Epidemiologia da Sífilis e HIV em cortadores manuais de cana-de-açúcar: bases para ações de promoção da saúde

Abstract

In Brazil, manual cane harvesting is still common in less developed regions and is predominantly carried out by migrant seasonal workers, mainly from the Northeast of Brazil. Migration results in family isolation, remaining far from their sexual partners. This situation may favor unprotected sex and thus make them vulnerable to sexually transmitted infections (STIs), including syphilis and Human Immunodeficiency Virus (HIV). The objective of this study was to investigate the epidemiology of syphilis and HIV in cane cutters in Goiás and Paraíba. It is a cross-sectional and analytical study carried out from February to September 2016, in the states of Goiás and Paraíba, in five sugar-alcohol plants. A total of 937 cane cutters participated in the study. All were interviewed and tested for serological markers of HIV (anti-HIV 1 and 2) and syphilis (anti-T.pallidum) by the rapid test (TR). The samples were positive for anti-T. pallidum (syphilis in life) were retested by VDRL (active syphilis). All of them were male, ranging in age from 18 to 67 years and almost half (47.4%) had up to four years of study. The majority were married or had a stable union (77.5%), had no prison history (90.4%) and reported an occupational accident (53.4%). A state analysis showed a higher proportion of sugarcane cutters in Goiás that reported multiple sexual partners, which consistently used condoms during sexual intercourse, consumed alcoholic beverages and cocaine (p <0.05). On the other hand, the frequency of homosexual relationships was higher in Paraiba cutters (p <0.05). A global prevalence of anti-HIV-1 of 0.3% (95% CI: 0.1-1.0), syphilis in life of 2.4% (95% CI: 1.6-3.6) and active syphilis of 1.2% (95% CI: 0.6-2.1). The variables religion and marijuana consumption were independently associated with syphilis in life. However, the first variable was shown as a protective factor (adjusted OR: 0.3, 95% CI: 0.1-0.8), and the second was risk-adjusted (adjusted OR: 2.94, 95% CI: 1,1-7,7). The results of this study show sociodemographic and behavioral differences between Goiás and Paraíba sugarcane cutters and the circulation of syphilis and HIV-1 in this impoverished population that has the potential for viral dissemination. The agreement of the public health services with sugar and alcohol industries to carry out prevention and health promotion actions in sugarcane cutters' workplaces would be an important strategy directed at this population of male rural workers.