Discrimination based on sexual orientation against MSM in Brazil: a latent class analysis / Discriminação por orientação sexual entre HSH no Brasil: uma análise de classes latentes

ABSTRACT Introduction: Discrimination based on sexual orientation can influence vulnerability to HIV, increasing exposure to risky sexual behavior among men who have sex with men (MSM). Objectives: To analyze data using latent class analysis (LCA) to identify groups of individuals with specific patterns of discrimination based on sexual orientation (DSO). Methods: Cross-sectional study using respondent-driven sampling in 12 Brazilian cities in 2016. LCA was used to characterize discrimination among MSM based on 13 variables in the survey questionnaire. The proportions of men reporting DSO and other variables of interest were estimated using Gile's Successive Sampling estimator. Results: Most MSM were young, single, had a religion, had a high school or college degree, black or brown skin color, and socioeconomic status classified as average. More than half of the participants reported that they had been discriminated against during the last 12 months due to their sexual orientation (65%), more than a third said they had felt afraid of walking in public places during the past 12 months, and about one-fifth of participants reported having been victims of physical or sexual assault due to DSO. DSO was classified into four latent classes: "very high", "high", "moderate" and "low", with estimates of 2.2%, 16.4%, 35.1%, and 46.19%, respectively. Conclusion: We observed a high proportion of discrimination against MSM in this study. The use of LCA differentiated parsimoniously classes of discrimination.

RESUMO Introdução: A discriminação por orientação sexual (DPOS) pode influenciar a vulnerabilidade ao HIV aumentando a exposição a comportamentos sexuais de risco entre homens que fazem sexo com homens (HSH). Objetivos: Examinar dados utilizando a análise de classes latentes (ACL) para identificar grupos de indivíduos com padrões específicos de DPOS. Métodos: Estudo transversal com entrevistados recrutados pelo processo amostral respondent driven sampling em 12 cidades brasileiras em 2016. A ACL foi usada para caracterizar o DPOS entre HSH com base em 13 variáveis do bloco de discriminação do questionário da pesquisa. As proporções de DPOS e das variáveis de interesse, bem como seus intervalos de confiança (95%) foram ponderados usando o estimador de Gile. Resultados: A maioria era de jovens, solteiros, com alguma religião, escolaridade média ou superior, cor da pele preta ou parda e com nível socioeconômico médio. Mais da metade referiu ter sido discriminado nos últimos 12 meses por sua orientação sexual (65%), mais de um terço referiu ter tido medo de andar em lugares públicos nos últimos 12 meses e em torno de um quinto dos participantes reportaram ter sofrido agressão física ou sexual na vida. A DPOS foi classificada em 4 classes latentes, "muito alta", "alta", "média" e "baixa", com estimativas de 2,2%, 16,4%, 35,1% e 46,19%, respectivamente. Conclusão: Observou-se alta proporção de discriminação entre os HSH participantes deste estudo. A utilização da ACL discriminou de maneira parcimoniosa as classes de DPOS.

Vulnerabilidade e fatores associados a HIV e sífilis em homens que fazem sexo com homens, Belo Horizonte, MG / Vulnerability and factors associated with HIV and syphilis among men who have sex with men, Belo Horizonte, MG

Introdução: a epidemia do HIV no Brasil caracteriza-se como concentrada em populações-chave, incluindo homens que fazem sexo com homens (HSH). No entanto, são pouco conhecidos os indicadores de monitoramento e avaliação da epidemia em nível estadual ou municipal destas populações. Objetivo: descrever comportamentos de risco e prevalências de HIV e sífilis em população de HSH em Belo Horizonte, MG.Métodos: estudo de corte transversal parte de estudo multicêntrico nacional entre HSH adultos. A amostra foi recrutada pela técnica Respondent Driven Sampling (RDS). Foram realizadas entrevistas semiestruturadas e exames para HIV e sífilis. Resultados: foram recrutados 274 HSH em Belo Horizonte. Os participantes eram principalmente indivíduos jovens, com alta escolaridade, de classes sociais A/B, que se autorreferiram gay ou homossexual e tinham alta proporção do uso irregular de preservativos. As prevalências ponderadas da infecção pelo HIV e de sífilis foram, respectivamente, 10,3 e 13,9%. Idade, cor, contar para a mãe ou pai sobre a orientação sexual, testagem prévia para o HIV ou sífilis, diagnóstico prévio de sífilis ou de outras DSTs foram estatisticamente associados a ambas as infecções (p<0,05). Estado civil, família ser indiferente ou desaprovar a opção sexual, ter melhor conhecimento sobre HIV/Aids, mas não saber avaliar sua percepção de risco estiveram estatisticamente associados somente ao HIV e classe social somente com sífilis. Conclusão: os resultados revelam a gravidade da epidemia do HIV na população de HSH residentes em Belo Horizonte. Políticas públicas no nível municipal e estadual devem ser implementadas e/ou revistas com urgência...

