurement of adherence was defined as an intake of less than 95% of the prescribed number of doses. Only the first occurrence of non-adherence was considered in this analysis. All analyses were stratified by gender. A Cox proportional hazard model was used to estimate the risk of non-adherence, and the time to non-adherence was estimated using the Kaplan-Meier method. RESULTS: The cumulative incidence of non-adherence was 34.6% (29.7% and 43.9% among men and women, respectively; p=0.010). Marital status (being married or in stable union; p=0.022), alcohol use in the month prior to the baseline interview (p=0.046), and current tobacco use (p=0.005) increased the risk of non-adherence among female participants only, whereas a self-reported difficulty with the antiretroviral treatment was associated with non-adherence in men only. For both men and women, we found that a longer time between the HIV test and first antiretroviral therapy prescription (p=0.028) also presented an increased risk of non-adherence. CONCLUSIONS: In this cohort study, the incidence of non-adherence was 1.5 times greater among women compared to men. Our results reinforce the need to develop interventions that account for gender differences in public referral centers. Additionally, we emphasize that, to achieve and maintain appropriate adherence levels, it is important to understand the barriers to seeking and utilizing health care services.

OBJETIVO: A prevalência do HIV em pacientes psiquiátricos é maior do que na população geral em diversos países. Diversos comportamentos de risco têm sido identificados em estudos em países desenvolvidos e em desenvolvimento. Entretanto, limitações amostrais restringem a generalização dos resultados em sua grande maioria. O objetivo deste trabalho foi apresentar resultados do primeiro estudo representativo de uma amostra nacional de pacientes psiquiátricos sobre a prática do sexo desprotegido e seus fatores associados. MÉTODO: Uma amostra representativa de pacientes adultos com transtornos mentais foi aleatoriamente selecionada de instituições públicas de saúde mental no Brasil. Dados sociodemográficos, comportamentais e clínicos foram obtidos por entrevista face-a-face e sangue foi coletado para exames sorológicos. Foi utilizada regressão logística para análise estatística. RESULTADOS: A prevalência da prática do sexo desprotegido ao longo da vida foi de 80,3%. Pacientes casados/em união, mais velhos e do sexo feminino, aqueles com múltiplos parceiros e morando somente com filhos ou com parceiros e aqueles com condições psiquiátricas menos graves praticaram o sexo desprotegido mais frequentemente. DISCUSSÃO: A avaliação de comportamentos de risco é um instrumento crítico para que profissionais de saúde sejam capazes de determinar as necessidades de cuidados relacionados ao HIV para seus pacientes garantindo o acesso ao tratamento e prevenção. Intervenções que abordam situações de risco na vida dos pacientes psiquiátricos - institucional ou individual - e que contribuam para sua capacidade de tomar decisões informadas sobre sua saúde sexual são urgentemente necessárias.

OBJECTIVE: The prevalence of HIV among psychiatric patients is higher than general population rates worldwide. Many risk behaviors have been identified in studies from both developing and developed countries, though sampling limitations restrict the generalizability of their results. The objective of this study was to report findings from the first national sample of psychiatric patients about lifetime practice of unsafe sex and associated factors. METHOD: A national multicenter sample of adults with mental illness was randomly selected from 26 public mental health institutions throughout Brazil. Sociodemographic, sexual behavior and clinical data were obtained from person-to-person interviews and blood was collected for serology testing. Logistic regression was used for analysis. RESULTS: The overall prevalence of lifetime unprotected sex was 80.3%. Married, older, female patients, those with multiple partners and living with children or partners only and those with less severe psychiatric diagnosis more often practised unsafe sex. DISCUSSION: Risk behavior assessment is a critical tool for clinicians to be able to determine needed HIV-related services for their clients and ensure appropriate follow-through with care and prevention. Interventions that address situational risks in psychiatric patients' lives-institutional and individual- and increase their ability to make informed decisions about their sexual health are urgently needed.

