History of syphilis in women living with AIDS and
               associated risk factors in São Paulo, Brazil

Pinto, Valdir Monteiro; Tancredi, Mariza Vono; Buchalla, Cassia Maria; Miranda, Angelica Espinosa

doi:10.1590/1806-9282.60.04.013

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Revista da Associação Médica Brasileira

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Sumário

ORIGINAL ARTICLES • Rev. Assoc. Med. Bras. 60 (4) • Jul-Aug 2014 • https://doi.org/10.1590/1806-9282.60.04.013 copy

History of syphilis in women living with AIDS and associated risk factors in São Paulo, Brazil

Antecedentes de sífilis em mulheres com Aids e fatores de risco associados, São Paulo, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to describe the epidemiological profile, risk behaviors, frequency of prior history of syphilis in women living with AIDS and to investigate associated factors.

Methods:

a cross-sectional study conducted with women living with HIV attending at Reference Center for AIDS in São Paulo. Demographic, behavioral, and clinical data were analyzed based on medical records.

Results:

a total of 598 women were included in the study and the prevalence of previous syphilis was 6.2% (95% CI 4,3-8,1). Seventy-three percent of women were less than 40 years of age when diagnosed with AIDS and 49.6% had more than eight years of formal education. 67.2% were white and 65.9% were not married or living with a partner, 53.2% reported that their first sexual intercourse aged more than 15 years, 56.5% reported having only one partner in the last year and 13% reported drug use. Regarding laboratory data, 83.8% had CD4+ <500 cells/ mm³ upon diagnosis of AIDS. Previous syphilis was associated with the use of crack cocaine [AOR = 6.8 (95% CI 1.7 - 27.5)], >1 sexual partner in the last year [AOR = 6.6 (95% CI 1.2 - 37.1)], CD4 + <500 cells/mm³ [AOR = 3.8 (women 1.1 - 13.6)], HIV diagnosis > 8 years [AOR = 2.4 (95% CI 1.0 - 5.8)].

Conclusion:

a high prevalence of previous syphilis was found in the population studied, and crack use was identified among the main associated risk factors. Interventions to reduce the risk of sexual transmission of HIV and syphilis must be strengthened, with the implementation of control actions, screening strategies, early diagnosis and treatment, preventing complications, reducing morbidity and improving sexual and reproductive health.

syphilis; sexually transmitted diseases (STDs); AIDS; risk behavior; women

Characteristics	Syphilis						p ^* CRT: Centro de Referenda e Treinamento em DST/Aids de Sao Paulo. *Pearson's test
	Yes (n = 37)		No (n = 561)		Total (598)
	n	%	n	%	n	%
Age range at the time of AIDS							0.392
≤ 40 years	25	67.6	415	74	440	73.6
> 40 years	12	32.4	146	26	158	26.4
	37	100.0	561	100.0	598	100.0
Education (years of study)							0.679
None	1	2.7	5	0.9	6	1
1 to 4 years	4	10.8	44	7.8	48	8
5 to 8 years	13	35.1	229	40.8	242	40.5
9 to 11 years	16	43.2	206	36.7	222	37.1
≥ 12 years	3	8.1	72	12.8	75	12.5
Ignored	-	-	5	0.9	5	0.8
	37	100.0	561	100.0	598	100.0
Race/color (self-reported)							0.526
White	22	59.5	380	67.7	402	67.2
Non white	15	40.5	179	31.9	194	32.4
Ignored	-	-	2	0.4	2	0.3
	37	100.0	561	100.0	598	100.0
Marital status							0.831
Single	10	27	155	27.6	165	27.6
Married/partner	14	37.8	190	33.9	204	34.1
Separated/divorced	8	21.6	100.0	17.8	108	18.1
Widow	5	13.5	111	19.8	116	19.4
Ignored	-	-	5	0.9	5	0.8
	37	100.0	561	100.0	598	100.0
HDI in the district of residence							0.607
> 0.550	21	56.8	364	64.9	385	64.4
0 - 0.550	16	43.2	197	35.1	213	35.6
	37	100.0	561	100.0	598	100.0

Characteristics	Syphilis						p ^* * Pearson's test
	Yes (n = 37)		No (n = 561)		Total (598)
	n	%	n	%	n	%
Age at first coitus							0.014
≤ 15 years	22	59.5	201	35.8	223	37.3
> 15 years	12	32.4	306	54.5	318	53.2
Ignored	3	8.1	54	9.6	57	9.5
No. of partners in the past year							<0.001
None	13	35.1	202	36	215	36
Single	15	40.5	323	57.6	338	56.5
2 to 5	4	10.8	14	2.5	18	3
More than 5	2	5.4	1	0.2	3	0.5
Ignored	3	8.1	21	3.7	24	4
Use of drugs							<0.001
Does not use	26	70.3	491	87.5	517	86.5
Crack	6	16.2	12	2.1	18	3
Other drugs	5	13.5	55	9.8	60	10
Ignored	-	-	3	0.5	3	0.5
Time of HIV diagnosis (years)							0.002
1 to 8 years	12	32.4	325	57.9	337	56.4
≥ 9 years	25	67.6	236	42.1	261	43.6
CD4 at AIDS diagnosis (cell/mm³)							<0.001
> 500	4	10.8	93	16.6	97	16.2
350 - 500	30	81.1	214	38.1	244	40.8
< 350	3	8.1	254	45.3	257	43
Number of pregnancies							0.01
0 to 3	19	51.4	400	71.3	419	70.1
More than 3	18	48.6	161	28.7	179	29.9

Characteristics of users
Characteristics of users	OR cr	95%CI (ORcr)	p
Age at first coitus
≤ 15 years	1	-	-
> 15 years	2.8	1.3 to 5.8	0.006
Ignored	1.4	0.4 to 5.2	0.599
No. of partners in the past year
None	1	-	-
Single	0.7	0.3 to 1.5	0.402
2 to 5	4.4	1.3 to 15.4	0.019
More than 5	31.1	2.6 to 365.6	0.006
Ignored
Use of drugs
Does not use	1	-	-
Crack	9.4	3.3 to 27.1	<0.001
Other drugs	1.7	0.6 to 4.6	0.288
Ignored
Time of HIV diagnosis (years)
1 to 8 years	1	-	-
≥ 9 years	2.9	1.4 to 5.8	0.004
CD4 at AIDS diagnosis (cell/mm³)
> 500	1	-	-
350 - 500	3.3	1.1 to 9.5	0.031
< 350	0.3	0.1 to 1.2	0.095
Number of pregnancies
0 to 3	1	-	-
More than 3	2.3	1.2 to 4.6	0.012

Characteristics of users	OR_aj	95% CI (OR aj)	p
Time of HIV diagnosis (years)
1 to 8	1	-	-
≥ 9 years	2.4	1.0 to 5.8	0.046
No. of partners in the past year
None	1	-	-
Single	0.6	0.2 to 1.3	0.201
2 to 5	6.6	1.2 to 37.1	0.032
CD4 at AIDS diagnosis (cell/mm³)
> 500	1	-	-
350 - 500	3.8	1.1 to 13.6	0.040
Use of drugs
Does not use	1	-	-
Crack	6.8	1.7 to 27.5	0.007
Other drugs	0.7	0.2 to 2.7	0.573

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[1] Correspondence: Address: Rua Santa Cruz, 81, São Paulo, SP. ZIP Code: 04121-000. Phone: +55 11 5087.9981, Mobile: +55 11 98162.9020. e-mail: vmpinto@usp.br; valdir.pinto@crt.saude.sp.gov.br