RESUMEN
Men who have sex with men are a target group for HIV prevention and control. HIV testing is part of a broader combination prevention strategy. This study aimed to analyze the predictors for adherence to HIV infection testing among Brazilian men who have sex with men. A cross-sectional study was conducted with 1438 participants, online selected for convenience in all regions of Brazil. Binary logistic regression analysis was used to identify independent predictors of HIV testing in the study population. Adherence to the HIV test was high (80.1%). Had condomless anal intercourse in the last 12 months (Adjusted Odds Ratio [AOR]: 1,659; 95% Confidence Interval [CI]:1,12 - 2,43; p = 0,010), knew one place to seek HIV testing (AOR 6,158 [IC95%: 4,27 - 8,86]; p < 0,001), Received counselling on HIV testing by a health professional (AOR 3,389 [IC95%: 2,28 - 5,02]; p < 0,001), Have been diagnosed with STI (AOR 2,266 [IC95%: 1,41 - 3,62]; p < 0,001) and Knew someone living with HIV (AOR 1,86 [IC95%: 1,29 - 2,67]; p < 0,001) were independently associated with higher chances of HIV testing.
Asunto(s)
Infecciones por VIH , Prueba de VIH , Homosexualidad Masculina , Humanos , Masculino , Estudios Transversales , Adulto , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/psicología , Brasil , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Prueba de VIH/estadística & datos numéricos , Adulto Joven , Persona de Mediana Edad , Adolescente , Cooperación del Paciente/estadística & datos numéricosRESUMEN
Prophylaxis based on antiretrovirals, such as pre-exposure prophylaxis to HIV (PrEP), has the potential to protect the populations most vulnerable to infection, which renews optimism for controlling the HIV epidemic. Against this backdrop, the aim of this article is to analyze the perceptions, negotiations and tensions surrounding the use of PrEP by men who have sex with men (MSM). This is a qualitative cross-section of a multicenter study, analyzing semi-structured interviews with 18 users of specialized HIV/AIDS healthcare facilities in the city of São Paulo/SP. The findings show that negotiating the use of PrEP among MSM involves looking for partners in which different sexual scenarios and the use of alcohol or drugs take place. Users gave PrEP the sense of facilitating the negotiation about the (non-)use of condoms and the (re)definition of care and prevention in different sexual-affective partnerships. The research broadens the debate on subjective aspects involving HIV prevention among MSM, especially with respect to its management in situations of negotiation involving other prevention strategies.
As profilaxias baseadas no uso de antirretrovirais, como a profilaxia pré-exposição sexual ao HIV (PrEP), têm o potencial de proteger as populações mais vulneráveis à infecção, o que renova o otimismo para controle da epidemia de HIV. Nesse cenário, o objetivo do artigo é analisar as percepções, negociações e tensões do uso de PrEP, no âmbito da prevenção combinada, em homens que fazem sexo com homens (HSH). Trata-se de um recorte qualitativo de estudo multicêntrico, com análise de entrevistas semiestruturadas com 18 usuários de serviços especializados em HIV/Aids da cidade de São Paulo-SP. Os achados apontam que a negociação do uso de PrEP entre os HSH perpassa situações de procura de parcerias, em que se desenrolam diferentes cenas sexuais e o uso de álcool ou drogas. Os usuários conferiram à PrEP o sentido de facilitador da negociação sobre o (não) uso do preservativo e a (re)significação do cuidado e da prevenção em diferentes parcerias afetivo sexuais. A pesquisa amplia o debate sobre aspectos subjetivos envolvendo a prevenção do HIV entre HSH, especialmente no que concerne ao seu gerenciamento em situações de negociações envolvendo as outras estratégias de prevenção.
La profilaxis basada en el uso de antirretrovirales, como la profilaxis de preexposición sexual (PrEP) al VIH, tiene el potencial de proteger a las poblaciones más vulnerables a la infección, lo que renueva el optimismo para controlar la epidemia del VIH. En este escenario, este artículo tuvo como objetivo analizar las percepciones, negociaciones y tensiones del uso de la PrEP, en el ámbito de la prevención combinada, para hombres que tienen sexo con hombres (HSH). Se trata de un recorte cualitativo de un estudio multicéntrico, con análisis de entrevistas semiestructuradas con 18 usuarios de servicios especializados en VIH/SIDA en São Paulo, Brasil. Los hallazgos indican que la negociación del uso de PrEP entre HSH involucra situaciones de búsqueda de parejas, en las que ocurren diferentes escenas sexuales y el uso de alcohol o drogas. Los usuarios atribuyeron a la PrEP el significado de facilitar la negociación sobre el (no) uso del preservativo y la (re)significación del cuidado y la prevención en las diferentes relaciones afectivo-sexuales. La investigación amplía el debate sobre aspectos subjetivos que involucran la prevención del VIH entre HSH, especialmente en lo que respecta a su manejo en situaciones de negociación que involucran otras estrategias de prevención.
Asunto(s)
Infecciones por VIH , Homosexualidad Masculina , Negociación , Profilaxis Pre-Exposición , Humanos , Masculino , Profilaxis Pre-Exposición/métodos , Infecciones por VIH/prevención & control , Adulto , Estudios Transversales , Parejas Sexuales/psicología , Adulto Joven , Placer , Persona de Mediana Edad , Conducta Sexual , Condones/estadística & datos numéricos , Entrevistas como Asunto , Fármacos Anti-VIH/administración & dosificaciónRESUMEN
BACKGROUND: Consistent monitoring of PrEP adherence with accurate measurement tools at point-of-care could greatly contribute to reaching adolescents with poor adherence. We aimed to assess the performance of indirect adherence measures to oral PrEP among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW). METHODS: PrEP15-19 is a prospective, multicenter, PrEP demonstration cohort study that includes AMSM and ATGW aged 15-19 in three Brazilian cities. A diagnostic accuracy study was conducted using tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots as the reference standard, along with three index tests: medication possession ratio (MPR), pill count, and self-report. We calculated the area under the curve (AUC) for protective TFV-DP levels (≥800 fmol/punch) and sensitivity (SE) and specificity (SP) for established cutoff points. RESULTS: We included 302 samples from 188 participants. Most of participants were AMSM (78.7%), aged 18-19 years (80.3%), and non-whites (72.9%). The AUC was 0.59 for MPR, 0.69 for pill count, and 0.75 for self-report. When combining MPR and self-report, the AUC increased to 0.77. Sensitivity was high for the cutoff points identified by the Youden index, 80% for MPR, 92% for self-report, and 97% for pill count. However, specificities were low 40%, 46%, and 38%, respectively. CONCLUSIONS: Indirect measures were able to discriminate adolescents with good adherence. However, their performance in identifying those with low adherence might be limited, suggesting that it is necessary to initiate adherence interventions when there is no evidence of perfect adherence. Combining measures can provide wider information on adherence.
Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Homosexualidad Masculina , Profilaxis Pre-Exposición , Personas Transgénero , Humanos , Adolescente , Masculino , Infecciones por VIH/prevención & control , Infecciones por VIH/diagnóstico , Brasil , Profilaxis Pre-Exposición/métodos , Femenino , Adulto Joven , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/administración & dosificación , Estudios Prospectivos , Administración Oral , Tenofovir/uso terapéutico , Tenofovir/administración & dosificación , Autoinforme , Adenina/análogos & derivados , OrganofosfatosRESUMEN
Although LGTBIQ+ groups have experienced social transformations towards greater levels of respect and public presence in Chile in recent decades, the life trajectories of older people remain marginal in studies and surveys regarding sexual and gender diversity. In a society where homophobia is a current and oppressive attitude despite important advances, it is essential to examine the experiences of older LGBTIQ+ people, especially because they are vulnerable to dual discrimination in old age owing to a combination of homophobia and ageism. This study involved an analysis of social ties based on the Convoy Model, to understand how different life courses have influenced the structuring of social networks in old age among gay men and trans women in Chile. Framed within the context of broader research into four axes of diversity in ageing, this study reports the results of thirteen biographies of older people (ten gay men and three trans women). In-depth interviews were conducted using a biographical approach in which the social links that accompany the life course are deepened. A thematic analysis strategy was applied and the interview data were processed through NVivo. The findings show three concentric circles surrounding the participants: closest (made up of partner, immediate family and chosen family), closer (made up biological and extended family) and close (made up of peers and neighbours). The older people are integrated into social networks with diverse compositions, share closeness and intimacy, receive emotional, informational and instrumental social support, and are active providers of reciprocal support. However, the study notes certain risk factors, such as the difficulty of cohabiting and maintaining relationships with a partner. Participants living alone reported fearing an absence of instrumental support during more advanced stages of the ageing process.
Asunto(s)
Personas Transgénero , Humanos , Chile , Masculino , Femenino , Anciano , Personas Transgénero/psicología , Apoyo Social , Homosexualidad Masculina/psicología , Persona de Mediana Edad , Relaciones Interpersonales , Red Social , Envejecimiento/psicología , Minorías Sexuales y de Género/psicologíaRESUMEN
OBJECTIVE: This study aims to understand the perceptions and practices of healthcare providers regarding the offer of HIV pre-exposure prophylaxis (PrEP) to gay and trans adolescents and young adults. METHODS: This qualitative research was developed as part of the PrEP1519 study, which was conducted from 2018 to 2021 to analyze the effectiveness of PrEP in adolescents and young adults. Data were collected from July 2020 to February 2021 at the municipality of São Paulo by combining participant observations and semi-structured interviews. The analytical process involved immersion in the empirical material and coding and categorizing it with the support of NVivo®. Interpretation followed the hermeneutic-dialectical principle and had the concept of Care in health practices as its horizon. RESULTS: The construction of trust-based relationships followed practices that acknowledge the uniqueness of youth and their demands and sought to strengthen their autonomy. Sensitive and supportive listening was pointed out as a welcoming practice that propelled care actions. Welcoming attitudes and support in facing stigma and violence (related or not to the use of PrEP) acknowledged the need to support adolescents and young adults to develop autonomy for prevention. The use of language close to young people's everyday life favored the construction of relationships of trust and positively influenced the development of autonomy and adherence to PrEP. The tension between technical and practical success occurred in the idealized search for adult-centric normativity as opposed to intersubjectivity. CONCLUSION: The perceptions and practices of healthcare providers are aligned with the concept of Care as they include actions beyond technical knowledge and recognize the contexts that increase the vulnerability of adolescents and young adults to HIV.
OBJETIVO: Compreender as percepções e práticas de profissionais de saúde no contexto da oferta de profilaxia pré-exposição ao HIV (PrEP) entre adolescentes e jovens gays e trans. MÉTODOS: Trata-se de pesquisa qualitativa desenvolvida como parte do estudo PrEP1519, realizada entre 2018 e 2021, com o objetivo de analisar a efetividade de PrEP entre adolescentes e jovens. Os dados foram produzidos de julho de 2020 a fevereiro de 2021 no sítio de São Paulo, combinando técnicas de observação-participante e entrevistas semiestruturadas. O processo analítico envolveu imersão no material empírico, codificação e categorização, com apoio do software NVivo®. A interpretação seguiu o princípio hermenêutico-dialético e teve como horizonte o conceito de cuidado inserido nas práticas de saúde. RESULTADOS: A construção do vínculo de confiança foi informada por práticas que reconheciam a singularidade dos/as adolescentes/jovens e suas demandas e buscavam impulsionar sua autonomia. A escuta sensível e solidária foi apontada como uma prática de acolhimento propulsora de ações de cuidado. Atitudes acolhedoras e suporte frente a situações de estigma e violências, relacionadas ou não ao uso de PrEP, convergiram para o reconhecimento da necessidade de apoio no desenvolvimento de autonomia para a prevenção entre adolescentes e jovens. O uso de linguagem próxima do cotidiano favoreceu a construção de relações de confiança, influenciando positivamente o desenvolvimento da autonomia e a adesão a PrEP. A tensão entre êxito técnico e sucesso prático foi observada na busca idealizada pela normatividade adultocêntrica em contraposição à intersubjetividade. CONCLUSÃO: As percepções e práticas dos/as profissionais de saúde se mostram coerentes com o conceito de cuidado, pois compreendem ações além dos saberes técnicos e reconhecem os contextos que aumentam a vulnerabilidade dos/as adolescentes e jovens ao HIV.
