Barreiras no acesso à Atenção Básica pela população LGBTQIA+: uma revisão integrativa / Barriers to access to Primary Care for the LGBTQIA+ population: an integrative review / Barreras de acceso a la Atención Primaria para la población LGBTQIA+: una revisión integradora

Introdução: A população LGBT constitui um grupo cujo acesso à saúde é historicamente limitado e ainda hoje é atravessado por questões complexas que envolvem desde a formação dos profissionais de saúde à própria estrutura organizacional do sistema assistencial. Apesar disso, a literatura científica acerca dos entraves que estes indivíduos enfrentam na Atenção Primária à Saúde (APS), porta de entrada e coordenadora do cuidado, é particularmente escassa. Objetivo: Caracterizar as barreiras envolvidas no acesso da população LGBTQIA+ à APS. Métodos: Trata-se de uma revisão integrativa de estudos científicos selecionados nas plataformas de busca PubMed e Portal Regional da Biblioteca Virtual em Saúde (BVS), sendo utilizados como descritores de busca os termos Minorias Sexuais e de Gênero, LGBTQIA+, APS e Acesso aos Serviços de Saúde. Foram incluídos artigos completos sem restrição de período nos idiomas inglês, português e espanhol. Foram excluídos textos do tipo: revisão bibliográfica; editorial; protocolos de estudo; opinião de especialistas e relato de experiência. Resultados: Foram selecionados 14 artigos, sendo seus conteúdos atribuídos a três eixos de discussão: barreiras físicas/organizacionais, barreiras sociais e barreiras relacionadas à educação/formação dos profissionais da saúde. Conclusões: É essencial expandir as discussões sociais acerca da temática de diversidade sexual e de gênero de modo a desconstruir os preconceitos instituídos; ademais, faz-se fundamental a revisão da estrutura física e organizacional ­ bem como da formação dos profissionais da saúde ­ para criar um ambiente assistencial inclusivo na atenção básica à população LGBTQIA+.

Introduction: The LGBT population is a group whose access to health care has historically been limited and is still crossed by complex issues ranging from the training of health professionals to the very organisational structure of the care system. Despite this, the scientific literature on the obstacles faced by these individuals in Primary Health Care, the gateway and coordinator of care, is particularly scarce. Objective: To characterize the barriers involved in the access of the LGBTQIA+ population to primary care. Methods: This is an integrative review of scientific studies selected from the PubMed and Virtual Health Library (VHL) Regional Portal search platforms, using as search descriptors the terms Sexual and Gender Minorities, LGBTQIA+, Primary Health Care, Health Services Accessibility. Complete articles were included without time restriction, in English, Portuguese and Spanish. Texts such as: literature reviews; editorials; study protocols; expert opinions and experience reports were excluded. Results: The review was composed by the selection of 14 studies, and their contents were assigned to three axes of discussion: physical/organizational barriers, social barriers, barriers related to education/training of health professionals. Conclusions: It is essential to expand the social discussions about the theme of sexual and gender diversity to deconstruct the established prejudices, moreover, it is essential to review the physical and organizational structure ­ as well as the training of health professionals ­ to create an inclusive care environment.

Introducción: La población LGTB es un colectivo cuyo acceso a la atención sanitaria ha estado históricamente limitado y sigue atravesado por complejas cuestiones que van desde la formación de los profesionales sanitarios hasta la propia estructura organizativa del sistema asistencial. A pesar de ello, la literatura científica sobre los obstáculos a los que se enfrentan estas personas en la Atención Primaria de Salud, puerta de entrada y coordinadora de la atención, es especialmente escasa. Objetivo: Caracterizar las barreras que supone el acceso de la población LGBT a la atención primaria. Métodos: Se trata de una revisión integradora de estudios científicos seleccionados de las plataformas de búsqueda PubMed y Portal Regional de la Biblioteca Virtual de Salud (BVS), utilizando como descriptores de búsqueda los términos Minorías Sexuales y de Género, LGBT, Atención Primaria de Salud, Accesibilidad a los Servicios de Salud. Se incluyeron artículos completos sin restriccíon de período, en inglés, portugués y español. Se excluyeron textos como revisiones bibliográficas, editoriales, protocolos de estudio, opiniones de expertos e informes de experiencias. Resultados: El corpus final de artículos se compuso de la selección de 14 artículos, y sus contenidos se asignaron a tres ejes de discusión: barreras físicas/organizativas, barreras sociales, barreras relacionadas con la educación/formación de los profesionales sanitarios. Conclusiones: Es esencial ampliar las discusiones sociales sobre el tema de la diversidad sexual y de género de manera que se deconstruyan los prejuicios institucionales, además, se hace fundamental la revisión de la estructura física y organizacional ­ así como la formación de los profesionales de la salud ­ para crear un ambiente asistencial inclusivo.

O (des)cuidado em saúde às pessoas LGBTQIAP+ dispensado por profissionais em unidades básicas de saúde / The (lack of)health care provided to LGBTQIAP+ people by professionals in primary care centers / El (des)cuidado en salud a las personas LGBTQIAP+ dispensado por profesionales en unidades básicas de salud

Objetivo: compreender o cuidado em saúde dispensado às pessoas LGBTQIAP+ por profissionais em Unidades Básicas de Saúde, a partir do referencial teórico da Política Nacional de Saúde LGBT (PNSILGBT) estabelecida pelo Sistema Único de Saúde (SUS). Método: estudo descritivo, com abordagem qualitativa, que entrevistou 12 profissionais de saúde da Atenção Básica. Os dados coletados passaram pela Análise Lexical utilizando-se do software IRAMUTEQ. Resultados: emergiram três categorias temáticas que possibilitaram compreender que os profissionais reconhecem as violências praticadas na assistência a essa população, as barreiras no acesso e as dificuldades enfrentadas por pessoas LGBTQIAP+. Considerações finais: o desconhecimento das políticas e a não percepção das consequências dessas ações para a saúde dessa população remete muito mais ao (des)cuidado do que efetivamente ao cuidado condizente as suas reais necessidades em saúde.

