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Analisamos a iniciação sexual masculina como um momento de aquisição de conhecimento, com base em 62 entrevistas de cunho etnográfico com homens jovens (18-24 anos) residentes em Porto Alegre, Rio de Janeiro e Salvador, Brasil, numa etapa da Pesquisa GRAVAD. Adotando uma perspectiva antropológica e comparativa, o exame dos relatos da primeira experiência amorosa e sexual revela que a primeira experiência sexual dos homens é um aprendizado corporal e social, através do qual os jovens adquirem conhecimento técnico sobre o uso de seus corpos e habilidade para se relacionar com outros, especialmente as mulheres. Estes são importantes demarcadores no processo de passagem à vida adulta. Consideramos, além de diferenças em termos de pertença a diferentes segmentos sócio-econômicos, as relações de gênero, especialmente modelos de masculinidade, demonstrando que a primeira relação sexual de um jovem é um momento social e simbolicamente marcante, que não se limita a um evento isolado, sendo, pelo contrário, uma experiência que envolve aprendizados de diferentes ordens e que integra um processo de se tornar homem.

Neste estudo, estimou-se a prevalência de gravidez na adolescência (GA), em Salvador, Rio de Janeiro e Porto Alegre, analisando-se o perfil de quem engravida e seus parceiros e os resultados da gestação. Trata-se de inquérito domiciliar, com entrevistas de uma amostra estratificada de homens e mulheres entre 18 e 24 anos, para a avaliação retrospectiva da GA. Foram entrevistados 4.634 jovens (85,2% dos elegíveis); 21,4% dos homens e 29,5% das mulheres com 20 anos e mais referiram GA, mas poucas se deram antes dos 15 anos (0,6% e 1,6%). A gravidez entre adolescentes foi relatada por 55,1% dos homens e 27,9% das mulheres; a maioria dessas teve a GA em relacionamento estável com parceiro mais velho (79,8%). A ocorrência de GA variou inversamente com a escolaridade e a renda. A primeira GA foi levada a termo por 72,2% das mulheres e 34,5% dos homens, estes com maior percentual de relato de aborto provocado (41,3% contra 15,3% das moças). Com o nascimento de um filho antes dos 20 anos, parte das moças parou os estudos temporária (25,0%) ou definitivamente (17,3%), mas 42,1% já se encontravam fora da escola.

Este artigo busca identificar os fatores que interferem nas escolhas reprodutivas de gestantes HIV positivo focalizando, em particular, o papel desempenhado pelos serviços de saúde e pela cultura médica nessas escolhas. O desejo e a realização de laqueadura tubária pós-parto constituem os eventos reprodutivos tomados como questões de análise. Os dados apresentados resultam de uma pesquisa desenvolvida em serviços de pré-natal nas cidades de São Paulo e Porto Alegre, que utilizou um desenho que combinou duas estratégias metodológicas: quantitativa, a partir de dados coletados em 427 prontuários clínicos, e qualitativa, por meio da observação etnográfica e realização de sessenta entrevistas em profundidade. A grande maioria de mulheres nas duas cidades manifestou o desejo de realizar a esterilização depois do parto. Entretanto, uma proporção muito maior de mulheres em São Paulo atingiu sua meta comparada a uma pequena proporção em Porto Alegre. A cultura médica local com relação à laqueadura, aliada à organização da prática de assistência ao pré-natal e parto, mostrou-se fator fundamental para compreender as diferenças encontrada nas duas cidades.

O trabalho aborda a adesão ao tratamento da tuberculose dentro do universo composto por homens e mulheres doentes e as conexões e conseqüências da doença na seu modo/fase de vida e no resultado final do tratamento. O estudo etnográfico, como um sub-estudo do Projeto Controle Epidemiológico da Tuberculose na Cidade de Pelotas, Rio Grande do Sul, propunha-se, inicialmente, verificar as razões existentes para que os pacientes não completassem o tratamento. Utilizou-se o método etnográfico de observação direta, conjugado com as entrevistas semi-estruturadas. A opção pela utilização do termo adesão é justificada pela preocupação em abranger outros fatores fundamentais, além da responsabilidade individualizada do enfermo. Esta abordagem possibilitou compreender as concepções de doença, as dinâmicas sociais entre os diversos protagonistas envolvidos no processo da doença e seu tratamento. Levaram-se em consideração alguns dos fatores implicados na adesão ao tratamento: características sócio-demográficas, fatores culturais, crenças populares, relação de custo benefício, aspectos físicos e químicos dos medicamentos, interação médico paciente e grau de participação familiar no tratamento.

