Zero knowledge and high interest in the use of long-acting injectable pre-exposure prophylaxis (PrEP) among adolescent men who have sex with men and transgender women in two capital cities in Brazil.

BACKGROUND: Adolescent men who have sex with men (aMSM) and transgender women (aTGW) are affected disproportionately by human immunodeficiency virus (HIV) infection. Although new methods of pre-exposure prophylaxis (PrEP), such as long-acting injectable (LAI-PrEP), have been approved by the Food and Drug Administration, their acceptability among aMSM/aTGW is not well known. METHODS: Forty-eight semi-structured interviews were conducted to assess the knowledge and interest in LAI-PrEP among aMSM/aTGW enrolled in a daily oral PrEP cohort from two capital cities of Brazil since 2019. RESULTS: Previous knowledge of LAI-PrEP remains scarce, but the high interest regarding its use has been reported. Interest in the use of LAI-PrEP is associated with eliminating the burden of daily responsibility or the risk of missing the necessary medications, lowering the costs of this method, increasing confidentiality, and decreasing the frequency of visiting PrEP clinics. The reported barriers to uptake included fear of injection, doubts on its effectiveness, side effects, and greater dependence on a health provider. CONCLUSIONS: There is an urgent need to strengthen the preventive strategies against HIV infection among the youth, enhance their knowledge and those of healthcare providers, and offer safe and new options.

Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study.

BACKGROUND: Adolescents face socio-structural, personal and programmatic barriers to HIV prevention services, highlighting the importance of understanding knowledge and acceptability as essential aspects to promote their broader access to pre-exposure prophylaxis (PrEP). We analyzed the acceptability of PrEP among adolescent men who have sex with men (MSM), travestis and transgender women (TGW). METHODS: A qualitative investigation was conducted as part of the formative research of the PrEP15-19 study, an ongoing demonstration study that analyzes the effectiveness of daily PrEP among adolescent MSM, travestis and TGW aged 15-19 in three Brazilian cities. A total of 37 semi-structured interviews and 6 focus groups were conducted. Building from thematic analysis focusing on participants' sexual encounters, perceptions about PrEP efficacy, and vulnerability contexts, we analyzed prospective acceptability of PrEP. FINDINGS: Knowledge about PrEP was incipient and characterized by adolescents' frequent doubts about its prescription and efficacy. The 'ideal' use of PrEP appeared together with consistent condom use, especially in casual sex. PrEP use was also mentioned as depending on increased learning about prevention management over time. Main barriers to PrEP use included the incorporation of a daily medication into participants' routine and its impact on their social lives, especially related to stigma. Concerns over short- and long-term side effects were also reported as barriers to PrEP use. TGW and travestis contrasted using PrEP with the precarity of their life conditions, and some expressed a critical vision about PrEP by associating it with pharmaceuticalization and trans necropolitics. CONCLUSIONS: Participants' low knowledge and acceptability of PrEP are circumscribed by a rigid perception of condom as the ideal prevention method and the context of their sexual relations. Prospective acceptability highlights that the successful uptake of PrEP depends on overcoming barriers of access to health services and confronting transphobia and homophobia as part of care.

Moral barriers to HIV prevention and care for gay and bisexual men: Challenges in times of conservatism in Brazil.

This article examines narratives about promiscuity that are emphasized by some gay and bisexual men who are themselves living with HIV. We used semi-structured interviews to assess the processes, outcomes, and meanings of HIV diagnosis among 10 young gay and bisexual men aged between 18 and 30 years old. Interviews were conducted in health service settings for the diagnosis and treatment of HIV and AIDS in Salvador, Brazil. Based on a socioculturally oriented approach, the narratives suggest that discourse about promiscuity seems to persist, or is even strengthened, in order to explain HIV infection among young gays/bisexual men and to emphasize a more restrained sexual life following HIV diagnosis. Despite the biotechnologies and biomedical advances, some difficulties and tensions also persist in the daily life of young people living with HIV. Difficulties in starting new relationships, dilemmas around responsibility for infection/transmission, fear and guilt are elements that stand out in these narratives, demonstrating that HIV discourses and practices may produce greater stigma and discrimination in current times, individualizing and blaming certain people for the infection/transmission of the virus, and marginalizing practices that do not conform to hegemonic heteronormativity.

Factors Associated with PrEP Refusal Among Transgender Women in Northeastern Brazil.

Brazil has recently integrated HIV Pre-exposure Prophylaxis (PrEP) into its public health system and offered to key populations such as transgender women (TGW). This study investigates factors associated with PrEP refusal among TGW living in one of the largest and poorest cities of Brazil. We recruited 127 TGW using Respondent Driven Sampling (RDS) in Salvador, Brazil. Latent class analysis (LCA) was used to define acceptability of PrEP. Two latent classes were identified: "high acceptability of PrEP" (91.3%) and "PrEP refusal" (8.7%). PrEP was less acceptable among white TGW and among those age 25 or older, with income above minimum wage (≥ US$252.87), and reporting unprotected receptive anal intercourse with (URAI) causal partners. The findings highlight how nuanced strategies that takes into consideration unique characteristics are needed to effectively address the acceptability of PrEP.

The meanings and practices of barebacking among Brazilian internet users.

This article originates from an online ethnography on barebacking (intentional unprotected anal sex) in Brazil, between the years 2004 and 2008. More specifically, some elements or conceptual dimensions present in discussions on barebacking will be examined. Based on internet discussion forums and 23 open online interviews, using the Windows Live Messenger program, it was possible to organise the practice of barebacking into two principal modalities: more extensive and involving greater contact and partial or involving reduced risks. The individuals who practise bareback sex may experience situations that include various forms of barebacking during their lives, such as the men who contract HIV and try to develop strategies to reduce the risks in their sexual interactions by, for example, avoiding ejaculating inside their partner or trying to establish sexual relationships with men of the same serological status. Therefore, in general, the different motivations for barebacking constitute a frontier region (of tension) between the pleasure of sensory contact and the risk of infection. Beyond producing a dichotomy between pleasure and risk, the various meanings described by the potential barebackers must be taken into account.

[Mediation practices in epidemiological research from an ethnographic perspective]. / Práticas de mediação na pesquisa epidemiológica sob o ponto de vista etnográfico.

During 1998 I accompanied a cultural communication network in the production of epidemiological data, which used an ethnographic approach to studies of science. Inserted in the daily activities of an epidemiological research group, I registered some aspects of the scientific production process, such as the strategies and negotiations involved in the maintenance and circulation of the data produced. This paper describes the trajectory of epidemiological research and the interaction network of its actors, including the participation of technicians in the negotiation of the scientific practices. In addition to highlighting the continuous activity of negotiation and transformation of epidemiological data and information, I analyze the separation of science and politics or of nature and culture-society, and emphasize the collective participation in the process of scientific production.