Revista Brasileira de Epidemiologia
Print version ISSN 1415-790X
SANTOS, Naila Janilde Seabra et al. AIDS in the State of São Paulo: changes in the profile of the epidemic and prospects for epidemiological surveillance. Rev. bras. epidemiol. [online]. 2002, vol.5, n.3, pp. 286-310. ISSN 1415-790X. http://dx.doi.org/10.1590/S1415-790X2002000300007.
HIV, initially associated with men who have sex with men, mainly in industrialized countries and Latin America, spread quickly reaching women, heterosexual men and children. The increasing inequalities between industrialized and developing countries become apparent in rates of HIV infection and AIDS mortality. As the differences in access to AIDS treatment grow, mortality due to AIDS decreases in richer countries and increases in poorer countries, with the exception of Brazil, one of the few countries in the world that has free distribution of combination antiretroviral therapy. In Brazil, AIDS mortality has been falling since 1996, and has been substantially affected by access to AIDS treatment. In this paper, data on STD and AIDS, collected from the epidemiological surveillance system of the State of São Paulo, were analyzed with the purpose of describing the profile of the AIDS epidemic, and discussing the way this disease affects women and young, poor and heterosexual persons. Until 12/31/2001, 106,873 cases were reported in the State of São Paulo, which was about 50% of the cases reported in the country as a whole. The highest incidence rates occur among individuals between 30 and 39 years of age. The number of cases and deaths has grown slightly in older individuals. AIDS affects all, the rich and the poor, but in past years it has been increasing in individuals with fewer years of education and non-qualified occupations. The increase in cases among heterosexual men and the fact that this mode of exposure is the most frequent among women corroborates the importance of heterosexual transmission in the AIDS epidemic. The STD and AIDS epidemiological surveillance system in Brazil is based mainly upon cases reported, and it has been used as the main source of information on the AIDS epidemic. These epidemiological surveillance data support the study of trends, prevention and care planning, and provides the means to promote information on AIDS to the population. Such data reflect the status of HIV several years after infection occurred, and this gap tends to grow due to many factors, such as antiretroviral therapy and others. In this manner, data take longer to enter the information system, and therefore, such information becomes increasingly distant from the actual magnitude of HIV infection. Other strategies for acknowledging trends of HIV infections are necessary in order to make its control more effective. Examples are reporting HIV infection in pregnant women and their children, and in people living with HIV (without AIDS); and implementing information from case reports, by introducing data on color or race, investigating forms of exposure to HIV infection, defining risks and vulnerability of population groups and by using the strategies of second generation epidemiological surveillance.
Keywords : HIV/AIDS; Heterosexuals; Women; Impoverishment; The elderly; Epidemiological Surveillance.