rodrigo zilli haanwinckel ministry of health of brazil health surveillance secretariat department of...
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Rodrigo Zilli Haanwinckel
Ministry of Health of BrazilHealth Surveillance Secretariat
Department of STD, AIDS and Hepatitis
Prevention of vertical transmission of HIV in Brazil
3
• Population – 190 million
• 27 States
• Municipalities - 5,561
• Area: 8,5 million sq km
Brazil
SUS - National Health System
• Federal law # 8080 (1988) - National Health System (SUS) established – “health as a citizen’s right and the government’s duty” - free and universal access to health care
• 100% of Brazilian people have the right to access the National Health System, including the prisoners.
Prevalence : 0.61%
(pop. 15 to 49 years old)
fem: 0.42%
male: 0.80%
HIV: General Data. Brazil,
Estimate nr of PLHA620,000
Detection of Pregnant Women with HIV/aids (cases and incidence rate/100,000 live births), by year. Brazil, 2005-2009(1)
FONTE: MS/ SVS/ Departamento de DST, Aids e Hepatites Virais
NOTA: (1) Casos notificados no Sinan até 30/06/2010
(2) Utilizados nascidos vivos no ano de 2008
Dados preliminares para os últimos 5 anos
2005 2006 2007 2008 2009
n rate n rate n rate n rate n rate
6091 2,0 6100 2,1 6532 2,3 5903 2,0 6104 2,1
Reported Cases of MCT of HIV in children less than five years-old.
Year Cases
2004 678
2005 683
2006 564
2007 483
2008
2009
533
468
Incidence rate of AIDS (by 100,000 inhabitants) in
children less than 5 years-old by Brazilian region and
year of diagnosis. Brazil, 1997 to 2009.
FONTE: MS/SVS/Departamento de DST Aids e Hepatites Virais.POPULAÇÃO: MS/SE/DATASUS em <www.datasus.gov.br> no menu informações em saúde > Demográfica e socioeconômicas, acessado em 20/10/2009.NOTA: (1) Casos notificados no SINAN e registrados no SISCEL/SICLOM até 30/06/2009 e SIM de 2000 a 2008. Dados preliminares para os últimos cinco anos.
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year of diagnosis
Inc
ide
nc
e r
ate
Brazil North Northeast Southeast South Midwest
*Brazilian local production (10 out of 21)
Year of introduction in parenthesis
RITONAVIR (1996)*
SAQUINAVIR (1996)*
INDINAVIR (1997)*
NELFINAVIR (1998)
AMPRENAVIR (2001)
LOPINAVIR/r (2002)
ATAZANAVIR (2004)
DARUNAVIR (2008)
TIPRANAVIR (2010)
ZIDOVUDINE (1993)*
ESTAVUDINE (1997)*
DIDANOSINE (1998)*
LAMIVUDINE (1999)*
ABACAVIR (2001)
DIDANOSINE EC (2005)
TENOFOVIR (2003)-2011*
NEVIRAPINE (2001)*
EFAVIRENZ (1999)-2007*
ETRAVIRINE (2011)
NTRI
ENFUVIRTIDE (2005)
PI
FUSION INHIBITOR
NNTRI
RALTEGRAVIR (2009)
INTEGRASE INHIBITOR
Antiretroviral drugs universally available in Brazil
Brazilian Penitentiary System
Scenario (Dec/2011): Incarcerated population: 471,254
441,907 (94%) – Men 29,347 (6%) – Women
• 1,779 penal facilities – 4 federal prisons
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Number of Reported Pregnant Women In Prision. Brazil, 2010 (n= 423)
NORTHNORTHEASTSOUTHEASTSOUTHMIDWEST
HIV, HPV and Syphilis prevalence in São Paulo’s feminine prison – 1997/1998 – Public Health Review - 2001
F. Lopes;M. Latorre;A. Pignarati;C. Buchalla
Population: female prisoners;City: São Paulo, SPSamples: 262HIV: 14,5%; HPV: 16,3%; Syphilis: 5,7%
Behaviour associated to HIV and HCV infection in female prisoners in a penitentiary of São Paulo, Brazil – Public Health Review - 2007
L. Strazza;E. Massad;R.Azevedo;H.Carvalho;
Population: female prisonersCity: São Paulo, SPSamples: 290 (299)HIV: 13,9%; HCV: 16,2%
Prevalence of HIV/AIDS in female in prision:
Increasing vulnerability context
Confining Conditions• Overcrowding• Inadequate facilities• Difficulties in accessing prevention and hygiene
materials (condoms, lubricants, toothbrushes, shavers)• Violence• Poor health care• Limited access to information
Practices that increase vulnerability• Drug Use• Unprotected sex• Sharing of tattoo and piercing equipment
The Brazilian Response to HIV & AIDS
Is focused on principles of protection and human rights;
Universal access; Is structured by the Policy of Attention to
Incarcerated Individuals; Is based on integral attention and access to
prevention materials (condoms, ART and testing);
Multisectoral actions.
HIV & AIDS in the Penitentiary System National Actions
• National Plan for Health in the Penitentiary System, 2003
• Regional Consultation for Latin America and the Caribbean on HIV & AIDS in Prison Settings, 2008
• National Consultation on HIV & AIDS in Prison Settings, 2009
• Technical Cooperation Project – Ministry of Health, Penitentiary System Authority and UNODC: HIV & AIDS prevention and assistance - Strengthening health care in the penitentiary system.
• National Plan for Health in the Penitentiary System - Revision
National Plan for Health in the Penitentiary System
Purpose:
Organize the access of inmates to public health services
Targeted population:
100% of Brazilian inmates
18 Brazilian states qualified and developing
Health Network Prevention:
Prevention commodities (condoms and harm reduction kits)
Breast milk substitute for exposed children Medication to inhibit breast milk production Hepatitis B vaccination
Diagnosis: Testing (HIV, STD, TB, hepatitis B and C) Follow-up procedures: viral load, CD4, genotype
Treatment: ART Treatment for opportunistic infections; STD treatment
Operational Plan for The Reduction of MCT of HIV
and Syphilis
Goals:• Reducing HIV MCT rate to less than
1%
• Eradicating congenital syphilis (<1 case/1,000) nationwide.
Main achievement:• From 1997 to 2009: 49% reduction in
the incidence rate of AIDS cases in children under 5 years old.
Challenges
Organization of the health care network Access to prevention materials Access to diagnosis and specialized
care to women in prision Monitoring of the PMCT in this
population Human rights as a key issue to reduce
vulnerabilities
