Dominant discourses on youth sexual health construct young people as at-risk subjects who engage in risky behaviours due to ignorance or poor decision-making. This dissertation challenges the prevailing assumption embedded in these discourses that young people’s sexual behaviours are based on individual rational choices. Drawing on Pierre Bourdieu’s theory of practice and R. W. Connell’s notion of hegemonic masculinity, this dissertation uses an interpretive approach to analyze the narratives and resonant texts of 24 young men in Toronto. It explores how young men construct and perform their masculine identities in the context of their socio-spatial environment; it also examines the strategies that young men use to compete for cultural capital and dominant positions in the homosocial and (hetero)erotic fields. The analysis yields a number of findings. First, it shows that gender identity is a state of being-doing-becoming. Guided by their gender-class-race habituses, young men engage in an unceasing process of defining, affirming, declaring, and validating not only their sense of who they are (self-identity) and where they belong (collective identity), but also the boundary that differentiates the ‘Self’ from the ‘Other’. Second, there is a dialectical relationship between the young men’s masculine habituses and their sexual practices. While all the young men engaged in hegemonic masculine practices to gain ‘respect’ from their peers, their practices varied according to their classes and ethnoracial backgrounds. At the same time, their (hetero)erotic practices are intricately intertwined with their homosocial practices, whereby the intra-group masculine expectations coupled with the broad hegemonic masculine discourses assert significant influences on their interactions with both young women and other young men. Finally, hetero-guy-talk constitutes an important everyday social interaction in which young men actively engage in the (re)production and/or resistance of hegemonic masculine discourses and practices. These results suggest that effective sexual health promotion (SHP) must go beyond the focus on individual sexual behaviours to address the historical, cultural, economic, and political contexts that shape the collective sexual health practices of young men. Furthermore, it may be useful to explore ‘hetero-guy-talk’ as an important ‘third’ space where young men are invited to interrogate and resist misogynist, masculinist, and homophobic practices and be supported to engage in humanizing sexual practices.

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-02-03T14:29:35Z No. of bitstreams: 1 arquivototal.pdf: 4700874 bytes, checksum: 46c2a6f8e964ef27528032f70c3c3f18 (MD5) / Made available in DSpace on 2016-02-03T14:29:35Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 4700874 bytes, checksum: 46c2a6f8e964ef27528032f70c3c3f18 (MD5) Previous issue date: 2015-04-07 / This work consists in the analysis of swing while an event that provides a set of developments related to the subjectivation processes in sexualities and conjugalities in the contemporary world. To do it, I had tried to understand how linked networks are formed to the swing sex from two specific paths: the analysis of on-line sex networks, with a focus on Sexlog (sex social network on the internet); and networks of sex off line, with attention to parties and establishments dedicated to the subject (houses and swing clubs). As one of the main points, "swing" category's labor in Brazil as a generic term used to discuss a set of sexual practices that do not summarize the practice of exchanging couples. It has important consequences, in respect to how this time, the swing event, it makes possible to think of other joints in relation to categories related to swing as the gender, sexuality and the subjectivation processes from those who practices them. In this sense, the swing would be a sexual/social event that would make the suspension or the temporary decrease of moral codes at the same time that would allow the emergence of other desires unlinked to morality, possible made through secret, intimacy and the shuffling points concerning sexuality. / Esta tese consiste na análise do swing enquanto evento que proporciona um conjunto de desdobramentos relacionados aos processos de subjetivação, às sexualidades e às conjugalidades no mundo contemporâneo. Para fazer isso, tentei entender como são formadas as redes de sexo vinculadas ao swing partindo de dois caminhos específicos: a análise das redes de sexo on line, com ênfase no Sexlog (rede social de sexo na internet); e das redes de sexo off line, com atenção às festas e aos estabelecimentos dedicados ao tema (casas e clubes). Como um dos pontos principais, parto da categoria "swing" no Brasil como um termo genérico que serve para problematizar um conjunto de práticas sexuais que não se resumem a prática da troca de casais. Isso possui desdobramentos importantes, com relação a como esse momento, o evento de swing, possibilita pensar em outras articulações com relação a categorias relacionadas ao swing como o gênero, a sexualidade e os processos de subjetivação dos sujeitos participantes. Nesse sentido, o swing seria um evento sexual/social específico que possibilitaria a suspensão, ou a diminuição temporária de códigos morais ao mesmo tempo em que permitiria a produção de outros desejos desvinculados à moral vigente, possibilitados através do segredo, da intimidade e do embaralhamento de pontos referentes à sexualidade.

