Os determinantes sociais, a infecção pelo HIV e a AIDS em uma capital na Amazônia brasileira: análise espacial e temporal

Abstract

Almost 40 years after its discovery, the Human Immunodeficiency Virus (HIV) continues to be a challenge for public health worldwide. In Brazil, the states of the Northern region have the greatest impact of the HIV epidemic, with a continuous increase in detection rates. This study aimed to perform the spatial and temporal analysis of the incidence of HIV infection and AIDS, and its relationship with social determinants. Ecological study employing secondary data of cases reported to the Notifiable Diseases Information System (SINAN), in the period 2007- 2018, of individuals living in the city of Belém/PA. Temporal analysis was performed using Box and Jenkins methodology. For the spatial analysis, incidence was analyzed using autocorrelation and spatial regression techniques, Kernel density to study the expansion of the HIV epidemic in the city, and sweep statistics to identify clusters of risk. During the study period, 6,007 new cases of HIV/AIDS were reported to SINAN. Time series analysis revealed stability of incidence from 2007 until October 2016, followed by an upward trend. Starting in January 2017, incidence rates showed irregular fluctuations until the end of December 2018. Seasonal behavior was observed for the forecast from 2019 to 2022. High incidence clusters were located in the central and transitional areas of Bethlehem. The epidemic progressed from 2007-2010 to 2015-2018. The spatial high-risk zone for HIV was observed in the transition zone (RR = 3.65; 95% CI = 2.47 - 5.34; p = 0.00016), while the spatiotemporal high-risk zone was observed in the central, transition and expansion zones (RR = 4.24; 95% CI = 3.92 - 4.52; p = 0.000). Incidence rates were directly correlated to Family Health Strategy (FHS) coverage (adjusted R² = 0.38). The upward trend observed in the incidence rates of HIV infection and AIDS in Belém may be correlated with the efforts of public policies to combat the virus. However, the irregular behavior in incidence rates from 2017 and the seasonal behavior revealed in the forecasts suggest a loosening in public health policies. This study provides subsidies for the development of public health strategies to combat HIV.