Uso de preservativo em homens que fazem sexo com homens: história individual e práticas culturais
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Data
2023-02-24
Autores
Brum, Maiara Medeiros [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
No Brasil, foram notificados, entre 2007 e junho de 2021, 266.360 novos casos de infecção pelo HIV em homens. Homens que fazem sexo com homens (HSH) estão entre as populações consideradas vulneráveis pela UNAIDS (2021). Apesar do preservativo ainda ser considerado uma das formas mais eficazes de prevenção da infecção pelo HIV, observa-se que o uso inconsistente do preservativo ainda é bastante comum para a população de HSH. A compreensão das variáveis dificultadoras ao uso do preservativo por HSH pode contribuir para melhor manejo terapêutico e planejamento de políticas públicas mais eficazes. Neste sentido, o objetivo deste estudo foi identificar, a partir de relatos verbais, fatores que podem interferir no uso do preservativo entre HSH, sob a ótica da Análise do Comportamento. Foram entrevistados 120 HSH (60 sem a infecção - G1 e 60 vivendo com HIV - G2), usuários do Serviço de Ambulatórios Especializados de Infectologia Domingos Alves Meira em Botucatu e a partir de convites efetuados em redes sociais e pela técnica de “bola de neve”. Para coleta dos dados foram utilizados um questionário elaborado pela própria pesquisadora e os instrumentos: Self Reporting Questionnaire (SRQ-20), Alcohol Use Disorder Identification Test (Audit) e Escala de Apoio Social (EAS). Para a análise dos dados foram calculadas as frequências e percentagens das respostas, bem como a comparação entres os grupos (G1 e G2) através do teste qui-quadrado. Do total de 120 HSH participantes, 79% referiram não ter dificuldade para solicitar o uso do preservativo a seus parceiros e 75% relataram não ter usado preservativos em todas as relações sexuais (sexo anal) nos últimos seis meses. Destaca-se maior número de participantes do G2 que relatou não saber o resultado de teste para pesquisa de HIV de todos os parceiros (p=0,0004). Quanto a diminuir a frequência ou interromper o uso, 81% relataram ter essas práticas em relacionamentos fixos, sendo essa prática mais frequente entre os participantes do G1 (p = 0,0107). Quando questionados sobre os motivos para o não uso do preservativo destacaram-se: confiança no parceiro (61%), prazer momentâneo (35%), fazer apenas sexo oral (25%). Em relação aos conhecimentos acerca da infecção pelo HIV/aids, 64% dos participantes acertaram entre 31 e 35 questões. Ao se investigar a relação entre o uso inconsistente do preservativo e os resultados dos instrumentos, observou-se que entre os participantes do G1 houve um maior uso inconsistente do preservativo entre aqueles que apresentaram consumo de risco para dependência de álcool (p = 0,0270), provável sofrimento mental (p = 0,0358), bem como para os que demonstravam maior percepção de apoio social – pontuações ≥79: 84,2% de uso inconsistente (p=0,0127). Os dados aqui encontrados sugerem que não há para essa população correspondência dizer-fazer, ou seja, falar sobre o uso do preservativo não implica na alteração do comportamento de usá-lo. O que mantém o uso inconsistente é o prazer (consequência imediata) e não a possibilidade de prevenção (consequência a longo prazo). Neste sentido, a regra provavelmente estabelecida por esta população é “Confio no meu parceiro, não preciso usar o preservativo”, o que inviabiliza o autocontrole para a escolha pela consequência a longo prazo. Quanto aos participantes do G1 é provável que exista para estes uma nova percepção sobre o HIV e a aids enquanto uma doença mais branda e facilmente controlável, e consequentemente com menor probabilidade de contaminação. Deste modo, acredita-se que políticas públicas de prevenção devem focalizar não apenas no uso do preservativo, mas também em ações que promovam um contexto que facilite o estabelecimento de práticas sexuais seguras.
