AIDS- and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study

Abstract

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.

Eliminating stigma and discrimination in sexual and reproductive health care: a public health imperative

“…Secrecy dominated the experiences of the participants, driven by the fear of being discriminated against and mistaken for a person living with HIV, and a desire to hide aspects of their sexual identity. 20 Challenging, disrupting, resolving…”

“…Using a comprehensive analysis of drivers, intersections, manifestations and outcomes of stigma for HIV prophylaxis, Ferraz and colleagues propose multilevel interventions ranging from societal (publicity and public debate) and systems approaches (monitoring, identifying good practices), to individual (training, counselling) responses. 20 Cullen and Korolczuk look at the role of public discourse and mass culture in disrupting stigmatisation. They provide a fascinating analysis of how the abortion campaigns in Poland and Ireland framed their arguments, combating stigmatisation of abortion through mainstreaming and empathetic or emotive means.…”

“…Using a comprehensive analysis of drivers, intersections, manifestations and outcomes of stigma for HIV prophylaxis, Ferraz and colleagues propose multilevel interventions ranging from societal (publicity and public debate) and systems approaches (monitoring, identifying good practices), to individual (training, counselling) responses. 20 …”

Effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohort studies in Brazil: COBra study protocol

“… 26 27 MSM and TGW may be less willing to disclose sexual health needs during the pandemic to avoid disclosing their sexual orientation and gender identity within the household. 28 Studies 29 have observed an increased difficulty among MSM and TGW in accessing HIV prevention services during the pandemic, disproportionately affecting young people. 30 In Brazil, barriers to picking up pre-exposure prophylaxis (PrEP) refills at health services were the main reason for adult MSM and TGW stopping PrEP during the pandemic.…”

Discrimination Due to Sexual Orientation and Associated Factors Among Men Who have Sex with Men in 12 Brazilian Cities: A Respondent-Driven Sampling Survey

“…HIV prevention guidelines for transgender population were also removed, arguing that this document contained "content that was offensive to the family"[53].The current political context in Brazil is one of increased stigma directed towards LGBT communities that most likely will increase DDSO. Between 2009 and 2016, the persistence and increase in DDSO may constitute a signi cant barrier of access to health services, as well as universal access to antiretroviral therapies to treat and prevent HIV (such as the Pre-and Post-exposure prophylaxis)[55][56][57].…”