Resumen: Este estudio analizó los desafíos para crear demanda para la participación en un proyecto de profilaxis pre-exposición (PrEP) al VIH en dos capitales brasileñas. Se trata de un estudio cualitativo realizado con hombres que tienen sexo con hombres y mujeres transgénero de 15 a 19 años residentes de dos capitales brasileñas. Para este análisis, se evaluaron 27 entrevistas semiestructuradas realizadas entre 2019 y 2020 con un análisis temático de contenido reflexivo. Para los participantes, crear la demanda por PrEP fue fundamental para el proceso de interacción, mediación, vínculo y apego y demostró ser eficaz para la aceptabilidad y adhesión de la PrEP. Los relatos de los adolescentes mostraron que las estrategias promovieron la prevención combinada del VIH, posibilitaron reuniones de reclutamiento, ayudaron a negociar y convencer a las personas a usar la PrEP, fortalecieron la educación entre pares y evocaron un sentimiento de “estar con” y “caminar juntos”, a pesar de los desafíos. Las interacciones, ya sean de manera presencial o online, con el uso de las tecnologías sociales, tuvieron un papel fundamental en el reclutamiento de adolescentes para el proyecto, en la ampliación del conocimiento sobre la PrEP y las demás estrategias de prevención combinadas, y en el acceso a servicios de salud y autocuidado. Resumen preexposición pre exposición (PrEP brasileñas 1 2 201 202 reflexivo participantes interacción mediación estar caminar juntos, juntos , juntos” interacciones online sociales combinadas autocuidado 20

Abstract: This study aimed to analyze the challenges in demand creation for participation in an HIV pre-exposure prophylaxis (PrEP) project in two Brazilian capitals. This qualitative study was conducted with men who have sex with men and transgender women aged 15 to 19 years who lived in two Brazilian state capitals. For this analysis, 27 semi-structured interviews carried out from 2019 to 2020 were evaluated by reflexive thematic content analysis. For participants, PrEP demand creation was essential for their interaction, mediation, bonding, and attachment and proved effective for PrEP acceptability and adherence. Adolescents’ narratives showed that the strategies promoted HIV combination prevention, opened up opportunities for recruitment meetings, helped to negotiate with and convince individuals to use PrEP, strengthened peer education, and evoked a feeling of “being with” and “walking together” despite the challenges. Face-to-face or online interactions using social technologies played a crucial role in recruiting adolescents for the project, expanding knowledge on PrEP and other combination prevention strategies and access to health services and self-care. Abstract preexposure pre exposure (PrEP capitals 1 analysis 2 semistructured semi structured 201 202 participants interaction mediation bonding adherence Adolescents meetings education being walking together Facetoface Face face selfcare. selfcare self care. care self-care 20

Resumo: Este estudo analisou desafios na criação de demanda para participação em um projeto de profilaxia pré-exposição (PrEP) ao HIV em duas capitais brasileiras. Trata-se de um estudo qualitativo realizado com homens que fazem sexo com homens e mulheres transgênero de 15 a 19 anos residentes de duas capitais brasileiras. Para esta análise, foram avaliadas 27 entrevistas semiestruturadas realizadas entre 2019 e 2020 com análise temática de conteúdo reflexiva. Para os participantes, a criação de demanda por PrEP foi essencial para o processo de interação, mediação, vínculo e apego e mostrou-se eficaz para a aceitabilidade e adesão à PrEP. As narrativas dos adolescentes mostraram que as estratégias promoveram a prevenção combinada do HIV, abriram oportunidades para reuniões de recrutamento, ajudaram a negociar e convencer os indivíduos a usar a PrEP, fortaleceram a educação entre pares e evocaram um sentimento de “estar com” e “caminhar juntos”, apesar dos desafios. As interações, sejam presenciais ou online, com o uso de tecnologias sociais, desempenharam um papel crucial no recrutamento de adolescentes para o projeto, na ampliação do conhecimento sobre PrEP e demais estratégias combinadas de prevenção, e no acesso a serviços de saúde e autocuidado. Resumo préexposição pré exposição (PrEP brasileiras Tratase Trata se 1 2 201 202 reflexiva participantes interação mediação mostrouse mostrou estar caminhar juntos, juntos , juntos” interações online sociais autocuidado 20

Resumo: Este estudo analisou desafios na criação de demanda para participação em um projeto de profilaxia pré-exposição (PrEP) ao HIV em duas capitais brasileiras. Trata-se de um estudo qualitativo realizado com homens que fazem sexo com homens e mulheres transgênero de 15 a 19 anos residentes de duas capitais brasileiras. Para esta análise, foram avaliadas 27 entrevistas semiestruturadas realizadas entre 2019 e 2020 com análise temática de conteúdo reflexiva. Para os participantes, a criação de demanda por PrEP foi essencial para o processo de interação, mediação, vínculo e apego e mostrou-se eficaz para a aceitabilidade e adesão à PrEP. As narrativas dos adolescentes mostraram que as estratégias promoveram a prevenção combinada do HIV, abriram oportunidades para reuniões de recrutamento, ajudaram a negociar e convencer os indivíduos a usar a PrEP, fortaleceram a educação entre pares e evocaram um sentimento de “estar com” e “caminhar juntos”, apesar dos desafios. As interações, sejam presenciais ou online, com o uso de tecnologias sociais, desempenharam um papel crucial no recrutamento de adolescentes para o projeto, na ampliação do conhecimento sobre PrEP e demais estratégias combinadas de prevenção, e no acesso a serviços de saúde e autocuidado.

Abstract: This study aimed to analyze the challenges in demand creation for participation in an HIV pre-exposure prophylaxis (PrEP) project in two Brazilian capitals. This qualitative study was conducted with men who have sex with men and transgender women aged 15 to 19 years who lived in two Brazilian state capitals. For this analysis, 27 semi-structured interviews carried out from 2019 to 2020 were evaluated by reflexive thematic content analysis. For participants, PrEP demand creation was essential for their interaction, mediation, bonding, and attachment and proved effective for PrEP acceptability and adherence. Adolescents’ narratives showed that the strategies promoted HIV combination prevention, opened up opportunities for recruitment meetings, helped to negotiate with and convince individuals to use PrEP, strengthened peer education, and evoked a feeling of “being with” and “walking together” despite the challenges. Face-to-face or online interactions using social technologies played a crucial role in recruiting adolescents for the project, expanding knowledge on PrEP and other combination prevention strategies and access to health services and self-care.

Resumen: Este estudio analizó los desafíos para crear demanda para la participación en un proyecto de profilaxis pre-exposición (PrEP) al VIH en dos capitales brasileñas. Se trata de un estudio cualitativo realizado con hombres que tienen sexo con hombres y mujeres transgénero de 15 a 19 años residentes de dos capitales brasileñas. Para este análisis, se evaluaron 27 entrevistas semiestructuradas realizadas entre 2019 y 2020 con un análisis temático de contenido reflexivo. Para los participantes, crear la demanda por PrEP fue fundamental para el proceso de interacción, mediación, vínculo y apego y demostró ser eficaz para la aceptabilidad y adhesión de la PrEP. Los relatos de los adolescentes mostraron que las estrategias promovieron la prevención combinada del VIH, posibilitaron reuniones de reclutamiento, ayudaron a negociar y convencer a las personas a usar la PrEP, fortalecieron la educación entre pares y evocaron un sentimiento de “estar con” y “caminar juntos”, a pesar de los desafíos. Las interacciones, ya sean de manera presencial o online, con el uso de las tecnologías sociales, tuvieron un papel fundamental en el reclutamiento de adolescentes para el proyecto, en la ampliación del conocimiento sobre la PrEP y las demás estrategias de prevención combinadas, y en el acceso a servicios de salud y autocuidado.

