Encuesta en línea de comportamiento sexual y prácticas de prevención del virus de inmunodeficiencia humana en varones gais y hombres que tienen sexo con hombres en Uruguay / Web-based survey on sexual behavior and HIV prevention practices in gay men and men who have sex with men in Uruguay / Pesquisa online de comportamento sexual e práticas de prevenção do Vírus da Imunodeficiência Humana em gays e homens que fazem sexo com homens no Uruguai

Resumen: Introducción: por ser los varones gais y los hombres que tienen sexo con hombres (HSH) una población con mayor incidencia de virus de inmunodeficiencia humana (VIH), ONUSIDA recomienda el monitoreo periódico mediante encuestas que releven información para reportar indicadores de prevención. La implementación de estos estudios en nuestro medio es limitada debido a la complejidad y costos de las metodologías tradicionales. Objetivo: generar información actualizada sobre prevención del VIH, con énfasis en uso de condón y realización de pruebas de tamizaje en gais/HSH de 15 a 49 años en Uruguay, implementando una estrategia metodológica innovadora. Material y método: estudio de corte transversal y analítico, en base a una encuesta online disponible entre octubre y diciembre de 2019. Resultados: se incluyeron 693 varones, 67% de Montevideo y 67% con nivel educativo terciario. Un 17% fue forzado a mantener relaciones sexuales alguna vez, 20% sufrió maltrato por su orientación y 68,4% ocultaba su orientación sexoafectiva en algún grado. Un 57,2% usó condón en la última relación sexual anal casual, observándose un descenso respecto al año 2012 (67,6%), mientras que la tendencia en la cobertura de prueba de VIH (66%) fue creciente comparada con estudios previos. La proporción de positividad de VIH fue de 13,3%. El análisis multivariado mostró que la menor probabilidad de uso de condón se asocia a: pareja estable en el último año, autoidentificación gay, prueba de VIH en el último año y vacunación para virus papiloma humano. La mayor probabilidad de uso se asoció a: participación en actividades de información, relaciones sexuales con personas con ITS/VIH. La menor probabilidad de realización de prueba de VIH se asoció con pareja estable y la mayor con el conocimiento de lugares de acceso a prueba y conocimiento de la profilaxis posexposición. Entre quienes conocían la profilaxis preexposición (375), 46,1% estaba dispuesto a recibirla y 1,3% había accedido. Conclusiones: la persistencia de situaciones de discriminación y violencia hacia varones gais/HSH necesita acciones más efectivas de promoción de derechos. Es necesario integrar innovaciones biomédicas en prevención que se complementen y potencien para el control de la epidemia. El uso de una encuesta en línea fue eficiente en el reclutamiento, aunque con sesgos en la selección, lo que desafía a mejorar esta estrategia metodológica.

Summary: Introduction: as gay men and men who have sex with men (MSM) constitute a population with a greater incidence of HIV, UNAIDS recommends regular surveillance by means of surveys that provide information that allows reporting prevention indicators. The implementation of these studies is limited in our context given the high complexity and costs of traditional methodologies. Objectives: to generate updated information about HIV prevention, with an emphasis on condom use and to implement screening tests in gay/MSM population between 15 and 49 years old in Uruguay, using an innovative methodological strategy. Method: transversal, analytical study by means of a web-based survey available between October and December 2019. Results: 693 men were included in the study, 67% from Montevideo and 67% of which had university studies. 17% of them had been forced to have sex in the past, 20% had suffered abuse because of their sexual orientation and 68.4% concealed their sex-affective orientation to some extent. 57.2% used condoms in their last casual anal sexual relationship, what evidences a decrease with regard to 2012 (67.6%), whereas a growing tendency in the HIV test coverage (66%) was observed, when compared to previous studies. HIV positivity rate was 13.3%. The multivariate analysis revealed a lower probability of condom use was associated to: a stable partner in the last year, gay self-identification, HIV test in the last year and having the HPV vaccine. The greater likelihood of use was associated to: participating in informative activities, having sex with people with STD/HIV. The lowest probability of having an HIV test was associated to a stable partner and the highest was associated to knowing where they could get tested for HIV and also knowing about the post-exposure prophylaxis. When considering those who knew about the pre-exposure prophylaxis (375), 46.1% was willing to receive it and 1.3% had agreed to it. Conclusions: the continuation of discrimination and violence towards gay men and MSM needs more effective right promoting actions. We need to integrate into prevention biomedical innovations that complement and leverage one another. The web-based survey was effective in terms of recruiting, although there were bias in the selection, what results challenging to improve the methodological strategy.

