Mulheres com HIV/AIDS no estado do Ceará: comportamentos, vida reprodutiva e fatores associados à infecção

Abstract

The HFV/AIDS epidemic continues to spread among women, the infection being mainly through heterosexual contact. Gender roles are important in this scenario. To describe the socio-economic, behavioral and reproductive characteristics, and to identify factors associated with HTV infection of women without and with ADDS, a case-control study was conducted. Cases were defined as women attending the HTV/AIDS outpatient clinic of a reference hospital in Fortaleza, Ceará. Controls were recruited from women attending other service in the hospital, between June and August 2004. 290 women with AIDS, 83 HIV women without AIDS and 209 controls were included in the study. In the population of women with a steady partner, 79,3% (AIDS), 62,3% (HIV) and 20,6% (controls) used a condom in the last sexual intercourse (p<0,001 for AIDS or HTV vs. controls). Of 106 seropositive women with an HIV negative partner or a partner of unknown serostatus, only 79 (75,2%) used a condom during last sex. The most frequent reasons for not using a condom were: "the partner objected", for seropositive women (53,8%); and "uses another contraceptive method", for controls (30,7%). HTV women had the infection diagnosed most frequently because the partner became ill (36,6%), whereas for women with AIDS the infection was most frequently diagnosed when they became ill (45,7%). The main mode of infection was heterosexual contact (79,5%). Only four seropositive women (1,1%) had used intravenous dmgs, but 20,6% of women with AIDS and 17,8% of HP/ women had current or previous partners who were intravenous drug users (IDU), while this proportion was only 4,0% for controls (p<0,001 for AIDS or HW vs. controls). Approximately 31% of seropositive women desired more children; 36,7% (AIDS), 34,6% (HIV) and 29,2% (controls) were sterilized. Of the seropositive women sterilized after HP/ diagnosis, 45,4% (AIDS) and 24,3% (HP/) had the procedure done because of a medical recommendation due to HIV diagnosis. Of those, 16,7% and 17,9%, respectively, still desired to have a child. The following factors were associated with infection for women with AIDS and HIV (respectively): perception of not being at risk for infection (relative risk ratio [RRR]: 12,3; 95% Cl: 7,1-21,5 and RRR: 7,3; 95% Cl: 3,7-14,4), being a widow (12,7; 3,5-45,5 and 5,9; 1,2-29,3), current or previous IDU partner (4,1; 1,4-12,3 and 5,0; 1,7-14,7), not knowing if they had an IDU partner (4,1; 1,4-12,3 and 6,4; 1,9-21,1), and age < 30 years (2,1; 1,1-4,0 e 4,9; 2,0-11,9). Factors associated with infection only for women with AIDS: perception of being at high risk for infection (3,7; 1,6-8,6), illiteracy (6,7; 1,4-31,3), > 4 lifetime partners (4,1; 2,1-8,1) and having a current job (0,5; 0,3-0,9). HIV infection prevention measures should address gender roles. The reproductive rights of seropositive women should be respected through non-coercive counselling and support of their reproductive decisions.