Background: Human immunodeficiency virus (HIV) remains a global challenge with an estimate of 37.9 million confirm cases. Testing remains a critical indicator of HIV diagnosis and treatment, as it is the primary step towards taking accountability for the protection of oneself and the protection of others. Aim: This secondary analysis of Liberia Demographic and Health Survey data from 2013 aimed to statistically describe the association between Knowledge, Attitude, and Practices (KAP), demographics factors such as age, education, marital status, wealth, religion, place of residence, and testing uptake.  Methods: A cross-sectional study of Liberian women (n=7353, aged 15 - 49 ) was performed. Statistical analysis of the chi-square test and logistics regression was employed to identify the association between independent variables (KAP), selected demographics factors, and the dependent variable (HIV testing).   Results: The key findings of the study are that there is a statistically significant relationship between comprehensive knowledge and testing for HIV. The attitude in terms of stigmatizing behavior is also significantly associated with testing uptake. Demographic factors age, education, being ever married, being a Muslim, belonging to the middle class, and living in the rural area are positive determinants of HIV testing in Liberia. The study confirmed that there is no statistically significant association between high-risk behavior and testing uptake among women aged 15-49 in Liberia. Conclusion: Knowledge, stigmatizing attitude, and some demographic factors are determinants of testing uptake in Liberia.

English: At DISA-clinic the researcher found that young women between the ages of 16 and 25 are faced with various sexual problems. As a result the aim of this study was to explore the socio-emotional influence of sexual problems on young women. For the purpose of this study an exploratory research design was used because little information was found on the socio-emotional influence of sexual problems on young women in available literature. A contribution can be made through exploring the socio-emotional influence that sexual problems have on young women. Sexual problems for the purpose of this study were organised in three main groups: Sexual dysfunctions; these include Dyspareunia, Vaginismus, Anorgasmia. Unintended pregnancy; these include abortion, adoption, early parenting. Sexually transmitted diseases and sexually related diseases; these include HIV infection and AIDS, Gonorrhea, Syphilis, Herpes. It was essential in this study to use a qua I itative research approach because the researcher wanted to explore the socio-emotional influence of sexual problems on young women and formulate a holistic understanding of this phenomenon. This qualitative study consequently presented the reader with an understanding of the socio-emotional influence that sexual problems have on young women. The data collection method which was used is document study. In this study personal letters of young women received between June 2002 and February 2003 were included. The researcher gathered one hundred and fifteen personal letters of young women that fitted the sample criteria. Seven main themes and related themes were identified in the personal letters and the researcher analyzed the information according to Creswell's spiral model. After these themes were identified it can be emphasised that there is definitely a sense of similarity between the influence of the three main groups of sexual problems on the socio-emotional functioning of young women. Consequently the researcher states that from the above seven themes that were identified, it became clear that various sexual problems influence young women's socioemotional functioning in a similar manner. Further research on preventing the rising statistics of sexual problems under young women is recommended. / Afrikaans: Die navorser het by DISA-kliniek gevind dat jong vrouens tussen die ouderdom van 16 en 25 gekonfronteer word met verskeie seksuele probleme. Gevolglik is die doel van die studie om die sosio-emosionele invloed van seksuele probleme op jong vrouens te eksploreer. Vir die doel van hierdie betrokke studie is 'n eksplorerende navorsingsontwerp gebruik omrede min informasie gevind is ten opsigte van die sosio-emosionele invloed van seksuele probleme op jong vrouens in beskikbare literatuur. 'n Bydrae kan gemaak word deur die sosio-emosionele invloed wat seksuele probleme op jong vrouens het, te eksploreer. Seksuele probleme is vir die doeleindes van die studie in drie hoofgroepe georganiseer: Seksuele disfunksies; wat insluit Dyspareunia, Vaginismus en Anorgasmia. Onbeplande swangerskappe; wat insluit aborsie, aanneming en vroee ouerskap. Seksueel oordraagbare siektes en seksueel verwante siektes; wat insluit MIV infeksie en VIGS, Gonorrhea, Sifilis en Herpes. Dit was essensieel in die studie om 'n kwalitatiewe navorsingsbenadering te volg omrede die navorser die sosio-emosionele invloed van seksuele probleme op jong vrouens wou eksploreer en 'n holistiese begrip van die betrokke fenomene wou kry. Die kwalitatiewe studie verskaf die leser gevolglik met 'n begrip van die sosio-emosionele invloed wat seksuele probleme op jong vrouens het. Die data-insamelingsmetode wat gebruik is, is dokumentanalise. In