Passivos, ativos and versáteis: men who have sex with men, sexual positions and vulnerability to HIV infection in the northeast of Brazil.

In Brazil, men who practise receptive anal sex (passivos) and both insertive and receptive anal sex (versáteis) are at greater risk of HIV infection than men who practise only insertive anal sex (ativos). In this study, which combined participant observation, 25 biographical interviews and a behavioural survey of 380 self-identified men who had sex with men in the metropolitan region of Recife (Brazil), we investigated how the sex-gender system, through body stylisation (masculine and effeminate) engenders desire and sexual positioning in men's sexual scenes. The analysis indicated that the sex-gender system tends to reinforce images that portray masculine men as ativos and effeminate men as passivos. However, regarding sexual positioning, sexual versatility is most common (83.3%), which can increase the likelihood of HIV infection and transmission. Stylisations also engender differences in violence related to sexual orientation (e.g. effeminate men were 1.9 times more likely to have experienced violence than masculine men) and desirability (e.g. effeminate men are 6.1 times more likely to be rejected erotically than masculine men). Sexual positioning and stylisation jointly enable community sexual scripts and pathways for HIV to circulate, producing individual and social vulnerability to the epidemic.

Facing negative reactions to sexuality education through a Multicultural Human Rights framework.

Sexuality education, its protocols and planning are contingent on an ever-changing political environment that characterizes the field of sexuality in most countries. In Brazil, human rights perspectives shaped the country's response to the AIDS epidemic, and indirectly influenced the public acceptability of sexuality education in schools. Since 2011, however, as multiple fundamentalist movements emerged in the region, leading to recurrent waves of backlashes in all matters related to sexuality, both health and educational policies have begun to crawl backwards. This article explores human rights-based approaches to health, focusing on a multicultural rights-based framework and on productive approaches to broadening the dialogue about sustained consent to sexuality education. Multicultural human rights (MHR) approaches are dialogical in two domains: the communication process that guarantees consent and community agreements and the constructionist psychosocial-educational methodologies. In its continuous process of consent, the MHR approach allowed for distinct values translation and diffused the resistance to sexuality education in the participant schools/cities, successfully sustaining notions of equality and protection of the right to a comprehensive sexuality education that does not break group solidarity and guarantees acceptability of differences.

Exploring ART intake scenes in a human rights-based intervention to improve adherence: a randomized controlled trial.

To assess the effectiveness of a psychosocial individual intervention to improve adherence to ART in a Brazilian reference-center, consenting PLHIV with viral load >50 copies/ml were selected. After 4 weeks of MEMS cap use, participants were randomized into an intervention group (IG) (n = 64) or control group (CG) (n = 57). CG received usual care only. The IG participated in a human rights-based intervention approach entailing four dialogical meetings focused on medication intake scenes. Comparison between IG and CG revealed no statistically significant difference in adherence measured at weeks 8, 12, 16, 20 and 24. Viral load (VL) decreased in both groups (p < 0.0001) with no significant difference between study groups. The lower number of eligible patients than expected underpowered the study. Ongoing qualitative analysis should provide deeper understanding of the trial results. NIH Clinical Trials: NCT00716040.

Youth and the COVID-19 crisis: Lessons learned from a human rights-based prevention programme for youths in São Paulo, Brazil.

Youths living in crowded impoverished urban areas face higher risk of infection by SARS-CoV-2. This article presents lessons learned from a preventive intervention project intersected by the COVID-19 crisis that moved from a mix-methods study design to online ethnography. The 'home-officed' research team e-witnessed high-school students' daily lives and collaborated in youths' and community-based organisations' responses in the territories where they study and live. Psychosocial distress increased, also driven by the disastrous governmental response to the health and economic crises. There was growing anxiety about meeting friends and dating, with structural limits for sustaining the recommended social distancing, which added to gender/sexuality-based violence. Simultaneously, we observed students becoming relevant actors through co-producing preventive practices, surpassing risk-group notions and combining SARS-CoV-2 prevention with sexuality, gender, racism and mental-health issues. They managed internet-mediated applications to promote critical thinking and collective actions aimed at health promotion among their peers, from their homes. Freire's concept of 'untested-feasibility' fostered researchers', students' and community leaders' imaginations in the face of this unprecedented crisis, thereby enhancing social responses to the epidemic to become rights-based comprehensive dialogical preventive activities. This ongoing intervention-research stresses how prevention sciences can go beyond reduction of this pandemic to a viral event.