Este artigo objetiva estudar a evolução da mortalidade por causas mal definidas na população com mais de 60 anos, residente em Belo Horizonte, Rio de Janeiro, São Paulo e Porto Alegre, entre 1996 e 2007. Foi analisada a evolução da mortalidade proporcional por causas mal definidas (CMD) no período, a distribuição dessas mortes por grupos etários, segundo códigos do Capítulo XVIII da Classificação Internacional de Doenças - CID-10, e a posição desse grupo de causas no total de óbitos em idosos. Avaliou-se, também, a razão de chances (IC95%) entre os óbitos por CMD e sua ocorrência em hospitais. A evolução da mortalidade proporcional por CMD nas capitais selecionadas, entre 1996 e 2007, indicou uma participação maior de óbitos por CMD em idosos no Rio de Janeiro, onde essas mortes ocupam a posição mais elevada (4º lugar) na ordenação dos grupos de causas para a população idosa. Nessa capital também o percentual de óbitos por CMD ocorridos em hospitais foi quase o dobro das demais. Conforme esperado, a classificação da causa do óbito como CMD mostrou-se negativamente associada à ocorrência em hospitais. Os resultados evidenciam boa qualidade da informação, mas indicam problemas recorrentes na prestação da atenção médica à população idosa.

The objective of this article is to study the evolution of mortality from ill-defined causes in the population over age 60 in the Brazilian cities of Belo Horizonte, Rio de Janeiro, São Paulo and Porto Alegre between 1996 and 2007. The evolution of the proportion of deaths due to ill-defined causes during this period was analyzed, as well as the distribution of these deaths by age group, according to the codes in Chapter XVIII of the International Disease Classification (IDC-10) and the position of this group of causes in the total number of deaths of elderly persons. The chance ratio (95%) for ill-defined causes and their occurrence in hospitals was also evaluated. The evolution of the proportion of deaths from ill-defined causes between 1996 and 2007 in the cities mentioned indicated that the highest proportion of deaths from ill-defined causes in the elderly was in Rio de Janeiro, where such deaths are in 4th place among all causes for this age group. In addition, the percentage of deaths from ill-defined causes that occurred in hospitals in Rio de Janeiro was almost twice as high as that in the other cities. As expected, the classification of cause of death as ill-defined was negatively associated with deaths that occurred in hospitals. The findings show good quality of information but indicate frequent problems in providing medical attention to the elderly population.

Este artículo se centra en estudiar la evolución de la mortalidad por causas mal definidas en la población con más de 60 años, residente en Belo Horizonte, Río de Janeiro, São Paulo y Porto Alegre, entre 1996 y 2007. Se analizó la evolución de la mortalidad proporcional por causas mal definidas (CMD) durante el período, la distribución de esas muertes por grupos de edad, según códigos del Capítulo XVIII de la Clasificación Internacional de Enfermedades - CID-10, y la posición de ese grupo de causas en el total de óbitos en ancianos. Se evaluó, también, la razón de oportunidades (IC95%) entre los óbitos por CMD y su ocurrencia en hospitales. La evolución de la mortalidad proporcional por CMD en las capitales seleccionadas, entre 1996 y 2007, indicó una existencia mayor de óbitos por CMD en ancianos en Río de Janeiro, donde esas muertes ocupan la posición más alta (4º lugar) en la ordenación de los grupos de causas para la población anciana. En esa capital, también el porcentaje de óbitos por CMD ocurridos en hospitales fue casi el doble que en las demás. Conforme lo esperado, la clasificación de la causa de óbito como CMD se mostró negativamente asociada a la ocurrencia en hospitales. Los resultados evidencian buena calidad de la información, pero indican problemas recurrentes en la prestación de la atención médica a la población anciana.

O objetivo deste trabalho foi verificar a proporção de início tardio da terapia anti-retroviral (TARV) e seus fatores associados. Estudo de corte transversal com pacientes de dois serviços públicos de referência (n = 310) em Belo Horizonte, Minas Gerais, Brasil. Atraso no início da TARV foi definido como ter contagem de linfócitos T CD4+ < 200 células/mm³ ou manifestação clínica de imunodepressão grave. A maioria era do sexo masculino (63,9%) e não possuía plano de saúde (76,1%). A proporção de início tardio da TARV foi 68,4%. Grande parte (75,2%) iniciou TARV < 120 dias após a primeira consulta médica. Estar desempregado, realizar anti-HIV por indicação de profissional de saúde, < 2 consultas no serviço até seis meses antes do início da TARV e tempo entre primeira consulta para o HIV e início da TARV < 120 dias estiveram associados de forma independente com início tardio da TARV. São necessários estudos que avaliem o custo-efetividade da realização do anti-HIV como teste de rastreamento da população geral. Facilitar o acesso dos pacientes com resultado positivo aos serviços de referência pode contribuir para a redução do número de pacientes que iniciam tardiamente a TARV.