die studie is anonieme, persoonlike briewe van jong vrouens ingesluit wat tussen Junie 2002 en F ebruarie 2003 ontvang is. Die navorser het een honderd en vyftien briewe van jong vrouens volgens die vasgestelde steekproefkriteria geselekteer. Sewe hooftemas en verwante temas is geidentifiseer vanuit die anonieme persoonlike briewe en die navorser het die data volgens Creswell se spiraal model geanaliseer. Na identifisering van die temas kan klem daarop geplaas word dat daar definitief 'n ooreenkoms bestaan tussen die invloed wat die drie hoofgroepe seksuele probleme op die sosio-emosionele funksionering van jong vrouens het. Gevolglik maak die navorser die aanname dat vanuit die geidentifiseerde sewe temas, dit duidelik is dat verskeie seksuele probleme 'n soortgelyke invloed op die sosio-emosionele funksionering van jong vrouens het. Verdere navorsing op die voorkoming van die stygende statistieke van seksuele probleme onder jong vrouens, word aanbeveel. / Dissertation (MSD (Play Therapy)--University of Pretoria, 2003. / Social Work and Criminology / MSD (Play Therapy) / Unrestricted

Philosophiae Doctor - PhD / In the decade since first identified, the Acquired Immunodeficiency syndrome (AIDS) has become a serious global disease. The nature of the Human Immunodeficiency Virus (HIV) that causes AIDS, whereby a carrier may be asymptomatic yet remain infectious, has enabled its dramatic spread. The number of AIDS cases is increasing exponentially, averaging a doubling time of between 8-15 months indifferent countries. Of the millions of HIV carriers, it is now estimated that all will eventually go on to develop full-blown AIDS and probably die within 15 years. Unlike other infectious diseases, there is currently no known vaccine or cure. Further, HIV is now virtually completely dependent on volitional sexual behaviours for transmission to occur. It is therefore an entirely preventable disease. However, since the behaviours that contribute to HIV-transmission are influenced by biological, psychological, and social factors, their alteration in line with safer sexual practices has been shown to be considerably complex and difficult. Intervention strategies that have relied on imparting knowledge about the disease have achieved limited success in influencing behaviour change. Unsafe sexual practices, and the risk of HIV-infection, often continue even when knowledge regarding prevention is adequate. It has therefore become apparent that other variables intrude which may mediate between knowledge acquisition, attitude formation, and consequent sexual behaviours. There appear to be no models which adequately explain the complexities in this area, and which enable adequate intervention strategies to be developed. The present study was undertaken to redress this problem, and to explore those variables that mediate in the area. Various psychological and social factors appear to be implicated in influencing sexual attitudes and behaviours. In order to adequately test the impact of psychosocial variables that were found to have significant associations in an exploratory study, a measuring instrument was developed. The AIDS Psychosocial Scale was statistically validated using content, frequency, factor, and reliability analyses and included psychological factors of self concept, defenses of denial, repression, and rationalisation, perceived empowerment in the form of locus of control and self efficacy, and the social factor of peer pressure susceptibility. The impact of these psychosocial variables on indices of knowledge, condom attitude, and sexual practices, and on other epidemiological variables was tested using a sample of students at the University of the Western Cape (n=308). Results indicated a number of correlational and causal links between variables, confirming the mediational role psychosocial factors have in influencing knowledge acquisition, attitude formation, and behaviour outcome. A profile of lower self concept, higher defenses, lower self-efficacy, more external locus of control, and higher peer pressure susceptibility emerged which was associated with poorer knowledge, more negative attitudes, and higher unsafe sex. Based on this study, a model of psychosocial mediation is developed and its implications for intervention strategies discussed.

Yes / Bids for mutuality in sexual partnerships are key to AIDS campaigning slogans such as `negotiate¿, `know your partner¿ and `use condoms¿. This paper explores the contradiction between more mutuality in sexual relations and the gender power politics that render such mutuality difficult to achieve in Africa, as well as the caricatures of `African sexuality¿ that have pervaded some of the literature. It looks at the new discourses of sexuality delivered via NGOs and the state as well as the ways in which customary silences about sex are being broken by ordinary people. It asks whether, given the threat of HIV infection, people are talking in new ways about sexual relationships, and how this talk is gendered. It also addresses the challenge to African feminism of sexuality discourses and how these need to be rethought in the context of AIDS. It concludes that the prospect of death by sex is transforming discourses, challenging customary sexual practice and putting gendered inequalities in question.