Abstract Background With the development of medical technology, many countries around the world have been implementing ethical guidelines and laws regarding Medically Assisted Reproduction (MAR). A physician's reproductive decisions are not solely based on technical criteria but are also influenced by society values. Therefore, the aim of this study was to analyze the factors prioritized by MAR professionals when deciding on whether to accept to perform assisted reproduction and to show any existing cultural differences. Methods Cross-sectional study involving 224 healthcare professionals working with assisted reproduction in Brazil, Italy, Germany and Greece. Instrument used for data collection: a questionnaire, followed by the description of four special MAR cases (a single woman, a lesbian couple, an HIV discordant couple and gender selection) which included case-specific questions regarding the professionals' decision on whether to perform the requested procedure as well as the following factors: socio-demographic variables, moral and legal values as well as the technical aspects which influence decision-making. Results Only the case involving a single woman who wishes to have a child (without the intention of having a partner in the future) demonstrated significant differences. Therefore, the study was driven towards the results of this case specifically. The analyses we performed demonstrated that professionals holding a Master's Degree, those younger in age, female professionals, those having worked for less time in reproduction, those in private clinics and Brazilian health professionals all had a greater tendency to perform the procedure in that case. A multivariate analysis demonstrated that the reasons for the professional's decision to perform the procedure were the woman's right to gestate and the duty of MAR professionals to help her. The professionals who decided not to perform the procedure identified the woman's marital status and the child's right to a father as the reason to withhold treatment. Conclusion The study indicates differences among countries in the evaluation of the single woman case. It also discloses the undervaluation of bioethics committees and the need for a greater participation of healthcare professionals in debates on assisted reproduction laws.

Abstract Background Infertility is associated with impairment in human life. The quality of life (QOL) construct allows measuring the impact of health conditions in a broader way. The study aimed to explore the impact of the psychological distress on QOL's dimensions in men experiencing infertility. Methods 162 men were completed a socio-demographic form, SF-36, WHOQOL-BREF, Beck Anxiety Inventory and Beck Depression Inventory. Hierarchical regressions included demographic and clinic variables, and subsequently depression and anxiety were added. Results and Discussion Model 1 was not accurate in predicting QOL. R2 values ranged from 0.029 (Social Functioning) to 0.149 (Mental Health). Eight domains were not associated with any of the predictors. In the second model, a R2increase was observed in all domains. R2 of QOL scores ranged from .209 (Role Physical) to .406 (Social Functioning). The intensity of the depression was a significant predictor for all outcomes. The load of depression was higher than the ones of the socio-demographic and clinical variables. Anxiety levels have also presented the same effect, but with less intensity. Conclusion Subthreshold depression and anxiety were major predictors of QOL in men experiencing infertility. Health professionals need to include assessment of psychological symptomatology to plan more efficient interventions to infertile patients.