The main objective was to assess the proportion of delayed initiation of antiretroviral therapy (ART) and associated factors. This was a cross-sectional study of 310 patients enrolled in two public health centers in Belo Horizonte, Minas Gerais State, Brazil. Delayed ART initiation was defined as starting treatment with a CD4 count lower than 200 cells/mm³ or clinical symptoms of severe immunodepression at the time of first antiretroviral prescription. The majority of participants were males (63.9%), had no health insurance (76.1%), and started ART less than 120 days after the first medical visit (75.2%). The proportion of delayed ART initiation was 68.4%. Unemployment, referral by a health professional for HIV testing, fewer than two medical visits in the six months prior to ART initiation, and time between first medical visit and ART initiation less than 120 days were independently associated with the outcome. Our results suggest that every patient 13 to 64 years of age should be offered HIV testing, which could increase the rate of early HIV diagnosis, and thus patients that tested positive could benefit from timely follow-up and antiretroviral therapy.

O objetivo deste trabalho foi verificar a proporção de início tardio da terapia anti-retroviral (TARV) e seus fatores associados. Estudo de corte transversal com pacientes de dois serviços públicos de referência (n = 310) em Belo Horizonte, Minas Gerais, Brasil. Atraso no início da TARV foi definido como ter contagem de linfócitos T CD4+ < 200 células/mm³ ou manifestação clínica de imunodepressão grave. A maioria era do sexo masculino (63,9%) e não possuía plano de saúde (76,1%). A proporção de início tardio da TARV foi 68,4%. Grande parte (75,2%) iniciou TARV < 120 dias após a primeira consulta médica. Estar desempregado, realizar anti-HIV por indicação de profissional de saúde, < 2 consultas no serviço até seis meses antes do início da TARV e tempo entre primeira consulta para o HIV e início da TARV < 120 dias estiveram associados de forma independente com início tardio da TARV. São necessários estudos que avaliem o custo-efetividade da realização do anti-HIV como teste de rastreamento da população geral. Facilitar o acesso dos pacientes com resultado positivo aos serviços de referência pode contribuir para a redução do número de pacientes que iniciam tardiamente a TARV.

The main objective was to assess the proportion of delayed initiation of antiretroviral therapy (ART) and associated factors. This was a cross-sectional study of 310 patients enrolled in two public health centers in Belo Horizonte, Minas Gerais State, Brazil. Delayed ART initiation was defined as starting treatment with a CD4 count lower than 200 cells/mm³ or clinical symptoms of severe immunodepression at the time of first antiretroviral prescription. The majority of participants were males (63.9%), had no health insurance (76.1%), and started ART less than 120 days after the first medical visit (75.2%). The proportion of delayed ART initiation was 68.4%. Unemployment, referral by a health professional for HIV testing, fewer than two medical visits in the six months prior to ART initiation, and time between first medical visit and ART initiation less than 120 days were independently associated with the outcome. Our results suggest that every patient 13 to 64 years of age should be offered HIV testing, which could increase the rate of early HIV diagnosis, and thus patients that tested positive could benefit from timely follow-up and antiretroviral therapy.

