AIDS- and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study.

Dulce Ferraz, Marcia Thereza Couto, Eliana Miura Zucchi, Gabriela Junqueira Calazans, Lorruan Alves Dos Santos, Augusto Mathias, Alexandre Grangeiro
Author Information
  1. Dulce Ferraz: Public Health Analyst, Escola de Governo em Saúde, Fundação Oswaldo Cruz , Brasília , Brazil. ORCID
  2. Marcia Thereza Couto: Professor, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil. ORCID
  3. Eliana Miura Zucchi: Assistant Professor at Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos , Santos , Brazil. ORCID
  4. Gabriela Junqueira Calazans: Researcher, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil. ORCID
  5. Lorruan Alves Dos Santos: PhD Candidate, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil. ORCID
  6. Augusto Mathias: PhD Candidate, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil. ORCID
  7. Alexandre Grangeiro: Researcher, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil.

Abstract

AIDS-related stigma is a major hurdle to care and it hinders people from accessing HIV prevention methods, such as post-exposure prophylaxis. This study was designed to explore how AIDS-related stigma impacts the experience of using non-occupational post-exposure prophylaxis (nPEP) for HIV after sexual contact. Data were gathered in in-depth interviews with 59 people who voluntarily sought out nPEP in five public healthcare facilities in Brazil between 2015 and 2016. Data were analysed into three thematic categories: fear of being mistaken for a person living with HIV and AIDS (PLWHA); desire to hide particular features of one's sexual life; and experiences of stigmatising behaviour due to nPEP use. Based on the Health Stigma and Discrimination Framework, predominant manifestations of AIDS-related stigma in each category were analysed, as well as their intersections with gender- and sexuality-related stigmas. Results show that experiences of using nPEP are permeated by AIDS-related stigma, intersecting with sexuality- and gender-related stigmas. Stigma experiences are mainly perceived, anticipated and internalised; stigma practices include prejudice and stigmatising behaviours. Taking antiretrovirals (ARVs) led participants to the fear of being discriminated against as a PLWHA and having particular features of their sexual identities disclosed. Thus, hiding nPEP was strategic to protect from stigmatising behaviour. As ARV-based prevention technologies are scaled-up, interventions designed to tackle AIDS- and sexuality-related stigmas must be expanded in Brazil. Required interventions include public campaigns about nPEP, educational programmes in healthcare settings to offer adequate support to nPEP users and investments in stigma research and monitoring.

Keywords

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MeSH Term

Acquired Immunodeficiency Syndrome
Adolescent
Adult
Brazil
Female
HIV Infections
Homosexuality, Male
Humans
Interviews as Topic
Male
Middle Aged
Post-Exposure Prophylaxis
Qualitative Research
Social Stigma
Young Adult

Word Cloud

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