Objective: to understand the health care provided to LGBTQIAP+ people by professionals in Primary Care Centers, based on the theoretical framework of the National LGBT Health Policy (PNSILGBT) established by the Unified Health System (SUS). Method: a descriptive study with a qualitative approach, which interviewed 12 primary care health professionals. The data collected was subjected to Lexical Analysis using the IRAMUTEQ software. Results: Three thematic categories emerged which made it possible to understand that professionals recognize the violence practiced in assisting this population, the barriers to access and the difficulties faced by LGBTQIAP+ people. Final considerations: the lack of knowledge of the policies and the lack of perception of the consequences of these actions for the health of this population leads much more to (lack of)care than to care in line with their real health needs.

Objetivo: comprender el cuidado en salud brindado a las personas LGBTQIAP+ por profesionales en Unidades Básicas de Salud, partiendo del marco teórico de la Política Nacional de Salud LGBT (PNSILGBT) establecida por el Sistema Único de Salud (SUS). Método: estudio descriptivo, con enfoque cualitativo, que entrevistó a 12 profesionales de salud de la Atención Básica. Los datos recogidos fueron analizados mediante Análisis Léxico utilizando el software IRAMUTEQ. Resultados: surgieron tres categorías temáticas que permitieron comprender que los profesionales reconocen las violencias ejercidas en la asistencia a esta población, las barreras en el acceso y las dificultades enfrentadas por personas LGBTQIAP+. Consideraciones finales: el desconocimiento de las políticas y la no percepción de las consecuencias de estas acciones para la salud de esta población reflejan mucho más el (des)cuido que efectivamente el cuidado acorde a sus reales necesidades en salud.

The challenges, opportunities and future of comparative physiology in the Global South: perspectives of early-career researchers.

Researchers in the Global South (GS, developing countries) make valuable contributions to the field of comparative physiology, but face economic and scientific disparities and several unique challenges compared with colleagues in the Global North (developed countries). This Perspective highlights some of the challenges, knowledge gaps and disparities in opportunity faced by GS researchers, especially those at early-career stages. We propose collaborative solutions to help address these issues, and advocate for promoting investment and cultural and societal change for a more inclusive research community. Additionally, we highlight the role of GS researchers in contributing expert knowledge on local biodiversity and the environment; this knowledge can help to shape the future of comparative physiology, allowing us to achieve a better understanding of the evolution of physiological mechanisms and to develop innovative solutions to environmental and biomedical challenges. With this Perspective, we hope to highlight the need to foster a more diverse, equitable and inclusive research landscape in comparative physiology; one that empowers GS scientists to address the global challenges associated with biodiversity loss, climate change and environmental pollution.

From HIV to Mpox: Socio-discursive Analysis of Communicable Diseases, Stigma, and Pathologization in Sexual Minorities in Brazil.

Discrimination and stigma are significant barriers to healthcare for the LGBTQIAPN+ community, necessitating a deeper analysis of their sociocultural causes. There is a notable gap in the literature regarding the understanding of socio-discursive representations and their impact on the stigmatization and pathologization of sexual minorities in the context of communicable diseases. This study aims to discuss the understanding of the sociodiscursive aspects of the health-disease process, particularly in stigmatized infectious diseases affecting the LGBTQIAPN+ community. The focus is on examining how news articles, or the set of analyzed texts (corpus), shape these perceptions. We conducted documentary research with a qualitative and discursive approach using news articles retrieved from Google NewsⓇ about diseases affecting the LGBTQIAPN+ population from 2011 to 2022. The analysis was based on critical discourse analysis, processed using MAXQDA and IRAMUTEQ software. The identified representations predominantly align with biomedical ideology, manifesting in a discourse that normalizes and medicalizes (normative-curative discourse), and notable for its pathologizing and stigmatizing nature. Six classes were found: Ethical professional dilemmas facing stigma, infection and contamination of the LGBT+ population, prejudice and discrimination in the form of information, stigma related to sexual behavior/orientation, Vulnerability and stigma related to infectious diseases, and strategies for minimizing health risk/stigma for the LGBT+ public. The most relevant analytical categories were related to infectious diseases and sexual identity. These themes were identified, indicating that media representations reinforce stigma and maintain unequal health practices (verticalization) for the LGBT+ community. Understanding these patterns within a broader historical context is crucial for promoting health education and strategies that challenge internalized prejudice. The need to reformulate cultural norms and develop health information and education policies is urgent. These policies should be led by professionals with a comprehensive and humanized vision, addressing the diverse needs of the LGBT+ population.