RESUMO OBJETIVO: Evidências indicam que pacientes com transtornos mentais têm elevada prevalência de infecções sexualmente transmissíveis, mas dados brasileiros são escassos. O objetivo deste estudo foi determinar a prevalência do HIV, hepatites C e B, e sífilis entre pacientes com transtornos mentais no Brasil. MÉTODO: Uma amostra representativa de pacientes adultos com transtornos mentais foi aleatoriamente selecionada de instituições públicas de saúde mental no Brasil. Dados sociodemográficos, comportamentais e clínicos foram obtidos por entrevista face-a-face e sangue foi coletado para exames sorológicos. Soroprevalências com intervalo de 95% de confiança foram obtidas com correção para o esquema amostral. RESULTADOS: Dos 2.475 pacientes entrevistados, 2.238 tiveram sangue coletado. A maioria era sexualmente ativa ao longo da vida (88,8%) ou nos últimos seis meses (61,4%), do gênero feminino (51,9%), solteira (66,6%), com metade dos participantes com menos de cinco anos de escolaridade e renda média mensal baixa individual (US$210). Uso de preservativo foi baixo em toda a vida (8%) ou nos últimos seis (16%). As soroprevalências gerais foram 1,12%, 0,80%, 1,64%, 14,7% e 2,63% para, respectivamente, sífilis, HIV, HBsAg, anti-HBc e anti-HCV. CONCLUSÕES: As soroprevalências encontradas são maiores do que outros estudos com populações representativas no Brasil, com altos índices de comportamento sexual de risco. Isto é preocupante e estratégias de prevenção e cuidado para as infecções sexualmente transmissíveis entre pacientes psiquiátricos devem ser urgentemente implementadas pelos serviços de saúde.

ABSTRACT OBJECTIVE: There is evidence that patients with mental illness have increased prevalence of sexually transmitted infections, but data in Brazil are scarce. The objective of this study was to determine the prevalence of HIV, hepatitis C and B, and syphilis among patients with mental illness in Brazil. METHOD: A multicenter representative sample of adults with mental illness was randomly selected from 26 mental health institutions throughout Brazil. Sociodemographic, sexual behavior and clinical data were obtained from person-to-person interviews and blood was collected for serology testing. Seroprevalence with 95% confidence limits were obtained correcting for sampling scheme. RESULTS: Of the 2,475 patients interviewed, 2,238 had blood collected. Most participants were sexually active ever (88.8%) or in the last 6 months (61.6%), female (51.9%), and single (66.6%). Half of the sample had less than 5 years of schooling and the mean monthly individual income was low (US$ 210.00). Condom use was very low either during lifetime (8%) or in the last 6 months (16%). Overall seroprevalence were 1.12%, 0.80%, 1.64%, 14.7% and 2.63% for, respectively, syphilis, HIV, HBsAg, anti-HBc and anti-HCV. CONCLUSIONS: Seroprevalences found were higher than other populations with representative studies in Brazil, with high rates of sexual risk behavior. This is of public health concern, and prevention and care strategies for sexually transmitted infections among psychiatric patients should urgently be implemented by health authorities.

INTRODUCTION: Despite improvement in clinical treatment for HIV-infected patients, the impact of antiretroviral therapy on the overall quality of life has become a major concern. OBJECTIVE: To identify factors associated with increased levels of self-reported quality of life among HIV-infected patients after four months of antiretroviral therapy. METHODS: Patients were recruited at two public health referral centers for AIDS, Belo Horizonte, Brazil, for a prospective adherence study. Patients were interviewed before initiating treatment (baseline) and after one and four months. Quality of life was assessed using a psychometric instrument, and factors associated with good/very good quality of life four months after the initiation of antiretroviral therapy were assessed using a cross-sectional approach. Logistic regression was used for analysis. RESULTS: Overall quality of life was classified as 'very good/good' by 66.4% of the participants four months after initiating treatment, while 33.6% classified it as 'neither poor nor good/poor/very poor'. Logistic regression indicated that >8 years of education, none/mild symptoms of anxiety and depression, no antiretroviral switch, lower number of adverse reactions and better quality of life at baseline were independently associated with good/very good quality of life over four months of treatment. CONCLUSIONS: Our results highlight the importance of modifiable factors such as psychiatric symptoms and treatment-related variables that may contribute to a better quality of life among patients initiating treatment. Considering that poor quality of life is related to non-adherence to antiretroviral therapy, careful clinical monitoring of these factors may contribute to ensuring the long-term effectiveness of antiretroviral regimens.