Asunto(s)
Actitud del Personal de Salud , Infecciones por VIH , Homosexualidad Masculina , Profilaxis Pre-Exposición , Investigación Cualitativa , Humanos , Masculino , Adolescente , Infecciones por VIH/prevención & control , Adulto Joven , Homosexualidad Masculina/psicología , Brasil , Adulto , Personal de Salud/psicología , Femenino , Personas Transgénero/psicología , Entrevistas como Asunto , Percepción , Conocimientos, Actitudes y Práctica en Salud , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/administración & dosificaciónRESUMEN
OBJECTIVE: This study aims to analyze the knowledge about the HIV event-driven pre-exposure prophylaxis (event-driven PrEP) scheme and the perception of its potential use among young men who have sex with men (MSM), travestis, and transgender women (TrTW) who were followed up in the cohort. METHODS: This qualitative study included 50 interviews with participants from the municipalities of Salvador and São Paulo, aged 15 to 19 years, who made daily use of PrEP or other preventive methods. They were addressed by different demand creation strategies. The in-depth interviews covered topics such as sexual practices, event-driven PrEP knowledge, acceptability, and motivations for its use. A two-stage thematic analysis was carried out on Nvivo, version 12. RESULTS: Most participants were unaware of event-driven PrEP, and many questioned its effectiveness and safety when receiving information about it. However, on learning about the program, many young people saw advantages, such as not having to take daily medication and the possibility of using it only at times of greater risk. Participants also found barriers to using event-driven PrEP, such as the unpredictability of sexual relations and the difficulty in administering dosages in this modality. CONCLUSION: Limited knowledge and experiences with daily oral PrEP influenced interest in event-driven PrEP, which highlights the need for information strategies that enable young MSM and TrTW to read about event-driven PrEP. Young people valued the autonomy and management of preventive methods provides by this new modality, which is more in line with the dynamics of their sexual lives, but they face challenges in managing event-driven PrEP.
OBJETIVO: O objetivo deste estudo é analisar o conhecimento sobre o esquema de Profilaxia Pré-Exposição ao HIV sob demanda (PrEP-SD) e a percepção do seu uso potencial entre jovens homens que fazem sexo com homens (HSH), travestis e mulheres trans (TrMT) em acompanhamento na coorte. MÉTODOS: O estudo qualitativo incluiu 50 entrevistas com participantes das cidades de Salvador e São Paulo, entre 15 e 19 anos, que estavam usando PrEP diária ou outros métodos preventivos. Eles foram abordados por meio de diferentes estratégias de criação de demanda. As entrevistas em profundidade abordaram temas como práticas sexuais, conhecimento sobre PrEP-SD, aceitabilidade e motivações para o uso. Foi realizada análise temática em duas fases usando o software Nvivo versão 12. RESULTADOS: A maioria dos participantes desconhecia a PrEP-SD e muitos questionaram a sua efetividade e segurança ao receberem informações sobre ela. No entanto, ao conhecer o esquema, muitos jovens perceberam vantagens, como a não obrigatoriedade diária de medicamentos e a possibilidade de uso apenas em momentos de maior risco. Barreiras para o uso da PrEP-SD também foram identificadas pelos participantes, como a imprevisibilidade das relações sexuais e a dificuldade em administrar as dosagens nessa modalidade. CONCLUSÕES: O conhecimento limitado e as experiências com a PrEP oral diária influenciaram o interesse por ela, o que aponta a necessidade de estratégias informativas que permitam o letramento dos jovens HSH e TrMT na PrEP-SD. Os jovens valorizaram a autonomia e a gestão da prevenção mais alinhada à dinâmica de sua vida sexual propiciada pela nova modalidade, mas enfrentam desafios na gestão da PrEP-SD.
Asunto(s)
Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Profilaxis Pre-Exposición , Investigación Cualitativa , Personas Transgénero , Humanos , Masculino , Profilaxis Pre-Exposición/métodos , Adolescente , Adulto Joven , Femenino , Infecciones por VIH/prevención & control , Personas Transgénero/psicología , Brasil , Homosexualidad Masculina/psicología , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/uso terapéutico , Conducta Sexual/psicología , Entrevistas como Asunto , Aceptación de la Atención de Salud/psicologíaRESUMEN
OBJECTIVE: To analyze the impact of intersecting systems of oppression on the continuum of PrEP care among adolescent gays, bisexuals, and other men who have sex with men (aGBMSM), and to examine how health professionals (HP) identify and address these challenges to provide sexual health care and HIV prevention. METHODS: This qualitative exploratory study was part of a cohort research project involving aGBMSM, travesties, and transgender women (aTrTW) using PrEP. Data analyzed consisted of 16 interviews with aGBMSM and eight with health professionals (HPs) in São Paulo study site. The methodological and theoretical framework for the interactive categorization of thematic analysis was based on an intersectional approach. RESULTS: The knowledge of aGBMSM about PrEP was influenced by the adverse effects of systems of oppression, particularly among Black adolescents, who acquired knowledge in a less technical manner compared to White adolescents. Most professionals recognized oppression and its impact on the PrEP care continuum (PrEPCC), especially noting the presence of racism. However, few articulated how different social markers compound barriers to the success of the PrEPCC. CONCLUSION: Social oppression affects the success of the PrEP care continuum (PrEPCC) in multiple ways. Health professionals (HPs) play a crucial role in mitigating and not perpetuating these negative experiences within health services, as well as in PrEP access, use, and adherence.
OBJETIVO: Analisar os impactos dos sistemas de opressão intersectados no continuum do cuidado de profilaxia pré-exposição sexual (CCPrEP) entre gays, bissexuais e outros homens que fazem sexo com homens (aGBHSH) e como estes são identificados e tratados por profissionais de saúde (PS), visando o cuidado à saúde sexual e prevenção do HIV. MÉTODOS: Estudo de investigação qualitativa integrado a uma pesquisa de coorte com aGBHSH e mulheres transexuais e travestis (aMTrT) em uso de PrEP. Foram analisados dados produzidos na cidade de São Paulo, integrando 16 entrevistas com aGBHSH e oito com PS. O referencial teórico metodológico se orientou pela categorização interativa de análise temática com enquadramento interseccional. RESULTADOS: Os conhecimentos sobre PrEP dos aGBHSH são afetados pelos efeitos negativos dos sistemas de opressão, sobretudo entre adolescentes negros que adquirem conhecimento de forma menos técnica quando comparados aos brancos. A maioria dos profissionais enxerga as opressões e as suas consequências, e confere protagonismo ao racismo, mas poucos articulam os diferentes marcadores sociais que potencializam barreiras para o sucesso do CCPrEP. CONCLUSÕES: As opressões sociais impactam o sucesso do CCPrEP de diferentes maneiras. Os PS são centrais para mitigação e não propagação dessas experiências negativas dentro do serviço de saúde e no acesso, uso e adesão à PrEP.
