STIGMATIZATION OF PRE-EXPOSURE PROPHYLAXIS (PREP) AS A BARRIER TO ADHERENCE TO COMBINED PREVENTION IN BRAZIL
DOI:
https://doi.org/10.53843/bms.v6i9.294Keywords:
Stigma. PrEP. HIV. Brazil. Prevention.Abstract
AIDS is an autoimmune disease caused by HIV. Currently, Brazil has more than 900 thousand people infected by this virus. To prevent or treat the infection, there are methods such as combined prevention, which associates different preventive methods for HIV, STIs and viral hepatitis. Within combined prevention, we have pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). This article aims to analyze the stigmatization of the use of PrEP as one of the main challenges for adherence to combined HIV prevention. This is a narrative literature review of articles indexed in PubMed, between 2013 and 2021. The analysis of the articles selected for review showed the stigma related to the individual with HIV as one of the main barriers to this implementation and continuation. In addition to the stigma, it was found that misinformation, fear of being tested for HIV, doubts about the drug's efficacy and risk of compensation, as well as structural failures in society, contribute to the limited use of PrEP in Brazil. The stigma attached to PrEP users compromises their adherence. Still, discriminatory speeches combined with a lack of incentives, through public health, contribute to stigmatization and little disseminated information about combined prevention.
Keywords: Stigma. PrEP. HIV. Brazil. Prevention.
Metrics
References
Ayala G, Makofane K, Santos G-M, Beck J, Do TD, Hebert P, et al. Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention. Journal of Sexually Transmitted Diseases [Internet]. 2013 Jul 8 [cited 2021 Aug 30];2013:1–11. Available from: https://www.hindawi.com/journals/jstd/2013/953123/
Calabrese SK, Tekeste M, Mayer KH, Magnus M, Krakower DS, Kershaw TS, et al. Considering Stigma in the Provision of HIV Pre-Exposure Prophylaxis: Reflections from Current Prescribers. AIDS Patient Care and STDs [Internet]. 2019 Feb [cited 2021 Aug 30];33(2):79–88. Available from: https://pubmed.ncbi.nlm.nih.gov/30715918/
) Calabrese SK, Underhill K. How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores.” American Journal of Public Health [Internet]. 2015 Oct [cited 2021 Aug 30];105(10):1960–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566537/
O vírus da Aids, 20 anos depois :: [Internet]. Fiocruz.br. 2021 [cited 2021 Aug 30]. Available from: http://www.ioc.fiocruz.br/aids20anos/linhadotempo.html
Golub SA. PrEP Stigma: Implicit and Explicit Drivers of Disparity. Current HIV/AIDS Reports [Internet]. 2018 Feb 19 [cited 2021 Aug 30];15(2):190–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884731/
Grangeiro A, Couto MT, Peres MF, Luiz O, Zucchi EM, Castilho EA de, et al. Pre-exposure and postexposure prophylaxes and the combination HIV prevention methods (The Combine! Study): protocol for a pragmatic clinical trial at public healthcare clinics in Brazil. BMJ Open [Internet]. 2015 Aug;5(8):e009021. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550731/pdf/bmjopen-2015-009021.pdf
Magno L, Dourado I, Sutten Coats C, Wilhite D, da Silva LAV, Oni-Orisan O, et al. Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Northeastern Brazil. Global Public Health [Internet]. 2019 Feb 4 [cited 2021 Aug 30];14(8):1098–111. Available from: https://pubmed.ncbi.nlm.nih.gov/30717633/
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O que é HIV | Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis [Internet]. Aids.gov.br. 2021 [cited 2021 Aug 30]. Available from: http://www.aids.gov.br/pt-br/publico-geral/o-que-e-hiv
