AIDS and Behavior

, Volume 23, Issue 6, pp 1541–1551 | Cite as

The Intersection of HIV, Social Vulnerability, and Reproductive Health: Analysis of Women Living with HIV in Rio de Janeiro, Brazil from 1996 to 2016

  • Christine M. ZachekEmail author
  • Lara E. Coelho
  • Rosa M. S. M. Domingues
  • Jesse L. Clark
  • Raquel B. De Boni
  • Paula M. Luz
  • Ruth K. Friedman
  • Ângela C. Vasconcelos de Andrade
  • Valdilea G. Veloso
  • Jordan E. Lake
  • Beatriz Grinsztejn
Original Paper


Comprehensive care for sexual and reproductive health (SRH) and social needs for women living with HIV remains limited globally. We aimed to assess trends in baseline sociodemographic, clinical, sexual, and reproductive characteristics among a cohort of HIV-infected women in Rio de Janeiro from 1996 to 2016. Participants were stratified into four time periods based on year of enrollment; we compared cross-sectional data from each period. Of 1361 participants (median age 36), most were black or mixed race (60.1%), unemployed (52.1%), and without secondary education (54%). Adolescent pregnancy was common (51.5%), and 18.3% reported sexual debut at < 15 years old. Nearly half (45.2%) had < 5 lifetime sexual partners, yet prior syphilis and oncogenic human papillomavirus prevalence were 10.9% and 43.1%, respectively. Lifetime prevalence of induced abortion was 30.3%, and 16% used no contraceptive method. Future research should explore interactions between social vulnerability, HIV, and poor SRH outcomes and healthcare models to alleviate these disparities.


HIV Sexual and reproductive health Women Disparities Brazil 


La atención integral de la salud sexual y reproductiva (SSR) y necesidades sociales para las mujeres que viven con VIH ha estado limitada al nivel global. Nuestro objetivo fue evaluar las tendencias de características sociodemográficas, clínicas, sexuales y reproductivas en una cohorte de mujeres infectadas por VIH en Río de Janeiro entre 1996 y 2016. Los participantes se estratificaron en cuatro períodos de tiempo según el año de enrolamiento; comparamos datos transversales de cada período. De 1361 participantes (mediana de edad 36), la mayoría eran negras o de raza mixta (60,1%), desempleadas (52,1%) y no tenían educación secundaria (54%). El embarazo en la adolescencia fue común (51,5%) y el 18,3% reportaron iniciación sexual antes de los 15 años de edad. Casi la mitad (45,2%) tenían menos de 5 parejas sexuales durante sus vidas, sin embargo, la prevalencia de la sífilis previa y del virus del papiloma humano oncogénico fue del 10,9% y 43,1%, respectivamente. La prevalencia de vida de aborto inducido fue 30,3% y el 16% no utilizaron ningún método anticonceptivo. Futuras investigaciones deberían explorar las interacciones entre la vulnerabilidad social, el VIH y los resultados adversos de SSR y los modelos de cuidado de la salud para aliviar estas disparidades.

Palabras clave

VIH Salud sexual y reproductiva Mujeres Disparidades Brasil 



We would like to thank the INI-Fiocruz study participants and staff who devoted their time and efforts to make this project possible. We would also like to thank Eddy Segura for his assistance with abstract translation.


This work was supported in part by the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at the University of California San Francisco. CMZ is a Doris Duke International Clinical Research Fellow. This work was also supported by the US National Institute of Health Grants NIH R25 MH087222 to JLC and K23 AI110532 to JEL. RBDB acknowledges funding from the Research Funding Agency of the State of Rio de Janeiro (FAPERJ) E-26/203.154/2017 and from the National Council of Technological and Scientific Development (CNPq) 310541/2017-4.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Christine M. Zachek
    • 1
    • 2
    Email author
  • Lara E. Coelho
    • 3
  • Rosa M. S. M. Domingues
    • 3
  • Jesse L. Clark
    • 2
  • Raquel B. De Boni
    • 3
  • Paula M. Luz
    • 3
  • Ruth K. Friedman
    • 3
  • Ângela C. Vasconcelos de Andrade
    • 3
  • Valdilea G. Veloso
    • 3
  • Jordan E. Lake
    • 2
    • 4
  • Beatriz Grinsztejn
    • 3
  1. 1.School of MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of MedicineUniversity of California Los Angeles David Geffen School of Medicine, South American Program in HIV Prevention Research (SAPHIR)Los AngelesUSA
  3. 3.Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
  4. 4.Department of MedicineThe University of Texas Health Science Center at Houston (UTHealth)HoustonUSA

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