Felicidad sexual y satisfacción con la seguridad sexual en hombres de Asunción y Central / Sexual happiness and satisfaction with sexual security in men from Asunción and Central

RESUMEN Introducción: la satisfacción y seguridad sexual son elementos clave para el bienestar masculino, integrando aspectos físicos y emocionales de la intimidad; estos conceptos engloban el disfrute pleno de las relaciones sexuales, junto con la comodidad y confianza en las prácticas de protección utilizadas. Objetivo: determinar la felicidad sexual y satisfacción con la seguridad sexual en hombres de Asunción y Central durante el 2023. Metodología: se realizó un estudio observacional, descriptivo de corte transversal en Asunción, y Central durante los meses de setiembre a noviembre del 2023. La población de estudio lo constituyeron los hombres elegibles que tenían mayor de 18 años, a quienes se les asignó el sexo masculino al nacer, residentes de las ciudades seleccionadas. Las variables del estudio fueron las demográficas, salud mental (ansiedad, depresión e ideación suicida). Resultados: el estudio incluyó 143 participantes. De estos, el 55,24 % (79) tenía entre 18 y 29 años, el 69,23 % (99) se identificó como gay, y el 12,59 % (18) como bisexual. Los Hombres que tienen sexo con hombres mostraron una mayor probabilidad de reportar satisfacción, con una odds ratio ajustada por edad de 2,82 (IC 95 %: 1,41-3,57, p=0,001) en comparación con los heterosexuales, tener tres o más parejas estables y once o más parejas no estables se asoció fuertemente con ser HSH (p=0,003 y p=0,001, respectivamente). Conclusión: los hombres que tienen sexo con hombres reportaron niveles más altos de satisfacción sexual, lo que sugiere una experiencia positiva en sus relaciones íntimas. Sin embargo, este grupo también mostró una tendencia a tener un mayor número de parejas sexuales, tanto estables como no estables. Estas diferencias en comportamientos sexuales pueden indicar distintas normas sociales o preferencias personales entre los grupos estudiados.

ABSTRACT Introduction: sexual satisfaction and safety are key elements for male well-being, integrating physical and emotional aspects of intimacy. These concepts encompass the full enjoyment of sexual relationships, along with comfort and confidence in the protective practices used. Objective: determine sexual happiness and satisfaction with sexual safety in men from Asunción and Central during 2023. Methodology: a cross-sectional study was carried out in Asunción and Central during the months of September to November 2023. The study population consisted of eligible men who were over 18 years of age, who were assigned the sex male at birth, residents of the selected cities. The study variables were demographics, mental health (anxiety, depression and suicidal ideation). Results: the study included 143 participants. Of these, 55.24 % (79) were between 18 and 29 years old, 69.23 % (99) identified as gay, and 12.59 % (18) as bisexual. Men who have sex with men showed a higher probability of reporting satisfaction, with an age-adjusted odds ratio of 2.82 (95 % CI: 1.41-3.57, p=0.001) compared to heterosexuals. Having three or more stable partners and eleven or more non-stable partners was strongly associated with being MSM (p=0.003 and p=0.001, respectively). Conclusion: men who have sex with men reported higher levels of sexual satisfaction, suggesting a positive experience in their intimate relationships. However, this group also showed a tendency to have a higher number of sexual partners, both stable and non-stable. These differences in sexual behaviors may indicate distinct social norms or personal preferences among the studied groups.

Gynecologic health care for LGBTQIA+ people.

Gender relations are a set of socially determined norms and rules that assign values, characteristics, and expectations to individuals based on their biological sex. These aspects also influence the clinician-patient relationship, since it has been for a long time based on cisheteronormativity. However, this attitude alienated the LGBTQIA+ community from health services. Global and specific gynecologic care needs to be offered to the LGBTQIA+ population, which has demands for sexual and reproductive health care. In this narrative review, we bring conceptual aspects, gender identity and expression, sexual history, screening for cancer and other care to the community.

Measurement invariance of the Intuitive Eating Scale-2 across country, ethnicity, sex, and sexual orientation: A cross-cultural study between Brazil and the U.S.

Intuitive eating is defined as being connected to internal hunger, satiety, and appetitive cues and flexibly using these cues to determine when, what, and how much to eat. The Intuitive Eating Scale-2 (IES-2) is a widely used measure of facets of intuitive eating. However, the scale has shown unstable factor structure in several validation studies and there is a lack of studies investigating the measurement invariance of the IES-2 beyond sex. We aimed to evaluate the psychometric properties of the IES-2, testing several factor structures among Brazilian and U.S. samples of men and women; to test measurement invariance across country of origin, ethnicity, sex, and sexual orientation; and to evaluate its internal consistency. Three models of the latent structure of the IES-2 were tested using confirmatory factor analyses (CFA) in a total of 1072 young adults (452 Brazilians and 620 Americans), aged 18-35 years. Results demonstrated that only a 3-factor solution with 11 items of the IES-2 showed adequate fit to the data for both countries. This model demonstrated scalar invariance across sex and sexual orientation, but only configural invariance was found across country of origin and ethnicity. Good internal consistencies were found for both the Brazilian and American samples. The present study provides support for a 3-factor solution with 11 items of the IES-2, to Brazilian and American samples. The study also offers evidence of internal consistency, and invariance between sex (i.e., male and female) and sexual orientation (i.e., heterosexual participants and sexual minority participants).

