LORRUAN ALVES DOS SANTOS
Projetos de Pesquisa
Unidades Organizacionais
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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- HIV risk perceptions and post-exposure prophylaxis among men who have sex with men in five Brazilian cities(2021) MATHIAS, Augusto; SANTOS, Lorruan Alves dos; GRANGEIRO, Alexandre; COUTO, Marcia TherezaIn the current context of the HIV epi-demic, multiple prevention strategies including biomedical interventions have been presented as alternatives for vulnerable groups. This study investigated homosexuals' and bisexuals' percep-tions of the risk of HIV infection and their expe-riences of using HIV post-exposure prophylaxis (PEP). We conducted a qualitative study with 25 men who have sex with men (MSM) in five Brazilian cities using semi-structured interviews. The results showed that the use of condoms was the main HIV prevention strategy employed by the respondents. In addition, condom failure, in-consistent condom use and intentional non-use are the main prompters of risk perception and the consequent decision to seek PEP. The respondent's perceptions and meanings of the use of PEP were mediated by prior knowledge of PEP. This work broadens the debate on the more subjective aspects of HIV prevention among MSM, especially those related to risk perception and the decision to use PEP in the context of combined prevention.
- PrEP perception and experiences of adolescent and young gay and bisexual men: an intersectional analysis(2023) SANTOS, Lorruan Alves dos; UNSAIN, Ramiro Fernandez; BRASIL, Sandra Assis; SILVA, Luis Augusto Vasconcelos da; DUARTE, Filipe Mateus; COUTO, Marcia TherezaStudies indicate gaps in knowledge about the barriers to access and adhere to HIV pre-exposure prophylaxis (PrEP) in adolescents. In this article, we ex-plore the perceptions and experiences of young gay, bisexual, and other men who have sex with men (YGBMSM) of the search, use and adherence to PrEP, considering their positions according to social markers of difference such as race/skin color, gender, sexuality, and social status. Intersectionality provides theoretical and methodological tools to interpret how the interlinking of these social markers of difference constitutes barriers and facilitators in the PrEP care continuum. The analyzed material is part of the PrEP1519 study and is comprised of 35 semi-structured interviews with YGBMSM from two Bra-zilian capitals (Salvador and Sao Paulo). The analyses suggest connections between social markers of difference, sexual cultures, and the social mean-ings of PrEP. Subjective, relational and symbolic aspects permeate the aware-ness of PrEP in the range of prevention tools. Willingness to use and adhere to PrEP is part of a learning process, production of meaning, and negotiation in the face of getting HIV and other sexually transmittable infections and the possibilities of pleasure. Thus, accessing and using PrEP makes several ado-lescents more informed about their vulnerabilities, leading to more informed decision-making. Interlinking the PrEP continuum of care among YGBMSM with the intersections of the social markers of difference may provide a con-ceptual framework to problematize the conditions and effects of implement-ing this prevention strategy, which could bring advantages to HIV prevention programs.
- Telehealth effectiveness for pre-exposure prophylaxis delivery in Brazilian public services: the Combine! Study(2023) GRANGEIRO, Alexandre; SANTOS, Lorruan Alves do; ESTEVAM, Denize Lotufo; MUNHOZ, Rosemeire; ARRUDA, Erico; MORAES, Renata Amaral de; WINKLER, Lisiane de Quadros; NEVES, Lis Aparecida de Souza; SANTOS, Juliane Cardoso Villela; KRUPPA, Mariele; ZUCCHI, Eliana Miura; ESCUDER, Maria Mercedes; LEAL, Andrea Fachel; KOYAMA, Mitti Ayako Hara; PERES, Maria Fernanda Tourinho; COUTO, Marcia Thereza; NETO, Jose Eluf; Combine Res GrpIntroductionPre-exposure prophylaxis (PrEP) delivery based on user needs can enhance PrEP access and impact. We examined whether telehealth for daily oral PrEP delivery could change the indicators of care related to prophylactic use in five Brazilian public HIV clinics (testing centres, outpatient clinics and infectious disease hospitals).MethodsBetween July 2019 and December 2020, clients on PrEP for at least 6 months could transition to telehealth or stay with in-person