Asunto(s)
Continuidad de la Atención al Paciente , Infecciones por VIH , Homosexualidad Masculina , Profilaxis Pre-Exposición , Investigación Cualitativa , Humanos , Masculino , Adolescente , Infecciones por VIH/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/psicología , Brasil , Minorías Sexuales y de Género/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Adulto Joven , Entrevistas como Asunto , Conocimientos, Actitudes y Práctica en Salud , Femenino , Adulto , Bisexualidad , Estudios de CohortesRESUMEN
OBJECTIVE: To identify the factors associated with HIV self-testing (HIVST) uptake among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) before and during the COVID-19 pandemic. METHODS: A cross-sectional HIVST uptake study was conducted among AMSM and ATGW. Peer educators and health professionals began providing HIVST in February 2019. The outcome was the HIVST uptake before and during the COVID-19 pandemic. The association between each predictor and outcome in each period was analyzed using simple and multiple logistic regressions, estimating odds ratios, and their respective 95% confidence intervals. RESULTS: The uptake was 229/510 (44.9%) and 382/1,075 (35.5%) before and during the pandemic. During the pre-pandemic period, HIVST uptake was higher in participants who reported receptive anal sex. During the pandemic, uptake was lower in participants with a steady sexual partner and higher in those with frequent oral sex with a steady partner in the previous three months. Before and during the pandemic, HIVST uptake was lower in ATGW and higher in those aged 18-19 years and in participants who lived alone. CONCLUSIONS: Uptake decreased during the pandemic. Sexual behavioral factors associated with HIVST uptake changed during the COVID-19 pandemic, showing the fluid dynamics of sexuality in AMSM and ATGW during this period. HIV programs can optimize the implementation of HIVST among adolescents and young people by incorporating effective and differentiated service delivery models to increase HIV testing uptake and to reach undiagnosed individuals effectively.
Asunto(s)
COVID-19 , Infecciones por VIH , Autoevaluación , Minorías Sexuales y de Género , Humanos , Masculino , Adolescente , COVID-19/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/diagnóstico , Adulto Joven , Minorías Sexuales y de Género/estadística & datos numéricos , Brasil/epidemiología , Personas Transgénero/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Prueba de VIH/estadística & datos numéricos , Adulto , Pandemias , Homosexualidad Masculina/estadística & datos numéricos , SARS-CoV-2 , Aceptación de la Atención de Salud/estadística & datos numéricosRESUMEN
OBJECTIVE: To identify recent HIV-1 infection and estimate HIV incidence among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in Brazil. METHODS: From January to December 2020, a cross-sectional analysis was conducted with baseline data from the PrEP1519 study, an HIV pre-exposure prophylaxis (PrEP) demonstration cohort in Brazil among sexually active AMSM/ATGW aged 15-19. For enrollment, participants were screened with a fourth-generation HIV rapid test. The recent infection testing algorithm (RITA) included a recency assay in blood specimens, viral load, and CD4 cell count prior to antiretroviral treatment use. Among these participants, RITA-based HIV incidence was estimated using a mean duration of recency infection of 214 days and a false-recent rate of 0.02. RESULTS: Out of the 494 participants screened, 21 tested positive for HIV. Following RITA, five adolescents had a recent HIV infection, 14 had long-term infections, and two did not have blood specimens available. We classified these two participants as long-term infection cases due to CD4 cell counts and previous use of antiretroviral treatment. Among those who tested positive, all but one were AMSM (94.7%), 73.6% were aged 18-19, and 76.2% were non-White. The HIV prevalence was 4.2%, and the estimated HIV incidence was 1.7%. CONCLUSIONS: The estimated incidence highlights the need for targeted HIV prevention interventions, such as PrEP, for sexual minority adolescents. Integrating RITA into routine HIV testing services for this population provides valuable information on the current HIV epidemic. This strategy can aid in monitoring the effectiveness of prevention efforts and improving early entry to HIV care.
Asunto(s)
Infecciones por VIH , Humanos , Adolescente , Masculino , Infecciones por VIH/epidemiología , Incidencia , Brasil/epidemiología , Femenino , Estudios Transversales , Adulto Joven , Homosexualidad Masculina/estadística & datos numéricos , Personas Transgénero/estadística & datos numéricos , Profilaxis Pre-Exposición , Recuento de Linfocito CD4 , Carga ViralRESUMEN
OBJECTIVE: Viral hepatitis and sexually transmitted infections disproportionally affect men who have sex with men (MSM) and transgender women (TGW). However, only a few studies have evaluated the prevalence of hepatitis in these populations, especially in youths and adolescents. This study aimed to estimate the prevalence of biomarkers for hepatitis A, B, and C among young and adolescent MSM and TGW in three Brazilian municipalities. METHODS: Baseline data were collected from a combination of HIV prevention cohort of young and adolescent MSM (AMSM) and TGW (ATGW) aged 15-19 years in three Brazilian municipalities. A social behavioral questionnaire was applied, and immunoassays were performed to detect antibodies against hepatitis A (anti- HAV IgG and IgM), hepatitis B (anti-HBc and anti-HBs), and hepatitis C virus (anti-HCV); testing for the active hepatitis B marker, HBsAg, was also performed. The prevalence of reactive tests and 95% confidence interval (CI) for proportions were measured. RESULTS: The prevalence of naturally or artificially acquired immunity for hepatitis A totaled 17.7% (95%CI: 15.4-20.4), whereas that of acute infection, 0.4% (95%CI: 0.2-1.2). For hepatitis B and C, prevalence rates totaled 2.8% (95%CI: 1.8-4.4) and 0.2% (95%CI: 0.1-1.1), respectively. About 25.7% (95%CI: 22.4-29.4) of participants were non-reactive for anti-HBc and reactive for anti-HBs, the latter being a vaccine marker for hepatitis B. CONCLUSIONS: The investigation of viral hepatitis biomarkers among vulnerable populations enables the early identification of infections, the provision of timely treatment, and an opportunity to point out the need to expand vaccination coverage.
Asunto(s)
Hepatitis B , Homosexualidad Masculina , Personas Transgénero , Humanos , Brasil/epidemiología , Masculino , Adolescente , Personas Transgénero/estadística & datos numéricos , Adulto Joven , Prevalencia , Homosexualidad Masculina/estadística & datos numéricos , Femenino , Hepatitis B/epidemiología , Hepatitis A/epidemiología , Hepatitis C/epidemiología , Biomarcadores/sangre , Estudios Transversales , Factores Socioeconómicos , Factores de Riesgo , Hepatitis Viral Humana/epidemiologíaRESUMEN
OBJECTIVE: This article discusses how Pre-Exposure Prophylaxis (PrEP) and the undetectable viral load=untransmissible (UVL=U) have produced reconfigurations in the contexts of affective-sexual encounters of young gay men/men who have sex with men (MSM) living with HIV (YLHIV). METHODS: In-depth interviews were conducted with nine YLHIV, aged 18 to 29, from two studies conducted in Salvador, Bahia, in 2019 and 2021. The narratives focused on unprecedented events in the prevention and treatment of HIV/AIDS, which have allowed experiences of greater intimacy and safety but also challenges and tensions in affective-sexual relationships. RESULTS: Different moments in the experience of living with HIV reveal different narratives of YLHIV concerning the new PrEP and UVL biotechnologies. Concerns surrounding possible HIV transmission or the obligation to reveal serology are more prominent among young people with the most recent diagnosis. In contrast, those with more extended serology experience are more comfortable and confident in the face of new technologies and their significant effects on sexual encounters. However, controversies remain regarding the moral and behavioral consequences of their use. Some YLHIV re-update concerns and bring reports about the continuity of stigma toward people living with HIV. Others emphasize the benefits of biomedical advances, opening up new interactive possibilities, including without the use of condoms, highlighting the existence of other practices, knowledge, dynamics, and ways of negotiating risk/care, with tensions in the field of sexuality itself. CONCLUSIONS: We reiterate the need to resume public policies in the field of HIV/AIDS beyond biomedical strategies, highlighting vulnerabilities, the dissemination of information about new HIV prevention and treatment technologies, respect for people's autonomy in their preventive choices, and the development of strategies to combat the stigma associated with HIV/AIDS.