Orthohepadnavirus infection in a neotropical bat (Platyrrhinus lineatus).

Hepatitis B virus (HBV) is the prototype of the Orthohepadnavirus genus and represents an important cause of chronic hepatitis, liver cirrhosis, and hepatic cancer in humans worldwide. To verify the occurrence and genetic variability of orthohepadnavirus among neotropical bats, we tested 81 liver samples of New World bats from São Paulo State, Southeastern Brazil, collected during 2012. PCR, sequencing, and phylogenetic analysis of Surface/Polymerase and Core viral genes confirmed the occurrence of the first isolate of bat orthohepadnavirus detected in South America. These results may contribute to subsequent studies of the origin, variability, host species, and evolution of bat orthohepadnaviruses in South America.

Rites of Resistance: Sex Workers' Fight to Maintain Rights and Pleasure in the Centre of the Response to HIV in Brazil.

Drawing on ethnographic research conducted from 2011 to 2015 and the authors' long-term engagement in diverse aspects of HIV and human rights advocacy in Brazil, this paper explores key elements of the Brazilian sex workers' movement response to HIV and the broader political factors that profoundly influenced its trajectory. We argue that the movement has constantly challenged representations of prostitution by affirming sex workers' roles as political actors, not just peer educators, in fighting the HIV epidemic and highlight their development of a sex positive and pleasure centred response that fought stigma on multiple fronts. Moments of tension such as the censorship of an HIV prevention campaign and implementation of 'test and treat' projects are analysed, as are the complex questions that Brazil's 2016 political and economic crisis evokes in terms of how to develop and sustain responses to HIV driven by communities but with material commitment from the State. We conclude with what we see to be the unique, central components of Brazilian sex workers' approach to HIV prevention and what lessons can be learned from it for broader collective health movements in Latin America and beyond.

[Opinions and attitudes regarding sexuality: Brazilian national research, 2005]. / Opiniões e atitudes em relação à sexualidade: pesquisa de âmbito nacional, Brasil 2005.

OBJECTIVE: To describe opinions and attitudes concerning sexuality of the Brazilian urban population. METHODS: A population survey was carried out in 2005 on a representative sample of 5,040 interviewees. An analysis of the attitudes regarding sexual initiation and sexual education of teenagers, considering gender, age, schooling, income, marital status, color, geographic region and opinion on fidelity, homosexuality, and masturbation. The results were contrasted with a similar survey carried out in 1998, when possible. RESULTS: Most interviewees selected the "sex is evidence of love" option when describing the meaning of sex. As in 1998, the majority was in favor of sexual initiation after marriage (63.9% for women vs. 52.4% for men initiation); results differed among religions. School teenage education on the use of condoms was supported by 97% of the interviewees across all social groups. The proportion of Brazilians who agreed with having access to condoms in health services (95%) and at school (83.6%) was high. Fidelity remained an almost unanimous value and there was an increase, in 2005, in the proportion of those in favor of sexual initiation after marriage, and in the rate of acceptance of masturbation and homosexuality compared to the 1998 survey. The younger generations tend to be more tolerant and egalitarian. CONCLUSIONS: As observed in other countries, this study confirms the difficulty in establishing a single dimension that guides sexual life ("liberal" vs "conservative"). The study suggests that the normativity concerning sexual activity should be understood in the light of the local culture and social organization of sexuality, considered by the STD/Aids programs. Opinions in favor of free access to preservatives at school clash with the slower results obtained in fighting the stigma and discriminating against homosexual minorities. The design of laical policies on sexuality allow for the dialog across different perspectives.

