RESUMEN
Many barriers to human immunodeficiency virus (HIV) testing among Black people exist. This study analysed the association between race/skin colour and lifetime HIV testing among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in three Brazilian cities. This cross-sectional study was nested within the PrEP1519 cohort, a multicentre study of AMSM and ATGW aged 15-19 years in Belo Horizonte, Salvador, and São Paulo, Brazil. The outcome variable was the lifetime HIV testing (no or yes). The main exposure variable was self-reported race/skin colour as White and a unique Black group (composed of Pardo-mixed colour and Black, according to the Brazilian classification). Descriptive statistics and bivariate and multiple logistic regression analyses were conducted to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) to determine the association between the main exposure and outcome, adjusted for covariates. White adolescents were tested more frequently than the unique Black group (64.0% vs. 53.7%, respectively; Ρ = 0.001). Multiple logistic regression analysis showed that the unique Black group of AMSM and ATGW had 26% (adjusted OR [aOR], 0.74; 95% CI, 0.55-0.98) and 38% (aOR, 0.62; 95% CI, 0.45-0.87) lower odds of being tested for HIV in a lifetime than Whites in model 1 and 2, respectively. Our findings highlight the role of racism in lifetime HIV testing among AMSM and ATGW. Therefore, an urgent need for advances exists in public policies to combat racism in Brazil.
RESUMEN: Existen numerosas barreras para la realización de las pruebas del virus de la inmunodeficiencia humana (VIH) entre la población negra. Este estudio analizó la asociación entre la raza/color de piel y haber realizado pruebas de VIH a lo largo de la vida entre hombres adolescentes que tienen sexo con hombres (AHSH) y mujeres transgénero (AMTG) en tres ciudades brasileñas. Este estudio transversal es parte de la cohorte PrEP1519, un estudio multicéntrico de AHSH y AMTG de 15 a 19 años en Belo Horizonte, Salvador y São Paulo, Brasil. La variable de resultado fue haber realizado la prueba del VIH a lo largo de la vida (no o sí). La variable de exposición principal fue la raza/color de piel autoinformada, categorizada como blanca y un grupo negro único (compuesto por color pardo/mixto y negro, según la clasificación brasileña). Se realizaron estadísticas descriptivas y análisis de regresión logística bivariada y multivariada para estimar los odds ratios (OR) ajustados y los intervalos de confianza del 95% (IC del 95%) con el fin de determinar la asociación entre la exposición principal y el resultado, ajustado por covariables. Los adolescentes blancos se hicieron la prueba del VIH con más frecuencia que el grupo negro único (64,0% frente a 53,7%, respectivamente; Ρ = 0,001). El análisis de regresión logística múltiple reveló que el grupo negro único de AHSH y AMTG tenía 26% (OR ajustado [aOR], 0,74; IC 95%, 0,550,98) y 38% (aOR, 0,62; IC 95%, 0,450,87) menores probabilidades de realizarse la prueba del VIH a lo largo de su vida que los blancos en los modelos 1 y 2, respectivamente. Nuestros hallazgos resaltan la influencia del racismo en la realización de pruebas de VIH a lo largo de la vida entre AHSH y AMTG. Por lo tanto, es urgente avanzar en la implementación de políticas públicas para combatir el racismo en Brasil.
Asunto(s)
Infecciones por VIH , Prueba de VIH , Disparidades en Atención de Salud , Homosexualidad Masculina , Racismo , Personas Transgénero , Adolescente , Femenino , Humanos , Masculino , Adulto Joven , Población Negra/estadística & datos numéricos , Brasil/epidemiología , Ciudades , Estudios Transversales , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/epidemiología , Prueba de VIH/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/etnología , Homosexualidad Masculina/psicología , Factores Socioeconómicos , Personas Transgénero/estadística & datos numéricos , Personas Transgénero/psicología , Población Blanca/estadística & datos numéricos , Población Blanca/psicología , Grupos Raciales/etnología , Grupos Raciales/estadística & datos numéricosRESUMEN
ABSTRACT 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)
Humanos , Infecciones por VIH , Adolescente , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , BrasilRESUMEN
RESUMO 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.
ABSTRACT 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.