OBJETIVO: Neste artigo, discutimos como a profilaxia pré-exposição (PrEP) e a carga viral indetectável=intransmissível (CVI=I) têm produzido reconfigurações nos contextos de encontros afetivo-sexuais de jovens gays/ homens que fazem sexo com homens (HSH) vivendo com HIV (JVHIV). MÉTODOS: Conduzimos entrevistas em profundidade com nove JVHIV, de 18 a 29 anos, oriundos de duas pesquisas realizadas em Salvador/Bahia, em 2019 e 2021. Focalizamos narrativas sobre acontecimentos inéditos na prevenção e no tratamento do HIV/aids, que têm permitido experiências de maior intimidade e segurança, mas também desafios e tensionamentos às relações afetivo-sexuais. RESULTADOS: Momentos distintos da experiência de viver com HIV revelam diferentes narrativas dos JVHIV com relação às novas biotecnologias de PrEP e CVI. Preocupações em torno de uma possível transmissão do HIV ou da obrigação de revelar a sorologia ficam mais destacadas entre jovens com o diagnóstico mais recente, enquanto aqueles com maior tempo de sorologia se colocam de forma mais confortável e confiante frente às novas tecnologias e seus efeitos significativos nos encontros sexuais, ainda que permaneçam controvérsias a respeito das consequências morais e comportamentais do uso delas. Alguns JVHIV reatualizam preocupações e trazem relatos sobre a continuidade do estigma em relação às pessoas vivendo com HIV. Outros JVHIV enfatizam os benefícios dos avanços biomédicos, com abertura para novas possibilidades interativas, inclusive sem uso da camisinha, sublinhando a existência de outras práticas, saberes, dinâmicas e formas de negociação do risco/cuidado, com tensionamentos no campo da própria sexualidade. CONCLUSÕES: Reiteramos a necessidade de retomada de políticas públicas no campo do HIV/aids para além das estratégias biomédicas, dando destaque às vulnerabilidades, à disseminação de informações sobre as novas tecnologias de prevenção e tratamento do HIV, ao respeito à autonomia das pessoas em suas escolhas preventivas e ao desenvolvimento de estratégias de enfrentamento aos estigmas associados ao HIV/aids.
Asunto(s)
Infecciones por VIH , Homosexualidad Masculina , Profilaxis Pre-Exposición , Humanos , Masculino , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Profilaxis Pre-Exposición/métodos , Adolescente , Adulto , Adulto Joven , Brasil , Homosexualidad Masculina/psicología , Sexo Seguro/psicología , Placer , Entrevistas como Asunto , Conducta Sexual/psicología , Investigación Cualitativa , Carga Viral , Asunción de Riesgos , Fármacos Anti-VIH/uso terapéuticoRESUMEN
OBJECTIVE: To understand the social representations of HIV and their repercussions for the healthcare among recently diagnosed youth. METHODS: This qualitative research was conducted within PrEP15-19, a study that analyzed the effectiveness of HIV pre-exposure prophylaxis in adolescents aged 15 to 19 years. Semi-structured interviews were conducted with nine participants, of whom eight identified themselves as gay men and one as travesti. All were diagnosed with HIV as this study was conducted in São Paulo and Salvador from 2019 to 2020. The interview guide covered aspects of HIV prevention and repercussions on care. Data were thematically analyzed and interpreted based on social representations theory. RESULTS: Participants reported experiences of stigma and discrimination related to their sexual orientation and gender identity and expression. Their diagnosis renewed these painful experiences as it referred to the common-sense social representations of HIV and AIDS based on precarious knowledge of HIV prevention, treatment, and transmission. Analysis of facilitators and barriers to care strongly related treatment adherence to health services welcoming people with information, support, and careful listening. Barriers were related to health services' constraints, such as lack of privacy, professionals' hostility, and insecurity regarding diagnosis confidentiality. CONCLUSIONS: The social representations of HIV are an important dimension of youths' experience receiving their diagnosis, especially since it renews stories of violence, homophobia, transphobia, stigma, and discrimination. Understanding this based on youths' narratives is an important tool to formulate public policies aimed at the needs of this age group. Therefore, building new social representations to mitigate stigma constitutes one of the most important elements to face the HIV epidemic among adolescents and youth.
OBJETIVO: Compreender as representações sociais do HIV e suas repercussões no cuidado de jovens recentemente diagnosticados. MÉTODOS: Foi realizada pesquisa qualitativa no contexto do estudo PrEP15-19, que analisou a efetividade da profilaxia pré-exposição sexual ao HIV entre adolescentes de 15 a 19 anos. Foram realizadas entrevistas semiestruturadas com nove jovens homens que fazem sexo com homens (HSH) e uma travesti. Todos receberam diagnóstico de HIV durante a inclusão no estudo realizado em São Paulo e Salvador entre 2019 e 2020. O roteiro de entrevista abordou aspectos da prevenção ao HIV e repercussões no cuidado. Utilizou-se análise temática dos dados, interpretados a partir da teoria das representações sociais. RESULTADOS: Os jovens relataram experiências de estigma e discriminação relacionadas à orientação sexual, identidade e expressão de gênero. Essas vivências trouxeram sofrimentos que foram atualizados na comunicação do diagnóstico, pois remetiam às representações sociais do HIV e aids disseminadas pelo senso comum, baseadas no conhecimento precário sobre prevenção, tratamento e transmissão do HIV. Na análise dos facilitadores e barreiras ao cuidado, a vinculação ao tratamento esteve fortemente relacionada ao acolhimento nos serviços de saúde, com informações e apoio, além de escuta qualificada. As barreiras estiveram relacionadas às fragilidades nos espaços de saúde que obstaculizam o cuidado, como falta de privacidade, hostilidade de profissionais e insegurança quanto à confidencialidade do diagnóstico. CONCLUSÕES: As representações sociais do HIV constituem uma importante dimensão da experiência diagnóstica de jovens, sobretudo por atualizar histórias de violência, homofobia, transfobia, estigma e discriminação. Sua compreensão, a partir dos discursos de jovens, constitui importante ferramenta para formulação de políticas públicas voltadas às demandas dessa faixa etária. Portanto, a construção de novas representações sociais que visem à mitigação do estigma torna-se um dos elementos mais importantes para o enfrentamento da epidemia de HIV entre adolescentes e jovens.
