Epidemiological profile of São Paulo City and regions
HIV and AIDS in São Paulo City 2014
Epidemiological profile of São Paulo City and regions SAÚDE
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HIV and AIDS in São Paulo City 2014
Presentation Today in São Paulo City (SPC) we have an HIV/AIDS epidemic that is concentrated and growing among Men who have Sex with Men (MSM) and other key populations, such as sex workers and drug users, despite the overall reduction in the number of AIDS cases and incidence rate. Moreover, given SPC’s size and diversity, the epidemic appears in different manners in the city’s different regions, many of which are the size of large municipalities. Taking this diversity into account, this summary of the city’s epidemiological profile provides both overall information for SPC and also information disaggregated according to the six Regional Health Coordination Units. In order to tackle the epidemic and its local characteristics, the City Health Department (CHD) invests in scaling up access to male condoms, making them easily available in places where there are large numbers of people. In addition, it makes efforts to reach key populations in places they frequent. Prevention commodities are distributed in more than 100 adult entertainment venues identified in the city’s central region, as well as in hostels, shelters, NGOs, squats, and to private companies with a high proportion of LGBT staff. With regard to street dwelling drug users, the Health Department’s Municipal STD/AIDS Program (PM STD/AIDS), in partnership with the Open Arms Program (Programa de Braços Abertos), performs testing, distributes condoms and provides treatment to people living with HIV/AIDS via the Department’s mobile clinics in the Luz and Campos Elíseos districts. The Open Arms Program is being scaled up in several districts: Leopoldina, in the Western region; Cidade Tiradentes, in the Eastern region; Complexo Bandeirantes, in the Southeast region ; Santo Amaro in the Southern region and Santana in the Northern region. The CHD, in partnership with the Human Rights and Citizenship Department (HRCD), has set up the Municipal LGBT Integral Healthcare Policy, initially in the nine Primary Healthcare Centers in the city’s central region in view of the large number of LGBT people who live, work or seek entertainment in that region. The project aims to provide integral healthcare to LGBT people, including hormone therapy, access to surgery, psychological accompaniment, voice modulation and so forth. The inclusion of transgender persons’ preferred name on their National Health System ID card, a right long claimed by LGBT people, is already a reality in SPC.
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Epidemiological profile of São Paulo City and regions
We have identified that becoming ill and dying of AIDS affects Black people more intensely. As such the AIDS prevention project entitled “Projeto Xirê - Prevenção à Aids na Roda dos Orixás” is undertaken by the specialized municipal STD/AIDS services in the city’s diverse regions and involves Afro-Brazilian religious leaders in the fight against the epidemic. Specific actions for the Black population are also designed and scaled up jointly by CHD (PM STD/AIDS and Black People’s Technical Health Sector), HRCD and the Municipal Racial Equality Promotion Department. The AIDS mortality rate is falling in SPC, although in an unequal manner. In order to gain an understanding of the conditions that lead to people dying of a disease for which there is efficacious treatment, PM STD/AIDS set up a Mortality Working Group with the aim of identifying new strategies to reduce AIDS-related deaths in SPC. CHD invests considerably in scaling up access to diagnosis and treatment, as well as in actions to improve the quality of healthcare. In 2014, 520 hours were spent on rapid HIV test training for 1,150 health workers from municipal primary care, specialized care and hospital health services. In order to improve healthcare quality, doctors specialized in infectious diseases have been hired to work in the Specialized Municipal STD/AIDS Network which is currently being scaled up in SPC . With effect from 2014 the Specialized Network now offers treatment to all people living with HIV/ AIDS, regardless of their CD 4 count, as well as providing supervised treatment for street dwellers. All these actions are in keeping with the proposal of the Health Ministry’s Department of STD, HIV, AIDS and Viral Hepatitis, the Joint United Nations Programme on HIV/AIDS and the World Health Organization to have 90% of all people living with HIV diagnosed, 90% of all people with diagnosed HIV infection being treated and 90% viral suppression in those being treated by 2020, in order to improve the quality of life of people living with HIV, decrease AIDS mortality and reduce new transmissions. New challenges are constantly appearing in the fight against the epidemic. Based on epidemiological and management information as well as research, SPC continually develops prevention, diagnosis and care strategies, whilst respecting the singularity of each territory and focusing them on key populations.