[Age and condom use at first sexual intercourse of Brazilian adolescents]. / Idade e uso de preservativo na iniciação sexual de adolescentes brasileiros.

OBJECTIVE: To analyze age and condom use at first sexual intercourse among Brazilian adolescents at two periods: 1998 and 2005. METHODS: Representative samples of the Brazilian urban population were interviewed during a household survey for two studies, carried out in 1998 and 2005. Interviewees included 670 sexually active young people (aged 16 to 19) who were selected for the study, 312 in 1998 and 358 in 2005. Pearson's chi-square test and Fisher's exact test (+/-<5%) were used to analyze the weighted data. RESULTS: In 2005, 61.6% of young interviewees had practiced sex and the average age for first intercourse was 14.9, with no significant difference to young interviewees in 1998. Condom use during first sexual intercourse increased significantly in both stable relationships (48.5% in 1998 vs. 67.7% in 2005) and casual relationships (47.2% in 1998 vs. 62.6% in 2005) across almost all segments. There were differences by gender, skin color and schooling for both age of first sexual intercourse and condom use, as per findings in 1998. Decreases in condom use for young people who were sexually active before the age of 14, across all types of partnerships, were marked in the Southeast region and for people with more schooling. CONCLUSIONS: As in other countries, there was a trend towards the stabilizing of the age of first sexual intercourse for young people aged 15 to 19. The postponement of the first sexual intercourse is more frequent among youth with more years of schooling, a theme that should be discussed in the planning of sexual education and STI prevention initiatives for adolescents. In terms of reductions in vulnerability to HIV, the increase in condom use at first sexual intercourse is both relevant and significant.

Religiosidade, juventude e sexualidade: entre a autonomia e a rigidez.

Esse artigo descreve como jovens religiosos e autoridades religiosas de sua comunidade compreendem a sexualidade, considerando suas experiências pessoais e como membros de comunidades religiosas. A análise pretende contribuir para que políticas públicas dedicadas à promoção da saúde sexual da juventude considerem a religiosidade, no contexto de um estado laico e da promoção do direito à prevenção. Foram realizadas 26 entrevistas abertas e semidirigidas em diferentes comunidades da região metropolitana da cidade de São Paulo (comunidades católicas, da umbanda, do candomblé e de diferentes denominações evangélicas) sobre iniciação sexual, casamento, gravidez, contracepção e prevenção das DST/Aids, homossexualidade, aborto e direitos humanos. Observou-se como jovens e autoridades religiosas convivem com a tensão entre tradição e modernidade e os distintos discursos sobre a sexualidade. Como sujeitos religiosos (do discurso religioso) e sujeitos sexuais (de discursos sobre sexualidade), devem ser incorporados pelos programas como sujeitos de direito nos termos de sua religiosidade.

The Care of the "flesh"in the sexual socialization of youth.

In this paper we discuss the positions of Christian leaders about "managing" the sexuality of young people, as contextualized by the sexual politics of the state. These reflections are a result of an ethnographic study, conducted through archival work, participant observation, and interviews with 47 religious leaders in Recife. The analysis shows the space of religion as a disciplinary site, operating through transcendent reasoning ("responsibility"). The person is expected to incorporate such reasoning, and thus, make the appropriate differentiations between "right" and "wrong". AIDS and adolescent pregnancy appear as a result of "temptations of the erotic flesh". Through the perspective of human rights and health, the article deconstructs the idea of the "flesh" as dominated by "temptation" and an "essential force", which leads the person to stray/sin/"risk"; resituating sexuality as a positive instance for subjects (of rights), and a condition for social fertility.

Desire to have children: gender and reproductive rights of men and women living with HIV: a challenge to health care in Brazil.