Asunto(s)
Infecciones por VIH , Investigación Cualitativa , Estigma Social , Humanos , Adolescente , Masculino , Infecciones por VIH/psicología , Infecciones por VIH/prevención & control , Infecciones por VIH/diagnóstico , Adulto Joven , Brasil , Femenino , Entrevistas como Asunto , Homosexualidad Masculina/psicología , Profilaxis Pre-ExposiciónRESUMEN
OBJECTIVE: To analyze the factors that increase the practice of condomless anal sex (CAS) among adolescent men who have sex with men (AMSM) and adolescent travestis and transgender women (ATGW) in three Brazilian state capitals. METHODS: PrEP1519 is a prospective, multicenter cohort study demonstrating the effectiveness of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among AMSM and ATGW aged from 15 to 19 years in three Brazilian state capitals. The analyses were performed with baseline cohort data, including 1,418 adolescents enrolled from 2019 to 2021. The outcome studied was CAS in the last six months, and the potentially associated factors were sociodemographic, behavioral, healthcare, and history of violence and discrimination. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (95%CI) were estimated. RESULTS: Most of the participants were AMSM (91.5%), aged 18 to 19 years (75.9%), Black (40.5%), with secondary or higher education in progress (92.7%), with CAS during the first sexual intercourse (54.2%), sexual initiation before the age of 14 (43.4%), and history of group sex (24.6%) and transactional sex (14.6%). The prevalence of CAS in the last six months was 80.6% (95%CI 78.5%-82.6%). Adolescents who reported condomless first sexual intercourse (aPR: 1.18; 95%CI 1.10-1.25), use of psychoactive substances (aPR: 1.09; 95%CI 1.03-1.16), and transactional sex (aPR: 1.11; 95%CI 1.04-1.20) had a higher prevalence of CAS in the last six months. We also found that those aged 15 to 17 years had a higher prevalence of CAS than those aged 18 to 19 (aPR: 1.07; 95%CI 0.99-1.13). CONCLUSIONS: The prevalence of CAS was high among AMSM and ATGW, being associated with practices that may increase the risk of sexually transmitted infections (STIs). Therefore, it is recommended to strengthen sexual health programs for young people that address the issue of sexuality and STI prevention, as well as to expand access to preventive methods, such as condoms and PrEP.
OBJETIVO: Analisar os fatores que aumentam a prática de sexo anal sem preservativo (SASP) entre adolescentes homens que fazem sexo com homens (aHSH) e travestis mulheres trans (aTrMT) em três capitais brasileiras. MÉTODOS: PrEP1519 é uma coorte prospectiva, multicêntrica, de demonstração da efetividade da profilaxia pré-exposição (PrEP) ao HIV entre aHSH e aTrMT, com idade entre 15 e 19 anos, em três capitais brasileiras. As análises foram realizadas com dados da linha de base da coorte, com a inclusão de 1.418 adolescentes inscritos de 2019 a 2021. O desfecho estudado foi SASP nos últimos seis meses, e os potenciais fatores associados foram sociodemográficos, comportamentais, de assistência à saúde e histórico de violência e discriminação. Foi realizada análise descritiva, bivariada e multivariada. Estimaram-se razões de prevalência ajustadas (RPa) e intervalos de confiança de 95% (IC95%). RESULTADOS: A maioria dos participantes era aHSH (91,5%), com idade de 18 a 19 anos (75,9%), pretos (40,5%), ensino médio e superior em andamento (92,7%), com relato de SASP na primeira relação sexual (54,2%), início da vida sexual antes dos 14 anos (43,4%) e história de sexo em grupo (24,6%) e de sexo transacional (14,6%). A prevalência de SASP nos últimos seis meses foi de 80,6% (IC95% 78,5%-82,6%). Adolescentes que relataram primeira relação sexual sem preservativo (RPa: 1,18; IC95% 1,10-1,25), consumo de substâncias psicoativas (RPa: 1,09; IC95% 1,03-1,16) e sexo transacional (RPa: 1,11; IC95% 1,04-1,20) tiveram maior prevalência de SASP nos últimos seis meses. Verificou-se também que aqueles com idade de 15 a 17 anos tiveram maior prevalência de SASP em comparação àqueles de 18 a 19 anos (RPa: 1,07; IC95% 0,99-1,13). CONCLUSÕES: A prevalência de SASP foi alta entre aHSH e aTrMT, bem como esteve associada a práticas que podem aumentar o risco de infecções sexualmente transmissíveis (IST). Assim, recomenda-se o fortalecimento de programas de saúde sexual para jovens que abordem o tema da sexualidade e prevenção de IST, tal como a ampliação do acesso a métodos preventivos, como preservativo e PrEP.
Asunto(s)
Infecciones por VIH , Homosexualidad Masculina , Profilaxis Pre-Exposición , Conducta Sexual , Personas Transgénero , Sexo Inseguro , Humanos , Adolescente , Masculino , Brasil/epidemiología , Adulto Joven , Estudios Prospectivos , Personas Transgénero/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Femenino , Profilaxis Pre-Exposición/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Sexo Inseguro/estadística & datos numéricos , Condones/estadística & datos numéricos , Factores de Riesgo , Factores Socioeconómicos , PrevalenciaRESUMEN
OBJECTIVE: To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis. METHODS: A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression. RESULTS: 608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1-7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22-6.92; CO-center: ORa = 1.91; 95%CI 1.10-3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94-1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78-0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63-5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78-0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10-3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18-3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV. CONCLUSION: The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities.
