Rethinking STI control strategies: epidemiological and social determinants insights from a combined ecological and cross-sectional study in a Brazilian capital.

BACKGROUND

Sexually transmitted infections (STIs) are associated with substantial adverse outcomes, including genital symptoms, pregnancy complications, infertility, increased risk of HIV transmission, and significant psychosocial impacts. Identifying priority areas for action and key elements to inform discussions on expanding access to STI prevention measures, including HIV pre-exposure prophylaxis (PrEP), is essential for planning effective control strategies.

METHODS

This ecological study aimed to analyze the occurrence of notifiable STIs using data from a medium-sized state capital during the five years preceding the introduction of PrEP. Data on confirmed cases of notifiable STIs (HIV/AIDS, syphilis, and viral hepatitis) reported to the Brazilian Notifiable Diseases Information System (SINAN) in Campo Grande from 2014 to 2018, along with socioeconomic and demographic data, were assessed. Spatial analysis methods were used to identify clusters and areas with increased risk of STI occurrence.

RESULTS

A total of 10,074 STI cases were reported to SINAN. Syphilis was the most frequently reported infection, accounting for 78.6% of cases, followed by HIV/AIDS (19.5%) and hepatitis B (1.9%). Higher risk for all three STIs was observed among non-white men over the age of 20 low educational attainment. Among HIV cases specifically, heterosexual individuals were the most affected, based on available data regarding sexual orientation. Spatial analysis revealed clusters of high incidence in peripheral neighborhoods of the city. Additionally, correlation analysis indicated an association between STI occurrence and lower socioeconomic conditions.

CONCLUSIONS

These findings suggest that STI control strategies should be re-evaluated to enhance coverage among individuals with the sociodemographic profile identified in this study, underscoring the need to broaden prevention strategies beyond traditionally defined key populations.