Mapping evidence on health promotion in HIV testing among men who have sex with men and transgender women using the social-ecological model and the vulnerability theoretical framework: a scoping review.

This study aimed to map the scientific evidence on health promotion in human immunodeficiency virus) HIV testing among men who have sex with men (MSM) and transgender women (TGW) based on the social-ecological model (i.e., individual, organizational and social levels) and the theoretical framework of vulnerability (i.e., individual, social, and programmatic levels). The reviewed studies indicated several barriers to accessing HIV testing (e.g., economic, structural, and bureaucratic) and demonstrated the potential for community approaches to promote greater access to HIV testing and minimize the stigma and discrimination associated with HIV testing, primarily through community leadership and social support networks. The socio-ecological model of health promotion and the vulnerability approach have the potential to contribute to improving HIV testing services by balancing the technical and political power of health services and providers with community participation while considering the social contexts. Therefore, there is a need for reflection on health promotion policies and programs aimed at expanding access to HIV testing among MSM and TGW through interventions that consider the social contexts and cultural perspectives. Moreover, inter-sectoral strategies aimed at improving living conditions and access to fundamental resources for maintaining health and well-being should be considered.

Zero knowledge and high interest in the use of long-acting injectable pre-exposure prophylaxis (PrEP) among adolescent men who have sex with men and transgender women in two capital cities in Brazil.

BACKGROUND: Adolescent men who have sex with men (aMSM) and transgender women (aTGW) are affected disproportionately by human immunodeficiency virus (HIV) infection. Although new methods of pre-exposure prophylaxis (PrEP), such as long-acting injectable (LAI-PrEP), have been approved by the Food and Drug Administration, their acceptability among aMSM/aTGW is not well known. METHODS: Forty-eight semi-structured interviews were conducted to assess the knowledge and interest in LAI-PrEP among aMSM/aTGW enrolled in a daily oral PrEP cohort from two capital cities of Brazil since 2019. RESULTS: Previous knowledge of LAI-PrEP remains scarce, but the high interest regarding its use has been reported. Interest in the use of LAI-PrEP is associated with eliminating the burden of daily responsibility or the risk of missing the necessary medications, lowering the costs of this method, increasing confidentiality, and decreasing the frequency of visiting PrEP clinics. The reported barriers to uptake included fear of injection, doubts on its effectiveness, side effects, and greater dependence on a health provider. CONCLUSIONS: There is an urgent need to strengthen the preventive strategies against HIV infection among the youth, enhance their knowledge and those of healthcare providers, and offer safe and new options.

Methodological issues in qualitative research on HIV prevention: an integrative review.

In view of the growing concern about the use of qualitative approach in health research, this article aims to analyze how the qualitative theoretical-methodological framework of HIV prevention is presented in empirical research. We conducted an integrative literature review with the following guiding questions: "How is the qualitative theoretical-methodological framework expressed in empirical research on HIV prevention?"; "What are the limits and potentials of the qualitative methodological designs employed?". In the qualitative methodological discussion, five dimensions guided the methodological course and the presentation of findings, from the analysis of the characterization of qualitative studies to the contextualization of the studies and the methodological approaches used, highlighting the use of semi-structured interviews with thematic content analysis. We also examined social categories and analytical references, drawing attention to the plurality of these theoretical-conceptual references and to the authors' polyphony, and identified the limits and potentials of qualitative research. This study focuses on a scientific topic that is related to a wide variety of social groups and analyzes how they are affected by it, examining issues related to social inequality and other analytical possibilities surrounding HIV prevention, and providing resources for a comprehensive methodological discussion. Hence, avoiding the risk of conducting qualitative research based on checklists that limit inventiveness and openness to different designs and forms of execution and analysis is as pivotal as ensuring that the research is consistent and detailed in publications.

[Nonclinical support workers of a reference hospital in Bahia, Brazil, as being essential and invisible in the face of COVID-19]. / Trabalhadores de apoio de um hospital de referência na Bahia, Brasil, no enfrentamento da COVID-19: essenciais e invisíveis.

In the context of hospital work during the COVID-19 pandemic, it should be acknowledged that the nonclinical support activities carried out by stretcher bearers, cleaning agents and administrative assistants were essential for the work process. This article analyzed the results of an exploratory stage of broader research with these workers in a COVID-19 hospital reference unit in the state of Bahia. Three semi-structured interviews were selected, using assumptions of ethnomethodology and ergonomics, to encourage these workers to talk about their work, The analysis concentrated on the work activities of stretcher-bearers, cleaning agents and administrative assistants from a visibility perspective. The study showed that these workers were rendered invisible by the scant social respect for their activities and level of schooling that prevailed despite the circumstances and excess workload; and revealed the essential nature of these services due to the interdependence between support work and care work and their contributions to patient and team safety. The conclusion drawn is that it is necessary to establish strategies such that these workers are valued socially, financially, and institutionally.

