Abstract

Disparities in mother-to-child transmission in Northeast Brazil: regional failures within successful country programs

L. Kerr¹, M.D.S. Cavalcante¹, M. Galvão², I. Dourado³, M. Machado¹, C. Kendall<sup>4

1</sup>Universidade Federal do Ceará, Saúde Comunitária, Fortaleza, Brazil, ²Universidade Federal do Ceará, Departamento de Enfermagem, Fortaleza, Brazil, ³Universidade Federal da Bahia, Instituto de Saúde Coletiva, Salvador, Brazil, ⁴Tulane University School of Public Health and Tropical Medicine, Center for Global Health Equity, New Orleans, United States

Background: Perinatal HIV prevention has been successful in developing countries but the disparities in the success between rich countries and poor countries have also been observed. Access to PMTCT remains a challenge in many developing countries. In 2007, the Ministry of Health launched the Plan to Reduce the Vertical Transmission of HIV and Syphilis in Brazil to address this need.
Methods: A cross-sectional study of children infected by HIV and/or living with parents with HIV/AIDS and/or who died of AIDS in Ceará State, Northeast Brazil was conducted between June 2008 and January 2009 to explore socioeconomic effects of HIV status. Proportion of children with an HIV positive test was calculated and stratified by age to estimate the impact of PMTCT programs. Chi-square test was employed to compare those proportions. Stata?10.0 software was used for the calculation.
Results: We interviewed 466 adults in hospital waiting for either a personal consultation for HIV, or who were responsible for children less than 13 years old with HIV. They also provided information about their family (n=1789). Our study showed that the children that are infected with HIV and/or who live in a household with one or both parents infected with HIV or dead from AIDS live in families of low social class and educational achievement. Seroprevalence does not demonstrate a reduction between the 0-2 cohort as compared to 3-4 and 5-12 years of age.
Conclusions: Brazil, with its successful PMTCT program overall, demonstrates great disparities. Data reported from this area are equivalent to many poor areas in sub-Saharan Africa. This argues that the global concerns for areas most affected by the epidemic must consider areas within some of the most prosperous countries in the world as targets.