Factors associated to HIV prevalence among adolescent men who have sex with men in Salvador, Bahia State, Brazil: baseline data from the PrEP1519 cohort

Magno, Laio; Medeiros, Danielle Souto de; Soares, Fabiane; Grangeiro, Alexandre; Caires, Priscila; Fonseca, Thaís; Westin, Mateus Rodrigues; Dourado, Ines

doi:10.1590/0102-311XEN154021

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ARTIGO • Cad. Saúde Pública 39 (Suppl 1) • 2023 • https://doi.org/10.1590/0102-311XEN154021 copy

Factors associated to HIV prevalence among adolescent men who have sex with men in Salvador, Bahia State, Brazil: baseline data from the PrEP1519 cohort

Fatores associados à prevalência do HIV entre homens adolescentes que fazem sexo com homens em Salvador, Bahia, Brasil: dados da linha de base da coorte PrEP1519

Factores asociados a la prevalencia de VIH entre hombres adolescentes que tienen sexo con hombres en Salvador, Bahia, Brasil: datos de referencia de la cohorte PrEP1519

Authorship SCIMAGO INSTITUTIONS RANKINGS

Adolescent men who have sex with men (AMSM) are at a heightened vulnerability for human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HIV and associated individual, social, and programmatic factors among AMSM in Salvador, Bahia State, Brazil. This is a cross-sectional study which analyzed baseline data from the PrEP1519 cohort in Salvador. Descriptive, bivariate, and multivariate analyses were conducted using the dimensions of vulnerability to HIV as hierarchical levels of analysis. Logistic regression models were used to estimate the odds ratios (OR) of the association between predictor variables and HIV infection. The prevalence of HIV infection among the 288 AMSM recruited to the project was 5.9% (95%CI: 3.7-9.3). Adjusted analysis showed a statistically significant association between self-identifying as a sex worker (OR = 3.74, 95%CI: 1.03-13.60) and HIV infection. Other associations with borderline statistical significance were the use of application programs to find sexual partners (OR = 3.30, 95%CI: 0.98-11.04), low schooling level (OR = 3.59, 95%CI: 0.96-13.41), failing to be hired or being dismissed from a job because of sexual orientation (OR = 2.88, 95%CI: 0.89-9.28), and not using health services as a usual source of care (OR = 3.14, 95%CI: 0.97-10.17). We found a high HIV prevalence among AMSM in Salvador. Furthermore, our study found that individual, social, and programmatic factors were associated with HIV infection among these AMSM. We recommend intensifying HIV combined-prevention activities for AMSM.