Links between HIV/AIDS care and reproductive health, including fertility options for people living with HIV (PLWH), have not been sufficiently addressed by health care providers. Moreover, few studies have addressed men in this regard. To describe attitudes toward parenthood and identify factors associated with desire to have children among men and women living with HIV a cross-sectional study involving a sample of 533 women and 206 men (bisexual and heterosexual) attending two reference sexually transmitted disease (STD)/AIDS centers in São Paulo, Brazil. Participants answered a standardized questionnaire. Desire to have children as the study outcome was compared between men and women and associated factors searched for in multivariable regression analysis. In contrast to previous studies conducted in developed countries, desire to have children in this sample was more frequent among men than among women and it was reported by 27.9% of participants (50.1% of men versus 19.2% of women). Women were more likely to anticipate doctors' strong opposition to PLWH getting pregnant and men reported lower information level about HIV/mother-to-child transmission (MTCT). Bisexual men were more likely to desire to have biologic children. Male gender, younger age, having no children, living with 1-2 children, and being in a heterosexual partnership were independently associated with desire to have children. Regardless of gender, the childless as well as the youngest should be regarded as groups to be particularly targeted by counseling, to be provided with objective information about reproductive rights and options. Further research is warranted to address the desire for children among strictly homosexual men.

[Vulnerability to HIV: tourism and the use of alcohol and other drugs]. / Vulnerabilidade ao HIV: turismo e uso de álcool e outras drogas.

OBJECTIVE: To describe situations of alcohol and other drug use involving tourists, and their implications regarding vulnerability to HIV. METHODS: This was an exploratory qualitative study conducted in communities that host tourism in the Vale do Ribeira, State of São Paulo, from October 2002 to February 2003. In the first stage of the study, 29 monitors in four host communities were interviewed to gather scenarios of drug use involving tourists. In the second stage, two workshops were held, bringing together 77 interviewees and health and education professionals from ten communities, in order to dramatize the scenarios gathered in the interviews and share repertoires for dealing with these situations and finding ways for preventing HIV. RESULTS: The scenarios showed that alcohol and other drug use by tourists increases their vulnerability to HIV transmission through favoring casual sexual intercourse without condoms and sexual harassment and abuse. HIV prevention work in these communities that host tourism needs to take into account the consumption of these substances which use creates difficulties regarding safe sex practices and, in the case of injecting drugs that are shared, constitutes a risk factor for HIV transmission. CONCLUSIONS: This study provided data to help in understanding how situations of alcohol and other drug use fit within daily life in these host communities, thereby extending the vulnerability to HIV. The study produced analysis of the social context of HIV transmission that may provide backing for drawing up prevention programs that are better adapted to these communities.

[AIDS, stigma and unemployment: implications for health services]. / Aids, estigma e desemprego: implicações para os serviços de saúde.

OBJECTIVE: To analyze the effect of the stigmatization and discrimination process in the work environment on the routine healthcare and well-being of men living with HIV/AIDS. METHODS: Qualitative study with 17 men living with HIV, conducted in 2002. Testimonies given in a group to discuss the difficulties concerning discrimination in the work environment were studied, by means of discursive practice analysis. The group, originating from a specialized center for HIV/AIDS treatment in the city of São Paulo, represented a segment of previous research. RESULTS: The discussion among participants pointed out the fact that antiretroviral treatment requires frequent visits to medical assistance services, resulting in absences and delays at work. To show medical certificates to justify absences at work, even without indicating AIDS, can lead to dismissal. Unemployed, many are barred during medical examinations and have their right to confidentiality violated. As a last resource, the request for retirement results in a humiliating or discriminatory scene during the medical inspection. CONCLUSIONS: Assistance planned with the patients' participation enables the broadening of psychosocial attention and the consideration of the needs of both employed and unemployed patients, acknowledging that the stigma limits care, affecting mental health and the evolution of infection. To reduce the effect of stigma and discrimination is something that requires intersectoral political articulation and will contribute to reach goals that are globally recognized as fundamental to control the epidemic.