Resumo: Introdução: como gays e homens que fazem sexo com homens (HSH) são uma população com maior incidência de HIV, o UNAIDS recomenda o monitoramento regular por meio de pesquisas que coletem informações para calcular indicadores de prevenção. A implementação desses estudos em nosso ambiente é limitada devido à complexidade e custo das metodologias tradicionais. Objetivo: gerar informações atualizadas sobre prevenção do HIV, com ênfase no uso de preservativos e testes de triagem em gays/HSH de 15 a 49 anos no Uruguai, implementando uma estratégia metodológica inovadora. Método: estudo transversal e analítico, baseado em questionário online disponível entre outubro e dezembro de 2019. Resultados: foram incluídos 693 homens, 67% de Montevidéu e 67% com nível superior. 17% foram obrigados a ter relações sexuais em algum momento, 20% sofreram maus-tratos devido à sua orientação e 68,4% ocultaram sua orientação sexual-afetiva em algum grau. 57,2% usaram preservativo na última relação anal casual, mostrando um decréscimo em relação a 2012 (67,6%), enquanto a tendência da cobertura do teste anti-HIV (66%) foi de aumento em relação a estudos anteriores. A taxa de positividade do HIV foi de 13,3%. A análise multivariada mostrou menor probabilidade de uso de preservativo associado a: parceiro estável no último ano, autoidentificação gay, teste de HIV no último ano e vacinação para papiloma vírus humano. A maior probabilidade de uso esteve associada a: participação em atividades informativas, relações sexuais com pessoas com IST/HIV. A menor probabilidade de realização do teste anti-HIV foi associada ao parceiro estável e a maior ao conhecimento dos locais de acesso ao teste e conhecimento da profilaxia pós-exposição. Entre os que conheciam a profilaxia pré-exposição (375), 46,1% estavam dispostos a recebê-la, 1,3% já haviam recebido. Conclusões: a persistência de situações de discriminação e violência contra gays/HSH requer ações mais efetivas de promoção de direitos. É necessário integrar inovações biomédicas na prevenção que se complementem e se fortaleçam para o controle da epidemia. A utilização de uma pesquisa online foi eficiente no recrutamento, embora com vieses de seleção, o que desafia a melhorar essa estratégia metodológica.

Fatores associados à troca de sexo por dinheiro em homens que fazem sexo com homens no Brasil / Factors associated with exchanging sex for money in men who have sex with men in Brazil

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.

Suspected COVID-19 flu-like syndrome in men who have sex with men and have been involved in casual sex / Síndrome gripal sospecha de COVID-19 en hombres que tienen sexo con hombres y se envolvieron en sexo ocasional / Síndrome gripal suspeita de COVID-19 em homens que fazem sexo com homens e se envolveram em sexo casual

ABSTRACT Objective: To evaluate the presence of flu-like syndrome suggestive of COVID-19 in men who have sex with men (MSM) and engaged in casual sex during a period of social isolation. Method: National epidemiological survey, applied in April and May 2020, by adaptation of Respondent Drive Sampling. Results: 1,337 MSM participated in the survey, of which 514 (38.4%) had fever associated with another sign or symptom of flu-like syndrome. Social, demographic characteristics, sexual practices and activities during the period of social isolation were statistically associated with the presence of flu-like syndrome. There was a statistical difference (p < 0.001) in the average of partners between those who had signs and symptoms of flu-like syndrome (3.5) and those who did not (1.7). Conclusion: Evidence of signs and symptoms indicative of flu-like syndrome suggestive of COVID 19 in Brazilian MSM who were involved in casual sex during the period of social isolation.

RESUMEN Objetivo: Evaluar la presencia de síndrome gripal sospecha de COVID-19 en hombres que tienen sexo con hombres (HSH) y se envolvieron en sexo con pareja ocasional durante distanciamiento social. Método: Averiguación epidemiológica, de abarcamiento nacional, aplicado en abril y mayo de 2020, por adaptación del Respondent Drive Sampling. Resultados: 1.337 HSHs participaron de la investigación, de los cuales 514 (38,4%) tuvieron fiebre relacionada a otra señal o síntoma de síndrome gripal. Características sociales, demográficas, prácticas y actividades sexuales durante el distanciamiento social han estáticamente relacionadas a la presencia de síndrome gripal. Hubo diferencia estadística (p < 0,001) en la media de parejas entre aquellos que tuvieron señales y síntomas de síndrome gripal (3,5) y aquellos que no los tuvieron (1,7). Conclusión: Se evidencia ocurrencia de señales y síntomas indicativos de síndrome gripal sugestivo de COVID-19 en HSHs brasileños que se envolvieron en sexo ocasional durante el período del distanciamiento social.

RESUMO Objetivo: Avaliar a presença de síndrome gripal suspeita de COVID-19 em homens que fazem sexo com homens (HSH) e se envolveram em sexo com parceiro casual durante período de distanciamento social. Método: Inquérito epidemiológico, de abrangência nacional, aplicado em abril e maio de 2020, por adaptação do Respondent Drive Sampling. Resultados: 1.337 HSHs participaram da pesquisa, dos quais 514 (38,4%) tiveram febre associada a outro sinal ou sintoma de síndrome gripal. Características sociais, demográficas, práticas e atividades sexuais durante o período de distanciamento social foram estaticamente associadas à presença de síndrome gripal. Houve diferença estatística (p < 0,001) na média de parceiros entre aqueles que tiveram sinais e sintomas de síndrome gripal (3,5) e aqueles que não os tiveram (1,7). Conclusão: Evidencia-se ocorrência de sinais e sintomas indicativos de síndrome gripal sugestiva de COVID19 em HSHs brasileiros que se envolveram em sexo casual durante o período do distanciamento social.

