HIV risk perceptions and post-exposure prophylaxis among men who have sex with men in five Brazilian cities. / Percepções de risco e profilaxia pós-exposição ao HIV entre homens que fazem sexo com homens em cinco cidades brasileiras.

In the current context of the HIV epidemic, multiple prevention strategies including biomedical interventions have been presented as alternatives for vulnerable groups. This study investigated homosexuals' and bisexuals' perceptions of the risk of HIV infection and their experiences of using HIV post-exposure prophylaxis (PEP). We conducted a qualitative study with 25 men who have sex with men (MSM) in five Brazilian cities using semi-structured interviews. The results showed that the use of condoms was the main HIV prevention strategy employed by the respondents. In addition, condom failure, inconsistent condom use and intentional non-use are the main prompters of risk perception and the consequent decision to seek PEP. The respondent's perceptions and meanings of the use of PEP were mediated by prior knowledge of PEP. This work broadens the debate on the more subjective aspects of HIV prevention among MSM, especially those related to risk perception and the decision to use PEP in the context of combined prevention.

No atual contexto da epidemia de HIV múltiplas estratégias de prevenção vêm se apresentando como alternativas para populações mais suscetíveis, incluindo as biomédicas. Este trabalho buscou compreender as percepções de risco ao HIV de homossexuais e bissexuais e a experiência de uso da Profilaxia Pós-Exposição sexual ao HIV (PEP Sexual). Trata-se de estudo de abordagem qualitativa com uso de entrevistas semiestruturadas com 25 participantes em cinco cidades brasileiras. Os resultados apontam que dada a proeminência do preservativo como estratégia de prevenção ao HIV/Aids, a falha do método, o uso não consistente e o não uso intencional constituem as referências centrais da percepção de risco e a consequente tomada de decisão de busca por PEP. Quanto às percepções e os significados do uso da PEP, estes são modulados pelo conhecimento prévio sobre o método. O trabalho amplia o debate sobre aspectos subjetivos envolvendo a prevenção do HIV entre HSH, especialmente no que concerne a percepção de risco e tomada de decisão para o uso da PEP no atual cenário da epidemia e no contexto da prevenção combinada.

Percepções de risco e profilaxia pós-exposição ao HIV entre homens que fazem sexo com homens em cinco cidades brasileiras / HIV risk perceptions and post-exposure prophylaxis among men who have sex with men in five Brazilian cities

Resumo No atual contexto da epidemia de HIV múltiplas estratégias de prevenção vêm se apresentando como alternativas para populações mais suscetíveis, incluindo as biomédicas. Este trabalho buscou compreender as percepções de risco ao HIV de homossexuais e bissexuais e a experiência de uso da Profilaxia Pós-Exposição sexual ao HIV (PEP Sexual). Trata-se de estudo de abordagem qualitativa com uso de entrevistas semiestruturadas com 25 participantes em cinco cidades brasileiras. Os resultados apontam que dada a proeminência do preservativo como estratégia de prevenção ao HIV/Aids, a falha do método, o uso não consistente e o não uso intencional constituem as referências centrais da percepção de risco e a consequente tomada de decisão de busca por PEP. Quanto às percepções e os significados do uso da PEP, estes são modulados pelo conhecimento prévio sobre o método. O trabalho amplia o debate sobre aspectos subjetivos envolvendo a prevenção do HIV entre HSH, especialmente no que concerne a percepção de risco e tomada de decisão para o uso da PEP no atual cenário da epidemia e no contexto da prevenção combinada.

Abstract In the current context of the HIV epidemic, multiple prevention strategies including biomedical interventions have been presented as alternatives for vulnerable groups. This study investigated homosexuals' and bisexuals' perceptions of the risk of HIV infection and their experiences of using HIV post-exposure prophylaxis (PEP). We conducted a qualitative study with 25 men who have sex with men (MSM) in five Brazilian cities using semi-structured interviews. The results showed that the use of condoms was the main HIV prevention strategy employed by the respondents. In addition, condom failure, inconsistent condom use and intentional non-use are the main prompters of risk perception and the consequent decision to seek PEP. The respondent's perceptions and meanings of the use of PEP were mediated by prior knowledge of PEP. This work broadens the debate on the more subjective aspects of HIV prevention among MSM, especially those related to risk perception and the decision to use PEP in the context of combined prevention.

Learning from combination HIV prevention programmes to face COVID-19 emerging pandemic.

Before a vaccine against SARS-CoV-2 became available, several measures to control COVID-19 pandemic are necessary. Analogously, in the absence of an available vaccine, Combination HIV Prevention Programmes have consolidated a large experience of biomedical, behavioral and structural interventions suitable for several epidemiological settings. Adaptation of such experiences can organize mid-term and long-term responses to face COVID-19.

