Espaços sociais da infecção pelo HIV em gestantes : análise espacial dos casos de fortaleza

Abstract

Although important advances are seen in aids control, its epidemic is still a public health issue and it is more prevalent among vulnerabilities groups in which social matters and life conditions are reported. The aimed was to realized the spatial analyzsis of the HIV positive pregnant women cases, and the socioeconomic features of Fortaleza suburbs, Ceará State – Brazil. It is an environmental study with spatial approach. Socioeconomic data were gathered from the 2010 Demographic census and the HIV positive pregnant women cases recorded between 2001 and 2011 in the Systems for Disease Notification, Mortality Information and Hospitalizations. Was analised 733 HIV pregnant women were analyzed. The 119 Fortaleza suburbs were used as analysis units. They were compatible with the census mesh of the Brazilian Institute on Geography and Statistics- IBGE. Was held the Pearson correlation analysis was performed between the cases and the socioeconomic indicators. The Freman-Tukey transformation was done to solve the instability of outcome indicators. As for the HIV cases among pregnant women, the multiple linear regression was applied and it identified the indicators that better explain the event. Next, the spatial linear regression model was then applied. The Moran index was used to assess the spatial autocorrelation. Mean month income of R$1,766.60 was identified by socioeconomic analysis as well as the mean ratio of people on the poverty line of 4.7%. Among the indicators with significant Moran index, the ratio of domiciles with 4 to 6 bathrooms, the ratio of people on the poverty line and the ratio of domiciles with bathroom or exclusive toilet with disposal system were cited. Suburbs with better socioeconomic conditions are located in the north and northeast regions of the town. There was a significant association between having prenatal care and adhering to treatment during pregnancy (p=0.001) and labor, having a cesarean delivery, and initiating treatment in children within the first 24 hours of life (p<0.001). There was spatial correlation between the ratio of HIV pregnant women and the parents mean income, the ratio of adequate housing, the ratio of domiciles with accumulated garbage and the ratio of domiciles with 4 to 6 inhabitants. These suburbs are mainly located in the northwest and southwest regions of the city. The spatial correlation was verified between the HIV positive pregnant women cases income, the ratio of poor people and the ratio of illiterate, and there is a cluster of it in regions located in the northwest of the town. The geographic association of HIV positive pregnant women cases with the socioeconomic indicators prove the need of interventions focused on health and on life condition improvements. The precarious conditions seen in the low income regions with inadequate infrastructure and sewage system are the predictors of case occurrences. Thus, it points towards the need of more effective and efficient interventions to fight against primary transmission and the vertical HIV transmission by taking under consideration interventions related to social contexts mainly in socially underprivileged regions.