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Smith DK, Herbst JH, Rose CE. Estimating HIV Protective Effects of Method Adherence With Combinations of Preexposure Prophylaxis and Condom Use Among African American Men Who Have Sex With Men. Sexually Transmitted Diseases [Internet]. 2015 Feb [cited 2021 Aug 30];42(2):88–92. Available from: https://pubmed.ncbi.nlm.nih.gov/25585067/
3) Sousa LRM, Elias HC, Fernandes NM, Gir E, Reis RK. Knowledge of PEP and PrEP among people living with HIV/aids in Brazil. BMC Public Health [Internet]. 2021 Jan 7 [cited 2021 Aug 30];21(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33413241/
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Prevenção ombinada - UNAIDS Brasil [Internet]. UNAIDS Brasil. 2019 [cited 2021 Aug 30]. Available from: https://unaids.org.br/prevencao-combinada/
Velloza J, Khoza N, Scorgie F, Chitukuta M, Mutero P, Mutiti K, et al. The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study. Journal of the International AIDS Society [Internet]. 2020 Mar [cited 2021 Aug 30];23(3). Available from: https://pubmed.ncbi.nlm.nih.gov/32144874/
Veloso VG, Mesquita F, Grinsztejn B. Pre-exposure prophylaxis for men and transgender women who have sex with men in Brazil: opportunities and challenges. Journal of the International AIDS Society [Internet]. 2015 Jul [cited 2021 Aug 30];18:20010. Available from: https://pubmed.ncbi.nlm.nih.gov/26198347/
Wilson EC, Jalil EM, Castro C, Martinez Fernandez N, Kamel L, Grinsztejn B. Barriers and facilitators to PrEP for transwomen in Brazil. Global Public Health [Internet]. 2018 Aug 7 [cited 2021 Aug 30];14(2):300–8. Available from: https://pubmed.ncbi.nlm.nih.gov/30084305/
Zucchi EM, Couto MT, Castellanos M, Dumont-Pena É, Ferraz D, Félix Pinheiro T, et al. Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study. Dalby AR, editor. PLOS ONE [Internet]. 2021 May 4 [cited 2021 Aug 30];16(5):e0249293. Available from: https://pubmed.ncbi.nlm.nih.gov/33945527/
1) Ayala G, Makofane K, Santos G-M, Beck J, Do TD, Hebert P, et al. Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention. Journal of Sexually Transmitted Diseases [Internet]. 2013 Jul 8 [cited 2021 Aug 30];2013:1–11. Available from: https://www.hindawi.com/journals/jstd/2013/953123/ DOI: https://doi.org/10.1155/2013/953123
Calabrese SK, Tekeste M, Mayer KH, Magnus M, Krakower DS, Kershaw TS, et al. Considering Stigma in the Provision of HIV Pre-Exposure Prophylaxis: Reflections from Current Prescribers. AIDS Patient Care and STDs [Internet]. 2019 Feb [cited 2021 Aug 30];33(2):79–88. Available from: https://pubmed.ncbi.nlm.nih.gov/30715918/ DOI: https://doi.org/10.1089/apc.2018.0166
) Calabrese SK, Underhill K. How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores.” American Journal of Public Health [Internet]. 2015 Oct [cited 2021 Aug 30];105(10):1960–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566537/ DOI: https://doi.org/10.2105/AJPH.2015.302816
O vírus da Aids, 20 anos depois :: [Internet]. Fiocruz.br. 2021 [cited 2021 Aug 30]. Available from: http://www.ioc.fiocruz.br/aids20anos/linhadotempo.html
Golub SA. PrEP Stigma: Implicit and Explicit Drivers of Disparity. Current HIV/AIDS Reports [Internet]. 2018 Feb 19 [cited 2021 Aug 30];15(2):190–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884731/ DOI: https://doi.org/10.1007/s11904-018-0385-0
Grangeiro A, Couto MT, Peres MF, Luiz O, Zucchi EM, Castilho EA de, et al. Pre-exposure and postexposure prophylaxes and the combination HIV prevention methods (The Combine! Study): protocol for a pragmatic clinical trial at public healthcare clinics in Brazil. BMJ Open [Internet]. 2015 Aug;5(8):e009021. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550731/pdf/bmjopen-2015-009021.pdf DOI: https://doi.org/10.1136/bmjopen-2015-009021
