HIV prevalence and factors associated with HIV positivity among Black people in primary care in Porto Alegre, Brazil, 2020-2022: a cross-sectional study

Brito, Emerson Silveira de; Teixeira, Marsam Alves de; Martins, Rafael Steffens; Pinheiro, Ben Hur Graboski; Rocha, Ana Carolina Monteiro da; Oliveira, Cáren Nunes de; Paula, Thayane Fraga de; Dornelles, Thayane Martins

doi:10.1590/S2237-96222025v34e20240014.en

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 34 • 2025 • https://doi.org/10.1590/S2237-96222025v34e20240014.en linkcopy

This document is related to:

10.1590/S2237-96222025v34e20240014.a

HIV prevalence and factors associated with HIV positivity among Black people in primary care in Porto Alegre, Brazil, 2020-2022: a cross-sectional study

Prevalencia del VIH y factores asociados a la positividad entre personas de raza negra en atención primaria en Porto Alegre, Brasil, 2020-2022: estudio transversal

SCIMAGO INSTITUTIONS RANKINGS

Objective To examine HIV prevalence among primary care service users and to investigate factors associated with positive HIV test results among Black people.

Methods This was a cross-sectional study with data from rapid HIV testing performed in health centers in Porto Alegre-RS, Brazil. Sociodemographic differences according to race/skin color and HIV test result were analyzed using the Chi-square test and Poisson regression with robust variance.

Results Out of 92,345 people tested, 38% were Black, with 3.4% HIV prevalence. Among Black people the following were associated with higher HIV prevalence ratios (PR): being male (PR 1.62; 95% confidence interval [95%CI] 1.41; 1.85), having elementary education (PR 1.69; 95%CI 1.27; 2.24), having tuberculosis (PR 1.76; 95%CI 1.22; 2.54) and being a street dweller (PR 1.75; 95%CI 1.41; 2.18).

Conclusion Black people, especially Black men with lower education levels, tuberculosis and street dwellers, have higher HIV prevalence, requiring greater attention from prevention strategies and testing for sexually transmitted infections.

Keywords
Sexually Transmitted Diseases; HIV Infections; Black People; Health of Ethnic Minorities; Cross-Sectional Studies

Characteristics	Total	White n (%)	Black n (%)	Asian/ indigenous n (%)	p-value^a
Sex					<0.001
Male	34,849	20614 (59.2)	13,854 (39.7)	381 (1.1)
Female	57,496	35,231 (61.3)	21,713 (37.7)	552 (1.0)
Age group (years)
12-17	4,261	2,406 (56.5)	1,795 (42.1)	60 (1.4)	<0.001
18-25	29,023	16,914 (58.3)	11,817 (40.7)	292 (1.0)
26-39	35,105	21,112 (60.1)	13,661 (39.0)	332 (0.9)
40-59	17,407	10,955 (62.9)	6,260 (36.0)	192 (1.1)
≥60	4,791	3,403 (71.0)	1,352 (28.2)	36 (0.8)
Schooling					<0.001
Elementary	27,767	14,960 (52.9)	12,710 (45.8)	383 (1.3)
High school	35,710	22,055 (61.8)	13,363 (37.4)	298 (0.8)
Higher education	8,068	5,949 (73.8)	2,053 (25.4)	69 (0.8)
Tuberculosis					<0.001
No	75,541	45,195 (59.9)	29,573 (39.1)	773 (1.0)
Yes	725	381 (52.6)	338 (46.6)	6 (0.8)
Street dweller					<0.001
No	74,022	44,479 (60.1)	28,801 (38.9)	742 (1.0)
Yes	2,244	1,097 (48.9)	1,110 (49.5)	37 (1.6)
HIV RT result					<0.001
Non-reactive	90,026	54,765 (60.8)	34,353 (38.2)	908 (1.0)
Reactive	2,319	1,080 (46.5)	1,214 (52.4)	25 (1.1)