Posições sexuais, estilos corporais e risco para o HIV entre homens que fazem sexo com homens no Recife (Brasil) / Sexual positions, body styles and HIV risk among men who have sex with men in Recife (Brazil)

Resumo O artigo apresenta resultados de pesquisa etnográfica na comunidade gay do Recife (PE), realizada por meio de observação participante e entrevistas. Objetiva compreender condutas sexuais de risco de homens que fazem sexo com homens (HSH) ao HIV, focando os sentidos das posições sexuais no intercurso anal — receptivo (IAR) e insertivo (IAI). Praticantes de IAR desprotegido são sujeitos a maior risco de infecção que praticantes de IAI. Os que praticam ambos, IAR e IAI, são elos amplificadores (maiores chances de receber e passar o vírus) nas cadeias de transmissão. O texto aborda as categorias êmicas, relacionadas com as identidades de gênero — pintosa (gay feminino), boy (gay masculino) e cafuçu (HSH e com mulheres, não gay, masculino, classe popular) — e com as identidades sexuais — ativo (IAI), passivo (IAR) e versátil (IAI e IAR) —, nos modos como significam as posições sexuais e produzem atração sexual. Os homens masculinos são os sexualmente desejados. Boys tendem a se relacionar com boys, e pintosas, com cafuçus. Há expressivo número de versáteis, o que amplia o risco coletivo dentro da comunidade gay. Por meio das relações entre pintosas e cafuçus, pode existir um caminho propício para o vírus circular mais entre a comunidade gay e a sociedade mais ampla.

Abstract The article presents the results of an ethnographic study of the gay community in Recife (PE), conducted via participant observation and interviews. It seeks to understand sexual risk conduct among men who have sex with men (MSM) and HIV, focusing on the significance of sexual positions during anal-receptive intercourse (ARI) and anal-insertive intercourse (AII). Those who practice unprotected ARI are subject to a greater risk of infection than those who practice AII. Those who practice both, ARI and AII, are amplifiers (greater chances of receiving and passing on the virus) in the transmission chains. The text addresses the emic categories related with gender identities - pintosa (female gay), boy (male gay), and cafuçu (MSM and with women, non-gay, male, lower social class) - and with gender identities - active (AII), passive (ARI), and versatile (AII and ARI) - in the ways they result in sexual positions and produce sexual attraction. Masculine men are the most sexually desirable. Boys tend to relate with boys, and pintosas with cafuçus. There is a significant number of versatiles, which increases the collective risk within the gay community. By means of the relations between pintosas and cafuçus, there is increased danger for the virus to circulate more among the gay community and society in general.

HIV testing and HIV knowledge among men who have sex with men in Natal, Northeast Brazil

ABSTRACT Background: Men who have sex with men (MSM) account for the highest prevalence of HIV in Brazil. HIV testing allows to implement preventive measures, reduces transmission, morbidity, and mortality. Methods: We conducted a cross-sectional study to evaluate HIV testing during lifetime, factors associated with the decision to test, knowledge about HIV transmission, and use of condoms between MSM from the city of Natal, northeast Brazil. Results: Out of 99 participants, 62.6% had been tested for HIV during lifetime, 46.2% in the last year. The most frequent reported reason to be tested for HIV infection was curiosity (35.5%). Correct knowledge about HIV was observed in only 9.2% of participants. In multivariate analysis, age (PR 0.95; 95%CI, 0.91-0.99; p = 0.041) and previous syphilis test (PR 4.21; 95%CI, 1.52-11.70; p = 0.006) were associated with HIV testing. Conclusions: The frequency of HIV testing among MSM from Natal is rather low, especially in younger MSM, and knowledge about HIV transmission is inappropriate.

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.

HIV/AIDS knowledge among MSM in Brazil: a challenge for public policies / Conhecimento sobre HIV/aids entre HSH no Brasil: um desafio para as políticas públicas

ABSTRACT Introduction: High level of HIV/AIDS knowledge is required for an effective adoption of preventive strategies. Objective: To assess HIV/AIDS knowledge among men who have sex with men (MSM) in 12 Brazilian cities. Methods: Respondent-Driven Sampling method was used for recruitment. HIV/AIDS knowledge was assessed by Item Response Theory. Difficulty and discrimination parameters were estimated, and the knowledge score was categorized in three levels: high, medium, and low. Logistic regression was used for analysis. Results: Among 4,176 MSM, the proportion of high level of knowledge was 23.7%. The following variables were positively associated with high knowledge (p < 0.05): age 25+ years old, 12+ years of schooling, white skin color, having health insurance, having suffered discrimination due to sexual orientation, having had a syphilis test, and having received educational material in the previous 12 months. Exchanging sex for money was negatively associated. Conclusions: The proportion of only 23.7% of high HIV/AIDS knowledge was low. We should note that the only potential source of knowledge acquisition associated with high level of knowledge was receiving educational materials. Our study indicates the need for expansion of public prevention policies focused on MSM and with more effective communication strategies, including the development of knowledge that involves motivation and abilities for a safer behavior.