Asunto(s)
Humanos , Conducta Sexual , Enfermedades de Transmisión Sexual , Adolescente , VIH , Personas Transgénero , Minorías Sexuales y de Género , BrasilRESUMEN
ABSTRACT 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)
Humanos , Masculino , Adolescente , Personas Transgénero , Minorías Sexuales y de Género , Prueba de VIH , Autoevaluación , COVID-19 , BrasilRESUMEN
PURPOSE: To explore legal and ethical challenges related to adolescents' participation in human immunodeficiency virus (HIV) research that may affect their best interests. METHODS: We analyzed the ethical principles and legal aspects of the participation of 15-17-year-old men who have sex with men and transgender women in the pre-exposure prophylaxis (PrEP) 1519 study, a PrEP demonstration cohort study in three Brazilian cities. The analyses of ethics review committees' (ERCs) evaluations and court decisions followed ethical and human rights principles. An HIV vulnerability score was created, and descriptive statistics and multivariate logistic regression were performed using data from 347 participants. RESULTS: The ERCs evaluated the benefits and risks of research participation, all finding that the benefits outweighed the risks. ERCs deferred responsibility for decisions about waiving parental consent to the judiciary. State courts reached different decisions about waiving parental consent, reflecting variation in recognition of adolescents' evolving capacities and the adolescent as a subject of sexual rights and the primary agent capable of deciding on their health and best interests. The most vulnerable adolescent participants were found in sites where the blanket waiver was in place. DISCUSSION: Judicializing the ethical review process is detrimental to fulfilling the ethical principle of justice and vulnerable adolescents' access to health research. ERCs must be sufficiently independent and autonomous and have the capacity to respect, protect, and help fulfill the rights of participants while ensuring the generation of adequate evidence to inform public health practice.
Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Personas Transgénero , Masculino , Humanos , Adolescente , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Brasil , Homosexualidad Masculina , Estudios de Cohortes , VIH , Fármacos Anti-VIH/uso terapéuticoRESUMEN
PURPOSE: This study aimed at describing the prevalence of symptoms of depression among 15-19 year old adolescent men who have sex with men (aMSM) and transgender women (aTGW), who were recruited in an HIV pre-exposure prophylaxis cohort study in three Brazilian capital cities. The study also examined potential associations, including violence and discrimination, with severe symptoms of depression among aMSM. METHODS: This is a cross-sectional study of baseline data among 730 aMSM and 56 aTGW recruited between February 2019 and February 2021. Sociodemographic and behavioral data were collected. The 20-item Center for Epidemiologic Studies Depression scale was used to screen for symptoms of depression. Scores of ≥22 points indicate the presence of severe symptoms associated with major depression. Logistic regression was used to assess independent associations among aMSM, adjusting for sociodemographic variables. RESULTS: Our findings indicate a high prevalence of symptoms of depression (overall prevalence = 58.5% and 69.6%; 21.2% and 25.0% for mild/moderate, and 37.3% and 44.6% for severe) among these aMSM and aTGW, respectively. Psychological violence (aOR = 1.74; 95% CI = 1.12-2.70), sexual violence (aOR = 1.79; 95% CI = 1.07-2.98), and discrimination due to sexual orientation (aOR = 1.71; 95% CI = 1.23-2.38) were independently associated with severe symptoms of depression in aMSM. DISCUSSION: The high prevalence of severe symptoms of depression and its association with psychological and sexual violence and discrimination creates cycles of vulnerability and carries important public health implications. Thus, our findings indicate public policies should consider assessing depression, psychological and sexual violence, as well as discrimination, especially in populations that will be targeted by interventions, such as the use of pre-exposure prophylaxis.