Our objective was to compare HIV prevalence between two national surveys among men who have sex with men in Brazil in 2009 and 2016. HIV prevalence was estimated stratifying by age and socioeconomic status. HIV prevalence increased from 11.9% [95% confidence interval (CI): 9.9-14.3], in 2009, to 19.1% (95% CI: 16.5 - 22.0), in 2016 [odds ratio (OR) = 1.8; 95% CI: 1.3-2.3] increasing 320% among Young MSM of low SES. Political leadership is needed to develop a scientifically sound and inclusive solution., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The effective testing of sexually transmitted infections (STIs) requires sampling from potential infection sites. This study aimed to assess the choice, satisfaction, and performance of self-collected samples (SCS) from potential infection sites for STI testing among transgender women in Brazil., Methods: TransOdara was a multicentric, cross-sectional STI prevalence study conducted in 5 Brazilian cities. Using respondent-driven sampling, 1317 transgender women 18 years or older were recruited. Participants completed interviewer-led questionnaires and provided swab samples from multiple sites (anorectal, oropharyngeal, genital) for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and human papillomavirus (HPV) testing. Participants were given a choice of SCS or provider-collected samples (PCS) at each site., Results: Most participants selected SCS for anorectal (74.9%; 95% confidence interval [CI], 72.4-77.3) and genital (72.7%; 95% CI, 70.2-75.1) sites, whereas fewer chose for oropharyngeal samples (49.8%; 95% CI, 47.0-52.6). For future testing, most participants expressed a preference for SCS for genital (72.2%; 95% CI, 69.5-74.7) and anorectal (70.2%; 95% CI, 67.6-72.7) sites. There was no significant difference in the positive test results for CT and NG between SCS and PCS at anorectal and oropharyngeal sites, or for HPV at anorectal and genital (penile or neovaginal) sites., Conclusions: This study demonstrated a high level of acceptability and usability of self-sampling for STI testing among transgender women. A preference for SCS was evident at the anorectal and genital sites, and the results of SCS were comparable to those of PCS. The findings suggest that multisite STI testing utilizing self-collection methods as a provided option can be effectively integrated into sexual health services for transgender women., Competing Interests: Conflicts of Interest: None declared., (Copyright © 2024 American Sexually Transmitted Diseases Association. All rights reserved.)

Background: Despite the preventive policies adopted, reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) has been limited. The risk of hepatitis C virus (HCV) infection has increased among the most vulnerable population groups, including MSM. The aim of this study was to estimate the prevalence of HCV infection and to assess risky practices among MSM from 12 Brazilian cities., Methods: This study was carried out from June to December 2016 using respondent driven sampling (RDS). Participants completed a self-administered questionnaire to collect behavioral, socioeconomic, and demographic variables. In addition, the rapid diagnostic test (RDT) for HCV was offered. Positive results were sent to Instituto Adolfo Lutz for confirmation., Results: A total of 4,176 participants were recruited and 23 samples were sent for confirmation. Of these, 16 were confirmed, resulting in a prevalence of 0.7% (95% CI: 0.3%-1.7%). The Southeast region showed a prevalence of 0.9% (95% CI: 0.3-2.6), followed by the South region, with 0.6% (95% CI: 0.2-2.1). The Northeast region had a prevalence of 0.3% (95% CI: 0.1-1.0) and the Midwest 0.1% (95% CI: 0.0-0.7). No positive cases were found in the North. Single men aged 40 years or older were the majority of participants exposed to HCV. High levels of alcohol consumption, illicit drug use, irregular condom use, in addition to infection with other STIs, were associated with exposure to HCV., Conclusions: STIs continue to be important health problems in Brazil and globally. Many STIs are inapparent for many years until they bring more serious consequences. Extra investment in HCV is also warranted, given that it can be eliminated. Relying solely on clinical data to provide information about inapparent infection, especially in stigmatized populations, will make that goal more difficult to achieve. Surveillance studies, such as the one reported here need to be repeated over time to demonstrate trends and to provide information for evaluation, program and policies. Investments in the most vulnerable populations are critical to achieve the World Health Organization global health goals including the elimination of viral hepatitis by 2030., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Hepatitis B virus (HBV) is a global public health problem and requires specific prevention actions, particularly focusing on the key populations, such as men who have sex with men (MSM). We aimed at assessing the prevalence of HBV infection, among MSM, in a multicity study in Brazil. In 2016, we conducted a survey using a respondent-driven sampling methodology in 12 Brazilian cities. Rapid tests (RT) were performed on 3178 samples from those MSM. Positive results were tested for HBV DNA and sequenced. If negative for HBV DNA, samples were tested for serological markers. The prevalence rate of HBV exposure and clearance was 10.1% (95% CI: 8.1-12.6), and 1.1% (95%; CI: 0.6-2.1) were confirmed to be HBsAg-positive. Of those samples tested for anti-HBs ( n = 1033), only 74.4% presented a serological profile analogous to that elicited by hepatitis B vaccination. Among HBsAg-positive samples ( n = 29), 72.4% were HBV DNA-positive, and from these, 18 were sequenced. HBV genotypes A, F, and G were found in 55.5%, 38.9%, and 5.6%, respectively. This study indicates high prevalence rates of MSM HBV exposure and a low positivity index for the serological marker of HBV vaccine immunity. These findings may contribute to the discussion of strategies to prevent hepatitis B and reinforce the importance of promoting HBV vaccination in this key population.