[Community-based intervention to control STD/AIDS in the Amazon region, Brazil]. / Intervenção de base comunitária para a prevenção das DST/Aids na região amazônica, Brasil.

OBJECTIVE: To describe a case study of community-based intervention, developed in a constructionist-emancipatory framework to control STD/AIDS. METHODS: Descriptive study developed in the town of Manacapuru, in the state of Amazonas, from 1997 to 2004, focusing on procedures designed in collaboration with government agents, health professionals and the community. Data on the dynamics of prostitution and condom sales in this town, preventive practices and STD/AIDS care and process assessment were collected. Actions targeting STD prevention and care in the public healthcare system, a testing center, an epidemiological surveillance system and sex workers' qualification were established concomitantly. RESULTS: It was observed the strengthening of sex workers as peer educators and their legitimization as citizens and health agents in projects involving transvestites, homosexuals and students. There was an increase in condom sales in town, as well as in condom use among sex workers; reduction in bacterial STD; and stabilization of the incidence of HIV/AIDS infections and congenital syphilis. The sustainability of the intervention program studied, organized within the sphere of action of the Sistema Unico de Saúde (National Health System), was promoted by a political pact, which guaranteed headquarters and municipal law-regulated budget, as well as by the constant debate over the process and program results. CONCLUSIONS: The study strengthened the notion that effective control of STD/AIDS depends on a synergic approach that combines interventions on individual (biological-behavioral), sociocultural and programmatic levels.

[HIV vulnerability in a shantytown: the impact of a territorial intervention, Rio de Janeiro, Brazil]. / Vulnerabilidade ao HIV em favela do Rio de Janeiro: impacto de uma intervenção territorial.

OBJECTIVE: To analyze the impact of a participatory sexual health promotion program implemented in a poor community and describe how the use of public and private spaces for sex is a factor that exacerbates vulnerability to HIV/Aids. METHODS: This ethnographic study was conducted in a Rio de Janeiro shantytown in 2002. Six thousand people live in precarious living conditions in which the lack of public policies, health posts, recreational activities, employment opportunities, and security consolidates power in criminal groups. Issues related to sexual health were addressed in addition to a participatory sexual health program implemented by a Community HIV Prevention Center established by a non-governmental organization. After two months of participatory observation, 35 semi-structured in-depth interviews were conducted with community members between the ages of 17 and 65. Eleven life histories of community leaders and HIV prevention promoters and seven focus groups formed from pre-existent community groups were analyzed. The material was categorized and analyzed qualitatively. RESULTS: The precarious nature of living conditions contributes to increased exposure to sexual practices while also enhancing the stigma experienced by the community for living in a shantytown. Through the implementation of the program by the Community HIV Prevention Center, children, teenagers and adults have become familiar with and knowledgeable of HIV/AIDS prevention; and teenagers and adults gained access to condoms. CONCLUSIONS: Although vulnerability to HIV was not affected, research results reveal that HIV prevention can become part of the local culture. HIV/AIDS prevention can be fomented by a local approach based on community participation and strengthening collective organizing.

[Deconstructing gender expectations from a minority standpoint: how to enter into a dialogue with male perpetrators of violence against women?] / Desconstruindo expectativas de gênero a partir de uma posição minoritária: como dialogar com homens autores de violência contra mulheres?

This article discusses limits and possibilities of the practice of a reflection group together with male perpetrators of violence against women. It is based on an ethnographic study, which included participant observation and interviews with the facilitators of a group held in a feminist non-governmental organization in partnership with the criminal justice system. Starting with the discussion of an emblematic scene, we argue in favor of this dialogue process as an alternative that could expand the limits of the judiciary approach. In order to enter into a dialogue with the peer group, the facilitators must consider the minority position of feminist viewpoints in the field of masculinity. This step alone makes it possible to cooperate with the participants such that, as they spontaneously and genuinely share their experiences, they come to acknowledge the inadequacy of their expectations regarding women. This way, a dynamic of care takes place between men, which is conducive to the mitigation of violence and serves as a complement to the promotion of gender equality.