Asunto(s)
Infecciones por VIH , Minorías Sexuales y de Género , Personas Transgénero , Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Brasil/epidemiología , Personas Transgénero/psicología , Depresión/epidemiología , Depresión/psicología , Estudios Transversales , Estudios de Cohortes , ViolenciaRESUMEN
PURPOSE: This study analyzed the sociodemographic and behavioral characteristics of adolescent men who have sex with men (aMSM) and transgender women (aTGW) initiating oral pre-exposure prophylaxis (PrEP) in human immunodeficiency virus (HIV) prevention clinics. METHODS: PrEP1519 is a prospective, multicenter, open-label PrEP demonstration cohort study of aMSM and aTGW aged 15-19 years living in three large Brazilian capital cities. For this analysis, we included adolescents who enrolled in PrEP1519 from February 2019 to August 2021. Adolescents who visited PrEP clinics were classified into four groups based on PrEP eligibility and on their decision to use PrEP: (1) ineligible for same-day PrEP initiation; (2) eligible for same-day PrEP initiation, initiated PrEP at first visit; (3) eligible for PrEP initiation, initiated PrEP after the first visit; and (4) eligible for same-day PrEP initiation but declined. The groups that were eligible for same-day PrEP initiation were compared using the Chi-square and Fisher's exact tests. RESULTS: Of the 1,254 adolescents enrolled in the PrEP1519 study, 61 (4.9%) were considered ineligible for same-day PrEP initiation. Of the 1,193 eligible for same-day PrEP initiation, 1,113 (93.3%) initiated PrEP [1,054 initiated PrEP in the first visit (88.3%) and 59 in subsequent visits (4.9%)] and 80 (6.7%) did not. Despite 90% of the PrEP decliners reporting a low risk of HIV infection, most reported condomless anal sex in the past six months (70%). DISCUSSION: Same-day PrEP initiation among aMSM and aTGW was high, highlighting that this strategy was important to promote PrEP initiation among adolescents with increased vulnerability to HIV in Brazil.
Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Personas Transgénero , Adolescente , Femenino , Humanos , Masculino , Fármacos Anti-VIH/uso terapéutico , Brasil , Estudios de Cohortes , Emtricitabina , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina , Estudios Prospectivos , Tenofovir , Adulto JovenRESUMEN
PURPOSE: To evaluate the adherence, safety, and feasibility of pre-exposure prophylaxis (PrEP) in real-world settings among adolescent men who have sex with men (AMSM) and transgender women (ATGW). METHODS: PrEP1519 is a single-arm, multicentric demonstration cohort study of daily oral PrEP among AMSM and ATGW aged 15 to 19 years in Brazil. Study visits occurred at baseline, weeks 4, 12, and then quarterly until 96 weeks. Descriptive statistics and a mixed logistic model for longitudinal data evaluated the factors associated with high adherence. RESULTS: One thousand sixteen AMSM and ATGW accessed the PrEP1519 clinics. Of those, 998 (98.2%) underwent clinical triage. Forty one were diagnosed with human immunodeficiency viruses (HIV) at baseline (4.0%) and 79 (7.9%) were not eligible for PrEP. Of the 878, 795 (90.5%) enrolled in PrEP, 82 (10.3%) were lost to follow-up, and 713 were included. There was no significant decrease in creatinine clearance; only two participants had grade-III aspartate aminotransferase elevation. Incident HIV infection occurred in eight participants (incidence rate [IR] = 1.64 per 100 person-years [PY]): two in 15-17 years (IR = 2.24 per 100 PY) and six in 18-20 years (IR = 1.51 per 100 PY). PrEP adherence was higher among those with more years of schooling, those reporting no difficulties in PrEP use due to side effects, and who had low HIV risk perception in the past three months. DISCUSSION: PrEP for AMSM and ATGW was safe and feasible in real-world settings. However, a higher IR among young adolescents and a higher adherence among less vulnerable people indicate the need for greater care, considering the specificities of this age group.
Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Personas Transgénero , Masculino , Humanos , Adolescente , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina , Fármacos Anti-VIH/uso terapéutico , Estudios de Cohortes , VIH , Brasil , Estudios de FactibilidadRESUMEN
PURPOSE: This study aimed to describe pre-exposure prophylaxis (PrEP) for HIV discontinuation in adolescent men who have sex with men (aMSM) and adolescent transgender women (aTGW) and to identify factors associated with discontinuation. METHODS: The PrEP1519 study included a cohort of aMSM and aTGW aged 15-19 years old, and it was conducted in three large Brazilian capital cities. For this analysis, we included adolescents who initiated PrEP. PrEP discontinuation was defined as no possession of PrEP pills for >90 days. Kaplan-Meier curves were used to analyze the probabilities of discontinuation, and survival distributions stratified by covariates were compared using log-rank or Wilcoxon tests. Cox regression models were used to estimate the adjusted hazard ratio (aHR) with a 95% confidence interval (95% CI). RESULTS: We included 908 adolescents, 829 (91.30%) aMSM and 79 (8.70%) aTGW, most of whom were 18-19 years (80.29%). The incidence rate of discontinuation was 75.6 per 100 person-years. The probability of discontinuation was 52.61% in the first year. The multivariate analysis demonstrated that the aTGW (aHR = 1.63; 95% CI: 1.02-1.64) and adolescents with a medium (aHR = 1.29; 95% CI: 1.02-1.64) or low (aHR = 1.65; 95% CI: 1.29-2.12) perceived risk of HIV infection had an increased risk of discontinuation, whereas the adolescents with a partner living with HIV had a lower risk of discontinuation (aHR = 0.57; 95% CI: 0.35-0.91). DISCUSSION: Adolescents with a high risk for discontinuation may need additional support that emphasizes the value of PrEP as a tool for HIV prevention because PrEP discontinuation was associated with a disconnect between HIV risk perception and HIV prevention.
Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Personas Transgénero , Masculino , Humanos , Adolescente , Femenino , Adulto Joven , Adulto , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina , Brasil , Fármacos Anti-VIH/uso terapéuticoRESUMEN
HIV Pre-exposure prophylaxis (PrEP) is an effective prevention tool, but there are still few studies about PrEP uptake among adolescents. We aimed to analyze the PrEP uptake process and factors associated with daily oral PrEP initiation among adolescent men who have sex with men (aMSM) and transgender women (aTGW) in Brazil. Baseline data from the first demonstration PrEP cohort study among aMSM and aTGW 15-19 years old (yo) ongoing in three large Brazilian cities (PrEP1519). After completing informed consent procedures, participants were enrolled in the cohort from February/2019 to February/2021. A socio-behavioral questionnaire was applied. Factors associated with PrEP initiation were assessed using a logistic regression model with adjusted prevalence ratios (aPR) and 95% confidence intervals (95%CI). Among recruited participants, 174 (19,2%) were aged 15-17 yo and 734 (80,8%) 18-19 yo. The rate of PrEP initiation was 78.2% and 77.4% for 15-17 yo and 18-19 yo, respectively. Factors associated with PrEP initiation were: black or mixed race (aPR 2.31; 95%CI: 1.10-4.84) among the younger adolescents 15-17 yo; experienced violence and/or discrimination due to their sexual orientation or gender identity (aPR 1.21; 95%CI: 1.01-1.46); transactional sex (aPR 1.32; 95%CI: 1.04-1.68); and having had between 2 to 5 sexual partners in the previous three months (aPR 1.39; 95%CI: 1.15-1.68) among those 18-19 yo. Unprotected receptive anal intercourse in the previous six months was associated with PrEP initiation in both age groups (aPR 1.98; 95%CI: 1.02-3.85 and aPR 1.45; 95%CI: 1.19-1.76 among 15-17 yo and 18-19 yo, respectively). The biggest challenge to promoting PrEP use for aMSM and aTGW was in the first steps of the PrEP uptake process. Once they were linked to the PrEP clinic, initiation rates were high.
Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Personas Transgénero , Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Homosexualidad Masculina , Brasil , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Estudios de Cohortes , Identidad de Género , Fármacos Anti-VIH/uso terapéuticoRESUMEN
Based on the incorporation of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy and considering the need to comprehend the use of medication among young people, this article analyzes narratives of gay men and transgender women from Belo Horizonte, Minas Gerais State, Brazil, participating in the PrEP1519 study. This is a qualitative research, based on the interpretative anthropology, developed by 10 in-depth interviews with PrEP users followed-up for at least three months between October and November 2019. The results showed that the drug was seen as the main motivation for participating in the study and as a strategy combined with the use of condoms, whether as additional prevention, or assuming the leading role. The medication revealed signs built by the gender performances and their relation to other medications, especially the experience of trans girls in hormonal therapy. Regarding the socialization of the use of PrEP, the narratives showed that there was no secret between the couples, which did not meant that stigmas on the association with HIV did not exist, mainly in the virtual context. In the family environment, they reported questions about the preventive function of the medication and the voluntary nature of the participation in the study. The youth's narratives revealed plural meanings of the medication and its social use, composing both the boys' and girls' performances. The signs attributed to the medication indicated that in addition to maintenance of health, the medication improves life and sexual freedom.
Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Personas Transgénero , Masculino , Humanos , Adolescente , Femenino , Homosexualidad Masculina , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Profilaxis Pre-Exposición/métodos , BrasilRESUMEN
Syphilis has reemerged as a serious public health problem in Brazil and worldwide, disproportionately affecting men who have sex with men (MSM) and travestis and transgender women (TrTGW). Studies on sexually transmitted infections (STI) in adolescents from these key populations are relatively scarce. This is a Brazilian multi-center, cross study with prevalence analysis, using as baseline the PrEP1519 cohort of sexually active MSM and TrTGW adolescents, recruited from April 2019 to December 2020. Analyses were made using the dimensions of vulnerability to STI/HIV and logistic regression models were conducted to estimate the odds ratios of the association between the predictor variables and positive treponemal test for syphilis at the moment of entry in the study. In total, 677 participants were analyzed; participants' median age was 18.9 years (IQR: 18.1-19.5); 70.5% (477) self-declared as black; 70.5% (474), as homosexuals/gays; and 48 (7.1%), as trans women or travestis. The baseline prevalence of syphilis was 21.3%. In the final logistic regression model, higher chance of syphilis was associated with: self-reported episode of STI in the last 12 months (OR = 5.92; 95%CI: 3.74-9.37), sex worker (OR = 3.39; 95%CI: 1.32-8.78), and < 11 years of schooling (OR = 1.76; 95%CI: 1.13-2.74). The prevalence of syphilis among MSM/TrTGW adolescents aged from 15 to 19 years was alarming, much higher than the described for the general population within this age range and associated with vulnerability factors. This reinforces the urgent need to strengthen public health programs to debate about race, gender, sexuality, and prevention.
Asunto(s)
Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Sífilis , Adolescente , Femenino , Humanos , Masculino , Adulto Joven , Brasil/epidemiología , Homosexualidad Masculina , Prevalencia , Conducta Sexual , Enfermedades de Transmisión Sexual/epidemiología , Sífilis/epidemiologíaRESUMEN
At the end of 2017, Brazil adopted HIV pre-exposure prophylaxis (PrEP) as part of a combination prevention strategy for the most at-risk populations. However, Brazil does not have specific guidelines for PrEP use among adolescents aged < 18 years. Therefore, researchers from different health disciplines conducted PrEP1519, the first PrEP demonstration cohort study, ongoing in three Brazilian cities - Salvador, Belo Horizonte, and São Paulo - among adolescent men who have sex with men and transgender women, aged 15-19 years. This study aims to evaluate the effectiveness of PrEP in real-world settings. Quantitative and qualitative methods were integrated to obtain data on PrEP acceptability, uptake, use, and adherence. Moreover, comprehensive services and friendly environments were implemented in the PrEP1519 clinics. This study aims to describe the collaborative efforts of interdisciplinary practices in the development of the PrEP1519 study. The articulation of researchers from different institutions and areas is challenging; but it also allows for a broader outlook on questions regarding the direction of the research, while enriching the decisions needed to be taken during the interactions and negotiations among the different individuals, including the youth team and participants. Furthermore, it reflects on the communication process between cultures and languages considering the trans-epistemic arena of knowledge production about HIV, sexually transmitted infections, PrEP, and other combination prevention strategies for adolescents.
Asunto(s)
Infecciones por VIH , Minorías Sexuales y de Género , Personas Transgénero , Masculino , Humanos , Adolescente , Femenino , Homosexualidad Masculina , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Brasil , Estudios de CohortesAsunto(s)
Síndrome de Inmunodeficiencia Adquirida , Fármacos Anti-VIH , Infecciones por VIH , Minorías Sexuales y de Género , Personas Transgénero , Masculino , Humanos , Femenino , Adolescente , Homosexualidad Masculina , Brasil , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Atención a la Salud , Fármacos Anti-VIH/uso terapéuticoRESUMEN
RESUMO Introdução: O objetivo deste estudo é analisar a aceitabilidade do autoteste de HIV entre adolescentes Homens que fazem Sexo com Homens e mulheres travestis e transexuais em três capitais brasileiras. Método: estudo qualitativo, com 6 Grupos Focais e 37 Entrevistas em profundidade, envolvendo 58 participantes, nas cidades de Belo Horizonte, Salvador e São Paulo, cuja análise temática de conteúdo orientou-se pelo Theoretical Framework of Acceptability. Resultados: boa aceitabilidade do autoteste de HIV, ainda que não homogênea entre participantes. Entre os aspectos positivos dos testes estão, por exemplo, a agilidade, a privacidade, a autonomia no monitoramento da própria saúde e a gestão emocional e de estigma. Em outra direção tem-se a preocupação em como lidar com um eventual resultado reagente e o questionamento do autoteste como estratégia de prevenção. O local de dispensação do autoteste é decisivo para potencializar ou não o uso, a depender da competência cultural para acolher a diversidade sexual e de identidade de gênero de adolescentes. Conclusão: Este estudo identificou o autoteste de HIV como uma estratégia fundamental para o incremento da autonomia e autocuidado entre adolescentes. Estas devem ser consideradas para maior adequação às culturas juvenis locais e, consequentemente, maior adesão à testagem.
