Pre-exposure prophylaxis use and discontinuation among Brazilian gay, bisexual, and other men who have sex with men: examining the role of internalized homonegativity and discrimination

作者：Karine M Barreto, Thiago S. Torres, Lucilene Freitas, Brenda Hoagland, Emília M. Jalil, Valdiléa G. Veloso, Beatriz Grinsztejn, Paula M. Luz · 发表于：BMC Infectious Diseases · 年份：2025 · DOI：10.1186/s12879-025-11742-4 · 被引用次数：3 · 研究领域：HIV/AIDS Research and Interventions、LGBTQ Health, Identity, and Policy、Adolescent Sexual and Reproductive Health

BACKGROUND: Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy yet use and persistence among populations at high vulnerability to HIV in Brazil remains suboptimal. We sought to quantify internalized homonegativity and discrimination using multi-item validated instruments and to estimate their associations with PrEP use and discontinuation among gay, bisexual, and other men who have sex with men (MSM). METHODS: A cross-sectional, web-based survey was conducted from November 2021 to January 2022, recruiting a convenience sample of MSM through dating apps and social media. The survey assessed sociodemographic characteristics, sexual behavior, substance use, HIV transmission knowledge (using the HIV Knowledge Assessment tool), internalized homonegativity (using the Reactions to Homosexuality Scale), and experiences of discrimination (using the Explicit Discrimination Scale). PrEP use was assessed with response options "I have never used PrEP" (henceforth "never used"), "I am currently using PrEP" (henceforth "current use"), and "I used PrEP in the past but stopped" (henceforth "discontinuation"). Unadjusted and adjusted associations between internalized homonegativity and discrimination and the outcomes a) "current use" of PrEP compared to "never use", and b) "discontinuation" compared to "current use", were estimated using logistic regression models. RESULTS: The analytic sample consisted of 2,840 participants, with PrEP use patterns distributed as fol...