RESUMO Objetivo: O objetivo do presente estudo é descrever as características sociodemográficas e comportamentais de um grupo de mulheres trans e travestis (MTT) com histórico de encarceramento e o contexto institucional e social desta experiência no Brasil. Métodos: Os dados são provenientes do Estudo TransOdara, de delineamento transversal, realizado em 5 capitais brasileiras no período de dezembro de 2019 a julho de 2021. As participantes foram recrutadas pela técnica Respondent-Driven Sampling (RDS), onde, após uma etapa inicial formativa e exploratória, as primeiras participantes foram identificadas; elas, por sua vez, recrutavam até outras seis mulheres trans e travestis para a pesquisa. O desfecho do estudo foi a experiência de encarceramento durante a vida apreendido através da pergunta: “Você alguma vez na vida já foi presa?”. Resultados: Um total de 1.245 MTT foram entrevistadas. Destas, 20,3% (n=253) experienciaram o cárcere. O encarceramento foi mais frequente entre as entrevistadas de 33 a 42 anos (35,6%), com menor escolaridade (45,5%), em situação de trabalho informal (30,3%) e entre aquelas que reportaram uso de drogas ilícitas (66,4%). A maioria (60,9%) das MTT ficou presa com homens cisgênero, e o motivo da prisão mais frequente foi o tráfico de drogas (30,4%), seguido de roubo (29,2%). Mais de um quarto das entrevistadas (26,3%) sofreu agressão, e 13,8% relataram ter sofrido violência sexual durante o encarceramento. Conclusão: Os resultados destacam a elevada prevalência de encarceramento entre MTT. Este encarceramento se dá em alas masculinas e em um contexto de altas taxas de violência física e sexual. Objetivo (MTT Brasil Métodos TransOdara transversal 201 2021 RespondentDriven Respondent Driven RDS, RDS , (RDS) onde exploratória identificadas elas pesquisa pergunta Você presa. . presa?” Resultados 1245 1 245 1.24 Destas 203 20 3 20,3 n=253 n253 n 253 (n=253 cárcere 4 35,6%, 356 35,6% 35 6 (35,6%) 45,5%, 455 45,5% 45 (45,5%) 30,3% 303 30 (30,3% 66,4%. 664 66,4% 66 (66,4%) 60,9% 609 60 9 (60,9% cisgênero 30,4%, 304 30,4% (30,4%) 29,2%. 292 29,2% 29 2 (29,2%) 26,3% 263 26 (26,3% agressão 138 13 8 13,8 Conclusão 202 (RDS presa? 124 24 1.2 20, n=25 n25 25 (n=25 35,6 (35,6% 45,5 (45,5% 30,3 (30,3 66,4 (66,4% 60,9 (60,9 30,4 (30,4% 29,2 (29,2% 26,3 (26,3 13, 12 1. n=2 n2 (n=2 35, (35,6 45, (45,5 30, (30, 66, (66,4 60, (60, (30,4 29, (29,2 26, (26, n= (n= (35, (45, (30 (66, (60 (29, (26 (n (35 (45 (3 (66 (6 (29 (2 (4 (

ABSTRACT Objective: The objective of the present study is to describe the sociodemographic and behavioral characteristics of a group of transgender women and travestis (TGW) with a history of incarceration and the institutional and social context of this experience in Brazil. Methods: The analyzed data were derived from the TransOdara Study, a cross-sectional study conducted in five Brazilian capitals from December 2019 to July 2021. Participants were recruited using the Respondent-Driven Sampling (RDS) technique, in which, after an initial formative and exploratory stage, the first participants were identified; in turn, these participants recruited up to six other transgender women and travestis for the research. The study’s outcome was the experience of incarceration throughout life, captured through the question: “Have you ever been arrested in your life?” Results: A total of 1,245 TGW were interviewed, of which 20.3% (n=253) experienced incarceration. Incarceration was more frequent among those aged 33 to 42 years (35.6%), with lower level of education (45.5%, p<0.001), engaged in informal work (30.3%), without a partner (67.2%), and among those who reported illicit drug use (66.4%). The majority (60.9%) of TGW were incarcerated with cisgender men, and the most common reasons for imprisonment were drug trafficking (30.4%) followed by robbery (29.2%). Over a quarter of the interviewees (26.3%) experienced assault, and 13.8% reported experiencing sexual violence during incarceration. Conclusion: The results emphasize the high prevalence of incarceration among TGW. This incarceration takes place in male wards and in a context of high rates of physical and sexual violence. Objective (TGW Brazil Methods Study crosssectional cross sectional 201 2021 RespondentDriven Respondent Driven RDS (RDS technique stage identified turn research studys s life question Have life? Results 1245 1 245 1,24 interviewed 203 20 3 20.3 n=253 n253 n 253 (n=253 4 35.6%, 356 35.6% , 35 6 (35.6%) 45.5%, 455 45 5 (45.5% p<0.001, p0001 p p<0.001 0 001 p<0.001) 30.3%, 303 30.3% 30 (30.3%) 67.2%, 672 67.2% 67 2 (67.2%) 66.4%. 664 66.4% . 66 (66.4%) 60.9% 609 60 9 (60.9% men 30.4% 304 (30.4% 29.2%. 292 29.2% 29 (29.2%) 26.3% 263 26 (26.3% assault 138 13 8 13.8 Conclusion 202 124 24 1,2 20. n=25 n25 25 (n=25 35.6 (35.6% 45.5% (45.5 p000 p<0.00 00 30.3 (30.3% 67.2 (67.2% 66.4 (66.4% 60.9 (60.9 30.4 (30.4 29.2 (29.2% 26.3 (26.3 13. 12 1, n=2 n2 (n=2 35. (35.6 45.5 (45. p00 p<0.0 30. (30.3 67. (67.2 66. (66.4 60. (60. (30. 29. (29.2 26. (26. n= (n= (35. 45. (45 p0 p<0. (67. (66. (60 (30 (29. (26 (n (35 (4 p<0 (67 (66 (6 (3 (29 (2 ( p<

ABSTRACT OBJECTIVE: Viral hepatitis and sexually transmitted infections disproportionally affect men who have sex with men (MSM) and transgender women (TGW). However, only a few studies have evaluated the prevalence of hepatitis in these populations, especially in youths and adolescents. This study aimed to estimate the prevalence of biomarkers for hepatitis A, B, and C among young and adolescent MSM and TGW in three Brazilian municipalities. METHODS: Baseline data were collected from a combination of HIV prevention cohort of young and adolescent MSM (AMSM) and TGW (ATGW) aged 15-19 years in three Brazilian municipalities. A social behavioral questionnaire was applied, and immunoassays were performed to detect antibodies against hepatitis A (anti- HAV IgG and IgM), hepatitis B (anti-HBc and anti-HBs), and hepatitis C virus (anti-HCV); testing for the active hepatitis B marker, HBsAg, was also performed. The prevalence of reactive tests and 95% confidence interval (CI) for proportions were measured. RESULTS: The prevalence of naturally or artificially acquired immunity for hepatitis A totaled 17.7% (95%CI: 15.4-20.4), whereas that of acute infection, 0.4% (95%CI: 0.2-1.2). For hepatitis B and C, prevalence rates totaled 2.8% (95%CI: 1.8-4.4) and 0.2% (95%CI: 0.1-1.1), respectively. About 25.7% (95%CI: 22.4-29.4) of participants were non-reactive for anti-HBc and reactive for anti-HBs, the latter being a vaccine marker for hepatitis B. CONCLUSIONS: The investigation of viral hepatitis biomarkers among vulnerable populations enables the early identification of infections, the provision of timely treatment, and an opportunity to point out the need to expand vaccination coverage.