ABSTRACT Introduction: The objective of this study is to analyze the acceptability of the HIV self-test among male adolescents who have sex with male and transgender women in three Brazilian capitals. Method: qualitative study, with 6 focus groups and 37 in-depth interviews with 58 participants, from the cities of Belo Horizonte, Salvador and São Paulo, whose thematic analysis was based on the Theoretical Framework of Acceptability. Results: the HIV self-test had good acceptability, although it was not homogeneous among participating adolescents. Positive aspects include, for example, agility, privacy, autonomy, monitoring one's health, and emotional and stigma management. In another direction are concerns about how to deal with an eventual reactive result and whether self-testing is a prevention strategy. The place where self-tests are given out is decisive to improving their use, which depends on cultural competence to accommodate sexual and gender diversities of adolescents. Conclusion: This study has shown that HIV self-testing is a fundamental strategy to increase adolescent autonomy and self-care. These should be considered to better adapt the test to local youth cultures and, consequently, achieve better compliance.
RESUMEN
Using baseline data from the PrEP1519 cohort, in this article we aimed to analyze: (i) the effectiveness of demand creation strategies (DCS) to enroll adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) into an HIV combination prevention study in Brazil; (ii) the predictors of DCS for adolescents' enrollment; and (iii) the factors associated with DCS by comparing online and face-to-face strategies for enrollment. The DCS included peer recruitment (i.e., online and face-to-face) and referrals from health services and non-governmental organizations (NGOs). AMSM and ATGW who agreed to participate in the study could opt to enroll in either PrEP (PrEP arm) or to use other prevention methods (non-PrEP arm). Bivariate and multivariate analyses were conducted and logistic regression odds ratios were estimated. The DCS reached 4529 AMSM and ATGW, the majority of which were derived online (73.8%). Of this total, 935 (20.6%) enrolled to participate (76.6% in PrEP arm and 23.4% in non-PrEP arm). The effectiveness of enrolling adolescents into both arms was greater via direct referrals (235/382 and 84/382, respectively) and face-to-face peer recruitment (139/670 and 35/670, respectively) than online (328/3342). We found that a combination under DCS was required for successful enrollment in PrEP, with online strategies majorly tending to enroll adolescents of a higher socioeconomic status. Our findings reinforce the need for DCS that actively reaches out to all adolescents at the greatest risk for HIV infection, irrespective of their socioeconomic status.
Asunto(s)
Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Personas Transgénero , Masculino , Humanos , Adolescente , Femenino , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Brasil , Profilaxis Pre-Exposición/métodosRESUMEN
Syphilis has reemerged as a serious public health problem in Brazil and worldwide, disproportionately affecting men who have sex with men (MSM) and travestis and transgender women (TrTGW). Studies on sexually transmitted infections (STI) in adolescents from these key populations are relatively scarce. This is a Brazilian multi-center, cross study with prevalence analysis, using as baseline the PrEP1519 cohort of sexually active MSM and TrTGW adolescents, recruited from April 2019 to December 2020. Analyses were made using the dimensions of vulnerability to STI/HIV and logistic regression models were conducted to estimate the odds ratios of the association between the predictor variables and positive treponemal test for syphilis at the moment of entry in the study. In total, 677 participants were analyzed; participants' median age was 18.9 years (IQR: 18.1-19.5); 70.5% (477) self-declared as black; 70.5% (474), as homosexuals/gays; and 48 (7.1%), as trans women or travestis. The baseline prevalence of syphilis was 21.3%. In the final logistic regression model, higher chance of syphilis was associated with: self-reported episode of STI in the last 12 months (OR = 5.92; 95%CI: 3.74-9.37), sex worker (OR = 3.39; 95%CI: 1.32-8.78), and < 11 years of schooling (OR = 1.76; 95%CI: 1.13-2.74). The prevalence of syphilis among MSM/TrTGW adolescents aged from 15 to 19 years was alarming, much higher than the described for the general population within this age range and associated with vulnerability factors. This reinforces the urgent need to strengthen public health programs to debate about race, gender, sexuality, and prevention.
