"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

Abstract

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.

Seroprevalence of anti-SARS-CoV-2 antibodies and factors associated with infection among adolescent men who have sex with men and transgender women in Salvador, Brazil

“…Considering the widespread denialist discourses on the seriousness of COVID-19, especially from the Brazilian Federal Government [ 16 ], it is possible to hypothesize that gender- and sexuality-diverse youth could have dealt with conflicting messages about the pandemic. In addition, an increase in psychological distress due to home confinement, family conflicts, and restriction of social circles was observed during this time [ 15 ]. Therefore, the ability to manage self-care and protect from COVID-19 may have been hindered even in the presence of high knowledge and adherence to some protection measures [ 15 ].…”

“…In addition, an increase in psychological distress due to home confinement, family conflicts, and restriction of social circles was observed during this time [ 15 ]. Therefore, the ability to manage self-care and protect from COVID-19 may have been hindered even in the presence of high knowledge and adherence to some protection measures [ 15 ].…”

“…Studies have indicated that adult MSM in Brazil, during the first year of the pandemic (2020), had difficulty complying with social isolation measures and engaged in sexual encounters with multiple partners [ 12 – 14 ]. Among adolescent MSM and TGW, it has been shown that the pandemic disrupted important dimensions of their life conditions and affected sexual and preventive behaviors [ 15 ]. Another study conducted with TGW in India, highlighted the lack of adequate knowledge, perceptions of low risk and non-adherence to COVID-19 prevention measures, and fear of declaring disease-related symptoms [ 9 ].…”

Exploring Stigma, Resilience, and Alternative HIV Preventive Service Delivery Among Young Men who Have Sex with Men of Color

“…Future research and programs need to address structural stigmatization and discrimination experienced by YMSM of color so that inequities they already experienced do not widen the gaps in HIV prevention outcomes that we have already seen during COVID-19 (Ferraz et al, 2023; Maragh-Bass et al, 2022). Multilevel interventions and solutions should focus on resilience-affirming care and destigmatizing approaches which could include (a) include remote telehealth PrEP navigators employed at the regional level to assist clients with LAI PrEP medication assistance programs; (b) stigma-informed LGBTQ health training mandates for providers who care for YMSM of color, and (c) reexamination of HIV prevention counseling approaches to utilize destigmatizing frameworks which move away from risk-based counseling and instead promote resilience-based and sex-positive communication with providers (Maragh-Bass et al, 2023).…”

“…For instance, in some areas of the country, HIV preventive services like HIV testing and PrEP appointments halted completely when the pandemic began (Maragh-Bass et al, 2022). In other cases, YMSM and other sexual minority groups who had sexual encounters during the pandemic reported lower PrEP adherence and attendance at follow-up consultations (Ferraz et al, 2023). Achieving EHE goals requires greater understanding of YMSM of color’s needs, given their low PrEP uptake and persistence even when they are interested in PrEP (and these barriers would not have disappeared entirely due to COVID-19; Janulis et al, 2018; Marsh & Rothenberger, 2019; Schnarrs et al, 2018; Siegler, Mayer et al, 2019).…”