Discriminação, não revelação da orientação sexual ou identidade de gênero no contexto familiar e o início do uso da profilaxia pré-exposição oral ao HIV entre adolescentes.

Abstract

Introduction: Discrimination and the non-disclosure of sexual orientation or gender identity within the family context can influence decisions related to sexual health and the prevention of HIV and other sexually transmitted infections, especially among adolescent men who have sex with men (AMSM) and transgender women and travestis (ATrMT). Thus, this study aimed to analyze the association between discrimination and non-disclosure of sexual orientation or gender identity within the family context and the initiation of pre-exposure prophylaxis for HIV (PrEP) use among AMSM and ATrMT. Methodology: Baseline data from the PrEP1519 cohort were used, a demonstration study on the effectiveness of PrEP among AMSM and ATrMT aged 15 to 19 years, conducted in Salvador, São Paulo, and Belo Horizonte between 2019 and 2023. Latent Class Analysis (LCA) was used to identify patterns of discrimination and non-disclosure of sexual orientation or gender identity within the family context, based on three categorical indicators. Descriptive, bivariate, and multivariate analyses were performed using logistic regression to estimate adjusted odds ratios (aOR) for the association between the predictor variable "discrimination and non-disclosure of sexual orientation or gender identity," obtained through LCA, and the outcome variable "PrEP initiation." Results: A total of 1,309 participants were included in the study, the majority being AMSM (91.4%), aged 18 to 19 years (74.9%), Black (72.1%), attending high school (71.9%), living in São Paulo (49.6%), and residing with parents or other family members (81.9%). Regarding PrEP initiation, 79.5% of participants started PrEP within 30 days after the first consultation. LCA identified three patterns among participants: i) low discrimination (67.6%, n = 885), ii) high discrimination (22.4%, n = 293), and iii) family unawareness of sexual orientation or gender identity (10.0%, n = 131). Multivariate analysis indicated that non-disclosure of sexual orientation or gender identity within the family context was associated with a lower likelihood of initiating PrEP use (aOR: 0.54; 95% CI: 0.34-0.83), whereas high family discrimination showed no statistically significant association (aOR: 1.23; 95% CI: 0.85-1.78). Conclusion: The findings suggest that non-disclosure of sexual orientation or gender identity within the family context may hinder the initiation of PrEP use. Thus, the importance of structural interventions, community support networks, and alternative modalities, such as injectable PrEP, is highlighted to ensure greater accessibility and adherence to prophylaxis among adolescents who face barriers in disclosing their sexual orientation or gender identity within the family context.