A proposição inicial do uso de camisinha como prevenção de HIV/aids está vinculada à noção de sexo seguro, desenvolvida pela comunidade gay estadunidense no início da década de 1980. No Brasil, o sexo seguro foi incorporado nas primeiras respostas à epidemia e, com o desenvolvimento das ações preventivas, a camisinha foi adotada como a principal estratégia de proteção contra a transmissão do HIV por via sexual. Atualmente, o segmento populacional composto por gays e outros homens que fazem sexo com homens (HSH) configura um dos focos de concentração da epidemia e, portanto, um dos públicos-chave para o direcionamento da prevenção. Este trabalho tem como objetivo recuperar os discursos acerca da camisinha como estratégia de prevenção de HIV/aids entre gays/HSH, construídos pela política pública de saúde e pelos movimentos sociais no Brasil, buscando compreender seus significados no contexto dos impasses enfrentados pela prevenção ao longo de sua história. O estudo é fundamentado nas abordagens construcionistas da sexualidade e utiliza como referências a perspectiva da vulnerabilidade e a teoria dos scripts sexuais. Trata-se de investigação qualitativa, realizada com base em entrevistas em profundidade com 13 pessoas que mantêm/mantiveram envolvimento significativo com o enfrentamento da epidemia de HIV/aids no país e/ou com a reflexão acerca das questões relativas à prevenção, especialmente no âmbito dos cenários sexuais gays/HSH. Foram selecionados atores de destaque no trabalho relacionado à promoção do uso da camisinha: condução de políticas públicas, produção de pesquisa e atuação em movimentos sociais LGBT e de aids. A partir das narrativas colhidas e de referências associadas, é apresentada uma recuperação histórica da trajetória da camisinha como prevenção de HIV/aids. A análise ressalta que a convergência dos discursos preventivos na recomendação da camisinha resvalou no tecnicismo, característico do processo de medicalização do social. O uso tecnicista da prevenção consistiu em (a) uma abordagem prescritiva, expressa na progressiva reprodução da mensagem \"use camisinha\"; (b) na descontextualização dos discursos preventivos em relação ao conteúdo sexual inerente ao uso da camisinha, contestada especialmente nas propostas de erotização desse insumo; (c) na postura impositiva de profissionais e campanhas de prevenção. Adicionalmente, a prevenção tem esbarrado nas dificuldades de abordagem do homoerotismo em função do fortalecimento de resistências moralistas e conservadoras na política brasileira. Esse cenário, que compromete os direitos de gays/HSH à saúde, é agravado por uma crise na estrutura dos programas de aids e das organizações dos movimentos sociais. Desse modo, o avanço no enfrentamento da epidemia e, mais especificamente, a redução das taxas de infecção em gays/HSH dependem da superação dessas barreiras, que tendem a se reproduzir na abordagem das novas tecnologias de prevenção em HIV/aids / The initial proposal for the use of condoms to prevent HIV/AIDS is linked to the concept of safe sex, developed by the gay community in the United States in the early 1980s. In Brazil, safe sex was incorporated in the early responses to the epidemic and, with the development of preventive actions, condom promotion was adopted as the main strategy to protect against HIV sexual transmission. Nowadays, the population segment composed of gay men and other men who have sex with men (MSM) represents one of the focuses of the epidemic concentration and therefore one of the key populations for targeting prevention. This work aims to recover the discourses on the use of condoms as an HIV/AIDS prevention strategy directed to gay/MSM population, built by both Brazilian public health policy and social movements, seeking to understand their meaning in the context of the impasses faced by prevention throughout his history. This study is based on constructionist frameworks of sexuality and uses as references the vulnerability perspective and the theory of sexual scripts. This is a qualitative research, carried out based on in-depth interviews with 13 people who keep/kept significant roles in fighting the HIV/AIDS epidemic in the country and/or in the reflecting on issues related to prevention, especially in the scope of gay/MSM sexual scenarios. The selected participants are prominent actors in the work related to the promotion of condom use: driving public policy, producing research and acting in LGBT and AIDS social movements. From the collected narratives and associated references, a historical recovery of the trajectory of the condom as an HIV/AIDS prevention is presented. The analysis points out that the convergence of preventive discourses on recommendation of the condom slipped on the technicism, characteristic