Antes de que se disponga de una vacuna contra el SARS-CoV-2, son necesarias varias medidas para controlar la pandemia de COVID-19. En forma análoga, en ausencia de una vacuna disponible, los Programas de Prevención del VIH combinados han consolidado una gran experiencia de intervenciones biomédicas, conductuales y estructurales adecuadas para varios entornos epidemiológicos. La adaptación de estas experiencias puede organizar respuestas a mediano y largo plazo para hacer frente a la epidemia de COVID-19.

Learning from combination HIV prevention programmes to face COVID-19 emerging pandemic / Aprender de los programas combinados de prevención del VIH para enfrentar la pandemia emergente COVID-19

Abstract Before a vaccine against SARS-CoV-2 became available, several measures to control COVID-19 pandemic are necessary. Analogously, in the absence of an available vaccine, Combination HIV Prevention Programmes have consolidated a large experience of biomedical, behavioral and structural interventions suitable for several epidemiological settings. Adaptation of such experiences can organize mid-term and long-term responses to face COVID-19.

Resumen Antes de que se disponga de una vacuna contra el SARS-CoV-2, son necesarias varias medidas para controlar la pandemia de COVID-19. En forma análoga, en ausencia de una vacuna disponible, los Programas de Prevención del VIH combinados han consolidado una gran experiencia de intervenciones biomédicas, conductuales y estructurales adecuadas para varios entornos epidemiológicos. La adaptación de estas experiencias puede organizar respuestas a mediano y largo plazo para hacer frente a la epidemia de COVID-19.

Learning from combination HIV prevention programmes to face COVID-19 emerging pandemic / Aprender de los programas combinados de prevención del VIH para enfrentar la pandemia emergente COVID-19

Before a vaccine against SARS-CoV-2 became available, several measures to control COVID-19 pandemic are necessary. Analogously, in the absence of an available vaccine, Combination HIV Prevention Programmes have consolidated a large experience of biomedical, behavioral and structural interventions suitable for several epidemiological settings. Adaptation of such experiences can organize mid-term and long-term responses to face COVID-19.

AIDS- and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study.

AIDS-related stigma is a major hurdle to care and it hinders people from accessing HIV prevention methods, such as post-exposure prophylaxis. This study was designed to explore how AIDS-related stigma impacts the experience of using non-occupational post-exposure prophylaxis (nPEP) for HIV after sexual contact. Data were gathered in in-depth interviews with 59 people who voluntarily sought out nPEP in five public healthcare facilities in Brazil between 2015 and 2016. Data were analysed into three thematic categories: fear of being mistaken for a person living with HIV and AIDS (PLWHA); desire to hide particular features of one's sexual life; and experiences of stigmatising behaviour due to nPEP use. Based on the Health Stigma and Discrimination Framework, predominant manifestations of AIDS-related stigma in each category were analysed, as well as their intersections with gender- and sexuality-related stigmas. Results show that experiences of using nPEP are permeated by AIDS-related stigma, intersecting with sexuality- and gender-related stigmas. Stigma experiences are mainly perceived, anticipated and internalised; stigma practices include prejudice and stigmatising behaviours. Taking antiretrovirals (ARVs) led participants to the fear of being discriminated against as a PLWHA and having particular features of their sexual identities disclosed. Thus, hiding nPEP was strategic to protect from stigmatising behaviour. As ARV-based prevention technologies are scaled-up, interventions designed to tackle AIDS- and sexuality-related stigmas must be expanded in Brazil. Required interventions include public campaigns about nPEP, educational programmes in healthcare settings to offer adequate support to nPEP users and investments in stigma research and monitoring.

Thematic synthesis HIV prevention qualitative studies in men who have sex with men (MSM) / Síntesis temática de estudios cualitativos de prevención del VIH en hombres que tienen sexo con hombres (HSH)

Abstract Background: Qualitative studies on HIV prevention strategies and methods among men who have sex with men (MSM) allow identify knowledge gaps and improve preventive actions. Objective: To make a thematic synthesis of the scientific productions that use the qualitative methodology in the strategies and methods of HIV prevention area among MSM. Methods: We conducted a literature review following the guidelines of the ENTREQ protocol. The analysis included 48 empirical studies published in Portuguese, English and Spanish between 2001 and 2018 available in the Medline, Embase, Scielo, Scopus, Bireme and Web of Science databases. Results: Where an increased production in the last six years and concentration in northern countries. Seven prevention methods were part of the study, with emphasis on pre-exposure prophylaxis, testing, condoms and behavioral strategies. The main topics discussed were stigma and support and care networks. Conclusion: we notice that an increasing production on prevention in the men who have sex with men segment results from the emergence of multiple preventive methods and strategies and their combined actions beyond the star role of condoms.