	Black - n (%)			White - n (%)
Characteristics	Non-reactive	Reactive	p-value^a	Non-reactive	Reactive	p-value^a
Sex			<0.001			<0.001
Male	13,204 (95.3)	650 (4.7)		20,016 (97.1)	598 (2.9)
Female	21,149 (97.4)	564 (2.6)		34,749 (98.6)	482 (1.4)
Age group (years)			<0.001			<0.001
12-17	1,776 (98.9)	19 (1.1)		2,389 (99.3)	17 (0.7)
18-25	11,599 (98.2)	218 (1.8)		16,711 (98.8)	203 (1.2)
26-39	13,137 (96.2)	524 (3.8)		20,660 (97.9)	452 (2.1)
40-59	5,864 (93.7)	396 (6.3)		10,627 (97.0)	328 (3.0)
≥60	1,314 (97.2)	38 (2.8)		3,349 (98.4)	54 (1.6)
Schooling			<0.001			<0.001
Elementary	12,174 (95.8)	536 (4.2)		14,278 (97.2)	412 (2.8)
High school	12,976 (97.1)	387 (2.9)		21,692 (98.4)	363 (1.6)
Higher education	2,001 (97.5)	52 (2.5)		5,872 (98.7)	77 (1.3)
Tuberculosis			<0.001
No	28,570 (96.6)	1,003 (3.4)		44,324 (98.1)	871 (1.9)
Yes	304 (89.9)	34 (10.1)		353 (92.7)	28 (7.3)
Street dweller			<0.001			<0.001
No	27,887 (96.8)	914 (3.2)		43,652 (98.1)	181 (1.9)
Yes	987 (88.9)	123 (11.1)		1,025 (86.4)	72 (6.6)

Variable	Prevalence ratio (95% confidence interval [CI])
Variable	Model 1 (crude analysis)	Model 2^a	Model 3^b	Model 4^c	Model 5^d
Sex
Male	1.84 (1.63; 2.09)	1.87 (1.65; 2.12)	1.74 (1.54; 1.98)	1.73 (1.52; 1.96)	1.62 (1.41; 1.85)
Female	1.00	1.00	1.00	1.00	1.00
Schooling
Elementary	1.66 (1.25; 2.20)	1.69 (1.27; 2.23)	1.82 (1.37; 2.42)	1.30 (0.97; 1.74)	1.69 (1.27; 2.24)
High school	1.15 (0.87; 1.54)	1.15 (0.87; 1.53)	1.30 (0.97; 1.74)	1.80 (1.35; 2.39)	1.28 (0.96;1.71)
Higher education	1.00	1.00	1.00	1.00	1.00
Age group (years)
12-17	0.38 (0.22; 0.66)		0.43 (0.23; 0.79)	0.44 (0.24; 0.81)	0.44 (0.24; 0.82)
18-25	0.67 (0.47; 0.94)		0.83 (0.57; 1.22)	0.84 (0.57; 1.23)	0.84 (0.57; 1.23)
26-39	1.38 (1.00; 1.91)		1.67 (1.17; 2.41)	1.68 (1.16; 2.42)	1.63 (1.13; 2.36)
40-59	2.24 (1.61; 3.11)		2.54 (1.77; 3.67)	2.55 (1.77; 3.69)	2.40 (1.66; 3.47)
≥60	1.00		1.00	1.00	1.00
Tuberculosis
No	1.00			1.00	1.00
Yes	2.85 (2.06; 3.95)			1.85 (1.29; 2.66)	1.76 (1.22; 2.54)
Street dweller
No	1.00				1.00
Yes	3.27 (2.74; 3.92)				1.75 (1.41; 2.18)

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[tfnte3] ^aModel 2: Sex and schooling; ^bModel 3: Sex, schooling and age group; ^cModel 4: Sex, schooling, age group and tuberculosis; ^dModel 5: Sex, schooling, age group, tuberculosis and street dweller.