RESUMO Introdução: Alto nível de conhecimento sobre HIV/aids é necessário para uma efetiva adoção de estratégias preventivas. Objetivo: Avaliar o nível de conhecimento sobre HIV/aids entre homens que fazem sexo com homens (HSH) de 12 cidades brasileiras. Metodologia: O método Respondent-Driven Sampling foi utilizado para recrutamento. O conhecimento sobre HIV/aids foi avaliado por meio de 12 perguntas e analisados pela Teoria de Resposta ao Item. Foram estimados os parâmetros de dificuldade e discriminação e o escore de conhecimento categorizado em três níveis: alto, médio e baixo. Regressão logística foi utilizada para a análise. Resultados: Do total de 4.176 HSH, a proporção de alto nível de conhecimento foi de 23,7%. Estiveram associados positivamente (p < 0,05) com o alto conhecimento: idade 25+ anos, escolaridade 12+ anos, cor da pele branca, ter plano de saúde, ter sofrido discriminação devido à orientação sexual, ter realizado teste para sífilis e recebido material educativo nos últimos 12 meses. Ter recebido dinheiro por sexo esteve negativamente associado. Conclusões: A proporção de apenas 23,7% de alto nível de conhecimento sobre HIV/aids foi baixa. Destaca-se que a única potencial fonte formal de aquisição de conhecimento associada com alto nível de conhecimento foi receber material educativo. Este estudo aponta a necessidade de expandir as políticas públicas de prevenção focadas no segmento HSH e com estratégias de comunicação mais eficazes, incluindo o desenvolvimento de conhecimento que envolva motivação e habilidade para um comportamento mais seguro.

The 12 city HIV Surveillance Survey among MSM in Brazil 2016 using respondent-driven sampling: a description of methods and RDS diagnostics / Inquérito sobre o HIV entre HSH no Brasil em 2016 usando respondent-driven sampling (RDS): descrição dos métodos e dos diagnósticos do RDS

ABSTRACT: Introduction: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil. Methods: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum. Results: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV). Conclusion: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.

RESUMO: Introdução: Este artigo detalha os métodos utilizados na segunda Pesquisa Nacional de Vigilância Biológica e Comportamental (BBSS) do HIV, sífilis e hepatite B e C entre os homens que fazem sexo com homens no Brasil. Métodos: O método Respondent-driven Sampling (RDS) foi utilizado em 12 cidades em 2016. A amostra foi iniciada com cinco a seis sementes em cada cidade. Testes rápidos para o HIV, sífilis e Hepatite B e C foram oferecidos aos participantes. O software RDS Analyst com o estimador de amostragem sucessiva (SS) de Gile foi utilizado para ajustar os resultados como recomendado, gerando um peso para cada indivíduo para análises. Osdados das 12cidades foram unidos em um único banco e analisados usando as ferramentas de dados complexos do Stata 14.0, com cada cidade sendo tratada como seu próprio estrato. Resultados: A duração da coleta de dados variou de 5,9 a 17,6 semanas e 4.176 homens foram recrutados nas 12 cidades. Dois sites não alcançaram o tamanho da amostra alvo devido a uma demora de seis meses na aprovação local do Comitê de Ética. Todas as cidades atingiram a convergência na principal variável estudada (HIV). Conclusão: O BBSS foi representativo e concluído conforme planejado e dentro do orçamento. A descrição dos métodos aqui é mais detalhada do que o habitual, devido às novas ferramentas e requisitos de diagnóstico das novas diretrizes do STROBE-RDS.

Human T cell lymphotropic virus type 1 infection among men who have sex with men in Central Brazil

ABSTRACT Human T cell lymphotropic virus type 1 (HTLV-1) was the first retrovirus discovered in humans and is endemic in several parts of the world. Because of risk behaviors, mainly sexual, men who have sex with men (MSM) are at high risk of acquiring HTLV-1 infection. A cross-sectional study was performed to estimate the prevalence of HTLV-1 infection, to characterize genetically HTLV-1 sequences and to identify risk behaviors associated with this infection among MSM in Central Brazil. A total of 430 MSM were enrolled in this study and three were shown to be HTLV-1 infected, prevalence of 0.7% (95% confidence interval: 0.4-0.9). Phylogenetic analysis showed that all HTLV-1 positive samples belonged to Cosmopolitan subtype Transcontinental subgroup A. Although the prevalence rate of HTLV-1 infection found in this study was similar to that observed among Brazilian blood donors, additional HTLV-1 preventive interventions need to be further implemented because this population is engaged in high-risk sexual behavior.

Risk behavior score: a practical approach for assessing risk among men who have sex with men in Brazil

ABSTRACT HIV/AIDS epidemic is not well controlled, and multiple sexual behavior factors help explain high rates of HIV infection among men who have sex with men (MSM). This article proposes to exam the use of a potential risk behavior score for HIV infection, based on the type and number of sexual partners, and condom use, and their associated factors in a sample of MSM in Brazil. A cross sectional RDS (Respondent Driven Sampling) study was performed among 3738 MSM aged 18+ years old from ten Brazilian cities. The risk behavior score was composed by the number of male partners and anal condom use in the last year with steady, casual, and commercial partners. Most participants were 25+ years old (58.1%), non-white (83.1%), and single (84.9%). Final weighted ordinal logistic model showed that age ≤ 25 years old (p = 0.037), homosexual or bisexual identity (p < 0.001), sexual initiation before 15-year-old (p < 0.001), having sex with men only in the last 12 months (p < 0.001), frequent alcohol and illicit drug use (p < 0.001), and use of local sites to meet sexual partners in the last month were independently associated with higher scores of risky behavior. Specific strategies should be developed aimed at the MSM population. Additionally, pre-exposed prophylaxis (Prep) should be considered for those at higher score as a strategy for reducing risk for HIV infection in this population.

