Factors associated with condomless anal sex among adolescent men who have sex with men and transgender women in three Brazilian state capitals: a PrEP1519 study
DOI:
https://doi.org/10.11606/s1518-8787.2024058005462Keywords:
Men who have Sex with Men, Transgender Women, Adolescent, Condomless anal sex, HIV/AIDS, Sexually Transmitted InfectionsAbstract
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.
References
Bock AMB. A adolescência como construção social: estudo sobre livros destinados a pais e educadores. Psicol Esc Educ. 2007;11(1):63-76. https://doi.org/10.1590/S1413-85572007000100007
Silva AA, Gubert FA, Barbosa Filho VC, Freitas RWJF, Vieira-Meyer APGF, Pinheiro MTM, et al. Health promotion actions in the School Health Program in Ceará: nursing contributions. Rev Bras Enferm. 2021;74(1):e20190769. https://doi.org/10.1590/0034-7167-2019-0769
Magno L, Marinho LFB, Zucchi EM, Amaral AMS, Lobo TCB, Paes HCS, et al. School-based sexual and reproductive health education for young people from low-income neighbourhoods in Northeastern Brazil: the role of communities, teachers, health providers, religious conservatism, and racial discrimination. Sex Educ. 2022;23(4):409-24. https://doi.org/10.1080/14681811.2022.2047017
Brandão ER, Cabral CS. Sexual and reproductive rights under attack: the advance of political and moral conservatism in Brazil. Sex Reprod Health Matters. 2019;27(2):1669338. https://doi.org/10.1080/26410397.2019.1669338
Brasil. Ministério da Saúde. Boletim Epidemiológico de HIV/Aids. Brasília, DF; 2022.
Kerr LRFS, Mota RS, Kendall C, Pinho AA, Mello MB, Guimarães MDC, et al. HIV among MSM in a large middle-income country. AIDS. 2013;27(3):427-35. https://doi.org/10.1097/QAD.0b013e32835ad504
Kerr L, Kendall C, Guimarães MDC, Mota RS, Veras MA, Dourado I, et al. HIV prevalence among men who have sex with men in Brazil: Results of the 2nd national survey using respondent-driven sampling. Medicine (Baltimore). 2018;97(1S):S9-15. https://doi.org/10.1097/MD.0000000000010573
Programa Conjunto das Nações Unidas sobre HIV/AIDS. In Danger: UNAIDS Global AIDS Update 2022. Geneva; 2022.
Leite BO, Magno L, Soares F, MacCarthy S, Brignol S, Bastos FI, et al. HIV prevalence among transgender women in Northeast Brazil – Findings from two Respondent Driven Sampling studies. BMC Public Health. 2022;22:2120. https://doi.org/10.1186/s12889-022-14589-5
Grinsztejn B, Jalil EM, Monteiro L, Velasque L, Moreira RI, Garcia ACF, et al. Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil. Lancet HIV. 2017;4(4):e169-76. https://doi.org/10.1016/S2352-3018(17)30015-2
Programa Conjunto das Nações Unidas sobre HIV/AIDS. Fast-tracking combination prevention: towards reducing new HIV infections to fewer than 500 000 by 2020. Geneva; 2015.
Programa Conjunto das Nações Unidas sobre HIV/AIDS. Global AIDS Update 2021: Confronting inequalities: Lessons for pandemic responses from 40 years of AIDS. Geneva; 2021.
