"I Can't Take This Shitty Quarantine Anymore": Sexual Behavior and PrEP Use Among Young Men Who Have Sex with Men and Transgender Women in Brazil During the COVID-19 Pandemic

This study analyzes how the COVID-19 pandemic affected sexual behavior and use of HIV prevention methods among young transgender women (YTGW) and young gay, bisexual and other men who have sex with men (YGBMSM) participating in an HIV pre-exposure prophylaxis (PrEP) demonstration study in Brazil. Online interviews with 39 participants aged 15-22 years old were conducted between September and November 2020 and analyzed based on social constructionism and human rights-based approaches to health. The pandemic disrupted interviewees' routines, negatively affecting their life conditions. Among those who did not have a steady partner, social distance measures led to temporary interruption of sexual encounters and increased sexting and solo sex. Conversely, for those who had a steady relationship such measures contributed to increasing sexual practices and intimacy. Participants who had sexual encounters during the pandemic reported having continued to use PrEP. However, home confinement with family, lack of privacy, loss of daily routines and changes in housing impaired PrEP adherence and attendance at follow-up consultations. These results highlight the importance of maintaining HIV-service delivery for these groups during a public health crisis, as well as to address the structural drivers of the epidemic with comprehensive HIV prevention policies and by ensuring access of YGBMSM and YTGW to social protection policies.

Testing, Inequities and Vulnerability of Adolescents to Sexually Transmitted Infections

Sexually transmitted infections (STIs) should form part of the comprehensive healthcare agenda for adolescents and young people (A&Y) and testing plays a strategic role in STI prevention. However, little attention has been paid to the social and programmatic obstacles to this practice among A&Y. The aim of this study is to describe the prevalence of testing for syphilis and HIV reported by a group of A&Y, analyzing its relationship with variables potentially indicative of inequities related to vulnerability to STIs. This was a cross-sectional survey applied to students at public high schools in three cities in the state of São Paulo, Brazil. The responses of 369 young people who reported having started sexual life were analyzed. The analysis included description of the frequencies of demographic and socioeconomic variables and their associations with testing for syphilis and HIV through the chi-square test. The concentration index (CI) was also calculated, with construction of the respective concentration curve for the associated variables. Positive associations were found between occurrence of testing and living in homes with up to three inhabitants, living in a marital situation with a regular or committed partnership, previous use of primary care services and previous use of hospitals or emergency services. The concentration curve for testing STIs showed significant contributions from the associated variables. The findings indicated that situations of inequity need to be addressed in order to reduce A&Y's vulnerability to STIs.

["If you're talking about poor communities, forget it!": (lack of) human rights advocacy for adequate food in primary healthcare]

This study aimed to understand the forms of professional work and proposed actions to achieve the human right to adequate food (HRAF) in the context of primary healthcare (PHC). Using a qualitative approach, the authors conducted semi-structured interviews (from May 2013 to July 2014) with healthcare workers that conducted educational groups on food and nutrition in PHC in the city of São Paulo, Brazil. Content analysis was performed to identify the proposed actions on food, with HRAF as the theoretical basis. We identified three categories of professional work based on the proposed actions for food and nutrition. The first approaches food as a biomedical dimension. The second focuses on access and availability of foods in the territory. The third approaches users' local food reality, centered on the team's work. The proposed actions feature those conducted by individuals with obligations towards HRAF (healthcare workers in PHC) and those performed by rights-holder (users of PHC in the Brazilian Unified National Health System). Food in contexts of poverty is treated as a problem with no solution. This study allowed approximations between "what to do" and "how to act" based on ways of grasping food through the definitions, professional work, and proposed actions to achieve HRAF in PHC. It also allowed elucidating the need to understand food as a human right and strengthening the responsibility of healthcare workers in PHC as duty-bearers towards HRAF in the context of social policies.