High HIV infection prevalence in a group of men who have sex with men

ABSTRACT Brazil is characterized by a concentrated AIDS epidemic, it has a prevalence of less than 1% in the general population. However, there are higher rates in specific populations, especially in men who have sex with men. The study's aim was to analyze the association between sociodemographic characteristics, sexual practices, sexual behaviors and the HIV infection in a group of men who have sex with men. Secondary data was collected between June 2014 and September 2015 in a research of cross-sectional design in the city of Rio de Janeiro, Brazil. Volunteers answered an online computerized questionnaire and took HIV test. Chi-squared distribution and multiple logistic regression was used. There were 341 participants. Most of them were racially mixed, single, average age of 30.6 years and with a higher education level. The HIV prevalence was 13.9%. Two logistic models were fit (insertive or receptive anal intercourse). Both models showed an association with HIV among those who had a HIV positive sexual partner (Odds Ratio ≈ 2.5) and a high self-perception of acquiring HIV (Model 1: Odds Ratio ≈ 7/Model 2: Odds Ratio ≈ 10). Low condom usage in receptive anal intercourse with casual partners had a direct association with HIV seropositivity, whereas insertive anal intercourse with casual partners with or without condoms were inversely related. The study identified a high prevalence of HIV infections among a group of men who sex with men with a high self-perception risk of acquiring HIV. The findings also showed a relation with sociodemographic and sexual behavior variables.

Medidas de salud mental y bienestar subjetivo en una muestra de hombres gays y mujeres lesbianas en Chile / Health and wellbeing of sexual minorities

Background: Most of the information in Chile about health and wellbeing of sexual minorities refers to risk behaviors. Aim: To assess health and wellbeing in a sample of Chilean homosexual men and women. Material and Methods: Spanish versions of the Satisfaction With Life Scale and Outcome Questionnaire-45 (OQ-45) were answered by 191 homosexual women and 256 homosexual men aged 18 to 67 years, from four Chilean cities. Results: Lesbian women have better levels of satisfaction with life and adjustment in personal relationships than homosexual men. Eight percent of respondents had suicidal thoughts in some moment of their life. Conclusions: The information gathered in this work could help in the development of mental health policies for sexual minorities.

Factors associated with self-reported discrimination against men who have sex with men in Brazil

ABSTRACT OBJECTIVE To estimate self-reported discrimination due to sexual orientation among men who have sex with men (MSM) in Brazil and to analyze associated factors. METHODS A cross-sectional study of 3,859 MSM recruited in 2008-2009 with respondent driven sampling. Data collection conducted in health centers in 10 Brazilian cities. A face-to-face questionnaire was used and rapid HIV and syphilis tests conducted. Aggregated data were weighted and adjusted odds ratio estimated to measure the association between selected factors and self-reported discrimination due to sexual orientation. RESULTS The sample was predominantly young, eight plus years of schooling, pardo (brown), single, low-income, and identified themselves as gay or homosexual. The prevalence of self-reported discrimination due to sexual orientation was 27.7% (95%CI 26.2-29.1). Discrimination was independently associated with: age < 30 years, more years of schooling, community involvement and support, history of sexual and physical violence, suicidal thoughts, and unprotected receptive anal intercourse. CONCLUSIONS The prevalence of self-reported discrimination among MSM in Brazil is high. These results challenge the assumptions that MSM-specific prevention and support programs are not required or that health professionals do not need special training to address MSM needs.

Loss to follow-up in a cohort of HIV-negative men who have sex with men: Project Horizonte

ABSTRACT OBJECTIVE The objective of this study is to estimate the attrition rates and evaluate factors associated with loss to follow-up between 1994 and 2011 in an open cohort of HIV-negative men who have sex with men. METHODS The Project Horizonte is an open cohort study that aimed to assess the incidence of HIV infection, evaluate the impact of educational interventions, and identify potential volunteers for HIV vaccine trials. The rates of losses to follow-up were estimated for three periods (1994-1999, 2000-2005, and 2006-2011). The variables analyzed were collected in a psychosocial questionnaire. Volunteers who dropped out were compared with the ones who remained in the study using a Cox regression model. RESULTS A total of 1,197 volunteers were recruited. The median follow-up time in the study (n = 626) was 4.2 years. The median follow-up time for the volunteers who dropped out of the study (n = 571) was 1.46 years. The overall rate of loss to follow-up was 11.6/100 person-years. Attrition rates by period were: 12.60 (1994-1999), 11.80 (2000-2005), and 9.00 (2006-2011) per 100 person-years. Factors associated with losses to follow-up were: age group of 21-30 years old, monthly per capita income of more than six or less than one Brazilian minimum wage, having more than two dependents, report of bisexual practice, and inconsistent use of condoms for receptive anal sex. CONCLUSIONS A slight decrease of the loss to follow-up was observed over time. Higher attrition rates happened in the first three years of follow-up. It is possible that the link of the volunteers were not yet well established. Those who reported inconsistent condom use in receptive anal sex were more likely to leave the study, suggesting an underestimation of the incidence of HIV infection in a cohort population. For greater effectiveness, retention strategies must be reassessed considering the connection between the characteristics of homosexual and bisexual behavior and the motivations to engage in health research.

