ABSTRACT OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15–49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women’s prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.

ABSTRACT OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15–49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women’s prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited. (PNC RS (RS macroregions macro regions attended crosssectional cross sectional 13432 13 432 13,43 1549 15 49 15–4 (SUS 201 2019 data womens s cards records reports 98.4%, 984 98.4% , 98 4 (98.4%) 575 57 5 57.5 th week 572 2 57.2% 1year year 1 parturient 5% macroregion region nonwhite non white andor school macroregions. regions. pregnancy 960 96 0 96.0 antiHIV anti HIV 558 55 8 55.8 syphilis 750 75 75.0 VDRL. VDRL . (VDRL) population revisited 1343 43 13,4 154 15– 20 98.4 9 (98.4% 57. 57.2 96. 55. 75. (VDRL 134 13, 98. (98.4 (98. (98 (9 (

RESUMO Introdução: O conhecimento do comportamento sexual de risco entre jovens tem sido amplamente reconhecido como ferramenta-chave para controlar a propagação do HIV. Este artigo tem o objetivo de retratar o comportamento de risco dos conscritos do Exército brasileiro à infecção pelo HIV segundo as macrorregiões brasileiras. Métodos: Foram utilizados dados de 37.282 conscritos, entre 17 e 22 anos, durante apresentação ao Exército em 2016. Estimaram-se as prevalências de HIV autorreferida e medida por exame laboratorial, além de indicadores de comportamento de risco, por macrorregiões geográficas. Resultados: Dos conscritos que compuseram a amostra, 75% relatou já ter iniciado atividade sexual, e a média de idade de início foi de aproximadamente 15 anos. O uso do preservativo variou de acordo com o tipo de parceria sexual, sendo menor na relação com parceiros(as) fixos(as) e maior nas parcerias menos estáveis. A prevalência da infecção pelo HIV medida através do diagnóstico laboratorial foi de 0,12% no Brasil, sendo mais prevalente na região Norte (0,24%). O consumo de álcool e drogas ilícitas foi maior na região Sul. Discussão: O estudo permitiu observar o monitoramento do comportamento de risco à infecção pelo HIV entre os jovens brasileiros. O menor uso de preservativo quando a parceria sexual é considerada estável pode estar contribuindo para aumentar o número de indivíduos infectados pelo HIV. Conclusão: Os resultados sugerem a necessidade de campanhas de divulgação para os jovens sobre práticas de sexo seguro, além da ampliação da oferta de testagem nessa população.

ABSTRACT Introduction: Knowledge about risky sexual behavior among young people has been widely acknowledged as a key tool to controlling the spread of HIV. This article aimed at presenting the risk behavior of Brazilian Army conscripts toward HIV infection according to the country’s geographic regions. . Method: We collected data from 37,282 conscripts, aged 17 to 22, during enlistment in the Brazilian Army in 2016. The prevalence of HIV infection, both self-reported and measured through laboratory results, and risk behavior factors were estimated by region. Results: 75% of the sample of conscripts reported to have already started sexual activity, and the average age of their sexual initiation was 15. Condom use varied according to the type of sexual relationship, being lower among steady partners and greater among less stable relationships. HIV prevalence assessed by laboratory tests was 0.12% across the country and the highest prevalence was observed in the North region (0.24%). Alcohol and illicit drug usage was higher in the South region. Discussion: The study allowed the observation of risk behavior monitoring for HIV infection among young Brazilians. Lower condom usage among steady partners may be contributing to an increase in the number of HIV-infected individuals. Conclusion: Results suggest the need to intensify prevention campaigns to disseminate safe sex practices among young people, in addition to the expansion of testing offer to this population.

RESUMO Introdução: O conhecimento do comportamento sexual de risco entre jovens tem sido amplamente reconhecido como ferramenta-chave para controlar a propagação do HIV. Este artigo tem o objetivo de retratar o comportamento de risco dos conscritos do Exército brasileiro à infecção pelo HIV segundo as macrorregiões brasileiras. Métodos: Foram utilizados dados de 37.282 conscritos, entre 17 e 22 anos, durante apresentação ao Exército em 2016. Estimaram-se as prevalências de HIV autorreferida e medida por exame laboratorial, além de indicadores de comportamento de risco, por macrorregiões geográficas. Resultados: Dos conscritos que compuseram a amostra, 75% relatou já ter iniciado atividade sexual, e a média de idade de início foi de aproximadamente 15 anos. O uso do preservativo variou de acordo com o tipo de parceria sexual, sendo menor na relação com parceiros(as) fixos(as) e maior nas parcerias menos estáveis. A prevalência da infecção pelo HIV medida através do diagnóstico laboratorial foi de 0,12% no Brasil, sendo mais prevalente na região Norte (0,24%). O consumo de álcool e drogas ilícitas foi maior na região Sul. Discussão: O estudo permitiu observar o monitoramento do comportamento de risco à infecção pelo HIV entre os jovens brasileiros. O menor uso de preservativo quando a parceria sexual é considerada estável pode estar contribuindo para aumentar o número de indivíduos infectados pelo HIV. Conclusão: Os resultados sugerem a necessidade de campanhas de divulgação para os jovens sobre práticas de sexo seguro, além da ampliação da oferta de testagem nessa população.

ABSTRACT Introduction: Knowledge about risky sexual behavior among young people has been widely acknowledged as a key tool to controlling the spread of HIV. This article aimed at presenting the risk behavior of Brazilian Army conscripts toward HIV infection according to the country’s geographic regions. . Method: We collected data from 37,282 conscripts, aged 17 to 22, during enlistment in the Brazilian Army in 2016. The prevalence of HIV infection, both self-reported and measured through laboratory results, and risk behavior factors were estimated by region. Results: 75% of the sample of conscripts reported to have already started sexual activity, and the average age of their sexual initiation was 15. Condom use varied according to the type of sexual relationship, being lower among steady partners and greater among less stable relationships. HIV prevalence assessed by laboratory tests was 0.12% across the country and the highest prevalence was observed in the North region (0.24%). Alcohol and illicit drug usage was higher in the South region. Discussion: The study allowed the observation of risk behavior monitoring for HIV infection among young Brazilians. Lower condom usage among steady partners may be contributing to an increase in the number of HIV-infected individuals. Conclusion: Results suggest the need to intensify prevention campaigns to disseminate safe sex practices among young people, in addition to the expansion of testing offer to this population.