Prevalence and vulnerability of homeless people to HIV infection in Sao Paulo, Brazil

OBJECTIVE: To assess the prevalence and vulnerability of homeless people to HIV infection. METHODS: Cross-sectional study conducted with a non-probabilistic sample of 1,405 homeless users of shelters in the city of Sao Paulo, southeastern Brazil, from 2006 to 2007. They were all tested for HIV and a structured questionnaire was applied. Their vulnerability to HIV was determined by the frequency of condom use: those who reported using condoms only occasionally or never were considered the most vulnerable. Multinomial and logistic regression models were used to estimate effect measures and 95% confidence intervals. RESULTS: There was a predominance of males (85.6%), with a mean age of 40.9 years, 72.0% had complete elementary schooling, and 71.5% were non-white. Of all respondents, 15.7% reported being homosexual or bisexual and 62,0% reported having casual sex. The mean number of sexual partners in the last 12 months was 5.4. More than half (55.7%) of the respondents reported lifetime drug use, while 25.7% reported frequent use. Sexually-transmitted disease was reported by 39.6% of the homeless and 38.3% reported always using condoms. The prevalence of HIV infection was 4.9% (17.4% also tested positive for syphilis) and about half of the respondents (55.4%) had access to prevention programs. Higher HIV prevalence was associated with younger age (18-29 years, OR = 4.0 [95% CI 1.54; 10.46]); past history of sexually-transmitted disease (OR = 3.3 [95% CI 1.87; 5.73]); homosexual sex (OR = 3.0 [95% CI 1.28; 6.92]); and syphilis (OR = 2.4 [95% CI 1.13; 4.93]). Increased vulnerability to HIV infection was associated with being female; young; homosexual sex; having few partners or a steady partner; drug and alcohol use; not having access to prevention programs and social support. CONCLUSIONS: The HIV epidemic has a major impact on homeless people reflecting a cycle of exclusion, social vulnerability, and limited access to prevention.

Família interdita: transgeracionalidade e subjetivação em três obras ficcionais

O objetivo deste estudo foi discutir a transmissão psíquica geracional em duas obras do escritor Mia Couto: Antes de nascer o mundo (2009) e Um rio chamado tempo, uma casa chamada terra (2003), e no conto A terceira margem do rio, de Guimarães Rosa (1962). As três obras são narradas pelos filhos e destacam a família como epicentro de uma trama de segredos, interditos e culpabilizações transmitidos de uma geração a outra, possibilitando a compreensão de que o seio familiar permite não apenas a organização das experiências emocionais, mas a também a transmissão de aspectos intersubjetivos aos quais nem sempre as personagens têm acesso. Os segredos ou a não revelação das verdadeiras histórias dos personagens são apenas uma das formas de transmissão, pois, mesmo ocultando o interditado, transfere-se algo, de modo que o não revelar também é uma maneira de destacar o interdito, aquilo que ainda não foi elaborado e que, por conseguinte, não recebeu inscrição psíquica.