In Brazil, the disproportionate impact of human immunodeficiency virus (HIV) on young men who have sex with men (YMSMs) has posed a longstanding challenge to public health officials.
Data indicates that HIV’s prevalence among YMSMs is nearly ten times that of the general population. Despite the considerable disease burden of HIV on the YMSM community in Brazil, scholarship on it is scarce and relatively uncomprehensive. Jalil and colleagues, in one of the first publications on the subject, analysed YMSMs’ experiences with HIV in a recent publication in The Lancet Regional Health – Americas.
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Not only does the study indicate a high prevalence of HIV among Brazil’s YMSM community, but it also reveals an alarmingly low rate of diagnosis awareness among those with infections. Between 2024 and 2029, GlobalData forecasts a decline in the diagnosed prevalent cases of HIV from almost 35,400 to around 32,700 among 18 to 24-year-old men in Brazil. While the diminishing disease burden is encouraging, it is critical to ensure the drivers in this trend are attributed to lower infection rates and not to insufficient diagnosis.
Stigma around sexuality impacts willingness to seek healthcare
Jalil and colleagues conducted their analysis as part of the Conectad@s project, a mixed-method study carried out to estimate the disease burden of HIV and other sexually transmitted infections (STIs) among YMSMs between the ages of 18 and 24. The project, which recruited 409 participants in the Rio de Janeiro area, measured prevalent and incident infections between 2021 and 2022. Participants were provided with a questionnaire that included items on gender identity, sexual behaviour, HIV and STI testing and diagnosis history, and knowledge of pre-exposure prophylaxis (PrEP). These data points were accompanied by testing for HIV, syphilis and hepatitis B and C. Following survey responses and testing, the cohort was separated by HIV positivity and prior knowledge of diagnosis.
Following testing, 90.20% of the participants had a negative HIV diagnosis, followed by 4.9% with a known diagnosis and 4.9% with a new diagnosis, indicating not only a high HIV prevalence rate, but a high proportion of individuals unaware of their diagnosis. Furthermore, HIV knowledge, awareness of PrEP, and prior HIV testing were all significantly lower in the new HIV diagnosis group. This group was also characterised by relatively low disclosure of sexual orientation. The authors draw on these data points, as well as the high prevalence of discrimination and mental health disorders across the cohort, to suggest that social stigma plays a particularly important mediating role in downstream health behaviours such as care-seeking and education on HIV.
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A high prevalence of mental health disorders appears across the cohort
The research carried out by Jalil and colleagues presents a troubling picture of HIV’s burden on the YMSM community in Brazil. The prevalence and incidence rates in this community, which are significantly higher than that of the general population, can be attributed to a wide variety of structural and behavioural factors. These health disparities, particularly in the context of widespread stigma and discrimination as reported by study participants, suggest a need for a multi-faceted approach to HIV prevention and treatment among YMSMs.
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By GlobalDataFirst, the lack of HIV knowledge in the YMSM community presents opportunities for targeted health promotion initiatives through the state of civil society. Services such HIV and STI education, as well as PrEP distribution, could bolster HIV prevention and diagnosis. At a structural level, efforts to reduce the stigma surrounding homosexuality more broadly may facilitate more open discourse on health challenges to the YMSM community.
