Spatial and temporal analysis of the human immunodeficiency virus in an area of social vulnerability in Northeast Brazil

Submitted: 7 February 2020
Accepted: 30 September 2020
Published: 26 November 2020
Abstract Views: 2578
PDF: 800
HTML: 31
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Human Immunodeficiency Virus (HIV) infection still represents an important public health problem, because it involves clinical, epidemiological, social, economic and political issues. We analyzed the temporal and spatial pattern of the HIV incidence in an area of social inequality in northeast Brazil and its association with socioeconomic indicators. An ecological study was carried out with a focus on all HIV cases reported in Alagoas State, Northeast Brazil from 2007 to 2016 using its 102 municipalities as the units of our analysis. Data from the Brazilian information systems were used. Georeferenced data were analyzed using TerraView 4.2.2 software, QGis 2.18.2 and GeoDa 1.14.0. Time trend analyses were performed by the Joinpoint Regression software and the spatial analyses included the empirical Bayesian model and Moran autocorrelation. Spatial regression was used to determine the influence of space on HIV incidence rate and socioeconomic inequalities. There was an increasing trend of HIV rates, especially in the municipalities of the interior. Significant spatial correlations were observed with the formation of clusters with emphasis on the coast of the state and in tourist regions. Spatial regression explained 46% of the dependent variable. The HIV incidence rate was positively influenced by rate of primary health care units (P=0.00), and negatively by Gini index (P=0.00) and proportion of heads of household without or low education (P=0.02). We conclude that the relationship found between indicators of better socioeconomic conditions and HIV infection suggests unequal access to the diagnosis of infection. Prevention and control strategies can be established according to each epidemiological reality.



PlumX Metrics


Download data is not yet available.


