title: Reconstructing the AIDS epidemic among injection drug users in Brazil.
abstract: The HIV/AIDS epidemic among injection drug users (IDUs) in Brazil has been unique in terms of temporal and geographical contrasts. This analysis explores these contrasts through the use of multilevel modeling. Standardized AIDS incidence rates among IDUs for Brazilian municipalities (1986-2000) were used as the dependent variable, with a set of social indicators as independent variables (covariates). In some States of the North/Northeast, the epidemic among IDUs has been incipient. The São Paulo epidemic extended to reach a network of municipalities, most of which located far from the capital. More recently, on a smaller scale, a similar extension has been observed in the southernmost States of the country. Both "number of physicians per inhabitant" and "standard distance to the State capital" were found to be associated with AIDS incidence. AIDS cases among IDUs appeared to cluster in wealthier, more developed municipalities. The relative weight of such extensive dissemination in key, heavily populated States prevails in the Brazilian IDU epidemic, defining a central-western-southeastern strip of wealthier middle-sized municipalities and more recently a southern strip of municipalities deeply affected by the epidemic in this population.
authors.affiliation: Centro de Informação Científica e Tecnológica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. mariana@cict.fiocruz.br
authors.forename: Mariana A
authors.initials: MA
authors.lastname: Hacker
authors.forename: Iuri C
authors.initials: IC
authors.lastname: Leite
authors.forename: Adrian
authors.initials: A
authors.lastname: Renton
authors.forename: Tania Guillén de
authors.initials: TG
authors.lastname: Torres
authors.forename: Renata
authors.initials: R
authors.lastname: Gracie
authors.forename: Francisco I
authors.initials: FI
authors.lastname: Bastos
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012959:Socioeconomic Factors; D013029:Space-Time Clustering; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*