Dulce Ferraz

In Brazil, young transgender women (YTW) bear a disproportionate burden of HIV, which persists despite technological advances in biomedical prevention. This study explores how rights violations across different areas of life shape YTW's vulnerability to HIV through an intersectional lens. We conducted 13 in-depth interviews and one group interview with YTW participating in an HIV pre-exposure prophylaxis (PrEP) cohort. Thematic analysis with intersectional sensibility focused on six dimensions: family, schooling, romantic-sexual relationships, friendships, work, and health. The results show that gender transition impacted all areas. Rights violations prevailed in family and school settings, while supportive friendships and romantic relationships contributed to protecting their rights. A synergistic effect emerged: family disruptions hindered education, leading to precarious jobs and increased exposure to sexual exploitation. Conversely, family and school support promoted education continuity and access to basic needs. Though healthcare discrimination was reported, HIV services were largely respectful and extended care beyond prevention. The findings highlight how interconnected rights violations during youth can deepen HIV vulnerability. Effective prevention must extend beyond biomedical access to include strategies that protect rights and strengthen community and institutional support for YTW.

A growing body of empirical research traces the impact of social media use on young women's psychological wellbeing. The aim of the present article is to explore young female users' affective relationship with social media platforms in the context of gendered, postfeminist self-making. Drawing on dialogical self-theory, this study analyses the interplay between different voices-of-the-self in participants' accounts of social media use. Participants construct social media use as a 'double-edged sword'. Being exposed to idealised content elicits self-othering, i.e. voices-of-the-self associated with postfeminist ideals devaluing various 'deficient' aspects of the self, and thus negative affects. To counter the adverse effects of self-othering, young women consume social media content aimed at normalising and thereby affectively re-integrating 'othered' aspects of the self. They also post selfies in order to be 'seen'. Our findings suggest that being negatively affected by social media requires young women to engage in ongoing affective labour to actively restore - if only temporarily - a sense of self-worth through social media use. The precariousness of the produced states of self-acceptance raises the question under what conditions social media use can have a positive impact on young women's self-understandings and thus psychological wellbeing.

Background: In 2020, people living with HIV (PLHIV) in France were worried that the COVID-19 health crisis would lead to long-term changes in their HIV care. Using data from the anonymous, online, cross-sectional survey ACOVIH, which was completed by PLHIV between July and September 2020, this study explored factors associated with worry about long-term changes to HIV care after the end of the first lockdown (17 March-11 May 2020). Methods: Using multivariate logistic regression, we compared participants who declared they were worried about long-term changes with those who did not, in terms of their demographic, behavioral, and socioeconomic characteristics, as well as their experience of the COVID-19 crisis and access to care. Results: Among the 249 respondents, 61.5% (n = 153) declared having worries about long-term changes to HIV care. Specifically, after adjustment for gender and age, PLHIV born outside of France (adjusted odds ratios (aOR) [95%CI] = 2.57[1.44;6.76]), those whose financial situation deteriorated since the beginning of the pandemic (4.87[1.97;13.20]), those with a history of HIV opportunistic infections (3.27[1.53;7.32]), and respondents who took psychotropic drugs (3.21[1.50;7.22]) were all more likely to declare having worries. In terms of related determinants, a deterioration in communication with their HIV medical team (3.47[1.61;7.94]), having worries about COVID-19 (1.36[1.14;1.62]), and believing that HIV treatment increased the risk of COVID-19 infection (1.52[1.15;2.03]), were all significantly associated with having worries about long-term changes to HIV care. Conclusion: In the context of future disease epidemics, taking into account the profiles of individual PLHIV, and providing clearer, targeted information on HIV care, could help reduce worry in this population about the continuity of HIV care and could foster efficient communication with care providers.

OBJETIVO: O objetivo deste estudo é analisar o conhecimento sobre o esquema de Profilaxia Pré-Exposição ao HIV sob demanda (PrEP-SD) e a percepção do seu uso potencial entre jovens homens que fazem sexo com homens (HSH), travestis e mulheres trans (TrMT) em acompanhamento na coorte. MÉTODOS: O estudo qualitativo incluiu 50 entrevistas com participantes das cidades de Salvador e São Paulo, entre 15 e 19 anos, que estavam usando PrEP diária ou outros métodos preventivos. Eles foram abordados por meio de diferentes estratégias de criação de demanda. As entrevistas em profundidade abordaram temas como práticas sexuais, conhecimento sobre PrEP-SD, aceitabilidade e motivações para o uso. Foi realizada análise temática em duas fases usando o software Nvivo versão 12. RESULTADOS: A maioria dos participantes desconhecia a PrEP-SD e muitos questionaram a sua efetividade e segurança ao receberem informações sobre ela. No entanto, ao conhecer o esquema, muitos jovens perceberam vantagens, como a não obrigatoriedade diária de medicamentos e a possibilidade de uso apenas em momentos de maior risco. Barreiras para o uso da PrEP-SD também foram identificadas pelos participantes, como a imprevisibilidade das relações sexuais e a dificuldade em administrar as dosagens nessa modalidade. CONCLUSÕES: O conhecimento limitado e as experiências com a PrEP oral diária influenciaram o interesse por ela, o que aponta a necessidade de estratégias informativas que permitam o letramento dos jovens HSH e TrMT na PrEP-SD. Os jovens valorizaram a autonomia e a gestão da prevenção mais alinhada à dinâmica de sua vida sexual propiciada pela nova modalidade, mas enfrentam desafios na gestão da PrEP-SD.