Keywords:
Men Who Have Sex With Men; Adolescent; HIV; Prevalence

Characteristics	Total sample		15-17 years		18-19 years		p-value
Characteristics	n	%	n	%	n	%
Individual dimension
Age (years)
15-17	43	14.9
18-19	245	85.1
Age at first sexual intercourse (years)	M = 13.9; SD = 3.1		M = 13.7; SD = 2.0		M = 14.0; SD = 3.2		0.020
< 15	139	50.2	28	66.7	111	47.2
≥ 15	138	49.8	14	33.3	124	52.8
Used a condom at first sexual intercourse							0.246
Yes	122	43.0	15	34.9	107	44.4
No	162	57.0	28	65.1	134	55.6
Uses apps to find sexual partners							0.071
No	131	45.5	25	58.1	106	43.3
Yes	157	54.5	18	41.9	139	56.7
Sexual partners in last three months							0.477 *
None	33	11.5	5	11.6	28	11.4
Just steady partners	63	21.9	12	27.9	51	20.8
Just casual partners	98	34.0	16	37.2	82	33.5
Steady and casual partners	94	32.6	10	23.3	84	34.3
Uses condoms during anal sex							0.412
Always	71	29.0	9	25.7	62	29.5
Not always with steady partners	65	26.5	8	22.9	57	27.1
Not always with casual partners	63	25.7	13	37.1	50	23.8
Not always with steady and casual partners	46	18.8	5	14.3	41	19.5
Age of casual sexual partners (years)							0.802
Up to 5	99	51.6	14	53.9	85	51.2
More than 5	93	48.4	12	46.1	81	48.8
Number of casual partners							0.711
None	98	34.0	17	39.5	81	36.0
1 to 4	139	48.3	19	44.2	120	49.0
5 or more	51	17.7	7	16.3	44	18.0
Condom broke or slipped off in last three months							0.861
Never	170	72.6	25	71.4	145	72.9
At least once	64	27.4	10	28.6	54	27.1
Group sex							0.563
No	239	83.0	37	86.0	202	82.4
Yes	49	17.0	6	14.0	43	17.6
How often alcohol use interferes in condom use							0.585
Never	169	77.5	26	81.3	146	76.9
Has interfered at least once	49	22.5	6	18.7	43	23.1
Social dimension
Race/Skin color							0.873
Non-black	38	13.2	6	13.9	32	13.1
Black	250	86.8	37	86.1	213	86.9
Schooling level							0.005 *
High school and higher education	263	91.3	34	79.1	229	93.5
Primary/Middle school and youth & adult education	25	8.7	9	20.9	16	6.5
Exchanged money or favors for sex in last three months							0.099 *
Never	258	89.6	35	81.4	223	91.0
At least once	30	10.4	8	18.6	22	9.0
Sexual orientation							0.990
Homosexual or gay	194	67.4	29	67.4	165	67.3
Bisexual, heterosexual	94	32.6	14	32.6	80	32.7
Self-identification as sex worker							0.217 *
No	267	92.7	38	88.4	229	93.5
Yes	21	7.3	5	11.6	16	6.5
Failed to be selected or was dismissed from a job because of sexual orientation							0.873
Never	250	86.8	37	86.1	213	86.9
At least once	38	13.2	6	13.9	32	13.1
Excluded or marginalized from family settings because of sexual orientation							0.304
Never	167	58.0	28	65.1	139	56.7
At least once	121	42.0	15	34.9	106	43.3
Programmatic dimension
Usual source of care							0.070
Primary healthcare facility, pharmacy, hospital, doctor	252	87.5	34	79.1	218	89.0
Nowhere, friends or relatives	36	12.5	9	20.9	27	11.0
Participates in an organized group, social movement or LGBTQI+ NGO							0.300 *
No	254	88.5	36	83.7	218	89.3
Yes	33	11.5	7	16.3	26	10.7
Has private health insurance							0.043
No	230	81.3	38	92.7	192	79.3
Yes	53	18.7	3	7.3	50	20.7
Ever received poor service at a health facility or by a health professional because of sexual orientation							0.532 *
Never	267	92.7	39	90.7	228	93.1
At least once	21	7.3	4	9.3	17	6.9
Ever received poor public service because of sexual orientation							0.867
Never	237	82.3	35	81.4	202	82.4
At least once	51	17.7	8	18.8	43	17.6