The HIV epidemic affects men who have sex with men (MSM) disproportionally in Brazil, and pre-exposure prophylaxis (PrEP) is effective for preventing HIV in this population. However, low perceived risk of HIV may influence the acceptability and decision to use PrEP. This study estimated the association between self-perception of HIV risk and acceptability of daily oral PrEP among Brazilian MSM. Respondent-driven sampling (RDS) was used for behavioral and biological surveillance to recruit 4,176 MSM 18 years or over in 12 Brazilian cities in 2016. Results were weighted using Gile's estimator in RDS Analyst software. Adjusted odds rations (OR) with 95% confidence intervals were calculated using multivariate logistic regression. Acceptability of daily oral PrEP was high (69.7%) among the 3,544 MSM available for analysis. Most participants self-reported low or moderate risk of HIV infection (67.2%) and a small proportion (9.3%) reported high risk. A dose-response relationship was observed between acceptability of PrEP and self-reported risk: PrEP acceptability was 1.88 times higher (OR 1.8; 95% CI: 1.24-2.85) among MSM whose perceived risk of HIV infection was low or moderate, and 5 times higher (OR 5.68; 95% CI: 2.54-12.73) among those who self-reported high risk compared to MSM reporting no HIV risk. MSM with the highest risk perception of HIV reported higher rates of PrEP acceptability. Given the availability of daily oral PrEP in the public health care system in Brazil, we suggest emphasizing counseling about self-perception of HIV risk as part of routine HIV prevention services., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Violence in the community can impact access to health care. This scoping review examines the impact of urban violence upon youth (aged 15-24) access to sexual and reproductive health and trauma care in Low and Middle Income Countries (LMICs). We searched key electronic health and other databases for primary peer-reviewed studies from 2010 through June 2020. Thirty five of 6712 studies extracted met criteria for inclusion. They were diverse in terms of study objective and design but clear themes emerged. First, youth experience the environment and interpersonal relationships to be violent which impacts their access to health care. Second, sexual assault care is often inadequate, and stigma and abuse are sometimes reported in treatment settings. Third is the low rate of health seeking among youth living in a violent environment. Fourth is the paucity of literature focusing on interventions to address these issues. The scoping review suggests urban violence is a structural and systemic issue that, particularly in low-income areas in LMICs, contributes to framing the conditions for accessing health care. There is a gap in evidence about interventions that will support youth to access good quality health care in complex scenarios where violence is endemic.

Most studies of sexual violence are with women, and although men who have sex with men (MSM) is the group of the men that has been most investigated for sexual violence, there are still several questions to be answered about sexual violence and sexual revictimization among MSM. This study aimed to estimate the prevalence of sexual violence in different stages of life and identify factors associated with sexual violence in adulthood among Brazilian MSM. We conducted an analysis with data from the study conducted in 2016 with 4,176 MSM from 12 Brazilian cities recruited through respondent-driven sampling (RDS), who answered a survey to a set of questions, among which some specific about sexual violence. Most participants were under 25 years old (56.5%), with more than 12 years of schooling (71.2%), mixed race (40.8%), single (86.2%), and belonging to some religion (50.9%). The lifetime prevalence of sexual violence was 20.3%. In our analyses, having experienced sexual violence in childhood and adolescence increased the odds of experiencing sexual violence in adulthood (prevalence ratio ratios [PRR] 4.93 (95% CI [1.99, 12.21]), as did experiencing physical violence (PRR 1.99; 95% CI [1.07, 3.71]) and receiving money for sex (PRR 2.26; 95% CI [1.17, 4.36]). In addition to violence in childhood and adolescence being risk factors for sexual violence in adulthood, we also observed that half of the sample experienced sexual violence repeatedly, characterizing sexual revictimization. It is important that health services are prepared to receive boys and men victims in order to reduce the chances of revictimization and other outcomes.

