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High-Risk Sexual Behavior, Binge Drinking and Use of Stimulants are Key Experiences on the Pathway to High Perceived HIV Risk Among Men Who Have Sex with Men in Brazil

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Abstract

In Brazil, pre-exposure prophylaxis (PrEP) is currently available for gay, bisexual, and other men who have sex with men. As PrEP use depends on an individual’s perceived risk, we explored pathways by which potentially modifiable behaviors lead to high perceived HIV risk. Using online surveys (N = 16,667), we conducted a path analysis on the basis of ordered sequences of multivariate logistic regressions. High perceived HIV risk was low (26.3%) compared to condomless receptive anal sex (41.4%). While younger age increased the odds of binge drinking and of condomless receptive anal sex, it was associated with decreased odds of high perceived HIV risk. In contrast, use of stimulants increased the odds of condomless receptive anal sex and of high perceived HIV risk. Our results suggest that binge drinking and use of stimulants are key points in different pathways to high-risk sexual behavior and may lead to different perceptions of HIV risk.

Resumen

En Brasil, la profilaxis previa a la exposición (PrEP) está disponible actualmente para hombres homosexuales, bisexuales y otros hombres que tienen sexo con hombres. Como el uso de PrEP depende del riesgo percibido de una persona, exploramos vías por las cuales los comportamientos potencialmente modificables conducen a un alto riesgo percibido de VIH. Utilizando datos de encuestas en línea (N = 16.667), realizamos un análisis de ruta sobre la base de secuencias ordenadas de regresiones logísticas multivariadas. El alto riesgo percibido de VIH fue bajo (26,3%) en comparación con el sexo anal receptivo sin condón (41,4%). La edad más joven aumentó las probabilidades de consumo de alcohol en exceso y del sexo anal receptivo sin condón, todavía se asoció con una menor probabilidad de alta percepción de riesgo sobre VIH. Sin embargo, el uso de estimulantes aumentó las probabilidades de tener sexo anal receptivo sin condón y de un alto riesgo percibido de VIH. Nuestros resultados sugieren que el consumo excesivo de alcohol y el uso de estimulantes son puntos clave en diferentes vías de conductas sexuales de alto riesgo y pueden llevar a diferentes percepciones del riesgo de VIH.

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Acknowledgements

Gilead Sciences covered the costs related to advertisement of the 2016 and 2017 surveys. The 2018 survey was made possible thanks to Unitaid’s funding and support. Unitaid accelerates access to innovative health products and lays the foundations for their scale-up by countries and partners. Gilead and Unitaid played no role in the study design, collection, analysis, or interpretation of data, the writing of the manuscript, or the decision to submit this manuscript for publication.

Funding

PML acknowledges funding from Coordenação de Aperfeiçoamento Pessoal de Nível Superior (CAPES) and Programa de Internacionalização da Fundação Oswaldo Cruz (PrInt-FIOCRUZ-CAPES). EEMM acknowledges receipt of a chercheur boursier career award from the Fonds de recherche du Québec—Santé.

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Authors and Affiliations

  1. Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil

    Paula M. Luz, Thiago S. Torres, Luana M. S. Marins, Valdilea G. Veloso & Beatriz Grinsztejn

  2. Research Institute of the McGill University Health Centre, Montreal, Canada

    Celline C. Almeida-Brasil & Joseph Cox

  3. Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada

    Joseph Cox & Erica E. M. Moodie

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  1. Paula M. Luz
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  2. Thiago S. Torres
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  4. Luana M. S. Marins
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  5. Valdilea G. Veloso
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  6. Beatriz Grinsztejn
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  8. Erica E. M. Moodie
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Contributions

TST, LM, VGV and BG conceived and implemented the surveys. TST, CCAB, JC, EEMM and PML conceived this study. TST and PML analyzed the data and generated the tables and figures. CCAB, JC, and EEMM provided guidance on statistical analyses and results interpretation. TST and PML reviewed the literature and drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version of the manuscript.

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Correspondence to Paula M. Luz.

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Luz, P.M., Torres, T.S., Almeida-Brasil, C.C. et al. High-Risk Sexual Behavior, Binge Drinking and Use of Stimulants are Key Experiences on the Pathway to High Perceived HIV Risk Among Men Who Have Sex with Men in Brazil. AIDS Behav 25, 748–757 (2021). https://doi.org/10.1007/s10461-020-03035-5

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