Estigma de identidad sexual y apoyo social entre los hombres que tienen sexo con otros hombres en Central y Asunción, Paraguay: un análisis cualitativo

Introducción: El estigma relacionado con la identidad sexual, especialmente entre HSH, sigue siendo un desafío importante en muchas culturas, este estigma puede aparecer de varias maneras, desde una discriminación explícita hasta estereotipos más discretos, y puede afectar negativamente la salud mental y emocional de quienes lo sufren. Objetivo: Analizar el estigma de identidad sexual y apoyo social entre los hombres que tienen sexo con otros hombres en Central y Asunción, Paraguay durante el 2024. Metodología: Estudio cualitativo, fenomenológico de tipo descriptivo y explicativo. Las categorías de análisis consideradas en este estudio fueron: a) Estigma y apoyo social en la comunidad en general, b) Divulgación de identidad sexual a la comunidad en general, c) Divulgación de identidad sexual a familiares y amigos y d) Estigma y apoyo social en la comunidad de LGBT. Resultados: Participaron del estudio, nueve HSH, donde los testimonios revelan el profundo anhelo de vivir con autenticidad y libertad. Los HSH en Paraguay desean poder ser ellos mismos sin temor a ser juzgados o rechazados, anhelan relaciones abiertas y honestas, y aspiran a una comunidad donde puedan compartir experiencias y apoyarse mutuamente Conclusión: Los HSH enfrentan obstáculos en su crecimiento y unión como comunidad. La ausencia de una comunidad fuerte y unida dificulta el apoyo mutuo y el desarrollo personal, además de la competencia y la falta de colaboración entre organizaciones e individuos crean un ambiente dividido, donde cada uno busca sus propios beneficios en lugar de trabajar juntos por el bien de todos.

Introduction: Stigma related to sexual identity, especially among MSM, remains a major challenge in many cultures, this stigma can appear in various ways, from explicit discrimination to more discreet stereotypes, and can negatively affect the mental and emotional health of those who suffer from it. Objective: Analyze the stigma of sexual identity and social support among men who have sex with other men in Central and Asunción, Paraguay during 2024. Methodology: Qualitative, Phenomenological Study of a descriptive and explanatory type. The analysis categories considered in this study were: a) Stigma and social support in the community in general, b) Disclosure of sexual identity to the community in general, c) Disclosure of sexual identity to family and friends and d) Stigma and social support in the LGBT community. Results: Nine MSM participated in the study, where the testimonies reveal the deep desire to live with authenticity and freedom. MSM in Paraguay want to be able to be themselves without fear of being judged or rejected, they long for open and honest relationships, and they aspire to a community where they can share experiences and support each other. Conclusion: MSM face obstacles in their growth and unity as a community. The absence of a strong and united community makes mutual support and personal development difficult, in addition to competition and lack of collaboration between organizations and individuals creating a divided environment, where everyone seeks their own benefits instead of working together for the good. of everyone.

The rising tide of HIV among young men who have sex with men in Brazil: insights from the Conectad@s study.

Background: Young gay, bisexual, and other men who have sex with men (YMSM) in Latin America experience disproportionately high rates of HIV. While new case numbers have stabilised in other demographics, the incidence of HIV in this particular group continues to rise. We estimated the prevalence of HIV and sexually transmitted infections (STI) and identified correlates of new HIV diagnoses among YMSM in Brazil. Methods: Conectad@s was a respondent-driven sampling-based study to recruit and engage YMSM in HIV prevention and treatment services in Rio de Janeiro, Brazil (November 2021-October 2022). Eligibility criteria were age 18-24 years and self-identification as MSM (cis/trans) or non-binary person who have sex with men. Participants underwent HIV/STI testing and completed a socio-behavioural questionnaire. We described baseline characteristics by HIV status and used logistic regression models to identify correlates of new HIV diagnoses. Trial ID: DERR1-10.2196/34885. Findings: Among 409 participants, 370 (90.5%) self-identified as cisgender men, nine (2.2%) transgender men, and 30 (7.3%) non-binary. Median age was 21 years (IQR: 20-23), with 80 (19.6%) aged 18-19 years. Most self-identified as Black or Pardo (70.6%); 109 (26.7%) never tested for HIV. HIV prevalence was 9.8%; 50% (n = 20/40) were newly diagnosed with HIV. Only nine participants ever used PrEP and three were currently using it. Overall, 133 (32.5%) reported sexual violence in their lifetime and 102 (24.9%) reported a suicide attempt. Prevalence of active syphilis, chlamydia, and gonorrhoea were 14.4%, 15.9%, and 14.7%, respectively. New HIV diagnoses were positively associated with engaging in high-risk behaviour (aOR 4.88 [95% CI: 1.88-13.40]) and anxiety (aOR 2.67 [95% CI: 1.01-7.70]), and negatively associated with ever disclosing sexual orientation (aOR 0.19 [95% CI: 0.04-0.92]) and HIV knowledge (aOR 0.77 [95% CI: 0.59-1.01]). Interpretation: High prevalence of HIV coupled with a high proportion of new HIV diagnoses underscore a potentially growing HIV epidemic among YMSM in Brazil. Funding: National Institutes of Health (NIH), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Ministry of Health of Brazil.

Development and Preliminary Validation of a Scale to Measure Perceived Therapist's Knowledge about Gender Identity Diversity among Trans and Non-Binary Individuals in Puerto Rico.

This study aimed to describe the development of the Perceived Therapist's Knowledge about Gender Identity Diversity Scale and to preliminarily validate this scale by describing its psychometric properties. This research instrument was constructed based on the existing literature and recommendations for instrument development. Initially, a 36-item scale was devised to assess perceived openness and knowledge about gender identity diversity in therapy. The content validation process involved 12 expert judges, leading to a refined 25-item scale. Participants consisting of 57 trans and non-binary Puerto Rican individuals completed the scale. Exploratory factor analysis revealed a unidimensional structure, supporting a single factor named "perceived knowledge about gender identity diversity in therapy." The final scale demonstrated excellent reliability (α = 0.978; Sα = 0.980; ω = 0.979), indicating strong internal consistency. This validated scale contributes to assessing primarily Hispanic trans and non-binary individuals' perceptions of their therapists' knowledge about gender identity diversity.

