Use of HIV prevention methods and contexts of the sexual practices of adolescent gay and bisexual men, travestis, and transgender women in São Paulo, Brazil

We aimed to understand the perspective and use of HIV prevention methods in context of the sexual practices of adolescent gay and bisexual men, travestis, and transgender women (TGW). In-depth interviews and focus group discussions were conducted with 22 adolescent gay and bisexual men, travestis, and TGW aged between 15 and 19 years in São Paulo, Brazil, as part of the formative research of the PrEP1519 study, an ongoing daily oral pre-exposure prophylaxis (PrEP) demonstration study among adolescents. Participants’ knowledge repertoire about prevention methods and their experience with them concentrated on condoms, which were regarded as the most well-known, “compulsory” practice, whose use was an individual responsibility. Prior HIV/STI testing was reported by a few participants as a measure to decide to discontinue condom use in stable relationships, whereas seeking testing after condomless sex was an attempt to repair a “failure” in prevention. The importance of commercial sex was striking among TGW and travestis, in which condom use often depended on clients’ decision, and drug use and risk of violence hindered decision-making and self-care. Adolescents showed little knowledge, frequent confusion, and no experience with post-exposure prophylaxis and PrEP. An incipient appropriation of the diversity of prevention methods and a rigid normativity about the use of condoms are key drivers in adolescents’ perception and use of HIV prevention methods. Adolescents’ risk management seems to be restricted in terms of their autonomy and ability to assess exposure across contexts, failing to include antiretroviral-based (ARV) methods, thus requiring tailored and context-sensitive strategies for an effective combination prevention approach.

本研究旨在结合青少年男同性恋者、双性恋男性、跨性别女性（Transgender Women, TGW）与特拉维斯蒂群体（travestis）的性行为场景，探究其对人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）预防手段的认知与使用情况。本研究于巴西圣保罗开展，作为PrEP1519研究的形成性研究（formative research）组成部分，共招募22名年龄介于15至19岁的上述群体青少年，采用深入访谈与焦点小组讨论的方式收集数据。PrEP1519研究是一项针对青少年群体的每日口服暴露前预防（pre-exposure prophylaxis, PrEP）示范研究，目前仍在进行中。受试者对预防手段的知识储备与使用经验均集中于安全套：安全套被视作最广为人知的“强制性”预防措施，其使用被视作个人责任。少数受试者表示，曾通过提前进行HIV/性传播感染（Sexually Transmitted Infection, STI）检测，来决定在稳定亲密关系中停止使用安全套；而在无保护性行为后主动寻求检测，则被视为对预防“失效”的补救行为。在跨性别女性与特拉维斯蒂群体中，商业性交易的影响尤为显著：在此类场景中，安全套的使用往往由客户决定，而药物滥用与暴力风险则阻碍了决策制定与自我照护。青少年群体对暴露后预防（post-exposure prophylaxis, PEP）与PrEP几乎一无所知，且常存在认知困惑，从未有过相关使用经验。青少年群体对预防手段多样性的初步接纳，以及对安全套使用的刚性规范，是影响其对HIV预防手段认知与使用的核心驱动因素。青少年的风险管理似乎受限于其自主决策能力与跨场景风险评估能力，未能涵盖基于抗逆转录病毒（antiretroviral, ARV）的预防手段，因此亟需制定适配场景的个性化策略，以实现有效的综合预防方案。