PrEP perception and experiences of adolescent and young gay and bisexual men: an intersectional analysis

Abstract

Studies indicate gaps in knowledge about the barriers to access and adhere to HIV pre-exposure prophylaxis (PrEP) in adolescents. In this article, we explore the perceptions and experiences of young gay, bisexual, and other men who have sex with men (YGBMSM) of the search, use and adherence to PrEP, considering their positions according to social markers of difference such as race/skin color, gender, sexuality, and social status. Intersectionality provides theoretical and methodological tools to interpret how the interlinking of these social markers of difference constitutes barriers and facilitators in the PrEP care continuum. The analyzed material is part of the PrEP1519 study and is comprised of 35 semi-structured interviews with YGBMSM from two Brazilian capitals (Salvador and São Paulo). The analyses suggest connections between social markers of difference, sexual cultures, and the social meanings of PrEP. Subjective, relational and symbolic aspects permeate the awareness of PrEP in the range of prevention tools. Willingness to use and adhere to PrEP is part of a learning process, production of meaning, and negotiation in the face of getting HIV and other sexually transmittable infections and the possibilities of pleasure. Thus, accessing and using PrEP makes several adolescents more informed about their vulnerabilities, leading to more informed decision-making. Interlinking the PrEP continuum of care among YGBMSM with the intersections of the social markers of difference may provide a conceptual framework to problematize the conditions and effects of implementing this prevention strategy, which could bring advantages to HIV prevention programs.

Prevenção combinada do HIV para homens adolescentes que fazem sexo com homens e mulheres adolescentes transexuais no Brasil: vulnerabilidades, acesso à saúde e expansão da PrEP

“…Oliveira et al 37 analisaram a ligação de adolescentes HSH e mulheres adolescentes trans com o serviço do PrEP1519 em Salvador através da mediação de navegadores de pares, mostrando que navegadores e adolescentes trabalham juntos, se influenciam e precisam um do outro para criar um vínculo com cuidados de saúde. Santos et al 38 exploraram as percepções e experiências de jovens gays, bissexuais e outros HSH de São Paulo e Salvador quanto a sua busca, uso e adesão à PrEP através de uma abordagem interseccional, ou seja, discutindo aspectos pessoais/relacionais e dimensões estruturais e simbólicas como facilitadores e barreiras para o contínuo do cuidado dentro da PrEP. Suas análises mostraram que, em termos individuais/subjetivos, as possibilidades de uso e a busca pela PrEP pertencem a um processo de aprendizagem baseado em experiências e ideais de prazer e liberdade em relação à percepção de risco e manejo da prevenção do HIV.…”

Combination HIV prevention for adolescent men who have sex with men and adolescent transgender women in Brazil: vulnerabilities, access to healthcare, and expansion of PrEP

“…They showed that navigators and adolescents worked together, affected each other, and needed each other to "do" or to produce an emotional bond with care. Santos et al 38 explored the perceptions and experiences of young homosexual, bisexual, and other MSM from São Paulo and Salvador regarding the search, use, and adherence to PrEP using the intersectional approach, i.e., discussing personal/relational aspects and structural and symbolic dimensions as facilitators and barriers to the continuum of care in PrEP. Their analyses revealed that, in individual/subjective terms, the possibilities of use and the search for PrEP are part of a learning process based on experiences and ideals of pleasure and freedom in the perception of risk and the management of HIV prevention.…”

Prevención combinada del VIH para hombres adolescentes que tienen relaciones sexuales con otros hombres y con mujeres adolescentes transgénero en Brasil: vulnerabilidades, acceso a la atención en salud y expansión de la PrEP

“…En el primero, Oliveira et al 37 analizaron la vinculación de HSH adolescentes y mujeres transgénero adolescentes a la clínica de PrEP en Salvador, a través de la mediación de navegadores pares y mostraron que navegadores y adolescentes trabajaban juntos, se afectaban mutuamente y se necesitaban para "hacer" o producir un vínculo con la atención. Santos et al 38 exploraron las percepciones y experiencias de jóvenes gays, bisexuales y otros HSH de los sitios de São Paulo y Salvador, en relación a la búsqueda, uso y adherencia a la PrEP utilizando el abordaje interseccional, es decir, discutiendo aspectos personales/relacionales y dimensiones estructurales y simbólicas como facilitadores y barreras para el continuo de cuidados en PrEP. Sus análisis revelaron que, en términos individuales/subjetivos, las posibilidades de uso y la búsqueda de la PrEP forman parte de un proceso de aprendizaje basado en experiencias e ideales de placer y libertad, en la percepción del riesgo y en la gestión de la prevención del VIH.…”