Acceptability of HIV self-test among adolescent men who have sex with men and transgender women in Brazil


BACKGROUND: HIV self-testing (HIV-ST) is a technology that is part of combined prevention initiatives, currently considered strategic for controlling the epidemic, and may be especially relevant for populations among which HIV prevalence is highest. The literature describes this technology as well accepted among different groups, but there are knowledge gaps concerning specific groups, such as adolescents. In this qualitative study, we aimed to analyze the acceptability of HIV-ST among adolescent men who have sex with men and transgender women in three Brazilian capitals.
METHODS: We carried out interviews and focus groups with 74 participants from the PrEP1519 study, being 25transvestites and transsexual womenand 49 men who have sex with men. All interviews were recorded, transcribed, and analyzed based on the Theoretical Framework of Acceptability (TFA) associated with the theoretical framework of vulnerability. The TFA comprises seven dimensions of acceptability: 'affective attitude', 'perceived effectiveness', 'intervention coherence', 'self-efficacy', 'participation load', 'ethicality' and 'opportunity costs'. We chose not to include the 'opportunity costs' dimension, considering that HIV-ST is currently distributed by the Brazilian Unified Health System for the adult population and that it may also be done for adolescents.
RESULTS: The analysis of the acceptability dimensions that make up the TFA show good acceptability of HIV-ST among men who have sex with men and transgender women, although not homogeneous. Among the positive aspects of the tests there are, for instance, the agility and confidentiality as components of 'affective attitude'; the practicality of use, privacy and emotional management related to the testing process associated to its 'self-efficacy' and 'perceived effectiveness'.However, there is the concern with how to deal with a positive result that is recognized as a 'participation load' and about the 'intervention coherence' there is a perception that testing is not effectively prevention method since for them this would only confirm an existing serological status.
CONCLUSIONS: The importance of expanding the dispensation of self-tests among adolescents is reinforced, considering the context of combined prevention, the particularities of the expectations of use and it concerns to enhance self-care and expand the recognition of its possibilities in preventing.

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