Morbidade por HIV e AIDS na região amazônida: análise temporal

Abstract

Introduction: Since the discovery of the Human Immunodeficiency Virus (HIV) and acquired immunodeficiency syndrome (AIDS) in the early 80s, the epidemic has become a serious public health problem due to its rapid worldwide dissemination. In Brazil, although the average detection rate of HIV and AIDS have shown a reduction of 9.4% in the last ten years, the North and Northeast regions showed growth (44.2% and 24.1%, respectively). Pará occupies the 8th position at national level in detection rate of HIV and AIDS (23.6 cases per 100,000 inhab.). Objective: to analyze the historical series of the HIV epidemic in the State of Pará. This study is a ecological time series, in which secondary data collected from the Notification Disease Information System were analyzed between 2007 and 2018 in the 144 municipalities of the State. The following variables were used: gender, age, race / color, education, exposure category and municipality of residence. Only residents in Pará and those over thirteen years old were included in the study. To calculate the incidence rate of HIV and AIDS, the number of new cases of HIV and AIDS among residents over 13 years old was considered as variable, divided by the number of the total population residing in the same age group in the municipalities, regions and state and multiplied the ratio by 100,000. Annual percentage changes (APC) in incidence rates were calculated using Joinpoint modeling. For the analysis of epidemiological variables between the two defined periods, the chi­square test and residual analysis were used. P≤0.05 values were considered statistically significant. Results: The incidence rates of HIV and AIDS in 2007 and 2018 increased by 420%. An inflection point was identified for the series, separating it into two trend periods: 2007 to 2012 (G1) and 2012 to 2018 (G2). In G1, the incidence increased with an annual percentage variation of 1.6% (CI = ­ 15.0 to 21.5; p≤0.05), while in G2, the variation was 29.8% (CI = 19.9 at 40.5; p≤0.05). Changes in age and education profile were observed between G1 and G2: in G1, adults with low levels of education were the most affected by the epidemic, while in G2, the young population with high levels of education. According to the analysis of the HIV infection trends together with the exploration of the socioeconomic dynamics of the municipalities whose HIV cases were more frequent in each of the state's mesoregions (Oriximiná, Belém, Bragança, Abaetetuba, Marabá, Parauapebas and Altamira). The incidence was higher in municipalities with better socioeconomic conditions, but with lower coverage of the Family Health Strategy. Identifying changes in the profile of new infections direct the visualization of key populations, as well as localized epidemics and their dissemination forms for the adoption of public health policies competent for the management of HIV infection.