ABSTRACT OBJECTIVE: Viral hepatitis and sexually transmitted infections disproportionally affect men who have sex with men (MSM) and transgender women (TGW). However, only a few studies have evaluated the prevalence of hepatitis in these populations, especially in youths and adolescents. This study aimed to estimate the prevalence of biomarkers for hepatitis A, B, and C among young and adolescent MSM and TGW in three Brazilian municipalities. METHODS: Baseline data were collected from a combination of HIV prevention cohort of young and adolescent MSM (AMSM) and TGW (ATGW) aged 15-19 years in three Brazilian municipalities. A social behavioral questionnaire was applied, and immunoassays were performed to detect antibodies against hepatitis A (anti- HAV IgG and IgM), hepatitis B (anti-HBc and anti-HBs), and hepatitis C virus (anti-HCV); testing for the active hepatitis B marker, HBsAg, was also performed. The prevalence of reactive tests and 95% confidence interval (CI) for proportions were measured. RESULTS: The prevalence of naturally or artificially acquired immunity for hepatitis A totaled 17.7% (95%CI: 15.4-20.4), whereas that of acute infection, 0.4% (95%CI: 0.2-1.2). For hepatitis B and C, prevalence rates totaled 2.8% (95%CI: 1.8-4.4) and 0.2% (95%CI: 0.1-1.1), respectively. About 25.7% (95%CI: 22.4-29.4) of participants were non-reactive for anti-HBc and reactive for anti-HBs, the latter being a vaccine marker for hepatitis B. CONCLUSIONS: The investigation of viral hepatitis biomarkers among vulnerable populations enables the early identification of infections, the provision of timely treatment, and an opportunity to point out the need to expand vaccination coverage. OBJECTIVE (MSM TGW. . (TGW) However adolescents municipalities METHODS AMSM (AMSM ATGW (ATGW 1519 15 19 15-1 applied anti (anti IgM, IgM , IgM) antiHBc HBc antiHBs, antiHBs HBs anti-HBs) antiHCV HCV (anti-HCV) HBsAg 95 CI (CI measured RESULTS 177 17 7 17.7 95%CI 95CI (95%CI 15.420.4, 154204 15.4 20.4 4 20 15.4-20.4) infection 04 0 0.4 0.21.2. 0212 0.2 1.2 2 1 0.2-1.2) 28 8 2.8 1.84.4 1844 1.8 4.4 1.8-4.4 02 0.11.1, 0111 0.1 1.1 0.1-1.1) respectively 257 25 25.7 22.429.4 224294 22.4 29.4 22 29 22.4-29.4 nonreactive non HBs, anti-HBs CONCLUSIONS treatment coverage (TGW 151 15- (anti-HCV 9 17. 420 15.420.4 15420 154 15. 204 20. 15.4-20.4 0. 21 0.21.2 021 12 1. 0.2-1.2 2. 84 1.84. 184 18 44 4. 1.8-4. 11 0.11.1 011 01 0.1-1.1 25. 429 22.429. 22429 224 22. 294 29. 22.4-29. 42 15.420. 1542 15.4-20. 0.21. 0.2-1. 1.84 1.8-4 0.11. 0.1-1. 22.429 2242 22.4-29 15.420 15.4-20 0.21 0.2-1 1.8- 0.11 0.1-1 22.42 22.4-2 15.42 15.4-2 0.2- 0.1- 22.4- 15.4-

ABSTRACT OBJECTIVE: To identify the factors associated with HIV self-testing (HIVST) uptake among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) before and during the COVID-19 pandemic. METHODS: A cross-sectional HIVST uptake study was conducted among AMSM and ATGW. Peer educators and health professionals began providing HIVST in February 2019. The outcome was the HIVST uptake before and during the COVID-19 pandemic. The association between each predictor and outcome in each period was analyzed using simple and multiple logistic regressions, estimating odds ratios, and their respective 95% confidence intervals. RESULTS: The uptake was 229/510 (44.9%) and 382/1,075 (35.5%) before and during the pandemic. During the pre-pandemic period, HIVST uptake was higher in participants who reported receptive anal sex. During the pandemic, uptake was lower in participants with a steady sexual partner and higher in those with frequent oral sex with a steady partner in the previous three months. Before and during the pandemic, HIVST uptake was lower in ATGW and higher in those aged 18–19 years and in participants who lived alone. CONCLUSIONS: Uptake decreased during the pandemic. Sexual behavioral factors associated with HIVST uptake changed during the COVID-19 pandemic, showing the fluid dynamics of sexuality in AMSM and ATGW during this period. HIV programs can optimize the implementation of HIVST among adolescents and young people by incorporating effective and differentiated service delivery models to increase HIV testing uptake and to reach undiagnosed individuals effectively. OBJECTIVE selftesting self (HIVST (AMSM (ATGW COVID19 COVID 19 COVID-1 pandemic METHODS crosssectional cross sectional 2019 regressions ratios 95 intervals RESULTS 229510 229 510 229/51 44.9% 449 44 9 (44.9% 3821075 382 1 075 382/1,07 35.5% 355 35 5 (35.5% prepandemic pre months 1819 18 18–1 alone CONCLUSIONS effectively COVID1 COVID- 201 22951 22 51 229/5 44.9 4 (44.9 382107 38 07 382/1,0 35.5 3 (35.5 181 18– 20 2295 2 229/ 44. (44. 38210 0 382/1, 35. (35. (44 3821 382/1 (35 (4 382/ (3 (

ABSTRACT OBJECTIVE: To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis METHODS: A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression. RESULTS: 608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1–7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22–6.92; CO-center: ORa = 1.91; 95%CI 1.10–3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94–1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78–0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63–5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78–0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10–3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18–3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV. CONCLUSION: The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities. OBJECTIVE preexposure pre exposure (PrEP communitybased community based (COs HIVvulnerable addition METHODS COcenter CO (CO-center COoutskirts, COoutskirts , (CO-outskirts) CTAcenter. CTAcenter CTA . (CTA-center) 202 2022 aMSM, aMSM (aMSM) aTTrans (aTTrans 1 years HIVnegative, HIVnegative negative, negative HIV-negative higherrisk higher risk regression RESULTS 60 center. 1–7 17 7 (1– days CO-outskirts 2.91 291 2 91 95CI CI 95 1.22–6.92 122692 22 6 92 1.91 191 1.10–3.31 110331 10 3 31 1.10–3.31) HDI (HDI 0.97 097 0 97 0.94–1.00 094100 94 00 0.82 082 82 0.78–0.86. 078086 0.78–0.86 78 86 0.78–0.86) outskirts, 3.06 306 06 1.63–5.75 163575 63 5 75 8 7. km. km km) 2.01 201 01 1.10–3.91 110391 highrisk high 2.02 02 1.18–3.44, 118344 1.18–3.44 18 44 1.18–3.44) CONCLUSION inequities (CO-outskirts (CTA-center 20 (aMSM 1– (1 2.9 29 9 1.22–6.9 12269 1.9 1.10–3.3 11033 0.9 09 0.94–1.0 09410 0.8 08 07808 0.78–0.8 3.0 30 1.63–5.7 16357 2.0 1.10–3.9 11039 11834 1.18–3.4 4 ( 2. 1.22–6. 1226 1. 1.10–3. 1103 0. 0.94–1. 0941 0780 0.78–0. 3. 1.63–5. 1635 1183 1.18–3. 1.22–6 122 1.10–3 110 0.94–1 094 078 0.78–0 1.63–5 163 118 1.18–3 1.22– 12 1.10– 11 0.94– 07 0.78– 1.63– 16 1.18– 1.22 1.10 0.94 0.78 1.63 1.18 1.2 1.1 0.7 1.6

