Fatores determinantes da exposição sexual ao HIV em adolescentes luso-brasileiros: uma análise de caminhos*

Abstract

Resumo Objetivo: analisar os efeitos diretos e indiretos de fatores determinantes da exposição sexual ao vírus da imunodeficiência humana entre adolescentes homens que fazem sexo com homens e as implicações para o cuidado em enfermagem. Método: estudo transversal, realizado com 578 adolescentes de 18 a 19 anos luso-brasileiros. Avaliaram-se inter-relações de situação conjugal, uso de aplicativos de relacionamento, prática de chemsex, desinformação, credibilidade do parceiro, práticas sexuais desafiadoras e medidas protetivas pouco eficazes sobre a exposição sexual ao vírus da imunodeficiência humana, com a técnica de Análise de Caminhos. Resultados: apresentou efeito direto significante para exposição sexual ao vírus da imunodeficiência humana: situação conjugal (β=-0,16), uso de aplicativos (β=-0,30), práticas sexuais desafiadoras (β=0,48) e medidas protetivas pouco eficazes (β=0,35). Nos caminhos indiretos: credibilidade do parceiro influenciou medidas protetivas pouco eficazes (β=0,77); ter relacionamento fixo/poliamoroso influenciou o uso de aplicativos de relacionamento (β=-0,46); chemsex, mediado por práticas sexuais desafiadoras (β=0,67), determinou maior exposição sexual. Conclusão: comportamentos sexuais dos adolescentes e configurações do relacionamento amoroso/sexual precisam ser considerados no planejamento da assistência em enfermagem para diminuir a exposição sexual ao vírus da imunodeficiência humana.

Intention to use PrEP among men who have sex with men and engage in chemsex: an international descriptive study

“…Among the possible explanations for this, the awareness of risk, the desire to minimize or mitigate the possibility of infection associated with recurring bareback sex, and the previous history of other STIs may lead individuals to healthcare services, sensitizing them to the importance of this strategy, and motivating them to consider the use of PrEP as a preventive measure. 32 An unexpected finding in this study was that individuals with knowledge of PEP demonstrated a lower intention to use PrEP. Given that both are closely related prevention strategies, it was anticipated that familiarity with PEP would increase the intention to use PrEP.…”

“…56 However, the literature points out that partner trust can influence this perception of risk, leading some MSM who have high trust in their partners to adopt prevention measures with little or no effectiveness, such as interrupted coitus, questioning the history of STIs, relying on the partner's physical appearance, or asking about serological status. 30,32 In addition, there is evidence that indicates that, although chemsex occurs more frequently with casual partners, these partners are not always unknown. 11,34,60 This is due to the greater difficulty in finding partners who share the same type of drug for sex, which can create a sense of closeness and trust even with casual partners.…”

“…A rigorous participant recruitment process has been described in previous research and used two combined and validated strategies for other populations. [31][32][33] The first consisted of intentional 'snowball' sampling, with adaptations to the virtual environment. 31,32 In this method, we intentionally selected the first 30 participants, called 'seeds,' and defined different characteristics to improve the ability to generalize the findings, dividing them according to age group (young adults and older adults), region or district of residence in each country, self-identified skin color (standardized as White/ non-White), income, and educational level.…”

“…[31][32][33] The first consisted of intentional 'snowball' sampling, with adaptations to the virtual environment. 31,32 In this method, we intentionally selected the first 30 participants, called 'seeds,' and defined different characteristics to improve the ability to generalize the findings, dividing them according to age group (young adults and older adults), region or district of residence in each country, self-identified skin color (standardized as White/ non-White), income, and educational level. Thus, the participants themselves helped recruit other individuals in similar situations through their social networks and contacts by sending them an invitation to participate.…”

“…The subsequent practices were delineated drawing upon prior studies: 30,32,38 a. Double penetration (DP): The act of being simultaneously penetrated by two or more partners.…”