Resumen Antecedentes: Los estudios cualitativos sobre estrategias y métodos de prevención del VIH entre hombres que tienen sexo con hombres ayudan a identificar lagunas de conocimiento y mejorar las acciones preventivas. Objetivo: Realizar una síntesis temática de las producciones científicas que utilizan la metodología cualitativa en las estrategias y métodos del área de prevención del VIH entre hombres homosexuales. Métodos: se realizó´ una revisión de la literatura siguiendo las pautas del protocolo ENTREQ. Se analizaron 48 estudios empíricos publicados en portugués, inglés y español entre 2001 y 2018 incluidos en las bases de datos Medline, Embase, Scielo, Scopus, Bireme y Web of Science. Resultados: La producción de artículos fue mayor en los últimos seis años, concentrados en los países del norte. Se abordaron siete métodos de prevención, con énfasis en profilaxis previa a la exposición, pruebas diagnósticas, condones y estrategias comportamentales. Los principales temas discutidos fueron el estigma y las redes de apoyo y atención. Conclusión: La creciente producción de prevención en el segmento hombres que tienen relaciones sexuales con hombres resulta de la aparición de múltiples métodos y estrategias preventivas y sus acciones combinadas más allá del protagonismo de los condones.

[Heterosexually active men, masculinities, HIV prevention, and the search for post-exposure prophylaxis following sexual exposure]. / Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida.

Hegemonic masculinity has distanced heterosexually active men from the responses to the HIV epidemic. However, with the combined prevention paradigm, post-exposure prophylaxis offers new ways to manage the risks of HIV infection, while at the same time bringing about new challenges. The aim of this paper is to discuss - through the lens of gender and masculinities - how heterosexually active men perceive their HIV risk and how they manage prevention methods and strategies, including post-exposure prophylaxis. Employing qualitative methods, 16 heterosexually active men in five health services from different Brazilian cities were interviewed. The analysis indicates that condom use - the main prevention method - was conditioned by subjective and contextual factors, and its failure stands out as the primary reason for seeking out post-exposure prophylaxis. We argue that ideals of hegemonic masculinity permeate perceptions and risk management discourses in the current context of the HIV/AIDS epidemic.

La masculinidad hegemónica distancia a los hombres heterosexuales activos de las respuestas a la epidemia de sida. Sin embargo, con el paradigma de la prevención combinada, la profilaxis posexposición sexual hace posible nuevas formas de gestionar los riesgos de infección, al tiempo que trae nuevos desafíos. El objetivo de este artículo es, a la luz de la perspectiva de género y de las masculinidades, discutir cómo los hombres heterosexuales activos perciben su riesgo frente al VIH, cómo manejan los métodos y estrategias de prevención, incluyendo la profilaxis posexposición sexual. El estudio de abordaje cualitativo entrevistó 16 hombres heterosexuales activos en cinco servicios de salud de diferentes ciudades brasileñas. El análisis señala que el uso del condón, principal método de prevención, fue condicionado a factores subjetivos y contextuales; y su fallo se destaca como el principal motivo de búsqueda de la profilaxis posexposición sexual. Los ideales de masculinidad hegemónica penetraron los discursos de percepción y gestión de riesgo en el actual contexto de la epidemia de sida.

Thematic synthesis HIV prevention qualitative studies in men who have sex with men (MSM).

BACKGROUND: Qualitative studies on HIV prevention strategies and methods among men who have sex with men (MSM) allow identify knowledge gaps and improve preventive actions. OBJECTIVE: To make a thematic synthesis of the scientific productions that use the qualitative methodology in the strategies and methods of HIV prevention area among MSM. METHODS: We conducted a literature review following the guidelines of the ENTREQ protocol. The analysis included 48 empirical studies published in Portuguese, English and Spanish between 2001 and 2018 available in the Medline, Embase, Scielo, Scopus, Bireme and Web of Science databases. RESULTS: Where an increased production in the last six years and concentration in northern countries. Seven prevention methods were part of the study, with emphasis on pre-exposure prophylaxis, testing, condoms and behavioral strategies. The main topics discussed were stigma and support and care networks. CONCLUSION: we notice that an increasing production on prevention in the men who have sex with men segment results from the emergence of multiple preventive methods and strategies and their combined actions beyond the star role of condoms.