Influenza vaccination coverage in countries of Latin America is low among priority risk groups, ranging from 5 to 75% among older people. This paper aims to describe and analyze the determinants of influenza vaccination hesitancy through the lens of the 3C model of confidence, complacency and convenience among middle-class, urban risk group populations in Brazil, Chile, Paraguay, Peru, Uruguay, countries in South America with contrasting vaccination coverage. Focus groups were conducted among four risk groups: pregnant women, mothers of children aged <6 years, adults with risk factors, and adults aged ≥60 years in samples of urban residents. Adults with risk factors expressed the most detailed perceptions about confidence in the vaccine. A wide range of perceptions regarding complacency were expressed across risk groups and countries, with pregnant women and mothers showing greater concerns while convenience had a narrower and generally more positive range of perceptions. Participants from Chile and Paraguay expressed the most contrasts regarding confidence and complacency. Information and communication strategies need to be tailored for risk groups while confidence and complacency should be addressed in synergy., Competing Interests: I hereby acknowledge that our project was financially supported by Sanofi Pasteur. This does not alter our adherence to PLOS ONE policies on sharing data and materials. One of our co-authors, Elsa Sarti, is an employee of Sanofi Pasteur. All other authors have no relevant conflicts of interest to report.

Introduction: Influenza morbidity and mortality are significant in the countries of South America, yet influenza vaccination is as low as 56.7% among pregnant women, reaching 76.7% of adults with chronic diseases. This article measures the relative values for the vaccination hesitancy indicators of confidence, complacency and convenience by risk-groups in urban areas of five countries of South America with contrasting vaccination rates, analyzing their association with sociodemographic variables and self-reported immunization status., Methods: An exit survey was applied to 640 individuals per country in Brazil, Chile, Paraguay, Peru and Uruguay, distributed equally across risk groups of older adults, adults with risk factors, children ≤6 and pregnant women. Indicators were constructed for vaccine confidence, complacency and convenience. Analysis of variance and multiple logistic analysis was undertaken., Results: Adults with risk factors are somewhat more confident of the influenza vaccine yet also more complacent. Convenience is higher for mothers of minors. Children and older adults report higher levels of vaccination. The 3Cs are more different across countries than across risk groups, with values for Chile higher for confidence and those for Uruguay the lowest. Complacency is lower in Brazil and higher in Uruguay. Results suggest that confidence and complacency affect vaccination rates across risk groups and countries., Conclusions: Influenza vaccine confidence, complacency and convenience have to be bolstered to improve effective coverage across all risk groups in the urban areas of the countries studied. The role played by country contextual and national vaccination programs has to be further researched in relation to effective coverage of influenza vaccine., Competing Interests: The authors have read the journal's policy and the authors of this manuscript have the following competing interests: ES and EPR are paid employees of Sanofi Pasteur and MAGB, BRZ and MR are paid employees of Evisys Consulting. BRZ and MR participated in the research as paid, pro-tempore employees of Evisys. EGC, BEP, JA, YC, PC, AFL, LN, DRK participated as Evisys consultants. Both Sanofi Pasteur and Evisys participated in study design and manuscript review. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

Background: Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result., Methods: Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile's estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times)., Results: For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability., Conclusions: The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.