This study focuses on the interrelationships between risky sexual practices, substance use, and arrest history. The sample consists of 948 newly arrested juvenile offenders processed at a centralized intake facility in 2006. A series of confirmatory factor analysis and structural equation modeling techniques are used to 1) determine if risky sexual behavior, marijuana and cocaine use, and arrest history form a unidimensional latent factor, 2) examine the direct effect of age on the latent factor, and 3) compare the factor structure, as well as the effect of age on the latent factor, across four demographic subgroups based on race and gender. Results provide moderate support for all three research objectives. Important similarities, as well as differences, in the factor structure across the four groups were found. The prevention and intervention implications of the findings, limitations of the current study, and directions for future research are discussed.

The purpose of this qualitative research study was to understand the facilitators and/or barriers to safer drug use and sexual practices among a sample of young female injection drug users (IDUs) who live in small towns/rural communities in Cape Breton, Nova Scotia. This study examined how economic status, relationships, social roles, small town/rural living, and stigma function as facilitators and/or barriers to safer practices. Eight female IDUs aged 20-31, living in small towns/rural communities in Cape Breton, engaged in face-to-face, semi-structured interviews. The women described what day-to-day life is like for female IDUs living in small towns/rural communities. They spoke about managing drug addiction, their understanding of safer and unsafe injection drug use and risky and safer sexual practices, as well as their experiences with services/supports. The information obtained from this study will help to inform harm reduction policy and program initiatives.

No Brasil, o s casos de AIDS entre homens que fazem sexo com homens (HSH) predominaram durante um longo período. A partir da década de 90, observa-se um declínio nesta categoria com o aumento de casos entre heterossexuais. Na região Nordeste, entretanto, os casos de AIDS entre HSH representam, ainda, cerca de 50% do total dos casos registrados em anos recentes. Nosso objetivo foi estudar o comportamento sexual e o padrão de consumo de drogas e álcool entre HSH no Ceará, enfatizando as tendências recentes e suas relações com práticas sexuais de risco para DTS/AIDS. Foram realizados quatro estudos seccionais em 1995, 1998, 2002 e 2005 no Ceará, nordeste do Brasil. A população do estudo foi composta por homens que fazem sexo com homens (HSH), com 14 anos ou mais , que referiram prática sexual anal ou oral com homens nos últimos 12 meses. A seleção dos participantes utilizou técnicas do tipo Snow Ball (1995, 1998, 2002); Time Space Sampling (2002) e Respondent Driven Sampling (2005). O primeiro artigo enfoca as tendências do comportamento sexual em Fortaleza ao longo destes quatro períodos e o segundo os preditores do consumo de álcool e drogas nos municípios de Fortaleza (n=401), Sobral (n=100) e a região do Cariri (n=100) em 2002. Análise se basearam nas comparações entre proporções, utilizando o teste do de Pearson e intervalos de 95% de confiança (IC95%) e análise de regressão logística multivariada para avaliação dos fatores associados ao consumo de álcool e drogas, utilizando-se como medida de associação a razão de chances (odds ratio OR) e seus respectivos intervalos de 95% de confiança. Resultados Práticas sexuais: Elevado percentual da população estudada referiu práticas sexuais de risco em 1995 (49,9%), decrescendo significativamente em 1998 (32,6%), tornando a crescer em 2002 (54,6%) e apresentando os menores percentuais em 2005 (31,4%). Este padrão não apresentou grandes variações por idade, mas em relação à escolaridade observou-se que os indivíduos com escolaridade mais elevada aumentaram as práticas de risco entre 1998 (28,6%) e 2002 (46,5%) decrescendo no último período (21,0%) enquanto aqueles com baixa ou média escolaridade só mostraram uma queda significativa no comportamento de risco entre 2002 (82,1% - baixa; 67,7% - média) e 2005 (29,1% - baixa; 34,3 média). A prática sexual anal com preservativo cresceu no decorrer dos anos variando de 43,3% a 53,7% entre a primeira e a última onda ( de tendência p<0.001). A relação anal sem preservativo foi uma prática com alto percentual na maioria dos anos. De 2002 a 2005, houve uma diminuição significativa (de alto percentual na maioria dos anos. De 2002 a 2005, houve uma diminuição significativa (de 57,7% para 26,3%) das relações fixas monogâmicas. Consumo de álcool e drogas: No estudo, 63% dos HSH participantes foram