RESUMEN

This study aimed to analyze the association between sociodemographic, programmatic and contextual factors and the receipt of money in exchange for sex among men who have sex with men (MSM). This is a multicenter, cross-sectional study conducted in ten Brazilian cities between 2008 and 2009. Adult MSM recruited through the Respondent Driven Sampling (RDS) were interviewed. Weighted Odds Ratio (ORw) was obtained through logistic regression, retaining the variables associated with the event (p < 0.05) in the final model. Of the total sample, 33.3% reported receiving money in exchange for sex in the last 12 months before the interview. The variables that were independently associated with the event were age less than or equal to 25 years, lower education, lower social classes, previous history of syphilis, using sites or services to find sexual partners in the previous month, very high risk behavior, using illicit drugs in the previous six months, self-identifying as heterosexual or bisexual, having suffered physical violence due to sexual orientation and having suicidal thoughts always or most of the time. It was observed that MSM who received money in exchange for sex had greater socioeconomic, programmatic and contextual vulnerability, potentially increasing the risk of HIV infection than the other MSM in the sample.

Objetivou-se analisar a associação entre fatores sociodemográficos, programáticos e contextuais e ter recebido dinheiro em troca de sexo entre homens que fazem sexo com homens (HSH). Estudo multicêntrico, transversal, realizado em 10 cidades brasileiras, entre 2008 e 2009. Foram entrevistados 3.749 HSH selecionados pela técnica amostral "Respondent Driven-Sampling" (RDS). "Odds Ratio" ponderado (ORp) foi obtido por meio de regressão logística, permanecendo no modelo final as variáveis associadas ao evento (p < 0,05). Da amostra total, 33,3% relataram ter recebido dinheiro em troca de sexo nos últimos 12 meses anteriores à entrevista. As variáveis associadas com o evento foram ter idade ≤ 25 anos, menor nível de escolaridade, classes sociais mais baixas, história prévia de infecção por sífilis, utilizar locais de encontros para ter parceiros sexuais, ter comportamento de risco para HIV muito alto e usar drogas ilícitas, se autoidentificarem como heterossexual ou bissexual, ter sofrido violência física devido à orientação sexual e apresentar ideação suicida sempre ou na maioria das vezes. Observa-se que os HSH que receberam dinheiro em troca de sexo apresentaram maior vulnerabilidade socioeconômica, programática e contextual, potencialmente aumentando o risco de infecção pelo HIV em relação aos demais HSH.

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RESUMEN

Resumo Objetivou-se analisar a associação entre fatores sociodemográficos, programáticos e contextuais e ter recebido dinheiro em troca de sexo entre homens que fazem sexo com homens (HSH). Estudo multicêntrico, transversal, realizado em 10 cidades brasileiras, entre 2008 e 2009. Foram entrevistados 3.749 HSH selecionados pela técnica amostral "Respondent Driven-Sampling" (RDS). "Odds Ratio" ponderado (ORp) foi obtido por meio de regressão logística, permanecendo no modelo final as variáveis associadas ao evento (p < 0,05). Da amostra total, 33,3% relataram ter recebido dinheiro em troca de sexo nos últimos 12 meses anteriores à entrevista. As variáveis associadas com o evento foram ter idade ≤ 25 anos, menor nível de escolaridade, classes sociais mais baixas, história prévia de infecção por sífilis, utilizar locais de encontros para ter parceiros sexuais, ter comportamento de risco para HIV muito alto e usar drogas ilícitas, se autoidentificarem como heterossexual ou bissexual, ter sofrido violência física devido à orientação sexual e apresentar ideação suicida sempre ou na maioria das vezes. Observa-se que os HSH que receberam dinheiro em troca de sexo apresentaram maior vulnerabilidade socioeconômica, programática e contextual, potencialmente aumentando o risco de infecção pelo HIV em relação aos demais HSH.

Abstract This study aimed to analyze the association between sociodemographic, programmatic and contextual factors and the receipt of money in exchange for sex among men who have sex with men (MSM). This is a multicenter, cross-sectional study conducted in ten Brazilian cities between 2008 and 2009. Adult MSM recruited through the Respondent Driven Sampling (RDS) were interviewed. Weighted Odds Ratio (ORw) was obtained through logistic regression, retaining the variables associated with the event (p < 0.05) in the final model. Of the total sample, 33.3% reported receiving money in exchange for sex in the last 12 months before the interview. The variables that were independently associated with the event were age less than or equal to 25 years, lower education, lower social classes, previous history of syphilis, using sites or services to find sexual partners in the previous month, very high risk behavior, using illicit drugs in the previous six months, self-identifying as heterosexual or bisexual, having suffered physical violence due to sexual orientation and having suicidal thoughts always or most of the time. It was observed that MSM who received money in exchange for sex had greater socioeconomic, programmatic and contextual vulnerability, potentially increasing the risk of HIV infection than the other MSM in the sample.

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Transgender (trans) women are disproportionally burdened by the HIV epidemic due to complex structural, psychosocial and biological factors. HIV pre-exposure prophylaxis (PrEP) is a biomedical prevention approach for people at substantial risk of acquiring HIV. This literature review assessed awareness, willingness to use, and barriers and facilitators for PrEP acceptability among trans women. A search was conducted through five databases and included studies with primary data and disaggregate results for trans women. Of 255 retrieved citations, 17 met the inclusion criteria and were included. Low to moderate knowledge about PrEP was observed among studies. However, willingness to use PrEP was predominantly high. Frequent barriers to PrEP acceptability included concerns about side effects, cost, hormone therapy, adherence, PrEP-related stigma and interaction with healthcare workers. Facilitators included perceived reduction of HIV risk, fear of HIV/AIDS and reduced dependence on partners. Findings suggest elevated interest in PrEP and highlight important barriers and facilitators that should be specifically addressed to optimize PrEP uptake and use among this highly vulnerable population.

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