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Transgender women (TW) are a key population in the dynamics of human immunodeficiency virus (HIV) dissemination, although little is known about their perceptions of HIV risk. In this embedded, nested, mixed-methods study, we assessed factors associated with condomless sexual intercourse among TW and explored their risk perceptions and vulnerabilities regarding HIV exposure. The first phase involved a cross-sectional study, followed by qualitative interviews. Condomless sexual intercourse during their last sexual encounter was reported by 37.3% of participants, and 16.1% previously tested positive for HIV. Age older than 21 years, single status, and being a sex worker were protective factors for condomless intercourse. Otherwise, TW who reported a past sexual partner with a known sexually transmitted infection and those aware of post-exposure prophylaxis had a greater risk of condomless sexual intercourse ( p  < 0.05) during their most recent encounter. The qualitative interviews revealed that, despite TW being aware of their risk of contracting HIV, their vulnerabilities overlapped their risk perception, making them trivialize or ignore the risk. This study will help to understand the HIV dynamics among TW and contribute to further health research, education, policymaking, and planning associated with specific health strategies to promote the sexual health of TW.

Anxiety and sleep disorders are highly prevalent affecting millions of people worldwide. Complementary therapies like art therapy, bibliotherapy, and music have been used to manage these problems. The objective of this study was to evaluate levels of anxiety and sleep disorder symptoms of participants before and after a 30-day intervention of listening to short poetic audios. Thirty-one participants listened to audio-taped messages, which associate music and literature for 30 days. Questionnaires were answered by participants prior to the start of the study (baseline collection) and after 30 days (final collection). Setting: the study was done in the city of Ribeirao Preto (Sao Paulo-Brazil). Participants were 31 adults with anxiety symptoms and sleep problems. The scores of the questionnaires were analyzed and compared by the t test for paired samples (α = 0.05), used to evaluate possible differences in anxiety and stress symptoms and sleep disturbances before and after the 30 days of intervention. Significantly lower levels of anxiety and sleep disorders were found after the 30-day intervention. This study reinforces the benefits of music and literature for improving the quality of life of people by reducing levels of anxiety and sleep disorder symptoms.

Background: Homeless men are highly vulnerable to acquisition of the hepatitis C virus (HCV) compared to the general population. In Brazil, a country of continental dimensions, the extent of HCV infection in this population remains unknown. The objective of this study is to investigate the epidemiological profile of exposure to HCV in homeless men in Central Brazil., Methods: A Cross-sectional study was conducted in 481 men aged over 18 years attending therapeutic communities specialized in the recovery and reintegration of homeless people. Participants were tested for anti-HCV markers using rapid tests. Poisson regression analysis was used to verify the risk factors associated with exposure to HCV., Results: The prevalence of HCV exposure was 2.5% (95.0% CI: 1.4 to 4.3%) and was associated with age, absence of family life, injection drug use, number of sexual partners, and history of sexually transmitted infections (STI). Participants reported multiple risk behaviors, such as alcohol (78.9%), cocaine (37.1%) and/or crack use (53.1%), and inconsistent condom use (82.6%). Injection drug use was reported by 8.7% of participants., Conclusions: The prevalence of HCV infection among homeless men was relatively high. Several risk behaviors were commonly reported, which shows the high vulnerability of this population. These findings emphasize the need for the development of specific strategies to reduce the risk of HCV among homeless men.

The Brazilian recombinant hepatitis B vaccine (VrHB-IB) is based on the expression of the recombinant antigen in Hansenula polymorpha yeast cells. Currently, data on the immunogenicity of this vaccine in older adults are nonexistent. This study aimed to evaluate the immunogenicity of VrHB-IB in adults over 40 years of age. From May to October 2011, 235 rural settlers between 2 and 93 years of age from the State of Goias in Brazil were eligible for vaccination. Of these, 180 accepted the first dose of the vaccine and 106 (58.9%) completed the vaccination schedule. Multivariate analysis revealed that individuals ≥ 40 years of age responded significantly less well to vaccination than younger adults. Also, a greater proportion of male nonresponders was observed (versus women; P = 0.02). These results point to the need for better evaluation of the immunogenicity of VrHB-IB in older adults., (© The American Society of Tropical Medicine and Hygiene.)

Background: Rural populations present an elevated risk of exposure to hepatitis A virus., Objective: The objective of this study was to estimate the prevalence and risk factors associated with hepatitis A virus infection among residents of rural settlement projects of southwest Goiás, Central Brazil., Methods: A total of 466 residents were interviewed and tested for the detection of anti- hepatitis A virus antibodies by ELISA., Results: The global prevalence of anti- hepatitis A virus was 82.2%. In individuals aged 5-9 years and 10-19 years, the prevalence was 15% and 58.8%, respectively. Persons in the 10-19 age group, with a history of life in encampments, with more than five people per residence consuming well water, were predictors for exposure to hepatitis A virus., Conclusion: Our results suggest that the hepatitis A virus endemicity in rural settlements in southwest Goiás similar to that found in the urban population of the Midwest Region, confirming the implementation of universal hepatitis A vaccination in children.