Fatores associados a infecção por HIV numa amostra respondent-driven sampling de homens que fazem sexo com homens, Salvador / Factors associated with HIV infection among a respondent-driven sample of men who have sex with men in Salvador, Brazil

RESUMO: Diante das evidências de que os homens que fazem sexo com homens são afetados de forma desproporcional pelas infecções por HIV, investigamos os fatores de risco sociodemográficos, biológicos e de comportamentos sexuais associados à infecção por HIV, na cidade de Salvador, Bahia. Este trabalho é um recorte da pesquisa nacional "Comportamento, atitudes, práticas e prevalência de HIV e Sífilis entre homens que fazem sexo com homens em 10 cidades brasileiras", que foi do tipo corte transversal e selecionou participantes via técnica Respondent Driven Sampling . Devido à prevalência do HIV ser menor do que 10% e ao reduzido tamanho da amostra (383), utilizamos regressão logística exata nas análises para medir associação entre os fatores de risco e a infecção por HIV. A prevalência do HIV foi de 6,3% (IC95% 3,9 - 8,8), e após o ajuste do modelo final, os fatores de vulnerabilidade que se associaram à infecção por HIV foram: não fez teste de sífilis na vida (OR = 3,1: IC95% 1,3 - 7,3), ter mais de 8 parceiros sexuais (OR = 3,3; IC95% 1,4 - 8,1). Este estudo mostrou a alta prevalência do HIV na amostra, em comparação a população geral, bem como confirmou a importância da realização do teste de sífilis na vida no contexto da epidemia do HIV, sendo que essa detecção precoce permite uma aproximação das ações de prevenção para DST.

ABSTRACT: Human immunodeficiency virus (HIV) continues to disproportionately affect men who have sex with men (MSM); therefore, we investigated the sociodemographic, biological, and sexual behavioral risk factors associated with HIV infection in the city of Salvador, Bahia. This study is part of the national survey Behavior, Attitudes, Practices and Prevalence of HIV and Syphilis among men who have sex with men in 10 Brazilian Cities, which is a cross-sectional survey whose participants were selected by means of the respondent-driven sampling. Exact logistic regression analysis was used to measure the association of potential risk factors with HIV infection due to an HIV prevalence lower than 10% and a small sample size (383). The prevalence of HIV was 6.3% (95%CI 3.9-8.8) and the risk factors associated with HIV infection in our adjusted final model included having never been tested for syphilis (OR = 3.1; 95%CI 1.3 - 7.3) and having more than eight sexual partners (OR = 3.3; 95%CI 1.4 - 8.1). This study highlights the high prevalence of HIV among MSM in the sample compared with the general population and confirms the importance of testing for syphilis in the context of the HIV epidemic as early detection may provide opportunities to prevent sexually transmitted diseases.

Social networks of men who have sex with men: a study of recruitment chains using Respondent Driven Sampling in Salvador, Bahia State, Brazil / Las redes sociales de hombres que mantienen sexo con hombres: estudio de muestreo en cadena con Respondent Driven Sampling en Salvador, Bahía, Brasil / Redes sociais de homens que fazem sexo com homens: estudo das cadeias de recrutamento com Respondent Driven Sampling em Salvador, Bahia, Brasil

Abstract Social and sexual contact networks between men who have sex with men (MSM) play an important role in understanding the transmission of HIV and other sexually transmitted infections (STIs). In Salvador (Bahia State, Brazil), one of the cities in the survey Behavior, Attitudes, Practices, and Prevalence of HIV and Syphilis among Men Who Have Sex with Men in 10 Brazilian Cities, data were collected in 2008/2009 from a sample of 383 MSM using Respondent Driven Sampling (RDS). Network analysis was used to study friendship networks and sexual partner networks. The study also focused on the association between the number of links (degree) and the number of sexual partners, in addition to socio-demographic characteristics. The networks’ structure potentially facilitates HIV transmission. However, the same networks can also be used to spread messages on STI/HIV prevention, since the proximity and similarity of MSM in these networks can encourage behavior change and positive attitudes towards prevention.

Resumen Redes sociales y de contacto sexual entre hombres que practican sexo con hombres (HSH) tienen un papel importante en la comprensión de la aparición de las enfermedades de transmisión sexual (ETS) y el VIH, debido a la posibilidad de circulación de los agentes infecciosos en estas estructuras. Los datos de Salvador, Bahía, Brasil, que se recabaron de la encuesta Comportamiento, Actitudes, Prácticas y Prevalencia de VIH y Sífilis entre Hombres que Practican Sexo con Hombres en 10 Ciudades Brasileñas, fueron recogidos en 2008/2009 en una muestra de 383 HSH, usando Respondent Driven Sampling. Se utilizó el análisis de redes sociales para investigar las redes de amigos y parejas sexuales. También se analizó la relación entre el número de conexiones (grado) y el número de parejas sexuales, y las características socio-demográficas. Las redes presentan estructuras que facilitan la transmisión del VIH. Sin embargo, se puede aprovechar para difundir información para prevención del VIH y las ETS, así como que la proximidad y la similitud de los HSH en estas redes pueden influir en el comportamiento y las actitudes positivas para la prevención de las mismas.