We address the limited understanding around the overlap between violence and HIV in Brazil. Data was from two clinic-based samples of HIV-positive ( n  =   1534) and HIV-negative women ( n  =   1589) in São Paulo and Porto Alegre. We conducted latent class analysis and identified violence typologies by type of violence, life course timing, frequency, and perpetrator, stratified by city and HIV-status. Overall, HIV-positive women experienced more lifetime physical and sexual violence than HIV-negative women. Twelve unique violence latent classes were identified. In São Paulo, HIV-positive women were likely to have endured physical violence several times (Conditional Probability [CP]: 0.80) by an intimate partner (CP: 0.85), and sexual violence several times (CP: 0.46) by an intimate partner (CP: 0.62). In Porto Alegre, HIV-positive women endured physical violence several times (CP: 0.80) by an intimate partner (CP: 0.70) during childhood/adolescence (CP: 0.48), and sexual violence several times (CP: 0.54) by an intimate partner (CP: 0.60). Findings inform interventions to educate around gender equity, violence, and the health effects of violence including HIV, integrate HIV and violence services, and improve the provision of bio-medical HIV prevention among HIV-negative women who experience violence.

Background: Scientific journals play a critical role in research validation and dissemination and are increasingly vocal about the identification of research priorities and the targeting of research results to key audiences. No new journals specialising in health policy and systems research (HPSR) and focusing in the developing world or in a specific developing world region have been established since the early 1980s. This paper compares the growth of publications on HPSR across Latin America and the world and explores the potential, feasibility and challenges of innovative publication strategies., Methods: A bibliometric analysis was undertaken using HPSR MeSH terms with journals indexed in Medline. A survey was undertaken among 2500 authors publishing on HPSR in Latin America (LA) through an online survey, with a 13.1% response rate. Aggregate indicators were constructed and validated, and two-way ANOVA tests were performed on key variables., Results: HPSR publications on LA observed an average annual growth of 27.5% from the years 2000 to 2018, as against 11.4% worldwide and yet a lag on papers published per capita. A total of 48 journals with an Impact Factor publish HPSR on LA, of which 5 non-specialised journals are published in the region and are ranked in the bottom quintile of Impact Factor. While the majority of HPSR papers worldwide is published in specialised HPSR journals, in LA this is the minority. Very few researchers from LA sit in the Editorial Board of international journals. Researchers highly support strengthening quality HPSR publications through publishing in open access, on-line journals with a focus on the LA region and with peer reviewers specialized on the region. Researchers would support a new open access journal specializing in the LA region and in HPSR, publishing in English. Open access up-front costs and disincentives while waiting for an Impact Factor can be overcome., Conclusion: Researchers publishing on HPSR in LA widely support the launching of a new specialised journal for the region with a vigorous editorial policy focusing on regional and country priorities. Strategies should be in place to support English-language publishing and to develop a community of practice around the publication process. In the first years, special issues should be promoted through a priority-setting process to attract prominent authors, develop the audience and attain an Impact Factor.

Introduction: This paper details the methods used in the second national Biological and Behavioral Surveillance Survey (BBSS) of HIV, syphilis, and hepatitis B and C among men who have sex with men in Brazil., Methods: Respondent-driven sampling (RDS) was used in 12 cities in 2016. The targeted sample size was initiated with five to six seeds in each city. HIV, syphilis, and Hepatitis B and C rapid tests were offered to participants. RDS Analyst with Gile's successive sampling (SS) estimator was used to adjust results as recommended and a weight for each individual was generated for further analysis. Data for the 12 cities were merged and analyzed using Stata 14.0 complex survey data tools with each city treated as its own stratum., Results: Duration of data collection varied from 5.9 to 17.6 weeks. 4,176 men were recruited in the 12 cities. Two sites failed to achieve targeted sample size due to a six-month delay in local IRB approval. No city failed to reach convergence in our major outcome variable (HIV)., Conclusion: The comprehensive BBSS was completed as planned and on budget. The description of methods here is more detailed than usual, due to new diagnostic tools and requirements of the new STROBE-RDS guidelines.

