Abstract

PIP: An evaluation of the dynamics of the AIDS epidemic in Brazil is presented employing techniques of geographical analysis. Results of research undertaken in the US (especially in New York City) were compared with those of a 1994 investigation carried out in the city of Sao Paulo, Brazil, by A. Grangeiro. In both cases geographical patterns of socio-demographic variables correlated with different patterns of the spread of the AIDS epidemic through the transmission groups. In the 1980s and in the beginning of the 1990s in New York City two kinds of epidemics erupted: one in the White gay community, which was subjected to intense preventive efforts, and the other one among intravenous drug users (IDUs) and young Black and Hispanic women. Recent characteristic trends of the AIDS epidemic in Brazil included the spread toward medium sized cities and to frontiers, cases among the poor and underprivileged, and the increase of heterosexual transmission and among IDUs. In 1994 the prevalence of HIV/AIDS was 36.3 cases per 100,000. In the state of Sao Paulo the rates were 19.2/100,000 in 1992 and 12/100,000 during 1993-94, and in Rio de Janeiro they amounted to 10.2 in 1992 and 9.0 in 1993/94. The incidence rose in the beginning of the 1990s in the southeast and central-east regions (7.0/100,000 in 1991) and in the states of the north, e.g., in Roraima (7.2/100,000 in 1991). The geographical distribution of the AIDS cases registered between 1987-1993 throughout Brazil was evaluated by means of work-sheets, maps, and statistics. Gravimetric Centers (GCs) of AIDS were situated within a triangle formed by the three main metropolitan areas of the southeast encompassing Sao Paulo, Rio de Janeiro, and Belo Horizonte. These GCs, especially S. Paulo, pushed towards the south and the northwest over this period in accordance with migration patterns. These complex geographical, socio-demographic, and transmission patterns pose difficulties for the development of prevention strategies.