Introduction: The HIV epidemic in Brazil is characterized as concentrated on key populations, incluiding men Who have sex with men (MSM). However, monitoring and evaluation indicators are not well known at Municipal or State levels. Objective: To describe risk behaviors and HIV and syphilis prevalences among MSM in Belo Horizonte, MG. Methods: Crosssectional study part of a national multicenter study among adult MSM in Brazil. The sample was recruited using Respondent Driven Sampling (RDS) technique. Semistructure interviews and serological exams for HIV and syphilis were conducted. Resultads: A total of 274 MSM were recruited in Belo Horizonte. Participants were mostly young, with high education, social classes A/B, self-reported as gay or homosexual and with high proportion of irregular use of condoms. Weighted prevalence of HIV infection and syphilis were, respectively, 10.3% and 13.9%. Age, color, sharing with their mother or father their sexual orientation, prior HIV and syphilis testing, and previous diagnosis of syphilis or other STDs were statistically associated with both infections (p<0.05). Marital status, family disapproval or indifference of their sexual orientation, better HIV/Aids knowledge, not knowing their chances of acquiring HIV were statistically associated only with HIV and social class only with syphilis. Conclusion: These results indicate the severity of the HIV epidemic amongthe MSM population in Belo Horizonte. Public policies at the municipal and state levels must be implemented and/or revised urgently...

Sexo anal receptivo desprotegido entre homens que fazem sexo com homens, Belo Horizonte, MG / Unprotected receptive anal sex among men who have sex with men, Belo Horizonte, MG

Introdução: a epidemia do HIV no Brasil é considerada concentrada em populações vulneráveis, principalmente em homens que fazem sexo com outros homens (HSH). Objetivo: este trabalho objetiva descrever as características do comportamento sexual de risco e analisar as características associadas ao uso inconsistente de preservativos nas relações sexuais anais receptivas entre homens que fazem sexo com homens (HSH) em Belo Horizonte, MG. Métodos: estudo de corte transversal, conduzido em 2008-2009, com 274 HSH recrutados pela técnica amostral do Respondent Driven Sampling (RDS). Odds Ratios foram estimadas por regressão logística. Resultados: entre 274 indivíduos,35,7% informaram uso inconsistente de preservativo nas relações anais receptivas nos seis meses anteriores à entrevista, com elevada proporção de parcerias sexuais múltiplas (média de 4,3 parceiros). Ser casado ou estar em união estável, identidade sexual autorreferida como gay, sentir-se tenso ou preocupado algumas ou muitas vezes nos últimos 12 meses, história de relação sexual sob efeito de álcool nos últimos seis meses, baixo conhecimento sobre transmissão do HIV e história de testagem prévia para sífilis foram fatores independentemente associados ao uso inconsistente de preservativos nas relações anais receptivas na amostra analisada. Conclusões: foi alta a proporção de uso inconsistente de preservativos nessa população de HSH. Estratégias de intervenções específicas devem ser desenvolvidas, com atenção especial para o uso de álcool e drogas, combate ao estigma e preconceito, além de ampliação à testagem e assistência integral à saúde. O indicador de uso inconsistente de preservativos nas relações anais receptivas deve ser incorporado no monitoramento e avaliação da epidemia de Aids no município...