Scientific literature on food and nutrition security in primary health care: A scoping review

There is a growing interest in the scientific community regarding Primary Health Care practices aiming at assessing and addressing Food and Nutrition Security. The focus is usually on outcomes, instruments and effectiveness, with no concern regarding theories or concepts. We aimed to map the theoretical frameworks regarding practices towards Food and Nutrition Security in Primary Health Care and describe its conceptualisations based on Ludwik Fleck's epistemological approach. We conducted a scoping review, including 14 databases. Within the 56 publications, the notion of Food and Nutrition Insecurity as a risk for health without further theorisations predominates. Other two minor theoretical frameworks coexist: Food and Nutrition Security as a social determinant of health and as the realisation of a human right. Few publications present Food and Nutrition Security conceptualisations. Of those who define it, there is great variability in the content and sources used. The most elaborated and homogenous conceptualisations are in the human rights group. This review exposes how the disputes surrounding a concept mostly built on policy and international relations penetrate the scientific field. When studying topics in the interface between science and health practices, notably those where controversies exist, researchers should explicitly express their theoretical and conceptual backgrounds.

[Can primary health care strengthen the right to adequate food as a human right in Latin America?¿Cómo la atención primaria de salud puede fortalecer la alimentación adecuada como derecho en América Latina?]

Forty years ago, the Declaration of Alma-Ata emphasized health as a human right, introduced primary health care (PHC) as a strategy to attain an acceptable level of health for all, and included the issue of food and nutrition as an integral part of PHC. The right to adequate food (RAF) is closely related to the right to health, since it is essential to ensure dignified living conditions that promote health. The historical peculiarities and the political and economic position of Latin America constitute barriers for the full realization of human rights, and especially social rights. In this sense, the present article aims to explore the modes by which PHC services can leverage the RAF in Latin America. In addition, the article describes measures that exemplify how countries can strengthen RAF through PHC. Finally, the text seeks to recover the emancipatory potential of PHC through a vision of human rights enforcement beyond the right to health. The overview shows that PHC has the capacity to fulfill human rights that are interdependent on health in the Latin American context.

["So I have no way of measuring": a portrait of health education groups in the city of São Paulo, Brazil]

: The study analyzed the social representations of primary health care professionals on evaluative processes of groups that work with food and nutrition, and described the educational strategies used in this care. This was a qualitative study from 2012 to 2014 in the city of São Paulo, Brazil, in which 48 interviews were analyzed. In the analysis of the interviews, for classification of the educational strategies in learning categories and contents, Bogdan & Biklen and Zabala were used, respectively. The evaluative processes used the collective subject discourse technique, based on Jodelet's social representations. Three learning contents were found in the educational strategies and four social representations of the evaluative processes which combined to reveal the presence of a conflict by a practice directed by the work process to quantitative and individual evaluative criteria and a health-promoting practice that used inclusive approaches and participant evaluation. In this practice, the study implicitly identified the presence of autonomy in health. The study revealed the need to acknowledge and systematize group planning as an educational tool that qualifies and empowers comprehensive care.

Pedagogical techniques in food and nutrition groups: the backstage of choice process

Resumo O estudo objetivou compreender as representações sociais dos profissionais de saúde que explicam a escolha de estratégias pedagógicas para o desenvolvimento de grupos educativos com o tema alimentação e nutrição, como espaços de promoção da saúde, na Atenção Primária à Saúde (APS). Pesquisa qualitativa, realizada por meio de observação sistemática de um encontro de cada grupo acessado e entrevista semiestruturada com os respectivos coordenadores das ações. Na análise, utilizou-se a técnica do Discurso do Sujeito Coletivo (DSC), fundamentada na Teoria das Representações Sociais. Foram gerados seis DSC, mostrando que a escolha das estratégias pedagógicas é feita considerando: a valorização da participação coletiva; o perfil da população; o acesso a recursos audiovisuais; a praticidade para os profissionais; a disponibilidade de recursos humanos; e o uso da experiência corporal. Fica evidente que as decisões sobre o uso de estratégias pedagógicas são influenciadas pelo contexto, relações de trabalho e instituição, além das próprias crenças e conhecimentos dos profissionais de saúde. A abordagem da alimentação e nutrição em grupos educativos como espaços promotores de saúde está inserida numa APS complexa, que envolve elementos estruturais, além das políticas públicas.