No contexto do trabalho hospitalar durante a COVID-19, é preciso reconhecer que as atividades de apoio exercidas por maqueiros, agentes de limpeza e auxiliares administrativos são imprescindíveis para o processo de trabalho. Este artigo analisou resultados de uma etapa exploratória de uma pesquisa ampla com esses trabalhadores dentro de uma unidade hospitalar referência para COVID-19 no estado da Bahia. Foram selecionadas três entrevistas semiestruturadas produzidas a partir da perspectiva do "fazer falar" sobre o trabalho, utilizando pressupostos da etnometodologia e da ergonomia. A análise incidiu sobre as atividades de trabalho de um maqueiro, um agente de limpeza e uma auxiliar administrativa, problematizadas a partir da díade essencialidade-invisibilidade. O estudo demonstrou que esses trabalhadores são invisibilizados pela desvalorização social de suas atividades e nível de escolaridade e resistem apesar das circunstâncias e do sobretrabalho; e evidenciou a essencialidade desses serviços pela interdependência entre o trabalho de apoio e o trabalho assistencial e suas contribuições para a segurança do paciente e da equipe. Conclui-se que é necessário criar estratégias para que esses trabalhadores sejam valorizados social, financeira e institucionalmente.

Between risk and pleasure: reflections on HIV prevention and care in the current context of PrEP use by men who have sex with men.

This study offers a set of reflections on the relationship between risk and pleasure in the field of HIV prevention and care, as it mediates new biomedical prevention/care technologies, particularly pre-exposure prophylaxis (PrEP), among men who have sex with men (MSM). We begin by investigating some studies about condomless sex between men, more specifically barebacking and PrEP use among young MSM. We base our analysis on the assumption that PrEP, as one of these new actants, has reconfigured the field of HIV prevention/care, especially in relation to the dimensions of risk and pleasure, with the potential to considerably reduce the chances of HIV infection while enabling maximum pleasure and a sense of greater safety and freedom. Despite this progress, we also problematize some of the ambivalences, tensions, and moral conflicts that still exist in the field of prevention, especially the potential for condomless sex. Finally, taking a praxiographic perspective on health care and foregrounding the situated practices of human and non-human actors/actants in interaction, we consider HIV/AIDS prevention as a more fluid, non-linear, erratic phenomenon that involves multiple types of knowledge, feelings, and participations, and is open to different kinds of experimentation. Besides a "logic of choice", we hold that health care is a permeable, continuous process that is enacted in situated practices and may produce different effects in response to a heterogeneous network of interactions.

Talking about inequities: A comparative analysis of COVID-19 narratives in the UK, US, and Brazil.

Disproportionate mortality and morbidity burdens of the COVID-19 pandemic and coinciding media coverage of public acts of violence perpetrated against people of color in 2020 precipitated reckonings with structural inequities in global, national, and local contexts. This cross-country comparative analysis aims to describe how people voice and make sense race, racism, and privilege in their experiences with COVID-19 infection in the United States, United Kingdom, and Brazil. Anchored by continuous reflection on our individual and collective positionality, we conducted an inductive comparative analysis conceptually situated in intersectionality and critical race theory. Countries used a shared qualitative methodology to collect and analyze 166 narratives of people with experience of COVID-19 infection from 2020 to 2023. We selected 19 cases that illustrate cross-national differences in peoples' acknowledgment and narration of structural privilege and disadvantage in their observations of COVID-19 in their countries and in their personal experiences. People in the US had the most fluency with voicing race directly. In Brazil, while some respondents (especially younger people) demonstrated high racial consciousness, others struggled to identify and talk about racial relationships. In the UK, people voiced racial identifications, though often within white norms of politeness and an accompanying sense of discomfort. The findings overall illustrate moments the interview becomes or does not become a space for voicing social categories and systemic underpinnings of difference in COVID-19 infections and healthcare experiences. We reflect on cross-country differences in historical and contemporary racialized discourse and elaborate on implications of focusing on voicing in qualitative research.

Building bridges to care: the experience of peer navigation in enabling linkage to PrEP for adolescent men who have sex with men and transgender women.

Vulnerable populations are at increased risk for HIV/AIDS, especially adolescent men who have sex with men (AMSM) and adolescent travestis and transgender women (ATGW). Pre-exposure prophylaxis (PrEP) is one component of combination HIV prevention and is already available for these populations in Brazil. However, ensuring its uptake entails certain challenges since inequality and barriers have traditionally marked access and linkage to the related public health services. Peer navigation could be a way of mediating the linkage process because it involves peers keeping track of others' care schedules, dynamically fostering linkage to care according to the needs of users and the actors involved in their everyday care contexts. Therefore, this study proposes analyzing peer-navigator-mediated linkage to PrEP care for 15- to 19-year-old MSM and transgender women from the PrEP1519 project in Salvador, Bahia State, Brazil. In total, 15 field notebooks/diaries, written in April-July 2019, by four peer navigators were analyzed, as were the transcripts of one focal group and 20 semi-structured interviews with adolescents (17 MSM and three trans women) between June and December 2019. Linkage via peer navigator and participant is influenced by emotional dynamics and shared personal characteristics. It is fluid and unstable and calls for care practices to be shaped to meet each participant's needs. For peer navigation to be adopted as a care strategy for sexually transmitted infection prevention and treatment, it should envisage not only increased linkage to care but also sensitivity to service users' specific characteristics and lived experiences.