Dissonance-Based Eating Disorder Prevention for Body-Dissatisfied Brazilian Cisgender Gay and Bisexual Men: A Randomized Controlled Trial With a 1-Year Follow-Up.

OBJECTIVE: Gay and bisexual men are at an increased risk for eating disorders (EDs) and muscle dysmorphia (MD) compared with their heterosexual counterparts. Existing dissonance-based (DB) EDs prevention programs for this population have been evaluated in the United States; however, these programs have not been evaluated in the Brazilian context. Thus, we investigated the feasibility, acceptability, and efficacy of a DB ED prevention program (i.e., the PRIDE Body Project) among Brazilian cisgender gay and bisexual men. METHOD: Eligible men were randomly assigned to either a DB intervention (n = 74) condition or an assessment-only control (AOC) condition (n = 75). Participants completed measures assessing ED and MD risk and protective factors at baseline, post-intervention, 1-month, 6-month, and 1-year follow-up. Those in the intervention condition also completed acceptability measures. RESULTS: Feasibility and acceptability ratings were highly favorable. Regarding efficacy, post-intervention results were not significant, except for self-objectification, which showed a significantly greater decrease in the DB condition compared with the AOC condition at all time-points of follow-ups (Cohen's d = -0.31 to -0.76). At follow-up, the DB condition showed significantly greater decreases in appearance-ideal internalization, drive for muscularity, self-objectification, ED and MD symptoms at 1-month, 6-month, and 1-year follow-ups (d = -0.33 to -0.92) compared with the AOC condition. Significant increases were observed in the DB compared with the AOC condition for body appreciation at 1-month, 6-month, and 1-year follow-ups (d = 0.31-0.81). DISCUSSION: Results support the feasibility, acceptability, and efficacy of the PRIDE Body Project up to 1-year in Brazilian cisgender gay and bisexual men. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC; available at http://www.ensaiosclinicos.gov.br/) number of registration: RBR-62fctqz.

Perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities: a systematic review.

We conducted a systematic review to explore the relationship between perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities. We included 39 studies divided into (i) correlations or associations, (ii) models using sexual HIV exposure as the outcome, and (iii) models using perceived risk for HIV acquisition as the outcome. The sample size range was from 55 to 16,667 participants, primarily cisgender men who have sex with men (73.3%) and White (51.3%). Sexual HIV exposure and perceived risk for HIV acquisition assessments and recall time frames across studies differed markedly. Most of studies (84.6%) found significant correlations, comparisons, or associations between different levels of perceived risk for HIV acquisition and high sexual HIV exposure. In addition, 51.3% of studies reported other variables associated with high sexual HIV exposure (i.e., misuse of substances or alcohol) or with high perceived risk for HIV acquisition (i.e., younger age). In conclusion, the association between perceived risk for HIV acquisition and sexual HIV exposure has shown to be consistent. However, the assessment for perceived risk for HIV acquisition should include more components of perception (i.e., an affective component), or for sexual HIV exposure should consider the different estimated sexual per-acts probability of acquiring HIV.

Barriers and facilitators for HIV rapid testing among transgender women and gay and other men who have sex with men in Brazil: A scoping review.

Transgender women (TGW) and men who have sex with other men (MSM) often encounter disparities in accessing HIV testing, leading to delayed diagnoses and worse prognoses. We analysed barriers and facilitators for accessing HIV rapid testing by TGW and MSM in Brazil, 2004-2023. Citations were included whether the study population consisted of individuals aged ≥18y old, and studies addressed HIV testing and have been conducted in Brazil. The study protocol was based on Joanna Briggs' recommendations for scoping reviews. We included 11 studies on TGW and 17 on MSM. The belief that one is not at risk of contracting HIV infection, fear expressed in different ways (e.g. lack of confidentiality) and younger age were the main barriers. Feeling at risk for HIV infection, curiosity, and favourable characteristics of the setting where the testing takes place were cited as the main facilitators. Barriers and facilitators specifically for HIV self-testing included, respectively, concerns about conducting the test alone vs. autonomy/flexibility. Brazil is unlikely to achieve the UN' 95-95-95 goal without minimising testing disparities. Combating prejudice against TGW and MSM in testing settings, along with educational campaigns and transparent protocols to ensure confidentiality, can help increase HIV testing among these populations.

Associations between Stigma, Depression, and Adherence to Antiretroviral Therapy in Brazilian Men Who Have Sex with Men Living with HIV.

Adherence to antiretroviral therapy (ART) is a complex and multi-determined process that is influenced by psychosocial variables. Although international studies have pointed to the adverse impact of HIV stigma, sexual stigma, and depression on ART adherence among men who have sex with men (MSM) with HIV, less is known about this association among Brazilians. We aimed to (a) evaluate indicators of depression, stigma related to HIV and homosexuality, and adherence to ART in a sample of Brazilian MSM living with HIV; (b) assess possible correlations between the variables analyzed, and (c) assess the impact of HIV and sexual stigma and depression on ART adherence. This cross-sectional study comprised 138 Brazilian MSM living with HIV as participants. Scales used included: a sociodemographic/clinical questionnaire, the questionnaire for assessment of adherence to antiretroviral therapy (CEAT-HIV), the Beck depression inventory (BDI-II), the internalized homophobia scale, and the HIV stigmatization scale. The mean adherence score was relatively high (78.83, within a range of 17-89 points). However, we observed inadequate ART adherence (CEAT-HIV < 75) in 28 (20.2%) respondents. Participants reported high scores for internalized sexual stigma, perceived sexual stigma in the community, and HIV stigma. Symptoms of depression were identified in 48.47% of participants. We found negative correlations between depression, HIV stigma, and treatment adherence, but not between sexual stigma and ART adherence. HIV-related stigma and sexual stigma were positively correlated with depression. Our regression analysis indicated that each year of age at diagnosis of HIV increased adherence by 0.22 points, on average. Each additional BDI-II score reduced adherence to ART by 0.20 points. The high prevalence of depression, HIV stigma, and sexual stigma, and their adverse effects on ART adherence and mental health, point to the need to implement evidence-based interventions to reduce sexual and serological stigma in the general population, as well as to mitigate the negative impacts of stigma on MSM living in HIV in Brazil. They also highlight the importance of periodically screening for these variables among MSM treated in Brazilian public health services, especially among those with inadequate adherence to ART.