Introduction: The Brazilian HIV epidemic is considered concentrated among vulnerable populations, particularly men who have sex with men (MSM). Objective: This paper analyzes the characteristics of sexual behavior and its associated factors among MSM in the city of Belo Horizonte, MG. Methods: Cross-sectional study conducted in 2008-2009, among 274 MSM recruited by Respondent Driven Sampling (RDS). Odds Ratios wereestimated by logistic regression.Results: Among 274 subjects, 35.7% reported inconsistent condom use in receptive anal intercourse in the 6 months preceding the interview, with a high proportion of multiple sexual partnerships (average of 4.3 partners). Final logistic regression model showed that being married or living in a stable relationship, selfreportedsexual identity as ?gay?, feeling tense or worried some or many times in the past 12 months, history of sexual intercourse under influence of alcohol in the last six months, low knowledge about HIV transmission and history of previous testing for syphilis were sefactors independently associated with inconsistent use of condoms during receptive anal intercourse in the sample. Conclusions: The proportion of inconsistent condom use in this MSM population was high. Specific intervention strategies for should be developed with special attention to the use of alcohol and drugs, fighting stigma and prejudice, as well as expanding testing and comprehensivehealth assistance. The indicator inconsistent condom use in receptive anal sex should be incorporated in the monitoring and evaluation of the Aids epidemic at the municipal level in this key population of MSM...

Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy

OBJECTIVE: We conducted a study to identify gender differences in factors associated with the first episode of non-adherence in the 12 months following the first antiretroviral prescription. METHODS: A concurrent prospective study of patients initiating antiretroviral therapy in Brazil was conducted from 2001-2002. The self-reported measurement of adherence was defined as an intake of less than 95% of the prescribed number of doses. Only the first occurrence of non-adherence was considered in this analysis. All analyses were stratified by gender. A Cox proportional hazard model was used to estimate the risk of non-adherence, and the time to non-adherence was estimated using the Kaplan-Meier method. RESULTS: The cumulative incidence of non-adherence was 34.6% (29.7% and 43.9% among men and women, respectively; p=0.010). Marital status (being married or in stable union; p=0.022), alcohol use in the month prior to the baseline interview (p=0.046), and current tobacco use (p=0.005) increased the risk of non-adherence among female participants only, whereas a self-reported difficulty with the antiretroviral treatment was associated with non-adherence in men only. For both men and women, we found that a longer time between the HIV test and first antiretroviral therapy prescription (p=0.028) also presented an increased risk of non-adherence. CONCLUSIONS: In this cohort study, the incidence of non-adherence was 1.5 times greater among women compared to men. Our results reinforce the need to develop interventions that account for gender differences in public referral centers. Additionally, we emphasize that, to achieve and maintain appropriate adherence levels, it is important to understand the barriers to seeking and utilizing health care services. .

Difficulties reported by hiv-infected patients using antiretroviral therapy in brazil

OBJECTIVE: To describe the degree of difficulty that HIV-infected patients have with therapy treatment. INTRODUCTION: Patients' perceptions about their treatment are a determinant factor for improved adherence and a better quality of life. METHODS: Two cross-sectional analyses were conducted in public AIDS referral centers in Brazil among patients initiating treatment. Patients interviewed at baseline, after one month, and after seven months following the beginning of treatment were asked to classify and justify the degree of difficulty with treatment. Logistic regression was used for analysis. RESULTS: Among 406 patients initiating treatment, 350 (86.2 percent) and 209 (51.5 percent) returned for their first and third visits, respectively. Treatment perceptions ranged from medium to very difficult for 51.4 percent and 37.3 percent on the first and third visits, respectively. The main difficulties reported were adverse reactions to the medication and scheduling. A separate logistic regression indicated that the HIV-seropositive status disclosure, symptoms of anxiety, absence of psychotherapy, higher CD4+ cell count (> 200/mm³) and high (> 4) adverse reaction count reported were independently associated with the degree of difficulty in the first visit, while CDC clinical category A, pill burden (> 7 pills), use of other medications, high (> 4) adverse reaction count reported and low understanding of medical orientation showed independent association for the third visit. CONCLUSIONS: A significant level of difficulty was observed with treatment. Our analyses suggest the need for early assessment of difficulties with treatment, highlighting the importance of modifiable factors that may contribute to better adherence to the treatment protocol.