Neste artigo aponto alguns desafios que a epidemia de AIDS vem apresentando àqueles envolvidos com a promoção da saúde de homens com práticas homossexuais. Apesar de os homossexuais destacarem-se no empenho para enfrentar a epidemia, com uma mobilização que gerou ONGs, manuais sobre sexo seguro e promoção dos direitos humanos, continuam sofrendo com a associação AIDS-homossexualidade. Divido os desafios a serem enfrentados em três campos: epidemiologia, prevenção e assistência. Saliento a importância da interdisciplinaridade dos diferentes saberes, da solidariedade entre pesquisadores e ativistas e da integralidade das ações de prevenção e assistência. As lições aprendidas indicam que as relações entre homossexualidade e saúde devem se definir a partir da solidariedade e da promoção da felicidade.
In this paper I discuss some challenges posed by the AIDS epidemic to those involved in the promotion of health among men with homosexual practices. Although homosexuals are at the forefront of the struggle against the epidemic, with a mobilization that has generated the creation of NGOs, safe sex manuals and the promotion of human rights, they are still suffering with the association AIDS-homosexuality. I divide the challenges into three fields: epidemiology, prevention and care. I highlight the importance of interdisciplinarity among the different fields of knowledge, solidarity among researchers and activists and the integration of prevention and care actions. The lessons learned indicate that solidarity and the promotion of happiness should be the basis upon which the relations between homosexuality and health should be determined

Adherence is integral to improving and maintaining the health and quality of life of people living with HIV. Two-hundred HIV-positive adults recruited from teaching hospitals and nongovernmental organizations (NGOs) in Rio de Janeiro City were assessed on socio-demographic factors, adherence to antiretroviral therapy (ART) and psychosocial factors hypothesized to be associated with ART. Predictors of non-adherence were analyzed using bivariate and multivariate analyses. Self-reported medication adherence was high (82% had adherence > 90%). Nonadherence was associated with personal factors (i.e. sexual orientation, self-efficacy), physical factors (i.e. loss of appetite) and interpersonal factors (i.e. doctor-patient relationship). Adherence in Brazil is as good, if not better, than that seen in the US and western Europe, which is noteworthy since the sample was derived predominantly from public healthcare settings. It is possible that the connection to NGOs in Rio de Janeiro City played a helpful role in achieving high levels of adherence in this sample of people living with HIV and AIDS. Recommendations, based on study findings, include enhancing and sustaining supportive services for NGOs, promoting patient self-efficacy and behavioral skills for adherence, increasing social network support and having healthcare providers directly address patients' medication beliefs, attitudes and experience with side effects.

RESUMO.Neste trabalho discutimos o posicionamento de lideranças cristãs sobre a "gestão" das sexualidades dos jovens, no contexto de interpelação das políticas sexuais do Estado. As reflexões resultam de pesquisa etnográfica, conduzida através de levantamento documental, observação e entrevistas com 47 religiosos em Recife. A análise dos dados evidencia o espaço religioso como instância disciplinar que opera a partir de uma razão transcendente ("responsabilidade"). Espera-se que esta seja incorporada pela pessoa, que, então, passa a ser capaz de fazer escolhas apropriadas e diferenciar o "certo" do "errado". Aids e gravidez na adolescência aparecem como resultantes das "tentações da carne/erótico". Na perspectiva dos Direitos Sexuais e à Saúde, o artigo visa desconstruir a carne como domínio de "tentação" e de "força essencial" que leva ao desvio/pecado/"risco"; ressituando-a como instância positiva dos sujeitos (de direitos), e condição de fertilidade social.Palavras-chave: juventude, socialização sexual, religiões cristãs. THE CARE OF THE "FLESH" IN YOUNG PEOPLE'S SEXUAL SOCIALIZATIONABSTRACT. The positions of Christian leaders on the "management" of young people's sexuality, as contextualized within the sexual politics of the state, are discussed. They are the result of an ethnographic study undertaken through archival work, participating observation and interviews with 47 religious leaders in Recife PE Brazil. Analysis shows the space of religion as a disciplinary site, operating through transcendent reasoning ("responsibility"). The person is expected to incorporate such reasoning and make the appropriate differentiations between "right" and "wrong". AIDS and adolescent pregnancy appear as a result of "temptations of the erotic flesh". From the perspective of human rights and health, the article deconstructs the idea of the "flesh" as dominated by "temptation," and as an "essential force" which leads the person to stray/sin/"risk". It resituates sexuality as a positive instance for the subjects (with rights) and a condition for social fertility.

Religious communities have been a challenge to HIV prevention globally. Focusing on the acceptability component of the right to health, this intervention study examined how local Catholic, Evangelical and Afro-Brazilian religious communities can collaborate to foster young people’s sexual health and ensure their access to comprehensive HIV prevention in their communities in Brazil. This article describes the process of a three-stage sexual health promotion and HIV prevention initiative that used a multicultural human rights approach to intervention. Methods included 27 in-depth interviews with religious authorities on sexuality, AIDS prevention and human rights, and training 18 young people as research-agents, who surveyed 177 youth on the same issues using self-administered questionnaires. The results, analysed using a rights-based perspective on health and the vulnerability framework, were discussed in daylong interfaith workshops. Emblematic of the collaborative process, workshops are the focus of the analysis. Our findings suggest that this human rights framework is effective in increasing inter-religious tolerance and in providing a collective understanding of the sexuality and prevention needs of youth from different religious communities, and also serves as a platform for the expansion of state AIDS programmes based on laical principles.