RESUMO OBJETIVO: Avaliar se adolescentes de minorias sexuais que iniciaram a profilaxia pré-exposição sexual (PrEP) em organizações comunitárias (OC) apresentam maior vulnerabilidade social e ao HIV em comparação com adolescentes em PrEP de um serviço de saúde convencional. Além disso, avaliar se esses adolescentes tiveram um acesso mais oportuno à profilaxia. MÉTODOS: Estudo demonstrativo da efetividade de PrEP, realizado na cidade de São Paulo, em duas OC, localizadas no centro (OC-centro) e na periferia (OC-periferia), e em um serviço convencional de testagem para o HIV (CTA-centro). Foram elegíveis para PrEP, entre 2020 e 2022, adolescentes homens cisgêneros que fazem sexo com homens (aHSH), travestis, mulheres transexuais e pessoas transfemininas (aTTrans), de 15 a 19 anos, HIV-negativos e com práticas de maior risco para o HIV. Indicadores de acesso oportuno e de vulnerabilidades dos adolescentes iniciando PrEP nas OC foram analisados, tendo por referência o CTA-centro e empregando regressão logística multinomial. RESULTADOS: 608 adolescentes iniciaram PrEP nas OC e CTA-Centro. Adolescentes das OC estiveram associados a um menor tempo de início de PrEP (1–7 dias; OC-periferia: ORa = 2,91; IC95% 1,22–6,92; OC-centro: ORa = 1,91; IC95% 1,10–3,31); e a um menor IDH de moradia (OC-centro: ORa = 0,97; IC95% 0,94–1,00; OC-periferia: ORa = 0,82; IC95% 0,78–0,86). Na OC-periferia houve aumento na chance de os adolescentes serem mais jovens (ORa = 3,06; IC95% 1,63–5,75) e morarem mais próximos ao serviço (ORa = 0,82; IC95% 0,78–0,86, média 7,8 km). Enquanto adolescentes da OC-centro estiveram associados ao maior conhecimento prévio de PrEP (ORa = 2,01; IC95% 1,10–3,91) e a alta percepção de risco (ORa = 2,02; IC95% 1,18–3,44). Não estiveram associadas aos adolescentes das OC as práticas sexuais de maior risco e as situações de vulnerabilidade ao HIV. CONCLUSÕES: A oferta de PrEP nas OC facilitou o acesso de adolescentes vulnerabilizados e pode contribuir para reduzir inequidades. OBJETIVO préexposição pré exposição (PrEP (OC disso MÉTODOS Paulo OCcentro (OC-centro OCperiferia, OCperiferia , (OC-periferia) CTAcentro. CTAcentro CTA . (CTA-centro) 202 2022 aHSH, aHSH (aHSH) travestis aTTrans, aTTrans (aTTrans) 1 anos HIVnegativos negativos analisados multinomial RESULTADOS 60 CTACentro. CTACentro Centro. Centro CTA-Centro 1–7 17 7 (1– dias 2,91 291 2 91 IC95 IC 1,22–6,92 122692 22 6 92 1,91 191 1,10–3,31 110331 10 3 31 1,10–3,31) 0,97 097 0 97 0,94–1,00 094100 94 00 0,82 082 82 0,78–0,86. 078086 0,78–0,86 78 86 0,78–0,86) 3,06 306 06 1,63–5,75 163575 63 5 75 8 7, km. km km) 2,01 201 01 1,10–3,91 110391 2,02 02 1,18–3,44. 118344 1,18–3,44 18 44 1,18–3,44) CONCLUSÕES inequidades (OC-periferia (CTA-centro 20 (aHSH (aTTrans 1– (1 2,9 29 9 IC9 1,22–6,9 12269 1,9 1,10–3,3 11033 0,9 09 0,94–1,0 09410 0,8 08 07808 0,78–0,8 3,0 30 1,63–5,7 16357 2,0 1,10–3,9 11039 11834 1,18–3,4 4 ( 2, 1,22–6, 1226 1, 1,10–3, 1103 0, 0,94–1, 0941 0780 0,78–0, 3, 1,63–5, 1635 1183 1,18–3, 1,22–6 122 1,10–3 110 0,94–1 094 078 0,78–0 1,63–5 163 118 1,18–3 1,22– 12 1,10– 11 0,94– 07 0,78– 1,63– 16 1,18– 1,22 1,10 0,94 0,78 1,63 1,18 1,2 1,1 0,7 1,6

ABSTRACT OBJECTIVE: To analyze the factors that increase the practice of condomless anal sex (CAS) among adolescent men who have sex with men (AMSM) and adolescent travestis and transgender women (ATGW) in three Brazilian state capitals. METHODS: PrEP1519 is a prospective, multicenter cohort study demonstrating the effectiveness of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among AMSM and ATGW aged from 15 to 19 years in three Brazilian state capitals. The analyses were performed with baseline cohort data, including 1,418 adolescents enrolled from 2019 to 2021. The outcome studied was CAS in the last six months, and the potentially associated factors were sociodemographic, behavioral, healthcare, and history of violence and discrimination. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (95%CI) were estimated. RESULTS: Most of the participants were AMSM (91.5%), aged 18 to 19 years (75.9%), Black (40.5%), with secondary or higher education in progress (92.7%), with CAS during the first sexual intercourse (54.2%), sexual initiation before the age of 14 (43.4%), and history of group sex (24.6%) and transactional sex (14.6%). The prevalence of CAS in the last six months was 80.6% (95%CI 78.5%-82.6%). Adolescents who reported condomless first sexual intercourse (aPR: 1.18; 95%CI 1.10-1.25), use of psychoactive substances (aPR: 1.09; 95%CI 1.03-1.16), and transactional sex (aPR: 1.11; 95%CI 1.04-1.20) had a higher prevalence of CAS in the last six months. We also found that those aged 15 to 17 years had a higher prevalence of CAS than those aged 18 to 19 (aPR: 1.07; 95%CI 0.99-1.13). CONCLUSIONS: The prevalence of CAS was high among AMSM and ATGW, being associated with practices that may increase the risk of sexually transmitted infections (STIs). Therefore, it is recommended to strengthen sexual health programs for young people that address the issue of sexuality and STI prevention, as well as to expand access to preventive methods, such as condoms and PrEP. OBJECTIVE (CAS (AMSM (ATGW capitals METHODS PrEP PrEP151 prospective HIV (HIV preexposure pre exposure (PrEP 1 data 1418 418 1,41 201 2021 sociodemographic behavioral healthcare discrimination Descriptive bivariate conducted aPRs (aPRs 95 95CI CI estimated RESULTS 91.5%, 915 91.5% , 91 5 (91.5%) 75.9%, 759 75.9% 75 9 (75.9%) 40.5%, 405 40.5% 40 (40.5%) 92.7%, 927 92.7% 92 7 (92.7%) 54.2%, 542 54.2% 54 2 (54.2%) 43.4%, 434 43.4% 43 4 (43.4%) 24.6% 246 24 6 (24.6% 14.6%. 146 14.6% . (14.6%) 806 80 80.6 78.5%82.6%. 785826 78.5% 82.6% 78 82 78.5%-82.6%) aPR (aPR 1.18 118 1.101.25, 110125 1.10 1.25 10 25 1.10-1.25) 1.09 109 09 1.031.16, 103116 1.03 1.16 03 16 1.03-1.16) 1.11 111 11 1.041.20 104120 1.04 1.20 04 20 1.04-1.20 1.07 107 07 0.991.13. 099113 0.99 1.13 0 99 13 0.99-1.13) CONCLUSIONS STIs. STIs (STIs) Therefore prevention methods PrEP15 141 41 1,4 202 91.5 (91.5% 75.9 (75.9% 40.5 (40.5% 92.7 (92.7% 54.2 (54.2% 43.4 (43.4% 24.6 (24.6 14.6 (14.6% 8 80. 78.5%82.6% 78582 785 78.5 826 82.6 78.5%-82.6% 1.1 101 1.101.25 11012 110 125 1.2 1.10-1.25 1.0 031 1.031.16 10311 103 116 1.03-1.16 041 1.041.2 10412 104 120 1.04-1.2 991 0.991.13 09911 099 0.9 113 0.99-1.13 (STIs PrEP1 1, 91. (91.5 75. (75.9 40. (40.5 92. (92.7 54. (54.2 43. (43.4 24. (24. 14. (14.6 78.5%82.6 7858 78. 82. 78.5%-82.6 1. 1.101.2 1101 12 1.10-1.2 1.031.1 1031 1.03-1.1 1.041. 1041 1.04-1. 0.991.1 0991 0. 0.99-1.1 (91. (75. (40. (92. (54. (43. (24 (14. 78.5%82. 78.5%-82. 1.101. 1.10-1. 1.031. 1.03-1. 1.041 1.04-1 0.991. 0.99-1. (91 (75 (40 (92 (54 (43 (2 (14 78.5%82 78.5%-82 1.101 1.10-1 1.031 1.03-1 1.04- 0.991 0.99-1 (9 (7 (4 (5 ( (1 78.5%8 78.5%-8 1.10- 1.03- 0.99- 78.5%-