Sofrimento Psicossocial e Sexualidade em Tempos de Covid-19 e de Ataque aos Direitos Humanos / Psychosocial Suffering and Sexuality in the Context of Covid-19 and Attacks on Human Rights / Sufrimiento Psicosocial y Sexualidad en Tiempos de Covid-19 y Ataque a los Derechos Humanos

Fragmentos da "vida-pandemia" colhidos em projetos de prevenção em territórios periféricos e escolares de São Paulo introduzem este texto. O impacto da perda de pessoas próximas para a Covid-19, a disseminação de informações falsas sobre a prevenção e cuidado e a desorganização do cotidiano atravessado pela pandemia emergem nas experiências de interação com jovens. A desigualdade e o desemprego cresciam antes da pandemia, assim como o número de eventos de saúde mental. Sustentando a integralidade na prevenção coproduzida com os jovens, acompanhamos a resposta sociocomunitária à sindemia em um contexto que expressa o impacto da década de ataques à educação sexual e das escolas online. A sexualidade, tema que originou os diferentes projetos de prevenção, foi difícil de abordar. Diferente da resposta à aids, identidades comunitárias-territoriais foram mobilizadas para produzir "inéditos viáveis" para essa emergência social e sanitária, mobilizando "resistência" à violação, à negligência governamental aos direitos humanos. Neste cenário, soma-se o ataque global aos DH que interpela sua universalidade e indivisibilidade e usa a sexualidade como bandeira para reinterpretar o sentido emancipador de solidariedade na diferença. A noção de sofrimento psicossocial permite lidar com o excesso de individualização e medicalização das experiências de sofrimentos estruturados por este contexto duradouro.'

Fragments of a "pandemic life" collected in prevention projects in outer city and school peripherical territories in São Paulo introduces this article. The impact of the loss of close people to COVID-19, the spread of false information about prevention and care, and the disorganization of daily life emerged from our sustained interaction with young people. Inequality and unemployment were growing before the pandemic, as was the number of mental health events. By co-producing and promoting integrality in prevention with young people, we have followed the social and community response to the syndemic in the context of online schools and school life under the impact of a decade of attacks on sex education. Sexuality, the theme that gave rise to most prevention projects, was challenging to address. Differently from the AIDS responses, community-territorial identities mobilized "untested feasibilities" for this social and health emergency by associating "resistance" to governmental negligence, violation, and the attack on human rights. Globally, this attack questions human rights universality and indivisibility, using sexuality to reinterpret its emancipatory sense of solidarity in difference. The notion of "psychosocial suffering" allows to deal with the excess of individualization and medicalization of suffering experiences structured by inequalities in this long-lasting context.

Fragmentos de "vida pandémica" recogidos en proyectos de prevención atravesados por la pandemia en territorios periféricos y escolares de São Paulo introducen este texto. El impacto de la muerte por Covid-19, la difusión de información falsa y la desorganización de la vida cotidiana emergen en las experiencias de interacción con los jóvenes. La desigualdad y el desempleo crecían antes de la pandemia, al igual que los eventos de salud mental. Apoyando la prevención integral coproducida con jóvenes, acompañamos la respuesta socio-comunitaria a la sindemia. La sexualidad, el tema que origino los proyectos de prevención, fue difícil de abordar con las escuelas en línea y en el contexto que expresa el efecto de la década de ataques a la educación sexual. A diferencia de la respuesta al sida, identidades comunitario-territoriales se movilizaron para producir inéditos viables para esta emergencia social y sanitaria, asociando "resistencia" a la negligencia, violación gubernamental de los derechos humanos. Globalmente, el ataque a los DH cuestiona su universalidad e indivisibilidad utilizando la sexualidad como bandera para reinterpretar el sentido emancipador de la solidaridad en la diferencia. La noción de sufrimiento psicosocial permite lidiar con el exceso de individualización y medicalización de experiencias de sufrimiento estructurado por desigualdades.