of the process of social medicalization. The technicist use of the prevention consisted of (a) a prescriptive approach, expressed in the forward playback of the message \"use condom\"; (b) the decontextualization of preventive discourses in relation to sexual content inherent in the use of condoms, especially contested in proposals of eroticizing this device; (c) the impositive posture of professionals and prevention campaigns. Additionally, prevention has bogged down in difficulties on the approach of homoeroticism due to the strengthening of moralist and conservative resistances in Brazilian policy. This scenario, which undermines the rights of gay/MSM to health, is exacerbated by a crisis in the structure of AIDS programs and organizations of social movements. Thus, the progress in confronting the epidemic and, more specifically, in the reduction of infection rates in gay/MSM depend on overcoming these barriers which tend to be reproduced in the approach to the new HIV/AIDS prevention technologies

介紹 / 愛滋病在中國男男性行為者中的流行持續增長，而新感染HIV的男男性行為者扮演著重要角色。本民族志研究採用了社會生態模式來探討與新感染HIV的男男性行為者中HIV二代傳播、心理健康、以及使用健康服務相關的問題。研究方法包括深入訪談、焦點小組訪談、非正式訪談和參與觀察。此外還採訪了志願者和醫護人員。資料分析採用主題內容分析法。 / 結果 / 在確診為HIV呈陽性後，大多數的男男性行為者經受過一定程度的心理及精神上的問題。與HIV相關的緊張性刺激影響著他們適應這個確診。HIV與一些重要的心理、社會和文化的條件呈現一種綜合流行。而大多數的男男性行為者通過自身的應變能力逐漸康復，其中一些人甚至體驗到某種程度的成長。人的應變能力是一種基於個人與環境互動的建構。 / 11名（占24.4%）HIV呈陽性的男男性行為者報告發生過無保護的肛交行為。基於性伴侶的不同類型，與無保護肛交行為相關的因素則有所不同。這些無保護的肛交行為往往同時伴隨著物質濫用、對風險的錯誤認識、以及消極的情緒或者心理和精神問題。阻礙無保護肛交行為發生的積極因素包括社會支援、自我保健、自我保護和志願服務。 / 自上而下的公共衛生服務傾向於控制和檢測而不是賦權于男男性行為人群，並且在很大程度上忽視了新感染HIV的男男性行為者的心理和精神健康、性健康、以及自我保健的能力。新感染HIV的男男性行為者的未滿足的需求已經被識別，且他們更願意到男男性行為人群的社區，尤其是感染者小組那裏去尋求服務和支援。但男男性行為人群的草根組織卻缺乏資金和技術的支持。 / 結論 / 新感染HIV的男男性行為者所遭遇的問題都植根於特定的個人際遇以及他們所生活的社會生態系統。是時候採取一種廣泛而綜合的“健康同志社區的觀點、促進自我保健的策略、以及具有文化敏感性和社會效能的措施來預防HIV的二代傳播以及促進新感染HIV的男男性行為者的社會福祉。人類行為的非線性的特徵要求愛滋病健康行為研究從強調生物行為的範式轉移到著重愛滋病的社會根源的範式中來。 / Introduction / Newly diagnosed HIV positive men who have sex with men (NHIVMSM) play an important role in accelerating the high HIV prevalence in China. This ethnographic study, employing a modified social ecological model integrating concepts of adaptation, cognition, affect and action, investigated the inter-related issues on secondary HIV transmission, mental health and services utilization in this population. Methodologies included in-depth interviews, focus groups, informal interviews and participant observations. Moreover, information was also obtained from volunteers and health care workers. Thematic content analysis was performed. / Results / Most respondents commonly experienced psychological or mental health problems (e.g. depressive symptoms and anxiety) after their HIV diagnosis. HIV stressors, such as constraints of being HIV positive, limited information and knowledge of HIV/AIDS, ART and its side effects, associated co-morbidities and significant costs in health care, appeared to shape their adaptation to the diagnosis. Moreover, a syndemic was apparent among NHIVMSM and some influential psycho-social and cultural conditions, such as adversities in their migrants’ life, social suffering as MSM, cultural trauma, stigma and discrimination. Most respondents drew on a range of personal resilience strategies and some respondents testified to have achieved post-traumatic growth. Resilience was presented within a person-situation interactional construct. / Eleven (24.4%) respondents reported practicing unprotected anal intercourse (UAI). Several respondents reported their UAI had occurred in the first few months after their diagnosis when they suffered considerably from uncertainty, perceived stigma and identity struggles. Factors associated with UAI were based on differing partner types, such as fear of losing partners in a context of non-serostatus disclosure in lovers or stable partners, tongzhi (gay) sauna setting and moral judgment in casual partners, and poor economic status in commercial partners. UAI usually happened simultaneously in context of substance use, risk misconceptions, encountering negative emotion or mental health problems. Positive factors against UAI included social support, self-care, self-protection and volunteerism. / The current top-down public health services tended to operate on control and surveillance instead of empowering MSM. This approach largely ignored psychological and mental health, sexual health and self-care capacities among NHIVMSM, whose unmet needs were identified as preferring to obtain services and support from MSM and/or PLWH communities. However, current MSM organizations lacked funding and technical support. Health care providers operated with suboptimal care protocols, training and technical support. Coordination and collaborations among health care institutes and MSM communities were relatively