RESUMO OBJETIVO: Analisar os fatores que aumentam a prática de sexo anal sem preservativo (SASP) entre adolescentes homens que fazem sexo com homens (aHSH) e travestis mulheres trans (aTrMT) em três capitais brasileiras. MÉTODOS: PrEP1519 é uma coorte prospectiva, multicêntrica, de demonstração da efetividade da profilaxia pré-exposição (PrEP) ao HIV entre aHSH e aTrMT, com idade entre 15 e 19 anos, em três capitais brasileiras. As análises foram realizadas com dados da linha de base da coorte, com a inclusão de 1.418 adolescentes inscritos de 2019 a 2021. O desfecho estudado foi SASP nos últimos seis meses, e os potenciais fatores associados foram sociodemográficos, comportamentais, de assistência à saúde e histórico de violência e discriminação. Foi realizada análise descritiva, bivariada e multivariada. Estimaram-se razões de prevalência ajustadas (RPa) e intervalos de confiança de 95% (IC95%). RESULTADOS: A maioria dos participantes era aHSH (91,5%), com idade de 18 a 19 anos (75,9%), pretos (40,5%), ensino médio e superior em andamento (92,7%), com relato de SASP na primeira relação sexual (54,2%), início da vida sexual antes dos 14 anos (43,4%) e história de sexo em grupo (24,6%) e de sexo transacional (14,6%). A prevalência de SASP nos últimos seis meses foi de 80,6% (IC95% 78,5%-82,6%). Adolescentes que relataram primeira relação sexual sem preservativo (RPa: 1,18; IC95% 1,10-1,25), consumo de substâncias psicoativas (RPa: 1,09; IC95% 1,03-1,16) e sexo transacional (RPa: 1,11; IC95% 1,04-1,20) tiveram maior prevalência de SASP nos últimos seis meses. Verificou-se também que aqueles com idade de 15 a 17 anos tiveram maior prevalência de SASP em comparação àqueles de 18 a 19 anos (RPa: 1,07; IC95% 0,99-1,13). CONCLUSÕES: A prevalência de SASP foi alta entre aHSH e aTrMT, bem como esteve associada a práticas que podem aumentar o risco de infecções sexualmente transmissíveis (IST). Assim, recomenda-se o fortalecimento de programas de saúde sexual para jovens que abordem o tema da sexualidade e prevenção de IST, tal como a ampliação do acesso a métodos preventivos, como preservativo e PrEP. OBJETIVO (SASP (aHSH aTrMT (aTrMT brasileiras MÉTODOS PrEP PrEP151 prospectiva multicêntrica préexposição pré exposição (PrEP 1 1418 418 1.41 201 2021 sociodemográficos comportamentais discriminação descritiva multivariada Estimaramse Estimaram se RPa (RPa 95 IC95%. IC95 IC . (IC95%) RESULTADOS 91,5%, 915 91,5% , 91 5 (91,5%) 75,9%, 759 75,9% 75 9 (75,9%) 40,5%, 405 40,5% 40 (40,5%) 92,7%, 927 92,7% 92 7 (92,7%) 54,2%, 542 54,2% 54 2 (54,2%) 43,4% 434 43 4 (43,4% 24,6% 246 24 6 (24,6% 14,6%. 146 14,6% (14,6%) 806 80 80,6 (IC95 78,5%82,6%. 785826 78,5% 82,6% 78 82 78,5%-82,6%) 1,18 118 1,101,25, 110125 1,10 1,25 10 25 1,10-1,25) 1,09 109 09 1,031,16 103116 1,03 1,16 03 16 1,03-1,16 1,11 111 11 1,041,20 104120 1,04 1,20 04 20 1,04-1,20 Verificouse Verificou 1,07 107 07 0,991,13. 099113 0,99 1,13 0 99 13 0,99-1,13) CONCLUSÕES IST. IST (IST) Assim recomendase recomenda preventivos PrEP15 141 41 1.4 202 IC9 91,5 (91,5% 75,9 (75,9% 40,5 (40,5% 92,7 (92,7% 54,2 (54,2% 43,4 (43,4 24,6 (24,6 14,6 (14,6% 8 80, (IC9 78,5%82,6% 78582 785 78,5 826 82,6 78,5%-82,6% 1,1 101 1,101,25 11012 110 125 1,2 1,10-1,25 1,0 031 1,031,1 10311 103 116 1,03-1,1 041 1,041,2 10412 104 120 1,04-1,2 991 0,991,13 09911 099 0,9 113 0,99-1,13 (IST PrEP1 1. 91, (91,5 75, (75,9 40, (40,5 92, (92,7 54, (54,2 43, (43, 24, (24, 14, (14,6 (IC 78,5%82,6 7858 78, 82, 78,5%-82,6 1, 1,101,2 1101 12 1,10-1,2 1,031, 1031 1,03-1, 1,041, 1041 1,04-1, 0,991,1 0991 0, 0,99-1,1 (91, (75, (40, (92, (54, (43 (24 (14, 78,5%82, 78,5%-82, 1,101, 1,10-1, 1,031 1,03-1 1,041 1,04-1 0,991, 0,99-1, (91 (75 (40 (92 (54 (4 (2 (14 78,5%82 78,5%-82 1,101 1,10-1 1,03- 1,04- 0,991 0,99-1 (9 (7 (5 ( (1 78,5%8 78,5%-8 1,10- 0,99- 78,5%-