Rocha GM, Kerr LRFS, Brito AM, Dourado I, Guimarães MDC. Unprotected receptive anal intercourse among men who have sex with men in Brazil. AIDS Behav. 2013;17(4):1288-95. https://doi.org/10.1007/s10461-012-0398-4
Rocha GM, Guimarães MDC, Brito AM, Dourado I, Veras MA, Magno L, et al. High Rates of Unprotected Receptive Anal Intercourse and Their Correlates Among Young and Older MSM in Brazil. AIDS Behav. 2019;24:938-50. https://doi.org/10.1007/s10461-019-02459-y
Guimarães MDC, Kendall C, Magno L, Rocha GM, Knauth DR, Leal AF, et al. Comparing HIV risk-related behaviors between 2 RDS national samples of MSM in Brazil, 2009 and 2016. Medicine (Baltimore). 2018;97(1S):S62-8. https://doi.org/10.1097/MD.0000000000009079
Sousa PJ, Ferreira LOC, de Sá JB. Estudo descritivo da homofobia e vulnerabilidade ao HIV/Aids das travestis da Região Metropolitana do Recife, Brasil. Cienc Saude Coletiva. 2013;18(8):2239-51.
Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: Systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39(4):1048-63. https://doi.org/10.1093/ije/dyq057
Magno L, Dourado I, Silva LAV, Brignol S, Amorim L, MacCarthy S. Gender-based discrimination and unprotected receptive anal intercourse among transgender women in Brazil: A mixed methods study. PLoS One. 2018;13(4):e0194306. https://doi.org/10.1371/journal.pone.0194306
Jalil EM, Torres TS, Pereira CCA, Farias A, Brito JDU, Lacerda M, et al. High Rates of Sexualized Drug Use or Chemsex among Brazilian Transgender Women and Young Sexual and Gender Minorities. Int J Environ Res Public Health. 2022;19(3):1704. https://doi.org/10.3390/ijerph19031704
Dourado I, Magno L, Greco DB, Zucchi EM, Ferraz D, Westin MR, et al. Interdisciplinarity in HIV prevention research: the experience of the PrEP1519 study protocol among adolescent MSM and TGW in Brazil. Cad Saude Publica. 2023;39(Supl 1):e00143221. https://doi.org/10.1590/0102-311XEN143221
Dourado I, Magno L, Soares F, Massa P, Nunn A, Dalal S, et al. Adapting to the COVID-19 Pandemic: Continuing HIV Prevention Services for Adolescents Through Telemonitoring, Brazil. AIDS Behav. 2020;24(7):1994–9. https://doi.org/10.1007/s10461-020-02927-w
Kleinman LC, Norton EC. What’s the risk? A simple approach for estimating adjusted risk measures from nonlinear models including logistic regression. Health Serv Res. 2009;44(1):288-302. https://doi.org/10.1111/j.1475-6773.2008.00900.x
Norton EC, Miller MM, Kleinman LC. Computing adjusted risk ratios and risk differences in Stata. Stata J. 2013;13(3):492-509. https://doi.org/10.1177/1536867X1301300304
Zucchi EM, Couto MT, Castellanos M, Dumont-Pena E, 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;16(5):e0249293. https://doi.org/10.1371/journal.pone.0249293
Felisbino-Mendes MS, Paula TF, Machado IE, Oliveira-Campos M, Malta DC. Analysis of sexual and reproductive health indicators of Brazilian adolescents, 2009, 2012 and 2015. Rev Bras Epidemiol. 2018;21(Supl 1):e180013. https://doi.org/10.1590/1980-549720180013.supl.1
Hentges B, Knauth DR, Vigo A, Teixeira LB, Leal AF, Kendall C, et al. Inconsistent condom use with casual partners among men who have sex with men in Brazil: a cross-sectional study. Rev Bras Epidemiol. 2023;26:e230019. https://doi.org/10.1590/1980-549720230019
Satcher MF, Segura ER, Silva-Santisteban A, Sanchez J, Lama JR, Clark JL. Partner-level factors associated with insertive and receptive condomless anal intercourse among transgender women in Lima, Peru. AIDS Behav. 2017;21(8):2439-51. https://doi.org/10.1007/s10461-016-1503-x