OBJETIVO: Descrever a confiabilidade/validade de um questionário semi-estruturado para avaliar comportamento de risco para as infecções sexualmente transmissíveis entre adultos com doença mental crônica. MÉTODO: Estudo-piloto transversal em um hospital psiquiátrico e um centro de atenção psicossocial. Dados clínicos, comportamentais e sociodemográficos foram coletados por entrevistas semi-estruturadas/prontuários médicos. Cento e vinte pacientes foram selecionados aleatoriamente a partir de listas pré-definidas de ambos os centros, enquanto 89 (74%) foram entrevistados, indicando uma taxa de não-participação de 26%. Protocolo, participação, consentimento e outros fatores foram avaliados. A entrevista semi-estruturada foi avaliada em sua confiabilidade (intra e inter-observador) e validade de construto, por repetição aleatória (razão 1:1), com até uma semana de intervalo. A confiabilidade foi estimada pelo percentual de concordância/coeficiente Kappa (intervalo de confiança 95%). A validade de construto foi avaliada pelo modelo Grade of Membership. RESULTADOS: Os coeficientes Kappa variaram de 0,40-1,00 para a maioria das variáveis. A análise Grade of Membership gerou três perfis de vulnerabilidade. O perfil um representou principalmente mulheres em relacionamentos estáveis que não usavam preservativo; o perfil dois revelou principalmente homens em relacionamentos estáveis, mas múltiplos comportamentos de risco; o terceiro perfil indicou uma alta proporção de uso de substâncias lícitas e/ou ilícitas. CONCLUSÕES: A confiabilidade e validade de construto indicaram que a entrevista foi adequada para captar os comportamentos de risco nesta população.

OBJECTIVE: To describe reliability/validity of a semi-structured questionnaire designed to assess risk behavior to sexually transmitted diseases among adults with chronic mental illness. METHOD: A cross-sectional pilot study was conducted in one psychiatric hospital and one mental health outpatient clinic. Clinical, behavioral and demographic data were collected from semi-structured interviews and medical charts. One-hundred and twenty patients were randomly selected from pre-defined lists in both centers while 89 (74%) were interviewed, indicating 26% nonparticipation rate. Protocol, participation rates, consent form and feasibility issues were assessed. The semi-structured interview was evaluated with regard to reliability (intra- and inter-rater) and construct validity by randomly repeating the interviews in a 1:1 ratio up to one-week interval. Reliability was estimated by percent agreement and Kappa statistics (95% confidence interval). Construct validity was assessed by Grade of Membership model. RESULTS: Kappa statistics ranged from 0.40 to 1.00 for most variables. Grade of Membership analysis generated three profiles. Profile one was represented by mostly women with no condom use in stable relationships; profile two revealed mostly men in stable relationship but with multiple risk behaviors; while profile three indicated a higher proportion of licit or illicit substance use. CONCLUSIONS: Reliability and construct validity assessment using Grade of Membership analysis indicated that the semi-structured interview was suitable for capturing risk behavior among patients with chronic mental illness.

OBJECTIVE: To describe the degree of difficulty that HIV-infected patients have with therapy treatment. INTRODUCTION: Patients’ perceptions about their treatment are a determinant factor for improved adherence and a better quality of life. METHODS: Two cross-sectional analyses were conducted in public AIDS referral centers in Brazil among patients initiating treatment. Patients interviewed at baseline, after one month, and after seven months following the beginning of treatment were asked to classify and justify the degree of difficulty with treatment. Logistic regression was used for analysis. RESULTS: Among 406 patients initiating treatment, 350 (86.2%) and 209 (51.5%) returned for their first and third visits, respectively. Treatment perceptions ranged from medium to very difficult for 51.4% and 37.3% on the first and third visits, respectively. The main difficulties reported were adverse reactions to the medication and scheduling. A separate logistic regression indicated that the HIV-seropositive status disclosure, symptoms of anxiety, absence of psychotherapy, higher CD4+ cell count (> 200/mm³) and high (> 4) adverse reaction count reported were independently associated with the degree of difficulty in the first visit, while CDC clinical category A, pill burden (> 7 pills), use of other medications, high (> 4) adverse reaction count reported and low understanding of medical orientation showed independent association for the third visit. CONCLUSIONS: A significant level of difficulty was observed with treatment. Our analyses suggest the need for early assessment of difficulties with treatment, highlighting the importance of modifiable factors that may contribute to better adherence to the treatment protocol.

