Fatores sociodemográficos e comportamentais associados à prevalência de infecção por HIV em adolescentes HSH em duas metrópoles do Brasil

Abstract

Introduction: The HIV/aids epidemic among adolescent men who have sex with men (AMSM) continues to increase globally. In Brazil, between 2007 and 2024, 29,187 new HIV infections were reported among adolescents aged 15 to 19 years, of which 65% occurred in males. Despite this, the prevalence of HIV and its associated risk factors remain poorly understood in this population. Objective: To estimate the prevalence of HIV among AMSM aged 15 to 19 years in the cities of Fortaleza and São Paulo and to identify sociodemographic and sociobehavioral factors associated with HIV infection. Methods: This is a mixed-methods study. In the qualitative phase, formative research was conducted to understand adolescents’ perceptions of their vulnerability to HIV/aids and to guide the implementation of the Respondent Driven Sampling (RDS) study between December 2021 and August 2022. In the quantitative phase, 275 AMSM participated. Serological samples were collected for HIV testing. The variables analyzed included: gender identity; sexual orientation; risk behaviors; social network characteristics, socioeconomic and sociodemographic characteristics, care and access to health services, knowledge and use of combined prevention strategies such as Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP), alcohol and drug use; stigma and discrimination; and mental health. The Pearson chi-square test was used to evaluate differences in the proportions of categorical variables associated with HIV infection. Weighted Poisson regression according to social network size was performed. A systematic review and meta- analysis were also conducted to compare the prevalence found in RDS studies conducted in Brazil and other countries. Results: Discrepancies were identified across categories of gender identity and sexual orientation among AMSM, as well as the presence of intersectional stigma and discrimination in family, schools, and healthcare services. AMSM living with HIV described strategies to conceal their serostatus, as well as difficulties adhering to routine testing, and abandonment of antiretroviral therapy (ART). In addition, frequent use of geosocial networks and dating apps to seek partners was observed, associated with inconsistent condom use and limited knowledge of combined prevention methods. The overall HIV prevalence was 2.6% (95%CI: 1.1-6.1) across both cities, 6.3% (95%CI: 2.3-15.9) in Fortaleza, and 2.3% (95%CI: 0.8-6.4) in São Paulo. Among risk factors associated with HIV infection, AMSM aged 18 to 19 years had a 13.8-fold higher likelihood of infection compared to those aged 15-17 years. In addition, having had unprotected anal intercourse in the past 12 months (PR=10.6); self-identifying as bisexual (PR=9.4); and presenting moderate or severe depressive symptoms (PR=7.7) were factors strongly associated with higher likelihood of HIV infection. Conclusion: The high HIV prevalence among AMSM in both cities suggests a resurgence of the epidemic in this population and indicates the urgent need for community-based HIV testing programs, as well as for addressing factors that accelerate HIV transmission among AMSM in urban areas, and expanding the response of combined prevention strategies.