A sífilis reemergiu enquanto problema sério de saúde pública no Brasil e no mundo, afetando de maneira desproporcional homens que fazem sexo com homens (HSH), travestis e mulheres transgênero. São relativamente escassos os estudos sobre infecções sexualmente transmissíveis (IST) entre adolescentes pertencentes a essas populações-chave. O estudo transversal multicêntrico brasileiro analisou a prevalência de sífilis na linha de base da coorte PrEP15-19 de HSH, travestis e mulheres transgênero adolescentes, sexualmente ativos, recrutados entre abril de 2019 e dezembro de 2020. As análises foram realizadas com as dimensões de vulnerabilidade a ISTs/HIV, e modelos de regressão logística foram construídos para estimar as razões de chances da associação entre as variáveis preditoras e um teste treponêmico positivo para sífilis na entrada do estudo. Foram analisados 677 participantes. A idade mediana era 18,9 anos (IIQ: 18,1-19,5), 70,5% (477) se autoidentificaram como pretos, 70,5% (474) como homossexuais/gays e 48 (7,1%) como mulheres trans ou travestis. A prevalência de sífilis na linha de base era 21,3%. No modelo final de regressão logística, as seguintes variáveis estiveram associadas com chances maiores de sífilis: autorrelato de episódio de IST nos últimos 12 meses (OR = 5,92; IC95%: 3,74-9,37), profissional do sexo (OR = 3,39; IC95%: 1,32-8,78) e menos de 11 anos de escolaridade (OR = 1,76; IC95%: 1,13-2,74). A prevalência de sífilis entre HSH, travestis e mulheres transgênero adolescentes entre 15 e 19 anos de idade foi alarmante, muito acima da taxa relatada na população geral nesta faixa etária, e esteve associada a fatores de vulnerabilidade. Os achados reforçam a necessidade urgente de fortalecer os programas de saúde pública com a discussão sobre raça, gênero, sexualidade e prevenção.
La sífilis ha resurgido como un problema serio de salud pública en Brasil y en todo el mundo, afectando desproporcionadamente a hombres que tienen sexo con hombres (HSH), travestis y mujeres transgénero (TrTGW). Los estudios de las enfermedades trasmitidas sexualmente (ETS) en adolescentes de estas poblaciones clase son relativamente escasos. Se trata de un estudio transversal brasileño multicéntrico, con análisis de prevalencia de la base de referencia de la cohorte PrEP1519 de hombres activos sexualmente que mantienen sexo con hombres y adolescentes TrTGW, reclutados desde abril de 2019 a diciembre de 2020. Se hicieron análisis, usando las dimensiones de vulnerabilidad a las ETS/VIH, y se realizaron modelos de regresión logística para estimar las odds ratios de la asociación entre las variables predictoras y la prueba treponémica positiva para la sífilis al comenzar el estudio. Se analizaron a 677 participantes. La media de edad fue 18,9 años (IQR: 18,1-19,5), 70,5% (477) se autodeclararon como negros, 70,5% (474) como homosexuales/gays y 48 (7,1%) como mujeres trans o travestis. La base de referencia de prevalencia de sífilis fue 21,3%. En el modelo final de regresión logística, se asociaron con una posibilidad más alta de sífilis: un episodio autoinformado de ETS en los últimos 12 meses (OR = 5,92; IC95%: 3,74-9,37), trabajadores sexuales (OR = 3,39; IC95%: 1,32-8,78) y < 11 años de estudio (OR = 1,76; IC95%: 1,13-2,74). La prevalencia de sífilis entre adolescentes HSH/TrTGW con edades de 15 a 19 años fue alarmante, mucho más que lo descrito para la población general en este rango de edad y asociado con factores de vulnerabilidad. Esto refuerza la urgente necesidad de fortalecer los programas de salud pública, discutiendo cuestiones de raza, género, sexualidad y prevención.
