Percepções e práticas de profissionais de saúde no atendimento a adolescentes e jovens gays, homens que fazem sexo com homens, travestis e mulheres transexuais que usam a profilaxia pré-exposição ao HIV (PrEP)

Abstract

Introduction: Health professionals have been present since the beginning of discussions on care and prevention and today they are a fundamental part of the response to the HIV epidemic that affects adolescents and young people and shows the importance of strategic actions to reduce vulnerability to infection. HIV Pre-Exposure Prophylaxis (PrEP) is widely studied and proven effective and since 2017 is part of Combined Prevention in Brazil. This research is justified from the understanding that the practices and perceptions of health professionals about care and provision influence and collaborate in the implementation of PrEP for adolescents as a public policy. Objective: To understand practices and perceptions of health providers about the care of adolescents and young MSM and TrMT who use PrEP. Methodological procedures: Data were produced from July 2020 to February 2021 as part of a qualitative investigation within the context of the PrEP15-19 study that evaluated the effectiveness of PrEP among adolescents and young people aged 15 to 19 years. Health providers who worked at the São Paulo were analyzed and the techniques of participant observation and in-depth interviews were combined. The analytical process involved immersion in the empirical material, coding and categorization. Data organization was performed with the support of NVivo® software. The interpretation followed the hermeneutic-dialectical principle and had as a conceptual framework the Care inserted in health practices. The analyzes comprehend the perceptions of the adolescents and young people served, the relationship between PrEP, care and autonomy, care practices aligned with Integrality and the relationship between the contexts of vulnerability to HIV and the practices of providers. Results: Eight professionals aged between 25 and 52 years were interviewed. Unpredictability and the perception of low risk were related as challenges in care and the understanding of these behaviors favored health promotion and protection actions. Sensitive and supportive listening was identified as a welcoming practice that boosted care actions and its absence was identified as a barrier to access that reinforced the perception of low demand for health services. The use of a language closer to everyday life favored the construction of trusting relationships, capable of influencing the development of autonomy and adherence to treatment. Welcoming and supportive attitudes in the face of stigma and prejudice related to the use of PrEP converged to the development of adolescents and young people's autonomy. Adolescents and young transsexuals and those who reported mental disorders were recognized as more vulnerable to exposure to risk and, therefore, received differentiated care, in line with Integrality practices. Conclusion: The perceptions and practices of health professionals are incorporated into the concept of Care, as they comprise actions beyond technical knowledge, and are also aligned with the principle of Integrality, as they recognize the contexts that increase the vulnerability of adolescents and young people to HIV. However, there are tensions between discourse and practice, observed from the search for technical success as opposed to practical success.