Resumo As redes sociais e de contato sexual entre homens que fazem sexo com homens (HSH) têm um papel importante na compreensão da ocorrência de doenças sexualmente transmissíveis (DST) e HIV, devido ao potencial de circulação de agentes infecciosos nestas estruturas. Dados da cidade de Salvador, Bahia, Brasil, que integraram a pesquisa Comportamento, Atitudes, Práticas e Prevalência de HIV e Sífilis entre Homens que Fazem Sexo com Homens em 10 Cidades Brasileiras foram coletados em 2008/2009 numa amostra de 383 HSH por meio da técnica Respondent Driven Sampling (RDS). Análise de redes sociais foi utilizada para investigar as redes de amigos e parceiros sexuais. Também foi avaliada a relação entre o número de conexões (grau), o número de parceiros sexuais e as características sociodemográficas. As redes apresentaram estruturas que facilitam a transmissão do HIV. Porém, estas redes podem ser exploradas para a disseminação de informações sobre a prevenção do HIV e DST, visto que a proximidade e similaridade dos HSH nessas redes podem influenciar comportamentos e atitudes positivas para a prevenção.

Cruising y e-citas: un nuevo contexto para los encuentros sexuales entre hombres jóvenes que tienen sexo con hombres / Cruising e e-compromissos: um novo contexto de encontros sexuais entre os jovens homens que fazem sexo com homens / Cruising and e-dates: a new context for sexual encounters among young men who have sex with men

Resumen El objetivo de este artículo es el de explorar el papel que juega, en la actualidad, la irrupción de la mediación tecnológica de la información y la comunicación en la configuración de nuevos contextos para la relación sexual. En concreto, hemos explorado una práctica determinada, el cruising, entre hombres jóvenes que tienen sexo con hombres contactado a través de las e-citas. Se ha apostado por la metodología cualitativa con la intención de recopilar los discursos sobre sexualidad, riesgos y salud que se generan y construyen entre el grupo de iguales. Según extraemos de nuestro estudio, el nuevo marco que confiere esta tecnología estaría caracterizado por (a) una mayor accesibilidad a dichas prácticas, (b) una mayor difusión de estas, (c) una mayor inmediatez de acceso a las propuestas, (d) la anticipación de lo que será ofrecido en la cita, (e) acceso anónimo que permite propuestas más atrevidas y (f) una apertura mayor a la diversidad de usuarios. Todos estos elementos confluyen en un cuadro que nos lleva a considerar una organización social renovada de la práctica sexual.

Resumo O objetivo deste artigo é explorar o papel que a irrupção da mediação tecnológica da informação e da comunicação desempenha na definição de novos contextos para a relação sexual. Em particular, explora-se uma determinada prática, o cruising entre os homens jovens que fazem sexo com homens contatados via e- encontros. Nossa aposta foi pela metodologia qualitativa, com a intenção de recolher os discursos sobre a sexualidade, a saúde e os riscos que são gerados e construídos entre o grupo de pares. De acordo com o nosso estudo, o novo quadro que oferece essa tecnologia seria marcado por: (a) uma maior acessibilidade a essas práticas; (b) uma maior divulgação das mesmas, bem como (c) um maior imediatismo de acesso para as propostas; (d) a antecipação do que vai ser oferecido no encontro; (e) acesso anônimo que permite propostas mais ousadas; e (f) uma maior abertura para a diversidade de usuários. Todos esses elementos convergem em um contexto que leva-nos a considerar uma nova organização social da prática sexual.

Abstract This article addresses the rapidly growing use of information and communication technologies in mediating new settings for sexual relations. The specific focus is on cruising among young men who have sex with men via e-dating. The study used a qualitative methodology with peer group discussions on sexuality, health, and risk. The new framework provided by technology is marked by (a) increased access to these practices, (b) greater dissemination of them, (c) greater immediacy of encounters, (d) anticipation of what will be offered during dates, (e) anonymous access, allowing bolder proposals, and (f) openness to a wider range of users. These elements converge in a framework that indicates a new social organization of sexual practice.

Medición simplificada del nivel socioeconómico en encuestas breves: propuesta a partir de acceso a bienes y servicios / Simplified indicator of socioeconomic status in short surveys: a proposal based on assets and services

Objetivo. Desarrollar un indicador socioeconómico para encuestas breves que permita una clasificación en relación con un criterio poblacional y que resulte parsimonioso. Material y métodos. Se generó un indicador socioeconómico a partir de variables dicotómicas de bienes y servicios. Se obtuvo la correlación de los resultados obtenidos de la Encuesta Nacional de Ingresos y Gastos en los Hogares ENIGH con los de una encuesta breve y se les comparó con los de un indicador construido a partir de un conjunto mayor de variables. Resultados. La concordancia para los quintiles 1, 2, 3, 4 y 5 del indicador amplio y el parsimonioso son 94, 94, 82, 83 y 89%, respectivamente. El coeficiente de correlación por rangos de Spearman fue de 0.85. Conclusiones. El indicador parsimonioso propuesto captura la heterogeneidad del nivel socioeconómico en la encuesta probada. Se sugiere su uso para encuestas breves debido a sus ventajas: a) se elabora con variables dicotómicas; b) las variables base no implican el cumplimiento de algún supuesto estadístico; c) es fácilmente calculado, y d) se puede utilizar para comparar grupos.