follow-up. Clients were clinically monitored until June 2021. A desktop or mobile application was developed, comprising three asynchronous consultations and one annual in-person consultation visit. Predictors influencing telehealth preference and care outcomes were examined. The analysis encompassed intent-to-treat (first choice) and adjustments for sexual practices, schooling, age, duration of PrEP use and PrEP status during the choice period.ResultsOf 470 users, 52% chose telehealth, with the adjusted odds ratio (aOR) increasing over time for PrEP use (aOR for 25-months of use: 4.90; 95% CI: 1.32-18.25), having discontinued PrEP at the time of the choice (aOR: 2.91; 95% CI: 1.40-6.06) and having health insurance (aOR: 1.91; 95% CI: 1.24-2.94) and decreasing for those who reported higher-risk behaviour (aOR for unprotected anal sex: 0.51; 95% CI: 0.29-0.88). After an average follow-up period of 1.6 years (95% CI: 1.5-1.7), the risk of discontinuing PrEP (not having the medication for more than 90 days) was 34% lower with telehealth (adjusted hazard ratio: 0.66; 95% CI: 0.45-0.97). When adjusted by mixed linear regression, no differences in adherence (measured by mean medication possession rate) were found between in-person and telehealth (p = 0.486) or at pre- and post-telehealth follow-ups (p = 0.245). Sexually transmitted infections increased between the pre-follow-up and post-follow-up choices and were not associated with in-person or telehealth (p = 0.528). No HIV infections were observed.ConclusionsOur findings indicate that telehealth for PrEP delivery can enhance service rationalization and reinforce the prevention cascade. This approach reduces prophylaxis interruptions and is mainly preferred by individuals with lower demands for healthcare services.
- HIV Pre-Exposure Prophylaxis (PrEP) among men who have sex with men: peer communication, engagement and social networks(2022) SANTOS, Lorruan Alves dos; GRANGEIRO, Alexandre; COUTO, Marcia TherezaHIV Pre-Exposure Prophylaxis (PrEP) has renewed optimism in controlling the HIV epi-demic, despite its continued growth among men who have sex with men (MSM). The popularity of dating-sexual dating apps and digital media pla-tforms in exchanging information and experien-ces about PrEP on peer social networks is recog-nized. However, studies on contexts, motivations, and scope in HIV prevention are scarce. The ar-ticle aims to understand the dynamics of virtual and face-to-face peer networks among MSM for the decision to use PrEP, its disclosure, and pu-blicity. Qualitative study using semi-structured interviews with 48 PrEP users from five Brazilian cities. Most interviewees share information and experiences about PrEP in peer social networks. However, its publication reveals tensions arising from the permanence of stigmas associated with homosexuality and HIV. The protagonism in ex-posing the use of PrEP expresses commitment to attracting new users. The relevance of peer social networks in sharing experiences and information about PrEP has the potential to diversify the tar-get audience and expand and democratize PrEP coverage in the country.
- Heterosexually active men, masculinities, HIV prevention, and the search for post-exposure prophylaxis following sexual exposure(2019) SANTOS, Lorruan Alves dos; COUTO, Marcia Thereza; MATHIAS, Augusto; GRANGEIRO, AlexandreHegemonic masculinity has distanced heterosexually active men from the responses to the HIV epidemic. However, with the combined prevention paradigm, post-exposure prophylaxis offers new ways to manage the risks of HIV infection, while at the same time bringing about new challenges. The aim of this paper is to discuss - through the lens of gender and masculinities - how heterosexually active men perceive their HIV risk and how they manage prevention methods and strategies, including post-exposure prophylaxis. Employing qualitative methods, 16 heterosexually active men in five health services from different Brazilian cities were interviewed. The analysis indicates that condom use - the main prevention method - was conditioned by subjective and contextual factors, and its failure stands out as the primary reason for seeking out post-exposure prophylaxis. We argue that ideals of hegemonic masculinity permeate perceptions and risk management discourses in the current context of the HIV/AIDS epidemic.
- Effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohort studies in Brazil: COBra study protocol(2021) FERRAZ, Dulce; DOURADO, Ines; ZUCCHI, Eliana Miura; MABIRE, Xavier; MAGNO, Laio; GRANGEIRO, Alexandre D.; COUTO, Marcia Thereza; FERGUSON, Laura; WESTIN, Mateus; SANTOS, Lorruan Alves dos; PREAU, MarieIntroduction The COVID-19 pandemic and its control measures have impacted health and healthcare provision in various levels. Physical distancing measures, for instance, may affect sexual health, impacting access to HIV prevention supplies and changing sexual behaviour, as well as mental health, increasing feelings of unsafety and weakening community support ties. These effects can be worsened among socially marginalised groups, such as men who have sex with men (MSM) and transgender women (TGW). Brazil is among the countries most affected by COVID-19 in the world, where control measures have been inconsistently implemented. We aim to investigate the effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult MSM and TGW in Brazil. Methods Convergent mixed-method prospective cohort study, nested in two ongoing HIV pre-exposure prophylaxis (PrEP) cohorts in Brazil, named PrEP1519 and Combina. Participants will be invited to answer, at baseline and after 6 months, a questionnaire about the effects of the COVID-19 pandemic on sexual behaviour, HIV prevention and mental health. Data on HIV infection and sexually transmitted infections (STI) will be collected as part of routine follow-up from the cohorts. Main outcome measures (HIV infection, STI and depression symptoms) will be observed within 12 months after baseline. Sample size is estimated at 426 participants. Complementarily, 50 participants will be invited to in-depth interviews through video calls or interactive voice response, and 20 will be invited to chronicle their lives during the pandemic through digital diaries. Triangulation will be done across qualitative methods and with the quantitative data. Ethics and dissemination The study was approved by Research Ethics Committees from the Brazilian Universities coordinating the study. Findings will be published in scientific journals and presented at meetings. Informative flyers will be elaborated to communicate study findings to participants and key stakeholders.
- Methodological issues in qualitative research on HIV prevention: an integrative review(2023) SPADACIO, Cristiane; SANTOS, Lorruan Alves dos; SORRENTINO, Isa da Silva; GOMES, Romeu; CASTELLANOS, Marcelo Eduardo Pfeiffer; ZUCCHI, Eliana Miura; GRANGEIRO, Alexandre; COUTO, Marcia TherezaIn view of the growing concern about the use of qualitative approach in health research, this article aims to analyze how the qualitative theoretical -method-ological framework of HIV prevention is presented in empirical research. We conducted an integrative literature review with the following guiding ques-tions: ""How is the qualitative theoretical-methodological framework expressed in empirical research on HIV prevention?""; ""What are the limits and poten-tials of the qualitative methodological designs employed?"". In the qualitative methodological discussion, five dimensions guided the methodological course and the presentation of findings, from the analysis of the characterization of qualitative studies to the contextualization of the studies and the methodologi-cal approaches used, highlighting the use of semi-structured interviews with thematic content analysis. We also examined social categories and analytical references, drawing attention to the plurality of these theoretical-conceptual references and to the authors' polyphony, and identified the limits and po-tentials of qualitative research. This study focuses on a scientific topic that is related to a wide variety of social groups and analyzes how they are af-fected by it, examining issues related to social inequality and other analytical possibilities surrounding HIV prevention, and providing resources for a com-prehensive methodological discussion. Hence, avoiding the risk of conducting qualitative research based on checklists that limit inventiveness and openness to different designs and forms of execution and analysis is as pivotal as ensur-ing that the research is consistent and detailed in publications.
- AIDS- and sexuality-related stigmas underlying the use of post-exposure prophylaxis for HIV in Brazil: findings from a multicentric study(2019) FERRAZ, Dulce; COUTO, Marcia Thereza; ZUCCHI, Eliana Miura; CALAZANS, Gabriela Junqueira; SANTOS, Lorruan Alves dos; MATHIAS, Augusto; GRANGEIRO, AlexandreAIDS-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.
- Thematic synthesis HIV prevention qualitative studies in men who have sex with men (MSM)(2019) MATHIAS, Augusto; SANTOS, Lorruan Alves dos; GRANGEIRO, Alexandre; COUTO, Marcia TherezaBackground: Qualitative studies on HIV prevention strategies and methods among men who have sex with men (MSM) allow identify knowledge gaps and improve preventive actions. Objective: To make a thematic synthesis of the scientific productions that use the qualitative methodology in the strategies and methods of HIV prevention area among MSM. Methods: We conducted a literature review following the guidelines of the ENTREQ protocol. The analysis included 48 empirical studies published in Portuguese, English and Spanish between 2001 and 2018 available in the Medline, Embase, Scielo, Scopus, Bireme and Web of Science databases. Results: Where an increased production in the last six years and concentration in northern countries. Seven prevention methods were part of the study, with emphasis on pre exposure prophylaxis, testing, condoms and behavioral strategies. The main topics discussed were stigma and support and care networks. Conclusion: we notice that an increasing production on prevention in the men who have sex with men segment results from the emergence of multiple preventive methods and strategies and their combined actions beyond the star role of condoms.