Homicide of Lesbians, Gays, Bisexuals, Travestis, Transexuals, and Transgender people (LGBT) in Brazil: a Spatial Analysis

Religious Affiliation, Internalized Homonegativity and Depressive Symptoms: Unveiling Mental Health Inequalities among Brazilian Gay Men

INTRODUCTION

Different religious narratives associate same-sex sexuality, in its various manifestations, with moral deviation or sin. Gay men who are socialized in more religious communities appear to experience and internalize greater levels of homonegativity, as well as to present greater indicators of depressive symptoms. The purpose of this study was to evaluate indicators of perceived homonegativity in the community and internalized, and signs/symptoms of depression reported by Brazilian gay men with a nominal religion and compare them to those reported by Atheists or Agnostics.

METHOD

Our sample comprised 194 Brazilian gay men, distributed into three groups: Christians (Protestants and Catholics, n = 71; 36.6%); Spiritualists (Kardecists or religions of African origin, n = 52; 26.8%) and Atheists or Agnostics (n = 71; 36.6%). The following measurement instruments were used: sociodemographic questionnaire, Internalized Homophobia Scale and Beck Depression Scale.

RESULTS

High mean scores of depression were verified in all groups, and 60% of the sample presented some level of depression. There was a higher level of self-reported homonegativity among Christians and Spiritualists compared to that reported by Atheists or Agnostics, with the differences between the groups being significant. The regression analysis indicated a significant effect of religion on homonegativity, but not on depression.

CONCLUSION

Our results suggest that gay men's chronic exposure to non-affirming religious affiliation contexts may harm the construction of a positive gay identity and should be taken into consideration when addressing mental health inequalities of sexual minorities.

Theoretical-methodological essay on gender identity information validity in epidemiological surveillance of violence

The inclusion of the "gender identity" field in the Brazilian violence surveillance system, although representing a step forward, still has limitations that may compromise epidemiological data validity. Existing response options for victims' identities do not adequately cover the diversity of this analysis category, resulting in classification biases. Additionally, the absence of options for cisgender identities reflects an approach that naturalizes these identities, while trans identities are considered deviant and subject to surveillance. To overcome these limitations, it is imperative to adopt a broader understanding of gender as a social and performative construction. This requires a reassessment of social structures and data collection instruments. In this context of discussion, this theoretical-methodological essay aims to reflect on gender identity measurement in the Reporting Diseases System interpersonal and self-inflicted violence surveillance system, taking as frameworks the theoretical conceptions about gender as a performative act and the foundations of validity in epidemiological investigations.

Mortality rates by gender and sexual orientation reveal a disproportionally high mortality among cisgender men of unknown sexual orientation and men who have sex with women in a cohort of people living with HIV in Rio de Janeiro, Brazil

BACKGROUND

Antiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation.

METHODS

We included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models.

RESULTS

Among 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35-3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different.

CONCLUSION

We observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population.

The Dandarah App: An mHealth Platform to Tackle Violence and Discrimination of Sexual and Gender Minority Persons Living in Brazil

Discrimination and violence are widely experienced by sexual and gender minority (SGM) persons worldwide. More than one SGM person is murdered every day in Brazil because of their sexuality or gender identity, which is the highest reported homicide rate in the world. Alt-hough discrimination and violence against SGM persons in Brazil are considered to be hate crimes, reporting is still suboptimal due to fear of police SGM phobia and victim blaming. Accessible and easily disseminated interventions are urgently needed. Herein, we describe the develop-ment of an mHealth solution to help address violence against SGM persons, namely the Rainbow Resistance: Dandarah App, with a synthesis of key results and feedback from the SGM community after 24 months of using the app. Twenty-two focus group discussions (FGDs) were conducted with SGM persons living in six Brazilian states: Bahia, Federal District, São Paulo, Rio de Janeiro, Minas Gerais, Sergipe, and Pará. A total of 300 SGM persons participated in the FGDs. A thematic analysis was performed to interpret the qualitative data. Content themes related to aesthetics, us-ability, barriers to resources, and likes/dislikes about the intervention arose from the FGDs. Participants found the intervention to be user-friendly, endorsed more likes than dislikes, and suggested a few changes to the app. The findings suggest that the intervention is usable and fit for future ef-fectiveness testing, and that it could fill an important gap in the well-being of SGM persons living in a country with high levels of discrimination and violence towards this community, i.e., Brazil.

Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study

Introduction

The HIV epidemic continues to disproportionately impact Latin‐American transgender women (TGW). We assessed factors associated with long‐term pre‐exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America.

Methods

HIV‐negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow‐up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long‐term PrEP engagement (3+ follow‐up visits in 52 weeks) and complete self‐reported adherence (no missed pills in the past 30 days) during follow‐up. For both outcomes, we constructed multivariable models controlling for country, socio‐demographics, sexual behaviour, substance use, STIs and self‐reported adherence at 4 weeks (long‐term engagement outcome only).

Results

From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed‐race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person‐years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long‐term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown‐HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self‐reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP‐related adverse effects (aOR:0.63 [95%CI:0.42–0.92]).

Conclusions

Although TGW were willing to enrol in ImPrEP, long‐term PrEP engagement and complete self‐reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans‐specific interventions supporting oral PrEP and exploring long‐acting PrEP strategies for TGW.

HIV epidemic among Brazilian women who have sex with women: An ecological study

The influences of public policies fighting HIV among women who have sex with women is scarcely studied. This study aimed to analyse the time series of human immunodeficiency virus (HIV) epidemic, between 2007 and 2020, among Brazilian women who have sex with women, in order to evaluate the effect of Brazilian policies for fighting HIV in this subpopulation compared to women who have sex with men (WSM). This ecological study employed HIV and acquired immunodeficiency syndrome (AIDS) new cases among women who have sex strictly with women (WSW), women who have sex with men and women (WSMW), and WSM reported to the Sistema de Informação de Agravos de Notificação from 2007 to 2020. Crude Brazilian and regional annual age-adjusted HIV/AIDS population-level incidence rates were calculated for WSW, WSMW and WSM. The rates were then analyzed using the Joinpoint regression model. A total of 102,890, 757, and 1,699 notifications of WSW, WSMW, and WSM living with HIV/AIDS were reported during the study period, respectively. South Brazilian region had the greatest HIV/AIDS incidence rates among WSM and bisexual women while the North region had the greatest incidence among WSW. In the WSM population, the temporal trends showed at least one stable or an increasing trend period from 2007 to 2013 or 2014, followed by one decreasing trend in all Brazilian regions. While among the WSMW most of the regions had a stable trend period from 2007 to 2020, in WSW group most of the trends had only one decreasing period. The decreasing trends were faster in WSM than in WSW. These results suggest a low efficiency of Brazilian policies for fighting HIV among WSW and WSMW and show the necessity of implementing new policies specific to this population.

Proportion of ALGBT adult Brazilians, sociodemographic characteristics, and self-reported violence

Asexual, lesbian, gay, bisexual, and trans (ALGBT) individuals face worse life conditions and violence rates than their heterosexual cisgender counterparts. Brazil is often highlighted for having one of the highest rates of hate-related homicides against ALGBTs in the world. However, to date, Brazil's ALGBT population has not been investigated with a representative sample, and basic information such as population size or sociodemographic characteristics are mostly based in non-systematic data. We aimed to assess the proportion of asexual, lesbian, gay, bisexual, trans and non-binary adults in Brazil, their sociodemographic characteristics, and self-reported violence rates. In 2018, a sample (n = 6000) of the Brazilian adult population answered a face-to-face survey assessing sociodemographic characteristics, gender identity, sexual orientation, and self-reported psychological, physical, verbal, and sexual violence. Among Brazilian adults, 12.04% are ALGBT: 5.76% asexual, 0.93% lesbian, 1.37% gay, 2.12% bisexual, 0.68 trans, and 1.18% non-binary. Compared to heterosexual cisgender men, most ALGBT individuals have worse socioeconomic indicators and higher rates of self-reported psychological and verbal violence. All ALGBT groups and heterosexual cisgender women reported sexual violence more often than heterosexual cisgender men. It was reported between 4 up to 25 times more often by heterosexual cisgender women and trans individuals, respectively. The rates of the other ALGBT groups sit among the two. Our findings provide evidence of the important size of the ALGBT Brazilian population, as well as their socioeconomic vulnerability, and concerning violence levels experienced by the group. Policy makers may refer to the present article in order to mitigate this population's vulnerability and to better understand its sociodemographic characteristics.

Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004-2015: a persisting problem

BACKGROUND

Global mortality from AIDS-related diseases has been declining since 2005, resulting primarily from the widespread use and early initiation of combination antiretroviral therapy. Despite the significant improvements, high rates of early mortality, usually defined as that occurring within the 1st year of entry to care, have been observed, especially in resource-limited settings. This analysis draws upon data from an observational cohort of people with HIV (PWH) followed at a reference center for HIV/AIDS care and research in the city of Rio de Janeiro, Brazil, to identify the pattern and factors associated with early mortality.

METHODS

The study population includes PWH aged 18 or older followed at the National Institute of Infectious Diseases Evandro Chagas who were enrolled between 2004 and 2015. The primary outcome was early mortality, defined as deaths occurring within 1 year of inclusion in the cohort, considering two follow-up periods: 0 to 90 days (very early mortality) and 91 to 365 days (early mortality). Cox proportional hazards models were used to identify the variables associated with the hazard of very early and early mortality.

RESULTS

Overall, 3879 participants contributed with 3616.4 person-years of follow-up. Of 220 deaths, 132 happened in the first 90 days and 88 between 91 and 365 days. Very early mortality rate ratios (MRR) show no statistically significant temporal differences between the periods 2004-2006 to 2013-2015. In contrast, for early mortality, a statistically significant decreasing trend was observed: mortality rates in the periods 2004-2006 (MR = 5.5; 95% CI 3.9-7.8) and 2007-2009 (MR = 3.9; 95% CI 2.7-5.7) were approximately four and three-fold higher when compared to 2013-2015 (MR = 1.4; 95% CI 0.7-2.7). Low CD4 count and prior AIDS-defining illness were strongly associated with higher hazard ratios of death, especially when considering very early mortality.

CONCLUSIONS

The present study shows an excess of mortality in the 1st year of follow-up with no changes in the mortality rates within 90 days among PWH from Rio de Janeiro. We note the significant impact of initiating treatment with immunosuppression, as evidenced by the increased risk of death among those with low CD4 cell count and with AIDS-defining illnesses.

Experiências de médicos de família e comunidade no cuidado com a saúde de pacientes lésbicas, gays, bissexuais, travestis e transexuais

Introdução: A comunidade lésbicas, gays, bissexuais, travestis e transexuais e suas particularidades associadas à saúde foram ignoradas por muitos anos. Embora a homossexualidade e a transexualidade não sejam mais consideradas doenças, ainda prevalece marginalização de muitas pessoas lésbicas, gays, bissexuais, travestis e transexuais a nível sócio-econômico-cultural e de acesso aos serviços de saúde. No que tange ao acesso à saúde, o primeiro contato do paciente Lésbicas, Gays, Bissexuais, Travestis e Transexuais dentro do sistema de saúde pode ser através do médico de família e comunidade. Objetivo: Analisar as experiências dos médicos de família e comunidade no atendimento às pessoas lésbicas, gays, bissexuais, travestis e transexuais na atenção básica da rede municipal de saúde em uma cidade no Sul do Brasil. Métodos: Desenvolveram-se dois grupos focais (13 profissionais no total), um deles constituído de seis médicos de família e comunidade autodeclarados heterossexuais e cisgêneros e outro grupo constituído de sete médicos de família e comunidade autodeclarados lésbicas, gays, bissexuais, travestis e transexuais, em julho de 2019. Resultados: Os participantes consideraram importante a temática da saúde lésbicas, gays, bissexuais, travestis e transexuais na atenção primária, embora ela tenha sido pouco explorada nos seus cursos de graduação. Relataram que as principais demandas dos pacientes lésbicas, gays, bissexuais, travestis e transexuais são as de saúde mental, violência e infecções sexualmente transmissíveis. Apontaram que possuem dificuldades em abordar questões que envolvem sexualidade e identidade de gênero em suas consultas. Conclusões: Os resultados reforçam a necessidade de os médicos de família e comunidade conhecerem especificidades da população lésbicas, gays, bissexuais, travestis e transexuais. Sugere-se que a temática da saúde da população lésbicas, gays, bissexuais, travestis e transexuais seja mais ensinada nos cursos de graduação em Medicina.

