ART-treated HIV-infected individuals seem to have impaired and/or less durable responses to YFV than HIV-uninfected individuals, which were associated with lower CD4(+)/CD8(+) ratio, but not with CD4(+) T-cell count. These results supports the notion that low CD4(+)/CD8(+) ratio, a marker linked to persistent immune activation, is a better indicator of functional immune disturbance than CD4(+) T-cell count in patients with successful ART.

AIDS-related stigma is a major hurdle to care and it hinders people from accessing HIV prevention methods, such as post-exposure prophylaxis. This study was designed to explore how AIDS-related stigma impacts the experience of using non-occupational post-exposure prophylaxis (nPEP) for HIV after sexual contact. Data were gathered in in-depth interviews with 59 people who voluntarily sought out nPEP in five public healthcare facilities in Brazil between 2015 and 2016. Data were analysed into three thematic categories: fear of being mistaken for a person living with HIV and AIDS (PLWHA); desire to hide particular features of one’s sexual life; and experiences of stigmatising behaviour due to nPEP use. Based on the Health Stigma and Discrimination Framework, predominant manifestations of AIDS-related stigma in each category were analysed, as well as their intersections with gender- and sexuality-related stigmas. Results show that experiences of using nPEP are permeated by AIDS-related stigma, intersecting with sexuality- and gender-related stigmas. Stigma experiences are mainly perceived, anticipated and internalised; stigma practices include prejudice and stigmatising behaviours. Taking antiretrovirals (ARVs) led participants to the fear of being discriminated against as a PLWHA and having particular features of their sexual identities disclosed. Thus, hiding nPEP was strategic to protect from stigmatising behaviour. As ARV-based prevention technologies are scaled-up, interventions designed to tackle AIDS- and sexuality-related stigmas must be expanded in Brazil. Required interventions include public campaigns about nPEP, educational programmes in healthcare settings to offer adequate support to nPEP users and investments in stigma research and monitoring.

La masculinidad hegemónica distancia a los hombres heterosexuales activos de las respuestas a la epidemia de sida. Sin embargo, con el paradigma de la prevención combinada, la profilaxis posexposición sexual hace posible nuevas formas de gestionar los riesgos de infección, al tiempo que trae nuevos desafíos. El objetivo de este artículo es, a la luz de la perspectiva de género y de las masculinidades, discutir cómo los hombres heterosexuales activos perciben su riesgo frente al VIH, cómo manejan los métodos y estrategias de prevención, incluyendo la profilaxis posexposición sexual. El estudio de abordaje cualitativo entrevistó 16 hombres heterosexuales activos en cinco servicios de salud de diferentes ciudades brasileñas. El análisis señala que el uso del condón, principal método de prevención, fue condicionado a factores subjetivos y contextuales; y su fallo se destaca como el principal motivo de búsqueda de la profilaxis posexposición sexual. Los ideales de masculinidad hegemónica penetraron los discursos de percepción y gestión de riesgo en el actual contexto de la epidemia de sida.

Resumo No atual contexto da epidemia de HIV múltiplas estratégias de prevenção vêm se apresentando como alternativas para populações mais suscetíveis, incluindo as biomédicas. Este trabalho buscou compreender as percepções de risco ao HIV de homossexuais e bissexuais e a experiência de uso da Profilaxia Pós-Exposição sexual ao HIV (PEP Sexual). Trata-se de estudo de abordagem qualitativa com uso de entrevistas semiestruturadas com 25 participantes em cinco cidades brasileiras. Os resultados apontam que dada a proeminência do preservativo como estratégia de prevenção ao HIV/Aids, a falha do método, o uso não consistente e o não uso intencional constituem as referências centrais da percepção de risco e a consequente tomada de decisão de busca por PEP. Quanto às percepções e os significados do uso da PEP, estes são modulados pelo conhecimento prévio sobre o método. O trabalho amplia o debate sobre aspectos subjetivos envolvendo a prevenção do HIV entre HSH, especialmente no que concerne a percepção de risco e tomada de decisão para o uso da PEP no atual cenário da epidemia e no contexto da prevenção combinada.