ANTECEDENTES: Los estudios cualitativos sobre estrategias y métodos de prevención del VIH entre hombres que tienen sexo con hombres ayudan a identificar lagunas de conocimiento y mejorar las acciones preventivas. OBJETIVO: Realizar una síntesis temática de las producciones científicas que utilizan la metodología cualitativa en las estrategias y métodos del área de prevención del VIH entre hombres homosexuales. MÉTODOS: se realizó´ una revisión de la literatura siguiendo las pautas del protocolo ENTREQ. Se analizaron 48 estudios empíricos publicados en portugués, inglés y español entre 2001 y 2018 incluidos en las bases de datos Medline, Embase, Scielo, Scopus, Bireme y Web of Science. RESULTADOS: La producción de artículos fue mayor en los últimos seis años, concentrados en los países del norte. Se abordaron siete métodos de prevención, con énfasis en profilaxis previa a la exposición, pruebas diagnósticas, condones y estrategias comportamentales. Los principales temas discutidos fueron el estigma y las redes de apoyo y atención. Conclusión: La creciente producción de prevención en el segmento hombres que tienen relaciones sexuales con hombres resulta de la aparición de múltiples métodos y estrategias preventivas y sus acciones combinadas más allá del protagonismo de los condones.

Hombres heterosexualmente activos, masculinidades, prevención de infección por VIH y búsqueda de profilaxis posexposición sexual consentida / Heterosexually active men, masculinities, HIV prevention, and the search for post-exposure prophylaxis following sexual exposure

RESUMEN La masculinidad hegemónica distancia a los hombres heterosexuales activos de las respuestas a la epidemia de sida. Sin embargo, con el paradigma de la prevención combinada, la profilaxis posexposición sexual hace posible nuevas formas de gestionar los riesgos de infección, al tiempo que trae nuevos desafíos. El objetivo de este artículo es, a la luz de la perspectiva de género y de las masculinidades, discutir cómo los hombres heterosexuales activos perciben su riesgo frente al VIH, cómo manejan los métodos y estrategias de prevención, incluyendo la profilaxis posexposición sexual. El estudio de abordaje cualitativo entrevistó 16 hombres heterosexuales activos en cinco servicios de salud de diferentes ciudades brasileñas. El análisis señala que el uso del condón, principal método de prevención, fue condicionado a factores subjetivos y contextuales; y su fallo se destaca como el principal motivo de búsqueda de la profilaxis posexposición sexual. Los ideales de masculinidad hegemónica penetraron los discursos de percepción y gestión de riesgo en el actual contexto de la epidemia de sida.

ABSTRACT Hegemonic masculinity has distanced heterosexually active men from the responses to the HIV epidemic. However, with the combined prevention paradigm, post-exposure prophylaxis offers new ways to manage the risks of HIV infection, while at the same time bringing about new challenges. The aim of this paper is to discuss - through the lens of gender and masculinities - how heterosexually active men perceive their HIV risk and how they manage prevention methods and strategies, including post-exposure prophylaxis. Employing qualitative methods, 16 heterosexually active men in five health services from different Brazilian cities were interviewed. The analysis indicates that condom use - the main prevention method - was conditioned by subjective and contextual factors, and its failure stands out as the primary reason for seeking out post-exposure prophylaxis. We argue that ideals of hegemonic masculinity permeate perceptions and risk management discourses in the current context of the HIV/AIDS epidemic.

CD4/CD8 Ratio Predicts Yellow Fever Vaccine-Induced Antibody Titers in Virologically Suppressed HIV-Infected Patients.

BACKGROUND: Yellow fever vaccine (YFV) induces weaker immune responses in HIV-infected individuals. However, little is known about YFV responses among antiretroviral-treated patients and potential immunological predictors of YFV response in this population. METHODS: We enrolled 34 antiretroviral therapy (ART)-treated HIV-infected and 58 HIV-uninfected adults who received a single YFV dose to evaluate antibody levels and predictors of immunity, focusing on CD4(+) T-cell count, CD4(+)/CD8(+) ratio, and Human Pegivirus (GBV-C) viremia. Participants with other immunosuppressive conditions were excluded. RESULTS: Median time since YFV was nonsignificantly shorter in HIV-infected participants than in HIV-uninfected participants (42 and 69 months, respectively, P = 0.16). Mean neutralizing antibody (NAb) titers was lower in HIV-infected participants than HIV-uninfected participants (3.3 vs. 3.6 log10mIU/mL, P = 0.044), a difference that remained significant after adjustment for age, sex, and time since vaccination (P = 0.024). In HIV-infected participants, lower NAb titers were associated with longer time since YFV (rho: -0.38, P = 0.027) and lower CD4(+)/CD8(+) ratio (rho: 0.42, P = 0.014), but not CD4(+) T-cell count (P = 0.52). None of these factors were associated with NAb titers in HIV-uninfected participant. GBV-C viremia was not associated with difference in NAb titers overall or among HIV-infected participants. CONCLUSIONS: ART-treated HIV-infected individuals seem to have impaired and/or less durable responses to YFV than HIV-uninfected individuals, which were associated with lower CD4(+)/CD8(+) ratio, but not with CD4(+) T-cell count. These results supports the notion that low CD4(+)/CD8(+) ratio, a marker linked to persistent immune activation, is a better indicator of functional immune disturbance than CD4(+) T-cell count in patients with successful ART.