ABSTRACT OBJECTIVE: To identify recent HIV-1 infection and estimate HIV incidence among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in Brazil. METHODS: From January to December 2020, a cross-sectional analysis was conducted with baseline data from the PrEP1519 study, an HIV pre-exposure prophylaxis (PrEP) demonstration cohort in Brazil among sexually active AMSM/ATGW aged 15-19. For enrollment, participants were screened with a fourth-generation HIV rapid test. The recent infection testing algorithm (RITA) included a recency assay in blood specimens, viral load, and CD4 cell count prior to antiretroviral treatment use. Among these participants, RITA-based HIV incidence was estimated using a mean duration of recency infection of 214 days and a false-recent rate of 0.02. RESULTS: Out of the 494 participants screened, 21 tested positive for HIV. Following RITA, five adolescents had a recent HIV infection, 14 had long-term infections, and two did not have blood specimens available. We classified these two participants as long-term infection cases due to CD4 cell counts and previous use of antiretroviral treatment. Among those who tested positive, all but one were AMSM (94.7%), 73.6% were aged 18-19, and 76.2% were non-White. The HIV prevalence was 4.2%, and the estimated HIV incidence was 1.7%. CONCLUSIONS: The estimated incidence highlights the need for targeted HIV prevention interventions, such as PrEP, for sexual minority adolescents. Integrating RITA into routine HIV testing services for this population provides valuable information on the current HIV epidemic. This strategy can aid in monitoring the effectiveness of prevention efforts and improving early entry to HIV care. OBJECTIVE HIV1 1 HIV- (AMSM ATGW (ATGW METHODS 2020 crosssectional cross sectional PrEP PrEP151 study preexposure pre exposure (PrEP AMSMATGW 1519. 1519 15 19. 19 15-19 enrollment fourthgeneration fourth generation test (RITA load CD RITAbased based falserecent false 002 0 02 0.02 RESULTS 49 2 longterm long term infections available 94.7%, 947 94.7% , 94 7 (94.7%) 736 73 6 73.6 1819, 1819 18 19, 18-19 762 76 76.2 nonWhite. nonWhite non White. White non-White 42 4 4.2% 17 1.7% CONCLUSIONS interventions epidemic care 202 PrEP15 151 15-1 00 0.0 94.7 9 (94.7% 73. 181 18-1 76. 4.2 1.7 20 PrEP1 15- 0. 94. (94.7 18- 4. 1. (94. (94 (9 (

ABSTRACT OBJECTIVE: This article discusses how Pre-Exposure Prophylaxis (PrEP) and the undetectable viral load=untransmissible (UVL=U) have produced reconfigurations in the contexts of affective-sexual encounters of young gay men/men who have sex with men (MSM) living with HIV (YLHIV). METHODS: In-depth interviews were conducted with nine YLHIV, aged 18 to 29, from two studies conducted in Salvador, Bahia, in 2019 and 2021. The narratives focused on unprecedented events in the prevention and treatment of HIV/AIDS, which have allowed experiences of greater intimacy and safety but also challenges and tensions in affective-sexual relationships. RESULTS: Different moments in the experience of living with HIV reveal different narratives of YLHIV concerning the new PrEP and UVL biotechnologies. Concerns surrounding possible HIV transmission or the obligation to reveal serology are more prominent among young people with the most recent diagnosis. In contrast, those with more extended serology experience are more comfortable and confident in the face of new technologies and their significant effects on sexual encounters. However, controversies remain regarding the moral and behavioral consequences of their use. Some YLHIV re-update concerns and bring reports about the continuity of stigma toward people living with HIV. Others emphasize the benefits of biomedical advances, opening up new interactive possibilities, including without the use of condoms, highlighting the existence of other practices, knowledge, dynamics, and ways of negotiating risk/care, with tensions in the field of sexuality itself. CONCLUSIONS: We reiterate the need to resume public policies in the field of HIV/AIDS beyond biomedical strategies, highlighting vulnerabilities, the dissemination of information about new HIV prevention and treatment technologies, respect for people’s autonomy in their preventive choices, and the development of strategies to combat the stigma associated with HIV/AIDS. OBJECTIVE PreExposure Pre Exposure (PrEP loaduntransmissible load untransmissible UVL=U UVLU U (UVL=U affectivesexual affective menmen MSM (MSM YLHIV. . (YLHIV) METHODS Indepth depth 1 29 Salvador Bahia 201 2021 HIVAIDS AIDS relationships RESULTS biotechnologies diagnosis contrast However reupdate re update advances possibilities condoms practices knowledge dynamics riskcare risk care risk/care itself CONCLUSIONS vulnerabilities peoples s choices (YLHIV 2 20 202

RESUMO OBJETIVO: Neste artigo, discutimos como a profilaxia pré-exposição (PrEP) e a carga viral indetectável=intransmissível (CVI=I) têm produzido reconfigurações nos contextos de encontros afetivo-sexuais de jovens gays/ homens que fazem sexo com homens (HSH) vivendo com HIV (JVHIV). MÉTODOS: Conduzimos entrevistas em profundidade com nove JVHIV, de 18 a 29 anos, oriundos de duas pesquisas realizadas em Salvador/Bahia, em 2019 e 2021. Focalizamos narrativas sobre acontecimentos inéditos na prevenção e no tratamento do HIV/aids, que têm permitido experiências de maior intimidade e segurança, mas também desafios e tensionamentos às relações afetivo-sexuais. RESULTADOS: Momentos distintos da experiência de viver com HIV revelam diferentes narrativas dos JVHIV com relação às novas biotecnologias de PrEP e CVI. Preocupações em torno de uma possível transmissão do HIV ou da obrigação de revelar a sorologia ficam mais destacadas entre jovens com o diagnóstico mais recente, enquanto aqueles com maior tempo de sorologia se colocam de forma mais confortável e confiante frente às novas tecnologias e seus efeitos significativos nos encontros sexuais, ainda que permaneçam controvérsias a respeito das consequências morais e comportamentais do uso delas. Alguns JVHIV reatualizam preocupações e trazem relatos sobre a continuidade do estigma em relação às pessoas vivendo com HIV. Outros JVHIV enfatizam os benefícios dos avanços biomédicos, com abertura para novas possibilidades interativas, inclusive sem uso da camisinha, sublinhando a existência de outras práticas, saberes, dinâmicas e formas de negociação do risco/cuidado, com tensionamentos no campo da própria sexualidade. CONCLUSÕES: Reiteramos a necessidade de retomada de políticas públicas no campo do HIV/aids para além das estratégias biomédicas, dando destaque às vulnerabilidades, à disseminação de informações sobre as novas tecnologias de prevenção e tratamento do HIV, ao respeito à autonomia das pessoas em suas escolhas preventivas e ao desenvolvimento de estratégias de enfrentamento aos estigmas associados ao HIV/aids. OBJETIVO artigo préexposição pré exposição (PrEP indetectávelintransmissível indetectável intransmissível CVI=I CVII CVI I (CVI=I afetivosexuais afetivo sexuais gays HSH (HSH JVHIV. . (JVHIV) MÉTODOS 1 2 anos SalvadorBahia Salvador Bahia Salvador/Bahia 201 2021 HIVaids aids segurança afetivosexuais. sexuais. RESULTADOS recente delas biomédicos interativas camisinha práticas saberes riscocuidado risco cuidado risco/cuidado sexualidade CONCLUSÕES biomédicas vulnerabilidades (JVHIV 20 202