Characteristics	HIV prevalence
Characteristics	n	%	p-value	OR	95%CI
Individual dimension
Age (years)			0,726 *
15-17	3	7.0		1.00	-
18-19	14	5.7		0.81	0.22-2.94
Age at first sexual intercourse (years)			0.434
< 15	9	6.5		1.00	-
≥ 15	6	4.5		0.66	0.23-1.90
Used a condom at first sexual intercourse activity			0.245
Yes	5	4.1		1.00	-
No	12	7.4		1.87	0.64-5.46
Uses apps to find sexual partners			0.061
No	4	3.1		1.00	-
Yes	13	8.3		2.87	0.91-9.01
Sexual partners in last three months			0.910 *
None	1	3.0		1.00	-
Just steady partners	3	4.8		1.60	0.16-16.01
Just casual partners	7	7.1		2.46	0.29-20.79
Steady and casual partners	6	6.4		2.18	0.25-18.83
Uses a condom during anal sex			1.000 *
Always	4	5.6		1.00	-
Not always with steady partners	4	6.2		1.10	0.26-4.58
Not always with casual partners	4	6.4		1.13	0.27-4.74
Not always with steady and casual partners	3	6.5		1.17	0.25-5.48
Age of casual sexual partner (years)			0.328
Up to 5	5	5.1		1	-
More than 5	8	8.6		1.77	0.56-5.62
Number of casual partners			0.945 *
None	5	5.1		1.00	-
1-4	9	6.5		1.29	0.42-3.97
5 or more	3	5.9		1.16	0.27-5.07
Condom broke or slipped off in last three months			0.075 *
Never	5	2.9		1.00	-
At least once	6	9.4		3.41	1.00-11.61
Group sex			0.181 *
No	12	5.0		1.00	-
Yes	5	10.2		2.15	0.72-6.41
How often alcohol use interferes in condom use			1.000 *
Never	8	4.7		1.00	-
Has interfered at least once	2	4.1		0.86	0.18-4.17
Social dimension
Race/Skin color			0.709 *
Non-black	1	2.6		1.00	-
Black	16	6.4		2.53	0.33-19.65
Schooling level			0.049 *
High school and higher education	13	4.9		1.00	-
Primary/middle school and youth & adult education	4	16.0		3.66	1.10-12.23
Sexual orientation			0.409
Homosexual or gay	13	6.7		1.00	-
Bisexual, heterosexual	4	4.3		0.62	0.20-1.95
Exchanged money or favors for sex in last three months			0.022 *
Never	12	4.7		1.00	-
At least once	5	16.7		4.10	1.34-12.58
Self-identification as sex worker			0.027 *
No	13	4.9		1.00	-
Yes	4	19.1		4.60	1.35-15.63
Failed to be selected or was dismissed from a job because of sexual orientation			0.057 *
Never	12	4.8		1.00	-
At least once	5	13.2		3.00	1.00-9.07
Excluded or marginalized from family settings because of sexual orientation			0.148
Never	7	4.2		1.00	-
At least once	10	8.3		2.06	0.76-5.57
Programmatic dimension
Usual source of care			0.046 *
Primary healthcare facility, pharmacy, hospital, doctor	12	4.8		1.00	-
Nowhere, friends or relatives	5	13.9		3.23	1.06-9.77
Participates in an organized group, social movement or LGBTQI+ NGO			0.426 *
No	14	5.5		1.00	-
Yes	3	9.1		1.71	0.47-6.31
Has private health insurance			0.748 *
No	15	6.5		1.00	-
Yes	2	3.8		0.56	0.12-2.54
Ever received poor service at a health facility or by a health professional because of sexual orientation			1.000 *
Never	16	6.0		1.00	-
At least once	1	4.8		0.78	0.10-6.22
Ever received poor public service because of sexual orientation			0.195 *
Never	12	5.1		1.00	-
At least once	5	9.8		2.04	0.68-6.06

Characteristics	p-value	OR_adjusted	95%CI
Individual dimension
Uses apps to find sexual partners	0.053
No		1.00	-
Yes		3.30	0.98-11.04
Social dimension
Schooling level	0.057
High school and higher education		1.00	-
Primary/Middle school and youth & adult education		3.59	0.96-13.41
Self-identification as sex worker	0.045
No		1.00	-
Yes		3.74	1.03-13.60
Failure to be selected or dismissal from a job because of sexual orientation	0.077
Never		1.00	-
at least once		2.88	0.89-9.28
Programmatic dimension
Usual source of care	0.057
Primary healthcare facility, pharmacy, hospital, doctor		1.00	-
Nowhere, friends or relatives		3.14	0.97-10.17

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[1] Correspondence
L. Magno Departamento de Ciências da Vida, Universidade do Estado da Bahia. Rua Silveira Martins 2555, Salvador, BA 41000-150, Brasil. laiomagnoss@gmail.com