weak. Tailored participatory health care is warranted, such as volunteerism, greater involvement of PLWH, health navigators and building supportive environment and services. / Conclusions / The problems of psychological and mental health, risky sexual behavior (UAI) and health services utilization that NHIVMSM encountered resulted from interactions between personal experiences and the social ecological systems they inhabited. Recommendation drawn include adopting a comprehensive and inclusive “healthy MSM community“ approach and a strategy of facilitating self-care to carry out culturally sensitive and socially effective measures to prevent secondary HIV transmission and to promote wellbeing among NHIVMSM. An emerging theoretical implication is that the nonlinearity of human behaviour requires paradigm shifting from a bio-behavioural emphasis to the social origin of HIV/AIDS. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Haochu. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 425-457). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes includes Chinese. / Abstract (English) --- p.iv / Abstract (Chinese) --- p.vii / Acknowledgements --- p.ix / Table of Contents --- p.xi / List of Tables and Figures --- p.xv / Glossary --- p.xvi / Abbreviation --- p.xviii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.1.1 --- High HIV prevalence and incidence among MSM in China --- p.1 / Chapter 1.1.2 --- Social and cultural environment faced by HIV positive MSM --- p.3 / Chapter 1.2 --- Sexual risk and secondary HIV transmission among HIV positive (and newly diagnosed) MSM --- p.7 / Chapter 1.3 --- Psychological and mental health among HIV positive (and newly diagnosed) MSM --- p.10 / Chapter 1.4 --- Health service utilization among HIV positive (and newly diagnosed) MSM --- p.13 / Chapter 1.5 --- Exploring complexities of secondary HIV transmission through qualitative studies --- p.14 / Chapter 1.6 --- Theories, concepts and the research framework --- p.15 / Chapter 1.6.1 --- Conceptualization of adaptation in medical anthropology --- p.15 / Chapter 1.6.2 --- The social ecological model --- p.17 / Chapter 1.6.3 --- Cognitive adaptation and self-control --- p.19 / Chapter 1.6.4 --- Emotion and motivation are influential in health behaviour --- p.21 / Chapter 1.6.5 --- Action world and its role in health behaviour --- p.24 / Chapter 1.6.6 --- Social control/social order --- p.26 / Chapter 1.6.7 --- Stigma --- p.27 / Chapter 1.6.8 --- Identity control --- p.29 / Chapter 1.6.9 --- Research framework --- p.32 / Chapter 1.7 --- Goals, objectives and research questions --- p.34 / Chapter Chapter 2 --- Methodology --- p.38 / Chapter 2.1. --- Entrée into the field --- p.38 / Chapter 2.1.1 --- The start of the research --- p.38 / Chapter 2.1.2 --- Pilot work --- p.39 / Chapter 2.2 --- The participants --- p.43 / Chapter 2.3 --- Data collection --- p.50 / Chapter 2.4 --- Data analysis --- p.58 / Chapter 2.5 --- Rigour --- p.62 / Chapter 2.6 --- Reflexivity --- p.68 / Chapter 2.7 --- Ethical considerations --- p.75 / Chapter Chapter 3 --- Social circumstances and MSM communities in Shenzhen --- p.78 / Chapter 3.1 --- Population and economic circumstances --- p.78 / Chapter 3.2 --- Shifting political situation --- p.80 / Chapter 3.3 --- A migrant society --- p.87 / Chapter 3.4 --- Shenzhen Culture --- p.93 / Chapter 3.5 --- MSM community and tongzhi subculture --- p.98 / Chapter 3.6 --- The subgroup of HIV positive MSM --- p.113 / Chapter 3.7 --- Public health implications --- p.117 / Chapter Chapter 4 --- Health care system and services related to HIV case detection and follow up --- p.118 / Chapter 4.1 --- Formal health care system --- p.118 / Chapter 4.2 --- Health insurance --- p.125 / Chapter 4.3 --- “Four Free and One Care“ policy --- p.126 / Chapter 4.4 --- Informal health care --- p.127 / Chapter 4.5 --- Services related to HIV case detection and follow up --- p.131 / Chapter Chapter 5 --- Psychological and mental health --- p.142 / Chapter 5.1 --- Negative mental health outcomes --- p.142 / Chapter 5.1.1 --- Depressive symptoms --- p.142 / Chapter 5.1.2 --- Anxiety symptoms --- p.146 / Chapter 5.1.3 --- Factors associated with negative mental health outcome --- p.150 / Chapter 5.1.3.1 --- Individual factors --- p.150 / Chapter 5.1.3.2 --- Interpersonal factors --- p.157 / Chapter 5.1.3.3 --- Cultural factors in community and family --- p.160 / Chapter 5.1.3.4 --- Institutional and structural factors --- p.163 / Chapter 5.2 --- Positive mental health outcomes --- p.166 / Chapter 5.2.1 --- Integrating negative experiences and recovery --- p.166 / Chapter 5.2.2 --- Resources for recovery --- p.169 / Chapter 5.2.3 --- Back to normal functioning --- p.170 / Chapter 5.2.4 --- Post-traumatic growth --- p.172 / Chapter 5.2.5 --- Factors associated with positive mental health outcome --- p.175 / Chapter 5.2.5.1 --- Individual factors --- p.175 / Chapter 5.2.5.2 --- Interpersonal factor --- p.181 / Chapter 5.2.5.3 --- Community-related factors --- p.184 / Chapter 5.2.5.4 --- Institutional factors --- p.187 / Chapter 5.3 --- Public health concern of suicidal ideation --- p.190 / Chapter 5.4 --- Impacts of psychological and mental health --- p.194 / Chapter 5.5 --- Summary of psychological and mental health in a modified socio-ecological mode --- p.195 / Chapter 5.6 --- Discussion --- p.197 / Chapter 5.6.1 --- The emerging of a syndemic in HIV and some psycho-social and cultural conditions --- p.197 / Chapter 5.6.2 --- Powerful social and cultural factors associated with mental health --- p.200 / Chapter 5.6.3 --- Resilience among newly diagnosed HIV positive MSM --- p.208 / Chapter 5.6.4 --- Service implications --- p.213 / Chapter Chapter 6 --- Sexual risk --- p.221 / Chapter 6.1 --- Continued unprotected anal intercourse (UAI) after being diagnosed HIV positive --- p.221 / Chapter 6.2 --- Changes in practising UAI during the study period --- p.222 / Chapter 6.3 --- Factors associated with UAI with non-commercial sex partners --- p.224 / Chapter 6.3.1 --- Individual factors --- p.225 / Chapter 6.3.2 --- Interpersonal factors --- p.229 / Chapter 6.3.3 --- Community-based factors --- p.231 / Chapter 6.3.4 --- Institutional factors --- p.234 / Chapter 6.4 --- UAI with commercial sex partners --- p.235 / Chapter 6.5 --- Comparing factors associated with UAI among commercial and non-commercial partners --- p.238 / Chapter 6.6 --- Reduced risky behaviour after diagnosis --- p.239 / Chapter 6.7 --- Factors associated with condom use --- p.241 / Chapter 6.7.1 --- Individual factors --- p.241 / Chapter 6.7.2 --- Interpersonal factors --- p.246 / Chapter 6.7.3 --- Community factors --- p.248 / Chapter 6.8 --- Other special issues related to risky sexual behaviour --- p.250 / Chapter 6.9 --- Summary of sexual risk in a modified socio-ecological model --- p.261 / Chapter 6.10 --- Discussion --- p.263 / Chapter 6.10.1 --- Prevalence of UAI --- p.263 / Chapter 6.10.2 --- Partner types and UAI --- p.265 / Chapter 6.10.2.1 --- Fear of losing partners in a context of non-serostatus disclosure --- p.266 / Chapter 6.10.2.2 --- Anonymous sexual encounters and moral judgment --- p.267 / Chapter 6.10.2.3 --- Economic barriers --- p.270 / Chapter 6.10.2.4 --- Intrapersonal contexts --- p.271 / Chapter 6.10.3 --- Critical views on some practices --- p.274 / Chapter 6.10.4 --- Emerging positive experiences from Shenzhen --- p.276 / Chapter 6.10.5 --- Service implications --- p.279 / Chapter Chapter 7 --- Health service seeking --- p.285 / Chapter 7.1 --- Problems identified in health service seeking --- p.285 / Chapter 7.2 --- Processes of adaptation --- p.289 / Chapter 7.3 --- Negative factors associated with health service seeking --- p.296 / Chapter 7.3.1 --- Individual factors --- p.296 / Chapter 7.3.2 --- Interpersonal factors --- p.302 / Chapter 7.3.3 --- Community-based factors --- p.304 / Chapter 7.3.4 --- Health care institution-based factors --- p.309 / Chapter 7.4 --- Positive factors associated with health service seeking --- p.319 / Chapter 7.4.1 --- Individual factors --- p.319 / Chapter 7.4.2 --- Interpersonal factors --- p.321 / Chapter 7.4.3 --- Community-based factors --- p.325 / Chapter 7.4.4 --- Factors in the health care institutes--free services --- p.328 / Chapter 7.5 --- Summary of health service seeking in a modified socio-ecological model --- p.329 / Chapter 7.6 --- Discussion --- p.331 / Chapter 7.6.1 --- Problems in health care institutes --- p.331 / Chapter 7.6.1.1 --- The top-down approach -- controlling instead of community building --- p.331 / Chapter 7.6.1.2 --- Problems among health care providers --- p.335 / Chapter 7.6.2 --- Tailored participatory approach to health care and education for HIV positive MSM --- p.339 / Chapter 7.6.3 --- Necessity for developing MSM communities --- p.342 / Chapter 7.6.4 --- Service implications --- p.349 / Chapter Chapter 8 --- Discussion and implications --- p.355 / Chapter 8.1 --- The occurrences of UAI and its hidden meaning --- p.355 / Chapter 8.2 --- Informing the future HIV epidemic among MSM in Shenzhen --- p.357 / Chapter 8.3 --- Difficulties of controlling the HIV epidemic among MSM --- p.361 / Chapter 8.4 --- New HIV prevention approach --- p.368 / Chapter 8.5 --- Critiquing theories for recommended changes --- p.386 / Chapter 8.6 --- Limitations of the study --- p.400 / Chapter 8.7 --- Conclusion --- p.405 / Appendix I to IX --- p.409 / Bibliography --- p.425

Thesis (M.S.W.)--McGill University, 1998. / Includes bibliographical references (leaves 117-127).