Vivencias y estrategias comunitarias de manejo del riesgo dentro de las prácticas chemsex: un estudio cualitativo / Community experiences and strategies of risk management within chemsex practices: a qualitative study

Resumen El auge en el estudio del uso sexualizado de drogas entre hombres gais, bisexuales u otros hombres que tienen sexo con hombres (HSH), conocido como chemsex, ha generado una multiplicidad de datos que contribuyen a su problematización en tanto cuestión de salud pública a través del vínculo con el VIH y las adicciones. El estudio de estas prácticas, desde un paradigma biomédico, se ha centrado en el riesgo y ha contribuido a su reducción como fenómeno único y cuantificable. Este estudio tiene como objetivo explorar la vivencia del riesgo en el transcurso de las prácticas, para conocer qué estrategias de manejo emplean frente a éste y de qué manera son generadas. Se realizaron entrevistas semiestructuradas a cinco practicantes de chemsex en el Área Metropolitana de Barcelona y, posteriormente se aplicó un análisis temático. Los hallazgos muestran cómo estos hombres detectan, asumen y enfrentan los riesgos presentes en estas prácticas, donde toman relevancia el tipo de relaciones que allí se dan y el círculo social del que disponen. Este estudio destaca también la creación de estrategias basadas en la experiencia y cómo la transmisión de estos saberes entre participantes facilita la toma de decisiones y el manejo del riesgo.

Abstract The rise in the study of sexualised drug use among gay, bisexual and other men who have sex with men (MSM), known as chemsex, has generated a multiplicity of data that contribute to its problematisation as a public health issue through the link with HIV and addictions. The study of these practices, from a biomedical paradigm, has focused on risk and has contributed to its reduction as a unique and quantifiable phenomenon. This study aims to explore the experience of risk in the course of the practices, to find out what management strategies they employ in the face of risk and how they are generated. Semi-structured interviews were conducted with five chemsex practitioners in the Metropolitan Area of Barcelona and, subsequently, a thematic analysis was applied. The findings show how these men detect, assume and confront the risks present in these practices, where the type of relationships that take place and the social circle available to them are relevant. This study also highlights the creation of strategies based on experience and how the transmission of this knowledge among participants facilitates decision-making and risk management.

Factores relacionados al interés e intención al uso de profilaxis preexposición al VIH en hombres gay y/o bisexuales, Colombia / Factors related to the interest and intention of using pre-exposure prophylaxis for HIV in gay and/or bisexual men, Colombia / Fatores relacionados ao interesse e intenção de usar profilaxia pré-exposição ao HIV em homens gays e/ou bissexuais, Colômbia

Resumen Introducción: la profilaxis preexposición al VIH (PrEP) ha demostrado disminuir la incidencia del VIH, pero su adopción en Colombia es aún incipiente. Para avanzar en la implementación de la PrEP como intervención de salud pública es necesario conocer el interés de las poblaciones en riesgo de VIH y los factores que facilitarían su uso. Objetivo: identificar los factores relacionados con el interés e intención de tomar PrEP en hombres gay/bisexuales. Metodología: estudio transversal analítico en una muestra no probabilística en ciudades principales de Colombia. Se exploraron las características sociodemográficas, conocimiento, motivaciones, habilidades conductuales y factores psicosociales, se utilizaron modelos logísticos para estimar la relación de estos factores con el interés y la intención de usar la PrEP. Resultados y conclusiones: participaron 552 hombres gay/bisexuales, 301 (54 %) reclutados en línea y 251 en persona. Solo el 40 % de la muestra sabía de la existencia de PrEP. 57.4 % (IC95%:54.9%-62.4%) reportaron interés e 52.9 % (IC95%: 48.5%-57.3%) intención de usar PrEP. El interés y la intención de usar la PrEP se relacionaron con actitudes y normas positivas hacia PrEP, así como con mayores habilidades relacionadas con servicios de PrEP. El estigma hacia la PrEP y los síntomas depresivos se relacionaron con menor interés e intención. Los resultados sugieren la necesidad de fomentar la información sobre PrEP, especialmente en poblaciones con más desventajas sociales y que experimentan más estigma, al igual que desarrollar intervenciones comunitarias que apoyen las motivaciones y las habilidades para usar la PrEP.