Os portadores de doenças mentais crônicas encontram-se em risco para a infecção pelo HIV e outras infecções sexualmente transmissíveis. Entretanto, a prevalência dessas infecções entre portadores de doença mental crônica ainda não está claramente estabelecida nesta população. A maioria dos trabalhos sobre o tema foi conduzida em países desenvolvidos, com amostras relativamente pequenas e não representativas. Foi realizada uma revisão sistemática da literatura para identificar estudos sobre a prevalência do HIV, sífilis, hepatite B e C entre pacientes com doença mental crônica no Brasil e no mundo. De um modo geral, as prevalências variaram de 0% a 29%, 3 a 66%, 0,4 a 38% e 3,3% a 7,6% para HIV, hepatite B, hepatite C e sífilis, respectivamente. Vários fatores de risco foram identificados e discutidos, embora a literatura atual não demonstre achados significativos gerados por estudos representativos. Tal revisão destaca a escassez de informação sobre a prevalência de infecções sexualmente transmitidas e seus fatores associados entre portadores de doenças mentais crônicas e identifica lacunas no conhecimento atual em países desenvolvidos bem como nos em desenvolvimento.

A limited number of studies worldwide have investigated the prevalence of HIV, syphilis, and hepatitis B and C infection among psychiatric patients. However, prevalence of these infections in the population with chronic mental illness has not been clearly established. Most of the published papers are from developed countries and have derived from relatively small and non-representative samples. We performed a systematic review of the published literature to identify studies on these infectious diseases within psychiatric populations in Brazil and other developing countries. Overall, prevalence rates varied from 0% to 29% for HIV; 1.6% to 66% for HBV; 0.4% to 38% for HCV; and 1.1% to 7.6% for syphilis. Several risk factors were identified and discussed, although sampling limitations restrict the generalization of study findings. This review highlights the lack of information on the prevalence of sexually transmitted diseases and their associated factors among persons with chronic mental illness and identifies gaps in the knowledge base in both developing and developed countries.

Os portadores de doenças mentais crônicas encontram-se em risco para a infecção pelo HIV e outras infecções sexualmente transmissíveis. Entretanto, a prevalência dessas infecções entre portadores de doença mental crônica ainda não está claramente estabelecida nesta população. A maioria dos trabalhos sobre o tema foi conduzida em países desenvolvidos, com amostras relativamente pequenas e não representativas. Foi realizada uma revisão sistemática da literatura para identificar estudos sobre a prevalência do HIV, sífilis, hepatite B e C entre pacientes com doença mental crônica no Brasil e no mundo. De um modo geral, as prevalências variaram de 0% a 29%, 3 a 66%, 0,4 a 38% e 3,3% a 7,6% para HIV, hepatite B, hepatite C e sífilis, respectivamente. Vários fatores de risco foram identificados e discutidos, embora a literatura atual não demonstre achados significativos gerados por estudos representativos. Tal revisão destaca a escassez de informação sobre a prevalência de infecções sexualmente transmitidas e seus fatores associados entre portadores de doenças mentais crônicas e identifica lacunas no conhecimento atual em países desenvolvidos bem como nos em desenvolvimento.

A limited number of studies worldwide have investigated the prevalence of HIV, syphilis, and hepatitis B and C infection among psychiatric patients. However, prevalence of these infections in the population with chronic mental illness has not been clearly established. Most of the published papers are from developed countries and have derived from relatively small and non-representative samples. We performed a systematic review of the published literature to identify studies on these infectious diseases within psychiatric populations in Brazil and other developing countries. Overall, prevalence rates varied from 0% to 29% for HIV; 1.6% to 66% for HBV; 0.4% to 38% for HCV; and 1.1% to 7.6% for syphilis. Several risk factors were identified and discussed, although sampling limitations restrict the generalization of study findings. This review highlights the lack of information on the prevalence of sexually transmitted diseases and their associated factors among persons with chronic mental illness and identifies gaps in the knowledge base in both developing and developed countries.