A ESTIGMATIZAÇÃO DA PROFILAXIA PRÉ-EXPOSIÇÃO (PREP) COMO BARREIRA À ADESÃO DA PREVENÇÃO COMBINADA NO BRASIL
DOI:
https://doi.org/10.53843/bms.v6i9.294Palabras clave:
Estigma. PrEP. HIV. Brasil. Prevenção.Resumen
Introdução- A AIDS é uma doença autoimune causada pelo HIV. Atualmente o Brasil possui mais de 900 mil pessoas infectadas por esse vírus. Para evitar ou tratar a infecção existe métodos como a prevenção combinada, que associa variados métodos preventivos ao HIV, às IST e às hepatites virais. Dentro da prevenção combinada, temos a Profilaxia pré-exposição (PrEP) e a Profilaxia pós-exposição (PEP). Este artigo tem por objetivo analisar a estigmatização do uso da PrEP como um dos principais desafios para a adesão da prevenção combinada ao HIV. Metodologia- Trata-se de uma revisão narrativa de literatura de artigos indexados no PubMed, entre 2013 e 2021. Resultados- A análise dos artigos selecionados para revisão evidenciaram o estigma relacionado ao indivíduo portador de HIV como uma das principais barreiras à essa implementação e continuação. Discussão- Além do estigma, verificou-se que a desinformação, o receio de realizar o teste para HIV, dúvidas sobre eficácia do medicamento e risco de compensação, assim como falhas estruturais da sociedade contribuem para a limitada utilização da PrEP no Brasil. Conclusão -O estigma ligado aos usuários de PrEP compromete a sua adesão. Ainda, discursos discriminatórios aliados ao déficit de incentivos, por meio da saúde pública, contribuem para a estigmatização e poucas informações difundidas acerca da prevenção combinada.
Métricas
Citas
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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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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Derechos de autor 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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