Abstract Introduction: HIV pre-exposure prophylaxis (PrEP) has been shown to reduce the incidence of HIV, but its adoption in Colombia is still beginning. To advance the implementation of PrEP as a public health intervention, it is necessary to know the interest of populations at risk of HIV and the factors that would facilitate its use. Objective: Identify factors related to interest and intention to take PrEP in gay/bisexual men. Methodology: Analytical cross-sectional study in a non-probabilistic sample in main cities of Colombia. Sociodemographic characteristics, knowledge, motivations, behavioral skills, and psychosocial factors were explored; logistic models were used to estimate the relationship of these factors with interest and intention to use PrEP. Results and conclusions: 552 gay/bisexual men participated, 301 (54%) recruited online and 251 in person. Only 40% of the sample knew of the existence of PrEP. 57.4% (95% CI: 54.9%-62.4%) reported interest and 52.9% (95% CI: 48.5%-57.3%) intention to use PrEP. Interest and intention to use PrEP were related to positive attitudes and norms toward PrEP, as well as greater skills related to PrEP services. Stigma toward PrEP and depressive symptoms were related to lower interest and intention. Our results suggest the need to promote information about PrEP, especially in populations with more social disadvantages and who experience more stigma, as well as to develop community interventions that support motivations and skills to use PrEP.

Resumo Introdução: Foi demonstrado que a profilaxia pré-exposição ao VIH (PrEP) reduz a incidência do VIH, mas a sua adopção na Colômbia está apenas a começar. Para avançar na implementação da PrEP como intervenção de saúde pública, é necessário conhecer o interesse das populações em risco de VIH e os fatores que facilitariam a sua utilização. Objetivo: Identificar fatores relacionados ao interesse e intenção de tomar PrEP em homens gays/bissexuais. Metodologia: Estudo analítico transversal em amostra não probabilística nas principais cidades da Colômbia. Foram exploradas características sociodemográficas, conhecimentos, motivações, habilidades comportamentais e fatores psicossociais; modelos logísticos foram utilizados para estimar a relação desses fatores com o interesse e intenção de uso da PrEP. Resultados e conclusões: Participaram 552 homens gays/bissexuais, 301 (54%) recrutados online e 251 pessoalmente. Apenas 40% da amostra sabia da existência da PrEP. 57,4% (IC 95%: 54,9%-62,4%) relataram interesse e 52,9% (IC 95%: 48,5%-57,3%) intenção de usar a PrEP. O interesse e a intenção de usar a PrEP estavam relacionados com atitudes e normas positivas em relação à PrEP, bem como com maiores competências relacionadas com os serviços de PrEP. O estigma em relação à PrEP e os sintomas depressivos foram relacionados com menor interesse e intenção. Os nossos resultados sugerem a necessidade de promover informação sobre a PrEP, especialmente em populações com mais desvantagens sociais e que sofrem mais estigma, bem como desenvolver intervenções comunitárias que apoiem motivações e competências para usar a PrEP.

Differences in the impacts of muscle dysmorphia symptoms on distress between heterosexual women and homo/bisexual women.

Muscle Dysmorphia (MD) and its psychological impacts on women, especially within sexual minorities, are still relatively understudied. The objective of this study was to compare the relationship of MD symptoms and psychological distress between heterosexual women and lesbian/bisexual women. Our sample consisted of 479 Brazilian cisgender women from the community, aged between 18 and 70 years (M = 32.78; SD = 10.45). Among them, 327 (68.27 %) identified as heterosexual, 134 (27.98 %) as bisexual, and 18 (3.76 %) as lesbian. To ensure there was no bias due to measurement error, the psychometric properties of the instruments in the sample were tested, and invariance between the groups was assessed. t-tests, structural equation modeling, and latent profile analyses were conducted to comprehend the differences between the groups. The results indicated significant differences and a greater severity of MD symptoms and distress for lesbian/bisexual women. The implications of these results are discussed, emphasizing the need for further exploration of MD studies within sexual minorities.

Feasibility, acceptability, and perceived usefulness of a community-evidence-based harm reduction intervention for sexualized stimulant use among Mexican gay, bisexual, and other men who have sex with men.

BACKGROUND: The use of stimulants and other substances with the purpose of enhancing, maintaining, and prolonging sexual activity is known as sexualized substance use. Also known as chemsex, this pattern of use has been mainly explored in high-income countries. The aim of this article was to assess the feasibility, acceptability, and usefulness of a community- evidence-based harm reduction intervention among Mexican gay, bisexual, and other men who have sex with men (gbMSM) adults who reported sexualized stimulant use in the past 6 months and who were not enrolled in any psychosocial treatment. METHODS: The in-person intervention was designed in partnership with gbMSM who used substances. It consisted of 39 harm reduction strategies before, during, and after episodes of use. The components of the intervention were health and self-care, safety, and psychopharmacology. The intervention was delivered at a university campus, a public recreational space, and an HIV public clinic. Feasibility to deliver the intervention was assessed based on enrolment and completion rates; acceptability through a 28-item, 5-point Likert scale (140 max.) constructed and validated for the Mexican population with good reliability coefficients; usefulness through a 5-point Likert scale ("not useful"-"very useful") for each of the 39 strategies; and potential behavioral change by subtracting the likelihood of implementing each strategy minus the frequency of use of the technique before the intervention. RESULTS: Participants (n = 19; recruitment rate = 35.2%; completion rate = 84.2%) rated the intervention as acceptable with a mean score of 121.6 (SD = 7.5). The highest potential for behavioral change was regarding the use of information about the half-life of stimulants, polysubstance use, and overdose prevention. CONCLUSIONS: This intervention is feasible when provided within public health services where potential participants are already in contact. Harm reduction strategies need to surpass sexually transmitted infections prevention and HIV care and focus on substance use and mental health strategies.

Self-Esteem, Self-Satisfaction with Voice, and Self-Assessment with Descriptive Terms of One's Own Voice for Voice Among Brazilian LGBTQIAPN+ People.

