Methods We searched PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature for studies of the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless populations. We also searched bibliographic indices, scanned reference lists, and corresponded with authors. W e explored potential sources of heterogeneity in the estimates by metaregression analysis and calculated prevalence ratios to compare prevalence estimates for homeless people with those for the general population. Findings We identifi ed 43 eligible surveys with a total population of 63 812 (59 736 homeless individuals when duplication due to overlapping samples was accounted for). Prevalences ranged from 0·2% to 7·7% for tuberculosis, 3·9% to 36·2% for hepatitis C virus infection, and 0·3% to 21·1% for HIV infection. We noted substantial heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus infection, and HIV infection (all Cochran’s χ² signifi cant at p<0·0001; I²=83%, 95% CI 76–89; 95%, 94–96; and 94%, 93–95; respectively). Prevalence ratios ranged from 34 to 452 for tuberculosis, 4 to 70 for hepatitis C virus infection, and 1 to 77 for HIV infection. Tuberculosis prevalence was higher in studies in which diagnosis was by chest radiography than in those which used other diagnostic methods and in countries with a higher general population prevalence than in those with a lower general prevalence. Prevalence of HIV infection was lower in newer studies than in older ones and was higher in the USA than in the rest of the world. Interpretation Heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus, and HIV suggests the need for local surveys to inform development of health services for homeless people. The role of targeted and populationbased measures in the reduction of risks of infectious diseases, premature mortality, and other adverse outcomes needs further examination. G uidelines for screening and treatment of infectious diseases in homeless people might need to be reviewed.

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Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis.

The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population’s access to health services and original articles with full text available online. The electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services. The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.

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Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review.

books by two independent reviewers. We also searched the research projects of 29 out of 40 Iranian universities of medical sciences from their websites. We contacted the Center for Disease Control (CDC) of the Iranian Ministry of Health and the Iranian Blood Transfusion Organization (IBTO) for searching national reports from the study time period. Medical students’ theses were also evaluated by two independent reviewers from the Iranian center for scientific documents and records (IranDoc). Finally, we consulted eight expert HCV researchers in Iran and searched their personal archives for additional citations. Forward and backward citations of searched items were also performed. Critical appraisal and selection of studies Two independent reviewers reviewed all citations thoroughly and checked for eligibility criteria to include the studies in the analysis. The inclusion criteria were all cross-sectional studies that specified temporal and geographic characteristics of the study; sufficiently declared objectives; and that used a valid 213 Seyed Moayed Alavian et al. Hepatitis Monthly, Summer 2009; 9(3): 211-223 sampling method that allowed for a generalization of the findings to the target population, valid measurement instruments for all study subjects, and appropriate analytic methods for the given sampling design and demographic characteristics. We revised the criteria developed by Sharifi et al. for this purpose (12). Data extraction After evaluating studies on these criteria, we extracted the findings of the included studies to Excel spreadsheets. The extracted data were year of the study, first author, province and district of the study, sample population, sampling method, sample size, HCV Antibody detection method, HCV Antibody kit name, mean age and standard error (SE) of subjects, percentage of male subjects, and HCV point prevalence in study subjects and/or in males/females and its SE. If there were other parameters reported other than SE, such as standard deviation, confidence interval, and/or P.value, the proper modifications were performed to calculate SE. Statistical analysis We analyzed the extracted data to estimate the point prevalence of HCV infection and its 95% confidence interval (CI) and used a Cochrane Q-test with a significance level of < 0.1 for checking the statistical heterogeneity of the results. We used a meta-analysis method with the “meta” command using fix/random model based on the results of the heterogeneity test. It seems that the meta-analysis method would not have been a suitable method to achieve the objectives of this systematic review because the weighting system of this method only considers sample size and not the size of the provincial population. We used a survey data analysis method to calculate the estimate of the nationwide prevalence rate considering the weight of each province as the ratio of the provincial population to the sample size(s), where the population of each province was retrieved from the Iranian national census at 2006 (7). In provinces with more than one prevalnce study (Tehran and Sistan-va-Baluchestan), the provincial prevalence was calculated by a meta-analysis of the studies, and the total sample size was determined by adding all study sample sizes. The analysis was performed with STATA 9.1 software (STATA Corp. LP). The results were shown in geographic maps using Arc View 3.2a software (ESRI Inc. NY).

Hepatitis C infection in the general population of Iran: a systematic review.

Addressing Health Care Disparities Among Sexual Minorities

Antiretroviral pre-exposure prophylaxis (PrEP) is recommended to prevent HIV infection among high-risk men who have sex with men (MSM) though not available in Brazil where the HIV epidemic persists unabated in this group. This cross-sectional study describes PrEP awareness and willingness and associated factors among MSM and transvestite/transgender women (trans women) pre-screened for the PrEP Brasil study. Awareness was reported by 61.3 % of the participants and was associated with age, education, site, study period and prior HIV testing. Most participants (82.1 %) were willing to use PrEP, which was associated with site, study period, number of male condomless anal sexual partners and anal sex with HIV positive/unknown partners. PrEP information is need among young and less educated individuals. Willingness to use PrEP was high and future studies should be conducted to confirm PrEP acceptability and the characteristics of the population who chose to adopt this intervention.