Queiroz AAFLN, Sousa AFL, Araújo TME, Brignol S, Reis RK, Fronteira I, et al. High rates of unprotected receptive anal sex and vulnerabilities to HIV infection among Brazilian men who have sex with men. Int J STD AIDS. 2021;32(4):368-77. https://doi.org/10.1177/0956462420968994
Alecrim DJD, Ceccato MGB, Dourado I, Kerr L, Brito AM, Guimarães MDC. Factors associated with exchanging sex for money in men who have sex with men in Brazil. Cienc Saude Coletiva. 2020;25(3):1025-39. https://doi.org/10.1590/1413-81232020253.18052018
Gutierrez EB, Pinro VM, Basso CR, Spiassi AL, Lopez MEBR, Barros CRS. Fatores associados ao uso de preservativo em jovens – inquérito de base populacional. Rev Bras Epidemiol. 2019;22:e190034. https://doi.org/10.1590/1980-549720190034
Hugo TDO, Maier VT, Jansen K, Rodrigues CEG, Cruzeiro ALS, Ores LC, et al. Fatores associados à idade da primeira relação sexual em jovens: estudo de base populacional. Cad Saude Publica. 2011;27(11):2207-14. https://doi.org/10.1590/S0102-311X2011001100014
Kapadia F, Latka MH, Hudson SM, Golub ET, Campbell J V., Bailey S, et al. Correlates of consistent condom use with main partners by partnership patterns among young adult male injection drug users from five US cities. Drug Alcohol Depend. 2007;91(Supl 1):S56-63. https://doi.org/10.1016/j.drugalcdep.2007.01.004
Sousa AFL, Queiroz AAFLN, Lima SVMA, Almeida PD, Oliveira LB, Chone JS, et al. Chemsex practice among men who have sex with men (MSM) during social isolation from COVID-19: multicentric online survey. Cad Saude Publica. 2020;36(12):e00202420. https://doi.org/10.1590/0102-311X00202420
Nevendorff L, Schroeder SE, Pedrana A, Bourne A, Stoové M. Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta-analysis. J Int AIDS Soc. 2023;26(1): e26054. https://doi.org/10.1002/jia2.26054
Mgbako O, Park SH, Callander D, Brinker DA, Kuhner C, Carrico AW, et al. Transactional sex, condomless anal sex, and HIV risk among men who have sex with men. Int J STD AIDS. 2019;30(8):795-801. https://doi.org/10.1177/0956462418823411
Bórquez A, Guanira JV, Revill P, Caballero P, Silva-Santisteban A, Kelly S, et al. The impact and cost-effectiveness of combined HIV prevention scenarios among transgender women sex-workers in Lima, Peru: a mathematical modelling study. Lancet Public Health. 2019;4(3):e127-36. https://doi.org/10.1016/S2468-2667(18)30236-6
Beattie TS, Kabuti R, Beksinska A, Babu H, Kung’u M, The Maisha Fiti Study Champions, et al. Violence across the Life Course and Implications for Intervention Design: Findings from the Maisha Fiti Study with Female Sex Workers in Nairobi, Kenya. Int J Environ Res Public Health. 2023;20(11):6046. https://doi.org/10.3390/ijerph20116046
Programa Conjunto das Nações Unidas sobre HIV/AIDS. HIV e trabalho sexual: série de fichas informativas sobre direitos humanos. Geneva; 2021.
Brasil. Lei nº 8.069, de 13 de julho de 1990. Dispõe sobre o Estatuto da Criança e do Adolescente e dá outras providências. Diário Oficial da União [Internet]. 1990 jul. 16 [citado em 23 maio 2024]. Disponível em: https://www.planalto.gov.br/ccivil_03/leis/l8069.htm.
Baral SD, Friedman MR, Geibel S, Rebe K, Bozhinov B, Diouf D, et al. Male sex workers: practices, contexts, and vulnerability for HIV acquisition and transmission. Lancet. 2015;385(9964):260-73. https://doi.org/10.1016/S0140-6736(14)60801-1
Beyrer C, Crago AL, Bekker LG, Butler J, Shannon K, Kerrigan D, et al. An action agenda for HIV and sex work. Lancet. 2015;385(9964):287-301. https://doi.org/10.1016/S0140-6736(14)60933-8
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