classificados como bebedores que se embriagam. Observou-se que o consumo crescente de álcool leva a um aumento do uso concomitante de outras drogas, sejam lícitas ou ilícitas. Foram variáveis preditoras de beber se embriagando: ter de 21 a 30 anos (OR: 1,5; IC 95%: 1,1-2,9); ter mais que 30 anos (OR: 1,6: IC95%: 1,2-2,3); ser solteiro/separado/divorciado (OR:3,0%; IC95%: 1,7-5,3); ser da raça negra (OR: 2,0 IC95%: 1,7-2,01); ser da raça parda (OR: 1,8 IC95%: 1,3-2,6); receber dinheiro por sexo (OR:2,0 IC95%: 1,8-2,9). As práticas sexuais dos SHS em Fortaleza apresentaram variações significativas ao longo doa anos estudados, semelhantemente a outros estudos internacionais. Vários fatores poderiam ser responsáveis por explicar o comportamento da curva observada em Fortaleza, seja no âmbito local, nacional ou internacional. Entre os fatores que podem explicar alterações observadas estariam: 1) redução nos recursos destinados à prevenção da AIDS no país devido a retirada de alguns organismos de cooperação internacional que se voltaram para outros países, como na África Leste Europeu, levando o Brasil a priorizar segmentos populacionais com maior vulnerabilidade; 2) grande impacto na prevenção das DST /AIDS na comunidade de homo/bissexuais masculinos, especialmente nos anos de 1998 a 2002; 3) o avanço no tratamento, surgimento de novas drogas, melhora da qualidade de vida e aumento da sobrevida, contribuindo para a construção da falsa ideia de segurança na população. Neste estudo a escolaridade mostrou-se um fator importante associado ao envolvimento em práticas sexuais não seguras. Os indivíduos com mais baixa escolaridade, no período de 1995 a 2002, se envolveram em maior risco, aparentando não terem sido atingidos pelas campanhas que possam ter ocorrido, principalmente no período de 1995 a 1998. A maior escolaridade apresenta-se como fator de proteção em todo o período estudado, provavelmente pelo maior acesso à informação. Finalmente, pode-se observar no ano de 2002 um elevado percentual de homens que consomem cinco ou mais doses em um dia típico e associam outras drogas ao consumo do álcool. Tal comportamento, dentro da população HSH, embora não seja caracterizado como dependência química, é alterado de maneira significativa pelo efeito etílico, levando à outras práticas de risco. Também se observou em nosso estudo que o consumo crescente de álcool leva a um aumento do uso de outras drogas, atuando para a adoção de comportamentos de risco. Existem evidências que suportam relação entre uso de outras drogas e a prática sexual de risco. Os indivíduos que referiram receber dinheiro em troca de sexo foram mais frequentemente classificados como bebedores que se embriagam. Os achados deste estudo mostram a importância da realização de uma vigilância comportamental contínua em relação ao HIV favorecendo o entendimento da dinâmica da epidemia junto das DST/AIDS nesta população vulnerável, assim como a importância que o álcool assume como problema de saúde pública neta população específica e a necessidade de se direcionar medidas voltadas para a sua prevenção. / In Brazil, cases of AIDS amonf men who make sex with men (MSM) predominated durinf a long period, but declined in the 90s as an increase was observed among heterosexual persons. In the Northeast Brazil, however, AIDS casis among MSM still account for 50% of all casis reportedrecently. To study the sexual behavior and patterns of alcohol and ilicit drugs consumption in Ceará, Brazil, emphasizing recent trends and their relation with risky sexual practices to STD/AIDS. Four surveys were carried out in the years of 1995, 1998, 2002 and 2005 in Ceará, Northeast Brazil. Study population included MSM of 14 years old or above reporting anal sex in the last 12 months. Different selection techniques were employed: Snow Ball (1995, 1998, 2002); Time Spaces Sampling (2002) and Respondent Driven Sampling (2005). The first manuscript focuses on the recent trends of sexul behvior of MSM in Fortaleza, and the scond evaluates the predictors of alcohol and drug sonsumtion in the cities of Fortaleza (n=401), Sobral (n= 100) and the region of Cariri (n=100) in the year of 2002. Analyses were based on th comparison between proportions (Pearson test and 95 % confidence intervals CI95%, as the measure of association between putative risk factors and alcohol and drug use. Sexual practices: high percentual percentage or risky sexual practices was reported in 1995 (49.9%), decreasing in 1998 (32.6%), increasing again in 2002 (54.6%) and presenting the lowest percentages in 2005 (31.4%). This pattern did not vary with age. Those participants with higher literacy increased their risky practices from 1998 (28.6%) to 2002 (46.5%), decreasing in the lastperiod (21.0%). Among