School-based sexual and reproductive health education for young people from low-income neighbourhoods in Northeastern Brazil: the role of communities, teachers, health providers, religious conservatism, and racial discrimination

Reaching Out to Adolescents at High Risk of HIV Infection in Brazil: Demand Creation Strategies for PrEP and Other HIV Combination Prevention Methods

“…Unlike our study, in the Brazilian National Health System (in Portuguese: Sistema Único de Saúde–SUS ) PrEP Program, where PrEP is only available for individuals aged 18 or above (as of 2022, PrEP became available for people over 15 years old), most PrEP users are white, with a high level of schooling, and aged between 30 and 39 years (Brasil, 2020b ). The intersection of race, sexuality, and age is important because discrimination against black male adolescents is a well-documented reality in Brazil, especially in schools, and generally manifests indirectly in social relations, with individuals being differentiated according to their ethnic background (Guimarães & Pinto, 2016 ; Magno et al, 2022 ). The high enrollment of participants with black skin color in the PrEP1519 study differs from studies with adolescents carried out in the USA (Bradley et al, 2020 ).…”

“…Youth and adolescents from low- and middle-income countries (LMIC) face barriers to HIV prevention (Patton et al, 2016 ) and are exposed to multiple factors that increase their risk for HIV infection. Such factors may operate at the individual level (e.g., low level of education, use of psychoactive substances, difficulty in talking about sexuality at one’s home and/or at school) (Felisbino-Mendes et al, 2018 ; Jarrett et al, 2018 ; Magno et al, 2022 ;), the programmatic level (e.g., limited availability of HIV prevention services, exigence of parental consent for consultations) (DeMaria et al, 2009 ; Magno et al, 2022 ), and the structural level (e.g., conservative environment, absence of legislative protection against sexual coercion, violence, and discrimination for adolescents) (Dubov et al, 2018 ; Magno et al, 2022 , 2019a , b ; Melesse et al, 2020 ).…”