OBJECTIVE: This study aims to understand the perceptions and practices of healthcare providers regarding the offer of HIV pre-exposure prophylaxis (PrEP) to gay and trans adolescents and young adults. METHODS: This qualitative research was developed as part of the PrEP1519 study, which was conducted from 2018 to 2021 to analyze the effectiveness of PrEP in adolescents and young adults. Data were collected from July 2020 to February 2021 at the municipality of São Paulo by combining participant observations and semi-structured interviews. The analytical process involved immersion in the empirical material and coding and categorizing it with the support of NVivo®. Interpretation followed the hermeneutic-dialectical principle and had the concept of Care in health practices as its horizon. RESULTS: The construction of trust-based relationships followed practices that acknowledge the uniqueness of youth and their demands and sought to strengthen their autonomy. Sensitive and supportive listening was pointed out as a welcoming practice that propelled care actions. Welcoming attitudes and support in facing stigma and violence (related or not to the use of PrEP) acknowledged the need to support adolescents and young adults to develop autonomy for prevention. The use of language close to young people’s everyday life favored the construction of relationships of trust and positively influenced the development of autonomy and adherence to PrEP. The tension between technical and practical success occurred in the idealized search for adult-centric normativity as opposed to intersubjectivity. CONCLUSION: The perceptions and practices of healthcare providers are aligned with the concept of Care as they include actions beyond technical knowledge and recognize the contexts that increase the vulnerability of adolescents and young adults to HIV.

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: To understand the perceptions and experiences of transsexual and travesti women and non-binary or gender-fluid people (TGWT+) in health services where they took pre-exposure prophylaxis (PrEP) in the periods before and during the pandemic, focusing on the resignification in the relationship with services and the continuity of HIV prevention via PrEP. METHODS: Qualitative research and analysis of empirical material generated in the contexto of broader studies were conducted. A total of 45 semi-structured interviews were conducted with TGWT+ PrEP users in the city of São Paulo and analyzed using iterative thematic content analysis. RESULTS: The TGWT+ interviewees gave new meanings to their struggles, daily lives and ways of caring for their health and played a central role within them. With its particularities, the COVID-19 pandemic became one more event among all the others that TGWT+ face daily. Alongside the COVID-19 pandemic, the TGWT+ were faced with the HIV epidemic, but with the possibility of prevention via PrEP. CONCLUSION: Based on a situated and conscious perspective, more explicit in the context of the health crisis, the TGWT+ intertwined conscious actions and care practices in dialog with health services. Further research on these groups from a spatiotemporal dynamic situated in specific contexts of meaning production would make it possible to advance prevention and care strategies, especially in times of health crisis.

OBJECTIVE: This study aims to analyze the knowledge about the HIV event-driven pre- exposure prophylaxis (event-driven PrEP) scheme and the perception of its potential use among young men who have sex with men (MSM), travestis, , and transgender women (TrTW) who were followed up in the cohort. METHODS: This qualitative study included 50 interviews with participants from the municipalities of Salvador and S & atilde;o Paulo, aged 15 to 19 years, who made daily use of PrEP or other preventive methods. They were addressed by different demand creation strategies. The in-depth interviews covered topics such as sexual practices, event-driven PrEP knowledge, acceptability, and motivations for its use. A two-stage thematic analysis was carried out on Nvivo, version 12. RESULTS: Most participants were unaware of event-driven PrEP, and many questioned its effectiveness and safety when receiving information about it. However, on learning about the program, many young people saw advantages, such as not having to take daily medication and the possibility of using it only at times of greater risk. Participants also found barriers to using event-driven PrEP, such as the unpredictability of sexual relations and the difficulty in administering dosages in this modality. CONCLUSION: Limited knowledge and experiences with daily oral PrEP influenced interest in event-driven PrEP, which highlights the need for information strategies that enable young MSM and TrTW to read about event-driven PrEP. Young people valued the autonomy and management of preventive methods provides by this new modality, which is more in line with the dynamics of their sexual lives, but they face challenges in managing event-driven PrEP.

Este relato, com linguagens textual e imagética, sistematiza o processo de criação e produção de um material de educação em saúde e popularização científica: a graphic novel “180 graus: minhas reviravoltas com o câncer de mama”¹. O livro aborda o câncer de mama por meio da linguagem dos quadrinhos para discutir este problema de saúde pública que, segundo estimativa do Instituto Nacional do Câncer (INCA), em 2023, afetaria mais de 73 mil mulheres no Brasil. O relato está organizado em cinco etapas: articulação de equipe e parcerias estratégicas; pesquisa e pré-produção do material para a história em quadrinhos (HQ); desenvolvimento da HQ; elaboração de materiais pedagógicos complementares à HQ; e edição e divulgação da HQ. Ao final, há também resultados, lições aprendidas e próximos passos.

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.