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Awareness and Willingness to Use Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men and Transgender Women in Brazil

This article focuses on the relationship between health care for women who have sex with women and representations of gender, sexuality, and the body. The study used ethnographic observation and in-depth interviews held from 2003 to 2006, with 30 women ranging from 18 to 45 years of age, belonging to different social segments, backgrounds, and sexual identities, living in Greater Metropolitan Sao Paulo. Analysis of the material pointed to greater difficulty in accessing gynecological care for lower-income women, those who had never had sex with men, or those with masculine body language. Not only the negative representations and experiences in relation to health services, but also identity constructions concerning gender and sexuality, are related to difficulties in accessing health care. Although a large share of the relevant international literature emphasizes the relationship between homophobia and decreased access to health services, the findings suggest that although situations involving discrimination are a reality, they were not considered impediments to the search for care, and were more associated with reporting of erotic practices and preferences at the services.

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Access to sexual health care for women who have sex with women in São Paulo, Brazil

OBJECTIVE: To estimate the prevalence of HIV infections, as well as hepatitis B and C and syphilis viruses in homeless people METHODS: Cross-sectional study with educational intervention, conducted in the city of Sao Paulo, between 2002 and 2003 A convenience sample of homeless people who used night shelters was selected, according to the following criteria: aged 18 or older and not showing psychiatric disturbances During interviews, sociodemographic and behavioral data were gathered and HIV, hepatitis B and C and syphilis laboratorial tests and post-test counseling were carried out RESULTS: A total of 330 shelter users participated, with an average age of 402 years, 809% of them male, having lived on the streets for one year in average Prevalences of 18% for HIV, 85% for hepatitis C virus, 306% for previous hepatitis B infection, 33% for chronic or acute infection by hepatitis B virus, and 57% for syphilis The consistent use of condoms was referred to by 213% of interviewees and the use of injecting drugs by 3% of them Positivity was 10% for HIV and 50% for hepatitis C virus among injectable drug users, versus 15% for HIV and 73% for hepatitis C among the others, showing an association between the virus and the use of injecting drugs Previous imprisonment was referred to by 79% of women and 266% of men, with a prevalence of 26% for HIV and 171% for hepatitis C virus CONCLUSIONS: The high prevalences of HIV and hepatitis B and C viruses require prevention programs based on vaccination against hepatitis B, early diagnosis of these infections and placement of homeless people into health services

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HIV infection, hepatitis B and C and syphilis in homeless people, in the city of São Paulo, Brazil

Sopa de letrinhas: Movimento homossexual e a produção de identidades coletivas nos anos 90

We conducted a time-location sampling sero-behavioral surveillance survey of men who have sex with men (MSM) in Sao Paulo, Brazil, the largest city in Latin America and the Southern Hemisphere (N = 1,217 interviewed with serological results for 771). HIV prevalence was 15.4 % (95 % CI 11.6–20.1), with only 45.8 % previously aware of their infection. HIV prevalence achieved 6.4 % among youth 18–24 years and was higher among MSM with lower socio-economic status. In multivariate analysis, correlates of HIV were older age, gay identity, lower socio-economic status, social networks with HIV-positive MSM, receptive anal sex, and internet sex partners. Policy change towards increasing avenues for HIV testing coupled with antiretroviral treatment regardless of CD4 count or stage of disease stand to benefit the MSM community if scaled up fast enough

High HIV Prevalence among Men who have Sex with Men in a Time-Location Sampling Survey, Sao Paulo, Brazil

Resumo O artigo objetiva problematizar aspectos relacionados a genero e direitos sexuais, bem como suas implicacoes no campo da saude. Para isso, utiliza-se o ensaio como desenho metodologico. Na primeira parte, procura-se discutir o feminicidio, destacando-se que ha mortes de mulheres devido ao fato de serem mulheres que se constituem de situacoes de lesa humanidade ou femi-genocidio. Em seguida, trata-se da diversidade sexual e de genero, com enfase na fragilidade do direito a ter direitos, que se expressa na piora das condicoes de saude da populacao LGBTI (Lesbicas, Gays, Bissexuais, Travestis, Transexuais e Intersexo). Por ultimo, discute-se o reconhecimento da pluralidade de genero e o limite aos direitos dos corpos fora da norma, criticando-se a reiteracao da normatividade cisgenera e binaria que pode reforcar a vulnerabilidade em saude de pessoas trans e demais corpos e identidades nao normativos. Conclui-se que, nos 30 anos de existencia do Sistema Unico de Saude, nao se pode desconsiderar avancos no campo politico, muitos deles criados por conta de movimentos sociais e iniciativas que procuram enfrentar o feminicidio e a nao assistencia adequada as pessoas LGBTI. Frente aos desafios, reitera-se a relacao necessaria entre promocao da saude e protecao de direitos humanos relacionados a genero e a sexualidade.

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Regina Facchini

Papers

Access to sexual health care for women who have sex with women in São Paulo, Brazil

HIV infection, hepatitis B and C and syphilis in homeless people, in the city of São Paulo, Brazil

Sopa de letrinhas: Movimento homossexual e a produção de identidades coletivas nos anos 90

High HIV Prevalence among Men who have Sex with Men in a Time-Location Sampling Survey, Sao Paulo, Brazil

Gender and sexual rights: their implications on health and healthcare