those with middle or low levels risky behavior declined from 2002 (82.1% - low; 67.7% - middle) to 2005 (29.1% - low; 34.3% - middle). We observed an increase of anal sex with condom between the first and the last wave (43.3% to 53.7% for trens p< 0.001). Anal sex without condom was very commom inmost of the years. Between 2002 and 2005 there was a decrease in monogamous stable relationship (from 57.7% to 26, and 3%). Alcohol and drug consumption: 63% of the MSM participants were classified as (binge drinking) drinkers.Increased consumption of alcohol was associated with an increase in the simultaneous use of other licit and illicit drugs. The predict onnected with (binge dronking) drinking were: age, 21-30 vs. <21 years old (OR: 1.5; CI95%: 1,1-2.9); >30 vs. <21 years old (OR: 1.6; CI95%: 1.2-2.3); civil status, being single/ separated/divorced vs. married/together (OR: 3.9; CI95%: 1.7-5.3); race, being clack vs. white (OR: 5.9; CI95%: 1.7-20.1); being mixed vs. white (OR: 1.8; 95% CI: 1.3-2.6); getting paid for sex (OR: 2.0; CI 95%: 1.4-3.0); having had an HIV test (OR: 1.7; CI95%: 1.3-2.2); family disapproval of MSM (OR: 1.4; CI95%: 1.1-1.9); using vs. not using any drug (OR: 2.3; CI95%: 1.8-29). The sexuak practices of MSM in Fortaleza varied significantly over the studied years, something also observed in other international studies. Many local, national and international contextual factors might be responsible for this trend: 1) reduction in financial resources for AIDS prevention in Brazil due to new priorities of internationak organizations, now focusing African and East European countries. This have led Brazil to give priority to more vulnerable segments of the population than MSM; 2) high impact of STD/AIDS prevention initiatives among homo / bisexual males, particularly in the years of 1998 and 2002; 3) the advances in treatment, leading to better quality of life and survival prespective, wich may have contributed to a false idea of security in this population. In our study, literacy was an important factor assicated to risky sexual behavior. Participants with low levels of education, during 1995 to 2002, were engaged in more risky practices, apparently not taking benefit of public health campaigns occurring mainly during 11995 and 1998. Higher literacy was a protective factor during all studied period and might be, in this setting, a proxy for access to information. Finally, we could observe in the year of 2002 an elevated percentage of MSM that use five or more alcohol doses in a typical working day and that associate the use of other drugs with alcohol consumption. This behavior among MSM, although not characterized as dependence, might favor sexual risky practices. We also observed that increasing alcohol consumption was associated with the use of other drugs, contributing to the adoption of other risky behavior. Participants that report taking money for sex were more frequently classified as (binge drinking) drinkers. The results of this study highlight the need of a continuous behavioral surveillance for HIV to better understand the dynamics of the epidemic among MSM and to inform STD and HIV prevention programs. The findings of this study show also the importance of alcohol abuse as a public health problem in this specific population and the need for specific prevention measures.

No Brasil, o s casos de AIDS entre homens que fazem sexo com homens (HSH) predominaram durante um longo período. A partir da década de 90, observa-se um declínio nesta categoria com o aumento de casos entre heterossexuais. Na região Nordeste, entretanto, os casos de AIDS entre HSH representam, ainda, cerca de 50% do total dos casos registrados em anos recentes. Nosso objetivo foi estudar o comportamento sexual e o padrão de consumo de drogas e álcool entre HSH no Ceará, enfatizando as tendências recentes e suas relações com práticas sexuais de risco para DTS/AIDS. Foram realizados quatro estudos seccionais em 1995, 1998, 2002 e 2005 no Ceará, nordeste do Brasil. A população do estudo foi composta por homens que fazem sexo com homens (HSH), com 14 anos ou mais , que referiram prática sexual anal ou oral com homens nos últimos 12 meses. A seleção dos participantes utilizou técnicas do tipo Snow Ball (1995, 1998, 2002); Time Space Sampling (2002) e Respondent Driven Sampling (2005). O primeiro artigo enfoca as tendências do comportamento sexual em Fortaleza ao longo destes quatro períodos e o segundo os preditores do consumo de álcool e drogas nos municípios de Fortaleza (n=401), Sobral (n=100) e a região do Cariri (n=100) em 2002. Análise se basearam nas comparações entre proporções, utilizando o teste do de Pearson e intervalos de 95% de confiança (IC95%) e análise de regressão logística