Adherence to Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in Portuguese-Speaking Countries

Abstract

Strengthening strategies to improve adherence to the use of pre-exposure prophylaxis (PrEP) in key populations constitutes a global health priority to be achieved across countries, especially in countries that share a high flow of people such as Brazil and Portugal. This study aimed to analyze the factors associated with adherence to PrEP among MSM from two Portuguese-speaking countries, highlighting the opportunities and preventive strategies for the global health scenario. This was a cross-sectional analytical online survey conducted from January 2020 to May 2021 with MSM in Brazil and Portugal. For analysis of the data, the Poisson regression model was used to estimate the prevalence ratio (PR) for developing a model to evaluate the associated factors in both countries in a comparative and isolated way. Adherence to PrEP use corresponded to 19.5% (n = 1682) of the overall sample: 18.3% (n = 970) for Brazil and 21.5% (n = 712) for Portugal. Having more than two sex partners in the last 30 days (aPR: 30.87) and routinely undergoing HIV tests (aPR: 26.21) increased the use of this medication. Being an immigrant (PR: 1.36) and knowing the partner’s serological status (PR: 1.28) increased adherence to PrEP in Portugal, whereas, in Brazil, it was being an immigrant (PR: 0.83) and not knowing the serological status (PR: 2.24) that promoted the use of this medication. Our findings reinforce the need to invest in programs and strategies to improve access and adherence to PrEP, especially in key populations.

HIV testing among immigrant men who have sex with men in Brazil

“…It is crucial to provide these individuals with clear information about the advantages and disadvantages of various strategies, emphasizing the importance of combining them with other effective measures, such as regular testing, especially for those involved in more vulnerable practices like bareback sex and chemsex. Both practices have been linked to an increased risk of HIV transmission, and when combined, they further elevate the risk due to disinhibition and impaired decision‐making associated with drug use (Queiroz, Matos, et al., 2019; Sousa et al., 2023). Chemsex can also lead to additional risky sexual behaviors, including group sex or prolonged sexual encounters, which heighten the likelihood of HIV transmission (Li et al., 2022; Stansfield et al., 2023).…”

“…Researchers approached participants through direct chat with online users, and data collection was carried out by adapting the Time Location Sampling (TLS) technique to the virtual environment. These involved researchers modifying their app location to specific regions and accessing users in those areas, following previously described methods (Queiroz et al 2019; Queiroz, Matos, et al., 2019; Sousa et al., 2023).…”

“…Migration between the eight Portuguese‐speaking countries (CPLP) – Angola, Brazil, Cabo Verde, Equatorial Guinea, Guinea‐Bissau, Mozambique, Portugal, Sao Tome and Principe, and Timor‐Leste (Góis & Marques, 2009))– has been increasing. Factors such as language proficiency, as well as political and social conditions in the respective countries, influence this immigration trend (Sousa et al., 2023). Portugal currently hosts the largest Brazilian community outside of Brazil.…”

Sexual Practices and Predisposition to PrEP Use Among Men Ages 50 Years and Older Who Have Sex With Men: A Cross-Sectional Study

“…In the subsequent sections, we examined variables pertaining to sexual practices, encompassing the following aspects: preventive measures against HIV during sex, engaging in sexual activity with a partner living with HIV, involvement in group sex (three or more people simultaneously), subjective self-assessment of HIV infection risk, preferred sexual positioning, engaging in receptive anal intercourse without a condom, recent participation in unprotected sex, drug use during sexual encounters or engaging in sex under the influence of drugs in the past six months, engaging in sexual activity at gay saunas, adult cinemas, gay bars, or other venues, engaging in bareback sex (unprotected anal intercourse), double penetration, or fisting, as well as the frequency of seeking health care services. We provided clear and accessible explanations for uncommon or potentially unfamiliar terms such as “cruising” (Gama et al, 2017), “double penetration (DP)” (Sousa, Lima et al, 2023; Teixeira et al, 2022), “chemsex” (Chone et al, 2021; Sousa, Camargo et al, 2023), and “gouinage” (Sousa, et al, 2019) to ensure participant comprehension.…”

Sexual exposure to HIV in Angolan men who have sex with men immigrants: A cross-sectional study in Portugal and Brazil

“…This is an analytical and cross-sectional study, carried out throughout Brazil and Portugal with men who have sex with men, from January 2020 to May 2021, as part of the “In_PrEP” project. 11,12…”