Thesis (doctoral)--Swinburne University of Technology, 2006. / Title from PDF title page (viewed on Nov. 30, 2006). Includes bibliographical references (p. 177-188).

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 47-01, page: . Includes bibliographical references

Thesis (Ph. D.)--University of Texas School of Public Health. Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0973. Adviser: Michael W. Ross. Includes bibliographical references.

A proposição inicial do uso de camisinha como prevenção de HIV/aids está vinculada à noção de sexo seguro, desenvolvida pela comunidade gay estadunidense no início da década de 1980. No Brasil, o sexo seguro foi incorporado nas primeiras respostas à epidemia e, com o desenvolvimento das ações preventivas, a camisinha foi adotada como a principal estratégia de proteção contra a transmissão do HIV por via sexual. Atualmente, o segmento populacional composto por gays e outros homens que fazem sexo com homens (HSH) configura um dos focos de concentração da epidemia e, portanto, um dos públicos-chave para o direcionamento da prevenção. Este trabalho tem como objetivo recuperar os discursos acerca da camisinha como estratégia de prevenção de HIV/aids entre gays/HSH, construídos pela política pública de saúde e pelos movimentos sociais no Brasil, buscando compreender seus significados no contexto dos impasses enfrentados pela prevenção ao longo de sua história. O estudo é fundamentado nas abordagens construcionistas da sexualidade e utiliza como referências a perspectiva da vulnerabilidade e a teoria dos scripts sexuais. Trata-se de investigação qualitativa, realizada com base em entrevistas em profundidade com 13 pessoas que mantêm/mantiveram envolvimento significativo com o enfrentamento da epidemia de HIV/aids no país e/ou com a reflexão acerca das questões relativas à prevenção, especialmente no âmbito dos cenários sexuais gays/HSH. Foram selecionados atores de destaque no trabalho relacionado à promoção do uso da camisinha: condução de políticas públicas, produção de pesquisa e atuação em movimentos sociais LGBT e de aids. A partir das narrativas colhidas e de referências associadas, é apresentada uma recuperação histórica da trajetória da camisinha como prevenção de HIV/aids. A análise ressalta que a convergência dos discursos preventivos na recomendação da camisinha resvalou no tecnicismo, característico do processo de medicalização do social. O uso tecnicista da prevenção consistiu em (a) uma abordagem prescritiva, expressa na progressiva reprodução da mensagem \"use camisinha\"; (b) na descontextualização dos discursos preventivos em relação ao conteúdo sexual inerente ao uso da camisinha, contestada especialmente nas propostas de erotização desse insumo; (c) na postura impositiva de profissionais e campanhas de prevenção. Adicionalmente, a prevenção tem esbarrado nas dificuldades de abordagem do homoerotismo em função do fortalecimento de resistências moralistas e conservadoras na política brasileira. Esse cenário, que compromete os direitos de gays/HSH à saúde, é agravado por uma crise na estrutura dos programas de aids e das organizações dos movimentos sociais. Desse modo, o avanço no enfrentamento da epidemia e, mais especificamente, a redução das taxas de infecção em gays/HSH dependem da superação dessas barreiras, que tendem a se reproduzir na abordagem das novas tecnologias de prevenção em HIV/aids / The initial proposal for the use of condoms to prevent HIV/AIDS is linked to the concept of safe sex, developed by the gay community in the United States in the early 1980s. In Brazil, safe sex was incorporated in the early responses to the epidemic and, with the development of preventive actions, condom promotion was adopted as the main strategy to protect against HIV sexual transmission. Nowadays, the population segment composed of gay men and other men who have sex with men (MSM) represents one of the focuses of the epidemic concentration and therefore one of the key populations for targeting prevention. This work aims to recover the discourses on the use of condoms as an HIV/AIDS prevention strategy directed to gay/MSM population, built by both Brazilian public health policy and social movements, seeking to understand their meaning in the context of the impasses faced by prevention throughout his history. This study is based on constructionist frameworks of sexuality and uses as references the vulnerability perspective and the theory of sexual scripts. This is a qualitative research, carried out based on in-depth interviews with 13 people who keep/kept significant roles in fighting the HIV/AIDS epidemic in the country and/or in the reflecting on issues related to prevention, especially in the scope of gay/MSM sexual scenarios. The selected participants are prominent actors in the work related to the promotion of condom use: driving public policy, producing research and acting in LGBT and AIDS social movements. From the collected narratives and associated references, a historical recovery of the trajectory of the condom as an HIV/AIDS prevention is presented. The analysis points out that the convergence of preventive discourses on recommendation of the condom slipped on the technicism, characteristic of the process of social medicalization. The technicist use of the prevention consisted of (a) a prescriptive approach, expressed in the forward playback of the message \"use condom\"; (b) the decontextualization of preventive discourses in relation to sexual content inherent in the use of condoms, especially contested in proposals of eroticizing this device; (c) the impositive posture of professionals and prevention campaigns. Additionally, prevention has bogged down in difficulties on the approach of homoeroticism due to the strengthening of moralist and conservative resistances in Brazilian policy. This scenario, which undermines the rights of gay/MSM to health, is exacerbated by a crisis in the structure of AIDS programs and organizations of social movements. Thus, the progress in confronting the epidemic and, more specifically, in the reduction of infection rates in gay/MSM depend on overcoming these barriers which tend to be reproduced in the approach to the new HIV/AIDS prevention technologies

