Gestão do risco sexual da infecção do HIV entre adolescentes homens que fazem sexo com homens, travestis e mulheres transexuais na região central de São Paulo

Abstract

Introduction: Adolescent men who have sex with men, transgender and transvestite women live in specific contexts of individual, social and programmatic vulnerability to HIV and, accentuated by homophobia and transphobia, demand targeted responses from public health policies to mitigate the HIV epidemic. So it is about seeking understanding through the experiences and narratives experienced by this population about sexual risk management, which assumes that each individual learns to create strategies in order to overcome their own risks, however it is mediated according to what each resignifies itself, and with the other issues that need to be addressed. Objective: To understand the risk management of HIV infection in sexual interactions among adolescent men who have sex with men, transvestites and transsexual women. Methods: The study was carried out with a qualitative approach with data obtained from a formative research carried out from a study entitled ¿PrEP Study 15-19¿ with participants who live or go to the central region of São Paulo. Thirteen semi-structured interviews were carried out, seven with transvestites and transsexual women and six with gay and bisexual men. The press conference included three transvestite participants and transsexual women and the focus group with nine gay and bisexual teenagers. The content analysis was guided in the light of Bardin's theories (2011). Results: Thirteen adolescents participated in the semi-structured interview voluntarily. Among six men, three identified as gay and three as bisexual, aged between sixteen and nineteen years old. Among the seven other participants, four identified as transexual women and three transvestites, three identified themselves as heterosexual, two as pansexual, and one as asexual/bisexual, aged between seventeen and nineteen years old. At the press conference we had two transsexual women and a transvestite, between seventeen and nineteen years old. For the focus group, we had nine participants between sixteen and eighteen years old; seven did not respond regarding gender identity, two identified themselves as men, eight gay and one bisexual. The speeches expressed a view of obligation, priority and hierarchy regarding the use of condoms to make them feel protected. It was shown a reflection of the way they receive information about prevention considered to be effective and how they feel responsible for its prevention and strive to incorporate it in their daily lives. Not using condoms for some refers to feelings like remorse and fear, for others, however, there is a feeling of comfort and security when adopted in relationships that involve penetration. Although it is recognized as necessary for HIV prevention, its effective use was conditioned to several contextual factors. Sexual relations with stable partners are perceived as having a greater sense of protection, while casual relationships have a greater chance of risk. Alcohol use and relationships with older partners experienced by gay and bisexual teenagers can influence the decision to use condoms. Among transvestites and transsexual women, condom adoption may be influenced by the use of cocaine and the partner's decision in sexual programs. Other prevention strategies, such as the rapid HIV detection test, PrEP and PEP appeared in the speeches as alternative options for when condom use failed. Conclusion: Adolescents talk about prevention based on the view of condom use as the main choice, even if on different contexts of exposure, reproducing the normative discourse of effectiveness of this method regardless of other dimensions based on the aspects of vulnerability that may make it its use inconsistent. In this way, actions and welcoming strategies should be adopted seeking to address the combined prevention strategies that make it possible to meet the specificities and singularities of this population.