Magno L, Dourado I, Sutten Coats C, Wilhite D, da Silva LAV, Oni-Orisan O, et al. Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Northeastern Brazil. Global Public Health [Internet]. 2019 Feb 4 [cited 2021 Aug 30];14(8):1098–111. Available from: https://pubmed.ncbi.nlm.nih.gov/30717633/ DOI: https://doi.org/10.1080/17441692.2019.1571090
Prevenção Combinada | Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis [Internet]. Aids.gov.br. 2021 [cited 2021 Aug 30]. Available from: http://www.aids.gov.br/pt-br/publico-geral/previna-se
O que é HIV | Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis [Internet]. Aids.gov.br. 2021 [cited 2021 Aug 30]. Available from: http://www.aids.gov.br/pt-br/publico-geral/o-que-e-hiv
Rachid M, Schechter M. LILACS-Manual de HIV/AIDS; Manual of the HIV/AIDS [Internet]. Bireme.br. Revinter; 2021 [cited 2021 Aug 30]. Available from: http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&src=google&base=LILACS&lang=p&nextAction=lnk&exprSearch=268638&indexSearch=ID
Boletim Epidemiológico HIV/Aids 2020 | Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis [Internet]. Aids.gov.br. 2020 [cited 2021 Aug 30]. Available from: http://www.aids.gov.br/pt-br/pub/2020/boletim-epidemiologico-hivaids-2020
Smith DK, Herbst JH, Rose CE. Estimating HIV Protective Effects of Method Adherence With Combinations of Preexposure Prophylaxis and Condom Use Among African American Men Who Have Sex With Men. Sexually Transmitted Diseases [Internet]. 2015 Feb [cited 2021 Aug 30];42(2):88–92. Available from: https://pubmed.ncbi.nlm.nih.gov/25585067/ DOI: https://doi.org/10.1097/OLQ.0000000000000238
3) Sousa LRM, Elias HC, Fernandes NM, Gir E, Reis RK. Knowledge of PEP and PrEP among people living with HIV/aids in Brazil. BMC Public Health [Internet]. 2021 Jan 7 [cited 2021 Aug 30];21(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33413241/ DOI: https://doi.org/10.1186/s12889-020-10135-3
Timerman, A; Magalhães, N. Histórias da AIDS. Autêntica, 2015.
Prevenção ombinada - UNAIDS Brasil [Internet]. UNAIDS Brasil. 2019 [cited 2021 Aug 30]. Available from: https://unaids.org.br/prevencao-combinada/
Velloza J, Khoza N, Scorgie F, Chitukuta M, Mutero P, Mutiti K, et al. The influence of HIV‐related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study. Journal of the International AIDS Society [Internet]. 2020 Mar [cited 2021 Aug 30];23(3). Available from: https://pubmed.ncbi.nlm.nih.gov/32144874/ DOI: https://doi.org/10.1002/jia2.25463
Veloso VG, Mesquita F, Grinsztejn B. Pre-exposure prophylaxis for men and transgender women who have sex with men in Brazil: opportunities and challenges. Journal of the International AIDS Society [Internet]. 2015 Jul [cited 2021 Aug 30];18:20010. Available from: https://pubmed.ncbi.nlm.nih.gov/26198347/ DOI: https://doi.org/10.7448/IAS.18.4.20010
Wilson EC, Jalil EM, Castro C, Martinez Fernandez N, Kamel L, Grinsztejn B. Barriers and facilitators to PrEP for transwomen in Brazil. Global Public Health [Internet]. 2018 Aug 7 [cited 2021 Aug 30];14(2):300–8. Available from: https://pubmed.ncbi.nlm.nih.gov/30084305/ DOI: https://doi.org/10.1080/17441692.2018.1505933
Zucchi EM, Couto MT, Castellanos M, Dumont-Pena É, Ferraz D, Félix Pinheiro T, et al. Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study. Dalby AR, editor. PLOS ONE [Internet]. 2021 May 4 [cited 2021 Aug 30];16(5):e0249293. Available from: https://pubmed.ncbi.nlm.nih.gov/33945527/ DOI: https://doi.org/10.1371/journal.pone.0249293
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Copyright (c) 2022 Maria Fernanda Marques dos Santos, Graziella Souza Guimarães, Marina de Souza Mantovani, Vyctor Pereira Alvarenga, Ana Luiza Camargos Lima, Ana Alice Soares Orçay
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