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Ferguson L, Grangeiro A, Natividad AA, Massa P, Rodrigues A, Ferraz D, Zucchi EM. Are Rights-Based Services Important? An Adolescent PrEP Demonstration Project in Brazil. Health Hum Rights 2024; 26:71-86. [PMID: 38933221 PMCID: PMC11197856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
In this study, we systematically examined the importance of human rights standards and principles for rights-based pre-exposure prophylaxis (PrEP) provision for marginalized adolescents. Nested within a demonstration study of PrEP provision to adolescent men who have sex with men, travestis, and transgender women, we carried out interviews in São Paulo, Brazil with 25 adolescents, eight health providers, and six workers involved in community-based demand creation. Analysis focused on participants' narratives about aspects of human rights within service delivery, including the availability, accessibility, acceptability, and quality of services; informed decision-making; nondiscrimination; and privacy and confidentiality. Clients and service providers highlighted the importance of availing a range of services beyond PrEP and described how community outreach and social media helped promote accessibility. Acceptability centered around clients feeling heard and respected. Health workers appreciated having time to build trusting relationships with clients to ensure quality of care and support informed decision-making. Nondiscrimination was valued by all, including using clients' chosen pronouns. Privacy and confidentiality were primary concerns for clients who were not "out" about their sexuality or PrEP use; to mitigate this, health workers sought to accommodate clients' preferred channels of communication. Rights-based PrEP services can help promote engagement and retention in PrEP services, particularly for marginalized populations.
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Affiliation(s)
- Laura Ferguson
- Associate professor of population and public health sciences at the University of Southern California (USC) and director of research at the USC Institute on Inequalities in Global Health, Los Angeles, United States
| | - Alexandre Grangeiro
- Scientific researcher in the Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Paula Massa
- Researcher in the Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ayra Rodrigues
- Researcher in the Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brazil
| | - Dulce Ferraz
- Postdoctoral fellow at the University of Lyon, France, and a public health analyst at Fundação Oswaldo Cruz, Brasília, Brazil
| | - Eliana Miura Zucchi
- Assistant professor in the Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brazil
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Brasil MHF, Patrício ACFDA, Nogueira WP, Freire MEM, Gir E, Silva ACDOE. Sexual behavior of university students in the context of the COVID-19 pandemic: a mixed-methods study. Rev Esc Enferm USP 2024; 57:e20230116. [PMID: 38315802 PMCID: PMC10843313 DOI: 10.1590/1980-220x-reeusp-2023-0116en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To analyze the sexual behaviors of university students during the COVID-19 pandemic. METHOD Mixed study, carried out on four campuses of a public university in Paraíba, Brazil, between March 2021 and April 2022. The research followed ethical precepts. RESULTS 404 university students were included, with an average age of 23.7 years, predominantly female, brown and single. The prevalence of self-reported sexually transmitted infections was 7.9%. Male students were more likely to engage in risky sexual behavior. Multiple logistic regression indicated that university students aged 25 or over who had engaged in casual sex in the last 12 months and had received or paid for sex were more likely to have sexually transmitted infections. The content analysis showed that social isolation was reflected in reduced consumption of alcohol and other substances, reduced sexual practices, increased use of social networks, as well as low adherence to condoms. CONCLUSION Physical distancing has an impact on the sexual behavior of university students, as well as on the consumption of alcohol and other substances.
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Affiliation(s)
| | | | - Wynne Pereira Nogueira
- Universidade Federal da Paraíba, Programa de Pós-Graduação em Enfermagem, João Pessoa, PB, Brazil
| | | | - Elucir Gir
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Dourado I, Soares F, Magno L, Amorim L, Eustorgio Filho M, Leite B, Greco D, Westin M, Tupinambás U, Massa P, Miura Zucchi E, Grangeiro A. Adherence, Safety, and Feasibility of HIV Pre-Exposure Prophylaxis Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil (PrEP1519 Study). J Adolesc Health 2023; 73:S33-S42. [PMID: 37953006 DOI: 10.1016/j.jadohealth.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/14/2023]
Abstract
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.
