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Is Sexual Risk Behavior Changing in Santos, Brazil?

Katia Alves
Clinical Pharmacology
Stanford University
November 2002


Since the beginning of Acquired immunodeficiency syndrome (AIDS) epidemic in Brazil, the port city of Santos has reported the highest rate of AIDS incidence in the country. Historically, injection drug users and sex workers have been identified as the highest risk populations in this area, but increasingly, HIV has bridged to other heterosexual risk groups.

Santos has been the focus of intense prevention and intervention campaigns including syringe-exchange for intravenous drug users, free condom distribution for high-risk behavior population, free anonymous human immunodeficiency virus (HIV) testing and counseling and municipal multimedia campaign.

The anonymous HIV testing sites (ATS) conduct HIV testing and counseling to over 2,000 clients yearly, and HIV prevalence has consistently been 7% to 8% from 1996-1999. The objective of that study is to assess the changes in sexual risk behavior among Santos' ATS clients from 1996 to 1999.

Risk behavior data were abstracted from ATS HIV testing and counseling forms from 7,641 clients who attended the ATS from 1996 to 1999. Three variables were selected to evaluate sexual risk for HIV in the previous year: "Inconsistent condom use" was defined from reported condom use with any partners and included "never" and "sometimes" as opposed to "always"; "multiple sex partners" was defined as having had two or more sex partners of any gender; "inconsistent condom use with multiple partners" was derived by cross-tabulating data on reported condom use and numbers of sexual partners. Risk behaviors were stratified by year, gender, sexual orientation, and HIV infection status is shown as the proportion (%) reporting.

Indicators of high-risk sexual behavior (inconsistent condom use and multiple sexual partners) among ATS clients in Santos were stable from 1996 to 1998 and declined in 1999. These trends were consistent among female and male heterosexual clients, but not MSM clients. No decline was seen among MSM, in the proportion reporting multiple sex partners over the 4-year period. Sexual risk declines among HIV negatives in 1999, but not among HIV positives.

No differences were seen in sexual risk between HIV positive and HIV negative clients except in 1999: a higher proportion of HIV positive clients report inconsistent condom use, multiple sex partners and inconsistent condom use with multiple sex partners. Sustained HIV prevention interventions are needed in Santos directed at reducing sexual risk behaviors among both female and male heterosexuals and especially MSM.