Gay and bisexual adolescents and other men who have sex with men: intersectionality and the PrEP care continuum
DOI:
https://doi.org/10.11606/s1518-8787.2024058005705Keywords:
Adolescent, HIV Prevention, Intersectional Framework, Young, Health PersonnelAbstract
OBJECTIVE: To analyze the impact of intersecting systems of oppression on the continuum of PrEP care among adolescent gays, bisexuals, and other men who have sex with men (aGBMSM), and to examine how health professionals (HP) identify and address these challenges to provide sexual health care and HIV prevention. METHODS: This qualitative exploratory study was part of a cohort research project involving aGBMSM, travesties, and transgender women (aTrTW) using PrEP. Data analyzed consisted of 16 interviews with aGBMSM and eight with health professionals (HPs) in São Paulo study site. The methodological and theoretical framework for the interactive categorization of thematic analysis was based on an intersectional approach. RESULTS: The knowledge of aGBMSM about PrEP was influenced by the adverse effects of systems of oppression, particularly among Black adolescents, who acquired knowledge in a less technical manner compared to White adolescents. Most professionals recognized oppression and its impact on the PrEP care continuum (PrEPCC), especially noting the presence of racism. However, few articulated how different social markers compound barriers to the success of the PrEPCC. CONCLUSION: Social oppression affects the success of the PrEP care continuum (PrEPCC) in multiple ways. Health professionals (HPs) play a crucial role in mitigating and not perpetuating these negative experiences within health services, as well as in PrEP access, use, and adherence.
References
Szwarcwald CL, Souza Júnior PRB, Pascom ARP, Coelho RA, Ribeiro RA, Damacena GN, et al. HIV incidence estimates by sex and age group in the population aged 15 years or over, Brazil, 1986-2018. Rev Soc Bras Med Trop. 2022;55(suppl 1). https://doi.org/10.1590/0037-8682-0231-2021
Ministério da Saúde (BR). Boletim Epidemiológico: HIV/Aids 2022 [Internet]. Brasília, DF: Ministério da Saúde; 2022 [citado 2024 mai 24]. Disponível em: https://www.gov.br/aids/pt-br/central-de-conteudo/boletins-epidemiologicos/2022/hiv-aids/boletim_hiv_aids_-2022_internet_31-01-23.pdf/view
Dourado I, Magno L, Greco DB, Zucchi EM, Ferraz D, Westin MR, et al. Interdisciplinaridade na pesquisa sobre prevenção do HIV: a experiência do protocolo de estudo PrEP1519 entre HSH adolescentes e mulheres trans no Brasil. Cad Saúde Pública. 2023;39(Suppl 1):e00139221. https://doi.org/10.1590/0102-311XEN143221
Ministério da Saúde (BR). Protocolo clínico e diretrizes terapêuticas para Profilaxia Pré-exposição (PrEP) de risco à infecção pelo HIV [Internet]. Brasília, DF: Ministério da Saúde; 2022 [citado 2024 mai 24]. Disponível em: https://www.gov.br/aids/pt-br/central-de-conteudo/pcdts/2017/hiv-aids/pcdt-prep-versao-eletronica-22_09_2022.pdf/view
Santos LA, Unsain RAFAF, Brasil SAA, Silva LAV, Duarte FM, Couto MT. PrEP perception and experiences of adolescent and young gay and bisexual men: an intersectional analysis. Cad Saúde Pública. 2023;39(Suppl 1):e00134421. https://doi.org/10.1590/0102-311XEN134421
Pena ÉD, Westin MR, Duarte MJ, Greco M, Silva AP, Martinez YF, et al. Quando a prevenção é o melhor remédio: profilaxia pré-exposição do HIV (PrEP) entre adolescentes gays e mulheres transgênero em Belo Horizonte, Minas Gerais, Brasil. Cad Saúde Publica. 2023;39(Suppl 1):e00097921. https://doi.org/10.1590/0102-311XEN097921
Westin MR, Martinez YF, Silva AP, Marques LM, Campos GB, Alves MDP, et al. Prevalência de sífilis e comportamento e práticas sexuais entre adolescentes HSH e travestis e mulheres transgênero em um estudo de coorte multicêntrico brasileiro sobre uso diário de PrEP. Cad Saúde Pública. 2023;39(Suppl 1):e00118721. https://doi.org/10.1590/0102-311XEN118721
Ferraz D, Dourado I, Zucchi EM, Mabire X, Magno L, Grangeiro AD, et al. Effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohort studies in Brazil: COBra study protocol. BMJ Open. 2021 Mar;11(4):e045258. https://doi.org/10.1136/bmjopen-2020-045258
Zucchi EM, Couto MT, Castellanos M, Dumont-Pena É, Ferraz D, Pinheiro TF, et al. Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: a qualitative study. PLoS One. 2021 May;16(5):e0249293. https://doi.org/10.1371/journal.pone.0249293
Kelley CF, Kahle E, Siegler A, Sanchez T, Del Rio C, Sullivan PS, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015 Nov;61(10):1590-7. https://doi.org/10.1093/cid/civ664