OBJETIVO: Avaliar se adolescentes de minorias sexuais que iniciaram a profilaxia pré-exposição sexual (PrEP) em organizações comunitárias (OC) apresentam maior vulnerabilidade social e ao HIV em comparação com adolescentes em PrEP de um serviço de saúde convencional. Além disso, avaliar se esses adolescentes tiveram um acesso mais oportuno à profilaxia. MÉTODOS: Estudo demonstrativo da efetividade de PrEP, realizado na cidade de São Paulo, em duas OC, localizadas no centro (OC-centro) e na periferia (OC-periferia), e em um serviço convencional de testagem para o HIV (CTA-centro). Foram elegíveis para PrEP, entre 2020 e 2022, adolescentes homens cisgêneros que fazem sexo com homens (aHSH), travestis, mulheres transexuais e pessoas transfemininas (aTTrans), de 15 a 19 anos, HIV-negativos e com práticas de maior risco para o HIV. Indicadores de acesso oportuno e de vulnerabilidades dos adolescentes iniciando PrEP nas OC foram analisados, tendo por referência o CTA-centro e empregando regressão logística multinomial. RESULTADOS: 608 adolescentes iniciaram PrEP nas OC e CTA-Centro. Adolescentes das OC estiveram associados a um menor tempo de início de PrEP (17 dias; OC-periferia: ORa = 2,91; IC95% 1,226,92; OC-centro: ORa = 1,91; IC95% 1,103,31); e a um menor IDH de moradia (OC-centro: ORa = 0,97; IC95% 0,941,00; OC-periferia: ORa = 0,82; IC95% 0,780,86). Na OC-periferia houve aumento na chance de os adolescentes serem mais jovens (ORa = 3,06; IC95% 1,635,75) e morarem mais próximos ao serviço (ORa = 0,82; IC95% 0,780,86, média 7,8 km). Enquanto adolescentes da OC-centro estiveram associados ao maior conhecimento prévio de PrEP (ORa = 2,01; IC95% 1,103,91) e a alta percepção de risco (ORa = 2,02; IC95% 1,183,44). Não estiveram associadas aos adolescentes das OC as práticas sexuais de maior risco e as situações de vulnerabilidade ao HIV. CONCLUSÕES: A oferta de PrEP nas OC facilitou o acesso de adolescentes vulnerabilizados e pode contribuir para reduzir inequidades.
Asunto(s)
Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Humanos , Profilaxis Pre-Exposición/estadística & datos numéricos , Profilaxis Pre-Exposición/métodos , Adolescente , Masculino , Infecciones por VIH/prevención & control , Brasil , Adulto Joven , Minorías Sexuales y de Género/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud Comunitaria/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico , Factores Socioeconómicos , Homosexualidad Masculina/estadística & datos numéricosRESUMEN
BACKGROUND: HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. OBJECTIVE: This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples' formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples' acceptability of P3 will be assessed. METHODS: The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. RESULTS: The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. CONCLUSIONS: Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. TRIAL REGISTRATION: ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63106.
Asunto(s)
Infecciones por VIH , Minorías Sexuales y de Género , Humanos , Masculino , Perú/epidemiología , Proyectos Piloto , Adulto , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Parejas Sexuales , Homosexualidad Masculina , Seropositividad para VIH , Composición FamiliarRESUMEN
Objectives: To investigate sexual practices and HIV risk perception among MSM, identifying associated risk factors and determinants. Methods: A cross-sectional epidemiological study was conducted with 144 MSM in Teresina, Piauí, Brazil, using the snowball sampling technique. Participants were recruited via snowball sampling and underwent rapid HIV testing, in addition to completing questionnaires on sexual practices, risk perception, and illicit drug use. Results: The majority of participants showed an unsatisfactory perception of HIV risk. Factors associated with this perception include non-penetrative sex as an HIV preventive measure, which increased the chances of having an unsatisfactory risk perception by 1.45 times (P = .04), engaging with known HIV-positive individuals without knowledge of their viral load (ORa = 2.70; P = .043), and using illicit drugs before/during sex (ORa = 0.29; P = .048). Conclusions: The results indicate a high prevalence of risky sexual practices and an unsatisfactory HIV risk perception among the MSM studied.
HIV Risk and Sexual Practices Among Men Who Have Sex with Men in BrazilThis study examines sexual practices and perceptions of HIV risk among men who have sex with men (MSM) in Teresina, Brazil. MSM are significantly more likely to contract HIV compared to the general population, with various factors influencing their risk. Despite this high vulnerability, many MSM do not perceive themselves to be at significant risk of HIV infection. Researchers surveyed 144 MSM to understand their sexual behaviors and how they perceive the risk of HIV. The study found that many MSM engage in risky sexual practices, such as not using condoms during oral sex, even though most use them during anal sex. Additionally, the study revealed that MSM often has a false sense of security when having sex with steady partners compared to casual partners. Key factors associated with a poor perception of HIV risk included low family income, engaging in non-penetrative sex as a preventive measure, having sexual relations with known HIV-positive individuals without knowing their viral load, and using illicit drugs during sexual activity. For instance, using illicit drugs, known as "chemsex," significantly increases risky behaviors, leading to a higher chance of HIV transmission. The study emphasizes the need for targeted health education and interventions for MSM. It suggests promoting regular condom use, better understanding of HIV transmission risks, and discouraging the use of drugs that impair judgment during sexual activities. Effective public health initiatives should be culturally sensitive and accessible to MSM of all income levels. By addressing these issues, health programs can better support MSM, reduce HIV transmission rates, and improve overall well-being.
Asunto(s)
Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina , Asunción de Riesgos , Conducta Sexual , Humanos , Masculino , Brasil/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Adulto , Estudios Transversales , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/psicología , Conducta Sexual/estadística & datos numéricos , Adulto Joven , Factores de Riesgo , Encuestas y Cuestionarios , Persona de Mediana Edad , Adolescente , Percepción , Sexo Inseguro/estadística & datos numéricos , Sexo Inseguro/psicologíaRESUMEN
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that consists in the use of antiretroviral drugs by seronegative people at risk of HIV. Negative perceptions, inadequate understanding, and access barriers have been associated with decreased medication adherence. Manaus is the largest city in the Brazilian Amazon, where the incidence of HIV/AIDS is high, and the rates of adherence to the antiretroviral treatment for HIV and PrEP are low. In this qualitative study among PrEP users, mostly MSM, we explored perceptions, knowledge, and access barriers. We conducted 21 in-depth interviews with an intentionally sampled group of participants who had used PrEP at least once in their lifetime, selected through the snowball technique, between April and July 2022. A thematic analysis was conducted with a predominantly inductive approach. We highlight three relevant themes: (i) access to information about PrEP and its influences on users, (ii) access, monitoring, and barriers encountered, and (iii) facilitators for PrEP adherence and sexual behaviors. One of the negative perceptions identified in the study involves a misunderstanding of the association between PrEP users and the HIV/AIDS status. Participants revealed that some non-PrEP users suspect that individuals claiming PrEP usage are concealing an HIV-positive status to engage in unprotected sex. Lack of information by health professionals regarding HIV prevention methods poses significant barriers to PrEP access and adherence. Participants emphasized social media's crucial role in PrEP awareness. The results suggest a need to increase digital outreach regarding PrEP, decentralize PrEP services, and provide comprehensive healthcare training to improve the effectiveness of the preventive measure.