In Brazil, 266,360 new cases of HIV infection in men were reported between 2007 and June 2021. Men who have sex with men (MSM) are among the populations considered vulnerable by UNAIDS (2021). Although condoms are still considered one of the most effective ways to prevent HIV infection, it is observed that the inconsiste nt condom use is still quite common for the MSM population. Understanding the variables that hinder condom use by MSM may contribute to better therapeutic management and planning of more effective public policies. In this sense, the aim of this study was t o identify, from verbal reports, factors that may interfere with condom use among MSM, from the perspective of Behavior Analysis. We interviewed 120 MSM (60 uninfected Meira Infectious DiseasesG1 and 60 living with HIV G2), users of the Domingos Alves Outpatient Clinic in Botucatu and from invitations made in social networks and by the snowball technique. For data collection, a questionnaire prepared by the researcher herself and the instruments were used: Self Reporting Questionnaire (SRQ Alcohol20), Use Disorder Identification Test (Audit) and Social Support Scale (SAS). For the data analysis the frequencies and percentages of the answers were calculated, as well as the comparison between the groups (G1 and G2) through the chisquare test. From the total of 120 MSM participants, 79% reported having no difficulty in asking their partners to use condoms, and 75% reported not having used condoms in all sexual intercourse (anal sex) in the last six months. We highlight the higher number of G2 participant s who reported not knowing the HIV test results of all partners (p=0.0004). As for reducing the frequency or discontinuing the use, 81% reported having these practices in regular relationships, and this practice was more frequent among G1 participants (p = 0.0107). When asked about the reasons for not using condoms, the main ones were: trust in the partner (61%), momentary pleasure (35%), and only performing oral sex (25%). Regarding knowledge about HIV/AIDS infection, 64% of the participants answered betwe en 31 and 35 questions. When investigating the relationship between inconsistent condom use and instrument scores, it was observed that among G1 participants there was a higher inconsistent condom use among those who presented risk consumption for alcohol dependence (p = 0.0270), probable mental distress (p = 0.0358), as well as for those who demonstrated higher perceived social support scores ≥79: 84.2% inconsistent use (p=0.0127). The data found here suggest that for this population there is no saydo c orrespondence, i.e., talking about condom use does not imply a change in the behavior of using it. What keeps use inconsistent is pleasure (immediate consequence) and not the possibility of prevention (longterm consequence). In this sense, the rule probab ly established by this population is "I trust my partner, I don't need to use a condom", which makes self to choose the long-- control term consequence impossible. As for the G1 participants, it is likely that they have a new perception of HIV and AIDS as a milder and more easily controllable disease, and consequently less likely to be infected. Thus, it is believed that public policies for prevention should focus not only on condom use, but also on actions that promote a context that facilitates the establis Keywords: hment of safe sex practices. HIV infection, men who have sex with men, HIV prevention, condom use, behavior analysis.
In Brazil, 266,360 new cases of HIV infection in men were reported between 2007 and June 2021. Men who have sex with men (MSM) are among the populations considered vulnerable by UNAIDS (2021). Although condoms are still considered one of the most effective ways to prevent HIV infection, it is observed that the inconsiste nt condom use is still quite common for the MSM population. Understanding the variables that hinder condom use by MSM may contribute to better therapeutic management and planning of more effective public policies. In this sense, the aim of this study was t o identify, from verbal reports, factors that may interfere with condom use among MSM, from the perspective of Behavior Analysis. We interviewed 120 MSM (60 uninfected Meira Infectious DiseasesG1 and 60 living with HIV G2), users of the Domingos Alves Outpatient Clinic in Botucatu and from invitations made in social networks and by the snowball technique. For data collection, a questionnaire prepared by the researcher herself and the instruments were used: Self Reporting Questionnaire (SRQ Alcohol20), Use Disorder Identification Test (Audit) and Social Support Scale (SAS). For the data analysis the frequencies and percentages of the answers were calculated, as well as the comparison between the groups (G1 and G2) through the chisquare test. From the total of 120 MSM participants, 79% reported having no difficulty in asking their partners to use condoms, and 75% reported not having used condoms in all sexual intercourse (anal sex) in the last six months. We highlight the higher number of G2 participant s who reported not knowing the HIV test results of all partners (p=0.0004). As for reducing the frequency or discontinuing the use, 81% reported having these practices in regular relationships, and this practice was more frequent among G1 participants (p = 0.0107). When asked about the reasons for not using condoms, the main ones were: trust in the partner (61%), momentary pleasure (35%), and only performing oral sex (25%). Regarding knowledge about HIV/AIDS infection, 64% of the participants answered betwe en 31 and 35 questions. When investigating the relationship between inconsistent condom use and instrument scores, it was observed that among G1 participants there was a higher inconsistent condom use among those who presented risk consumption for alcohol dependence (p = 0.0270), probable mental distress (p = 0.0358), as well as for those who demonstrated higher perceived social support scores ≥79: 84.2% inconsistent use (p=0.0127). The data found here suggest that for this population there is no saydo c orrespondence, i.e., talking about condom use does not imply a change in the behavior of using it. What keeps use inconsistent is pleasure (immediate consequence) and not the possibility of prevention (longterm consequence). In this sense, the rule probab ly established by this population is "I trust my partner, I don't need to use a condom", which makes self to choose the long-- control term consequence impossible. As for the G1 participants, it is likely that they have a new perception of HIV and AIDS as a milder and more easily controllable disease, and consequently less likely to be infected. Thus, it is believed that public policies for prevention should focus not only on condom use, but also on actions that promote a context that facilitates the establis Keywords: hment of safe sex practices. HIV infection, men who have sex with men, HIV prevention, condom use, behavior analysis.
Descrição
Palavras-chave
Infecção por HIV, Prevenção ao HIV, Uso de preservativo, Preservativos - Uso, Avaliação de comportamento, Sexo seguro para prevenção da AIDS, Homossexualidade masculina