Awareness of Prevention Strategies and Willingness to Use Preexposure Prophylaxis in Brazilian Men Who Have Sex With Men Using Apps for Sexual Encounters: Online Cross-Sectional Study

Torres, Thiago Silva; Boni, Raquel Brandini De; Vasconcellos, Mauricio Tl; Luz, Paula M.; Hoagland, Brenda; Moreira, Ronaldo I.; Veloso, Valdiléa G.; Grinsztejn, Beatriz

doi:10.2196/publichealth.8997

Cited by 49 publications

(63 citation statements)

References 77 publications

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“…PrEP awareness has been previously shown to be associated with older age, higher education, and higher income among those from Brazil (28)(29)(30). These findings held true in our study.…”

Section: Discussionsupporting

confidence: 89%

“…Daily use of GSN apps to find sex partners was positively associated with PrEP awareness in Brazil. Agreeing with other literature, this finding shows that GSN applications may be used as a platform to spread awareness of PrEP and education (29,41,42). Exposure to PrEP information in GSN applications may occur through advertisements or in users' profiles where they indicate PrEP use (41,43).…”

Section: Discussionsupporting

confidence: 75%

“…As seen in previous studies, willingness to use PrEP is strongly associated with awareness (27)(28)(29)35).…”

Section: Discussionsupporting

confidence: 69%

“…Our exposure of interest was higher risk for HIV acquisition defined using the United States' Centers for Disease Control and Prevention's (CDC) MSM risk index score defined by the suggested cut-point of 10 for increased risk of HIV infection (36). Cocaine was used in addition to methamphetamine as methamphetamine use was virtually non-existent in our study population (29,30).…”

Section: Variable Definitions and Categorizationmentioning

confidence: 99%

“…It was concluded that efforts to raise awareness of PrEP and HIV risk perception among younger and less educated MSM and TGW need to be increased (27). Factors previously shown to be associated with PrEP awareness in Brazil included older age, more years of education, higher income, having more friends with the same sexual orientation, marijuana use, having an HIV positive partner, having more than 5 partners in the previous 6 months, and ever having an HIV test (28)(29)(30). In Peru, PrEP awareness was assessed in focus groups with Peruvian MSM, TGW, and female sex workers; respondents in all three groups indicated little to no knowledge or awareness of PrEP (31).…”

Section: Introductionmentioning

confidence: 99%

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PrEP awareness among men who have sex with men at higher risk for HIV in Brazil, Mexico, and Peru, 2018

Assaf

Konda²,

Torres

et al. 2019

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IntroductionPrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting low awareness. We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among men who have sex with men (MSM) from these countries. MethodsMSM were recruited to complete an online survey via advertisements on Facebook, Grindr, and Hornet from March-June 2018. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, lived in these countries, and provided informed consent. Higher risk was defined using a CDC score indicating an increased risk of HIV infection and the suggested cutpoint of 10. We used Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk and PrEP awareness; socio-demographics and other risk variables were considered potential confounders. Separate models were conducted for Brazil, Mexico, and Peru. ResultsAfter exclusion, 19,457 MSM were available for analysis. Overall PrEP awareness was 64.9%, with those from Brazil reporting highest awareness (68.8%), followed by Mexico (64.1%), and Peru (46.6%). In Brazil, 53.8% were classified as higher risk for HIV, 51.9% in Mexico, and 54.2% in Peru. Higher risk for HIV was associated with PrEP awareness among those in Brazil (aPR 1.04, 95% CI 1.01, 1.06), but no association was seen in Mexico or Peru. Additionally, having more than high school education, high income, daily use of gay social networking (GSN) applications, and substance use were associated with PrEP awareness in each country. ConclusionHigher risk of HIV infection was associated with increased PrEP awareness in Brazil. However, this association was weak indicating that MSM at higher risk, who would benefit from PrEP, are often not aware of this prevention strategy. In the remaining countries, there was no association between risk and awareness, highlighting a disconnect between need and knowledge. As PrEP is introduced, awareness should increase, as in Brazil where PrEP has been available longer. Interventions to increase PrEP awareness are paramount to increase PrEP uptake and prevent HIV infections. GSN applications and social media could play an important role to achieve this goal.

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“…PrEP awareness has been previously shown to be associated with older age, higher education, and higher income among those from Brazil (28)(29)(30). These findings held true in our study.…”

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 75%

“…As seen in previous studies, willingness to use PrEP is strongly associated with awareness (27)(28)(29)35).…”

Section: Discussionsupporting

confidence: 69%

Section: Variable Definitions and Categorizationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

PrEP awareness among men who have sex with men at higher risk for HIV in Brazil, Mexico, and Peru, 2018

Assaf

Konda²,

Torres

et al. 2019

Preprint

Self Cite

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Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries

et al. 2019

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Introduction There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. Methods Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV‐positive partners had viral load (VL) tested; HIV‐negative partners reported sexual behaviour and perceptions of their HIV‐positive partner's VL results. Within‐couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom‐protected, biomedically protected (undetectable VL and/or pre‐exposure prophylaxis [PrEP]), or not protected by either (HIV‐negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). Results A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three‐quarters of HIV‐positive partners were consistently virally suppressed (<200 copies/mL) during follow‐up, and HIV‐negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One‐third of HIV‐negative partners used daily PrEP during follow‐up. Over follow‐up, 73.8% of couples had CLAI. HIV‐negative partners reported 31,532 acts of anal intercourse with their HIV‐positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom‐protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two‐thirds (n = 983) were when the HIV‐negative partner was insertive (strategic positioning). Of the 490 acts when the HIV‐negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. Conclusions Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.

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Impact of COVID-19 Pandemic on Sexual Minority Populations in Brazil: An Analysis of Social/Racial Disparities in Maintaining Social Distancing and a Description of Sexual Behavior

et al. 2020

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We conducted a web-based survey to understand the impact of social distancing measures on Brazilian MSM and transgender/non-binary lives. A total of 3486 respondents were included in this analysis and the great majority were cismen (98%). The median age was 32 years (IQR: 27–40), 44% non-white, 36% low schooling and 38% low income. Most of participants reported HIV negative/unknown status (77%). Participants on-PrEP reported more condomless anal sex than those off-PrEP. Conversely, 24% off-PrEP were at substantial HIV-risk. PrEP/ART continuation were reported by the majority, despite reports of impediments to medication refill. Transgender/non-binary reported more mental health problems and challenges to access health care. Social and racial disparities were associated with unattainability of maintaining social distancing. Tailored social and economic support policies during COVID-19 pandemic should be made available to these populations. Challenges for PrEP/ART access will demand the implementation of innovative solutions to avoid the expansion of the HIV epidemic.

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Awareness of Prevention Strategies and Willingness to Use Preexposure Prophylaxis in Brazilian Men Who Have Sex With Men Using Apps for Sexual Encounters: Online Cross-Sectional Study

Cited by 49 publications

References 77 publications

PrEP awareness among men who have sex with men at higher risk for HIV in Brazil, Mexico, and Peru, 2018

PrEP awareness among men who have sex with men at higher risk for HIV in Brazil, Mexico, and Peru, 2018

Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries

Impact of COVID-19 Pandemic on Sexual Minority Populations in Brazil: An Analysis of Social/Racial Disparities in Maintaining Social Distancing and a Description of Sexual Behavior

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