Asunto(s)
Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina , Profilaxis Pre-Exposición , Investigación Cualitativa , Humanos , Masculino , Brasil , Adulto , Homosexualidad Masculina/psicología , Infecciones por VIH/prevención & control , Persona de Mediana Edad , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/administración & dosificación , Accesibilidad a los Servicios de Salud , Adulto Joven , Cumplimiento de la Medicación/psicología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Conducta Sexual/psicología , PercepciónRESUMEN
INTRODUCTION: Different religious narratives associate same-sex sexuality, in its various manifestations, with moral deviation or sin. Gay men who are socialized in more religious communities appear to experience and internalize greater levels of homonegativity, as well as to present greater indicators of depressive symptoms. The purpose of this study was to evaluate indicators of perceived homonegativity in the community and internalized, and signs/symptoms of depression reported by Brazilian gay men with a nominal religion and compare them to those reported by Atheists or Agnostics. METHOD: Our sample comprised 194 Brazilian gay men, distributed into three groups: Christians (Protestants and Catholics, n = 71; 36.6%); Spiritualists (Kardecists or religions of African origin, n = 52; 26.8%) and Atheists or Agnostics (n = 71; 36.6%). The following measurement instruments were used: sociodemographic questionnaire, Internalized Homophobia Scale and Beck Depression Scale. RESULTS: High mean scores of depression were verified in all groups, and 60% of the sample presented some level of depression. There was a higher level of self-reported homonegativity among Christians and Spiritualists compared to that reported by Atheists or Agnostics, with the differences between the groups being significant. The regression analysis indicated a significant effect of religion on homonegativity, but not on depression. CONCLUSION: Our results suggest that gay men's chronic exposure to non-affirming religious affiliation contexts may harm the construction of a positive gay identity and should be taken into consideration when addressing mental health inequalities of sexual minorities.
Asunto(s)
Depresión , Homosexualidad Masculina , Humanos , Masculino , Brasil , Adulto , Homosexualidad Masculina/psicología , Depresión/psicología , Depresión/epidemiología , Persona de Mediana Edad , Adulto Joven , Salud Mental , Homofobia/psicología , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricos , Religión , Encuestas y Cuestionarios , Religión y PsicologíaRESUMEN
BACKGROUND: The global burden of sexually transmitted infections (STIs) poses a challenge in the context of HIV pre-exposure prophylaxis (PrEP) programmes. We aimed to explore factors associated with prevalent, incident, and recurrent STIs in men who have sex with men (MSM) and transgender women on PrEP in Brazil, Mexico, and Peru. METHODS: ImPrEP was a prospective, single-arm, open-label, multicentre study that enrolled MSM and transgender women in the context of the public health systems of Brazil (14 sites), Mexico (four sites), and Peru (ten sites) between February, 2018, and June, 2021. Eligibility criteria followed regional PrEP guidelines at the study start, including participants aged 18 years and older, not living with HIV, and reporting at least one of the following in the previous 6 months: condomless anal sex (CAS), anal sex with partner(s) living with HIV, any bacterial STI, or transactional sex. Eligible participants were screened and enrolled on the same day to receive daily oral PrEP (tenofovir disoproxil fumarate 300 mg and emtricitabine 200 mg). We assessed three outcomes: prevalent bacterial STIs, incident bacterial STIs, and recurrent bacterial STIs. Testing occurred at baseline and quarterly for syphilis, anorectal chlamydia, and anorectal gonorrhoea. Behavioural data were collected at baseline and quarterly. The study was registered with the Brazilian Registry of Clinical Trials, U1111-1217-6021. FINDINGS: Among all 9509 participants included in the ImPrEP study (3928 [41·3%] in Brazil, 3288 [34·6%] in Mexico, and 2293 [24·1%] in Peru), 8525 (89·7%) had available STI results at baseline and were included in the prevalent STI analysis, and 7558 (79·5%) had available STI results during follow-up and were included in the incident and recurrent STI analyses. 2184 (25·6%) of 8525 participants had any bacterial STI at baseline. STI incidence during follow-up was 31·7 cases per 100 person-years (95% CI 30·7-32·7), with the highest rate for anorectal chlamydia (11·6 cases per 100 person-years, 95% CI 11·0-12·2), followed by syphilis (10·5 cases per 100 person-years, 9·9-11·1) and anorectal gonorrhoea (9·7 cases per 100 person-years, 9·2-10·3). Although only 2391 (31·6%) of 7558 participants had at least one STI during follow-up, 915 (12·1%) participants had recurrent diagnoses, representing 2328 (61·2%) of 3804 incident STI diagnoses. Characteristics associated with prevalent, incident, and recurrent STIs included younger age, multiple sex partners, receptive CAS, substance use, and previous STI diagnoses at baseline (incident or recurrent only). INTERPRETATION: Our findings underscore the nuanced dynamics of STI transmission among MSM and transgender women across Latin America, highlighting an urgent need for tailored interventions to mitigate STI burden effectively, especially among the most susceptible individuals. FUNDING: Unitaid, WHO, and ministries of health (Brazil, Mexico, and Peru). TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
Asunto(s)
Homosexualidad Masculina , Profilaxis Pre-Exposición , Personas Transgénero , Humanos , Masculino , Personas Transgénero/estadística & datos numéricos , Adulto , Femenino , Estudios Prospectivos , Homosexualidad Masculina/estadística & datos numéricos , Perú/epidemiología , Enfermedades Bacterianas de Transmisión Sexual/prevención & control , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Brasil/epidemiología , Adulto Joven , México/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/uso terapéutico , Prevalencia , Adolescente , IncidenciaRESUMEN
This work discusses the health promotion challenges of men who have sex with men (MSM) through the use of data from a conversation circle with people from institutions that provide services to MSM in the Metropolitan Region of Recife. The results allow for the identification of the following challenges for health promotion work, not only for MSM but also for sex dissidents: difficulties with the use of identity categories, stigmatization for providing them with sexual health care, structural racism, the deprivation of liberty, extreme poverty, and literacy.
O texto discute os desafios para promoção da saúde de homens que fazem sexo com homens (HSHs) por meio de dados oriundos de uma roda de conversa, com pessoas de instituições que prestam serviços para HSHs na Região Metropolitana do Recife. Os resultados permitiram identificar desafios para o trabalho de promoção à saude, não só para HSHs, mas para pessoas sexo-dissidentes: dificuldades com o uso das categorias de identidade; estigmatização por prestar-lhes cuidado em saúde sexual; racismo estrutural; contexto de privação de liberdade; extrema pobreza; letramento.