Background: Qualitative studies on HIV prevention strategies and methods among men who have sex with men (MSM) allow identify knowledge gaps and improve preventive actions. Objective: To make a thematic synthesis of the scientific productions that use the qualitative methodology in the strategies and methods of HIV prevention area among MSM. Methods: We conducted a literature review following the guidelines of the ENTREQ protocol. The analysis included 48 empirical studies published in Portuguese, English and Spanish between 2001 and 2018 available in the Medline, Embase, Scielo, Scopus, Bireme and Web of Science databases. Results: Where an increased production in the last six years and concentration in northern countries. Seven prevention methods were part of the study, with emphasis on pre-exposure prophylaxis, testing, condoms and behavioral strategies. The main topics discussed were stigma and support and care networks. Conclusion: we notice that an increasing production on prevention in the men who have sex with men segment results from the emergence of multiple preventive methods and strategies and their combined actions beyond the star role of condoms.

AgradecimentosAgradeço à CAPES pelo fomento da bolsa que me permitiu realizar este trabalho.Agradeço ao Prof. Heráclito Barbosa de Carvalho por abrir a porta do Departamento de Medicina Preventiva da Universidade de São Paulo.Meu muito obrigado aos voluntários desse estudo. Sem vocês, nada disso seria possível. Agradeço à Lilian e à Gorete, secretárias do Departamento de MedicinaPreventiva, que ajudaram com todos os processos burocráticos.Obrigado aos amigos que iniciaram essa jornada comigo e aos que conheci durante o caminho. Mas, especialmente, tenho que agradecer à Ana Lucia Spiassi pela grande ajuda em momentos de total confusão e loucura, e à Márcia Cunha, por me apoiar em momentos muito difíceis e me ajudando a tomar uma das decisões mais importantes de todo esse processo.Não posso esquecer dos amigos que sempre estiveram a postos com seus ouvidos para receber minhas lamúrias e desventuras. Desses, quero deixar um obrigado especial para Camila Monteiro, Grace Noronha, Gina Orsório, Juliana Kodaira, Barbara Moura, Bruna Demari, Liza Uchimura e Andréa Tenório. Meu muito obrigado.Obrigado a minha família que, mesmo a distância, sempre se orgulharou e me apoiou em todos os meus estudos.Ao meu marido, Ricardo Palacios, quero fazer um agradecimento especial. Na verdade, não sei como transformar em palavras o que gostaria de dizer.Tenho que agradecer não só pela vida compartilhada, mas pela ajuda em todos os momentos deste trabalho; nas comemorações, nos choros, nas crises, nas evoluções e revoluções. Obrigado pelo apoio e pelo amor incondicional. Te amo. Resumo

Technologies for prevention of HIV and other sexually transmitted infections (STIs) have changed and improved over the last decade. Men having sex with men (MSM) are among the HIV target populations as well among the most vulnerable to HIV infection, therefore, from a combined prevention perspective, the use of post-exposure prophylaxis (PEP) in combination with other methods and prevention strategies is highly recommended. The scientific literature has limited qualitative studies in this segment on decision making regarding the use of combined prevention, more specifically of PEP. Taking into account the possible combinations of social markers, such as sexual orientation, gender, generation, race / ethnicity and social class, risk perceptions and vulnerability of MSM; the objective of this work is to understand the process of choosing the PEP strategy in the context of combined prevention programs of and the impact of its use on the affective-sexual experience of MSM. Two articles were written focusing on this subject, the first one is a synthesis thematic of literature, which is a qualitative review of prevention methods and methods among MSM. The text demonstrates the primacy of studies addressing some HIV prevention methods and strategies in the MSM group at the expense of others, and relevance of stigma issues and support networks in the effectiveness of surveyed prevention methods and strategies. The second article is a qualitative analysis of empirical material derived from interviews with 25 MSM using PEP in five Brazilian cities. The article investigates risk perceptions and the PEP use experience, contributing to the strengthening of the discussion on the stigma impacts and the great potential of the support networks for combined prevention as a whole. The two common findings, stigma and support networks, are shown as key pieces to understand and act in prevention with the MSM population, bringing even more theoretical elements to the discussion on combined HIV prevention.

Before a vaccine against SARS-CoV-2 became available, several measures to control COVID-19 pandemic are necessary. Analogously, in the absence of an available vaccine, Combination HIV Prevention Programmes have consolidated a large experience of biomedical, behavioral and structural interventions suitable for several epidemiological settings. Adaptation of such experiences can organize mid-term and long-term responses to face COVID-19