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HIV and AIDS in Sﾃ｣o Paulo City 2014
Sﾃグ PAULO CITY (SPC) DATA The epidemiological data on HIV/AIDS is obtained from the National Notifiable Diseases System (SINAN) database, with complementation from other databases, such as: SIM (mortality information system), SICLOM (medication logistics control system), SISCEL (laboratory test control system) and other sources. After checking the quality of the data, the HIV/AIDS epidemiological surveillance team (CCD/COVISA) links the various data sources and analyzes the data to provide the basis for planning STD/HIV/AIDS prevention and care actions.
AIDS Cases Sex Ratio Evolution in SPC
Number of AIDS Cases, 1980-2013, in Sﾃ｣o Paulo City (SPC) - 86,112 86,112
1997
Male 62,060 (72,1%) Female 24,052 (27,9%)
2013
Number of AIDS Cases and Incidence Rate, SPC, 2011, 2012, 2013:
2011
2012
N
TI
N
TI
N
TI
2437
21,5
2440
21,4
2130
18,6
Source: SINAN - CCD/COVISA
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2013
Epidemiological profile of São Paulo City and regions
AIDS Incidence Rate in people aged 13 and over, by Administrative District of residence, SPC, 2013. Pari - RHCU Southeast IR - 74,4
AIDS Incidence Rate in SPC in people aged 13 and over Brás – RHCU Southeast IR - 86,8
22,1
República – RHCU Center IR - 92,3 IR até 20,4 20,4 --| 38,4 38,4 --| 56,3 56,3 --| 74,3 74,3 --| 92,3 Source: SINAN - CCD/COVISA
Reported AIDS cases in males aged 13 and over, according to the following exposure categories: Men who have Sex with Men (HSH), Heterosexual, Injecting Drug Users (IDU) and Unknown, 1980-2013, SPC. 1500
1000
500
0
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
MSM
Heterosexual
IDU
Ignored
Source: SINAN - CCD/COVISA
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HIV and AIDS in São Paulo City 2014
Age Group
Schooling in people aged over 19, SPC, 1980 and 2013.
Highest IR between 2000 and 2013 Males: Males
30 - 39 years
From 2010 increases the proportion of 12 years or more of schooling.
Female
Female:
In the period analyzed, females had lower schooling than males, with a slight increase in those with 12 years or more schooling. The largest proportion had 4 to 7 years schooling.
Up until 2010:
30 - 39 years 2011 onwards:
40 - 49 years
Source: SINAN - CCD/COVISA
Race/Color Reported AIDS cases and Incidence Rate in people aged 13 or over by race/color, gender and year of diagnosis. São Paulo City, 2010-2013. Race/color Sex Year of diagnosis White Black
IR
IR
IR
Male
2010
36,4
60,1
36,5
2011
36,2
59,7
36,3
2012
36,0
59,4
36,1
2013
35,8
59,0
35,9
Female
2010
10,4
31,0
16,3
2011
10,3
30,8
16,2
2012
10,3
30,7
16,1
2013
10,2
30,5
16,1
IBGE population data – Estimate derived by applying proportion to total - CEINFO/CHD
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Brown
Epidemiological profile of S達o Paulo City and regions
AIDS deaths, in those aged 13 or over, and Mortality Rate
Mortality Rate by Race/Color, SPC, 2012 Race/Color: Black: 12.8 Brown: 7.2 White: 5.8
2011 N
2012
MR
874 7,7
HIV
MR
788
6,8
Year
(not AIDS), SPC, 2013
1,785 (77,6%)
Female:
N
N
TM
768 6,7
MSM and Age Groups
2300 reported HIV cases Male:
2013
515 (22,4%)
13-19 years 20-29 years 30- 39 years
of diagnosis
%
%
%
2011
4,0
53,0
28,9
2012
6,7
52,2
28,2
2013
6,3
53,0
27,2
Source: SINAN - CCD/COVISA
Reported male and female HIV cases, aged 13 or over, by exposure category, 2011,2013, SPC.
MALE
Exposure Category
2011
2012
2013
N
%
N
%
N
%
1,013
39,7
1,169
40,1
1,207
40,4
Heterosexual
332
13,0
360
12,4
382
12,8
IDU
37
1,4
24
0,8
29
1,0
MSM
Female
Heterosexual
362
77,0
423
76,8
416
81,3
IDU
22
4,7
12
2,2
8
1,6
Source: SINAN - CCD/COVISA
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HIV and AIDS in S達o Paulo City 2014
Information by Region Number of AIDS cases and Incidence Rate, by Regional Health Coordination Units of residence, SPC, 2011, 2013.