RESUMEN
At the end of 2017, Brazil adopted HIV pre-exposure prophylaxis (PrEP) as part of a combination prevention strategy for the most at-risk populations. However, Brazil does not have specific guidelines for PrEP use among adolescents aged < 18 years. Therefore, researchers from different health disciplines conducted PrEP1519, the first PrEP demonstration cohort study, ongoing in three Brazilian cities - Salvador, Belo Horizonte, and São Paulo - among adolescent men who have sex with men and transgender women, aged 15-19 years. This study aims to evaluate the effectiveness of PrEP in real-world settings. Quantitative and qualitative methods were integrated to obtain data on PrEP acceptability, uptake, use, and adherence. Moreover, comprehensive services and friendly environments were implemented in the PrEP1519 clinics. This study aims to describe the collaborative efforts of interdisciplinary practices in the development of the PrEP1519 study. The articulation of researchers from different institutions and areas is challenging; but it also allows for a broader outlook on questions regarding the direction of the research, while enriching the decisions needed to be taken during the interactions and negotiations among the different individuals, including the youth team and participants. Furthermore, it reflects on the communication process between cultures and languages considering the trans-epistemic arena of knowledge production about HIV, sexually transmitted infections, PrEP, and other combination prevention strategies for adolescents.
No final de 2017, Brasil adotou a profilaxia pré-exposição do HIV (PrEP) como parte de uma estratégia de prevenção combinada para as populações com maior risco de infecção. Entretanto, o país não dispõe de diretrizes específicas para o uso da PrEP entre adolescentes abaixo de 18 anos de idade. Assim, pesquisadores de diferentes disciplinas de saúde realizaram o PrEP1519, o primeiro estudo de coorte de demonstração da PrEP, atualmente em andamento em três cidades brasileiras - Salvador, Belo Horizonte e São Paulo - entre homens adolescentes que fazem sexo com homens e mulheres transgênero, entre 15 e 19 anos de idade. O estudo busca avaliar a efetividade da PrEP em contextos da vida real. Foram integrados métodos quantitativos e qualitativos para obter dados sobre a aceitabilidade, adoção, uso e adesão à PrEP. Além disso, foram implementados serviços integrados e ambientes acolhedores nas clínicas PrEP1519. O estudo busca descrever os esforços colaborativos das práticas interdisciplinares no desenvolvimento do estudo PrEP1519. A articulação de pesquisadores de diferentes instituições e áreas representa um desafio, mas permite um olhar mais abrangente sobre questões relativas à direção da pesquisa, ao mesmo tempo em que enriquece as decisões necessárias durante as interações e negociações entre diferentes indivíduos, inclusive a equipe de jovens e os participantes. Além disso, reflete o processo de comunicação entre culturas e linguagens, considerando a arena trans-epistêmica da produção de conhecimento sobre HIV, infecções sexualmente transmissíveis, PrEP e outras estratégias de prevenção combinada para adolescentes.
A finales de 2017, Brasil adoptó la profilaxis previa a la exposición al VIH (PrEP) como parte de una estrategia de prevención combinada para las poblaciones de mayor riesgo. Sin embargo, Brasil no tiene directrices específicas para el uso de la PrEP entre los adolescentes < 18 años. Por lo tanto, investigadores de diferentes disciplinas sanitarias llevaron a cabo el PrEP1519, el primer estudio de cohorte de demostración de la PrEP, en curso en tres ciudades brasileñas -Salvador, Belo Horizonte y São Paulo- entre hombres adolescentes que tienen relaciones con hombres y mujeres transexuales, de entre 15 y 19 años. El objetivo de este estudio es evaluar la eficacia de la PPrE en entornos reales. Se integraron métodos cuantitativos y cualitativos para obtener datos sobre la aceptabilidad, la aceptación, el uso y la adherencia de la PrEP. Además, se implementaron servicios integrales y entornos amigables en las clínicas de PrEP1519. Este estudio pretende describir los esfuerzos de colaboración de las prácticas interdisciplinarias en el desarrollo del estudio PrEP1519. La articulación de investigadores de diferentes instituciones y áreas supone un reto; pero también permite ampliar la visión de las cuestiones relativas a la dirección de la investigación, a la vez que enriquece las decisiones que debían tomarse durante las interacciones y negociaciones entre los diferentes individuos, incluyendo el equipo de jóvenes y los participantes. Además, reflexiona sobre el proceso de comunicación entre culturas y lenguas teniendo en cuenta el ámbito trans-epistémico de la producción de conocimiento sobre el VIH, las infecciones de transmisión sexual, la PrEP y otras estrategias de prevención combinada para adolescentes.