OBJECTIVES: To analyze self-esteem, self-satisfaction with voice, and self-assessment with descriptive terms of one's own voice among Brazilian LGBTQIAPN+ people. STUDY DESIGN: Cross-sectional, observational, qualitative-quantitative study. METHODS: The study included any person who identified as Brazilian LGBTQIAPN+ and excluded those under 18 years old. Participants answered a sociodemographic questionnaire, the Rosenberg Self-Esteem Scale, and the Descriptive terms of one's own voice (which were analyzed with text processing techniques). The 10 terms most listed as positive or negative were selected for simple logistic regression associated with the Rosenberg Self-Esteem Scale. The alpha level of significance used in all analyses was 5%. RESULTS: The study considered the responses from 411 participants. It is noteworthy that 92.45% (n = 380) of the studied population identified as cisgender. Among the participants, 28 were classified as having unsatisfactory self-esteem, 208 as having average self-esteem, and 178 as having satisfactory self-esteem. Individuals with unsatisfactory scores described themselves using terms such as "high," "boring," "ugly," "unfriendly," and "masculine," while those with average scores used terms like "insecure," "nasal," "out of tune," and "high." Those with satisfactory scores associated themselves with terms such as "expressive," "sympathetic," "kind," "pleasant," and "stable." The terms "cheerful," "adequate," and "boring" significantly associated with the Rosenberg Self-Esteem Scale.score. CONCLUSION: LGBTQIAPN+ people with unsatisfactory self-esteem referred to their voices with negative descriptive terms, similar to people with average self-esteem, who often did not select any positive term. On the other hand, people with satisfactory self-esteem assessed their voices with positive descriptive terms and few negative adjectives. People with satisfactory scores are more likely to think that their voice is "cheerful" and less likely to consider it "adequate" or "boring" than people with unsatisfactory scores on the Rosenberg Self-Esteem Scale. The majority of participants were cisgender homosexual males, thus caution should be exercised in generalizing the data to the entire community.

Autoeficácia do uso de preservativo entreestudantes de graduação em enfermagem / Self-efficacy of use among undergraduate nursing students / Autoeficacia del uso del condón entre estudiantes universitarios de enfermería

Objetivo: Verificar a autoeficácia no uso de preservativo de estudantes do curso de graduação em enfermagem de uma Universidade Pública Federal no interior de Minas Gerais. Métodos: Estudo observacional, transversal e descritivo com abordagem quantitativa, realizado com discentes de graduação em enfermagem. Utilizou-se um instrumento sociodemográfico e a Escala de Autoeficácia no Uso de Preservativos. Resultados: Participaram 148 estudantes, predominando na faixa etária de 18 a 25 anos (74,3%), de cor branca (52,7%), gênero feminino (82,4%) e heterossexuais (77,7%). Dos 117 (79,1%) com vida sexual ativa, 53 (45,3%) usam preservativo e 51 (43,6%) usam pílula ou injeção. Observou-se alta pontuação na autoeficácia no uso de preservativo. Houve diferenças significativas nas dimensões Habilidade, Assertividade e escore total da escala entre os que têm e os que não têm vida sexual ativa. Conclusão: Os estudantes mostraram ter conhecimento satisfatório sobre a autoeficácia do uso de preservativos, apesar da baixa adesão. Isso ressalta a importância de estratégias educativas focadas na prática efetiva e consistente do uso de preservativos para prevenção de Infecções Sexualmente Transmissíveis. (AU)

Objective: Verify self-efficacy in condom use among undergraduate nursing students at a Federal Public University in the interior of Minas Gerais. Methods: This was an observational, cross-sectional, and descriptive study with a quantitative approach, conducted with undergraduate nursing students. Data were collected using a sociodemographic instrument and the Condom Use SelfEfficacy Scale. Results: A total of 148 students participated, predominantly aged 18 to 25 years (74.3%), identifying as white (52.7%), female (82.4%), and heterosexual (77.7%). Of the 117 students (79.1%) who were sexually active, 53 (45.3%) reported using condoms and 51 (43.6%) used pills or injections. High scores in condom use self-efficacy were observed. Significant differences were noted in the Skill, Assertiveness, and total score dimensions of the scale between sexually active and inactive students. Conclusion: The students demonstrated satisfactory knowledge regarding the self-efficacy of condom use, despite low adherence rates. This underscores the importance of educational strategies focused on effective and consistent condom use practices for the prevention of Sexually Transmitted Infections. (AU)

Objetivo: Verificar la autoeficacia en el uso del preservativo entre estudiantes de enfermería de una Universidad Pública Federal del interior de Minas Gerais. Métodos: Estudio observacional, transversal y descriptivo con enfoque cuantitativo, realizado con estudiantes de grado en enfermería. Se utilizó un instrumento sociodemográfico y la Escala de Autoeficacia en el Uso de Preservativos. Resultados: Participaron 148 estudiantes, predominando en el rango de edad de 18 a 25 años (74,3%), de raza blanca (52,7%), género femenino (82,4%) y heterosexuales (77,7%). De los 117 (79,1%) con vida sexual activa, 53 (45,3%) usan preservativo y 51 (43,6%) usan píldora o inyección. Se observó un alto puntaje en la autoeficacia en el uso de preservativos. Hubo diferencias significativas en las dimensiones Habilidad, Asertividad y puntuación total de la escala entre los que tienen y no tienen vida sexual activa. Conclusión: Los estudiantes mostraron tener un conocimiento satisfactorio sobre la autoeficacia del uso de preservativos, apesar de la baja adhesión. Esto resalta la importancia de estrategias educativas enfocadas en la práctica efectiva y consistente del uso de preservativos para la prevención de Infecciones Sexualmente Transmisibles. (AU)