RESUMO Objetivo: O objetivo do presente estudo é descrever as características sociodemográficas e comportamentais de um grupo de mulheres trans e travestis (MTT) com histórico de encarceramento e o contexto institucional e social desta experiência no Brasil. Métodos: Os dados são provenientes do Estudo TransOdara, de delineamento transversal, realizado em 5 capitais brasileiras no período de dezembro de 2019 a julho de 2021. As participantes foram recrutadas pela técnica Respondent-Driven Sampling (RDS), onde, após uma etapa inicial formativa e exploratória, as primeiras participantes foram identificadas; elas, por sua vez, recrutavam até outras seis mulheres trans e travestis para a pesquisa. O desfecho do estudo foi a experiência de encarceramento durante a vida apreendido através da pergunta: “Você alguma vez na vida já foi presa?”. Resultados: Um total de 1.245 MTT foram entrevistadas. Destas, 20,3% (n=253) experienciaram o cárcere. O encarceramento foi mais frequente entre as entrevistadas de 33 a 42 anos (35,6%), com menor escolaridade (45,5%), em situação de trabalho informal (30,3%) e entre aquelas que reportaram uso de drogas ilícitas (66,4%). A maioria (60,9%) das MTT ficou presa com homens cisgênero, e o motivo da prisão mais frequente foi o tráfico de drogas (30,4%), seguido de roubo (29,2%). Mais de um quarto das entrevistadas (26,3%) sofreu agressão, e 13,8% relataram ter sofrido violência sexual durante o encarceramento. Conclusão: Os resultados destacam a elevada prevalência de encarceramento entre MTT. Este encarceramento se dá em alas masculinas e em um contexto de altas taxas de violência física e sexual.

ABSTRACT Objective: The objective of the present study is to describe the sociodemographic and behavioral characteristics of a group of transgender women and travestis (TGW) with a history of incarceration and the institutional and social context of this experience in Brazil. Methods: The analyzed data were derived from the TransOdara Study, a cross-sectional study conducted in five Brazilian capitals from December 2019 to July 2021. Participants were recruited using the Respondent-Driven Sampling (RDS) technique, in which, after an initial formative and exploratory stage, the first participants were identified; in turn, these participants recruited up to six other transgender women and travestis for the research. The study’s outcome was the experience of incarceration throughout life, captured through the question: “Have you ever been arrested in your life?” Results: A total of 1,245 TGW were interviewed, of which 20.3% (n=253) experienced incarceration. Incarceration was more frequent among those aged 33 to 42 years (35.6%), with lower level of education (45.5%, p<0.001), engaged in informal work (30.3%), without a partner (67.2%), and among those who reported illicit drug use (66.4%). The majority (60.9%) of TGW were incarcerated with cisgender men, and the most common reasons for imprisonment were drug trafficking (30.4%) followed by robbery (29.2%). Over a quarter of the interviewees (26.3%) experienced assault, and 13.8% reported experiencing sexual violence during incarceration. Conclusion: The results emphasize the high prevalence of incarceration among TGW. This incarceration takes place in male wards and in a context of high rates of physical and sexual violence.

ABSTRACT OBJECTIVE: This article discusses how Pre-Exposure Prophylaxis (PrEP) and the undetectable viral load=untransmissible (UVL=U) have produced reconfigurations in the contexts of affective-sexual encounters of young gay men/men who have sex with men (MSM) living with HIV (YLHIV). METHODS: In-depth interviews were conducted with nine YLHIV, aged 18 to 29, from two studies conducted in Salvador, Bahia, in 2019 and 2021. The narratives focused on unprecedented events in the prevention and treatment of HIV/AIDS, which have allowed experiences of greater intimacy and safety but also challenges and tensions in affective-sexual relationships. RESULTS: Different moments in the experience of living with HIV reveal different narratives of YLHIV concerning the new PrEP and UVL biotechnologies. Concerns surrounding possible HIV transmission or the obligation to reveal serology are more prominent among young people with the most recent diagnosis. In contrast, those with more extended serology experience are more comfortable and confident in the face of new technologies and their significant effects on sexual encounters. However, controversies remain regarding the moral and behavioral consequences of their use. Some YLHIV re-update concerns and bring reports about the continuity of stigma toward people living with HIV. Others emphasize the benefits of biomedical advances, opening up new interactive possibilities, including without the use of condoms, highlighting the existence of other practices, knowledge, dynamics, and ways of negotiating risk/care, with tensions in the field of sexuality itself. CONCLUSIONS: We reiterate the need to resume public policies in the field of HIV/AIDS beyond biomedical strategies, highlighting vulnerabilities, the dissemination of information about new HIV prevention and treatment technologies, respect for people’s autonomy in their preventive choices, and the development of strategies to combat the stigma associated with HIV/AIDS.

RESUMO OBJETIVO: Neste artigo, discutimos como a profilaxia pré-exposição (PrEP) e a carga viral indetectável=intransmissível (CVI=I) têm produzido reconfigurações nos contextos de encontros afetivo-sexuais de jovens gays/ homens que fazem sexo com homens (HSH) vivendo com HIV (JVHIV). MÉTODOS: Conduzimos entrevistas em profundidade com nove JVHIV, de 18 a 29 anos, oriundos de duas pesquisas realizadas em Salvador/Bahia, em 2019 e 2021. Focalizamos narrativas sobre acontecimentos inéditos na prevenção e no tratamento do HIV/aids, que têm permitido experiências de maior intimidade e segurança, mas também desafios e tensionamentos às relações afetivo-sexuais. RESULTADOS: Momentos distintos da experiência de viver com HIV revelam diferentes narrativas dos JVHIV com relação às novas biotecnologias de PrEP e CVI. Preocupações em torno de uma possível transmissão do HIV ou da obrigação de revelar a sorologia ficam mais destacadas entre jovens com o diagnóstico mais recente, enquanto aqueles com maior tempo de sorologia se colocam de forma mais confortável e confiante frente às novas tecnologias e seus efeitos significativos nos encontros sexuais, ainda que permaneçam controvérsias a respeito das consequências morais e comportamentais do uso delas. Alguns JVHIV reatualizam preocupações e trazem relatos sobre a continuidade do estigma em relação às pessoas vivendo com HIV. Outros JVHIV enfatizam os benefícios dos avanços biomédicos, com abertura para novas possibilidades interativas, inclusive sem uso da camisinha, sublinhando a existência de outras práticas, saberes, dinâmicas e formas de negociação do risco/cuidado, com tensionamentos no campo da própria sexualidade. CONCLUSÕES: Reiteramos a necessidade de retomada de políticas públicas no campo do HIV/aids para além das estratégias biomédicas, dando destaque às vulnerabilidades, à disseminação de informações sobre as novas tecnologias de prevenção e tratamento do HIV, ao respeito à autonomia das pessoas em suas escolhas preventivas e ao desenvolvimento de estratégias de enfrentamento aos estigmas associados ao HIV/aids.

ABSTRACT OBJECTIVE: To evaluate whether adolescents from sexual minorities who initiated pre-exposure prophylaxis (PrEP) in community-based organizations (COs) are more socially and HIV-vulnerable compared with their counterparts from a conventional health service. In addition, to evaluate whether these adolescents had more timely access to prophylaxis METHODS: A PrEP demonstration study was conducted in the city of São Paulo in two COs, located in the center (CO-center) and the outskirts (CO-outskirts), and a conventional HIV testing service (CTA-center). Between 2020 and 2022, cisgender male adolescents who have sex with men (aMSM), transgender and gender diverse adolescents (aTTrans) aged 15 to 19 years, HIV-negative, with higher-risk practices for HIV were eligible for PrEP. Indicators of timely access and vulnerabilities of adolescents initiating PrEP in COs were analyzed using CTA-center as a reference and multinomial logistic regression. RESULTS: 608 adolescents initiated PrEP in COs and CTA-center. Adolescents from COs were associated with a shorter time to PrEP initiation (1–7 days; CO-outskirts: ORa = 2.91; 95%CI 1.22–6.92; CO-center: ORa = 1.91; 95%CI 1.10–3.31); and a lower housing Human Development Index (HDI) (CO-center: ORa = 0.97; 95%CI 0.94–1.00; CO-outskirts: ORa = 0.82; 95%CI 0.78–0.86). In CO-outskirts, there was an increased chance of adolescents being younger (ORa = 3.06; 95%CI 1.63–5.75) and living closer to the service (ORa = 0.82; 95%CI 0.78–0.86, mean 7.8 km). While adolescents from the CO-center were associated with greater prior knowledge of PrEP (ORa = 2.01; 95%CI 1.10–3.91) and high-risk perception (ORa = 2.02; 95%CI 1.18–3.44), adolescents from the COs were not associated with higher-risk sexual practices and situations of vulnerability to HIV. CONCLUSION: The provision of PrEP in the COs facilitated access for vulnerable adolescents and may contribute to reducing inequities.