Almeida E, 2012. Econometria espacial aplicada. Campinas, SP: Alínea, 498 pp.
Anselim L, 2005. Exploring a spatial data with GeoDaTM: a work-book. Rev. version. Urbana Center for Spatially Integrated Social Science of University of Illinois, USA.
Barankanira E, Molinari N, Niyongabo T, Laurent C, 2016. Spatial analysis of HIV infection and associated individual characteristics in Burundi: indications for effective prevention. BMC Public Health 16:1-11. DOI:
Bastos F, Szwarcwald C, 2000. AIDS and pauperization: principal concepts and empirical evidence. Cad Saúde Pública 16:65-76. DOI:
Bellenzani R, Blessa C, Paiva V, 2008. Scripts em cena: HIV e mercado sexual no contexto turístico. Psicol estud 13:653-662. DOI:
Bingenheimer J, 2010. Men’s multiple sexual partnerships in 15 Sub-Saharan African countries: sociodemographic patterns and implications. Stud Fam Plann 41:1-17. DOI:
Bose S, 2017. Demographic and spatial disparity in HIV prevalence among incarcerated population in the US: a state-level analysis. Int. J. STD AIDS 29:278-86. DOI:
Brasil, 2013. Portaria nº 3.275, de 26 de dezembro de 2013. Dispõe sobre a realização de testes rápidos, na atenção básica, para a detecção de HIV e sífilis. Ministério da Saúde.
Brasil, 2014. Portaria nº 1.271, de 6 de junho de 2014. Define a Lista Nacional de Notificação Compulsória de doenças, agravos e eventos de saúde pública nos serviços de saúde públicos e privados em todo o território nacional. Ministério da Saúde.
Brasil, 2018. Ministério da Saúde. Secretaria de vigilância em saúde, departamento de vigilância, prevenção e controle das IST, HIV/Aids e hepatites virais. Boletim Epidemiológico HIV/Aids. 72 p.
Crabtreeâ€Ramírez B, Belaunzaránâ€Zamudio PF, Cortes CP, Morales M, Sued O, Sierraâ€Madero J, Cahn P, Pozniak A, Grinsztejn B, 2020. The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead. Journal of the International AIDS Society 23:e25468. DOI:
Figueiredo R, Mcbritton M, 2007. Cultura de turismo e população litorânea: contatos afetivo-sexuais de verão. Bol Inst Saúde 41.
Galvão J, 2002a. Access to antiretroviral drugs in Brazil. The Lancet 360: 1862–1865. DOI:
Galvão J, 2002b. Brazilian policy for the distribution and production of antiretroviral drugs: a privilege or a right? Cad Saúde Pública, 18: 213-219. DOI:
Garnelo L, Lima J, Rocha E, Herkrath, F, 2018. Acesso e cobertura da atenção primária à saúde para populações rurais e urbanas na região norte do Brasil. Saúde debate 42, n. 1, set. 2018. DOI:
Grangeiro A, Castanheira E, Nemes M, 2015. The reemergence of the Aids epidemic in Brazil: Challenges and perspectives to tackle the disease. Interface - Comunicação, Saúde, Educação 19:5-8. DOI:
Holanda E, Galvão M, Pedrosa N, Paiva S, Almeida R, 2015. Análise espacial da infecção pelo vírus da imunodeficiência humana entre gestantes. Rev Latino-Am Enfermagem 23:441-449. DOI:
Hofer C, Magalhães M, Frota A, Oliveira R, Abreu T, Manhães B, Bond J, Périssé A, 2018. HIV Vertical transmission in Rio de Janeiro, Brazil: does the distance matter? AIDS Care 6:1-4.
Instituto Brasileiro de Geografia e Estatística (IBGE). Censo Demográfico 2010. Características da População e dos Domicílios. Available at:
Instituto Brasileiro de Geografia e Estatística (IBGE). Estados - características da População. 2019. Available at:
Instituto de Pesquisa Econômica Aplicada (IPEA). Atlas da vulnerabilidade social nos municípios brasileiros 2015. Available at
Joint United Nations Programme on HIV/AIDS (UNAIDS), 2019. 90-90-90: na ambitious treatment target to help end the AIDS epidemic 40 pp.
Melo EA, Maksud I, Agostini R, 2018. HIV/Aids management at the primary care level in Brazil: a challenge for the Unified Health System? Rev Panam Salud Publica 42:e151. DOI:
Momenyan S, Kavousi A, Poorolajal J, Momenyan N, 2018. Spatial inequalities and predictors of HIV/AIDS mortality risk in Hamadan, Iran: a retrospective cohort study. Epidemiol Health 40. DOI:
Paiva S, Pedrosa N, Galvão M, 2019. Análise espacial da Aids e os determinantes sociais de saúde. Rev bras epidemiol 22. DOI:
Parker R, Camargo Jr K, 2000. Poverty and HIV/AIDS: anthropological and sociological aspects. Cad Saúde Pública 16:89-102. DOI:
Pascoe S, Langhaug L, Mavhu W, Hargreaves J, Jaffar S, Hayes R, Cowan F, 2015. Poverty, food insufficiency and HIV infection and sexual behaviour among young rural Zimbabwean women. PLoS One 10:1-21. DOI:
Padilla MB, Guilamo-Ramos V, Bouris A, Reyes AM, 2010. HIV/AIDS and tourism in the Caribbean: an ecological systems perspective. Am J Public Health 100,1:70-7. DOI:
Pinho CM, Dourado C, Lima MCL, Maia TS, Silva JFAS, Silva EL, Fonsêca BRL, Cabral LMS, Silva ALGGB, Andrade MS, 2020. Evaluation of HIV control measures in primary care. Electronic Journal Collection Health 12, 8:2-14. DOI:
Qian S, Guo W, Xing J, Qin Q, Ding Z, Chen F, Peng Z, Wang L, 2014. Diversity of HIV/AIDS epidemic in China: a result from hierarchical clustering analysis and spatial autocorrelation analysis. AIDS 28:1805-13. DOI:
Rocha KB, Santos RRG, Conz J, Silveira ACT, 2016. Network transversality: matrix support in the decentralization of counseling and rapid testing for HIV, syphilis, and hepatitis. Saúde Debate 40, 109:22-33. DOI:
Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, Van Lunzen J, Corbelli G, Estrada V, Geretti A, Beloukas A, Asboe D, Viciana P, Gutiérrez F, Clotet B, Pradier C, Gerstoft J, Weber R, Westling K, Wandeler G, Prins J, Rieger A, Stoeckle M, Kümmerle T, Bini T, Ammassari A, Gilson R, Krznaric I, Ristola M, Zangerle R, Handberg P, Antela A, Allan S, Phillips A, Lundgren J, 2016. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA 31:171–181. DOI:
Santos A, Paiva V, 2007. Vulnerabilidade ao HIV: turismo e uso de álcool e outras drogas. Rev Saúde Pública 41: 80-86. DOI:
Silveira R, Pinheiro R, 2014. Entendendo a necessidade de médicos no interior da Amazônia - Brasil. Rev bras educ med 38:451-459. DOI:
Simkhada P, Sharma A, Van Teijlingen E, Beanland R, 2016. Factors influencing sexual behaviour between tourists and tourism employees: a systematic review. Nepal J Epidemiol 6:530-538. DOI:
Sousa A, Pinto Júnior V, 2016. Spatial and temporal analysis of Aids cases in Brazil, 1996-2011: increased risk areas over time. Epidemiology and Health Services 25:467-476. DOI:
Steinert J, Cluver L, Melendez-Torres G, Herrero R, 2017. Relationships between poverty and AIDS illness in South Africa: an investigation of urban and rural households in KwaZulu-Natal. Glob Public Health 12:1183-1199. DOI:
Xing J, Li Y, Tang W, Guo W, Ding Z, Ding G, Wang L, Qin Q, Xu Y, Qian S, Mahapatr T, Wang L, 2014. HIV/AIDS Epidemic among older adults in China during 2005–2012: results from trend and spatial analysis (2014). Clinical Infectious Diseases 59:53–60. DOI:
Wabiri N, Shisana O, Zuma K, Freeman J, 2016. Assessing the spatial nonstationarity in relationship between local patterns of HIV infections and the covariates in South Africa: a geographically weighted regression analysis. Spat Spatiotemporal Epidemiol 16:88-99. DOI:
Wand H, Ramjee G, 2015. Spatial clustering of “measured†and “unmeasured†risk factors for HIV infections in hyper-endemic communities in KwaZulu-Natal, South Africa: results from geoadditive models. AIDS care 27:1375–1381. DOI:
Zambenedetti G, Silva R, 2016. Descentralização da atenção em HIV/Aids para a atenção básica: tensões e potencialidades. Physis 26:785-806. DOI:
Zhang Y, Xiao Q, Zhou L, Ma D, Liu L, Lu R, Yi D, Yi D, 2015. The AIDS epidemic and economic input impact factors in Chongqing, China, from 2006 to 2012: a spatial-temporal analysis. BMJ Open, 5. DOI:
Zulu L, Kalipeni E, Johannes E, 2014. Analyzing spatial clustering and the spatiotemporal nature and trends of HIV/AIDS prevalence using GIS: the case of Malawi, 1994-2010. BMC Infectious Diseases 14. DOI:

How to Cite

Melo, G. C. de, Oliveira, E. C. A. de, Leal, I. B., Silva, C. P. M. de F. S., Beltrão, R. A., Santos, A. D. dos, Reis, R. K., Nunes, M. A. P., & Araujo, K. C. G. M. de. (2020). Spatial and temporal analysis of the human immunodeficiency virus in an area of social vulnerability in Northeast Brazil. Geospatial Health, 15(2).

List of Cited By :

Crossref logo

Similar Articles

You may also start an advanced similarity search for this article.