A profilaxia pré-exposição (PrEP) ao HIV se consolidou como uma importante estratégia de combate ao avanço da epidemia. Ainda assim, a incidência de casos da infecção vem aumentando na população jovem, assim como a de outras infecções sexualmente transmissíveis (ISTs), que atuam como importante fator de risco para transmissão do HIV-1. Entre as infecções mais frequentemente diagnosticadas estão Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG). A presença de lesões na mucosa genital e anal são fatores de risco estabelecidos para a transmissão do HIV-1, porém o impacto das infecções assintomáticas ainda é pouco conhecido. Dados recentes mostram que a ativação sistêmica de linfócitos T é um fator de risco para a aquisição da infecção pelo HIV-1. Nesse estudo, estudamos a ativação de linfócitos T na presença de infecção anorretal assintomática por CT e/ou NG. Células mononucleares do sangue periférico de voluntários do PrEP Brasil, um estudo clínico demonstrativo de PrEP ao HIV em homens que fazem sexo com homens, foram descongeladas para análise da ativação de linfócitos T. Trinta e quatro participantes com swab anorretal positivo para CT e/ou NG foram selecionados, enquanto assintomáticos e negativos para outras ISTs. Trinta e cinco controles foram selecionados randomicamente. Encontramos uma maior frequência de linfócitos T CD8+ HLA-DR+CD38+ (1,5 vs. 0,9% p < 0,005) no grupo com infecção assintomática. Os linfócitos T CD8+ de memória também apresentaram uma maior expressão dos marcadores de ativação. Os marcadores de exaustão e senescência foram significantemente mais expressos no grupo com a infecção. Não foi observado aumento ou diferença nos níveis de CD14 solúvel no plasma. Nossos achados demonstram que as infecções anorretais assintomáticas por CT e NG induzem a ativação sistêmica de linfócitos T CD8+. Considerando a alta prevalência dessas infecções e o risco associado de aquisição da infecção pelo HIV-1, o rastreamento periódico e o tratamento sistemático devem sem explorados em conjunto com as estratégias de prevenção ao HIV / Oral antiretroviral pre-exposure prophylaxis (PrEP) has been established as a pivotal strategy in the prevention against HIV epidemic. However, the incidence of HIV-1 infections has been rising among the youth, as well as other sexually transmitted infections (STIs), acting as an important risk factor for HIV-1 acquisition. Infection by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are among the most diagnosed. Although the presence of mucosal lesions is a known risk factor for HIV-1 acquisition, the potential increase in risk associated with asymptomatic STIs is not completely understood. Recent data defined higher T cell activation as a single risk factor for sexually acquired HIV-1 infection. We examined the effect of asymptomatic CT and/or NG anorectal infection on immune activation. Peripheral blood mononuclear cells from participants of PrEP Brasil, a study of daily oral PrEP among healthy men who have sex with men, were analyzed for T cell activation by flow cytometry. Thirty-four participants with positive anorectal swab for CT and/or NG were selected, while negative for other STIs and without any reported symptoms. Thirty-five controls were randomly selected. We found a higher frequency of CD8+ HLA-DR+CD38+ T cells (1.5 vs. 0.9% p < 0.005) in the group with CT and/or NG infection and a greater median proportions of activation markers expression in CD8+ T cells with memory phenotype. Exhaustion and senescence markers were also significant higher in the infected group. No difference was observed in the soluble CD14 levels. Our findings suggest that asymptomatic CT and NG anorectal infection lead to a systemic activation of the T cell compartment. Considering the high prevalence of asymptomatic infection and the risk of HIV-1 acquisition associated, regular screening and treatment should be explored as an adjuvant tool for HIV prevention

Esta tese examina políticas de prevenção da infecção pelo HIV voltadas para homens que fazem sexo com homens (HSH) no Brasil sob a ótica dos conceitos de vulnerabilidade, Cuidado e reconhecimento. Para tanto, propõe-se a estudar políticas públicas de saúde à luz do referencial da vulnerabilidade e dos direitos humanos. Teve como objetivo compreender de que forma processos de (não)reconhecimento, ou desrespeito, no âmbito do cuidado público de saúde, compreendido como conjunto de políticas, serviços e ações voltadas à prevenção do HIV e da aids, contribuem para os processos de vulnerabilização de HSH ao HIV e à aids no contexto da epidemia e das respostas produzidas no Brasil e no estado de São Paulo, em particular. Trata-se de estudo qualitativo, que adota perspectiva interdisciplinar, em composição que integra diferentes técnicas de pesquisa. Houve produção de material empírico original por meio de entrevistas semiestruturadas com gestores de políticas públicas de prevenção e ativistas dos movimentos de aids e LGBT. A produção e interpretação desse material empírico, orientado pelo quadro teórico acima apresentado, foram cotejadas