Objective. To develop a socioeconomic index for brief surveys that allows a classification in relation to a reference population with a parsimonious approach. Materials and methods. A socioeconomic index was created using assets and use of services indicators to predict income level within a national representative survey of income (ENIGH, National Survey of Households Income and Expenditures) and then tested with data from a survey among key populations (men who have sex with men/transvestite, transgender, transsexual/female sex workers) and compared to an already published indicator. Results. The concordance for quintiles 1, 2, 3, 4, and 5 between the two indexes were 94, 94, 82, 83, and 89%, respectively. The Spearman's rank correlation coefficient was 0.85. Conclusions. The proposed parsimonious index captures the socioeconomic level heterogeneity in the MSM/TTT/FSW survey. The use of this index is suggested for short surveys because of the next advantages: a) it uses dichotomic variables; b) the variables used do not imply the fulfillment of any statistical assumption; c) it is easily calculated; d) it can be used for comparing groups.

Vulnerability in the context of HIV and syphilis infection in a population of men who have sex with men (MSM) in Salvador, Bahia State, Brazil / La vulnerabilidad en el contexto de VIH y sífilis en una población de hombres que mantienen sexo con hombres (MSM) en Salvador, Bahía, Brasil / Vulnerabilidade no contexto da infecção por HIV e sífilis numa população de homens que fazem sexo com homens (HSH) no Município de Salvador, Bahia, Brasil

Social, individual, and programmatic vulnerability of men who have sex with men (MSM) in the context of the HIV epidemic and other sexually transmitted infections (STI) is a reality in many countries. The survey Behavior, Attitudes, Practices, and Prevalence of HIV and Syphilis in Men Who Have Sex with Men in 10 Brazilian Cities selected 383 MSM in the city of Salvador, Bahia State, Brazil, using the respondent driven sampling (RDS) technique. Individual vulnerability early sexual initiation (51%), average of eight sex partners, and unprotected receptive anal sex with casual (32%) and steady partners (45%) and positive rapid tests HIV (6.5%) and syphilis (9%). Social vulnerability young adults (80%), black race/skin color (91%), mean monthly family income of BRL 1,000.00, and personal history of discrimination (57%). Programmatic factors no previous HIV test (63%) and no access to lubricant gel (88%). The study showed a profile of vulnerability and the urgent need for interventions and STI prevention in the MSM population in Salvador, in addition to high prevalence rates for HIV and syphilis. .

La vulnerabilidad social, individual y programática de los hombres que mantienen sexo con hombres (HSH) en un contexto de infección del VIH y enfermedades de transmisión sexual (ETS) es una realidad en muchos países. En la encuesta Comportamiento, Actitudes, Prácticas y Prevalencia de VIH y Sífilis entre Hombres que Practican Sexo con Hombres en 10 Ciudades Brasileñas, 383 hombres conformaron la selección en Salvador, Bahía, Brasil, según respondent driven sampling (RDS). El perfil de la vulnerabilidad personal es inicio temprano de la actividad sexual (51%), promedio de 8 parejas sexuales, la práctica de relaciones sexuales receptivas sin protección: pareja ocasional (32%), fijos (45%), VIH positivo (6,5%) y sífilis (8,8%). Vulnerabilidad social adultos jóvenes (80%), negros (91%), con ingresos medios por hogar de R$ 1.000,00 y que sufrieron algún tipo de discriminación (57%). Factores programáticos ninguna prueba de VIH en la vida (63%) y sin acesso a gel lubrificante (88%). Identificado un perfil de vulnerabilidad, y la urgente uimplementación de la intervención y la prevención de enfermedades de transmisión sexual entre los HSH en la ciudad. Hubo un perfil de vulnerabilidad y una necesidad urgente de acciones de intervención y prevención de enfermedades de transmisión sexual durante la investigación de la población en este municipio, además de una alta prevalencia de VIH y sífilis. .

A vulnerabilidade social, individual e programática dos homens que fazem sexo com homens (HSH), no contexto da epidemia do HIV e doenças sexualmente transmissíveis (DST) é uma realidade em muitos países. A pesquisa Comportamento, Atitudes, Práticas e Prevalência de HIV e Sífilis entre Homens que Fazem Sexo com Homens em 10 Cidades Brasileiras, selecionou, no Município de Salvador, Bahia, Brasil, 383 HSH via técnica respondent driven sampling (RDS). Vulnerabilidade individual início precoce da vida sexual (51%), média de oito parceiros sexuais, sexo anal receptivo desprotegido com parceiro casual (32%) e fixo (45%), e teste rápido positivo: HIV (6,5%) e sífilis (9%). Vulnerabilidade social adultos jovens (80%), negros (91%), renda familiar média de R$ 1.000,00 e sofreram algum tipo de discriminação (57%). Fatores programáticos sem teste do HIV (63%), sem acesso ao gel lubrificante (88%). Observou-se um perfil de vulnerabilidade e urgente necessidade de ações de intervenção e prevenção às DST no município na população pesquisada, além de altas prevalências do HIV e sífilis. .