multivariada para avaliação dos fatores associados ao consumo de álcool e drogas, utilizando-se como medida de associação a razão de chances (odds ratio OR) e seus respectivos intervalos de 95% de confiança. Resultados Práticas sexuais: Elevado percentual da população estudada referiu práticas sexuais de risco em 1995 (49,9%), decrescendo significativamente em 1998 (32,6%), tornando a crescer em 2002 (54,6%) e apresentando os menores percentuais em 2005 (31,4%). Este padrão não apresentou grandes variações por idade, mas em relação à escolaridade observou-se que os indivíduos com escolaridade mais elevada aumentaram as práticas de risco entre 1998 (28,6%) e 2002 (46,5%) decrescendo no último período (21,0%) enquanto aqueles com baixa ou média escolaridade só mostraram uma queda significativa no comportamento de risco entre 2002 (82,1% - baixa; 67,7% - média) e 2005 (29,1% - baixa; 34,3 média). A prática sexual anal com preservativo cresceu no decorrer dos anos variando de 43,3% a 53,7% entre a primeira e a última onda ( de tendência p<0.001). A relação anal sem preservativo foi uma prática com alto percentual na maioria dos anos. De 2002 a 2005, houve uma diminuição significativa (de alto percentual na maioria dos anos. De 2002 a 2005, houve uma diminuição significativa (de 57,7% para 26,3%) das relações fixas monogâmicas. Consumo de álcool e drogas: No estudo, 63% dos HSH participantes foram classificados como bebedores que se embriagam. Observou-se que o consumo crescente de álcool leva a um aumento do uso concomitante de outras drogas, sejam lícitas ou ilícitas. Foram variáveis preditoras de beber se embriagando: ter de 21 a 30 anos (OR: 1,5; IC 95%: 1,1-2,9); ter mais que 30 anos (OR: 1,6: IC95%: 1,2-2,3); ser solteiro/separado/divorciado (OR:3,0%; IC95%: 1,7-5,3); ser da raça negra (OR: 2,0 IC95%: 1,7-2,01); ser da raça parda (OR: 1,8 IC95%: 1,3-2,6); receber dinheiro por sexo (OR:2,0 IC95%: 1,8-2,9). As práticas sexuais dos SHS em Fortaleza apresentaram variações significativas ao longo doa anos estudados, semelhantemente a outros estudos internacionais. Vários fatores poderiam ser responsáveis por explicar o comportamento da curva observada em Fortaleza, seja no âmbito local, nacional ou internacional. Entre os fatores que podem explicar alterações observadas estariam: 1) redução nos recursos destinados à prevenção da AIDS no país devido a retirada de alguns organismos de cooperação internacional que se voltaram para outros países, como na África Leste Europeu, levando o Brasil a priorizar segmentos populacionais com maior vulnerabilidade; 2) grande impacto na prevenção das DST /AIDS na comunidade de homo/bissexuais masculinos, especialmente nos anos de 1998 a 2002; 3) o avanço no tratamento, surgimento de novas drogas, melhora da qualidade de vida e aumento da sobrevida, contribuindo para a construção da falsa ideia de segurança na população. Neste estudo a escolaridade mostrou-se um fator importante associado ao envolvimento em práticas sexuais não seguras. Os indivíduos com mais baixa escolaridade, no período de 1995 a 2002, se envolveram em maior risco, aparentando não terem sido atingidos pelas campanhas que possam ter ocorrido, principalmente no período de 1995 a 1998. A maior escolaridade apresenta-se como fator de proteção em todo o período estudado, provavelmente pelo maior acesso à informação. Finalmente, pode-se observar no ano de 2002 um elevado percentual de homens que consomem cinco ou mais doses em um dia típico e associam outras drogas ao consumo do álcool. Tal comportamento, dentro da população HSH, embora não seja caracterizado como dependência química, é alterado de maneira significativa pelo efeito etílico, levando à outras práticas de risco. Também se observou em nosso estudo que o consumo crescente de álcool leva a um aumento do uso de outras drogas, atuando para a adoção de comportamentos de risco. Existem evidências que suportam relação entre uso de outras drogas e a prática sexual de risco. Os indivíduos que referiram receber dinheiro em troca de sexo foram mais frequentemente classificados como bebedores que se embriagam. Os achados deste estudo mostram a importância da realização de uma vigilância comportamental contínua em relação ao HIV favorecendo o entendimento da dinâmica da epidemia junto das DST/AIDS nesta população vulnerável, assim como a importância que o álcool assume como problema de saúde pública neta população específica e a necessidade de se direcionar medidas voltadas para a sua prevenção. / In Brazil, cases of AIDS amonf men who make sex with men (MSM) predominated durinf a long period, but declined in the 90s as an increase was observed among heterosexual persons. In the Northeast Brazil, however, AIDS casis among MSM still account for 