This paper reports human immuno-deficiency virus (HIV) prevalence in the 2nd National Biological and Behavioral Surveillance Survey (BBSS) among men who have sex with men (MSM) in 12 cities in Brazil using respondent-driven sampling (RDS).Following formative research, RDS was applied in 12 cities in the 5 macroregions of Brazil between June and December 2016 to recruit MSM for BBSS. The target sample size was 350 per city. Five to 6 seeds were initially selected to initiate recruitment and coupons and interviews were managed online. On-site rapid testing was used for HIV screening, and confirmed by a 2nd test. Participants were weighted using Gile estimator. Data from all 12 cities were merged and analyzed with Stata 14.0 complex survey data analysis tools in which each city was treated as its own strata. Missing data for those who did not test were imputed HIV+ if they reported testing positive before and were taking antiretroviral therapy.A total of 4176 men were recruited in the 12 cities. The average time to completion was 10.2 weeks. The longest chain length varied from 8 to 21 waves. The sample size was achieved in all but 2 cities.A total of 3958 of the 4176 respondents agreed to test for HIV (90.2%). For results without imputation, 17.5% (95%CI: 14.7-20.7) of our sample was HIV positive. With imputation, 18.4% (95%CI: 15.4-21.7) were seropositive.HIV prevalence increased beyond expectations from the results of the 2009 survey (12.1%; 95%CI: 10.0-14.5) to 18.4%; CI95%: 15.4 to 21.7 in 2016. This increase accompanies Brazil's focus on the treatment to prevention strategy, and a decrease in support for community-based organizations and community prevention programs.

This study analyzed the meanings given to the Brazilian National Men's Health Policy (PNAISH) by those involved in its implementation to find out how a policy formulated at national level is reflected in local contexts. In five cities, from each macro region of the country, a set of 6 narratives and 21 semi-structured interviews were held with health managers and professionals; the information on the Policy was developed according to the Meaning Interpretation Method. The Policy is generally perceived as positive. Among the meanings given, it is emphasized that the policy is seen, by some, as a comprehensive care that guides actions to address men as a whole in Primary Care; then again, others perceived it as a reduction to urological problems. The policy was also perceived as something vague, which does not detail how to proceed to take men to the services and to better assist them, or something episodic, being the policy reduced to the accomplishment of specific events rather than ongoing actions in everyday services. The different meanings guide practices and actions, which may signal the effective and continued engagement of the professional with the policy, being a key element for its monitoring and evaluation.

Given the implications of stigma for HIV/AIDS prevention and control of the epidemic, as emphasized by UNAIDS, this study analyzes the Brazilian academic production on health, AIDS, stigma, and discrimination, available in the SciELO database from 2005 to 2010. Brazilian research on the theme is modest as compared to the international literature, but the studies follow the same trend of focusing on individual experiences of discrimination as opposed to analysis of stigma and discrimination as social processes associated with power relations and domination (macro-social structures) and the characteristics of individuals and social groups that shape social interactions. The current study seeks to analyze the reasons for the scarcity of studies on the social perspective towards stigma and discrimination in the field of public health and the implications for the development of proposals to deal with HIV/AIDS-related discrimination.

Objective: To review the findings on quality of life (QOL) and health-related quality of life (HRQOL) among infertile women, men and couples., Design: Systematic review., Methods: Publications between January 1980 and July 2009 in Medline, PsycInfo, Embase and Health and Psychosocial Instruments were compiled using the following inclusion criteria: papers published in peer-reviewed journals; written in English, French, Spanish or Portuguese; presented original findings; assessed quality of life or health-related quality of life as an outcome; included infertile subjects without other clinical conditions; used validated measures., Interventions: None., Main Outcome Measures: Quality of life and health-related quality of life., Results: Fourteen studies were included in the review. Educational level, will to have children, poor marital relationship, previous in-vitro fertilisation attempt and duration of the infertility were predictors of lower mental health scores in infertile men. Women had significant lower scores on mental health, social functioning and emotional behaviour. Among infertile subjects, women had lower scores in several QOL or HRQOL domains in comparison to men., Conclusions: Evidences indicate important QOL or HRQOL impairments in infertile women. Among men, it does not appear to be intense. There is scarce knowledge regarding the impact of infertility on couples.