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Affiliation(s)
- Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Leila Amorim
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Marcos Eustorgio Filho
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Beo Leite
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Dirceu Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mateus Westin
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Unaí Tupinambás
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paula Massa
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, São Paulo, Brazil
| | - Alexandre Grangeiro
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Maragh-Bass AC, Williams T, Agarwal H, Dulin AK, Sales J, Mayer KH, Siegler AJ. Exploring Stigma, Resilience, and Alternative HIV Preventive Service Delivery Among Young Men who Have Sex with Men of Color. Clin Nurs Res 2023; 32:1046-1056. [PMID: 37401801 DOI: 10.1177/10547738231184295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Stigmatization on the basis of race, sexuality, gender identity, and/or use of pre-exposure prophylaxis (PrEP) exacerbates HIV disparities for young men who have sex with men of color (YMSM). We explored resilience, healthcare experiences, stigma, and impact of coronavirus disease 2019 (COVID-19) on PrEP care needs among YMSM of color through virtual in-depth interviews. Analyses used adapted grounded theory/constant comparison. Regarding healthcare-based stigma, participants enacted multilevel resilience which was critical to their care retention during COVID-19 (Themes 1 and 2). Some participants noted that remote care could minimize healthcare stigma and promote retention in care and/or on PrEP (Theme 3). Participants were interested in long-acting injectable (LAI) PrEP but expressed concerns about cost, effectiveness, and side effects (Theme 4). Community-based venues like pharmacies were preferred spaces for getting LAI PrEP injections (Theme 4). Although expansion of telehealth that helped mitigate care retention challenges during COVID-19 was temporary, continued telehealth use may reduce stigmatization and promote long-term retention and PrEP persistence.
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Affiliation(s)
- Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
- Global Health Institute, Duke University, Durham, NC, USA
| | - Tia Williams
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Harsh Agarwal
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
| | - Akilah K Dulin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jessica Sales
- Department of Behavioral, Social, and Health Education Sciences (BSHES), Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Wootton AR, Soled KRS, Puckett JA, Garrett-Walker JJ, Hill AP, Delucio K, Veldhuis CB. Community (dis)connectedness and identity among LGBTQIA+ people during the COVID-19 pandemic: A qualitative cross-sectional and longitudinal trajectory study. PSYCHOLOGY & SEXUALITY 2023; 15:170-192. [PMID: 38800743 PMCID: PMC11114605 DOI: 10.1080/19419899.2023.2241868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/27/2023] [Indexed: 05/29/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic and associated shelter-in-place ordinances passed in the first year of the pandemic rapidly limited access to in-person social interactions, raising concerns of diminishing social support and community cohesion while psychological stressors increased. For LGBTQIA+ people, connectedness to the LGBTQIA+ community is known to buffer against the harmful effects of stressors and decrease risks for poor psychological and behavioral health outcomes. The current study uses qualitative cross-sectional and trajectory analysis methods to characterize how LGBTQIA+ people's perceptions of community connectedness shifted during the first year of the pandemic. A convenience sample of LGBTQIA+-identified people in the U.S. completed an initial online survey in September 2020 (n = 298 and a follow-up survey in September 2021 (n = 129). The survey included changes in connectedness to the LGBTQIA+ community since the pandemic's beginning. Thus, we used both cross-sectional (between-person analyses) and longitudinal trajectory (within-person analyses) qualitative approaches to understanding changes in LGBTQIA+ people's sense of connection to the LGBTQIA+ community across the first two years of the COVID-19 pandemic. Eight cross-cutting themes (related to identity shifts/exploration, disconnection, online connections, and increased awareness of social justice issues) were identified and then organized within each level of the Social-Ecological Model of LGBTQIA+ wellbeing (i.e., the individual-, couple-, interpersonal-, organizational-, community-, and chronosystem- level). Given the importance of social support for LGBTQIA+ wellbeing, more longitudinal research is needed to determine whether these changes persist after the resolution of the acute phase of the pandemic.
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Affiliation(s)
- Angie R Wootton
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Kodiak R S Soled
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jae A Puckett
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - J J Garrett-Walker
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Aaron Perry Hill
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Kevin Delucio
- Fairhaven College of Interdisciplinary Studies, Western Washington University, Bellingham, WA, USA
| | - Cindy B Veldhuis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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Santos CC, de M. Lima FW, Magno L, Soares F, Ferraz D, Grangeiro A, Zucchi EM, Préau M, Mabire X, Matos HRSS, Dourado I. Seroprevalence of anti-SARS-CoV-2 antibodies and factors associated with infection among adolescent men who have sex with men and transgender women in Salvador, Brazil. BMC Public Health 2023; 23:61. [PMID: 36624484 PMCID: PMC9829219 DOI: 10.1186/s12889-022-14969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Brazil was strongly affected by the COVID-19 pandemic and the impact of the pandemic on sexual and gender minorities' youth remains unknown. This study aimed to estimate the seroprevalence of SARS-CoV-2 antibodies and associated factors among adolescent men who have sex with men (AMSM) and transgender women (ATGW) participants of a human immunodeficiency virus (HIV) pre-exposure prophylaxis cohort study (PrEP1519). METHODS This is a cross-sectional design conducted between June and October 2020 in Salvador, Brazil. Serum samples were collected from AMSM and ATGW aged 16-21 years between June-October 2020. IgG and IgM anti-SARS-CoV-2 were detected by chemiluminescence immunoassay, and data were collected through a socio-behavioral questionnaire. RESULTS Among the 137 participants, the seroprevalence of anti-SARS-CoV-2 IgG and IgM was 20.4%; 16.8% of the participants were positive for IgG, and 11.7% for IgM. In the multivariable analysis, the seroprevalence was two times higher among those who never wore masks (OR= 2.22; 95% CI: 1.08-4.57) and among those who believed that they could be easily cured of the disease (OR= 2.05; 95% CI: 1.05-4.01). CONCLUSIONS The high seroprevalence of SARS-CoV-2 antibodies among gender and sexual minority youth seems to be informed by behaviors and attitudes that contrast with public health measures and the potential severity of the disease when vaccination was still not available.