RESUMO:Neste trabalho, buscamos apresentar os resultados de recente análise dinâmica contextual sobre as oportunidades e barreiras para a saúde sexual e reprodutiva dos jovens brasileiros. Na realização da pesquisa, revimos a literatura acadêmica mais recente, identificamos as principais ações governamentais e não-governamentais sobre essa temática e entrevistamos alguns especialistas da área. No decorrer deste trabalho, apresentamos os principais temas, concepções e ações, quando o assunto é saúde sexual dos jovens, e identificamos algumas das lacunas nas pesquisas e intervenções de educação não-formal até a inserção da educação sexual nos parâmetros curriculares nacionais na segunda metade da dé-cada de 1990. Finalizando, apresentamos uma agenda de ações e estudos no sentido de fomentar estratégias mais eficazes de promoção da saúde sexual e reprodutiva dos jovens brasileiros. Palavras-chave:Saúde sexual e reprodutiva. Juventude brasileira.Análise contextual. Epidemia de HIV/AIDS. gravidez na adolescência. TOWARDS ADULTHOOD: CHANCES AND BARRIERS IN THE SEXUAL HEALTH OF YOUNG BRAZILIANSABSTRACT: In this paper we present the results of a recent contextual dynamic analysis about the chances and barriers in the * Todos os autores são membros da Associação Brasileira Interdisciplinar de AIDS (ABIA).

IntroductionCritical technological advances have yielded a toolkit of HIV prevention strategies. This literature review sought to provide contextual and historical reflection needed to bridge the conceptual gap between clinical efficacy and community effectiveness (i.e. knowledge and usage) of existing HIV prevention options, especially in resource-poor settings.MethodsBetween January 2015 and October 2015, we reviewed scholarly and grey literatures to define treatment literacy and health literacy and assess the current need for literacy related to HIV prevention. The review included searches in electronic databases including MEDLINE, PsycINFO, PubMed, and Google Scholar. Permutations of the following search terms were used: “treatment literacy,” “treatment education,” “health literacy,” and “prevention literacy.” Through an iterative process of analyses and searches, titles and/or abstracts and reference lists of retrieved articles were reviewed for additional articles, and historical content analyses of grey literature and websites were additionally conducted.Results and discussionTreatment literacy was a well-established concept developed in the global South, which was later partially adopted by international agencies such as the World Health Organization. Treatment literacy emerged as more effective antiretroviral therapies became available. Developed from popular pedagogy and grassroots efforts during an intense struggle for treatment access, treatment literacy addressed the need to extend access to underserved communities and low-income settings that might otherwise be excluded from access. In contrast, prevention literacy is absent in the recent surge of new biomedical prevention strategies; prevention literacy was scarcely referenced and undertheorized in the available literature. Prevention efforts today include multimodal techniques, which jointly comprise a toolkit of biomedical, behavioural, and structural/environmental approaches. However, linkages to community advocacy and mobilization efforts are limited and unsustainable. Success of prevention efforts depends on equity of access, community-based ownership, and multilevel support structures to enable usage and sustainability.ConclusionsFor existing HIV prevention efforts to be effective in “real-world” settings, with limited resources, reflection on historical lessons and contextual realities (i.e. policies, financial constraints, and biomedical patents) indicated the need to extend principles developed for treatment access and treatment literacy, to support prevention literacy and prevention access as an integral part of the global response to HIV.

Religious institutions, which contribute to understandings of and mobilization in response to illness, have played a major role in structuring social, political, and cultural responses to AIDS. We used institutional ethnography to explore how religious traditions – Catholic, Evangelical, and Afro-Brazilian - in Brazil have influenced HIV prevention, treatment and care on a local and national level over time. We present a typology of their division of labor and uncover overlapping foci grounded in religious ideology and tradition: care of people living with HIV (PLHIV) among Catholics and Afro-Brazilians; abstinence education among Catholics and Evangelicals; prevention within marginalized communities among Evangelicals and Afro-Brazilians; and access to treatment among all traditions. We conclude that institutional ethnography, which allows for multi-level and inter-level analysis, is a useful methodology and that the religious discourses used to frame discussions of HIV, AIDS, and PLHIV – e.g., as an issue of suffering, inequality, or immorality – may vary within religious institutions across time and space. We suggest that further multi-level examinations of religious institutions’ responses to the epidemic may reveal opportunities for cross-denominational collaboration, within-denomination intervention, and policy change.

Increasing access and frequency of human immunodeficiency virus testing are critical to stemming the epidemic. In Brazil's concentrated epidemic, human immunodeficiency virus prevalence in the men who have sex with men/transgender population far exceeds that in the general population, but testing rates fall below what is needed to ensure early detection and treatment. Over-the-counter human immunodeficiency virus self-testing kits, now available in stores in the U.S., have enormous potential to increase testing access and frequency and to facilitate early detection and treatment. With the advent of human immunodeficiency virus self-testing upon us, it is timely to engage the scientific community, government, and civil society in a dialog around how to best utilize this technology in Brazil. We summarize recent research on over-the-counter testing among men who have sex with men, raise potential questions and challenges to using self-tests, suggest implementation strategies, and outline a research agenda moving forward.