RHCU
2011
2012
2013
N
IR
N
IR
N
IR
RHCU CENTER
264
60,1
244
55,7
196
44,4
RHCU WEST
209
20,3
174
16,8
152
14,6
RHCU EAST
425
17,8
466
19,4
344
14,2
RHCU NORTH
517
23,2
488
21,8
436
19,4
RHCU SOUTHEST
569
21,4
601
22,6
526
19,7
RHCU SOUTH
422
16,4
428
16,4
455
17,3
2,437
21,5
2,440
21,4
2,130
18,6
SPC
Number of new AIDS cases by RHCU, SPC, 2011, 2013. RHCU
2012
2013
Sex
Sex
Sex
Sex
Sex
Male
Female
Male
Female
Male
RHCU CENTER
112,6
13,5
99,9
16,4
83,1
9,9
RHCU WEST
35,0
7,6
27,5
7,6
25,4
5,2
RHCU EAST
24,4
11,7
28,0
11,4
20,8
8,1
RHCU NORTH
31,5
15,9
32,6
12,2
30,0
10,0
RHCU SOUTHEAST
34,5
9,9
36,0
10,7
31,4
9,4
RHCU SOUTH
23,0
10,3
24,4
9,1
26,3
9,0
SPC
32,6
11,6
33,2
10,8
29,4
8,9
Source: SINAN - CCD/COVISA
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2011
Sex Female
Epidemiological profile of S達o Paulo City and regions
Sex Ratio in 2013 S達o Paulo City
RHCU North
RHCU Center
RHCU Southeast
RHCU West
RHCU South
RHCU East
Number of Deaths and Mortality Rate, by RHCU, SPC, 2011, 2012, 2013.
2011
2012
2013
RHCU
N
MR
N
MR
N
MR
RHCU CENTER
59
13,6
55
12,6
46
10,4
RHCU WEST
50
4,9
48
4,6
38
3,6
RHCU EAST
218
9,1
217
9,0
169
7,0
RHCU NORTH
201
9,0
168
7,5
160
7,1
RHCU SOUTHEAST
186
7,0
146
5,5
182
6,8
RHCU SOUTH
134
5,2
128
4,9
143
5,4
SPC
874
7,7
788
6,8
768
6,7
Source: SIM/PRO-AIM/CEInfo/SMS/PMSP Preliminary data as at 30/06/2014, subject to alteration.
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HIV and AIDS in São Paulo City 2014
Abbreviations and acronyms list Aids – Acquired immune Deficiency Syndrome CDC – Centers for Disease Control CEINFO – Coordination of Epidemiology and Information COVISA – Health Surveillance Coordination RHC – RegionaL Health Coordination STD – Sexually Transmitted Disease WG – Working Group HIV – Human Immunodeficiency Virus MSM – Men who have Sex with Men IBGE – Brazilian Institute of Geography and Statistics LGBT – Lesbian, Gay, Bisexual, and Transgender SPC – São Paulo City N – Number WHO – World Health Organization NGO – Non–Governmental Organization PM DST/Aids – STD/aids Municipal Coordination RME – STD/aids Municipal Outpatient Centers SICLOM – Medication Logistics Control System SIM – Mortality Information System SINAN – National Notifiable Diseases System SISCEL – Laboratory Control System HRCD – Human Rights and Citizenship Department CHD – City Health Department NHS – National Health System IR – Incidence Rate ( Number of New Cases per 100.000 inhabitants/year) MR – Mortality Rate ( per 100.000 inhabitants/year) UBS– Primary Healthcare Centers IDU – Injecting Drug User UNAIDS – United Nations Programme on HIV/AIDS
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Mayor of São Paulo City Fernando Haddad Municipal Health Secretary José de Filippi Junior Municipal STD/AIDS Program Coordinator Eliana Battaggia Gutierrez Production, distribution and information SÃO PAULO MUNICIPAL HEALTH DEPARTMENT Municipal STD/AIDS Program Rua General Jardim, 36 – Térreo Vila Buarque – São Paulo/SP – Postcode 01223-010
HIV and AIDS in São Paulo City 2014
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