[Decentralization of the HIV/AIDS epidemic and inter-municipal flow of hospital admissions in the Zona da Mata, Minas Gerais State, Brazil: a spatial analysis].
The aim of this article was to analyze the decentralization of the HIV/AIDS epidemic (a shift towards rural areas or away from the coast) and to investigate access to HIV/AIDS services from 1988 to 2002 in the Zona da Mata, Minas Gerais State, Brazil. An ecological study was performed using temporal and spatial approaches. A hospital admissions flow between municipalities developed, and the reference group was AIDS patients over 15 years of age admitted in 1996 and 2004, residing in municipalities in the Zona da Mata. There were 2,469 reported AIDS cases in individuals over 15 during the period. Mean incidence and mortality rates were calculated and recalculated by a local empirical Bayesian method in order to more clearly represent the municipalities with the highest concentration of cases and deaths. Decentralization of the epidemic was observed. Juiz de Fora was the municipality with the most cases and may have acted as a hub for spread of HIV in the region. Hospital care for AIDS cases in the Zona da Mata was concentrated in that municipality. There is a strong need to further investigate why referral hospitals in other municipalities in the region have not participated in providing management and care for HIV/AIDS patients.
Secretaria Municipal de Saúde de Cataguases, Avenida Astolfo Dutra 600, Cataguases, MG, Brazil. clautartaglia@gmail.com
Cláudia Tartaglia
CT
Reis
Dina
D
Czeresnia
Christovam
C
Barcellos
Wagner Souza
WS
Tassinari
D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D001938:Brazil / Q000453:epidemiology; D003695:Delivery of Health Care / Q000458:organization & administration*; D003710:Demography; D004196:Disease Outbreaks; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy; D006297:Health Services Accessibility; D006760:Hospitalization; D006773:Hospitals, Municipal / Q000458:organization & administration; D006801:Humans; D015994:Incidence; D011157:Population Dynamics; D014505:Urban Population