This paper explores the reproductive preferences and outcomes of HIV-positive women in two cities in Brazil. We used three types of data, all drawn from women who delivered in public sector hospitals: (1) clinical records of 427 HIV-positive women; (2) pre- and postpartum in-depth interviews with 60 HIV-positive women; and (3) a prospective survey carried out among 363 women drawn from the general population. The HIV-positive samples were collected on women who had prenatal care between July 1999 and June 2000, and the general population survey was conducted with women who started prenatal care between April 1998 and June 1999. Among the women in the clinic sample, we found dramatic differences in the proportion sterilized postpartum: 51% in Sao Paulo vs. 4% in Porto Alegre, compared to 3.4% and 1.1%, respectively, of women in the general population. Our qualitative data suggest that HIV-positive women in this study had strong preferences to have no more future children and that female sterilization was the preferred way to achieve this end. Therefore, we conclude that the large difference in rates is mainly due to HIV-positive women's differential access to sterilization in the two settings. In-depth interviews revealed that women in Sao Paulo were often encouraged by clinic staff to be sterilized postpartum. In contrast, HIV-positive women in Porto Alegre clinics were not offered sterilization as an option and those who requested it were repeatedly put off. The striking difference found in the frequency with which doctors provide postpartum sterilization to seropositive women in our study sites deserves attention and discussion in the respective medical communities. At the higher level of national policy on reproductive rights, there may be grounds for reopening discussion about the norms regarding postpartum procedures, and for devoting far more resources to expanding contraceptive options.

This study aims to estimate the prevalence of adolescent pregnancy (AP) in three Brazilian cities Salvador, Rio de Janeiro, and Porto Alegre and to examine the profiles of pregnant girls and their partners in relation to pregnancy outcomes. Data for a retrospective assessment of AP were collected using an interview-based household survey applied to a stratified sample of males and females aged 18-24. A total of 4,634 individuals were interviewed (85.2 % of the eligible individuals). 21.4% of males and 29.5% of females aged 20-24 reported AP, but few such pregnancies had taken place before age 15 (0.6% and 1.6%). Pregnancy between adolescent partners was reported by 55.1% of males and 27.9% of females. 79.8% of the latter became pregnant while involved in a stable relationship with an older partner. AP levels varied inversely to schooling and income levels. 72.2% of females and 34.5% of males carried their first AP to completion, and more cases of induced abortion were reported by male partners in pregnancies (41.3%) than by females (15.3%). With the birth of the first child, 25.0% of women interrupted their studies temporarily and 17.3% definitively. However, 42.1% of primiparous mothers were already outside school before pregnancy.

This paper presents the results of anthropological research on graphic and verbal images of the reproductive system carried out among 99 women and 103 men living in four shantytowns in Porto Alegre, Brazil. Interviewers were instructed to ask for the drawings in the course of interviews lasting 12-20 hours. Some 55 drawings of the female reproductive system by men and 99 by women were produced and are analysed here together with information from the interviews and observational data. The majority of the men's drawings of women's reproductive system tended to include 'external' body parts only, in contrast with the 'hidden' nature of the internal body parts, which were commonly depicted by the women. Women have been more exposed to the health system than men and the majority made basic biomedical types of drawings. However, their verbal representations were sometimes informed by other notions and values and their physical experience of their bodies. Lack of contact with the health system does not fully account for the men's apparent lack of knowledge about the reproductive body. Rather, biomedical knowledge was simply not a point of reference for the men's understandings of the body. The majority of drawings made by men of the female reproductive body portrayed the primacy of sexuality in their view of the reproductive system.

An ecological conceptual framework that supports the interdependence of the marital and the parent-child relationships is used to guide this discussion of the determinants of marital change during the transition to parenthood. New parents are at risk of experiencing increased marital conflict after the birth of their infant, which is associated with negative developmental outcomes for their children. Descriptive questions that pediatric nurses can ask both parents in assessing marital satisfaction and suggestions for interventions to ease the stresses of the transition for parents are presented.