com documentos das políticas, serviços e ações de saúde, cuidado e prevenção do HIV e da aids voltadas às populações de gays e HSH; observação de caráter etnográfico de eventos presenciais e de atividades no âmbito das redes sociais atinentes à prevenção do HIV e da aids entre gays e outros HSH; conversas informais com informantes-chave; e análise de resultados de outras pesquisas, quantitativas e qualitativas, disponíveis em bases públicas. Caracterizando-se como um estudo de análise de políticas públicas. Foi elaborada uma história narrativa dos diferentes momentos das respostas políticas à epidemia de aids entre gays e outros HSH no Brasil com vistas a compreender e constituir o cenário das políticas públicas de prevenção do HIV voltadas para HSH. Tendo sido identificados os principais paradoxos transformadores das respostas políticas: o paradoxo dos \"grupos de risco\" que reverteu abordagem discriminatória em visibilidade; a maior institucionalização das organizações com atividades em HIV/aids, incorreu em maior despolitização, com reforço ao tecnicismo das ações; a contraposição das políticas de prevenção focadas nos direitos e na visibilidade social à especificidade de uma política de prevenção ancorada e estruturante das políticas de saúde. A partir das narrativas produzidas nas entrevistas, particularmente, daqueles trechos que se referem às tensões e aos conflitos no que tange à prevenção, procedeu-se a duas naturezas de leitura interpretativa: 1) com vistas a caracterizar o cuidado público, identificou-se: como as leituras acerca da doença e da epidemia são usadas para justificar políticas de prevenção; como se dão as diferentes abordagens preventivas, calcadas em distintos conceitos operativos e recursos tecnológicos; e, por fim, como se dão as diferentes modalidades de organização da gestão (recursos financeiros e humanos, as formas de participação e diálogo com a comunidade, continuidade das ações, avaliação, transparência, accountability); e 2) destacou-se, nestes aspectos, aquelas respostas que expressam manifestações de indignação e desrespeito, de forma a mirar sob a perspectiva do reconhecimento e das capacidades e possibilidades de respostas das políticas no diálogo com necessidades, desejos e anseios dos sujeitos gays e HSH / This thesis examines HIV prevention policies aimed at men who have sex with men (MSM) in Brazil from the standpoint of the concepts of vulnerability, care and recognition. Therefore, it is proposed to study public health policies in the light of the vulnerability and human rights framework. The purpose of this study was to understand how the processes of (non) recognition, or disrespect, in the scope of public health care, understood as a set of policies, services and actions aimed at the prevention of HIV and AIDS, contribute to the processes of vulnerability of MSM to HIV and AIDS in the context of the epidemic and the responses produced in Brazil and the state of São Paulo in particular. It is a qualitative study, which adopts an interdisciplinary perspective, in a composition that integrates different research techniques. Original empirical material was produced through semi-structured interviews with managers of public prevention policies and activists of the AIDS and LGBT movements. The production and interpretation of this empirical material, guided by the theoretical framework presented above, were compared with documents of the policies, services and actions of health care and prevention of HIV and AIDS for the populations of gays and MSM; ethnographic observation of face-to-face events and activities within the social networks related to the prevention of HIV and AIDS among gays and other MSM; informal conversations with key informants; and analysis of the results of other quantitative and qualitative researches available in public databases. Characterized as a study of public policy analysis. A narrative history of the different moments of the political responses to the AIDS epidemic among gays and other MSM in Brazil has been elaborated with a view to understanding and setting the scene of the public policies of prevention of HIV directed to MSM. Having identified the main transforming paradoxes of political responses: the paradox of \"risk groups\" that reversed discriminatory approach in visibility; the greater institutionalization of organizations with activities on HIV/AIDS, which incurred in greater depoliticization, with reinforcement to the technicality of actions; the contraposition of prevention policies focused on social rights and visibility to the specificity of an anchored and structuring prevention policy based on health policies. From the narratives produced in the interviews, particularly from those excerpts that refer to tensions and conflicts regarding prevention, two types of interpretive reading were performed: 1) with a view to characterizing public care, it was identified: how the readings about the disease and the epidemic are used to justify prevention policies; as are the different preventive approaches, based on different operational concepts and technological resources; (financial and human resources, forms of participation and dialogue with the community, continuity of actions, evaluation, transparency, accountability); and 2) highlighted in those aspects those responses that express manifestations of indignation and disrespect, in order to look from the perspective of recognition and the capacities and possibilities of responses of the policies in the dialogue with the needs, desires and aspirations of the gay and MSM

