Motivações e experiências de uso da profilaxia pré-exposição ao HIV em mulheres profissionais do sexo

Abstract

Introduction: The HIV/AIDS epidemic in Brazil is concentrated in some population segments associated with the majority of new cases of infection, the sex professionals, for example. Facing this reality, the MS included this segment in the PrEP offer, classifying it as key population, due to its high vulnerability. Pre-exposure prophylaxis (PrEP) is widely studied, proven effective and, since 2017, integrates Combined Prevention in Brazil. The present study is justified due to the little knowledge of this prophylaxis, pointing out the need for researches on the importance and efficacy of this medication, to achieve broad coverage and, consequently, improve prevention policies for this population. Objective: Understand the experience of using pre-exposure prophylaxis to HIV among female sex professionals. Methodological Procedures: The data were collected between August 2018 and April 2019, in the city of São Paulo, as part of a qualitative investigation inserted in the context of the Combina! Study pragmatic assay carried out in health services specialized in HIV/AIDS located in São Paulo, Fortaleza, Ribeirão Preto, Porto Alegre and Curitiba. This is a qualitative study of ethnographic approach, being used for the analysis of empirical data, the instrumental of semi-structured interviews, with women sex professionals who were using or had used pre-exposure prophylaxis. The analytical process involved immersion in the empirical material, coding, and finally categorization: (1) Motivations identified in relation to the beginning and continuity of PrEP; (2) Stigmas associated with prostitution and AIDS that are articulated in PrEP use experiences. Results: Eighteen cis women, sex professionals, aged between 21 and 44, were interviewed. With regard to race/color, most of the women recognized themselves as white, corresponding to 12 interviewees, 3 (three) declared themselves black and 3 (three) as brown. In relation to PrEP, recognition of exposure and vulnerability to HIV remains an inevitable experience shared by sex professionals. There were several motivations that made them go in search of prophylaxis. Situations such as multiple partners, high frequency of sexual intercourse, and sex, most often with strangers, were reasons that made them adhere to PrEP. The women also expressed some unfavorable situations that made it difficult to maintain adherence or assiduity to treatment, such as the use of alcohol or drugs and the side effects in some of them, at the beginning of adherence. Using PrEP led participants the fear of being discriminated against as PLHIV and having their professional lives disclosed. Hiding PrEP use was a strategy to protect themselves from stigmatizing behavior. Conclusion: The experiences of PrEP use among female sex workers in this study made it possible to understand the difficulties, and the motivations of adherence to prophylaxis, confirming the importance of investments in dissemination about the availability of PrEP in SUS, so that the general population and the vulnerable population are aware of this important prophylaxis, and thereby mitigate the stigma related to prostitution and AIDS in order to promote and protect women's human rights.