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Affiliation(s)
- Carina C. Santos
- grid.8399.b0000 0004 0372 8259Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
| | - Fernanda W. de M. Lima
- grid.8399.b0000 0004 0372 8259Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
| | - Laio Magno
- grid.442053.40000 0001 0420 1676Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brazil ,grid.8399.b0000 0004 0372 8259Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Fabiane Soares
- grid.8399.b0000 0004 0372 8259Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Dulce Ferraz
- grid.418068.30000 0001 0723 0931Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz, Brasília, Brazil ,Pole of Social Psychology, UMR 1296 Radiations: Défense, Santé, Environnement, Université Lyon 2, Lyon, France ,grid.9851.50000 0001 2165 4204PHASE (Psychology of Health, Aging and Sport Examination), Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Alexandre Grangeiro
- grid.11899.380000 0004 1937 0722Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eliana Miura Zucchi
- grid.412267.40000 0000 9074 7896Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brazil
| | - Marie Préau
- Pole of Social Psychology, UMR 1296 Radiations: Défense, Santé, Environnement, Université Lyon 2, Lyon, France ,grid.9851.50000 0001 2165 4204Institut de Psychologie, Université de Lausanne, Lausanne, Switzerland
| | - Xavier Mabire
- Pole of Social Psychology, UMR 1296 Radiations: Défense, Santé, Environnement, Université Lyon 2, Lyon, France ,grid.9851.50000 0001 2165 4204PHASE (Psychology of Health, Aging and Sport Examination), Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Helen R. S. S. Matos
- grid.8399.b0000 0004 0372 8259Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
| | - Inês Dourado
- grid.8399.b0000 0004 0372 8259Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Chakrapani V, Newman PA, Sebastian A, Rawat S, Mittal S, Gupta V, Kaur M. Mental health, economic well-being and health care access amid the COVID-19 pandemic: a mixed methods study among urban men who have sex with men in India. Sex Reprod Health Matters 2022; 30:2144087. [PMID: 36476183 PMCID: PMC9733688 DOI: 10.1080/26410397.2022.2144087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Scant empirical research from Asia has addressed the impact of COVID-19 on sexual minority health. We aimed to explore and understand the impact of COVID-19 on income security, mental health, HIV risk and access to health services among men who have sex with men (MSM) in India. We conducted a concurrent mixed methods study from April to June 2020, including a cross-sectional survey and in-depth semi-structured interviews with MSM recruited from three non-governmental organisations providing HIV prevention services in Chandigarh, India. We examined the associations of sexual minority stressors (sexual stigma, internalised homonegativity), economic stressors, and stress due to social distancing, with depression and anxiety, HIV risk, and access to health services. Survey findings (n = 132) indicated that internalised homonegativity and stress related to social distancing were significantly associated with depressive and anxiety symptoms. Results also showed reduced access to condoms, HIV testing and counselling services. Qualitative findings (n = 10) highlighted adverse economic impacts of COVID-19, including loss of employment/wages and engaging in survival sex work, which contributed to psychological distress and HIV risk. The COVID-19 pandemic has resulted in considerable psychological and financial distress among low socioeconomic status MSM in India, including those involved in sex work - communities already marginalised in economic, family and healthcare sectors. Structural interventions to improve access to mental health and HIV services and decrease financial burden are critical to mitigate the impact of COVID-19.
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Affiliation(s)
- Venkatesan Chakrapani
- Chairperson, Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India; DBT/Wellcome Trust India Alliance Senior Fellow, The Humsafar Trust, Mumbai, India. Correspondence: ,
| | - Peter A Newman
- Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Aleena Sebastian
- Assistant Professor, National Institute of Advanced Studies (NIAS), Bangalore, India
| | - Shruta Rawat
- Research Manager, The Humsafar Trust, Mumbai, India
| | - Sandeep Mittal
- Deputy Director (Targeted Interventions), Chandigarh State AIDS Control Society (CSACS), Chandigarh, India
| | - Vanita Gupta
- Project Director, Chandigarh State AIDS Control Society (CSACS), Chandigarh, India
| | - Manmeet Kaur
- Professor, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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