O comportamento \"barebacking\" é definido como o intercurso sexual anal entre homens que fazem sexo com homens (HSH) que decidem intencionalmente não usar preservativos, no contexto de risco do HIV. O comportamento sexual compulsivo (CSC) pode agir na motivação do comportamento \"barebacking\", aumentando o risco de transmissão do HIV, sendo que no Brasil a prevalência do HIV entre HSH é de 10,5%. Objetivos: estimar a frequência do comportamento \"barebacking\" nos HSH compulsivos sexuais, e investigar a associação do comportamento \"barebacking\" com: infecção pelo HIV; comportamento sexual de risco; severidade do CSC; transtorno associado ao uso de álcool e drogas; grau de otimismo em relação ao tratamento do HIV; capacidade de vinculação afetiva tipo segura; consolidação da identidade; e as seguintes dimensões de personalidade: busca de novidades, esquiva ao dano, dependência de gratificação e autodirecionamento. Métodos: estudo transversal realizado em amostra de HSH que buscaram tratamento para o CSC. Participaram 55 homens compulsivos sexuais, sendo que 21 apresentavam o comportamento \"barebacking\" e 34 não. Foram avaliados em entrevista psiquiátrica para verificação dos critérios de elegibilidade (critérios de dependência de sexo e de Impulso Sexual Excessivo, diagnósticos de exclusão, nível cognitivo). Todos responderam os seguintes instrumentos: Inventário de Consolidação de Identidade, Escala de Vinculação de Adulto, Escala de Compulsividade Sexual, Escala de Otimismo/Ceticismo no contexto dos tratamentos do HIV, Inventário de Temperamento e Caráter, Instrumento de Avaliação de Risco no Comportamento Sexual, além de questões complementares quanto ao comportamento \"barebacking\" e HIV. Ainda participaram de entrevista com a pesquisadora, que teve a finalidade de investigar a intencionalidade do não uso do preservativo. Resultados: 38% da amostra apresentaram comportamento \"barebacking\", sendo que 64% apresentaram orientação homossexual e 36% bissexual, e o comportamento \"barebacking\" associou-se à homossexualidade (p < 0,05). Comparando-se indivíduos com e sem o comportamento \"barebacking\", não se encontrou diferença em relação: a transtornos relacionados ao uso de álcool e/ou drogas, ao otimismo quanto ao tratamento do HIV, à vinculação afetiva, às dimensões de personalidade esquiva ao dano e dependência de gratificação. Houve uma tendência à associação à severidade do CSC, à consolidação da identidade e à busca de novidades. Houve associação negativa com a dimensão de personalidade autodirecionamento (p < 0,001). A prevalência do HIV foi de 20% na amostra total e de 43% dentre os participantes com comportamento \"barebacking\" (p < 0,05). Conclusões: a orientação homossexual e o baixo autodirecionamento foram preditores de comportamento \"barebacking\" neste estudo, sugerindo menor autonomia, reduzida força de vontade, desorganização, baixa capacidade de controle interno, baixa autoaceitação e baixa autoestima, como característica de personalidade dos que apresentam comportamento \"barebacking\" / The barebacking behavior is defined as anal intercourse among men who have sex with men (MSM) who intentionally decide do not to use condoms in the context of HIV risk. Compulsive sexual behavior (CSB) can act in motivating the barebacking behavior increasing the risk of HIV transmission, whereas in Brazil the prevalence of HIV among MSM is 10.5%. Goals: To estimate the frequency of barebacking behavior in sexually compulsive MSM, and to investigate the association of barebacking behavior with: HIV infection, sexual risk behavior, severity of CSB; substance disorders; degree of optimism regarding the treatment of HIV; ability to develop secure emotional attachment type, identity consolidation, and the following personality dimensions: novelty seeking, harm avoidance, reward dependence and self-directedness. Methods: Cross-sectional study in a sample of MSM who sought treatment for CSB. 55 sexually compulsive men participated, of whom 21 presented the barebacking behavior and 34 do not. All of them were underwent to psychiatric interview for verification of eligibility criteria (criteria for sex addiction and Excessive Sexual Drive, exclusion psychiatric diagnosis, and cognitive level). All answered the following instruments: Identity Consolidation Inventory, the Adult Attachment Scale, Scale of Sexual Compulsivity, Scale Optimism/Scepticism in the context of HIV treatments, Temperament and Character Inventory, Instrument Risk Assessment in Sexual Behavior, plus additional questions regarding the barebacking behavior and HIV. They were also interviewed by the researcher, whose purpose was to investigate the intentionality of not using condoms. Results: 38% of the sample presented barebacking behavior, whereas 64% were gay and 36% bisexual, and barebacking behavior was associated with being gay (p < 0.05). Comparing subjects with and without the barebacking behavior no difference was found in relation to: substance disorders, optimism regarding the treatment of HIV, adult attachment, personality dimensions harm avoidance and reward dependence. There was a trend toward association with severity of CSB, and the consolidation of identity and novelty seeking. There was a negative association with the personality dimension self-directedness (p < 0.001). HIV prevalence was 20% in the total sample and 43% among participants with barebacking behavior (p < 0.05). Conclusions: gay and low self-directedness predicted barebacking behavior in this study, suggesting low autonomy, reduced willpower, disorganization, low ability for internal control, low self-acceptance and low self-esteem, as personality characteristics from those presenting barebacking behavior