Ezennia O, Geter A, Smith DK. The PrEP care continuum and black men who have sex with men: a scoping review of published data on awareness, uptake, adherence, and retention in PrEP care. AIDS Behav. 2019 OCT;23(10):2654-73. https://doi.org/10.1007/s10461-019-02641-2
Shannon G, Morgan R, Zeinali Z, Brady L, Couto MT, Devakumar D. Intersectional insights into racism and health: not just a question of identity. Lancet. 2022 Dec;400(10368):2125-36. https://doi.org/10.1016/S0140-6736(22)02304-2
Bowleg L, Malekzadeh AN, Mbaba M, Boone CA. Ending the HIV epidemic for all, not just some: structural racism as a fundamental but overlooked social-structural determinant of the US HIV epidemic. Curr Opin HIV AIDS. 2022 Mar;17(2):40-5. https://doi.org/10.1097/COH.0000000000000724
Couto MT, Oliveira E, Separavich MAA, Luiz OC. The feminist perspective of intersectionality in the field of public health: a narrative review of the theoretical-methodological literature. Salud Colect. 2019;15:e1994. https://doi.org/10.18294/sc.2019.1994
Bauer GR. Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc Sci Med. 2014 Jun;110:10-7. http://dx.doi.org/10.1016/j.socscimed.2014.03.022
Monteiro SS, Villela WV, Soares PS. The interaction between axes of inequality in studies on discrimination, stigma and HIV/AIDS: contributions to the recent international literature. Glob Public Health. 2013 Apr;8(5):519-33. https://doi.org/10.1080/17441692.2013.779738
Watkins-Hayes C. Intersectionality and the sociology of HIV/AIDS: past, present, and future research directions. Annu Rev Sociol. 2014 Jul;40:431-57. https://doi.org/10.1146/annurev-soc-071312-145621
Cho S, Crenshaw KW, McCall L. Toward a field of intersectionality studies: theory, applications, and praxis. J Women Cult Soc. 2013;38(4):785-810.
Neale J. Iterative categorization (IC): a systematic technique for analysing qualitative data. Addiction. 2016 Jun;111(6):1096-106. https://doi.org/10.1111/add.13314
Hancock A-M. Intersectionality as a normative and empirical paradigm. Polit Gend. 2007;3(2):248-54. https://doi.org/10.1017/S1743923X07000062
Ministério da Saúde (BR). Painel PrEP [Internet]. Brasília, DF: Ministério da Saúde; 2023 [citado 2023 Sep 9]. Disponível em: http://www.aids.gov.br/pt-br/painel-prep
Cazeiro F, Leite JF, Costa AJ. Por uma decolonização do HIV e interseccionalização das respostas à aids. Physis (Rio J). 2023;33:e33024. http://dx.doi.org/10.1590/S0103-7331202333024
Bowleg L, Teti M, Malebranche DJ, Tschann JM. “It’s an uphill battle everyday”: intersectionality, low-income black heterosexual men, and implications for HIV prevention research and interventions. Psychol Men Masculinity. 2013 Jan;14(1):25-34. https://doi.org/10.1037/a0028392
Lee-Foon NK, Logie CH, Siddiqi A, Grace D. Exploring young black gay, bisexual and other men who have sex with men’s PrEP knowledge in Toronto, Ontario, Canada. Cult Heal Sex. 2022 Nov;24(3):301-14. https://doi.org/10.1080/13691058.2020.1837958
Dourado I, Magno L, Greco DB, Grangeiro A. Prevenção combinada do HIV para homens adolescentes que fazem sexo com homens e mulheres adolescentes transexuais no Brasil: vulnerabilidades, acesso à saúde e expansão da PrEP. Cad Saúde Publica. 2023;39(suppl 1):e00228122. https://doi.org/10.1590/0102-311XPT228122
Haubrick KK, Whiteley L, Arnold T, Leigland A, Ward LM, Brock JB, et al. Impact of homophobia and racism on comfort receiving pre-exposure prophylaxis at various locations among black MSM in Mississippi. AIDS Behav. 2023 Jun;27(6):1870-8. https://doi.org/10.1007/s10461-022-03918-9
Magno L, Soares F, Zucchi EM, Eustórgio M, Grangeiro A, Ferraz D, et al. Reaching out to adolescents at high risk of HIV infection in Brazil: demand creation strategies for PrEP and other HIV combination prevention methods. Arch Sex Behav. 2023 Feb;52(2):703-19. https://doi.org/10.1007/s10508-022-02371-y
Calabrese SK, Kalwicz DA, Modrakovic D, Earnshaw VA, Edelman EJ, Bunting SR, et al. An experimental study of the effects of patient race, sexual orientation, and injection drug use on providers’ PrEP-related clinical judgments. AIDS Behav. 2022 May;26(5):1393-421. https://doi.org/10.1007/s10461-021-03495-3
Published
Issue
Section
License
Copyright (c) 2024 Eduardo Araújo de Oliveira, Lorruan Alves dos Santos, Eliana Miura Zucchi, Paula Massa, Alexandre Grangeiro, Marcia Thereza Couto
This work is licensed under a Creative Commons Attribution 4.0 International License.
Funding data
-
Conselho Nacional de Desenvolvimento Científico e Tecnológico
Grant numbers 404055/2018-4 -
Ministério da Saúde