50% of all casis reportedrecently. To study the sexual behavior and patterns of alcohol and ilicit drugs consumption in Ceará, Brazil, emphasizing recent trends and their relation with risky sexual practices to STD/AIDS. Four surveys were carried out in the years of 1995, 1998, 2002 and 2005 in Ceará, Northeast Brazil. Study population included MSM of 14 years old or above reporting anal sex in the last 12 months. Different selection techniques were employed: Snow Ball (1995, 1998, 2002); Time Spaces Sampling (2002) and Respondent Driven Sampling (2005). The first manuscript focuses on the recent trends of sexul behvior of MSM in Fortaleza, and the scond evaluates the predictors of alcohol and drug sonsumtion in the cities of Fortaleza (n=401), Sobral (n= 100) and the region of Cariri (n=100) in the year of 2002. Analyses were based on th comparison between proportions (Pearson test and 95 % confidence intervals CI95%, as the measure of association between putative risk factors and alcohol and drug use. Sexual practices: high percentual percentage or risky sexual practices was reported in 1995 (49.9%), decreasing in 1998 (32.6%), increasing again in 2002 (54.6%) and presenting the lowest percentages in 2005 (31.4%). This pattern did not vary with age. Those participants with higher literacy increased their risky practices from 1998 (28.6%) to 2002 (46.5%), decreasing in the lastperiod (21.0%). Among those with middle or low levels risky behavior declined from 2002 (82.1% - low; 67.7% - middle) to 2005 (29.1% - low; 34.3% - middle). We observed an increase of anal sex with condom between the first and the last wave (43.3% to 53.7% for trens p< 0.001). Anal sex without condom was very commom inmost of the years. Between 2002 and 2005 there was a decrease in monogamous stable relationship (from 57.7% to 26, and 3%). Alcohol and drug consumption: 63% of the MSM participants were classified as (binge drinking) drinkers.Increased consumption of alcohol was associated with an increase in the simultaneous use of other licit and illicit drugs. The predict onnected with (binge dronking) drinking were: age, 21-30 vs. <21 years old (OR: 1.5; CI95%: 1,1-2.9); >30 vs. <21 years old (OR: 1.6; CI95%: 1.2-2.3); civil status, being single/ separated/divorced vs. married/together (OR: 3.9; CI95%: 1.7-5.3); race, being clack vs. white (OR: 5.9; CI95%: 1.7-20.1); being mixed vs. white (OR: 1.8; 95% CI: 1.3-2.6); getting paid for sex (OR: 2.0; CI 95%: 1.4-3.0); having had an HIV test (OR: 1.7; CI95%: 1.3-2.2); family disapproval of MSM (OR: 1.4; CI95%: 1.1-1.9); using vs. not using any drug (OR: 2.3; CI95%: 1.8-29). The sexuak practices of MSM in Fortaleza varied significantly over the studied years, something also observed in other international studies. Many local, national and international contextual factors might be responsible for this trend: 1) reduction in financial resources for AIDS prevention in Brazil due to new priorities of internationak organizations, now focusing African and East European countries. This have led Brazil to give priority to more vulnerable segments of the population than MSM; 2) high impact of STD/AIDS prevention initiatives among homo / bisexual males, particularly in the years of 1998 and 2002; 3) the advances in treatment, leading to better quality of life and survival prespective, wich may have contributed to a false idea of security in this population. In our study, literacy was an important factor assicated to risky sexual behavior. Participants with low levels of education, during 1995 to 2002, were engaged in more risky practices, apparently not taking benefit of public health campaigns occurring mainly during 11995 and 1998. Higher literacy was a protective factor during all studied period and might be, in this setting, a proxy for access to information. Finally, we could observe in the year of 2002 an elevated percentage of MSM that use five or more alcohol doses in a typical working day and that associate the use of other drugs with alcohol consumption. This behavior among MSM, although not characterized as dependence, might favor sexual risky practices. We also observed that increasing alcohol consumption was associated with the use of other drugs, contributing to the adoption of other risky behavior. Participants that report taking money for sex were more frequently classified as (binge drinking) drinkers. The results of this study highlight the need of a continuous behavioral surveillance for HIV to better understand the dynamics of the epidemic among MSM and to inform STD and HIV prevention programs. The findings of this study show also the importance of alcohol abuse as a public health problem in this specific population and the need for specific prevention measures.