Race and color information improve the HIV/AIDS control strategies in São Paulo city

Abstract

 Introduction: Although the Aids epidemic in São Paulo city (SPC) has concentrated in men who have  sex with men, sex workers, drug users and incarcerated people, known as key populations, the analysis  according to race/color brings important information to improve the HIV/Aids control strategies. The  Municipal Health Department (MHD) of São Paulo records the information about race/color since 2004.  As the 2010 Census recorded the race/color information for the entire Brazilian population, these data  allowed to calculate the rates of Aids detection (DR) and of the mortality (MR). Objective: To analyze  the Aids epidemic according to race/color in SPC. Methodology: From the cases of Aids registered in  the National System of Diseases Compulsory Notification (DCN/SINAN), the rates of Aids detection  and of mortality were calculated according to the race/color variable in SPC from 2010 to 2014. Results:  In the analyzed period, the Aids detection rate (DR) per 100,000 inhabitants were reduced in white (37.3  to 30.7) and black (61 to 51.8) men, and the rates have risen among dark-skinned men (37.9 to 40,6).  Among white women (10.7 to 7.3), black (31.3 to 21.4) and dark-skinned women (16.5 to 13.4), the  variations were negative. However, when the mortality rates (MR) were analyzed by the same criteria,  while the MR fell down among the white males (9.3 to 8.1) and females (2.9 to 2.5), among the black  males (18,6 to 25.6), females (7.7 to 10.3) and dark-skinned males (8.4 to 11.3) and females (4.9 to 5.3),  the MR grew up in the SPM. DR and MR among the dark-skinned male and female persons showed  the intermediate values of those presented by white and black persons. Discussion: In the SPC, the Aids  epidemic has been more harmful to black and dark-skinned persons when compared to white people.  A disparity between the evolution of DR and MR among the blacks and dark-skinned patients was  found; and the apparent improvement of the DR without the expected reduction of MR may actually  represent low access to HIV testing among non-white people. There is a need to identify the possible  barriers to HIV testing and the early treatment of blacks and dark-skinned patients. Among the probable  causes that explain the found results, the institutional racism cannot be ruled out. Conclusion: From  the presented findings, the strategies have been implemented to reduce the impact of Aids among the  non-white population of SPC, including a broader articulation with the Civil Society Organizations.  Everyone, regardless of skin color, the access to information, prevention, diagnosis and treatment has  to be at hand. This is in accordance with the principle of equity, one of the bases of the Brazilian Health  System-SUS. Analysis on the Aids epidemic according to the race/color should be performed for not  increasing the heavy burden of stigma and discrimination that affect the black population in Brazil.