Reiki therapy in the Unified Health System: meanings and experiences in integral health care.

OBJECTIVES: to understand the meanings of Reiki therapy in the Unified Health System, based on the experiences of users and therapists. METHODS: thematic oral history study, conducted with 12 users and 11 Reiki therapists, in three public health services, in the city of São Paulo, SP, in 2018. The interviews were transcribed and categorized, through thematic content analysis, with the help of the Atlas.ti software. RESULTS: for the interviewees, Reiki activates a universal energy, offering benefits to the body, mind, and spirit. The engagement of therapists in such practice was motivated by the desire to carry out voluntary work. Users claim to seek this therapy to overcome a state of suffering and use natural practices. FINAL CONSIDERATIONS: the meanings and experiences with Reiki therapy are many, but they converge in the understanding of this practice as a producer of health, well-being, and quality of life, through care centered on the integral human being.

Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study.

BACKGROUND: Adolescents face socio-structural, personal and programmatic barriers to HIV prevention services, highlighting the importance of understanding knowledge and acceptability as essential aspects to promote their broader access to pre-exposure prophylaxis (PrEP). We analyzed the acceptability of PrEP among adolescent men who have sex with men (MSM), travestis and transgender women (TGW). METHODS: A qualitative investigation was conducted as part of the formative research of the PrEP15-19 study, an ongoing demonstration study that analyzes the effectiveness of daily PrEP among adolescent MSM, travestis and TGW aged 15-19 in three Brazilian cities. A total of 37 semi-structured interviews and 6 focus groups were conducted. Building from thematic analysis focusing on participants' sexual encounters, perceptions about PrEP efficacy, and vulnerability contexts, we analyzed prospective acceptability of PrEP. FINDINGS: Knowledge about PrEP was incipient and characterized by adolescents' frequent doubts about its prescription and efficacy. The 'ideal' use of PrEP appeared together with consistent condom use, especially in casual sex. PrEP use was also mentioned as depending on increased learning about prevention management over time. Main barriers to PrEP use included the incorporation of a daily medication into participants' routine and its impact on their social lives, especially related to stigma. Concerns over short- and long-term side effects were also reported as barriers to PrEP use. TGW and travestis contrasted using PrEP with the precarity of their life conditions, and some expressed a critical vision about PrEP by associating it with pharmaceuticalization and trans necropolitics. CONCLUSIONS: Participants' low knowledge and acceptability of PrEP are circumscribed by a rigid perception of condom as the ideal prevention method and the context of their sexual relations. Prospective acceptability highlights that the successful uptake of PrEP depends on overcoming barriers of access to health services and confronting transphobia and homophobia as part of care.

When public health systems are news: a comparative analysis of the journalistic coverage in Brazil and Spain. / Quando os sistemas públicos de saúde são notícia: uma análise comparativa da cobertura jornalista no Brasil e na Espanha.

This study aimed to undertake a comparative analysis of the journalistic coverage of the National Health System (SUS) by "Folha de São Paulo", and the National Health System (SNS) by "El País". This qualitative study was anchored in the news values theory focusing on selection and construction news values and content analysis. All the contents published during 2013 of both newspapers were analyzed. "Folha" brought 88 covers, with 100 cover stories in total, and "El País" had 37 covers and 39 cover stories. "Folha's" coverage focused on the "Mais Médicos" program, while most of the news in El País focused on the privatization of the Spanish public health system. The most important news value in both was related to government. As a second category, in "Folha", controversy prevailed, focusing on the clash between the Federal Councils of Medicine and the Ministry of Health. Impact was the second most popular category in the Spanish newspaper. Concerning the news values of construction, we found that the newspapers used diverse resources. "Folha" adopted simplification in its approach, whereas "El País" invested in personalization and dramatization to sensitize readers with accounts of users, where the background was often the privatization process of health care services.

Este trabalho teve como objetivo analisar, de forma comparativa, a cobertura jornalística sobre o Sistema Único de Saúde (SUS), na "Folha de São Paulo", e sobre o Sistema Nacional de Salud (SNS), no "El País". O presente estudo, de cunho qualitativo, ancorou-se nos valores-notícia de seleção e de construção e em análise de conteúdo. Foram analisadas as capas publicadas em 2013 de ambos os jornais. A Folha trouxe 88 capas, com 100 chamadas no total e, no El País, foram 37 capas e 39 chamadas. A cobertura da "Folha" centrou-se no programa Mais Médicos; e, no "El País", a maioria das notícias enfocou a privatização da saúde pública espanhola. O valor-notícia mais presente nos dois foi governo. Como segunda categoria, na Folha, prevaleceu a polêmica, enfocando o embate que se formou entre os conselhos federais de medicina e o Ministério da Saúde. No caso do diário espanhol, a segunda categoria mais presente foi o impacto. Em relação aos valores-notícia de construção, as estratégias foram diversas. A "Folha" lançou mão da simplificação em relação à abordagem adotada, e o "El País" investiu na personalização e na dramatização para sensibilizar os leitores ao trazer relatos dos usuários em que, em muitos casos, o pano de fundo era o processo de privatização da saúde.