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Magno L, Soares F, Zucchi EM, Eustórgio M, Grangeiro A, Ferraz D, Greco D, Escuder MM, Dourado I. Reaching Out to Adolescents at High Risk of HIV Infection in Brazil: Demand Creation Strategies for PrEP and Other HIV Combination Prevention Methods. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:703-719. [PMID: 35876978 PMCID: PMC9310684 DOI: 10.1007/s10508-022-02371-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Using baseline data from the PrEP1519 cohort, in this article we aimed to analyze: (i) the effectiveness of demand creation strategies (DCS) to enroll adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) into an HIV combination prevention study in Brazil; (ii) the predictors of DCS for adolescents' enrollment; and (iii) the factors associated with DCS by comparing online and face-to-face strategies for enrollment. The DCS included peer recruitment (i.e., online and face-to-face) and referrals from health services and non-governmental organizations (NGOs). AMSM and ATGW who agreed to participate in the study could opt to enroll in either PrEP (PrEP arm) or to use other prevention methods (non-PrEP arm). Bivariate and multivariate analyses were conducted and logistic regression odds ratios were estimated. The DCS reached 4529 AMSM and ATGW, the majority of which were derived online (73.8%). Of this total, 935 (20.6%) enrolled to participate (76.6% in PrEP arm and 23.4% in non-PrEP arm). The effectiveness of enrolling adolescents into both arms was greater via direct referrals (235/382 and 84/382, respectively) and face-to-face peer recruitment (139/670 and 35/670, respectively) than online (328/3342). We found that a combination under DCS was required for successful enrollment in PrEP, with online strategies majorly tending to enroll adolescents of a higher socioeconomic status. Our findings reinforce the need for DCS that actively reaches out to all adolescents at the greatest risk for HIV infection, irrespective of their socioeconomic status.
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Affiliation(s)
- Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula41.150-000, Salvador, Bahia, Brazil.
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia e Políticas Públicas, Universidade Católica de Santos, São Paulo, Santos, Brazil
| | - Marcos Eustórgio
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Alexandre Grangeiro
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Dulce Ferraz
- Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz, Brasília, Distrito Federal, Brazil
| | - Dirceu Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Abstract
Sexually transmitted infections are increasing in Brazilian adolescents and youth. The aim of this study was to investigate the association of self-esteem, self-efficacy, and other psychosocial variables with condom use behavior and sexual debut in a sample of adolescents from Santa Maria-RS. Data was collected with 452 adolescents (57% girls), mean age of 15.9 years (SD = 1.4), using the Brazilian Youth Questionnaire – Phase II. Condom use behavior was not associated with self-esteem or self-efficacy in the logistic regression model, contrary to the main hypothesis. General self-efficacy was positively associated with sexual debut, while religiosity was negatively associated with this outcome. Family support was associated with older age at sexual debut. The findings support the importance of analyzing different sexual behaviors separately, as they may have distinct predictors. Studies should use specific measures of self-efficacy when studying sexual behavior and measure how participants value different sexual behaviors.
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Paiva V, Garcia MRV, França-Jr I, da Silva CG, Galeão-Silva LG, Simões JA, Ayres JR. Youth and the COVID-19 crisis: Lessons learned from a human rights-based prevention programme for youths in São Paulo, Brazil. Glob Public Health 2021; 16:1454-1467. [PMID: 33870865 DOI: 10.1080/17441692.2021.1916055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Youths living in crowded impoverished urban areas face higher risk of infection by SARS-CoV-2. This article presents lessons learned from a preventive intervention project intersected by the COVID-19 crisis that moved from a mix-methods study design to online ethnography. The 'home-officed' research team e-witnessed high-school students' daily lives and collaborated in youths' and community-based organisations' responses in the territories where they study and live. Psychosocial distress increased, also driven by the disastrous governmental response to the health and economic crises. There was growing anxiety about meeting friends and dating, with structural limits for sustaining the recommended social distancing, which added to gender/sexuality-based violence. Simultaneously, we observed students becoming relevant actors through co-producing preventive practices, surpassing risk-group notions and combining SARS-CoV-2 prevention with sexuality, gender, racism and mental-health issues. They managed internet-mediated applications to promote critical thinking and collective actions aimed at health promotion among their peers, from their homes. Freire's concept of 'untested-feasibility' fostered researchers', students' and community leaders' imaginations in the face of this unprecedented crisis, thereby enhancing social responses to the epidemic to become rights-based comprehensive dialogical preventive activities. This ongoing intervention-research stresses how prevention sciences can go beyond reduction of this pandemic to a viral event.
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Affiliation(s)
- Vera Paiva
- Social Psychology, University of São Paulo (USP), São Paulo-SP, Brazil
| | - Marcos R V Garcia
- Human Sciences and Education, Federal University of São Carlos (UFSCar), Sorocaba, Brazil
| | - Ivan França-Jr
- School of Public Health, University of São Paulo (USP), São Paulo, Brazil
| | | | - L G Galeão-Silva
- Social Psychology, University of São Paulo (USP), São Paulo-SP, Brazil
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- Social Psychology, University of São Paulo (USP), São Paulo-SP, Brazil
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