Symbolic violence in undergraduate LGBT students’ experiences

Abstract Since childhood, symbolic violence has been a process experienced by LGBT people facing the sanctions of hegemonic heteronormativity. University is a space of possibility and change for many people, with a particular expectation: of greater openness to moral plurality and, thus, diversity. This article investigates experiences of symbolic violence, and the contours of the habitus lived by LGBT university students, by using unstructured interviews with 16 students, analyzed from the theoretical framework of Bourdieu. Symbolic violence was present in all their lives, showing itself in different environments and institutions, including the university academic life, but mostly on their family and school life. Facing impositions of the heterosexual habitus, individuals develop resources, with the acquisition of social capital, such as LGBT militancy, standing out. However, the university needs to concretize specific actions to face violence and respect diversity, considering its role as an institution socially responsible for the education of citizens on top of professionals. This is a challenge already present in the definition of the ethical-political university agenda, that becomes even more complex in times of struggle for the very maintenance of the democratic system in the Brazilian State.

Violência simbólica na experiência de estudantes universitários LGBT

Resumo Desde a infância, a violência simbólica é um processo vivenciado por pessoas LGBT diante das sanções da heteronormatividade hegemônica. A universidade se constitui como espaço de possibilidade e mudança para muitas pessoas, com uma expectativa em particular: a de maior abertura à pluralidade moral e, portanto, à diversidade. Este artigo investiga as experiências de violência simbólica e os contornos do habitus vividos por universitários LGBT, por meio de entrevistas não estruturadas com 16 estudantes analisadas a partir do arcabouço teórico de Bourdieu. A violência simbólica se mostrou presente na vida de todos, se manifestando em diversos ambientes e instituições, inclusive na vida acadêmica universitária, mas principalmente na vida familiar e escolar. Diante das imposições do habitus heterossexual, os indivíduos desenvolvem diversos recursos, com destaque para a aquisição de capital social, como a militância LGBT. No entanto, a universidade precisa concretizar ações específicas de enfrentamento às violências e de respeito à diversidade, considerando seu papel como instituição socialmente responsável pela educação de cidadãos para além de profissionais. Esse é um desafio já presente na definição da agenda ético-política universitária, que se torna ainda mais complexo em tempos de luta pela própria manutenção do sistema democrático no Estado brasileiro.

Systematic review of the characteristics of LGBT homicides

The lesbian, gay, bisexual and transgender (LGBT) population has long been excluded, a reality produced by social marginalization, which is still present in today's society. This article aims to present a quantitative profile of LGBT homicides, focusing on the crimes, victims, and perpetrators. We conducted a systematic review of quantitative studies on LGBT homicide using the following databases: PubMed Central (Medline), Latin American and Caribbean Center for Health Sciences Information (LILACS), Embase (Elsevier), Scopus (Elsevier), the Virtual Health Library (BVS), and APA PsycNet. The searches were run using terms taken from the Medical Subject Headings (MESHs) and Health Sciences Descriptors (DeCS - BVS). Sixteen studies were included. Homicides tended to involve a single victim and single perpetrator and occur at the victim's residence or in public locations. Victims were more likely to be older than the perpetrator and offenders were usually unknown to the victim. Transgender people were the most affected group and most of the victims in this group were aged under 30 years. The findings of this review confirm that LGBT homicides may be considered "hate crimes" and that victims are generally killed with firearms or non-firearms, beaten to death or suffocated.

[Trend, spatialization and circumstances associated with violence against vulnerable populations in Brazil, between 2009 and 2017]

The scope of this study was to analyze the trend, spatialization and circumstances associated with violence against vulnerable populations in Brazil between 2009 and 2017. Descriptive analysis, spatialization and polynomial regression were used. A total of 1,116,331 cases of violence were notified, with an increase of 667.5% over the period. In all populations under research there was a predominance of physical violence against women with low levels of schooling, perpetrated by men in residences. Sexual and psychological violence was highlighted in female and LGBT populations. Negligence, however, was significant among people with disabilities, children/adolescents, and the elderly. At least 65% of the notifications of violence in Brazil were characterized as indiscriminate regarding the motivation behind the act. Tendency analysis showed a rise of interpersonal violence against women (+8.5%), disabled people (+7.1%), elderly individuals (+55.4%), natives (+99.4%), LGBT people (+3.4%) and racial violence (+30.2%), except for violence against underaged individuals, which showed a decrease (-11.4%). In North and Northwest regions violence against women and underaged individuals prevailed, while in Midwest, South and Southeast regions the LGBT, disabled and elderly populations were most subject to abuse.