Objectives: To evaluate the hepatitis B immunization status of female sex workers (FSWs) in Central-West Brazil and to evaluate their compliance with and immune response to hepatitis B vaccination delivered using outreach strategies., Methods: A total of 721 FSWs recruited in 2 large cities in Central-West Brazil were interviewed and screened for the presence of hepatitis B virus (HBV) markers. Hepatitis B vaccine was offered to all women susceptible to HBV, using outreach strategies. The immune response of FSWs who received a full course of vaccine was assessed following the final vaccine dose., Results: We found that 27.6% of FSWs, the majority of whom were aged 18 to 25 years, had serological evidence of previous hepatitis B vaccination. A total of 434 FSWs were eligible for vaccination, 389 (89.6%) of whom accepted the first hepatitis B vaccine dose. Of those, 64% received a second dose and 37.5% received all three doses. Through the outreach strategy, there was a 52.2% increase in the number of women who received the second dose and a 67% increase in the number who received the third dose. Of the 146 women who received a full course of vaccine, 105 accepted testing for quantitative anti-HBs (hepatitis B surface antibody) following the final vaccine dose, and 92.4% of those tested had developed protective levels of anti-HBs. Lower education level, workplace, and length of prostitution were predictors of full-vaccine acceptance., Conclusions: The present findings illustrate the benefits of using outreach strategies to overcome the difficulties of vaccinating hard-to-reach populations such as FSWs.

Although dopaminergic systems are more commonly associated with the reinforcing effects of various stimuli, numerous reports have demonstrated a relationship between changes in dopaminergic transmission and aversive situations. In the present study, we examined the involvement of D1-like and D2-like receptors in the expression of conditioned freezing using the context as the conditioned stimulus. Intraperitoneal injections of the D1 agonist SKF38393 or the D1 antagonist SCH23390 did not change the conditioned freezing in rats subjected to the contextual fear paradigm. In contrast, intraperitoneal injections of the D2 agonist quinpirole and the D2 antagonist sulpiride caused a significant dose-dependent reduction in the expression of contextual conditioned freezing. As these data may reflect that the systemic manipulations acted on dopaminergic receptors in different brain areas, the effects of administration of quinpirole and sulpiride into the ventral tegmental area (VTA) and the basolateral amygdala complex (BLA) on the expression of contextual conditioned freezing were also evaluated. Intra-VTA quinpirole and intra-BLA sulpiride injections reduced the conditioned freezing response; intra-VTA sulpiride and intra-BLA quinpirole injections had no significant effects. These data suggest that D2-like receptors, but not D1-like receptors, play an important role in the expression of contextual conditioned freezing. Quinpirole may act at D2 presynaptic receptors located in the VTA, decreasing dopamine levels in the terminal fields of the mesolimbic pathway. The effects of sulpiride, in contrast, appear to be triggered by an action on postsynaptic dopaminergic receptors located in the BLA. However, it cannot be totally excluded that the injected solutions did not also affect neighboring amygdalar regions. Together with previous findings, the present data suggest the need to consider dopaminergic mechanisms in the mesolimbic circuit as novel targets for the pharmacological treatment of fear-related disorders, especially post-traumatic stress disorder.

Objective: to investigate knowledge on sexually transmitted diseases (STDs), STD-related risk behaviors, and signs/symptoms of STDs among female sex workers (FSWs)., Methods: a cross-sectional study was conducted with a probabilistic sample comprising 395 women recruited using a respondent-driven sampling method between 2009 and 2010. The data were collected during face-to-face interviews., Results: most of the participants were young adults, had a low educational level, and had poor knowledge on the transmission paths of the human immunodeficiency virus (HIV). Over one-third of the participants were not able to describe the signs/symptoms of STDs. The prevalence rates of vaginal discharge and wounds/ulcers were 49.0% and 8.6%, respectively, but 41.7% of the women had not sought treatment., Conclusion: the results indicate the need for public health policies focusing on the control and prevention of STDs in this population, especially for the FSWs who are active in an important prostitution and sex tourism route in central Brazil.

Objective: To evaluate the frequency of sexually transmitted diseases (STD) and associated risk factors based on self-reporting by long-haul truck drivers in Brazil., Method: From October 2005-October 2006, 641 long-haul truck drivers that travel federal highway BR-153, traversing the country from south to north, were interviewed. A structured interview was used to collect sociodemographic data. The truck drivers also completed a self-administered questionnaire on risk behaviors and STD history. The data were adjusted and analyzed using logistic regression., Results: Of 641 drivers interviewed, 620 (96.7%) provided answers on STD history. Of these, 35.6% (95% confidence interval (CI) = 31.9-39.6) reported past or current STD. Being 30 years of age or older was statistically associated with having a history of STD. In addition, truck drivers who reported using amphetamines (odds ratio (OR) = 1.7; 95%CI = 1.1-2.6), having been incarcerated (OR = 2.2; 95%CI = 1.2-4.2), and sexual relations with sex professionals (OR = 1.9; 95%CI = 1.3-2.8) had increased odds for having a history of STD., Conclusion: These results confirm that Brazilian truck drivers are highly vulnerable to STD and show the importance of prevention programs targeting this specific group, one that is constantly on the move and may efficiently disseminate STD.