How heterogeneous are MSM from Brazilian cities? An analysis of sexual behavior and perceived risk and a description of trends in awareness and willingness to use pre-exposure prophylaxis

Abstract

Background: Brazil has the largest population of individuals living with HIV/AIDS in Latin America, with a disproportional prevalence of infection among gays, bisexuals and other men who have sex with men (MSM). Of relevance to prevention and treatment efforts, Brazilian MSM from different regions may differ in behaviors and risk perception related to HIV. Methods: We report on MSM living in 29 different cities: 26 Brazilian state capitals, the Federal District and two large cities in São Paulo state assessed in three web-based surveys (2016-2018) advertised on Grindr, Hornet and Facebook. Using logistic regression models, we assessed the association of risk behavior with HIV perceived risk as well as factors associated with high-risk behavior. Results: A total of 16,667 MSM completed the survey. Overall, MSM from the North and Northeast were younger, more black/mixed-black, of lower income and lower education compared to MSM from the South, Southeast and Central-west. Though 17% had never tested for HIV (with higher percentages in the North and Northeast), condomless receptive anal sex (previous 6 months) and high-risk behavior as per HIV Incidence Risk scale for MSM were observed for 41 and 64%, respectively. Sexual behavior and HIV perceived risk had low variability by city and high-risk behavior was strongly associated with high HIV perceived risk. Younger age, being gay/homosexual, having a steady partner, binge drinking, report of sexually transmitted infection (STI) and ever testing for HIV were associated with increased odds of high-risk behavior. Awareness and willingness to use PrEP increased from 2016 to 2018 in most cities. Conclusions: Overall, MSM socio-demographic characteristics were heterogeneous among Brazilian cities, but similarities were noted among the cities from the same administrative region with a marked exception of the Federal District not following the patterns for the Central-West. Combination HIV prevention is most needed among young men who self-identify as gay/homosexual, report binge drinking or prior STI.

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

“…The question “In your opinion, what is your risk of getting HIV during social distancing period?”, which had five possible options (“No risk”, “Low risk”, “Moderate risk/50%”, “High risk”, and Certain/100%”), assessed the HIV perceived risk. We categorized that variable into three groups: “No risk”, “Low risk”, and “High risk” (which included the categories “Moderate risk/50%”, “High risk” and “Certain/100%”), as previously described [ 18 ].…”

“…Variables were included in the adjusted model regardless of significant p-value thresholds in univariate analysis. To build the model, race was dichotomized into white/Asian vs. non-white (black/mixed-black/native), and country region was dichotomized into Southeast/South vs. other, following previous study conducted among Brazilian MSM [ 18 ]. Analyses were performed using Software R version 4.0.0 [ 19 ].…”

High rates of unprotected receptive anal sex and vulnerabilities to HIV infection among Brazilian men who have sex with men

“…For this reason, we chose the relevant variables according to the scientific literature on the subject. 2,6,8,16,17…”

“…As HIV has an heterogeneous epidemiological pattern and distribution - that is, the trends vary depending on the country analyzed - infection reduction, prevention, and control should be performed according to the epidemiological pattern of infection of each country. 2,3…”

“…Brazil is culturally diverse and has unequal rates of inequality and significantly wide-ranging sexual behaviors and risk perceptions among MSM, 2 which has considerable implications for facing the country’s epidemic.…”