RESUMO OBJETIVO: Avaliar se adolescentes de minorias sexuais que iniciaram a profilaxia pré-exposição sexual (PrEP) em organizações comunitárias (OC) apresentam maior vulnerabilidade social e ao HIV em comparação com adolescentes em PrEP de um serviço de saúde convencional. Além disso, avaliar se esses adolescentes tiveram um acesso mais oportuno à profilaxia. MÉTODOS: Estudo demonstrativo da efetividade de PrEP, realizado na cidade de São Paulo, em duas OC, localizadas no centro (OC-centro) e na periferia (OC-periferia), e em um serviço convencional de testagem para o HIV (CTA-centro). Foram elegíveis para PrEP, entre 2020 e 2022, adolescentes homens cisgêneros que fazem sexo com homens (aHSH), travestis, mulheres transexuais e pessoas transfemininas (aTTrans), de 15 a 19 anos, HIV-negativos e com práticas de maior risco para o HIV. Indicadores de acesso oportuno e de vulnerabilidades dos adolescentes iniciando PrEP nas OC foram analisados, tendo por referência o CTA-centro e empregando regressão logística multinomial. RESULTADOS: 608 adolescentes iniciaram PrEP nas OC e CTA-Centro. Adolescentes das OC estiveram associados a um menor tempo de início de PrEP (1–7 dias; OC-periferia: ORa = 2,91; IC95% 1,22–6,92; OC-centro: ORa = 1,91; IC95% 1,10–3,31); e a um menor IDH de moradia (OC-centro: ORa = 0,97; IC95% 0,94–1,00; OC-periferia: ORa = 0,82; IC95% 0,78–0,86). Na OC-periferia houve aumento na chance de os adolescentes serem mais jovens (ORa = 3,06; IC95% 1,63–5,75) e morarem mais próximos ao serviço (ORa = 0,82; IC95% 0,78–0,86, média 7,8 km). Enquanto adolescentes da OC-centro estiveram associados ao maior conhecimento prévio de PrEP (ORa = 2,01; IC95% 1,10–3,91) e a alta percepção de risco (ORa = 2,02; IC95% 1,18–3,44). Não estiveram associadas aos adolescentes das OC as práticas sexuais de maior risco e as situações de vulnerabilidade ao HIV. CONCLUSÕES: A oferta de PrEP nas OC facilitou o acesso de adolescentes vulnerabilizados e pode contribuir para reduzir inequidades.

ABSTRACT OBJECTIVE: To analyze the factors that increase the practice of condomless anal sex (CAS) among adolescent men who have sex with men (AMSM) and adolescent travestis and transgender women (ATGW) in three Brazilian state capitals. METHODS: PrEP1519 is a prospective, multicenter cohort study demonstrating the effectiveness of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among AMSM and ATGW aged from 15 to 19 years in three Brazilian state capitals. The analyses were performed with baseline cohort data, including 1,418 adolescents enrolled from 2019 to 2021. The outcome studied was CAS in the last six months, and the potentially associated factors were sociodemographic, behavioral, healthcare, and history of violence and discrimination. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (95%CI) were estimated. RESULTS: Most of the participants were AMSM (91.5%), aged 18 to 19 years (75.9%), Black (40.5%), with secondary or higher education in progress (92.7%), with CAS during the first sexual intercourse (54.2%), sexual initiation before the age of 14 (43.4%), and history of group sex (24.6%) and transactional sex (14.6%). The prevalence of CAS in the last six months was 80.6% (95%CI 78.5%-82.6%). Adolescents who reported condomless first sexual intercourse (aPR: 1.18; 95%CI 1.10-1.25), use of psychoactive substances (aPR: 1.09; 95%CI 1.03-1.16), and transactional sex (aPR: 1.11; 95%CI 1.04-1.20) had a higher prevalence of CAS in the last six months. We also found that those aged 15 to 17 years had a higher prevalence of CAS than those aged 18 to 19 (aPR: 1.07; 95%CI 0.99-1.13). CONCLUSIONS: The prevalence of CAS was high among AMSM and ATGW, being associated with practices that may increase the risk of sexually transmitted infections (STIs). Therefore, it is recommended to strengthen sexual health programs for young people that address the issue of sexuality and STI prevention, as well as to expand access to preventive methods, such as condoms and PrEP.

RESUMO OBJETIVO: Analisar os fatores que aumentam a prática de sexo anal sem preservativo (SASP) entre adolescentes homens que fazem sexo com homens (aHSH) e travestis mulheres trans (aTrMT) em três capitais brasileiras. MÉTODOS: PrEP1519 é uma coorte prospectiva, multicêntrica, de demonstração da efetividade da profilaxia pré-exposição (PrEP) ao HIV entre aHSH e aTrMT, com idade entre 15 e 19 anos, em três capitais brasileiras. As análises foram realizadas com dados da linha de base da coorte, com a inclusão de 1.418 adolescentes inscritos de 2019 a 2021. O desfecho estudado foi SASP nos últimos seis meses, e os potenciais fatores associados foram sociodemográficos, comportamentais, de assistência à saúde e histórico de violência e discriminação. Foi realizada análise descritiva, bivariada e multivariada. Estimaram-se razões de prevalência ajustadas (RPa) e intervalos de confiança de 95% (IC95%). RESULTADOS: A maioria dos participantes era aHSH (91,5%), com idade de 18 a 19 anos (75,9%), pretos (40,5%), ensino médio e superior em andamento (92,7%), com relato de SASP na primeira relação sexual (54,2%), início da vida sexual antes dos 14 anos (43,4%) e história de sexo em grupo (24,6%) e de sexo transacional (14,6%). A prevalência de SASP nos últimos seis meses foi de 80,6% (IC95% 78,5%-82,6%). Adolescentes que relataram primeira relação sexual sem preservativo (RPa: 1,18; IC95% 1,10-1,25), consumo de substâncias psicoativas (RPa: 1,09; IC95% 1,03-1,16) e sexo transacional (RPa: 1,11; IC95% 1,04-1,20) tiveram maior prevalência de SASP nos últimos seis meses. Verificou-se também que aqueles com idade de 15 a 17 anos tiveram maior prevalência de SASP em comparação àqueles de 18 a 19 anos (RPa: 1,07; IC95% 0,99-1,13). CONCLUSÕES: A prevalência de SASP foi alta entre aHSH e aTrMT, bem como esteve associada a práticas que podem aumentar o risco de infecções sexualmente transmissíveis (IST). Assim, recomenda-se o fortalecimento de programas de saúde sexual para jovens que abordem o tema da sexualidade e prevenção de IST, tal como a ampliação do acesso a métodos preventivos, como preservativo e PrEP.